Stashing Behavior, Yeast Infection, and Lazy Eye – PediaCast 082
- How Old is Too Old to See a Pediatrician?
- Stashing Behavior
- Flat Heads
- Yeast Infections
- Lazy Eye Comment
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Dr. Mike Patrick: Bandwidth for PediaCast is provided by Nationwide Children's Hospital. For every child, for every reason.
Announcer: Welcome to PediaCast. A pediatric podcast for parents, the Listener Edition. And now direct from Birdhouse Studios, here is your host, Dr. Mike.
Dr. Mike Patrick: Hello everyone and welcome to PediaCast. A pediatric podcast form moms and dads. This is Dr. Mike, coming to you from Birdhouse Studios. And as always, we'd like to welcome all of you to the program. It is episode 82 for Friday, November 16th 2007. Teenagers, flat heads, and yeast infections.
I have to tell you folks I am really glad it's Friday. Because this what we call, in my office, it was my full week. And what that means is I did not have a call night. So there was no night this week that I was on call for a practice. Now, we have a pretty big practice. There's six pediatrician all together. We have a very large patient population. So being on call is pretty busy. So you think that a full week will be nice because you don't have any call. The only problem is, the way we work our schedule is when you have call, you have the morning off that you're on call. And then you have office hours in the afternoon. Just seeing sick visits and you have office hours in the evening till about 10:00 at night just seeing sick patients. But then the next day, you just work in the morning and you have the afternoon off. So, even though you work in the evening, you got a morning off and then afternoon off each week which is fantastic especially working on PediaCast. But on a full week, there is no call, so I have to work basically nine to five, Monday to Friday.
Now, I know the rest of the world works nine to five, Monday to Friday, but when you're seeing 48 kids in an eight hour day, five days in a row, during cold and flu season, it's very, very hectic to say the least. Some of you may be wondering why I have not mentioned anything about Stickam here recently. They're for a while, every show we were recording, we're putting up live on Stickam as I recorded it and you'll noticed we haven't done that for a while. And the reason that we haven't done that is actually, I've been having some technical difficulties with Stickam. Not, with the video but with the audio. It tends to cut in and out. And I'm still trying to figure out exactly why that is. I think it has something to do with Flash player settings and the way that I'm recording it with Garage Band. And so, they're having some technical issues with that. But hopefully we will get those ironed out soon or we may look for a different way to provide the show live to you. We're exploring some options out there.
So, anyway that's the reason we haven't said anything about it. We still would like to get the show out live for people who are interested in interacting with the show that way. Maybe with a chat window and you can ask questions during the show, that sort of thing. So, that's we're working on it. It's in the pipe and we'll see how it goes.
All right, so what are we going to talk about today? Well, how old is too old to see a pediatrician? Stashing behavior, we'll talk about that. Flat heads, yeast infections and we have a listener who made a comment about lazy eyes, that's all coming up. Don't forget if there is a topic you would like us to discuss, if you have a question, a comment, a concern or a request any of these things, just go to pediacast.org and click on the Contact Link. You can also email email@example.com, make sure you let us know where you're from when you send your email or call the voice line at 347-404-KIDS.
Now, I know I've mentioned this before, but I prefer to do the show live and not edit in the music mixes and all that. I just want to do the show. And so I had to explain there, I got a little trigger happy with my finger as we were leaving that first segment, so, I guess that is one of the consequences of not liking to do post production.
All right, our first listener is Renee from Eugene, Oregon. And Renee says, "Hi, Dr. Mike. I have a question about how long a child uses a pediatrician. My husband and I are pregnant with our first due Christmas day and are in the process of getting recommendations for a pediatrician. We have a number of good leads so far. Last night my husband asked if I have a preference of gender for our pediatrician. And honestly it had never occurred to me, however in that moment I also remembered an incident with my own pediatrician".
"He was a very nice man who I liked throughout my childhood at around 11 I think I had to get a physical either for school or for sports. My mom took me to the pediatrician and I remember it being one of the most uncomfortable and as an 11 year old, humiliating experiences of my life. Just to clarify nothing inappropriate happened. My mother was there the whole time. It was just the shyness of my new self-awareness as a preteen that made the experience very uncomfortable for me. A bit after that I switched to an adult doctor who is a female and since then I've always had female doctors. I'm completely comfortable taking my daughter, we know it's a girl to a male pediatrician. I was just curious how long children usually stay with a pediatrician and where they go afterwards. It's seems a bit early for a ten year old to see a gynecologist which she just go to my general practitioner then? Note, I'm one of those rarely sick people so I haven't even seen my own GP, like five years and that was because I cut the tip of thumb off with a knife".
