Ask the Pediatrician
Easing Your Child’s Anxiety at the Doctor’s Office
Contributed by Dr. Jaime Friedman from the CPMG office in 4S Ranch
Pediatricians have all been there — the child is screaming, the parent is anxious, and the exam just isn’t getting done. During a busy day, it’s hard to wait for a parent to calm their child for an adequate lung or ear exam, so now the doctor is anxious! There are preparatory steps that a parent can remember to make a visit to the doctor more comfortable for the little patient:
- Prepare your child in advance. Let him/her play doctor with a set of toy doctor tools. Bring the toys with you, or bring a stuffed toy for the doctor to examine.
- Don’t lie about shots or promise that there won’t be any if you are coming for a well visit. The immunization schedule is always being updated and boosters get added. The shots are usually built into the well visit and are part of preventative care, so that is the best time to get them done if they are needed.
- Make sure you can hold your child for the exam, even if they are freaking out. The exam will be faster and more effective if your child is still.
- Avoid saying “it’s ok” or “it won’t hurt.” It is better for your child to hear you validate his/her emotions and know that being scared or nervous is actually ok. They don’t have to like or enjoy what’s being done to them.
- It’s ok to have a “lovey” or favorite toy with you, or even a song or movie on your phone to distract your child.
We understand that coming to see us can be scary. Let’s face it, the wait is boring, we use big words and there may be something painful coming.
But when it’s all over, we both want what is best for your child, which is to have an accurate exam and diagnosis. The best way to make that happen is for your child to be at ease and cooperate as much as possible. If that means a little bribery is needed (do I hear sticker and lollipop?), well, I’m not going to object!
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Is My Kid Normal?
I am not happy about it, but my 6-year-old son still wears these at night.
Unfortunately, I know at least three 8-year-olds who are also nighttime bed wetters, so this could be a problem for two more years minimum. 🙁
Although I’ve read a lot about it on my own and have surveyed lots of friends, I just have to ask a pediatrician for help. How can a mom get her child who is potty trained during the day out of diapers/pull-ups/bedwetting underwear at night?
The Mom’s Guide is partnering with Children’s Physicians Medical Group to answer child health and developmental questions, starting with mine.
Pediatrician Whitney Edwards, M.D.: Being dry at night has very little to do with being toilet trained and typically is not behavioral. Like night terrors and sleep walking, prolonged bedwetting is generally a manifestation of deep sleep.(This is different from the situation in which a previously dry child begins to wet the bed again, which deserves an evaluation.)
20-30% of five to six year olds are still not dry at night. If your child is still wetting the bed at age six, or the bedwetting is causing problem in the family, discuss options with your pediatrician.
Do you have a developmental or health concern that you’d like a local pediatrician to address? If yes, please participate in our new feature, “Ask the Pediatrician.” Post your question here or send it anonymously to firstname.lastname@example.org and a mom’s guide pediatric partner will provide an answer and, hopefully, give San Diego moms a little peace of mind.
San Diego Pediatrician & Mother Talks About the Flu Vaccine
Earlier this winter the mom behind the Mom’s Guide (me!) started to wonder if giving the flu vaccine to her family was necessary and, more importantly, safe. Just mentioning my concern on Facebook started a big debate. One of the 6,000 + followers of that page is San Diego mom and Children’s Physicians Medical Group pediatrician Jaime Friedman, M.D., and she asked to be able to present the medical facts. Of course I welcomed Dr. Friedman’s input, and I hope you do as well…
As a local pediatrician, and part of the medical group that partners with the Mom’s Guide to San Diego, I felt it was very important to respond to a recent thread of posts on the Mom’s Guide Facebook page regarding flu vaccines. The media often highlights extreme medical cases for the sake of the “story”, sometimes without providing thorough information on the topic for the viewer to come to their own educated conclusion.
