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)

August is National Breastfeeding Month.

And as much as I hate the word “journey,” allow me to tell you about my breastfeeding journey.

I figure there’s a lot of curiosity out there about a pediatrician’s breastfeeding experience. I mean I sit in my clinic rooms all day counseling about it, right? So surely it was an easy task for me? Surely I would sit in daily joyful motherhood bliss while my babe nursed happily with ease and comfort, right?

Heck. No.

In fact, I disliked a lot about breastfeeding. But I loved some of it, too.

(And guess what? GASP! This pediatrician used some formula, too! What? Did she say the F word?)

Before I gave birth to my first kid, I knew breastfeeding could be challenging for some moms. I didn’t worry or fret about it too much, though, because how hard could it be?

I mean, you just put the baby on the boob, right? I’m a pediatrician! I got this!

Ahahahahahahha.

My first kid refused to latch from day one. I worked with lactation consultants. I struggled with pain. I had his mouth anatomy evaluated (all was fine). I tried shields. I had supply issues. My kid screamed. Every. Nursing. Session. And I cried every nursing session. His reflux was constant and affected positioning, length of feeds, and general happiness.

My postpartum anxiety was vicious. And made everything probably 10 times worse than it already was.

So, I decided to pump. Exclusively.

And it was the hardest damned thing I’ve probably ever done.

It satiated my need for control in a situation where I felt I had no control. But it was hard. And mentally and physically exhausting.

I’d pump in my office many times a day, running late for patients and adding stress to an already stressful day. And while my also-pumping work partner would pull out 10 ounces at a time when she pumped during lunch with me, I’d get a measly 3 or 4.

And every day, I went into the bathroom and cried. What was wrong with me? Why was motherhood feeling so robotic and protocoled and cold? Why did I cry for 45 minutes if I spilled a bottle?

But I knew pumped milk was so beneficial to my baby. So I kept on going. For 6 months. Until my supply tanked because I couldn’t pump enough at work. So we used formula. And guess what? My baby survived. And I survived.

It took such a mental toll on me to not be able to breastfeed my child that when I was pregnant with my second, my husband and my mom both nervously asked me…”you have some cans of formula just in case…right?”

They asked me this out of the kindness of their hearts, and I responded with, “yep! In the closet!” because I too remembered the dark days. And I wanted the experience with my next baby to be different.

And it was different.

Guess who breastfed like a champ? My next kid.

And the breastfeeding experience was great. And flawless. And so easy. And tear-free.

I loved bonding with my child in this special way. I loved feeling like nutrition and protection were transferred to her from my body. I even loved the exhausting 3 am feeds.

So why tell you all this?

To let you know that every mother is different, just as every child is different.
To let you know you aren’t alone if you felt breastfeeding was a struggle you totally weren’t prepared for.
To let you know even the professionals are human, and struggle just as much as you do.
To let you know it is okay to both love and hate breastfeeding.
To let you know I (and any pediatrician) will never judge you for the choices you make in how you feed your child.

As your family travels to the beach this summer, remember to include health and safety measures to ensure you and your children have the best vacation possible. 

Sunscreen often comes to mind, however, there are some other precautions to consider. Cook Children’s Medical Advisor for Digital Health, Dr. Diane Arnaout, M.D., shared helpful tips when preparing for the beach. She sees a variety of beach-related medical conditions each year and offers tips to avoid trouble.

Dr. Arnaout reminds us it only takes 15-20 minutes for a sunburn to form. Hence, it’s essential to apply and reapply sunscreen routinely and ensure all body parts are covered.

“Don’t forget the top of the ears -- that’s where I tend to see the most sun damage, especially in boys because they don’t have that hair covering their ears. I see lots of freckling and burned skin here,” Dr. Arnaout said.

Dr. Arnaout also talked about using shade and clothing, such as longer swim shorts and shirts to avoid harmful, cancer-causing ultraviolet (UV) rays. By doing so, we can protect our kids from day one. 