You know Renee, you go off on tangents just like I do. So, I'm loving it. "Do you have any experience with this issue in your practice? If there are women doctors in the practice, could my daughter stay with her pediatrician but simply see the woman doctor for physicals when she gets to be a preteen age. Any ideas or suggestions. Thanks Dr. Mike. Love the show. Renee".
All right, well Renee thanks for your question. There are several of them there. First I want to say, I love seeing teenagers. And we will see kids until they're out of college. We basically say we'll see them until they're done with school. Once they have their own job and their own insurance, it's probably time to switch doctors. So, generally as long as they're in school including college, we'll continue to see them. And really, the adult on set type diseases hypertension, hypercholesterolemia, this kind of things typically are going to be more in the 30's and 40's when they start.
So, 20 year old and teenagers really are a lot alike. And pediatricians are certainly capable of treating them. Now it is true that many teenagers migrate away and perhaps, it's really kid dependent. Some of them feel really uncomfortable in the waiting room with bunch of sick kids; they feel a little self-conscious about it. I think that is probably less true on our office because we do see a lot of teenagers. So, there is always some teenagers in the waiting room. So, I don't think that's as much of an issue where we practice. And personally the reason I love seeing teenagers is it adds variety to the day. There's a different set of problems than we see with infants and variety is the spice of life. You can actually carry on an adult like conversation with teenagers as a patient. It's one of these things where if I see crying babies all day long, it starts to stretch your nerves a little bit.
And so, seeing teenagers interspersed throughout the day for me makes practice much more enjoyable.
Now as it turns out, with regard to female doctors, we don't have any female doctors in our practice. It's a practice of six men and we don't have any female doctors in the practice. Now, that is not planned. It just so happens that in the past when we have the openings for new doctors, we picked the person who we like best and we thought fit in. And it's just happened that always be a man. Now, you can argue, well, you need a woman in there, but, I'd rather have a man that fits in with our group than a woman who doesn't. OK, I know that sounds really bad. Oh, boy. I'm going to get myself in big trouble over this one. No, what I'm just saying is just that if we have an opening in our practice and there was a well-qualified woman who fit in, by all means, you'll be more than welcome to be in our practice.
And I'm not digging myself out of this one very well. I don't think that gender of the doctor really matters. Especially, until the preteen years. And you are talking a decade. So I don't think you want to pick the doctor that may not match your family the best based solely on their gender, if you're doing it solely on the purpose of your child being more comfortable a decade from now. I think the here and now personal interactions are going to be much more important and then deal with the discomfort later as it comes. I will say that most practices, at least the ones, the one that I'm in now, the ones I've been in, they really encourage you to see your regular doctors as much as possible. Certainly for the well checkups, You wouldn't… I don't think it will be good just see one doctor for sick visits and a different doctor for well check ups.
I mean, there's exception obviously if the acute illness comes up. But, for the most part you want someone who knows you and your child very well. And if there is some discomfort to it, as long as that's handled in an appropriate manner, there's certainly ways to maintain modesty to the highest extent possible regardless of the doctor's gender. We can use gowns and we certainly don't make preteens, at least I don't, make preteens sit only in their underwear on the table with nothing else on. We all do things a little bit differently and I know in my practice I take the time and extra effort to maintain modesty especially for preteens and teen age girls to the highest extent that is possible. So, my personal suggestion would be to base on who you feel comfortable with personality wise, and not necessarily the gender. You don't want the right gender but the wrong doctor, you know what I'm saying?
And certainly you can switch docs within the groups later on if the need arises, at least for most groups. In other words, you are seeing one person and you could switch to the female doctor in the group. But I wouldn't just see them for the well checkup side. I'd switch to them completely. OK. So that's my two cents, and maybe more like a quarter.
This one comes from Krista. And Krista said, "Hi, Dr. Mike. Our son who will be four years old in January has recently started sneaking around and stashing items around the house. Some things recently stolen from our possession or the coveted TV remote control, kitchen sponge, Halloween candy, a mango, a towel, a remote control rat, which was a Halloween decoration, and some of his own toys. Is this normal behavior? He says he likes to hide things in his secret spot. Our concern is that he is very, very sneaky and what he is basically doing is stealing behind our backs. Is this something that we should be worried about and should we have a talk with him about it. Thanks for all your help in advance. Sincerely, Krista".
