A Basic Review of Eczema & A New Blankie

Eczema (also known as “atopic dermatitis”) is a skin condition where allergens or other irritants make your child’s skin itchy, red, rough, and/or flakey. Doctors sometimes refer to it as “an itch that rashes” because the scratching or rubbing usually comes before any changes in the skin. In its mildest form it is often just considered “sensitive skin”, but in its most severe form it can require hospitalization and serious drugs to alter a child’s immune system.

In order to prevent an eczema flare, or to relieve mild irritation, it is important to keep the skin moisturized, as well as avoiding “triggers” which the skin responds to by becoming inflamed. Common triggers are: chemicals, harsh soaps or cleaning products, perfumes/fragrances, dyes, synthetic fabrics (e.g. polyester), wool, sweat, dry air, stress, sudden temperature changes, and anything the child is allergic to (e.g. food allergies and/or pet dander).

How do you avoid so many things? For serious eczema, an allergist can help you identify specific triggers that make your child’s eczema worse. However, everybody can take some simple steps to help their child with sensitive skin:

1. Daily bath to clean the skin. Eczematous skin gets infected easily, since open areas take away your immune system’s biggest barrier. Use warm water (not too hot or cold), and bath briefly, since long baths can make the skin worse. Use soap-free cleansers (e.g. original Dove bar or Cetaphil). As soon as the child gets out of the bath, pat the skin dry (rubbing makes things worse) and cover it in a layer of moisturizer (ointments lock in the moisture best, which is why so many people love Aquaphor for their sensitive skin).
2. Always use dye-free, fragrance-free soaps and cleansers, especially for the laundry. Many people use Dreft detergent for their baby’s clothes, but this is full of chemicals. Run all of the baby’s laundry through an extra rinse cycle to be sure to get rid of any chemical residue.
3. Re-apply your moisturizer (e.g. Aquaphor) a few times a day.
4. Keep fingernails short to avoid scratching.
5. Many older children (and adults) with eczema report their symptoms worsen at night, so make sleeping conditions as comfortable as possible. A cool mist humidifier can help keep the air cool and moist. Use distilled water in the humidifier, do not use any menthol or scented discs in it, and clean out the reservoir with vinegar every 3 days. Children age 2 and older may be helped by taking an antihistamine before bed (discuss this with your pediatrician before giving it to your child).

Babies have a larger surface area to body mass ratio then older kids/adults, and their skin is thinner. This makes them especially susceptible to irritants, and you want to avoid using medicated creams as much as possible, since more is absorbed into their system then in older children/adults. 

A mother whose baby has severe eczema created a blanket to help relieve her child’s skin irritation, and she gave me a blanket to try out. It is the Elli & Nooli Organic Cotton Pique Blanket (http://www.amazon.com/Loopiblanket-Organic-Blanket-Pacifire-Fastner/dp/B008MBMYZ8/ref=sr_1_2?s=baby-products&ie=UTF8&qid=1346005373&sr=1-2&keywords=elli+%26+nooli). 

I brought it to work to try with a few patients, and then brought it home to my toddler son. It is designed for infants, but since it is big enough to swaddle them comfortably, it is actually big enough (30” x 40”) to cover my toddler in bed (although he will soon outgrow it). This is now my son’s favorite blanket, and since giving it to him over a month ago, he insists on using it every night to sleep. He reports that it is “comfy”. The certified organic cotton means that it is less irritating than other fabrics, as well as being chemical-free and pesticide-free. The pique weave (tight weave forming raised mini squares all over) keeps air flowing under the blanket, and even allows some air exchange through the blanket. It keeps my child warm, without over-heating, so he is not sweating at night, despite living in a house with no air conditioner during a heat wave (for the past 2 weeks only, we are moving soon). Overall, I really like this blanket, and would recommend it for babies with sensitive skin.

Please note that although this post mentions many brands (e.g. Dove, Cetaphil, Aquaphor, Elli & Nooli), this is NOT a sponsored post, and I have no financial stake in any of these companies.

Coughs, Colds, and Croup

Even though it's a beautiful summer here in Southern California, we are still seeing some coughs, colds, and croup, so here are my tips to help keep your family comfortable as they clear their viruses:

Helping a child with nose congestion:

-          Use a nasal saline mist (such as Little Noses nasal saline mist) to spray moisture into each nostril and help clear her out. I like the mists more than the drops because you can hold the canister right below her nose and spray it in, without touching the canister to the actual nose, and without sticking anything directly up the nose. These are also sterile, so you don't have to worry about the water source.

