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'pediatric' Parentelligence posts

Lymph nodes in children

One of the most common referrals to my pediatric surgery practice is (in the parents’ words) “to check out this lump and make sure it’s nothing to worry about.”  Lymph nodes are part of the less publicized part of the circulatory system: the lymphatics.  Lymphatics play a key role in our body’s immune system, and lymph nodes grow in response to an infection in the “neighborhood” to produce cells necessary to hopefully resolve the infection. 

About half of all children will develop enlarged lymph nodes (cervical lymphadenitis) in the neck for example, and the vast majority of these are in response to a minor infection in the area (sore throat, sinus infection, ear infection, etc.).  Often the infection is quite subtle and might not be identified.  These nodes typically go through a pattern of growing and then receding in size once the infection resolves.  This process can take several weeks to months.  The nodes may become tender, warm, and there may be some redness of the overlying skin.  Your child might complain of pain in the area, be fussier, have fever, and/or have decreased appetite.  If the node itself becomes infected, it can turn into an abscess and would require antibiotics and a drainage procedure.  Any possibly infected lymph node should be evaluated by your doctor.
 
Some enlarged lymph nodes ...

When do kids need antibiotics?

Winter can seem like one long continuous “sick day” for families - kids pick up frequent infections at school or daycare and pass them around to everyone at home.  Often it feels like by the time the illness has worked its way through the household, a new one has started!  Even for physicians, it can sometimes be difficult to distinguish between viral and bacterial infections.  Since antibiotics cannot treat viruses, they are often over-prescribed - which can lead to significant side effects in children and also contributes bacteria becoming resistant to existing medications.  In November 2013, the American Academy of Pediatrics released an updated guidance regarding antibiotic treatment, helping answer the frequently asked question about when kids need antibiotics.

Here's what you should know about antibiotics in these situations:

  • Ear infections ...

Tips for keeping young athletes safe and healthy

We all know exercise is an important factor in maintaining an active and healthy life. However, over-exercising can lead to a rare, but serious complication known as rhabdomyolysis – a medical team that literally means ‘dissolution or destruction of skeletal muscle’. There has been a recent increase in rhabdomyolysis amongst teen athletes so it is important to recognize the warning signs and learn how to prevent them.

The classic triad of rhabdomyolysis is dark urine, muscle weakness or fatigue, and muscle pain. Although exercise can be the primary factor, other key contributing elements such as dehydration, genetic conditions (e.g. sickle cell), metabolic disorders, nutritional supplements, drug use, and heat stress can exacerbate muscle damage. Without appropriate medical evaluation and care, rhabdomyolysis can cause permanent damage to the kidneys and may even be life-threatening in severe cases. Here are some tips to help your young athlete remain active and healthy:

  1. Maintain adequate hydration – preferably with plain water.  Sports and energy drinks may often contain caffeine and excessive amounts of sugar which can cause dehydration.  On average, children that are 6-10 years old should have about 1L of fluid a day, children 10-14 years old should have 1.5L/day and teens over 14 years should have at least 2L of fluid a day. It is important to increase fluids with increased activity due to the additional fluid losses that occur.
  2. Eliminate protein supplements. A recent study by the American Academy of Pediatrics found ...

Infants with Milk Allergy

A 4 week-old infant and his mother came to my office last week.  The mother had started seeing small flecks of blood and stringy mucous in the infant’s diapers a week prior.  The baby was fine in every other way, breast feeding normally, and looked quite healthy when I examined him.

I diagnosed the infant as having cow’s milk protein-induced proctocolitis, the term referring to allergic inflammation of the lower gastrointestinal tract from exposure to cow’s milk. 

This is a diagnosis I make often. Here's what you should know about infants with milk allergies:

