Daily Dose

Kids Who Snore

1.30 to read

Does your child snore?  If so, have you discussed their snoring with your pediatrician.  A recent study published in Pediatrics supported the routine screening and tracking of snoring among preschoolers.  Pediatricians should routinely be inquiring about your child’s sleep habits, as well as any snoring that occurs on a regular basis, during your child’s routine visits.  

Snoring may be a sign of obstructive sleep apnea and/or sleep disordered breathing (SDB), and habitual snoring has been associated with both learning and behavioral problems in older children. But this study was the first to look at preschool children between the ages of 2-3 years.

The study looked at 249 children from birth until 3 years of age, and parents were asked report how often their child snored on a weekly basis at both 2 and 3 years of age.  Persistent snorers were defined as those children who snored more than 2x/week at both ages 2 and 3.  Persistent loud snoring occurred in 9% of the children who were studied.

The study then looked at behavior and as had been expected persistent snorers had significantly worse overall behavioral scores.  This was noted as hyperactivity, depression and attentional difficulties.  Motor development did not seem to be impacted by snoring.

So, intermittent snoring is  common in the 2 to 3 year old set and does not seem to be associated with any long term behavioral issues. It is quite common for a young child to snore during an upper respiratory illness as well .  But persistent snoring needs to be evaluated and may need to be treated with the removal of a child’s adenoids and tonsils.

If you are worried about snoring, talk to your doctor. More studies are being done on this subject as well, so stay tuned.

Daily Dose

Spring Allergy Season Is Around the Corner

1:15 to read

As the seasons begin to change, pay attention to your child's symptoms, as they may vary when the pollen count is rising. Flu season is winding down around here and RSV is also waning. I continue to see coughs and colds, but the knowledge that spring has sprung usually sustains everyone. The winter viruses will hopefully soon pack up their bags and move on until next winter. We will get to stop hearing those nagging coughs and runny noses will stop dripping. But this means spring allergy season will be approaching.

We really don't see seasonal allergies until a child is around the age of two. After that you may notice that your child gets a clear runny nose, or itchy eyes and a scratchy throat as the season changes. Allergies, unlike viral upper respiratory infections will respond to antihistamines. As the seasons begin to change, pay attention to your child's symptoms, as they may vary with the pollen count.

Make sure that you have your child's allergy nose sprays and medications on had and ready to begin in the next month. If you think your child may be developing allergies have a discussion with your doctor about the appropriate use of antihistamines for your child. Nasal steroids used on a daily basis may be life altering for children with allergies. There are many options for treating allergies and luckily they do respond to medications unlike those pesky winter viral infections.

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

Daily Dose

The Difference Between Cradle Cap And Dandruff

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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

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.

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Daily Dose

Swollen Lymph Nodes

1:30 to read

A parent’s concern over finding a swollen lymph node, which is known as lymphadenopathy, is quite common during childhood.  The most common place to notice your child’s lymph nodes are in the head and neck area.

Lymph nodes are easy to feel  around the jaw line, behind the ears and also at the base of the neck, and parents will often feel them when they are bathing their children.  Because young children get frequent viral upper respiratory infections (especially in the fall and winter months), the lymph nodes in the neck often enlarge as they send out white cells to help fight the infection. In most cases these nodes are the size of nickels, dimes or quarters and are freely mobile. The skin overlying the nodes should not appear to be red or warm to the touch. There are often several nodes of various sizes that may be noticed at the same time on either side of the neck.   It is not uncommon for the node to be more visible when a child turns their head to one side which makes the node “stick out” even more.

Besides the nodes in the head and neck area there are many other areas where a parent might notice lymph nodes.  They are sometimes noticed beneath the armpit (axilla) and also in the groin area.  It your child has a bug bite on their arm or a rash on their leg or even acne on their face the lymph nodes in that area might become slightly swollen as they provide an inflammatory response. In most cases if the lymph nodes are not growing in size and are not warm and red and your child does not appear to be ill you can watch the node or nodes for awhile.  The most typical scenario is that the node will decrease in size as your child gets over their cold or their bug bite.  If the node is getting larger or more tender you should see your pediatrician. 

Any node that continues to increase in size, or becomes more firm and fixed needs to be examined. As Adrienne noted in her iPhone App email, her child has had a prominent node for 7 months. Some children, especially if they are thin, have prominent and easily visible nodes.  They may remain that way for years and should not be of concern if your doctor has felt it before and it continues to remain the same size and is freely mobile.  Thankfully, benign lymphadenopathy is a frequent reason for an office visit to the pediatrician, and a parent can be easily reassured.

