Ask the Doctor - Women's & Children's

Q: I have been on birth control for three years. I missed three pills in a row and have been bleeding for three weeks. Is this normal?

Q: I am in my mid-twenties and have developed very painful cramps during my period. I think I may have endometriosis. What is this condition, and is there a cure?

Q: I was told I had the HPV virus. I had surgery for it (cone biopsy) and just had a pap smear and it came out normal. Can you give me more information on HPV?

Q: I am 32 weeks pregnant and have a terrible case of poison ivy. What can I do?

Q: My child is prone to ear infections, particularly in the summertime when he spends a lot of time swimming. Is there anything I can do to prevent this?

Q: Will using a tampon cause me to lose my virginity?

Q: Do you know any techniques to help a teething infant?

Q: How long should a parent wait to call the doctor when their child is sick? Should they call if the child has a fever and it disappears the next day?

Q: Why do children suck their thumbs? Is it dangerous and, if so, how can it be treated?

Q: Why were children's cold medications recently banned and, as a parent with two children under the age of five, what should I do when my child is sick?

Q: In light of the recent recalls of children’s toys and products that contain lead, what should I know about the dangers of lead? What can I do to protect my child?

Q: My child just started school. What are the most common illnesses that I should expect and how can those illnesses be treated?

Q: Parental dilemma: Is it OK to spank?

Q: Questions on sons, daughters and injuries

Q: My daughter is going to camp this summer for a week. She has never been gone from home that long. What advice do you have for helping reduce her homesickness while she's away?

Q: My child has been diagnosed with ADHD. Besides taking medication, what else can my child do to help with the condition?


Q: I have been on birth control for three years. I missed three pills in a row and have been bleeding for three weeks. Is this normal?

Breakthrough bleeding is not uncommon for women on birth control pills. This can be caused from missing a pill or two or taking them at different times in the day. But it also occurs for no reason at all. My rule-of-thumb is to change the brand of the pill if bleeding happens three cycles in a row.

Combination birth control pills are composed of the hormones estrogen and one of eight types of progestins. Each progestin has a different potency giving it different progestational, estrogenic, and androgenic effects. The result of these effects (which may be experienced as a side effect) depends on the combination of the type and dosages of progestin and estrogen. Women may also respond differently to the combination effects of various pills.

Combination birth control pills that contain a higher estrogen level, higher progestin potency, and lower androgen potency tend to be less likely to produce the side effects of spotting and acne. The following pills have been shown to reduce the chances of breakthrough bleeding: Demulen 1/50, Desogen, Ortho-Cept, Ovcon 50, Yasmin, Zovia 1/50E, Estrostep FE. As a side note, Demulen 1/50 has also been shown to minimize problems with acne.

Estrostep FE, on the other hand, follows more of a high androgenic/low estrogenic pattern (which differs from the "suggested" combination pattern associated with reducing spotting). This brand, however, is a triphasic pill that was actually designed to help prevent breakthrough bleeding while attempting to keep hormone exposure as low as possible.

Progestin is incorrectly associated with increased early or mid-cycle breakthrough bleeding and spotting. It is actually the estrogen dose (rather than the specific progestin) that is most associated with breakthrough bleeding. This means that higher estrogen dosages can counteract the likelihood of spotting. For pills containing ethynodiol diacetate, the brands that also include higher levels of estrogen can alleviate this side effect (and thus minimize spotting).

To rule out any other cause of breakthrough bleeding, schedule an appointment with your Ob/Gyn for a pelvic exam, ultrasound, and further work up. It is also important to know which pill you are on, determine if it is the same pill, or has changed recently.  It is also important to be aware of possible side effects of birth control pills. These include nausea and vomiting, headaches, irregular bleeding, weight gain or weight loss due to changes in eating habits, breast tenderness, and increased breast size.

Aparna Tamaskar, MD, practices family medicine with a specialty in women's health and gynecology at PMC Physician Associates: Family Medicine in Brodheadsville.

 
Q: I am in my mid-twenties and have developed very painful cramps during my period. I think I may have endometriosis. What is this condition, and is there a cure?

Endometriosis is a common health problem in women. About five million women in the United States have endometriosis. In general, women with endometriosis get their monthly period, are in their mid to late twenties, and have symptoms for two to five years before finding out they have the disease. This condition gets its name from the word endometrium, the tissue that lines the uterus (womb). Tissue that looks and acts like the lining of the uterus grows outside of the uterus in other areas of the body. These areas can be called growths, tumors, lesions, or nodules. Most endometriosis is found on or under the ovaries, behind the uterus, on the tissues that hold the uterus in place, on the bowels or bladder. This "misplaced" tissue can cause pain, infertility, and very heavy periods.

