WHAT'S UP, DOC?
AS PARENTS, THE HEALTH OUR CHILDREN IS PARAMOUNT. AT THE FAMILY GROOVE WE'RE
CONSTANTLY ASKING QUESTIONS ABOUT—READ: STRESSING OVER—THE WELL-BEING OF OUR
CHILDREN. HERE PEDIATRICIAN DR. JESSICA GRANT GIVES US THE ANSWERS WE'VE BEEN
LOOKING FOR. PHEW—WE'RE FEELING BETTER ALREADY.

TFG: What are common allergens in the fall?
JG: Allergens vary by season and by demographic area. However, to make thinking about them easier, they can be
divided into broad categories. One category involves the pollens, and in the fall, the culprit is ragweed. Molds are
another category of fall allergens. They peak in the late summer and autumn and are found in falling leaves and soil.
Two specific molds seen in the fall are alternaria and cladosporium. Other common triggers that are not specific to the fall, but which may become more irritating as people spend more time indoors, are dust mites (which can be stirred-up by dirty ventilation systems), pets, rodents and cockroaches.

Symptoms of allergies include runny nose, sneezing, itchy and watery eyes, congestion and coughing. Treatment aims at attacking these symptoms. The best treatment is, if possible, avoidance of the triggers. This may mean keeping bedroom windows closed overnight when the pollen count is high (since pollen often is made in the early dawn). Older children should be encourage to shower after spending time outdoors to remove pollen from the hair and skin. Exposure to dust mites, one of the most common triggers, can be minimized by using plastic covers on mattresses and pillows, washing bed linens frequently (every two weeks), and removing carpets and curtains. For those with animal allergies, it is best to remove the animal from the house. For those who simply can’t get rid of good old Kitty, keeping the animal out of the bedrooms will provide some help. Cigarette smoke and strong perfumes should be strictly avoided.

TFG: What are the latest treatments for allergies?
JG: Despite these modifications, however, many people will continue to have allergic symptoms. For this reason, there is a host of medical remedies available:

	Antihistamines (such as Benadryl, Claritin, Allegra, Zyrtec) work on the entire body to relieve symptoms of allergies. They often work well and can prevent many symptoms with one dose per day. They can, however, cause sleepiness or irritability in children. These work best if taken every day to control symptoms, rather than waiting until you are having full-blown allergy attack.
	Leukotriene modifiers (such as Singulair). They tend to be less effective than other methods, but some patients report very good control with these medicines. They can also be used in addition to other medicines discussed here.
	Intranasal corticosteroids (such as Nasonex, Flonase). These tend to be very effective for runny or continuously congested noses. Many of the younger children, however, do not like to use them. For those who are committed to trying these, blow your nose prior to the spray and do not blow your nose afterwards or you will have lost all the medicine you just sprayed.
	Eye drops (such as Patanol). These tend to be very effective for the itchy, watery, red eyes. Again, however, putting drops in a child’s eye every day can become quite a fight.
	Nasal decongestant sprays are available, but I do not recommend using them because they can have serious side effects. In addition, when stopped, they can cause a phenomenon known as rebound in which you develop recurrence of the symptoms that can be even worse than before you started the medicine.
	Finally, as a last resort, there are allergy shots, which can be given by an allergist to train your body against responding to your triggers. They require very frequent visits to the allergist ,however, and take an extended period of time to become effective. And if children don’t like nose sprays and eye drops, you can imagine how they feel about getting shots every one to two weeks.

I often recommend starting with a daily antihistamine pill (or liquid). If this does not seem to work, then I add medicines that attack the site of trouble directly (nose sprays or eye drops). It is important to remember that some of the medicines (especially the nose sprays) take two to three weeks to work, so give them a real try before throwing them out. Also, remember that different pills work differently for different people, so you may need to try a few before you find a good match. Finally, once you find a good match, start the medicine before the season kicks into full gear.

TFG: Can you give parents tips on preventing colds?
JG: Unfortunately, there are no magic answers to preventing the colds we see so often in children once they return to school. As I tell parents when I am asked this, if I had this solution, I could retire young and wealthy. Advice is based on the obvious. Encourage your children to wash their hands, constantly. Every doorknob, pencil and desk has germs waiting. If they don’t want to go to the bathroom repeatedly to wash-up, consider getting them liquid anti-bacterial gel they can carry in their bookbags. Teach them to avoid sharing food, juice or straws with others. Consider the flu shot. And lastly, accept that from two to five years old, if they are in school, children will be sick frequently. The average number of colds for the toddler is from three to ten per year, and if each cold lasts four to ten days, they can be sick as much as 1one-third of the days of the year. Remind yourself this is normal and will improve as they grow and learn more hygienic habits.

