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Daily Dose

Breastfeeding & Bottle Feeding

1:30 to read

As you know, I am a huge advocate for breastfeeding your new baby. But, with that being said I also know that there are different circumstances for each mother and baby and that some new mothers either choose to breast feed for a short period of time or not at all. I always talk to the mothers about making their own choice, and to not feel they are being judged by anyone.

 

But many mothers are concerned about not breastfeeding and the long term implications for their baby.  They feel “guilty” if they choose not to breastfeed or if they in fact want to breast feed and are unable to for some reason.  I assure them that infant formulas continue to be improved upon and now contain DHA, ARA and oligosacharides that are found in breast milk.  Formula has safely been used for many years and that they themselves may have been a formula fed baby (you usually don’t even know!).

 

So… I am always interested in studies related to breastfeeding. There are good studies that continue to the show the many benefits to breastfeeding, including lower the risk of allergies, ear infections and SIDS. It is also known that breast feeding helps build a child’s immune system. Parents often ask “if I breast feed for X number of days or weeks is that enough?”.  I have not seen any data to quantitate a simple answer to that question.

 

Several years ago it was thought that babies who were breastfed had a higher IQ (by several points), and this was later found not to be the case. It seems that a child’s IQ is actually better explained by long term factors such as family background, genetics and education.

 

The impact of breast feeding on cognitive abilities continues to be studied and debated.  A new study just released in the April issue of Pediatrics  looked at 8,000 families and did not show a statistically significant difference in cognitive ability at ages 3 or 5 years between those babies that were breastfed for 6 months and formula fed babies.  They also looked at the relationship between breastfed and formula fed babies and parent rated hyperactivity scores. They found lower parent rated hyperactivity scores for 3 year olds only, but those benefits were not maintained in the long term. Again, much of this behavior may be based on genetics and environment.

 

Bottom line in my opinion…..adequate nutrition for your baby is the most important factor. Whether that is breast or bottle is up to each mother, and maternal well-being and feelings of happiness are so important in the first few months of an infant’s life.  

 

 

 

Daily Dose

PU: Body Odor

1.00 to read

I received an email from a mother who asked if her 5 year old son, an avid athlete, could wear deodorant?  It seems that his arm pits “smell like a grown man”.  I have actually been asked this on occasion in my office and I have even noticed body odor (BO) during exams on some 5-8 year olds.   

Most children start to “stink” as they begin to enter puberty, but there are occasional children that for unknown reasons, develop BO without any signs of puberty. If it seems that your child is entering puberty at an early age, you do need to talk to your doctor.  If your child happens to be one of those kids who are just odiferous, there are several things that you can do.

Number one, make sure that your child is bathing/showering everyday, and that they wash their armpits well. Some little boys (and I bet a few girls) just pop in and out of the shower without touching soap on most of their bodies.  (I used to smell my boys hair when they came out of the shower, sometimes still smelled sweaty, no soap!).

If daily bathing does not do the trick, it may be time to use a deodorant, which just masks the smell. This often works for younger kids who are really stinky rather than sweaty.  An anti-perspirant actually stops and dries up perspiration and may not be needed until an older age.

There are numerous deodorant products available, some of which are natural as well. Head to the store and read labels to decide which one you prefer.

Daily Dose

Mumps Outbreak!

1:30 to read

The latest infectious disease outbreak is in the Boston area where several colleges have reported cases of mumps. Mumps is a viral illness that causes swelling of the salivary glands as well as other symptoms of fever, fatigue, muscle aches and headache.    Harvard University has been hit the hardest and has now documented over 40 cases this spring.  Boston is a city with numerous colleges all in close proximity, and there are documented mumps cases at Boston University, University of Massachusetts  and Tufts as well.  These Boston area colleges are all in close proximity and are merely a walk, bike or train ride away from one another, so these students, while attending different universities may all co-mingle at parties and athletic events.

Mumps is spread via saliva (think kissing), or from sharing food, as well as via respiratory droplets being spread after coughing or sneezing. It may also be spread via contaminated surfaces that will harbor the virus. People may already be spreading the virus for  2 days before symptoms appear and may be contagious for up to 5 days after their salivary glands appear swollen….so in other words there is a long period of contagion where the virus may inadvertently be spread. It may also take up to 2-3 weeks after exposure before you come down with mumps.

