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Daily Dose

The Case to Vaccinate

1:30 to read

The flu continues to be in the nightly news. I am also continuing to see so many anxious parents who are alarmed by the 60 pediatric deaths that we have unfortunately seen during this lengthy flu season…which is still not over. While each and every death due to complications from influenza is tragic, the number of deaths that have occurred this influenza season do not compare to the deaths we used to see due to bacterial meningitis. Thousands and thousands of children have had the flu this winter (both influenza A and B), and fortunately we have only seen 60 deaths.  Even with the best medical care in the world, people do die from flu.  Fortunately, the flu vaccine although not “perfect” does help to prevent complications and mortality from flu, but some people continue to be skeptical of getting a flu vaccine. 

 

I am old enough to remember how many children died from meningitis prior to the introduction of vaccines to prevent H. Flu and Pneumococcal meningitis. Although it is impossible to compare flu and bacterial meningitis, the incidence of death and complications from bacterial meningitis was far higher than that from influenza. But, for some reason this news story is not reported…and the children who died from these diseases did not have their stories reported on a nightly basis or on social media websites (when there were none). 

 

So..not to diminish the influenza epidemic this year and those tragic complications and deaths, why would anyone decline being vaccinated….for bacterial meningitis or flu?  Yet, there are still parents who choose not to vaccinate their children for diseases that had death rates far higher than those seen with flu.  Some of those parents who choose to either not vaccinate or postpone vaccines are worried about their children getting the flu…I just cannot understand this?  If you are so worried, why would you not do anything that you could to prevent your child from getting sick and having complications from an illness…which means get vaccinated!!

 

This years flu season is still not over…and unfortunately there will be some, both young and old, who succumb from complications due to influenza. If you are not vaccinated go get a vaccine…it still remains the best protection you can get!! Remember, for the vast majority of children, the flu is simply another viral upper respiratory illness and can be managed at home with symptomatic treatment.  If you have concerns contact your doctor and if your child is worsening seek emergency treatment. 

 

I would love you hear your thoughts! 

Daily Dose

Valentine's Day

1:00 to read

Valentine’s Day is always a good time to remember how important it is to show affection…and in reality we parents hopefully show our children affection throughout the year.  But we can all be reminded that children need to hear positive and encouraging words from parents. The American Academy of Pediatrics recommends that parents “avoid using sarcasm or mockery and get rid of put-downs” when talking to children. Being a good role model and modeling the behavior that you would like to see in your child is the key to positive parenting.

 

Children, like adults, can also get in bad moods. I sometimes see patients during clinic where the chief complaint from the parents is…”my child has to be sick because they are SO CRANKY!”.  That makes me smile, as I remember days in my own home where I would say to myself, “if I wasn’t a pediatrician I would take my child to the doctor as there must be a reason for this behavior”. Actually, when your child is angry or even just in a bad mood try giving them a hug, cuddle or just quick kiss on the cheek to let them know you love them….and if they are older save the discussion for what is causing the moodiness for a later time. Picking the time for talking is really important…boy did I have to learn that!

 

It is always important to spend time alone with your child…even when life is so busy. Setting aside a special time each week for a game, a bike ride, or even a ball game gives your child something to look forward to. For Valentine’s Day what about making homemade Valentine’s for younger siblings or for the grandparents. All ages can be involved in this project and everyone cherishes a handmade Valentine.  

 

One of the things I really love to do with my grandchildren is to bake cookies and decorate them together. So, we have a date scheduled to bake cookies this week and I have all of the icing, sprinkles and glitter ready for decorating…and giving for Valentine’s Day treats!!!

Daily Dose

Sleep & Your Baby

1:30 to read

Once a new baby joins a family one of the first questions I am often asked is, “when will my baby sleep thru the night?”.  SLEEP is one thing that all parents crave and for one reason or another many parents with infants over 6 months of age, complain that their baby is still not “sleeping through the night”. If your baby or child is not sleeping well, that typically means that parents are having disturbed sleep as well.   

