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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.

Parenting

Should You Take the Kids "Black Friday" Shopping?

2:00

The day after Thanksgiving is one of the busiest shopping days of the year. It’s come to be known as “Black Friday;” a day where deals can definitely be found.

In some places, it has become more like a scene from the movie “Fight Club” than a shopping spree. There seems to have developed a need so great for the cheapest electronics and clothes that people are willing to fight, push and steal from each other to get them.

So, should you take your kids with you if you’re planning on doing a little shopping on this unruly day?  The short answer is no. However, if you find yourself in a situation that it’s either the kids go, or there is no holiday shopping to be had, then do some planning ahead of time to prepare.

If there is anyway possible to avoid taking a newborn into a crowd of grabbing hands, shoving elbows and long lines – not to mention the germs- please do it.  Newborns will be the most vulnerable and will demand all of your attention. If you do take a baby with you, make sure you have a partner who can help with your baby’s care and safety.

In an article on The Penny Hoarder, author Nicole Dieker, reached out to Rosemarie Groner, a mother of two and owner of the Busy Budgeter blog, for tips on how to successfully navigate Black Friday with the kids.

Groner shares her thoughts and suggestions on the topic.

Though not typically recommended, this may be the day when giving your little one unlimited screen time on a tablet or cell phone is warranted. An all-day shopping trip becomes more fun for the kids when there is a digital distraction to keep them occupied.

It’s also a good idea to pack small toys to keep kids entertained, and Groner suggests packing special toys that kids don’t usually get to play with. 

It’s also possible to buy new toys to increase the delight/distraction factor – just make sure the new ones are within your budget.

Packing your kids’ favorite snacks is another great way to delight and distract. The kids get their favorite goodies — and yes, this is the time to pull out those special-occasion treats — and you also save money by not having to buy snacks at the food court. 

“Packing a cooler full of drinks, sandwiches and portable snacks like Go-Gurt, trail mix and chips can help you avoid the high cost of eating out,” Groner explained. It’ll also help you keep the kids happy, fed and hydrated so you can keep shopping. A small roll around cart is essential for keeping everything you’ll need portable.

What about those famous Door-busters? Should you tackle those? Many stores have moved the open door time for these super-shopping events to Midnight or 1:00 AM. Some people even camp out in front of the store hoping they will be the first ones through the doors.

Groner suggests you skip it. “Unless I could save several hundred dollars on something I would have bought anyway, I would skip the frustrations involved in that. I can’t think of anything that I could get to make camping outside of a store with kids overnight worth it.” If you feel left out on great deals – look for the same items online on Cyber Monday. Shop in your pajamas with a cup of coffee, from your own home instead!

If Black Friday shopping is still calling your name, shop in teams. If you’ve got another parent, relative or friend available to shop with you, use the power of teamwork.

“It’s a great idea to team up with another adult,” Groner said. “That would give you both a chance to break away for a few minutes kid-free to grab something while the other handles the kids.”

With two adults, you also have someone available to take kids to the bathroom, sit with them as they eat a snack and help entertain them when they get bored.

If you have a small child, consider using a well-made child harness to make sure your little one doesn’t disappear in the crowd.

Black Friday shopping has become a sport for those who are free to move about easily, have plenty of stamina and little distraction. If you’re the parent of small kids, online shopping may be just the ticket for your holiday gifts.

Story source: Nicole Dieker, https://www.thepennyhoarder.com/life/how-to-survive-black-friday-shopping-with-your-kids/

 

Your Child

Checking Out Your Kid’s Apps

2:30

Apps are today’s equivalent to yesterday’s skates, cabbage patch dolls, transformers, NERF balls and video games.   Every kid wants one and there are plenty to go around.

A recent article on CNN.com looked at the dilemma many parents face when their little one wants a popular app downloaded onto their phone. A couple’s 9-year-old daughter wanted the app, Musical.ly. Her classmates were using it and sharing content and she wanted to be able to join in on the fun. It basically enables you to share your own music videos to popular songs. 

