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Daily Dose

Giving Your Child Medicine

1:15 to read

Since I recently wrote an article about teaching young children to swallow pills, here is another reason to teach this to children sooner than later. The American Academy of Pediatrics has a new policy statement encouraging parents, physicians and pharmacists to use only metric measurements on prescriptions,medication labels and dosing cups to ensure that kids receive the correct dose of medication.

In other words, no measuring medications with teaspoons or tablespoons and especially not the ones in the cereal drawer.  Because spoons come in many sizes, they are not precise enough to measure a child’s medication.  For infants, toddlers and young children, a small error in dosing, especially if repeated for many doses, may be toxic.  

These recommendations also mean that doctors, like myself, need to prescribe medications in metric units like milliliters rather than teaspoons. We also need to instruct parents to use metric dosing devices, and not any measuring devices that have confusing markings with both teaspoons, tablespoons and milliliters. The medication should also come with an appropriate sized dosing device to avoid the possibility of two and three fold dosing errors.

The recommendations also call for manufacturers of over the counter medications to eliminate labeling, instructions and dosing devices that contain units other than metric units...no more 1 teaspoon, but rather 5 milliliters.

I am going to make a conscious effort to make sure that I am now writing my prescriptions with the correct units and help make dosing errors less of a problem and all medications safer for my “little” patients.

No more kitchen spoons!!!

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

New Year New You

1:30 to read

With the New Year upon us what better time to talk about changing some habits.  Why is it that habits are certainly easy to acquire, but difficult to change?  I saw a book on The New York Times Bestseller list about “Habits” and I am committed to reading it this year.  

I know that we started many “bad” habits when my husband and I were new parents, and I talk to my patients every day about not doing the same things I did.....but, even with that knowledge there are several recurrent habits that I wish parents would try to change....or better yet, don’t start.

Here you go!

#1  Do not have your baby/child sleep with you  (unless they are sick).  This is a recurrent theme in my practice and the conversation typically starts when a parent complains that “I am not getting enough sleep, my child wakes me up all night long”.  Whether that means getting in the habit of breast feeding your child all night long, or having your two year old “refuse” to go to sleep without you...children need to be independent sleepers. Some children are born to be good sleepers while others require “learning” to sleep, but either way your child needs to know how to sleep alone. I promise you...their college roommate will one day thank you.

#2  Poor eating habits.  Family meals are a must and healthy eating starts with parents (do you see a recurrent theme?). I still have parents, with 2, 3 or 4 children who are “short order cooks” which means they make a different meal for everyone.  Who even has the time?  Sounds exhausting!!  Even cooking 2 meals (breakfast, dinner) a day for a family is hard to do for 20 years, but enabling your children to have poor eating habits by only serving “their 4 favorite foods- is setting them up for a lifetime of picky and typically unhealthy eating.  Start serving one nutritious family dinner and let everyone have one night a week to help select the meal. Beyond that, everyone eats the same thing.  Easy!  If they are hungry they will eat.

#3  No electronics in your child’s room. If you start this habit from the beginning it will be easy....if you have a TV in your child’s room when they are 6-8, good luck taking it out when they are 13-15.  First TV in their room should be in a college dorm.  For older children make sure that you are docking their electronics outside of their rooms for the night. Everyone will sleep better!

These may sound easy....so give it a try.  

Happy New Year!

 

 

Daily Dose

Ear Infections

1:30 to read

Musings from the very busy pre-holiday pediatric office:  with all of the advances in technology over the last 30 years why is it that examining a child’s ears and visualizing their eardrum continues to be challenging?  I started thinking about this while examining a very unhappy, strong and febrile toddler….probably the 20th patient of the day. 

 

During the “sick season” many of the patients who come to my office are young children whose parents are worried that they may have an ear infection.  This concern is one of the most frequent reasons for pediatric office visits. While I realize that many of my colleagues are in the operating room operating on brains or doing open heart surgery (truly saving lives) the one advantage that they have is that their patient is under anesthesia while they are doing complicated procedures. Which only means that they are not trying to wrestle, cajole, or coax a child into letting them look into their ear canal, and then only to find that you can’t see a thing as the canal is full of wax (cerumen).  

 

At times examining ears can be fairly simple and straight forward, but some days it seems that it may be easier to attempt to fly than to look at a 16 month old child’s ears. Today was one of those days. It seemed that every child I saw had a temperature over 102 degrees, and they all had “waxy” ears. While there are several ways to remove wax from the ear canal, none of them is easily done in a toddler, especially when the wax is hard and difficult to remove. Having 3 children myself and one who had recurrent ear infections and tympanostomy tubes, I know what it is like to have to hold your child on the pediatrician’s exam table while they irrigate or “dig” wax out of the ears.  Not fun….!!!  But, at the same time I realize that this is the only means to see if the ear is infected and if there is the need for an antibiotic. 

