Daily Dose

Teens & Good Habits

1.15 to read

I saw a teenage patient recently and it reminded me about the need for good habits.  He had started his freshman year and his first semester did not get off to a great start. 

Now, this is a great kid and he is typically a good student. But for some unknown reason (hormones, attitudes, better things to do) he just decided that he didn’t need to study. School had never been too difficult for him and he just thought he could “sail through” his first semester of high school without a lot of effort. Guess what, he didn’t sail, the headwind was stronger than he thought. 

So, when he was in for his check up we started talking about how he could get back on the right track for his second semester. The consensus was, he needed good habits. 

Whether we are discussing good study habits, or good eating habits of good bedtime habits, it is much easier to start off with good habits rather than to try and undo/change bad habits. 

If I am discussing starting good habits, it really doesn’t matter if it is parents who have a 1 year old or a teenager the premise is the same; try to begin with good habits but if they lapse regroup. 

So, in this case, the teenager and study habits, he had forgotten his good habits and he needed to get back on track. We sat down during the check up and planned the best time for him to study, where to study and how to prioritize his subjects.  We figured out that he needed to tackle his hardest subjects first. Secondly, he felt as if he studied better at school than at home, so it was agreed that he would stay for an hour or so after school in the library to try and get his homework started.  We discussed turning off all of the outside distractions while he was studying (and maybe he would get his cell phone privileges back too). 

He agreed that we would see how the next 6 weeks went and that he would check back in. His parents agreed to try and let him get his own good habits started and I am ready to bet that he is ready to set sail again!!


Daily Dose

Meningitis Outbreak

1:30 to read

There has been another outbreak of the meningococcal disease among college students at The University of Oregon.  If you remember a year or so ago, there was an outbreak at Princeton University as well as one at UC Santa Barbara.  The meningococcal bacteria may cause a serious blood infection, meningitis or in some cases both diseases and may even be fatal.  

Meningococcal disease seems to cluster in adolescents who come into close contact with one another...such as on college campuses with students living in dorms and other residence halls.  The bacteria is spread via respiratory droplets which may occur when coming into close direct contact with an infected person...in other words even a roommate, or suite-mate.  

The latest cases of meningococcal disease in Oregon have been due to Serogroup B infection, which caused the outbreaks at the other universities as well.  Most colleges have required that students receive a meningococcal vaccine against Serogroups A, C, W, and Y (Menactra, Menveo) ...but until recently there had not been a vaccine against Type B disease.  The FDA recently approved two vaccines against serogroup B, and they are Trumenba and Bexsero.  These vaccines were given to thousands of students at Princeton and UCSB during the previous outbreaks, even before they were approved by the FDA, as they have been well studied and were already being given in Europe. 

Although these vaccines are not yet routinely recommended in the United States, in certain situations, such as people who are immunocompromised, or during an outbreak such as that at the University of Oregon, the vaccine may be recommended. You can see the guidelines for vaccine recommendations on the CDC website as well.

The early symptoms of the disease often mimics the flu with fever, body aches, headache, nausea.....but quickly progress to have far more serious symptoms.  As a pediatrician that takes care of a lot of college students (and who saw a case of Serogroup B disease several years ago), I am always on the alert.

Daily Dose

Skin Lesion: Staph or Pimple?

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I just received an email question from a teenager who happened to attach a picture of a skin lesion she was worried about. I think it is great that teens are being proactive about their health and are asking questions about issues that are concerning to them.  BRAVO!!

So, this “bump” sounds like it started out as a possible “zit” on this 16 year old girl’s neck.  She admitted to lots of “digging” into the lesion and then became concerned that it didn’t seem to be getting any better.  She said that friends told her that it could be scabies, or possibly staph.  Leave it to friends to make you more apprehensive about the mystery bump. Looking at the picture it looks like it could be a simple pimple and in that case the best medicine is to LEAVE IT ALONE. The hardest thing to get teens to do (and also adults) is not to pick at pimples or bumps on their bodies, as this could lead to a skin infection. Many times just washing the “zit” and leaving it alone, it will go away.  When you go “digging” into it you break the skin and allow bacteria to enter the now open wound and you can get a skin infection. 

