Things Your Mother Told You That Were Wrong

Written by Herschel Lessin MD

My first appointment of the day is a visit I enjoy immensely: the first well baby visit for a new mother and her newborn infant. At this visit, new mothers and very often new fathers, will have their first interaction with the Pediatrician. They usually come loaded with questions. After all, babies don’t come with an instruction manual. Despite the many books on the market that try to serve as one, there is nothing like a dose of reality to make the entire process seem nothing short of overwhelming.

EVERYONE IS AN EXPERT

If you’ve ever been pregnant or had children, you’ve undoubtedly noticed an odd phenomenon. People who normally wouldn’t even consider giving unsolicited advice about your personal life seem suddenly unable to suppress their desire to tell you all the secrets of delivering and raising a healthy and happy child.

Most of the advice is very good and will work very, very well. A lot of it, however, falls into the category of “Old Wives’ Tales”.

TO WHOM DO YOU TURN?

One does not have to be an old wife to pass along an old wives’ tale. In fact, a lot of what people call “common sense” is not really very sensible. As a parent, you must make decisions that affect your children’s lives, and yours as well. It is one of your many jobs as a parent to filter through the enormous amount of well meaning advice you receive and decide which of it is useful and effective.

Your Pediatrician ought to be of some help here. A large part of pediatric practice is the giving of advice that helps parents cope with the thousands of small day to day challenges that this new young person in their lives will bring. Your doctor should be ready, willing and able not only to dispense such advice, but to comment on advice given by others and found in the media (including the Internet). My job as the Pediatrician is to give you a convincing reason why my advice might be better than your mother’s.

OLD WIVES TALES ABOUT FOOD

The care and feeding of children is a fertile area for unsolicited advice. Feeding a child has an emotional impact that is often way out of proportion to the problems involved. This is easily understood, since if we can’t even feed our children, what kind of parents are we? The wonderful truth is that our kids seem to survive and thrive no matter how we try to feed them. Now I am not talking about families in which poverty prevents children from getting enough to eat. I am talking about middle class families where this is not an issue. Here are a few pieces of advice you ought to ignore:

If you don’t force a child to eat, he’ll starve. NOT TRUE.

Young children generally eat when they are hungry, rarely overeat, and refuse food only when it they honestly don’t want it, or if it upsets their parents enough to be fun. Never fight with a child over food. You will lose.

Early introduction of solids will make a young infant sleep through the night. NOT TRUE

Infants generally do not want or need solids prior to around 4 months of age. They will sleep through the night when they are good and ready. Giving them a few spoons of cereal at bedtime which contains perhaps 20 calories will not put them out for the night.

You shouldn’t give a child with a cold, milk because it causes phlegm.

Unless your child is one of the few that are actually allergic to milk, there is no truth to this one. If your child with a cold wants milk, give it to him. No harm done.

OLD WIVES TALES ABOUT FEVER

Fever and illness is another fertile area for bad advice.

“Feed a cold, starve a fever…” or is it “Starve a cold and feed a fever?” It really doesn’t matter, since both are wrong. Good nutrition is important to all children, especially sick ones. One should maintain the best nutrition possible, regardless of colds or fever. If a child has a stomach bug, some degree of dietary restriction is often suggested, but a quick return to good nutrition is always the goal.

A high fever is dangerous.

While the disease that causes the fever may indeed be dangerous, the fever itself is not. A fever in a child that is acting well is rarely a cause for alarm. The only exception to this is in the case of heat stroke, where the body’s sweating mechanism is not working. Then body temperature can rise to 107 or higher which is a danger all by itself. In the absence of heat stroke, the temperature will not rise more than 106, which while very scary, will not, in itself cause harm. A high fever can be an indication of a serious underlying illness, so high fevers should always be discussed with your Pediatrician.

Parents are constantly asking me if it is OK to give their feverish child a bath. It is OK. A lukewarm bath may help lower the temperature and may make the child look and feel better. So bathe away — it’s not a problem. Just don’t let the child get so cold as to shiver. That will raise his internal temperature and make him feel worse.

You must keep a head injured child awake. Not Always

If your child has a head injury that is severe enough to cause loss of consciousness, it is severe enough to seek immediate medical attention. If your child has a minor head injury, it is often normal to be sleepy, but not unconscious. Trying to keep such a sleepy child awake will only make him feel worse. One should check such a child frequently to make sure he is arousable, and always call your doctor for further instructions after any significant head injury.

OLD WIVES TALES THAN CAN CAUSE HARM

While most old wives tales cause only anxiety, a few can cause harm. The most common one is the advice to put something greasy like butter on a burn. This is dangerous. Grease will hold the heat inside the skin, deepening the burn and making it more severe. If your child is burned, the first thing to do is to get something cool, but not freezing, on it. This will reduce the heat and minimize the damage.

Poison ivy is dangerous if it involves the eyes.

