Teething

Is your little one preparing for the arrival of some adorable teeth?  Dr. Jessica Long has tips to get both of you through this trying time!

I always love seeing babies for their four month well checks – they are smiley and interactive but not yet scared of coming to see the pediatrician. They are also drool monsters with a continuous thread of saliva running down their chin and many are sporting adorable bibs to catch the never ending flow of spit.  This excessive drooling is a normal sign of the sweet little teeth that will pop up in the next few months.  Now that my youngest has hit this phase as well I am reminded of all the tricks of the trade to help your baby deal with the discomfort of teething.

Around 4-6 months of age it is normal for your little one to put everything in her mouth to gnaw on and sometimes be a bit cranky.  These are signs of teething and, while they can’t be entirely prevented, there are certainly things you can do to help ease the discomfort.  Thankfully a handy tool is always available – your finger!  With a clean finger you can massage your baby’s gums or just let her chomp on your finger with her gums (keep away from any teeth that have already popped through!).

Cold temperature is also comforting so offer a cool washcloth or chilled (not frozen) teething ring. If your child has started solids, you can put a piece of frozen fruit in a mesh or silicone food feeder, which lets him enjoy the coolness and firmness of the fruit on his gums without worrying about choking.

When all else fails, it is safe to use pain medicine to help alleviate the achiness.  Babies under 6 months of age can be given acetaminophen (Tylenol) and those over 6 months old can also try ibuprofen (Motrin).  These medications can be especially helpful if your baby is having a hard time falling or staying asleep due to teething discomfort.  Though there are a variety of other medications available over the counter for teething, avoid any with benzocaine or lidocaine which can be harmful – even fatal – to your baby.

Now what to do about the constant drool?  Keep a clean dry cloth handy for frequent face wiping.  Since all of that saliva can be irritating to your child’s skin, he might enjoy having a moisturizer rubbed onto his cheeks and chin to protect from the onslaught of drool.  Hacks for magically cleaning all this drool laundry without taking up your entire day are outside of my scope of expertise and I would in fact appreciate help in that department!

Big Kids and Sleep

Sleep (or lack thereof) is one of the biggest frustrations we deal with as parents. Here are Dr. Jessica Long’s tips on how many hours of sleep children need at each age and how to create a nighttime routine to achieve these sleep goals.

September is always a busy month in our household. School, homework, extracurriculars – there’s a lot to incorporate back into the daily routine, which is fun but also exhausting. By the end of the day our whole family is spent and everyone is exhausted. I know more sleep is the answer, but how exactly do we successfully get our children to sleep earlier, sounder and longer?

How much sleep your child needs depends a lot on her age. The American Academy of Sleep Medicine (AASM) recommends that preschoolers (3-5 years) get 10-13 hours of sleep, grade-schoolers (6-12 years) get 9-12 hours and teens (13-18 years) get 8-10 hours. Parents, as we know, routinely survive on 5 hours without problems (just kidding!).

So how do we meet these lofty sleep goals? Bedtime rituals are incredibly helpful in getting your child’s mind and body ready for sleep. A bath, brushing teeth, and a book may be the perfect routine for your 5 year old. Your middle-schooler might find it helpful to journal a bit before lights out. Whatever works for your family, make sure you plan for a sufficient amount of time to complete the bedtime ritual. Start the process 30-60 minutes prior to bedtime so that your child is sound asleep at an appropriate time.

Prepare your child’s room for sleep success as well. Keeping the temperature cool, the windows dark, and the bed free of too many toys/books/stuffed animals helps to set the scene for a good night’s sleep. My eldest daughter hoards dozens of books in her top bunk. We routinely have to declutter her bed to encourage her to close her books at an appropriate time to maximize her rest.

Probably the least popular advice I give to patients and their parents about improving sleep hygiene involves screen time. There is no wrath like a teenager who has been told she can’t charge her phone in her room overnight. Ideally, all screens should be turned off at least one hour prior to bedtime and all electronics should be charged outside of the bedroom. We are all guilty of checking our phones right before bedtime so make this a family goal to help improve everyone’s rest.

Sleep is a very important aspect of your child’s overall health. Poor sleep can affect mood, concentration and grades at school, behavior and more. If you are worried about your child’s sleep, discuss it with her pediatrician.

Happy zzzzz’s!

 

Ear Piercing Safety

You know the day is coming when your tween is asking to have her ears pierced. Do it the safe way with these tips from Dr. Jessica Long.

