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Feeding Your Baby: Tips for Successful Breastfeeding

For anyone entering parenthood today, you’ve undoubtedly heard the phrase “breast is best,” and for good reason. That’s because there are simply no substitutes that rival the invaluable health benefits of breast milk, which explains why the American Academy of Pediatrics recommends feeding babies breast milk exclusively for the first 6 months, and as long as possible – ideally throughout the first year. Yet according to the CDC’s 2013 Breastfeeding Report Card, while nearly 4 out of 5 new moms start breastfeeding, only half are still doing so at 6 months, and fewer still – only about twenty-five percent – continue throughout the full first year.

As with so many aspects of parenthood, it has been my experience that it’s one thing to know what to do, and altogether another to know how do it. In the case of breastfeeding, the fact of the matter is that what’s “natural” doesn’t always come naturally. Too many moms are caught off guard by this and quit early because they don’t have the support they need. In other words, they mistakenly think they’re failing when they’re really not. That’s why I think it’s so important to share the following breastfeeding insights and practical tips, as they can really help to increase the odds of breastfeeding success.

  • Catching on to latching on. Don’t be afraid to ask for help if at first your baby doesn’t succeed. Some babies are born with the ability to latch on to the breast correctly right from the start, but others really benefit from some hands-on training before they catch on to this all-important skill.
  • Be sure to send out an SOS (in Search out Support)! Anyone who’s ever done it knows breastfeeding can be time-consuming, tiring, or – if we’re being honest with ourselves – even downright demanding. Breastfeeding moms should always remember to ask for support – whether it’s in the form of a helping hand at the hospital, help tending to baby’s other night-time needs, or to fend off any feelings of isolation or frustration.
  • Remember it’s a matter of supply and demand. Fussy babies often fool moms into believing their milk supply is inadequate. Instead of simply assuming that extra fussing and/or frequent nursing are sure-fire signs of breastfeeding failure, it helps to first understand how the concept of supply and demand applies. Whether in the earliest days of breastfeeding or in the weeks after settling in to a predictable nursing routine, fussing and acting hungry is how babies communicate their growing “demands” so that they can successfully increase the milk supply. If you have any concerns, always remember to check-in with your pediatrician to make sure that everything is on track.
  • Get comfortable. This not only includes finding a comfortable feeding position that works for you and your baby – whether it’s a cradle hold, a football hold, or laying side-by-side – but also becoming comfortable with breastfeeding in general. The ability to find a comfortable position, feel adequately covered-up, and nurse in public and/or on-the-go all serve to make breastfeeding a more enjoyable experience.
  • Don’t get too irritated. Be aware that there are some mild irritations that can show up during the first few days of breastfeeding – most notably some nipple irritation and uterine cramping – but tend to go away within days. After that, remember to be on the lookout for and seek medical advice throughout your breastfeeding months for the onset of any new irritations in order to keep blisters, cracks, blocked milk ducts, or mastitis (breast infection) from getting in the way of an otherwise painless and enjoyable breastfeeding experience.3
  • And finally – remember that breast milk each day really can help keep the doctor away. Not that I am in any way advocating the avoidance of your pediatrician, since a close partnership with your pediatrician and regular checkups are key to your baby’s health. Rather, I find it is both empowering and motivating to finish any discussion of breastfeeding with a reminder that breastfeeding is a great investment in your baby’s overall health – one that not only provides them with the ideal food, but also lots of other health benefits and plenty of opportunity for shared bonding time.

Originally posted on Omaha World Herald’s Live Well Nebraska

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Why E-Cigarettes Have Me Worried

The more I hear about e-cigarettes, the more they have me worried. And unfortunately, I’m not the only one who’s hearing a lot about these increasingly popular “alternatives to tobacco cigarettes.” In fact, a recent nationally-representative survey found that 40 percent of Americans have heard of the electronic nicotine delivery systems (ENDS) affectionately referred to as “e-Cigs”, teens seem to be quite taken by them, and annual sales this year are shaping up to be a predicted $1 billion. But that’s not all. Here are a few other compelling reasons why I’m worried.

