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Daily Dose

PU: Body Odor

1.00 to read

I received an email from a mother who asked if her 5 year old son, an avid athlete, could wear deodorant?  It seems that his arm pits “smell like a grown man”.  I have actually been asked this on occasion in my office and I have even noticed body odor (BO) during exams on some 5-8 year olds.   

Most children start to “stink” as they begin to enter puberty, but there are occasional children that for unknown reasons, develop BO without any signs of puberty. If it seems that your child is entering puberty at an early age, you do need to talk to your doctor.  If your child happens to be one of those kids who are just odiferous, there are several things that you can do.

Number one, make sure that your child is bathing/showering everyday, and that they wash their armpits well. Some little boys (and I bet a few girls) just pop in and out of the shower without touching soap on most of their bodies.  (I used to smell my boys hair when they came out of the shower, sometimes still smelled sweaty, no soap!).

If daily bathing does not do the trick, it may be time to use a deodorant, which just masks the smell. This often works for younger kids who are really stinky rather than sweaty.  An anti-perspirant actually stops and dries up perspiration and may not be needed until an older age.

There are numerous deodorant products available, some of which are natural as well. Head to the store and read labels to decide which one you prefer.

Daily Dose

Separation Anxiety

1.45 to read

I received an email from a mother who was concerned because her toddler son was crying when they left him at day care.  They were “alarmed” as he had not previously cried when they dropped him off and wondered if this was “normal” or a sign of a problem. Actually, this phenomenon should be quite reassuring to a parent as this is a sign that your child is developmentally on track, and has developed a healthy attachment to his parents. 

All children go through periods developmentally when they are more prone to separation anxiety.  As a new parent you are often concerned about “leaving” your child under the care of someone other than a parent. But, in actuality, it is far easier to leave a newborn or an infant than it is to leave a 8-9 month old.

By the time a child reaches this age they are beginning to show signs of stranger anxiety. In other words, they now recognize the faces and voices of their parents, routine caregivers, siblings etc.

But, when a new person (and face) reaches out for a 9 month old it is not uncommon for that child to suddenly panic and burst into tears. This is not because the “stranger” has done anything at all, but because the child now understands being separated from their parent and may fear that the parent is leaving forever. 

The bond between parent and child has been successfully established, which is quite healthy. This is the beginning of teaching a child that a parent may leave for work, school or even a trip, but that they will return.  Just because a parent leaves for awhile, they are not gone forever. 

This first stage of separation anxiety can provoke feelings of anxiousness in both child and parent, but it is an essential part of normal development. Separation anxiety, like almost all behaviors, varies from child to child. While some childen are more clingy than others, some may just be “wired” in a certain way and are more vulnerable to separating from a parent. Regardless, it is important for a child to begin to deal with healthy separation. 

During the ages of 12 – 24 months separation anxiety seems to peak, and the period of crying or anxiety when a parent drops a child at day care or Sunday school, or even at a grandparents house may escalate. 

While a child may cry after being dropped off, most children will then calm down and may be distracted and will begin playing soon after the parent has left. Again, some children just seem to take longer to adjust, so don’t be alarmed if  one child cries for 2 minutes, while another may take up to 20-30 minutes to settle down. 

Toddlers do not understand the concept of time, and therefore each one may react differently.  While happily playing while the parent is gone, it is not uncommon for the child to cry again upon seeing their parent when being picked up.  For the toddler, the return of the parent may remind them of how they felt when the parent left earlier in the day. 

For most children separation anxiety decreases between 2 -4 years of age as you can explain, and a child can understand, where you are going, how long you will be gone etc. 

For children who have rarely been left with others, it may be more difficult at this age.  Remember, healthy separations are important for both parent and child, and the idea that no one will “babysit” or care for your child other than a parent is not realistic nor does it teach your child to build trust in others. 

The more experience a child has had with earlier normal periods of separation the easier different transitions will be.  Remember, they will all be going to school one day and you want to prepare them for that separation.

Lastly, every child has good days and bad days and almost every child will have a phase when it is harder to separate than others. Just remember to hang in there, be re-assuring to your child when you leave them, do not prolong the departure, and be understanding about their anxiety. As with so many experiences in parenting, “this too shall pass”. 

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

Your Teen

Overweight Girls Start Periods At Earlier Age

1.45 to read

Early-onset menstruation is linked to later health problems such as breast cancer, said Sarah Keim, a researcher at The Ohio State University College of Medicine in Columbus, who wasn't involved in the new study. Girls who get their period early in life are also more likely to have sex sooner than their peers, Keim added, which increases the risk of teen pregnancy and sexually transmitted diseases.It's nothing new that girls are getting younger and younger when they have their first period, but experts worry that the current obesity epidemic could be fueling that trend.