In many cases this may be due to staph or strep from your hands.  This may sometimes require a topical or oral antibiotic to treat the infection, when it may have been something that should have been left alone. There are skin infections that we are seeing in the community that are due to MRSA (methicillin resistant staph) which have become quite frequent in the last several years. In this case that small “bump” usually arises quite quickly, often times it is confused with an insect bite. But very quickly the bump becomes more inflamed, tender and often quickly grows in size. Many times there will be drainage from the bump which now resembles a boil.  In my experience the hallmark of MRSA infections is how quickly they arise and how painful they are.  They have a fairly classic appearance (see old post on Staph).

MRSA infections often have to be drained and require different antibiotics than ”regular” skin infections. In most cases it is necessary to obtain a culture of the drainage so that the appropriate antibiotic may be selected. In some circumstances the infection is quite extensive and may even require surgical drainage and IV antibiotics, requiring a stay in the hospital.  MRSA is a serious infection and is often seen in teens who share articles of clothing or participate in sports where they are showering, using equipment etc that is shared. Remember to use your own towels, and athletic equipment when you can.

This teen also asked “if you have staph would you have it forever?” In actuality, many of us harbor staph in our noses and we all rub our noses throughout the day and then touch other parts of our body as well as other objects. This then passes the bacteria from person to person, sometimes via another object. If you are not symptomatic, don’t worry about whether you have staph in your nostrils, but do adhere to good hand washing and try to keep your hands away from your face. For patients who have had recurrent skin MRSA infections, I often prescribe an antibiotic cream to be put in the nostrils as well as in the nostrils of all close contacts (family members). I also recommend that the patient bath in an anti-bacterial soap and take a bleach bath every week to help decrease the bacterial colonization with staph. It seems that this has helped prevent reoccurrences of staph for the individual as well as for other family members. Lastly, this is certainly not scabies, but we have an older post on that too with pictures!

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

Daily Dose

Treating Motion Sickness

With spring break under way, I seem to be getting some phone calls from patients of mine who have been on the road travelling and dealing with a child with motion sickness.Many areas around the country are enjoying spring break. What's interesting this time of year and during the summer months, is the amount of calls I receive from patients of mine who have been on the road travelling and dealing with a child with motion sickness. Whenever I get calls like this it brings back memories of my own children and episodes of throwing up in many different locales, YUCK!  

So, maybe this will help you be better prepared than I was when this first happened to our family while riding in the infamous minivan. The most common cause of motion sickness is car sickness, but children may get sick while on airplanes or boats too. It seems that about 58% of children between the ages of four and 10 experience the symptoms of car sickness. Younger children are also affected, but may not be able to verbalize the sensations of motion sickness. It seems to be due to an increased sensitivity to the brain’s response to motions. The brain receives signals from the motion-sensing parts of the body (the eyes, the inner ear, and the nerves in the extremities), and in most situations all three areas respond to any motion. When the signals the brain sends and receives are in conflict, (typically between the ear which senses movement, while the eye does not), the symptoms of motion sickness occur. The signs of motion sickness usually start with a slight feeling of queasiness: “I have a stomachache” is heard from the backseat of the car. Dreaded words to any parent. In some cases children can be sick before you have even gotten out of town and on the highway. The initial nausea is then followed by a cold sweat, fatigue and loss of appetite. A younger non- verbal child may just become restless, pale, sweaty and cries. At some point these symptoms are usually followed by vomiting. By then you have figured it out! The best treatment for motion sickness is like many things: prevention! If you have already experienced motion sickness with your child plan ahead for trips. If your child is over the age of two, place them in their carseat in the middle of the backseat and face them forward. Provide a small nutritious snack prior to the trip rather than a big meal, and avoid dairy (there is nothing worse I can assure you from personal experience). Open the windows to provide fresh air. Do not let your child play video games or read while the car is in motion, Try to distract them by singing or talking. Sleeping may also be helpful, so at times you may plan your trip around naps and bedtime. Frequent stops for a child who is feeling sick are a necessity. Letting them lay flat for a few minutes while the car is stopped and even applying a cool rag may make them feel better. Try small sips of carbonated beverages or crackers to help the nausea. Some children who have a tendency to get sick may do well if they are pre-medicated for a trip with either Dramamine or Benadryl. Although these medications typically cause drowsiness, some children may have the opposite reaction and become agitated. You might want to try them prior to a trip. Check with your doctor about dosages. Lastly, be prepared and have zip lock bags and hand wipes available in case of emergency. This will make everyone in the car a little happier. That’s your daily dose, we’ll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

