Mommy MD

Medicine Mondays: Children and Twitching; Pregnant and Breastfeeding; Hair Loss after Pregnancy

shesmith00@hotmail.com (Dr. Cason) — Sun, 24 Aug 2008 02:46:00 +0000

Hi welcome back to Medicine Mondays-

As suggested by the title, each Monday I'll post the answers to questions that I have collected over the week. If you have a question please feel free to send me an email or leave me a comment. I welcome every comment and hope to help answer some questions. Just remember that my advice is not a substitute for a physical exam and medical advice that your family doctor can provide.

The following comes from a reader on my personal blog- DrCason.org

Children and Twitching

Question:

My baby does this thing a couple times a day where her left foot twitches, and when I say twitches I mean TWITCHES, it usually only happens if there is a little bit of pressure on it, like if she is pushing on my hands with her feet. What’s that all about?

Answer:

What you are describing is called clonus. Clonus is a series of involuntary repetitive movements that occur when the muscle is stretched. It is usually found at the ankle. This is a normal finding in newborns. If it is present when you are older it can be a sign of neurological injury. It is best to go to your pediatrician so they can exam your baby and determine whether this is still within a normal range for your child.

Anemia and Getting Pregnant

Question:

When having my baby I lost a lot of blood and ended up have 2 blood transfusions. MY hemoglobin are back to normal now(I’m an iron champion!) but she still told me that I should wait until my baby is at least 6 months before we start trying to baby number two. THAT SUCKS! I do NOT want to be like 7, 8, or 9 months pregnant in my middle of summer. Do I really have to wait?

Answer:

I can't answer this as an OB so it's best to go to your doctor to find out her reasons. But as a pediatrician I can say that the baby's iron level is heavily dependent on the mother's iron stores. So the health of your baby is really dependent on you! Just because your levels have now come up to normal does not mean that your stores are at a normal level. Go back and talk with your OB. It may be that she will be flexible with her recommendations and you can work together to create a plan for your next pregnancy!

Pregnancy and Breastfeeding

Question:

If I increase my food intake by a gazillion times is it safe to breast feed while being pregnant?

Answer:

I have heard of a lot of women doing this. Most people are concerned with 1. The possibility that the growing fetus will be deprived of essential nutrients and 2. That the hormone- oxytocin- that is released during breastfeeding could induce labor. Only your OB can tell you what they are comfortable with and what precautions you need to take.

Hair loss after Pregnancy

Question:

When will my hair stop falling out by the handfuls? My hair is everywhere I’m like a big shaggy dog!!

Answer:

Oh my goodness this happened a lot to me as well! In pregnancy one of the reason that your hair gets so thick is that it goes into a resting phase. That is you actually cont to grow hair but the shedding stops. The American Pregnancy Association says this about hair loss and pregnancy:

The most common period of hair loss occurs approximately three months after delivery. The rise in hormones during pregnancy keeps you from losing your hair. After delivery, the hormones return to normal levels, which allows the hair to fall out and return to the normal cycle. The normal hair loss that was delayed during pregnancy may fall out all at once.

Up to 60% of your hair that is in the growth state may enter into the telogen resting state. The hair loss usually peaks 3-4 months after delivery as your hair follicles rejuvenate themselves. As noted before, this hair loss is temporary and hair loss returns to normal within six to twelve months.

There you go everyone. More Medicine Mondays next week. Drop me a comment or an email if you have a question for me!

Medicine Mondays- Early Intervention, Teething, Allergy Testing, Hidradenitis- Suppurativa and Infertility

shesmith00@hotmail.com (Dr. Cason) — Mon, 18 Aug 2008 03:07:00 +0000

Hi Everyone!

Welcome to my second installment of Medicine Mondays!

I started Medicine Mondays just last week on my other website DrCason.org and have had such a good response that I've decided to move it to my professional site. This way even more people can benefit from these great questions!!

As suggested by the title, each Monday I'll post the answers to questions that I have collected over the week. If you have a question please feel free to send me an email or leave me a comment. I welcome every comment and hope to help answer some questions. Just remember that my advice is not a substitute for a physical exam and the medical advice that your family doctor can provide.

Okay! Lets get started:

Early Intervention and Speech Delay in Children

Question:
When should Early Childhood Intervention be called in on a situation? My daughter now 15 months old really doesn’t say anything. I discussed with our pedi at her 9 month appointment in preparation for her 12 month appt. where she is supposed to be saying 6 words including mama and dada. Well, at 15 months says mama and dada occasionally and doesn’t really say anything else - audible that is. I think she tried to say her brother’s name and maybe ball or milk, but not much else. She I ask for Early Intervention to come in and work with her? I know the little ones all talk at their own pace and I am thinking it will just come, but what if there is something going on that I am ignoring.
We are starting sign language which she does: more and please. Jakey spoke late right?

Answer:
Yes. Jakey spoke later than my other two girls and I wasn't so much getting worried as I was just getting overwhelmed with all the screaming!! His language blossomed with signing!

