Mrs. Mom takes a vacation

When was the first time that you were away from your kids?  After 4+  years of parenting, I am currently experiencing my first weekend away from both of my two young chickadees, and off at a conference in Chicago!  And guess what . . .  I miss them.

Amazing how it’s so easy to get enraptured in the professional connections that this conference affords and get to meet people doing so much and so actively within the medical community – and with the larger area of children’s health and well being – and then suddenly think of my 1 year old daughter squeaking “I yuv you” over the phone to me early this morning.

Can it be that she is experiencing a few days of life without her mommy, while mommy is pumping and saving up milk for the little one?  Is she enjoying her naps with daddy and bonding time . . just the two of them?  An overwhelming sense of both freedom and envy overtakes me as I think of her cuddly body and her smiles, and how I miss the musical adventurous storytelling of my son. Bet he is negotiating right now with his grandmother about how many books he will get to read for bedtime.

Strangely, this quick weekend jaunt which I thought would be quite lengthy turns out to be almost complete, and soon I will be gathering my son from his own Chicago visit and heading back home. What will the reunion be like?  How different my kids will be after this time of separation, brief though it may seem!

Posted in Personal Tagged with: , , , ,

Return of the [Digital] Native

A few weeks ago I returned from my first conference I have attended as a pediatrician.  What better way to spend this occasion than to attend the 2014 AAP ExperieNCE, the American Academy of Pediatrics National Conference and Exhibition.  My husband and kids joined me in sunny San Diego for this conference, and I was struck by how happy and engaged I would feel now experiencing pediatrics from a more macroscopic perspective – learning about politics and advocacy while continuing some of my general medical education, and networking with fascinating colleagues all the while. It was a fun experience.

After the conference, I joined T and the kids, who during my work trip were enjoying a seemingly endless parade of amusement park experiences. We decided this should culminate in a trip to Disneyland in Anaheim, California. I had never been there and was excited to go, and I must admit – seeing my son run up to Pluto was pretty darn fun. But the experience gave me one major regret.


We weren’t going to go in – but the wait was barely five minutes and T really wanted to learn about the technology there.  I figured, hey, if we want to see it we might as well do so. Let’s go in and see what it’s all about. What I thought I’d see: a museum exhibit of Marvel comics with a few opportunities to meet characters, so why not.

And at first it was fairly interesting. On the top floor on which you enter, there were – as I expected – some Kinect-style videogames, futuristic driving simulators, and yes, some comic book characters. But after a glimpse into “driving” of the future, we descended down the steps to the first floor, where we saw the Microsoft “Dream Home.”

Stepping into this “Dream home” after being at the AAP Conference reminds me of the time I went to Vegas after visiting the Grand Canyon. Wholly disturbing.

Let me explain.

One of the highlights of the conference is getting a sense of the Academy’s agenda for the coming year – in the past major themes have been immunization, mental health, obesity, safe sleep for example – and become issues for which the Academy advocates in years to come. This year Early Childhood ages 0 to 5 took the stage, as pediatricians from around the country put in their word for advocating for children, investing in children, to make the early childhood experience a strong foundation in terms of health and literacy. Specifically, certain potential detractors from childhood health including toxic stress – or stressful childhood experiences – were addressed as issues that could not only affect the children, but could affect the generation descending from these children as well.

And let’s not forget the stresses that can be experienced by all children today in the form of screens. Pediatricians are very concerned that entertainment in the forms of near-constant access to screens could be very detrimental to our children’s brain development. Traditional learning happens in the 3-dimensional world, and the more we learn from the screen, potentially the fewer connections may be made in the complex recesses of our brain.  While technology is a terrifically cool phenomenon – who among us hasn’t marveled by the ease with which our children can get acquainted with the family iPads and start playing the so-called interactive games – it has its limitations. And while most of us understand that some time getting acquainted with the screen is important to thriving in the digital world, we are highly concerned about children’s attentions getting diverted, language development decreasing, and normal human interactions ever-moving to the sidelines.

So here I am, the average pediatrician, stepping into what Microsoft envisions to be my life in the future. The first thing I noticed? Screens. Screens EVERYWHERE.  5-6 screens as picture frames in each room for artwork which was simply backlit screen images. 10-20 screens holding family photographs and sitting atop a grand piano. An automatic grand piano that had its own screen with someone playing in the background, and the keys moving animatedly to the music. So much for screen-free living spaces.

