My name is Dr. Edna Tello, MD. I am a board certified pediatrician, wife, mother of two, and community health educator. I started this blog in response to questions and requests from many of my parents, friends, and family members.
To all my readers happy Valentine’s month! This is the month of celebrating friendship and love. Since we celebrate with delicious chocolate, plenty of candy and pink and red hearts, I am dedicating this blog to the heart. Kids’ hearts that is!
The heart is an amazing muscle which pumps approximately 1.3 gallons per minute or 1872 gallons of blood in 24 hours! The heart starts beating at approximately the 6th week of gestation. For the pregnant mommies who want to ensure a healthy cardiovascular start for the baby, make sure you are eating a good healthy diet especially rich in folic acid and take your prenatal vitamins as recommended. All the major organs are formed by the first trimester. Always check with your doctor if taking any medications as some medications can cause birth defects and affect the development of the cardiovascular system which includes heart and vessels. If there is a family history of heart defects or unusual heart rhythms especially in first degree relatives like siblings or parents you need to tell your obstetrician as soon as possible. Usually a specialist called a perinatologist can do a very advance level 2 ultrasound which may be able to detect major heart structural abnormalities.
The American Academy of Pediatrics is now recommending heart screening for all newborns by doing a very simple test called pulse oxymetry. This consists in putting a small probe on the baby’s finger and matching the heart rate with oxygenation at room air. If there are any discrepancies further testing will be ordered. Since this is just a recommendation most hospitals are just starting to adopt it as a policy in most newborn nurseries. You can ask your pediatrician and request this very simple test.
Heart murmurs are a very common finding in perfectly healthy newborns and children. If any heart murmur is detected at birth it needs to be followed by the pediatrician who then will refer to the pediatric cardiologist or may order an ultrasound of the heart. A heart murmur is the sound of blood going through the different structures of the heart. If there is a structural abnormality the sound deviates from the usual sound that we appreciate with the stethoscope. In newborns and older children the majority of the murmurs are innocent but they always need to be investigated. If an infant is not gaining appropriate weight or he/she is having major difficulties feeding always asks your doctor as this can be a sign of heart trouble.
In school age children and adolescents signs and symptoms of heart disease are exercise intolerance, with extreme fatigue, weakness, almost passing out with or without exercise and syncope. Abnormal heart beats very rapid, skip beats or irregular heartbeats should always be investigated with the pediatrician and even may require a cardiology referral. For athletes with any of these symptoms competitive sports should be put on hold until cleared by a cardiologist and although not a universal requirement I would even recommend a screening EKG for any child playing competitive sports at the varsity level in high school and planning to play in college. Chest pain very rarely is related to heart problems more commonly maybe a sign of respiratory or musculoskeletal issues.
Childhood obesity increases the risk for early cardiovascular disease. We are starting to see many obese children with high cholesterol, high triglycerides, high blood pressure and diabetes.
For a healthy heart a well balanced diet, consisting of fruits and vegetables, lean meats, grains and legumes is essential. Avoid processed sugars, foods that come prepackaged with high levels of sodium, and preservatives, juices that are bottled or come in boxes, and sodas. A good diet, daily exercise and a good dose of laughter are the secrets for a healthy heart.
Staying on the subject of vision health in dedication of National Eye Care Month, there is a truth in the fact that we are what we eat. Vitamins obtained from the food that we eat help us sustain different systems in our body. Vitamin A is important for our skin and hair. It helps maintain healthy gums bones and teeth, supports our immune system, and extremely important for the health of our eyes, especially night vision. Vitamin A is a fat soluble vitamin found in carrots as well as in milk and dairy, cereals, some green, yellow veggies, deep yellow and orange fruits (sweet potatoes, and squash) as well as in organ meats like liver (yikes not my favorite!).
If there is Vitamin A deficiency a patient can have problems seeing at night, dry eyes, growth delay, very dry and rough skin, and a weak immune system susceptible to infection. However, TOO MUCH OF A GOOD THING CAN ALSO CREATE PROBLEMS. Never take overdose of any vitamin especially vitamin A. Children and adults can eat yellow vegetables everyday and this will not cause an overdose. This recommendation is for parents or adult administering high doses of a specific vitamin supplement bought from a store in a liquid or chewable vitamin form. This can be extremely harmful: high levels of vitamin A taken as a supplement can cause liver failure, hair loss, bone pain, headaches, fatigue, diarrhea, blurred vision and birth defects if taken in high doses during pregnancy.
