By Sandra Treybig, M.D.

The dreaded pimples-

Should my child see a dermatologist?

The answer is sometimes yes, but for the most part no!

Your pediatrician is very familiar with acne and can treat most patients!

Acne can start young -age 8-definitely talk to your doctor if this occurs Or mainly when adolescence hits.

Some kids care and others don’t

Still it is important to address the issue Start with a good cleaning regimen-bacteria that cause acne flourish in the greasy dirty environment that makes up most teenage skin!

If cleaning is not enough -talk to your pediatrician about meds  (before ordering “proactive”

). There are many prescription creams that can help and sometimes oral medicines are needed (antibiotics). But remember, there is no overnight cure. These regimens sometimes take 3 or more weeks to work and sometimes there is a worsening before any improvement is noticed!!  If no improvement after trying a regimen for several months , then discuss derm referral.

Acne can cause some severe depression in kids so bring up the subject with your kids and discuss it with your pediatrician!

By Lola Culwell M.A.

         Swimmer’s Ear is an infection of the outer ear canal, also known as Otitis Externa. It is treated with antibiotic ear drops. Swimmer’s Ear can not spread from one person to another. All age groups can be affected by it; however it is most common in children. To reduce the risk of Swimmer’s Ear keeps your ears as dry as possible. You can use ear plugs when swimming. The best are silicone plugs which form a seal on the outside of the ear.  Also use a towel to dry your ears tilting your head from side to side. Remember never put q-tips in your ear. Talk to your health care provider about using drops after swimming.

We guarantee this will happen to you. Your child will spike a fever at night or fall off the jungle gym on a weekend and you will need medical care after normal business hours.

  The first step is to determine if our office is open. Capital Pediatric Group is open until 9pm each weeknight and is open 8-5pm on Saturday and 8-12p on Sundays. Clearly, this is the best place for you to go. Your doctor’s office has your child’s chart. Your doctor may even be the provider who is working. And even if someone else in the practice sees your child, the medical record for the visit will be in his chart for your doc to follow up on, if necessary. That is the advantage of having a medical home.

  Even if it is something straightforward like an ear infection or Strep throat, it’s best to be evaluated by one provider group that can look at the big picture—to track how many ear infections or Strep infections have occurred and select the appropriate antibiotic and determine the next course of action

  But, it’s a good idea to find out where your doctor suggests you take your child in the event that he/she is not available. 

  Urgent care clinics and convenience clinics located in national pharmacy chains are cropping up all over the city. Many are staffed by nurse practitioners. Emergency medicine or family practice docs often work in freestanding after-hours clinics. It’s rare to find a pediatrician or pediatric specialist in one of these places. Most community hospitals do not staff their emergency rooms with pediatric specialists, either.

  Why do we point this out? Well, any local ER should be able to handle simple stitches or broken bones. But for some pediatric emergencies, your child will get better care when there is a pediatric specialist in the house. We recommend Dell Children’s Medical Center for emergency care.

      It’s smart to call our after hours line before you go running anywhere to be sure that your not wasting your time or money (emergency rooms and minor emergency centers charge higher co-payments for their services). What may seem like an emergency to you may, in reality, be less serious—that is, it can be taken care of with an office visit the next day.

Capital Pediatric Group is open 362 days a year, and has served Austin’s families for over 50 years.

Hours: 8-9 pm Weekdays

8-5 pm on Saturday

8-12 pm on Sunday

Walk-in sick visits welcome.

By Joyce Jordan, LVN

There is a growing concern about childhood obesity. Obesity effects about 17 % of all children and Adolescents in the United States, the rate has tripled from one generation ago. Our children are eating more and exercising less, contributing to Heart Disease, High Blood Pressure, Asthma, Sleep Apnea and Social discrimination. Encourage healthy eating habits. Start with portion control, Low-fat or non-fat milk or dairy products, Lean meat, poultry, fish, lentils and other proteins. Limit sugar-sweetened drinks Drink water, Eat fruits, Vegetables, Whole grains. Limit intake of sugar and saturated fat. Help kids stay active, strengthening bones, decreasing Blood Pressure. Reducing stress and anxiety, weight management, Brisk walking, jumping rope, playing tag, swimming, dancing, playing soccer etc. For further information go to C.D.C. gov.Healthyweight/children index

