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Parenting

Picky Eaters and Personality

1:45

If you have a child that is a picky eater, the reason may have more to do with his or her personality than the food you give them, according to a new study.

Researchers found that little ones who were more naturally inhibited also tended to be picky eaters.

"From the time they're very young, some infants are more 'approaching' and react positively to new things, whereas other infants are more 'withdrawing' and react negatively to the same stimuli," said study author Kameron Moding.

"But very few studies have examined whether infants show similar approach and withdrawal behaviors in response to new foods, so this is what we wanted to investigate," added Moding. She is a postdoctoral fellow at University of Colorado, Denver.

Researchers observed how 136 infants responded to new foods and toys during the first 18 months of life. They found that the children who were more reserved about playing with new toys were also more reserved about trying new foods.

The researchers determined that there might be a link between personality types and attitudes about food.

"It was striking how consistently the responses to new foods related to the responses to new toys," Moding said in a Penn State news release.

"Not only were they associated at 12 months, but those responses also predicted reactions to new objects six months later. They also followed the same developmental pattern across the first year of life," she added.

Getting some children to try new foods can be a challenge, but Moding says parents shouldn’t give up offering a variety of foods to their kids.

Keep trying! Research from other labs has consistently shown that infants and children can learn to accept new foods if their caregivers continue to offer them," Moding said. "It can take as many as eight to 10 tries, but infants and children can learn to accept and eat even initially disliked foods."

Story source: Robert Preidt, https://consumer.healthday.com/caregiving-information-6/infant-and-child-care-health-news-410/picky-eater-it-might-just-be-your-child-s-personality-725183.html

Daily Dose

Hurricanes & Your Health

1:30 to read

The last week has been a tough one for Texans, and especially for those who live in Houston and along the Texas Gulf Coast.  Having my son, brother and mother all with houses in Houston, I have been watching the “Harvey” situation quite closely. Fortunately, my family is lucky enough not to have flood damage and they have not had to leave Houston.  But, too many other families have suffered flooding and have been forced to evacuate their homes and seek refuge in shelters not only in Houston, but in Dallas where I live as well. 

 

There are many families who are now living in very close quarters where they may be for sometime…as it will take weeks and months if not years to recover from this disaster and to rebuild the homes, schools, churches and businesses that have been either damaged or destroyed. 

 

The necessary relocation of families and children into shelters is also “a perfect storm” for the possibility of the spread of infectious disease. This is an important time in which managing the spread of illness and infection is paramount. What this means is that EVERYONE needs to be up to date on their immunizations to prevent the spread of vaccine preventable diseases. 

 

If you have ever “skipped” a vaccine by choice or missed a vaccine, now is the time to get your child’s vaccines updated. This is not only for those who have had to evacuate, but for everyone, as infectious diseases are spread outside of the shelters and as well.  We pediatricians are working in the shelters to try and make sure that everyone is vaccinated as they arrive, but there are those who are too young to be vaccinated and others who do not have their medical records to ensure accuracy of their vaccines. It is an arduous process.

 

But, for the public health system which will be stretched even more so during the flood recovery, vaccines are one of the most important ways to protect people. It only takes one person who might get mumps, measles or whooping cough to spread it to hundreds of others….all living in close proximity. These people will then also leave their shelter to go to school, church the store or even a temporary job where they may put others at risk, you never know if you might be exposed.

 

Lastly, it is really time to get those flu shots!!! The last thing we need is an early flu season with a large group of un-immunized people…and most doctors have already received shipments of flu vaccine.

 

Please please pray for these families who have lost so much and protect everyone by immunizing your children (and yourself).  

 

 

Your Child

Young Kids Overdosing on Dietary Supplements

2:00

It’s no surprised that the majority of American adults now take one or more dietary supplement daily. During the last decade, many households have switched from a simple multivitamin to more specific supplements for different dietary needs. It’s become a billion dollar industry even though many scientific studies have shown mixed results on the effectiveness of supplements on a person’s health.

What may surprise you though is the number of children that are accidently overdosing on dietary supplements found in the home. Children under the age of 6 are the most affected.

A typical scenario might play out like this.  A curious toddler opens a bottle of melatonin found on the kitchen counter, and accidentally overdoses on a supplement typically used by adults to help with sleep.

In that case, the doctor who treats the child may only have to deal with a very tired 3-year- old, but it might have been a far more serious scenario if a different dietary supplement, such as the energy product ephedra or the male enhancement herb yohimbe, had been swallowed.

