A note to my readers

I have written this page for one year and have received a lot of positive feedback. I give my sincere gratitude to all of you who have been reading it. I have published an index to make it easier to find articles you want to read. Each is listed with the month it was published. In my first year of doing the blog, I wrote at various intervals. To make it easier for my readers, I will start to publish an article every week on Friday. Thank you for you time and your support.  John O'Connell

Index of Titles/Subjects for 2012/2011

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Abdominal Pain

1     .     Constipation and tummy pain  Jan 2001

2     .     When to worry about abdominal pain  Sept 2012

3     .     Celiac disease  Nov 2012

Acetaminophen (Tylenol)  Feb 2012

ADHD

1     .     ADHD basics  April 2012

2     .     ADHD diagnosis  April 2012

3     .     Is it ADHD?  Nov 2012

4     .     ADHD Treatment  May 2012

Allergies and Asthma

1     .     Food allergies (1)  Jan 2012

2     .     Food allergies (2)  March 2012

3     .     Living on a farm to decrease asthma Nov 2012

4     .     Peanut allergy  Oct 2012

Antibiotics

1     .     Rash on antibiotics   June  2012

2     .     Using antibiotics sensibly  June 2012

Anxiety in children   Nov 2012

Arsenic in rice cereal   Sept 2012

Bedwetting  April 2012

Behavior

1     .     Behavior problems in toddlers  April 2012

2     .     Don’t teach, play  Dec 2012

3     .     Oppositional child  June 2012

4     .     Teaching behavior  Feb 2012

5     .     Temper tantrums  Feb 2012

6     .     Spanking  Aug 2012

Booster seats   Dec 2012

Circumcision  June 2012
Celiac disease  Nov 2012

Contraception in teenagers  Dec 2012

Chronic cough  March 2012

Chronic runny nose  March 2012

Croup  Feb 2012

Diet

1     .     Teaching healthy eating habits  Jan 2012

2     .     Starting on solids  Jan 2012

3     .     You can lower your child’ risk for heart disease  Aug 2012

Diet supplements and performance-enhancing drugs  June 2012

Discipline – Teaching discipline and behavior  June 2012

Earring alert  Oct 2012

Eczema  April 2012

Expectant mothers – What every expectant mother should know  Oct 2012

Feeding

1     .     Changing bad eating habits  Feb 2012

2     .     Feeding your newborn   Dec 2011

3     .     Feeding your 1 year-old (1)  Feb 2012

4     .     Feeding your 1 year-old (2)  March 2012

5     .     Starting on solids  Jan 2012

Formula  Dec 2011

Fever

1     .     Fever (1)  Jan 2012

2     .     Fever (2)  Jan 2012

3     .     Fever (3 ) Dec 2012

4     .     Fever longer than 3 days  Dec 2012

5     .     Fever seizures  Jan 2012

6     .     How to tell when a fever is dangerous  July 2012

7     .     The latest news on fever  Aug 2012

8     .     Taking your child’s temperature  July 2012

Fluoride   April 2012

Head Trauma

1     .     Bicycle helmets – pro and con  Aug 2012

2     .     Should a CT be done after head trauma?  Aug 2012

Head lice  March 2012

Holding kids back in school  July 2012

Infants  0 to 6 months

1     .     Diaper rash  March 2012

2     .     Fussy 1 month-old  Nov 2012

3     .     "The baby's crying"  Dec 20112

4     .     Gass and reflux  Jan 2012

5     .     Letting an infant cry  Sept 2012

6     .     Sleeping in infants  Jan 2012

7     .     Teaching good sleeping habits  March 2012

8     .     Starting solid foods   Jan 2012

9     .     Pacifiers   Jan 2012

1       .  Pooping problems  2012

Influenza 

1     .     Children at risk for death from influenza   Nov 2012

2     .     Influenza vaccine  Nov 2012

Intussuseption   Aug 2012

Jaundice in the newborn  June 2012

Masturbation looks like seizures in toddlers   May 2001

Meningitis  Oct 2012

Newborn

1     .     Circumcision  June 2012

2     .     Diaper rash  March 2012

3     .     Excessive tears  Jan 2012

4     .     Feeding your newborn  Dec 2011

5     .     Formula  Dec 2011

6     .     Jaundice in newborn  June 2012

7     .     Pacifiers   Jan 2012

8     .     Teaching good sleep habits  March 2012

9     .     Tongue-tie  March 2012

 One year-old

1     .     Don’t teach, play!   Dec 2012

2     .     Feeding one year-olds  Feb 2012

3     .     Feeding one year-olds  March 2012

4     .     Teaching behavior  Feb 2012

5     .     Temper tantrums  Feb 2012

6     .     Toddlers and bottles  March 2012

7     .     Spanking  Aug 2012

Pacifiers   Jan 2012

Potty training

1     .     Potty training  Jan 2012

2     .     More on potty training   Oct 2012

Rabies  Aug 2012

Sensory integration dysfunction   June 2012

Skin Problems

1     .     Skin problems in young athletes  Aug 2012

2     .     Diaper rash  March 2012

3     .     Eczema  April 2102

4     .     Moles  Jan2012

5     .     Rash on antibiotics  June 2012

6     .     Rash behind the ears  April 2012

Sleep

1     .     A cure for older child sleep problems  Sept 2012

2     .     Infant sleeping  Jan 2012

3     .     Letting your child cry  Sept 2012

4     .     Sleeping with mom and dad  Feb 2012

