In my experience, 90% of girls are not excited when puberty starts. And it’s not just their impending period that’s on their mind. Most girls are happy with the body they have and see no reason for it to change. This uncertainty happens because the physical changes of puberty precede the psychological ones. When I discuss this with girls at their 10- or 11-year-old checkups, my goal is twofold. First, I want them to know that they are not alone in their feelings about puberty. Second, I want parents to know that girls may be reluctant to talk about puberty even though moms want to provide them with the benefit of their experience. However, I encourage moms to always keep their “radar on.” If a girl brings up pubertal issues, moms should drop what they’re doing and be open for a discussion.
I also share a story about what happened in my own home when my daughter, now 21, turned eleven. My wife and I bought Molly a copy of the American Girl book, The Care and Keeping Of You, which is a terrific book for girls entering this stage of their lives. Molly looked at the book and literally threw it across the room. We told her that was okay, but added that her mom would be available to discuss anything in the book if Molly wanted to. Over the next six months, we found her occasionally reading the book at night before bed.
My final comment on this subject at checkups is to remind girls that puberty takes years to finish, and I guarantee that they will be happy with their grownup bodies once the process is over.
Parents often have questions about the things they see in their baby’s mouths. Here are the most common findings you may notice.
- Epstein’s Pearls. These are white spots on the roof of a baby’s mouth. They are usually the size of a sesame seeds. They disappear in a month or two.
- Bahn’s Nodules. These are white spots on the top or sides of a baby’s gums. They are bigger than Epstein’s Pearls, and parents sometimes mistake them for teeth. They disappear by 6 months.
- White or irregular gums. Some babies have smooth gums. Others have tiny ridges. The sides of a baby’s gums sometimes look white instead of pink. These are all normal findings.
- White coating on the tongue. Most parents are aware that newborns can get a yeast infection called thrush. However, if all you see is a thin, white coating on your baby’s tongue, it’s most likely from breast milk or formula. With thrush, you usually see cheesy-looking material on the inside of the cheeks and lips and on the roof of the baby’s mouth.
- Tongue-tie. This is hard for parents to see, but most have heard about it. The bottom of the tongue attaches to the floor of the mouth with a thin band of tissue called the lingual frenulum. In some cases, the frenulum is tight, thick or attaches near the tip of the tongue. If this happens, it may be harder for your baby to nurse properly. Doctors and nurses routinely check for this at newborn visits. In some cases, the baby will be referred to an oral surgeon or an ENT doctor to “clip” the frenulum.
In my last blog, I mentioned that it takes 6 months for testicles to descend from the abdomen into the scrotum. If this process doesn’t occur properly, a baby will be born with an undescended testicle. (If the testicle can be felt in the inguinal canal, it’s referred to as a partially undescended testicle.) In many cases, an undescended testicle will drop to its normal position by 2 to 3 months of life. If this fails to occur, the baby will be referred to a pediatric urologist.
Prior to puberty, a boy’s testicle is roughly the size and shape of a peanut. This fact, combined with an active scrotal reflex, often pulls the testicle into the lower part of the inguinal canal. We call this a retractile testicle. It’s not the same as a partially undescended testicle. In pre-adolescents, testicles commonly “hide” when boys giggle during the genital exam.
The way doctors differentiate between a partially undescended testicle and a retractile testicle is to see what happens when the boy squats. During a squat, a retractile testicle will drop down so it can be easily pulled into the scrotum; a partially undescended testicle will not. If there is any question about this, your child will be referred to a pediatric urologist.
If your child can’t get through the genital exam because he’s ticklish, there is a way parents can identify a retractile testicle without seeing a urologist. Have your child sit in a warm bath for about 5 minutes. Because the testicles are meant to be cooler than the body, retractile testicles will almost always drop down into the scrotum, which itself gets “baggy” in warm water. If you see or feel the testicles in the lower scrotum, you don’t need an appointment with a urologist.
When I see boys for routine physicals, I always check their testicles for lumps or swelling. The most common problem I find in the first year of life is something called a hydrocele. A hydrocele is a collection of fluid around the testicle.
