Search for tag: "pediatrics"

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.

Parents will often come into well-child visits with their little ones and are shocked to learn that their child is due for shots, or they're pleasantly surprised to find out their child doesn't need any shots. So here are the basics on when kids are due for childhood immunizations.

This is the schedule from the Centers for Disease Control in conjunction with the Advisory Committee on Immunization Practices, which help set out the schedule based on a ton of research.

First, it's the hepatitis B vaccine, and that's normally given with the vitamin K shot at birth.

The next set of vaccines is given at 2, 4, and 6 months old. Now, this will seem like a lot of shots, but it's designed to give babies the maximum protection against bacterial and viral illnesses that hit infants and toddlers most and provide protection after they lose the natural immunity they got from their mothers through the placenta before birth.

At the 2-, 4-, and 6-month well-visits, they get three shots and they get one oral vaccine. The shots are Pediarix, which is a combination vaccine containing DTaP for diphtheria, tetanus, and whooping cough. It also contains hepatitis B and polio.

The second is Hib, for Haemophilus influenza type B, which can cause ear infections and meningitis, a bacterial infection of the lining of the brain and spinal cord, which can be fatal.

The third is Prevnar, and that protects against streptococcal pneumonia bacteria that cause ear infections, meningitis, pneumonia, and infections of the bloodstream.

The oral vaccine is called RotaTeq and protects against rotavirus, which is a nasty viral infection that causes vomiting and diarrhea severe enough to hospitalize babies due to dehydration. This is a virus that I saw a lot when I was in residency. The vaccine didn't come out until just after my oldest son was 4 months old. The first dose has to be given before 3 months old, so he didn't get it. I was pregnant with him when I caught rotavirus after being on the inpatient service and he got it at 5 months old. It was definitely not fun.

At 9 months, unless it's influenza season, babies get a break from shots, but they are still due for a well-visit.

The next well-visit is at 12 months. At that age, they get their fourth Prevnar, and then they have completed that series. They also get their first hepatitis A vaccine and they get vaccines to protect them from measles, mumps, rubella, and varicella, also known as chicken pox.

Then at 15 months, they get the DTaP and the Hib again, which completes the Hib series.

And at 18 months, they get the second hepatitis vaccine and complete that series.

Then we give kids a break again.

The next vaccines are what most parents call the kindergarten shots. We give them at age 4, but they can be given any time after age 4 and before the child starts kindergarten. The schools will need documentation that your child has had these when you register them.

The kindergarten shots are combination vaccines also, which is good because, again, it means fewer pokes for more protection.

The first is Kinrix, which is DTaP and polio. The second is called ProQuad, which is measles, mumps, rubella, and varicella. This finishes the polio, measles, mumps, rubella, and varicella series.

The next vaccines are given at 11, and many parents call these the junior high vaccines.

Now, let me clarify. There are current recommendations to start the HPV, human papillomavirus vaccine, at age 9. That is a new recommendation that is just now being put out. The HPV vaccine protects them from a virus that causes warts and cancer in the mouth, throat, and genitals. It's the one that causes cervical cancer in women, and one of the biggest causes of oral cancer in men.

The other junior high vaccines include the first dose of Tdap, which is the adult dose of tetanus, diphtheria, and whooping cough. The P stands for pertussis, which is whooping cough.

And people still need them every 10 years pretty much for the rest of their lives. This is the one that everyone asks about if they have a puncture wound. The whole "if you step on a rusty nail, you have to have this vaccine." Yeah, it's that one.

They also get one for meningitis groups A, C, W, and Y. There are several brand names for this vaccine. Menveo is the one we give at our clinic. This vaccine protects against the Neisseria meningitidis bacteria that causes meningitis. They get the second dose at 16.

There is an additional vaccine for meningitis group B that some teens need for college. It can be given from ages 16 to 23.

So those are the basic vaccines, the ones that are needed for school specifically. Of course, there are always other vaccines like for influenza and COVID.

Also, if you are traveling outside of the United States, there may be other vaccines you need to visit other parts of the world. For those, you would be best to check with the health department or a travel clinic of your local hospital, as your pediatrician would not have those vaccines at their office.

If you have any questions about any of these vaccines, please talk to your child's pediatrician.

