Daily Dose

Getting Your Baby to Sleep!

1:30 to read

Did you know one of the biggest Google internet searches for parents revolves around “how do I get my baby to sleep?”  I guess that any new parent in the middle of the night is online searching for “THE ANSWER”, so of course you “Google it”!

Now that we are grandparents and the baby is about 6 weeks old (although technically she is a week old, as she was 5 weeks early) my son is also looking for answers on the internet to that same question....how to make her sleep, so I can too! He even asked me if their was “magic” to this?

If only there was an answer on Google or in any book. It just takes time and every baby is different.   I guess there are some babies that sleep through the night from the time they get home from the hospital, but I have never seen one.  I think some parents just forget that at some time or another they were up at night with a newborn.

A newborn baby does not understand circadian rhythm and they are really not “trying” to keep parents up at night.  It takes weeks for a newborn to even begin to have some “routine” to their day and I try never to use the word “schedule” when discussing a newborn.  A baby is not a robot, they do not eat every 3 hours and then sleep for 3 more before eating again. They are “little people” and their tummies sometimes need to eat in 2 hours and then later it may be 3 hours before another feeding.  Don’t you sometimes eat an early lunch one day and a later lunch the next? 

But by trying to awaken the baby throughout the day and offering a feeding every 2-3 hours you will hopefully notice after several weeks that your baby is eating more often during the day and suddenly may thrill you and sleep 4 hours at night. it just takes time....YOU cannot make it happen.  I tease new parents that awakening a newborn during the day and prayer is about all you can do....all babies do eventually sleep, but it may not be right after you get them home from the hospital...think several months (as in 2-4) and you will be happy if it happens sooner.

Lastly, with all of the tech in the room, don’t pick up your baby in the middle of the night if they are just “squirming” around. Babies are notoriously loud sleepers and if they are not crying let them be and you may be surprised that they arouse and went back to sleep. If your baby cries you absolutely go get them and console them and feed them too if it is time. An infant should not be left to cry. 

This too shall pass and sleep will come, but there will be new stages down the road that will keep parents up at night, of that you can be assured. Comes with the territory.

Daily Dose

Middle Ear Issues

1:30 to read

I just read a really intriguing study on children who have persistent middle ear fluid (otitis media with effusion) in The Canadian Medical Association Journal. Persistent middle ear fluid is fairly common and is often a reason that children will undergo a day surgical procedure to insert tympanostomy tubes (ear tubes).  In fact, my 11 month old granddaughter just had tubes placed.

The treatment for middle ear fluid is often to just “watch and wait” and in many cases the fluid will resorb on its own and the problem is solved. But for persistent fluid surgery was often recommended. For older children I often would see if they could learn the “valsalva maneuver” which would increase the pressure in the nasopharynx and help open the eustachian tube. This is the same maneuver you use to “pop” your ears after an airplane flight.  The only problem is that some children don’t seem to be able to understand how to do this as there is not a way to really let them know how it feels when performed correctly.

In this study, 300 children aged 4 -11 years who had had recent ear symptoms and persistent fluid in one of both ears were randomized to “usual care” or were taught to use a nasal balloon.  The nasal balloon with auto inflation is a device which is inserted into one nostril while occluding the opposite nostril and the child blows up the balloon through their nose. By doing this they increase the pressure in their nasopharynx and open up the eustachian tubes and clear the fluid.  Genius…. the child can see that they are doing the maneuver properly as the balloon blows up….and it is both painless and fun!!

In the study the children, used the nasal balloon 3 times a day for up to 3 months and they were more likely to “achieve normal middle ear pressure” than the children who did not use the auto inflation balloon.  

This is certainly low cost and can be taught in the pediatrician’s office with minimal time and effort for both parent and child. Who wouldn’t want to try this rather than have a surgical procedure?

I am now going to look into where to purchase this product (wish I had thought this up) and try this on some of my own patients. I am sure there are plenty of kids that would love to blow up a balloon with their nose…perfect for a show and tell demonstration as well!

Daily Dose

It’s The Season For Bug Bites & Stings

1:30 to read

Children love to be outside in the spring and summer when the daylight is longer and the backyard, playground, or campsite can become a magical play space. Insect bites are bound to happen. Most are just an annoyance, but make sure you know which ones to be concerned about and which ones may just require a hug and a kiss.It’s that time of year when insect bites and stings start showing up on your kids. Knowing how to prevent and treat common insect bites and stings, and knowing when to not overreact, can help keep your kids safe and healthy.