Nobody was really sitting in these dimly lit caverns of rooms. They were simply these humming, buzzing, automated rooms that seemed to exist by themselves, barely even needing a person to navigate the interior.

Geez, I thought, with this as my competition, how will we as a profession be able to stress to families that screens are to be avoided? If each room has not zero, not one, but many screens, where do we even choose to look? And how do we live our lives so that we can see these screens adequately? In the darkness?  Will our dimly backlit screen-optimized Dream Homes do everything for us, even simulate our presence?

As I adjusted to my new environs, I wandered into a children’s bedroom, enabled with four bedtime stories ready to be told. Okay, I thought, as a cast member prepared to read us Walt Disney’s Peter Pan, one of my favorite Disney-fied tales.  T, the kids, and I sat down to watch as he invited some of the children to sit up near him in the pirate ship that was in the corner of the room.

As the gentleman began his story the entire room illuminated with screens – projections of video on the walls of the home, sparkles of lights of Tinkerbell, animatronic furniture, and loud music.  The disjointed storytelling, though animated and “entertaining,” was impossible to follow with so much going on around us.

While our kind reader encouraged the children to get engaged in the story, it didn’t really work.  I couldn’t help but notice my son gazing at one of the screens on the side of the room. He was mesmerized by a video clip of Peter Pan. The images had nothing to do with the lines of the story that the man was telling, nor did they relate to the music we were hearing. The other children were all focused on different things but there was no harmony here, simply fireworks of entertainment that failed to convey a thing. And the cacophony went on So. Darn. Fast.

It was when the cast member encouraged the kids to come up to shoot Wendy and Peter Pan down with the cannon that we took it as our cue to leave. My son – only 3 years old – wasn’t enjoying the noisiness of that part very much. And let’s face it, I was so overwhelmed by the spectacle that I was ready to leave. I had to get myself out of there before I started hyperventilating. Yes, I’m kind of a lame-o.  But I know myself and that show just wasn’t agreeing with me.

All this is to say – Pediatricians: I encourage you to go and see Innoventions. Learn more about what we’re up against when it comes to screens.  Parents: Do you believe it when they tell you this is the future?  How do you feel about it?


Posted in Pediatrics, Personal Tagged with: , , , , , , ,

My own little Doc McStuffins

Sometimes I can’t believe what a shrewd little thinker I have on my hands. Some things just can’t be taught.

My son, a three year old going on 30, has always been my cautious child. Childproofing was lost on him. What would possess a reasonable human being to put anything other than the occasional piece of chocolate into his mouth, anyway?

My daughter, on the other hand, has quite a varied appetite at the tender age of nine months. A renegade crawler who scours the floor for munchies, she enjoys lettuce, pieces of plastic bag, paper, leaves and stems, dirt, and pretty much any object she can find. No, a nine month old should not eat ANY of those things. She has taught me what a terrible job I have done childproofing.

So it is commonplace for me to bend down to inspect her mouth for unseemly items. The other day, not quite up to the task myself, I asked little L to look into his sister R’s mouth. Not expecting anything to happen, I continued finishing up my household task and was about to check it out myself, when,

“Mommy! I need a puff.”

“What, honey? A puff?”

“Yes, mommy, a puff,” and he held out his hand.

So I retrieved a crunchy oat puff from the pantry and placed it into his fingers. Gingerly he held it near Sister’s face.

“Open your mouth, Sister,” he instructed. “Open wide!” As the puff neared R’s lips I laughed to myself as I saw her jaw drop open with Laki peering expectantly into her mouth.

“Nothing in there, Mommy!” he exclaimed triumphantly.

“Go ahead, L,” I said, “you can give her the puff now.”

And he happily fed her. And she happily ate. Methinks I’ve found a cheap and viable alternative to tongue depressors.