A lot of commercials will tell you that your child needs special vitamins or supplements, or they won't grow properly or have the best brain development they can. But what vitamins or supplements do healthy kids really need? Well, the answer might surprise you. Even if they're a picky eater, they don't need special vitamins, supplements, or nutrition drinks.

Many of us grew up on chewable vitamins. I know I did. That's what parents did. I remember taking a daily chewable Flintstones vitamin every morning as a kid. And I was kind of a picky eater too, but I never had a problem growing.

We really don't see vitamin deficiencies in the United States like in some other countries. Everything seems to be fortified in our stores. Cereals provide a good balance of vitamins and minerals. Milk has added vitamins A and D. Even orange juice can be bought with extra calcium.

Yes, ideally, kids should have a balanced, healthy diet. They should have at least three servings of dairy, five servings of fruits and vegetables. They should have protein from meats and eggs and beans, and they should eat whole grains.

Often, parents will think that their child has fatigue or anemia, look pale, or be so picky that they aren't getting enough nutrients. Most kids, unless they are having excessive dairy intake, do not have iron-deficiency anemia. Toddlers can, but again, that goes back to the milk intake.

If they have true fatigue or pallor, your child's pediatrician can do blood tests to see if they are anemic.

For other vitamins, we do not routinely do blood work to check those vitamin levels unless there is an underlying medical reason for checking them. Also, insurance companies often will not pay for those extra tests either.

If your child has a lot of eating restrictions, say, due to food allergies, digestive or genetic conditions, which cause problems with digestion, or autism, then a daily vitamin would be a good idea. Same with if they are on a vegan diet.

If your child just isn't eating a good variety of foods because they want to eat fast food or junk food a lot, then it's more a matter of getting your kids to understand that this is not healthy eating and work on the eating habit rather than letting them continue their food choices long term. Instilling a good relationship with healthy foods when kids are little will help encourage them to eat more healthy their entire lives.

If you do give your child vitamins or supplements, be sure to follow the dosing guidelines exactly. Some vitamins and minerals can be bad in doses too large for children. Make sure your kids can't just help themselves to the vitamins. They come in tasty forms now, and kids may think they're more like treats and they should be treated more like medicine.

Also, make sure your child is a little bit older if taking chewable vitamins. They can be choking hazards for kids under 4.

Basically, the bottom line is most kids don't need extra vitamins and supplements. They need encouragement and education on eating a good variety of healthy foods.

Nutrition from food itself is better absorbed than that from a tablet. Start them off eating healthy. Don't fall for those cute faces that beg and plead for fast food or cookies or candy all the time. It's okay if they don't eat sometimes because eventually they will, even if only healthy foods are offered.

And stay strong. It's hard, but if you stick with teaching your kids about healthy foods, you will teach them a lesson that will help them for the rest of their life.

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.

Parents often wonder if their baby is lazy. I have parents use that term all the time. If their child isn't doing everything they think they're supposed to be doing, the parent labels their child as lazy.

For example, I have parents telling me a lot that their 12-month-old is lazy because they're not walking. Your child isn't lazy. Walking can start any time from 9 months until 18 months.

Parents will tell me their child is lazy because they want to be fed. If your child is under 18 months old and still learning how to use utensils, that's not lazy. They're just still learning. If they're 4 and they want you to feed them, that's not laziness. It's them being manipulating and trying to get you to do what they want.

Parents will also ask me about why their child isn't talking. They think that their 18-month-old should be saying sentences and instead only says about five words. Well, the biggest language explosion happens between 18 months and 3 years old. By 18 months, they should be saying four words, in addition to mama and dada. Boys tend to talk later than girls too. Not sure why, but that tends to be what I see. Girls tend to be more social. Boys tend to develop their motor skills faster.

I get the opposite too. Some parents think their children are developing completely normally when, in fact, they're behind on motor or speech milestones. This is one reason we do the autism screening at 18 and 24 months, to catch those kids that are behind and determine: Is this expressive speech delay? Are there not enough opportunities for motor development? Is there a concern for autism? Does the child have a different diagnosis that requires evaluation by specialists?

