When To Worry About Chronic Abdominal Pain

     The most common cause of recurrent abdominal pain in children is constipation. Constipated children often have large stools although they can have episodes of explosive diarrhea, too. They can complain of pain anytime, but frequently complain during or shortly after a meal. Between episodes of cramping, they feel well. The habit of stool withholding is hard to change, so constipation frequently comes back even after it has been resolved with treatment. It never helps a parent to ask a child if he has “pooped today”, because every child knows that the correct answer is “yes”.

     There are many more serious causes of recurrent abdominal pain and parents need to watch for certain signs to know when to be concerned. If a child has problems swallowing or has mouth sores, he needs evaluation. Constipation can cause occasional vomiting, loose stools and even occasional fever, but any child with abdominal pain and chronic or bloody diarrhea, recurrent fevers or recurrent vomiting needs to be seen by his caretaker. If a child with chronic abdominal pain has weight loss or poor growth, it is very concerning.  A child who wakes up at night with abdominal pain is likely to have a more serious reason for the pain. Chronic skin rash and sore or swollen joints are also worrisome signs.  Finally, the child who has a family history of inflammatory bowel disease, celiac disease, ulcers, diabetes or sickle cell disease needs extra evaluation.

Arsenic In Rice Cereal

We’ve been told about mercury in fish. We’ve been told about arsenic in apple juice. Now we are told about arsenic in rice and rice products. It’s no surprise. We have been gradually polluting our water for a century and water is in every living cell in the world.

     Parents want their children to have healthy diets, but we don’t need to switch back and forth each time a new scientific report is published.

   We follow rules we were taught when we were growing up. Starting your baby on rice cereal has been a standard of our culture for decades. But it isn’t based on any science.  

     Babies grow just fine on breast milk or formula up until six months of age. They don’t need any solid food. But, between four and six months, most infants are chewing on anything they can get their hands on, so it is natural for parents to want to start solids earlier. A little solid food here and there is fine for young infants. But rice cereal and other processed baby foods are not necessary.

     Before six months of age, it is thought that the gut can “leak” complex proteins into the blood stream and feeding a lot of different proteins to infants between birth and six months old might increase the risk of allergies. But after six months of age, babies have a normal human gut and can digest anything they can chew. The best diet for adults and infants is eating lots of fresh fruits and vegetables with some animal protein. Eat minimal amounts of processed food, added sugars and juices. Feed your infant what you are eating and, as long as your diet is healthy, your infant will be eating a healthy diet.

     Mush, crush or grind what you are eating so your infant won’t choke on it. You don’t have to introduce foods in any specific order ("vegetables before fruits"; "yellow before green").  Relax and make meal time a happy family time for everyone. Keeping it simple and ignoring the “rules” will give you and your child the best diet possible.

"Let Your Child Cry" Or Not

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     It seems people never tire of debating whether or not to “let a child cry”. Don’t allow yourself to be drawn into this senseless argument.

   As parents, we are caretakers and teachers. This means that give our children what they need (not necessarily what they want) and we teach them the things that will help them as they grow.

   When a child is tired, he needs sleep. A tired child feels terrible and, because he doesn’t understand why he feels terrible, he begins to fuss and cry. Infants will go from happy to crying in seconds about every three hours. Most toddlers need both a morning and afternoon sleep time. Rocking or walking until the child is asleep is not helpful. The child drifts off and then wakes up again when laid down and crys harder because he feels worse. When it is obvious an infant or toddler is tired, be sure that he is not soiled and then rock, sing or read until he is drowsy and then put the child down in the crib while he is still awake. He’ll cry because he wants you to hold him all night long, but you know that’s not realistic and you want him to learn how to self-quiet. He’ll cry for a short time, but he’s tired! He’ll burn off the residual energy and then go to sleep. Don’t “camp out” in his room – again, unrealistic – you aren’t going to stay there all night. By helping him to learn how to quiet himself, he’ll be able to do it when he wakes up during the night (which all infants and many toddlers do) and you won’t have to go back in and quiet him multiple times.

     Using the same principles, when a child has a mild injury, approach it “matter-of-factly” at first. Recognize that the child is hurt and, usually, frightened. Assess how much damage has actually been done and let the child know –“ It looks like you are going to be all right, but I know it hurts”. Then give the best medicine - a hug. But don’t teach your child that whenever they are hurt, frightened or upset that they immediately need to run to you to “make it better". Sure, it feels good to you but it doesn’t help the child.

     Finally, when a child wants something, allow them to try getting it for themselves before you step in and help them. If they cry and whine in frustration (which they all do) ignore it and wait until they use another method to indicate the need to you. It is fine to stand by them and encourage them while they struggle and, often, they will solve the problem and get what they want by themselves. That is an invaluable lesson for them and will result in you listening to less whining the next time.

A Cure For Sleep And Behavior Problems

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     It’s official. There now have been enough studies that all agree that what a child watches on TV, DVDs and video games has a direct effect on sleep problems and behavior problems.

   The negative effects are across all age groups – preschool, school-aged and adolescent. They also do not seem to be related to the total amount of time a child spends watching a screen. The content of what the child is watching is what makes the difference. Even if the child watches violent media early in the day it still had negative effects on both sleep and behavior.  When age-appropriate, non-violent, non-frightening TV programs, DVD’s or video games are substituted for the inappropriate ones, children who were identified as having problems going to sleep definitely get better and children identified as being aggressive improve their behavior.

      It is hard to understand why preschoolers are allowed to watch violent or frightening TV programs or violent video games. Perhaps the parent doesn’t believe there is an effect on the child, the parent is watching an evening program that is violent or the parent is playing a violent video game with the child watching. Either way, it is now clear that these viewing habits cause an increase in aggressive behavior in children and also cause sleep problems – especially difficulty falling asleep. 

     Generations grew up watching cartoon characters bang each other with over-sized hammers and they laughed at it. The kind of violence children are exposed to today is graphic, realistic and frightening. If your child has problems falling asleep or is having problems with aggressive behavior, take a good look at what the child is exposed to on screens and monitors. Substituting Dora for CSI may be boring for you, but it will definitely help your child.

Honey For Cough And Cold Symptoms

     The September 2012 issue of Pediatrics reported a study that looked at the effectiveness of honey in improving nighttime cough symptoms in children between 1 and 5 years old who had simple colds.

     The World Health organization recommends honey as a cough medicine. Previous studies have shown honey to be better at improving night cough than either dextromethorphan or diphenhydramine – two common nonprescription cough and cold medication ingredients that frequently cause side effects in young children.  Nonprescription cold medications are potentially dangerous and have been reported to be associated with accidental overdose and death. There is no evidence that these medications are effective or decrease cold symptoms and we are not sure what is a correct pediatric dosage for them. The FDA advisory committee recommends that parents do not give cough and cold medications to children under 2 years of age.

     Honey has always been known to be useful for medical reasons. It has been used to help heal wounds because it has antibacterial properties. It also has excellent antioxidant properties. The study published in September compared three types of honey with a placebo that tasted similar to honey. All three of the types of honey decreased the child’s nighttime cough and sleep difficulties due to a cold. The problem with the study is that the dose of honey given was about 2 tablespoons which some children might refuse to take. Also, going to sleep with a dose of sugar in your mouth is a good way to get dental cavities, so the honey should only be used for a short time.

     It is very important for parents to remember that honey should never be given to children less than 1 year of age. We are not totally sure why, but infants under a year have a risk of getting infant botulism if they are given honey. Infant botulism is a severe, sometimes fatal nerve weakness that has been reported to occur even after small doses of honey in babies.