Daily Dose

Babies Rolling Around in Their Crib

Many babies roll around in their crib, but should parents worry they will spend too much time on their tummy and not be able to roll on their back?I received an email from the parents of a 3½ month old daughter who has recently learned how to roll from her back to her tummy.  Their “conundrum”, as they put it, was twofold.  They were concerned about her sleeping on her tummy, as well as the fact that she would get upset after she rolled from her back to tummy and would then “scream loudly” So,what to do?

Most babies learn to roll around 4 months of age and like everything else there is variability in this milestone.  Many babies learn to roll tummy to back first, typically while they are having tummy time. Suddenly you realize that the baby has used their arms to push up and then over onto their back.  Watching them do this is fun, as they will often look up with big startled eyes almost as saying, “Wow, this is like an amusement park ride!”, while other babies will let out a shriek and start to cry as they were scared by the whole event.  Remember we are all different and some of us (me) like roller coasters that go upside down and backwards and others (one of my children) would still rather give up a week’s allowance than get on a ride like that. There are also babies, like the one in question, who learn to roll from their back to tummy first.  This often occurs at night and causes a lot of concern, as all parents hear from the beginning, put your baby “back to sleep”.  But, even when sleep positioners were being used (they are no longer recommended), many an infant would figure out how to roll from their back to get all cozy and sleep on their tummy. Once your baby has achieved this milestone on their own, you cannot keep them from becoming a tummy sleeper. It is important that you still put the baby to bed on their back, but after that your baby will begin to find their own sleep position which many times is at the opposite end of the crib and may be on their tummy. Trying to be a vigilant parent who turns the baby back over is an exercise in futility as they have a mind of their own and will just flip over again, which is not as cute at 3 am. . You do not  need a video monitor or check on your baby every 10 minutes to see if they have rolled during the night.  As an infant has learned to roll it is also assumed that they will turn their head to clear their nose and mouth and the risk of SIDS decreases. Now, in the case of the baby in the email, she loved to flip from back to tummy, but then it would make her upset and she would scream.  Every time the parents went in there and turned her over and settled her again on her back, she would flip over to her tummy again, and the screaming would re-start.  In this case, I think you have to let your baby fuss (scream loudly) for a few minutes to see if they will either roll back over or fall to sleep again. It is so hard to hear your baby so upset, but she got herself in this mess (first of many) and so it is the beginning of figuring out how to handle it. She will either cry or roll, and you can flip a coin to see which comes first. After she has cried for 5 – 10 minutes I would go back in the room, try to soothe her while she is on her tummy (remember she rolled there) and then see if she will calm down and go back to sleep.  This is going to take patience and time and some sleep deprivation (which you had hoped was past I am sure), as she learns to self-console again after rolling over.  The good news is that she has achieved an important developmental milestone with rolling over. Lastly, once your baby is rolling remember never to leave them unattended on the bed, changing table, couch etc.  I call this 4–6 month old a “floor baby” as it is best to leave them on the floor on a blanket while you run to get a diaper or answer the phone etc.  Many a baby, including my own, has rolled right off that bed to the floor, usually without sustaining any injury but causing a lot of parental worry and guilt.  That experience must be like a free fall ride at Six Flags! That's your daily dose for today. We'll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

Chubby Toddlers & Weight Gain

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So, what goes on behind closed doors? During a child’s check up, I spend time showing parents (as well as older children) their child’s growth curve. This curve looks at a child’s weight and height, and for children 2 and older, their body mass index (BMI). This visual look at how their child is growing is always eagerly anticipated by parents as they can compare their own child to norms by age, otherwise called a cohort. 

I often then use the growth curve as a segue into the discussion about weight trends and a healthy weight for their child. I really like to start this conversation after the 1 year check up when a child has  stopped bottle feeding and now getting regular meals adn enjying table food. 

This discussion becomes especially important during the toddler years as there is growing data that rapid weight gain trends, in even this age group, may be associated with future obesity and morbidity. Discussions about improving eating habits and making dietary and activity recommendations needs to begin sooner rather than later. 

I found an article in this month’s journal of Archives of Pediatrics especially interesting as it relates to this subject.  A study out of the University of Maryland looked at the parental perception of a toddler’s (12-32 months) weight. The authors report that 87% of mothers of overweight toddlers were less likely to be accurate in their weight perceptions that were mothers of healthy weight toddlers. 

They also reported that 82% of the mothers of overweight toddlers were satisfied with their toddler’s body weight. Interestingly this same article pointed out that 4% of mothers of overweight children and 21% of mothers of healthy weight children wished that their children were larger. 

Part of this misconception may be related to the fact that being overweight is becoming normal.  That seems like a sad statement about our society in general. 

Further research has revealed that more than 75% of parents of overweight children report that “they had never heard that their children were overweight” and the rates are even higher for younger children. If this is the case, we as pediatricians need to be doing a better job.  

