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Daily Dose

Teaching Kids Morals & Values

1.30 to read

This is the time of year we all become very reflective, even my young patients. I love to ask them what the holiday season means to them.  Some are about “wanting” while some about “giving”. 

During a recent office visit, I was having a discussion with the mother of young patients of mine.   She and her husband had been talking about “giving rather than receiving” and how to begin to instill those values in their children.

Their children were getting to the age where they wanted an allowance for doing chores: making their beds or setting the table.  They decided to start giving their kids $1 a week for allowance.  

At the same time, they set up three different “banks” for their children with jars which were labeled: SPEND, SAVE, GIVE.  Each week, their children got to decide how to divide up their dollar, with the caveat that some amount had to go in each jar. (The parents were also clever in that they gave them the dollar in coins).

This mother was commenting on how her children were already understanding the concept of giving and saving, while at the same time learning how much to spend. She found it interesting to listen to her children’s comments while they each wrangled with how to divide up the money.  She also noted how their different personalities played into the dividing the funds. She found that their reasoning changed each week.

As Christmas and Hanukah drew closer, her children were putting more money in the GIVING jar and talking about why, as well as what, they wanted to do that money.  Each of the children had specific ideas of how to GIVE their money and to whom.

I love this idea and think that it is such a clever way to start teaching children about how we all have to “divide” up our money. It doesn’t matter what amount you start with or what age children you have, it works for all!  Teaching the basic premise of money management with SPEND, SAVE, GIVE is a lesson for all and what better time of year to discussing GIVING.  

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

Daily Dose

Wash Your Hands to Stop Illnesses

1.00 to read

Happy Handwashing Day! Yes, today is Global Handwashing Day and it’s the 5th year that this day has been celebrated on October 15th.  While most people are aware of the importance of washing their hands, very few people use both soap and water which is the MOST effective way to remove bacteria. 

Handwashing with soap is such an important way to prevent disease transmission, especially for children under the age of 5.  Diarrheal diseases and respiratory diseases are the top two killers of children around the world (over 2 million children around the world die from these diseases each year). 

Simple handwashing with soap and water can prevent the spread of disease and decrease the number of children who will get sick. This is true in both developed and underdeveloped countries and is an inexpensive and reliable way to prevent disease transmission. 

Handwashing with soap could reduce the incidence of diarrhea by 30% and respiratory infections by 21% in children under the age of 5 years. 

So, as we approach the peak time of year for both respiratory and diarrheal disease in the United States, let’s all pull out the soap and remember to wash your hands!  Set an example for everyone especially your kids and teach then all about good handwashing and the importance of using soap and water. 

Remember to tell your kids to sing the ‘Happy Birthday” song as they wash.  That’s about as long as you need to scrub away most germs.

Daily Dose

When Bug Bites Get Infected

1.00 to read

It is the season for bug bites and and I am seeing a lot of parents who are bringing their children in for me to look at all sorts of insect bites. I am not always sure if the bite is due to a mosquito, flea or biting flies, but some of them can cause fairly large reactions. 

The immediate reaction to an insect bite usually occurs in 10-15 minutes after bitten, with local swelling and itching and may disappear in an hour or less. A delayed reaction may appear in 12-24 hours with the development of an itchy red bump which may persist for days to weeks.  This is the reason that some people do not always remember being bitten while they were outside, but the following day may show up with bites all over their arms, legs or chest, depending on what part of the body had been exposed. 

Large local reactions to mosquito bites are very common in children. For some reason, it seems to me that “baby fat” reacts with larger reactions than those bites on older kids and adults. (no science, just anecdote). Toddlers often have itchy, red, warm swellings which occur within minutes of the bites. 

Some of these will go on to develop bruising and even spontaneous blistering 2-6 hours after being bitten. These bites may persist for days to weeks, so in theory, those little chubby legs may be affected for most of the summer. 

Severe local reactions are called “skeeter syndrome” and occur within hours of being bitten and may involve swelling of an entire body part such as the hand, face or an extremity. These are often misdiagnosed as cellulitis, but with a good history of the symptoms  (the rapidity with which the area developed redness, swelling, warmth to touch and tenderness) you can distinguish large local reactions from infection.

Systemic reactions to mosquito bites including generalized hives, swelling of the lips and mouth, nausea, vomiting and wheezing have been reported due to a true allergy to the mosquito salivary proteins, but are extremely rare. 

