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Your Teen

10 Reasons Teens Act The Way They Do

2:30

Anyone in the midst of raising a teen knows that the adolescent years can be some of the most difficult to get through and understand.

As a parent or guardian of a teenager that wants to be more independent, but also needs supervision and guidance, the times can be challenging indeed.

If that’s the position you find yourself in, you may be asking – what’s going on in that youngster’s brain? Actually, there’s a lot happening!

There are several scientific reasons an adolescent brain can be similar to a toddler’s: After infancy, the brain's most dramatic growth spurt occurs in adolescence. Here’s 10 things you may not know about your teen’s brain.

10. Critical period of development. Adolescence is generally considered to be the years between 11 and 19. It’s easy to see the outward changes that occur in boys and girls during this time, but inside, their brains are working on overdrive.

"The brain continues to change throughout life, but there are huge leaps in development during adolescence," said Sara Johnson, an assistant professor at the Johns Hopkins Bloomberg School of Public Health.

Parents should understand that no matter how tall their son has sprouted or how grown-up their daughter dresses, "they are still in a developmental period that will affect the rest of their life," Johnson told LiveScience

9. The growing brain. Scientists used to believe the greatest leap in neuronal connections occurred in infancy, but brain imaging studies show that a second burst of neuronal sprouting happens right before puberty, peaking at about age 11 for girls and 12 for boys.

The adolescent's experiences shape this new grey matter, mostly following a "use it or lose it" strategy, Johnson said. The structural reorganization is thought to continue until the age of 25, and smaller changes continue throughout life.

8. New Thinking Skills. This increase in brain matter allows the teenager to become more interconnected and gain processing power, Johnson notes.

If given time and access to information, adolescents start to have the computational and decision-making skills of an adult. However, their decisions may be more emotional than objective because their brains rely more on the limbic system (the emotional seat of the brain) than the more rational prefrontal cortex.

"This duality of adolescent competence can be very confusing for parents," Johnson said, meaning that sometimes teens do things, like punching a wall or driving too fast, when, if asked, they clearly know better.

Sound familiar?

7.  Teen tantrums. While teens are acquiring amazing new skills during this time, they aren’t that good at using them yet, especially when it comes to social behavior and abstract thought.

That’s when parents can become the proverbial guinea pig. Many kids this age view conflict as a type of self-expression and may have trouble focusing on an abstract idea or understanding another's point of view.

Particularly in today’s heavy media influenced world, teens are dealing with a huge amount of social, emotional and cognitive flux says Sheryl Feinstein, author of Inside the Teenage Brain: Parenting a Work in Progress (Rowman and Littlefield, 2009.)

That’s when they need a more stable adult brain (parents) to help them stay calm and find the better path.

6. Intense emotions. Remember the limbic system mentioned earlier (the more emotional part of the brain)? It’s accelerated development, along with hormonal changes, may give rise to newly intense experiences of rage, fear, aggression (including towards oneself), excitement and sexual attraction.

Over the course of adolescence, the limbic system comes under greater control of the prefrontal cortex, the area just behind the forehead, which is associated with planning, impulse control and higher order thought.

As teens grow older, additional areas in the brain start to help it process emotions and gain equilibrium in decision-making and interpreting others. But until that time, teens can often misread parents and teachers Feinstein said.

5. Peer pressure. As teens become better at abstract thinking, their social anxiety begins to increase.  Ever wonder why your teen seems obsessed with what others are thinking and doing?

Abstract reasoning makes it possible to consider yourself from the eyes of another. Teens may use this new skill to ruminate about what others are thinking of them. In particular, peer approval has been shown to be highly rewarding to the teen brain, Johnson said, which may be why teens are more likely to take risks when other teens are around.

Friends also provide teens with opportunities to learn skills such as negotiating, compromise and group planning. "They are practicing adult social skills in a safe setting and they are really not good at it at first," Feinstein said. So even if all they do is sit around with their friends, teens are hard at work acquiring important life skills.

4. Measuring risk.  "The brakes come online somewhat later than the accelerator of the brain," said Johnson, referring to the development of the prefrontal cortex and the limbic system respectively.

At the same time, "teens need higher doses of risk to feel the same amount of rush adults do," Johnson said. Not a very comforting thought for parents.

This is a time when teens are vulnerable to engaging in risky behaviors, such as trying drugs, sex, getting into fights or jumping into unsafe water.

