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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.

Newborns do a lot of strange movements and behaviors that quite often scare parents. What are normal newborn reflexes, and when should parents worry?

The first one most parents know and call the startle reflex. It's technically called the Moro reflex. Parents often tell me it's when their baby gets scared, but that's not really the reason. Babies don't get scared as newborns. It's due to their nervous system response to a sudden change in sensory stimulation.

And it's a good thing, actually. In fact, it's able to be seen on ultrasounds when a mom is only 16 weeks pregnant, and a baby's own cry can even stimulate it. It lasts until babies are about 2 to 3 months old.

So when should you worry? Well, if you had a difficult labor and there was concern that your baby might have had some oxygen deprivation, then an exaggerated Moro reflex could be concerned for something called hypoxic-ischemic encephalopathy. Basically, the brain is hurt by having the oxygen supply cut down.

Neurologists can help evaluate and treat this, and the good news is it's picked up really closely after birth. And if there's any concern, your baby will be in the intensive care unit really quickly for a full evaluation. If your baby is otherwise in the normal newborn nursery and goes home, there's a good chance this is not what your baby has.

Another normal reflex is the suck or rooting reflex. And that's just what it sounds like. It's basically what helps the baby learn to find a food source and eat. This reflex doesn't start until about 32 weeks of pregnancy, which is why preemies have such a hard time learning how to eat. This reflex is fully developed at about 36 weeks.

Now, when parents see this, they automatically think their baby is hungry and often that's true. It could be that it's just the reflex and they suck on their fingers and hands as a self-soothing behavior. I see a lot of parents trying to force their babies to eat and then the babies get over-full and throw up.

Then there's the tonic neck reflex. We call it the fencing reflex because they have one arm outstretched and one bent and they're about to say, "En garde!" Some parents worry that there is a problem because both arms aren't in the same position or both arms aren't being used the same way at the same time. But this is normal, and it can last until they're about 7 months old.

Finally, this isn't a reflex, but it's something parents ask me about all the time at the newborn checkups. It's called periodic breathing. Babies do this weird thing where they look like they're breathing really fast, then they can hold their breath for up to 10 seconds, and then they take a big breath in and then they're back to normal breathing. And it can happen when they're sleeping or when they're awake. And it usually lasts until they're about 6 months old.

Babies' lungs are still developing and their brains are still trying to figure out how to send messages to the lungs to remind them to breathe. Basically, they are still trying to figure out this whole breathing thing and breathing patterns. And it looks scary, but it's normal.

So when should you worry about your baby's breathing? If they're consistently breathing more than 60 times a minute, if they're having retractions where it looks like their stomach muscles are sucking in under their ribs, if they are making grunting noises with each breath, or if they hold their breath for more than 20 seconds and turn blue, those are not periodic breathing, and that needs to be evaluated right away to see if your newborn's oxygen is low. Depending on how severe the symptoms are, the best place for your newborn to be evaluated for breathing issues may be the emergency room.

One last thing. What about those eyes? Well, babies have very little control over their eye movements right away. That's why they always look at you cross-eyed. They're trying to figure out how to control their eye movements and learn to focus on things.

Also, it's not uncommon for a baby to roll their eyes when they're sleeping or when they're almost asleep, like when they're going to sleep or trying to wake up. But this should not be the norm. If they are not rolling their eyes but doing more of a rhythmic back and forth, something called nystagmus, that is absolutely not normal.

If your baby rolls their eyes often, that is not normal. If your baby's eyes roll and your little one also has stiffness in their arms or legs or has shaking that doesn't look like the startle reflex, that could be a seizure and that's an immediate trip to your local children's emergency room.

Many things can cause seizures in a new baby, including low blood sugar, low calcium levels, metabolic diseases, or brain abnormalities, in addition to epilepsy and high fevers. Your child will probably be admitted to the hospital and see a neurologist for tests to determine why they are having these weird movements and possible seizures.

