Q&A: Ask the pediatrician! Dr. Diana Blythe answers your questions about kids’ health

Have a question for Dr. Blythe? Write to her at [email protected]. For more information on Dr. Blythe, go to pediatricassociates.com.

April 29, 2013

Q: My 5-year-old daughter just had her adenoids and tonsils removed because of snoring and possible sleep apnea. Can you explain sleep apnea in children? Can it come back later? — M.S., West Palm Beach

A: Too bad your daughter had to have surgery, but hopefully she will get more restful sleep now. There are two main types of sleep apnea (or not breathing while sleeping): central sleep apnea and obstructive sleep apnea.

In central sleep apnea, the brain simply does not prompt the body to breathe. A very common example of this would be premature babies who need caffeine to stimulate their central nervous system enough to breathe. Before a baby on caffeine can go home from the neonatal intensive care unit, he or she has to pass a trial period off caffeine while on monitors to ensure there are no more episodes of prolonged apnea (20 seconds or longer). If there is any concern, the neonatal specialist will keep the baby longer, or send the baby home on an apnea monitor. Which of these occurs depends on many factors, and the safety of the baby always comes first.

Your daughter was treated for obstructive sleep apnea. While sleeping, the airway relaxes and enlarged tonsils or adenoids that do not cause problems during the waking hours can obstruct the airway. All people will snore at some point. This is not a concern unless prolonged pauses in breathing, or apnea, occur, in which case your child’s pediatrician will refer you to an ear, nose and throat specialist, to discuss potentially removing the tonsils and adenoids.

If the obstructive sleep apnea was caused by enlarged tonsils and adenoids, your daughter should be safe from it coming back after the surgery. Leftover remnants of the tonsils and adenoids can grow again but usually not enough to cause obstructive sleep apnea.

April 17, 2013

Q: My girlfriend’s 5-year-old son was told he has HSP. Is that bad? It seems to be a serious illness. Should he go to the ER, or since he has already seen his pediatrician is that enough?

A: Good news! If he was sent home after getting a diagnosis of HSP, or Henoch-Schönlein purpura, his pediatrician must not believe he has a bad case. HSP can be caused by an unusual reaction to infection, medication, insect bite, food or vaccination. It is more common in children, especially boys.

HSP causes an inflammation of the blood vessels, or vasculitis. When blood vessels are inflamed or irritated, they can leak. The first noticeable sign of HSP blood vessel inflammation is usually of the skin. The leaking red blood cells cause a skin rash called purpura. The rash likely led your girlfriend to take him to the doctor. Often this rash is preceded by joint pain, but not always.

However, there can also be inflammation with HSP, as well as leaking of the blood vessels in the intestines and the kidneys. If there were intestinal or kidney involvement, that would be of more concern. A simple urine test can check the kidneys. If you suspect blood in the stool, that can also be checked. In fact, kidney involvement is rather common with HSP, and many doctors check the urine whether you have noticed dark-colored urine or not.

Whether or not your girlfriend’s doctor sent her son to the emergency room depends on the symptoms he had in the office. She would have been told to call her pediatrician if she noticed any new symptoms like lethargy, bloody stools, dark urine or increasing abdominal or joint pain.

The treatment prescribed may be ibuprofen for joint pain, antibiotics if there is a bacterial infection, or steroids if there is kidney involvement. If the symptoms are more severe, hospitalization may be required. Most kids with HSP do not need to be hospitalized, but all kids with HSP need to be monitored closely by a pediatrician.

March 14, 2013

Q: My son turned 4 in December. He was daytime potty-trained at 2 1/2, but is still wearing a diaper at night. I’ve tried cutting out milk/liquids by 6 p.m. (he goes to bed between 7 and 7:45), and I have him pee right before bed. Is he going to be wearing a diaper overnight in kindergarten? — M.D., Wellington

A: Congrats on having him daytime potty-trained at 2 1/2 years old. Unfortunately nighttime potty-training usually takes longer and many children are still not nighttime trained at 4 years old. It is more likely to occur in boys and often runs in families. Ask family members privately and you may be surprised at how many of them wet the bed as children.

Most girls are fully trained by age 5 and boys by 6. According to the American Academy of Pediatrics, nocturnal enuresis (nighttime bed-wetting) affects 5 million children older than age 6 in the United States.

You are correct that limiting fluid intake is a must. Many times it is the little things that get in the way. Kids will drink water after brushing their teeth and not realize how much they consumed. Ask your son how much water he drinks, rather than if he drinks water. By not putting him on the defensive, you will be more likely to find out if he is drinking something.Emptying the bladder like you are having him do just before bed is also imperative. In addition, have your son empty his bladder just after dinner. Another influencing factor may be constipation, where the stool fullness presses on the bladder. Urinary tract infections and stress, among other things, can cause enuresis as well.

One other thing to try is having him relax with quiet time for the last hour before bed. If his muscles are not moving much, he will not have increased blood supply to the muscles. When we relax and do not need the extra blood supply, our body gets rid of the fluid by making urine. If the first time his body relaxes is when he lays down in bed, he may have a full bladder during the night. A good way to start relaxation time is reading to him before bed. It will help him relax and get him interested in books. Avoid the TV because that can affect his quality of sleep.

If these suggestions do not help, talk to your pediatrician. There are other possible medical reasons and options that take into account your child’s personal medical and social history.

Nov. 6, 2012

Q: Is it OK to give 3-month-old babies oatmeal instead of rice cereal?

A: Congratulations! Your baby is growing up. There are many new steps coming for you and baby. Starting solid foods is one that many parents enjoy. Before deciding which food to start with, think about whether your baby is ready for solids on a spoon. In general, do not add solids to a bottle unless your baby’s pediatrician tells you to do so because of reflux.

In order to start solids, babies must be able to hold their head steady while sitting in a seat. In other words, they must be a “supported sitter.”

Additionally, younger babies have a tongue thrust reflex, meaning the tongue pushes the spoon out of the mouth. Most term babies lose this reflex around 4 months old. Pediatricians usually recommend waiting until 4 months to start solids, but check with your pediatrician to see if your baby is ready.

The American Academy of Pediatricians recommends continuing to exclusively breastfeed without introducing solids until 6 months old if that is your baby’s milk source.

Whether you are breastfeeding or bottle feeding, please continue to give babies their milk source in addition to the solids.

Once you decide your baby is ready, single grain cereals are a good place to start. While rice is the most common, you can also try oatmeal or barley. Rice and oatmeal are good for babies with softer stools, as they can firm up stools. If your baby is already a little constipated, you may consider a barley cereal instead.

Whichever type of cereal you try, give that cereal for at least three days before making any changes and do not add anything new during this time. Bon appetit!

Oct. 22, 2012

Q: I am on the fence about getting my son vaccinated for chickenpox. Is it safe? — D.C., Fort Lauderdale

A: Great news! The chickenpox vaccine is quite safe, and your child does not have to get chickenpox disease. The need for chickenpox parties is over.

The chickenpox vaccine, also called varicella vaccine, is one of the regular childhood shots — and kids are able to avoid the effects of the chickenpox disease. Now, you may wonder why your child should get the vaccine when you may have simply had an itchy rash during your childhood bout with the chickenpox. Most cases of chickenpox are mainly a few days and nights of fever, headache, stomachache, itching and scratching. While the vaccine does protect against these symptoms, it really is given to avoid the more severe cases of chickenpox.

Not only can chickenpox cause blisters on the skin, but also on the throat, eyes, genitals and anus. While less common, chickenpox can also cause pneumonia, encephalitis (brain inflammation), myocarditis (heart inflammation) and, in rare cases, death. Unfortunately, when healthy people get chickenpox, we do not know who will get a severe case and who will get a more mild case.

The groups we do know are at highest risk for severe chickenpox disease are newborns, pregnant women, people with chronic disease or taking steroids or on chemotherapy, and all adults in general.

Please, consider getting your child vaccinated against the chickenpox and talk to your pediatrician about any concerns or questions.

Sept. 20, 2012

Q: My 13-year-old struggles with his weight. I do the best I can to help him make healthier choices and to monitor what he eats, but we could use some guidance. Is there a diet designed for kids this age? — L.S., Sunrise

A: The early teen years are tough enough, without also having to struggle with weight. The psychological effects need to be considered just as much as the physical effects. Keep the focus on becoming healthy rather than losing weight. The whole purpose of health is to be better to our bodies, but we do not want to starve ourselves of needed nutrition. The goal should be to become a healthier person in the future, not to lose 10 pounds this week.

One of the easiest ways to start: Cut all of the sugars from drinks. While drinking two glasses of milk daily is necessary to our nutrition, make it skim or 2 percent milk. All other drinks should be water. Fruit juice is nature’s sugar water — and the hidden Achilles’ Heel of many dieters. One glass of “all natural” juice, made with about nine oranges, is roughly 400 calories, or 20 percent of the average person’s suggested calorie intake. While oranges have many vital nutrients, think how much more satisfying nine whole pieces of fruit would have been. Make the calories count!

On the snack side, make ’em healthy. By limiting all between-meal snacks to fresh fruits and veggies (no dip), you are making the calories count and increasing your son’s fruit and vegetable intake. On the food side, watch portion sizes. A portion of meat, pasta, or bread should be about the size of that person’s palm. If after one serving, he is still hungry, load him up on the vegetable side.

Also, know the difference between a craving and actual hunger. Many times, we confuse these two things. If your son wants one food in particular, that is a craving. If your son wants food in general, he is hungry. Always fulfill healthy food needs, and rarely fulfill food wants.

As for exercise, the goal is one hour every day, not including physical education activities at school. If your son already does an hour daily, great. However, if he does not remember the last time he put on gym shoes, start him off slowly. Fifteen minutes a day is better than nothing! Once he is comfortable with that, increase to 30 minutes, then 45 and then 60. (If your child has a chronic health condition, talk to your pediatrician about a safe exercise routine. When in doubt, ask your pediatrician first!)

Stay positive — and if you really want this to succeed, get healthy with your son. It will be much easier for your son to start healthy lifestyle changes if you do it all together. Good luck!

July 31, 2012

Q: My daughter constantly gets painful ingrown toenails, but only on the big toe of her left foot, not the right foot. I am always cutting the nail back to ease the pain, but it never seems to go away. Is there something I can do to prevent it? And why is this only occurring on one toe and not the others? — N.B., Lake Worth

A: As a fellow sufferer of ingrown toenails in the past, I truly feel for your daughter. Unfortunately, sometimes what helps our pain in the present contributes to more pain in the future. By cutting back the nail to alleviate the current discomfort, patients can leave a tiny spike at the edge of the nail that they do not notice. This tiny spike continues to be ingrown and may be the cause of her future pain as it grows out. The future of the nail needs to be addressed just as much as the present.

After multiple ingrown toenails, your daughter likely has hypertrophic (overgrown) skin in that area. A podiatrist can help cut away the excess tissue, in addition to cutting the toenail and removing the mechanical irritation caused by the ingrown nail. In addition, there might be an underlying infection that needs to be treated. Sometimes this is a bacterial infection, other times it’s a fungal infection.

In order to prevent future ingrown toenails, never cut the nails too short and do not cut the sides of the nail. This allows the leading edge of the nail to always be outside of the skin and prevents it from becoming ingrown.

As for why it only happens on one foot, this sometimes happens. Among other things, it may have started because of an infection or injury with the remnant toenail growing differently, or be caused by a shoe that is too tight. Whichever the reason, see a podiatrist now and follow the simple preventive measure I mentioned in the future.

June 28, 2012

Q: We are very concerned over our 6-year-old grandson’s eating habits. He only eats fish sticks, chicken nuggets or pizza. We have never seen him eat a vegetable. He doesn’t take vitamins, but I don’t see how vitamins could replace real vegetables. We are concerned that even though he is a child this could affect his cholesterol in the future. Can you share your medical advice?

A: In a time where processed food is fast, easy and cheap, many children are missing out on the health benefits of fruits and vegetables. While fruits are more naturally sweet, and most kids like some fruits, we are not so lucky with vegetables.

First, know that you cannot change the past, no matter how much you worry. Try to focus on better eating in the future. In addition, realize that this change in diet will require a series of baby steps. Some are so imperceptible that you do not feel like anything is being done.

If he is not eating veggies now, try for one taste of vegetable a day for a few weeks, then two and slowly increase until he is eating five full servings per day. Right now, five full servings may seem impossible, but one taste a day is an obstacle that is easier to clear. If you start trying to achieve five vegetable servings per day with a kid who does not eat veggies, you are setting yourself up for failure.

Be creative and try making cauliflower mash instead of mashed potatoes. Yes, this actually tastes good. If he will drink fresh fruit smoothies (without sugar), try blending in a vegetable. Carrots usually mix quite easily, and small amounts of spinach can be hidden in a berry smoothie. Sweet potato mash or baked sweet potato fries are other good ideas. Cut up broccoli into small pieces, or slice the corn kernels off the cob and sprinkle with parmesan cheese. Basically, do anything to make the veggies less boring to a picky eater.

Also, do not cook the veggies until they are too mushy. While some adults can like this texture, kids will likely run.

If your grandson’s parents seem overwhelmed with the idea of making the veggies, try out recipes yourself and give them the recipes that taste good. To decrease fat, start by baking chicken nuggets and fish sticks rather than frying. For rushed parents, this has the added benefit of being easier to clean up. After he is OK with the baking aspect, try baked fresh chicken strips or pieces of tilapia with panko crumbs or parmesan cheese sprinkled on top. It will still be crunchy but have less salt.

Vitamins are a good idea, especially for a picky eater, though you are correct that they do not take the place of fresh fruits and vegetables.

As for his cholesterol, that can be a quick finger check at the pediatrician’s office, or possibly an arm blood draw. If he has not had a screening test yet, it is not a bad idea anyway.

In the end, the eating habits children pick up now affect both their present and their future. By changing their eating habits now, you are protecting their future health.

June 19, 2012

Q: My 16-year-old daughter is always getting strep throat. Her symptoms are only a slight scratchy throat and never a fever. I am told it can be harmful to her organs if she continues to carry it and it’s not treated right away. What are my options and should I be concerned? — P.C., Fort Lauderdale

A: Poor kid! First, make sure to go to your pediatrician’s office for sore throats, if possible. This allows your doctor to really count the times per year that your child gets strep throat. Unfortunately, sometimes you have to go to an emergency department or urgent care center that is not affiliated with your pediatrician, because you are out of town or your doctor’s office is closed. Make sure to call your pediatrician’s office to let them know about the strep throat anyway. Your child’s pediatrician should be their medical home, and their chart should reflect all urgent care and ED visits — not just their standard physicals and home office sick visits.

Strep throat is caused by a bacteria called Streptococcus pyogenes. In order to determine whether a sore throat is strep throat or a viral infection, a test must be done. A throat swab for a five-minute rapid test will be performed and, if positive, antibiotics will be prescribed. If the rapid test is negative, the second swab will be used for a throat culture that requires a few days for results. Do not take antibiotics if no test is done.

On the other hand, if the test is positive for strep, take all the antibiotics as instructed. By only taking some of the antibiotics, symptoms are improved for a time but the infection is not cured. This also increases the risk of the more dangerous effects of strep like scarlet fever, rheumatic heart disease and kidney inflammation.

In addition, your pediatrician may want to check for a carrier state, though it is very difficult to truly determine carrier state. Since antibiotics during an acute infection virtually eliminate the most dangerous effects of strep, positive strep tests, whether acute or suspected carrier, will most likely be treated with antibiotics.

Your concern level really depends on how often your child is getting strep throat. Your pediatrician will help you decide if she may need more than antibiotics, based on how many times a year she gets strep throat and how many years in a row this occurs. If strep is occurring too often, a referral to an ear, nose and throat specialist may be needed.

June 4, 2012

Q: Summer is almost here and my children love to spend a lot of time in the water. Unfortunately, my youngest one has eczema. During the summer, it’s really difficult to control the exacerbations. Even though sunscreen is extremely necessary, it makes his skin even more irritated. What is the best way to manage this skin condition during summertime?

A: Many parents are wondering the same thing this time of year. The good news is that eczema care during the summer is just an extension of good care during the rest of the year.

You should be hydrating your child’s skin, moistening with water then moisturizing the skin once or twice daily. Contrary to what many believe, water is great for eczema because skin needs water. If you moisturize skin without the water, you are just putting oil or cream on dry skin. If you wet the skin first, you are able to trap the water next to the skin with the moisturizer, and the combination helps with hydration. Both steps are necessary. Apply to moist, not soaking wet, skin.

This same trick can be used for dry, cracked or chapped lips.

For good skin care, always use cleansing and moisturizing products with no scents or perfumes. If something smells great, it is not for someone with eczema. The same advice goes for sunscreen.

You are absolutely correct that sunscreen is necessary, even for kids with eczema. Sunburned skin is not just irritating and painful in the moment, but is also a risk for skin cancer later in life. Vanicream is one brand made specifically for sensitive skin, but there are other options. Whichever product you choose, make sure it’s at least SPF 30.

Since your child loves to swim, chlorinated water in pools can really dry out and irritate his skin. Make sure to rinse him off with fresh water after exiting a pool. After this, reapply sunscreen if staying outside, or moisturizer if going home.

Hopefully, by following these few simple tricks you can have a summer with less eczema exacerbations.

May 21, 2012

Q: My school-age children have been sick with colds lately and, because of conflicting information in the news, I’m still unsure about which over-the-counter medications are safe to use. Can you advise? — S.C., Boca Raton

A: Good question, and I agree that the news has been conflicting lately. A few years ago, the advice was no over-the-counter cough or cold medicines for children younger than 2 years old, then it was younger than 4. Now, the American Academy of Pediatrics says to avoid giving these meds to children younger than 6.

For school-age children (6 and older), you should be safe with over-the-counter medications. What you have to look for in this case is combination products. Many cough and cold products combine two or even three medications. Read labels and make sure you are not doubling up on any of these medications. If you are giving acetaminophen (Tylenol) as a fever reducer, make sure it’s also not present in the cough and cold medicine you are giving. In addition, keep in mind that children often have multiple caregivers, so everyone should be aware of which medications are being used.

For ages 4 to 6, check with your pediatrician.

For kids younger than 4, simply avoid over-the-counter medications with a few exceptions. Some homeopathic medications can be used in this age group. Chestal, for example, is a honey-based product that you can give kids age 2 and older.

Now babies, especially younger than 3 months old, should be taken to the pediatrician for a cold.

If this is all too confusing, or you would rather try natural remedies, here are a few suggestions:

For congestion, clear the nasal passages with a saline flush. For babies younger than 6 months, you can also try to suction after the flush. (You may be wasting your time with babies older than 6 months, because they will fight the suction.) If your child can breathe, eat and sleep normally, do not worry about congestion.

Often, the cough that comes with a cold is good because it helps clear the airways of mucus. If your child only has an intermittent cough, avoid suppressing the cough. However, if cough is your child’s main problem, honey is a good way to soothe both the cough and the irritated throat. Toddlers ages 1-2 can get a quarter to half teaspoon of honey, as needed. One teaspoon for children up to 12 years old; two teaspoons for those older than 12. Honey should be avoided in babies younger than age 1 because of the risk for botulism.

For coughing spasms, try a warm shower. For kids with asthma, their cough medicine is their asthma medicine and it should be used when they first start coughing. Cough suppressants can cover up an asthma cough and mask the symptoms of asthma.

Most importantly, do not be afraid of fever. Fever is a good thing and a tool to help the body fight off infection. If your child is still active and playful, a fever does not need to be treated. On the other hand, because fever is a sign that the body is fighting off infection, your child should not have contact with other kids until 24 hours after the last fever or fever reducer.

No matter which method you try, if your child is having difficulty breathing, becomes sluggish or dehydrated, you should see a pediatrician.

May 2, 2012

Q: My 6-year-old son was recently diagnosed with a moderate allergy to dairy products. What are the differences/benefits of soy milk vs. almond milk? He also has a peanut allergy, so he does already have an intake of soy [as part of] soy nut butter. Also, do we need to watch intake of soy in young girls? — S.K., Davie, Fla.

A: While cow’s milk has even more of the nutrition that we use, there are times when parents are obligated to make a different choice. Sometimes the family is vegan, or the child has a milk protein allergy or lactose intolerance.

Soy milk is a good alternative, if cow’s milk is not possible, and there is no real evidence of negative effects on young girls. Soy milk has good amounts of protein and calcium. In addition, it has no saturated fats. The downside is that it can affect absorption of certain nutrients.

Almond milk is another choice that tastes pretty good. Almonds are actually tree nuts, while peanuts are legumes. Almond milk may be a possibility, despite a peanut allergy. Ask the allergist if your son has a tree nut allergy before trying. As for nutrition, almond milk has much less protein and B vitamins and may be sweetened with a lot of sugar. If you choose almond milk, please look at the sugar content.

Whichever you choose, make sure the milk alternative is fortified with vitamin D.

A bit of good news is that most kids will outgrow a milk allergy by their late teens, so talk to your child’s allergist or pediatrician about reintroducing cow’s milk as they get older. Even kids with lactose intolerance can eventually tolerate small amounts of milk.

April 14, 2012

Q: My son is 17 years old and has been complaining of stomach aches for nearly five to six months now. He is being seen by a gastroenterologist who put him on prescription Prilosec and Carafate. I was told he has gastritis. He has been on the medications for two months and he still has pains in the lower stomach area, and I think the medicine is masking a problem. What could be causing these pains? What do you suggest I do? — A.K.C., Sunrise

A: Poor guy! He must be miserable. Here are a few ideas for you to discuss with your son’s gastroenterologist.

The stomach is in the top part of the abdomen above the umbilicus, or belly button. With regard to his pain, it really depends on whether you mean the lower stomach or the lower abdomen. If his gastroenterologist believes the pain is in the lower stomach, Prilosec and Carafate are two great medicines to use. If his pain is really in the lower abdomen underneath his belly button, his gastroenterologist will want to know about that.

The type of inflammation that is occurring in his stomach can exist in other parts of his gastrointestinal tract as well. Likely, there was a plan for a follow-up appointment, about two months after the first visit to make sure the medicines are working.

After two months of taking the medication as directed for gastritis, you would expect him to feel better. If he still has pain, his gastroenterologist may want to do more testing to find the source. In addition, it is possible that in the past two months his gastritis pain is getting better and is now allowing you to focus in on other abdominal pain.

