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Daily Dose

Teach Your Kids Good Manners

1.15 to read

Spring is always a busy time of year with end of school parties, proms, graduations, and lots of invitations.  These invitations are often sent not only to parents but many times they are sent to the kids as well. Some invitations have a reply card or say “please reply” or RSVP.   

Do your kids know what RSVP means?  Although it is French, surely everyone still knows it means “reply if you please”. Has RSVP been replaced by LOL and OMG? It is a common courtesy to respond to an invitation and one that all children need to learn (maybe some adults as well). 

Over the years I have had to explain this courtesy to my own children. Sometimes they just did not understand why I bugged them to reply in a timely matter.  After looking at the bulletin board where I would put check marks and dates by our response, I would often ask them if they had replied as well? This question was often answered with, “Not yet, trying to decide, or “ They know that I am coming ” or lastly “ I’ll do it later”.  Such answers did not seem to be exactly what I had hoped to hear. Of course, I couldn’t relent until we had closure on this issue and I knew that they had responded.  I was the bothersome mother after all!

For many years they seemed clueless as to head counts and party prep. I would re-iterate that by getting an idea of how many people are going to attend any event the hosts can make sure that there are enough seats for everyone coming, or enough food to eat and drinks for all. Otherwise, you either spend way too much over buying or end of scrounging as you didn’t plan on that many people. “Whatever”, right? 

Well, now that they are older, they were just complaining to me that they had not heard from guests for a party that they were planning. “How do I know how much food to order?”, “How do you rent tables and chairs if you don’t have a head count?”  “Why do people wait till the last minute to reply?”  “Didn’t their parents bug them about replying?”  And finally, music to my ears, “Mom you should write a blog about learning to reply to invitations”! 

So...here it is. Teach your kids (beginning at early ages) how to reply to a party. Have them pick up the phone to reply to the 5 year old birthday party, or learn to write an email response when they are accepting an invitation to attend an event. Teach them to reply in a timely manner, and if something does change, let the hosts know.  Lastly, I still don’t see any reply messages that say “text me if you are coming”, but I am sure that is just around the corner.  

Good manners are ageless and timeless.

Daily Dose

Are Kids Too Connected?

1:30 to read

We are living in a digital world which is ever changing. In light of this, the American Academy of Pediatrics (AAP) has been reviewing their recommendations regarding screen time. While there has been much written on the subject, the newest data from many families regarding their digital experience shows just how “connected” we really are.

The AAP has not yet published a new policy statement on this matter (due in 2016), but their Growing Up Digital working group has just released new guidelines in the hopes of giving parents some practical guidance. While the AAP has previously recommended limiting screen time to “2 hours/day”, the one size fits all does not seem to work (which is true of many things).  We are all living in an “online” world, and it appears it is only getting more “connected” via screens, so how do you really deal with this? 

I personally still think it is very important to try and limit screen time for children under the age of two. This is the basis of parenting….be aware of the importance of modeling behavior even beginning at the earliest ages. Which means you too have to limit your screen time when you are with your baby and toddler,and spend more time talking or reading to your child (which is still shown to be important in early brain development) without your phone/computer distracting you. This does not mean that your toddler never has the chance to watch Daniel Tiger or Sesame Street, but be aware of how much they are watching.  As a parent, I know too well myself that sometimes an 18 month old is safest in front of a screen watching a “healthy” program, while you shower or cook a meal and parents shouldn't feel “guilty” about this. Once done…turn off the screen…these are good habits to begin with.

As your child gets older it is equally important to “parent” their screen time, and to teach them the appropriate use and behaviors of their “on line” lives.  While so many kids are now on a screen during the school day,  as well as for homework and out of school assignments, remind your children that face to face interaction is very important.  While the world is totally available digitally, socialization “off-line” teaches other skills that cannot be found when engaging solely on a screen - even with Skype and FaceTime.  Like many things moderation seems to be the key. Another recommendation, have “tech-free” zones. This is especially important at meal time and bedtime.

I also think it is important to enforce no screen before school and while in the car on the way to school.  Conversation during mealtimes is so important!  (whether at home or in a restaurant). It is often one of the few times in the day that a family is all together. Carpooling to school is another great opportunity to talk and listen to the kids, rather than having a movie playing on the DVD player.  I remember driving our teenagers and their friends to school or sporting events and listening while they just talked to one another.  It was one of the best times to hear what was going on in their lives. Save that DVD player for long trips and special occasions. 