Old wives’ tales also wrongly tell us that some very mild things are dangerous. Poison ivy on the face may cause swelling of the eyelids, but while this is very uncomfortable, it will cause no lasting harm. Oh, and by the way, poison ivy is caused by oil found on the plant. Once it is washed off, you cannot spread poison ivy by touching the affected areas.

Another worry is that one should not let a child cry because that will cause him harm or he’ll choke. This is not true. The only one harmed by prolonged crying is the parent listening to it.

COLICS

There are few things in life as miserable to live through as the first 3 months of life with an infant who has colic. The old wives will tell you that there is something that you are doing to cause the colic or that there is a real medical problem. Once a good physical examination has ruled out organic illness, you should realize that not only is it NOT your fault, no one has any idea what causes colic. It is extremely common, and that there is very little anyone can do to make it better. It will, however, magically go away after the baby is 3 months old, if you live that long.

A FEW MORE PIECES OF QUESTIONABLE ADVICE

Over the years, I have heard of more complaints and illnesses attributed to teething than almost any other cause. Some facts about teething. First of all, it rarely is severe enough to wake a child up at night out of a sound sleep. If your child is up at night and has a cold, think ear infection, not teeth. Teething does NOT cause fever. It does not cause congestion or mucus and it does not cause diarrhea. It can make an awake child irritable and is best dealt with by either occasional use of rub on anesthetics or by giving a dose of acetaminophen by mouth.

Another thing new parents are often told is: “Don’t pick the baby up all the time, you’ll spoil him!” This is absolutely wrong. Young infants need to be picked up a lot in order to have normal psychological development. As they get older, they can be spoiled, but rarely by paying attention to their legitimate needs.

I am also amazed at how important it is for people to have their children be “regular.” Perhaps it’s the influence of all those laxative commercials. Being regular is of no importance to young children. Most children will find their own pattern and timing of bowel movements, from once a day to once a week for some infants. Going once a day is not special.

I’ll finish up with feet. I’ve never understood why so many grandparents feel that if you let a young infant stand up, he’ll get bow legs. He won’t. And believe it or not, buying an infant an expensive pair of shoes will not prevent flat feet. Aside from the fact that all infants have flat feet, this is rarely, if ever, a problem at any age as long as the foot is flexible. In any case, shoes make absolutely no difference.

CONCLUSION

Bringing a new baby into your lives is an exhilarating and exhausting experience. It can provoke a great deal of anxiety. I encourage new parents to seek out advice from any source of support that you can find. Just be sure that the advice is good advice, so you don’t fall victim to old wives’ tales.

Dr. Lessin has been practicing Pediatrician in the Hudson Valley since 1982. He is a founding partner and serves as both Medical Director and Director of Clinical Research at the Children’s Medical Group

Important Fever Facts For Parents.

Today's post comes from Dr. Kerry Frommer Fierstein, MD, FAAP. Dr. Fierstein is a practicing pediatrician. Born in the Bronx and raised in Queens; she's  a New Yorker all the way. She works at Pediatric Health Associates, PC, a division of Allied Pediatrics of New York. 

In a recent article the American Academy of Pediatrics reviews the facts and fiction that surround fever in children and reminds nurses and pediatricians to better educate parents about fever.

Important fever facts:

The following information does not apply to infants under three months of age for whom you should contact your pediatrician urgently for any temperature of 100.4oF (38oC) or higher.

• There is no “normal” temperature. 98.6 is an average and many children will normally run a little higher or a little lower. In addition, throughout the day, a given child’s temperature will vary by as much as a full degree.
• Fever can be helpful in fighting infections. Fever slows down the growth of viruses and bacteria while activating our immune system.
• Higher fever does not necessarily mean a more seriously ill child. Most fevers, no matter how high, are brief and not dangerous. However, if your child has a fever greater than 101 degrees Fahrenheit for more than 48 hours you should see the doctor to discover the cause of the fever.

Fevers do not cause brain damage or death. Children with fevers above 104 degrees are not at increased risk of problems because of their temperature (the one exception is heat stroke, which usually occurs from over activity in warm weather.) Fevers can cause “febrile seizures” but these types of seizures, though scary to watch, do not cause any permanent effects. Furthermore, there is no evidence that Tylenol (acetaminophen) or Motrin (ibuprofen) use will reduce the risk of fever seizures.

Parents should remember:

• The #1 reason to bring down your child’s fever is to make him/her more comfortable.
• It is not necessary to wake your child to give him/her fever medicine.
• Look at your child, not the thermometer. If your child is drinking, quietly playing, or sleeping, do not worry about fever. If your child looks poorly and is too weak to drink, he/she should be seen by the doctor regardless of the temperature.

This was originally posted on the Survivor- Pediatrics Blog - http://survivorpediatrics.wordpress.com/

What Can I Do to Prevent Swimmers Ear in my Children?

This article appears AAP News Vol. 32 No. 6 June 2011, p. 34 

Swimming is a great way for kids to stay active, especially during the summer months. However, the combination of heat, humidity and water can lead to an ear condition called acute otitis externa, more commonly known as swimmer’s ear.

