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Daily Dose

Breastfed Babies & Diaper Rash

1:30 to read

I was shopping at Target just the other day and happened to be in the “baby aisle” looking for one of those snack cups with the lids to let little fingers get in and not let the puffs fall out.  I needed it as part of a baby gift basket.  Useful for sure!!

So…while I am browsing, I see a young mother and her mother looking at diaper creams and obviously trying to decide which one to buy. I could’t resist offering help (always worry about being intrusive). When I asked what they were trying to treat the mother said, “ my new baby has this raw and red diaper rash right around his bottom”.  “He is just 12 days old and I change his diaper all of the time….how could he possibly get a diaper rash? What am I doing wrong?”

As we say in Texas, “bless her heart”!!! I asked if she was breast feeding,  and she was,  then I immediately knew what she meant. A breast fed infant will poop ALL OF THE TIME.  Many times you change a new diaper and as soon as the next diaper is put on the baby stools again. There are many times when your infant may poop a bit of stool during sleep and when you get them up they have a dirty diaper…all normal. No new mother guilt!!

The good news is that a newborn who is stooling a lot is probably getting plenty of breast milk as well…and that means they are gaining weight too!  The flip side is that it is not uncommon for a newborn to get that raw red bottom during the first month or so of breast feeding.  After that time, the stools do slow down a bit and diaper rash is less common.

The best remedy I have found for treating that tender new bottom is a combination of a diaper cream that contains zinc (Destin, Dr. Smith’s, or Boudreaux’s Butt Paste) and a bit of a liquid antacid (Mylanta, Maalox, Gaviscon). I put  a blob of diaper cream in my palm and then pour a bit of the antacid into it and mix….you can’t use too much of the liquid or it will run off.  Then I take that combo and coat the baby’s bottom. You can’t over do it. Use it with each diaper change.   It seems to do the trick and is easy. Several years ago I told a mother about the concoction (she had 4 children and was very sleep deprived) and I  just said use some antacid if you have some. She called later in the day and said she had tried to crush up the tablets and mix it with diaper cream and it wasn’t working.  I have since learned to be a bit more specific about a LIQUID antacid.  

 

 

 

 

 

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

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

Breaking Bad Habits

1:15 to read

Do any of your children bite their nails or suck their thumbs? If so, are you always saying, “take your fingers out of your mouth, they are dirty”, or “if you keep biting your nails you will get sick due to all of those germs on your fingers”!  I was guilty of saying those very things to my own children, and I also remember being a nail biter and my mother saying the same thing to me.

Well, who would have thought that a study just released today in the journal Pediatrics might make us parents eat our own words (it wouldn’t be the first time).  The study, “Thumb-Sucking, Nail-Biting and Atopic Sensitization, Asthma and Hay Fever” suggests that “childhood exposure to microbial organisms reduces the risk of developing allergies”.  Who knew that there might be something so positive coming from a “bad habit”.  

This study was done in New Zealand and followed over 1,000 children born between 1972-1973 (dark ages) whose parents reported that they either bit their nails or sucked their thumbs at 5,7,9 and 11 years old. The participants were then checked at ages 13 and again at 32 years old to look for an allergic reaction ( by skin prick testing) against at least one common allergen.  And guess what…at 13 years of age the prevalence of an allergic reaction was lower among those children who HAD sucked their thumbs or bitten their nails.  Incredibly the the findings persisted almost 20 years later!  This study even looked at cofounding factors including sex, parental history of allergies, pet ownership, breast feeding and parental smoking… none of which played a role. 

So, while not advocating for children to suck their thumbs or bite their nails (which unfortunately I did until high school when I decided to have nails to polish) there may be a silver lining….a protective effect against allergies that persists into adulthood. 

Lemonade out of lemons!!!

Daily Dose

Early Talkers

1:30 to read

Is your child a precocious talker?  Most children start to acquire words around 12-15 months, but that means 5-10 words and building. By the time a child is 18 months old they are often mimicking when you ask them to say a word, and some are putting 2 words together. This is all very normal development. But there are few children who are just “early talkers” who are speaking in full sentences by the time they are 18-24 months! 

I think having such a verbal child during the early toddler years is both a “blessing and a curse”. I know that from raising my own children, where my oldest was quite verbal by 20 months, and was “bossing us around” before age 2!!  I also see this same dilemma in my little patients.  While some parents are worried that their 2 year old does not put 3-4 words together, others want to know how you can stop the chatter.  Parents.....we always have issues. 

