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My Child Has Ear Wax In His Ear, Should I Be Worried?

Written by Kristen Stuppy MD. Dr. Stuppy is a practicing pediatrician in Kansas. She feels privileged to be able to help families keep their children healthy and she loves watching entire families grow!  Dr Stuppy is active on Facebook and puts a more personal touch to pediatric topics on her blog.

5085250_f520We make ear wax, also known as cerumen. Many people are annoyed by wax buildup, but it has a purpose! Wax grabs all the dust, dirt, and other debris that gets into our ears.

It also moisturizes the ear canal ~ without it our ears become itchy. It even has special properties that prevent infection. That’s all good stuff, so don’t be too frustrated with a little wax!

Most often the wax moves from the inner part of the ear canal to the outer edge of the canal on its own.

It is amazing to me how our bodies are put together so perfectly: it is designed so the wax is made deep in the canal, then skin cells and wax migrate to the outer edge of the canal, taking with them debris! Some people naturally make dry wax, others make wet wax.

This can be due to genetics and other factors. The important thing to remember with this is how your wax tends to build up and how to best keep it from building up.

If wax builds up it can cause pain, itching, ringing in the ear, dizziness, decreased hearing, and infection. Inappropriate cleaning with hard and/or sharp objects (such as an cotton swabs or paperclips) can increase the risk of infection or even perforation of the ear drum.

Even special cotton swabs made “safe for ears” can push wax deeper and cause a solid collection of wax plugging up the canal.

How can parents help babies and kids keep their ears clean?

  • Routine bathing with clean warm water allowed to run into the ear followed by a gentle wiping with a cloth is all that is needed most of the time.
  • Ear drops made for wax removal with carbamide peroxide can be put in the ear as long as there is no hole in the ear drum or tubes. The oily peroxide acts to grab the wax and bubble it up. Then rinse with clean warm water and a soft cloth (see syringe tips below).
  • If there is excessive buildup, daily use of drops for 3-5 days followed by weekly use of the drops to prevent more buildup is recommended. (For particularly stubborn wax, using drops 2-3 times/day for 3-5 days initially can help.)
  • Make your own solution of 1:1 warm water:vinegar and gently irrigate the ear with a bulb syringe.
  • Mineral oil or glycerin drops can be put in the ear. Let a few drops soak for a few minutes and then rinse with warm water and a soft cloth.
  • Occasional use of a syringe to gently irrigate the ear can help. Using the bulb syringe:
  • First, be sure it is clean! Fungi and bacteria can grow within the bulb ~ you don’t want to irrigate the ear with those! While they can be boiled, they are also relatively inexpensive and easily available, so frequent replacement is not a bad idea.
  • Use only warm water /fluids in the ear (about body temperature or just above body temperature is good). Cold fluids will make the person dizzy and possibly nauseous!
  • If using drops first, put the bottle in warm water or rub it between your hands a few minutes (as if rubbing hands together to warm them, but with the bottle between the hands). Don’t overheat the fluid and risk burning the canal!
  • Have the child stand in the tub or shower.
  • Pull up and back gently on the outer ear to straighten out the canal.
  • Aim the tip slightly up and back so the water will run along the roof of the canal and back along the floor. Do NOT aim straight back or the water will hit the eardrum directly and can impact hearing.
  • Don’t push the water too fast ~ a slow gentle irrigation will be better tolerated. If they complain, recheck the angle and push slower. If complaining continues, bring them to the office to let us do it to be sure there isn’t more to the story.
  • Refill the syringe and repeat as needed until the wax is removed.
  • Use a soft cloth to grab any wax you can see and dry the ear when done. Some people like to use a hair dryer set on low to dry the canal. Just be sure to not burn the skin!
  • If wax continues to be a problem, we can remove it in the office with one of two methods:
  • After inspecting the ear canal carefully with an otoscope (or as I call it with the kids: my magic flashlight), we can use a curette (looks like a spoon or a loop depending on provider’s preference and wax type) to go behind the wax and pull it out.

This is often the fastest method in the office, but is not always possible if the wax is too flaky or impacted into the canal leaving no room for the curette to pass behind the wax. It should only be done by trained professionals… don’t attempt this at home!

  • If the wax is plugging up too much of the canal, the canal is very tender, or if the wax is particularly flaky and breaks on contact with the loop, we will let the ear soak in a peroxide solution then irrigate with warm water.

This process takes longer but is better tolerated by many kids and they think it is fun to “shower their ear”. We often must follow this with the curette to get the softened wax completely out.

