Daily Dose

'Twas the Night Before Christmas

Are you feeling overwhelmed by the night before Christmas? Many parents do including me!It is the night before Christmas and I think I am feeling like many mothers (and fathers) out there, overwhelmed!! Each year I try to plan to have a “calm” holiday with an organized gift list, and everything wrapped early so that our family may spend quiet time together today in anticipation of Christmas. Why is it that I may have struck out again?

If you could see my “office” right now, you would be surprised that I could even write today. The top of my desk is strewn with journal articles, rehearsal dinner seating charts, year-end CME (continuing medical education), and lots of ribbons and gift enclosure tags. I am not even sure what goes with what! I am also decorating the mantels with fresh garland, arranging flowers and trying to keep our sweet yellow lab Maggie from eating the Christmas ornaments and the fresh greenery. While I am doing all of that I must tell you that my sons are either asleep, watching TV or working from home and “just want to veg”. It is at this time each year that I feel defeated as a mother. The visions of family singing carols beside the tree that they helped decorate, are a figment of my imagination. This is when I think it must be different if you have daughters. Do girls rally to help their mothers with the preparation of Christmas? Do they come and ask to help decorate the tree (if they are older than eight), or are they dying to learn to tie a bow on a gift? About this time while I am in a major reflective mood, a patient of mine (now a freshman in college), drops by to deliver a coffee cake and at the same time admires the berries that I am using to decorate. It must be a different world with girls. So, on this Christmas Eve, I wish that I could tell you “all is calm”, but I think I still have a lot to get done before I sleep tonight. I am sure that mothers and fathers everywhere feel the same way, and that is what is wonderful about parenting! We are all in this together. By Christmas morning, it will somehow all get finished and the family will get to gather together to open gifts, have Christmas breakfast or lunch or dinner and hopefully appreciate how fortunate we are to be a family. For those precious moments it does seem “perfect’ and I am thankful for that. I will take many pictures to remember these times together. I wish each of you a Christmas morning filled with memories after a chaotic week.  Merry Christmas!

Daily Dose

Talking To Children About Sex

2.00 to read

With the recent news that teenage pregnancy rates are declinging, it seems to be a good time to discuss the importance of talking to your children about sex.Good news! Teenage pregnancy rates are declining.  So, I thought this would be a good time to discuss the importance of talking to your children about sex.

The “birds and the bees” talk is a sentinel moment and should be a required prerequisite before your child enters middle school. For some parents this “talk” is easy and does not intimidate them, but for others they get sweaty palms, and feel sick to their stomachs.is also a group in between. Wherever you fall in the spectrum really doesn’t matter, but this is one of the most important discussions parents will have with their children.  Many parents start discussing the differences between boys and girls as young as age 4 or 5. I myself have given this talk countless times and teach a class at our church as well. But, when it was time to discuss this with our first son, I too felt ill prepared. The discussion was necessitated as he was about eight-years-old and kept singing a song with the words “sex you up” in it. Obviously, I had let him listen to some inappropriate song on the radio. Nevertheless, this prompted my husband and myself to head to the bookstore to look for the appropriate book/books to begin the initial discussion and I know that book has been well worn over the years. It was not detailed, but explained in fairly simple terms how a “mommy and a daddy” each had “special parts, (which were identified correctly) that “connected” and that a sperm and an egg came together to make a baby. It was very basic, with simple cartoonish type pictures. We read the book and had a discussion together and answered any questions that he had. It went fairly well, he took in the information and went outside to play. That is just the beginning. The time came up again for further discussion when he announced at about age nine that his pet hamster, Sally, “was going to have babies.” Immaculate conception alone in her cage. Discussion number two was just around the corner. I myself do not think that any one discussion about human reproduction and sex is enough. It also depends when you begin these discussions. Some inquisitive children will ask hundreds of questions, while others won’t say a word, either way the talks must go on. Keep the information age appropriate no matter where you begin. Don’t be embarrassed as if you are they will be too. That is why it is called: The Facts of Life. But as children enter their teen years I think the discussions should be explicit and open. If you think they cannot find any information they would like by just surfing the web, then wake up, as it is all there. I would much rather sit down with my own children and discuss every detail they would like to know and at the same type impart factual information as well as our family values. The more information you give them the better decisions they may make. I believe that they should be taught abstinence, but also what to do if they are going to engage in pre-marital sex, which by the way does include oral sex. Let them know about condoms, birth control and other methods to prevent STD’s and pregnancy. We are failing our children if we do not empower them to make thoughtful, well informed choices with as much guidance as we can give them. Seeing the teen birth rate on the rise should never be due to lack of information and family discussions. That’s your daily dose, we’ll chat again tomorrow. Send Dr. Sue your question now!

