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By contactus@allchildrenpeds.com
August 01, 2018
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By Dr. Claire Cowley, FAAP, CLC

"Sleep with the fishes", "to sleep per chance to dream", "sleep like a baby", "sleep on it", "beauty sleep".  Sleep is monumental and essential as in this Irish Proverb:  "A good laugh, a long sleep are the best cures in a doctor's book".  Did you know animals would die of sleep deprivation before starvation?  So sleep is important for our looks, our health, both mental and physical; philosophers, writers and most everyone agree.  Thomas Edison wrongfully, we now know, disagreed "sleep is an absurd waste of time".  Americans now sleep about two hours less than they did a century ago with alarming consequences.  Underslept people are more moody, irritable, and irrational.  Sleep deprived suspects held by the police, it's been shown, will confess to anything in exchange for rest.  Lack of sleep in adults is associated with hypertension, obesity, type 2 diabetes, changes in cognitive function, increased heart disease and increased dementia risk.

In children sleep deprivation mimics ADHD (Attention Deficit Hyperactivity Disease) and is associated with depression, bedwetting, behavioral issues and growth disturbance.

How much sleep do children need?  Toddlers and preschoolers need about 11-13 hours, perhaps 11 at night and 2 hours of napping.  The napping may be no more than a quiet time; grade schoolers need 9-12 hours and teens through early adulthood need 8-10 hours.

Parents note sometimes that a child past their bedtime has a hard time settling down and may fight sleep and for those, an earlier bedtime may be appropriate.  Usually a bedtime between 7 and 8pm is appropriate with waking between 6:30 and 7:30am.  Kids that are more tired fight sleep and naps and exhibit some negative behaviors like defiant behavior, being accident prone and excessive talking.  Watch for the earliest signs of sleepiness; rubbing their eyes, lack of focus, yawning or crankiness.  Wait too long and you'll see a child who is wired, jumpy, frantic and a lot harder to get down.

Adolescents are a whole different set of issues:  so many activites and cell phones and other devices practically attached to their bodies.  Overscheduling, jobs, and homework make it difficult to get enough sleep.  During sleep we produce growth hormone which we need in youth to attain full growth and througout our lives to service all of our body systems.

One of the best things we can do as parents in this regard is model good sleep hygiene ourselves, by making good habits a family priority.  Look at the time a child needs to be up in the morning and plan backwards to get the proper amount of sleep.

A wise college student told me this past week that they noticed when they studied prior to a reasonable bedtime and got a good night's sleep they did better on testing than cramming all night. Our waking brain collects information and our sleeping brain consplidates, edits and stores it.  Think of our high achieving, fast track bright adolescents getting 5 and 6 hours of sleep on school nights; they risk depression, obesity, hypertension, ADHD like symptoms and more accidents due to loss of alertness.  In the United States on the Monday after Daylight Savings Time changes, there's a jump in fatal car crashes and heart attacks by 25%.

Melatonin is available over the counter and is suggested even by some physicians to promote good sleep.  Do we really need it?  Our levels surge at about 6 months of age and decline after age 50.  Circadian rhythm is the natural sleep wake cycle set up by light and dark to which the brain responds by releasing melatonin, signalling our brain to sleep.  Healthy humans without organic brain issues, circadian rhythm disturbances (like blindness or jet lag), ADHD or autism shouldn't  require extra melatonin.  Rather, a regular bedtime, a pre-bedtime routine which does not include stimulating activities like TV or rough play, a routine in which the parent is not in the room when the child falls asleep is best.  No caffeinated beverages for 6 hours prior to bedtime and no screen time 1 to 2 hours prior to bedtime.  The routine should be 20-45 minutes and might involve 3-4 soothing activities like bathing, changing to pajamas and reading stories.  The child goes to bed drowsy but awake.  A consistent bedtime helps to reinforce our natural circadian rhythm and fall asleep more easily, security at a very basic level.

Think of the homeless kids in our community trying to get an education while sleeping in cars, shelters and unstable situations.  Think of the attributes of the sleep deprived child; it's no wonder they have issues in school.  In closing, I have included an excellent link with a table to summarize good sleep hygiene.  Sources: The American Academy of Pediatrics, National Geographic, UpToDate and the online resource "Sleep Lady". 



