Twitter Facebook RSS Feed Print
Daily Dose

Allergy Season

1:30 to read

Allergy season is quickly approaching and if your child is known to have seasonal allergic rhinitis (nasal congestion, runny nose, itchy nose and sneezing) during the fall months, it is time to begin the use of their intra-nasal steroids and oral antihistamine on a daily basis.  It is also easy to begin therapy for suspected allergic rhinitis as both nasal steroid sprays and non-sedating antihistamines are available over the counter, and there are many choices as well (liquids, chewables, and pills).

 

Interestingly, I just read an article from a study done in India which looked at Vitamin D levels in children with allergic rhinitis.  It was a small study, only 42 children, between the ages of 5-15 years were followed. The authors looked at nasal symptom scores in children who were maintained on their allergic rhinitis protocol but one group received a Vitamin D supplement as well. 

 

Vitamin D is known to have effects on T and B cells which may link Vitamin D to immune related conditions and allergies. There are many interesting studies involving Vitamin D and the role it plays in our daily lives and there continues to be a lot of controversy on the topic as well. 

 

But, with that being said, in this study children who received Vitamin D supplementation (400-800 IU per day depending on age of the child) not only had higher Vitamin D levels, they also had lower nasal symptom scores. 

 

Of course in the study they looked at Vitamin D levels pre and post treatment. But it would seem to me (being an allergy sufferer myself) that adding a daily dose of Vitamin D to my allergy regimen couldn’t hurt.  

 

There continues to be an increase in allergic disease around the world and at the same time, more and more people are seeking protection from the sun (from which we make cutaneous Vitamin D). Sun protection continues to be a good idea too. Of course, this is only one study, and further research with greater study participants are necessary. But in the meantime, you might discuss adding a dose of Vitamin D to your child’s allergy regimen with your pediatrician. 

 

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

Teens & Skin Care

I am seeing a lot of teens this summer for their “routine” checkups and skin care is always part of our discussion.

I am seeing a lot of teens for their “routine” checkups and skin care is always part of our discussion. Some teens are just blessed with good skin, and when you ask them what they do to their skin their reply is “nothing’. That is not the norm. Adolescence is the prime time for acne and whether the breakouts are mild or persistent, good skin care is the beginning for everyone.
The first thing that all adolescents need to do is to wash their face twice a day. You do not need “fancy” skin potions or lotions either, the drugstore has more than enough choices to begin a good cleansing program. Using a mild soap- free cleanser may be enough to begin with , something like Purpose, Basis, Aquanil or Neutrogena. If the skin is more oily and acne prone try a cleanser that contains glycolic or salicylic acid , products like Neutrogena Acne wash, or Clean and Clear, you will need to read labels to look at the ingredients. These provide gentle exfoliation of the skin surface. Wash with a soft cloth but don’t scrub or buff, just wash.
After washing your face in the morning, always apply a gentle non-comedogenic moisturizer WITH sunscreen. This will not cause acne, but will prevent sun damage that we all get on a daily basis. This is not the same as applying sunscreen for a day at the beach or lake. Again, I like Oil of Olay complete, or Neutrogena but there are many others out there, so find your favorite.
At bedtime, after washing your face, if skin seems to be getting break outs begin using a 5% benzoyl peroxide lotion (you only need a dime size amount for the whole face) applied after your face has completely dried from the washing. If it is applied to a wet or damp face it may cause redness. Benzoyl peroxide products come in several strengths and may be titrated up in strength as tolerated.
If this regimen is not working well it is probably time for a visit to the doctor to discuss some prescription products. More on that another day.
That's your daily dose. We'll chat tomorrow.
Tags: 
Daily Dose

Baby's First Foods

1:30 to read

Have you heard of “baby led weaning” (BLW)? Many of my patients who have infants that are ready to start “solid foods”, also called complementary foods, have questions about this method. Most babies begin eating foods along with breast milk or formula somewhere around 5 - 6 months of age.  So BLW is not really “weaning”,  as your infant will continue to have breast milk or formula in conjunction with foods…so this really should more aptly be named “baby self feeding”. 

In this method you never offer your baby “mush” or pureed foods, but rather offer them foods from the table.   While I am a huge advocate of self feeding (old term is finger feeding), I also think that early on offering a baby “mushy” food on a spoon is an important milestone. In fact, for most babies at 5 -6 months, it is difficult to pick up a small piece of food to self feed as the pincer grasp has not developed. So, a baby is trying to get food to their mouths by cupping it or hoping it sticks to their hand while pushing pieces around their tray. Some parents will put the food into their baby’s hand.  But, by 8-ish months most babies have developed their pincer grasp and the finger feeding should be preferred.  

