Daily Dose

Summertime Can Mean Snakebites

1:15 to read

Due to wet weather, snakes are being oushed out into the open. What does it mean? There is a higher risk of being bitten by a snake. News reports have families on alert: snakes are being pushed out into the open.  More snakes mean the potential for more snakebites.  I have never treated a patient with a snakebite and thought they were quite uncommon. Unfortunately, a rattlesnake bit a friend of mine (they are out of the hospital and doing well) so upon review I have learned a lot more about venomous snakebites.

There are actually over 45,000 snakebites reported in the U.S. each year. The majority of these are due to non-poisonous snakes and often requires little or no treatment. The days of the old Cowboy movies showing rope tourniquets being applied to the area of the bite and the cutting and “sucking” of the venom are over! Don’t start practicing “movie medicine” if you find yourself dealing with a snakebite. There are about 8,000 venomous snakebites reported each year. Fortunately, with these large numbers and the advent of anti-venom, only six to eight people die each year secondary to a venomous snakebite. Unfortunately, due to their smaller size, children do not handle snakebites as well as adults, and the fatality rate is higher in children.

In the U.S. 99% of poisonous snakebites are by the subfamily pit viper, which includes rattlesnakes, copperheads and cottonmouths (YUCK). The other species of poisonous snake found in the U.S. is the coral snake. I am not going to detail the specific treatment for each type of bite, but if a snake bites your child the first thing to do is to determine if it was a poisonous snake. Non-poisonous snakebites cause minimal pain, no swelling and really only require local wound care with irrigation and antibacterial soap. If the bite is thought to be from a poisonous snake the child should be transported to the nearest hospital. Do not put a tourniquet around the bite, apply ice or suction the area of the bite as these are all thought to cause more tissue damage than benefit.

Pit viper bites typically cause symptoms of swelling, bruising and progression within minutes of the bite. Children typically have more severe symptoms with nausea, vomiting, sweating, muscle weakness and clotting abnormalities, all of which are a medical emergency. Anti-venom should be delivered within four hours of the bite and will be given until improvement in systemic symptoms is achieved. All of this is done in the ICU setting. That’s your daily dose, we’ll chat again tomorrow.

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Daily Dose

Why Babies Get "Goop" In Their Eyes

1:15 to read

If you have recently had a baby you may already know about “clogged tear ducts”. This is also named nasal lacrimal duct obstruction and is fairly common in newborn infants in the first weeks to months of life.

A baby’ s tear duct, the tiny little hole in the inner corner of the eye, is very small and narrow and may often get obstructed. If that is the case the tears that an infant makes gets backed up and may form a thickened “goopy” discharge in the eye. At times when this occurs the baby’s eye will seem to be “glued” shut as the goop gets in the eyelashes and almost seems to cement those little eyes shut. Occasionally the eye will look a little puffy due to the debris in the eye. The best thing to do for this problem is to use a warm compress or cotton ball dampened with warm water to wipe the eyelashes and remove the discharge from the eye.

Once the “goop” is removed and your baby opens their eye, look at the whites (conjuctiva) of the eye. The conjunctiva should not appear to be red or inflamed. The goop will re-accumulate over time, but the eye itself should continue to look clear. Babies with clogged tear ducts do not appear to be ill and continue to eat well. The only problem should be the goopy eye. In order to help open the clogged duct you can try to massage the inner lower corner of the baby’s eye (beneath the tear duct itself), several times a day. Gently apply pressure to the area and do this several times a day. The eye “goop” always seems to be worse after the baby has been sleeping. It is also not uncommon for one eye to clear up only to have the other eye develop “goop”.  Most of these obstructions resolve on its own by four to six months of age. If the tear duct continues to be obstructed, talk to your pediatrician about a possible referral to the pediatric ophthalmologist.

That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

Make Breastfeeding Enjoyable, Not Hard Work

The New Year is off to a quick start and my office is busy with so many new babies. Such fun, and happily most of my new babies are being breast fed, which is the best source of nutrition for a new baby.

