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Daily Dose

Diabetes On the Rise

1:30 to read

It is National Diabetes Awareness Month and unfortunately diabetes continues to be a growing problem among our nation’s children.  Did you know that every year there are over 25,000 children diagnosed with diabetes?  

 

To begin with there are two different types of childhood diabetes, type 1 and type 2 and while both cause an elevated blood sugar, they also differ in many ways.

 

Type 1 diabetes was formerly called juvenile onset diabetes and is typically diagnosed in children and adolescents. Only 5% of those with diabetes have type 1 diabetes. Many parents worry that their child may develop diabetes because they eat too much sugar…and while eating sugar is not good for you, it does not directly cause type 1 diabetes.  Type 1 diabetes is an autoimmune disease in which the immune system attacks and destroys the beta cells ( insulin producing cells)  of the pancreas. Scientists are not exactly sure why this occurs, but it seems to be a combination of genetic and environmental factors, and actually has nothing to do with diet. 

 

Type 1 diabetes comes on suddenly and causes dependence on insulin for the rest of the child’s life. The symptoms of type 1 diabetes usually include extreme thirst, frequent urination (day and night), increased appetite and sudden weight loss. Children who develop type 1 diabetes appear tired, thin and sick. I tell many a parent who worry that their child is diabetic, that they really cannot miss the symptoms and just drinking a lot of water will not be the only symptom. 

 

Fortunately, the ways in which insulin is given continues to improve and most children now use an insulin pump which delivers insulin in a more consistent manner than in previous years.  But, even with new insulin delivery systems and the hopes for pancreas transplants, type 1 diabetes is challenging for a family to manage. 

 

Type 2 diabetes which was previously called “non insulin dependent diabetes” differs in that it was previously typically diagnosed in adults, but it is now rising in children.  In type 2 diabetes the body isn’t able to use insulin in the right way and the glucose in the blood stream is less able to enter the cells. This is called insulin resistance.  So, the pancreas tries to produce even more insulin to keep blood sugar levels normal. Over many years the pancreas may wear out completely. Type 2 diabetes is sometimes controlled with an oral medication rather than insulin.

 

Type 2 diabetes seems to develop more frequently in those children who are overweight, less active and often have a parent with diabetes. As more children in this country have developed obesity, the number of cases of type 2 diabetes has also continued to rise.  In many cases if a child changes their lifestyle and eats a healthy diet, loses weight and exercises the body may be able to restore normal insulin balance. In this way type 2 diabetes differs from type 1 diabetes.

 

If you are concerned that your child is showing any signs of diabetes make sure to consult your doctor.  Continue to promote healthy eating habits and daily exercise for all children!

 

 

Daily Dose

Migraines in Children

1.15 to read

I received an email via our iPhone App inquiring about migraines in children. Headaches are a common complaint throughout childhood, but pediatricians have recognized that children have many different types of headaches which include migraine headaches. 

Migraine headaches are best diagnosed by obtaining a detailed history and then a thorough neurological exam. There are several characteristics of childhood migraines that are quite different than adult migraines. While adult females have a higher incidence of migraine headaches, males predominate in the childhood population. 

Childhood migraines often are shorter in duration than an adult migraine and are less often unilateral (one sided) than in adults. Only 25-60% of children will describe a unilateral headache while 75-90% of adults have unilateral pain.  Children do not typically have visual auras like adults, but may have a behavioral change with irritability, pallor, malaise or loss of appetite proceeding the headache.  About 18% of children describe migraine with an aura and another 13% may have migraines with and without auras at different times. When taking a history it is also important to ask about family history of migraines as migraine headaches seem to “run in families”. 

Children who develop migraines were also often noted to be “fussy” infants, and they also have an increased incidence of sleep disorders including night terrors and nightmares. Many parents and children also report a history of motion sickness. When children discuss their headaches they will often complain of feeling dizzy (but actually sounds more like being light headed than vertigo on further questioning). 