Now, I'll end with this as a heads-up. There was a recent article published in the "Journal of Pediatrics" outlining about how developmental guidelines for the first five years of life needed updating, and the Centers for Disease Control just adopted these new guidelines.

It will take a little while for everyone to catch up with these new guidelines when pediatricians do their screening evaluations at well-child visits. But we have a general good idea of where your child should be. As pediatricians, we are really good at figuring out if your child is on track developmentally, or if they need to see a specialist for a speech or motor developmental delay.

If you are concerned about a specific developmental issue with your child, be sure to discuss it with your child's pediatrician.

Emotional support animals are a common request in doctor's offices lately. What are emotional support animals really? And what should you know before you request paperwork?

At least a few times a month we're getting asked to write letters for patients for their animal to be allowed in the home as an emotional support animal. While a pediatrician or a family doctor can legally write these letters, we can only do so if there is a clear mental health diagnosis that we are actively managing. Sometimes your pediatrician may refer you to a licensed mental health provider to get an accurate diagnosis and write your letter.

Not all primary care providers are comfortable writing emotional support letters, especially if we are not involved in managing the diagnosis. Please don't ask a doctor who has never met your child to write the letter for you. We can't. There are certain specific criteria for what constitutes a diagnosis that qualifies your child for an emotional support animal.

One thing parents need to understand when they are asking for a letter, they are now claiming that the animal is not a pet. The letter will have to be written to show that the purpose of owning the animal is that the animal will help with symptoms of mental illness that their child has. An emotional support animal is not covered under the Americans with Disabilities Act. That requires additional training and certification, and they would need to be qualified as a service animal in order to be covered under the Americans with Disabilities Act.

A letter from your doctor will not guarantee that your request will be accommodated as it will only state that your child has an emotional disability and that the pet helps calm their symptoms. An emotional support animal is not a service animal. You can't just take it wherever you want. Often parents are wanting the letter so the child can have their animal with them if they move, but they may also want a waiver of the pet fees in their new housing location.

While a landlord needs to allow the animal in the home with that letter, the landlord may or may not grant a waiver of the pet fees. Also, please don't ask a doctor to write a letter for you when you do not yet own the animal. Remember owning an animal is a huge responsibility. There's training, feeding, cleaning up poop, and vet bills for routine care, sick visits and all those vaccines that are required. You need to be able to properly care for an animal.

If you cannot give that animal the best care and love it deserves, then it would be best to find other ways to help your child treat their mental illness. I get it, I'm a hound mom myself, and I know how much snuggling a puppy can help after a stressful day. I know how much comfort my boys get from our dog when they are having a hard time.

However, it is very important to understand that emotional support animals are technically a form of therapy. The letters need to come from the provider who is addressing the child's mental health needs, usually a therapist or psychiatrist. If you have questions about emotional support animals, you can ask your child's pediatrician, but please understand if we think it best if your child's mental health provider write the letter.

Well-child visits are still happening during COVID. What can you expect during your child's visit?

When COVID first hit hard, the American Academy of Pediatrics had a big concern that came true for a lot of pediatric providers -- well-child visits would come to a screeching halt. We also became concerned that there would be outbreaks of diseases again due to kids, especially babies, not coming into the office to get their vaccines.

Well, the good news is, in most cases, your doctor's office is probably one of the safest places to be outside of your house. Every office is different, but most of us are trying to divide the waiting room into sick and healthy sides. At check-in, every person is asked screening questions to see what area they need to wait in and also to make sure if someone is sick, that our staff takes appropriate precautions.

Only one parent is allowed in a visit per child. Parents are informed of this when they schedule the appointments, and I know we welcome the parent who couldn't be in the clinic to be involved in the visits through FaceTime. I've actually done two visits today where the parent who couldn't be in the visit was involved via FaceTime, and we were able to have a great conversation. Everyone is wearing eye protection and surgical masks also, and if there are concerns about COVID, we have complete PPE gowns and respirators that we wear.

We disinfect chairs, table, and toys in between each patient, and I have several rooms, so we are able to let the room sit for about 15 minutes to let the disinfectant dry by rotating which rooms we have patients in. We have separate exits for the patients who do not need to go back to the front of the clinic, and there is abundant hand sanitizer. We also have strict precautions for when we think somebody has COVID in terms of letting the room settle with the droplets, cleaning everything including the floors, and using special filters to cycle the air through.

