Goodby

     After writing this blog for over three years, I've decided to end it. I thank the people who have followed it. If it has been beneficial to you or if you have any comments, I'd love to hear them. You can contact me at: jandtoc@msn.com.                 John O'Connell

Stuttering

     Between the ages of 3 and 4, about one in 10 children will begin stuttering.  It is more common in boys than in girls and occurs in all races and cultures.

     The majority of early childhood stuttering is normal and will resolve by itself, but parents need to watch for signs that the stuttering may be a more severe and persistent problem.

     Normal stuttering most often involves short words at the beginning of the sentence. More severe stuttering often involves the first letter of words and can happen any place in the sentence. A child saying, “Mom…mom…mom…I want to go” is less worrisome than a child saying, “M…m…m…m…mom, I want to g…g…g…go”.

     There are other factors that increase the risk that the stuttering may be more severe. If another family member continued to have a stutter through adolescence or into adulthood, the risk is greater. If the child begins to stutter after age 4 or stutters for longer than 12 months, the risk of severe stuttering increases. Severe stuttering involves more than 10% of the child’s speech with the stuttering lasting longer than 1 second. Children with normal stuttering don’t seem embarrassed or upset about their stuttering, but children with severe stuttering may raise the pitch of their voice and become frustrated while struggling to speak.

      There are many support resources for stuttering that can be found online and there are a variety of treatments used by speech therapists. With mild stuttering and no other risk factors, waiting and watching for a while may be a parent’s best choice of action. A report in Pediatrics in 2013 found that waiting a year before beginning therapy did not seem to have any effect on the child’s development or emotional state. However, if parents are very concerned or if any of the risk signs mentioned above are present, referring a child earlier should be considered.

When Eyes Are Pink

     Because it is one of the most common problems of childhood, there are some basic facts that parents should know about “pinkeye”.

     “Pinkeye” simply means that the eye has a red discoloration. There are different medical problems that can cause the eye to be red – some don’t need any treatment and some need immediate care.

     The most common cause of a red eye is a viral infection. This usually comes along with a viral cold – fever, runny nose, congestion and cough. The eye is mildly red and has lots of tearing. Older children will complain that it feels like “something is in my eye”. (If there are no cold symptoms, check – there could be something in the eye!) Usually the eye is not sensitive to light and there should be no pain. A viral infection of the eye can cause the eye to be “pink” for a few weeks. The major problem is that this kind of infection is very contagious and can easily spread through a day care or classroom. Unfortunately, there is no effective treatment for a viral pinkeye. Even more unfortunate is the fact that many day care centers insist that the child be on antibiotics before they are allowed to return even thought the antibiotics do nothing to treat the infection or prevent its spread.

     Allergy can also cause a child’s eyes to be red. This pinkeye comes on seasonally and is accompanied by other allergy symptoms. The eye has lots of tearing and itches – you will always see the child rubbing his eyes. A thin, clear bubble can appear on the white area of the eyeball or bumps may develop on the inside of the lower lid. This pinkeye can be treated with antihistamines, just like the other allergy symptoms.

     A more serious infection is a bacterial infection of the eye. Sometimes a viral infection of the eye can change into a bacterial infection and sometimes bacterial infections occur spontaneously. A blocked tear duct in a newborn can also sometimes develop into a bacterial infection. This infection causes the eye to be really red. There is usually a thick, colored discharge from the eye and the eye may not be sensitive to light but may have some pain. This infection needs to be checked right away and treated with antibiotics.

     There are two other lumps near the eye that can cause the eye to be pink. A sty is a little pimple-like bump with pus in it that appears at the edge of the eyelid just at the base of the eyelash. There is usually some tenderness, swelling and redness around the bump. This is treated with warm compresses and antibiotics.

     A firm bump can also develop under the center of the upper or lower eyelid. This can cause some irritation and redness in the eye itself. This is called a chalazion and is also treated with warn compresses and, sometimes, with antibiotics.

     Finally, even if the eye is not pink, any child who complains of pain in the eye or vision problems needs to be seen by a physician right away.

Things To Do When the New Baby Arrives

     The August issue of Pediatric News has an excellent article by Barbara Howard M.D., assistant professor of pediatrics at Johns Hopkins. The article discusses things that new parents (and parents-to-be) need to discuss.