Vitamin B2 also known as Riboflavin also helps to maintain vision health. It is found in organ meats (I still cannot eat liver!), dark meat from chicken or turkey, dairy, fortified cereals, grains and green leafy veggies like collard, spinach, kale.
If your toddler or child gives you a bit of difficulty eating the yellow vegetables remember to substitute with cantaloupes, oranges, grapefruits. Vitamin A and B2 are also found in yogurt and cheese as well as fortified cereals. So eat up to these great foods to maintain your vision health.
In honor of National Eye Care Month, I will be dedicating this month’s posts to vision care tips. In the spirit of the New Year, there is no better time to schedule a new eye exam for the entire family.
As a part of the health screening before school entry, I recommend having your children’s vision formally checked. Between the ages of 3 and 4 all children should have their vision screened. Your child should have his/her eyes check by the pediatrician with every well visit. However, I recommend a more detailed exam and it should be performed by a pediatric ophthalmologist or by an optometrist who is comfortable evaluating young children.
These are some red flags that should be immediately investigated in regards to your children’s vision:
- A severe headache that is persistent; Children should not have headaches. Mark a calendar for everyday he/she complains of headache and make note of the time of the day. This could be a sign of a vision or a more serious problem. If the headache is associated with other symptoms always contact your pediatrician immediately.
- Watching TV, playing video games or computer games too close as if unable to see clearly
- Needing to read books too close
- Squinting frequently
- Lazy eye
- Family history of refractory eye problems like astigmatism, far sightedness or near sightedness
- History of Prematurity
Eye exams are as important as your dental exams. Have your eyes checked once a year. And kids remember to eat your carrots: Vitamin A is good for your EYES.
Stay tuned for my next post on Vision Nutrition!
The Flu Season has already begun are you and your little ones prepared? I am sure that you are all seeing and hearing the commercials to come and get “The Flu Shot.” They are giving them at your local pharmacy, at the health department, and in your primary care physician’s office. Before you make your decision about receiving this vaccine, I’m sure you have several questions.
What exactly is this “Flu Shot?”
There are two types of influenza vaccines: a live and non live. The live means an actual viral particle is given to the patient, this vaccine is popular because is non injectable and given through a nasal spray. The live vaccine should never be given to children under age 2 years, children who have asthma or recent history of wheezing or anybody who is immunocompromised. The non live is injectable but it contains the inactivated virus as the main component of the vaccine. There are also a preservative free or with preservative version of the vaccine. In this case the preservative is thimerosol which contains small traces of mercury. I never like to give my children or my patients anything with mercury preservative if I can prevent it. Ask your provider which version they have so you can make the best decision for you and your child(ren).
Why is there a new vaccine every year?
There are different influenza strands and every year the virus mutates or changes. Therefore a new vaccine is made using a combination of strands from the most recent outbreaks worldwide. Once the vaccine is given to a patient it will start working in the immune system at day three of vaccination, but it is not until after day 7 that you will have full immunity. If during that period you are exposed you will still get the flu.
Who is more susceptible to the flu?
I recommend the flu vaccine every year for all children who are six months and up especially for little ones with chronic conditions like asthma, diabetes, history of extreme prematurity, and heart disease.
What are the possible side-effects?
All vaccines have potential side effects. The possible side effects of the flu vaccine can range from nothing, to minor redness and swelling at the site of the vaccine, to pain and soreness of the site for several days after the vaccine; to the most unusual but possible fever, body aches and headaches. Other possible side effects may present if the child is allergic to any components of the vaccines, then the child should not receive the vaccine: the possible side effect can be hives, wheezing, difficulty breathing which are signs of severe allergy called anaphylaxis. The vaccine contains some chicken egg component therefore if a child is allergic to eggs he/she should not receive the vaccine. Thankfully the most severe side effects are very rare.
As I stated in my previous posting the best preventions for the Flu are hand washing and the vaccine. I arm myself, my family, and my patients with the flu vaccine every year.
For more information on the flu vaccine visit http://www.cdc.gov/vaccines/pubs/vis/#flu .
Two years ago, my daughter Sarah woke up feeling extremely weak, with terrible chills and an uncontrollable fever of over 103. It took me less than two minutes to realize what she had, “The dreaded FLU!” The flu is a contagious illness caused by the influenza virus which symptoms include: fever, body aches, sore throat, severe cough, and in some cases abdominal pain, vomiting and diarrhea. I’m sure these all sound familiar, so how can you tell that your little one has more than just a cold? Look for these main differences:
- Body Aches
- Constellation of all the symptoms
- Unbreakable fever
- The duration of the symptoms- the fever can last up to 7 days and the cough can stay for 2 more weeks!