By contactus@allchildrenpeds.com
May 16, 2018
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 The prevalence of dental cavities has decreased over the past couple of decades, but continues to account for one of the most common chronic diseases. Many oral health concerns begin in childhood, but the risk of developing dental disease decreases with good preventative care.

Below are some of the most common questions addressed with pediatricians about the health of children’s teeth.

  • When should parents start brushing their child's teeth? 

It is never too early to start going through the motions of brushing your child's teeth. Before your child has teeth, you can simply massage his/her gums. Daily dental cleaning should begin when your child's first tooth appears, which usually happens between 4-15 months of age. If your child does not have his/her first tooth by 18 months, discuss with your pediatrician about a referral to the dentist.

  • How long should children brush their teeth?

It is recommended to brush for 2 minutes. Try to create fun activities to keep your child engaged while brushing his/her teeth such as singing a song, playing music, or setting a timer. 

  • What toothbrush should parents buy?

For infants, it is recommend using a small, soft bristled toothbrush. For younger children, parents should consider buying a toothbrush with a thicker handle so it is easier to hold. Be creative and purchase a toothbrush that has a character or color that your child likes.

  • What toothpaste should parents buy and how much to use?

Toothpaste with fluoride is recommended for children of all ages. For children under 3 years of age, it is recommend using a small smear of toothpaste, about the size of a grain of rice. For children 3-6 years of age, it is recommend using a pea-size amount of toothpaste.

  • When should children have their first dental visit?

The American Academy of Pediatrics (AAP) and American Dental Association (AAPD) recommends to schedule the first dental visit at or near one year of age. Early dental visits and teeth brushing reinforces the importance of oral health. If oral diseases are diagnosed early, the problems can be eliminated or kept from getting worse. If your family does not have a dentist, talk with your pediatrician at the next visit about a pediatric dentist in your area. 

  • In addition to teeth brushing, how can parents help prevent tooth decay?

There are additional steps that parents can take to help prevent tooth decay in their children. Never put your child to bed with a bottle or sippy cup containing formula, milk, or juices. These drinks contain sugar which can cause tooth decay. Also, try to transition from a bottle to a cup at or near 1 year of age.

Limit sugary drinks provided to your child. The AAP recommends no more than 4 ounces of diluted juice daily for children 6-12 months, and no more than 4-6 ounces for children 1-6 years of age. No sugary drinks are recommended for children younger than 6 months. Additionally, limit sweet and sticky foods such as hard candy, gummies, and fruit roll-ups.

By contactus@allchildrenpeds.com
April 18, 2018
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Compiled by Jeffrey L. Wampler, MD, FAAP (not one original thought)

One of the most common complaints we get called about is a cough.  Many things can cause a cough.  Children get many illnesses in the winter that cause a cough.  Parents often worry that the cough is a sign of something ominous.  Furthermore, coughs that last for a long time are often distressing to both the child and the parent.

What is a cough?  Coughing occurs when something gets into the airway below the vocal cords.  The upper airway starts at the back of the nose and moves down to the vocal cords.  The lower airway include the trachea, the right and left bronchus which leads to each lung, the small tubes of the lungs called bronchioles, and the air sack.  On youtube there is a video...(https://wwwyoutube.com/watch?v-usAgJoVYVSc&feature-youtu.be) showing how a cough occurs in the body.

Coughs in chldren are most commonly due to post nasal drip.  Mucous drains from the upper airway into the lower airway.  However, some coughs originate in the lower airway and it's important to differentiate.  Sometimes an xray may be needed.  It is very helpful for the parent to be able to describe the cough.   (https://pediatricpartners.blogspot.com/2013/12/my-childs-cough-and-breathing-sounds.html)

Common Cold:  Colds are viral illnesses that cause mucous production in the upper airway.  The cough occurs from post nasal drip of the mucous.  They last about 10 days but the cough may linger beyond that.  Viral Cough:  This is similar to a cold but the lower airway is infected by the virus.  This means patients will not have the typical runny nose or congestion that occurs with a cold.  Again, this cough can last for weeks.

Influenza:  The flu is a severe viral infection that causes fever, body aches, fatigue, headache, sore throat and cough.  There is usually less mucous production in the upper airway with the flu compared to a cold.  Also, the fever is usually higher compared to the common cold.