"We see it all the time," said Dr. Barbara Pena, research director of the emergency medicine department at Nicklaus Children's Hospital in Miami.

From 2005 through 2012, the annual rate of accidental exposures to dietary supplements rose in the United States by nearly 50 percent, and 70 percent of those exposures involved young children.

"The biggest increase [in accidental overdoses] was in children under 6. It got our attention," said study author Henry Spiller, director of the Central Ohio Poison Center of Nationwide Children's Hospital in Columbus. Ninety-seven percent of the time, the children swallowed the supplements while at home, the study found.

The U.S. Food and Drug Administration (FDA) does not regulate dietary supplements, so there is no guarantee that the ingredients listed have been tested or that they are what they claim to be. The FDA can only take action if the supplements are shown to cause harm.

During the 13 years of the study, Spiller's team also found an increase from 2000 to 2002, when the rates of calls to U.S. poison control centers involving supplements rose 46 percent each year. From 2002 to 2005, the researchers found the rates of calls declined. Spiller suspects that is because the FDA banned ephedra in 2004, after supplements containing it had been linked with adverse heart events and deaths.

Overall, only about 4.5 percent of the cases in the study had serious medical outcomes. During the 13-year period tracked, 34 deaths were attributed to supplement exposure, Spiller said.

The supplements most often associated with the greatest toxicity were ephedra (ma huang,) yohimbe (found in male enhancement supplements and other products) and energy drinks and drugs.

Ephedra is now banned, but yohimbe is not. Nearly 30 percent of yohimbe exposure calls in the study resulted in moderate or major harm. Yohimbe can cause heartbeat rhythm changes, kidney failure, seizures, heart attack and death, the researchers noted.

Often, children find the supplements on a kitchen counter, Spiller said. Parents and others may equate dietary supplements with being natural, and therefore safe. Parents usually don't keep track of how many pills are left in a supplement bottle, he said, making it more difficult to tell poison control staff how many pills were taken in an accidental exposure.

Adolescents are also susceptible to overdosing on energy products loaded with caffeine and other ingredients that can cause abnormal heart rhythms or even a heart attack. 

Both Spiller and Pena suggest that parents and caregivers treat supplements the same way they do prescriptions or O-T-C drugs.  Keep all supplements in a locked cabinet or on a high closed shelf if young children are in the house or likely to visit.

Supplements are especially scary, Pena noted, because it's not always possible to know the potency of the product.

The study was published in the Journal of Medical Toxicology.

Story source: Kathleen Doheny, http://www.webmd.com/children/news/20170725/us-kids-overdosing-on-dietary-supplements#1

Parenting

Back-to-School Jitters

2:00

Where did the summer go? Some children will be headed back to school in less than a week and others within the next couple of weeks. It’s not uncommon for kids to be a little anxious as the big day draws near. Your child may be feeling a lot of emotions right now, ranging from high anxiety to  “I can’t wait.” That's understandable. Think back on how you felt when you started a new job or were moving to a new part of the country, it’s quite similar but without the benefit of life experience to help you process the changes.

Besides the unknown of a new school year, there’s the challenge of getting back into an early morning routine and the addition of after-school activities to everyone’s schedule. It’s a hectic time but with a lot of patience and a little smart planning, it can go smoother than you might think.

If your child’s school offers an orientation or back–to-school night, one way to help ease your little one’s fear is to take them and let them see the school, meet their teachers and say hello to some fellow students before classes begin. A familiar face or two can help make the transition go a little smoother during that first week of school.

If your child is able to meet his or her teachers, give them time to talk and get to know each other, if only briefly. Let your child answer any questions the teachers have instead of answering for them. You might even help your child come up with a few questions they can ask the teacher.

You could check with the teacher and see if he or she would mind having a picture taken with your child. As school day approaches, you can show it to your child talk about meeting their teacher. A little thing like that can help your child develop a familiar feeling for the teacher before school starts.

Since it’s always a good idea to read to your youngster, choose books with a back-to-school theme. There are lots of children’s books that tell meaningful stories about kids facing the challenges of moving to a new school, the first year of school, making new friends and lots of other possible scenarios in story form.

Get organized! Easier said than done, I know. If you’re organized and ready for school it not only relieves some of the pressure on you, but for your children too. Chaos or uncertainty about where to go and what to do adds fuel to a child’s concerns about whether everything is going to be OK or not. 

Let your child help create a study area in the home. Being involved in at least some of the decisions can help make this a personal adventure that they have some say in.