Lastly, parents need to know and be aware of what their kids are doing on line….this is true for children of all ages.  Begin with solid family rules and expectations for appropriate use of social media and the digital world…and just like many things the boundaries and limits will change as your child gets older.  But if you find your child is using technology inappropriately there need to be consequences.  We all make mistakes, but use mistakes as teachable moments.  

Digital life is here to stay, and the technology changes in a nano-second, so watch for more and more information on this topic.

 

 

 

Daily Dose

Favorite Christmas Songs

1.00 to read

I have been taking a poll among my patients as to their favorite Christmas carols. This means I have asked patients from the ages of 3-22 years to weigh in. It is such fun to hear all of the different responses.  So this is “TKD” Christmas play list presented by my patients. 

When I asked a 3 year old what Christmas song he liked he quickly said, “Twinkle Twinkle Little Star”. I agree it does sound like a Christmas song...the star, right?  

The younger set likes “Frosty the Snowman”,  “Rudolph the Red Nose Reindeer”, “Santa Claus is Coming to Town”, as well as “Silent Night” which many of them are signing for their school Christmas programs.  I can still remember watching my own children perform these songs and “Silent Night” with elementary school voices could bring me to tears!!  Such sweet and innocent voices. 

Some of the other favorites have been “I Saw Mommy Kissing Santa Claus”, “Alvin and The Chipmunks”, “Rockin’ Around the Christmas Tree”, and “Jingle Bells”. 

The older kids like “All I Want for Christmas is You”, “Let it Snow, Let it Snow” (maybe wishing for a white Christmas here in Texas), and Santa Baby”. 

And for me.....I still love “Oh Holy Night” and “Ave Maria”, they just make the season. Christmas Eve always ends with the beautiful hymn “Joy to the World”. 

I can confess that by Christmas, my family is a bit over my continuous stream of carols......but I promise I will turn them back on again next year. 

 

Daily Dose

White Patches on the Skin

1:30 to read

I saw a 10 year old patient last week for her routine physical. One of her mother’s concerns was that her daughter had “white patches” under both of her arms.  Once I examined her I told her mother that the “white patches” were actually due to Vitiligo, which is an acquired disorder of pigment loss. 

Vitiligo is caused by a reduction in functional melanocytes, the cells that cause pigmentation in the skin. Vitiligo often develops before the age of 20 and there is no difference in predilection for male over female cases.  In children the hypopigmented areas are often first noted on sun exposed areas like the face (around the eyes and mouth) and well as on the hands.  The underarm area (axilla) is often involved, as are areas around the genitalia. In many cases the depigmentation is symmetrical (both arm pits, or hands or knees). 

Although the exact cause of Vitiligo is not clear, it is known that it has an immunogenetic basis, as there is a positive family history of others with vitiligo in 30 -40 % of patients. There are numerous theories as to different reasons that the melanocytes (pigment cells) are not working. The genetics of vitiligo is also being studied with changes seen on certain chromosomes. 

So why doctors are not clear as to how and why Vitiligo occurs, in most cases it does seem to be slowly progressive. There is spontaneous repigmentation in 10-20% of patients, especially in sun exposed areas of young patients. 

The problem with Vitiligo is that treatment is often lengthy and is frequently unrewarding. There is not “one way” to treat Vitiligo that will ensure repigmentation and resolution. Dermatologists have used phototherapy for treatment, but facial areas and small patches seem to be most responsive. A recent study showed that narrow band UVB therapy was superior to UVA therapy, but studies continue. 

Potent topical corticosteroids are also used to help promote re-pigmentation.  Topical immune modulators such as Tacrolimus have also been tried. 

With all of this being said, a referral to a dermatologist that is familiar with treating Vitiligo is of upmost importance. The sooner the treatment for these “white patches” the better. 

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

Daily Dose

What Are Breast Buds?

1.15 to read

I received a phone call today from a mother who was worried about the “bump” beneath her 12 year old daughter’s nipple. I do get this phone call quite often and even see mothers and daughters in the office who are concerned about this lump?  First thought is often, “is this breast cancer?”  The answer is a resounding “NO” but rather a breast bud.  While all mothers developed their own breast buds in years past, many have either forgotten or suppressed the memory of early puberty and breast budding.