Babies and children may be more affected by bites or stings than adults. Let’s start with some common spring and summer insects. Spider bites Most spider bites do not actually penetrate the skin, and the majority of spiders found in the U.S are mostly harmless with the important exception of the black widow spider and the brown recluse spider, which are both dangerous to humans. Spider bites are fortunately uncommon. In many cases, presumed spider bites are actually due to another skin condition or an insect sting. The black widow spider is said to feel like a pin-prick, and some victims do not even realize they have been bitten. Sometimes you may notice double fang marks on the skin. The most common symptoms where the bite occurs are immediate pain, burning, swelling, and redness. Other symptoms may include chills, fever, nausea and vomiting, and severe abdominal pain. While black widow spider bites are hardly ever fatal, rare deaths have occurred from brown recluse spider bites and are more common in children than in adults. At first the bite of a brown recluse spider leads to a mild stinging, followed by local redness and severe pain that usually develops within eight hours but may occur later. Some reports of brown recluse bites describe a blue or purple area around the bite, surrounded by a whitish ring and large red outer ring in a "bull's eye" pattern. A fluid-filled blister forms at the site and then sloughs off to reveal a deep ulcer that may turn black. If bitten by a brown recluse or black widow spider - Cleanse the wound. Use soap and water to clean the wound and skin around the spider bite. - Slow the venom's spread. If the spider bite is on an arm or a leg, tie a snug bandage above the bite and elevate the limb to help slow or halt the venom's spread. Ensure that the bandage is not so tight that it cuts off circulation in your arm or leg. - Use a cold cloth at the spider bite location. Apply a cloth dampened with cold water or filled with ice. Seek immediate medical attention. Treatment for the bite of a black widow may require an anti-venom medication. Doctors may treat a brown recluse spider bite with various medications.

Bee Stings In most cases, bee stings are just annoying and home treatment is all that's necessary to ease the pain. But if you're allergic to bee stings or you get stung numerous times, you may have a more serious reaction that requires emergency treatment. Most of the time the symptoms from a bee sting will be minor. Your child may experience a burning pain, a red welt, and slight swelling. Some children may have a stronger reaction with extreme redness and swelling that gets bigger over a couple of days. Children, adolescents, and adults who are allergic to bee stings may have a severe reaction called anaphylaxis. About 3% of people who are stung by bees quickly develop these anaphylaxis symptoms. - Skin reactions in parts of the body other than the sting area, including hives and itching and flushed or pale skin (almost always present with anaphylaxis) -  Difficulty breathing -  Swelling of the throat and tongue -  A weak and rapid pulse -  Nausea, vomiting or diarrhea -  Dizziness or fainting -  Loss of consciousness -  Convulsions -  Fever -  Shock may occur if the circulatory cannot get enough blood to vital organs. For most Bee stings you can apply an ice pack or cool compress, a meat tenderizer solution which can be made by mixing one part meat tenderizer and 4 parts water. Soak a cotton ball in the solution and apply to the bite for 15020 minutes. A baking soda paste works well or a topical anti-itch cream such as Calamine lotion. Talk to your pediatrician about ways to prevent bee stings and possible immunotherapy if your child is allergic. Multiple stings can be a medical emergency in children, older adults, and people who have heart or breathing problems. If your child is allergic to bee stings always have an EpiPen available and use it right away as your pediatrician has directed. Wasps, hornets, and yellow jacket stings are similar to bee stings.

Fire Ants A bite that will get your child’s attention quickly belongs to the fire ant. Fire ants are so named because their venom induces a painful, fiery sensation. When disturbed, fire ants are very aggressive. To help children avoid fire ants, parents should regularly check their yards and their children's play areas for the presence of the ants and their mounds. Then they should either eliminate the ants or make sure children avoid them. If a child is stung, apply ice to the bite site for 10 to 15 minutes. Elevate the extremity where the child was bit. Clean and clip the child's fingernails to prevent any secondary infection that can result from scratching the bite. Check with the child's pediatrician for the correct dose of an oral antihistamine to reduce itching and inflammation A small percentage of children stung -- probably less than 0 .5 percent -- experience a severe (anaphylactic) reaction. These occur within minutes of a sting and vary in severity. A child who is stung and within minutes begins to experience hives, weakness, dizziness, wheezing, difficulty swallowing, shortness of breath or confusion should be taken immediately to the nearest emergency room. Watch the area for signs of infection over the next couple of days.

