I’m a pediatrician. Here’s what I want you to know about vaccines.

By Dr. Katherine Williamson, a CHOC Children’s pediatrician

dr-katherine-williamson
Dr. Katherine Williamson, a CHOC Children’s pediatrician

Proper vaccination is important for all people, but especially infants and babies. When children follow the recommended immunization schedule outlined by the American Academy of Pediatrics (AAP), they are better protected against potentially life-threatening diseases.

As a pediatrician, I get a lot of questions about baby vaccination and vaccines for children. In observance of national immunization month, here are the most common questions I get about vaccines.

Are vaccines safe?

Vaccines are one of the most important things we can do to help protect our children’s health. Vaccines and proper handwashing, more so than all other interventions, have proven to be the most safe and effective ways to prevent disease.

What is the proper vaccine schedule?

The current immunization schedule outlined by the AAP and Centers for Disease Control & Prevention has been researched and proven to be the most effective and safest way for children to be vaccinated against potentially fatal diseases. It’s important to know that no alternative schedule has been shown to be as safe and effective.

I get frequent questions from expectant and new parents who are concerned about the number of vaccines given to kids at one time under the recommended schedule. The amount of antigen (protein) in the vaccine that is put into your child’s body is 100,000 times less than if your child has a common cold, so there’s no concern about overwhelming their immune system when they get their vaccines.

Do I really need a flu shot every year?

Yes. Influenza causes a higher number of death and illness over any other disease annually in the US, and your best chance of preventing influenza is the flu vaccine. Symptoms of influenza include high fevers, chills, muscle aches, and respiratory symptoms that can lead to pneumonia and respiratory failure. Children under 2 years and adults over 60 years of age are at the highest risk of becoming seriously ill if they are exposed to influenza.

The CDC recommends an annual influenza vaccine for everyone 6 months of age and older. You should be vaccinated as soon as the influenza vaccine becomes available. Although flu season peaks between December and February, it can start as early as October and last through May.

What can I do to make my child more comfortable while receiving a vaccination?

Studies have shown that preparing your child for vaccinations should ideally include three components” explaining what will happen, how it will feel, and strategies for coping with any related stress or discomfort. Here’s more tips on how to make shots less stressful.

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Eczema Treatment for Kids

By Dr. Eric Ball, a CHOC Children’s pediatrician

What is eczema? Atopic dermatitis, more commonly known as eczema, is a common skin condition that can plague everyone from babies to grown-ups. It can be as mild as a nuisance, or more serve with skin so dry it cracks, bleeds or gets infected. Most kids will get an itchy skin rash at some point in childhood, but about one out of every 10 kids will develop eczema.

Eczema causes are unknown, but it’s believed to be a combination between genetics and a trigger, which could be certain foods, seasonal or environmental allergies, stress, hormones and weather. Diagnosing eczema can be tricky because each child has a unique combination of symptoms that can vary in severity, and there is no test to diagnose it definitively. If you suspect your child has eczema, consult your pediatrician. They will conduct a physical examination, and help you identify things in your child’s environment that may be contributing to skin irritation.

Eczema is not contagious, so there is no need to keep a child with eczema home from daycare or school.

Eczema symptoms

Eczema symptoms typically appear within the first few months of life, and almost always before a child turns 5. More than half of all children who suffer from eczema will outgrow it by the time they’re teenagers.

Between 2 and 6 months of age, kids with eczema will have itchy, dry, red skin and small bumps. These eczema symptoms can appear on their cheeks, forehead or scalp. It may spread to the arms, legs and trunk; in the bends of the elbows; behind the knees; or on the backs of the wrists and ankles.

Eczema symptoms tend to worsen and improve over time. For many kids, it begins to improve by the age of 5 or 6; others may have flare-ups into adolescence and early adulthood. In many cases, eczema goes into remission and symptoms may disappear altogether for months or even years.

How to treat eczema

There is no known eczema cure. However, your child’s pediatrician may prescribe a topical corticosteroid, also known as cortisone or steroid creams or ointments, which are commonly used to treat eczema. These “eczema creams” are usually applied directly to the affected area twice a day. Continue using these corticosteroids for as long as your doctor suggests.