“Try to keep kids, especially under 6 months, completely covered with an umbrella or some kind of shade because they can burn much more easily,” she said. Parents should know, according to Dr. Arnaout, that you CAN put sunscreen on your child at that age, but doctors prefer an umbrella, with exceptions for their feet. 

Lifejackets & Riptides

When taking your child to the lake, lifejackets are commonly used for children. However, Dr. Arnaout observed that many parents do not think to bring a lifejacket to the beach.

“When we go to the beach, people will assume the kids will be playing in the sand without any danger, but kids can wander off and get swept into the water very easily,” Dr. Arnaout said.

Although riptides are not ordinary on the Texas coast, it is important to keep them in mind. Dr. Arnaout shares some tips in the event your child runs into riptides. 

“Especially older kids, if it’s dragging them, do not fight it, but let it take you in the direction it needs to,” Dr. Arnaout said. “You can tire out easily trying to fight a riptide.”

Skincare & Jellyfish Stings

We’ve all seen it in the movies, TV shows or heard stories of someone peeing on a jellyfish sting, so surely that’s the way to cure one, right? Contrary to popular belief, that is false, according to Dr. Arnaout. 

Dr. Arnaout shares that peeing on a jellyfish sting is only a myth. It might make the sting worse. The most effective treatment is vinegar. However, there are other things you can do if your child is stung by a jellyfish. 

“The tentacles of jellyfish have these little stingers that can get stuck in your skin. One of the best and immediate things you can do is go back in the water and a lot of them will wash off. You don’t want to rub it off, but you can take a credit card and gently scrape the stingers off, ” she added. 

Last but not least, it’s time to talk about skincare and gentle clothing at the beach. Be aware of mesh lining and life vest straps, which they can harm the skin.  Dr. Arnaout says she has seen many instances where the mesh lining or buckles from lifejackets irritate private parts, especially for boys. It is important to be aware of the materials inside your children’s swimsuits. 

“I think it’s not well known that the mesh lining of these suits or even the straps that go down in that area can be super abrasive and can cause a lot of chafing and a lot of pain,” Dr. Arnaout explained.

When I graduated from my pediatric residency 11 years ago, I knew there would be questions from parents daily about their child's growth, development, illness, behavior, etc. 

"What’s this new movement?"

"Is this behavior normal?"

"What should I be doing about this rash?"

But there are seriously some things I get asked about that make me chuckle every day – not because they’re silly, as no question for your doctor is unimportant – but because I never knew I’d be answering them so often!

Here are seven of the most uncommon, common questions asked by parents: 

1. "Is this much earwax normal?” – The answer is probably yes. We make earwax daily, some of us more than others, and in all types of colors and textures. Earwax protects our ear canal and prevents infection.
2. “Is my baby’s teeth grinding normal?” – Yes! When they get those fun new chompers, it’s really common for them to click and grind them as they explore that new feeling in their mouth. I remember it setting off my baby alarm sometimes at night because it was so loud…
3. “Why does my baby have rosy cheeks?” – Sometimes babies get rosy cheeks. It’s often due to dry skin or cold weather. But sometimes, babies just have beautiful, well-circulated cheeks. And 99% of the time it bothers parents more than the baby.
4. “What is this little bump at the bottom of my baby’s skull?” – Okay, I know this is oddly specific, but there are two little lima bean-shaped/sized lymph nodes on the back of the skull, top of the neck area. They are called occipital lymph nodes and nearly everyone feels them on their baby’s scalp at some point, especially after that first bath and shampoo. They’re normal and as long as they’re not growing or more are showing up, you’re okay to just observe them.
5. “Every time I pick up my baby, her shoulder/hip/arm joints pop! Is this normal?” – Yes. Growing joints mean popping joints. As long as your baby isn’t crying in pain, totally fine.
6. Toenails. Toenails. Toenails. Baby toenails are weird. Some have wings. Some are flat. Some are curved. I never knew I’d dedicate so much time to toenails in check-ups!
7. And finally… “Is his penis color normal??” – Baby penises are different from adult penises, including the color. Some are blue. Some brown. Purple, pink, orange. As long as your baby does not appear in pain and that color hasn’t changed recently or suddenly… just go with it.