Posted in Baby, Humor, Pediatrics, Personal, Safety Tagged with: , , , , , , , , , ,

What healed my daughter’s eczema

Just a short little ditty here because I have another post planned but now that my daughter’s skin is [practically] pristine, I want to share some of the things we have learned:

1) Her skin is very sensitive to heat and sun – almost immediately with sun exposure or being in a very hot environment, R will get a heat rash, including red bumps on her cheeks and arms.   Cooling her down helps this rash calm very quickly.

2) Her eczema otherwise required simply the tincture of time to improve.  Interventions we used consistently, including frequent bathing, oatmeal baths, and thick emollients helped her skin heal, but it still had a bit of a rough, dry texture to it. Enter (once again) ceramide-containing creams.  These made a huge difference in turning the dry “eczematous” skin to smooth baby-soft skin. While her skin was very rashy with bad eczema the cream had made little difference, but after it was healed and simply in a dry phase, infusing her skin with ceramide definitely worked.

3) Traveling to Vancouver also healed my daughter’s skin – I attribute this to the temperate climate with fewer allergens and less humidity, but to be frank I do not have a truly good explanation about what worked about the journey. All I know is: Being there worked wonders for her.

4) Cutting nails short short short is still key for her – whenever I leave them long she scratches and it starts a new healing process for her, so I would still not underestimate this intervention! It really works!

5) It looks like food allergies were not really at play for her in terms of skin health, though for digestive health food restrictions (such as eliminating dairy and eggs) have really helped her.

6) Other things that we did that probably made no difference? Changing clothes detergents, changing soaps (though we do this in general because her skin is dry), selenium sulfide preparations.

Just a few thoughts on her eczema this evening. Cheers and happy fall!

Posted in Health, Medical Topics, Pediatrics, Personal Tagged with: , , , , , , , , ,

Treating my Baby’s Eczema: The case of the itchy scalp

I grew up with terrifically dry skin which, at first handshake, makes people think that I must be 67 years old — that is, unless they are staring me in the face and see I otherwise look about my age. Because of this, throughout my pediatric practice I have made it a point to get good at treating eczema – first through myself, then through recommendations to the many patients with eczema I treated in clinical practice.

Let it be a fitting thing that, just as I gave birth to my picky-eater first child, I should also give birth to a child with skin rougher and drier than my own. And that skin is giving me a run for my money.

Since a month or two of age I could tell that R’s skin was drier than the average infant’s – a bit of scaliness here, some flaking to the scalp there. As a newborn she used to lie in her crib and shake her head back and forth like a miniature Stevie Wonder. This is what I thought, at least, until she turned 4 months old and, with newfound control of her hands and fingers, she began to scratch her head and ears furiously as she shook her head back and forth. All this time she’s been itchy, I realized.

So out came the creams, salves, oils, and ointments. Not just the few that I had on deck, the ones I’d massage into her gingerly every day or every other day after a quick bath. I went from being the one to give advice on skincare to getting advice from every angle – mostly at my own frustrated behest. “Use Aquaphor!” “Give her a massage with [insert name of oil/ointment/cream here]”. Eat this, do that. Unfortunately, no matter what I do, I am not sure that people believe the truth of my predicament (as I constantly advised the same to my patients): no matter what I do, the skin doesn’t get any better.

It came to a head a few weeks ago when, covered with itchy red bumps and her scalp bleeding, my baby saw her to her pediatrician and was prescribed antibiotics and a light topical steroid. At that point, I decided to turn a new, entirely more disciplined leaf regarding my daughter’s skin. But to my dismay, just as we were getting a handle on things and moisturization was working, her skin got much much worse — with a severe viral infection atop the eczema — and we were back on medications. That struggle brought us to the dermatologist and has taken us even further into the realm of understanding regimented eczema care.

Here is what I have learned:

1) Itching really does make the rash worse. I could do all the skin care I wanted for days and days, but within about 5 minutes of finding utility for a particular sharp fingernail, my daughter could destroy weeks of effort. So it’s really important to control the scratching. So I cover her hands with socks, or put a stretchy, light hat on her head, or both, as an effort at damage control.

2) Be vigilant about fingernail length. I cut my daughter’s nails with a clipper exactly every day and a half and “prn” (which means “as needed” in medspeak). I don’t bother using a nail file – it makes her nails short but sharp, so clipper it is. And if I miss a day, she could end up a scratchy mess, so timing is key. Every nail, every other day.