We need to begin counseling parents (and their children when age appropriate) about diet and activity even for toddlers. By doing this across all cultures we may be able to change perceptions of healthy weight in our youngest children in hopes that the pendulum of increasing obesity in this country may swing the other way. 

That’s your daily dose for today.  We’ll chat again tomorrow.

Daily Dose

Diagnosing Diabetes

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I often see parents who come in worried that their child might have diabetes. I thought this would be a great opportunity to discuss the symptoms of type 1 diabetes, which was previously known as juvenile onset diabetes. 

While there is much in the news about type 2 diabetes, which is typically related to childhood obesity, the mystery of type 1 diabetes has not yet been totally elucidated. Type 1 diabetes affects about 1 in 400 children and adolescents. There does seem to be a genetic predisposition (certain genes are being identified) to the disease and then “something” seems to trigger the development of diabetes. Researchers continue to look at viral triggers, or environmental triggers (such as cold weather as diabetes is more common in colder climates). Early diet may play a role as well, as there is a lower incidence of diabetes in children who were breast fed and who started solid foods after 6 months of age.   

In type 1 diabetes the pancreas does not produce enough ( or any) insulin. Insulin is needed to help sugars (glucose) in the diet to enter cells to produce energy.  Without insulin the body cannot make enough energy and the glucose levels in the blood stream become elevated which leads to numerous problems. Children with type 1 diabetes are often fairly sick by the time they are diagnosed.  

The most common symptoms of type 1 diabetes are extreme thirst (while all kids drink a lot this is over the top thirst) frequent urination ( sometimes seen as new onset bedwetting with excessive daytime urination as well), excessive hunger,  and despite eating all of the time, weight loss and fatigue.  

Any time a child complains of being thirsty or seems to have to go the bathroom a lot, a parent (including me) worries about diabetes. But, this is not just being thirsty or having a few extra bathroom breaks or wetting the bed one night. The symptoms worsen and persist and you soon realize that your child is also losing weight and not feeling well. 

Although diabetes is currently not curable, great strides have been made in caring for diabetics and improving their daily life. I now have children who are using insulin pumps and one mother has had an islet cell transplant. The research being done is incredible, and hopefully there will one day be a cure. 

In the meantime, try not to  worry every time your child tells you they are thirsty or tired, as all kids will complain about these symptoms from time to time.  But do watch for ongoing symptoms.  

Lastly, eating sugar DOES NOT cause type 1 diabetes. Now it may lead to weight gain which can lead to type 2 diabetes....but that is another story. 

Daily Dose

Best Ways to Hydrate

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The temperatures across the country have hit triple digits and while your kids are outside playing and maybe sweating a bit they need to make sure to stay hydrated. But, do you really know when it is appropriate for them to have water? What about a sports drink?  Who picks?

While pediatricians have been effective in discouraging families from drinking full calorie carbonated beverages, and schools have phased out full-calorie soft drinks in cafeterias and vending machines, there has been huge growth in the sports drink market.   It seems that these sports drinks are now the third fastest growing beverage category in the US, after energy drinks and bottled water. Many of these beverages are being marketed towards children and teens and are not always the best beverage of choice.

Sports drinks are flavored beverages that contain carbohydrates, along with minerals and electrolytes, and they should be used specifically for hydration in athletes. Advertisements would suggest that these products may optimize athletic performance and replace fluid and electrolytes lost in sweat during exercise. For the average child who is just outside playing and participating in routine physical activities, the use of a sports drink is really unnecessary, good old water will do the trick.

It is important to teach children to hydrate with plenty of water before, during and after regular exercise.  If we doctors and parents are encouraging exercise as a means of improving overall health and wellness, providing sugary sports drinks seems counter intuitive. Some kids may not even burn as many calories with their exercise as they may receive from one bottle of a sports drink. In other words a child’s overall daily caloric intake may increase without any real nutritional value provided by a sports drink. Back to reading labels!!

For athletes who are participating in vigorous exercise, or in conditions of prolonged physical activity, blood glucose is an important energy source and may need to be replenished; in which case sports drink providing additional carbohydrate may be appropriate.  But, different sports drinks contain differing amounts of carbs, anywhere from 2-19 grams of carbohydrate per 8 oz serving. The caloric content of sports drinks is 10 – 70 calories per serving.  You must look at the labels and judge the intensity and duration of exercise to decide which drink to use. Children are not looking at calories, but rather the labels they recognize from ads, so pay attention.

With summer here it is good to know that sports drinks really are not indicated for use during meals or snacks, and are not a replacement for low fat milk or water. Turn on the faucet and cut down on calories and cavities!

That’s’ your daily dose for today.  We’ll chat again tomorrow.

