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

A Baby Girl!

1.15 to read

Did you hear my big news?? I am officially a grandmother of a new “premature” but healthy baby girl!!! Yes a GIRL!!  After raising three sons I really thought I had mistaken the text announcing a baby girl.   As you probably know, all important information is now received via a text.....so as all four first time grandparents sat in the labor and delivery waiting room one of us got the text that read.....healthy but tiny baby girl...all good!! 

Now, if you have ever sat with a group of friends where everyone is awaiting the same information via text you know that despite the sender pushing send at the same time...the text may arrive on one person’s phone before another, even when sitting right next to each other. That was the case in the waiting room.....we all had phones, but one grandparent got the text first and read it and we all went, REALLY, for real a girl?? 

Despite the fact that our sweet grand daughter wanted to arrive 5 weeks early, she weighed in at 4’12” and only had to spend 8 days in the hospital.  She must have known how excited we all were and we wanted to be able to hold her sooner than later.  

After 2 nights in the neonatal ICU, where she had wonderful care and reassuring doctors and nurses, she was moved to the Special Care Nursery where we were allowed to hold her and feed her and gaze upon her in wonder.   Just think four doting grandparents who all wanted to hold her....we should have had quadruplets.  

After a few days of “feeding and growing”  she was discharged and I am happy to report she is now a whopping 5 lbs of pure joy. She is home with her parents and thriving.    

What a gift to watch your own children begin their parenting journey. I am doing the best I can to “keep quiet” and just enjoy being a grandmother...sometimes not easy but trying. Parenting never ends....especially when you are a mom. I can’t wait to take a grand daughter shopping, put bows in her hair and have tea parties, and all of the things my boys just didn’t want to do. We are tickled PINK!!!

Daily Dose

Calming Parent's Fears About Night Terrors

1;30 to read

I received an e-mail from a viewer today about night terrors. Her concern was “my son is having what I think are nightmares, but he talks and makes no sense and seems to be afraid and I am not sure what is going on.”

Her description is perfect for night terrors, which typically occur in children during the pre-school and early elementary years. The peak age is between five and seven years, and night terrors usually resolve before adolescence. About three percent of children experience night terrors.

Night terrors are part of sleep disturbances known as parasomnias, and are characterized by partial arousal during non-REM sleep. Night terrors therefore typically occur during a child’s early hours of sleep, when non-REM sleep is deepest. Most children with night terrors will stay in their bed, but cry out and appear anxious and upset, but are also very confused. Some children may run down the hallway with heart racing and breathing fast as if they are being chased. Until you see a child having a night terror it is difficult to explain how anxiety provoking it is for a parent who doesn’t realize what is going on.

I speak from experience as our third child had classic night terrors, but the first time he appeared in a “semi” awake state screaming and sweating, I would have sworn he was in horrible pain. Not the case, as after about two to five minutes most children will calm down (on their own as you cannot awaken them or comfort them during the event) and return to sleep and have no recollection of the episode the following morning. It is a very helpless feeling until you realize that your child is really not awake at all.

The other big difference between night terrors and nightmares is that the child has no sense of dread or of being scared to sleep. They have no fear or anxiety about these events occurring, and while the sleep terror ends abruptly with rapid return to deep sleep there is complete amnesia to the event. The best treatment is in reassuring parents. It is also important to make sure that your child has a regular bedtime routine and that they are getting sufficient sleep. This sleep disturbance is really more disturbing to the family than the child and will resolve over time. Just remember to let babysitters know, as it may be quite unsettling for a new sitter who has just put precious children to bed!

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

Daily Dose

Have Your Child's Blood Pressure Checked

1:00 to read

When you take your child in to the pediatrician for a check-up do they check their blood pressure? The American Academy of Pediatrics (AAP) recommends that children, beginning at the age of three years, should routinely have their blood pressure checked.  

