At the first visit to our office there are a few common questions about newborns so I thought I would take the time to put our answers in writing.
1. "When can I take my baby out?" What we worry about in new babies is the risk of infection. You get sick from germs that you catch from other people so we recommend avoiding crowds and sick people especially for the first two months of life. I would particularly avoid young children and places where people are going to touch your child. (for example, work, church, family gathering, or a party) It is fine to take your newborn outside to go for a walk or to take an older sibling to the park.
2. "When can I put lotion on my baby's skin?" Most babies peel in the first 3 weeks of life. This is a natural phenomena that lotion doesn't help. If your baby's skin feels dry at about 1-2 months of age then you may use lotion. We do not recommend baby lotion but instead suggest you use petroleum jelly (Vasoline), Eucerin Cream, or Aquaphor. Baby lotion smells good but doesn't work and often babies get a rash from the perfumes in it.
3. "How much should I feed my baby?" We are born with the ability to self regulate how much food we need so a newborn will eat what they need to grow. As a parent your job is to offer breast milk or formula and let your baby eat until they are full. They might want more at some feedings than others. Most newborns will eat 2-3 ounces at a time in the first few weeks of life. I would recommend feeding your baby at least every 3 hours during the day. If you baby doesn't get enough to eat during the day (or sleeps too much during the day!) then they will wake up more at night. Rice cereal does not make your child sleep longer (old wive's tale).
4. "How do I take care of my baby's umbilical cord?" The short answer to this question is to do nothing. We used to recommend putting rubbing alcohol on the umbilical cord but recent studies have found that it makes no difference in healing time. I suggest moving the cord away from the skin once a day -- I sometimes see where the cord gets stuck to the skin and just moving it around will help prevent this. It is normal for the cord to look gooey and sometimes bleed. We worry if there is an area of redness around the belly button.
5. "Where should my baby sleep?" We recommend that your newborn sleep in a bassinet or crib. It is safest for them to sleep flat on their backs with no pillows or fluffy blankets around them. Sleep positioners are not recommended. It is tempting to put your newborn in bed with you but that is a safety hazard for them. (also if they get used to sleeping with you it is hard to transition them to the crib!)
Thursday, November 21, 2013
Monday, October 21, 2013
Choices
It's that time of year again! The time when parents routinely ask their child if they want a shot or not. (yes, you read that right). Repeatedly I will recommend a flu shot for a child and the parent will turn to the child and ask them if they want a shot. So I thought I would take a few minutes and discuss choices.
Let's start out with why we should give kids choices? For one, choices help children feel like they have some control in their life. It would be unpleasant if someone decided all day long what we should wear, eat, and do. Second of all, giving kids choices gives them practice for when they are an adult and have to make all their decisions themselves.
There are also reasons why we should not give kids choices. Most importantly is that their brain is not developed so they cannot always decide what is safe or healthy. There are also times that it is the best interest of our time and sanity not to give choices or too many choices. (For example asking a child what they want for dinner every night.)
So... when to offer choices. First of all, if there is no choice then don't offer one! For example don't ask your child if they want to sit in their car seat or if they want to brush their teeth. I would start to offer choices at a fairly young age (1-2 years). I would keep it simple. Do you want the apple or the banana? Red cup or blue cup? Pink shorts or orange ones? As kids get older then you can have them make more complex choices. For example, what would you like for dinner one night this week? Which sport do you want to play? Teens should be even more complex tasks such as managing their time and money. As always you should be there as a parent to help them guide their choices. And again don't offer a choice that is not acceptable to you or not safe!
Back to the flu shot question. I would not recommend asking your child if they want a shot. This is a decision that you as a parent have to make. Choices that would be appropriate would be asking your child if they want the Flumist (nasal spray) or shot. (they must medically be able to have the mist so I would check with us first before offering this choice). Also a teen has the ability to participate in the decision about whether or not to have the flu shot.
I hope this helps!