What about virtual well-child visits? Some providers are doing them that way if there are no vaccinations needed. Others are doing only in-person. It's best to check with your pediatrician's office to see what they're doing.

So the next question is, how do you know if your child is due for a well-visit? Well, at our office, we do what is called outreach, meaning that our computer people can generate a list of all the kids that are coming due for well-visits or shots. We call and send letters reaching out to those families to have them schedule appointments. Not all offices have this ability though. If you're not sure if your child is due, please call your pediatrician's office, and they can let you know if an appointment is due and help you schedule at the same time. Your child's health is very important to your pediatrician. Please be sure to keep up with all of their necessary visits during this crazy time.

Dr. Gellner: You are in need of finding a new pediatrician whether it's because you're expecting your first child, you moved to a different city, your insurance has changed, or your previous provider has left their practice. It can be a pretty stressful situation. But I'll let you know some tips to help make this a little easier.

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Dr. Gellner: Finding the person you like and trust to help you raise your child, take care of them in sickness and in health, it can be tricky. The first thing I would say to do is to ask people around you who have children. Who did they see? Do they like their pediatrician? Do they like the staff at their pediatrician's office? Is the location close to you? Are their hours convenient?

I can't tell you how many new patients I get that come in saying, "You see my neighbor's kids or my family member's kids." It's actually quite humbling and an honor as a pediatrician to know that so many parents speak highly of me.

Next, call your insurance company. Do the pediatricians whose names keep coming up amongst your friends take your insurance? Doctor bills can be expensive, so make sure you pick a pediatrician in your network.

I then look them up online. Most practices not only have a short biography about their provider outlining what their education is. They'll also say if they're board certified. Do they have a particular area in medicine that they really like to practice? For example, my biography points out that my areas of expertise are preventive care, childhood obesity, and allergy and asthma management.

The biography also should give you a little insight into their personal life, like what do they like to do when they're not working. You might find that someone has a particular hobby that you do as well, which makes for a great icebreaker when you go in for your first appointment. Many of my new patients lately have been from Texas. And when they see I did a lot of my education in Texas, it's an instant connection. When you look them up online, also look at their reviews. What do other parents say about that provider?

Finally, when you've done all your homework and you've found someone who you think would be a good fit for your family, schedule a visit to establish care when your child is ready for a well visit or if they're sick or if they have a chronic condition that needs long-term care. Use that visit to see how this provider interacts with your child. Do they talk to your child as well as you? Is your child comfortable? Does your child leave with a smile on their face even if shots are involved in the visit? If you have a positive experience and you feel like you and your child connect well with the new pediatrician, then you know you found your match.

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Interviewer: How to help your young child after a traumatic event. We'll talk about what you can do next on The Scope.

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Interviewer: Dr. Katherine Rosenblum is the director of the infant and early childhood clinic at the University of Michigan. When scary things happen to young children, we're talking about infants, toddlers preschoolers, what can you do to help them through that? Is this something that a lot of parents don't recognize first of all?

Dr. Rosenblum: I think it's something that people often overlook because we think young kids are really little, maybe it won't affect them so much, maybe they won't remember things that happened, and also because it's hard for them to tell us what they're thinking and feeling if they don't have the words for it yet. But in fact little kids are affected by scary things that happen in the environment or that happen to them. So we often think about how young kids actually do experience trauma or stress and what we want people to be thinking about is how we can help them to manage those feelings. I think how we can help them cope.

Interviewer: How do you define trauma or stress to that age group?

Dr. Rosenblum: Little kids deal with little stresses all the time. For example, starting at a new school, Mom or Dad is going to work and we have to adapt to separations. It's hard but kids can learn to manage that. It's a stress and it helps them learn I can manage little stresses.

Trauma, in contrast, is something that's so big that actually it overwhelms the individual's ability to cope effectively, and especially for little kids. When they're faced with something that is traumatic or really, really distressing, then what they need is a lot of help to be able to figure out how to recover from that and to be able to recover from that. It really requires additional support from outside.

Interviewer: So are we talking about emotional trauma exclusively or physical trauma as well?

