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Daily Dose

Happy New Year!

1:30 to read

Happy New Year!!  So here we go again with the New Years resolutions and the “to do” list.  I  try to figure out something each year that I am going to “resolve” to do….one of which continues to be to learn how to play bridge. Somehow I have had the same resolution for two years and yet I still cannot play…at least well. I start off with a bang and just as I can “kind of sort of” play a real game, I somehow get too busy to play and here we go again…back to beginner. I need a new plan!

 

I was having dinner with my “adult children” and they were talking about their New Yea'rs resolutions and it seems they have “categories” of resolutions. In other words they have several different resolutions…which they called personal, professional, social etc. Their thought is that they are more likely to succeed if they have more than one goal??  Maybe they are correct? New approach?

 

So…with that being said let’s think about several different areas that might be good for family resolutions. 

 

Family meals:  We all vowed to try to eat out less and cook at home more often. Not only is it less expensive, it is often healthier and an important time for families to come together to discuss their day. Whether your child is 2 ,10, or 20 yrs old,  just eating together as a family has been shown to improve moods, behavior, school performance and yes, reduces obesity.

 

Electronic media:  As I am on the computer typing I am reminded about how often we all have our faces engrossed in a screen. Some of my young patients know how to “Swipe” and “Refresh” before they can even walk!!  As the world becomes more electronic we are are becoming more isolated…and this is especially true of children. Making a family commitment to limit screen time for all ages may be difficult but is important for building language, social skills and even better sleep. Texting is not talking…who needs a study to confirm that?

 

Exercise: Who doesn’t vow to get more exercise every year…well maybe not young children who long to go outdoors regardless of the weather. But for everyone else, we are becoming more and more sedentary and that is probably somewhat related to the above issue (electronic media).  Make a family plan to exercise at least 3 -4 days a week, maybe after family dinner? Walking, bike riding  (helmet please), playing soccer in the yard, shooting hoops together, or even playing tag, make it easy. Getting our children to move continues to be important for overall health.   They will sleep better, snack less and exercise also gets those good endorphins flowing.  If you keep it up you actually do “feel better”. 

 

Smoking: If you are a parent that smokes…. resolve to “give it up for your children”.  Second hand smoke is REAL, and more and more data shows how it may contribute to SIDS, asthma and other lung problems in children. Model behavior you want to see in your children.  Teen smoking continues to be an issue and many teens are experimenting with electronic cigarettes which then often lead to smoking at a later age. Giving up smoking saves a lot of money towards a fun trip or night out!!

 

OK - let me know how your family does after a few months!! I am hopeful to stay on track for all of 2017. Happy Healthy New Year!!

Your Teen

Parents Need to Have the “Sex Talk” With Their Kids

2:00

Let’s face it, talking to your child about sex isn’t something a parent looks forward to, but a new study says teens who have had a serious conversation about sex with one or both parents are more likely to use condoms or birth control is they are or become sexually active.

“The take home message is that parents do matter, and these conversations do matter,” said Laura Widman, lead author of the new paper and an assistant professor of psychology at North Carolina State University in Raleigh.

While the more information you can present to your child in a way that addresses the health aspects of sexual activity is good, parents don’t have to be experts says Widman, “Just having the conversation is important,” she said. “That’s the good news.”

According to the Centers for Disease Control and Prevention (CDC), nearly half of high school students have had sexual intercourse. Almost 60 percent of high school students surveyed who have had sex said they used a condom when they last had sex, but 14 percent of sexually active teens said they did not use any birth control the last time they had intercourse.

Young people, aged 15 to 24, make up only a fraction of the sexually active population, but they bear a disproportionate burden of sexually transmitted diseases. And while teen pregnancy rates have dropped significantly, there were still 625,000 teen pregnancies in 2010, and nearly half of them –273,000 — gave birth.

Widman noted that results from the study showed that teens who communicated with their parents about were more likely to communicate with their sexual partners and to use condoms.

