Twitter Facebook RSS Feed Print
Daily Dose

Tummy Aches

1:30 to read

I am getting a lot of phone calls and texts with concerns about  tummy aches. I have even started seeing patients in the office with complaints of “my tummy hurts”, and we are just in the first week of school. I know that school nurses are dealing with this common complaint as well.   Amazingly, I don’t see very many complaints of tummy aches during the “lazy days of summer”…but once school starts they seem to become more prevalent.

Don’t get me wrong…while the tummy aches are real and painful, they are usually not due to anything serious.  In many cases I see,  the abdominal discomfort may be due to a bit of anxiety and stress that often comes as children get back into the classroom.  While the child may not be aware of “stress”,  their body does sense it and the gut responds with abdominal pain. 

The children that I am already seeing are all healthy and growing well. They do not appear to be “ill” when I see them, but will complain that their tummy hurts. When I have them point to where the pain is, they typically point right around their belly button (periumbilical).  If asked to point to the one place where it “hurts the most”  they typically still cannot localize it…it’s just all over! Having generalized pain is typically a good sign, rather than having point tenderness in one area.  Upon further questioning they do not have a fever, have not had vomiting or diarrhea, DO NOT wake up in the middle of the night with abdominal pain and often cannot remember if they “pooped“ today or yesterday but usually swear that their “poop” is “normal” . (I am not always sure about that - stool history in kids is quite hit and miss!) 

A few of the children say that eating makes their tummy ache worse while others report it feels better if they eat. They typically are not having issues with a specific food.  (It also depends what they are given to eat - often they will eat their favorite food if given the opportunity).  

For some of the children the pain is “bad enough” that they come home from school, but once home their parents report that after an hour or so they seem better.  Other children stay in school, but the minute a parent picks them up they start saying “my tummy hurt all day at school”!  

I remember that one of my sons often had tummy aches during the school year and we were talking about it the other night (he is now an adult).  He says he remembers being worried about school and “hiding” in the morning when it was time to go to school (I would be looking all over for him as his older brother was already out the door, and anxious that he would not get to school on time,  while I had the younger brother on my hip as I searched the house).   Talk about getting a stomach ache…mine was in knots by the time I would get to work.  It would only be several hours later when I would get the phone call from the school nurse that he was there with a tummy ache.  He now says that he remembers that by the time he was 8 years old it all just changed and it went away. 

Many times all it takes is a little reassurance that the tummy ache is not serious. I tell the children that everything on their exam is normal which is a good thing. Sometimes it seems to help a tummy ache if I prescribe the child some extra fiber and maybe a Tums  a good source of calcium too). Who knows if it is placebo effect… but just by doing something they feel a bit of relief. The one thing I do know…they need to keep going to school and it usually gets better once they are settled back into a school routine.  


Daily Dose

School & Infectious Disease

1:30 to read

I received an email this week from a patient…subject line: “potential exposure to Herpangina”.  In the body of the email was the following:

Dear Parents,

We want  to inform you that a case of Herpangina disease has been reported for a child at ….. room #112.  This is a contagious disease that  is spread by direct contact with another person or contaminated objects.  Herpangina is an illness caused by a virus, characterized by small blister-like bumps or ulcers that appear in the mouth, usually in the back of throat or the roof of the mouth. The child often has a high fever with the illness. We have attached further information about this common childhood illness published by Children’s Hospital in Boston. Our teachers are carefully disinfecting their room to help prevent further spread of the disease.

The mother of the child that sent me the email was “freaked” out and “worried” about  sending her child back to pre-school.  

My question is this, when did it become a “rule” to notify parents in a pre-school or day care setting that there were viral illnesses circulating?  It certainly seems unnecessary to me to send notification of EVERY childhood illness that occurs and for most of my families only serves to cause anxiety.  Some of the schools in our area post a sign on the entry that says something to the effect:  “there are cases of diarrhea, RSV, hand foot and mouth and fevers being reported in children that attend this school.”  Really, is it that surprising or necessary? Seeing that many of the numerous viral illnesses that children get these days are spread via respiratory droplets and contact with surfaces, such as toys and tables that everyone touches (computers too), children are exposed to things all of the time.  Do you go to work and ask your co-workers in a conference room..have you had diarrhea, a cough or a sore throat in the last day?

