Daily Dose

Ebola in U.S.


It was only a matter of time before a case of Ebola virus was diagnosed in the United States. It just so happens to be at the hospital that I practice in which is also directly across the street from my office.  I can already tell you that there is a lot of concern from our patient families as well as from friends who were at the hospital today including my daughter in law. Concern is one word, but hysteria and misinformation are also words that come to mind.

When I first heard the news I too was skeptical that the person admitted to Presbyterian Hospital of Dallas would actually have Ebola virus. We have been on the “alert” for enterovirus D-68, which has also been making headlines, but Ebola was not on my “radar:.  The moment that the CDC announced that the patient had indeed tested positive for Ebola virus, the news helicopters started circling above the office (not quite a many as there were for George Clooney’s wedding), but a considerable number (and noisy!).

I have fielded emails, texts and phones calls beginning this afternoon and into the night from concerned parents.  The first thing to know is that Ebola virus is not transmitted as a respiratory pathogen like flu, or a cold or even enterovirus.  (My daughter in law did not have a mask on as she went to her appointment this morning and she too was a bit concerned until we spoke). 

The Ebola virus is transmitted when you come into contact with body fluids like saliva, blood, urines, or feces from the patient and then can enter your body through micro-abrasions or cuts.  It is not a virus that you will catch if you walked by the patient or passed the patient in the hallway or the airport.  Again, you must come into contact with body fluids to catch this virus.

This patient is in strict isolation within the hospital which means only certain medical personnel will even be in contact with him.  The area that I practice in and the babies that we see in that hospital are in no risk for exposure to the virus. There are always infection control procedures within the hospital and they will continue to be followed.  

So, there is no reason to panic.  I am not afraid or concerned about continuing to work within the hospital. We will continue our regular days in the office and reassure families that they are not at risk. We pediatricians are still more concerned about airborne viruses such as RSV and flu that will cause considerable illness, and will soon begin circulating.  Get your flu vaccines, wash your hands, get enough sleep, exercise and continue to have healthy family meals. Remember, keep your child ( or yourself) home from day care or school if they have a fever.  This is still the best prescription to stay healthy.


Daily Dose

Exercise Can Maintain Heart Health

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Moms and dads...you have an exercise plan but what about your kids? Your child's heart health is important too! Heart health is based on genetics, diet and lastly exercise. (For adults and my teen patients as well, need to add smoking and drinking to the discussion).  

While I start talking about healthy eating during infancy the discussion about exercise comes a bit later.  If you have a toddler you know they “exercise”.....all day long, and never stop except to sleep! But as our children get older, once again it is up to the parents to model behavior, including exercise. 

I regularly ask, “how much time does your child play outside?” (I know it is much harder in winter months), “what does your child do for exercise outside of school?” and “do you exercise as a family?’”.  Once a child is older, say 5 or so, I include them in the questioning as well as they are a wealth of information. I ask them “if they ride a bike”....they love to tell me about taking off their training wheels. Then I ask “who they ride with and where do they go?”.  I also ask about bike helmets, you would be amazed at how many children tell me that they wear a helmet, but their parents don’t! (HINT HINT to parents). 

I find that most children under the age of 10 or so do get a fair amount of exercise, but as they get older many have stopped playing sports outside of school and have chosen to spend more time being sedentary.  They are not just watching TV, but have found other interests like music, art, drama, chess and even computer programming.  All of that is great, but children still need exercise and many schools have cut PE programs especially once you get to middle school and high school. This means that parents once again may have to encourage exercise, for the whole family. Walking the dog, family bike rides, tennis matches, front yard kickball or badminton.  Get the family exercising together....they may not even realize. 

The hardest group I have to encourage to exercise are my teens who are just not athletes (I can sympathize).  We all have our talents, but for some sports are not it.  I find myself asking my teenage patients, how much exercise they get and so many say, “None”.  Many say, “walking between classes” is all of their exercise, and the idea of walking to school is long gone for most.  Many of my teens start to gain weight after puberty and have to be reminded that we all stop growing....so you can’t keep gaining weight. Exercise has to be done on a regular basis...again it is about lifestyle. 