The treatment of local reactions to bites involves the use of topical anti-itching preparations like Calamine lotion, Sarna lotion and Dommeboro soaks.  This may be supplemented by topical steroid creams (either over the counter of prescription) to help with itching and discomfort. 

An oral antihistamine (Benadryl) may also reduce some of the swelling and itching. Do not use topical antihistamines. Try to prevent secondary infection (from scratching and picking) by using antibacterial soaps, trimming fingernails and applying an antibiotic cream (polysporin) to open bites. 

Due to an exceptionally warm winter throughout the country the mosquito population seems to be especially prolific. The best treatment is prevention!! Before going outside use a DEET preparation in children over the age of six months, and use the lowest concentration that is effective.  Mosquito netting may be used for infants in strollers.  Remember, do not reapply bug spray like you would sunscreen. 

Daily Dose

Reflective Gear for Baby

1.15 to read

I was driving home from work the other night…it was a beautiful spring evening.  The sun had already set and it was already dark. I was in my neighborhood, which I must say is not well lit, but it is a neighborhood   Our neighborhood does not have sidewalks, so people (who are out for an evening walk) usually do so in the street.  We’re all familiar with each other, so most of us are good about slowing down and watching out for pedestrians. 

So, I came upon a young couple strolling with their baby in a stroller. They were all dressed in black, and the stroller was black as well. I suddenly realized that they were right in front of me on the side of the road. I could not see them at all until I was right on top of them!! Scary. 

This made me think about taking a walk with a baby in a stroller. Or actually, strolling at dusk or night at all. All of the strollers that I typically see in my office are dark in color. I wonder if they have any reflective stripes or coverings on them at all? Certainly, the one I saw the other night did not have any markings that reflected as my headlights scanned the road. 

On top of that, both parents were dressed in dark sweat clothes, and they to did not have on any reflective “gear” at all either. They were a family of three, 2 walking, one in a stroller and they appeared as a dark blur. 

I guess the point of this is that your child’s stroller should have reflective tape or something (I see a great marketing idea here) on it. If you (mom or dad) go out for a night time stroll, don’t wear dark colors and wear reflective gear. The more markings the better!  Safety is paramount and being seen is the most important part of being a pedestrian. 

Being an early morning walker myself, often before dawn, I am now the proud owner of a reflective vest and arms bands for my early morning walks. Lesson learned for me as well. 

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

Daily Dose

Kids Should Drink Milk, Even If It Is Chocolate

2.00 to read

I have always be a huge advocate of children drinking milk. From the time “my” babies go from breast or formula to milk at the age of one year, I discuss the need for dairy products to ensure adequate calcium and Vitamin D in a child’s diet.I have always been a huge advocate of children drinking milk. From the time “my” babies go from breast or formula to milk at the age of one year, I discuss the need for dairy products to ensure adequate calcium and Vitamin D in a child’s diet.

It is easy to have children drink milk when they are toddlers, but as children get older and decide that they “prefer” water or even juices or soft drinks it may be harder to get them to choose milk. Unfortunately, once a child enters the “real” world with school and sports, they realize that there are other beverages offered besides milk. So, what to do?  Well, I think it is preferable to have children and adolescents continue to drink milk, even if it means having chocolate or strawberry milk. There have actually been studies in the pediatric literature that have shown it is preferable to have a few extra calories from the sweetener in flavored milks, than to forgo drinking milk. Like many things, it is a trade off. It is difficult to provide a child’s daily calcium and vitamin requirements without having several glasses of milk a day as well as other dairy products. When looking at the calorie content for low fat chocolate milk compared to low fat milk we are only talking about 30 – 50 calorie difference per cup of milk (it seems to depend on the brand). I know that the calories may be cumulative, but if you take away a sugary cereal in the morning, or that after school fast food, the calorie difference would never be noticed. One could also argue that if we our children spent more time playing outside rather than on their play stations or computers, the extra calories from chocolate milk would never be noticed. Bottom line, it’s all about choices. Over the years I have also found that many children want to drink chocolate milk for the short-term and then will come back to regular white milk. If they continue to drink milk throughout their childhood they are also more likely to drink milk as young adults, which is still an important time for “banking calcium”. Bone health and many of the exciting new studies regarding vitamin D continue to outweigh the debate about calories. I really don’t think that my overweight patients are getting their extra calories from milk, but rather cookies, fast foods, and soft drinks. I wish milk was the culprit. Lastly, I did have chocolate milk in our house, but if you are really worried about the calories, I have been known to “dilute” chocolate milk with white milk and it is still chocolate. There are lots of little things like that we can do as parents and it seems to work well for everyone. I will have other Mommy secrets later; remind me about trying that with cereals. That’s your daily dose, we’ll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

Leaving Children in a Hot Car

21 deaths have been attributed to children left in a hot car. What every parent needs to know. It is SO HOT in many areas of the country and summer is just beginning. With extreme heat comes the concern for vehicular heatstroke among children who may be (inadvertently) left inside of a car.

