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Your Baby

Recall: Skip Hop Convertible High Chair

2:00

The U.S. Consumer Product Safety Commission (CPSC,) Health Canada and Skip Hop have recalled the Skip Hop Tuo Convertible High Chair after discovering that the front legs on the highchair can detach from the seat, posing a fall and injury hazard to kids.

The recalled item is the charcoal colored Tuo Convertible High Chair, which converts into a toddler chair.

Consumers with the chair should check for style numbers 304200 and 304200-CN with the date codes HH102016, HH11/2016, HH3/2017 and HH4/2017, which can be found on the back of the chair.

Skip Hop has received 13 reports of the legs of the high chairs detaching, resulting in two reports of bruises to children.  

The Skip Hop Convertible High Chair was sold at Babies ”R” Us, Buy Buy Baby, Target, Kohls, Dillards and other children specialty stores nationwide and online at Amazon.com and Skiphop.com from December 2016 through September 2017 for about $160.

Consumers should immediately stop using the recalled high chairs and contact Skip Hop for a free replacement. 

You can contact Skip Hop toll-free at 888-282-4674 from 9 a.m. to 5 p.m. ET Monday through Friday, or online at www.skiphop.com and click on “Recalls” for more information.

Story source: https://www.cpsc.gov/Recalls/2018/Skip-Hop-Recalls-Convertible-High-Chairs-Due-to-Fall-Hazard

Your Child

Protecting Your Child’s Skin in Winter

3:00

Between the cold weather outdoors and the dry heat indoors, your child’s skin can become dry, itchy and irritated.

Dry skin is a common problem in winter because as the humidity level drops and the air cools, the water in your skin evaporates more quickly. Babies and small children’s skin is very delicate and more susceptible to drying out.

As the temperatures drop outside, we naturally tend to spend more time indoors. This time, it’s the heat in the house that sucks the moisture out of the air. Dry indoor air not only dries out your skin, it also dries out your mucous membranes, leading to dry, chapped lips, dry noses (nosebleeds), and dry throat (hoarseness, sore throat).

There are several ways you can help combat these skin irritating scenarios.

Moisturize, moisturize, moisturize. The general rule is the thicker the better. If your child's skin is still dry even with daily moisturizing, try switching from a lotion to a thicker cream or ointment. Ointments are best at keeping moisture in the skin, but they can feel greasy. Just use small amounts and gently rub it into the skin. Creams rub in without leaving a greasy feel on the skin.

You might also want to consider moisturizing twice a day – once after bathing and once during the day. If your child doesn't have the patience for a midday slather, you might let them listen to a favorite song or watch a video while you apply the moisturizer. Or, if he or she is old enough, let them do it by themselves, if that makes the routine more agreeable.

Make sure that your child is well hydrated. Dry skin lacks moisture. Offer your child plenty to drink year-round to replace the moisture that's evaporating from his or her skin. If your child is still a baby, stick with breast milk or formula for at least the first six months, unless his doctor advises otherwise.

Keep in mind that drinking a lot of water won't do anything if you don't moisturize as well. It's like pouring water into a bucket with a hole, says Seth Orlow, Director of pediatric dermatology at New York University School of Medicine.

Without moisturizer to hold in the water, your child's skin won't properly hydrate.

Trim back on bath time. Bathing dries a child's skin because it removes the skin's natural oils along with the dirt. Instead of a 30-minute bath, cut bath time down to about 10 minutes. Use warm water – not hot – and soap up sparingly. In fact, Orlow suggests using a fragrance-free, soap-free cleanser, which is much less harsh than regular soap.

Once you take your child out of the bath, quickly pat him dry with a towel, and then apply moisturizer immediately. Applying the moisturizer within minutes of taking your child out of the tub will seal in the water that's still in his skin from the bath.

To help with the dry air inside the home, make sure that you run a humidifier during the night when your little one is sleeping. Humidifiers can help soothe dry sinuses, bloody noses and cracked lips. They can also help ease symptoms of a cold or another respiratory condition.

When using a humidifier, make sure it is maintained properly and kept clean to avoid bacteria and mold. Find out what humidity levels are recommended by the manufacturer.

When outside, shield your child’s lip with thin layer of petroleum jelly or lip balm to create a barrier against the elements.

Protect against frostbite. Dress your baby in mittens and a hat or hood, and don't stay out too long. Extend the cover on your stroller to block the wind. If your baby's skin looks red, use a warm washcloth to restore circulation. This may take several applications over a period of time. Call your doctor if her skin color isn't normal in a couple hours.

