Pediatrix

Screen time refers to the amount of time spent watching a television, computer, game console, or cell phone screen.  With the increased usage of media, the average screen time has risen drastically from just a generation ago.  An increasing number of pediatricians urge parents to recognize that high amounts of screen time can have several negative results, including:

• Health – Excessive time spent in front of the computer or a television means less time spent doing other activities such as playing sports, interacting with peers, or developing outside interests. If your child’s school does not have a physical fitness program, your child may be at additional risk for developing obesity.

• Academics – Children who watch excessive amounts of TV will often shirk academic responsibilities for the appeal of media.  Setting a strict school-first policy with your child can help correct this, in addition to limiting the overall amount of time allowed to watch TV.  If allowed, children will often choose to stay up late to watch television, resulting in less sleep and tiredness while at school the next day. Even one hour of lost sleep can prevent your child from focusing and retaining information.

• Social – The average 8 to 18-year-old spends over 7 hours interacting with media every day.  Children who choose to watch television or play computer games rather than interact with friends may struggle with social development. This can create social anxiety, bullying and behavioral problems.

Some television viewing can be productive; there are many educational programs on various broadcasting stations that can provide historical, cultural and educational benefits for viewers.  Encourage your children to watch these programs and watch with your child to enjoy them together.  Likewise, if you have a game console or computer with games for your child, play those games together and limit the time played.  Otherwise, limiting screen time is the best way to negate the development of potentially harmful side effects.

If you are concerned about the time your child spends with media but do not know how to approach the situation, please contact your family practice specialist at Pediatrix at (602) 866-0550.

Sincerely,

Subir K. Mitra, MD, FAAP

Pediatrix understands that outdoor play and a healthy amount of Vitamin D are important for growing kids, but prolonged exposure to the Ultraviolet rays from the sun can become problematic to people of all ages.  Ultraviolet rays are dangerous because they can trigger a chemical reaction within your body’s cells and may cause:

• Premature aging of the skin
• Development of skin cancer
• Development of cataracts

As winter draws to a close, the dangers of the sun and ultraviolet rays become more prominent.  Rising temperatures and longer days attribute to increased sunlight exposure, while the risks to your child increases as well.  No one understands these dangers more than Pediatrix.  You can never be too careful when it comes to the proper skin care in the harsh Arizona climate.

The use of sunscreen is important, but what is just as necessary is a clear understanding of the types of sunscreen and how to properly apply it to your child – of which Pediatrix is here to help.

There are two primary types of sunscreen: physical sunscreen and chemical sunscreen.  Physical sunscreen is the more traditional type of sunscreen; it is the type that you squeeze out of the bottle and lather on to the skin, paying close attention to those hard to reach areas.  Physical sunscreen creates a protective layer for your skin, blocking most of the ultraviolet rays from the sun so that the skin cannot absorb them or their harmful properties.

Chemical sunscreen contains organic chemicals and is often squeezed on to the skin just like physical sunscreen.  The key difference between chemical and physical sunscreen is that where physical sunscreen blocks the ultraviolet light from penetrating your skin, the chemical sunscreen absorbs most of the ultraviolet rays, allowing a small fraction to actually reach your skin.

When applying sunscreen to your child, it is important to cover all exposed areas of the skin.  It is also important to use the recommended amount of sunscreen; many people use as little as half the recommended amount of sunscreen by the bottle, so be sure to read the directions clearly!

If you are concerned about your child’s exposure to the sun or have noticed the development of worrisome marks on the skin, please contact your pediatrician at Pediatrix.  Make an appointment to discuss proper sun exposure and the recommended sun protection for your child.

Sincerely,

Subir K. Mitra, MD, FAAP

The Phoenix pediatricians at Pediatrix understand a parent’s desire to make their sick child feel better, but prescribing antibiotics may not always be the answer. In fact, in some cases antibiotics can do more harm than good.

Giving a child unnecessary antibiotics does three potentially harmful things:

• It exposes your child to the drug’s potential side effects.
• It increases the child’s resistance to antibiotics, so when antibiotics are necessary to treat an infection in the future, a stronger drug may be required.
• It contributes to antibiotic overuse in the community, which can lead to the growth of new antibiotic resistant strains of bacteria or superbugs.