Because we talk about healthy and unhealthy things at home a lot, he agreed to eat some broccoli (bear with me, folks – this green food took over 5 years to happen. It was not easy and I consider it a huge victory that will likely be short-lived).

My daughter refused all the broccoli and all the fruit. Not havin’ it.

My son ate 3 pieces of broccoli, two bites of neon orange, licked every ranch molecule off the plate, and then asked for the 4-month-old Oreos in the pantry.

Yogurt ranch for the win.

They both drank milk. Score. Protein.

Dad worked late. Two working parents. We didn’t sit at the table together today.

There was a lot of talking and distraction by: counting to 100, temporary tattoos, our cats howling, and arguing about what 6+6 equals (9, in case you didn’t know). Also someone threw a strawberry and someone cried because there was no “real dessert”.

Even your pediatrician worries about her kids’ nutrition, and even your pediatrician doesn’t follow her own rules sometimes. And this picture doesn’t represent what my kids actually got in their stomachs. And every meal looks different at my house.

I used to be that childless pediatrician who always said, “I’m never gonna have the kid that only eats a couple of things! My kid is going to eat a wide range of nutritious foods! I’m a pediatrician, for crying out loud!”

Then God and Mother Nature got together and decided I needed to be taught a lesson, and gave me my firstborn child. Cue the Uncrustables.

There is no topic I talk about more in my office than picky eating. Well, maybe poop. But seriously - you’re all worried about it. And you should know that you’re not alone.

GENERAL INFO:

• Picky eaters are often children who are sensitive to their surroundings, to tastes, and to textures. Some are anxious kids in general. Some have sensory problems and are sensitive to other things like loud noises, certain smells or how clothes or shoes feel. Some are children on the autism spectrum. These kids may have heightened awareness of these senses, thus making new foods a challenge.
• Most kids who are picky are “just normal kids” though.
• The majority of kids I see who are picky will grow up to be TOTALLY NORMAL AND FUNCTIONAL EATERS (shout-out to my sister Christina who used to only eat cereal and Fritos as a kid and who now makes quinoa and kale salads for fun.)
• Picky eating may be pre-programmed in us. Think about it. Maybe we are avoidant of bitter things (like some vegetables) in our youth in order to self-preserve? Caveman toddlers needed to know to avoid the poisonous plant or fruit, which often had a bitter taste. This might be a partial explanation for why so many kids are picky.
• It is very normal for children, especially toddlers, to only eat the same thing for awhile. My daughter lived on blueberries and yogurt for a solid two weeks once, even though other things were offered to her.
• It is very normal for small children to only eat a few bites of food some days, and eat giant meals on other days.
• Milk is a great source of protein for picky kids. An 8 ounce glass of milk has 8 grams of protein in it. Try to keep it below 20-24 ounces a day for your picky eater though. Kids who just depend solely on milk for nutrition and avoid other foods can get anemic.
• Giving your picky kiddo a multivitamin with iron daily is a great idea. It's not gonna be as good for them as the nutritionally dense veggies and fruits are, but it won't hurt.

WHEN DO I WORRY?

• If a child completely refuses an entire food group, I worry. If they shun all dairy, I worry they won’t get enough calcium for their bones. If they refuse all fruits and veggies, I worry that they’re gonna get constipated or have a nutritional deficiency (these typically only develop in the most severe cases and over the long-term).
• If a child is extremely picky and is a very small kiddo, I worry.
• If they are losing weight, I worry.

Most picky eaters are your run-of-the-mill “chicken nugget and mac and cheese” type. They gag sometimes with new foods, and often don’t want to stray from the 10-15 foods they’re “OK” with. The majority of your kids will fall in this category.

But some kids are extremely picky. These kids may have something called Avoidant Restrictive Food Intake Disorder (ARFID). The diagnostic criteria are here.

If your child meets any of these criteria, it’s best to talk to your pediatrician. Your kiddo might need therapies that can help with introducing new foods and could benefit from seeing a nutritionist as well to assure they’re getting the nutrients they need.