Hopefully, I have been able to help a little with ideas to discuss with his gastroenterologist during his followup appointment.

April 4, 2012

Q: My son’s 6-month-old boy is 30 pounds, and their pediatrician says he is in the 100th percentile. Their pediatrician also says they have nothing to worry about. However, I am indeed worried that this weight will be a lifelong curse. He is breastfed exclusively, but they have been giving him baby food as well for the past month. Please advise.

A: While 30 pounds would be unusual for a 6-month-old baby — and could be too much — we are missing two important details: his height and rate of growth.

If he is an unusually tall baby, the weight should be greater than average. Babies who are short should weigh less than their peers. Your grandson’s height and weight percentiles should be similar.

In addition, his pediatrician will be looking at his rate of growth. The rate of growth for his weight should be around 1 pound per month. If he is gaining significantly more each month, it may be too much. But again, it depends on his height and rate of growth for height.

Another thing consider is how much milk and food he is getting. If mom is pumping her breast milk, he should get no more than 32 to 36 ounces per day. If your grandson breastfeeds, do not worry as breastfed babies tend not to overfeed. Bottle-fed babies can overfeed whether the bottle contains formula or breast milk. His pediatrician should ask how much baby food he is getting.

In summary, weight and height should have similar percentiles. Whether a baby weighs too little or too much depends on height.

Feb. 21, 2012

Q: My daughter is 8 years old, but she’s already beginning to develop breast tissue and underarm hair. Isn’t she too young for that? Should I be worried? What should I do about it? — N.B., Lake Worth, Fla.

A: The good and possibly surprising news for you is that everything sounds normal here. Even though 8 years old is a scary age for parents to consider their daughters as starting puberty, it still falls into the range of normal. The beginning of female puberty starts with the development of secondary sex characteristics and usually occurs between ages 8 and 13.

Most girls start showing signs of puberty with the beginning of breast development, or thelarche, around age 10. Development of the breasts can be one-sided at first, but breast size will even out with time. Axillary (underarm) or pubic hair usually follow within the next year, and menstruation, or menarche, a year or so after that.

Development of secondary sex characteristics before or after the normal range does not mean anything has to be wrong, but it does mean you should speak to your pediatrician to find out why puberty is early or delayed. Most of the time, your children are simply developing at their own pace, but a referral to a pediatric endocrinologist may be needed if puberty starts before age 8 or does not start by 13.

Feb. 8, 2012

Q: Are there any real benefits to male circumcision? — J.F., Boynton Beach, Fla.

A: For a long time, it was thought that male circumcision protected against urinary tract infections. But as more published studies showed this commonly held belief was not proven true without confounding factors, the American Academy of Pediatrics moved away from recommending routine male circumcision. In addition, some insurance companies do not even cover circumcision because it is not medically necessary for most boys.

Now you may be wondering about those confounding factors I mentioned. When some of the studies were done, they included premature infants who were not circumcised because they had not been discharged from the hospital yet. The boys did have increased risk of urinary tract infections, but prematurity is a risk for urinary tract infection by itself. We do not know if these boys had urinary tract infections because they were premature or uncircumcised. Because of this possible confounding factor, we cannot count these particular studies that show increased rates of urinary tract infection in uncircumcised males.

There are some medical reasons to consider circumcision, and your pediatrician will tell you when one of these arises. Families should be made aware of both the risks and the benefits. Some possible risks include bleeding and infection, whereas potential benefits can involve decreased risk of some sexually transmitted diseases later in life.

Mainly, it becomes a personal choice for the family. Sometimes the decision is made for cultural or religious reasons.

Feb. 1, 2012

Q: My daughter had a fever in December and again in January. Her pediatrician told us it was viruses, based on her blood test result, and there was nothing we could do to treat it. However, the last time her fever lasted four days and the highest temporarily went up to almost 104 at night — even using both acetaminophen and ibuprofen (alternating). I also tried home remedies (lukewarm bath and cool washcloth), but nothing seems really helpful. I am just wondering if there is really no treatment for a viral infection? Could you please advise of any other effective ways to reduce a high fever? — M.P., Davie

A: Fevers from viral illnesses can be frustrating, and many parents are tired of pediatricians telling them: “It is just a virus.” It is never the pediatrician’s intention to say that your child is not sick — just that a previously healthy child with a normal immune system is capable of fighting off a viral infection, usually within a few days to a week. During that time, they may look miserable, but nature has given them the tools to fight off the infection. Fever is one of those tools.

While fevers scare parents, it is part of the body’s way of signaling that an immune response is needed. By elevating the temperature, the body releases certain things that help us fight off infection. Try not to treat fevers in a healthy child, unless your child is feeling sick because of it. Some children are lethargic with a 102 fever and others are jumping around the room. Treat the child, not the number.

Give the child plenty of fluids to prevent dehydration. Also, keep kids from any activity where they may come into contact with other children until 24 hours after the last fever spike of 100 degrees or higher. Remember that if you have to give the child a fever reducer to keep temperature down, it still counts as a fever and they are still contagious.

If the fever is making your child feel miserable, try an ibuprofen product every six to eight hours as needed. Alternate with acetaminophen if the ibuprofen does not last the full six to eight hours.

If your child’s fever reaches 104, give her a dose of ibuprofen and recheck the temperature in 30 minutes. If the fever has lowered and she feels better, wait and see how she progresses. But if the fever continues to go up, take her to a doctor or the emergency room.

For babies younger than 2 months old with a fever greater than 100.4, go to the emergency room immediately. For babies 2 months to 1 year old with fever, call your pediatrician.

Now, if you think your child may have the flu, check with your pediatrician. While there are medications for influenza, many make your child feel better only 12 to 24 hours faster than their own immune system. In addition, all medications have the risk of side effects. Most pediatricians do not prescribe antiviral medications unless there are underlying chronic medical conditions or the child is quite sick and you are considering hospitalization.

Jan. 11, 2012

Q: My 2-year-old daughter has [had a] vomiting problem for several months. It only happens once a week, but she throws up a whole lot every time and I have to change her clothes after that. I noted that she usually vomits after a meal or excessive crying. Besides that, she acts normal without other symptoms. Sometimes she even runs and jumps again right after the vomiting. Is it normal? What should I do to prevent it from happening again? — E.M., Plantation, Fla.

A: Good news! Given what you described, it sounds like everything is probably normal. Most importantly, you said that there are no other symptoms and she is active immediately after vomiting.

Unless she is overfilling her stomach when she particularly likes a meal, there really is nothing much to do about the vomiting. Pay attention and check whether those meals are when she eats more than usual. In addition, foods that are spicy or acidic increase the chance of reflux.

As for vomiting after crying, this will pass when her tantrums pass. Increased pressure in the abdomen from crying or coughing often makes kids vomit. Try distracting her by flipping the lights on and off during a tantrum, but do not look at her. You can also try moving just around the corner into another room, as tantrums often end when you are not there to pay attention to them. With luck, her tantrum may stop before she vomits.

If you do notice new symptoms, speak with your pediatrician.

Dec. 27, 2011

Q: My daughter is 2 years and 5 months old and keeps getting sick! This is the fifth time in less than a month. I took her to the pulmonologist and she was prescribed Xopenex. She got better for almost a week, [then] got a 103 fever from out of the blue that lasted one day and then went away for a week. Then yesterday she got 102 fever again. The pediatrician said nothing to worry about and to give her Tylenol. Is this normal? Is there anything I can do so she doesn’t get sick so often? — M.S., Davie, Fla.

A: Wow, it sounds like you are getting quite worried! Hopefully, I can make you feel a little better.

When children are toddlers, they get sick frequently with viruses. Because their immune systems are seeing these normal childhood illnesses for the first time, they get sick. The good news is that each time they catch a virus, children build their immunity by making antibodies. Given the fact that your daughter had three separate fevers separated by one month and then two weeks, she still falls into the range of normal.

Xopenex is a medicine that opens up the smaller airways of the lungs so she can breathe more easily. It is for symptom control and does not cure. If she never needs Xopenex again, it was likely just a childhood illness. Most kids have wheezed at some point in their lives. However, if she starts to need Xopenex with every cold virus, she may have extra-sensitive airways. If this happens, please talk to your pediatrician about the possibilities.

Make sure she gets enough sleep, proper nutrition and practices good hand-washing. In addition, please consider a yearly flu vaccine and, remember, no school or day care for at least 24 hours after the last fever or fever reducer.

Ask the pediatrician! Dr. Diana Blythe answers YOUR questions. To submit your question, fill out the form here.

Nov. 22, 2011

Q: My 1-year-old is in day care and constantly fights ear infections and colds. I want to help boost his immune system with echinacea or vitamin C. What is your opinion on remedies like echinacea, and how can I help his immune system? — K., Davie

A: Poor little guy! When kids start day care, they can frequently come down with colds as they build up their immunity to common cold viruses. This can be normal, even in kids who are healthy.

In addition, some of these colds lead to ear infections because of swelling around a tube called the Eustachian canal. The middle ear (behind the eardrum) drains into the back of the throat via this tube. Often with colds, this canal is swollen shut and the fluid cannot drain out. The more bacteria in that fluid, and the longer that fluid stays, the higher the likelihood of an ear infection developing. As we get older, the Eustachian canal drains more easily and we get fewer ear infections.

Unfortunately, the best way to really boost children’s immunity is to let them get the cold in the first place. Once their bodies see the cold, children begin to make antibodies against it and these antibodies will protect them later. They can continue to get colds in the future (there are many different cold-causing viruses), but the antibodies children make to fight one type of cold will protect them from missing school because of that same cold virus later.

Kids will get most of the common cold viruses during childhood; the only question is whether they get them early in childhood or later at school age.

As for helping his immune system, the best thing you can do is to make sure he lives a healthy lifestyle. Providing him with a good night’s sleep, a well-balanced diet with plenty of fruits and vegetables and very few sugary drinks is a great way to start. Most kids can get what they need from a well-balanced diet, and this also helps them develop good eating habits.

Now, if you would like to supplement with extra vitamin C or echinacea, that should not be a problem. But you could consider a children’s multivitamin instead, for an even more balanced approach.

Nov. 9, 2011

When should I start cleaning my baby’s teeth? Do I need to use toothpaste, and what type of toothpaste? How should I teach her (one year old) to spit out the toothpaste rather than swallow it, and rinse the mouth with water after brushing? Thanks. ? E.H., Miami

Your baby is growing up! Go ahead and start cleaning her teeth today. The right time to first clean a baby’s teeth is as soon as you see them. In addition, see if your insurance covers a dental visit. The American Academy of Pediatric Dentistry recommends that children visit the dentist by one year old.

To get ready for the dentist, begin with a soft bristle toothbrush or finger toothbrush. As for toothpaste, use a non-fluoride paste until she can spit on request or use only a tiny smear of fluoride paste. By the time she is a couple years old, she will be able to spit out the toothpaste and rinse her mouth out with water. At this time, you can start using a pea-sized amount of fluoride toothpaste, rather than just a smear.

The most important part of brushing her teeth is allowing her to be part of the fun. Even if you use a finger toothbrush, give her a toothbrush to use when you brush your teeth. The more she owns the behavior of brushing her teeth, the more likely she is to continue brushing her teeth when it is her responsibility. Make it part of your morning and evening rituals to brush your teeth together. In this way, it will become an automatic part of her morning just like putting on clothes or eating breakfast.

Hope this helps!

Nov. 2, 2011

Is there such a thing as an allergy to mosquito bites? I know you can be allergic to bee stings, but it seems my 10-year-old daughter reacts badly to mosquito bites. They seem to be larger and redder and itchier than with my other kids. Is this possible, and how can we treat it? ? E.L., Tamarac

Kids can definitely be extra sensitive to mosquito bites, but you are unlikely to see the extreme allergic reactions that you may with bee stings. Because of this, mosquito bites are not usually dangerous, but can be as quite bothersome to your child.

Oral antihistamines, like Benadryl, can help the symptoms, as well as cool compresses. In addition, you can try an over-the-counter steroid cream, if there is a large amount of inflammation. It should resolve on it’s own, but if it opens up apply a triple antibiotic cream so it does not get infected.

Most importantly, if you do only one thing, try to avoid the mosquito bites in the first place. Use loose, long pants and long-sleeved shirts with socks and shoes rather than sandals. Avoid dawn/dusk outings and scented skin products or laundry detergents. For babies less than two-months old, try mosquito screens for their strollers.

For children two-months and older, insect repellants are a possibility. The most common repellants use DEET, which is safe, and should be applied only once daily. In addition, there are various natural products and oils that have varying effects. However, the best alternative to DEET is picaridin. There is less skin irritation and a more pleasant smell to picaridin products while still being safe and effective.

Hope this helps!

Oct. 26, 2011

My 11-year-old son spends a lot of time in the dark. By which I mean he plays video games and watches TV in his room with al the lights off for a few hours a day. I’ve always been told that it is bad for your eyes to do that, but when I tell him that, he thinks I’m just trying to get him to stop playing games and watching TV. Can you give me some more information about this so I can explain to him why it’s unhealthy? – T.W., Weston

Fantastic question and your timing could not be better! Just today we are learning about a new study being presented at the American Academy of Ophthalmology’s annual meeting. It appears that too much time on video games or TV means your child is more at risk for nearsightedness. On the flip side, each hour spent outdoors decreases the risk of nearsightedness. Why is this?

While I am not an ophthalmologist, this study simply makes sense! The senses that we use, here vision, are the ones that we cultivate and grow. If we only look at things that are close like video games or TV, it seems reasonable that our ability to see things far away would not be strengthened. If we play outside, we are looking at things both near and far.

In addition to the help with seeing farther away, outside play is good for our general and mental health. Children that spend less time inside playing video games or watching TV and more time exercising are less likely to be overweight, have diabetes (type 2) or be depressed. Also, exercise helps boost self-esteem and improves sleep. Whatever reason you use, more outside play/exercise and decreased TV/videogame time is good for your son.

Hope this helps!

Oct. 19, 2011

I am an expectant mother for the first time. I noticed recently that the label on a jar of honey says it should not be given to children under 1 year of age. Why can’t babies have honey? L.P.-Coral Springs

Good for you for reading labels! You found a great piece of information to talk about.

No doubt your friends have also wondered about this question when they had kids.

One of the great things about honey is that there is very little to no processing. We are basically eating sugar directly from nature. Because of the lack of processing, we may take in botulinum spores along with the honey.

For adults or older children, the immune system of our digestive tract takes care of these spores without problem. Because of the normal but immature immune system of babies, spores can stick around and multiply much more easily than in adults or older children. More spores means more risk of botulism.

By the time your baby is one year old, the American Academy of Pediatrics considers honey to be safe.

Hope this helps and congratulations on your first baby!

Oct. 12, 2011

I am about to give birth to my second child, and I’m considering having an epidural for the pain during the delivery. What, if any, are the side effects of the epidural on the baby? T.C.- Kendall

Since more than fifty percent of women delivering at hospitals get epidurals, your question is a fantastic one. In fact, epidurals are the most common type of pain relief requested during the labor and delivery process. During an epidural, a needle is placed in the small of your back that allows you to have local pain relief in the lower part of your body. Epidurals done by an experienced anesthesiologist should be safe and effective for both you and the baby. For those women who are considering an epidural, here are some things to discuss with your obstetrician.

The biggest benefit of an epidural is decreased pain during the delivery process. Better pain control means a friendlier labor and less exhaustion. Epidurals also allow you to be aware during a cesarean section, whether scheduled or emergency. If you planned a vaginal delivery and now need an emergency cesarean, having an epidural already done will allow the surgery to take place while you are aware. You will be able to greet your baby as soon as they are born and have earlier breastfeeding, rather than waiting to wake up after the anesthesia. Hopefully, an emergency cesarean is something you do not have to experience, but it is something to consider during your labor and delivery planning.

On the opposite side, epidurals can increase the labor time in a vaginal delivery. By not feeling the contractions as strongly, pushing becomes more difficult and you may need medicine to make you contract more strongly or other help in getting the baby out. In addition, soon after the medicines are given through the epidural, there may be a very brief drop in the baby’s heart rate. Your baby will be closely monitored, and this brief drop in heart rate should not be dangerous and should resolve within a few minutes. Most of the possible effects on the baby occur if the mother’s blood pressure drops too low because of the epidural. Because the mother’s blood pressure is constantly monitored, her doctor can quickly correct a blood pressure drop and this should not pose a problem for the baby.

Talk to your obstetrician about all the possibilities for pain control during delivery so that you can feel comfortable with whichever decision you make.

Hope this helps!

Oct. 5, 2011

How much sun is too much sun for a five year old? I ask because I want to start taking my son to see the Dolphins play, but I’m worried that 1 pm games, right under the hot sun, could be too much for him. What do you think? ? B.W., Pembroke Pines

There is no reason you and your son cannot enjoy the game! Most five year old children will do fine watching a football game at 1pm, as long as you take simple precautions and look for warning signs that the sun is affecting him.

Before the game precautions include, dressing him in loose clothes and a hat, applying a quality sunscreen and making sure he is drinking plenty of water. After the game starts, or while tailgating, look for signs that the sun is affecting him.

Sweating excessively, cramps, dizziness, nausea or weakness are signs of overheating. If any of these occur, go into the covered part of the stadium and have him drink water while cooling off. If you are tailgating, turn on the car and start the air-conditioner while having him drink water. In either case, do not return to the heat unless he is completely better and have the stadium’s emergency services check him to make sure everything is ok.

If not taken care of early, he may get skin that is hot and red but dry, strange behavior, confusion, vomiting or start refusing water. These are late signs that the body’s cooling mechanisms are overwhelmed and mean that you now have a medical emergency called heatstroke or sunstroke. Let stadium personnel know immediately so that he can receive emergency attention.

To avoid these problems of overheating, make sure he drinks plenty of water and take breaks in the covered areas frequently. Football games should be fun and safe. Taking these simple precautions should allow you to enjoy the game without problem.

Hope this helps and GO DOLPHINS!

Sept. 28, 2011

What are your thoughts on Human Growth Hormone for kids? My son is 10 and he’s the shortest kid in his class. I don’t think he’s too abnormally small, but my husband wants him to be an athlete and thinks being small hurts his chances, so he wants to give him HGH supplements. What do you think? – A.M., Ft Lauderdale

Human growth hormone (HGH) is very safe if prescribed by a pediatric endocrinologist because of a true growth hormone deficiency. If a child does not have enough hormone naturally occurring in their body, an endocrinologist may prescribe growth hormone shots. However, just because kids are not tall, does not mean they have growth hormone deficiency.

Talk to your pediatrician about your son’s rate of growth, or how much he grows every year. Some kids have constitutional growth delay which is a fancy way of saying “late bloomer”. If he is growing taller at a good rate but is still short, he probably does not have growth hormone deficiency. However, if he has started to fall off his growth curve and is not growing a decent amount each year, a pediatric endocrinology referral may be a good idea.

Until you see your pediatrician, remember that not everyone is the tallest kid in the class. Just because someone is short, does not mean he or she cannot be a good athlete. Being fast and maneuverable are assets by themselves.

Hope this helps!

Sept. 21, 2011

My daughter is 9, and I’m not happy with the options available for her lunch at school. The cafeteria food is not nutritious, and on most days, seems like it’s really unhealthy ? pizza, hot dogs, mozzarella sticks and things like that. If I wanted to start packing her a healthy lunch everyday, what would you say I should include? She’s a good eater, so anything that you think is healthy and that kids would enjoy is a great suggestion. ? C.G., Miramar

Good question! Even though the majority of schools are getting pretty good about what they serve for school lunches, it sounds like your school has some work to do. With the increasing numbers of overweight and even obese children, learning proper eating habits at a young age is incredibly valuable. While the home environment is most important, children do eat 1/3 of weekday meals at school.

School lunches should be moderate size and include a few choices. While the menu is ultimately up to each family, here is one idea. A sandwich using whole grain bread with lean meat is a good start. Try adding a yogurt, cut up fruits or veggies and finish off with water or skim milk. Please do not include sugary drinks, chips or cookies, as these are empty calories.

To be safe, add a cooling pack to keep the perishables cold enough. In addition, tell your daughter why you are giving her a packed lunch or you run the risk of her selling it to another kid and buying the unhealthy lunch.

Hope this helps!

Sept. 14, 2011

I read that there is already a flu shot available for this upcoming season. Is there any benefit to getting the shot for my boys (they are 8 and 10) now, rather than waiting until the fall when we normally get the shot? ? P.C., Margate

Getting the flu vaccine now will give your boys protection from influenza (the flu) in the time between now and when you usually get the vaccine. The flu and the flu vaccine are seasonal, or different every year. Therefore, last season’s flu vaccine may not protect your children from the type of influenza circulating this year.

In addition, it takes one to two weeks for our bodies to react fully to vaccines. So if your boys get the flu vaccine today, they might not have all possible protection for another two weeks.

Most importantly, while influenza infections usually peak in the winter months, that does not mean they cannot peak earlier during the fall months like we had in the 2009-2010 flu season. Getting your children vaccinated earlier rather than later allows them to maximize the benefits of the flu vaccine by giving them early flu season protection.

Sept. 7, 2011

My son is 5-years-old and just started school. He hasn’t had the chicken pox yet, but I’m sure he’ll get it eventually. I know some parents actually expose their children to kids with chicken pox so they can catch it and then get it over with. Is this safe? Do you suggest I do that? — M.A., Cooper City

Great news! Your child does not have to get chickenpox! The need for chickenpox parties is over. Now, the chickenpox vaccine, also called varicella, is one of the regular childhood shots and kids are able to avoid the effects of the chickenpox disease.

If your child is current on vaccines, he has already had two chickenpox vaccines. The first of the two doses is given at the one year-old exam and the booster dose is given at the four-year-old exam, but neither dose can be given early. So if his four-year-old exam was squeezed in the week before his birthday and the five-year-old exam has yet to occur, he may be due the booster dose.

Hope this helps!

Aug. 31, 2011

Is it normal for a toddler to have a reddish pimple with whitehead on the cheek? I understand that some newborns have baby acne, but my daughter is already 22 months. What could be causing that and what can I do? – – E.S., Sunrise

What you are describing is called a pustule and can be caused by many different things. Given your daughter’s age and the fact that there is only one, the most likely scenario is a simple bug bite, possibly a fire ant. People who have experienced a fire ant bite may remember a pustule like what you are describing. Oral antihistamines, like Benadryl, can help the symptoms, as well as cool compresses. In addition, you can try an over-the-counter steroid cream, if there is a large amount of inflammation. It should resolve on it’s own, but if it opens up apply a triple antibiotic cream so it does not get infected.

