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When is it time to worry about the cough?

Written By Jennifer Shaer MD, FAAP, FABM, IBCL

CoughIt seems like kids cough all winter long. When is it time to worry about the cough? When can you treat it at home and when should you go to the doctor?

There are many causes of coughing in children. Most commonly, a cough is caused by a viral upper respiratory infection. However, coughs can also be caused by asthma, pneumonia, croup, bronchiolitis, whooping cough, sinusitis, allergies, reflux and even an inhaled foreign body. This article will review the …

Viral upper respiratory infections

This is the common cold. A cough from a cold will typically last two weeks. There is commonly some productive phlegm toward the end of a cold. Antibiotics do not help viral illness so it is best to let this type of cough run it’s course. It is common to have some fever with a viral upper respiratory infection for the first few days. However, you should visit the doctor if the fever lasts more than a few days. You should also be seen if the cough lasts more than a week or the fever comes back after having stopped.

Whooping cough (pertussis)

Recently there has been a resurgence of pertussis. Pertussis will start off looking like the common cold. However, instead of getting better, the cough gets worse. Children with pertussis will cough many times in a row.

They will often lose their breath and take a big “whoop” breath at the end of a series of coughs. Babies with pertussis will sometimes stop breathing and turn blue. Pertussis is extremely dangerous to babies and is preventable by vaccine. It is important to make sure that your baby gets all his pertussis vaccines. In addition, we now give teenagers and adults a pertussis vaccine.

Asthma

A cough from asthma is usually not associated with a fever. Kids with asthma will cough more with exercise and at night. Asthma is usually triggered by a cold so children who have a history of wheezing should always see the doctor when they are coughing.

Bronchiolitis

Bronchiolitis is when a viral upper respiratory infection moves into your baby’s chest and causes wheezing. Signs that your baby’s cold might be bronchiolitis include trouble nursing or taking a bottle, heavy or fast breathing and wet sounding cough. In general, babies with a cough should see the doctor.

To learn more about coughs, or any other medical conditions your child may be facing, visit HealthyChildren.org.

Dr. Shaer is a pediatrician and a board certified lactation consultant (IBCLC). She is director of the Breastfeeding Medicine Center of Allied Pediatrics of New York.

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6 Simple Back-to-School Tips For Parents

ImageMost kids are back in school. But that doesn’t mean we can’t make on the fly improvements to help us get back into a routine. Here are 6 quick tips to help you get back on track:

  1. Restart the bedtime routine: It’s hard to get up for school the first day unless you start back into a normal bedtime routine now.
  2. Set up a place for homework: Set expectations now and get organized. Kids thrive on routine and organization.
  3. Talk to your child’s teacher, school psychologist or nurse: If you have ANY concerns about your child academically, socially or medically, reach out in advance. Being proactive is always better than being reactive.
  4. Prepare for sick days: Kids will inevitably get sick at the beginning of the school year as they come back together in such close quarters. Kids who have asthma often benefit from restarting their controller medications in anticipation of this. Visit your doctor to discuss this or any other medical needs before school starts.
  5. Consider helping kids in school districts with less: DonorsChoose.org makes it easy to help classrooms in need. Public school teachers post classroom project requests. Find a project that has some meaning to you and your family.
  6. Don’t stress: Back to school can be stressful for everyone. Try and relax and take it one day at a time.

Dr. Shaer is a pediatrician and a board certified lactation consultant (IBCLC). She is director of the Breastfeeding Medicine Center of Allied Pediatrics of New York.

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Can I Spoil My Newborn?

Written By Jennifer Shaer MD, FAAP, FABM, IBCL

Parents of newborns often ask me if holding their baby too much will spoil him or her. The answer to this question is a resounding “No”.

Newborn babies are accustomed to being held 24/7. This was their existence during their entire gestation. Any amount of time that a newborn is not being held can be stressful. An infant does not need to learn and cannot learn to be independent immediately after birth. Newborns do not have the capacity to be lazy or manipulative at this stage.

The best way to comfort and care for a newborn is to imagine recreating the feeling of being in utero. If your baby falls asleep on your chest, enjoy it. Newborns regulate body temperature, heart rate and breathing best when lying chest to chest with mother or father.