I understand notifying parents of illnesses, such as meningitis, measles, mumps…even chickenpox that are infectious and may be serious or life threatening. Thankfully, there are very few cases of these illnesses to report, now that the MAJORITY of children receive vaccines to these diseases. 

By putting these emails, texts and notices out for every parent to become alarmed about…and then to come to the doctor out of concern that their child  “may get sick….even before they have a symptom”,  serves no purpose. Herpangina and Hand Foot and Mouth are very similar viral illnesses, and both are caused by enteroviruses. It is at times hard to distinguish one illness from the other. But, with that being said, the treatment is solely symptomatic. In other words, treat the fever, make your child comfortable and don’t let them go back to school until they are fever free for 24 hours.  

Lastly, your child is going to catch a lot of these viruses, no matter what you do when they go out to play, shop or go to school. Each time they catch a viral illness it actually helps them to build antibody in order that their immune system may get stronger and stronger. I think the better note is….as winter comes children will get more coughs, colds and viral infections…if you think you child is not feeling well or running a fever, please keep them home from school for the day.  It is just a normal part of childhood…we don’t need any more anxiety in this world.   


Your Child

Healthy Diet Improves Reading Skills


Good nutrition not only improves your child’s physical condition but may also advance his or her reading abilities, according to a new Finnish study.

Researchers in Finland found students' reading skills improved more between first grade and third grade if they didn't eat a lot of sugary foods or red meat, and if their diet consisted mainly of vegetables, berries and other fruits, as well as fish, whole grains and unsaturated fats.

The study involved 161 students between the ages of 6 and 8 (first through 3rd grade). Researchers reviewed the children's diets and their reading ability using food diaries and standardized reading tests.

The study showed that a healthier diet was associated with better reading skills by third grade, regardless of how well the students could read in first grade, the researchers said.

"Another significant observation is that the associations of diet quality with reading skills were also independent of many confounding factors, such as socioeconomic status, physical activity, body adiposity [fat] and physical fitness," study author Eero Haapala said in a University of Eastern Finland news release. He is a postdoctoral researcher at the University of Eastern Finland and the University of Jyvaskyla.

As with most studies, the research did not prove cause and effect, but an association between the foods the students ate and their reading skills.

The study's authors noted that parents, schools, governments and corporations all have an opportunity to enhance academic performance in schools by making healthy foods more available to children.

The study was published recently in the European Journal of Nutrition.

Story source: Mary Elizabeth Dallas,



536 views in 3 months

Back to School, Back to Sleep!

Daily Dose

The Homework Battle

1:15 to read

Homework is one of the least favorite exercises for both parent and child.

Homework is one of the least favorite exercises for both parent and child. I was reminded of this while helping my five and seven-year-old nephew and niece with their homework recently. It seems like yesterday since I was helping our own sons with homework, when in actuality it was many years ago. It is easy to forget the complaining, cajoling and pleading to get homework finished. But it is also an important exercise in helping your children get an organized workplace at home, to having family rules about computer and TV time before homework is finished and to teach independent study skills as a child matures.

So... trying to get my niece and nephew to settle down for homework with out getting up, trying to "sneak" back to the computer andto focus on the letter ‘N’, was a real test of forgotten parenting skills. I am not sure I was a total success. They did not want to do their homework, gave me 10 reasons it wasn’t necessary and told me "Aunt Sue you are the meanest aunt we have", which I am sure was not a compliment.

After much stalling, begging and promising "we" finished one worksheet for first grade and a Pre-K sheet glued with picture of ‘N’ words cut from catalogs (while he searched for Christmas presents for me to buy him). It was organized chaos to say the least, but it was finished! The short story is, have a set time for homework and a place for your young children to work, where they are within your sight, but also without a lot of distraction.