“We know that being able to communicate with a partner about condom use is one of the best predictors of whether teens use condoms or not,” Dr. Widman said. “So providing kids with the language they need and getting the message across that the subject is not off-limits or taboo can make a difference in their behavior.”

Some parents worry that talking about sex with their child somehow sends a message that they are approving of that behavior. However, studies have found that children who are comfortable talking about sex are actually more likely to delay sexual activity and be older when they first have intercourse.

“Parents fear that if they bring these issues up, they’re signaling that it’s okay to have sex, but that’s completely untrue – we know that parents who bring it up, and bring it up regularly, their kids are least likely to have sex,” said Vincent Guilamo-Ramos, a professor of social work at the Center for Latino Adolescent and Family Health at New York University’s Silver School of Social Work and author of an article about that topic that was published recently in JAMA Pediatrics.

Parents aren’t the only ones uncomfortable talking about sex, so are their kids.  In a 2012, half of the kids surveyed said they were uncomfortable talking to their parents about sex. Only 19 percent of the parents said they were uncomfortable having the “sex talk” with their child.

Children often think that if they ask questions, their parents “will overreact or assume they’re having sex,” said Dr. Guilamo-Ramos, who has developed some pointers on talking with your children.

If you’re wondering how to start that conversation with your child, the Office of Adolescent Health, part of the U.S. Department of Health and Human Services, has these tips:

·      Use current events, pop culture or developments in your social circle to start conversations about sex, healthy relationships and contraception. It’s not a one-time chat, Dr. Guilamo-Ramos said. “Talk to your child on a regular basis.”

·      Take on the tough topics, like birth control and sexual orientation.

·      Pay attention to a teen’s romantic relationships. Teens in intense romantic relationships are more likely to have sex, especially if the partner is a couple of years older than your child.

·      Address your child’s concerns, not just your own. “They want help with the real life pressures they’re experiencing in social situations,” said Dr. Guilamo-Ramos. “Talk with them about what a healthy relationship looks like, and help them come up with strategies and short one-liners that will help them get out of tough situations.”

·      Make sure to talk to your sons, not just your daughters. “Parents’ messages are often more directed to girls than boys,” he said. “And boys aren’t getting the information they need.”

The findings from the North Carolina State University research stem from a large analysis of adolescent health data, based on more than 50 studies involving 25,314 teens over the course of 30 years. The link between parental communication and safer sex practices, while modest overall, is strongest for girls and for teens that talked with their mothers, according to the research, published online in JAMA Pediatrics

As with most studies, the results do not prove a conclusion, only an association. 

Source: Roni Caryn Rabin, http://well.blogs.nytimes.com/2015/11/04/why-parents-should-have-the-sex-talk-with-their-children/?_r=0

 

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Your Baby

Safety Recall: Infant Bicycle Helmets

1:30

Pacific Cycle is recalling about 129,000 bicycle helmets with magnetic no-pinch buckle chinstraps, due to choking and magnet ingestion hazards. These helmets are sold exclusively at Target stores.

The magnetic buckle on the helmet’s chinstrap contains small plastic covers and magnets that can come loose, posing a risk of choking and magnet ingestion to young children.

The helmets are made for infants ranging from one to three years old. The helmet and its straps come in various colors and design patterns. The buckles have small plastic covers and enclosed magnets. “SCHWINN” is printed on the front of the helmets. Only helmets with the magnetic no-pinch chinstrap buckles are affected by this recall.

Pacific Cycle has received three reports of the plastic cover coming loose. No injuries have been reported.

Consumers should immediately take the helmets away from children and contact Pacific Cycle for instructions on how to receive a free replacement helmet.

The helmets were sold exclusively at Target stores and online at www.target.com from January 2014 through April 2016 for between $18 and $25.

Consumers can contact Pacific Cycle toll-free at 877-564-2261 from 8 a.m. to 5 p.m. CST Monday through Friday, email customerservice@pacific-cycle.com or online at www.schwinnbikes.com and click on “Support” then “Safety & Recalls” or www.target.com and click on “Product Recall” for more information. 