So what can a parent do during this risky time? "Continue to parent your child." Johnson said. Like all children, "teens have specific developmental vulnerabilities and they need parents to limit their behavior," she said.

It’s when being a parent to your child instead of trying to be their “friend” is more difficult but much more important for their physical and emotional safety.

3. Yes, parents are still important. According to Feinstein, a survey of teenagers revealed that 84 percent think highly of their mothers and 89 percent think highly of their fathers. And more than three-quarters of teenagers enjoy spending time with their parents; 79 percent enjoy hanging out with Mom and 76 percent like chilling with Dad. That’s not 100%, but it’s probably more than you thought.

One of the tasks of adolescence is separating from the family and establishing some autonomy, Feinstein said, but that does not mean a teen no longer needs parents – even if they say otherwise.

"They still need some structure and are looking to their parents to provide that structure," she said. "The parent that decides to treat a 16 or 17 year old as an adult is behaving unfairly and setting them up for failure." 

Listening to your teen and being a good role model, especially when dealing with stress and the other difficulties life can present, can help your teen figure out their own coping strategies.

2. Sleep. Ah, yes, sleep. Although teens need 9 to 10 hours of sleep a night, their bodies are telling them a different story. Part of the problem is a shift in circadian rhythms during adolescence: It makes sense to teen bodies to get up later and stay up later, Johnson said.

But due to early bussing and class schedules, many teens rack up sleep debt and "become increasingly cognitively impaired across the week," Johnson said. Sleep-deprivation only exacerbates moodiness and cloudy decision-making. And sleep is thought to aid the critical reorganization of the teen brain.

"There is a disconnect between teen’s bodies and our schedules," Johnson said.

Shutting down the electronics an hour before bedtime has been shown to help teens as well as adults get to sleep quicker and sleep better. No computer, TV, video games or cell phones.

1.The “I am the Center of the Universe” syndrome. You may have noticed that your teen’s hormones are causing quite a bit of havoc. Experts say that’s to be expected. But you may still wonder- what the heck is going on with my kid?

The hormone changes at puberty have huge affects on the brain, one of which is to spur the production of more receptors for oxytocin, according to a 2008 issue of the journal Developmental Review.

The increased sensitivity caused by oxytocin has a powerful impact on the area of the brain controlling one’s emotions. Teens develop a feeling of self-consciousness and may truly believe that everyone is watching him or her. These feelings peek around age 15.

While this may make a teen seem self-centered (and in their defense, they do have a lot going on), the changes in the teen brain may also spur some of the more idealistic efforts tackled by young people throughout history.

"It is the first time they are seeing themselves in the world," Johnson said, meaning their greater autonomy has opened their eyes to what lies beyond their families and schools. They are asking themselves, she continued, for perhaps the first time: What kind of person do I want to be and what type of place do I want the world to be?

Until their brains develop enough to handle shades of grey, their answers to these questions can be quite one-sided, Feinstein said, but the parents' job is to help them explore the questions, rather than give them answers.

And there you have it. Teen’s brains are exploding with new data, confusing signals and dueling desires. It’s a tough time in one’s development- but rest assured, what you teach them by example and compassion as well as how you gingerly help guide them will last a life-time. Even when you do the best you can, there are no guarantees that they will turn out the way you’re hoping they will – they are after all- individuals with a will and a mind of their own. But now you know a little more about why your teen acts the way they do.

Story Source: Robin Nixon, http://www.livescience.com/13850-10-facts-parent-teen-brain.html

Daily Dose

Homemade Cure for Coxsackie?

1:30 to read

Desperate times call for desperate measures…or so it seems according to several of my patient’s mothers who have resorted to all sorts of “cra-cra” stuff to “treat” their child’s “HFM” - hand foot and mouth infection.  Remember, HFM is a viral infection that most children get in the first several years of life. It may cause all sorts of symptoms but in a classic case the child develops a macular-papular (flat and/or raised) vesicular rash on the palms, soles and buttocks. In some children the rash is fairly mild and in others it can look pretty disgusting and uncomfortable…but it has to fade away on its own…with time.

