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Daily Dose

Tummy Aches

1:30 to read

I am getting a lot of phone calls and texts with concerns about  tummy aches. I have even started seeing patients in the office with complaints of “my tummy hurts”, and we are just in the first week of school. I know that school nurses are dealing with this common complaint as well.   Amazingly, I don’t see very many complaints of tummy aches during the “lazy days of summer”…but once school starts they seem to become more prevalent.

Don’t get me wrong…while the tummy aches are real and painful, they are usually not due to anything serious.  In many cases I see,  the abdominal discomfort may be due to a bit of anxiety and stress that often comes as children get back into the classroom.  While the child may not be aware of “stress”,  their body does sense it and the gut responds with abdominal pain. 

The children that I am already seeing are all healthy and growing well. They do not appear to be “ill” when I see them, but will complain that their tummy hurts. When I have them point to where the pain is, they typically point right around their belly button (periumbilical).  If asked to point to the one place where it “hurts the most”  they typically still cannot localize it…it’s just all over! Having generalized pain is typically a good sign, rather than having point tenderness in one area.  Upon further questioning they do not have a fever, have not had vomiting or diarrhea, DO NOT wake up in the middle of the night with abdominal pain and often cannot remember if they “pooped“ today or yesterday but usually swear that their “poop” is “normal” . (I am not always sure about that - stool history in kids is quite hit and miss!) 

A few of the children say that eating makes their tummy ache worse while others report it feels better if they eat. They typically are not having issues with a specific food.  (It also depends what they are given to eat - often they will eat their favorite food if given the opportunity).  

For some of the children the pain is “bad enough” that they come home from school, but once home their parents report that after an hour or so they seem better.  Other children stay in school, but the minute a parent picks them up they start saying “my tummy hurt all day at school”!  

I remember that one of my sons often had tummy aches during the school year and we were talking about it the other night (he is now an adult).  He says he remembers being worried about school and “hiding” in the morning when it was time to go to school (I would be looking all over for him as his older brother was already out the door, and anxious that he would not get to school on time,  while I had the younger brother on my hip as I searched the house).   Talk about getting a stomach ache…mine was in knots by the time I would get to work.  It would only be several hours later when I would get the phone call from the school nurse that he was there with a tummy ache.  He now says that he remembers that by the time he was 8 years old it all just changed and it went away. 

Many times all it takes is a little reassurance that the tummy ache is not serious. I tell the children that everything on their exam is normal which is a good thing. Sometimes it seems to help a tummy ache if I prescribe the child some extra fiber and maybe a Tums  a good source of calcium too). Who knows if it is placebo effect… but just by doing something they feel a bit of relief. The one thing I do know…they need to keep going to school and it usually gets better once they are settled back into a school routine.  


Daily Dose

Sans the Screen

1:30 to read

A bit of fall weather has finally arrived and with it “we” Texans can finally go back outside and enjoy some fresh air rather than the artificial (necessary luxury) air conditioning that we have lived in for the last several months. Texas has brutal summers!

So….with the cooler weather and the opening of Shake Shack in Dallas I thought it was the perfect time for a field trip (and a hamburger). My husband and I headed out for lunch only to find a long line but decided that we had time to “kill” so we decided to just hang out and wait our turn. While standing in line and then waiting for our double cheeseburgers (sometimes you just go for it! , I started looking around and noticed once again that most people were all looking down at some sort of phone screen.

There were people of all ages waiting in line and and on the lawn area but I would have to guess that greater than 80% were not engaged with anyone other than their own screen. This included children who had an iPad to pass the time, or teens and their friends, to millennials and then the “older” folks as well.  I suddenly realized that everyone is so busy scrolling through their phones and seeing what the rest of the world (or their hundreds of Facebook friends) are doing that they are not experiencing their own lives. We are living other people’s lives via a phone screen rather than being in the moment (even a boring one) of our own life.  

I was equally guilty (before I had this revelation) as I was taking a picture of the Shake Shack line to send to my children who had lived in NYC and loved the SS burgers.  I am not sure they really “cared” about the line at SS, although one replied to the text and picture with a picture of his own showing a  tray with burgers and fries…and the text, “ we have already been”. 

The whole discussion about how much time the world now spends looking at a screen or socializing via a text or email rather than a conversation continues to evolve, but experts in child development are concerned. Their concerns surround things like language development and social skills and the ability to carry on a conversation whether at home, or school or eventually at work,  as well as how to understand body language. The number of children that I now see with issues surrounding social skills and how to interact on a playground or in a class room seems to be growing and I wonder if any of this relates to electronics….call me crazy, but I really think there is a correlation.

