Anemia is a deficiency in red blood cells, also called “low hemoglobin”. Symptoms of anemia include fatigue, pale skin color, fast heart rate, or may have no symptoms at all. It is common practice at either the 12 month or 15 month visit for your pediatrician to check your child for anemia. This is usually done in the office with a finger poke, like a diabetic testing their sugar. 

Normal range for hemoglobin:

• Age 6-24 months is 11-13
• Age 2-6 years is 11.5-13.5
• Age 6-12 years is 12-15
• Age 12-18 years:
  • Males is 13-15.5 
  • Females is 11.5-15

 There can be multiple causes of anemia. Drinking too much whole milk (over 24oz per day) is a very common reason for toddlers to be anemic. This is due to the fact that the calcium in dairy products inhibits the absorption of iron in the gut. 

Another common cause of anemia in children is insufficient intake of iron containing foods. High iron containing foods include spinach and other leafy green vegetables, red meat, lentils, beans, chickpeas, soybeans (edamame), peas, quinoa, tofu, broccoli, canned tuna, and dark chocolate. 

Here’s a meatball recipe I suggest for a big blast of iron: 1 lb lean ground beef, 1 lb cooked lentils, 10oz bag spinach- cooked, 2 eggs, ½ cup bread crumbs (even tear up 2 slices of sandwich bread instead), ¼ cup ketchup, seasonings of your choice (I use Worcestershire sauce, garlic powder, salt & pepper). Mix all ingredients together with your hands, form into 2 inch meatballs, and bake in 350 degree oven for 20 minutes. Don’t forget about your old trusty iron skillet! Lug that heavy pan out and start using it often to pan sauté your meat and vegetables to add iron into other foods you are already cooking.

 There are other more rare causes of anemia including inherited red blood cell defects such as sickle cell disease and thalassemia and serious infections. 

If your child has moderate to severe anemia, they may require a prescription iron supplement, but I’ll warn you, it is one of the nastiest tasting medications I have ever tried. (In pediatric residency, we had the opportunity to “taste test” about 20 different medications commonly prescribed, so we understand exactly what the children’s medications taste like.) In lieu of this, our hematology clinic offers iron infusions if deemed necessary. Warning, even taking a daily over the counter multivitamin will not prevent or treat anemia in a picky eater, as most vitamins do not contain iron.

 Talk with your pediatrician if you are concerned your child may be anemic, especially out of the 12-15 month age range when they are usually checked.

 COVID-19 has brought about many challenges over the past two years, one of which is worsening mental health crisis. Last school year, with many children and teens being taught virtually from home and socially isolated, depression and anxiety increased significantly. Your pediatrician could be the right person to help manage your child’s mental health needs, but if necessary, can refer to the proper mental health professional.

 Evaluating and treating mental health conditions, such as ADHD, autism, depression and anxiety, is one of my soapboxes. Treating a patient for ADHD, for instance, is just as important as treating any medical health condition. Just like I believe it’s important to treat some ear infections with antibiotics, or some asthmatics with an inhaler, I think it’s equally important to address the need for medications for some kids with ADHD. Usually for a child with untreated ADHD, it is not just poor school performance that is the issue. Often, they lack social skills, have difficulty maintaining friendships due to immaturity, have poor self-confidence, and have strained relationships with parents and siblings. They DESERVE the right treatment, whether that is therapy, medication, or a combination of both. This is a group effort. As the parent and as the pediatrician, we have a common goal of supporting your child to be the best that they can be.

 At every well child visit starting at age 11, we give the patient a depression questionnaire. This is a good starting place to bring up feelings of being down or having anxiety in a teen who doesn’t express his or her feelings openly at home. Additionally, if you or your pediatrician thinks the child may have ADHD, screening questionnaires called Vanderbilts are two page forms for both the parent and the teacher to fill out, and will help the pediatrician determine if your child has ADHD, oppositional behavior disorder, conduct disorder, anxiety or depression symptoms as well.

 Medications to treat ADHD, depression and anxiety could come with side effects, so schedule an appointment to discuss with your pediatrician in detail. ADHD and depression medications work differently in each person, and can take more trial and error than an antibiotic for instance. Your pediatrician should know their limitations as well, and for me, after the patient has tried and failed my third prescribed ADHD medication, I will refer to a psychiatrist.