My biggest tips:

  • Never use cotton tipped swabs, pipe cleaners, pencils, fingernails, or anything else that is solid to clean the ear! (Note: I still don’t recommend them if the package says “safe” ~ they aren’t!)
  • Don’t put liquid in the ear canal if there is a hole in the ear drum (tubes are included in this). Pus draining from the ear is a sign that there might be a hole.
  • Ear candles are not a safe solution. Burns are too big of a risk!
  • The ear canal is very sensitive, especially if wax buildup has been there a while and has caused an infection of the skin in the canal. Anything put into the ear can increase any pre-existing pain.
  • If the skin is friable from prolonged wax and/or infection there is often bleeding with cleaning. If you notice this at home, your child should have the ears evaluated in our office.
  • We will look for holes in the ear drum, scratches on the skin in the canal, and signs of infection needing antibiotic.
  • Some people who suffer from itchy ears can help themselves by NOT cleaning their ears so much!
  • Earwax usually can be left alone. Only try to clean it out if there are signs of problems with it (ear pain, ringing in the ears, decreased hearing, etc).
  • If kids don’t tolerate removal with the methods above, bring them in for us to take a good look. There might be more to the story that needs to be addressed.
  • If there is significant ear pain, pus or bleeding from the ear, or an object in the ear, bring your child in to the office to have us assess and treat.
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Is Your Child Outgrowing Her Generic Concerta Dose?

Methylphenidate (also known as Concerta).

Methylphenidate (also known as Concerta). (Photo credit: Wikipedia)

Written by Kristen Stuppy MD. Dr. Stuppy is a practicing pediatrician in Kansas. She feels privileged to be able to help families keep their children healthy and she loves watching entire families grow!  Dr Stuppy is active on Facebook and puts a more personal touch to pediatric topics on her blog.

Generic Concerta Not Working Like the Brand Used To? It might not be that you’re outgrowing the dose…

I used to be a huge fan of generics. They save money, right? They are equivalent to the brand name, right?

That’s what I’ve always been taught and what I teach.

I’ve been jaded by many problems and now disagree with the above. Generics aren’t always cheaper than the brand name. Some generics are not equivalent to the name brand.

A recent discussion on a psychology/pharmaceutical listserv I follow brought up the issue of generic Methylphenidate HCl not working as well as the brand name Concerta. Several members had some great insight into why this is.

The discussion peaked my interest in the issue and I started looking online for information earlier this week.

Ironically today I went to pick up a family member’s medicine. We have filled at the same pharmacy previously for generic “Concerta” and have always gotten the equivalent generic.

When I looked at the pills in the bottle today, I told the pharmacy tech they weren’t OROS (see below). She looked confused. She had no clue what I was talking about.

(Lesson to all: if you have any questions, ask to talk to the pharmacist. Hopefully they will understand the pharmacology better than the tech.)

Generics for Concerta (Methylphenidate HCl) might have the same active ingredient, but have a completely different time-release system, resulting in varying drug peaks in the bloodstream.

The original Concerta (from Watson pharmaceuticals) uses a special technology to time-release the active drug. This time-release technology is called OROS (osmotic controlled release oral delivery system). There are several other time-release methods.

The active ingredient may be imbedded in various substances from which the medicine must exit slowly or a gel cap is filled with beads that dissolve at different rates. With the technology used by Concerta, the capsule IS the time release. It doesn’t dissolve.

The medicine is slowly released through a small hole in one end of the capsule. The pill works like a pump, pulling in water from the intestines, pushing the medicine out of the tube slowly throughout the day. See this photo from Medscape.

Screen Shot 2013-05-13 at 9.43.07 AM

I have recently learned that not all generic formulations of Methylphenidate HCl are using this technology. This alters the time-release nature of the active medicine.  For some people this substitute might be just fine, or even preferable.

But if it seems like your medicine isn’t lasting long enough, has times that it works well followed by times it doesn’t until the next peak, or any other problems — check your pills!

You can tell the difference by closely looking at the capsules. The OROS capsules are a unique shape, a little more blunted than a standard capsule. If you look really closely at the ends, you will find that one has a “dimple” where there is a small hole covered by a thin layer matching the rest of the capsule. I just happen to have at least one of three dosages.

IMG_0564

So if any medicine doesn’t work like it used to, look closely at the pill itself to see if it is the same as previously. If you don’t have any left, ask the pharmacy for the company / maker of the medicines you’ve filled over the past several months.

Let your doctor know if you can’t use a substitution so they can specify “Watson brand only.”  If the new “brand” works better, be sure to ask for that manufacturer.

Do not ask your physician to simply increase dosing, because with the next prescription you might get the OROS pill, and the new dose will be too high.

