Welcome your Royal Highness Prince (name to come) and congratulations to new parents Prince William and Duchess Kate.
A new study just published in the August online edition of Pediatrics confirms what I see in my practice.
If you look at a baby's legs it is easy to see how they were folded so that they fit inside the uterus. Those little legs don't get unfolded until after delivery.
I still get a lot of questions about starting solid foods in a baby.
Summertime in the pediatrician's office means lots of check ups, and often this includes those tweens/teens/and college students who were too busy to schedule their doctor's appointments during the school year. The next three months will be busy indeed.
With HPV back in the news after Michael Douglas revealed that his throat cancer was due to HPV, what better time to remind parents and young adults of the need for the HPV vaccine. The HPV vaccine has been available in the U.S. for over seven years, but statistics from the CDC continue to show that the HPV vaccine is still not being given at the same rate as other recommended vaccines. In other words, we doctors need to ensure that every person between the ages of 11-26 who we see is offered the vaccine, this also means we need to educate.
HPV causes CANCER! This is truly the first anti-cancer vaccine, and I am hopeful that I will see more vaccines to prevent cancer while I continue to practice. I am sure that there will be more anti-cancer vaccines in our children's lifetime. This is exciting news as research continues on ways to combat cancer.
But.....for some reason (that is difficult for me to understand both as a parent and a physician), some parents are refusing to have their children vaccinated despite ongoing evidence that HPV is widely prevalent and causes numerous cancers. The fact that this virus is transmitted sexually seems to be the root cause of parental concern. Do parents not assume that their own children will become parents one day as well? Dont they want to be grandparents one day? Well, that means having sex with a partner. At some point in time, our children do become sexually active and shouldn't they all be protected as much as possible?
Giving adolescents the HPV vaccine does not promote sexual activity. In fact, I think that by having a discussion abou
Parents, you know you can say all sorts of funny things and now here come cute, clever kids comments. This has been a week of kids say the darndest things.
A verbal little 3 year old came in this week and while I was getting his chart opened on the computer, I asked him what's the matter? He is the third child in the family and is quite comfortable coming to the doctor and is always chatty. His response was,I have the God bless you's. Now I admit that I was not quite sure what he meant? Then it hit me! He was sneezing a lot and that was what the God bless you''s meant. How smart is that!
He then proceeded to tell me that he had been sneezing and coughing. He also happens to have asthma, so I asked him if he had been wheezing as well. His response to all of these questions was equally bright. He said , I haven't had to use my puffer, my breaving is okay.
I examined him (by this time he is watching a cartoon on his iPad) and he was spot on. His lungs were clear as a bell, he had a clear watery runny nose and his nasal mucosa was swollen. He also had allergic eyes. He was using an antihistamine but not his steroid nose spray.
So I tweaked his allergy medicines a bit and reminded his mom to have him bathe or shower after he had been playing outside. I also suggested that they use a nasal saline rinse on him as well, as this would help to get the pollens out of his nose after he had been outside, and may be one of the best cures for the God bless you's.
Who says children can't give a good history? I often find that the young patient is a great communicator and may open a doctor's eyes to different ways of relaying a new symptom. Whether is from a 3 year old, a tween or a teen, having a patient that you know and that is comfortable talking to the doctor is the key to a good history. This is was a great remind
Did you know that May is National Teen Pregnancy Prevention Month? I really think that this should be a topic of interest to parents year round, but this is a good month to be reminded of the importance of educating our children about their sexuality.
The good news is that the teenage pregnancy rate is going DOWN! The bad news is that 750,000 teens in the United States experience a pregnancy each year and 400,000 will give birth. That means that 70 young women out of every thousand become pregnant. To continue to reduce these statistics requires improved education and continued dialogue about the risk of teen pregnancy.
Although some teens think that becoming pregnant is a way to escape their own situation, the reality is that teens who become pregnant are less likely to finish high school or enter college, and are more likely to experience poverty. Being a parent is a hard job for any one, but trying to be a teen parent is almost impossible, even with good support systems. The effects of teen pregnancy are far reaching for all of society.
