Ask the Pediatrician!
Date:
12/10/2008 | 12:00 pm
Do you have questions about what you’re reading in the news? Do any over-the-counter cold remedies work? Is Vitamin D important for your child? Should children be vaccinated for meningitis? If you have questions you’d like to ask a pediatrician, please click here and come back on December 10th or after for the answers.
Dr. April Douglass-Bright received her medical degree from the University of Connecticut and completed an internship and residency at St. Christopher's Hospital for Children in Philadelphia.
April Douglass-Bright, M.D.: Good afternoon and thank you for joining today’s Health eTalk.
There are always new developments in health care for children and adolescents. As parents it is often difficult to know what is right for your child. Whether it’s news about meningitis vaccines, food allergies, over-the-counter medications for flus and colds, vitamins, the news media has stories every week about one health or safety issue after another. Sometimes you just want to ask your pediatrician a question – and that’s what I’m here for today. I will do my best to answer your questions about health care decisions for children. I won’t be able to diagnose, but I will try to give you guidance. So let’s begin with your questions!
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My son Vincent is a patient of yours. He is 11 years old and in 6th grade. I noticed in the summer he started to blink hard as if he has developed a tick. Should I have him checked, or should I wait this out? Mary Ellen Dragone from Pitman |
12/10/2008 12:00:38 PM |
April Douglass-Bright, M.D.:
It is quite possible that Vincent has developed a simple motor tic. Tics are brief, abrupt, repetitive involuntary movements that usually involve the face neck and shoulders. Eye blinking and throat clearing are very common examples and they can occur in as many as 20% of school aged children. Tics have a tendency to be worse when a child is stressed, tired or anxious.
Although tics are not fully understood, they may be a transient phenomenon of normal brain development. They sometimes run in families. Most are completely harmless and go away on their own. Since calling attention to the tics often make them worse, it is best to ignore them.
Please feel free to make an appointment with me if Vincent's tics are interfering with school, cause anxiety, become very intense or if he develops multiple tics.
And don't forget to tell him and little sis that Dr. Bright said "hello"!
Although tics are not fully understood, they may be a transient phenomenon of normal brain development. They sometimes run in families. Most are completely harmless and go away on their own. Since calling attention to the tics often make them worse, it is best to ignore them.
Please feel free to make an appointment with me if Vincent's tics are interfering with school, cause anxiety, become very intense or if he develops multiple tics.
And don't forget to tell him and little sis that Dr. Bright said "hello"!
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Cold season is upon us again. When I had my kids I used a cold humidifier. Now that I am raising my 4 month old grandchild, I was told to use a warm humidifier. I always was taught the warm humidifier promotes bacterial growth and increases lung infections. Which is right? Janice from Paulsboro |
12/10/2008 12:02:45 PM |
April Douglass-Bright, M.D.:
Cold and Flu season is definitely upon us and the use of a humidifier can be helpful. Both warm and cool humidifiers are equally effective at humidifying the air. This added humidity helps to ease cough and congestion when your little one has a cold. Both need to be properly and periodically cleaned to prevent the growth of bacteria and mold. I prefer the use of a cool humidifier because it is safer for children. A child can burn themselves with the hot water used and warm steam produced with a warm humidifier if they get too close.
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My 6 year old gets ear infections so often. What can I do to keep this from happening? Leila from Cherry Hill |
12/10/2008 12:05:30 PM |
April Douglass-Bright, M.D.:
This is a very good question. There are several things a parent can do to decrease the risk of a child developing an ear infection:
1. Decrease exposure to secondhand smoke - research shows that exposure to smoke increases the risk of colds, asthma and ear infections.
2. Decrease exposure to other kids who may be sick. For example, if feasible, have the child attend a smaller daycare center or at least one with a good sick policy!
3. Breastfeed! Breastmilk contains factors that help protect against several illnesses. For bottlefed babies, do not feed the infant lying down because that can block the auditory tube and increase the risk of ear infections.
4. Try to wean your child from the pacifier by 6 months of age. Babies who use the pacifier beyond 12 months of age are more likely to get ear infections.
5. Immunize your child! The conjugate pnuemococcal vaccine and the flu vaccine in particular can decrease the risk of ear infections.
6. Last but certainly not least - frequent handwashing will decrease the spread of germs that can cause colds which in turn will decrease the risk of ear infections.
If your child continues to get recurrent ear infection, be sure to discuss this with your pediatrician.
1. Decrease exposure to secondhand smoke - research shows that exposure to smoke increases the risk of colds, asthma and ear infections.
2. Decrease exposure to other kids who may be sick. For example, if feasible, have the child attend a smaller daycare center or at least one with a good sick policy!
3. Breastfeed! Breastmilk contains factors that help protect against several illnesses. For bottlefed babies, do not feed the infant lying down because that can block the auditory tube and increase the risk of ear infections.
4. Try to wean your child from the pacifier by 6 months of age. Babies who use the pacifier beyond 12 months of age are more likely to get ear infections.
5. Immunize your child! The conjugate pnuemococcal vaccine and the flu vaccine in particular can decrease the risk of ear infections.
