Sunday, September 30, 2007

TV Under the Age of Two

Dr. Cason:

I know the AAP recommends no screen/TV time before the age of 2. My question is, if the AAP recommends that, how come there are so many videos for children under 2? (Baby Einstein) I don't allow my daughter to watch a video or TV (Sesame Street) unless I'm desperate to have her entertained while I'm getting ready to leave in the morning. I feel guilty and I feel that I'm somehow ruining my child!

Anonymous

Dear Anonymous,

Don’t feel too bad, a lot of parents are not only allowing their children to watch TV but actually encouraging it. TV is the babysitter that gives parents a break and lets them get dinner made or a shower completed. I admit it. I’ve done it at times. In fact the picture is of my oldest when she was only 18 months old! I too have been worried about what TV does to kids so I did some research and this is what I found.

Gradually since the introduction of television there has been debate whether TV is harmful to our kids. In 1999 the American Academy of Pediatrics - AAP- released a policy statement recommending no television programs for children under the age of two. They stated that “research on early brain development shows that babies and toddlers have a critical need for direct interactions with parents and other significant care givers for healthy brain growth and the development of appropriate social, emotional, and cognitive skills.”

Recommendations are one thing but reality is another. The reality is that kids all over America are still watching TV… A lot of TV. Most people aren’t aware of the AAP’s recommendation. The Kaiser Family Foundation in a 2003 study researched America’s media habits. They found that 49% of parents thought educational videos were "very important" in the intellectual development of children and only 6% of parents were aware of the AAP’s recommendation of no TV under two years of age. When the study was repeated in 2005, there was a slight improvement in perception. Now only 38% thought that videos were very helpful. But despite this, they still found that 61% of children under the age of two, watch TV, a video, or a DVD for 1 hr and 19 minutes per day.

Until recently we didn’t know a lot about TV and its effect on our children under the age of two. Recent studies found that it might not be all that harmful for a child over the age of two. In fact a study in the November 2006 issue of Pediatrics, A Systematic Review for the Effects of Television Viewing by Infants and Preschoolers found that educational TV may have a positive effects on toddlers and preschoolers. Researchers conducted a literature search and found 376 articles dealing with children and television. Of these, 12 met the criteria of being a controlled trial. They were conducted between 1973 and 2000 and focused specifically on television content viewed by children under age 6 and its impact on learning, racial preference, aggression, pro-social behavior, self-regulation and imagination. It was concluded that there is evidence to suggest that educational television programs, such as Sesame Street and Mister Rogers, can help in the acquisition of general knowledge plus improve overall cognitive knowledge among young children. It can also improve their imaginative play and racial attitudes. However “there is evidence that television viewing can increase a child's display of aggression. Children who watch aggressive programs and cartoons with lots of violence can be more likely to engage in aggressive behavior than those that do not.”

None of these previous studies looked at infant television viewing or examined the content of videos designed for children. Not until recently that is. A new study was published in the Journal of Pediatrics titled Associations between Media Viewing and Language Development in Children Under Age 2 Years It appears it is the very young baby who is affected most by these videos. Researchers found that for every hour per day spent watching baby DVDs and videos, infants 8-16 months understood an average of six to eight fewer words than infants who did not watch them. For toddlers 17-24 months of age, Baby DVDs and videos had no positive or negative effect on the vocabularies.

Now that recent studies show that TV under the age of 16 month may be linked to impaired language development, the question remains: How does this affect the “Baby Media” market. Are they responsible for informing their consumers of these findings? The Campaign for a Commercial free Childhood thinks so. I’ll talk more about that tomorrow.

Sheila Cason, MD

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Saturday, September 29, 2007

Hello Kitty

When I was milling around at the Japanese art exhibit the other day and saw a little Hello Kitty tucked in the corner I had to smile. Somehow this small kitten without a mouth - which by the way, is because she speaks from her heart - is everywhere in my home. I never expected to see a toy from my childhood be more popular now than it was when I was little.

As a young girl I wasn’t a big Hello Kitty fan. It’s not that I didn’t like her; she just wasn’t a toy I played with. Because of my unfamiliarity with her I have purposely not decorated their lives with this cute kitten. But once I saw that they adored her, I had to allow them to collect her. Why? Because I have really tried to let my children have their own childhood and not make them repeat mine. I know you know what I mean. When you have children, it’s like you get a “do over” and it’s tempting to fill their childhood with everything you always wanted from your childhood. The problem is they didn’t get the memo and don’t know the rules. They want what you don’t and don’t want what you do! It isn’t easy to let go of that dream. But I try. I figure someone has to be the adult.

So I’m proud to say I have come to terms with my children’s fascination with Hello Kitty. In fact just the other day I bought a Hello Kitty water bottle for my daughter to take to preschool. Because I love my children, that little kitten is growing on me!

Sheila Cason, MD

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Friday, September 28, 2007

Origami for Children


Yesterday’s toy exhibit had such a great display of origami that I was inspired to investigate more about this ancient Japanese art. Origami uses a small number of different folds, but they can be combined in a variety of ways to make intricate designs. In general, these designs begin with a square sheet of paper whose sides may be different colors. There are a wide variety of books on origami; many are designed specifically with children in mind.

Friedrich Froebel, the German founder of the Kindergarten Movement, introduced paper folding into kindergarten as one of the childrens’ recreations. Though he wasn’t aware of the Japanese word “origami” he was definitely on to something. Jane Healy in her book: Endangered Minds: Why Children Don’t Think and What We Can Do About It points out that performing crafts such as origami helps kids to develop their mind. Origami uses both the left hemisphere - responsible for logical thinking, number skills, reading, speech, and scientific ability, and the right hemisphere – responsible for insight, three-dimensional perception, imagination, and musical and art abilities. It is thought that because origami uses both the right - creative, and left - logic hemispheres, it helps to develop the pathway between the two. When this pathway between the two hemispheres is used frequently then children can have a richer imagination and manipulate ideas better.

I found a website Activity Village.co.uk that has easy fun origami patterns for kids. My kids have been playing with their creations all afternoon!

