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Daily Dose

Five Minutes for Mom

1.15 to read

I’m doing a lot of check ups this summer and a lot of questions surrounding behavior.  I have had many a parent lately who keeps asking me, “what is wrong with my 2-3 year old, they used to be so sweet but they are driving me crazy!”  It is a statement that has been uttered by most parents at different times while dealing with toddlers and young children. As I have said before, this is typically NOT an easy stage, but it is so important in terms of child development, behavior modification and early discipline. It requires a great deal of PATIENCE as well. 

For most of the parents it is just a matter of being reassured that: 

  1.  Their child is not “possessed”

B.   They are not the only one going through this

C.   This too shall pass 

One of my fondest memories while dealing with my own children during these years was of a very cute book that I would read to them after a long day! They loved the book, as did I, as it is written for both a parent and child to enjoy. 

The book is entitled “Five Minutes Peace” by Jill Murphy.  I found my hardback copy (I haven’t saved much from my boys early childhood, but did keep a good book collection for future use) and opened it to find that it had an inscription.  It had been given to my oldest son

for his 3rd birthday. The inscription read, “have mommy read this to you and I bet she will enjoy it as much I hope you will”.  The mother who had brought it for a birthday gift had 3 children and her youngest was the same as age my oldest. She was a wonderful mother and she used to give me such sage advice.  This book kept me sane many a day and then I went on and bought several other books about The Large Family. They are all very special books. I recommend you get on Amazon and buy one and see for yourself. 

And guess what?  I am now taking care of this same mother’s 3 most adorable grandchildren and yes, they too have a copy of “Five Minutes Peace” for their mommy to read to them. 

That's your daily dose for today.  We'll chat again tomorrow.

Daily Dose

Teens & Skin Care

I am seeing a lot of teens this summer for their “routine” checkups and skin care is always part of our discussion.

I am seeing a lot of teens for their “routine” checkups and skin care is always part of our discussion. Some teens are just blessed with good skin, and when you ask them what they do to their skin their reply is “nothing’. That is not the norm. Adolescence is the prime time for acne and whether the breakouts are mild or persistent, good skin care is the beginning for everyone.
The first thing that all adolescents need to do is to wash their face twice a day. You do not need “fancy” skin potions or lotions either, the drugstore has more than enough choices to begin a good cleansing program. Using a mild soap- free cleanser may be enough to begin with , something like Purpose, Basis, Aquanil or Neutrogena. If the skin is more oily and acne prone try a cleanser that contains glycolic or salicylic acid , products like Neutrogena Acne wash, or Clean and Clear, you will need to read labels to look at the ingredients. These provide gentle exfoliation of the skin surface. Wash with a soft cloth but don’t scrub or buff, just wash.
After washing your face in the morning, always apply a gentle non-comedogenic moisturizer WITH sunscreen. This will not cause acne, but will prevent sun damage that we all get on a daily basis. This is not the same as applying sunscreen for a day at the beach or lake. Again, I like Oil of Olay complete, or Neutrogena but there are many others out there, so find your favorite.
At bedtime, after washing your face, if skin seems to be getting break outs begin using a 5% benzoyl peroxide lotion (you only need a dime size amount for the whole face) applied after your face has completely dried from the washing. If it is applied to a wet or damp face it may cause redness. Benzoyl peroxide products come in several strengths and may be titrated up in strength as tolerated.
If this regimen is not working well it is probably time for a visit to the doctor to discuss some prescription products. More on that another day.
That's your daily dose. We'll chat tomorrow.
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Daily Dose

Teen Suicide is Real

1.30 to read

I love ‘Glee’, but I just watched the latest episode and I was really surprised, appalled, and disturbed by the scene where a bullied, depressed teen was shown trying to hang himself. What in the world?  I even had to rewind it to make sure I was correct in what I had seen? I found myself sitting through the commercial break trying to decide if I could even watch the rest of the program. 

