The Why? letter #2 (Growing Pains)

16 Nov

The Why? Letter #2

Why does my kid have growing pains and what are they?  It’s a great question and it’s also a question that 20-40% of parents are going to ask since it happens that often in children.  So let’s dive in and see if we can clear some stuff up.

First off, growing pains often get called “bone pain” and this is wrong.  It would be best to be described as muscle pain.  We do see “growing pains” happen during the periods when children experience very rapid phases of growth, but it is not from their bones hurting as they grow.  We see growing pains occur during the ages of 2-6 years old and then again from about 9-12 years of age.  They will usually occur more at night and your child will often wake up crying in pain.

So what causes them?  Well we think there are two different causes to this pain.  The first cause is damage.  These kids are not very nice to their bodies and treat them terrible; jumping, running, falling and running into things.  We do our healing during the night and sometimes healing hurts.  The second cause is growing, bones grow faster than muscles and tendons and when they are having rapid phases of growth the muscles and tendons have to be stretched to catch up…that stretching sometimes causes pain.

So how do we know it’s growing pains and not something much worse?  Everyone has heard the horror story of a parent that was told by their doctor their child had growing pains and it ended up being a bone tumor, so how do we know?  To start off we would like to have a history of a child complaining of multiple different sites hurting.  Not at the same time, but that they may have complained of the right leg this week and last week it was the left leg.  Bone tumors are usually solitary so we worry more if the pain is in the same spot all the time.  We should see nothing with growing pains.  If we see anything like swelling, redness or feel any warmth we worry something else is going on.  Finally the child should like you to rub the area that hurts when they are having growing pains, but the bad things will hurt worse when they are touched or rubbed.

If your child is having pain that you are thinking might be growing pains just talk to your doctor, rub the painful area if they want you to, and use some ibuprofen or a heating pad on the area.  They tend to last a week or so, be more common at night and then they will go away only to show up again on some night when you are deep asleep and probably having the best dream of your life.

The Why ? Letter #1

31 Oct

The Why? Letter

 

We are often asked as pediatricians, “Why do they always get fever at night?” There is a reason besides the fact that they just want to drive you crazy since all the pediatric offices are now closed (OK they just may want to drive you crazy).

First you need to know how a normal temperature works. We all know that a normal body temperature is 98.6 Fahrenheit right? Wrong! 98.6 F is an average body temperature. Our body will naturally fluctuate a degree in each direction throughout the day. That means that a normal body temp can range from 97.6-99.6 F right? Again wrong! That is the average, meaning that body temps actually follow one of those bell shaped curves we tried to skip learning about while we were in school. About 84% of people fall in that curve with 7% of people falling above that range and 7% falling below it. Therefore before you think your child had a temp it would be a great idea to know what your child’s temp is normally. Therefore we as physicians have determined that a fever is anything over 100.4.

Back to the question of, WHY at night? Part of the reason is you may not have seen or touched your child all day. They may have had a fever during the day, but until you touch them you didn’t notice it. They do get higher temps during the night and early morning. Remember that paragraph you just read about those temp ranges? Well our normal body temp tends to be higher at night and early morning. The reason has to do with the complicated subject of our normal body steroids. Our normal body steroids tend to dip at night between 9 pm and 4-5 am. This dip in our steroid level is the reason our temps go up. Just FYI this dip is also responsible for croup and asthma being worse at night and the reason that most deaths occur during these hours.

Now you know, but does it mean anything? Not really, just know it isn’t more worrisome. You freak out about how high that temp is, but doctors very rarely do. We are more concerned that they have a fever rather than how high it is. We also believe you that they had a fever during the night (as long as you actually took it with a thermometer). We know that the temp naturally goes down during the day when we are going to be seeing them. It is very rare that you need to go to the emergency room for a fever unless there is something else going on. The exception to this is if you have a baby less than two months old (we consider this fever an emergency) or if you have recently had a surgical procedure.

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Breastfeeding

28 Mar

Breast feeding and things you need to know:

  1. Breast feeding is best for MOST babies.  That most is very important and gets left out a lot.  If you can’t breast feed your baby for reasons either to do for your baby or you, its OK your baby will be fine.  Not breastfeeding is not something to waste energy or guilt on, you have a newborn…you are busy enough.
  2. It will hurt initially (for maybe up to the first couple of weeks), they tell you it won’t but it will.  This doesn’t mean you are doing something wrong, it means that part of your body isn’t used to being chewed on by a Doberman.  It needs to get used to the trauma and that takes time.
  3. If you start to look like ground beef and are wanting to scream in pain every time you breastfeed ask us or your OB/GYN for help.  I have some prescription ointment that will help…a bunch.
  4. If your breast starts to look really red, feel hot or you get a fever, call your OB you could have mastitis (an infection of your breast) and need antibiotics.
  5. Breastfeeding takes a lot out of mommy (literally), make sure you are getting plenty of fluids, taking a calcium supplement and getting some rest.
  6. After the first several days of getting your baby used to breastfeeding a pacifier is fine.  Babies like to suck on things and if they don’t have a pacifier then you are the pacifier.  Pacifiers have been proven to reduce ear infections and reduce the incidence of SIDS.
  7. Breast milk is deficient in Vitamin D.  Your baby will need a Vitamin D supplement.  These come in a dropper that you give 1 ml to your baby by mouth everyday.
  8. It’s tough and lots of work but it is something that only you can do for your baby and it has numerous benefits to you and your baby.  Revel in the fact that you are doing something that only you can do for your baby.