Dr. Rosenblum: Actually, it can be a whole range of things. One of the most common traumatic experiences for young kids is accidents. They get injured or hurt. And that can be really scary and overwhelming and parents might see that after an accident they're afraid, they're more fearful, they're more clingy, that sort of thing, dog bites, things that can happen in the environment.

Interviewer: Falling off of a play set maybe even.

Dr. Rosenblum: Absolutely right. If it was really a scary experience, maybe they had a broken arm, or they had to have some sort of a medical procedure, those things can be really distressing. But with support they can really recover from that.

Big traumas are things that are just told really overwhelming to to the child. It might be witnessing someone being seriously hurt or injured, or really scary events that happen in the community. Those are things that we really think of as true traumas. They overwhelm that young child's sense of, "I can I can cope." It really creates a sense of intense fear or threat, danger.

Interviewer: Seems like we're talking about a wide range of things like from separation anxiety because a parent is going to work versus a traumatic accident. Are they all kind of dealt with the same way or do they require different strategies?

Dr. Rosenblum: The one thing that's sort of common across all of those things for young kids and the number one thing that young kids need when they're managing things that are challenging is the support and help of their primary caregivers, what we think of as their attachment figures, their parents. Young kids are totally dependent on their caregivers to help them navigate life's challenges, and whether those challenges are small or big they're turning to their primary caregivers for help with coping.

Interviewer: I'm sensing here as a parent a little bit of a struggle because on one hand, I don't want to over . . . because a little bit of stress and that sort of thing's good so I don't want to maybe overprotect or over . . . I mean how do you decide how much?

Dr. Rosenblum: It's really important to on one level follow your child's cues. So your child is going to be showing you, :I need you in some way," and parents have an intuitive sort of sense often of, "When my child needs me, I'm going to go to them and help them." Doesn't mean that you're going to prevent them from having to face challenges. Normative things like going to school, that's really important and you're helping them learn how to balance. But when young kids are experiencing something that a parent knows is really really stressful, then I think it's actually really important for the parents to sort of say, "Hey I'm here. I'm here with you. You're safe right now. I'm going to take care of you. I'm going to protect you"

Interviewer: And what does that interaction look like? Say a child falls off of a play set. You can tell the over the next couple of days there is a big fear there. My dad was a rancher. He'd say, "You get bucked off the horse you get back on". Is that the approach you take or is there a better approach?

Dr. Rosenblum: Let me sort of step back and share something with you that's sort of interesting. We often have people who sort of say, "Hey, I'm worried about spoiling my child. If my child is crying and I pick them up, is that going to spoil them?" What we actually know from the research is that when kids express feelings like being afraid or sad and they have parents who pretty consistently and reliably go to them and help them with those experiences, they actually end up as they get older being more able to cope with life's punches if you will, the hard things that come in life. They can sort of bounce back get up and do things better on their own as well.

So I think two things. One, we want kids to be able to try to sort of manage small things on their own. If your dad saw you sort of fall down and bump your knee, it might be totally appropriate to take a moment, sort of look and say, "Hey, wait a second, is he really hurt? Is he really distressed or is he going to be able to sort of bounce back from this on his own?" That's totally appropriate. But if he sees that you're really crying, that you're really hurt, and you're looking up, that's a time where we really hope a parent is going to say, "Hey buddy. You know I'm here for you. I've got your back. Come here and let me help you."

Interviewer: With an adult I might validate somebody's feelings a bit. "I totally understand why that was a scary experience." Do you do the same thing with kids?

Dr. Rosenblum: Absolutely. "That was really scary. But you know what? I'm here. I'm going to help you and you're going to be okay." Little kids really like to know that someone's there, someone's got their back, someone's going to scoop them up, give them a hug and then help them be able to sort of do that bounce, get back into normal daily routines and experiences. That's another piece that's really important here. I think the other part of your question was, "I don't want to over react." I don't think it's overreacting to really be asking how is my child managing, am I seeing . . . If something scary, something really big happens, use your child as your guide. Look at your child's behavior. Is your child looking more fearful, having trouble sleeping, a little bit more clingy? If all of those things are true then that's a time to give a little bit more. But if your child seems to be doing okay, all right, be a watchful observer. Use your child to help you determine what your child needs.