Hydroceles have an interesting history. Although a baby’s gender is decided at the moment of conception, both sexes develop along the same path until the third month of pregnancy. At that point, a group of cells in the lower abdomen develop into ovaries in females or testicles in males. If the baby is a girl, the ovaries are in the correct anatomic position. If the baby is a boy, the testicles need to descend into the scrotum. This process takes about six months. As the testicles move downward, they pass through the inguinal canal before reaching their proper position in the scrotum.
After the testicle enters the scrotum, the inguinal canal is supposed to fuse thereby separating the abdominal cavity from the scrotum. In some cases, this doesn’t happen and a small amount of fluid travels into the scrotum. Most of the time, this occurs before birth and the hydrocele will be detected at the baby’s first examination. In some cases, fluid moves into the scrotum after birth, in which case the hydrocele won’t be found until the baby is older. Most turn up between 1 and 4 months of age.
Hydroceles are not dangerous and usually resolve before a child’s first birthday. If they persist beyond a year, there’s a possibility the child also has an inguinal hernia. In this case, he should see a pediatric urologist or a general pediatric surgeon.
At the time of birth, a baby’s umbilical cord has a shiny, off-white color. Over the next few days, the cord will dry out and turn a dark brown or black color. As this happens, the cord will shrink and often looks like a scab on the baby’s abdomen. In the past, the umbilical stump was coated with a blue dye after birth and parents were told to clean the area with rubbing alcohol at every diaper change. These recommendations were discontinued because they were found to increase the time it took for the cord to fall off. Nowadays, parents don’t need to do anything special other than keeping the stump from becoming irritated by the baby’s diaper and avoiding baths until the cord falls off.
A few things may happen that worry parents during the 7 to 10 days that it takes for the cord to fall off.
- The base of the cord may develop a gooey, greenish-yellow appearance. This is normal and not a cause for concern.
- The cord may smell bad. The reason the cord falls off is because it no longer has a blood supply, and the baby’s immune system is rejecting the dead tissue. If the stump became infected, the skin around the belly button would become red and swollen. If you think your baby’s umbilical stump is infected, you should see the doctor promptly.
- The cord may bleed a little before or after it falls off. If this happens, you can gently clean the excess blood with a cotton swab.
- A red, fleshy lump may appear after the cord falls off. This is called an umbilical granuloma. It’s not serious, but doctors treat the area with silver nitrate to make the lump fall off.
Most food allergies manifest themselves with non life-threatening reactions such as facial swelling or hives. That being said, it’s important to let the doctor know if your child has had an allergic reaction to a food. This will not only reduce the possibility of a serious reaction in the future, but you will be taught how to deal with such reactions.
Oral allergy syndrome is not a serious food allergy. Instead, it’s a mild reaction to foods that many people have not heard about. It occurs when someone experiences an itchy or tingling sensation in his mouth or throat after eating certain foods. The person does not get hives, facial swelling or other symptoms associated with a potentially serious food allergy.
Oral allergy syndrome is seen in people with spring and summer pollen allergies. It turns out that certain food have an allergen (something a person can be allergic to) that cross reacts in people who are allergic to certain types of pollen. Here are some examples.
If you’re allergic to birch pollen, you may react to apples, pears, cherries, plums, peaches, kiwi, celery, carrots, parsley, hazelnuts and almonds. If you’re allergic to grass, you may react to tomatoes, melons, celery, peaches and oranges.
The most interesting thing about oral allergy syndrome is that the person will not have symptoms if he eats the same food after it’s been cooked. In other words, apples cause symptoms, but applesauce does not. The reason you don’t react to the cooked food is because the allergen is destroyed when the food is processed.
Lots of parents think that giving a child acetaminophen or ibuprofen prior to seeing the doctor will compromise the visit. This is not true. Fever reducing medicine won’t make it harder for the doctor to figure out what’s wrong. In fact, reducing a child’s fever usually makes it easier for the doctor because the child is more likely to cooperate if her temperature is lower during the visit.
The same thing is true for asthma medicine or any other drug your child is taking. Unless the doctor or nurse specifically tells you not to give a medicine before a visit, you should do what you can to control your child’s symptoms.