What you see isn’t always what you get. Ask any teen to describe what’s in an e-cig and the likely answer you’ll get is that it’s “just water vapor,” and therefore harmless. For those of you who have yet to pay much attention to e-cigs and don’t yet know what they actually are, let me explain why this is a dangerous misperception. E-cigs are devices – many of which are designed to look similar to cigarettes – that do in fact vaporize appealing-flavored solutions into a mist that can be inhaled into the lungs. But while “water vapor” may be what you see, what e-cig users actually get is a vaporized chemical mixture typically composed of nicotine, propylene glycol and other chemicals. And what we do know is that nicotine can be highly addictive.

What you don’t know can hurt you. Just because e-cigs don’t produce tar or ash like cigarettes do does not mean they’re safe. In fact, the World Health Organization (WHO)’s Tobacco Free Initiative states that the potential risks they pose for the health of users remain undetermined, the safety has not been scientifically demonstrated, and scientific testing indicates that there is significant variation in the amount of nicotine and other chemicals contained in each product. Their conclusion, and one that I share: Until e-cigs are deemed safe and effective and of acceptable quality by a competent national regulatory body, consumers should be strongly advised not to use any of these products.

E-cigs are a step in the wrong direction. According to the Legacy Foundation, youth cigarette use declined sharply between the mid-1990’s and 2010, leveled off in 2011, and continued to decrease in 2012. In contrast, the CDC reports that e-cigarette use by minors is rapidly increasing – having doubled between 2011 and 2012. While advocates argue that e-cigs are a “safer alternative” to cigarette smoking, there are no scientifically proven methods for using e-cigs as cigarette replacements. In the meantime, they have me and just about everyone I know who’s involved in promoting healthy behaviors worried because they run the very real risk of initiating new teen e-cig smokers and making smoking cool again.

Looks can be appealing. Speaking of cool – it’s not so long ago that cigarettes were considered cool. In fact, too many movies still portray those who smoke cigarettes to be dashing, daring and desirable. Now enter e-cigs and you’ve got a new and even more appealing high-tech design. Now I’m not just worried that all of the longstanding public health efforts directed towards keeping teens from smoking will go up in smoke, but quite possibly go up in vapor as well.

Jenny McCarthy can be quite convincing. As if the enticing flavors and the convenience and the easy accessibility of sleek new e-cigs wasn’t enough, Advertising Age recently reported that Jenny McCarthy – known for her many years speaking out against childhood vaccination despite nearly two dozen scientific studies to the contrary – has signed on to be the new face of the leading brand of e-cigarettes. And even though tobacco advertisers haven’t been allowed to advertise on TV since 1971, e-cigarette makers now can because unlike their tobacco-containing counterparts, e-cigs are not yet regulated by the FDA. This really has me worried, given that a recent study on the international reach of tobacco marketing among young children confirms that pro-smoking messages delivered through marketing and the media can reach very young children and influence attitudes and behaviors around smoking.

So now that you hopefully agree that I’m justifiably worried, I hope you’ll join me in being proactive about it. Talk to your kids about e-cigs. Find out what they know, what they’ve heard, what they’ve seen. And make very sure they are well-informed – both about what e-cigs are, and about what they’re not!

Originally posted on Omaha World Herald’s Live Well Nebraska

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Back-to-School Parenting: Addressing Common Ailments

It’s that time of year again, when prepared parents get a head start on supply shopping while our children eagerly pick out new backpacks in anticipation of the rapidly approaching return to school. As both a parent and a pediatrician, I’ve found that this is the time when it’s also useful to arm oneself with information about some of the more common ailments and health-related challenges of the season.

What first comes to mind, in addition to the annual scramble to get school physicals and sports forms signed (a necessary and important pre-requisite for getting the school year off to a good start), are the not-so-eagerly anticipated maladies that predictably show up each fall. While children predictably share everything from strep throat, pinkeye, and common cold viruses to dreaded head lice – I’ve found that it’s the back-to-school headaches and stomach aches that have a way of leaving parents scratching their heads wondering which ones warrant being taken seriously.

