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While tobacco use is at an all time low among teenagers the use of marijuana is on the rise. According to the annual 2012 Monitoring the Future Survey (which is administered annually to over 45,000 students grades 8-2 in both public and private ...
I was recently involved in the care of a 17 year-old boy in our practice who had meningococcal meningitis. Meningococcal meningitis is a rare bacterial infection, but meningococcal disease continues to cause 75-125 deaths/year in the U.S. ...
Welcome your Royal Highness Prince (name to come) and congratulations to new parents Prince William and Duchess Kate.
During our summer vacation, which happened to be overseas, I began to notice a recurring theme. Teenagers from around the world often behave in a similar way. That is, maybe it really is something in a teen's nature that affects behavior and attitudes....
A new study just published in the August online edition of Pediatrics confirms what I see in my practice.
An article in the news caught my eye today when I noticed that The World Health Organization (WHO) called an emergency meeting to discuss the infectious disease known as MERS (Middle East Respiratory virus, formerly known as nCoV). ...
They have been fortunate that no one in their own immediate family had died, and therefore she had never really discussed death with her daughter. I could sense that she was dreading the discussion, just as much as some parents dread discussing sexuality with their children. ..
If you look at a baby's legs it is easy to see how they were folded so that they fit inside the uterus. Those little legs don't get unfolded until after delivery.
I still get a lot of questions about starting solid foods in a baby.
Did you know that the first day of summer, June 21, not only kicks off sun, fun and relaxation, but it is also National ASK Day.
The summer months are typically the time of year when children play more often in homes of their friends, or even other family members. While we parents ASK all sorts of questions to ensure our childs safety, parents need to ASK if there are guns where their kids are playing?
National ASK Day, is a collaboration between The American Academy of Pediatrics (AAP), and the Center to Prevent Youth Violence (CPYV). Statistics show that about 1/3 of homes with kids also have guns, many of which are left unlocked and may even be loaded!
An average of 8 kids and teens are killed by firearms everyday and 42 additional children/teens are seriously injured (according to CDC data). 88% of the children who are injured or killed in unintentional shootings are shot in their own homes or in the homes of relatives or friends.
Other studies show that 42% of parents who own guns keep at least one unlocked, and 25% keep at least one loaded, and UNBELIEVABLY 14% keep one unlocked AND loaded! I cannot believe this myself. Scary!
Children are curious and clever. They may see their parent with a gun and it is left out and suddenly a tragedy has occurred. Accidental? Hard to use that word when this accident may be prevented. Talking to a child about gun safety and the danger of firearms is great, but not enough. Curiosity and availability may win when a child wants to play with the gun. Kids are clever and may f
I just read an article published in the journal Pediatrics which once again validated the importance of family routines. In this study researchers from Ohio State University looked at household routines as they related to childhood obesity, an ever escalating problem.
The research, conducted in 2005, but published this year, analyzed over 8,500 four year old children. 18% of the children were identified as obese. Families were then asked if they regularly ate evening meals together, did their children have a bedtime and receive adequate sleep, and was television time limited within the home? When looked at more closely a little more than half of the children reported having family dinners 6 or 7 evenings a week.
There were 57% of the children who were reported to have 10.5 hours of sleep per weeknight. Only about 40% of the studied children were reported to watch less than 2 hours of television or movie viewing per weekday. When looked at in terms of those children who were exposed to all 3 routines, the prevalence of obesity was 14%, while those children not exposed to any of the 3 routines had a prevalence rate for obesity of 24.5%. The research also found that the number of household routines was a predicator of obesity and that by adding a routine, there was a 17% reduction in odds for obesity as a new routine was added.
These household routines seem to be fairly easy to initiate in that they may be accomplished without any cost etc. Establishing good routines for family meals has repeatedly been shown to improve a childs academic success, attention, risk of using alcohol and drugs and overall well being. If it could also reduce the incidence of obesity what a win!! Just one more reason to plan for a family to eat dinner together. This study did not even discuss healthy food choices, which might make the statistics even more compelling, and what about adding eating breakfast togeth
Summertime in the pediatrician's office means lots of check ups, and often this includes those tweens/teens/and college students who were too busy to schedule their doctor's appointments during the school year. The next three months will be busy indeed.
With HPV back in the news after Michael Douglas revealed that his throat cancer was due to HPV, what better time to remind parents and young adults of the need for the HPV vaccine. The HPV vaccine has been available in the U.S. for over seven years, but statistics from the CDC continue to show that the HPV vaccine is still not being given at the same rate as other recommended vaccines. In other words, we doctors need to ensure that every person between the ages of 11-26 who we see is offered the vaccine, this also means we need to educate.
HPV causes CANCER! This is truly the first anti-cancer vaccine, and I am hopeful that I will see more vaccines to prevent cancer while I continue to practice. I am sure that there will be more anti-cancer vaccines in our children's lifetime. This is exciting news as research continues on ways to combat cancer.
But.....for some reason (that is difficult for me to understand both as a parent and a physician), some parents are refusing to have their children vaccinated despite ongoing evidence that HPV is widely prevalent and causes numerous cancers. The fact that this virus is transmitted sexually seems to be the root cause of parental concern. Do parents not assume that their own children will become parents one day as well? Dont they want to be grandparents one day? Well, that means having sex with a partner. At some point in time, our children do become sexually active and shouldn't they all be protected as much as possible?
Giving adolescents the HPV vaccine does not promote sexual activity. In fact, I think that by having a discussion abou
I love talking to parents about behavior modification and that includes beginning to discipline their children. I really think this is one of the most important jobs for parents and it is hard to believe that your most precious, perfect child will at times misbehave. It happens to all of us!
I would recommend to start using time out as a means of behavior modification when a child is somewhere between 15-18 months of age. For those of you who watch Super Nanny, she coined the word the naughty step which is her version of time-out chair.
When you begin time out, pick a small chair in the house which you can use consistently for time-out. Never use a child's crib or bed, as you do not want them to think that bed is for misbehaving. After a child gets used to doing time out you can use all sorts of chairs and do time out anywhere. Like many things it just takes practice.
When putting your child in time out get down to their eye level, explain why they must sit in the chair, and hold them from behind (with your arms wrapped around them like you are a rope). I use a timer even at this young age so your child begins to understand how long they will be sitting in time out. Time out is typically one minute per year of age.
After time out is finished, get back to eye level and explain that the next time you ask them to mind you, they may choose to listen and they will not have to go to time out. These are such important words for a child's entire life, as they need to understand that they are making choices for their behavior. In other words, taking ownership of making a bad choice and knowing that there will be consequences. You will use these words over and over, you made a bad choice therefore....the consequence is....for a young child it is time out, for older children it may be no TV, or no going to a party, or even no driving. All versions of
I saw a young boy (this week) who was bitten by a dog. Very sad as I began to think this is the time of the year that I will start seeing more bites. Why? Warmer weather brings families outdoors and I've noticed more dog parks popping up. I have experience with dog bites as a pediatrician and mom.
