Warts

Warts are caused by a virus infection, although we are not certain why some people get warts and others don’t. Even without treatment, most warts will go away in about 2 years, but, when they are on the hands, face or feet, they can be bothersome and embarrassing. Plantar warts can be especially uncomfortable. (The sole of the foot is also called the “plantar surface” of the foot, so warts on the sole of the foot are called “plantar warts”. They aren’t different from regular warts but occasionally are deeper into the surface of the foot due to constant pressure. There is no such thing as a “planter’s wart”.)

     For centuries, different things have been used to treat warts with different levels of success: milkweed sap, dandelion sap, garlic juice, nail polish and Elmer’s glue to name a few. Out of the many commercial products used to treat warts, the only ones that the FDA judges to be effective are salicylic acid in concentrations over 6 % or urea in concentrations over 30%.  They both get rid of the wart by dissolving the skin cells. They are available in liquids, gels, creams or soaked into pads. With higher concentrations, the effectiveness is greater, but the surrounding tissue can be irritated and injured. Treatment may have to be continued for up to 3 months on a regular basis to finally get rid of the wart.

     It is common to “freeze” warts in a caregiver’s office by applying liquid nitrogen. Parents and kids need to know that freezing hurts. Trying to do it “gently” usually results in the wart not being removed, but being too aggressive can harm the deep layers of skin and cause damage to the tissue underneath or permanent scaring. After freezing, the area hurts again as it re-warms and a blister usually develops in the area as it heals. The area can develop a superficial temporary scar. Sometimes a new “ring of warts” develops around the scar where the original wart was, but these usually resolve by themselves in a short time. There are wart-freezing products sold over the counter but they don’t seem to be as effective. This may be because they are not liquid nitrogen and don’t get as cold or it could be that the child simply won’t allow the parent at home to apply the painful procedure long enough.

   Another method used in caregiver’s offices is to apply canthrone (often called “bug juice” because it comes from a beetle). This doesn’t hurt at first, but hurts after the application. It is a very irritating chemical and needs to be washed off within three hours of application or it can cause a severe reaction. 

     There are reports that simply covering the wart with Scotch tape, duct tape, athletic tape or band-aids can cause them to go away, but we don’t know why. Even if the child and the parents decide to allow the wart to go away on it’s own, I’ve found covering the wart with a band-aid is helpful, especially with warts on the hands. It seems to be impossible not to pick at things on our hands (think of calluses and hangnails) and picking seems to encourage the warts to spread. Covering hand warts discourages picking and covering plantar warts on the feet puts a soft pad over them and makes them a little less uncomfortable.

Dental Problems In Kids

     Dental cavities are the most common chronic health problems in children. They are 5 times more common than asthma and 7 times more common than hay fever. They are especially common in lower-income families. While access to dental care is a problem – a study in 2012 reported that less than half of children on Medicaid received a routine dental visit in 2008 - the consumption of sugary drinks is prevalent in all levels of society and those drinks are one of the main sources of dental disease.   

     As common as dental problems are, they are easily preventable. The first problem is the “bow-mouth” gap between the upper and lower front teeth which is caused by a toddler having a pacifier in his mouth all day long,  This doesn’t actually cause cavities, but it is a frequent concern for parents. A pacifier is a wonderful way to settle a baby down and, in the first six months of life, parents should allow pacifiers at any time.  But, after six months of age, infants will grab anything nearby and chew on it, so it is a perfect time to stop the daytime pacifier habit. The six month-old is still allowed to have a pacifier as much as he wants at nap-time and night-time to settle down, but during the day the pacifier “disappears”. If you don’t give your infant a day-time pacifier, he won’t develop the habit, won’t ask for it during the day and you will never have a pacifier problem.

     The most important thing parents can do to prevent cavities is to limit sugar-containing drinks to being milk at meals. Feedings during the night with breast milk or formula coat the teeth with sugar that then sits for hours. After one year of age, infants rarely need feedings during the night and usually only want to suck on something to go to sleep with. That can be a pacifier or a bottle of water, but parents should avoid milk, formula or juice at night. During the day, many toddlers suck on a bottle or sippy-cup of milk or juice all day long or are continually snacking on goldfish or fruit snacks. This constant exposure to sugar rapidly creates cavities that can often lead to expensive and painful surgery by age two. Again, the way to prevent these cavities is to give milk with meals, give water to drink between meals and to eliminate juice from the toddler’s diet.  Rather than giving your child “100% real fruit juice”, give 100% real fruit.

     Finally, after the first teeth erupt, brush the toddlers teeth with a small (grain of rice sized) amount of toothpaste twice a day. Now that there is fluoride in most toothpastes and rinses, adding fluoride to drinking water has become less important. Fluoride treatments are helpful and can be applied in many primary care physicians’ offices.

