Where in the World Did You Hear That?

Dr. William J. Mesibov, M.D., board certified Pediatrician, separates fact from fiction as he dispels common Wives’ Tales about children’s issues.  The topics covered include:

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Chapter 1: Teething, It’s Not What You’ve Been Taught

Chapter 1

TEETHING, IT’S NOT WHAT YOU’VE BEEN TAUGHT

Infant Teething BabiesI can’t begin to count how many times I’ve heard intelligent parents express the conviction that teething causes fever, congestion, diarrhea, diaper rashes and pain.  Although these beliefs about teething are almost universal, they’re all myths.  Teething causes none of the above symptoms. The only result of teething is teeth.  Where did these ideas come from?  Lots of babies get their first cold, fever, or stomach virus during the second six months of life, the same period when, coincidentally,  baby teeth start to erupt.  Until science understood the role of antibodies and immunity, it was thought that teething somehow weakened the baby and produced illness.  We now know that this is untrue.

Where in the world did you hear?

Babies usually get sick from teething.

Sound Advice

It’s not true.  During the first six months, most infants simply don’t get sick.  They’re protected by maternal antibodies which had come across the placenta before birth.  This kind of protection is called Passive Immunity and it only lasts for a limited time.  By the age of six months, most of these antibodies are gone and, coincidentally, new teeth are starting to erupt (about one or two every month.)  So, here we have two unrelated events occurring at the same time: loss of immunity and the appearance of baby teeth.  The baby, now low on antibodies, is suddenly more susceptible to common germs in the environment, resulting in minor illnesses, often with fever.   Every episode of nasal congestion, fever, or diarrhea is due to a germ or an allergy, not to innocent erupting teeth.

The Conclusion

It’s very important to pay attention to any sign that your baby might be sick.  Teething is never an answer.  Always describe the symptoms to your pediatrician and let the doctor decide if any action is necessary.

Where in the world did you hear?

Drooling means the baby is teething.

Sound Advice

Drooling isn’t related to teething at all!  This is another case of guilt by association: babies who drool are, coincidentally, often teething.  The real explanation lies with the salivary glands in the baby’s mouth.   The production of saliva, present from birth, increases every month as those glands get larger.  Babies swallow that saliva but they are not very good at keeping up with large volumes. Usually around four months, there is so much saliva that the baby can’t keep up by swallowing fast enough.  Where does all that saliva go?  It goes outside the mouth and we see it as drooling.   It’s not until the baby’s swallowing capacity catches up with the saliva production, sometime after seven or eight months that excessive drooling disappears.  Guess what may be happening at the time we see all that drooling?  It’s the coincidental eruption of teeth.  You’ll notice that, as babies get older, they still teethe but they no longer drool.   So, do the teeth cause the drooling?  No.

The Conclusion

Old Wives’ Tales don’t die easily.  Drooling is a normal function of your developing baby, not related to teething.  If the baby is out of sorts and drooling, don’t blame the teeth.

Where in the world did you hear?

Babies are cranky and don’t sleep well because their gums hurt.  It helps to rub something on their gums and give them Tylenol so they (and their parents) can get some sleep.

Sound Advice

Believe it or not, there is no evidence to suggest that normal teething causes any pain.  It’s true that babies do get whiney and cranky during this time.  However, most pediatricians attribute this somewhat volatile behavior to increased social awareness, separation anxiety and communication frustration.   It’s easy to demonstrate to parents that the gums show absolutely no evidence of irritation, inflammation or even tenderness.  You can confirm this yourself by gently pressing on the gums with your finger: no pain, usually a smile. Babies usually look back at their examiner with nothing but benign contemplation when tongue blades are probing these “sensitive” areas.  Can an erupting tooth ever cause a problem?  Although uncommon, erupting teeth can cause slight bleeding under the gum, resulting in a tender black blister,  a hematoma.  Also uncommon, gingivitis, an inflammation of the surrounding gum, usually due to a virus, can create discomfort during teething.  But those are rare occurrences, easily seen when inspecting the gums and should not be confused with the usual pale, slightly swollen appearance of normal, non-painful teething that the vast majority of babies enjoy.  Further proof that teething does not hurt: ask an older child, age six or older, if it hurts when his big, adult teeth are erupting?  Almost never.

The Conclusion

Most babies do not experience pain with teething and don’t require medicine.  Don’t assume that your baby’s whining or poor sleeping is related to physical discomfort.  It’s a mistake to give Tylenol, Advil or any other medicine to help your baby sleep or calm down since all medicines can cause toxicity, especially if used frequently.  Always consult with your doctor before dispensing any medicine to your baby.

Have any questions? Please contact Dr. Mesibov

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Chapter 2: My Baby Doesn’t Sleep

Chapter 2:

MY BABY DOESN’T SLEEP

Baby Won't SleepThis subject really hits home. My children were horrible sleepers and, during their first few months, my wife and I spent our days like zombies, fantasizing about how wonderful a night’s sleep would be. As a young physician, I had received no training in infant sleep problems and I desperately tried any method suggested to help our baby (and therefore us) to sleep. Nothing worked, not antihistamines, extra feedings, long rides in the car, recorded sounds or even earplugs for the parents.

Based on the unending flow of advice about this subject, one would think that all babies should be easily trained to sleep. The truth of the matter is that, short of general anesthesia, infants can’t be coerced to sleep through the night until their brain matures. Depending on genetics, this sleep timetable is variable and no amount of manipulation will alter the timing. Therefore, suggestions that babies should be fed more, kept awake during nap times, or have their formulas changed will not result in happier parents or sleepier infants. Some “solutions” can, in fact, result in sleep interference.

Where in the world did you hear?

 Babies should have a full tummy in order to sleep. Most babies wake up because they’re hungry and they need an extra good feeding to hold them through the night.

 Sound Advice

It’s a widely held belief that babies sleep poorly because of hunger. Unless the baby is calorie deprived and losing weight, nothing could be further from the truth. Giving babies extra feedings or early solids may cause cramps and bloating and, as a result, poor sleep. These fed-to-sleep babies are often overweight, not starving at all. Surprisingly, infants who cry a lot and sleep poorly will show improvement when intervals between feedings are lengthened. Most full term babies require a feeding every three to four hours, preferably four, since it takes that long for the stomach to fully empty after the last feeding. Parents shouldn’t let themselves be fooled by the vigorous sucking of a crying baby. Sucking is a reflex and even a baby who is filled to the brim with milk, ready to “explode,” may exhibit frantic sucking when offered a nipple. There may be a short interval of peace after an extra feeding, but then the crying resumes with greater intensity than earlier.

The Conclusion

Resist those suggestions to give extra feedings at bedtime. This “remedy” will not improve sleep for anyone, but it may result in an overweight, distressed, cranky baby.

Where in the world did you hear?

Babies who are cranky and don’t sleep usually have gas. The only way to get some relief is to change the formula.

Sound Advice

It’s part of our culture to assume that “gas” is an evil condition causing pain and misery. This conviction is based on myth, not on any fact. All healthy humans produce gas in their large intestine. Bacteria residing in the normal colon produce gas through fermentation. Gas is a part of life and the passage of flatus is a normal, painless bodily function. If the baby is healthy, gaining weight and has normal bowel movements, the passage of gas while crying is normal, caused by the forceful contraction of abdominal muscles. It does not cause pain and it does not interfere with sleep. Crying merely increases the passage of gas, therefore babies who cry a lot tend to pass more gas. The reverse is not true. Unless the baby has an allergic condition, suffers from persistent diarrhea or passes hard, formed stools, changing his diet will not help him sleep

The Conclusion

Don’t start playing “change the formula” just because your baby passes gas. You might be removing an excellent source of nutrition and end up substituting something which is less than ideal for your baby. Always discuss the problem first with your pediatrician before making any changes.