Daily Dose

Teens Not Getting Enough Sleep

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If you're the parent of a teen, this does not surprise you at all:  teens do not get enough sleep!    

An online study released by the Center for Disease Control and Prevention says, “70 percent of high school students are not getting the recommended hours of sleep on school nights”.  I could have done that study in my office on any given day of the week! 

Having raised 3 teenagers as well as thousands of teens in my practice, I know this to be true, first hand. The problem is this age group is least likely to believe or convince that lack of sleep causes a plethora of physical as well as psychological problems. 

According to the CDC study, which was just published online in Preventive Medicine, insufficient sleep is associated with numerous “risky” behaviors including drinking alcohol, smoking cigarettes, fighting, lack of physical activity and being sexually active.  The data on sleep was accumulated from the 2007 National Youth Risk Behavior Survey where students were asked, “on an average school night, how many hours of sleep do you get?” Insufficient sleep was defined as less than 8 hours, while sufficient sleep was 8 or more hours per night. On an average school night, almost 70% of responders reported insufficient sleep.  

In my practice I ask every child/adolescent about their sleep habits and routinely find teens are averaging between 5–7 hours of sleep per night. They also come in everyday with a chief complaint of FATIGUE! 

I used to tell my own sons throughout their high school years that they needed to be in bed at 10:30p.m.  They could not understand why I was up “prowling around their rooms” in the dark of night demanding, that they go to bed. “No one else has a bedtime in high school” was the common complaint.  

But I also told them that I made my living out of telling teens (and their parents) that the reason their child “felt badly” was not mono, or a dreaded disease, but lack of sleep.  

Those teens who did not have adequate sleep also drank more soft drinks (did not include diet), used computers for 3 or more hours every day, admitted to current alcohol, cigarette and marijuana use, were sexually active, and also expressed more feelings of being sad or hopeless or even of having suicidal thoughts. 

If we could improve these statistics and reduce so many teenage “health risk behaviors” by just having parents enforce bedtimes, it sure seems like an easy sell. 

Set a time, turn off the electronics and “put your teen to bed”. I know they have homework and tests and papers to write, but they also must be healthy, and rested to make good choices in both school and outside the home. 

Oh, the study also found that watching 3 or more hours of television each day was not related to insufficient sleep. You might leave that part out!  

Daily Dose

Head Flattening on the Rise!

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A recent study published in the online edition of Pediatrics confirms what I see in my practice. According to this study the  incidence of positional plagiocephaly (head flattening) has increased and is now estimated to occur in about 47% of babies between the ages of 7 and 12 weeks.  

The recommendation to have babies change from the tummy sleeping position to back sleeping was made in 1992. Since that time there has been a greater than a 50% decline in the incidence of SIDS. (see old posts).  But both doctors and parents have noticed that infants have sometimes developed flattened or misshapen heads from spending so much time being on their backs during those first few months of life.

This study was conducted in Canada among 440 healthy infants.  In 1999, Canada, like the U.S., began recommending  back sleeping for babies. Canadian doctors had also reported that they were seeing more plagiocephaly among infants.  

The authors found that 205 infants in the study had some form of plagiocephaly, with 78% being classsified as mild, 19% moderate and 3% severe.  Interestingly, there was a greater incidence (63%) of a baby having flattening on the right side of their heads.  

Flattening of the head, either on the back or sides is most often due to the fact that a baby is not getting enough “tummy time”.  Although ALL babies should sleep on their back, there are many opportunities throughout a day for a baby to be prone on a blanket while awake, or to spend time being snuggled upright over a parent’s shoulder or in their arms.  Limiting time spent in a car seat or a bouncy chair will also help prevent flattening.

Most importantly, I tell parents before discharging their baby from the hospital that tummy time needs to begin right away. It does seem that some babies have “in utero” positional preference for head turning and this needs to be addressed early on. Think of a baby being just like us, don’t you like to sleep on one side or another?  By rotating the direction the baby lies in the crib you can help promote head turning and prevent flattening.  

Lastly, most cases of plagiocephaly are reversible. Just put tummy time on your daily new parent  “to do list”.   

Daily Dose

Developmental Milestones & Your Baby

Dr. Sue takes you through milestones during a baby's first year.There are always a lot of questions about your child’s development beginning in infancy and it continues until they are grown. I must say, the longer I practice, the more “variations” on normal I see.

