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Daily Dose

When Children Pull Their Own Hair

WHat can yo do if your child pulls their hair out?I received an email via our iPhone App from a mother who was concerned that her 12 year old son had started pulling out his eyelashes.  This is called trichotillomania.

Trichotillomania is an impulse control disorder which is characterized by "the excessive pulling of one’s own hair which results in hair loss.” It may be eyelashes, like this adolescent boy, or it may be hair on any other part of the body. It most commonly involves scalp hair, but eyelash and eyebrow pulling is the second most common site.  The hair pulling may result in small amounts of hair loss, which may not even be noticeable, to such excessive pulling resulting in total loss of eyelashes, brows or even baldness. Hair pulling in childhood may begin during toddler and pre-school years, where it seems to be more of a “habit” than a compulsion. In this case the hair pulling is typically short lived and resolves on its own. Hair pulling that occurs in children of older ages (peaks are seen between the ages of 5 -8 and during the teen years) is a type of obsessive compulsive disorder where the person cannot resist the behavior and of may even experience gratification when pulling out their own hair. At this point the compulsion leads to the inability to resist pulling one’s own hair, which may in turn cause more anxiety and stress, which then leads to more hair pulling and a vicious cycle occurs. At this point ,the behavior may have gone on for months and then is labeled trichotillomania. In my own experience with children who have trichotillomania, the child often tries to hide the behavior, and may even deny the hair pulling despite the fact that they have an area of baldness or even no eyebrows. They will often act is if they cannot figure out how the hair loss occurred. Parents too may not see the child  actually pulling their own hair and also are confused as to the etiology of the hair loss.  Children may experience a great deal of distress secondary to their hair pulling,  not only from the actual loss of hair, but they may also avoid school or social situations due to embarrassment. Self inflicted hair pulling is a psychiatric disorder that is often difficult to treat and requires professional help. When seeking professional help look for a psychologist or psychiatrist who has experience in this area. That's your daily dose for today.  We'll chat again tomorrow! Send your question to Dr. Sue!

Daily Dose

Wear Sunscreen During Spring Break!

1.30 to read

Spring break season has begun and many families will be heading to the mountains for skiing or to the beach for some warmer weather.  Either destination requires sun protection, especially for the face. 

I have just returned from skiing with my best friend from medical school days, who is a dermatologist. Whenever we travel together I know that one of her big focuses will be if I am wearing sunscreen and enough of it!!  She was teaching (reprimanding) the teens and young adults on the trip as well, as they needed some sunscreen “re-education”. 

The sun was shining for our entire trip and we had lots of snow, so perfect conditions for great skiing but also for a sunburn. On top of the direct sun, the reflection of the sun off the snow (or the sand at the beach) just adds to the risk for sun damage to the face.   

The best way to protect your face (and this goes for other areas too) is to apply a GENEROUS amount of sunscreen to the face and neck at least 30 minutes before heading outside.  She advocates layering sunscreen as well. By that I mean put on a base of sunscreen and really rub it into the skin. 

If you are using a spray on sunscreen you need to rub it in as well.  I used an SPF of 60 for my face.  Then wait for 10-15 minutes and get those ski clothes on (that takes awhile).  After letting the sunscreen absorb I reapplied another GENEROUS (maybe an ounce) of sunscreen to my face and neck.  What my derm friend told me is that layering a 60 SPF plus a 60 SPF does not make the protection 120 SPF, but it does make it more likely that you are getting better sun protection than one layer alone. Make sure that you are also applying sunscreen to the lips followed by Chapstick or lip balm that also contains sunscreen. 

Now, throw a small tube of sunscreen and lip balm in your pocket so that you can re-apply later on, as you know that you should continue to re-apply if you are spending the day outside. There are also some good sunscreen sticks that are convenient with an SPF of 50 or more. These are great for a parent to use on children off and on during the day. I am a fan of the Neutrogena and Cerave products, as they are hypoallergenic as well. 

Enjoy the break....but be sun smart too. 

 

 

 

 

Daily Dose

Summer Viruses Are Gearing Up

1.15

Is it hot enough for you? Summer is here for a bit! Winter viruses are a distant memory (good bye flu and RSV), summer viruses which have been laying dormant are once again rearing their angry heads.