Aug. 24, 2011

The summer in south Florida is so hot. There is always a quick and large change in temperatures from outside to inside. Some friends told me that the baby can adjust to change naturally, but others recommended me putting extra cloth on her when we go in and out from hot to cold. So my concern is if baby can get sick from the temperature change? If so, can I do anything to prevent that from happening? Thanks. – – F.T., Miami

The good news is that both your friends are potentially correct! Healthy, full term babies should easily be able to adjust to temperature changes in South Florida. In addition, they should be comfortable in the same type of clothing you are wearing. If you feel comfortable in short-sleeves, put your baby in short-sleeves. If you need long-sleeves, put your baby in long-sleeves.

In other words, if you need an extra layer when coming inside, your baby may also need an extra layer. If you take a minute to adjust and do not need extra clothes, then that is likely what your baby needs as well. For a premature baby, your pediatrician may modify this advice depending on how recently your premature baby was born.

Aug. 17, 2011

What is an appropriate explanation/discussion about a miscarriage to a toddler? I recently miscarried twins at 10 weeks.

We have a 2 3/4 year old little girl who was pretty excited about the coming babies. Since it happened 5 days ago, she’s only mentioned the babies 1x or 2x but we have not said anything directly to her about this. She may have picked up some sense of something having happened and she was with us at the OB’s office when we found out.

I don’t want to avoid the subject nor pretend nothing happened. What do you think Dr. Blythe?

Miscarriage is an emotional hurricane and you are doing the right thing by waiting until you figure out what to say. While what you do and say is personal, I will try to help a little with some guidance. First, do not give all the details, simply say babies have to grow in a certain way to become babies. Since they didn’t grow like babies usually do, they didn’t become babies. To adults or older children, this may seem like you are diminishing the importance of your unborn babies but it is all young kids are ready for. In addition, do not be afraid to show some, but not all emotion. If it just happened and you cannot talk about it without dissolving into tears, wait until you can talk about it while showing your sadness without worrying your daughter. For some this might be a few days, for others much longer.

Most importantly, take care of your needs and give your grief an outlet. Cry as often as you need to and lean on your partner for support. Also, this is something you both are experiencing, so remember although your partner may try to act tough, you both need to grieve.

Hope this helps!

Aug. 10, 2011

My baby is almost two. She has eczema on her hands and feet. I have been using 1% hydrocortisone and Eucerin lotion on her for a week, but didn’t see it helps. I understand that 1% hydrocortisone contains steroid that is not recommended being used for more than a week. Could you please advise if there is anything I can do to help my baby, because it seems very itchy to her? Thanks a million. ? C.J., Miami

Poor thing! Eczema really can be itchy. First thing to do is check if you are using any new skin products, fabric softeners, or detergents. You’ll want to avoid scents and perfumes in any of these. New foods could also be the cause of this week-long problem.

As for treatment, starting with a low potency steroid ointment like the 1% percent hydrocortisone and a good moisturizer like Eucerin is a great start. Make sure to moisten the skin before using the moisturizer in order to trap in the water. However now that it has been a week and there is no relief, she should probably see your pediatrician.

Depending on the severity of the skin problem, there are stronger ointments and oral medications that may help and you will want to make sure it is not infected. In addition, talk to your pediatrician about other possible diagnoses. Two of the possibilities are contact dermatitis and acropustulosis of infancy. A child can easily get contact dermatitis by walking around barefoot and touching things. Acropustulosis of infancy (another rash on the hands and feet that usually self resolves) is more common in her age group than the dyshidrotic eczema that occurs on the hands and feet. The good news is that for both of these other diagnoses, the low-potency steroid that you are using is still a good start. Now it is time to see your pediatrician and possibly a dermatologist, or skin specialist.

Hope this helps!

Aug. 3, 2011

My child is starting kindergarten in August. It’s really going to be his first time surrounded by other kids all day. What are the most common illnesses kids share with each other, and how can I tell if he’s picked one up? L.L, Fort Lauderdale, FL

If your child has not been in daycare or preschool before starting kindergarten, you should definitely get ready for him to be sick more often than his usual. This does not mean he is a sickly kid! He just has not been exposed to the different illnesses previously.

Getting sick even every month during that first year of school for kids who are not used to being around other children can be normal. Some of the frequent illnesses are common colds, stomach flus, Hand Foot and Mouth, pink-eye, and Fifth’s Disease. Unfortunately, there are too many common childhood illnesses to name them all.

When your son gets sick, make sure he drinks plenty of fluids and gets lots of rest so his body can fight off the infection. If he is not better in a few days, take him to see his pediatrician and remember, no school or contact with other kids for at least twenty-four hours after the last fever or fever reducer.

July 27, 2011

I’m a first-time mom with a 7-month old boy, and he seems to hold his breath a lot. I know this isn’t uncommon, but every time it happens I can’t help but worry. Am I just overreacting? — L.W., Margate, FL

Hopefully, we can make you feel better. It is very common for babies to hold their breath for as much as five to ten seconds, usually after periods of rapid breathing. This is called periodic breathing and you will notice it while your baby is sleeping. This pattern of breathing is most evident during the first few months of life and will decrease over the first year of life as the brain matures.

When your baby holds his breath, how does he look? If your child is gasping, stiffens up or turns blue, it is concerning and you should call 911. If he is sleeping peacefully with no color change and starts breathing rapidly but peacefully again on his own, this is periodic breathing.

Hope this helps!

July 21, 2011

We have a six-year-old son. His grandmother was always his babysitter, but she recently moved, and now we don’t have a regular sitter. There are plenty of teens in the neighborhood who have offered to babysit for us, but I’m not sure how to go about choosing the right one. Are there specific questions I can ask and things I can look for to help find the right babysitter? — L.P., Hollywood

What an important question! The good news is that the answer begins with something easy. First thing to do is to ask friends with kids. Finding a good babysitter is like finding a good pediatrician; recommendations from other parents are worth their weight in gold!

If you have just moved to the area or are the first of your friends with kids, some things to look for in a sitter during interviews are whether they are CPR/First Aid certified or have attended a Red Cross Babysitter course. Also ask what they will do in potential situations. It is a job interview and you are allowed to ask questions. Good grades can be a sign of responsibility. Have the potential babysitter spend an hour or two while you are still at home. In addition, if the sitter’s parents want to meet you, that is a great sign. Responsible parents are more likely to have responsible children.

Other practical issues are deciding what skills you are looking for in a babysitter. Do you want them to pick your kid up from school? Are you looking for someone to help with homework or do some informal tutoring? Do your kids listen to them? For instance, a 14 year old baby sitter may be appropriate for a 6 year old, but not for a 12 year old. Most importantly, trust your instincts.

Hope this helps!

My son is 9, and he’s starting to express some concern about his belly button. He has an “outie” and he says the other kids at school poke fun at it. Outside of telling him he has nothing to be ashamed of, is there any medical solution to turn an “outie” to an “innie?” — R.H., Delray Beach

No kid likes to be made fun of and you did the right thing by telling him he has nothing to be ashamed of concerning his “outie”. As for a medical solution, it certainly exists.

Another name for an “outie” is an “umbilical hernia”. This is actually a place in the muscular wall of the abdomen that never closed. It started out as a way for the placenta to transfer nutrients to the growing baby during pregnancy. After birth, the umbilical cord stump will fall off and the hole the nutrients went through will close. If this does not occur, you have an umbilical hernia. Most will still close once the child starts walking and surgical options are not usually considered until at least 3 years old for asymptomatic kids. Because the likelihood of the hernia closing after 3-5 years old is almost zero, the surgical option needs to be considered.

Some people may think that it is only cosmetic, but that could not be farther from the truth. The muscular wall of our abdomen not only holds us up, but it holds our internal organs inside. When the pressure inside our abdomen increases such as during laughing, crying, or coughing, loops of our intestines can push out though the umbilical hernia causing it to bulge. After we stop, the loops of intestine stop bulging. Unfortunately, sometimes the loops get caught outside and this is called incarceration. The longer the loops stay incarcerated, the more chance of strangulation. During strangulation, the blood supply to that part of the intestines is compromised and this can cause tissue damage. With most kids, it never comes to this. However, it is possible and asking your pediatrician for a referral to a pediatric surgeon is a good idea. If you do decide on the surgery, most likely it will be an outpatient procedure. This means you will take your child home on the day of surgery once they wake fully from the anesthesia. The goal is for your child to spend about a week taking it easy at home and be back to normal within a few weeks.

By going to the pediatric surgeon, you are not obligating your child to surgery. You are simply getting the information you need to make the decision.

Hope this helps!

July 14, 2011

How early is too early to know if my 2-year-old needs glasses? When is it ok for an eye exam, and how early is it ok for glasses? O.F., Plantation

Usually eye exams start around the three-year-old well exam. Until this age, it is difficult for kids to follow directions enough for us to tell with basic vision screens. In addition, they are more likely to possess the words to identify objects. As for how early to use glasses, it depends on the reason. If the eye specialist says glasses, use them.

Most kids do not need an eye specialist to check their vision, but some may. If you have any specific reasons that you are worried about vision on your two-year-old, talk to your child’s pediatrician or family doctor. Depending on what you are worried about, your doctor may decide to refer you to an eye specialist.

Hope this helps!

July 6, 2011

I just sent my 9-year-old off to sleep-away camp, and within a week he called to let me know he has pink eye. I’m not really all that familiar with it. Can you tell me what it is and whether I should be worried, or if the camp should be able to handle it? –R.I., Pompano Beach

Rest easy! You should not have anything to worry about. The camp will likely take him to the doctor in town to get his eyes checked. Pink eye, or conjunctivitis, is an inflammation or infection of the membrane lining the lids and covering the white part of the eye. This membrane is called the conjunctiva.

While there are numerous causes of pink eye, some common causes are viral (#1), bacterial, allergic and irritant. If the cause is viral or bacterial, warm compresses applied to closed eyes may alleviate the symptoms. Time will heal most viral conjunctivitis and about half of bacterial conjunctivitis, but most pediatricians will give antibiotic eye drops for suspected bacterial causes. For allergic or irritant causes, flushing the eyes with water or cool compresses applied to closed eyes can help. In addition, there are allergy eye drops.

Whatever the cause of pink eye, it will most likely not affect the fun your child has at camp or cause much trouble for him. If you are worried, just call the camp and find out more information. Any good camp will be happy to talk to you.

Hope this helps!

June 29, 2011

I have a two-year-old, and I’m wondering at what age I can have her take swimming lessons? — D.I., Plantation

Thank you for asking about swimming lessons! Feel perfectly safe starting your child with swimming lessons today. Many swimming instructors, including the Red Cross, will start lessons beginning at 6months old.

You may think? “What can my six month old learn to do in the pool?” They can learn to be comfortable so that when they are older the focus is on learning to swim rather than battling a fear of the water.

Even at two years old, the majority (though not all) of what you will do in a swim class is comfort. By this time, kids can start learning to climb up ladders, hold onto the side of the pool and tread water. To make this safe, parents will need to be in the water with their children or have a solo instructor. Most of the reason for one-on-one attention is that the majority of two-year-olds do not have the ability to follow more than basic directions and certainly not for any extended period of time. In the water, that is dangerous and swimming should be both fun and safe.

By three or four years, your child will likely be able to follow instructions better and can be part of a small group class with an instructor and no parent. This does not mean you should wait until your child is three or four to start lessons. Rather, you should plan to be in the pool with your child during these earlier lessons.

Hope this helps!

My son is a thumb sucker. This was ok when he was a baby and even a toddler, but he’s 6 now, and he’s still got his thumb in his mouth. What can we do to help him outgrow this bad habit? — E.W., Delray Beach

Good for you in being concerned when he still sucks his thumb at six. Many kids will suck their thumbs into the entry of their toddler years. Unfortunately, the longer they continue after this, the higher the risk to mouth formation and speech development.

One of the easiest ways to start is to try short periods of time without sucking the thumb. Go out to lunch or the playground. You are not saying “never”, just not right now. As your child gets comfortable with short periods of time and early success, try longer periods of time and give small rewards for accomplishing the set goals, no matter how small the goal. This is called positive reinforcement and is an effective way to tackle most behavior changes.

Also, you can wrap the thumb with a band-aid to help your child remember or use Thum, a bitter tasting but safe liquid painted onto the thumb. You may distract your child with other activities and avoid prolonged TV time which is when children suck their thumbs without realizing. If none of these ideas work, talk to your dentist or pediatrician about other methods to try. Most importantly, never punish or embarrass your child for sucking their thumb. In addition to being unworthy of a good parent, it will only serve to increase thumb sucking.

Hope this helps!

June 22, 2011

Now that school is over, my two kids have been spending time outside, and it seems that once the sun starts to go down, the mosquitoes come out. Do you have any tips for how best to prevent mosquito bites while the kids play outside? –W.R., Plantation

Great question! Between the mosquitoes feasting on either my sister or my husband, I usually have nothing to fear. For those of you who are less lucky, here are a few ideas.

First thing in trying to prevent mosquito bites is to use long pants and long-sleeved shirts with socks and shoes rather than sandals. Loose-fitting, lighter fabrics should not overheat your kids while still providing an actual physical barrier to the mosquitoes. Avoiding dawn/dusk outings and scented skin products or laundry detergents is also a must. For babies less than two-months old, try mosquito screens for their strollers.

For children two-months and older, insect repellants are a possibility. The most common repellants use DEET and should be applied only once daily. If you choose these use the percentage DEET appropriate to the hours outside. Higher percentages of DEET are used for longer hours outside.

In addition, there are various natural products and oils that have varying effects. However, the best alternative to DEET is picaridin. There is less skin irritation and a more pleasant smell to picaridin products while still being safe and effective. Whether you like to use wipes, sprays or aerosols, picaridin is a great choice.

Hope this helps!

June 15, 2011

My daughter is 8 and she’s starting to enter the world of sleepovers. I don’t have a problem with her sleeping out at a friend’s house, but I am concerned since she does have occasional issues sleeping through the night. Do you have any tips to help make sure sleepovers go smoothly? — D.A., Delray Beach

Less actual sleeping occurs at “sleepovers” than on a regular night. By not sleeping through the night, most likely she will be the life of the party. Your night owl may have found her niche. As for other sleepover issues, I will address a few common problems.

For kids who are scared of the dark, try bringing a battery-powered nightlight. If the problem is anxiety in new situations, a cell-phone to call home is a good idea. Easily bored or hyperactive kids may benefit from a handheld game or book to read so they do not wake everyone up at 3am. Discuss bedwetting with your pediatrician.

Basic tips for all kids would include telling the host parents about any medications or allergies your child has. In addition, getting sleep the night prior and night after is very important. For socialization issues, talk about sharing and hurt feelings before the sleepover. Most importantly, realize that this is a learning experience for your child.

Hope this helps!

My 16-year-old son says he’s sweating a lot more than usual lately. I know it’s been hot out, but he says it happens inside too, in the air conditioning. Is this normal for a teenage boy? — E.S., Miami

Increased sweating definitely occurs during puberty and on average, boys do sweat more than girls. In fact, boys often sweat twice as much as girls. However, an increase in sweat production is very normal for a teenage boy or girl at this age.

Most likely, exertion, hormone levels, anxiety or increased weight is the culprit behind increased sweating. Have your child use loose fitting clothes during exercise and drink plenty of fluids. If you think increased weight may be the problem, talk to you pediatrician about ways to get a better match between height and weight. Also, ask if your child’s personal medical history and medications may affect sweating.

Hope this helps!

June 8, 2011

I have a question about baby food. I’m a new mom, and I’m considering, once my baby is ready for actual food, making my own baby food, rather than buying the stuff in the jar. My plan is just to buy fresh produce and run it through the food processor. Is there anything, nutrition-wise, my baby would be missing out on by eating homemade food as opposed to store-bought food? — K.P., Deerfield Beach

Motherhood suites you as I can feel the energy you have! Whether you use homemade or store-bought baby food, you can feel comfortable that both are safe and nutritious.

By choosing to make your own food, your baby does not need to miss out on nutrients. This can be affected by whether you use formula or breastmilk. Formulas do add extra vitamins and minerals. On the other hand, if you are breastfeeding only, your baby should already be used to taking extra vitamin D and it will be easy to switch to a multivitamin with iron. Talk to your pediatrician about whether a multivitamin is right for your baby. It is really a personal choice on whether to make your own baby food. The two biggest benefits to making your own baby food are that you know everything in the food (because you made it) and it can be much more economical. The downside is the time involvement. If you love to cook and breeze through regular meals, this should not be a problem for you. If you are learning to cook as your baby grows, it might be more trouble than it is worth. Most people will find themselves somewhere in the middle.

If you do decide to make your own food, buying fresh and using the food processor is the right way to go. Wash the produce well and try to use the purees fresh or freeze them to use later. Avoid canning the foods as this can lead to health risks, if not done properly.

Hope this helps!

June 1, 2011

¿My family has a history of poor vision — almost everyone has been wearing glasses since they were young. At what point does it make sense to have my daughter’s vision tested to see if she will need glasses too? She just turned two. — G.S., Pompano Beach¿

Interestingly, when to test is not based on her ability to see, but rather her ability to follow directions and name objects. Around three-years-old, children start to have not just the words to name objects, but also the willingness to do so on request.

Ask your pediatrician to check at the three-year well check, but do not worry too much if it does not go smoothly. Some kids are just not ready to test until the next year. Remember also that they might just be scared. No matter what, vision and hearing have to be checked before the school years start.

Hope this helps!

Hopefully this question doesn’t sound too strange, but my wife is expecting our first child in August, and I’m starting to worry. As a new dad, I want to help as much as possible, but at the same time, I don’t want to get in the way and create problems during what I expect will be a really busy, confusing and chaotic time. What advice do you have for me? — D.C., Miami Beach¿

Rather than strange, your uncertainty sounds utterly and completely normal! Funny thing is that your wife likely feels the same way. It is possible that both of you are trying to be strong for the other one which leaves each worried, uncertain and in need of some unburdening. The good news is that you still have a few months. One night soon, order your favorite take-out and just talk about what worries each of you. Then ask each other what would be helpful. You might not get answers immediately, but you will have started the discussion.

I know, I know. You wanted a list of things to accomplish, but reality is both simple and hard at the same time. Rather than trying to read each other’s minds (impossible, unless you are characters in the next X-Men movie), just ask. I promise, you will not be getting in the way and it will be appreciated.

Hope this helps!

May 25, 2011

Adults are always warned about stress, but is it something to worry about with kids too? My 10-year-old seems so overwhelmed with homework and school assignments, plus other activities. Is there a worry that the stress he seems to be feeling could make him sick? ? A.W., Fort Lauderdale

Young kids are definitely not immune to stress! In fact, kids will often show physical symptoms as a result of stress. The concept of “stress” is harder for them to understand so they complain about something they can understand like a stomachache or headache.

You can divide the activities into groups like necessary, wanted and neither. Necessary activities are things like household and family duties, religious obligations and school classes. Wanted activities are anything else that kids or their parents actually want to do. Get rid of anything that falls under neither.

Start by planning around the necessary activities. Break down the necessary obligations into pieces and praise your child when they finish pieces. In addition, encourage short breaks between hard activities like homework.

For instance, when a kid comes home from school have them start one class’s homework almost immediately. Most likely, they have not been in class for over an hour and do not need a break yet, even if they want one. After finishing one subject, they can take a ten-minute break. Breaks can even include small household chores like walking the dog or taking out the trash. Plus, kids are less likely to whine about chores if the alternative is homework.

Another idea is the finish the easy subjects first. I know this sounds counterintuitive, but just hear me out. Let us pretend it is an older child who very well may have three or more hours of homework. By finishing the easier subjects first, the child feels a sense of accomplishment. Additional benefit, is that your child can focus full attention on the hard subject at the end because they have finished the others first. Most importantly, do not let kids put things off. Finishing a month-long project in the last weekend is very stressful.

If these necessary activities fit into your child’s life and there is time for the wanted activities, add them slowly. As for the neither activities, just get rid of them. Life is too short to fill it up with activities that are neither necessary nor wanted.

Hope this helps!

May 18, 2011

I recently had a baby, and I’ve been to two pediatricians, each of which have suggested childhood vaccines on a different schedule. One suggested spacing them out as much as possible, while the other doctor said they should happen over a more condensed period of time. What do you suggest? — L.P., Pembroke Pines

Congratulations! You made the good decision to vaccinate your baby. Now comes the decision on how to schedule.

Like most pediatricians, my practice follows the evidence-based schedule that is recommended by the American Academy of Pediatrics. You can find this schedule at http://www.aap.org/immunization/. The experts in the field decided that this is the schedule that they want to promote in order to lessen the cases of vaccine preventable serious illness. Many of the vaccinations are given in the first fifteen months of life with additional vaccines between four and six-years-old and at eleven-years-old. You also have booster vaccines when you become an adult.

The immune system is perfectly capable of handling more than one vaccine a visit and you have fewer days of an irritable child if you group the vaccines. However, if you are uncomfortable for any reason, many pediatricians, including myself, will work with you on an alternate vaccine schedule. A good pediatrician will welcome your questions on vaccines and their scheduling. The most important thing is that you vaccinate!

Hope this helps!

I’m about to have my first child, and I’m excited, but also really nervous. Can you tell me what kinds of things I should be looking out for, especially in the first few weeks, to make sure I’m raising a healthy baby? — C. D., West Palm Beach

Congratulations! The first thing to do is have a prenatal visit with a few pediatricians near you to see where you want to go after your baby is born. By doing this, you will already have someone to answer your questions after the birth. The last thing you want is to be searching through the phone book with a sick newborn. Ask your friends which pediatrician their children see. If you are the first of your friends, some research is in order.

Everyone wants a pediatrician who is likable, but there are other things to look for as well. The pediatrician should be board certified and have convenient hours. Evening or weekend hours, as well as same-day sick appointments, are very helpful to working parents. The most important thing though is that your pediatrician listens to you. Ask any questions during this prenatal visit that you like. If you are planning on breastfeeding, definitely ask questions during this visit. Remember, this is the person whom you are trusting with the health of your child. Likeability, trust, respect and knowledge are all important. In addition, the “What To Expect?” books have great information presented in an easy to understand way.

