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Daily Dose

Is it Appendicitis?

1.15 to read

Last night, a patient called me and wondered if their daughter had appendicitis. I always thought it would be the easiest diagnosis, and that we would call the surgeon and whisk the patient off to the operating room for an appendectomy, just like Madeline (one of my favorite books as a child). Well, over the years have I been taught a few things. At times the diagnosis is easy. The patient has the classic symptoms of a "tummy ache" that starts around the belly button, they may vomit a few times and have a fever and the parent in all of us thinks, "yuk, another one of those tummy viruses". But over several hours the tummy aches worsens, and moves from around the belly button (peri-umbilical) to the right lower quadrant and the nausea and vomiting persist and your child just looks SICKER. At the same time you may notice that they have a funny walk, and won't stand up straight, as they try to get to the bathroom and when possible, they move very little at all, as any movement makes the pain worse. This is classic appendicitis. For a parent, that means a phone call to the pediatrician, day or night, as that child needs to be examined. On the other hand some children just forgot to read Nelson's text book of pediatrics. They don't vomit, they may not have a fever, they are a little nauseated, but when pressed could still eat, and it only hurts in their right lower quadrant, everything else is just okay. These are the difficult cases to diagnose. These children require a lot more history, repeat exams and lab tests and may even need a CAT scan to look at their appendix. But, you don't want to miss an appendicitis, as a perforated appendix is serious and requires a lengthy hospitalization. So as a parent and a doctor, if your child's tummy ache seems to be getting worse, it may be worth a trip to the doctor to feel that tummy, run a few tests and decide how to proceed. It is not always as easy as in a book or on TV. That's your daily dose, we'll chat tomorrow!

Daily Dose

Concerns About Bumps On Arms

A number of patients, especially young girls, are concerned about tiny little bumps on their upper arms or on their thighs.A number of patients, especially young girls, are concerned about tiny bumps on their upper arms or on their thighs. Typically the skin lesions that they are complaining about are little, flesh-colored to slightly red bumps (almost like goose bumps) that give the skin a sandpaper-like texture.

They are usually noticed on the outer upper areas of the arms and also may occur on the upper part of the thighs and occasionally on the cheeks. This “rash” is called keratosis pilaris and is an inherited skin condition that occurs in up to about 40 percent of the population. In other words it is very common and is most commonly noticed in children and young adults. It may also occur in infants and is often of concern to the mother, but does not bother the your-baby in the least. In this condition there is an over production of keratin from the skin that then plugs the hair follicle. The tiny bumps that then form on the skin each represent a plug of dead skin cells that form at the site of the entrapped hair follicle. The “bumps” seem to be most bothersome to teens as the bumps may sometimes be red and irritated and therefore more noticeable. The teenage girl population often picks at these, which only makes them more noticeable and a cycle erupts. There has not been a definitive way to “cure” the skin problem. Most people are not bothered by the rash other than for cosmetic purposes, which is of huge importance to my adolescent girl population (funny how teen boys seem to be unaware of the rash) and will do anything to try and lessen the bumps. Moisturizers are the mainstay of treatment and those that contain urea or lactic acid seem to be preferred and should be used liberally and frequently. Medications that cause mild peeling are also helpful in opening the plugged hair follicles and remove excess skin. These are typically retinoids, like “Retin- A”, or adapalene, “Differin” which are also often used to treat acne, and are by prescription. At times using a topical steroid cream with a retinoid may also improve keratosis pilaris. Different patients respond differently and it may take several products to help control keratosis pilaris. Unfortunately, therapy must be continued on a regular basis or the rash will re-occur. The rash of keratosis pilaris usually does lessen with age, and many adults say that they hardly notice it any more! Like so many things in life. That’s your daily dose, we’ll chat again tomorrow. Send your question to Dr. Sue!

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.

Daily Dose

Spring Weather Brings Spring Rashes

Tonight I saw a little girl who had a hive like (urticarial) rash on her trunk, arms, legs which seemed to migrate from place to place.Sunday evening at our house if often house call night. It is rather fun for my husband (and me) to have young children in our very quiet house. Seems I miss my college boys most on Sundays too, so house calls are therapy for everyone. Tonight I saw a little girl who had a hive like (urticarial) rash on her trunk, arms, legs which seemed to migrate from place to place.

