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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

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

When To Worry About Stuttering

1.15 to read

I received an e-mail today from a mother who is concerned about her 2 1/2 year old daughter who has started stuttering in the last week. She asked ”is this something to be worried about or just watch it and see?”

This is a common question from parents with preschool aged children, and is typically most frequent between 18 months and five years of age. Stuttering at this age is called disfluency or pseudo stuttering and is quite common as children learn to speak and develop more complex speech patterns.

In many cases the stuttering occurs out of the blue, and may last for several weeks, and resolve, but may return off and on during the preschool years as a child is learning more and more language. In a preschooler who is stuttering the parents usually note that the child repeats an initial sound such as l-li-like or s-st-star or may have frequent pauses with “um” and “er”. It is not uncommon to see this happen when a child is excited, or anxious or tired.

They may stumble or words or sounds and after a good night’s rest you may see an improvement. They often don’t seem to realize that they are even stuttering as their brains and mouth try to keep up with one another. Remember they have a lot to say!

The best medicine for stuttering is for a parent to reassure their child that it is okay to slow down as sometimes it is hard to make the words correctly. A hug from Mom or Dad while they are reassuring their child is also helpful. Practice slow and relaxed speech when you are talking to your child and try not to rush them when they are talking, even if the stuttering is bothering you. When your child asks you a question, pause before answering to also model behaviors with speaking. Reading aloud with your child in a slow and normal manner is also beneficial (I remember nights of trying to rush through those early books to try and get everyone in bed!).

The best person to emulate is Mr. Rogers, think of how relaxed he always was when speaking. He never seemed as if he was hurrying for anything! In most cases a child’s stuttering will not last more than weeks to several months and will resolve on its own.

If you think the problem is increasing in severity or is causing stress and anxiety for your child it may be time for a discussion with your pediatrician.

Do you have any tips?  Feel free to share them with us!

Daily Dose

Preschool Nutrition Can Be Challenging

1.30 to read

Does your child eat three meals a day with healthy snacks along the way? I often find myself talking to parents about establishing healthy eating habits especially when you have a preschooler. Preschool children, specifically the two to five-year-old set are notoriously picky eaters, and parents need to recognize that this is developmentally appropriate, although frustrating for parents.

This is an appropriate time to begin teaching children the importance of healthy eating habits to encourage a lifetime of good health and prevent obesity. A good place to start to get information is “MyPyramid for Preschoolers”, a website sponsored by the U.S. Department of Agriculture. This website not only covers what your children should be eating, but also is full of good advice on handling picky eaters, how to monitor your child’s growth and ideas to encourage physical activity.

The website encourages parents to lead by example and let your children see you eating a wide array of foods including fruits, vegetables, and whole grains throughout the day. There are ideas for healthy snacks that can be eaten on the run, as you get back into carpools and after school activities. Even the toddler set is busy after school!

Remember: do not let food choices become a battle or an issue. Do not make negative food comments around your children, and keep trying new things. It may take up to 20 attempts or more before your child will try something new, but if you don’t keep trying you will never know if they might really like broccoli.

Also, no “yucky faces” for the adults and older children while at the table and eating their meal. That will only discourage your toddler from trying unfamiliar foods. Put on that happy face, even if it is not your favorite food, it might be your child’s.

The most important message is to make mealtime and snack time pleasant and healthy. Even a toddler can help with planning and preparing a meal. This website is really quite good and interactive as you can enter your child’s first name, age, gender and typical amount of activity and the site will generate a plan just for your child! Can’t be easier than that.

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

Daily Dose

Your Child's Check Up

1:15 to read.

How many times have I talked about my clever patients. I continue to be amazed at how smart my patients are…and how much they teach me….as well as how they make me laugh.  

I was seeing a young lady the other day who was complaining of a cough. She was about 11 years old. She was not one of my regular patients, as she was a patient of a partner of mine who was out of town, so she came to see me about her cough.  

So..I started asking her and her mother about her cough and quickly realized that she was more than capable of answering my questions ( the best kind of patient to have).  Her mother was great and deferred to her, as her daughter was doing such a good job with her history.  I asked her if the cough was problem during the day or night or both? She replied “during the day”. I asked her if the cough was worse when she was playing or exercising during the day? The answer was “no”.  I then started asking her about the quality of the cough…(I also had the benefit of hearing her cough while I was getting her history).  I then asked her if the cough was dry or if it was wet and “gunky”?  I was not sure if the would understand if I asked her if it was “productive”?  

Surprisingly , she looked at me and said , “do you mean do I produce phlegm?”.   There are many parents that don’t understand that word!!  Then realizing that she was quite bright and knew words that I swear I learned in med school (okay maybe undergrad biology?), I asked her if she could spell phlegm. Of course, she immediately spelled the word correctly!!  