As for some typical concerns that may come during the first few weeks, I will address a few. Important to know is that babies lose weight after birth; sometimes near seven to ten percent of birthweight; fevers in newborn babies should never be ignored and babies should always sleep by themselves on their back. These along with feeding and jaundice questions will be addressed at your first visit which should occur one to three days after you take your newborn home. Whether the visit is the day after nursery discharge or a couple days later may, among other things, depend on feeding, weight, jaundice or simple scheduling issues.

By the two-week visit, your baby should be back at birthweight with any jaundice and feeding issues resolving. Your baby will likely be starting to pick up his or her head and will startle at loud noises. At about one-month, you will begin to see smiles though likely not at anything in particular. By two months old, your baby should smile at specific things, like your smile or your cooing to him or her.

Have fun with your new baby and I hope this helps!

My son’s bottom two front teeth have been loose for months. He’s always wiggling them, and I would have expected after 3-4 months that they would have fallen out already. At what point should I take him to the dentist to see about having them pulled? — R.W., Fort Lauderdale

What a big step for him! Losing the first baby teeth is a quite an event for kids and I assume these are his first as they are the bottom front teeth. As for how long it takes, it really depends on the kid.

Some kids notice that something feels different well before they seem to be loose. Other kids notice when they bite into an apple and the teeth fall out within a week. Most will take anywhere from one week to a couple of months. If it really has been four months, it should be almost time for his usual every six month cleaning and I would suggest talking to his dentist.

The American Academy of Pediatric Dentistry recommends that children visit the dentist by one-year-old. If you already took your child to the dentist, then GREAT JOB! If he has not yet seen a dentist, now is a great time to start. The dentist might want to wait and see what happens, or address it in another way.

Hope this helps! Dr. Blythe

May 4, 2011

It’s starting to get really hot out, and my 7-year-old son loves playing outside. He drinks plenty of water, so I’m not worried about dehydration, but I am concerned that too much time in the sun could be bad for him. How long can he play outside on these hot summer days before he needs to come in for a break? — D.R., Plantation

With the weather getting warmer, your question arrives with good timing! When school ends for the summer, it will be even more important. Having your son drink plenty of water is the right thing to start with. Kids usually do not need sports drinks, unless they are sweating for an hour or more. Sure the body loses some electrolytes, but if he is not sweating for extended periods of time, his body can adjust. Now, when your son is seventeen rather than seven and is playing football in full pads for two hours in the hot sun, an electrolyte filled sports drink will be a good idea.

As for how long is too long to be outside – try not to think about a specific amount of time. Among other things, it depends on the activity, the heat and the child. Start the activity with a good sunscreen and watch for signs that the heat is affecting your child. Sweating excessively, cramps, dizziness, nausea or weakness are signs of overheating and demand cooling down and water. More importantly, you have to be wary of skin that is hot and red but dry, strange behavior, confusion, vomiting or refusing water. These are late signs that the body’s cooling mechanisms are overwhelmed and mean that you now have a medical emergency called heatstroke or sunstroke. This means calling 9-1-1, or your local emergency number.

While heat related illness is more prevalent in the summer as temperatures rise, parents and kids being aware of the signs mean that fun in the sun can still be had.

Hope this helps!

I have two daughters, 3 and 5, and it seems like they keep passing a cold back and forth. Any suggestions for how to get them both feeling better while limiting the possibility of them passing the problem back and forth? ? H.E., Delray Beach

Preventing the common cold is a worry of many parents! Without being terribly ill, children can still be miserable. Whether this is the same cold being passed back and forth or more likely a series of different colds, you still take the same preventative measures.

When coughing or sneezing, use a tissue or handkerchief. If neither is available, try using an elbow rather than a hand. In addition, wash little hands after using the restroom, touching the face, eating, coughing or sneezing. Do not share utensils, toothbrushes or cups and be sure to wipe down surfaces that they touch regularly like door knobs, handles, toys, etc. Keeping children away from tobacco and cigarette smoke also protects them from being more susceptible to colds.

As for colds that have already come and gone, consider them protection from the next time your children see that particular cold virus.

Hope this helps!

Apr. 27, 2011

Our newborn is spitting up all the time. It seems to happen far more often than it did with our first child. Is there a reason for this, and is it anything to worry about? — D.D., Pembroke Pines

The good news is that, most likely, there is nothing to worry about. The bad news is that you probably have tons of laundry in your future. All babies will spit up a little and some babies can spit up a lot.

As long as your baby is growing well and does not seem to be in pain, the spitting up should not be a problem. If your baby seems to be in pain when spitting up, talk to your pediatrician about thickening the feeds with baby rice cereal to start. This allows the mixture to be thicker so it does not come up as easily.

If you have tried thickening every feed and your baby seems to be in pain, is not growing well, or has projectile vomiting, it may be time to consider other ways of helping. Your pediatrician will take into account your baby’s past medical history in deciding what else should be done. Most babies will grow out of spitting up without much intervention, it just seems like it lasts forever.

Hope this helps!

Apr. 20, 2011

How soon after a baby is born can he or she travel on an airplane? — J., England

A good idea is to wait until two weeks after they have had the first set of vaccines. This allows the baby’s body to have an immune response to the vaccines. Most pediatric offices give these at the two-month-old appointment. If you need to travel prior to that, you can give the vaccines a little earlier. Talk to your pediatrician about the timing, as it will depend on your baby’s medical history. In addition, use good hygiene. Do not let strangers or siblings with dirty hands touch the baby and bring a cover to protect from people coughing.

Now, this doesn’t change the fact that babies’ ears are hard to clear. While adults can chew gum or move their jaw to clear the ears and relieve the pressure, babies cannot. To help your baby with this, give a bottle or breastfeed on take-off and landing. For babies, the act of swallowing helps relieve the pressure.

Hope this helps!

My son is 11 months old and has been having nightmares the past few weeks. He whimpers in his sleep and will even at times have tears. When he is awake he is a very happy baby always playing and smiling. A friend told me they had the same issue with their son at about the same age and were told it was separation anxiety. Is this a common occurrence at this age and about how long does it usually last? ? C.M., Miami

As strange as it seems, babies can have nightmares (though some may debate this). Despite his age, which is appropriate for separation anxiety, it does not seem like your son’s problem is related to separation anxiety. While awake, he is happy and playful and has no problems with separation anxiety. He may just have nightmares.

There are a few things to do to help him sleep easier. Make sure he has a nightlight. Have him sleep in the same place every night. If you do watch small amounts of television with him, do not do it directly before bedtime. Also, if he wakes up crying, you may want to take him to see his pediatrician to rule out causes of nighttime pain/waking such as ear infections or teething.

Hope this helps!

Apr. 13, 2011

My three-year-old seems really resentful of his new little sister. Ever since she’s been born, he’s seemed upset, even though we still go out of our way to give him plenty of attention. I know it can be hard on kids when a new baby is born. Are there any suggestions you have for cheering him up? A.D., Pembroke Pines

Thank you for asking this question! Many older siblings are jealous of new babies. The child who has always been your perfect little angel is now unrecognizable.

Even when you go out of your way to give the older child plenty of attention, it is still only a portion of your attention. There was never the need to share your attention before and even three-year-olds notice this.

Even though a mother’s natural instinct is to pay the most attention to the new baby, make every attempt to flip that time to your older child. Your newborn needs very few things except nutrition and shelter. Spend your precious little extra time showering your older child with attention. Try to spend as much alone time with him as possible.

For mother’s who are expecting their second child, bring a present home from your baby to the older child. This should not be anything big or expensive. Consider it attention from your baby to your older child. Also, try to have anyone who comes to see the new baby pay attention to your older child first. Most importantly, try to have fun with your new family.

Hope this helps!

Apr. 6, 2011

How young is too young for a flu shot? My 8-year-old suffered with a terrible bout of the flu this year that lasted two weeks and only recently got better. It’s not something I want her to go through again if I can help it. Should I plan to get her a flu shot next year?–V.E., Wellington

Yikes! I am so sorry he had to go through that! Influenza , or “Flu”, makes kids much more sick than a common cold. The Flu is a serious viral infection that may make kids miserable. Unfortunately the Flu is still showing up, even though it is already April. In my pediatrics group, we are continuing to vaccinate against the Flu until May this year.

The Flu vaccine is recommended yearly for people age 6months and older, with very few exceptions. The vaccine comes in a nasal spray or shot. The nasal spray can be used for two-year-olds and older, unless they have certain chronic diseases. In addition, for eight-year-olds and younger, a second booster vaccine will be needed during the first flu season that they are vaccinated.

Talk to your pediatrician about getting the Flu vaccine next year and maybe even this year.

Hope this helps!

My 3 1/2-year-old daughter refuses to use the potty for her bowel movement. She has no problem using the potty otherwise, but she asks for a diaper for a bowel movement. I’ve tried to stop using diapers, but it only led to severe constipation and cramps. She ended up having her bowel movements at night in her sleep. I have read that children with this issue will eventually use the potty and not to force the issue. What do you think? Any suggestions? Thank you!–B.B., Hollywood

Do not worry! This sounds very normal. Many kids resist using the potty for bowel movements, even when they will use it otherwise. There are some tips you can try to help things along.

Having your child sit on the potty for five to ten minutes starting about fifteen minutes after meals will make use of the body’s natural reaction to have a bowel movement soon after eating. You can read your child a book to distract them. In addition, having a chart with stickers given for the days they use the potty will reward them. If you feel it is becoming a fight, do not force the issue. Come back to it in a week or so.

Sometimes the difficulty is in the act of having a bowel movement itself. If a child is constipated, it hurts. If it hurts, kids will “hold it”. Try fruits like prunes, pineapple and watermelon. If the bowel movements are still hard after increasing the fruits, talk to your pediatrician. Another thing you can do is to get your child a crate or stepstool to put her feet on. It can be difficult to have a bowel movement when the feet are not touching something. Try picking up your own feet the next time and you will see what I mean.

Hope this helps!

Mar. 30, 2011

What precautions should be taken at school for a six-year-old with dairy allergies? — E.W., Miami Beach

You are doing the most important thing by thinking about it! First, make sure both the school and your child know about any food allergy. Most schools are pretty good about keeping kids away from their allergy causing foods. However, other kids do not know what to do.

Even if you pack your child’s meals and the school knows…kids trade food. It happens. Tell your child of the specific allergy and take him grocery shopping with you. Talk to him about his allergy and show him the foods he should avoid. Make him an active rather than passive part of his food choices.

In addition, talk to your pediatrician and see if there are any medicines your child should keep with the school nurse.

Hope this helps!

Mar. 16, 2011

What do you think of hand sanitizer? My 10-year-old daughter rubs it on her hands all the time. I know it’s supposed to kill germs and that’s good, but I have friends who tell me that it doesn’t work, and only makes the germs stronger? I don’t want my child using it if it’s dangerous.–H.H., Davie

Both your daughter and your friends are partially correct! Hand sanitizers do kill some germs and in most cases are very safe. Regular use should be fine, but problems with hand sanitizers arise when they are used too often.

Since the majority of sanitizers are alcohol-based, they can dry out the skin. When skin gets too dry, it can become brittle and crack. These cracks in the skin are a risk for infection. Our skin is one of the greatest barriers against infection that we have. Keeping our skin moist and healthy is very important to our overall health.

My preference is for good old-fashioned soap and water, but hand sanitizers can be used on occasion for when you cannot get to a sink.

Hope this helps!

I’ve read in many places that you should not give honey to babies, because it can cause botulism. Why is it dangerous for babies, but not for older kids or adults? –R.T., Hollywood

No doubt your friends have also wondered about this question. While eating honey, your baby (or anyone else) can ingest the botulinum spores. Because of the immature digestive system of babies, these spores can colonize and multiply much more easily than in adults or older children. The increased spores allow for increased toxin. The botulinum toxin is what causes the symptoms of botulism, so more toxin equals more symptoms.

By the time your baby is one year old, the American Academy of Pediatrics considers honey to be safe. However, you will still hear many pediatricians stick to the recommendation of no honey until two years old.

Hope this helps!

Mar. 9, 2011

I know this is going to sound strange, but my 4-year-old has a thing for eating dirt. She doesn’t eat it in huge amounts, but if we’re at the park or the playground with other kids, she’ll sometimes pick up a handful and just eat it. I don’t think this will kill her, but is there anything I should be really worried about? I think this phase will eventually pass. — K.Q., Deerfield Beach

Actually, it does not sound strange at all! About one in four kids, usually between ages one and six will have cravings for non-food items. This condition is called pica. Most of the time it lasts a few months and goes away on it’s own. Among other things, it can be just a habit, a desire for the different texture, or a sign of low levels of a certain nutrient. Interestingly enough, women can experience these same cravings when they are pregnant.

When you see your pediatrician, report what it is that your child is eating. Most pediatricians will want to look for anemia and lead levels, at least. Depending on what is being eaten, they might look at other things as well.

It can be challenging for parents to deal with pica. Some kids respond to mild punishment like taking them home from the park if they eat dirt there. Some just need to be distracted with an alternate healthy snack. Importantly, talk to your pediatrician about what might work best for your child.

Hope this helps!

Mar. 2, 2011

I have a 7 week old little boy, he was born premature and takes Similac Neosure Formula, He seems to be constipated a lot. Everyone says give him Dark KARO Syrup, is this ok, it seems to work sometimes. Is this ok or is there something better we should be doing? We are going to call his Doc. Monday but would like your opinion. — C.M., Hickory, N.C

Most importantly, keep him on the special formula for premature infants until talking to your pediatrician. In addition to having more calories per ounce, there are nutrients specifically added for the premature baby. Similac Neosure and Enfamil Enfacare are two widely available premature infant formulas.

Whether or not a baby is constipated can be very confusing. It really depends on what is inside the diaper. If days pass between stools and it is soft, he is not constipated. If he has daily hard, little, rabbit pellets, there is some constipation. If you are worried because your baby seems to strain to stool, most likely you have nothing to worry about as it takes time for babies to get the muscle strength needed. Breastfed babies tend to stool more often, but not always.

If your pediatrician agrees that he has constipation, Karo syrup is a good place to start. Your pediatrician may also recommend adding a small amount of prune juice to each bottle. Likely one of these options will work for you. There are suppositories for babies but they can be tricky and I try to avoid them. If your baby is still constipated, let your pediatrician know so you both can decide on the next step.

Hope this helps!

Feb. 23, 2011

When can I introduce eggs to my baby? I have an 8 month old, very healthy boy with no problems of allergies or anything else. He drinks a gentle formula because of some gas problems he had. He is eating solids and has not had any problems at all. — A., Fort Lauderdale

Great question! It is also one for which you have probably found many different answers. Eggs are one of the most common sources of food allergy, along with milk, peanuts, treenuts, soy, wheat, shellfish and fish.

Most pediatricians will advise waiting until 1 year old to introduce eggs into your child’s diet. However the source of egg allergy mainly lies in the egg white, so introducing egg yolks at 8-9 months is fine. In order to make it safe, hard boil the egg and then peel off the egg white. Simply separating the egg will leave small amounts of the egg white in the yolk. Now if this sounds like a hassle to you (as it does to me) or you just want to be conservative, wait until 1 year old to introduce eggs.

This all changes if your child has a close family history (sibling or parent) of egg or severe food allergy or your child has bad eczema. In this case, there is a higher risk of allergy and waiting until 2 years old to introduce eggs is a good idea.

Hope this helps!

We are sending our 8-year-old to sleep-away camp for the first time this summer. I know it’s well in advance, but are there any specific medications or other items we should plan on packing to make sure he’s got everything he needs? Also, are there any shots or other things we should do before he goes? — L.D., Weston

Sleep-away camps make most kids excited and many parents anxious. Your son should have a great time and getting out of our comfort zones and learning to adapt is good for both kids and adults.

It is good to start thinking well in advance. Like schools, often camps are going to have over-the-counter things like Tylenol, Motrin, Benadryl, etc. Most likely, all you have to do is sign a consent to have the camp administer them per package instructions. The medications you do have to take care of are the prescription medications. Talk to your pediatrician about any daily medications that your child takes and what you need to do about them.

As for camp shots, keeping your child up to date on the required school vaccines is a good start. In addition, the American Academy of Pediatrics has recommended vaccines. In Flu season, the flu vaccine should be given. If eleven or older, the meningitis vaccine should be up to date. Most pediatricians will have recommended these while you child was getting the required shots for school. Before you tell your child they need more shots, call the pediatrician to see if they have already had them. If your child is going to camp out of country, go to the Centers for Disease Control website (www.cdc.gov) or a travel health agency, like Passport Health (www.passporthealthusa.com). The recommendations for preventing malaria vary depending on geographic area and other specific foreign country requirements change constantly. However, if it turns out you only need to prevent malaria, your pediatrician should be able to write you a prescription.

In addition, most camps will have a list of things to bring and some require physical exams with the pediatrician. Other good ideas are a favorite comfort item, like a pillow, blanket or toy and cell-phones with chargers. Also, do not forget sunscreen and insect repellent. Most importantly, if your child will be near pools, lakes, or rivers, swimming lessons are a must. Please make sure your child knows how to swim.

Hope this helps!

Feb. 9, 2011

My 15-months girl runs all over the places and always hits here and there. Last night, she hit on the corner of the wall and got bruises and bleeding on her forehead. She cried about for a minute and then played again as usual. I put Neosporin on the bleeding area, and baby does not want me put the ice pack on her. As a first time mom, I am always worried when things happened like that. So could you please tell me 1) what should I do to treat the wound after the falls and bumps, and 2) when should I be concerned and call the doctor? — C., Naples

Congratulations on your girl being so active at a young age! You must be very proud of her mobility. Unfortunately for kids, coordination lags behind mobility and that means lots of lumps, bumps, scratches and scrapes. As for what to do, your instincts are great.

If there is any open skin, be sure to clean it well first with running water and then with hydrogen peroxide. Afterwards, put on a triple antibiotic cream, like Neosporin. If the skin truly splits open, see your pediatrician soon after the injury. Depending on the size and depth of the cut, it may need to be closed using stitches, Steri-Strips (skin tape) or Dermabond (skin glue).

For bumps on the head, ice will help bring down swelling that can be quite large and scary to parents. Fortunately, ice can help quite quickly. Unfortunately, most toddlers will not sit still for the ice. If you wrap a thin towel around the ice pack (or package of frozen peas), your child will not startle as much. If it is still to traumatizing, just forget about it. Icing does not help much after the first twenty four hours anyway.

When to be concerned is when a child is not able to be consoled or vomits, loses consciousness or acts in an unusual way, has seizures or severe headache, the bone feels uneven or there is a cut that may cause significant scarring. If any of these happen or your mommy instincts say something is not right, please go to the emergency room immediately.

Hope this helps!

Feb. 2, 2011

My 1-year-old is in day care and is constantly getting a cold which will include runny nose, cough and ear infections 100-percent of the time. I have taken him to an ENT who suggested tubes in his ears as he observed some fluid behind the eardrum but is there another alternative that I can try first? Would requesting a vitamin prescription from his pediatrician be a smart move or should I go right for the tubes in his ears? I would like to avoid a surgery for my little one if there is a less invasive alternative that works. Thanks! — C.M., Pompano Beach

The question on whether to have surgery or not is always a complicated one. You are doing the right thing for your child by asking questions. The final decision may still end up being tubes, but you will know that you looked at all the options first.

Let us start with the basics on why healthy kids get ear infections after colds. The middle ear (behind the eardrum) drains into the back of the throat via the Eustachian canal. Often with colds, this canal is swollen shut and the fluid cannot drain out. The more bacteria that are in that fluid and the longer that fluid stays, the higher the likelihood that an ear infection occurs. As we get older, the size of the Eustachian canal grows larger and the angle makes it easier to drain.

Ear tube surgery is for kids whose infections or fluid build-up are chronic and there are guidelines followed by ENT doctors (ear, nose and throat specialists). If your child’s medical history is consistent with these guidelines, ear tubes may be recommended to improve speech and hearing, decrease infections or both.

The least invasive alternative is simply waiting it out. Your child will have more infections, more fluid and potentially more antibiotics, but time (years) usually will cure this problem. Evidence of this is that few adults get ear infections. Also, the reason I said potentially more antibiotics is that most one-sided ear infections will resolve without antibiotics by just waiting a few days to start the antibiotic.

Another alternative is trying to decrease the fluid by decreasing the swelling near the Eustachian canals. Your pediatrician, or ENT, may recommend antihistamines or decongestants depending on the age of the child. If you can get the fluid to drain, the likelihood of ear infections or speech/hearing problems decreases. Better this can happen without tubes, but sometimes they are necessary. Please discuss the choices with both your child’s pediatrician and ENT.

Hope this helps!

Jan. 26, 2011

My daughter is 11 years old and still wets the bed. Even though she goes to the bathroom just before bed, limits her liquids, if I don’t wake her a couple of hours later, she will wet the bed. When I do wake her and she goes to the bathroom, her bladder is FULL like she hasn’t gone all day. Often, even though she and the bed are wet, she still doesn’t wake up. It’s very frustrating for both of us. What could be causing this problem? I have already taken the necessary steps to prevent this from happening, but it doesn’t work. ? S., Fort Lauderdale

The two of you have really been working at this! Primary nocturnal enuresis frustrates many parents and children. It is more likely to occur in boys and often runs in families. You might not know however because adults usually are not readily open on the fact that they wet the bed as a child. Ask family members privately and you might be surprised.

You are correct that limiting fluid intake is a must. Try no extra fluids after 7pm. Many times it is the little things that get in the way. Kids will drink water after brushing their teeth and not even realize how much they consumed. When asking your daughter, ask how much water she drinks rather than if she drinks water. She can still say “none” but it does not put her on the defensive and you will be more likely to find out if she is drinking something.

Emptying the bladder just prior to bed is also imperative. In addition to this, have your daughter empty her bladder just after dinner. Caffeine needs to be cut out of her diet as well. Caffeine inhibits ADH (anti-diuretic hormone). ADH helps us maintain bladder control. Another influencing factor might be constipation, where the stool fullness presses on the bladder. Urinary tract infections and stress, among other things, can cause enuresis as well.

If strictly avoiding later evening fluids, cutting out caffeine and emptying of the bladder prior to bed do not help, talk to your pediatrician about other possible medical reasons and options that take into account your child’s personal medical and social history.