6. Last but certainly not least - frequent handwashing will decrease the spread of germs that can cause colds which in turn will decrease the risk of ear infections.
If your child continues to get recurrent ear infection, be sure to discuss this with your pediatrician.
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3 week old baby drinking similac with iron constipated with gas struggling to have a bowel movement. He has had a bowel movement everyday however you can observe his struggle with bowel movement. Continues to eat no temp...whining and uncomfortable at night...moaning only at night time . Michelle from Blackwood |
12/10/2008 12:07:50 PM |
April Douglass-Bright, M.D.:
The majority of small infants, especially those less than 3 months will appear to "struggle" while having a bowel movement. Very commonly, they grunt, groan and strain but that is usually not a sign of a problem. It is just a little difficult having a bowel movement while lying on your back because one is not eliciting the help of gravity! If your baby is having regular, soft bowel movements daily, then he is not constipated. All babies have gas, although some will have more gas than others because of the immaturity of the digestive system. Most babies improve after the first 3 months or so of age. I always say that gas is only a problem if you don't let it out! If things don't improve or if your baby is vomiting, has hard stools, is not gaining weight or is not feeding well, then you should talk to your pediatrician.
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My daughter is just about to turn one and she still only has two bottom teeth. Is that normal or is she a little behind? Dawn from Woolwich Township |
12/10/2008 12:09:12 PM |
April Douglass-Bright, M.D.:
Typically, infants start teething around 4 months, although the 1st tooth typically does not erupt until about 6-7 months. The bottom two teeth are usually the 1st to come in. However, there is a broad range of normal for teething - some infants erupt teeth sooner than others and some are a bit delayed. Your daughter is still well within the range of normal tooth development so you have no reason to be concerned at this time.
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Do you think the Nintendo Wii Fit provides exercise for children? Jeannie from Marlton |
12/10/2008 12:11:21 PM |
April Douglass-Bright, M.D.:
I really think it all depends on how "active" your child is when he plays. Although this activity is better than no activity, there is no substitute for good old fashioned team sports or dance or gymnastics or swimming...Anything that get your child off the couch!!
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How can I help my grandson, who is a teen, cope with the symptoms of Tourettes? Sandy from Collingswood |
12/10/2008 12:13:38 PM |
April Douglass-Bright, M.D.:
Tourette's syndrome is the most severe tic disorder characterized by multiple motor and vocal tics. Coping with Tourette's can be quite a challenge at any age but especially for a teenager who may already have to deal with other issues such as coming of age. Without knowing the extent of his symptoms or other associated diagnosis, the best advice I can give is to:
4. Don't be afraid to seek help, especially if your grandson has symptoms of poor self esteem, anxiety or depression .
1. Become informed - learn all you can about Tourette's. Ask your doctor any questions you may have.
2. Find a support group.
4. Don't be afraid to seek help, especially if your grandson has symptoms of poor self esteem, anxiety or depression .
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My son is 5 years old. He frequently falls and seems uncoordinated for his age. He is doing well in school and is healthy otherwise. Should I be concerned or is this something he will outgrow? Patrice from Chesterfield, NJ |
12/10/2008 12:15:12 PM |
April Douglass-Bright, M.D.:
This probably is not a problem. However, your child should have a full exam by his pediatrician to complete neurological exam and to check his muscle strength and tone. All of this can be done in your pediatrician's office.
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If a child is born with Retinoblastoma, what are the chances of recurring cancers for his future? Marge from Clementon |
12/10/2008 12:17:39 PM |
April Douglass-Bright, M.D.:
Retinoblastoma is a rare cancer of the retina in the eye. It can occur in one or both eyes. It can be inherited from a family member. It is very important to have close follow up after treatment, especially because there is a high incidence of secondary cancers. The most common secondary cancer is osteosarcoma, a type of bone cancer.
The exact chance of secondary tumor development depends on many factors and is not the same for every patient. You should discuss this with a Pediatric Oncologist.
The exact chance of secondary tumor development depends on many factors and is not the same for every patient. You should discuss this with a Pediatric Oncologist.
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I've heard that vaccination before 2 years of age may be associated with the development of autism in some children. Should I postpone MMR shots till my child is older 2? thanks Hieu from Beltsville |
12/10/2008 12:19:47 PM |
April Douglass-Bright, M.D.:
There is no evidence to support that early vaccinations cause autism. Vaccinations are extremely important to your child's health. Your pediatrician will discuss with you the appropriate schedule.
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My grandaughter is 1 1/2, should she be on a multi-vitamin? She won't take any liquid medications...she gags on them. Thanks so much. Donna from Blackwood |
12/10/2008 12:20:35 PM |
April Douglass-Bright, M.D.:
In my opinion, vitamins are always worth taking, especially given the new requirements for Vit D. The liquid vitamins are not very palatable unfortunately! Most toddlers are able to take a chewable vitamin by 18 to 24 months.
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My daughter is going to be 2 years old. What over the counter meds are safe for cold and flu symptoms...I hear so many conflicting things about the meds that are out there. Kim from Voorhees |
12/10/2008 12:21:41 PM |
April Douglass-Bright, M.D.:
Colds and Flu are caused by viruses. We recommend supportive care such as a vaporizer, using a nasal aspirator, lots of fluids etc. The use of over the counter cough and cold medications is not recommended for children under the age of 6 and especially under the age of 2. There is no evidence that these medications work in these young children and there is the potential for side effects and improper dosage.
