No doubt – the HPV vaccine (Gardasil) is the vaccine I hear the most hesitancy about. And yet I convince parents each and every day to get it – with patience, understanding, and some awesome, strong evidence that it works and is safe.

Little background: HPV (Human Papilloma Virus) is a nasty little virus that you get from other people – through intercourse, oral sex, or just heavy “making out” (yes: kissing can spread HPV).

The CDC states that at least 75% of the reproductive-age population has been exposed to HPV!

HPV lays dormant in most people, but sometimes it causes growth. Sometimes, uncontrolled growth.

Uncontrolled growth = cancer. Cancers of the cervix, vagina, anus, mouth, throat, head and neck in women and men. It also causes anogenital warts. Fun times.

HPV is one of the main reasons women get Pap smears – to see if this virus is causing trouble.

“The HPV vaccine? Isn’t that the new one? It seems like it hasn’t been out very long.”

• The first HPV vaccines were released in 2006.  That’s almost 17 years ago! 17 YEARS!
• The updated version (from the 4-strain to the 9-strain) came out in 2014. 9 years ago!
• It ain’t new! It’s been used for almost two decades and has been given safely to over 270 million people across the world!

“Isn’t this a little early to get a vaccine for something that’s transmitted through sex? My kids aren’t having sex.”

• The vaccine works BETTER when you are YOUNGER. Your immune system is SMARTER when you’re younger, and holds onto the “information” for longer periods of time!
• As evidence of this, you only need two shots if you get the series before age 15. After age 15, you need three shots.
• It is devastating to think about – but why not protect our kids from things that are out of our (and their) control as well? What if something happened to them, like sexual abuse?

“Are there any bad side effects or reactions to this vaccine?”

• In my 12 years of practice as a general pediatrician, I have never seen a severe reaction to an HPV vaccine.
• A sore arm, dizziness, and fainting can be common 15 minutes following the vaccine, so we often will watch them in the office for a while after they get the shot.

“Does it work?”

• Heck yes, it does. Like, really well. Better than most vaccines, actually.
• The longest studies done on these vaccines are at 10+ years, and they seem to be between 90-97% effective at preventing these cancers and warts.
• There is evidence nearly 99.9% of people who get the shot create some form of antibody to the virus.

“Why should boys get this vaccine?”

• Boys give HPV to girls. And vice versa.
• Boys can get anal cancer, anogenital warts, oral cancer, and throat cancer from this virus.

“Why should I believe you about all this? The internet says I shouldn’t get this vaccine.”

You don’t have to believe me. Though I am a pediatrician who has given thousands of HPV vaccines in my practice.  It’s OK. I know some vaccines just seem plain ole scary.

Maybe believe my cousin, though? She’s a cancer doctor. A gynecologic oncologist, to be exact. And what virus does she spend all day battling in order to save the lives of women? HPV.

My cousin is Mae Zakhour, and she practices gynecologic oncology at Spectrum Health Medical Center in Grand Rapids, MI. She treats HPV cancers in women, daily - some as young as 25!

Her exact words to me – to share with you – are:

“Timely HPV vaccination is the safest and most effective way to prevent cervical cancer and other HPV-related diseases. As a gynecologic oncologist, I see and treat young women with cervical cancer on a weekly basis, and even for those in whom cure is a possibility, it comes with a cost.

The treatment for cervical cancer, > 95% of which are caused by HPV, can have devastating effects on a woman’s fertility and quality of life. I want to do everything possible to prevent that for my children. They are getting the HPV vaccine.”

So there you have it. Two moms, who also happen to be doctors, sharing information with you to help you make a very important decision for your child.

And both letting you know we’re getting our kids vaccinated for HPV at age 9 without hesitation!

It’s normal to be nervous about vaccines. What I hope you take from this is more confidence in the HPV vaccine - by knowing it’s super safe, it’s been out a long time, it’s super effective, and it’s super important.

RELATED: New Study Says Boys Less Likely to be offered HPV vaccination (checkupnewsroom.com)

Vaccine and Immunization (cookchildrens.org)

‘We Have a Vaccine That Can Prevent Cancer' (checkupnewsroom.com)

Texas Ranks Near Last in HPV Vaccination Rate (checkupnewsroom.com)

At my house, the 4- and 6-year-old natives are growing restless. The backyard isn’t cutting it anymore, biking up and down the street is growing old, and running around in the sprinkler now holds as much joy as a root canal. The parks are calling our name.

