Welcome to my blog! I am Dr. Lauretta Stombaugh (Dr. S) and I have been part of the Hendersonville Pediatrics family for over 6 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. Ready, set, go!!
(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.
Babies are easy to forgive when they are fussy because they are innocent little ones who are justtrying to communicate their needs. One year olds are celebrated for their wobbly steps and their (usually) sweet first words. They are also easier to forgive because they eat almost everything, giggle at most things and may still take two naps. Two year olds are misunderstood. They are not so “terrible” at two. They are sometimes terrific. They eat the same 5 foods which makes grocery shopping and prepping easier. Language starts to blossom, but they don’t often yell embarassing things in public. They are learning and still helpless in some ways because communicating is a struggle. But let’s talk about the threenagers. Where do I begin? They are not exacty “terrible” and can be fabulous. Here’s my take on threenagers.
How do you know that you’re living with a threenager? What can you do to help them and yourselves navigate a wonderful yet trying year?
The not so fabulous part:They wake up at 6 am regardless of the time they go to bed. Seriously? They can go to bed at 2 am and they will still wake at 6am and act like they slept for 12 hours. Three year olds need about 11 hours of sleep (+1 nap) each day. A bedtime routine helps because routines create security for these little people. The stability of a bedtime plan, whatever it may be for your family, will benefit you in the end. Even if it takes time to get there. Try a picture chart with simple prompts. If you cannot keep your toddler in bed call us! I just walked mine back to bed 45 times last night. Forty. Five. Times. We can both visit our in office psychologist Dr. Dalton for some help! (Dr. Dalton can help with all kinds of toddler behavior like picky eating, tantrums, potty training, biting.) They need to have their sock seams lined up perfectly along their toes. They want to wear the same thing repeatedly. Choose your battles. As long as they are warm enough, appropriate and have an entire outfit on, let them wear what they want. This can instill confidence. It can make mornings much easier for everyone. Sure there are times when parents need to choose the outfit. That is not the case on most days. Give up on that struggle. Don’t get me wrong, I do like when all of my kids have clean faces, brushed hair and clean clothes. The truth is, it never lasts long. Try your best. Be realistic about what makes kids comfortable and happy. They complain about nearly everything. The wrong color cup, the sleeve is too long, the sleeve is too short. Their legs hurt. Their tummy hurts. Their hair hurts. They aren’t there yet. They aren’t tired. They aren’t hungry. The cheerio broke. The key is to acknowledge their emotions, don’t cater to their every whimper and pick your battles as they say. When kids are frustrated, sad, tired, hungry, confused, they just want to be validated. You can probably relate as all humans just want to be heard. So listening is not giving in. Listening may soften their mood just enough to calm them even more. When they are calmer, you can teach them about the situation, expectations and acceptable behavior. This is no easy task. If you get halfway there, you are succeeding. I often only get halfway there.
The fabulous part:They are curious. They ask a lot of questions. So much excites them especially if they see that it excites you! If you are stuck with a fussy toddler, bring them outside and explore new things. Better yet, act excited and bring new things to them like a new storybook, a new toy or a new song. They are brutally honest. My three year old walked through the supermarket today and as we passed every MIDDLE aged man, he said, “ Mom! He’s an old grandpa!” in his best, squeaky voice. Of course I replied in my best loud voice, “he doesn’t look old.” To which he replied, “Yes he does! He looks like an old grandpa!” And although I was embarassed, I recognize his innocence. They see the world from a different perspective. A really cool one. One that is not tainted by greed, jealousy, negative energy. Toddlers are curious and accepting of what they discover. It may mortify you, but respect the innocence. They are creative. They are so proud of their artwork, their towers and their forts. My three year old brought home a “watercolor” entitled, “My Favorite Colors” from preschool yesterday. It had not one colorful mark on it. Dark gray, light gray, black and a sort of muddy green color. He was proud of of it and so was his Mommy. It is not necessary to praise every piece of artwork, every high test score, every star they received for good behavior. Just praise the ones that will really build them up. After all, we build them up so that they can one day build themselves up when we are not there. Confidence is necessary for the many successes we imagine for our children.
Some say that threenagers are stubborn. I like to decribe them as insistent. If you give them two choices, they will insist on a third. If you firmly state that TV time is over, they will insist on watching “just one more”. While this can be irritating for us, lets view it was our toddlers being confident enough to insist. They are being active not passive, yes? This is not a green light to praise them for this, but rather a time for you to practice your positive discipline skills. The “kind and firm” approach where you reiterate that TV time is limited. Engage them in the next activity. Assure them that they can have another show on another day (no concept of time at three!) Usually this ends with a “tank you mom.”
They can say things with a certain expression, in a certain voice, with eyes looking up at you, that can make you feel like your heart is just melting. The best kind of melting. The one that is not describable. The one that makes all of the “line up my sock!” arguments worth it.
Love your threenagers.
