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Pediatrics - Raising a Healthy Child

Raising a Healthy Child

Raising a Healthy Child - Acne

We still are not sure why some people have more acne than others, but we know that acne is the result of a combination of factors, and that even with treatment, acne does not disappear overnight.

The basic problem is blocked skin pores. The result is a blackhead or a whitehead. The whitehead is the forerunner of a pimple. Blackheads usually do not cause pimples, but they are unsightly.

What makes acne worse? If you scrub your face, pick it, or rub it too much, the walls of the pores may break and cause more pimples. Pinching and popping pimples, blackheads or whiteheads may cause scarring. Some cosmetics or cover-ups actually may block pores. Avoid greasy make-up, and use mild soaps rather than astringents, to wash your face.

Treatment involves unblocking the pores, and it may take four to six weeks of using medication before you see changes. There are a number of medicines available to treat acne. Some work better for some people than others, so it may take a bit of experimentation before you find the one that works best for you. In cases that are difficult to manage, you may choose to see, or be referred to, a dermatologist, a physician specializing in diseases and conditions of the skin.

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Raising a Healthy Child - Antibiotics

Antibiotics help our bodies fight bacterial infections, but if used improperly, they can do more harm than good. Since many illnesses are caused by viruses, antibiotics are not needed, and should not be used to treat these diseases. A good example is the common cold.

Overuse of antibiotics has led to increasing bacterial resistance. In other words, antibiotics do not work on bacteria upon which they used to work. We are used to calling some antibiotics "weak" (i.e. Amoxicillin) and others "strong" (i.e. Zithromax, Rocephin). The truth is that all antibiotics are "strong" if used properly. The difference is in what types of bacteria they can kill, and in what parts of our bodies they are effective. For example, Rocephin is used for serious bacterial infections like sepsis or meningitis, and Amoxicillin is an excellent drug to treat ear infections, strep throat or sinusitis.

Your child’s physician should decide whether an antibiotic is needed or not. If it is prescribed, use it as directed.

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Raising a Healthy Child - Bedwetting (Enuresis)

Enuresis is the lack of urinary continence beyond age four for daytime, and beyond age six for nighttime, or the loss of continence after at least three months of dryness. There is a genetic predisposition to this problem.

Enuresis can indicate a serious anatomic illness or physiologic abnormality, but most often it is caused by the immaturity of control mechanisms. For example, 90% of four-year olds are continent during the day, but only 75% of them are continent at night. Nighttime continence improves in time. By age eight, at least 90% of children have no problems, and 98% of children 12 to 14 years of age are problem free. Treatment options may include observation, medications (DDAVP), counseling, or bed alarms. Bladder stretching exercises or limiting fluid intake at bedtime have very limited effects.

Medications are quite hard to discontinue, as the problem tends to come back. At this point, bed alarms are the best treatment, and patience is required, because it may take a few weeks or months to see a result. In any case, it is important for your child to understand that he or she is not to blame for the problem, and that together you will work to improve the situation. Emotional support is one of the most important parts of successful treatment for enuresis.

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Raising a Healthy Child - Choosing a Day Care Provider

Choosing a day care provider for your child is a very important decision. The day care you choose should be licensed and/or accredited by a recognized standard-setting body. Here are some other things to watch for:

  • Facility – spacious, safe and clean; availability of age appropriate toys and equipment; emergency phones, lights, fire alarms are working; safe playground equipment and surfaces;
  • Program – staff to child ratios and group size meet standards at all times; a flexible, child-oriented schedule includes alternating active and quiet activities; discipline consists of teaching expected behavior – not punishment; good sanitation is practiced; healthy "family style" meals and snacks are offered; plans are practiced for the management of injury, illness and evacuation.
  • Staff – a director monitors and improves program; nurturing caregivers receive regular training; low staff turnover; a primary caregiver is assigned to each child; adult observation of caregivers is provided
  • Parent Involvement – parents are encouraged to help with programs and are always welcome with nothing "off-limits" to parental inspection.
  • Consultants – are used in the areas of health, mental health, and nutrition.

