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Debunking myths about soy, our guest blogger today is esteemed pediatrician Dr. Roy Benaroch. In practice near Atlanta, Georgia, he is an assistant clinical professor of pediatrics at Emory University, a father of three, and the author  of The Guide to Getting the Best Health Care for your Child  and Solving Health and Behavioral Problems from Birth through Preschool . We enjoy his blog The Pediatric Insider  and we think you will enjoy the except below.

Drs. Lai and Kardos

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From LeeAnn: “Are soybeans (edamame) safe for my 11 year old daughter to eat? I have heard that they can ‘mess with’ her hormones?”

You want to see a freakshow? Try googling this topic. I found one essay, on a “news” site, that blamed soy products for everything from stroke to vision loss to homosexuality. On the other hand, other authors love soy: it will apparently prevent heart attacks, improve the symptoms of menopause, and help flush the toxins out of your body while improving your sex drive (women) and fracture healing (men.) On one site, in two adjacent paragraphs, I found a breathless author worrying that soy could cause breast cancer, followed by a second paragraph extolling its virtues in preventing breast cancer.

Please.

Soybeans contain a group of chemicals called “phytoestrogens” (sometimes called “isoflavones”) that are chemically somewhat similar to human estrogen hormones. In the 1970’s and 1980’s, some research showed that in the laboratory, these compounds could activate human estrogen receptors, presumably causing estrogen-like effects. So that’s the germ of truth.

But these phytoestrogens activate human estrogen receptors very, very weakly. They’re also easily broken down by cooking and processing, and by enzymes in the human body. It would take a tremendous amount of soy, eaten every day, to have anything close to a genuine hormonal effect. No human study has shown anything close to a measurable effect of consuming soy, at least not in ordinary amounts.

So: enjoy your edamame, tofu, and soy burgers. Dip your sushi in a little soy sauce, and try this tasty recipe from Alton Brown. If you want to be super-careful, just don’t do all of this on the same day.

The Pediatric Insider

© 2010 Roy Benaroch, MD
Printed with permission in Two Peds in a Pod

this tasty recipe

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Why does that big pimple always appear the night before prom, picture day, her sweet sixteenth birthday party or any other important event in your teen’s life?

A rite of passage, acne is caused by a combination of genetics and bad luck.  The perception of acne as a problem depends on the eye of the beholder. When I see a teenaged patient in my office for acne, the first question I ask is, “Who is more concerned about the acne? The parent or the patient?” Some kids have very mild acne, yet those kids perceive their pimples are the size of golf balls. Other kids are oblivious, and the parents are more upset than the teen.

Even if your teen starts to break out with what she perceives are huge blemishes but are really the size of pin pricks, do take her seriously. Many effective, safe products can diminish mild acne and thus greatly help self-esteem in a self conscious teen. Also, make sure to probe to see if a negative perception of her appearance extends to an overall poor body image. Sometimes distress over minimal acne can be an early sign of body image disorders such as anorexia nervosa or bulimia.

The categories of acne medicines are:

                -Topical antibiotics such as benzoyl peroxide or clindamycin, applied directly to skin- works to kill the bacteria that lead to acne

                -Other topical medications such as tretinoin (Retin A) and adapalene (Differin) stop acne formation mainly by penetrating into the deep layers of the skin to loosen acne causing pores

                -Oral antibiotics, such as minocin, clindamycin or  erythromycin also kill the bacteria that lead to acne formation 

                -Accutane, an oral medical reserved for severe, scarring acne. Can cause significant birth defects and so girls who take it must also take birth control pills and have periodic pregnancy tests. Chemical imbalances may occur, so blood work is required for both sexes.

                -Hormonal therapy (birth control pills)- works best for females who break out near their periods, smooths out the hormonal fluctuations which fire up acne.

I always remind my patients that most treatments take six weeks to work. For kids who experience dry skin with the topical medications, use noncomedogenic (non acne forming) moisturizer liberally.Dermatologists and pediatricians schedule follow up visits for acne at 4-6 week intervals. If your teen has mild acne but truly doesn’t want to bother with treatment, just encourage washing with a mild cleanser (for example Dove soap) once daily.  Tell him also to use a clean washcloth or soft paper towel to dry off after each washing. Applaud his self-confidence and lack of obsession with a skin condition which almost always improves with time.

Myth buster: eating chocolate does not cause acne. The chocoholic in me is greatly relieved by this knowledge. 

Truth:  arranging hair to hide the face tends to make acne worse. Avoid oily hair gels and sprays. In addition, touching and picking at the skin also causes irritation in an already irritated area.

Finally, what to do on prom night? Cosmetics work wonders, and parental reassurance, even if your teen waves it aside, can take care of the rest.

Julie Kardos, MD with Naline Lai, MD
©2010 Two Peds in a Pod℠

 

 

 

 

 

 

 

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Here’s a quick blast of more summer hints.