We are a dog family and my husband and I had our first dog, Mrs. Brown, before our oldest son was born. She was the perfect dog, a mutt that my brother (who is a vet) had found and gave yo us.
When the boys came along she was wonderful and would follow them around the yard and to the closest neighbors, I would always know where the kids were as Mrs. Brown would be waiting on the porch for them.
Our next dog was a golden retriever, Maddie, that our middle son wanted, and she too was a member of our family for 12 years. Sweet (but a bit lazy), she was so sad as each of our sons left for college. She was suddenly the only child left at home. It broke our hearts when she died and the boys had not gotten a chance to get home to see her.
Thinking we didn't need a dog in a empty house was a mistake. The youngest son felt like he should have a dog (even though he was away at college) and I thought a little dog might be nice. No way, according to the youngest son, we are a big dog family, and so we now have 4 year old Maggie, a yellow lab. Sweet, smart and spoiled is all I can say.
Now, back to dog bites. I think it is important for children to be around dogs (and other pets as well) but to have a respect for them. Just like we teach children, stranger danger, the same goes for dogs. Teach your children not to approach strange dogs, or reach through a fence to pat a dog. Always ask the owner before trying to pet a dog.
I would not recommend buying your child a dog until they are around 4 years of age. But, if you
I have been receiving a lot of calls, emails and questions on twitter regarding Michael Douglas' admission that his oral cancer was caused by HPV.
Coxsackie virus is rampant once again! I have seen too many kids to count (TMKTC) with symptoms of coxsackie virus and the classic skin rash associated with hand, foot and mouth disease. Many parents are telling me that their day care centers are having outbreaks which is what typically happens at this time of year.
Like many viruses, coxsackie can make some children quite miserable, while others have very few symptoms but never the less are contagious and shed the virus to others. Viruses are just plain ole contagious, even with the best precautions to help prevent spreading the illness. Best prevention continues to be hand washing!
The classic symptoms of hand, foot and mouth disease are a fever, sore throat, and a rash which looks like small red spots or even a bit of a blister, occurring on a childs palms, soles and often in their throats causing pain. We are also seeing many children who have a rash on their buttocks, and legs as well. The rash is often confused for a diaper rash if there are no other associated symptoms.
Coxsackie virus typically lasts from 3 -7 days. While some children are terribly cranky and uncomfortable and will even drool rather than swallow their own spit, other seem to not even notice the rash on their hands or feet. The treatment is totally symptomatic, which means acetaminophen or ibuprofen for fever and discomfort and keeping your child hydrated.
Most kids don't have a great appetite when they have a sore throat (do you?), so I am a big believer in popsicles, Slurpees, ice cream, fozen yogurt, shaved ice.....the list is long. You just want to make sure your child is h
OK, I am back to the subject of squeeze pouch foods or as another cute 2 1/2 year old called it squeegy fruit. I have written about this before as I was fascinated by these when they first hit the market. On the one hand, I get that they are convenient and are easy to use for those first months of pureed baby foods, but beyond that, I think they are given to older children.
It seems that more and more kids are enjoying squeegy fruit and also slurping pureed vegetables. The issue is these pouches foods are being masqueraded as healthy foods. Yes, they are fruits and vegetables often mixed together, but if you read the labels it gets a bit more complicated.
I see so many toddlers in my office who are happily sucking down a packet of apples and blueberries. These parents are adamant that their kids don't drink juice boxes or eat junk food but at the same time they are letting their children suck down several of these pouches a day. This is also often in place of meals, as many of these children are described as picky eaters. I saw a little boy today who had been vomiting, but was on the exam table with pouch to mouth as he drank/at a combo of apples, peas and something else. (note: not recommended when vomiting).
So....I decided to look up the nutritional value of these pouches....many of them although all organic or described as healthy do contain a lot of carbohydrate and sugars. Actually, as much as two fruit roll ups! Yes, I did a little comparison and 2 of the dreaded fruit rolls ups contain 23 grams of carbs and almost 11 grams of sugar.....while a 3.2 ounce pouch has somewhere between 19-24 grams of carbs and between 14-23 grams of sugar.
The point of this is not to say that squeeze pouches are bad, or that a child should never have a fruit roll up. Rather, it is to point out that even healthy snacks can be fu
Parents, you know you can say all sorts of funny things and now here come cute, clever kids comments. This has been a week of kids say the darndest things.
A verbal little 3 year old came in this week and while I was getting his chart opened on the computer, I asked him what's the matter? He is the third child in the family and is quite comfortable coming to the doctor and is always chatty. His response was,I have the God bless you's. Now I admit that I was not quite sure what he meant? Then it hit me! He was sneezing a lot and that was what the God bless you''s meant. How smart is that!
He then proceeded to tell me that he had been sneezing and coughing. He also happens to have asthma, so I asked him if he had been wheezing as well. His response to all of these questions was equally bright. He said , I haven't had to use my puffer, my breaving is okay.
I examined him (by this time he is watching a cartoon on his iPad) and he was spot on. His lungs were clear as a bell, he had a clear watery runny nose and his nasal mucosa was swollen. He also had allergic eyes. He was using an antihistamine but not his steroid nose spray.
So I tweaked his allergy medicines a bit and reminded his mom to have him bathe or shower after he had been playing outside. I also suggested that they use a nasal saline rinse on him as well, as this would help to get the pollens out of his nose after he had been outside, and may be one of the best cures for the God bless you's.
Who says children can't give a good history? I often find that the young patient is a great communicator and may open a doctor's eyes to different ways of relaying a new symptom. Whether is from a 3 year old, a tween or a teen, having a patient that you know and that is comfortable talking to the doctor is the key to a good history. This is was a great remind
Here is another one of the can't believe what I hear at the office! I was on call the other night and it was around bedtime when I walked in the exam room to see 2 little girls (actually they are part of a triplet set but their brother was home). Their dad had brought them in because they had rashes and bug bites. Nothing too serious. They are adorable 2 years old and very well behaved.
So, after examining the rashes and bites and determining that they could be dealt with a bit of cortisone cream, the dad and I were discussing a few more things. Of course the girls got bored, and as you know a bored 2 year old typically doesn't sit still, especially when it is time for bed. So as the girls jumped up and down off the table and picked out more stickers their Dad was getting tired as well. By the way, he is a great father and he and has wife have handled having triplets with such ease. They were meant to have multiples.
Well, before we could finish up the appointment the girls had gotten into the diaper bag, pulled out snacks and were enjoying themselves. As much as he was ready to go, they were not ready to pack up and leave and he was having a hard time getting them to listen.
Here comes the line of the night! He turns to the girls in a moment of what to do next and says,if you don't behave and listen to me, Dr. Sue is going to make you sick! LOL! I have heard a lot of Dr. Sue will give you a shot if you don't behave, but I have never heard this one. While I don't believe in threatening kids with shots at the doctors, this was a new one.
After I stopped laughing I told the girls that this was not true, doctors would and could not make them sick, but they did need to listen to their dad!!