I did stay tuned and I must admit that I am glad that I did. I am just concerned about some of the teen viewers who may not have watched what happened next. 

Thankfully, Karofsky, did not successfully commit suicide, but he did end up in the hospital. Why did he feel so desperate? What could lead a teenager to feel so sad, defeated and ALONE, that they would attempt to kill themselves?  In this case, the character was “outed” about his sexuality (I think on Facebook). He was then taunted by the entire football team and chased from the locker room, which led to his attempted suicide. 

This story line touched too close to some real situations I have had with my own patients. I have been the pediatrician for patients who have killed themselves.  Their parents and friends will never understand what could have driven them to such a decision, nor will I. 

I do know that suicide cannot be hidden and that there needs to be open discussions between adults and teens about suicide   While the ‘Glee’ episode did that, I think it was unnecessary to show this young man preparing to hang himself.     

The teachers and students on ‘Glee’ all openly discussed the attempted suicide.  Mr. Shue even gathered the Glee club to talk about his own teen years and how he had at one time thought about killing himself.  

He then had the students in glee club talk about something 10 years in the future that they were looking forward to.  This helped each of them to realize while their problems might seem insurmountable for the moment, that was never the case. There was so much to live for in the future. 

It was really interesting that in the next several days in my office more than a few adolescents and their parents also brought up the ‘Glee’ episode. Many of them were equally disturbed and concerned about the vivid depiction of an adolescent trying to end their own life.  Several had talked about turning it off, but the show did lead to conversations with their own families and friends.  I guess that the “shock factor” may be a conversation starter. 

Lastly, the ending of ‘Glee’ was also shocking.....maybe too much to discuss in one show. Suicide and texting while driving may have been better tackled in separate episodes? 

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

Daily Dose

Treating Migraines in Children

What is the best way to treat a migraine in children?So, we have discussed migraines and looked at how to diagnose in the pediatric population. Now it’s time to decide how to treat the headache. Just like diagnosing the headaches, it is important to individualize treatment for each child, with the goal being fast relief, no rebound or re-occurrence, with minimal or no side effects to the medications.

When I see a patient who has a history compatible with migraines, I not only have the child and parents keep a headache log, but I spend a lot of time discussing early treatment of the headache. One of the first things you learn in medical school about treating pain is “get ahead of the pain”.  This means that you need to be aware of your symptoms and begin therapy earlier than later, as pain that has gone on for some time is much harder to treat.  I find that one of the best ways to explain this to a parent and also an older child is to talk about surgery. When you have a surgical procedure, the anesthesiologist does not wait for you to “wake up” and tell him that it hurts, they have already given you pain medication to “keep ahead of the pain” before they wake you up. If you have ever had surgery you know this to be true. The same pain principles apply to treating headaches, especially migraines. At the first sign of a migraine, with or without an aura, I usually prescribe an ibuprofen (Motrin, Advil) product.  In studies, ibuprofen was more effective for headache relief than acetaminophen. I use a “generous” (10mg/kg/dose) dose and repeat it once in 3 -4 hours if the headache has not resolved. You do not want to use ibuprofen more often than several times a week or you may find that your child actually gets rebound or overuse headaches.  Ibuprofen is available in liquid, chewable and pill form so can be used in a young child with suspected migraines.  I also like to use naprosyn (Aleve) in older children who can swallow pills.  It too is a non-steroidal anti-inflammatory  and is available over the counter. The most frequently used medications for childhood migraines are called triptans.  This class of drugs has been around for more than a decade now, but they are not FDA approved for use in children and adolescents because of the difficulty in designing a study (this is true of many different medications.)  Regardless, they are frequently used to treat childhood migraines with good results, tolerability and a good safety profile. There are many different drugs, with names like Imitrex, Zomig, Maxalt, Frova, and the newest drug Treximet (a combination of a triptan and a non steroidal drug), and all have a similar safety profile. Once a child has “failed” therapy with an over the counter non-steroidal drug, I typically use these drugs as “rescue” medications.  Just like many other medications, each person seems to respond differently, so it may be a bit of trying different medications to see which one works “best” for each migraine sufferer. When a patient seems to find the best triptan, it is important to start the medication at the earliest onset of a migraine. I also try to help adolescents distinguish between “different” types of headaches, so that they are not using this class of drugs too frequently (max 3 headaches a week).  Not every headache is a migraine! If these medications do not relieve the headaches within 48-72 hours more aggressive therapies need to be used, and preventative treatments and strategies should be considered.  There are many studies underway looking at the combined effects of biofeedback therapy and cognitive behavioral therapy in combination with medications. These are discussions that each parent/child should have with their own physician as it relates to their headache frequency and pain level. That's your daily dose for today.  We'll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