Ticks Ticks are common in grasses and wooded areas. If you have pets make sure they are tick free. Ticks are usually harmless but they can carry Lyme disease. To remove a tick begin by taking a cotton swab or cotton ball. Dip the swab or cotton ball in a small glass container that you will be throwing out after use. Place a small amount of rubbing alcohol in the bottom of your container. Use at least 2 tablespoons of alcohol. Dab on the site of the tick on the child or pet. Do not let it run, that is why you are dabbing it rather than pouring it on the site. If there is excess, dab it with another cotton swab or cotton ball. Let this cotton ball or swab sit on the tick for 3 minutes. This suffocates the tick and he will back out for retrieval with tweezers. If that method is unsuccessful, use the alcohol swab again and let the area dry. Then take a clean, unused cotton swab and glob a dollop of Vaseline petroleum jelly on the site where you see the tick. Let this stay on top of the tick for 3 minutes. You will then remove the tick and the Vaseline petroleum jelly.

Mosquitoes Probably the most common insect bite in the spring and summer come form mosquitoes. Ivillage.com has these tips for treating and preventing mosquito bites. The usual reaction is a local skin inflammation that is red, raised and very itchy. If your child scratches the bite, it may become infected as well. Here's what you can do for your children to help ease the itch and pain caused by mosquito bites. Treatments: Apply anti-itch creams like calamine as needed to help prevent scratching • Use anti-inflammatory creams like cortisone cream to help ease the inflammation and itching • If there is severe itching and multiple bug bites use antihistamines like Benedryl. Because they tend to make children drowsy, they work particularly well at night. •  Antihistamines like Claritin, Allegra, and Zyrtec tend to be much less sedating, buit check with your pediatrician about the correct dosage and whether these products are safe for children. Other Suggestions:
 Keep your child's fingernails cut short to prevent scratching • Apply cold wet compresses to the area to ease discomfort • Have your child wear long pants and long sleeves (if the temperature is bearable) • Make sure window screens are used if you keep windows open in your home • Use insect repellant to help prevent bites from occurring Choosing an Insect Repellant DEET is the best insect repellant in terms of effectiveness against flies, gnats, chiggers, ticks and other insects. The higher the DEET concentration the better it works. For children, however, the EPA recommends a concentration of 10 percent or less to prevent side effects and toxicity.

Scorpions Scorpion bites are painful but mostly harmless. The only dangerous scorpion in North America, probably the most venomous of all North American bugs is the bark scorpion. Bark scorpions are found in all of Arizona, extending west across the Colorado River in to California and east in to New Mexico. Scorpions are related to spiders, ticks and mites. Usually, they only sting to protect themselves or of they feel threatened. Scorpions can get caught up in bedding or crawl in to shoes so always check your child’s clothing and bed if you suspect scorpions may be around.  Scorpion stings without a serious reaction can be treated with ice on the sting and over-the-counter pain medication. Bark scorpion anti-venom is available only in Arizona. Any sting that shows signs of a bark scorpion needs to be treated at a hospital. Anti-venom has been shown to significantly reduce the effects of the sting. Children love to be outside in the spring and summer when the daylight is longer and the backyard, playground, or campsite can become a magical play space. Insect bites are bound to happen. Most are just an annoyance, but make sure you know which ones to be concerned about and which ones may just require a hug and a kiss. For pictures of several types of insects such as Black Widow and Brown Recluse spiders, check out http://www.webmd.com/allergies/slideshow-bad-bugs

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

Teething Pain

1.15 to read

I am getting a lot of questions from patients related to teething, pain, and the routine use of products to alleviate the pain.  

The FDA recently issued a warning to parents who use OTC products like Oragel and Anbesol on their infant’s gums for relief of teething pain. These products come as both liquids and gels, and benzocaine is the active pain reducing ingredient.

It has now been found that excessive amounts of benzocaine may lead to a very rare condition called methemoglobinemia. (Hemoglobin is the molecule in the red blood cell that carries oxygen) . With methemoglobinemia there is a reduced amount of oxygen that is carried in the bloodstream which may lead to a bluish gray discoloration to the skin, shortness of breath, a rapid heart rate and fatigue and lethargy. Again, key word is rare.

Although the FDA did not withdraw these products from the market, they did recommend that they not be used in children under two, and then should be used “sparingly”. Unfortunately, the benzocaine containing products do not yet contain warning labels and some of my patients are still asking about using them.