Where in the world did you hear?

Babies sleep better at night if they’re tired. Try to keep the baby awake late in the day, even if he seems to want a nap.

Sound Advice

Withholding sleep during the daylight hours is an exercise in futility. Interrupting an infant’s sleep rhythm generally does nothing but increase irritability. There is no harm in waking a sleeping baby but this maneuver will rarely achieve better nighttime sleep. Is there anything an exhausted parent can do? A recent study has shown that exposing the baby to sunlight during the early afternoon seems to result in better sleep patterns at night. When compared with babies who were kept in dull lighting all day, infants who were exposed to more daytime light had significantly better night sleep. Most babies, regardless of light exposure, begin to sleep through the night by three months. A stubborn minority, to the dismay of the family, continues to wake throughout the night even past the fourth month. Parents shouldn’t despair; there is a successful technique that can be employed once the infant is more than four months. The method, called “non¬intervention,” is based on a study of three groups of non-sleeping infants. Group one parents consoled the baby upon each night awakening; group two parents waited for increasingly long intervals before going in to the crying baby; group three parents allowed the baby to cry, even for several hours “non-intervention.” After only a few nights, most of the “non-intervention” infants had learned to fall asleep without assistance, usually by the second or third night. The “contract” learned by the baby is “if it’s dark and I am in my crib, I go to sleep.” If the infant wakes when the sun rises, even as early as 6 A.M., then the parent must acknowledge the “contract” and go to the baby. This method is very successful, but some parents, unable to stand by while the baby cries, will simply try one of the other methods and wait a little longer for peaceful nights. It should be stressed that all babies should be put into their cribs at bedtime while still awake. The baby must always associate the crib as the “instrument” of sleep, not mommy’s arms, and not the infant seat. If mommy always cuddles the baby to help him fall asleep, he will never fall back asleep alone, expecting (and demanding) that same treatment before he nods off again,

The Conclusion

The good news is that, by six months, almost all babies are sleeping through the night no matter what technique is used. If an infant is still waking after this age, it behooves the parents to have a discussion with their Pediatrician to discuss sleep and the general health of the baby. Often, a small change in routine will result in success.

Have any questions? Please contact Dr. Mesibov

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Chapter 3: Fever

BABY HAS FEVER

Infant FeverI’ll never forget one late night phone call. Barely able to contain herself, Mrs. X blurted out that Anthony’s rectal temperature was 99! Perplexed, I asked what Anthony, six years old, was doing while we were on the phone. “He’s watching TV,” she said. When I asked why she even took his temperature, Mrs. X explained “Why, I take his temperature every night!” Needless to say, Mrs. X’s fear of fever was extraordinary. However, many parents, while more relaxed than Mrs. X, still share, to a small degree, that same dread of fever. Physicians sometimes contribute to this anxiety by encouraging fever therapy around-the-clock, often involving more than one medicine every two to three hours. This fever phobia is unwarranted and can lead to harmful side effects.

Where in the world did you hear?

Fever can cause brain damage. Keep both ibuprofen (Advil) and Tylenol handy. It’s a good idea to give both. Get that fever down, fast!

Sound Advice

Relax! By the time your baby becomes a teenager, you will have dealt with more than twenty febrile (feverish) episodes, almost all without incident. The fear of brain damage from fever is unfounded. Only lack of oxygen or the most severe, life-threatening infections can damage the central nervous system, not fever.

Fever is a natural mechanism to fight infection: increased body temperature helps the body kill germs. Studies have shown that without fever, some laboratory animals are unable to survive even mild infections. It follows that excessive dosing with acetaminophen and ibuprofen may diminish the body’s natural response to fight infection. These medicines have potential side effects: acetaminophen can produce liver toxicity, ibuprofen can result in ulcerations in the intestinal tract and kidney toxicity, and using both by alternating actually increases the risk of damaging the kidneys.

Despite such dangers, many parents, and even some physicians, routinely alternate ibuprofen and acetaminophen every two to three hours no matter how high the fever. This is unwise and not in the best interests of the child. Temperature control is easily and safely accomplished using a single medication, either acetaminophen or ibuprofen, following the schedule advised on the label, along with hydration and sponging, when needed. Always keep in mind that in all cases of fever, the single most important therapy is an adequate fluid intake, since heat increases fluid loss

The Conclusion

There’s no reason to panic when your child has fever. This is the natural way his body fights germs and it won’t cause brain damage. It is important, however, to always determine the cause of the fever. While the fever, in itself, does not damage vital organs, the germs responsible for the fever may, in fact, be dangerous. The cause of all fevers should be investigated so that serious illnesses are detected and treated.

Where in the world did you hear?

Fever is dangerous because it causes convulsions.

Sound Advice

This fear is generally unfounded. Fever convulsions, called febrile seizures, occur almost exclusively in families with a genetic predisposition for this condition. In other words, if there is no family history of fever convulsions, it is less likely, no matter how high the fever, that an infant will experience such an event. As frightening as the word “seizure” sounds, the good news is that these febrile episodes are generally harmless, last less than a minute or two, and only occur between the ages of six months and six years. A myth surrounding febrile seizures is that they are brought about by very high temperatures. This is not true. Although the mechanism is not well understood, convulsions seem to be triggered by sudden shifts of temperature, often occurring at fevers no more than 101 F and rarely occurring more than once in an illness, no matter how high the fever. Some parents discover that their child is running fever only after they witness a brief convulsion.  Since these events usually occur when there is a positive family history and usually present without warning, it is futile to be a fever watch guard.

The Conclusion

Fever convulsions rarely occur unless there is a family history of such occurrences.  Children who do experience these episodes are generally none the worse for them, they are brief and cause no damage (except to the poor parents who witness these events.)  High fever, in itself, will not cause a fever convulsion.

Where in the world did you hear?

Use an alcohol rub to get the fever down.

Sound Advice

Alcohol rubs have been used for generations to attempt to cool feverish patients. This method should be abandoned. Studies have shown that alcohol cools the skin so rapidly that it causes blood vessels to constrict, diminishing heat loss and actually causing the temperature to rise! In addition, the alcohol fumes have actually contributed to temporary central nervous system disturbance in some children. Therefore, use of alcohol is a no-no. Cooling is best accomplished by evaporation of water from the skin, the larger the surface area used, the better. When a child is immersed in a tepid bath, most evaporation occurs from the shoulders on up, not a very efficient method to obtain effective cooling.

Most important, fluid intake should be adequate. No matter how difficult the task, infants should be made to drink enough fluid to ensure regular urination. If the urine is dark yellow rather than clear, it indicates inadequate hydration: more fluids should be administered.

If, after administering either acetaminophen or ibuprofen, the fever remains high, the towel wrap method should be used. This technique is very effective. Approximately 30 minutes after taking the fever medicine, the infant or child should be completely undressed. A very large towel is soaked in room temperature water and then wrung partially dry. The child is wrapped, mummy style, from neck to toes and held for several minutes until the towel feels much warmer. This evaporative method rapidly removes a great deal of heat from the patient and will usually cause the fever to drop a few degrees. It is more effective and less traumatic than using a cold bath. The towel is then removed and the patient rubbed with a dry towel and put into light clothing.

