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

Early Talkers

1.15 to read

Is your child a precocious talker?  Most children start to acquire words around 12-15 months, but that means 5-10 words and building. By the time a child is 18 months old they are often mimicking when you ask them to say a word, and some are putting 2 words together. This is all very normal development. But there are few children who are just “early talkers” who are speaking in full sentences by the time they are 18-24 months! 

I think having such a verbal child during the early toddler years is both a “blessing and a curse”. I know that from raising my own children, where my oldest was quite verbal by 20 months, and was “bossing us around” before age 2!!  I also see this same dilemma in my little patients.  While some parents are worried that their 2 year old does not put 3-4 words together, others want to know how you can stop the chatter.  Parents.....we always have issues. 

Example:  When I come into the exam room for a 2 year old check up, the precocious talker looks up and says, “Hi Dr. Sue...what took you so long?”.  Or they may tell their parent that they “don’t need any help” as I ask them to climb on the exam table. Recently a little boy looked right at his mother and said, “I’ve got this”, when I asked him to take off his shoes.  

On another day a little girl was impatient to leave and kept asking her mother if they could go to the park after they left my office.  The mother kept telling the little girl, “maybe” . Finally, exasperated, the 2 year old said, “what’s the answer, yes or no?””  How do you keep a straight face? 

A verbal child can bring you to your knees, both laughing and sometimes wanting to cry.  How can a 2 year old know just what to say to make a parent feel inadequate?  Is it inborn? This seems to be especially true if you have had another child and the 2 year old is instructing you on how to parent “their baby”.   

So, if your child is a talker write down all of those clever sentences they blurt out......one day you will look back and laugh.  I often saw myself in my 2 year old as he told complete strangers , “my mommy says my baby brother cries all of the time, and he has colic!”  Out of the mouth of babes, and I still remember it.  Bittersweet.

Daily Dose

Do Germs Make You Cringe?

1:30 to read

I see a lot of parents who are “germaphobic” and are constantly sanitizing anything and everything that may come into contact with their baby. I am not just talking about a newborn...but rather older infants and young children, especially as they start to creep and crawl around their environment.  Their mother’s purses have a bottle of hand sanitizer in easy reach and many have the bottle attached to the diaper bag or stroller as well. 

But now comes a new study which may help everyone relax a bit...and maybe stop constant disinfecting as well.  A recent study in The Journal of Allergy and Immunology found that children, under the age of 1, who shared a “dirty” home, with mouse and cat dander as well as cockroach droppings (I know you are all cringing now)  were less likely to develop allergies or wheezing by age 3.  

This idea has been called the “hygiene hypothesis”.  In other words, having children who are growing up in relatively sterile environments, may lead the immune system to “compensate” by reacting to pollen, dust and dander when there are fewer germs to ward off!  Now this doesn’t mean you have to stop keeping your house clean and never making a bed or vacuuming again ( novel idea), but the constant scrubbing and sanitizing may be a bit much. You don’t need anti bacterial soap in every room!

There have been other interesting studies done among children who live on farms.  They were taken into the barn as infants with hay, dander and animals all around them. They too were found to have fewer allergies than urban children.  So...playing on the dirty barn floor might not only be necessary for farm children, but also protective.

Should you run out and buy mice, a cat and try to breed roaches? I don’t think that is the recommendation.  Interestingly, this study did not show that having a dog was protective ....hmmmm when my kids were younger we did have a cat as well as a dog, not by choice but by my middle son’s insistence. Having always had dogs, somewhere in his early child hood years he “bargained” with us to adopt a black kitten that we all grew to love.  Maybe that was the best decision we made.  Fortunately none of my children have allergies or asthma. 

Lots of interesting studies on the horizon relating to this topic....stay tuned as I will keep you posted!