Sunscreen:  Apply SPF (Sun Protection Factor) of at least 15, and use more than you think is necessary.  SPF gives you an idea of how long it may take you to burn.  SPF of 15 means you will take 15 times longer to burn…if you burn in one minute, that’s only 15 minutes of protection! So apply, reapply and reapply. Sunscreen is fine for even young babies. For a baby’s first application of sunscreen, test the sunscreen by rubbing a small amount (size of a quarter) on the inner forearm and watch for a reaction. Clothing and shade work best to protect the skin, but not all clothing is protective. Depending on the weave and the fabric, protection fluctuates with each piece of clothing. Look for UPF (ultraviolet protection factor) ratings. A UPF rating measures the amount of UV light that reaches your skin. Higher numbers are better. For example, a rating of 100 means 1/100 or one percent of all rays will reach the skin.


Swimming:  Lessons are fun and safe for all ages (including young toddlers). Studies have shown that children who drown are more likely to NOT have had swimming lessons compared to same age children who have not drowned.  Even if he graduated from swimming lessons, attend to your child around water, whether it is a swimming pool, lake, puddle or bath. Lessons are not a substitute for adult supervision. Also, do not submerge your baby underwater. Contrary to media hype, your baby will NOT automatically hold his breath.


Patients frequently ask me when pool water is safe for a baby’s skin. Frankly, I worry more about sunburn from sunlight reflecting off the water than damage from contact with pool water. Just wash her with soap and water after she is done swimming for the day. If the chlorine in a pool seems to dry your baby’s skin, apply moisturizer after her bath.


Mosquito Bites:  Initially wash with soap and water. For the itch: apply hydrocortisone 1% cream or ointment up to 4 times daily. Give oral diphenhydramine (brand name Benadryl) before bedtime to prevent your child from scratching in his sleep. Signs of an infected bite include new or worsening pain, increasing redness, any pus-filled area, or red streaks extending from the bite. Swelling, itchiness, and some redness at the site of the bite are signs of local irritation but not necessarily infection.


Bike helmets:  Insist on the use of bike helmets. Head trauma from falling off bikes, roller blades, scooters, and skateboards often happen in the summer when kids say they are “too hot” to wear their helmet.


I would write more, but I have to go adjust a bike helmet on my sun-screened son who is scratching his bug bite as he is getting ready to bike to a neighbor’s pool to swim, under adult supervision.


Julie Kardos, MD with Naline Lai, MD
©2010 Two Peds in a Pod℠            

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Okay ready? Put your palms together. Fold your pinkie and ring fingers down. Tuck in your middle and pointer fingers. Cross your thumbs. Allow your BFF to lean over and suddenly push your knuckles together:  c-r-a-c-k ! She cracks your knuckles.

It’s one in a long line of mildly torturous friendship games children play. Remember building a “rose garden” on your friend’s arm by pinching his forearm until it turned beet red?

As I watch my kids play the “knuckle cracking game,” I am reminded of a question  parents often ask: “He is always cracking his knuckes! Won’t that cause early arthritis?”

When I look over at the object of the parent’s complaint in the office, the child usually gives me a big grin, and c-r-a-c-k, happily demonstrates to me the reason for the parent’s question. To the parent’s dismay, I tell the family knuckle cracking will not lead to early arthritis. However, I always laugh and warn the kid that harm from cracking knuckles comes not from the action of cracking knuckles but rather from an irritated parent’s wrath.

What’s the consequence of allowing a friend to crack your knuckles? That I do not know… although I have a suspicion the parental consequence is similar to when you crack your own.

Naline Lai, MD with Julie Kardos, MD
©2010 Two Peds in a Pod℠

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Earlier in the month I attended a developmental pediatrics conference in Philadelphia. The keynote speaker, Barry Zuckerman MD, professor and chairman of pediatrics at Boston University, raised a set of thoughtful questions. Parents can use the answers as a starting point for understanding how they were raised. Here are some of the questions with modifications:

 

        -What was it like growing up? Who was in your family? Who raised you?

 

        -Do you plan to raise your child like your parents raised you?

 

        -How did your relationship with your family evolve throughout your youth?

 
How did your relationship with your caregivers (mother/father/aunt/grandparent/etc) differ from each other? What did you like or not like about each relationship?

 
Did you ever feel rejected or threatened by your parents? What sort of influence do they now have on your life?

 
Did anyone significant die during your youth? What was your earliest separation from your parents like? Were there any prolonged separations?

 
If there were difficult times during your childhood, were there positive role models in or outside your home that you could depend on?

 

Some of these questions may be tougher than others to answer. Ultimately you are not your parents (although you may feel otherwise when you hear a familiar phrase escape your own lips), and likewise your children are not you. Parenting techniques that worked, or did not work, for your parents will not necessarily work, or not work, for you. However, stopping to reflect on your own youth will help you understand why you parent the way that you do.

