Comments for Ask I AM Pediatrician at http://www.iammodern.com , comment 0 to 20 out of 31 comments http://www.iammodern.com Sat, 11 Oct 2008 04:18:38 +0100 FeedCreator 1.7.2 http://www.iammodern.com/pediatrician/ask-i-am-pediatrician.html#pc_236 Dear Karina, What you describe could be eczema. The eczema rash usually is a dry scaley rash mostly found on skin surfaces that are rubbed a lot. The most common areas are around the elbows, knees, neck and waist area, but it can occur anywhere. The rash tends to be itchy. There are many causes of eczema, usually some sort of allergic reaction (food, meds, soaps, etc). Other irritants can also bring it on. The key to succesful management of eczema is to find out what the cause is and avoid it if possible. I generally recommend daily use of a moisturizer lotion, wearing clothes with soft fibers (not wool), and using mild soaps and detergents to wash body and clothes. Scratching itchy skin will make the rash come out. For flare ups I'll have parents apply over the counter hydrocortisone twice a day for five days. The degree and amount of eczema can vary widely. Also, parents need to be aware of conditions which may look like eczema. If you use a steroid cream and the rash gets worse, seek medical attention immediately. Sometimes ringworm (skin fungal infection) can look like eczema. The best course of action is to use moisturizers regularly and an anthistamine like Benadryl or Claritin for itchiness. For more serious flare ups we tend to use some form of steroid cream for several days. The most serious cases require presciption steroid creams and/or immunomodulater creams. On occasion, prescription oral medications are needed. The thing to remember about eczema is that you are able to control it, but not cure it. No matter what you do, once you stop treatment, the rash can come back at any time. The good news is that most children will outgrown their eczema at some time. We tend to see more eczema cases in the winter when the weather is cool and dry. If the rash doesn't respond to treatment, or gets worse, then a visit to your pediatrician will help. Good luck with that rash, Dr. Bill - Dr. Bill Mon, 29 Sep 2008 22:37:50 +0100 http://www.iammodern.com/pediatrician/ask-i-am-pediatrician.html#pc_235 Dr. Bill, my daughter gets at least one or two red dry patches of skin every year. They seem to come and go on their own but last several weeks. Does this sound like excema? If so, what is the best remedy? - karina Sat, 27 Sep 2008 10:56:08 +0100 http://www.iammodern.com/pediatrician/ask-i-am-pediatrician.html#pc_234 Dear Confused About Medicine , You're absolutely right. Since the recall of cold meds for small children and the new FDA recommendations, parents have very little recourse to treat their sick children. Most of the problems occured in very small children who were overdosed with various cold meds. The problem we face is that the available over the counter cough/cold meds work minimally at best. Many of them may even create unwanted side effects. When looking at the many cogh/cold remedies you will see that there are four main types of ingredients (decongestant, antihistamine, antitussive, and expectorant). You will find a large variety with every possible combination. In the "old" days I would suggest that parents buy single ingredient meds and treat that specific symptom. But nowadays, a cold med with a decongestant and antihistamine is your best bet. Benadryl ,also know as diphenhydramine, is a very good antihistamine, it's main drawback is that it will cause drowsiness. I currently use this type of med for my daughter when she gets cold symptoms. Supportive care in the form of taking plenty of fluids, vaporizer, and proper positioning help a little. For very bad cold symptoms, there are a few prescription cold medications which I have found to be pretty effective in controlling symptoms. The best way to treat colds is to prevent them. Steps like encouraging good handwashing, using disposable tissues, cover our coughs, and avoiding contact with sick persons help. I'm a big proponent of taking vitamin C for the prevention of colds. Some studies have also shown that certain forms of zinc (zinc gluconate) might also reduce the duration of colds. If you find that your child's symptoms last for two weeks or more or that they are getting worse, then a visit to your pediatrician is warranted to rule out any other illness. Hope this helps. - Dr. Bill Fri, 26 Sep 2008 00:05:58 +0100 http://www.iammodern.com/pediatrician/ask-i-am-pediatrician.html#pc_232 