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Daily Dose

Picky Eaters

1:15 to read

There is an interesting article in Pediatrics which looks at children who were identified by their parents as picky eaters. It seems that being a picky eater (now also called selective eating), may not just be a phase for some children. Selective eating and a child’s  food preferences may be an indicator of other psychological problems.

Picky eating affects about 20% of children. In this study from Duke University, 917 children ages 2-6 who were identified as picky eaters by their parents were followed over 3 years.  The author found that those children with “moderate picky eating habits” were more likely to have symptoms of anxiety, depression and ADHD.  Children who had severe selective eating ( those children who had intense aversions that made it difficult to eat outside of their home) were even more likely to have social anxiety and depression.

I found this study to be fascinating as it does not show that picky eating causes psychological issues or even vice versa…..but it does show that there is a correlation between the two. I think this only substantiates what I have seen in my own practice and I often ask parents is this a “nature or nurture issue”, or both?

While many children go through phases when they only want peanut butter and jelly for lunch or could live on chicken nuggets and pizza, some children seem to develop more intense feelings related to food choices.  Many parents that I see say , “we just try to ignore it” and their child seems to “move on”. But over the years other parents have said that “their child would starve to death if they did not capitulate to their picky eating”, and that the struggles it caused were “just not worth the anxiety”.  Even before this study, it seemed that some children “are just wired” differently.

These children also seemed to have heightened issues with textures and tastes, that you sometimes even notice in a child as they begin to eat soft table foods between 9-12 months of age. Are these the children that go on to become extremely picky eaters? Could it be that these children are just born with heightened sensitivity to taste, texture and smell?

All in all this is an interesting study which actually raises more questions about how to handle a picky eater. Is there one right answer….like most things the answer is NO. But having family meal time is still important and I always start with the statement, “a parents job is to provide their children with a healthy well balanced meal, and their child will decide if they want to eat it” . Sounds easy enough…..but for some it may not be.

So, if you find that your child is getting more selective, food choices are more intense and this is causing anxiety for both parent and child, make sure you discuss this with your pediatrician.  

Daily Dose

New Sleep Recommendations

1:30 to read

SLEEP! Who can get enough of it?  More and more studies point to the need for a good night’s sleep. But, as a new parent, you are sleep deprived, and then when your children get older they may sleep through the night,  but they want to wake up at the crack of dawn.  Once your children are adolescents their days and nights are totally up side down,  they often want to stay up too late and sleep half the day away.

Sleep is an important way to rest our brains and reset our bodies for another day.  Circadian rhythm helps to regulate sleep/wake cycles.  But trying to make sure that your children get enough sleep seems to be a never ending battle (at least in many houses). It is also one of the most frequent concerns of many of my patient’s parents.  

A recent study which was undertaken by the National Sleep Foundation reviewed over 300 articles published in peer reviewed journals between 2004-2014. Based upon their review here are the updated sleep recommendations:

Newborns (0- 3 months) 14 - 17 hours

Infants (4 -11 months) 12 - 15 hour

Toddlers (1- 2- years) 11 - 14 hours

Preschoolers (3 - 5) 10 - 13 hours

School aged children ( 6 - 13) 9 - 11 hours

Teens (14- 17)  8 - 10 hours

Young adults (18 - 25) 7 - 9 hours

So, how do your children stack up with their sleep?  Parents with newborns complain that their children may sleep 15 hours/ day, but not in the increments that they would like, while parents with children over the age of 13 rarely report that their children are getting  8 - 10 hours of sleep.

One mother recently was exasperated as her daughter age 7 would go to bed at 7:30 pm but woke up everyday at 6 am. I explained to her that her daughter was getting enough sleep, and that unfortunately her biological clock was set and that short of making her stay in her room until 6:45 when she wanted her to get up, there was not much to do.  The problem is that many parents cannot go to bed when their children do, (dishes, laundry, work emails, etc to get done while the children sleep.) So while their children may be getting enough sleep the parents are often sleep deprived!

While a good night’s sleep is important for mood and focus there is a lot of data suggesting that children who get enough sleep are less obese, are less likely to get into trouble and are certainly more pleasant to be around.

So, have a good nighttime routine beginning with a regular bedtime for your children. Commit to no electronics in their bedrooms and turn off any electronics at least an hour before bed.  We parents need to do the same!

Daily Dose

Earlier Bedtimes May Fend Off Teen Depression

1.15 to read

A new study shows that one key to having happy and less depressed children is to have earlier bedtimes.A new study confirms something pediatricians and parents already suspected: one key to having happy, healthy and less depressed children is to have earlier bedtimes.

