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So your daughter comes to you and says, "It hurts to pee." Is it automatically a urinary tract infection? Not so fast. Girl parts are super-sensitive, especially between the ages of potty-training to puberty, and there could be a few things going on. So how do you know what the problem is?
Diagnosing UTIs in Children

First, your daughter would need to be seen. We cannot diagnose urinary tract infections in girls over the phone. We need them to actually come into the office and pee so we can do a urinalysis test. That will show if she has a UTI or if she's dehydrated and her burning with urination is due to concentrated urine.

It will also show if there is blood in the urine or any signs of diabetes as well, which doesn't cause burning with urination, but does cause frequent urination, which is another sign of a possible UTI.
Treatments for UTIs in Children

If your daughter does have a UTI, we can treat her with antibiotics while sending her urine off to get a culture at the lab and find out what type of bacteria is causing her UTI and make sure she's on the correct antibiotic.

If your daughter does not have a UTI, then we need to ask a few more questions, like is she drinking enough water? Does she take bubble baths? Is she wiping too hard? Is she wiping at all? Is she wiping in the right direction? Does she have any vaginal symptoms? And yes, we have to ask if anyone has touched her inappropriately down there.

Based on those answers, we can talk about treatments. Will drinking more water help? What about cranberry juice? Which may or may not help, depending on what's going on. Does she need any special creams for her private area? Does she need to work on better hygiene? If she is sexually active, do we need to test for chlamydia or gonorrhea? Is this not a urinary issue but more a vaginal issue?
What NOT to do for Your Child's UTI

Everything is in such a small space in that area that it can be hard to figure out what is going on and what the correct treatment is.

I've had parents ask me about certain home remedies that I can tell you, you should not do. Don't do the following. Don't have your daughter douche to clear out the UTI.

Similarly, I had one mom tell me that she was told to soak a tampon in probiotic kefir and insert it in her vagina to treat a UTI. Neither of those will help because a UTI is in the urinary system and inserting something into the genital system won't help. Just because they're in close proximity doesn't mean that they are treated the same.

Don't put random creams in or on your daughter's privates without finding out what the main cause of her symptoms are. Sometimes, that will make the problem worse.

And don't give antibiotics that were left over from a previous infection, because not all antibiotics will treat urinary tract infections.

So if your daughter has girl-part issues, please bring them in to be seen by their pediatrician. We can help you figure out exactly what is going on and what is best to help them feel better.

Parents often ask me when I will be able to tell if their baby can see normally. That's hard. But vision screening is something that we do at well-child visits if your child does not already see an eye doctor. Today, I'll discuss the basics of vision screening in kids.
Vision Screening for Children Under Age 3

For children under age 3, any vision concerns need to be referred to a pediatric ophthalmologist, who is a medical doctor who treats eye issues. Some optometrists, who are doctors of optometry, or ODs, will see kids as young as 6 months old, but not usually.

Now, as pediatricians, we look at the eyes of kids starting at birth. We look to see if they have congenital cataracts, if their red reflexes are good. You know, when you take a picture of your kid and they have really bright red pupils, that's actually a good thing. We'll see if they have lazy eye or any other eye concern for which we need to have them see a specialist. But it's hard to check in the office to see if they need glasses at that age.

The American Academy of Pediatrics last updated their vision screening guidelines in 2021. We start doing vision exams at well-child visits starting at the age of 3. I usually tell kids at their 2.5-year well-child visit that when they come back to see me at 3, we'll have them play a picture game with my medical assistants.

It's actually the screening for visual acuity, which is to evaluate to see if they need to see an eye doctor for possible glasses. But a picture game sounds a whole lot more fun.
Vision Screening for School-age Children

Kids up until age 4 normally have 20/40 vision, and by age 5, they will have 20/30 vision. After that, their vision should be 20/25 or better. 20/20 is what most people know as normal vision, and that's what they should ideally have by age 6.

Often, the schools will want a child's vision screened before kindergarten. They will also do vision screening in the schools periodically. The parents will be notified if their child fails their vision screen, and we can repeat the vision exam here to make sure of the results, especially if the screener at school did not document on the letter what the child's visual acuity was.

Then we can help the family find an optometrist that can do a more in-depth vision evaluation and see what kind of glasses the child may need.

The forms that the schools send home usually require a signature from an actual optometrist to prove that the child saw an eye doctor. As pediatricians, we are not qualified to complete those forms and they will be returned to the parents if we fill them out. So if your child gets one of those forms, they do need to see an actual eye doctor.
How Often Should Your Child Have Their Vision Screened?

We recommend that a child has their vision screened at least once a year. That's why we do them at the well-child visits, which also happen once a year.

If your child wears glasses or contacts, the optometrist will let them know how often they need to be seen. Normally, it's still every year to make sure their prescription has not changed.

If you have any questions about your child's vision, talk to your child's pediatrician and we will evaluate what we can and let you know if your child needs to see an optometrist or an ophthalmologist for further testing.

Eating disorders have been around for a very long time, but they have skyrocketed in recent years. A recent report from the Centers for Disease Control and Prevention found that emergency room visits for mental health issues have increased at an alarming rate for kids aged 5 and up just since 2020. This is not just for anxiety and depression, but it seems that eating disorders are also increasing, especially among teen girls.
Why Eating Disorders are Increasing in Children

Why? Researchers who are studying the trends think that lack of structure in the daily routines of teens, emotional distress, and even fluctuations in whether families had food available or not, all contributed to the increase.