In certain circumstances a younger child should have their blood pressure checked too. With the growing epidemic in obesity, pediatricians are seeing more children with abnormal blood pressure readings. It is important that the right sized blood pressure cuff is used for measuring a child’s blood pressure. There are standards for blood pressures for different age children. The standards are also based on a child’s height.

When a child’s blood pressure reading is greater than the 90th percentile for their age they are said to have pre-hypertension. The prevalence of childhood hypertension is thought to be between one and four percent and may even be as high as 10 percent in obese children. Obesity plays a role but, related to that is also inactivity among children, diet, and their genetic predisposition for developing high blood pressure. Then it is appropriate for further work up to be done to evaluate the reason for the elevation in blood pressure.

If I find a child with a high blood pressure reading during their physical exam, it is important to re-take their blood pressure in both arms. I also do not depend on automated blood pressure readings, as I find they are often inaccurate and I prefer to use the “old fashioned” cuff and stethoscope to listen for the blood pressure. If the blood pressure reading is abnormal, then I have the child/adolescent have their blood pressure taken over a week or two at different times of the day. They can have the school nurse take it and parents can also buy an inexpensive blood pressure machine to take it at home. I then look at the readings to confirm that they are consistently high. The “white coat” syndrome, when a doctor assumes that the elevated blood pressure is due to anxiety, may not actually be the case, so make sure that repeat blood pressures are taken. If your child does have elevated blood pressure readings it is important that further evaluation is undertaken, either by your pediatrician or by referral to a pediatric cardiologist.

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

Daily Dose

Foods You Can Eat When Breast Feeding

1.30 to read

Should breast feeding moms avoid certain foods?I was making hospital rounds today and talking to all of the new moms (and dads) about their newborns.  I love talking to new parents about the importance of having healthy meals to support breast feeding! I even had a young dad asking “what foods should I avoid cooking for my wife while breast feeding?”  How cute is that! Can we clone him?!

After breast feeding my 3 children, I have decided that you can really eat whatever you want!  I know some people swear that certain foods you eat will cause a breast fed baby to have gas. But think about it, bottle fed babies and breast fed infants all have GAS!  None of the formulas contain broccoli, or cauliflower or beans or tomatoes and bottle fed babies have gas too. It is just a fact, newborn babies are gassy for the first several months as their digestive tracts mature. And yes, it is stinky too! So… I told this dad, “good for you for cooking for your wife.  Make her healthy, well balanced meals and throw in a few of her favorite foods.”  I would not change anything unless you can definitely correlate that a food ALWAYS makes your baby more uncomfortable (and that is so hard to keep track of). Eat what you want (in moderation) to be healthy and happy.  I have no data but feel certain that happier mothers must in some way have an effect on a  baby, so at least enjoy mealtime. When I had a colicky baby (previous post), I tried eating only broth and bland foods, and with me equally miserable and starving…this stressful situation only got worse. Final words, if I was going to try eliminating anything from my diet while breastfeeding to try and help “relieve “a gassy baby, it would be excessive dairy, as there has been some data on this. Remember, everything in moderation. I’m willing to bet that by the time your baby is 4 months old (the magic age) you are not even worried about what you are eating, as you are having too much fun laughing with your baby! What foods (if any) bothered your baby while breast feeding? I would love your comments.  Leave them below. That’s your daily dose for today. We’ll chat again tomorrow.

baby, breast feeding, Daily Dose, mom
Daily Dose

Fruits & Veggies in a Pouch

1.15 to read

OK, I am back to the subject of “squeeze pouch foods” or as another cute 2 1/2 year old called it “squeegy fruit”.  I have written about this before as I was fascinated by these when they first hit the market. On the one hand, I get that they are convenient and are easy to use for those first months of pureed baby foods, but beyond that, I think they are given to older children.  

It seems that more and more kids are enjoying “squeegy fruit” and also “slurping” pureed vegetables. The issue is these pouches foods are being “masqueraded” as healthy foods.  Yes, they are fruits and vegetables often mixed together, but if you read the labels it gets a bit more complicated.

