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Q.

"Is it safe for my 9 month old baby to be put under for surgery?"



A. Anesthesia is generally safe in experienced hands. A specially trained doctor, an anesthesiologist, will be in charge of administering medications, IV fluids, maintaining an airway, and monitoring your child’s heart rate, blood pressure and oxygen saturation throughout the surgery. If available, you could request a pediatric anesthesiologist or one with experience supervising infants. You may also schedule a pre-surgery meeting to speak with an anesthesiologist to ask questions you may have. Many hospitals have pre-op visits for children and family to tour the operating room and see the equipment used to make the whole experience less scary. When possible, parents are encouraged to accompany the child into the O.R. and stay until the child is “asleep” and again when the child is in the Recovery Room as the child awakens. Often your surgeon requests a “pre-op” visit with your pediatrician 1 – 2 weeks prior to the surgery date to be “cleared” of any acute illnesses & to make note of any chronic issues that may affect your child during the operation. Some important issues to note would be any past complications with anesthesia, both for the child or family members. Any problems the child may have with his/her heart, lungs, kidneys, liver, G-I tract or bleeding disorders should be recorded. If the child was born prematurely or has any anatomical anomalies with his/her tongue, chin or palate, or the child has any chronic conditions such as drug allergies, asthma, diabetes or G-E reflux, it should be recorded.



Q.

"Can scoliosis be caused by heavy backpacks or sports?"



A. The cause of Scoliosis is not known in 3 out of 4 cases. Muscular Dystrophy and Central Nervous System disorders can cause Scoliosis. Heavy backpacks and sports do not cause Scoliosis.



Q.

"I heard that the Flu Mist is a live vaccine. Does this mean my child can spread the virus for a few days after receiving the vaccine? Will she become ill from the mist?"



A. The nasal spray or mist form of influenza vaccine contains live but attenuated (weakened) virus. The transmission of vaccine viruses to close contacts has occurred but only rarely. Vaccine recipients do not need to be isolated nor do they need to stay home from school. For children, the vaccine may cause mild symptoms such as runny nose or cough, fever, headache and muscle aches, wheezing or abdominal pain with occasional vomiting and diarrhea, but not full blown influenza. Some children prefer the nasal spray immunization as no needles are involved. However, some restrictions do apply. The live influenza vaccine is approved for people between the ages of 2 through 49 years of age. Children 6 months to 2 years must receive the inactivated (shot) vaccine. Children less than 6 months old should not receive either influenza vaccine. Other children who should not receive the inactivated influenza vaccine shot include: Children less than five years of age with asthma or one of more episodes of wheezing within the past year. People with long-term health conditions such as heart, lung, kidney or liver diseases, metabolic diseases such as diabetes, or blood disorders. People with certain muscle or nerve disorders (example: seizures, cerebral palsy), that can lead to breathing or swallowing problems, weakened immune systems, children or long-term aspirin treatment, pregnant women, people with very stuffy noses at the time of the vaccination. Some people may not be able to get either live or inactivated influenza vaccine if they have a serious allergic reaction to eggs or if they are moderately or seriously ill at the time of the vaccination.



Q.

"Can I spoil my baby by picking her up when she cries? I’ve been told to let her “cry it out” if everything seems okay when she cries. She’s 4 months old."



A. I don’t believe you can “spoil” a 4-month old baby by picking her up when she cries. An infant has limited ability to make her needs and wants known. She may cry because she’s hungry, gassy or in pain, has a wet diaper, overtired or lonely, for example. Sometimes she may just be comforted by the warmth of your body or the sound of your heartbeat. A baby is totally dependent on her caregiver for all her wants and needs. It’s a huge responsibility but also the most rewarding job you’ll ever have. Enjoy her! Trust your instincts. Having said that, some babies need to fuss before falling asleep and waiting 5 minutes or so to see if she can settle herself would not be unreasonable. Also if a baby is crying for an extended period of time and is difficult to console, a visit to your pediatrician to rule out an ear infection or other problem may be warranted.



Q.

"My son is 7 weeks old. I can see his soft spot move when he breathes. Should I be concerned?"