Winter Skincare & Sun Protection

Your family needs sunscreen and moisturizers during the winter months. Even though winter is upon us in full force, you want to make sure you don’t forget skin care and sun protection. Due to the drier air and the need to turn up the heat, it is important to protect your skin and keep it from drying.  In general, you need to use a gentle bath soap such as Vanicream or Cetaphil during this time of year.

It is not necessary to bath or shower every day in the winter months.  Try bathing your children every other day and see if this might help with some of the dry skin symptoms. Shorter baths and warm rather than hot water will also help prevent dry skin symptoms.  Right after the bath, while the skin is still damp get out a good moisturizer such as Cetaphil, Cerave, Vanicream or Aveeno (some of my favorites) and apply it generously. This method will help increase the absorption of the moisturizer. The dry air and heat also dries other parts of our body including the nose and lips. To protect the lips make sure you use a lip balm that has sunscreen in it with at least SPF 15. Children often lick their lips and have excessive chapping and redness. This is called lip lickers dermatitis.  Mother’s laugh when I tell them this term, as it totally describes the problem.  It is best treated by bringing their “licking habit” to the child’s attention (if they are old enough to understand the problem). Use Chapstick, or Aquaphor, and apply it frequently so that the child is actually licking off the moisturizer rather than the skin. Cover the skin around the lips too if they are licking that area. If it is really inflamed you can use an over the counter steroid to help calm down the redness. Unfortunately, this is a habit that takes a while to break but be consistent with the moisturizer.  I often go reapply the chapstick once a child has gone to bed and the licking has stopped. For outdoor activities you will also need a chapstick or lip balm that contains a sunscreen with an SPF of at least 15 or greater.  For an older child get them their own stick so that they learn to reapply the lip protection throughout the day. Nasal mucosa can also get dry and the skin inside the anterior nares (the part just inside the nostril) may become irritated.  As children often pick and rub at their noses the skin inside the nostril can crack and allow bacteria inside.  To help prevent infection you can buy Polysporin (an over the counter antibiotic cream). Take a little bit of the Polysporin on a q-tip and put it inside each nostril, just inside the tip.  After applying squeeze the nose together to help disperse the antibiotic inside the nose.  It is best to try and do this both morning and night. Bloody noses are also more common in the winter and may be prevented by using a saline nose drop and some aquaphor or Vaseline inside the nose. I also like the brand Ayr Gel. Sunscreen is not only for use in the summer.  Children who are outside in the snow require sun protection too. When travelling to areas with higher altitude and snow it is especially important to protect your children’s skin (and yours too). The reflection of the sun off the snow only makes it more intense, and liberal use of sunscreen to sun exposed areas is necessary. Throw a stick of sunscreen in the parka and reapply sunscreen throughout the day. Use a broad spectrum sunscreen which has both UVA and UVB protection.  Neutrogena makes some excellent ones. Lastly, when you tuck a child in at night a cool mist humidifier in their room may help prevent dry skin and lips. A little moisture added to the dry heat can make a big difference. Try it and let me know if this works for your family!

