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
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!
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.
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.
Monday, April 28, 2014
Cradle Cap and Seborrheic Dermatitis
Seborrheic dermatitis is a skin condition with red patches that can be divided into two types: cradle cap (infants) and seborrheic dermatitis (older children and adults). For infants, it will often start within the first month or two of birth and last until the infant is somewhere between 6-12 months of age. Older children that develop this find it happens late in or after puberty. There is a genetic component: it does tend to run in families.
"Seborrheic" means "runny or seeping oil" and the rash is often accompanied by yellowish oily film or scaly crust. The rash in infants is most often just on the forehead, but there may be a rash in many other areas. This rash may be red and in splotchy areas or be many fine small "pimple" looking spots. There may be an oily or crusty appearance to the top of the smaller rashy areas. Seborrheic dermatitis can be itchy but is not always.
What to do if your child has cradle cap? For infants where there is not much cradle cap and it does not cause your infant to scratch at the area, it is fine to just watch. The first step in treatment is to massage baby oil into the area 20-30 minutes before a bath. Then wash the hair with the usual baby shampoo that you use. After the bath, gently brush at the area with a soft-bristled brush. Do this regularly (2-3 times a week or more) until the cradle cap improves and the flakes are removed. Then repeat as needed in future weeks. Remember that the baby oil will not cure the cradle cap, just keep it calmed down until the cradle cap improves as the months go by.
For those infants and children that the baby oil and brushing is not effective, we recommend trying using one of the over the counter medicated shampoos: Head 'n' Shoulders, Selsun Blue, or Neutragena T-Gel. Note: these are the same ones you and I would use. They do not make "infants" or "kids" forms of these. All of these can sting the eyes so be cautious about rinsing them out while keeping them out of the eyes (tilt the head back and pour the water front to back). These shampoos can be used daily or a couple times a week. If the cradle cap improves over a couple weeks, you may just need to use the medicated shampoo once a week. The baby oil can still help get the oily scales off the scalp.
Most of the infants are not itchy with the cradle cap. However, for those infants that are itchy and the above measures are not helping, it can really help to use the over the counter 1/2-1% hydrocortisone cream (such as "Cortaid"). Apply a thin layer to the cradle cap once or twice a day. Ideally, this is only done when the itching is bad and for 3-7 days then off for the same amount of time.
For older children with dandruff, itching, and seborrheic dermatitis, we recommend they use one of the three shampoos (Head 'n' Shoulders, Selsun Blue, or Neutragena T-Gel). If using that on a regular basis does not help, we can discuss here in the office -- there are prescription strength shampoos that can really help. If despite even the prescription medication your child's medication is no better, we would have them see a dermatologist.
"Seborrheic" means "runny or seeping oil" and the rash is often accompanied by yellowish oily film or scaly crust. The rash in infants is most often just on the forehead, but there may be a rash in many other areas. This rash may be red and in splotchy areas or be many fine small "pimple" looking spots. There may be an oily or crusty appearance to the top of the smaller rashy areas. Seborrheic dermatitis can be itchy but is not always.
What to do if your child has cradle cap? For infants where there is not much cradle cap and it does not cause your infant to scratch at the area, it is fine to just watch. The first step in treatment is to massage baby oil into the area 20-30 minutes before a bath. Then wash the hair with the usual baby shampoo that you use. After the bath, gently brush at the area with a soft-bristled brush. Do this regularly (2-3 times a week or more) until the cradle cap improves and the flakes are removed. Then repeat as needed in future weeks. Remember that the baby oil will not cure the cradle cap, just keep it calmed down until the cradle cap improves as the months go by.
For those infants and children that the baby oil and brushing is not effective, we recommend trying using one of the over the counter medicated shampoos: Head 'n' Shoulders, Selsun Blue, or Neutragena T-Gel. Note: these are the same ones you and I would use. They do not make "infants" or "kids" forms of these. All of these can sting the eyes so be cautious about rinsing them out while keeping them out of the eyes (tilt the head back and pour the water front to back). These shampoos can be used daily or a couple times a week. If the cradle cap improves over a couple weeks, you may just need to use the medicated shampoo once a week. The baby oil can still help get the oily scales off the scalp.
Most of the infants are not itchy with the cradle cap. However, for those infants that are itchy and the above measures are not helping, it can really help to use the over the counter 1/2-1% hydrocortisone cream (such as "Cortaid"). Apply a thin layer to the cradle cap once or twice a day. Ideally, this is only done when the itching is bad and for 3-7 days then off for the same amount of time.
For older children with dandruff, itching, and seborrheic dermatitis, we recommend they use one of the three shampoos (Head 'n' Shoulders, Selsun Blue, or Neutragena T-Gel). If using that on a regular basis does not help, we can discuss here in the office -- there are prescription strength shampoos that can really help. If despite even the prescription medication your child's medication is no better, we would have them see a dermatologist.