But is it safe?

Let me let you in on a little secret – there’s so much we still don’t know about this virus.

And by “don’t know” I mean, there are no great, large, long-term studies about the virus out there. My guidance for you is, at best….educated guessing. So bear with me.

In my office, I’m constantly asked “well….what are YOU doing with YOUR family, Dr. Diane?”

Well, I’ve read a lot. And it seems like the conditions ripest for catching the virus are in enclosed spaces with a large number of unmasked people, within areas of poor ventilation.

So…playgrounds and parks seem low risk. With some planning.

What is my family doing?

1. We have a heart-to-heart each and every time we go. If a playground has more than 1-2 families presently playing, we will try again later, or try a different park. My kids no longer melt down if a park is too full; it’s part of the game plan to be as safe as possible. They know this is part of the deal.
2. Also – we talk about keeping distance from other families. The CDC recommends keeping 6 feet between households if possible. In most playgrounds this is feasible, if not too many folks are there. My kids have adapted to the idea of “well, the swings are full, so it’s see-saw time until that family is done using the swings!”
3. This may not be easy for little ones, like those under age 3, so it’s important to watch over your kids and gently guide their curiosity to other parts of the park if they seem to drift towards new friends.
4. The CDC says if you can’t keep 6 feet of distance between your family and another, to wear masks if over age 2. In the Texas heat, my kids just wouldn’t be able to deal with this. Also, I’m just not comfortable with crowded parks yet. So we leave the playground if lots of people arrive – and again, that’s part of the heart-to-heart talk we have before we go.
5. We pee before we go. Using public restrooms ups your risk. If you have to use them, wash hands thoroughly afterwards.
6. Some news sources are telling you to “wipe down surfaces before your kid plays on it." I feel like park time is so chaotic, this would be really difficult for me to do. Constant movement and large playground pieces make me feel like this is near impossible. Studies show that the virus can live anywhere from 5 hours to 3 days on metals, which is worrisome, but the virus degrades pretty quickly on hot surfaces (thank you Texas sun). I think if you have wipes and your child is super focused on a favorite piece of playground equipment, absolutely, wipe away. But I think handwashing at the end of your trip is more important.
7. I keep hand sanitizer in my car and we use it the moment we get in. We also wash our hands thoroughly once we get home for at least 20 seconds.

I know it’s sad to think of all this THINKING for something as simple as a trip to the playground. But it won’t be this way forever, you guys. Being careful like this buys us time, resources, education, medications, and possibly a vaccine soon. It’s not forever – but why not keep things as safe as possible in these uncertain times?

Get outside and enjoy this summer safely.

Dr. Diane

Related Stories:

• Cook Children’s Physicians Create Guide to Help Kids Safely Return to School amid COVID-19 Pandemic
• Should My Chld Go To Summer Camp?
• When Can My Child Start Playing Sports Again?
• Should I Take My Child To Daycare?
• Helping Families Manage COVID-19 Stress

What The Flu Is

The flu is a respiratory illness.

The flu happens every year. It hits hard from December through March (and other months, but those primarily). There are deaths every year. Kids, healthy people, old people, babies and folks with chronic illness die every year. This year we're trending lower at Cook Children's than in previous seasons. I really, really, really hope it stays that way.

Overall, remember that the flu is usually a "mild" illness (I mean, you feel like you've been hit by a truck, but we call that "mild" in medicine, ha).

It hits fast and fevers can go high, which is worrisome. But with a lot of rest, fluids, pain and fever reducers, things usually get better after 3-5 days. The cough and congestion can last for 2 weeks.

Sometimes, rarely, it can get bad. Really bad. The flu can cause: Pneumonia. Sinusitis. Ear infections. Brain inflammation (encephalitis). Heart inflammation (myocarditis). Asthma attacks in asthmatics. Death. That escalated quickly.

You hear us talk a lot about Flu A and Flu B. They are just two different strains of influenza. They are the two types that circulate the globe each year. In the states, Flu A usually arrives first and in general is considered the more severe strain. But overall, there is little difference in how they present clinically and we can’t really tell them apart without a flu test.