Daily Dose

Bright Light & Sneezing

1:30 to read

What is the connection between bright light and sneezing? DId you know it was hereditary?I have always noticed that I frequently sneeze when I walk outside, and this was especially noticeable this summer with all of the bright sunny HOT days that we experienced. I thought I had remembered that my mother often did this too and when I asked her she confirmed this.

I was recently reminded of this again when I was with my youngest son moving him back to school. It seemed that every time we walked outside to get another load of boxes he sneezed! We both sounded like “Sneezy” one of the Seven Dwarfs.

Of course my son announced, “Mom are you just realizing this? I have always sneezed just like Ohma and you do”. Oh well, I am finally catching on.

This of course piqued my curiosity and then I remembered that I had read something about “the photic sneeze reflex”.  It has also been name ACHOO: Autosomal Cholinergic Helio-Opthalmic Outburst (and you thought ACHOO was the sound you made!)

It is estimated that this reflex affects about 1 in 4 people. It is inherited in the autosomal dominant manner (remember your days in biology and big B and little b?) If you have the “sneezy gene” your child has a 50-50 chance of also having it.

This reflex has been known for a long time but there wasn’t much science as to the cause. But a recent study (very small only 20 people) compared photic sneezers to controls and found that when shown a shifting pattern of images, the visual cortex of the sneezers showed higher activity than those of the control subjects.

There needs to be much more research done on this topic with larger groups of people studied to further confirm this finding.  But, nevertheless, it is interesting that scientists are now trying to elucidate the mystery of the photic sneeze.

In the meantime I realized that another one of my son’s also has the gene. Funny how you suddenly recognize a familial pattern to sneezing only to find out it is in the genes. It also reminds me I have a blue eyed and 2 brown eyed children, back to those genes again.  Just like they taught me in medical school, take a good family history!

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

Daily Dose

Feeding Baby Solid Foods

1.15 to read

I still get a lot of questions about starting solid foods in a baby.  The recommendation from the American Academy of Pediatrics is somewhat confusing as the latest recommendation is that mother’s should exclusively breast feed for the first 6 months of life...which means you do not start solid foods until 6 months.  But, the recommendation for formula fed infants is to begin introduction of solid foods between 4-6 months of age.

I recommend that parents routinely wait until their baby (whether breast or bottle fed) is about 5 1/2 months old to begin solid foods.. For a first baby, parents are really anxious to start cereal as they think it will, “make them sleep all night”, or want to try out all of those spoons people gave them as gifts. Those cute grand parents perpetuate the idea that cereal=sleep. Again, a myth, the majority of children are sleeping by 4 months of age whether breast or bottle fed, and no cereal.  Cereal is less calorie dense than milk! If we all drank breast milk or formula all day long we would definitely have weight problems, but for the first 4-6 months of life milk is all the baby needs.  

Whether you start your baby on solid foods at 4 or 6 months, it is important that you do give your child infant cereal. Whether you want to use rice cereal, oatmeal or mixed grains, baby cereal is iron and zinc fortified. The amount of iron and zinc in fruits, vegetables and even baby food meats is actually very low.  Baby cereals also provide vitamin B and other vitamins that are important for a baby’s nutrition. 

So, for parents who want to make their own baby food fruits, vegies and meats I am all for that. Did you know that there is more iron in pureed cooked meats than in infant prepared jar meats? But not all parents cook and some are uncomfortable in pureeing food at home. 

 At the same time, I encourage families to continue baby cereals for as long as they can.  For first children that may be until they are even 15-18 months of age. They don’t “know” that there are other cereals out there.   Mixing in some fruit will make that baby cereal just taste great as well as increase the absorption of iron.  Those toddlers will learn that we have Cheerios and Corn Flakes, and if it is your 2nd, 3 rd or even 4th child, they know about Cocoa Puffs and Fruit Loops by the age of one and are reaching for their siblings Captain Crunch. 

Birth order does play a role in foods introduction!

Daily Dose

Anti-Vaccine Movement

1.30 to read

It seems that the “anti-vaccine” movement is still alive and well and has been a hot topic on Twitter and Facebook again. Unfortunately, much of what I have read on these sites seems to be inaccurate and based on a lot of emotion and very little science.  But, emotional posts can be quite persuasive, especially to a new parent who wants to do EVERYTHING for their new child.  I would think that would include protecting them from deadly diseases that have NOT been totally eradicated.

One of the first things you learn during your early medical school days is the mantra that doctors should “first do no harm”.  I have continued my daily pediatric practice with that in mind.....so how could I not vaccinate my precious patients?  Vaccines have been well studied ( and continue to be studied) and absolutely DO protect children (and adults) from numerous diseases....including polio, bacterial meningitis, whooping cough and measles.  Vaccines are also safe.....how many different studies does it take to assure parents of this? 