Getting your ears pierced can be a momentous occasion.  For some kids, it happens when they are babies and they have no memory of it.  For others, it’s a birthday promise they’ve been counting down towards for years. My three year old is already begging for earrings but has to wait until the arbitrary age of seven (I’m such a mean mom).  Regardless of when the big moment happens, you want to make sure it’s done right.

Be sure to choose a clean and reputable place.  Your pediatrician might even offer it as we do at Spring Valley Pediatrics.  You’ll want to make sure the person poking a hole in your child’s ears is well trained, wears new disposable gloves, and uses equipment that is sterilized to decrease the chance of infection.

Be sure to choose the right earrings.  Since nickel is a main culprit of allergic reactions, stick to hypoallergenic materials like sterling silver or 14-, 18- or 24-karat gold.  At Spring Valley Pediatrics, our patients choose from a variety of earrings all made of 14-carat gold or surgical stainless steel.

Be sure to be up to date with vaccines.  Most pediatricians recommend your little one have received her third tetanus shot, typically given at the six-month-old well-visit, before any ear piercing.  We want to make sure this elective procedure carries as little risk to your child as possible.

Be sure to follow proper care of your piercing.  For the first six weeks after your ears are pierced, it is important to wash the ear lobe (while keeping the earring in) twice a day with soap and water.  We provide our patients with another cleaning solution to use in addition to soap and water twice a day. Turn the earrings, like winding a watch, twice a day as well.   After 6 weeks of keeping the original earrings in, you can replace them for other light stud earrings but avoid any heavy or dangling earrings for 4-6 months.  Also don’t leave your earrings out for more than 24 hours until your piercing is at least six months old – you don’t want those holes closing up!

Be sure to call your doctor if your new ear piercing is red, painful, or has discharge.  No matter how careful you are, infections can happen so be sure to be seen by your physician if things don’t seem right.

Happy piercing!

How to Help Your Children Avoid Insect Bites

Anyone who has spent a second in DC during the Summer knows that the mosquitos can be especially brutal (we are on a swamp after all). Don’t let these pesky bugs keep you and your family from enjoying time outside with these tips from Dr. Jessica Long.

image

My kids are loving these long, sunny summer days and begging for some outdoor adventures.  However, if you are a true city girl like I am, the thought of leaving your concrete jungle and venturing into the grass and the trees may fill you with trepidation.  I do not like bugs and it greatly detracts from the nature time the rest of my family craves.  Plus, a new alert that West Nile positive mosquitos have been found in Ward 3 does little to calm my neurotic nature.  Obviously, I cannot prevent any and all insect encounters but there are many safe and effective ways to minimize my family’s exposure.

While complete avoidance of insects is not a realistic goal, we can be mindful of where we spend our time and what we wear.  Avoid areas with tall grass that ticks love to cling to as well as stagnant water that is a breeding ground for mosquitos.  When outside in the evenings when mosquitoes love to munch, choose long sleeves and pants that are light and breathable.  The same goes for hikes in the woods or tall grass to prevent ticks from attaching to your skin.  Be sure to do a “tick check” in the evenings when you’ve been outdoors (even your own backyard counts).  They especially like to hide in armpits, in and around ears, inside the belly button, back of the knees and between the legs, around the waist, and in your hair.

It is also a good idea to apply insect repellant to exposed skin and clothing. However, hitting the bug spray aisle of the store can be overwhelming.  There are so many options and ingredients!  Lotions, sprays, wipes, DEET, picardin – what should you choose?

The American Academy of Pediatrics and the Centers for Disease Control both give the thumbs up for 10-30% DEET in children as young as 2 months (keep the under 2 month babies away from insects completely). DEET has also been shown to be safe in pregnant and breastfeeding moms.  Another option is Picardin, a synthetic compound approved in the US in 2005 and protects about as well as 10% DEET.  There are also many repellants that contain essential oils such as citronella, cedar, soybean, and eucalyptus (the latter should be avoided in children under 3 years old).  While these are considered safe, they have to be reapplied frequently and long-term follow up studies are lacking.

Similar to sunscreen, whichever insect repellant you choose must be reapplied frequently.  10% DEET and products that function like it last about 2 hours while 30% DEET keeps you covered for up to 5 hours.  Choose the lowest concentration you need for adequate coverage; no need to go with 30% DEET if you are planning on playing in your backyard for an hour.

