Daily Dose

A Baby Girl!

1.15 to read

Did you hear my big news?? I am officially a grandmother of a new “premature” but healthy baby girl!!! Yes a GIRL!!  After raising three sons I really thought I had mistaken the text announcing a baby girl.   As you probably know, all important information is now received via a text.....so as all four first time grandparents sat in the labor and delivery waiting room one of us got the text that read.....healthy but tiny baby girl...all good!! 

Now, if you have ever sat with a group of friends where everyone is awaiting the same information via text you know that despite the sender pushing send at the same time...the text may arrive on one person’s phone before another, even when sitting right next to each other. That was the case in the waiting room.....we all had phones, but one grandparent got the text first and read it and we all went, REALLY, for real a girl?? 

Despite the fact that our sweet grand daughter wanted to arrive 5 weeks early, she weighed in at 4’12” and only had to spend 8 days in the hospital.  She must have known how excited we all were and we wanted to be able to hold her sooner than later.  

After 2 nights in the neonatal ICU, where she had wonderful care and reassuring doctors and nurses, she was moved to the Special Care Nursery where we were allowed to hold her and feed her and gaze upon her in wonder.   Just think four doting grandparents who all wanted to hold her....we should have had quadruplets.  

After a few days of “feeding and growing”  she was discharged and I am happy to report she is now a whopping 5 lbs of pure joy. She is home with her parents and thriving.    

What a gift to watch your own children begin their parenting journey. I am doing the best I can to “keep quiet” and just enjoy being a grandmother...sometimes not easy but trying. Parenting never ends....especially when you are a mom. I can’t wait to take a grand daughter shopping, put bows in her hair and have tea parties, and all of the things my boys just didn’t want to do. We are tickled PINK!!!

Daily Dose

Facial Rash

1:30 to read

Lots of babies and toddlers have problems with recurrent rashes around their mouths. It is most bothersome to their parents…who think it is “unsightly, especially in pictures”.  The problem is,due to the fact that babies and toddlers drool and they also always have their fingers and/or hands in their mouths.  Remember, a child is in their “oral phase” from birth through the toddler years….and everything goes into their mouths.

On top of the safety issues with a child putting everything into their mouths and the risks surrounding choking….all of this hand to mouth often leads to a rash which is a type of “peri-oral” dermatitis. It is usually a bit red (erythematous) and bumpy (papular) and will have good and bad days.   So how do you get rid of it?

It is not and “easy” fix but here are some things that help. Pacifiers are one of the biggest rash causing culprits as a child sucks and the drool accumulates around the outside of the mouth and under the pacifier.  I love pacifiers for younger children (<12-18 months), but if your child (like the one in the picture) still has a pacifier and is over 12 months of age taking away the pacifier (another post ) will absolutely help.  

Another reason for the rash is frequent face washing and wiping.  What parent is not constantly wiping their child’s face?  In fact, one night when I was seeing a mother with her child for this very rash and I “suggested” that she wipe his face less frequently she said to me rather emphatically “I do not wipe his face!! “  Well, I wonder why he did not have all sorts of leftover carrot, pears, peas and yogurt on his face?  At any rate, the less frequently you wipe off the “schmutz” the less drying and irritation to the skin.  Still hard to do as your child finger feeds often missing their mouth.

So the mainstay of treatment is a barrier/moisturizer as well as a topical steroid cream. I usually recommend something like Aquaphor or Vaseline and I apply it often and generously. Especially when your child is heading to bed, coat the area…even under that pacifier if necessary.  On days that it looks especially inflamed, I add an over the counter steroid cream, such as Cortaid or Cortizone.  When using the steroid a tiny amount “pea sized” is all you need, put that on first, followed by the layer of Aquaphor or Vaseline. The steroid cream will help “get the red out” but it is not to be used daily.  Use the steroid for several days, take the Christmas card picture and stop the steroid for awhile. I use the steroid “as needed” rather than daily. 

I recently learned that an occasional child is “allergic” or reacts to the lanolin alcohol in Aquaphor and the rash might get worse instead of better. If that seem to be the case and you have been using Aquaphor you might switch to simple pure petrolatum like Vaseline.  

The best news is that most of these rashes clear up on their own over time when your child moves out of the oral, messy mouth stage and won’t be drooling and having their face wiped all of the time….but next up is the “anal phase”!

Daily Dose

Kids & Too Much TV

1:30 to read

Another recent study has just been released which confirms that children are getting close to 4 hours of background TV noise each day. While many parents are aware of the need to limit their children’s active screen time (which includes TV, video game, telephone texting and computer screens) to no more than 2 hours per day, background TV time may be equally important. The American Academy of Pediatrics also discourages any TV viewing for children under age 2 years. 

