Jan 28, 2019

Dr. Gellner: With this being my fifth year of recording, my producers have asked me to do a best of episode with the top five topics I think parents need to know about before bringing their child to their pediatrician. These are concerns that I hear often or ones that really need to be in the spotlight. I'm Dr. Cindy Gellner, and you're listening to my "Five Best Topics" on The Scope.

Announcer: Keep your kids healthy and happy. You are now entering the "Healthy Kids Zone" with Dr. Cindy Gellner on The Scope.

Dr. Gellner: It was pretty easy to come up with my top choice -- the poop on poop, everything parents want to know about their kid's poop. It's pretty amazing how obsessed parents are with their kid's poop. Parents have even brought me poopy diapers and sent me pictures of their child's poop wondering what's going on. Babies and kids have developing digestive systems, so their pooping cycles are different from those of us as adults.

For newborns, dyschezia or apparently painful pooping is the norm until they learn how to coordinate all the muscles needed to poop. For breastfed babies, pooping with every feeding or only once a week are both normal. While formula-fed babies can go several times a day to once every three to four days.

Kids who are potty training often get scared of pooping and start holding it in leading to constipation issues. Some kids develop constipation shortly after they turn one, especially if there's a family history of others with constipation.

I see so many kids with constipation, I've actually been given the nickname of the poop whisperer at my office. Not one I choose for myself, but apparently I'm good at fixing constipated kids. The bottom line literally is everyone poops a little differently. If it hurts, if there's blood, if it's rock hard and causing stomach pain, then it's time for your child to be seen.

For number two, I would choose anything mental health related. Most pediatricians will tell you that we are the ones managing anxiety, depression, ADHD, behavior issues, most of the psychiatric issues in kids lately. There are days I see so many patients with behavior or mental health issues that I feel like a child psychiatrist.

Sadly, there's been a notable increase in mental health issues in people of all ages, and there's not been an increase in the number of mental health providers to help manage these issues. While all of us pediatricians are able to address many mental health diagnoses, there are some that are just out of our scope. We aren't counselors or therapists. Many of us cannot manage complex mental health issues, and medication prescriptions can be tricky as there aren't as many options for patients under age 18.

Your pediatrician will be the one that you bring your child to for the initial evaluation. But please understand that we can only help so much and often we need to refer you to a specialist. I always explain it as you wouldn't want your child's psychiatrist to manage your child's asthma. The pediatrician is better at that. In the same way, a child psychiatrist is better for addressing your child's mental health needs if they are beyond what we as pediatricians are trained to do and are comfortable treating.

Number three would be kids and colds. It seems that's my daily special lately. Everyone is coming in coughing, sneezing, not wearing a mask, so I wear mine and look like a duck all day. It's hard when you see little ones coming in and they look miserable and parents are exhausted. And for most of these viruses, all you can do is nasal saline, humidifier, honey if they're over one and lots and lots of TLC.

Parents often bring their kids in wanting something to help make their kids feel better faster, but unfortunately there isn't much out there other than supportive care. Antibiotics won't help unless they have a bacterial infection, like an ear infection or pneumonia. Breathing treatments won't help unless they have asthma. Green boogers don't always mean a sinus infection and pulling at ears doesn't automatically mean an ear infection.

Cold meds aren't safe in kids under age six, and many adult cold medications contain aspirin which aren't safe for anyone under 18. As a parent, I know how frustrating it is and how one would do anything to make their child feel better, but with cold viruses, it's symptom relief only.

Number four would probably need to be any of my Debunking Old Wives' Tales pieces. I spend a good deal of time on these in the office. No, your child can't get a cold because the weather changed or they went outside without a coat. Yes, your child can get their vaccines if they just have a mild virus. No, teething doesn't cause a fever or diarrhea. And yes, a little bleeding when your newborn's umbilical cord is coming off is actually normal and expected. And unfortunately, no, telling your child to eat their carrots won't really improve their eyesight.

Number five would have to be picky eating in toddlers. I get this concern at least once a day. I've had it twice today. Usually at a well-child visit when I asked how a child's eating is and parents tell me they were doing so good and now I can't get him to eat anything, I'll look at the growth curve and show the parents that their child has gained two pounds since I last saw them, and the parents are like, "How can that be? They're not eating?"

Well, kids' metabolisms put the brakes on between one and five. They only gain a few pounds a year during that before they hit their kindergarten growth spurt, so their eating patterns change. Some days they'll eat great. Other days they'll have five Cheerios and call it a day. Some days they will only eat mac and cheese for a whole week, and the next week mac and cheese is the most disgusting food on the planet and they won't go near it. Yep. All normal.

Our kids wouldn't eat well at home, but they did great at daycare or at a restaurant and we decided they just needed an audience to eat. As pediatricians, we're good at tracking your child's growth and if there are any red flags, we'll let you know. Until then the best advice is don't force your child to eat. Limit milk to 24 ounces per day, so they don't fill up on liquids, and make meals a positive experience. And trust that when your kid is hungry, they'll eat.

So those are my top five topics that I think parents need to listen to before rushing to their pediatricians' office. Hopefully, they've been helpful.

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