So now that you’re armed and ready to fight those insect bites, get out there and enjoy this gorgeous DC summer!  My family might even convince me to get out there, too.

Fever 101 – When to call the pediatrician

As parents we often see it coming – crankiness, sleepiness and loss of appetite followed by a fever. Here Dr. Jessica Long gives advice on when to call the pediatrician.

If there is one complaint or concern that pediatricians get called about the most, it’s fever.  They’re rough – kids are miserable with them, parents are worried about them, and there’s a lot of misinformation on the internet about them.  However, I’m here to calm your fever phobia and hopefully allow you and your child to sleep a little more soundly, even if her temperature isn’t 98.6 degrees Fahrenheit.

What is a fever?

Doctors consider a fever to be a temperature of 100.4 or higher., A fever is not an illness but instead a sign that your child’s body is fighting an infection – whether a virus or a bacteria – and is actually an important part of your child’s defense against these invaders. How high a fever is does not provide any clues as to what your child is fighting.  A common cold can cause a child to have a temperature of 104 while strep throat might raise it to only 100.8.  Don’t let a high number alarm you if your child is otherwise doing ok and likewise don’t ignore a slight fever in a child who looks ill.

What to do?

You actually don’t have to do anything.  If your child is comfortable, playful, and eating and drinking well despite his 101 temperature, it’s ok to just watch and wait.  However, if your child is miserable, then acetaminophen or ibuprofen (in children older than 6 months) is the way to go.  Some stubborn fevers may require that you use both of those medications and it is safe to alternate them if needed.  Be sure to reference a weight based dosing chart, like the one we have here at Spring Valley Pediatrics, to ensure your child is getting the correct amount of medicine.   Giving too small a dose will not reduce the fever as effectively.

When your child has a fever, he will lose fluids more quickly.  Be sure to encourage lots of drinking to avoid dehydration and call your doctor if he is crying without making tears, has a dry mouth or lips, or is not urinating frequently.

When to call your pediatrician

If your baby is under 3 months old and has a rectal temperature of 100.4 or higher, call your pediatrician right away.  Fever and illness can be more serious and progress faster in younger infants so do not hesitate to wake your physician in the middle of the night if your baby has a fever.

If your older child has fever as well as other symptoms – a stiff neck, severe headache or sore throat, rash, repeated vomiting or diarrhea, signs of dehydration – or is unusually drowsy or fussy, give your pediatrician a call.  If your child’s fever continues for 3 days, it’s worth chatting with your doctor about whether or not your child should be brought in for a visit.

The other time to call is when you’re worried, even if your child is not experiencing any of the symptoms above. We are always happy to talk our families through any concerns.  That’s what we are here for.

How to Handle Separation Anxiety

It is heartbreaking to leave your child when he is upset. Read on for tips from Dr. Jessica Long on how to ease your child’s separation anxiety.

Nothing pulls at your heart strings like your child crying when you need to leave.  It makes you feel awful and, even if your little one recovers as soon as you are out of sight, makes you feel horribly guilty the entire time you are away.  Separation anxiety is a normal part of your child’s development but that does not make it any easier to endure.

Babies start to experience separation anxiety around the age of 4-7 months once they realize that you exist even when you are not right in front of them (this is known as “object permanence”).  They want you when you’re not there and are sad when you leave, even if it’s just to walk to the other room.  As our babies grow into toddlers, episodes of separation anxiety become less frequent but can be more intense (think crying, yelling, tantrums).  School-age children can even exhibit separation anxiety, especially with big changes like starting school or a new sibling in the house.  Thankfully though, it’s unusual for daily separation anxiety to continue in your school-age child. If it does, you should discuss it with your pediatrician.

So what’s a parent to do when you have to leave the house – now! – but you have a sobbing child clinging to your leg?  First off, no matter how tempting it is, don’t sneak out.  Your child needs to trust you and suddenly disappearing will only make her more fearful of your absences.  Instead, let her know that you are leaving and when you’ll be back in terms she’ll understand (“after you wake up from your nap” or “right before lunch”).  Just as importantly, keep that promise and be home when you say you will.  Develop a goodbye ritual that you use each time, to provide consistency, but keep it short.  Longer rituals may lead your child to fixate on the idea of you leaving.

Remember that practice makes perfect.  Being separated from a parent is important for your little one’s development, and it’s healthy for him to spend some time away from you.  Even having a friend, family member, or nanny provide child care for a few hours gives you the chance to practice your goodbye ritual and allows your child to experience special time with other trusted adults in his life.

