Daily Dose

Dog Flu Is Going Around

1:15 to read

Funny time of year for me to be blogging about flu?  Well, now it is “dog flu” that has been spreading across the United States.  Dog flu is caused by an influenza virus and is a contagious respiratory disease in dogs. There have not been any reported human infections with either of the viruses that cause dog flu.  The viruses are also of the Influenza A variety and cause symptoms similar to those seen in humans including cough, runny nose, fever, lethargy and at times severe respiratory symptoms including pneumonia. Sadly, there have been dog deaths reported due to this infection. 

Because dog flu is a fairly new virus now being seen in the United States, most dogs have never been exposed to this virus.  Due to this, just like new influenza types in humans, most dogs that are exposed (about 80%) may develop dog flu but remember most will have mild symptoms and just require supportive care including extra fluids and rest.

If you are concerned that your dog may be showing signs of dog flu there is a test that your vet may administer ( just like we do flu tests for kids!). Extremely ill dogs, especially young puppies or pregnant dogs may have a harder time handing the virus ( again, does this sound familiar?).

But, the main thing to know is that this flu is not being seen in humans.  There is a vaccine for one of the types of dog flu and the veterinary community it working on other vaccines.

So, no need to worry about the kids and their pet dog!!  Just like your children make sure your dog is up to date on their vaccines, gets a healthy diet, exercises daily, has enough sleep and enjoys lots of family time too. But,  this is a good time to remember that human flu vaccine will begin to be available by the end of the summer. But don’t worry, I will remind you! 

Daily Dose

Prebiotics and Probiotics

1:30 to read

There has been plenty of discussions about using prebiotics and probiotics in your child's diet. What is the difference between the two?There has been a lot of discussion lately (in both medical and lay literature) surrounding the use of prebiotics and probiotics.  The first question patients/parents often ask is what is the difference between the two “biotics”? Prebiotics are non-digestible nutrients that are found in foods such as legumes, fruits, and whole grains. They are also found in breast milk.  Prebiotics have also been called fermentable fiber. Once ingested, prebiotics may be used as an energy source for the good bacteria that live in the intestines. Probiotics are beneficial live bacteria that you actually ingest. These bacteria then pass from the stomach into the intestine to promote “gut health”. The gut is full of bacteria and these are the “good bacteria”.  

There are currently hundreds of different probiotics being marketed. The research on the value of using prebiotics and probiotics has been ongoing, but there are actually very few randomized, double blind, controlled studies to document that pre and pro-biotics provide any true benefit to treat many of the diseases that they are marketed to treat. There are several areas where probiotics have been shown to be beneficial. By beginning probiotics early in the course of a viral “tummy infection” in children the length of diarrhea may be reduced by one day. Probiotics have also been shown to be moderately effective in helping to prevent antibiotic associated diarrhea, but not for treatment of that diarrhea.

There are also studies that are looking at giving very low birth weight premies probitoics to help prevent a serious intestinal infection called necrotizing enterocolitis. To date there seems to be evidence to support this and there are currently more ongoing studies. Studies are also being done to look at the use of probiotics as an adjunct to the treatment of irritable bowel syndrome, infantile colic, and chronic ulcerative colitis as well as to possibly prevent eczema.  While preliminary results are “encouraging” there is not enough evidence to date to support their widespread use. In the meantime, there are so many different products available.  Prebiotics and probiotics are now often found in dietary supplements as well as in yogurts, drink mixes and meal replacement bars. It is important to read the label to see if these products are making claims that are not proven such as, “protects from common colds”,  or “good bacteria helps heal body”.  Many of the statements seem too good to be true!

Until further studies are done there is no evidence that these products will harm otherwise healthy children, but at the same time there is not a lot of data to recommend them. They should never be used in children who are immunocompromised,  or who have indwelling catheters as they may cause infection. This is a good topic to discuss with your doctor as well.

Daily Dose

Your Teen's Eating Habits

1:30 to read

While seeing patients one evening, I saw a 15 year old boy who had come in complaining of feeling dizzy and tired. It was the end of school as well, so he was busy with studying and finals.  This is the kind of patient that is typically given a 15 minute appointment.....but needs a lot more than that to figure out what is going on.

