Child Health 411

I’m sad to say that this will be my final post on the Child Health 411 blog. It has been a great year! I hope you have enjoyed reading my advice on children’s health and parenting.

Last month’s WebMD Magazine featured an interview with Eat, Pray, Love author Elizabeth Gilbert. In it, she shared her 10 tips for healthy living. (Number 10 on her list is “floss,” and I totally agree!) Since this is my last post, I thought I’d share my own pearls of health wisdom.

1. Be a good role model. If you want your child to eat healthfully, exercise regularly and limit time in front of the TV or computer… start by doing these things yourself.

2. Do a preconception visit. Pre-pregnancy health affects your pregnancy and your growing baby. See your health practitioner before you are pregnant. Aim for your ideal body weight (BMI) before pregnancy.

3. Know your BMI. It stands for Body Mass Index. And, it tells you if you are at risk for health-related consequences of obesity. Check yours and your child’s. Make lifestyle changes if that number is too high. I know it is easier to say than to do.

4. Trust yourself. You have the skills to be a good parent. Really.

5. Happy parents have happy children. Take time for yourself and for your marriage. You’ll be amazed by the results.

6. Vaccines are safe. They protect your child from diseases you don’t want her to have. Seriously. Get your child vaccinated. I wouldn’t do anything different with my own kids.

7. You are planting the seeds of discipline. Do not expect a tree to grow overnight. It will take months or even years to see the results of your calm and consistent discipline techniques. Don’t give up.

8. Sleep is underrated. It rejuvenates the body and mind. Make it a priority for you and your child. Establish a healthy sleep routine and stick to it. Let your baby self-soothe when he is old enough to do so (around 4-6 months of age). It’s a critical life skill.

9. It takes a family. You don’t have to do-it-all to win Parent of the Year. Share responsibilities between your partner and your kids (as they become old enough to help out). Remember, happy parents have happy children.

10. Floss.

It has been a great year! Thanks for reading my blog. If you want to stay in touch, you can find me at www.baby411.com. And, check out the September issue of WebMD the Magazine. We’ll be talking about pregnancy and my new book, Expecting 411.

Have you enjoyed health and parenting advice on the Child 411 blog? Post your comments on the Parenting Community.

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Eggs have been making the news lately with three major nationwide recalls due to potential contamination with the bacteria, salmonella. The recalls involve eggs from Wright County and Hillandale Farms in Iowa.

But what’s the big cluck about it? Well, if you handle these eggs or eat them partially cooked (a.k.a. poached or soft boiled), you can potentially get pretty sick.

Salmonella (specifically salmonella enteriditis) is the most common form of bacterial food poisoning. Within 12 hours to 3 days after an exposure, people develop nasty diarrhea, vomiting, fever and stomach cramps. Unlike the watery diarrhea one typically sees with a stomach virus, salmonella usually causes diarrhea mixed with mucus and/or blood. And this lovely infection lasts up to a week. Ugh.

The good news is that most people fully recover without needing any special treatment or medication. Some unlucky people can get dehydrated and end up being hospitalized. And a few very unlucky people can be seriously ill from this infection. That includes young infants, people with weakened immune systems and the elderly.

Besides this Iowa egg issue, there are other ways to get this bug. So, how do you avoid getting salmonella and other forms of food poisoning?

1. Make sure to thoroughly wash countertops, sinks and cutting boards with soap and water when preparing foods with eggs, raw meat or poultry.

2. Only prepare fully cooked eggs.

3. Make sure hamburger/ground beef is cooked completely until it is brown. Yes, pink makes a juicier burger but it also makes a germ-filled one.

4. Use pasteurized eggs in recipes that call for raw eggs (like Caesar salad dressing).

5. Keep eggs, meat and poultry properly refrigerated.

6. Keep all baby bottles, pacifiers and breast pump supplies away from food preparation areas.

7. Keep pet iguanas or turtles out of the kitchen counter area. (You think I am joking… I had a patient get salmonella this way). Make sure to wash hands thoroughly after handling.

8. Buy only pasteurized apple cider and other juice products.

9. Wash hands thoroughly after visiting a petting zoo.

Take home tip: If you or a family develops diarrhea that is bloody or mucousy, it’s time to call your doctor.

