Press Release :
AUGUST 2004
JULY 2004
MAY 2004
MARCH 2004
APRIL 2004
AUGUST 2003
AUGUST 2004
Q : School is starting. How do I get my kids to bed early? During summer they don't go to bed until after 10p.m.
A : Children, even more so than adults, are creatures of habit. Significant deviations from established routines can create stress, poor sleep, and other behavior issues. Returning to school can also induce significant stress, so establishing your desired sleeping routine well before school starts will allow for any reactions to bedtime change to occur before school begins.
Some parents find their children can make the transition to the desired bedtime in 1-2 days by simply waking them early and sending them to bed at the desired time. This approach is quick but may not work for all children. For those who need a more gradual approach, try sending them to be 10-15 minutes earlier each night, and awaken them a corresponding amount earlier than usual until you reach your desired bedtime. Before deciding which approach to use, think about your children and how they respond to change: do they "go with the flow" and respond to rapid change easily, or do they need a more gradual approach to change?
Remember, many children do not get enough sleep. The average school age child needs 9-11 hours of sleep per night; teenagers need even more. Keep this in mind as you set your children's bedtimes.
Q: My daughter will be starting junior high in the fall, and with the added homework load I know she will have many textbooks. How can I make sure that she doesn't injure herself with her heavy backpack?
A: Take the following steps to minimize the chance that carrying a backpack will cause your child back pain or other health problems. First, limit the weight your child carries in a backpack to 10-15% of her body weight. Purchase a backpack with a waist strap to provide extra support and more balance for the weight. Backpacks with padded, wide shoulder straps and a padded back are also a good idea. Avoid single strap bags, and encourage your child to wear her backpack over both shoulders. If the backpack is simply too heavy, have your child use a backpack with wheels. If your child experiences back, neck, or shoulder pain during the school year don't assume that it is caused by her backpack. Children with severe or persistent pain should be evaluated by their pediatrician.
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JULY 2004
Q : My 2-year-old daughter never wants to wear her bicycle helmet. She says it is not cute on her. What do I do? Does she have to wear it if we are just going a short way?
A: It is a good idea to use a bicycle helmet even when a child is riding a tricycle. Children learn by example and habit, and it is much easier to enforce use if a helmet is started from the ' beginning. Also, although the risk is not high, there is still a risk of head injury with even a tricycle. As for any fashion concern, there are many kid helmets that are both comfortable and cute. And don't forget to wear a helmet yourself, as this will speak louder than words (or fashion).
Lori Walsh, M.D.
Glenbrook Pediatrics
Q: My 1-year-old is prone to earaches. Anything I can do?
A: Ear infections are common in infants and toddlers. The symptoms can include fever, ear pain and difficulty with eating and sleeping, usually in a child who already has a cold. Ear infections occur year round, but are more common in winter when cold viruses are more common. Some children are more susceptible than others to developing ear infections.
There are some things you can do to help decrease your child's risk of ear infections. Breast feeding for as long as possible can provide immunity to infections, and has been shown to decrease the risk. Avoiding exposure to tobacco is also helpful. There is some evidence that pacifier use promotes ear infections, so minimizing this may help.
Children in large group day care contract more colds and ear infections. If your child is suffering from frequent . infections, and is in day care, he may benefit from being in the smallest group setting possible. Children with older siblings also have more frequent ear infections for the same reason. Fortunately, they also experience many benefits from having those big brothers and sisters around.
In some children, this problem is greatly improved with surgical placement of ear tubes. Talk to your pediatrician about this option if the infections continue to occur.
Mary C. Hall M.D.
Glenbrook Pediatrics
Q: Why does my child need a booster seat?
A: Car accidents are the leading cause of death and serious injury among children between the ages of 4 and 8 years, claiming more than 500 lives each year. Recent studies show that fewer than seven percent of children between the ages of 4 and 8 years are placed in booster seats while in the car, despite current recommendations to do so by the U.S. Department of Transportation and the American Academy of Pediatrics.
Children outgrow a convertible car seat when they weigh 40 pounds and are about 4 years of age. But they are still too small for lap-shoulder belts to fit properly. When a child who is restrained with a poorly fitting belt becomes involved in a car crash, the lap-belt tends to ride up onto the abdomen, resulting in potentially serious injury to the internal organs or spine.
