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Daily Dose

Swollen Lymph Nodes

1:30 to read

A parent’s concern over finding a swollen lymph node, which is known as lymphadenopathy, is quite common during childhood.  The most common place to notice your child’s lymph nodes are in the head and neck area.

Lymph nodes are easy to feel  around the jaw line, behind the ears and also at the base of the neck, and parents will often feel them when they are bathing their children.  Because young children get frequent viral upper respiratory infections (especially in the fall and winter months), the lymph nodes in the neck often enlarge as they send out white cells to help fight the infection. In most cases these nodes are the size of nickels, dimes or quarters and are freely mobile. The skin overlying the nodes should not appear to be red or warm to the touch. There are often several nodes of various sizes that may be noticed at the same time on either side of the neck.   It is not uncommon for the node to be more visible when a child turns their head to one side which makes the node “stick out” even more.

Besides the nodes in the head and neck area there are many other areas where a parent might notice lymph nodes.  They are sometimes noticed beneath the armpit (axilla) and also in the groin area.  It your child has a bug bite on their arm or a rash on their leg or even acne on their face the lymph nodes in that area might become slightly swollen as they provide an inflammatory response. In most cases if the lymph nodes are not growing in size and are not warm and red and your child does not appear to be ill you can watch the node or nodes for awhile.  The most typical scenario is that the node will decrease in size as your child gets over their cold or their bug bite.  If the node is getting larger or more tender you should see your pediatrician. 

Any node that continues to increase in size, or becomes more firm and fixed needs to be examined. As Adrienne noted in her iPhone App email, her child has had a prominent node for 7 months. Some children, especially if they are thin, have prominent and easily visible nodes.  They may remain that way for years and should not be of concern if your doctor has felt it before and it continues to remain the same size and is freely mobile.  Thankfully, benign lymphadenopathy is a frequent reason for an office visit to the pediatrician, and a parent can be easily reassured.

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

Daily Dose

Happy Thanksgiving From The Kid's Doctor

:30 to read

I just wanted to take this opportunity to wish everyone a Happy Thanksgiving. I hope that you have the opportunity to gather around the family table with many generations and enjoy this special day of Thanksgiving. 

I am thankful for my family, for our many friends who we will gather with and for all of the many blessings that we have. I am also so appreciative of those who are serving our country around the world and here at home, and for their many sacrifices that enables each of us to live in freedom. I wish that I could hug their family members who will be without them this Thanksgiving and pray that their loved ones will return home safely. Have a blessed Thanksgiving.

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Daily Dose

No More Fever Phobia!

1.30 to read

Parental concerns about children with fever continues to be the primary reason for phone calls to pediatricians offices, visits to the doctor and late night trips to the ER.  The term “fever phobia” is not new and one of the hardest things to “teach” parents is the mantra “fever is your friend”. What?  How can that be?  What if the thermometer reads 103.7 degrees?  Well, the latest report by the American Academy of Pediatrics reiterates that fever phobia is an unnecessary and unfounded worry, as the number on the thermometer is just that, a number, and is not indicative of degree of illness.  In other words, degrees Fahrenheit does not correlate with degree of illness. It is hard not to think that a thermometer that reads 103.7 degrees is not indicative of a life threatening illness. But fever in and of itself is a symptom and not an illness. The body’s reaction to fighting an infection is typically a febrile response, and fever may be a protective mechanism. I spend a lot of time with my patients and their parents discussing fever and what a fever means.  It is hard to discuss a fever in the abstract, and most parents say that they will not “fear a fever”. But, when the actual time arrives and their child has a fever, it is a whole different thing. Despite all of the education about “fever is your friend” the thermometer with 103.7 degrees flashing at you is a scary proposition. Of course it seems reasonable to think your child is” sicker” if their temperature is higher, and I know as a mother and pediatrician, your child does “look pathetic” with a high fever. The fever makes you feel yucky, and your heart rate goes up as does your child’s respiratory rate, this is a body’s normal response to a fever. When you have a higher temperature you don’t feel a lot like eating or playing, you are often happy to just lay on the bed or a couch and watch a movie and eat a popsicle or have a glass of Gatorade. But, taking fluids and watching a movie or quietly reading a book is a good sign that your child is not “too” sick. Young children with a fever are often whiny and pathetic, but they will have moments when they will play, or eat a cookie, and then become pathetic again soon thereafter. That up and down is a good sign. Treating a fever with either acetaminophen or ibuprofen is recommended only to make your child feel better. Treating a fever is not always necessary and some studies show that an illness may resolve sooner if the fever is left untreated. When and if you do decide to treat your child’s fever, make sure that you use the correct dosage of medication, which should be based on a child’s weight. I try to give each family a medication-dosing chart for acetaminophen and ibuprofen at their 2 month visit so that they may tape it inside the medicine cabinet and can refer to it when needed. I promise you there will be many nights of fever to face during the course of parenting!  As you learn to “relax” while reading a thermometer, each illness will become a little easier. Lastly, it is not necessary to awaken a child from a nap or during the night to take their temperature, or treat a fever. An uncomfortable child will wake up and demand your attention.  Fever does not cause “a scrambled brain” (term from a patient of mine), and you will not have caused brain damage if you let your child sleep with a fever. Sleep is usually one of the best treatments for illness, so let a feverish child rest and wait to take their temperature and treat the number on the thermometer. Chant with me “fever is your friend”!!! That’s your daily dose for today.  We’ll chat again tomorrow.

