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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”.

Daily Dose

How to Swallow a Pill

1:15 to read

I have always been a proponent of teaching children to swallow a pill.  In fact, I think I taught my boys to swallow a pill before they were 5 years old, mainly because I was tired of trying to find the measuring cup or syringe for the liquid medicine, which often didn’t go down “like spoon full of sugar”, even though we would sing the song during dosing. 

By the time one child had learned to swallow a pill the other two boys, as competitive as they were, decided that they too could do it, even the 2 year old.  So, based on that experience I have been encouraging young patients to swallow pills, and even teaching them in the office with my stash of mini M&M’s and Tic Tacs!  I also know that if you wait too long it becomes a huge ISSUE.

Well, who knew that someone would actually study “pediatric pill swallowing”?  In an article just published in the May issue of Pediatrics the authors looked at different pill swallowing interventions.  They found that up to 50 % of children were unable to swallow a pill.   Problems swallowing pills included a variety of reasons including fear, anxiety and intolerance to unpleasant flavors. 

The authors reviewed 5 articles published since 1987 which found that behavioral therapy, flavored throat sprays, specialized pill cups and verbal instruction with correct head and tongue positioning all helped children to swallow pills. They also found that pill swallowing training as “young as 2 years helped increase the likelihood of ease of pill swallowing”.

So, like many things....jump in with your young child and master the art of pill swallowing sooner than later. It will make everyone’s life easier.

Last caveat, I always tell my patients who are older “non-pill” swallowers, “you cannot possibly operate a motor vehicle if you can’t swallow a pill”! This is usually a huge motivator for the “late swallower” and they conquer the challenge. 

Your Baby

Sing to Soothe Your Crying Baby

1:30

Have you ever reached the end of your patience trying to soothe a crying baby? Next time, switch to singing instead of talking. You may be surprised at the results.

Researchers at the University of Montreal in Canada, found that infants respond sooner and stop crying longer when listening to a song instead of speech.

The small study involved 30 healthy infants, aged between 6 and 9 months. The purpose of the research study was to investigate how the emotional self-control of the infants would be influenced when they are exposed to music or speech.   

The researchers maintained the objectivity of the study by not using any sounds that could have been recognized by the children.

For their study, researchers at the University of Montreal in Canada, played Turkish music and two types of speech -- ‘baby-talk' and regular adult-directed dialogue to the infants.

Researchers deliberately chose a language and music that would be unfamiliar to the babies.

Mothers were placed behind the children to avoid contact and the environment cleared of any other possible stimuli.

After playing both the music and regular speech to the children, researchers found that singing was twice as effective at calming distressed babies compared to exposure to regular dialogue: Babies remained calm for an average duration of nine minutes before breaking out in tears, while dialogue -- both the ‘baby-talk' and adult speech -- kept them calm for less than half that time.

The findings are significant, authors note, because Western mothers speak more to their babies, than sing.

"Our findings leave little doubt about the efficacy of singing nursery rhymes for maintaining infants' composure for extended periods," said study co-author Isabelle Peretz in a statement.

"These findings speak to the intrinsic importance of music, and of nursery rhymes in particular, which appeal to our desire for simplicity, and repetition."

Next time your baby is cranky, don’t be bashful; break out all the nursery rhymes you know and sing away. It may be the just the sound your baby wants to hear.

The study was published in 2015 in the journal Infancy.

Story source: http://www.ctvnews.ca/health/singing-more-effective-than-talking-to-soothe-babies-study-1.2631472

 

 

Parenting

Recent Hurricane Disasters May Have Lasting Impact on Kids

2:15

Children may experience long lasting trauma from either living through or even viewing images of natural disasters such as hurricanes, Harvey and Irma, experts say.

"Compared to adults, children suffer more from exposure to disasters, including psychological, behavioral and physical problems, as well as difficulties learning in school," Jessica Dym Bartlett, a senior research scientist at Child Trends, said in that organization's news release.

