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New nutrition labels, same healthy eating advice

We all know that as a nation, we are getting bigger and heavier. Worse still, our future - our children- are becoming obese and unhealthy at increasingly younger ages. For decades, the scourge of obesity was blamed on a high calorie, high fat diet. Turns out, we have probably been doing it wrong all these years and our bulging waistline attests to this colossal failure. Research and the medical community now have increasing evidence that the real villain of the story is a very sweet little molecule called fructose. Fructose is what gives us the sweetness in table sugar (sucrose)…also in brown sugar, honey, agave, and of course, high fructose corn syrup. Call it by any name, but sugars are dangerous to our health. Fructose is addictive, much in the same way as alcohol and illicit drugs are. In fact, sugar (fructose) metabolism closely replicates alcohol metabolism except for the acute effects on brain. Sugar has been likened to alcohol without the buzz!

You may already have heard about First Lady Michelle Obama’s work with the FDA which has led to newly proposed changes to nutrition labels on packaged foods. The amount of sugars, specifically, “added sugars” will be part of that new label. I am not implying that a zero added sugar diet will be the panacea for the pandemic of obesity and ill health. We still need to eat healthy and exercise right. There is no magic pill, no startling new advice. Remember what our grandmothers used to say:
 

If your newborn is diagnosed with hypospadias

As a pediatric urologist, I am frequently asked to consult with parents whose newborn son has hypospadias.  

Hypospadias is usually diagnosed during the physical exam right after the baby is born.  When parents see the abnormal penile anatomy they naturally want to learn about the diagnosis and understand what, if anything, needs to be done. Answering these questions, discussing options, and performing reconstructive surgery to help restore normal penis appearance and function are some of the most rewarding things I do as a pediatric urologist. 

I would like parents who have a son born with hypospadias to be reassured that the anatomy can be reconstructed, the surgery is well tolerated, and a good outcome with a normal, or near normal, penis appearance and function can be achieved.

It is not urgent to treat newborns with hypospadias because they can usually pee (urinate) just fine through their existing urinary opening.

In fact, when hypospadias is the only condition noted in a newborn physical exam there is a low chance of additional developmental abnormalities. Additional tests and studies on the baby are usually not necessary.

It is important to note that if any unusual shape of the penis or urethral opening (where the pee comes out) is present then circumcision (if desired) should not be performed until after the child is examined by a pediatric urologist. This is because the pediatric urologist may need to use the foreskin tissue for the surgical repair. 

Here are answers to some commonly asked questions:  

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 ...

Parent's guide to newborn testing, screening, and prevention measures

When picturing the first days of an infant’s life, what we look forward to the most is love. We express our love in so many ways: skin-to-skin, breastfeeding, swaddling and snuggling. 
 
Love also means keeping them safe. 
 
Advances in maternal-infant health are one of the greatest success stories of the 20th century, with a drop in the death rate of 99%. But some of those dangers only stay in the past through constant vigilance. Behind every screening test and preventive measure is a careful, research-driven rationale. Here are seven newborn tests, screenings, and prevention measures you should know about:
 
Vitamin K injection 
Vitamin K is vital for blood to clot properly. Newborns cannot make Vitamin K and it is poorly transferred in breast milk. Without this injection, babies are at risk for spontaneous bleeding from the umbilical cord, mucus membranes, even in the brain. Giving Vitamin K has greatly reduced this "hemorrhagic disease of the newborn," but rates are increasing as more parents refuse it. Oral Vitamin K has not been shown to prevent this potentially devastating disease. 
 
Hepatitis B vaccine
This is an anti-cancer vaccine. Before this vaccine existed, approximately 10,000 kids under age 10 contracted hepatitis B each year. Most had no known exposure to it. Kids are more likely than adults to get very sick and to have complications. Vaccination at birth has greatly reduced rates of pediatric liver cancer due to hepatitis B. 
 
Antibiotic eye ointment
This prevents bacterial eye infections. Some of these infections are associated with sexually transmitted bacteria, but not all of them are. Negative testing or a monogamous relationship does not ...

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 ...

Jaundice in newborn babies

As a new parent, you’re understandably eager and excited to leave the hospital and settle into your new routine with your baby. Sometimes, that routine is delayed due to the baby’s blood test confirming hyperbilirubinemia, also known as jaundice.

Jaundice in newborns is caused by an excess of red blood cells. Jaundice is seen as a yellow color to the skin, appearing first at the head (skin and sclera – or “whites of the eyes”) then progressing to the feet. As it decreases, it lessens in reverse. Before birth, the placenta removes bilirubin from the baby’s system; after birth, the baby’s liver takes over. In breast-fed babies, an imbalance between mother’s milk supply and baby’s feeding can lead to a higher-than-expected bili level. In addition to ensuring the baby is feeding well and having enough wet/stool diapers, phototherapy or “bili lights” may be needed. Bili lights help speed up the process by breaking down the bilirubin in the skin.

For phototherapy, your baby will be ...
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