When it comes to stomachaches, parents often find it difficult to determine which ones are “real,” and which are simply the result of not wanting to go to school. By “real,” most parents are thinking of the stomach-flu type illnesses that often cause symptoms like fever, vomiting and/or diarrhea. It’s important for parents to understand, however, that stomach aches not attributable to a virus or other medical cause can still be quite real. Stress-related stomachaches in school-age children are actually quite common and often said to be the equivalent of headaches in adults. Even if the underlying cause is due to a child’s stress or desire not to attend school, very “real” symptoms (such as vomiting and diarrhea, but not fever) can result, and it’s worthwhile trying to identify and address the underlying cause(s).

Similarly, the appearance of headaches can often cause parents to question whether they are serious or simply related to new school year nerves. When it comes to getting a head start on school-year headaches, as well as stomachaches, it’s always important to consider when they first start (after the first day of school? or during the family’s eagerly anticipated summer vacation?), when they occur (first thing in the morning? Or after a long day of reading and/or computer use?), how bad are they (do they make your child stop doing even those things they really enjoy? Or only get in the way of chores and going to school?) And what makes them better or worse.

There are common medical explanations – the eye strain and/or the yet-identified need for glasses, or the onset of seasonal allergies, for example – but it’s equally important to enlist your child’s doctor if you need help sorting out stress-related causes of headaches and/or stomach aches, as the resulting symptoms can be just as “real,” and addressing them just as important.

Getting a handle on these school-time ailments, as well remembering to help ensure your children get a good night’s sleep and eat a good breakfast, will go a very long ways towards making this a more enjoyable and productive school year.

Originally posted on Omaha World Herald’s Live Well Nebraska

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Top reasons people visit the doctor during the summer

As my children finish out another school year and the whole family settles in to our summer routine, I can’t help but be reminded of how nice it is to have made it through another winter of cold and flu season. After a winter of spending significantly more time indoors and in closer quarters with other people – the characteristic of winter which inevitably leads to more effective sharing of illness-causing germs and more frequent trips to see the doctor – I routinely find myself welcoming the sunshine, the swimming, and all of the other outdoor activities that summer brings.

As I buy my summer supply of sunscreen, fill prescriptions for allergy meds and remind my teenagers that they are still expected to wear their bicycle helmets, however, I am also reminded that stepping into summer fun and sun is not without its own set of reasons to visit the doctor. After all, this warmly welcomed season comes with its own set of most common illnesses, ailments and injuries.

Seasonal Allergies. For millions of allergy sufferers, some of the sure signs of summer – freshly cut grass, pollen and weeds to name a few – also serve to bring about itchy eyes and runny noses. Allergy symptoms that often start in the spring can and often do persist throughout the summer and into the fall, and can range from annoying eyes, nose and skin irritations to more serious sinus infections and difficulties with breathing and wheezing – all of which may warrant a trip to the doctor for diagnosis and/or treatment.

Bites. Need I say more? Spider bites. Mosquito bites. Tick bites. These too are the signs of the season, and in some cases warrant a trip to the doctor – in some cases for identification, because of increasing pain, redness, swelling, or the appearance of a rash, or for symptomatic treatment.

Broken Bones. Along with the welcoming outdoor weather and increased physical activity of the summertime comes a noticeable increase in injuries which, in addition to the common bumps, bruises, and skinned knees characteristic of the season comes the increased likelihood of broken bones. While necessitating a trip to the doctor, the good news about broken bones is that despite the temporary pain and limitations, children’s bones actually heal incredibly well.

Diarrhea. Not only do summer viruses have the distinct ability to cause some less-than-desirable effects when it comes to vomiting and diarrhea, but so do several bacteria known for contaminating food and summertime fun. That means that in addition to recognizing and regularly acting on the importance of hand washing when dirty, when in contact with germy hands or surfaces, or when exposed to someone who is sick, remember to heed.

Rashes – in addition to bug bites, rashes such as heat rash, increasingly dry skin and eczema, sunburns, and contact rashes such as poison ivy all tend to make their appearances in summer. Generally, a trip to the doctor is warranted either to figure out what the rash is, and/or figure out how best to treat the often-associated discomforts.

