Daily Dose

Your Child's Well Check

2.00 to read

From the moment your baby is born until you send them off to college, your child will be seeing his/her pediatrician for “well child check-ups”. These are regularly scheduled visits which occur quite frequently when you have a baby or toddler and become a yearly visit once your child is over the age of 3. The well child visit is an extremely important part of a pediatrician’s job, and is also your child’s medical home.

In fact, one of the most rewarding aspects of being a pediatrician is having the privilege to observe a child from birth through their teens, in a sense, “helping to raise them”. Therein lays the reason for check-ups.

When you see your pediatrician for a check-up, I’m sure you get your child’s weight, height, BMI, (and blood pressure once they are older), as well as their growth percentiles.

The doctor also does a physical exam on your child, which is hopefully all normal. But there is a lot more than that to your visit. This is the time for your doctor to discuss your child’s milestones; whether that is sitting up for the first time, first words or how they are performing in first grade.  These conversations continue for all of your child’s school years as well.

It is also the time to discuss multiple other topics which should include sleep habits, nutrition and safety which is pertinent to all age groups. As your child gets older the conversation should include discussions about school performance, bullying, studying, screen time, family meals, exercise, and the child’s interests.

For the teen patient I think it is important to discuss sexuality, peer pressures, driving, and the adolescent’s long term goals.  The list goes on and on, but certain topics should certainly be yearly discussions which are then tailored to the age of the child.

 As a child gets older it is important to have some time where the doctor may be alone with the adolescent who may want some “private time” with the doctor. It is equally important that the exam includes time spent with the both the parent and the adolescent to wrap up the check up and answer any questions that a parent may have had that their adolescent did not.

For my patients 18 and older, I find that many times their parents do not come for their check-ups as the relationship has now become a bit more about a young adult with their doctor. Everyone is different and there is not a “right” way to handle the adolescent, but it is more important to have an open rapport and conversation between patient and doctor.

Lastly, every check-up should have time for questions. It is helpful if parents have a list of questions ready for the doctor.  Young parents often have simple questions as they are new parents. So, they often start off with “I think this is a stupid question…” but, there is not a “dumb” question as they have never been parents before.  For parents with older children the questions are often more lengthy and may even require another visit or phone call to follow-up or complete the conversation.  In either case, the check-up is the place for questions.

I really enjoy my patient’s check-ups and continue to realize the importance of the well child exam and the doctor-patient relationship. Don’t miss them.

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

Daily Dose

Dangers of Texting While Driving

I was watching the news the other evening (not the same as morning news surfing while on the treadmill) and there was a news segment on texting while driving.

We have discussed this issue on the radio show several times. The data surrounding accidents occurring secondarily to texting while driving becomes more alarming each day. In this segment they showed a public service announcement (PSA) that had been shown in Great Britain, which was produced to show the dangers of texting while driving. The introduction talked about risks of accidents while texting while also discussing how texting is as dangerous, if not more, than drinking and driving. They then showed a clip, which was produced to show teens in a car talking together, while at the same time texting other friends. The simulated PSA then goes on to show the driver being distracted as she answers a text and the ensuing accident involving multiple vehicles. This piece then shows the girls in the car (remember it is a re-enactment, also in slow motion at times) as they are hitting the other cars, being thrown about inside their car. It is so difficult to watch as the girls are catapulted inside the car, into one another, as well as into the windshield and dashboard, and there is blood everywhere. As the piece closes, all of the cars come to a stop and the girls are shown. They slowly realize that they have been in an accident and one of their friends is dead. The entire segment probably lasted no more than a minute, but it may have been one of the most difficult 60 seconds to watch, as it is many parents’ nightmare! This PSA is not being shown in the U.S. and some parents may think it is too graphic to show to their children. In my opinion, any teen that has a phone and a driver’s permit/license should be required to watch this, and younger teens may need to watch this too.  There have been fatal accidents involving trains, and buses all secondary to the driver texting while on the job. The statistics continue to show an alarming number of accidents due to driver inattention due to texting. My son has a friend whose precious sister was recently killed in an accident that is thought to be due to the fact that she was texting while driving. There were no drugs, or alcohol and she had on her seat belt. It occurred on a beautiful morning without rain or fog but she crossed the median while driving. The rest of the story is tragic. We have all become addicted to our phones, and Blackberry’s. There is NOTHING so important that it cannot wait until we have stopped the car. Not a business meeting, call from home or teen party or rendezvous that needs to be instantly answered. The only job we need to have while driving is to focus on driving. I am continually reminding myself of this, as I feel my Blackberry vibrate while I drive. I have to resist the urge to look. Maybe it is better to just turn it off while in the car. We all managed to function without instant communication for a long time.  Life went on. If you haven’t seen this, watch it with your teens. Make a point of reiterating the dangers of texting while driving. Have them turn off their phones in the car. It is too bad we can’t have a device that will turn the phones off when we start the car, and make us ALL resist the urge to be in constant communication. Turn on the music; it is less distracting than a phone! That’s your daily dose, we’ll chat again tomorrow.