I know that we all say things out of desperation, but please don't use the lines the doctor will give you a sh
The surge in allergies this year has been due to a very wet winter and the weather this spring has brought erratic temperatures and lots of wind. The perfect storm for the "allergic cascade" to inflict itself on everyone's nasal mucosa. The best preventative for nasal allergy symptoms (allergic rhinitis) has been the use of intranasal steroids. These steroid sprays have been used for the past 15 years and clinical studies have shown that intranasal steroids are superior to oral antihistamines. Intranasal steroids function by inhibiting the production of chemical mediators such as histamine and prostaglandin that cause inflammation and mucous production. In other words they are more of a preventative medication, while an antihistamine is treating the histamine that was released once you inhaled the offending tree or grass pollen. Intranasal steroids may also help eye allergy symptoms too. The problem is getting young kids to let you use a nose spray on them. The same holds true for the older tween and teen crowd who complain that they "just don't have the time to use it everyday" (it must take all of 15 seconds to use on yourself!) They have been shown to be effective within 3-12 hours, although will reach their maximum effectiveness after several days to weeks of use, so using it daily and throughout the allergy season is going to give you the maximum therapeutic effect. There are many different brands available and everyone seems to have their favorite. If one spray seems to bother your child due to scent, or intensity of the spray ask your doctor to try another brand. Many times they will have a sample and give you several to try and then prescribe the one that is easiest to get your child to use. It may be trial and error, but finding the right nasal steroid may just change your allergy season. That's your daily dose, we'll chat again tomorrow. Oh, God Bless You! Send your question to Dr. Sue!
I recently received a question from a Twitter follower related to cradle cap and dandruff. She wanted to know if there was a difference in the two. You know there really isn't as they are both due to seborrheic dermatitis, an inflammatory condition of the skin in which the skin overproduces skin cells and sebum (the skins natural oil). Cradle cap is the term used for the scaly dermatitis seen on the scalp in infants. It is also seen on the eyelids, eyebrows, and behind the ears. It is typically seen after about three months of age and will often resolve on its own by the time a baby is eight to 12 months old. It is usually simply a cosmetic problem for a baby as it looks like a yellowish plaque on a baby's scalp and is often not even noticed by anyone other than the parents. Unlike seborrheic dermatitis in adults, cradle cap typically doesn't itch. It is thought that cradle cap may occur in infancy due to hormonal influences from the mother that were passed across the placenta to the baby. These hormones cause the sebaceous glands to become over active. In some severe cases an infant's scalp becomes really scaly and inflamed and causes even more parental concern, as it appears that the infant is uncomfortable and may be trying to scratch their head by rubbing it on surfaces. The treatment for cradle cap is to wash the baby's scalp daily with a mild shampoo and then to use a soft comb or brush to help remove the scales once they have been loosened with washing. When washing the head make sure to get the shampoo behind the ears and in the brows (keeping the soap out of baby's eyes). This is usually sufficient treatment for most cradle cap. In situations where the greasy scales seem to be worsening it may help to put a small amount of mineral oil or olive oil on the baby's head and let it sit (I left a small amount on my children's heads overnight) and then to shampoo the following day. The oil will help the scales to loosen up and come off more easi
We are all saddened by the tragic devastation in Oklahoma and surrounding communities leveled by yesterday's tornadoes. There are numerous tragic and traumatic events which occur across our country (and around the world) and at times, children may be witnesses to these events. With that being said, how do you discuss these tragedies with a child? think the most important thing to remember when talking to a child about a trauma or tragedy is to use words that are appropriate for the child's age and vocabulary and to acknowledge your own feelings as well. They need to know that you too were scared, sad, upset or anxious about the event. Ask them how they felt and listen to the words that they use as you may use those words again when talking to your child. While every child is different you can often follow their cues as to how much and how detailed a discussion to have, and when and how to bring the topic up again. Some children are talkers and want to discuss things at length, while others may be quieter and take some time to absorb the information. Don't force the discussion. A parent knows their children and the discussion may/will be different for each child and will be further impacted by their ages. For young children, it is also important to let them know that "Mommy and Daddy" are there and will take care of them and protect them, but at the same time bad things sometimes happen. That is why parents take precautions and are responsible (like holding hands when crossing the street, or wearing a helmet etc).But, if something does happen it is so important to validate your child's feelings while at the same time teaching your child coping skills and resilience. If your child does view a traumatic event it is not unusual for them go through a period when they are afraid of separation, or have nightmares etc. They sometimes develop somatic complaints like tummy aches, headaches, and non specific complaints of "I just don't feel well". This is normal, but you shou
I see a lot of girls who are preoccupied with their weight. It seems that more and more girls, at younger and younger ages begin to ask, am I fat? or does this dress make me look fat? or even why do I have a fat on my stomach that I can pinch?
The world we live bombards young girls with images of being thin and of the perfect body. We all know that a Barbie doll is not a realistic image of a woman's body, just as the cover of People magazine or the cover of Teen Vogue is also not always real. Many models are 10-20% below their ideal weight, and movie stars often have their pictures photo-shopped to appear thinner. The obsession with being thin has only continued to contribute to the increasing incidence of eating disorders, in girls as young as 10 and 11.
Anorexia and bulimia are both examples of eating disorders. Anorexia is a syndrome in which there is insufficient caloric intake to maintain normal weight and growth, which is associated with a disturbed body perception, an intense fear of weight gain, and obsession of being thinner. Girls (who are more commonly affected) truly believe that they are fat, even when they are emaciated and they fail to be able to distinguish a healthy weight.
Anorexia occurs in about 1% of the adolescent population, and is most commonly seen in females (90%), who are Caucasian (95%). It is also seen more commonly in middle to upper middle class families.
Bulimia is defined as binge eating followed by compensatory behavior in order to prevent weight gain. These behaviors may include vomiting (purging), laxative abuse, diuretic usage, stimulan
Did you know that May is National Teen Pregnancy Prevention Month? I really think that this should be a topic of interest to parents year round, but this is a good month to be reminded of the importance of educating our children about their sexuality.
The good news is that the teenage pregnancy rate is going DOWN! The bad news is that 750,000 teens in the United States experience a pregnancy each year and 400,000 will give birth. That means that 70 young women out of every thousand become pregnant. To continue to reduce these statistics requires improved education and continued dialogue about the risk of teen pregnancy.
Although some teens think that becoming pregnant is a way to escape their own situation, the reality is that teens who become pregnant are less likely to finish high school or enter college, and are more likely to experience poverty. Being a parent is a hard job for any one, but trying to be a teen parent is almost impossible, even with good support systems. The effects of teen pregnancy are far reaching for all of society.
Studies show that teenagers who receive comprehensive sex education are 50% less likely to experience teen pregnancy compared to those who were taught abstinence only sex education. Other studies have recently shown that the decline in teen pregnancy rates are due to increased contraception use. But, 39% of sexually active teens did not use condoms when they last had sex, and only 23% of teen reported that they or their partner used hormonal birth control.