3) Keep ’em wet. Ongoing through the eczema debateOne question you may have about eczema treatment is whether to bathe multiple times a day and keep children in wet wraps versus the other end of the spectrum – barely bathe them at all. I’ll admit that this is an individual decision based on what works best in your child, but for us and pervading the more recent literature, a frequent moisture source is helpful. For my daughter, this means bathing at least once a day, and no ordinary bath. I no longer use soap or fragrances of any kind, but I am now about to give the colloidal oatmeal bath industry their biggest client. Every bath is an oatmeal bath with a 10-15 minute soak. (One hint – just get the plain fragrance-free 100% colloidal oatmeal – don’t get a “baby” preparation – if it says “baby” it WILL be more expensive and also comes in smaller quantities – save yourself a few bucks and just use less of the packet for one bath. Save the rest for next time.
ADDENDUM 8-6-2014: (See cross-outs above) and clarification here: As my colleague, an pediatric allergist, has noted, whether to keep kids wet versus dry is not really a debate – physicians are in consensus that regular soaking baths and especially wet wraps can improve eczema a lot. There are other treatments which he discussed – and about which I will not go into more detail here – like bleach baths, which can also really improve eczema. You can discuss alternate treatments with your doctor.

4) Selenium sulfide doesn’t work for everyone. As a public health pediatrician this was one of my most frequent treatments for patients with cradle cap or fungal skin issues, but my daughter’s eczema has a scalp component that is itchy, rough, and flaky. Using selenium didn’t do much for her itching and didn’t change the rash, but it did give her head an unpleasant odor that also affected her washcloths. Odor: just a tiny detail. It also stings her eyes and must be removed carefully. It may get another shot as we move into round two of skin care, but I’m not expecting miracles.

5) Massage two or three or six times a day with the most nourishing ointment or oil that you can find. My current concoction is a homemade preparation of coconut oil, vegetable shortening, olive oil, shea and cocoa butter, and jojoba oil. But to be honest just the plain coconut oil or shortening works fine. It’s important to check the melting temperatures of your products (it’s easier to apply if it melts easily in the hand) and check labels before you buy – a cocoa butter cream typically has a very small percentage of cocoa butter and lots of other additives. Same goes with other preparations that include the ingredients I have listed above. Probably the cheapest and easiest thing is to just buy a tub of vaseline or unflavored vegetable shortening and call it a day, and boy do they both work well! I haven’t tried Aquaphor, but there are also other more expensive creams I have recently tried which contain ceramides, which are a component in skin cells that are generally lacking in skin with eczema. Unfortunately these preparations haven’t helped my daughter much, so I don’t bother with that anymore.

6) Be willing to try steroid creams for the skin, if the doctor recommends them When my daughter’s eczema started to arise I was the last person who wanted to try steroid creams, but with her most recent flare they did wonders to calm down the rash with just a few uses, and now we are willing to have Judicious use of creams as prescribed by the doctor. It is important, however, to use these very sparingly and only as needed because steroid creams can thin the skin and are absorbed by the body – and too many steroids can affect hormones in the body, so still be careful.

7) Diet can be related to eczema As a very young pediatrician this was something that I didn’t buy into before, but now that it’s my own kid – dietary restrictions were some of the first changes that I made in my daily routine. The dermatologist mentioned that in her experience food allergies can be related to eczema, and I will never forget a child who I met in residency who had a terrible infected eczema case and when I met him a few months later, when several food allergies had been identified, he also had much improved skin. There may not be credence to me restricting my dairy and egg intake, but I have been able to manage this change and I do notice a change when I do “cheat” on the diet.

In any case I hope that this was helpful and I welcome questions and commetns. I have had lots of people suggesting various guidance and as I learn more I will try to post. In my new job I am writing a ton, so scratching that itch has made me blog much much less than I normally would, but staying off my computer at home has also meant me enjoying each day with the kdidies. Now time to enjoy a good night’s sleep!

Posted in Baby, Pediatrics, Personal Tagged with: , , , , , , , , , , , , , , , , , ,

Featured Posts

@doc2mom on Twitter

My Social Networks

  • Facebook
  • Pinterest
  • LinkedIn
  • Twitter