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My 3 yr old was diagnosed last week with Pinkeye. This week, he's complaining of his left ear hurting (same side as the Pinkeye). Is there any relation between the two? Kim from Bellmawr |
12/10/2008 12:23:02 PM |
April Douglass-Bright, M.D.:
Yes, Kim, there is a relationship between pinkeye and an ipsilateral (that means on the same side) ear infection. There is a particular bacteria that causes both of these infections and it requires antibiotic treatment. You should take your child to their pediatrician for an exam and, if necessary, medication.
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We feed our four month old daughter Similac Advance ready-to-feed (liquid in a bottle) formula. When we saw that Similac offers an organic version, we thought we might like to use that instead. My wife drinks organic milk and says it tastes much better, so we presume it's better quality. However, we noticed in the list of ingredients that Similac substitutes the extra lactose added to Similac Advance with maltodextrin and cane sugar for the organic product. When I asked them why, they said it's because there's is not enough organic lactose available for them to procure. My question is whether the benefit of organic would be outweighed by the detriment of what I presume is an inferior sugar/carbohydrate. I don't know how much "better" lactose is that maltodextrin and cane sugar, but I assume they are at least somewhat better since that's what Similac uses in Similac Advance. Here are the ingredient lists: Advance: http://abbottnutrition.com/products/products.aspx?pid=344 Organic: http://abbottnutrition.com/products/products.aspx?pid=223 Thank you. Dan Dan from Fountain Valley |
12/10/2008 12:24:13 PM |
April Douglass-Bright, M.D.:
Sorry Dan. I think I may have to defer your question to our nutritionist. I am unable to comment on the superiority of lactose vs maltodextrin or cane sugar. I can say that I know of no detrimental effects of any of the many different carbohydrates used in commercial infant formulas. They are safe and provide caloric value. If using an organic product is important to you, then stick to that. Of course, the ultimate organic formula is breast milk!
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3 weeks ago my 7 year old son started 18 mg of Concerta to treat his ADHD-Inattentive. His biggest side affect is great difficulty falling asleep. Until beginning this medication he routinely fell asleep by 8:30 wthout trouble. To help him, we give him warm milk each night and keep to a calmimg routine. He is still struggling to sleep by 10:30 or 11 consistently. Any suggestions? We hesitate to reduce the Concerta because other than sleep he is responding well to the dosage. Our pediatrician suggested OTC neuratonin (spelling?) but we've heard it can be too strong. Jeanine from Chews Landing |
12/10/2008 12:26:11 PM |
April Douglass-Bright, M.D.:
The use of stimulant medications for ADHD can be beneficial for many children, but there can also be side effects such as insomnia. It sounds like you have already implemented an important intervention-making sure that your son has a good, consistent calming bedtime routine. Try to follow that routine every night. You may also want to try to give the medication 30 - 60 minutes earlier in the morning. If this is not working, you may need to talk to your pediatrician regarding the possibility of decreasing the dose or changing to a different medication.
It sounds like your pediatrician may have suggested melatonin. Melatonin is a hormone that is often used to promote sleep. There is little information or research on how well it works or what the best dose is. But, from what we know, it appears to be safe and most useful in children with neurological problems. You should discuss with your pediatrician the pros and cons of using melatonin.
It sounds like your pediatrician may have suggested melatonin. Melatonin is a hormone that is often used to promote sleep. There is little information or research on how well it works or what the best dose is. But, from what we know, it appears to be safe and most useful in children with neurological problems. You should discuss with your pediatrician the pros and cons of using melatonin.
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What is your opinion on using pacifiers with babies. I am a soon to be grandmother and I am not crazy about the idea of using them but would like your opinion. Thx. Cordia from Stamford |
12/10/2008 12:30:10 PM |
April Douglass-Bright, M.D.:
I bet you are excited about being a grandmother!Pacifier use has always been controversial. I recommend to my parents that if they have an infant who likes to suck, then a pacifier can help. There is new evidence that the use of a pacifier in small infants may decrease the risk of SIDS. This may a be a reason to give it a try. I would not however, force the infant to take the pacifier - after all, it's one more thing you have to wean them from.
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My pediatrician said it was ok to give Benadryl to my 2 year old daughter for a cold...should I stop doing this for future colds? Charlie from Philadelphia |
12/10/2008 12:33:17 PM |
April Douglass-Bright, M.D.:
Benadryl is safe and is the only "cold" medicine that you could consider using. I would only use it if your child has copious, thin, watery nasal discharge. It may help mitigate post nasal drip and therefore help with the cough.
April Douglass-Bright, M.D.
: Thank you for emailing your terrific questions. We’ve covered a number of topics and the transcript of your questions and my answers will be on www.cooperhealth.org for whenever you’d like to come back and review it. In fact, the transcripts for all of our eTalks are on our web site when you need them. I hope this eTalk has been helpful. Thanks so much for joining me today.
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