What The Flu Isn’t

The flu is not a stomach bug. There is no "stomach flu." That's called gastroenteritis. Your child is throwing up, but doesn't have a runny nose or cough? It's not the flu.

How Do You Prevent The Flu?

Scared to vaccinate? Hear stories? Hate shots? Have an uncle who loves to talk up a good conspiracy theory? Know this: some years, you can still get the flu even if you get the flu vaccine. It depends on how well we predict what strains of the flu will be circulating the globe that year. And some years, it's not a good match.

BUT it's usually milder, if you do get it. It GREATLY reduces your chance for hospitalization and death. I get it every year for my kids and my family. If you ask any pediatrician or ICU doc what viruses put fear into their hearts, I'll bet you influenza tops that list. I always tell my patients, even if it’s a "bad match" year, isn't a 30 percent effective seatbelt better than no seatbelt at all?

We can't know how good of a match the vaccine was until the flu season is over in April. So ignore the dramatic news reports.

Tamiflu can help make it less severe sometimes, for some people.

WASH YOUR HANDS! The flu can live on some surfaces up to 24 hours in cold weather! Think about all those door handles you touch! The cash you get handed back from the cashier! The snot that flies from every person's sneeze can cover a 6 foot radius around them! Wash. Those. Hands!

How Long Are You Contagious?

You are contagious with the flu 1-2 days BEFORE you start showing symptoms. How sneaky is that?

You are contagious 5-7 days after you start to show symptoms. Your KIDS can be contagious up to 10 DAYS after they start to show symptoms.

You should keep your kids out of school for at LEAST 24 hours after their last fever. This means fever without the use of meds to keep it down. If it's financially feasible for you, I'd even try to keep your kids out at least 7 days after the first symptoms start.

When Should You Worry?

Call us (or your pediatrician) anytime if you're worried about the flu. We can walk you through what is normal and what isn't.

These are the reasons to worry:

• Fast breathing or trouble breathing
• Bluish skin color
• Not drinking enough fluids
• Not waking up or not interacting
• Being so irritable that the child does not want to be held
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion
• Severe or persistent vomiting
• Flu-like symptoms that improve but then return with fever and worse cough

Stay Healthy Friends,

Dr. Diane

To Learn more about this topic:

• Infuenza/Flu Information
• Is It a Cold or the Flu?
• Pediatricians Say Kids with Egg Allergies Should Now Get The Flu Shot

Let me be real for a second – it’s been a pain in the you-know-what. We’re updating, changing, training, stressing. I may or may not have purchased more wine this month than usual.

Why are we doing this?

Because it’s better. It’s faster, more efficient, more organized, and SAFER than our old systems.

We are doing it because it will lead to better overall care for your child.

I’m actually really excited about it. As a pediatrician, my days revolve around a computer. Many of you may notice I always bring a computer into the room with me. I show you how your kiddo has grown. I take notes to remember important things you tell me. I look up what happened in the hospital when you went to the Cook Children’s ER. I read that consult note from when your child saw the ENT.

The way I do those things will be changing.

Things will be new and glitchy at first – just like any big change is -- but overall, the improvements in your child’s care will be awesome.

But… what does all of this mean for you and your children?

It means that, for a little while, you might experience a bit of a longer wait in the pediatrician’s waiting room, or urgent care, or ER as we learn to use the system.

You might experience slightly longer hold times on our phones while my staff is figuring out how best to schedule your kiddo’s appointment.

Our front desk people have to get used to the changes in booking appointments, changing charts, and updating your insurance information. Don’t worry, it’ll speed up with time.

Our nurses might need a little extra time to type in what medications your child is on, their medical history, and your concerns. Again – this’ll improve quickly.

It means that I, as your PCP, will be able to know every single thing that happened to your child in the hospital (as opposed to a tiny summary that doesn’t give me much information). Every single vital sign, oxygen reading, X-ray, lab result, consult note – I’ll have access to all of it! I may fumble around for the first few days when I try to show you things on my computer. Feel free to giggle at me.

It means that your child’s specialists and I will be able to communicate more effectively.

It means that YOU will have a new portal system called MyChart.

This thing is awesome!

