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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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Diagnosis

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Your Teen

Most Parents Don’t Know Their Teen’s Vaccination Status

1:45

Most parents believe that they are on top of their kids’ immunizations, but that may not be true, especially where their teen is concerned.

Data from the Centers for Disease Control and Prevention (CDC) shows that adolescents are not getting all their recommended vaccinations, however, more than 90% of parents believe that their teenager had received all vaccinations necessary for their age, according to a C.S. Mott Children’s Hospital National Poll.

“In the United States, vaccines have long been recommended for babies and at kindergarten entry; more recently, several vaccines have been recommended for the adolescent age group,” Sarah J. Clark, MPHa research scientist from the Institute for Healthcare Policy & Innovation at the University of Michigan, and colleagues wrote. “However, data from the CDC indicate that national vaccination rates are well below public health targets, particularly those that require more than one dose, such as meningitis, human papillomavirus and annual influenza shots.”

The poll focused on vaccination for teenagers between 13 and 17 and included a national sample of parents.

Most parents had reported that their adolescent child had definitely (79%) or probably (14%) had all vaccinations recommended for their age, despite 36% of parents not knowing when their child is due for their next vaccine. The rest believed their child was due for their next vaccine within the next year (19%) or in more than a year (26%). One in five parents believed their teenager needed no more vaccines (19%).

The majority of parents polled relied on information about their child’s upcoming immunizations from their doctor’s office either through an office visit, scheduled appointment or a reminder that was sent. Rarely, would a notice be sent from the school, health plan or the public health department. A large number were not aware of how to be notified about upcoming vaccinations. 

"Parents rely on child health providers to guide them on vaccines in childhood and during the teen years,” Clark said in a press release. “Given the general lack of awareness about adolescent vaccines shown in this poll, there is a clear need for providers to be more proactive for their teen patients.”

Parents can be more proactive in finding out about their teens and younger children’s immunization requirements by checking their child’s school website or calling the school. The CDC also has a website with vaccination recommendations for children of all ages, including college students at https://www.cdc.gov/vaccines/schedules/index.html

The 2017-2018 school year will be here before you know it. Many schools will start up again in mid to late August. Do yourself and your child a huge favor by getting their immunizations up-to-date before the last minute rush!

Story source: https://www.healio.com/pediatrics/vaccine-preventable-diseases/news/online/%7Be6c9d80d-86d4-48a7-9090-b1e489e6db56%7D/majority-of-parents-unaware-of-teens-incomplete-vaccination-status

Daily Dose

Jaundice in Newborns

1:30 to read

It is not at all uncommon for a healthy newborn to develop jaundice in the first several days of life. Bilirubin is produced when red blood cells are broken down. It is a yellow pigment that we all metabolize in the liver and then it is excreted in urine and stools. In an newborn, the body produces almost 2-3 times the bilirubin that an adult does. Because newborns are also “immature” their liver cannot keep up with the bilirubin production and therefore bilirubin levels rise. In some cases the bilirubin is high enough to cause a yellowing of the skin (jaundice), and this is termed physiologic jaundice of the newborn. 

 

Your infant will have their bilirubin level checked while they are in the hospital and your pediatrician will follow any bilirubin levels that seem to be rising. In most hospitals the bilirubin is tested transcutaneously (through the skin), and you may never know that you baby has been tested. If bilirubin levels seem to be high, a blood test will be performed to more accurately assess the bilirubin level. If bilirubin levels continue to rise a baby may then be put under phototherapy (special blue lights that breaks down bilirubin in the skin and help it to be eliminated). Phototherapy prevents extremely high levels of bilirubin which may get into the brain and could be toxic to the baby and cause brain damage.

 

When a baby is put under phototherapy they may be in a basinette or wrapped in a “bili-blanket”  and they will wear sunglasses to prevent any damage to their eyes from light. They are usually naked or only in a diaper so that as much skin is exposed as possible. In most cases the bilirubin levels have peaked by day of life 3 or 4 and the baby will no longer need phototherapy. While the baby is under the “bili-lights” they will continue to have blood tests (from their heels) to follow the bilirubin levels.