Ask which manufacturer makes the generic for Concerta sold at your pharmacy. Watson Pharmaceuticals is the one that is approved by Ortho McNeill Janssen Pharmaceuticals to market the OROS system pills.

Mallinckrodt markets another type (not OROS) in the US. If your pharmacy doesn’t use your preferred pill type and you plan to shop elsewhere, be sure to let them know why!

 

Reporting Adverse Events: If you have an issue with the duration of action of a different brand of Methylphenidate HCl you should report it to the FDA. This will allow them to review cases and possibly stop the substitution of these non-equivocal products. Click on this link for the MedWatch Report.

Resources:

The Pre-MMA 180-Day Exclusivity Punt? What Gives? A legal blog explaining how medicines lose their exclusivity and can become generically available, specifically the Concerta dispute.

How To Tell The Difference Between Concerta and Generic Concerta A Canadian ADHD blog provided the picture of how to recognize the difference. Generic formulations have been available in Canada years prior to in the US.

Special thanks to the members of the Child-Pharm listserv!

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Will Having a Baby Stand Make Them Bow Legged?

Written by Kristen Stuppy MD. Dr. Stuppy is a practicing pediatrician in Kansas. She feels privileged to be able to help families keep their children healthy and she loves watching entire families grow!  Dr Stuppy is active on Facebook and puts a more personal touch to pediatric topics on her blog.

I am surprised how often I am asked if having a baby “stand” on a parent’s lap will make them bow legged or otherwise hurt them.

Old Wives Tales are ingrained in our societies and because they are shared by people we trust, they are often never questioned.

Allowing babies to stand causing problems is one of those tales. If an adult holds a baby under the arms and supports the trunk to allow the baby to bear weight on his legs it will not harm the baby.

Many babies love this position and will bounce on your leg. It allows them to be upright and see the room around them. Supported standing can help build strong trunk muscles.

Other fun activities that build strong muscles in infants:

Tummy time: Place baby on his tummy on a flat surface that is not too soft. Never leave baby here alone, but use this as a play time. Move brightly colored or noisy objects in front of baby’s head to encourage baby to look up at it. Older siblings love to lay on the floor and play with baby this way!

Lifting gently: When baby is able to grasp your fingers with both hands from a laying position, gently lift baby’s head and back off the surface. Baby will get stronger neck muscles by lifting his head. Be careful to not make sudden jerks and to not allow baby to fall back too fast.

Kicking: Place baby on his back with things to kick near his feet. Things that make a noise or light up when kicked make kicking fun! You can also give gentle resistance to baby’s kicks with your hand to build leg muscles.

Sitting: Allow baby to sit on your lap or the floor with less and less support from you. An easy safe position is with the parent on the floor with legs in a “V” and baby at the bottom of the “V”. When fairly stable you can put pillows behind baby and supervise independent sitting.

Chest to chest: From day one babies held upright against a parent’s chest will start to lift their heads briefly. The more this is done, the stronger the neck muscles get. This is a great cuddle activity too!

What were your favorite activities to help baby grow and develop strong muscles?

Are You A Little Confused About Car Seat Rules and Regulations?

Written by Kristen Stuppy MD.  Dr. Stuppy is a practicing pediatrician in Kansas. She feels privileged to be able to help families keep their children healthy and she loves watching entire families grow!  Dr Stuppy is active on Facebook and puts a more personal touch to pediatric topics on her blog

Many parents are confused by car seat rules, regulations, and recommendations. For many it is a rite of passage with the first birthday to turn kids around forward facing. Then they move to a booster before kindergarten and they loose the booster on their 8th birthday.

What is magic about any age that allows a child to sit in the next level of seating?

Kids vary greatly in their size at these ages, yet age seems to determine seating for many kids. We don’t pick clothing based on age. Shoes are not worn based on age. Why don’t we fit kids into cars as carefully as we fit them into clothing?

There is so much misinformation out there, it’s no wonder people are confused!

And it’s not only confusion, but parents make choices based on so many other factors. For some it is convenience for themselves ~ it’s easier to let a child self buckle in a booster. Sometimes the numbers of kids combined with the size of the car simply don’t allow rear facing for the tots.

Many parents simply want to give up the fight with kids as they fight to grow up into the next step. So many temptations for parents to move onto the next level before kids are ready. I understand, really! It was a fight to get my kids into car seats (forward and backwards) as infants and toddlers.

They would arch their back and I felt like I would break them as I pushed on their middle to force them back while I pulled on arms and buckles to force them in.

I can’t tell you how many times my daughter at 10 years/5th grade complained that she was “the only one still in a booster!” She just recently (finally) can fit into some seats without a booster, but the seat needs to be narrow. Thank you, growth spurt!