Parents are also concerned about starting solid foods and the possibility of choking.  I am always discussing how to make sure that your child avoids choking hazards with foods. In other words, no whole grapes, or hot dogs, or popcorn or chunks of meat.   Other hazards are raw carrots, apples, celery and any “hard” food that your baby might be able to bite a chunk of and then choke. But, if you cook the carrots and then cut them in small bites they are easily handled by a baby who is self feeding.  It is really all about the consistency of the food as once your baby has lower teeth they can easily bite/pry off a big “chunk” of food that could lead to a choking hazard.

Interestingly, there was a recent study that looked at the incidence of choking in children who started with self feeding vs those fed traditionally with pureed foods from a spoon. In this study of about 200 children between 6 - 8 months of age the incidence of choking was similar, while there were more gagging events in the BLW group.  Fortunately, “the choking events resolved on their own”. Gagging is quite different than choking. Some children will gag on pureed foods just due to texture issues. 

I am an advocate of what I am going to call parent led feeding followed by early self feeding of appropriate foods. By the time a child is 9 months of age they should be able to finger feeding the majority of their meals. But there are some foods that are just not conducive to finger feeding at all….yogurt, apple sauce, puddings…and they will be spoon fed until your child is capable of using a spoon which is anywhere from 12 -18 months.   But as a reminder, whenever you offer your child a finger food you should remember two things, #1 is the piece small enough that my child cannot choke and #2 is the food cooked well enough to not pose a choking hazard.  

Several years ago there was a 1 year old in our practice who was given a piece of an apple to chew on… she bit off a chunk of the apple, aspirated and died. It was a terrible accident.  I will never forget that….and re-iterate to all of my patients…a pork chop, or chicken leg or any number of foods can become a choking hazard if your child bites off a chunk. Children really don’t chew until they are around 2 years, they just bite and try to swallow so I pay a great deal of attention to what foods they are offered.

Old school and new school…the combo seems to make sense to me. 

Daily Dose

Car Seat Safety

1:30 to read

I recently received a text from a patient who asked if she could turn her 17 month old child’s car seat around and have it forward facing in the back seat. She said that her car seat instructions read “may forward face after the child weighs 20 lbs”.

 

Not long after that, another patient came in for her 18 month check up and during the course of the check up I always ask about car seat position.  I remind them that they should continue to have their child in a rear facing car-seat until they 2 years of age.  The child’s mother said that she had turned the car seat around to forward facing because the child “did not like rear facing”.  Interesting discussion with a toddler.

 

So, this just so happens to be Child Passenger Safety Week and National Car Seat Check Saturday as well. What a better time to remind parents that the safest way to restrain your child who is under the age of 2 years (depending on your carseat height and weight restrictions)  is in a rear facing car seat.  

 

In a recently published article in the journal Pediatrics, about 38% of 17-19 months olds were not following AAP recommendations to ride in a rear-facing car seat. The recommendations were changed in 2011 as studies found that young children in a forward-facing car seat were 5 times more likely to be seriously injured than those in a rear-facing seat. 

 

In the study many of the families involved who had their children forward-facing often said that they “thought their child was too tall or too heavy to be rear-facing”. Others commented that “their feet were touching the back seat and they looked uncomfortable”. 

 

Interestingly, your child has been in a rear-facing car seat since birth, so it is strange that they “prefer” to forward face.  Kind of like being in the middle seat of an airplane, if you have never been seated on the aisle you don’t know the difference in seats.

 

If you are concerned about the appropriate car seat for your child or how to install it, this is a good week to have a car seat expert help make sure that your child is riding in the safest car seat possible. If your child is under the age of 2…that also means rear facing!  

 

 

 

 

 

  

Tags: 
Daily Dose

How to Treat Poison Ivy

1.15 to read

With the long weekend here, many families are enjoying the outdoors. But with outdoor activity, your children may develop summer rashes like poison ivy, poison oak or poison sumac. Each plant is endemic to different areas of the country, but unfortunately all 50 states have one of these pesky plants. Teach your children the adage “leaves of three, let it be”, so they come to recognize the typical leaves of the poison ivy.

The rash of poison ivy (we will use this as the prototype) is caused by exposure of the skin to the plant sap urushiol, and the subsequent allergic reaction. Like most allergies, this reaction requires previous exposure to the plant, and upon re-exposure your child will develop an allergic contact dermatitis. This reaction may occur anywhere from hours to days after exposure, but typically occurs one to three days after the sap has come into contact with your child’s skin and they may then develop the typical linear rash with vesicles and papules that are itchy, red and swollen. Poison ivy is most common in people ages four to 30. During the spring and summer months I often see children who have a history of playing in the yard, down by a creek, exploring in the woods etc, who then develop a rash. I love the kids playing outside, but the rash of poison ivy may be extremely painful especially if it is on multiple surface areas, as in children who are in shorts and sleeveless clothes at this time of year. The typical fluid filled vesicles (blisters) of poison ivy will rupture (after scratching), ooze and will ultimately crust over and dry up, although this may take days to weeks. The fluid from the vesicles is NOT contagious and you cannot give the poison ivy to others once you have bathed and washed off the sap. You can get poison ivy from contact with your pet, toys, or your clothes etc. that came in contact with the sap, and have not have been washed off. If you know your child has come into contact with poison ivy try to bath them immediately and wash vigorously with soap and water within 5

Daily Dose

Gassy Baby? No Problem!