All of the students who have come down with mumps had been vaccinated with the MMR vaccine (mumps, measles, rubella).  Unfortunately, the mumps vaccine is only about 88% effective in preventing the disease. Despite the fact that children get two doses of vaccine at the age of 1 and again at 4 or 5 years….there may be some waning of protection over time. This  may also contribute to the virus’s predilection for young adults in close quarters on college campuses. Something like the perfect infectious disease storm!

In the meantime there are some studies being undertaken to see if adolescents should receive a 3rd dose of the vaccine, but the results of the study are over a year away.

In the meantime, be alert for symptoms compatible with mumps and make sure to isolate yourself from others if you are sick.  Harvard is isolating all of the patients with mumps for 5 days….which could mean that some students might even miss commencement.  Doctors at Harvard and other schools with cases of mumps are still on the watch for more cases …stay tuned.

 

 

 

 

Daily Dose

Brown Spots on Your Baby?

1:30 to read

I was examining a 4 month old baby the other day when I noticed that she had several light brown spots on her skin. When I asked the mother how long they had been there, she noted that she had started seeing them in the last month or so, or maybe a couple even before that.  She then started to point a few out to me on both her infant’s arm, leg and on her back.

These “caramel colored” flat spots are called cafe au lait macules, (CALMs) and are relatively common. They occur in up to 3% of infants and about 25% of children.  They occur in both males and females and are more common in children of color.  While children may have a few CALMs, more than 3 CALMS are found in only 0.2 to 0.3% of children who otherwise do not have any evidence of an underlying disorder.  

Of course this mother had googled brown spots in a baby and was worried that her baby had neurofibromatosis (NF).  She started pointing out every little speckle or spot on her precious blue eyed daughter’s skin, some of which I couldn’t even see with my glasses on. I knew she was concerned and I had to quickly remember some of the findings of NF type 1.

Cafe au lait spots in NF-1 occur randomly on the body and are anywhere from 5mm to 30 mm in diameter. They are brown in color and have a smooth border, referred to as “the coast of California”. In order to make the suspected diagnosis of NF-1 a child needs to have 6 or more cafe au lait spots before puberty, and most will present by 6 -8 years of age.

For children who present for a routine exam with several CALMs ( like this infant), the recommendation is simply to follow and look for the development of more cafe au lait macules. That is a hard prescription for a parents…watch and wait, but unfortunately that is often what parenting is about.

Neurofibromatosis - 1 is an autosomal disorder which involves a mutation on chromosome 17 and may affect numerous organ systems including not only skin, but eyes, bones, blood vessels and the nervous system. Half of patients inherit the mutation while another half have no known family history.  NF-1 may also be associated with neurocognitive deficits and of course this causes a great deal of parental concern. About 40% of children with NF-1 will have a learning disability ( some minor, others more severe).

For a child who has multiple CALMs it is recommended that they be seen by an ophthalmologist and a dermatologist yearly,  as well as being followed by their pediatrician.  If criteria for NF-1 is not met by the time a child is 10 years of age,  it is less likely that they will be affected, despite having more than 6 CALMs.

The biggest issue is truly the parental anxiety of watching for more cafe au lait spots and trying to remain CALM…easier said than done for anyone who is a parent. 

Daily Dose

How to Treat Stool Holding

Stool holding part 2: how to treat this common ailment.On Friday, we discussed stool holding and encopresis: what it is and why kids have trouble going to the bathroom.   Now it’s time to discuss treatment.