Try to get homework done earlier than later; it’s always harder when both parents and children are tired. Make their homework their responsibility, even from early elementary years, as it sets the stage for the rest of their years of homework. Lastly, don't ask Aunt Sue the pediatrician to help; she has "way too many rules".

That's your daily dose, we'll chat tomorrow.

Your Child

Setting Up a Routine for Homework


If yours is like a lot of families, you’re just not quite ready to face the homework hurdle. But like it or not, after school assignments have arrived and helping your child get into a regular routine can actually make it easier for everyone.

Deborah Linebarger, PhD, associate professor of education at the University of Iowa, has come up with six tips to help families get back in the assignment swing of things.

Be prepared: Even if you’ve already picked up all the supplies your child needs at school, make sure the staples needed to complete assignments are also available at home. Items like pencils, erasers, folders, clips, rulers, computer paper & toner should have their own space and be ready to use if needed. This is also a good time let them set up a special place in the house where they can work undisturbed and with all the supplies they need. You may discover you have a budding interior designer with a knack for organization!

Set A Schedule: You child should do her homework at the same time every day. Many kids need a break after school for a snack and a little running around first. It's best to get homework done as early as possible -- when it drags on past dinner and toward bedtime, the work is likely to take longer and be sloppier.

Bedtime: Don’t leave homework till the last minute, make sure that it’s finished and checked at least a couple of hours before bedtime. Just like adults, children need plenty of good sleep to function well the next day. Preschoolers typically need 11-13 hours each night. Six to thirteen year olds need around 9-11 hours and teens need about 8 -10 hours a night. Make sleep a priority by having a cool, quiet and dark bedroom. Establish an appropriate bedtime for your child and stick to it. Cut off the access to computers, TVS, phones and any electronics at a minimum of an hour before it’s time for sleep. Quieting and slowing down before it’s actually time to nod off can help relax your child.

Break it down. Younger kids might get a week's worth of homework on Monday to turn in by Friday. Older children may have big responsibilities like term papers and science projects. Help them break large projects into smaller steps, and make sure they start early.

Keep up with your child’s assignments so that you’re not surprised by a last minute science project the night before it’s due!

Encourage "peer collaboration" -- to a point. It may be helpful for siblings close in age to do homework together. The older one may be proud and happy to offer help to the younger one. But if they bicker more than they cooperate, it's time for separate spaces.

What if you have a child with ADHD? As you probably already know, children with ADHD are more likely to face extra challenges with completing their homework.

He or she will need even more supervision and guidance, Linebarger says.

"Start by breaking up homework into really bite-sized amounts," she says. "For a younger child, that may be only about 10-minute increments. Expand them slowly as they show they're able to handle it." And expect that your child will need you to watch her homework efforts closely to make sure he or she stays on task.

When they gets distracted -- and they will -- encourage your boy or girl to do something physical to get back on track. "Let her jump up and run around for 5 minutes, or have him do 10 push-ups or 30 jumping jacks," Linebarger says. "Research shows that acute physical activity right before a challenging mental task helps to control behavior."

Children with ADHD often hear a lot of criticism, be sure and compliment them and encourage them when they’ve completed a difficult task.

When they manage to sit still for that 10 minutes of homework, or come home with their homework folder in order, give them lots of praise for making a great choice," Linebarger says.

It won’t be long till summer is a fond memory and the school year is just how things are. You can help your child adjust to this either new or familiar way of getting through Monday through Friday by using the tips above and finding out what adjustments may need to be made to work best for your family.

Source: Gina Shaw,


Your Child

Lice Is Going Around

How to treat lice.I keep hearing that there are lice out there! Lice are a part of childhood, albeit the gross part, but it really has nothing to do with where you live or go to school or how often your kids take their baths, its about hair.

Lice are obligate human parasites and require a human scalp to live, they can only live off the host for 6 -25 hours.  Lice most commonly infect children between the ages of 3 – 12 years and there estimated to be between 6 – 12 million cases of lice in children per year. So, if your child has lice, you are not alone!  Transmission of the louse is most commonly from close personal contact especially head to head.

