Daily Dose

Toddler Behavior

1.30 to read

Do you have a toddler? If so you are in the throes of some difficult, albeit sometimes funny, yet inappropriate behavior. It happens to every parent...suddenly their precious child turns into Dr. Jekyll and Mr. Hyde.  Somewhere around 15-18 months, you will most likely see this change in behavior. Although most books refer to the “terrible twos” I really think it is the “me no wanna” 18-30 month old. 

“Me no wanna” is the phrase we often used around our house, and it was coined when the boys were toddlers. It just seemed like the best line when our sweet toddler would rather have a tantrum than do the simple task that we wanted him to do. Example: please put your toy back in the box. “Me no wanna”, I would prefer to fall to the floor and scream.   

How is it that your typically sweet 20 month old child can be in middle of playing nicely and then suddenly seems possessed as they fling themselves to the floor kicking and screaming?  What is the matter?  Are they having a seizure? Or is it that “something” just didn’t seem right to them and they are angry and frustrated???  How can they change behavior so quickly.?   (hint, foreshadowing for those teen years). 

You never know with a toddler what kind of answer you will get when you say something as easy as “let’s get on your shoes to go outside”. Sometimes they happily run get the shoes, bring them to you, sit down and the shoes go on licitly split.  The next time they get the shoes, throw them across the room, lay on the floor and look at you like “me no wanna”. 

Trust me, you are not a “bad” parent, you are just living through some really challenging parenting. It is exhausting at times, but while this age is typically difficult it is some of your most important parenting. This is really the beginning of behavior modification.  Your brilliant toddler is testing you, this may be the first time you the parents understand why everyone talks about boundaries and consequences. 

Some children also express their “me no wanna” by acting out with hitting, biting and kicking. Again, very inappropriate behavior. Your job is to change that behavior by using time out, or taking away a toy or even putting the child to bed early.. There are so many ways to start letting your toddler know that there are consequences for misbehaving, and that tantrums don’t work. 

I am in throes of “me no wanna” again, only this time it is with a puppy! Seems very similar to me.

Daily Dose

Back-to-School & ADHD

Back to school and ADHD. How soon can you tell if your child has attention problems?This is the first full week of school for many students across the country and with just a few days of school under their belt, parents have already begun dialing and texting their pediatrician about their child's attention issues and ADHD.  

I have to smile/laugh, as I have already received more than a handful of phone calls directly related to the subject of ADHD.  This happens every year, somehow it has become predictable, and I can only continue to be amazed that any parent would think that a few school days is enough to determine anything about how the school year is going to go!  I mean REALLY (like my teenage patients like to say), I think everyone has ADHD for at least the first 7–10 days of school. That includes most teachers, administrators, school nurses, and yes, the students! Despite the fact that we all talk about “getting ready” for back to school, and establishing the bedtime routines, and early morning awakenings, followed by a healthy breakfast and an afternoon snack and homework done at a reasonable hour, it takes some time to really get it together.  It brings to mind the movie 'Home Alone' when they are all so organized for their early morning trip and then it all falls apart when the alarm clock doesn’t work and the “rush” begins. I saw a lot of tired children yesterday, who admitted that they had not gotten to bed as early as had been planned, but have better intentions for the next night. That seems more like reality for most of us. So, how can a parent call after 1 day of school to say “Johnny went back on his medication today and I don’t think it is working”, or “Sarah seemed to be distracted at school today and did not bring the right book home for homework and I think we might need to have a conference about ADHD”.  Does that sound silly to you? It happens every year. Think about your first day on any “new” job, it is often unorganized, difficult to focus, hard to remember what you need to bring to the meeting, or what form you fill out next.  Yet alone finding out where the bathrooms are, where you park etc. It is the same thing for our children as they start a new year. They may be in a new school, or at least a new classroom, often filled to the brim as new students are added at the last minute. They have never met the teacher before, who is also going to be giving them numerous directions for his or her classroom rules and expectations. They have to find the bathrooms, cafeteria, library and playground. They may have lockers far away from their classes, the text book that they thought was going to be used might have already changed. The list is endless.  Getting back into a “good school routine” is a bit of a journey and not a race, and giving a child a few days to figure it out seems to be more appropriate to me. With that being said, I called each of my patients back and basically discussed waiting for a week or two to get everyone settled in before making medication changes, or having conferences with teachers or pediatricians about attention issues.  Patience seems to be the word that comes to mind and remembering that starting any new “job” takes a bit of time to become adjusted. That's your daily dose for today. We'll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

Farmer's Marker: Family Fun!