Sheila Cason, MD

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Thursday, September 27, 2007

Japanese Toy Exhibit

While here in Guam, we are lucky to glimpse into some of the local culture as well as nearby cultures such as Japan. We spent today viewing the traveling exhibition, “Japanese Toys: Traditional and Contemporary” exhibit at Guam’s Isla Center for the Arts. The Japan Foundation collaborates with overseas museums on a wide range of exhibitions from traditional to contemporary arts. This exhibit introduces the “multiplicity and richness of Japanese toys, which reflect the everyday lives, the customs, and the aspirations of the Japanese people.”

It was a small but well put together showing of the variety of toys ranging from traditional toys to pre-modern toys, bamboo and wooden toys, as well as modern toys. The toys were beautiful and intricate. I particularly liked the “Battledores”. The top photo is an example of a battledore which I found to be striking.
Battledores are wooden paddles that were used for games of battledore and shuttlecock, which were traditionally played by girls. It first started being played as early as the fifteenth century and was later popularized in the latter half of the seventeenth century. Birds, flowers, and the faces of popular Kabuki actors were portrayed on one or both sides of the battledores. A piece of art by itself, elaborately decorated battledores are also made for display.

The Kokeshi were also simply beautiful. The wooden dolls were shaped using a lathe. The round head is attached to a limbless, cylindrical body, with a face painted on the head and floral and other designs on the body. They were originally folk dolls peculiar to the Tohuku region. They are said to have originated with dolls made from woodworkers living in the mountains for their small daughters.

I have other examples of the Japanese toys in my photostream. Can you see the little Hello Kitty and the origami? More about them later…

Sheila Cason, MD

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Wednesday, September 26, 2007

Preschool

My “little” middle girl is a “big” girl today as she headed off to her first day of preschool. As I get ready to return to work, I have been looking into options for her care and sure enough a space was available at the preschool so I grabbed it! I felt guilty; she had all of one day to prepare herself. It turns out that one day was too long.

She cried and wailed, “I want to go NOW!”

“Hold on”, I said. “We’ll go tomorrow.”

“Can I have a backpack and bring lunch?”

“Yes sweetie and your blanket to have at nap time”

She sniffled a while longer and then seemed satisfied that I was telling the truth.

When we woke up this morning, she was all smiles telling her sister proudly that she was off to school. She loaded up an impossibly large backpack. I couldn’t convince her to take the smaller one. And she was out the door! It went amazingly well. She waited patiently at the front desk for me to finish her paperwork. As she watched the fish in the fish tank, she kept asking when she could go see her friends. Once she got in the classroom, she was a little hesitant. You can see in the picture she’s looking at the door. But soon she was posing with her “buddy” and asking the teacher when she could paint. I gave her a “thumbs up” and left.

Sending her to preschool was so much easier than I had expected. She’s a little more “sensitive” than her siblings but it helps that we’ve both seen her sister do well. I expect there will be some tweaking and growing pains. Hopefully she’ll be able to take a nap there. I cannot have two sleep deprived girls! I’m off soon to go pick her up. I hope it went well!

Scholastic.com has some great tips on how to ease separation anxiety.

Sheila Cason, MD

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Tuesday, September 25, 2007

Cranky Days

Boy has life changed since kindergarten started. I expected the tears - both mine and hers. I expected the long days - again, both mine and hers. What I didn’t expect was to wait all day for her company and then see it dissolve into a screaming match once she got home.

It starts insidiously enough. First her exasperation is amusing. We’re still honeymooning from her long day away from home, and I’m just glad to see her. Then she decompensates abruptly into screaming, hitting and generally just being an entirely different child. By the time bedtime hits my patience has long been worn away.

I suspect her behavior may be linked to sleep deprivation. For the first time she’s having long days without a nap. I realized her behavior may be fatigue related when one day, in the middle of screaming, she started hysterically laughing and finally out escaped a yawn. Now that’s tired! I haven’t quite figured out what to do. I’ve tried one on one time and making sure she gets her naps when she’s home. She also goes to bed early on school nights. It seems to be helping a little.
Suggestions anyone?

Sheila Cason, MD

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Monday, September 24, 2007

French Bread

I’ve been making french bread now that I have a little more time on my hands. Twice a week, I’m in the kitchen mixing and kneading by hand. I’ve always loved my bread machine, but there something really authentic about these loaves! Not only does it taste great it has the added benefit of having no artificial ingredients or preservatives. It has nothing but flour, water, salt, and yeast. I love it when it’s still warm from the oven.

French Bread (Adapted from Better Home and Gardens: New Cook Book- 1996)

  • 5 ½ - 6 cups all- purpose flour

  • 2 packages of active dry yeast

  • 1 ½ teaspoons salt

  • 2 cups warm water (120 degrees to 130 degrees)

  • Cornmeal

  • 1 slightly beaten egg white

  • 1 tablespoon water



  1. In a large mixing bowl stir together 2 cups of the flour, the yeast, and salt. Add the warm water to the dry mixture. Beat with an electric mixer on low to medium speed for 30 seconds, scraping the sides of the bowl constantly. Beat on high speed for 3 minutes. Using a wooden spoon, stir in as much of the remaining flour as you can.

  2. Turn the dough out onto a lightly floured surface. Knead in enough remaining flour to make a stiff dough that is smooth and elastic. (8-10 minutes total) Shape the dough into a ball. Place dough in a lightly greased bowl, turning once to grease surface of the dough. Cover and let rise in a warm place till double in size. (about 1 hour).

  3. Punch dough down. Turn dough out onto a lightly floured surface. Divide the dough in half. Cover and let rest for 10 minutes. Meanwhile, lightly grease a baking sheet. Sprinkle with cornmeal.

  4. Roll each portion of dough into a 15 x 10 inch rectangle. Roll up, jelly-roll style, starting from the long side; seal well. Pinch ends and pull slightly to taper. Place seam down on prepared baking sheet. In a small mixing bowl stir together egg white and water. Brush some of the egg white mixture over the loaves. Cover and let rise till nearly double in size (for 35-45 minutes). Using a sharp knife, make 3 or 4 diagonal cuts about ¼ inch deep across the top of each loaf.

  5. Bake in a 375 degree oven for 20 minutes. Brush again with some of the egg white mixture. Continue baking for 15-20 minutes more or till bread sounds hollow when you tap the top with your fingers. Immediately remove bread from baking sheet. Cool on wire racks.