The medicinal component of treatment begins with  cleaning out the rectum. This is typically done by using enemas (Fleets) to get rid of the large amount of old stool that has distended the rectum.  Mineral oil given orally may also help the stool to be evacuated (it is tasteless but a child can see the oil, so get a soft drink or juice and put a top on it and mix in the mineral oil and serve with a straw), you can also mix into oatmeal. I typically use an enema to start and then keep up daily mineral oil for awhile until the stools are routinely soft and not painful.  Enemas are not well liked by anyone.  A daily laxative is also important. Milk of Magnesia and Miralax are my favorites.  The dose may be titrated but you want to ensure that your child is having a stool every day. The laxatives are not habit forming, but are serving a purpose to help the colon begin to work correctly again. Once your child is having regular bowel movements without pain, or avoidance you can slowly wean the laxative too, but do this over several months. Dietary therapy is also important to help soften stools and decrease the transit time of stool in the colon. Healthy eating habits which incorporate high fiber foods are helpful. The formula for fiber intake is the child’s age in years + 6 = number of grams of fiber /day. You would be surprised at fiber content of foods and they are all listed on the food packages. Benefiber is also a good source of fiber and can be used daily.  I like  to use Metamucil cookies too and if necessary put a little icing on top.  Adding more fluid to a child’s diet is equally important , and a “prune juice cocktail” made with prune juice and seven up or ginger ale is a great way to get in some more fluid with additional laxative benefit. (you taste it not bad at all!) Lastly, behavior modification.  Begin by establishing a regular toileting schedule. This is typically after each meal (to take advantage of the gastro-colic reflex which occurs after eating and causes intestines to contract) and at bedtime.  I sometimes use a timer as a game to try and have the child “beat the clock” in pushing out their poop, and then they receive a “prize” (Dollar store is adequate, does not need to be expensive etc.). A child needs lots of positive reinforcement with charts, stickers to show their progress and even larger reward (maybe trip to bookstore, or ice cream store etc) for a week of good work. Remember, this is not an overnight resolution but typically takes weeks to months of work, so be creative as to positive reinforcement. If your child does not stool every day, try using a suppository and increasing the laxative.  They can also practice doing the Valsava maneuver (where you hold your breath and bear down to have a bowel movement) which will also help them push out the stool which should be soft. If your child is in school you need to discuss these strategies with the teacher so that the child has adequate bathroom time when needed. By working on all 3 areas encopresis can be treated and successfully cured while saving the child embarrassment and anxiety that often comes with it. No one wants to have “poopy pants” they just need the tools to fix the problem. For very difficult cases you may need to ask your pediatrician about using a behaviorally trained pediatric psychologist for assistance. That’s your daily dose for today.  We’ll chat again tomorrow.

Daily Dose

Kids Should Drink Milk, Even If It Is Chocolate

I have always be a huge advocate of children drinking milk. From the time “my” babies go from breast or formula to milk at the age of one year, I discuss the need for dairy products to ensure adequate calcium and Vitamin D in a child’s diet.I have always been a huge advocate of children drinking milk. From the time “my” babies go from breast or formula to milk at the age of one year, I discuss the need for dairy products to ensure adequate calcium and Vitamin D in a child’s diet.

It is easy to have children drink milk when they are toddlers, but as children get older and decide that they “prefer” water or even juices or soft drinks it may be harder to get them to choose milk. Unfortunately, once a child enters the “real” world with school and sports, they realize that there are other beverages offered besides milk. So, what to do?  Well, I think it is preferable to have children and adolescents continue to drink milk, even if it means having chocolate or strawberry milk. There have actually been studies in the pediatric literature that have shown it is preferable to have a few extra calories from the sweetener in flavored milks, than to forgo drinking milk. Like many things, it is a trade off. It is difficult to provide a child’s daily calcium and vitamin requirements without having several glasses of milk a day as well as other dairy products. When looking at the calorie content for low fat chocolate milk compared to low fat milk we are only talking about 30 – 50 calorie difference per cup of milk (it seems to depend on the brand). I know that the calories may be cumulative, but if you take away a sugary cereal in the morning, or that after school fast food, the calorie difference would never be noticed. One could also argue that if we our children spent more time playing outside rather than on their play stations or computers, the extra calories from chocolate milk would never be noticed. Bottom line, it’s all about choices. Over the years I have also found that many children want to drink chocolate milk for the short-term and then will come back to regular white milk. If they continue to drink milk throughout their childhood they are also more likely to drink milk as young adults, which is still an important time for “banking calcium”. Bone health and many of the exciting new studies regarding vitamin D continue to outweigh the debate about calories. I really don’t think that my overweight patients are getting their extra calories from milk, but rather cookies, fast foods, and soft drinks. I wish milk was the culprit. Lastly, I did have chocolate milk in our house, but if you are really worried about the calories, I have been known to “dilute” chocolate milk with white milk and it is still chocolate. There are lots of little things like that we can do as parents and it seems to work well for everyone. I will have other Mommy secrets later; remind me about trying that with cereals. That’s your daily dose, we’ll chat again tomorrow. Send your question or comment to Dr. Sue!