A. Baby’s skull bones are not completely fused at birth. This allows for brain growth in the first two years of life. The area where the skull bones do not meet are called the fontanelles. The large diamond shaped soft spot on the top of the head in the front is the anterior fontanelle. The fontanelle may pulsate which is simply the pulsation of the brain blood vessels with each heartbeat. This pulsating action gives the soft spot its name “fontanelle”, meaning “little fountain”. So it is normal for the anterior fontanelle to pulsate with each heartbeat, and you don’t need to worry.



Q.

"My 14 month old son is no longer on formula. Should he be on iron?"



A. A child who does not have enough iron in their diet may develop anemia, a condition that limits the ability of blood to carry oxygen. Iron deficiency is very common at this age, and that is one reason why pediatricians routinely do a blood test at approximately 1 year of age. If your child eats a well-balanced diet of fruits, vegetables, proteins, whole grains (such as 100% whole wheat bread or whole grain pasta) and dairy (but not more than about 24 ounces of milk per day), then he will probably have a normal amount of iron in his body. Some foods that are rich in iron are red meats, eggs, ironfortified cereals, potatoes, prunes, raisins, and many dark green leafy vegetables. Foods containing vitamin C help the body to absorb iron, so eating a variety of foods at a meal can be helpful. The blood test will help your pediatrician to determine if your child needs an iron supplement. Iron supplements should not be given unless prescribed by your pediatrician.



Q.

"Is it safe for my 9 month old baby to be put under for surgery?"



A. Anesthesia is generally safe in experienced hands. A specially trained doctor, an anesthesiologist, will be in charge of administering medications, IV fluids, maintaining an airway, and monitoring your child’s heart rate, blood pressure and oxygen saturation throughout the surgery. If available, you could request a pediatric anesthesiologist or one with experience supervising infants. You may also schedule a pre-surgery meeting to speak with an anesthesiologist to ask questions you may have. Many hospitals have pre-op visits for children and family to tour the operating room and see the equipment used to make the whole experience less scary. When possible, parents are encouraged to accompany the child into the O.R. and stay until the child is “asleep” and again when the child is in the Recovery Room as the child awakens. Often your surgeon requests a “pre-op” visit with your pediatrician 1 – 2 weeks prior to the surgery date to be “cleared” of any acute illnesses & to make note of any chronic issues that may affect your child during the operation. Some important issues to note would be any past complications with anesthesia, both for the child or family members. Any problems the child may have with his/her heart, lungs, kidneys, liver, G-I tract or bleeding disorders should be recorded. If the child was born prematurely or has any anatomical anomalies with his/her tongue, chin or palate, or the child has any chronic conditions such as drug allergies, asthma, diabetes or G-E reflux, it should be recorded.



Q.

"My daughter has been on Zyrtec for many years. We adjust the dose to her symptoms. Are there any long term effects for Zyrtec?"



A. Zyrtec (Cetirizine) is a common allergy medication with mild short-term side effects. However, like other medications, long-term use of Zyrtec can be associated with side effects which can become health issues if not properly attended. Somnolence (drowsiness) is the most common adverse reaction associated with its long-term use and is mainly dose-related. It occurs in about 14% of patients over 12 years of age, and in 4% of children between 6 and 12 years of age. Fatigue and dry mouth are present in 6% of patients over 12 years old. Patients may complain of abdominal pain (4%) and headache (12 to 14%) which can occur regardless of dosage. Insomnia occurs in 9% and fatigue occurs in 4% of children over one year of age. Irritability and fussiness can be a problem in those under one year old. Mood changes have been reported. Most adverse reactions associated with Zyrtec are mild and self-limiting when the medication is stopped. There is no information to indicate that abuse or dependency occurs with Zyrtec.



Q.

"My sons seems to be developing ADD. He is a freshman in High School. He can’t seem to stay on task for very long. Is this an adjustment to High School or should I have him tested? Three of his teachers have contacted me with the same concerns."



