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Daily Dose

Brown Spots on Your Baby?

1:30 to read

I was examining a 4 month old baby the other day when I noticed that she had several light brown spots on her skin. When I asked the mother how long they had been there, she noted that she had started seeing them in the last month or so, or maybe a couple even before that.  She then started to point a few out to me on both her infant’s arm, leg and on her back.

These “caramel colored” flat spots are called cafe au lait macules, (CALMs) and are relatively common. They occur in up to 3% of infants and about 25% of children.  They occur in both males and females and are more common in children of color.  While children may have a few CALMs, more than 3 CALMS are found in only 0.2 to 0.3% of children who otherwise do not have any evidence of an underlying disorder.  

Of course this mother had googled brown spots in a baby and was worried that her baby had neurofibromatosis (NF).  She started pointing out every little speckle or spot on her precious blue eyed daughter’s skin, some of which I couldn’t even see with my glasses on. I knew she was concerned and I had to quickly remember some of the findings of NF type 1.

Cafe au lait spots in NF-1 occur randomly on the body and are anywhere from 5mm to 30 mm in diameter. They are brown in color and have a smooth border, referred to as “the coast of California”. In order to make the suspected diagnosis of NF-1 a child needs to have 6 or more cafe au lait spots before puberty, and most will present by 6 -8 years of age.

For children who present for a routine exam with several CALMs ( like this infant), the recommendation is simply to follow and look for the development of more cafe au lait macules. That is a hard prescription for a parents…watch and wait, but unfortunately that is often what parenting is about.

Neurofibromatosis - 1 is an autosomal disorder which involves a mutation on chromosome 17 and may affect numerous organ systems including not only skin, but eyes, bones, blood vessels and the nervous system. Half of patients inherit the mutation while another half have no known family history.  NF-1 may also be associated with neurocognitive deficits and of course this causes a great deal of parental concern. About 40% of children with NF-1 will have a learning disability ( some minor, others more severe).

For a child who has multiple CALMs it is recommended that they be seen by an ophthalmologist and a dermatologist yearly,  as well as being followed by their pediatrician.  If criteria for NF-1 is not met by the time a child is 10 years of age,  it is less likely that they will be affected, despite having more than 6 CALMs.

The biggest issue is truly the parental anxiety of watching for more cafe au lait spots and trying to remain CALM…easier said than done for anyone who is a parent. 

Daily Dose

Toddler Constipation

1:30 to read

I get so many questions about toddlers and constipation.  Constipation relates to stool frequency and consistency.  It is important to understand that everyone has different bowel habits and not all children will have a stool every day.  While some children will have several stools a day another may have a stool every 2 -3 days. Both of these scenarios may be normal and not an indicator of problem.  At the same time, stool consistency is important. If your child has  hard, dry, pebble like stools ( rocks rather than softer snakes or blobs ) this may be an indicator of constipation. Everyone will occasionally have a hard stool, but this should not occur consistently. Lastly, it should not be painful to pass the stool. While toddlers may grunt or push, or even start to “hide” to poop, it should not cause real pain.

With all of that being said, it is not uncommon for toddlers to become constipated as they often are also becoming picky eaters. Due to this “phase”,  some young children will drink too much milk in place of eating meals and this may lead to constipation. Your toddler should be drinking somewhere between 12 -18 ounces of milk per day.  Many children also load up on other dairy products like cheese, yogurt and cottage cheese, which while healthy, may also lead to too much dairy intake and contribute to constipation.

Water intake is also important to help prevent constipation. If your child is drinking too much milk, substitute some water as well.  It is a balancing act to make sure your child is getting both milk and water. If necessary I will also put the smallest amount of apple or prune juice in the water. By the age of 1 year, your child should no longer have a bottle as their main source of nutrition is no longer in the liquid form!