The solution to this problem is the regular use of a booster seat during driving for children weighing between 40 and 60 to 80 pounds (usually between 4 and 8 years of age). Boosters should be used in the back seat with a lap-shoulder belt. The state of Illinois has recently passed a law requiring that all children under 8 be properly restrained during driving, which includes the correct use of a booster seat. Additional information on child passenger protection is available from the American Academy of Pediatrics at www.aap.org.
Corrie Goergen, M.D.
Glenbrook Pediatrics
Questions for Pioneer Press from Glenbrook Pediatrics July 13, 2004
Q: I am confused about when to use acetaminophen and when to use ibuprofen for fever and /or pain in my children. Can you help?
A: Acetaminophen and ibuprofen are the most frequently used over the counter medicines for fever and pain in children yet there have not been many studies comparing them in terms of efficacy or side effects. A recent study showed that both drugs seem to work the same for pain such as dental and sore throat pain but that ibuprofen does a better job of reducing fever and it is longer lasting ( 6 hours versus 4 hours for acetaminophen). Whether either drug helps a certain type of pain or whether by dosing them regularly versus on an as needed basis seems to make a difference, is unknown.
In general, pediatrics has a longer track record with acetaminophen but ibuprofen is widely used in children older than six months. Despite the unknown, here are some good rules: 1. Always take the proper dose at the proper interval. Keep a record if necessary. 2. Don't alternate acetaminophen and ibuprofen. Although this is done, there is no good evidence that it is safe. 3. See your doctor with any concerning symptoms with fever or if it persists for three days. Any infant less than six weeks should not take any medicine but should see a doctor with any temperature greater than 100.5 rectally. 4. Ibuprofen should be taken with food. 5. All medicines should be kept out of the reach of children. 6. See what works best for your child.
Lori A. Walsh, M.D.
Glenbrook Pediatrics
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MAY 2004
Q : My husband and I just had a baby. Is it safe to travel out of the country with our newborn?
A: Many Americans travel internationally for business or pleasure. With careful planning, international travel with an infant can be a safe and enjoyable experience.
Before embarking on your trip, consult your pediatrician about your child's health. Make sure he has received all the recommended immunizations for his age, and carry a copy of his immunizations with you, as well as relevant medical records. Children should carry identifying information in their own clothing, in case family members become separated.
Air travel is safe for healthy newborns. If your child has a chronic heart or lung problem or recent respiratory illness, however, consult your pediatrician. All children under 2 should sit in a car seat to avoid injuries during turbulence. Continue to use your car seat for ground transportation during your trip.
Infants are at increased risk for diarrhea transmitted by contaminated food and water. These illnesses occur in developing countries with inadequate water treatment and sewage systems. Breast milk is an excellent source of sterile nutrition, and also will help your child recover more quickly from diarrhea. Use only bottled water to prepare infant formula and food. Wash hands frequently, as well as all pacifiers and toys. Packets of oral re-hydration solution can be purchased and brought along in case your infant develops diarrhea.
If you are fortunate enough to be traveling to a sunny climate, you will need to protect the baby's skin. Use lightweight clothing and a hat, and avoid being outdoors in midday sun. It is safe to use small amounts of sunscreen to protect exposed skin. Likewise, if you will be in a mosquito-infested area, use protective clothing and avoid mosquitoes as much as possible. Insect repellents should not be used in children less than 2 months old. Excellent additional information about health issues in particular countries is available at www.cdc.gov.
Mary C. Hall, M.D.
Glenbrook Pediatrics
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MARCH 2004
Q : My family and I are heading to Costa Rica in March. What kinds of shots do we need to get, if any?
A: Travelers to Costa Rica and other developing countries encounter infections not typically seen in the United States. The first step in preparing for the trip is to assure that everyone in the family is up to date on the usual immunizations. A physician visit at least four to six weeks before the trip is recommended to review health records and update standard immunizations.
Hepatitis A is a common food borne illness in Central America An effective vaccine for Hepatitis A is available for adults and children over 2 years old. It is given in two doses six months apart, but partial protection is provided within two to four weeks after the first dose.
Children less than 2 years old should receive immune globulin to protect them from hepatitis A. They are protected immediately after the injection and the effect persists for three to five months.