 

With the advent of the HIB and Pneumococcal vaccines the incidence of ear infections has dropped significantly, as these bacteria were common causes of otitis. But, ear infections are still the #1 reason that a child receives an antibiotic, especially in the first 2 years of life.  Therefore, a good ear exam is one of the most important things your pediatrician does, as I know you don’t want your child to receive an unnecessary antibiotic!

 

Please know that pediatricians do not enjoy making a child uncomfortable, but somehow that ear drum needs to be seen…especially in a sick child.   

 

So…why has some brilliant medical device inventor not found a way to wave a magic wand over a child’s ear to “tell me” if their ear is infected?  To date, I have not seen any “new” ways to accurately examine an ear other than with the otoscope…and a clean ear canal…which means unhappy children (and parents ) while I try to clean their ears.  

 

Remember, don’t use q-tips in your child’s ears and if your pediatrician has to struggle a bit to clean out  your child’s ears, it is only because they are doing a good job!!  I am waiting for the “easy” button….surely it is coming…maybe Santa will bring it!

 

 

   

Daily Dose

It's Cold Season!

1:30 to read

Although it is just getting really cold across the country, it feels as if we have been in full cold and cough season for awhile.  The office sounds like what I call “kennel cough” as every child seems to be  coughing…. even those who are just coming for check ups. 

 

Parents often ask, “what is the best way to keep from catching a cold?” and the answer continues to be, “wash your hands and try not to touch your hands to your eyes, nose and mouth”.  Easy enough for an adult (well maybe not), but trying to tell your toddler not to put their hands in their nose or mouth is nearly impossible! That is one reason that children get so many colds in the first several years of life. Toddlers typically get the most colds as they have just started having playmates with whom they share not only toys but their germs…all part of growing up.

 

I remind parents that coughs are there for a reason. While they are a huge nuisance, and cause a lot of sleepless nights for both the child and parent, a cough is there to keep the lungs clear, and a cough is actually protective. In other words, coughing helps you clear the lungs of mucous that comes with a cold and helps to prevent pneumonia and secondary infections.  But, with that being said, learning to cover your mouth when you cough is not only polite, but it is also protective for others. It is a big day when your child learns to cover their mouth with the crook of their arm (better than the hand). Who knew as a parent this would be a milestone for your child?

 

Whenever your child is sick and has a cough and cold it is important to not only listen to their cough but to actually observe how they are breathing.  Parents send me videos or voicemails of their child coughing, but I am usually more interested in seeing their chest and watching their breathing. Your child may have a huge productive cough and sound terrible, but have no respiratory distress. With that being said, your child may also have a tiny little non-productive cough and be struggling to breath. In most cases the visual is more important than the audible. 

 

The best treatment for a cold and cough continues to be the tried and true…saline and suction to clear the nose of the mucous and make it easier to breath, a warm bath or shower before bed to loosen up the mucous, a cool mist humidifier in the bedroom and honey for the cough. Remember, you cannot use honey in a child under the age of 12 months! 

 

Don’t panic if your child gets sick, as each time they fight off a cold and cough they are actually boosting their immune system…small victories.  It is not unusual for a toddler to get 6 - 7 colds in one season (and their parents get half as many as that from them). Once your child turns about 3 you will see that they don’t get a cold every other week and also seem to handle the viruses a bit more easily.

 

If your child has any difficulty breathing you need to call your pediatrician!

 

 

 

 

 

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Back to School

Back to School Stress

Daily Dose

Are Kids Too Connected?

1:30 to read

We are living in a digital world which is ever changing. In light of this, the American Academy of Pediatrics (AAP) has been reviewing their recommendations regarding screen time. While there has been much written on the subject, the newest data from many families regarding their digital experience shows just how “connected” we really are.

The AAP has not yet published a new policy statement on this matter (due in 2016), but their Growing Up Digital working group has just released new guidelines in the hopes of giving parents some practical guidance. While the AAP has previously recommended limiting screen time to “2 hours/day”, the one size fits all does not seem to work (which is true of many things).  We are all living in an “online” world, and it appears it is only getting more “connected” via screens, so how do you really deal with this? 

