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Daily Dose

Baby Naming in the Hospital

1:15 to read

An interesting article was published this week in Pediatrics. If you have had a baby or visited the newborn nursery you typically see that a newborn is named “Babygirl or Babyboy Smith” on their crib and chart.  These are the temporary names given until the baby is named and the birth certificate is filled out. Well, it seems that these temporary names can cause quite a bit of confusion and may also contribute to medical errors, especially when there are babies with the same last name.   

These temporary names are even more problematic when a newborn is admitted to the neonatal intensive care unit (NICU), which was the case for my grand daughter last summer. While there may be few orders in the regular newborn nursery which are used for every baby, in the NICU each baby has many different orders and issues.  

A study was done looking at ways to cut down on medical errors in orders written in the NICU by using more distinct temporary names for newborns. In the study they incorporated using a mother’s first name into the newborn’s first name (for example, Susansgirl Smith). By changing the manner in which temporary names were used there was a 36% reduction in orders being placed in the wrong chart and then having to be retracted.

So, the next time you head to the NICU or newborn nursery for a visit you may soon notice a difference in the way temporary names are used. I can see how this would really make a difference as we often have several newborns in the nursery with the same last names and it can be confusing, even when the chart is labelled “name alert”. I like this idea and I would think it would be easy to implement this change without needing a lot of new training or computer programs.  We will all just get used to seeing longer temporary names on those baby cribs!

Daily Dose

Ear Tubes

1:00 to read

I had been seeing a 3 year old VERY verbal patient for several months as he would intermittently complain to his mother that his “ears were ON?”.  He would tell her this off and on but could not explain what he meant by this statement. He did not say his ears hurt, he did not have a fever, he was sleeping well….but he seemed to be bothered enough to talk about it from time to time.

 

His mother brought him in to see me a few times and his exam was normal…but one day when she brought him in I noticed that he had clear fluid behind his ear drum(serous otitis). His eardrum was not inflamed and his exam was otherwise normal.  When a child has fluid behind their ear drums it is not always a sign of infection, and in this case you watch and see if the fluid goes away on its own. 

 

Well, he continued to talk to his mother about his “ears being ON”, and he even told his teachers a few times.  Because he continued to talk about it ( over about 3 months) I sent him to see a pediatric ENT.

 

When the ENT saw him he also noted that he had some fluid behind one of his ear drums. Because he had had persistent fluid it was decided to place ear tubes….

 

And guess what? Once he had ears tubes placed he told me his “ears had turned off”!!  I guess he sometimes felt funny or heard sounds differently and that was his way to express his ear issue - on and off! What took me so long?

Children continue to amaze me. 

Daily Dose

Eating Disorders

1.30 to read

I see a lot of girls who are preoccupied with their weight. It seems that more and more girls, at younger and younger ages begin to ask, “am I fat?” or “does this dress make me look fat?” or even “why do I have a fat on my stomach that I can pinch?”.  

The world we live bombards young girls with images of being thin and of the “perfect body”.  We all know that a Barbie doll is not a realistic image of a woman’s body, just as the cover of People magazine or the cover of Teen Vogue is also not always “real”.  Many models are 10-20% below their ideal weight, and movie stars often have their pictures “photo-shopped” to appear thinner.  The obsession with being thin has only continued to contribute to the increasing incidence of eating disorders, in girls as young as 10 and 11.  

Anorexia and bulimia are both examples of eating disorders.  Anorexia is a syndrome in which there is insufficient caloric intake to maintain normal weight and growth, which is associated with a disturbed body perception, an intense fear of weight gain, and obsession of being thinner. Girls (who are more commonly affected) truly believe that they are fat, even when they are emaciated and they fail to be able to distinguish a healthy weight.     

Anorexia occurs in about 1% of the adolescent population, and is most commonly seen in females (90%), who are Caucasian (95%). It is also seen more commonly in middle to upper middle class families.   

Bulimia is defined as binge eating followed by compensatory behavior in order to prevent weight gain.  These behaviors may include vomiting (purging), laxative abuse, diuretic usage, stimulant abuse, and enemas.   

Girls who develop eating disorders often have many common personality characteristics. They are typically pretty, over achieving, perfectionistic, anxious, sensitive, self critical, and have a desire to please others.  They often will say that their eating disorder “gave them a sense of control in a world out of control”.  

