|
Pediatrician Alan Greene, a member of the clinical faculty at the Stanford University School of Medicine in Stanford, California, answers a range of questions about infant care, including the keys to helping babies develop strong immune systems. Greene also explores the use of “baby signs” or sign language to help a child’s frustrations in communicating during the so-called terrible twos. Greene offers solutions for teething pains and reassures parents with concerns about their child’s “picky” eating habits.
Q: Does getting water in my baby’s ear cause ear infections? I’ve heard conflicting stories.
 |
|
Also on Encarta |
|
 |
|
|
|
|
A: Water in the ear does not cause ear infections. Ear infections are caused by germs that enter the ear through the back of the nose or throat.
Water in the ear can cause an infection of the skin lining the ear canal, however. This is called swimmer‘s ear, and is very uncommon in babies and toddlers, even those who spend a lot of time in water.
Bacteria normally live in the ear canal with no ill effect. If the ear is wet for a long period of time, the skin can become prunelike in the same way one‘s fingers and toes become soft and wrinkled when waterlogged. Bacteria can easily move into the soft skin. Tiny scratches in the ear canal (usually from sticking a finger or some other object into the ear) also leave the skin vulnerable to infection. The skin can even be breached if the ear becomes extraordinarily dry and the skin cracks. To prevent swimmer’s ear, make sure the ears are completely dry after they get wet. Turning the head back and forth and gently pulling the ear in different directions helps drain water from the ear. Using a towel, dry the opening of the ear very carefully as far as you can reach (never penetrate the inside of the ear with the towel or smaller objects).
|
|
Also on MSN |
|
|
|
|
|
|
To prevent swimmer’s ear, put a few drops of rubbing alcohol in the ear each time it becomes wet. Another good alternative is a few drops of white vinegar; the acetic acid inhibits the growth of bacteria in the skin.
Q: Does giving my daughter acetaminophen (Tylenol) to reduce fever interfere with her body’s natural defenses? It does make her more comfortable, but I wonder if it prolongs her illness by not allowing the fever to “break.”
A: A child’s high fever is always terrifying to parents. Fever as enemy is deeply ingrained in our cultural memory. But far from being an enemy, a fever is part of the body’s defense against infection. While a fever signals to us that a battle might be going on in a child’s body, the fever is fighting for the child, not against.
Most bacteria and viruses that cause infections thrive at 98.6 degrees F (37 degrees C). Raising the temperature a few degrees can give the body an extra edge. In addition, a fever activates the body’s immune system, accelerating the production of white blood cells, antibodies, and many other infection-fighting agents.
Fever treatment is not likely to be helpful if a child is drinking plenty of fluids, is comfortable, and is able to sleep. Steps should be taken to lower a fever if the child is uncomfortable, vomiting, dehydrated, or having difficulty sleeping. Sleep and hydration are also an important part of healing.
If comfort (not sleep or fluids) is the main reason for reducing a fever, the illness may last an extra day—but the whole experience may be more comfortable.
Q: My baby is a very distracted and picky eater. Should I worry about her becoming malnourished?
A: This is a common worry. Feeding our babies is such a core part of our role as parents that we deeply want to know that we are doing it right.
Children’s feeding needs change in response to their activity level, their developmental phase, the air temperature, and the relative humidity, and sometimes because of viruses they pick up. Some days they may need almost nothing, others they may need quite a bit.
Babies are born with a sophisticated internal mechanism for determining just how much food they need to thrive. Healthy babies given the right selection of healthful foods will tend to eat just the right amount, so our job is to provide a healthful selection of foods.
When we force or coax babies to keep eating, they lose trust in their bodies’ own signals. Airplane noises are not needed to encourage good eating habits.
Babies who aren’t getting enough to eat tend to be irritable or droopy. A bright, happy child is a good sign. Babies should urinate regularly. If they don’t urinate in eight hours, it bears looking into. Throughout childhood, their growth will be plotted at regular check-ups to be sure that they are growing on target for themselves.
Q: What tests can be done to find out if my baby has reflux?