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Raising a Healthy Child - Circumcision

The issue of circumcision has become very "hot" over the last few years. The American Academy of Pediatrics (AAP) recently issued a statement regarding this procedure which neither recommended nor disagreed with it. Its only recommendation was the use of an appropriate analgesic (numbing) during the procedure. The AAP recommendation, however, may have only minimal impact on how and if the procedure is done, since in most states, obstetricians are the physicians who perform circumcisions. For soon to be parents, there are a few facts that you need to consider before deciding whether or not to choose the procedure for your baby boy.

Increasing public awareness of this issue may raise some questions, and some parents may opt not to circumcise their sons since there is less evidence that circumcision provides any benefits. Parents may also prefer to leave this decision up to their growing boys, since removal of the foreskin is essentially irreversible and may be treated as a purely cosmetic procedure.

There is quite a growing movement against circumcision, which potentially may have a negative impact on the popularity of this procedure. Surprisingly, there are already places in the United States where circumcised boys constitute a minority.

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Raising a Healthy Child - Colds

Now that fall has settled in, we will certainly see children get more colds. During infancy and the preschool years, children average seven or eight colds each year. School age children average five or six colds per year. Adolescents finally reach an adult level of approximately four colds per year.

Children get these infections because they are exposed to one or more of the estimated 200 cold viruses. The younger the child, the fewer viruses he has been exposed to and the less antibody protection he has acquired as a result. The rate of colds triples in fall and winter when people spend more time crowded together indoors, breathing re-circulated air. Smoking in the home increases a child’s susceptibility to colds and coughs, as well as ear infections, sinus infections, croup, wheezing, and asthma.

Children get over colds by themselves. The number of colds your child acquires will decrease over the years as his or her body builds up a good supply of antibodies to various viruses. Although you can reduce the symptoms, you can’t shorten the course of the cold. There are many over the counter medicines to treat the symptoms of colds, including runny nose and stuffiness, headache, etc. Never use aspirin to treat the symptoms of a cold in children. Aspirin can be a cause of Reyes Syndrome, a potentially fatal condition. As with any medicine, make sure you understand the directions for use, the side effects, and the proper dose. If you have any questions, ask your pediatrician or pharmacist for help.

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Raising a Healthy Child - Constipation

Constipation usually refers to the uncomfortable or painful passage of large and hard stool. Often there is no obvious cause for constipation. It tends to run in families, especially where the diet is frequently low in fiber and high in milk, and fluid intake is low. Fecal soiling is common, and is caused by involuntary passage of watery content around the hard, retained stool in the rectum.

Newborns and infants seem constipated every time they have a bowel movement even though the stool they pass is "watery" in nature. Formula fed babies tend to have more formed stools than breast fed babies and tend to have bowel movements less frequently.

Bowel movements, even every few days, are considered normal as long as they are not too hard and do not cause significant discomfort. Most of the time, constipation can be treated at home by increasing fiber and fluid in the diet, but if persistent, or if present before "toilet training" years, the condition should be evaluated by a doctor.

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Raising a Healthy Child - Convulsions

Convulsions associated with acute febrile illness (fever) in otherwise healthy children are called febrile seizures. This problem affects 2% - 4% of children, mainly in the second year of life. There is a 30% risk of recurrence of seizure with subsequent febrile illness, and 3% - 6% of children with febrile seizures will likely develop epilepsy later in life.

Generally, no "special" studies are indicated and no anti-seizure medications are needed. Treatment is directed towards the underlying illness which causes the fever. Fever is controlled with Tylenol, Motrin, sponge baths, or more sophisticated cooling equipment.

Cool or ice baths are not recommended any longer since they cause constriction of the peripheral blood vessels, and internal body temperature actually increases. Convulsions can be frightening to parents, and should not be ignored, but generally their effects are temporary. Consult your child’s pediatrician for proper diagnosis and treatment.