Let's start out with why we should give kids choices? For one, choices help children feel like they have some control in their life. It would be unpleasant if someone decided all day long what we should wear, eat, and do. Second of all, giving kids choices gives them practice for when they are an adult and have to make all their decisions themselves.
There are also reasons why we should not give kids choices. Most importantly is that their brain is not developed so they cannot always decide what is safe or healthy. There are also times that it is the best interest of our time and sanity not to give choices or too many choices. (For example asking a child what they want for dinner every night.)
So... when to offer choices. First of all, if there is no choice then don't offer one! For example don't ask your child if they want to sit in their car seat or if they want to brush their teeth. I would start to offer choices at a fairly young age (1-2 years). I would keep it simple. Do you want the apple or the banana? Red cup or blue cup? Pink shorts or orange ones? As kids get older then you can have them make more complex choices. For example, what would you like for dinner one night this week? Which sport do you want to play? Teens should be even more complex tasks such as managing their time and money. As always you should be there as a parent to help them guide their choices. And again don't offer a choice that is not acceptable to you or not safe!
Back to the flu shot question. I would not recommend asking your child if they want a shot. This is a decision that you as a parent have to make. Choices that would be appropriate would be asking your child if they want the Flumist (nasal spray) or shot. (they must medically be able to have the mist so I would check with us first before offering this choice). Also a teen has the ability to participate in the decision about whether or not to have the flu shot.
I hope this helps!
Wednesday, September 4, 2013
Journal Watch
I recently read the August edition of Infectious Diseases in Children and learned a couple of interesting things so I thought I would share them.
The first was a study looking at the prevalence of HPV (human papilloma virus) in teenage girls before and after the introduction of the HPV vaccine. Over 4000 samples were tested before and after the vaccine's introduction. Before the vaccine was released the prevalence of HPV in these samples was 11.5%. After the vaccine was released the prevalence was 5.1%. This is a 56% decrease. (and only 62.5% of the poplulation studied had received all three doses of the vaccine). This study shows that the HPV vaccine works well.
The second was a review of the treatment of warts. (NOT the ones in the genital area). Warts are frustrating to us because there is no reliable way to get them to go away. All warts go away on their own but it can take 1-2 years and most of us are not that patient. The review article concluded that nothing works well or quickly but that salicylic acid (sold over the counter in products such as Compound W) works the best. They found that regular use of it for 12 weeks works about 75% of the time. The article found that freezing warts doesn't work. A little success is found when someone experienced freezes it but even then there is a low success rate. The article also looked at the use of duct tape. They found that using silver duct tape might work but transparent duct tape definately doesn't work. My conclusion after reading this article is that salicylic acid might work but that wart removal is frustrating to all!
The first was a study looking at the prevalence of HPV (human papilloma virus) in teenage girls before and after the introduction of the HPV vaccine. Over 4000 samples were tested before and after the vaccine's introduction. Before the vaccine was released the prevalence of HPV in these samples was 11.5%. After the vaccine was released the prevalence was 5.1%. This is a 56% decrease. (and only 62.5% of the poplulation studied had received all three doses of the vaccine). This study shows that the HPV vaccine works well.
The second was a review of the treatment of warts. (NOT the ones in the genital area). Warts are frustrating to us because there is no reliable way to get them to go away. All warts go away on their own but it can take 1-2 years and most of us are not that patient. The review article concluded that nothing works well or quickly but that salicylic acid (sold over the counter in products such as Compound W) works the best. They found that regular use of it for 12 weeks works about 75% of the time. The article found that freezing warts doesn't work. A little success is found when someone experienced freezes it but even then there is a low success rate. The article also looked at the use of duct tape. They found that using silver duct tape might work but transparent duct tape definately doesn't work. My conclusion after reading this article is that salicylic acid might work but that wart removal is frustrating to all!
Tuesday, August 20, 2013
3 More Trends
Awhile back I wrote about trends that I have noticed recently. I have been practicing for 19 years so I find it interesting as to what changes over time. So here are some more. We will start with the good.
