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Daily Dose

Catch a Cough

1.00 to read

I can’t stop talking about coughs because that is all I hear every day!  It is truly a cacophony of coughing in my office, but I also hear coughing everywhere I go.  Not only is it cough and cold season but flu is here as well and those coughs just seem to shake the roof.

So, a clever little girl, who was just getting over the flu (she had not gotten her flu vaccine) was coughing in the exam room and her mother reminded her to cover her mouth.  The little girl immediately put her elbow over her mouth as she let out a huge cough. Remember too that coughing is a protective mechanism to move mucous and helps prevent pneumonias....so coughing is not “bad”. 

Right after she finished coughing she looked at me and said, “Dr. Sue, that is how your catch your cough!”  How smart! You are indeed catching the cough in your elbow so you don’t let anyone else “catch” it!  Once again, taught by my patients. And, growing up in the digital ag, they wanted me to take their picture and post it to teach everyone how to "catch"! So, here they are.

Cover your mouth and catch your cough in your elbow....the cough is one thing you don’t want to share this holiday season.

Get your flu vaccine too...it is not too late. 

Daily Dose

Heart Murmurs

What can you do if your child has an "innocent" heart murmur?I received an email from Brinley who was worried that her 1 year old had recently been found to have an “innocent heart murmur” and she wondered what this meant. Did she need to see a specialist? A heart murmur is simply an extra sound the doctor hears when listening to your child’s heart with their stethoscope. A murmur is caused by the flow of blood through the heart or the major blood vessels around the heart. In the case of an “innocent” heart murmur the flow is through a completely normal heart and is solely due to turbulence but there is nothing else wrong with a child’s heart therefore, the term ”innocent murmur”. These murmurs may also be called functional, benign, or a Still’s murmur. Innocent murmurs are very common and may be heard at different times in a child’s life. Some cardiologist’s quote that somewhere between 50 - 90% of children will have an “innocent murmur” at some time during their childhood. None of these children have any underlying cardiac pathology. It is quite common to hear an “innocent murmur” in a child due to the fact that their heart is close to their chest wall, especially in thin children. It is also not uncommon for the doctor to hear the murmur on one exam and maybe not on the next, as it depends on the position the child is in when they are examined as well as other factors. Fever is one of the most common reasons that a child is found to have an innocent murmur as their heart rate is typically higher and the blood flow is more dynamic. The quality of the murmur is what lets the doctor know that it is an “innocent murmur”. Murmurs are graded on intensity from a grade 1 to grade 6 (the loudest). Most benign murmurs are a grade 1 or grade 2, and they have a musical or vibratory quality. If you have concerns about an innocent murmur a pediatric cardiologist may be consulted. In most cases they will not only listen to your child’s heart, but also do an EKG and an echocardiogram to ensure that your child’s heart is structurally normal. Don’t worry. These murmurs usually go away as your child reaches adolescence. That's your daily dose for today. We'll chat again tomorrow.

Daily Dose

2016 Goals

1:15 to read

Just finished cleaning up after the Christmas holidays and I resolved that I was going to “de-construct” the decorations before the next holiday…and not have to face the New Year with that task looming.  Now I can move on to some different resolutions!

The more and more that I realize how much time we all spend “hunched” over a screen of some sort, the more I think that this year should be about finding time to disconnect.  It used to be that you could just turn off your phone when you wanted to be “unavailable”.  That seemed so easy…people would just have to call back later, right?  But now we try text, email, g-chat, face time….all sorts of ways to try to connect.  It is much harder to be on the DL or unavailable. 

I continue to read new data on the need for personal communication via oral language, rather than a text or email. But the immediacy of communication these days makes it seem that we don’t talk any more, we just type!!  This is even becoming an issue for younger and younger children as they focus on their “baby”computers and screens that are given to them to watch…rather than on their parents and caregivers faces and interactive language.  There is already data to show that the interaction with a screen is not the same as that with a human….and that language may even be delayed.

So the point of this is that my resolution is to take time everyday to just disconnect from a screen and enjoy a bit of old fashioned solitude and quiet time.  I am going to get up each day and not rush to the computer to check any “late breaking” emails from overnight.  I am also  going to turn off the I-phone which as they taught me early on at the Apple store, is not really a phone but rather a hand held computer!  I hope that there may be an hour every morning and another in the evening when I am totally disconnected….I’ll let you know how I do. Don’t worry if you can’t “find” me….I am just off the grid.