A: Reflux is a backflow of liquid in the direction opposite its normal movement, such as the regurgitation of stomach and peptic juices associated with acid indigestion and hiatal hernia.
A barium swallow or an upper-GI X ray can be used to diagnose reflux—if the child happens to reflux during the snapshot. A ragged esophageal lining is sometimes seen between episodes, and that would also be good evidence. A negative test doesn’t tell you anything, however.
A pH probe is more likely to find reflux if it is present. This test uses a probe that rests in the esophagus to detect acid that may slosh there through the course of an entire day. But some kids don’t slosh every day.
Looking directly at the esophageal lining (with a scope) is the most reliable way to detect reflux, but it is also the most invasive. This procedure usually involves snipping a tiny bit of lining to look at under a microscope.
Often the diagnosis of reflux is made based on the patient’s story and a physical exam alone. Improvement of symptoms with reflux treatment adds weight to this type of diagnosis.
Q: Is it useful to teach sign language to a baby?
A: Many of the emotional meltdowns children experience between 9 and 30 months of age spring from their frustration at not being able to communicate. Their ideas far outstrip their language skills. The “terrible twos” are less terrible when children have learned more ways to get across their intense and conflicting thoughts. Baby signs are a wonderful way to do this. Shaking the head or moving the hand is far easier to learn than the intricate manipulation of the lips, jaw, and tongue necessary for each new word. Large muscle coordination is learned before small muscle coordination—at about the same time kids want to express themselves. Baby signs can also speed language development.
These very simple maneuvers create rewarding ways for parents to connect with their children. They make an already magical time even richer, deepening family bonds. As older children get involved, not only can baby signs lessen temper tantrums and frustration in the little ones, but they can ease sibling rivalry as well.
The book Baby Signs by Linda Acredolo and Susan Goodwyn is a terrific resource for parents with children under three. For children who attend schools that use American Sign Language (ASL), ASL can afford the same benefits as baby signs, as long as the signs are simple.
Q: How can I soothe my child’s teething pain without giving her medicine?
A: When they are teething, babies often bring their own hands to their mouths because pressure on the gums brings relief. Massage tends to be more soothing when it comes from someone else, and teething is no exception. A great way to comfort a teething baby is to rub the gums firmly and gently with a clean finger. The first few passes are sometimes a bit uncomfortable, but babies relax as the massage continues.
Chewing cool objects helps teething pain. Wet washcloths or terrycloth toys fresh from the fridge or freezer have been the most popular with babies and toddlers in my practice. Some are delighted with smooth, hard objects, like the handle of a clean hairbrush. I haven’t seen many babies who prefer soft plastic teething rings. Whatever you select, be careful that the object is not something your child might choke on.
If your baby is still uncomfortable, try chamomile tea (or chamomile-containing homeopathic teething tablets or gels). Parents report that these gentle remedies have been lifesavers.
Q: My hospital’s nurse-consulting service says to add one degree to temperatures taken under the arm when I take my baby’s temperature. None of my parenting books mention this. What’s the right method?
A: With temperatures now being taken under the arm, in the ear, in the mouth, and in the rectum, checking for a fever has gotten a bit confusing. For instance, the rectum is normally warmer than under the arm—but how much warmer varies.
When talking to your doctor or nurse, tell them how you took the temperature and what reading you got. They can help you interpret the results.
While 98.6 degrees F (37 degrees C) is considered the normal core body temperature, this value varies among individuals, among different areas of the body, and throughout the day. The daily variation is minimal in children less than six months of age, about 1 degree in children 6 months to two years old, and gradually increases to 2 degrees per day by age six. A person’s baseline temperature is usually highest in the evening. Body temperature, especially in children, is normally raised by physical activity, eating, strong emotion, heavy clothing, elevated room temperature, and elevated humidity. A rectal temperature up to 100.4 degrees F (38 degrees C) may be entirely normal (no fever). However, lower values might be a fever, depending on the child. If you get an under-arm reading over 99.5 degrees F (37.5 degrees C) and need to know if your child has a fever, it is best to retake the temperature using any of the other, more reliable methods.
