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Tuesday, December 27, 2011

Homework Battle Plan

Any parent with school aged children knows that homework can be a battle.  Even good students can procrastinate, prefer to play, or have practice after school leaving little time for homework.  Then there are the kids who struggle...

I think I threw my son's middle school homeroom teacher for a loop on back to school night.  She mentioned that I can always look on line to see the assignments, and I replied something to the effect of, "I don't have homework, so I'll never look.  It is his responsibility to know what is due."  I am not an absent parent.  I do ask about his day, what he's doing in class, and what his plans are with friends.  He knows I care because I show interest in him, but I don't micro-manage his day.  I do not want to be the parent responsible for the college kid who fails because Mommy can't manage his schedule.  Of course, I know my son and he's self motivated and capable of keeping track of assignments.  Another child might need more help, but at this age I would recommend covertly looking at the assignments and guiding with questions and looking for the student to offer solutions and plans to get the work done.


How can you help your kids with homework without letting it become your problem?  I am a firm believer that kids are the students, not the parents.  Kids need to take ownership of their homework and all other aspects of school.  Of course, for many kids this is easier said than done, but I hear all too often of college kids who have Mommy call the Professor to question a grade.  That is totally unacceptable.  Kids need to practice ownership from early on.  Parents need to guide always, but manage less and less as the kids grow.

Not every solution comes from a cookie cutter mold.  Kids have different personalities and abilities.  You know your kids best.  Think how they work and what makes them tick.

Many parents underestimate the problem with missing out on basics:  sleep, nutrition, and exercise.  If kids don't get the amount of sleep they need, healthy foods, and regular exercise, they will not be as successful academically.  I have blogged on this previously, and really feel that finding balance is important for everyone.


Kids have different problems with homework at different times, and they each deserve their own solutions. Not one of these "types" fits every child perfectly. Most kids have more than one of these qualities, but tend to fit into one type best.

Procrastination:  There is always something more fun to do than work.  Kids will put off overwhelming tasks or big projects because, well, there's a lot to do.
Ask not only what homework they have for tomorrow, but if there are any big projects due in the future.  See if they can estimate how much time it will take to do the project and help them plan how much to do each night to get it done on time.  
Breaking big assignments or long worksheets into small pieces with short breaks in between can help kids focus.  Use a timer for breaks or do a fun quick activity, like silly dance to one song.
Allow kids to have some "down" time after school for a healthy snack (brain food) and to run off energy.  Limit this time with a timer to 30 minutes or so.  The timer helps kids know there is an end point to the fun, and then it's time for work.  Play can resume when work is done correctly.
Poor Self Confidence: Kids who are afraid they won't understand their homework might fear even starting. They blame the teacher for not teaching it correctly. They might complain that they are stupid or everyone else is smarter. They blame the class for being too loud, causing distraction and therefore more homework.  They might complain of chronic headaches or belly aches.
Be sure to praise when kids do things right and when they give a good try.  Be honest, but try to think of something positive to tell them each day.  When they don't meet expectations, first see if they can see the mistake and find a solution themselves.   Guide without giving the solution.  Then praise the effort!
Find their strengths and allow them to follow those.  If they are poor in math but love art, keep art materials at home and display their projects with pride.  Consider an art class.  Remember to budget time.  Over scheduling can result in anxiety, contributing to the problems. 
Perfectionist:  While the desire to do everything right has it's benefits, it can cause a lot of anxiety in kids.  These kids think through things so much that they can't complete the task.  See also the "poor self confidence" section above, because these kids are at risk for feeling they are failures if they don't get a 100% on everything.  They can have melt downs if the directions don't make sense or if they have a lot of work to do.
Help your child learn organizational techniques, such as write down assignments and estimate time to do each project. Plan how much time to spend each day on big projects and limit to that time.  Help them review their progress in the middle of big projects to see if they are on track.  If not, have them establish another calendar and learn to review why they are behind.  (No self-blame.  Is it because one step took longer than projected, they were invited to a movie and skipped a day, they got sick and were not able to work...  This helps plan the next project and builds on planning skills.)
 Remember to give attention and praise for just being your kid.  These kids feel pressure to succeed, but they need to remember that they are loved unconditionally.  
If you notice they have an incorrect answer,  state "that isn't quite right. Is there another way to approach the problem?"  
Not everything is about the grade.  Praise the effort they put into all they do, not the end point.  Make positive comments on other attributes: a funny thing they said, how they helped a younger child, how they showed concern for someone who was hurt.
Encourage them to try something new that is outside their talent.  Not only are they exploring life, but they are developing new skills, and learning to be humble if they aren't the best at this activity.  Help them praise others.  Model this behavior in your own life.  