Stings. Head outdoors in the summer and you’re sure to find bees. While I only just finished listening to a world-renowned bee expert give a TED talk on how crucial bees are to the world’s food supply, nevertheless as a physician when I hear “bees” I think bee stings. While a run-of-the-mill bee sting doesn’t typically necessitate a doctor visit, some people can have enough pain, swelling and even – in some instances, all-out allergic reaction that requires medical attention.

Sun-related. While sun may be one of the things we all look forward to most about summer, having a healthy respect for its ability to cause sunburn, dehydration and heat stroke – especially during the peak hours of 10a to 2p – can help keep your family out of the doctor’s office, as can making sure you stay well-hydrated and well-equipped with sunscreen.

Swimmer’s ear. Also referred to as “otitis externa,” this common ailment of summer occurs as the result of repeated exposure to water, and typically presents itself as an annoyingly itchy and often painful irritation of the ear canal. While the pain and redness are often alarming enough to bring people in to see their doctors, the good news is that simply drying out the ear canal and treating the infection work very well.

Viral illnesses. While we all tend to think of winter as the time for cold and flu viruses to lurk, there are still plenty of summertime viruses – most notably a group called enteroviruses – that can cause anything from vomiting and diarrhea to hand foot mouth, and/or croup-like illnesses. In most cases, what most determines the need for a trip to the doctor is the persistence of high fevers, dehydration, lethargy, accompanying rashes, or simply reassurance.

Well visits (for school). I would be remiss as a pediatrician if I did not remember to mention that while you may think of them as “school physicals”, summertime is actually a great time to beat the crowds of people who wait until just before school starts and take your school-age child in now for his/her annual well visit (not to mention camp physical, sports participation physical, etc).

Originally posted on Omaha World Herald’s Live Well Nebraska

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Signs of Spring: Recognizing, preventing and treating seasonal allergies

While most people welcome spring with open arms, an estimated 35 million new and seasoned allergy sufferers may not be so excited. These folks are generally the first to realize that spring is, quite literally, in the air. They’re faced with questions about how to recognize, understand, prevent and treat seasonal allergies. While it’s hard to believe with snow still on the ground, the fact is we’re fast approaching that predictable time of year when the runny noses of “cold season” are replaced by those provoked by pollen.

In general, think of allergies as the body’s over-reaction to something. That “something” being an allergen – certain foods, pet dander, dust, medicines, mold spores, pollen, etc.

Every person is different when it comes to whether their body reacts to allergens, which ones and how bad. Some people go through life with no allergies whatsoever. Others experience reactions ranging in severity – from a simple runny and/or itchy nose, eyes, mouth, throat and ears, to wheezing or worse.

These symptoms definitely have some overlap with those of the common cold. In fact, the runny/stuffy nose and sneezing offer little insight into whether a cold or an allergy is to blame. Coughs, on the other hand, are more likely to mean cold. And the presence of itchy eyes or nose points to allergies. There’s actually a term for that habitual upward nose-wiping gesture you often see kids doing. It’s called an “allergic” or “nasal salute.”

If you start seeing possible allergy symptoms in your kids, have a conversation with their pediatrician. Figuring out the cause of your child’s symptoms is going to determine how best to treat and prevent them. The ideal approach is to prevent exposure to the culprit allergen(s) altogether. In many instances, avoidance can be challenging but nevertheless doable – like peanuts or penicillin.

In contrast, spring’s molds and pollens literally make their way into the air we breath, making absolute avoidance much less realistic. A typical pollen season can run from March through October, and the amount of pollen in the air can vary from day to day depending on the weather (with hot, dry and windy days especially bad). Keeping windows closed, using an air conditioner, air purifier, humidifier or air filters, and staying indoors when pollen counts peak can certainly help.

There is also a wide range of medicines – antihistamines, nasal steroids, decongestants, and allergy shots – that help prevent allergic reactions or minimize symptoms once they appear.

