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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

Walking to School

1:30 to read

Now that school is back in session and the temperatures are cooling off, an easy way to get you and your child some extra exercise is to walk to school!!  I am thinking it should become a weekly event across the country - how about “walk to school Wednesdays”?

 

I realize that not everyone lives in an area where it is possible to walk to school. But, there are many children who do live close enough, but they are typically driven to school by parents or in a carpool.  I practice in an area where it would be easy for many children to walk to school, but when I ask them if they walk to school they typically give me a quizzical look and answer “no”.  

 

Many parents are concerned that their children don’t get enough exercise and this is a way to sneak in some daily exercise.  Walking together also gives parents a time to talk with their children. It is really a gift of time together. I remember that my children could walk to school for the several years when we lived nearby their elementary school. They are really some of my fondest memories, coffee cup in hand and the dog on a leash and walking the boys to school. It was a sad day when they said, “mom, we want to ride our bikes”.  They would meet some of their other friends (I was the helmet “cop”) and off they went.  No more talks with their mother or holding hands to cross the street…but growing up.

 

There are other perks of walking too!!!  Think about avoiding those long carpool lines. What about the gas that is saved and less pollution for the environment.  No one arguing about sitting next to the window or what radio station to listen too either. And for those children who tend to get car sick…this is a great solution!

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Daily Dose

Mom Judging

1:30 to read

This whole “mommy judging” is really becoming too much!  The latest involves Christy Teigen and her decision to go out to dinner 2 weeks after the birth of her daughter.  Why is she being judged about going out with her husband?  Even a new mother needs to eat!

When I am seeing a newborn for their first visit to the pediatrician I spend a great deal of time talking with the baby’s parents about the stress of having a newborn. While there are so many “highs” after bringing a new baby home, there are also the “lows” of feeling overwhelmed, sleep deprived, and feeling as if you aren’t prepared to be a parent (even after taking every class and reading every book).  For many parents just hearing that they are experiencing “normal” emotions is reassuring.  

During these discussions (while I am usually rocking that sweet newborn) I also inquire as to whether there are family or friends nearby,  or any other help in the home…knowing that “all hands on deck” can be a wonderful feeling when you just need a break, and yes, every parent, especially new parents need to have “a break”.  Whether that is a nap, or a long shower, or a quick trip to the store to pick up that special “sleep sack” you know will help your baby sleep…a break is healthy.  

A new mother also needs to eat and sleep to ensure that she is making milk in order to successfully breastfeed her newborn.  I remember being a new mother, even 30 years ago, and skipping meals because I was either “too tired”  to eat or “too busy” and my husband being wonderful and saying, “your Mom is going to keep the baby for an hour or two while we go out for a quick dinner!”.  While I am sure that I had a bit of trepidation about leaving our son,  and also figuring out how to nurse him just before we darted out the door,  I went!  The good news was that there were no cell phones or social media to interfere with our “new parent” quiet dinner out. i did not have to call home or text every 30 seconds to check on the baby, and my mother was quite capable of babysitting for an hour or two. No one was posting a picture of us leaving our baby, or commenting that I was “ a bad mother” for leaving my home….in fact, the whole event went unnoticed.  What I also remember is the feeling of re-connecting with my husband (who was also a new father), and having a quiet, nutritious dinner which re-energized us for another long day or night….

But now fast forward to 2016 and the CONSTANT connection with the world!!  Add in a celebrity who is being photographed day and night and whose every move is discussed and dissected. In this case being judged as a new mother for going out to dinner.  Christy did not take her new baby out to a crowded restaurant (you know how I feel about that), nor did she leave her baby home unattended.  She did not put her baby at risk at all. What she did do, was go out for dinner with her husband, albeit with lots of paparazzi following her. Going to dinner does not mean she “is an unfit mother”, it has nothing to do “with bonding with her baby” or “neglecting a newborn”.  So, she didn’t get to make a choice on her own, she didn’t put the issue out there for public comment either….she simply went out to dinner. Enough…leave her and other new mothers alone.

 

 

Parenting

New Year Family Resolutions!

1:45

It’s the start of a brand new year and many of us will be evaluating our physical and mental health, goals and habits to see where we can make improvements. New Year’s resolutions always start off hopeful, but for many of us, fade away as day to day activities send us back on the treadmill of life.

However, it doesn’t have to be that way and when you share resolutions with someone else, there’s always that personal reminder that goals were set for a reason.

That’s why making resolutions, not as individuals, but as a family can keep hope alive.  Begin by making family resolutions a tradition that starts at the beginning of the year and has checks and balances throughout the year.  At the end of the year, see how everyone did and what could be done to make the next year even better.