A. The diagnosis of ADD occurs in the school aged population with a prevalence of from 5-10%. While the hyperactive child is often diagnosed fairly early in the school age population, many kids with primarily attention issues may present in later years, even high school. Usually however these patients have had some years of underachievement, frustration and attending unhappiness. An A student who consistently gets B’s and C’s may in fact have ADD. High school is not too late to bring up your concerns about your child. Lack of focusing in H.S. can be caused by many problems OTHER THAN ADD, such as anxiety, depression, home/social stress, drug use, and even some medical problems. This is definitely an issue which needs to be addressed by your physician, perhaps in tandem with a psychotherapist as well. Your child is facing at least 7 more years of vital schooling and it is never too late to deal with these issues.



Q.

"My daughter gets poison ivy a few times each year and, even with treatments, she still has an itchy rash for a few weeks. What are the best treatments for poison ivy?"



A. In approximately 70% of the population, poison ivy causes a delayed hypersensitivity reaction because of contact with the plant’s resin, “uroshiol.” Usually in one to three days after contact, the skin erupts with itchy, red papules and vesicles which can weep and crust. The fl uid from the vesicles is not contagious to others and will not make the rash spread. The rash persists for 1 – 3 weeks. The best treatment is avoiding contact. Show your child a photo in a book or on the internet of the classic plant with groupings of three slightly notched leaves so she can recognize it. Destroy with chemicals or physically remove it from your yard. Do not burn it as the oils can vaporize and be breathed in or still land on skin or in eyes. Pets can also bring it in on their fur. Wash hands with soap and water and change clothes when coming inside after potential exposure. She could also try a product called “Ivy Block” which is said to prevent the binding of the resin with the exposed skin. If she, unfortunately, still gets a reaction, calamine lotion, Aveeno oatmeal baths, cool compresses, and oral antihistamines may all help. Oral steroids for 2 – 3 weeks for severe cases or for when certain areas of the body are affected may also be prescribed by your doctor.



Q.

"My 8-year-old sometimes gets unexpected nosebleeds. Is this normal?"



A. Nosebleeds in children between 2 and 10 years of age are very common, especially in boys. Most children of that age will have at least 1 nosebleed. Children have nosebleeds for many reasons, and most of the time they are not serious. The most common cause of nosebleeds is minor trauma inside the nose, usually from nose picking. Other common causes include direct trauma to the nose, colds and allergies, low humidity or irritating fumes. Less common causes are anatomical problems inside the nose, abnormal growths and abnormal blood clotting. You should call your pediatrician if your child is experiencing frequent nosebleeds, if the bleeding is excessive, or if the bleeding is only coming from your child’s mouth.



Q.

"Can preventive measures be taken against SIDS?"



A. There are many things a parent can do to reduce their baby’s risk of SIDS (Sudden Infant Death Syndrome), the leading cause of death in infants age 1 month to 12 months in the United States. First of all, quit smoking if you plan to become pregnant. Smoking during pregnancy and after your child is born increases the risk of SIDS. Go to the doctor regularly during your pregancy for routine prenatal care. Once the baby is born, he or she should never share a bed. The safest place for the infant to sleep during the first months is in a crib with a firm mattress in the parent’s room. All soft objects and loose blankets should be kept out of the crib. Babies should always be put to sleep on their backs (never on the stomach or side). In order to avoid overheating, the baby should be lightly clothed, and not be near a radiator or direct sunshine. Also, using a pacifier once breastfeeding is fully established may reduce the risk of SIDS.



Q.

"My 13-year old daughter was diagnosed with a severe case of herpes infection a couple of years ago, with fever, and sores in the mouth and throat which lasted for several weeks. She occasionally gets cold sores in her lips now. Is there any thing we can do to prevent another severe outbreak?"



A. The major symptom of herpes simplex infection is the outbreak of painful blisters on a red base, often around the lips area, which rupture to form ulcerative scabs lasting for few days to few weeks. The first episode of herpes infection is usually worse, and can be accompanied by fever, headache, and tender, enlarged lymph nodes. Further outbreaks and recurrences tend to be milder, shorter in duration, and can be triggered by stress, a cold, fever, fatigue, sunburn and local trauma to the skin.
Herpes can be treated but not cured. Avoiding triggering factors such as sunburn and stress can help prevent additional outbreaks. Lysine supplements and zinc may be beneficial in preventing recurrences, but no unbiased clinical evidence exists to support this. Therapy to suppress herpes with the daily oral antiviral medication Acyclovir is considered for patients with very frequent (more than 2 outbreaks in 4 months) and/or particularly symptomatic recurrences. Daily oral Acyclovir therapy, however, may contribute to the risk of developing resistance to the drug, so re-evaluation is needed after one year to decide if longer suppressive therapy is needed.