Taking the proper precautions to avoid salmonella? Concerned that you’ve bought recalled eggs? Post your comments on the Parenting Community.

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It’s that time again! Whether your child is getting on the bus for the first time or he’s starting his senior year, it’s exciting and stressful for parents and students alike.

Besides buying the coolest backpack and pencil holders, here are a few other things to add to your back-to-school checklist:

1. Self-discipline: Have a conversation about personal responsibility. As a parent, it’s our inclination to rescue our kids… which sometimes means making a special trip up to school to drop off the homework that got left on the kitchen table. But, school gives children an opportunity to practice their life skills in a safe environment. Let your child forget his homework and let him see the consequence of being disorganized. These are teaching moments.

2. Confidence: Talk about making good decisions and sticking to them. A child with good self-esteem will not cave to peer pressure. She will lead and not follow. Remember those words every exasperated parent has shouted, “If everyone else was jumping off of a bridge, would you?!” Make your child feel good about her reasoning and judgment. Then, you won’t have to worry that she will blindly follow others.

3. Exercise: If your child plays a sport, exercise time is automatically part of his schedule. But many tweens and teens don’t exercise on a regular basis if they aren’t involved in a team sport. Make physical activity part of your child’s daily routine. Kids spend several hours a day sitting in a desk, and then a few hours (or more) sitting down to do their homework. Make exercise a priority and a mental health break.

4. Set media limits: Twitter, Facebook, cell phones, text messaging, video games, TV shows, and surfing the web… need I go on? As if school, homework and after school activities aren’t enough, electronic communications and screen time can take up the rest of a child’s waking hours. Make a family plan to spend time together without disruption from a TV or a friend who is calling or texting your child during dinner. Turn off the electronics completely or set a curfew for them.

5. Sleep: Sleep is powerful and underrated. With so many things on your child’s plate, she may sacrifice sleep to cram for a math test or have a text conversation with her best friend. Remind your child how much better she will feel (and how much better she will perform on that math test) if she gets the sleep her body needs. Set a reasonable bedtime and try to enforce it as much as possible.

Happy school year!

What’s on your back-to-school checklist? How do you prepare your child for the start of the school year? Share your tips with the Parenting Community.

This has been a busy week around the office!  I usually try to take my vacation this week so I can avoid the craziness, but no such luck this year…  You see, families with school-aged children are trying to get those last minute check-ups done before the school year begins.

This leaves me asking the standard list of questions at each appointment. Here are a few examples:

• “How much time do you spend in front of a screen (TV/computer/video game) every day?” (Less than two hours a day is the right answer.)

• “Do you brush your teeth at least twice a day?”  (You’d be surprised how many kids go to school in the morning with unbrushed teeth! Really.)

• And, “Do you take or buy your lunch?”

The lunch question is more important than you might think. School lunch programs are designed to provide nutritious lunches, right? In theory, that’s true. In reality, it just doesn’t happen. Having my own two kids attend public schools, I have seen the menus and eaten at the school cafeterias. I’m sorry, but I would really like to see the nutrition facts for the Salisbury steak or the beef enchilada plate sometime. Color me skeptical.

And, it’s no surprise to me that kids who eat school lunches are more likely to be overweight. According to a 2010 study from the University of Michigan, school lunch buyers eat more fatty meat, drink sugary beverages, and eat fewer fruits and veggies than kids who pack their lunch. The problem: healthy food choices may be in the lunch line, but that’s not what the kids are selecting.

So, our job as parents is to A) make sure kids make healthy food choices in the lunch line and/or B) pack a healthy lunch for them. Better yet, let your child help pack his lunch.

And when you pack that lunch, aim for fresh food instead of prepackaged stuff. Pack up an apple or banana instead of fruit cocktail or mandarin oranges. Offer raw carrots and lowfat ranch dressing instead of a side of chips with that sandwich. And, give a water bottle or lowfat milk as a drink. Trust me, it can be done.

Yes, it takes some planning and grocery shopping. And yes, we are all very busy people. But, it takes less than 10 minutes before bedtime to pack a nutritious lunch.

