healthcare from cradle to college

Dr Lowe and her husband welcomed their new baby, Coby Lowe, on August 13th.  Both mom and baby and doing great.  Dr Lowe will be home with baby Coby and his big brother Bryson until December.  While she is away, care of her patients will be covered by Dr Daniels, Dr Idzerda, and by Dr Nancie Nordwick, who is filling in until Dr Lowe returns in December.  CONGRATULATIONS DR LOWE!

Dr Daniels' advice was featured in the latest issue of LEAP, a parenting supplement in the Bozeman Chronicle.  Here's a copy of the article:

Question: 

Can a two year old have growing pains?  My son was restless and crying and kicking his legs last night.  It seemed like he couldn't get comfortable.  When I started to massage his calf, he calmed down and fell asleep.  If it is growing pains, what can I do to alleviate his pain?

Answer:

Growing pains are usually felt in the legs of children in two age ranges, 3 to 5 years old and again from 8 to 12 years old, though it may be possible for them to occur in younger children as well. 

Growing pains are a normal part of childhood for 25-40% of kids.  The pains are typically throbbing muscle pain felt in the front of the thigh, behind the knee or in the calf.  They can occur in one or both legs and the location can change from one episode to another.  They usually occur at night but sometimes occur in the late afternoon or early evening.  They can be severe enough to wake a child from sleep but are almost always gone by the morning.  They also feel better when touched or massaged, not worse.  The cause of the pain is not well understood.

Importantly, growing pains never come with swollen or red joints, fever, fatigue, weakness, rash, loss of appetite, limping or changes in usual daytime activity.  They also are not associated with injury.  If any of these symptoms are present, or if the leg hurts when touched, a child should be seen by his or her doctor to rule-out serious causes of pain that may require treatment by a physician.

If your child has leg pain and none of the worrisome symptoms listed above, then it may be nothing more than growing pains.  Growing pains feel better with massage of the area and gentle stretching of the leg muscles.  They may also feel better with warmth from a hot water bottle or rice sock.  Older children can use a heating pad though this is not safe in younger children.

Expect the pain to be completely gone in the morning, and for your child to play as usual without any limp.  If the pain persists, or recurs frequently, or if any other symptoms of concern are present, call your doctor for an appointment.

Older tweens and teens can get a different kind of pain associated with growing called apophysitis, or growth plate inflammation.  This pain differs from growing pains in several ways.  It usually occurs in the front of the shin or in the heel.  When it occurs in the shin it is associated with mild swelling just below the knee.  Pressing on the shin or the heel brings out the pain.  The pain occurs because inflammation in the growth plates caused by the rapid growth of the bones and muscles.  This pain tends to wax and wane for 1-3 years.  It is relieved by regular stretching and the occasional use of ibuprofen, and fully resolves once the period of rapid growth is complete.  Just like with growing pains, if the pain is severe or present every day, call your child’s doctor for an appointment to rule-out more serious causes of pain.

Dr. Daniels is a pediatrician and co-founder of Acorn Pediatrics in Bozeman.  She and the other pediatricians across the country strongly believe that routine vaccination is an essential part of a healthy childhood.  Parents are strongly encouraged to fully vaccinate their children to prevent diseases that can be deadly or cause permanent injury.  Some of these diseases, such as whooping cough, are still common in the United States.   Many less common diseases, like measles, mumps and meningitis, are increasing in frequency in areas where vaccination rates are inadequate.  Pediatricians understand that families receive vaccine information from a wide variety of sources that can sometimes cause confusion.  You doctor would be happy to discuss any vaccine questions that you may have.

Dr Daniels' advice was featured in the April issue of LEAP, a parenting supplement in the Bozeman Daily Chronicle.  here's a copy of the article:

Question: 

My son will start kindergarten in the fall.  He’s excited to go to school but a little nervous about getting shots.  What vaccines does he need, and how can I prepare him for the visit to the doctor’s office?

Answer:

Congratulations!  Kindergarten will be a great adventure for both of you! 

There’s lot to do to be ready to start.  You’ll have forms to complete, a birth certificate and immunization records to gather up, school supplies to purchase, and of course, the visit to see your child’s healthcare provider. 

During this important visit, the doctor or nurse practitioner will start by checking your child’s growth and development.  She or he will also test your child’s vision to be sure he can see well at school and at play.   Some offices will also do a hearing test.  Then your child will have a physical exam to check him over from top to bottom.  Many offices will also apply a few small dabs of numbing cream to the arms at this time to minimize the discomfort of the immunizations.

Then, he’ll be ready for his vaccines.  Provided that he has had all of his regular baby shots previously, he will get three shots (though some offices will give the same immunizations in four shots, instead of three).  All the shots are boosters, which means he has had them in the past, and the current doses of vaccine extend his immunity into the future, and in many cases create life-long immunity. 

* Shot #1 contains DTaP and Polio vaccine and prevents diphtheria, tetanus and polio, which thanks to effective immunization programs are all quite rare in the United States.  It also prevents pertussis, which is still relatively common.  Pertussis infection, also known as whooping cough, causes about 100 days of cough and when passed to younger children, can cause very serious, even fatal, illness.  This vaccine not only protects your child, but also infants with whom he comes in contact.  In some doctor’s offices, DTaP and Polio vaccine are given as two separate shots.