1:30 to read

So you are home from the hospital with your newborn baby and suddenly you realize that the babies you see on TV never cry -  but your newborn is not reading the same script.  All babies have some fussy times, and this is especially true of a newborn in the first few months of life.  While a “typical” baby cries for a total of  3-4 hours a day, there are other babies that seem to be more difficult.  

 

Besides praying for an easy baby it seems to be luck of the draw and you don’t get to pick your baby’s temperament. In many of the cases of an “irritable” infant parents point to the fact that their baby acts uncomfortable and will frequently pass gas or draw up their legs or arch their backs as if something “hurts”.   

 

Your newborn’s tummy and intestines are just as “new” as they are and early on it may be more difficult for some babies to digest breast milk or formula.  In this case pediatricians often try to make changes in a breast feeding mother’s diet (taking out dairy), or changing a formula to a lactose free formula to see if that helps a baby to be more comfortable and less fussy. There are also “elemental formulas” that may be tried for extremely fussy babies. Discuss this with your own pediatrician.

 

Little tummies do make a lot of gas (you hear those toots all of the time) and I often recommend a trial of Little Remedies Gas Relief Drops® which contain simethicone (to help break up gas bubbles). These drops are especially made for infants and do not contain any alcohol, preservatives or dyes.  You can try using the gas drops after your baby has been fed as well as at bed time. 

 

Colic is defined as crying that occurs in an infant for at least 3 hours a day, for 3 days a week, for at least 3 weeks.  Colic typically “rears its angry head” after a baby is 3 -4 weeks of age.  For those irritable, colicky babies (I had one and you will know) I also like to try Little Remedies Gripe Water which is made with ginger and fennel, herbs that have been shown to help relax the  smooth muscle of the intestine.  Again, these drops do not contain any alcohol….which is very important. 

 

I also recommend swaddling and a pacifier for “non- nutritive” sucking to help calm a crying baby.  Many babies also like being on their tummies (tummy time is important developmentally as well) when they are fussy, and you can even massage their backs as well. Remember, even if tempted,  NEVER let your baby sleep on their tummy, even if you are in the room!! Backs to sleep only.

 

Babies also seem to like motion to calm them so holding your baby and rocking or swaying may help decrease crying. A walk in the stroller is sometimes another great way to get a fussy baby to settle down. Fresh air is good for both parent and child!

 

Daily Dose

No More Fever Phobia!

1.30 to read

Parental concerns about children with fever continues to be the primary reason for phone calls to pediatricians offices, visits to the doctor and late night trips to the ER.  The term “fever phobia” is not new and one of the hardest things to “teach” parents is the mantra “fever is your friend”. What?  How can that be?  What if the thermometer reads 103.7 degrees?  Well, the latest report by the American Academy of Pediatrics reiterates that fever phobia is an unnecessary and unfounded worry, as the number on the thermometer is just that, a number, and is not indicative of degree of illness.  In other words, degrees Fahrenheit does not correlate with degree of illness. It is hard not to think that a thermometer that reads 103.7 degrees is not indicative of a life threatening illness. But fever in and of itself is a symptom and not an illness. The body’s reaction to fighting an infection is typically a febrile response, and fever may be a protective mechanism. I spend a lot of time with my patients and their parents discussing fever and what a fever means.  It is hard to discuss a fever in the abstract, and most parents say that they will not “fear a fever”. But, when the actual time arrives and their child has a fever, it is a whole different thing. Despite all of the education about “fever is your friend” the thermometer with 103.7 degrees flashing at you is a scary proposition. Of course it seems reasonable to think your child is” sicker” if their temperature is higher, and I know as a mother and pediatrician, your child does “look pathetic” with a high fever. The fever makes you feel yucky, and your heart rate goes up as does your child’s respiratory rate, this is a body’s normal response to a fever. When you have a higher temperature you don’t feel a lot like eating or playing, you are often happy to just lay on the bed or a couch and watch a movie and eat a popsicle or have a glass of Gatorade. But, taking fluids and watching a movie or quietly reading a book is a good sign that your child is not “too” sick. Young children with a fever are often whiny and pathetic, but they will have moments when they will play, or eat a cookie, and then become pathetic again soon thereafter. That up and down is a good sign. Treating a fever with either acetaminophen or ibuprofen is recommended only to make your child feel better. Treating a fever is not always necessary and some studies show that an illness may resolve sooner if the fever is left untreated. When and if you do decide to treat your child’s fever, make sure that you use the correct dosage of medication, which should be based on a child’s weight. I try to give each family a medication-dosing chart for acetaminophen and ibuprofen at their 2 month visit so that they may tape it inside the medicine cabinet and can refer to it when needed. I promise you there will be many nights of fever to face during the course of parenting!  As you learn to “relax” while reading a thermometer, each illness will become a little easier. Lastly, it is not necessary to awaken a child from a nap or during the night to take their temperature, or treat a fever. An uncomfortable child will wake up and demand your attention.  Fever does not cause “a scrambled brain” (term from a patient of mine), and you will not have caused brain damage if you let your child sleep with a fever. Sleep is usually one of the best treatments for illness, so let a feverish child rest and wait to take their temperature and treat the number on the thermometer. Chant with me “fever is your friend”!!! That’s your daily dose for today.  We’ll chat again tomorrow.