Q.

"I am having problems potty training my 2 year old. Should I be concerned? What is a good age to begin?"



A. Most two year olds are still in diapers. In my experience the average age for a child’s first success at toileting is 27 months and being trained 2 1⁄2 years of age. However, 15% of healthy, normal three year olds are not completely potty trained. That group probably includes future rocket scientists and other successful people. Bowel control is usually achieved earlier than bladder control, except in the case of a child with chronic constipation. When a child demonstrates a body awareness with respect to toileting, and is willing to sit on the potty/toilet to void or stool, then he is ready to establish a behavioral pattern of normal toileting. It is not unusual for a child to show some initial interest at an early age, much to the great satisfaction of parents, only to relapse and become resistant to using the potty. At this time parents should simply back off. At three, kids are usually amenable to some reward system, although parents should not make too much of a big deal about what is a normal, expected function. The number one reason for a child to be resistant to efforts to potty train is chronic constipation with the association of pain and discomfort with a normal bodily function. This latter issue can be discussed with your child’s physician.



Q.

"I just brought my baby home from the hospital. When should she have her first visit with her pediatrician? What should we expect on the first visit?"



A. The first baby visit after your newborn is discharged from the hospital will be between 1 and 7 days. If your baby had a very short time in the hospital (less than two days), or if she has any symptoms such as poor feeding or jaundice (yellowness), the Pediatrician will want to see her fairly soon, in a day or two to check the weight, baby’s color and activity level. If your baby was discharged after 2 days or more in the hospital and is perfectly healthy and normal with no symptoms the Doctor may choose anytime for the first exam, most likely from 3 to 7 days after discharge. The exam may be just a quick weight, color and activity check but sometime within the first week or so the doctor will do a complete exam of your baby. Two exams were already done in the hospital. The exam will include using an instrument to check the eyes, a stethoscope to check heart and lungs, and a complete body exam. The doctor will also listen to your questions and have feeding or other advice for you. In any case if, during the first two months of life, your baby has a fever, or is cold and clammy, or becomes jaundiced (yellow), or has breathing difficulties, call the doctor right away. Be sure to have baby sleep flat on his or her back since this decreases the risk of SIDS (sudden infant death syndrome).



Q.

"We are expecting a son in a few months. What are the pros and cons of having him circumcised?"



A. Circumcision is the surgical removal of the foreskin from the penis. It appears to have some medical benefits, but also carries potential risks. Despite the benefits and risks, circumcision is neither essential nor detrimental to the boy’s health.
The American Academy of Pediatrics does not find sufficient evidence to medically recommend circumcision or argue against it. Circumcised infants are less likely to develop urinary tract infections, and have less penile problems such as irritation and inflammation. The benefit may even go beyond infancy to adulthood. Neonatal circumcision confers some protection from penile cancer. Circumcised males may also be at lower risk for sexually transmitted diseases, including HIV.
Complications of newborn circumcision occur in between 0.2% to 3% of cases. Of these, the most frequent are minor bleeding and local infection. Other less common complications include meatal narrowing, fistula formation, etc. There is also considerable evidence that newborns who are circumcised without local pain killer experience pain and psychological stress. It is therefore recommended that pain relief measures be used if their baby is to be circumcised.



Q.

"What is dysgraphia and how is a child tested for this disorder?"



