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!!
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.
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.
- 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.
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.