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

When Bug Bites Get Infected

1.00 to read

It is the season for bug bites and and I am seeing a lot of parents who are bringing their children in for me to look at all sorts of insect bites. I am not always sure if the bite is due to a mosquito, flea or biting flies, but some of them can cause fairly large reactions. 

The immediate reaction to an insect bite usually occurs in 10-15 minutes after bitten, with local swelling and itching and may disappear in an hour or less. A delayed reaction may appear in 12-24 hours with the development of an itchy red bump which may persist for days to weeks.  This is the reason that some people do not always remember being bitten while they were outside, but the following day may show up with bites all over their arms, legs or chest, depending on what part of the body had been exposed. 

Large local reactions to mosquito bites are very common in children. For some reason, it seems to me that “baby fat” reacts with larger reactions than those bites on older kids and adults. (no science, just anecdote). Toddlers often have itchy, red, warm swellings which occur within minutes of the bites. 

Some of these will go on to develop bruising and even spontaneous blistering 2-6 hours after being bitten. These bites may persist for days to weeks, so in theory, those little chubby legs may be affected for most of the summer. 

Severe local reactions are called “skeeter syndrome” and occur within hours of being bitten and may involve swelling of an entire body part such as the hand, face or an extremity. These are often misdiagnosed as cellulitis, but with a good history of the symptoms  (the rapidity with which the area developed redness, swelling, warmth to touch and tenderness) you can distinguish large local reactions from 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 and Dommeboro soaks.  This may be supplemented by topical steroid creams (either over the counter of prescription) to help with itching and discomfort. 

An oral antihistamine (Benadryl) may also reduce some of the swelling and itching. Do not use topical antihistamines. Try to prevent secondary infection (from scratching and picking) by using antibacterial soaps, trimming fingernails and applying an antibiotic cream (polysporin) to open bites. 

Due to an exceptionally warm winter throughout the country the mosquito population seems to be especially prolific. The best treatment is prevention!! Before going outside use a DEET preparation in children over the age of six months, and use the lowest concentration that is effective.  Mosquito netting may be used for infants in strollers.  Remember, do not reapply bug spray like you would sunscreen. 

Daily Dose

When Bug Bites Get Infected

1.00 to read

It is the season for bug bites and and I am seeing a lot of parents who are bringing their children in for me to look at all sorts of insect bites. I am not always sure if the bite is due to a mosquito, flea or biting flies, but some of them can cause fairly large reactions. 

The immediate reaction to an insect bite usually occurs in 10-15 minutes after bitten, with local swelling and itching and may disappear in an hour or less. A delayed reaction may appear in 12-24 hours with the development of an itchy red bump which may persist for days to weeks.  This is the reason that some people do not always remember being bitten while they were outside, but the following day may show up with bites all over their arms, legs or chest, depending on what part of the body had been exposed. 

Large local reactions to mosquito bites are very common in children. For some reason, it seems to me that “baby fat” reacts with larger reactions than those bites on older kids and adults. (no science, just anecdote). Toddlers often have itchy, red, warm swellings which occur within minutes of the bites. 

Some of these will go on to develop bruising and even spontaneous blistering 2-6 hours after being bitten. These bites may persist for days to weeks, so in theory, those little chubby legs may be affected for most of the summer. 

Severe local reactions are called “skeeter syndrome” and occur within hours of being bitten and may involve swelling of an entire body part such as the hand, face or an extremity. These are often misdiagnosed as cellulitis, but with a good history of the symptoms  (the rapidity with which the area developed redness, swelling, warmth to touch and tenderness) you can distinguish large local reactions from 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 and Dommeboro soaks.  This may be supplemented by topical steroid creams (either over the counter of prescription) to help with itching and discomfort. 

An oral antihistamine (Benadryl) may also reduce some of the swelling and itching. Do not use topical antihistamines. Try to prevent secondary infection (from scratching and picking) by using antibacterial soaps, trimming fingernails and applying an antibiotic cream (polysporin) to open bites. 

Due to an exceptionally warm winter throughout the country the mosquito population seems to be especially prolific. The best treatment is prevention!! Before going outside use a DEET preparation in children over the age of six months, and use the lowest concentration that is effective.  Mosquito netting may be used for infants in strollers.  Remember, do not reapply bug spray like you would sunscreen. 

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DR SUE'S DAILY DOSE

Nutrition and your baby.

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