 

There has been a lot of HFM in our area and much anxiety among parents about this infection….fueled a lot by social media identifying who has HFM and where they go to school and how many cases there are. (too much information!!). Parents are even posting…places to “stay away from”. So, some of my patient’s parents are scouring their child looking to see if there might be a bump..and could this be HFM and if so, what do I do to “stop” it!  That would be “nothing” besides good hand washing..as this is a viral infection and you may be exposed to it almost anywhere.

 

Since coxsackie virus has been around for years, this means that most adults had the virus when they were young.  But, several moms and dads whose children have HFM have also shown me a rash on their palms and soles, that I presume may be HFM? They are kind of freaked out and may be uncomfortable too…but this is not life threatening.  Even so,  several parents are resorting to THE GOOGLE to get their medical information… and one young mother kindly brought me all of the stuff that she had gotten to treat her son’s HFM as well as hers.  She was earnest in hoping that this was the “cure”…and did I know about all of these remedies?

 

Here we go, her potions!  Epsom salts for baths as this is an “antiviral”, turmeric and ginger in veggie juice, crushed garlic which she was mixing with small amounts of orange juice and squirting into her toddlers mouth with a syringe, lavender essential oil and lastly “virgin” coconut oil massages.   

 

I was most impressed that her sweet toddler was eating, drinking and bathing in all of this!!! Unfortunately, despite her best efforts it took about 2 weeks for his rash to totally disappear and she kept him under house arrest for most of that time!!  He really could have gone out long before that as he was over his acute illness, but she wanted every “mark” to have faded. She was most chagrined to hear that he might get HFM again. I am not sure the her “voo-doo” did any good, except in her mind. 

 

Lastly, if you do resort to “internet medicine” remember the oath, “first do no harm” and check with your pediatrician about some of the advice you might find on-line, not everything may be safe.

 

Your Child

Gluten-Free Diet Not Recommended for Healthy Children

2:00

A “gluten-free “ label on a food product is one sure way to increase sales as the popularity of such items continues to rise.

For people with Celiac disease or gluten sensitivity, eating gluten can cause diarrhea, abdominal pain, upset stomach and bloating. However, for healthy adults and particularly children, there are many reasons to avoid going gluten-free according to a commentary recently published in the Journal of Pediatrics, by Norelle Reilly.

Dr. Norelle Reilly is Assistant Professor of Pediatrics at Columbia University Medical Center and the director of pediatric celiac disease in the Division of Pediatric Gastroenterology and the Celiac Disease Center at Columbia University.

In a recent Time Magazine article, Reilly lays out four reasons why healthy children should not be on a gluten-free diet.

1. Gluten is not naturally toxic except for people with celiac disease, however, in almost all children, gluten travels through the intestine without causing disease and will never lead to problems. To date, science has not shown that there is a toxin in gluten that makes it bad for our bodies. A balanced diet containing fresh fruits and vegetables, lean proteins, and a variety of carbohydrate sources is the best way for healthy children to stay healthy, Reilly notes.

2. A gluten-free diet may not provide balanced nutrition for children. Some people assume that gluten-free food and healthy food as the same thing. Not necessarily so, says Reilly.

Many gluten-free substitutes for items such as breads and cookies are actually higher in fat and calories than gluten-containing varieties. Gluten-free items such as some cereals and breads may also not be nutrient fortified to the same degree as those with gluten. Folate and B-vitamins are often added to our usual starch staples, silently protecting people whose diets may not be very balanced from deficiency. Without these quiet sources of nutrition, vitamin deficiencies could develop, she writes.

Gluten-free foods are often fiber deficient, which is important for gastrointestinal health, including maintaining regular bowel movements. Quite commonly, children who initiate a gluten-free diet become constipated. Increased consumption of rice, a common gluten substitute, may also expose children to more arsenic in their diets, as arsenic is frequently present in the earth where rice is grown.

Reilly says that growing bodies and brains require balanced nutrition. For those children who need a gluten-free diet, balance can be implemented safely and healthfully with the guidance of an experienced registered dietitian to help avoid all of these and other nutritional pitfalls.

3. Have your child tested for celiac disease before putting them on a gluten-free diet. You can’t know for sure whether your child is gluten sensitive or has celiac disease until a physician has tested them. Symptoms alone are not enough to determine whether your child has celiac disease. Being on a gluten-free diet before having your child tested can make it more difficult to determine whether he or she actually does or does not have the disease.