More Information: Public Service Announcement (WARNING: This is a dramatization, containing realistic graphic material)

Daily Dose

New Year New You

1:30 to read

With the New Year upon us what better time to talk about changing some habits.  Why is it that habits are certainly easy to acquire, but difficult to change?  I just saw a book on The New York Times Bestseller list about “Habits” and I am committed to reading it this year.  

I know that we started many “bad” habits when my husband and I were new parents, and I talk to my patients every day about not doing the same things I did.....but, even with that knowledge there are several recurrent habits that I wish parents would try to change....or better yet, don’t start.

Here you go!

#1  Do not have your baby/child sleep with you  (unless they are sick).  This is a recurrent theme in my practice and the conversation typically starts when a parent complains that “I am not getting enough sleep, my child wakes me up all night long”.  Whether that means getting in the habit of breast feeding your child all night long, or having your two year old “refuse” to go to sleep without you...children need to be independent sleepers. Some children are born to be good sleepers while others require “learning” to sleep, but either way your child needs to know how to sleep alone. I promise you...their college roommate will one day thank you.

#2  Poor eating habits.  Family meals are a must and healthy eating starts with parents (do you see a recurrent theme?). I still have parents, with 2, 3 or 4 children who are “short order cooks” which means they make a different meal for everyone.  Who even has the time?  Sounds exhausting!!  Even cooking 2 meals (breakfast, dinner) a day for a family is hard to do for 20 years, but enabling your children to have poor eating habits by only serving “their 4 favorite foods- is setting them up for a lifetime of picky and typically unhealthy eating.  Start serving one nutritious family dinner and let everyone have one night a week to help select the meal. Beyond that, everyone eats the same thing.  Easy!  If they are hungry they will eat.

#3  No electronics in your child’s room. If you start this habit from the beginning it will be easy....if you have a TV in your child’s room when they are 6-8, good luck taking it out when they are 13-15.  First TV in their room should be in a college dorm.  For older children make sure that you are docking their electronics outside of their rooms for the night. Everyone will sleep better!

These may sound easy....so give it a try.  

Happy New Year!



Daily Dose

How Much Sleep?

With school back in session I keep hearing “how much sleep does my child, tween or teen need?”

With school back in session I keep hearing “how much sleep does my child, tween or teen need?” The answer is probably more than you think. Elementary age kids still need 10 to 11 hours of sleep a night, while those teens need about 8.5 hours. With all of the activities after school and then the homework load I often hear, “there just isn’t enough time to get to bed on time”. But more important than soccer, piano, or dance etc. is a good night’s sleep.

Insufficient sleep has been correlated with a multitude of issues from focusing and overall school performance, to obesity and even to further sleep related problems. But parents must believe in the importance of sleep to keep their kids on the right track. Sometimes that means dropping an after school activity in order to fit in homework, family dinner and a little wind down time before bed. It may be a tough to enforce, but one of the best parts of the day is bedtime! That’s your daily dose. We’ll chat tomorrow!

Daily Dose

Chicken Pox is Going Around

1.15 to read

Do you remember having chickenpox when you were a child, or do you remember your children having chickenpox? Chickenpox is a viral illness caused by Varicella Zoster (VZV) which occurs most commonly in children under the age of 12 years. Since the introduction of the varicella vaccine in the 1990’s, the incidence of chickenpox in the United States has dropped dramatically.  

Children receive the varicella vaccine at both 1 and 4 years of age.  It is not  given before that time as it was not shown to be as effective.  Because of the success of the vaccine chickenpox is no longer a “common” childhood illness. In fact, many young doctors may not remember having chickenpox as a child themselves and they may have never seen a case in their practice.

I was recently shown a picture of one of my own patient’s nephew who had been sick with a “funny” rash. He is 3 months old and has had his first set of vaccines.  The baby was seen by 2 different doctors at urgent care centers before being seen by his own pediatrician. He was initially told that he had coxsackie virus (hand,foot and mouth) but the rash had started on his chest and was spreading to his face, arms and legs.The story and the rash were not consistent with HFM disease. When his own doctor saw him he immediately told the mother that this was chickenpox...in fact, pretty classic chickenpox. He had also unknowingly exposed a lot of other people to the illness. 