* Shot #2 contains MMR vaccine and prevents measles, mumps and rubella.  Rates of measles and mumps are increasing in the United States in locations with poor rates of vaccination.  Unfortunately, Montana was recently ranked as one of the worst states in the country for overall vaccination rates.  This puts all children at increased risk of vaccine-preventable illnesses since it is easier for epidemics to spread within the group.

* Shot #3 contains Varicella vaccine and prevents chicken pox and it’s common complications of scarring and skin infections, as well as it’s rare complications of brain inflammation and death.  This second dose of vaccine provides long-lasting immunity.

After the immunizations are given, most offices offer a special surprise of some sort to congratulate your child on being brave.

To prepare your child to have a good visit at the doctor’s office, let him know in advance all the things he can expect to do there.  Talk reassuringly about kindergarten shots.  Explain that they are a really important part of keeping him healthy now and when he’s older too.  If your health care provider is a pediatrician in Bozeman, you can tell your child about the numbing cream and reassure him that the shots will not hurt very much (if you get your child’s healthcare from another source, consider asking when you schedule your appointment about whether or not they use the cream).  It is best to be honest about the fact that he will be getting shots, and avoid promising that the shots won’t hurt.  Children will be more anxious about future visits if you aren’t truthful.  It might also be helpful to let your child know that he will not need shots for school again until he turns 11 or 12 years old, though we still recommend a flu vaccine (by shot or nasal spray) each year in the late summer or fall.

After all of that, your child will be ready to start his great new adventure of kindergarten!  Hooray!

Dr. Daniels is a pediatrician and co-founder of Acorn Pediatrics in Bozeman.  She and the other pediatricians in our region and across the country strongly believe that routine vaccination is an essential part of a healthy childhood.  Parents are strongly encouraged to fully vaccinate their children to prevent diseases that can be deadly or cause permanent injury.  Some of these diseases, such as whooping cough, are still common in the United States.   Many less common diseases, like measles, mumps and meningitis, are increasing in frequency in areas where vaccination rates are declining.  Pediatricians understand that families receive vaccine information from a wide variety of sources that can sometimes cause confusion.  Your doctor would be happy to discuss any vaccine questions that you may have.

Dr Daniels' advice was featured today in the LEAP parenting section of the Bozeman Daily Chronicle.  Here's a copy of the article:

RSV is respiratory syncytial virus, a common cold virus that is prevalent at this time every year.  In school-age children and adults, it causes cough, congestion, and runny nose.  In younger children, especially those less than 1 or 2 years old, it causes a more substantial illness known as bronchiolitis.  This is caused by inflammation of the tiniest airways in the lungs called bronchioles.  Infants will have cough, bothersome nasal congestion, and often fever for a few days.  Many will also wheeze (a high-pitched whistle when they breathe out), breathe faster than normal, and have a diminished appetite. The illness usually lasts 2 weeks.  A small number of infants will be sick enough to require a stay in the hospital if they need oxygen or intravenous fluids to treat dehydration. 

So how worried should you be?  In general, not very worried, but it depends upon the age and medical history of your little one. 

If your child is generally healthy and older than two years old, he is unlikely to have wheezing or difficulty breathing.  Kids in this age group generally need nothing more than typical treatment for cold symptoms:  lots of tender loving care, extra fluids to drink, and children’s ibuprofen (Motrin or Advil) or acetaminophen (Tylenol) if they have fever or sore throat.  Decongestants (like pseudoephedrine) and cough medicines (like dextromethorphan) are not recommended as they are generally ineffective.  If a child has fever for more than the first few days of the illness, or if the fever goes away and then comes back, he should be seen by the doctor to determine if he has a bacterial ear infection or pneumonia.

For younger children under 2 years old, careful observation for more serious symptoms is needed, though the vast majority will weather RSV without severe complications or need for hospitalization.  Babies at the highest risk are those under 6 months of age, those born prematurely, and those with chronic lung problems.  A young child needs to be seen by the doctor sooner if RSV is suspected, especially if she is breathing fast or drinking less than normal.  Call your child’s doctor or 911 immediately if she has any bluish discoloration to her skin. 

As with big kids, treatment of milder symptoms in infants and toddlers includes lots of love, encouraging fluid intake and use of pain relievers (acetaminophen ONLY for infants under 6 months).  Nasal saline drops are also useful to help clear congestion.  You can buy these drops, or make your own.  Drip 2-3 drops in each nostril.  Often the baby will sniff or sneeze and this moves the mucus and makes breathing easier.  I recommend using the drops frequently but avoiding the bulb syringe to suck the drops back out since this is unnecessary and painful for the baby.  Running a humidifier at night is also helpful.  As with older kids, a baby should be seen by the doctor if he has more than 2-3 days of fever, or if the fever goes away and then returns.  A significant portion of infants with RSV will get a bacterial ear infection during the course of this illness.  Though older children may resolve an ear infection without treatment, this is less likely for children under two years old and they should have a visit to the doctor. 

 NASAL SALINE RECIPE:

Stir 8 ounces of filtered or distilled water together with ½ teaspoon of salt and ¼ teaspoon of baking soda in a clean container.  Store the drops at room temperature and discard every 2 days.

Try this remedy FOR KIDS OLDER THAN ONE YEAR OLD:

Add the juice from half a lemon and 2-3 tablespoons of honey to 1 cup of warm water.  Stir.  This tasty beverage provides fluid to help thin mucus (making it easier to cough out of the lungs), Vitamin C to boost immune function and the magic of honey to soothe a sore throat and quiet cough. 

NOTE:  NEVER given an infant under 1 year old honey.