*The study from The University of Pennsylvania’s Annenberg School for Communication defines background TV as “TV that is on in the vicinity of the child that the child is not attending to”.  The research looked at TV exposure in 1,454 households with children aged 8 months-8 years. The study found that younger children and African-American kids were exposed to more background TV than other children.  Having background TV noise of any kind can disrupt mental tasks for all and may also interfere with language development in younger children. 

Those households that had the least background TV exposure were those that did not have a TV in the child’s room!! That doesn’t seem to be a surprising finding at all. Many parents leave the TV on in a child’s room to help them sleep, although there are numerous studies to show exactly the opposite effect, TV disrupts sleep. I now routinely ask every parent during their child’s check up if there is a TV in the child’s room. I also ask every older child the same question, and there are many teens who are not happy with me when I encourage their parents to take the TV out of the bedroom of their adolescent. There is just no need to have a TV in the bedroom of children of any age.  I have given up on this discussion with my college aged patients! 

While many parents are doing a good job of monitoring what their children are watching on TV, and how long they are watching, we may not be doing as well when it comes to background TV.  While older kids hear news stories or language that they needn’t be exposed to, a younger child’s language skills may be delayed due to background TV noise. 

So, the kitchen TV needn’t be on while you are making your children their breakfast before school or in the evening while eating dinner. Family dinner is one of the most important times of the day and conversation is the key. No one needs to try to talk over the TV, just turn it off! 

Lastly, keep reading those bedtime stories for children of all ages; this is key to language, and appropriate language at that. 

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

Daily Dose

Paddling in School

1:30 to read

I just finished reading an online post from a pediatrician in another state whose daughter has just started kindergarten. It seems that in her state, and her school, they may still “paddle” children for misbehaving. WHAT?!?!

In fact, the school sent a note home with her child that re-iterated the “school rules” surrounding paddling and asked that the parent sign the note that they agreed to paddling. Are you kidding me…what parent would sign a note agreeing to let someone HIT their child?  Parent’s have been arrested for spanking their children in a public place….but now you can let someone else paddle your child? 

I talk to parents about discipline even before their child turns one. Many a parent will tell you I am “the strict” doctor.  From the beginning, I discourage spanking (although I will admit to spanking my own children several times during their childhood - usually out of total frustration and never felt good about it) and begin with some simple strategies. For example when your 6-7 month old learns that they can make a new shrieking sound to get attention “ignore the behavior” and it will often go away.  Or, what about telling your child that you “will not pick the food up off the floor if they throw it” and then following through….they will not go hungry I assure you.

As children get older I discuss re-directing, time-out, taking away a toy.  For the older child it may be taking away screen time, missing a birthday party and for the teens taking away the cell phone,car or being grounded at home with parents.  But spanking and paddling is never part of the discipline/behavior modification discussion. And now I find out that there are still 19 states that allow paddling in their schools!! 

The mother of this child had not been aware of this rule. She could not believe that she was asked to sign a form to allow her child to be paddled. In this case we are also talking about 5-7 year olds who are just starting school where they will begin to learn school rules and expectations of kindergarten and 1st graders. Every teacher seems to have many strategies for discipline and behavior modification. Not one that I spoke with mentioned spanking or paddling. I am not sure that I even agree with taking away “recess” for misbehaving from this age group…(another conversation)  but certainly not corporal punishment.

The interesting part of this story is that the behavior issues were related to little boys “playing guns”  while they were on the playground. The school has a “zero tolerance for acting out play with guns”  but allows you to hit a child???  What kind of mixed message is that about violence? I know that while raising our three sons, despite our protests about violence and guns,  they seemed to turn anything we gave them into a “play gun” and that was long before they were ever even given a Nerf gun. 

Do your schools have policies regarding corporal punishment? I feel as if I have gone back in time 50 years - only all of this information came from that entity called the internet!!!


Daily Dose

Treating Bee Stings

Bee stings are a right of passage during childhood, always memorable, but never fun.I was outside today and noticed that the bees are back, pollinating the flowers in my garden, but ready to sting too if they are crossed by bare feet or errant hands. Bee stings are a right of passage during childhood, always memorable, but never fun. Our office receives numerous calls about how to handle a bee sting. First thing is to get some ice or a cool compress on the sting, which relives both PAIN and swelling.

While the ice is working you can take a peek and see if the stinger is still in the skin, and if so do not go grab tweezers or your fingernails to try and remove the stinger. If you do that you will only make the sting worse. The best way to remove the stinger is by using the edge of a credit card to gently scrape the stinger out of the skin. Honey Bees leave behind their stinger while wasps and hornets do not. Unless the child is allergic to bee stings most people will only have a local reaction. If there are any symptoms associated with the sting such as swelling of face, mouth, lips, or difficulty swallowing or breathing, give an immediate dose of Benadryl (diphenhydramine) while calling 911. If the child has a known bee hypersensitivity and they have an epi pen you will need to use it and also call 911. For local reactions after the sting is cleaned you can apply calamine lotion or a topical steroid cream. For swelling and discomfort a dose of Benadryl is also recommended, as well as a pain reliever like ibuprofen which will also relieve local inflammation along with pain relief. The sting is usually not uncomfortable for more than 24 hours. Make sure to watch for signs of infection with increasing redness, streaking or pain at the site of the sting. If the area seems to be getting worse rather than better it is a good idea to let you pediatrician take a peek. That's your daily dose for today, we'll chat again tomorrow.