Interviewer: Would there be a point where you'd visit a counselor?

Dr. Rosenblum: Absolutely. So if your child is continuing to persist in showing more clinginess, looks very fearful, can't sort of do the normal routines, seems really distressed or you're just really concerned about them, trust your gut, talk to the primary and pediatricians are a great resource. They can help you sort out is this something that we can sort of wait and see and sort of watch and wonder? Or is this something where it might actually be helpful to get some extra help?

Interviewer: Do you have a resource if a parent's listening right now on their like, "This is great. I'd like to learn more"?

Dr. Rosenblum: There's a really wonderful website called the National Child Traumatic Stress Network and they have a website, NCTSN.org, and that provides wonderful resources for parents, for teachers of young kids about how to help kids manage really scary or big things. For smaller sort of things, the more every day sorts of occurrences, there are a number of resources that are available as well. The American Academy of Pediatrics has a website dedicated for parents and there's also a wonderful resource called Zerotothree.org. Again, lots of resources to help parents navigate life's challenges with young kids.

Announcer: We are your daily dose of health, science, conversation. This is The Scope, University of Utah Health Sciences Radio.

Dr. Gellner: No more flu mist means another shot for your child. How can you help your child prepare for this and other vaccines? I've got some advice today on The Scope. I'm Dr. Cindy Gellner.

Announcer: Keep your kids healthy and happy. You are now entering the Healthy Kids Zone with Dr. Cindy Gellner on The Scope.

Dr. Gellner: You've probably heard that the Centers for Disease Control and Prevention is dumping FluMist. I know, my kids are disappointed too. But a CDC advisory panel found that the spray is so ineffective at protecting from the flu that it shouldn't be used anymore. Vaccine experts aren't sure why the mist isn't working but none of that really matters to parents who are now wondering how to prepare their children to face the flu shot needle.

There's definitely a lot of hype when it comes to those dreaded shots. Needles strike fear into the hearts of many people, no matter how old they are. The most important thing a parent can do is to keep calm. If you're freaking out, your kids will follow suit.

Honesty is most important when it comes time to get any shot. Explain to your child that it may hurt for a second and tell them why the shot is important to protect them. Ask them to think about how strong their body is going to be, and how well the good immune systems cells will be able to fight the bad germs that this vaccine is protecting them against. Kids will be more receptive to shots if they understand why it's important for them to get them.

However, while honesty is key, don't give your child too much time to stew over the fact that a shot is coming. They may get more worked up, or they may be cool with a shot, it all depends on the child. And if they are going to be extremely anxious during the entire visit, I recommend telling them at the end of the visit. If they're older kids or kids that are not too afraid, then being honest with them before the appointment is best.

Once at the appointment, present a united front with the person who is giving the shot. Don't let your child cower, kick, or hide in your arms. That could end up hurting them more than the shot and may also result in an injury to the person giving the shot. Instead, help the person giving the shots put your child in the position that is the safest for administering shots, while still being there to comfort them.

Talk to your child while they're getting the shots. Make eye contact with them. Let them know you're right there and you'll give them the biggest hug when they're done because they've been so brave. I've sung to my boys when they were younger and had their kindergarten shots. That seemed to help.

Taking steps to help with the pain from shots can help as well. Give your child acetaminophen or ibuprofen but not until after the shot to reduce inflammation that may cause pain. We don't recommend giving anything beforehand anymore since some studies show that blocking the fever response may interfere with the immune system response.

With some shots, the pain, redness, and swelling may last for up to 24 hours. Pain may occur when medicine in the shot goes into the body and then again over the next few days as the body's immune system does its job building up antibodies. When all else fails, it may be time to make a deal with your child. One word: bribery. It goes a long way with kids. A special treat after the appointment for their bravery is always a hit.

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Interviewer: Searching DNA for clues to the cause of death, up next on The Scope.

Announcer: Examining the latest research and telling you about the latest breakthroughs. "The Science and Research Show" is on The Scope.

Interviewer: I'm talking with Dr. Marty Tristani-Firouzi, a pediatric cardiologist at the University of Utah. Paint me the scene here, a child dies unexpectedly, which is a horrible situation in any case. But, if it's not clear why the child died, what's typically done to find the cause of death?