Studies show that teenagers who receive comprehensive sex education are 50% less likely to experience teen pregnancy compared to those who were taught abstinence only sex education. Other studies have recently shown that the decline in teen pregnancy rates are due to increased contraception use. But, 39% of sexually active teens did not use condoms when they last had sex, and only 23% of teen reported that they or their partner used hormonal birth control.
Parental involvement in sex education should occur in every home. This begins with that first, birds and bees talk with your child. A comment from a recent young patient after reading Where Did I Come From with her parents DISTURBING ! (cue my laughter).
The conversation needs to continue during the tween years an
I am going to start right off by saying, I don't have daughters, so maybe that is why this seems strange to me, but, why are little girls already getting mani/pedi's with their moms? I don't mean teen girls, I am referring to the 3-12 year old crowd.
I see these little girls in my office with painted fingers and toes, and I often ask them, who painted your fingernails?. I thought the typical answer would be my mom, or my big sister, but it is quite often I hear, I had them painted at the nail salon. Of course, I then have to ask, oh, was this for your birthday?, and many of them do say it was, but many also say, I go with my mom all the time.
WHAT? I can remember my first manicure was on the day before I was married. It was a big deal, and i think my parent's agreed to it because in those days we all had a picture of our hands with the new wedding bands on. Do you have one of those, husband and wife with hands overlying one another? I still love that picture, and yes my nails were perfect. i also remember that it took me the 6 months prior to finally stop biting my fingernails, in order to even have nails to manicure! Nail biting is one habit that took me years to break, but out of necessity for wedding pictures I stopped and never went back.
I watched several little girls getting mani/pedi's the other day. They sat there, perfectly still at the age of 4 (my boys would have played in the pedi bowls I am sure), enjoying picking out polish and choosing flowers to be painted on their toes (to which I overheard one mother saying, do you know how much this is costing?). Odd comment considering the fact that the mother had obviously brought her daughter and how can a 4 year old understand how much professional nail care costs?
I just think that parents need to show a bit of restraint in indulging their children in such
What are the words that a child first speaks that changes everything?
How many times have you cooked dinner only to have your child tell you, I don't like that! It is a common theme in many families...it doesn't matter whether Mom or Dad fixed the meal.. our children don't hesitate to tell us their true feelings. I can remember that many times I had even prepared dinner thinking I was fixing my children's favorite foods. But, guess what.....they didn't agree.
Dinner is one of the most important times in a family's day. It is the time to gather together for a meal, but more importantly it is a time to just be together. Whether you child eats the meal is really not the important part....I know may be shaking your head in disagreement, but it really is not about the food, it is about being together.
The longer I think about it.. the more I have come to understand this. One of my patients recently told me that she had made her child's favorite, macaroni and cheese. When he (all of 3 years old) sat down for the meal he looked at his parents and announced....I prefer Panera. (that should be a TV ad). How can that not devastate you the parent that fixed the meal? But, don't let it. Tell your child that you are just happy to be together to talk and enjoy one another....don't let their food choices ruin the meal or turn the meal into a food argument. It is not worth it, and we parents all need to remember that our children will not starve if they miss a meal.
I think meal preparation for a family is somewhat analogous to having a dinner party. When you invite guests to dinner they don't ask you what you are cooking or planning on serving before they accept your invitation. They come to dinner and if by chance they don't like what you have prepared, they don
Back to more funny office stories - they really keep my job interesting and always a little bit of fun.
How much fun is a 4-6 month old baby? I just love this age, and if you have a baby of your own, you probably know what I mean. I call this age a chia baby! They are just perfect and low maintenance like the chia pet.
Think about it, this precious aged baby only requires watering, i.e. they just drink - no real food yet, so no meal planning or mess to clean up. They don't move , so you know where they are at all times, no looking for them under foot, or worrying if they will be home on time. They sleep for at least 6-8 hours at night (those early months were much more exhausting) and typically wake up with a smile on their face.
When you talk to this age baby they smile, babble and laugh at whatever you say. They think you are funny and clever (not always the case during their teen years), even when you might not be. A 4 month old baby packs up easily and can travel, just like moving a chia pet from one window sill to another. (wait till toddlerhood and trying to convince the same child to sit still on a plane).
