What’s a strawberry hemangioma?

hemangioma-in-childStrawberry hemangiomas are a collection of tiny capillaries that are typically located on the skin. Some are present at birth and others develop in the first few months of life. Hemangiomas have a tendency to get bigger over time, but most resolve without treatment by the time a child is 5 to 10 years.

If the hemangioma is very large or in a vulnerable location like the mouth or eye, it can be treated with a medication (propranolol) that hastens its resolution.

What are the incubation periods of some common childhood illnesses?

child-rash-on-faceThere is a lag time between being exposed to an infection and coming down with the disease. This time frame is called the incubation period. 

The value of knowing
the incubation periods for common infections is that you can better gauge if you have “dodged a bullet” regarding something you or your child has come in contact with. Here are the incubation periods for some well-known childhood infections.

  • common cold: 1 – 3 days
  • conjunctivitis (“pink eye”): 1 – 3 days
  • croup: 2 – 7 days
  • fifth disease: 4 – 14 days
  • hand/foot/mouth disease: 3 – 6 days
  • herpes (“cold sores”): 2 – 12 days
  • impetigo: 1 – 7 days
  • Influenza: 1 – 4 days
  • molluscum contagiosum: 1 week – 6 months
  • mononucleosis: 4 – 6 weeks
  • pertussis (“whooping cough”): 1 – 2 weeks
  • pinworms: 2 – 6 weeks
  • roseola: 5 – 12 days
  • RSV: 2 – 8 days
  • strep throat: 1 – 3 days
  • viral gastroenteritis (“stomach flu”): 1 – 3 days

What’s in a teaspoon?

medication-teaspoonWhen I was growing up, no one used syringes or measuring cups to dole out medication. As a result, a child could easily be over or under dosed. Why? Because the spoons used for ice cream and yogurt can vary a lot in terms of what they hold. Nowadays, doctors and parents need to be more precise in the way they give medicine to kids.

If a doctor tells you to give your child a teaspoon of Motrin for fever, he means you should administer 5 ml, not what fits in the spoons you use at mealtime.

Modern parents know this, but I thought it was worth blogging about. A measured teaspoon is 5ml. It can be given with a syringe, a measuring cup like in the picture above or in measuring teaspoon.

Are febrile seizures dangerous?

child-with-feverWatching a child have a febrile seizure is one of the scariest things a parent can experience. One minute, the child is acting normal or mildly sick and the next, his eyes roll up, he gets stiff all over, his lips turn blue and his body starts to shake. In most cases, a febrile seizure lasts a minute or less, but it seems much longer to the parent who’s watching it.

Febrile seizures occur in 3 percent of children between 6 months and 5 years. The seizure is triggered by the rapid rise in temperature that accompanies an illness. In some cases, parents don’t even know their child had a fever at the time of the seizure.

After the seizure has stopped, children are typically a bit floppy and “out of it” for a while. They usually start to act like themselves within 5 minutes or so.

About 30 percent of children who have a febrile seizure will have another one. Recurrences usually occur within a year of the first seizure. The younger a child is at the time of his first seizure, the more likely he will have another one.

Febrile seizures are rarely dangerous and children with simple febrile seizures don’t need to be treated with anti-seizure medication because the drugs are more dangerous than the seizures themselves. Children with complicated febrile seizures sometimes needed to be treated with medication. A complicated febrile seizure lasts more than 15 minutes, involves one side of the body or recurs within a 24-hour period.

It’s understandable that parents want to aggressively treat fever after their child has had a febrile seizure. However, research has shown that aggressive fever management does not prevent febrile seizures. The reason parents need to know this fact is because they might otherwise blame themselves, each other or baby sitters because a child had a seizure during an illness.

For more information about febrile seizures, check out the following link:


It’s common for fathers to bond with their babies after mothers

dad-and-newbornMany years ago, I read an article by a first time mother and father. The mom described bonding to her baby immediately. The dad, on the other hand, did not feel the same attachment as his wife. He didn’t tell anyone about this for months because he was embarrassed about not immediately “falling in love” with his baby. He did everything he was supposed to in terms of supporting mom and baby, but he felt a bit like an outsider at the beginning of his son’s life.

Ever since I read that article, I have made a point of telling new fathers that it’s “normal” for moms to bond to babies before they do. My rationale for this is as follows:

  • The baby was biologically connected to the mom for the entire pregnancy.
  • Men typically grow up playing with action figures and balls instead of dolls.
  • Adult men are less likely than women to interact with other people’s babies before they become parents themselves.

I find that most new fathers are relieved to hear this information. I often joke that this observation does not get them out of chores. I also reassure them that they will become deeply attached to their babies in time.