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

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

Insect Bites are Everywhere!

1.30 to read

We are definitely in the “dog days of summer” and despite temperatures above 100 degrees (not just here in Texas either), it seems that insects thrive in hot weather. The mosquitoes here are just horrible and I see at least 2-3 patients a day that come in because their children have been bitten by “some bug”, most of which I believe are mosquito bites. 

I have been surprised that so many of the parents who are bringing their children in to have their bites checked are not using any insect repellent.  They seem shocked that their child can be bitten just walking into day care, or while on the playground for just 10 minutes, or even while they are in the pool.  It only takes a second for that mosquito to swoop in and bite and you never even know it until you see that swollen bite later that day or even in the next morning. (It’s a mystery why children seem to have bigger reactions to the bite and plenty of of local swelling).  Many parents are convinced that there are bed bug bites, but I truly believe these are just pesky mosquitos.  I even got one the other morning while walking out my front door just to get the morning paper! 

The best way not to “worry” about bites is to prevent them. For infants who are usually in a stroller I would use mosquito netting to start.  It is easy to drape their carseat or stroller as you go outside.  But as a baby gets older and is now outside more, and for those toddlers and older children the most important thing is to pick a mosquito repellent and use it.  

If your children are going to camp or day care, use it in the morning before they are going outside.  Reapply in the evening as well if you are going to spend time outside as well. You do not reapply insect repellent throughout the day like you do sunscreen, so pick the strength of  repellent based on the amount of time you will be outside.  Products with DEET, picardin, and oil of eucalyptus may be used in children (age dependent).  See www.cdc.gov for a listing of insect repellents by brand.  

Fortunately, to date (through the end of July  2013) there have only been a total of 53 cases of West Nile virus disease in people, with 3 deaths in the U.S. (Compare to 2012 with 5,674 cases of disease and 286 deaths).   

While 35 states have reported WNV activity much of the middle of the country is not evening reporting activity (maybe we should all move for a few months). This is all great news. But we still have a lot of summer left, so keep using precautions and drain that standing water around your house as well ...this helps the entire community.

Daily Dose

Update on Autism

1:30 to read

Every parent watches for their baby’s first smile.  After the smiles are giggles and laughs and before you know it your baby is saying "dada" and "mama" and their vocabulary begins to explode. Suddenly you realize that your child is putting words together and may even start telling you what they want!  These developmental milestones all typically occur in the first 2 years of life.

Developmental screening is an important part of your visits to your pediatrician...especially for the first 2-3 years of life.  In many practices a parent fills out some sort of developmental screening questionnaire prior to their “well-baby” visit asking age appropriate questions....such as “does your child babble?”, “does your child point at objects?” “does your child play patty cake?”  “does your child put 2 words together?”.  During the check up your pediatrician is also watching how your child is interacting with their parents as well as with the doctor. I sometimes find that parents are “hard graders” and do not give their child credit for some milestones that I think they are actually doing when I am examining them.  Remember, there is a wide range of normal in the first several years of life. Not every baby does every thing at the same time!

Socialization and interaction is a very important part of early childhood development, but for some babies making eye contact and developing language skills is delayed. In fact,  for some children socialization and language seems to develop later and seems to be “different” than that of other children. These so called “red flags” in a baby’s development may be early signs of autism.  

The diagnosis of autism is typically not made until a child is between 18 months- 3 or 4 years of age.  The diagnosis of autism is based upon observation of a child’s communication and social interaction and for older children on their activities and interests. There is NOT a single test to diagnose autism.  In other words, your doctor cannot do a blood test to definitively diagnose autism spectrum disease (ASD). The diagnosis of ASD relies upon characteristic behaviors seen in a child, not on one milestone.

If you have concerns about your child’s development make sure you bring them up with your child’s pediatrician.  While it is hard for a parent to “wait and see” what happens over several months some babies will achieve their language and social skills later than others. Just like learning to read...some children do it earlier than others.

The most important thing is that you interact with your baby in those early years!! Talk, sing, read aloud and engage them in early play....as we know that every child needs that same stimulation.  

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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DR SUE'S DAILY DOSE

What causes white patches on your child's skin?