Hope this helps!

Jan. 19, 2011

My child was born heavy, around 10 lbs. He’s now one-year-old and he continues to be on the heavy side. At what point should I start to be concerned that my child is pre-disposed to being overweight, and what can I do about it? ? A. ? Fort Lauderdale

Do not worry! You definitely do not need to do this alone. First thing to do is decide if there is a weight concern. Please talk to your pediatrician about whether your child is actually overweight. If they are taller, they should weigh more. If they are shorter, they should weigh less. Every patient at a pediatrics practice has a growth chart. Your child’s height and weight percentiles should be similar. If your child’s weight percentile is significantly higher than the height percentile, you may have something to think about regarding weight.

Being overweight is both one of the simplest and the hardest problems to address. The easiest way to think about maintaining weight is that calories in need to equal calories out. By that I mean the calories that are consumed need to equal the calories that are expended. We gain weight when the calories we eat or drink are greater than the calories that we burn.

During childhood, the calories we eat or drink should be more than the calories we burn. These are times of incredible growth and development for our bodies and brains. It can be difficult to get the right balance of calories. Unless there is an enormous difference between height and weight, the focus at one year old would be on maintaining the weight until you child grows into it. One good way to do that is to decrease the amount of juice.

Fruits and vegetables are very healthy. However, by making them into juice you remove most of the fiber, as well as any nutrients in the skin. Most of the time you are just left with the sugar water. Yes, it is all natural sugar water with some vitamins, but it is sugar water. Why do you think kids like juice so much? Just 4-5 four ounce sippy cups of juice can equal one fifth of the daily calorie requirement of a one year-old. In addition to the 16-24 ounces of milk per day, give water. If your child doesn’t like water, try mixing juice and water together. Slowly add more water and less juice.

Talk to your pediatrician about other ways that might fit your child’s personal needs. Just ask us, we are here to work with you.

Hope this helps!

Jan. 12, 2011

Can camera flash hurt a baby’s eyes? A.S., Jupiter

Great question! Given the amount of pictures babies have taken, there are lots of parents who are glad you asked. Feel comfortable that your baby’s eyes are safe. What I think you are referring to is something called “Flash Blindness”.

Flash Blindness is not actual blindness, but rather a momentary state where the eyes are overwhelmed by the bright light. The worst thing that will happen is a subsequent funny looking picture because your baby cannot seem to focus. Wait a minute before taking another picture and your baby will be able to focus again. This effect will be even more exaggerated at night because the pupils are more dilated and let in more light. You may experience a similar sensation when you walk outside into bright sunshine from a dark building. While it might feel strange, it is not dangerous.

Hope this helps!

Jan. 5, 2011

My 5 year-old son has a recurrent problem with peeling lips. Every couple of days the entire top layer of both lips will peel off. He does not have any rash, sores, mouth infections or odd chewing habits. This has been going on for around 6 months. We constantly apply plain Vaseline lip balm and will scrub them with a washcloth when they get too scratchy. Do you have any ideas or suggestions? — J.H., Kansas

This sounds like cheilitis, or dry, chapped lips, and can happen for many different reasons. One of the most common of these is environment. Cold or windy weather pulls the moisture from the skin and causes the person to lick their lips. This creates a frustrating cycle and makes the lips worse. Unfortunately, it is quite hard to get a kid whose lips hurt or itch to stop doing the one thing that makes them feel better. One way to help almost any cause of cheilitis is to moisten the lips well with plain water while being as gentle as possible. After the lips are moist and your child can smile and talk without problem, cover them with plain lip balm to trap in the water. Take care not to use any lip balms that cause the lips to tingle as these may have menthols and can actually cause the lips to dry out even more. Also, be wary of lip balms that taste good as this causes children to lick their lips, thereby removing the lip balm.

Dehydration caused by exercise, sunburn or high fever can also be a reason. While you can also use the above advice, the most important thing to do here is to drink more fluids. If your child has an illness and is not drinking much at one time, encourage sips very frequently and offer popsicles. Pedialyte popsicles are a great thing to have in the freezer and can be a sanity-saver for parents. If your child does not like Pedialyte, you can use Gatorade or Powerade. Pedialyte is the first choice though, as it has more electrolytes and less sugar.

Thumb-sucking is another possibility for dry lips and one of the hardest to tackle. Like any bad habit, there are a myriad of ways to address the problem. Whichever you choose, try to place the majority of attention on alternate good behaviors while giving as little attention as possible to the bad habit.

If none of these suggestions help, talk to your pediatrician about other possible causes that take into account your child’s dietary and medical histories.

Hope this helps!

Dec. 29, 2010

I recently had a baby and am concerned about him getting his vaccines. I’ve read articles claiming that vaccines can cause autism. I’ve also seen articles saying this is not true. Which is it? Is there a way to get him the right vaccines while limiting the risk of problems? — K.K., Davie

Rest assured, vaccines do not cause autism. However, even though that is true, parents should not have to feel pressured or forced into anything concerning their children. The relationship with the pediatrician should be collaborative one. There should be give and take going in both directions. Parents should be able to ask about anything regarding their child. Good pediatricians should welcome and not feel threatened by questions. But those questions go in both directions. Do not feel threatened by the pediatrician asking why you are hesitant on vaccines or want an alternative schedule. Those questions are also part of the collaborative relationship. Use these questions as a way to get to know the pediatrician better. Remember, both of you are asking questions because you want to know what the other one thinks.

Most pediatricians, including myself, agree with the American Academy of Pediatrics (AAP) recommendations on vaccines and their scheduling. This schedule can easily be found on the AAP website, www.aap.org. However, there are certainly a multitude of alternative vaccine schedules from which to choose. In order to feel more comfortable about vaccines, research them. Look at the AAP website and the Centers for Disease Control website (www.cdc.org). If in your research you also want to look at alternative schedules, go ahead but make sure you are looking at websites done by medical experts. If a parent comes to me and wants to give the vaccines but simply on a different schedule, I am happy to work with that even though my first choice is the AAP schedule. This is all part of the collaborative relationship that should be valued very highly.

Hope this helps!

Dec. 22, 2010

My 9-year-old has terrible allergies. Almost every day he wakes up with a runny nose, sneezing, itchy eyes, etc. We’ve tried everything from Claritin to steroid nasal sprays, and nothing seems to do the job. In the case of the nasal sprays, they stopped the nasal symptoms, but caused side effects that were too much him to tolerate, so we had to stop using it. Do you have any other suggestions for how to keep these symptoms under control? ? D., Fort Lauderdale

Allergies can be very frustrating to parents. While parents know their kids are not “sick”, parents also know those same kids can be miserable. From your question, it seems that your son has allergic rhinitis, also known as hay fever or nasal allergies.

Antihistamine over-the-counter medicines can help mostly with the itching, sneezing and runny nose. Decongestants can help with congestion but may cause your child to be cranky. If these types of medications do not help, your pediatrician may prescribe other allergy medications.

Steroid nasal sprays are very effective for allergic rhinitis, but the side effects can be irritating. Good technique in using the spray is helpful. First, clean out the nose with saline and blow the nose prior to using a steroid nasal spray. The medicine will hit the skin and not the mucus. When already inside the nose, aim the bottle tip toward the same side eye for the first spray and toward the same side ear for the second if prescribed. This allows the spray to be deposited on the correct part of the nose (the nasal turbinates). If the tip is inserted straight into the nose, the spray can be left on the middle part of the nose called the nasal septum. The nasal septum is very sensitive and easily dries out, leading to nosebleeds or nasal dryness and irritation. When used correctly, this same effect on the nasal turbinates causes the allergic runny nose to stop the constant drainage. Another bothersome side effect can also be helped by good technique. Snorting the spray can lead to a bad taste in the mouth because the spray has moved past the nose into the throat. Instead, simply sniff the spray like smelling a flower and the medicine will stay in the nose. By using good technique, you can get more out of the steroid nasal spray and have fewer side effects.

Ways to keep allergies under control without medicine start with finding out what your child’s allergies are. Some tests are available through your pediatrician. Some tests need to be done at the office of an allergy specialist. When you know what your child’s allergies are, you can learn techniques to avoid the allergic triggers. Here are a few examples. If your child is allergic to pollen, keep the windows closed and avoid outdoor activities when the pollen count is high. If the allergy is to cockroaches, do not leave food or dirty dishes out and call an exterminator. If allergic to a beloved pet, do not let the pet into the bedroom or onto the furniture. If dust mites are the problem, cover mattresses and pillows with allergen proof covers and avoid carpets, cloth curtains, extra pillows or stuffed animals on the bed. In addition, wash bedding weekly in hot (not warm) water and use HEPA filters.

Hope this helps!

Dec. 15, 2010

My friend’s baby has rash a week after his one-year chicken pox and MMR vaccines. The rash has lasted for two weeks and most of it is on his back and chest with a few spots on the legs and arms. My friend thinks it is a normal reaction from the vaccines. But I noted that the rash areas are red with blisters on the top. So I have two questions: 1) is this the normal side effect from vaccines? And 2) is it contagious to other kids who have been vaccinated? – R., Miami

Poor baby! Your friend should discuss it with her pediatrician, but 1 to 5 percent of kids can get a rash after the chickenpox and MMR vaccines. Usually this rash, sometimes with a low grade fever, occurs one to two weeks after vaccination. Often it is at the injection site, but can be scattered as well.

Since you describe the rash as red with blisters, the chickenpox vaccine is probably the culprit. These blisters can take two weeks to crust over and then longer to disappear entirely. Chickenpox vaccinated kids should not worry about the rash being contagious, but unvaccinated or immunocompromised kids should not have contact until the rash is completely crusted over.

Hope this helps!

Dec. 8, 2010

My grandson is 2 years and 4 months. I notice at around 3 or 4 months his soft spot had already grown together. He has been very slow. He did not smile until 3 months or walk until 18 months. He babbles but doesn’t speak words. Not even “mama” or “daddy.” His head has always been rather large and oddly shaped. As a grandmother I am very concerned. I read a article about metopic craniosynostosis. Am I being an overreacting grandmother or is there call to be concerned? ? T.

After reading your excellent question, it seems you have two main concerns, head shape and development. Hopefully, I can help to address both of them.

Craniosynostosis is the early closure of one of the sutures lines of the skull. The suture lines are where the different bones of the head grow together to form the adult skull. Think of it as a puzzle with pieces that fit together once they grow. On top of the head in the front, four different bones will eventually merge. Because of the rounded edges of these bones early in life, there is a space where they do not quite meet which is commonly called “the soft spot”. Actually there are a few “soft spots” to the head that are small and most people are not aware of them.

The frontal “soft spot” grows together somewhere between 9 months and two years. If it seems to have closed earlier, this could be a type of craniosynostosis (of which metopic is one kind). However, it could also be hard connective tissue and not actually bone. Because you report your grandson’s head is oddly shaped, craniosynostosis is still on the list of possibilities. There are some imaging studies that can be done and his pediatrician can help decide which, if any, would be appropriate.

With regard to development, most kids with craniosynostosis of only one suture line do not have delays because the head is able to accommodate the expanding brain by growing along the other suture lines of the skull. Some developmental problems are seen when the skull does not grow because the brain is not growing, rather than the other way around. If your grandson is not speaking any words at two years four months old and his hearing is fine, his pediatrician will probably want to get a developmental evaluation. If he seems to understand everything but simply is not talking, he may just need speech therapy. Many kids, including myself, have needed speech therapy.

Hope this helps!

Dec. 1, 2010

My daughter was delivered by C-section because she was in the breech position. At four months she is still tilting her head a little to one side which concerns me. Do you frequently see this problem in breech babies? At what point should I seek help to correct this problem. My pediatrician said to lay her on her opposite side when she sleeps, but it doesn’t seem to be improving. Any ideas? — M., Fort Lauderdale

The good news is that there are a few different things you can do, depending on how advanced your pediatrician thinks her neck is. It sounds like your daughter has torticollis, or twisted neck. The most common reasons for this lie in the muscles of the neck. And yes, you are correct! Breech position makes it more likely, but so do multiple or large babies, small mommies and difficult deliveries. It can occur because of strain on the neck muscles during delivery or cramped space during pregnancy.

Since you have tried to help this at home and she still has symptoms, a good physical therapist can help incredibly. Even though another appointment takes time out of a new mom’s busy schedule, the results are worth it. Unfortunately, it can take weeks to get the first appointment. Until then, position her so that if she wants to look at anything interesting, she has to turn her head to the side that she doesn’t like. You can move her room around or simply turn her around 180 degrees in her crib. Also, as much tummy time as possible is a must because it gets the head up! As with any baby, tummy time should always be monitored.

Hope this helps!

Nov. 24, 2010

My daughter is one year old. She coughs right after she gets up in the morning almost every day for about a month. Her cough sounds “wet” and it seems like she wants to spit out the mucus from her throat. But she only coughs in the morning and has no other symptoms. I talked to her pediatrician at one year check-up. The Dr. listened to her chest and told us her lung is clear and everything is fine. However, she still coughs now. So my question is what may be the reasons for her morning coughs and should I be concerned? Thanks a lot. ? R., Fort Myers

Two pieces of good news! Her lungs are clear and she has no other symptoms. Without seeing your daughter, what this sounds like is post-nasal drip from allergic rhinitis. You may also have heard the terms hay fever, seasonal allergies or nasal allergies. The wet cough comes from the mucus that drips down the back of the throat when sitting upright in the morning. While it may be scary and seem that she is bringing the mucus up from her chest, in reality it is the mucus dripping down from her nose to the back of the throat. Ask your pediatrician at the next visit if this seems reasonable when combined with her physical exam. If your pediatrician agrees, there are plenty of things you can do. Small doses of the over-the-counter medicines are options, as well as some prescription medicines. Your pediatrician can help you decide which will be best for your daughter.

Hope this helps!

My 28 month old son is anemic. As an infant, I gave him a daily, liquid iron supplement that eventually discolored his adorable baby teeth. When he became old enough to start drinking juice, I began mixing his supplement in his juice which helped to reduce the staining effect.

Now, as a toddler, his teeth are growing in further and I am noticing more and more that his teeth appear very yellow, even though he does not take a liquid supplement anymore.

Is there some way to reverse the effects these supplements have had on the color of his teeth? I certainly don’t want to use a whitener, but are there any remedies you can recommend for naturally restoring or whitening a toddler’s teeth? ? K., Hollywood

Congrats on knowing the trick of mixing iron supplement drops in juice! Not only does it help reduce the staining, but also it makes getting your child to take the iron supplement less of a fight. As for the staining, I am unclear which part of the tooth looks more yellow after growing in further. If it is the part furthest from the gums, this may be from the iron supplement. Usually using baking soda can help clear some of the staining at the time. However, depending on how long it has been since you used the supplements, it is possible that this will not be as effective. Also, baking soda does not taste very good so make sure you have someone helping you. Most toddlers will do their very best to fight you. If the staining is at the gum-line, this make not be staining from the iron supplement, but rather plaque buildup. Toddlers are very fidgety and is can be hard to get them to sit still for a thorough teeth brushing. Either way, your dentist will be the best resource for the staining.

Hope this helps!

Nov. 17, 2010

My daughter is one year now. Do I need to switch from formula to cow milk? I heard that formula contains more vitamins and minerals that the baby needs than milk. Therefore, my question is which is better between toddler formula and cow milk for baby’s growth and development? — J., Fort Lauderdale

Happy birthday to your daughter! I hope she enjoyed the cake and candles. As for your question, it is a good one and is best answered in two parts.

At one year old, we can make the transition from formula to whole cow’s milk. This does not mean you have to do it right away. If you still have a few cans of infant formula left over, use them up. Some kids take to whole milk right away and sometimes you need to transition them with a milk/formula mixture. Slowly make the mixture more milk and less formula.

The goal of the toddler years is to have nutrition through variety. The best food would be a well-rounded diet with whole milk. However, you are correct that toddler formula has increased vitamins and minerals. Some things added to toddler formula are iron, vitamin c, vitamin e, DHA (omega 3) and ARA (omega 6). All of these are available to your child in a well-rounded diet. An easy source of vitamin c is citrus fruit. An easy source of iron and vitamin e is fortified cereals. DHA (omega 3) is readily abundant in salmon, codfish and tuna. ARA (omega 6) can be found in turkey, chicken and almonds. Almonds are also a good source of vitamin e. If your child is a picky eater, you may want to try a toddler formula.

Most kids can get what they need from a well-balance diet and this also helps them to develop good eating habits in the future. With the rise in childhood obesity, starting good eating habits early is essential. Good luck and talk with your pediatrician if you still have questions.

Hope this helps!

Nov. 10, 2010

My 3 year old is complaining of her teeth hurting. I tried brushing her teeth and they were bleeding and little red. A few days ago she had fever but not anymore. What should I do? – W.G., New York

Hi,

Your poor baby! That probably scared her also. While there are quite a few reasons that the bleeding could have occurred, I will cover a couple basic ideas.

If she recently had an infection, then the most likely is something called ITP (Idiopathic Thrombocytopenic Purpura). Basically, her body could be breaking down the platelets in her blood. Platelets help your blood clot, so she would bleed more easily. Usually this just causes easy bruising and bleeding for a temporary period of time. Rarely, is this condition serious or long-term.

Infections, among other things, can also cause suppression of all blood cell types at the same time. This is called aplastic anemia and is more involved. In addition to the platelet problems, there are red cell and white cell problems. White blood cells are the infection fighting cells of our body. If they are low, it is harder to fight off infection. Red blood cells carry the oxygen in our blood. If they are low, we feel tired.

Either of these two things could be the cause of the bleeding, but what it really comes down to is that she needs a blood test at her pediatrician’s office to see if it is one of these two things or something else.

Hope this helps and please get a blood test.

Nov. 3, 2010

My son is five years old and is anemic. I have tried all kinds of iron vitamins, organic chewables, liquid, Flintstones with iron and the taste of all them makes him gag. Getting him to take the vitamin every day creates a bad time for the whole family. Are there any kids iron supplements you know of that don’t taste horrible and also, are there pill vitamins with iron for his age they are supposed to swallow (Can a five year old be taught to swallow a pill whole?)? ? J., Pompano Beach

Wow! It sounds like you really have been trying hard. After receiving your question, I bought a few brands of chewable and liquid iron containing vitamins. After a personal taste test, I can see why your son hates them. They are truly horrendous! One option is that he could take the pills and learn to swallow them by starting with M&Ms or Skittles. The good news is that you can mix the liquid iron supplements in juice or water (not milk because calcium makes it harder for the body to absorb iron). Give him a glass of citrus juice mixed with the liquid iron supplement one hour before dinner and the whole family should be happier.

Now you are probably thinking of two questions. “Why citrus juice?” Vitamin C which is high in citrus fruits helps with iron absorption. “Why one hour before dinner?” Iron is also more easily absorbed one hour before or two hours after meals.

I hope this helps!

Oct. 27, 2010

My grandson is four-months-old and is breastfed solely. At his four month check up his pediatrician said he was concerned about his weight gain and wanted him to be supplemented with formula. My daughter had just started to give him a little stage 1 baby food and rice cereal a couple of days before his appointment. He also said to go ahead and give him more baby food. The baby was in the 25th percentile in height and between the 5th and 10th percentile in weight. He is alert, active, grasping toys, almost rolling over and quite frankly just an all around pleasant baby. He does not look skinny, but he is not a “Gerber” looking baby. My daughter is very distressed and does not want to give him formula. The pediatrician set up an appointment for 1 week after his four month appointment and advised my daughter that if he did not show signs of weight gain they were going to run tests on him. My daughter has not given him any formula but instead is trying to nurse him to the point he is just stuffed. He loves the baby food and she has increased that as well. I almost feel like we are going to create an unhealthy baby by overfeeding him. What do you think? ? K., Dania Beach

First thing to do is congratulate your daughter on having breastfed solely for the first four months. As for the discrepancy between the height and weight, his pediatrician could be worried for multiple reasons. If the pediatrician wants to see him back in one week, they are very concerned. It is rare for pediatricians to recommend supplementing with formula, especially with a mother who has obviously shown she has the skills to breastfeed successfully for four months.

Now, I can only hypothesize (make an educated guess) as I don’t have your grandson’s growth chart. What would make sense is that he is starting to fall off the growth curve. In other words, it is probably not that moment of his height/weight but rather that his “rate of growth” is not adequate.

For instance, if he had been at the 3rd percentile for weight/ 25th percentile for height at the two month visit and increased to the 10th percentile for weight/25th for height, that would be considered a good “rate of growth. While a goal is to be in matched percentiles, the “rate of growth” is even more important. Maybe there is something changing about the milk supply. Between the two and four month visits, moms will usually go back to work. If a mother does not have a place she feels comfortable pumping at work, this can leave 8 or more hours without any stimulation. Being a working mom who breastfeeds can itself have a toll on stress hormones. Also, it may be as simple as dehydration. Milk supply can decrease for any of these reasons. As for overfeeding him, that is very hard to do by nursing whereas with bottle feeding it is easy.

As I do not have all the information, please have your daughter bring her questions to her pediatrician. The pediatrician will want to talk about calorie input, calorie absorption and calorie usage. There are many reasons why a child may not be growing well. Most often, the problem is with calorie input (not enough calories going in). If this is not the problem, the tests the pediatrician runs have to do with calorie absorption and calorie usage.

Hope this helps!

My 11-month-old girl has had a cold for about a week. Her nose is congested very badly. So I have to use saline drops and then bulb syringe to clear the mucus at least 5-6 times a day. My questions if the high frequency of suction will irritate or even harm the baby’s sensitive nose lining? ? J., Plantation

The snotty nose? One of the best ways to get called to pick up your child early from daycare. It really is amazing how much mucus can come out of tiny noses. And yes, if you suction your child’s nose too frequently or too energetically, you can irritate the nasal mucosa (nose lining). Here is something to think about.

Ask yourself why you are cleaning out the nose. At eleven months, a child will be better at breathing out of the mouth than at a younger age. A congested nose may look ugly, but not necessarily need to be cleaned out. However, if your child is having trouble eating or breathing, you will need to suction.

After adding the saline drops to the nose, gently massage the soft part of the nose. This will help mix the saline and the mucus, thereby softening the mucus and allowing it to be removed more easily. Suctioning after gently massaging the nose will be more effective and you will suction less often.