Bee and Wasp stings

27 Mar

Warmer weather is now upon us. Those of us living in east Tennessee realize that with warmer weather come insects. Bee and wasp stings can be quite traumatic for both the child and the parent. The most important thing to consider is allergies. It is important to recognize the signs of a severe allergic reaction to a sting. Some of the things to consider are as follows:

  1. Trouble breathing
  2. Feeling of faintness or dizziness
  3. Hives
  4. Abdominal pain or vomiting
  5. Swelling of the tongue
  6. Prior history of allergic reactions to stings

If your child is experiencing any of these symptoms seek immediate medical attention. It is important if you have a known allergy to bee or wasps to make sure that you have an epi pen at your disposal for such emergencies. If it is expired or close to the expiration date, you should call your pediatrician and have the prescription refilled.

For those who are not allergic to stings, treatment can be rather simple.

  1. Remove the stinger. You can use tweezers or your fingernail to remove the stinger. Try not to pinch the stinger because it can inject more venom into the skin.
  2. Control the swelling with ice and keep the part of the body that has been stung elevated. Remove any jewelry or tight fitting clothing to prevent any further injury due to swelling. Swelling will often be worse the day after so don’t panic if it is larger the next morning.
  3. For pain, ibuprofen or Tylenol may be used.  If itching becomes a problem, antihistamines such as Benadryl can be taken.

It may take 2-5 days for the area to heal. It is also important to keep the area clean to prevent infections.  I hope this is helpful to everyone.

Car seat laws

26 Mar

Traveling with children can be both an enjoyable experience and can be one of the most trying ordeals that could test the faith of the most devout parents. Regardless of the trials and tribulations of traveling with little ones, the most important thing is their safety.  One of the most frequently asked questions is child restraint laws.  This is a brief overview of the restraint laws in Tennessee.

  1. Children 1 year of age and less than 20 lbs should be placed in a car seat in the rear facing position of the back seat of the automobile. Be sure to check the weight limits on the car seat you decide to purchase
  2. Children older than 1 year up to 4 years of age and weighing more than 20 lbs must at a minimum be placed in a car seat in the forward facing position in the back seat of your automobile. The American Academy of Pediatrics recommends rear facing until two years of age with a size appropriate high backed rear facing car seat.
  3. Children ages 4 through 8 and that are less than 4ft 9 inches tall must be placed in a booster seat in the back seat of your automobile. If your child is not in that age group but is less than 4ft 9 inches they must still be placed in a booster seat.
  4. Children 9 through 12 years of age and taller than 4ft 9 inches must wear a seatbelt at all times. It is preferred that they are placed in the back seat if possible.
  5. All passengers 13 years of age and older must wear a seatbelt even if they are sitting in the back seat.

It is important to remember that the driver of the vehicle is responsible for making sure that all passengers 16 years of age and younger are properly restrained. A fine of $50.00 will be assessed for each passenger not properly restrained. If the parents are present but not driving it is their responsibility to make sure their child is transported safely. So in short, make sure your kids are properly restrained for their safety and yours.

Poison Ivy

25 Mar

With summer time approaching, children are going to want to be out and about playing. One of the many conditions seen in the pediatrician’s office during spring and summer is poison ivy. Poison ivy has a 3 pointed leaf that change color with the seasons. Colors include reddish in the spring, green in the summer, and yellow or orange in the fall.

The allergy to poison ivy isn’t the leaves but the oil in the leaves and vines. Depending on how allergic an individual is to the oil determines how bad the rash is after contact.  The rash can appear from 4 hours to up to seven days after exposure.  Appearance of the rash may look red with blistering and itching. The more exposed area the larger the rash. As scratching at the rash will make the area larger as the rash will follow the scratch marks.

Several things can be done to prevent exposure:

  1. Avoid areas that you know have poison ivy
  2. Make sure to wear proper clothing and cover all areas of exposed skin that may come in contact.
  3. Wash all outdoor equipment that may have come in contact with soap and water.
  4. If a possible exposure has occurred there are soaps like Zanfel and Tecnu that can be purchased at pharmacies to wash off the oil from poison ivy.

If exposure has already occurred, wash area with soap and water as soon as possible. Wash your hands frequently to include under the finger nails to prevent spreading the oil to other areas of the body. If the rash spreads to the face or around the eyes treatment with a steroid injection followed by a 9 day oral steroid may be needed.  For smaller exposed areas such as the arms and legs, a cold compress, calamine lotion, nonprescription hydrocortisone cream or an antihistamine may be used to help with the itching.  If the symptoms appear worse and do not seem to be improving give us a call.

Sunscreen

25 Mar

As warmer weather is approaching it is time to think about sunscreen. They say that 85% of the damage that leads to skin cancer happens when you are less than 18 years old. That means as parents we have a huge responsibility of protecting our children from skin cancer. So how do we go about picking out a sunscreen?

You want a sunscreen that has protection against UVA and UVB radiation. It needs to be water resistant and have a SPF of at least 35. It needs to be reapplied every hour and a half or so and about every 45 minutes if you are in water. Especially lay it on thick on problem areas such as nose, ears, and the back of the neck.

We usually recommend Water Babies by Coppertone for most children because it has everything you need, it’s easy to find, and it’s one of the cheapest out there. If your child has sensitive skin I recommend Blue Lizard which can be found at bigger pharmacies.

Get your kids outside, have fun, but keep them safe and sunburn free.