1. Less soda drinking. I have noticed that my patients are drinking less soda and more water. This is a great trend! I do want to remind my patients that lots of other drinks have sugar in them besides soda. These include gatorade, sports drinks, koolaid, lemonade, juice, and sweetened tea. Keep up the good work.
Next the bad.
2. Poor teeth brushing. I routinely ask all my school age patients if they are brushing their teeth two times a day. These days it seems that I mostly get the answer of "No, I only do it once a day." Good care for the teeth is so important because these are the teeth that they will have for 80-90 years. Problems in childhood only lead to problems later in life leading to pain, expense and sometimes dentures!
3. Staying up late on weekends. Now we all know high school and college students like to stay up late on weekends but lately I have been seeing 7-10 year olds staying up until 2am regularly. I don't know about parents today but I always wanted my kids to go to bed so I could have some peace and quiet! If your children don't get enough sleep they are likely to be cranky, have poor behavior, and not do as well in school. I recommend that your child (and teen and yourself!) stay on a regular schedule where bedtime is the same time every night.
1. Less soda drinking. I have noticed that my patients are drinking less soda and more water. This is a great trend! I do want to remind my patients that lots of other drinks have sugar in them besides soda. These include gatorade, sports drinks, koolaid, lemonade, juice, and sweetened tea. Keep up the good work.
Next the bad.
2. Poor teeth brushing. I routinely ask all my school age patients if they are brushing their teeth two times a day. These days it seems that I mostly get the answer of "No, I only do it once a day." Good care for the teeth is so important because these are the teeth that they will have for 80-90 years. Problems in childhood only lead to problems later in life leading to pain, expense and sometimes dentures!
3. Staying up late on weekends. Now we all know high school and college students like to stay up late on weekends but lately I have been seeing 7-10 year olds staying up until 2am regularly. I don't know about parents today but I always wanted my kids to go to bed so I could have some peace and quiet! If your children don't get enough sleep they are likely to be cranky, have poor behavior, and not do as well in school. I recommend that your child (and teen and yourself!) stay on a regular schedule where bedtime is the same time every night.
Monday, August 5, 2013
Flu Shots This Season
Our office finds that each year brings a new challenge in the ordering of flu shots. The good news for this year is that we are supposed to get plenty of flu shots in the next few weeks! The interesting part this year is that there are two different types of flu shots available this year.
Traditionally the flu vaccine has protected against 3 strains of the flu. The strains change yearly based on what the experts predict will go around the community. 2 strains of influenza A and one strain of B are included. If you are one of the unlucky people who still gets the flu even though you have had the shot it may be because you got a strain that wasn't included in the vaccine. To help with this problem the vaccine manufacturing companies have developed a quadrivalent vaccine that includes two A strains and two B strains.
What has resulted this year is that some manufacturing companies have made quadrivalent vaccine (4 strains) some have made trivalent vaccine (3 strains) and some companies have made both. We are limited to what brands we can use because not all brands are for use in children and in fact there is only 1 brand for use in kids under age 3. So our choices are limited.
It looks like this year we are going to have mostly trivalent available. We are on the waiting list for quadrivalent but are not likely to get any. Of interest, the Flumist only made quadrivalent this year. So for injection we will only have trivalent and for inhaled we will only have quadrivalent.
I suspect that next year no one will make trivalent any more so there will be plenty of quadrivalent available.
As always if you have questions give us a call. We will announce on Facebook when our flu vaccines are available.
Traditionally the flu vaccine has protected against 3 strains of the flu. The strains change yearly based on what the experts predict will go around the community. 2 strains of influenza A and one strain of B are included. If you are one of the unlucky people who still gets the flu even though you have had the shot it may be because you got a strain that wasn't included in the vaccine. To help with this problem the vaccine manufacturing companies have developed a quadrivalent vaccine that includes two A strains and two B strains.
