Educational Toys(redux)

In the words of the immortal Paul Simon, “I’ll repeat myself, at the risk of being crude…”  In playing with your child–especially your toddler–there is much more learning that takes place in the interaction between child and parent/playmate than child/toy.  I have spoken about this just recently.  

Regarding this important topic I wanted to share some information that just came to my attention.  Here is a study from JAMA Pediatrics regarding language acquisition in electronic vs simple, old fashioned toys.  If you want, just focus on the discussion.  Here is an editorial on the same subject.

What is cool about the study is that, while it was small (only about 27 families, all white and middle class) it took place right in the child’s home so it was able to assess the real world events during actual play sessions.  What the researchers found was that parents tended to remain more engaged in interactions with the child while using the simpler toys.  The high tech, “bells and whistles” EXPENSIVE toys tended to cause the parents to put the situation more on auto-pilot and leave the kid to his own devices with the toy.  Using electronic toys the parents spoke about 40 words/minute.  With simple toys like blocks it was 56 words/min and books were 67 words/min. Even the quality of the talk was better with more descriptive sentences used with the simpler stuff.

Am I advising AGAINST using computer toys, tablets, programs?  Of course not.  Whatever you and especially you child likes, whatever stimulates them, whatever is helpful and useful in your efforts to play with and teach your child is great.  But the toy/game is merely the vehicle that gets you there–it isn’t the trip and certainly not the destination.  Those things are you and your child, playing and enjoying each other.  And LEARNING TOGETHER.

My point is that you should buy whatever toys you and your child like.  Simple or complex.  High or low tech.  But don’t feel guilty if it isn’t the expensive latest gizmo.  If you don’t like it, don’t understand it, and especially don’t feel like you can afford it, that’s fine.  If you play with your child you are doing something so much better, more important, and ultimately more valuable for both your child and you.

More and better learning that way.  AND when your child is grown, and you are old and gray, they will cherish the memory of playing with Mom and Dad a lot more fondly than the stupid tablet (at least, now that I am mostly there, that is what I am hoping!)

A Happy and Healthy New Year to all. Thanks for following.

Pediatric Psychiatric Collaborative

I am a participating physician in the Pediatric Psychiatric Collaborative (PPC), an exciting new program administered by Dr. Steven Kairys at the K Hovnanian Children’s Hospital (KHOV)at Jersey Shore Medical Center.  This important initiative was developed by by a team lead by Dr. Kairys in response to a severe lack of treatment services available to New Jersey Children with developmental, behavior, and mental health difficulties.  The PPC is funded by a grant from the state legislature and has 2 primary functions.

Firstly, measure the scope of the problem.  Pediatricians like me have parents and children fill out carefully developed screening questionnaires which are designed to identify children who may be at risk. Dr. Kairys, Chair of pediatrics at KHOV since 2002, is an expert in adolescent health who has worked diligently during his tenure to improve the quality and access of pediatric care and in particular mental health services there.  He is performing academic analysis on the raw information that we docs “in the field” provide to develop usable data to show trends and directions in this area.  This information can be used to create programs to aid patients struggling with these disorders.  As they say in business school “if you cannot measure it, you cannot manage it.”

The second part of the PPC is helping affected children receive treatment.  With some of the grant Steve has put together a team of pediatric psychiatrist and psychologists, counsellors, and social workers.  All of us “front line” doctors providing those questionnaires(note: they are all anonymous to maintain strict confidentiality) have access to this dedicated, highly qualified team for our patients who need this care.  As a pediatrician who has practiced in Ocean County for almost 30 years I can attest to the frustration of diagnosing a child with mental health issues and then having few options to call upon and/or poor insurance reimbursement available to defray the often prohibitive costs of this ongoing treatment.  Now I have something to offer here.  I have already sent plenty of children to the PPC for evaluation and coordination of care and it has made a real difference in their lives.  We haven’t “cured” anybody in the few months since the program’s inception (July), but we’ve given many kids a new start and real hope.

The PPC’s original mandate covers Ocean, Monmouth, Burlington, and Camden counties but it will be expanded into 4 more counties in 2016 (which 4 to be determined) and hopefully statewide shortly thereafter.  It is so rewarding to be able to participate with Dr. Kairys and other colleagues in the PPC and to now be empowered to act as opposed to little more than hand holding previously. KHOV has become a regional powerhouse in the field of children’s healthcare over the past several years.  Under Steve’s dynamic guidance, with these types of ideas, Jersey Shore has earned high regard among pediatric thought leaders throughout the US.  KHOV and Dr. Kairys are certainly assets for me and my patients.

Thanks for following, please send along questions.

Did you know?

How often am I asked by parents for recommendations regarding the use of various over the counter (OTC) medications to treat annoying, if self limited, symptoms of common illnesses.  If you have been following you probably know that I try and take a conservative approach to these drugs.  Here’s why.