Most importantly, separation anxiety is temporary.  Our children continue to grow, mature, and get used to new situations.  Stay loving and consistent in your goodbye routine and it will become easier and easier.

Meet Dr. Sepehri

We are excited to introduce our newest physician, Dr. Ellie Sepehri, who will be joining us this Fall.

Dr. Long

Dr. Ellie Sepehri is a Potomac, Maryland native returning to the DC area. Dr. Sepehri is a Winston Churchill High School Bulldog and a University of Maryland Terrapin. She received her Bachelor’s degree at University of Maryland- College Park in cell biology and was a Phi Beta Kappa recipient upon graduation. She obtained her Master’s and Doctor of Medicine degrees from Eastern Virginia Medical School in the beautiful waterside Hampton Roads area.

At Eastern Virginia, Dr. Sepehri was a recipient of the Arnold P. Gold research award for her scholarly and community efforts in the Tidewater Autism community. She is also a two-time recipient of the Mann T. Lowery Humanitarianism in Medicine award for her volunteer work with special needs children.

Dr. Sepehri then went on to pursue her Pediatric Residency training at Sinai Hospital of Baltimore where she focused greatly on developmental pediatrics, spearheading a project to conduct developmental consults at the Kennedy Krieger Institute. Her medical passion is in pediatric behavior and development, with special emphasis on temper tantrums, teaching formal positive parenting skills/classes, developmental delays, and working with a multi-disciplinary team to maximize each child’s full developmental potential.

Dr. Sepehri is married and has a sprightly young son and a vibrant 4.5lbs Maltipoo named Bodhi. You can catch Dr. Sepehri designing elaborate rooftop gardens, miniature dollhouse collecting, and playing trains with her son in her spare time. She is fluent in English, Farsi, and Spanish. Dr. Sepehri is delighted to be joining the Spring Valley Pediatrics team and serving as a healthcare advocate and champion for the children of metropolitan DC.

How To Handle Immunization Anxiety

As parents we all know that immunizations, although necessary, can be a source of anxiety for little ones (and for us!). Here are  Dr. Jessica Long‘s tips on how to keep our children calm during immunization visits.

I always hoped that, since I’m a pediatrician, my children would have no qualms about anything that happens at the doctor’s office. I was wrong. My children get as upset about shots, as fearful of a blood draw, and as manic about opening their mouths for a strep swab as the next kid. But shots don’t have to be a horrible experience for kids and parents alike. There are simple things we can do to calm our child, no matter her age, to make everything go a bit smoother.

Leading up to the doctor’s visit, your toddler or school-aged child may ask if it will hurt. Honesty is the best policy. Let him know that yes, it will hurt for a second, but it won’t be bad and you’re right there with him. Some kids like to role play beforehand, pretending to be the doctor giving shots to their parent or stuffed animal, which can make them more confident for the real thing.

At the doctor’s office, the first step in calming your child is checking in on your own mood. If you are relaxed that will rub off on your little one; if you’re stressed, that will too. How would you feel about getting a shot yourself? Probably not exactly excited about it, but also not too worried or afraid. You should feel that way about your child getting a shot. And your child will notice how you feel, and will tend to feel that way herself. Children are perceptive – pretending won’t help.

At the time of the shot, distraction can be very helpful. An infant may want to nurse, suck on a pacifier, or be skin to skin on a parent, all of which have been shown to reduce the stress of painful procedures in babies. An older child may want to hugged or cuddled, read a book, or even watch a favorite video on your phone. Encouraging your child to cough loudly right before and right after the shot has also been shown to reduce painful reactions in school aged kids and even middle schoolers (yes, they get scared, too).

Congratulate your child on being cooperative and brave, but don’t make too big a deal out of it Give her a high five, a hug or a cuddle to let her know you’re proud of her and then head out for a small reward. In our house we go for cake pops, and knowing there is a special treat waiting for my girls (and me!) at the end of a tough doctor’s visit puts everyone a little more at ease.

Strep Throat

We made it through flu season (fingers crossed), but what about the dreaded strep? Read on for advice from Dr. Jessica Long on how to handle this often painful infection.

Now that flu is leaving the D.C. area, it seems like strep throat has happily filled the void. If you have a school-aged child, chances are you have had at least one experience with strep throat. It’s almost a parenting rite of passage to get the “There is strep in the classroom” letter home from the teacher! Even though you hear about it all the time, what exactly is strep throat and why are pediatricians so quick to treat it with antibiotics?