-          Use a humidifier. Only put distilled or sterile water into it (not tap water). Clean it at least every 3 days. Do NOT use the menthol or eucalyptus discs/drops that come with some humidifiers.

-          If she suffers from allergies and is over age 4, you can use an over the counter antihistamine to help decongest her (e.g. children’s Benadryl). Under age 4: ask your pediatrician about these. Do NOT use the over the counter medications known as “decongestants” or “medicated cough syrups”, as these have been shown to have more risks than benefits in children under age 6 years old.

-          If he is very congested you can steam up your bathroom and sit in the bathroom with your child. Make sure the air is okay and the child does not have any access to the hot water. Never leave a child alone in the steam!
-    If you want to, you can use a vapor rub on the feet or chest of a child. It has not been proven to help or hurt. However, do not let the rub get near her nose or mouth! Vapor rub placed under the nose has been reported to cause wheezing in some children, and it is dangerous to ingest. Call poison control if your child eats any of this, or gets it in their eye 1-800-222-1222 (an important number to keep in your cell phone for emergencies).

-          Children under age 2 years usually can not blow their noses, so help decongest them (e.g. get the boogies out) by using a Nose Frida (http://www.fridababy.com/) which is a device you put in the nostril and use to literally suck the snot out. Sounds gross, but there is a filter (which needs to be changed every day) which prevents you from getting any snot in your mouth. You can do this before feeds and before sleep, or just as needed to clear out the mucus in your baby’s nose. I like this better than traditional nasal aspirators because it’s much easier to clean, is difficult to put it too far into the baby’s nose, and it gets a lot more of the snot out. The key to good suction is to hold the other nostril closed, when you suck out boogers from the first nostril (should take less than 1 second).

The Snot Sucker

Helping a child with a “wet” or “phlegmy” cough:

-          Do all of the above for nasal congestion plus the following:

-          Have her sleep propped up at 30 degrees so the mucus drains easily (if over 1 year of age).

-          Give children over age 1 year a big spoonful of honey twice a day. The honey has now been shown to help relieve cough symptoms in kids & help them sleep, in 2 published randomized control trials (scientific studies). The honey they used was NOT "raw", which can have dangerous bacteria in it.
-     Warm liquids, such as chamomile (caffeine-free) tea and lemon, or chicken soup, can help people feel better. 

-          Zinc may help shorten colds and soothe sore throats, but this has not been proven conclusively. You can get this in some non-medicated cough syrups, such as Zarbees (for over age 1 since it also contains honey), or in zinc lollipops (over age 2, observing child while they eat them) at CVS (I haven’t seen them anyplace else- let us know in the comments if you find them in other places). If he is over age 7 years you can give him the zinc cough drops that are available at all pharmacies.

Helping a child with a dry, barking, or croupy cough:

-          Do all of the above for nasal congestion & wet coughs plus the following:

-          Use a cool-mist humidifier. Use distilled/sterile water in it. Clean it at least every 3 days by rinsing out the water tank with distilled vinegar and then washing that out.

-          If the child is having a coughing fit, or breathing like Darth Vader, take him for a walk outside in the cool air, or hold him in front of an open freezer for a few minutes, to reduce the swelling in his throat. If that is not helping, call your pediatrician for immediate medical advice, or call 911 if he is actually having trouble breathing.

Check out other mom pediatrician blogs on the topic, such as this one from Dr. Stuppy:
http://pediatricpartners.blogspot.com/2013/12/but-snot-is-green-or-how-can-we-treat.html

Other Important Stuff:

-          If your child is wheezing, noisy breathing, breathing hard, breathing quickly, breathing with flared nostrils, or other signs/symptoms not mentioned, please call your pediatrician or 911, or take them to the ER immediately. This information is not intended to act as a substitution for speaking to your physician or using common sense!

-          If your child is breathing so hard that they have trouble walking or talking, or if their lips or fingernails turn blue, please call 911 for immediate medical assistance.

-          Some of the products listed above can be found on my pinterest health board: http://pinterest.com/motek42/kids-health/. I have not been paid to review any of these products and I do not get money from their sales- I am just letting you know what has worked in my experience.