• You’ll be able to look up your child’s vaccine records and print them, see summaries of all of our visits together, and ask me (and my staff) direct emailed questions!
• You can look up test results, see lab work, and find out when your next appointment is!
• Go to www.cookchildrens.org/mychart for more information - You can sign up now!
• It means that we will be SAFER – more safety checks on prescriptions, and constant updates to how we calculate and order things.
• It means it will be less of a hassle for us to get your child’s medical records from many hospitals around the country.

Bear with us, friends, as we embark on this new journey. I promise, it makes a difference in your child’s care.

And feel free to bring us some sympathy chocolate at the office on March 1st…. ;-)

It hasn't always been easy for us this year. At 4 a.m. or so during Thanksgiving, I heard the telltale "croup cough" coming from my daughter's monitor. It's such a scary sound - that weird bark coming from deep inside your child's chest. They panic, and you panic. They were fine earlier...now this? I took this photo of her at a golf course near our house a mere hours before bed.

The hoarse cry, the worry in her eyes, the sometimes high fever (hers was 102 and making her feel miserable), and a cough that rivals any seal's bellow. And it's always in the middle of the night. Why can't croup make its appearance at lunchtime? 

I remembered the most important thing to do is to keep her calm, and comfortable. The coughing, the gagging, the throat pain - croup is really mean.

I gave her a dose of Motrin, laid down in bed with her (for any of you who know me....you know this is waaay outta the norm for Dr. Diane, Captain Strict of Sleepland), ran my fingers through her curls, and propped her up on me to help her cough. In the morning, we will take a steamy shower with a bunch of toys, and take it easy.

Just a reminder that we are parents, too. We worry just as much as you do, and are losing just as much sleep But as my arm burned up with her fever heat, as my neck grew cramped from laying on 3 unicorns instead of my favorite pillow, I realized she won't always need me like this. In fact, one day, she'll probably kick me out of her room and tell me to leave her alone.

So I bent my pediatrician sleep rules a little bit. Parenting really turns you into a softie, doesn't it? 

Dr. Diane

We doctors call them "aphthous ulcers" because we cannot use names in medicine that are easily pronounceable. Come on.

That's one of the most common questions I get while doing my AMAs on our Willow Park Pediatrics Facebook page. 

The answer I give, most of the time, is - nothing.

Here's a few points about vitamins. Short and simple.

1. If your kiddo eats a well-rounded, healthy diet, they don't need a daily vitamin. This means meats, milk, veggies, fruits, and whole grains daily.
2. If your kiddo has a "bad day" - a.k.a. a chicken-nugget, mac-and-cheese kinda day, offer a simple chewable children's multivitamin that day.
3. Limit your child's milk intake to 20-24 ounces or less per day. While we love the calcium and Vitamin D in milk, it hinders the absorption of other vitamins, like iron, and fills kids up so they don't eat the other foods they are supposed to eat.
4. Large doses of certain vitamins can actually be harmful. Be careful of natural websites/naturopaths who claim "megadoses" of vitamins can cure ailments. Be especially careful with kids, as there is lacking research about this and some bad side effects can happen.
5. If your child is a vegan or a vegetarian, or allergic to milk, they need a daily vitamin. Talk to your pediatrician about this.
6. Certain medical conditions require vitamin supplementation. Think food allergies, GI tract disorders like celiac and Crohn's, and endocrinologic (hormone) problems. Talk to your doc.
7. Vitamins can have SIDE EFFECTS! Yes! Vitamins! For example, B vitamins are associated with night terrors and nightmares. Other vitamins can cause nausea, dizziness, vomiting, headaches. They're similar to medications, folks - yet not as strictly regulated by the FDA - and you have to be careful with them.

Cook Children's published a good article about vitamins a few years ago. Check it out!

Hugs,

Dr. Diane

About the Author

My son Jack marched up to me this morning and announced, "Mama, there's a raisin in my nose!"

And that sucker was pushed in real deep. 

I didn't have any of my fancy extraction tools at home to get it out, so I'm gonna let you in on a little secret I learned about in residency: the "Mother's Kiss." Google it. It's great for getting out small things wedged up your kid's nose.

You close the "open" nostril and blow into your child's mouth. The pressure pops the object right out. It needs to be the "force of a sneeze"... whatever that means.

It worked beautifully for me today. I actually changed it up a bit and closed his mouth while I blew into his "open" nostril (I know...the things we do for our children). I was able to blow it out just enough to reach in and grab it.