These creams and ointments vary in strength, so do not apply a topical corticosteroid intended for someone else.

Your doctor may suggest nonsteroidal medications instead of a topical steroid. These may also prescribe antihistamines to help control itching, or an oral or topical antibiotic to prevent or treat secondary infections common in kids with eczema.

How to help your child with eczema

  1. Avoid frequent hot baths or showers, which dry out the skin. Use warm waters and mild soaps during bath time. Gently pat their skin dry, instead of scrubbing or toweling.
  2. Avoid fabrics that may irritate their skin including wool or coarsely woven materials. Favor materials that “breathe” such as cotton.
  3. Apply moisturizing ointments like petroleum jelly, lotions or creams to their skin two to three times per day. Always apply within a few minutes of bathing after a gently pat dry, before the skin has fully dried. Do this in addition to using a cream prescribed by their pediatrician.
  4. Apply a cool compress to the skin to ease itching.
  5. Eliminate known allergens from your home, including certain foods, dust or pet dander.
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How to Deal With a Toddler Who is a Picky Eater

By Dr. Eric Ball, a CHOC Children’s pediatrician

Most babies are great eaters. The average twelve-month-old will eat most of what he is offered. At my son’s first birthday party, I remember that he happily ate broccoli and strawberries, and only nibbling on his birthday cake. Three months later, my wife and I were begging him to just try or lick a piece of broccoli. What happened?

Some studies suggest that over 90 percent of toddlers and preschoolers are described by their parents as picky. I have a few theories about what happens to these formerly stellar eaters:

  • Children’s growth velocity slows down dramatically after their first birthday. The average child gains 15 pounds in the first year of life and only 5 pounds in the second year. Most of the food your baby ate went to growth, whereas most of a toddler’s food will go to running around and playing. Therefore, a toddler’s hunger will be variable. There will be days when they are hungrier than other days. It is normal for toddlers to have meals― or even days― when they eat little. There are also days when a toddler might eat more during a meal than their parents.
  • The last thing a toddler wants to do is sit in a highchair for thirty minutes and eat a meal. They want to play and explore. The average toddler or preschooler will eat just enough to get the energy to play more. When their tank is refilled, off they go!
  • Kids get smarter as they get older. Eventually my son realized that chicken nuggets taste better than broccoli. Since toddlers have no knowledge of nutrition, they want to eat what they like the most. At this stage, the biggest pitfall parents can make is to start allowing their toddlers to decide what food will be served. They will obviously choose the junk food that tastes best to them.

So, what do you do with your newly picky eater? I was raised in a strict household where my brothers and I were forced into eating our food. My brothers and I all struggled with obesity as children and were all very picky eaters. My wife’s family had one rule for the table, “Eat what you want, leave the rest.” There was no arguing or bargaining around the dinner table in their home. My wife and her brother were always a healthy weight and ate a good variety of foods. Here are some tips that I learned from my wife’s family that I try to pass onto my patients and my own children:

As parents, we are in control of the quality of the food offered to our children, and they are almost 100 percent in control of the quantity that they eat.

Toddlers have a fierce independent streak and the more they are pushed, the more they push back. Do not bribe, coerce, or force your children to eat. Sit your toddler down for three well rounded meals per day and at least one healthy snack per day. Make sure that he is offered a variety of healthy foods at each meal. If he eats what is served, that is fantastic. If he does not eat what is served, that is okay, too, but do not offer him anything else. We parents are not short order cooks. If the family is eating chicken, rice and broccoli, then that is what the toddler should be served. If he is offered macaroni and cheese after he whines that he does not like chicken, then you have essentially taught him that in order to get macaroni and cheese, simply whine and refuse your food. This is the first step in the making of a picky eater. It is better to excuse him from the table if he does not want what he is served rather than give him something else. Children do not starve themselves to death. Place the dinner plate in the refrigerator, and he can have a second chance at eating his dinner later that evening if he decides he’s hungry.

Maximize your opportunities for successful meals by not filling up on liquid calories and snacks.