Q: How can I boost my child’s immunity?
A: Here are the ABCs and the XYZs of maintaining and promoting immune function:
Antibiotics. Avoid unnecessary antibiotics and antibiotic soaps. The more kids use antibiotics, the more likely they are to get sick, with longer, more stubborn infections caused by more resistant organisms.
Breastfeeding. Breast milk is known to protect against gastrointestinal tract infection, otitis media (ear infection), invasive Haemophilus influenzae type B infection (which can cause meningitis, pneumonia, and inner ear infections), and infections of the upper and lower respiratory tracts—even for years after the breastfeeding is done. Kids who didn’t breastfeed average five times more ear infections.
Cigarette smoke. Keep your child as far away from it as possible! Exposure to second-hand smoke is responsible for many health problems, including more than 2 million unnecessary ear infections each year in the United States.
Sleep. Late bedtimes and poor sleep leave children vulnerable.
Vaccines. Prevnar and the flu vaccine are particularly helpful for protecting children from common infections in daycare.
Water. Plenty of fluids support immune function.
Xylito. This is a natural, nonsugar sweetener (found in raspberries and plums) that has been proven to prevent ear infections, sinus infections, and tooth decay. It is available as chewing gum, mints, and in powder form.
Yogurt. The beneficial bacteria in active culture yogurt can help prevent tummy aches, diarrhea, food poisoning, food allergies, eczema, sinus infections, bronchitis, pneumonia, and colds—among other things!
Zinc. Good nutrition (plenty of fresh fruits, vegetables, and whole grains, and supplements where the diet is not adequate) is a foundation for good health. Lack of zinc is the most likely to result in increased infections. A multivitamin is a good safety net.
Q: At her kindergarten physical my daughter had her blood pressure checked. I think it was the first time. Wherever I look on the Internet, I find adult blood pressure readings. What is a normal blood pressure in a five-year-old girl?
A: A normal blood pressure in five-year-old boys and girls would be up to 109/69.
Q: What is the best way to prevent a child in daycare from catching a cold, a cough, or the flu from other children?
A: Infections can be avoided both by decreasing the exposure to germs and by boosting your child’s immunity. Here are six things to check for at your child’s daycare to decrease germ exposure:
1. Class size. A daycare of six or fewer children dramatically decreases germ exposure (and illness), especially in the winter months. Often this is not practical.
2. Hand-washing. We all know it is a good idea, but when a daycare actually does wash children’s and providers’ hands at key moments, the results are spectacular. Key moments? The most important times are after nose wiping, after diapering or toileting, before meals, and before food preparation. Before a child picks his or her nose would be nice but is not quite practical.
3. Instant hand sanitizers. Talk about convenient! A little dab will kill 99.99 percent of germs without any water or towels. A hand sanitizer uses alcohols to destroy germs physically. It is an antiseptic, not an antibiotic, so resistance can’t develop. And here’s the cool part—it’s fun. Many kids think it’s a treat to get to use it! We asked our son’s daycare to try it, and they began washing all those times they knew they should.
4. Paper towels. Use them instead of shared cloth towels.
5. Clean mats. Washing sleeping mats less than once a week results in more infections.
6. HEPA filters. These devices can remove 99.97 percent or more of the pollen, dust, animal dander, and even bacteria from the air. Plants can also be excellent air purifiers (if no one is allergic).
Q: I’ve read that children who drink soy milk have fewer ear infections. Do you think that is true?
A: Of the kids who are prone to ear infections (about 30 percent of all kids), allergies are the underlying cause about 30 percent of the time. Cow’s milk is the most likely nonairborne culprit. Presumably it causes inflammation of the eustachian tubes—the tubes that normally keep the ears clean and drained. It can also change the nature of the secretions.
So yes, many kids who have ear infections would have fewer infections if they drank soy milk. Soy may even promote better ear conditions in some kids who are not allergic to cow’s milk.
Breast milk, of course, is the best drink to give babies if you want to prevent ear infections.
Q: What is intoeing? Do children generally outgrow this condition? Are there remedial treatments later in life?