The infection often is caused by bacteria being carried into the outer ear canal. Symptoms of swimmer’s ear include redness, swelling, itching, drainage of pus and pain.

Following are some tips from the Centers for Disease Control and Prevention to prevent and treat swimmer’s ear:

Keep your ears as dry as possible.

• Use a bathing cap, ear plugs or custom-fitted swim molds when swimming to keep water out of ears. 

Dry your ears thoroughly after swimming or showering.

• Use a towel to dry your ears well. 
• Tilt your head and hold each ear facing down to allow water to escape the ear canal. 
• Pull your earlobe in different directions while the ear is faced down to help water drain out. 
• If water is still in the ears, consider using a hair dryer to move air within the ear canal. Be sure the hair dryer is on the lowest heat and speed/fan setting, and hold it several inches from the ear. 

Don’t put objects, including cotton-tip swabs, pencils, paperclips or fingers, in the ear canal.

Don’t try to remove ear wax. It helps protect your ear canal from infection.

• If you think the ear canal is blocked by ear wax, consult your pediatrician rather than trying to remove it yourself. 

Consult your pediatrician about using commercial alcohol-based ear drops or a 1:1 mixture of rubbing alcohol and white vinegar after swimming.

• Drops should not be used by people with ear tubes, damaged ear drums, outer ear infection or ear drainage (pus or liquid coming from the ear). 

Consult your pediatrician if your ears are itchy, flaky, swollen or painful, or if you have drainage from your ears.

© 2011 American Academy of Pediatrics. This information may be freely copied and distributed with proper attribution.

Vision Screen – An important part of your child’s wellness

We often encounter parents that think that children only need check-ups when they are due for vaccines. Although vaccine preventable diseases are an important part of the wellness checkup, there are many more things to evaluate, test and screen that are equally important in assessing a child’s health.

Among them are vision screens, which are often an overlooked aspect of child’s development. Eye examinations and vision assessments are vital for the detection of conditions that result in problems with school performance or in some cases, life-long visual impairment. Early detection of treatable eye disease in infancy and childhood can have far reaching implications for vision, learning and social development and, in some cases, for general health.

The American Academy of Pediatrics as well as the American Academy of Ophtalmology recommend that "examination of the eyes should be performed beginning in the newborn period and at all well-child visits."

Because children do not complain of visual difficulties, vision screenings in an important part of the complete pediatric eye care.

At Salud, we perform two different types of vision screen. The first one is the most common and one that probably you are familiar with, which is the vision acuity screening. This is the one where shapes and letters are displayed on a chart and patients stand about 10 feet away with one eye covered reading the letter or shapes.

The other vision screen we perform is more high-tech. We conduct the Enfant Pediatric VEP Vision Testing System which is a child-friendly, non-invasive medical device that does not require sedation or dilation. This high-tech device gives us an objective method to test children as young as six months of age for visual defects such as optic nerve disorders, amblyopia (also called lazy eye), and conditions that can lead to amblyopia.

As always, if you have any questions about these tests, feel free to call our office. If your question is a little more involved and you have a specific question about your child, you may need to make an appointment to discuss further your issue.

At the very least, it is great piece of mind to know that your child has perfect vision which will allow him/her to reach their maximum potential.

What Does A Pediatrician Do During a Sports Physical?

Recently, on our practice’s Facebook page, we posted an update reminding parents to schedule their sports physicals.

A parent jumped on and asked what goes into a sports physicals. He mentioned that in the past, his kids' sports physical only consisted of a height and weight.

Dr. Betancourt responded to the inquiry that gave some insight as to what a sport physical entails. Below is her reply:

Sport participation examination should be lots more than measuring weight and height. During sport participation we make our best attempt to identify potential risk factors that can affect a student performance. We do this by obtaining a thorough history --both personal and family history -- and a complete examination.

It is not unusual to find a significant family history event such as an early death in family members. This prompts the pediatrician to refer the student for a complete cardiac evaluation and a "cardiology clearance" ought to be issued before participation is permitted.

Some physical findings can be clues of genetic syndromes that involve cardiac and great vessel disease, like Marfan Syndrome (very tall kids, look perfect for basketball!!!). Also, during this evaluation, the doctor should make sure that complete rehabilitation has been completed from previous injuries so the athlete does not injure him/herself more.

There is not, to the date, a formal recommendation to routinely perform an EKG or an echocardiogram to all students, but it is left to the discretion of the doctor to perform it if there is a cardiac risk factor identified.

But, with any test, there is a percentage of normal patients with no identified risk factors that can still have a potentially life threatening condition not caught by the "sport participation" exam... just like a stress test may bring up symptoms of coronary disease, but a normal stress test would not guarantee the patient would not still have an ongoing ischemic disease.

Oh, and I almost forgot! We also update the student immunization and talk about avoidance of risky behaviors.

All in all I think it is very worth it!