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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

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

Teens Not Getting Enough Sleep

1.30 to read

If you're the parent of a teen, this does not surprise you at all:  teens do not get enough sleep!    

An online study released by the Center for Disease Control and Prevention says, “70 percent of high school students are not getting the recommended hours of sleep on school nights”.  I could have done that study in my office on any given day of the week! 

Having raised 3 teenagers as well as thousands of teens in my practice, I know this to be true, first hand. The problem is this age group is least likely to believe or convince that lack of sleep causes a plethora of physical as well as psychological problems. 

According to the CDC study, which was just published online in Preventive Medicine, insufficient sleep is associated with numerous “risky” behaviors including drinking alcohol, smoking cigarettes, fighting, lack of physical activity and being sexually active.  The data on sleep was accumulated from the 2007 National Youth Risk Behavior Survey where students were asked, “on an average school night, how many hours of sleep do you get?” Insufficient sleep was defined as less than 8 hours, while sufficient sleep was 8 or more hours per night. On an average school night, almost 70% of responders reported insufficient sleep.  

In my practice I ask every child/adolescent about their sleep habits and routinely find teens are averaging between 5–7 hours of sleep per night. They also come in everyday with a chief complaint of FATIGUE! 

I used to tell my own sons throughout their high school years that they needed to be in bed at 10:30p.m.  They could not understand why I was up “prowling around their rooms” in the dark of night demanding, that they go to bed. “No one else has a bedtime in high school” was the common complaint.  

But I also told them that I made my living out of telling teens (and their parents) that the reason their child “felt badly” was not mono, or a dreaded disease, but lack of sleep.  

Those teens who did not have adequate sleep also drank more soft drinks (did not include diet), used computers for 3 or more hours every day, admitted to current alcohol, cigarette and marijuana use, were sexually active, and also expressed more feelings of being sad or hopeless or even of having suicidal thoughts. 

If we could improve these statistics and reduce so many teenage “health risk behaviors” by just having parents enforce bedtimes, it sure seems like an easy sell. 

Set a time, turn off the electronics and “put your teen to bed”. I know they have homework and tests and papers to write, but they also must be healthy, and rested to make good choices in both school and outside the home. 

Oh, the study also found that watching 3 or more hours of television each day was not related to insufficient sleep. You might leave that part out!  

Daily Dose

Do Essential Oils Boost Immune System?

1:30 to read

Although it is still hot and officially summer, soon everyone will be heading back to school  and coughs and colds (and eventually flu, another topic) will be just around the corner. I had a patient ask me about the use of essential oils. Her 2 1/2 year old daughter is heading to preschool for the first time and she “had heard from her friends that essential oils help a child’s immunity during cold season”.

Unfortunately, there is very little data at all to confirm that statement. I only wish that rubbing a bit of lavender oil on would help prevent the common cold. While it may smell great and be relaxing....there is no data that I can find to show that there is any reproducible science to the claims that essential oils boost the immune system.  

While I was researching I found many sites stating that “eucalyptus oil is an anti-viral” and “peppermint oil is an anti-pyretic (fever reducer)”.  Tea tree oil is touted as being “both anti -bacterial and anti-fungal” (I don’t know of other drugs that can claim both!).  But, I just don’t see any data to support all of this. 

The word essential refers to the essence of the plant the oil is derived from, rather than being “essential” to your health. While in most cases essential oils (which are highly concentrated) used as aromatherapy are not harmful for adults, it may be a different story in children, especially those under the age of 6. While labels may say  “natural” it may not always mean safe.  Many oils are poisonous if ingested and there have been reports of accidental overdoses in children with several different oils. In one report tea tree oil and lavender oil applied topically have been shown to cause breast enlargement in boys.  Oil of eucalyptus and peppermint are high in menthol and cineole.  These substances may cause children to become drowsy have decreased respirations.  While there are articles stating that the use of menthol (Vicks) on a child’s feet may be helpful during a cold for reducing a cough, do not use this if child is young enough to put their feet in their mouths. 

I must say that I sometime use a few drops of eucalyptus oil in the shower when I have a cold as I think it smells great and seems to help “open up” my head. Whether this is in “my mind” or a response from my olfactory centers which sends calming messages to respiratory center is not clear. But, I am not ingesting it or using it topically. 

 

Daily Dose

Spoon-feeding Your Baby

1.15 to read

I continue to see a lot of new babies (so fun) and there seem to be a lot of questions and concerns around when to start feeding a baby solids and how to actually do it as well. 

The consensus about beginning solid foods has really not changed in the last 30 years. Infants do not need to begin solid foods until somewhere around 6 months of age, give or take a few weeks. 

It has also long been recommended to start feeding a baby rice cereal as their first solid food. Again, there is no real data on this and the AAP is at work on new feeding guidelines as I write this. We may be changing things around and starting protein before cereal? 

Never the less, I typically recommend starting a baby with some type of cereal as it is easy to make and easy to wipe up if your baby does not like it!!  One of the biggest things about beginning foods is it can tend to be messy, and this is an important part of a baby’s feeding experience as well. 