Daily Dose

Do's & Don'ts About Antibiotics

1.30 to read

I have had many parents call me asking for me to prescribe an antibiotic for their child's cold and I tell them time and again...they do not work when your child has a cold!

Antibiotic prescribing is highest for young children. But, antibiotics need to be used appropriately in order to ensure that drugs are effective, as well as to prevent antibiotic resistance.  The whole country is well into the “cough and cold season” and most of these illnesses are caused by viruses.  ANTIBIOTICS can only cure bacterial illnesses - not viral illnesses. 

Taking an antibiotic for a viral illness will NOT cure your child’s cough and cold, nor will it help your child feel better any faster, and it will NOT keep others from catching your child’s viral illness.  These viral illnesses include colds, influenza (flu), RSV, most sore throats (unless strep) and even most sinus infections.  Not even all ear infections may need an antibiotic to resolve, especially in children over the age of 2-3 years. 

Although many people “believe” that green mucous means a bacterial infection, as your body’s immune system works to fight off a viral upper respiratory infection mucous can change color. It is quite common for the color to change from clear, to yellow to green before the viral infection resolves. This does not mean that a child (or adult) needs an antibiotic. 

Lastly, while antibiotics may be life saving, there are potential complications that can occur when taking an antibiotic, including tummy aches and diarrhea as well as serious allergic reactions.  You want to only take antibiotics when really needed. 

I have spent the last 2 weekends on call and already feel like I have seen a million green runny noses, including my own!!  But a little saline nose rinse, lots of kleenex, some steamy showers and time will work for the majority of us.  Almost every parent asks me “don’t you have something else that will WORK for this cold”? Honestly, if I did I would be taking it myself and selling it on the internet for $9.99 a bottle!!  I do know, but it is not an antibiotic! 

But you can go to www.cdc.gov/getsmart/index.html . This site may give you some more tips on how to help your child’s viral illness. 

Daily Dose

How to Treat Poison Ivy

1.15 to read

With the long weekend here, many families are enjoying the outdoors. But with outdoor activity, your children may develop summer rashes like poison ivy, poison oak or poison sumac. Each plant is endemic to different areas of the country, but unfortunately all 50 states have one of these pesky plants. Teach your children the adage “leaves of three, let it be”, so they come to recognize the typical leaves of the poison ivy.