I see so many toddlers in my office who are happily “sucking down” a packet of apples and blueberries.  These parents are adamant that their kids don’t drink juice boxes or eat “junk food” but at the same time they are letting their children “suck down” several of these pouches a day.  This is also often in place of meals, as many of these children are described as “picky eaters”.  I saw a little boy today who had been vomiting, but was on the exam table with pouch to mouth as he “drank/ate” a combo of apples, peas and something else.  (note: not recommended when vomiting).

So....I decided to look up the nutritional value of these pouches....many of them although “all organic” or described as “healthy” do contain a lot of carbohydrate and sugars.  Actually, as much as two fruit roll ups!  Yes, I did a little comparison and 2 of the “dreaded” fruit rolls ups contain 23 grams of carbs and almost 11 grams of sugar.....while a 3.2 ounce pouch has somewhere between 19-24 grams of carbs and between 14-23 grams of sugar.  

The point of this is not to say that “squeeze pouches” are bad, or that a child should never have a fruit roll up.  Rather, it is to point out that even “healthy” snacks can be full of sugar.  Rather than a fruit roll up or a  squeeze pouch, what about a piece of fruit?  Sure, it may be a bit messier to cut up a piece of fruit, but those pouches are not teaching children about textures and chewing.

Pouches are great for travel, special occasions and babies. But, they are not for toddlers and certainly not for everyday consumption.  Oh lastly, they are bad for the teeth as well!  

Daily Dose

Celebrating My Son's Birthday & Motherhood!

Dr. Sue reflects on 27 years of motherhood.27 years ago today I became a mother.  At the same time, I was just finishing my pediatric residency, so I thought I was “prepared” to be a mother.

The first thing I figured out, within just a few short hours was that while being a pediatrician helped me (most of the time) recognize serious illness in my own children, it did not “prepare” me for motherhood . Being a parent is on the job training!

Looking back with joyous nostalgia about the birth of our first son, I remember how excited we were to be new parents.  The pictures of that precious 6 lb. 6 oz. baby boy, who is now 6”2” tall, show blissfully happy young parents cuddling their newborn.  But, by the time we had been home for 48 hours I had already been reduced to tears as I tried to figure out breastfeeding (that is on the job training for sure), and my precious baby boy had bruises on his ears as I tried to “push his head to my breast”, as I had been instructed. I can now laugh about how inept I was, but gradually we figured out breastfeeding, only to move on to the next hurdle. Luckily you don’t have a crystal ball to realize that there are many other hurdles and hoops to jump through during the parenting years. You just figure them out as you get there, and vow to never give up. Well, happily our precious son managed to teach us novice parents so many things along the way. We often tell him that the first child is somewhat of an “experiment” as you learn from your mistakes.  Some things you swear you will never do again, and others work well and are repeated with each subsequent child. You can’t pick your parents or your birth order, so each child has somewhat of their own experience depending on where they fall within the family. But each child is loved equally and unconditionally. One day I remember trying to instruct our second son (probably about 3 at the time) on some topic (can’t really remember what), but the older son (age 5) leaned over to tell his brother what to do.  When I pointed out to the eldest son that I was the mother and could handle it, his very quick response was, “if you were doing a better job, I wouldn’t have to help you”. I guess he had already figured out we were new at this game and he had some input that might help us out!   How did I manage to keep a straight face, as I can still laugh at that story today! As I am writing this, I continue to remember some of the best advice I ever received and continue to give today.  Parenting never ends, but while the days and nights seem endless, the years go flying by.  I know this to be true as I enter year 28 of being a mother and I am still learning! I would love to hear your first time mom stories! Don’t be shy, send me your advice!

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Daily Dose

First Cold

1:30 to read

My office is hopping with a lot of little ones and their first colds. The worst cold that a parent experiences is not their own cold, but their child’s first  one.  Unfortunately, babies that are born in the fall and winter months often get their first cold earlier than a baby born during the spring and summer. 

