Shoes In The Early Years

     Baby shoes have gone from being cherished bronzed mementos of baby’s first step to “let them go barefoot”. Parents still hear many opinions about what shoes are right for toddlers and when to start using them, but parents and doctors all agree that the old white, rigid, high-top, stiff-soled baby shoes are out. Most of the body parts we have after tens of thousands of years of evolution work pretty well (sinuses excluded) and the feet were not designed hoping that the right shoes would be invented someday.

     Before infants are walking, shoes and socks only serve to keep the feet warm. Before the baby is walking, those tiny infant shoes are very cute, and they cause no problem as long as they are loose enough.

     When your baby starts to walk, going barefoot is the best for him. It helps baby learn to balance naturally using his toes. If the foot needs extra warmth, socks with gripping material on the bottom work well.  When baby starts to walk outside of the home, buy shoes that are flexible. Experts recommend shoes with rubber soles that you can bend in half with the toe up and can twist from side to side. Be sure the shoe is loose and the foot is not constricted. There should be about the width of your thumb between the toes and the tip of the shoe.

     It seem that flip-flops are the most popular shoe for kids in summer, but they are tough to run in, they don’t work well for climbing on the park equipment and the toes are open to injury. Closed-toe, soft tennis shoes are great for doing all the things kids love to do and give a reasonable level of protection.  As soon as possible back at home, take both the shoes and socks off and go back to barefoot.

     Hand-me-down clothes are great, but you shouldn’t put your toddler in hand-me-down shoes. Everyone walks differently and shoes wear differently. He has to break his shoes in to match his way of walking.  But as rapidly as kids grow out of shoes, paying $40 a pair for “specially fitted” shoes is probably not worth it. Along with being flexible, comfortable, protective and fun, shoes should be cheap. You’ll go through a lot of them before he leaves for college.

     If your child has in-toeing or other specific problems, you need to speak with your child’s caregiver or a podiatrist.

Pediatric Deaths From Influenza

     Winter is upon us and it is the time to talk about influenza. Influenza in children usually causes symptoms for a few days and then goes away without treatment or complication. However, it can cause more serious problems: pneumonia, brain infection and death.

     In 2004, the Center for Disease Control began collecting information about pediatric deaths from influenza and some of that information was reported in the November issue of Pediatrics.

     In looking at the children who died of influenza between 2004 and 20012, it was found that half of them had pre-existing medical conditions such as asthma, cerebral palsy or chromosomal abnormalities. These children have always been known to have a high risk of death from influenza. Most of these children were in the hospital when they died. But 43% of the children who died from influenza were healthy children without previous high-risk medical problems. For reasons that we don’t understand, these previously healthy children usually died within 3 days of the onset of the influenza symptoms – the influenza became severe so rapidly that the healthy children died at home or in the emergency room rather than in the hospital.

     People have many reasons for not vaccinating their children against influenza. Some say, “My child is healthy and should be able to fight off influenza without problems”. This study showed that previously healthy children actually got severely ill faster than children with other medical problems. Other people say that they know of people who got the vaccine and still got influenza. It is true that the vaccine is not 100% effective – 9% of the healthy children in the study who died had been given full immunization – but that still means that 91% of the children who died were not fully vaccinated, so vaccination proved to be very effective in preventing severe complications of influenza. The study also shows the importance of immunizing younger children. Parents sometimes say that they don’t want to vaccinate their younger children “because they are too small” yet children between 6 months and 5 years of age were found to be at greater risk of dying from influenza, especially children under 2.

     The vaccine against influenza comes in many forms and parents should talk to their caregiver about which is best for their child. It is not recommended for infants under 6 months of age, so caregivers of these infants should be vaccinated and the infants should not have contact with adults and children who have not been vaccinated or who have any influenza symptoms. Any child who develops influenza symptoms should receive anti-viral medications as soon as the diagnosis is made. Children who have severe symptoms, who are in the hospital, who have previous medical problems or who are under 2 years old should receive the anti-viral therapy without waiting for lab results to confirm the diagnosis.

Sinus Infection

     All parents are aware of the problems that have come from using too many antibiotics and we all are trying to give as few of these medications as possible to our kids. Ear infections used to be the most common reason children were given antibiotics, however, doctors now realize that ear infections often cure themselves without needing antibiotics. Another common reason for giving antibiotics was sinus infection. Now the American Academy of Pediatrics has come out with new guidelines for diagnosing and treating sinus infections in children between the ages of 1 and 18 years of age. By following these guidelines, we should be able to further decrease the use of antibiotics.

     Colds and upper respiratory infections are the most common infections that affect children in general, but most of these infections are caused by viruses that are not killed by antibiotics.  No treatment is necessary for the child to recover.  At the beginning of a cold, the child’s nose has a clear discharge that gradually gets thicker over a matter of days. As this happens, the child’s cough gets worse. Cough and congestion that comes with a normal cold can last up to two weeks, but the child usually feels better after a few days and the symptoms gradually improve. The first new guideline states that if thick nasal congestion and cough last for more than 10 days without any improvement at all, the child could possibly have a sinus infection

     The next new guideline states that X-rays and CAT scans are not recommended to make the diagnosis of sinus infection. Anytime a child has a cold, these X-rays can look positive even in a child who doesn’t have a sinus infection, so these tests aren’t helpful.