By 6 months of age a baby should be able to self soothe and fall asleep on their own and the majority of babies are sleeping 10-12 hours thru the night as well.  After many years of practicing pediatrics and dealing with my own children’s sleep issues, I spend quite a bit of time with my patients discussing healthy sleep habits.  Like most things, it is easier to start off with good habits and bedtime routines.

So….when parents come in at the 6 month visit and are concerned about their baby’s sleep and awakenings I typically discuss “letting their baby cry it out”. This advice is met with varying responses.  Some parents are ready to get a good night’s sleep and will do “anything”, while others think I am “a mean doctor” and would “never let their baby cry”.  Like most things it is not always black and white and that is why we have chocolate and vanilla.  But, in my experience, the sooner you deal with sleep issues the faster they seem to resolve…

A recent article in Pediatrics should now reassure parents that they are not “harming their baby” by letting them “cry it out” which is called graduated extinction.  The study done in Australia found that infants whose parents let them “cry it out” fell asleep 13 minutes sooner than a control group and woke up less often during the night, and had no significant differences in stress levels (based upon salivary cortisol levels). The study also found no long term effects on parent-child attachment.  All good news for some sleepless parents who are considering this method to get their baby to sleep through the night. 

The researchers also looked at another behavioral sleep training intervention called “bedtime fading” which some feel is a “gentler” method of sleep training. In this case a baby’s bedtime is delayed with the thought that a sleepier child will fall asleep faster and may not cry as long.  This may be an easier method for some parents who continue to be anxious about “graduated extinction”.  This too showed that infants fell asleep sooner than controls but they showed no change in the number of nighttime awakenings.

Bottom line, sleep is important for the entire family ….all ages.  This article should hopefully go a long way in reassuring sleep deprived parents that a baby’s cries are not harmful and may actually get everyone to sleep faster, longer and more peacefully….you just have to believe the research and hang in there. 

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Daily Dose

Your Kids Need Protein!

1:30 to read

Nutrition and healthy eating habits are always a topic of discussion during my patient’s check-ups.  Interestingly, I hear many tweens and teens tell me, “I am now a vegetarian”.  While I am thrilled that my patients are developing an awareness about their nutrition, I am equally amazed by what they think a vegetarian diet is.

Many a parent has cornered me before their child’s check up concerned about their child’s recent announcement that they are vegetarians and it has actually caused some heated family discussions surrounding nutrition and dietary requirements. The parents say that their child just decided that they no longer wanted to “eat meat” and that they were vegetarians. 

So…many of these new “vegetarians” don’t even like vegetables, and a few are confused by the difference between a vegetable and a fruit. When I ask them if they eat broccoli, cauliflower, green beans, asparagus, eggplant and potatoes, I find that more than a few turn their noses up at most of those suggestions and simply eat potatoes as their vegetable of preference. They also eat avocados, and are surprised to find out that it is a fruit, but it is a good source of healthy mono unsaturated fats.  A few are a bit more adventuresome and actually eat a wide variety of vegetables including lentils and black beans as a source of protein.  

The same thing goes for fruits although for the most part they do admit to having a broader palate when it comes to fruits that they will eat.  Apples, bananas, berries, grapes are all favorites and many of these kids will eat fruit all day long.  Fruit is healthy for sure, but also contains sugars (far preferable to the sugar in the M & M’s I am eating while writing). 

The biggest problem with their “vegetarian diet”?   They just eat carbs! So I have coined the term “carbohydratarian” to describe them. Most of these patients are female and they eat carbs all day long.  They have cereal, toast, bagels for breakfast, followed by grilled cheese, french fries or a quesadilla for lunch and then dinner is pizza or pasta, and maybe a salad (lettuce only).  They like crackers, bread and almost all pasta (rarely whole wheat ). Rice is another favorite.

I too could probably eat a lot of these carbs every day….I think many people enjoy their carbs. But these kids are not meeting many of their nutritional requirements. They are getting very little protein! They are also growing…some at their most rapid rate during puberty. When I talk about adding protein to their diet they are often reticent to add eggs, fish or beans to their food choices. 