Strep, short for streptococcus, comes in different forms but Group A Strep (aka streptococcus pyogenes or GAS for short) is the one that tends to infect the tonsils. The tonsils are a pair of soft tissue masses that are in the back of the throat. When they get infected, by either a virus or a bacteria, they can get larger, red, painful and sometimes even have pus on them. Though viruses are the main culprit of sore throats in kids, if your child continues to complain throughout the day of throat pain or has fever, belly pain, or a rash, it’s a good idea to see the pediatrician.

If your pediatrician wants to check if your child has strep throat, she will order a rapid strep test that can be done right there in the office. After a quick q-tip “tickle” of the tonsils, your doctor will have an answer in just a few minutes. The rapid strep test is good at checking to see if your child is infected but it misses a few people (it catches between 90-95% of people who have strep throat). Therefore, most physicians will also do a culture to see if strep grows from the swab over 24-48 hours. This extra test will make your pediatrician that much more confident that if the test is negative your child truly does not have strep throat.

We treat strep throat for a few reasons. First off, it makes kids feel better faster and who doesn’t want that? Also, after 24 hours of antibiotics your child is no longer contagious and can safely go back to school and activities without infecting friends and family. Plus, strep throat that goes untreated can lead to more serious infections such as an abscess of the tonsils, kidney problems, and even rheumatic heart disease. That’s why it’s important to take the full course of antibiotics if they are prescribed even though your child will feel back to normal in just a few days.

The biggest question on every parent’s mind is how to prevent this in the future? Unfortunately, that can be tough since strep throat can be spread a few days before a child has any symptoms. Throat infections are passed through the air by sneezing, coughing, or touching someone who has it, so remind your child to be vigilant about hand washing, to cough or sneeze into her elbow (not her hands!), not to share drinks and food, and to stay home from school when she doesn’t feel well.

Baby Proofing 101

Once your baby is mobile, it’s time to start making some changes around the house to protect your curious little one. Read on for tips from Dr. Jessica Long on best practices for baby-proofing.

There are a lot of ways parenthood changes us but one I did not expect was how drastically different our house would look. Never mind the scooters on the front porch, the chalk drawings on the sidewalk, or the toys strewn everywhere inside and out. There are more subtle differences I never would have guessed like covers on the outlets, gates on the stairs, and not a loose coin to be found. Baby-proofing your home is a huge but important endeavor and it involves changing habits and routines you never really knew you had.

How do you even start making your home safe for your little one who, at a very young age, can (and will) start reaching for things and sticking them in her mouth? Suddenly a benign water bottle lid becomes a potential choking hazard. The dog food bowl becomes your child’s most desired possession. And don’t get me started on how every electric cord in the house suddenly becomes a beacon of fun.

As you prepare to baby-proof, I recommend looking in each room in your house, ideally from the much lower viewpoint of your child, to see what potential dangers there are. There are obvious things like installing baby gates at the top and bottom of all stairs but also more subtle hazards like window blind cords that should be tucked out of reach. In bedrooms and living rooms, make sure furniture is secured to the wall so that your curious child does not accidentally topple it over when trying to pull up on it. The same goes for TVs, which are notorious for causing injuries to young children.

In kitchens and bathrooms, invest in strong cabinet and drawer locks so that curious hands do not find medications or cleaners. When possible, store toxic or poisonous substances up high as well as locked away to minimize the chances of your little one accidentally getting ahold of them. Outlets should be covered and electrical cords should be taped down or hidden behind furniture so as not tempt curious babies.

One of the big changes that needs to be made, and maintained over time, is keeping choking hazards out of your child’s reach. Gone are the days where you can toss loose change on the table without thinking or absent-mindedly leave batteries on the counter – both pose serious threats to your child. When ridding your space of choking hazards, use the toilet paper roll rule. If an item is small enough to fit through the cardboard tube, it should be placed out of reach of your child. While this is a routine that can take time to master, it will soon become second nature and ensures your child can crawl, walk, climb and explore in a safe space.

Once you’ve seemingly covered your house in bubble wrap, the next step is seeing what your child gets into. All the baby-proofing in the world doesn’t replace good adult supervision, and watching your child will reveal new hazards to abate Plus, every child is different, so while your first may never have looked at an outlet, your second may be found licking one (true story). You will likely continue to update and change your safety precautions as needed and as your child grows.