 Regarding therapy, the best place to start is with the insurance holder’s Employee Assistance Program (EAP), a benefit often listed next to medical and dental information. The EAP often covers a limited number of insurance paid therapy visits for the teenager, usually six sessions.

 So if you are concerned about any mental health condition in your child or teen, your first (and maybe last) stop should be your pediatrician’s office. Give them a call and schedule today, and see what improvements you can achieve together.

I own a 70-pound pitbull/boxer rescue dog. He is a giant baby, a cuddle bug, and a momma’s boy. He is scared of thunderstorms, the ice cream truck, new people and places. He loves doggie daycare and salmon jerky. As precious as he is, I keep a very close eye when he’s around children.

Part of your responsibility as a parent is to teach your young children safety around dogs. Any breed can be great around children, and any breed can be bad around children. Any dog breed can bite. The most common victims are children who are bitten by a family pet. A literature search from 1970 to the present found the top reason for a dog to bite is when a child is teasing the dog. This includes grabbing at the dog, pulling his tail, tugging his hair, yanking a paw, or climbing on him. The top breeds associated with dog bites documented in medical records are “unknown” (often these are smaller dogs such as Chihuahuas), followed by pitbull, mixed breed, German shepherd, terrier and rottweiler. It is more the temperament of a dog than the breed that can lead to a bite.

The circumstances that cause a breed to bite include the behavior of the victim, parents, and dog owner. Dogs don’t bite “out of the blue”, many bites could be prevented if people learn to read dog’s body language. A happy dog will wag its tail and his whole body will join in on the “happy dance.” A dog who is about to bite will have its tail sticking straight up and moving quickly back and forth, have a rigid body, and can growl. The dog could alternatively look fearful with tucked tail, cowered body, repeated yawning and averting your gaze.

Teach your children to ask the dog’s owner if they can approach, and if told no, do NOT go near the dog. This includes innocent appearing family pets. Older dogs may have reduced hearing and vision, and could be startled if an unfamiliar family member, especially a young child, starts to run up to them and attempt to “play”. Small children have unpredictable movements and make weird noises, which can startle a dog and cause them to react. Do not take food, water or toys away from the dog, and do not tease them in any way. Give respect to your pet.

Any breed can become your family pet. Patience and training are key when introducing a new dog to the family. ALWAYS watch your small children around any dog, and teach them to not tease or corner any dog. These strategies should enable you to have only happy memories with man’s best friend.

These are general recommendations for healthy eating and lifestyle habits I recommended to all patients in the B.C. era (Before Coronavirus). They are still appropriate today, with a few other recommendations listed below. I advise to have at least one hour of physical activity daily. Limit screen time to less than two hours per day. You must eat five servings of fruits and vegetables daily. No sugary drinks, including juice and soda. Highly limit fast food, fried food, and junk food. Limit simple carbohydrates, add more complex carbohydrates (brown rice, wheat bread and pastas) and lean proteins (chicken, fish, ground turkey).

What to do if your child refuses to eat their vegetables? Here’s Dr. Bailey’s rule: if your child refuses to eat the vegetable on their dinner plate, no muss, no fuss and no cuss - just take away all screen time for the next 24 hours. No TV, no video games, no phone, no computer (aside from school assignments). They will think their life is over, and will re-consider eating their six bites of vegetables the next night, I guarantee.

Here are ways to add/hide vegetables into other foods: mix 50/50 cauliflower rice with brown rice, add a can of pureed pumpkin or puree a zucchini into spaghetti sauce and soups, make healthy smoothies containing plain Greek yogurt, berries, spinach, flax and/or chia seeds, honey, and 2% or soy milk.

Before COVID-19 and quarantine, I gave the above advice to patients and parents. I write this now, understanding that times have momentarily changed for all of us. Recent studies have shown that children are eating one extra meal per day and getting four to five additional hours of screen time (video games, tv, smart phones) every day, over and beyond what they were doing one year ago. I saw one teenager a few months ago whose phone was logging an average of 13 hours of screen time daily!!

