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.
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