Eating disorders can develop at any time, but we see it most often in teens and more likely to be girls than boys. The National Eating Disorders Association reports that the rate of eating disorders has risen by 119% in kids under 12 just in the last few years, and anorexia is now the third most common chronic illness in teens only behind asthma and obesity.

Kids who are predisposed to anxiety, such as having a strong family history of anxiety or depression, seem to be more prone to eating disorders. Some clinical studies by psychologists also indicate that teens who spend more time on social media may be more at risk because they can exacerbate poor body image and constantly bombard kids with diet trends, and those can trigger eating disorders.

Teens with eating disorders often compare their bodies to peers and can feel bad about themselves if they don't have what they believe to be the perfect body.
How to Know if Your Child Has an Eating Disorder

So what are some signs to look out for if you think that your child may be at risk for an eating disorder? Well, look for behavioral changes. Kids, when they are struggling with body image issues, will often isolate themselves, withdrawal from social activities or seem overly sad or angry.

Some big behavior changes that parents should watch out for according to the National Alliance for Eating Disorders is hiding food, eating in secret, starting a new diet, obsessing over physical activity, or going to the bathroom every time after eating a meal.
Next Steps if You Think Your Child Has an Eating Disorder

The first step, if you think your child might have an eating disorder, is to make an appointment with your child's pediatrician. We can check their height, weight, and body mass index and look for any alarming trends. If there are concerns, we can do labs and possibly an EKG.

If the labs and EKG are reassuring, then the next step is to get a psychiatrist involved. If the labs or EKG are not okay, then your child may be admitted to the hospital to medically stabilize them while they start working on treatment options for their eating disorder.

A psychiatrist needs to be involved because these are brain-based illnesses with biological, psychological, and social components, not just something your child chooses to do usually.

Parents need to educate themselves too. Some good resources are the National Eating Disorder Association, Project HEAL, and the National Association of Anorexia Nervosa and Associated Disorders, also FEAST.

Your child needs their feelings and struggles supported, and with the stigma of shame around eating disorders that can make the problem worse. This is a disease that affects entire families. There is help out there. Your pediatrician is the first place to start. But be aware this is not something your pediatrician will manage. It involves a lot of therapy and work with a mental health provider.

Needle phobia. It's something that as a pediatrician I see every day, several times a day. At least two-thirds of children have a fear of needles. It's hard to tell who is worse with it though, little kids or teenagers.

Unfortunately, vaccines are still given as shots at this time, and kids get a lot of shots to help build their immune system. At the mere mention of being due for vaccines or blood work, some kids will just burst into tears.

So what can you as a parent do to help when your child is due for a vaccine or needs blood work done? I always will tell parents and kids at the well visit before they are due for vaccines that the next time they have a checkup, there are shots involved.

Mainly, I do this to avoid surprises. Often parents will say that they had no idea their child was due for shots. So when I tell the kids, they remember the next time and that actually seems to help them be better prepared. It's the surprise "you need a shot" announcement that catches kids off guard more and their anxiety goes through the roof.

Parents also feel better knowing that they can tell their child that, "We talked about this," and that they can prepare their child in advance, not spring it on them on the drive to the office or once they get here.

One thing we as pediatricians ask that you don't do is tell your kid that if they don't behave, they'll get a shot. I hear that all the time as a scare tactic and it really bothers me. I'm not going to give your child a shot if it's not needed.

If you tell your child in front of me that I will give your child a shot if they misbehave, I will tell your child that I don't give shots for behavior, but I do have time out spots in the clinic.

And for the teenagers, if they get out of hand, we do have security officers who can help with behavior outbursts. And yes, sometimes that has been needed when the teenagers become violent.

Kids often will ask me if the shots hurt. Well, they are shots. They're not fuzzy caterpillars. Same with the needles we use to draw blood. I tell kids that, "Yes, they hurt just a little, but it's over quickly," and, "We have to use the needles, but for a good reason," and it's to make sure that they are healthy.

I try to be upfront and honest with the kids. Even little kids understand when you tell them the truth in a calm manner and explain why we are doing what we are doing.

I had a vaccine one day and I saw a patient later who was afraid of getting a shot. I showed her my Band-Aid and she was so surprised. She was like, "But you're the doctor." And I said, "Yes, I am, and I sometimes have to get shots too." She then said if I was brave enough to get one, then so was she.

I also tell kids when they're old enough what vaccines they're getting and why they're getting them. I ask if they have any questions about the vaccines, and that seems to help them understand the importance of the vaccines.

Same with the blood work. I explain everything to them so that they know I'm not ordering labs just because I want to torture them. It's because I'm trying to figure out what is going on in their bodies and how to make them healthier.

I also have the advantage of telling kids and parents that my medical assistants are who I trust with my own family and who I trust to draw my blood and give me any immunizations. So they know that they're in good hands.

I let them know that I don't like getting needles poked in me either, so they know they're not alone and that I get it.

I talk directly to the kids so they know they're heard and we are doing what we can to make this as easy an experience as we can. And they know that they get a sticker when they're done for being so brave, no matter how old they are.

So while needle phobia is a real thing, there are ways as parents that you can help make immunizations and blood draws less scary, which goes a long way when the kids are here in the office.