Daily Dose

Antibiotics May Boost Risk for Recurrent Ear Infection

1.15 to read

Did you know that repeated use of antibiotics to treat acute ear infections in young children increases the risk of recurrent ear infections by 20 percent? Researchers in the Netherlands found that 63 percent of children given the antibiotic amoxicillin had another ear infection within three years, compared with 43 percent of children given a placebo at the time of their initial infection. The results of the study are published online in the July edition of BMJ. Researchers looked at 168 children, aged six months to two years. In the group given amoxicillin, 47 out of 75 children had at least one recurrent ear infection, compared with 37 of 86 children in the placebo group. That equated to a 2.5 times higher risk of recurrent ear infection for the amoxicillin group. However, the study also found that 30 percent of children in the placebo group had ear, nose and throat surgery after their initial infection, compared with 21 percent in the amoxicillin group. The higher recurrence rate among children who took amoxicillin could be due to a weakening of their body's natural immune response as a result of taking an antibiotic at the initial stage of infection, the researchers said. Antibiotic use in such cases may cause an "unfavorable shift" toward the growth of resistant bacteria. Antibiotics may reduce the length and severity of the initial ear infection, but may also result in a higher number of recurrent infections and antibiotic resistance, the researchers stated. Because of this, they said, doctors need to be careful in their use of antibiotics in children with ear infections.

Daily Dose

Vapor Rubs: Do They Really Work?

1:15 to read

 There was a great article recently published in the online journal of Pediatrics.  I had to read it as it was titled, “Vapor Rub, Petrolatum, or No Treatment for Nocturnal Cough”.  Having been a fan of both Vick’s Vapor Rub and Mentholatum since I was a child, I knew it was a MUST read article.

You can ask all of my family members, once we hit cough and cold season, the “vapor rub” jar goes next to my bed to help me during my frequent colds (see previous posts!).  I have such fond memories of being with my grandmother, Gaga, who at the first sign of a cold,  would rub Vicks all over my chest, which was then occluded by a warm damp CLEAN dishtowel, then followed by my flannel nightgown.  She would lovingly tuck me into bed, and shut the door and the whole room smelled like camphor, and menthol.   To me it was wonderful, my brother hated it!! As I grew older, my mother would hear me sniffle or blow my nose and down the hall she would come with the trusty Vick’s jar for self-application. Once I became a mother, in the family tradition, I too would rub a little Vick’s on my children’s chest, with no basis on medical fact, only what Gaga did. Funny thing, we all seemed to get better.

Two of my own children grew to despise the tradition, while one still asks for Vick’s or Mentholatum when he gets a cold.  There are old jars all over the house. I even bought several of the “plug ins” to use during cold season, which are the new fangled way to get that wonderful VR aroma into the room. They make a great stocking stuffer! So, with that history, what could be better than a study out of Penn State University that looked at the use of vapor rub (VR) to improve cold symptoms and nighttime cough.  With the recent FDA guidelines which limit the use of OTC cough and cold products in young children, many parents are at a loss as to what to do to help their child’s cold symptoms. The investigators looked at 138 children between the ages of 2 – 11 years. They were randomized to receive vapor rub (VR), petrolatum alone or no therapy.  Parents were then asked to grade their child’s symptoms and sleep on Day 1 when none of the children received therapy, and then again on Day 2 when they were randomized to therapy. 

The VR group scored best in improving cough, congestion and overall sleep for the children (and therefore their parents). This is the first evidence based therapeutic trial that I am aware of, for a remedy that is over a century old. As noted in the article, there were some irritant effects seen in the VR group with complaints of a stinging sensation to eyes, nose and or skin (I can hear my own children saying “it’s stingy”). Most of these complaints were transient in nature.  Despite older concerns about camphor when it was used as an oil that could cause possible toxicity if swallowed, skin exposure alone really has little systemic effect.   The FDA has approved camphor as an effective anti-cough preparation (anti-tusssive), but has limited concentrations to 11%. The concentration in VR is 4.8%. So, if parent’s are trying to improve nighttime cough and sleep disturbance in their children over the age of 2, there is a study to show it is time to go back to vapor rub preparations.  The mechanism for improved sleep is not really known, but whether it improves cold symptoms directly or through the aromatic effects, a better night’s sleep is good for everyone!!!  Could there be coupons to follow?