“Children Will Eat If They’re Hungry”

Yes, this is true. When I moved dinnertime from 5:30 to 6 p.m. in my house, there was a noticeable difference in how much they ate and how little they whined for snacks later on in the evening. But remember the other things that fill our kids up – sometimes that little handful of Goldfish crackers an hour ago was all that was needed to keep their dinner hunger cues away. Sometimes a cup of milk before the meal will cause lunch to end in a meltdown. Snacks and milk are fine if your kiddo needs them and is an easy eater, but I just wanted to open your eyes to how easily a picky kid’s hunger can be satiated so you can better understand the food refusal.

Healthy portion sizes for kids are typically much smaller than parents may think. Protein should be the size of a child’s palm (meats, fish, beans). Veggie/fruit portion – what they can grasp with two fists. Pasta or bread? One fist. This may change depending on a growth spurt or more hunger that day due to exercise. But it illustrates how little they may need sometimes. 4 green beans. 2 apple slices.

Kids are very good at knowing how much food they need to eat. In fact, they’re better than us at it. You put me in front of a box of donuts and I’m gonna eat way more than I need because…donuts. Small kids are great at stopping when they’re done with being hungry. They don’t loosen belts or overstuff themselves. In fact, I often guide older, overweight kids to watch their younger siblings when they eat – small kids usually stop eating when the hungry goes away, not when they feel really full.

Along those lines, don’t force kids to “finish your plate.” In a day and age when kids are bigger than ever, this is just antiquated and unhealthy. Give them small portions and allow for seconds if they’re having a hungry day.

Dips. Sauces. Do it. It’s fun, and different. Use Greek yogurt to make the creamy ones. Throw onion soup mix in there, or a ranch spice packet. Try hummus. Try salsa.

New illustrated plates. Fun spoons. Twirly straw for that veggie-packed smoothie. Kids love special stuff like that. And might be more willing to try something new if it’s fun.

I know it’s enticing, but try not to use dessert as a “reward” or “bribe.” It sort of sets the stage for associating sweets/treats with success. And we’re reinforcing that what was on the dinner plate isn’t as good as the dessert.

Again, remember that some kids do sit on the edge of the eating spectrum in the “severe” zone. ALWAYS talk to your pediatrician if you feel like your kiddo might be really struggling. If he’s small, eats fewer than 5-7 things, throws up and gags on a daily basis, or has very high anxiety with food, ask for help! Feeding therapy is wonderful. Our dietitian and nutritionist friends are so helpful to doctors and parents alike. We can get through it together as a team!

I barely scratched the surface here. Please speak up in the comments if you have any other advice or ideas!

Lettuce romaine calm,

Dr. Diane Arnaout

I watched in horror as her dad carried her down the hallway and into one of the exam rooms. She looked stiff. She looked like she was in pain. Her face was grimaced. What in the world? Why was this very healthy 4-year-old being carried in? My stomach sank.

Something was very wrong with Elizabeth.

This was in June 2018. I’d seen her a few days before, during her little brother’s checkup. I couldn’t help but notice how quiet she was being. She sat still, in a corner. This was a child that usually loved to bop all over the room.

“Elizabeth, kiddo, you feeling okay?”

“She’s not feeling well. She’s had a little fever and seems under the weather,” said her mom Heather.

I checked her out, looking in her mouth and ears, and listened to her heart and lungs. She looked fine.

“I think this is something viral. Why don’t you let her rest this weekend and let me know how she’s doing next week?”

Little did I know that “next week” meant three days later, and that her dad would be carrying her in like a limp, broken doll into our office.

Nurse practitioner Tara Haraldson and I ran right behind them into the exam room.

She screamed in pain whenever her head was turned. Her neck was stiff, rigid. She hadn’t been eating much and wouldn’t drink. She was having a hard time talking. I was really worried she had meningitis. She was in so much pain she had to lay on the floor of her parent’s car to get to the office.

“Things got much worse yesterday. We took her to the ER earlier this weekend but they thought maybe it was just pneumonia so they tried antibiotics. Her neck pain started that night and has only gotten worse. She can’t turn her head and she’s hurting so much we can barely move her.”