Each child moves at their own pace and even little goobly gook could actually mean something to them. Be patient and use sign language to augment her language. I wrote an article giving you some Tips to Using American Sign Language if you need some suggestions.

Now in regards to Early Intervention. I have one rule. If I am really concerned then I refer any time there is something suspicious.

I have found that you really can't go wrong. There really is never too early of a time to call in for an evaluation. If a child is suspected of having a problem, such as speech delay, it can help to refer them early and get some additional services going.

Speech delay by itself is not that worrisome at 15 months- some babies just develop on their own. Such as my son. But I will look really closely at whether the child is socializing well. Are they looking at you for social cues? Do they point to what they need? If you point at something, do they follow your finger and look as well. These are very important markers in detecting autism. Autism that is detected at an early age can be helped a lot with early intervention.

Having said all of that, it might be that your child is right on target. Make an appointment with your doctor so they can evaluate her again!

Teething and Analgesics

Question:
Is it true that you can give tylenol or motrin for up to 5 days for teething? Then is it 5 days off and back on again?

Answer:
I don't give Tylenol or Motrin for that long. You shouldn't need to either at least not for teething. I would talk with your pediatrician to see if there is something else going on. If they are uncomfortable try teething rings or Orajel. Hyland make some teething tablets and some people swear by it!

Children and Biting

Question:
How do I get my 15 month old to not think her brother (3.5 years old) is a piece of meat she can just bite all the time? We really think she is a tiger and he is her prey! We tell her no, but she just laughs at us and then goes back in for the kill.

Answer:
LOL! Mine have all done that too. Most kids are just testing boundaries. Let them know that this is not acceptable by firmly saying no and then redirecting them. But don't go overboard! I have found that if you get too dramatic about the event then they are intrigued by the response and will seek to repeat the offense. Then you're in trouble!

Allergy Testing in Children

Question:
My eldest (14yo) daughter just had allergy testing (not nearly as involved as your son’s) because she reacted to some almonds she ate…but the testing came up negative. Ummmm…can you explain to me why she would still be reacting to them if she tested negative? We’re not talking anaphylaxis…just some mild swelling. They did do a RAST at the clinic...I don't know the results of that one...we never saw those results. The tests the allergist did were scratch tests on her arms, and the only reaction she had was to the control.
The allergist made a comment about her having just an oral reaction to the almonds, but not being truly allergic. I wish he'd explained more!

Answer:
Ahh! this is a little tricky. What most people are talking about when they talk about food allergies is an immediate IgE mediated allergic response. This is when the mast cells that contains histamine come in contact with an allergen and break open inducing an allergic response. The reaction can be as simple as some hives or mild swelling or as dangerous as an anaphylactic reaction.

We can test a child's blood for their IgE level in response to a certain allergens (RAST testing) and this can help in predicting what their reaction to the food or allergen will be. I say "help"and "predict "carefully because we don't know EVERYTHING we need to know about allergies in kids. We do think that the gold standard for whether a child is allergic or not is actually what happens when they eat the offending agent never mind what the RAST level is. In the future I will be writing a deeper in-depth article about this using all my info that I have gleaned from my son's allergies.

Now what to do about your child's allergic reaction? With a RAST that's negative and a skin test that's negative and an allergist saying she's not allergic, then she's probably not allergic. At least not with an IgE mediated allergic response. BUT you need to be absolutely sure about this before you give her almonds in the future.

I have heard of Almonds inducing a contact dermatitis. This may be what you are talking about with your child. This can cause redness and painful fissuring of the lips.

Hidradenitis-suppurativa

Question:
Do you have any ideas on how to help Hidradentitis- suppurativa?
I am trying only over the counter medications or herbal remedies as I don't have a doctor. I've had this condition for the past 30 years, but only a few weeks ago found out the name for it. I've gone to doctors in the past for help but have never had any success.

Answer:
This is a tough condition to have. It is chronic skin inflammation that we think may be actually be a severe form of acne. I recommend that you seek the help of a dermatologist. They will be able to help you in the management of your condition. There is no reasons to be treating yourself- unless its so mild that you can control it!

Your doctor may suggest some topical or oral medications as outlined in the article I've highlighted above. (I know that you've seen this as you sent me the link!)

One thing that I will mention as a side note is that we are currently learning more about acne and its relation to diet and inflammation. A low glycemic diet rich in veggies, fruit, seafood, and grass-fed meat can help control acne because it controls inflammation. Since Hidradenitis-supportiva is acne related this may help it as well.

Infertility

Question:
Hi Dr. Cason! I just found your site (DrCason.org)today and I love it already! I have a question and maybe you can answer it. My husband and I have been trying to conceive for over a year and have been extensively tested for various things. The only thing that has been abnormal has been my progesterone and estrogen ( both are low). I purchased progesterone cream, do you think this will do the trick? My husband is in the army and it is a fight to get anything done at our military treatment facility. They do not want to help us. Every last thing has been a struggle!

