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Daily Dose

Fainting

1:30 to read

Seeing your child faint is always scary for a parent. But in reality, fainting (syncope) is more common than one realizes. Fainting is defined as a transient loss of consciousness and occurs in 15-20% of children.  It is very reassuring to a parent to hear that in most cases fainting is not serious and is only due to cardiac causes (a parental fear) 2-6% of the time.

When parents bring their child in “because they fainted”, the most important part of the evaluation is a good history.  I ask both the parent and child questions.  If there were witnesses other than a parent it is important to question them as well.

I always want to know when the event occurred? Was it when they first had gotten up in the morning, had they eaten before the event?  Do they remember how they felt before they fainted, and did they feel “funny or dizzy” beforehand?  Were they actively exercising when it occurred?  Do they remember “waking up” and how they felt? Did they “wet their pants”?  Most importantly is there any family history of a sudden cardiac event or death (ask about drowning or seizures).

Parents often want to “have a lot of tests run” to rule out “everything”…but after a good history the most important next step is a thorough physical exam.  Just good old fashioned medicine, prior to anything else.  

The most common reason for fainting is often an association with “emotional stress - like seeing blood”, but there are other causes such as hunger and low blood sugar, heat, anxiety, or dehydration. This type of fainting is called vaso-vagal sycope or neurocardiogenic syncope.  Thankfully this type of fainting can be managed by teaching the patient to recognize their symptoms  and protecting them from falling and hurting themselves, not from fainting but from a possible secondary head injury. I tell every one of my patients that has fainted….if you feel funny, dizzy, see spots or whatever and “think” you are fainting, SIT DOWN!!! Fainting will not kill you but cracking your skull might.

I usually do a baseline EKG on children who have a “first fainting episode”, as it is an easy test and I have an EKG machine in my office.  ( not all doctors will even do an EKG).  This will rule out some abnormal rhythms or cardiac enlargement.  Although each case is different, there are “red flags” that should prompt a more extensive evaluation. Fainting that occurs during exercise should always have a more detailed work-up. Having a family history of certain cardiac diseases should also necessitate further work up. In these cases I typically refer patients to a pediatric cardiologist for further evaluation which might include an echocardiogram, a stress test or even cardiac monitoring. 

Actually, all 3 of my own children fainted during their teen years..so weird, but I did know it was more common than people think. Interestingly, they all seemed to “outgrow” fainting.  Anecdotally, In my own experience fainting seems to be so much more common during adolescence, while those hormones are raging…which is very stressful.

Daily Dose

PU: Body Odor

1.00 to read

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

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

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

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

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

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Daily Dose

Toddler Constipation

1:30 to read

I get so many questions about toddlers and constipation.  Constipation relates to stool frequency and consistency.  It is important to understand that everyone has different bowel habits and not all children will have a stool every day.  While some children will have several stools a day another may have a stool every 2 -3 days. Both of these scenarios may be normal and not an indicator of problem.  At the same time, stool consistency is important. If your child has  hard, dry, pebble like stools ( rocks rather than softer snakes or blobs ) this may be an indicator of constipation. Everyone will occasionally have a hard stool, but this should not occur consistently. Lastly, it should not be painful to pass the stool. While toddlers may grunt or push, or even start to “hide” to poop, it should not cause real pain.

With all of that being said, it is not uncommon for toddlers to become constipated as they often are also becoming picky eaters. Due to this “phase”,  some young children will drink too much milk in place of eating meals and this may lead to constipation. Your toddler should be drinking somewhere between 12 -18 ounces of milk per day.  Many children also load up on other dairy products like cheese, yogurt and cottage cheese, which while healthy, may also lead to too much dairy intake and contribute to constipation.

Water intake is also important to help prevent constipation. If your child is drinking too much milk, substitute some water as well.  It is a balancing act to make sure your child is getting both milk and water. If necessary I will also put the smallest amount of apple or prune juice in the water. By the age of 1 year, your child should no longer have a bottle as their main source of nutrition is no longer in the liquid form!

Fiber is also important so offer plenty of whole grains and limit the “white foods” that toddlers love (yes, the bread, cereal, pasta). If you always buy whole wheat pasta and whole grain breads your children will never know the difference. Stay away from processed white foods whenever possible.  It is also easy to throw flax seed or bran into muffins or smoothies (disguising fiber). I also sometimes use Metamucil cookies (they are pre made) and may even resort to dot of icing smeared on it and offer it as a cookie for snack, along with a big glass of water.