If your child decides that they want to change their lifestyle and might consider becoming a vegetarian or vegan, I would encourage you to have them meet with a certified nutritionist to explore their likes and dislikes as well as to educate them as to their nutritional needs.

I must say…..very few of these patients have maintained their vegetarian lifestyle, but if they choose to, they need to know the difference between a fruit and a veggie!

 

Daily Dose

Breath-holding & Fainting

2.00 to read

Have you ever fainted?  I bet you may have not realized how common fainting is in the pediatric age group?  I know this from my own children (yes, I had 2 “fainters” and boys no less) as well as from many of my patients.

The medical term for fainting is syncope, and it really is common among children. It starts during the toddler years with breath-holding spells.  Many in this age group (up to 50%) will hold their breath when they are hurt or angry.

When a child holds their breath while crying (you can just see it happening in front of you) they will often turn a bit blue and “pass out”. This is a type of fainting. This can be very scary for parents who have never seen their precious child have such an attitude and then hold their breath over not getting the cookie? Yes, this is a normal part of being a toddler! They are very emotional and labile at this age (foreshadowing for teen years?) and most toddlers don’t have a lot of language yet, so when they get mad or frustrated they just SCREAM! But, while screaming, the child forgets to take a breath, and then the brain and autonomic nervous system takes over and the breath holding leads to fainting.

The breath holding spell, as scary as it is, is just a form of fainting. It will not hurt your child, but it may take your breath away!

My advice? Try not to pay attention to your child if they begin having breath-holding spells. It may be hard to “ignore” the first two or three, but these “spells” usually last for months (maybe years) and you do not need to rush to your child when they hold their breath. By calling attention to the event you may inadvertently reinforce the behavior. As a child gets older, the breath holding will stop (but not the tantrums?) and there will be new behaviors to conquer. Do you have a breath-holder? How do you cope? Let us know!

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

Daily Dose

The Reality of Teen Suicide

1.30 to read

I have been saddened by the recent suicide of Washington State quarterback Tyler Hilinski. It is hard for me to fathom the pain his parents are suffering at the loss of their son. There are really no words for the shock and grief that is felt on so many levels.

Unfortunately, teen suicide is not as uncommon as you might think. Each year, there are thousands of teens that commit suicide. Suicides are the 3rd leading cause of death for 15–24 year olds. In 2000, the CDC reported 1 out of 12 teens attempts suicide and up to 1 in 5 teens state that they have contemplated suicide at some point during their adolescent years. The statistics also show that the incidence of teen suicide has been increasing over the last years, which seems to correlate with the mounting pressures, both real and perceived, that our youth feel. As an adult I think "what could be that terrible to drive a teen to end their life when so much lies ahead of them?”.  But a teen’s brain is not fully developed, and as any parent with a teen knows, teenagers are often impulsive with little thought of the true consequences of their actions.

Teen suicides are usually related to depression, anxiety, confusion and the feeling that life is not worth living. An event such as a break up with a girlfriend or boyfriend, substance abuse, or failure at school may lead to suicide.

There are also gender differences among teens who commit suicide.  Teen girls are more likely to attempt suicide than teen boys. With that being said, teen boys are more likely to complete a suicide.  Girls are more likely to use an overdose of drugs to attempt suicide while boys are more likely to shoot themselves.  While a girl may use an overdose or cutting  as a “call for help”, there is often little opportunity for  intervention with a male who sustains a self inflicted gun shot or may even hang themselves.  Male suicide attempts are typically more violent and are 4 times more likely to be successful.

There are several things that parents, teachers and friends should be aware of as “warning signs” for adolescent depression and the possibility of suicide. A teen who suddenly becomes isolated, changes friends, has a change in their school attendance or grades,  has a substance abuse problem, is being bullied  or begins to make statements in reference to ending their life,  should be taken seriously. Professional help is absolutely necessary when dealing with these issues and parents should not attempt to “solve the teens problems” on their own.   

