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Daily Dose

Happy Thanksgiving!

1:30 to read

This is the week that really kicks off the holiday season and for me it often begins with reflection.  I am often guilty of not appreciating the many blessings that I have, and rather focus on just getting through one day at a time. But as I reflect, I realize that I have so much to be grateful for and much of that gratitude is for my family.

When you are in the throes of parenting, I think it is sometimes hard to appreciate many of the blessings that we have as families. As parents we are anxious for the next stage, whether that is having a baby sleep through the night or wanting your child to talk, start school, begin to read, or finish their college applications. Parenting is so often about looking ahead rather than living in the moment.

It is sometimes hard to take a breath and sit on the floor and play with your baby, or let your elementary school child read you a book at bedtime, or enjoy editing your high school student’s next paper (why was that always a Sunday night at 9 pm event?).  But, from someone who has been there, sit back, take a breath, put down your electronics and appreciate whatever stage your child is in right now!  For this too shall pass...

Why not take a minute during Thanksgiving and ask each one of your children what they are thankful for, and write their answers down on a note card to file away to read years from now. It is fun to see their answers and how their gratitude changes with age....some of their answers are funny, others are quite thought provoking.

As our family grows, now with a granddaughter and a new daughter in law, I find myself trying to take my own advice. We are fortunate to be gathering together for Thanksgiving and I am going to “re-start” the tradition with their comments on paper... No more trying to remember what they said and no videos either. Just a note card that each of us will write on and a box to keep the cards in.  One day our adult children and their children can read all of these comments...and be thankful for family. 

Your Baby

High Lead Levels in Baby Bracelet

2:00

After an infant girl in Connecticut developed lead poisoning, the cause was found to be a bracelet made with lead beads. Doctors discovered that the 9-month-old had abnormally high blood lead levels during a routine checkup.

Her blood lead level was 41 micrograms per deciliter (ug/dL); anything over 5 ug/dL is considered abnormal, according to a recent report by the Centers for Disease Control and Prevention (CDC).

Health investigators visited the infant’s home to try and determine where the lead originated. They found lead based paint on windows in the home; however, the child would not have been able to reach the windows. There were also 3 siblings in the house between 3-5 years old whose lead levels tests came back normal.

Investigators also found a homemade bracelet that the infant was given to chew on to relieve teething pain. The beads on the bracelet contained extremely high levels of lead; 17,000 parts per million (ppm). The amount of lead that's considered safe for children's products is 90 ppm or 100 ppm, depending on the type of product, according to the U.S. Consumer Product Safety Commission (CPSC).

Investigators were unable to track down the manufacturer of the beads in the Connecticut case or the bracelet maker, according to the report.

In 2003 and 2006, there were several cases of severe lead poisoning and death linked to lead-containing jewelry and charms marketed to children, the report said. After these instances, the CPSC set limits on the amount of lead allowed in products marketed to kids, and each year, there are recalls of children's jewelry that exceed those limits. However, the limits do not apply to products that aren't intended for use by children, the report noted.

There's no safe amount of lead exposure for children, according to the CDC, and the toxic heavy metal can affect nearly every part of the body. In many cases, lead exposure can occur with no obvious symptoms. Symptoms of severe lead poisoning can include confusion, seizures, coma and death.

Lead in the body is distributed to the brain, liver, kidney and bones. It is stored in the teeth and bones, where it accumulates over time.

For severe cases of lead poisonings, doctors will sometimes recommend Chelation therapy or EDTA chelation therapy.

There are safe non-toxic ways to treat teething pain in infants. The American Academy of Pediatrics (AAP) suggests using a chilled teething ring or “gently rubbing or massaging the gums with one of your fingers.”[3] However, there are safety concerns about plastic teething rings.  A 2015 study found chemicals that can affect the child’s hormones (also called endocrine-disrupting chemicals, or EDCs) in several types of plastic baby “teethers..”For this reason, parents may want to avoid using teethers made of any kind of plastic. While there are several non-plastic alternatives on the market which claim to be safe, some of these products may not have been adequately tested. In addition, some teething products could break or leak, presenting other safety concerns.

Safe ways to help your infant through the teething period include gum massage, a chilled spoon from the refrigerator (not the freezer!) to suck on, a chilled wet washcloth dipped in water, breast milk or chamomile tea to chew on, or chilled foods such as applesauce or yogurt to soothe pain.