Parental involvement in sex education should occur in every home. This begins with that first, birds and bees talk with your child. A comment from a recent young patient after reading Where Did I Come From with her parents DISTURBING ! (cue my laughter).
The conversation needs to continue during the tween years an
I am going to start right off by saying, I don't have daughters, so maybe that is why this seems strange to me, but, why are little girls already getting mani/pedi's with their moms? I don't mean teen girls, I am referring to the 3-12 year old crowd.
I see these little girls in my office with painted fingers and toes, and I often ask them, who painted your fingernails?. I thought the typical answer would be my mom, or my big sister, but it is quite often I hear, I had them painted at the nail salon. Of course, I then have to ask, oh, was this for your birthday?, and many of them do say it was, but many also say, I go with my mom all the time.
WHAT? I can remember my first manicure was on the day before I was married. It was a big deal, and i think my parent's agreed to it because in those days we all had a picture of our hands with the new wedding bands on. Do you have one of those, husband and wife with hands overlying one another? I still love that picture, and yes my nails were perfect. i also remember that it took me the 6 months prior to finally stop biting my fingernails, in order to even have nails to manicure! Nail biting is one habit that took me years to break, but out of necessity for wedding pictures I stopped and never went back.
I watched several little girls getting mani/pedi's the other day. They sat there, perfectly still at the age of 4 (my boys would have played in the pedi bowls I am sure), enjoying picking out polish and choosing flowers to be painted on their toes (to which I overheard one mother saying, do you know how much this is costing?). Odd comment considering the fact that the mother had obviously brought her daughter and how can a 4 year old understand how much professional nail care costs?
I just think that parents need to show a bit of restraint in indulging their children in such
Just home from the office and on call. Once again, I keep on learning and laughing with my patients. I saw a mom, dad and their two young boys last evening. The boys were about 4 and 6. When I walked into the room, it was so quiet, and then I realized that their clever mother had them playing the quiet game. Seems I lost as I talked first!
She brought the boys in that evening as she had just gotten a note from the school that there had been several cases of scabies in her son's class. In her words, she freaked out and decided a trip to the pediatrician was necessary.
So, when I asked her if the boys had a rash or had been complaining of being itchy, she just looked at me? No there was none of that, it was just the whole idea that they might have SCABIES?! Of course she had been online and could identify the mite if necessary. She was certain that I needed to treat the boys, and maybe she and her husband? She just said ,do whatever you have to do!
She then decided that maybe we should worry about lice as well, as don't these yucky bugs go together? Luckily, her precious little boys had crew cuts, so that was an easy rule out.
So, seeing that they did not have any rashes, really no complaints other than maternal anxiety (we moms are good at that), I told her all was well. She seemed okay with that except she didn't want to send her children back to school until the school exterminated the whole building and she thought she would wash all of their sheets and vacuum her house that night.
I had to laugh as I told her there would always be germs and bugs around, no matter how clean we try to be. In fact, one of my own children had scabies many years ago and it took an allergist to diagnose him - no one had thought about scabies, but boy did he have a rash!
I guess she fel
What are the words that a child first speaks that changes everything?
How many times have you cooked dinner only to have your child tell you, I don't like that! It is a common theme in many families...it doesn't matter whether Mom or Dad fixed the meal.. our children don't hesitate to tell us their true feelings. I can remember that many times I had even prepared dinner thinking I was fixing my children's favorite foods. But, guess what.....they didn't agree.
Dinner is one of the most important times in a family's day. It is the time to gather together for a meal, but more importantly it is a time to just be together. Whether you child eats the meal is really not the important part....I know may be shaking your head in disagreement, but it really is not about the food, it is about being together.
The longer I think about it.. the more I have come to understand this. One of my patients recently told me that she had made her child's favorite, macaroni and cheese. When he (all of 3 years old) sat down for the meal he looked at his parents and announced....I prefer Panera. (that should be a TV ad). How can that not devastate you the parent that fixed the meal? But, don't let it. Tell your child that you are just happy to be together to talk and enjoy one another....don't let their food choices ruin the meal or turn the meal into a food argument. It is not worth it, and we parents all need to remember that our children will not starve if they miss a meal.
I think meal preparation for a family is somewhat analogous to having a dinner party. When you invite guests to dinner they don't ask you what you are cooking or planning on serving before they accept your invitation. They come to dinner and if by chance they don't like what you have prepared, they don
Back to more funny office stories - they really keep my job interesting and always a little bit of fun.
Last night, a patient called me and wondered if their daughter had appendicitis. I always thought it would be the easiest diagnosis, and that we would call the surgeon and whisk the patient off to the operating room for an appendectomy, just like Madeline (one of my favorite books as a child). Well, over the years have I been taught a few things. At times the diagnosis is easy. The patient has the classic symptoms of a "tummy ache" that starts around the belly button, they may vomit a few times and have a fever and the parent in all of us thinks, "yuk, another one of those tummy viruses". But over several hours the tummy aches worsens, and moves from around the belly button (peri-umbilical) to the right lower quadrant and the nausea and vomiting persist and your child just looks SICKER. At the same time you may notice that they have a funny walk, and won't stand up straight, as they try to get to the bathroom and when possible, they move very little at all, as any movement makes the pain worse. This is classic appendicitis. For a parent, that means a phone call to the pediatrician, day or night, as that child needs to be examined. On the other hand some children just forgot to read Nelson's text book of pediatrics. They don't vomit, they may not have a fever, they are a little nauseated, but when pressed could still eat, and it only hurts in their right lower quadrant, everything else is just okay. These are the difficult cases to diagnose. These children require a lot more history, repeat exams and lab tests and may even need a CAT scan to look at their appendix. But, you don't want to miss an appendicitis, as a perforated appendix is serious and requires a lengthy hospitalization. So as a parent and a doctor, if your child's tummy ache seems to be getting worse, it may be worth a trip to the doctor to feel that tummy, run a few tests and decide how to proceed. It is not always as easy as in a book or on TV. That's your daily dose, we'll chat tomorrow!
While I am on the subject of vaccines it is important to remember that it is not only infants and young children who receive vaccines. Children (and even adults) continue to need vaccines and some vaccines are not given until a child is in the tween and teen years.
Why? For one reason, our bodies need booster doses of vaccines to remind our immune systems to keep us protected. Pertussis (whooping cough) is a good example of this. We are in the middle of an epidemic of whooping cough across this country, in part due to the fact that adults had not been re-immunized against whooping cough. Adults who get pertussis often just have a prolonged cough, they do not get as sick as infants and young children. But, they are contagious during their lengthy cough illness and a baby who is not yet protected can get seriously ill and even die from whooping cough. There have been deaths related to whooping cough.
Other vaccines are given during the tween/teen years to prevent a type of meningitis that clusters in adolescents and young adults. Meningococcal meningitis has two peaks, one in children under the age of 1 and again during the teens and early twenties. The first dose of this vaccine is given at age 11 and a booster dose is given at age 16, just prior to teens leaving for college and living in close quarters in dorms and apartments. Make sure your child gets that second dose!