Chapped skin, which gets ruddy, peels, and even cracked, usually strikes the face, bottom, or spots where skin rubs, like the folds at the wrists. "Chapped skin is basically dry skin that has become inflamed," says Peter Lio, MD, attending physician in dermatology at Children's Hospital Boston. Blame anything irritating: wind, friction from clothing, drool on the chin, a runny nose, or a wet diaper.

Spend as little time in the elements as possible, and bundle him up when you do go outside. Using a thick moisturizer such as Eucerin, Aquaphor, or petroleum jelly on your baby's cheeks (or other problem areas) will add to his natural barrier and help treat any skin that's already chapped.

It may be downright cold outside, but that doesn’t mean you have to keep your kids indoor 24/7. If you bundle your little one up in layers and cover their head, feet and hands, apply balms and preventative creams– they should be able to be outside for short periods – depending on the temperature and wind chill.

One other little fact that may surprise you, kids can get a heat rash if they become overheated from too many layers of clothing. Make sure to keep an eye on how they are doing and if you think they are getting overheated, have them come inside, rest a bit and remove some of the extra layers.

Story sources: https://www.babycenter.com/0_dry-skin-in-children_1515109.bc

Wendy Toth and Rebecca Felsenthal, https://www.parents.com/baby/care/skin/infant-winter-skin-symptoms/

https://www.mayoclinic.org/diseases-conditions/common-cold/in-depth/humidifiers/art-20048021

Daily Dose

Constipation

1:30 to read

Constipation is a topic that every pediatrician discusses….at least weekly and sometimes daily. It is estimated that up to 3% of all visits to the pediatrician may be due to constipation. Constipation is most common in children between the ages of 2 and 6 years. I have been reading an article on updated recommendations for diagnosing and treating common constipation. The most important take home message is “ most children with constipation do not have an underlying organic disorder. Diagnosis should be based on a good history and physical exam for most cases of functional constipation”.

 

Like many things in medicine….the evaluation and treatment of constipation has also changed a bit since the last guidelines were published in 2006. It is now appropriate to define constipation with a shorter duration of symptoms (one month vs two) and some of the most common diagnostic criteria (Rome IV Diagnostic Criteria) include the child having less than 2 stools/week, painful or hard bowel movements, history of large diameter stools (parents will tell me their 3 year olds “poops” clog the toilet), and some may have a history of soiling their underpants. 

 

By taking a good history you can avoid unnecessary tests..including X-rays which are not routinely recommended when evaluating a child with possible constipation.  In most cases physical findings on the abdominal exam will confirm the diagnosis in combination with the history. I often can feel hard stool in a child’s left lower quadrant and when asked the last time they “pooped”, no one can really recall. 

 

The preferred treatment is now polyethylene glycol (PEG) therapy. PEG is now used to help “disimpact a child” as well as to maintenance therapy.  Where as enemas were often previously prescribed, PEG therapy has been shown to be equally effective in most cases, is given orally and is much less traumatic (for parent and child!). PEG works by drawing more water into the stool, causing more stool frequency. There are many brands of PEG including Miralax and GoLytely among others. Miralax works well for children as it is tasteless and odorless and can easily be mixed in many liquids without your child knowing it is there. 

 

The guidelines now state that for children with functional constipation maintenance therapy with PEG should continue for as least 2 months with a gradual tapering of treatment only after a full month after the constipation symptoms have been resolved. I usually tell parents that this is equivalent to about how long it takes for them to forget that they have been dealing with constipation….and then begin tapering.

 

Lastly, there is no evidence that adding additional fluid or fiber to a child’s diet is of benefit to alleviate constipation….although it may “just be good for them in general”.

 

 

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Your Toddler

Recall Reminder: 8th Child Dies From Fallen IKEA Dresser

2:00

IKEA has voluntarily issued a reminder about its recall of MALM and other models of chests and dressers due to a serious tip-over hazard. An 8th child has reportedly died after being trapped under a fallen IKEA dresser.

CEO Lars Petersson said Ikea wants to increase awareness of the recall campaign for several types of chest and dressers that can easily tip over if not properly anchored to a wall.

The initial recall was issued in June 2016, for 17.3 million chests and drawers. The Swedish retailer and the federal safety regulators are reminding customers to take immediate action to secure the dressers, or to return them.

This recall re-announcement involves MALM and other IKEA chests and dressers that do not comply with the requirements of the U.S. voluntary industry standard (ASTM F2057-14).  The recalled children’s and adult chests and dressers include the MALM 3-drawer, 4-drawer, 5-drawer and three 6-drawer models and other non-MALM models.  The recalled children’s chests and dressers are taller than 23.5 inches; recalled adult chests and dressers are taller than 29.5 inches. 