Talk to your pediatrician first before applying any over-the-counter products for teething. Never put Lidocaine on your child’s gums.

In 2016, the FDA urged parents to avoid homeopathic teething rings that contain Belladonna. Belladonna comes from the deadly nightshade plant and can be poisonous.

The bottom line on easing teething pain in infants is to talk with your pediatrician about ways to help your little one can get through this sometimes challenging time.

Story sources: Sara G. Miller, https://www.livescience.com/60287-teething-bracelet-causes-lead-poisoning.html

 

 

 

Your Child

Kid’s Allergies Linked to Depression and Anxiety

2:00

According to the Asthma and Allergy Foundation of America, 40 percent of U.S. children suffer from allergies. It is the third most common chronic disease in kids under the age of 18.

A new study suggests that children who have allergies at an early age are more likely to have problems with anxiety and depression than those that do not.

One reason may be that children with allergies tend to keep their troubles to themselves or  “internalize” them.

“I think the surprising finding for us was that allergic rhinitis has the strongest association with abnormal anxiety/depression/internalizing scores compared to other allergic diseases,” said lead author Dr. Maya K. Nanda of the division of Asthma, Allergy, and Immunology, at Children’s Mercy Hospital in Kansas City, Missouri.

Rhinitis is more commonly called “hay fever” and includes symptoms such as a runny nose, sneezing, and itchy or watery eyes.

The researchers studied 546 children who had skin tests and exams at age one, two, three, four and seven and whose parents completed behavioral assessments at age seven. They looked for signs of sneezing and itchy eyes, wheezing or skin inflammation related to allergies.

Parents answered 160 questions about their child’s behaviors and emotions, including how often they seemed worried, nervous, fearful, or sad.

Researchers found that the four-year–old children with hay fever symptoms or persistent wheezing tended to have higher depressive or anxiety scores than others at age seven.

The more allergies a child had, the higher the anxiety and depression scores.

“This study can't prove causation. It only describes a significant association between these disorders, however we have hypotheses on why these diseases are associated,” Nanda told Reuters Health by email.

Another reason for the association may be that children with allergic diseases may be at increased risk for abnormal internalizing scores due to an underlying biological mechanism, or because they modify their behavior in response to the allergies, she said.

Other studies support the idea that that a biologic mechanism involving allergy antibodies trigger production of other substances that affect the parts of the brain that control emotions.

In a 2005 study, Teodor T. Postolache, MD, associate professor of psychiatry and director of the mood and anxiety program at the University of Maryland School of Medicine in Baltimore found that peaks of tree pollen increased with levels of suicide in women.

Postolache says allergic rhinitis is known to cause specialized cells in the nose to release cytokines, a kind of inflammatory protein. Animal and human studies alike suggest that cytokines can affect brain function, triggering sadness, malaise, poor concentration, and increased sleepiness.

The new study took race, gender and other factors into account, “so the strong association between allergic disease and internalizing disorder we found is definitely present,” Nanda said.

The severity of mental health symptoms varied in this study. Some children had anxiety and depression that needs treatment, while others were at risk and required monitoring, she said.

“We think this study calls for better screening by pediatricians, allergists, and parents of children with allergic disease,” Nanda said. “Too often in my clinic I see allergic children with clinical anxiety (or) depressive symptoms; however, they are receiving no care for these conditions.”

“We don't know how treatment for allergic diseases may effect or change the risk for internalizing disorders and we hope to study this in the future,” Nanda said.

Experts hope that if parents know that allergies may contribute to their child’s mood or behavior, they will be more likely to keep a closer eye on their child for signs of depression or anxiety and seek treatment if necessary.

The study was presented in The Journal of Pediatrics.

Sources: Kathryn Doyle, http://www.reuters.com/article/us-health-kids-allergies-depression-idUSKBN0UC1TW20151230

David Freeman, http://www.webmd.com/allergies/features/allergies-depression

 

Your Baby

Alert! 180,000 Baby Pacifiers Recalled Due to Choking Hazard

1:30

Munchkin is recalling their Lightweight Pacifiers and Clips. The clip cover can detach from the pacifier’s clip, posing a choking hazard for young children.

his recall involves Munchkin’s Latch lightweight pacifiers and clips sold as a set. The pacifiers were sold in five styles: designer, rattle and heartbeat clips with 0m+ natural shape pacifiers, and designer and rattle clips with 6m+ orthodontic pacifiers. The designer pacifiers and clips 0m+ and 6m+ are in three color patterns: blue and white strips, orange and with white polka dots and pink with white polka dots. The rattle pacifiers and clips 0m+ and 6m+ are green with beads in the pacifier cover to make a rattle sound and have a polka dot strap. The heartbeat pacifiers and clips have a red, heart-shaped pacifier cover and red and white polka dots on the strap.