  1. It’s more common than you think. 2-3% of infants in the U.S. are allergic to cow’s milk protein. It is even more common in infants with eczema or who have parents or siblings with allergies.
  2. It’s seen in breast fed babies.  Over 50% of infants with this condition are breast milk-fed infants.  But remember, the babies are allergic to the dairy in their moms’ diets, not to their mothers’ breast milk per se!
  3. Switching to soy or goat’s milk doesn’t work.  Over two-thirds of infants with cow’s milk protein allergy “cross-react” to soy protein (which means that they may not be truly allergic to soy protein, but their immune systems are just too “immature” to know the difference between the two).  Similarly, if a mother switches from drinking cow’s milk to goat’s milk, it won’t help, because the source is still a “different species”; the infant’s immune system will still respond to the “foreign” protein.
  4. Treatment takes time. The inflammation resolves when all traces of cow’s milk (and soy), are  removed from the infant’s diet.  In the case of formula-fed infants, we switch to special hypoallergenic formulas.  Typically after a successful switch, the bleeding stops within a week.  However, with breast fed infants, the improvement can be a little slower.  Since it can take up to 2 weeks for the dairy in a mother’s diet to circulate into her breast milk, the full effects may not been seen for up to a couple weeks.
  5. Allergy testing is not recommended.  The type of allergy that ...

How to give safe gifts to children during the holidays

As the holidays approach, parents often wonder what toys are safe for their little ones.  When making your list and checking it twice, here are some tips to ensure that toys are appropriate for the age and developmental stage of your giftees.

For younger children/infants:

  • Make sure all parts are larger than the child’s mouth.  Most children age 3 and under consistently put toys in their mouth, and some older children do as well.  A small-parts tester, or “no-choke tube” is about the size of a small child’s airway and can be purchased to test parts if you are unsure.  If a part or toy fits inside the tube, it’s too small to be safe.
  • When buying stuffed toys, look for embroidered or secured parts rather than pieces (such as eyes or noses) that could be removed and swallowed.  Remove all loose strings and ribbons.  Avoid animals with stuffing made of small pellets or material that could cause choking. Be aware that stuffed toys given away at carnivals, fairs, or in vending machines are not required to meet safety standards, so be especially careful with these!
  • When buying hanging toys for cribs, ensure that the child cannot grab any portion, and that strings or wires are short.  These types of toys should be removed when the infant can push up onto his or her hands and knees.
  • Keep plush toys and loose, soft bedding out of the cribs of infants and young children as these can cause suffocation.

For all children:

  • Look for labeling on the package that indicates what ages the toy is appropriate for.  Remember that this doesn’t have to do with how smart your child is, it is based on physical and developmental skills for his or her age group and should be followed.
  • Ensure that batteries are  ....

Infant and Child Development is not about ‘stuff’

When we are bombarded by information and products, how are we as new parents supposed to decipher what is in the best interest of our child when it comes to their development? 

Parents can quickly become bombarded with information about everything they need to do to optimize the first months of their child’s very impressionable life. A new, overwhelmed, sleep deprived parent can find everything from music for math skills, swaddling positioners for longer sleep, bottles for better speech development, and even multiple equipment options to speed up a child’s progression for walking.  Today there are so many items available for purchase that if a person wanted to, they could  go through an entire day never having to hold, cuddle, snuggle, whisper, sing, gaze, laugh, or touch their baby…..and that is exactly the point.  When it comes right down to it, the best things that we can provide for our babies development has nothing to do with the “stuff”!

Here’s what advertisements for most baby products don’t tell you:

Bedwetting during travel or holiday season

It’s November already and the holidays are right around the corner.  For a lot of families, this means either traveling to visit others, or out of town family members will be coming to celebrate. For families who have a child experiencing wetting accidents (day or night time), this can pose a challenge for both. For the child, they can experience embarrassment and shame, with a fear of having an accident in someone else’s home, or in a different environment (i.e. sleeping in someone else’s bed). For the parent(s) it’s a concern of how to manage the logistics of the wetting accidents. This combined with the hustle and bustle of the holiday season adds stressors for everyone, taking away some of the fun and enjoyment of the season.

Here are some tips to help both you and your child successfully manage this scenario:

  • Supplies to have on hand or pack when traveling:
    • Waterproof disposable underwear (pull ups) – pack more than you think you will need just in case
    • Protective vinyl pants – these look just like regular underwear and can be worn over pull ups for added protection
    • Waterproof overlays or disposable underpads – these protective pads have an absorbent layer and a waterproof layer. They can be placed right on top of regular sheets and can be swapped out for a clean one if they become wet or soiled.
    • If your child will be sleeping in a sleeping bag, there are waterproof sleeping bag liners available
    • Large plastic bags – pack plenty in case of an accident. They help isolate any odor and are a sanitary way to store any wet underwear, pajamas or bedding
    • Clothing that is machine washable
    • A urine stain or odor remover
       
  • Talk with your child about ...
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