I have been lucky in love. This August is 34 years with my wonderful wife, Kim.  She has stayed with me and even loved me so much for so long for I know not why.  But here we are.   And, truthfully, Kim is not perfect either.  She has one big flaw: her nose.  Now, we are talking function, nor form, here.  Her nose is an attractive part of her still very beautiful face.  But Kim comes from a  family where the proper question isn’t “what are you allergic to” but rather “what aren’t you allergic to?”  If mucous was marketable Kim and I could be millionaires on her clogged, honking, snoring “shnozola.”  Now its April.  So let’s discuss allergies a bit.

A quick overview.  Our bodies sometimes recognise certain chemicals–like pollen–as “foreign” and the immune system will mount an imflammatory response to destroy that invader.  Spring pollens are generally trees and grass, fall brings ragweed and dust is pretty much year round.  The pollen stimulated response causes mast cells to release various chemicals like histamines and leukotrienes.  These chemicals cause various anatomic and physiologic changes like capillary leakage, fluid accumulation, “goblet cells”(one celled glands) to release mucous.  We experience this as stuffy nose, cough, itchy, runny eyes, swollen face, sometimes asthma symptoms. Thus “hay fever” and “allergic rhinitis.”

What can be done about this?  We will not discuss medications but shall limit this discussion to environmental and lifestyle controls.


  • Avoid tobacco smoke.
  • Cotton or nylon rugs backed with rubber.
  • Control household odors–keep lids on cooking/storage utensils, use exhaust fans, avoid use of fireplace; room deoderizers, moth balls, insect spray.
  • Regular maintenence of fireplace, heating and AC ducts.
  • Keep allergy sufferer out of house during vigorous cleaning
  • Maintain ambient humidity at 35-50% with room regulators
  • Lysol or clorox are good for mold control.
  • Child should not play in the attic, basement, or garage.
  • Pay attention to weather reports and use caution with outside play on high pollen days.
  • Consider change of clothes as soon as coming into house from outside.
  • Limit household plants.  Pets may be a problem (this is a tough one!!)

In the child’s room:

  • Limit stuffed animals.  Use washable toys when possible
  • No upholstered furniture or rugs, everythiing should be washable
  • Don’t store toys or out-of-season clothing in child’s room.
  • Keep closets clean and doors closed.
  • Heat/AC vents in child’s room should be closed or covered with 3 layers of cheesecloth fliters.
  • No pets or plants in bedroom.
  • Windows and doors fit tightly.
  • Use non-allergic pillow and high quality plastic lined pillow and mattress encasings.

There are lots of medicines that can be effective when the above does not provide symptomatic relief.  Give me a call to discuss.  Also, I invite questions or comments, and thanks for following.


After that miserable winter, I’m still basking in the early spring warmth.  So last week bike safety, this week let’s talk sun exposure.  Two million people are diagnosed with skin cancer each year.  Skin cancer primarily affects adults but does account for approximately 3% of childhood cancer.  Most lesions are strongly sunlight associated and it is estimated that people typically absorb about 50% of their total lifetime UV exposure by age 20.  So focusing on your child’s skin protection can provide a lifetime of dermatologic health.

Principles of sunscreen use:

  • Use broad spectrum products that protects from both UVA (causes skin aging and passes through glass) and UVB (sunburn, blocked by glass)
  • Apply liberally and generously coat skin, especially on the face
  • SPF 30 blocks about 97% of the sun’s rays.  Beyond SPF 50 there is essentially no further benefit.  Higher SPF does not last longer.  I say that if you think you need more than SPF 30, it’s just time to get out of the sun.
  • Sunscreen for any child 6 months and above.  Under 6 months–why do they need sunscreen?  Just keep them out of direct sunlight.
  • That delightfully soft, smooth baby feel is thinner skin and underlying baby fat.  And thinner skin burns easier.  So babies are more prone to sunburn.  And remember–beach sand reflects sunlight up, so that umbrella is of little use to prevent sun exposure to you or your baby.
  • Reapply every 2-3 hours, especially after swimming or profuse sweating.  No sunscreen is “waterproof.”
  • Context is important–sun exposure is more intense in July than October, in Florida compared to New Jersey, at the beach compared to your back yard, and it’s strongest from 10a-2p.

