Topic of the week: Let’s talk poop!
I have been working in the pediatric field for over 20 years now, and there is one topic that seems to come up with alarming regularity: poop. Parents are obsessed with their child’s poop – how often they go, what color it is, what it smells like… Whatever question you could think of about pediatric bowel movements, I guarantee you I’ve already been asked. Therefore, in this week’s blog, I decided to get down and dirty with the facts about fecal matter.
Let’s tackle the one of the most common complaints first: constipation. It can be very distressing for both the child and the parents when things aren’t moving through like they should. Firstly, I try to stress to parents that constipation is about the consistency of the stool, not the frequency. In other words, it is not as important how often they go, it’s how the stool looks. Constipation produces very hard, difficult to pass stools. Often they appear like pebbles or rocks. Older children will report pain and straining with bowel movements, and they are often accompanied by bright red blood that comes from small tears in the anus from the large stool volume. If the child is pooping infrequently, but the stools are soft, that is not constipation. It is not necessary for an infant or child to have a bowel movement every day. In fact, some exclusively breastfed infants can poop once a week or so and have entirely normal and soft stools.
If a child is truly constipated, there are several home remedies that are perfectly acceptable to try. Giving the child extra water, giving juice half and half with water (particularly apple, white grape, or prune juice), and increasing fiber rich foods can all help. My favorite home remedy is Dark Karo Syrup. You can find it in the sugar aisle of the grocery store. 1 teaspoon a day of Dark Karo Syrup always gets them going!
The idea behind treating constipation in children is to soften the stool, not stimulate the moving and cramping of the bowels. In other words, we use stool softeners not laxatives. All the remedies listed above are stool softeners, which means they encourage the colon to absorb more water from the body, which in turn makes the stool softer. There are some medications I commonly prescribe that do the same thing. Miralax powder is effective and safe for children, as is Mineral Oil, Milk of Magnesia, and Colace.
Now let’s discuss the opposite problem – Diarrhea. The official definition of diarrhea is having at least three loose, liquid, or watery bowel movements each day. It is very common in toddlers, and is often seen in conjunction in a viral gastrointestinal illness along with vomiting. While this can be extremely upsetting to parents (not to mention hard on the diaper budget), diarrhea by itself is usually of little medical concern. I always encourage parents to take their cues from their child. Are they active or lethargic? Are they eating and drinking, or not taking anything by mouth? What does the stool look like? Does it contain mucus or blood?
If a child is acting normal, taking in adequate fluids with no vomiting, and there is no blood or mucus in the stool, it is not usually necessary to treat the diarrhea except with what we call the “BRAT” diet. These are foods that are gentle on the GI system and promote formed stool. B stands for bananas, R stands for rice, A stands for applesauce, and T stands for toast. This diet, along with fluid replacement with water or Pedialyte, is usually all that is needed. Beware of sugary beverages such as soda pop, fruit juices, and Gatorade. The sugar in these drinks can make diarrhea worse.
Sometimes for diarrhea I recommend probiotics. These are the “good” bacteria in the GI system that promote the normal production and passing of soft-formed stool. Most brands are over the counter and come in liquid, powder, chewable, and tablet forms. Some brand names include Culturelle, Florastor, and Lactinex.
So there are the answers to two of the biggest poop concerns. As always, if you are unsure about what to give your child, the home remedies aren’t working, or there are other symptoms along with either constipation or diarrhea, please bring your child into the office for an appointment. Otherwise I wish you and your child happy pooping!
Topic of the week: The One Book Every Parent Should Own
By the time I gave birth to my first daughter, I had been working as a registered nurse in the Neonatal Intensive Care for several years. I felt completely comfortable caring for even the sickest and tiniest of babies, but when the doctor swaddled my newborn baby girl and placed her gently into my arms, I was absolutely terrified!
They say babies don’t come with manuals or operating instructions, but I think maybe they should. When you haven’t had more that 2 hours sleep for days, family is giving all sorts of uninvited advice, and you are lost in a haze of diapers, feedings and spit-ups, where can you turn for the answer to the age-old question: Is this normal?
For most of us, Google is usually the first entity we consult, and while there is good information on the Internet, you have to be careful. Not everything you see is founded in what health care providers call “evidence based medicine.” Books, however, especially books published by and/or endorsed by the American Academy of Pediatrics, are fantastic sources of information that you know you can count on. My absolute favorite is Caring for Your Baby and Young Child published by the American Academy of Pediatrics.
This book is full of all the information parents need to know. It is divided nicely by age (newborn to age 5), and it tells you what to expect, what is normal, and things you should discuss with your child’s doctor. Particularly helpful, the back section of the book goes through the most common childhood illnesses in alphabetical order, the symptoms, and how you can help your child. There are sections on learning CPR and treatment for choking, and extremely helpful dosing charts for common over–the-counter medications for you baby and young child.
This month, Irving Pediatrics will be having a drawing in our office where you can win a copy of this book! Come to see us and register for your chance to own your very own copy! The winner will be drawn from the entries on October 31, 2019.