Additional bits of advice in the age of COVID and limited social interaction: increase daily physical activity to two to three hours per day. Take family walks. Read every day, find a good age appropriate book series for each child. The library is open and they even make it easier with curbside pickup and drop off. Get in the kitchen: make use of your child’s five hours a day on their phone and let them research new healthy recipes. I suggest each child over age 7 is responsible for prepping and making dinner once a week, under parent supervision, especially when using a knife or cooking on the stovetop. The rule is you must serve a green or orange vegetable, and everyone must eat what is served. Kids get control one night a week and take an active role in family dinners. They’re more likely to eat what is served to them if they require everyone to eat their served food too. And lastly, cut yourself some slack. We don’t have to have Pinterest-worthy dinners and activities every day. Do your best to provide ideas for good physical activity and nutritious meals, and try to limit couch potato time.

Poop jokes are not my favorite kind of jokes. But they are a solid number two!!

Joking aside, constipation can be a major pain in the behind. I just can’t stop myself!

Let’s get down to business. Constipation is NOT HOW OFTEN you go, but what it looks like WHEN you go. I have infant patients who only poop every 8-10 days, and what comes out when they finally poop is a volcanic explosion of the normal newborn yellow, seedy stools. Children can have vastly different pooping patterns, some poop three times a day, others poop once a week, and that is their own normal pattern. However, hard to pass, rabbit pellet or large hard balls of stool are never normal. “Normal” stools are Type 3 and Type 4 on the Bristol stool scale.

That’s right, enjoy the pictures of poop while you’re perusing this article during your lunch break; the things we do for our kids is special, right?!

Constipation is usually diet-related due to picky eaters. Favorite foods of toddlers and children that can worsen constipation include: bananas, sweet potatoes, milk, cheese, crackers, bread, pasta, and cookies. You can add a few things into your child’s diet to help relieve the hard stools: yogurt, probiotic, fiber gummies, flax and chia seeds, plenty of water (six or more cups per day for elementary age and older) and eating high fiber fruits and vegetables (think celery, spinach, apples with skin, berries). Also, a sedentary body will be more prone to constipation, so get up and get at least 1 hour of strenuous physical activity daily.

After making dietary changes, the treatment of constipation depends on the age of your child.

For infants who are solely on breastmilk and/or formula and truly are constipated, you can help facilitate a stool by checking his or her rectal temperature, or massaging the tummy in a clockwise motion.

For infants older than 6 months who have started pureed foods, remember the “p” foods help you poop: pears, peaches, prunes. So offer “p” fruit jars and a variety of green vegetables. You can also give 2-4 ounces of an electrolyte solution, such as Pedialyte, per day to add more fluids into the gut.

For toddlers, elementary age and beyond, discuss with your doctor if medication can be helpful. Over-the-counter stool softeners, such as Miralax, used short term can add fiber bulking to the stool and start allowing it to pass more comfortably. Give this a few days to work, it is not a magic quick fix as it is not a laxative. Your doctor may consider prescribing a laxative medication (I sometimes prescribe lactulose for my patients) if his or her symptoms warrant its use.

There are several medical reasons why your child may be constipated, so a problematic pooper is precisely a proper purpose to pop it to your pediatrician.

Well, we made it to December. What a year! Ups and downs, good and bad.It’s nearly the end of 2020. After a more casual and calm Thanksgiving, it’s now time to gear up for all the December celebrations including Hanukkah, Christmas, Kwanzaa and New Year’s Eve.

It’s a magical time and can still be magical even if we have to celebrate in a different way this year. I really want to stress how important it is to just stay at home with only your family unit. Rethink those travel plans; you can instead Zoom and FaceTime extended family members. Don’t get mask fatigue, continue to wear it properly anytime you leave the house. Get some cute matching holiday themed mask patterns and keep the kids interested in them. Buy pine tree or gingerbread soaps and make hand washing a delight to your senses.

Allow time this Christmas and holiday season for a little more down time, less stress, and just be present with your core family unit. No need to make another large meal; change it up with Christmas brunch, enchiladas, or home made pizzas. I think I’m making brunch!