Reilly suggests that if you are concerned that your child may have a problem with gluten, speak to your child’s doctor before banning it from your child’s diet. A child with celiac disease needs special monitoring over time and their family members may need to be tested. Even if you plan to give the diet a try regardless of the test result, it is extremely important for your child and family’s health to know why the diet is necessary.

4. A gluten-free diet is hard to maintain and expensive. For children who require this limited diet for long-term health, parents, schools, and the medical teamwork to make the child’s experience in school and at home as easy as possible.

Reilly notes that the children she has treated for celiac disease would trade in their gluten-free diet in an instant if they knew gluten would not make them sick.

In addition she adds, gluten-free foods are incredibly expensive and for many families the diet can be challenging to financially sustain in the long run.

Many adults prefer a gluten-free diet, but Reilly cautions that parents should check with their pediatrician or family doctor before putting their healthy children on the same eating plan.

Story source: Norelle Reilly, http://time.com/4329517/4-reasons-why-your-kids-should-not-be-gluten-free/

Parenting

Parents, Encourage Your Child to Stand Up to Bullying!

2:00

We’ve all read the stories about how a crowd of bystanders have not intervened or called the police for help, as someone was being bullied, attacked or beaten. It’s a horrible thought that if you need assistance, no one will respond.

When children grow up in a home that encourages standing up to bullying, they are more likely to step up to the challenge than kids who’ve been taught to stay out of it, according to a recent U.S. study.

About one in 10 children are victims of bullying, and many anti-bullying programs are focused on getting bystanders to intervene, researchers note in the Journal of Clinical Child and Adolescent Psychology. While previous research has linked certain parenting practices to higher odds that kids will be victims or perpetrators of bullying, less is known about how parents impact what children do as bystanders.

Researchers surveyed more than 1,400 fourth and fifth graders about how their classmates responded in a bullying situation. On average, the kids participating in the study were 11 years old.

They also interviewed parents at home and gave them hypothetical bullying scenarios, asking them how they would advise their children to respond.

In school, kids whose classmates said they might intervene to stop bullies and to comfort victims were more likely to have parents at home who told them getting involved was the right thing to do, the study found. At the same time, kids whose parents told them to stay out of it were both less likely to help victims and more likely to become perpetrators. 

“We were surprised to find that when parents told children not to get involved, children were actually more likely to join in the bullying,” said lead study author Stevie Grassetti, a psychology researcher at the University of Delaware. 

Based on the study results, it makes sense for school anti-bullying efforts to involve parents and endeavor to give children consistent messages about prevention in both settings, the authors conclude.

One limitation of the study is that during school visits; researchers didn’t define what constitutes bullying the authors noted. With home visits, researchers assumed parents gave kids the same advice about the hypothetical incidents that they would offer in real life, which might not always be the case, the researchers also point out.

Parents are role models for how children learn to respond to life’s unpredictable situations. They see and absorb everything their parents say and do. To teach your child compassion and courage, start by being a good example of both and letting them know that standing by and doing nothing to remedy the situation is not an option.

Story source: Lisa Rapaport, http://www.reuters.com/article/us-health-children-bullying-parents-idUSK...

Daily Dose

Giving Your Child Medicine

1:15 to read

Since I recently wrote an article about teaching young children to swallow pills, here is another reason to teach this to children sooner than later. The American Academy of Pediatrics has a new policy statement encouraging parents, physicians and pharmacists to use only metric measurements on prescriptions,medication labels and dosing cups to ensure that kids receive the correct dose of medication.

In other words, no measuring medications with teaspoons or tablespoons and especially not the ones in the cereal drawer.  Because spoons come in many sizes, they are not precise enough to measure a child’s medication.  For infants, toddlers and young children, a small error in dosing, especially if repeated for many doses, may be toxic.  

These recommendations also mean that doctors, like myself, need to prescribe medications in metric units like milliliters rather than teaspoons. We also need to instruct parents to use metric dosing devices, and not any measuring devices that have confusing markings with both teaspoons, tablespoons and milliliters. The medication should also come with an appropriate sized dosing device to avoid the possibility of two and three fold dosing errors.

The recommendations also call for manufacturers of over the counter medications to eliminate labeling, instructions and dosing devices that contain units other than metric units...no more 1 teaspoon, but rather 5 milliliters.

I am going to make a conscious effort to make sure that I am now writing my prescriptions with the correct units and help make dosing errors less of a problem and all medications safer for my “little” patients.