Example:  When I come into the exam room for a 2 year old check up, the precocious talker looks up and says, “Hi Dr. Sue...what took you so long?”.  Or they may tell their parent that they “don’t need any help” as I ask them to climb on the exam table. Recently a little boy looked right at his mother and said, “I’ve got this”, when I asked him to take off his shoes.  

On another day a little girl was impatient to leave and kept asking her mother if they could go to the park after they left my office.  The mother kept telling the little girl, “maybe” . Finally, exasperated, the 2 year old said, “what’s the answer, yes or no?””  How do you keep a straight face? 

A verbal child can bring you to your knees, both laughing and sometimes wanting to cry.  How can a 2 year old know just what to say to make a parent feel inadequate?  Is it inborn? This seems to be especially true if you have had another child and the 2 year old is instructing you on how to parent “their baby”.   

So, if your child is a talker write down all of those clever sentences they blurt out......one day you will look back and laugh.  I often saw myself in my 2 year old as he told complete strangers , “my mommy says my baby brother cries all of the time, and he has colic!”  Out of the mouth of babes, and I still remember it.  Bittersweet.

Daily Dose

Bump on Your Child's Leg?

1:15 to read

I recently saw a young adolescent patient who had noticed a “lump or bump” on her leg which she had noticed for some time and she had now wondered what it was. She said that she had initially thought she had bumped her leg,  but she had continued to watch it and noticed that it did not seem to be going away. So, after many months of watching it and wondering what it was she decided to come ask me.

On her exam she had a notable “bump” or mass on her lower leg, about the size of a half dollar. There was no surrounding bruising and the mass was non-tender. She told me it really did not bother her, and she was more concerned as she thought it was noticeable and a friend had asked her about the “bump”.  Other than cosmetic concerns, it did not cause any problem.

The most common reason for this bump is an osteochondroma, which is a benign bone tumor. The most common time to find this type of tumor is during periods of rapid growth during adolescence. They are usually found in the leg (femur, tibia) or the upper arm (humerus). 

So, I sent her for an x-ray which was compatible with the diagnosis of a benign osteochondroma. She then had a CT of the area which confirmed the diagnosis.  Most osteochondromas are solitary and the chance for malignant transformation is rare (less than 1%).  So, after discussing her case with a pediatric orthopedic surgeon it was decided to just watch it.  

She had mixed emotions about her diagnosis, as she was happy to know what caused the “bump” but was concerned that her friends would continue to ask her about it. Of course her parents were relieved to find out that it was benign and would likely never require any treatment.

We all decided to watch it for now…..as the tumor typically stops growing after an adolescent has completed their growth spurt and the growth plates of the bones are closed.  

Daily Dose

Scoliosis Testing Raises A Lot of Questions

It seems that it is school screening season for scoliosis (curvature of the spine) in our area and I am seeing a number of 'tweens who are being referred for evaluation of possible scoliosis. The testing is typically done in the middle school years as children approach puberty or are in early puberty. The screeners look at several areas of a child's back, including shoulder symmetry, scapular symmetry, hip level, and observation of the spine while standing and then lastly during forward flexion

Again, this is just a screening procedure in hopes of identifying those children who may show early signs of scoliosis and have appropriate intervention if necessary. I have noticed several referrals from schools and when I have seen the child there has already been a great deal of worry that they are "going to wear a brace for life, and never go to school again", or even "have surgery right away". Several of the kids were not even clear what they were having done, but they knew it was "BAD" that they got a note and one boy said he overheard "we've got an early one". Problem was he wasn't clear what they were talking about and of course thought the worst. So, if your child is screened and shows any abnormality, before jumping to conclusions and going to the internet (which typically may show the worst cases), reassure your son or daughter that you are taking them to their pediatrician to get a second opinion, as well as further information. Due to the fact that we screen early, most referrals may only show one shoulder being slightly higher, or one hip a little higher, and in that case it may be most appropriate to watch the child every six months to see if the asymmetry changes and worsens. It is most important to keep a close eye on these changes during the period of rapid growth during puberty. You do not want to wait two years to check again. By keeping a close eye, if the problem does worsen, x-rays will be taken to determine the degree of curvature. At that point, the child may possibly be braced, and typically just in the after school hours and at night. Early bracing usually prevents the need for surgery. When found early and treated you can mitigate long-term problems with severe scoliosis. That's your daily dose, we'll chat again tomorrow.

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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?”.  

 

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