They may also complain of associated blurred vision, abdominal pain, nausea and vomiting, chills, sweating or even feeling feverish. A child with a migraine appears ill, uncomfortable and pale and will often have dark circles around their eyes. It seems that migraine headaches in childhood may be precipitated by hunger, lack of sleep as wells as stress. But stress for a child may be positive like being excited as well as typical negative stressors. 

Children will also tell you that their headaches are aggravated by physical activity (including going up and down stairs, carrying their backpack, or even just bending over). They also complain of photophobia (light sensitivity) and phonophobia (sensitive to noises) and typically a parent will report that their child goes to bed in a dark room or goes to sleep when experiencing these symptoms. 

Children with migraines do not watch TV or play video games during their headaches. They are quiet, and may not want to eat, and may just want to rest.  Nothing active typically “sounds” like fun. To meet the diagnostic criteria for childhood migraine, a child needs to have at least 5 of these “attacks” and a headache log is helpful as these headaches may occur randomly and it is difficult to remember what the headache was like or how long it lasted, without keeping a log. 

There are many new drugs that are available for treating child hood migraines and we will discuss that in another daily dose.  Stay tuned! 

Daily Dose

Parents Need To Take Concussions Seriously

Dr. Sue explains why parents need to take concussion seriously. They are a brain injury.I have blogged previously about the latest recommendations concerning concussions and restrictions on activity after sustaining a  concussion. This subject has been in the news a great deal lately, not only within the medical community, but also within the NFL and other major sports groups.

There is more and more data to show that concussions in and of themselves are dangerous, but that repetitive concussions may cause even greater damage to the brain, especially to the still developing brain of young athletes. I just saw an eleven year old boy who is a soccer play, actually, he is the goalie. He was at school, just playing around in the gym, when he sustained a concussion after running into another child head on and falling backwards.  The boy remembered falling, but shortly thereafter he became disoriented, could not take a test due to the fact that his memory was impaired, and subsequently vomited. His concerned parents brought him to my office to be evaluated.  By the time I saw him he was feeling better, and he had a normal neurological exam. Based upon the history of his injury he was diagnosed with a concussion.  Because of this he and his parents were advised that he not participate in sports for a minimum of a week.  Of course, as it would turn out,  his school soccer team was supposed to be in the State championship game in 48 hours.  Their team was 92 -0.  After much discussion and a conversation with his coach the parents we all agreed that he would not play. The following day, I received an email from his father who felt that his son was doing well and was “back to normal”.   He had been re-thinking the issue of his son not playing and wanted me to reconsider my instructions for his son not to play. He even noted that he himself had played college soccer and had often played after suffering a concussion.  He felt that if his son played (if he was absolutely needed to secure a win) and did not do “headers” that he would be okay. What was he thinking?  I don’t really think he was thinking about anything other than his son’s team winning a State championship. He seemed to have tunnel vision, and could not see that there would be many more soccer games in his son’s future, but another concussion could cause long term problems for his son.  So, I stood by my recommendation, for which his mother “thanked me”.  His team played the game and of course they lost. I felt terribly for their loss, but at the same time, knew that medically this was the appropriate decision. So many times, we as parents get so “wrapped up” in our children’s lives, whether it be in sports, academics or even having the “best” birthday party, that we lose sight of the “big picture”.  I see the” big picture” as trying to make the best decisions for our children, given the best information that we have to help make that decision. Many of those decisions may not be easy, but we as parents know they are right.  Whether that is keeping your child from playing a soccer game after suffering a concussion, or taking away a teen’s cell phone and computer privileges after they have been drinking under age.  There are so many of these difficult decisions and we all hope to make them correctly. This patients family did, and I am proud of them! That's your daily dose for today.  We'll chat again tomorrow! Send your question or comment to Dr. Sue!

Daily Dose

Happy Thanksgiving!

