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Daily Dose

Brown Spots on Your Baby?

1:30 to read

I was examining a 4 month old baby the other day when I noticed that she had several light brown spots on her skin. When I asked the mother how long they had been there, she noted that she had started seeing them in the last month or so, or maybe a couple even before that.  She then started to point a few out to me on both her infant’s arm, leg and on her back.

These “caramel colored” flat spots are called cafe au lait macules, (CALMs) and are relatively common. They occur in up to 3% of infants and about 25% of children.  They occur in both males and females and are more common in children of color.  While children may have a few CALMs, more than 3 CALMS are found in only 0.2 to 0.3% of children who otherwise do not have any evidence of an underlying disorder.  

Of course this mother had googled brown spots in a baby and was worried that her baby had neurofibromatosis (NF).  She started pointing out every little speckle or spot on her precious blue eyed daughter’s skin, some of which I couldn’t even see with my glasses on. I knew she was concerned and I had to quickly remember some of the findings of NF type 1.

Cafe au lait spots in NF-1 occur randomly on the body and are anywhere from 5mm to 30 mm in diameter. They are brown in color and have a smooth border, referred to as “the coast of California”. In order to make the suspected diagnosis of NF-1 a child needs to have 6 or more cafe au lait spots before puberty, and most will present by 6 -8 years of age.

For children who present for a routine exam with several CALMs ( like this infant), the recommendation is simply to follow and look for the development of more cafe au lait macules. That is a hard prescription for a parents…watch and wait, but unfortunately that is often what parenting is about.

Neurofibromatosis - 1 is an autosomal disorder which involves a mutation on chromosome 17 and may affect numerous organ systems including not only skin, but eyes, bones, blood vessels and the nervous system. Half of patients inherit the mutation while another half have no known family history.  NF-1 may also be associated with neurocognitive deficits and of course this causes a great deal of parental concern. About 40% of children with NF-1 will have a learning disability ( some minor, others more severe).

For a child who has multiple CALMs it is recommended that they be seen by an ophthalmologist and a dermatologist yearly,  as well as being followed by their pediatrician.  If criteria for NF-1 is not met by the time a child is 10 years of age,  it is less likely that they will be affected, despite having more than 6 CALMs.

The biggest issue is truly the parental anxiety of watching for more cafe au lait spots and trying to remain CALM…easier said than done for anyone who is a parent. 

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Daily Dose

"White Noise" and Babies

1.00 to read

I received an email from Meredith (via our iPhone app) because she had heard that “white noise” might cause a child to have speech/language delays. She used a sound machine in her children’s rooms at night, and was concerned about the possibility of “interfering with their speech”.

So, I did a little research and found an article from the journal Science in 2003.  A study from the University of CA at San Francisco (UCSF) actually looked at baby rats who listened to “white noise” for prolonged periods of time. The researchers found that the part of the auditory cortex (in rats) that is responsible for hearing, did not develop properly after listening to the “white noise”.   

Interestingly, when the “white noise” was taken away, the brain resumed normal development. Again, this study was in baby rats, and to my knowledge has not been duplicated.  But, these baby rats were exposed to hours on end of  "white noise” which may not be the same thing as sleeping with a “sound machine” at night. 

We might need to be more concerned about background “white noise”. We do know that babies learn language by listening and absorbing human speech. They need to hear their parent’s talking to them from the time they are born.  They listen to not only their parent’s speech, but also to siblings, grandparents etc. and from an early age respond to that language by making cooing sounds themselves, often imitating the sounds they have heard. They are also exposed to a great deal of “white noise” or background noise with the televisions being on, computers, telephones, vacuum cleaners, lawn mowers etc. going on all day.  The “white noise” that may be reduced by turning off televisions, videos, computers etc and replacing that background noise with human speech through reading, singing and just talking to your baby and child could only be beneficial. One might surmise that “white noise” in the form of a sound machine at night would not affect a child’s speech development, as this is not a time for language acquisition.

Having a good bedtime routine, reading to your child before bed, or singing them a lullaby will encourage language development, and the sound machine may ensure a good night’s sleep.  Just turn it off in the morning!

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

Food Textures

1.30 to read

If you have a baby between the ages of 8-9 months and have already been offering them pureed baby foods it may be time to start some textures as well.  Many parents are a bit “wary” of offering any food that hasn’t been totally pureed, but it is important that your baby starts to experiment with foods that have different consistencies. 

Of course this does not mean you hand your baby anything that they could choke on like a grape, or piece of meat etc. But instead of totally pureeing carrots, why not cook them well, chop them up a bit and put them on the high chair tray. It is fun to watch how they touch and feel the carrots, before they “smoosh and moosh” them and get them to their mouths.   