Pneumonia:  This a probably what parents worry about the most.  Pneumonia is not usually present at the start of a cough or cold as it is frequently a secondary infection to the cold virus.  This is because the sticky environment that the cold virus creates is a perfect home for bacteria.  The infection, and pus it creates, fills the air sacks, making it hard to breathe and causing a high fever.  If your child has any difficulty breathing, seek medical care right away.  Pneumonia is also caused by viruses so not all pneumonia infections require antibiotics.  Furthermore, older kids and teens can get walking pneumonia which is caused by the bacteria Mycoplasma.  Your child's doctor may want a chest x-ray to determine if your child has pneumonia and what type they may have.

Bronchiolitis:  Caused by RSV, bronchiolitis is an infection of the bronchioles, or small tubes in the lungs.  The extreme amount of mucous production plus the airway causing cough, distress with breathing and sometimes wheezing. RSV is more severe for young babies so please take your child to the doctor right away if you suspect it.

Croup:  Croup is a viral illness that causes swelling in the upper airway.  The cough is described as barky and some children will make a sound when breathing in known as stridor.  Placing the child in a steamy bathroom or going out into the cool night air can calm a croup cough.

Sinusitis:  The diagnosis of sinusitis is made after a cold and cough have been present for at least 10-14 days.  The diagnosis is not made for a child that has a dry lingering cough that is gradually getting better, which is the typcial pattern.  The diagnosis should be made in the setting of continued congestion, worsening symptoms after 2 weeks, headache or face pain, and possibly new onset of fever.  Even if your child has symptoms of sinusitis, it will often get better on its own, so there is not a rush to start antibiotics.  However, it is a good idea to discuss treatment options with your child's doctor.

Whooping cough:  Sadly we still diagnose this dangerous vaccine-preventable infection that is caused by the bacteria Bordatella pertussis.  The infection starts with mild cold symptoms but eventually progresses to a sever spasmodic cough.  Young babies and children will create the classic whoop sound when breathing in following a coughing fit but older children may not.  Furthermore, babies may stop breathing all together.  Older children will cough so hard that they will throw up following the coughing fit.  Unfortunately, whooping cough can be fatal at worst and cause 3 months of cough at best, so make sure your whole family is up to date on their whooping cough vaccines.

Bronchitis:  Bronchitis is inflammation in the bronchus, or large tubes, of the lower airway.  While it is a common diagnosis in adults, especially smokers, it is not common in young children.  The symptoms typically overlap with either a cold or asthma.  The most common cause of bronchitis is a viral infection so antibiotics are not indicated unless there is a secondary pneumonia that has developed.

Asthma:  While asthma is not an infection and is going to require its own post, the most common trigger for asthma is a cold.  Therefore, if you think your child is wheezing during their illness, it is best to see the doctor.  Some chronic coughs may actually be cough-variant asthma even in the absence of wheezing so this is something your doctor may consider if you child has a chronic cough lasting more than 4 weeks.

How should you treat a cough?  If your doctor has prescribed antibiotics for pneumonia, a sinus infection or whooping cough, give the whole course as prescribed.  Because most causes of coughs are viral, there isn't anything we can give to make it go away any faster and antibiotics are not appropriate.  But there are things you can do to comfort your child and ease their symptoms.

  1. Clear the airway by using saline in the nose
  2. Keep secretions looser by maintaining good hydration
  3. Soothe the throat with warm fluids and honey (only over 1 year of age)
  4. Use cough drops for children over 4 years old
  5. Use steam or a humidifier to keep the nasal passages from clogging up
  6. Avoid smoke exposure
  7. Only give decongestants or cough suppresant medications to children over age 6 and only give if it seems to temporarily help the symptoms

When is it time to worry?  As already mentioned above, if your child is coughing longer than 10 days, has any distress with breathing or chest pain, seek medical care.  Watch for rapid breathing, retractions (when the muscles sink between the ribs) and extra labor with breathing.  LIsten for sounds with breathing like stridor (whistle sound with inspiration) or wheezing (whistle sound with expiration).  Sometimes parents hear a whistling sound that they think is wheezing but is actually from breathing through a blocked nose.  Also, parents often worry in a small child that they can feel a rattle in the chest.  This is the child breathing through musous that is most likely in the upper airway.  When in doubt, take your child to see the doctor and if your child is getting tired from breathing, can't seem to catch their breath or looks blue around the lips, call 911.