Hope this helps!

Oct. 20, 2010

My son was circumcised at birth. He is 14 months old now. How do I know if he has penile adhesions? — M.W., Pompano Beach

This certainly can be confusing as there are many different versions of normal after a circumcision. Start by gently pulling back what is left of the foreskin. There should be a distinct line between the head of the penis and the foreskin without any overlapping skin. If you see a distinct line most of the way around except where the leftover foreskin seems to be sticking to the head of the penis, this might be a penile adhesion. By cleaning the area, you can slowly (over weeks to months) get rid of minor adhesions that are already there and lower the chances of getting new ones.The foreskin of a circumcised penis should be gently pulled back(never forced) and the area cleaned of any buildup. This white buildup is called smegma and is comprised mainly of dead skin cells.

Also, please take into account that this advice is only for parents of circumcised boys. In boys who are not circumcised, it can be normal for the foreskin to not completely retract until puberty. It should not be forced. If you are still worried, ask your son’s doctor. It is our job as pediatricians and family doctors to not just care for your child, but to answer your questions as well.

Hope this helps!

My baby is now 6 weeks old. At about 3 weeks she developed thrush in the mouth. I took her to the pediatrician and she prescribed Nystatin Oral Solution. We’re about 3 weeks into using this medication and though her tongue has shown some signs of clearing up, she still has the white cottage-cheesy-looking sores in the inside of her jaws. She hasn’t lost her appetite (thank goodness), but sometimes she seems to be in such pain and discomfort. What else can I use since this medication is not working, and how can I prevent this from happening again? — A., Fort Lauderdale

Thrush, a yeast or fungal infection of the mouth, is very common in babies. Yeast thrives in warm moist places and can be quite persistent. Nystatin is going to be the first choice medication for most pediatricians, myself included, because it is effective, safe and readily available. Before going through the hassle of getting a different prescription from your child’s doctor, here is a tip. Try “painting” the white patches with Nystatin before your baby swallows the medicine. By “painting”, I mean dripping the medicine over the white patches. This allows the yeast to be affected both by direct contact and then when the medicine is absorbed. If this doesn’t work, see your baby’s doctor about changing the medicine.

As for prevention, it depends on if you are breastfeeding or using bottles. If you are breastfeeding and having sharp pains that feel like glass splinters when your baby feeds, you could have a yeast mastitis, or nipple infection. Only treating your baby’s thrush won’t help because there is reinfection from the nipple. You may need to be treated, as well. If you are bottle-feeding, thoroughly clean all bottles and nipples and allow them to dry completely.

Hope this helps!

Oct. 13, 2010

Is there any cough medication suitable for a 3 1/2 year old? It seems like all the cough medicines out there are for kids six or older. Your advice is greatly appreciated. — K.L., Miramar

Great question! While there are prescription cough medications available from your child’s doctor, it is difficult finding an over-the-counter cough medicine. One great option available to you is just a simple teaspoon of honey for children older than two years. The thickness of the honey is able to coat the upper part of the throat and alleviate some of the cough. Chestal is a homeopathic cough medicine available without a prescription that also uses the properties of honey for kids two years and older.

Honey, however, will not help with cough caused by problems in the lungs themselves. Two examples of these are pneumonia (a type of lung infection) or asthma. If your child has a persistent cough that seems to be getting worse and is running a high fever, the pediatrician or family doctor should be seen as this may be a sign of pneumonia. If your child has asthma, a cough is sometimes the only sign of an asthma flare. All children who have asthma and a cough should first try their asthma medication.

Hope this helps!

My 2 year old son is having trouble sleeping. He fights going to sleep every night. And then at about 2:30 in the morning he wakes up again. This is something that has recently, and it hasn’t stopped, it happens every night. He snores, and always seem to be congested. Could this be because of his snoring? — N.P., Boca Raton

Hopefully, we can get both of you better sleep! You are absolutely correct that snoring can cause problems sleeping.

Snoring that started relatively recently can be a sign of nasal congestion caused by an infection or nasal allergies. Most infections will have clear to yellow to green mucus coming from and plugging up the nose. Saline (salt water) drops or spray in the nose with a massage of the soft part of the nose can loosen up the mucus so it is easier to suck out with the bulb suction. This helps alleviate the mechanical blockage of the mucus. If the thick mucus lasts longer than two weeks, call and make an appointment with your pediatrician or family doctor to see if you need antibiotics. If the mucus is mostly clear and your child also has itchy eyes and/or sneezing but no fever, this may be a sign of nasal allergies and your doctor can help you find a medicine.

Chronic snoring which causes your child to wake up from sleep can be a sign of obstructive sleep apnea. Listen to your child sleeping and if you think the snoring is so bad that there are pauses in breathing, you should see your child’s doctor. Something helpful to bring is a recording of your child’s snoring. If your pediatrician or family doctor is worried about obstructive sleep apnea, they will refer you to an ENT doctor (ear, nose and throat specialist).

Hope this helps!

Read previous answers from Dr. Noel Alonso below.

July 20, 2010

Q: My 2 year old daughter was diagnosed with “lazy-eye” by her pediatrician. We are seeing a pediatric ophthalmologist and are worried about the long-term effects of this condition. Is she going to be blind? ? Juliet from Hallandale, FL

A: Amblyopia, or “lazy eye” is a condition that affects 3-4% of children, making it the most common reason for vision problems in children.

The brain continues to develop vision from birth to about age 10. If a child has a weaker eye, the brain can “shut down” the connections to the weaker eye, starting a series of events which may result in blindness if not treated early. Therefore, early recognition is important.

Symptoms that may suggest a problem with vision include eyes that deviate or do not appear to function together. The inability to judge depths and frequently bumping into objects may also imply that there is a problem.

Common causes of amblyopia include strabismus (abnormal deviation of the eyes), near- or far- sightedness, and conditions that keep light out of the eye, such as cataracts or abnormal drooping of the upper eyelid (ptosis).

Therapies are aimed at strengthening the weaker eye. Treatments may include patching of the stronger eye for a few weeks to months. Other treatments may include glasses or eye drops. Severe cases of strabismus may require surgery to properly align the eyes.

As a general rule, all children should have their vision checked from ages 3-5 and promptly referred for treatment if there are any problems on the evaluation.

Best Wishes!

July 13, 2010

Q: What is the best advice for sunscreen use in children? ? Jessica from Deerfield Beach, FL

A: When selecting an appropriate sunscreen, it is important to understand the differences between the types of ultraviolet radiation. UV-B light is that which causes sunburns. Sun Protection Factor (SPF) is a measure of efficacy against UV-B rays.

In contrast, research over the last few years has suggested that UV-A light is the most likely culprit in the development of skin cancer. It also plays a role in the aging of skin. A recently introduced star rating system measures a product’s protection against UV-A light.

Parents should purchase broad-spectrum products which will protect against both forms of ultraviolet light.

In general terms, the higher the SPF, the more protection a product offers. Products with an SPF rating of 30 block out about 93% of all UV-B rays. Products with an SPF 50 block out about 97%. About one ounce should be applied prior to exposure and then every two hours to ensure maximal protection. Applying sunscreen as suggested, a typical bottle should last about two days.

Infants younger than one year should be kept out of direct sunlight. Of course, limiting sun-exposure during peak times (i.e. 10 am ? 4 pm), wearing hats and sunglasses, and wearing clothes that do not allow much light through can also aid in protecting from overexposure to sun’s rays.

Best wishes for a healthy summer!

June 22, 2010

Q: My family has lived in the same home for three generations and I am worried about the potential exposure to lead in my son. Should my child be screened for lead? ? Erin from Roslyn, NY

A: It is estimated that about 1/4 of all US children are still at risk for lead exposure. Lead exposure usually occurs from two primary sources ? airborne exposure and exposure to lead chips and dust, usually from lead based paints. Other sources may include old plumbing and even ceramics.

Lead exposure can produce a variety of clinical manifestations, from cognitive impairment to behavioral symptoms. Other findings may include severe anemia, abdominal pain, clumsiness and sleepiness.

The findings of hyperactivity, learning disabilities, aggression and increased rates of delinquency in children and adolescents who were exposed to lead as infants suggest that the symptoms of lead exposure may be life-long.

Current strategies call for testing of all children by age 2, when lead levels reach their peak. Ideally, children should also be checked by age one, particularly if they are at increased risk for lead exposure.

Early detection is critical as delayed recognition can lead to irreversible changes in your child’s development. Your local health department can assess your home’s lead risk and can advise as to any changes that may need to be undertaken in the home.

Best Wishes!

June 14, 2010

Q: How can I best take care of my infant daughter’s new teeth? ? Nicole from Fort Lauderdale, FL

A: Proper care of your infant’s teeth is one of the most effective ways to establish good life-long habits and to prevent the onset of dental caries (“baby bottle syndrome”).

Though every newborn is different, most will have eruption of their first teeth by about 4-6 months. These are usually the bottom front teeth. Teething can cause a variety of symptoms, including fussiness and drooling. Contrary to popular belief, teething does not cause fever or diarrhea.

Care of the teething infant may include teething rings, cold cloths, and pain management such as acetaminophen or topical anesthetics. Though sometimes used in the old days, alcohol should never be used to lessen the pain associated with teething. Infants process alcohol less efficiently than adults and even a small amount may be fatal.

Some pediatric dentists advocate cleaning of your child’s gums as soon as they are born. This can be safely accomplished by using a moist cloth. As soon as your baby’s first tooth erupts, parents can safely begin brushing with a small amount of fluoride toothpaste on a soft bristle infant’s toothbrush. Parents should brush their child’s teeth twice daily.

In addition to brushing, parents should not allow their children to fall asleep with a bottle. Complete weaning from the bottle should be accomplished by about 12-15 months. Furthermore, parents will also want to limit sugary foods or beverages.

Finally, your child should have an initial visit with a pediatric dentist by the age of one. This will help establish a “dental home” for your child and will help optimize your child’s oral health. The American Academy of Pediatric Dentistry (www.aapd.org) has a useful search tool for pediatric dentists in your area.

Best Wishes!

May 25, 2010

Q: My son was diagnosed as having molluscum contagiosum. He has it on his chest, abdomen and legs. My pediatrician says to wait to have them removed. What should I do? ? Irina from Weston, FL

A: Molluscum contagiosum is caused by a virus belonging to the pox family of viruses that infects only the skin. The rash looks like small flesh colored bumps on the skin. On close inspection, they may also have a small indentation in the center.

As its name suggests, it is highly contagious and seen almost exclusively in children with developing immune systems and in adults with compromised immunity.

It is usually spread by direct contact with someone with the virus. The person can also spread it to other areas of their own body by scratching off the surface and touching unaffected skin.

Molluscum is usually self-limited and requires no treatment. These lesions, left alone, can resolve after a period of months though some linger for years.

If treatment is required, it is very similar to that for warts. These may include application of liquid nitrogen, excision with a scalpel, or various topical formulations consisting of acidic solutions or other immune modifying agents. These can usually be done in your pediatrician’s office.

Your pediatrician can help you to decide which course of action is most appropriate. If lesions cover large areas or if on areas such as the face, then enlisting the aid of a pediatric dermatologist may be advisable.

Best Wishes!

May 18, 2010

Q: My daughter was recently diagnosed with a low functioning thyroid on her newborn screen. Her pediatrician wants to put her on synthroid. How serious is this? ? Morgan from Port St. Lucie, FL

A: Currently, all 50 states mandate the testing of thyroid gland functioning in newborns. The stakes could not be higher, as children with delayed diagnosis of hypothyroidism show increased rates of poor growth and developmental and cognitive delays.

Symptoms suggestive of low functioning thyroid (congenital hypothyroidism) may include jaundice, large fontanels, constipation and low body temperatures.

It is recommended that children who have low functioning thyroid (congenital hypothyroidism) start supplementation with thyroid hormone immediately and continue until the age of two to prevent permanent damage to the developing brain.

If the diagnosis is inconclusive on the basis of the newborn screen, your pediatrician may want to repeat levels but will usually start on thyroid hormone pending confirmation, especially if the infant has signs and symptoms suggesting this very serious condition.

Finally, accurate diagnosis is essential thus your pediatrician may want to order imaging studies and more sensitive blood tests to rule out any other cause for hypothyroidism.

Best Wishes!

May 11, 2010

Q: My 11 year old daughter was recently diagnosed with scoliosis. I have recently been reading a lot about specific yoga therapies to assist in preventing the degree of curvature from progressing. Is there anything to this? ? Deborah from Coconut Creek, FL

A: Scoliosis is an abnormal curvature of the spine estimated to affect approximately 2 % of the American population. Depending on the degree of curvature your physician may recommend observation, bracing, or in severe cases, surgery.

Many factors affect the severity of scoliosis including genetics, skeletal age, nutritional status, neurologic system maturity, and the presence of illnesses or certain endocrine diseases. The majority are usually related to heritable causes, and in most cases do not progress beyond adolescence when immature bones become fully developed.

In reviewing the literature for the applicability of yoga to the treatment of scoliosis, I was astonished at the lack of scientifically designed studies measuring its effects. I do know that its use is gaining more traction.

A sensible treatment plan would probably include input from your orthopedist because of the gradually progressive nature of scoliosis. They may recommend other therapies that are proven to delay or halt the progression of the abnormal curvature.

While not all yoga moves would be appropriate in the management of scoliosis, some gentle posture training, stretching, and exercises that would not place undue strain on the abnormal curvature may be used as adjuncts to conventional treatments.

Best Wishes!

Apr. 27, 2010

Q: My husband and I are debating whether or not to circumcise our newborn baby boy. What are your thoughts on this topic? ? Gloria from Fort Lauderdale, FL

A: The decision whether or not to circumcise your son is one that should be carefully considered. Certainly many factors may play a role, not the least of which are personal preference and religious beliefs.

Circumcision involves removing the foreskin to expose the penis and the urethral meatus (the opening which allows urine to flow). Like any other procedure, certain risks are involved. Bleeding, adhesions and increased rate of infection are examples. These are uncommon in the hands of an experienced practitioner.

What about medical reasons for circumcision? There is some evidence that suggests that circumcised males may have a lesser risk of penile cancer and decreased transmission of STDs and HIV. It has also been shown that males that are circumcised carry a slightly lesser risk of developing urinary tract infections. While these reasons may be compelling for some, the differences between study groups have not been sufficient for the American Academy of Pediatrics to recommend routine circumcision.

In consulting with your pediatrician on your available options, be sure to ask about type of instrument used (which may impact post-operative healing) as well as the availability of anesthesia.

Best Wishes!

Apr. 20, 2010

Q: My grandson is 3 years old and had a skin infection with MRSA. Can he get this again and what can we do to prevent this from spreading? ? Frank from Orchard Park, NY

A: MRSA infections are a form of resistant staphyloccal infections. Staphylococci (or commonly “staph”) normally live on the skin of healthy people.

When there is a break in the skin’s barrier, such as by a cut, an insect bite, or a catheter, these bacteria can enter the lower layers of the skin and spread.

Commonly, these infections cause a reaction in the skin, termed cellulitis. The skin may become red, hot and somewhat tender. Sometimes, they may form abscesses and drain pus. Less frequently these infections can spread into the adjacent bone or bloodstream, and infect the heart or lungs.

Children are more susceptible to these infections as a result of less mature immune systems and less than desirable hand washing practices! Those engaged in contact sports such as football or wrestling are at higher risk of contracting MRSA. Finally, the sharing of equipment or living in unsanitary conditions are also risk factors for developing MRSA infections.

As with other infectious agents, handwashing is the most important step in preventing transmission. Other considerations may include not sharing personal items, keeping open wounds covered, and sanitizing linens.

Not all antibiotics are effective for this infection. Your pediatrician can obtain a culture of any draining wound and write for specific antibiotics. Unfortunately, though these infections can be treated rather easily, there are cases where children become colonized and may be prone to repeated infections. In such cases, the entire family may require treatment to eradicate the bug. There is a role here for topical as well oral antibiotics. Bathing in bleach (1/2 cup in 1/4 filled bathtub for 5 minutes twice a week) may also help to control these staph infections.

Best wishes!

Apr. 13, 2010

Q: My 9 year old son was diagnosed with high blood pressure. My pediatrician wants to put him on medication because in spite of having lost some weight his blood pressure remains high. Should he be placed on these medications at this early age? ? Kris from Lauderdale by the Sea, FL

A: High blood pressure in children, or hypertension, is a growing problem in the US. Its associated comorbidities, including obesity, diabetes, hypercholesterolemia, and the metabolic syndrome are also on the rise.

The latest guidelines define hypertension as a systolic (the “high” number) or diastolic (the “low” number) blood pressure exceeding the 95th percentiles for children of comparable age, height and gender. A “pre”-hypertension state exists when the values are between the 90th-95th percentiles.

The American Academy of Pediatrics urges screening blood pressures as part of a child’s annual visit beginning at age three. Children with other underlying medical issues or risk factors should have blood pressures measures sooner in life. Borderline blood pressures should be confirmed by serial measurements made over time.

For those children with pre-hypertension, a reasonable treatment plan would include modification of diet and physical activity. No medications would be required unless the child had associated complications of high blood pressure, such as diabetes, heart disease, or kidney disease.

The management of children in the hypertension category would include medications as well as dietary modifications and increased physical activity. Depending on the severity of the hypertension and because high blood pressure has many possible reasons, the child may need to undergo other testing. This may include blood and urine tests, imaging studies, and tests for specific involvement of other organs, such as the heart, kidneys, or thyroid gland.

The options for treating hypertension are varied, and your pediatrician can help to choose the right plan for your son.

The goal is to prevent the long-term damage caused by high pressures on sensitive organs. The hope is that sufficient control will allow weaning of medications and perhaps elimination altogether.

Best Wishes!

Apr. 6, 2010

Q: My 5 year old daughter had recently become very anxious about staying with anyone except for me. She has anxiety about going to school and even sleeping for fear of having bad dreams. Why is this happening now? ? Alyssa from Crewe, VA

A: Judging by the symptoms you describe, your daughter may be suffering from separation anxiety disorder. It is quite normal for children of this age to exhibit some separation anxiety, but it does require a bit of investigating on your part.

Your letter did not make clear if there were any other significant changes in the child’s structure. For instance, a change of schools, a divorce or a move can cause stress that can show up as separation anxiety.

Patient and frequent communication with your child may help to shed light on the situation. What are her dreams about? Did something occur at school that has made your child anxious or afraid? Is your child being bullied? Are there unrealistic demands on the child? Is your child afraid of what may happen to you? Loving reassurance that you are ever present in their lives may help your child overcome some of these fears.

The timing of these behaviors may also offer some clues. Some children’s anxiety may show up as a physical complaint, such as abdominal pain. Does your child do well on weekends only to have the symptom recur on Monday morning?

Children will model behaviors, including anxious ones. Therefore, speaking to your children in a calm, assertive manner will help avert the transference of parental anxiety allowing a more conducive environment to express their concerns.

If these symptoms persist or impact the family’s quality of life, your pediatrician may refer you to a qualified mental health professional for further treatment which usually consists of behavioral therapy and in some case medications.

Best wishes!

Mar. 25, 2010

Q: My grandson is 2 months old and had a soft, green stool over two days ago. He is now crying and has not had a bowel movement in 2 days. What does this mean? ? Frank from Orchard Park, NY

A: Stools are ever-changing in the first few months of life, and much can be gleaned from their color. Usually, the first 48 hours of life display a change in stool color and consistency from black, tarry stools typical of meconium to the darker green stools typical of the next few days of life.

Stools then usually take on a color and consistency characteristic of their source of intake. Breast-fed babies’ stools are usually mustard yellow and seedy, somewhat runny and without foul odor. Bottle fed newborns usually have tan colored stools which are slightly more formed than breast-fed babies’ stools.

Green stools are usually not worrisome. Sometimes they may be suggestive of an illness, while other times they may be associated with iron fortification, food intolerance or maternal dietary habits in a breast-fed baby.

Your doctor should see your baby immediately if the stools are bloody, the abdomen is distended or firm, or if there is associated fever or vomiting.

Best wishes!

Mar. 23, 2010

Q: My 11 month old son recently had a urinary tract infection and was treated with antibiotics. He is now well but my doctor wants to order a voiding cystogram. Is it absolutely necessary to subject him to yet another test at his age? ? Bonnie from Miramar, FL

A: Urinary tract infections (UTIs) are a fairly common cause of fevers in children. They are much more common in girls than boys and though treatment options for these are fairly straightforward and effective with the use of antibiotics, they require a bit of a workup to ascertain the exact nature and extent of the infection.

First, your doctor will probably order a urinalysis and urine culture in a child, particularly below the age of 2, with a high fever and no other obvious source for infection or risk factor. It is in these children that a diagnosis of urinary tract infection is made up to 15% of the time.

Obtaining a urine specimen is usually best obtained by a catheter which ensures the most accurate result. Sometimes a bag specimen may be obtained but the risk of contamination and false-positive results is high if not done properly.

Your doctor may then prescribe an antibiotic to treat a urinalysis suspicious for an infection and will wait for confirmatory culture results. Once those are known, the decision can be made on how to proceed with management.

A kidney ultrasound is usually obtained in younger children to rule out any potential anatomic abnormalities of the kidney and bladder. This is straightforward and usually not stressful on the child. Your doctor may then order a voiding cystogram (VCUG) or a nuclear study to assess kidney health. This workup is crucial in young children with a first time urinary tract infection or in boys less than 5 because of their higher risk of urinary tract abnormalities.

A complete medical history, physical examination, and family history are pivotal in the accurate diagnosis and treatment of UTIs. Common causes of repeated UTIs include improper hygiene, reflux of the bladder, or congenital abnormalities of the urinary system.

Best Wishes!

Mar. 18, 2010

Q: My 6 month old son has had a rapid increase in his head circumference, and our pediatrician has recommended a head ultrasound. What does this rapid increase in head circumference mean? ? Will from New York, NY

A: Large head circumference, termed macrocephaly, can be familial, congenital (something children are born with) or acquired from many different reasons.

Children’s heads are usually about 35 centimeters at birth and grow about one centimeter every month for the first six months. After that the development slows down to where children’s heads are about 47 centimeters by one year of age. Tracking trends is vitally important, and like weight and length, your pediatrician should routinely measure your child’s head circumference at every visit until about the age of two.