The Conclusion

Never use alcohol to lower the temperature of a feverish child. Immersing in a cold tub will help but is uncomfortable and not very efficient. The best method is the towel-wrap, as described.

Have any questions? Please contact Dr. Mesibov

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Chapert 4: Ear Infections

CONFUSION ABOUT EAR INFECTIONS

Ear InfectionsPediatricians spend more time in the diagnosis and treatment of ear infections than almost all other ailments combined. Since the middle ear can’t be seen without instruments, the possibility of an ear infection lurks in the mind of every parent whose child is cranky or feverish, especially when no other cause is apparent. Some physicians respond to this ear anxiety by treating almost every sick child with antibiotics when the eardrum is just slightly inflamed. Yet studies in Europe show that most mildly infected ears resolve without treatment and, except for pain medications, often do not require antibiotics. In the United States, antibiotics are still used rather heavily and for long periods but there is a growing trend to treat for shorter periods, often less than five days, and to withhold antibiotics unless the ear appears severely infected. This seems to be a wise compromise and in the best interests of the patient.

Where in the world did you hear?

Always cover your child’s head in bad weather. Exposure causes ear infections.

Sound Advice:

If this, my mother’s advice, was heeded, we would also believe that getting our feet wet, exposing our ears to windy or wet weather or not wearing a hat are reasons ears get infected. Mom, sorry, you’re wrong! The middle ear is completely protected from the environment by the ear drum. Nothing, not even a roaring waterfall, can enter that cavity from the outside. As long as the ear drum is intact, ear infections don’t occur from exposure to the “elements.” Ear infections are an inside job! Germs invade the middle ear cavity only when mucus or swollen adenoids block the Eustachian tube. And that happens only as a result of a cold or allergies, not because of exposure to dampness or inclement weather. Going out without a hat will only result in a cold head, not an infected ear.

The Conclusion:

Not to worry. Ear infections are the result of germs, not foul weather or wet heads.

Where in the world did you hear?

Frequent ear infections will result in delayed speech development.

Sound Advice:

This simply is not true. Studies have shown that, despite recurrent ear infections and persistent fluid behind the drums (serous effusions) children will still develop normal speech and vocabularies. What really counts in developing speech skills is exposure to talkative and literate caretakers. But many parents (and some physicians) are quick to resort to the surgical insertion of ventilating tubes, myringotomy and tympanostomy, for recurrent ear infections or persistent fluid. This procedure, although considered minor surgery, isn’t without complications and should be used only as a last resort. Children commonly develop lots of ear infections in the first three years of life, most episodes being uncomplicated, resolving quickly, with or without antibiotics. Only when ear infections are associated with serious illness such as mastoiditis, frequent high fevers or failure to thrive does surgical intervention deserve consideration. Parents are often alarmed when, during the course of ear infections or serous effusion, tympanograms and/or audiograms are abnormal. These findings are temporary and all tests will revert to normal once the infection subsides and fluid is gone. It’s misleading to perform these tests when the eardrum still appears abnormal since the poor results are a foregone conclusion. Recurrent fluid behind the eardrum in a happy, thriving child is not a good reason to perform surgery, especially if medical treatment (nasal or oral steroids, anti-inflammatories) can reduce or resolve the fluid. It’s not a permanent condition and resolves over time, leaving no permanent damage. The good news is that almost every child past the age of four will have healthy ears regardless of his past history. Usually it’s in the best interest of the child to treat conservatively and wait for the better times to come.

The Conclusion:

Recurrent ear infections are common in many families and, unless accompanied by more serious illness, are harmless and don’t interfere with speech or long term health.

Where in the world did you hear?

Children who get a lot of ear infections have poor immunity.

Sound Advice:

It’s genetics, not immunity. Lots of parents have a history of childhood ear infections and, more times than not, their children will inherit this trait. Eustachian tubes, which connect the nose and the middle ear, are usually the problem, failing to keep germs out. Others may have inherited allergic traits: chronic nasal congestion and mucus blocking the tube. But age and growth usually come to the rescue and, after the age of four, most ear infections will be just a memory and these kids will be strong and healthy.

In the meantime, medical science has provided vaccines that are effective in reducing this misery. Foremost is the pneumococcal vaccine, given to all infants after two months of age, resulting in almost 20 percent fewer ear infections. Flu vaccine adds to that protection, protecting even further. Then there’s maintenance: keeping nasal mucus down to a minimum using nasal saline, nasal steroids, allergy treatment and anti-inflammatory drugs.

The Conclusion:

Children with frequent ear infections have normal immunity. As they grow older, the infections will stop. And, no, they don’t need additional vitamins.

Where in the world did you hear?

Children always run fever when their ears are infected.

Sound Advice:

Generally, this is not the case. Pediatricians often see children who have “red hot” ear infections but normal or only slight elevations of body temperature. Fever usually doesn’t come from the infected ear but rather from an accompanying illness such as a flu or other virus. In rare instances, illnesses such as mastoiditis or abscesses will cause fever, but these children appear severely ill. Needless to say, all children with fever should be evaluated by the doctor. Only careful examination will reveal the source of the illness.

The Conclusion:

Never assume that fever in a child is caused by an ear infection. Fever always should be investigated to determine the source.

Where in the world did you hear?

Cancel your flight reservation: you can’t fly if you have an infected ear!

Sound Advice:

Would you believe that the safest time to fly may be when both ears are infected or filled with fluid? Here’s the reason: normal eardrums stretch easily under pressure, sometimes causing pain, especially if there is nasal congestion blocking the Eustachian tubes. But it’s a different story when eardrums are infected and swollen. The sick eardrums are much less mobile and, guess what, cabin pressure rarely budges them. In a study performed on airline passengers with various ear problems, almost all discomfort occurred in those passengers whose ears were normal before boarding. Sick ears flew best!

Of course, it’s best to fly when changes in cabin air pressure are not felt at all. This happy situation occurs when the nasal passages are clear and the Eustachian tubes are open. This is important, since, in small children even a tiny amount of nasal congestion can result in a miserable plane flight. The remedy is a simple over the counter medicine called Neo-Synephrine nose drops or spray which comes in varying concentrations, from

⅛ to ½ percent. Babies less than twenty pounds need only ⅛  percent. Once boarding the aircraft, the neosynephrine should be gently sprayed into the child’s nostrils while the head is tilted down (one or two drops are fine) or dropped into the nostrils with the head tilted back. While taking off, try to get the child to suck or swallow some liquid, then relax and enjoy the flight. When the flight crew announces that the plane will shortly begin descent, repeat the entire procedure. It is especially important for the child to drink and swallow during descent since the increasing cabin pressure pushes on the eardrums and, unless the Eustachian tubes are clear, pain and crying can occur.

The Conclusion:

Don’t cancel your flight if your child has an infected ear. Take precautions to keep the Eustachian tube open and have a good trip.

Have any questions? Please contact Dr. Mesibov

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Chapter 5: Antibiotics

ANTIBIOTICS: MISUSED AND MISUNDERSTOOD

Antibiotics InfantsMost parents feel relieved when an antibiotic is prescribed for their sick child. That’s why it’s hard to convince worried parents that antibiotics are sometimes not a good idea and, in fact, may be harmful! Some physicians, when dealing with anxious parents, feel pressured to prescribe antibiotics even when they’re sure that such treatment is unwarranted. The doctor may worry that he will be perceived as incompetent when he explains that the illness should be allowed to run its course. But unnecessary treatment, although tempting to both parents and physicians, is not a good choice and can lead to unwanted results.