I am always ready to take a 4 month old baby home with me for a few days. I tell the parents at the 4 month check up that I will gladly babysit . I just wish I could keep a 4-6 month old baby around at all times. I do believe that this stage of infancy is God's gift to parenting.
Don't worry, there are many different stages in a child's life that are also special and perfect, but this is just the first one. This stage is well worth the first months of sleep deprivation and exhaustion! If you have a younger baby, hang in there, it's getting ready to get really
Did you read the latest study from the CDC about the number of infants who are starting solid foods too soon? One of the only things that I think has stayed pretty constant since I began practicing medicine (and what I did with my own children), was waiting until they were around 6 months of age to begin solid food.
Beginning a baby on solid foods is not really momentous, in that it does not make a baby sleep through the night, it does not make them less fussy, or gain weight faster, but it certainly is a little more work. A baby really does just fine on breast milk or formula for the first 6 months of life. It is wonderful to watch a newborn grow and thrive, and it all happens with milk alone.
While many new parents are anxious to start solids, there is no rush. Actually, once you are starting baby foods you soon figure out that it is really more work, and you get to fix meals for the next 18 years! Formula or breast milk seems like a great meal when you are too tired to cook one night when they are older. Milk for dinner just doesnt work for a 10 year old.
Early introduction of solid foods may be linked to obesity, diabetes, eczema and celiac disease. While the studies on these issues continue, why risk any of these problems when your baby is doing well on breast milk or formula alone for 6 months?
When beginning solid foods your baby should be able to sit up in their high chair and open their mouths when the spoon is introduced. There is no magic as to how much a baby will even eat when you start baby foods. For some babies, eating solid foods is cosmic and they may love it and continue to eat more and more.
I see a lot of parents who bring their baby/toddler/child in to the pediatrician with concerns that their child might have an ear infection. One of the reasons for their concern is often that their baby is tugging on their ears.
Babies find their ears, just like their hands and feet, around 4 -6 months of age. I guess a baby must think this ear tugging is fun and feels good as maybe babies have itchy ears just like adults. It also seems to be a self soothing habit for other children who seem to pull on their ears when they get tired and cranky. Maybe it is related to new molars coming in at the back of the jaw line?
Whatever the cause, it often concerns parents who are told by their friends or relatives, I am worried, this ear pulling probably means the child has an ear infection. So, being a good parent off you go to your pediatrician only to find out that the ears a beautiful and clear!
Most babies and children do not get an ear infection without ANY other symptoms besides ear pulling. In most cases infants and toddlers will get a secondary ear infection during cold and flu season. The multitudes of viral respiratory infections that children get in the first 3 years of life, often cause continuous runny noses and congestion. This congestion causes fluid to build up in the middle ear space which connects to the nasal passages via a small canal called the eustachian tube.
Infants and children have so called immature eustachian tubes that are soft, and don't drain well and the tube gets inflamed and swollen from the viral infection as well. At times this fluid gets secondarily infected from bacter
Proper dental care for your child begins early, really with the eruption of that long awaited first tooth. It is easy to wipe off the first teeth with a wet washcloth or baby toothbrush. It is easy in the beginning when your baby will not be bothered by it, it gets a bit harder as your baby decides to clamp down and not open their mouth. Why a child figures this out before they are one, who knows?
Parents should know that they never put their baby to bed with a bottle, that is why there are bars on the crib, the bottle should not go behind the bars! Same thing if you are breastfeeding, do not let your child fall asleep on the breast or nurse off and on through the night as this may also contribute to cavities. The saliva in a baby's mouth helps cleanse the teeth as well, so you want to have time without milk in the mouth for this natural cleansing to occur.
I usually start talking about using a toothbrush around 9-12 months when your child can hold a toothbrush and put in in their own mouth. It is a fun game to play as you brush your own teeth and they want to mimic the behavior. For some reason a child also always wants your toothbrush so often Mom or Dad is suddenly using the Dora toothbrush while child has nice Oral-B!
At any rate, you can begin using a non fluoride baby tooth paste and as your child starts to mimic spitting out toothpaste you can buy a children's brand toothpaste with fluoride. Get into the habit of play brushing twice a day.