Because there is often mention in the car seat instruction manual that kids can turn around at 1 year and 20 pounds, many parents think kids must turn around at that age/size. This is not true per car seat safety testing (unless the seat is older and has lower size restrictions- and then it should be replaced).

It is not required by law in any state or safe by safety standards to turn around at this age/size. The head size of toddlers is still very large compared to their body.

The force on the spinal cord is much greater for a toddler in a forward facing crash due to the larger head and lower muscle strength compared to older children and adults.

The two biggest concerns I hear from parents about rear facing seats:

  • The kids hate being rear facing.
  • The legs are too long.

I find that many kids are perfectly happy rear facing. Others are not happy being strapped in period. Either way, sometimes what kids like isn’t what’s best for them. I just want kids to be the safest they can be!

Parents worry that once the legs can reach past the seat that rear facing is not safe. That sounds reasonable: the long legs would be squished or uncomfortable for kids.

While it is true that most kids will outgrow the rear-facing seat due to height before weight, it is okay to remain rear facing as long as they fit the limits posted on the side of the car seat.

Read your manual. If you can’t find it, look online. Studies have shown that kids are 5 times safer rear facing! Even if they kick the back of the seat. In Sweden they keep kids rear facing until 4 years of age!

There are many sources of confusion with car seats and boosters. The law does not equal the recommendations by safety experts and it differs from state to state. The law is the minimum requirement for buckling kids in car seats.

The law does not necessarily mean the safest way to buckle the kids up. Car seats and boosters vary by age and size limitations, there is no standard. Cars vary in the size and angles of their seats, making the car seat or booster fit differently in every model of car.

The law often does not support the best safety standards:

  • Most states (29) do not require kids to wear helmets on bicycles, yet we know that they save lives.
  • Only 20 states require all motorcyclists to wear helmets.
  • Only two states prohibit children under 1 year from riding on a bicycle/carrier.
  • Three states have no booster seat laws.
  • Only 5 states have seat belt requirements in school buses.
  • Kansas law allows tots to turn forward facing at 1 year and 20 pounds and allows kids over 4 years to ride in booster seats.

My recommendations:

Keep kids rear facing until they are at the maximum height and weight of their rear-facing car seat. If the car seat does not allow rear facing until at least 2 years and 30 pounds, buy another seat.

Kids can be forward facing in a 5 point harness from 2 years/30 pounds (or bigger if your seat allows rear facing longer) until they are at least 40 pounds and 4 years of age (many seats will harness larger children).

The harness is always safer, but when a child can sit still, not unbuckle self inappropriately, sit without leaning forward/to the side, and the shoulder and lap belts fit them appropriately, then they can sit in a booster with the seat belt.

Kids can sit without a booster when they can pass the 5 Step Test. For more on why they shouldn’t graduate out of a booster too soon, check out this great page on The Car Seat Lady.

Kids should never sit in the front seat until they are teenagers (or the size of a teen).

Never turn off the air bag to allow kids to sit up front. Think for a minute: why are airbags there in the first place? To save lives!

People in the front seat are MUCH more likely to be injured/killed in a crash. If the child is too short and the airbag will hit them in the face instead of the chest, they need to be in back!

Never buy a used car seat or booster seat from someone you don’t know well. You cannot guarantee it has not been in an accident and you should not use a seat after an accident.

Do not use expired car seats. They expire in 5-8 years due to breakdown of the materials of the seat, older technology, and unavailability of replacement parts. Check the labels on the seat for expiration date or use 6 years from date of manufacture.

I wonder how long it will be before the safety recommendations are even stricter: rear facing until 4 years like Sweden?

I always joke that the babies born today will drive backwards by joystick by the time they can drive!

Don’t let your kids take the lead with decisions. Don’t do what the neighbors do. Do what you know is safest for your children. Their lives may depend on it!

For more information and state specific laws:

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Starting Solids: The Old and the New and the Myths

Written by Kristen Stuppy MD

Many parents are excited yet apprehensive to start foods with their infants. So many questions, so many fears. So much food introduction guidance has changed in recent years, that what you did with your older kids might not be current. Change takes time, so not everyone agrees on the “new” rules. Talk to your own pediatrician to see their take on it all!

The older “rules” for starting foods were so confusing… different sources will vary on these rules.

  • don’t feed before 6 months is now ok to feed at 4 months if baby’s ready
  • don’t give nuts, eggs, and other “allergy” foods until ____ (2/3/5 years, varying by expert) is now it is okay to give allergy foods unless there is a family history of food allergy
  • don’t start more than one food every 3-5 days is now introducing multiple foods at one time is ok
  • start with rice, then add vegetables, then meat., wait until last for fruit is now begin with any foods, but try to make nutritious choices, such as meat which is high in iron and protein

Variations of this were plenty, depending on the provider’s preferences. No wonder there is so much confusion!!!!