Dr. Firouzi: There is an investigation at the scene to try and understand the circumstances of the death. A lot of infants that die, and fall into the category of sudden infant death syndrome may have certain situations with sleeping on a mattress which isn't firm, or somehow they became smothered, someone rolled on top of them. That sort of a thing would identify a cause of death. But more commonly, an autopsy is required. And the autopsy then rules out unknown cancers. It can also reveal trauma that would be a non-accidental death. Frequently, the autopsy ends up being negative. And then we get back to the situation where the family is told, "We really don't know why your child died."

Interviewer: There must be a presumption that the heart is the cause for the many of these sudden deaths. Is that true?

Dr. Firouzi: That is true. And I think the literature supports that as a general assumption. It's such a profound event. The heart is so crucial in maintaining our survival. And we know that arrhythmias can cause sudden death. In patients that are known to have specific diseases, some of them will suffer a sudden cardiac death. And so by excluding the pathology, by saying these are autopsy-negative sudden deaths, in the young, I think the majority of clinicians in the country would presume they were arrhythmic until proven otherwise

Interviewer: Part of what you're doing, is kind of getting beyond the traditional autopsy. Why is it not enough?

Dr. Firouzi: If the heart looks normal structurally, even under histology, the heart can look completely normal and yet these individuals can have died of an arrhythmic death and have other family members. And so . . .

Interviewer: So a heart arrhythmia . . .

Dr. Firouzi: A heart arrhythmia where the heart beats too fast or too slow and that results in sudden death. So the term "molecular autopsy" refers to the ability to do DNA analysis of the deceased victim and that really goes the step beyond the traditional histological autopsy.

Interviewer: What can the DNA tell you?

Dr. Firouzi: The hope is to perform genetic analysis of the deceased individual and identify either known variants and known genes that cause inherited arrhythmias or novel genes that we haven't yet associated with arrhythmic risks. And our hope is that we can find this in deceased individual and then sequence the first-degree relatives and find out whether other family members carry that damaging variant.

Interviewer: Why is it important to know the cause of death? I mean, it's something that's already happened so it just for peace of mind or are there other reasons as well?

Dr. Firouzi: Sure, that's a great question. A lot of families want to know why so that they can have some sense of closure. But I think more importantly is whether other family members are at risk. So for the arrhythmic types of death, many times these arrhythmias run in the family and the family may not know that. And this sort of sentinel finding of sudden can occur in these types of inherited arrhythmias. And the question then is who else in that family is at risk of dying suddenly? And this is a very difficult thing for families to process because they're in this grieving process and then finally they're told that maybe they have something in their family and maybe their other children will have the same demise.

Interviewer: So even if this one child dies at a very young age, there could be older members of the family that are still at risk?

Dr. Firouzi: Absolutely. That is exactly right.

Interviewer: So what exactly are you looking for in the DNA?

Dr. Firouzi: There are specific families of arrhythmias. The most common and probably the most well recognized is the family of long Q-T syndrome, of which there are up to twelve genes that have been implicated in long Q-T syndrome. What we see, at least in Long Q-T syndrome and a lot of other inherited arrhythmias, there are other family members that carry that disease variant. And they may be normal. They may have normal electrocardiograms if we put them under stress, like an exercise stress test. Sometimes they will behave normally as well.

But if we further stress them by giving them a medication and testing whether they have electrocardiographic findings, sometimes under those more extreme circumstances, we can uncover the clinical phenotype that is consistent with the disease. And so the key part of this is not just to do the DNA analysis on the deceased, but to do a clinical analysis and a DNA analysis on the first-degree relatives.

Interviewer: And you had mentioned too that a part of this whole initiative is discovery as well. I mean, there are some genetic variants that we know about, but there are probably a lot we don't know about.

Dr. Firouzi: Yes, absolutely. So there have been a few studies that have used this concept of the molecular autopsy where they go through sequentially and look at a series of individuals that had died suddenly. And in maybe 20% of those sudden death victims, you can find a variant in a known gene that is known to cause arrhythmia disorders and sudden death.

But the majority don't have a simple variant. And the fact that they died from an arrhythmic death, presumably, would suggest that indeed they have some genetic disorder and that variant may lie outside the coding region, which outside the exome in the whole genome space in some area that has not been well characterized. And the majority of DNA has not been characterized.