Kids eating too many Halloween treats? Try this trick

holoween-costumesI love Halloween and even though my kids are now young adults, I still eagerly buy bags of bite size treats for the little ghouls and goblins that come to my house on October 31st. Perhaps this is sacrilege coming from a pediatrician, but it’s hard to let go of childhood dreams.

Despite my confession, it used to drive me crazy to watch my kids gobble up pounds of candy every fall. My wife came up with a perfect solution to our dilemma. She offered to buy back their candy.

While it’s true that my kids would never sell us a Reese’s Peanut Butter Cup, they did get rid their less favorite candy. At a typical post-Halloween transaction, we would buy about 30 percent of their bounty.

We did include one rule with the deal, however. They were not allowed to use the money to buy more candy!

Limit visitors the first week you are home with your baby

Having newborn-visitorspeople visit during the first week at home is a mixed blessing. Doctors routinely encourage new mothers to breastfeed their baby 8 to 10 times a day. Immediately after giving this advice, they tell you to get lots of rest. If you do the math, you will quickly see that it’s impossible to feed babies that much and get much rest.

While it helps to have friends or relatives assist you in taking care of the baby, what begins as a 5-minute visit can easily stretch to an hour or more. As a result, loved ones can unintentionally prevent you from taking a catnap or just closing your eyes to rest.

I advise new parents to restrict or discourage visitors during their first week or two that a baby is at home. It’s terrific for people to bring food or do some shopping for you, but they shouldn’t stay for more than 30 minutes. In addition, it’s a good idea for fathers to tell friends and family about limited visiting hours so moms can concentrate on nursing.

How to make tummy time easier

tummy-timeI recommend that parents don’t worry about tummy time until babies are 4 weeks old. The reason for this is because it’s hard enough in the first month to feed, bathe and get babies to sleep without worrying about head contr

Once parents start tummy time, lots of questions come up. How long should it last? How many times a day should we do it? What should we do if our baby cries during tummy time?

No one has studied this scientifically, but I recommend doing tummy time 3 or 4 times a day for about 5 to 10 minutes per session. If your baby cries during tummy time, there are a few things that might help.

  • Pull the baby’s elbows in towards the body. This stabilizes the shoulder area and may make it easier for the baby to lift her head.
  • Lie on the floor with the baby so when she looks up, she sees your face.
  • Put the baby on her dad’s chest while he’s leaning back at a 30 to 45 degree angle. This will make it easier for the baby to lift her head. This can also work on a mom’s chest unless the baby smells the breast and looks down instead of up.
  • Babies may be more willing to do tummy time at certain points during the day. A good time to try it is shortly before a feeding when she’s alert, but not too hungry.

How to clean a newborn’s vagina

newborn-cleaningSome people recommend that parents ignore the whitish material that accumulates between the labia majora (outside vaginal lips) and labia minora (inside vaginal lips). I prefer that parents clean the area because otherwise poop can get mixed in with the discharge and irritate the baby’s skin.
However, cleaning this area often makes parents nervous. I recommend two things to make this easier. First, you don’t need to remove all of the goo at one time. Second, clean the area by gently wiping with a cotton washcloth in a downward direction. (I prefer washcloths to cotton balls because they have better traction.) Third, if you clean the area with each diaper change, less goo will accumulate and the whole process becomes simpler.

Why newborns poop when they’re nursing

african american mother with newbornThe first stool a baby has is a thick, green, gooey mess called meconium. (For the record, meconium consists of all the stuff babies swallow during his fetal life: skin cells, hair, and other material floating around in the amniotic fluid.) After passing a handful of these sticky poops, a baby has something we refer to as “transition stools.” These poops are runny, green, and foamy. In fact, if your baby has a transitional stool when his diaper is off, you may see it shoot 12 inches through the air! But rest assured, they’re not dangerous and will fade into memory in a couple of days.
When a person’s stomach fills with food, it triggers a reflex that stimulates peristalsis. (Peristalsis is the name for the rhythmic contraction of muscles that push food from the beginning of the gastrointestinal tract to the end.) This explains why adults and older kids often have a bowel movement after eating. However, this reflex is much more active in babies, which is why they often poop while nursing. But the poop that comes out when your baby eats is waste from the feeding that went in hours ago.

Is it normal for newborns to grunt or strain when they poop?

African-American-Mother-and-BabyIt’s hard to see your baby cry, especially when she’s pooping. Parents often assume that babies are constipated if they strain or cry when they poop. Although this is true in older children, babies commonly grunt and strain with defecation because of a reflex that causes them to push when fecal material enters the rectum. However, if this behavior concerns you, be sure to mention it to the doctor at the baby’s next checkup. In rare cases, a baby’s anal opening may be too tight or her anus may be in the wrong position. Although rare, these anatomic variations can make it more difficult to pass stool.