A. Learning disorders affect 3 – 10% of school age children. Dysgraphia is a disorder of written expression. It may not be diagnosed until later grades when schoolwork demands larger amounts of well organized written work. Several subtypes of dysgraphia exist. A child with this disorder may have problems visualizing the shapes of letters or words. His handwriting may be poorly legible with inconsistent spacing between words. Another child may have grapho-motor memory problems with difficulty recalling letter and number forms rapidly and accurately. That child may spend a lot of time on individual letters and prefer printing to cursive writing. Another example would be a child who has trouble localizing his fingers and specific hand muscle groups while writing. He may need to keep his eyes very close to the paper and apply excessive pressure to his pencil. Learning difficulties benefit from a multidisciplinary evaluation with input from the primary pediatrician and a pediatric developmental specialist and/or a psycho-educational specialist to analyze the child’s academic skill set. A child also has a guaranteed right for a school evaluation as per U.S. Public Law 101-476 and IDEA (Individual with Disabilities Education Act). If a problem is diagnosed, under section 504 of the Rehabilitation Act of 1973, the child may qualify for educational accommodations. Examples of such accommodations could include using a word processor versus writing, or giving oral versus written reports. Occupational therapy may also be helpful.



Q.

"What is colic, and how can I be sure it is colic? What is the cause of colic? What can help?"



A. All healthy normal babies go through periods of seemingly endless crying for no apparent reason. The amount of time a baby spends each day fussing and crying usually peaks at about 2-3 weeks of age (often occurring in late afternoon or evening) and then improves. Colic is commonly described as excessive, intense, paroxysmal crying which happens between 2 weeks and 4 months of age. Babies typically stiffen, draw up their legs, seem gassy. Crying may results in a great deal of air-swallowing which may aggravate the problem. There are many proposed causes of colic: excessive intestinal gas, psychosocial stress during pregnancy, parental anxiety, feeding positions, exposure to cigarettes. In addition, intestinal causes have been blamed, including overfeeding, reflux, and milk protein allergy. The first step in treating a crying infant is to identify common causes of fussing such as hunger, wet diapers, being cold or uncomfortable. If there is no obvious cause, soothing music, eye contact, touching, rocking and playing may be effective. A nursing mother should also consider decreasing her intake of cows milk, evaluating foods she is eating as well as medications. Nicotine has potent adverse effects on breastfed, as well as all babies. Your doctor should be able to help you decide whether your fussy baby has an identifiable problem which needs to be addressed. Talk to your doctor before trying herbal products or other unproven and potentially harmful remedies. All babies go through seemingly endless intense fussy episodes, which are in fact generally harmless. Crying itself does no physical harm to your child. Try to remain calm yourself during these episodes, and search out helpful interactions with your infant that help him (or her) develop his own way of relaxation, or “self-calming”.



Q.

"My 8 yr. old daughter is always sleepy. She sleeps 14 or more hours a day. She is moody, has dry skin and nails, and complains of aches and pains often. What should we be asking our pediatrician to check?"



A. Often when a parent notes that their child “sleeps a lot” it is important to know just what that means: does the child stay up nights and is hard to awaken in the morning, naps frequently or is the child actually very fatigued, limited in stamina or strength, unable to carry on activities that would be normally expected. With your child, it is always important to take a good history and perform a thorough exam to help identify problems that may be present. Her symptoms might well suggest a hormonal problem such as low thyroid. The commonest nutritional deficiency at this age is iron deficiency. These two problems are easily diagnosed with laboratory tests. Although it is critical to identify and treat any medical problem present, it is always equally critical to keep in mind that emotional problems and psychiatric conditions might also present themselves with physical complaints. Your child’s complaints certainly demand a prompt medical evaluation.



Q.

"What is a safe age to use sunscreen on a baby? I often walk her outside in a carriage. Is it safe to use baby sunscreens on her face and any other exposed areas?"



A. The American Academy of Pediatrics recommends avoiding sun exposure for babies under 6 months. Finding a shady spot or using a canopy or umbrella on your carriage will help. It is also recommended that you dress her in lightweight long pants, a long-sleeved shirt, and a brimmed hat. If, however, adequate shade and clothing are not available, a minimal amount of sunscreen with AT LEAST 15 SPF (sun protective factor) can be applied to small areas, such as the infant’s face and back of the hands. Contact your pediatrician if your child develops a rash. Parents of young children older than 6 months should apply sunscreen to their child’s exposed skin at least 30 minutes prior to going outside, even on cloudy days. A sunscreen made for children is ideal, preferably waterproof. Sunscreen can be applied to exposed areas, including the face (especially the nose and cheeks), ears, hands, feet, shoulders, etc. It should be applied carefully around the eyes, avoiding the eyelids. Remember to reapply after 2 hours, or after swimming or sweating. Clothing should be made of tightly woven fabric. A hat with at least a 3 inch bill should be worn forward. Sunglasses will be helpful to protect your child’s eyes. Limiting sun exposure during the hours of peak intensity, 10 a.m. to 4 p.m., is also important to keep in mind.