What are your resolutions?

Daily Dose

How To Prevents SIDS

1:15 to read

A new study on swaddling and sudden infant death (SIDS) was just published this week in the journal Pediatrics. Not surprisingly, it found that infants who were swaddled and placed on their sides or stomach had a higher incidence of SIDS. It has been routinely recommended for more than 15 years that all babies sleep on their backs and since that time the incidence of SIDS has been dramatically reduced.  Unfortunately not everyone follows the AAP recommendation. 

While it has been known that tummy sleeping has been associated with SIDS this meta analysis looked at data which was gathered over two decades and from 3 different global sites. The review found that infants who were swaddled and placed on their sides were almost twice as likely to experience SIDS and the risk of SIDS did double in those babies who were swaddled and placed on their stomachs.  

I discuss swaddling with all of my patients as there are so many different swaddle blankets available.  Actually, one of the first things a newborn nurse seems to teach a new parent is how to swaddle their baby.  While swaddling has been promoted to aid in calming a newborn as well as to help their sleep, the recommendation that the baby be placed on their back in their crib continues..  Many a baby looks like a little burrito….. rolled up in the swaddle and then being placed on their back in the crib.

But is seems from this study that some babies were being swaddled and then placed on their side to sleep. Unfortunately, even a newborn may squirm enough that they then move from their side into the prone position.  Older infants who are swaddled may actually roll from their back to their tummies, even while swaddled. While the association between swaddling and SIDS remains unclear, I think this is a good reason to start getting a baby out of a swaddle once they are rolling. So around the 3 month mark I start having parents loosen the swaddle and try to just lay the baby on their back without being swaddled.

Let me re-iterate, this article does not confirm an association between swaddling and SIDS.  I do think it is a good reminder for putting a baby, “back to sleep” and once they are rolling “ditching” the swaddle seems to make even more sense. Once less thing to worry about, right?

 

Daily Dose

Summer Slide

1:30 to read

School is out for everyone and that means lots of “down time “ for school children - all ages. I think that summer is really an important time for kids to get bored a bit.  In other words, fewer schedules, less connected to electronics, more play time and less stress….hopefully for all. I do know that as a working parent, I don’t think summer was as “unstressful” for me as it was for my children…as I had to continue to make sure that they had good child care and supervision - always challenging at times, but it all worked out and I would try to schedule a bit more time for me to be available for some fun outings.  

But, with fewer schedules and more time to “hang out” some children do experience what is referred to as “the summer slide”.  This can be defined as “the loss of academic skills over the summer break”. When children don’t read, work on math problems, or are not engaged in some sort of learning activity their skills and knowledge over the course of a 2-3 month summer vacation may regress. There is data to show that the loss in learning does vary with grade level,  subject matter and socioeconomic status - but most children show some negative changes when they are tested at the beginning of the summer vacation as compared to the end of the summer.  

The best way to try and prevent the summer slide is to have an idea or plan on how to keep your children interested in learning….but by doing different things than one might do during the school year.  

How about a summer book club or reading program that you might find either on line or through your public library.  There are book lists and fun reading projects for all ages…and if your child is older you might join them in reading one of the classics or even a new novel and discussing it together.  Even if your child claims to “not like to read” these programs are fun and reading a sports book or a scifi adventure may spark their reading.

Field trips:  Whether you live in the city or suburbs or even the country there are many FREE places to visit in your community. That might be a simple trip to the park to play while at the same time talking about why we have parks, and green spaces.  Museums typically have programs for children of all ages …and many are interactive with the parents. It is amazing how much “new” stuff there is to learn, for all of us.  If you are fortunate to live in driving distance to a national park or seashore take advantage of the many free events there. 

Mass transit: I know that when we finally got light rail in Dallas I took the opportunity to ride the rail with our young boys….all sorts of learning taking place as we read signs, and learned how to read a map of the rail system.   We also saw some local sites that we had never taken advantage of.  Inexpensive way to spend a day and the subway, light rail and bus systems in some areas are really growing.