Because of this, baby wearing has become popular of late and is a great way to nurture your baby hands free while taking care of yourself and even your other kids.

However, this does not mean that you need to be a slave to your baby. If you need to put your baby down and he cries, it will not harm him in the long run.

My advise is to follow your instincts. Hold your baby whenever you want to without the guilt that you are spoiling him.

Cherish this time. All too soon he will be grown up. On the other hand, do not fret if you have to or want to put him down to take care of something. Consider using a sling which will allow you to multitask.

As babies grow up, this advice changes. Older babies do benefit from learning how to self soothe. For now, enjoy those first few months. Forget the laundry, cooking, entertaining and other chores unless critically important. Spend this time bonding with your newborn and enjoy every moment while it lasts.

 

Dr. Shaer is a pediatrician and a board certified lactation consultant (IBCLC). She is director of the Breastfeeding Medicine Center of Allied Pediatrics of New York.

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My Child Has A Fever, Should I Be Afraid?

Written By Jennifer Shaer MD, FAAP, FABM, IBCL

Everyone gets nervous when their child has a fever. However, fever is not dangerous. There are many myths surrounding fever. Here are some facts about fevers:

Fever helps the body fight infection. Fever helps slow growth of bacteria and viruses. It also enhances the immune fighting cells in the blood.

A high fever does not necessarily mean that there is a serious disease. Many viral illnesses can cause very high fevers. While these fevers might be high, they will go away without any help in three to five days.

Fevers do not cause brain damage.

Again, fever is a normal physiologic response. The only time that fever is dangerous is when it is from heat stroke or hyperthermia. Symptoms of heat stroke are red hot dry skin with no sweating and confusion.

Infections and illnesses that cause fever do not cause heat stroke and are not dangerous. It is true that a small percent of children who get a fever will have a febrile seizure. Febrile seizures occur in about 4% of kids. They can be very scary to watch but they do not cause brain damage.

Medicines to lower fever are not expected to bring the temperature down to normal.

Ibuprophen and acetaminophen are often used to bring down fever in children. However, these medicines will only help the child feel better for a short time.

When the medicine wears off, the fever will return. Your child will continue to have fever for as long as the illness lasts (usually 3-5 days). Also, these medicines will lower the fever but they are not expected to bring the temperature back to normal.

It is expected and helpful to have some fever while your child is sick.

Of course you want your child to be comfortable and you do not want your child to get dehydrated from a high fever but remember that the fever is helping your body fight infection.

Also when your child is sick, he or she should be resting. If you bring the temperature back down to normal with medicine than he will want to run around a play. The goal in using medicine for fever control is to keep your child comfortable while his body is fighting the illness.

Fevers will not continue to rise without treatment. The brain has a “set point” temperature that it will reach and then start to come down, even without medicine.

Medicines to bring down fever will not prevent a febrile seizure.

One in twenty five children will have a febrile seizure. It is impossible to predict and it is impossible to prevent. Remember that while they are scary, they are not dangerous.

Do not use medicine to try and prevent a seizure. Medicine for fever should only be used to keep your child comfortable.

It is most important to determine the cause of your child’s fever.

Fever is just a symptom.

If the fever is from strep throat or an ear infection then he might need antibiotics. If the fever is from a virus, then it will need to “run its course”.

You should bring your child to the doctor to help determine the cause of the fever. Once you know the cause, you can relax.

Medicines come in many shapes and sizes and they are dosed based on your child’s weight. To determine how much medicine your child should take, visit Allied Pediatrics – Med Dosage Resource

Dr. Shaer is a pediatrician and a board certified lactation consultant (IBCLC). She is director of the Breastfeeding Medicine Center of Allied Pediatrics of New York.

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Ten Tips to Help Prevent Childhood Obesity

Written by Dr. Jennifer Shaer MD., FAAP., IBCLC

There is a lot of attention these days on childhood obesity. How do cute chubby babies grow into unhealthy overweight children? It’s very easy. Weight management is an uphill battle for everyone. It is only successful for adults when they have the desire and determination to make a change. The problem for kids is that they want what they want, when they want it. Children cannot understand the consequences of overeating and lack of exercise. They cannot be expected to make healthy food choices on their own. It is up to parents to instill healthy eating habits in their kids. Here are a few tips.