I see many young girls (and I have treated 2 anorexic teen age boys) who have what I call, “disordered eating”. In other words, they are the picky eater who has gotten even more picky. They are suddenly obsessive about food, count calories, weigh their food or talk about being fat.  They talk about diets and may have mother’s who are very self conscious about their weight as well who may also have “eating issues”.  There is often discussion at meals about who will eat what, how much and when. Mealtime is often an anxiety provoking, stressful “event”.  In other words, food has become a preoccupation.   These symptoms coupled with a preoccupation about appearance and body image are warning signs of developing a full blown eating disorder.    

If your child is showing any of these symptoms, and you see abnormal weight loss or unusual behaviors surrounding eating and mealtime the most important thing you can do is to talk to your doctor. Do not wait until your child has a full blown eating disorder.   You do not have to see your daughter have weight loss, missed periods, secretive behaviors surrounding mealtimes, evidence of binge eating, or ritualized eating behaviors to be concerned about a possible eating disorder. The earlier the problem is recognized and addressed the easier it is to treat. 

Both anorexia and bulimia treatments are intensive and involve an interdisciplinary approach.  Treatment teams should include your primary care physician (who is comfortable treating eating disorders), a psychiatrist and/or psychologist, and a nutritionist.  It takes a team to treat these issues. It also takes a great deal of family involvement, including both individual and family therapy. 

The best advice I have is to begin family mealtimes at young ages where the focus is on eating a healthy meal together. Less focus on food and more focus on family values, attitudes and behaviors will help to instill healthy eating habits.  A little family exercise is a good thing too.  

Daily Dose

Check Up Questions from The Kid's Doctor

1.15 to read

The longer I practice the “smarter” I think I get to be. Maybe not “smarter” but for sure wiser.  An example of this is how I (now) ask questions about family routines. 

For many years I have asked parents about their child’s daily routines, such as bedtime, sleep habits, breakfast and dinner time, after school activities etc.  This is great for infants, toddlers and preschoolers, but I suddenly realized that by the age of 5-6 years, most kids do a great job with answering questions, and yes they do so honestly! 

So, to get an idea about mealtimes, I usually ask a child what they have for breakfast, especially the school aged children. My mother always told me breakfast was “the most important” meal of the day and that continues to be true. Too many children leave home in the morning, ill prepared for school and academics, due to the lack of breakfast.  Once I hear how a child starts the day it is a good introduction to other meals. 

I ask kids of all ages about dinner time and “who fixes dinner?”.  I am surprised and saddened to hear how often a child does not know what a family dinner is. But at the same time another group will tell me that “mommy and daddy both cook”.  Love that!

On to bedtime. If you ask a 6 year old what time they go to bed they say “zero eight zero zero”.  Now that took me a while to figure out that they are all telling time on digital clocks!  I totally get the code now. I also ask them who puts them to bed, if they have a hard time going to sleep, if they stay in their bed all night and when do they get up for school.  Good way to hear about routines and sleep.

I also ask them questions such as “ when do you brush your teeth”, “what do you wear on your head when you ride your bike or scooter?”, “where do you sit in the car?” and they always have honest answers. (us parents tend to sometimes fudge things a bit, but not a kid). 

 

I think I will keep adding to “ Dr. Sue’s test questions”, and call it “Kids say the honest things.”

Daily Dose

Measles Outbreak

1:30 to read

Entering Disneyland where the sign reads, “The Happiest Place on Earth”, it does not also say, “Beware of Infectious Diseases!”.  But, if you think about it...what better place to contract any infectious disease than Disneyland where many of the visitors are under the age of 12 years....and I know from my own experiences as a parent taking children to Disney...even if not feeling well nothing stops a child at Disney. That means not even a fever.  (Other parents have reported the same thing to me when they went;  fever/tylenol and then off to theme park). 

So, now reports of at least 70 cases (and counting) of measles which children have contracted while visiting Disneyland in December. Not all of the confirmed cases have even been in California with cases are now in Utah, Washington, Colorado and Mexico.  With continued new cases, and our mobile population, unintentional exposures will occur, so unfortunately there are expected to be more cases.

Measles is a VACCINE PREVENTABLE DISEASE!!!  I repeat, you can prevent measles but that means your child needs to receive an MMR at 1 year and again between 4-5 years of age.  About 3/4 of the current new measles cases were unvaccinated, by choice.  Several of the children were too young to receive the vaccine and so they were unprotected for that reason.  Orange County (home of Disneyland) has one of the highest rates of vaccine refusers, and Dr. Bob Sears practices there as well where he admits that “many/most” of his patients refuse some vaccines.  In my humble opinion he has had a big impact with families who are making vaccine choices. Dr. Sears' books are “wishy washy” on this subject and he has proposed an “alternative vaccine schedule” which has not been scientifically proven to work. Dr. Paul Offit a pre-eminent scientist, doctor and vaccine proponent has some good articles discussing his feelings about alternative vaccine schedules. Feel free to check them out. 