So while a lot of these normal behaviors look concerning, they are often just part of your baby adjusting to being in the outside world. If your baby has any of the not-so-normal behaviors I talked about, please have them see their pediatrician right away or go to your closest pediatric emergency room.

Today, I'll discuss some questions I get about crying children.

So let's start with babies. Babies cry a lot. Babies cry because they have no other way to communicate. Babies cry when they want a clean diaper, they cry when they're hungry, they cry when they're tired, they cry when they're in pain, they cry when they're over stimulated and want to be left alone, they cry when they're scared. Basically, again, they cry a lot.

Babies from 2 weeks to 3 to 4 months cry even more sometimes because they are in the period of purple crying. They can cry and cry for what seems like no reason at all, and it's actually a normal developmental stage.

Then, on to toddlers, they cry mostly because they're trying to figure out their emotions. It seems like they are very stubborn and negative. And you can tell because their favorite word is "no," but they're learning how to get what they want. They're learning that if they're told no and they cry, sometimes they'll get what they want. Sometimes they won't. And it's almost as if they start training you as parents to give in to their cries to keep them quiet. Yes, toddlers are sneaky that way.

This is where trying to reason with a toddler is like trying to reason with a pet rock. You can talk to them, but they're hardheaded and often don't listen. Trust me, you'll get through that phase. Just be patient and do everything consistently. And eventually, they'll come through.

School-age kids cry too. Often, again, because their feelings are hurt or their bodies are hurt. These are legitimate tears. School-age kids cry for a reason. And often, they can tell you why. And this is good because they are learning the communication skills they didn't have as toddlers. As a parent, you know you can help them through whatever is causing their hurt.

Teenagers, well, often they'll either cry all the time or they'll hold their emotions in and never cry. Teenagers are harder to decode, but if you keep the lines of communication open with your teen, then when they do show emotion, you'll be able to start having more in-depth and maybe even adult conversations with them and try to help navigate them and navigate what is bothering them as they struggle through the teenage years and become those young adults we all want them to become.

Every age and stage has their own reasons for crying. If you have concerns about your child's crying, go ahead and ask your pediatrician. Chances are we've heard your concern before and are usually able to help.

It's been an issue for several weeks now, parents scrambling to try and find baby formula amid the shortage. So what are you supposed to do? You have a hungry baby who needs to eat.

Like many women, I was unable to completely provide enough breast milk to feed my boys. Trust me. It wasn't for lack of trying to increase my supply with supplements, medications, pumping, working with my OB and five lactation consultants. And we learned, for me, I have a medical condition that just won't allow me to make as much as my kids needed, so I had to supplement. And I find this is often the case for many of my patients' mothers.

Often, some women just choose not to breastfeed, and they want to just give formula. And that's okay too. Most important is for the baby to be fed and loved.

So what exactly happened to cause this formula shortage? The manufacturer of Similac products, Abbott Nutrition, recalled powdered formula brands due to bacterial contamination in some of their batches. This, combined with supply chain issues, triggered a nationwide formula shortage.

For families that were affected, this has triggered a lot of questions about what to do. The easiest thing that parents can do is to just switch to a different infant formula. I know that sounds scary, but many store brands and other brands, like Enfamil and Gerber, have formulas that are equivalent to Similac.

Most babies do just fine on a cow's milk-based formula, and there are a ton of variations for whatever your babies might need — gentle formulas, formulas for soft bowel movements, formulas for breast milk supplementation, formulas with extra ingredients to help with digestion and brain development. There are so many options out there.

I often recommend generic or store brand formulas because they're cheaper, but they still have the same nutritional quality as the brand names. We used generic versions of gentle formulas for both of our boys and found they actually tolerated them better than the brand names.

What if your baby is on a special formula, like for milk protein allergy or prematurity? The good news is these formulas really aren't affected by the shortage as much. Your pediatrician can help figure out what is best for your baby in those situations. There are milk banks where women who have excess breast milk donate their milk, and that's a great source for babies who are preemies. Neonatal intensive care units often work with milk banks to get milk for preemies. The milk is strictly screened and totally safe.