My office has been overflowing with really hot feverish kids of all ages.   I think the most likely culprit for much of the illness we are seeing right now is an enteroviral infection.  For some reason, it makes us parents feel better if we can “name that virus”, seems to help validate the illness.  

Enteroviral infections typically cause a non-specific febrile illness and with that you can see fairly high fever. In other words, just like the thermometer as summer heat arrives , 101-104 degrees of fever is not uncommon in these patients.  Remember the mantra, “fever is our friend”. I think it is almost worse to have a high fever in the summer as you are even more uncomfortable because it is already hot!

With that being said, if your child has a fever, don’t bundle them up with layers of clothes and blankets.  It is perfectly acceptable to have your younger child in a diaper and t-shirt, and older children can be in sundress or shorts rather than long sleeves and pants.  Bundling may increase the body temperature, even while you are driving to the doctor’s office. I often come into a room with a precious baby who is running a fever and they are wrapped in blankets, let them out! That hot body needs to breathe.

These summer enteroviruses may cause other symptoms as well as fever, so many kids right now seem to have sore throats and are also vomiting and having diarrhea. With this type of virus you also hear complaints of headaches and body aches (myalgias).  The kids I am seeing don’t look especially sick, but they do feel pretty yucky!  Just kind of wiped out, especially when their temps are up.

Besides treating their fevers, treat their other symptoms to make them comfortable.   If they are vomiting do not give them anything to eat and start giving them frequent sips of liquids such as Pedialyte (for the younger ones) and Gatorade or even Sprite or Ginger Ale. Small volumes are the key. 

I often use pieces of Popsicle or spoonfuls of a Slurpee to get fluids in kids. I always tried to pick drink colors for my own kids that were easier to clean up, in case they were going to vomit again, so no bright red!  The cold fluids may also help to soothe a sore throat. Once the vomiting has stopped, and it is usually no more than 12-24 hours, you can start feeding small amounts of food, but I would steer away from any dairy for a day or two. Again, nothing worse than thinking your child is over vomiting, fixing them I nice milkshake (comfort food) and seeing that thrown up!  Many a mother has come into my office wanting to strip after being vomited on, in a hot car no less.   I don’t think there is a car wash around that can fully get rid of that smell!

Most enteroviral infection last anywhere from 2-5 days. There are many different enteroviruses too, so you can get more than one infection during the season. This is not just a virus you see in children, so watch out parents you may succumb as well. Keep up good hand washing and your child should stay home from school, the pool, camp, day care etc. until they have been fever free for 24 hours. 

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

Daily Dose

Jessica Simpson's Weight Gain

1.30 to read

Jessica Simpson has been getting a lot of press and TV time related to the amount of weight she gained during her recent pregnancy and the difficulty she is having “shedding” the pounds.  I just thought I needed to “WEIGH IN” on this subject as I don’t think the real issue is being discussed.  

As a pediatrician, I am not as concerned about when or how she loses the excessive weight that she packed on during her pregnancy.  I am more worried about the message that she is sending to other pregnant women.  Excessive weight gain during pregnancy may cause complications that could jeopardize an unborn baby’s health. It is not safe to gain all of that weight during a pregnancy. 

Jessica Simpson is quoted saying that she is a “southern girl” and enjoys fried foods, macaroni and cheese and cream gravy. Most obstetricians recommend that a woman of average weight gain between 25-35 lbs during a pregnancy. If a woman is overweight prior to becoming pregnant she may only need to gain 15-20 lbs during the 9 months. Being pregnant does not mean that you can forget all about nutrition, eat excessively and gain 100 lbs. (educated guess on my part). 

A woman who gains excessive weight during a pregnancy may have complications and is more likely to develop high blood pressure as well as gestational diabetes.  Gestational diabetes is typically controlled with dietary changes alone, but in some cases a pregnant woman may even require insulin. Gestational diabetes puts the baby at risk for having blood sugar problems at birth. At the same time, blood pressure problems may be dangerous for the mother and put the baby at risk for premature birth and all of the problems that are related to prematurity. 

At the same time, excessive weight gain during pregnancy typically causes the newborn to be what is termed, “large for gestational age”.   These big babies are often delivered by C-section either electively or emergently and again there are more complications seen after a C-section than a vaginal delivery. 