It’s reasonable to think that children who have actually had to live through the devastation of being in a hurricane could be traumatized and suffer post-traumatic stress syndrome, (PTSD.) But child mental health experts say that even kids who have seen pictures of the damage and watched news reports can also be traumatized and may develop similar symptoms of PTSD such as depression and anxiety.

"Understand that trauma reactions vary widely. Children may regress, demand extra attention and think about their own needs before those of others -- natural responses that should not be met with anger or punishment," Dym Bartlett said.

To help children through this difficult time, parents should create a comforting and safe environment where their child’s basic needs are met. Keep to regular schedules and other routines that provide children with a sense of safety and predictability.

Children that stay busy are also less likely to have continuing negative thoughts; boredom can worsen adverse thoughts and behaviors. Youngsters are less likely to feel distress if they play and interact with others, Dym Bartlett noted.

Limiting your child’s exposure to the continuous images and descriptions of disasters coming from news reports is also helpful, but it’s not necessary to try and eliminate everything pertaining to catastrophes. It’s better to help children understand what has happened in age-appropriate language and to empathize hope and positivity. Reassurance that you are there for them and will do all that is humanly possible to protect them can ease some of the fear associated with disasters.

"Find age-appropriate ways for children to help. Even very young children benefit from being able to make a positive difference in others' lives while learning important lessons about empathy, compassion and gratitude," Dym Bartlett said.

If a child continues to have difficulties coping for longer than six weeks after an event, like the hurricanes, the National Child Traumatic Stress Network recommends seeking professional help.

Parents and caregivers should also make sure that they take care of their own emotional health during these trying and sad times.

Story source: Health Day News, https://www.upi.com/Health_News/2017/09/12/Hurricanes-may-take-lasting-emotional-toll-on-kids/4141505232381/?utm_source=sec&utm_campaign=sl&utm_medium=14

Daily Dose

What New Babies Need

1:30 to read

I have many friends whose own children are now having babies and they always ask, “what all do we need to have/buy for a new baby these days?”  While many things have changed since I had my own children, many have not,  and I still think “less is more” is a good adage to follow, especially for a newborn.  We all have a tendency to buy too much, or the “latest and greatest” only to find out that it is not necessary.

Carseat - a rear facing car seat is a must for your newborn!!!  Look at all of the reviews on line and pick which seat works best for you.  Do you want one with a base that you can also clip on to a stroller?  Remember your baby will sit in a rear facing car seat until 2 years. This is one item I would spend my money on!!

The baby needs a place to sleep so buy a crib and a good mattress.  If you are going to have more than one baby I would buy something that will last through several children. I like having a crib (rather than a toddler bed), as your baby will be in the crib for several years and then can move to a regular bed…no need for an “in between”.  Do not use an “old” crib that has drop sides, due to safety concerns. So that means the one that I had kept in the garage (from my kids) was a throw away! I usually move the first child to a bed when I need the crib for the next baby…no specific age. Bumpers are no longer recommended, so that saves money too!

Changing table or dresser for the millions of diaper changes.  It is so helpful to not have to bend over each time. I would also buy a diaper cream (Dr. Smiths, Destin or Butt paste) to have on hand….your baby will probably get a diaper rash at some time during their time in a diaper.

Baby bath tub: while you can bathe your baby in the sink, the newer bathtubs do make it easier for a newborn and you can use it in the tub as well until your baby can sit up alone. Remember, you will NEVER leave your child in the tub alone…even with all of the seats, rings and things  that they sell to support your baby!!  For bathing I like gentle bath wash like Cetaphil, Cerave, and Eucerin products….good for all skin types.  Pick one!