The other part of the discovery is can we find variants in this what was thought to be desert landscape of the genome, which actually probably plays an important role in the regulation of the ion channels that we know cause these sudden death disorders.

Announcer: Interesting, informative and all in the name of better health. This is The Scope Health Sciences Radio.

Dr. Gellner: We'd all have x-ray vision if we could, am I right? Do certain activities we've been warned about actually hurt our eyes? Old wives' tales about eyes today on The Scope. I'm Dr. Cindy Gellner.

Announcer: Keep your kids healthy and happy. You are now entering The Healthy Kids Zone with Dr. Cindy Gellner on The Scope.

Dr. Gellner: They say eating carrots will improve your eyesight, not true. But this old wives' tale has a really cool back story. It may have started during World War II when British intelligence spread a rumor that their pilots had remarkable night vision because they ate lots of carrots. They didn't want the Germans to know they were secretly using radar.

Carrots and many other vegetables high in vitamin A, do help maintain healthy eyesight, but eating more than the recommended daily allowance won't improve your child's vision. In fact, it can turn your child orange like a Oompa Loompa. That's called beta-carotenemia. Not good.

Reading in dim light will damage your eyes. False. Although reading in a dimly lit room won't do your child's eyes any harm, good lighting can prevent eye fatigue and make reading easier during the pile of homework they have to do every night.

Too much TV is bad for your eyes. Well, watching television won't hurt your child's eyes no matter how close to the TV they sit. But too much TV is a bad idea for kids. Two hours of screen time or less people. Research shows that kids who consistently spend more than 10 hours a week watching TV are more likely to be overweight, aggressive, and be behind in school. So get them outside playing instead.

And we've all heard this one growing up. If you cross your eyes they'll stay that way. Sorry mom, not true. Only 4% of children in the United States have strabismus, a problem with the eyes are not aligned correctly giving the appearance that they're looking in different directions. Eye crossing however does not lead to strabismus.

And no, your child will not shoot their eye out if they play with BB guns responsibly. But when it comes to your child's eyes, if they have any problems, see a pediatric eye doctor right away.

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Dr. Gellner: Old wives' tales about food and drinks, we've heard them all. I'll clear up which ones are true and which ones are not on today's Scope. I'm Dr. Cindy Gellner.

Announcer: Keep your kids healthy and happy. You are now entering The Healthy Kids Zone with Dr. Cindy Gellner on the Scope.

Dr. Gellner: Number one, feed a cold and starve a fever. False. Both high fever and colds can cause fluid loss, and drinking plenty of fluids can help prevent dehydration. And with both fevers and colds it's fine for your child to eat whenever they want and whatever they want. But don't be surprised if your kid doesn't want to eat at all. As a parent, you don't eat either when you're sick. They'll eat when they're ready. Hydration is more important.

Next, wait an hour after eating before going swimming. No. According to the American Red Cross, it's not necessary for anyone to wait an hour after eating before going in the water. However, if your child had a big fatty meal and they're on a swim team and have a meet, it might be a good idea to let their food digest some. No one wants puke in the middle of the pool. The Red Cross also advises against chewing gum or eating while in the water. Your child could choke.

Next, coffee stunts your growth. That's false. In that coffee won't affect your child's growth, but too much caffeine doesn't belong in a child's diet anyways. Not to mention the acid in coffee and what it does to their sensitive stomachs. Coffee and caffeine can prevent the absorption of calcium and vitamins as well. So don't just give it to them.

Fish is brain food. This one is true. Fish is a good source of Omega 3 fatty acids and it's been found to be very important in brain function. Certain fish like tuna however, have significant levels of mercury, which isn't good for kids either. So keep those fish down to once a week.

One we've all heard, chocolate causes acne. Thank goodness this one's false. Although eating too many sugary high fat foods is not a good idea for anyone, studies show that no specific food has been proven to cause acne.

Spicy food can cause ulcers. Yes and no. Spicy foods may aggravate ulcer symptoms in some people but in kids they're more likely to cause indigestion.

While these are old wives' tales, remember, eating a healthy diet is never old advice.

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