My article in Parents magazine

Please read my article in the September issue of Parents magazine.  It's about food allergies, a subject close to my heart.
Here's the link...
http://t.meredith.ly/SRqkL0R

Corticosteroid Therapy

My son, Max, has just recovered from a viral illness, one that produced noisy breathing in him last weekend.  It was scary, and I suppose anybody reading this would think to themselves, "Wait, she's a pediatrician, she should know how to deal with a child's noisy breathing."  Somehow it is different when it's my own child who's ill, and because I am not so good at making decisions when it comes to my own kids' health, I had my partner look at Max.  We decided to give him a two-day course of oral Prednisone, a corticosteroid, to reduce the inflammation of his airway.  It did the trick and helped him breathe more comfortably.
 
Steroids have a bad reputation with the general public; we hear of doping scandals in the Olympics, and the news media hypes up stories about athletes and anabolic steroids.  But corticosteroids in medicine are in a different class altogether; they are used to treat everything from asthma and croup to lupus and vasculitis.  The main side effect of steroid therapy is stomach irritation, but this can be averted by antacid therapy if needed.  Primarily acting to suppress inflammation, corticosteroids do have great utility and benefit.

Warts

Verruca vulgaris is the fancy medical term for common warts.  And common they are, even in children, and usually found on the bottoms of feet or around the fingernail beds.  Sometimes parents find it difficult to distinguish a wart from a callus.  A wart is characterized by tiny dark specks on it, which are really thrombosed capillaries.  As with many things in medicine, warts are virally induced, and as it turns out, there is no great therapy for them.  A friend of mine showed me her daughter's warts the other day, and I told her she could try an over-the-counter preparation with salicylic acid.  If warts on the bottom of feet start to bother the child, I do recommend a visit to a podiatrist or dermatologist for liquid nitrogen or laser therapy.  But without any treatment, warts can disappear on their own, whether it be next week or next year.  In many cases, I end up telling parents just to wait the warts out; sometimes patience really is the best medicine.

Waxing On About Ear Wax

It's a good visit for me and the patient.  Flushing wax out of a child's ear is far from glamorous, but I find it satisfying when a big ball of wax emerges and suddenly the child says, "Oh, my gosh, I can hear again!"  The parent is usually a little disgusted to see how much wax can emerge from the child's ear; invariably she asks what she can do to prevent the wax buildup.  Relax, I say, God made ear wax for a reason; it helps to keep the pH of the ear canal balanced, and it helps to prevent infections of the ear canal.  If wax builds up such that a child is complaining he can't hear well, a parent can use an over-the-counter solution that softens the wax, which will work its way out of the ear.  If not, it takes about two minutes at the pediatrician's office to flush out the wax.  I do caution parents not to use Q-tips to go digging for wax.  Q-tips cause too many ear canal abrasions from forceful probing by parents.  In fact, Q-tips usually push the wax in further.

So ear wax is your friend, I always tell parents.  It's a good thing; don't do battle with it, and certainly not with Q-tips.  In the not-so-common instance when the buildup actually prevents a child from hearing well, a pediatrician will find it very gratifying to flush it out.

Childhood Vaccination - It's A Very Good Thing

I understand parental anxiety.  I'm a parent who worries about everything about my kids.  But there is one thing I have never worried about, and that is giving vaccines to my children.  I'm a big proponent of vaccines and the world of good they've done and continue to do in reducing mortality, morbidity and misery.  Imagine what it would be like to fear your child becoming crippled from polio.  Imagine your child contracting measles and developing encephalitis from the infection.  Imagine your son becoming sterile from a mumps infection.  Today's parents don't have to fear such diseases because of childhood vaccination.  Because these diseases now seem so antiquated and remote to parents of our generation, it has become easy for some moms and dads to be cavalier about vaccines.  Oh, my child isn't going to get polio or measles, they say.  I'll just count on everyone else getting vaccinated, and that will protect my child indirectly.  Selfish argument?  Absolutely. 