Dr. Bill, I am so confused about the types medicine I am no longer allowed to give my children. Is Benadryl safe? What do I give my children without worrying about hurting them? Are there natural alternatives? Thank you very much. I read your advice column religiously and love this set up. - Confused About Medicine Tue, 23 Sep 2008 22:01:55 +0100 http://www.iammodern.com/pediatrician/ask-i-am-pediatrician.html#pc_229 Dear Jill S, The symptoms you are describing do suggest allergies. The only sympton you didn't mention was itchiness in your eyes or nose, that would be even more suggestive of allergies. Ragweed is still in full bloom. Kids can and do inherit their parents propensity towards having allergies. So it isn't a far-fetched idea that everyone in the house has allergies. But you all can also be a part of what I call the "Sickness Tsunami". Usually about 1-2 weeks after school starts, everyone comes down with cold symptoms which can last several weeks. Typically infections give you fevers and more generalized symptoms. But I have seen many patients have severe ear or sinus infections and not show any fever or pain. You could consider using one of the over the counter anti-allergy meds like: Benadryl, Claritin, Zrytec, or their generic equivalents. If these help, it's most likely you're dealing with allergies. The problem with these symptoms lasting this long is that they can cause secondary problems, like sinus and ear infections. It's never a bad idea to consult with you pediatrician and have him or her check things out. There are some other things that can be checked or examined to determine the difference between allergies and infections. I hope this helps. Remember, no question is to silly to ask. Dr. Bill - Dr. Bill Sun, 21 Sep 2008 20:39:38 +0100 http://www.iammodern.com/pediatrician/ask-i-am-pediatrician.html#pc_226 I have had a cold for two weeks, my nose, sneezing, the post nasal drip and the soreness it creates in my throat... the kids, the same. Is this something you are seeing out there? No fever, no body aches. Just nasal misery?... Could it be allergies? I am so lost and embarrassed to call the peds for a silly cold. But 2 weeks??? - Jill S. Fri, 19 Sep 2008 19:46:13 +0100 http://www.iammodern.com/pediatrician/ask-i-am-pediatrician.html#pc_215 Dear Hulya, Since your son just had his check up recently, all you need is for your pediatrician's office to fill out the form. If he's playing sports, the schools require that the physical be done after May 1st. Since he had it done in June you shouldn't have any problem. The month of August we're packed with back to school/sports physicals. School starts next week, so you'll need that form filled out ASAP. Some offices take a few days to fill out the forms. Dr. Bill - Dr. Bill Thu, 28 Aug 2008 00:05:28 +0100 http://www.iammodern.com/pediatrician/ask-i-am-pediatrician.html#pc_214 Hi Dr. Bill, I have a quick question. I wanted to clarify what is necessary for back to school paperwork. My son had a check up this June. What do I do with the paper sent home from school for his physical and immunization? Do I call the peds office or do I have to go in? What does your practice require? Thanks, Hulya - hulya Tue, 26 Aug 2008 19:27:32 +0100 http://www.iammodern.com/pediatrician/ask-i-am-pediatrician.html#pc_211 Dear HCM, Your dilemma about this possible chicken pox situation is quite interesting. The timing for the exposure does fit the typical incubation period (7-14 days) for Chicken Pox transmission. What is not typical is that so many children with the same exposure are all coming up with "Chicken Pox". The vaccine is very protective and only about 1% of vaccinated children will still get it. Kids with Chicken Pox who were vaccinated tend to only get a few spots and are less sick. Typical symptoms begin as a cold-like illness and then several days later, the rash devolops. The spots, or rather vessicles (they are little water blisters) can be very itchy. You can also look in your child's mouth and look for red spots. Some other things that could give similar rashes are related viruses to Chicken Pox, bug bites, and contact with plant sap. The distribution of the rash can be helpful. If it's only on "exposed" surfaces (ie areas of skin not covered by clothing, then insect bites and contact derm are possibilities. Also check the scalp. Since all the children were at the same place at the same time, all the above possiblities can apply. I would make sure each parent contacts