The most interesting phenomena to me is that over the last year or so I have noticed many young mothers are “breastfeeding” their babies, but they really just pump breast milk and then give the expressed breast milk to their baby in a bottle. Now, in some circumstances, such as an infant in the NICU, or a baby who has difficulty with sucking and swallowing, it may be a necessity for a mother to pump her milk and then the milk is given in a bottle to the baby. But, these are perfectly healthy babies, and the mothers really want their babies to receive breast milk, but the moms are so concerned about the amount of breast milk that their baby is getting that they want to pump and measure it and quantify their baby’s intake. What happened to just putting the baby to the breast and feeding the baby every 2 -3 hours? I know I must be getting old, but half of the fun and enjoyment from breastfeeding came from having skin to skin contact with the baby, as well as the ease of just lifting the nursing bra and putting the baby to the breast. I don’t think I even thought about pumping breast milk until I was heading back to work. I never really “knew” how much milk they received, but they were nursing and gaining weight and I guess I just “believed” that it would all work. Now, it seems that so many of my young mothers cannot stand not knowing how much milk their baby is getting, even if they are gaining weight and are thriving. They just want to quantify every ounce and it makes them feel better to pump and then bottle-feed. That just seems like SO much work to me. It is not an exact science. Sometimes they probably receive a different amount of milk than at other feedings, but an infant is like the rest of us in that they too may eat different amounts. I use the analogy of “sometimes I order a salad at lunch and sometimes a double cheeseburger” it just depends how I feel that day. Your baby is the same; he or she does not “have” to take the same 4 ounces at every feeding. That is the wonder of breastfeeding; you just nurse for 10 to 15 minutes per side and “voila” the baby wets and poops and gains weight. Unless there are problems with weight gain it really doesn’t matter how much the baby gets at every feeding. It is not an exact science. This concept of breastfeeding and not knowing the exact amount has been driving many new mothers crazy, as they want to put the exact amount down for each feeding and are “sure” if their baby only took 4 ounces instead of 3 that their baby would sleep better. The parents have also been able to enter all of this information into their iPhones and they have spreadsheets and calorie counts to show me. What I wouldn’t have done for that when I was a resident and had to calculate how many calories a sick baby had eaten in the last 24 hours. Again, this was only done for sick babies in the hospital, not a healthy newborn or infant. Too much information is not always better. Relaxing and enjoying your baby is so important. Try to make it easier rather than harder, and just nurse your baby and pump occasionally to give the baby a bottle if you plan on being out, or just need to take a relaxing bath and let your husband feed the baby. But counting every ounce and calorie in a normal healthy newborn and measuring breast milk for each feeding is not necessary. And you know what, the baby will not sleep any better either! That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

Your Child's Sitter

1:30 to read

Do you ever leave your child with a babysitter or caregiver? Weird question right? But some parents never want to leave their child with someone else....and I am not sure that is healthy for either parent or child.   

I recently had this discussion with parents of a 3 year old child who was having a terrible time with separation anxiety. While many children go through stages of separation anxiety, by the time a child is 3-4 years they are typically past this stage. When I was talking with this family they told me their child had never been left with anyone.  

I guess as a working mother I was incredulous. What? Had the parents never gone out to dinner or to a party, a concert, lecture  or even on a night away for some much needed “couple” time?  They told me that they would occasionally call in grandparents but typically took their child everywhere with them.  (I think there are many places such as movies, adult restaurants, and other venues that might not want the 2 year old in tow).   I suppose some would say the child was fortunate, but I really believe that as a child reaches age 2ish they need to begin learning to separate from their parent. Not for days or weeks, but for either a play group, a pre school program, the gym nursery or something where the child is learning a bit of independence.   

While some parents are quite fortunate that they don’t have to leave their child to go to work every day, the concept of leaving your child for any hour or two with a trusted babysitter should not cause anxiety for the parent and ultimately not the child. Separation is an important milestone, as your child learns that while you may leave for an hour or two, you always return. There is security in that knowledge. They will also learn how to interact with  other adults and children, which is often different than they do with their own parents.  (Ask any teacher about that phenomena). 

Autonomy and independence are typically traits that parents desire for their children.  Parents also need to have some autonomy as well.....I think this makes for a better parent child relationship in the long run.  Little steps in separating become bigger steps as a child grows older....starting with a babysitter or nursery for an hour or two on occasion is often the beginning. 