Answer:
Welcome!! Now I'm not an OB/GYN but I will say that if your progesterone and estrogen are low it may be contributing to your infertility problems! You need estrogen to ovulate normally and progesterone to help make the endometrium viable.

I know so little about infertility issues that I found you another expert! Edward Joseph Ramirez, MD, FACOG.I just searched and searched and found you someone who is Army trained!! Yeah !! It just might make a difference in your case as he may still have some contacts in the military and may be able to point you in the right direction!

Good luck everyone!

Please let me know if I can answer any more questions or point you in the right direction!

Twelve Alternatives to Lashing Out at Your Child

shesmith00@hotmail.com (Dr. Cason) — Fri, 11 Apr 2008 03:47:00 +0000

I always expected to adore my children. I had visions of cooing over every cute look and phrase they uttered. We’d spend the day walking hand in hand down the beach and later cuddle over book in front of the fire. What I didn’t expect was the tears and screams- theirs and mine. What I didn’t expect was to clasp my hands in desperation and pray fiercely for patience. And when that doesn’t work, I hide in the bathroom, taking deep breaths before they come banging on the door.

In the spirit of Child Abuse Prevention Month, may you find your coping mechanism. Here are some tips.

1. Take a deep breath... and another. Then remember you are the adult. Children are little and look to you for guidance.

2. Close your eyes and imagine you're hearing what your child is about to hear. This can stop you cold.

3. Press your lips together and count to 10... or better yet, to 20.

4. Put your child in a time-out chair (remember this rule: one time-out minute for each year of age.)

5. Put yourself in a time-out chair. Think about why you are angry: is it your child, or is

your child simply a convenient target for your anger?

6. Phone a friend. It helps just to say, I’m going crazy!! My friends laugh and remind me that this too shall pass.

7. If someone can watch the children, go outside and take a walk. My husband and I will take turns giving each other a break.

8. Take a hot bath or splash cold water on your face.

9. Hug a pillow.

10. Turn on some music. Sometimes it drowns out the screaming!

11. Pick up a pencil and write down as many helpful words as you can think of. Post it on the refrigerator and refer to it often.

12. Admit to you child that you need some space. I say this a lot and amazingly it works… sometimes.

Adapted from the website: Prevent Child Abuse America.

Hmph!

shesmith00@hotmail.com (Dr. Cason) — Wed, 09 Apr 2008 08:15:00 +0000

First Family Photo Shoot

shesmith00@hotmail.com (Dr. Cason) — Sun, 06 Apr 2008 05:34:00 +0000

We braved ourselves a few Saturdays ago and actually dared to get a family photo...The results were unexpected but delightful. Thank you Expressions Studio!

We had to start the session with some pretzels...

And then it was easy going ...

But after a while Jacob got a little cranky...so we just kept taking photos...

then we needed a rest session!

And he was off...

And it was time to say goodbye...

It's the Little Things

shesmith00@hotmail.com (Dr. Cason) — Sat, 29 Mar 2008 05:21:00 +0000

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

shesmith00@hotmail.com (Dr. Cason) — Mon, 17 Mar 2008 23:06:00 +0000

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

ADHD Meds and Your Underweight Child

shesmith00@hotmail.com (Dr. Cason) — Sat, 08 Mar 2008 06:09:00 +0000

Dr. Cason,

Hello. I have a 10 year old little girl that is being treated for ADHD. She is currently on Vyvanse. The medication is working well for her. My problem is she is very underweight. She is 50 lbs. You can see every bone in her body! Protruding hips, ribs, and back bone. She is just scant of the 10% percentile on her growth chart so her pediatrician says not to worry unless she is 5% percentile. I could not even imagine what she would look like then!

We have tried to add other medications to increase appetite like Mirtazapine, but this is an extremely strong medication and knocks her out for a day. I don't want her to take that at 10. She eats high fat foods, (cheese, beans, ice cream, peanut butter, pasta etc.)I also give Pediasure once a day; she eats normally for her age but does not gain weight. I hear often from other people how skinny she looks too, so I don't think it's just me being too concerned.

She also seems to have a decreased immune system, she is sick often, and seems to catch everything going around. I am tired of being told not to worry when my child is always sick and is (not matter what the chart says) way under weight. Any suggestions?

Thanks so much... -K

Dear K,

Loss of appetite is a very common side effect of ADHD medications. ADHD meds can be very helpful for those kids where other options to treat ADHD meds haven’t been found to be helpful. Vyvanse (Lisdexamfetamine dimesylate) is a prodrug of dextroamphetamine which belongs to the group of medicines called central nervous system (CNS) stimulants. Stimulants are the most effective medications available for the treatment of ADHD as they increase alertness and concentration. Unfortunately the way that ADHD meds work also is the specific reason why your child is underweight. It suppresses appetite.

It sounds like you’re doing all the right things. Some people do add Remeron (Mirtazapine) because at low doses it acts as a antihistamine which increases sleepiness and stimulates appetite but there has been some concern over the use of anti-depressants and suicidal ideation in children. You definitely need to have someone experienced with ADHD
manage your child’s case.