Overweight or obese girls get their first period months earlier than their normal-weight peers, according to a Danish study. Early-onset menstruation is linked to later health problems such as breast cancer, said Sarah Keim, a researcher at The Ohio State University College of Medicine in Columbus, who wasn't involved in the new study. Girls who get their period early in life are also more likely to have sex sooner than their peers, Keim added, which increases the risk of teen pregnancy and sexually transmitted diseases. About 17 percent of American kids and teens are obese, according to the Centers for Disease Control and Prevention. For the study, researchers used information on body mass index (BMI) -- a measure of weight in relation to height -- and age at first period from about 3,200 Danish girls born between 1984 and 1987. The girls started their period just after they had turned 13, on average, which is about half a year later than in the U.S. Keim said part of the reason for this difference may be that African-Americans tend to start their periods before white girls. On average, a girl got her period about 25 days earlier for every point her BMI increased. For a female of about average height and weight, a one-point change in BMI is equivalent to about six pounds. Overweight and obese girls, for example, got their period three to five months before normal-weight girls, said Anshu Shrestha, a graduate student at UCLA School of Public Health, who worked on the study. There has been past research showing a link between BMI and when girls start menstruating. However, since this study was done more recently, it shows that the link is holding up in today's generation, Keim said. The researchers also found that a girl's mother's weight was related to when her daughter started menstruating, but less so than earlier work had hinted. For every point her mother's BMI when pregnant went up, the girl's period came about a week earlier, according to the new study, which was published in the journal Fertility and Sterility. Keim said the Danish findings reinforce the importance of keeping a healthy weight. "It's important for your entire life, starting from very early on," she told Reuters Health. "And it can even affect your children's health." Talking to your daughter about Menstruation. Most girls begin to menstruate when they're about 12, but periods are possible as early as age 8. That's why explaining menstruation early is so important. But menstruation is an awkward subject to talk about, especially with preteen girls, who are often embarrassed by this discussion. So what's the best way to approach this ticklish topic? If your daughter asks questions about menstruation, answer them openly and honestly. Provide as many details as you think she needs at the time. It's OK to let your daughter set the pace, but don't let her avoid the topic entirely. If she's not asking questions as she approaches the preteen years, it's up to you to start talking about menstruation. Don't plan a single tell-all discussion. Instead, talk about the various issues - from basic hygiene to fear of the unknown - in a series of short conversations. Consider it part of a continuing conversation on how the human body works. Remember, your daughter needs good information about the menstrual cycle and all the other changes that puberty brings. If her friends are her only source of information, she may hear some nonsense and take it for fact. To introduce the subject of menstruation, you might ask your daughter what she knows about puberty. Clarify any misinformation and ask what questions she might have. It may be helpful to time your conversations with the health lessons and sex education your daughter is receiving in school, or you could broach the subject before a routine doctor's appointment. You can tell your daughter that the doctor may ask her whether she's gotten her period yet. Then ask if she has any questions or concerns about menstruation. Girls might prefer to learn about menstruation from a female family member, but sometimes that's not possible. If you're a single father and you're not comfortable talking about menstruation, you might delegate these conversations to a female relative or friend. The key is to make sure the information is relayed somehow. The biology of menstruation is important, but most girls are more interested in practical information about periods. Your daughter may want to know when it's going to happen, what it's going to feel like and what she'll need to do when the time comes. - What is menstruation? Menstruation means a girl's body is physically capable of becoming pregnant. Each month, one of the ovaries releases an egg. This is called ovulation. At the same time, hormonal changes prepare the uterus for pregnancy. If ovulation takes place and the egg isn't fertilized, the lining of the uterus sheds through the vagina. This is a period. - Does it hurt? Many girls have cramps, typically in the lower abdomen, when their periods begin. Cramps can be dull and achy or sharp and intense. Exercise, a heating pad or an over-the-counter pain reliever may help ease any discomfort. - When will it happen? No one can tell exactly when a girl will get her first period. Typically, however, girls begin menstruating about two years after their breasts begin to develop. Many girls experience a thin, white vaginal discharge about one year before menstruation begins. - What should I do? Explain how to use sanitary pads or tampons. Many girls are more comfortable starting with pads, but it's OK to use tampons right away. Remind your daughter that it may take some practice to get used to inserting tampons. Stock the bathroom with various types of sanitary products ahead of time. Encourage your daughter to experiment until she finds the product that works best for her. - What if I'm at school? Encourage your daughter to carry a few pads or tampons in her backpack or purse, just in case. Many school bathrooms have coin-operated dispensers for these products. The school nurse also may have supplies. - Will everyone know that I have my period? Assure your daughter that pads and tampons aren't visible through clothing. No one needs to know that she has her period. - What if blood leaks onto my pants? Offer your daughter practical suggestions for covering up stains until she's able to change clothes, such as tying a sweatshirt around her waist. You might also encourage your daughter to wear dark pants or shorts when she has her period, just in case. Your daughter may worry that she's not normal if she starts having periods before, or after, friends her age do, or if her periods aren't like those of her friends. But menstruation varies with the individual. Some girls have periods that last two days, while others have periods that last more than a week. It can even vary this drastically from month to month in the same girl. The amount of blood lost each month can vary, too, usually from 4 to 12 teaspoons (about 20 to 60 milliliters). It's also common for girls to have irregular periods for the first year or two. Some months might even go by without a period. Once your daughter's cycle settles down, teach her how to track her periods on a calendar. Eventually she may be able to predict when her periods will begin. Schedule a medical checkup for your daughter if: - Her periods last more than seven days - She has menstrual cramps that aren't relieved by over-the-counter medications - She's soaking more pads or tampons than usual - She's missing school or other activities because of painful or heavy periods - She goes three months without a period or suspects she may be pregnant - She hasn't started menstruating by age 15 The changes associated with puberty can be a little scary. Reassure your daughter that it's normal to feel apprehensive about menstruating, but it's nothing to be too worried about and you're there to answer any questions she may have.