     The newborn period is a time of stress and also a time of huge changes. How a couple interacts during this period can have long-term effects on their relationship. Difficulties that arise when a new baby enters a family can have both positive and negative effects on the marriage that can last for years.

     Mothers need to feel that the father of the baby is a true partner. He needs to be sympathetic to the fear and pain she endured in labor and delivery and also to the complete exhaustion she will be dealing with in the first weeks at home.  Fathers need to listen closely to their partner and remember how important it is to ask up front, “what can I do for you”.  A loving husband may bring home flowers and then be hurt when the wife is bothered by the smell and actually wanted him to give her a foot rub.

     Fathers and mothers both have to realize that their relationship has changed in a very fundamental way now that a new person has been introduced into it. Things are never going back to the way they were. It is important that parents have honest discussions about their sexual relationship, breast/bottle feeding, how to handle sleep problems, how to handle relatives who want to visit and how to share the everyday workload. Parents need to be absolutely open about both their emotions and their beliefs. If there are differences in religious or cultural beliefs, these also need to be discussed. If the parents are able to engage in this kind of discussion early, they will probably be able to continue as the child grows older and issues like discipline, feeding, and school arise.

     For second-time parents, Dr. Howard also recommends being realistic and honest with the baby’s older siblings. Parents should avoid the “you’ll have a new brother to play with” attitude because babies aren’t much fun for a long time and all the sibling will see is how much the baby takes away time that they used to have with the parent. They’ll see how, when the baby screams and cries, the parents drop whatever they were doing and go to interact with the baby, so, the logical conclusion is that if they act the same way, the parent will spend more time with them. Potty-trained siblings may want to be in diapers again. Parents can ease the situation by allowing the sibling to openly express any feelings they have – especially the negative ones – and by making special one-on-one time every day with the sibling that cannot be interrupted by the baby.

Sleep Habits At All Ages

     One of the most common problems encountered by parents of children of any age are sleep problems. Questions about sleep patterns are some of parents most frequently asked questions.

     Sleep affects almost every aspect of our lives - not only our energy level and ability to concentrate, but even our basic physical health, immune system function and metabolism. If a child has sleep problems, the entire family can be affected.

     As every parent knows, newborn infants have very erratic sleep patterns. Up until a year of age, infants can need up to 18 hours of sleep daily, but that often comes in 3 hour bursts. Another problem with infants is that they can go from being happy to being miserably tired in less than a minute. Determining whether an infant is crying because he is hungry, wet or tired can be often be difficult for parents because each seems to come on instantaneously. Sometimes, the infant will give a clue with the rubbing of the eyes or ears, but most of the time a parent simply has to go through the list: first, check to be sure he is dry (and remember, sometimes even a small spot of wet will set an infant off); if not wet, try to feed – if the infant stops crying and starts eating, he was probably hungry. If the infant isn’t wet and refuses food, he is probably tired. Rock him, hold him and read to him for a short time and then put him in his crib and leave – even when the crying starts up again. If he is tired, he’ll cry for a while and then go to sleep. Remember infants often wake themselves up in REM dream sleep, so no matter when he wakes up, if he is crying inconsolably, go through the same list again. He might have woken himself up 2 hours into a 3 hour nap and what he actually needs is to go back to sleep for awhile. 

     As children get older, parents can establish and maintain good sleep habits. Co-sleeping in the parent’s bed should always be avoided. Co-sleeping with infants is dangerous and co-sleeping with older children it a difficult habit to change and results in neither the child nor the parent getting adequate sleep. Maintain the last hour before bedtime/lights out as a quiet time for reading together, baths, talking about the day and making plans for tomorrow. Most experts still recommend no “screen time” during this hour before bed – TV, computers, electronic games or phones. For parents who are both working and feeling like they don’t have enough time with their kids, this hour may end up being the best quality time of the day.

     After elementary school, the child needs to start to assume more control over his own bedtime routine. If parents have established good sleep habits since day one, this transition will be easier. Homework should be done early in the evening and the last hour before bed should still be quieter and more “screen-free”. Even though it is impossible to stop late-night phone calls and computer use, parents need to continue to encourage good sleep patterns.

What Is Causing My Child's Diarrhea?

     Diarrhea is a common problem in children and it is helpful for parents to have some general rules of thumb that can identify what might be causing the diarrhea. Doctors divide diarrhea into three groups: acute (which lasts for 1-2 weeks), persistent (which lasts for 2weeks to one month) and chronic (which lasts for over a month). Of course, when your child has diarrhea, it is impossible to know how long the diarrhea is going to last unless you have a crystal ball but the categories can still be helpful.