One wonders how that could possibly happen, but in 2010 there were 49 deaths of children who were found inside of cars, and already in 2011 there are 23 deaths being reported. We continue to see record setting temperatures and there is plenty of summer still ahead. I'm writing this hoping that this tragedy can be averted. As busy as parents are these days, it is still hard to fathom how a child can be left (usually in the back seat) inside of a parked car. With a sleeping child in a car seat, and a busy parent heading to work,  a meeting or even the grocery store, a parent may just “forget” that their child is with them. No noise, no reminder and the car is locked and left for minutes, hours or even the day, before someone returns to find the child who has succumbed to heat stroke. Horrific but true. A child’s thermoregulatory system is different than adults and their body temperatures may warm at a rate 3-5 times faster than that of an adult. This means that even several minutes inside of a hot car (even with the windows cracked) may cause heatstroke and ultimately death. Remember that these deaths are due to hyperthermia and this different than 104 degree fever in a child with a viral illness. Fever and hyperthermia are NOT synonymous terms. Heatstroke is a medical emergency.  If you ever come upon a child who has been left inside of a car, not only should you try to locate the driver of the car, but at the same time call 911. Minutes may matter when trying to resuscitate a victim of heatstroke. If the child is unresponsive begin CPR while waiting for the paramedics. How can a parent be reminded that they have left a child in the car?  When routines change it seems accidents may happen. A different parent dropping off at day care, or taking a different route to work may be to blame as 51% of these deaths occurred when a child was forgotten in the car. Make sure to leave yourself a reminder that you have your child in the back seat. Put the child’s toy or stuffed animal in the front seat to remind you that your child is there. At the same time leave your purse, car keys, cell phone, or briefcase in the back seat. By doing this you will immediately look in the back seat before locking and leaving the car. A rear facing car seat (now recommended until age 2 years), may not allow you to visualize your child when glancing in the rear seat. Checking the back seat before locking the door should become a habit for every parent. Lastly, 30% of vehicular heat strokes occurred when a child had been playing inside of an unattended vehicle. Make sure that your car is always locked after parking it in the driveway etc. Do not leave the windows down where a child might be able to climb in the car and then is not noticed. There are also reports of children dying after climbing into a car with an unlocked trunk. Lock all doors and trunks each time you leave the car! Remember the adage “beat the heat, check the backseat”. These are tragic, yet preventable deaths. That's your daily dose for today. We'll chat again tomorrow.

Daily Dose

The Joy of Fun Summer Activities

1:15 to read

While doing summer checkups and discussing everyone's summer plans I started thinking that I should really be asking about some of the basics like summer and all of the wonderful activities to do. We have talked about swimming and camps and staying abreast of academic work, but what about the basics of summer? The good, old-fashioned leisure time activities that we all used to do. While doing summer checkups and discussing everyone's summer plans I started thinking that I should really be asking about some of the basics.

So here are the things that come to my mind: Basic summer skills for all of us to remember and to teach. All of this is free, easy and are really akin to life skills that all children should probably master at some point in their childhood.

  • Jumping rope
  • Riding a bike (of course with a helmet)
  • Skipping a stone
  • Pumping a swing
  • Blowing bubbles
  • Catching a ball
  • Throwing a ball (don't think I have still mastered this, wonder if it is too late?)
  • Turning a somersault
  • Playing hopscotch
  • Playing four square
  • Learning how to float on your back
  • Fly a kite
  • Catching fire flies

Don't feel pressured to do this all at once, as childhood is a long time. But enjoy the time spent with your children accomplishing these simple pleasures. Why don't you let me know things that you think of and that you feel are essential skills of summer? I am sure I have missed many. That’s your daily dose, we’ll chat again tomorrow.

Send your question or comment to Dr. Sue!

Daily Dose

The Reality of Teen Suicide

2 recent suicides have stunned one community. Many parents are asking why?I have been saddened by the two suicides and one attempted in our community during the last two months. As a parent and pediatrician, it is hard for me to fathom the loss of a child due to self-harm.  There are really no words for the shock and grief.