Probably what will be most effective in helping your child gain weight is to give your daughter a
medication holiday if that’s feasible and okay with your doctor. You can give them a rest over the weekend and on vacations when increased attention won’t be as necessary for school or homework. I’ve also had some parents focus on feeding their children calorie rich foods as the medication wore off. This would be a time where the “No food before bedtime” rule could be bent.

I think your child is very thin as well. I charted her on a growth chart and my calculations showed a ten year old child who is 50 lbs is less than the 3rd percentile for her wt. Put another way, she is the average weight of a 7 year old. Given that she is on ADHD meds this may be the reason and if she otherwise looked healthy, it would be reasonable to not undergo other specific testing at this time. But if she’s sick a lot, she may be having other medical issues and would warrant a check up with her doctor. What labs need to be checked will be tailored to your child’s
specific situation and symptoms.

For now I would go back to your pediatrician and really talk with them. Bring up your concerns. Often when I have a family come in and express a deep concern, I will order labs even if I think everything is okay. I find it’s worth it to under go the tests for peace of mind. If the labs are normal you can assume it’s just the meds. You can then focus on giving her high calorie foods, medication holidays and returning for follow ups to monitor her growth. If your doctor isn’t comfortable managing the ADHD or poor weight gain, she can be referred to a behavioral specialist and a nutritionist for management.

Please see my other article on Tips on Mealtime and Your Underweight Child.

Best of luck to you,

Sheila Cason MD

How to Balance Work and Life

shesmith00@hotmail.com (Dr. Cason) — Tue, 26 Feb 2008 22:40:00 +0000

Are you like me? Are you constantly feeling pulled between work and life? The other night I was trying to get some work done and my oldest kept interrupting me. When I finally had enough I snapped at her and she started crying. I felt terrible of course and then gave her my undivided attention. She soon felt better and went to bed without any problems. Later that evening I stumbled across Stephen Covey’s blog post. How to Strike a Work and Life Balance. He said “…having a good work/life balance means that your actions and priorities are aligned in a way that is taking care of what is really important to you.” I fell asleep pondering this and woke up with a headache. I definitely wasn’t aligning my actions and priorities. I had to admit I was fractioning my time in too many places and I wasn’t taking care of what was the most important to me- my family.

That next morning, I cornered my husband on his way out the door. He’s honest and always willing to offer constructive feedback. Over a cup of coffee we discussed my priorities. Though I was practicing pediatrics part time I was still “working” more than ever. I had so much on my plate, even my hobbies felt like obligations. That morning he asked me what my goals were. What did I hope to accomplish? With my life? With my time? When I paused to answer questions that I had never asked myself, I knew it was time to scale back and focus on just a few things. I went back to Stephen Covey’s post for inspiration.

Covey hit home again. He said, “To a chronic multi-tasker everything is a task. Soon, the things in life that are really important to them are in the same list as everything else, and the only tasks that get done are the ones that have become urgent, but often aren’t very important.” The problem was that I was achieving just for the sake of achieving. I had a growing list of to dos and even that which was supposed to rejuvenate me felt like an obligation.

I slowed down and thought about what I would regret if I didn’t do. I thought about my life and discarded activities that kept me busy but didn’t contribute to my long range goals. If you commit to asking yourself what is really most important, then the little things that start to distract you- the urgent but not important tasks such as checking email, surfing the internet and blogging daily fall to the wayside. I discarded two of my three blogs, designing my website and slowed down with my parenting column. I kept my writing course and taking photos for fun. I also signed the girls up for soccer and started to volunteer in Gabby’s kindergarten class. I am focusing on organization so I have more time to play such as cooking meals that will give me leftovers for days.

Covey says there are no quick fixes and he’s right. It’s hard to change an achievement mentality. Ever since I was little I had a “goal.” Now I’m grown and I have to ask myself, “Now what is my goal and when do I actually reach it?” I have to ask myself, “How long do I delay gratification?” Do I vacation when I’m retired? When my kids are grown? When I’m no longer around?

I keep telling myself that people are more important than things and experiences are more important than material goods. When I focus on this, it becomes easier to align my work and life. I still worry that I’m not “producing” enough- whatever that means. But in 10 years I’ll look back and know that I went to their soccer games and read to their class. I have to tell myself that THIS is important. This moment. Right here. Right now.

Sheila Cason MD

The Importance of Family Vacations

shesmith00@hotmail.com (Dr. Cason) — Thu, 21 Feb 2008 09:57:00 +0000

Well we did it! After months of planning we headed off to Cairns, Australia in search of koalas and kangaroos. It’s been almost two weeks since we’ve been home but I can still smell the ocean air as we sailed our way to Green Island, taste the perfectly crispy fish and chips we ate by the pool nightly and feel the warm wet air as we hiked through the Daintree Rainforest. It took some patience to take a family of five to another country and I surely could have used the money for something that seems more tangible but studies show that this wouldn’t have made us happier.