The HPV vaccine is given to tweens to prevent cervical and penile cancers as well as genital warts. The vaccine is given prior to any exposure to the HPV virus as it provides protection, but does not treat HPV infections. Once again, you need a series of 3 vaccines to prevent 4 specific types of HPV, and scientists are hard at work to develop an even better vaccine that will cover more serotypes of HPV. This is really the first anti-cancer vaccine and our children w
April 20-27 is National Infant Immunization Week. Although there are infants and children in this country being immunized every day, this is the week to remind parents, caregivers and health care professionals of the importance of vaccines.
Infants are immunized against 14 vaccine preventable diseases. Vaccines are now given to prevent not only older diseases like diphtheria, tetanus and polio but for diseases like bacterial meningitis, chicken pox and a viral diarrheal disease. Vaccines are one of the greatest public health achievements of the past century, and more vaccines are in the pipelines to continue to save lives.
Although some parents have been concerned and even misinformed that vaccines cause autism, study after study, including one published last month, have shown that there is NOT a link between vaccines and autism. What we do know is that vaccines save lives, lots of lives.
Before the meningitis vaccines for both pneumococcal and H. flu bacterial infections were available there were hundreds of children who died each year. I can remember taking care of some very sick children, and even doing spinal taps in my office to rule out meningitis. Some of the spinal taps were positive and a few of my young patients were fortunate to survive bacterial meningitis, but they are now adults with deafness. We had a few children in our practice during the 1980s who died from meningitis.
During my early years of practice bacterial infections of the blood were also more common and we hospitalized a lot more infants and children than we do now. I will also never forget a previously healthy 2 year old little boy who died from chickenpox and a bacterial infection of his blood stream. This occurred almost 20 years ago, before the chickenpox (varicella) vaccine was available. He would have been pro
More funny stories from work.
I was on call yesterday. In my practice, call days are pretty long. On a given call day, I might be responsible for making hospital rounds all morning (I may go to 3 or 4 different hospitals) and then work evening office hours as well. The evenings in the office are typically pretty busy and for some reason some of the sicker children seem to come at night. Usually not a lot of time for chatting with the patients or their parents.
The other night was a bit slower (maybe spring is finally here and all of those colds are going away!) and I was finishing up with a toddler who had been wheezing and was getting breathing treatments. While waiting for her treatment to finish, her mother and I started talking and somehow got to the subject of funny things our mothers had said to us. (I think because her own mother had told her that her daughter was wheezing because she hadnt been wearing a coat during the last cold snap. This is a myth).
At any rate, I remember my own mother telling me during those teen years to always wear matching undergarments in case I got into an accident. At the time it sounded a bit weird, but looking back now, it is kind of morose. I mean REALLY!!! But I sometimes laugh out loud thinking about those words of wisdom.
I saved the best line of this conversation for last. This young mother, with her really cute 20 month old daughter in her lap, looks up at me and says, I bet I tell this one to just make sure she has underwear on when she goes out, who cares about the color!
How much fun is a 4-6 month old baby? I just love this age, and if you have a baby of your own, you probably know what I mean. I call this age a chia baby! They are just perfect and low maintenance like the chia pet.
Think about it, this precious aged baby only requires watering, i.e. they just drink - no real food yet, so no meal planning or mess to clean up. They don't move , so you know where they are at all times, no looking for them under foot, or worrying if they will be home on time. They sleep for at least 6-8 hours at night (those early months were much more exhausting) and typically wake up with a smile on their face.
When you talk to this age baby they smile, babble and laugh at whatever you say. They think you are funny and clever (not always the case during their teen years), even when you might not be. A 4 month old baby packs up easily and can travel, just like moving a chia pet from one window sill to another. (wait till toddlerhood and trying to convince the same child to sit still on a plane).
I am always ready to take a 4 month old baby home with me for a few days. I tell the parents at the 4 month check up that I will gladly babysit . I just wish I could keep a 4-6 month old baby around at all times. I do believe that this stage of infancy is God's gift to parenting.
Don't worry, there are many different stages in a child's life that are also special and perfect, but this is just the first one. This stage is well worth the first months of sleep deprivation and exhaustion! If you have a younger baby, hang in there, it's getting ready to get really
We are all saddened by the tragic event that occurred during the Boston Marathon. There are numerous tragic and traumatic events which occur across our country (and around the world) and at times, children may be witnesses to these events. With that being said, how do you discuss these tragedies with a child?
I think the most important thing to remember when talking to a child about a trauma or tragedy is to use words that are appropriate for the child's age and vocabulary and to acknowledge your own feelings as well. They need to know that you too were scared, sad, upset or anxious about the event. Ask them how they felt and listen to the words that they use as you may use those words again when talking to your child.
While every child is different you can often follow their cues as to how much and how detailed a discussion to have, and when and how to bring the topic up again. Some children are talkers and want to discuss things at length, while others may be quieter and take some time to absorb the information. Don't force the discussion. A parent knows their children and the discussion may/will be different for each child and will be further impacted by their ages.
For young children, it is also important to let them know that Mommy and Daddy are there and will take care of them and protect them, but at the same time bad things sometimes happen. That is why parents take precautions and are responsible (like holding hands when crossing the street, or wearing a helmet etc).But, if something does happen it is so important to validate your child's feelings while at the same time teaching your child coping skills and resilience.
Another on call weekend just completed, and it seems that gastroenteritis, also known as the tummy bug or stomach flu (whatever term you want to use) which causes vomiting and diarrhea, is still around. I walked into a lot of exam rooms with tired parents and kids all of whom had been vomiting and having diarrhea, not a fun weekend for a family at all. The most likely culprit is norovirus.
Norovirus causes about 21 million cases of gastro per year and leads to about 70,00 hospitalizations. You can get norovirus at any time of the year but it is most commonly seen during the winter, and it seems to be hanging around into early spring this year. This has been a particularly bad year for norovirus as there was a new strain so even more people seemed to get sick. That includes my own husband!
Norovirus is the leading cause of gastroenteritis in pre-school children. In a recent study, about 21% of the cases of acute gastroenteritis in children younger than 5 were due to norovirus. That compares to 12% due to rotavirus which used to be the primary cause of viral gastroenteritis. Since the introduction of rotavirus vaccine over 5 years ago the rates of rotavirus disease have steadily been dropping, and now norovirus has taken its place! You know those viruses, they are smart.
Norovirus causes inflammation of the lining of the stomach and intestines resulting in severe nausea, vomiting and diarrhea. These symptoms begin soon after exposure and typically last 1-3 days. Many children will also run a low grade fever (around 101) and complain of tummy cramps.
The only treatment is symptomatic: begin frequent sips o
A federal judge ruled last week that an over the counter emergency contraception, which helps prevent pregnancy if used within 72 hours after sexual intercourse, would be made available for all ages.