their pediatrician and lets them know the situation. If we're having this many break-through infections. then the health department and even CDC need to know. I hope this info helps, Let me know if you have more specific questions. (also sorry for the late response). Good luck, Dr. Bill - Dr. Bill Sat, 23 Aug 2008 09:49:26 +0100 http://www.iammodern.com/pediatrician/ask-i-am-pediatrician.html#pc_207 Hello Dr.Bill, My 18 month old son was recently diagnosed with chicken pox-even though he received his chicken pox vaccine at his 15 month check. He has no other symptoms other than ten red bumps and his doctor said that is normal for a child who received a vaccination. We were at the beach a week ago and now one by one all the children we stayed with are getting these red bumps on their body. Now I have several mothers staying home thinking their children have chicken pox-is there a similar kind of skin rash that might get confused with chicken pox? I was wandering because all of these children are up to date with their vaccinations and they all have the exact same symptoms with no fever or major itching. Thanks, HCR - HCR Mon, 18 Aug 2008 13:10:27 +0100 http://www.iammodern.com/pediatrician/ask-i-am-pediatrician.html#pc_202 Dear KRM, There's no reason why you can't have the level checked now. If it's really elevated, then you have that much more time to deal with it. Your daughter's profile seems like a low risk for high cholesterol. Good luck - Dr. Bill Sat, 09 Aug 2008 01:01:54 +0100 http://www.iammodern.com/pediatrician/ask-i-am-pediatrician.html#pc_201 I forgot to mention - she is very lean, 95th percentile in height and 90th in weigh. Not overweight. Only history of high cholesterol runs in my side of the family but my husband and I both enjoy healthy levels. - KRM Fri, 08 Aug 2008 13:46:36 +0100 http://www.iammodern.com/pediatrician/ask-i-am-pediatrician.html#pc_200 Dr. Bill, thank you for your response. I do have another question related to this subject. Should I wait the suggested 3 months to do a fasting lipd panel... ? If the meal prior to the screen affected the results, my gut is to test now and see what her 'true' numbers are. She is an incredibly active kid, swimming daily in the summer and enjoying outside sports as well as gymnastics. She drinks 1 % milk and I consider her diet healthy but higher in fat due to eggs, cheese, use of butter in meals and ice cream. We do buy whole-wheat bread and other products whenever possible to up her fiber intake as she is not that fond of fruits and veggies. She loves oatmeal and Cheerios. So again, I was surprised to see the high number, especially because as an adult I have been so conscious about my diet - never thought I had to worry so much about hers.... your feedback is greatly appreciated. Thank you for participating in these forums. - KRM Fri, 08 Aug 2008 13:40:45 +0100 http://www.iammodern.com/pediatrician/ask-i-am-pediatrician.html#pc_199 written by Denise , August 07, 2008 Dear Dr. Bill, Finally my 2 year old is not breastfeeding anymore!... Now what do I do with the very painful, Pamela Anderson boobs? I look obscene and I can't lift my arms from the pain. Help... Dear Denise, I'll try to give some general advice on this, but I will defer to my GYN and Lactation consultant collegues for more in depth advice. Hopefully you were able to gradually wean and not stop cold turkey. The body uses a feed back mechanism in that if less milf is expressed, less is made. Most experts suggest using cold packs on the breasts. I've also heard of using cold cabbage leaves as well. When my wife did this, she scored the side against the skin and changed them every couple of hours. You can also pump a little to lessen the engorgement, but not too much or you will continue to stimulate production. Also use ibuprofen (Motrin or Advil) or Tylenol for pain control. It may take a week to a month for things to get back to "normal". Wearing a bra that fits well without too much constriction may help. If pain persists especially if you have a fever and or blood discharge, contact your GYN immediately. Also of note is that once you stop breastfeeding, fertility will increase, so be prepared to take measures if necessary to prevent pregnancy. Hope this was helpful. - Dr. Bill Thu, 07 Aug 2008 23:29:37 +0100 http://www.iammodern.com/pediatrician/ask-i-am-pediatrician.html#pc_198 written by KRM , August 06, 2008 Dr. Bill- Last week, my 5 yr old daughter was given a cholesterol screening at the peds office during her 5 yr check up. It