Hope this helps you in your time of crisis 

Hugs,Dr. Diane

Tetanus is a nervous system disorder that causes severe muscle spasms. It is caused when a spore that is in the soil, known as Clostridium tetani, gets into damaged skin. It will not grow in healthy tissues, which is why things such as splinters and other puncture wounds, burns, and certain fractures put the body at risk for it. Once inside the body it produces a toxin that irreversibly attaches to the spinal cord and brain stem, and after a few days the symptoms begin.

I can’t imagine many diseases that would make me feel more helpless than if I watched my child in the grips of tetanus. It starts with restlessness, sweating, and rapid heartbeat. Later it progresses to the inability to open the mouth due to muscle spasms (lock jaw). They have episodes of intense and painful contraction of muscles and intense muscle spasms that can be triggered by stimuli such as physical touch, light, or sound. It would be so terrible to try to comfort my child and triggering an episode of them arching their back, clenching their hands, straightening their legs, and holding their breath. The worst part is that there is no change in their awareness, they know it is happening, and they know that it hurts.

The muscles surrounding the throat and lungs can even stiffen to the point that they may need help breathing as well. They are usually monitored in the intensive care unit due to this, and also for the need to control pain.

An intensive care doctor told us the story of a young unvaccinated child with tetanus: “She was walking outside with her parents in a large field, and cut her foot on something. Soon after, she started having muscle spasms in her calves. They got more and more intense, so her parents brought her to the hospital.” The child ended up needing intensive treatment, including numerous rounds of painful treatment injections. The parents finally realized how important vaccination was when she was transferred to the ICU because there was concern she would need assistance with her breathing.

How long can the symptoms last? A long time. The toxin attaches to the nerve and requires the new nerve growth until symptoms resolve, usually around 4-6 weeks. The main treatment is trying to control the pain, and ensuring they continue to breathe.

The bad news is that we can’t eliminate the element in the soil that causes tetanus, and we certainly can’t protect our children from open wounds.

But we CAN give them a vaccination that can prevent this terrible disorder!

Related stories:

• The Flu Can Kill
• It's only the flu that killed her
• Chicken pox: Why We Vaccinate

About the author

Sperry Binnicker is a nurse practitioner at Willow Park. Sperry joined Cook Children's in 2009 in the Pediatric Intensive Care Unit (PICU). In that role, she earned the Daisy Award, an award given to a nurse that is nominated and selected by the parents of patients for excellence in patient care. She continued her education while working full time and received her master’s degree from the University of Texas at Arlington in May of 2015.She is a Board Certified Pediatric Nurse Practitioner and a member of the National Association of Pediatric Nurse Practitioners. Learn more about the Willow Park staff here.

Here’s the part where I am supposed to tell you about the 7-14 days of awful symptoms. Tell you that your body will feel like it is sinking into a deep hole. That your muscles will ache with every racking cough that escapes your body. That you will burn with high fevers for five days. That your head will feel like it’s exploding. That the drainage from your upper airways will puddle into your stomach, and that will make you barf. Sounds great, right? Well, you’ll get over it.

And you’ll slowly pick yourself back up. And eventually you will go back to work or school.

And you’ll tell yourself, “Geez…I am getting the flu shot from now on.” ;-)

But that’s not what I’m going to talk about. I’m going to speak for the thousands of people who no longer are able to speak about influenza. Because the flu can kill. And it has. 

Heck – there have been giant worldwide pandemics of the flu. The influenza pandemic of 1918-1919 killed more people than those that died in World War I - somewhere between 20 and 40 million people (though some sources list 50+ million). It has been cited as the most devastating epidemic in recorded world history.

The last flu pandemic we had was in 2009 (H1N1) and it killed over 200,000 people.

The flu is a “really really bad guy”, as my 2 year old likes to say. It’s super contagious (an infected sneeze or a cough a few feet away from you, and you’ll start to show symptoms within 4 days). It’s meanest to young children, older individuals (age 65+), pregnant women, and folks with underlying medical problems (think chronic lung problems like asthma, people with immune system dysfunction, diabetes, kidney disease, liver problems).

But let’s put all that aside. Let’s say you’re a healthy young person.