New rules are much easier. I like easier.

  • Start new foods between 4 and 6 months, when your baby shows interest and is able to sit with minimal support and hold the head up.
  • Don’t give honey until 1 year of age.
  • Don’t give any textures your baby will choke on.

Done.

That’s it. Nothing fancy. Any foods in any order. Multiple new foods on the same day are okay. Common sense will hopefully guide types of foods. Nothing too salted. Try nutritious foods, not junk.

These minimal rules can make parents weary.

What about food allergies if foods are given too early?

Research does not support the thought that starting foods earlier lead to allergies. In fact, there is research to support that starting foods earlier might prevent food allergies. A full 180 degree change!

Pregnant women and breastfeeding mothers no longer have to avoid nuts or other allergy foods in most cases. If there is a close family member with a food allergy, it might still be beneficial to wait to introduce that food. Talk with your pediatrician in that case.

I admit that I was initially nervous about telling parents it was okay to give nut products in infancy. Not just the allergy aspect, but also choking risks. ~ Back to the no textures your baby will choke on… nuts are hard and round– two no-nos, peanut butter is thick and sticky– another choking risk.

Any of the more allergy prone foods should first be offered in small amounts at home. These foods include nuts, egg, and fish. Do this only if there is no one in your house who is allergic to that food.

Have diphenhydramine allergy syrup around just in case, but remember most kids are NOT allergic, and starting younger seems to prevent (not cause) allergy. In the case of nuts, since there is also a choking risk, you can try a food cooked with nuts or nut oil.

What about saving the fruit for last so they don’t get a sweet tooth?

Babies who have had breast milk have had sweet all along! Breast milk is very sweet, yet babies who are graduating to foods often love the new flavors and textures with foods.

Formula babies haven’t had the sweet milk, but they can still develop a healthy appreciation of flavors with addition of new foods. Saving fruit for last simply doesn’t seem to make a difference.

Adding fruits alone is not very nutritious though, so fruits should be added along with other more nutritious foods. The more colors on our plates, the healthier the meal probably is!

I thought they couldn’t have cow’s milk until after a year?

Cow’s milk is not a meal in itself (like breast milk or formula). It is missing many vitamins and minerals, so babies need to continue breast milk or formula until at least a year. Cow’s milk may lead to allergies or eczema, including formulas made with cow’s milk.

Milk products, such as cheese and yogurt can be given to babies as part of an otherwise well rounded diet as long as they don’t show any allergy risks to milk. Regardless of dairy intake, it is recommended for infants under 6 months to have 400 IU Vitamin D/day and those over 6 months to take 600 IU Vitamin D/day as a supplement.

I thought they should have cereal first…

Rice cereal has been the first food for generations, probably because grandma said so. There has never been any research supporting giving it first. With white rice and other “white” carbohydrates under attack now, it is no wonder the “rice first” rule is being debated. Despite being fortified with vitamins and iron, it is relatively nutrient poor, so choosing a meat or vegetable as first foods will offer more nutrition.

Shouldn’t we wait on meat?

Waiting on meat due to protein load was once recommended, but no longer felt to be needed. Pureed meats (preferably from your refrigerator… baby food meats are not very palatable!) are a great source of nutrition for baby! Some experts recommend meat as the first food due to its high nutritional value and low allergy risk.

How do we know what they’re allergic to if we start several new things at once?

First, most kids are not allergic.

Second, if they are allergic to a food, it is often days/weeks/months before the allergy is recognized. Waiting 3 days between food introduction simply doesn’t allow recognition unless it is hives or anaphylaxis, and there are a small number of foods that account for most of these reactions.

If your child has one of these reactions we can test to see what the offender was. This is recommended with severe allergies since people with one allergy might have other allergies, and identification for avoidance is important.

Allergy symptoms can be broad and often are not specific: dry skin (eczema), runny nose, hives, swelling of lips, difficulty breathing, vomiting, diarrhea, or blood in the stool. If you think your child is allergic to a food, discuss with your doctor. Severe symptoms (anaphylaxis) demand immediate attention!

How do we know when to start foods? I wanted to start to help baby sleep through the night, but I heard starting too soon increased obesity and diabetes.

When babies are able to sit with minimal support and hold their head up and when thye show interest in food by reaching for it they might be ready. They can wait until 6 months to start foods, but some studies show poor weight gain and nutritional balance as well as resistance to foods if started after 6 months.