5     .     Teaching good sleep habits   March 2012

Sore throat   Oct 2012

Speech problems and stuttering  May 2012

Teenagers

1     .     K2, Spice and bath salts  Nov 2012

2     .     Diet supplements and performance enhancing drugs  June 2012

Teething  March 2012

Temper tantrums  Feb 2012

Ticks and tick –caused diseases  April 2012

Toddlers

1     .     Behavior  April 2012

2     .     Behavior Feb 2012

3     .     Bottles  March 2012

4     .     Sleep problems  Sept 2012

5     .     Spanking Aug 2012

6     .     Teach by playing  Dec 2012

7      .     Temper tantrums  Feb 2012

Tonsillectomy  Aug 2012

Tongue-tie   March 2012

Urine, bladder and Kidney infections  Feb 2012

Vaccines

1     .     Alternative vaccine schedules   Jan 2012

2     .     Influenza vaccine   Nov 2012

3     .     Thimerisol in vaccines  June 2012

4     .     Whooping cough vaccine  Aug 2012

Vitamin D  March 20112

Vomiting and Diarrhea   Feb 2012

X-rays: things to consider   July 2012

Emeregency Contraception For Teenagers

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     There are various forms of emergency contraception – medicines that will prevent pregnancy if taken within 120 hours after unprotected intercourse. It has been shown that if emergency contraception is available to teenagers the rate of teen pregnancy and, subsequently, the need for teen abortions is reduced. In most US states, teenagers older than 17 can get emergency contraception without a prescription but adolescents under 17 have to obtain a prescription. Both the American Academy of Pediatrics (AAP) and the American College of Obstetricians – Gynecologists (ACOG) have long supported making the emergency oral contraceptive called Plan B One–Step an over-the-counter medication available without prescription to any age group. The FDA agreed with this in 2011, but the agency was overruled by the Secretary of the US Department of Health and Human Services despite the fact that Plan B has been proven to be safe and effective in preventing pregnancies in 80% of cases of unprotected intercourse.

     The latest recommendation from the AAP encourages physicians to give girls under 17 a prescription for the “morning-after pill” before they need them. Some physicians and some parents hold ethical objections to teenage sex or sex outside of marriage. Others have moral objections to contraception in general. The AAP cautions physicians to “be aware of the ways in which the underlying beliefs they bring to clinical practice affect the care that they provide”. The Academy says that if pediatricians refuse to give emergency contraception treatment or information to teenagers on the basis of conscience, they are violating their duty to their adolescent and young adult patients and are morally obligated to refer the patient to a physician who will.

     13% of 15 year-olds, 43% of teens from 15 to 19 and 70% of 19 year-olds have sex, and the rate of teenage sexual assault is as high as 10%. Approximately 8 female adolescents out of 100 who have unprotected sex will get pregnant. If emergency contraception is used appropriately in those 100 cases, only 2 of those teens would get pregnant. Studies have repeatedly shown that availability to contraception and information about contraception does not increase sexual activity among teenagers. Physicians need to stop putting their own moral or political beliefs ahead of the welfare of their adolescent patients.

"The Baby's Crying!"

     In the first two months of life, babies cry. They cry a lot. This is difficult for many moms to deal with. After delivery, moms can find themselves exhausted, emotional and anxious - all of which makes it hard to live with a crying infant. Parents also get fooled by the first two weeks of the baby’s life when all the baby does is eat and sleep. After two weeks, when the serious fussiness starts, we are sure that we are doing something wrong, but babies naturally fuss and cry more and more up to about 2 months of age. This fussiness resolves by six months of age but by then you have already pulled most of your hair out. We also have our expectations about how babies should act and those can be wrong. Babies can sleep up to 18 hours a day, but some babies only do it in 2-hour intervals. Babies in those first fussy months can easily cry up to two hours a day.

     The first thing I do when the baby is crying is to change him. Sometimes, even if he is not wet, just readjusting the diaper or loosening the tabs can settle him down (You try stuffing a wad of material the size of your head into your underwear and see how comfortable it is!). The next thing is to try to feed him no matter when he last ate. If he doesn’t eat and keeps crying, it’s time for some quiet walking, rocking, reading and comforting. If he doesn’t settle down or if he starts to fall asleep, it’s time to go down into the crib. Even if he is asleep in your arms, he’ll wake up when you lay him down. Either way, it is OK to let him cry in his crib until he calms himself down and falls to sleep.

