Daily Dose

Roseola Cases Rising

1.00 to read

I have recently seen several cases of roseola and don’t want this viral illness to be confused with measles.  Roseola, also called exanthem subitum, is a viral illness which is typically seen in children between the ages of 7-13 months.  90% of cases of roseola occur in children under the age of 2 years. This viral illness is most often caused by human herpesvirus (HHV) type 6 (not the herpes that causes cold sores).

Children with roseola develop a fairly high fever (up to 104 degrees) which lasts for 3-7 days.  Other symptoms besides the fever may include fussiness and decreased appetite. Some children may have mild upper respiratory symptoms, or swollen gland in their neck. For many children, when the fever is treated, they are fairly happy and playful. 

The high fever seen with roseola ends fairly abruptly at which time a pinkish/red rash appears on the child’s chest (trunkal area) and then spreads over the body. It is at this time that parents (and grandparents) worry that their child has measles.  Roseola is typically easily distinguished from measles by history alone, as the rash of roseola develops once the fever has resolved, and the child no longer appears ill. Children with measles are still sick when the rash appears, usually a day or 2 after their fever and symptoms have developed. The few children I have seen with measles looked very ill and uncomfortable and may be older.  Young children with roseola are happy and playful once the rash appears.  The rash may last anywhere from hours to days.

Roseola, like most viral illnesses, is spread through respiratory droplets after an infected person coughs, sneezes, or talks. Another person then comes in contact with the droplets and within 5-15 days after exposure they become ill. With young children who share “all” it is easy to see why roseola is a quite common childhood illness. 

Roseola is seen year round, but may have peaks in spring and fall. Roseola is rarely seen in adults, so it is thought that having roseola in childhood may provide some lasting immunity.

The treatment for roseola is totally symptomatic. Fever control to help a child feel more comfortable, fluids for hydration and anything that just helps your child to feel better.

Once a child is fever free and the rash has developed they are no longer contagious.

Don’t confuse measles and roseola.....they are totally distinct illnesses.  Remember you can prevent measles with the MMR vaccine.  Roseola is just another one of those illnesses most children and parents must muddle through.

Daily Dose

Bug Bite or Staph Infection?

I received another e-mail with an attached picture (you can take a look too) asking me my thoughts on what to do about this child’s bite. My first thoughts are, “is this really a bite, or is it an early staph infection?”I received another e-mail  asking me my thoughts on what to do about this child’s bite. My first thoughts are, “is this really a bite, or is it an early staph infection?”

This is often a common problem even in the office setting. A parent brings in a child and there is no history of a known bite, and at this time of year there really are not that many bugs creeping around biting our arms and legs. At the same time, the lesion looks fairly benign, it is not warm to the touch, or tender, and the patient or parents aren’t sure how long it has been there. When faced with this dilemma, I often take a “sharpie” marker and draw a circle around the area and instruct the parent to keep the area clean with an antibacterial soap (don’t worry, “sharpie” does not wash off that fast). I also have them give the child a dose of an antihistamine, like Benadryl (diphenhydramine), which might help if it is indeed a bite. Then we wait and watch. If it is a bite, in most cases it will look a little better by the following day, or at a minimum unchanged. In the case of a staph skin infection the area typically appears larger than the original “sharpie” mark. It is also usually hot, red and tender by now. It may have “declared” itself to be a bacterial infection as it has a purulent center that can be drained. When I say drained, I mean at the doctor’s office so it can be done in a sterile manner and also the purulent material may be sent for culture and sensitivity. DO NOT poke, squeeze, take a needle or anything to drain the lesion at home. Remember NO PICKING!! By doing this at home you may take a completely benign lesion that will go away on its own in several days, and actually break the skin and cause a secondary infection. This is hard for many to resist, but resist! If the said “bite” turns out to be an actual skin infection, then by culturing the drainage, the organism which is often staph, may be identified as a “staph” that is susceptible to many antibiotics, or it may indeed be the unfortunately more and more common MRSA. MRSA or methicillin resistant staph is causing frequent skin infections within the community rather what we previously thought of as a hospital infection. The most important thing is to pay attention to the “bite” and if is worsens make sure you go see the doctor. We should get up follow up in the next several days!! That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

New Year New You

1:30 to read

With the New Year upon us what better time to talk about changing some habits.  Why is it that habits are certainly easy to acquire, but difficult to change?  I just saw a book on The New York Times Bestseller list about “Habits” and I am committed to reading it this year.  

I know that we started many “bad” habits when my husband and I were new parents, and I talk to my patients every day about not doing the same things I did.....but, even with that knowledge there are several recurrent habits that I wish parents would try to change....or better yet, don’t start.

Here you go!

#1  Do not have your baby/child sleep with you  (unless they are sick).  This is a recurrent theme in my practice and the conversation typically starts when a parent complains that “I am not getting enough sleep, my child wakes me up all night long”.  Whether that means getting in the habit of breast feeding your child all night long, or having your two year old “refuse” to go to sleep without you...children need to be independent sleepers. Some children are born to be good sleepers while others require “learning” to sleep, but either way your child needs to know how to sleep alone. I promise you...their college roommate will one day thank you.