Fiber is also important so offer plenty of whole grains and limit the “white foods” that toddlers love (yes, the bread, cereal, pasta). If you always buy whole wheat pasta and whole grain breads your children will never know the difference. Stay away from processed white foods whenever possible.  It is also easy to throw flax seed or bran into muffins or smoothies (disguising fiber). I also sometimes use Metamucil cookies (they are pre made) and may even resort to dot of icing smeared on it and offer it as a cookie for snack, along with a big glass of water.

Fruits and veggies are a must…even if you think your child won’t eat them! Your toddler needs 2 servings of fruits and veggies every day and rotate what you offer them.  You will be surprised at how one day they may refuse something and they next they will eat it. Don’t give up on fruits and veggies,  it may literally take years for your child to eat peas…but if they aren’t offered a food repetitively they will probably never it eat. I know a lot may get thrown to the floor but just clean it up and persevere.  Not only will this help their stools but their long term healthy eating habits as well.

Movement is also important to help keep the bowels healthy and “moving”.  Making sure that your toddler is moving seems crazy, as they are on the go all of the time.  But with an older child make sure they are getting plenty of time for play and exercise outside or in…and not just sitting in front of a screen.

Lastly, for short term issues with constipation it is also okay to try using milk of magnesia (MOM) or even Miralax….but ask your doctor about dosing in toddlers.   

Daily Dose

Potty Questions Keep Coming

1.15 to read

Potty training always gets lots of questions and one of the most common is having a child who will "tinkle" in the potty but is not yet "pooping". When potty training all three of my boys, they all pooped later than they tinkled. I know some people disagree, but I certainly think I hear of more people who have to work a little harder and longer to get to pooping on the potty. It may be due to a toddler's fear of letting their poop go, or the difference in sensation with stooling or any number of issues that toddlers are working through as they are potty trained.

Whatever the reason for children who arenot wanting to poop, you have to continue to be patient and praise their success on the potty with urination. Continue to discuss poop within the family, and let your child see you going to the bathroom. Talk about how animals, birds, fish and people all poop and they don't do it in a diaper or underpants but in the potty. During all of this conversation (and while you are frustrated), make sure that your child is not holding stool and becoming uncomfortable, which only adds to anxiety and fear and further withholding poop. You might want to try putting your child on a prune juice cocktail, milk of magnesia, or Miralax to soften the stool and ensure that they are having a soft stool every couple of days. A toddler will often hold their stool until bedtime when they are in their diaper and will then poop or may ask for a diaper to poop during the day. This is not uncommon and usually does not last terribly long. If they want to poop in their diaper I would have them sit on the potty with a diaper and poop and then put them back in their training pants. I also praise and rewardthem for sitting on the potty to poop, even if it is in a diaper, and use a sticker chart or M&Ms or both. Hopefully, over time they will realize that sitting on the potty to poop is perfectly normal and will give up the diaper. You can even cut a hole in the diaper to let the stool come out into the potty so that they may see that it is not painful, scary or difficult. Always remember to praise and not punish and to be patient and consistent with your messages about poop. Rewards seem to go a long way, and albeit small, they often work wonders. It may take several months of persistence to conquer the poop issue, so remain calm. If they continue to have problems have a further conversation with your doctor about the possibility of stool holding and encopresis. That's your daily dose, we'll chat again soon.

Daily Dose

Don't Miss Out on Summer Fun!

1.00 to read

The lazy days of summer seem like the perfect time to engage in playtime activities. My summer months at the office are particularly busy doing check ups as everyone is out of school. This means that I seem to see a lot of children in the 5-12 year group, and I enjoy getting to talk to them about their summer fun. 

I have suddenly realized that many of the children in this age group seemed to have “missed” some key milestones in child development, which I think most of us adults learned during the lazy days of summer.  I think learning to ride a bicycle and learning how to swim are two MUSTS of child development. While not all children will want to one day participate in a swim team, or a bike race, being able to swim and pedal a bicycle are life long skills. Who knows, with the price of gas we may all be heading back to bicycles as preferred transportation, at least for short distances.  