ADHD Medication

1:30 to read

If your child takes medications for ADHD you may be noticing that your insurance company may be denying coverage for these prescriptions, or they are wanting to use a generic version of the medication your child may be taking.  It seems that this is becoming more and more prevalent and I get phone calls from patients asking what they should do?

Medications for ADHD have never been inexpensive and for some families, especially without insurance coverage, they are cost prohibitive.  For a child who has been diagnosed with ADHD, it is known that a combination of medication and behavior modification provides the best outcome.

When I begin a child on medication for ADHD I typically start with a brand name drug and do not use any generics.  I explain to parents that although I am a believer in generic drugs, and use them frequently, I want to make sure that any effects of the drug (positive or negative) are indeed due to medication and are not influenced by a difference in a generic drug.  Once a patient has been on medication and is doing well, if there is a generic available, I will often prescribe it in order to be more cost effective.

Over the years patients have commented to me that they do not feel as if the generic version of their given ADHD medication is working well. While these are anecdotal reports, they have not been uncommon. In that case some of my patients have opted to pay for the more expensive brand name medication.

The FDA just released an interesting article that states just that....studies have recently found that generic versions of the drug Concerta (by 2 different manufacturers) “may not provide the same therapeutic benefits for some patients” as does the branded medication.  While Concerta has a “drug releasing system” that provides 10 -12 hours of extended effectiveness, it seems that the generic drugs may relase more slowly, and the diminished release rate may not provide the same effect for the patient.

So, if your child is on these medications and you have tried a generic version and were concerned about their effectiveness, now is the time to discuss with you doctor.  This may not be the case for all, but it is certainly worth knowing there is now data on this subject.

Daily Dose

Infant Immunization Week

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April 20-27 is National Infant Immunization Week.  Although there are infants and children in this country being immunized every day, this is the week to remind parents, caregivers and health care professionals of the importance of vaccines.  

Infants are immunized against 14 vaccine preventable diseases.  Vaccines are now given to prevent not only “older” diseases like diphtheria, tetanus and polio but for diseases like bacterial meningitis, chicken pox and a viral diarrheal disease. Vaccines are one of the greatest public health achievements of the past century, and more vaccines are in the pipelines to continue to save lives.

Although some parents have been concerned and even misinformed that vaccines cause autism, study after study, including one published last month, have shown that there is NOT a link between vaccines and autism.  What we do know is that vaccines save lives, lots of lives.

Before the meningitis vaccines for both pneumococcal and H. flu bacterial infections were available there were hundreds of children who died each year.  I can remember taking care of some very sick children, and even doing spinal taps in my office to rule out meningitis. Some of the spinal taps       were positive and a few of my young patients were fortunate to survive bacterial meningitis, but they are now adults with deafness.  We had a few children in our practice during the 1980‘s who died from meningitis.  

During my early years of practice bacterial infections of the blood were also more common and we hospitalized a lot more infants and children than we do now.  I will also never forget a previously healthy 2 year old little boy who died from chickenpox and a bacterial infection of his blood stream.     This occurred almost 20 years ago, before the chickenpox (varicella) vaccine was available.  He would have been protected just a year later when the vaccine was introduced.  My youngest son received one of the first doses of varivax vaccine after it was approved as I knew that children did die from chickenpox and I could not give him that vaccine fast enough!

We all owe a great deal of gratitude to the brilliant scientists who study diseases and develop vaccines to prevent those diseases.  There are years  and years of work that go into not only developing a vaccine, but study after study to prove their efficacy and safety.  We are all healthier for this dedication.