I do not serve milk or juice with meals, only water. When my son was a toddler, if he had milk with his dinner, he would chug the milk until he was almost completely full, and then eat little or no food A ten-ounce cup of whole milk has more calories than an equivalent sized soda. I would save milk or juice for snack time and limit my children to no more than 16 ounces of milk per day. In fact, I filled a 16-ounce measuring cup with milk each morning so that my children could see exactly how much milk would be allotted for the day. When the cup was empty, the milk for the day was over.

Give your toddler mutually acceptable choices for snack foods.

I will offer my children an apple or a pear for a snack. If they respond that they want Goldfish crackers, I will remind them again that their choices are between an apple and a pear.

Eat as a family whenever possible.

Children are much more likely to eat their food if they see others eating the same food. It is hard to expect a toddler to eat peas if he is the only one eating them. Even if work schedules make a true family meal impossible, try to have one parent sit with the children and eat small portions of what the children are served.

Allow children to participate in food preparation.

Most people are more willing to eat something of which they have ownership. Even something as simple as having your toddler stir the peas and corn may increase the odds that he will eat them.

If there are foods that you do not want your children to eat, do not buy those foods.

Good nutrition starts at the grocery store. If a child’s only options for snacks are fruits or vegetables, it is likely that he will eat them. Most toddlers and preschoolers eventually are smart enough and agile enough to find that stash of Oreos in the cabinet.

In medical school, I was repeatedly taught that parents should not make mealtime a battle. That lesson didn’t fully sink in until I had my own children and I realized how quickly a lovely family meal could degenerate into a stress-filled ordeal. By applying the simple family rule of “Eat what you want, leave the rest,” mealtime at our home is once again a pleasant experience.

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Stomach Flu vs. Influenza

Many people talk about the “stomach flu” when they’re feeling sick to their stomachs. It isn’t the same as influenza or the flu. Stomach flu is an illness called gastroenteritis, which is usually caused by a virus. The seasonal flu, or influenza, is a virus in the upper respiratory system. Each year from October to May, millions of people all across the U.S. come down with the flu.

Stomach flu (gastroenteritis)

Someone with the stomach flu may have the following symptoms:

  • Stomach cramps
  • Diarrhea
  • Fever
  • Nausea
  • Vomiting

He or she will usually feel sick for a day or two and then feel better. Unfortunately, there is no vaccine or cure for the stomach flu or gastroenteritis. Here’s how you can make the stomach flu go away:

  • Get lots of rest
  • If you’re throwing up, avoid solid food. When you feel up for reintroducing food, start with bland items like bananas, rice, applesauce or toast.
  • Sip fluids, such as water, or try a popsicle.
  • To avoid dehydration, sip small amounts of beverages that contain electrolytes.

Seasonal flu (influenza)

When people have influenza, they usually feel worse than they do with a cold. Most people start to feel sick about two days after they come in contact with the flu virus. They might have:

  • Fever
  • Chills
  • Headache
  • Muscle aches
  • Dizziness
  • Loss of appetite
  • Tiredness
  • Cough
  • Sore throat
  • Runny nose
  • Nausea or vomiting
  • Weakness
  • Ear pain
  • Diarrhea

Sometimes, influenza can turn into pneumonia. This is especially dangerous for babies, or kids and adults with pre-existing health conditions. If you think your child has influenza, see a doctor.

How to treat the flu

Most kids with influenza will get better at home. Make sure your child:

  • Drinks plenty of fluids
  • Gets plenty of sleep
  • Takes acetaminophen or ibuprofen to relieve fever and aches.
  • Wears layers that are easy to remove. Children might feel cold one minute and hot the next.

Fever and most other flu symptoms often go away in about five days, but kids may experience a lingering cough or feel weak. Children should be kept home from school or daycare until they have been fever-free for 24 hours.

Tips for keeping your kids safe from the seasonal flu:

There are several things you can do to help your family avoid the seasonal flu.

  1. Get a flu shot. It’s better to get vaccinated later in the season than not at all. The Centers for Disease Control recommends annual influenza vaccinations for everyone 6 months and older.
  2. Practice proper hand washing. Besides getting a flu shot, proper hand-washing is the best way to prevent the spread of illness, including the seasonal flu.
  3. Stay away from people who have a fever. Ask friends, family and caregivers who have had a fever or chills within the past 24 hours to stay away from your child. Likewise, keep your little ones home from school or daycare for 24 hours after they’ve had the same symptoms.
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I’m a Pediatrician. Here’s What I Ask My Own Child’s Doctor.