I personally still think it is very important to try and limit screen time for children under the age of two. This is the basis of parenting….be aware of the importance of modeling behavior even beginning at the earliest ages. Which means you too have to limit your screen time when you are with your baby and toddler,and spend more time talking or reading to your child (which is still shown to be important in early brain development) without your phone/computer distracting you. This does not mean that your toddler never has the chance to watch Daniel Tiger or Sesame Street, but be aware of how much they are watching.  As a parent, I know too well myself that sometimes an 18 month old is safest in front of a screen watching a “healthy” program, while you shower or cook a meal and parents shouldn't feel “guilty” about this. Once done…turn off the screen…these are good habits to begin with.

As your child gets older it is equally important to “parent” their screen time, and to teach them the appropriate use and behaviors of their “on line” lives.  While so many kids are now on a screen during the school day,  as well as for homework and out of school assignments, remind your children that face to face interaction is very important.  While the world is totally available digitally, socialization “off-line” teaches other skills that cannot be found when engaging solely on a screen - even with Skype and FaceTime.  Like many things moderation seems to be the key. Another recommendation, have “tech-free” zones. This is especially important at meal time and bedtime.

I also think it is important to enforce no screen before school and while in the car on the way to school.  Conversation during mealtimes is so important!  (whether at home or in a restaurant). It is often one of the few times in the day that a family is all together. Carpooling to school is another great opportunity to talk and listen to the kids, rather than having a movie playing on the DVD player.  I remember driving our teenagers and their friends to school or sporting events and listening while they just talked to one another.  It was one of the best times to hear what was going on in their lives. Save that DVD player for long trips and special occasions. 

Lastly, parents need to know and be aware of what their kids are doing on line….this is true for children of all ages.  Begin with solid family rules and expectations for appropriate use of social media and the digital world…and just like many things the boundaries and limits will change as your child gets older.  But if you find your child is using technology inappropriately there need to be consequences.  We all make mistakes, but use mistakes as teachable moments.  

Digital life is here to stay, and the technology changes in a nano-second, so watch for more and more information on this topic.

 

 

 

Your Child

Are Overindulgent Parents Raising Narcissistic Kids?

2:00

The authors of a new study say their research demonstrates that narcissism in children is cultivated by parental overvaluation: parents believing their child to be more special and more entitled than others. In contrast, high self-esteem in children is cultivated by parental warmth: parents expressing affection and appreciation toward their child.

"It comes pretty naturally," said senior study author Brad Bushman, a professor of communication and psychology at Ohio State University. "Most parents think their children are special, and deserve better treatment. But when our children receive special treatment, they become narcissistic and come to believe they deserve more and are superior to others."

On the opposite end of the scale, researchers found that children raised in an atmosphere of simple parental warmth were more likely to have an appropriate level of self-esteem, but not narcissism.

"It's good to be a warm parent and a loving parent, but it's not OK to treat your children as if they are better than others," Bushman concluded. "Everyone we meet is better than us at something, and the fact that we're all human beings makes us equally valuable."

In the study, researchers evaluated 565 children aged 7 to 11 from middle-class neighborhoods in the Netherlands, along with their parents.

Parents and children answered a series of questions designed to assess a child's narcissism and self-esteem, as well as a parent's warmth and overvaluation of their child. Researchers administered the questionnaires four times over a period of 18 months.

The research team found that parents who overvalued their children -- reflected in statements such as "my child is more special than other children" -- did end up with children who were overly convinced of their own importance.

"I honestly believe one of the most dangerous beliefs that a person can have is that they are [more] superior than others," Bushman said. "When people think they are superior to others, they behave very badly. It's much better to treat everybody like we are all part of the human family, and are all worthy of respect."

The study did not prove that parents who idolize their children cause their child to be narcissistic; it only showed a link between the two.

Bushman believes that children should earn their rewards and not simply be given them.

"In America, we have it all backward. We assume if we boost our child's self-esteem, they'll behave well. We assume self-esteem is the panacea for every ill," he said. "Rather than boost self-esteem and hope our kids act well, we should wait for good behavior and then give them a pat on the back for that."

James Garbarino, senior faculty fellow at the Center for the Human Rights of Children at Loyola University Chicago, warned that parents who treat their children as though they walk on water are setting them up to sink like stones later in life.

"It's a good investment to temper narcissism, because otherwise you are setting your kids up for a big fall later in life," Garbarino said. "Eventually, life shows you that you're not that special. You've heard the saying, 'Time heals all wounds?' In this case, 'Time wounds all heels.' "

What is narcissism? Narcissism is an obsession with one’s self and an exaggerated sense of entitlement. A narcissistic personality seeks attention constantly and considers themselves better than others. When they feel humiliated, they can lash out aggressively or even violently. They set unrealistic goals and often take advantage of others to achieve those goals.