Each year, thousands of teens commit suicide nationwide (it’s the third-leading cause of death for 15 to 24-year-olds). In 2000, the Centers for Disease Control reported that one out of 12 teens attempts suicide and that up to one in five teens stated that they had contemplated it at some point during their adolescent years. Statistics also show that the incidence of teen suicide has been increasing, which seems to correlate with the mounting pressures — both real and perceived — that our youths feel. As an adult, I think, “What could be that terrible to drive a teen to end their life when so much lies ahead of them?” But a teen’s brain is not fully developed, and as any parent knows, teenagers are often impulsive with little thought of the consequences of their actions. Teen suicides are usually related to depression, anxiety, confusion and the feeling that life is not worth living. A break-up with a girlfriend or boyfriend, substance abuse or failure at school may lead to suicide attempts. There are also gender differences among teens who commit suicide. Teen girls are more likely to attempt suicide than teen boys. But teen boys are more likely to complete a suicide. Girls are more likely to use an overdose of drugs to attempt suicide, and boys are more likely to shoot themselves. While a girl may use an overdose or cutting as a call for help, there is often little opportunity for intervention with a boy who sustains a self-inflicted gunshot or who hangs himself. Male suicide attempts are typically more violent and are four times more likely to be successful. Be aware of the warning signs and take them seriously: -Sudden isolation or change in friends -Change in school attendance or grades -Problems with substance abuse -Signs of being bullied -Too much time on social media sites -Excessive texting -Statements about ending his or her life Professional help is absolutely necessary when dealing with these issues; parents should not attempt to solve the problems on their own. There are numerous resources available, and the suicide prevention hotline at 1-800-SUICIDE is a 24-hour service. Lastly, firearms should not be kept in a home unless they are locked, and the key should always be in the care of a parent. More than half of teen suicides are inflicted by guns. It might also be prudent not to have ammunition in the house if you do have a gun. If an impulsive, depressed teen has to buy ammunition before attempting suicide, he might be more likely to have an epiphany and realize that things are not hopeless. Any deterrent may be all that is necessary to prevent a suicide. Do me a favor, go hug your child as soon as you can and tell them how much they are loved!

Daily Dose

Why Kids Hold Their Stool

Dr. Sue explains a very common bathroom issue and why it occurs.Poop and stool habits account for numerous discussions among parents, especially for those with newborn children or parents who are in the throes of potty training.  It's true, no topic is off limits when it comes to raising healthy, resilient kids!

A problem that is more common than many know (or not willing to admit to) affects children  who do not want to poop, in other words, stool holding. Stool holding is called encopresis and is often seen in children with a history of chronic constipation or who have had stool avoidance issues. Chronic constipation and encopresis may be related to a child having had pain with going to the bathroom. The normal response to the need to poop is to go the bathroom.  Seems very simple right?  While everyone may occasionally have a difficult or painful bowel movement, some children who have pain with pooping recall that it hurt “so, why would I continue to poop and have it hurt?”  In this case when a child feels the urge to poop they also feel they need to hold the poop in. The urge to poop is due to the fact that stool has entered and stretched the rectal vault, which in turn sends impulses to the brain that “I need to poop.” If this feeling is repressed (by a child who doesn’t want to poop), the pressure may lessen for awhile but stool continues to fill the rectum, which gets more stretch and even further distended with stool. As this scenario occurs multiple times a day, the stool becomes a larger mass filling the distended rectum, which can no longer be totally “held in”.  When the child inadvertently relaxes the rectal sphincter, the softer fecal material will escape from the rectum and causes an “accident” and soiling of a child’s underwear. Many times a child is totally unaware that soiling has even occurred, but this is only “the tip of the iceberg” as there is still a huge amount of stool that is being held in the rectum. This held-in stool is usually hard, and dry and painful to pass. The treatment of encopresis is multidisciplinary, with a combination of medicinal intervention, dietary changes and behavior modification. This must involve both parents and child and it may take as long as 4 – 12 months to adequately treat and resolve the issue. Explaining the mechanics of stooling to both parent and child is important. It is also important that both parent and child understand that encopresis is NOT a behavioral problem nor is it “all in a child’s mind”. It occurs because the colon is not working as it should. Unfortunately, there is not a “quick fix” for encopresis and patience is important. More on treating encopresis on Monday.


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Lots of discussion about using prebiotics and probiotics in your child's diet. What is the difference between the two?


Lots of discussion about using prebiotics and probiotics in your child's diet. What is the difference between the two?

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