Traveling with Children

Fortunately for us modern moms and dads, anywhere we want to go is just a plane, train, or automobile ride away. Despite the conveniences of modern transit, traveling with children remains a difficult endeavor. Here are a few tips to make your journey a little smoother:

1) Know your rights.
This sounds funny, but a lot has recently changed in U.S.A. airport security rules. For example children under 12 do not need to remove their shoes during screening. According to the TSA's website, you may carry as much juice and milk for toddlers as you "need until you reach your destination". The precise definition of how much you need varies by who is screening you at security.  During one trip with my then 1 year old, the security agent at LAX insisted that 3 small juice boxes was too much for a 5 hour flight, and threw all of our drinks away. I did not know enough to argue and instead I spent $$$ buying some non-organic, non-dilute juice for my child at the airport :( This also brings up the point to remember to be flexible, and give your self extra time for the unexpected.
For the latest information, check out the government's website:
http://www.tsa.gov/travelers/airtravel/children/index.shtm

2) Know your company.
Certain airlines and hotel chains are better at hosting children than others. Conversely, some airlines have recently banned children from first class on their flights, so don't expect an upgrade (or even friendly service) on those airlines. Malaysia Airlines is going to institute a "child free zone" even in their economy cabin on some flights. In general, European and Asian companies have been known to be friendlier to children on flights than USA airlines, often providing coloring books, special snacks, small toys, and other treats for families. Some airlines offer pre-boarding for families with infants and toddlers, while others have none. This may be more annoying than you think. When traveling with our then 2 year old, we had to wait until first class, business class, and everyone with a silver/gold card from the airline boarded (more than half of the passengers) before we were allowed to get on with a toddler, car seat, and hand luggage. Trying to get past the tiny aisle with people everywhere and a large car seat was not fun, and I think it disturbed the other passengers as well. Allowing us to board early, install the car seat and settle in would have prevented a lot of hassle for everyone. However, when we got to our destination we stayed at a hotel that provided us with squeaky bath toys and other amenities in the room that made us feel like family.
Here is a recent article from yahoo on the most family friendly airlines:
http://travel.yahoo.com/ideas/best-airlines-for-families.html

3) More tips just for flying with children:
- Try and book a flight with as few stops as possible, as take-off, landing, and boarding are the toughest times.

- Make sure you have assigned seats together in advance. Many companies have been separating families on flights, and then you rely on your fellow passengers to switch seats so you can sit together.

- I take our car seat when flying with my son, to make sure he is strapped in securely during our flight. This also ensures that he has a safe car seat for automobile travel when we arrive at our destination. It is also easier for him to fall asleep during the flight in his car seat, and more difficult for him to annoy other passengers by kicking them or climbing on the chairs. We use a GoGo Kidz Travelmate to turn the car seat into a stroller at the airport.

- To avoid pain from the changes in pressure in the ear during flights, teenagers and adults can chew gum or drink water to encourage swallowing, and thereby open up the eustachian tubes in their ears to relieve the pressure. For babies the best way to do this is breast (or formula) feeding. Breast (or formula) feeding has the added bonus of providing sugar to the infant, which is a natural pain reliever. For toddlers, diluted juice in a straw cup works well. Older children can suck on lollipops to get them swallowing (and happy and distracted by candy). Nasal sprays can also help relieve congestion and prevent pain during the flight, but speak to your pediatrician about this (salt water sprays can help babies with stuffy noses, while kids with ear infections or sinus problems may need a prescription nasal spray). If all this ear tube talk is confusing, check out the ear anatomy pics here:
http://pinterest.com/motek42/ear-infections/

- I recommend waiting as long as possible before flying with infants. The younger an infant is, the less developed their immune system, and the more likely they are to get sick. The air on airplanes is re-circulated so it is very easy to pick up germs from other travelers, even ones who are seated far away from you. Infants younger than 2 months old who catch an illness with fever may have to undergo extensive testing, including blood, urine, and spinal fluid exams if they get sick. I know this is not possible for all families, but waiting until your infant is 9 months or older can save you a lot of hassle and illness later on. In addition, the USA is currently experiencing a surge in measles cases, most of which can be traced to foreign travel- see these links for more information:
http://www.reuters.com/article/2012/04/19/usa-health-measles-idUSL2E8FJDSD20120419
http://wwwnc.cdc.gov/travel/page/measles-for-air-travelers.htm
And don't forget to check the CDC website, and make an appointment with your pediatrician at least 2 months prior to any foreign travel, so you can get medications and vaccinations for your trip.