At the same time I have noticed a fair number of parents who are concerned about their young children’s motor development.  This is the 2-4 year old group where I am sometimes amazed when the parent of a 3 year old tells me that their child “does not jump high enough”. What?  How about getting out the jump rope again, and drawing hopscotch on the sidewalk to practice hopping and jumping. These are free exercises that can help boost coordination while having fun together. What about learning to skip and to balance on a beam (doesn’t have to be at gymnastics) a two by four in the back yard or park works just as well. Learning to pump a swing is another. I can remember how proud I was when I mastered that skill (makes me smile, even today). 

So while the last days of summer are here, make a list of not only summer reading, or computer skills that your child needs to finish, but of some of those childhood milestones as well.  Hop, skip, jump rope, ride a bike, learn to swim. College applications might start asking about those milestones one day too?  Stranger things have happened.

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Daily Dose

Late Teether?

1:30 to read

Time for another of those moments in my office when I just turn my head and say “what?”.  The latest...during a 9 month old check up the child’s mother expressed concern that her daughter did not yet have any teeth.  

When I explained to her that this was totally within the range of normal, and in fact, I myself loved babies without hair or teeth in the first year of life!!! Why? They are “low maintenance”.  Don’t have to worry about washing dirty hair or brushing those first teeth...plenty of time to deal with that later on right?

But her concern was real...she was very worried about her daughter’s lack of teeth.  I reassured her that it was not uncommon, there are a lot of babies that will not get a tooth until around 1 year of age and late teething often runs in families.  I wondered if she knew when she or her husband had gotten their first tooth?

Upon further questioning her real concern was that she had been “told”  “if your child is a late teether they will also be a late reader?”  Was this something her friends told her on Facebook or on their Instagram post? I thought I had heard all sorts of concerns about teeth erupting...things like my child is fussy, doesn’t sleep well, drools a lot, chews on everything, has runny poop.....but won’t be able to read?  There is just too much information or rather “mis-information” out there.

So, it was such a relief for me to be able to tell her that I was not aware that there was any relationship between teething and reading. In fact...one of my own children had his first tooth erupt at 6 months (which is about average) and he ending up being dyslexic (which is another blog on successful ways to help children with learning differences).   My middle son did not get a tooth until about 18 months (which did worry my mother, she was ready to put money into savings for baby dentures), and he was reading before kindergarten ( which had nothing to do with us...we were focused on trying to teach his older brother how to read).

See why I love my job....something new everyday.... thankfully some of the concerns have no basis in fact....and I get to reassure parents.  

Daily Dose

Why Kids Bang Their Heads

Dr. Sue talks about why some kids bang their heads.I have had several questions both online and on–air from parents who “are concerned because their child will bang their foreheads when they get upset”. 

One listener wanted to know if she needed to take her child “to a specialist”.  Thankfully, she does not need to find the “headbanging specialist” whoever that may be, as head banging among babies and toddlers is really quite common.  Up to 20% of babies and toddlers may bang their heads on purpose, and not surprising to me, boys are 3 times more likely to bang their heads than girls! Head banging is a habit, and it typically “rears its ugly head” between the ages of 18 – 24 months.  Head banging typically resolves by the time a child reaches the age of 3, but by that time many parents are ready to bang their own heads. For toddlers head banging may actually be a self comforting mechanism for children to help themselves relax and fall asleep. Many parents will comment that the head banging often occurs in the crib rail or wall beside the crib. Head banging is often a common sign of frustration during the toddler years.  During a tantrum a child may bang their head on the floor as a way of showing strong emotion, when they are not yet verbal enough to use words to express feelings. The best way to put an end to head banging is by ignoring your child’s behavior. Toddler’s may get a few bruises on their foreheads, but they know exactly how hard they can hit their head without causing serious injury. You may not realize it, but toddler’s are really quite bright, and they are seeking attention through head banging (albeit negative behavior to get attention), so running to them each time just reinforces their behavior. The sooner they realize that you are not going to intervene or respond to their head banging the more quickly the behavior will stop. Just beware, that by the time your child is a teen, they usually don’t resort to head banging to vent their frustration, but use a barrage of words to convey their unhappiness with you!  Something to look forward to. That's your daily dose.  We'll chat again tomorrow!

