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Daily Dose

Baby Food in a Pouch?

1.15 to read

I have a lot of patients who have been coming to my office bringing along these new “pouches” of food for their babies. Somehow, pureed baby food has gone from jars to squeeze pouches with new concoctions like peas, pears, and carrots, or squash, apples and broccoli.  There are many different makers of this latest “baby invention”.  

The pouches are handy for feeding infants as you can just squirt some of the puree onto the spoon and then feed the baby.  Most infants initially eat pureed foods whether from a jar, a pouch or even pureed at home, as they begin foods and have to  “learn to eat” from a spoon. 

But, I am noticing several new problems related to these convenient and “healthy” pureed foods.  As I had more and more mothers pulling these pouches out of their purses and offering them to their toddlers I started to read the labels. 

Marketing is always important and the moms told me these were organic and natural etc. etc. They said their kids “loved” them and the mother’s were excited that their children were getting their fruits and vegetables. Here is the good news/bad news story. 

Many of the brands that I looked at might have squash as the first ingredient on the front label, but when you looked at the actual ingredients apples were listed first. Same for other combinations, while the veggies were prominently displayed on the front label the fruit was actually the main ingredient. 

Now, I am not saying that fruit is not good for you, of course it is! But, fruit contains natural sugars, tastes sweet and good, and is also caloric. I asked different mothers how often their child “slurped” their snack and many started telling me they gave them to them throughout the day. “It is so much easier than trying to get them to eat vegetables. I don’t even try real veggies as they won’t touch them.” Back to baby food for those that are not babies! 

The problem with this is that toddlers need to start experimenting with textures and different foods. Children are supposed to learn to feed themselves and pick up cooked squash and broccoli and ripe pears. 

They need to feel the texture between their fingers as well as in their mouths. Have you watched a child between 9 months -2 years eat?  Usually not that pretty, but effective. They mush it up in their hands, put it in their mouths, taste it, swallow some, maybe spit some out, and then repeat the process. This is very important for learning about textures and tastes. 

You also learn to throw food off your tray and the lesson that if you throw food all of the time your parents will not pick it back up. Sometimes the dog will eat it, which can be fun to watch, but you also might get hungry and actually try a bite or two of different things.  If you don’t experiment with textures and messy self feeding at a young age your child may miss out on some of the important “side effects” of self feeding and have issues with textures as an older child. 

Pureed pouches of food might be convenient, and may be good for travel or a special treat but should not be substituted for “real food”.  Too many of these pouches a day could lead to too much sugar and cavities, especially as the puree is “sucked” into the mouth and the teeth are exposed to more sugar than if eaten and swallowed in small bites. 

I remember those pouches being for astronauts who were in space and had to squeeze their pureed meal into their mouths due to zero gravity, they were not meant for earthly children as substitutes for eating food. 

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

Daily Dose

Adenovirus is Going Around

Adenovirus is going around. Just what is it and how do you treat it. Ask Dr. Sue.I can’t quite get off the topic of winter viruses without also discussing adenovirus.  We have already discussed RSV as a cause of colds and bronchiolitis and those ubiquitous rhinoviruses, but another nasty virus that spreads like wildfire during the late winter months is adenovirus.