He was with his father who said that his son had not had a fever, had not otherwise been ill with cough or cold symptoms. Upon further questioning the teen said he was just tired and thought he might faint....although he had not.  He had gone to school that day. He was not involved in athletics and had no history of previous syncope (fainting). There was not a history of sudden cardiac death in the family. He also had a fraternal twin who was healthy. He usually tried to get about 6-8 hours of sleep a night. He denied drug or alcohol use. He had not had weight loss. HIs exam was entirely normal with normal vital signs.

But, when questioned about his eating habits he informed me that he was a vegan.  His father sat there quietly while I discussed his son’s choices.  He said that he had decided to be a vegan about a year prior, and that he rarely ate with his family. When I asked him to give me an idea of a typical breakfast, lunch and dinner I was amazed at what I heard. He really only ate “junk food”. He ate sugary cereal for breakfast, he might eat a veggie burrito for lunch, and he would often eat another fast food burrito or taco for dinner. He did not eat fruit at all. His Dad said that everyone else in the family ate “normal” meals, and that they were offered to his son as well.

I am writing this to illustrate one of the problems I see with teens who decide to become vegetarians or vegans etc, but really are just what his Dad so correctly stated are “junk food vegans or vegetarians”.

After a lengthy discussion and some lab work,  he was sent home with instructions to research ways to improve his diet even as a vegan, which in turn would probably help his fatigue. He was also stressed about the end of school.... which was another discussion as well!

Both eating issues and stress cause teens to have a lot of complaints of fatigue and feeling blah...I see them all day long. This adolescent agreed to   come back in a month with his diary of meals and he is going to see our nutritionist over the summer.

He was a delightful young man....and I was only an hour behind...but at least we got to the bottom of the problem.

Daily Dose

Pregnancy & Sleep

1:15 to read

Why is it that as you get further into your pregnancy you sleep less?  I am sure that it is just a factor of being “bigger” and as one mother said to me, “having another human inhabit your body”. It is often hard to find a comfortable position to sleep in, and even if you do, the baby may not want to stop moving when it is your bedtime.

But, I also really think this is all in God’s plan to get a mother (and father who often says his wife keeps him up) ready to be new parents. It is just foreshadowing of the weeks to come when you bring that newborn home from the hospital.  You have already learned to “survive” with less sleep.

The first few weeks at home with that most precious baby is really just about survival. I don’t care what you read or how many classes you take...there really are no “rules” or “tricks” to get thru the first 6-8 weeks of being a new (or seasoned) parent.  

I tell my parents the only “rule” is that the baby MUST sleep on their BACK..other than that try to do the feed, play, sleep routine that you think will just happen, but know at times your baby just does not want to go to sleep when you want them to!! They are not abnormal and you are not a “bad” parent.....they are just newborns with developing brains and sleep cycles. I promise, this too shall pass and longer sleep cycles will come.

So, if you are awake one night toward the end of your pregnancy and reading this, look at the bright side.  Your body is just getting you even more prepared to be a “great” parent....you already know how to survive with interrupted and less sleep.      

Daily Dose

College Students and Curfews

1:30 to read

Colleges are out and many students are home for the summer.  But with the return of your child to “the nest” comes a whole new set of issues. Trust me I have been there (more than once).

Your son or daughter has been living in a dorm, apartment, or house....with their own “rules and routines”.  Most college students living away from home have not had to really answer to anyone. If they want to stay up all night, come home at sunrise or sleep all day....you have not been involved. 

But now they are back....hopefully having managed to do well, despite their crazy schedules.  Does this “new normal” of theirs work at your house? It certainly didn’t in ours, especially where both parents were working.

A friend had advised me, “don’t give them a curfew over the summer , they have not had one at college”.  That may be some of the worse advice I have ever gotten!!  When your child is living in your house and you wake up at 2 am and they are not home....well, you assume the worst, right?  Then you try to call them and it goes to voice mail...of course...more worry. After one night like that pacing the floors I knew in my heart of hearts that summer rules, even for college kids are a must!