Parenting is wonderful and challenging. I was having a conversation about parenting recently. The person suggested, that when you are in the middle of the chaos, ask yourself, “are you doing the best that you can right at this moment?” This is golden. We usually are. It’s just reminding ourselves is a hard thing to do. Especially when we are busy telling our toddlers, “don’t eat paper”, “don’t pick up your sister by the neck”, “stop picking your nose and wiping it on me”, “don’t pee on other people’s pumpkins”.
It’s a September “almost Fall” Saturday. I decide to take four kids to the apple orchard. Solo. With two toddlers who had not napped. One of whom hates everything: the carseat, mornings, nights, days, diaper changes, clothes, naps, black, white, colors, being held, being put down, sleeping alone, sleeping in my bed. But everyone had clothes on (and shoes) and no one was bickering so to the farm we go! “Fresh air will make them happy” I thought. And it did. Eventually.
So I drive to the farm singing “the itsy bitsy spider” in my 12 passenger van, freshly vacuumed with no goldfish on the floor. On the way, my 8 year old comments that she hopes it drizzles just enough for her to smell the rain. My little nature lover. Then she starts to argue with my 6 year old. The 8 yo yells from the back of the van, “Ma! Can you imagine what she will be like as a teenager?” and just as the nausea hit me, I was about to say something motherly like, “she’s a strong willed girl”, the 6 yo shouts out and starts crying, “Mom! I dropped my mascara!” There’s my answer. In that moment I realized how different they really are. How different all of our kids are. There are no two of them who have had the exact same experiences living in this world. Perspective is a beautiful thing. They each have their own. They each have their loves and their hates. So the first piece of advice is to recognize this. Individuality is a great thing.
I drive on and I hear, “he loves me. he loves me not.” from both of them although not in sync. There goes the clean floor. Yes, yellow flower petals all over the car before I can even say, “respect the car” in my best motherly voice. We all have one. It’s the voice you use when you are teaching them, attempting to stay calm and remembering the parenting book you read diligently when you were pregnant with the first kid. Stay calm. Be kind.
We arrive and I get everyone across the hopping parking lot alive. My oldest reminds me that I should have brought the double stroller so I don’t lose the littles. This is true.
We start out at the goats. We can’t feed them because I don’t have any quarters. Oh the drama. I tell them to just enjoy watching the goats be goatlike. whatever mom.
Next, we go play to the play area. The bigs run to this big plastic tube which they happily swing on. There’s a brave dad pushing it with about 10 giggling kids. The mom beside me holding her 2yo says to her toddler, ”no honey you are too little for that.” In my mind I’m thinking, “whatever. it’s only 2 feet off the ground. my fearless toddler will be fine.” I lift her up to sit in front of sissy. Not even 10 seconds later, I see them fall off the side in slow motion and the baby’s leg gets stuck under the tube. Really? The little starts screaming. The big starts panicking, “free my sister!” I run over with a few others and we lift the plastic tube. I sit down and calm them, anxiously waiting to see if the baby can walk on her leg. She’s more bothered because her shoe got dirty. She limps a few steps and then runs full force ahead to the hay stacks. Whew. No ER visit. I’m doing the best that I can. Next piece of advice, if it can happen, it probably will happen. Risky play can be valuable for our children. It teaches them confidence. Just be mindful of that light tap on your shoulder and why it is there.
Three potty breaks later, after our bellies are filled with donuts and cider slushies and a few more arguments transpire, I try to get the dreaded photo. The one where they are all looking in the same direction. Imagine one kid mad jumping off of the wheel barrel. Another crying in the wheel barrel. The littles in the wheel barrel looking away with the baby over the other’s shoulder. Dress over her head. Marker streaked legs with only a diaper view. A wet diaper with the green stripe. Really? It’s a no go.
Lastly, we are ready to ride the cow train pulled by a tractor. Woohoo! I squeeze myself into a metal cow named Bessie, place the baby on my lap and buckle us in seeing as we already had one injury today. As I’m waiting a mom in front of me asks how many kids I have. Then she screams to her husband in the 2nd cow, “See honey, she has four and she’s still smiling!” I’m smiling because I’m about to relax in fresh air for 9 full, glorious minutes while my kids are buckled into cows and can’t get out. Advice: pay for that cow ride. Find the relaxation wherever you can.
It’s my favorite time of day. 5 pm. Cool and comfortable in the mountains. I gently wrestle the baby into the carseat as she turns all shades of red. We head home singing “The Itsy Bitsy Spider” and I realize that I have to feed them again. Already? Make a meal. Serve a meal. Clean up a meal. Repeat. Do I even have meat defrosted? Do I have a green veggie for a side? That well balanced meal will have to wait. Cereal it is. And that is OK, Because I’m doing the best that I can and you are too. If our children are mostly happy, loved and love others, and have meaningful, healthy experiences, we are doing OK.