In formula fed babies it has been shown to increase the risk of obesity at 3 years (6x!) if foods are started before 4 months of age. That risk is not seen in exclusively breast fed infants or those who begin foods after 4 months of age.

It is still an old wive’s tale that starting solids will help baby sleep through the night. Babies tend to sleep longer stretches at this age, so it is no wonder that this myth perpetuates. Start foods because you see signs that baby is ready, not because you want longer sleep patterns!

How do I know how much to feed my baby?

Babies will let you know when they are full by turning away, pursing their lips, spitting out food, or throwing foods. As they eat more food, they will need less breast milk or formula. In general a baby who is gaining weight normally will self regulate volumes.

What’s better: baby foods bought at the store or home made foods?

Marketing and ease of preparation has made pre-prepared foods for us all common place. It does not mean they are any better. They cost more than home made foods. I didn’t make baby foods when my kids were babies because I thought it would be too hard, but now I puree foods to put into recipes (my kids are like many who aren’t fans of veggies and I want to improve their nutrition). It really isn’t hard. You can take whatever you are cooking for your family and put it in a food processor or some blenders and with a little water to get it to a texture baby can eat: voila! Home made food. There are of course many baby food cook books and ideas of how to freeze meal-sized portions so you can make multiple meals at one sitting. There is help for parents who want to safely prepare baby food at home at the USDA website.

My baby only wants table foods. Is that okay? Don’t they need pureed foods first? He doesn’t have many teeth!

Pureed foods are what most babies start with due to the easy texture, but some babies quickly develop the ability to pick up small pieces of food with the pincher grasp (finger/thumb) and want to feed themselves. If they are able to get the food in their mouth, move it to the back safely with their tongue, and swallow without choking, they are ready to feed table foods… at least with some textures. Beware of chewy or hard foods as well as round foods ~ these all increase the risk of choking.

Most babies will be able to eat table foods between 9 and 12 months. They tend to not have molars until after 12 months, so they grind with their gums and use all their saliva to help break down food. They need foods broken into small enough pieces until they can bite off a safe bite themselves.

Don’t put the whole meal on their tray at once… they will shove it all in and choke! Put a few bites down at a time and let them swallow before putting more down. Rotate food groups to give them a balance, or feed the least favorite first when they are most hungry, saving the best for last!

This is a great time for parents, sitters, and other caregivers to take a refresher course on CPR in case baby does choke. Infants and young children are more likely to choke on foods and small objects, so it is always good to be prepared!

How much juice should my baby drink?

In general I think babies don’t need juice at all. They can practice drinking from a cup with water. Juice adds little nutritional value and a lot of sugar. Eating fruit and drinking water is preferable. If they do drink juice, it should be 100% fruit or vegetable juice, not a fruit flavored drink! No more than 4 ounces/day of fruit juice is recommended.

What about organic?

There is not enough evidence to recommend organic food, since the nutritional components of the foods are similar regardless of how they were farmed.

Organically grown foods do have lower pesticide residues than conventionally farmed produce, but it is debated if this is significant or not to overall health. Conventionally farmed produce have the pesticide levels monitored, and they fall within levels that are felt to be safe.

Organic farming rules also dictate no food additives or added hormones, which is also an area of study for health risks and benefits, but not enough data is available to give an educated opinion yet.

Organic farming is generally felt to be better for the environment, but the sustainability of that is questioned.

Many argue that the taste of organic foods is superior.

Organic farming might increase the risk of bacterial and fungal contamination or heavy metal content, so it is very important to wash fresh fruits and vegetables well prior to cutting or eating (as you should with all fresh foods).

For more information, see the USDA site.

A backyard garden can be inexpensive, organic, and a great way for your kids to learn about growing and preparing healthy foods!

 

Dr. Stuppy is a practicing pediatrician in Kansas. I feels privileged to be able to help families keep their children healthy and she loves watching entire families grow!  Dr Stuppy is active on Facebook and puts a more personal touch to pediatric topics on her blog.  

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Your Child’s Fever, Good or Bad?

Written by Kristen Stuppy MD

Fever is scary to parents.

Parents hear about fever seizures and are afraid the temperature will get so high that it will cause permanent brain damage. In reality the way a child is acting is more important than the temperature. If they are dehydrated, having difficulty breathing, or are in extreme pain, you don’t need a thermometer to know they are sick.

Fever is uncomfortable.

Fever can make the body ache. It is often associated with other pains, such as headache or earache. Kids look miserable when they have a fever. They might appear more tired than normal. They breathe faster. Their heart pounds. They whine. Their face is flushed. They are sweaty. They might have chills.

Fever is often feared as something bad.

Parents often fear the worst with a fever: Is it pneumonia? Leukemia? Ear infection?