This is also a good time of year to teach your children a few of the “basics”…whether that is how to pump a swing, or ride a bike with or without training wheels, how to tie their shoes, wash the car, or catch a ball …lots of life skills that may get ignored during the school year, and these are skills everyone should know. 

 

 

Daily Dose

Throwing the Bottle Away

1:30 to read

When a child reaches their first birthday, they have already reached many milestones. But when a child turns one, mom and dad need help their child do one more thing says pediatrician Dr. Sue Hubbard. “They need to throw the bottle away, she says.” “Developmentally, a your baby does not need to suck for nutrition at age one.”

After that first birthday, children should be drinking whole milk out of a sippy cup. The fat in whole milk is essential for the child’s developing brain. Dr. Hubbard says to do the transition from bottle to sippy cup cold turkey. “At 9 months, buy a sippy cup, one without a nipple, and give it to your child to play with. This will help teach him how to hold it. Then start with whole milk, never juice or water.” 

Dr. Hubbard says that studies have shown that prolonged bottle feeding leads to increased dental cavities, iron deficiency, anemia and obesity. “I’ve heard parents say ‘My child won’t drink out of a sippy cup.’ I say yes they will if they are thirsty. They won’t starve or get dehydrated.” If you wait until a child is 15 to 18 months old to remove the bottle, it becomes more of an issue she warns. Once your child has transitioned to a sippy cup, Dr. Hubbard reminds parents to only offer the sippy cup to the child at meal and snack times. “A child should never carry a sippy cup around the house,” she says.

Daily Dose

Too Much Pressure to Play Sports?

1:30 to read

Does your child play a sport “after school”?  It seems children as young as 3-4 years of age are now involved in soccer and even football.  Some children are barely walking before they are signed up for a team.  Parents tell me various reasons for this including, “if they don’t start young they will be at a disadvantage athletically”, “if we don’t get on a team now, there will not be room for our child once they start kindergarten or first grade”,  and “our child wants to play and wear a uniform”. I just see lots of issues with burn out.

It seems awfully early to start “team sports” to me. I am a huge advocate of families and children playing together and learning all sorts of games and sporting skills. Kicking a soccer ball in the yard, or hitting the wiffle ball off of the tee, or having Dad throw a pass with the football all seems pretty “normal” to me. But organized sports with a 3 year old who is still in diapers….really?  Maybe one of the “guidelines” should be you have to be potty trained.  Yes, this is true, I see children in diapers who “will not pee or poop in the potty” according to their parents, but they go to soccer practice?  What is wrong with this picture?

So, while some of these well intentioned parents have told me that they are having fun being the coach, or attending games with other friends, their pre-school children “don’t have time to be potty trained”. They are too busy going to school, followed by organized activities that “it is just easier to let them stay in diapers”. I was even with a 4 year old at a football game and she was still in diapers?

At some point these children and parents will need to skip a practice or two and stay home long enough to get potty trained.  I am noticing that children are getting older and older before they are potty trained. I know there are books written on this topic with the philosophy that “the child will ultimately train themselves”, or “ how to potty train in 3 days, with a child who shows no interest”…or something along those lines.  But really, in my experience, if you watch your child’s cues, spend the time to “talk bathroom habits” and have the “time” to be home to potty train most children are potty trained between 24-36 months of age.  Yes, there are occasional children (none of my own) that just show interest earlier and say things like “I go potty now” and really do it on their own. There are also some who are more difficult to get interested and may be harder to potty train…but again, which is probably a more important life time skill…..getting out of a diaper or trying to figure out how to line up for a soccer game? I’m just saying.

Daily Dose

When Parents Date

1.30 to read

I recently saw some patients of mine who are now teens. They were brought in for their check ups by their father who i had not seen in some time.  He has a boy and a girl about 16 and 14 years old.  I knew that there had been some “issues” within their family, but is had actually been several years since i had seen them.

As it turns out the parents had divorced, the mother had some problems with addiction and the father now had custody of the children. He was trying to get “everything back on track”, including visits to the pediatrician.  

After seeing each of the kids alone and talking to them, they actually seemed to be doing extremely well. They had seen a counselor during some of the more tumultuous times and were happy to be in a “stable” environment and had “less family stress” as they put it. They were both doing well in school, had lots of friends and were involved in different sports and school activities.  They said that their sad had been instrumental in getting things “back to normal”, or back to a “new normal”.  

