Friday, December 8, 2017

What to do when children and teenagers vomit with exercise.

     Some athletes vomit during exercise. This can happen at younger ages, but typically occur when teenage athletes push themselves hard during workouts. There are some things to do to help prevent this issue.
     One of my teenage sons has struggled with vomiting when pushing himself during workouts. He does vomit more easily with bad coughs or stomach upset versus some other folks, but he did not have vomiting with exercise until high school.
     If someone struggles with this issue, we would ask some other questions to make sure it was not from something more complicated. We ask questions about acid reflux and and whether the vomiting happens after coughing. We ask about timing of eating and drinking when it comes to exercise.
     If nothing else is complicated about the history, there are some helpful recommendations to help reduce the chances of vomiting during exercise.
-- Eat a small snack 30 minutes before exercise.
-- Avoid exercising in extreme heat.
-- Watch your exercise intensity. The athlete may need to dial-back their intensity.
-- Stay hydrated. Drink 8 ounces of water every 20 minutes of exercise. If the exercise is going to be high-intensity for more than 45-60 minutes, drink sports drinks instead of water.
-- Cool down gradually.

     If your child struggles with this issue and is not improving while following these recommendations, call during routine office hours to discuss.
    

Why do children tell lies?

     At some point during your child's early life, they will lie to you. It is aggravating and frustrating for parents, but inevitably it happens. Our hope as parents is that it does not happen very often. Here is some more information about how to approach this issue.
     Why does anyone lie? To get what they want or to avoid punishment. "No, Dad did not give me a cookie today!" (when they have already had their once-a-day treat). "I was not running in the living room!" (when the lamp got knocked over again). "My brother was on the iPad longer than me!" (when they want more iPad time).
     Sadly, we are in a current situation where it is hard to point to well known adults that your child may look up to - athletes, politicians, etc. - as good examples of "always tell the truth". This makes it difficult when we all get mixed messages from daily life, including for children. When others see someone not tell the truth then get what they want or avoid punishment, even otherwise well-behaved children (and adults) are more tempted to not to tell the truth.
     Certainly, when you know (or are quite certain) that your child is not telling the truth, your best bet as parent is - as always - consistency. By that I mean that you should routinely give your child some negative consequences for lying whenever it happens. We all are more likely to keep repeating an action or behavior if we are not negatively reinforced for it. And we are more likely to stop an action or behavior if we are regularly and consistently negatively reinforced for it.
     Those negative consequences may be a time-out, a removal of privileges (no iPad for the day or no cookie for tomorrow), etc. Stick to your guns: if you say it ("no TV today"), follow through with it (they get no TV today). Otherwise, you are accidentally giving your child the idea that they can sometimes "get away with it".
     One more note: I think it is important to model good behavior to your children. I truly believe if you model to your child that it is important to tell the truth, they are more likely to tell the truth themselves. I recall a time my one son and I were in a fast-food restaurant. When I handed the cashier money, they gave me back too much money. I said "Here, take the $5 back. Then we are even. You gave me too much cash back." The cashier was happy and I was happy for a small moment to emphasize to my son that telling the truth is important.
     So to conclude, do not be too frustrated if your children lie, be consistent with your negative reinforcement, and - as always - call us during routine office hours if you have other concerns.

Friday, December 1, 2017

Keratosis Pilaris

     Keratosis pilaris is a chronic skin condition that is quite common. It is one of the skin issues we are asked about frequently in the office. It often appears in the first few years of life, it is worse when the weather is colder, and cannot be entirely cured. The rash rarely itches, but it does for some folks. It tends to be genetic with some families having multiple folks who have keratosis pilaris.
     Keratosis pilaris appears as small rough bumps on the back sides of the upper arms, sides of the thighs, and cheeks of the face. It tends to look flesh colored in paler skinned individuals, but can look darker pigmented in persons with naturally darker pigments. It can spread from these areas or be just in one of these areas (arms) but not others. It may worsen when the air is more dry (during the winter months when heating the house drops the humidity in the house).
     Keratosis pilaris is more common in families with allergic illnesses - eczema, allergic rhinitis/hay fever, asthma, and food allergies. Many times, a person only has some of these issues, not all. So if dad has allergies and mom has had eczema, their children could have keratosis pilaris even if they have no other of these issues.
     Keratosis pilaris is not curable. You can keep it under control, but it cannot be made to go away permanently. It keep it under control, it needs to be regularly treated. Often that treatment will be on a daily or multiple days per week.
     For many years, our go-to treatment for keratosis pilaris was a lotion called Lac Hydrin Lotion. Sadly, it appears the manufacture has discontinued the product. Some of the available products are ones you may need to check in stores and online to find. All of these products are available at Amazon.com. Here are the products I would recommend now, with the CeraVe product being the best:

CeraVe Renewing SA Lotion
AmLactin Alpha-Hydroxy Therapy Daily Moisturizing Body Lotion
Geritrex Geri-Hydrolac Lotion

If you have tried one of these for a few weeks without relief, try a different listed product. Note that many other great creams and lotions used for dry skin (Eucerin, Aveeno, Cetaphil, or other CeraVe products) often do not work on keratosis pilaris.
     If all else fails and the rashy bumps are bothersome, we often refer a patient to a dermatologist for further help.