There are so many foods that are easily offered to a baby to get them used to feeling different textures.  This is the very beginning of experimenting with finger foods, and this doesn’t just mean puffs or cheerios either. I like to encourage babies to feel cold, gooey, warm, sticky, all sorts of different textures which will ultimately help them become better and more adventuresome eaters as they get older.  

Unfortunately, I see far too many little ones (and not so little ones too) continuing to eat totally pureed foods and then becoming adverse to textures as they did not get the experience at an early enough age. 

It is also fun to watch your child as they begin to pick up foods that have been chopped and diced into small soft pieces. In the early stages they have to scoop and lick the food from their fingers and hands, but very quickly their pincer grasp takes over and suddenly they can pick up that well cooked green bean or pea!!  Such a feat and worthy of a home video to send to the grandparents for sure. 

So, put out some mushy food and let them play - I know it is messy but that is what being a kid is often about!

Daily Dose

Stranger Danger

1.30 to read

We had a question via our iPhone App from an aunt who wanted to talk to her twin 4 year old nephews about “stranger danger”. Unfortunately, this topic has been in the news quite frequently lately with child abduction cases being reported all around the country.

The National Center for Missing and Exploited Children has numerous resources for educating children about safety.  Interestingly, most perpetrators are not actually strangers, but are often someone the parents or another adult knows and may have been around the child on occasion. So, it seems that “stranger danger” may not be the appropriate term to use when teaching our children, especially younger, children about safety. It is important that the conversation about safety begins with children at young ages. It is often easier to use teachable moments to begin the conversation with young children. 

Talk to your child about “safe” strangers, as it is hard for a child to understand why you are talking to grocery store clerks, or people on the playground in the park, and yet they are strangers. It may be best to teach a child to watch out for dangerous behaviors from adults, rather than saying “never talk to strangers”.  Talk about adults who might approach them for directions, or to find a missing pet and role play as to what they should  do. At the same time, teach them that they can turn to “strangers” such a store clerks or mothers with children for help if they are scared.

While talking about this subject use a calm reassuring manner.  You do not want to make your child “too” anxious as most people they will meet are not dangerous, and children do need to interact and trust numerous people around them that they will meet in  different situations.

Another good way to discuss the issue of “stranger danger” is by reading books to young children that deal with the issue. Several good books that I like are:  The Berenstein Bears Learn About Strangers; A Stranger in the Park; I  Can Play it Safe.  There are many other books out there too, so head to your library  or your local bookstore to get some more recommendations. The librarians are often helpful with finding “age appropriate” books.  Lastly, this is not a one time conversation, but should be discussed at different ages and stages of your child’s life.

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

Daily Dose

Circumcision Care

How to care for a baby's circumcisionThe questions continue about little boys and circumcision.  Recently, a reader asked if her 7 month old son’s circumcision could “grow back”.

I am often asked this question when examining little boys especially infants who have a large “fat pad” above the base of their penis which pushes down on the penile shaft. Once a boy has been circumcised (see old post on this issue) and the circumcision has healed, I show parents how the “head or glans” of the penis should look and how to continue to push back the foreskin when they are bathing their son. There are definitely two schools of thought on this and some doctors prefer to just “leave the skin alone.”  Pediatric urologists seem to differ on their thoughts on this issue too.  At any rate, if you push on the base of the penis with your fingers around the shaft  the skin will spontaneously pull back and the glans of the penis may be washed. If you do not do this then debris will gather in the area around the glans and the skin will get “stuck” with the “gunk”  there and the penis will not only look different, but at times it will appear as if the “circumcision has grown back”. When this occurs, the result is termed penile adhesions.  But, bottom line, by beginning to clean the penis thoroughly and retracting the foreskin wit diaper changes and bathing the problem usually does not get started. When a circumcised male infant is in my office for their routine check up and found to have penile adhesions I point out the issue to the parents. This is typically at the 2, 4 or 6 month visit.  They may even note during their questions as I start my exam that their sons penis looks “funny” and would I make sure that I “ check it out”.  The adhesions are typically very thin at this point and it is easy to manually reduce the adhesions with very little pain to the infant. In my experience this is preferable to waiting until the adhesions are worse or sending the patient to the urologist. It is easy for the parent’s to then get a visual of what their child’s penis looks like with and without adhesions as they often forget what the glans or head of the circumcised penis looks like.  I tell them it should look like a mushroom cap with the stalk beneath.  When the fat pad has pushed the skin over the penis it is important to review cleaning as the penis often gets hidden (like a turtle in the shell) and hygiene may not be as easy. I tell parents to continue cleaning the penis just like other areas of their child until they are bathing or showering alone. It is really easy (I have 3 sons). If boys do continue to  develop penile adhesions they will typically resolve on their own once the child reaches about 5 years of age. So for worried parents with preschoolers I reassure them that “this too shall pass”.  Occasionally severe cases of adhesions where an actual band of tissue occurs may require surgical intervention. I do think that there are many pediatricians with differing views on penile adhesions, just as with many other no life threatening issues in pediatrics. That's your daily dose.  We'll chat again tomorrow. Send your question to Dr. Sue right now!