Plan B One Step, the pre-packaged emergency contraceptive has been available as an over the counter morning after pill since 2006 (although its sale has been restricted to those 17 years and older). Even though it is an over the counter medication you have to ask the pharmacist for the package which is behind the counter, and if you are under the age of 17, you need a prescription. Plenty of hoops to jump through.
What's the debate all about and why is a federal judge deciding this? In late 2011, the FDA voted to make Plan B One Step universally available as an over the counter medication. Soon thereafter Kathleen Sebelius, the secretary for HHS, disagreed with the FDAs decision and did not approve the FDAs recommendation. The judge in his ruling concluded the administration had not made its decisions based on scientific guidelines and that its refusal to lift restrictions on access to the pill was arbitrary, capricious and unreasonable.
Not only did the FDA recommend unrestricted access to the morning after pill but the American Medical Association (AMA), The American Congress of Obstetricians and Gynecologists (ACOG) and The American Academy of Pediatrics (AAP), agreed as well. All groups felt that the science showed the safety of the pill, and that restrictions for its sale kept teenagers from using the drug in a safe and timely way to prevent pregnancy.
I discuss the use of Plan B with my adolesc
Did you read the latest study from the CDC about the number of infants who are starting solid foods too soon? One of the only things that I think has stayed pretty constant since I began practicing medicine (and what I did with my own children), was waiting until they were around 6 months of age to begin solid food.
Beginning a baby on solid foods is not really momentous, in that it does not make a baby sleep through the night, it does not make them less fussy, or gain weight faster, but it certainly is a little more work. A baby really does just fine on breast milk or formula for the first 6 months of life. It is wonderful to watch a newborn grow and thrive, and it all happens with milk alone.
While many new parents are anxious to start solids, there is no rush. Actually, once you are starting baby foods you soon figure out that it is really more work, and you get to fix meals for the next 18 years! Formula or breast milk seems like a great meal when you are too tired to cook one night when they are older. Milk for dinner just doesnt work for a 10 year old.
Early introduction of solid foods may be linked to obesity, diabetes, eczema and celiac disease. While the studies on these issues continue, why risk any of these problems when your baby is doing well on breast milk or formula alone for 6 months?
When beginning solid foods your baby should be able to sit up in their high chair and open their mouths when the spoon is introduced. There is no magic as to how much a baby will even eat when you start baby foods. For some babies, eating solid foods is cosmic and they may love it and continue to eat more and more.
During an adolescent check up, I talk to each teen about smoking. While the rates of cigarette smoking in teens continues to drop, 20% of teens in the U.S. consider themselves to be regular smokers.
Added to that statistic is the fact that every day almost 3,900 adolescents under the age of 18 try their first cigarette. Little do they know how addicting nicotine is. 30% of those teen smokes will continue smoking into adulthood.
Smoking has many health hazards which we all know: it causes cancer, emphysema and heart disease. It also shortens a persons life span by 10-15 years. But teens know these facts and continue to smoke. What many teens need to be reminded of is that smoking also causes more immediate side effects such as bad-breath, yellow fingernails and teeth, smoke smell on their hair and clothes and premature aging of their skin!! These facts seem to be of more interest to many teens.
I just saw a study out of Australia in which teens tested a software program that showed them what they would look like in their 50s and 60s if they continued to smoke. There is a Canadian based company that has developed face-aging software called April. (the program is on the web at http://www.ageme.com).
The researchers conducted a randomized controlled study at eight pharmacy sites in Australia targeting young smokers. There were 160 participants (ages 18-30), 80 in control group and 80 in the intervention group. The study was conducted over a six month period.
Participants were asked to complete a baseline questionnaire. They all received a self-care guide on smoking. But for the intervention group, the researchers took a picture of each participant and downloaded it on a laptop to show them what they would like as a smoker or a non smoker at age 55. Those in the intervention group
I keep getting so many questions about tummy time Ever since the American Academy of Pediatrics recommended that all infants sleep only on their backs (to reduce the chance of SIDS), parents forget or are afraid to put their baby's on their tummies. Tummy time is important to help reduce the incidence of head flattening as well as to give your baby time to develop different muscle groups.
Tummy time is encouraged from the first days after a baby's birth, but so many parents ask, just how much time? Tummy time does not mean timed in the sense that you do it for a certain amount of time or minutes a day. Tummy time, is not rigid.....it is flexible. Off and on throughout the day when your baby is awake, you let them experience tummy time.
Just like so many activities with a newborn, sometimes tummy time is for only a minute or two before the baby starts to fuss or cry. Other times an infant may enjoy their tummies for 10- 20 minutes before they are ready for a change.
At other times you put the baby on their tummy, they settle down and then decide to fall asleep. Keep in mind, you MUST turn them over, even if you are watching them. Remember, NO TUMMY sleeping until your child rolls over on their own.
So, many parents come in during the first days to weeks after their baby's birth with not only feeding charts, but pee and poop charts and graphs of tummy time down to the minutes. It is really not necessary to graph the amount of tummy time your baby gets, just make sure you remember to do it.
As your baby gets older, they typically enjoy their tummies for longer periods of time and ar
Just back from an evening call night in the office and it was like dermatology clinic! But the funniest thing was that 4 of the children I examined, all of different ages, had the same thing: Lip Lickers Dermatitis.
It is beginning to be the time of year when the weather gets cooler, the humidity drops and children who are in the habit of licking their lips develop dry cracked and chapped lips. Not only do children lick their lips, they also tend to lick the skin around their lips which results in more chapping and irritation, and the cycle begins. One little girl I saw could actually lick all of the way up to her nostrils!! She had to show me for me to believe that this is why her nose was chapped, I foolishly thought it was from blowing her nose.
Every one of the kids habitually licked their lips while I examined them, even before telling them of their diagnosis. Several of the concerned parents doubted the diagnosis of lip lickers dermatitis, but I pulled out a derm book and proudly showed them pictures that looked just like their child. The rash can get quite raw and inflamed and if irritated and rubbed enough may even get secondarily infected.
The problem with lip lickers dermatitis is that it is a habit, just like thumb sucking, nail biting and hair twirling. As you know habits are hard to break, even when they cause discomfort. It is so hard not to moisten you lips when they are dry and are becoming drier. Licking your lips seems to improve the dryness but only for a moment.
The treatment of choice is to try and break the habit as well as to use a protective barrier on the lips and around the mouth. This is best accomplished with a thick layer of Aquaphor or Vaseline that must be reapplied quite frequently. For an older child you can give them a pocket tube to carry so that they may apply the moisturizer as often as need be, even every 30 minutes to an hour.
To aid in the treatment the thicker the layer of Aquaphor
Do you have a teenager? If so, have they received their HPV vaccine?
HPV stands for Human Papilloma Virus, which may cause cervical and penile cancer, oral cancers and genital warts. There has been a vaccine available since 2007.
A recent study in the journal Pediatrics looked at vaccination rates for teens and the HPV vaccine. While 80% of teens are receiving their Tdap booster, and 63% of teens are current on their meningococcal meningitis vaccine, only 32% of teens have received all 3 doses of HPV vaccine.