Lice do not have wings so they are not flying around a classroom or on the playground.  The most recent issue with lice is that they are becoming resistant to the over the counter products like Rid and Ni, which have been the gold standard for years. These are still used for first line treatment, as well as removing the nits (egg casings) from the hair with a nit comb. It is often easiest to do this with a dark towel or sheet draped over your child’s shoulders so that you can see the nits as they are coming off of the hair shaft.  It is very hard to see nits in light hair.   Nix and Rid do not kill the eggs, so it is recommended that a second application be used in a week to 10 days. Once you have treated your child appropriately they may return to school, there are no longer “no nit policies”. If you notice that your child still has lice after a couple of days despite appropriate over the counter treatment, call your doctor. Don’t try to smother the lice with mayo, olive oil, Vaseline  or a shower cap, as lice don’t have lungs, so this does not work!  Never think about applying  kerosene to the child’s  hair or even shaving their heads. There are some newer treatments available. I have had success using Ovide, which is only available by prescription in the United States (but is an OTC product in the UK, in case you are traveling).  Another new product, Ulesfia, is also available. It is made of benzyl alcohol and inhibits the louse respiratory spiracles (no lungs remember) and thereby does result in asphyxiation of the louse. The only problem with this product is that it takes quite a few bottles to cover a child with a thick head of hair, and this may make it cost prohibitive. Another product that is being used in Canada (again if you are wanting to pick up some lice treatment while away) is Resultz which is isopropyl myristate, and it is in phase 3 trials in the US.  Other products such as Bactrim and Ivermectin have been used “of label” with some success. At time parent’s are willing to travel to Canada to find “the cure” as they become so frustrated with re-occuring lice problems. Remind your children not to share combs, bows, hats etc with their friends.  Lastly, some people advocate treating all household contacts (even without symptoms of itchy head) to eliminate an outbreak within a family. Now, stop scratching your head.  We'll chat again tomorrow!

Daily Dose

Paddling in School

1:30 to read

I just finished reading an online post from a pediatrician in another state whose daughter has just started kindergarten. It seems that in her state, and her school, they may still “paddle” children for misbehaving. WHAT?!?!

In fact, the school sent a note home with her child that re-iterated the “school rules” surrounding paddling and asked that the parent sign the note that they agreed to paddling. Are you kidding me…what parent would sign a note agreeing to let someone HIT their child?  Parent’s have been arrested for spanking their children in a public place….but now you can let someone else paddle your child? 

I talk to parents about discipline even before their child turns one. Many a parent will tell you I am “the strict” doctor.  From the beginning, I discourage spanking (although I will admit to spanking my own children several times during their childhood - usually out of total frustration and never felt good about it) and begin with some simple strategies. For example when your 6-7 month old learns that they can make a new shrieking sound to get attention “ignore the behavior” and it will often go away.  Or, what about telling your child that you “will not pick the food up off the floor if they throw it” and then following through….they will not go hungry I assure you.

As children get older I discuss re-directing, time-out, taking away a toy.  For the older child it may be taking away screen time, missing a birthday party and for the teens taking away the cell phone,car or being grounded at home with parents.  But spanking and paddling is never part of the discipline/behavior modification discussion. And now I find out that there are still 19 states that allow paddling in their schools!! 

The mother of this child had not been aware of this rule. She could not believe that she was asked to sign a form to allow her child to be paddled. In this case we are also talking about 5-7 year olds who are just starting school where they will begin to learn school rules and expectations of kindergarten and 1st graders. Every teacher seems to have many strategies for discipline and behavior modification. Not one that I spoke with mentioned spanking or paddling. I am not sure that I even agree with taking away “recess” for misbehaving from this age group…(another conversation)  but certainly not corporal punishment.