The MALM chests and dressers are constructed of particleboard or fiberboard and are white, birch (veneer), medium brown, black-brown, white stained oak (veneer), oak (veneer), pink, turquoise, grey, grey-turquoise, lilac, green, brown stained ash (veneer), and black.  A 5-digit supplier number, 4-digit date stamp, IKEA logo, country of origin and “MALM” are printed on the underside of the top panel or inside the side panel.  

To see a complete list of other non-MALM chests and dressers included in this recall, click on this link www.IKEA-USA.com or http://www.ikea.com/ms/en_US/ikea-chest-and-dresser-recall/index.htmlon IKEA’s website.

Dangerous tip-over incidents often occur when curious kids climb on furniture in an attempt to access TVs, toys, remotes or other desired items.  While the threat is serious, the solution is simple. Anchor TVs, furniture and appliances in the home. And when product recalls are announced, act on them immediately. Visit AnchorIt.gov to see how TV and furniture tip-over incidents occur and the simple steps to prevent them.

Story Source: https://www.cpsc.gov/Recalls/2018/IKEA-Reannounces-Recall-of-MALM-and-Other-Models-of-Chests-and-Dressers-Due-to-Serious-Tip-over-Hazard

Your Child

“Holiday Asthma” and Children

2:00

Mix together a Christmas tree, decorations pulled out of dusty storage; perhaps a new kitten or puppy, plus dry heat in the house from cold temperatures and you’ve got a recipe for “Holiday Asthma.” Those are just a few of the things that can trigger a child’s asthma attack.

“Each individual‘s asthma triggers differ,” says Kristy Miller, a spokesperson for the Environment Protection Agency. "However, from an indoor environmental perspective, the primary asthma triggers include secondhand smoke, pet dander, mold, dust mites, and pest droppings. During the winter months, many people spend more time indoors, so steps should be taken to reduce or eliminate exposures to these environmental asthma triggers."

How you can you help your child avoid these common holiday triggers? We found helpful information when WebMD turned to an expert for advice.

One dangerous trigger is respiratory infection. Respiratory infections are rampant during the winter months, particularly during the holidays, when families travel around the country, with millions of other sneezing and coughing merry-makers.

“Asthma flair-ups are frequently due to infections,” says Richard Honsinger, MD, of the Los Alamos Medical Care Clinic. “And during the holidays, we see an increased number of respiratory infections with all the traveling and with people sharing their bugs that cause asthma symptoms to worsen.”

How can you avoid these harmful infections? One solution is to avoid traveling during one of the most contagious times of the year. The other is to make sure that your child and other family members properly wash their hands. That may sound too simple, but a good scrubbing with warm water and soap for at least 15 seconds--can reduce the number of germs your kids pick up over the course of the day, which in turn helps lowers the risk of catching a cold and triggering asthma.

Many families have switched from using real trees to artificial Christmas trees for convenience and to avoid allergies. However, the actual culprit may be the decorations.

“People get all their ornaments out of their basements and closets and they’re covered in dust,” Honsinger says.

The Christmas tree all lit up with warm lights and decorated with old bulbs is a perfect recipe for asthma trouble in kids, so wipe it down with a damp cloth before you set it up in the middle of your living room to remove outdoor allergens. Before you drag your holiday storage containers out of the basement, give them a good dusting so they’re free of mites, pest droppings and other unpleasant holiday treats, and wash decorations before you put them on the tree.

Roaring fireplaces not only provide a traditional backdrop for the holidays, but also come in handy for warming the house. Unfortunately, fireplaces can trigger asthma.

“Fireplaces and stoves and things that leak smoke are things that increase the asthma response,” says Honsinger. “It’s not a true allergy--you can’t test for smoke allergies on the skin--but we know that particulate matter or burning material in the air causes an increase in asthma symptoms.”

Particulate matter can also mean exhaust and cigarette smoke, explains Honsinger. So before you set off to visit family members or friends that smoke, remember to pack your child’s medicine – and be prepared to head home early if asthma symptoms flare up.

Then there is the new kitty or puppy issue. Giving your child a puppy or kitten for Christmas sounds like an enchanting idea, but don’t forget that that adorable little bundle is covered in dander--a common asthma trigger.

“Parents get their kids a new dog for Christmas, when they don’t know if the kids are allergic or not,” says Honsinger, who is a professor of clinical medicine at the University of New Mexico. “It’s a time of year when its cold, so pets are indoors more often than not, so their dander is inside as well and we see an influx of pet allergies and asthma symptoms.”