If you’re not the lucky winner, don’t despair! The book is an available at most major book retailers, including Amazon and Barnes and Nobel for about $16.00. Most libraries also have copies that you can consult for free.
Check it out for yourself! You will not be disappointed!
Topic of the week: The Flu Vaccine
It’s that time of year again. Everywhere you look, healthcare workers are standing with syringes in hand; ready to give you a flu vaccine. Over the years, we as a society have been inundated with common myths and misconceptions about the flu vaccine, and vaccination rates have decreased as a result. So let’s discuss the flu vaccine, and why you and your child should strongly consider having one this year.
The influenza virus is nothing new, we as healthcare consumers have just forgotten how large a threat it can be. One of the worst flu pandemics occurred about 100 years ago in 1918. Often referred to as the “Spanish Flu,” it was estimated that over 1/3 of the world’s population became infected with this highly dangerous flu strain. Over 50 million people lost their lives due to flu-related complications.
More recently, you may remember the H1N1 influenza pandemic of 2009. This strain was nicknamed “The Swine Flu.” Over 500,000 people worldwide died due to this particularly virulent flu strain before an effective vaccine was introduced for the public at large.
Battling the influenza virus is complicated because there are many different strains of the flu and they are constantly mutating, making vaccines less effective. Every year the World Health Organization (WHO) attempts to predict which flu strains will be most common in the upcoming flu season, and a new seasonal flu vaccine is created. This is why you need a new flu vaccine each year.
Some common questions about the vaccine:
- Who should be vaccinated? The CDC and WHO recommend vaccination for all individuals 6 months and older each flu season.
- Will the flu vaccine give me the flu? Absolutely not! The flu virus in the vaccine is an inactivated virus. It is not possible to contract flu from the vaccine.
- When should I be vaccinated? The best time for vaccination is during the months of September and October. It takes approximately 2 weeks to develop immunity to the flu strains in the vaccines, and flu season typically runs roughly from December through March.
- Can I still get the flu even though I was vaccinated? Unfortunately the answer is yes. As I mentioned, the vaccine is comprised of the strains most likely to be circulating in any given flu season. It is possible to contract a strain that was not included in the vaccine. However, it has been proven that patients that contract the flu after being vaccinated that year experience a milder illness that lasts for a shorter period of time than those who did not get the vaccine.
I strongly encourage you to speak to your health care provider about flu vaccination and also to conduct your own research on reputable Internet sites such as the Centers for Disease Control (www.cdc.gov) and the World Health Organization (www.who.int).
Topic of the week: Fever is your Friend
One of the most common reasons parents bring their children to the doctor is fever. While fever can be very scary for parents and children alike, it is important to remember what a fever is and its purpose in maintaining your child’s health.
What is considered a fever? Temperatures of 100.4 degrees Fahrenheit or above are considered a fever. Temperatures between 98.6 degrees and 100.3 degrees are not considered “low grade fevers.” These are fluctuations of normal body temperatures, and are no reason to be unduly concerned.
Why do we get fevers? A fever is an important part of your child’s immune system. It signals the body that there are invaders (bacterial or viral) and sets up the immune system to attack these invaders.
Do high fevers cause permanent damage? No. Remember, the fever is helping your child fight off infection. Fevers DO NOT cause brain damage!!! A small percentage of children (about 4 %) will develop a condition known as Febrile Seizures, meaning they experience seizures when they get a fever. These seizures are benign, and besides being frightening to watch, no brain damage is done.
When do I bring the child to the doctor? For healthy children with no chronic conditions, we typically recommend you bring in your child to our office if he/she runs a fever for 3 days. As for infants under 2 months of age, any fever should be evaluated immediately in our office or in the emergency room.
As I continue to write this blog, you will hear me repeat this fundamental fact: Pay attention to how your child looks and acts. You know him/her better than anyone. Many children go along happily as they normally would (playing, eating, sleeping) even with a high fever. Other children look sick, are lethargic, and may have other symptoms. If your child falls in the first category, treatment of the fever is not warranted. Remember, the fever is doing its job – fighting off the bacterial or viral invaders in your child’s body. There is no harm in “watchful waiting” and not breaking out the Ibuprofen or Acetaminophen right away.
If your child seems uncomfortable, you may want give him/her ibuprofen or acetaminophen. Please call office if you do not know the correct dosage for your child. It is calculated by weight of the child. When choosing a medication for your child, remember that infants 1-8 months old may only use Acetaminophen (Tylenol) ever 4-6 hours. Nine months and up, Ibuprofen (Motrin, Advil) may be used every 6-8 hours. With your physician’s permission, you can alternate these 2 medications every 4 hours as needed.
In closing, please remember that fever is not an illness – it is a physiologic response to help the body fight off foreign invaders. Although it can be scary for parents, try to take comfort that your child’s body is doing exactly what it is supposed to be doing in order to return your child to health.