Infants under the age of 1 are not yet vaccinated and may be exposed to chickenpox without every knowing they came into contact with someone who may have just started breaking out. You may not realize that the few bumps on your child’s chest are early chickenpox, and since the virus is spread via airborne droplets (cough, sneeze, breath) the virus is already being spread. It is not that anyone “wants” to expose someone to chickenpox or any other illness, but in many cases you may be contagious before you realize you are sick.

So, if your child gets a “weird” rash that begins on the trunk as small red bumps and then continues to spread up and out (face, arms, legs) and bumps develop into small blisters then crust over, you still need to think about chickenpox....but you may need to get the “older” doctor in the practice to confirm the diagnosis.  

Daily Dose

Sunscreen Apps!

1.15 to read

Have you vacationed this summer and if so wherever you go you have probably had some sun exposure? Whether you are at the beach, in the mountains or out sightseeing it is important to make sure you are using sunscreen on a regular basis and that means all of the kids as well.

I am happy that I find more and more of my patients and their parents using sunscreen on a regular basis.  At this time of year it is a good idea to apply a liberal amount of sunscreen on your child to just start off the day.  I would always use a SPF of at least 30. Again, this is just for a normal day as your child may be in and out of the house, or on the playground at day camp, or day care.  Remember, this is just the “base” coat, and not enough for prolonged sun exposure.

While I was planning on some sun exposure during vacationing I came across an article about different apps that are available to help you calculate how much sun exposure you are getting and the risk of sunburn as well. Who knew how many different ones were available?  

You can use these apps and actually type in your location and your child’s skin type and then they calculate how long you can be in the sun. The apps also recommend sunscreen strengths as well.  Some of the apps actually have a timer to remind you how much longer you can be in the sun and when to reapply sunscreen.  How clever is this to use, especially for a teen who is spending the day at the lake and never seems to “remember” to reapply sunscreen.

I have decided that I am going to download a few of these apps and try them out over the next several weeks and see what I think.

Bottom line....keep re-applying sunscreen for any lengthy sun exposure...you don’t need an app for that advice.  

Daily Dose

Treating Impetigo

1.00 to read

Mosquitoes are out in full force and while we are seeing higher than normal cases of West Nile Virus (WNV) in many states, we pediatricians are more often diagnosing impetigo secondary to bug bites, than a case of WNV (thank goodness!). 

Those pesky mosquito bites, or any other type of insect bite (hopefully you are applying bug spray to your kids as well) just scream for a child to scratch them. With scratching comes abrasion to the surface of the skin and those little fingers (even if washed) harbor bacteria that can penetrate the breaks in the skin and set up an infection.  Once those fingers go on to scratch yet another bite the infection can be moved from place to place (the name for the spread of the infection by the fingers is auto-inoculation) and before you know it you see several to many little inflamed, honey crusted, weeping lesions on the skin surface. This is classic impetigo (not INFANTIGO as some like to call it). 

Impetigo is typically caused by the bacteria staph or strep and even frequently washed hands harbor bacteria.  If you notice one or two bites that are looking inflamed and “weepy” it may just take a prescription antibiotic ointment to treat the infection. 

In some cases the area of infection involves multiple areas on the face, arms, legs, and buttocks (where kids typically pick and scratch) and your doctor may want to prescribe an oral antibiotic to treat the infection. 

The best treatment is always prevention, so continue to use insect repellant appropriately, trim those fingernails, discourage scratching and picking and use an antibacterial soap for bathing. If you see an area looking like it is getting infected treat it early and you may be able to avoid taking an oral antibiotic.

Daily Dose

Difference in Temperaments in Twins

It seems that recently I have been seeing quite a few new infant twins and also my first set of triplets. It is great fun for me as their pediatrician, but I can only imagine what it is like to bring two or three babies home from the hospital and into their “new” home.

