Daily Dose

Moles On A Child's Skin

1:30 to read

Everybody gets moles, even people who use sunscreen routinely. Moles can occur on any area of the body from the scalp, to the face, chest, arms, legs, groin and even between fingers and toes and the bottom of the feet.  So, not all moles are related to sun exposure.

Many people inherit the tendency to have moles and may have a family history of melanoma (cancer), so it is important to know your family history. People with certain skins types, especially fair skin, as well as those people who spend a great deal of time outside whether for work or pleasure may be more likely to develop dangerous moles. Children may be born with a mole (congenital) or often develop a mole in early childhood. It is common for children to continue to get moles throughout their childhood and adolescence and even into adulthood.

The most important issue surrounding moles is to be observant for changes in the shape, color, or size of your mole. Look especially at moles that have irregular shapes, jagged borders, uneven color within the same mole, and redness in a mole. I begin checking children’s moles at their early check ups and look for any moles that I want parents to continue to be watching and to be aware of. I note all moles on my chart so I know each year which ones I want to pay attention to, especially moles in the scalp, on fingers and toes and in areas that are not routinely examined. A parent may even check their child’s moles every several months too and pay particular attention to any of the more unusual moles. Be aware that a malignant mole may often be flat, rather than the raised larger mole. Freckles are also common in children and are usually found on the face and nose, the chest, upper back and arms. Freckles tend to be lighter than moles, and cluster. If you are not sure ask your doctor.

Sun exposure plays a role in the development of melanoma and skin cancer, so it is imperative that your child is sun smart. That includes wearing a hat and sunscreen, as well as the newer protective clothing that is available at many stores. I would also have your child avoid the midday sun and wear a hat. Early awareness of sun protection will hopefully establish good habits and continue throughout your child’s life.

That’s your daily dose, we’ll chat again tomorrow. Send your question to Dr. Sue!

Daily Dose

It's Allergy Season!

1:30 to read

WOW!  A busy week in the office and while I was on call in the evening,  the biggest problem right now seems to be allergies!  While some parts of the country may still be experiencing cold and a few snow flake, many states are warming up and the trees and grasses are starting to spread their pollens. In fact, my backyard is covered in yellow oak tree pollen, and some of it is so thick it looks like tumbleweeds. This cannot be good for anyone.

While I am finally seeing fewer and fewer children with the multitude of winter upper respiratory infections I see every year, the allergy season is looking “wicked” this year.  Seasonal allergies due to pollens from grasses and trees are typically not seen in children until they are over 24 months of age.  At times it is difficult to distinguish the last of the cold viruses from early allergy symptoms. But at this time of year, a good history is important (always) as well as a family history of allergies.

The good news is, there are a lot of medications available to help relieve the symptoms of itchy eyes, scratchy throat, cough, and drippy nose.  While the non-sedating antihistamines like Claritin, Zyrtec, and Allegra have been available over the counter for quite some time, intra-nasal steroids are now available as well. 

Intra-nasal steroids are one of the mainstays of allergy treatment, as they are a preventative medication. When used on a daily basis they help to prevent the “allergic cascade” that occurs when you inhale all of those pollens blowing in the wind.  They work best when used every day for the duration of allergy season which is really dependent on where you live. Allergy sufferers in the northeast will typically have symptoms later in the spring/summer than those in the “sunbelt”.

So you can now pick up Flonase and Nasacort over the counter and use them daily, even in children.  Make sure you try to aim the spray toward the outer side of the nostril and not toward the nasal septum (middle). This will allow the steroid spray more coverage as well as to try and help nosebleeds which may be a side effect of a nasal steroid spray. 

Lastly, with all of the kids playing outside in the “yellow mist” of pollen, make sure to bath/shower them and wash their hair when they come in.  This will help to reduce some of the itching and rubbing of their eyes and nose as well!

Daily Dose

Ebola Fear Running High

1:30 to read

As the weekend passes and there are thankfully no further cases of Ebola disease in any of the people who had the earliest contact with Thomas Eric Duncan (the first patient to be diagnosed with Ebola),  I hope people may be reassured that we are not in the throes of an Ebola epidemic in the United States and that the people who are at greatest risk of contracting the disease are unfortunately those health care workers who are treating the infected patient. 

Despite every precaution possible, and all of the personal protective equipment available, I am well aware that nothing is ever 100% .  But, with that being said, we (all health care professionals) continue to learn from mistakes as well as victories and I am sure that as we go forward combatting Ebola or other emerging viral infections, there will be new recommendations and procedures to learn, which is not a new concept in medicine.  That is how progress is made.