So, at our house college students (I don’t care how old), need to be respectful of house rules.  Even if they can get up and go to work after 3 hours of sleep, I can’t.  So midnight curfew, just like high school, goes back into place. Nothing good happens after midnight anyway, right?  If they want to stay up in their room or go watch TV in the den, or make a sandwich at 2 am, that is fine by me. I just want to know that they are home and I don’t have to dream about horrible events that are happening when I don’t know where they are.  They always ask, “you don’t know what I am doing when I am at school, so what’s the difference?”  The difference is , “out of sight, out of mind” (sort of).  In my mind I can imagine that they are tucked in their dorm bed at 10 pm.....I always think good thoughts. Those unsettling thoughts only come when they are home.... and that bed is empty.  

Daily Dose

Pool or Trampoline? The Safety Debate

1:15 to read

Do you have a pool or trampoline in your yard? Both pools and trampolines are fun for children, and both pose dangers as well. I saw a patient today who asked me my opinion of trampolines. It seems that she and a friend, both of whom have elementary school age children, are having a "discussion" about trampolines. My patient is totally against having a trampoline in her yard, although she has a pool. Her friend says that it is safer to have a trampoline than a pool. And so their debate continues.

Both pools and trampolines are fun for children, and both do pose dangers. But as my own children often told me "according to you Mom, everything that is really fun, is dangerous!" The biggest issue surrounding children playing in pools and jumping on trampolines is parental supervision. When children are taught safety and are given rules to follow that are then enforced, they may have fun and be safe at the same time. Pools are fenced, and gated. Parents watch their children swim. This is usually the party line. But trampolines also require the same amount of supervision and many parents don't realize this.

Most trampoline injuries occur when children are unsupervised. Many serious trampoline accidents occur when children of disproportionate weights are doubling jumping and the smaller child becomes a missile and is thrown from the trampoline when serious neck injuries may occur. Trampolines are also safest when they are buried in the ground or have safety nets on the side. Letting children jump unsupervised is as dangerous as swimming alone.

So, I can't resolve this friendly discussion, but I do know that both pools and trampolines require parental supervision and strict safety rules to ensure the safest possible experience. And yes, they are both fun! That's your daily dose, we'll chat again soon.

Daily Dose

Too Much Pressure to Play Sports?

1:30 to read

Does your child play a sport “after school”?  It seems children as young as 3-4 years of age are now involved in soccer and even football.  Some children are barely walking before they are signed up for a team.  Parents tell me various reasons for this including, “if they don’t start young they will be at a disadvantage athletically”, “if we don’t get on a team now, there will not be room for our child once they start kindergarten or first grade”,  and “our child wants to play and wear a uniform”. I just see lots of issues with burn out.

It seems awfully early to start “team sports” to me. I am a huge advocate of families and children playing together and learning all sorts of games and sporting skills. Kicking a soccer ball in the yard, or hitting the wiffle ball off of the tee, or having Dad throw a pass with the football all seems pretty “normal” to me. But organized sports with a 3 year old who is still in diapers….really?  Maybe one of the “guidelines” should be you have to be potty trained.  Yes, this is true, I see children in diapers who “will not pee or poop in the potty” according to their parents, but they go to soccer practice?  What is wrong with this picture?

So, while some of these well intentioned parents have told me that they are having fun being the coach, or attending games with other friends, their pre-school children “don’t have time to be potty trained”. They are too busy going to school, followed by organized activities that “it is just easier to let them stay in diapers”. I was even with a 4 year old at a football game and she was still in diapers?

At some point these children and parents will need to skip a practice or two and stay home long enough to get potty trained.  I am noticing that children are getting older and older before they are potty trained. I know there are books written on this topic with the philosophy that “the child will ultimately train themselves”, or “ how to potty train in 3 days, with a child who shows no interest”…or something along those lines.  But really, in my experience, if you watch your child’s cues, spend the time to “talk bathroom habits” and have the “time” to be home to potty train most children are potty trained between 24-36 months of age.  Yes, there are occasional children (none of my own) that just show interest earlier and say things like “I go potty now” and really do it on their own. There are also some who are more difficult to get interested and may be harder to potty train…but again, which is probably a more important life time skill…..getting out of a diaper or trying to figure out how to line up for a soccer game? I’m just saying.