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Raising a Healthy Child - Diapers

Whether you are using disposable or cloth diapers, your child will very likely develop diaper rash. Rashes are generally caused by irritation of the skin from prolonged contact with urine or stool. Most of the rashes are benign (harmless) and will disappear after 1-2 days. All you need to do is to change the diaper more often and use any of the over-the-counter diaper creams. You can apply the same measures to prevent development of diaper rashes. Vaseline, Balmex, or Daily Care work well.

For more severe rashes, you may want to use "stickier" or "medicated" ointments or creams, such as Desitin. These ointments work well but they are hard to wipe off, so use a little baby oil for easy removal.

Powders are not recommended unless they are medically indicated. Powder tends to form small, hard "pebbles" that can worsen the rash. They can also be easily inhaled, especially by younger babies, and can cause serious respiratory problems.

If the rash is persistent or involves larger areas, it should be evaluated by your physician, since some of the lesions (sores) may be due to fungal or bacterial infection. Occasionally, diaper rash may be caused by a systemic (general) illness.

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Raising a Healthy Child - Diarrhea

Diarrhea refers to an increase in frequency and/or a decrease in consistency of bowel movements and is a very common pediatric problem. Most often caused by viruses, diarrhea is also caused by bacteria, parasites, and inappropriate diet. Chronic diarrhea may be a sign of more serious, often lifelong, illness. Diarrhea usually lasts a few days but, especially in younger patients, may last a few weeks. No tests are necessary unless there is a suspicion of an unusual cause.

Prevention of dehydration and malnutrition is the key for treatment. Rehydrating fluids, such as Pedialyte, are very important but should not be used for more than 24 hours. Regular diet should be reinstituted preferably within the first 24 hours. The BRAT diet (Banana, Rice, Apple, Toast) can be of some value in the older pediatric population about 2 years old and above, but is not routinely recommended. Withholding milk products is not of clear benefit. Antidiarrheal medications can be harsh on the system, and are generally not recommended in the younger pediatric population.

Good hand washing is the best way to prevent the spreading of bacteria. The Rotavirus vaccine should significantly decrease the incidence of diarrhea. Ask your child’s physician for advice regarding the appropriate immunization schedule, and carefully monitor your child’s diet to avoid frequent bouts of diarrhea.

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Raising a Healthy Child - Earache

Earache is the most common reason for seeing a pediatrician. Children from 6 months to 6 years of age are most commonly affected. Earache is most likely due to the inflammation of the middle ear, which develops secondary to the obstruction of the Eustachian tube, which connects the middle ear with the throat. Obstruction of the Eustachian tube can result from infection, allergy, enlarged adenoids or specific anatomical or physiological features. Males are more prone to ear infections, and having siblings at home, formula feeding, bottle propping, day care attendance, the winter season, and cigarette smoke exposure will likely increase your child’s chances for developing ear infections.

Many ear infections will get better on without direct treatment. Over the counter medicines may be used for pain. Antibiotics have been proven to prevent complications stemming from ear infections. Injection of Rocephin is an approved option for the treatment of this common problem. Oral antibiotics, however, remain the preferred form of treatment for ear infections. Your pediatrician may choose to wait with starting an antibiotic depending on your child’s age and symptoms.

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Raising a Healthy Child - Eating Healthy

An overly busy lifestyle does not promote healthy eating, but what and how we eat can affect our general health significantly. Learning how to eat healthy should start as early in life as possible. Eating small, frequent meals is definitely the best way to fight and prevent weight gain since most of the calories will be used right away. Large, infrequent meals tend to provide excess calories which are "saved for later" as fat tissue. However, it is not easy to use these deposited calories. It takes a few days for the body to begin using fat tissue as an energy source.

The fast growing bodies of children definitely need a well-balanced, variable diet. This will not only provide all the necessary nutrients, but will also most likely prevent many gastrointestinal, cardiovascular, and neurological problems. Some parents are concerned that their children will not get the proper nutrition, and choose to add vitamins to their diets, but vitamin supplements are not generally indicated for children with healthy eating habits. The general rules of small, frequent, varied meals, and limiting sugary or high fat snacks will keep most children healthy and less fussy about eating later in life.