Daily Dose

Ear Tugging & Your Child

1.15 to read

I see a lot of parents who bring their baby/toddler/child in to the pediatrician with concerns that their child might have an ear infection. One of the reasons for their concern is often that their baby is tugging on their ears.  

Babies find their ears, just like their hands and feet, around 4 -6 months of age.  I guess a baby must think “this ear tugging is fun and feels good” as maybe babies have “itchy” ears just like adults. It also seems to be a self soothing habit for other children who seem to pull on their ears when they get tired and cranky.  Maybe it is related to new molars coming in at the back of the jaw line?   

Whatever the cause, it often concerns parents who are told by their friends or relatives, “I am worried, this ear pulling probably means the child has an ear infection”.  So, being a good parent off you go to your pediatrician only to find out that the ears a beautiful and clear! 

Most babies and children do not get an ear infection without ANY other symptoms besides ear pulling.  In most cases infants and toddlers will get a secondary ear infection during cold and flu season. The multitudes of viral respiratory infections that children get in the first 3 years of life, often cause continuous runny noses and congestion. This congestion causes fluid to build up in the middle ear space which connects to the nasal passages via a small canal called the eustachian tube.   

Infants and children have so called “immature” eustachian tubes that are soft, and don’t drain well and the tube gets inflamed and swollen from the viral infection as well.  At times this fluid gets secondarily infected from bacteria that find their way to the middle ear.  Voila....an ear infection ensues. 

So, if a parent brings their child in for “pulling on their ears” and they are otherwise well (no cough, congestion, runny nose and sleeping well) I usually ask if they want to “wager” if their child has an ear infection.  That is really not fair, as this sweet parent is only concerned because typically someone else told them they should be.  But, in this case a quarter bet is usually made and I end up with a lot of quarters.  (they are good for all of the other bets I do lose with parents and kids about all sorts of things). Friendly betting at the pediatrician’s office, wonder if I am going to be investigated! 

Don’t worry about simple ear pulling especially when you see it happening all of the time.   

Lastly, with the new guidelines for prescribing antibiotics for an ear infection parent’s don’t need to worry as much about a prescription for antibiotics and a few days of waiting will not hurt.  

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

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

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

Newborn Schedules

1:30 to read

I am trying to decide if I am giving “old” advice when I am talking to new parents about their new baby. Here’s the dilemma…”when can I get the baby on a schedule?” This has become one of the first questions I am asked, sometimes even before the baby has left the hospital.

 

I know there are differing opinions on many things “pediatric”, but schedules for a newborn just is a hard thing for me to understand.  This tiny new baby is not a robot and has not been programed to eat at 8, 11, 2, 5, 8, and 11 and to sleep all night.   But….many new parents begin to try and get their baby on this schedule right away (I can name a few books that advocate this). That is all fine by me if I thought it worked….but I think it actually leads to many of the new parents coming in for their visits at 2, 4 and 8 weeks totally stressed out!  They seem to spend a great deal of time trying not to feed their baby any sooner than 3 hours and doing all sorts of things to try and get their baby to sleep thru the night without eating, which may actually be keeping them up longer than if they just fed their newborn based on their cues to eat every 2 -4 hours.