If your child has asthma, eczema or other allergies, it’s probably a good idea to have him or her skin tested for animal allergies -before you start picking out a puppy or kitten name.

During the winter months, cold air is something most people aren’t going to be to able to avoid unless you live in a warm region of the world and even then- surprises happen.

“We know that breathing cold, dry air will increase asthma symptoms,” says Honsinger. “It excites the receptors in the lung causing asthma to come on quickly.”

Cold air dries the lungs out, and makes the chest tighten, explains Honsinger. Warm, moist air, however, is just what a kid with asthma needs.

“During cold weather have your child wear a scarf when he’s outside,” says Honsinger. ”They breath through the cloth and it catches moisture. Then they breath back in through it and it warms the air and makes the air moist. Then they’re less likely to get that feeling of tightness.”

To be on the safe side, if your child is playing outside, monitor her peak flow every hour or so. 

“Use a peak flow meter so you can see how fast your child’s air is coming out,” says Honsinger. “Use a set of guidelines that you set up with your physician, so if the peak flow drops below a certain level, use medicine. If it drops further, you better seek help. It’s something to watch.”

Because pharmacies and pediatricians may have irregular hours during the holidays, be prepared in advance. “If your child has asthma, have your medicine supply intact over the holidays when everything closes down,” says Honsinger. “If your child uses an inhaler or a nebulizer, make sure you have these on hand, so if asthma symptoms flare up in the middle of Christmas, you have something at home to start treatment right away.”

If your child doesn’t respond to available treatment, take him or her to the emergency room. Asthma isn’t something you want to let get the upper hand.

By applying some of these tips, your child may be able to escape “Holiday asthma!”

Merry Christmas and Happy Holidays from the Kids Doctor!

Story source: Heather Hatfield, https://www.webmd.com/asthma/features/holiday-asthma-triggers-for-kids#1

Daily Dose

Is Fruit Juice Healthy?

1:30 to read

I remember when my children were small that it was “routine” to begin offering infants dilute juice around 6-9 months of age.  Over the years the AAP (American Academy of Pediatrics) continued to advise against offering fruit juice to children under the age of 6 months.  Now…decades later, the AAP has just issued new guidelines including the recommendation “not to offer juice to children under the age of 1 year”.

 

The new recommendations will be published in the June issue of Pediatrics in which they write, “while parents may perceive fruit juice as healthy, it is not a good substitute for fresh fruit and just packs in more sugar and calories.”  The article continues to state, “small amounts in moderation are fine for older kids, but are absolutely unnecessary for children under 1 year.”

 

I always diluted juice for my children, even when they were older.  I would just add a few cans of water to concentrated juice and they never even knew it. It just seemed logical to me at the time. But while 100 percent fresh or reconstituted juice may be healthy, it should still be limited depending on a child’s age.  The concern over steadily increasing obesity rates as well as dental health and the risk of cavities makes even fresh fruit juice a culprit for added calories and sugar.

 

The recommendations include:  toddlers should never be given juice from a bottle or in a sippy cup that allows them to consume juice (even diluted) throughout the day. I continue to recommend that the bottle “goes bye-bye” at the 1 year birthday party and a child only drinks from a sippy cup at meals and snacks after that.  

 

The child should also not have a sippy cup to “wag around all day”.   Parents often tell me that “their child drinks water all day long” but again that may keep them from eating a healthy meal if they drink throughout the day. You know how many adult diets recommend “drink tons of water all day” so you won’t feel hungry…same may be said for a toddler who is already a picky eater.  

Small children get plenty of fluids at meals and snacks and are not hydrating for athletics like my older patients. There are no recommendations that young children drink a certain amount of water everyday….although parents swear their child needs 16 ounces a day?

 

In reality children of all ages should be encouraged to eat whole fruits and be educated about the difference between the fruit they choose and juice.  With “juicing” being so popular, they need to know that even “green juice” lacks dietary fiber and may contribute to excessive weight gain.  I agree that fruit juice is better than no fruit…but for toddler ages 1-3 years, no more than 4 ounces of juice a day, children age 4-6 only 4-6 ounces a day and for children 7-18 years only 8 ounces (1 cup) of juice. The recommendation is that a child should have 2-2.5 cups of whole fruit per day. 

 

I still recommend that my young patients only consume milk (low fat is fine) and water on an everyday basis and add juice later on…when their friends happen to tell them about juice boxes etc. If I am going to buy juice at all I recommend 100% fresh fruit juice and if you can, get juices with added calcium (a little extra never hurts!).

Lastly, juice is not appropriate for re-hydration or for the treatment of diarrhea. For those instances it is necessary to use an “oral re-hydration solution”.

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