Resolution: a decision to do or not do something. That’s about the clearest definition I’ve seen. Decisions are important – one decision may not always be the complete journey, but it’s a beginning. Without beginnings, nothing changes.

The best way to teach your children the importance of New Year’s resolutions is by making it a family tradition.

Dr. Benjamin Siegel, professor of pediatrics and psychiatry at Boston University School of Medicine, suggests saying, “Each one of us is going to state a few things that we want to continue to do and things we’d like to change that would make us feel better about ourselves and how our family works.”

Each family member gets a chance to share something they are proud of and something they would like to change. Depending on the age of your children, it may help if one or both parents go first. If your child is old enough to write, have he or she write down their accomplishments and goals. If they cannot write yet, you can write for them. Copy down exactly what they are saying without trying to “improve” the grammar or goal.

Ideas for families can include group activities as well as individual undertakings. Resolutions for the entire family might include taking a monthly hike, playing board games twice a month or committing to more volunteering activities. Try to limit the number so they are more doable and more meaningful. “A list of 100 things is impossible,” Siegel says. “It should be based on things that are doable without economic hardship.”

Post your list in a place where the family will see it on an ongoing basis such as on the refrigerator or a bulletin board in the kitchen. Dr. Kathleen Clarke-Pearson, a clinical assistant professor of pediatrics at the University of North Carolina School of Medicine, suggests making a resolution box, in which each family member can drop in his or her resolutions, and then pull them out at a later date to review them.

What your child needs to work on depends on your child. If you are concerned about his diet, then encourage healthier eating habits for him as well as the whole family. If your daughter’s room is a mess, try to help her commit 10 minutes a day to cleaning it. As your child ages, he can be more active in coming up with goals, which will mean more to him when he achieves them.

For preschool-aged children, the American Academy of Pediatrics (AAP) recommends resolutions that focus on cleaning up toys, brushing teeth and washing hands and being kind to pets. However, parents who consider these behaviors part of their regular expectations may want to provide resolutions that focus on higher goals.

Older children can begin to understand the relationship between a resolution and an improved outcome. Younger kids may view the whole exercise as a game. It doesn’t matter; whatever helps each family member accomplish his or her goal is the more important issue.

When your child gets into adolescence, the AAP recommendations focus more on the child taking more responsibility for his actions, including taking care of his body, dealing with stress in a healthy way, talking through conflict, resisting drugs and alcohol and helping others through community service.

Parents are the role models in this dynamic. Just as with everything else you do, your child is watching. “Parents should be reflective about how they wish to be in the coming year,” Siegel says. “It’s a good opportunity to promote good mental and physical health.”

Just like adults, kids know the thrill of accomplishing something, especially when their parents acknowledge them. As you go over the family list of resolutions each month or quarter, take time to acknowledge the successes, along with reinforcing the resolutions that need more attention. “Children will benefit by having the parent praise them, which will improve their self-esteem,” Siegel says. “This will help them with self-regulatory behaviors that they can integrate into being a healthy adult.”

Review time is not punish time for unmet resolutions. That may seem obvious, but emotions can get the best of us when things don’t go the way we planned. It’s important to be flexible but also understanding. The resolution is a guide for betterment, not written in stone. Understanding, compassion and dealing with issues head-on can help keep everyone on track.  Learning to take responsibility for our decisions, being able to change our mind and find a better solution and discussing new options, all help in making resolutions a reality.

However your family arrives at resolutions, the best part is that you’re doing it together and learning how to manage your role not only in the family but also in the larger world.

Story source: Laura Lewis Brown, http://www.pbs.org/parents/holidays/making-new-years-resolutions-child/

 

Your Baby

Formula-Fed Babies: How Much and How Often?

2:00

There are many reasons a mother may choose to use formula instead of breast milk when feeding her newborn. There are also times when mothers decide to switch from nursing to formula, as their baby gets a little older.  Whether you’re breastfeeding or giving formula, it’s generally recommended that babies be fed when they seem hungry.

What kind of schedule and how much formula do formula-fed babies need? It all depends on the baby. While each infant’s appetite and needs may be a little different – there are general rules of thumb that can be helpful for moms to know.

According to Healthychildren.org, after the first few days, your formula-fed newborn will take from 2 to 3 ounces (60–90 ml) of formula per feeding and will eat every three to four hours on average during his or her first few weeks.

Occasionally, you may have a sleeper who seems to like visiting dreamland longer than most babies. If during the first month your baby sleeps longer than four or five hours, wake him or her up and offer a bottle.

By the end of his or her first month, they’ll usually be up to at least 4 ounces (120 ml) per feeding, with a fairly predictable schedule of feedings about every four hours.