So…at that moment as I watched those around me, I vowed to put down my own screen, record less of where I was or what I was doing (which is not necessary ) and to live in my moment…and not worry about what everyone else is doing.  My husband and I spent the next hour enjoying the weather, the hamburgers and each other’s company…sans the phone!  

Of note, I did watch one young mother corral her two precious toddlers and play hide and go seek while waiting….kuddos to her, they looked like they were having a ball.

Daily Dose

Kids & Cellphones

1:30 to read

There is a new study out from the National Toxicology Program in which rats were exposed to radio frequency radiation for nine hours a day for two years beginning in utero.  They compared these rats to those that were not exposed and interestingly some of the male rats developed tumors in their hearts and brains and the controls did not.

I am writing about this as another deterrent to giving children a cell phone at a young age and for not having a home phone. While it is too early to say if this study has any bearing on humans and obviously the exposure was heavier than normal, this may serve as another deterrent to giving children a cell phone at a young age. It may also help to bring “land lines” back into the home. 

Call me old school, but I continue to believe and counsel patients, having a home phone is still important.  Without a home phone how can you call your child when you are away and they may be home with a babysitter….and not depend on the caregivers cell phone?  I also think that some children may be ready to stay at home for 30 min to an hour at a time while their parents go to the store, or pick up a sibling from school etc. before they are ready for a cell phone. By having a home phone the child has a means of contacting their parents, neighbors or emergency personnel and don’t risk losing a cell phone or any of the other numerous issues associated with owning a cell phone.

A home phone also gives children an opportunity to learn how to answer a phone and begin “screening” phone calls for the family and to learn phone etiquette….which is not always taught when parents are answering the cell and handing it off to their child.  What about the days when we were taught to say “Hello, Hubbard residence” when answering the phone?  Or having your mother sit by your side while you called a friend’s house and started off the conversation with, “may I please speak to…Sally?”. Phone etiquette was such an important part of every child’s life.

Once your child does have a cell phone it also seems that they may spend more time isolated from the family when on the phone….and may spend longer amounts of time on the phone than when the phone was in the family kitchen. Even my grown children often go outside to take their cell phone call….wonder what they are talking about, me?  I digress….

The American Academy of Pediatrics continues to recommend that parents should limit the use of cell phones by children and teens. A cell phone is not a toy and emits radiation.  Keeping this source of radiation away from our children for as long as possible seems prudent while more research continues…and this study just gives parents a bit more ammunition when their 6 year old starts off with, “everyone else has a cell phone…when can I have one?”.  


Daily Dose

Marketing Healthy Foods to Kids

1:15 to read

The marketing of foods to children continues to be a hot topic.  As any parent knows…by the time your child is 3, 4 or 5 years old…they can often point to the box of sugary cereal with their favorite cartoon character on it, or identify a sign (McDonalds, Chic-Fil-A, Pizza) although they are not yet reading.  Companies are very clever when it comes to marketing…especially to children who drive a lot of consumer choices.

But, a recent article in Pediatrics shows how marketing may also drive healthy food choices. The study entitled, “Marketing Vegetable in Elementary School Cafeterias to Increase Uptake”, looked at the number of students who chose fresh vegetables from the salad bar at 10 elementary school cafeterias in a large school district over a six-week period.

The study included four different groups. In the first group the schools displayed vinyl banners with branded cartoon vegetable characters. These banners were then wrapped around the salad bar bases. The characters displayed “super human” strength related to eating vegetables (the Popeye of my generation - with his spinach).  The second group of schools showed short television segments which had vegetable characters delivering healthy nutritional advice. In the third group of schools both the salad bar banners and TV segments were used to promote healthy nutrition and food choices.  The fourth group was the control group and received no intervention.  The intervention schools also had decals with the vegetable characters placed on the floor which directed the children to the salad bars.

The results?  Nearly twice as many students ate vegetables from the salad bar when they were exposed to the banners.  More than 3 times as many students who were exposed to both banners and TV segments went to the salad bar (more girls than boys ). Interestingly, the marketing campaign also increased the number of students who chose a vegetable serving in the regular lunch line as well. 

So, it seems that branded marketing strategies may be used in a positive way to promote healthier food choices among young children.  Now we just have to get the advertisers to change some of their branded messaging aimed at young children from the “junk” to the healthy foods, as we have data to show that kids will choose good foods…especially if their super heroes like it too!

Daily Dose

Breath-holding & Fainting

2.00 to read

Have you ever fainted?  I bet you may have not realized how common fainting is in the pediatric age group?  I know this from my own children (yes, I had 2 “fainters” and boys no less) as well as from many of my patients.