     The last new guideline is that, if the parent or the doctor thinks the child may have a sinus infection, they should wait three more days before starting antibiotics to see if there is any improvement. If the child’s symptoms still don’t improve during that extra three-day wait, antibiotics should be started.

     Antibiotics are important medications when they are used properly. Bacterial resistance to antibiotics due to over-use is increasing every year.  It is up to all of us to use antibiotics only when they are necessary and constantly updating the guidelines for the use of antibiotics is one way for that to happen.

Infant Sleeping

                 In the first few months of life, moms feed, rock or hold their tired infants until the baby is asleep. This works well at first, but results in a baby who can only go to sleep under those same conditions.  That means a time will come when it is time to teach your baby a new sleep habit.

     Having the baby sleep with you is dangerous; allowing him to sleep in the infant seat isn’t good for him and driving him around the neighborhood all night isn’t good for anyone. Sleeping in the crib – preferably in another room from mom and dad – is the goal.  But, as with all habits, it has to be taught and abandoning old habits while learning new ones is tough for all of us.

     Once you know for sure that a fussy baby is dry and not hungry, it’s time to sleep. You can do a little of the old habit – feeding or rocking until the eyes are closing and baby is relaxing, but then it’s time for the new habit. I like tummy-patting while I’m holding baby because it can be continued as a means of quieting even after a baby has been laid down in the crib. Soft singing or talking works well, too. You can sit alongside the crib and maintain touch or verbal contact until the shock of being laid down wears off and your baby settles down again.

     Remember you are not abandoning your baby, you are just teaching him a new habit. Avoid the guilty feelings. Also remember that few of us learn something when we first try it. Expect your baby to wake up soon after being laid down even if you were successful at first. No problem. Have a diaper nearby to change him, if necessary, without taking him out of the crib. If you see eye-rubbing and sleepy behavior, tummy-rub again and give him some time to fuss a little to see if he’ll go back to sleep. You will probably need to do this multiple times, but each time he falls asleep in the crib, you are getting closer to your goal – even if he only sleeps a short time. Don’t get discouraged.

     Hover, sometimes Junior will be really tired and crabby and no degree of calming will keep him from crying in the crib when laid down. If he is dry and fed, let him cry for as long as you can stand it. I usually say at least 5 minutes and you need to watch a clock because 1 minute of listening your baby cry feels like 30 minutes.

     Your baby will learn to get himself to sleep in his crib if you just keep up the practice. He’ll also do better at staying asleep during the night because then, when he wakes up in light sleep, he’ll be able to fuss until he goes back to sleep again. Life will be better for both of you.

   

Whooping Cough Vaccination

     There is an increasing trend for parents to decide not to give recommended childhood vaccinations or to give them on an altered schedule. There are many reasons given: the baby is too young to get so many shots; the diseases aren’t around anymore; there are dangerous things given in the vaccines; the medical community overstates the risks; the medical and pharmaceutical communities are in collaboration with the big drug companies and are only after the money.

     Even though the numbers of reported diseases that are preventable by vaccine are rising, doctors have been reluctant to blame the lack of vaccination on that increase. In an effort not to blame the lack of vaccination, researchers have said that the increase in these diseases is possibly due to such things as the diseases being easier to diagnose, the immunity from vaccinations wearing off and the diseases themselves changing.

     A study done at Johns Hopkins School of Public Health and reported in a recent issue of Pediatrics looked directly at whether parents’ refusal to give their children vaccinations was related to their children getting pertussis – whooping cough. Whooping cough used to be a catastrophic disease that could come into a town and wipe out a large population of the adults and children. A vaccine for it was developed in 1947 and whooping cough faded into history as “one of those diseases children used to get”. However, whooping cough is now one of the diseases that has been coming back in outbreaks all around the country.

     The study reported in Pediatrics is a very complex and sophisticated study that eliminated all other variables and looked whooping cough outbreaks in California in 2010. Between 2000 and 2010, the rate of parents choosing not to vaccinate their children doubled in California. In some school districts, 84% of the children weren’t vaccinated. The study clearly showed the 2010 outbreaks of whooping cough were due to lack of vaccination. This lack of vaccination was not due to parent’s inability to pay for the vaccines or lack of information – the children who were not vaccinated were from families with upper socioeconomic status and higher education level. These children got whooping cough because their parents chose not to give the vaccine.

     Whooping cough, measles, polio, and diphtheria still exist. The sad fact is that during those 2010 California outbreaks of pertussis, ten of the children died from it. Whether the parents were following a “natural medicine” fad or they just thought they were smarter than decades of dedicated medical research, the fact remains that they watched their child die from a preventable disease. When parents refuse vaccinations or decide to “wait until the child is older”, those parents need to understand that they have chosen not to protect their child from a dangerous disease and they must be willing to accept the consequences.