Adenovirus is one of those viruses that can cause just about any symptom from head to toe (literally).  In children it most commonly causes respiratory and intestinal symptoms. This blog is really going to cover the respiratory illnesses related to ‘adeno’. We will talk nasty tummy stuff another time. Just like other viral infections, adenoviral infections seem to cluster, as these viral particles are easily spread from person to person. The virus is spread by respiratory droplets or by coming into contact with objects or surfaces on which the viral particles have landed and then are picked up by our hands. Surfaces like doorknobs, telephones, toys and desks etc.  Adenovirus is hardy and like many viruses can live on surfaces for many hours. Once exposed to the virus, a child will typically develop symptoms in 2-14 days after exposure. In other words, you rarely know where you picked this up, but daycare and schools are prime breeding grounds for viral infections, and most children will develop an adenoviral infection before they are four years old. Adenoviral symptoms are typically like other respiratory viruses, fever, cough, sore throat, runny nose and swollen lymph nodes. Adeno may also cause croup, bronchiolitis (like with RSV) and pneumonia.  The symptoms of the virus typically last for 7 -10 days, although it may take up to two weeks for the infection to resolve. Adenovirus also causes conjunctivitis  (inflammation of the membranes that cover the eye) which is commonly referred to as pink eye.  With adenoviral pink eye you usually see swollen eye lids, that may even appear to be slightly bruised and bright red eyes with excessive tearing and drainage. At times, there seem to be epidemics of this type of conjunctivitis. In younger children adenoviral infections may also be associated with an ear infection which develops after the upper respiratory symptoms. The only treatment for these nasty viral infections is the USUAL:  treat the symptoms. Fluids, rest and a cool mist humidifier to help with the cough. I am a big believer in taking hot showers, or sitting in a steamy bathroom or bath to help loosen up all of the mucous (how can one little person make so much?), and good nose blowing to relieve the congestion.  The sore throat may be relieved by eating popsicles and ice cream, while others prefer warm tea or lemonade, whatever is most soothing for your child. For the discomfort in the eyes, you can use an over the counter artificial tear drop to relieve the “grainy” feeling and help with the discharge. Try to keep your child’s (and you too as adults will get this) hands away from their eyes.  Frequent, but not excessive hand washing is one of the ways to prevent passing the virus to other family members. So, there are many viruses out there right now, and who knows which one is the definitive culprit for the coughs and colds we are all experiencing. Knowing the names of all of these viruses may make you feel better that you are not getting the same thing over and over, but at the same time the treatment for all  viral respiratory infections is still to treat the symptoms and wait! Antibiotics don’t help these infections.  They all take time to go away. No one ever wants to hear that. That's your daily dose for today. We'll chat again soon.

Daily Dose

It's Croup Season!

1.45 to read

It is definitely fall and all around the country, the temperatures are cooling off and the chill is in the air at night. With the cooler temperatures more of those pesky viruses come out and once again I am seeing croup.

Croup is a viral upper respiratory infection that causes swelling of the trachea and larynx (voice box) which causes young children to cough and at times to bark like a seal. This hoarse raspy cough is most problematic in younger children who have smaller airways.  

Children often go to bed at night with nothing more than a little runny nose, and then suddenly awaken with this barking cough. Many times the noise emanating from the child’s room sounds more like a sick animal than your previously healthy toddler and may be alarming to both parents and the child.  

Whenever you awaken to a croupy child, the first thing to do is turn on the hot shower and shut the bathroom door as you head down the hall to your child’s room.  After getting your child, grab several of their favorite books and head back to the steamy bathroom. Sit in the bathroom and try to calm your child down and let the steam work.

Typically in several minutes (or until the hot water runs out) their coughing should improve and they will relax. Remember, they have suddenly awakened and are trying to figure out what is going on as well so they may appear to be tired and anxious as well.

In most cases the steam and humidity will help to relax the airway. If the steam doesn’t seem to be working after 5– 10 minutes try going outside into the cool night air. Many times a frantic parent will put their child into the car for a trip to the ER, only to find the child perfectly calm and no longer coughing on arrival to the hospital. The reason being, the cool air has also helped to calm the coughing.

If your child is having stridor (a high pitched squeal) when they breath in and appears to be having any respiratory distress with pulling of their ribs when they are breathing (called retractions), then you need to call your doctor. If they are coughing and turning bright red while coughing be reassured that they are still moving air well. You should not see any duskiness or blue color and if you do call 911. (Remember the adage blue is bad, and red is good).

If by morning your child is having continued symptoms you may want to see your doctor as steroids (given orally or by injection) may be used to help shrink the airway swelling. Most cases of croup do not require hospitalization. After several days of croup your child will probably be well.  

Lastly, older children and adults may also get the virus that causes croup, but with larger airways will simply show signs of laryngitis and being hoarse.