Be a role model

Eating healthy is a family affair and children learn by example. It is unreasonable to expect one person in the family to be on a “diet”. Set the house up properly and think of healthy eating and exercise as a lifestyle change instead of a diet. Fill the cabinets and refrigerator with healthy snacks, fruits and vegetables. If the chips and junk food are not there, then they are not an option. If a child is whining that he wants the cookies, it is easy to say “no” if there are none in the house.

Watch portion sizes

There is an absolute distortion of what a portion size is these days. Read labels and measure your food just to get a sense of what a portion size is.

Recognize appetite as opposed to hunger

There is a big difference between appetite and hunger. Offer anyone an ice cream sundae and he will have an appetite. Just because your child will eat an entire plate of cookies, does not mean he is hungry.

Stop making your child clean his plate

It is really important to let your child decide how much he wants to eat. Young children have the ability to actually eat when they are hungry and stop when they are full. Your job as a parent is to choose what foods to offer and when to offer them. Your child’s hunger should determine how much of the meal he eats. If he chooses to eat very little at one meal, he will eat more at the next. Mealtime should not be stressful.

Do not use food as a reward

There are better ways to reward good behavior than giving junk food. Everyone should be allowed to eat junk food on occasion. The key is to limit unhealthy foods and limit the portions. Good behavior is an expectation aside from food.

Don’t drink your calories

An easy way to watch calorie intake is to drink more water. Kids can absorb a lot of calories by drinking juice, soda and even milk. When drinking milk, choose fat free.

Slow down. It takes time for the brain to realize that the stomach is actually full. If your child eats slower and drinks water while eating then he will get full faster. Do not allow second portions unless he is truly still hungry. Keep the serving platters off the table to make it more inconvenient to reach for a second serving.

Avoid emotional eating

If your kids are bored or happy or sad, then help them find something else to do.

Do not allow your kids to eat in front of the television or computer

Lots of calories can be eaten without even realizing it when you eat in front of the TV.

Be active as a family

Take a walk or go for a bike ride. Get off the couch and get moving.

Dr. Shaer is a pediatrician and a board certified lactation consultant (IBCLC). She is director of the Breastfeeding Medicine Center of Allied Pediatrics of New York. Dr. Shaer is dedicated to helping nursing mothers achieve their breastfeeding goals.

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On Mother’s Day, We Should Be Supporting ALL Mothers

By Jennifer Shaer, MD FAAP IBLC

Time Magazine has caused quite a stir this week with its cover featuring a three year old breastfeeding. The article is about a philosophy of parenting called attachment parenting and the controversy is two-fold.

The first issue surrounds the cover title “Are you mom enough?”. This provocative title implies that if you do not breastfeed your child until he is three and do not practice attachment parenting then you are less of a mother.

While attachment parenting works for many, to imply that it is the only way to raise a well-adjusted child is misleading and inflammatory.

The second issue surrounds the cover photo and the concept of nursing a toddler. As a pediatrician and a breastfeeding medicine specialist the photo of a three year old standing up while nursing and looking at the camera should be easy for me to look at, and yet it is not.

Why does this photograph evoke such emotion?

Medically speaking, there is every reason for a child to continue nursing until he self-weans. In most societies that embrace self-weaning, children routinely breastfeed until well over two years old.

However, it is so rare to see a toddler in our society nursing that the image is unsettling. I ask myself, “why am I uncomfortable looking at this picture when I am such a strong supporter of breastfeeding?”

There is truly a societal and social expectation that is ingrained in all of us, and it works to the detriment of breastfeeding as a whole. As I think about my patients, I recognize a pattern.

Upon initiating breastfeeding, most women are proud to give their baby the best start to life and are proud of themselves for being successful in the first big parenting challenge. However, as mothers continue to breastfeed, there comes a point when they turn from proud to embarrassed.

I see the look on their faces or the tone in their voices when they tell me that the 15 or 18 month old is STILL nursing. The mother who was once confident and proud begins to feel like an outcast and a social deviant.

Many women at this point either force the baby to wean, secretly nurse (the “closet nurser”) or stand up for themselves as Jamie Lynne Gumet has done in this article.