Be sure to brush up on your allergy-prevention plan and treatment if your child has been diagnosed with seasonal allergies in years past, and check in with your pediatrician if you suspect them.

As we jump straight from the snow into spring, many little noses are likely to keep on running, so keep an eye out for the telltale signs of allergies vs. cold. And it’s not a bad idea to continue to keep a box of tissues on hand!

Originally posted on Omaha World Herald’s Live Well Nebraska

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Arming teachers with what they really need…pencils, books, and healthy, school-ready children!

There’s no ignoring it. The topic is everywhere. Our country is engaged in a national debate about gun control, and in many cases, whether or not we should arm our teachers. I certainly have concerns about putting guns in closer proximity to our children, since the absence of guns from their homes and communities has been proven the most effective way of preventing firearm-related injuries within this age group. And while the conversation about gun control is long overdue, I feel compelled to point out that there is a more important discussion when it comes to arming teachers.

Far less controversial and already proven “arms” exist, and we actually know a lot about what works when it comes to ensuring our children stay safe and healthy while at school. Here are a few ideas.

Books. Helping children grow up with a love of reading in a literacy-rich environment is crucial for their future success and well being. Every educator and pediatrician I’ve met agrees – children must spend their first few years of school learning to read in order to spend the rest of their lives reading to learn. The sad fact is that far too many child care settings and elementary schools lack the books (or the budget) needed to make this happen. And Omaha is not immune to this problem.

Breakfast. As the co-author of Food Fights, a book that offers solutions to kid-related nutritional challenges, it should come as no surprise that I believe that good nutrition (all day every day) is essential for kids (and adults, for that matter). It’s needed for good physical health, concentration and the ability to learn. The fact of the matter is, hungry children simply don’t learn as well as others. So it’s time to ask the tough questions: How do we provide all children, especially those who are disadvantaged, with a nutritious breakfast?

School nurses and other health professionals. Our health and ability to learn are inextricably intertwined, especially in our children’s earliest years. Unfortunately, budget cuts often leave our schools with little, if any, access to a school nurse or other health professional. Even fewer child care centers have this much-needed access, despite the existence of clear justification for these health consultants.

Vaccines and other germ-fighting tools. Making sure children and teachers are fully vaccinated is so important. This also means insuring measures are in place to limit the spread of infection and missed school days. We need to arm our teachers not only with the paper and pencils, but with vaccinated children, cleaning supplies and disinfecting procedures. Access to hand washing sinks, soap, hand sanitizer, bleach water and/or disinfecting wipes are small investments that can yield big returns.

Children who are ready-to-learn. Key words here: when they enter kindergarten. We have irrefutable evidence that proves investing in early childhood and a strong foundation is hugely important for safety, health and lifelong well being. We also know this foundation must be laid in the earliest years of a child’s life – well before he or she enters kindergarten. That’s why efforts such as First Five Nebraska and Educare are so crucial.

Originally posted on Omaha World Herald’s Live Well Nebraska

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The advantages and disadvantages of organic foods

A recent trip to supermarket left me feeling better than usual about my family’s grocery shopping habits.

I made my way to the dairy aisle armed with new and must-have information from a recent American Academy of Pediatrics (AAP) report. The topic: Advantages and disadvantages of organic foods.

As someone whose family consumes about six gallons of milk every week, I’ve questioned whether my desire to save a not insignificant amount of money buying non-organic milk might be putting my three children at risk. And I’m fairly sure I’m not the only mom who has had this internal debate. After all, according to the report, as of 2010 the U.S. organic food industry was estimated to be over worth over $28 billion. And on average, organic products cost anywhere from 10 to 40 percent more than those that are non-organically produced.

So I was relieved, and albeit a bit surprised, to learn that the AAP committee (comprised of experts in both nutrition and environmental health) concluded, “There is no evidence of clinically relevant differences in organic milk and conventional milk.”

That’s right, no evidence that organic milk has less bacteria in it. No evidence that conventional milk has any worrisome bovine growth hormones. And few, if any, nutritional differences of any significance.

