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Daily Dose


1:30 to read

Some of my adolescent patients (who are over 18 years) have come in for check ups and shown me their latest “fashion statement”, a tattoo or an occasional tongue piercing.  While years ago it was teenage girls with pierced belly buttons, that fad has declined (at least in my patient population), and societal acceptance of tattoos and other body piercings is more common. While I do see tattoos, tongue piercings and eyebrow piercings within my practice… it seems that I also notice them far more frequently on the parents of the new babies I am seeing.


While tattoos and body piercings may be a form of self-expression for a teen, it is also important to remember that there may be risks involved.  A recent article in Pediatrics reviewed risks and consequences of the ever growing “body modification” trend.


In several surveys somewhere between 20%-38% of youths 18-24 years old have a tattoo or body piercing (other than ear lobe) and the perception of the association between having a tattoo or body piercing and engaging in high risk behavior is changing.  


But, when a teen asks me about tattoos or body piercings I do remind them that there are risks involved, including infection. While most teens worry about a skin infection I also remind them of the risks of HIV, hepatitis B and C and even tetanus…so you want to make sure you have an up to date tetanus vaccine before thinking about a tattoo or piercing. You also want to make sure that there are good antiseptic processes and sanitary practices in place when choosing a tattoo parlor and always use a professional tattoo artist.  


I also tell them that tattoos should be viewed as being “permanent”, and I would consider where I had the tattoo placed, and would it be possible to cover it if necessary for employment opportunities?  In the not too distant past I remember our office requiring any employee with a visible tattoo to have it covered with long sleeves but while those days are over, at least in my  office, other employers may have rules about tattoos or body piercings. Because tattoos are supposed to be permanent I also remind teens that trying to remove an ill placed or “out of style” tattoo is difficult, expensive and may only be partially effective. 


If any piercing or tattoo begins to look infected or has skin changes the adolescent should definitely seek treatment with a physician. Better still….maybe use a henna “non-permanent tattoo” and limit piercings to the ear.









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.



Recall: 587,000 Preferred Kids Wind-Up Musical Toys


More than 500,000 wind-up musical toys are being recalled because of a choking hazard. The stuffed animals come in a variety of animal characters and colors.

The recalled Preferred Kids Wind-Up Musical Toys have a metal post and /or handle that can detach and get stuck in a child’s throat if they put the part in their mouth.

The firm has received six reports of parts from the wind-up handle detaching from the toy. No injuries have been reported so far.

Consumers should immediately stop using the recalled toys, take them away from young children and contact Kids Preferred for a free replacement toy.

The toys were sold at Carter’s, Target, Walmart and other stores nationwide and online from January 2016 through August 2017 for between $11 and $20.

Consumers can contact Kids Preferred toll-free at 888-968-9268 from 8:30 a.m. to 5 p.m. ET Monday through Friday, email at or online at and click on “Product Safety” for more information.

The model number and batch code are printed on the smallest white sewn-in label behind the care label.

A list of model numbers and batch codes as well as photos and descriptions of the recalled toys can be found at

Daily Dose

Placebo Effect

1:30 to read

October is State Fair of Texas month in Dallas!  If you have never been to the Texas State Fair you really don’t know what you are missing….as you cannot see or do everything in one day. Just a few of the highlights include the automobile show, followed by the agricultural areas,  the animals being shown and auctioned, and the incredible number of canned goods and baked goods with prize winning ribbons.  Then there is Big Tex and the midway and any number of fried foods….fried cookie dough, fried Oreos, fried peanut butter and jelly and the favorite corny dogs!!  But many kids prefer cotton candy and snow cones, which come in any color and flavor you can imagine.


One young mother was in the office the other day after spending a day with her kids at the fair. Not only is it overwhelming in how vast it is, it is also an expensive outing for a family…especially with children who “want one of everything”. So she was telling me that her children had “blown through” their money on foods and games when one of the children wanted another snow cone. She was trying to explain to them that they could not have anything else…when she came up with the most clever idea!


How about a marshmallow snow cone? I must say I was a bit confused.  But, she told me she went and got ice chips and put them in a cup and told the children they were marshmallow snow cones, and that is why they were white and not colored.  The children LOVED them and were thrilled that their mother had acquiesced for another treat.  Everyone walked happily to the car eating their marshmallow snow cone and were very content.  The ride home was without tantrums or tears!


What an ingenious mother! Thinking on her feet, saving money and everyone was happy. The placebo effect at its best. 

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. 