Fruits and veggies are a must…even if you think your child won’t eat them! Your toddler needs 2 servings of fruits and veggies every day and rotate what you offer them.  You will be surprised at how one day they may refuse something and they next they will eat it. Don’t give up on fruits and veggies,  it may literally take years for your child to eat peas…but if they aren’t offered a food repetitively they will probably never it eat. I know a lot may get thrown to the floor but just clean it up and persevere.  Not only will this help their stools but their long term healthy eating habits as well.

Movement is also important to help keep the bowels healthy and “moving”.  Making sure that your toddler is moving seems crazy, as they are on the go all of the time.  But with an older child make sure they are getting plenty of time for play and exercise outside or in…and not just sitting in front of a screen.

Lastly, for short term issues with constipation it is also okay to try using milk of magnesia (MOM) or even Miralax….but ask your doctor about dosing in toddlers.   

Your Teen

Alcohol-Branded Clothing & Accessories Linked to Youth Alcohol Use

2:00

The T-shirts, handbags, backpacks, hats, jackets and sunglasses we wear and carry all say a little something about who we think we are or would like to be. Clothing with slogans and photos, accessories with name –brands or specific designs help express, at least a small way, how we connect with others and want others to connect with us.

From politics to religion to music and movies – we’re not likely to wear something that we philosophically disagree with. That’s pretty much true in all age groups.

So, what does it mean when teens proudly wear clothing and carry products with alcohol-brands up front and center?

According to a large review of different studies on the topic, teens that own caps, shirts, and other merchandise displaying alcohol logos are more likely to drink.

Australian researchers reviewed results from 13 studies looking at alcohol-branded merchandise and teen alcohol use. The research included more than 26,000 kids and teens, mostly from the United States.

Four studies looked specifically at young people who hadn't started drinking alcohol. Those who owned alcohol-branded merchandise were more likely to start drinking a year later, the researchers said.

While the study doesn’t prove causation (teens will drink if they own alcohol-branded items), it does show an association between the two activities.

"It is possible that owning the merchandise makes young people more likely to drink, or that young people who drink are more likely to want to own the merchandise, or a combination of these effects," explained study leader Sandra Jones. She's director of the Centre for Health and Social Research at Australian Catholic University in Melbourne.

Dr. Victor Strasburger, lead author of the American Academy of Pediatrics' Children, Adolescents, and Advertising policy statement, said, "The studies showed that this ownership contributes to onset of drinking, not the amount of drinking.”

“But we know that when teenagers begin drinking, they tend to binge drink, not use good judgment, and drive when drunk or intoxicated," he added.

Because of the study’s findings, Jones believes that promotional alcohol-branded products encourage drinking among adolescents.

"As they transition through adolescence, young people are developing their sense of identity," she said.

"The things that they wear, carry, and consume help to create and convey their desired identity. There is increasing evidence that brands facilitate this by allowing the young person to take on and project the desirable characteristics that are associated with that brand. These characteristics and brands then become a part of their sense of self, as well as the way that others see them," Jones said.

In addition to hats, caps and T-shirts, other examples of alcohol-related products include accessories, such as bags, backpacks, belts, lighters, sunglasses, wallets and key rings. Other promotional items include drinking glasses, utensils, cooler bags, bottle openers and coffee cups, the researchers said.

Depending on the study, ownership of such items ranged from 11 percent to 59 percent of the young participants. Ownership was higher among older children and males, the researchers said.

Most of the studies didn't find any gender differences. But two studies did find that the association between branded merchandise and drinking issues was actually stronger for girls.

Jones noted that company policies and regulations could help prevent the availability of such products for teens. She recommended restricting the sale of alcohol promotional products where the sale of alcohol is allowed, that alcohol-branded clothing not be made in children’s sizes and toys and gimmicks that appeal to children be discontinued.

Jones also noted that it’s not only up to businesses and government to regulate the availability of these products to kids, but parents as well.

"Many of these items are given away for free at promotional events or as gifts with purchase, and parents may hand them on to their children -- or allow others to do so -- without processing the fact that they are providing their child with extended exposure to an advertisement for an alcohol brand," she said.

Strasburger said the media are often irresponsible when it comes to alcohol. "They depict alcohol use as normative behavior, or a solution for complex problems, or show being drunk as funny," he said. "We spend something like $5 million on alcohol advertising every year, then we wonder why so many teenagers drink. It's not rocket science."

The findings were publised online in the April 1st edition of the journal Pediatrics. 

Story source: Don Rauf, http://consumer.healthday.com/kids-health-information-23/kids-and-alcohol-health-news-11/booze-branded-merchandise-may-spur-teen-drinking-709478.html

 

 

 

Daily Dose

Play It Safe While Playing on the Slide

Do you remember the first time your child went down a sliding board? Or do you have a toddler who is about ready to make their first trip down the slide?