4) Have your bags packed with items that will keep your child calm, quiet and comfortable. 
I prefer small, light items. If you are used to distracting your child with your phone or other electronic items, keep in mind that you will not be able to use them on take-off or landing, and they might run out of batteries on long car trips, so make sure to pack low-tech items as well. I recommend packing a carry-on or car bag with:

• baby wipes (good for cleaning up messes for kids of all ages)
• snacks
• your own sippy cups or bottles
• four more diapers than you think you need
• several different sizes of ziplock bags (for messes, soiled clothes, soiled diapers, and they are just generally handy to have)
• a medical bag (children's acetaminophen, children's ibuprofen, children's benadryl, bandaids)
• sunscreen (the sun through a car's windows can burn a child, and then sun through a plane's window has more radiation than down on the ground, so slather yourself and your child with sunscreen to avoid sunburns and -much later- skin cancer)
• lollipops for age 4 and above
• extra clothes (even for older children, as it's easy to get spilled-on during a flight or car trip, and you never know if, when, or where you'll get stuck)
• books
• re-usable stickers
• dry-erase crayons and board
• a soft blanket
• your child's lovey (favorite blankey, stuffed animal, or other comfort item). 

I've linked to a few of these items, as well as book suggestions, on pinterest:
http://pinterest.com/motek42/traveling-with-children/

This blog has many more great travel tips, and this link is for a funny story illustration why you shouldn't feel bad about that huge carry on with all of the extra supplies:
http://eatpackgo.com/pack/pack-diaper-ninja/

Traveling with children is a lot more stressful than traveling alone, but with patience, planning, and a large bag it can be a fabulous adventure.

Have any good tips or links of your own? Please tell us in the comments!

(photo of my son in his car seat, looking out of the airplane window, photo taken by me 2009 (c) )

Preparing for a Perfect Pediatrician Experience

Taking your precious baby to the doctor can be a harrowing experience, but with a little preparation, it can go as smoothly as a baby’s bottom. Here are some tips for getting your children, and yourself, ready for your next visit:

1)      Prepare your children in advance by reading books about going to the doctor, so they know what to expect. This is especially important for toddlers, who are old enough to remember prior visits involving shots, but is also good for older children.  Try to do this far in advance of any appointment, such as having a regular bedtime story about visiting the doctor, so your child considers it a regular thing. If your child loves a certain character, e.g. Elmo or Dora, read them a book involving that character’s visit to the doctor. Otherwise, I recommend books like the Usborne First Experiences series. I pinned links to these books (and others) on my pinterest boards (http://pinterest.com/motek42/).

2)      Get a doctor play set and have your child practice using the stethoscope, otoscope (ear light), and other tools on their family members and stuffed animals.

3)      If your child has a “luvvy” (special blanket or toy to make them feel comfortable), be sure to bring it with you to the visit, even if they only use it in bed at home. This will help comfort them.

4)      For young children, bring a doll, so the physician can check the doll first, lessening the fear the child may have about the medical tools. You can also have the doctor check mommy or daddy first, but in my experience children are comforted more by having their doll checked then their parents. It works even better when the doll has ears and a mouth that opens.

5)      Bring snacks and drinks. You never know if you will have to wait a while for the doctor to see you, or just sit and wait for a test result. Sugar has been found to be a natural pain reliever in babies, and I find that breast milk or formula for babies, juice or a lollipop for toddlers, calms them down faster than anything else after shots. One caveat- do not let them eat/drink during the visit, especially if they will have their throat checked (like for sore throat or tummy pains), as the food pieces can get in the way of the doctor having a good look, and can interfere with tests, such as the one for strep throat.

6)      Bring diapers, wipes and baggies for soiled items (these are good things to have in your bag at all times, prior to school age). You can not rely on your pediatrician having the size or brand of diapers your child uses on hand. Wipes come in handy for many things, not just cleaning little butts, and the pediatrician visit often brings out the snot, spit-up, and other fun stuff. Help the next patient have a more pleasant experience by placing any soiled items in a sealed bag, so the room does not smell bad. An extra baggy also comes in handy for soiled clothes and toys.

7)      Dress your child appropriately, and bring a blanket. Clothes that are easiest to remove or lift-up are best. No need to dress fancy. You should also bring a small blanket to cover your baby, since they will likely have their clothes removed for vitals signs (measuring) by the nurse, and you don’t put them back on until after the physician has checked your child. If you have an older child, at least have them remove any jackets and tight or complicated clothing.

8)      Bring ANY MEDICATION you have given your child, even if your doctor prescribed it, it is herbal, or over-the-counter. This is the best way to avoid diagnosis and medication errors.