Overall, if your child is coughing but is not having any difficulty breathing and has had a normal exam by the doctor, don't worry.  It is likely to pass.  However, if things get worse or the breathing looks labored, seek medical care.



  • AAP.org
  • Jaime Friedman, MD, FAAP
  • Web MD
  • UptoDate.com


By contactus@allchildrenpeds.com
December 18, 2017
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by Dr. Kathleen Maurer

Not too many years ago, children got most of their shots before they started kindergarten, and older children only needed an occasional tetanus booster .  Things have changed over the past decade, and several important vaccines are now recommended  for 11-18 year olds. Your pre-teen or teen-ager may be less than enthusiastic about getting vaccines when they come if for a sports physical or yearly exam, but it may help if they are prepared and understand the benefits of being protected from some very serious diseases. 

    1. Hepatitis A - This vaccine protects against a virus that affects the liver and can easily be transmitted person to person. There have also been a number of outbreaks through contaminated food or food handlers. International travel is also a risk factor, but with a more global society, community outbreaks have become more common. About 10-11 years ago, we began routinely giving Hepatitis A vaccine at 15 months and 2 years of age, so most of our younger patients have already had this vaccine, but many over 12 have not had this. Beginning in 2018, Kentucky Schools are requiring this vaccine for all students, so those who have not had it will need to get it. Students will need to have 2 doses of Hepatitis A vaccine at least 6 months apart.  If your child has not had both doses of Hepatitis A vaccine, please call our office to schedule an appointment.

     2. Pertussis (whooping cough) - Although this vaccine is included in the routine baby shots and preschool boosters, immunity tends to wane over time, and community outbreaks have become common. Older children and adults with pertussis may only have a very persistent and annoying cough, but this disease can be very dangerous and even fatal for vulnerable newborns and babies who are too young to be fully vaccinated. Beginning about 6 years ago, the Center for

Disease Control (CDC) and American Academy of Pediatrics (AAP) recommend all 11 year olds receive a dose of pertussis vaccine which is combined with tetanus vaccine (Tdap). This is now required for all Kentucky School children. (also recommended for all women during pregnancy, close contacts of all newborns and infants, childcare workers, and healthcare providers)

     3. Meningitis A vaccine (meningitis A, C, W, Y) -This vaccine protects against several strains of bacteria that can infect the blood, brain and spinal cord and cause serious and life threatening illness. It is most common in teens and young adults, and can spread quickly. The scary thing about this devastating and potentially deadly infection is that it can infect otherwise healthy young people, and its onset tends to be very rapid. A dose of Meningitis A vaccine is required at age 11, with a booster dose at age 16. (Certain high-risk patients may need to get this vaccine before age 11) 

     4. Meningitis B vaccine - This vaccine protects against a serogroup of the meningitis bacteria that is not included in the required Meningitis A vaccine. Within the past 5 years, multiple college campuses have experienced outbreaks of Meningitis B. The symptoms are identical to the other strains of meningitis, causing serious illness or deaths. Two doses of this vaccine are recommended for 16-18 year olds, and especially encouraged for those who will be heading to college. 

      5. HPV - Human Papilloma Virus is very prevalent in the population in general and is the cause of almost all cases of cervical cancer in women and some genital and head and neck cancers in men, as well as genital warts. Although its primary means of transmission is through sexual contact, it is not only careless people who contract this infection. Most people have no symptoms at all from this virus and it eventually clears on its own, but some cases will persist and lead to cancers. The first HPV vaccine, which covered for the most common cancer-causing strains, was approved in 2006.  The current Gardasil 9,  which has expanded protection against more strains of the virus, was approved in 2014. HPV vaccine is recommended for both boys and girls, ages 11 and up (approved down to age 9) Those who receive the first dose of vaccine prior to their 15th birthday only need 2 doses, 6 months apart, while those 15 and older will need 3 doses. 

By contactus@allchildrenpeds.com
February 07, 2017
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Welcome to our Blog!  Each month one of our providers will be posting about a topic that covers important information related to children's healthcare.  We invite you to suggest topics that you would like to see covered in our blog.  This page is for you and your kids.  To suggest a topic just call our office and let the Reception desk know you would like to make a suggestion for the Blog.  That suggestion will be relayed to our providers.  Welcome and please let us know next time we see you what you think, we value your feedback!