When visiting your pediatrician with a sick child, keep in mind that some illnesses are caused by viruses, which cannot be treated by antibiotics. Colds, the flu, and chickenpox are all viral infections. Giving an antibiotic to treat a viral infection will do nothing to treat the infection; furthermore, this will kill healthy bacteria, lowering the child’s immune system and making them more susceptible to future bacterial infections.

Of course, there are cases of illness when antibiotics are warranted and should be prescribed to help your child heal. Bacterial infections, strep throat, ear infections, bacterial pneumonia, and bladder infections are typically treated with the use of antibiotics.

Your pediatrician will know what illnesses necessitate the use of antibiotics, but the responsibility to prevent antibiotic overuse is also yours as a parent. As much as you want to make your child’s sniffles or sore throat go away, it is important to resist the urge to ask for antibiotics every time your child is ill.  In addition, never give a child antibiotics that were leftover from a previous prescription or that were prescribed to someone else. Your Phoenix pediatrician will prescribe antibiotics if they will truly help your child.

When antibiotics are prescribed, follow all instructions and always complete the entire course of antibiotics, even if the child feels better before the end of the course. Stopping antibiotic treatment before the cycle of antibiotics is completed allows some bacteria to remain, which could cause your child to get sick again and need another round of antibiotics.

If you have questions or concerns about antibiotic overuse contact Pediatrix, your Phoenix pediatricians.

Sincerely,

Subir K. Mitra, MD, FAAP

You may have heard marketers use the phrase ‘Get them while they are young’ when trying to attract new customers. But how young is too young?  Last year the fast food industry alone spent over $300 million to target children and teens as young as two.  The total amount spent marketing junk food products to adolescent and teen-age children?  $2 billion.

Companies selling junk food products are speaking to your children early and often, through a variety of media channels. Their messages are aggressive and relentless, aimed at influencing the dietary choices of society’s youngest consumers. Sugar sweetened drinks and fast food are the unhealthiest products marketed to children. These aggressive marketing strategies are an enormous contributing factor to the skyrocketing rates of diabetes, high blood pressure, and obesity among children.

Recent studies have shown that preschool-aged children who have been regularly fed foods high in sugar, salt, and fat, learn to recognize junk food brands and prefer these foods to healthier options. These preferences are often unchanged into adulthood. Preferring junk food to healthy meal choices has long-term health implications, as junk food lacks vitamins and nutrients critical for growth and development. Some studies have even shown a measurable drop in IQ points in children who ate predominately processed foods.

When parents allow marketers to effect how they feed their children, the results can be deadly. Obesity, diabetes, high blood pressure, and even stroke—all diseases that once only affected middle-aged adults—are now impacting children. Young people must consume less calorie rich, sugar sweetened, and nutrient poor, junk food. Parents must monitor the amounts of junk food their children are consuming, and teach children healthy eating habits from a young age.

Junk food companies did get one thing right: if you ‘get them while they are young’ you will have a long-term impact on a child’s tastes and preferences. As a parent it is your responsibility to instill healthy habits while your children are young. Providing nourishing, truly healthy food will have both an immediate and lifelong impact on your child’s health.

To learn more about the dangers of a junk food rich diet contact Pediatrix, your Phoenix pediatricians. Make an appointment to discuss healthy eating habits and complete balanced nutrition for your child with a Phoenix pediatrician.

Sincerely,

Subir K. Mitra, MD, FAAP

Pediatrix

As pediatricians in Phoenix, we at Pediatrix have been increasingly aware that childhood obesity is becoming an epidemic across the country.  Too often parents are late to recognize that their children have become overweight.  Children are developing heart disease, high cholesterol, and type 2 diabetes, which was previously known as “adult onset diabetes.”  Being overweight also affects children’s psychological well being, reducing their self-worth and coping skills. The longer a child is overweight the more likely it is they will be overweight as an adult.  We must take steps to break such an unhealthy cycle.

Like adults, kids need exercise.  Children need at least one hour of physical activity every day. Early childhood is the best time to establish good fitness habits so kids can enjoy exercise rather than learning to avoid it.