I remember watching my child climb the ladder up a sliding board, and then looking back and saying, “Mommy, you come with me.” So, up the ladder you go, putting your child in your lap for that first sliding board experience. Isn’t that the safest and easiest way to teach your child about a sliding board? What a sense of accomplishment, for both parent and child. Such a fun day at the park!! Well, I was reading a study by Dr. John Gaffney in an issue of the Journal of Pediatric Orthopedics. Dr. Gaffney noted that he was seeing fractures of the tibia (shin bone) in toddlers, many of whom had a history of being on a slide. I must admit, I haven’t ever seen a fractured tibia from a sliding board accident, but he looked at medical records for all tibia fractures he treated over an 11- month period. Of the 58 tibia fractures he studied, eight (13.8%) were sustained while playing on a playground slide. The age range of these patients was 14 – 32 months, and the average age of the eight patients in the study was 20.7 months. All of the tibia fractures associated with playing on a slide were sustained while going down the slide on the lap of an adult or an older sibling. None of the eight children studied had been on the slide alone. Dr. Gaffney states, “if a toddler is riding by himself and gets his leg stuck against the side of the slide, he can stop himself fairly easily, but with a parent’s weight added in you have greater velocity and momentum and it is harder to stop and the leg may get wedged and subsequently break.” He advises that if a child cannot use a sliding board independently, you should look for another age appropriate piece of playground equipment. I guess that would mean the sandbox. Thank goodness that I was lucky enough that all of my children made it safely down the slide with their parents, as I know both my husband and I were on the slide numerous times. I am sure I have pictures of that event, but I will be telling my patients about this interesting study. Like many things, there are risks involved, so find a smaller slide that your child can handle alone, or just wait until they are bigger. It ironic that something that we think will make our children safer might actually cause more injury. That’s your daily dose, we’ll chat again tomorrow. Send your question to Dr. Sue right now!

Daily Dose

Politics & Vaccines

1:30 to read

As we head into another election cycle, I bet many of you watched the recent GOP debates (23.1 million viewers).  I too was watching and listening, but I must say my ears perked up when I heard several of the candidates discuss the issue of childhood vaccines.  Suddenly I was hearing politicians or political “wanna bees” discussing whether or not children should receive vaccines?  I held my breath as I heard several of the candidates, some of whom are even physicians who presumably understand science, discuss vaccine safety, alternative vaccine schedules and the relationship of vaccines to autism.

I truly was aghast to hear Donald Trump discuss his anecdote of a child who purportedly had their vaccines and suddenly “became autistic” (which is a diagnosis made over time). Then there was Dr. Ben Carson, a pediatric neurosurgeon who stated  “we are probably giving way too many vaccines in too short a period of time”.  Had he forgotten children with meningitis?  As I sat in front of the TV and groaned I heard Dr. Rand Paul add, “vaccines are one of the greatest medical discoveries of all time, but even if science doesn’t doesn’t say bunching them up is a problem, you ought to be able to spread vaccines out a little bit”. Has he done a study to show that alternative schedules work?

Many of their statements were based on “faulty logic”, and had “no scientific basis” and some were entirely anecdotal. Numerous studies from around the world have proven that there is no link between vaccines and autism. Vaccines have only gotten safer and are essential for public health.  Stick to the facts…were the fact checkers watching?  Where was the rebuttal?

As a pediatrician who discusses vaccines with patients on a daily basis I must say I was horrified by these statements.  If politicians want to weigh in on childhood vaccines then it is incumbent upon them to be “briefed” and up to speed about the science behind the childhood vaccine schedule and vaccine safety.   While they are learning about foreign policy, economic decision making and the recent issues surrounding global immigration ( all of which seem to be more of a political policy issue than childhood vaccines) maybe they need a crash course in public health.  Misinformation about vaccines from those who have a national television audience is unacceptable. Having a child “go un-immunized”  due to statements that were made during  the GOP debate, has the potential to harm many children. Just look at the recent measles outbreak….these are serious issues. 

The president of the AAP quickly released a statement endorsing the childhood vaccination schedule, the importance of vaccines and vaccine safety. Many pediatricians as well as other physicians have also re-iterated the importance of vaccines being given according to the vaccine schedule. As Dr. Remley stated, “what is best for children is to be fully immunized”. plain and simple. I am hopeful that the 23 million debate watchers heard her message.