Daily Dose

The Difference Between Cradle Cap And Dandruff

1.15 to read

I recently received a question from a Twitter follower related to cradle cap and dandruff. She wanted to know if there was a difference in the two.

You know there really isn’t as they are both due to seborrheic dermatitis, an inflammatory condition of the skin in which the skin overproduces skin cells and sebum (the skins natural oil). Cradle cap is the term used for the scaly dermatitis seen on the scalp in infants. It is also seen on the eyelids, eyebrows, and behind the ears. It is typically seen after about three months of age and will often resolve on its own by the time a baby is eight to 12 months old. It is usually simply a “cosmetic” problem for a baby as it looks like a yellowish plaque on a baby’s scalp and is often not even noticed by anyone other than the parents. Unlike seborrheic dermatitis in adults, cradle cap typically doesn’t itch. It is thought that cradle cap may occur in infancy due to hormonal influences from the mother that were passed across the placenta to the baby. These hormones cause the sebaceous glands to become over active. In some severe cases an infant’s scalp becomes really scaly and inflamed and causes even more parental concern, as it appears that the infant is uncomfortable and may be trying to scratch their head by rubbing it on surfaces. The treatment for cradle cap is to wash the baby’s scalp daily with a mild shampoo and then to use a soft comb or brush to help remove the scales once they have been loosened with washing. When washing the head make sure to get the shampoo behind the ears and in the brows (keeping the soap out of baby’s eyes). This is usually sufficient treatment for most cradle cap. In situations where the greasy scales seem to be worsening it may help to put a small amount of mineral oil or olive oil on the baby’s head and let it sit (I left a small amount on my children’s heads overnight) and then to shampoo the following day. The oil will help the scales to loosen up and come off more easily. For babies that have very inflamed irritated cradle cap a visit to your pediatrician may be warranted to confirm the diagnosis. In persistent cases I often recommend shampooing several times a week with a dandruff shampoo that has either selenium (Selsun) or zinc pyrithione (Head and Shoulders) making sure not to get any in the infant’s eyes. I may then also use a hydrocortisone cream or foam on the scalp that will lessen the inflammation and itching. In these cases it may take several weeks to totally clear up the problem. As children get older, especially during puberty, you may see a return of seborrhea as dandruff. Again you can use dandruff shampoos. It also seems that with the overproduction of sebum there is an overgrowth of a fungus called “malessizia” so using a shampoo for dandruff as well as a antifungal shampoo (Nizoral) often works. I have teens alternate different shampoos, as sometimes it seems to work better than always using the same shampoo for months on end. Teens don’t like white flakes falling from their scalp and unlike a baby, a teen is worried about the cosmetic issues of seborrhea! That’s your daily dose, we’ll chat again tomorrow. Send your question to Dr. Sue!

Daily Dose

Summer Series: How to Treat Common Insect Bites

From May/June until fall I consistently see children who are brought to my office for me to look at their insect bites.As we continue our summer series, it’s time to talk about pesky insect bites.  From May/June until Fall, I consistently see children who are brought to my office for me to look at their insect bites.  Just last week a mother brought in a 7 year old that she thought had chickenpox, but in reality it was numerous bug bites, which were located on the child’s arms and legs (exposed skin) rather than on the trunk which is seen with early chickenpox.  