That's your daily dose for today.  We'll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

Is it Appendicitis?

1.15 to read

Last night, a patient called me and wondered if their daughter had appendicitis. I always thought it would be the easiest diagnosis, and that we would call the surgeon and whisk the patient off to the operating room for an appendectomy, just like Madeline (one of my favorite books as a child). Well, over the years have I been taught a few things. At times the diagnosis is easy. The patient has the classic symptoms of a "tummy ache" that starts around the belly button, they may vomit a few times and have a fever and the parent in all of us thinks, "yuk, another one of those tummy viruses". But over several hours the tummy aches worsens, and moves from around the belly button (peri-umbilical) to the right lower quadrant and the nausea and vomiting persist and your child just looks SICKER. At the same time you may notice that they have a funny walk, and won't stand up straight, as they try to get to the bathroom and when possible, they move very little at all, as any movement makes the pain worse. This is classic appendicitis. For a parent, that means a phone call to the pediatrician, day or night, as that child needs to be examined. On the other hand some children just forgot to read Nelson's text book of pediatrics. They don't vomit, they may not have a fever, they are a little nauseated, but when pressed could still eat, and it only hurts in their right lower quadrant, everything else is just okay. These are the difficult cases to diagnose. These children require a lot more history, repeat exams and lab tests and may even need a CAT scan to look at their appendix. But, you don't want to miss an appendicitis, as a perforated appendix is serious and requires a lengthy hospitalization. So as a parent and a doctor, if your child's tummy ache seems to be getting worse, it may be worth a trip to the doctor to feel that tummy, run a few tests and decide how to proceed. It is not always as easy as in a book or on TV. That's your daily dose, we'll chat tomorrow!

Daily Dose

Breath-holding & Fainting

2.00 to read

Have you ever fainted?  I bet you may have not realized how common fainting is in the pediatric age group?  I know this from my own children (yes, I had 2 “fainters” and boys no less) as well as from many of my patients.

The medical term for fainting is syncope, and it really is common among children. It starts during the toddler years with breath-holding spells.  Many in this age group (up to 50%) will hold their breath when they are hurt or angry.

When a child holds their breath while crying (you can just see it happening in front of you) they will often turn a bit blue and “pass out”. This is a type of fainting. This can be very scary for parents who have never seen their precious child have such an attitude and then hold their breath over not getting the cookie? Yes, this is a normal part of being a toddler! They are very emotional and labile at this age (foreshadowing for teen years?) and most toddlers don’t have a lot of language yet, so when they get mad or frustrated they just SCREAM! But, while screaming, the child forgets to take a breath, and then the brain and autonomic nervous system takes over and the breath holding leads to fainting.

The breath holding spell, as scary as it is, is just a form of fainting. It will not hurt your child, but it may take your breath away!

My advice? Try not to pay attention to your child if they begin having breath-holding spells. It may be hard to “ignore” the first two or three, but these “spells” usually last for months (maybe years) and you do not need to rush to your child when they hold their breath. By calling attention to the event you may inadvertently reinforce the behavior. As a child gets older, the breath holding will stop (but not the tantrums?) and there will be new behaviors to conquer. Do you have a breath-holder? How do you cope? Let us know!

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

Daily Dose

Why Kids Hold Their Stool

Dr. Sue explains a very common bathroom issue and why it occurs.Poop and stool habits account for numerous discussions among parents, especially for those with newborn children or parents who are in the throes of potty training.  It's true, no topic is off limits when it comes to raising healthy, resilient kids!