Swaddle blankets: WOW there are a million on the market and they all “claim” to help your baby to sleep better. I don’t think any of the products say “it will also takes weeks to months for your baby to sleep through the night” , no matter what you use.  I do like the thin swaddle blankets as they are useful for a number of things besides swaddling. Once you have your baby have the nurses show you how to swaddle (quick and easy).  The Miracle Blanket, Woombie and Halo also make it easy to swaddle as well. Pick one (or two) and stick with that.  Remember, your baby is going to be put in their crib on their back whether swaddled or not!! NO TUMMY SLEEPING.  

Diaper Bag: again their are a million out there in all shapes, sizes and price points. In the beginning you need to have a pad for changing (you will end up changing that baby all sorts of weird places), diapers, burp clothes, wipes…as your baby gets bigger you will have bottles, cups, toys all shoved in there too. All of my patients seem to have a travel size Purell strapped to the side of the bag as well. I would get a bag that you can wipe out as there will be spills of all sorts of stuff in that bag I assure you!  Somehow, over time you go back to “less is more” and the diapers end up in your purse!!  

So…that is a start. Will do another post on some other products in the future. 

 

 

Daily Dose

CPR

1:00 to read

I was seeing a newborn the other day and the parents had a great idea. Their baby had spit up and they were concerned about how to clear his airway.  When we discussed how to hold the baby to clear the airway they had the great idea of having a CPR “teaching party” for a group of their friends who also had young babies!

 

I do encourage new parents (actually all parents and even grandparents) to take a CPR class. I am fortunate that we have yearly CPR class in our office which keeps us all up to date. 

 

It is fairly easy to find local CPR classes either through the YMCA, the American Heart Association and often through the hospital where you deliver your baby.  But, in these cases you have to take the class on “their schedule”. What a great idea to host a party with your friends and hire a certified CPR instructor to come to you!!

 

You know I do like to “isolate” my newborn patients from crowds (for 6-8 weeks), but it is fun to gather with other parents of newborns to get some social interaction. If everyone brought their baby, and a dish for dinner, it could be a mini dinner party followed by CPR training….ending with wine!

 

So…let’s start planning CPR parties, I may even do one for my friends who are becoming grandparents!

 

 

Your Toddler

Is Your Child a Biter?

2.00 to read

At some time or another your sweet child is going to bite or wallop someone, most likely another kid. And yes, it's embarrassing to have to pull your child off another or to apologize to grandma because her grandchild just took a chunk out of her arm. 

Know that you’re not alone - all kids bite and /or hit. The key to stopping aggression in children is teaching them that there are alternative ways to handle frustration and biting is not acceptable behavior.

Not all biting stems from anger. The younger the child, the less chance that biting is an aggressive behavior. It can also be a simple case of exploration. Young children bite for many reasons, from painful gums because they are teething to seeing what kind of reaction they get. Children between the ages of one and three typically go through a biting phase they eventually outgrow.

While biting may be a normal phase kids go through, it’s something you want to discourage.

Let’s look at some of the reasons kids bite.

  • They're in pain. When babies bite, typically it's because they're teething. They're just doing it to relieve the pain of their swollen, tender gums.
  • They're exploring their world. Very young children use their mouths to explore, just as they use their hands. Just about everything infants or toddlers pick up eventually winds up in their mouths. Kids this age aren't yet able to prevent themselves from biting the object of their interest.
  • They're looking for a reaction. Part of exploration is curiosity. Toddlers experiment to see what kind of reaction their actions will provoke. They'll bite down on a friend or sibling to hear the surprised exclamation, not realizing how painful the experience is for that person.
  • They're craving attention. In older kids, biting is just one of several bad behaviors used to get attention. When a child feels ignored, discipline is at least one way of getting noticed -- even if the attention is negative rather than positive.
  • They're frustrated. Biting, like hitting, is a way for some children to assert themselves when they're still too young to express feelings effectively through words. To your child, biting is a way to get back a favorite toy, tell you that he or she is unhappy, or let another child know that he or she wants to be left alone.

So, how do you prevent or teach your child that they can’t go through life biting others?

