Cough Medicines

School has been in session for a few weeks, and cough and cold viruses have begun to circulate again now that kids are back in close quarters.  When a child comes in with symptoms of cough, congestion and runny nose for a few days, and his physical exam is normal, I reassure the parent that the child is most likely suffering from a virus.  That means no antibiotics, just fluids and rest.  Time, I say, the child just needs some time to recover from the virus.  If the child is under 4, I also stress that no cough and cold meds are approved by the FDA for this age group.  And for the older kids, the plethora of cold and congestion meds that are sold as over-the-counter preparations may make a parent feel better that she's tried something, but the cough syrup probably isn't going to make the child feel any better.  I understand how a parent needs to feel she's doing something for her child by offering some sort of medicine, but as a pediatrician, I emphasize that clinical research points to little utility for cough and cold preparations.  Thankfully, most parents can appreciate that a child shouldn't be needlessly medicated.  Sometimes the best medicine for a cold really is chicken soup.

Lice, Lice, Dreaded Lice

The American Academy of Pediatrics recently stated that schools should not have "no nits" policies.  Since lice is not felt to be a public health threat, this statement by the AAP means that children should not be excluded from school once they have been treated for lice just because they still have nits in their hair.  Nits are the egg casings of the lice and are difficult to manually remove.  I'm so glad the AAP has this laissez-faire attitude to lice.  Parents get hysterical about lice and often need to be reminded that there are far worse diagnoses that children receive.  A few weeks ago, I saw a little girl in the office who complained of an itchy head.  She had lice crawling at the roots of her hair.  The mom was horrified, in shock.  I told her that it was, after all, just lice; it wasn't leukemia or lymphoma or diabetes that we were talking about.  You should wash out your linens, I told her, but lice should be treated as an inconvenience and nothing else.  And don't feel like your family is dirty or unclean in any way, I continued, because lice doesn't discriminate; it affects kids from all socioeconomic classes. 

After calming this mom down though, I thought about how I would react if one of my kids got lice.  I have to admit that the sight of the bugs crawling in the child's hair did make my stomach turn.  Come to think of it, I probably wouldn't react so well either.  I'm just going to hope that lice won't invade my house any time soon.

When Should Breastfeeding End?

My sister is still breastfeeding her 16 month old, and her husband thinks it's time to stop.  She can't resist her child's pleas to nurse before he sleeps; her husband feels the breastfeeding should end now that their child enjoys sips of diet Coke and can chomp readily on pretzels.  My brother-in-law asked me what is the oldest age I know of when a child was still breastfeeding.  I answered, flippantly, "Well, our dad nursed until he was four, but it was World War II then, Singapore was under siege by the Japanese, and his mom had no other choice."

I do see my brother-in-law's point, though; there is something remotely distasteful about a toddler or an even older child sucking on his mom's breasts.  But I also understand how hard it is to stop because the breastfeeding bond is such a strong one between mom and child.  I loved nursing myself, and I was loath to say goodbye to breastfeeding because it meant the end of a unique and special stage of babyhood.  The American Academy of Pediatrics encourages breastfeeding for as long as possible, above and beyond the baby's first year of life if the mom is willing.  But for my sister and brother-in-law, I told them that the decision to stop breastfeeding was ultimately a very personal one, one that they would have to resolve by themselves.

Wake-Up Calls

Max flung himself on me this morning at about 6:45, and a few minutes later, I heard Sophia's footsteps race down the hall to our room.  Wishing so desperately for a few more minutes of sleep, I knew the day had begun as I made space for them in bed.  And then I thought of a mom of two college-aged boys who I saw in the office a few weeks back.  She had said that she can't believe how quickly time flies, that she hates saying good-bye to her sons at the end of the summer, that sometimes in the mornings, she lies in bed and wishes that her boys were little again so that they could could running to her room in their PJs.  What she said hit home with me this morning.  Instead of groaning for more sleep, I told myself to appreciate little moments like I had at 7AM, when the kids snuggled up against me.  I know there will come a day when my kids won't need me the way they do now, and then I will want to turn back time.  But when that day comes, I do hope I'll be getting more sleep.