Co-dependence:  Helicopter parenting is a term often used to describe the parent hovering over the child in everything they do. This does not allow a child to learn from failing. It does not allow a child to grow into independence.  It allows the parent to "own" the problem of homework.  These kids call home when they leave the homework or lunch on the kitchen table for Mommy to bring it to school.  These kids grow up blaming everyone when things don't go their way and Mommy can't fix it. They don't learn to stand up for themselves.  They seem constantly immature with life situations.
Young children need more guidance, but gradually decrease this as they get older.  Teachers can help guide you on age appropriate needs.  Most parents must sign a planner of younger kids, but as kids get older the kids become more responsible for knowing what the homework is.  Many schools now have websites that parents can check homework assignments, but be sure the kids own the task of knowing what is due too.  
Have a place that children can work on homework without distraction (tv, kids playing, etc).
Be available to answer questions, but don't do the work for them.  If they need help, find another way to ask the question that might help them see the solution. Get a piece of scrap paper that they can try to work through the problem.  If they have problems with reading comprehension, have them read a few lines then summarize to you what they read.   They can take notes on their summary, then read the notes after the entire chapter to get a full summary.
Busy, busy, busy:  Some kids are really busy with after school activities, others just rush through homework to get it done so they can play.
Set limits on how much screen time (tv, video games, computer time) kids can have each week day and week end.  A maximum of 10 hours per week of screen time is recommended by experts.  If they know they can't watch more than 30 minutes of tv, they are less likely to rush through homework to get to the tv.  
Ask kids to double check their work and then give to you to double check if you know they make careless mistakes.  Don't correct the mistakes, but kindly point them out and ask if they can find a better answer.  Once they learn that they have to sit at the homework station until all the work is done correctly, they might not be so quick to rush. 
If kids have after school activities the time allowed for home work and down time are affected.  Avoid over scheduling, especially in elementary school.  Be sure they have time for homework, sleep, healthy meals, and free time in addition to their activities.  Are the activities really so important that they should interfere with the basic needs of the child? Is the child mature enough to handle the work load?
Kids who are in constant motion can't seem to sit still long enough to do homework.  Be sure they have the proper balance of sleep, nutrition, and exercise or all else will fail.   Praise their efforts when they are successful.  Set a timer after school to let them play hard for 30 minutes, but then make them sit. Help little ones organize what needs to be done and break homework into several smaller jobs.  Set regular 5 minute breaks every 30 minutes so they can release energy.  Set a timer to remind them to get back to work and compliment them when they get back on task.
Struggling despite help:  There are many reasons kids struggle academically.  Reasons vary, such as behavior problems, anxiety, illness, learning disabilities, bullying, and more.

If they are struggling academically, talk with the teacher to see if there are any areas that can be worked on in class or with extra help at school.  Can the teacher offer suggestions for what to work on at home?
If kids have chronic pains or school avoidance, ask what is going on.  Depression and anxiety aren't obvious and can have vague symptoms that are different than adult symptoms.  Bullying can lead to many consequences, and many kids suffer in silence.  If your child won't talk to you, consider a trained counselor.
Talk with your pediatrician if your child is struggling academically despite resource help at school or if he suffers from chronic headaches or tummy aches.  Treating the underlying illness and ruling out medical causes of pain is important.  Depression, anxiety, ADHD, and other learning disorders can be difficult to identify, but with proper diagnosis and treatment, these kids can really succeed and improve their self confidence!



Friday, December 9, 2011

Help us help you!

Hello.  This is Dr. Stuppy.  I'm returning your call about...