Well, Krista. It's sounds to me like your four year old has a game going on here. I do believe that four year-olds know right from wrong. I do think they understand the concept of stealing. I think, unless you have a four year old who is developmentally delayed and truly mentally challenged. I think your average four year old knows exactly what's going on here. And I think that you have to impress upon him that this is not acceptable behavior. It's not funny and if he hides something, this is how I would handle it with my own kids. How we did, well not now, they're 10 and 13, but this is how I would have handled it when they were four. If you're sure that they've hidden something, you tell them, you know that's not right, I want it back. And we will give you the count of five to tell us where it is or to go get it.
And if you get to five, none of these, four and a quarter, four and a half, four and a three quarters. It's 1, 2, 3, 4, 5. And if you get to five, and they haven't told you where it is, it's an immediate time out. And again we've talked about this before; time out would be on the floor, back up against the cabinets in the kitchen. Put the kitchen timer on for one minute for each year of age. So it should be about four minutes. If they keep getting up, then you want to hold them down. Not to the point where you're bruising them or hurting them. But you just hold them down and don't look at them. Don't wait till the timer goes off. Again, if they're going to sit there quietly, you don't have to hold them down. And then when the timer goes off, give them a big hug. Tell them that you love them. The reason that happened is because you got to five and they didn't tell you where it is and now you are going to give them another chance. And you start counting to five again. And if they think it's funny, and you get to five again, bang! You just do another time out.
And there may be a couple of nights when you are doing this for two hours. But, the second night, it will probably be only one hour. And the next night, only half an hour. I mean it takes time. You have to be consistent. You don't want to give in. You've got to follow through. But, I do think you need to address this seriously because it starts out this way. It's a game to your child. But it's also a child who is not obeying and it starts out as a four year old hiding things but where does that lead? It leads to big trouble down the road. So I would get that under control for sure. But, on the other hand you do want to be certain he really took it before you start this process cause if didn't really take it, pretty much destroy your trust and credibility. So, you better know where those secret spots are and maybe go check them to see if the thing is there before you embark on that process.
OK. Next stop is Elizabeth. And Elizabeth is in Frisco, Texas. She says "Hi, Dr. Mike. First of all I want to mention that I love your show and I find it so informational. I find that I have access to my very own…… that was her word by the way.
I might have use informative but I think informational is probably a President Bush word. It's a real word you know. "I feel that I have access to my very own…" there you go, I'm making fun of my listeners, I'm so sorry Elizabeth, "I feel that I have access to my very own pediatrician, not just the one my child sees every few months…", Oh, that's nice, I just offended you. "Anyhow, my son who is four months has just been diagnosed with plagiocephaly and I would like to hear more information on this matter. My son's pediatrician referred me to an orthodist but I would like to hear from a doctor's perspective how not correcting this problem at an early age can have adverse effects as they get older. I have found that this problem has becoming more prevalent since the back to sleep campaign so I can see this is something pediatricians will face more often. Thanks, Elizabeth".
What Elizabeth is talking about here is if you put kids down on their back all the time, especially if they don't move too much, some kids are going to get flat spot at the back of their head. And an orthodist is someone who is going to make a helmet or a band that is made of hard plastic that the child wears around their head which helps it not to get flat. So it helps to remold the skull. Now, I do want to mention I don't think that this is something that is going to become more prevalent or that pediatricians will face more often because the back to sleep campaign has been around since the early 90's. It's really nothing new and I think we're seeing the same amount of this condition as we have seen for the last 10 years and probably what we will see for the next 10 years. It's often, this is one of those things and there's many of them in pediatrics. This is one of those things where there's not a right and wrong thing that is clearly there. You're going to have some controversy when it comes to this.
And my own personal opinion on this is that if you have true plagiocephaly where it really is flatness because of position, then, most of these cases are going to remold in time, all on their own without needing a helmet or a band or any of these things. Especially as the infant starts to move and isn't in a single position so much. So, you want to make sure that you're increasing their up time, their tummy time all of these sorts of things so they are not lying on the same spot all the time. Certainly they're going to be on the same spot when they're sleeping but then as they're awake more, they're up and around and they're not lying flat on it so much.
I certainly in my own practice have seen many, many kids with pretty impressive flat spots on their skull. In particularly in the back. Have nothing done, no helmet, no bands, no nothing and by the time they are two or three years old, they have a nice round head and everything is fine.