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

Daily Dose

Talking With Children About Sex Education

None of us wants our children to have bad memories of how they learned about their own bodies and sexuality.I have been helping teach a course to elementary students on their bodies and sexuality. It is really interesting as we teach both parents and their children, in separate rooms, so that parents are comfortable with discussing sexuality with their children as well as having doctors and nurses teach basic sex education to their children. It is a three-week series with different topics each week and really opens up the lines of discussion for parents and gives them information for further subjects and discussion as their child matures.

The most striking thing to me is how many parents admit to being "afraid or nervous" or feel ill-prepared for this discussion and many of those feelings come from their own experience learning about "the birds and the bees". If there is anything to learn from this, one would think, is that none of us wants our children to have bad memories of how they learned about their own bodies and sexuality. So, I recommend that starting from a young age you use the correct noun for body parts. No one has a problem saying this is your eye, or nose or ear, so when identifying other body parts stick with the correct words. By doing so you begin this journey of sex education with the correct words at hand. It is easier to discuss a subject with knowledge of the body part you are talking about than having to back track and re name things. Lastly, when your child asks a question, take the time to answer them truthfully, even if it is only a one-line answer, rather than saying "I can't talk to you about that yet" or something along those lines. Open the door slowly and it is easier to go in....remember it is a continuum of information which does not end for many years. That's your daily dose, we'll chat again tomorrow.

Daily Dose

Migraines in Children

1:30 to read

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

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

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

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

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

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

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

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

Daily Dose

Constipation is a Common Pediatric Ailment

1.15 to read

I received a question from one of our twitter followers about her daughter who was recently found to be constipated. She wanted some information on treating constipation.

Do you know how common constipation is in pediatrics? I must discuss this at least once a day, and I have dealt with “poop issues” in my own home while raising my boys. As a mother, I was really amazed at how much discomfort and disruption of a child’s life simple constipation can cause. Constipation is defined as reduced frequency of or painful stooling in a child for two or more weeks.

The majority of pediatric patients have functional constipation, and rarely have issues secondary to anatomic, physiologic or metabolic problems. It is not uncommon to see children have a change in their stools as they become toddlers with varying eating habits, during elementary school years when children don’t want to use the bathroom at school and even later in life.

Once your child has been potty trained, it is often difficult to get a good history of their “poop” habits, and many children and even teens will report that they have “normal” stools and then on abdominal exam or x-ray are found to have “tons of poop”. There are several ways to treat constipation, and there are several different products that may be used without problems.

For daily management of constipation I recommend using either milk of magnesia (MOM) or Miralax (polyethylene glycol) which may be used safely for long periods of time. MOM is easy to use in an infant and can be started in 1/4 to 1/2 teaspoon daily and may be increased as necessary in order to produce a soft stool at least every 24 to 48 hours.

As children get older they may not be as willing to take MOM in larger doses and Miralax has truly been a “miracle” in that it is tasteless and odorless and may be mixed with juice for easy acceptance.  The starting dose for Miralax is 1/2 to 1 capful (17 grams) per day in a child over the age of one to two years. I tell the parents again to titrate the dose either up or down, to produce a soft stool every day or every other day.

I also advocate using bite sized prunes, prune juice-apple juice “cocktails”, and Metamucil cookies to help maintain normal “mushy” stools. For children who have problems with constipation or resistance in stooling, it is important that they have a dedicated time each day to use the bathroom. Good poop habits often take practice before becoming routine. Treating for many months may not be uncommon, especially in children who have ongoing constipation issues.

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

Daily Dose

Uber & Teens

1:30 to read

Do you have Uber cars in your area?  I first found out about Uber (and I am only using them as an example) when my son lived in NYC and often used the car service. Later on I heard about college kids using Uber as well.  In that case, many college kids did not have cars and/or they were being “responsible” after being at a party.

But recently, in conversations with my adolescent patients, I have heard that high school kids are using Uber to come home after a party, or other social activities. In otherwords, their parents are not picking them up from the dance, concert, or party but are letting their children (often young girls) call Uber.  Where are their parents and what are they thinking?