So, heart health and exercise should be a focus for families year round, see if you can get your family moving as we head into spring!

Daily Dose

Winter Season & Eczema

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I received these nice pictures and a question via email the other day. The mother was concerned as she had found this “spot” on her 6 year old son’s back. He was otherwise well and she did not see any other “spots” or rash.   

Her son complained that the “spot” was itchy so being the good mother she applied some over the counter cortisone cream for several days (which I always tell patients to try). After 2 days of it not improving, but not worsening, she thought it might be ringworm (also a good thought) and she applied an OTC anti-fungal cream.  Again, the rash was not better, but really not worsening or spreading.  That is an important part of the history. 

Now in medicine you learn about red herrings, which are part of a patient’s history that may not really have any bearing to their current problem....but one has to consider it. In this case, her dog developed a lesion and was taken to the vet and was diagnosed with a staph infection, but the vet told the mom that the dog was not contagious to humans.  Red herring or is that the problem? 

After looking at all of the pictures (which is never as good as seeing a rash in person), I am thinking that this may be nummular eczema, (nummular means coin shaped, hence the round)  The history is right as is was not bothersome other than being itchy, and eczema is often called the “itch that scratches”.   

With all of this cold dry weather and heaters on full blast all over the country eczema is having a heyday.  I have seen a ton of these little inflamed patches on skin of all ages (my own hands are a mess).   The treatment of choice is to moisturize the skin and also the use of a topical steroid. But, it takes a long time to see an improvement in the spots and they may change on a daily basis depending  on the weather, bathing and how much lubrication and moisturizing you are doing.  

I would use an OTC moisturizer that contains ceramides (Cetaphil Restoraderm, Cerave, Aveeno for eczema) and use it liberally and frequently.  I would also apply an OTC steroid several times a day (under the moisturizer). Eczema also sometimes requires a stronger topical steroid that is prescription. 

Hope that helps.....but if not improving after 7-10 days it may be worth a visit to your pedi for up close and personal diagnosis.

Daily Dose

Preschool Nutrition Can Be Challenging

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Does your child eat three meals a day with healthy snacks along the way? I often find myself talking to parents about establishing healthy eating habits especially when you have a preschooler. Preschool children, specifically the two to five-year-old set are notoriously picky eaters, and parents need to recognize that this is developmentally appropriate, although frustrating for parents.

This is an appropriate time to begin teaching children the importance of healthy eating habits to encourage a lifetime of good health and prevent obesity. A good place to start to get information is “MyPyramid for Preschoolers”, a website sponsored by the U.S. Department of Agriculture. This website not only covers what your children should be eating, but also is full of good advice on handling picky eaters, how to monitor your child’s growth and ideas to encourage physical activity.

The website encourages parents to lead by example and let your children see you eating a wide array of foods including fruits, vegetables, and whole grains throughout the day. There are ideas for healthy snacks that can be eaten on the run, as you get back into carpools and after school activities. Even the toddler set is busy after school!

Remember: do not let food choices become a battle or an issue. Do not make negative food comments around your children, and keep trying new things. It may take up to 20 attempts or more before your child will try something new, but if you don’t keep trying you will never know if they might really like broccoli.

Also, no “yucky faces” for the adults and older children while at the table and eating their meal. That will only discourage your toddler from trying unfamiliar foods. Put on that happy face, even if it is not your favorite food, it might be your child’s.

The most important message is to make mealtime and snack time pleasant and healthy. Even a toddler can help with planning and preparing a meal. This website is really quite good and interactive as you can enter your child’s first name, age, gender and typical amount of activity and the site will generate a plan just for your child! Can’t be easier than that.