 

As babies are now being discharged in 24-48 hours after delivery some babies will develop jaundice after they have already gone home…so you your doctor will plan on seeing you 1 to 2 days after your are discharged. But, should you notice that your baby seems to be getting more jaundiced you should call you doctor and be seen sooner.  

 

Just this week I saw a baby who continued to become more jaundiced after he went home. At times I see this when a mother is breast feeding and her milk has not yet “come in”.  If a baby is not getting a lot of milk then they cannot poop and pee out bilirubin…somethings just take time to get going with feeding, peeing, pooping and liver maturation. So…this baby boy was started o home phototherapy. Rather than re-admitting him to the hospital, a pediatric home health care company sent out a nurse with a bill blanket who instructed the parents on the use of it. The baby was then able to feed at home every 2-3 hours, and the bili-blanket was used throughout the day and night. The parents lived so close to the office that they would bring the baby in for bilirubin tests, while in other cases the nurse will go to the home to do the testing.  Home phototherapy in an otherwise healthy infant does not disrupt the new family and really helps the mother establish her breast feeding and lets “everyone” sleep in their own beds!

 

This baby only required phototherapy for 24 hours…in some babies it may be longer. Once the bilirubin was back in a “safe range” the lights were discontinued and he will continue to process the bilirubin on his own. His little yellow face and eyes will be the last evidence of his newborn jaundice and “one for the baby books” as it should never be a problem again.

 

Parenting

When is Your Child Ready for a Cell Phone?

3:00

Did you know that ninety-five percent of Americans own a cell phone of some kind? The percentage of cell phone ownership among 18-29 year –olds is even higher at 100%, according to the Pew Research Center on Internet and Technology.

It’s no surprise that more and more young kids are asking their parents to get them one.

So, what is the appropriate age to give your child a phone? The answer depends on several factors.

There’s no doubt about the convenience of having a cell phone handy when you need to communicate with someone. If your child has a cell phone, you can call or text him to find out where he is and what he's doing and inform him of your own plans. It can make you feel safer just knowing where your kids are. And in an emergency, a cell phone can be crucial if your child needs to reach you -- or vice versa.

While there are many good reasons to have a cell phone on hand, there are some down sides too.

One thing to consider is that they can become addictive. Sending and receiving texts, playing video games, watching movies as well as checking in on social media sites can impact your child’s sleep patterns and psychological wellbeing. Do you think your child is able to handle that kind of extra stress? Are you willing to put in the time, or have the time yourself, to monitor your child’s phone use and lay down the rules about how often they can use their phone?

There are also other health considerations; cell phones use radio waves. That's radiation (though it's not like what you'd get from an X-ray). Can cell phone radiation affect your child’s health, especially if children start using phones at a very young age when their brains are still developing?

In 2011, an international study showed no link between cell phone use and brain tumors in adolescents and teens. The researchers pointed out, though, that the people in that study didn't use their phones as much as people do today. Many health experts believe more current studies need to be done over a longer period of time. It may be take several decades to find the answer.

Social interaction and cell phone use go hand in hand. It can often be positive thing. It's one way kids can learn to relate to other kids. But there is also the potential for "cyber bullying” which is social harassment via text, instant messaging, or other social media. Many smartphones have a "location sharing" feature, which could raise concerns about people stalking kids as they go from place to place.

There isn't a lot of research yet on how cell phones affect mental and emotional health. But early studies show that frequent texting and emailing can disrupt kids' concentration. It can also become compulsive if kids start being "on call" 24/7 to keep up with their friends. That’s one of the addictive challenges – even for adults.

A child’s age shouldn’t be the only determining factor before deciding on when children are ready for their own cell phone.

Caroline Knorr, parenting editor with the nonprofit group Common Sense Media, says, "Maturity and the ability to be responsible are more important than a child's numerical age.

She says, "We want our kids to be independent, to be able to walk home from school and play at the playground without us. We want them to have that old-fashioned, fun experience of being on their own, and cell phones can help with that. But parents have to do their research and talk to their children and make sure they're using the phones safely themselves, too."