What has resulted this year is that some manufacturing companies have made quadrivalent vaccine (4 strains) some have made trivalent vaccine (3 strains) and some companies have made both. We are limited to what brands we can use because not all brands are for use in children and in fact there is only 1 brand for use in kids under age 3. So our choices are limited.
It looks like this year we are going to have mostly trivalent available. We are on the waiting list for quadrivalent but are not likely to get any. Of interest, the Flumist only made quadrivalent this year. So for injection we will only have trivalent and for inhaled we will only have quadrivalent.
I suspect that next year no one will make trivalent any more so there will be plenty of quadrivalent available.
As always if you have questions give us a call. We will announce on Facebook when our flu vaccines are available.
Monday, July 29, 2013
Asthma Learning Collaborative
If you have a child who wheezes or has asthma we may have asked you to fill out an asthma form when you have been in the office in the last few months. This is because our office is participating in a learning collaborative that is helping us improve our asthma care.
The learning collaborative is organized by the American Academy of Pediatrics and includes about 25 practices in 4 states. The program lasts 15 months and involves phone calls, classes and paperwork for the doctors. For the patients it involves surveys. The information from the surveys gets entered into an asthma registry. We are then able to analyze our data to see what we can improve on.
We were initially overwhelmed by the amount of work but have grown to really like the surveys. We have found that we are better able to identify how our patients are doing. Most of the time we know but sometimes we will be surprised about how many ER visits or missed school days that a patient had. We can also target our education about asthma better. For example who needs education about spacer use or preventive medications. This fall we will be able to use the information to make sure our high risk patients get flu shots.
So... we thank everyone for filling out the surveys. It is helping us take better care of your child!
The learning collaborative is organized by the American Academy of Pediatrics and includes about 25 practices in 4 states. The program lasts 15 months and involves phone calls, classes and paperwork for the doctors. For the patients it involves surveys. The information from the surveys gets entered into an asthma registry. We are then able to analyze our data to see what we can improve on.
We were initially overwhelmed by the amount of work but have grown to really like the surveys. We have found that we are better able to identify how our patients are doing. Most of the time we know but sometimes we will be surprised about how many ER visits or missed school days that a patient had. We can also target our education about asthma better. For example who needs education about spacer use or preventive medications. This fall we will be able to use the information to make sure our high risk patients get flu shots.
So... we thank everyone for filling out the surveys. It is helping us take better care of your child!
Wednesday, May 1, 2013
Transition to an Adult Doctor
It's almost graduation time! Graduation from school as well as from the pediatrician. Once teens are 18 and have graduated from high school / gone off to college then it is time to transition to either a family practice doctor or an internist. Here are some things you can do to help with the transition.
1. Make sure your teen knows their medical history. Do they have any drug allergies? Have they had any surgeries? What medications do they take and what is the dose?
2. Teach your teen their family history. They need to know what health problems their biological parents and grandparents have had.
3. Teach your teen about over the counter medications and send them with a basic supply when they move out. (This way they won't be calling you at 3am about what they should take for a headache!)
4. Have your teen do their own paperwork. When forms need to be filled out for sports, driver's license, doctor's office have the teen do it and be available to help with questions. When they go to college send them with their insurance card (or a photocopy, front and back).
It is best to work on these things during the teen years so that they are all set when they leave the nest. We routinely encourage kids and teens to answer questions about themselves and to ask questions as well. By the time they graduate from high school they should be able to go to the doctor by themselves!
1. Make sure your teen knows their medical history. Do they have any drug allergies? Have they had any surgeries? What medications do they take and what is the dose?
2. Teach your teen their family history. They need to know what health problems their biological parents and grandparents have had.
3. Teach your teen about over the counter medications and send them with a basic supply when they move out. (This way they won't be calling you at 3am about what they should take for a headache!)