 

A new baby is really very immature neurologically (think startle reflex, no smiling), and at times may want to eat in 2 .5 hours rather than 3. Not because they are thinking about how long until  their lunch break or how they want to wake their parents up at night to mess around with them, but rather because they are hungry!

 

For most babies, not all, after 6-8 weeks of more “on-demand” feeding ( but no more often than every 2 hours during the day), with regular awakening between feedings during the day, a baby will suddenly begin to develop a rhythm and schedule. The idea that your baby will eat, “play and stay awake” and then sleep routinely beginning at birth is absurd to me. I know that sometimes they will stay awake longer than you want, and at other times they are so sleepy you can barely awaken them, but with practice and patience it will change.

 

Trying to keep a newborn from eating at 1 am or 4 am,  just makes you the parent more sleep deprived and your baby hungry. As their tummy gets bigger and their body starts to figure out circadian rhythm, life becomes easier. But an APP that tells me that “now is the time to feed the baby” is just NOT NECESSARY.  

 

The struggle to “get a baby on schedule” seems to be a favorite topic….but one day looking back and after the baby begins to sleep longer periods of time at night, you may realize it was actually easier than the next phases of parenting….when your child does walk and talk!

 

 

 

 

Daily Dose

Kids Learn Tech Skills Before Life Skills

New study days that young children are learning how to use a an computer or Smartphone BEFORE they know how to ride a bike!Did you happen to see the new study which was just released by software maker AVG Technologies?  The company solicited 2,200 mothers to answer a survey looking at skills their children have; riding a bike or tying a shoe as well as those very important early childhood skills such as how to use an iPad or Smartphone!

While 21% of 4-5 year olds knew how to use a Smartphone or iPad application, only 14% of those same kids could tie their shoes. For children 2-5 years, 69% could operate a computer mouse, 58% could play a computer game but only 52% knew how to ride a bike (I am assuming that means pedaling a tricycle or a bike with training wheels for that age?). Seems incredible to me that more kids have computers than tricycles?  Also, 25% of 2-5 yr olds could open a Web browser, only 20% knew how to swim.  Technology is definitely changing the world, but is it all beneficial? The CEO of AVG Technologies commissioned the survey to show how young children are interacting with technology. He emphasized that parents need to be educating their young children about their online world and need to be promoting internet/online safety at very young ages. It used to be “when do I have the sex talk” now it is being replaced with ”how soon do I need to talk about online safety and technology?”. Obviously, if one looks at this study, the latter needs to come much sooner than one might think.   If you don’t teach children online safety early on, they might just find “the sex talk” online anyway, even before they can perform some very basic life skills like writing their own name. But the most disturbing aspect of this study is that it suggests that our children are way too wired and may be missing out on simple, yet important life skills. I myself have seen many a two year old open their parent’s iPad and turn on a movie while in the exam room.   They can recognize different icons and switch between applications but are not yet capable of talking in complete sentences. Some of these children are the same ones who at two years are not yet putting themselves to sleep at night, cannot sleep through the night and still have a bottle or pacifier!  Some parents are convinced that their child may not be capable of mastering these normal developmental milestones, while at the same time are thrilled about their child’s computer skills. Seems a little mixed up to me. Priorities sometimes get confused. As I have discussed many times before, it is important for children to have time to explore, create and use their imagination, without the benefit of constant technology.  I can remember when Velcro tennis shoes came out and our boys wanted those shoes. But, before succumbing to Velcro we felt it was important to learn to tie a shoe. Once that skill was mastered, Velcro shoes became a favorite, even if just for a while. Of course, as with many things, the Velcro lost its allure and they were back to tying shoes by middle school.  The basics have staying power. Technology is important and will continue to be so, but what if the computer is “down” and you need to write a story with pencil and paper, or draw a picture without the benefit of a computer screen. There are certainly many life skills to be mastered, the list is too long. What about pumping a swing, jumping rope, playing ball, and just being a kid.  The race to teach kids technology and to help them compete in our constantly “wired” world may be detrimental to a child’s physical and emotional health. We as parents need to remember to “turn off the technology” and get back to basics. There is time for both. What do you think? Leave your comments below.

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What can you do if your child stinks?

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