The treatment for the flu is usually supportive. In the most uncomplicated cases physicians will recommend plenty of fluids, rest and ibuprofen or acetominophen for the fever and body aches. In cases where the patient may be at risk for complications he/she may be prescribed antiviral medications to shorten the duration of symptoms. If you or your little ones are experiencing these symptoms be sure to consult with your primary care physician right away.
According to the CDC and the Journal of the American Medical Association, every year in the US approximately 36,000 people die from complications of influenza, especially very young children, the elderly and those with weakened immune systems. The US influenza season starts in September, ending in May with a peak in January-February. The best prevention for any infection other than vaccination is hand washing. This can protect you and your little ones from “the flu,” and all other viruses that can cause severe infections. I give myself and my entire family the vaccine every year, and I recommend for children six months and up to prevent yearly infections.
During the holidays not only do we get to wear pretty clothes, eat great food but we also get to go on a plane, train or car to visit relatives and friends as part of your family tradition.
Here are a few tips to make your trip an enjoyable and healthy experience for the family whatever your destination or mode of transportation.
What to Pack?
- Pack lightly, but even if you are going to sunny California bring a couple of long sleeve cotton shirts and a pair of long pants in case the weather changes.
- Bring movies, video games, coloring books or age appropriate quiet activities like coloring. If you are traveling with multiple children and it is a long trip bring a little treasure box with small treats from the dollar store, one per hour of flight/drive and take out one at a time.
- Bring their favorite blanket or teddy bear to comfort them and hopefully help them take a nap.
- Bring a few treats such as pretzels or crackers as there may not be food served on the plane.
In the Plane:
- For infants and toddlers prepare for takeoff and landing by giving a bottle or pacifier to help with ear pressure.
- It is ok to let them be active and play before traveling or if possible in the afternoon or evening where there could be a better chance they will sleep during the flight. Do not get them over tired or ever medicate them with antihistamines (like Benadryl) or cough medications. These medications can cause hyperactivity and jitteriness instead of somnolence. Children should not be medicated with this purpose ever.
- Wear comfortable shoes and clothes in layers; it is usually cold in the plane and remember you must remove clothes when going through security. So make sure shoes and jackets are easy to remove and put on.
- Bring sanitizing wipes and clean their little hands after checking in and after going through security. Thousands of people traffic these areas every day.
In the Car:
- All of the above apply with the exception of the ear pressure issue unless you are going to very high altitudes, like traveling to the mountains.
- Prepare to make several stops during the trip and make them count by strategically planning interesting places to stop for bathroom and food. Road trips can be interesting and very relaxing if well planned.
Make the best of every situation and make sure they get enough food and rest and your children will be fine during the trip. If your child is very young and gets fussy remember not to have unrealistic expectations: I get a little fussy when I don’t get to sleep on my bed.
By: Dr. Edna Tello, MD
As a parent and a pediatrician, I would like to remind you that potty training should be a fun process. It was fun for my family. We have happy and funny stories with Daniel and Sarah; we even have great stories of training our puppy, Peanut. All mammals big and small will eventually attain this milestone, and that goes for the human species as well. Most children start becoming interested in potty training around their 2nd birthday, and most attain the skill by 3 ½ yrs old. They become curious and interested in everything you do. Going to the bathroom is no different. Allowing them to be in control and celebrating their achievement is important. However, recognizing that your child is developmentally ready for potty training is really the key to success. Many claim that training a 12 month old toddler has been done, yet if your child is still trying to master walking and climbing, going to the bathroom in the toilet is not realistic, or even possible. Often, these children will regress and develop other issues related to stool and urinary withholding, which can lead to severe constipation, encopresis, and recurrent urinary tract infections, ultimately causing great stress on the child and the family.
THE FOUR P’S OF POTTY TRAINING
When children are ready for potty training, they will become interested and curious. Take the opportunity and start the process at that time, not a minute earlier. Waking up dry from a nap and/or in the morning are definite signs that the child is ready for bowel and bladder control. Mark your calendars and pick a time that is realistic for you and your family: try not to pick the week you are going on a trip to Disney for the first time, the week you are moving and starting a new job, or better yet, the week you’re bringing the new baby brother or sister home.
Get developmentally appropriate books and videos (books with simple pictures of smiling children going through the process) and start reading or watching them with your child as a way of preparing him/her. You will need a small, fun potty– as an alternative you can get a little doughnut to put on the toilet; loose fitting cotton underwear; and some fun stickers to make a reward chart. Place potty in visible, easily accessible area of the house.