1:30 to read

This is the week that really kicks off the holiday season and for me it often begins with reflection.  I am often guilty of not appreciating the many blessings that I have, and rather focus on just getting through one day at a time. But as I reflect, I realize that I have so much to be grateful for and much of that gratitude is for my family.

When you are in the throes of parenting, I think it is sometimes hard to appreciate many of the blessings that we have as families. As parents we are anxious for the next stage, whether that is having a baby sleep through the night or wanting your child to talk, start school, begin to read, or finish their college applications. Parenting is so often about looking ahead rather than living in the moment.

It is sometimes hard to take a breath and sit on the floor and play with your baby, or let your elementary school child read you a book at bedtime, or enjoy editing your high school student’s next paper (why was that always a Sunday night at 9 pm event?).  But, from someone who has been there, sit back, take a breath, put down your electronics and appreciate whatever stage your child is in right now!  For this too shall pass...

Why not take a minute during Thanksgiving and ask each one of your children what they are thankful for, and write their answers down on a note card to file away to read years from now. It is fun to see their answers and how their gratitude changes with age....some of their answers are funny, others are quite thought provoking.

As our family grows, now with a granddaughter and a new daughter in law, I find myself trying to take my own advice. We are fortunate to be gathering together for Thanksgiving and I am going to “re-start” the tradition with their comments on paper... No more trying to remember what they said and no videos either. Just a note card that each of us will write on and a box to keep the cards in.  One day our adult children and their children can read all of these comments...and be thankful for family. 

Daily Dose

Marketing Healthy Foods to Kids

1:15 to read

The marketing of foods to children continues to be a hot topic.  As any parent knows…by the time your child is 3, 4 or 5 years old…they can often point to the box of sugary cereal with their favorite cartoon character on it, or identify a sign (McDonalds, Chic-Fil-A, Pizza) although they are not yet reading.  Companies are very clever when it comes to marketing…especially to children who drive a lot of consumer choices.

But, a recent article in Pediatrics shows how marketing may also drive healthy food choices. The study entitled, “Marketing Vegetable in Elementary School Cafeterias to Increase Uptake”, looked at the number of students who chose fresh vegetables from the salad bar at 10 elementary school cafeterias in a large school district over a six-week period.

The study included four different groups. In the first group the schools displayed vinyl banners with branded cartoon vegetable characters. These banners were then wrapped around the salad bar bases. The characters displayed “super human” strength related to eating vegetables (the Popeye of my generation - with his spinach).  The second group of schools showed short television segments which had vegetable characters delivering healthy nutritional advice. In the third group of schools both the salad bar banners and TV segments were used to promote healthy nutrition and food choices.  The fourth group was the control group and received no intervention.  The intervention schools also had decals with the vegetable characters placed on the floor which directed the children to the salad bars.

The results?  Nearly twice as many students ate vegetables from the salad bar when they were exposed to the banners.  More than 3 times as many students who were exposed to both banners and TV segments went to the salad bar (more girls than boys ). Interestingly, the marketing campaign also increased the number of students who chose a vegetable serving in the regular lunch line as well. 

So, it seems that branded marketing strategies may be used in a positive way to promote healthier food choices among young children.  Now we just have to get the advertisers to change some of their branded messaging aimed at young children from the “junk” to the healthy foods, as we have data to show that kids will choose good foods…especially if their super heroes like it too!

Daily Dose

Gassy Baby? No Problem!

1:30 to read

So you are home from the hospital with your newborn baby and suddenly you realize that the babies you see on TV never cry -  but your newborn is not reading the same script.  All babies have some fussy times, and this is especially true of a newborn in the first few months of life.  While a “typical” baby cries for a total of  3-4 hours a day, there are other babies that seem to be more difficult.  

 

Besides praying for an easy baby it seems to be luck of the draw and you don’t get to pick your baby’s temperament. In many of the cases of an “irritable” infant parents point to the fact that their baby acts uncomfortable and will frequently pass gas or draw up their legs or arch their backs as if something “hurts”.   