You start with consistent prevention and move on to discipline if they are older.

  • If your baby is teething, make sure to always have a cool teething ring or washcloth on hand so he or she will be less likely to sink teeth into someone's arm.
  • Avoid situations in which your child can get irritable enough to bite. Make sure that all of your child's needs -- including eating and naptime -- are taken care of before you go out to play. Bring along a snack to soothe your child if he or she gets cranky from being hungry.
  • As soon as your child is old enough, encourage your child to use words such as “I'm angry with you" or "That's my toy" instead of biting. Other ways to express frustration or anger include hugging (not hitting) a stuffed animal or punching a pillow. Sometimes redirection is helpful; shortening activities or giving your child a break can help prevent the rising frustration that can lead to biting and other bad behaviors.
  • Give your child enough of your time throughout the day (for example, by reading or playing together), so he or she doesn't bite just to get attention. Extra attention is especially important when your child is going through a major life change, such as a move or welcoming a baby sibling. If your child is prone to biting, keep an eye on any playmates and step in when an altercation appears to be brewing.

You’ve done all that is possible to prevent another biting situation, and low and behold your child is biting another. What do you do then?

When your child bites, firmly let your child know that this behavior is not acceptable by saying, "No. We don't bite!" Explain that biting hurts the other person. Then remove your child from the situation and give the child time to calm down. It’s important that you remain calm.

Seeing your child bite another is naturally going to create an unpleasant reaction in you. As soon as you witness a biting episode, your body tenses, your heart races, and even if you don't actually scream, you really want to. The angrier you are, the tenser the situation becomes. You are much more likely to strike your child when you let your anger get the best of you. Take a deep breath, assess the situation and intervene calmly. Remove your child, let him or her calm down and explain (yes, once again) that biting is not going to be tolerated. If your child is old enough to understand time-out, this is a good time to use it. If not, remove the child from the temptation. Playtime is over.

One way some parents handle biting is to bite their own child to show them how painful it can be. Doing what you are telling your child not to do sends a mixed message. It’s similar to hitting your child and then saying “don’t hit others.” Most likely your child will experience how painful it is because another child will bite them someday.

The point is not so much that biting is painful, the action itself is unkind, unproductive and wrong.

When biting becomes a habit or continues past the age 4 or 5, it may stem from a more serious emotional problem. This is the time to ask for help from your pediatrician, family doctor or a child psychologist.

If your child is bitten, wash the area with soap and water. If the bite is bleeding and the wound appears to be deep, call your child’s doctor. The bite may need medical treatment, which could include antibiotics or a tetanus shot or both.

Biting is a horrible habit to get into and a difficult one to stop. Start teaching your child early that momma and daddy are not putting up with it and that there are better ways to explore the world and handle frustration.

Source: http://www.webmd.com/parenting/guide/stop-children-from-biting

Daily Dose

Flu Vaccine

1:30 to read

Even though the temperatures are topping out in the high 90’s around many parts of the country, it is still the time of year that pediatric offices are just receiving their flu vaccines for the 2017-2018 season.  Our office received our first shipments about 10 days ago and we have already started immunizing. This includes “my” precious 6 month old babies - all the way through to my college patients. 

 

There are 2 questions on parents and their kids minds:

 

#1 Is it too early to get a flu vaccine?

#2 Is there “flu-mist” available this year? 

 

I bet you can guess who is asking question #1 and who wants to know about question #2.

 

So here you go:

 

#1  It is NOT too early to start getting your flu vaccine. Once you receive the vaccine it takes several weeks to develop antibody levels and these antibodies have been shown to last throughout the flu season. Flu season is also temperamental….in that it sometimes decides to arrive sooner than is typical- which means you want to be prepared in case of an early influenza season. So, if you are in your pediatrician’s office, go ahead and opt in for the vaccine…and then you save yourself a trip back later in flu season…and in many cases another co-payment!