She was delightful patient and is another example of “kids say the darnedest things”.  We had a great conversation and it was so helpful to be able to get a good history from her. The history is just as critical as the physical exam in diagnosing a patient… so a good communicator makes a doctor’s job a lot easier.

The only time she was not communicative…when I told her she needed her flu vaccine, and YES it was a shot! Sorry, but this is to keep you healthy.

Daily Dose

Too Much Pressure to Play Sports?

1:30 to read

Does your child play a sport “after school”?  It seems children as young as 3-4 years of age are now involved in soccer and even football.  Some children are barely walking before they are signed up for a team.  Parents tell me various reasons for this including, “if they don’t start young they will be at a disadvantage athletically”, “if we don’t get on a team now, there will not be room for our child once they start kindergarten or first grade”,  and “our child wants to play and wear a uniform”. I just see lots of issues with burn out.

It seems awfully early to start “team sports” to me. I am a huge advocate of families and children playing together and learning all sorts of games and sporting skills. Kicking a soccer ball in the yard, or hitting the wiffle ball off of the tee, or having Dad throw a pass with the football all seems pretty “normal” to me. But organized sports with a 3 year old who is still in diapers….really?  Maybe one of the “guidelines” should be you have to be potty trained.  Yes, this is true, I see children in diapers who “will not pee or poop in the potty” according to their parents, but they go to soccer practice?  What is wrong with this picture?

So, while some of these well intentioned parents have told me that they are having fun being the coach, or attending games with other friends, their pre-school children “don’t have time to be potty trained”. They are too busy going to school, followed by organized activities that “it is just easier to let them stay in diapers”. I was even with a 4 year old at a football game and she was still in diapers?

At some point these children and parents will need to skip a practice or two and stay home long enough to get potty trained.  I am noticing that children are getting older and older before they are potty trained. I know there are books written on this topic with the philosophy that “the child will ultimately train themselves”, or “ how to potty train in 3 days, with a child who shows no interest”…or something along those lines.  But really, in my experience, if you watch your child’s cues, spend the time to “talk bathroom habits” and have the “time” to be home to potty train most children are potty trained between 24-36 months of age.  Yes, there are occasional children (none of my own) that just show interest earlier and say things like “I go potty now” and really do it on their own. There are also some who are more difficult to get interested and may be harder to potty train…but again, which is probably a more important life time skill…..getting out of a diaper or trying to figure out how to line up for a soccer game? I’m just saying.

Daily Dose

Toddler Constipation

1:30 to read

I get so many questions about toddlers and constipation.  Constipation relates to stool frequency and consistency.  It is important to understand that everyone has different bowel habits and not all children will have a stool every day.  While some children will have several stools a day another may have a stool every 2 -3 days. Both of these scenarios may be normal and not an indicator of problem.  At the same time, stool consistency is important. If your child has  hard, dry, pebble like stools ( rocks rather than softer snakes or blobs ) this may be an indicator of constipation. Everyone will occasionally have a hard stool, but this should not occur consistently. Lastly, it should not be painful to pass the stool. While toddlers may grunt or push, or even start to “hide” to poop, it should not cause real pain.

With all of that being said, it is not uncommon for toddlers to become constipated as they often are also becoming picky eaters. Due to this “phase”,  some young children will drink too much milk in place of eating meals and this may lead to constipation. Your toddler should be drinking somewhere between 12 -18 ounces of milk per day.  Many children also load up on other dairy products like cheese, yogurt and cottage cheese, which while healthy, may also lead to too much dairy intake and contribute to constipation.

Water intake is also important to help prevent constipation. If your child is drinking too much milk, substitute some water as well.  It is a balancing act to make sure your child is getting both milk and water. If necessary I will also put the smallest amount of apple or prune juice in the water. By the age of 1 year, your child should no longer have a bottle as their main source of nutrition is no longer in the liquid form!

Fiber is also important so offer plenty of whole grains and limit the “white foods” that toddlers love (yes, the bread, cereal, pasta). If you always buy whole wheat pasta and whole grain breads your children will never know the difference. Stay away from processed white foods whenever possible.  It is also easy to throw flax seed or bran into muffins or smoothies (disguising fiber). I also sometimes use Metamucil cookies (they are pre made) and may even resort to dot of icing smeared on it and offer it as a cookie for snack, along with a big glass of water.

Fruits and veggies are a must…even if you think your child won’t eat them! Your toddler needs 2 servings of fruits and veggies every day and rotate what you offer them.  You will be surprised at how one day they may refuse something and they next they will eat it. Don’t give up on fruits and veggies,  it may literally take years for your child to eat peas…but if they aren’t offered a food repetitively they will probably never it eat. I know a lot may get thrown to the floor but just clean it up and persevere.  Not only will this help their stools but their long term healthy eating habits as well.

Movement is also important to help keep the bowels healthy and “moving”.  Making sure that your toddler is moving seems crazy, as they are on the go all of the time.  But with an older child make sure they are getting plenty of time for play and exercise outside or in…and not just sitting in front of a screen.