#2  Poor eating habits.  Family meals are a must and healthy eating starts with parents (do you see a recurrent theme?). I still have parents, with 2, 3 or 4 children who are “short order cooks” which means they make a different meal for everyone.  Who even has the time?  Sounds exhausting!!  Even cooking 2 meals (breakfast, dinner) a day for a family is hard to do for 20 years, but enabling your children to have poor eating habits by only serving “their 4 favorite foods- is setting them up for a lifetime of picky and typically unhealthy eating.  Start serving one nutritious family dinner and let everyone have one night a week to help select the meal. Beyond that, everyone eats the same thing.  Easy!  If they are hungry they will eat.

#3  No electronics in your child’s room. If you start this habit from the beginning it will be easy....if you have a TV in your child’s room when they are 6-8, good luck taking it out when they are 13-15.  First TV in their room should be in a college dorm.  For older children make sure that you are docking their electronics outside of their rooms for the night. Everyone will sleep better!

These may sound easy....so give it a try.  

Happy New Year!



Daily Dose

Foods You Can Eat When Breast Feeding


Should breast feeding moms avoid certain foods?I was making hospital rounds today and talking to all of the new moms (and dads) about their newborns.  I love talking to new parents about the importance of having healthy meals to support breast feeding! I even had a young dad asking “what foods should I avoid cooking for my wife while breast feeding?”  How cute is that! Can we clone him?!

After breast feeding my 3 children, I have decided that you can really eat whatever you want!  I know some people swear that certain foods you eat will cause a breast fed baby to have gas. But think about it, bottle fed babies and breast fed infants all have GAS!  None of the formulas contain broccoli, or cauliflower or beans or tomatoes and bottle fed babies have gas too. It is just a fact, newborn babies are gassy for the first several months as their digestive tracts mature. And yes, it is stinky too! So… I told this dad, “good for you for cooking for your wife.  Make her healthy, well balanced meals and throw in a few of her favorite foods.”  I would not change anything unless you can definitely correlate that a food ALWAYS makes your baby more uncomfortable (and that is so hard to keep track of). Eat what you want (in moderation) to be healthy and happy.  I have no data but feel certain that happier mothers must in some way have an effect on a  baby, so at least enjoy mealtime. When I had a colicky baby (previous post), I tried eating only broth and bland foods, and with me equally miserable and starving…this stressful situation only got worse. Final words, if I was going to try eliminating anything from my diet while breastfeeding to try and help “relieve “a gassy baby, it would be excessive dairy, as there has been some data on this. Remember, everything in moderation. I’m willing to bet that by the time your baby is 4 months old (the magic age) you are not even worried about what you are eating, as you are having too much fun laughing with your baby! What foods (if any) bothered your baby while breast feeding? I would love your comments.  Leave them below. That’s your daily dose for today. We’ll chat again tomorrow.

Daily Dose

The Importance of a Healthy Lunch

Now that our school-aged children have gotten back to class it is a great time to discuss school lunches. I like to ask my patients and their parents about their school lunches. It is interesting to hear what kids like to eat for lunch. Of course like so many things, there is a huge amount of variability surrounding school lunch choices.

It seems that elementary school aged children enjoy buying school lunch especially when the cafeteria experience is novel. But because the choices are typically not as plentiful in the elementary school cafeteria, some children will choose to the take their lunch. The one thing that I find to be most typical is that the pizza and chicken nugget lunch days are a lot more popular than grilled chicken and vegetable days. Unfortunately, school lunches are not typically the most “healthy” and are often loaded with fats. By the time children reach middle school and high school the cafeteria becomes more of a smorgasbord of choices and the “hot lunch” tray is not the only choice available. With the vast array of choices from salads, to sandwiches and many snack items, I often hear that the “tween” and teen set pick and choose their favorite foods and fall far short of anything that resembles a well balanced lunch. The combination of a hamburger and fries, or a bagel and yogurt may be the chosen lunch items. I rarely hear milk as the beverage of choice. By the time teens their junior and senior year in high school many campuses allow their students to have “off campus” lunches. In this case the “fast food world” awaits them around every corner. It is not unusual for this age group to enjoy a “super sized” combo meal and a large Coke. Most of the girls I see opt for a “diet” Coke to round out the meal. Probably not what most parents would consider a healthy lunch. The word fruit is rarely mentioned. To start teaching children about healthy eating habits we need to begin in early elementary school. Sit down with your child and the school lunch menu and look over the choices. It might make sense to “make a deal” that they may buy their lunch two days a week and you will pack them a lunch on the other three days. They can put stars or check marks on the days that they want to buy. When packing a lunch let your child be involved, while at the same time guiding their choices. The prepackaged pizza and lunchables are not good choices. Choose whole grain breads for the sandwich. Use lean sandwich meats. Add some cheese for some added calcium. Peanut, almond or cashew butter provides protein too. Cut up veggies in clever ways to make them more appealing. Chips may be baked and put them in your own sandwich bag. There are many great ways to pack and delicious and healthy lunch, and it is probably cheaper too! That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

The Danger in BPA Bottles

I have been getting plenty of question about BPA in your-baby bottles.I recently received an email from a parent who’s 4 year old son is a patient of mine, and she is pregnant and due with a your-baby girl in the next month. On top of all of that she is also a pediatrician. At any rate, her question was regarding BPA (bisphenol A) in bottles, and whether I thought she should throw out bottles that she had used with her son in favor of newer bottles. I will tell you that her son is a perfectly delightful, bright, inquisitive and developmentally normal little boy and he received breast milk and formula from BPA containing bottles.