When our children get enough sleep, they are happy, playful, and in a pleasant mood. When a child does not get enough sleep, a number of health problems can arise. Lack of sleep in children has been associated with depression, anxiety, inattention, irritability, poor memory, and poor school performance. When children are young infants, it is important to keep bedtime consistent. Infants should be laid to rest while sleepy but still awake. Adequate nap time can vary between children and year by year, but is very important to ensure they rest well at night. Check out this website from the American Academy of Pediatrics which goes over sleep needs at various ages: http://kidshealth.org/parent/general/sleep/sleep.html

2-4 months: 10 hours at night, 3 naps of 1.5 to 2 hours
6-9 months: 11 hours at night, 2 naps of 2 hours
12-15 months: 11.5 hours at night, 2 naps of about an hour
18 months-3yrs: 11 hours at night, one long nap of about an hour
4-5 years: 11 to 11.5 hours at night
6-10 years: 10 hours at night
11+ years: 9 hours at night

A consistent, predictable bedtime is key to help your child sleep. Read to them at night to help them unwind and keep the bedtime routine as consistent as possible. As children get older, distractions such as TV, homework, social activities, and computers can keep a child from getting adequate amounts of sleep. Avoid TV on school nights, and help your child prioritize. Early school start times (7:30am) also put an extra strain on tired chidlren and are associated with reduced concentration and increased risk for car accidents compared to later start times (8:30am). Place sleep at a top priority in your child’s schedule.

http://www.sleepfoundation.org/article/sleep-topics/children-and-sleep

Elise Kibler, MD

By Allan Frank, M.D.

This year Austin has been fortunate in that influenza has been mild. We started seeing cases about 4-6 weeks ago. In contrast to previous years the number of patients has been reduced. There has been a preponderance of type A disease- mainly high fever and respiratory congestion. This viral illness does respond to an oral medication-Tamiflu. For it to be effective, it should be started in the first 48 hours. A few cases of influenza b have also been found. Vaccines-both by injection and nasal spray ( if no problem with asthma) helps to prevent this and will continue to be given through the month of April.

By Thomas Hughes, M.D.

There has always been a question of whether or not children with expressive language delays developed other behavior problems as they got older. As it turns out, toddlers identified as “late talkers” had no increase in psychosocial problems compared with other children during childhood or adolescence, as long as they didn’t have other co-morbid behavior problems at the time of diagnosis. A large study in Australia followed 1,200 children whose speech is not delayed and compared them with 142 children not using expressive language vocabulary.  They were followed from infancy until age 17. They found that they did not have any more psychosocial issues than children who did not have an expressive language delay. This should give reassurance to parents of kids who are “late talkers”.

By Linda Hill, RN, IBCLC

I am sure many of you have visited the big baby retail store in search of that perfect bottle for your breastfeeding baby and felt a bit overwhelmed at the choices!  Glass, plastic, liners, slow flow, newborn flow, stage one flow, wide mouth, standard neck, vented, colic free, BPA free, more like breast … yipes! If only ONE of them stated they were colic free or more like breast, it wouldn’t be so hard, but they ALL claim the same things, so how do you decide and who do you believe?

I have done my own testing on these bottles to help take the guess work out of it and at least narrow down the choices parents face!  I tested all of the above bottles using a symphony hospital grade pump at 128 mmHg, which is equivalent to a newborns suck. (McClellan,Geddes,Kent,Garbin, Williams,Hartmann)  Each bottle was tested for one minute and the test was repeated 2-3 times for each one.  I am going to list for you the results for each of the bottles.  The number you will be reading indicates how many milliliters was removed in 1 minute.  Ideally, you want something that is slow so that your baby experiences a nice relaxed pace and is not forced to gulp the milk down too quickly, as that can add to swallowing too much air, which in turn will make him fussy and have gas pains!  So, here are the results:

