Kids Corner with Dr. S 

 

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Welcome to my blog! I am Dr. Lauretta Stombaugh (Dr. S) and I have been part of the Hendersonville Pediatrics family for over 8 years. I have decided to share this blog because I feel that it is vital for parents and caregivers to be well-informed as well as have access to solid, accurate medical information. Your children are our children and we take pride in the excellent care we provide here at Hendersonville Pediatrics. Please join me monthly (or every two weeks if my four kids allow me time to write!) and I will in turn provide interesting, helpful and maybe even comical blogs. Please share a link to my blog! Ready, set, go!!

       

                                                                               It's All About Balance

     A cherished friend, recently shared an interesting article with me which focuses on positive attachment and its’ effect on children later in life. It discusses ways to form a positive attachment or loving bond with your children. Be mindful of their need to have close physical contact early on. Some older generations may view this as spoiling the child, lacking boundaries or the “attachment parenting” style. In some ways it parallels attachment parenting, however, in more ways it is vital for a healthy child. We know this when we look at studies on orphans who lack the physical contact, bonding experiences and attachment early on. It affects their physical growth, mental capacity and ability to learn and thrive.

     I believe that wherever you are from, whatever decisions you make in your life, whomever you choose to partner with, that there is an art to how you live. The first step is recognizing that it’s there. The next step is finding out exactly where it is in the space of your days and how it feels. How can you be in touch with it most of the time? Specifically, the art of parenthood is present the second you hold your child for the first time, whether you give birth, adopt, foster or choose to be a guardian.

      After a visit to my daughter’s friend’s house for a party, she says, “Mommy. ____’s mom told her not to tell me something, but she did tell me.” A few thousand scenarios quickly sweeped across my mind and I casually said, “Oh really? Well, you know that you can tell me anything.” And then, she calmly said, “She has lice.” Ah! The dreaded,anxiety-producing, blood -loving parasite! I reassured her that she would likely escape getting lice, this time, because I was sure that her friend was already treated. (scratch, scratch) Of course, I had to then convince myself. Here are some debunked myths about lice.

     A few weeks ago, I attended the national conference for the American Academy of Pediatrics. It was a positive experience with many “friendly pediatricians” (as we are often called) wandering the conference center drinking insane amounts of Starbucks with their cell phones encased in colorful cases. Throughout the day, I glanced out the south end of the building and watched as 20-30 people picketed against circumcision. I tried to avoid that group because I was not interested in their negative energy. Circumcision is always a source of controversy just like the vaccine debate. As pediatricians we aim to be mindful of both perspectives. It is a personal decision impacted by ethical, religious, scientific and emotional beliefs. Here is some unbiased information for you to ponder.

     The Amercian Academy of Pediatrics (AAP) policy statement published in 2012, states that “the health benefits of newborn male circumcision outweigh the risks.” then, “the procedure’s benefits justify access to this procedure for families who choose it,” and later “health benefits are not great enough to recommend routine circumcision.” Well that doesn’t make it easy to make this decision if you have a boy now does it? So, it basically says the good outweighs the bad, but there’s not enough good for the AAP to recommend circumcision. Where does that leave parents of males in the US with regard to this decision? …caught somewhere in between the social norms, religious beliefs, scientific studies and the desire to make the “right” decision for their child.

The Negatives (b/c I’d like to end this blog on a positive note)

     Male circumcision is a surgical procedure. Albiet a minor one, the risks are still real. There can be bleeding, disfigurement of the penis, infection and pain. Studies show that newborns who are circumcised have high heart rates, elevated blood pressures and high cortisol levels (stress hormones) during and following the procedure. Therefore, it is standard practice to use a local anesthetic as well as another method of pain control (lollipop for comfort? pacifier?). Excessive bleeding can occur, particularly if there is an unknown bleeding disorder, but also in normal, healthy newborns. It is usually minor and easily controlled with simple measures. Infection is always possible, but the procedure is done following strict, sterile precautions. Then there is the ethical point that the newborn cannot verbalize consent. Consider though that performing a circumcision after 1-2 months old or years later is more risky and more painful. It usually requires general anesthesia, incurs a higher cost and has a higher risk of complications. Circumcision is not usually covered by insurance unless medically indicated (rarely the case). Circumcisions can be costly (over $200). Paying cash upfront is normally required. Lastly, it is not guaranteed that a circumcision will end with the desired cosmetic effect. Some physicians remove less foreskin than others which can result in excess foreskin.

The Positives:

According to the CDC website, these are some conditions which may occur in uncircumcised males at higher rates:

• Urinary tract infection
• Penile inflammation (swelling)
• Candidiasis (yeast infection)
• Phimosis and paraphimosis (where the retracted foreskin gets stuck)
• Inferior hygiene (can result in a collection of smegma or dead skin cells)
• Sexually transmitted infections including high-risk human papillomavirus (HPV), genital herpes simplex virus (HSV), trichomoniasis, mycoplasma, syphilis, chancroid, and HIV
• Physical injuries to the foreskin, including coital injuries
• Cancers of the penis, prostate, and cervix

While some of these are rare, others can be recurrent issues for some boys/ men. A circumcision can make the above less likely. Some believe that it is easier to keep a circumcised penis clean, however, good hygiene is possible in an uncircumcised male. Regardless, care should be taken to gently pull back the foreskin when bathing. Eventually it will be easily retracted although this can take years.