That is how my phone calls start, then they take various turns.  Some are easy, some not so easy.  I'd like to discuss what makes a phone call to the doctor's office more productive, so we can help you better.  All examples are entirely fictitious, made up of 12 + years of phone call experiences.

Many calls start off like this:
Hi. This is Mary Sue. My son has a rash and I want to know what to do.
Me: ????? I must ask many questions for more information.  
Some callers don't seem to know what to say, so they only answer direct questions.  How old is your son? When did the rash start? What does it look like? Has it changed? Does it itch or hurt? Any other symptoms? What have you used to treat it? Did that help? Has he had any new ingestions, lotions, or creams? Does he have a history of allergies? Anyone else with a rash that looks like this? On and on...

Or like this:
Hi.  Thanks for calling back. My son Jack is 3 years old.  Well, really his birthday isn't until next month, but he's almost 3.  He has had a fever for 2 days, maybe 3 days because he felt warm but he wasn't acting funny or sick that first day he felt warm.  He actually was fussy last week, but I don't think he ever had a fever then.  I was thinking maybe he didn't sleep well last week, but I don't know why.  I took his temperature and it was 100.3, that was on Tuesday around 7am.  I gave Tylenol, and it went down to 97.9, but then 4 hours later it was back up to 99.7....  
My thoughts so far: Get to the point. 
Sorry, but that's true.  I care about my patients, but so far this phone call has taken me quite a bit of time and I really know nothing except this almost 3 year old has an elevated temperature (not even a true fever).  


When parents call, they need to summarize with pertinent facts.  While they shouldn't leave out important helpful information, they don't need to mention every time they took a temperature.
Much like the evening news: they can't do a play by play of every football game.  There's no time and it serves no purpose.  A few highlights of the game and the score.  That works well.  People get a pretty good idea of how the game went.  

It's the same thing with phone calls to your doctor's office or on call provider.  We have thousands of patients.  Not all call the same day, but during peak cold and flu season last year our office took 50-90 calls/day (the highest numbers on Mondays).  One phone nurse has 8 hours to answer up to 90 calls in addition to filling out insurance forms and other tasks.  (We have great nurses that help out if they have time, but if the phones are busy, I guarantee the office is busy too!)  They simply can't spend 15 minutes chatting about every detail.  That's for your friend and you to discuss over coffee.

After hour phone calls during the winter are also more frequent.  It is not uncommon for me to be on the phone with one parent and another call comes in.  This is at the same time I am trying to watch my son's game or go to the grocery store.  I really don't want to sit and chat.  I don't have time for play by play action.  Again, I really care about my patients, but I can do a better job at answering your questions if you are clear and concise.


Things that help us help you over the phone:

  • Know what is going on.  When a parent calls and the child is at daycare or grandma's so the caller doesn't know details, we can't really help.  Write down the pertinent facts to get them straight if you need to.
  • Start with your child's full name and birth date.  Include any significant past history, such as your infant was born at 28 weeks gestation, or your coughing 3 year old has a history of wheezing.
  • Give pertinent facts related to the concern.  
  • If your child has a fever, give the number of days of fever, the maximum temperature, and how it was taken.  If you have given a fever reducer, share that.
  • Briefly describe symptoms and what you have done to help them as well as if your child responded or not to the treatment.  Remember treatments are not only medicines, but if you use a vaporizer or saline for a cold, or have stopped dairy and used G2 for vomiting, let us know. 
  • If your child has a rash, it is typically best for us to see the rash, but if you call about a rash describe it in terms of location, color, and size (many find it helpful to relate to common objects, such as quarter-sized).
  • Note if there is a pattern to the symptoms, such as headache every day after school or barky cough only at night.
  • Let us know any medications your child typically takes in addition to ones you have tried for the current symptoms.  
  •  Leave out details that don't help.  Trends and generalizations work well.  If we want more details, we can always ask. 
Examples of good call starters:
  • I am calling about Joe Smith, birth date 9.12.08. He has had a fever for 3 days, up to 101.3 under the arm. It comes down with ibuprofen, but is right back up in 6 hours.  He also has sore throat and headache. He's drinking well but not eating much for 3 days.
  • Sally Smith, birth date 9.12.11, has vomited 6 times in the past 12 hours. If I give formula it immediately comes up. She is now dry heaving and hasn't had a wet diaper in 12 hours. She doesn't have a fever but looks tired and it is hard to wake her to drink. She doesn't have diarrhea. Her older brother had the stomach flu a few days ago but is now better.
  • John Smith, birth date 9.12.11, was in the NICU for 2 months due to prematurity. He has been fussy all day and is now breathing fast and hard and is not able to drink more than a few sucks at a time. He doesn't have a fever, but I'm really worried. 