     Viral infection causes the most common form of diarrhea: acute diarrhea. This often begins with fever and vomiting for 24 -48 hours and then the child has diarrhea for a week or two. At first, the stools may be very frequent and the child may feel very ill. The greatest risk with this form of diarrhea is dehydration and the only treatment is to give lots of water and electrolytes to keep the child hydrated. This means small sips frequently of a rehydrating solution: a mixture of water, sugar and salts. After a few days the frequency of the stools will slow down, but they may stay liquid for 2 weeks. If the symptoms are more dramatic or there is blood in the stool, a bacteria such as E. coli could be the cause of the diarrhea and the child’s caregiver should be consulted.

     Persistent diarrhea usually doesn’t come on as dramatically as acute diarrhea. The child may have cramping and a few loose stools but continues to have them longer than 2 weeks. This type of diarrhea is most commonly caused by an infection with a small organism called a protozoan parasite. The most common ones are Giardia and Cryptosporidium. These parasites are usually in water and the child becomes infected by drinking the water. Giardia is common in small, natural sources of water such as streams and ponds and wells. Cryptosporidium can survive up to 10 days in chlorinated water, so it is commonly found in swimming pools. Cryptosporidium is also sometimes acquired in petting zoos (so, good hand-washing should always be the rule after being in a petting zoo). With these infections, the child is not terribly sick, but he may have cramping. The stools are not frequent, but they are persistently liquid. Protozoan parasite infections can be difficult to diagnose. Even though there may be many eggs in the child’s stools, they may be difficult to find in a stool sample. There are medications that can kill the parasite and treat the diarrhea.

     If the child’s diarrhea lasts for longer than a month, or if it seems to come and go for longer than a month, it is chronic diarrhea. Strangely enough, one of the most common causes of chronic diarrhea is constipation. The child has recurrent abdominal cramps – especially after meals. Some stools are large and hard but others are explosive and liquid. A simple X-ray of the abdomen will show whether too much stool is the cause of the problem. Other causes of chronic diarrhea are: gluten intolerance, food (especially milk) allergy, lactose intolerance and any of the many forms of inflammatory bowel disease. This kind of diarrhea needs a full work-up by the child’s caregiver. 

Cutting The Umbilical Cord

     For a long time, Nurse Practitioners and Midwives have tried to convince medical doctors to delay cutting the umbilical cord after birth. Historically, the umbilical cord was not cut immediately after birth and in most third world countries cutting the umbilical cord is also delayed for over 1-2 minutes after birth. In contrast, in this country the umbilical cord is usually cut 10 to 15 seconds after birth.

     Not clamping the cord results in the infant getting extra blood that is pumped out of the placenta after birth. Medical doctors have believed that this extra blood was harmful to the infant because it caused the infant to have too much blood and it also increased the risk of jaundice in the first few days of life. Midwives have held that humans have always waited to clamp the cord because the extra blood is helpful to the baby.

     There are two studies in the August, 2014 issue of Pediatrics, the official journal of the American Academy of Pediatrics, which go a long way to support the opinion that clamping the cord should be delayed. The first is a very complex, scientific study that measures stress in the newborn.  The researchers found that not only did the extra blood from the placenta reduce the post-delivery stress of the newborn, but it also gave some helpful elements that helped the infants deal with the stress of delivery. The second study was done in a rural Tanzania hospital and it found that, even in healthy infants who were breathing on their own after delivery, the complication rate for the infants was decreased by 20% for every 10-second delay in clamping the cord after the infant started breathing.

     The current practice in most American hospitals is that immediately after birth the cord is clamped and cut and then the infant is given to the nurse, pediatrician, or nurse practitioner who is responsible for the infant’s immediate care. The doctor who is responsible for the delivery needs to concentrate on the mother’s care. Delaying the cutting of the cord would be difficult. The second study suggested that, even if the infant wasn’t breathing at first, delaying the cutting of the cord was still beneficial. But when an infant isn’t breathing after delivery, our current way of thinking is that the infant should immediately be given respiratory support with a bag-mask respirator. Doing this at the foot of the delivery bed would mean a significant change in the procedure.

     Modern medicine improves its care by continually questioning its practices and procedures. If these studies hold to be true, it may result in changes in every delivery room in the country.