1.15 to read

I was lucky to get a few weeks away and to travel this summer and came back with a renewed energy to cook even healthier meals.  If I could, I would plant a garden with a lot more than my few “scraggly” tomato plants, but Texas weather along with my less than green thumb seem to limit me. One of my new passions is going to one of my local farmer’s markets to buy local and fresh produce.  

What I have discovered is that the Farmer’s Market is a fun family excursion, it is free and what a great learning experience. Along the way you also get to buy fresh produce and commit to some healthier eating habits. Win, win, win!

During routine check ups I love to ask kids about their eating habits.  I usually ask “what is your favorite vegetable?”  I laugh at some of the responses, but I am impressed that some children really do love broccoli and spinach and I am convinced it is due to early exposure.  I also ask about favorite fruits and I also like to ask what they have for a favorite dinner and who cooks it.....a subtle way of getting some good information on family meals.

A trip to the market is a great teaching experience too - as children can learn what an eggplant looks like, or that there are so many different kinds of lettuce. Seeing the veggie in “real time” rather than on an I-pad is also important.  Who knew that there are round and long squash and that some looks like spaghetti on the inside?

So as you start back to school and hopefully cooler temperatures in the next month, let’s all try to be healthier.  More fruits, veggies and lots of color on the plate.....I may just try to plant a cucumber, I hear they are easy to grow?  I’ll keep you posted :)

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

Treating Motion Sickness

With spring break under way, I seem to be getting some phone calls from patients of mine who have been on the road travelling and dealing with a child with motion sickness.Many areas around the country are enjoying spring break. What's interesting this time of year and during the summer months, is the amount of calls I receive from patients of mine who have been on the road travelling and dealing with a child with motion sickness. Whenever I get calls like this it brings back memories of my own children and episodes of throwing up in many different locales, YUCK!  

So, maybe this will help you be better prepared than I was when this first happened to our family while riding in the infamous minivan. The most common cause of motion sickness is car sickness, but children may get sick while on airplanes or boats too. It seems that about 58% of children between the ages of four and 10 experience the symptoms of car sickness. Younger children are also affected, but may not be able to verbalize the sensations of motion sickness. It seems to be due to an increased sensitivity to the brain’s response to motions. The brain receives signals from the motion-sensing parts of the body (the eyes, the inner ear, and the nerves in the extremities), and in most situations all three areas respond to any motion. When the signals the brain sends and receives are in conflict, (typically between the ear which senses movement, while the eye does not), the symptoms of motion sickness occur. The signs of motion sickness usually start with a slight feeling of queasiness: “I have a stomachache” is heard from the backseat of the car. Dreaded words to any parent. In some cases children can be sick before you have even gotten out of town and on the highway. The initial nausea is then followed by a cold sweat, fatigue and loss of appetite. A younger non- verbal child may just become restless, pale, sweaty and cries. At some point these symptoms are usually followed by vomiting. By then you have figured it out! The best treatment for motion sickness is like many things: prevention! If you have already experienced motion sickness with your child plan ahead for trips. If your child is over the age of two, place them in their carseat in the middle of the backseat and face them forward. Provide a small nutritious snack prior to the trip rather than a big meal, and avoid dairy (there is nothing worse I can assure you from personal experience). Open the windows to provide fresh air. Do not let your child play video games or read while the car is in motion, Try to distract them by singing or talking. Sleeping may also be helpful, so at times you may plan your trip around naps and bedtime. Frequent stops for a child who is feeling sick are a necessity. Letting them lay flat for a few minutes while the car is stopped and even applying a cool rag may make them feel better. Try small sips of carbonated beverages or crackers to help the nausea. Some children who have a tendency to get sick may do well if they are pre-medicated for a trip with either Dramamine or Benadryl. Although these medications typically cause drowsiness, some children may have the opposite reaction and become agitated. You might want to try them prior to a trip. Check with your doctor about dosages. Lastly, be prepared and have zip lock bags and hand wipes available in case of emergency. This will make everyone in the car a little happier. That’s your daily dose, we’ll chat again tomorrow. Send your question or comment to Dr. Sue!

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Daily Dose

RSV is Going Around

RSV is here and can be one of the scariest illnesses for parents of young babies. Dr. Sue tells you what this virus is and the best ways to treat it. Whew, this is a  busy week! Busy for you too, I'm sure. I've seen many coughs, colds and another baby with RSV.  RSV is the acronym for respiratory synctial virus, which is a winter-time upper respiratory infection that causes colds and coughs, but also an illness known as bronchiolitis.