Remember:  Our website has many pearls of wisdom.  Often when we give advice it is already stated on our site.  Parents sometimes call multiple times because they can't remember what we said.  This is frustrating on both ends of the phone.  We wrote it down for a reason.  Use our site!

Things that cannot be done by our on call providers:

  • Prior authorization for an ER or urgent care visit.  These must be done during office hours, and most of the time our office is not involved.  These are typically done by the location at which your child is seen.
  • "Allow" you to leave a busy ER.  It sounds silly, but I have had many calls from the waiting room at ER/Urgent Cares with parents asking if I think it okay that they leave due to a long wait. If you thought it necessary to go in the first place, I would be open to a malpractice lawsuit if I told you to go home without being seen.  You should ask their triage nurse who can make that assessment.
  • Refill medications.  We typically expect that your child is seen prior to most prescription refills for best medical care.  If it is urgent that your child have a refill, such as an inhaler, they should be seen to evaluate the concern. There are exceptions to every rule, but don't be upset if the on call provider refuses to call out a prescription. 
  • Make a diagnosis.  We cannot see the ear, listen to the lungs, or feel the belly over the phone.  A physical exam and sometimes labs or radiology studies are needed to make a diagnosis.  If your doctor claims to be able to diagnose by phone to call out prescriptions, I would suggest that they are not doing the best of care.

Some things are best done with a visit for further evaluation.  

  • Difficulty breathing.  If a child is having difficulty breathing and you don't have treatments at home that work, he needs to be seen as soon as possible.
  • Dehydration.  An infant who hasn't urinated in 6-8 hours or an older child who hasn't urinated in 12 hours might be dehydrated and should be seen as soon as possible.
  • Some fevers. Temperature above 100.4F under the arm in an infant under 3 months or under immunized child can be serious and should be seen as soon as possible.  Fevers lasting more than 3-5 days or with other concerning symptoms require an evaluation.
  • Uncontrollable pain.  If you have used standard pain relievers and your child is still hurting, we cannot do anything by phone that will improve the situation. A careful exam might find a treatable cause of pain.
  • Most rashes.  Though these don't necessarily need to be seen emergently unless there are other concerns, rashes cannot be evaluated on the phone and a physical exam is needed.
  • Chronic problems.  If your child has been dealing with anything for more than a few days, it might help to schedule a visit with your usual provider.
  • Diagnosis vs information.  If you want a diagnosis, we need to see your child.  We cannot tell if the ear is infected or if your child has Strep based on symptoms alone.  If you want advice of what to do with symptoms, we can generally give advice.  Remember that our website also has most of this information too!
  • Behavior problems.  These are best discussed with your usual provider, not an on-call provider who doesn't know your child. Most of these build up over time and are not emergent issues.
  • Injuries.  If your child has a moderate or severe head injury, possible broken bone, laceration, or other injury symptoms they require evaluation.  Lacerations must be repaired as soon as possible, so don't wait until office hours the next day!
Help me help you!  Let me know what else you need to know to be an educated caller.  I'd be happy to answer questions about when to call, what to ask, and what to expect.  If I left any questions unanswered, please ask!

Dr S

Monday, December 5, 2011

How to get kids to take medicine

A recent facebook post discussed how to give medicine to children, but left out how to give liquid medicine. A reader asked for advice, and I wanted to expand my original answer.