Daily Dose

Life Lessons

1.30 to read

I recently spoke to a group of mothers with sons who were in high school. I was discussing “boys to men....the high school years”.   As I was writing my remarks I was thinking about the many lessons I learned while parenting my sons through their high school years.  Funny how it sometimes seems like long ago, and at other times it seems as if it was just yesterday. 

I think one of the biggest lessons I learned while raising teens is something that my mother and father both told me.  There were so many occasions when I begged my parents for “something”. I can remember telling them, “it’s not fair, eryone else has a phone in their room!”  But, being the good parents that they were, they explained all of the reasons that I didn’t need to have my own phone.  I thought that my parents could afford to put a phone in my room, but they said that wasn’t the point.  Their reply was often “just because we can doesn’t mean we should”. 

That statement has probably been made by parents for hundreds of years. But I must say, it is often hard for some parents to follow this adage. We all want to give our children as much as we can, but sometimes by not giving, we are all being better parents. 

Just because you can give your toddler an iPad doesn’t mean that you should. Just because you can give your elementary school child and I-phone doesn’t mean you should.  The same for giving your child a TV in their room, or a car for turning 16.  I really admire the parents who can truly give their child “most anything”, but know that their children need to learn to wait.  

So, I spoke to the parents group about trying to follow my own parents statement when raising my sons. They would probably tell you that we were sometimes “mean and strict” and that they would get upset when we would say “just because we can doesn’t mean we should”.   I think it worked well for our family.....waiting is a hard but necessary lesson. It often makes you more appreciative as well.  

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Sportsmanship with Drew Pearson

Daily Dose

Parenting is Not a Competitve Sport!

1:30 to read

When did parenting become the latest competitive sport?  I have heard all sorts of new parents, even on their baby’s first day of life... start off by saying that their baby is “not....insert what their friend’s baby is already doing.” Does that mean not breathing as fast, or having a lower heart rate...I mean what is there to be competitive about in the first 24-48 hours?

It has always been hard to be a parent, and self doubt is one of the biggest issues a parent faces....but to start off feeling like you are already “failing’ is totally crazy.  There are so many feelings that a new parent experiences, without having competition even enter their minds.

Babies sleeping longer, crawling earlier, talking more...that only seems to be the beginning. Soon it is about who’s reading first, is on the more competitive soccer team at the age of 6, or even has the biggest birthday party. Unfortunately, all of this is shared on social media....which means that you are feeling “competitive” or inadequate with not only your closest group of friends but with hundreds if not thousands of people, and many of whom you don’t even know. It is just too much!

At the same time you are also getting comments about your parenting....which I think only compounds all of the emotions and worries and questions parents experience. Instead, why not rely on your own circle of friends, family and maybe a book or two on raising children.  

So....I would resist the urge to share every moment of your baby’s life and milestones with the social media world, or to compare your baby with total strangers....there will always be someone who does something earlier and faster....and that does not always mean better. 

Parenting is definitely a marathon...but not a competitive one. 

Daily Dose

Bump on Your Child's Leg?

1:15 to read

I recently saw a young adolescent patient who had noticed a “lump or bump” on her leg which she had noticed for some time and she had now wondered what it was. She said that she had initially thought she had bumped her leg,  but she had continued to watch it and noticed that it did not seem to be going away. So, after many months of watching it and wondering what it was she decided to come ask me.

On her exam she had a notable “bump” or mass on her lower leg, about the size of a half dollar. There was no surrounding bruising and the mass was non-tender. She told me it really did not bother her, and she was more concerned as she thought it was noticeable and a friend had asked her about the “bump”.  Other than cosmetic concerns, it did not cause any problem.

The most common reason for this bump is an osteochondroma, which is a benign bone tumor. The most common time to find this type of tumor is during periods of rapid growth during adolescence. They are usually found in the leg (femur, tibia) or the upper arm (humerus). 

So, I sent her for an x-ray which was compatible with the diagnosis of a benign osteochondroma. She then had a CT of the area which confirmed the diagnosis.  Most osteochondromas are solitary and the chance for malignant transformation is rare (less than 1%).  So, after discussing her case with a pediatric orthopedic surgeon it was decided to just watch it.  

She had mixed emotions about her diagnosis, as she was happy to know what caused the “bump” but was concerned that her friends would continue to ask her about it. Of course her parents were relieved to find out that it was benign and would likely never require any treatment.

We all decided to watch it for now… the tumor typically stops growing after an adolescent has completed their growth spurt and the growth plates of the bones are closed.  


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