Then we have the group of parents who believes their child will become autistic if they get too many vaccines.  The group of researchers from Britain who started all this vaccine and autism talk in the 1990s recently retracted their statements.  Hallelujah, we pediatricians cried, when that announcement was made.  There is no good science to support any link between vaccines and autism.  Some parents also worry that the number of vaccines we give can overwhelm the immune system.  My partner, Dr. Michael Segarra, likes to tell moms that a child's pacifier introduces more antigens into the body than the vaccines we give at one visit!  He's absolutely right. 

I know that there are parents out there who will remain skeptical of vaccines no matter how much information we pediatricians give them, but I also like to tell these parents that if I didn't think vaccines were safe and necessary, I certainly wouldn't have given them to my kids.  I think that says a lot.

Cell Phone Use in the Doctor's Office

When a mom's cell phone rings in the middle of an office visit with me, she's usually apologetic.   But I tell her to answer it, especially if she's got other kids.  Don't feel bad, I say, the school might be trying to get in touch with you, or maybe your husband is.  I understand; I've had to answer a call in the middle of a visit to my doctor before.  But yesterday, I had one mom whose behavior really amazed me.  I walked into the exam room, and she was deep in the middle of a conversation.  I eventually gathered that her call was not of a very urgent nature, because I got to hear the next five minutes of it.  She smiled at me, as I talked to her five-year old for the duration of the call, but she made no attempt to get off the line until she finished chatting.  I like her, and maybe she feels so comfortable with me that she didn't feel like she needed to get off her phone.  Maybe she felt it was a good opportunity for me to converse with her child.  But ultimately, I think such behavior was just rude.  I would never have dreamed of continuing a call with my doctor or dentist waiting for me, and I hope that most people out there will continue show some respect when it comes to cell phone use.

Let The Baby Cry, or To Ferberize or Not to Ferberize?

Friends of mind have a nine-month old baby who isn't sleeping well.  For the sake of anonymity, I'm going to call them Rich and Grace.  They are first-time parents, and like all new parents, their world has revolved around their little girl from the minute she was born.  She's been rocked to sleep every night and for every nap, and now she can't go to sleep without being held by mom or dad.  She wakes every three hours or so and protests loudly when she discovers that she's in her crib and no longer in those warm arms of her parents.  To get her back to sleep, they give her a bottle of warm formula; then she's rocked in a parent's arms again before they gingerly put her back into her crib.

Rich and Grace are exhausted.  They remind me of my sleepless nights with my first child.  At Sophia's nine-month well-visit, my partner, Dr. Katz, asked me how she was sleeping.  I admitted that I was still up every few hours and confessed that I couldn't ignore her cries at night.  He looked at me quizzically, and said, "Come on, you know what you have to do.  Put her down when she's still awake, so that she gets used to soothing herself to sleep, and don't rush to her room when she cries in the middle of the night.  And God forbid that you feed her every time she wakes up!"  I knew he was right, although that didn't stop me from feeling affronted when I read what he wrote in Sophia's chart under the "Sleep" column: "Still wakes at night; Mother can't ignore." 

But I have to admit Dr. Katz had a point.  We finally approached sleep the way the famous Dr. Ferber championed.  By ignoring Sophia's cries in the middle of the night, we trained her to sleep.  It took hardening my heart and shutting my ears to ignore her pitiful cries, and I spent some nights with my pillow over my head when I heard her crying for me.  But the torture paid off, and she learned to sleep well.  For Rich and Grace, I would tell them to place the baby in her crib when she's awake so that she learns to put herself to sleep.  For the first week, they can allow themselves to pick her up when she cries in the middle of the night.  But by no means should they continue feeding her through the night.  And after that first week, they shouldn't even go into the room.  Some pediatricians would advise going into the room every ten minutes of so just to pat the baby on the back, but I always found that showing up in Sophia's room without actually picking her up made her cry even harder.

The crying is so hard to hear, but it really doesn't do the baby any harm.  And when it does stop and the baby learns to sleep through the night, it's a blessing for everyone involved.  Imagine how good it feels to sleep through the night, I always tell parents.  Well, a baby reaps the benefits of a solid night's sleep as well.  I hope Rich, Grace and their little girl get some good sleep soon.