Sheila Cason, MD

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Sunday, September 23, 2007

Jack Johnson

Yesterday’s activities wiped us out so much that today we’re spending the day indoors. It helps that it’s raining, so I don’t feel all that guilty. The baby’s taking an early nap. So the rest of us are snuggled on the couch to watch the movie: Curious George. For the moment no one is screaming and everyone is at peace, including myself.

I love the movie Curious George because of the music. Jack Johnson does the soundtrack. His mellow sweet tunes make it enjoyable for just about everyone. I’m sure I’m like most people in that I crave peaceful moments. One day I woke up and my mother’s voice had replaced my own.

I actually found myself saying, “Will you please turn that noise down!”

Jack Johnson provides a welcome relief to the mind numbing screaming that can often accompany children’s shows. Here is a bit from the chorus of Upside Down where he eloquently captures the innocence and wonderment of childhood.

I want to turn the whole thing upside down
I'll find the things they say
just can't be found
I'll share this love I find with everyone
We'll sing
and dance to Mother Nature's songs
I don't want this feeling to go away

Sheila Cason, MD

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Saturday, September 22, 2007

Birthday Party

Have you noticed that children’s birthday parties have a tendency to get out of hand? When my oldest turned four, we had a big party. I spent weeks planning, days cooking and hours cleaning. Hundreds of dollars went in choosing the perfect food and decorations.
I don’t think many people, including my daughter, remember the flavor of the cake or the color of the streamers. I was stressed ¾ of the time, and it was only when I was left with a crowd of close friends that I finally relaxed. I vowed I wouldn’t do it again.

Today made me rethink birthday parties. I’ve never really believed that a child’s birthday party could be easy, but I saw it happen! We celebrated my friends’ little boy turning two at Ypao Beach, a local beautiful spot here in Guam. The guests were relaxed and playful- collecting shells and making sand castles. The decorations were stunning- lots of beach and beautiful water. The food was simple and yummy - cool drinks and pizza. We laughed and giggled, kids and grownups alike.

A birthday party is about helping a family celebrate their child growing up. It doesn’t have to be elaborate but it helps to be genuine. Real friends will thank you for the opportunity to gather and share in your celebration. So thank you my friend. And happy birthday little man. We had a great time.

Sheila Cason, MD

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Friday, September 21, 2007

Fear in Toddlers

Oh it was pitiful. Just two days ago I was putting my kids to bed and my baby – 16 months old- started to point at the bookshelf and say:
"Duuu! Duuu! Duuu!." His little brow was all crinkled up.
Something was definitely wrong. So I peered around at the book case, and there innocently perched was the “I’m a little giraffe book” by Tim Weare. Now I love this book. All my children have loved it too including the baby a while ago. But the way it was sitting in the bookshelf, the little giraffe face must have looked a little menacing.

“This?” I asked.

I slowly picked it up and put my index finger in the plastic giraffe head and wiggled it.

“See, it’s okay.”

His eyes widened, and he turned and ran in the other direction.

I couldn’t help but laugh a little - not in front of him of course. Poor baby! I’d never seen him like that! He’s such a rough and tumble boy. And it is such a cute giraffe. We can never fully predict what it is that will be scary to a child. And we can’t rush them to get over it. We can just be there with them and provide some security. Soon he forgot about it and was playing with another book. Later my husband tried to show it to him again. Nope- that little giraffe was still scary. He ran off.

Today his sister was playing with the book and he watched her quietly… and I watched them even more quietly. Soon he picked the book up and tried to explore the giraffe head with his finger. I guess his curiosity was piqued, and it was not so scary anymore.
For more information regarding toddlers and fear, Parents.com has a great article!

Sheila Cason, MD

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Thursday, September 20, 2007

Bathtub Safety

My baby is crazy for the bathtub! He giggles, laughs and generally has a rollicking good time. If there is any indication that it’s bath time, he turns and without looking back, hightails it in the direction of the tub. The other day I let him play for a while because it’s a good way for him to get comfortable in the water. But just because I want him to be comfortable doesn’t mean I let him take risks he can’t handle. I pulled up a stool and didn’t leave his side for a second. Sure enough 10 minutes into bath time, while he was slipping and sliding around, he fell back nearly submerging himself. I caught him just as he was about to go under.

As you know, from my January post: Drowning Prevention, I’m a big advocate for water safety. USA Safe Kids.org reports that drowning is the leading cause of accidental injury-related deaths among children ages 1 -4. 10% of all childhood drownings occur in bathtubs. Female children have a bathtub drowning rate of twice that of male children. My own daughter loves to put her face in the water and pretend she’s sleeping. Yeah I know. It freaks me out too!

I can’t emphasize this enough: Don’t leave your child in a bathtub unattended! Drownings happen fast and the consequences are devastating. Even I’ve been tempted to step away for a second to get something. It’s better to just pull them out and let them drip all over the place. That’s a mess you can clean up.

Sheila Cason, MD

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Wednesday, September 19, 2007

Chores and Children

Chores and children are like peas and carrots. They are a natural, inevitable pairing and one I like to encourage! I admit that when it’s chore day, it’s tempting just to do it all myself while the kids are watching a movie or down for their naps. But I’m a firm believer that kids learn when they're young. If you start out when they’re little then they don’t see at as “chores”. They just get to help out Mommy and what could be better than that?

The struggle is to slow down and allow them to help! They ask all the time. My rule is if it’s dangerous then it’s a firm no but most tasks can be modified for the child and their age. Know that it won’t be perfect if your kids do it. But who cares about perfect. The worst that could happen is that you’d have to touch it up when they’re done. Quality time doesn’t just mean that you’re snuggling on the couch reading Angelina Ballerina. It’s about spending time with your kids. No matter what you are doing. Even taking out the trash can be a bonding moment.