Parents whose teenagers had not received a first HPV vaccine or completed the series often said that the vaccine was not needed or necessary.
Other parents whose children had not received the HPV vaccine and who did not intend to vaccinate their children stated that they were worried about the safety or side effects of the vaccine.
The HPV vaccine has had a good safety record and has been shown to be very effective in preventing HPV infections. The vaccine has been studied in the United States for amost 7 years, and in Europe and Australia for almost 10 years.
The vaccine does not treat HPV disease, but rather prevents it, so the vaccine needs to be given to adolescents prior to any exposure to the virus. While many parents feel comfortable discussing sexuality with their children, other parents are uncomfortable with vaccinating their children for a sexually transmitted disease.
Getting parents to complete the series (which is given over a 6 month period) has also been a hurdle and the vaccine is not effective until all 3 shots in the series has been completed.
If you have questions about the HPV vaccine, talk to your doctor in order that all of your questions can be answered. I know I have given my 3 children the vaccine and encourage all of m
I seem to get several calls each year about acute mountain sickness which may occur when traveling to altitudes above 5,000 feet (1,500 meters), but is typically associated when travelling to altitudes of 8,000 14,000 feet (2,440 4,270 meters). To give you a frame of reference, Denver, Colorado is 5,280 feet above sea level, while Vail, CO is 8,200 feet. Fortunately, most people will not have serious problems when traveling to higher altitudes. The human body acclimatizes to higher altitudes by allowing your body to function with less oxygen without having distressing or debilitating symptoms. Despite that, the body is not functioning as well as it does at sea level, as the air is less dense at higher altitudes and consequently there is less oxygen available for breathing. The first thing you may notice is a slight increase in respiratory rate, which will help to increase oxygen delivery to the lungs but at the same time results in the loss of extra CO2. Some people may also notice an increase in heart rate. I think that most children without underlying medical problems (chronic pulmonary or cardiac problems), seem to actually acclimate better than adults. But in some cases you may notice that your child has non-specific symptoms such as irritability (I must admit hard to tell if altitude, traveling or just having a bad day), decreased appetite, headaches, disrupted sleep (always seems to happen when travelling with children) and occasionally vomiting. All of these symptoms usually resolve after several days and may be minimized by planning a gradual ascent to higher altitudes. So, driving may be better than flying, but..I can remember several days while driving to Colorado with cranky children and we were not even out of Texas! I also think one of the boys vomited due to the driving and not altitude. Oh well, fond memories nonetheless. For some children and teens who have experienced repetitive episodes of altitude sickness
It's March Madness and I for one love college basketball! Being a mother of boys always meant that there sporting events to attend, you name it my boys did it. Soccer, baseball, basketball, football, golf, tennis, lacrosse, track. No dance lessons or cute tutus around my house, just lots bats, balls and helmets.
It also meant that there always seemed to be a sporting event on TV that someone wanted to watch. I am not much of an athlete, but I did always enjoy the spectator aspect of basketball, maybe because I think I somewhat understood the game. I could even occasionally be found on the outdoor court playing a little b-ball with my boys, although I don't think I ever scored a basket.
At any rate, one of the things I did love to do is fill out the NCAA brackets. This came about due to necessity. The boys would all be waiting for the brackets to be announced and then they would frantically print copies for distribution among the family. Many a family breakfast or dinner was spent with heads down discussing the top teams, filling in choices and how much for the family pool. If you can't beat them, join them, and so I would ante up and figure out my teams. I never had much basis for intelligent choices, but dumb luck is sometimes a good thing.
Now, while I am not advocating gambling, a little family wagering can be a healthy endeavor. Filling in brackets and discussing the night's games is a great way to communicate. And it is not just a one day or night conversation. These games go on for a weeks! Our family would talk about the teams, watch some games together and some years even trekked to see some of the teams when games were played in our area. Good family times and memories.
I see a lot of parents who bring their baby/toddler/child in to the pediatrician with concerns that their child might have an ear infection. One of the reasons for their concern is often that their baby is tugging on their ears.
Babies find their ears, just like their hands and feet, around 4 -6 months of age. I guess a baby must think this ear tugging is fun and feels good as maybe babies have itchy ears just like adults. It also seems to be a self soothing habit for other children who seem to pull on their ears when they get tired and cranky. Maybe it is related to new molars coming in at the back of the jaw line?
Whatever the cause, it often concerns parents who are told by their friends or relatives, I am worried, this ear pulling probably means the child has an ear infection. So, being a good parent off you go to your pediatrician only to find out that the ears a beautiful and clear!
Most babies and children do not get an ear infection without ANY other symptoms besides ear pulling. In most cases infants and toddlers will get a secondary ear infection during cold and flu season. The multitudes of viral respiratory infections that children get in the first 3 years of life, often cause continuous runny noses and congestion. This congestion causes fluid to build up in the middle ear space which connects to the nasal passages via a small canal called the eustachian tube.
Infants and children have so called immature eustachian tubes that are soft, and don't drain well and the tube gets inflamed and swollen from the viral infection as well. At times this fluid gets secondarily infected from bacter
Proper dental care for your child begins early, really with the eruption of that long awaited first tooth. It is easy to wipe off the first teeth with a wet washcloth or baby toothbrush. It is easy in the beginning when your baby will not be bothered by it, it gets a bit harder as your baby decides to clamp down and not open their mouth. Why a child figures this out before they are one, who knows?
Parents should know that they never put their baby to bed with a bottle, that is why there are bars on the crib, the bottle should not go behind the bars! Same thing if you are breastfeeding, do not let your child fall asleep on the breast or nurse off and on through the night as this may also contribute to cavities. The saliva in a baby's mouth helps cleanse the teeth as well, so you want to have time without milk in the mouth for this natural cleansing to occur.
I usually start talking about using a toothbrush around 9-12 months when your child can hold a toothbrush and put in in their own mouth. It is a fun game to play as you brush your own teeth and they want to mimic the behavior. For some reason a child also always wants your toothbrush so often Mom or Dad is suddenly using the Dora toothbrush while child has nice Oral-B!
At any rate, you can begin using a non fluoride baby tooth paste and as your child starts to mimic spitting out toothpaste you can buy a children's brand toothpaste with fluoride. Get into the habit of play brushing twice a day.
Next hurdle is flossing which is now called jumping rope by our favorite pediatric dentist. I found jumping rope to be a bit of a challenge wi
I have to remind myself to ask clear-cut, open-ended questions when examining patients. This is what I was taught to do in medical school, and I think I need a refresher.
I was reminded of this again while examining an adolescent patient. She had been a patient for many years so I knew her quite well. With the new electronic medical records I am using I find that I am not always making eye contact while I ask questions. It was far easier before I wrote down my notes now I type them, then head to a different screen for medications, updates etc. making this a bit more cumbersome with less eye contact - surely there is a better way! At any rate, I knew this young woman had been taking birth control pills and I wanted to add this to her current medications, so I asked are you still sexually active? without really looking up (which I should have done!).