I realize that once your child heads off to college you hope and pray that they are making good choices and are being safe. You don’t really plan on picking them up after an event or talk to them that same night about what they have been doing and with whom.  But when we had high school age children, my expectations were that we, the parents, were responsible for taking our teens to the party and to pick them up. Once they were driving the “rules” changed a bit in that they were then often driving themselves to an event and then would drive home and we would be up waiting for them to get home.  They always knew that we would be there when they got home and also that if there were any “issues” we were also available to pick them up. We talked a lot about underage drinking as well as driving and responsibility.  Never did I think they would call a cab or car service, nor was that idea ever broached, they were to call their parents.

So now that these “app” car services are available around the clock, are parents abrogating their responsibilities for parenting teens?  By allowing their teens to call a car service for their ride home, are parents seemingly not interested in where their child has been or who they have been with or what they have been doing before they get home?  You certainly can drop your child at a concert or party and tell them to text Uber to get a ride home, but does this parental non-participation quietly help to condone inappropriate, risky, teen behavior?

Although picking your child up at the end of the evening or checking on them when they pull in the driveway will never ensure that your teen does not get into trouble, I think it does help them think a bit more about having to interact with their parents at curfew time. This “worry” might help lead them to make a better decision about drugs, alcohol or whom they are hanging out with. Putting teens into the “hands” (cars) of strangers as their ride home just seems wrong. Parents be aware. 

Daily Dose

The First Newborn Visit

I know the office will be busy with many new babies born at the end of last week.Monday morning heading to the office and I know the office will be busy with many new babies born at the end of last week. This is one of my favorite times when young parents bring that precious your-baby in after being home for a few days. Now the questions begin, not usually as many when you are in the hospital and the your-baby has nurses helping as caregivers.

The most common response after I ask, "how things are going as a family", is "we are tired, but elated", and "I don't know babies could make that much noise". IT is amazing that even while sleeping babies do make a lot of little squeaks, burps, snorts and toots! The biggest thing to review at this visit is how the your-baby is feeding, stooling and wetting and making sure that they are not too jaundiced. Physiologic jaundice of the newborn is normal, but occasionally a better develops high levels of bilirubin and may need to have it treated with phototherapy. Lastly, sleep position. Tired parents will do almost anything to get their newborn to sleep. The only condition is that they must sleep on their backs. The "back to sleep" program has drastically reduced the incidence of SIDS, so all infants should be put down to sleep on their backs. Babies do need tummy time while they are awake, but it is tempting to let them sleep that way if they seem more comfortable. The answer when I am asked this is NEVER, until your your-baby is old enough to roll over on their tummy by their self. The best part of the visit is that I get 15 minutes of holding a newborn! That's your daily dose, we'll chat tomorrow.

Daily Dose

Do Your Kids Drink Milk?

1:30 to read

I have noticed over my years in practice that fewer and fewer patients  drink milk every day. You may wonder why I ask the question, “does your child drink milk?”.  Calcium is an important nutrient which in necessary for healthy bones. But you have to put that calcium into your bones when you are a child and adolescent which means milk at meals. By age 18 years about 90% of your peak bone mass has been laid down.

Most children that I see are not drinking many soft fact, many tell me they don’t like “fizzy drinks” at all...even on special occasions they would prefer “fancy waters”.  But, when I ask them what they drink at dinner they often say, “water”. I then ask their parents if they even pour milk for their children and they too say their child prefers water.

I am not sure how water became the preferred drink among many of my patients. When and how did parents and children decide that children need to drink a certain amount of water a day. I have never found any recommendations about water consumption in healthy children.  But there are recommendations regarding calcium and Vitamin D intake.

Children between 1-3 years of age need 700 mg/day of calcium, while 4-8 year olds need 1,000mg/day and 9-18 year olds need 1,300mg/day.  It is also recommended that all children between ages 1-18 years receive 600IU of vitamin D a day.  The best way to meet calcium and vitamin D needs is through food sources, including milk.  

With statistics showing that less than 15% of adolescent girls in the United States meet the recommended dietary allowance for calcium, many young girls may be setting themselves up for osteopenia and osteoporosis in their adult years. 

Exercise is equally important for maintaining bone health...which means more time outside or in the gym, rather than in front of a screen!

Change your habits and start pouring milk with your child’s meals and then go outside and get some vitamin D and exercise.


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