The flu can kill you, too. Or at least – make you really really really sick. Sicker than the majority of lucky souls who get away with the scenario in the opening paragraph.

I am a general pediatrician. During my training in medical school and residency I personally have taken care of:

• Countless cases of severe sinusitis, pneumonia, and ear infections due to getting the flu (which then makes kids susceptible to bacterial infections like these).
• A teen girl who was so sick with the flu that within 24 hours of catching it, she started urinating a brown substance. This substance was broken down muscle proteins. She was experiencing a well-known complication of the flu: rhabdomyolysis. Her muscles were literally breaking down and her kidneys were trying so hard to clear all the junk out that they eventually shut down. She needed dialysis. She spent 3 weeks in the hospital.
• A young pregnant woman contracted the flu while 29 weeks pregnant. The flu killed her in 24 hours due to respiratory distress (pneumonia) and her organs shut down. The woman birthed the baby while on life support and the child never knew his mother.
• A child with relatively mild asthma caught the flu, which made his asthma flare so bad that he required ventilation by a machine for over a week in the ICU. During that time, the flu made his body susceptible to other organisms, and he had to be treated for pneumonia and a blood infection called sepsis as well.
• In the PICU, I cared for a young boy who was, prior to the hospitalization, happy, vibrant, and healthy. There were pictures all over his ICU bed of him riding bikes and eating birthday cake. He caught influenza in school and within a few days it attacked his heart, causing something called myocarditis. The heart stopped beating as well as it usually does, and he needed full life support. That child eventually needed a heart transplant.

I want to say, “I’m not telling you these stories to scare you.” But I am. I want you to be scared of the flu. Because I’ve seen what it can do. And I don’t want that to happen to you or your family. Yes, the majority of the cases of the flu are mild. But sometimes, they aren’t.

The flu vaccine can help your body fight the flu. If you get the vaccine, our hope is that you or your child will either not suffer from any clinical symptoms, or develop an illness that is much milder than if you did not vaccinate. The vaccine was developed not only to save lives, but to prevent millions of days of missed school and missed work.

The people who are against vaccination will argue a couple of points I’d like to discuss:

• “The flu vaccine makes you sick.” – This is a common misconception. The flu vaccine can’t make you sick because it is either completely inactivated or it is not even the virus itself, but a protein that looks like the virus (tricking your body into making an army against it). Sometimes people get mild symptoms after the vaccine like a headache, general achiness, and a low-grade fever. People mistake this as being “the flu” when really it is their immune system generating antibodies and starting a great immune response. Also remember that the flu vaccine is usually given in the fall and winter, when tons of other respiratory viruses are circulating. Folks may catch those and the vaccine is usually blamed.
• “The flu vaccine doesn’t work”. – Actually, some years, this has been true for some people. The World Health Organization (WHO) recommendations are based on global surveillance of circulating influenza strains and on the effectiveness of the vaccine from the previous year. Sometimes they get it right. Sometimes they don’t. The flu is sneaky – It can mutate quickly. We don’t know until the flu season is in full swing. By that point, the vaccine has already been made and shipped out. So it’s important to get it every year regardless. And we hope for the best. Most years, it is right on target.

PLEASE consider yearly vaccination against influenza for yourself and those you love. The flu vaccine changes every year, so you need a new shot every year to boost your immunity against the strains we think will be the “bad guys” that year.

Related links:

• It's only the flu that killed her
• Chicken pox: Why We Vaccinate
• 4 Facts Parents Need To Know About the Flu

She is a sweet and happy baby who loves to babble ("mamama"... be still my heart!), pick up small toys and explore them slowly, play peek-a-boo, pick up her tiny foods with two fingers, point, laugh, and clap.

Things she cannot do? Crawl with her belly off the floor. Pull up to stand, or really put much weight on her legs at all. Shift from sitting to crawling to sitting again. Cruise along the furniture while holding onto it. She has delays in what we call “gross motor development” – the development of the “big movements.”

I see patients all the time at our Willow Park office that have gross motor delays, so I know not to worry. Lots of things can contribute to this. Sometimes it's just genetics. Sometimes it’s the baby's weight-to-height ratio. I notice that leaner, smaller kids tend to develop these movements faster, and bigger, longer kids sometimes need more time to build the strength to try these things. As you can see from the pictures, Abby has not missed any meals. There are exceptions to every rule of course, but I think this plays a role.