Regular exercise helps children

• Maintain a healthy weight
• Develop healthy bones, muscles, and joints
• Increase self-confidence and self esteem
• Build a strong immune system
• Have more energy
• Reduce anxiety, depression, and improve overall mood
• Have better quality sleep

Unfortunately, the popularity of video games and television has resulted in a steep decline in children taking part in regular exercise and outdoor activities.  Parents should limit “technology time” and encourage children to play outside.  In fact, the American Academy of Pediatrics recommends that screen time (television and video games) be limited to 1-2 hours a day.  Including the whole family in outdoor or physical daily activities can set a good example and be fun for everyone.

As pediatricians in Phoenix, we see the many opportunities to get outside and enjoy our beautiful weather.  We encourage you to help your children form healthy habits.  The earlier they learn to make exercise a part of their daily life, the more likely they are to grow up healthy and become active adults.

If you are concerned about your child’s weight or have questions about healthy exercise contact Pediatrix, your pediatricians in Phoenix. Make an appointment to discuss healthy exercise plans for the whole family.

Sincerely,

Subir K. Mitra, MD, FAAP

As a pediatrician in Phoenix, I often see children drinking sports drinks.  What’s shocking to me is that these drinks often contain more than twice the recommended daily sugar for an adult!  This is just one example of a growing epidemic of including too much sugar in a child’s diet.  It is important to understand the impact a child’s sugar intake has on their weight and overall health. When making nutritional choices, parents should keep in mind that calories from sugar add up quickly and over time can lead to weigh gain and other severe health issues.

Let’s differentiate between natural sugar and added sugar.  Natural sugar is found in unprocessed items exactly as they would be found in nature, such as the sugar in a strawberry.  Added sugar is any additional sugar that is added to foods during preparation.  Sugar additives and sweeteners such as high fructose corn syrup, dextrose, and fructose are frequently added as a preservative in processed foods.  Do not be misled—even foods that do not taste sweet have these ingredients.  For instance, many varieties of crackers contain high fructose corn syrup although you would not classify them as sugary foods.

There are three main sources of sugar in a child’s diet.  Soda and sports drinks can contribute up to 30% of added sugar intake for your child.  Obvious sweets like cake, cookies, and ice cream are the second source of sugar in your child’s diet.  Both of these sources of sugar are fairly obvious, but it takes a very savvy consumer to recognize the third.  Through hidden sugar sources you may be unknowingly adding a significant amount of sugar into your child’s diet. Often advertised as healthy, items like granola bars, yogurt, trail mix, and soy milk mislead consumers about their sugar content.  Therefore, it is imperative that you read nutrition labels as well as the list of ingredients on a product.  The closer sugar is to the beginning of the list, the more sugar there is the food product.

The World Health Organization recommends that less than 10% of calories in a diet should come from added sugar.  Obviously, the most foolproof way of directing your child to healthy snacks is to provide them only healthy choices.  To curb your child’s sweet tooth, start by replacing some of their mid-day sweets with natural sugar and an item high in protein, like strawberries and a cheese stick.  The natural sweetness of the fruit will help curb their taste for sugar, while the protein in the cheese stick will leave them feeling fuller for longer, reducing the temptation to eat a sugary snack a few minutes later.

Desserts and treats can still be enjoyed—but in moderation.  A healthy diet is all about balance. Completely eliminating all sugar from a diet is unrealistic, but providing and encouraging healthy meals and snacks, teaching good eating habits, and saving sweets for special occasions will benefit your child’s health significantly.

If you are concerned about your child’s sugar intake or weight, please contact your pediatrician at Pediatrix.  Make an appointment to discuss healthy nutrition options for your child.

Sincerely,

Subir K. Mitra, MD, FAAP

While children are writing their lists to Santa, parents are writing out their holiday gift list. While your child may ask for a specific toy, it may be hazardous to their health. Just because a toy is on the market does not guarantee it is safe—it is your job as a parent to be an educated consumer.

Here is a SAFE TOYS acronym to help parents select appropriate toys:

• Small Pieces – If you have young children, avoid toys with small parts. A general rule of thumb is if your child is younger than three, do not purchase toys with pieces smaller than an empty toilet paper roll.
  