While not only renewing my confidence in my longstanding milk purchase habits, the report went one step further noting that organic foods are not nutritionally superior to their traditional counterparts. This isn’t to say the two are created equal, because organic foods do contain fewer pesticides. It’s just not yet clear whether the reduced pesticide exposure makes any difference to our health.

So with new information in hand, as a consumer, pediatrician and parent, my stance is simple: Until we know more, err on the side of caution. Limiting pesticide exposure, especially in pregnant women, infants and young children, isn’t a bad idea considering the potential risky effects these chemicals may have on brain development.

Another big take away from the AAP report was that, above all else, we should focus on eating plenty of fresh fruits and vegetables. More importantly than the organic vs. non-organic debate is the conversation about simply eating fruits and veggies in the first place. The average American diet is lacking in fresh produce, so any, organic or not, is better than none. If cost isn’t a concern to your family, then by all means, feel free to buy organic. But if it is, don’t let that keep you away from the produce section or feel guilty when grabbing your next gallon of milk.

Other links of interest:

2008 Consumer Reports Article: Fruits and Vegetables, When to Buy Organic

Environmental Working Group’s “Shopper’s Guide to Pesticides”

Originally posted on Omaha World Herald’s Live Well Nebraska

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The truth about American Idol’s “Idol Bug”

I recently got around to watching a recorded episode of American Idol. Aside from all the melodrama associated with stress, sleep deprivation, and watching people who dream of living life in the spotlight compete against each other, I was struck by the fact that the episode was impressively reminiscent of the opening scenes from the movie Contagion. For anyone who hasn’t seen the movie, suffice it to say that the storyline is focused on the ensuing devastation invoked by the uncontrolled spread of a dangerous new virus.

Okay, so no one died on American Idol’s Hollywood Week episode. But I did experience the same sense of foreboding. Idol contestants shaking hands, exchanging frequent high-fives, offering each other lots of hugs, and just generally partaking in a whole lot of close contact also known as germ-sharing behavior. Worse yet, there was a clearly identified “Patient Zero” in the mix – runny nose, fever, fatigue and all. If germs were visible, I’m pretty sure any viewers who somehow missed the not-so-subtle foreshadowing by the shows producers would have been cringing along with me long before contestant after contestant proceeded to fall ill.

Hmmmm…If only germs were visible…Now there’s a thought. I majored in cellular, molecular biology, so I’ve admittedly had more opportunities to visualize germs than most. But the concept of helping people – even young children – be visually reminded of the presence of germs isn’t out of reach. In fact, there are even cool (and relatively inexpensive) soaps and science  kits that help children (and adults) visualize just how effective (or ineffective) they are at washing germs off their hands.

It is my sincere hope, however, that it won’t take actually visualizing germs for all of us to take stock in what simple measures we already know are effective in preventing the spread of germs. For a quick refresher, let me spell them out for you so you will have them at your (hopefully clean) fingertips! After all, the truth about the “Idol Bug” is that it was likely just another (admittedly nasty and poorly timed) virus making the most of making people sick.  More than just another virus, however, it was also a really good, attention grabbing reminder for the reported 19 million  that we’re still in the middle of cold and flu season, and that the sharing of germs that happened in Hollywood while the cameras were running could happen anywhere – especially to those who neglect to take the following actions!

Wash your hands with soap and water. Handwashing is particularly important not only before eating and after using the bathroom, but any time you or your children are sick or come in contact with people who are sick (or germy surfaces like grocery cart handles). And don’t just settle for a quick rinse. Lather up the soap and be sure to get all areas of the hands – both front, back and in-between fingers.

Cover your cough. I can tell you from lots of child-care-owning experience that it’s entirely possible to teach even very young children to not only cover coughs, but to do so with their arms rather than their hands. They may not get it right early on or every time, but over time they’ll pick up on this very important form of prevention. The fewer illness-causing germs that are coughed into one’s hands, the fewer that stand to contaminate surfaces or get shared directly with others.

