Saturday, December 23, 2017

Storing Breast Milk and Formula

     We are frequently asked in the office about how long breast milk and formula can be safely stored. The major risks for going past this limits is accidentally introducing an unhealthy bacteria to the infant ("spoiled milk") or the breast milk or formula having its ingredients break down.
     Although you can find a wide variety of guidelines on the Internet, I find it easier to keep it simple to remember: follow the Rules of Six for breast milk storage. Breast milk can be safely consumed if stored for 6 hours at room temperature, 6 days in the refrigerator, and 6 months in the freezer. If the breast milk is kept in an insulated cooler bag, it should be used within 24 hours.
     The guidelines for formula are different. A bottle of formula should be kept at room temperature for no more than 1 hour. Formula prepared from powder then stored in the refrigerator should be used within 24 hours. Formula prepared from concentrate or ready-to-feed formula may be stored in the refrigerator for 48 hours. A can of powdered formula should be used within 30 days of opening.
     Here is a link to some more detailed information about safely storing breast milk from the Centers for Disease Control. Here is a link to an article about storing infant formula from Healthy Children.

Wednesday, December 20, 2017

Updated Information on the Prevention of Tooth Decay

     In the 23 years I have been in practice, the recommendations about fluoride and children has changed. Although there is great deal of information supporting the safe use of fluoride to prevent tooth decay, recommendations about how much and how often have frequently changed. Here is an updated description of the current recommendations.
     One note: you can find a lot of misinformation on the Internet. And a great example is the misleading, non-scientific, and sometimes outright false and outrageous anti-fluoride information on the Internet. Do not believe this misinformation. It safe to use fluoride to prevent teeth decay.
     The current recommendations:
1. It is helpful to have your child drink fluoridated water and to cook using fluoridated water. In Central Ohio, our public water supply has fluoride added. Drinking bottled water does not reliably give enough fluoride. Most household water filters do not remove fluoride, but it is worthwhile making sure (by reading the filter's information).
2. Once babies have their first teeth, brush their teeth daily with a grain of rice sized amount of fluoride containing toothpaste. Once they reach 3 years of age, it should be a pea sized amount of fluoride containing toothpaste.
3. Routinely see the dentist by 3 years of age, sooner if recommended by the pediatrician.
4. Fluoride varnishes are recommended once a number of teeth have extruded. We now do the fluoride varnish at 18 month, 24 month, and 30 month check ups. The kids seem to be tolerating it just fine. The varnish stays on your teeth for 4-6 hours. During those 4-6 hours, it is best to maintain a soft diet and avoid hot liquids. Do not brush or floss during that 4-6 hours after the varnish (you can resume normal dental care the next day). If you take supplemental fluoride, stop for 3-4 days after the varnish is applied.
     If you interested in reading more, here is a link to more information from the website Healthy Children.

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 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.