was non-fasting and the result was 219 and I was shocked! She had eggs, butter and cheese for breakfast 2 hrs prior - how much can this affect the result? We will go back in 3 months for a fasting screen - what would you recommend us do in the meantime in terms of dietary changes, etc.? Should I be concerned, I didn't think a little kid's cholesterol could be so high! Dear KRM I'm attaching the American Academy of Pediatrics Guidelines just recently released below. With increasing rates of obesity and cardiovascular disease in younger people, the medical community is getting more aggressive with early intervention to reduce risk and reverse disease. The level of 219 is not surprising after a meal. The meal she ate is associated with higher cholesterol, but not necessarily unhealthy. Things that need to be considered are your daughter's weight percentile for age, level of physical activity, family history of heart disease/high cholesterol, and the breakdown of the types of cholesterol in the total amount. (LDL = Bad cholesterol, HDL = good cholesterol) When we test levels in our patients, we request a fasting panel that includes total cholesterol, LDL, HDL, and triglycerides ( I may even order a fasting glucose and insulin level to be complete). These results along with weight, physical activity, blood pressure, family history helps us determine risk and if we need to take action to reduce the risk. If your daughter is normal weight for height, tends to be relatively active in her physical activities, eats a healthy diet, and you have low risk factors in your family, I would probably just keep doing what you have been doing and see what the fasting levels really are. You also need to remember that cholesterol is an important component in cell membrane growth. (ie. good for growing bodies as long as it is being used and not deposited in your arteries) There's nothing wrong with encouraging a healthy diet, it will build good habits and forces us parents to eat more healthy as well. If your daughter's levels do remain high, then a healthy diet higher in fiber coupled with increased activty would be your first formof treatment. If cholesteol levels continue to run high, then a nutritionist and/or pediatric cardiologist should be consulted. Below are the APP reccomendations. Good luck and let me know if you have any more specific questions. Below is a policy on a clinical report appearing in the July issue of Pediatrics, the peer-reviewed, scientific journal of the American Academy of Pediatrics (AAP). For Release: July 7, 2008, 12:01 am (ET) The American Academy of Pediatrics has issued new cholesterol screening and treatment recommendations for children. The policy statement, “Lipid Screening and Cardiovascular Health in Childhood,” recommends cholesterol screening of children and adolescents with a family history of high cholesterol or heart disease. It also recommends screening patients whose family history is unknown or those who have other factors for heart disease including obesity, high blood pressure or diabetes. Screening should take place after age two, but no later than age 10. The best method for testing is a fasting lipid profile. If a child has values within the normal range, testing should be repeated in three to five years. For children who are more than eight years old and who have high LDL concentrations, cholesterol-reducing medications should be considered. Younger patients with elevated cholesterol readings should focus on weight reduction and increased activity while receiving nutritional counseling. The statement also recommends the use of reduced-fat dairy products, such as two percent milk, for children as young as one year of age for whom overweight or obesity is a concern. # # # - Dr. Bill Thu, 07 Aug 2008 23:00:33 +0100 http://www.iammodern.com/pediatrician/ask-i-am-pediatrician.html#pc_197 by Sandy , August 04, 2008 At what age should a toddler start to run more like a kid and less rigid? Thank you, Dear Sandy, The answer would depend on when the toddler began to walk. When toddlers start to walk they tend to toe walk and keep hands outstretched. They will walk in straight lines stop, turn, and walk. As they get more experienced, you'll notice turning and stooping on the fly. I've seen toddlers as early as 15 months walk well. The later they walk the later the gait becomes normal. You should notice some improvement over time however. If your toddler seems to not be improving his walking/running, then I would recommend that you have