Ideas for kid-friendly activities:

1. Snowball fight: even if it’s not a White Christmas here in North Texas, crumble up paper or empty out the sock drawer!
2. Bake and decorate Christmas cookies and be ready for sugar overload.
3. Board games: bring out the old favorites and play several rounds of age-appropriate games.
4. Christmas movie marathon!
5. Get active outside. Even if it’s brisk, put on that winter-weather gear and walk the dog, take a family bike ride, or play flag football.
6. Go on a drive around the neighborhood to look at Christmas lights.
7. Enjoy a concert at home: many cultural centers now offer live-streamed concerts in the comfort of your home. Check into your favorite or even a new cultural event.
8. Reverse presents: have the kids clean out their toy boxes and drop off at a local donation center.
9. Make Christmas cards and drop off at nursing homes or assisted-living centers, to residents who likely will not see their own families for a big Christmas celebration.
10. Put on a fashion show! Pull out your old prom dress, dance costumes, or letterman’s jacket and let the kiddos take turns in mommy’s and daddy’s clothes. Tell them the story of the clothing item and why it’s so special.
11. Lights out! Sit in only the light from the decorated tree, candles, and fireplace, and read Christmas books together.

This year is one for the record books. Let’s do our part to give our children some happy memories this holiday season. It will put a smile on your face too.

First of all, families need to discuss risks and benefits of traveling by car or plane. I understand the desire to see your grandparents at Thanksgiving and Christmas. My own Grandma is in an assisted living center and I have had very little contact with her over the past six months. We don’t want our relatives to spend the holidays alone, but we also don’t want to put them in any unnecessary risk. So, do we stay or do we go?? There is no “correct” answer to that question. We want to cherish time with our relatives, especially the elderly ones, but need to be cautious if visiting older or immunocompromised family members.

If you choose not to travel, having a small intimate family holiday will be a nice change from the normal, sometimes stressful, celebration. You can FaceTime or Zoom other family members and still be engaged at mealtime, present opening, cooking favorite recipes, and even coordinate games together. Technology affords us the opportunity to stay close, even when we’re far away.

Ideas for a socially-distanced holiday:

• Cook a family recipe and host a contest on who nailed it the best: presentation, taste, closeness to “how Grandma makes it.”
• Gingerbread house decorating contest.
• Play games: My family was laughing so hard we couldn’t speak when we played the Heads Up! game on our phones last year. Grandma nearly peed herself laughing when her clue was “monkey” and all adults ran around the kitchen acting like crazy animals at the zoo!
• Make a shared album for photos/ videos and upload pictures daily for the rest of the family to see and enjoy.
• Purchase themed family pajamas and put on a fashion show.
• Holiday light or tree decorating contest.
• Scavenger hunt/treasure map.

If you choose to travel, I recommend smaller groups visiting older or immune compromised family members. This is not the best year for a 50 person family reunion. Stay in the largest home available and spread out. Wear a mask for close contact inside and when cooking. Wash hands more frequently. Weather permitting, eat and socialize outside. Who wouldn’t love making s’mores in a fire pit?!

Ideas for safe traveling during the holidays:

• When driving: many fast food restaurants do not allow customers inside for potty stops, so be mindful to stop at rest stops or gas stations. Wear your mask inside, wash your hands very well, and have hand sanitizer in the car. Pack snacks and drinks and limit unnecessary pit stops.
• If travelling by plane: pick the first flight of the day when the plane is the “cleanest.” Pack plenty of snacks so you don’t need to purchase in the airport; I advise fruit & veggie squeeze packs, trail mix, crackers, cereal bars, practically enough to be a mini meal if needed. Use antibacterial wipes and hand sanitizer often. Keep your mask on the entire time you are in the airport and on the plane.

In this unprecedented year, holidays may look different. Decide on what will work best for your family this season and be safe no matter what you choose.

It’s a common question to ask your pediatrician. "What is the daily calorie need of your infant or child?"

Here’s a chart that covers the normal daily calorie need to sustain healthy growth. Average weight and lengths are listed for reference for infants. Base the calorie needs of your growing infant more off of their weight and height, rather than their age, until age 2. Also listed is the approximate number of ounces of breastmilk or formula your infant should consume to obtain the daily necessary calories (for a solely breastfed or formula fed infant, it does not take into account the calories from pureed baby foods).