About 180,000 of the pacifier and clip sets have been sold. They were available from Babies R Us, Target, Wal-Mart and other mass merchandisers, juvenile product, baby boutique and discount stores nationwide and online at amazon.com, munchkin.com and other website from March 2014 through March 2016 for between $11 and $15.

The firm has received 10 reports (5 in the U.S. and 5 in Canada) of the clip cover detaching from the pacifier clip. No injuries have been reported. 

Consumers should immediately take the clip away from young children and contact Munchkin for a free replacement Lightweight Pacifier pack with two pacifiers or a full refund.

There is a toll-free consumer hotline available for more information at 877-242-3134 from 7 a.m. to 5 p.m. PT Monday through Friday or online at www.munchkin.com, click on Help at the bottom of the page and then Recalls for more information.

Story source: http://www.cpsc.gov/en/Recalls/2016/Munchkin-Recalls-Latch-Lightweight-P...

Daily Dose

Sick Child? Have Patience

1:30 to read

I just got off the phone from texting with the mother of a 3 year old patient of mine. It was late in the afternoon and her son had just started crying that his mouth hurt.  I was texting her from the back of a car en route to the airport..the wonders of technology!

She was concerned because the pain had come on so abruptly, but she text me that he did not have a fever, had not had a fall or trauma to hurt his mouth, and that when he opened his mouth she could not see anything that would cause “obvious pain”.  

I asked her a few more questions via text and recommended that she might try giving him a dose of ibuprofen and see if he calmed down and felt better, but I did not hear back from her for awhile.

It was then that I realized that pediatrics and parenting have quite a bit in common…one of the similarities being patience.  

While she was concerned that her child had suddenly started crying due to some sort of pain, much of pediatrics is about watching and waiting.  We parents all want to keep our children pain free, but sometimes things will hurt both physically, and as your child gets older, emotionally (which may be even worse to watch).  A parents first instinct is to find the cause of the pain and “fix it”.  Whether that means a band aid, a kiss on a boo-boo, or medicine.. “just make it better”.

But in many cases in pediatrics and actually all of medicine, it is about watching, following, and waiting, which is not as easy as it may sound. Doctors, parents and patients often have to “be patient” and see what evolves.  Not all tummy aches are cases of appendicitis, not all falls cause a concussion and not all boo-boos result in broken bones (thank goodness!).

But for a parent to hear “let’s see what happens in an hour or so” may sound like a lifetime and waiting just seems crazy when there is a “doc in the box” on every corner.  You may see where I am going with this.

So, by the time I heard back from this concerned mother, she was already at the nearby “doc in the box” waiting for a doctor to see her son, who by now had stopped crying.  She had already put him in the carseat for the drive to the clinic before she read my text, so he had not even had any ibuprofen.

According to the clinic doctor (or nurse), the child “had an ear infection causing his pain” and she was given a prescription for antibiotics.  Once the mother was home and I could talk to her I asked if they had prescribed medication for pain relief, such as ear drops and/or ibuprofen. She said she only had the antibiotic prescription which she had filled, but her child had stopped complaining of pain.

So, I was not there, and did not see her child, but I wonder if ibuprofen might have done the trick and alleviated his pain..and also kept him off of an antibiotic until he could be seen the following day in the office?

But in this age of “quick” medicine and a clinic on every corner,  a patient/parent may not need to wait and see what evolves. I wonder if this “quick” medicine may be one reason we see antibiotic overuse . I’m just saying….  

Daily Dose

Flying With A Baby

1:15 to read

Overheard on the plane this week:  I am in row 15 and there is the cutest most precious 4-5 month old baby girl behind me in row 16.  Key point….she is sleeping as we are making our approach!