So, if your child is not up to date on their immunizations, this is the week to start to play catch up. If you have a new baby, plan on starting immunizations at their 2 month check up. Big shout out for vaccines!

Daily Dose

Kids & Cell Phone Use

Did your child get a cell phone over the holiday? Have you set rules, boundaries and limits? You should and here's why. I have been walking through my waiting room recently and noticing that a lot of my “younger” patients have their own cell phone. So, I have now begun to routinely ask all of my patients over the age of 8, if they have a cell phone. I must say I am surprised that some 8-9 year olds actually do!!

I'm not sure why a child in elementary school needs a cell phone. Who are they calling?  What happened to being able to either go to the office at school to make a phone call or I asking your teacher if you might use their phone to call a parent if necessary?  Is that not possible anymore?  I know that younger children are also texting on the cell phone and I am not sure how some of them can text when they are not yet fluent readers.  I digress. After learning if a patient has a cell phone, I have also started to ask about rules for the phone. Have the parents established rules for cell phone use?  When the phone may be used, how many minutes the child has (does everyone have unlimited minutes now?), who they may call and what time is the phone “put to bed at night”. I have always asked my patients about their bedtimes and bedtime routines, but I am now interested in when the cell phone heads to bed too and gets turned off.  I am not talking about high school juniors and seniors, I am really speaking more to the children I see in elementary, middle and early high school. The older kids are yet another story. Many of my patients seem to have very good rules about when the phone may be used, to whom they may call (especially the younger ones) and when the cell phones are turned off. But, just like those parents who still think that having a TV in a child’s room is a rite of passage, there are those parents who do not think it is necessary to set rules for the phone. I disagree. Children really do crave guidelines and need to have clear messages regarding the use of their cell phones. If you start off with “the rules of the phone” it lets a child understand that owning a cell phone is still a privilege, and that with that comes responsibility including when and how the phone may be used.  I do not think that a phone needs to be on once bedtime routines have started, and the phone should have a bed time too.  The easiest way to do this is by having a “family docking station” where the phones are put each night, turned off and charged. If this habit begins early on, it is easier to continue as your child gets older. Once again good habits are easier to make than trying to break bad ones. Having a middle school child on the cell phone in their room under the covers at 11 pm at night is not an uncommon occurrence and if the phones are put up each night it makes the temptation less likely.  The glow of the phone beneath the covers is a dead giveaway, as is the call record that shows use after the stated bedtime. Take the opportunity to review your child’s cell phone log on occasion. I was stunned at the number of calls high schoolers received after 11 pm when the phones were “supposed” to be off. Lastly, set rules about texts and let your child know that you will occasionally be reading their texts. They should be taught early on that anything they write should be fair game for a parent to read. Remind them that text messages never go away, somehow they may be retrieved from cyberspace even after deleted.  That amazes me, but we have all seen it in the news.  Discuss “sexting” too. If you don’t bring these things up they may find themselves in a situation they were ill prepared for, and make a poor decision. Being able to call your child when you need them is nice, but maybe we are all a little too connected at too young an age.  Like many things, once you let your child have their own cell phones it may be hard to go back. But remember, it is a privilege and the rules need to be followed or the phone may be taken away.  We parents just need to follow through. That's your daily dose for today. We'll chat again tomorrow.

Daily Dose

Colds & Suctioning Your Child's Nose

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I am beginning to sound like a broken record, but we are in the throes of cold and flu season and unfortunately there are a few more months of this.  As every parent knows, colds (aka upper respiratory infections) are “age neutral”. 

In other words, there is not an age group that is immune to getting a cold and for every age child (and adult for that matter), the symptoms are the same. Congested nostrils, scratchy sore throat, cough, and just plain old feeling “yucky”. When an infant gets a stuffy nose, whether it is from “normal” newborn congestion, or from a cold, they often have a difficult time eating as an infant is a nose breather.  When they are nursing and their nose is “stopped  up”, they cannot breath or even eat, so it is sometimes necessary to clear their nasal passage to allow them to “suck” on the bottle or breast. 

