Twitter Facebook RSS Feed Print
Daily Dose

Uber & Teens

1:30 to read

Do you have Uber cars in your area?  I first found out about Uber (and I am only using them as an example) when my son lived in NYC and often used the car service. Later on I heard about college kids using Uber as well.  In that case, many college kids did not have cars and/or they were being “responsible” after being at a party.

But recently, in conversations with my adolescent patients, I have heard that high school kids are using Uber to come home after a party, or other social activities. In otherwords, their parents are not picking them up from the dance, concert, or party but are letting their children (often young girls) call Uber.  Where are their parents and what are they thinking?

I realize that once your child heads off to college you hope and pray that they are making good choices and are being safe. You don’t really plan on picking them up after an event or talk to them that same night about what they have been doing and with whom.  But when we had high school age children, my expectations were that we, the parents, were responsible for taking our teens to the party and to pick them up. Once they were driving the “rules” changed a bit in that they were then often driving themselves to an event and then would drive home and we would be up waiting for them to get home.  They always knew that we would be there when they got home and also that if there were any “issues” we were also available to pick them up. We talked a lot about underage drinking as well as driving and responsibility.  Never did I think they would call a cab or car service, nor was that idea ever broached, they were to call their parents.

So now that these “app” car services are available around the clock, are parents abrogating their responsibilities for parenting teens?  By allowing their teens to call a car service for their ride home, are parents seemingly not interested in where their child has been or who they have been with or what they have been doing before they get home?  You certainly can drop your child at a concert or party and tell them to text Uber to get a ride home, but does this parental non-participation quietly help to condone inappropriate, risky, teen behavior?

Although picking your child up at the end of the evening or checking on them when they pull in the driveway will never ensure that your teen does not get into trouble, I think it does help them think a bit more about having to interact with their parents at curfew time. This “worry” might help lead them to make a better decision about drugs, alcohol or whom they are hanging out with. Putting teens into the “hands” (cars) of strangers as their ride home just seems wrong. Parents be aware. 

Daily Dose

Moles On A Child's Skin

1:30 to read

Everybody gets moles, even people who use sunscreen routinely. Moles can occur on any area of the body from the scalp, to the face, chest, arms, legs, groin and even between fingers and toes and the bottom of the feet.  So, not all moles are related to sun exposure.

Many people inherit the tendency to have moles and may have a family history of melanoma (cancer), so it is important to know your family history. People with certain skins types, especially fair skin, as well as those people who spend a great deal of time outside whether for work or pleasure may be more likely to develop dangerous moles. Children may be born with a mole (congenital) or often develop a mole in early childhood. It is common for children to continue to get moles throughout their childhood and adolescence and even into adulthood.

The most important issue surrounding moles is to be observant for changes in the shape, color, or size of your mole. Look especially at moles that have irregular shapes, jagged borders, uneven color within the same mole, and redness in a mole. I begin checking children’s moles at their early check ups and look for any moles that I want parents to continue to be watching and to be aware of. I note all moles on my chart so I know each year which ones I want to pay attention to, especially moles in the scalp, on fingers and toes and in areas that are not routinely examined. A parent may even check their child’s moles every several months too and pay particular attention to any of the more unusual moles. Be aware that a malignant mole may often be flat, rather than the raised larger mole. Freckles are also common in children and are usually found on the face and nose, the chest, upper back and arms. Freckles tend to be lighter than moles, and cluster. If you are not sure ask your doctor.

Sun exposure plays a role in the development of melanoma and skin cancer, so it is imperative that your child is sun smart. That includes wearing a hat and sunscreen, as well as the newer protective clothing that is available at many stores. I would also have your child avoid the midday sun and wear a hat. Early awareness of sun protection will hopefully establish good habits and continue throughout your child’s life.

That’s your daily dose, we’ll chat again tomorrow. Send your question to Dr. Sue!