Source: http://www.cpsc.gov/en/Recalls/2016/Pacific-Cycle-Recalls-Infant-Bicycle-Helmets/

Daily Dose

It's the Sick Season

1:30 to read

Well, the New Year is starting off with a flood….of illness that is.  It is a typical winter in the pediatrician’s office with a bit of every virus you can name. RSV, flu, norovirus, just to start the list.  While so many parents want to name the virus, it is typically not necessary as you treat many viruses in the same manner, symptomatically.  

 

So, if your child is coughing and congested it may be due to any number of upper respiratory viruses, but the most important thing to remember…..how is your child breathing and is your child having any respiratory distress?? I sound like a broken record in my office as I remind our nurses to have parents take off ALL small children’s shirts, gowns, onesies and look at how they are breathing as you never want to miss a child who may be “working to breath”. In many cases, the visual of a child’s chest as they take breaths is more important than any cough they may have.  So remember this: “visual inspection and not just audible”.  Sending me a video of a child coughing is rarely helpful, but a video of their breathing is very important when trying to decide how to guide a parent.

 

Another tip: In most cases if your child is having respiratory distress they are quiet, as they are conserving their energy…which means they are not fighting with their sibling or running around the house, but are often sitting quietly. This also means that when they come to the doctor they are not screaming and yelling in anticipation of the doctor…again, they are usually sitting quietly in their parent’s lap. While a happy quiet child is a pleasure at my office, in a toddler it is not typical.

 

Lots of diarrhea and vomiting in our area as well. In this case, I am always trying to make sure that a child is not getting dehydrated. So, the things to look for include if your child has tears, saliva in their mouth and if they are urinating (having wet diapers).  If your child is vomiting you have to remember to wait about 30 minutes after they have vomited before giving them anything to drink….even if they are “begging for a drink”. Once they have not vomited you need to give them TINY sips of clear liquid and keep offering sips every 10 - 15 minutes. If you do this, in most cases you can keep the child from vomiting repeatedly.  Once they are keeping down sips you can go up in volume.  It is like the turtle and the hare….slow and steady wins!!  

 

With diarrhea alone it is more difficult for your child to become dehydrated, as you can have them keep drinking to keep up with the loss in their stool. Many parent “worry” as their child does not want to eat…and that is ok, the fluids are the most acute issue. You can go without food for quite some time…..don’t you ever skip a meal?

 

Keep washing those hands…and I hope you had your flu shot as I promise…it will come. 

 

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

Pink Eye

1:30 to read

This is another time of the year that I see a lot “pink eye”.  Any time the eye is pink..you have “pink eye”, which mothers seem to be quite confused by!!   They often comment…”this is pink eye?” , to which I respond, “well, the child’s eye (conjunctiva) is pink (red), so yes…this is pink eye”.  The term is just a description of the eye….but then you need to determine why the eye is “pink”.

 

Conjunctivitis is one of the most common causes of a pink eye….and there are many different types of conjunctivitis.  As with any condition the history is really important in helping to determine why a child’s eye is inflamed.  Several of the most common causes of the “pink eye” are bacterial, viral and allergic conjunctivitis.

 

Bacterial conjunctivitis often shows up in younger children and they have lots of matting of the eye lids and lashes and a mucopurulent discharge (gooey eyes). Some moms say that the “goo of gunk” comes as quickly as they can wipe it.  The child often has a lot of tearing and will rub the eyes as they feel that something is in their eye and it is irritated.  Bacterial conjunctivitis will typically resolve in 8 -10 days on its own, but antibiotic eye drops are used to shorten the course  of the pink eye and also reduce the contagiousness.  It seems as if every child in a day care class room will get conjunctivitis as they constantly rub their eyes and touch toys!!  Hand washing helps….but you can’t wash a child’s hands every time they touch their eyes.