4. Have your teen do their own paperwork. When forms need to be filled out for sports, driver's license, doctor's office have the teen do it and be available to help with questions. When they go to college send them with their insurance card (or a photocopy, front and back).
It is best to work on these things during the teen years so that they are all set when they leave the nest. We routinely encourage kids and teens to answer questions about themselves and to ask questions as well. By the time they graduate from high school they should be able to go to the doctor by themselves!
Tuesday, January 22, 2013
Kids and Chores
Boy have I been lazy! I haven't blogged for 2 months. Maybe I need a New Year's resolution.
Let's talk about chores today. Why do we make kids do them? For one, I think it is important as part of making kids become productive members of society. Do I want my kids going out into the world not knowing how to clean a bathroom or do laundry? Also I want my kids to feel responsible for themselves. There will be no mom to clean up after them in their workplace or home as an adult. Lastly, of course they are slave labor!
Here is what I have found helpful over the years.
1. Start early. If a chore or clean up becomes part of a routine it makes eveyone's life easier. For example get kids in the habit of putting their dirty clothes in the hamper when they take them off and clearing their place at the table when they are done eating.
2. Make things simple. Kids (and most adults) have trouble following vague or complicated directions. Instead of telling your child to clean their room tell them one thing to do at a time. For example, put the books on the bookcase.
3. Do it together. If you are working with or near your child you will get better results.
4. Accept less than perfect results. Kids are not going to clean as well as you and if you criticize repeatedly they are less likely to put forth an effort (and argue more!)
5. Assign a day of the week for recurring chores. In our house different kids are assigned days of the week that it is their turn to do the dishes. This eliminates the "I did it last time" argument.
6. Play to their strenghs / give choices. Now, I wouldn't give a choice if they get to do a chore or not but I will give my kids a list of three chores that need to be done. They each get to pick one and then I will take what is left over. It turns out I have one child who would rather clean the bathroom than vacuum. Go figure!
7. Give a time frame for completion for older kids. I discovered that if I didn't give a deadline my kids would wait and wait and wait...
8. Keep it short. Give a task that can be done in 15 minutes or less. (I do this for myself and it works great. Instead of cleaning the whole bathroom at a time I will scrub the tub one day, mop the floor another, etc)
9. Praise!
Let me know what strategies work for you .
Let's talk about chores today. Why do we make kids do them? For one, I think it is important as part of making kids become productive members of society. Do I want my kids going out into the world not knowing how to clean a bathroom or do laundry? Also I want my kids to feel responsible for themselves. There will be no mom to clean up after them in their workplace or home as an adult. Lastly, of course they are slave labor!
Here is what I have found helpful over the years.
1. Start early. If a chore or clean up becomes part of a routine it makes eveyone's life easier. For example get kids in the habit of putting their dirty clothes in the hamper when they take them off and clearing their place at the table when they are done eating.
2. Make things simple. Kids (and most adults) have trouble following vague or complicated directions. Instead of telling your child to clean their room tell them one thing to do at a time. For example, put the books on the bookcase.
3. Do it together. If you are working with or near your child you will get better results.
4. Accept less than perfect results. Kids are not going to clean as well as you and if you criticize repeatedly they are less likely to put forth an effort (and argue more!)
5. Assign a day of the week for recurring chores. In our house different kids are assigned days of the week that it is their turn to do the dishes. This eliminates the "I did it last time" argument.
6. Play to their strenghs / give choices. Now, I wouldn't give a choice if they get to do a chore or not but I will give my kids a list of three chores that need to be done. They each get to pick one and then I will take what is left over. It turns out I have one child who would rather clean the bathroom than vacuum. Go figure!
7. Give a time frame for completion for older kids. I discovered that if I didn't give a deadline my kids would wait and wait and wait...
8. Keep it short. Give a task that can be done in 15 minutes or less. (I do this for myself and it works great. Instead of cleaning the whole bathroom at a time I will scrub the tub one day, mop the floor another, etc)
9. Praise!
Let me know what strategies work for you .
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