Her parents had noticed the rash the night before and the father had given her some Benadryl before bed. She seemed fine, they didn't think much about it, and then the rash returned later the following day. She was otherwise totally well. No fever, cough, breathing problems etc. and she was racing around pointing out her blotches that seemed to itch. She was otherwise oblivious. This kind of rash is common in early spring as the pollens start to fly. Although parents rack their brains trying to figure out the instigating allergen, we typically never know. These are not hives that are associated with breathing problems and allergic reactions to foods or drugs. The treatment of choice is to keep the child from being overheated (hives will be more prominent and itch more), start an antihistamine like Benadryl, or a non-sedating medication like Claritin or Zyrtec. You can take these on a daily basis for several days and see if the rash goes away. If it does, I recommend staying on the antihistamine for several days even after the hives have resolved, then stop the medication and see if the hives return. These rashes are typically short lived, although on occasion the child may need to stay on antihistamine throughout the spring at which time you should have your child see their doctor. That's your daily dose, we'll chat again tomorrow.

Daily Dose

Taking the Pain Out of Growing Pains

Growing pains usually present in children around the age of four or five and last through early elementary school.Growing pains are a frequent complaint in children. Although pediatricians don't fully understand the etiology of growing pains, their presentation is fairly typical. Growing pains usually present in children around the age of four or five and last through early elementary school. These pains are usually located in the calves of the legs, behind the knees and often occur in the middle of the night.

Children describe these pains as tightening and throbbing of the muscles. I can still remember waking up in the middle of the night with these pains (I'm not divulging how long ago that was) and having my father come in to rub my legs, and then put a heating pad on my legs. I don't think we had Tylenol or Advil at that time. The thing that always helped the most was massage, and then they would finally go away and everyone got to go back to sleep. Parents often note that growing pains occur more frequently after their child has been extremely active. Why some children have pains recurrently while others never complain is not understand. Besides complaining of leg pain, again usually at night, there are no other related symptoms such as fever, limping, rash, or joint swelling. Your child should play normally and not be limited in their activity due to growing pains. Continue to use massage; heat and pain relievers as necessary and these growing pains do go away over time. That's your daily dose, we'll chat again tomorrow.

Daily Dose

Talking With Children About Sex Education

None of us wants our children to have bad memories of how they learned about their own bodies and sexuality.I have been helping teach a course to elementary students on their bodies and sexuality. It is really interesting as we teach both parents and their children, in separate rooms, so that parents are comfortable with discussing sexuality with their children as well as having doctors and nurses teach basic sex education to their children. It is a three-week series with different topics each week and really opens up the lines of discussion for parents and gives them information for further subjects and discussion as their child matures.

The most striking thing to me is how many parents admit to being "afraid or nervous" or feel ill-prepared for this discussion and many of those feelings come from their own experience learning about "the birds and the bees". If there is anything to learn from this, one would think, is that none of us wants our children to have bad memories of how they learned about their own bodies and sexuality. So, I recommend that starting from a young age you use the correct noun for body parts. No one has a problem saying this is your eye, or nose or ear, so when identifying other body parts stick with the correct words. By doing so you begin this journey of sex education with the correct words at hand. It is easier to discuss a subject with knowledge of the body part you are talking about than having to back track and re name things. Lastly, when your child asks a question, take the time to answer them truthfully, even if it is only a one-line answer, rather than saying "I can't talk to you about that yet" or something along those lines. Open the door slowly and it is easier to go in....remember it is a continuum of information which does not end for many years. That's your daily dose, we'll chat again tomorrow.

Daily Dose

Development Seems to Happen Overnight

It still amazes me how quickly children change.It is still fun for me to see my patient's growing up. I saw a 12-year-old girl today and suddenly she is "pubescent". Why do I act like that is surprising? It really shouldn't be as this is the normal age to see a young girl developing, but it still amazes me how quickly children change. Boys do the same thing only it is typically a little later. The cute "little" girl at 10 is now looking more like a young lady.