Daily Dose

Breast Feeding Woes

1:30 to read

I recently read an editorial in The New York Times entitled “Overselling Breast Feeding”. It was written by Courtney Jung who is a professor of political science at the University of Toronto.  It was quite interesting to me as she stated “the moral fervor surrounding breast feeding continues unabated, with a steady stream of advocacy and education campaigns”.  The WHO (World Health Organization) developed “ten steps to successful breast feeding” in hopes of increasing breast feeding initiation and duration around the world. Hospitals have been designated “Baby-Friendly”  (aren’t they all supposed to be?)  if they adhere to these steps as well. But the United States has done well with breast feeding rates as 79% of mothers initiate breast feeding.

Most, if not all of the new mothers I make rounds on are proponents of breast feeding. They have read the books, gone to classes and are determined to be successful at breast feeding. But, in my experience over the last several years, I have actually seen more and more new mothers becoming over-wrought and wary of breast feeding fueled by the “rules” that they are being required to follow. With that being said, having someone “tell you that you must breast feed your baby in the first hour after birth”, and that “your baby must remain in your room 24 hours a day“, and that they “may not have a pacifier”, “and should “breast feed on demand” is actually anxiety promoting and leaves many a new mother exhausted and tearful within a day or two of having a baby. 

While breast feeding is “natural” it also requires some practice and the only practice is really “on the job” training.  Some babies just latch on quickly and are pros immediately, but not all babies will become proficient at breast feeding in the first day or two. The mothers are told to “let the baby nurse on demand” and some mothers have had their babies at the breast for hours on end and are exhausted, with sore and bleeding nipples. I have walked in to too many hospital rooms with a mother in tears and a fretful baby, and a “helpless” new father.  Some feel as if “they are failures” as mothers before they even are discharged, and at the same time are having serious doubts about continuing to breast feed.  They are sure that their baby will catch serious illnesses and have a lower IQ if they don’t breast feed, but how can they maintain this constant breast feeding and no sleep and never put a pacifier in their baby’s mouth??? Is there only one way to be successful at breast feeding?

I loved breast feeding but it was a long time ago and we were instructed by caring nurses “to just go home and put the baby to the breast every 2-3 hours”. While that may not have been the best education has the pendulum swung too far?  Will giving the baby one bottle when a mother is having postpartum anxiety and sleeplessness really harm the baby?  Should a mother have to sign an order allowing her baby to have a pacifier??   While guidelines for breast feeding are helpful should they be so rigid that a mother “gives up” on breast-feeding because she can’t follow 10 steps in the first 24-48 hours?   

The New York Times article was quite interesting and I had to agree with many of the author’s  points. Supporting a woman’s choice to breast feed is admirable and “policy changes promoting maternity leave, and flexibility” are definitely needed to encourage women to continue to breast feed. But as she states “is all of this breast feeding advocacy crossing the line?”   A mother should choose to breast feed because she wants to, and that does not mean if her baby does not breast feed in the first hour that she will never bond with her baby or be successful at breast feeding.  Some woman are unable to breast feed for a multitude of reasons and that decision should not label her as a “bad mother”.  Again, breast feeding, like a woman’s breast, is not “one size fits all”. 

 

Your Teen

Young Male Athletes, Parental Pressure and Doping

1:45

When 129 young male athletes, whose average age was 17, were asked what would make them consider “doping” as a way to boost their athletic ability – the majority said parental pressure.

A new study from the University of Kent in England asked the young male athletes about their attitudes on "doping" -- the use of prohibited drugs, such as steroids, hormones or stimulants, to increase athletic competence.

These substances, sometimes called performance-enhancing drugs, can potentially alter the human body and biological functions. However, they can be extremely harmful to a person's health, experts warn.

The study group was also asked about four different aspects of perfectionism. The areas were: parental pressure; self-striving for perfection; concerns about making mistakes; and pressure from coaches.

Only parental pressure was linked to positive feelings about doping among the athletes, the study authors found. Although the study was small, it did point out how important demanding expectations from parents can be to kids. 

Lead author of the study, Daniel Madigan, a Ph.D. student in the university's School of Sport and Exercise Sciences, said the findings suggest that parents need to recognize the consequences of putting too much pressure on young athletes in the family.

"The problem of pressure from parents watching their children play sports is widely known, with referees and sporting bodies highlighting the difficulties and taking steps to prevent it," Madigan said in a university news release.

"With the rise of so-called 'tiger' parenting-- where strict and demanding parents push their children to high levels of achievement -- this study reveals the price young athletes may choose to pay to meet their parents' expectations and dreams," Madigan added.

The researchers only focused on young men for this study but plan to investigate if the same result will occur with young female athletes, and if there are differences between athletes in team versus individual sports.

The study findings are scheduled for publication in the April print issue of the Journal of Sports Sciences.

Story source: Robert Preidt, http://teens.webmd.com/news/20160229/young-athletes-pressured-by-parents-may-resort-to-doping

 

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