Next hurdle is flossing which is now called jumping rope by our favorite pediatric dentist. I found jumping rope to be a bit of a challenge wi
I have to remind myself to ask clear-cut, open-ended questions when examining patients. This is what I was taught to do in medical school, and I think I need a refresher.
I was reminded of this again while examining an adolescent patient. She had been a patient for many years so I knew her quite well. With the new electronic medical records I am using I find that I am not always making eye contact while I ask questions. It was far easier before I wrote down my notes now I type them, then head to a different screen for medications, updates etc. making this a bit more cumbersome with less eye contact - surely there is a better way! At any rate, I knew this young woman had been taking birth control pills and I wanted to add this to her current medications, so I asked are you still sexually active? without really looking up (which I should have done!).
She suddenly says emphatically and loudly, Dr. Sue, I am not promiscuous, you know I am only having sex with one partner (long pause) how could you call that sexually active?
Point well taken! Not only did I not make good eye contact when I was talking to her (which I think is rather rude on my part), I asked her a question in doctor talk rather than using something less formal. She was correct, I would not consider her active, which she thought was synonymous with promiscuous.
She was an older adolescent who was smart enough to be using contraception while she was having sex with one partner. After clearing up the active part she also informed me that her partner was also wearing a condom to prevent transmission of infection. She had done everything correctly by coming to me prior to having sex and discussing contraception and disease prevention.
If you are a new parent or even if you have older children, you can probably remember your baby's first smile, almost vividly I bet!! When a parent first brings their new baby home from the hospital it is such a time of great joy, but parents quickly learn how demanding a newborn baby really is. The first 6-8 weeks of a baby's life is all about eating, peeing, pooping and maybe a little sleep, although not on any sleep schedule an adult can remember. The little sleep a parent and the newborn gets comes in 2-3 hour increments and after about 6 weeks of sleep deprivation a new parent can understand why sleep deprivation is used on POWs. It sometimes does feel like torture. But just when you think you can't take it ANYMORE, and wonder why you thought you wanted a baby, (and you are actually telling your baby this), you suddenly realize that your baby is making eye contact and REALLY SMILING! It is such a wonderful and amazing moment! One little smile can erase weeks of no sleep and pure exhaustion. At that moment you begin to understand why you wanted to be a parent, and the pure joy a small smile can bring. Parenting, like so many things in life, is about give and take. With a newborn it is all take, take, take, and then suddenly that tiny little baby learns to smile and they are giving!! The smiles, which are soon followed by sweet coos and goos, become ever more frequent, and the give and take becomes a bit more equal. A parent has unconditional love for their child, and that never changes. But to have your child reciprocate that love, with just a first smile, is a moment that will always be remembered. That smile will get a parent th
If you are a new parent or even if you have older children, you can probably remember your baby's first smile, almost vividly I bet!!
When a parent first brings their new baby home from the hospital it is such a time of great joy, but parents quickly learn how demanding a newborn baby really is. The first 6-8 weeks of a baby's life is all about eating, peeing, pooping and maybe a little sleep, although not on any sleep schedule an adult can remember. The little sleep a parent and the newborn gets comes in 2-3 hour increments and after about 6 weeks of sleep deprivation a new parent can understand why sleep deprivation is used on POWs. It sometimes does feel like torture.
But just when you think you can't take it ANYMORE, and wonder why you thought you wanted a baby, (and you are actually telling your baby this), you suddenly realize that your baby is making eye contact and REALLY SMILING! It is such a wonderful and amazing moment! One little smile can erase weeks of no sleep and pure exhaustion. At that moment you begin to understand why you wanted to be a parent, and the pure joy a small smile can bring.
Parenting, like so many things in life, is about give and take. With a newborn it is all take, take, take, and then suddenly that tiny little baby learns to smile and they are giving!! The smiles, which are soon followed by sweet coos and goos, become ever more frequent, and the give and take becomes a bit more equal.