By six months, your baby will typically consume 6 to 8 ounces (180–240 ml) at each of four or five feedings in twenty-four hours.

Since babies can’t communicate with words, parents have to learn how to read the signs and signals baby uses to express wants.

How do you know your baby is hungry? Here are signs baby may be ready to eat:

•       Moving their heads from side to side

•       Opening their mouths

•       Sticking out their tongues

•       Placing their hands, fingers, and fists to their mouths

•       Puckering their lips as if to suck

•       Nuzzling against their mothers' breasts

•       Showing the rooting reflex (when a baby moves its mouth in the direction of something that's stroking or touching its cheek)

•       Crying

The crying signal can be confusing for parents. It doesn’t always mean the same thing. Crying is also a last resort when baby is hungry. Your baby should be fed before he or she gets so hungry that they get upset and cry. That’s why guidelines are helpful when starting out.

Most babies are satisfied with 3 to 4 ounces (90–120 ml) per feeding during the first month and increase that amount by 1 ounce (30 ml) per month until they reach a maximum of about 7 to 8 ounces (210–240 ml). If your baby consistently seems to want more or less than this, discuss it with your pediatrician. Your baby should drink no more than 32 ounces (960 ml) of formula in 24 hours. Some babies have higher needs for sucking and may just want to suck on a pacifier after feeding.

Eventually, baby will develop a time schedule of his or her own. As you become more familiar with your baby’s signals and sleep patterns, you’ll be able to design a feeding schedule tailored to your infant’s needs.

Between two and four months of age (or when the baby weighs more than 12 pounds [5.4 kg]), most formula-fed babies no longer need a middle-of-the night feeding, because they’re consuming more during the day and their sleeping patterns have become more regular (although this varies considerably from baby to baby). Their stomach capacity has increased, too, which means they may go longer between daytime feedings—occasionally up to four or five hours at a time. If your baby still seems to feed very frequently or consume larger amounts, try distracting him with play or with a pacifier. Sometimes patterns of obesity begin during infancy, so it is important not to overfeed your baby.

The most important thing to remember is that there is no “one schedule and formula amount fits all” when it comes to babies and their needs.

No one can tell you exactly how often or how much your baby boy or girl needs to be fed, but good communication with your pediatrician and learning how to read your baby’s body language will go a long way in keeping baby’s feedings on track.

Story sources: https://www.healthychildren.org/English/ages-stages/baby/feeding-nutrition/Pages/Amount-and-Schedule-of-Formula-Feedings.aspx

http://kidshealth.org/en/parents/formulafeed-often.html

 

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Daily Dose

Father's Day

1.15

With Father’s Day approaching, I always have frequent thoughts of my own father. He has been deceased for quite some time and I am saddened (especially at this time of year) that he did not get to see his grandsons become young adults. He would have been so proud of them and in many ways they are like him. 

One of the many exceptional attributes that my dad possessed was the ability to FIX ANYTHING!  I grew up not knowing about the Maytag Man, the plumber or the electrician as my dad fixed the washer, the electrical socket or the garbage disposal.  Of course, like most homes, there was always a running list of things to be fixed. 

Because my dad was often gone for long periods of time (he worked for the government in intelligence) my mother would say we would “have to wait for your father to return” to fix whatever it was, and when dad returned he would get right to work. If he didn’t know how to fix something he somehow figured it out and that was before you could “GOOGLE IT”!  I remember him painting the house, building our downstairs rec room and taking apart an early computer just to see how it worked. 

Being able to “fix” things must somehow be a genetic link as I now see this trait in several of my own children (you know who you are). When I was a newlywed I was shocked to learn that not all men had this gene.  When something broke in the house I would automatically tell my husband and he would lovingly attempt to “fix it”. But, what I quickly learned was that while my husband has many wonderful traits he did not inherit the “fix it gene”. Many a repair man has been called to our home to “fix” the problem created by my loving husband who attempted home repairs. 

But several of my boys loved to watch their grandfather fix things and take things apart. As they got older, they would come to the rescue to help around our house with the laundry list of issues and repairs.  

Many of the issues these days revolve around technology and they all inherited their grandfather’s technology “fix it gene” as well. Unfortunately, they are not in the next room any more to call upon when I have no idea why my computer is frozen or when I cannot even turn on my iPod to play music in all of the rooms of the house. 

So as we approach this Father’s Day I am thankful for all of the lessons learned from my own father, and for his “fix it gene”.  But, with all of the boys out of the house, I now have a handyman on speed dial. 

Happy Father’s Day!

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Count your blessings this Thanksgiving!

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