The article:   Medical Mom: A spoon full of sugar helps the medicine go down


The facebook question:   She gives great advice on pills, but what about liquid medications that kids just WON'T swallow? I've tried putting it in his cheeks, but the flavor they mixed it with he hates :(


Of course, there is so much to giving medicine to kids.  They already feel sick for most of the medicines we give, and anything is distasteful when you feel sick, regardless of the flavor the pharmacist adds.  Some medicines have a horrible aftertaste that is difficult to mask.  Some upset the stomach.


If medicine is vomited within 30 minutes, it generally can be given again. If your child vomits more than 30 minutes after the medicine is swallowed, do not offer it again.


I don't miss the days of liquid medicines! My son (who suffered from many ear infections) spit out most medicine (and often vomited what he swallowed).  My daughter didn't need as many medicines as him, but as the expert vomiter (she would vomit whenever she didn't get her way as an infant) and expert manipulator, she had unique issues to get the medicine down.


Needless to say, I learned a lot of tricks trying to get them to keep medicines down.


Most liquids taste better cold, so check with your pharmacist if the medicine can (or should) be refrigerated.  Also ask if it can be mixed with juice or foods.  Some should be given on an empty stomach without food and only sips of water. 


Be sure you have a properly sized medicine syringe or medicine cup for all liquid medicines.  Shake the bottle well before dispensing.


If it can be mixed into juice, jelly, or yogurt, be sure to mix in a small enough volume that you can ensure your child will take the entire amount.  You can measure the amount of medicine in a syringe, then fill the remainder of the syringe with drinkable yogurt, juice, or whatever liquid is okay to mix with the medicine.  (Always ask your pharmacist first!) 



Sometimes using a medicine that comes in a capsule that can be sprinkled onto a spoon of yogurt, jelly, or applesauce works well.   Yogurt tubes are especially great for this if your child eats these. Put the contents from the capsule on the top of the open tube, and they suck it down as they enjoy the yogurt.  Ask your pharmacist if you can mix the medicine with foods first!  


For infants: Try squirting it in the inner cheek and blowing on the face. I don't know why, but it seems to make infants swallow.  You can also put it in a nipple and allow them to drink from the nipple, which bypasses most of the taste buds on the tongue! After the medicine is swallowed, use the nipple for water or formula/milk to rinse all the medicine down as long as it does not need to be given on an empty stomach. 


Preschoolers: This age might feel "big" if allowed to hold the medicine cup themselves.  Supervise closely so they don't spill it.  Praise when they did it!


Preschool and up: Offer a chocolate syrup chaser. Syrup is thick and masks a lot!  Another trick is to offer a popsicle (or ice) first.  This numbs the taste buds, making the medicine taste less noticeable.


Holding the child's cheeks to make them pucker their lips until swallowed sometimes works (though I found kids can still spit it out that way!) 


You can also have the pharmacist flavor most medicines, and if you pick the right flavor, it can help. Ask for suggestions, since the flavor added might not be the best for the particular medicine. 


Bribery works with preschoolers and up. (A thing I promised myself I would NEVER do... but once I had kids and realized bribery works, I reserve it for the really important things.)


As for most of my behavioral advice: praise a job well done! If they took the medicine, tell them you are happy they did.


When you think your child is able to swallow pills without choking, teach with small candies, such as Tic Tacs or mini M&Ms.  I always suggest using a cup with a straw, since when you drink out of a cup you tilt your head back, narrowing the throat.  A straw allows you to keep your neck neutral. Once swallowing a small candy is mastered, you can use real medicine capsules or tablets, as long as the dose is correct for the child's weight.


Sometimes making a game of it works. My husband came up with this trick for our daughter when she was 5-6 years old.  Remember she was the expert manipulator.  She threw a fit about taking a medicine and made getting out of the house for school on time difficult a couple of days. He suggested that if she was ready for school by 7:15, she could throw a fit for 10 minutes. If she wasn't ready until after 7:20, she could only throw a fit for 30 seconds.  Either way we would set the timer for her fit, then she would take the medicine.  Of course we knew she'd never be ready early (and she really couldn't tell time well in kindergarten) so when it was time for medicine, we set the timer for 30 seconds and told her to throw a good fit.  She threw a great fit, then took the medicine without a problem. It was as if owning it worked for her, and she then took the medicine each day for the rest of the week after setting the timer for a fit.  By the end of the week she could hardly throw a fit she was giggling so much!