Q.

"My grandson was born with a cleft in his upper palate. What causes this & what should be done, and what age is best to correct this?"



A. The palate, the roof of the mouth, is formed early in the developing unborn baby. Sometimes the components do not fully meet together causing a space, or cleft. Cleft palate is one of the more common birth defects, occurring in about 1 in every 1000 births. It is sometimes part of a “syndrome”, a collection of several birth defects, but often is the only problem present. Cleft palate is caused by a combination of inherited and environmental factors. If a child has a relative with cleft palate, the chance of being born with cleft palate is increased. Other factors may include a substance that the mother was taking early in the pregnancy, such as alcohol or certain medications. A mother who has an infection with toxoplasmosis or rubella in the first trimester also has an increased risk of having a baby with cleft palate. A baby with cleft palate will require special attention when born, specifically with breathing and feeding. The doctors, nurses and therapists will help the parents use special bottles and other tools to make sure the baby is getting adequate nutrition. Hearing, ear-nose-throat (ENT), plastic surgery and orthodontic evaluations should be done in the first few months of life. These children are at greater risk for ear infections and usually require tubes placed in their ear drums by an ENT. The cleft palate is usually repaired at around 12 months of life. Between 2 to 4 years old these children usually require a speech therapy evaluation. With treatment including all of the above professionals, a child with cleft palate should do very well.



Q.

"My son developed a disorder called ITP-whose symptoms mimic those of Leukemia. Bruises appeared all over his limbs and his platelet count dropped very low. What is the cause of ITP and is there anything that can prevent it from recurring?"



A. Of those children who develop acute idiopathic thrombocytopenia purpura (ITP), 50 – 65% do so one to four weeks after a viral illness. The virus causes their bodies to develop an autoimmune response which results in the spleen destroying their own platelets. The platelet functions in the clotting process of the body. The child (often 1 – 4 years of age), presents with the sudden onset of generalized petechiae and purpura which resemble small and large bruises. In some cases, a child may have bleeding gums, nosebleeds, blood in stool, or rarely (less than 1%), an intracranial bleed into the brain. The good news is that 70 – 80% of children will spontaneously recover within 6 months without treatment. 20% develop chronic ITP. Some advocate treating patients to keep platelet counts above 20,000 (normal value 150,000). The treatments available: Intravenous immunoglobulin, intravenous Anti- D infusions, high dose steroids, or splenectomy all involve potential complications and possible need for re-treatments. There are no known remedies to prevent the recurrence of ITP. Decreased platelet counts can have many other causes so any child with these symptoms should be evaluated immediately by the doctor.



Q.

"What is best for toddlers, whole milk or 2%?"



A. Between 1 and 2 years I recommend whole milk. Toddlers use the fats for proper nervous system development. Specifically don’t use skim under the age of 2 years.



Q.

"My teen needs a sports physical but I just brought him to his pediatrician for a physical a few months ago?"



A. A physical is good for 12 months. Ask the staff at your Doctor’s office to have the doctor fill out the sports form.



Q.

"Can children get shingles? What are the symptoms?"



A. Unfortunately children can get shingles. The symptoms are the same as in an adult. Itching and/or pain and a small blistered rash in an isolated spot on one side of the body.



Q.

"My 3 year, 9 month old twins have stopped napping. They seem very tired now and are having night terrors. How much sleep do they need?"



A. Three year olds need 10-12 hours in a 24 hour period. Three year olds still could use naps. Parents or other caregivers need to find a quiet time to lay down with the children. A nap would do them good also. Night terrors are a common and normal thing.


This general Information is not intended to provide individual advice. Please make an appointment with a physician to discuss you particular situation and needs.
 

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