9)      Entertainment. Quiet books, reusable stickers, or even movies on your phone are a good way to keep children quiet while waiting for the physician or nurse. These can also be good tools for calming children down if they get upset during the visit. I do NOT recommend these as temper tamers for everyday use, but they are fine on special occasions.

10)   Don’t forget a list of questions to ask the doctor, so you make sure to get the most out of your visit. You may also want a paper and pen to write down any diagnoses or instructions, so you don’t forget how much ibuprofen you are supposed to give when your toddler wakes up screaming at 3am. If your doctor has not brought it up, you may want to ask them what do if your child worsens, and when to return.

11)   If you need a copy of vaccination records or school forms, contact the office in advance, and do not forget your paperwork! You should also bring your insurance card (if you have one and expect the insurance to cover your visit) each time.

12)   When possible, try to schedule your visits for the first time slot of any shift, so that you can avoid a possible wait if the office gets backed up. You should also try to schedule visits for the middle of the week, or early afternoon, as Mondays, Fridays, weekends, and evenings tend to be the busiest times in the office. Alternatively, you may want to try the last appointment of the day. This will have the greatest chance of having to wait, but then neither you nor the physician feels rushed.

13)   Give yourself an extra 15 to 30 minutes to get to the appointment, find parking (or deal with public transportation delays), and complete any forms.

14)   Finally, try to relax! When you have a positive attitude, your child will feel better too J

Have any tips of your own? Please put them in the comments!

(my son becomes comfortable with the stethoscope at home (c) )

Interviewing a Pediatrician

Recently, one of my friends asked me what questions she should ask when interviewing a prospective pediatrician, so I thought I'd share my answer with everyone:

1) What insurance do you take?
Of course, this is only important if you're using insurance. I know several families now that have health insurance for emergencies, but pay for general health maintenance out of their own pockets. This reduces their overall medical expenses (because they have a cheap insurance plan, only for emergencies), and allows them to see whatever doctor they like. These families usually use free clinics for vaccinations, or pay out of pocket. This only works if your family is healthy. If you choose the latter option, ask about visit prices instead.

2) What hours is the office open for well visits? For sick visits? When is your chosen primary pediatrician actually in the office during the week?
Keep in mind that the smaller the office, the less hours they are usually open. So if you want to do well visits at night or on weekends, you will probably have to go with a very large practice, and may be seeing a different doctor (or nurse practitioner) each time.

3) Who covers for your physician when they are not in the office, not on call at night, or they are on vacation?
For night call, is the person on the phone a physician from your practice, a physician from another practice, or a physician extender (NP or PA) or nurse?

4) Do you use electronic medical records?
These can reduce errors, and allow the physician on call (if they are a doctor from the same practice) to access your chart at night and on weekends, if needed.

5) Can I always get a same day sick visit appointment?

6) Who answers regular questions by phone during the day? What I mean by this one is, does your pediatrician call you back if it is not urgent? Does a nurse handle most questions about illnesses on the phone? Does another physician answer the phone when your physician is not available?

7) Are there any physician extenders (nurse practitioners or physician assistants)? Are they the ones to see you for same-day sick visits or phone calls, or will your physician or their partner see you?

8) Are there separate sick and well waiting rooms? Are there separate sick and well exam rooms?
This reduces the chance of your baby being exposed to a virus

9) What is your vaccine policy?
If the physician allows un-vaccinated children in their practice, consider that your baby (who is too young to be vaccinated for certain diseases) may be exposed to somebody in the waiting room with measles, chicken pox, etc...

10) How often do you see the baby for child for regular check-ups?
This can actually vary quite a bit between pediatricians for the first 3 years of a child's life. After that, your child is seen for an annual well check every year.

11) Do you have a website? Do you use email to communicate with patients?

12) What hospitals do you cover? Will your chosen primary physician be the one to see your baby everyday in the hospital (when they are born and if they are admitted later) or will one of the covering physicians see them?

13) What kind of parenting resources can you offer?

14) Where is the best place to park or closest public transportation stop?
I have found (at least in big cities, such as LA and NY), that the best place to park for my doctor appointments is often somewhere other than the valet parking in the medical building. The website or administrative assistants at your pediatrician office should be able to tell you the best (free) place to work, as well as help you get there by public transportation, if that's your preferred mode of transport.

That's all I can think of for now, but please leave your tips in the comments section!

[My son is too young to be your pediatrician right now, but isn't he cute? ;) (c) ]