For chore ideas check out Wondertime’s The Right Chore for the Right Age

Sheila Cason, MD

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Tuesday, September 18, 2007

Thrush

Sometimes it’s the little pediatric problems that are the most distressing for parents. Take, for example thrush. I’ve had many a parent tearing their hair out because of this unwelcome organism. Seen with many babies this common condition is caused by Candida albicans. Candida is found typically in the mouth and on the skin and other places in all people. Normal bacteria that are present and a healthy immune system keep Candida in check. People who are immunocompromised or infants whose immune systems are not fully matured yet can commonly get thrush. Thrush looks like small white plaque like material on the inner mouth and lips. Some children can be very fussy while others appear to have minimal discomfort.

Treatment is usually saved for those babies who are uncomfortable or who have a more extensive case. Traditionally the topical application of Nystatin suspension has been used to treat thrush. You can drop the medicine in the baby’s mouth or apply it directly to the lesions with a cotton tip applicator. But be careful not to contaminate the bottle of medicine by touching the medicine dropper to your baby’s mouth and then replacing the dropper in the bottle. Sterilize the nipples of baby bottles and pacifiers. Nursing mothers will need to treat their nipples as well.

Gentian Violet is another alternative to therapy besides Nystatin. No prescription is necessary and can often be found in drugstores. Like the name suggests it’s purple and messy! Using daily for three to four days is typical. If your baby has not responded after 3-4 days or they have sores that develop, discontinue use and call your pediatrician. For thrush that has not responded to Nystatin, there is another class of drugs – the Azoles- that can be used. However this has been shown to cause liver problems in some people and should only be used when prescribed by your pediatrician.
There is a popular theory that says that otherwise healthy people can get systemic candidiasis. This “Candida Hypersensitivity” is then claimed to be one of the causes of “Idiopathic Environmental Intolerances” of which the symptoms are a long list of general complaints including fatigue, depression and joint pain. It is reported that a “Candida diet” along with certain vitamins and supplements can help eliminate the body of excessive yeast and restore balance. There is no scientific evidence that this is necessary. The American Academy of Allergy, Asthma, and Immunology (AAAAI) has evaluated “Candida Hypersensitivity” and reports that “there is no scientific proof that Candida albicans causes such a condition.” Admittedly the information available for and against systemic yeast infections is massive and confusing. What we do know is that the rare person that does succumb to a systemic yeast infection is also immunocompromised and extremely ill. They are being cared for in an intensive care unit and not walking around with vague complaints. Stephen Barrett, M.D. of Quackwatch.org has done a great job of compiling information regarding this theory.

Talk with your pediatrician before starting any therapy particularly if your child’s thrush is recurrent or severe. Severe thrush along with other clinical signs can be an indicator that there is an underlying immune deficiency. Remember that infant oral thrush is common. Just because you see a little thrush in the mouth does not mean that treatment is necessary.

Sheila Cason, MD

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Monday, September 17, 2007

Choices

Well it looks like my Guam pediatric license has come through. I’ll be soon working again and I’m excited and nervous. Pediatrics is a love of mine. It peppers my conversation. It colors my world. But being a mom is my greatest love. These last 3 months have been a gift. I have discovered what being a full time stay at home mom is like.
For three months my children have been my center. For the first time I wasn’t afraid of fevers, missed buses or traffic congestion. I knew I’d be there to handle it all. I knew I didn’t have to arrange my schedule to accommodate theirs. Their schedule was my schedule. My patience and time management were challenged. I was stressed but it was different. I went weeks without time to myself. Some days were bliss. I’d catch the wave of motherhood and ride it! Smooth and fun, it felt great! Then other days were pure pandemonium. I found myself trapped under that exhausting wave of cleaning, cooking and refereeing fights.

I have realized that there is no perfect answer to whether you should stay at home or work part time or full time. There is no “best” way of doing it. It’s just what works for you. I read recently that peace comes from owning your choice. We all have choices. I chose to be a pediatrician. I chose to get married and to have three children. I chose to stay at home and soon I will choose to return to work part time. It’s freeing and empowering to know that I wanted this.

Sheila Cason, MD

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Sunday, September 16, 2007

Chocolate Mayo Cake

This chocolate mayo cake recipe is perfect for kids because it’s safe to let them indulge in the “quintessential childhood activity” of licking the bowl. The mayonnaise has no raw eggs therefore the risk of acquiring salmonella is removed. It’s easy enough for the kids to make with you. Our family recipe is below.

Chocolate Mayo Cake
  • 2 cups all purpose flour
  • 1 cup sugar
  • 2 teaspoons baking soda
  • 5 tablespoons unsweetened cocoa
  • 2 cups mayonnaise
  • 1 cup ice cold water
  • 1 teaspoon vanilla

Mix all dry ingredients and add remaining ingredients. Beat at medium speed until mixed. Pour into lightly greased and floured tin pans. Bake at 350 degrees for 25-30 minutes or until done. I frost mine with the chocolate frosting recipe found on the unsweetened cocoa can. Delicious!

Sheila Cason, MD

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Saturday, September 15, 2007

Salmonella

Ahh… What a great day! My kids baked a birthday cake for their daddy! There’s nothing better than seeing kids amped up about a chocolate cake. I usually don’t allow them to lick the bowl because raw eggs can harbor salmonella. But my chocolate mayo cake recipe is safe because it’s made with mayonnaise not raw eggs.

Salmonella refers to a group of bacteria that can cause a diarrheal illness. The serotypes Typhimurium and Enteritidis are the most common in the United States and has been known to cause illness for over 100 years. When people become sick with the bacteria it is known as Salmonellosis. Most people recover without antibiotics but some people can go on to have other complications. According to the CDC: Centers for Disease Control and Prevention:

“Most types of Salmonella live in the intestinal tracts of animals and birds and are transmitted to humans by contaminated foods of animal origin.”

In the 1970’s strict procedures for cleaning and inspecting eggs were implemented and made salmonellosis caused by external fecal contamination of egg shells extremely rare. However, there is a current epidemic of Salmonella infection that is due to intact and disinfected grade A eggs. The organism Salmonella enteritidis silently infects the ovaries of healthy appearing hens and contaminates the eggs before the shells are formed. Try to avoid eating raw eggs. This is especially important for high risk populations such as the elderly, infants and the immunocompromised. More information regarding Salmonella may be found from the CDC website.

All three of my kids really enjoyed making the cake. You can see how excited the baby is to lick the bowl! Tomorrow I’ll give you the recipe!