While dad, David G. Allan, didn’t say yes or no right away, he did tell her he would do some research and let her know his and his wife’s decision.

It’s a good thing he decided to check it out.

His online research provided commentary and articles about the app plus an opportunity to sign up and give it a try.

After downloading the app and examining the content, he and his wife chose to veto the request.

In a Facebook post, he laid out his 3 reasons why.

“I found sexual content in user profiles and videos, without trying very hard. There was easy, direct exposure to strangers. Adult strangers. And I found no way to filter out those first two items, even with privacy settings on. The privacy settings seemed to only reduce other risks.”

The app’s terms and conditions says signup requires users to be age 13 and older, but user age is self-reported and something parents can restrict only for app downloads at the device level.

When a website says that a child must be 13 years or older to use an app, that’s just a legal way to protect themselves; it is not necessarily because they want to protect your child.

A 1998 law titled the Children's Online Privacy Protection Act details the responsibilities of developers to protect online privacy and safety of kids under age 13. Website operators reduce their legal culpability by putting that age cutoff in their terms and conditions.

Over breakfast the next morning, Allan told his daughter that she would not be allowed to download the app and the reasons why. “I explained to her that an important part of my job as a parent is to do everything I can to keep her safe. And because she trusts that I've got her back in all things, my permission to use social media brings with it the assumption that it is a safe thing for her to do.”

Turns out that some of his daughter’s friends’ parents read his post and deleted the app from their child’s phone. It wasn’t long before his 9-year-old and her classmates were on to the next app. He checked that one out as well and allowed her to get it.

A good point made in the article is, “We will all have different ideas of what's appropriate, but it's the conversation and deliberation that's important. And the flipside of social media is that it gives us a great forum with which to engage in it.”

It’s not easy being a parent. There are times when you have to say no and stick to it, but giving the no a reason, puts it in context for a child. They may not like it, but at least they no why you’ve made that choice.

Apps are not going away and younger and younger children are finding them and sharing them. It’s imperative that parents not only know what apps their child is using, but that they do the research on these products. It’s one way to help keep your child a little safer when the digital world offers something that is simply not appropriate.

Story source: David G. Allan, http://www.cnn.com/2017/11/10/health/screen-decisions-go-ask-your-dad/index.html

 

Daily Dose

Over The Counter Products

1:30 to read

So, if you have read my daily doses you are aware that my “news watching” comes from morning TV while I am getting ready for work!!  I often find myself talking to the TV, especially when it is a medical segment which includes pediatrics.  While I am excited that morning TV is covering health topics, some of the information may be a bit “misguided” when a pediatrician is not the one discussing a pediatric topic.

I “heard” another example of this the other morning when the morning shows were discussing the “top pharmacist picks for over the counter products”.  It seems they surveyed pharmacists  and then compiled a list of “favorite” name brand OTC products in numerous categories - I don’t  think there was much science behind this. At any rate, we all have our “favorite” go to “OTC” products which for one reason or another we prefer. Does that actually mean they are better?

So, here are a few that I had issue with:

Allergy medications: They picked Claritin, but why not Zyrtec or Allegra?  They are all second generation anti-histamines and there is not a great deal of data that one is better than another. If push came to shove and I could only pick one antihistamine it would be Benadryl (diphenhydramine) - despite its sedating properties it is still a great drug.

Topical antibacterial medication: They picked neosporin and I would pick polysporin. Neosporin contains neomycin which may cause an allergic contact reaction. Other than neomycin they are quite similar and both contain topical lidocaine for pain relief.  Guess what -  they are made by the same company!!  

Pain relief:  They picked Advil, but why not Motrin or generic ibuprofen.  I am frugal and buy whatever is on sale, same drug.  I always remind parents of this as sometimes they get confused and say, “Advil didn’t work so I gave them Motrin” double dosing them with same drug. Be careful.