Daily Dose

Help Your Child Stop Smoking

Today is the National Smoke Out where every smoker is supposed to put out his or her cigarettes for the day on the road to stop smoking. Why am I writing about this on a kid's health Web site? Well, unfortunately teenage smoking is still an ever-present issue. There are still thousands of kids every day who begin smoking, as young as 11 or 12 years of age. Statistics show that 50% of high school teens will have smoked at some time in their life, and many of them will continue to smoke.

Smoking is glamorized in movies, in magazines and in ads appealing to kids. But you know, the consequences of smoking are never shown. Why don't they show you the yellow teeth (all of the models have pretty white teeth, right)? They don't talk about disgusting breath, or smelly clothes and hair and what about lung cancer and emphysema? The list is so long and the consequences of nicotine addiction are so great, but our kids don't get that message. We in the media need to educate, not glamorize or fail to report consequences. Second had smoke is also an issue. More and more data is being released about the effects of second hand smoke including promoting allergies, asthma, and even lung cancer. Who wants their children exposed to smoke as they walk out of malls, office buildings, restaurants and airports? So, if you smoke, this is the day to set the example for your child and STOP SMOKING. If you have a teen who is smoking, sit down once again and talk to them about nicotine addiction, and the cumulative effects of smoking. Teens really do listen; you just have to tell them more than once or even twice...don't give up. That's your daily dose, we'll chat tomorrow.

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Daily Dose

Poison Control in Your Home

1:15 tow atch

Our office gets many calls from parents who are worried that their child may have swallowed a stray pill, or a berry or plant leaf.  The list is endless. Despite every parents efforts at childproofing their home (childproofing cabinets, electrical outlets etc, should begin as your your-baby starts to crawl) at times a toddler finds something stray and the first place it goes is in their mouth.

The phone number that needs to be at every parent's fingertips is the number to the Poison Control Center. That number is 1-800-222-1222 and should be on your speed dial or on a sticker on your phone.

The poison control center is the national source for information on poisoning and I have been so impressed with their professional, yet compassionate manner and their knowledge base. If your child does accidentally ingest a household cleanser, or a drug have the bottle handy when you call them so that you can read them the label. It is much easier for them to help you decide what to do for the ingestion with complete information. Telling them that it was a small white pill leaves millions of possibilities; so make sure that you do keep all medications, whether over the counter or prescription, in their appropriate bottle. Fortunately, many ingestions may be benign and require no treatment, but do not assume this until you have spoken with Poison Control. The use of syrup of ipecac, to induce vomiting after ingestion is no longer recommended. Thank goodness!

That's your daily dose, we'll chat again tomorrow.

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Daily Dose

Middle Ear Issues

1:30 to read

I just read a really intriguing study on children who have persistent middle ear fluid (otitis media with effusion) in The Canadian Medical Association Journal. Persistent middle ear fluid is fairly common and is often a reason that children will undergo a day surgical procedure to insert tympanostomy tubes (ear tubes).  In fact, my 11 month old granddaughter just had tubes placed.

The treatment for middle ear fluid is often to just “watch and wait” and in many cases the fluid will resorb on its own and the problem is solved. But for persistent fluid surgery was often recommended. For older children I often would see if they could learn the “valsalva maneuver” which would increase the pressure in the nasopharynx and help open the eustachian tube. This is the same maneuver you use to “pop” your ears after an airplane flight.  The only problem is that some children don’t seem to be able to understand how to do this as there is not a way to really let them know how it feels when performed correctly.

In this study, 300 children aged 4 -11 years who had had recent ear symptoms and persistent fluid in one of both ears were randomized to “usual care” or were taught to use a nasal balloon.  The nasal balloon with auto inflation is a device which is inserted into one nostril while occluding the opposite nostril and the child blows up the balloon through their nose. By doing this they increase the pressure in their nasopharynx and open up the eustachian tubes and clear the fluid.  Genius…. the child can see that they are doing the maneuver properly as the balloon blows up….and it is both painless and fun!!

In the study the children, used the nasal balloon 3 times a day for up to 3 months and they were more likely to “achieve normal middle ear pressure” than the children who did not use the auto inflation balloon.  

This is certainly low cost and can be taught in the pediatrician’s office with minimal time and effort for both parent and child. Who wouldn’t want to try this rather than have a surgical procedure?

I am now going to look into where to purchase this product (wish I had thought this up) and try this on some of my own patients. I am sure there are plenty of kids that would love to blow up a balloon with their nose…perfect for a show and tell demonstration as well!