There are numerous resources available and the suicide prevention hotline at 1-800-SUICIDE is a 24 hour service. Lastly, over half of teen suicide deaths are inflicted by guns.   Firearms should not be kept in a home unless they are locked, and the key should always be in the care of a parent.  It might also be prudent not to have ammunition in the house if you do have a gun. If an impulsive, depressed teen has to go buy ammunition before attempting suicide they might be more likely have an epiphany and realize that things are not as hopeless as they think.  Any deterrent may be all that is necessary to prevent a suicide and the ensuing heartbreak for all those that knew them.

Send your question or comment to Dr. Sue.

Daily Dose

Breaking Bad Habits

1:15 to read

Do any of your children bite their nails or suck their thumbs? If so, are you always saying, “take your fingers out of your mouth, they are dirty”, or “if you keep biting your nails you will get sick due to all of those germs on your fingers”!  I was guilty of saying those very things to my own children, and I also remember being a nail biter and my mother saying the same thing to me.

Well, who would have thought that a study just released today in the journal Pediatrics might make us parents eat our own words (it wouldn’t be the first time).  The study, “Thumb-Sucking, Nail-Biting and Atopic Sensitization, Asthma and Hay Fever” suggests that “childhood exposure to microbial organisms reduces the risk of developing allergies”.  Who knew that there might be something so positive coming from a “bad habit”.  

This study was done in New Zealand and followed over 1,000 children born between 1972-1973 (dark ages) whose parents reported that they either bit their nails or sucked their thumbs at 5,7,9 and 11 years old. The participants were then checked at ages 13 and again at 32 years old to look for an allergic reaction ( by skin prick testing) against at least one common allergen.  And guess what…at 13 years of age the prevalence of an allergic reaction was lower among those children who HAD sucked their thumbs or bitten their nails.  Incredibly the the findings persisted almost 20 years later!  This study even looked at cofounding factors including sex, parental history of allergies, pet ownership, breast feeding and parental smoking… none of which played a role. 

So, while not advocating for children to suck their thumbs or bite their nails (which unfortunately I did until high school when I decided to have nails to polish) there may be a silver lining….a protective effect against allergies that persists into adulthood. 

Lemonade out of lemons!!!

Daily Dose

Teens and Sexting

1.30 to read

Sexting, the combination of the words sex and texting, is the practice of electronically sending explicit images or messages from on person to another. There has been a lot of media attention in recent years looking at legal cases involving teens and sexting as well as cases of bullying or harassment of the teen who’s picture is spread beyond the intended recipient.  

But data on teen sexting has been lagging and different authors site numbers somewhere between 1% of teens to 30% of teens who have engaged in sexting.  There is now some new “real” data out of The University of Texas Medical Branch at Galveston that not only looks at the prevalence of sexting among high school students, the study also looked as the relationship between sexting and sex and risky sexual behaviors. This was a really interesting study! 

The study looked at 948 high school students from 7 public schools in Houston area, over a 2 year period.  Participants ranged in age from 14-19 years and were in either 10th or 11th grade.  

So, 28% (that’s more than 1 in 4) of teens reported having sent a naked picture of themselves via text or e-mail (sexting).  There were no differences between the number of boys and girls who sent a sext. However, 68% of girls reported having been asked to send a sext, compared with 42% of boys.  But, 46% of boys had asked someone to sext compared to 21% of girls.  Of those who were asked to send a sext, girls (27%) more often reported being “bothered a great deal” by this than boys (2%).  Almost all girls and half of the boys were “bothered a little bit” by having been asked to sext. 

Age also played a role in sexting with the proportion of teens who reported having been asked to send a sext peaking at 16-17 years of age (61%) and declining in those 18 years and older (53%). 

Lastly, for both boys and girls, teens who had “sexted” were also more likely to have begun dating and to have had sex than those who did not sext. The study also showed that teen girls who engaged in “sexting” also engaged in more high risk sexual behaviors, admitting to multiple partners and the use of drugs or alcohol before sex. 

Yes this is yet another topic for discussion among parents and their teens and also for pediatricians to discuss with their adolescent patients.  Office visits keep getting longer;  discussing sexting may also be a way for doctors to discuss sexual behaviors with teen patients.   

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