GI complaints:  Pharmacists picked Pepto-Bismol. I do not recommend Pepto-Bismol to  children as it contains  bismuth subsalicylate which is related to aspirin and has been associated with Reye’s Syndrome.  The bottle is labelled “do not use under the age of 12 years” due to this concern, but parents may not read the fine print. There is a Children’s Pepto that contains only calcium carbonate and may be given to children as young as 2 years….really important to read the labels as there are many choices with similar names.

Lip balm: Their choice was Carmex. I do not recommend lip balm/gloss that contains menthol or camphor as it may actually damage the lips and cause more drying…so you apply more then it is a vicious cycle.  You want to use lip balm with bees wax or petrolatum and no fragrance. I like Aquaphor, Burt’s Bees and Vaseline.  

Formula: Their choice was Enfamil.  I recommend any of the formula brands including Simliac and Gerber as well as some Organic Formulas if my patients desire.  I don’t know why they would pick only one brand…no data on that either.

Sunscreen:  Their choice Neutrogena, which I also love. They make good products that are hypoallergenic and PABA free, and they have many different vehicles (spray, lotion, stick) to choose from. I am also a fan of Cerave products and they now have sunscreen for babies.  But the most important fact is to use a sunscreen of any brand with an SPF of at least 30 and one that contains zinc or titanium dioxide and no PABA or oxybenzone. 

Those are just a few of my comments and favorites.

 

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Daily Dose

What New Babies Need

1:30 to read

I have many friends whose own children are now having babies and they always ask, “what all do we need to have/buy for a new baby these days?”  While many things have changed since I had my own children, many have not,  and I still think “less is more” is a good adage to follow, especially for a newborn.  We all have a tendency to buy too much, or the “latest and greatest” only to find out that it is not necessary.

Carseat - a rear facing car seat is a must for your newborn!!!  Look at all of the reviews on line and pick which seat works best for you.  Do you want one with a base that you can also clip on to a stroller?  Remember your baby will sit in a rear facing car seat until 2 years. This is one item I would spend my money on!!

The baby needs a place to sleep so buy a crib and a good mattress.  If you are going to have more than one baby I would buy something that will last through several children. I like having a crib (rather than a toddler bed), as your baby will be in the crib for several years and then can move to a regular bed…no need for an “in between”.  Do not use an “old” crib that has drop sides, due to safety concerns. So that means the one that I had kept in the garage (from my kids) was a throw away! I usually move the first child to a bed when I need the crib for the next baby…no specific age. Bumpers are no longer recommended, so that saves money too!

Changing table or dresser for the millions of diaper changes.  It is so helpful to not have to bend over each time. I would also buy a diaper cream (Dr. Smiths, Destin or Butt paste) to have on hand….your baby will probably get a diaper rash at some time during their time in a diaper.

Baby bath tub: while you can bathe your baby in the sink, the newer bathtubs do make it easier for a newborn and you can use it in the tub as well until your baby can sit up alone. Remember, you will NEVER leave your child in the tub alone…even with all of the seats, rings and things  that they sell to support your baby!!  For bathing I like gentle bath wash like Cetaphil, Cerave, and Eucerin products….good for all skin types.  Pick one!

Swaddle blankets: WOW there are a million on the market and they all “claim” to help your baby to sleep better. I don’t think any of the products say “it will also takes weeks to months for your baby to sleep through the night” , no matter what you use.  I do like the thin swaddle blankets as they are useful for a number of things besides swaddling. Once you have your baby have the nurses show you how to swaddle (quick and easy).  The Miracle Blanket, Woombie and Halo also make it easy to swaddle as well. Pick one (or two) and stick with that.  Remember, your baby is going to be put in their crib on their back whether swaddled or not!! NO TUMMY SLEEPING.  