The baby’s temperament can also lead to delays. Some kids want to go go go...and some are completely fine with sitting still and working with what is in a close vicinity. Abby certainly fits into this latter scenario.

Of course there are numerous medical conditions that can cause motor delays. Always make sure, if your child has delays, to ask your pediatrician for a good neurological exam to check things like muscle tone.

Unfortunately, I believe what has played a big role in Abby’s delay is the amount of time she has spent in her favorite jumpers.

Baby jumpers, bouncers, exersaucers, and activity centers (they’re all basically the same thing) are stationary devices that allow a child to “stand” and bounce prior to developing those skills naturally. Kids love them because they’re fun and stimulating – most have toys and games attached – and they get to see more of the room and things going on around them, along with getting a chance to bounce up and down easily. Parents love them, because, let’s face it – they’re a quick and safe option for a break.

Baby walkers are similar – except they are on wheels so babies can bounce/pull themselves around the house. I have never owned one of these because they come with safety risks – children can fall down stairs, tip over, touch a hot stove, get pushed by siblings, pinch fingers, and slam into walls in these devices, and as fun as they seem, they’re not a good idea.

Around 4-5 months we started putting Abby in a jumper and she was thrilled! Finally she could be propped up and see everyone! She could control her body enough to bounce, and loved it. We were happy too, because we were constantly chasing her 2-year-old brother around, and it was nice to have a safe place to plop her down while that happened. Admittedly, it became a habit. When we’d read books, Abby would be propped up to be able to see the pictures. When we’d sing songs and play music with her big brother…Abby would get to howl and jump along in the bouncer. When we had to deal with the 2-year-old tantrums (and boy are those frequent)…in she went. Emptying groceries? Bouncer. Going to bathroom? Bouncer. Cooking dinner? Boom. Folding laundry? Ker-splat. She was probably in them a total of an hour to an hour and a half a day.

Looking back, she was in the bouncer way too much. Learn from my mistake, friends. Yes, pediatricians make mistakes.

Other doctors may think these things are harmless, but I respectfully disagree. Especially since I suspect my own child has likely been affected. Physical therapists have been warning parents for years about the problems with bouncers. And the more I’ve researched it, the more I’ve realized that too much time in these things can be detrimental to a child’s development.

I spoke with Gail Abaray, a pediatric physical therapist in Weatherford, who told me, "Bouncers don't allow infants to explore and move. They are limited in what they can do, and are stationary. And that pull to explore is so important. When they cruise the furniture, they learn about lateral movement, and how to turn their legs and feet. In a stationary bouncer, all of that coordination can't happen."

Look at the picture of Abby in her favorite bouncer. See how she’s on her tiptoes? This is typical and leads to the majority of the strength being recruited from her calves and thighs. What is not getting a workout is her hip, gluteal, pelvic and core muscles – and these are the ones that help children crawl and eventually walk.

Their hips are spread unnaturally wide by a piece of stiff fabric. They often lock their knees, especially the younger babies.

Babies cannot see their feet or the ground in these devices either – and thus cannot coordinate their body well in them.

Their upper bodies are also thrust forward – taking all the pressure/weight off their gluteal and hip muscles. The very muscles they need to strengthen.

The same things happen in walkers – babies are pulling themselves along while most of their weight is supported, and this works out and coordinates all the wrong muscles. They also can’t see the ground or their feet. “Walkers” are a true oxymoron here – they lead to delays in walking naturally.

So what do I recommend to parents now? Well…go buy a bouncer! They’re great! But – use them in moderation. Don’t put one in every room, like I did – it’ll only lead you to use them more. Use it only for very short periods of time – maybe 15 minutes here and there, once or twice a day – 20 or 30 minutes a day, max! Physical therapist Gail agrees: "I always tell parents not to feel guilty for using them. I did! But moderation is key!"

And avoid walkers in general. I am not convinced they’re safe or worth the money.

Don't feel guilty if you've put your baby in a bouncer - we all need breaks. And it's hard to deny they're so happy in them! But remember the big picture - kids need to learn to explore their environment on their own. It's vital to their development!