No more kitchen spoons!!!

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

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

Taking Your Child to the Doctor

1:15 to read

I imagine that you have heard the saying, “motherhood is the necessity of invention”?  It seems I must use this saying often as I can overhear my nurses quoting me and using the phrase as well.

 

There are many times I find myself in an exam room with a young patient and their mother when the mother says, “I forgot the……”. Sometimes it is a diaper (easily available in any pediatrician’s office), maybe a bottle (we have those too), a child’s favorite “lovie” (dire), and in many cases a pacifier.  Getting through the office visit without some of these necessities may make not only the child miserable, but also their parent.

 

Just the other day an adorable 5 month old baby and her cute mother came in because the baby had a cold and some eye drainage. Her mother was concerned that she might have an ear infection.  The first part of my exam was easy and the baby had a clear chest and no respiratory distress. She let me look at her nose and throat as well. Then it was time for the ear exam and of course the ear canals were waxy and I could not see her ear drum.  This means I have to use an instrument to remove the wax from the ear canal before I can get a good look at her ear drum.  The first ear was cleaned out and her ear drum was clear!!  But the second ear was more difficult to clean and the baby started to WAIL during this. Her mother looked frantically for something to soothe her..but she had forgotten her diaper bag with all of her stuff. So, once the ear canal was cleaned …she was pronounced ear infection free. While this was great news for the mother, the baby just continued to cry, loudly and angrily. 

 

I was trying to discuss the cold with the mother, but it was difficult for either of us to hear with the baby screaming. What to do…..? The only thing I had in the exam room was the basket of lollipops and stickers that we offer to children at the end of their exam.  I tried making a “sticker pop” on a tongue depressor to entertain and distract the baby…no such luck. The mother then looked at the lollipops, took out a grape one and unwrapped it and put in the baby’s mouth…INSTANT calm and smile on her face!!  Hysterical laughter from both of us as we took a picture to send to the father with the caption…Baby’s first food!!  Priceless. 

 

Love a mother like that…motherhood IS the necessity of invention!!

Daily Dose

Twisted Neck?

1:30 to read

Under the heading of “continuing to learn” every day…comes a new case.

 

A patient of mine who is 4 years old was playing with his brother the other morning while his mother was making their breakfast. He was a “well child” and woke up in a good mood, ready to eat and go to preschool.  She could see the boys playing while she was cooking and then suddenly the 4 year old started to scream and cry that his “neck hurt”.  At first she thought “he was pretending or over reacting” as there did not overtly seem to be anything wrong. The only thing she noticed is that he refused to turn his neck and held his head in an awkward position.

 

He continued to cry and actually scream - so she tried to calm him down and gave him some ibuprofen as well. Despite this he would not move his neck and was unconsolable, to the point that she almost took him to the ER but instead she brought him to the office.  He was noted to be crying and seemed uncomfortable and refused to move his neck at all.  His exam was otherwise normal. Even with careful questioning there was no history of trauma. He had slept through the night before this had occurred. He had a cold several weeks before, but had since improved. He did not have a fever.

 

He seemed to be in such pain that he was sent for neck X-rays which were read as normal. But he continued to be miserable….so who do you call?? 

 

I spoke to a pediatric orthopedic surgeon and he said he really did not have any ideas. Next call, the pediatric neurosurgeon. After hearing the symptoms he immediately said that he thought this little boy had “rotatory dislocation/subluxation” of the two upper cervical vertebrae in his neck (C-1 and C-2). He explained to me that in most cases the displacement resolves spontaneously, but in some cases the child continues to be uncomfortable as there is associated spasm of the sternocleidomastoid muscle, which causes the torticollis. (twisted neck).It may be seen in children after a recent upper respiratory infection and is then called Grisel Syndrome.

 

Treatment for the acute condition…pain control and muscle relaxation.  This was all news to me and I had to go to textbook (online of course) to even read about the condition.  The neurosurgeon walked me through treatment and the child was sent home on a very low dose of valium and continued ibuprofen. When I spoke to the mother later that evening the child was already more comfortable and had started to move his neck. 

 

I called her the following morning and she said that he had not required any further valium and slept well and was actually on his way to preschool! WOW….I was thrilled he was better so quickly and that I was that much “smarter”. Wonder if I will ever see rotatory subluxation of the cervical vertebra again? I’ll be ready.

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