I start feeding a baby cereal from the spoon, typically as a breakfast meal, after the baby has had their morning breast or bottle feeding. I pick the mornings as most babies are happy in the morning, so you can pick the best time to feed your own baby. You don’t want to start a new project with a fussy baby. 

Put your baby in the Bumbo chair or high chair, so they are sitting up, and mix up the cereal (with either breast milk or formula) to the consistency that you can spoon feed it. Not so thick your child gags and not so thin it runs off the spoon.  Then you just do the airplane to the mouth game (somehow I always find myself also saying “yum, yum”) and see how your baby feels about eating cereal. Some babies love it and others will seal those lips and scream. There is no magic about beginning solid foods and don’t try to “make your baby open their mouth”, it is practice practice. 

After several days to weeks you will see that your baby is enjoying the high chair and is interested in spoon feeding and you can begin to feed other pureed foods. I also add more solid feedings to their day so that they are ultimately getting 3 solid meals (breakfast, lunch and dinner) as well as their bottle or breast feedings. Yes, that often means you are actually spending more time feeding than before. 

I usually begin veggies, then fruits then meats, but again there is no “perfect” way to add additional solid foods. Just feed your baby lots of different pureed foods with different tastes, as you will see they will eat almost anything at this age. Enjoy that as it all changes once they are a toddler! 

Spoon feeding is fun and is not the biggest source of a babies calories until they are older. It is just the beginning of getting your baby interested in the spoon and new textures in their mouths. Another new experience for both parent and baby. 

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

Daily Dose

Bump on Your Child's Leg?

1:15 to read

I recently saw a young adolescent patient who had noticed a “lump or bump” on her leg which she had noticed for some time and she had now wondered what it was. She said that she had initially thought she had bumped her leg,  but she had continued to watch it and noticed that it did not seem to be going away. So, after many months of watching it and wondering what it was she decided to come ask me.

On her exam she had a notable “bump” or mass on her lower leg, about the size of a half dollar. There was no surrounding bruising and the mass was non-tender. She told me it really did not bother her, and she was more concerned as she thought it was noticeable and a friend had asked her about the “bump”.  Other than cosmetic concerns, it did not cause any problem.

The most common reason for this bump is an osteochondroma, which is a benign bone tumor. The most common time to find this type of tumor is during periods of rapid growth during adolescence. They are usually found in the leg (femur, tibia) or the upper arm (humerus). 

So, I sent her for an x-ray which was compatible with the diagnosis of a benign osteochondroma. She then had a CT of the area which confirmed the diagnosis.  Most osteochondromas are solitary and the chance for malignant transformation is rare (less than 1%).  So, after discussing her case with a pediatric orthopedic surgeon it was decided to just watch it.  

She had mixed emotions about her diagnosis, as she was happy to know what caused the “bump” but was concerned that her friends would continue to ask her about it. Of course her parents were relieved to find out that it was benign and would likely never require any treatment.

We all decided to watch it for now…..as the tumor typically stops growing after an adolescent has completed their growth spurt and the growth plates of the bones are closed.  

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.

Daily Dose

New Test for Baby

1.30 to read

If you recently had a baby (or are getting ready to) you may have noticed another “test” being performed on your newborn before they leave the hospital. Earlier this year the American Academy of Pediatrics endorsed the routine use of pulse oximetry to enhance detection of critical congenital heart disease.  

Critical congenital heart defects (CCHD) are serious structural heart defects that are often associated with decreased oxygen levels in infants in the newborn period. These heart defects account for about 17-31% of all congenital heart disease (or about 4,800 babies born each year in the U.S.)  

While some of these defects are found on pre-natal ultrasounds, and some may be evident immediately after birth when the pediatrician hears a murmur or the baby has difference in their pulses, others may not present until a baby is several hours - days of age.  Using pulse oximetry to measure a baby’s oxygen levels before they are discharged is just another method of screening a child, and if there are abnormalities a baby would undergo further evaluation with an echocardiogram and would see a pediatric cardiologist. 

Pulse oximetry is routinely used in all aspects of medicine these days and requires a simple non-invasive device that is placed on a babies finger or toe to measure the level of oxygen in the blood. (looks a little like ET device to light up a finger). It works by comparing the differences in red light, which is absorbed by oxygenated blood, and infrared light, which is absorbed by deoxygenated blood.  

In a large study just published in the journal Lancet (looking at over 230,000 newborns), simple pulse oximetry detected 76% of congenital heart defects, with only a rate of 0.14% false positive results. The risk of false positives was even lower than that when pulse ox was performed when the baby was over 24 hours of age. Pretty impressive! 

It has been estimated that about 280 infants with unrecognized CCHD are discharged from newborn nurseries each year. Congenital heart disease also accounts for somewhere between 3-  % of infant deaths. With early intervention and surgery the chance of survival from CCHD is greatly improved. 

So ask your pediatrician or obstetrician if they are doing routine pulse oximetry in your hospital nursery.

 

 

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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