As your child becomes more independent (think middle school or high school), they're closer to needing a phone than younger children whom you still take everywhere.

"Look for the developmental signs," Evans says. "Does your child lose his belongings? Is he generally a responsible kid? Can you trust him? Will he understand how to use the phone safely? The rate at which kids mature varies -- it will even be different among siblings."

And think long and hard about whether your child actually needs rather than just wants that phone. "Children really only need phones if they're traveling alone from place to place," Evans says. "Kids in carpools may not need phones, but kids traveling on a subway, bus or walking to school may. It's about who they are as individuals, what's going on in their lives, and how much they can handle, not a certain age or grade."

If you’ve made the decision that your little one can have a cell phone, here are some ideas to make it work for you and your child.

Should you check who your child is calling and what she's tweeting?

Absolutely, Knorr says. "I know that kids consider mobile devices to be personal property," she says. "And they don't want their parents snooping around. But I think parents are justified in saying, 'I understand this can be used for good but it also can be misused. So every now and then I'm going to check to make sure you're using it responsibly and respectfully.' Then make it an ongoing dialogue: 'Have you gotten weird texts?' 'Any calls that made you uncomfortable?' 'Who are you texting?'"

But you might want to skip the GPS locator services. Neither Knorr nor Evans recommends them unless your child is showing a pattern of getting into trouble.

"Most kids don't need GPS trackers on them," Evans says. "That's really feeding on our anxiety as parents more than meeting a true safety need."

"The issue is really about educating children how to use cell phones in appropriate ways," Evans says. "Cell phones can definitely be beneficial, as long as you know your individual child."

Start with a basic phone for a young child. There are still phones that do not include a camera, Internet access, games or texting.  You’ll most likely get some push back from your child on this, so be prepared to tell him or her why your starting with this type of phone. “ Remind her (or him) that phones are tools, not toys. "It's about safety, not social status or games," Knorr says.

If your child’s phone has texting or Internet abilities, set limits. Most cell phone companies allow you to cap the number of texts a user can send or receive as well as the number of minutes the cell phone can be used. You also can block Internet access and calls from unapproved numbers on most phones.

Designate times when the phone needs to be turned off such as meal times, study time, out walking and at least an hour before bedtime.

Provide your child with and teach them how to use earphones. Until more is known about the impact of cell phone radiation, it’s better to be safe than sorry.  However, also teach them the appropriate places to wear earphones. It can be dangerous for children (and adults) to wear them when walking or bicycling – they may not be able to hear oncoming traffic. It also can take their focus off of what is going on around them.

Teach your child good cell phone etiquette. Children aren't born knowing the rules about how to use cell phones respectfully, including not using them to spread rumors, not taking (or sending) photos without people's permission, not sending inappropriate photos or texts, not having personal conversations in public places – and, of course, never communicating with strangers, no matter how they present themselves. It's up to you to teach them. And by all means, make sure you obey the same rules. Children learn more by watching how their parents handle things than by simply being told what to do.

There’s also a clever contract you can sign with your child when you give them the cell phone. It sets certain rules that they agree to follow and is a good resource that can be reviewed time and time again. CTIA has it listed and printable at this link.

It’s a different world than when we were kids. For most parents, cell phones either didn’t exist or were not as complex and portable as they are now. So, when do you give your child his or her own cell phone? Only after careful consideration to how it will impact their life. Once he or she owns one, it will be an extreme challenge to take it back.

Story source:  Susan Davis, http://www.webmd.com/parenting/features/children-and-cell-phones#1

http://files.ctia.org/pdf/bsw/example_of_family_rules.pdf

 

 

Your Child

Trampoline Safety Tips

2:00

Trampolines are a lot of fun and great exercise, but they also come with risks for injuries.  All the hopping, bouncing and tumbling can sometimes lead to accidents, particularly if more than one child is on the trampoline. The American Academy of Orthopaedic Surgeons (AAOS) and the American Academy of Pediatrics (AAP) has released a list of safety precautions parents should take if there is a trampoline at the house.

