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