Choosing to not vaccinate your child unfortunately can “cause harm”.  Do parents not realize that we are all exposed to diseases unknowingly?   I know that there isn’t a parent out there that would purposely expose their child to a disease....especially one that could cause death. But with that being said, the bacteria ( h. flu and pneumococcus) that cause meningitis are often harbored in a person’s nose and are just a sneeze away from an unprotected baby.  When I used to do spinal taps on a regular basis on very ill children, some of whom indeed had bacterial meningitis, every parent would ask, “how did my child get this?”  The answer at that time was, “we don’t know where they were exposed”.  Not a very good answer to give parent’s of a critically ill child, some of whom would die. 

Since the vaccines against meningitis have been released I have not seen a case of H.flu or Pneumococcal meningitis in my practice. I can’t remember the last time I did a spinal tap.  Those are memories I don’t need to experience again.  My office was also involved in the studies for the HIB meningitis vaccine and I saw first hand how labor intensive and difficult vaccine studies are. There were a lot of parents at that time that allowed us to stick their infants for blood samples on (many times, on a regular basis) to prove that the vaccine provided antibody and protection for their baby.  Thank you to all of those parents!

So.... I continue to be alarmed that there are parents (often clustered in certain areas) that want to deny their child vaccines.  I wonder what their baby would say, if they had the chance to choose to get vaccinated. Unfortunately, they don’t.

Daily Dose

Is It A Viral Sore Throat Or Strep Throat?

1.30 to read

It only takes the winter season to usher in an array of illnesses in the pediatrician's office. As you know, we are smack in the middle of flu season, with cases and deaths being reported daily. To review (again), flu like symptoms for all influenza strains are typically similar with fever, sore throat, cough, congestion, headaches and body aches. Occasionally there may be some nausea or vomiting but that is not seen as often. Flu like symptoms seem to begin with general malaise and then develop over the next 12–24 hours and you just feel miserable. Some of the confusion now is about sore throats and the difference between a sore throat with the flu, which is due to a viral infection, and strep throat, which is a bacterial infection. As for most things in life, nothing is 100 percent and the same goes for viral and bacterial sore throats. But, with that being said, there are certain things that might make a parent think more about a viral sore throat than strep throat and vice versa. Viral sore throats, which we are seeing a ton of with the flu right now, are typically associated with other viral symptoms which include cough, and upper respiratory symptoms like congestion or runny nose. A viral sore throat may or may not be accompanied by a fever. In the case of flu, there is usually a fever over 100 degrees. With a viral sore throat you often do not see swollen lymph nodes in the neck (feel along the jaw line) and it doesn’t hurt to palpate the neck. If you can get your child to open their mouth and say “AHHH” you can see the back of their throat and their tonsils, and despite your child having pain, the tonsils do not really look red, inflamed or “pussy”. Even though it hurts every time you swallow, to look at the throat really is not very impressive. Strep throat on the other hand, typically occurs in winter and spring (that is when we see widespread strep), but there are always some strep throats lurking in the community, so it is not unusual to hear that “so and so” has strep, but you don’t hear a lot of that right now. Over the next 2 months, there will be a lot more strep throat. Strep throat most often affects the school-aged child from five to 15 years. Children get a sudden sore throat, usually have fever, and do not typically have other upper respiratory symptoms (cough, congestion). This is another opportunity to feel your child’s neck and see if their lymph nodes are swollen, as strep usually gives you large tender nodes along the jaw line. When you look at the throats of kids with strep they usually have big, red, beefy tonsils (looks like raw meat) and may have red dots (called petechia) on the roof of the mouth. The throat just looks “angry”. Sometimes a child will complain of headache and abdominal pain with strep throat. Some children vomit with strep throat. The only way to confirm strep throat, again, a bacterial infection, is to do a swab of the back of the throat to detect the presence of the bacteria. There are both rapid strep tests and overnight cultures for strep. Most doctors use the rapid strep test in their offices. If your child is found to have strep throat they will be treated with an antibiotic that they will take for 10 days. Again, antibiotics are not useful for a viral sore throat and that is why strep tests are performed. I’m sure we’ll talk more about sore throats, but in the meantime, get those flashlights out and start asking your kids to say "ahhh". That's your daily dose for today. We'll chat again tomorrow.

Daily Dose

Who Knows Their Phone Number?

1.15 to read

Can you recite your spouse and your children’s cell phone numbers? Trying to remember 7 digits used to be easy but now I think our brains are losing the ability. I am finding more and more children who do not know their own home phone numbers (many don’t have a “home phone” to remember, there are just numerous cell phones at the house ).  One of the first things children used to memorize was their home phone number, it was a proud accomplishment for a 4-6 year old.  

