Saturday, June 2, 2012

Teething Gel Might be Harmful

Concerned about teething pain?  You might consider simply using a teething ring or toy.  Some toys can be chilled in the freezer so the baby has something cold to bite on.  As a last resort you could try an occasional dose of acetaminophen. 

I think teething pain is overestimated.  It's easy to blame fussiness, a temper tantrum, difficulty falling asleep, drooling, chewing on things, and picky eating on teething.  Babies always show lots of behavior that we call "teething" such as drooling, mouthing things, and biting on objects.  Older kids also get new teeth (after their baby teeth fall out).  They don't complain that much when their adult teeth come it.  I don't think I've known them to need teething gel.

Teething gels contain benzocaine, which is a topical anesthetic.  Rarely, young children have a condition which can cause them to have a life threatening reaction to these anesthetics.  If the tube of gel is left accessible to a young child they may ingest too much, making such a reaction worse.  A few years ago a patient in my pediatric practice almost died when she ingested a tube of teething gel and developed the life-threatening condition of methemoglobinemia. 

I don't think the benefit of the teething gel is worth the risk it may pose for an infant or young child. 

Here is a link for more information:
FDA warns parents on using benzocaine to relieve pain of teething babies | Drug Store News

 (And, in case you were wondering, teething does not cause a "fever-level" temperature--so if the temperature is over 100.5 degrees F, then think about an illness!)

As always, the information in this blog is not meant to provide personal medical advice or treatment for any individual--for that you will always need to rely on your own personal pediatrician!

Thursday, May 31, 2012

A Computer Game to Treat Depression

Depression in teenagers can be devastating, and it's more common than you think.  Recommended options for treatment include Cognitive Behavioral Therapy, other forms of counseling, and anti-depressant medications.  Some teens are quite reluctant to see a therapist, however, and medication isn't always enough.

 A study was recently published in the British Medical Journal which evaluates the effectiveness of a video game ("Sparx") that teaches skills usually learned during cognitive behavioral therapy.  These results are very interesting, as they demonstrate the video game was even more effective than therapy in alleviating symptoms of depression.

This is new, and not yet available to the general public.  But it's exciting to think that we may soon have more options available to help depressed teenagers!

Monday, April 2, 2012

Shopping Carts Are For Groceries

Don't let your child's head be the watermelon!
My on call weekend is over, and I am enjoying an evening at home when I can just worry about my own kids for a while. Not that I mind doing my job, it's just refreshing to be free of the on-call phone for an evening.

It was interesting this weekend that I was grocery shopping with my 9-year-old daughter while I answered a call about a child who fell out of a shopping cart. My daughter was having a lovely time pushing our grocery cart, standing on the sides or front while I pushed, and at times coasting along for a ride while the cart rolled down the aisle. She was a big help to me, "guarding" our cart while I ran back to get the Italian bread crumbs that were strangely located in the cheese and yogurt aisle.

The child who had fallen out of the cart was in the cart basket jumping up and down while her parents unloaded the cart into their car. Luckily, she was fine except for a bump on her head. 

I have had so many "fall out of the cart" calls over the years that it seemed like a good topic for a blog post. And I learned some interesting information when I did a bit of research:

  1. Most shopping cart injuries occur in children under five years of age.
  2. Common types of shopping cart fall injuries are fractures and head injuries.
  3. Most falls from shopping carts involve children riding in, climbing into, or climbing out of the shopping cart basket.
  4. Another important cause of shopping cart injuries are "tip-overs." 
  5. Older siblings are often involved in "tip-overs" when they lean or ride on the cart, throwing it off-balance.
  6. Parents are near the cart when most of the injuries happen, but most parents step away from the cart several times during a shopping trip.

I am sure the parents of the child who fell out of the cart basket now realize it's not a safe place for a child to ride. However, after reviewing all of this research I had to reflect on what I personally could do to make grocery shopping with my 9-year-old safer. For example, I shouldn't allow her to ride on the sides of the cart OR leave her alone!

What advice can I give you? Don't take your child grocery shopping?

At least don't let them ride in the basket or sides of the cart. Make short, quick shopping trips so your child doesn't get too bored. Keep one hand on your young child at all times. Have an organized list that allows you to get in and out of the store efficiently. Shop when it isn't crowded so it's easier to focus on your child.  And don't let them ride in the basket.

Friday, March 30, 2012

Babies Coughing and Wheezing: Does Your Baby Have RSV?

It's late.  Your baby is coughing and wheezing.  Everything seems worse in the middle of the night.  What kind of cough is it?  What is going around this time of year?  What should you do?

A common virus has really taken off in the last month or two.  You have probably heard of it:  RSV.
RSV stands for Respiratory Syncytial Virus.  For older kids and adults it usually just causes a bad cold.  However, infants and toddlers can be hit hard by this virus.  RSV causes a lot of mucous drainage.  This is hard for babies because they greatly prefer to breathe out of their noses.  The infection causes wheezing and congestion in the lungs of small children.  RSV can cause a fever and may lead to ear infections and prolonged cough.

Sometimes I have called this "baby bronchitis."  Although that comparison helps people understand the condition a little better, bronchiolitis is not actually the same thing as bronchitis.  Bronchitis affects the larger airways in the lungs (the "bronchi") and leads to a significant productive cough.  Bronchiolitis affects the smaller airways, deeper in the lungs.  These flexible, narrow airways are called bronchioles.  They collect mucous and then tend to tighten up with each breath.  This leads to wheezing and a painful sounding, tight cough.

Here are some examples of the symptoms of bronchiolitis.  You will hear wheezing (both with inhale and exhale) and see retractions.  When the skin sucks in above the sternum (breastbone) or between the ribs with each breath, these are retractions. 

This video shows a baby with bronchiolitis who has retractions in her neck (called suprasternal retractions), wheezing with inhaling and exhaling, nostrils flaring with each breath, and a tight little cough (at the end of the video).  Although the dad mentions during the video that she has croup, actually this is a better video of bronchiolitis.

The next video shows a baby with head bobbing.  It is a sign of difficulty breathing in young infants.  Because he is using his neck muscles to help him breathe it pulls his head forward with each breath.

Here is a pretty good example of a bronchiolitis cough.  It starts about 20 seconds into the video.  You might also notice that the baby seems to cough up mucous into her mouth, which she then chews on for a while before she swallows it.  Sometimes babies with bronchiolitis gag on the phlegm and actually throw up after coughing.

RSV bronchiolitis can be mild, moderate, or severe.  Mild bronchiolitis causes wheezing and coughing, but babies can still smile, laugh, drink, and eat.  More severe bronchiolitis can cause rapid breathing, significant retractions, pale or bluish skin tone, prolonged coughing spells, gagging and vomiting with cough.

In another blog post I will discuss some home treatment for RSV bronchiolitis, and what can be done for a child in the office, emergency room, or hospital.  Please remember that my blog is not intended to substitute for the advice of your own personal pediatrician!  Words on a page cannot replace your own observations, or those of the doctor who knows your child.