Pediatrics

Should we use antipsychotics to treat ADHD?

Conditions
October 19, 2014

Polypharmacy, or use of multiple psychiatric drugs, for treatment of attention deficit hyperactivity disorder (ADHD) is on the rise. A recent study compared treatment with basic therapy (stimulants plus parent training) with augmented therapy (those two plus risperidone, an atypical antipsychotic). The study concluded that treatment with risperidone was superior.

When children show dramatic improvements in behavior on risperidone, now being prescribed with increasing frequency for ADHD and a range …

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7 common reasons for refusing vaccines

Meds
October 3, 2014

The Centers for Disease Control and Prevention (CDC) reported that between January 1 and May 23 of this year, there were 288 cases of measles reported in the US. That’s more than the total number of cases in any year since 2000, when measles was eliminated in the U.S..

We have got to get more people immunized.

Essentially all of the cases were linked to “importations,” cases brought in from other countries …

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When your child doesn’t poop: Solving the constipation death spiral

Conditions
September 27, 2014

Michelle wrote in: “We trained my 3-year-old son approximately 3 months ago, and it’s been great. He’s been having virtually no accidents. The problem is that he’s terrified of making ‘dirty’ on the toilet. He does it in his pamper at night when he’s sleeping. He’s very verbal about it, and tells me that he’s scared to let the dirty come out. It’s really difficult to deal with because there …

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Stop calling nurse practitioners mid-level providers

Physician
July 14, 2014

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I really hate it when a nurse practitioner is called a mid-level provider.

“Mid-level provider” isn’t even a legal or academic term. It is slang developed to demean or minimize a health professional, who is not an MD.

The term “mid-level provider” is primarily aimed at nurse practitioners (NPs) as well as physician assistants (PAs) and midwives. It is insulting to health professionals …

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Reasons why your wait time at the doctor’s office is so long

Physician
June 16, 2014

Painful wait times at the doctor’s office.  It’s an old story with few exceptions.

As a dad, I have to deal with many of the same issues of parenting that you deal with: sleepless nights , fevers and holding my kids down for shots (my wife did it once, I think, then she promptly retired from this job).  However, waiting at the pediatrician is not something I have to do.  So, I can’t truly empathize …

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Should BMI be used to measure obesity in children?

Conditions
April 25, 2014

Stephanie wrote in about a very common problem:

My daughter is 4 years old. She isn’t the tallest cat in town (she is about the 15th-25th percentile for height), and her BMI always ends up being in the high range (like over 85%). I worry about it. I am very health conscious for myself and my family. We live by all of the “rules.” And yet.

The family doctor doesn’t worry — …

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Real men don’t leave their wives right after birth

Physician
April 20, 2014

News broke recently that Daniel Murphy, second baseman for the New York Mets, recently took two days off for paternity leave, causing him to miss Major League Baseball’s opening day and the season’s second game to be with his wife and child.

Mike Francesa, a popular New York sports radio personality, devoted about 20 minutes of his Wednesday broadcast on WFAN to a rant against paternity leave. According to him, a …

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A pediatrician’s survival story: Remembering the children

Physician
February 22, 2014

I have just turned on my computer. It is midnight. I should be trying to sleep right now.

My 5-year-old is sick and I am on call for the next few nights. Fortunately, my daughter should get better in a day or two. She needs Tylenol for her fever, mama’s love and time to kick this virus. But as I sat in bed holding her and waiting for her fever to break, …

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5 truths about fevers in children

Conditions
February 10, 2014

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The flu, RSV, colds, croup, strep throat, ear infections. They all have one thing in common: they can cause fevers. And as any parent can attest to, it’s often the fever itself that freaks us out more than anything and prompts many parents to call their child’s pediatrician or hustle them off to the emergency room.

Fever is clearly not a parent’s …

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Holding children back a grade and ADHD: A problem or solution?

Conditions
January 3, 2014

I’ve been skeptical of the trend of “holding back” children with late birthdays. These are kids, usually born in the summer, who are just a few months short of the next grade cut-off. Some parents wonder whether it would be wise to hold them back a few months, so they end up one of the oldest (rather than youngest) kids in their class. This might seem to confer an advantage …

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When children are abused by foster parents

Physician
December 26, 2013

I click open the x-ray viewer.  After 4 years in emergency pediatrics, I am not really surprised that a tibia fracture underlies the bruised ankle I unexpectedly encountered on physical exam.  Yet I audibly gasp as the chest x-ray loads.  The torso in question belongs to a chubby little cherub of a 3-month-old in room 11, brought in for red eyes.  I begin to count the fractured ribs — 1, …

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How to talk to a child with autism

Conditions
December 25, 2013

The holiday season means most of us will be socializing with colleagues and neighbors, friends and family.  Chances are good this circle of friendly acquaintances and loved ones will include a child with autism.

Why? An estimated 1 in 88 children are now diagnosed with the neurological disorder, with a four times prevalence for boys.  Among other challenges, those with autism often have difficulties with social communication (be it verbally or …

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Treat your child’s fever before the doctor’s appointment

Conditions
December 24, 2013

It’s the beginning of cold and flu season. That means a lot of kiddos, big and small, are coming to the office with fever.

As docs, we know that fevers can freak moms and dads out. Kids look pretty awful when their temperature climbs, and it is understandable that parents want to bring them to the office for an evaluation.

In the exam room, I often hear worried parents …

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Going the extra mile for patients: How friendly is too friendly?

Physician
November 22, 2013

Recently, a family in my practice decided to move out of state, back to where they had lived before. When we said goodbye, the mother said that she was sad to change pediatricians. The pediatrician they would be returning to, she said, “only takes care of strictly medical things.”

Clearly, she meant that I take care of more than the strictly medical things. I was flattered, especially since this was something …

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Asthma in children: A complete primer

Conditions
November 15, 2013

Asthma is a common problem in children — nearly 10% now have it — and the number is increasing. Researchers are not sure of the reasons for this steady increase, but decreased air quality, lower activity levels among children, and an increase childhood obesity have all been implicated. Whatever the cause, it means that millions of American children take medicine for asthma. A significant number of these children end up in …

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Radiation from x-rays and living in Denver: They’re not the same

Conditions
October 9, 2013

My kids were at the dentist this weekend for their routine cleaning and check ups (yes, Saturday hours!) when the hygienist mentioned x-rays. I smiled and mentioned I’d rather discuss the need with the dentist after his exam. This isn’t a dental x-ray thing, this is what I do for every test that involves ionizing radiation.

My son, Oliver, has had more radiation than most people will have. Ever. In fact, …

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4 myths and truths about milk

Conditions
October 2, 2013

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We’ve heard some interesting things about cow’s milk over the years. I am going to share with you four myths about milk that I continue to hear from my patients’ parents.

Myth #1: Don’t give milk to a child with a fever; the milk will curdle (or some other variant).

Truth: As long as your child is not vomiting, milk is a perfectly acceptable …

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