I sent her to Cook Children’s Emergency Room via ambulance. I called the ER doctor to let them know she was coming. That physician also thought it was likely meningitis. We agreed she needed a brain MRI and a spinal tap right away.

Barely one hour later, the ER doctor called me – “It’s acute flaccid myelitis.”

“WHAT?!”  I nearly spit out my drink.

This was almost a myth. A pediatric rarity. "The rare polio-like illness that's affecting kids across the country". A disease that affected less than 1 child in a million. I’d only read about this in medical journals. What in the world was it doing in my office – heck, in my city…. in my state?

A 'Polio-type Illness'

The words rang in my head for hours after I got the phone call. I struggled to remember what I had learned about this rare disease in years past. I had certainly never seen it in person – nor had any doctor I knew.

Elizabeth’s AFM was found via her brain MRI. They wheeled her into the ER and took her straight to the MRI machine. The radiologist watched as the images loaded on the screen. She had color changes on it, spanning from the bottom of her brain (the brainstem) all the way down her spinal cord. The radiologist knew what it was in a matter of minutes, and called the ER doctor immediately.

As I sat in my office staring into space that afternoon, I’d remembered that there was an outbreak of this disease in Colorado in 2014. The headlines were splashed all over the front of my medical journals as a warning. Watch out for this, pediatricians! Keep your eyes peeled for this awful polio-like illness. Thankfully, the cases had slowly vanished and I hadn’t heard about it for awhile. Until now.

Why do we keep calling it a “polio-type illness”? Well… because this disease looks exactly like polio. Except, it’s not polio. It’s a brother of polio – not a cousin, or a distant relative – a brother. And it is a terrifying reminder of what polio used to be (and hopefully will never be again).

Polio, caused by the poliovirus, is in the enterovirus family. There are hundreds of enteroviruses. Stay with me.

The heroine of my story

Back to Elizabeth, the heroine of my story. While in the ER, they noticed she couldn't stand without severe dizziness. And that her right arm wasn't working very well. Her face was drooping on one side.

Her mother later told me that in the ER, the doctor said that she may never walk again. She may need a breathing machine for the rest of her life. She may not live. They were absolutely terrified.

Her parents ran frantic Google searches, and called families across the state. I dug up every study I could find on the 2014 outbreak and read until my eyes crossed. What could we do to help her?

She was wheeled up to the Cook Children’s Pediatric Intensive Care Unit for extremely close observation. They were worried her breathing muscles might become weak, or her brain function might continue to decline.

I don’t think I slept more than 20 minutes that night. I know Elizabeth’s parents didn’t.

We were waiting to see what would happen to Elizabeth’s body. And there was nothing the ICU doctors, the infectious disease doctors, or the neurologists could do to stop this. Steroids, antibiotics, antiviral medications, other forms of therapy – all were deemed useless over the past few years. We were helpless.

So we watched.

(This is the end of part 1. Read the conclusion to the story tomorrow.)

Summer is nearly here! Let's quickly hit some of the most common questions I get around this time of year - about sunscreen, DEET, and life jackets.

1. Sunscreen:

Use it! Even on a cloudy, not-very-hot day! 80% of the sun's rays penetrate clouds! And bounce off sand and snow!

Start using it at age 6 months. Prior to 6 months, do not have your baby in direct sunlight - put them under heavy shade and put a hat on them. If you can't find shade, use sunscreen on small amounts of their skin and try to cover skin with clothing.

Go with SPF 30-50 for your kids. I don't care about brand.

Zinc oxide (the stuff that won't disappear when you rub it in) is the best. It physically blocks the harmful rays. Great for nose, ears, cheeks, tops of shoulders.

Put it on 15-30 min BEFORE YOU GO OUT.

Reapply every 2 HOURS.

PUT ON MORE THAN YOU THINK YOU NEED. 1 teaspoon per limb is about right. 1 tsp for back, 1 tsp for chest. 1/2 tsp for face.