So.....I wish that the media would not put the focus on how Jessica Simpson is going to lose the weight or how much she is going to be paid to lose all of those pounds, but rather on the fact that she jeopardized the health of her newborn. She was fortunate that she had a beautiful and healthy newborn daughter. 

We all have had cravings while pregnant, but healthy eating and regular exercise are still recommended to ensure the health of the unborn baby.  Jessica Simpson’s weight gain and diet is not the role model we pediatricians want for pregnant moms to follow! 

Daily Dose

Making Memories

1.15 to read

I am seeing so many patients this summer for their routine check ups and it makes me realize how much I love the elementary school years!  All of the parenting years are great, but those years when your child is between the ages of 5 - 11 are especially precious! These are really the years that so many family memories are made. 

When I am seeing these children for their check-ups I always ask them what they’ve been doing over the summer.  Their faces light up as they talk about trips to see grandparents, or trips to the lake or special trips to the beach or the mountains. Whether the trip is just to the local pool or to far off places, these are the times that children love being with their family!!  The family pictures are always of smiling children (many with missing teeth) who are so happy to be posing with their Mom, Dad and siblings doing the many things that families do during the lazy days of summer...swimming, boating, digging sand castles, fishing, cooking out...any number of summer activities.  The pictures are always cute and the kids love being photographed.  Great Christmas card material! 

Now, fast forward to the “tween-teen” years.  There are the same trips to see grandparents or to the beach and some lucky children will get to travel to exotic places. But, in many cases the “kids” are being “forced” to gather for that special picture. It is almost like you have to pull those front teeth to get them to pose for a picture. There is suddenly “attitude” in the photo. Have you had that same experience?  How quickly our children change. 

The elementary school years are so great!! The kids are big enough to travel, enjoy the trip and to behave (usually).  The memories of being together with your children during a special summer trip and immortalizing it in photos is really a photo moment. (it is probably more like a digital moment these days)  Pure joy! 

You simply can’t take enough pictures of your children experiencing a new adventure, or time spent with a grandparent or heading out for camp.  These are the pictures that you will use one day for the high school yearbook page, or the graduation video or even the rehearsal dinner. Every family has these pictures and to remember the time together couldn’t be more special! 

So, go make memories with those 5-11 year olds. It doesn’t get better.... and yes those special times do continue, but they maybe a bit different as your children hit that next phase the tween/teen years.   

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

Daily Dose

Childhood Obesity

1.30 to read

Everyone knows that obesity is on the rise and it is often beginning in childhood.  During well-child visits (and often during a visit for colds or flu) parents often bring up a child’s weight.  By using growth charts it is fairly easy for the doctor to show a parent and child where they fall on the growth curve and BMI (body mass index) curve as well. When discussing weight issues it is sometimes difficult to decide what terms are appropriate to use.

A study just published on line in Pediatrics surveyed 445 parents of children 2–18 years of age to assess what are perceived to be the most appropriate terms to be used when discussing weight issues in a child. The study, done at Yale University, was interesting in that more than 60% of parents said that referring to a child as “extremely fat” or “obese” would be “most stigmatizing and the least motivating terms to encourage weight loss.”

In this study, American parents preferred that terms such as “unhealthy weight”, “weight problem” or “being overweight” be used to discuss weight issues and that these terms would also be more motivating for weight loss.

In the same study about 36% of parents said that they would “put their children on a strict diet” in response to weight stigma from a doctor. This is concerning as well as since research has shown that severe dieting and restriction of calories in young children may backfire and may at times lead to other issues including eating disorders.

Whether we call it an unhealthy weight or being overweight or even using the term fat probably depends on each family and their own preferences. But whatever we call it, the topic should be addressed at each well child visit. The basic tenets of a healthy body weight still depend on eating a well balanced diet and getting daily exercise. Why does that sound so simple?

The easiest way to start to control weight gain is to begin with good habits when your children are young. If children are raised from their toddler years with a wide variety of healthy foods presented to them at meal and snack time, they will learn to enjoy these foods. “Grazing” should be discouraged and discussions should not be about “what you will or won’t eat” but rather about gathering for family meals and enjoying the time together. Parents needn’t be “short order” cooks, a child will eat if they are hungry and given the opportunity. But by offering a limited variety of foods and preparing just a few items that a child “likes” the stage is already being set for poor eating habits down the road.