The study was conducted by researchers at Columbia University and appears in the journal Sleep. It shows that adolescents and teens with strict bedtimes of 10 p.m. or earlier were less likely to be depressed and to have suicidal thoughts than their classmates whose parents allowed them to stay up till midnight or even later. Another study published in the Journal of Adolescent Health examined the sleep habits of more than 12,000 high school students and found that a mere eight percent are getting at least the recommended nine hours of sleep per night. The Columbia researchers found that bedtimes set by parents were almost as important as the total number of hours slept. Kids who were sent to bed at midnight or later were 24 percent more likely to be depressed and 20 percent more likely to have thoughts about suicide compared to teens whose lights had to be off by 10 p.m. The researchers surveyed 15,000 children in grades seven through 12 and their parents and found that more than two-thirds of the adolescents said they went to bed when they were supposed to. For 54 percent of kids, that's 10 p.m. or earlier on school nights. Another 21 percent must go to bed by 11 p.m, and 25 percent go to bed at midnight or later. The teens were also asked to fill out depression questionnaires and were asked whether they had seriously thought about suicide over the past year. Scientists have long known that there was a link between depression and poor sleep. But there has always been a question as to whether the depression caused insomnia or whether poor sleep led to depression. The fact that parent-enforced bedtimes play such a significant role suggests lack of sleep may actually be a cause, not just an effect of depression. As you know, I believe it's critical for all teens to have a firm bedtime.  Begin winding down their night by turning off all electronics 1/2 hour before they head to bed. No TV on in the background and their cell phone should be charging on the family docking station in the kitchen. Tuck your teen in tonight at a reasonable's good for both parent and teen. That's your daily dose for today. We'll chat again tomorrow.

Daily Dose

Vapor Rubs: Do They Really Work?

1:15 to read

There was a great article recently published in the online journal of Pediatrics.  I had to read it as it was titled, “Vapor Rub, Petrolatum, or No Treatment for Nocturnal Cough”.  Having been a fan of both Vick’s Vapor Rub and Mentholatum since I was a child, I knew it was a MUST read article.

You can ask all of my family members, once we hit cough and cold season, the “vapor rub” jar goes next to my bed to help me during my frequent colds (see previous posts!).  I have such fond memories of being with my grandmother, Gaga, who at the first sign of a cold,  would rub Vicks all over my chest, which was then occluded by a warm damp CLEAN dishtowel, then followed by my flannel nightgown.  She would lovingly tuck me into bed, and shut the door and the whole room smelled like camphor, and menthol.   To me it was wonderful, my brother hated it!! As I grew older, my mother would hear me sniffle or blow my nose and down the hall she would come with the trusty Vick’s jar for self-application. Once I became a mother, in the family tradition, I too would rub a little Vick’s on my children’s chest, with no basis on medical fact, only what Gaga did. Funny thing, we all seemed to get better.

Two of my own children grew to despise the tradition, while one still asks for Vick’s or Mentholatum when he gets a cold.  There are old jars all over the house. I even bought several of the “plug ins” to use during cold season, which are the new fangled way to get that wonderful VR aroma into the room. They make a great stocking stuffer! So, with that history, what could be better than a study out of Penn State University that looked at the use of vapor rub (VR) to improve cold symptoms and nighttime cough.  With the recent FDA guidelines which limit the use of OTC cough and cold products in young children, many parents are at a loss as to what to do to help their child’s cold symptoms. The investigators looked at 138 children between the ages of 2 – 11 years. They were randomized to receive vapor rub (VR), petrolatum alone or no therapy.  Parents were then asked to grade their child’s symptoms and sleep on Day 1 when none of the children received therapy, and then again on Day 2 when they were randomized to therapy. 

The VR group scored best in improving cough, congestion and overall sleep for the children (and therefore their parents). This is the first evidence based therapeutic trial that I am aware of, for a remedy that is over a century old. As noted in the article, there were some irritant effects seen in the VR group with complaints of a stinging sensation to eyes, nose and or skin (I can hear my own children saying “it’s stingy”). Most of these complaints were transient in nature.  Despite older concerns about camphor when it was used as an oil that could cause possible toxicity if swallowed, skin exposure alone really has little systemic effect.   The FDA has approved camphor as an effective anti-cough preparation (anti-tusssive), but has limited concentrations to 11%. The concentration in VR is 4.8%. So, if parent’s are trying to improve nighttime cough and sleep disturbance in their children over the age of 2, there is a study to show it is time to go back to vapor rub preparations.  The mechanism for improved sleep is not really known, but whether it improves cold symptoms directly or through the aromatic effects, a better night’s sleep is good for everyone!!!  Could there be coupons to follow?

That's your daily dose for today.  We'll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

War On Zika Virus

1:30 to read

If you are an avid reader of my Daily Dose, you know I have been keeping a close eye on Zika virus.  I continue to get phone calls, texts and e-mails from anxious parents about the Zika virus.  While most of the previous questions were regarding travel to areas in Mexico, Central America, South America or the Caribbean and were from women who were pregnant or who were thinking about becoming pregnant, I am now getting questions about even getting pregnant - period.