And as an aside, your child only needs to wake up about 2 minutes earlier in the morning to guarantee those teeth get brushed before school.

Get a fresh start this school year!

What are your kids eating for lunch? Do you have any tips for putting together a nutritious and delicious lunch? Share your ideas with the Parenting Community.

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When your child has a sore throat, it’s important to find out if it’s strep throat or not. Ever wonder why? Strep (officially called Group A Streptococcus) is a bacterial infection that needs to be treated with antibiotics. And, all the other sore throats caused by the virus of the week just need time and TLC to resolve.

Why does strep need to be treated? While many people clear the throat infection on their own, untreated strep can do some pretty serious damage in other body parts. Untreated strep can infect the heart, brain, and joints. That’s called rheumatic fever. And it’s why we need to know if that sore throat is due to strep bacteria.

Doctors have always known that strep prefers to infect school-aged kids instead of babies, toddlers or preschoolers. But a recent study in the journal, Pediatrics, confirmed this. About 37% of school-aged children who see their docs for a sore throat will have a Strep infection. But, only 24% of children under five years of age have Strep when they have a throat infection. Bottom line: little kids usually get viral sore throats, big kids are more likely to have Strep.

So, how do docs know when it’s strep throat (besides doing a strep test, of course).

Here are 10 things that make me think of strep:

1. 5 years of age or older?
2. Sore throat WITHOUT runny nose or cough?
3. Sore throat WITH headache and/or stomachache?
4. Sore throat and fine, pinpoint, sandpapery/rough feeling rash (called “scarlet fever”)?
5. Sore throat and raised dots on the tongue (called “strawberry tongue”)?
6. Sore throat and a persistent fever for more than a couple of days?
7. (For girls) sore throat and a really red vaginal area?
8. Sore throat and really red skin around his/her anus?
9. Strep going around your child’s school, childcare, or your house (late fall, winter, spring)?
10. A history of getting strep throat before?

If you think your child has strep, don’t panic. Even if your child has had the illness for a few days, antibiotics will do the trick to clear the infection and prevent rheumatic fever. Just make an appointment to see your child’s doctor!

What do you do when your child complains of a sore throat? Share your comments with the Parenting Community.

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Here’s some scary news: more American girls, particularly Caucasians, are starting puberty at age seven compared to those born 10-30 years ago. No, that wasn’t a typo. Girls are developing breast tissue at seven years of age. That’s first or second grade, folks. It was embarrassing enough to wear that training bra in fifth grade when I was growing up. Imagine how it feels for girls today!

A study published in the journal Pediatrics this week looked at this disturbing trend. Girls ages 6-8 years old in three metropolitan areas — New York, San Francisco and Cincinnati — were evaluated for the first sign of puberty (breast development).

Here’s what researchers found:

• 10.4% of Caucasian 7-year-olds and 18.3% of 8-year-olds had breast tissue.
• 14.9% of Hispanic 7-year-old girls and 30.9% of 8-year-olds had breast tissue.
• 23.4% of Black, non-Hispanic 7-year-old girls and 42.9% of 8-year-olds had breast tissue.

Once breast tissue develops, it’s about two years until a girl menstruates (gets her first period). According to a 2003 report, the median age for American girls to have their first period is 12.4 years. (Less than 10% of girls menstruated under 11 years of age and more than 90% of girls menstruated by 13.75 years of age.) With girls beginning puberty development at 7 or 8, that means they will be menstruating at age 9 or 10. That’s third or fourth grade!

So, what do you need to know if you have a daughter?

Q. Are there any health concerns with early puberty?

Yes. Early puberty is associated with a greater risk of breast cancer and endometrial cancer. Studies also show that girls who develop earlier may have more issues with poor self-esteem, poor body image, earlier sexuality and eating disorders.

Q. Why is this happening?

That’s the million dollar question. This particular study did not address the potential reasons for early puberty, but it seems to be a combination of genetic and environmental factors. The researchers did not look at exposures to environmental chemicals (e.g. “endocrine disruptors”) or dietary patterns in the girls who were studied. In my professional experience, I believe early puberty is another health consequence of the obesity epidemic. Overweight girls reach puberty sooner.