Vaccinate. I often get asked longingly in interviews about whether or not we’ll ever discover how to prevent the common cold. I agree that this would be nice, as the symptoms associated with the common cold can certainly be quite pesky. But the severity of the common cold is nothing compared to all of the vaccine-preventable diseases (think measles, mumps, rubella, diphtheria, tetanus, polio) we are now able to effectively prevent. Simply put, vaccination is deserving of its recognition as one of the biggest public health success stories of the past century.

Avoid contact with those who are ill. Within reason, that is. That means that when you’re sick, it’s best to limit contact with others whenever possible – especially in the first days of an illness, when you have a fever, the flu, or other significant symptoms likely to spread germs and infect others (such as a lot of coughing).

Disinfect contaminated surfaces. Think snotty tissues on the nightstand, door knobs, telephone receivers, or any other high-traffic surfaces that are likely to have come in contact with unwashed, germy hands.  Germs can live for hours (and in some instances, days), so don’t forget to disinfect contaminated surfaces.

Originally posted on Omaha World Herald’s Live Well Nebraska

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Brushing teeth: Parental reflections on the importance of oral health and pink princess toothbrushes

I sometimes cringe when I witness the power that putting Disney Princesses on pink and purple toothbrushes has on increasing the likelihood that girls will happily engage in the ever-so-healthy habit of brushing their teeth. To be fair, let me also say that I’m sure I’d be equally impressed by Transformers or Cars or Spiderman or any other enticing children’s toothbrushes that predictably coax boys into opening wide and brushing. That said, I’m going to save my concerns about of the influence of today’s societal “norms” on children and gender stereotyping for another day in order to focus on the very important topic of the month: children’s oral health.

It seems a bit superficial to start out by admitting that I do, in fact, love Princess toothbrushes. Not that I use one personally, of course, but rather I love that they have a way of getting even the feistiest and most willful of four, three, and even two-year-old girls to proudly tell me just how excited they are to own and use one (or two or even three) of these agents of change.

That’s right, I am hoping to convince you (in hopefully 800 words or less) that what may seem like a cute little toothbrush is actually much more than what it may seem. Especially in combination with a few other crucial factors (such as toothpaste, fluoride, and dental sealants), toothbrushes really can serve as powerful agents of change.

I am aware that for many of us, getting our kids to brush their teeth is something we know we should do and therefore commit to implementing from very early on in our parenting careers. Based on the number of questions I’m asked, I’m pretty sure a majority of us have also had to cope with babies’ erupting teeth, searched for ways to get toddlers to open their mouths, and/or struggled to get tweens and teens to take us seriously when we remind them to brush their teeth. All their teeth. With toothpaste. Not every so often, but every day.

So each February, when Children’s Dental Health Month rolls around, I’m happy. Happy because I am painfully aware of how difficult it can be to draw much-needed attention to the importance of children’s oral health – especially as a topic of key national importance. If setting up a campaign and dedicating a month to this worthy cause is what it takes, I’m all for it.

If this month serves as a useful reminder for all of you to brush up on tips for taking care of teeth – from baby’s to teen’s and everyone in between – then we’re off to a good start. It’s also a good time to double check your calendar and make sure your children (starting at the age of one!) are scheduled to get dental check-ups every six months.

But I also hope February’s increased focus on children’s oral health gives you an even healthier appreciation for just how much impact oral health – or the lack thereof – can have on children’s overall health, self-image, and well-being. Cavities and tooth decay (or “dental caries”) are actually considered a chronic disease. And not just any chronic disease, but one that affects more children in the U.S. than any other (five times more than asthma!) and is projected to afflict fifty percent of all children entering kindergarten this year. When left untreated, tooth decay has the very real potential to cause pain, infections, and subsequent difficulty playing, eating, speaking and learning. In fact, it is estimated that children miss nearly 51 million school hours each year because of dental-related illnesses alone. That’s not even to mention the social importance of a smile and just how damaging tooth decay can be to one’s self-esteem.