Have a positive attitude toward the process. Always use proper and positive words, even when the child is just trying. Do not use words like yucky, dirty, or bad, as children will then associate negative words with a healthy, pleasant function (let’s be real; every person enjoys potty time!). The same-sex parent or older siblings can demonstrate the mechanics, including flushing and hand washing.
Start by sitting the fully clothed child on the potty so that he or she feels comfortable. Then, if the child begins using pull-ups (this is before underwear), transfer the contents of them into the potty, or toilet, and flush. Make the flushing fun.
Put on big boy or big girl underwear and start! You must remind the child repeatedly to use the restroom during the day: before and after snacks and meals, during active play time, before and after nap time, and before bed time. Some people use timers; I found it a little more stressful, but if that works for you, go for it. Remember to include hand washing after every successful event. Day time routines will be attained before night time ones.
Follow every attempt, successful or not, with verbal praise. Appear sincerely pleased that your child is trying. Never get angry or upset if the child has an accident. Recruit other family members to call or check in daily: a favorite aunt’s or uncle’s praise can go a long way.
Create a reward chart with stickers or happy faces for every successful attempt; some people do m&m’s or jelly beans, but I do not like to reward children with food. Praise and small rewards are more effective.
Remember, this process can last a weekend, a week, or a full month, but you will be successful if you do not stress and enjoy this special time in your child’s life. If your child has attained total bowel control and bladder control during the day, the process is almost complete. A small percentage of the population can occasionally have persistent bed wetting up until the late school years. Always consult your pediatrician during regular physicals about this issue. If this is a new problem, after months or years of total bladder control, or if bed wetting is a source of emotional stress, please consult your pediatrician immediately, as this can be a symptom of a physiologic issue like a urinary tract infection.
Have fun! It’s Potty time!
We are getting ready for my favorite time of the year: The holidays. It all starts with Thanksgiving and ends with New Year. But whether you celebrate Christmas, Hanukkah or Winter Festival you know very well that there is one common denominator: Delicious food and lots of it!!!
Dr. T wants to remind you that there is still place for healthy eating at the Thanksgiving Meal and during the holiday season:
- Main Course-If you are cooking a turkey or chicken or other meats there are now the hormone free, and naturally grown free range poultry available in the green section of your local supermarkets.
- Sides: Look for alternative recipes to your common dishes. Some feature healthier ingredients or substitutes for the high calorie foods. For example if the ingredients that require butter or mayo: there are olive oil butter and olive oil mayo in the market. The good news is that all Thanksgiving foods can be very healthy: Vegetables dishes like carrots, green beans, corn, pumpkins, brussel sprouts, sweet potatoes and mashed potatoes are the popular side dishes.
- Fruits and Vegetables: Choose organic fresh fruits and vegetables. Take advantage of new local farmer markets they are becoming very popular and I guarantee there is one near you. Visit http://www.localharvest.org/ to find your nearest one. If this option is not reasonable for you instead of canned veggies try frozen, but of course fresh is always best!
- Drinks: Serve water, or naturally prepared juices (not boxed juices). No sodas, or other carbonated or diet drinks are good for children.
- Desserts: For desserts choose fresh apple pie, fresh cherry pie, pumpkin pie and breads. If you make it at home even better! If you decide you want cakes and cookies it is time to get that the recipe book and make it yourself. It is always healthier if you use fresh ingredients rather than from a box. If preparing cakes, or cupcakes you can substitute apple sauce instead of oil for moisture. If the recipes require eggs use whites only egg. Instead of white refined sugar use brown sugar.
I am wishing you and your wonderful families a safe and healthy Thanksgiving! I am thankful for my family, patients, health, and to those of you reading my posts and sharing this valuable knowledge.
This little recipe is a Dr. T’s original. Well…. and my kids helped out too!
4 chicken breasts boneless and skinless
Plain bread-crumbs on a flat plate
¼ cup of plain egg whites
Salt and seasoning per your own taste
¼ cup of olive oil
- Cut the chicken breast into thin strips or small nugget size pieces. The thinner the cut the faster and better the cutlets will cook.
- Season the chicken with plain salt or poultry seasoning according to your taste. Although some bread crumbs contain seasoning use the plain ones. It is better when you control the sodium/salt you add to your food. The already seasoned ones contain 630 mg of sodium per serving which is a large quantity.
- Dip the cutlets thoroughly in the egg whites.
- Roll them on the bread crumbs.
- Fry them in very hot olive oil until completely and thoroughly cooked.
Enjoy these cutlets! These are easy, yummy and very healthy. Lot better for you and your children than the precooked, frozen, store brand or fast food.
By: Dr. Edna Tello, MD