Our job as parents is to provide healthy meals (and snacks) to our children, while the children will have to decide whether or not to eat it. There will be days that they are getting their favorite foods and others that they may not, but in the long run they will be a better and healthier eater. It would be nice not to have to figure out the correct term to use for being overweight or even obese.  Maybe we can cure it in the next generation and the terminology will become obsolete!

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

Daily Dose

Teaching Kids How To Swallow A Pill

Teach your child how to swallow a pillLife would be a bit easier (when your child is sick) if your child knew how to swallow a pill.

I am continually reminded about the number of kids and teens that don't swallow pills, and ask, "does that medication come as a liquid?" Even some of my "adult" patients (code for friends over 40) call and ask if their cholesterol lowering medication is available as a liquid as they just can't swallow a pill! These are people that can run companies! So...due to that fact, I am convinced, like many things in life, the younger you learn to do something, the easier it is. The old adage, "can't teach an old dog new tricks" is true, young children are excited about trying new things and accomplishing milestones, so put pill swallowing on the list.

I started teaching my own children how to swallow pills when they were around four-years-old. It really came out of necessity when we were on a trip and one of them developed a fever and I did not have any liquid Tylenol with me. Being the novice "parent pediatrician" at the time, I thought I could just "push the pill down their throat", like the dog. Guess what? It doesn't work, as they just gagged and threw up all over me! Lesson learned. I have found the best way to teach a younger child to swallow a pill is to make it a game. I took the boys to the nearest 7-Eleven where we bought their favorite tic-tacs (coated on the outside like a caplet so won't stick) and then let them pick their favorite sugary horrible never allowed drink. I think it was a Coke or 7-Up at the time (forbidden fruit at home). We went home with candy and drinks in hand (mini M&M’s also work well) and began the tutorial. It helps to have a little friendly competition too. Show your child how to put the tic-tac on the back of their tongue (not on the tip) and then have them "GUZZLE" the drink.  That is why you need to use their favorite drink so they really want to drink it robustly. You can't learn to swallow a pill with a small amount of liquid, you need a "big gulp" to wash it down. When kids are younger they usually don't worry about "choking" or gagging, but once they are older they start analyzing and worrying about how the pill will get stuck or gag them and their anxiety gets in the way. Look at it like going down a slide for the first time, or jumping into the pool, younger kids are usually less fearful (not always a good thing). For many children it will take several tries before the tic-tac is miraculously washed down!! They are so proud and excited and want to show you that they can do it again and again (therefore practice with candy and NOT real medication). By the time they are really becoming proficient they will often say, "look, I can do three at a time!!). Once they are swallowing it is very easy to use junior strength Tylenol or Motrin, which are smaller and coated. Again, once they are swallowing pills the size of the pill really doesn't matter as they all "wash down" the same way. I use the analogy of learning to ride a bike, once you can do a two-wheeler, you can probably ride your friends bike that may have a little bigger tires, if need be. They all pedal the same way and require balance. Pills are pills, just pop and swallow! I also jokingly tell all of my young patients that it is "Dr. Sue rule" that they are able to swallow a pill before they can drive a car!! Come on, putting a teen behind the wheel of a car is HUGE, and swallowing a pill seems much easier compared to learning to drive. I must say that the majority of my patients can swallow a pill by early elementary school, and many even younger. Learning to swallow a pill is a right of passage during childhood. Make it fun and cross this off of the "to do list"! That’s your daily dose, we’ll chat again tomorrow. Send your question to Dr. Sue!

Daily Dose

Teaching Your Kids About Their Private Parts

Why do parents give their child's private parts nicknames instead of real names? If you have a child who is over the age of 15 months I know that you have played the game  "where’s your nose, where’s your eyes, where’s your ears?” It is a favorite for both parent and child as a toddler learns to point to various body parts. This game is also an important milestone in observing a child process language (receptive speech) and follow a command.  But, what happens after your child has learned the usual body parts?   In other words, what about the rest of their anatomy, specifically their “private parts”.