Now, that's not to say they aren't some kids out there who have in the past been helped by these helmets and these bands. Because they certainly will remold the skull more quickly and maybe prevent it from becoming as flat as otherwise would, I can't imagine that those plastics things are very comfortable for the baby. And they're expensive and they to be custom made and at least the last time I checked into it, insurance do not cover them very well. But you are going to get a group of professionals who swear by them. I mean you're going to have pediatricians that swear by it, you're going to have neurosurgery type of people or orthopedic type people who swear by them. And you're going to have a group of pediatricians and neurosurgeons and orthopedic guys who are just as credible, just as well trained, just as well respected who think they're nonsense. So there are not a lot of good guidance. I guess what we need is a really good study to show if they help or not. And that to my knowledge has never been done.
So, if you're a pediatric researcher, this may be something for you. Although, again if most of these kids get better anyway on their own, do you really even need to do the research? Now, here's the key though. If your child is developing a flat spot on their skull, you cannot assume that it is just plagiocephaly. You just can't, because there are some other things that can cause flat spots that need to be addressed. So, this is something you definitely you want to bring to you pediatrician's attention. The biggest thing that we would be worried about here is something called "Craniosynostosis". It's a big word, but it's basically a premature fusing of the skull sutures and that can create a very misshapen head because of the premature fusing of the sutures. And generally, that is going to require surgery and the sooner that you diagnosed it and figure out that that's what's going on, the better.
So, if you have a flat area of the skull, you got to make sure that craniosynostosis is not going on. Now the other thing too that we've talked about this before, some kids with torticollis, which is positional with the head where neck, they have a neck spasm of the neck muscle on one side and they're head is tilted to one side. And if the flatness is because of torticollis, then that is something that you definitely want to deal with and address. And actually we did have a show where we talked about torticollis. It was PediaCast episode number 25. And we'll put a link on the Show Notes to that if you're interested in hearing more about torticollis and flat skull because of that.
So in summary, I think that in my own practice, helmets, usually don't recommend them. They probably can be helpful in a very small sub set of kids. Most of these flat spots are going to reshape on their own over time with no intervention needed at all. But you do need to see your pediatricians so they can rule out other problems that do need treatment, do need address that could also cause some misshapenness of the skull.
Some other links I have for you, kidshelp.com had a nice article on positional plagiocephaly. We'll have a link to that on the Show Notes. Also, a site called keepkidshealthy.com. They have a nice article on craniosynostosis. And then, there was also a very interesting article form the Penn State, Pediatric Neurosurgery Group. It's a whole article on molding helmet therapy. So it got some of the pros about it. So, again I'm saying it's controversial. There's a group who agree, there's a group who don't agree. And I am including on the Show Notes a link to a group who agrees with it. So, you can check that out.
OK. Listener number four. This is Yolanda in Ohio. My home state. And Yolanda says, "Hi, Dr. Mike. I just found your podcast through the Manic Mommies. I am completely addicted". Until she hears me making fun of my listeners.
"I have three children, ages 5, 3 and 2. And I seem to live at the doctor's office. As you can imagine it is very difficult with all three children in the doctor's office to get all of my questions answered. My daughter was just diagnosed with a vaginal yeast infection. And we are currently treating her with a yeast infection cream. My question to you is, what causes a yeast infection in a three year old and is this common? I'm sorry if you covered this in the past episode; I'm still going back and listening to all the past ones. I know that you always thank your family at the end of each episode. I would like to personally thank your family for letting you do this podcast". See kids. "As a parent, it is nice to know that an answer about my child's health is just a click away".
OK. So, yeast infections in a 3 year old. But first let me say, it's probably not really a vaginal yeast infection. It's probably more of a just the groin area having the yeast kind of between the legs on the labia. That may be the labia minora.
So, you spread them apart a little bit down there and you see some redness and some dots. But a vaginal yeast infection is going to be deep up inside the vagina with the mucousy discharge and the itching. And that is not nearly as common as once they get into the preteen and definitely into the teenage years, that's common. But in a toddler, that will be very uncommon and make you worried a little bit. Now, that's not to say that a yeast infection down there is bad in a three year old, because like I said more of a superficial infection is pretty common. And I'm assuming that that is what you daughter has since you're using just a yeast infection cream that you are putting on with your finger, it's unlikely that you're sticking that up into the vagina, I would hope not cause that will be an issue. So I'm assuming this is a superficial infection and those are pretty common.
Now, why would they be common? Well, yeast, the yeast that causes it, candida, that's the most typical one, but there are others. They're everywhere. They're everywhere in the environment. They're very opportunistic. They'll grow wherever they have a nice place to grow.