Lastly, for short term issues with constipation it is also okay to try using milk of magnesia (MOM) or even Miralax….but ask your doctor about dosing in toddlers.   

Daily Dose


1:15 to read

Many years ago when children asked their parents “where did I come from?” they answered “the stork brought you”.  The picture of the stork’s beak holding on to the baby’s neck and flying to drop the baby on the new parent’s doorstep was known by all….but things change and that visual is not known by my newest parents.  In fact they look at me with completely blank stares when I discuss the birthmark on the nape of their child’s neck.

But the term “stork bite” comes from that old story, and the red birthmark seen on up to 50% of babies necks is also called nevus flammeus or nevus simplex. They are flat, pink and irregularly shaped and while they occur most commonly on the nape of the neck, they are common on the forehead, eyelids and above the upper lip as well. They are due to capillaries close to the skins surface. The stork bites on the face typically fade over time while the ones on the nape of the neck may continue to be present but are obscured and typically forgotten once the baby has hair. Many people are not even aware that they themselves have one.

When I am doing a newborn exam I see so many of these little “flat red patches” that I often to forget to bring them up as they are small and typically fade….but sometimes a parent will specifically ask about them. After I apologize for not bringing it up….as I know they are small and fade, but they are concerned,  I tell them that they are “stork bites” and get that blank look.  Then I launch into the etiology for the name etc. But, things are getting ready to change as STORKS a new animated movie is just bring released.  The old myth of the stork is making a come back!

So…if your baby has this small birthmark, no need to worry.  Be assured that most will fade but if they have not resolved by the age of 3 or 4 years, there are now lasers available to treat them.

In the meantime..take your family to see "STORKS" so they are aware of where “you used to come from”!  We can still tell our children the myth of the stork and then make sure to discuss the truth about “where did I come from?”. 




Daily Dose

Baby's First Foods

1:30 to read

Have you heard of “baby led weaning” (BLW)? Many of my patients who have infants that are ready to start “solid foods”, also called complementary foods, have questions about this method. Most babies begin eating foods along with breast milk or formula somewhere around 5 - 6 months of age.  So BLW is not really “weaning”,  as your infant will continue to have breast milk or formula in conjunction with foods…so this really should more aptly be named “baby self feeding”. 

In this method you never offer your baby “mush” or pureed foods, but rather offer them foods from the table.   While I am a huge advocate of self feeding (old term is finger feeding), I also think that early on offering a baby “mushy” food on a spoon is an important milestone. In fact, for most babies at 5 -6 months, it is difficult to pick up a small piece of food to self feed as the pincer grasp has not developed. So, a baby is trying to get food to their mouths by cupping it or hoping it sticks to their hand while pushing pieces around their tray. Some parents will put the food into their baby’s hand.  But, by 8-ish months most babies have developed their pincer grasp and the finger feeding should be preferred.  

Parents are also concerned about starting solid foods and the possibility of choking.  I am always discussing how to make sure that your child avoids choking hazards with foods. In other words, no whole grapes, or hot dogs, or popcorn or chunks of meat.   Other hazards are raw carrots, apples, celery and any “hard” food that your baby might be able to bite a chunk of and then choke. But, if you cook the carrots and then cut them in small bites they are easily handled by a baby who is self feeding.  It is really all about the consistency of the food as once your baby has lower teeth they can easily bite/pry off a big “chunk” of food that could lead to a choking hazard.

Interestingly, there was a recent study that looked at the incidence of choking in children who started with self feeding vs those fed traditionally with pureed foods from a spoon. In this study of about 200 children between 6 - 8 months of age the incidence of choking was similar, while there were more gagging events in the BLW group.  Fortunately, “the choking events resolved on their own”. Gagging is quite different than choking. Some children will gag on pureed foods just due to texture issues. 

I am an advocate of what I am going to call parent led feeding followed by early self feeding of appropriate foods. By the time a child is 9 months of age they should be able to finger feeding the majority of their meals. But there are some foods that are just not conducive to finger feeding at all….yogurt, apple sauce, puddings…and they will be spoon fed until your child is capable of using a spoon which is anywhere from 12 -18 months.   But as a reminder, whenever you offer your child a finger food you should remember two things, #1 is the piece small enough that my child cannot choke and #2 is the food cooked well enough to not pose a choking hazard.  

Several years ago there was a 1 year old in our practice who was given a piece of an apple to chew on… she bit off a chunk of the apple, aspirated and died. It was a terrible accident.  I will never forget that….and re-iterate to all of my patients…a pork chop, or chicken leg or any number of foods can become a choking hazard if your child bites off a chunk. Children really don’t chew until they are around 2 years, they just bite and try to swallow so I pay a great deal of attention to what foods they are offered.


Old school and new school…the combo seems to make sense to me. 


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