Daily Dose

Bug Spray & Bug Bites!

1:15 to read

 It’s that time of year again when the bugs start to return from their “off season vacations” and pediatricians start to see children who are suffering from uncomfortable bug bites.

The best way to prevent bites from the myriad of insects including mosquitoes, mites, chiggers, flies and fleas is by using an insect repellent. Insect repellents do not prevent bites from stinging insects such as bees, hornets and wasps. The AAP recommends using bug sprays in children who are older than 2 months of age when necessary for preventing insect bites during outdoor activities. The most common insect repellent is DEET, a chemical that has been studied for over 50 years. Most of the OTC bug sprays contain DEET in different strengths. The higher the concentration of DEET, which typically ranges from 5 – 30 %, the greater the protection and length of effectiveness. I usually recommend starting with the lowest concentration of DEET, which typically provides protection for 1-2 hours, and use a higher concentration as needed for longer protection.

The number of bites a child receives and their reaction to bites are different in all children, so each child may need a different concentration of DEET to be effective. With concentrations of DEET above 50% (not recommended for children), the effectiveness and duration of protection actually plateaus, so there is really no benefit from higher concentrations.

Another product approved for use in the U.S. about 5 years ago is picardin. Picardin provides similar protection in both duration and effect to DEET. Cutter, Skin So Soft and Off all have some products containing 7-10% picardin. The advantage to picardin containing products is that they are odorless (unlike DEET) and do not feel as greasy on the skin and are less likely to cause skin irritation and damage to fabrics . With all products you must read the labels to see what you are getting. There has been some recent data on the use of natural products such as oil of eucalyptus which the CDC has found to be comparable in its duration of effectiveness in preventing mosquito bites, to lower concentrations of DEET. It may also work well against ticks (Repel).

Eucalyptus oil may be poisonous if ingested in large quantities and should not be used in children younger than 3 years of age. Other studies have found that 2% soybean oil (Bite Blocker for Kids) has similar levels of protection to products containing 5-15% DEET, and may provide up to 90 minutes of protection from mosquitoes. This may be a useful product for short term exposures. Chemical repellents containing permethrin kill ticks on contact but should never be applied to the skin, but may be applied to clothing. Insect repellents should not be reapplied throughout the day, as is sunscreen. Parents should be instructed to spray the insect repellent on their hands first and then apply to their child and do not apply to the areas around the nose and mouth. 

It is a good idea to wash the repellents off with soap and water at the end of the day. That’s your daily dose for today. We’ll chat again tomorrow.

Daily Dose

Can TV Impact Language Development?

A new study looks at how television, which may even be background noise, may interfere with parent-child interaction and conversation.There has been a lot written about television watching in children and the effects it has on their overall health and well being, including learning, moods, academics and even sleep habits.

A study published in Archives of Pediatrics and Adolescent Medicine is interesting as it looked at how television, which may even be background noise, may interfere with parent-child interaction and conversation. In this study every hour that a child spent within earshot of a television, fewer words were spoken by the parents to their young children and fewer vocalizations were made by the children. In the United States about 30% of households have their TV's on all the time. Although the American Academy of Pediatrics discourages television or even video viewing (why do all of those Baby Einstein DVD's sell?) before the age of two, parents continue to have televisions and DVD's playing not only at home but in the car, while a child isin their stroller holding the portable DVD or iPhone with a video playing etc. I see this everywhere I go, even in the office exam rooms where we encourage reading a book while waiting, but many toddlers are adept at even turning on their own DVD. This study showed that each additional hour of TV exposure by the child (study children ages 2 months - 4 years) was associated with a decrease of 770 words (about 7%) that the child would hear from an adult during a recording session. Recording sessions were done on random days for up to 24 months during the study. Additionally, the additional hour of TV exposure was associated with a reduction in the number and length of vocalizations in the child. As pediatricians we are always concerned about language development, from the first babbles of a 2 -4 month old your-baby, to first words around 1, followed by putting words together at 15-24 months and then the sentences that 2-4 year olds use which become more complex with age. Could it be that in some children who have language delays that we should be inquiring about television exposure, even as background noise? Pulling out books and music to stimulate language may be old fashioned but seems to be the gold standard. That's your daily dose, we'll chat again tomorrow. Send your question or comment to Dr. Sue!

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