The body changes brought on by hormones follow a fairly typical pattern and if you see it happen in your own child, you too may be astonished at how quickly they can change. I remember one day many years ago that a father of three precious girls told me that he was going to lock his daughters in the closet before the "breast fairy" came. He continued by saying that despite his best efforts and much to his own amazement it seemed to "happen over night." The closet was never completed and he is now the proud father of two married daughters, two grandsons and a daughter in medical school. How time flies. The "typical" course of pubertal development for girls begins with breast budding and then progresses through further body changes, a spurt in height over an 18-24 month period and then the beginning of menstrual periods, which is called menarche. This is a process and takes time but it seems to happen in front of your eyes. There are lots of good books on this topic, so start looking before you even need them. Preparing your daughter for these body changes with good, factual information is one of the most important parenting jobs. Your daughter may not want to discuss puberty, but it is a vital necessity that you as parents do. Remember the fairy, she arrives overnight. That's your daily dose, we'll chat again tomorrow.

Your Teen

Sugary Drinks May Increase Early Menstruation in Girls


The consumption of sugar-filled beverages has been linked to an increased risk of childhood obesity and type2 diabetes. A new study shines another light on the association between high-sugar drinks and young girl’s potential health problems.

Researchers found that, on average, girls who consumed more than 1.5 servings of sugar-sweetened beverages started menstruation 2.7 months earlier than girls who consumed two or fewer servings of these drinks each week.

The team said their findings raise concerns because earlier menstruation has been associated with increased risk of breast cancer. They say a 1-year decrease in age at first menstruation is estimated to raise the risk of breast cancer by 5%. "Thus, a 2.7-month decrease in age at menarche likely has a modest impact on breast cancer risk."

In another study, early menstruation has also been linked to a slight increase of risk for hypertension, heart attack and stroke.

According to the Centers for Disease Control and Prevention (CDC), approximately half of the US population consumes sugary drinks on any given day, including around 60% of females aged 2-19 years.

This latest study is the first to associate sugary drink consumption in girls with the age of first menstruation, or menarche.

To reach their findings, Prof. Karin Michels, associate professor at Harvard Medical School in Boston, MA, and her team analyzed 5,583 girls aged 9-14 years who were a part of the Growing Up Today Study, which involves 16,875 children of participants from the Nurses Health Study II.

At the beginning of the study in 1996, none of the girls had started their periods. In a follow-up in 2001, 159 girls (3% of the participants) had started menstruation.

During the 5-year study, the girls were required to complete a dietary questionnaire that revealed their consumption of sugary drinks. The drinks contained added sugars such as sucrose, glucose and corn syrup.

They were also asked how often they consumed the drinks.

The team found that at any age between 9 and 18.5 years, girls who consumed more than 1.5 servings of sugary drinks each day were approximately 24% more likely to begin menstruation in the next month than girls who drank two or fewer servings each week.

Overall, the girls who drank the most sugar-laden drinks began their periods aged 12.8 years, while those who drank the least amount began menstruation at age 13.

These results remained significant even after the researchers accounted for other factors that could influence the age of first menstruation, such as body mass index (BMI), birth weight, height physical activity, ethnicity/race, family composition and how often the girls ate dinner with their family.

The team notes sugary drinks have a higher glycemic index than naturally sweetened drinks, which can trigger a rise in insulin concentrations. An increase in insulin concentrations can lead to a rise in concentrations of sex hormones, which can cause earlier menstruation - a potential explanation for the team's findings.

While drinking too many sugary drinks may lead to early menstruation in young girls, the more pressing health problem is likely to be obesity and type2 diabetes. These are problems that can lead to more serious health issues over a child’s lifetime.

Helping children understand the health benefits of laying –off these kinds of drinks (whether regular or artificially sweetened), when they are young will make it much easier for them to resist getting hooked by the time they reach the age of puberty.

The study’s findings were published in the journal Human Reproduction.

Source: Honor Whiteman,

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