Q. Is milk the culprit?

Probably not. I get this question a lot. I’ve read the medical literature and I do not think that bovine growth hormone (rBGH) or soy milk is the reason for early puberty. But, I recommend your kids drink skim or 1% milk after age two. Whole or 2% provides too much fat and obesity is clearly a risk factor for early puberty.

Q. What can I do to try to prevent my daughter from going through puberty early?

Offer her healthy food options. Keep her active physically. And keep a close eye on her body mass index. Don’t shrug it off if your child’s doctor has concerns.

Worried about your daughter hitting puberty early? Voice your concerns on the Parenting Community.

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Having a miscarriage is heartbreaking for many couples, especially those who have had difficulty conceiving. Naturally, the first question that arises is: When is it safe to start trying again?

The World Health Organization (WHO) currently recommends that couples wait at least six months after miscarriage before attempting another pregnancy.

A research study published in the British Medical Journal this week questions the existing recommendation. The study looked at almost 31,000 women who conceived after miscarriage between 1981 and 2000.

The results? Women who conceived within six months of miscarriage were less likely to miscarry again. They were also less likely to have a C-section delivery, a premature delivery or a newborn with a low birthweight. This group of women, however, were more likely to have labor induced. Women who conceived two years or more after a first miscarriage were more likely to have an ectopic pregnancy (fertilized egg implants in an abnormal location) or a termination.

Does that give everyone the green light to conceive immediately after a pregnancy loss? No. WHO recommendations aside, most practitioners advise a woman to wait for two or three menstrual cycles before conceiving again. It gives her body time for the lining (endometrium) of the womb (uterus) to rejuvenate and be ready to sustain another pregnancy. It also gives couples a little time to grieve and prepare emotionally for another pregnancy attempt.

So before you get back to babymaking, check with your practitioner. The length of time you wait between pregnancies depends on each couple’s situation. For instance, there is a difference between having a very early pregnancy loss and having one in the second trimester.

Have a story to share about trying to get pregnant following a miscarriage? Talk about your experience with the Trying to Conceive Community.

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You may have seen the headlines, especially if you live in California. But, in case you’ve missed it… California is in the midst of perhaps the worst whooping cough (pertussis) epidemic in 50 years. There have been 2,174 cases reported and tragically, seven infants have died this year in the state.

So, why are we seeing such a rise in whooping cough when it is supposed to be a vaccine preventable disease? If every child gets his shots on time, wouldn’t the germ have no one to infect?

I wish it were that simple. But the world of infectious diseases is very complex. Getting every child his vaccinations on time goes a long way in preventing this disease, though. Here are a few hurdles:

1. Whooping cough epidemics occur in cycles about every 3-5 years. The last major epidemic was in 2005, so it was bound to happen.

2. Immunity to whooping cough does not last forever — whether you are vaccinated for protection or even if you have had the disease. Teens and adults lose their immunity over time. That’s why it is so important to get the whooping cough booster shot (called Tdap).

3. Babies under two months of age are too young to be vaccinated. And they do not have adequate immunity until they have received at least three doses of whooping cough vaccine (at six months of age). So, they rely on those around them to be protected by vaccination and not spread the infection to them. Up to 80 percent of babies get whooping cough from a loved one in their household (most often, it’s spread from their mom).

4. Adults often don’t know they have the illness. It may look like a common cold at the beginning of the infection and then it becomes a cough that just lingers on forever (whooping cough is also known as the “100 Day Cough”). People are contagious for the first four weeks of the illness.

So, what can you do to protect you and your family from whooping cough? Make sure your child is up to date on his shots and make sure you are, too! If you can’t remember the last time you got your tetanus shot (or the last time you got one was from your own pediatrician!), you need to roll up your sleeve and get the Tdap (Tetanus, diphtheria and pertussis). You can get the Tdap vaccine from your doctor or even at your local pharmacy/grocery store. You just have to ask for it. No excuses!

It is such a major public health issue that the state of California has expanded its vaccine recommendations beyond the standard vaccination schedule. Californians who are ages 7 and up, those over age 64, and pregnant women are included in the expanded recommendations.