The most important thing is to remember why you are giving the medicine.  If it is an antibiotic or other medicine that is important to completely take, then it is more important than if you are simply trying to give a fever reducer.  A fever reducer might make your child feel better, but it really isn't required.  If it is required, then you need to play hard ball and do whatever it takes to get the medicine down.  


What has worked for your kids to take medicine?  Please share your tips!



Saturday, December 3, 2011

Fever is...

fever, temperature, sick

Fever is scary to parents.
Parents hear about fever seizures and are afraid the temperature will get so high that it will cause permanent brain damage.  In reality the way a child is acting is more important than the temperature.  If they are dehydrated, having difficulty breathing,  or are in extreme pain, you don't need a thermometer to know they are sick.
Fever is uncomfortable.
Fever can make the body ache. It is often associated with other pains, such as headache or earache.  Kids look miserable when they have a fever. They might appear more tired than normal.  They breathe faster. Their heart pounds. They whine.  Their face is flushed. They are sweaty.  They might have chills.
Fever is often feared as something bad.
Parents often fear the worst with a fever: Is it pneumonia? Leukemia? Ear infection?  
Fever is good in most cases. 
In most instances, fever in children is good.  It is a sign of a working immune system.  
Fever is often associated with decreased appetite.
This decreased food intake worries parents, but if the child is drinking enough to stay hydrated, they can survive a few days without food.  Kids typically increase their intake when feeling well again.  Don't force them to eat when sick, but do encourage fluids to maintain hydration. 
Fever is serious in infants under 3 months, immune compromised people, and in under immunized kids.
These kids do not have very effective immune systems and are more at risk from diseases their bodies can't fight.  Any abnormal temperature (both too high and too low) should be completely evaluated in these at risk children.   
Fever is inconvenient.
I hate to say it, but for many parents it is just not convenient for their kids to be sick.  A big meeting at work.  A child's class party.  A recital.  A big game or tournament.  Whatever it is, our lives are busy and we don't want to stop for illness.  Unfortunately, there is no treatment for fever that makes it become non-infectious immediately, so it is best to stay home.  Don't expose others by giving your child ibuprofen and hoping the school nurse won't call.
Fever is a normal response to illness in most cases.
Most fevers in kids are due to viruses and run their course in 3-5 days.  Parents usually want to know what temperature is too high, but that number is really unknown (probably above 106F). The height of a fever does not tell us how serious the infection is.  The higher the temperature, the more miserable a person feels.  That is why it is recommended to use a fever reducer after 102F.  The temperature does not need to come back to normal, it just needs to come down enough for comfort.

Fever is most common at night.
Unfortunately most illnesses are more severe at night.  This has to do with the complex system of hormones in our body. It means that kids who seem "okay" during the day have more discomfort over night.  This decreases everyone's sleep and is frustrating to parents, but is common.  

Fever is a time that illnesses are considered most contagious.
During a fever viral shedding is highest.  It is important to keep anyone with fever away from others as much as practical (in a home, confining kids to a bedroom can help).  Wash hands and surfaces that person touches often during any illness.  Continue these precautions until the child is fever free for 24 hours without fever reducers.  (Remember that temperatures fluctuate, so a few hours without fever doesn't prove that the infection is resolved.) 
Fever is an elevation of normal temperature.
Normal temperature varies throughout the day, and depends on the location the temperature was taken and the type of thermometer used.  Digital thermometers have replaced glass mercury thermometers due to safety concerns with mercury.  Ear thermometers are not accurate in young infants or those with wax in the ear canal.  Plastic strip thermometers and pacifier thermometers give a general idea of a temperature, but are not accurate.  
To identify a true fever, it is important to note the degree temperature as well as location taken.  (A kiss on the forehead can let most parents know if the child is warm or hot, but doesn't identify a true fever and therefore the need to isolate to prevent spreading illness.)  I never recommend adding or subtracting degrees to decide if it is a fever.  In reality, you can look at a child to know if they are sick.  The degree of temperature helps guide if they can go to school or daycare, not how you should treat the child.  Fevers in children are generally defined as temperatures above 100.4 F (38 C).