Where in the world did you hear?

Children with fever, cough or sore throats always recover more quickly with antibiotics.

Sound Advice

Not true. Most common illnesses in children are infections caused by viruses, microscopic particles that multiply inside our cells. Viruses are unaffected by antibiotics. The vast majority of childhood illnesses, the common cold, bronchitis, sore throats (except “strep”) and the ubiquitous flu, among others are caused by viruses. Using antibiotics for those illnesses is the wrong treatment. When antibiotics are used against viruses (say, taking Penicillin for a virus cold) we end up destroying the harmless germs that live in our body and, as a result, stronger, antibiotic-resistant germs move in. The next time we get a sinus infection or an earache or, perhaps, pneumonia we may have to deal with monster bacteria that we have allowed to grow freely.

The Conclusion

Antibiotics are not a panacea for all infectious illnesses. They should be carefully selected to treat only appropriate bacterial infections, never a viral illness.

Where in the world did you hear?

All antibiotics have to be taken for ten days.

Sound Advice

Why ten days? Not much science to support that assumption. Recent studies have suggested that shorter treatment periods for many infections are as effective as longer durations and may lessen our chances of cultivating resistant germs and dealing with side effects. Some urinary and genital tract infections are effectively treated with a single dose of antibiotic. A strep throat can be successfully eradicated with three to five days of selected antibiotics. Ear infections may be successfully treated with only a few days of antibiotic or, according to our European medical colleagues, with no treatment at all!

The Conclusion

Check with your doctor after getting a prescription filled. Some pharmacists automatically write ten days on the label. Those instructions may be incorrect.

Where in the world did you hear?

Green, thick mucus means infection.

Sound Advice

There’s no relationship between the color or thickness of mucus and the presence of infectious bacteria. Surprised? Studies have shown that mucus color results from lymphoctes and inflammatory proteins in the mucus, not to any harmful bacteria. In fact, the longer mucus is produced, the greener and thicker it becomes. That’s why a common cold lasting more than three or four days produces green mucus. Almost always, we’re dealing with viruses, no antibiotic required. Unless the mucus is mixed with purulent material (called pus,) antibiotics are usually worthless and, in fact, may do harm. Antibiotics should be used only when bacteria are causing the illness, based on evidence such as frankly purulent material, blood counts, cultures when possible, and, most important, the clinical appearance of the patient. Experience counts.

The Conclusion

Although it’s a universal belief that discolored mucus is a signal to start antibiotic treatment, antibiotics should be withheld unless the patient’s clinical condition or a culture indicates a bacterial infection. Inappropriate use of antibiotics can only cause harm.

Where in the world did you hear?

I never give my child amoxicillin. He’s immune to it. It doesn’t work for him.

Sound Advice

Except for allergies, we don’t develop an immunity to antibiotics. It’s a myth. You may have heard someone say, “that antibiotic doesn’t work for them.” Not true. Most previous treatment failures happen because the antibiotic was used for a viral infection, worthless. Or it was given to treat a resistant germ or the dose wasn’t correct. There are no people in whom antibiotics don’t work. There are, however, germs which are, indeed, antibiotic proof. Doctors shouldn’t prescribe antibiotics automatically. Doing so without considering the most likely germ involved and the recommended dose based on the child’s weight will cause treatment failure. If these questions are addressed properly, all appropriate antibiotics should be effective. But don’t forget, most times, it’s not appropriate to give any antibiotic.

The Conclusion

All correctly chosen antibiotics should work equally well in every patient, regardless of previous experiences with that medicine.

Where in the world did you hear?

Don’t give your child too many antibiotics, they’ll lower his immunity and discolor his teeth.

Sound Advice

Antibiotics have no adverse effect on immunity. Our bodies produce antibodies (immunity) in response to an infection. When antibiotics eliminate that infection, production slows down but never stops. That’s not a problem. The immune system is still fully capable of producing antibodies when they’re needed.

Teeth are safe from all antibiotics except for a class rarely used for children nowadays, tetracyclines. Tetracycylines enter growing teeth, discoloring them, and are therefore never prescribed in children less than 12. There are some children, however, who are born with faulty enamel. Their teeth are often dark and occasionally malformed. Nothing related to antibiotics.

The Conclusion

Antibiotics are extremely safe in children. Unless the child has demonstrated an allergic reaction such as hives, wheezing or swelling there are very few side effects. The most common mild reaction to any medicine is vomiting and diarrhea, antibiotics being no exception.

Sinusitis and Bronchitis, over diagnosed and over treated: a commentary

There are probably no medical conditions more inappropriately treated with antibiotics than “sinusitis” and “bronchitis.” Not a day goes by when parents declare they (or their children) have “sinusitis” because of persistent nasal congestion, pressure in the face, and a post-nasal drip. But probably fewer than five percent of these patients actually have a bacterial infection in their sinuses, ie sinusitis. The vast majority of these symptoms are caused by viruses, allergies and environmental irritants. Even CT scans are not conclusive evidence of bacterial sinus infections, some physicians finding that allergy and colds can result in “positive” scans. According to most researchers, true sinusitis causes a prolonged daytime cough usually lasting more than two to three weeks. In the absence of a chronic cough and purulent (pus in the mucus) nasal discharge, many of the symptoms of congestion, pressure and difficult nasal breathing can be completely relieved by the frequent use of nasal saline sprays. Even thick, discolored mucus can often be dispatched with nasal saline washes along with nasal steroid sprays, and some of the newer anti-inflammatory medications which block leukotrienes.

Bronchitis is another winner in the antibiotics-for-nothing sweepstakes. This may be the most abused diagnostic word in the medical dictionary, a label applied liberally by physicians and patients for almost any loud, annoying or persistent cough. Once the diagnosis of bronchitis is mentioned, the patient is usually treated with antibiotics. This treatment is ill advised since viruses, allergy or reactive airways cause almost every episode of bronchitis. The medical literature is full of studies that fail to show bacteria as the cause of bronchitis. Patients who are treated with expectorants and bronchodilators recover as quickly as those who take antibiotics, avoiding the pitfalls of unnecessary medication.

Have any questions? Please contact Dr. Mesibov

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Chapter 7: Outdoors

PLEASE DOCTOR, WHEN CAN I GO OUTSIDE?

My mother was convinced that, at the first sign of illness, I was to be sent immediately to my bed. Except for trips to the bathroom, I was not allowed to wander out until every vestige of illness was gone. Mom didn’t discriminate between a little sneeze and the high fever of the flu, sick was sick and my orders were to stay in my bedroom until I was once again healthy. I must admit that this was not entirely unpleasant. I had a break from school, dozed off whenever the mood struck me, and my father and mother waited on me hand and foot. It was my mother’s firm belief that going out when ill was to court disaster: bronchitis, pneumonia or worse. But she was wrong. Studies have not only failed to show any benefit from forced bed rest, they suggest that prolonged immobility can even interfere with healing.

Where in the world did you hear?

Newborns are fragile and shouldn’t be taken out of the house for several weeks.