She suddenly says emphatically and loudly, Dr. Sue, I am not promiscuous, you know I am only having sex with one partner (long pause) how could you call that sexually active?
Point well taken! Not only did I not make good eye contact when I was talking to her (which I think is rather rude on my part), I asked her a question in doctor talk rather than using something less formal. She was correct, I would not consider her active, which she thought was synonymous with promiscuous.
She was an older adolescent who was smart enough to be using contraception while she was having sex with one partner. After clearing up the active part she also informed me that her partner was also wearing a condom to prevent transmission of infection. She had done everything correctly by coming to me prior to having sex and discussing contraception and disease prevention.
I have had several clever little patients lately who are enjoying driving their parents crazy by taking off their diapers and then doing all sorts of things with pee-pee and even poop around the house! A pregnant mother with a 2 1/2 year old walked in to my office just this week, without an appointment, but with lots of tears. She told the receptionist she just had to see me and when asked if it was an emergency she answered truthfully, it was an emergency to her. Seems as if her toddler had taken off his diaper during a nap, and painted the walls with poop! That is enough to bring anyone to tears, yet alone a tired, stressed, hormonal pregnant woman. So, we worked her into my schedule which means I was behind, seeing patients but sometimes that just happens. At any rate, after a few more tears and tissues, I told her I might not have all of the answers for her defiant toddler, but I thought I could help with this issue. Just put that diaper on backwards! It usually is enough of a deterrent to most children who are unable to reach around and unfasten the diaper. We used duct tape to keep that diaper on, but this is an easier solution and works about 95% of the time. One mother told me you are a genius, wish it was so. Many other toddler issues to drive a parent crazy, but this issue was resolved. Now we have to talk about potty training him, but that seems a few more months down the road.
Diaper Dilemma
I have had several clever little patients lately who are enjoying driving their parents crazy by taking off their diapers and then doing all sorts of things with pee-pee and even poop around the house! A pregnant mother with a 2 1/2 year old walked in to my office just this week, without an appointment, but with lots of tears. She told the receptionist she just had to see me and when asked if it was an emergency she answered truthfully, it was an emergency to her.
Seems as if her toddler had taken off his diaper during a nap, and painted the walls with poop! That is enough to bring anyone to tears, yet alone a tired, stressed, hormonal pregnant woman.
So, we worked her into my schedule which means I was behind, seeing patients but sometimes that just happens. At any rate, after a few more tears and tissues, I told her I might not have all of the answers for her defiant toddler, but I thought I could help with this issue. Just put that diaper on backwards! It usually is enough of a deterrent to most children who are unable to reach around and unfasten the diaper. We used duct tape to keep that diaper on, but this is an easier solution and works about 95% of the time. One mother told me you are a genius, wish it was so.
Many other toddler issues to drive a parent crazy, but this issue was resolved. Now we have to talk about potty training him, but that seems a few more months down the road.
If you are a new parent or even if you have older children, you can probably remember your baby's first smile, almost vividly I bet!!
When a parent first brings their new baby home from the hospital it is such a time of great joy, but parents quickly learn how demanding a newborn baby really is. The first 6-8 weeks of a baby's life is all about eating, peeing, pooping and maybe a little sleep, although not on any sleep schedule an adult can remember. The little sleep a parent and the newborn gets comes in 2-3 hour increments and after about 6 weeks of sleep deprivation a new parent can understand why sleep deprivation is used on POWs. It sometimes does feel like torture.
But just when you think you can't take it ANYMORE, and wonder why you thought you wanted a baby, (and you are actually telling your baby this), you suddenly realize that your baby is making eye contact and REALLY SMILING! It is such a wonderful and amazing moment! One little smile can erase weeks of no sleep and pure exhaustion. At that moment you begin to understand why you wanted to be a parent, and the pure joy a small smile can bring.
Parenting, like so many things in life, is about give and take. With a newborn it is all take, take, take, and then suddenly that tiny little baby learns to smile and they are giving!! The smiles, which are soon followed by sweet coos and goos, become ever more frequent, and the give and take becomes a bit more equal.
A parent has unconditional love for their child, and that never changes. But to have your child reciprocate that love, with just a first smile, is a moment that will always be remembered. That smile will get a parent th
Despite every parent's best efforts, most babies will develop a bothersome diaper rash sometime during their days in diapers. Diaper rashes may be treated with numerous creams and lotions and everyone seems to have their favorites. I have always been a fan of the zinc-based preparations as I think they coat the skin and provide more protection. I recently had a phone call from a patient who said she had "tried everything" and her son's bottom was still red, raw, bumpy and causing him discomfort. Of course it was over the weekend, so she wanted to see if we could figure this out before the office opened on Monday. If your child develops a diaper rash that does not respond in the first couple of days to the usual "potions" then you might assume they have developed a secondary fungal infection with their diaper rash. Yeast diaper dermatitis is more common than even pediatricians think and doesn't always look like the classic picture of "satellite lesions" on a red base. In a recent article it was estimated that more than 50% of persistent diaper rashes involve yeast, so I think it would make sense to try an over the counter anti-fungal cream in addition to your usual diaper cream. So for that bothersome diaper rash a trial of a zinc-based diaper cream mixed with a little Maalox (yes, the antacid) and a yeast cream may just do the trick and get rid of the red and the yeast. If the rash persists, it's time for a visual diagnosis by your pediatrician. That's your daily dose, we'll chat again tomorrow.


text:
Local Area Agreement 2008 -2011
Birmingham new Local Area Agreement (LAA) 2008-11 has been approved by central government. The focus now will be the delivery of the LAA and how we can use it to make a difference to public services and the quality of life for people in Birmingham.
LAAs are a "deal" between local partners and national government. National government offers simplified funding and accountability arrangements, in return local partners agree to deliver the agreement outcomes (which are based on national and local priorities). The objective is to improve key outcomes for Birmingham, by making better use of funding and innovative delivery of services and strengthening partnership working. It is the delivery plan for the Birmingham Community Strategy, Birmingham 2026: Our vision for the future, and focuses on the critically important strategic priorities for the city.
This LAA is a new starting point. It is, we hope, what will capture central government contribution to making a better Birmingham over the next three years, and increase collaboration across all the partners, agencies and communities to accelerate the city performance.Our Vision for the Birmingham LAA
To achieve our vision, five key outcomes have been set for the people of Birmingham. These are: -
- Succeed economically: Benefiting from training jobs and investment
- Staying safe in a clean and green city: Our citizens living in communities that they want to belong to
- Being healthy: Enjoying long and healthy lives
- Enjoying a high quality of life: Benefiting from good housing and renowned culture and leisure opportunities
- Making a contribution: Valuing one another and playing an active part in the community
The Local Area Agreement attached below shows the nineteen priority outcomes the LAA is seeking to achieve, along with the indicators chosen to measure progress towards achieving these outcomes.
Local Area Agreement 2008 - 2011 (Size: 799 Kb Type: PDF )
Copyright: Copyright Restricted

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