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

Daily Dose

Leaving Your Child Home Alone

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I get asked the questions a lot "At what age can I leave my child home alone?"  There is no simple answer but a progressibe one.

I tend to think most children are ready to spend 20-30 minutes alone at home between the ages of 10-11, but every child is different.  It depends on a number of things including how your child feels about being alone, the length of time, and if you and your child have discussed how to handle emergencies and getting a hold of you or a neighbor in case there is an emergency or even just a question that needs to be answered.  

Well, this topic brought up an interesting question, what do you do when you leave your child alone and there is not a home phone?  I have never even given that a thought as I am “old school” and still have that landline in my house. It just gives me a “good feeling” to know that it is there, even if it rarely rings. (although the kids know to call the home number as I typically turn off the cell as soon as I hit the door from work).   

More and more families have given up a home phone and I think this brings up so many different topics for discussion, but for starts how does your child call you when you leave them alone?  Or how do they call the trusty neighbor if they need something.  Do you get them a cell phone? Do you have to have an extra cell phone to have at home?  It seems to me that a home phone is important for just that reason. In case of an emergency, your child can pick up the phone and call for help, assistance or just a friendly voice. I don’t think they need a cell phone!  

Also, landlines are relatively inexpensive. Cell phones for 8,10, 11 year olds?  Sounds inappropriate and expensive.  Wouldn’t it be easier to keep a home phone so children can learn to answer a phone, use good phone manners, and when you are ready to let them stay at home by themselves for a few minutes, there is always a phone available. I don’t know, just seems easy solution to me.    

What do you think? I would love to hear from you!


Daily Dose

Carseat to Driverseat!

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You know how often I have written about carseat safety and the latest guidelines for car seat usage......well, it is National Child Passenger Safety Week and a new study confirms what I have seen in my own practice, a lot of parents are not always taking the time to buckle up their children in car seats and booster seats.

An online survey funded in part by the General Motors Foundation, polled over 1,000 parents and caregivers of children under the age of 10. They were asked about the use of car seats and booster seats for their children. One in four parents admitted to having driven their child without using a car seat or booster seat. Many of the parents were described as being “affluent, highly educated and young”.  Men were also more likely to break the “buckle up rule” than women.

Motor vehicle crashes are the leading cause of death to children.  Statistics from previous years show that about 1/3 of children killed in car accidents were not using a car seat, booster seat, or a seat belt.  There is NO reason for this, and children need to be buckled up, “every time on every ride”.

I have heard many excuses from parents about the “hassle” of using a rear facing car seat until the age of 2 years. Some of the comments have been, “it is just too hot in Texas to rear face the car seat”, “ I think she is bored facing backwards and prefers to forward face”, “the DVD player is not visible when they are rear facing”. All true comments, and I just am amazed by my own patients who are well educated, caring and concerned parents. 

The same comments have been made about booster seats, “I think he feels awkward going to school in a booster seat”, “we were not going very far so we just use the seat belt, rather than the booster,  when close to home”, “no one else at our school uses a booster”. Peer pressure at this age?

Other comments about seat belt safety I have heard? Parent’s tell me that, “the booster seat won’t fit in the Porsche, so they buckle up their 7 year old in the front seat, when driving with Dad”. “She throws a fit about riding in the backseat and fights with her sister so we let the 9 year old ride in front”.  The list goes on and on.  I personally wish that we could not have had children in the front seat when my boys were young as they always “called shotgun” and fought to get to the front seat, which led to several fingers caught in the car door, and many tears. Would have embraced the no front seat until 13 year law!

Lastly, parents need to follow the rules as well. Our kids are watching what we do and they will become drivers one day. The biggest admonition to teens is “Always buckle up” and “Don’t text or talk on cell phone when driving”.  Teens have the lowest rate of seat belt use of all age groups, so they need to see their parents following rules.