TFG: How do I know my toddler is getting proper nutrition, especially since she’s a very picky eater?
JG: Though almost all parents worry about nutrition in their toddlers (precisely because so many are picky eaters), most children are getting sufficient calories and vitamins. It is key to realize that the normal portion size for a one to two-year-old is what he can fit in the palm of his hand, which is a much smaller amount than we tend to expect. Also realize that the younger toddlers will rarely eat even this small amount of food in one sitting. Rather they will frequently pick at a spoonful or two, run around the room for a while, and then return for another spoonful.

Your pediatrician can help you monitor the health of your child. They will plot their weight and height on a growth-curve at each visit and as long as they are growing well, rest assured they are most likely receiving adequate nutrition. Your pediatrician may also take a blood test to monitor for anemia (low red cells), especially at the one and two-year-old visits, because this is the most common manifestation of inadequate intake that we see.

Most toddlers are picky eaters. This is the age of wanting macaroni and cheese every day. This is normal, and, as long as they are requesting a relatively nutritious food (not cookies or ice cream), it is okay to let them have what they want. Eventually they will change to another food for a period of time, and so on.

There are a few simple steps to help make sure your child is getting proper nutrition. One is to limit juice intake. Juice has NOTHING nutritious in it, even the ones that say 100% natural fruit juice. They are still merely sugar and calories. And once your little one fills up on juice, she will not want to eat much. Second, monitor milk intake. Unlike our babies who need large quantities of milk each day, children older than one year need no more than 16 ounces (one to two cups) per day of milk. Excess milk intake is one frequent reason for failure to take adequate amounts of other foods and one common reason for anemia. Finally, avoid junk food for snacks. Stick to healthier snacks like cheese and fruits. This may mean having to carry a little baggy of goodies in your purse or knapsack since it may be hard to find healthy snacks on the go. But the pay-off is that not only will this help ensure your child is eating a full diet, it will also establish healthy habits for later in life.

TFG: On growth charts, what does percentile mean? When should I be worried?
JG: Growth charts measure both the height and weight of your child and compare these measurements to other children of the same age. A standard growth chart shows the range of normal growth for children. At each pediatric visit, your doctor will likely mark where your child falls on this standard curve. This can be used to determine the percentile for your child’s growth. If, for example, your child is at the 25% for weight, this means that 25% of children who are the same age as your child weigh less than or equal to your child. 75% of children weigh more than your child. A child whose weight is exactly in the middle of all children of that age is at the 50%. There are different growth curves for boys and girls, and there are separate growth curves for children with specific permanent illnesses.

There are a few cases in which you should be concerned. One case is if your child is “off the curve”, meaning she is smaller then 5% of children or bigger than 95% of children. This is rare, but would be one reason your pediatrician might be concerned. Most parents worry about their child being too small, but with current trends in our country towards obesity, it is just as important to worry about your child being too big. Children who are bigger than the 95% are often obese, and obese children are at high risk of becoming obese adults, with associated risks of heart disease, hypertension, and diabetes.

Another reason to be concerned is if your child has had a large change in her percentile. It is less important if your child is on the big size or the little size than if she suddenly goes from being a big child (75%) to being a small child (10%). As a pediatrician, I want to see my patients growing on the same percentile curve at each visit. Large changes in percentile may cause your pediatrician to do further tests. Remember that growth curves are only a comparison to other children of that age, so though helpful, they are only one piece of information. Your pediatrician will help you interpret them in the case of your child.

TFG: When is vision/ hearing testing necessary in small children?
JG: All children should have routine screening done for both vision and hearing that is age-specific. For starters, newborn babies in many states have screening hearing tests done in the newborn nursery. At pediatrician visits, your pediatrician will inspect both the eyes and ears during the examination and will observe your baby’s activities to see if she is watching you, moving her eyes and responding to your voice as is appropriate depending on her age. Your pediatrician may also ask you specific questions about the baby’s activities at home that are tailored to the age of your child to determine if she seems to be hearing and seeing. These may sound like simple tests, but they actually contain significant information. Assuming development in these areas seems appropriate, routine screening for vision in all children begins at three years of age and for hearing at four years of age, though this will depend on how cooperative your child is. Screening will continue every one to two years throughout childhood.

There are some cases in which more in-depth screening may be needed before your child is three years old. For example, certain diseases are associated with hearing or visual problems, and your pediatrician may therefore refer these children to ear or eye specialists. Children with a family history of certain problems may also be referred.

Finally, if you are worried about something, bring it up with your pediatrician. With regard to hearing, if your baby does not seem to respond to noises (first by startling, later by looking) or if your older child does not seem to hear you, alert your doctor. All children with speech delay deserve a full hearing assessment because hearing difficulties are a common reason for speech problems. With regard to vision, if you feel like your child has trouble seeing (a baby who does not make eye contact, an older infant who does not follow you with his eyes, a toddler who complains of trouble seeing), tell your pediatrician. Children with frequent headaches also often need an eye exam.

Click back next month when Jessica Grant MD give us the scoop on shots—for some it's a sore subject.