Breast buds are small lumps the size of a blueberry or marble that “erupt” directly beneath a young girl’s areola and nipple. Most girls experience breast budding somewhere around 10-12 years of age although it may happen a bit sooner or even later. It is one of the early signs of puberty and estrogen effects.

Many girls will complain that the nipple area is sore and tender and that they are lopsided!! It is not unusual for one side to “sprout” before the other. Sometimes one breast will bud and the other is months behind. All of this is normal. 

While a lump in the breast is concerning in women reassure your daughter that this is not breast cancer (happy that they are so aware) but a normal part of body changes that happen to all girls as they enter adolescence.   Breast budding does not mean that their period is around the corner either, and periods usually start at least 2 years after breast budding (often longer).

Breast buds have also been known to come and go, again not to worry. But at some point the budding will actually progress to breast development and the continuing changes of the breast during puberty.

Reassurance is really all you need and if your daughter is self-conscious this is a good time to start them wearing a light camisole of “sports bra.”  

Daily Dose

Migraines in Children

1.15 to read

I received an email via our iPhone App inquiring about migraines in children. Headaches are a common complaint throughout childhood, but pediatricians have recognized that children have many different types of headaches which include migraine headaches. 

Migraine headaches are best diagnosed by obtaining a detailed history and then a thorough neurological exam. There are several characteristics of childhood migraines that are quite different than adult migraines. While adult females have a higher incidence of migraine headaches, males predominate in the childhood population. 

Childhood migraines often are shorter in duration than an adult migraine and are less often unilateral (one sided) than in adults. Only 25-60% of children will describe a unilateral headache while 75-90% of adults have unilateral pain.  Children do not typically have visual auras like adults, but may have a behavioral change with irritability, pallor, malaise or loss of appetite proceeding the headache.  About 18% of children describe migraine with an aura and another 13% may have migraines with and without auras at different times. When taking a history it is also important to ask about family history of migraines as migraine headaches seem to “run in families”. 

Children who develop migraines were also often noted to be “fussy” infants, and they also have an increased incidence of sleep disorders including night terrors and nightmares. Many parents and children also report a history of motion sickness. When children discuss their headaches they will often complain of feeling dizzy (but actually sounds more like being light headed than vertigo on further questioning). 

They may also complain of associated blurred vision, abdominal pain, nausea and vomiting, chills, sweating or even feeling feverish. A child with a migraine appears ill, uncomfortable and pale and will often have dark circles around their eyes. It seems that migraine headaches in childhood may be precipitated by hunger, lack of sleep as wells as stress. But stress for a child may be positive like being excited as well as typical negative stressors. 

Children will also tell you that their headaches are aggravated by physical activity (including going up and down stairs, carrying their backpack, or even just bending over). They also complain of photophobia (light sensitivity) and phonophobia (sensitive to noises) and typically a parent will report that their child goes to bed in a dark room or goes to sleep when experiencing these symptoms. 

Children with migraines do not watch TV or play video games during their headaches. They are quiet, and may not want to eat, and may just want to rest.  Nothing active typically “sounds” like fun. To meet the diagnostic criteria for childhood migraine, a child needs to have at least 5 of these “attacks” and a headache log is helpful as these headaches may occur randomly and it is difficult to remember what the headache was like or how long it lasted, without keeping a log. 

There are many new drugs that are available for treating child hood migraines and we will discuss that in another daily dose.  Stay tuned! 

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

Why Vitamin D is Important!

1:30 to read

As a follow up to the blog last week on children, calcium and vitamin D needs, a recent article in a Canadian Medical Journal reports that children who drink non-cow’s milk, such as soy, rice, almond and goat’s milk have lower serum vitamin D levels than those who are drinking vitamin D fortified cow’s milk.

This study looked at 2800 children between 1-6 year olds, and their consumption of either cow’s milk which is all vitamin D fortified and those who drank non-cow’s milk, in which case fortification is voluntary.  The researchers then looked at blood samples to measure vitamin D levels.

The researchers found that children who drank non-cow’s milk had nearly three times the risk for having low vitamin D levels.

So...bottom line...when I am discussing milk and dairy intake with families I am going to reiterate the need to drink cow’s milk, or children may need to continue vitamin D supplementation  and for most parents, including myself, it is hard to remember to give a vitamin or mineral supplement every day for a child’s entire life!).  A glass of vitamin D fortified milk at meals seems an easier choice in most cases.

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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