All kids need enough sleep and getting into a good sleep routine can help ease them into the changes school is going to require. As you already know from experience, a tired child is more likely to feel overwhelmed, nervous and cranky.  If you haven’t already, start the new bedtime routine now so that you don’t have the arguments and resistance during the first days of school when everyone is trying to find their footing.

The main thing to remember is that your child, whether it’s their first day to attend, or their last year of school, is going to feel a little jittery. Reassure him or her that everything is going to be fine. The new schedule, classmates, studies and activities will be familiar sooner than they think. Let them know that you understand how the unknown can be a little scary, but that this is also a time when good things can happen as they explore all their new opportunities. 

 

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Your Baby

Should Newborns Sleep in Yours or Their Own Room?

2:00

It’s an age-old question, should your newborn sleep in his or her own bed in the parents’ bedroom for a while or start their sleeping habits in their own room?

A new study suggests infants benefit from sleeping in their own room, but the American Academy of Pediatrics (AAP) says the dangers may offset the benefit.

Recent research from a hospital in Philadelphia says babies go to sleep earlier, take less time to fall asleep, get more total sleep over the course of 24 hours, and spend more time asleep at night when they don’t share a bedroom with their parents. Parents also report that they get more rest as well.

“There are a number of possible reasons that babies sleep better in their own room,” said lead study author Jodi Mindell, associate director of the Sleep Center at the Children’s Hospital of Philadelphia. 

“One main reason is that they are more likely to self-soothe to sleep,” Mindell said by email.

During the study, researchers found that parents who put babies to sleep in a separate room were less likely to feed infants to help them fall asleep at bedtime or when they awoke during the night.

When babies had their own rooms, parents also perceived bedtime to be less difficult.

The study focused on infants 6 to 12 months old. Researchers examined data from a questionnaire completed by parents of 6,236 infants in the U.S. and 3,798 babies in an international sample from Australia, Brazil, Canada, Great Britain and New Zealand. All participants were users of a publicly available smartphone app for baby sleep. The researchers noted that because of the use of the smartphone app, results might not be the same for a larger population of households.

The AAP recommends that newborns sleep in their own bed in their parents’ bedroom till the infant is at least 6 months of age to minimize the risk of sleep-related death. Ideally, babies should stay in their parents’ rooms at night for a full year, AAP advised 

The reason for the AAP recommendation is because babies sleeping in the same room as parents, but not the same bed, may have a lower risk of sudden infant death syndrome (SIDS).

The safest spot for infant sleep is on a firm surface such as a crib or bassinet without any soft bedding, bumpers or pillows, the guidelines stressed. 

“Pediatric providers have been struggling with what to tell parents since the release of the AAP recommendations,” Mindell said. “Once a baby is past the risk of SIDS, by 6 months of age, parents need to decide what works best for them and their family, which enables everyone in the family to get the sleep they need.”

SIDS deaths occur most often from birth to six months but can also happen in older babies that were the focus on the study, said Dr. Lori Feldman-Winter, a coauthor of the AAP guidelines and pediatrics researcher at Cooper Medical School of Rowan University in Camden, New Jersey. 

“If the only goal is to increase sleep, then the results may be compelling,” Feldman-Winter said in an email to Reuters Health. “However, since we don’t know the causes of SIDS and evidence supports room sharing as a method to decrease SIDS, giving up some sleep may be worth it.”

The study was published online in the journal Sleep Medicine.

Story source: https://www.reuters.com/article/us-sleep-infants-location/parents-find-older-babies-sleep-better-in-their-own-room-idUSKCN1BC5QI

 

Your Child

FDA Warning: High Lead Levels in Herbal Remedy

2:00

The Food and Drug Administration is issuing a warning to parents and caregivers about high lead levels found in the herbal remedy, Balguti Kasaria Ayurvedic Medicine.

The herbal remedy is marketed for use in infants and children for various conditions such as rickets, cough and cold, worms, and teething. According to the product packaging, the product claims to help with digestion and bowel movement and improve the immune system.

The North Carolina Division of Public Health first reported high levels of lead after testing the product.

In addition, the Michigan Department of Health and Human Services notified the FDA that two children were found to have high levels of lead associated with the use of this product. The families of the children affected stated that they had the product mailed to them from India. At this time, the FDA has received one report of developmental delays in a child who was administered this product.   

Ayurvedic medicine is one of the world's oldest holistic healing systems. It was developed more than 3,000 years ago in India.