Daily Dose

How to Swallow a Pill

1:15 to read

I have always been a proponent of teaching children to swallow a pill.  In fact, I think I taught my boys to swallow a pill before they were 5 years old, mainly because I was tired of trying to find the measuring cup or syringe for the liquid medicine, which often didn’t go down “like spoon full of sugar”, even though we would sing the song during dosing. 

By the time one child had learned to swallow a pill the other two boys, as competitive as they were, decided that they too could do it, even the 2 year old.  So, based on that experience I have been encouraging young patients to swallow pills, and even teaching them in the office with my stash of mini M&M’s and Tic Tacs!  I also know that if you wait too long it becomes a huge ISSUE.

Well, who knew that someone would actually study “pediatric pill swallowing”?  In an article just published in the May issue of Pediatrics the authors looked at different pill swallowing interventions.  They found that up to 50 % of children were unable to swallow a pill.   Problems swallowing pills included a variety of reasons including fear, anxiety and intolerance to unpleasant flavors. 

The authors reviewed 5 articles published since 1987 which found that behavioral therapy, flavored throat sprays, specialized pill cups and verbal instruction with correct head and tongue positioning all helped children to swallow pills. They also found that pill swallowing training as “young as 2 years helped increase the likelihood of ease of pill swallowing”.

So, like many things....jump in with your young child and master the art of pill swallowing sooner than later. It will make everyone’s life easier.

Last caveat, I always tell my patients who are older “non-pill” swallowers, “you cannot possibly operate a motor vehicle if you can’t swallow a pill”! This is usually a huge motivator for the “late swallower” and they conquer the challenge. 

Daily Dose

Dealing with Warts

1.30 to read

Warts are one of the most common skin lesions seen in pediatric practices. Warts also drive parents and some kids crazy!  According to one study up to about 1/3 of school children have warts.  

Warts are viral infections of the skin which are caused by human papilloma viruses (HPV).  There are more than 100 types of HPV and different types of HPV cause different types of warts. The most common warts on hands and knees are caused by HPV types 1,4, 27, 57.  These are not the HPV types that cause sexually transmitted infections 

Some people seem to be more prone to getting warts than others, and it is not uncommon to see several children in one family dealing with warts. The HPV virus is spread through skin to skin contact or through contaminated objects or surfaces. In other words, they are hard to prevent.  HPV can also have a long incubation period, so when parents ask, “Where and when did my child get this wart virus?”, my answer is typically, “not even the CIA will be able to tell you that”.  

I many cases if the warts are left alone they may resolve on their own in months to years (one study showed two thirds remission in 2 years) ......but with that being said, most teens (especially girls) want those warts to “be gone!” 

There are several different ways to treat warts and one of the most effective is with over the counter (OTC) products that contain salicylic acid.  Salicylic acid acts as an irritant that activates an immune response against HPV.  There are tons of different OTC products and in many studies there was not one product that proved superiority over another, so I would buy an “on sale” salicylic acid for starters. I know from using these on my own children that you have to be consistent and persistent in their use....but it did work. 

If OTC products don’t seem to be working the next step for those who are determined to try and get rid of the wart,  is to head to the doctor who may try freezing the wart with liquid nitrogen or using cantharidin.  Unfortunately, there is typically a little pain involved with these products. 

Like so many other things, sometimes it may pay to just to wait it out and see if the virus just gives up and goes away!

Daily Dose

It's Allergy Season!

1:30 to read

WOW!  A busy week in the office and while I was on call in the evening,  the biggest problem right now seems to be allergies!  While some parts of the country may still be experiencing cold and a few snow flake, many states are warming up and the trees and grasses are starting to spread their pollens. In fact, my backyard is covered in yellow oak tree pollen, and some of it is so thick it looks like tumbleweeds. This cannot be good for anyone.

While I am finally seeing fewer and fewer children with the multitude of winter upper respiratory infections I see every year, the allergy season is looking “wicked” this year.  Seasonal allergies due to pollens from grasses and trees are typically not seen in children until they are over 24 months of age.  At times it is difficult to distinguish the last of the cold viruses from early allergy symptoms. But at this time of year, a good history is important (always) as well as a family history of allergies.