And if you think about it, your old breads and warm moist environment in the wrapper and after a week or two, yeast can start to grow in your bread. And it can start to grow elsewhere too where there is a warm, moist environment including the skin. Now, normally bacteria on the surface of the skin protect us from the growth of yeast. Because there's just no room for the yeast to grow because our skin is teeming with bacteria, good bacteria. Now remember kids who are young or often on antibiotics for one thing or another, they may have strep throat, they may have an ear infection and pneumonia. They're on antibiotic, and the antibiotic not only kills the bacteria that's causing their infection. But it's also kills normal bacteria as well. And that's not the only thing that can kill bacteria anti-bacterial soaps, body washes for kids, they have anti-bacterial on them, well those are also going to kill your normal good bacteria. And if you kill the good bacteria that live in the space in the groin area, it's a warm moist environment, and yeast are going to come in and grow there.
Now, the good news is the anti-fungal cream like your using will kill the yeast in most cases and not affect the recolonization with bacteria. So once they're off the antibiotic then the bacteria, the normal bacteria of the skin is going to come back and grow and be there to protect them against a future yeast infection. Now, does that mean that every child who has an antibiotic is going to get a yeast infection between their legs, no, of course not. And it's also not the case that every single time they have this infection it's only following the use of antibiotics. But I mean, just in general, this is the sort of process that makes it more easier for this sort of thing to happen.
If you have a kid with recurrent yeast infections, especially in multiple locations, then you do worry a little a bit about the status of their immune system. Because recurrent yeast infections can pop up in people whose immune system don't work very well. So, that's something to keep in mind. But again having a few yeast infections here and there is not a big deal. But if it's every month, then at some point, you do start to worry about that a little bit.
All right, and finally, we have Brenda in Indiana. And this is really a comment, not a question. But it's a good one. Brenda says, "You are on the mark with optometrist versus ophthalmologist. Thanks for sticking to your guns. My daughter's school found vision issues in the routine school exam. We took her to our family optometrist because I wear contacts. And he put her in glasses. I asked him several times. We we're being seen every three months about eye exercises. And finally after two years, no change in vision. I discussed with our pediatrician about getting her to see someone else. He referred us to an ophthalmologist who couldn't believe she hadn't been patched ever".
"So, at eight and a half years of age, which by the way is very, very late, we started patching her for a couple of hours a day during intense eye time such as homework and piano practice. He warned she was at the outer edge of what was believed to be effective time to patch. We eventually decided to get a specialist who dealt with children and to quit messing around with doctors who may not be what our children need. We really felt like we screwed up on this one as parents making the correct or informed decision. We now take both children to Riley Children's Hospital, to a pediatric ophthalmologist. My daughter's eyes are fairly close to each other in strength now and interestingly our son is having some of the same issues. Thanks for helping us to make informed decisions". And that's from Brenda.
So, thanks for your comments Brenda. Hey look, I don't write them folks. I'm simply the messenger on that one. All right, we're going to take a quick break and we will be back to wrap up this week and to wish you a good weekend. We'll do that right after this.
And as always, thanks go out to Nationwide Children's Hospital in beautiful Downtown Columbus for sponsoring our bandwidth for this podcast. Also Vlad, over at vladstudio.com. He is an artist in Russia who provides the artwork for our website in the feed and of course thanks to all of you for making a little time in your day for PediaCast.
And also, thanks to my family as well. And thanks to the listener who thanked my family too. I'd like to remind you there is an audience survey at the website, at pediacast.org. It helps us collect demographic data. Also the PediaCast shop is open for your shopping pleasure. We have t-shirts, to help you spread the words about the program. Remember there is no upcharge on our part with these t-shirts. You get them through our cost because it's really more about spreading the word for us than us making a profit off a t-shirt. Reviews in iTunes are most helpful. I think we are up to 146. So we got 6 new ones this week. Again my goal is to reach 200 by the New Year. So, if you haven't made time to go to iTunes and write a review for PediaCast it would be most appreciated. If you want to give me a Christmas present, don't send me anything; just give me an iTunes review that will be very, very nice, OK.
Also, poster page, you can download poster to hang up on bulletin boards and of course word of mouth is always the best. Don't forget this weekend; the "Buck Eyes" are playing the "Michigan Wolverines". Go Buck Eyes, Saturday noon, ABC. The Buck Eyes have something to prove after they lost last week. And of course the winner will probably go to the Rose Bowl.
So until next week, if the Buck Eyes win, I'll be in a good mood next week and I may be talking like this if they lose. We're only going to have three shows I think next week. We're going to have an abbreviated schedule because of Thanksgiving. And until then this is Dr. Mike, saying stay safe, stay healthy and stay involved with your kids. So long everybody.