My Two Year Won't Sleep

Hi Dr. Cason,

You took care of my twins in SD almost 2.5 yrs ago. You offered some guidance when we were having sleep issues with them before. Guess what? My daughter is having sleep issues again. She's in her own room in a big girl bed. She just finished getting her 2yr molars. I've taken her to the pedi 2-3 times to rule out any obvious physical problem. Nothing. This child is a beast at night! She wakes up 3-4 times a night and it's always at the same times, like clockwork. She won't fall asleep on her own. If I don't stay with her at her initial bedtime she'll get up out of bed countless times. We are dealing with a speech delay so she's unable to tell me what's wrong. She doesn't want daddy. Just me. I haven't had a full night's sleep in months. I refuse to take her to bed with us. Instead I go to her bed, but it's the same darn problem! I don't want to sleep in the Dora bed. I'd like to sleep with my husband! I've read a bunch of books and done some research, but nothing seems to be working. I guess I'm just looking for some insight. Nothing's different as far as bedtime routines. She was having this behavior even before we put her into her own room and big bed. I'd appreciate any thoughts of yours! Thank you.

- Lisa

Hi Lisa,

Good to hear from you!

I think you have hit the nail on the head. It's teaching her to sleep at the initial bedtime that will solve your problems. Remember that when children go to sleep they need to to learn to put themselves down. When she is arousing out of her sleep in the middle of the night, she just wants to replicate what happens when she originally goes to sleep.

Solve the bedtime problem and your on your way to solving the latter problem. Sounds easy right?

Remember the key to any behavior issues with children is consistency. Develop a good bedtime routine- bath, book and bedtime.

When mine were littler we used stickers to reward them in the AM if they went to bed nicely. Also now if they talk then I close the door. They really want it open so that usually works.
When we are busy with company and ignore their yelps and cries and playtime then usually they rile themselves up even worse. When we are consistent and won't tolerate any playing they go to sleep. For a long while we had to take out the offending person - remember I have three kids - and put them to sleep on their own in the guest room. We warned once and then took them out. When we forgot and yelled, warning them incessantly but not backing it up- not too surprisingly they pushed it further and further.

Some people will use a gate at the door. This isn't being a mean parent this is ensuring their safety. They can't be allowed to roam the house at will.

So the upshot is- Tuck her in her bed at night and walk away. Expect that she will stay there. When she comes out, take her back. No talking, no cajoling, no yelling. If she keeps coming back out then stand by her door. The key is not to ignore her when she comes out and let her play or run around. She comes out, take her back. If she's crying in her room but staying there then I would leave her be.

It's a matter of wills. You're older and wiser and have more tenacity. You can do it!

Let me know how it works!

Sheila Cason MD

Possible Food Allergies in An Adult

Hi Dr. Cason,

I am an adult with what I believe is a food allergy. I noticed a couple of years ago that after I ate theater popcorn with butter, within a half hour I began with an itchy throat, a cough, and increased production of mucous and nasal drainage. A few days ago I was on a flight and ate some of the airline peanuts, the same thing occurred. Yesterday, I ate some banana chips...over the course of 30 minuets...I had the same symptom....I read the label on the banana chips and it said they were processed in a plant that also handles peanuts and other nuts...what is your take on this?

Anonymous


Hi,


It certainly sounds suspicious for a food allergy. It is not uncommon for adults who have previously tolerated a food, to suddenly have an allergy. I would definitely visit your physician where they can do some blood testing and possibly do either a skin test or refer you to an allergist.

Remember the gold standard for food allergies is whether you are able to tolerate eating the food. If the blood and skin test come up negative and you still have symptoms when you eat a food then by definition you are allergic. The opposite is also true. If the blood and skin test come up positive and yet you have no symptoms when you eat a food then by definition you are not allergic.

Keeping this in mind then I would not test everything under the sun, just the foods you are concerned with. Peanuts sound reasonable. I'm not sure what to make of the popcorn reaction. It could be that the oil the popcorn was popped with was peanut oil. That would fit with the other reactions.

So bottom line- go see your doctor and get an Epi Pen. Keep two with you at all times until you can get some more answers as to your possible allergies. Better to be safe!

Take care.

Sheila Cason MD

Eleven Years Old and Underweight

Dear Dr. Cason,

My grand child is 11 and weighs 55 lbs, short (familial) , he eats little but has large normal bowel movements. He had symptoms of ADD and has difficulties learning. Because of his weight he has never been on meds for very long. He has kept some babyish habits(sucking fingers and playing with clothing labels).He has been extremely healthy and has done well in sports. His parents have found that he seems to be doing better since he does triathlons and eats better after swimming. His mother is obsessed with keeping her weight down and is also very thin, she maintained herself on a fat free diet while pregnant. The father was also low weight, ADD as a child . We feel that his poor intake maybe related to his lower functioning . He gets easily frustrated and cries.
Any input would be appreciated.
Thank You !

- BR


Dear BR,

At 11 years of age 55 lbs is certainly low, but it is difficult to tell exactly what is going on. It is good that he is active and eats well at times. I am assuming with the mention of the extreme health issues at homes that there may be some restriction in what foods are available to him. By no means should a child be on a fat free diet or carbohydrate restricted. But even if he has a variety of food available to him, given his home environment, he may be picking up some unhealthy habits. It is not completely uncommon to see eating disorders in young children- boys included.

Also with your mention of some young child like behaviors- sucking fingers and playing with clothes tag,there may be a developmental issue such as pervasive developmental disorder. Remember that very frequently children can fit a certain diagnosis such as ADD when really there may be an other diagnosis to be considered. Often children who are very sensitive in general can have oral aversions. Textures, taste and temperature can play a large role in what they prefer to eat.