Daily Dose

Top Health Risks for Young Adults

When I think of the youth of today, we tend to think they are pretty healthy, but the reality is that our youth are facing numerous health issues now that will have long term consequences as they grow older.The CDC (Centers for Disease Control and Prevention) recently issued a health report entitled "Top Health Risks for Young Adults". When I think of the youth of today, we tend to think they are pretty healthy, but the reality is that our youth are facing numerous health issues now that will have long term consequences as they grow older.

This report was geared at the young adult ages 18 - 29, but many of the same issues are facing even younger children. The leading cause of death for young adults is unintentional injuries, which killed 40/100,000 young adults in 2005. These injuries are often traffic fatalities, many associated with drinking and driving and even under age drinking and driving. There are over 1,700 deaths per year due to binge drinking. The list of injuries is extensive as these are years for risk taking behaviors. Teens and young adults feel invincible, and the party line is usually, "this won't happen to me!" These topics should be discussed over and over again with our children beginning at young ages. The more they hear the better. Obesity was also on the list. As we all know obesity is skyrocketing in this country. The statistics are daunting and the obesity rates for young adults tripled between the 1970's and 2005-2006. With the economic problems we are all facing, more families may be making less healthy choices due to the cost of food. A box of macaroni and cheese is far less expensive than grilled chicken breasts, but the long-term consequences may be far more lasting. The statistics for younger children are not encouraging either. We the parents must make better food choices for ourselves and our children in order to combat an epidemic of obesity and health related issues such as diabetes, high blood pressure and heart disease. Exercise is also necessary for overall good health and only 36% of young adults get regular exercise, and only 26% report strength training at least twice/week. Our older school age children are also not meeting goals for exercise, as many schools no longer require P.E. credits or daily gym class. How many kids "pick" gym class if it is not required, especially if they are already having weight problems and therefore may be embarrassed to exercise while at school? Lastly, smoking!! In 2006, 29% of men and 21% of women ages 18 - 29 were smokers. Most of them report that they began smoking at a much younger age. The conversation about smoking in adolescence needs to be reinforced with our children. Nicotine is addictive and the media continues to show smoking without showing any of the horrible consequences of smoking: cancer, emphysema and death. So, happy spring, we can all get out and exercise and enjoy cookouts during the nice spring weather. The family as a whole will benefit. That's your daily dose, we'll chat again soon. More Information: Centers for Disease Control and Prevention

Your Child

Are Kids Too Wired?

2.00 to read

In an effort to keep up with my tech-savvy patients and their parents, I read a study from a well-known software maker that confirmed something we all know: are kids are extremely wired.

The company solicited 2,200 mothers to answer a survey looking at skills their children have; such as riding a bike or tying a shoe as well as those very important early childhood skills such as how to use an I-Pad or Smartphone.  21% of four-five year olds knew how to use a Smartphone or I-pad application, only 14% of those same kids could tie their shoes.

For children two–five years old, 69% could operate a computer mouse, 58% could play a computer game but only 52% knew how to ride a bike. Seems incredible to me that  more kids have computers than bicycles? 25% of two-five year olds could open a Web browser, only 20% knew how to swim.  Technology is definitely changing the world, but is it all beneficial?

The company's CEO commissioned the survey to show how young children are interacting with technology. He emphasized that parents need to be educating their young children about their online world and need to be promoting internet/online safety at very young ages. It used to be “when do I have the sex talk” now it is being replaced with ”how soon do I need to talk about online safety and technology?”. 

The most disturbing aspect of this study is that it suggests that our children are way too wired and may be missing out on simple, yet important life skills.

I myself have seen many a two year old open their parent’s iPad and turn on a movie while in the exam room.   They can recognize different icons and switch between applications but are not yet capable of talking in complete sentences. Some of these children are the same ones who at two years, are not yet putting themselves to sleep at night, cannot sleep through the night and still have a bottle or pacifier!

Some parents are convinced that their child may not be capable of mastering these normal developmental milestones, while at the same time are thrilled about their child’s computer skills. This seems a little mixed up to me. Priorities sometimes get confused.

Technology is important and will continue to be so, but what if the computer is “down” and you need to write a story with pencil and paper, or draw a picture without the benefit of a computer screen? There are certainly many life skills to be mastered; riding a bike, pumping a swing and playing catch.

The race to teach kids technology and to help them compete in our constantly “wired” world may be detrimental to a child’s physical and emotional health. All parents need to remember to “turn off the technology” and get back to basics. There is time for both.

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