This topic came to mind the other day while I was seeing a little girl who was complaining of burning and itching with urination.  This is not an uncommon problem in the 3-6 year old little girl set, and part of the physical exam involves looking at the child’s “private parts”. As I begin talking to both the parent and child I always start off with the statement, “I am going to look at your vagina, and it will not hurt”. I also say “no one else should pull your underpants down and touch your vagina. The only people that can touch your vagina are you, your mother or father, and the doctor. These are your private parts, they are covered by your underwear and never let a stranger or even a friend pull down your underpants”. It is important that this age child understand who may or may not pull down their underpants. But, with that being said, it is always amazing to me how many parents say, “we don’t call it a vagina or penis”, and on this occasion the mother said, “Dr. Sue means your bunny hopper!!”  Okay, really? What in the world is a “bunny hopper?”  Why would a parent not name the body parts correctly and where do these names for vagina and penis find their derivation? Over the years I should have kept a list of “secret names” for vagina and penis as I have heard many. From the “princess patch” to “peanut” to “bo-hiney” you name it, there seem to be many parents who either are uncomfortable, or just cannot bring themselves to use the correct word for genitalia. Even Oprah has her word, “va-j-jay”. I submit that we go back to the correct anatomical name. It is so important to teach your children the appropriate words for penis and vagina. Just as they learn eyes, ear, nose, knee, foot, toe they need to know the names of their “private parts”. If you begin with the correct words it never seems awkward or uncomfortable and is no different than naming any other body part. You will be surprised at how easily your child accepts these words, but uses them appropriately too.  It is also important to name body parts correctly, especially if there is ever a question of inappropriate touching or abuse, in order that a child can correctly explain what happened. I still have to laugh when I hear all of the different names a child hears when a parent discusses genitalia, it must be confusing.  But regardless of what you name it, a penis and a vagina are private parts and need to be covered by our underpants, keep repeating that message to your child. What do you think? Would love to hear from you!

Daily Dose

Why Parental Emotion Always Takes Over

1:30 to read

Why do parents let their emotions take over their child's diagnosis? Because we love out children and want the best for them. I was seeing patients in the office this week and noticed a young mother and her two daughters who had been in my office frequently in the last several months. Yes, it is the season for more visits to the pediatrician but she seemed to be in the office fairly often.   She was in this day with her 3 year old daughter who had complained of a “tummy” ache, and she was convinced that her daughter had appendicitis.

Here’s the scene: 3 year old little girl with long hair and a bright smile  prancing around the exam room in her leggings and UGG boots as if she is a rock star!  This (supposedly) sick little girl is putting on quite a show for both her 1 year old sister and her mother.  She looked adorable, but not sick!  While her mother and I chatted, I continued to watch her daughter out of the corner of my eye. According to her mother, the child had complained of a tummy ache earlier that day, and pointed to her side. She said she didn’t want lunch.  No fever, vomiting, or diarrhea. Nevertheless, her mother was worried that her daughter might have appendicitis.  She was convinced that the “tummy ache” must be something serious.

After examining this precious child, it was obvious that her “tummy ache” was not due appendicitis. So, her mother asked, “why do I always go to THE DARK SIDE”. When I asked her what that meant she said, “why does my brain always jump to the worst conclusion”. “Why am I here so often with my daughters? They have headaches that I am sure are brain tumors, or a tummy ache that must be appendicitis, or bruises that I am convinced are due to leukemia.” I don’t think it is actually a parent’s brain that takes them “to the DARK SIDE”, but rather it is the HEART! 

Sometimes we parents (and doctors who are parents too) know intellectually that the child’s complaint is probably nothing. It is most likely that the headache is just that (how often do you yourselves get one?) and the tummy ache could be due to gas or constipation rather than an “appendix ready to burst”.  But our emotional and sometimes irrational side takes over and suddenly we have “gone to the DARK SIDE” with fears of the worst possible diagnosis.  Truly, it happens to all of us at times. As a pediatrician and mother I do know this, bad things get worse and the child’s complaints get more frequent or new symptoms develop. The “bad” things do not just go away.

As they teach you early on in medical school,”when you hear galloping hooves, think of horses not zebras. “  In other words, think about common reasons for a symptom before jumping to the infrequent and life threatening diagnosis. We parents need to heed that advice too.   Sometimes a few hours to days of watching a child will keep you from going to “the dark side” as you realize your child has moved on from the tummy ache to wanting to go outside and play or to dancing around the room. Remember to try and stay on the “bright side” and see if the symptoms resolve.

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

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