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:

https://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/

https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional

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.