Does it hurt to wash your baby’s soft spot?

Pressing-Babys-Soft-SpotThe medical name for a baby’s soft spot is called the anterior fontanel. This is an opening between the bones of the skull that allows the cranium to grow. The fontanel is covered with a very tough membrane so you will not hurt it when you wash your baby’s hair. Although doctors would never recommend poking the fontanel, you can scrub it gently with a hairbrush like the rest of your baby’s scalp.

Do umbilical hernias need to be treated?

Umbilical-hernia-in-childUmbilical hernias are caused by a weakness in the ring of muscles that surround the belly button. Because of this weakness, abdominal fluid or intestinal contents can push on the skin covering the belly button causing a bulge. The bulge will be more noticeable if a baby is crying or if an older child is standing up.

Umbilical hernias are common and not serious. In the past, parents were told to bind the hernia so it would go away. This does not work and may create a rash on the baby’s abdomen. Fortunately, most resolve on their own by the time children start first grade. If they persist beyond this point, they may need to be repaired surgically.

Umbilical hernias rarely cause harm. Once in my 30-year career, a piece of intestinal fat got “stuck” in the hernia ring had to be fixed on an emergency basis. The way I knew something was wrong was because the area was red and the baby was crying. When I pressed on the hernia, instead of being easily pushed back in, it was hard and tender to touch.

Reassuring older kids that shots don’t hurt that much

Giving a shot to an older kidIt’s common for toddlers and young children to be afraid of shots. Although I never had to chase my own kids to get them to hold still for a shot, lots of parents have to do this. What I have frequently noticed, however, is that older kids almost always end up being surprised that the shot hurt less than they thought it would. Why does this happen?

Not only do we all have fears, but we also have a tendency to remember our fears when faced with similar experiences in the future. That’s why most people hate going to the dentist even if they’re getting a cleaning instead of having a cavity fixed.

Although young children experience pain when they get shots, older kids are usually not that bothered by the shot itself. However, older kids are often worried about shots because they remember the pain they had in the past.

You may be able to help in this situation if you remind your child that shots haven’t hurt much in the last few years. Another way to deal with this is to have kids write themselves a note after the shot. Then, the following year, you can show them the note, which reminds the child the shot didn’t hurt that much.

How to take a rectal temperature in newborns

Child-Rectal-ThermometerAfter a baby is born, hospital nurses take armpit temperatures. They do this for two reasons. First, they want to be sure a baby’s temperature doesn’t drop as she adjusts to being outside the uterus. Second, because the nurses take temperatures multiple times per day, they do it in a way that is quicker and less disruptive for the baby.

Once you take your baby home, you should take rectal temperatures if you’re concerned that the baby is sick or has a fever. The reason for this is because rectal temperatures are the most accurate way to check for fever, and a doctor’s diagnostic approach to fever is based on rectal temperatures. Pediatricians define fever in the first three months as a rectal temperature of 100.4 degrees or higher.

It’s much easier to take rectal temperatures on newborns than older infants. There are different ways to do this, but I prefer having a baby lying across my legs with her bottom facing up. I separate her buttocks with one hand and gently insert a lubricated digital thermometer with the other. I insert the tip about ½ inch and hold the thermometer in place with two fingers of the same hand I used to separate the baby’s buttocks. That way I don’t have to worry that the device will poke the baby if she wiggles or moves.

How much calcium and Vitamin D do children need?

How-Much-Calcium-For-KidsThe Institute of Medicine updated their recommendations for calcium and Vitamin D a few years ago. When looking at the table, keep the following point in mind. Adults need 1,000 mg of calcium per day. Most food labels list the amount of calcium as a percentage of the adult daily requirement. To interpret what this means for kids, you will need to do a little math. For example, it a portion has 80 percent of the daily requirement, that means it contains 80% of 1,000 or 800 mg. Similarly, if the portion has 35 percent of the daily requirement, that means it contains 35% of 1,000 or 350 mg.

At some point, food labels may list the amount of calcium in mg rather than percentage figures. Until that time, plan on doing some calculations in order to figure out how much calcium your kids are getting.

The best way to obtain nutrients is from what you eat, but anyone who spends time with children knows that can be an uphill battle. If your child doesn’t get the optimum nutrients from his diet, a supplement is the next best option.

Age Calcium (mg/day) Vitamin D (IU/day)
Birth to 6 months 200 400
6 months to 1 year 260 400
1 to 3 years 700 400
4 to 8 years 1,000 600
9 to 13 years 1,300 600
14 to 18 years 1,300 600
19 to 30 years 1,000 600

Check out the following links for more information about calcium and Vitamin D:



Is scarlet fever still dangerous?