A problem that is more common than many know (or not willing to admit to) affects children  who do not want to poop, in other words, stool holding. Stool holding is called encopresis and is often seen in children with a history of chronic constipation or who have had stool avoidance issues. Chronic constipation and encopresis may be related to a child having had pain with going to the bathroom. The normal response to the need to poop is to go the bathroom.  Seems very simple right?  While everyone may occasionally have a difficult or painful bowel movement, some children who have pain with pooping recall that it hurt “so, why would I continue to poop and have it hurt?”  In this case when a child feels the urge to poop they also feel they need to hold the poop in. The urge to poop is due to the fact that stool has entered and stretched the rectal vault, which in turn sends impulses to the brain that “I need to poop.” If this feeling is repressed (by a child who doesn’t want to poop), the pressure may lessen for awhile but stool continues to fill the rectum, which gets more stretch and even further distended with stool. As this scenario occurs multiple times a day, the stool becomes a larger mass filling the distended rectum, which can no longer be totally “held in”.  When the child inadvertently relaxes the rectal sphincter, the softer fecal material will escape from the rectum and causes an “accident” and soiling of a child’s underwear. Many times a child is totally unaware that soiling has even occurred, but this is only “the tip of the iceberg” as there is still a huge amount of stool that is being held in the rectum. This held-in stool is usually hard, and dry and painful to pass. The treatment of encopresis is multidisciplinary, with a combination of medicinal intervention, dietary changes and behavior modification. This must involve both parents and child and it may take as long as 4 – 12 months to adequately treat and resolve the issue. Explaining the mechanics of stooling to both parent and child is important. It is also important that both parent and child understand that encopresis is NOT a behavioral problem nor is it “all in a child’s mind”. It occurs because the colon is not working as it should. Unfortunately, there is not a “quick fix” for encopresis and patience is important. More on treating encopresis on Monday.

Daily Dose

Constipation is a Common Pediatric Ailment

1.15 to read

I received a question from one of our twitter followers about her daughter who was recently found to be constipated. She wanted some information on treating constipation.

Do you know how common constipation is in pediatrics? I must discuss this at least once a day, and I have dealt with “poop issues” in my own home while raising my boys. As a mother, I was really amazed at how much discomfort and disruption of a child’s life simple constipation can cause. Constipation is defined as reduced frequency of or painful stooling in a child for two or more weeks.

The majority of pediatric patients have functional constipation, and rarely have issues secondary to anatomic, physiologic or metabolic problems. It is not uncommon to see children have a change in their stools as they become toddlers with varying eating habits, during elementary school years when children don’t want to use the bathroom at school and even later in life.

Once your child has been potty trained, it is often difficult to get a good history of their “poop” habits, and many children and even teens will report that they have “normal” stools and then on abdominal exam or x-ray are found to have “tons of poop”. There are several ways to treat constipation, and there are several different products that may be used without problems.

For daily management of constipation I recommend using either milk of magnesia (MOM) or Miralax (polyethylene glycol) which may be used safely for long periods of time. MOM is easy to use in an infant and can be started in 1/4 to 1/2 teaspoon daily and may be increased as necessary in order to produce a soft stool at least every 24 to 48 hours.

As children get older they may not be as willing to take MOM in larger doses and Miralax has truly been a “miracle” in that it is tasteless and odorless and may be mixed with juice for easy acceptance.  The starting dose for Miralax is 1/2 to 1 capful (17 grams) per day in a child over the age of one to two years. I tell the parents again to titrate the dose either up or down, to produce a soft stool every day or every other day.

I also advocate using bite sized prunes, prune juice-apple juice “cocktails”, and Metamucil cookies to help maintain normal “mushy” stools. For children who have problems with constipation or resistance in stooling, it is important that they have a dedicated time each day to use the bathroom. Good poop habits often take practice before becoming routine. Treating for many months may not be uncommon, especially in children who have ongoing constipation issues.

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

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DR SUE'S DAILY DOSE

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