I have never recommended using these products in the first place. I always wondered if they really helped a baby who was teething, as I am not sure you can tell when a baby is actually teething.  If you watch any infant over the age of 4 months, their hands are always in their mouths, and they are constantly drooling!  Does that mean they are getting teeth? Unlikely, as most babies don’t even cut their first tooth until about 6 months, so they have been drooling and putting anything they can in their mouths for months prior. The drooling and “gnawing” on their hands (and sometimes feet too) is rather a developmental milestone and not always a sign of teething.

My theory is let the baby chew on a teething ring, a frozen piece of a bagel (cut into quarters, good for gnawing but you need to throw it out when getting soft to avoid choking) or rub their gums with a cold washcloth if you think your child has discomfort.

The same thing goes for using acetaminophen or ibuprofen excessively. Some parents are giving a nightly dose during the “teething months/years” and this is too much medicine.  Children go through a lot of sleep changes and awakenings which tend to occur during suspected early teething times and many parents attribute nighttime awakenings to teething pain. They are not synonymous. Remember that temporal events are NOT always causal.

Babies will get teeth for many years to come and once the first several have broken the skin we don’t seem to pay as much attention anyway, right? I mean, who is going to worry about a child cutting their 2 year old molars, there are way too many other issues to deal with (tantrums, climbing, throwing food) than if their molars are erupting.

So, save your money and don’t buy teething products. Now even the FDA agrees!

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 drinks...in 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.

Daily Dose

Lactose Intolerance

How do you know if your child is lactose intolerant?A parent emailed me via our iPhone App and asked if her child’s constipation, which started as he was transitioning from formula to whole milk, could be a sign of lactose intolerance. She is concerned because her son is now having very hard stools.

Actually, lactose intolerance does not typically cause constipation, but conversely causes abdominal pain and often loose stools or diarrhea.  In the case of this 1 year old child who suddenly is having hard stools, it may seem to be “caused” by the switch from formula to whole milk, but is probably coincidental. It is routinely recommended that parents stop giving a child a bottle and formula at 1 year, which often results in a toddler drinking less milk (recommended amount is about 16 ounces /day) and therefore they are getting less fluid which may result in harder stools. This is also the age that children’s diets are changing as they are self feeding and often eat a lot of carbohydrates (breads, noodles, rice etc) and fewer fruits and vegetables, even when offered as they become “pickier” eaters. All told this often leads to bouts of constipation that can be managed with the addition of more fluids as well as clever ideas such as apple prune juice, bite sized prunes (often can be “sold” as raisins to a young child) and even with milk of magnesia if necessary. (see older posts on constipation) Lactose intolerance is defined as the inability to digest lactose which is a sugar found in milk and milk products.  It is due to a deficiency in the enzyme lactase, which is produced by cells lining the small intestine.  Lactose intolerance is uncommon in young children and is typically not seen before the age of 2 -3 years.  It is more common in older children and teens who may complain of abdominal pain, cramping, gas, bloating and diarrhea after ingesting dairy products. In most cases lactose intolerance is diagnosed on clinical history alone, and if suspected is managed by eliminating dairy products to see if the symptoms improve.  In many cases even children with a lactase deficiency may tolerate some lactose in their diet such as a scoop of ice cream, or milk on their cereal, but only experience symptoms when they have “too much milk”. Fortunately, there are products, such as lactose free milk, which will provide a child with the necessary vitamin D and calcium which is so important during childhood. Dietary supplements should also be used in children who do not drink milk in order that they meet their daily calcium and vitamin D requirements. Lastly, lactose intolerance is different than a milk allergy which is fairly uncommon and is due to an allergy to the proteins in milk, not the lactose.  True milk allergy usually presents in early infancy. That's your daily dose.  We'll chat again tomorrow! Send your question to Dr. Sue!

Daily Dose

Breast Feeding Woes

1:30 to read

I recently read an editorial in The New York Times entitled “Overselling Breast Feeding”. It was written by Courtney Jung who is a professor of political science at the University of Toronto.  It was quite interesting to me as she stated “the moral fervor surrounding breast feeding continues unabated, with a steady stream of advocacy and education campaigns”.  The WHO (World Health Organization) developed “ten steps to successful breast feeding” in hopes of increasing breast feeding initiation and duration around the world. Hospitals have been designated “Baby-Friendly”  (aren’t they all supposed to be?)  if they adhere to these steps as well. But the United States has done well with breast feeding rates as 79% of mothers initiate breast feeding.