 

Viral conjunctivitis usually occurs in combination of with systemic viral illness. Sore throat, fever and bright red eye are often seen in older children and teens and is due to adenovirus.  While the eye is red, the discharge is typically watery and matting is much less common. These patients are contagious for up to 12 days so it is important to practice good eye/hand hygiene, especially in the household. Artificial tears may help the feeling of eye irritation, but antibacterial eye drops rarely help except in cases of a secondary infection.  I get many phone calls from parents saying, “we tried prescription eye drops and they are not working”. I make sure to tell my older patients to take out their contacts and wear glasses for 7-10 days.

 

At this time of year I am also seeing a lot of seasonal allergic conjunctivitis.  These children have intensely itchy and watery eyes, as well as swelling of the eyelids and area surrounding the eyes. They look like they have been crying for days as they are so swollen and miserable. Many also have a very watery nasal discharge. They do not have fever. Using over the counter medications for allergy control, such as nasal steroids and anti-histamines will help some of the allergic symptoms. There are also over the counter eye drops (Zaditor, Patanol) that help when used daily.  During the worst of the season I make sure that the child has daily hair wash and eyelash and eyebrow wash with dilute soapy water to make sure the pollen is removed after they have been playing outside. It is nearly impossible to keep a child indoors for the 6 or more weeks of allergy season!

 

Your Toddler

AAP: Winter Car Seat Safety

2:00

So far in Texas, this year’s El Nino weather pattern has made for a pretty mild winter compared to previous years. But, other areas around the country are being hit hard with a wintery punch and it’s only a matter of time till temperatures drop and snow and ice find their way to the Lone Star State.

Winter can be a bit tricky for child car seat use. While it sounds like the opposite might be true, bulky clothing such as coats and snowsuits should not be worn under the car seat harness.

More padding - more cushion right? That seems logical until you know what happens when a car crashes. In a wreck, fluffy padding immediately flattens out from the force, leaving extra space under the harness. A child can then slip through the straps and be thrown from the seat.

So how can you keep your little one warm and protected while buckled up? The American Academy of Pediatrics (AAP) has these tips to help strike a comfortable and safer balance.

·      Use a coat or blanket over the straps. You can add a blanket over the top of the harness straps or put your child's winter coat on backwards (over the buckled harness straps) after he or she is buckled up. Some parents prefer products such as poncho-style coats or jackets that zip down the sides so the back can flip forward over the harness. Keep in mind that the top layer should be removable so your baby doesn't get too hot after the car warms up.

·      Use a car seat cover ONLY if it does not have a layer under the baby. Nothing should ever go underneath your child's body or between her body and the harness straps. Be sure to leave baby's face uncovered to avoid trapped air and re-breathing. Many retailers carry car seat bundling products that are not safe to use in a car seat. Just because it's on the shelf at the store does not mean it is safe!

·      Dress your child in thin layers. Start with close-fitting layers on the bottom, like tights, leggings, and long-sleeved bodysuits. Then add pants and a warmer top, like a sweater or thermal-knit shirt. Your child can wear a thin fleece jacket over the top. In very cold weather, long underwear is also a warm and safe layering option. As a general rule of thumb, infants should wear one more layer than adults. If you have a hat and a coat on, your infant will probably need a hat, coat, and blanket.

·      Don't forget hats, mittens, and socks or booties. These help keep kids warm without interfering with car seat straps. If your child is a thumb sucker, consider half-gloves with open fingers or keep an extra pair or two of mittens handy — once they get wet they'll make your child colder rather than warmer.

·      Get an early start. If you're planning to head out the door with your baby in tow on winter mornings, you need an early start. You have a lot to assemble, and your baby may not be the most cooperative. Plus, driving in wintry conditions will require you to slow down and be extra cautious.

·      Tighten the straps of the car seat harness. Even if your child looks snuggly bundled up in the car seat, multiple layers may make it difficult to tighten the harness enough. If you can pinch the straps of the car seat harness, then it needs to be tightened to fit snugly against your child's chest.

·      Remember, if the item did not come with the car seat, it has not been crash tested and may interfere with the protection provided in a crash. Never use sleeping bag inserts or other stroller accessories in the car seat.

·      Store the carrier portion of infant seats inside the house when not in use. Keeping the seat at room temperature will reduce the loss of the child's body heat in the car.