Diaper Bag: again their are a million out there in all shapes, sizes and price points. In the beginning you need to have a pad for changing (you will end up changing that baby all sorts of weird places), diapers, burp clothes, wipes…as your baby gets bigger you will have bottles, cups, toys all shoved in there too. All of my patients seem to have a travel size Purell strapped to the side of the bag as well. I would get a bag that you can wipe out as there will be spills of all sorts of stuff in that bag I assure you!  Somehow, over time you go back to “less is more” and the diapers end up in your purse!!  

So…that is a start. Will do another post on some other products in the future. 

 

 

Parenting

Helping Kids Cope With Tragic Events

2:00

Another all too common tragedy has saddened the hearts of Americans this week. Just 35 days after a man opened fire on a crowd of concertgoers in Las Vegas, killing 58 people and wounding nearly 500 others, another mass killing has taken place. This time in the small community of Sutherland Springs, Texas, leaving 26 people dead and 10 critically injured.  About half of the victims were children, according to news reports. This follows a terrorist attack in New York City on Halloween that killed 8 people. The heartbreak and numbers are gut wrenching to think about.

These kinds of horrific events can make the world seem like a terrifying place, particularly for kids.

How can you help your child cope with such frightening news? As a parent or a caregiver, how you react can have a strong impact on how your child views his or her own safety.

Dr. Jennifer Caudle, an associate professor at Rowan University School of Osteopathic Medicine in Stratford, suggests that parents shield their children from news reports.

"Children may become upset by news coverage," Caudle said. So monitor and limit what they see, hear or read. This may reduce their anxiety and help them deal with these unsettling events, she explained.

Other suggestions include:

  • Ask your child what they have already heard about the event. 
  • Provide the facts but try not to make judgments about the situation. 
  • Avoid upsetting details, and reassure children that people are working hard to make things better for everyone. 
  • Don't pressure kids to talk about the events, but encourage them to share their feelings by talking, drawing or writing. 
  • Let children know they can come to you for information and that they are free to ask questions. 
  • Remind children that their home is a safe place. 
  • Let children know that people may react differently to hard-to-understand events.

If your child or adolescent seems to be obsessing over the events and is having a hard time putting things in perspective, they may need professional help. 

"Problems with sleeping, changes in appetite or behavior, mood changes and new physical complaints, such as stomach aches and headaches, could -- in some children -- be a sign that they are having a difficult time coping," she said. "If this is the case, make sure your child sees a health care professional."

The National Institute of Mental Health (NIMH) says that it is important to let your child know that you will do your best to take care of him or her, that you love them and it’s okay for them to feel upset or sad.

NIMH also offers these tips:

  • If your child is having trouble sleeping give them extra attention, let them sleep with a light on, or let them sleep in your room (for a short time).
  • Try to keep normal routines, for example, reading bedtime stories, eating dinner together, watching TV together, reading books, exercising, or playing games.

Unfortunately, these types of tragedies don’t appear to being going away anytime soon. But, you can help your child (and yourself) by reminding them that although there are some people that might want to inflict harm on others, most people are loving and kind. They want a safe place for children to grow up in and they are doing their best to make this world a better place.

Story sources: Mary Elizabeth Dallas, https://consumer.healthday.com/mental-health-information-25/child-psychology-news-125/helping-children-cope-when-a-mass-tragedy-strikes-728263.html

https://www.nimh.nih.gov/health/publications/helping-children-and-adolescents-cope-with-violence-and-disasters-parents/index.shtml

Daily Dose

Thanksgiving Blessings

1:30 to read

This is the time of year that we all sit down to be thankful and to express gratitude. Teaching children to be grateful is an important lesson and begins even when they are little children.

 

I am reminded of this this week as I have been getting my house ready for Thanksgiving….but for some reason have been having a few rooms in my house painted…the week before the holidays?!?!  Not sure what in the world came over me.