An appropriate amount of self-esteem comes and goes in cycles. It’s a child’s sense of worth and belonging. Family, friends, failure, skills and accomplishments play a large role in the building and re-building of self-esteem. A child is better able to achieve a healthy dose of self-esteem when parents offer realistic support and respect in their child’s struggles. Self-esteem can also come from helping others.

As parents, most of us believe that our children are indeed special – that’s a normal parental outlook. This study however, looks at the type of parent that believes his or her child is not only special (in their eyes) but should also be seated far above all others. The kind of parenting that teaches a child that everything they desire should be given to them even at the risk of hurting others. 

The study was published in the March online edition of the Proceedings of the National Academy of Sciences.

 Sources: Dennis Thompson, http://www.webmd.com/parenting/news/20150309/overindulgent-parents-may-breed-narcissistic-children

http://www.webmd.com/mental-health/narcissistic-personality-disorder

Your Teen

Alcohol-Branded Clothing & Accessories Linked to Youth Alcohol Use

2:00

The T-shirts, handbags, backpacks, hats, jackets and sunglasses we wear and carry all say a little something about who we think we are or would like to be. Clothing with slogans and photos, accessories with name –brands or specific designs help express, at least a small way, how we connect with others and want others to connect with us.

From politics to religion to music and movies – we’re not likely to wear something that we philosophically disagree with. That’s pretty much true in all age groups.

So, what does it mean when teens proudly wear clothing and carry products with alcohol-brands up front and center?

According to a large review of different studies on the topic, teens that own caps, shirts, and other merchandise displaying alcohol logos are more likely to drink.

Australian researchers reviewed results from 13 studies looking at alcohol-branded merchandise and teen alcohol use. The research included more than 26,000 kids and teens, mostly from the United States.

Four studies looked specifically at young people who hadn't started drinking alcohol. Those who owned alcohol-branded merchandise were more likely to start drinking a year later, the researchers said.

While the study doesn’t prove causation (teens will drink if they own alcohol-branded items), it does show an association between the two activities.

"It is possible that owning the merchandise makes young people more likely to drink, or that young people who drink are more likely to want to own the merchandise, or a combination of these effects," explained study leader Sandra Jones. She's director of the Centre for Health and Social Research at Australian Catholic University in Melbourne.

Dr. Victor Strasburger, lead author of the American Academy of Pediatrics' Children, Adolescents, and Advertising policy statement, said, "The studies showed that this ownership contributes to onset of drinking, not the amount of drinking.”

“But we know that when teenagers begin drinking, they tend to binge drink, not use good judgment, and drive when drunk or intoxicated," he added.

Because of the study’s findings, Jones believes that promotional alcohol-branded products encourage drinking among adolescents.

"As they transition through adolescence, young people are developing their sense of identity," she said.

"The things that they wear, carry, and consume help to create and convey their desired identity. There is increasing evidence that brands facilitate this by allowing the young person to take on and project the desirable characteristics that are associated with that brand. These characteristics and brands then become a part of their sense of self, as well as the way that others see them," Jones said.

In addition to hats, caps and T-shirts, other examples of alcohol-related products include accessories, such as bags, backpacks, belts, lighters, sunglasses, wallets and key rings. Other promotional items include drinking glasses, utensils, cooler bags, bottle openers and coffee cups, the researchers said.

Depending on the study, ownership of such items ranged from 11 percent to 59 percent of the young participants. Ownership was higher among older children and males, the researchers said.

Most of the studies didn't find any gender differences. But two studies did find that the association between branded merchandise and drinking issues was actually stronger for girls.

Jones noted that company policies and regulations could help prevent the availability of such products for teens. She recommended restricting the sale of alcohol promotional products where the sale of alcohol is allowed, that alcohol-branded clothing not be made in children’s sizes and toys and gimmicks that appeal to children be discontinued.

Jones also noted that it’s not only up to businesses and government to regulate the availability of these products to kids, but parents as well.

"Many of these items are given away for free at promotional events or as gifts with purchase, and parents may hand them on to their children -- or allow others to do so -- without processing the fact that they are providing their child with extended exposure to an advertisement for an alcohol brand," she said.

Strasburger said the media are often irresponsible when it comes to alcohol. "They depict alcohol use as normative behavior, or a solution for complex problems, or show being drunk as funny," he said. "We spend something like $5 million on alcohol advertising every year, then we wonder why so many teenagers drink. It's not rocket science."

The findings were publised online in the April 1st edition of the journal Pediatrics. 

Story source: Don Rauf, http://consumer.healthday.com/kids-health-information-23/kids-and-alcohol-health-news-11/booze-branded-merchandise-may-spur-teen-drinking-709478.html

 

 

 

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