The interesting part of this story is that the behavior issues were related to little boys “playing guns”  while they were on the playground. The school has a “zero tolerance for acting out play with guns”  but allows you to hit a child???  What kind of mixed message is that about violence? I know that while raising our three sons, despite our protests about violence and guns,  they seemed to turn anything we gave them into a “play gun” and that was long before they were ever even given a Nerf gun. 

Do your schools have policies regarding corporal punishment? I feel as if I have gone back in time 50 years - only all of this information came from that entity called the internet!!!


Your Child

Getting Ready for a New School Year!


As summer break begins to wind down, preparations for a new school year are gearing up.  Whether it’s the first day of school for your little one or your teen’s first year of college, making the transition from vacation to a daily schedule requires some pre-planning.

Typically, the most difficult changeover for everyone is getting used to a regulated bedtime routine. Getting enough sleep will help family members handle the switch better. I know that’s much easier said than done, but it's worth the effort. Now is a good time to start preparing for a new school year schedule.

As pediatrician, Dr. Sue Hubbard, has said previously in her Daily Dose article, a couple of weeks before the start of a new school year is when families should start getting used to a new schedule.

“In order to try and minimize grouchy and tired children (and parents too) during those first days of school, going to bed on time will be a necessity. Working on re-adjusting betimes now will also make the transition from summer schedule to school schedule a little easier. If your children have been staying up later than usual, try pushing the bedtime back by 15 minutes each night and gradually shifting the bedtime to the “normal” hour. At the same time, especially for older children, you will need to awaken them a little earlier each day to re-set their clocks for early morning awakening,” Hubbard noted.

Another important detail to take care of before school begins is making sure your child is current on all immunizations. Each state has its own requirements and exemptions. In Texas for instance:

K-12 grades are required to have - the Tetanus/ Diphtheria/ Pertussis (Tdap) vaccine, Measles, Mumps and Rubella (MMR) vaccine, the Polio vaccine, Hepatitis B vaccine, and the varicella vaccine. K through 6th grade are also required to get the Hepatitis A vaccine and 7th through 12 grades, a meningococcal vaccine.

Also highly recommended, but not a state law requirement, is the Human Papillomavirus Vaccination (HPV) for boys and girls.

You can find out exactly what your state’s school immunization program is by logging onto and clicking on your state.

And lets not forget our college bound students! Universities have their own policies, but these vaccines and booster shots are highly recommended by physicians and most universities: Meningococcal conjugate vaccine (MenACWY), Tdap, HPV vaccine and the seasonal flu vaccine. Be sure to check with your child’s school to see what specific vaccines are required or suggested.

The first day of school for kindergarteners and / or first-graders can be unsettling for kids and parents. Here are a few ways you can help your child face the uncertainty:

·      Remind your child that there are probably a lot of students who are uneasy about the first day of school. This may be at any age. Teachers know that students are nervous and will make an extra effort to make sure everyone feels as comfortable as possible.

·      Point out the positive aspects of starting school.  She'll see old friends and meet new ones. Refresh her positive memories about previous years, when she may have returned home after the first day with high spirits because she had a good time.

·      Find another child in the neighborhood with whom your student can walk to school or ride on the bus.

·      If it is a new school for your child, attend any available orientations and take an opportunity to tour the school with your child before the first day.

·      If you feel it is needed, drive your child (or walk with him or her) to school and pick them up on the first day.

Nutrition is an important factor in children doing well in school. During the summer break kids often get off schedule with their eating habits. Start the early morning routine at least a week before school actually starts so that everyone has a chance to get used to having and preparing breakfast early.

Studies have shown that children who eat healthy, balanced breakfasts and lunches are more alert throughout the school day and earn higher grades than those who have an unhealthy diet. 

Back-to-school- shopping, new schedule arrangements, homework time and space, immunizations, after-school sports and activities – they’re all part of a new school year.

One way to help keep everybody on track is with a calendar that is placed where everyone can see it and update it.

Here’s to a new school year that is full of learning, exciting experiences and good grades!




Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.



Norovirus is going around and is very contagious.

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.


Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.