Remember that the best sunscreen is a roof over your head and the clothes on your back(and head–don’t forget hats!!)

If your child should sustain a sunburn, you should apply cool compresses and moisturizers to the reddened skin(scented products use chemicals that may further irritate and sting).  Oral analgesics like acetaminophen or ibuprofen are useful for pain.  Do not pop blisters if they form but rather you should call me.

As always, I invite questions or comments, and thanks for folowing.

Bicycle Safety

Now that we are finally enjoying a real spring weekend, I want to remind everyone about bicycle helmets and safety.  Everyone should wear helmets while riding (a slight qualifier below).  By the way, I also recommend helmets for in-line skates, skateboards, scooters, and even pogo-sticks.

Every year there are approximately 300,000 ER visits and 10,000 hospital admissions due to bicycle injuries.  In 2010 there were 800 deaths and annual economic losses from bike injuires are estimated at $5 billion.

Each bicycle helmet should have a sticker certifying that it meets standards set by the Consumer Product Safety Commission.  It should fit to be snug but not tight. Straps should always be fastened and one should never wear a hat under your helmet.  If you fall and strike the helmet with any force, it needs to be replaced.

There is actually some controversy attached to bicycle helmet use.  Many safety experts point out–accurately–that helmets are not a guarantee of safety and their use can sometimes deflect us from focusing on the many other  steps that are essential to maximize safety:

  • Use sidewalks and bike lanes wherever available
  • Always ride with–not against–traffic
  • Follow traffic rules and obey signs and signals/lights
  • Wear proper clothing–loose fitting pant legs or loose back pack straps can get caught causing hazards
  • Proper footwear–sneakers, not sandals or flip flops; also no heels, cleats.  Never barefoot
  • No headphones–be alert to traffic sounds
  • Keep bike properly tuned(chains, brakes, gears etc) and tires properly inflated
  • Make sure bike has visible reflectors
  • Size bike to child’s height: there should be 1-3″ between top bar and child’s groin when straddling the bike

A final word: safety first, of course.  But I do want to encourage parents to be cognizant of the social pressures of your kids’ world.  I believe it’s in no one’s interest to dogmatically dictate to your kids(especially your teen boys) about things that very well could lead to their being ridiculed or ostracized from their friends.  Listen to their concerns, talk with them, work with them here and in all things.  Patience and understanding for their reality is always your best approach.

I encourage questions or commentsand, as always, thanks for following.

Speech III–Stuttering

Let’s wind up our discussion about children’s speech development with some thoughts about stuttering. More technically called “dysfluency, ”  stuttering or stammering is a very common occurrence in the language acquiring toddler. It is very uncommonly a serious concern. Typical onset is about 18-24 months to 5 years and it is more common in boys than girls. 1/5 children stutter but only 1/20 will last longer than 6 months. Children may struggle with the word’s first syllable (l-l-l-like) or prolonged sounds (sssee) or repeatedly interupt themselves with “um”. Stuttering is often part of normal language development and will usually pass. People often believe it can be caused by emotional problems. This is rarely the case–far more typical is the reverse, where stuttering is the cause of emotional distress. Even more infrequent is stuttering as a sign of brain damage/injury or mental illness.

We should pay attention to some special circumstances (not “warning signs”):

  • Stuttering continues after the age 5
  • Increasing frequency of stuttering
  • Tension or straining of facial muscles
  • Rising vocal pitch with stuttering
  • Child begins to visibly avoid speaking in public/social situations
  • Family history of prolonged or severe stuttering

If your toddler is stuttering I recommend:

  • Endeavor to have conversations in a relaxed fun environement
  • Speak slowly and clearly yourself
  • Listen closely when your child is speaking
  • Don’t rush them, don’t finish their words or sentences
  • Engage in conversations in the absence of distractions like tv or video entertainment-dinnertime family conversation is great
  • Don’t’ pressure your stuttering child to speak publicly if he does not desire to do so
  • Singing or reciting nursery rhymes together can help your child and increase his confidence in his speaking skills

I will close by saying again that stuttering is rarely a serious concern and usually a transient phenomenon. Please don’t hesitate to contact me with questions or concerns, Thanks for following.