 

Naline Lai, MD with Julie Kardos, MD

© 2010 Two Peds in a Pod℠

 

 

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It’s June, a time of hellos and goodbyes.


 


Change in routine can be tough.  For some children and teens the transition from school year to summer unmasks depression.


 


The signs of depression in younger children can look different than depression in teens and young adults.  Younger children are less likely to tell you that they feel sad- often because they can not pinpoint what is wrong.    Of course everyone is allowed periodic “bad days”, but when there are more “bad days” than “good days” action must be taken.  Below are some warning signs that your child may be depressed:


 


Feels down or sad much of the time


Acts angry much of the time


Acts “out of control” or has new behavior problems that seem resistant to your usual discipline measures.


Loses interest in activities which normally bring pleasure, withdraws from friends


Exhibits changes in sleep patterns-difficulty falling asleep, numerous awakenings, or excess sleeping


Has feelings of worthlessness (feelings she let a family member or teacher down, etc.)


Finds it difficult to concentrate


Performs worse in school, grades slip, or tries to avoid going to school


Shows low energy or fatigue or conversely seems restless or “hyper”


Alcohol or drug use (attempts at “self-medicating”)


Expresses thoughts of being better off dead or desires to hurt himself.


 


If you suspect your child is depressed, ask him the hard questions. Ask him if he is thinking of hurting himself or others.  Ask if he wants to commit suicide. You will not be “planting an idea.” Asking will allow you to find the medical help he needs immediately.  Not asking may lead to death. We always tell patients and their parents not to hesitate to call “911” or go to the emergency room if the patient is suicidal.  After all, it is an emergency– a life is at stake.


 


Sometimes it’s not your child who is depressed.Your child’s friend may confide that he or she is extremely sad and may tell your child to keep the information a secret.  Let your child know that her friend is giving a “cry for help” and that it is appropriate to share information with adults.


 


Children and teens can have “real” depression just like adults and they need treatment from an experienced health care professional just like adults do. Consequences of untreated depression, just like adults, can include loss of enjoyment in life, estrangement from friends, school or job failure, and untimely death from suicide.


 


Naline Lai, MD and Julie Kardos, MD


© 2010 Two Peds in a Pod℠

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Sand and specks of dried seaweed fly into the air. Your kids are on the beach shoveling their way to China.  “Watch out!” you yell. “Watch those shovels! The ocean is big. The beach is big. You don’t need to be right on top of each other.  There is plenty of sand for everyone.”

You sigh and go back to counting snacks and unearthing buried flip-flops.  You look back at the kids. Aw, you think to your self, they look so cute. Just as you reach for the camera, the idyllic moment is shattered. Your youngest is holding his eye and everyone, even the kid who threw sand into the injured child’s face, is crying.

Quickly you grab a water bottle and flush the irritating granules out of his eye.  Satisfied nothing is left, you ask, “Does that feel better?”  Your child ruefully nods, and resumes holding his eye.  An hour later his eye is still watering. What next?

With any eye injury, pain, watery eyes or visual changes are all reasons to seek medical care. In this case, the sand or a little wood chip probably caused a scratch on the outer layer of the eye.  This layer, called the cornea, heals very quickly. But like a scratch on any part of the body, the major potential complication is infection.

The most common way for health care providers to find a scratch on the cornea is to place a dye (fluorescine) into the injured eye. This dye glows under black light. The dye pools wherever there is a depression or scratch on the eye. Pictured here is a photo of a child I saw in the office the other day. The scratch is marked with an arrow. If an abrasion is found, your child’s doctor will prescribe antibiotic eye drops to prevent infection.  Placing a patch over the eye has not been shown to hasten healing. However, for comfort, some children prefer putting on an eye patch for a day.

It’s a good thing our eyes are set back in our skulls, otherwise, we’d constantly have scratches on our eyes. Despite any precautions you may take, accidents still happen. Years ago a nurse I knew accidentally rolled over in bed and scratched her spouse’s eye with her diamond engagement ring.  Imagine explaining that to the in-laws.

Naline Lai, MD with Julie Kardos, MD

© 2010 Two Peds in a Pod

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“Mom, can we do screen?”

My kids ask me this question when they are bored.  Never mind the basement full of toys and games, the outdoor sports equipment, or the numerous books on our shelves. They’d watch any screen whether television, hand-held video game, or computer for hours if I let them. But I notice that on days I give in, my children bicker more and engage in less creative play than on days that I don’t allow some screen time.

Babies who watch television develop language slower than their screen-free counterparts (despite what the makers of “educational videos” claim) and children who log in more screen time are prone to obesity, insomnia, and behavior difficulties.  The American Academy of Pediatrics recommends no more than two hours of television watching a day for kids over the age of two years, and NO television for those younger than two.