Sound Advice

I recall one family who asked, during their baby’s 3-month checkup, if they could “start” taking walks in the neighborhood. Ouch! That family probably had a bad case of cabin fever. Most parents are not quite so timid but, let’s face it, there is no universally accepted “exit time” for babies. I’ve had some pediatricians tell me they advise parents to wait until the baby is two months old because they don’t want to deal with fever in young infants. So silly. Has no one told them that the concentration of germs is higher inside the house than outside? Don’t they know that for the first six months, babies rarely get ill, having “borrowed” adult antibodies from their mom before birth. There are no statistics to even suggest that taking babies outside or, heaven forbid, shopping has any relationship with illness or disease. Staying in the house for months or even weeks is a threat to the mental health of the parents, resulting in depression and resentment, a dreadful way to start a relationship with the baby. Using common sense, dressing the baby appropriately to avoid chilling or overheating, avoiding crowds, sick adults and children with mucus dripping from their noses is all that’s needed to justify an outing. With a healthy baby, the first outing is coming home from the hospital. Having survived that trip, there should be no restrictions. Want to get out? Don’t worry if it’s cold or hot or windy or rainy. Dress the baby for the weather and have a ball!

The Conclusion

There is not a shred of evidence to suggest that babies have to be cloistered at home for the first few weeks. They, and the parents, can experience the great outdoors whenever the urge occurs.

Where in the world did you hear?

All sick children have to rest in bed. They’ll only get worse if they run around.

Sound Advice

Now that’s really bad advice! It’s hard to accept, but resting in bed may prolong an illness and, in some cases, make things worse. Surgeons have known for decades that post-op patients who stay in bed develop all sorts of complications including blood clots and pneumonia. Unless a patient is comatose or in intensive care, early ambulation is enforced with a smile.

In the Armed Forces, volunteers infected purposely with cold and flu bugs were studied. Doctors provided some patients with a warm bed, while others donned work boots and performed strenuous chores in the cold and the wet outdoors. The results were surprising. Recovery took longer for the patients who stayed in bed! Are you sick? Get up and rake those leaves!

Naturally, being active while ill does not eliminate the need to take appropriate medicines, drink plenty of fluids and attempt to stay well nourished. Exertion to the point of exhaustion is not a good idea since even the immune system can get tired. Modest activity, on the other hand, helps the body to recover more quickly.

The Conclusion

Being ill does not require staying in bed unless fatigued. If your child feels energetic and wants to be up and around, let him play, he’ll probably recover more quickly.

Where in the world did you hear?

Don’t play in the rain. You’ll catch cold. And don’t you dare go out without your hat, you’ll get sick.

Sound Advice:

Not likely. You can’t get ill with a cold, flu or even pneumonia by exposure to the elements. All infectious illnesses are due to germs, not weather. Getting your feet or head wet might make you sneeze a few times due a phenomenon called vasomotor rhinitis, but it won’t bring germs into your body and it won’t lower your immune system. Unless you’re trapped in a snow storm for hours, lost at sea or have become hypothermic some other way, your immune system will work whether or not your feet are wet.

The Conclusion

Rain or snow, getting caught in foul weather might be a little uncomfortable, but it will not result in illness.

Where in the world did you hear?

Growing children should be protected from germs and dirt. Always keep your home meticulously clean, avoiding dust and animal hairs.

Sound Advice

Would you believe that the opposite appears to be true? At the risk of shocking the compulsive cleaners and animalphobes among us, it seems that infants benefit from exposure to dust, dirt and animal dander. It’s called the Hygiene Theory and there’s growing evidence that infants whose immune systems are exposed to dust and animal dander end up having less allergies, including eczema and asthma, and have a lower risk of autoimmune diseases such as MS later in life. Children who are brought up in large families and those who attend day care derive similar benefits. Who would have guessed that?

The Conclusion

Keeping children in a dust-free, socially isolated, animal-free environment may not be in their best interests. Loosen up, let a little dust accumulate in those corners, get a few pets and make sure your child has lots of contact with other kids.

Have any questions? Please contact Dr. Mesibov

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Chapter 6: Colic

THE MYTH OF COLIC

I am painfully aware that some babies spend almost all their waking hours crying and screaming. I have known parents to be suicidal at worst and depressed at best with babies such as these. But to label their babies as having “colic,” a meaningless phrase to describe an unhappy, distressed baby, merely lets the doctor off the hook and allows the parent to have a “diagnosis.” We might as well say “baby crying!” The diagnosis of colic should be relegated to the garbage pile. We know something is bothering the baby, and it’s the job of the doctor to try to figure it out.

Where in the world did you hear?

Colicky babies have cramps in their tummy.

Sound Advice

“Colicky” babies are the recipients of countless remedies for “cramps” such as herbal teas, gripe water, antispasmodics, simethicone, antacids, pain killers, heating pads and even sedatives, almost all inappropriate and many potentially harmful. Before any therapy is given, it’s important to look at the evidence.

Cramps don’t occur if stools are normal. However, if the movements are loose, bloody, mucusy or hard then the baby’s tummy might well be the source of the problem. Since milk intolerance or protein allergy can make the baby sick, changing the formula to a specialized hypoallergenic formula or modifying mom’s diet when nursing might solve the problem. But these changes will only be effective if the baby’s digestive system is the true source of the crankiness. If the stools are normal, usually soft, yellow to light brown, and if the baby is gaining weight, it’s time to look elsewhere.

The Conclusion

If the stools are normal in appearance, parents will be frustrated to find that cramp remedies or changes in diet usually don’t solve the problem. It’s important to look elsewhere.

Where in the world did you hear?

Colicky babies have too much acid in their stomachs.

Sound Advice

Cranky babies are often given simethicone drops or antacids in the hope of neutralizing excess gastric acid. But in the absence of symptoms such as spitting up, these measures usually don’t work. Babies who do spit up a lot, however, may be suffering from GERD, gastroesophageal reflux disorder, a cause of painful heartburn. GERD babies sometimes display peculiar behavior, Sandifering, when nursing or taking a bottle: pulling away in pain, extending the neck or arching the back, as though swallowing a razor blade. Those babies with GERD can be turned into angels when their gastric acid is tamed with thickened feeds and antacids such as Zantac or Mylanta. Simethicone is not an antacid and, except for eliminating a few air bubbles in the upper stomach, is quite worthless.

The Conclusion

It helps to observe your baby’s behavior when feeding, especially if she is unusually cranky. If spitting up or pulling back occurs, antacid treatment should help. Otherwise, look for another explanation for the crying.

Where in the world did you hear?

Colicky babies are very hungry. You’ve got to feed them more often.

Sound Advice

What a mistake! A common but rarely recognized cause of distress is overfeeding. Most parents and some doctors mistakenly attribute almost all crying to hunger: when the baby cries a lot, she gets fed a lot. Many “colicky” infants find themselves getting fed every one to two hours in response to crying. Mom has no life! Sticking a nipple in her infant’s mouth usually reduces the crying, but only for a short time. Then the cycle begins all over again. These “hungry” babies may spit up a lot and have frequent stools despite prodigious weight gain. Hungry babies? Not a chance. These poor creatures are miserable from intestinal overload or bloating: overeating. Remember how you felt the last time you ate or drank a lot more than you should have? Not surprisingly, these babies usually stop their excessive crying (and sleep better) when their feeding schedule is stretched to every four hours, giving them time to empty their stomachs and digest their last meal. What a relief for everyone!

The Conclusion

Unless your baby is failing to gain weight, it is a mistake to respond to cranky behavior with increased feeding. This usually makes the problem worse.

Where in the world did you hear?

The baby is cranky because she’s constipated. She’ll feel better if she can relieve herself more often.