 

#2  Sorry kids and parents (and doctors too), there is not going to be a nasal mist influenza vaccine again this year.  The studies of the live attenuated influenza vaccine (FluMist) from the 2015-2016 flu season found that FluMist was only 5% effective in children ages 2-17, compared with 60% effectiveness for the inactivated (shot) flu vaccine.  While no one wants tears - pediatricians do want to give a vaccine that has been found to work - which means a shot.

 

Just to clarify…as parents often ask…”if the flu vaccine is not always 92-99% effective like our routine childhood vaccines, why should we get a shot?”.  My short answer, “would you buy a lottery ticket if you had a 60% chance of winning, rather than .000000001% chance?”. If you don’t get a flu vaccine it is guaranteed that you didn’t get any flu protection…I would rather go with the odds of it working (and winning the lottery which I would buy a ticket for with better odds).  We also have data that shows that those children who received flu vaccine had less chance of complications and hospitalization than those who were not vaccinated. 

 

Start scheduling your family's flu vaccine today.

 

 

 

 

 

 

 

 

  

Parenting

Choosing a Dog for the Family

2:00

Dogs make great companions and it doesn’t take long before they become “one of the family.”

If you’re considering adding a dog to the family unit, there are several questions you need to answer first.

What kind of dog is best for your family? It depends.

What kind of space can you provide? You'll want to pick a dog whose size and needs are a good match for your household. Do you live in an apartment – where a smaller dog might do better – or do you have plenty of space in a backyard for a larger dog to run and play?

What is your family lifestyle like? Is everyone on the go most of the time, or is someone typically around to train and care for your pet?

Does anyone suffer from pet allergies? There are breeds that don’t shed or shed very little. There are even some that are considered “hypoallergenic.”

Who is the one in the family that will spend the most time caring for the dog?

When kids are in love with the idea of getting a dog, they often make promises to walk, clean up after and feed it. But, who is really going to be the dog’s caregiver? The younger the child, the more likely a parent is to be the one who takes care of the dog. Are you ready to make that commitment?

However daunting it may feel, remember that a funny thing often happens when a dog enters the family dynamic, they usually win everyone over; so caring for one may become more of a loving habit than an unwelcomed chore.

Having a dog can be a great way to help instill responsibility, empathy and life’s difficult lesson on how to say goodbye to a loved one, in a child. If you’ve grown up with pets, you already know how many special moments they provide. If you've never owned a dog, read up on the benefits verses the challenges. There are pros and cons to seriously consider. Dogs need love and to feel welcomed to thrive - just like people. 

The American Kennel Club lists several breeds of dogs that are usually very good with children. Some of the top suggestions are:

·      The Boxer

·      The Beagle

·      The Golden Retriever

·      The Labrador Retriever

·      The Weimaraner

·      The Soft Coated Wheaten Terrier

·      The Newfoundland

·      The Bulldog

·      The Bull Terrier

These are all specific breeds, but many a great dog can be found in a shelter or adoption center. These are typically mixed-breeds but often have fewer health problems than full breeds and a unique sense of appreciation. There are also rescue organizations that find homes for particular breeds.  

If you decide on a puppy, know that there will be several phases it will go through. If you have the patience and the puppy gets positive training along the way – you’ve got a dog that knows and understands your family. 

An older dog can be just as valuable, doesn't need potty training and after a transition period, can fit in remarkably well. 

Not every family is ready to take on the responsibility of owning a dog; sometimes the timing just isn’t right. But when the stars align and you’re ready to give it a try, there’s nothing better than the smile on your child’s face when he or she meets the new family member – and not to forget – that sloppy kiss and wagging tail that greets you when you start the day!

Story source: Joan McClusky, https://consumer.healthday.com/general-health-information-16/pets-and-health-news-531/choosing-a-great-family-dog-725834.html

http://www.akc.org/dog-breeds/best-dogs-for-kids/

 

 

 

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