Other food borne illnesses can be avoided with careful food preparation. Eat only well cooked food, and fruits and vegetables that you have peeled yourself. Drink only bottled or boiled water. Avoid tap water and ice cubes. Avoid dairy products unless you know they have been pasteurized.
A number of insect borne illnesses are present in Costa Rica The most well known of these is malaria. The Centers for Disease Control Web site (www.cdc.gov/travel/) is an excellent source of information regarding malaria risk in different areas of a given country.
If you are traveling to a malaria infested area, you will need to take a medication to prevent malaria infection. Even if you are not traveling to a malaria infested area, it is important to avoid insect bites.
Bring along an insect repellent that contains DEET (diethylmethyltoluamide) and apply it daily to exposed skin. It is safe to use DEET in children older than 2 months of age, but children should use repellents containing less than 10 percent DEET
Wear long sleeves and long pants, especially in the evening. Wear shoes at all times.
Travel to Costa Rica is a wonderful opportunity for your family to enjoy the tropical climate and learn about another culture. These simple precautions will help ensure a healthy and enjoyable trip.
Dr. Mary Hall
Glenbrook Pediatrics
Q: My five year old is still wetting the bed. What can I do?
A: Bedwetting, or enuresis, is a common problem in young school age children. It affects about 20 percent of 5 year olds, with about 15 percent of those achieving control with each additional year of age. Boys are affected more often than girls by a 3:2 ratio.
Most children with enuresis have nighttime symptoms only. (Children having daytime difficulty with control or painful bladder contractions may have urinary tract abnormalities and should be evaluated by a physician.)
Enuresis is believed to reflect a less mature neurologic control of bladder function. It is more frequently seen in children with smaller bladders and who sleep very deeply. It is easy to understand how the combination of a small bladder, deep sleep and less control can lead to leakage.
It is also clear that most children with enuresis are not lazy, they simply sleep through the signals that normally awaken us and don't have the space or neurologic control to hold the urine.
Because most children with enuresis will improve with age, treatment should be considered only when the child experiences stress or embarrassment. Most pediatricians would not recommend intervention until the child is at least 5 years of age.
Available treatments for enuresis have shown only limited success. Medications can control symptoms, but most children relapse when the medication is stopped.
A variety of alarms are available to alert the sleeping child of wetness; these have shown the best results and the lowest relapse rates. Talk with your pediatrician about these options if you and your child are ready.
Dr. James Olson
Glenbrook Pediatrics
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APRIL 2004
Q: My little girl keeps getting warts. What can I do about it?
A: Children frequently develop warts. Warts are caused by viruses, and thus are somewhat contagious. The two types of warts children usually experience are the common wart and molluscum contiagiosum. The common wart usually is solitary, and has an irregular shape and a scaly surface. The warts can vary in size, but generally are the size of a pencil eraser, and may be found anywhere on the body. Planter warts are common warts located on the bottom on the feet, which tend to grow inward and can be painful due to the weight bearing function of the feet. Planter warts develop a lot of callous skin around the wart, so they appear larger. Four treatments exist for the common wart: Over-the-counter wart medicine, cryotherapy (freezing), cantharidin and surgery.
The over-the-counter wart medicine includes salicylic acid. The medicine is applied to the wart with a brush, and then a piece of duct tape is put over the wart during the night. Another option is a patch that contains the. medicine. I prefer the brush with the tape over the patch, because you have more control over the application of the medicine.
These approaches take about two to four weeks with daily applications, but are less painful than other options. -
Cryotherapy is when a doctor freezes the wart with liquid nitrogen, and the wart falls off about seven to ten days later. However, the process can be painful to some degree.
Cantharidin is a liquid medicine applied by a doctor that will blister the wart, which then falls off in seven to 10 days. At the time of application, it is without pain, but pain can occur in 24 to 48 hours.
Mottuscum contogtosum are small flat smooth warts, a little larger than pinpoints, slightly raised and occurring in groups. They can be found on the torso, genital areas and extremities.
Molluscom contiagiosum can be left alone, and will go away in 1 1/2 to 2 years. If you wish to remove them, cantharidin or surgical removal is the best option.