An ultrasound can safely be done through a child’s fontanel (“soft-spot”). This study can adequately assess the size of the brain and its compartments. It can also tell whether the child has hydrocephaly, a condition in which the brain cannot adequately process cerebrospinal fluid (CSF), due to an obstruction along this fluid’s normal path of flow. In this case, a prompt referral to pediatric neurosurgeon is warranted.

Causes of hydrocephaly can include mutations in certain genes, infections, and congenital anatomic abnormalities in the structure of the brain.

There is also one study from 2003 published in the Journal of the American Medical Association where researchers at UC San Diego correlated rapidly enlarging heads to an increased risk of developing autistic spectrum disorders.

Continued vigilance and prompt referral for imaging and subspecialty care are the cornerstones in successfully managing children with macrocephaly.

Best Wishes!

Mar. 16, 2010

Q: My 3 year old daughter collided with a friend on the playground and developed a little egg on the front part of her head. I called my pediatrician and was told to watch her for any changes in behavior. Should my daughter have a cat scan of the head? ? Julie from Cooper City, FL

A: Much research has been done on head injuries in children younger than five and as result guidelines for the management and imaging of little children’s heads have become more specific. The risks of exposure to radiation from a cat scan (CT) must be weighed against the potential yield of such a study.

Historical factors that are important in determining how to proceed include age of child, location on the skull of the injury, the mechanism of injury, height of the fall if any, and surface (for example, carpet versus tile). Your pediatrician may elicit questions as to the child’s behavior immediately after the event and after a period of observation.

If there was a loss of consciousness, vomiting, persistent headache, or change in mental status, your doctor may elect to observe the child for an extended period of time or recommend a CT of the head.

It is important to note that the frontal bone is one of the strongest bones in the body and thus blows to the front of the head are usually less dangerous than those to other parts of the skull.

Though not always preventable, the use of safety devices such as helmets when bicycling or skating should always be encouraged. Proportionally, a child’s head has a larger surface area in relation to the rest of her body which can help explain why head injuries are so common in children.

If your child did not have a loss of consciousness or vomiting, and was acting and appearing normally except for the “egg” on her forehead, I would forego the CT scan and watch for a few hours to assure that there was no change in her status.

Best wishes!

Mar. 11, 2010

Q: My 13 year old daughter complains of frequent headaches. Are headaches inherited? What other treatment options exist beside Tylenol or Advil? Could headaches mean something else? ? Shay from Fort Lauderdale

A: Headaches are very common in children and are usually not related to anything worrisome. They may be related to illness such as the flu or an ear infection, or to the consumption of certain foods such as those with increased sugar content, caffeine, or certain food dyes. Commonly implicated foods include cheese, lunch meats (with their nitrates as preservatives), chocolate, fried foods, caffeinated soft drinks, and alcohol.

Straining of vision such as with watching too much television or playing video games, and adolescent hormonal changes associated with puberty, and lack of sleep are also commonly thought to trigger headaches.

In working up a headache, the most important assessment should be sought from your pediatrician, who will obtain a history and perform a detailed physical examination with particular emphasis on the neurologic system.

Your pediatrician may then offer a treatment strategy or recommend further testing. As part of the evaluation, a thorough check of vision and perhaps imaging studies such as CT or MRI may be obtained.

Some headaches do run in families, but may not necessarily look like those in adults. More recently, migraines have been recognized in young children with increasing frequency. These are unlike typical migraines in adults in that they are usually not as long-lasting and the pain may be on both sides as opposed to the classic migraine headache. They may be associated with the premonition that a headache is about to occur (aura), an aversion to lights or sounds, and muscle fatigue or weakness.

Warning signs of headaches include those that are constantly recurring or waking the child from sleep. Other include those that are made worse by coughing or abdominal straining, those that are accompanied by changes in mental status, fevers, vomiting or rashes as these may signify a more significant cause of headache, such as a tumor or meningitis or encephalitis.

Treatment options may range from biofeedback to acetaminophen and ibuprofen to migraine medications being used with more regularity in pediatrics. Other simpler measures such as placing the child in a dark, quiet room and avoidance of potential triggers should also be part of any treatment plan. A headache journal detailing the circumstances around a particular headache may be useful in diagnosing the types of headaches in your child, particularly if they are of a chronic nature.

Best Wishes!

Mar. 4, 2010

Q: My 8 year old daughter suffered from two episodes of abdominal pain that awoke her from sleep last week. She had no vomiting or diarrhea. The pain lasted for 1-2 hours then disappeared. What is the going on with her? ? Mayra from Hollywood

A: Abdominal pain is a very common complaint in school aged children, and usually the reasons for such are straightforward. It is estimated that up to 15% of all children suffer from abdominal pain with some regularity as to impact attendance in school.

Common reasons for abdominal pain include gastroenteritis (“stomach flu”), reflux and constipation. Other less common but no less important reasons include appendicitis, irritable bowel syndrome, celiac disease and inflammatory bowel disease (Crohn’s disease or ulcerative colitis, for example).

Much can be learned from the child’s presentation ? its location, intensity, and quality (sharp, dull, cramping) can help in the diagnosis. Similarly, any alleviating or provocative factors must be considered. Accompanying symptoms may include diarrhea, vomiting, decreased appetite, weight loss, fever, or painful urination.

A thorough history and physical examination can yield answers in the majority of cases. But in others, your pediatrician may obtain blood work, stool or urine samples or imaging studies to help rule out certain diseases.

Dietary and family history can also aid in the diagnosis of abdominal pain. History of lactose intolerance, multiple formula changes in infancy, intolerance to gluten containing products, or history of autoimmune conditions in family members may help to arrive at a proper diagnosis.

If the reason for the pain is still elusive, a gastroenterologist is often recruited. They in turn may suggest testing such as an upper gastrointestinal series (Upper GI) or endoscopy, as well as more specific laboratory tests.

In some school aged children, a reason for abdominal pain is not ascertained in spite of rigorous investigation. In such cases, a diagnosis of functional abdominal pain may be made. This diagnosis is made in otherwise healthy children, with normal physical exams, and with a negative work-up.

These children often do well after a few weeks without a need for further specific therapy. Some children may benefit from increased fiber in their diets, decreased consumption of sorbitol (an artificial sweetener found in some candies, gum, and fruit juices), and decreasing consumption of carbonated soft drinks.

Finally, as abdominal pain is sometimes seen in children with underlying stress or anxiety, every effort should be made to identify these and implement adequate coping skills.

Best wishes!

Mar. 2, 2010

Q: How many ear infections are too many? My grandson has had six in his 10 months and his ENT has deferred ear tubes. Now they do not want to give him antibiotics either! ? Joni from Fort Lauderdale

A: Ear infections are among the most common reasons for a visit to the pediatrician’s office, and the most common reason for which antibiotics are still prescribed in this country.

The management of ear infections has changed in the last few years, from the role of antibiotics to the appropriate referral for ear tubes if warranted. A number of years ago, one could be justified in sending children for evaluation of ear tube placement if a child exceeded more than a certain number of infections over a predetermined time period.

Nowadays, pediatricians and ENTs are more likely to draw a distinction between acute ear infections and those with fluid behind the ear drum. This distinction is important because it will help to guide management.

Fluid in the middle ear, termed otitis media with effusion, is a common finding in children with concurrent upper respiratory infections or allergy symptoms. This fluid does not produce any clinical signs and will usually resolve over a few weeks.

In contrast, acute infections are usually painful, inflamed and may take on a reddish or yellow color indicative of an active infection in the middle ear.

While antibiotics play a key role in managing acute middle ear infections, there is growing evidence that “watchful waiting” in select patients may be the preferred course of action. In an age of growing antibiotic resistance, many practitioners are advocating this approach.

The majority of ear infections are caused by viruses, and therefore antibiotics will not hasten resolution in these cases. Similarly, antibiotics could be safely withheld in older children (i.e > six months) in which the illness is not severe or where the diagnosis is uncertain. If this is your course of action, there should be a follow-up evaluation in 48-72 hours or sooner if the child worsens.

Current recommendations for referral for placement of ear tubes include those children with persistent fluid in the middle ear (> three months), their hearing status and speech development, and those with other developmental risk factors (e.g. Down syndrome, craniofacial abnormalities). These should be discussed at length with your primary care provider.

Your grandson’s course of management from here should weigh out the relative frequency of infections with the risks inherent to surgery and their overall developmental health. Hearing screens and assessment of speech should be included as part of his routine check-ups.

Best Wishes!

Feb. 25, 2010

Q. My son was recently hospitalized with rotavirus and we found out that everyone at daycare had been sick with this illness. What is this and can he get it again? — Jacinta from Davie, FL

A. Rotavirus infection is common during the winter and spring months and is a leading cause of gastroenteritis (“stomach flu”) and dehydration in infants, toddlers, and small children, particularly those in day-care settings.

Rotavirus causes symptoms such as fever, abdominal cramping and vomiting early in its course, leading to the watery, greenish, foul smelling stools for which this infection is known. Some children may develop a fine, salmon colored rash with the infection. Rotavirus may cause profound dehydration if not treated aggressively and early.

Most children can be adequately managed at home with oral rehydration solutions (for example, Pedialyte or Lytren). Some children may require IV fluids if they are unable to keep up with their diarrheal losses.

As with many infectious diseases in children, prevention is key! Hand-washing is one of the most important measures that one can use to prevent the transmission of rotavirus. Also, hand washing between diaper changes in infants in day care settings can help prevent the spread of infection. Children can shed rotavirus in their stools for up to two weeks after an infection!

There is also a vaccine available for children that helps to prevent the most common types of rotavirus. Though there are different types circulating at any given time, vaccination can help lessen the severity of illness if not prevent it altogether. Children can get rotavirus again, though usually repeat infections are less severe.

Your doctor can perform a quick test of the stool to confirm if rotavirus is present in the stool or if your child’s symptoms are due to something else that may require a different management approach. Best wishes!

Feb. 23, 2010

Q. Could you please talk about the effects of second-hand smoking on children? Beth from Margate

A. Second-hand smoking, that is, the combined exposure to smoke from tobacco containing products and that exhaled by smokers, has been linked to many significant health issues in children.

Infants exposed to second-hand smoke in-utero tend to be of a smaller birth weight and to have an increased risk of pulmonary infections, asthma, and poor lung function. They may also suffer from repeated upper respiratory and middle ear infections. Additionally, many go on to have behavioral and cognitive learning deficits. Most worrisome of all, however, is that infants exposed to second-hand smoke are at four times the risk of dying from SIDS than children from non-smoking households.

If you are a smoker, quitting will improve the overall quality of your family’s health. Your children will also be less likely to pick up this habit if they come from a non-smoking household. If you choose to continue to smoke, try to do so outside so as to minimize exposure.

Best wishes!

Feb. 15, 2010

Q. What are your thoughts on co-sleeping? I read that most cultures engage in this practice, yet it is frowned upon by the medical establishment here in the US. — Angela from Miramar

A. Co-sleeping, or bed-sharing, is a subject that is much debated in the pediatric community. The research supporting co-sleeping is solid in terms of enhanced breastfeeding and maternal-infant bonding, and improved sleep for both mother and child. Stress hormones are also more regulated in children who share a bed with their parents.

The other side of the coin is that bed-sharing can be hazardous under certain conditions. For example, maternal smoking puts the infant at higher risk of death, as does sharing the bed with more than one person. Similarly, parents who are impaired (drugs or alcohol) also place the infant at higher risk for injury. Infants are also at risk for being smothered if parents are obese, over-tired, or if they share a bed with a sibling younger than 11 years old.

Research has shown that room-sharing, not bed-sharing, may reduce the incidence of SIDS and still offer the benefits of co-sleeping. This is also the current American Academy of Pediatrics recommendation for a safe sleeping environment. Infants should be placed on a firm mattress free of pillows, cushions or comforters that may interfere with the sleeping infant. Waterbeds and couches are not proper sleeping surfaces for babies.

Finally, it is worth mentioning that growing infants should always be placed on their backs when sleeping, as this has consistently shown to reduce the incidence of SIDS.

Best wishes!

Feb. 1, 2010

Q: Since my 14 year old son began middle school, he has a problem controlling his anger. He snubs those close to him and does not admit to a problem. My daughter had a depressive episode and I myself use Wellbutrin for anxiety. Is this behavior a sign of depression? What should we look for? — Laura from Lake Stevens, WA

A:. As you are suspecting, depression in children may not manifest as it would in adults. Sometimes children will act out in defiance, anger, or hyperactivity and in turn may be inaccurately diagnosed as having a conduct disorder or attention deficit disorder. If the child is an adolescent, sometimes the behavior may be passed off as normal teenage behavior.

About 5-10% of children suffer from depression at any one point in time. Prevailing theories about the causes of depression support an imbalance in the brain’s neurotransmitters (particularly serotonin and/or norepinephrine). Depression may also run in families.

Children become depressed for many of the same reasons adults do: death of a loved one, a break-up or physical illness, among others. Feelings of sadness and grief are experienced by everyone at one time or another, but are usually temporary. In depression, these symptoms are usually present for longer periods and interfere in many aspects of the individual’s life and functioning. Classic symptoms can range from feelings of sadness, inability to focus or loss of interest in usual activities, irritability and mood swings, and changes in appetite or sleep patterns.

Treatment options may include traditional cognitive behavior therapy, either individually or with the family. Some may be candidates for antidepressant therapy which may help restore the brain’s normal neurotransmitter equilibrium. Children on these medications need to be evaluated prior to and during the initiation phase of these medications as they have been associated with an increase in suicidality in some patient populations.

Depression does not mean that your child is weak, lazy or lacking in any way. It is crucial to remember that this is a real illness that requires immediate attention and evaluation by your pediatrician and a qualified mental health professional. Best wishes!

Jan. 21, 2010

Q. My son snores at nighttime so loud that it wakes us up on most nights. I am worried he may not be getting enough oxygen and worry about the long-term effects that this will have on him. His doctor has prescribed decongestants but these have not helped. I am worried. — Trina from Delray Beach

A. It is important to realize that up to 20 percent of all children snore and that this does not always imply that there is something wrong with your child. Some kids may snore because of a cold but this usually resolves once the cold symptoms improve. Others may snore because of enlarged tonsils or adenoids or because of a congenitally obstructed airway (such as in children with Down syndrome or Pierre Robin sequence). Still other children may have a condition known as obstructive sleep apnea (OSA) in which snoring is a symptom of a more serious problem.

OSA in children is different than that from adults, which is usually related to obesity. Parents may report that their child is not getting enough restful sleep, or that they appear tired during the day. OSA has been linked to attention-deficit and hyperactivity disorder (ADHD), behavioral problems, bed-wetting, and over time, heart and lung problems.

An audio recording of your son snoring at night may assist your pediatrician in assessing the situation. Besides a careful history and exam, your doctor may suggest a course of nasal steroids or decongestants if there is reasonable suspicion that there may be an upper airway obstruction. Though not classically seen in children with OSA, those that are overweight should be counseled on sound nutrition and dietary practices.

Your pediatrician should be alerted to your concerns immediately. It sounds as if your son may need an overnight polysomnogram (a sleep study), done in a hospital setting. This study is considered the gold standard in diagnosing OSA.

Specialty referral may be indicated if the tonsils or adenoids need to be removed, or if the problem is due to a neurologic or pulmonary problem. If the obstruction is due to the congenital anatomy of the child (such as in those children with Down syndrome), then special devices or supplemental oxygen in the form of CPAP can be used to alleviate the obstruction to allow for improved quality of life and more restful sleep.

Best wishes!

Jan. 18, 2010

Q. I think my 16-year-old may be using marijuana but I do not have any proof. How do I know if she is and do you suggest that I look through her things to find the proof I may need? — Graciela from Coral Springs

A. According to CDC statistics up to 25 percent of all teenagers admit to having smoked marijuana at some time. Not only is marijuana use on the rise, but so is the use of other illicit drugs and alcohol. Cigarette smoking, on the other hand, appears to have stabilized according to recent data.

Children who are experimenting with marijuana may show changes in mood, may appear depressed or irritable. Relationships may fracture and your child may seek a new set of friends who are also engaging in marijuana use. In fact, use of marijuana by their peers is the most common reason why a child would start using marijuana in the first place.

Some children may appear disheveled and not care about appearances, and their performance in school may begin to suffer. Children may appear overly silly and laugh inappropriately. Their eyes may appear bloodshot or they may appear unbalanced when walking. The child may also appear somewhat fatigued once the effect of the drug wears off.

Short term problems with marijuana use include elevated heart rate and blood pressure, double vision, dizziness, and disinhibition. Children using marijuana are more likely to be involved in car crashes and to engage in unprotected sex. Long term use is associated with the amotivational syndrome and with the potential for branching into other drugs.

Does this give you the right to spy on your kids?

Absolutely!

Trust is very hard to develop and harder to rebuild once it is broken, and you should not go into your child’s belongings at every fancy. But anytime you suspect that your child may be involved in illegal, immoral or dangerous activities it is your parental responsibility to intervene. Of course, the opportunity to confess should always be offered first to your child, but do not be swayed by their denials or attempts to manipulate you into thinking that you were wrong in snooping.

Your duty to your child is to protect and guide them. If you have evidence that your child is acting inappropriately, or that they are showing poor judgment in important areas of their lives, then it is your right and responsibility to make sure they cause no harm to themselves.

Jan. 11, 2010

Q. My 2-year-old suffered a seizure with a fever a few months ago and I am worried about the long-term effect that this seizure had on her development. Will she continue to have seizures and should I have her on medicine as suggested by her doctor? — Claudia from Hallandale, FL

A. Febrile seizures are common occurrences in young children, affecting up to 3 percent of all children aged 6 months to 5 years. As frightful as these events appear to the observer, most children experiencing this type of seizure will not suffer long-term effects. While many theories exist as to the cause of these seizures, most agree that it is the young child’s immature nervous system that makes them particularly prone to the effects of fever.

It is important to have your pediatrician obtain a careful history so as to pinpoint a cause for the fever. Your doctor may order lab tests depending on the clinical situation. If the seizure does not seem to be typical for that associated with fever, your doctor may have a pediatric neurologist evaluate your child. Examples of other possible testing include MRI/CT of the brain and/or electroencephalogram (EEG) to map specific areas of the brain that may be involved in the development of the seizure.

Children regain their normal function shortly following a seizure. Rarely do children experiencing a first-time febrile seizure require medication to prevent further episodes. It is important to realize that 30 percent of those children with febrile seizures will have a recurrence, but that their risk of developing epilepsy (a seizure disorder) is not significantly greater than that of the general population.

Jan. 4, 2010

Q. My 4-year-old grandson refuses to have a bowel movement on the toilet and instead soils his underwear many times during the day. The child still wears diapers during the day and at night will have crying spells and will have a bowel movement while sleeping. The child’s diet is very poor and I have suggested stool softeners but the parents have refused to use them. What can I do? — Gerre from Boca Raton, Fla.

A. Encopresis describes the leakage of stools in children and is often associated with constipation. The definition of constipation varies for each child. While 3-4 soft bowel movements per week may be ok for some children, other children passing hard stools every day may be constipated.

The treatment for constipation can usually be divided into manageable short- and long-term goals. The short-term goal is to completely empty the bowel in an attempt to restore the normal size and function of the colon. Your pediatrician can suggest ways to do this, but this phase may involve the temporary use of stool softeners (which are non-habit forming), enemas or laxatives. Because constipation implies the passage of hard, painful stools, emptying the bowel also breaks this cycle of pain with defecation that the child has been conditioned to expect.

The long-term goal is to establish regular bowel habits. The incorporation of a nutritious and balanced diet is crucial to a successful outcome. Fiber from fruits, vegetables and whole grains will help promote healthy bowel function. Similarly, the avoidance of processed foods and colas, sugary sweets, and excessive amounts of dairy products will help overcome this problem and establish healthy lifelong eating habits.

Parents should make sure that their children are taking in plenty of water and that they are getting enough exercise. Finally, parents should also ensure that children are setting up regular “potty-times” where they are expected to sit on the toilet from 10 to 15 minutes each day. This will teach children to recognize their own bodies’ signals and urge to defecate.

It is important to remember that treating constipation and encopresis can be a frustrating problem for parents, children and pediatricians. Many children with encopresis suffer from low self-esteem because of this problem. A system that rewards a child for accident-free days can be set-up, and parents can keep a journal to record their results.

Never assign blame to the child, and remember that patience and reassurance will guarantee the highest chances for success. Best wishes!

Dec. Dec. 21, 2009

Q. My son was diagnosed with Type I diabetes two years ago. I am quite concerned with the amount of insulin he is taking. I still have not accepted his condition because neither his father nor I have diabetes, and he passed the glucose tolerance test. Could there be any other medical condition that results high glucose reading? — Kenya from Fort Lauderdale

A. There are many conditions that can result in a person’s blood sugar being too high, a condition termed hyperglycemia. Among these are stress (from increased cortisol levels), infections, and also the consumption of too much sugar or food. The most serious, and thus the one that must be ruled out is diabetes mellitus (DM).

Type 1 (juvenile onset) diabetes is caused by a destruction of the cells responsible for making insulin in the pancreas. No insulin is made.

In Type 2 (adult onset) diabetes, not enough insulin is made. It is interesting that we are now seeing more children with adult onset diabetes, likely related to the surge in childhood obesity. Usually, these children (and adults) can control their blood sugar by maintaining a healthy weight, engaging in physical activity, and by making good food choices.

One of the tests to make the diagnosis of DM is the glucose tolerance test, in which the patient drinks a predetermined quantity of carbohydrate and blood sugar values are monitored over a two to three hour period. It is usually diagnostic in all stages except very early disease, and is more accurately used to diagnose Type 2 diabetes or diabetes associated with pregnancy.

Other tests to make the diagnosis of Type 1 diabetes that can be more reliable and easier to obtain include a fasting blood glucose level, a hemoglobin A1C (HbA1C), and/or specific antibodies or genetic factors that are present in someone with Type I diabetes.

Your case demands the attention of a pediatric endocrinologist who can accurately make the diagnosis, a nutritionist to advise on the dietary and lifestyle choices to be made, and your pediatrician to coordinate follow-up care for your child.

Dec. 16, 2009

Q. My 6-month-old quads have cold symptoms, stuffy noses, but no temperature. What should I give them to relieve their symptoms? — Ethel from Pembroke Pines

A. With all the “regular” cold viruses that give parents headaches and with influenza (seasonal and H1N1) crashing the party this year, there seem to be a lot more runny noses this year than most!