Enough of the soap box...but this should be yet another wake up call that many of the diseases younger parents think are “not around” are indeed showing a resurgence.  Measles cases are the highest they have been for over 20 years in the U.S. Pertussis (whooping cough) rates are still on the rise here as well.  Polio continues to be a problem in other parts of the world despite huge efforts in vaccinating and trying to eradicate this disease.

Fortunately, there have been no deaths in the latest measles outbreak but there have been hospitalizations.  Only hoping people go get their children vaccinated as there is no other way to stop this.  It makes so much sense and seems simple. There are so many places to get a vaccine!! 

Daily Dose

Taking Your Child to the Doctor

1:15 to read

I imagine that you have heard the saying, “motherhood is the necessity of invention”?  It seems I must use this saying often as I can overhear my nurses quoting me and using the phrase as well.

 

There are many times I find myself in an exam room with a young patient and their mother when the mother says, “I forgot the……”. Sometimes it is a diaper (easily available in any pediatrician’s office), maybe a bottle (we have those too), a child’s favorite “lovie” (dire), and in many cases a pacifier.  Getting through the office visit without some of these necessities may make not only the child miserable, but also their parent.

 

Just the other day an adorable 5 month old baby and her cute mother came in because the baby had a cold and some eye drainage. Her mother was concerned that she might have an ear infection.  The first part of my exam was easy and the baby had a clear chest and no respiratory distress. She let me look at her nose and throat as well. Then it was time for the ear exam and of course the ear canals were waxy and I could not see her ear drum.  This means I have to use an instrument to remove the wax from the ear canal before I can get a good look at her ear drum.  The first ear was cleaned out and her ear drum was clear!!  But the second ear was more difficult to clean and the baby started to WAIL during this. Her mother looked frantically for something to soothe her..but she had forgotten her diaper bag with all of her stuff. So, once the ear canal was cleaned …she was pronounced ear infection free. While this was great news for the mother, the baby just continued to cry, loudly and angrily. 

 

I was trying to discuss the cold with the mother, but it was difficult for either of us to hear with the baby screaming. What to do…..? The only thing I had in the exam room was the basket of lollipops and stickers that we offer to children at the end of their exam.  I tried making a “sticker pop” on a tongue depressor to entertain and distract the baby…no such luck. The mother then looked at the lollipops, took out a grape one and unwrapped it and put in the baby’s mouth…INSTANT calm and smile on her face!!  Hysterical laughter from both of us as we took a picture to send to the father with the caption…Baby’s first food!!  Priceless. 

 

Love a mother like that…motherhood IS the necessity of invention!!

Daily Dose

Treating Altitude Sickness

1.30 to read

What can you do if your child suffers with altitude sickness.With winter breaks in full swing, many families are traveling. Some families are heading to the mountains to ski and encounter higher altitudes.

I seem to get several calls each year about “acute mountain sickness” which may occur when traveling to altitudes above 5,000 feet (1,500 meters),  but is typically associated when travelling to altitudes of 8,000 – 14,000 feet (2,440 – 4,270 meters).  To give you a frame of reference, Denver, Colorado is 5,280 feet above sea level, while Vail, CO is 8,200 feet. Fortunately, most people will not have serious problems when traveling to higher altitudes.  The human body acclimatizes to higher altitudes by allowing your body to function with less oxygen without having distressing or debilitating symptoms.  Despite that, the body is not functioning as well as it does at sea level, as the air is less dense at higher altitudes and consequently there is less oxygen available for breathing. The first thing you may notice is a slight increase in respiratory rate, which will help to increase oxygen delivery to the lungs but at the same time results in the loss of extra CO2.  Some people may also notice an increase in heart rate. I think that most children without underlying medical problems (chronic pulmonary or cardiac problems), seem to actually acclimate better than adults. But in some cases you may notice that your child has non-specific symptoms such as irritability (I must admit hard to tell if altitude, traveling or just having a bad day), decreased appetite, headaches, disrupted sleep (always seems to happen when travelling with children) and occasionally vomiting. All of these symptoms usually resolve after several days and may be minimized by planning a gradual ascent to higher altitudes.  So, driving may be better than flying, but…..I can remember several days while driving to Colorado with cranky children and we were not even out of Texas! I also think one of the boys vomited due to the driving and not altitude. Oh well, fond memories nonetheless. For some children and teens who have experienced repetitive episodes of altitude sickness I have used a prescription medication called Diamox to minimize symptoms.  I would not recommend this for young children.  You should speak with your doctor about the use of this medication, as it aids in acclimatization by increasing the excretion of bicarbonate in the kidney, which will stimulate the respiratory rate and improves oxygenation.  Some families who are frequently sick when skiing or hiking also have portable oxygen to use to help alleviate symptoms for the first several days they are at higher altitudes. For most of us, just maintaining hydration and taking the first few days of exercise a little slower is enough for our bodies to acclimate and enjoy the trip! That's your daily dose.  We'll chat again tomorrow. Send your question to Dr. Sue right now!