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Daily Dose

Mandatory Newborn Screenings

Newborn screenings vary state to state, however, this is currently under review by the federal governement.As you know, if you have had a baby, all babies undergo routine newborn screening for multiple metabolic disorders. The initial newborn screening test is performed on a heelstick blood sample in the first 24-48 hours after a baby’s birth and then the baby is typically re-screened after about 1-2 weeks as some of the metabolic  disorders are only detected after a baby has been on milk (breast or formula) for a while.

The use of newborn screening tests is not federally mandated, but varies from state to state.  In most cases states screen for somewhere between 25 – 30 tests routinely.  There is a push for these newborn screening tests to become universally  mandated  so that all states would be screening for the same diseases.  For instance, the state of Texas now screens for 29 diseases with the addition of screening for cystic fibrosis in December of 2009. There is an committee, the Secretary’s Advisory Committee for Heritable Disorders in Newborns and Children (ACHDNC) that reviews requests from individuals or organizations to nominate a heritable disorder to be considered by the ACHDNC for inclusion in the recommended uniform screening panel.  The advisory committee adopted a list of 29 recommended conditions for inclusion to the uniform screening panel in September of 2005. At the end of January of this year the panel recommended to add severe combined immunodeficiency (SCID) to the uniform newborn screening panel. This is the first addition since 2005. While the newborn screen looks at diseases  that you may know more about such as thyroid disease, adrenal insufficiency, sickle cell disease and PKU (the initial screening test developed in the 1960’s) there are other less known diseases that may be screened for.  There were several diseases that the committee considered for inclusion, but SCID was the only disease that was recommended for inclusion.  SCID affects somewhere  between 1 in 100,000 to 1 in 40,000 newborns. This group of disorders is characterized by the absence of an immune system which results in recurrent infections which may be life threatening if not treated in the first months of life. So, when you have a new baby, check to see which metabolic diseases your state is screening for.  It does seem incongruous to me that a baby born in Florida may not be screened for the same diseases as a baby born in New York or Nebraska. A universal test seems to make sense so that ALL babies are treated equally and parents are not confused as to which disease process their baby has been screened for.  A baby’s possible life threatening disease should not be screened differently based upon the state they live in! That's your daily dose for today.  We'll chat again soon.

Daily Dose

Advice from My Mom

1.15 to read

I have been visiting my mother for an “early Mother’s Day” celebration and she and I spent an evening reminiscing about all of the advice she has given me over the years. The funny thing is that I often catch myself talking to my own children, and even my patients, and say, “I am sounding just like my mother”. The reason being is that she has given me a lot of good advice. 

The best advice which has stood the test of time is “do the best that you can and you can be anything you want.” Both she and my dad told me that, while they continued to support me as I pursued a career in medicine. Boy, was I lucky or what? 

She also told me “you should also always be able to take care of yourself.” That has also been great advice and something I have told my own children. The good news for me is that my children have listened to me (to date) and I am so proud of their work ethic, their integrity and their goals. They have made it easy to parent them. 

Another good piece of advice remains as true today as it did 40 years ago;  “never chase a boy (they always had to call first) and all of your dates must come to the door to meet your parents.” As a mother of sons, I told my boys how important it is to go to the door, make eye contact with the girl’s parents, introduce themselves, and to let the parent know that they are responsible gentleman and will always respect their daughter. This advice is timeless.  I saw it first hand when our oldest son went to ask his now father-in-law for his daughter’s hand in marriage. It made me so proud to hear how responsible and respectful he had been. (He listened!) 

Here are a few more “Jeanne-isms” worth remembering: 

-No white shoes before Easter or after Labor Day

-Stand up straight and hold your shoulders back 

-If you can’t say something nice, don’t say it at all  

I know you too have memories of wonderful mothers’ advice worth sharing. Keep passing them on to your children. Many are timeless, no matter what we used to think. 

Happy Mother’s Day to all!

Daily Dose

Screen Time & Vision Problems?

1.30 to read

I received a question via our iPhone App from a Dad who was concerned about all of the new electronics his children are using and whether all these gadgets might harm his child’s vision?  Good question.