The AAOS and the AAP both say that children 6 years and younger should not be allowed on trampolines.

"Children younger than age 6 are less likely to have the coordination, body awareness and swift reaction time necessary to keep their bodies, bones and brains safe on trampolines," said Dr. Jennifer Weiss, a Los Angeles pediatric orthopedic surgeon and academy spokesperson.

The most common injuries children suffer on trampolines are sprains and fractures caused by falls on the trampoline mat, frame or springs. Collisions with other jumpers; stunts gone wrong; and falls off the trampoline onto the ground or other hard surfaces, are also injuries physicians see.

Landing wrong can cause serious or permanent injuries even when the trampoline has a net and padding. The majority of injuries occur when there is more than one person on the trampoline.

The AAP doesn’t recommend that parents buy a home trampoline, but if you decide to have one, they offer these safety guidelines:

  • Adult supervision at all times
  • Only one jumper on the trampoline at a time
  • No somersaults performed 
  • Adequate protective padding on the trampoline that is in good condition and appropriately placed
  • Check all equipment often 
  • When damaged, protective padding, the net enclosure, and any other parts should be repaired or replaced

The AAOS adds these safety precautions:

  • Place the trampoline-jumping surface at ground level. Remove trampoline ladders after use to prevent unsupervised use by young children.
  • Regularly inspect equipment and throw away worn or damaged equipment if you can't get replacement parts.
  • Don't rely on safety net enclosures for injury prevention because most injuries occur on the trampoline surface. Check that supporting bars, strings and surrounding landing surfaces have adequate protective padding that's in good condition.
  • Close adult supervision, proper safety measures and instruction are crucial when a trampoline is used for physical education, competitive gymnastics, diving training and similar activities.
  • Have spotters present when participants are jumping. Do not allow somersaults or high-risk maneuvers unless there is proper supervision, instruction and protective equipment such as a harness.

Another tip that the AAP offers trampoline owners is to check their homeowner’s insurance policy to obtain a rider to cover trampoline-related injuries if not included in the basic policy.

Story sources: Robert Preidt, https://consumer.healthday.com/fitness-information-14/trampolining-health-news-285/surgeons-warn-of-trampolines-down-side-724795.html

https://healthychildren.org/English/safety-prevention/at-play/Pages/Trampolines-What-You-Need-to-Know.aspx

 

Daily Dose

4th of July Celebrations!

1:30 to read

The 4th of July weekend is here, which means many families will celebrate with a long weekend with other families and friends. Let’s remember the importance of making it a safe holiday!   

Of course the celebration includes fireworks which are definitely fun to watch, but at the same time, when they are used by consumers (many of whom are children and teens) rather than by trained professionals, there are many associated risks.  Being on call in the ER as a new doctor was one of the scariest and longest nights in my life...and I can remember seeing children with burns...several which were disfiguring. Burns remain one of my biggest fears.

In 2013 there were an estimated 11,400 people treated in emergency rooms for fireworks related injuries, and the risk of fireworks injury was highest for children ages 0- years, followed by children 10-14 years. I know that having fireworks in your backyard or on the beach is fun, but also dangerous. Although I was used to my boys saying, “ Mom, you tell us that everything that is fun is too dangerous...which not only included fireworks, but trampolines, and motorcycles.”  I am sticking to that.

The majority of fireworks related injuries were to the extremities followed by those to the head (eyes, ears, face).  The greatest number of injuries were caused by small firecrackers, sparklers, and bottle rockets. Did you know that a sparkler burns as hot as 1200 degrees F, while water boils at 212 degrees F and wood burns at 575 degrees F!! Even a left over sparkler may cause a significant burn to little hands.

Fireworks are best left to the “hands” of the experts. Fireworks are dangerous and can be unpredictable, especially in the hands of amateurs (including parents).  Public firework displays are equally enjoyable and are carefully planned and executed. Especially with drought conditions and fires already raging in parts of the U.S. it is especially important to be aware of the risk of inadvertently setting a small fire from a misguided bottle rocket.  That small fire may lead to an even bigger fire which destroys acres of land as well as puts firefighters themselves at risk. No one wishes for that scenario but there were over 17,500 fires caused by fireworks in previous years. 