With that information, and knowing that I am thrifty, I thought long and hard and decided that in my opinion I would toss the old bottles in favor of the newer BPA free bottles. The top manufacturers of your-baby bottles voluntarily stopped using BPA in their bottles at the end of 2008. These bottles include, Dr. Brown, Avent, Playtex, Evenflo and numerous others. It is easy to find BPA free bottles that are well marked and most large chain stores are no longer selling your-baby bottles containing BPA. The cost involved to replace old bottles seems minimal, and the data regarding the safety of BPA to infants and children continues to be released with more ongoing studies underway. There will be more data available in the coming months and years. The Endocrine Society who held their annual meeting last week presented “worrying” evidence about the effects of BPA , including the statement that “endocrine disruptors (which includes BPA) do have effects on male and female development, prostate cancer, thyroid disease, and cardiovascular disease”. There are concerns that infants and children may be particularly susceptible to BPA and possible long term effects on brain development and behavior. So, with these recent studies and more concern regarding the levels of BPA found in your-baby bottles as well as comparison data of exposure to BPA between breast and bottle fed infants, it seems prudent to me to purchase newer bottles that are BPA free. Cross this issue off of the mother worry list. The cost of new bottles is minimal as compared to future concerns about BPA. That's your daily dose for today. We'll chat tomorrow!

Daily Dose

Leaving Your Child Home Alone

At what age can you leave your child home alone?

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

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

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

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

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

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

Daily Dose

TV Show "The Slap"

1:30 to watch

I was intrigued by one of the new “winter replacement shows” on TV, entitled “The Slap”. After watching numerous ads promoting the show, my interest was piqued and I did a bit of research on the background of the show.  Seems that this was a book that was the made into a series in Australia, and now is a new TV drama for the states. (It does have a lot of good actors).


If you have not heard/seen anything about the show it is based on the premise that a child is misbehaving (really awfully I might add) while at a party with several families and their children. When this child gets totally out of line and his parents seem to either be unaware of his behavior or ignore the behavior, another parent (also a Dad) slaps the child.  And so it goes....the real question, “is it ever appropriate to physically discipline someone else’s child?”.

So, resounding answer is NO!  But at the same time this has illicit a great deal of discussion about parenting.  While there is no “right way” to parent, most of the parents I asked agreed that they have been in the position when they felt that a friend’s child was behaving inappropriately, and the parents of said child did not seem to react or discipline their child.  What do you do then?

Some say that while the child “deserved a good spanking” by their own parent, they would never physically touch another person’s child. But, sometimes you do find your self either telling the child’s parent to do something, or at least reprimanding the ill behaved child. It is always a slippery slope.

While it seems more and more parents are taking the “I choose to ignore the behavior” approach, or tell me, “I don’t want to use the word NO with my child”, children do need to be disciplined.  Everyone who has been a parent for at least a year should understand this. Children are like “cavemen”, they do not come out of the womb and understand social mores and behavior. We are all innately ego centric, self centered and want our own way....but parents are there to teach children that the world does not revolve around them. We are all in this society together.  That is what parenting is about...while there is not one way to get there, discipline is a must.  

Limits, boundaries, redirection and a clear cut “NO” teaches children how to behave....whether from a parent, a teacher or a family friend. A “slap”....never in my book.

Daily Dose

Life Changing Words

1.15 to read

What are the words that a child first speaks that changes everything??  Can you guess?   The first word that a child learns that is truly life changing for a parent is the word NO!  I have so many parents that have told me they are not going to use the word.....well how do you think you can go through parenting without saying NO?   

There are a lot of words that connote the same meaning, such as, “I would prefer that you didn’t do that”, or “ that was not a good choice”.  But the word NO is powerful and necessary as a parent, and a child quickly learns the power of the word as well. 

It is really cute when your child first “kind of understands” the power of NO.  Think about how many times a day a baby/toddler shakes their head NO. It really doesn’t matter what you ask them, their first inclination is to shake their heads NO. “Do you want ice cream?”, “NO”.  “Do you want to go to the zoo?”, “NO”.  The list is endless.  But, it is very cute as they start to figure out the difference between NO and YES.

The next life changing word, MINE!!  Suddenly a child learns about being possessive and they have a word for it. No longer are they just tugging at the toy they want, or holding their favorite stuffed animal or pacifier. When you try to take it away they say... MINE.  WOW... another powerful word.

Now, pause for a moment in development. What comes next?  Your child learns to link two words together (which is very important during the toddler years) and suddenly they blurt out...“NO MINE”.

Life is never the same again!!!! 

Let me know if you agree....and if your baby is under one...watch out this phase is coming. 


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