The rash of poison ivy (we will use this as the prototype) is caused by exposure of the skin to the plant sap urushiol, and the subsequent allergic reaction. Like most allergies, this reaction requires previous exposure to the plant, and upon re-exposure your child will develop an allergic contact dermatitis. This reaction may occur anywhere from hours to days after exposure, but typically occurs one to three days after the sap has come into contact with your child’s skin and they may then develop the typical linear rash with vesicles and papules that are itchy, red and swollen. Poison ivy is most common in people ages four to 30. During the spring and summer months I often see children who have a history of playing in the yard, down by a creek, exploring in the woods etc, who then develop a rash. I love the kids playing outside, but the rash of poison ivy may be extremely painful especially if it is on multiple surface areas, as in children who are in shorts and sleeveless clothes at this time of year. The typical fluid filled vesicles (blisters) of poison ivy will rupture (after scratching), ooze and will ultimately crust over and dry up, although this may take days to weeks. The fluid from the vesicles is NOT contagious and you cannot give the poison ivy to others once you have bathed and washed off the sap. You can get poison ivy from contact with your pet, toys, or your clothes etc. that came in contact with the sap, and have not have been washed off. If you know your child has come into contact with poison ivy try to bath them immediately and wash vigorously with soap and water within 5

Daily Dose

Moles On A Child's Skin

1:30 to read

Everybody gets moles, even people who use sunscreen routinely. Moles can occur on any area of the body from the scalp, to the face, chest, arms, legs, groin and even between fingers and toes and the bottom of the feet.  So, not all moles are related to sun exposure.

Many people inherit the tendency to have moles and may have a family history of melanoma (cancer), so it is important to know your family history. People with certain skins types, especially fair skin, as well as those people who spend a great deal of time outside whether for work or pleasure may be more likely to develop dangerous moles. Children may be born with a mole (congenital) or often develop a mole in early childhood. It is common for children to continue to get moles throughout their childhood and adolescence and even into adulthood.

The most important issue surrounding moles is to be observant for changes in the shape, color, or size of your mole. Look especially at moles that have irregular shapes, jagged borders, uneven color within the same mole, and redness in a mole. I begin checking children’s moles at their early check ups and look for any moles that I want parents to continue to be watching and to be aware of. I note all moles on my chart so I know each year which ones I want to pay attention to, especially moles in the scalp, on fingers and toes and in areas that are not routinely examined. A parent may even check their child’s moles every several months too and pay particular attention to any of the more unusual moles. Be aware that a malignant mole may often be flat, rather than the raised larger mole. Freckles are also common in children and are usually found on the face and nose, the chest, upper back and arms. Freckles tend to be lighter than moles, and cluster. If you are not sure ask your doctor.

Sun exposure plays a role in the development of melanoma and skin cancer, so it is imperative that your child is sun smart. That includes wearing a hat and sunscreen, as well as the newer protective clothing that is available at many stores. I would also have your child avoid the midday sun and wear a hat. Early awareness of sun protection will hopefully establish good habits and continue throughout your child’s life.

That’s your daily dose, we’ll chat again tomorrow. Send your question to Dr. Sue!

Daily Dose

What Are Breast Buds?

1.15 to read

I received a phone call today from a mother who was worried about the “bump” beneath her 12 year old daughter’s nipple. I do get this phone call quite often and even see mothers and daughters in the office who are concerned about this lump?  First thought is often, “is this breast cancer?”  The answer is a resounding “NO” but rather a breast bud.  While all mothers developed their own breast buds in years past, many have either forgotten or suppressed the memory of early puberty and breast budding.

Breast buds are small lumps the size of a blueberry or marble that “erupt” directly beneath a young girl’s areola and nipple. Most girls experience breast budding somewhere around 10-12 years of age although it may happen a bit sooner or even later. It is one of the early signs of puberty and estrogen effects.

Many girls will complain that the nipple area is sore and tender and that they are lopsided!! It is not unusual for one side to “sprout” before the other. Sometimes one breast will bud and the other is months behind. All of this is normal. 

While a lump in the breast is concerning in women reassure your daughter that this is not breast cancer (happy that they are so aware) but a normal part of body changes that happen to all girls as they enter adolescence.   Breast budding does not mean that their period is around the corner either, and periods usually start at least 2 years after breast budding (often longer).

Breast buds have also been known to come and go, again not to worry. But at some point the budding will actually progress to breast development and the continuing changes of the breast during puberty.

