Friday, May 30, 2014

Iodine Deficiency in Pregnant and Breastfeeding Women

     The American Academy of Pediatrics has just come out with a Policy Statement about iodine deficiency in pregnant and breastfeeding women in the United States. A good review of the issue is here. Iodine is needed for your thyroid gland and for normal brain development. Ideally, pregnant and breastfeeding mothers would take in 230 micrograms of iodine per day. Make sure your prenatal vitamin contains at least 150 micrograms per day -- it will say on the label. Not all do. The rest of the iodine will come from foods that we eat. Here is a good article listing foods that contain iodine.

Friday, May 23, 2014

The Fearless Formula Feeder blog

     I just discovered the Fearless Formula Feeder blog by Suzanne Barston. I am an advocate for the health benefits for babies who breastfeed and their mothers. However, I totally "get" why Suzanne Barston has written a book and writes this blog. Families who formula feed their infants can feel a lot of flack from others. I appreciate the support that Suzanne Barton is giving these families. I know many families who would also appreciate that support.

Tuesday, May 20, 2014


     Teething in children occurs when the child drools more, chews on things, and fusses when their teeth develop under their gums. The average infant starts between 2-4 months with teething. On average, the first tooth breaks through near the center of the lower gums at between 6 and 7 months. However, it is normal to have teeth pop through anywhere between 2 months and 18 months. Once the teeth starting coming in, they will usually come in the following pattern and timing: 6 months -- 2 center bottom teeth. 8-12 months -- 4 top center teeth. 12-14 month -- 4 first molars come in. 15-18 months -- 4 eye teeth (canines) come in. 20-30 months -- two year molars come in. There is a great variation between children in when the teeth come in. We see 2 and 4 month olds in the office with baby teeth. We also see children who come in at the 15 month visit with no teeth.
     Like other conditions in children, how much it bothers each child is different. Some child sleep poorly, do not eat well, and fuss around excessively off and on. Other children seem to breeze through the teething. One of my children seemed to have an easy time with the front teeth but molars really bothered him.
     Over the years, we have been asked many, many times "Does teething cause ______?". Fevers, diarrhea, coughs, congestion, runny noses, throwing up, and rashes are often blamed on the teething. Teething does NOT cause a fever. Remember, we mean temperatures over 100.5 degrees. When a large study looked at children with fevers who were in that teething age (6-24 months), they found an illness (cold virus, ear infection, throat infection, etc.) in virtually all of the infants and toddlers. We think the excess saliva can cause more than usual spitting up, an eating change from teething pain could make the bowel movements more runny, and a little bit of congestion or an occasional cough. Truthfully, I think it bothers us as parents when our children become ill. We feel that somehow we have failed to keep them healthy. That drives us to blame something we cannot control -- "It must be the teething!". That way we feel better and we can better justify the symptoms. Also, it makes us feel like the child is not contagions. Also, realize that the symptoms of teething would last from 4 months until you were past your second birthday.
     So what to do for the teething? Each child seems to respond to different teething treatments, so you may need to try different things when your children are fussy with teething. Realize if they are drooling and chewing but not fussy, you need to do nothing but wait for the teeth to pop through. Many children will feel better if they are chewing on teething toys -- some children will want hard plastic toys, some will prefer the soft toys (even chewing on stuffed animals or a blanket), and some will like the teething helpers that you keep in the freezer or refrigerator to keep them cold. We think it is safe to use the occasional dose of Baby Oragel or Anbesol which contains benzocaine. Although there is a danger in over-use (it can numb the throat if small amounts are not used and this could lead to choking) and the rare chance that someone has methemoglobinemia and will react to benzocaine (as well as other medications), we have not had anyone have a dangerous reaction to these products over the years. We want you to be cautious about Tylenol or Motrin use for teething. If you use 2-3 doses in a week, I think that is fine. Daily, regular use for teething is not good for the stomach or kidneys(ibuprofen/Motrin) or liver (acetaminophen/Tylenol).
     One tricky issue is that many children will tug on their ears at the time of teething. If the child also has a runny or congested nose from a viral upper respiratory infection and is tugging on their ears, it is possible it is caused by the teething pain and not an ear infection. We are happy to see your child during walk ins or a sick appointment to confirm it is not an ear infection.
     Last but not least: here is a link to the Healthy Children website's info on teething. Call with questions!

Monday, May 12, 2014

Proper use of hydrocortisone and other steroid creams.

     Hydrocortisone and other steroid creams are used for itching and rashes with inflammation (eczema, seborrheic dermatitis, poison ivy, etc.). The 1/2 and 1% hydrocortisone creams are available over the counter. The stronger steroid creams are only available by prescription.
     Although these creams can be very helpful, they also have some side effects. They can thin the skin, lighten the pigment of the skin, and make the blood vessels under and in the skin look more prominent. The tricky thing about lightening the pigment is that the conditions that we treat with steroid creams also cause the same thing: eczema and poison ivy patches often cause so much irritation to the skin that the pigment of the skin looks lighter. The good news about this lighter pigment is that it tends to improve as the months go by once the eczema or poison ivy are gone. However, make sure to use a good sun block with titanium dioxide and zinc dioxide to help protect from sun damage when out in the sun. The pale areas have a harder time recovering their pigment if allowed to become sun burned.
     So how should you safely use these creams? One rule to follow is to use the weakest cream that works. That means that if improvement is seen with over the counter hydrocortisone cream, use that instead of moving to something stronger. Remember we are looking for improvement after using the creams over 3-5 days. Even if eczema comes back after you stop using it after 3-7 days of hydrocortisone, we still think of the hydrocortisone cream has successfully helping.
     If the rash looks much better after 3-7 days of a steroid cream, stop using it for a while and see how the rash does without it. Eczema will likely need another round of a few days to a week of the steroid cream periodically, but poison ivy rashes will likely improve and you will not need to re-use the cream soon. Ideally, for every number of days you used these creams, you should avoid them for the same length of time. For instance, to help your child's eczema if you normally will do the steroid cream for 5 days in a row, follow that with at least 5 days without the steroid cream before using it again.
     If an over the counter hydrocortisone cream is not helping, we will want to see the rash. We can decide whether a prescription strength cream is needed. This can done at a walk-in visit during walk-in hours, a scheduled ill visit, or a well check.