This is a great time to go over some general ground-rules when it comes to dealing with common colds. Most of these are caused by viruses and therefore need to run their course. Antibiotics usually are not needed. There are some cases where bacterial infections can overlap your child’s symptoms and may require antibiotics or other types of medicines. If your child’s cold symptoms do not appear to be getting better after about a week to 10 days, your pediatrician should be consulted for further evaluation.

Always make sure that your child stays adequately hydrated by offering plenty of liquids and monitoring their urine output. Simple interventions such as the use of nasal saline (and bulb suctioning in those less than one year) and continued use of a cool-mist humidifier may offer some benefit to your child.

Is your child suffering from a fever as well? Fevers may be safely treated with acetaminophen or ibuprofen in weight-appropriate doses so as to not necessitate alternating these medications. You can speak to your pediatrician concerning the right dose for your child.

Though milk has never been proven to increase mucus production, it does appear to thicken the mucus that is already there making it more difficult to clear from tiny nasal passages. Limiting milk intake and offering clear liquids would be a prudent idea.

For children older than 12 months, a cough may be treated safely with the use of buckwheat honey (available in local organic food stores). There is some research that supports its superiority over common OTC cough and cold medicines at suppressing cough. One-half teaspoon can be given safely to 1-2 year olds, and one teaspoon to those above the age of two.

While on the subject of OTC cough and cold medicines, it is probably best to not give these to children four and younger. Research has never supported their effectiveness. In fact, the potential for their overdose or abuse has forced the government to limit availability and to completely remove them off the shelves for those younger than four. These should be used with caution and only on the advice of your pediatrician.

If your child is not acting appropriately, runs persistently high fevers, is not improving as expected or is less than two months old, your child should be seen their doctor.

Dec. 14, 2009

Q. My son was diagnosed with Type I diabetes two years ago. I am quite concerned with the amount of insulin he is taking. I still have not accepted his condition because neither his father nor I have diabetes, and he passed the glucose tolerance test. Could there be any other medical condition that results high glucose reading? — Kenya from Fort Lauderdale

A. There are many conditions that can result in a person’s blood sugar being too high, a condition termed hyperglycemia. Among these are stress (from increased cortisol levels), infections, and also the consumption of too much sugar or food. The most serious, and thus the one that must be ruled out is diabetes mellitus (DM).

Type 1 (juvenile onset) diabetes is caused by a destruction of the cells responsible for making insulin in the pancreas. No insulin is made.

In Type 2 (adult onset) diabetes, not enough insulin is made. It is interesting that we are now seeing more children with adult onset diabetes, likely related to the surge in childhood obesity. Usually, these children (and adults) can control their blood sugar by maintaining a healthy weight, engaging in physical activity, and by making good food choices.

One of the tests to make the diagnosis of DM is the glucose tolerance test, in which the patient drinks a predetermined quantity of carbohydrate and blood sugar values are monitored over a two to three hour period. It is usually diagnostic in all stages except very early disease, and is more accurately used to diagnose Type 2 diabetes or diabetes associated with pregnancy.

Other tests to make the diagnosis of Type 1 diabetes that can be more reliable and easier to obtain include a fasting blood glucose level, a hemoglobin A1C (HbA1C), and/or specific antibodies or genetic factors that are present in someone with Type I diabetes.

Your case demands the attention of a pediatric endocrinologist who can accurately make the diagnosis, a nutritionist to advise on the dietary and lifestyle choices to be made, and your pediatrician to coordinate follow-up care for your child.

Dec. 9, 2009

Q. My 11-year-old son has recently been withdrawing from his friends and activities at school, and his grades are starting to drop. A parent of one of his friends called to tell us that the problem is a bully at his middle school. My son fakes illness and is practically in tears as Monday rolls around. What should we do? ? Dan in Coral Springs

A. Bullying is a serious issue. Bullying can negatively impact a child’s self-esteem, can trigger depression and anger, and studies show that victims of bullying sometimes think about suicide. The bully, too, is at increased risk for increased violent and oppositional behavior as an adult. Everyone is impacted by bullying.

First, bring this issue to the attention of an authority figure, be they a teacher, coach, or principal. This can be done without the bully’s knowledge and will alert those in positions of power to the situation.

Teach your child to not to lose his composure by reacting to the bully and giving in to their demands. Teaching a child to keep a cool head and walk away shows them that conflict resolution doesn’t always have to involve physical aggression. Contrary to what many people may think, physically confronting a bully may cause even further escalation and usually will not end the bullying.

Encourage your child to forge strong friendships, as loyalty to a friend is a strong deterrent to bullies. Ensure that your child never walks home alone.

If bullying continues despite these measures, consider attending local school board meetings where the issue can be discussed and measures implemented. Some examples of such measures include speaking with children frequently and honestly about bullying and having students sign an “anti-bullying” pact, which has students pledge they will not bully, and that they will report any bullying to authorities.

Dec. 7, 2009

Q. My 5-year-old daughter is wetting the bed three to four nights a week. We have cut off liquids a couple hours before bedtime, have her go before we put her to bed and at one point woke her up in the middle of the night to go and she still ends up soaking wet some mornings. She also will wet her pants at school or playing outside. I am at a loss and a little embarrassed. Can you help me, please? — Meredith from Pompano Beach

A. Bed-wetting is referred to as primary enuresis if the child has never achieved bladder control, and secondary enuresis if the child had achieved control for more than six months. And it is a very common problem, affecting up to 10 to 20 percent of all children from the ages of 5-12. Rarely is bed-wetting a sign of a more significant problem.

The first step is to have your pediatrician perform a urinalysis to check for signs of infection or diabetes, and to perform a thorough history and physical examination to rule out other potential causes of bed-wetting. Even constipation can sometimes present as bed-wetting.

Its origins are poorly understood, though genetics, hormonal issues, and the neurodevelopmental maturity of the child may play a role.

There should not be any blame or shame in dealing with this problem, and as varied as the many suspected causes, the available options are just as varied. A voiding journal can be kept and a reward system for dry nights can be implemented. In addition, children should also be encouraged to assist with the clean-up, and this should never be structured as a punishment.

Additionally, limiting caffeine intake and fluids before bedtime, or nighttime waking can help eliminate this problem. A bed-wetting alarm/buzzer can help the child coordinate the impulses from his bladder and awakening from sleep.

Medications are also available to help with this problem, though success is variable and relapse is common. These can also have side effects such as dry- mouth and constipation so the decision to start these medications should be tried after consultation with your health care provider.

Nov. 25, 2009

Q: My daughter is 1 year and 8 months old and developed a pretty bad cold over the last few days but has gotten better, but now she has developed sores in her mouth. Her mood is just awful. We are using Tylenol and Motrin for pain, but can we do something more? — Edward from Miami

A: It sounds as if your daughter may have developed a condition known as gingivostomatitis, a condition usually marked by the appearance of ulcers on the gums, the tongue or the inner lining of the mouth. Often they are accompanied by fevers, refusal to eat or drink anything, and maybe some stomach upset or diarrhea.

Gingivostomatitis is usually caused by a virus known as coxsackie virus. Parents know this virus as the one that causes “hand- foot and mouth” disease. Some other viruses (such as herpes virus) can also cause these ulcers. Being a virus, antibiotics offer no benefit.

Regardless of the cause, the most important thing at this time is to ensure that your daughter stays hydrated, and this can be done in several ways. Cool liquids, popsicles, electrolyte drinks (Gatorade or Pedialyte) and Jell-O are clever ways to introduce some fluids to hurting children. Avoidance of spicy or citric foods should be the rule. Pain management is also critical and therefore make sure you are dosing Tylenol and Motrin adequately — your pediatrician’s office can help with this. If you can control pain with either of the above, then that would be preferable over alternate dosing.

Make sure that you keep an eye on how much urine your child is making, as this can be a way of measuring intake. This illness usually runs its course in about 4-7 days. If your child refuses everything offered to her, if she appears listless or is not getting better, you may need to see your doctor to initiate more aggressive therapies.

Nov. 23, 2009

Q: My 7-year-old son has recently exhibited distinct and strong body-odor from his armpits. Since he seems too young for that, should we be concerned? — Ted from Miami

A: The presence of body odor is usually the result of sweat mixing with bacteria normally found on the skin. Hormonal changes can usually make the smell much stronger, and thus body odor is usually more of a problem in adolescence or in adults. If it happens early in life, it is referred to as premature adrenarche.

Isolated body odor in your child may in fact be normal, but I would be concerned that he may be entering puberty early. In your son’s case, I would pay close attention to signs such as axillary (armpit) or pubic hair, a growth spurt, or other signs of early sexual development. If any of these were present, I would request X-rays of the wrist and hand to determine his bone age and make sure that it is in line with his real age. I would also request some blood work and urine tests to determine if any of the hormones that control the onset of puberty and sexual development are out of balance.

Though it most likely is not a cause for concern and may only require observation, a thorough history and exam by his pediatrician could help sort out the reasons for his body odor.

Nov. 11, 2009

Q. I have a 2 year old with Down Syndrome. What’s concerning me is his small head circumference. He is at the third percentile, while his weight and height run about 50th to 75th percentile on a normal chart. I am extremely concerned about where my child will fall on the spectrum. Please help! — Joyselena from Hickory, NC

A: Down Syndrome (DS) occurs in about 1 in 700 births in this country, making it the most common genetic cause of developmental delay. It occurs most commonly in children born to mothers above the age of 35, in boys, and in families in which the genetic material may be passed on to offspring (a translocation), in which case future pregnancies are at higher risk for development of DS.

Children with DS do exhibit microcephaly, or small head circumference. Your pediatrician can monitor your child for associated conditions of DS: obesity, hearing loss (because of repeated ear infections), less active thyroid (hypothyroidism), blood disorders, or problems with their heart. Your child should have routine checks of their height, weight and head circumference as well as yearly screens for some of the above conditions. In some cases a referral to a genetic specialist or DS clinic can coordinate the recommended follow-ups for children with DS.

Children with DS have a varied range of intelligence and abilities. The complete care of a child with DS requires a multidisciplinary approach and may include a general pediatrician, developmental/behavioral pediatrician, physical, occupational and speech therapists, geneticist and other medical subspecialties.

Children with DS can and do accomplish much given the right tools and support. Encourage and challenge these children to grow and learn new skills. The sky is the limit if we remember they are children first, and their disability a distant second. Best wishes!

Nov. 9, 2009

Q. My son will be 3 years old next month and his lymph nodes seem to swell up every month with fevers. When he is sick he refuses to eat or drink anything. He has a history of seizures with fevers. Is this reason for concern and is it something he will go through the rest of his life? — Denise from Miramar

A. Lymph nodes serve a very valuable purpose in protecting our bodies from illness. Just like tonsils and adenoids, they can sometimes become enlarged in childhood and most often decrease in size as your child grows up. Illnesses in the area can cause enlargement in the size of the lymph nodes, as in strep throat for example where the glands in the neck become large and somewhat tender.

Lymph nodes are usually present in the head and neck areas, groin area, and in the axillary (armpit) area. Usually they are small in size (less than 1 cm) and have a very soft texture. A recent illness is the primary reason why lymph nodes may be present. Sometimes these can become infected in which case they may reddened and very tender. These respond very well to antibiotics. In other cases the appearance of lymph nodes may cause concern for certain illnesses such as lymphomas. Thankfully, these are rare.

My best suggestion is to bring this to the attention of your pediatrician who can assess their size and consistency and can monitor their progression. If these nodes become hard, if they do not roll easily underneath your fingertips, if they seem to have collected together into one large mass, or if they are enlarged for more than six weeks, your child may need further diagnosis and evaluation.

Nov. 5, 2009

Q. My son is 9-years-old and has two sores on the tip of his tongue that are extremely painful! Is this concerning and how are they treated? — Concerned Mom in Fort Lauderdale

A. Most mouth sores are very innocent and usually require no treatment other that waiting for them to disappear, which most do by about two weeks. These sores occur for many reasons, but usually because of local trauma. Accidental biting of the tongue, rubbing the tongue against the back of the teeth, or burning the mouth with hot foods are common reasons for these sores to appear.

Infections, such as those related to herpes virus or to hand, foot and mouth disease are another cause of mouth sores. These infections typically have a fever associated with them that helps to differentiate it from traumatic causes.

Canker sores (or aphthous ulcers) usually occur as a result of stress or illness but differ from the others in that the lesions are usually single and mostly occur on the gums or the inner lining of the mouth.

If the eyes are the window to the soul, then the mouth is the window to the digestive tract. Not surprisingly, nutritional deficiencies can sometimes show up as sores in the mouth. A daily multivitamin rich in B- vitamins can help promote healing.

If painful, it is probably best to avoid citrus or spicy foods. Avoid consuming extremely hot foods. Acetaminophen or ibuprofen may be taken for pain. Additionally, cool water rinses or popsicles are a good way to alleviate pain and to keep your child hydrated while he gets better. Your pediatrician should be consulted if your child is not taking in fluids, or if he is failing to improve as expected.

Nov. 2, 2009

Q. My 17-year-old daughter was diagnosed with anemia last year. She was on iron supplements and her numbers came up. We recently found out again that she was extremely anemic with low iron levels. Which form of the H1N1 vaccine should she receive? Does being anemic increase the risk of infection? — Janet from Cooper City

A. Iron deficiency anemia is the most common nutritional deficiency in the U.S. and affects one-third of the world’s population. It is commonly seen in children being transitioned to whole milk (or between the ages 9-18 months), in women of childbearing age who lose iron through their menstruation, and in persons with an inadequate dietary intake of iron.

Iron is needed to make hemoglobin, which is found in red blood cells. There is some evidence that severe anemia due to any cause (including iron-deficiency) can increase the risk of infection. In less severe cases of anemia, the facts are contradictory.

Being that we are in flu season and owing to the apparent chronic nature of your daughter’s anemia, I would recommend vaccination. The inactive “flu shot” would be the recommended route, as well as aggressive iron supplementation.

Recommended dietary allowances (RDA) for iron vary from 10 milligrams per day for young children, to 15-20 milligrams per day for women of childbearing age. Pregnancy and breastfeeding may increase requirements up to 30 milligrams per day.

Champion iron-containing foods include shellfish, liver, beef, poultry and fish. Iron can also be obtained from eggs, beans, iron fortified cereals, breads, pastas and dark leafy vegetables.

Taking in vitamin C, from citrus, strawberries, broccoli, or tomatoes for example, can boost the absorption of iron. Also, a multivitamin with sufficient B-complex vitamins is not only a wise choice for overall health but can also promote iron metabolism. Finally, preparing food in iron cookware can enhance iron availability in foods.

Oct. 28, 2009

Q. My 13-year-old daughter is 5’2″ tall and weighs 150 pounds. She has recently become very withdrawn. I am afraid of what may happen physically and emotionally to her as she becomes a young woman. What can I do to help her? — Sarah from Fort Lauderdale

A. This is a common question I encounter owing to the number of children that are overweight in this country. The figures are staggering. It is estimated that as many as one-third of all children in the U.S. are overweight.

The physical tolls on the child are well-known — high blood pressure, heart disease, asthma, and diabetes to name a few. The lesser known effects are those related to their psychological and social well-being. Children that are overweight may suffer from depression, low-self esteem and a distorted self-image. Others may tease, bully or discriminate against them.

Any weight reduction strategy should employ both dietary management and an exercise plan. Your pediatrician or a registered nutritionist may help formulate a dietary plan which should be heavier on the fruits and vegetables and leaner on the fats and “non-essential” calories (sodas, fast-foods, sweets, etc.).

As for exercise, it is recommended that children receive at least 1 hour of physical activity per day. This should be fun, and can be as simple as walking in your neighborhood. This can also be a shared family activity which can strengthen relationships, build young bodies, and foster a positive self-image.

An accurate body mass index (BMI) measurement will give you an objective starting point. This can be easily done through the use of BMI calculators available online (one of the easiest ones to use is from the National Institutes of Health.

Your child’s pediatrician can rule out other reasons for weight gain and may recommend psychological support, but this should not prevent you and your child from benefitting from improved nutrition and exercise! Best wishes!

Oct. 21, 2009

Q. My 18-month-old daughter recently fell at the playground and started favoring her right leg. There was no redness, swelling, bruising, or tenderness. X-rays were normal. The doctor told me to give her Motrin and within hours she was back to herself. We were told it could be a muscle strain. Should I be concerned that there is more going on here? — Vanessa of Denver, CO

A. As children are growing and learning to walk, bumps and bruises are sure to follow. In your daughter’s case, I am relieved that x-rays were normal and that the injury seemed to improve with ibuprofen (Motrin). These facts would make a soft-tissue injury (bruising/sprain/strain) more likely.

When the mechanism of injury seems insignificant or if the event was not witnessed, it is helpful to know if there was fever present or if there had been a recent illness. Though soft tissue injuries are the most common causes of a limp, some require more urgent attention than others.

If your child had a history of a fever or did not otherwise appear well, your physician may order some lab work to determine if the cause may be related to a more serious problem (such as underlying bone or joint infection).

Because a limp can be due to any process involving the lower extremity (foot, ankle, leg, hip) or spine, I would advise that this complaint in a child be investigated by your primary care provider, especially if your child is too young to verbalize the exact nature of the problem.

Oct. 19, 2009

Q. My son is almost 3 and has had croup every year since 3 months old. Is there any way to prevent this or boost my son’s immune system so this doesn’t happen? Will he always be prone to having croup? — Jacqueline of Fort Lauderdale

A. Croup is an illness typical in children from infant to preschool-age. It is usually preceded by one to two days of common-cold-like symptoms that give way to the dry, barky cough classic for this illness. Though usually mild, it can last for up to one week and can be worse at nighttime.

Croup is usually brought on by parainfluenza virus, although any viral upper respiratory infection can cause croup. It is spread by coughing or sneezing, therefore good hygiene and strict hand-washing are essential. Similar to its cousin, the seasonal flu, illness does not confer long-lasting natural immunity and so reinfection is common.

In a small portion of children, repeated croup may occur from other treatable conditions, such as chronic allergies or gastroesophageal reflux (GERD). A thorough history by your pediatrician can help in working through the many reasons for its recurrence in your son.

The immediate treatment for croup consists of breathing moist, humidified air (by a humidifier or even by breathing steam from a running hot shower), which can help alleviate the horrible cough. If your child looks to be struggling for air or if there is any color change in the lips or face, your child should be seen immediately. Medical management for this illness may include supplemental oxygen, steroids, or specific breathing treatments via a nebulizer.

Oct. 7, 2009

Q. My 11-month-old son is due for his 1 year vaccinations, which includes the MMR. Can the vaccines be split or delayed until later? I am wary of the vaccine given all the press about the MMR and autism. — Belinda of Lauderhill

A. First, allow me to emphasize the need for honest dialogue with your pediatrician concerning this area of health care. Your child’s health is paramount to both parties and provides a good starting point for communication.

The most current and reliable information was the recent “vaccine courts” decision which looked at over 900 independent research studies to attempt to determine whether a link existed between vaccination with MMR and the subsequent development of autism. The result was that no link could be found.

Current theories regarding the development of autistic spectrum disorders include probable genetic links as well as the failure to attain certain developmental milestones in the first 12 months of life.

The use of alternate vaccine schedules has gained in popularity in recent years and for a variety of reasons, too long for the space allotted here. I know of certain pediatric practices that will split or delay vaccinations, but the research to date has failed to show that doing so will provide any measurable benefit for children. This may in fact put children at increased risk for longer periods of time for acquiring vaccine preventable illnesses.

While no one-size-fits-all mentality is appropriate here, a review of the available medical research and partnership with your child’s pediatrician may alleviate some of the concerns with these vaccines and foster a climate of trust that will benefit your child in the long run.

Oct. 5, 2009

Q. I have a 6 1/2 year old son with severe food allergies and reactive airways disease. He cannot receive the flu vaccine because of his egg allergy. Will the new vaccine have egg protein and what other precautions can we take? — Jodie of Coral Springs

A. Your son is not a candidate for either vaccine at present. The first of four currently approved vaccines for 2009 H1N1 will be rolled out later this week and the remainder during the coming weeks. The vaccine manufacturing process for this strain as well as the seasonal influenza is identical and will include egg protein in the virus culture. One pharmaceutical company is trying to avoid the use of eggs by incorporating cell cultures, but that vaccine may not be available for some time.

In your case, the risks of vaccination may outweigh any potential benefits. However, you may be able to better protect your son by ensuring that all close contacts are vaccinated to lower the risk of acquiring the flu. Similarly, the early use of antivirals (such as Tamiflu) within 48 hours of the development of flu-like symptoms may shorten the duration and severity of symptoms.

If there is doubt as to whether a true egg allergy is present, direct skin testing or vaccination (done in a controlled environment — such as a pediatric allergist’s office) may determine the presence and extent of the allergic reaction.

Finally, prevention strategies such as hand washing are never overstated and really do work!

Sept. 26, 2009

Q. My 14-month-old daughter was diagnosed with RAD. Does reactive airways disease make her more likely to get the swine flu? — Gregory of Fort Lauderdale.

The new school year combined with the heightened alert over the 2009 H1N1 (“swine” flu) has parents asking many questions concerning this illness.

Reactive airways disease (RAD) is a term given to a condition similar to asthma, bronchitis, or hyperactive airways disease. Like asthma, is treated with nebulizer treatments, steroids, and sometimes antibiotics.

First, let me reassure you that RAD does not make your child more likely to acquire H1N1. That is the good news. However, having RAD (or asthma, diabetes or a cardiac condition) can put your child at higher risk for complications from H1N1.

Children with these conditions are strongly urged to vaccinate annually against seasonal influenza (the “flu”) and also against H1N1 when the vaccine becomes available in the next few weeks. Proper hand-washing technique (at least 20 seconds — enough to sing the ABC song start to finish) should be reinforced throughout the school year. Additionally, coughing or sneezing into your elbow or the use of tissue and its proper disposal are always recommended. Reminding your child not to touch their eyes, nose, or mouth can also help prevent transmission of the flu virus.

Finally, you should make time to formulate an asthma treatment plan with your pediatrician in the event your child develops the flu and worsening asthma symptoms. A copy should be provided to your child’s caregivers and to their school. This treatment plan can be downloaded directly from the Centers for Disease Control website.

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