It is such a helpless feeling for a new parent to see their baby with a runny nose, red rimmed eyes and a cough.  While newborns routinely experience nasal congestion, a cold is different. With a cold the baby’s nose will run and have clear to colored mucous,  and they will typically cough, just like all of us with a cold. They just look so pathetic...but you need to know what to watch for....as there will be more colds throughout the winter.

A baby (over the age of 2 months) may run a bit of a fever with their cold. A fever is defined as a temperature over 100.4 degrees. I am old school and still do rectal temperatures....just don’t think the temporal and ear thermometers are accurate.  The fever, if they even have one, should not last more than a day or two and should respond to the appropriate dose of acetaminophen for your child’s weight.

The biggest concern for a baby with a cold is how they are breathing. While they may look pitiful with that gunky nose, and have a loose junky cough, how your child is breathing is most important. You need to actually look at your child’s chest while they are breathing and coughing to make sure that they are not having any respiratory distress. Undo their onesie or take off the nightgown and look at their chest.  You do not want to see your child’s chest moving in and out (which is called retracting) or see that they are using their tummy (which is going up and down) to help them breathe.  The cough may sound horrible, but always look at their chest (visual more important than audible). They should also be nice and pink...even when they are coughing.  A cool mist humidifier in their room at night will also help.

Best thing for gunky nose is a nasal aspirator or nose Freda with some saline drops. Clearing the nostrils is often one of the best ways to help your child breathe, which will also help them to take the bottle or breast. A baby may not eat as well when they are sick (same as you and me) but they will take enough to stay hydrated and have wet diapers.  Being sick at any age typically effects your appetite and as your child is feeling better their appetite will improve as well.

Getting past that first cold is a milestone for baby and parents....but if you have any concerns about your child’s breathing, hydration or persistent fever, always call your doctor.

Daily Dose

Curfews When Home For The Holidays

1:30 to read

I have learned that one of the hardest adjustments for both parent and child is that first winter vacation home from college. I woke up this week and realized that it's my youngest son's birthday. At this very hectic time of year I often ask myself, "why did I have a baby during the holidays?" I think the answer would be "we just wanted another baby", not thinking that I would have an almost Christmas baby. But, the point of this is not about trying to have birthday parties for your child when you have a million other things to do. Or about always thinking we would celebrate half birthdays in the summer, which never happened.  Or trying to shop for both birthday and Christmas gifts, and swearing never to "cheat" him, but still taking things from closet to tree each year trying to figure out which gift should be for which occasion. The real discussion is about curfews.

It is such an exciting time for parents. Welcoming your child back home after that first long semester away! I am always longing for family dinners, games by the fire and "adult" conversation about their favorite professor or class. Discussions about new friends, roommates, second semester and what they think they will major in. Instead, most of the conversations are about plans they have to visit friends or hang out or do something away from the house and parents. This is always followed by the parental, "what time will you be home?" (to play the fireside family game). The reply seems to be universal, "I am in college now, I don't have a curfew in college."

Several years ago a parent of a patient and I were discussing this issue and they agreed with the theory that curfews were no longer appropriate. One of the great things about my job is that parenting advice goes both ways, and over the years I have learned so much from both patients and their parents. But this time the experiment, which lasted for one night, only reinforced my belief that college kids should have curfews while home. This is especially important if you have younger kids at home who are in school, parents with jobs or anything that requires getting up in the morning and getting a good night's sleep. The "young adult" college student usually has a different clock, and my idea of reasonable time and theirs is not always in sync. I could be getting up when they think it is time to come home. I still subscribe to the "nothing good happens after midnight" theory.

So.... If you have a college freshman arriving home this week after finals, have the discussion about curfews. They always argue, "you don't know when I come home when I am at school." That does ring true, but when they are "home", parents just get a better night's sleep once their "baby" is also tucked into bed.

That's your daily dose, we'll chat again soon.

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DR SUE'S DAILY DOSE

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