Sound Advice

Constipation as a cause of crankiness? True constipation, the presence of hard, formed stool is not common in young infants. Although some babies wait several days before relieving themselves, especially when nursing, the stool produced is usually soft. These babies are usually relaxed and happy, despite having passed their last stool some time ago. This is not constipation! Parents often fear their infant is constipated when they observe straining, grunting and purple faces when defecation is attempted. Another surprise awaits the anxious parent: the stool finally produced is usually soft, not the granite boulder anticipated after all that labor. Is this constipation? No. It’s just that these babies haven’t yet learned to relax their rectal sphincter muscles when pushing normal stool out. It’s like trying to force a door open that’s still latched shut. This temporary discomfort can be relieved by gently stimulating the anus with a glycerin suppository when the baby is straining. After a few weeks, virtually all babies catch on and the purple faced bowel movement is a thing of the past.

Babies are truly constipated when infrequently passed stool is large and formed, looking more like the stool of an older child or an adult. True constipation can, indeed, result in cramps, excessive gas, fullness and discomfort while feeding. Usually increasing fluid intake, changing the formula or adding prune juice (usually one or two ounces daily) to a bottle should solve this dilemma. When these simple remedies fail to work, the baby needs to be evaluated for other conditions such as Hirschprung’s Disease and hypothyroidism, among others. Often, the cause is genetic. Just ask mom about her bowel habits.

The Conclusion

Although it’s common to blame constipation for almost everything, must cranky babies are not constipated even when their movements are infrequent. If your cranky baby doesn’t pass large, hard stools, look for another answer.

Where in the world did you hear?

Colicky babies have too much gas.

Sound Advice

Here’s another “condition” which supports the drug manufacturers. Favored by most grandmothers and caretakers around the world, gas is our most popular scapegoat. Does gas cause pain? Usually not! Gas, a normal byproduct of intestinal bacteria, passes painlessly through the colon and out the rectum, albeit with some fanfare. Sometimes excessive gas is a sign of dysfunction, such as retained stool or formula intolerance but those conditions are unlikely if stools are normal and the baby is gaining weight. Babies always pass more gas when crying due to abdominal muscle contractions. Crying produces flatulence, not vice versa. Think of it, do you ever cry when you pass gas?

The Conclusion

Every human being produces gas. Babies are shameless and expel gas at will, especially when they’re crying. However, there is no evidence that normal gas produces pain, nor is it a sign of illness. Be happy that your baby passes gas, it means that he is alive and well.

Where in the world did you hear?

Babies who are always cranky must have something wrong with them.

Sound Advice

Despite exhaustive efforts by parents, some infants are just plain miserable! Don’t blame the frustrated parents. Some babies who are cranky with no apparent reason may have inherited an irritable temperament. Every baby is born with a different threshold for crankiness. Have you ever noticed that some babies always seem relaxed while others jump out of their skin when you look at them? Nothing appears to soothe some infants, neither singing, cuddling nor rocking seems to work. These babies are a source of great frustration, parents feeling guilty and inadequate. Nothing could be further from the truth since these parents usually expend much more energy in the care of their babies than those whose babies are “laid back.” These cranky babies eventually become mellower and parents learn to deal with a slightly whiney personality as the child matures.

And then there are those infants who are happy most of the day until they enter the “witching” hours, usually between 6 P.M. and midnight. This group can drive parents to drink. For no apparent reason, witching hour babies cry inconsolably for several hours during the evening. Nothing soothes them and yet nothing is wrong with them. They merely cry at the top of their lungs until the period of “witching” passes, reverting to their former peaceful, happy state. Most pediatricians feel that this merely represents an immature arousal cycle in the infant’s developing central nervous system. The good news is that this irritable condition, usually inherited from one or both parents, is short lived, a few weeks at the most. Questioning the grandparents almost always reveals that one of the parents was a “difficult” baby. The cure for this type of “colic” comes with time since, by six to eight weeks most babies learn to enjoy life a little more. So do the parents.

The Conclusion

It’s important to rule out all organic causes of discomfort in your baby. If he is healthy but continues to be cranky, don’t despair. Time is on your side and even the most miserable baby, after a few weeks, should become much happier. So should you.

Have any questions? Please contact Dr. Mesibov

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Chapter 8: Avoiding Panic

AVOIDING PANIC WHEN YOUR CHILD IS ILL

It’s human nature for parents to worry about their kids, fearing the worst with each illness or injury. Although extremely few pediatric illnesses are serious, it’s hard for Moms and Dads not to be anxious. Signs and symptoms of minor ailments are often mistakenly attributed to serious illnesses, creating panic. Pediatricians spend a lot of time reassuring parents, explaining that very few tummy aches are appendicitis, very few headaches are brain tumors and stiff necks are almost never meningitis.

Where in the world did you hear?

He’s got a bad tummy ache. It’s probably his appendix.

Sound Advice

Tummy aches are, without doubt, the most common complaint brought to pediatricians.   No other symptom brings more concern and speculation. No other complaint has so many possible causes.

Yet most acute abdominal complaints are related to minor illnesses such as stomach viruses, colds, and “strep” sore throats. When tummy aches seem to recur, constipation, excessive acid, food intolerance, or irritable bowel are the usual causes. And some complaints are merely attention-getting devices or excuses to avoid school.

In an otherwise healthy child, the single most common cause of recurrent tummy aches is constipation. This condition, often unrecognized by parents, accounts for more abdominal pain than all other causes combined. Many children are so used to passing large, even adult-sized stools that their family mistakenly considers this pattern to be normal. Worse, many parents, although suffering from constipation themselves, don’t have a clue about the stool habits of their toilet trained children. Kids who are constipated often have severe, crampy abdominal pains, especially after meals. They fail to have daily bowel movements, the stools are large, sometimes resulting in toilet stoppage, and they have a great deal of flatulence. If left alone, constipation may worsen with time, resulting in fecal soiling, embarrassment and needless guilt. Constipation should not be ignored. Ideally, all children should pass at least one soft stool every single day.

Remedies include dietary changes, fiber, stimulants, softeners and agents which add liquid to the stool, such as propylene glycol (Miralax.) Parents must become aware of variations or delays in stooling and, even in the absence of tummy complaints, must occasionally ask to peek at the stool before the toilet is flushed. The pediatrician can be a big help in guiding the parents through the frustrating maze of treatments. At times, it’s necessary to enlist the help of a Gastroenterologist but parents should not be discouraged since almost all constipation can be cured.

How will we know if abdominal pain is caused by something more serious than a virus or constipation?  How do we tell if the child has appendicitis?  There are no sure fire signs that clearly indicate a hot appendix but most kids with appendicitis have steady pain which doesn’t go away , most commonly felt in the area around the belly button or the lower right side of the abdomen.  The pain is often severe enough that walking upright is difficult.  Don’t count on fever, vomiting, or diarrhea to suggest a diagnosis since stomach viruses can cause the same symptoms. However, vomiting which comes right after a burst of pain is suspicious. When in doubt, a visit to the doctor for an abdominal examination is a wise move, If the doctor is suspicious, lab tests or even a CT scan may be necessary.  Happily, the vast majority of children with abdominal pain don’t end up in the operating room.

The Conclusion

Most tummy aches in children are caused by common conditions which are easily treated. Appendicitis is relatively rare. Don’t ever panic. It doesn’t help. Be sure to consult with your child’s doctor when tummy aches persist. A visit to the doctor’s office may be in order.

Where in the world did you hear?

 A stiff neck may mean meningitis.