Bronchiolitis is an inflammation of the lower respiratory tract that is seen in infants and young children, often due to a viral infection. At this time of year, throughout the country,  the most common cause of bronchiolitis is RSV.  RSV is seasonal virus, and is  typically seen from November until April, but in recent days and weeks, the number of  young children coming to my office with coughs and wheezing just sky rocketed. Once you hear the frequent, tight, wheezing coughs in the hallways, and listen to a few wheezy babies, you know that RSV has arrived. Unfortunately, in my area it looks like it is going to be a busy RSV season. RSV is a viral infection, and like so many other viruses, including influenza, some years the virus just seems worse than others.  In the last few days I have already admitted several babies who had RSV bronchiolitis, and have required hospitalization for supportive care with oxygen supplementation. Fortunately, they are doing well and no one required intensive care. At this time of year, every parent I see who has brought in their sick, coughing, wheezing baby hears basically the same thing. “Your baby probably has RSV which is a viral infection, somewhat like a cold .” When you say RSV, they all cringe, but you need to understand what you are looking for. When older children and adults get this infection, we get a nasty cough, lots of congestion and have a dreaded winter cold.  But, when a baby gets this infection the virus may cause inflammation and constriction of the lower respiratory tract which results in wheezing and in some cases difficulty breathing. The key point is “difficulty breathing”. Babies who are having difficulty breathing will not only have a frequent tight cough, but they will also exhibit signs of “increased work of breathing”.  This means that you may notice that the infant is retracting, which means that they are using their rib muscles or abdominal muscles to help them breath.  This is a visible sign of respiratory distress, and you will see their chest cage move in and out as they work to breath. Babies may also grunt with each breath, or cough so hard that they turn dusky or blue. All of these symptoms are significant and are need for concern and a visit to the pediatrician.   With that being said, most babies handle the virus and will cough and wheeze and have a lot of mucus and secretions, but will not exhibit signs of respiratory distress. They may appear “pathetic” and cough a lot and be up and down at night due to cough and congestion, but they will not show signs of retracting or increased work of breathing. When your baby has a cold and cough it is imperative that you look at their chests. That means turn on the lights, lift up their jammies or unzip their onesie and look at how they are breathing. Is their chest sinking in with each breath?  Can you see their ribs moving in and out as they are retracting?  Are the using their abdominal muscles to help them breath?  Can you hear a wheeze or grunting or are they just congested and coughing? Lastly, look at their color. A baby who is coughing and turning red in the face is good, a baby with a  dusky or blue face or lips or mouth is bad. It is basic:  red is good, blue is bad! For infants who are showing signs of respiratory distress, they may need to be hospitalized for supportive care, and supplemental oxygen. (there is are recent study about using hypertonic saline treatments for hospitalized babies. It looks interesting).  Because RSV is a virus, antibiotics won’t help.  There are no medications to “fix” the problem.  It is once again “tincture of time” for the illness to run its course. That may mean several days to a week in the hospital for some babies. That's your daily dose for today. We'll chat again tomorrow. Send your question to Dr. Sue.

Daily Dose

A Baby's Neck Issue

1:30 to read

Torticollis is becoming more and more common and it may be related to several different things. Torticollis is defined as a “twisted neck”, or as my grandmother used to say, a “wry neck”.  Most of us have experienced a tight neck after a bad night’s sleep, and you can hardly turn your head to back out of the garage it is so painful, but be reassured your baby does not have any discomfort, but will just hold their head somewhat “tilted”.

A baby’s 40 weeks spent in utero may cause some positional deformities of the head and neck.  Due to the intrauterine positioning a baby may “favor” turning their head to one side rather than another. At the same time back sleeping which is recommended for all babies, may also contribute to torticollis.  

In order to help the baby resolve the tightness in the neck which is actually due to the sternocleidomastoid muscle being tight, your doctor may have you do several things early on to help stretch the neck muscle.  

If your baby prefers to look to the right they have left sided torticollis. In this case turn your baby in the crib so they have to turn to the left to look out (they don’t want to face a boring wall). When you are feeding them have the bottle on your right arm. When changing diapers, place the baby so that they have to tur left to see you.  Hold the baby on your left hip as well and burp them on your right shoulder. All of these strategies will help to stretch the muscle.  On top of this the baby needs to have tummy time, when awake, and work of having them turn to the left during this time too. Lastly, do gentle neck stretches 3-4 times a day and massage the tight muscle.  

If your baby prefers to look to the left also called right sided torticollis, reverse the above.

Your baby should continue to work on stretching so that their head will also not get flattened on one side or another, which is called plagiocephaly.  By continuing to have tummy time and neck stretches, most cases of torticollis will resolve. In severe cases or when you don’t feel that the baby is improving,  ask you doctor about the possibility of physical therapy.