Scarlet Fever in KidsStrep throat is caused by a bacterial species called Streptococcus pyogenes. There are more than 100 types of strep based on their cell structure. Of these, a small number produce a toxin that can cause scarlet fever.

The symptoms of strep throat include fever, sore throat, headache, stomachache and fatigue. On examination, a child will typically have red and swollen tonsils with or without pus and swollen, tender lymph nodes where the neck meets the jaw. With scarlet fever strains, a child will develop additional findings: a red, strawberry-appearing tongue and a sandpapery or gooseflesh rash on the body. A week or so after the infection resolves, the skin on the child’s body may peel.

Before the development of antibiotics, scarlet fever was a deadly disease. As a result, some people (especially grandparents) may worry if they hear that a child has scarlet fever. Nowadays, scarlet fever is a different illness, and doctors just consider it a strep throat with a rash.

One fact about scarlet fever is very interesting. It appears that not only does a child have to be exposed to a certain strain of strep to develop scarlet fever, but his body has to react to the bacteria in such a way that the rash occurs. Although I have experienced hundreds of patients giving strep to their brothers and sisters, I have never had two cases of scarlet fever in the same family at the same time. This doesn’t mean it can’t happen, just that it’s quite rare.

Does your baby’s head have a funny shape?

Baby Head Shape

In the past, babies rarely got funny shaped heads because they slept on their tummies. When we started putting babies to sleep on their backs 20 years ago, unusual head shapes started to be noticed. The pictures above show three types of head shapes: symmetrical, plagiocephaly (flat on one side) and brachycephaly (flat along the back).

A baby’s head will take on an unusual shape if he spends more time sleeping with his head in one direction. This occurs because more pressure is applied to one area and the head “molds” the corresponding location. In most cases, this represents a temporary finding that will resolve over time.

When pediatricians examine babies with unusual head shapes, we look for two problems. This first is a common condition called congenital muscular torticollis. If a baby has torticollis, the neck muscles that bend and rotate the head are tighter on one side causing the baby to spend more time turned in one direction when asleep. It many cases, it will also be noticed when the baby is awake. Over time, this will deform the shape of the skull. Torticollis is treated with physical therapy or watchful waiting depending on its severity.

The second is a rare condition called craniosynostosis. In this situation, one of the skull bones is not growing properly because it is “stuck” to the opposing bone, causing a misshapen head. If there is a question whether your baby has this condition, he will be x-rayed or referred to a pediatric specialist (neurosurgeon or plastic surgeon) for a thorough evaluation.

For the past 10 years or so, companies have sprung up to “fix” plagiocephaly and other asymmetric head shapes. A handful of studies have been published showing that this is not necessary. If your baby’s head is flat on the side or back because of positional forces, the problem will usually resolve by 2 to 3 years of age. The head may not look perfect, but a corrective helmet won’t make it look any better.

What is tummy time, and why is it important for infants?

Tummy Time InfantsNow that babies sleep on their backs, it’s important for them to get tummy time throughout the day to help strengthen the muscles in their arms, neck, shoulders and back. I usually recommend that parents start tummy time when babies are 4 weeks of age. You could do this sooner, but I figure parents have enough things to worry about in the first month without putting tummy time on their list.

There is no “right way” to do tummy time, but it makes sense to do it when babies are alert. First, put the baby tummy down on a firm surface like a couch, bed or the floor. If possible, lie down next to the baby, which will encourage her to look up and see your face. If the baby is fussy, you can help support her upper body by pulling her elbows in to her sides. If you smile and talk to your baby, she will be more likely to work her muscles to make tummy time a success. If your baby is still fussy, try putting her on a slant to make it easier to look up. The best way to accomplish this is to put her on her father’s chest while he is lying at a 30-degree angle.

Do tummy time for 5 to 15 minutes a handful of times during the day and evening. Obviously, how long tummy time lasts will depend on your baby’s interest. Never leave the baby alone in this position, even for a second, or she may roll over and hurt herself. Likewise, make sure you are alert because we don’t want babies to fall asleep during tummy time because that is a SIDS risk just like sleeping on their tummies at night.

How does a circumcision heal?

circumcision healingWhen a newborn’s penis is circumcised, the head of the penis (glans) will be red and wet looking for 3 to 5 days. During the healing process, it’s common for the glans to develop small yellow patches. These areas are part of the healing process and do not mean the baby has an infected circumcision. (If you’ve ever had a cut inside your mouth, you’ll recall that it heals with a whitish or yellow patch rather than a tradition scab. The same thing happens to a circumcised penis.)

I’ve been practicing pediatrics for over 30 years, and I have never seen an infected circumcision. If this were to occur, the redness would extend from the glans to the shaft and then towards the baby’s body. If you see this, call your doctor right away.