The good news is, there are a lot of medications available to help relieve the symptoms of itchy eyes, scratchy throat, cough, and drippy nose.  While the non-sedating antihistamines like Claritin, Zyrtec, and Allegra have been available over the counter for quite some time, intra-nasal steroids are now available as well. 

Intra-nasal steroids are one of the mainstays of allergy treatment, as they are a preventative medication. When used on a daily basis they help to prevent the “allergic cascade” that occurs when you inhale all of those pollens blowing in the wind.  They work best when used every day for the duration of allergy season which is really dependent on where you live. Allergy sufferers in the northeast will typically have symptoms later in the spring/summer than those in the “sunbelt”.

So you can now pick up Flonase and Nasacort over the counter and use them daily, even in children.  Make sure you try to aim the spray toward the outer side of the nostril and not toward the nasal septum (middle). This will allow the steroid spray more coverage as well as to try and help nosebleeds which may be a side effect of a nasal steroid spray. 

Lastly, with all of the kids playing outside in the “yellow mist” of pollen, make sure to bath/shower them and wash their hair when they come in.  This will help to reduce some of the itching and rubbing of their eyes and nose as well!

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

The Science Behind Febrile Seizures

1:30 to read

As we head into “sick season" and I have been seeing many children with fevers, I thought it would be a good time to talk about febrile seizures.With the "sick season" upon us, I have been seeing many children with fevers so I thought it would be a good time to talk about febrile seizures.

A febrile seizure is defined as a seizure associated with fever in the absence of other known causes of seizures. About 5 percent of children between the ages of six months and six years will have a febrile seizure. That doesn’t sound like a lot of children but seeing that I have a son that had febrile seizures it is that statistic that really doesn’t mean much when you have a child that is part of that statistical equation. Did that make sense? Reassuring a parent that a febrile seizure is benign and will not cause any long-term problems is a “hard sell” while they are watching their child seize. I even felt scared and helpless and I knew what was happening! When my son had his first febrile seizure at about 18 months of age, I will never forget a nurse saying to me, “Didn’t you give him Tylenol or something, as he has a high fever?” She did not realize that I was a pediatrician, and I tell this story to other parents whose children have febrile seizures, as parents always feel guilty. (What is that with parental guilt?). I hope she did not have realized how guilty that might make a parent feel, for as I already thankfully knew, giving anti-pyretics (like Tylenol or ibuprofen) does not necessarily prevent a child from having a febrile seizure.

We know that febrile seizures may occur in some children with a fever of only 101 degrees, while another child may be running a much higher temperature and not have a seizure. About 30 percent of children that have a first febrile seizure will go on to have another. That is the concern of many parents who have children who experienced a febrile seizure. Parents will try to do anything they can to “ward off” another seizure when their child gets yet another fever. I was reminded of this again while I was reading an article from The Archives of Pediatric and Adolescent Medicine. The study, done in Japan, looked at giving children with a history of febrile seizures, extra doses of fever reducing medications. Despite this, fever-reducing medications did not appear to reduce the incidence of recurrences, even when children received an extra dose of medication. It seems that children who have febrile seizures may respond differently to fever reducing medications during a febrile event. There seems to be an innate difference in mechanism of fever in those children who have seizures and those that do not. We have known that there is often a history of other family members having febrile seizures, so this may be further evidence or metabolic differences in some individuals with fever? So, despite a parent’s best effort to lower a fever, especially in a child who has already had a febrile seizure, a seizure may still occur.

Take home message: Febrile seizures are scary, but benign and children outgrow these seizures. Never feel guilty, even if you are asked if you gave Tylenol, or something to lower the fever. Looking at this study it probably wouldn’t have changed a thing.

That’s your daily dose, we’ll chat again tomorrow. Send your question to Dr. Sue!