 

Your newborn’s tummy and intestines are just as “new” as they are and early on it may be more difficult for some babies to digest breast milk or formula.  In this case pediatricians often try to make changes in a breast feeding mother’s diet (taking out dairy), or changing a formula to a lactose free formula to see if that helps a baby to be more comfortable and less fussy. There are also “elemental formulas” that may be tried for extremely fussy babies. Discuss this with your own pediatrician.

 

Little tummies do make a lot of gas (you hear those toots all of the time) and I often recommend a trial of Little Remedies Gas Relief Drops® which contain simethicone (to help break up gas bubbles). These drops are especially made for infants and do not contain any alcohol, preservatives or dyes.  You can try using the gas drops after your baby has been fed as well as at bed time. 

 

Colic is defined as crying that occurs in an infant for at least 3 hours a day, for 3 days a week, for at least 3 weeks.  Colic typically “rears its angry head” after a baby is 3 -4 weeks of age.  For those irritable, colicky babies (I had one and you will know) I also like to try Little Remedies Gripe Water which is made with ginger and fennel, herbs that have been shown to help relax the  smooth muscle of the intestine.  Again, these drops do not contain any alcohol….which is very important. 

 

I also recommend swaddling and a pacifier for “non- nutritive” sucking to help calm a crying baby.  Many babies also like being on their tummies (tummy time is important developmentally as well) when they are fussy, and you can even massage their backs as well. Remember, even if tempted,  NEVER let your baby sleep on their tummy, even if you are in the room!! Backs to sleep only.

 

Babies also seem to like motion to calm them so holding your baby and rocking or swaying may help decrease crying. A walk in the stroller is sometimes another great way to get a fussy baby to settle down. Fresh air is good for both parent and child!

 

Daily Dose

What Are Breast Buds?

1.15 to read

I received a phone call today from a mother who was worried about the “bump” beneath her 12 year old daughter’s nipple. I do get this phone call quite often and even see mothers and daughters in the office who are concerned about this lump?  First thought is often, “is this breast cancer?”  The answer is a resounding “NO” but rather a breast bud.  While all mothers developed their own breast buds in years past, many have either forgotten or suppressed the memory of early puberty and breast budding.

Breast buds are small lumps the size of a blueberry or marble that “erupt” directly beneath a young girl’s areola and nipple. Most girls experience breast budding somewhere around 10-12 years of age although it may happen a bit sooner or even later. It is one of the early signs of puberty and estrogen effects.

Many girls will complain that the nipple area is sore and tender and that they are lopsided!! It is not unusual for one side to “sprout” before the other. Sometimes one breast will bud and the other is months behind. All of this is normal. 

While a lump in the breast is concerning in women reassure your daughter that this is not breast cancer (happy that they are so aware) but a normal part of body changes that happen to all girls as they enter adolescence.   Breast budding does not mean that their period is around the corner either, and periods usually start at least 2 years after breast budding (often longer).

Breast buds have also been known to come and go, again not to worry. But at some point the budding will actually progress to breast development and the continuing changes of the breast during puberty.

Reassurance is really all you need and if your daughter is self-conscious this is a good time to start them wearing a light camisole of “sports bra.”  

Daily Dose

Stop Debate Over HPV Vaccine

2.10 to read

I have been receiving a lot of calls, emails and questions on twitter regarding Michael Douglas' admission that his oral cancer was caused by HPV.  

If you have an adolescent, I am hopeful that your own doctor has already discussed the prevalence of STD’s among the adolescent and young adult population with both you and your tween/teen/young adult.  If not, you need to know that HPV infection is one of the most common sexually transmitted diseases, with over 6,200,000 new cases annually with the peak rates of infection occurring in women 25 years and younger. 

HPV is what doctors would call, “a bad player”.  There are over 100 serotypes of this virus, and you often don’t even know you have it before you have passed it on to someone else.