These daily calorie counts are a general guideline, but other factors such as chronic medical conditions, medications, and extreme physical activity can change what your child actually requires in a day. If you are concerned your child is not eating enough, or is eating too many calories in a day, schedule an appointment with your pediatrician.

Your child has ADHD, and you’ve gone through testing, 504 plans, in school accommodations, trialing of different medications and dosages. Now what?

ADHD is a difficult condition to treat because treatment has to be tailored to each child. Standard stimulant medications such as Adderall and non-stimulant medications such as guanfacine (Intuniv) do a good job, but what else can you as the parent do to optimize your child’s ADHD treatment?

Behavior therapy by a licensed psychiatrist or psychologist can be very helpful, and they often will have an option for parent training too. Parent training focuses on age and developmentally appropriate behavior expectations, and giving clear commands/ rules rather than a general “behave” or “be good.” Behavior therapy can also be offered to your child one-on-one or in small groups, but is more effective when the parents are involved in sessions.

Children, especially those with ADHD, live in the moment. I recommend a reward chart calendar with stickers given for good behavior and accomplished chores, a daily visible reminder and source of accountability. At the end of the week, review the chart together and only give the small reward (i.e. a Sno-Cone) for a complete week of good behavior. If your child had several days at school of poor behavior notes, no prize should be given that week. Praise good behaviors when they occur, “You’re playing so nice with your brother right now” or “I am proud of you for sharing your toys”, that way your child hears and acknowledges what behaviors you want them to continue.

You also need to appropriately discipline your child. Again, age and developmental ability is key. No 6 year old boy, ADHD or not, can be expected to sit still for eight hours in a row. Children need plenty of physical activity and brain breaks. Find what discipline works for your child. For some, time outs and calm down techniques do the trick, others need electronics or favorite toys taken away for the day.

Regarding discipline: you will NOT irrevocably damage your child by disciplining them. They can be told NO and turn out just fine. They can be punished by time outs or however you deem is necessary and still be fine. The American Academy of Pediatrics offers good advice on the best ways to discipline a child.

Raising children is HARD. Raising a child with ADHD can be harder. When a child misbehaves, respond calmly and clearly. Hold your hands tightly behind your back, bend down to the child, speak in a low and authoritative tone, and let them know that behavior is unacceptable. Then turn away, no attention is given to a poor behavior. I have so much respect for the parent of the screaming child on the floor of Walmart who will not give in to their child’s demand, compared to the parent or grandparent who silences the child by giving the desired treat. What does a child learn from that? Answer: throw a big enough fit and I’ll get whatever I want. This is NOT what we want, the child cannot be the one in control!

After they are settled down from the tantrum, now is the time for a conversation on what wrong they did, their feelings in that moment, and let them brainstorm on how to not duplicate the bad behavior. Now time for the punishment- i.e. put away the toy out of reach but NOT out of sight if the poor behavior was throwing that toy at their brother, or saying I’m sorry and being grounded from an upcoming activity for sass-mouthing mom. Again, point out times the child is acting well so they don’t feel like the only time they’re getting feedback is for naughty behaviors.

Other tips for parents: Create a routine and try to stick to it daily. Limit choices so they still can assert some independence, but not be overstimulated (i.e. choose this outfit or that one, or between two vegetables at dinner). Limit distractions during homework time, but know that some children concentrate better with white noise (i.e. classical music) or when they are moving (i.e. under desk cycle). Be clear, specific and brief when giving directions. Help your child get organized and put their backpack, shoes, etc in the same place every day. Create opportunities for positive feedback, whether from sports, art, or music, find something where they feel good about themselves and watch their self-confidence grow!

In the classroom, busy bodies with hyperactivity need special non-distracting accommodations to better their attention and to not be disruptive. I recommend a balance ball chair, or under desk cycle to allow for muscle movement without constantly jumping out of one’s chair. Give your child’s hands something to touch (not those fidget spinners!). I suggest taping both sides of Velcro strips under the desk to allow for the tactile stimulation that these kiddos crave.