It’s based on the belief that health and wellness depend on a delicate balance between the mind, body, and spirit. Its main goal is to promote good health, not fight disease. But treatments may be geared toward specific health problems.

In the United States, it’s considered a form of complementary and alternative medicine (CAM).

Parents and caregivers should familiarize themselves with the symptoms of lead poisoning. High lead levels have also been found in toys, costume jewelry and other products that children use.

The symptoms are:

  • Developmental delay
  • Learning difficulties
  • Irritability
  • Loss of appetite
  • Weight loss
  • Sluggishness and fatigue
  • Abdominal pain
  • Vomiting
  • Constipation
  • Hearing loss
  • Seizures
  • Eating things, such as paint chips, that aren't food (pica)

Lead poisoning symptoms in newborns - Babies exposed to lead before birth might:

  • Be born prematurely
  • Have lower birth weight
  • Have slowed growth

The FDA is urging parents and caregivers to stop giving the product to children and to consult a healthcare professional. Balguti Kesaria is sold online and made by different companies, including Kesari Ayurvedic Pharmacy in India. The product has also been mailed or brought into the United States.

Story sources: Da Hee Han, PharmD, http://www.empr.com/safety-alerts-and-recalls/balguti-kesaria-ayurvedic-medicine-high-lead-levels/article/680132/

http://www.webmd.com/balance/guide/ayurvedic-treatments#1

http://www.mayoclinic.org/diseases-conditions/lead-poisoning/symptoms-causes/dxc-20275054

Your Child

Helping Children Cope With Frightening News Events

2:30

Gone are the days when most Americans got their news from 3 or 4 sources around the evening dinner hour. Today, thousands of news reports (some real, some fake) instantly flood our phones, computers, TVs and radios, sometimes with real time graphic images.

While some news events may be difficult for even adults to comprehend (with all our life experience and knowledge about current affairs), children don’t have that advantage when they hear and see things that feel threatening to their safety and family stability.

The Journal of American Medical Association, (JAMA) Pediatrics, has published a free online patient’s page dedicated to How to Talk to Your Children About Tragedies in the News.

The amount of information available on current events is almost instant. Sometimes parents don’t have a chance to screen what their children see and hear, so it’s important to know how to talk with your children about what they are experiencing.

The JAMA article is broken down into different age groups. Your approach should differ depending on your child’s age and ability to understand complicated situations.

A good place to start in discussing a tragic event is by asking what your child has already heard. After you listen carefully, you can ask what questions they have. It is important to be honest about what happened and to focus on the basics. It is not necessary to share every detail, and it is important to avoid speculating about what might happen next. Listen closely to your child for misinformation or underlying fears. Remind your child that you are there for him or her and will keep them safe. A key underlying message for parents to convey is, “It is ok if this bothers you; we are here to support each other.”

For very young children, news events can be frightening because they don’t understand context. Children may wonder; is this going to happen to us? Is this happening in our neighborhood? Are my friends ok? Are we next? News media coverage can include graphic images and sounds. It is best to share information with children by discussing it rather than showing the media coverage. Young children may have more questions about whether they are truly safe and may need help separating fantasy from reality. Some children may become clingy or regress in behavior such as wetting the bed or sucking their thumbs. It is important to be patient and to support your child if he or she reacts in this way. Do not ignore your child’s fears or brush them off. Realize that children see the world from a different perspective.

For older children and teenagers, it may be more difficult to avoid exposure to these events in the news. Kids on social media outlets often see stories and videos on their phones while at school or out with friends.- before you have a chance to preview the news. When there is a concerning news event and you have the opportunity, try to preview it before showing it to them so that you know what to expect and what key points to discuss. Then watch it together. Older children and teenagers may want more information about the tragedy and the recovery efforts. They may have opinions about the causes as well as suggestions to prevent future tragedies or a desire to help those in need. Listen to what they say and validate their concerns. If they’ve already seen something tragic, again, ask them what they think about it and talk about their concerns and what they see as a next step in coping.

Other ways you can help your child manage unsettling news are:

  • Be a calm presence. It is okay for children to see adults be sad or cry, but consider excusing yourself if you experience intense emotions.
  • Reassure your child of his or her safety. Consider reviewing your family’s plans for responding to an emergency.
  • Maintain the routine. To give your child a sense of normalcy, keep up your family’s usual dinner, homework, and bedtime routine.
  • Spend extra time together. This can foster your child’s sense of security. Encourage your child to express his or her feelings.
  • When possible, do something to help. Consider ways that you and your family can help survivors and their families.