What can I say about this situation? This child is not being forced to breastfeed. He is not being abused and this is not pornography as some people suggest. Nobody can force a 3 year old child to do most of anything that he doesn’t want to do, let alone breastfeed.

The problem with this image is that it is so contrary to what we accept as normal. The problem with this image is that we as a society cannot accept breastfeeding a toddler.

I know in my heart that this is normal but my gut reaction can’t easily be changed. Just as I know in my heart that gay couples should have the right to marry, yet when faced with two men kissing in front of me, I am uncomfortable.

The unsettled feeling that I get when looking at this picture is my own weakness. I applaud Jamie Lynne Grumet and Time Magazine for helping me take one step closer to accepting what is biologically normal.

On mother’s day, we should be supporting ALL mothers. If we stop passing judgment on one another then we will truly be showing our children how to behave as adults.

Dr. Shaer is a pediatrician and a board certified lactation consultant (IBCLC). She is director of the Breastfeeding Medicine Center of Allied Pediatrics of New York. Dr. Shaer is dedicated to helping nursing mothers achieve their breastfeeding goals.

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Do You Feel Cheated When You Don’t Get a Prescription After Visiting the Doctor?

Written by Jennifer Shaer MD, FAAP, FABM, IBCLC

It makes sense that physicians want to DO something to help their patients get better. That’s what we went to medical school for, right? Sick patients tend to expect the same from their doctors, a quick fix for their illness. One of the hardest things to learn as a doctor is that sometimes the best thing we can do for a patient is to get out of his way and let his body do what it does best, heal itself.

How many times have you heard your doctor say, “it’s a virus” or “you’re fine”. How many times do you feel dissatisfied when you leave the office without a prescription? The fact of the matter is that doctors prefer to give medicines to help you get better. It’s very easy to say, “you have strep throat, here is an antibiotic and you should feel better in a day or two”. It’s a lot harder to tell a parent that her sick child has a virus and that the best thing she can do is give supportive care until the child fights it off.

Here are some things to consider the next time you leave the doctor without a prescription.

The hardest thing your doctor does is diagnose your problem.

The symptom of a stomach ache can be caused by anything from appendicitis to gas. A headache can be caused by anything from stress to a brain tumor. When you visit the doctor, you should focus on how thoroughly your doctor listens to you, examines you and explains to you what she is thinking.

When your doctor says “you have a virus” or “I don’t find anything”, it doesn’t mean that you are not sick.

Understand that your doctor can be frustrated that he has nothing to offer you to get better. He would LIKE to give you a medicine but sometimes a medicine is not indicated and all you need is “tincture of time” to get better.

Do not feel cheated if you do not get a prescription.

Sometimes it takes a doctor more time and energy to explain an illness and why antibiotics are not needed.

Doctors do not want to withhold antibiotics.

When we choose not to give an antibiotic it is because we do not believe it will help and in fact in many cases it will make the situation worse. Certain viral illnesses react badly to antibiotics. Antibiotics can cause allergic reactions and gastrointestinal side effects.

Every time doctors prescribe a medication, they have to weigh the risks and the benefits. Everyone who watches television has heard the disclaimers at the end of medication commercials. “This medication can cause a multitude of problems. If you feel X,Y,Z stop taking this medicine and call your doctor immediately.” Even routine fever control medications have the possible side effect of liver injury. It stands to reason that if the doctor is certain your illness is going to get better without medication then he will not want to take the chance of exposing you to a medication side effect.

On the flip side, don’t be afraid to take antibiotics when indicated.

Recently there has been so much bad press about antibiotics that people seem afraid to use them at all. Antibiotics are absolutely indicated to treat bacterial infections. Let your doctor determine whether or not you have a bacterial infection.

Remember that you and your physician are partners in your health.

Don’t stop going to the doctor because you think you won’t get medication. Remember, it’s the diagnosis that you really need your doctor for. Make sure you keep the lines of communication open. Explain your concerns, let your doctor explain his and make sure you understand and agree with his recommended treatment plan.

Dr. Shaer is a pediatrician, board certified lactation consultant (IBCLC) and a member of the Academy of Breastfeeding Medicine. She is founder of the first breastfeeding medicine practice on Long Island. Dr. Shaer is dedicated to helping nursing mothers achieve their breastfeeding goals.