Daily Dose

RSV is Going Around

RSV is here and can be one of the scariest illnesses for parents of young babies. Dr. Sue tells you what this virus is and the best ways to treat it. Whew, this is a  busy week! Busy for you too, I'm sure. I've seen many coughs, colds and another baby with RSV.  RSV is the acronym for respiratory synctial virus, which is a winter-time upper respiratory infection that causes colds and coughs, but also an illness known as bronchiolitis.

Bronchiolitis is an inflammation of the lower respiratory tract that is seen in infants and young children, often due to a viral infection. At this time of year, throughout the country,  the most common cause of bronchiolitis is RSV.  RSV is seasonal virus, and is  typically seen from November until April, but in recent days and weeks, the number of  young children coming to my office with coughs and wheezing just sky rocketed. Once you hear the frequent, tight, wheezing coughs in the hallways, and listen to a few wheezy babies, you know that RSV has arrived. Unfortunately, in my area it looks like it is going to be a busy RSV season. RSV is a viral infection, and like so many other viruses, including influenza, some years the virus just seems worse than others.  In the last few days I have already admitted several babies who had RSV bronchiolitis, and have required hospitalization for supportive care with oxygen supplementation. Fortunately, they are doing well and no one required intensive care. At this time of year, every parent I see who has brought in their sick, coughing, wheezing baby hears basically the same thing. “Your baby probably has RSV which is a viral infection, somewhat like a cold .” When you say RSV, they all cringe, but you need to understand what you are looking for. When older children and adults get this infection, we get a nasty cough, lots of congestion and have a dreaded winter cold.  But, when a baby gets this infection the virus may cause inflammation and constriction of the lower respiratory tract which results in wheezing and in some cases difficulty breathing. The key point is “difficulty breathing”. Babies who are having difficulty breathing will not only have a frequent tight cough, but they will also exhibit signs of “increased work of breathing”.  This means that you may notice that the infant is retracting, which means that they are using their rib muscles or abdominal muscles to help them breath.  This is a visible sign of respiratory distress, and you will see their chest cage move in and out as they work to breath. Babies may also grunt with each breath, or cough so hard that they turn dusky or blue. All of these symptoms are significant and are need for concern and a visit to the pediatrician.   With that being said, most babies handle the virus and will cough and wheeze and have a lot of mucus and secretions, but will not exhibit signs of respiratory distress. They may appear “pathetic” and cough a lot and be up and down at night due to cough and congestion, but they will not show signs of retracting or increased work of breathing. When your baby has a cold and cough it is imperative that you look at their chests. That means turn on the lights, lift up their jammies or unzip their onesie and look at how they are breathing. Is their chest sinking in with each breath?  Can you see their ribs moving in and out as they are retracting?  Are the using their abdominal muscles to help them breath?  Can you hear a wheeze or grunting or are they just congested and coughing? Lastly, look at their color. A baby who is coughing and turning red in the face is good, a baby with a  dusky or blue face or lips or mouth is bad. It is basic:  red is good, blue is bad! For infants who are showing signs of respiratory distress, they may need to be hospitalized for supportive care, and supplemental oxygen. (there is are recent study about using hypertonic saline treatments for hospitalized babies. It looks interesting).  Because RSV is a virus, antibiotics won’t help.  There are no medications to “fix” the problem.  It is once again “tincture of time” for the illness to run its course. That may mean several days to a week in the hospital for some babies. That's your daily dose for today. We'll chat again tomorrow. Send your question to Dr. Sue.

Pages

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.

 

DR SUE'S DAILY DOSE

Why your baby needs to be in a rear facing car set.

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.

 

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.