    During this difficult period, it is also important for parents to take care of themselves. Sleep as much as you can, recognize when you need a break and talk with people who are understanding without being judgmental. If your baby isn’t eating well, is acting unusually or if you are just worried, talk with you baby’s caregiver. We love to talk about babies and any time you are worried, we are worried.

Fever Longer than 3 Days

     In previous articles about fever I have stated that the usual course of fever is about three days of day and night fever followed by two to three nights of fever without daytime fever and then all fever resolves.

     If daytime fever lasts longer than three days, the child needs to be examined. The cause could be a more severe infection such as a urinary tract infection, but parents need to be aware of another possible cause: Kawasaki disease.

     Kawasaki disease is not an infection but is a generalized inflammation in the body. The first sign of it is daytime fever that lasts longer than three to four days. It can also cause red eyes without discharge, generalized rash, swelling in the fingers and toes and a peculiar red discoloration of the lips. The real reason parents need to know about this disease is that it can cause a weakening of the arteries in the heart and severe permanent heart damage. This serious complication can be prevented if the child is treated early enough. The problem for parents and physicians is that many of the more classic symptoms may not appear right away which makes diagnosis difficult. The longer treatment is delayed, the greater the risk of heart disease. A study done at Children’s Hospital Colorado showed that heart vessel damage occurred in 21% of the children who had been sick for 5 days, 60% of children who had been sick for 7 days and 80% of children sick for 10 days.

   The important message for parents is that daytime fever from routine viral infections does not last longer than three days. Kawasaki disease may only present with prolonged fever, especially in younger infants and any child with a prolonged fever needs to be closely evaluated. If there is any evidence of Kawasaki disease, the child needs to be hospitalized right away and treated to prevent heart damage.

Booster Seats In Older Children

     Car accidents are the third leading cause of death in children between 1 and 18 years of age. Most parents are careful to always use an appropriate car seat for infants and children less than 4 and all 50 states have enacted legislation requiring car seats for this age group. Statistics show a dramatic decrease in death and injury from motor vehicle accidents in infants to 4 year-olds. However, even though booster seats for children between ages 4 and 8 are highly effective in preventing injury and death in car accidents, parents are much less careful about using booster seats. These children are often simply buckled in with adult seat belts.  A study done in 2008 reported that less than half of children ages 4-5 and about a third of children ages 6-7 were placed in booster seats.

     A study published in the December 2012 issue of Pediatrics looked at the fatality rates of children between ages 4 and 7 in states that have laws requiring booster seats for older children versus states that do not. They found that states that had laws requiring booster seats for older children had lower car accident fatality rates in this age group and this was especially true in the older children.

   The message is clear to parents: when your child outgrows his car seat, you need to use a booster seat until he is up to a height of 4 feet 9 inches. Putting a smaller child in a regular seat with an adult seat belt is dangerous. Always use a booster seat for children ages 4 to 8 until they are tall enough to safely use the regular adult seatbelt alone. It would also be good for everyone concerned with children’s safety to advocate for state legislation requiring booster seats in older children.

    

Don't Teach, Play!

     Parents sometimes feel in competition with other parents. Parents inwardly compare whose child walked the earliest or whose child learned the alphabet soonest. We put the focus on teaching and we forget that toddlers learn best by playing. We also make the mistake of thinking about playing as only running and shouting. The most important way for a toddler to play is by exploring – wandering in a safe place, examining whatever takes his interest with a parent following behind talking to him and sharing his exploration with him.  Let the toddler determine the activity and allow his short attention span to move wherever and to whatever he finds. Forget about “games” and, especially, about “rules”.

     This important play activity needs an area with lots of things to touch, climb on, move, carry and stack. What is even more difficult for busy parents is that it demands time. Exploration cannot be directed and should never be hurried. The parent can offer a running monologue with the “learning” part tucked into it: “You have a blue shoe”; “There are two books on the table”. If the toddler finds something that is not to be played with, a firm “No” from the parent is a wonderful way of teaching discipline. If the child obeys and doesn’t touch the object, the parent should immediately praise him for “listening” and go right back to happy exploration. If a tear results, ride with it and the child will settle himself down and find something else to explore soon enough.  Exploration play serves as a way for the toddler to learn to deal with his own anger and frustration – he might struggle to climb up on something while the parent holds back, allowing him to struggle while giving reassurance: “You can do it”. It can also teach that when mom or dad says, “No”, he needs to listen to it.

     If the exploration starts to result in too many toddler tears, the child is probably tired and needs a break. If you find yourself getting frustrated or upset, it is time for you to take a break. Find someone to take over child-care for a while and spend a little time taking care of yourself.