Leaf Van Boven, an assistant psychology professor at the University of Colorado at Boulder, who has studied the topic of happiness and well-being, says that if you really want to be happier you need to stop buying more stuff and start doing more. "An orientation toward life experiences tends to make people happier than an orientation toward pursuing materialistic goods.”

Van Boven explains that this is because experiences are more open to positive reinterpretation. The appeals of purchases soon wither after acquisition but experiences quite literally get better with time. This process of positive reinterpretation means that you get to enjoy your vacation again and again even long after it’s over. I’ve already thought less of Jacob vomiting at the breakfast table and more of the magic butterfly dances and the sleepy koalas.

Another reason you should focus on experiences rather than buying objects is because “experiences are more central to one’s identity”. If you think back on who you are, most likely it’s because of what you’ve experienced and not what you’ve bought. That perfect sweater or cool bracelet didn’t make you who you are today and you certainly won’t remember it when you’re old and gray. We would do best to forgo that impulse to amass more materialistic goods and instead plan on using that money in learning to dive or ride a horse.

Because we’re in Guam and are lucky to have such proximity to different countries and their diverse cultures, we’re taking advantage of it. But, your next family vacation needn’t take you to another country; it can easily be a weekend in the woods camping. And you don’t have to spend a lot of money to fully appreciate the experience. Some of the best moments of our trip were the simplest. I can still see the look on my children’s faces when Jacob ate his first ice cream cone; Brianna held a butterfly and Gabby danced in the water fountain.

Don’t forgo certain life necessities in favor of experiences. We all need to prioritize and focus on what our family needs. But if you’re debating whether to buy a new car or save for that family vacation, go for the family vacation. Experiences will contribute more to you and your child’s happiness than buying the latest car model. Remember that your life is a collection of your experiences not your possessions. For more ideas on how to focus on more fun and less stuff go to the Center for a New American Dream.

Sheila Cason MD

Reference:Van Boven, Leaf To Do or to Have? That is the Question Journal of Personality and Social Psychology 2003, Vol 85, No 6. 1193-1202

Oops! How Did That Get Up There?

shesmith00@hotmail.com (Dr. Cason) — Wed, 20 Feb 2008 10:33:00 +0000

I Love My Family

shesmith00@hotmail.com (Dr. Cason) — Wed, 13 Feb 2008 22:15:00 +0000

Here's my crew and I'm so grateful for the joy they bring to my life!

Saying "I Love You" never goes out of style. You can make a choice everyday to show love for your family. It's easy to become ensnared in the little details that make up our world. We can actually start to believe that a clean house or our job is more important than being present and kind to our loved ones.

Each year around Valentine's day the American Academy of Pediatrics publishes 14 Ways to show Love for Your Child. I wrote about it last year but it's worth repeating!

1. Use plenty of positive words with your child. Try to avoid using sarcasm with your child.
They often don’t understand it, and if they do, it creates a negative interaction.

2. Respond promptly and lovingly to your child's physical and emotional needs and banish
put-downs from your parenting vocabulary.

3.Make an extra effort to set a good example at home and in public. Use words like
"I'm sorry," "please," and "thank you."

4.When your child is angry, argumentative or in a bad mood, give him a hug, cuddle, pat,
secret sign or other gesture of affection he favors and talk with him about his feelings.

5.Use non-violent forms of discipline. Parents should institute both rewards and restrictions
many years before adolescence to help prevent trouble during the teenage years. Allowing
children of any age to constantly break important rules without being disciplined only
encourages more rule violations.

6.Make plans to spend time alone with your young child or teen doing something she enjoys.

7.Mark family game nights on your calendar so the entire family can be together. Put a
different family member's name under each date, and have that person choose which
game will be played that evening.

8.Owning a pet can make children, especially those with chronic illnesses and disabilities,
feel better by stimulating physical activity, enhancing their overall attitude, and offering
constant companionship.

9.One of the best ways to familiarize your child with good food choices is to encourage him
to cook with you. Let him get involved in the entire process, from planning the menus to
shopping for ingredients to the actual food preparation and its serving.

10.As your child grows up, she'll spend most of her time developing and refining a variety of
skills and abilities in all areas of her life. You should help her as much as possible by encouraging
her and providing the equipment and instruction she needs.

11.Your child's health depends significantly on the care and guidance you offer during his
early years. By taking your child to the doctor regularly for consultations, keeping him safe
from accidents, providing a nutritious diet, and encouraging exercise throughout childhood,
you help protect and strengthen his body.

12.Help your child foster positive relationships with friends, siblings and members of the
community.

13. One of your most important gifts as a parent is to help your child develop self-esteem.
Your child needs your steady support and encouragement to discover his strengths. He needs
you to believe in him as he learns to believe in himself. Loving him, spending time with him,
listening to him and praising his accomplishments are all part of this process.