• Appropriate Content – Be mindful of the age of the child receiving the gift. From video game violence to the content of a book series, take into account the child’s perspective and how the material will be received.
• Flying Objects – Toy planes and model rockets can be a lot of fun if used correctly and under proper supervision. When used incorrectly they have the potential to cause serious damage and injuries.
• Electrical Toys – Toys that plug in put your child at risk of electrical shock and burns. Select battery operated models instead. Just remember that batteries are small pieces.
• Toxic Chemicals – Children’s toys have been found to contain dangerous levels of chemicals of concern such as lead, mercury, cadmium and arsenic. Research toys before purchasing to ensure their safety.
• Open Packages – Never purchase a toy if the package has been opened or tampered with.
• “You’ll shoot your eye out, kid” – Remember Ralphie from the classic movie, A Christmas Story, who wants a BB gun for Christmas? From BB guns to Nerf guns, these toys do have the potential to cause harm. If a child does receive a gift that ‘shoots,’ remind them that it should never be aimed at anyone’s head, younger children, or pets.
• Sharp edges – avoid toys that have sharp edges or the potential to cause abrasions. Parents should also be careful when opening packaging, as this too can be dangerous.

Keeping your family safe and healthy should always remain a priority. Please contact Pediatrix if you have any specific holiday health concerns for your child.

Pediatrix offers resources on safety recalls to ensure that your child’s toys are safe year-round.

Pediatrix physicians are available after office hours during the week and on weekends and holidays. If you have a non-urgent matter, please schedule an appointment during normal business hours. To contact the physician on call, please call (602) 866-0550.

Have a safe holiday season.
Subir K. Mitra, MD

Food allergies are on the rise nationally. As a pediatrician, I am experiencing this phenomenon in the clinic; but I am also living with it. My child has significant anaphylactic food allergies, so I understand this problem on a personal level.

The range of reactions that may occur along the allergy spectrum creates a lot of confusion among people. One person may exhibit a mild rash or gastrointestinal symptoms, while another may manifest significant airway swelling that restricts airflow and can be life threatening in a very short amount of time; this is anaphylaxis.

Other hurdles arise when there is a lack of understanding regarding what anaphylaxis looks like. Many health care providers, including physicians, may not have witnessed anaphylaxis first hand to recognize its presentation.

In addition, many people are avoiding foods for a variety of health reasons. Some examples include celiac disease, which is gluten sensitivity; or perhaps, a healthcare provider has recommended a restrictive diet for behavioral or developmental concerns. This further clouds and confuses those who might be caring for or interacting with your child.

As a result, a parent must be their child’s best advocate in the school setting. Schools do have a responsibility to make your child’s school experience as risk free as possible. Parents should request that epinephrine be placed where it may be needed: the cafeteria, classroom and nurse’s office. Providers and teachers in these areas should be trained to recognize anaphylaxis and they should know how to administer an Epipen. It is not realistic to expect young students to alert an adult when in distress or administer an epinephrine shot to themselves.

Parents can advocate for food free or food restricted classrooms. Children do not have to be rewarded with food (as an aside – we are living in a societal epidemic of obesity). In addition, cafeterias can have food allergy tables, where more care and observation can happen for this at risk population. A trained adult should monitor this table.

Remember the squeaky wheel gets the grease. You are your child’s best advocate. Be safe…

David Kleiner, MD, FAAP

Our parents, grandparents and friends often offer their ideas about how to treat certain problems, sometimes they may seem outlandish.  Here’s a little summary of a few remedies that work and a few you shouldn’t try.