Daily Dose

Sex On The Internet

1:30 to read

I have always felt comfortable discussing the human body and sexuality with my patients. In fact, when talking to parents about language development and how a child learns language, I often discuss playing the game “where is your eye, where is your nose?”. Over time a child learns not only to point to the body part, but will soon say the word. Quickly thereafter children ask about their other body parts and I encourage parents to call them by their correct name…penis, testicle, vagina, etc. This is easy for some parents, but some find it awkward and anxiety provoking…and need a bit of prodding as they feel uncomfortable even saying the words out loud.

So, when it comes to a child getting older and discussing puberty and developmental changes I again have some parents who say….” REALLY, do I have to discuss this” or  “can’t they just learn this at school” or “isn’t there a book they can read”?  Some others will say, “ I think my child is too young”…but their child may be 10 or 11. By this age some children I see are already starting to have  body changes, and may have wondered “what is happening to me?”.  But what I find equally interesting is that I also routinely ask their child “do you have a cell phone, computer or iPad?” and therefore many have internet access.  Now, why are the two being discussed together….? Because it seems that many kids are learning about sex and sexuality from the internet and social media, rather than from their parents.  So, not only are parents unaware that their child already “knows” more than they think, they also do not realize that their child’s idea of sex may be totally skewed and even inappropriate, depending on what website they have “stumbled upon” for information.

It seems that more and more young kids may be getting an education in pornography rather than sex and human sexuality. In many cases these young kids are “innocent” when they type the word “SEX” into the Google search….but what pops up is not.  This in fact happened to a young partner of mine who called me, her son’s pediatrician, in “horror” to tell me what she had found on her sons I-pad. “PURE PORN” I believe were the words she used.  While she and her husband had talked to him about body changes and sex before (I remember I gave her my previously well used book “Where Did I Come From”. But, being a normally curious boy ( or girl) he had gone to his iPad (which he uses with guidelines and supervision) and typed in SEX . WHOA…you should see the places he went!   When he was “discovered”,  he admitted that he was scared when he saw the pictures, as well as confused.  After a lengthy discussion about “healthy” sex and some more appropriate pictures, his iPad was put in “time-out” for awhile.

But, is this how today’s youth are going to learn and think about sex and sexual relationships….from internet porn that they have seen either intentionally or accidentally? I  expect that there are going to be more and more problems with our teens and young adults having what I would term “inappropriate sexual relationships”  if their knowledge and expectations are learned from these sites.  I don’t know how you possibly block all of this sexual information, some of which is quite inappropriate, oppressive and seemingly not consensual, from our kids.  At the minimum you need to make sure that you are having conversations about sex as your child gets older… use the appropriate terms for body parts as well as positions and types of sex … because they might be aware of a lot more than you think, and are too confused and embarrassed to ask. 

 

Daily Dose

Umbilical Cord Hernia

1:15 to read

It is not uncommon for me to see a newborn baby in the first few weeks of life with an umbilical hernia.  Once the umbilical cord detaches and is healed, some babies have an “outy” belly button.  While this causes a bit of parental concern, the bulge is typically due to the fact that the abdominal muscles around the belly button have not fully closed.  

In some cases the hernia may be tiny and barely noticeable, but in other cases the “bulge” may be as big as a quarter or half dollar.  The bulge is often bluish in color and “squishy” as the hernia allows a small bit of the intestine to push through he defect.

While the hernia is disconcerting for parents...who often wonder if their baby’s belly button will always be an “outy” or if they will need surgery...in most cases the muscles usually come together and the hernia will close on its own over months...sometimes several years.

When I was first in practice it was not uncommon for me to see a baby come in who had their tummy “bound” with an Ace bandage and maybe a quarter or half dollar “pushing” the belly button back in. But over the years I guess the word is out that this really does not help and like many things in parenting if you just leave it alone...it will get better.

Lastly, you may notice that the hernia gets bigger when your baby cries or pushes to poop. Don’t worry that is totally normal...it is just the increased pressure on their abs...and when the baby relaxes the hernia is not as apparent and should easily be pushed back into the tiny defect.  

If you have any concerns make sure to talk to your doctor.

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

How to treat allergies this season.

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.