Adiri           70 ml/min

Calma         38 ml/min

Medela        20 ml/min

Avent          16 ml/min

Breastflow  14 ml/min

Bornfree      13 ml/min

Elan             13 ml/min

DrBrown     12 ml/min

Playtex

   Drop ins    10 ml/min

    Ventair     10 ml/min

To help this make sense:  15 ml is ½ an ounce.  We DON’T want your baby to scarf down a 3 ounce bottle in 3-4 minutes, and that is possible with some bottles.  Your baby needs to be able to fulfill his sucking need.  If he is a breastfed baby, then he is used to sucking for about 30 minutes for his meal, depending on his age and ability.  If he is allowed to drink it down in just a few minutes, he is going to still want to suck and will suck on his hand or fuss and you may misinterpret his need to suck for hunger. (and then overfeeding begins)  So, to help you out, pick a slower flowing bottle!  The other things you can do to slow down his feedings from the bottle are to keep the bottle more horizontal and the nipple only ½ full of milk.  Watch your baby and slow down the feeding when he shows you stress cues.  (furrowed brow, opening eyes wide, flaring nostrils, increased wiggling, spilling milk out of his mouth, and lastly, choking/coughing)  Parents are encouraged to slow down the bottle by taking the flow of milk away from the baby about every 3-5 swallows so that the bottle feeding remains calm. (You can keep the nipple in the baby’s mouth; just tip the milk out of the nipple) 

A few other tidbits:  NB (newborn), slow flow and stage one are all the same.  You want to use this speed until the baby is around 3 months of age.  Your baby will often cue you into the need for a faster flowing nipple around 3-4 months by fussing/chewing/or refusing it.  Change the nipple to a “medium” flow and he is usually happy again!

Also, as of 2009, all bottles were made BPA free.  And lastly, if you use a “vented” bottle (all of the above are vented except for the generic medela one, third from left) and keep the feeding slowly paced, then he shouldn’t take in any excess air which could give him a tummy ache.  (thus no colic)  Happy Feeding!

I

By Ari Brown, M.D.

I’m breastfeeding as well as pumping and storing my expressed breast milk. Do you have any suggestions for how many and which type of baby bottles to buy?

Answer: We asked our lactation consultant, Linda Hill, for her advice:

As of 2009, all bottles are BPA free, but you wouldn’t want to use bottles stored up from your friends that are several years old (or get from a yard sale where you don’t know how old they are).

The best storage options from best to worst are:

glass  (downfall: breakable)

plastic (downfall: some of the fat content adheres to sides of bottle)

bags   (downfall:  some of the fat content adheres to sides of bag, more likely to spill or tear.  Stackable - takes least amount of room)

I usually recommend storing in 3 ounce increments as most babies drink 2 1/2 to 3 ounces.  

Many choose to use bags, just be sure they are specifically for freezing milk.  Medela bags hold up better than Lansinoh and Gerber. Always leave space in the bags and the bottles as the milk will expand as it freezes.

You need only 3-5 feeding bottles, and at least 20 storage bottles.  (or bags)  Fresh breastmilk is always best, so your goal is not to have a freezer full of milk. 

I usually recommend starting a bottle a day (of expressed breastmilk) around 2-4 weeks.  Many moms are so desperate for sleep, that the two week mark is often quite a treat to get a break.

There are two ways I recommend the bottle:

1)  Mom pumps after morning feedings til has 3 ounces saved up for evening bottle.  She breastfeeds at midnight (or thereabouts) and sleeps thru the 3 am feeding.  Dad offers bottle at this feeding.  Mom breastfeeds at next feeding. (around 5-6)  That means she has gone 5-6 hours without emptying her breasts and is going to be really full.  So when baby is done eating, she will pump off all the excess.  She now has milk for the next evenings bottle and feels like a new woman having gotten 5-6 hours of sleep.

2)  Mom pumps after morning feedings til has 2 ounces saved up for evening bottle.  Babies often “cluster feed” in the evenings leaving mom little time to get much of anything done, so Dad comes in and saves the day with a supplemental bottle during these cluster feedings.  Example:  Mom breastfeeds at 5p, 6p, 7p and dad saves the day (and gets to have dinner made) by swooping in with a bottle at 8p when the baby is fussing yet again!  2 ounces is usually plenty since baby has been eating all night! 

Word of caution:  babies often show a very strong preference for the breast around 2 months of age.  If you want your baby to be able to take a bottle down the road, stick to your guns and continue to have her take a bottle a day, no matter how much she balks!

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By Sarah Kiger, LVN

Summer is just around the corner are you ready for camp or next year school sports? If your child is planning on attending camp this summer or participating in sports next year in school they will more than likely need a physical form completed before they can do that. It’s time to start planning those well child exams don’t wait till the last minute book those appointments now. Remember check with your insurance provider as they all differ in when and how often these exams can be done. Also check your forms some camps require visits within a specific time period so don’t make your appointment too early. Don’t get caught in a crunch spare yourself the stress.