Daily Dose

Does Your Child Have A Crooked Finger?

What Can You Do For A Crooked Finger?I received an email via our iPhone App from a mom who was worried that her daughter had a “crooked” finger.  She did not give any more specifics, but the most common finding in children is a curvature of the 5th or “pinky” finger called clinodactyly.

The word clinodactyly is derived from the Greek words kliner “ to bend” and dactylos, “a finger”.  Clinodactyly is typically caused by abnormal growth and development of the small bones of the finger resulting in the curvature of the finger in the same plane as the palm.

Clinodactyly may occur in up to 10% of the population, but occurs to different degrees.  It is typically a benign condition but has been associated with numerous syndromes where it occurs in combination with other abnormalities. There are several common characteristics seen with clinodactyly. It  is more common in males and is often bilateral (occurs on both hands). It is frequently seen in families as an inherited “condition” and is thought to be autosomal dominant,  so when you go to a family reunion look at everyone’s fingers as you probably have a lot of siblings or cousins who have the same bent finger. When clinodactyly is minimal and does not cause any problem the best treatment is simply watchful waiting.  If the “deformity” becomes progressive as a child grows, then xrays may be obtained to further delineate the abnormality and surgical treatment may be undertaken.  A board certified hand surgeon would be the preferred choice to do this surgery. Send your question to Dr. Sue!

Daily Dose

Homeopathic Medicine

1:30 to read

I am sitting here writing this while “sucking” on a honey-lemon throat lozenge and drinking hot tea…as it is certainly cough and cold season and unfortunately I woke up with a scratchy throat. I am trying to “pray” it away and drink enough tea to drown it out. While I am not sure it will work, drinking hot tea all day will not hurt you!

 

At the same time (multi-tasking) I am also reading an email from a mother with a 4 month old baby, and they are out of town. Her baby now has a fever and runny nose and she sent me a picture of a homeopathic product for “mucus and cold relief” and wonders if it is safe to give to her infant.  The short answer is NO…even though the product says BABY on the label and has a picture of an infant.

 

Although homeopathic medicines were first used in the 18th century and are “probably safe” it is still unclear if they really work. Unfortunately,  there have been adverse events and deaths associated with some products ( see articles on teething tablets). The principle of homeopathy is that “ailments can be cured by taking small amounts of products that, in large amounts, would cause the very symptom you are treating. In other words, “like cures like” as these products contain “natural ingredients” that cause the symptoms that you are trying to treat, but that have been so diluted as to hopefully stimulate your body’s immune system to fight that very symptom. In this case, congestion and runny nose due to a cold.

 

So…I looked at all of the ingredients which included Byronia, Euphrasia, Hepar and Natrum…to name a few. Byronia is used as a laxative for constipation, Euphrasia is supposed to help with inflammation, Hepar is for people who tend to get “cold and therefore cranky and irritable” and Natrum is used for inflammation due to “too much lactic acid”.  This is the short version. The bottle also says contains less than 0.1% alcohol, but it has alcohol! 

 

While the FDA does monitor how homeopathic medications are made, they do not require these companies to show proof that these medications do what they say they do, as they are “natural”.   With that being said, natural does not always mean effective or safe.  Just as over the counter cold and cough medications are not recommended for children under the age of 2, I too would not recommend homeopathic products be given to an infant.

 

Best treatment for a cold and cough in young children?  Use a saline nasal spray followed by nasal suctioning to relieve the nasal congestion and mucus. I would also use a cool mist humidifier in the baby’s room to keep moisture in the air and help thin the mucus ( especially once the heat is on in the house). Make sure the baby is still taking fluids (breast or bottle) but you may also add some electrolyte solution to give your baby extra fluids if you feel as if they are not eating as well.  Lastly, always watch for any respiratory distress or prolonged fever and check in with your pediatrician!

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