I don't like the sprays. They miss spots and can be inhaled. If you have to use them, spray a ton on your hands and rub it it in good.

More good info about sunscreen here: https://www.checkupnewsroom.com/5-tips-to-protect-your-chi…/

2. DEET:

DON'T BE SCARED OF IT. It is not "DDT"! It is safe down to age 2 months. It is the BEST way to prevent insect bites and this has been proven time and again in medical studies.

Read a ton about this in another article I wrote here:

https://www.checkupnewsroom.com/the-deets-on-deet/

If you absolutely don't want to use DEET, go with Picaridin.

Those wrist bands ain't gonna do anything.

3. Life jackets!

Use only life jackets that are approved by the US Coast Guard.

Here are the types (compliments of the AAP Healthy Children website):

TYPE 1: This jacket floats the best. It is designed to turn most people who are unconscious in the water from the face-down position to an upright and slightly backward position. This jacket helps the person to stay in that position for a long time. It is to be used in open water and oceans. It is available in only 2 sizes: 1 size for adults more than 90 pounds and 1 size for children less than 90 pounds. (Type 1 is the most bulky but has the greatest ability to turn a child "face-up".)

TYPE 2: This jacket can turn a person upright and slightly backward but not as much as the Type 1 jacket. It may not always help an unconscious person to float face up. It is comfortable and comes in many sizes for children. (More comfy but will only turn SOME children "face-up".)

TYPE 3: This jacket is designed for conscious users in calm, inland water. It is very comfortable and comes in many styles. This life jacket is often used for water sports and should be used only when it is expected that the rescue can be done quickly. (Least bulky, most comfortable. Good support for children who have some swimming skills.)

This summer, I will be using Type 1 lifejackets for my kids when we go to the ocean or are at the lake. I will be using Type 2 when we are in the wading pool. My kids are 2 and 4 and I will be within a few feet of them at all times when they are in/around water.

WATCH YOUR CHILDREN AT ALL TIMES WHEN THEY ARE IN OR AROUND WATER. DROWNING IS SILENT.

Let me say that again: DROWNING IS SILENT.

Cook Children's has a great drowning prevention resource page. Click here to learn more.

Hope this helps answer your burning hot summer questions!

Hugs,

Dr. Diane Arnaout

Both allergies and colds share a lot of similar symptoms:

• Sore throat
• Runny nose 
• Sneezing 
• Coughing 
• Feeling tired 
• Feeling achy

Honestly, it can be hard even for us to tell the difference when we examine kids.

HOWEVER, you don't get a fever with allergies. If you have a little fever (or a big fever), that's most likely a cold.

ALSO,  "itchiness" in general of nose and eyes, makes me think more allergies than cold.

AND, the time is important - Did  it come on really quickly? That's most likely a cold. Has it been going on for months with a slow onset? Most likely allergies.

Both allergies and colds can make you more susceptible to other problems like ear infections and sinus infections. That's why we say if your symptoms are lasting longer than 2 weeks, come in and see us so we can help.

"How do I know what to do?" Well, that depends on a lot of things.

Is your child under age 1? If so - this is more likely a cold than allergies (a child has to be alive longer than a year to develop allergies to their environment). Elevate the head of their crib. Stick a blanket under the mattress. Would you want to lay flat on your back with a bad cold? Suck out all that snot with a Nose Frida (dont knock it til you try it). Use saline drops. Tylenol (or ibuprofen if over 6 months) for the headaches and throat pain. Run a hot shower and sit in a steamy bathroom for a bit. And lots of lovins. There ain't much you can do for the tiny ones. They just have to push through it.

If they're over age 1 and they have what seems to be a cold, try some honey along with all of the above. It's been proven to help just as much as medication. There are some over-the-counter medications that have honey in them too. I wouldn't try cold medicines until they're at least 4. Studies don't even show that they help much.

If it's allergies - you have lots of over the counter options like Benadryl, Zyrtec, Claritin, and Allegra. Some nose sprays are also very helpful and we can prescribe those in the office. And there is a prescription medication called montelukast that I find can help some kids.