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Raising a Healthy Child - Fevers

Managing a fever in a child is one of the most common concerns of parents. Here is some helpful information which will help alleviate some of the worry.

  • From birth to 2-3 years of age, the most reliable and adequate way to check for fever is to take your child’s temperature rectally. Older children can have their temperature taken under the arm, in the mouth, in the ear, or over the blood vessels in temporal area of the head. All of these methods are convenient, but not all are accurate.
  • Fever is present if your child’s rectal temperature is over 100.4 degrees.
  • Fever is one of the ways the body fights an infection so is not always necessary to treat a fever.
  • Fevers of 100 to 104 degrees are not harmful. "Brain damage" generally does not occur unless the temperature is more than 107 degrees for a few hours.
  • If your baby has a fever and is younger than three months, he or she must always be seen by a physician.
  • Do not use aspirin to treat fever in children. It has been associated with development of brain and liver damage known as Reyes Syndrome.

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Raising a Healthy Child - Infant Feeding

The old adage, "the breast is best" is true. Breast milk is the perfect food for newborns, and children up to four months old. Breast milk is always available, is the right temperature, and breastfeeding can be an important bonding time for mother and baby. Discuss breastfeeding with your obstetrician and your baby’s pediatrician, and follow these feeding guidelines to give your baby proper nutrition during the first year.

  • Birth-4 months – Only breast milk or formula – no water supplements, no juices, no solids. Do not add cereals to thicken the formula unless directed by your baby’s doctor.
  • 4-6 months – Begin solid foods. Any younger than this, babies are not ready for solids. They cannot control their heads well enough to prevent choking and aspiration, and their stomachs are not ready to digest and absorb the nutrients from the solid foods. Solids started too early may also put your baby at increased risk for allergies.
  • 8-10 months – Add solid foods with texture, but still soft enough to be mashed by baby’s gums.
  • 12 months – You can replace breast milk or formula with whole milk. Your baby’s brain needs fat for normal growth.

Remember: Do not give more than 8 ounces of juice per day; do not give chips, nuts, seeds, raisins, popcorn or anything that is small and hard until your child is three years old. These foods are too easy to swallow whole and may be sucked into the lungs.

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Raising a Healthy Child - Newborn Skin Rashes

There are several common skin rashes in newborns. Some may require treatment and others do not. Knowing what to look for can alleviate the worry.

  • Toxic Erythema of the newborn, also called "bed bites rash," resembles bug bite lesions. It is extremely common and seen usually during the first or second week of life. It will disappear by itself, and no treatment is necessary.
  • Milia is white or yellow pimples, most often on the face. It usually resolves within a month without any treatment, but if it lasts more than a few months, medical attention may be needed.
  • Miliaria Ruba or Miliaria Crystallina, also called "prickly heat," is red or white pimples caused by sweat retention. If severe, it may require medical treatment.
  • Bohn’s Nodules and Epstein’s Pearls are round pearly white or yellow "dots" on gums or palate. It resolves itself within the first weeks of life without treatment.
  • Acne Neonatorum resembles acne in adolescents and is probably a result of hormonal stimulation. It usually does not require treatment.

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Raising a Healthy Child - Pink Eye

In children, "pink eye" is most commonly caused by adenoviruses, a group of viruses responsible for causing infections in the upper respiratory tract. "Pink eye" spreads rapidly and often affects a significant number of children at the same time. Even though no specific treatment against viruses exists, either antibiotic drops or ointments are used. This is done because "pink eye" is not routinely cultured, and there is a good chance of either primary or secondary bacterial infection. Contact lens wearers are at an increased risk for developing "pink eye" caused by unusual or hard to treat bacteria.

Redness of the conjunctivas (mucous lining of the eyelids) can also be associated with allergies or irritation, such as after sun exposure. This redness is also accompanied by severe itch, with some tearing, but not other symptoms.