I understand that there continues to be a lot of anxiety surrounding Zika due to the fact there is much that is still not known about the virus. Even though the virus was first isolated in 1947, it was not until 2015 that the virus spread across the Pacific Ocean to French Polynesia and ultimately to The America’s. Since that time there have been documented outbreaks of the Zika virus and to date mosquitos infected with Zika have been found in 33 countries (and counting ). The possible connection between Zika and the congenital malformation microcephaly (a brain malformation causing a small head ) continues to be studied and most recently the CDC identified the Zika virus in the tissue of two babies who died in Brazil with microcephaly.  

But with the some of the best and brightest minds working day and night on learning more about how this virus is transmitted, how to treat and prevent the virus, and the link between Zika and birth defects, the current goal is to protect pregnant women and advise that they not travel to areas with known endemic Zika transmission.  As Tom Frieden who is the director of the CDC stated, “the virus is not a major threat to the rest of the population”.  

So with that being said, while Zika is new and can be scary, it seems unrealistic for young women in the United States of America to postpone becoming pregnant out of fear alone.  While it seems likely that mosquitos with Zika may ultimately reach the southern areas of the United States once the weather gets hot and humid, that is still just a prediction.  At the same time, the U.S. government and many brilliant scientists are working to combat the Zika virus preemptively with mosquito control, education about preventing mosquito bites and ongoing fast tracking of a possible vaccine against the virus. It is hoped that a vaccine may be available by the end of 2017….which is lightning speed when looking at the typical timeline for vaccine development.

Unfortunately, there have been many times in past history when there has been fear about a new and emerging disease…some of which were also thought to be related to birth defects or were especially harmful to young children. Fortunately, scientists ultimately found cures or vaccines or drugs to combat these diseases. That is my hope for the Zika virus as well…but it will take time.

But to think that women of child bearing age are going to delay a pregnancy due to the Zika virus seems to be an emotional decision rather than a decision based on current knowledge and facts.  As one of my patient’s mothers said to me, and she is currently pregnant with her second baby due later this summer, “I cannot live my life in fear as so many things change on a daily basis….but I do need to be smart.  So I am not going to go to the Bahamas for a vacation as planned”. I agree with her and my advice is this: if you are planning on a pregnancy there is currently no reason not to continue with those plans (I am giving that same advice to my own children as well).  

Daily Dose

Teaching Good Playground Manners

We saw democracy at work yesterday and this is a good time to parlay those lessons to our children and the playground. Teaching our kids to play nicely with one another and to be inclusive begins in toddlerhood and continues throughout their childhood. Children need to learn to share the swings and monkey bars, and to invite others to play with them. The sandbox is another great place to learn to play in unison, while working together to build castles and cities in the sand. It is easier to build a city with a group than alone.

Play with your children on the playground so that they may watch how you interact with other children and share and involve others while playing. Young kids need to learn that pushing, hitting and bullying is not appropriate. It is age appropriate for young children to show some of these inappropriate behaviors, but with parental guidance children learn the importance of sharing and how to manage group play. By the time your child reaches elementary school these appropriate play behaviors should be instilled in them. Keep practicing. That's your daily dose, we'll chat tomorrow.

Daily Dose

Water Safety

1:15 to read

I was reminded of the importance of pool safety after watching the news and hearing that 3 children were found in a nearby apartment pool, under water and unresponsive.  

There are about 3,500 fatal unintentional drownings per year, which is about 10 deaths per day.  Drowning is the second leading cause of death in children ages 1-14 years.  For every child who dies from drowning, there are 4 non-fatal drowning victims who suffer severe and life changing injuries.

Drowning is preventable!!  Although many people think of drowning victims screaming and yelling, drowning is actually quick and silent.  It only takes seconds (the time to grab a towel, or answer the phone) and a child may become submerged. Most drownings also occur in family pools.  Because I have always had a fear of drowning we did not build a pool until our boys were all older than 10 years and were excellent swimmers ( was I a bit over zealous with swim lessons and swim team, maybe...)?  Children as young as 2-3 years can safely begin swim lessons and begin the process of mastering how to tread water, floating and basic swim strokes. 

Another rule for safe swimming is “never swim alone!”.  Teach your children the importance of the buddy system when they are swimming, even in a backyard pool. Adults need to be designated “water watchers” and know that they are responsible for watching the children in the pool and will never leave them unattended. The “water watcher” should regularly scan the bottom of the pool, and will need to have a phone at the pool for emergency use only.  Adult water watchers have only 1 watch the pool, no poolside chatting or distractions. It is a big job!

Anyone with a pool or who is a caregiver of children who are swimming needs to become CPR certified.  CPR skills can save lives and prevent brain damage.   