So, as pediatricians, we strive to “do no harm” when caring for our patients. Unfortunately, there are some situations where we can only educate parents on the facts, debunk the myths and share our experiences. We can tell you with honesty what we would choose for our own children as far as vaccination, circumcision, medication choices, etc. We realize that these are ultimately your decisions. Just remember that trust is a vital part of any relationship. We trust our parents because they know their children better than we do. We aim for our parents to trust us and the information we provide as pediatricians.

Dr. S

- please share your topics for future blogs on our Facebook page or my twitter account (LaurettaStombaugh @hpedsdoc). This blog is for our families! I’m happy to write on any, appropriate, pediatric topics!

(please read: If your child is ill, he/she needs to be examined by one of our physicians. Each child is different and we can never diagnose over the phone or on any type of social media. This blog is for informational and educational purposes only. Call our office for an appointment.)

     Here we go! This is a blog I’ve been wanting to write for awhile. The use of antibiotics is a hot topic for both the medical and parenting communities. This seems to be a timely blog as we head into “sick season”. So sit back and enjoy as I tackle some of the common myths. Antibiotics take one…

     Typical scenario: Your 9 month old infant has had 3 days of runny nose (yellow nasal drainage), a cough (keeping him, the entire house and the dog up all night) and fever (highest temperature was 101.4). He has some vomiting mainly when he coughs really hard, no diarrhea and is fussy. His appetite is decreased and he only wants his bottle. After a third night without sleep, you sleepily call our office and schedule a same day appointment with me later that day. I walk into the exam room and I find your little one fussy, snotty and clingy. I’m still happy to see him of course because even kids with dripping snot are adorable. His ears are not infected. His lungs sound clear. He does not have a rash. He has a soft tummy and he is well hydrated. Your child and I play with the tongue depressors a bit as I explain that a virus is likely causing his cold. The interventions for the common cold in his age group include fluids and saline nasal drops (or spray) to thin secretions. A cool mist humidifier can help as well. If fever is causing discomfort it can be treated with an over the counter medication like Acetaminophen or Ibuprofen (never aspirin!). Outside of close monitoring for breathing problems, dehydration and more frequent vomiting, there is not much we can do at this point. “But Dr. S, the snot is yellow. Doesn’t this mean it’s a bacterial infection?” Actually, if you blow your nose on any given morning you will likely see yellow snot when you have no other symptoms. Yellow snot can be present in a bacterial infection but it is not indicative of one. Many viral illnesses cause thick, yellow nasal mucous. Antibiotics do not work on any viral infectons. I consider the number of days your kiddo has been sick, the presence of concerning findings on my exam (like an ear infection or pneumonia) and if your child is worsening (even if only a few days of illness). “But Dr. S, I want to catch the infection before it becomes a bacterial one. Can’t an antibiotic prevent a bacterial infection?” Not exactly. Viruses are usually handled well by our immune systems. Only sometimes are they complicated by a bacterial infection. Viruses can change the ability of the body to clear mucous leading to the increased attachment of certain bacteria. So, you cannot prevent this with an antibiotic because it would have to directly affect the environment that allows the bacteria to grow, not necessarily the actual bacteria itself. “But Dr. S, my child is not eating any food. Is this dangerous?” Well, if the child does not eat for a few days, there is no harm in that. They must drink, however, to keep up with hydration. So, keep the fluids going as this helps hydrate them and thin the mucous. You don’t really need a mucolytic (like Mucinex) if you are drinking enough. “Dr. S, if you recommend letting our kids’ immune systems do the fighting during a virus, then why don’t we do this for a bacterial infection?” Now this is a great question! First off, we don’t actually have antivirals for most viruses anyway. But we use antibiotics for bacterial ones because they have saved millions of lives since they were discovered. Certain infections must be treated immediately such as urinary tract infections, pneumonia, skin infections, STDs and meningitis simply because they can cause very serious complications or death if not treated. Others, like Strep Throat and ear infections, usually require an antibiotic to prevent rheumatic fever and meningitis/mastoiditis, respectively. Also, in some cases, the illness will improve a day or two earlier making life (and sleep) easier for everyone. “But Dr. S, if it’s just a cold then why do we have to bring our child in for a visit?” I believe parents know their kids better than anyone. But, it is dangerous for you to attempt to diagnose a lung infection, ear infection, Strep, a rash or another illness (even if you have your own stethoscope or otoscope) because so many symptoms overlap. We have seen thousands of ears and listened to thousands of lungs. First kids do not always follow the textbook. Second, one kid could have a headache with fever and be diagnosed with a sinus infection while the next kid could have meningitis. Both kids can look sick and have the exact same complaints. This is why I think pediatrics should be recognized and respected for what it is…we have to examine kids who fight back:) kids who can’t talk yet:) kids who change things up all of the time. Kids who suprise us by beating the odds and by caving quickly. The saying goes, “children really aren’t little adults”. Things can go south quickly and so we always encourage you to call us if you are worried. “But Dr. S, we (family members) all have a cold, our physician put us on antibiotics and we got better.” Did you get better because of the antibiotic or was it started just as you were recovering (thanks to your immune system) and your improvement would have occurred anyway?

     So, the next time your child has a cold and you expect an antibiotic, reread this blog and remember our goal is to keep your kid healthy and comfortable. Antibiotics are not always benign and can cause resistance, side effects, allergic reactions, even other types of infections. We’ve been there. Sick kids are exhausting. Just be patient, trust your child’s natural defenses and trust us.