What about mixing infant formula differently to make it last longer? This is a big fat no. Adding extra water to make diluted formula is bad. I've seen it happen more than once, where parents do this and it has actually landed their babies in the intensive care unit. What happens is that too much water upsets the balance of salts in their body because the babies' kidneys can't process that much water. That causes the babies' sodium levels to drop to the point that the babies have seizures, and it could be fatal.

Babies will not get the correct amount of nutrients if the formulas are diluted. That is why we have specific instructions on how to properly mix formulas.

What about all of those homemade baby formula mix recipes? Those aren't a good idea either. While, in the past, people made their own baby formula, that was before we had a really good handle on the specific nutritional needs of infants. And those homemade baby formulas don't provide the right concentration of nutrients that we now know babies need. Some babies have even been hospitalized after being given homemade formulas.

Finally, what if your baby is close to turning 1? Can you start milk early? Well, it depends on how early. Babies actually need the nutrition that is in formula until they're 12 months old. I would say that if they're within two weeks of turning 1, you can start transitioning to whole milk. Transitioning before that puts them at risk of iron deficiency anemia because milk has no iron in it. Also, once they start drinking milk, they need to limit their consumption to 16 to 24 ounces per day, or they could develop iron deficiency anemia as toddlers.

Parents often ask what milk kids can have if they don't want to give their kids cow's milk. Luckily, there are a lot of alternatives. Soy and pea milk are the most similar to whole milk in terms of nutrition. They can also have oat milk or nut milks, like almond or cashew milk. Plant-based milks are good for calcium and vitamin D, but they may not have the best nutrition when it comes to protein, fat, and calories, things toddlers need from ages 1 to 2, as their brains are still developing. And other milks, like goat's milk, can cause pernicious anemia due to vitamin deficiencies.

The good news is there are reports that the formula shortage should start to improve in a few months once the factories get the okay from the Food and Drug Administration to resume production. Until then, hopefully, parents are able to find alternatives.

It seems there has been a big increase in the number of children being diagnosed with sensory disorders. One reason may be that kids with sensory issues actually have other diagnoses, such as ADHD, anxiety, PTSD from abuse, and autism, just to name a few examples. Other times, some kids may just be sensitive to some things but not others and don't actually meet the full criteria. It has only recently been added to the psychiatry diagnosis textbook, the DSM-5.

Sensory processing disorders are basically where kids are sensitive to sounds, textures, or other stimuli to the point where it is beyond normal childhood behavior and causing a disruption in the child's life and also in the life of the family. Any of the five senses, taste, touch, smell, sight, and sound can be affected. Often children with sensory issues also have poor fine motor skills or have a hard time with social cues and interactions. They have a hard time regulating their emotions.

One study shows that sensory processing disorders affect 5% to 15% of school-aged children. Another study showed that there may be a biological cause with abnormalities in the white matter of a child's brain that could explain sensory issues.

Some children are hypersensitive to things and may think everything is too loud or too bright. They are the ones who are covering their ears often or have a low pain threshold or are super picky with eating certain textures. They have a hard time focusing and controlling their emotions, and they don't like to be touched. Other children are hyposensitive and they crave input, trying to get more sensory input. They're more likely to have a high pain threshold, put things in their mouths, hug too tightly, invade other people's personal space, or rock and sway.

One big issue is that there is still so much to be learned about sensory processing disorders. Your pediatrician can suspect your child has a sensory processing disorder but cannot actually make the diagnosis. Again, there are so many other brain issues that can present with similar symptoms so it takes a developmental or a behavioral specialist or even a neuropsychologist to get an official diagnosis. Your pediatrician will refer your child to someone who can help do a full and complete evaluation to get the correct diagnosis. The mainstay of treatment for sensory processing disorders is occupational therapy. Occupational therapists can help kids and parents learn ways to manage their sensory needs.