My husband and I had quite a bit of adjusting to do with the addition of one baby at a time, to total three!! But, one of the most interesting things to me as a doctor/mother is the differences that infants have in temperament. Even with a twin or a triplet, knowing that the babies had the “same” intra-uterine experience, and usually relatively the same delivery, they may have such different personalities and temperaments. I can often see this even in the first few days in the nursery, but it becomes more evident in the first several weeks. Parents of “multiples” will often comment that “twin A’ seems easier to settle, or “twin B” is more alert, but more difficult to console. Now with the new triplets, these parents are also acutely aware of the differences in their baby’s personalities, some of which may be due to gender (there are two boys who are identical, and a girl). As often as we parents say, “don’t compare your children”, how can you not compare children born on the same day and within minutes of one another? Parents are always marking milestones including the first smile, first time to sleep through the night, first time to roll, and so on and so on.  Now think about having two or three babies and someone does something before the others. Does that mean that that child is a “genius” or are the others “slow”? What if the one that smiles first is also the most “difficult” of the infants in terms of calming and soothing, is that indicative of a problem? It just amazes me that these parents don’t come in with more stories like that. It is also hard to “understand” that what you do for one baby to get them to sleep is exactly the opposite of what the other one likes. All of these little nuances show up very early and will most likely continue throughout their childhood. In other words, it seems to me that we are really born with some genetic temperament, that are then molded by our experiences. Even when twins or triplets seem to have the “same” experiences they are often very different. This difference is really seen in fraternal twins or triplets who are given the same toys to play with, but will play with them in a completely different way, especially by gender. As one mother of multiples said to me, “if you think I have time to show them how to play differently you are crazy!” they just do it! The little girl takes the blocks and quietly builds a tower, while her brother knocks his blocks down as quickly as he stacks them. Watching these children is like a child development course for me as their pediatrician, so fascinating. Genetics and how that may affect our innate personality is quite fascinating, and is even more pronounced in twins and triplets. It must be great fun to watch that unfold, but I really hear more about their sleep habits and differences in the early days, than who smiled first! Sleep is the great equalizer. That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

The Difference Between A Viral Sore Throat & Strep Throat

It only takes getting the kids back in school for the pediatrician’s office to see an upswing in illness. But this year it came on particularly early and we are definitely seeing more illness in the first week of fall than is typical.

Most of the illness being reported around the country is due to Influenza A, H1N1 (swine flu) and the majority of cases seem to be occurring in the five to 24 year old age group, in other words the school aged, elementary through college aged kids. To review again, flu like symptoms for all influenza strains are typically similar with fever, sore throat, cough, congestion, headaches and body aches. Occasionally there may be some nausea or vomiting but that is not seen as often. Flu like symptoms seem to begin with general malaise and then develop over the next 12 – 24 hours and you just feel miserable. Some of the confusion now is about sore throats and the difference between a sore throat with the flu, which is due to a viral infection, and strep throat, which is a bacterial infection. As for most things in life, nothing is 100 percent and the same goes for viral and bacterial sore throats. But, with that being said, there are certain things that might make a parent think more about a viral sore throat than strep throat and vice versa. Viral sore throats, which we are seeing a ton of with the flu right now, are typically associated with other viral symptoms which include cough, and upper respiratory symptoms like congestion or runny nose. A viral sore throat may or may not be accompanied by a fever. In the case of flu, there is usually a fever over 100 degrees. With a viral sore throat you often do not see swollen lymph nodes in the neck (feel along the jaw line) and it doesn’t hurt to palpate the neck. If you can get your child to open their mouth and say “AHHH” you can see the back of their throat and their tonsils, and despite your child having pain, the tonsils do not really look red, inflamed or “pussy”. Even though it hurts every time you swallow, to look at the throat really is not very impressive. Strep throat on the other hand, typically occurs in winter and spring (that is when we see widespread strep), but there are always some strep throats lurking in the community, so it is not unusual to hear that “so and so” has strep, but you don’t hear a lot of that right now. As we get into winter there will be a lot more strep throat. Strep throat most often affects the school-aged child from five to 15 years. Children get a sudden sore throat, usually have fever, and do not typically have other upper respiratory symptoms (cough, congestion). This is another opportunity to feel your child’s neck and see if their lymph nodes are swollen, as strep usually gives you large tender nodes along the jaw line. When you look at the throats of kids with strep they usually have big, red, beefy tonsils (looks like raw meat) and may have red dots (called petechia) on the roof of the mouth. The throat just looks “angry”. Sometimes a child will complain of headache and abdominal pain with strep throat. Some children vomit with strep throat. The only way to confirm strep throat, again, a bacterial infection, is to do a swab of the back of the throat to detect the presence of the bacteria. There are both rapid strep tests and overnight cultures for strep. Most doctors use the rapid strep test in their offices. If your child is found to have strep throat they will be treated with an antibiotic that they will take for 10 days. Again, antibiotics are not useful for a viral sore throat and that is why strep tests are performed. I’m sure we’ll talk more about sore throats as we get into winter. But in the meantime, get those flashlights out and start looking at throats. That’s your daily dose, we’ll chat again tomorrow.


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