Every year many thousands of people become ill with influenza. Of those, hundreds to thousands die. Unfortunately, while the very old, very young and chronically ill are most severely affected, many who die of influenza are perfectly healthy. Influenza should not be confused with the common cold or a viral illness causing vomiting and diarrhea. It is more severe, causing sudden onset of high fever, body aches and fatigue. Many people also experience a cough, headache, sore throat, or diarrhea. The illness is very uncomfortable and can result in pneumonia, bronchitis or sinusitis. It also can exacerbate chronic illnesses including asthma. Most people are sick for 1-2 weeks.
The best ways to prevent the flu are good hand washing and vaccination. The vaccine was first introduced in the 1940s for the military. Since then it has repeatedly been perfected and proven to be safe and effective. In fact, each year the vaccine is altered to keep up with the mutating virus. The vaccine works by introducing proteins from the surface of the virus into the body so that the individual can make their own antibodies to the virus. The injected vaccine is NOT a live virus and one cannot get the flu from the vaccine. Because the vaccine is given during respiratory virus season many people develop other illnesses around the same time as vaccination and mistake that illness for “getting the flu from the shot”. Also, it takes 2 weeks for the vaccine to be effective so exposure to the virus around the time of vaccination can still result in illness. Some common side effects include soreness at injection site, feeling achy and low grade fever for 1-2 days. These symptoms are far less severe than actually having an influenza infection. There is also a live attenuated vaccine available that is sprayed into the nose. While this is a live virus it is weakened so that it does not cause infection. However, side effects may be more prominent than injection, including runny nose, headache and wheezing. It should not be given to people with a history of asthma.
While serious reactions, such as allergy or anaphylaxis, are rare they do occur. Do not get the vaccine if you have had a reaction in the past or if you have a severe allergic reaction to eggs. Signs of a severe reaction include hives, paleness, dizziness, difficulty breathing and racing heart rate. The number of severe reactions to the vaccine is far less than the number of severe infections that occur every year.
Here at Children’s Physicians Medical Group we believe that vaccination is safe and the best way to prevent infection. Our doctors offer the vaccine to children 6 months and up. For more information, and to determine which type of flu vaccine is best for your child, please contact your pediatrician or go to the CDC website www.flu.gov.
The Sunscreen Brands Recommended by Local Pediatrician
Most parents remember to put sunscreen on their kids when going to the beach or pool, but sunscreen should be used every day. As a rule of thumb, sunscreen should be applied daily, and not just on sunny days. It should be applied every two hours while outdoors and more often if your child is sweating or getting wet.
Protecting against UV rays requires a lot more than sunscreen alone. In addition to wearing a good sunscreen, you still need to take other precautions. Keep your kids in the shade when possible, and stay inside when UV radiation levels are highest. Have your kids wear a hat and sun-protective clothing, preferably with a UVP (ultraviolet protection rating) on the label. And most importantly, babies under 6 months should be kept out of the sun altogether.
Need help choosing a sunscreen? First and foremost, make sure it’s kid-friendly. The sensitive skin of babies and children is easily irritated by chemicals in adult sunscreens, so avoid sunscreens with para-aminobenzoic acid (PABA) and benzephenones like dioxybenzone, oxybenzone, or sulisobenzone. Children’s sunscreens use ingredients less likely to irritate the skin, like titanium dioxide and zinc oxide. Unlike chemical ingredients, these protect babies’ skin without being absorbed.
For children 6 months and older, look for a sunscreen designed for children that is labeled “broad spectrum,” to ensure that they are protected from both UVA and UVB rays. The AAP recommends using a sunscreen with an SPF of 15 or higher, but many experts (as well as myself) recommend an SPF of 30 or higher.
There are plenty of options to choose from, so here’s a quick list of my favorites: Aveeno Baby, Neutrogena Pure and Free Baby, California Baby, Mustela High Protection Sun Lotion, and Blue Lizard. All of these offer excellent protection, are safe on sensitive skin, and are chemical free.
One final note, remember, sunscreen doesn’t work unless it is applied generously and often, even on cloudy days!
Have a great summer—Dr. Gina Rosenfeld