14. Don't forget to say, "I love you" to children of all ages!

Sheila Cason MD

Neglect in Children

shesmith00@hotmail.com (Dr. Cason) — Sun, 10 Feb 2008 22:20:00 +0000

Dear Dr. Cason,

Child Protective Services has just placed my Cousin-in-law's son with me after years of abuse and neglect. He is 4 years old and has epilepsy, but has not been to his neurologist in a year. He is very skinny, you can feel every bone in his body and his spine and shoulder blade are very pronounced. You can see all of his ribs, and his stomach sticks out. His head is very large for his body. I am trying to get him in to a specialist since his neurologist has retired, but his medical records have become trapped somewhere in the CPS system. Do you have any advice or recommendations until I can get him in? He eats so much; I don't know if he was underfed or if there is some underlying problem.

Thanks, Anonymous

Dear Anonymous,

I’m happy to see that Child Protective Services has placed this little boy with you. You obviously care about his well being and are looking into his various medical issues. If he is actively having seizures, then he needs a medical exam now- even if that means taking him into your local Emergency Room. If he is not actively seizing and appears thin but well then you can take him to your local pediatrician or family practitioner. Child Protective Services can point you in the right direction if you can't find one. Don't worry about not having his medical records right now just take him for the exam. As a general pediatrician I have often seen children within the foster care system. The majority didn’t have their medical records and I did the best I could to reconstruct their medical history and start the appropriate treatment.

Without a physical exam and a detailed medical history, it’s hard to say exactly whether the child’s thin appearance is due to an underlying medical issue or is simply related to neglect. His large head size could be related to his seizure disorder or could appear large in relation to his small stature. When the brain is actively growing in size – up until two years of age - the calories will specifically be used first for head growth then stature and lastly weight.

Neglect, even treated, can have significant ramifications. The National Academies Press, in the online book titled: (1993) Commission on Behavioral and Social Sciences and Education, states that Even after diagnosis and treatment, the psychological consequences of emotional neglect persist. Some studies suggest that certain signs of severe neglect (such as when a child experiences dehydration, diarrhea, or malnutrition without eceiving appropriate care) may lead to developmental delays, attention deficits, poorer social skills, and less emotional stability.

So we will have to wait to see what his future holds for him. In the meantime he is lucky to be in a stable home and receiving the specific care he needs. To help increase your foster child's weight, please see my article labeled Tips on Mealtime and your Underweight Child for some specific recommendations. I wish you and your family well. No doubt that it will be a difficult time for everyone. Please let me know if I can answer any other questions.

Sheila Cason MD

Guess who came to visit?

shesmith00@hotmail.com (Dr. Cason) — Wed, 30 Jan 2008 23:22:00 +0000

Tips on Mealtime and your Underweight Child

shesmith00@hotmail.com (Dr. Cason) — Mon, 28 Jan 2008 22:05:00 +0000

If you’re like me then you’re searching for ways to get good nutritious food in your kids’ belly but also finding ways to give them enough calories. Remember that as parents you are responsible for what is offered and where and when it is presented. You are also responsible for providing a safe and enjoyable environment during meal times.

Children on the other hand are responsible for deciding how much food they will eat and whether they will eat at all. Make sure you:

1. Offer variety of nutritious foods.
2. Offer foods that are safe.
3. Offer serving sizes that are appropriate.
4. Eat meals at the table.
5. Eat at regular times.
6. Serve as good role models when choosing foods to eat.
7. Don’t pressure or bribe the child to eat.
8. Avoid arguing or negative behaviors during meals.

Children should be eating at least three meals a day with two snacks. I’ve had parents think their child was “always eating” but when you broke it down they weren’t eating a lot of calories. They were snacking on rice cakes and grapes. I had one mom say that she thought carbohydrates were bad for her child and tried to limit them. Contrary to the adult diet kids actually need a lot of carbohydrates. Because kids are little and not eating a lot they need to have nutrient dense foods as well as energy dense foods.

A food is nutrient dense if the vitamin and mineral content is more than its energy or calorie content such as lean meats, beans, oranges, carrots, broccoli, whole-wheat bread, and whole-grain breakfast cereals. Energy dense foods contribute more calories than they do nutrients such as chips, sodas, cookies and ice cream. Remember to balance healthy nutrient dense foods with energy dense foods.

Feeding children particularly an underweight child can be stressful if you micromanage their meals. I know it’s tempting to chase them around the house with a forkful of food. But don’t. Try instead to:

1. Give them small meals that have both nutrient dense and energy dense foods and drinks.
2. Add fats to food such as butter on potatoes and toast, mayo and cheese on sandwiches.
3. Offer whole fat products, such as milk, cottage cheese, creamed soups, pudding and yogurt.
4. Add calories to foods such as fruit in heavy syrup and vegetable with cheese sauce.

Don’t forget to visit your pediatrician for a thorough exam.

Sheila Cason MD

Pretty Things

shesmith00@hotmail.com (Dr. Cason) — Wed, 23 Jan 2008 22:17:00 +0000

The Underweight Child

shesmith00@hotmail.com (Dr. Cason) — Tue, 22 Jan 2008 03:46:00 +0000

Dear Dr. Cason,

My underweight 2 1/2 year old (negative in the weight charts) was breastfeed until 22 months of age. She always refused a bottle. When I started to introduce milk to her at 12 months she wouldn't have anything to do with it.