By Dr. Sarah Kay Herrera, a CHOC Children’s pediatrician

Since I was 11 years old, I knew I wanted to be both a pediatrician and a mom. Today, I get to take care of children within the CHOC Primary Care Network at Sea View Pediatrics and be a mom to my 4-year-old daughter. You might think that being a pediatrician has its advantages as you become a parent yourself, but I often find myself worrying more. Just like the parents who come to my practice, I also turn to my pediatrician for an objective perspective to calm my mommy nerves and take care of my daughter.

sarah-kay-herrera-md
Dr. Sarah Kay Herrera, a CHOC Children’s pediatrician

Here are some of the questions I ask my child’s pediatrician, and what they’ve told me:

What are the best parenting books?

  • “Caring for Your Baby and Young Child, 6th Edition, Birth to Age 5” from The American Academy of Pediatrics
  • “Baby 411: Clear Answers & Smart Advice for Your Baby’s First Year, 8th Edition” by Dr. Ari Brown and Denise Fields
  • “Happiest Baby on the Block” DVD by Harvey Karp
  • “1-2-3 Magic: 3-Step Discipline for Calm, Effective, and Happy Parenting” by Thomas Phelan, PhD

How can I maximize my baby/toddler/preschooler’s development?

  • Toys must be age appropriate. Toys that are too small have the potential to be a choking hazard
  • All ages: sing, talk, dance, read
  • Newborn: colored toys with soothing music like baby gym, rattles
  • 6 months – 1 year: picture or texture books, musical toys, pots and pans, squeeze toys, peg toys, push/pull toys
  • 1-2 years: stacking toys, push/pull toys, household cleaning toys, musical instrument toys, telephone toys (no cords), toy cars
  • 2 -5 years: encourage them to begin using their imagination during this age. Puzzles, age -appropriate Legos, blocks, tricycles or scooters with a helmet, kitchen toys, balls, doctor’s kit
  • 5-9 years: encourage your child to develop new skills during this time. This can include biking with a helmet, playing sports or other games with balls, using blunt scissors or sewing kit under supervision, playing board games and puzzles.

What are some tricks to keep my picky eater eating healthy?

  • Use a plate with dividers: half the plate should be for fruits and vegetables, a quarter for protein, and a quarter for grains.
  • Give something you know your child will love as well as something new to try he may not like.
  • Eat the same thing your child eats at the table. This shows your child you enjoy your food.
  • Hide vegetables in soup or mix in dishes such as stir fry.
  • Consistency and positive experience is key.

How do you sleep train? What’s the deal with sleep regression?

  • Remember babies need to sleep on their back in their own crib.
  • Recommended book: Solve your child’s sleep problems by Dr. Richard Ferber
  • You can start sleep training when your baby is 4-6 months old but discuss a specific plan with your child’s pediatrician.
  • Place baby in crib still awake to train her how to self soothe. This is the same for toddlers as well. There will be crying, and that is ok.
  • some days will be better than others. this is a problem that all parents face.
  • For ages 1 and up, try a baby night light that changes color for bed time and when it’s time to wake up

Should I be concerned about my child’s fever?

  • Even if your child’s temperature is above the standard 98.6 degrees, we define fever as having a temperature of 100.4 degrees or greater. If your child has a fever for at least three to five days, it’s time to see the pediatrician. This rule doesn’t apply to babies less than one month old; any fevers for them are considered urgent and should be seen in the Emergency Department.
  • Try to give as many details to your pediatrician about your child’s illness and behavior as you can.

My child has a rash. Do they need to see the pediatrician?

Rashes should be examined by a pediatrician. During your appointment, tell your pediatrician about any other symptoms your child is experiencing along with their rash, how it started and how it is progressing. Photos can be helpful, but many times photos will not be enough for diagnosis alone. Your pediatrician needs to see and touch the rash and examine the child thoroughly.

Even though I’m a doctor, I trust my daughter’s pediatrician for an objective opinion. Don’t forget to schedule your well child checks as this is the perfect time to ask questions on development, diet, and overall well-being of your child.

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