     When thinking about a toddler’s health, it is common to overlook the teeth, but that oversight can lead to long-term problems.

Gas And Reflux In Infants

     All infants in the first 2 months of life fuss a lot. All parents of fussy young infants want to know "what's wrong" and how it "cure"it. When an infant is fussy and also has loud, grumbling bowel sounds, or passes a lot of gas – from either end - it is commonly said that he has “gas” as if it was an actual medical diagnosis. However, there is no such medical diagnosis. Gas is not a disease. It is normal for the gastrointestinal tract to have air in it and abdominal grumbling is the sound of the normal movement of the bowel as the food moves down the tube. Infants can also get air into their intestine by crying. When an infant cries, air gets pulled into the stomach and normally either goes up with a burp or moves down the tube. It is important to realize that the crying causes the “gas” to be in the intestinal tract – the “gas” does not causing the crying. Far too much concern and energy is put into burping, changing formulas, changing nipples and worrying about diet just because the infant is thought to have “gas”. The burping and farting that infants do is the normal releasing of the air that is in the gut. Parents don’t need to do anything to help that process and there is no god evidence that it causes a baby to be fussy.

     In the last 20 years, the number of infants diagnosed as having reflux has skyrocketed. True gastroesophageal reflux (GERD) is actually rare in infants, but infants are frequently diagnosed as having reflux just on the history of spitting up a lot without a good medical evaluation. These infants are often given medications called protein pump inhibitors (PPIs) that decrease stomach acid. A large study of prescribing practices in the US showed a 16-fold increased use of one of the popular forms of PPIs from 1994 to 2004. The FDA has not approved PPIs for children younger than a year of age, but most of the infants diagnosed as having reflux and placed on these medications are much younger. The hope is that the medication will relieve the fussiness by “curing” the “reflux”, but there is no good scientific evidence that PPIs relieve distress in infants better than placebo and PPIs also do not decrease spitting up. This eliminates both of the reasons that PPIs are commonly given to infants. There are definite side effects that can result from using PPIs but, unfortunately, they are rarely discussed. Before automatically asking that their fussy, spitty infant be placed on reflux medication, it would be better if parents look at other causes of fussiness and discuss reflux realistically with their infant’s caregiver.

"Attatchment" Is Not "Being Glued-To"

     Attachment Parenting is a popular movement. It represents the far swing of the opinion pendulum away from Spock’s “don’t spoil your child” school. Like all dogmas, it contains the implicit threat that if you don’t parent the “right” way, your child will have lots of problems (most of which you caused).

     In the first year of life, children develop attachment with their parents. This attachment develops from repeated interactions in which the baby gives the parent a cue that they have a need, the parents responds to that cue by helping the child meet that need and then the baby responds to the parent’s action. These interactions, when repeated many times over a long period of time, create trust and love.

     Children need to be loved.  Truly loving someone means caring about them, trying to understand their needs and being committed to helping them attain those needs without feeling like you have to personally meet their every need. It means being happy as they grow and become whoever they are, wanting to spend time with them whether sad, happy, fearful or quiet and, most important, enjoying them without trying to change, or control them.

     Children also need to be taught. It is nice when your teacher cares about you, but a teacher doesn’t have to be someone who loves you. Parents naturally get confused because parenting demands that they be both.

         Children need to be fed. Breastfeeding is a healthy, easy, cheap way to feed infants, but it is not the only way – formula works just fine. Children need to be held but they don’t need to be held all day long in a sling. Children need to be changed when they are wet, but they don’t need special diapers.

     The first way that infants cue their parents is crying. It is silly to say, “Don’t let the baby cry” because you have no control over whether another human being cries or not. But when the baby cries, he is giving you a cue that he has a need. It also makes no sense to say, “Allow the baby to cry” if a parent thinks it means “don’t interact in a way that addresses the infant’s needs”. It is easy to know that if the diaper is wet, you should change it and if the child is still crying when he is dry, you offer food. If not wet or hungry, the child may just want to be held and interacted with. But if the infant still cries or falls asleep in your arms, then he is tired. Your job is not to “get him to sleep”. Your job is to allow him to go to sleep. If you continue to try to hold him, you’ll keep waking him up. If you let him fall asleep in your arms and then lay him down, you’ll wake him up. A tired child cries until he goes to sleep because he feels miserable. You can hold and rock him until he settles down, but before he goes to sleep, put him in the crib. He’ll cry, but you can stay for a while, sing to him, talk to him and show him you’re with him as he settles himself down. Don’t hold him all night and don’t co-sleep. Co-sleeping is dangerous and it’s important for you to respect yourself and give yourself the personal time we all need to recharge.

     An excellent source for reasonable advice and helpful information is www.zerotothree.org. Go to the “Behavior and Development” section for free articles on infants and toddlers.