Reassurance is really all you need and if your daughter is self-conscious this is a good time to start them wearing a light camisole of “sports bra.”  

Daily Dose

Babies & Bow-Legs

1.15 to read

Fact or fiction: if a young baby puts any weight on their legs they'll become bow legged? Dr. Sue weighs in.I’m sure you have noticed, babies like to stand up! With that being said, I still hear parents coming into my office who say, “I am scared to let my baby stand up as my mother (grandmother, father, uncle) tells me that letting a baby put weight on their legs will cause bow-legs!  How is it possible that this myth is still being passed on to the next generation?

If you look at a baby’s legs it is easy to see how they were “folded” so that they fit inside the uterus. Those little legs don’t get “unfolded” until after delivery. A newborn baby’s legs continue to stay bent for awhile and you can easily “re-fold” those legs to see how your baby was positioned in utero. Almost like doing origami. So, how do those little bent legs get straight?  From bearing weight. If you hold a 3-5 month old baby upright they will instinctively put their feet down and bear weight.  A 4 month old likes nothing more than to jump up and down while being held. They will play the “jumping game” until you become exhausted. That little exercise is the beginning of remolding the bones of the leg, while straightening the bones. If you look at most toddlers many do appear bow-legged as the bones have not had long enough to straighten. Over the next several years you will notice that most children no longer appear bow legged. For most children the bow legs have resolved by the age of 5 years. I child’s final gait and shape of their legs is really determined by about the age of 7 years. Next time you hear the adage about bow legs, you can politely correct the myth. Standing up is going to make that baby have straight legs! That’s your daily dose for today.  We’ll chat again tomorrow.

Daily Dose

Prebiotics and Probiotics

1:30 to read

There has been plenty of discussions about using prebiotics and probiotics in your child's diet. What is the difference between the two? There has been a lot of discussion lately (in both medical and lay literature) surrounding the use of prebiotics and probiotics.  The first question patients/parents often ask is what is the difference between the two “biotics”? Prebiotics are non-digestible nutrients that are found in foods such as legumes, fruits, and whole grains. They are also found in breast milk.  Prebiotics have also been called fermentable fiber. Once ingested, prebiotics may be used as an energy source for the good bacteria that live in the intestines. Probiotics are beneficial live bacteria that you actually ingest. These bacteria then pass from the stomach into the intestine to promote “gut health”. The gut is full of bacteria and these are the “good bacteria”.  

There are currently hundreds of different probiotics being marketed. The research on the value of using prebiotics and probiotics has been ongoing, but there are actually very few randomized, double blind, controlled studies to document that pre and pro-biotics provide any true benefit to treat many of the diseases that they are marketed to treat. There are several areas where probiotics have been shown to be beneficial. By beginning probiotics early in the course of a viral “tummy infection” in children the length of diarrhea may be reduced by one day. Probiotics have also been shown to be moderately effective in helping to prevent antibiotic associated diarrhea, but not for treatment of that diarrhea.

There are also studies that are looking at giving very low birth weight premies probitoics to help prevent a serious intestinal infection called necrotizing enterocolitis. To date there seems to be evidence to support this and there are currently more ongoing studies. Studies are also being done to look at the use of probiotics as an adjunct to the treatment of irritable bowel syndrome, infantile colic, and chronic ulcerative colitis as well as to possibly prevent eczema.  While preliminary results are “encouraging” there is not enough evidence to date to support their widespread use. In the meantime, there are so many different products available.  Prebiotics and probiotics are now often found in dietary supplements as well as in yogurts, drink mixes and meal replacement bars. It is important to read the label to see if these products are making claims that are not proven such as, “protects from common colds”,  or “good bacteria helps heal body”.  Many of the statements seem too good to be true!

Until further studies are done there is no evidence that these products will harm otherwise healthy children, but at the same time there is not a lot of data to recommend them. They should never be used in children who are immunocompromised,  or who have indwelling catheters as they may cause infection. This is a good topic to discuss with your doctor as well.

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DR SUE'S DAILY DOSE

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