Unfortunately, the media (of which I must include myself) has once again managed to try to frighten the public and has done a good job of putting the three cases of Ebola out of 318 million Americans (unfortunately including 1 death) at the top of the news 24 hours a day.  The cameras continue to focus on the hospital in which I go in and out of every day.  This continued media presence has also affected the doctors who practice in the hospital as well as the professional buildings on the same campus. These doctors are my colleagues and friends and are great doctors.  

People have been canceling their dermatology visit in a professional building not even attached to the hospital and postponing a mammogram in another building.  Some patients will not come to my practice across the street from the hospital and would prefer to drive 20 minutes north to another office?   

There are parents keeping a child home from school because their classmate’s father is one of the doctors (heroes) taking care of the Ebola patients.  What are they thinking? How is this idea of catching Ebola from walking into an office or down a hallway or being in the same school being sustained?  Basically due to unsubstantiated fear and not fact. Fact is this illness is not airborne you must come into contact with body fluids of the sick patient.

Emotions are running wild in my hometown of Dallas. But emotions will not treat or eradicate Ebola, only good science will. Thankfully we have that available to us in our country. 

So listen to those who are knowledgable about infectious disease not lay people who expose their own ideas based on “what if’s”. Don’t listen to the pundits who are arguing with some of the best scientists and doctors that we have because if they themselves get sick one day, they will be seeking out these very same physicians and nurses to care for them. 

But one thing I am sure of, we will have influenza this winter and you can try to protect yourself and your family with flu vaccine.  There has never been a more important year to get vaccinated. Run, don’t walk and get vaccinated!

Daily Dose

Amber Beads for Teething?

1:30 to read

What is the deal with these amber teething beads?? Suddenly so many of “my” babies are wearing these little necklaces, which are “supposed” to help with teething. I worry they are a choking hazard and I have no clue why they would help a baby get their teeth?

I have previously written about teething and the many thoughts and/or “myths” surrounding babies and tooth eruption. A baby typically gets their first tooth around 6 months of age, and they are usually the lower 2 central incisors.  But, some babies will get teeth a bit earlier and some babies will not get a tooth until 15-18 months of age. The latest age that I have seen for a first tooth to come in was 22 months, and yes that child is totally normal and has all of their teeth!

Teething gets a bad rap for causing any fussiness in an infant once the baby reaches 4 months of age.  Whether the baby is fussy day or night, it is often attributed to teeth ( prior to this age it is “gas”). But, while many babies are drooling and putting their hands in their mouth and chewing on toys, it is probably actually due to development of hand to mouth coordination rather than tooth eruption.  A baby becomes really fixated orally around this age...and this stage last until they are about 24 months...you will see, everything goes straight to their mouth!

I am sure I remember my first child’s “teething” but I am also sure I could not begin to tell you when the 3rd son got his first tooth.  My middle son was the “crankiest baby/toddler” on the planet (he is a gem now) and he did not get a tooth until he was about 15 months old, and promptly knocked out his upper middle tooth around 2!   Don’t remember pain with teeth coming in or out?!?

So, back to the amber beads...I think they are a bit like essential oils...not sure what they really do. I also worry that a baby might get tangles up in the necklace and get asphyxiated...even though they are supposed to break apart. I would NOT take the risk. 

Lastly, you don’t see 5-6 year olds wearing amber beads as they lose their teeth and get their first permanent teeth. You also don’t hear a parent make excuses for a cranky/tired elementary school aged child....”she is just behaving like this because she is teething”, sounds a bit crazy right?

We parents like to have reasons for everything...and I don’t care if you blame teeth for making a baby fussy...I am just not sure there really is a correlation and certainly not for month after month...as a child gets 20 teeth in the first 2-3 years of life.   

Daily Dose

Ear Infections Can Develop Quickly

1:15 to read

One of the things that I sometimes see in my practice, which is interesting to me as a pediatrician, and was equally interesting when I had young kids, is how quickly a child's ear exam can change.

You are taught that in medical school, but when you really see it happen it with your patients or your own child you become a real believer. As the saying goes, seeing is believing. I can remember checking one of my boy's ears for an ear infection early in the morning before heading out to work, and declaring, "his ears are perfectly clear". How could it be, my husband would inquire, "that they seem worse after we have been at work all day" and lo and behold, I would re-check their ears and a normal morning ear is an abnormal evening ear. What a difference 12 hours can make! Not a very good warranty on ears and infections.

I was reminded of this yesterday when a patient called and said that her little boy had developed "disgusting" eye drainage which was worsening since I had seen them in the office a few days ago. They had just returned from taking both of their young children to Disney World, and she "couldn't believe they came home sick!" That's a whole 'nother column. At any rate, seeing that they lived fairly close I told them to swing on by and let me look at him again. I think she was just hoping I would call in eye drops. The two precious boys arrived at my doorstep on Saturday night and lo and behold after looking in the youngest child's ears, both of his ears were so infected. So, once again I was a believer in ears changing, and he did not need eye drops he needed to have oral antibiotics to clear up his ears (and subsequently his eyes). There are several lessons from all of this. Ears can change quickly, eye drainage in a toddler with a cold may often really indicate that their ears are infected, and house calls are a good thing.