In many cases, the offending biting insect is not accurately identified, as it could be the ubiquitous mosquito, or biting flies, gnats or fleas. Systemic reactions from insect bites are much less common that systemic reactions to insect stings. The immediate reaction to the insect bite usually occurs in 10–15 minutes with local swelling and itching, and may disappear in an hour or less.  The delayed reaction may appear in 12–24 hours with the development of an itchy red papule (bump) which may persist for days to even weeks. This is the reason that some people do not remember being bitten while they were outside, but the following day may present with the bites all over their arms and legs or chest, depending on what part of the body was exposed. Large local reactions to mosquito bites are common in children. For some reason it seems to me that “baby fat”  reacts more to the bite of the mosquito. (No science here).  The toddler set will often have itchy, red, are warm swellings appearing within minutes of the bites and they may even go on to develop bruising, and spontaneous blistering in 2–6 hours after being bitten. These bites then may persist for days or weeks, so in theory their little legs will be affected for most of the summer.  Severe local reactions are called “sweeter syndrome” and occur within hours of being bitten and may involve swelling of an entire body part such as the hand, face or extremity.  These are often misdiagnosed as cellulitis, but with a good history, the rapidity with which the area developed redness, swelling, warmth to touch and tenderness,  would be uncommon for a bacterial infection. Systemic reactions to mosquito bites including generalized hives, swelling of the lips and mouth, nausea, vomiting and wheezing have been reported due to a true allergy to the mosquito salivary proteins but are extremely rare. The treatment of local reactions to bites involves the use of topical anti-itching preparations like Calamine lotion,  Sarna lotion, Dommeboro soaks etc.  This may be supplemented by topical steroid creams (either over the counter or prescription) which may be used several times a day for a week or so to minimize scarring. An oral antihistamine (Benadryl)  may also reduce some of the swelling and itching.  Do not use topical antihistamines.  It is also important to try and prevent secondary infection (by scratching and picking) by using antibacterial soaps, trimming fingernails and applying an antibiotic cream like Polysporin to open bites. The best treatment is actually prevention. Using a DEET preparation before going outside (lowest concentration that is effective) may be used in children over the age of 6 months.  Mosquito netting may be used for infants. Try to avoid going outside at dawn and dusk and make sure that you check pots etc for standing water that may be breeding areas for mosquitoes. Wearing long sleeves and long pants will also help (can’t imagine when it is 105 degrees !) That's your daily dose for today.  We'll chat again tomorrow! Send your question to Dr. Sue right now!

Daily Dose

Infant Weight Gain & Obesity

1:15 to read

A new study out of Harvard that was published in Pediatrics, looks at infant weight gain and links to childhood obesity. This is an interesting study, as previous studies had typically looked at weight alone as a predicator for future problems with obesity. In this study the authors looked at both weight and length as a measure of fatness.

They also looked at weight as a dynamic process, in other words, it was not how much you weighed, but how quickly you gained the weight in infancy. The authors found that the correlation between rapid infant weight gain and later obesity was striking. Other studies have also looked at the relationship between infant and childhood weight but this study makes a compelling argument that early rapid weight gain, even in the first months of infancy, could have long term health consequences.

So, armed with this knowledge, what can a parent do? Follow the AAP guidelines to exclusively breast or formula feed your baby for the first six months of life. If a your-baby is formula fed, limit their daily intake to an appropriate amount for age. Many parents, for a multitude of reasons, decide to add cereal to their baby's bottle in hopes that this will "make their infant sleep through the night". To my knowledge there has never been any data to confirm this, (maybe the Mommy network) and additional calories in infancy may lead to long-term consequences. Juices and early introduction of your-baby foods may also add unnecessary calories. This study points out the need to modify weight gain in infancy in a manner that will balance the needs of an infant's brain as well as their body, during this time of rapid development.

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

Daily Dose

Do Essential Oils Boost Immune System?

1.30 to read

Although it is still hot and officially summer, soon everyone will be heading back to school  and coughs and colds (and eventually flu, another topic) will be just around the corner. I had a patient ask me about the use of essential oils. Her 2 1/2 year old daughter is heading to preschool for the first time and she “had heard from her friends that essential oils help a child’s immunity during cold season”.

Unfortunately, there is very little data at all to confirm that statement. I only wish that rubbing a bit of lavender oil on would help prevent the common cold. While it may smell great and be relaxing....there is no data that I can find to show that there is any reproducible science to the claims that essential oils boost the immune system.  

While I was researching I found many sites stating that “eucalyptus oil is an anti-viral” and “peppermint oil is an anti-pyretic (fever reducer)”.  Tea tree oil is touted as being “both anti -bacterial and anti-fungal” (I don’t know of other drugs that can claim both!).  But, I just don’t see any data to support all of this. 

The word essential refers to the essence of the plant the oil is derived from, rather than being “essential” to your health. While in most cases essential oils (which are highly concentrated) used as aromatherapy are not harmful for adults, it may be a different story in children, especially those under the age of 6. While labels may say  “natural” it may not always mean safe.  Many oils are poisonous if ingested and there have been reports of accidental overdoses in children with several different oils. In one report tea tree oil and lavender oil applied topically have been shown to cause breast enlargement in boys.  Oil of eucalyptus and peppermint are high in menthol and cineole.  These substances may cause children to become drowsy have decreased respirations.  While there are articles stating that the use of menthol (Vicks) on a child’s feet may be helpful during a cold for reducing a cough, do not use this if child is young enough to put their feet in their mouths. 

I must say that I sometime use a few drops of eucalyptus oil in the shower when I have a cold as I think it smells great and seems to help “open up” my head. Whether this is in “my mind” or a response from my olfactory centers which sends calming messages to respiratory center is not clear. But, I am not ingesting it or using it topically. 




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