Most, if not all of the new mothers I make rounds on are proponents of breast feeding. They have read the books, gone to classes and are determined to be successful at breast feeding. But, in my experience over the last several years, I have actually seen more and more new mothers becoming over-wrought and wary of breast feeding fueled by the “rules” that they are being required to follow. With that being said, having someone “tell you that you must breast feed your baby in the first hour after birth”, and that “your baby must remain in your room 24 hours a day“, and that they “may not have a pacifier”, “and should “breast feed on demand” is actually anxiety promoting and leaves many a new mother exhausted and tearful within a day or two of having a baby. 

While breast feeding is “natural” it also requires some practice and the only practice is really “on the job” training.  Some babies just latch on quickly and are pros immediately, but not all babies will become proficient at breast feeding in the first day or two. The mothers are told to “let the baby nurse on demand” and some mothers have had their babies at the breast for hours on end and are exhausted, with sore and bleeding nipples. I have walked in to too many hospital rooms with a mother in tears and a fretful baby, and a “helpless” new father.  Some feel as if “they are failures” as mothers before they even are discharged, and at the same time are having serious doubts about continuing to breast feed.  They are sure that their baby will catch serious illnesses and have a lower IQ if they don’t breast feed, but how can they maintain this constant breast feeding and no sleep and never put a pacifier in their baby’s mouth??? Is there only one way to be successful at breast feeding?

I loved breast feeding but it was a long time ago and we were instructed by caring nurses “to just go home and put the baby to the breast every 2-3 hours”. While that may not have been the best education has the pendulum swung too far?  Will giving the baby one bottle when a mother is having postpartum anxiety and sleeplessness really harm the baby?  Should a mother have to sign an order allowing her baby to have a pacifier??   While guidelines for breast feeding are helpful should they be so rigid that a mother “gives up” on breast-feeding because she can’t follow 10 steps in the first 24-48 hours?   

The New York Times article was quite interesting and I had to agree with many of the author’s  points. Supporting a woman’s choice to breast feed is admirable and “policy changes promoting maternity leave, and flexibility” are definitely needed to encourage women to continue to breast feed. But as she states “is all of this breast feeding advocacy crossing the line?”   A mother should choose to breast feed because she wants to, and that does not mean if her baby does not breast feed in the first hour that she will never bond with her baby or be successful at breast feeding.  Some woman are unable to breast feed for a multitude of reasons and that decision should not label her as a “bad mother”.  Again, breast feeding, like a woman’s breast, is not “one size fits all”. 


Daily Dose

Stop Cyberbullying Now!

1:30 to read

There have been a lot of recent stories about bullying occurring on social media sites. I have such mixed feelings about social media, and ironically I myself am writing a blog for our website and app.  The Kid’s Doctor is  active on Twitter (@TheKidsDoctor) and Facebook (TheKidsDoctor) as well.  So, I realize to stay current, social media is a must and it is usually quite beneficial and is a source of instant information and sharing. Maybe too instant?

But with that being said, why do some people feel they may use it as a “bully pulpit”.   Why do they feel compelled to be mean and even vulgar?  I spend a great deal of time discussing this topic with my adolescent patients and their parents but I am concerned that sometimes even parents are guilty of “cyber bullying”.

How do parents teach their children right from wrong, or how to behave appropriately in society....by modeling behavior themselves. Our children are watching us and looking to their mother and father to “show them the way”.  Leading by example is often difficult but absolutely imperative, and this includes social media and bullying.

For all of the years I have practiced I have seen that in most, maybe not all cases,  having parents who model appropriate behavior is one of the keys to raising healthy, compassionate, resilient and well balanced children.  It sounds simplistic but it works.

Curt Schilling recently wrote an interesting and compelling article discussing this very issue.  Right after he posted a congratulatory tweet announcing his daughter’s college acceptance his daughter received terribly inappropriate hateful and hurtful messages. He was able to “trace” the tweets to accounts and therefore knew exactly who had sent these messages. Unfortunately, there are often not consequences for cyberbullying or inappropriate behavior....at least for now.  Did the messengers get punished? Did their parents even know? I should hope so.

Social media is here to stay, but there has to be a way to teach our children (and adults) that there are consequences for behaving badly especially when the whole world is aware of your behavior.  It is time for the pendulum to swing back to morals, civility,manners....and as my mother would say to me, “Emily Post would not approve”. 


Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.