If you have concerns that your child may have a sensory issue, please talk to your child's pediatrician and ask them for a referral to a specialist who can get them the right diagnosis and treatment.

So we've been dealing with COVID for a while now, and we are seeing kids who have what we call long-hauler symptoms. So what are these and is there anything that can be done?

In general, kids do pretty okay with COVID. Some have mild symptoms, some get pretty sick but recover after a week or two, and some kids have no symptoms at all. But more and more what I'm seeing are kids whose parents are saying, "I didn't know it would be this bad," or, "Why are they still having symptoms?"

Unfortunately, no one can predict who will develop long-haul COVID symptoms. There is a study out of England that shows that up to 15% of kids up to age 16 will still have symptoms five weeks after they initially test positive for COVID.

Long-haul symptoms can happen in kids who have minimal or no symptoms or in kids that have severe symptoms. That's the tricky thing with COVID. It doesn't follow any rules and it seems to do whatever it pleases on its own time frame.

So what are the symptoms of long-haul COVID? The most common are fatigue, brain fog or difficulty concentrating, breathing issues, chest, joint, or muscle pain, chronic cough, and headache. We also see changes in the sense of taste or smell, mood changes, or lightheadedness when standing up.

I know. It seems like anything can be a symptom of long-haul COVID. And not all of those symptoms can be attributed to having had COVID in the past.

How is long-haul COVID diagnosed? Well, that's tricky too. There are no specific tests that can be done. Your pediatrician can rule out other conditions and will usually refer your child to a specialist if their symptoms persist. But there are no good tests.

We have no idea how long it will last, we don't know what causes it, and we don't know what the treatment will be other than supportive care and treating your child's symptoms as best as possible. But there is no cure.

As we continue to move forward with COVID, hopefully we will have more answers as to how to help long-hauler symptoms. Until then, treating your child's symptoms and getting them set up with specialists to help with their specific medical needs is the best we can do.

Parents will often bring their kids in to see me for skin issues, and I also get a lot of phone calls about rashes. Well, the hard part is I can't see your child's rash over the phone. Rashes are one of those things that your pediatrician will need to see in person or through a video visit in order to determine what the cause of the rash is and what to do about it.

Babies and diaper rashes are one very common concern. Babies get diaper rashes very easily, even within days of being born, because their skin is super sensitive. In fact, their skin is not fully developed until about 6 months old, which is why we say no sunscreen or bug spray until then.

Babies are also in diapers and they pee and poop a lot. Diaper rashes are basically contact skin issues due to the diaper fibers and due to the normal body chemicals and bacteria in the urine and stool.

Some babies are okay with just having diaper rash cream put on their bums. Others get more like burns. We used to even make our own diaper rash cream for our older son. His skin was so sensitive we joked that he would get a diaper rash if we looked at him wrong. We ended up using burn cream mixed with zinc oxide for him.

Parents often ask which diaper cream I recommend. My answer? Whichever works for your baby. I don't have a personal preference, and some creams work better for some babies than others.

If the diaper rash is red and bumpy, though, that's a yeast diaper rash. It's more in the front of the diaper area and less on their bottoms. Any over-the-counter yeast cream can help with that.

Then there are dry skin issues. Every winter, I have parents bringing their children to me for an all-over body rash that can be itchy. That's often either just dry skin dermatitis or eczema. For both, start with a cream that says "dry sensitive skin." And you can try mixing a little over-the-counter hydrocortisone with it and apply it twice a day for a few days.

Some kids with really bad eczema end up needing prescription creams, and that's when a trip to your pediatrician is needed.

There are all sorts of rashes. Most are viral, some are bacteria, but for all other rashes, it's best to have your child seen so we can check it out and see what treatment is needed.

Viral rashes need no treatment. They'll go away on their own. Bacterial ones sometimes just need topical antibiotics, but sometimes need a prescription for oral antibiotics.

If you have a concern about your child's skin, go ahead and bring your child in to see their pediatrician. Chances are we've seen your child's rash before and are able to help.