That's your daily dose, we'll chat again tomorrow.

Daily Dose

Kids & Cell Phone Use

Did your child get a cell phone over the holiday? Have you set rules, boundaries and limits? You should and here's why. I have been walking through my waiting room recently and noticing that a lot of my “younger” patients have their own cell phone. So, I have now begun to routinely ask all of my patients over the age of 8, if they have a cell phone. I must say I am surprised that some 8-9 year olds actually do!!

I'm not sure why a child in elementary school needs a cell phone. Who are they calling?  What happened to being able to either go to the office at school to make a phone call or I asking your teacher if you might use their phone to call a parent if necessary?  Is that not possible anymore?  I know that younger children are also texting on the cell phone and I am not sure how some of them can text when they are not yet fluent readers.  I digress. After learning if a patient has a cell phone, I have also started to ask about rules for the phone. Have the parents established rules for cell phone use?  When the phone may be used, how many minutes the child has (does everyone have unlimited minutes now?), who they may call and what time is the phone “put to bed at night”. I have always asked my patients about their bedtimes and bedtime routines, but I am now interested in when the cell phone heads to bed too and gets turned off.  I am not talking about high school juniors and seniors, I am really speaking more to the children I see in elementary, middle and early high school. The older kids are yet another story. Many of my patients seem to have very good rules about when the phone may be used, to whom they may call (especially the younger oanes) and when the cell phones are turned off. But, just like those parents who still think that having a TV in a child’s room is a rite of passage, there are those parents who do not think it is necessary to set rules for the phone. I disagree. Children really do crave guidelines and need to have clear messages regarding the use of their cell phones. If you start off with “the rules of the phone” it lets a child understand that owning a cell phone is still a privilege, and that with that comes responsibility including when and how the phone may be used.  I do not think that a phone needs to be on once bedtime routines have started, and the phone should have a bed time too.  The easiest way to do this is by having a “family docking station” where the phones are put each night, turned off and charged. If this habit begins early on, it is easier to continue as your child gets older. Once again good habits are easier to make than trying to break bad ones. Having a middle school child on the cell phone in their room under the covers at 11 pm at night is not an uncommon occurrence and if the phones are put up each night it makes the temptation less likely.  The glow of the phone beneath the covers is a dead giveaway, as is the call record that shows use after the stated bedtime. Take the opportunity to review your child’s cell phone log on occasion. I was stunned at the number of calls high schoolers received after 11 pm when the phones were “supposed” to be off. Lastly, set rules about texts and let your child know that you will occasionally be reading their texts. They should be taught early on that anything they write should be fair game for a parent to read. Remind them that text messages never go away, somehow they may be retrieved from cyberspace even after deleted.  That amazes me, but we have all seen it in the news.  Discuss “sexting” too. If you don’t bring these things up they may find themselves in a situation they were ill prepared for, and make a poor decision. Being able to call your child when you need them is nice, but maybe we are all a little too connected at too young an age.  Like many things, once you let your child have their own cell phones it may be hard to go back. But remember, it is a privilege and the rules need to be followed or the phone may be taken away.  We parents just need to follow through. That's your daily dose for today. We'll chat again tomorrow.

Daily Dose

Measles Outbreak

1:30 to read

Entering Disneyland where the sign reads, “The Happiest Place on Earth”, it does not also say, “Beware of Infectious Diseases!”.  But, if you think about it...what better place to contract any infectious disease than Disneyland where many of the visitors are under the age of 12 years....and I know from my own experiences as a parent taking children to Disney...even if not feeling well nothing stops a child at Disney. That means not even a fever.  (Other parents have reported the same thing to me when they went;  fever/tylenol and then off to theme park). 

So, now reports of at least 70 cases (and counting) of measles which children have contracted while visiting Disneyland in December. Not all of the confirmed cases have even been in California with cases are now in Utah, Washington, Colorado and Mexico.  With continued new cases, and our mobile population, unintentional exposures will occur, so unfortunately there are expected to be more cases.

Measles is a VACCINE PREVENTABLE DISEASE!!!  I repeat, you can prevent measles but that means your child needs to receive an MMR at 1 year and again between 4-5 years of age.  About 3/4 of the current new measles cases were unvaccinated, by choice.  Several of the children were too young to receive the vaccine and so they were unprotected for that reason.  Orange County (home of Disneyland) has one of the highest rates of vaccine refusers, and Dr. Bob Sears practices there as well where he admits that “many/most” of his patients refuse some vaccines.  In my humble opinion he has had a big impact with families who are making vaccine choices. Dr. Sears' books are “wishy washy” on this subject and he has proposed an “alternative vaccine schedule” which has not been scientifically proven to work. Dr. Paul Offit a pre-eminent scientist, doctor and vaccine proponent has some good articles discussing his feelings about alternative vaccine schedules. Feel free to check them out. 