Warts occur frequently, but can be traumatic to children due to cosmetic reasons. Warts tend to reoccur even after appropriate treatment, thus requiring multiple treatments to the same warts. Just remember that warts will ultimately go away.
Patrick Gries, M.D.
Glenbrook Pediatrics
Q: My newborn keeps getting diaper rash. What can I do?
A: When diaper rash is present, keep the area clean and dry with frequent diaper changes. Expose your baby's bottom to air as much as possible; for example, keep the diaper off during naps.
Stop using baby wipes; instead rinse your baby's diaper area with water with every diaper change (a squirt bottle of water can be good for this). Do not remove diaper cream that is already present, as you will remove healing skin over the rash as well. Wash the skin with a mild soap only after bowel movements, then rinse well. Soak inflamed skin in warm water for 15 minutes each day.
If your infant has a mild diaper rash, use an ointment containing zinc oxide, such as A and D, Balmex or Desitin. Vaseline combined with Desitin and comstarch in a 1:1:1 ratio is also an effective barrier mixture.
If your baby has diarrhea, use a diaper cream containing an ingredient to neutralize acids from the urine and stool that can irritate your child's skin. Examples of this include: Maalox and zinc oxide cream mixed in a 1:1 ratio, acid mantle cream or Sensicare cream (available over the counter, but behind the pharmacy counter; ask your pharmacist for acid mantle or Sensicare).
Avoid talcum powder due to the risk of pneumonia if inhaled by your baby. If you suspect a yeast diaper rash, a cream such as Lotrimin (purchased over the counter) can be applied beneath the
barrier cream. Consult with your doctor before using any antifungal cream, as use when the diaper rash is not due to yeast can promote future resistance.
Bring your baby to see your pediatrician if the diaper rash is not improved in three to four days, if the rash looks infected (yellow pus, blisters, rapidly spreading redness or red streaks), if your child
begins to act sick, or if you have any questions.
Dr. Corrie Goergen
Glenbrook Pediatrics
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AUGUST 2003
Glenbrook Pediatrics/ Lori Walsh, MD Responses to questions for Pioneer Press August 15, 2003
Q: My 16 year old daughter wants to get her ears pierced. Is it safe to go to a store in the mall?
A: The major issues to consider when piercing ears are:
1. Sterile technique and equipment. The ear piercer should wear gloves, use alcohol to clean the area and use sterile or one time use only equipment. Most earrings for piercing come sterilized and prepackaged for individual use.
2. Obtaining a pre- piercing history of eczema, allergies to metals or a history of keloid scarring. For the former, certain metal combinations should be avoided and for the latter, ear piercing may need to be avoided depending on the history.
3. Proper placement of the earring on the ear lobe so that it is even as well as in a part of the ear that can support a heavy earring. (you never know how styles will change)
Ear piercing stores at a local mall usually do a fine job of carrying this out.
Q: My 12 year old daughter no longer wants to drink milk. She thinks she'll gain weight. Is it OK for her not to drink milk anymore?
A: Milk is the major source for most Americans of their daily calcium and vitamin D . If your daughter stops drinking milk she should take calcium supplements of 1200mg and vitamin D of 400 mg per day to provide enough to support healthy bone deposition. She is at an age of peak bone formation and she would be at risk for osteoporosis, a disease that speeds up bone loss as she gets older. It might be worth finding our why your daughter doesn't like to drink milk. Is it the taste? Is it a misconception that skim milk is fattening? Does it upset her stomach? Many of these issues can be overcome with education, dietary ideas such as adding a bit of chocolate, changes to 1% milk if skim is too bland or using lactaid milk for an upset stomach that may be from a deficiency of a milk digestive enzyme or changing to a soy or rice based milk fortified with vitamins D and calcium.
Q: My toddler is still sucking his thumb. Should I be worried?
A: It is perfectly natural for a toddler who has sucked his thumb in infancy to continue into the second year. It is a comfort to a toddler as they progress through many stages and changes (ie wean from the bottle, learn to walk, begin to talk, learn how to separate). It does need to be weaned at some point (usually before the fourth birthday or so) because of the structural rearrangement it has on the palate. A behavioral approach when a child is cognitively able to understand the process around 21/2-3 years can work well with a lot of parental encouragement.
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