Monday, April 21, 2014
Water Safety and Swimming Lessons
The American Academy of Pediatrics found for many years that it was difficult to answer the question of "Is my child less likely to drown if they have taken swim lessons?". That might seem like the answer would be "Of course they are safer if they have had swim lessons." However, for a long time, it was not known for sure if that was true. And a long time worry has been whether parents and guardians could drop their guard about the child swimming if the parent and guardian knew that the child had swimming lessons.
Here is the Healthy Children's website about drowning prevention and swim safety. And here is another good webpage about the same subject. From the same website, here is an audio piece to listen to about infant and toddler swimming lessons. One last link -- this directly from the American Academy of Pediatrics.
So I do think swim lessons are fine for young toddlers. Formal swim lessons for children 4 years of age and above are a good idea. BUT never let your guard down. Even with good swimmers. Do not assume someone else is supervising your child while they are in the water.
Here is the Healthy Children's website about drowning prevention and swim safety. And here is another good webpage about the same subject. From the same website, here is an audio piece to listen to about infant and toddler swimming lessons. One last link -- this directly from the American Academy of Pediatrics.
So I do think swim lessons are fine for young toddlers. Formal swim lessons for children 4 years of age and above are a good idea. BUT never let your guard down. Even with good swimmers. Do not assume someone else is supervising your child while they are in the water.
Tuesday, April 15, 2014
2014 Mumps Outbreak in Central Ohio
Mumps is a viral infection that causes swelling of one or more of the saliva (spit) glands, usually the parotid glands (in your cheeks in front of the ears). About one of three cases of mumps show no obvious symptoms. Mumps can cause swelling of the testes, ovaries, or breast tissue one week after the parotid gland swelling. These are more common with young adults and adults with mumps. Mumps rarely causes much in the way of cough, runny nose, and congestion. It commonly causes achiness, low grade fever, tiredness, and decreased appetite. Mumps is spread person-to-person by sharing cups, utensils, kissing, etc. Children with mumps are contagious for a few days ahead of the symptoms starting and 5 days after the swelling of the parotid glands.
The vaccine for prevention of the mumps became available in the 1960s and by 1977 was a routine part of the vaccine schedule in the United States. Since then, the chances of getting mumps in this country has plummeted to a low "normal" of 200-300 cases across the country each year. In some years there have been as many as 1000-6000 cases, especially amongst college students. Although those children and adults who are not vaccinated are more prone to develop the mumps, in outbreaks many of those that develop have been vaccinated. The vaccine provides very good but not perfect protection.
Because of the success of the vaccine, we have never had a confirmed case of the mumps seen by Hilliard Pediatrics. That continues to be true as April 15, 2014 -- despite the recent outbreak in Central Ohio. Currently the recommendation is to not change anything about the timing of the two mumps vaccines -- giving in combination with the measles and rubella vaccines at 12 months of age and 5 years of age. Although the recommendation would be for those with just one MMR vaccine and past the age of 5 years to receive a second dose now, no other recommendations are made at this time.
We do want to see children with symptoms that could be mumps. There is testing available that can confirm that it indeed is mumps. The symptoms of sore throat and fever are treated, but generally the illness passes on its own without other complications.
Keep vaccinating your children.
UPDATE: As of May 21, 2014, we do have a teenager in the practice that we are highly suspicious that he has mumps. He attends a Hilliard high school.
As of May 30, 2014, we have now seen two cases of mumps. Initially, the lab work to confirm that it was mumps was paid for the CDC or NIH. Now it is not. And the testing costs as much as $400-600 and takes 10-14 days to come back. So we are not gong to routinely test to confirm that the cases we see are indeed the mumps.
The vaccine for prevention of the mumps became available in the 1960s and by 1977 was a routine part of the vaccine schedule in the United States. Since then, the chances of getting mumps in this country has plummeted to a low "normal" of 200-300 cases across the country each year. In some years there have been as many as 1000-6000 cases, especially amongst college students. Although those children and adults who are not vaccinated are more prone to develop the mumps, in outbreaks many of those that develop have been vaccinated. The vaccine provides very good but not perfect protection.
Because of the success of the vaccine, we have never had a confirmed case of the mumps seen by Hilliard Pediatrics. That continues to be true as April 15, 2014 -- despite the recent outbreak in Central Ohio. Currently the recommendation is to not change anything about the timing of the two mumps vaccines -- giving in combination with the measles and rubella vaccines at 12 months of age and 5 years of age. Although the recommendation would be for those with just one MMR vaccine and past the age of 5 years to receive a second dose now, no other recommendations are made at this time.
We do want to see children with symptoms that could be mumps. There is testing available that can confirm that it indeed is mumps. The symptoms of sore throat and fever are treated, but generally the illness passes on its own without other complications.
Keep vaccinating your children.
UPDATE: As of May 21, 2014, we do have a teenager in the practice that we are highly suspicious that he has mumps. He attends a Hilliard high school.
As of May 30, 2014, we have now seen two cases of mumps. Initially, the lab work to confirm that it was mumps was paid for the CDC or NIH. Now it is not. And the testing costs as much as $400-600 and takes 10-14 days to come back. So we are not gong to routinely test to confirm that the cases we see are indeed the mumps.
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