Also, a wise allergist once told me that if you rinse out your kid's nostrils when they come indoors, it helps a lot (it washes away all the allergens/pollens clinging to the hairs in the nose and really helps symptoms go away faster). You could also try nasal saline spray here and just have them hold their head over the sink.

Hugs!

Dr. Diane

I should call this: "The Eustachian Tube - Dictator of Ear Happiness." More later on that.

Few things I want to put out there first:

1) There are two kinds of ear infections: middle ear infections (otitis media - the type you get tubes for) and otitis externa (outer ear infection, no tubes for this)

2) "Water in the ear" from a bath or pool typically does NOT cause middle ear infections! It CAN cause something called "otitis externa," or, "swimmer's ear," which is an ear canal/skin infection that may require ear drops to improve. I'm not going to talk about that kind of ear infection today. From here on out when I say "ear infection," I mean the middle-ear kind.

3) Ear infections are incredibly common. Do NOT freak out if your child gets one. Five out of six kids will have at least one by their third birthday (and most will have more than one).

4) A "red ear" does not mean a child has an ear infection.

5) A "baby messing with an ear" does not necessarily mean they have an ear infection.

6) A fever with your child's cold does not necessarily mean an ear infection is happening. The only way to know if your child has an ear infection is to have the ear drum examined by a medical provider.

Why do ear infections happen? Well....snot. And inflammation. Snot and inflammation from colds. Snot and inflammation from allergies. Snot and inflammation from just walking into the door of daycare or that play date.

The inflammation blocks a vital little guy called a eustachian tube. Look at the picture to the left. Find the eustachian tubes. See how they're a little exit canal for the inner part of the ear? They drain the ear. An infant's eustachian tube is smaller than an adults', and more horizontal. That causes problems. It just doesn't drain well.

It swells up, gets blocked off, and the snot in the middle ear has nowhere to go. Once the cold or allergies are better, it de-swells, opens up, and voila!, ear infection is gone. All the junk drains out. The baby's eustachian tube is different than an older kid's, or adult's. This fact along with the fact that babies and toddlers are snot machines and always putting things in their mouths - that's why they get more ear infections. We hope they "outgrow" this eustachian tube problem (and hands in mouth problem) by age 2-3.

It can take 3 weeks to 3 months for the fluid to drain out of the ear. And your kiddo may have an ear infection and you'd never know about it, and that's ok - because they usually get better on their own! Most ear infections are VIRAL! That means the fluid just has a virus in it, and it will all go away on its own thanks to our great immune systems.

When I look into a child's ear, I examine the ear drum to know if they have an infection or not. When there is no infection, an ear drum is translucent, kind of like a shower door. When it is infected, it is red, bulging out, and full of what looks like pus. Sometimes this is just viral fluid. But sometimes, while that eustachian tube is all swollen and blocked off, the liquid stuck in the inner ear gets bacteria in it. We can tell the difference by looking in there. And that is why some children need an antibiotic for some ear infections. To kill the bacteria while we wait for the eustachian tubes to un-swell.

So...who needs "tubes?"

There are a few things that cause kids to get lots of ear infections:

1. Being in a child care setting (lots of kids...lots of snot).

2. Secondhand tobacco smoke exposure (as if you needed another reason to quit).

3. Taking a bottle to bed (when the child lays down and drinks, the milk actually puddles in the area where the eustachian tube meets the nose/throat and causes swelling and bacteria to hang out back there - this habit also causes cavities - no bottles in bed, folks!!)

Some kids have really tiny eustachian tubes that stay really swollen all the time. If they're around other kids a lot, like day care, they get tons of colds each year, and that's normal. However their little eustachian tubes mostly stay swollen shut, sometimes for months at a time. And we see them in our office 1-2 times a month for repeated ear infections.

I guess a "rule" I follow is that if a child gets 5-6 bacterial ear infections in a year, or more than 3 months of constant fluid in the ear, I will send them to the Ear-Nose-Throat doctor to get tympanostomy tubes (or just "tubes", as most people know them) put in. This brilliant procedure creates a little "canal" for the fluid to escape from the inside of the ear. They fall out in about a year, when we hope they've "outgrown" the problem.