·      Pack an emergency bag for your car. Keep extra blankets, dry clothing, hats and gloves, and non-perishable snacks in your car in case of an on-road emergency or your child gets wet on a winter outing.

·      Make sure your cell phone is charged. If there is an emergency, you want to be able to reach 911 or call for assistance in case of a flat tire or engine trouble.

This is a time when there is a lot of holiday travel from state to state or just down the road to grandma’s house.

Remember, it’s not just children in car seats whose coats shouldn’t be tucked under the harness, adults and older children should make sure their coats are on the outside of the seat-belt.

Little steps can make a big difference in everyone’s safety.

Source: https://healthychildren.org/English/safety-prevention/on-the-go/Pages/Winter-Car-Seat-Safety-Tips.aspx

Daily Dose

New Sleep Guidelines for Your Baby

1:30 to read

I am sure that many of you heard about the latest recommendations on infant sleep that the American Academy of Pediatrics has released. The latest policy statement from the AAP recommends that all infants sleep in their parents room, but not in the parents bed,  for at least the first 6 months of life and preferably for the first year!!  This is big news and quite a change from the previous sleep recommendations which were published in 2011.

 

All of the latest recommendations regarding sleep are intended to help to reduce the incidence of SIDS (Sudden Infant Death Syndrome), which is the leading cause of death for children under the age of 1 year. SIDS in one of the greatest fears of all parents. While “the back to sleep” campaign has reduced the incidence of SIDS, there are still over 3,500 babies in the U.S. who die suddenly and unexpectedly every year while sleeping. (this includes some from suffocation and strangulation and not SIDS).

 

In addition, the recommendations re-iterate that the baby should not co-sleep with their parents, but should be in a crib or bassinet with a firm sleep surface, in the parents’ room. These new recommendations, may be driven by the reality that breast feeding mothers are exhausted and often fall asleep while nursing their baby. If the mother is sitting in a chair or on the couch and falls asleep the baby may be at risk of suffocation if they roll into a cushion or fall down between pillows. If the mother is in bed breast feeding and accidentally falls asleep at least the baby is on a firm surface - make sure when you do breast feed your baby in bed to remove all loose blankets and pillows in the area around your baby prior to feeding - just in case.

 

Although it has been a long ago, I always put our infants in their own cribs to sleep -  you might say I was obsessed. One night, shortly after the birth of our 3rd child I found myself on my hands and knees looking under the bed. When my husband was awakened and asked me “what are you doing?” I replied…”looking for the baby!” He then reminded me that I had put the baby in his crib in the nursery right after I had finished breastfeeding him.  I truly had no memory and thought he had fallen under our bed!! This, from someone who had previously stayed up for 36 hours during residency working in the hospital and thought I could handle sleep deprivation- clearly not true!! I just remember the feeling of being frantic! 

 

The AAP continues to recommend that the crib be essentially bare - in other words, no bumpers, no blankets, no stuffed toys, just the fitted crib sheet. The baby should always be placed on their back to sleep…once your baby learns to roll from back to front ( which typically happens after they have learned to roll tummy to back), they may be left to sleep on their tummy. Even with a baby in your room you cannot get up all night to keep trying to keep them from rolling over!  

 

The AAP does recommend using a pacifier for sleep times ( I am a huge pacifier fan as you know). The only problem with a pacifier is convincing The Parents that it is time to “get rid of the paci” once their baby is over a year old….. sometimes hard to sell that concept.

 

Lastly, the APP reiterated that they do not support the use of any of the devices sold to new parents to help “prevent”  SIDS. In other words, all of the technology being marketed including  “anti-SIDS mattresses, home cardiorespiratory monitors, and even fancy video monitors.  While many a well intentioned parent will invest a lot of unnecessary money and time trying to make the baby safe during sleep, the mantra “less is more” is now the best way to ensure safe sleep for your baby. I remind parents that there will be plenty of ways to spend that money  - start the college savings!

 

 

 

 

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DR SUE'S DAILY DOSE

Why kids need to wear life jackets while boating.

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