Daily Dose

Eeek...Ticks!

1:30 to read

It is the time of year many families are spending time outdoors including camping and hiking. I often get phone calls from worried parents about finding a tick on their children and concerns about what to do.  Ticks are most active in the warmer months (April - Sept), while we are also enjoying vacations.  Many parents are concerned about tick borne illnesses,  as well as just being “grossed” out with the idea of finding a tick on their child. 

The number one thing to remember is to try to prevent a tick bite, which means using insecticide before you plan on hiking etc. It is important to use a product that contains enough DEET, so if you are going to an area with an increased incidence of ticks ( especially that carry disease)  use a product that contains 20-30% DEET, which will provide several hours of protection.  Make sure to avoid your child’s hands, eyes and mouth.   You can also spray your clothes with a permethrin product prior to exposure.  Interestingly, the clothes that have been sprayed with a 0.5% permethrin product remain protective through several washings.  

Now that you have protection before you go out you want to bathe or shower after you return from an outdoor activity, and the sooner the better.  This is the best time to check your child for ticks. Check their head and hair as well as in the ears, belly button, groin, between their legs and under their arms. 

If you find a tick use fine tipped tweezers to grasp the head of the tick as close to the skin as possible. Resist the urge to “yank” the tick, but rather apply slow steady upward pressure to release the tick from the skin. Once the tick is removed wash the area with alcohol or soap and water.  It is a myth that you can remove the tick by painting it with fingernail polish.  

While not all ticks transmit disease, in certain areas of the country the black-legged deer tick may cause Lyme disease.   In most cases a tick must be attached for 36-48 hours before the bacteria (Borrelia burgdorferi) is transmitted. So, back to the bath and look for ticks after you are home for the day. 

Once the tick is removed and the area is cleaned you are generally good to go. You do not need to “save” the tick to show to the doctor. But, if you live in an area known for Lyme disease ( the Northeastern U.S. in particular), watch for a red bull’s eye rash that spreads over several days. This typically occurs within a week after the tick bite. A small red bump left after the tick bite is not the same thing and will resolve in a day or two, rather than “grow”. Lyme disease also causes fever, chills, headache, joint pains and swollen lymph nodes. 

Lyme disease is best treated early with a course of antibiotics….so if concerned seek treatment in the early stages of infection.

Daily Dose

Fruits & Veggies in a Pouch

1.15 to read

OK, I am back to the subject of “squeeze pouch foods” or as another cute 2 1/2 year old called it “squeegy fruit”.  I have written about this before as I was fascinated by these when they first hit the market. On the one hand, I get that they are convenient and are easy to use for those first months of pureed baby foods, but beyond that, I think they are given to older children.  

It seems that more and more kids are enjoying “squeegy fruit” and also “slurping” pureed vegetables. The issue is these pouches foods are being “masqueraded” as healthy foods.  Yes, they are fruits and vegetables often mixed together, but if you read the labels it gets a bit more complicated.

I see so many toddlers in my office who are happily “sucking down” a packet of apples and blueberries.  These parents are adamant that their kids don’t drink juice boxes or eat “junk food” but at the same time they are letting their children “suck down” several of these pouches a day.  This is also often in place of meals, as many of these children are described as “picky eaters”.  I saw a little boy today who had been vomiting, but was on the exam table with pouch to mouth as he “drank/ate” a combo of apples, peas and something else.  (note: not recommended when vomiting).

So....I decided to look up the nutritional value of these pouches....many of them although “all organic” or described as “healthy” do contain a lot of carbohydrate and sugars.  Actually, as much as two fruit roll ups!  Yes, I did a little comparison and 2 of the “dreaded” fruit rolls ups contain 23 grams of carbs and almost 11 grams of sugar.....while a 3.2 ounce pouch has somewhere between 19-24 grams of carbs and between 14-23 grams of sugar.  

The point of this is not to say that “squeeze pouches” are bad, or that a child should never have a fruit roll up.  Rather, it is to point out that even “healthy” snacks can be full of sugar.  Rather than a fruit roll up or a  squeeze pouch, what about a piece of fruit?  Sure, it may be a bit messier to cut up a piece of fruit, but those pouches are not teaching children about textures and chewing.

Pouches are great for travel, special occasions and babies. But, they are not for toddlers and certainly not for everyday consumption.  Oh lastly, they are bad for the teeth as well!  

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DR SUE'S DAILY DOSE

Lice is becoming more resistant to routine treatment.