So I’m willing to admit that making the leap from Princess toothbrushes to this serious of a topic is a big one. But the fact of the matter is that I couldn’t agree more with Jeff Sheldon (a Community Health Educator in the Nebraska Department of Health and Human Services Office of Oral Health and Dentistry) and Nebraska’s Chief Medical Officer, Dr. Joanne Schaefer that taking care of our children’s teeth is an under-emphasized health priority in Nebraska. I’m fairly certain that Rick Ruggles’ recent article entitled Children walk out with smiles put a smile on their faces like it did mine as he described Creighton Dental School’s Give Kids a Smile event earlier this month. I just hope that everyone remembers that oral health is important every day of every month – for your children, and for all children. If we want to invest in our kids, let’s be sure to invest in their smiles too.

For more information on children’s oral health, you can go to:

Originally posted on Omaha World Herald’s Live Well Nebraska

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Parenting a sick child: When a child’s cough is cause for concern

I was recently asked by a concerned parent, “When is a kid’s cough something you should worry about?” As a pediatrician, I feel obligated to point out from the outset that, in most instances, this is a question that really needs to be discussed directly with one’s own pediatrician. There are, however, several general cough concepts I can share with you that will hopefully help you gain a better big picture perspective.

It’s first worth pointing out that a cough, at the most basic level, is simply a reflex that exists to help keep things out of the airway. Even though it may not seem like it when your child is up and coughing in the middle of the night, a cough (like a fever) can actually serve a useful purpose.

As for considering the various causes of a cough, some of the most common in children include infections, asthma, choking or having something stuck in the airway, croup, habit coughing, and certain medical conditions (usually ones children are born with). Some are easy to identify, while other causes can take a bit more sleuthing. Even when you have identified the underlying cause, it may not always give you a definitive answer as to whether to be concerned. In the case of cough-inducing infections, plenty of common colds can cause an inconvenient, annoying cough. Pertussis, on the other hand (also caused by an infection and referred to as “whooping cough”) is known for it’s nagging cough…and the fact that it can prove deadly to infants.

When it comes right down to it, figuring out when to worry about a cough needs to be treated as a problem-solving venture. The following are some of questions most worth considering and the symptoms you’ll want to be on the lookout for.

Age matters.  Any cough in a baby three months or younger warrants a visit to the doctor’s office.

At a loss. It’s one thing to cough. It’s altogether another when the cough takes one’s breath away and is accompanied by more concerning signs such as troubled, noisy, and/or fast breathing.

Time of day. Taking note of how much, how often, and even when during the course of the day and/or night your child coughs can provide some telltale clues. Mucus drainage, for example, typically tends to trigger an increase in nighttime coughing. Habit coughs, on the other hand, tend to go away during sleep.

Persistence counts. More than 2 weeks of a cough definitely warrants a check-up. Coughs associated with run-of-the-mill colds don’t usually last this long, while pneumonia, sinusitis, and other causes of persistent cough often do.

Describe the circumstances. Any history of a sudden cough – especially following a gagging or choking episode – is particularly concerning for a foreign object in an airway.

Over-exposure. Consider if your child’s cough matches that of his siblings, his preschool classmates, or others he’s recently come in contact with. While I’m on the subject, let me also take this opportunity to add that while it’s a very wise idea to take advantage of practical and effective measures to stop the spread of germs – think hand washing, vaccines, and basic disinfection of contaminated surfaces – it’s unnecessary and, more importantly, unrealistic to think that you can (or should) keep your child away from all germs.

Wet or Dry. A mucusy cough is often referred to as a “wet” cough, whereas a cough without mucus is more likely to be called a “dry” cough. While determining whether a cough is wet or dry doesn’t automatically determine the underlying cause or inherently tell you how concerned to be, it can prove to be useful information.

For better or for worse. It’s fairly straightforward but worth saying that taking note of what triggers your child’s cough and what makes it better can be key in figuring things out. Croupy coughs tend to be worse at night and better with moist air. Asthma coughs can be caused by known allergens, may worsen with exercise and respond well to albuterol or other asthma medications.

Additional warning signs. Any time a child has other accompanying symptoms of concern such as a high fever, coughing so hard they are vomiting, coughing enough that they refuse (or are unable) to drink, or cough up blood, it’s time to head to the doctor. to the doctor.

Originally posted on Omaha World Herald’s Live Well Nebraska