September 21 is National Seat Check Saturday, and Safe Kids will be hosting more than 500 child seat inspections across the country. If you have questions about your car seat or booster seat look at www.safekids.org to find a location near you. Buckle up, do it correctly, and don’t CHEAT!

Daily Dose

Summer Viruses Are Gearing Up


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

Anxiety & Kids

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There isn’t a day that goes by that I don’t find myself talking to a patient or a parent about anxiety. I see patients as young as 4 years old who are “anxious” about sleep, school or after school activities. I also see plenty of high school students with the same concerns.  It doesn’t seem to be getting any better either, as I think more and more of my patients visits are often related to stress and anxiety rather than to strep throat or an ear infection. 

This begs two questions: How did stress and anxiety become so prevalent and how do we change it?

If I knew the answers to that I could write a best seller!! But I do think I have some ideas.  Some of the stress and anxiety that our children feel at an early age may have some roots in genetics. Anxiety seems to have a genetic predisposition but is it all inborn?  Can you change some of a child’s early reactions to situations by the way a parent reacts?  I think that the answer is yes. 

Very young children pick up on parental cues. For example, I had a young mother who recently came in and was worried because her 14 month old son was being “pushed” in play group and he would sometimes even fall down. She was tearful while she was talking about this and at the same time she was guarding his every move in the exam room. No falling in here!   

I asked if the other mother’s were appropriately talking to their toddlers who had done the pushing and she said they had, but it was just “too much to bear”. She was not going to go to play group (they might not invite her back) if he was going to get pushed. I could feel her anxiety flowing to her newly walking son.  

Another patient recently brought her child in due to recurrent stomach aches.  After getting a good history and talking about the tummy aches with the child directly, it seemed as if they might be due to stress and anxiety. The mother then began to talk about her own stomach aches and how debilitating they were for her and all of the tests that she thought should be run.  This conversation was in a bit too much detail for an 8 year old to hear. After a minute or so the little boy said, “I think my tummy aches feel better when I talk about them to my feelings doctor”.  Hmmm....wish the Mom would have let me know that bit of information earlier.  Mother’s anxiety being passed to child?

So.... when appropriate try to “down play” the falls or tummy aches of child hood.  Lot’s or reassurance that “it will be okay, or let me kiss it and make it better” often works wonders.     

Daily Dose

No Needle Shots?

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Over the last several months I have had a lot of patients (especially those that are old enough to talk) ask me about the new needless jet injectors for vaccinations. Of course anything that says “no needle” and “painless” has a lot of appeal for both doctor and patients, especially in pediatrics.  Our practice has not decided whether to try out the new jet injectors and we are still giving the standard shots, not always with smiling patients. How do jet injectors actually work? By using a thin high pressure of liquid to penetrate the skin with the vaccine.

Well, now that it is flu vaccine season, there has been a lot of advertising about needless injections for flu vaccine. Many drug stores and/or grocery stores had advertised that you could get your flu vaccine, “pain free”.  Sounds great, right?

Not so fast, the FDA recently announced that “all vaccines including flu vaccine be administered in accordance with their labeling.” This means that flu vaccine has not been studied when given by the new jet injectors. The FDA also stated that there “was no data to show the safety or efficacy of flu vaccine or other vaccines given by injectors”.  The only vaccine that has currently been approved to be given by the jet injectors is the MMR (measles, mumps, and rubella) vaccine.

The flu vaccine may be given by the traditional method with a needle, or as a nasal mist (for use in children 2 years of age and older). Most of our patients opt for a “flu mist” if they can talk and sniff. It is amazing that there are several children who really do prefer a shot, and they tell me that they would “never” sniff something up their nose. Different strokes for different children.

But in the meantime, I am not jumping on the jet injector bandwagon. The FDA is now stating that each vaccine needs to be evaluated for both safety and efficacy when given by a jet injector. I am sure that those studies will be forthcoming.

In the meantime, RUN to get your flu vaccine, it is time to get vaccinated as sick season is starting and who wants the flu!

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


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