Sheila Cason, MD

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Friday, September 14, 2007

Feral cats

My three year almost killed a kitten recently because of her childhood exuberance! It’s hot here in Guam so we spend most weekends slathered with sunscreen and playing at the pool’s slide. Recently I found the kids giggling and squealing over a tiny feral cat that was hanging out by the steps to the slide.

He was so cute and if I wasn’t a pediatrician I might have loved over that kitten myself! But I am a pediatrician and I couldn’t help but think what disease that little guy was carrying. The local animal shelter works with the community to find homes for these cats. But despite this, they are still abundant. In fact, as I am writing this a feral cat just walked by my window. Children need to be watched around feral cats they can carry diseases. The CDC: Centers for Disease Control and Prevention report that “Infants and children less than 5 years old are more likely than most people to get diseases from animals. This is because young children often touch surfaces that may be contaminated with animal feces (stool), and young children like to put their hands in their mouths. Young children are less likely than others to wash their hands well.” The most common disease that can be transmitted are: Cat Scratch Fever , the Plague and Toxoplamosis.

My girls resisted the kitten as long as they could. They crouched and said hello every time they walked up the steps. For most of the day, I caught little children careening down the slide and sent them on their way. But late in the day, a little brown furball came flying down that slide too. I scooped him up as he came by me and wouldn’t you know it my 3 year old, giggly and blissful, came flying down right after it. Yep! She had picked up that kitten and sent it off for a ride! Can you believe that? Just goes to remind you that kids and animals need to be watched, not only for their own safety, but for the animals!

Sheila Cason, MD

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Thursday, September 13, 2007

What’s Your Magic Number?

This past weekend I was awakened by my oldest at 5:30 am. She was clutching her dollys and asking to join us in slumber. I usually resist all requests – unlike their father who, most of the time, without hesitation will just scoop them up. He says he doesn’t realize it and, by the way, aren’t they just the sweetest. Yes of course they are! But I can’t sleep squished in our teeny now made even teenier queen sized bed! Funny, despite this, my children still always come to me. Probably because the other part of the time daddy is snoring through their request. This time I was tired -meaning lazy- and wanting to grab a few more minutes before the other two were up. I grunted and gave permission to come aboard.

She wasted no time. Immediately she scrambled up getting a little stuck on the mattress because of the excessive amounts of STUFF in her hands. Now, my child is a packrat, just like her mommy. I normally need to ask, cajole and then as a last resort yell at her not to bring every nick picky thing with her to the swimming pool, shopping trip or play date. So this early sleepy morning I was winding up to give her some must needed feedback. I also uncharacteristically kept quiet. She grabbed all three of “her children” and snuggled deep in the covers, closing her eyes. I rolled over and thought to myself. I know what you mean baby girl; three is just perfect for me too!

Sheila Cason, MD

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Wednesday, September 12, 2007

Rainy Days

It’s been raining most of the day here on Guam. It’s common during this time of year as July to November is Guam’s rainy season. I love it. There something about the rain that’s so peaceful. Life here has a slower pace anyway but things seem even more relaxed when it rains. People just aren’t in a hurry. It isn’t unusual to see a crowd of people waiting outside the stores for the rain to pass.

According to the Guam Visitors Bureau The mean annual rainfall varies from about 80 inches in the central and coastal lowlands up to 110 inches on the uplands in southern Guam. Throughout the year the easterly trade winds, usually between 4 and 12 miles per hour (mph), are present. Most often the winds are less than 24 mph, except during major tropical storms or typhoons, small scale storms, or squalls, that can occur at any time and with little notice. Typhoons can occur any month of the year but they are most common July through September.

The rain is warm and lovely, perfect to play in! The photo is of my three year old trying to catch a frog.

Sheila Cason, MD

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Tuesday, September 11, 2007

Suggested Websites

There are a lot of great websites that I visit. Some are strictly for info regarding patients but others are for fun. I had a hard time with this list because though I surf around occasionally, I spend a lot of my free time writing for my column. In fact it was difficult writing this column because as I found myself researching the sites, I’d get whisked away in some parallel life.

Soon I’d be laughing to Catherine Newman’s blog or analyzing the American Academy of Pediatric current updates and all the while time clicks by. I then start frantically glancing at my screen and then the clock. The screen the clock…Anxiety starts to creep up because – and I know you can relate- naptime will soon be over. Here’s what I like to peruse. And when I’m not cleaning, writing and perusing, I take in the loveliness of Guam. The photo is the view from Asan Bay Overlook taken yesterday when I was out for a drive.



For General Pediatric and Medical Info:



For Household Management and Cooking:

  • http://flylady.net/ This site is one of my favorites! I could spend all day just reading the testimonials. If you need to get organized, plan your time or just need to have a laugh go here! Warning if you’d rather read about organization than actually do it because you could get caught up with this site. But they factor that in. They tell you to stop and go work for 15 minutes and then come back!


Parenting Blogs:



Parenting Websites:

  • Babycenter.com http://www.babycenter.com/ I looked on this nearly every day when I was pregnant with all three of my kids. They have a great section where you can see week by week what your baby should look like in utero. Because of this, I knew when my baby was growing her fingernails and how big she was – as compared to fruit ! J I loved it. Every night I’d come home and tell my husband we have a plum now. Oh! Now she’s an avocado!

  • Parents http://parents.com/parents I especially like the community section. Lots of real moms with interesting ideas and great help.

  • Wondertime http://wondertime.go.com/ This site has a wonderful array of info, games and teaching tips for young children!!


If you have any sites that you can’t live without send me a comment!!

Sheila Cason, MD

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Monday, September 10, 2007

Constipation in Children: Part Three - 10 Tips for Prevention and Treatment

The following is a guideline to handle constipation in kids. Remember to talk with your pediatrician. Believe me they are familiar with constipation and want to see your child feel better.

1. Drink plenty of water: If you drink a lot of water your colon doesn’t need to take it from your food. If you have a hard time getting your child to drink then have them eat fruit. Fruits have a lot of water naturally.

2. Increase fiber: This means whole grains, fruits, and vegetables. Fiber holds in the water and can make it easier to go. But if you increase fiber without increasing water they will get more constipated!