Obsessing About Weight

I saw a teenaged patient this past week who started crying when we talked about her weight.  She had put on about ten pounds since her last checkup, but by no means does she qualify as overweight.  Amidst her tears, she told me that she hated the way she looked and that she was willing to do anything to lose weight. We talked about healthy lifestyles and how I wanted her to focus on healthy eating and exercise for a healthy heart and body, not for some number on the scale.  Since I've been thinking about obesity lately, I find it ironic that the patients of mine who don't need to lose weight are the ones usually willing to make the lifestyle changes necessary to do so. 

Whenever I sense that a patient might be getting a little carried away with weight concerns, we talk about the importance of three healthy meals a day and a modicum of exercise rather than overdoing the workouts.   And I try to emphasize how it is wrong to feel guilty for eating the occasional sweet treat.  Unfortunately, there are some girls out there whose obsession with their weight becomes a mental disease, and these are the anorexics and bulimics who need intensive psychotherapy and sometimes medical hospitalization.  But extremes aside, it is sad that our society, which idolizes paper-thin models and actresses, has created a culture in which most adolescent females worry about their weight.  As parents, it should be our goal to instill self-esteem and healthy eating habits in our young girls so that they grow up happy with their looks and comfortable in their bodies.  A tall order, perhaps, but a goal to strive for nonetheless.

Obese Kids

My sister and brother-in-law came to visit us this week, and on the plane, they were seated next to a teenaged boy who was so fat that he spilled out of his seat.  They thought he was about 13 years old, and my brother-in-law noticed that he drank regular soda and snacked continuously on the flight over from Chicago.  When we were kids, I don't remember many overweight classmates at all.  Within a span of just one generation, it seems that American children have piled on the calories and put on the weight.  I'm seeing more and more patients who are overweight, and these children are at risk for future health problems like high blood pressure and diabetes.

In an effort to offer some concrete advice to overweight patients and their parents, I ask if portion control is an issue.  In today's society, it almost always is.  We are blessed and cursed that in this country, we have too much relatively cheap food.  People from other countries of the world would be astounded by the bounty of food available in the local Stop 'n' Shop.  I always ask if a child drinks a lot of soda and juice, sources of unnecessary calories for so many kids.  The amount of snacks that we give our children is also out of control although I feel hypocritical when I discuss snacking, being an inveterate nosher myself.  Lots of today's kids, my own included, have become accustomed to snacking every two hours, instead of saving their appetites for three healthy meals a day.  Bedtime snacks too should be banned.  Brush your child's teeth after dinner, I advise, and then only allow water after dinnertime.  And last but not least, I try to stress the importance of exercise, especially for this generation of kids who loves Nintendo, cable and computer time.  All of this is, of course, such easy advice to give but often so difficult to implement and enforce.

Juice Is The Devil

A mother questioned me on the subject of juice last week.  But, why, she asked, why do you say that I shouldn't give juice to my kids?  Because you don't want to get them hooked on that garbage, I replied.  Your twins are only 15 months old.  Don't let them get used to the taste of juice because eventually they'll reject milk and water.  So many kids in this country can't drink plain water by the time they're five years old and then it's a slippery slope to drinking sodas and iced teas.  The mother continued to press the subject by saying that she thought water was so boring.  Think about tooth decay, I had to say, and the unnecessary sugar calories that you'll be saving your kids.  Apparently, 10-15% of calories a day in an American diet come from sugary drinks.  Even the drinks that proclaim themselves to be 100% juice just encourage a sweet tooth.  A child is far better off eating a piece of fresh fruit than sucking on a sippy cup filled with juice.

I had to invoke my own children to try to convince this mother about the evils of juice; I told her that Max would drink juice all day if I he could, but if no juice is in my fridge, he drinks milk or water.  With vitamin D and calcium defiencies being hot topics in medicine these days, it's especially important to make sure that kids get their three dairy servings a day.  After all this discussion, the mother didn't look entirely convinced.  I wonder if she left my office to head to Shop Rite to stock up on Kool Aid.