I didn't really worry about it until after I stopped breastfeeding her. After trying all forms of milk (various formulas, even chocolate and strawberry milk) it turns out the only thing she would drink is Pediasure vanilla milk. That was fine but it started to get really expensive (I'd limit her to a bottle a day, but they cost more than $1 a bottle -- and that adds up). I found out that she loves "cafe con leche" -- milk with a tiny bit of decaf instant coffee, a little sugar, and a capful of vanilla extract. She looooooves it. It is cheap, healthy (I think), and tasty.

My husband is concerned that the coffee, since it is a diuretic, could dehydrate her (she does have a constipation problem which is relatively under control with Benefiber, Miralax, water, prunes, persimmons, whole wheat bread, etc.). I serve her about 2 cups of milk with a scant teaspoon of decaf coffee -- she drinks only one of these a day. I'd really appreciate it if you could tell me if this is healthy or dangerous? - J.

Dear J-

I feel for you. In a country that has excessive rates of childhood obesity, it can be disconcerting when the problem is actually the opposite- your child is underweight. The first thing you need to do with your underweight child is go to your pediatrician. There is a difference between a child who is just thin for their age and actually “failing to thrive”. Some people will think that every child that is less than the 5% in the growth charts is “failing to thrive” but this isn’t so. There can be healthy children that are just small and that is normal for them. A physician evaluates a child’s weight not based on just one point in time but rather over multiple points in time. At their well-child checks, we analyze their growth by looking at how their growth is plotted against the growth chart. It may be normal for a child to be at the bottom of the growth chart as long as they are still moving along at an acceptable rate. But there are some children who plateau and then drop, failing to even keep up with the expected growth patterns. These children are truly “failing to thrive”.

Making the diagnosis of “failing to thrive” vs. “small for size” is important. In a thin child who is still growing and doing well, you would just offer them nutritious foods and continue to monitor them. It’s important to avoid micromanaging a child and their meals. Over controlling a child can lead to control issues and food “strikes”. If, however, your child is actually dropping off the growth curve or failing to grow at the expected rate, then a diagnostic workup is indicated. Your pediatrician can look into whether there is a chronic medical condition that is contributing to their declining growth. If they are found to be otherwise healthy, then they may recommend keeping a food diary and meeting with a nutritionist to help boost their caloric intake.

In regards to your question about Pediasure and Milk here is the breakdown: Pediasure (8 oz) has 237 calories, 7 grams of protein 9 grams of fat and 31 grams of Carbohydrate. Whole Milk (8oz) has 146 calories, 7.8 grams of protein, 7.9 grams of fat and 11 grams of carbohydrate.When you compare the two, you are actually probably doing okay in terms of calories by giving her 2 glasses of her café con leche but she is definitely missing out on some iron.

Excessive dairy intake (greater than 24 ounces in one day) can lead to iron deficiency. Kids will fill up on the calorie rich but iron deficient milk products and avoid any other “real" food. Pediasure can get expensive but some insurance companies will pay for it if it is part of the medical treatment for the child. The diuretic action of coffee is due to the caffeine. So a scant amount of decaf coffee, while not exactly nutritious, probably isn’t all that bad as well. You may want to try blending different things in with the milk such as a banana. My sister did this with great success for her kids!

To help the- otherwise healthy but underweight- child, try to look at why your child isn’t gaining much weight. Here are some common reasons:

1. Too much juice: Excessive juice can start to replace other food groups when children are too full to eat real food.

2. Low fat diets: Children under two years of age need high fat diets for growth and brain development.

3. Skipping breakfast: It’s just as important that children get calories and nutrients in the morning as well as at other mealtimes.

4. Restricted diets: Kids who are served vegan diets need to have their meals planned carefully to make sure that they are getting the nutrients that they need.

I hope this helps! My next post will offer tips on mealtime and your underweight child.

Sheila Cason MD

Banana Bread Anyone?

shesmith00@hotmail.com (Dr. Cason) — Wed, 16 Jan 2008 10:43:00 +0000

Memories

shesmith00@hotmail.com (Dr. Cason) — Tue, 15 Jan 2008 22:09:00 +0000

I wonder what my children will remember.

Will it be the rushed mornings as we run out the door? Regularly I call to Gabby to check if the bus has come. A loud noise rumbles by and I shout, " Is that the bus honey?"

"No Mommy, it's the trash tuck!" She always exclaims.

They sound amazingly similar to me.

Or will they remember that daily, just before that, I always brush their hair. Will they remember that I kiss the top of their heads after the loose strands are all tucked away.

I know that I think I'll remember. Of course I'll remember, for it is stuck in my mind and repeated day after day. But I know that I too will forget.

Maybe when we are older and sharing a cup of coffee, they'll remind me and we'll all laugh about how Mommy used to confuse the bus with the trash truck.

And I'll smile as I laugh and remember the smell of their hair...