Now that we have “smart phones” I think memorizing addresses and phone numbers is becoming a lost art.  Our brains are just not absorbing the numbers when all we have to do is push a name or say a command and the number is dialed.  Maybe not as smart as we think?

I guess the first question is: do you even have a home phone or do your kids call your cell phones?  Do they know your phone numbers by memory? Can they recite them to a teacher or a police officer if necessary?   I posed this question to several young parents this week, and they all kind of laughed and said, “you know I had not really thought about it”.

I see kids as young as 1-2 years using the iPad, also know as “my pad” and they use words such as “refresh”, “swipe”, “password” and “app”  so easily.  They can call their parents when they are just 12-18 months old by pushing the picture on the screen.....but do they ever know the number they are calling?  Do children still know about calling 911, or do they look for the icon of the police?

Keep teaching your children their phone numbers...they may need to call you at some time without having an “app for that”!

Daily Dose

Parenting is Hard

1.30 to read

Did you read the online article about a mother selling her 4 tickets to the One Direction Concert on eBay? It seems that it may have been a hoax but the gist of the matter was this “fake” mother was selling tickets that she had purchased to take her daughter and friends to the concert. In the online post, the mother (using some very inappropriate language) said that she was selling her tickets to punish her daughter for her inappropriate behavior. 

I applaud parents who do set boundaries and limits which also means having consequences when children break the rules. In many circumstances taking away something often teaches children a lesson.  I disagree with posting it all over the internet. This is a discussion that can and should happen in the home, between parent and child (of any age), rather than sharing the issue and humiliating their child. 

I often relate a similar story with my own children when talking about consequences with parents. When my boys were about 7, 5 and 2 we had tickets to breakfast with Santa and a parade after that. The older boys had been before and really looked forward to this annual event.  They were at the age that they constantly bickered and fought (often) and it just wore me out. 

The day before the event I told them that if they did not stop fighting they would not go to breakfast with Santa.  Well, it must not have been an hour later that the older two were fighting and I said, “that’s it, you are not going to see Santa or the parade!”  I picked up the phone and called a friend who had two children and asked if she wanted to join us the following day to see Santa.  The following day the 2 year old and I left the house and the 7 and 5 year old starred out the window crying as I backed out of the driveway.  I will never forget those sad faces. I was equally sad as I too loved taking the kids to this annual, but they had just pushed and pushed. They still say they remember that punishment and my friend still has the picture of her kids on Santa’s lap! 

The moral of this is really two fold. A parent’s job is to be a parent and at times it is hard, really hard. But teaching children about consequences for their choices and behavior is one of the most important jobs a parent has. With that being said, humiliating your child is never appropriate, even when you are pushed to the limits.  Being a parent means you can’t resort to acting like your child.

Daily Dose

Baby Teeth to Big Teeth!

1.15 to read

Proper dental care for your child begins early, really with the eruption of that long awaited first tooth.  It is easy to wipe off the first teeth with a wet washcloth or baby toothbrush.  It is easy in the beginning when your baby will not be bothered by it, it gets a bit harder as your baby decides to clamp down and not open their mouth.  Why a child figures this out before they are one, who knows? 

Parents should know that they never put their baby to bed with a bottle, that is why there are “bars on the crib”, the bottle should not go behind the bars!  Same thing if you are breastfeeding, do not let your child fall asleep on the breast or nurse off and on through the night as this may also contribute to cavities.  The saliva in a baby’s mouth helps cleanse the teeth as well, so you want to have time without milk in the mouth for this natural cleansing to occur. 

I usually start talking about using a toothbrush around 9-12 months when your child can hold a toothbrush and put in in their own mouth.  It is a fun “game” to play as you brush your own teeth and they want to mimic the behavior.  For some reason a child also always wants your toothbrush so often Mom or Dad is suddenly using the Dora toothbrush while child has nice Oral-B!  

At any rate, you can begin using a non fluoride baby tooth paste and as your child starts to mimic spitting out toothpaste you can buy a children’s brand toothpaste with fluoride.  Get into the habit of “play brushing” twice a day. 

Next hurdle is flossing which is now called “jumping rope” by our favorite pediatric dentist.  I found “jumping rope” to be a bit of a challenge with a toddler but it is just an attempt to start thinking about flossing.  Like everything else it takes practice and most kids will open their mouths and let you help floss once they are a bit older around 2 1/2 - 3.  Don’t hold them down flailing and crying to floss...try, try again as they become more cooperative. 

Lastly, try to avoid sticky foods.  Knowing that it may be challenging to get a really good “brush and floss” in with an 18 month old, limit raisins, sticky juices, and all of those gummy snacks that will stick in the grooves of the teeth.  Water should be drink of choice between meals and milk with meals, all of this out of a cup after the age of 1!

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