Sound Advice

A complaint of a painful neck will almost always land a child in a doctor’s office. No matter how well the child appears, the specter of meningitis materializes as soon as the words “my neck hurts” are uttered. I can’t tell you how many times a frightened mother has brought her playful, but complaining, child into the office worried that this may be the beginning of a serious illness. The fears are unfounded. Meningitis, an infection of the lining of the brain and spinal cord, does not present itself in this manner. Patients with meningitis almost never complain that their necks feel stiff.  They’re just too sick. Most children with this scary condition are “out of it,” barely able to lift their heads, usually running high fever and having vomited at least once, perhaps many times. Children with meningitis look gravely ill, not just flu-like. The stiff neck of meningitis is actually an involuntary resistance encountered only when the physician performs a neck flexion maneuver, not a complaint by the patient.

Tearful complaints of “stiff necks”are common in kids who are not sick, but suffering from torticollis, painful spasm of the muscles on one side of the neck, something like a “Charlie horse.” The children are very uncomfortable, having to keep their heads tilted to one side until the pain subsides. But they’re not ill and usually require no more treatment than local heat, ibuprofen and about 48 hours of taking it easy.

And viral illnesses too, especially the Flu (Influenza) can result in painful muscles, including the neck. Parents sometimes panic when their feverish child complains of muscle pain near to the shoulder or the neck. But these kids, although sick with the virus, are not seriously ill. Any alert child who can voluntarily complain about pain in the neck area does not have meningitis, as proven by the physician when he gently, but successfully, flexes the patient’s neck. And one more sign that’s most important: kids who have meningitis don’t smile.

The Conclusion

Don’t panic. Stiff or painful necks in an alert, active child is never a sign of meningitis.

Where in the world did you hear?

If your child gets headaches, maybe it’s a brain tumor.

 Sound Advice

Kids get lots of headaches, but tumors, thank goodness, are very uncommon. Hardly a day goes by without the pediatrician dealing with headaches. In fact, studies have shown that, by the time children reach 15 years, as much as 82% have experienced headaches.

In the pediatrician’s office, the most common causes of simple headaches in children are viral illnesses, with or without fever. The parents may not even be aware that theft child has fever until there is a complaint of a headache. These headaches always respond to tylenol and fluids. Certainly no cause for alarm.

Recurrent headaches can be debilitating and depressing. By far, migraine headaches are the most common cause of recurrent pain, causing 44% of all chronic headaches in children. Migraine headaches, usually one sided, pounding and often associated with vomiting have been estimated to affect almost 10% of the pediatric population by the age of 15. Migraine is a family thing. It’s almost a certainty that other relatives suffer from the same problem. Although it’s likely that these headaches will continue into the adult years, there are effective medications to both prevent as well as treat attacks.

Muscle tension-type headaches account for another 30% of children’s headache. These headaches, described as crushing or pressure, usually located in the front and radiating to the back of the head, are not genetic and appear to be emotionally or behaviorally based. Although there is no true hereditary link, tension-type headaches are often seen in one or both parents. Treatment is with simple analgesics and, when needed, behavior modification.

Would it surprise you to know that chewing gum is the culprit in a large percentage of children with headaches? Parents are usually amazed to find that incessant chomping on chewing gum is a frequent cause of both ear pain and chronic head pain, especially in the sides of the head above the ears. The cure for this headache is obvious: stop the gum.

And then there’s caffeine. Kids can develop headaches from drinking Coke, Pepsi or ice tea. This diagnosis is confirmed when symptoms are relieved after discontinuing all caffeine containing products for at least one week. And don’t forget MSG, often found in Chinese food: some kids are intolerant to this additive and will get pounding headaches after a good bowl of Won Ton soup.

A unique problem encountered by the pediatrician is dealing with conditions that are falsely associated with headaches. “Eye strain” is very popular but, in fact, is no more a cause of headache than a wart on the foot. Most pediatric ophthalmologists will tell you that poor vision or even muscle imbalance does not result in headaches, and, although it’s important to correct any existing eye abnormalities, don’t expect any effect on head pain. Perhaps the most popular incorrect diagnosis is “sinusitis.” Sinus infection as a cause of headaches is mostly a myth. Infections of the paranasal sinuses can cause chronic daytime coughing, purulent drainage from the nose and occasional pressure and tenderness of the cheekbones, the teeth or the areas above the eyes but they do not cause headaches! Despite the fact that many physicians treat “sinus” headaches with antibiotics, there is no medical basis for such an approach and the use of antibiotics for headache is inappropriate and potentially harmful.

Brain tumors certainly do cause headaches but I am happy to report that they are quite rare. Most pediatricians will see a child with this serious illness only once every 10 years. Children with this serious condition will usually awaken from sleep with a severe headache and some vomiting, and neurological testing will be abnormal. Diagnosis is usually made by CT scan or an MRI. Most kids with headaches do NOT have a brain tumor.

The Conclusion

Although there are many reasons for children to have headaches, they are rarely serious. Headaches should never be ignored, however, and it always in the best interests of the child to have him seen by his pediatrician to determine the cause.

Have any questions? Please contact Dr. Mesibov

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Chapter 9: Eating Habits

IS THERE ANYTHING MY CHILD WILL EAT?

Kids Eating HealthyThe first time I encountered a child with a food fetish, I thought his parents were joking.  Their son, they explained, a well mannered, handsome twelve year old refused to eat anything but bagels and cream cheese.  No meat, no chicken, no fruit, no veggies, no pasta, no rice, no cake, no juice.  According to his mom, he had been drinking milk and eating bagels and cream cheese exclusively since he was a toddler.  I thought he would “grow out of it.”  I was wrong. He persisted following this bizarre diet throughout high school. No amount of coercion or persuasion by parents or doctors could change his eating habits.   It wasn’t until he went off to college that he attempted to change.  What happened?  Away at school, he realized that he was considered “odd” and, finally, at the age of nineteen, asked me to refer him to a psychologist for help.  With help, his eating habits eventually normalized.  A good outcome at last but, who knows what arterial damage his years of cream cheese brought?  Eating properly is more than a social skill, it’s the foundation for a healthy life. 

Where in the world did you hear?

Lots of kids are fussy eaters.  Don’t worry about their eating habits, they’ll outgrow them.  Just make sure they eat something, it doesn’t matter what it is.

Sound Advice

Bad idea!  Pediatricians are challenged on a regular basis by children with compulsive eating habits.  The food chosen by the compulsive eater varies from child to child, being as bizarre as Fruit Loops or Captain Crunch to more common items such as macaroni and cheese, peanut butter, frankfurters, chicken nuggets or french fries. And, of course, these kids never eat vegetables and almost never any finned fish.    Parents of these food fetish children invariably yield to their children’s demands, thinking it’s only a “phase” and choosing to go along with desires of the child rather than face conflict at meals or refusal to eat entirely.  This parental passiveness only reinforces the child’s fixation on his bizarre and unhealthy diet, often leading to a lifetime of unbalanced, unhealthy eating.  Not all children will eventually see the light as the “bagel boy” luckily did.  I’ve encountered adults who confessed to me that they can’t eat in public because the sight of “normal” food actually makes them ill. What a life!

Lopsided eating isn’t only a social liability, it’s a threat to health.  It’s well recognized that a balanced diet consisting of vegetables, fruit, nuts, fish and dairy promotes good health and, according to some studies, a longer life by more than a decade.  Diets high in saturated fats promote atherosclerosis and heart disease, even in the arteries of children and teens.  Vegetables and fruits are sources of  anti-oxidants, substances which protect against heart disease and cellular damage.  Children who are allowed to grow older with unhealthy eating habits often continue these horrendous patterns throughout adulthood, suffering from obesity,  suboptimal health and, in some, premature death.