A: If children’s feet turn inward, they are said to be pigeon-toed or to have intoeing. This may involve one or both feet. Most children begin life with moderate intoeing. Gravity and muscle-use patterns sculpt our bodies over time. When a child begins walking, both the femur (the large bone in the thigh) and the tibia (the large bone in the calf) undergo a gradual process of external rotation that continues for at least six months after the child has been walking fully, and sometimes much longer.
The turning-in can occur at the foot, the tibia, or the hip. It commonly occurs at a combination of these sites. Whatever the cause, discuss your child’s intoeing with your pediatrician, and follow the condition at your child’s well-child examinations. Intoeing is usually part of the dynamic, flowing design of human development. Most likely, you will see the intoeing resolve itself. If not, there are effective treatments available, including surgery later in life if the problem is severe.
Q: My daughter has white patches on her cheeks. Her skin is dark, so I am concerned. She is almost 15 months old. I think she may have pityriasis alba. I have been putting Aquaphor on it. Does this sound right?
A: Pityriasis alba (Latin for “white, scaly patches”) is the most common cause for such white patches. Children develop uneven round or oval patches, especially after sun exposure. The patches are dry with very fine scales. They are most common on the face (cheeks), neck, upper trunk, and upper arms of children 3 to 16 years old.
These patches are completely benign and are similar to a mild form of eczema. They are most common in children with dry skin. The involved patches don’t darken with sun exposure the way the surrounding skin does. Treatment involves daily lubrication with a good moisturizer (such as Aquaphor), especially whenever the skin gets wet. Sometimes mild topical steroid creams, such as those with 1 percent hydrocortisone, help.
Even with no treatment at all, however, pityriasis alba spots will disappear on their own—although it may take months to years. Some people get pityriasis alba every summer during childhood. Even then, the pigmentation will eventually end up normal.
If this doesn’t sound like what your daughter has, tinea versicolor is another common cause, although it is usually found in older children. This is similar to athlete’s foot and is treated with an antifungal medication or a selenium shampoo, such as Selsun Blue.
With both pityriasis alba and tinea versicolor, the white patches will persist for a while, even if the condition is effectively treated. It will take at least several weeks for the newly healthy skin to adjust its color to the amount of ongoing sunlight exposure so that it will match the surrounding skin.
At your daughter’s upcoming 15-month exam, it would be wise to ask the doctor about the patches and get a diagnosis just to be sure.
Q: Part of my job as a case manager includes educating parents about what it means to have a pediatrician and how to use our health-care system. What is the role of a pediatrician and what should parents expect from a good practitioner?
A: Pediatricians are physicians who are dedicated to helping parents raise happy, healthy children. After graduating from four-year programs at medical schools, we take at least three years of additional hospital residency training devoted entirely to children’s health.
Pediatricians perform routine well-child physical exams throughout a youngster’s childhood. By following children over time, we are able to track their growth and development. Thus we can make recommendations tailored specifically to the needs of the family and child. At each well-child visit we make sure that a child is on track. Then, we tell parents what they can expect in the months ahead, helping them enjoy significant childhood milestones, be prepared for common problems, and prevent the most likely injuries in their children’s lives. We also take time to answer questions.
In between these visits we are available for questions, for sick visits, and for emergencies. Having one physician follow a child’s care can stop important health issues from falling through the cracks. Different pediatricians fulfill these goals with different styles and different levels of availability. It’s important for parents to have a pediatrician who fits with their family so that everyone understands one another well.
Q: I was given a medical form for enrolling my child in school and was puzzled. What is a UA test? Why is it needed? What would a normal reading be?
A: The UA test is a urinalysis. Many aspects of the urine are tested. On a school form, the normal result would be “negative” or “normal.” We check the urine as a screening test to look for chronic infections (not all urinary tract infections have symptoms), diabetes (sugar in the urine), kidney problems (protein in the urine), and a host of other things. Many conditions will show up on a UA.
Appears in
Immune System; Infancy; Pediatrics
|
Hotmail
Messenger
My MSN
MSN Directory
Appears in