Lastly, if you have a pool you need layers of protection - which  means a barrier around your pool. I have heard many a family tell me that their child “could never get out the door to the pool, it has several locks and an alarm”.  Despite the best of intentions, no parent can watch their child 24 hours/day.  Toddlers have been known to push a stool over to unlock a door, or a door is inadvertently left unlocked or ajar. Remember, it only takes seconds for a child to become submerged. 

By the way, I am following my own advice and a pool fence is going up to protect our granddaughter...the bigger the better.

Daily Dose

Update All Immunizations

1.15 to read

August is National Immunization month and what better time than now to make sure your baby, child, tween, teen or even adults are immunized.  With all of the news surrounding pertussis (whooping cough) outbreaks across the country, and now measles in several states, the importance of vaccinating is paramount.

Vaccines have been proven to prevent disease. But in order for vaccines to be effective the majority of the population must be protected.  By vaccinating upwards of 90% of the population the entire “herd” community is protected. When vaccine rates dip below this threshold a disease such as measles or whooping cough can cause illness, not just isolated to one person, but spread to those who have not been immunized or to those who have lapsed immunizations and whose immunity has lessened. This scenario seems to be part of the case for pertussis as the adult population had not been vaccinated against pertussis for many years. It is now evident and recommended that adults as well as children receive a booster dose of pertussis in the form of a TdaP vaccine.  That means ALL adults. 

As summer comes to an end, I know that winter illnesses and busy pediatric offices are just around the corner.  Parents ask me everyday, why does my child get a cold or a cough, or a fever and vomiting?? That is because we do not “yet” have vaccine for the common cold or for norovirus or enterovirus or adenovirus. Those vaccines may be available one day. BUT, we do have vaccines for rotavirus (winter time vomiting and diarrhea),  measles, chickenpox, and FLU!

Great news is that the flu vaccine for 2013-2014 is now quadrivalent, which means that there are 4 strains of flu in the vaccine (2 for flu A and 2 for flu B). This should provide even greater protection.

So, as you are getting all of your kids ready for school and immunized think ahead about flu vaccine as well. It is already arriving in our office and we will be vaccinating all fall in hopes of keeping more illness away this winter.  The best protection against disease continues to be vaccines - spread the word, not the disease. 

Daily Dose

Break Out The Sunscreen!

1:15 to read

As the temperatures continue to warm up across the country and everyone is spending more time outdoors, it is time to break out the sunscreen.  The majority of a child’s sun exposure (somewhere between 50 – 80%) occurs before the age of 20.

Sun exposure is directly related to the risk of melanoma, and melanoma is on the rise in youth.  To prevent sunburn damage it is imperative that parents begin using sunscreen on their children at very young ages, even younger than 6 months. Sunscreen needs to be applied about 15 minutes before your child heads out to play, swim or any outdoor activity.  Sunscreen should then be re-applied at least every 2 hours, and more often if a child is swimming or perspiring.  An ounce of sunscreen is about the amount necessary to cover a child for a single application.

There are two types of ultraviolet rays.  UVA rays which penetrate more deeply into the skin causing damage to the DNA which subsequently leads to wrinkles, aging and skin cancer.  UVB rays penetrate the first layer of the skin and typically are the rays that cause sunburn.  There are 20 times more UVA rays in the environment than UVB.  Therefore, you need to look for a sunscreen product with both UVA and UVB protection. It is also good to look for a sunscreen that will provide a physical block like zinc oxide (now micronized so it is transparent on the skin) or titanium oxide.  These blocks help scatter the UV light and are typically less irritating and less allergenic than chemical sunscreens. These products may be preferable in young children, and remember you can use sunscreen on children under 6 months of age if they are going to be sun exposed.

Chemical sunscreens contain compounds that abosorb some of the sun’s damaging rays, including PABA, cinnamates, Parsol and helioplex. Many parents with infants are concerned about using sunscreen.  Both the American Academy of Pediatrics and the American Academy of Dermatology state that sunscreen may be used on infants, but preferably an infant will not be exposed to the sun for any extended period of time.  An infant’s skin contains less melanin and therefore is even quicker to burn.. Children should also wear sun-protective clothing that is now readily available at chains like Target and Walmart, and is available in all different sizes. Infants should also wear a hat.  Putting an infant under an umbrella does not provide complete sun protection either as the sun’s rays may penetrate through an umbrella or awning.

The use of a good sunscreen with frequent re-application will make your child sun-smart and prevent those burns that we know are a major cause of later skin cancers. That's your daily dose for today. We'll chat again tomorrow. Send your question to Dr. Sue right now! Check the UV Index in your neighborhood here


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Struggling with feeding your kids healthy (er) meals. Rule of thumb: don't stress over it!


Struggling with feeding your kids healthy (er) meals. Rule of thumb: don't stress over it!

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