The medical term for fainting is syncope, and it really is common among children. It starts during the toddler years with breath-holding spells.  Many in this age group (up to 50%) will hold their breath when they are hurt or angry.

When a child holds their breath while crying (you can just see it happening in front of you) they will often turn a bit blue and “pass out”. This is a type of fainting. This can be very scary for parents who have never seen their precious child have such an attitude and then hold their breath over not getting the cookie? Yes, this is a normal part of being a toddler! They are very emotional and labile at this age (foreshadowing for teen years?) and most toddlers don’t have a lot of language yet, so when they get mad or frustrated they just SCREAM! But, while screaming, the child forgets to take a breath, and then the brain and autonomic nervous system takes over and the breath holding leads to fainting.

The breath holding spell, as scary as it is, is just a form of fainting. It will not hurt your child, but it may take your breath away!

My advice? Try not to pay attention to your child if they begin having breath-holding spells. It may be hard to “ignore” the first two or three, but these “spells” usually last for months (maybe years) and you do not need to rush to your child when they hold their breath. By calling attention to the event you may inadvertently reinforce the behavior. As a child gets older, the breath holding will stop (but not the tantrums?) and there will be new behaviors to conquer. Do you have a breath-holder? How do you cope? Let us know!

That's your daily dose for today. We'll chat again tomorrow.

Daily Dose

Your Kids Need Protein!

1:30 to read

Nutrition and healthy eating habits are always a topic of discussion during my patient’s check-ups.  Interestingly, I hear many tweens and teens tell me, “I am now a vegetarian”.  While I am thrilled that my patients are developing an awareness about their nutrition, I am equally amazed by what they think a vegetarian diet is.

Many a parent has cornered me before their child’s check up concerned about their child’s recent announcement that they are vegetarians and it has actually caused some heated family discussions surrounding nutrition and dietary requirements. The parents say that their child just decided that they no longer wanted to “eat meat” and that they were vegetarians. 

So…many of these new “vegetarians” don’t even like vegetables, and a few are confused by the difference between a vegetable and a fruit. When I ask them if they eat broccoli, cauliflower, green beans, asparagus, eggplant and potatoes, I find that more than a few turn their noses up at most of those suggestions and simply eat potatoes as their vegetable of preference. They also eat avocados, and are surprised to find out that it is a fruit, but it is a good source of healthy mono unsaturated fats.  A few are a bit more adventuresome and actually eat a wide variety of vegetables including lentils and black beans as a source of protein.  

The same thing goes for fruits although for the most part they do admit to having a broader palate when it comes to fruits that they will eat.  Apples, bananas, berries, grapes are all favorites and many of these kids will eat fruit all day long.  Fruit is healthy for sure, but also contains sugars (far preferable to the sugar in the M & M’s I am eating while writing). 

The biggest problem with their “vegetarian diet”?   They just eat carbs! So I have coined the term “carbohydratarian” to describe them. Most of these patients are female and they eat carbs all day long.  They have cereal, toast, bagels for breakfast, followed by grilled cheese, french fries or a quesadilla for lunch and then dinner is pizza or pasta, and maybe a salad (lettuce only).  They like crackers, bread and almost all pasta (rarely whole wheat ). Rice is another favorite.

I too could probably eat a lot of these carbs every day….I think many people enjoy their carbs. But these kids are not meeting many of their nutritional requirements. They are getting very little protein! They are also growing…some at their most rapid rate during puberty. When I talk about adding protein to their diet they are often reticent to add eggs, fish or beans to their food choices. 

If your child decides that they want to change their lifestyle and might consider becoming a vegetarian or vegan, I would encourage you to have them meet with a certified nutritionist to explore their likes and dislikes as well as to educate them as to their nutritional needs.


I must say…..very few of these patients have maintained their vegetarian lifestyle, but if they choose to, they need to know the difference between a fruit and a veggie!


Daily Dose

Omega-3 Fatty Acids

1:30 to read

Many of the patients that I see who have problems with attention and focus as well as other behavioral and learning issues have been started on all sorts of different medications. For some children their medications seem to be “working well”. But, for some children it has been difficult to find the “right” medication to alleviate all of their symptoms.  Studies have shown that anywhere from 10%- 30% of children with ADHD do not respond favorably to stimulant medications. Therefore,  it is not uncommon for their parents to inquire about the use of alternative or complementary medications. In several cases their parents have already started “dietary supplements”, which at times they are reluctant to admit to, or ask for my opinion.  