As for miss Abby-pants? Well, we got rid of all the bouncers and for the past month have set strict tummy time rules – she must work for toys on the floor for nearly the entire day, and must practice standing several times a day. She yells at me about it all day, but boy has this tough love helped. She has already shown vast improvements. She is now able to stand supporting herself on a piece of furniture, can quickly army crawl (using her arms mostly), and is starting to lift that big belly off the floor! We are also enlisting the help of a local pediatric physical therapist to help with some exercises and strategies. Slowly but surely, she’ll get there!

Hugs,

Dr. Diane

Constipation is the cause of alllllll the things. Just joking.

No, but really – it’s one of the most common things I see in my office at Willow Park, and it causes strange problems sometimes. Parents often don't believe me when I tell them it's constipation causing the problem. 

What is constipation? It doesn't necessarily mean your child isn't stooling daily. A kiddo can be constipated and poop many times a day. Constipation means hard, dry stools. They’re often painful to push out. And yes, most kids with constipation will go a few days between stools.

I really feel that constipation has become more prevalent over the years because of how our kids' diets have changed. In general, kids are eating less fresh fruits and veggies and depending more on packaged goods for snacks and meals. 

There are lots of medical causes for constipation as well. Did you know that hard poops can cause:

1. Stomach pain
2. Withholding of stool
3. Vomiting
4. Refusal to eat
5. New urinary accidents
6. Wetting the bed
7. Diarrhea
8. Poop accidents 
9. Blood in stools, blood in diaper
10. Fever (yes it can cause fever! mostly lowgrade)

Here's the deal - and let's get down and dirty about it. The things your kids eat affect the quality of their poop. If they eat and drink things that don't have much fiber (think cheese, yogurt, pastas, cookies, white bread, bananas, milk, goldfish crackers), their stools will be harder. 

Also, did you know our bodies absorb water out of our stools if we need it? So if your kiddo isn't drinking enough water, his body will just take it out of the poop, and it will become hard. 

The poop gathers at the “end of the tube” in a child’s body – the rectum and descending colon – and stretches everything out a lot. See the pic. This chronic distension leads to problems with the “valves” inside the rectum. Sometimes, this leads to leaking – soft stools can leak out without the child being able to control it. 

These big bulky stools can also push on neighboring organs, like the bladder, and even push urine out sometimes. And children with chronic constipation tend to develop poor control of their pelvic muscles and can lose control over their bladder, leading to leaking. One study showed that after being treated for constipation, 89% of 250 kids had complete resolution of their daytime wetting problems.

When the stools become hard, they hurt to push out. So kids don’t want to poop. So they hold it in. And the body slowly takes water out of it. And the stools get harder. And more difficult and painful to push out. Thus starts the painful cycle. 

Kids can get constipated anytime, but I find it’s most common 1) when babies start solid foods, 2) when kids start potty training, and 3) when kids start school.

So how do you fix the problem? Well, that depends on the severity of the problem and the age of the kiddo. But some general rules:

1. WATER. LOTS OF IT. Children and teens should drink at least 6 to 8 cups of water a day. 
2. Fresh fruits and veggies! I encourage kids to eat green veggies, prunes and other fruits (but not bananas), bran, whole grain bread. Sometimes those puree pouches with the kale, spinach, and broccoli are a good start for the picky kids.
3. Certain fruit juices – ok, we pediatricians are NOT big fans of juice. But I’ll make an exception in this case – go with prune, or pear.
4. Fiber supplements – flax seeds are great. Fiber gummies and cookies are good, too.
5. Behavioral and schedule changes – encourage a routine for “potty time”. 20-30 min after meals, have your kiddo sit on the toilet for 5 minutes. Encourage your child to listen to his body and stop playing when he feels the urge to “go” (and not hold it in). 
6. Do not punish your child, or get mad, if he has an accident (urine or stool) – remember, this isn’t under his control!
7. Avoid those foods I mentioned before for a few days – bananas, cheese, crackers, milk (if over age 1), breads, pastas.

If there is anything I can’t express enough to parents – it’s BE PATIENT! It takes many months for the intestines to stretch out and constipation to form in toddlers and children, and it takes many months (sometimes even years) to treat it. Sometimes we use safe laxatives or glycerin suppositories to help during the really rough patches – call or come visit us to talk more about that if you think its necessary. 

Hugs,Dr. Poop (er, Diane)