So what can parents do?  First and foremost, parents must not stand idly by while their child continues to consume unhealthy food.  When I was quite small my mother often reminded me that the starving children overseas (in post WWII Europe) would be only too happy to eat anything and that I should be grateful to have wholesome food.  I wasn’t grateful but I did respond to her chiding.  And as a physician, I have found that children from less advantaged homes tend to reject food less than more privileged children.  Why?  Fewer choices.  One no-nonsense caretaker grandmother was surprised when I asked if her grandchildren were picky.  “Picky?” she looked at me as if I was strange, “They eat what I give them.” 

Why don’t all children eat what they are given?  They’re never hungry. The reason?  Snacks.  Well-meaning parents are often intimidated by their children’s refusal to eat.  These poor parents allow themselves to be bullied and yield to their kids’ desires by giving them unhealthy snacks, high in fats and sugar, throughout the day.  Naturally, when lunch or dinner is served, the kids have no appetite, vegetables and healthy proteins are rejected on sight.  Faced with this rebellion, mom compounds the nutritional disaster by becoming a short-order cook, removing the offensive healthy meal and replacing it with macaroni and cheese, hot dogs, french fries or chicken nuggets.  Afraid her children will starve if they refuse the food on the table, wanting to avoid a mealtime struggle, she unwittingly perpetuates an unhealthy routine.    

Children are best served by three healthy meals daily consisting of a blend of protein, carbohydrates and fats.  Snacking is unnecessary both from a nutritional and an energy pick-up standpoint.  Yet, in our society, snacks have become woven into the daily routine of many families. Therefore, it is important that those snacks are healthy, consisting of fruit or vegetables and never given closer than three hours before the next major meal.   Snacks which are high in sugars or fats are appealing to most children but are unhealthy and lessen the desire to eat good food.

How do we handle kids who only want chicken nuggets or French fries?  This situation is unhealthy and parents must deal with it in a gentle but firm manner.  Healthy foods, especially vegetables and fruits, must be placed on the child’s plate at least once daily even though they may be rejected.  Yelling or coercion should definitely be avoided.  A simple statement declaring “gosh, that’s what’s for dinner” gives a non-hostile message that the meal presented is not negotiable.  Surrendering to screaming, tantrums or refusal to eat by supplying the child with his desired “junk” is a bad precedent both for the table and for life.  If the child refuses to eat this meal, he will be hungrier for the next.  He won’t starve and he won’t become dehydrated.  

Studies have shown that children will eventually accept healthy foods if they are placed before them repeatedly.  Of course, foods must be varied.  The same carrots or spinach on the plate every night will be a definite turn-off.

What about kids who are “rewarded” with snacks throughout the day?  Even if the snacks are healthy, the end result may be a lifestyle of self gratification through eating.  Children who have been brought up expecting food when bored, cranky or idle  often have problems developing social skills, becoming physically fit or learning to be self sufficient or creative.  After all, rather than being active and learning to amuse themselves, these children just get something to eat.  When food is made the primary focus of the waking hours, social skills suffer, the children constantly seeking gratification through eating.  There are many unhealthy, obese adults who wish they had been brought up differently.

The Conclusion

Learn to control the timing and quality of snacks and always offer healthy foods to your children whether they want it or not.

Where in the world did you hear?

Kids don’t get heart disease from cholesterol.  Whoever heard of a kid getting a heart attack?  Let them eat what they like, you can worry when they get older.

Sound Advice

Wrong, wrong, wrong.  Not only can children have high cholesterol, some have evidence of atherosclerotic heart disease by the time they are three years old.  Autopsies of “healthy” kids after automobile accidents have revealed coronary artery lesions in early adolescence.  Think about this: heart disease can start in childhood. 

Does that mean that parents have to lock their children in the house and feed them nothing but oatmeal?  Obviously not, since we know that good health can come from eating a wonderful variety of fun foods and being active.   Foremost in the minds of parents should be a “foods to avoid” list consisting of any items high in fat and sugars.   The American Heart Association has established the guideline that fat Calories should make up less than 30% of the total diet, much of that fat being unsaturated.  Without having to take a calculator to the store, parents can generally feel safe if their kids’ total daily fat intake is between 50 and 75 grams, starting at age two and ending at age 10.   And how can you tell how much fat you’re buying?  Read the labels and do a little simple arithmetic.  If your child’s magic number is 60 grams of fat per day, you might be impressed that a single slice of pizza contains 10 to 20 grams, some ice cream bars contain 40 grams and some cheese snacks contain, omigosh, 60 to 70 grams of fat in a single bag!  Kids who eat lots of cheese, hot dogs, fried chicken, fast foods, ice cream and cookies are living dangerously. 

As a rule of  thumb, any single serving of more than 10 grams should be given extra thought before presenting it to your child.  What’s good to give your kids?  Try cereals and whole-grain breads, yogurt, low-fat cheeses and milk, soups with veggies, rice, fresh fruit, chicken, ham or turkey meats, canned tuna, fresh fish, and  varieties of vegetables, both raw and cooked.

The most important thing to remember is that parents must be in control of the eating patterns of their children.  Good health and longevity are, in many ways, determined by the kinds of food we eat.  Children often want foods that are dangerous to their health and it is our job to steer them to a lifestyle that includes healthy eating.

The Conclusion

Foods and snacks that are high in saturated fat can lead to heart disease even in small children.  Parents must make smart choices for their children, avoiding those foods which can pose a risk to health.

Where in the world did you hear?

You know why your kid is so jumpy and nervous?  It’s the sugar in his food.  If you want him to calm down, you’d better change the way he eats.

Sound Advice

Your child may be jumping off the walls, but you can’t blame it on the sugar in his diet.  It’s a myth.  Sugar does not cause hyperactivity.  In fact, studies have shown that there is no connection between sugar and hyperactive behavior.  When brain metabolism is analyzed, the findings indicate that sugar has the opposite effect, that is, it actually produces a sedating effect on the brain.  Surprised?  Does that mean that you can now load your children with sugary treats?  Of course not.  Children who eat a lot of sweets suffer from poor nutrition, usually sacrificing vegetables, fruits and fish to their craving for sugar.  And in those families with a history of diabetes or obesity, high glucose loading may lead to early pancreatic disease and overweight. 

An occasional sweet following a healthy meal is sensible and harmless.  But when children consistently consume sweets or junk snacks between meals they are developing an unhealthy lifestyle.  Parents often express frustration at their inability to stop their children from invading the pantry despite warnings to the contrary.  The solution is obvious: mom and dad must stop stocking their pantries with junk.   Unless the children have a credit card, only the parents are to blame if sugary snacks are readily available in the house.  Not only will a healthy house cleaning be good for the kids, it will be equally good for the parents.

Carbonated soft drinks, especially colas have no redeeming value.  They have the same drawbacks as sugary snacks and, worse, can result in defective calcification of the bones.  Drinking soda should be avoided.  If the child is thirsty, water, juice or milk should fill the bill but drinking milk or juice within three hours of the next meal will usually adversely affect the child’s appetite.

What about sugar substitutes and diet drinks?  Avoid them.  There are no long term studies in children to assure that these compounds are safe.  Never give your child anything without a long, proven record of safety.

The Conclusion

Sugar is a natural, safe form of energy.  It does not cause kids to become hyperactive.  However, overindulgence results in nutritional imbalance, poor eating habits and a threat to long term health.

Have any questions? Please contact Dr. Mesibov

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