 

The mother of the baby is traveling with her mother so there are is a grandmother along to dote on this darling baby. The mother of the baby says to her mother…”we need to wake her up now!!!”  “Mom, please wake her up as we need to feed her NOW!”  At this point the mother takes out a whisk of some sort to put into the breast milk…do you have to mix with a whisk now?

 

So…of course they wake up the baby who starts to cry, but just a bit…and then the grandmother starts to feed the baby the bottle.  The mother is saying, “Mom, just make her eat”.  Now it is really bumpy as we are getting ready to land and I was wishing I had a bottle to calm me too!

 

The baby seems to be quietly eating, but then must have stopped eating as now the mother of the baby takes the baby from the grandmother and starts to try to give her daughter the bottle.  She starts talking to the baby saying, “ please keep eating so your ears will stay clear” followed by “Mommy is going to drink the bottle, so you can see me keeping my ears clear too”.  “If you keep sucking your ears will be pain free”. 

 

Everything seems to be going well…although we still have not landed, when the mother says “I am going to force feed you to keep your ears clear!”  Uh…oh I am thinking, I know where this may be going.  But it seems so far, so good. 

 

Just as we are about to touch down I hear this gurgling noise from behind me and then the mother saying, “Oh dear she is spitting up!!”   Really, are you shocked??

 

But…I must say, the baby was quiet and content…who knows, I would have never awakened that sweet baby girl, but then again, I still believe, “never wake a sleeping baby”, even on an airplane.

 

 

 

Daily Dose

Bathing Your Baby

The end of summer baby “boom” is still going on and new parents are coming in with all sorts of questions…including how do I bathe my baby?  As many mothers and their babies are being discharged from the hospital after 24 hours, they really don’t have the opportunity to “practice” new parent skills, including giving their baby a bath.

Bathing your baby is really fun and is a good bonding experience for parent and child.  The bath also keeps your baby clean and smelling “sweet”.  I was convinced that it would also help them to relax and to sleep longer (not scientific at all - but it works for us right?).  At any rate, you can bathe your baby every day or every 2-3 days, or even once a week. It is really personal preference…but that wonderful “after bath smell” makes me smile.

Many people buy infant bath tubs and there are tons to choose from. I like the the “Puj Tub” or the “Tummy Tub” as you can easily put them in the kitchen sink (grandparent friendly), but you want to make sure that there are no sharp edges or places where a baby might get bumped or injured when you put the tub in the sink.  Some people use a folding tub (be careful not to pinch the baby) or inflatable tub  these may collapse), because they are easier to store if you have limited space.

The number one rule for a bath - NEVER leave your baby alone in the tub, not even when they can start sitting up. A baby may drown in an inch or two of water…so never even turn around to check your phone or check an email.  You should also make sure that the water temperature is correct and every new parent should check the hot water heater and lower the temperature to 120 degrees F, so prevent burns. Regardless, always check the water temperature before you put the baby into the tub.

I am also a fan of using mild soaps..including Cetaphil, Cerave, Aveeno, and Aquaphor  baby wash. If your child tends to have sensitive skin it is best to avoid fragrances and harsh chemicals.  I also like to moisturize the infant after a bath with baby lotions from these same companies. New data is showing that frequent moisturizing (twice a day) may also be important in preventing allergies later in life…. so why not enjoy some baby massage…and keep watching for more information on this issue.

 

 

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Daily Dose

Fear of the Doctor

.45 to read

It’s every child’s nightmare…getting a shot at the doctor’s office. 

It breaks my heart every time I see those crocodile tears running down a precious face.  What’s a parent to do? 

I know it may FEEL like every time your child visits the doctor they have to get a shot, but this is not the reality.  

So how can you help ease your child’s fear of the doctor?  Start by letting your child know what they can expect at their visit.  

Tell them the doctor will listen to their heart. Have them practice saying ahhh so we can take a peek at their throat.  We’ll also look in their ears and nose. 

Tell them the doctor will check how tall they are and weigh them too.  Make sure you also let your child know the doctor will check their arms, legs and touch their belly. 

Have your child bring their favorite toy or lovey with them…these are good distractions. 

Don’t forget to celebrate your child’s bravery!  Reward them by going out and doing something fun together!  Your child has earned it. 

One thing you should never do…lie to your child.  Yes a shot hurts but tell them it will be over quickly and remind them of how big and strong they’re getting and how proud you are of them!

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