 

But, cleaning out cabinets and drawers in preparation for the painters produced so many long forgotten cards and art projects that my own children had done…with Thanksgiving themes.  Little hand prints on paper with fingers for the feathers, cut out turkeys and cornucopia with prayers of Thanksgiving and of course pictures of the children in Pilgrim costumes for the Thanksgiving play.  I have loved every minute….and find myself becoming a “hoarder” as it is so difficult to throw any of those memories away!!  Of course when I called my sons to ask “do you want any of this” they all replied, “NO WAY”…and do not drop anything at our house!  Just throw it out….little hand prints on a home made trivet, how can I do that?

 

I am hopeful that many of you are making Thanksgiving memories with your young children and beginning conversations about gratitude.  It is amazing the wonderful things that children will say when they are asked what they are grateful for. 

 

One of the highlights of my week has been when a patient came in with her 3 year old son who had just made a turkey at preschool with all of the different colored paper feathers. On each feather he had written (or rather he had dictated to his teacher) what he was thankful for. There was a different name on each feather…including his Mom, Dad, sister, and there in that wonderful plume was also Sue-Sue (what he calls me)!! Another aside, I took care of his mother when she was a child and through college.

 

So, while I am thankful for so many things this year including 2 new grandsons and another soon to be daughter in law (April wedding), I am also thankful for my patients who have made me part of their families!  How fortunate am I to be able to continue to practice pediatrics and now have the privilege of taking care of a second generation of adorable and precious children.

 

Happy Thanksgiving!

 

 

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Daily Dose

Ear Infections

1:30 to read

Musings from the very busy pediatric office:  with all of the advances in technology over the last 30 years why is it that examining a child’s ears and visualizing their eardrum continues to be challenging?  I started thinking about this while examining a very unhappy, strong and febrile toddler….probably the 20th patient of the day. 

 

During the “sick season” many of the patients who come to my office are young children whose parents are worried that they may have an ear infection.  This concern is one of the most frequent reasons for pediatric office visits. While I realize that many of my colleagues are in the operating room operating on brains or doing open heart surgery (truly saving lives) the one advantage that they have is that their patient is under anesthesia while they are doing complicated procedures. Which only means that they are not trying to wrestle, cajole, or coax a child into letting them look into their ear canal, and then only to find that you can’t see a thing as the canal is full of wax (cerumen).  

 

At times examining ears can be fairly simple and straight forward, but some days it seems that it may be easier to attempt to fly than to look at a 16 month old child’s ears. Today was one of those days. It seemed that every child I saw had a temperature over 102 degrees, and they all had “waxy” ears. While there are several ways to remove wax from the ear canal, none of them is easily done in a toddler, especially when the wax is hard and difficult to remove. Having 3 children myself and one who had recurrent ear infections and tympanostomy tubes, I know what it is like to have to hold your child on the pediatrician’s exam table while they irrigate or “dig” wax out of the ears.  Not fun….!!!  But, at the same time I realize that this is the only means to see if the ear is infected and if there is the need for an antibiotic. 

 

With the advent of the HIB and Pneumococcal vaccines the incidence of ear infections has dropped significantly, as these bacteria were common causes of otitis. But, ear infections are still the #1 reason that a child receives an antibiotic, especially in the first 2 years of life.  Therefore, a good ear exam is one of the most important things your pediatrician does, as I know you don’t want your child to receive an unnecessary antibiotic!

 

Please know that pediatricians do not enjoy making a child uncomfortable, but somehow that ear drum needs to be seen…especially in a sick child.   

 

So…why has some brilliant medical device inventor not found a way to wave a magic wand over a child’s ear to “tell me” if their ear is infected?  To date, I have not seen any “new” ways to accurately examine an ear other than with the otoscope…and a clean ear canal…which means unhappy children (and parents ) while I try to clean their ears.  

 

Remember, don’t use q-tips in your child’s ears and if your pediatrician has to struggle a bit to clean out  your child’s ears, it is only because they are doing a good job!!  I am waiting for the “easy” button.

   

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