Sometimes, I send a kid to ENT if I've put them on 3 or more rounds of antibiotics and they're still having fevers and still in pain and I just can't get that dang fluid to go away. Who wants a kid on antibiotics for that long!? Another reason to see the ENT is if the fluid is making it hard for a child to hear. When a small child can't hear, they can't learn to speak. I've seen kiddos get ear tubes and within 1 week they are talking up a storm! It's amazing.

However, surgeries and anesthesia comes with risks. If you're worried your child has had too many ear infections, talk to us. We will let you know if we think it's time to see the ENT.

Wow...this was long. I hope it helped you learn something about one of the most common ailments we see in the office!

When my son Jack was born via C-section, everyone had something nice to say about his beautiful round head. “It’s so perfect! Not like the poor little cone-headed babies!” Little did they know that his pretty little spherical skull would soon resemble a pancake on one side.

Does your baby’s head have a flat spot? A flat region?  A flat continent?  Do not fear!  It’s likely normal skull flattening (the fancy medical term is positional plagiocephaly), it’s totally normal, and only rarely do baby craniums need any “fixing.”

Let’s talk about infant skulls – like many baby body parts, they aren’t small versions of the adult skull. They are unique and functional. They are made of bone plates that are loosely held together, and they can move and shift. This special ability helps the baby with an easy exit through the birth canal, and allows the brain to rapidly grow during the first year of life.

However, after that exit, there are lots of external forces that can flatten the infant skull. Often, it’s due to your pediatrician’s golden rule of putting her on her back to sleep. In 1992 we launched this campaign to reduce the rate of SIDS, or Sudden Infant Death Syndrome. What came next was a beautiful drop in the number of babies dying in their sleep, and the unfortunate side effect was the rise of plagiocephaly. 

So your baby is a few months old now, you’ve been putting her on her back to sleep like your pediatrician recommended, and now she’s got a big ole flat spot on the back of her head. What can you do to make it better?

• Give her plenty of supervised tummy time while she’s awake. Find new toys or objects to stimulate her everyday. A mirror is very entertaining! Prop her up on a pillow to give her a little height (And her heavy head a soft landing pad). I find the breastfeeding pillows have the perfect curve for it. 
• Hold your baby while she’s awake to relieve pressure from carriers, swings and infant seats.
• Alternating things in the room to encourage laying on the other side of the head. I found that putting a bright light-up toy, or a mirror, or even myself on a certain side would encourage Jack to look that direction and relieve the pressure on the flat spot. This also works during naps/sleep time – if your baby likes looking out the slats of the crib, flip her head/feet orientation in the crib so that she has to turn her head a different direction.
• There are many commercial items that claim to “round out baby’s head,” with new things coming out everyday. Research these products carefully and bring it up with your pediatrician before making the purchase, to assure they are safe.

When is a funny-shaped head a true medical problem?  If you have concerns about your baby's head shape, always feel free to talk with your pediatrician about it. Pediatricians typically evaluate the shape of an infant's head during the physical exam at the many checkups they gets during her first year. Usually positioning changes (like the ones listed above) can fix a flat head over time, but sometimes a helmet can be used in severe cases to help it along. In rare cases, we advise that a specialist be seen, like a physical therapist or a neurosurgeon.

Rare instances include:

• The flattening has led to facial changes, like a protruding portion of the forehead, and/or one ear that sits asymmetrically to the other.
• A misshapen head that is due to the skull's bone sutures closing too early (called craniosynostosis - your pediatrician is trained to notice signs of this)
• If you notice that your baby has problems with or may even be unable to turn her head to one side, leading to skull flattening, it may be due to a tight neck muscle - a condition called torticollis.

So my point – and I do have one - is that I’ve seen many funny-shaped heads in my office (and witnessed the evolution of a pretty darn cute one at home), and the vast majority fix themselves over time. Always talk with your pediatrician if you’re worried. That’s what we’re here for!

And as for Baby Jack, he did lots of tummy time to help get rid of those flat spots!