Fever is rarely dangerous, though parents often fear the worst.

This is the time of year kids will be sick more than normal.  With each illness there can be fever (though not always.)


What you can do:

  • Be prepared at home with a fever reducer and know your child's proper dosage (especially with the recent dosing changes to acetaminophen!) 
  • Use fever reducers to make kids comfortable, not to bring the temperature to normal.
  • Have an electrolyte solution at home in case of vomiting. 
  • Teach kids to wash their hands and cover coughs and sneezes with their elbows.  
  • Stay home when sick to keep from spreading germs.  It is generally okay to return to work/school when fever - free 24 hours without the use of fever reducers.  
  • Help kids rest when sick.
  • If the fever lasts more than 3-5 days, your child looks dehydrated, is having trouble breathing, is in extreme pain, or you are concerned, your child should be seen.  A physical exam (and sometimes labs or xray) is needed to identify the source of illness in these cases.  A phone call cannot diagnose a source of fever.
  • Any infant under 3 months or immune compromised child should be seen to rule out serious disease if the temperature is more than 100.5.

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Excessive milk can cause anemia? How?

A recent facebook posting recommending limiting milk intake prompted questions from followers about iron deficiency anemia from milk.  Nutrition and iron balance is actually a relatively lengthy discussion, so I will try to explain it here.

Short answer:  Cow's milk has little iron.  When kids drink a lot of milk, they don't eat iron-containing foods in sufficient volumes.  Cow's milk also has big proteins that can cause microscopic bleeding in the gut. The more milk consumed, the more bleeding (though usually still not seen in the stools).
More milk = more blood loss from the gut
                              but less blood produced because less iron in the diet
                                                 = anemia

Iron is used to build healthy red blood cells that carry oxygen throughout our bodies.  Too few red blood cells in the body is called anemia.  Red blood cells are made in our bone marrow and they live for about 3 months.  It is important for the body to continually make new red blood cells as it breaks down and removes old ones.

In general anemia can be caused from several factors:

  • too little blood produced (iron deficiency being a major risk for this)
  • increased blood loss (ie excessive bleeding)
  • increased destruction of blood cells in the body (typically from abnormal blood cells or infection)
Iron deficiency can be due to several factors:
  • poor iron absorption due to disease (some studies show milk inhibits iron absorption)
  • poor iron in the diet (the most common cause)
  • long term slow blood losses (such as heavy monthly periods or GI bleeding)
  • increased iron need (such as a growth spurt or pregnancy)

Why does preventing iron deficiency anemia matter? Because the most common symptom of anemia is no symptoms.  It can go unnoticed for quite a while in some kids, yet cause long term problems with growth and development.  Symptoms develop when the anemia becomes more severe and include tiredness, looking pale, irritability, decreased appetite, slowed development, weakness, immune dysfunction, and pica (eating non food substances- such as dirt).

Newborns are designed to drink their mother's milk.  Humans have learned to make formulas that can nourish babies if they aren't able to drink their mother's milk for whatever reason.  Cow's milk, soy milk, and goat's milk are not acceptable for infants due to the nutritional voids they have (not just iron).  After about 1 year of age babies tend to wean from mother's milk and/or formula onto whole milk.  (Newer recommendations allow weaning onto low fat milk--another topic entirely.)  Unfortified non-human milks contain very little iron.  The iron in human milk is better absorbed and iron is supplemented into formula.  If toddlers and children drink too much milk, they fill up on it and don't eat a variety of other food groups that include iron and other important nutrients missing in their milk.

Foods that are good sources of iron:

  • meats and poultry (especially organ meats, such as liver)
  • lentils, peas, and dried beans
  • eggs
  • oysters, clams, and fish
  • molasses
  • peanut butter
  • soy
  • pumpkin or sesame seeds
  • fruits such as prunes, apricots, and raisins
  • vegetables such as spinach, kale, broccoli, and other greens
  • whole grain fortified breads and cereals


Vitamin C increases iron absorption, so eat foods with iron and Vitamin C at the same meal!