3. Get plenty of exercise: Kids should have an hour a day. Make sure they exercise outside of school. One PE session a week is not enough!

4. Decrease refined food: Such as cracker and chips. If you don’t watch it, it’s easy for the kids’ diet to consistent mostly of refined foods. Don’t cut the carbs just make sure they are whole grains. Look at the label it should say greater than 3 or 4 grams of fiber per serving. Don’t eat “white” foods such as white bread or white rice.

5. Decrease your dairy: No more than 24 ounces of dairy in one day.

6. Limit bananas: This advice is mixed. I see so many people will say no, it causes no problem and others will say yes, it does. I’d welcome any comments that people have.

7. Get a bathroom schedule: Remember that the body wants to go to the bathroom after eating. It’s nature. Don’t fight it! Give kids plenty of time in the morning to go before school. Some kids will be constipated after starting school or camp because they withhold going.

8. Go when you need to go: Don’t ignore the urge. The colon will only expand and adjust to the stool, and then it’ll keep doing its job. The colon will extract more water from the stool, and the stool will become harder. This, for obvious reason, makes it even harder to go.

9. If your child is chronically constipated then evacuate the stool to begin with using enemas or suppositories. Don’t overuse enemas. It can mess up the colon’s natural ability to function. Stool softeners are not habit forming and can be taken for a long time without any problems.

10. Keep the stool moving by using oral agents: Such as mineral oil, Lactulose, milk of magnesia and polyethylene glycol which is also known as Miralax. Miralax and Lactulose work by keeping water in the intestine. You may need to adjust the dose because the stools can get runny. Lactulose can cause cramps. Mineral oil works by coating the stool and helping it glide out. It doesn’t taste great but by keeping it cold it can be made more palatable. Do not give mineral oil to a child under 4 years of age or a child who has swallowing problems. They may accidentally get it into their lungs and cause a serious type of pneumonia. Let your pediatrician guide you!

Good luck! Remember again that if you increase fiber without increasing water your child will get more constipated! Make a plan with your pediatrician and then stick with it. If it isn’t working call them! The may be able to tweak the plan a little and answer questions so that your child can be successful.

Sheila Cason, MD

Sources: The North American Society for Pediatric for Gastroenterology, Hepatology and Nutrition http://www.naspghan.org/

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Sunday, September 09, 2007

Constipation in Children: Part Two - Encopresis

Encopresis is a common pediatric problem. It is defined as having fecal soiling. Often the child will be unaware that they have liquid stool leak in the underwear and not notice the smell. Encopresis often is a result of chronic constipation. Constipation first occurs because of a recent viral illness or happens because they are withholding. Kids at school and camp often don’t want to go in public restrooms and will ignore the body’s urge to go. This makes the stool back up and become even harder, which makes having a stool painful and the child withholds even more stool and the cycle continues. If this cycle is left to perpetuate it will cause encopresis. If you remember the colon’s “job” is to extract water. If the stool builds up and stays in the colon, water will be extracted. The stool will get harder and the colon stretches to accommodate the new larger amount. A colon that is over stretched doesn’t work correctly, and then the child doesn’t feel the urge to go which leads to more stool holding. This cycle results in encopresis. It’s because the new stool that’s being formed has nowhere to go, and it leaks around the hard stool into their underwear.

To help the colon return to its normal size, you need to get rid of the stool. You can do this with enemas and suppositories under your pediatrician’s guidance. Too many enemas or laxatives may interfere with the body’s ability to use the bathroom. You may also use oral medication to help clean your child out and keep them regular. Again your pediatrician can help.

If the colon is kept clear and regular, it will go back to its normal size and the child should then be able to have spontaneous regular bowel movements. This takes a lot of dedication on the parent’s part and it may also take to help of a pediatric gastroenterologist to make this work. I see a lot of parents who give up too early or stop once the child’s bowel movements normalize a little. You have to continue the treatment and talk with your pediatrician. The North American Society for Pediatric for Gastroenterology, Hepatology and Nutrition’s website is an excellent resource. You may access them at http://www.naspghan.org/.

They can help you find a pediatric gastroenterology specialist in your area. Tomorrow I’ll give you tips regarding the prevention and treatment of constipation.

Sheila Cason, MD

Sources: The North American Society for Pediatric for Gastroenterology, Hepatology and Nutrition http://www.naspghan.org/

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Saturday, September 08, 2007

Constipation in Children - Part One

Like any mom, I’m a little obsessed with my children’s bowel movements. Am I crazy if I say I know when they go and the consistency?

Before children I would say, “Yes Ma’am you are.”

But now? Now I know I’m just like every other mom that comes in my office.

Constipation in kids is one of the most common complaints I see in my office! Constipation is defined as a decrease in the frequency of bowel movements or passing painful hard bowel movements. A lot of parents want their children to go everyday. I have to admit, I’m one of those people! But there is no ideal schedule per se. What you really want to know is what the stool looks like. I’ve had parents say their child goes everyday but its tiny hard balls and they cry. That’s constipation. Some will say they go after a week and it clogs the toilet. That’s constipation. Some will say they go every three days but it’s soft. That’s not constipation.

It’s normal for kids to get constipated when the have had an illness, been traveling, or have started school or camp. Once they get behind in their fluids then constipation often ensues. The treatment tends to be multi factorial. If the child has a lot of stool and is having fecal soiling called ”encopresis” then they may need an initial clearing out with an enema or suppository. But most kids only need a little tweaking with their diet. You can increase their water, fiber and avoid dairy and make sure they visit the bathroom after eating.

By working with your pediatrician you can devise a plan for your child. If they have chronic constipation or encopresis then you may need to be seen by a pediatric gastroenterologist. This is a specialist that takes care of children with chronic constipation, abdominal pain, diarrhea, vomiting, and other medical disorders of the gastrointestinal tract. My husband teases me that I spend too much time looking at my kids’ poop but I recently was happy to see he was really like me and other moms when I saw him leaning over the toilet analyzing our kids green stool. It turns out that grape juice turns the stool green! Who knew?