A parent has unconditional love for their child, and that never changes. But to have your child reciprocate that love, with just a first smile, is a moment that will always be remembered. That smile will get a parent th
There isn't a day that goes by that I don't find myself talking to a patient or a parent about anxiety. I see patients as young as 4 years old who are anxious about sleep, school or after school activities. I also see plenty of high school students with the same concerns. It doesn't seem to be getting any better either, as I think more and more of my patients visits are often related to stress and anxiety rather than to strep throat or an ear infection.
This begs two questions: How did stress and anxiety become so prevalent and how do we change it?
If I knew the answers to that I could write a best seller!! But I do think I have some ideas. Some of the stress and anxiety that our children feel at an early age may have some roots in genetics. Anxiety seems to have a genetic predisposition but is it all inborn? Can you change some of a child's early reactions to situations by the way a parent reacts? I think that the answer is yes.
Very young children pick up on parental cues. For example, I had a young mother who recently came in and was worried because her 14 month old son was being pushed in play group and he would sometimes even fall down. She was tearful while she was talking about this and at the same time she was guarding his every move in the exam room. No falling in here!
I asked if the other mother's were appropriately talking to their toddlers who had done the pushing and she said they had, but it was just too much to bear. She was not going to go to play group (they might not invite her back) if he was going to get pushed. I could feel her anxiety flowing to her newly walking son.
Another patient recently brought her child in due to recurrent stomach aches. After getting a good history and talking about the tummy aches with the child directly, it seemed as if they might be due to stress and a
What has happened to nursery rhymes? Have they been lost in translation? I saw a cute 4 year old patient the other day who had fallen at pre-school and gotten a really nice bump on the middle of her forehead. Fortunately she was just fine, except for the goose egg. When I told her she was just like Humpty Dumpty she looked at me with big wide unknowing eyes and said, Who?
Her mother and I proceeded to tell her the nursery rhyme about Humpty's great fall. I think she was amazed that her mom and I knew the same rhyme! Her mother told me she had never thought about reading her children nursery rhymes, but at the same time she agreed that nursery rhymes needed to be passed along to each generation. I think she was on Amazon ordering a Mother Goose book while we were talking!
Seeing that I am Dr. Hubbard, I remember being teased for years about being a child who lived in a shoe. As I got out of college and medical school, I found that it was convenient to have the last name of Hubbard, so when I was being introduced as Dr. Hubbard or calling in a prescription, I would say Hubbard, like Old Mother. It has only been in the last 5 years or so that people would say, Who? Now I have to spell my last name.
I often talk about going back to the basics. I think nursery rhymes may fall into that category as well. These rhymes, although often nonsensical and whimsical, should not be forgotten. The Cow that Jumped Over the Moon, or Little Miss Muffet and her friend Jack Horner are too treasured to be forgotten. It is such fun to hear a young child recite a rhyme that they have heard over and over again, even if it takes years for them to understand their meaning.
I have saved my own childhood book of nursery rhymes that my parents read to me, and I read them to my own children, now I have to wait for grandchildren. I can't wait to enjoy reading them aloud to the next generation. Is this a hin
If there is one thing that everyone hates about going to the doctor's office it is the wait. Unfortunately, in pediatrics there are so many variables as to how the day may go, and too many times our patients end up having to wait. But one thing I have noticed is how parents handle the wait and how clever many a mother (or father) may be.
For many years our waiting rooms had toys and a very large fish tank for kids to enjoy while waiting. Of course, we have now succumbed to having TV in our waiting rooms. We also have a library area with books and puzzles. The fish tank is still there as well, but I think the TV gets the majority of eyes.
Once the patient gets to the exam room there may be another wait and this becomes more challenging for parents as the rooms are tiny and there is not a TV or fish tank. Many parents then use their cell phone or iPad to provide in room entertainment for their children.
Parents with older children will sometimes have their children bring their homework so they can get a head start on that. Adolescents often are either doing homework or updating their Facebook page or texting their friends and they barely look up when I walk in.
Here is a picture of one clever mom and her 1st grade son who managed to spend some quality waiting time in the exam room. She said that she always has spelling word flashcards in her purse (written on paper) and that she uses them to work on reading skills.
When I walked in the room there they sat with the cards all spread out on the counter. He was happily working on combining words to makes sentences! No