your pediatrician check him out. Usually girls take longer and boys start sooner....but this isn't written in stone. I would expect that by age two all toddlers have a "normal" walk. Some things to note are excessive clumsiness, asymetric walk (one side moves different than the other), toe walking, or refusal to walk. Hope this helps - Dr. Bill Thu, 07 Aug 2008 22:29:23 +0100 http://www.iammodern.com/pediatrician/ask-i-am-pediatrician.html#pc_190 Dear Dr. Bill, Finally my 2 year old is not breastfeeding anymore!... Now what do I do with the very painful, Pamela Anderson boobs? I look obscene and I can't lift my arms from the pain. Help... - Denise Thu, 07 Aug 2008 08:25:41 +0100 http://www.iammodern.com/pediatrician/ask-i-am-pediatrician.html#pc_188 Dr. Bill- Last week, my 5 yr old daughter was given a cholesterol screening at the peds office during her 5 yr check up. It was non-fasting and the result was 219 and I was shocked! She had eggs, butter and cheese for breakfast 2 hrs prior - how much can this affect the result? We will go back in 3 months for a fasting screen - what would you recommend us do in the meantime in terms of dietary changes, etc.? Should I be concerned, I didn't think a little kid's cholesterol could be so high! - KRM Wed, 06 Aug 2008 18:16:42 +0100 http://www.iammodern.com/pediatrician/ask-i-am-pediatrician.html#pc_182 At what age should a toddler start to run more like a kid and less rigid? Thank you, - Sandy Mon, 04 Aug 2008 23:14:32 +0100 http://www.iammodern.com/pediatrician/ask-i-am-pediatrician.html#pc_154 written by Pareet , July 12, 2008 Dear Dr. Bill, I have two children that are very hard to feed. I often feel that they do not get enough vitamins and minerals they need. They never eat vegetables and fruits are very minimal. Is there a vitamin I can give them? A natural one that doesn't contain corn syrup and preservatives. My children are 8 and 2. Thank you . Dear Pareet, This is a very common discussion that I have with the majority of my parents in my practice. The answer to your question really depends on several variables. I’ve found that kids in the long run will eat foods that are good for them. Picky eating is a common trait in toddlers, even to the point of only eating one or two foods. They tend to prefer the starches and occasionally will eat some meat. Veggies and fruits may be “off the menu” for some time. Older kids may just be continuing old habits that they learned early on. In that situation, you may have to set rules that he or she can’t have snacks or desserts until they at least eat a portion of their meals. Most people will also say not to make special meals just for them, as this will also perpetuate bad habits. My 23-year-old cousin still gets his meals served different from the rest of us. When dealing with this situation of pickiness, I advise my parents to try different ways of presenting foods to their kids. Perhaps arranging the food in creative designs, or as something that they enjoy (planes, trains, cartoon character). Other parents have pureed veggies and mixed them into sauces put on the food. Try to use the child’s interests as a source of ideas to present them their meals. Some kids are grazers and tend to pick all day. These kids drive parents crazy since they appear to not eat at all, but when you add up all the calories, they actually eat quite a bit. When I have a child who truly is not eating enough, I suggest either Carnation Instant Breakfast Shake or Pediasure as a supplement. These have a large portion of the daily-recommended vitamins and minerals as well as calories for an average daily intake. As for vitamins, there are quite a few to choose from. Some parents opt for the organic preservative free ones, others for the standard “Flintstones”. With the sheer number out there it’s very hard to make a specific recommendation. I give my daughter (who will only eat rice, pasta, or cous cous, and sometimes chicken strips) the gummy vites and Omega 3 fatty acid gummy fish that you can get at those large discount stores. If you do have concerns about your children’s nutritional status, I would recommend that you take them to your pediatrician and have him/her evaluate their growth compared to the standard growth curves as well as to your family’s growth history. If they are showing signs of malnutrition then they may need further work-up for the cause as well as special supplements or even a referral to a nutritionist to work out a new diet regimen. - Dr. Bill Tue, 15 Jul 2008 00:32:11 +0100