Patients with "pink eye" should be seen by a doctor. Treating this common problem is very important, because in certain cases, the consequences of pink eye can include the development of total blindness.

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Raising a Healthy Child - Siblings

Most brothers and sisters (siblings) argue and bicker occasionally. Children tend to fight over possessions, space on the sofa, time in the bathroom, the last donut, and a host of other seemingly unimportant issues. Quarreling is an inevitable part of sibling relationships. On most days, brothers and sisters are friends and companions, but on some days, they are rivals and competitors because they want to gain their parents’ attention and to be their parents’ favorite. The positive side of sibling rivalry is that it gives children a chance to learn to give and take, share and stand up for their rights. Here are some tips to help the situation:

  • Encourage children to settle their own disagreements;
  • Try to stay out of the middle;
  • If an argument becomes too loud or annoying, do something about it;
  • Do not permit hitting, breaking things, or name-calling;
  • Stop arguments that occur in public places;
  • Protect each child’s personal possessions, privacy and friends;
  • Avoid showing favoritism;
  • Praise cooperative behavior; and
  • Take steps to prevent fighting or name-calling.

For the most part, these arguments will become less frequent, and if children learn to settle differences peacefully while they are young, they will be less likely to have major disagreements when they become teenagers, or if they do, they will be more likely to settle them before they end up in violence.

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Raising a Healthy Child - Television Viewing

Young American people spend an average of 22 hours per week watching television. If this habit continues, today’s children will have spent 8 ½ years of their lives in front of the TV screen by the time they are 70-years-old! There is a strong link between obesity in children and the amount of time spent in front of television.

Also of great concern is the questionable content of what is being viewed. The areas of greatest controversy are exposure to violence, sexuality, and commercialism. Multiple studies have demonstrated association between television violence and aggressive behavior in children, although mediated viewing, that is television watched and discussed with parents, will lessen the likelihood that the child will imitate what he or she sees on the screen. There is also a probable link between very high rates of teenage pregnancy and sexual activity when television serves as the major, and sometimes the only, source of sex education.

The American Academy of Pediatrics recommends limiting television-viewing time to a maximum of 1-2 hours per day and advocates parental control over what their children are watching. The Academy strongly cautions against using television as a "baby sitter." The same rules apply to time spent in front of the computer.

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Raising a Healthy Child - Thumb Sucking

Thumb sucking is a very natural way of self-soothing. It is observed in the fetus as early as 18 weeks gestation and continues after birth. About 80% of all infants suck their fingers or thumbs, and girls are more likely to engage in thumb sucking than boys.

Thumb sucking generally does not require intervention unless it persists beyond 4 years of age or is associated with dental problems, finger deformities, skin problems, or social or psychological problems. Some treatment strategies include: identifying and eliminating stress; empowering the child – the child’s active involvement is essential - gentle reminders; praise and reward systems; application of a bitter tasting substance; and using gloves, splints, or socks over the hands.

Obligatory thumb sucking is another intervention which involves the requirement of 10 to 15 minutes of thumb or finger sucking every day. The idea behind it is to change a pleasurable experience to an obligation. Thumb sucking will then likely lose its appeal.

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Raising a Healthy Child - Warts

Warts are caused by a virus that invades the uppermost layer of the skin. The risk of contagion from hand, foot and flat warts seems to be small so there should be no concern about carrying out everyday activities. Warts on children disappear without treatment over a period of several months to several years without any bad consequences. However, since warts can be spread to others, and to new locations on the child, treatment may be appropriate.

Several wart remedies are available over-the-counter. However, you might mistake a wart for another kind of skin growth, which may need medical attention. Do not use over-the-counter medications before talking to a dermatologist or your child’s doctor. Warts on the feet are usually very resistant to over-the-counter medications, and they will most likely need treatment by a physician.

Sometimes it seems new warts appear as quickly as old ones are treated. This usually happens because old warts have shed virus into the surrounding skin before they were treated. Thus, new "baby" warts are growing up around the original "mother" wart. The best way to minimize this problem is to treat new warts as soon as they develop.

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