I suggest taking him to a developmental pediatrician. If there isn't one available then take him to his pediatrician and ask for a consult. They should be able to tease out what issues are at play here and give you a better idea how to help your grandchild.

Good luck and let me know if you have any other questions.

Sheila Cason MD

Soft Neurological Signs in Young Children and My Personal Experiment

Dear Dr. Cason,

I have a son who is 4 and also a twin. He twitches his fingers and does this circular motion with his hands when he talks, but mostly when he is excited.(his arms stay at his side).My doctor says its just a nervous thing and that he will learn how to control it, but it worries me. What do you think?- CS

Dear CS-

It sounds like what you are describing is neurological overflow or what others will call "soft" neurological signs". These soft neurological signs are often used to describe signs that are either difficult to obtain or interpret. It is commonly seen in immature nervous systems of very young children. Persistence of these signs beyond a certain age though may indicate a future problem with attention and/or learning disorders or other cerebral dysfunctions.

You can test your child for soft neurological signs a couple of different ways.

1. Ask your child to walk across a room on their tip toes. As they perform this look for tremors and "overflow" involuntary movements that occur with his hands and his face.

2. Ask your child to touch the tip of their finger to the tip of your index finger and then touch the tip of their nose again. Do this three times. As they perform this look for tremors and "overflow" involuntary movements that occur with their other hand and their face.

Remember again, that the presence of these signs may or may not indicate future problems. The best thing you can do is discuss your concern with your pediatrician and if you are still concerned, they can refer you to visit with a pediatric neurologist who can evaluate your child and offer specific recommendations.

I hope this helps. I couldn't find any specific ages in which these soft signs should be gone. Most articles suggested that beyond age 5 or 6 was concerning for other conditions. Now as luck would have it I have a 4 and a 6 year old. They are both full term and otherwise developmentally on target.Tomorrow I shall do my own little experiment and let you know what I found!

*Warning* This is not a true "experiment" and one should take it as an interesting task and not necessarily indicative of how other 4-6 year olds will perform.

*11/18/08 Update*

Standing at the bus stop today I had a chance to test my children. The older 6 year old certainly did well. The four year old splayed her fingers a little as she touched her nose and had difficulty with balancing as she did the tip toe walk.I wouldn't necessarily call this a soft sign but she did show less coordination. I would expect her to get better at this and have no worries about her development overall.

I'd be curious what other people found out! Let me know by leaving me a comment.

What To Do When You Don't Like Your Doctor's Nurse

Dear Dr. Cason,

I just need some advice on a certain situation. My pediatrician used to have a fabulous nurse in the office that recently left and was replaced by a horribly incompetent one. She was awful at giving my 15 month old her shots and it really traumatized her, not to mention the needle came apart from the syringe as she injected one of them and the needle was stuck in my daughter's leg and some of the vaccine got on me instead of in my daughter. That's just one example of the horrible experience. What my question is, is how should I handle this situation? How would you prefer a mom to handle this situation if it was your nurse? I just really don't want this nurse to give my daughter any more shots. She has never been so traumatized by shots before, they have never been a big deal to her or me. I am already nervous about her next checkup. I want to handle the situation correctly but not get anybody in trouble. My pediatrician is just as caring as you are, so I would guess she would want the same actions taken that you would. Thanks so much for your time! - R



Dear R,

Oh no, that sounds like it wasn't a good moment for anyone! Situation like this happen all the time. I'm sure that there are many different ways you could handle the situation. For example you could go to the nurse and explain your concern or go directly to the office manager as they are trained to handle patient complaints. However the simplest thing is just to go directly to your child's pediatrician. She'll definitely want to know that something occurred and how she can best help you feel comfortable.

Don't rule out that this nurse may be very good and just have made a mistake. She also may be inexperienced and need more training. But then again she may truly be incompetent and need to be relieved of her duities. Having said all this, regardless of why it happened, someone needs to know so they can ensure that it doesn't happen again. I hope that this works out for you. Already it's stressful to bring your child in and watch them anxious but to worry if the nurse is doing the best of their ability is extra stressful.

Don't feel guilty about getting anyone in "trouble". As human beings we'll make mistakes and it's critical to receive constructive feedback. This is how we become better and grow as individuals and professionals. I do hope though at some point you'll talk directly to the nurse. She may have been having an off day and feel just as terrible as you do. I know that I've made mistakes and have been immensely grateful when I'm allowed the chance to make it better. If only just to say that I'm sorry.

Please let me know if I can be of any other help.

Sheila Cason MD

Ask and Discuss Questions in the Medrounds Pediatric and Parenting Forum

Discussion Forum

I spend a lot of time talking and listening. It’s my profession! As a pediatrician I was trained to listen, ask questions, do a physical exam and mold all the information into diagnosis. I can’t help but give advice particularly if I feel something will harm a child. My children’s friends all hear my opinion on helmets and bike riding. I practice medicine every day because I love it. I love my patients- they make me laugh and smile. I love my patient’s families. I am inspired and awed by them. I love my colleagues. I love discussing cases and determining the best care for the children. All these people make me a better doctor and a better mom. I have dedicated my life to other parents’ children as well as my own. Often my two worlds collide. You can see that my pediatric advice is often peppered with my own experiences as a mother. I started my column because I knew there would be people that needed the advice. But I am also interested in hearing what you all think! Medrounds.org has started discussion forums that will facilitate the exchange of information. I welcome everyone to log on and participate!


Sheila Cason MD, FAAP