Enough of the soap box...but this should be yet another wake up call that many of the diseases younger parents think are “not around” are indeed showing a resurgence.  Measles cases are the highest they have been for over 20 years in the U.S. Pertussis (whooping cough) rates are still on the rise here as well.  Polio continues to be a problem in other parts of the world despite huge efforts in vaccinating and trying to eradicate this disease.

Fortunately, there have been no deaths in the latest measles outbreak but there have been hospitalizations.  Only hoping people go get their children vaccinated as there is no other way to stop this.  It makes so much sense and seems simple. There are so many places to get a vaccine!! 

Daily Dose

RSV

1:30 to read

Flu season seems to be winding down but RSV (respiratory synctial virus) season is still here and actually arrived a bit later than usual this year. RSV is a common upper respiratory infection that causes cold symptoms with cough, runny nose, congestion and in some cases wheezing.  

But when new parents hear that there is RSV in their day care or school they often “freak out”. While RSV may cause cough, wheezing and respiratory distress in some young children (more commonly in those with underlying lung or cardiac disorders), thankfully for most it is just a really bad cold!

Statistically, 2% of infants less than 12 months of age are hospitalized for RSV each year.  But, that also means that 98% of infants do not require hospitalization!!  Much better odds that your child will be okay than if you play the lottery, right?

It really doesn’t make much of a difference as to which virus causes your child’s (or your) cold.  What is more important is how your child is breathing!!  Because a baby’s nostrils and airways are smaller, it is not uncommon for parents to be concerned that their child sounds noisy when they are breathing. I think it is more important to look at how your child is breathing rather than listening to their stuffy nose and coughing. This means that you need to take off their t-shirt or jammies and actually look at their chest, and make sure that you cannot see their ribs pulling in and out, or see their abdominal muscles doing work of breathing. You should also not see your baby’s nostrils flaring or see any change in their color...always pink, never dusky or blue!  The cough with RSV is horrendous and sounds terrible as well, but look at how they are breathing and their color when coughing.

It is also important that your child stays hydrated, even though they may not take their bottle or fluids as well as usual. You should always see “spit” in their mouths and tears when they cry and wet diapers (may not be sopping, but wet).  Remember, you probably don’t want to eat as much when you are sick yourself. Offer more frequent feedings. No schedules when your child is sick.

Best treatment, suck the mucous out of your baby’s nose and turn on a cool mist humidifier. They may also feel better when more upright, that is probably why there are many nights with a baby spent rocking on your shoulder when they are sick.

If you have any concerns about how your child is breathing you should always contact your doctor...better be safe. 

Daily Dose

Jimmy Kimmel's Vaccine Points

1:30 to read

The measles outbreak continues (156 cases in the U.S.) and more and more people are speaking up about vaccinations. In fact, Jimmy Kimmel did a great stand up discussing the importance of vaccinating children. He made several valid points, including the fact that many parents “trust” Facebook posts over doctor’ science and recommendations to vaccinate children.  He also mentioned the fact that there are people who believe Jenny McCarthy’s views on vaccine safety over science.

So, Jimmy Kimmel makes a good point...if you don’t trust your doctor to vaccinate you child (who has gone to school for at least 11 years to become a board certified pediatrician), why would you trust them to stitch up your head, or treat your other maladies. I guess it is a bit of a double edged sword.

But the measles outbreak points to the fact that when you choose not to vaccinate your child, you are not only putting your own child at risk, but you put other children who may be too young to get the vaccine (my grand-daughter included), or be immunocompromised at risk.

If your child does not get vaccinated and develops tetanus after stepping on a dirty nail...you are not putting any one else at risk of getting tetanus. But,  are you then going to take your child to the same doctors who recommended that you vaccinate them and you will now rely on them to save your child’s life. There is a lot of irony when thinking about that terrible scenario.

My granddaughter just had her 6 month vaccines, including the first half of her flu vaccine. She ran a fever that night and her worried parents called me. She was fussy, uncomfortable and deprived her parents of some sleep, but after receiving some acetaminophen and TLC from her parents she was back to her happy self in 24 hours.  A much faster recovery than from meningitis, rotavirus, tetanus, flu or polio, all of which could also be deadly.

She will be getting her booster flu in a month and her MMR (mumps, measles, rubella) the minute she turns one.  In the meantime, I am depending on everyone else to immunize their own children against measles to protect her.

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