Daily Dose

Ready for Summer Camp!

1.30 to read

Summer camp season is upon us, I can tell from the number of forms I am signing each day!!  Many parents ask me when their child is ready for an overnight camp experience?  While you and I know that every child is different and some may be “camp ready” sooner than others, here are a few tips to show readiness for “sleep away” camp. 

Most children are ready to spend a week or two away from their parents between the ages of 8 - 10.  Older children may even want to spend a month or 2 at camp (certainly was the case for one of mine and not the others). But, age is not the only factor involved in deciding camp readiness. A child who has siblings going to camp may even be ready to join their brother or sister when they are as young as 7 years old.  They might miss their sibs more than their parents! 

For starters, has your child asked about going to camp, or have you asked them how they feel about going “away” to camp?   Does your child like to spend the night at a friend’s house or spend the night with relatives? Or, are they the type of child who always calls to get picked up because they want to “sleep in their own house”.  If you can’t spend one night away, I would not suggest leaping to 2 weeks of overnight camp. 

Has your child gone to a day camp before, made new friends easily and asked to go back for more?  Do they like certain types of camps that fit specialized interests, or are they just there to “do everything!”. These should be questions to answer when deciding about an overnight camping experience as well. 

Research camps with friends and neighbors. Do you want your child to be “far away” in different environment?  (both culturally and seasonally). What about accessibility and travel arrangements to and from camp? These decisions might also help you to choose camps either in or out of state. Some children would much prefer an overnight camp where you take them and pick them up rather than arriving at a new camp via bus or plane. 

Lastly, remember like so many other parenting decisions, this is a camp for your child.  Just because you went to “Camp --------” does not mean that it is necessarily the right camp for your child.  Be open- minded and take some time to visit a few camps this summer while they are open.  Just like colleges, best time to visit is when they are in session! 

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

 

Daily Dose

Stranger Danger

1.30 to read

We had a question via our iPhone App from an aunt who wanted to talk to her twin 4 year old nephews about “stranger danger”. Unfortunately, this topic has been in the news quite frequently lately with child abduction cases being reported all around the country.

The National Center for Missing and Exploited Children has numerous resources for educating children about safety.  Interestingly, most perpetrators are not actually strangers, but are often someone the parents or another adult knows and may have been around the child on occasion. So, it seems that “stranger danger” may not be the appropriate term to use when teaching our children, especially younger, children about safety. It is important that the conversation about safety begins with children at young ages. It is often easier to use teachable moments to begin the conversation with young children. 

Talk to your child about “safe” strangers, as it is hard for a child to understand why you are talking to grocery store clerks, or people on the playground in the park, and yet they are strangers. It may be best to teach a child to watch out for dangerous behaviors from adults, rather than saying “never talk to strangers”.  Talk about adults who might approach them for directions, or to find a missing pet and role play as to what they should  do. At the same time, teach them that they can turn to “strangers” such a store clerks or mothers with children for help if they are scared.

While talking about this subject use a calm reassuring manner.  You do not want to make your child “too” anxious as most people they will meet are not dangerous, and children do need to interact and trust numerous people around them that they will meet in  different situations.

Another good way to discuss the issue of “stranger danger” is by reading books to young children that deal with the issue. Several good books that I like are:  The Berenstein Bears Learn About Strangers; A Stranger in the Park; I  Can Play it Safe.  There are many other books out there too, so head to your library  or your local bookstore to get some more recommendations. The librarians are often helpful with finding “age appropriate” books.  Lastly, this is not a one time conversation, but should be discussed at different ages and stages of your child’s life.

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

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