Sheila Cason, MD

Sources: The North American Society for Pediatric for Gastroenterology, Hepatology and Nutrition

http://www.naspghan.org/

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Friday, September 07, 2007

Teaching Children

Yesterday I introduced colors to the baby. It wasn’t fancy. He was eating fruit loops; crumbs and slobber were all over the place. I seized the opportunity! Every time he put a green one in his mouth I said, “Green!” I also asked where the green one was but he pointed to the blue and then ate it. I’m not worried, he’ll get it. My other two did. But we haven’t always learned on the fly like that.

Long ago when I was a new mom, juggling the kids and unaccustomed to multitasking, I had a friend and her 2 year old over. The 2 year old was brilliant! She knew her colors, how to count and ABC’s the whole works.

My friend shrugged and said, “When she’s taught it, she just kinda gets it.”

Ahhh…She was taught! See that was my problem. I wasn’t used to showing kids what they need to learn. I was always around adults who’d learned those a million years ago. I also was so used to school that I thought to learn you needed a large chunk of time at a specific time of day. I didn’t think it was possible to teach her in a few minutes a day. Boy was I wrong. After I thought about it for awhile, I turned everything into an opportunity to teach. I like to cook so I bring my kids into the kitchen. When I need something I ask them to count out 5 of them and help them count them out. I ask them if they want their toast in squares, triangles, or rectangles. I talk and ask questions the whole time when I cook. You get the idea…

Soon I will send my baby to preschool but mostly for the socialization. At this young age I can teach him what he needs to know at home. The opportunity to teach and learn is everywhere. Wondertime is one of my favorite magazines to give you ideas how to teach and open children to the wonder and joy of life.

Sheila Cason, MD

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Thursday, September 06, 2007

The Middle Child

Now with my oldest in school, you may ask how my little ones that have been left behind are. They’re doing well. The baby is a baby. His world is about the same. But my middle girl is the big sis now and rising to the occasion! It’s weird not having my oldest there. She’s a talker and a leader. She normally takes her sister by the hand and helps her with everything. I don’t mind because I’m usually juggling the baby but my middle child has been habituated to it! They even role play mommy and baby! You can guess who is who!

At first with her sister gone all day, my little girl’s world was all topsy-turvy. She cried the night before kindergarten and said her sister was “gonna be gone forever.” I think she is not used to seeing herself as separate from her sister. I have always worried that being a middle child she’d get lost amidst the chaos of three kids. Some people will talk about birth order and how the middle child may feel unloved or left out. They suggest pointing out that the middle child has the best of both worlds. They are both a big sibling and a little sibling. With her older sister at school, I have had more time with her, and I have really seen the difference. She seems older and more capable. There still are times when she asks for help. But most of the time, it’s stuff that she is able to do. I think she is used to her sister just doing it all for her, and I was used to letting her sister do it all for her. Now if she’s stuck or needs something, I help her figure out how she’s going to solve it. The photo posted is of her picking up all her little toys from the bathtub. I suggested a basket when she wanted me to pick them up.

I love having three children. I hope she knows how special, unique, and lucky we feel to have her in our life! I have been telling her that she is the big sister to her baby brother and sure enough today she grabbed a diaper and put it on him! What was so funny was that he let her! Now who is the mommy and who is the baby? She’s out under her sister’s shadow and shining.

Sheila Cason, MD

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Wednesday, September 05, 2007

Speech Delay - Question for Dr. Sheila Cason

Dear Dr. Cason,

My 15 month old hasn’t started to talk. Is this something that we should be worried about or just watch closely? I have read many books about it and most of them say that by 15 months they should be saying a hand-full of words by now. I was just wondering what your advice is.

Anonymous

Dear Anonymous,

I get this question a lot!! Parents look around, compare their child to others and then start to ask the question, “Does my child have a speech delay?” When a parent comes in my office and is concerned about a speech delay. I listen pretty carefully. It’s stressful to think there might be something going on. I first ask if the child points and if they make eye contact. I want to immediately assess if there are deeper developmental issues. At 1-2 years of age language should really start to take off. Because language is a highly complex task, speech delay can be an early presenting problem of a child who has other developmental disorders. After talking with them about their concerns, I then get a piece of paper, write everything down and really count up the words. Does he say up, down, mama, dada, papa, more, dog? Don’t worry about articulation issues at this young of an age. Sometimes I have noticed that parents will think their 16 month old isn’t speaking. But if you really break it down, it turns out they say one particular mumble every time for water. This is their word for it! Then I look at the other mumbles!

A 1 year old should have between 3-5 words and by the time they are 18 months then they will have between 10-20 words. Don’t get stuck on the number though! But I have to admit I’m a little stuck on the number and have written all of my boy’s words down!! He’s 16 months old has taken his time acquiring language; he’s much different than my girls were. Remember that the norms are guidelines and all children will have their own rate of language acquisition. When I finally couldn’t take him screaming duuuuhhh for everything I got very aggressive about teaching him American Sign Language. This is a great way to tap into the language capacity of the child. He now signs more: please, thank you, want, food and water and milk and his favorite “all done”. Speech Delay.com is a good user friendly site to get some basic ASL and tips how to use the signs.

If you suspect your child has a speech delay, the best thing you can do is check with your pediatrician. They are trained to evaluate your child and refer you if there is a concern. But, having said that, many people – including friends, family and even your child’s doctor- will say don’t worry let’s wait and see. You don’t have to do that. If you really want an expert opinion then ask to see a speech-language pathologist certified by the American Speech-Language-Hearing Association for a professional evaluation. You can check your child’s milestones yourself by looking at the website of the American Speech- Language- Hearing Association. They have great articles and detailed explanations regarding speech delay. Good luck and don’t forget to read everyday and talk, talk, talk!! These two are the best things you can do for your child regardless of whether they have a speech delay or not.

Sheila Cason, MD

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Tuesday, September 04, 2007

First Day of School

Oh my gosh! There she went! She climbed aboard – with trepidation – that big yellow school bus and headed off to kindergarten. I cried and I’m still crying now. How did the time go by? I remember when she was born. How can that be? When she was a baby I had to work 36 hours at a time. I would pump my breast milk all day and night long, and I ached to hold her. I used to take her blankie to work with me and sleep with it. For every day of her almost 5 years of life I have fretted and worried. Even when I’ve had to go to work, I always knew exactly where she was. She doesn’t ever get more than 3 feet away from me. She holds my hand. She brushes my hair away from my face. She says, “Thank you mommy for making me dinner” and at random unexpected times she signs “I Love You” with her hand. And I’m supposed to just watch her climb onto a bus and hope that somehow it all works out? I’m supposed to hand her over to strangers and trust that the two of them will work it out?