I thought of beginning this blog with a story of a child or teen who had been bullied. As I researched online, I was overwhelmed by the faces of these beautiful children and teens, many of whom commited suicide. I realized I could have named this blog “cyberbullying” as much of bullying involves social media. As physicians, we are indirectly witnesses to bullying often. We are aware that much of the bullying is kept secret as it creates embarassment for those being bullied and those who bully. We see how traumatic it can be for these children and their families. We long to help these kids and yet we feel helpless at times. So we educate. We communicate that it is OK to talk about bullying. We remain sensitive to it and the pain it causes.
Approximately, 20 % of children are bullied. This does not include those who do not admit to being bullied. Bullying can be physical, verbal, or social. Cyberbullying invloves chat rooms, email, social media sites and texts. Regardless of the type, it can be just as damaging to a child’s self-esteem. It can be the source of depression which in turn can lead to suicidal thoughts/ behaviors and unfortunately death by suicide.
Kids and teens who are depressed may seem sad or have sleeping or eating issues. They can seem angry. Bullied kids can exhibit risky behaviors, start using drugs/ alcohol or start cutting. They can be withdrawn and lose interest in things that would normally find them joy. If they are suicidal, you may see an abnormal interest in death They may start giving possessions away. They may seem overwhelmed, commenting that things would be better without them. Anxiety can surface. School avoidance is common as well.
Who is at risk for being a bully?
-those who experience a tumultous home environment
-violence in the home
-kids with low self-esteem
Who is at risk for being bullied?
-those who have conflicts with peers
-those with low self-esteem
-those who are perceived as “different”
What can we do?
-First, recognize any changes in your children/teens and take them seriously. Talk to your school counselor, principal or pediatrician immediately.
-Next, make sure all weapons and medications are unavailable.
-Keep the lines of communication open with your children and get them into psychotherapy if needed.
-Raise your children to be kind and thoughtful. Teach them to intervene if they see someone being treated unfairly. This is one of the proven interventions which can decrease bullying.
-In extreme situations, law enforcement may be needed
Call us if you need guidance.
This is one of the most common questions pediatricians are asked each day in practice (along with “how can i get my kiddo to sleep through the night?”). School absences can be difficult for caregivers due to childcare issues and missed workdays, troubling for school officials and can cause children to fall behind in extreme cases. My advice to my patients sometimes includes, “use your mommy or daddy judgement” because you know your child better than anyone. Other times, it is streamlined alongside the recommendations of our infectious disease colleagues.
The Common Cold
-no fever for 24 hours provided your child is acting normally and is not having difficulty breathing
-it is OK to go to school with cold symptoms such as runny nose, nasal congestion, cough, sore throat unless you feel like your child needs to rest (or snuggle)
-tidbit: yellow and/or green and/or glowing yellow-green nasal drainage does not always mean an antibiotic is necessary, our decision to prescribe an antibiotic (to treat only bacterial infections) is based more on length of symptoms and/or worsening symptoms
-need to be on antibiotics for 24 hours (remember that not all eyes that are red = “pink eye” so always have your child examined by a physician), pink eye can be caused by viruses, bacteria, allergies or chemicals, it does not always require antibiotics (only the bacterial kind)
Strep Pharyngitis or Strep Tonsillitis
-free of fever AND on antibiotics for at least 24 hours (although there have been some recent articles suggesting less than 24 hours may be sufficient, no official change to the recommendation as of yet)
-despite the “no nit” policies at many schools, the recommendation is to stay out of school just until all live lice are gone (always recheck for at least 1 week for newly hatched lice, retreat if necessary)
-once treatment has started even if itching and lesions are still present
-once treatment has started, keep lesions covered with a bandaid
-return to school after all lesions have crusted over AND there are no new lesions for 48 hours
-always consider what the fever is from and how your child feels, but the general rule is fever free for 24 hours
\Vomiting and/or diarrhea
-if fever is present? no fever for 24 hours
-vomiting? no vomit for 24 hours
-diarrhea? no diarrhea for 24 hours
Hand Foot Mouth (Coxsackie Virus)
-no fever and when blisters are dried up
-feeling well enough and drinking enough to be at school for a given time
-tidbit: fever = 100.4, your temperature varies throughout the day and so 99 degrees in a child who is usually 98 degrees does not constitute a fever because it is likely a normal variation
-tidbit: fever is caused by infection. if you treat it with Ibuprofen (Motrin) or Acetaminophen (Tylenol), it will likely return if the infection itself is not treated / if the infection is still active in one’s body.
So the magic number is 24, however, the most important thing to remember is to listen to your child, decipher what is reality and what is drama and have a low threshold for bringing them in to see us. Similar to well check ups, while we examine your child we are looking for specific findings to rule out (or rule in) certain dieases, some of which can have lasting effects if not treated.
Please come in and get your kids vaccinated against the flu this September! Watch our website and our new facebook page “Hendersonville Pediatrics” for announcements.
Stay tuned for my next blogs on bullying and common rashes!