I also visited with the dad and he told me he had a new concern.  He was really happy about how well his children were doing, all good.   It seems that he had just started dating agiain, and he was not quite sure how to handle the subject with his kids.  He told me that he had had several dates and his kids wanted to know....what’s next?

I had to laugh a bit, as we had just discussed his children dating.  My response was, “be honest with them”.  If you asked your teen after 2 dates “where is this going?”, they would probably reply, “dad, who knows, we’ve only had 2 dates...I’m not getting married!”.

I told him I would tell his children the same thing,  in a manner of speaking. I would acknowledge that I was enjoying dating, that I had no plans to get married any time soon, and did not even know if i was ready to be “exclusive” ( is that the adult version of Facebook official?) with anyone at this point.  

I would also make it clear that I would keep them updated if and when things changed, but in the meantime they did not need to worry. Their dad would be there everyday to get their breakfast, have dinner with them and continue their “new normal”. It was just such a good feeling seeing all of them happy!

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Daily Dose

The Difference Between A Viral Sore Throat & Strep Throat

It only takes getting the kids back in school for the pediatrician’s office to see an upswing in illness. But this year it came on particularly early and we are definitely seeing more illness in the first week of fall than is typical.

Most of the illness being reported around the country is due to Influenza A, H1N1 (swine flu) and the majority of cases seem to be occurring in the five to 24 year old age group, in other words the school aged, elementary through college aged kids. To review again, flu like symptoms for all influenza strains are typically similar with fever, sore throat, cough, congestion, headaches and body aches. Occasionally there may be some nausea or vomiting but that is not seen as often. Flu like symptoms seem to begin with general malaise and then develop over the next 12 – 24 hours and you just feel miserable. Some of the confusion now is about sore throats and the difference between a sore throat with the flu, which is due to a viral infection, and strep throat, which is a bacterial infection. As for most things in life, nothing is 100 percent and the same goes for viral and bacterial sore throats. But, with that being said, there are certain things that might make a parent think more about a viral sore throat than strep throat and vice versa. Viral sore throats, which we are seeing a ton of with the flu right now, are typically associated with other viral symptoms which include cough, and upper respiratory symptoms like congestion or runny nose. A viral sore throat may or may not be accompanied by a fever. In the case of flu, there is usually a fever over 100 degrees. With a viral sore throat you often do not see swollen lymph nodes in the neck (feel along the jaw line) and it doesn’t hurt to palpate the neck. If you can get your child to open their mouth and say “AHHH” you can see the back of their throat and their tonsils, and despite your child having pain, the tonsils do not really look red, inflamed or “pussy”. Even though it hurts every time you swallow, to look at the throat really is not very impressive. Strep throat on the other hand, typically occurs in winter and spring (that is when we see widespread strep), but there are always some strep throats lurking in the community, so it is not unusual to hear that “so and so” has strep, but you don’t hear a lot of that right now. As we get into winter there will be a lot more strep throat. Strep throat most often affects the school-aged child from five to 15 years. Children get a sudden sore throat, usually have fever, and do not typically have other upper respiratory symptoms (cough, congestion). This is another opportunity to feel your child’s neck and see if their lymph nodes are swollen, as strep usually gives you large tender nodes along the jaw line. When you look at the throats of kids with strep they usually have big, red, beefy tonsils (looks like raw meat) and may have red dots (called petechia) on the roof of the mouth. The throat just looks “angry”. Sometimes a child will complain of headache and abdominal pain with strep throat. Some children vomit with strep throat. The only way to confirm strep throat, again, a bacterial infection, is to do a swab of the back of the throat to detect the presence of the bacteria. There are both rapid strep tests and overnight cultures for strep. Most doctors use the rapid strep test in their offices. If your child is found to have strep throat they will be treated with an antibiotic that they will take for 10 days. Again, antibiotics are not useful for a viral sore throat and that is why strep tests are performed. I’m sure we’ll talk more about sore throats as we get into winter. But in the meantime, get those flashlights out and start looking at throats. That’s your daily dose, we’ll chat again tomorrow.

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What is baby led weaning when it comes to first foods?

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