Over the years, parents have given me tips on how they limit screen time. Here are some ideas for cutting back:

  • Have children who play a musical instrument earn screen time by practicing music. Have children who play a sport earn screen time by practicing their sport.
  • Turn off the screen during the week. Limit screen to weekends or one day per week.
  • Set a predetermined time limit on screen time, such as 30 minutes or one hour per day. If your child chooses, she can skip a day to accumulate and “save” for a longer movie or longer video game.
  • Take the TV, personal computer, and video games out of your children’s bedrooms. Be a good role model by taking them out of your own bedroom as well.
  • Turn off the TV during meals.
  • Turn off the TV as background noise. Turn on music instead.
  • Have books available to read in relaxing places in the house (near couches, beds, etc.). When kids flop on the couch they will pick up a book to relax instead of reaching for the remote control.
  • Give kids a weekly “TV/screen allowance” with parameters such as no screen before homework is done, no screen right before bed, etc. Let the kids decide how to “spend” their allowance.

 

 

Not that I am averse to “family movie night,” and I understand the value of plunking an ill child in front of a video in order to take his mind off his ailment. In fact, Dr. Lai lives in a house with three iPod Touches, two iPhones, a Nintendo DS and three computers. But I do find it frightening to watch my otherwise very animated children lose all facial expression as they tune in to a television show.

For more information about how screen time affects children, see the American Academy of Pediatrics web site (www.aap.org) and put in “television” in the search box.

Let us know how you dissuade your children from the allure of the screen.

Julie Kardos, MD with Naline Lai, MD
© 2010 Two Peds in a Pod ℠

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Your son’s baseball league has just upped the ante, moving from “coach pitch” to “kids pitch.” The good news is that your budding major league pitcher gets some practice. The bad news is that the pitches can be wild. Thank goodness for batting helmets!

So what if the unthinkable happens? You are cheering your child on, when suddenly the wild pitch (or the hit ball, or the wild throw to first base) wacks into your child’s head. He is knocked down and you go running.

First evaluate if your child is conscious. Passing out even momentarily is a reason to seek medical attention right away. Most likely he will not have passed out and will want to return to play. However, the safest bet is to have your child sit out the rest of the game.

Next determine if your child is bleeding inside his head. You may see a growing lump on his head which looks gruesome. However, we pediatricians are less concerned about bleeding or bruising that occurs on the outside of his skull than about possible bleeding inside his skull.

How can you tell where the bleeding is? Again, a loss of consciousness, or passing out, is a worrisome event that may signal bleeding on the inside. In addition, watch for blurry or double vision (“I see two mommies!”), inability to speak clearly or rationally, difficulty walking or loss of balance, vomiting more than once (some kids vomit once when they are scared or in pain), or headache so severe that it is not relieved by acetaminophen (Tylenol) or ibuprofen (Motrin, Advil).  Not all symptoms appear immediately.

So now your child has cheered the team on to victory, enjoyed the after-game snack, has forgotten about the trauma, and is nodding off in the back seat of your car. As you drive him home you remember some vague advice about not letting your child fall asleep after a head injury. Now what?

Go ahead and let your child sleep for a couple of hours, he probably is tired both from the game and from the injury.  You have the rest of the day to observe him.

Sometimes, injuries are not conveniently timed. If a head injury occurs right before bedtime, you will not be able to watch for signs of internal head bleeding because your child will be sleeping. The best way to assess him is to wake him briefly every 2-3 hours throughout the night. 

If your child makes it to 24 hours without symptoms, it is unlikely your child is bleeding inside his head. However, if your child still seems “off” he needs medical attention. Even if he is not bleeding, he may have a concussion (now termed “traumatic brain injury”).

Although it’s never easy to see your child hurt, whether it’s a scrape on the knee or a bump on the head, you can empower yourself by knowing what to watch for. Now that’s using your noggin!

Julie Kardos, MD and Naline Lai, MD
© 2010 Two Peds in a Pod℠

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Here is a photo of a lovely plant nestled along side the bicycle path my family rode on over the weekend. Recognize it? “Leaves of three, let them be!”- That’s right, it’s either poison oak or poison ivy. In this case my iphone captured poison ivy in its late spring glory. As we rode along I barked at my family to avoid the poison ivy, reminded them about Lyme ticks, rubbed in sunscreen, fitted bike helmets and fretted over everyone’s hydration status.  Nothing is more jovial and carefree than a bike ride with your pediatrician mom!


Back by popular demand are the links to summer posts which some of you missed last year when we initially launched Two Peds in a Pod.


Yes, you too can start summer by spewing health tips at your children.

Naline Lai, MD with Julie Kardos, MD

© 2010 Two Peds in a Pod℠

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