After doing a bunch of research, there is not a lot of data to support the idea that all of this new technology can cause actual visual problems.  But the constant use of computers, electronic games, and smartphones for messaging as well as good old fashioned TV watching may cause eye fatigue. The number of hours kids spend on these activities continues to grow, and even for a diligent parent who is watching their child’s screen time, the hours a child is on line at school must be factored in. It seems that 97% of all classrooms in the US have a computer or computers.

A study done in 2009 showed that the number of people with nearsightedness has been increasing in the last 30 years, and whether this is due to the amount of time we all spend doing “near work” is unclear.

The most important fact: limit your child’s screen time and count time on their phone texting, as well as on line on the computer or in front of the TV.  It is cumulative. Encourage your child to take a break from the screen every 20 -30 minutes to let their eyes rest and to also adjust to some far away vision. 

Smaller screens with smaller print also require more work for the eye muscles, which much contract to allow the eyes to focus. So, having your child read articles and lengthy papers on a bigger screen would be preferable to long reading tasks on their smartphone.

I see a lot of kids with tired necks and backs from leaning over their computers. They rarely associate their “screen time posture” with other aches and pains. Kids should be encouraged to sit up in a chair at a desk with their feet on the floor while working on the computer. 

The computer or game screen should be at least 20 – 28 inches away from their eyes. Have your child move around and change positions when possible if they playing games etc and not at a desk.

Lastly, and most importantly, limit your child’s total screen time to no more than 2 hours /day.  That may be more challenging than seeing the screen!

That’s your daily dose for today. We’ll chat again tomorrow.

Daily Dose

Mommy Guilt

1.15 to read

I spent part of my Mother’s Day reading the Time magazine article on attachment parenting.  The cover is obviously quite provocative and has stirred a lot of discussion in and of itself.  Even SNL spoofed it! But the greater discussion seems to me to be on how women mother and parent. What constitutes a good enough mother? (wonder if there is going to be a follow up article on fathers just in time for Father’s Day - what would that cover look like?) 

I guess my first thought about the article is that mother’s often feel like they are not good enough. I don’t think that is necessarily influenced by how long you breast feed, or if you let your child sleep in your bed, or if you ever yelled at your child. It is something about the female brain and we feel guilty about so many issues as they relate to mothering.  I have now practiced for over 25 years and the topic of maternal guilt has always been an issue for so many of the mothers I see on a daily basis, it doesn’t seem to change.  Me included! 

For some reason, the female hormones estrogen, progesterone, and prolactin that surge at the time of a baby’s delivery must also turn on some deep area of the brain related to guilt.  I often joke that “with the final push” comes enough guilt to last a mother’s lifetime. (seems to happen with a c-section as well).  The attachment to that baby is so deep that any little thing can cause maternal anxiety and it often starts with whether or not to breastfeed your baby. So let’s start with that subject. 

As a pediatrician I am a huge advocate for breast feeding, but with that being said I have also seen many a mother who is unable to breastfeed. There are any number of reasons (including breast reduction surgery and no let down, maternal medications which might affect the baby, and a mother who was diagnosed with breast cancer while pregnant who started chemo immediately after delivery.) 

There are also some mother’s who just don’t want to breastfeed. Should they be judged inadequate right out of the gate? I don’t think that is my role as a pediatrician to make that mother feel guilty. I think I need to discuss the options and the benefits of breastfeeding but at the same time realize that one size does not fit all. Is it worth having a depressed, sad and anxious mother who is unhappily breastfeeding, over a bottle fed baby with a happy mother? I think maternal well-being and feeling bonded to that newborn is what is important, whether that be with a breast or bottle. You can be attached to that baby without out actually having a latch. 

So...I digress. What about guilt and motherhood? I just don’t know how to fix it but I don’t think that the front of Time magazine really helped, but did provoke lots of conversation. 

What do you think?  I would love your thoughts! Leave them below.

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