There is evidence that the brains of children with ADHD are deficient in certain kinds of omega-3 fats. I like the Smarty Pants brand of kid’s vitamins that contain omega 3 along with a complete multi-vitamin.

Also, caffeine can HELP your child to FOCUS and be more CALM. I know. This seems counterintuitive! But think of how a stimulant medication works: the same way caffeine does, it balances what brain chemical is low and instead of the brain over-reacting and creating too high of levels causing hyperactivity, the brain can “relax”. I don’t like the thought of children drinking sodas on a daily basis, but allowing a mini can of caffeinated beverage at breakfast for a struggling ADHD child can be of big benefit, just make sure they brush their teeth very well afterward.

Continuing the topic of food/ drinks and ADHD, some children are highly sensitive to processed foods and/or food dyes. Red dye 40, among other artificial dyes, is known to worsen behavior issues. As we should anyway, eat more whole fruits and vegetables, lean proteins and whole grains. Limit or eliminate highly processed, sugary, and dyed junk foods and snacks. This includes breakfast cereals: Lucky Charms, Fruit Loops, Cap’n Crunch and Apple Jacks are full of food coloring. Cheerios (plain and many of their varieties), Trix, Cocoa Puffs, Reese’s Puffs, and Golden Grahams are free of artificial coloring and have no high fructose corn syrup. Start looking at the ingredient list of any packaged item you buy, from cake mix to jello, to ketchup and popsicles- try to find a “natural”, “no artificial dyes or ingredients” version.

There is so much that goes into optimal management of your child’s ADHD. Talk with your Pediatrician about where to start. Talk to them again when you’re stuck in a rut and need to know what else can be done.

Is it necessary to get a sports physical this year?

After all, are we even going to have sports this year? Plus, in the age of COVID, you may feel hesitant to bring your child to a pediatrician’s office right now.

I understand your concern about going to a doctor’s office, but I promise it’s never been a better time to be seen! We have increased our cleaning protocol, which was already great, in the office and we want you to rest assure we have a clean and safe environment for you and your child.

So to answer your question in short, YES. Let’s take a look at why a sports physical is so important.

Not only is a yearly sports physical required by the school district to be cleared for sports, going to your pediatrician for a yearly well check-up is vital to the health of your child. At a wellness visit, we review growth and development, catch up on vaccines, address any concerns from the child or parent, as well as perform a complete physical exam. We also assess vision, hearing and order any labs or imaging deemed necessary.

It is far better to obtain your child’s sports physical from board-certified pediatricians, such as a Cook Children’s physician, who perform a complete well child checklist. Specific to the sports physical component, we take a heart history of the patient and family and check from head to toe for any joint or muscle issues. So even if your child’s sport gets postponed or canceled because of our current pandemic, this is a great way to evaluate the health of your young athlete.

In 2019, over 495,000 boys and 330,000 girls participated in high school athletics in Texas. Participating in sports is a great way for your child to remain physically active. Healthy bodies fight off infections such as COVID-19 better. We recommend at least one hour of strenuous physical activity daily (this means the heart is pumping hard, and you’re breaking a sweat!).

During the sports physical/ well check, we are making sure the heart is capable to handle this elevated level of activity. One specific condition we evaluate for during a sports physical is a potentially fatal heart condition called HOCM (hypertrophic obstructive cardiomyopathy) that has been found to occur in 1 out of every 500 adults, and can cause sudden cardiac death in young athletes. Your pediatrician will evaluate if your child has an increased risk of HOCM, and we can refer him or her to a Cook Children’s cardiologist for timely assessment. If you’ve ever heard Cook Children’s referred to as a system, this is where it comes in handy. Your pediatrician actually works with the cardiologist to provide history and get your child seen quickly.

Heart ailments and many other diseases can be evaluated at your sports physical. Please call your pediatrician today and schedule your child’s sports physical. School starts in less than three weeks!

Citations:

Raj MA, Bansal P, Goyal A. Hypertrophic Obstructive Cardiomyopathy. [Updated 2020 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430820/

Number of participants in high school athletic programs in Texas 2009-2019

Published by Christina Gough, Aug 30, 2019