Yes, I guess I am. It was harder than I thought it would be. I tried not to let her see me scared and nervous and teary. How do I tell her all the things I need to tell her? I want to warn her and keep her safe and innocent. I want her to explore but I want her to stay with me. She looked at me yesterday, with her bright blue eyes and asked, “What if the other girls don’t want to play with me?” And my heart broke because I know it’ll happen. Someone will do it to her. And as much as I don’t want it to happen she might do that to someone else.

I can’t stop her from making mistakes. I cannot protect her from feeling pain. It’s a very real and necessary thing about growing up. We cannot make some of the hard experiences easier. It’s just not within our power. We can be there for them, but we cannot do it for them. I would have gone in her place if I could. I love her that much that I’d endure a thousand “first day of school” days. But it’s her school, and it’s her life. Okay, okay I know she’s only in kindergarten but today it felt real to me. Today I saw a little person who will only get bigger and wiser and there’s nothing I can do to slow that down. I just have to wipe the tears away and enjoy her at each step.

Sheila Cason, MD

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Monday, September 03, 2007

Field Trip

Having three children in 4 years has been a lot of work and tomorrow my oldest is off to school! It’s the last day before the first day of kindergarten, and I’m seriously teary!!


I’m not kidding! I’m queasy just thinking about it. Her backpack is packed. Her lunch is made and her clothes are all laid out. My big girl!!


I’ve been so nervous that when my 3 year old said “ Mommy I want to go somewhere”, we threw some lunch in a bag and we were out the door in about a half an hour! We went on a little field trip with the kids down to Gef Pa’go Chamorro Cultural Village. It’s located in Inarajan, Guam. It’s also known as "Inalåhan" in the indigenous Chamorro language and is located in the south eastern part of the island. We ate our picnic and took a tour. This island keeps amazing me. The people were kind and told all kinds of stories. The kids, aside from being distracted by a little mother cat, were very into the demonstrations. We learned how they make coconut candy, recover salt from the ocean, make ropes and weave baskets. The photos are on my flickr photostream. I hope you enjoy them

Of course now I’m home again and back to worrying. The kids are asleep as I write this. I know, I know… she’ll be okay… It’s me I’m worried about. :)

I think I’ll just tell myself what I would tell any mom that has a new kindergartner. Don’t worry she’ll do great! You should be proud. You’ve done your job well and now it’s her turn to go explore a little, to have her own little field trip!

Sheila Cason, MD

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Sunday, September 02, 2007

Banana Bread

We made banana bread the other day. Yes, I have been enjoying staying at home! Here’s the recipe! It’s from The New Best Recipe: All-New Edition with 1,000 Recipes by the Editors of Cook's Illustrated Magazine . It’s a great book if you love to cook and especially great if you love to read about cooking.


  • 2 cups unbleached flour, plus more for dusting the pan (the kids too of course!)

  • 1 ¼ cups walnuts, chopped coarse

  • ¾ cups sugar

  • ¾ teaspoon baking soda

  • ½ teaspoon salt

  • 3 very ripe, soft, darkly speckled large bananas, mashed well (about 1 ½ cups)

  • ¼ cup plain yogurt

  • 2 large eggs, beaten lightly

  • 6 tablespoons (¾ stick) unsalted butter, melted and cooled

  • 1 teaspoon vanilla extract

Adjust oven rack to the lower-middle position and heat the oven to 350 degrees. Grease the bottom and sides of a 9x5-inch loaf pan; dust with flour, tapping out the excess.

Spread the walnuts on a baking sheet and toast until fragrant, 5-10 minutes. Set aside to cool.

Whisk the flour, sugar, baking soda, salt, and walnuts together in a large bowl; set aside.

Mix the mashed bananas, yogurt, eggs, butter, and vanilla with a wooden spoon in a medium bowl. Lightly fold the banana mixture into the dry ingredients with a rubber spatula until just combined and the batter looks thick and chunky. Scrape the batter into the prepared loaf pan.

Bake until the loaf is golden brown and a toothpick inserted in the center comes out clean, about 55 minutes. Cool in the pan for 5 minutes, then transfer to a wire rack. Serve warm or at room temperature. (The bread can be wrapped with plastic wrap and stored at room temperature for up to 3 days).

Sheila Cason, MD



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Saturday, September 01, 2007

Food Allergies in the School

It’s almost school time for my kindergartner, and I’m scheduled to bring snacks for the entire class. I don’t know what I’ll bring but I know that it won’t be anything with peanuts. There is a little girl in her class that’s allergic to peanuts- I know because I asked! I know all about peanut allergy from my 6 year old nephew. Since my sister found out that he was allergic, I have learned more from her than all of my medical school and residency training put together! This is mostly because the field of allergy and immunology is rapidly changing. We now know things that we didn’t know five to ten years ago.

A food allergy is an immune response to certain types of food. The most common food allergies in children are eggs, peanuts, milk, nuts, soy, fish, wheat, and shellfish.
The symptoms of food allergies can be varied. The most common reactions are: vomiting, diarrhea, hives, eczema, difficult breathing, and possibly a deadly reaction – anaphylactic shock. I once had a patient that handed her granddaughter a bit of an almond. The little girl immediately started sneezing!! The grandmother watched her puzzled until she realized she was allergic and showing early signs of an anaphylactic reaction. They called 911 and the child was given immediate medical attention. It happens that fast!

If you suspect your child has an allergy, talk with your pediatrician. And if your child isn’t allergic, remember that other children may be. With the increase in food allergies, chances are, you know a child who has a food allergy. Be aware of the foods you send with your child to school. Be especially careful of feeding other people’s children. I know I will. I’ll be extra careful and treat that mother’s little girl just like she was my own child.
The American Academy of Allergy, Asthma & Immunology has more information that can be accessed at their website: http://www.aaaai.org/.

Sheila Cason MD

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