Tuesday, November 28, 2017

Prenatal Meetings With the Pediatrician

     Many pediatricians hold meetings with expectant families. This allows parents who are expecting their first child to meet with the pediatrician before the birth of their child. This allows you to meet the doctor, see the office, and ask questions.
     We call these meetings "prenatals". We schedule those with one of our doctors and a handful of couples. They are scheduled in the early evening and we meet in our lobby. The doctor will tell you more about themselves, our office, and what you can expect at the hospital and with bringing your child to our office. We will show you our exam rooms. You will have an opportunity to ask questions of the doctor. The meetings usual last 20 minutes or so. If there are a number of questions, they can go longer. If you see a particular doctor at a prenatal, we anticipate that you will have that doctor as your primary care doctor here in the office.
     You do not need to do a prenatal to bring your newborn to our office. You also will not need to let us know prior to the birth of your infant that you are bringing your infant to our office. In other words, you do not need to tell us at the prenatal that you will bringing your child to our office.
     If you are interested in scheduling a prenatal meeting with a doctor here in the office, call our routine office number 614-777-1800 during routine office hours and speak with the front office staff.

Friday, November 10, 2017

What happened with your flu shot supply?

     You may be asking yourself this question: what happened with Hilliard Pediatrics flu shot supply?
     I will answer that. But some background. We order the vaccine from a supplier. Most offices place their order in February to receive the vaccine in August to September. How do we determine how much we order? We look at previous years supply and use and make an educated guess. The year that FluMist went off the market, we dramatically increased our flu shot order to have enough vaccine for those who had received the flu shot and those who received the FluMist in the past.
     We have about 10,000 patients. If we gave each of the infants two doses and all the older children 1 dose a year, we would go through more than 10,000 doses a year. We do not use that many. We realize some families do not vaccinate their children with the flu vaccine routinely. Other patients receive the vaccine in other places.
     Last year, it was the second year without the FluMist. We felt like the demand in the office was steady but not high. By the end of January, we ran out of our supply and most of the families seeking the vaccine from our office received it here. Typically we run out of the vaccine between late November and early January.
     This past Winter, we placed our current order for the same number of flu shots as last year. Although we added a new doctor, our total number of patients has not changed much. We received the vaccine in August (earlier than some years) and then began vaccinating our patients. As usual, we were giving the vaccine in the office and check-ups and (were appropriate) sick visits. We also had our usual flu shot walk-in clinics. How busy each flu shot clinic is seems to vary over the years. This year, we were less busy than usual until the last few clinics where the numbers went up.
     The week before we ran out, we realized we would need more vaccine. When we called, we were initially told we could order as much as we needed. After discussing in the office, we called the next day to be told the previous days information was in fact not true -- they could not supply us with any further vaccine.
      We have been asked why we do not hold back vaccine for the youngest of patients who need a second dose. We do not do that. In fact, we could not as we believed up until the last minute that we could order more vaccine. And we fully intended to order more. There other logistical issues with holding back vaccine to give to someone else.
     So what about next year? Surely we will order more vaccine. But we have found that each year has its challenges. We appreciate that many of our patients are able to and do receive the vaccine in the office each year.
   
   
   

Monday, October 23, 2017

Children with Easy Bruising Who Take Fish Oil Supplements

     We are asked regularly about children who bruise easily. If children have impressive bruises that occur after minor injuries, we will likely ask about your child's history with other issues that make us worry about a bleeding disorder. These questions include:
     Does your child have easy bleeding with minor mouth injuries or teeth cleaning?
     Does your child have frequent or hard to stop nose bleeds?
     Has your child had excessive bleeding after minor procedures?
     Does your child pass blood with a bowel movement?
     Has your child had painful, swollen joints after minor injuries?
     What medications or supplements does your child take?

     A combination of history and physical exam can prompt us to do screening labs or a referral to the hematologist at Nationwide Children's Hospital. Other histories and physical exams are reassuring.

     On a personal note: I spoke with my eye doctor in the last year about my eyes being dry. I had already tried some other remedies, so my eye doctor recommended that I try taking fish oil supplements. I began taking Occuvite and noted only so much improvement. I then switched to a higher dosed supplement, this time Member's Mark Triple Strength Wild Alaskan Fresh Fish Oil Softgels with 900mg of Omega 3. At my annual check up last week, I mentioned my easy bruising this year and the first thing my doctor said was "It is those Omega 3 supplements you take!". So now I am weighing the "eyes less dry" with the "easy bruising" tendencies.

     So a good thing to know is that fish oil/omega 3 supplements can increase the tendency to easy bruising. If your child is regularly taking these supplements, let your doctor know this if they are going to have surgery or if they have been prone to easy bruising.

Friday, August 25, 2017

Safe Sleep for Newborns and Beyond

     My oldest son is now 22 years of age. Back in 1990's, the cribs had wide enough slates that it was possible to get an arm or leg stuck between the slats. This prompted it to become nearly universal to use bumper pads to keep the arms or legs getting stuck and to pad the area so an infant would not "get hurt".
     This was not the safest sleep environment. We know now that there were more cases of SIDS and injured arms and legs with that setup. Now the slats are close enough to prevent these issues and it is recommended to not use any bumper pads. The chairman of the Consumer Product Safety Commission, Elliot Kaye states "I reiterate my belief that the public should stop using padded crib bumpers. The overwhelming evidence show that they do nothing more than contribute to the deadly clutter in many of our nation's cribs. Based on the real risk they present, it is a mystery to me why they continue to be sold." I agree.
     The Ohio legislature recently passed a law, Sub Senate Bill 332. It includes a bumper ban. I believe it goes into effect at the end of 2017. The law prohibits the manufacture or sale of non-mesh crib bumpers. The law allows for the sale of mesh crib bumpers for the next 3 years. The law will then ban the mesh crib bumpers if the Consumer Product Safety Commission (CPSC) has not created safe standards for mesh crib bumpers.
     "Bumpers are unnecessary and pose a real risk to the safety of infants." - Dr. Sarah Denny, Nationwide Children's Hospital.
     For more information about safe sleep for infants: here on the Ohio AAP website.