Interestingly, there is recent data regarding dietary supplements that parents and pediatricians should be paying attention to…and open to discussing.  A study that was presented last fall at the American Academy of Child and Adolescent Psychiatry showed that omega-3’s “could augment the response in children aged 7-14 years who were receiving psychotherapy for depression and bipolar disorders”. There have been  studies as well that have shown “significant improvements with Omega-3’s relative to placebo for problems including aggression as well as depression and anxiety symptoms”.  There are also numerous studies looking at ADHD symptom improvement in those using Omega-3’s, and again the results have been mixed, made even more difficult by the fact that ADHD is a subjective diagnosis.  

Another issue that requires more study is how these fatty acids actually work within the body and brain. Omega-3’s are an important building block of the brain and it is present in the brain's cell membranes, where it is thought to facilitate the transmission of neural signals.  Current thought is that these fatty acids may change the cell membrane fluidity and may also have anti-inflammatory effects….but a lot of research continues on the issue of mechanism of action. 

Several of the studies looked at dosage of the Omega 3 fatty acid supplements and “it seemed that there were more positive trials related to higher daily doses of  certain omega 3 fatty acids including eicosapentaenoic acid (EPA) and docosahexanoic acid (DHA).  There need to be further studies to address the amount and ratio of these Omega-3’s as they are used for supplements. 

So while the research continues as to the effectiveness of Omega 3’s on focus, mood, behavior and learning it is important for all children to consume enough Omega-3 fatty acids in their diet. Eating fatty fish a few times a week would be beneficial for the health of all children - and the decision to supplement beyond that may be a topic for discussion with your own physician. 


Your Teen

Teens Are Taking Risks "Just For Fun"

News study says teens are engaging in risky behavior just for the thrill of it.Every parent of a teen knows, the teen years can be a rollercoaster ride. Parents find themselves telling their teens to slow down while driving, don’t engage in risky behaviors, and stay away from alcohol and drugs.  But why do teens engage in this behavior? A new study says:  it’s for the thrill of it.

A study published in the journal Cognitive Development found that teens, especially 14 year olds were the most likely to take risks because it is an escape. "The reason that teenagers take risks is not a problem with foreseeing the consequences. It was more because they chose to take those risks," Stephanie Burnett, of the University College London's Institute of Cognitive Neuroscience, explained in a university news release. This is the first evidence from lab-based study that adolescents are risk takers. Advice to parents?  Begin the dialogue early, when your child is in elementary school.  Clearly discuss your expectations and lay out the consequences of engaging in any risky behaviors.  The sooner you begin having these age-based conversations the better.

Daily Dose

When Children Pull Their Own Hair

WHat can yo do if your child pulls their hair out?I received an email via our iPhone App from a mother who was concerned that her 12 year old son had started pulling out his eyelashes.  This is called trichotillomania.

Trichotillomania is an impulse control disorder which is characterized by "the excessive pulling of one’s own hair which results in hair loss.” It may be eyelashes, like this adolescent boy, or it may be hair on any other part of the body. It most commonly involves scalp hair, but eyelash and eyebrow pulling is the second most common site.  The hair pulling may result in small amounts of hair loss, which may not even be noticeable, to such excessive pulling resulting in total loss of eyelashes, brows or even baldness. Hair pulling in childhood may begin during toddler and pre-school years, where it seems to be more of a “habit” than a compulsion. In this case the hair pulling is typically short lived and resolves on its own. Hair pulling that occurs in children of older ages (peaks are seen between the ages of 5 -8 and during the teen years) is a type of obsessive compulsive disorder where the person cannot resist the behavior and of may even experience gratification when pulling out their own hair. At this point the compulsion leads to the inability to resist pulling one’s own hair, which may in turn cause more anxiety and stress, which then leads to more hair pulling and a vicious cycle occurs. At this point ,the behavior may have gone on for months and then is labeled trichotillomania. In my own experience with children who have trichotillomania, the child often tries to hide the behavior, and may even deny the hair pulling despite the fact that they have an area of baldness or even no eyebrows. They will often act is if they cannot figure out how the hair loss occurred. Parents too may not see the child  actually pulling their own hair and also are confused as to the etiology of the hair loss.  Children may experience a great deal of distress secondary to their hair pulling,  not only from the actual loss of hair, but they may also avoid school or social situations due to embarrassment. Self inflicted hair pulling is a psychiatric disorder that is often difficult to treat and requires professional help. When seeking professional help look for a psychologist or psychiatrist who has experience in this area. That's your daily dose for today.  We'll chat again tomorrow! Send your question to Dr. Sue!


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Struggling with feeding your kids healthy (er) meals. Rule of thumb: don't stress over it!


Struggling with feeding your kids healthy (er) meals. Rule of thumb: don't stress over it!

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