Some HPV serotypes also cause cancer, and researchers are realizing that it doesn’t just cause cervical cancer, but vaginal, vulvar, penile, rectal and oral-pharyngeal cancers (mouth, tongue, tonsils).

When Harald Zur Hausen was awarded the 2008 Nobel Prize in medicine it was for the research he had done in the 1970’s and 1980’s that identified HPV (specifically types 16 and 18) as the most common cause of cervical cancer. (side note: read “The Immortal Life of Henrietta Lacks”).  Hausen’s discovery enabled other brilliant scientists to develop the FIRST anti-cancer vaccine against HPV.  The first HPV vaccine was released in the United States in 2005. 

With all of this background , I cannot comprehend why there is any debate surrounding the HPV vaccine. The comment that the HPV vaccine is dangerous and can cause mental retardation is unfounded.

As stated in a press release by the AAP, “there is no scientific validity to this statement.” Since the vaccine has been introduced worldwide there have been more that 35 million doses given with an excellent safety record. Anyone can go to the CDC website to look up safety information on any given vaccine, so do some research. You should also know that doctors, as well as patients are reporting any adverse events related to a vaccine and this ongoing monitoring (post-marketing surveillance) continues to ensure the safety of a vaccine even after it has been approved.  

Lastly, the reason that the vaccine is given at age 11-12 (approved down to age 9) is two- fold. You want to give the vaccine PRIOR to exposure to the virus, and unfortunately studies continue to show that some teens are engaging in sexual activity, which is not only sexual intercourse, at very young ages.

The vaccine prevents infection with certain HPV serotypes, but it does NOT treat HPV. Secondly, the vaccine produces a robust immune response in this age group to provide excellent protection. In other words, more bang for your buck!

More and more studies are being done on HPV, with exciting new data about disease reduction being shown in other countries where the vaccine has been given even longer. There couldn’t be better news, the vaccine is working if we give it!

Keep talking to your adolescent about STD’s.  Discuss abstinence, condoms, teen pregnancy, and any other information they need to be well informed so that they make good choices as they go through their adolescent and young adult years. At the same time, get both girls and boys their HPV vaccines, it might just save their life.  

Has your daughter or son received their HPV vaccine? I would love to hear from you!

Daily Dose

Dealing with Warts

1.30 to read

Warts are one of the most common skin lesions seen in pediatric practices. Warts also drive parents and some kids crazy!  According to one study up to about 1/3 of school children have warts.  

Warts are viral infections of the skin which are caused by human papilloma viruses (HPV).  There are more than 100 types of HPV and different types of HPV cause different types of warts. The most common warts on hands and knees are caused by HPV types 1,4, 27, 57.  These are not the HPV types that cause sexually transmitted infections 

Some people seem to be more prone to getting warts than others, and it is not uncommon to see several children in one family dealing with warts. The HPV virus is spread through skin to skin contact or through contaminated objects or surfaces. In other words, they are hard to prevent.  HPV can also have a long incubation period, so when parents ask, “Where and when did my child get this wart virus?”, my answer is typically, “not even the CIA will be able to tell you that”.  

I many cases if the warts are left alone they may resolve on their own in months to years (one study showed two thirds remission in 2 years) ......but with that being said, most teens (especially girls) want those warts to “be gone!” 

There are several different ways to treat warts and one of the most effective is with over the counter (OTC) products that contain salicylic acid.  Salicylic acid acts as an irritant that activates an immune response against HPV.  There are tons of different OTC products and in many studies there was not one product that proved superiority over another, so I would buy an “on sale” salicylic acid for starters. I know from using these on my own children that you have to be consistent and persistent in their use....but it did work. 

If OTC products don’t seem to be working the next step for those who are determined to try and get rid of the wart,  is to head to the doctor who may try freezing the wart with liquid nitrogen or using cantharidin.  Unfortunately, there is typically a little pain involved with these products. 

Like so many other things, sometimes it may pay to just to wait it out and see if the virus just gives up and goes away!

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