Start planning your holiday fireworks viewing now....from a safe venue! Happy 4th!

Daily Dose

PU: Body Odor

1.00 to read

I received an email from a mother who asked if her 5 year old son, an avid athlete, could wear deodorant?  It seems that his arm pits “smell like a grown man”.  I have actually been asked this on occasion in my office and I have even noticed body odor (BO) during exams on some 5-8 year olds.   

Most children start to “stink” as they begin to enter puberty, but there are occasional children that for unknown reasons, develop BO without any signs of puberty. If it seems that your child is entering puberty at an early age, you do need to talk to your doctor.  If your child happens to be one of those kids who are just odiferous, there are several things that you can do.

Number one, make sure that your child is bathing/showering everyday, and that they wash their armpits well. Some little boys (and I bet a few girls) just pop in and out of the shower without touching soap on most of their bodies.  (I used to smell my boys hair when they came out of the shower, sometimes still smelled sweaty, no soap!).

If daily bathing does not do the trick, it may be time to use a deodorant, which just masks the smell. This often works for younger kids who are really stinky rather than sweaty.  An anti-perspirant actually stops and dries up perspiration and may not be needed until an older age.

There are numerous deodorant products available, some of which are natural as well. Head to the store and read labels to decide which one you prefer.

Daily Dose

Bug Bites

1:30 to read

It is the time of year for bugs and bites and I see a lot of kids with bites coming into my office.  Parents want to know “what kind of bite it is?” and in most of the kids I see, they are having a reaction to a mosquito bite. Parents are extremely concerned that the reaction may be abnormal and lead to breathing issues or that the bite it is infected. For some reason, baby and toddler skin just seems to swell more - that is not science but my observation…maybe because they are “yummier”?  At any rate, the best way to avoid “the mystery bite” is by using insect repellent.

 

The AAP recommends that children be protected from mosquitoes as they may not only cause discomfort and itching, but may cause several viral illnesses including West Nile, Zika and Chikungunya. Insect repellents will also prevent ticks, some of which may transmit Lyme Disease.  

 

Both the AAP and CDC recommend the use of DEET containing repellents for children 2 months of age and older. For young infants it is often easy to protect them from bites by using mosquito netting over their stroller or carseat when they are outdoors.  Once your child is older and hard to “contain” beneath mosquito netting you may use a DEET containing repellent and start with the lowest concentration - you will need to read the labels on each product.  The protection and effectiveness for DEET products of different concentrations is similar, but a higher concentration provides a longer duration of protection. Picardin has also been approved for use in concentrations of 5-10 %. The higher the concentration the longer the duration of protection as well.  So choose accordingly. I often have several products at our house and decide which to use based on the length of time we are enjoying the backyard, age of child or adult and method which I want to use to apply (spray, lotion, wipes).

 

You do not want to choose a product that contains both sunscreen and an insect repellent. Sunscreen should be applied about every 2 hours and bug spray should be applied far less frequently. I recommend applying the insect repellent with my hands rather than trying to spray a young child who is a moving target. I even put the bug spray on those precious bald baby heads (if over 2 months).  It is also important to wash the insect repellent off at the end of the day - bath time for all!

 

It is also important to dress appropriately if you are going outdoors. When possible dress your child in long sleeves, pants and even socks which will prevent bites. Avoid brightly colored and flowery clothes (may be boring), as these too attract insects.

 

It is also especially important to remove standing water around your house and yard. After a rain or watering check any standing water and empty any residual water from buckets, candles, bird baths or empty pots. Standing water is an easy breeding ground for mosquito larvae.  The type of mosquito that carries Zika also prefers to be close to houses…so it is really important drain standing water near your house. 

 

Enjoy the summer and don’t be afraid of bug sprays in children if you use them appropriately, as prevention is always preferable!

 

 

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