Fever is good in most cases.

In most instances, fever in children is good. It is a sign of a working immune system.

Fever is often associated with decreased appetite.

This decreased food intake worries parents, but if the child is drinking enough to stay hydrated, they can survive a few days without food. Kids typically increase their intake when feeling well again. Don’t force them to eat when sick, but do encourage fluids to maintain hydration.

Fever is serious in infants under 3 months, immune compromised people, and in under immunized kids.

These kids do not have very effective immune systems and are more at risk from diseases their bodies can’t fight. Any abnormal temperature (both too high and too low) should be completely evaluated in these at risk children.

Fever is inconvenient.

I hate to say it, but for many parents it is just not convenient for their kids to be sick. A big meeting at work. A child’s class party. A recital. A big game or tournament. Whatever it is, our lives are busy and we don’t want to stop for illness. Unfortunately, there is no treatment for fever that makes it become non-infectious immediately, so it is best to stay home. Don’t expose others by giving your child ibuprofen and hoping the school nurse won’t call.

Fever is a normal response to illness in most cases.

Most fevers in kids are due to viruses and run their course in 3-5 days. Parents usually want to know what temperature is too high, but that number is really unknown (probably above 106F).

The height of a fever does not tell us how serious the infection is. The higher the temperature, the more miserable a person feels. That is why it is recommended to use a fever reducer after 102F. The temperature does not need to come back to normal, it just needs to come down enough for comfort.

Fever is most common at night.

Unfortunately most illnesses are more severe at night. This has to do with the complex system of hormones in our body. It means that kids who seem “okay” during the day have more discomfort over night. This decreases everyone’s sleep and is frustrating to parents, but is common.

Fever is a time that illnesses are considered most contagious.

During a fever viral shedding is highest. It is important to keep anyone with fever away from others as much as practical (in a home, confining kids to a bedroom can help). Wash hands and surfaces that person touches often during any illness.

Continue these precautions until the child is fever free for 24 hours without fever reducers. (Remember that temperatures fluctuate, so a few hours without fever doesn’t prove that the infection is resolved.)

Fever is an elevation of normal temperature.

Normal temperature varies throughout the day, and depends on the location the temperature was taken and the type of thermometer used.

Digital thermometers have replaced glass mercury thermometers due to safety concerns with mercury. Ear thermometers are not accurate in young infants or those with wax in the ear canal. Plastic strip thermometers and pacifier thermometers give a general idea of a temperature, but are not accurate.

To identify a true fever, it is important to note the degree temperature as well as location taken. (A kiss on the forehead can let most parents know if the child is warm or hot, but doesn’t identify a true fever and therefore the need to isolate to prevent spreading illness.)

I never recommend adding or subtracting degrees to decide if it is a fever. In reality, you can look at a child to know if they are sick. The degree of temperature helps guide if they can go to school or daycare, not how you should treat the child. Fevers in children are temperatures above

  • 100.4 F (38 C) rectally
  • 99.5 F (37.5 C) in the mouth
  • 99 F (37.2 C) under the arm

Fever is rarely dangerous, though parents often fear the worst.

This is the time of year kids will be sick more than normal. With each illness there can be fever (though not always.)

What you can do?

  1. Be prepared at home with a fever reducer and know your child’s proper dosage (especially with the recent dosing changes to acetaminophen!)
  2. Use fever reducers to make kids comfortable, not to bring the temperature to normal.
  3. Have an electrolyte solution at home in case of vomiting.
  4. Teach kids to wash their hands and cover coughs and sneezes with their elbows.
  5. Stay home when sick to keep from spreading germs. It is generally okay to return to work/school when fever – free 24 hours without the use of fever reducers.
  6. Help kids rest when sick.
  7. If the fever lasts more than 3-5 days, your child looks dehydrated, is having trouble breathing, is in extreme pain, or you are concerned, your child should be seen. A physical exam (and sometimes labs or xray) is needed to identify the source of illness in these cases. A phone call cannot diagnose a source of fever.
  8. Any infant under 3 months or immune compromised child should be seen to rule out serious disease if the temperature is more than 100.5.
Dr. Stuppy is a practicing pediatrician in Kansas. I feels privileged to be able to help families keep their children healthy and she loves watching entire families grow!  Dr Stuppy is active on Facebook and puts a more personal touch to pediatric topics on her blog.  

Do you ask if the adults supervising your children have had background checks?

Written by Kristen Stuppy MD

Recent news about a well known person repeatedly sexually abusing children over many years has many parents angry, confused, and simply aghast.

Many of us feel like we do all we can to protect our kids and our kids aren’t at risk, yet statistics show that any child could be a victim. Studies reveal that about 20% of women and 10% of men experienced sexual abuse as children.

