I have been receiving a lot of calls, emails and questions on twitter regarding Michael Douglas' admission that his oral cancer was caused by HPV.
Coxsackie virus is rampant once again! I have seen too many kids to count (TMKTC) with symptoms of coxsackie virus and the classic skin rash associated with hand, foot and mouth disease. Many parents are telling me that their day care centers are having outbreaks which is what typically happens at this time of year.
Like many viruses, coxsackie can make some children quite miserable, while others have very few symptoms but never the less are contagious and shed the virus to others. Viruses are just plain ole contagious, even with the best precautions to help prevent spreading the illness. Best prevention continues to be hand washing!
The classic symptoms of hand, foot and mouth disease are a fever, sore throat, and a rash which looks like small red spots or even a bit of a blister, occurring on a childs palms, soles and often in their throats causing pain. We are also seeing many children who have a rash on their buttocks, and legs as well. The rash is often confused for a diaper rash if there are no other associated symptoms.
Coxsackie virus typically lasts from 3 -7 days. While some children are terribly cranky and uncomfortable and will even drool rather than swallow their own spit, other seem to not even notice the rash on their hands or feet. The treatment is totally symptomatic, which means acetaminophen or ibuprofen for fever and discomfort and keeping your child hydrated.
Most kids don't have a great appetite when they have a sore throat (do you?), so I am a big believer in popsicles, Slurpees, ice cream, fozen yogurt, shaved ice.....the list is long. You just want to make sure your child is h
OK, I am back to the subject of squeeze pouch foods or as another cute 2 1/2 year old called it squeegy fruit. I have written about this before as I was fascinated by these when they first hit the market. On the one hand, I get that they are convenient and are easy to use for those first months of pureed baby foods, but beyond that, I think they are given to older children.
It seems that more and more kids are enjoying squeegy fruit and also slurping pureed vegetables. The issue is these pouches foods are being masqueraded as healthy foods. Yes, they are fruits and vegetables often mixed together, but if you read the labels it gets a bit more complicated.
I see so many toddlers in my office who are happily sucking down a packet of apples and blueberries. These parents are adamant that their kids don't drink juice boxes or eat junk food but at the same time they are letting their children suck down several of these pouches a day. This is also often in place of meals, as many of these children are described as picky eaters. I saw a little boy today who had been vomiting, but was on the exam table with pouch to mouth as he drank/at a combo of apples, peas and something else. (note: not recommended when vomiting).
So....I decided to look up the nutritional value of these pouches....many of them although all organic or described as healthy do contain a lot of carbohydrate and sugars. Actually, as much as two fruit roll ups! Yes, I did a little comparison and 2 of the dreaded fruit rolls ups contain 23 grams of carbs and almost 11 grams of sugar.....while a 3.2 ounce pouch has somewhere between 19-24 grams of carbs and between 14-23 grams of sugar.
The point of this is not to say that squeeze pouches are bad, or that a child should never have a fruit roll up. Rather, it is to point out that even healthy snacks can be fu
Parents, you know you can say all sorts of funny things and now here come cute, clever kids comments. This has been a week of kids say the darndest things.
A verbal little 3 year old came in this week and while I was getting his chart opened on the computer, I asked him what's the matter? He is the third child in the family and is quite comfortable coming to the doctor and is always chatty. His response was,I have the God bless you's. Now I admit that I was not quite sure what he meant? Then it hit me! He was sneezing a lot and that was what the God bless you''s meant. How smart is that!
He then proceeded to tell me that he had been sneezing and coughing. He also happens to have asthma, so I asked him if he had been wheezing as well. His response to all of these questions was equally bright. He said , I haven't had to use my puffer, my breaving is okay.
I examined him (by this time he is watching a cartoon on his iPad) and he was spot on. His lungs were clear as a bell, he had a clear watery runny nose and his nasal mucosa was swollen. He also had allergic eyes. He was using an antihistamine but not his steroid nose spray.
So I tweaked his allergy medicines a bit and reminded his mom to have him bathe or shower after he had been playing outside. I also suggested that they use a nasal saline rinse on him as well, as this would help to get the pollens out of his nose after he had been outside, and may be one of the best cures for the God bless you's.
Who says children can't give a good history? I often find that the young patient is a great communicator and may open a doctor's eyes to different ways of relaying a new symptom. Whether is from a 3 year old, a tween or a teen, having a patient that you know and that is comfortable talking to the doctor is the key to a good history. This is was a great remind
Here is another one of the can't believe what I hear at the office! I was on call the other night and it was around bedtime when I walked in the exam room to see 2 little girls (actually they are part of a triplet set but their brother was home). Their dad had brought them in because they had rashes and bug bites. Nothing too serious. They are adorable 2 years old and very well behaved.
So, after examining the rashes and bites and determining that they could be dealt with a bit of cortisone cream, the dad and I were discussing a few more things. Of course the girls got bored, and as you know a bored 2 year old typically doesn't sit still, especially when it is time for bed. So as the girls jumped up and down off the table and picked out more stickers their Dad was getting tired as well. By the way, he is a great father and he and has wife have handled having triplets with such ease. They were meant to have multiples.
Well, before we could finish up the appointment the girls had gotten into the diaper bag, pulled out snacks and were enjoying themselves. As much as he was ready to go, they were not ready to pack up and leave and he was having a hard time getting them to listen.
Here comes the line of the night! He turns to the girls in a moment of what to do next and says,if you don't behave and listen to me, Dr. Sue is going to make you sick! LOL! I have heard a lot of Dr. Sue will give you a shot if you don't behave, but I have never heard this one. While I don't believe in threatening kids with shots at the doctors, this was a new one.
After I stopped laughing I told the girls that this was not true, doctors would and could not make them sick, but they did need to listen to their dad!!
I know that we all say things out of desperation, but please don't use the lines the doctor will give you a sh
The surge in allergies this year has been due to a very wet winter and the weather this spring has brought erratic temperatures and lots of wind. The perfect storm for the "allergic cascade" to inflict itself on everyone's nasal mucosa. The best preventative for nasal allergy symptoms (allergic rhinitis) has been the use of intranasal steroids. These steroid sprays have been used for the past 15 years and clinical studies have shown that intranasal steroids are superior to oral antihistamines. Intranasal steroids function by inhibiting the production of chemical mediators such as histamine and prostaglandin that cause inflammation and mucous production. In other words they are more of a preventative medication, while an antihistamine is treating the histamine that was released once you inhaled the offending tree or grass pollen. Intranasal steroids may also help eye allergy symptoms too. The problem is getting young kids to let you use a nose spray on them. The same holds true for the older tween and teen crowd who complain that they "just don't have the time to use it everyday" (it must take all of 15 seconds to use on yourself!) They have been shown to be effective within 3-12 hours, although will reach their maximum effectiveness after several days to weeks of use, so using it daily and throughout the allergy season is going to give you the maximum therapeutic effect. There are many different brands available and everyone seems to have their favorite. If one spray seems to bother your child due to scent, or intensity of the spray ask your doctor to try another brand. Many times they will have a sample and give you several to try and then prescribe the one that is easiest to get your child to use. It may be trial and error, but finding the right nasal steroid may just change your allergy season. That's your daily dose, we'll chat again tomorrow. Oh, God Bless You! Send your question to Dr. Sue!
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
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.