Sheila Cason MD

Corneal Abrasions in Children

shesmith00@hotmail.com (Dr. Cason) — Mon, 14 Jan 2008 05:25:00 +0000

A pitiful site isn’t it?

I thought so too! She broke my heart all day long. It started at 3:30 am when she came running to my room screaming, “I scratched my eye! I scratched my eye!”

I pulled her to me and saw that she was rubbing her eye like crazy with the corner of her blankie. I thought that might be the problem but she distinctly corrected me saying that her fingernail scratched her eye and that the blankie was helping. Who was I to argue?

This sounded classically like a corneal abrasion, a scratch or injury to the cornea, the clear surface that covers the front of the eye. It can be very common in kids and presents often with symptoms of eye pain, tearing, and light sensitivity. Because I never delay treatment when it comes to the eye – and neither should you- I took her to go see her Daddy. Lucky for us he’s an Ophthalmologist. We talked all about her fears before we got there: “No, he won’t cut on you. No, there are no shots. No he won’t poke your eye out.” She seemed a little reassured but still clung to me.

It was a relatively easy examination because of the mixture of anesthesia and fluorescein stain drops he put in her eye. I was surprised to see that – no kidding- within seconds she was back to normal. “How long does this last?”, I asked hopefully. “Only about 15 minutes”, he replied. It was just long enough for him to get his exam. The stain allowed him to see the scratch when viewed with a special light. And, as he said, it looked like she’d caught her fingernail on the cornea and peeled a piece of it off like wallpaper. After he prescribed some antibiotic ointment to prevent infection, placed a patch over her eye for comfort, she was my shadow for the rest of the day.

She did great despite my fear that she would cry all day long. My oldest hovered over her. It was such a cute site to see her leading her by the hand. For once there was no fighting! My youngest, however did his best to antagonize her; He kept leaning over and ripping the patch off. Poor thing! But within 12 hours she was feeling better. And by the next day you’d never know that anything was wrong!

Sheila Cason MD

American Sign Language: Fingerspelling E,F,G,H

shesmith00@hotmail.com (Dr. Cason) — Thu, 10 Jan 2008 10:13:00 +0000

H

Here's the next lesson in fingerspelling the alphabet. The girls were all over the place but between the two I was able to get 4 letters! Whew!

Sheila Cason MD

A Faithful Ride

shesmith00@hotmail.com (Dr. Cason) — Wed, 09 Jan 2008 10:12:00 +0000

Looks a little lonely don't you think?

American Sign Language:How to Fingerspell A,B,C,D

shesmith00@hotmail.com (Dr. Cason) — Tue, 08 Jan 2008 09:52:00 +0000

A

B

C

D

That's my girl giving you Mommy MD's first fingerspelling lesson! She's been signing since she was eight months old and loves to learn new signs! Make sure the shapes are crisp and clear and facing outward. Practice in front of a mirror if you want to see how they look to other people.

Sheila Cason MD

Goofing Around

shesmith00@hotmail.com (Dr. Cason) — Mon, 07 Jan 2008 10:22:00 +0000

Back to school and the uniform policy is now being strictly enforced! She didn't seem to mind though. She was all giggles and spunk coming off the bus this afternoon.

That's my little ham!

Sheila Cason MD

Baby's Sensitive Skin

shesmith00@hotmail.com (Dr. Cason) — Fri, 04 Jan 2008 10:04:00 +0000

Baby soaps and lotions always sound so nice, almost irresistible. Even I can hardly wait to use a special product when it claims to give me a delicious smelly baby as well as a calm happy baby who drifts off to dreamland peacefully. But for some babies it can be havoc for their skin. “Soothing” “Calming” “Refreshing”. Even I’m tempted to lather up my children and send them to bed squeaky clean and smelling delicious. In fact, when I mention to some parents to stop the sweet lotion and soaps they look a little dejected. If you’re using these baby soaps and lotions without any problem then keep on using it.

Unfortunately a baby’s skin is so sensitive and prone to rashes you may have to sacrifice the baby perfumes in favor of health skin. A baby can have an allergic reaction to what appears to be the most simple of cleansers, even those labeled just for baby or sensitive skin. Cetaphil liquid soap or a baby’s soap can work well for some babies but there are those few that will break out with even these good choices. If your child is this sensitive here’s what I like to use.

Plain water or a mild bar soap such as Dove for sensitive skin. I also like California Baby shampoo and cleansers.

Follow the bath with a good mild lotion. My favorite is Vaseline Deep Moisture Creamy Formula. Make sure you put it on when the skin is still moist.

Hydrocortisone 1 % cream used twice daily for 3-4 days can be used on reddened areas. Be sure to check with your pediatrician because the rash may a fungal infection and will need different medication.

These three things used in combination can calm most irritated skin. There are babies whose rashes are a sign of eczema and they will need to have their skin cared for by their physician. Make sure you check with your pediatrician for guidance. For now you’ll have to be content to see the pink fresh skin only scented with their natural sweet smell. What could be better than that?

Sheila Cason, MD