Common and rare serious side effects of widely advertised OTC drugs:

  • pseudoephedrine and phenylephrine (these are the main ingredients in Sudafed or Mucinex)–hypertension, insomnia, headache, anxiety, elevated heart rate and palpitations, tremor, urinary retention, elevated glucose.  Accordingly, they can interact with diabetes meds, anti-hypertensives, meds for depression or anxiety.
  • guafenicine (active ingredient in many “expectorants”)–rash, nausea and vomiting, rarely kidney stones
  • anti-histamines (Benadryl, Chlor-trimeton, others)–fatigue, dizziness, blurry or double vision (keep this in mind when you send your child to school or your teen off in their car!), paradoxical CNS stimulation, constipation or urinary retention; rarely they can cause a variety of severe blood problems like hemolytic anemia, low platelets or white blood cells; even seizures or psychosis.
  • dextromethorphan (the “DM”of many cough suppressants)–commonly drowsiness/fatigue (again, watch those teens driving).  This drug is commonly abused (called a “robo-high”) and is rarely associated with serotonin syndrome.

Note that the above chemicals are often mixed in a variety of cold preparation brands like Dimetapp, Triaminic, Nyquil and Dayquil, etc–so these effects can be additive and overlap.

  • Immodium(for diarrhea)–commonly causes cramps, nausea, constipation.  Rarely there can be arrest of intestinal activity(“ileus”)which can lead to swelling of the colon (“toxic megacolon” and severe intestinal obstruction with rupture and peritonitis).  Also, consider the reason one develops diarrhea: your intestines are irritated by an infection or some toxin.  Your body’s response is to flush water through the irritated tissue and speed up the intestines squeezing(peristalsis) to cleanse the offending agent out of the body so it can heal.  This drug slows that process, working against the natural healing mechanisms your system is employing to correct the problem.
  • Peptobismol–tinnitus(ringing of ear), constipation.  The chemical name of this medicine is bismuth subsalicylate, so it is similar to aspirin, and if used in children during viral infections it can rarely lead to life threatening Reye syndrome

So, as you can see, these are not benign substances.  The indications for their use must be carefully considered.  I think there are 3 questions that should be answered:

  1. Are the symptoms disrupting the child’s life routines–eating, sleeping, playing, concentrating in school?
  2. Can the symptoms be controlled/alleviated using non-pharmacologic interventions–fluids, nasal saline, rest, modified diet?
  3. Is there scientific evidence that the medicine actually works to relieve those symptoms?

When you call or come into my office I can help you answer those questions so we can decide together what is the best approach for your child’s condition.  So don’t be afraid to contact me–that’s why I’m here.

Thanks for following.

Molluscum Contagiosum

The lesion that you are looking at in the lead picture is called molluscum contagiosum.  These funky looking little guys are a specific kind of wart caused by a skin infection from a variety of viruses in the pox family.  They are exceedingly common and in almost all instances are exceedingly unserious.  All age groups can be affected but they do seem to have a predilection for children aged 1-5 ( under age one seem to be protected by maternal immunity).

They can occur anywhere on the body; thankfully in my experience facial lesions are relatively rare.  They do pop up more in dry, irritated areas so people with conditions like eczema are at greater risk.  Usually a person will develop a few lesions although it is not rare for a crop of many to erupt on contiguous skin as a person can self inoculate via scratching.  Molluscum don’t erupt suddenly like a mosquito bite but rather grow over a period of days or weeks and spread more slowly–if at all–over a few months.  They are usually no bigger than 2-4 mm, pearly white to pinkish-red and the hallmark of molluscum is they are “umbilicated”–the center is depressed giving the appearance of mini-volcanoes.  They are filled with a hard whitish material if broken open but don’t worry: they don’t “erupt” like volcanoes, don’t drain or weep fluid.

As their name implies, they are contagious by direct person to person contact.  But given their typically extremely benign nature there is little that must be done other than keeping lesions covered where possible, careful hand washing, keeping surfaces cleaned, and avoid the sharing of clothing, towels, etc.

As I’ve stated, in most instances this is a very mild condition and the warts will typically resolve (“involute”) spontaneously in 18-24 months on their own without any treatment.  It is not rare for them to sometimes last for 5 years, however.  The skin usually heals completely leaving no mark or scar.  As such, I generally try and reassure parents and follow a course of watchful waiting only.  If necessary, scraping, burning, or freezing will remove them but these procedures can leave scars.  I usually reserve removing them to  warts located on the face and given the scar potential in their removal I prefer that these procedures be performed by dermatologists or plastic surgeons–specialists trained to minimize scars. A variety of “off label” oral treatments  have been tried over the years to make them melt away but to date none of those approaches has ever been shown to be more effective than placebo so I never recommend them.white molluscum

red molluscum

Please send along questions or comments and thanks for following.