Daily Dose

New Sleep Recommendations

1:30 to read

SLEEP! Who can get enough of it?  More and more studies point to the need for a good night’s sleep. But, as a new parent, you are sleep deprived, and then when your children get older they may sleep through the night,  but they want to wake up at the crack of dawn.  Once your children are adolescents their days and nights are totally up side down,  they often want to stay up too late and sleep half the day away.

Sleep is an important way to rest our brains and reset our bodies for another day.  Circadian rhythm helps to regulate sleep/wake cycles.  But trying to make sure that your children get enough sleep seems to be a never ending battle (at least in many houses). It is also one of the most frequent concerns of many of my patient’s parents.  

A recent study which was undertaken by the National Sleep Foundation reviewed over 300 articles published in peer reviewed journals between 2004-2014. Based upon their review here are the updated sleep recommendations:

Newborns (0- 3 months) 14 - 17 hours

Infants (4 -11 months) 12 - 15 hour

Toddlers (1- 2- years) 11 - 14 hours

Preschoolers (3 - 5) 10 - 13 hours

School aged children ( 6 - 13) 9 - 11 hours

Teens (14- 17)  8 - 10 hours

Young adults (18 - 25) 7 - 9 hours

So, how do your children stack up with their sleep?  Parents with newborns complain that their children may sleep 15 hours/ day, but not in the increments that they would like, while parents with children over the age of 13 rarely report that their children are getting  8 - 10 hours of sleep.

One mother recently was exasperated as her daughter age 7 would go to bed at 7:30 pm but woke up everyday at 6 am. I explained to her that her daughter was getting enough sleep, and that unfortunately her biological clock was set and that short of making her stay in her room until 6:45 when she wanted her to get up, there was not much to do.  The problem is that many parents cannot go to bed when their children do, (dishes, laundry, work emails, etc to get done while the children sleep.) So while their children may be getting enough sleep the parents are often sleep deprived!

While a good night’s sleep is important for mood and focus there is a lot of data suggesting that children who get enough sleep are less obese, are less likely to get into trouble and are certainly more pleasant to be around.

So, have a good nighttime routine beginning with a regular bedtime for your children. Commit to no electronics in their bedrooms and turn off any electronics at least an hour before bed.  We parents need to do the same!

Daily Dose

Stop Cyberbullying Now!

1:30 to read

There have been a lot of recent stories about bullying occurring on social media sites. I have such mixed feelings about social media, and ironically I myself am writing a blog for our website and app.  The Kid’s Doctor is  active on Twitter (@TheKidsDoctor) and Facebook (TheKidsDoctor) as well.  So, I realize to stay current, social media is a must and it is usually quite beneficial and is a source of instant information and sharing. Maybe too instant?

But with that being said, why do some people feel they may use it as a “bully pulpit”.   Why do they feel compelled to be mean and even vulgar?  I spend a great deal of time discussing this topic with my adolescent patients and their parents but I am concerned that sometimes even parents are guilty of “cyber bullying”.

How do parents teach their children right from wrong, or how to behave appropriately in society....by modeling behavior themselves. Our children are watching us and looking to their mother and father to “show them the way”.  Leading by example is often difficult but absolutely imperative, and this includes social media and bullying.

For all of the years I have practiced I have seen that in most, maybe not all cases,  having parents who model appropriate behavior is one of the keys to raising healthy, compassionate, resilient and well balanced children.  It sounds simplistic but it works.

Curt Schilling recently wrote an interesting and compelling article discussing this very issue.  Right after he posted a congratulatory tweet announcing his daughter’s college acceptance his daughter received terribly inappropriate hateful and hurtful messages. He was able to “trace” the tweets to accounts and therefore knew exactly who had sent these messages. Unfortunately, there are often not consequences for cyberbullying or inappropriate behavior....at least for now.  Did the messengers get punished? Did their parents even know? I should hope so.

Social media is here to stay, but there has to be a way to teach our children (and adults) that there are consequences for behaving badly especially when the whole world is aware of your behavior.  It is time for the pendulum to swing back to morals, civility,manners....and as my mother would say to me, “Emily Post would not approve”. 


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