Like adults, some children may have difficulty with events for a variety of unexpected reasons. Think back to 9-11. How many of us were prepared to watch the towers collapse and the horror and anguish of the families that were missing relatives and friends in the buildings? How we feared that there was a possibility that our country was under attack. It was one of the most devastating events our country has ever experienced in the modern age of instant media information.

Time has helped us put that day in perspective, but the repeated showing of the planes flying into the towers gave many Americans PSTD symptoms. It was almost too much to comprehend. Remember that when your child is scared or anxious about a current event. Help them realize that tragedies do happen, but we can and most often, do survive.

Some signs that a child is not coping well include sleep problems, physical complaints such as feeling tired, having a headache or stomachache, or just feeling unwell. Changes in behavior may include regressive behavior such as acting more immature or being less patient, and mental health concerns like sadness or heightened depression or anxiety. Sometimes it can be hard to tell if a child is reacting in a typical way to a tragic event or if there is something else going on.

Talk with your child’s pediatrician if you are concerned about your child’s reaction.

These are uncertain times. Everyone seems to be a bit on edge, wondering when the next shoe will drop. Have a plan on how to talk to your youngster about current events. Most of all have patience and be a good example of calmness and reassurance; that no matter what happens, you have their best interests at heart.

Story source: http://jamanetwork.com/journals/jamapediatrics/fullarticle/2646851

 

Daily Dose

Over The Counter Products

1:30 to read

So, if you have read my daily doses you are aware that my “news watching” comes from morning TV while I am getting ready for work!!  I often find myself talking to the TV, especially when it is a medical segment which includes pediatrics.  While I am excited that morning TV is covering health topics, some of the information may be a bit “misguided” when a pediatrician is not the one discussing a pediatric topic.

I “heard” another example of this the other morning when the morning shows were discussing the “top pharmacist picks for over the counter products”.  It seems they surveyed pharmacists  and then compiled a list of “favorite” name brand OTC products in numerous categories - I don’t  think there was much science behind this. At any rate, we all have our “favorite” go to “OTC” products which for one reason or another we prefer. Does that actually mean they are better?

So, here are a few that I had issue with:

Allergy medications: They picked Claritin, but why not Zyrtec or Allegra?  They are all second generation anti-histamines and there is not a great deal of data that one is better than another. If push came to shove and I could only pick one antihistamine it would be Benadryl (diphenhydramine) - despite its sedating properties it is still a great drug.

Topical antibacterial medication: They picked neosporin and I would pick polysporin. Neosporin contains neomycin which may cause an allergic contact reaction. Other than neomycin they are quite similar and both contain topical lidocaine for pain relief.  Guess what -  they are made by the same company!!  

Pain relief:  They picked Advil, but why not Motrin or generic ibuprofen.  I am frugal and buy whatever is on sale, same drug.  I always remind parents of this as sometimes they get confused and say, “Advil didn’t work so I gave them Motrin” double dosing them with same drug. Be careful.

GI complaints:  Pharmacists picked Pepto-Bismol. I do not recommend Pepto-Bismol to  children as it contains  bismuth subsalicylate which is related to aspirin and has been associated with Reye’s Syndrome.  The bottle is labelled “do not use under the age of 12 years” due to this concern, but parents may not read the fine print. There is a Children’s Pepto that contains only calcium carbonate and may be given to children as young as 2 years….really important to read the labels as there are many choices with similar names.

Lip balm: Their choice was Carmex. I do not recommend lip balm/gloss that contains menthol or camphor as it may actually damage the lips and cause more drying…so you apply more then it is a vicious cycle.  You want to use lip balm with bees wax or petrolatum and no fragrance. I like Aquaphor, Burt’s Bees and Vaseline.  

Formula: Their choice was Enfamil.  I recommend any of the formula brands including Simliac and Gerber as well as some Organic Formulas if my patients desire.  I don’t know why they would pick only one brand…no data on that either.

Sunscreen:  Their choice Neutrogena, which I also love. They make good products that are hypoallergenic and PABA free, and they have many different vehicles (spray, lotion, stick) to choose from. I am also a fan of Cerave products and they now have sunscreen for babies.  But the most important fact is to use a sunscreen of any brand with an SPF of at least 30 and one that contains zinc or titanium dioxide and no PABA or oxybenzone. 

Those are just a few of my comments and favorites.

 

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