Sexual abuse crosses all socioeconomic groups, all racial groups, all ethnicities, and all neighborhoods. Often the perpetrators are the least suspected: a family member, a coach, a neighbor.

Signs of abuse in kids can be subtle. They are often attributed to something else.

If kids do try to talk about feeling scared or not safe with someone: LISTEN. They don’t make this stuff up!

I appreciate the organizations that require background checks on all adults around kids. I have had my background checked on many occasions: job related, coaching my daughter’s cheerleading squad, volunteering at my children’s school, and volunteering at a local children’s theater.

I was never offended by these requests and always supported these checks, but some parents grumble. I suspect they just don’t understand. Many schools, sports organizations, and scouting organizations require teachers and volunteers to have routine background checks. Does yours?

Do you ask if the adults supervising your children have had background checks?

Most do not.

I am not even sure how I feel about this. I suspect it gives a false sense of security, knowing that many abusers have many victims before being caught. They would have normal background checks. They are often personable, friendly, someone who grooms victims and their families to gain trust.

If background checks aren’t full proof protection, what should a parent do? I believe that the best protection about abuse is to show love to your children, educate yourself and them about abuse, and frequently talk with them.

Knowledge is Power!

Teaching kids about proper boundaries is important. Let them know that their swim suit area is private, and no one should be able to look or touch there without permission from mom or dad.

Young children should learn their full address, phone number, first and last name (and first/last names of parents).

Remind kids that there are no secrets between kids and their parents. They can tell you anything. They can keep your birthday gift a surprise though! Secrets that scare them are especially important to tell! They will NEVER get in trouble for telling about a scary secret.

Know your children’s friends, their friend’s parents, teachers, coaches, piano teachers, etc. Offer to help as much as possible at school and activities.

Be sure there are no secluded areas in the places your child goes. Kids should always remain in a group with adults. A minimum of two adults is safest.

For your protection, if you must take other kids to a public restroom, stand in the main door with it open and let the kids go into stalls alone.

Teach kids that adults will never need help from kids to find a missing puppy. Adults can ask other adults, not kids, for directions if lost. Give examples and role play.

Caution kids when they wear shirts with their name clearly posted on the outside that strangers will “know” their name. Stay especially close when your kids have their name displayed. It is easier for a stranger to trick them: “Johnny, your mom told me to come get you. She is hurt. Come with me.” What kid wouldn’t question that???

Question about new toys or gifts. Kids might earn token gifts from coaches or teachers as a reward system, but if your child is getting bigger, more expensive gifts, that is a cause for alarm.

If kids are lost, have them find another child to ask for help. Usually the other child has a safe adult with them that can help. (Plus kids are less intimidated talking to other kids when they are already scared and lost.)

Parents of today need to learn about protecting kids on line.

Bullying now does not stop in the safety of one’s home. On line threats, photos, and comments follow kids everywhere and are very dangerous. Keep computers in public areas, monitor cell phone use, teach kids to never give identifying information on line, and use a computer monitoring system.

Abusers often target kids who are feeling unloved. They groom those kids (and their families) by befriending them, making them feel special, and giving them gifts. The kids start to deeply care for that person, and then the confusion of feelings does not allow the child to easily tell on the person.

Show your kids love in many ways: time spent one on one talking and playing (not watching tv), show interest in your children’s activities, give good touches (ruffling hair, pat on the back, hugs), and build your child’s self confidence.

Building confidence in kids is tricky. Be careful in how you word things… it is always okay to say “I enjoyed watching your game,” whether your child was the star player or had a horrible game.

You can say something about how proud you are of the effort they put into something even if the outcome wasn’t good. Try to avoid saying “better next time,” since that means they didn’t do well this time. Praise frequently and honestly from the heart.

Create a safe environment at home. If kids witness fighting among parents, or parents don’t treat others with respect, the children will learn that this is acceptable behavior.

They have a strong potential to get seriously injured at home or to enter abusive relationships as adults. Seek help if your home is not safe! Use a public computer if yours might be monitored and click here or call 1.800.422.4453 (1.800.4.A.Child) from a safe phone.

Learn more about protecting against abuse and what to do if you suspect it. There are on line resources, such as TheSafeSide or PreventChildAbuse, and locally The Sunflower House to learn about abuse. GetNetWise and NetSmartz411 have information about keeping kids safe on line.

Dr. Stuppy is a practicing pediatrician in Kansas. I feels privileged to be able to help families keep their children healthy and she loves watching entire families grow!  Dr Stuppy is active on Facebook and puts a more personal touch to pediatric topics on her blog.