With that being said, an infant’s developmental milestones are very important and typically occur in the following order.  A baby will begin turning their heads from side to side at about one month of age. By two months a baby will be exhibiting a reciprocal smile and will make good eye contact.  Shortly after this, typically around four months a baby will reach out at a toy, grab it and put it in their mouths. They may also start rolling at about 4 -5 months of age.  Around 6 months a baby will start to sit when propped, and then will begin what is called “prop sitting”. In other words, they put their hands down to support themselves while sitting and then over days to weeks you notice that they no longer need their hands for support and they are sitting alone. After sitting the next milestone, somewhere around 8 – 10 months comes “schooching” and then true crawling.  The last milestone of infancy is walking, which is typically around 12 -15 months of age. With all of these milestones every baby is a little different. You should see that your baby accomplishes one of the milestones and progresses to the next, but it may not be exactly at the 4 month or 6 month age. Most importantly, progress is important and you do not want to see your baby “get stuck” and seem to lack interest in achieving the next milestone. Lastly, practice helps, so spend time with your infant on the floor, sitting between your legs, and practicing the “prop sit”. Also make this a fun time together to not only achieve the milestone of sitting, but to just enjoy playtime. If you do not think that your child is making progress in their development, or have ongoing concerns,  it is worth a visit and a discussion with your pediatrician. That's your daily dose for today. We'll chat again tomorrow. Send your question of comment to Dr. Sue!

Daily Dose

Pet Turtles And Salmonella Risk?

The link between pet turtles and salmonella I was recently traveling to a medical meeting and often use my airplane time to catch up on my journal reading. An article from Pediatrics discussing the issue of pet turtles and salmonella infections caught my eye.

In this study of a multi-state outbreak of Salmonella (a bacteria that causes vomiting and diarrhea)
in 2007 and 2008, the long known link between turtles and salmonella was being reviewed.  Of 107 patients identified from 34 states, over 50% were less than 10 years of age, and 60% of 78 patients who were available for interviews reported exposure to turtles the week before they became ill. It also seems that small turtles (I had them when I was growing up), accounted for 87% of the exposures.

Sales of small turtles have been banned by the FDA since 1975 (I am really showing my age), but are currently being sold over the internet, in flea markets and even in some retail stores, without any warnings of possible salmonella infection. In fact, some people will advertise “salmonella free” turtles which have never been bred. Due to this there has been an increase in small turtle ownership over the last 10 years and up to 6% of salmonella infections in the U.S. are due to reptile contact rather than from food -borne sources. In fact, those small turtles are not the only source of salmonella infections, but all reptiles may carry this organism including iguanas, other lizards and even snakes. (okay, I have to admit with three sons we had all of these during their childhood, not knowing they could cause illness). Another interesting fact is that you do not even have to touch the reptile, (which I hated to do), but cleaning the water and the aquarium (which WAS often my job!) is also a source of exposure. So, few parents and obviously this pediatricians are aware of the fact that salmonella infections from reptiles are actually on the rise. It’s not just those small turtles that live in the bowl with the palm tree, but all of those reptiles pose a risk for infection. As parents do know, it is hard to keep children from touching or playing with the turtle, or iguana and hand washing right after touching a pet often does not occur. No one likes vomiting and diarrhea, and it may not always be due to the food at the picnic! That's your daily dose for today.  We'll chat again tomorrow. Send your question to Dr. Sue now!

Daily Dose

Winter Season & Eczema

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I received these nice pictures and a question via email the other day. The mother was concerned as she had found this “spot” on her 6 year old son’s back. He was otherwise well and she did not see any other “spots” or rash.   

Her son complained that the “spot” was itchy so being the good mother she applied some over the counter cortisone cream for several days (which I always tell patients to try). After 2 days of it not improving, but not worsening, she thought it might be ringworm (also a good thought) and she applied an OTC anti-fungal cream.  Again, the rash was not better, but really not worsening or spreading.  That is an important part of the history. 

Now in medicine you learn about red herrings, which are part of a patient’s history that may not really have any bearing to their current problem....but one has to consider it. In this case, her dog developed a lesion and was taken to the vet and was diagnosed with a staph infection, but the vet told the mom that the dog was not contagious to humans.  Red herring or is that the problem? 

After looking at all of the pictures (which is never as good as seeing a rash in person), I am thinking that this may be nummular eczema, (nummular means coin shaped, hence the round)  The history is right as is was not bothersome other than being itchy, and eczema is often called the “itch that scratches”.   

With all of this cold dry weather and heaters on full blast all over the country eczema is having a heyday.  I have seen a ton of these little inflamed patches on skin of all ages (my own hands are a mess).   The treatment of choice is to moisturize the skin and also the use of a topical steroid. But, it takes a long time to see an improvement in the spots and they may change on a daily basis depending  on the weather, bathing and how much lubrication and moisturizing you are doing.  

I would use an OTC moisturizer that contains ceramides (Cetaphil Restoraderm, Cerave, Aveeno for eczema) and use it liberally and frequently.  I would also apply an OTC steroid several times a day (under the moisturizer). Eczema also sometimes requires a stronger topical steroid that is prescription. 

Hope that helps.....but if not improving after 7-10 days it may be worth a visit to your pedi for up close and personal diagnosis.

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