REMEDIES THAT WORK:
Honey for cough and sore throat—a study a few years ago showed that honey improved night time cough better than no treatment or dextromethorphan, like in Robitussin DM.  Honey can coat and soothe a sore throat.  Some people add lemon to honey to help break down mucous.  No honey for babies under 2 years old due to risk of infant botulism.
Yogurt for certain diarrheas and yeast infections—yogurts with live active cultures can help replace the “good bacteria” that are killed off by antibiotics and therefore help prevent or lessen diarrhea caused by antibiotics.  It can help shorten the duration of some bacterial and viral diarrheas.  Yogurt may help prevent oral and diaper area yeast infections.  Look for the “live and active cultures” seal on the container because if it’s been heat treated the bacteria are killed.
Ginger for nausea—Ginger ales usually are artificially flavored and contain no ginger.  Use fresh ginger root from the produce section boiled in water to make your own ginger tea or candied ginger.
Vaseline for lice—Not advised for long hair.  Key is to massage it thoroughly into hair and scalp and comb thoroughly with lice comb.  Repeat daily for 5-7 days.  The problem is that it is difficult to wash out of hair.
Caffeine containing drinks for headaches—helps pain meds like tylenol act faster that’s why you’ll find caffeine in many headache meds. Many of the HA meds have approx. 65mg of caffeine, coffee 100mg, Mountain Dew and Pepsi One each have 55mg, but other caffeinated sodas have far less caffeine.  The flip side is that if you drink a lot of caffeine daily when you miss a day of caffeine you can get headaches.
Cranberry juice for urinary tract infections—cranberry contains a compound that prevents bacteria from attaching to the bladder wall so maybe helpful for prevention or at very earliest signs—not for full fledged urinary infection.  Most of the cranberry juices on the store shelves are juice mixes and you need to drink a few glasses per day.  Or can take cranberry pills.
Chammomile tea for colic, gas, bloating and anxiety—chammomile has anti-spasm effects on the intestines.  Also, it reaches the brain for a soothing, anxiety easing effect.  Make sure to get caffeine-free chammomile tea.
Gargling with salt water for sore throat or gums—salt draws water out of inflammed tissue to help decrease the inflammation.
 
REMEDIES WITH MIXED EFFECTIVENESS:
Melatonin for insomnia—although some people report that melatonin helps them sleep, there is no scientific evidence that melatonin is more effective than placebo (sugar pill).  It has low risk of toxicity so it wouldn’t hurt to try it.
Meat tenderizer for fire ant bites or bee stings—McCormick’s tenderizer, make sure it’s not seasoned because it contains pepper. Mix 1 part tenderizer and 4 parts water to make a paste; rub it on with soaked cotton ball for a few minutes. It works to break down proteins in ant venom to help lessen the venom’s effect.  A dermatology journal showed no difference in symptoms with or without tenderizer used.  Since there’s minimal risk of side effects it wouldn’t hurt to try this.

I have been practicing Pediatrics in Phoenix for 9 years and trained at Phoenix Children’s Hospital for 3 years prior to that.  Yet every year I am shocked and saddened by the number of needless drownings of children in the valley.  Summer is here and families enjoy vacation and time relaxing at home.  Many families in the valley have swimming pools and use them a great deal during this time of year.  Moreover, families on vacation very often get away to a location near the beach or with a swimming pool.  While swimming and playing in the pool are common and beloved ways of keeping cool this summer, it is important to remember our children’s safety in the pool.  We’ve all seen the posters and television public service announcements reminding us to “watch our kids around water.”  But no matter how many campaigns are launched each spring and summer season, Phoenix still experiences the painful reality of childhood drownings.  In fact, thusfar this year  Phoenix and the surrounding areas have had 50 water-related incidents and families have suffered 10 deaths, including 5 children (as documented by the Children’s Safety Zone).  Therefore, it is vital to be vigilant about watching our children in and around the pool.  The American Academy of Pediatrics has recently revised its statement regarding swim lessons for children ages 1 to 4.  Even if your child has had swim lessons, this should not create a false sense of security because accidents still happen in and around the water.  An adult should always be present while children are swimming or playing in and around a pool.  Because not all drownings and near-drownings occur during designated pool time, a barrier should separate your pool from the house.  Many children wander out of their homes and fall in the pool unbeknownst to the adults at home.  Therefore, a pool fence should securely and completely surround the pool.  It still astounds me how many houses in Phoenix do not have pool fences.  Everyone thinks that “it can’t happen to me or my child.”  Believe me when I tell you that I have had the unfortunate experience to speak with parents when a drowning has happened to them.  

Subir K. Mitra, MD, FAAP

For your convenience, the Phoenix Fire Department has issued an in-depth checklist for pool safety.

**Please note that although this blog and the aforementioned information is mainly about pool safety, it is important to watch our children around ALL water, whether they are in a bathtub or near a bucket of water.