Are your vaccinations up to date? What about your child’s? Share your comments with the Baby’s First Year Community.

It makes me itchy just thinking about lice. You too, probably. But learning about these little guys makes it a bit easier to tolerate when your child comes home with them someday!

What are lice?
The human louse feeds on our hair. And, they travel from one head to the next by crawling. No, they don’t fly (they are wingless). And lice really like it if you share combs, hairbrushes or hats with another person — that way they can be easily transported to a new home on someone else’s head.

Are lice a sign of poor hygiene?
Head lice do not care whether you are rich or poor, have stellar hygiene or bathe once a week. They are equal opportunity creatures. Don’t be embarrassed if your child gets an infestation. Grossed out, yes. Embarrassed, no.

How do I look for head lice in my child?
Adult lice are brown and large enough to be seen but they move very quickly. So, it’s much more common to diagnose head lice by finding their white eggshells (called nits). The nits stick firmly to the hair shaft close to the scalp. (Unlike dandruff, that easily brushes out or moves when you shake your head.) You’ll find them mostly behind the ears and the back of the neck. Start looking if your child is suddenly scratching his head for no other good reason (they’re pretty itchy!).

How are lice treated?

1. Start with tried and true over-the-counter remedies like Rid or Nix (1% permethrin or pyrethrin). Do one treatment, and then repeat seven to 10 days later.
2. Don’t obsess about cleaning the entire house!
3. Any items that are used in the hair (brushes, combs, hair clips) can be placed in an airtight plastic bag for four weeks and then they are ready for use again.
4. The problem: lice are becoming increasingly resilient and resistant to treatment. Other options include: prescription Ulesfia (benzyl alcohol) wash or Ovide (malathion). Some doctors also prescribe a higher potency permethrin product called Elimite. There are also other over-the-counter options. Tea tree oil and Cetaphil lotion may also treat head lice, but the evidence that they work is more anecdotal than scientifically proven.

Does my child need to stay home until the lice are treated?
No. Kids often get sent home from school when lice are detected. However, this week the American Academy of Pediatrics (AAP) reiterated their position on this outdated strategy: kids should not be excused from school due to head lice.

Lice are an infestation, and they have usually been alive and well on a child’s head for at least four weeks before the itchiness occurs and diagnosis is made. And they do not spread when children are sitting at their desks and learning. So, kindly ask your school to check out the AAP’s website if they have any concerns.

Found a lice solution that worked on your child? Share your strategy with the Parenting Community.

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This one is on my top 10 FAQ list during after-hours phone calls! So, let me enlighten you so you know what to do next time your child gets a nasty cut or scrape. (And yes, it will happen to you!)

Rule #1: Stitches need to be placed within 12 hours of the injury. Otherwise, closing the wound increases the risk of infection. So, you’ve got to decide before the office opens the next morning.

Rule #2: If you cannot get the bleeding under control, or you can see fat or bone (usually deeper than 1/4 inch), you need to seek medical attention.

Rule #3: Cuts to the eyebrows and lip/skin lines usually need stitches for the best cosmetic result. Since both areas have a definite line, you want the two sides of the wound to have the best chance of finding each other.

Rule #4: Injuries to the mouth and lips bleed like stink, but rarely need stitches. All that blood flow to the area also allows the wounds to heal very quickly.

Rule #5: If the wound is due to a human or cat bite, it needs to be cleaned really well and might require antibiotics. But, these wounds usually do not get stitches.

Rule #6: Wounds that are getting red, tender or are draining need to be seen by a medical provider.

Rule #7: If your child is up to date on his shots, he probably won’t need another tetanus shot. But, check with your doc to be sure.

Rule #8: Sometimes staples or Dermabond (human superglue substance) can be used instead of stitches. But regardless of which method is used, all wounds need to be kept clean.

Rule #9: Stitches and staples need to be removed, but the length of time depends on the location of the injury. The person who places them will give you specific instructions for follow-up.

Rule #10: Don’t freak out. Your child will do better with a calm parent at the helm!

Has your child gotten stitches? How did you handle the situation? Share your experience or advice with the Parenting Community.