Of course it is self evident that an infant cannot blow their nose, or rub or pick their nose so they must either be fortunate enough to sneeze those” boogers” out or have another means to clear the nose.  This is typically accomplished by using that wonderful “bulb syringe”. In our area they are called “blue bulb syringes” and every baby leaves the hospital with one tucked into their discharge pack.  As a new parent the blue bulb syringe looked daunting as the tip of the syringe appeared to be bigger than the baby’s nose.  But, if you have ever watched a seasoned nurse suck out a newborn’s nose, they can somehow manage to get the entire tip inside a baby’s nose. For the rest of us the tip just seemed to get inside the nostril and despite my best efforts at suctioning nothing came out. Once a nurse showed me the right “technique” I got to be a pretty good “suctioner”.  With the addition of a little nasal saline, which you can buy in pre made spray bottles, or which may be made at home with table salt and warm water, the suctioning gets a little easier as the nose drops helped to suction the mucous.

Now, I have become a firm believer that there is a place for suctioning a baby’s nose, but once a child is over about 6 months of age they KNOW  what you are getting ready to do. I am convinced that a 6 month baby with a cold sees the “blue bulb syringe” approaching their face and their eyes become dilated in fear of being suctioned!!  Then they begin to wail, and I know that when I cry I just make more mucous and the more I cry the more I make. So a baby with an already stuffy nose gets even more congested and “snotty” and the bulb syringe is only on an approach to their nose. It also takes at least two people to suction out a 6 – 12 month old baby’s nose as they can now purposely move away , and hit out to you to keep you away from their face and nose. It is like they are saying, “ I am not going to give in to the bulb syringe” without a fight! I swore I would not have a child with a “green runny nose” that was not suctioned.

As most parents know, don’t swear about anything, or you will be forever breaking unreasonable promises to yourself!  I think bulb suctioning is best for young infant’s and once they start to cry and put up a fight I would use other methods to help clear those congested noses.  Go back to the age old sitting in a bathroom which has been steamed up with hot water from a the shower. Or try a cool mist humidifier with some vapor rub in the mist (aroma therapy).  Those noses will ultimately run and the Kleenex will come out for perpetual wiping. Unfortunately, it takes most children many years before they learn to blow their nose, but what an accomplishment that is!!!  An important milestone for sure.

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

Daily Dose

'Twas the Night Before Christmas

1:30 to read

Are you feeling overwhelmed by the night before Christmas? Many parents do including me! Each year I try to plan to have a “calm” holiday with an organized gift list, and everything wrapped early so that our family may spend quiet time together today in anticipation of Christmas. Why is it that I may have struck out again?

If you could see my “office” right now, you would be surprised that I could even write today. The top of my desk is strewn with journal articles, rehearsal dinner seating charts, year end CME (continuing medical education), and lots of ribbons and gift enclosure tags. I am not even sure what goes with what! I am also decorating the mantels with fresh garland, arranging flowers and trying to keep our sweet yellow lab Maggie from eating the Christmas ornaments and the fresh greenery. While I am doing all of that I must tell you that my sons are either asleep, watching TV or working from home and “just want to veg”. It is at this time each year that I feel defeated as a mother.

The visions of family singing carols beside the tree that they helped decorate, are a figment of my imagination. This is when I think it must be different if you have daughters. Do girls rally to help their mothers with the preparation of Christmas? Do they come and ask to help decorate the tree (if they are older than eight), or are they dying to learn to tie a bow on a gift? About this time while I am in a major reflective mood, a patient of mine (now a freshman in college), drops by to deliver a coffee cake and at the same time admires the berries that I am using to decorate. It must be a different world with girls. So, on this Christmas Eve, I wish that I could tell you “all is calm”, but I think I still have a lot to get done before I sleep tonight. I am sure that mothers and fathers everywhere feel the same way, and that is what is wonderful about parenting! We are all in this together.

By Christmas morning, it will somehow all get finished and the family will get to gather together to open gifts, have Christmas breakfast or lunch or dinner and hopefully appreciate how fortunate we are to be a family. For those precious moments it does seem “perfect’ and I am thankful for that. I will take many pictures to remember these times together. I wish each of you a Christmas morning filled with memories after a chaotic week.  Merry Christmas!


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