Pain is one of the most common symptoms of endometriosis. Symptoms include very painful menstrual cramps, pain with periods that gets worse over time, chronic pain in the lower back and pelvis, pain during or after sex, intestinal pain, painful bowel movements or painful urination during menstrual periods, heavy and/or long menstrual periods, spotting or bleeding between periods, infertility, and fatigue. Women with endometriosis may also have gastrointestinal problems such as diarrhea, constipation, or bloating, especially during their periods.

You are more likely to develop endometriosis if you began your period at an early age, have heavy or long periods, have a short monthly cycle (27 days or less), or have a close family member with endometriosis. Some studies suggest that exercising regularly and avoiding alcohol and caffeine can help in avoiding endometriosis.

Growths of endometriosis are almost always benign, but still can cause many problems. Patches of endometriosis respond to a woman's monthly cycle. Each month the growths add extra tissue and blood, but there is no place for the built-up tissue and blood to exit the body. For this reason, growths tend to get bigger and the symptoms often get worse over time. Tissue and blood that is shed into the body can cause inflammation, scar tissue, and pain. As the misplaced tissue grows, it can cover or grow into the ovaries and block the fallopian tubes. This can cause fertility issues as well as problems in the intestines and bladder.

There is no cure for endometriosis, but there are many treatments for the pain and infertility that it causes. The treatment you choose will depend on your symptoms, age, and plans for getting pregnant. For some women with mild symptoms, doctors may suggest taking over-the-counter pain medicines or prescription pain relievers. When pain medicine is not enough, doctors often recommend hormone medicines to treat endometriosis. Birth control pills block the effects of natural hormones on endometrial growth preventing the monthly build-up and breakdown of growths. This can make endometriosis less painful. Birth control pills also can make a woman's periods lighter and less uncomfortable. In extreme cases, surgery may be required.

If you think you have endometriosis, talk with your obstetrician/gynecologist. He/she will conduct a pelvic exam, ultrasound, MRI, tissue biopsy, or in some cases laparoscopic surgery to correctly diagnosis endometriosis. As with any medical condition, you may consider joining a support group to talk with other women. There are support groups on the Internet and in many communities. It is also important to learn as much as you can about the disease. Talking with friends, family, and your doctor can help.

Aparna Tamaskar, MD practices family medicine with a specialty in women’s health and gynecology at PMC Physician Associates: Family Medicine in Brodheadsville.


Q: I was told I had the HPV virus. I had surgery for it (cone biopsy) and just had a pap smear and it came out normal. Can you give me more information on HPV?

Nearly half of the U.S. population, both men and women either have been or will be affected by Human Papillomavirus. Yet most never know it. More than 130 versions of the virus exist, and of these, approximately 40 are sexually transmitted. Human Papillomavirus, better known as HPV, is the most common sexually transmitted infection causing genital warts, cervical cancer, and other HPV related cancers. The Centers for Disease Control estimates 20 million people are currently infected with HPV, with more than six million joining their ranks each year. More than 40 percent of sexually active young women have the virus. But now a new vaccine for young women may help stem its spread.

People may be HPV carriers, experience no symptoms, and unknowingly infect others. 
Like many viruses, it’s possible to contract and successfully fight HPV with no adverse effects. It may disappear after a month or a year. HPV can also linger before manifesting as either an embarrassing nuisance or a life-threatening condition.

HPV may be so prevalent because of its mode of transmission. The virus is spread by direct skin-to-skin contact including sexual intercourse, oral sex, anal sex, or any other modality involving hand to genital contact. It is very unlikely that HPV is transmitted from touching objects such as a toilet seat. The risk of infection increases with the number of sexual partners. Patients who have other sexually transmitted diseases such as chlamydia, gonorrhea, HIV, hepatitis, or syphilis are also more susceptible to HPV. Condoms do not completely protect against infection.

The low risk form of the virus is most commonly associated with genital warts, which may appear anywhere in the genital area alone or in groups.  The warts have a cauliflower-like surface and can range in size from a few millimeters to several centimeters. Treatment can include chemical solutions, and genital warts may or may not go away in time. Normally, the body’s immune system combats HPV, but if not, genital warts appear on the skin and mucous membranes of the genital region. Warts are embarrassing, but, generally won’t become cancerous.

Higher risk HPV virus types 16,18, 31, 33, and 35, are linked to an estimated 70 percent of cervical cancer. Females infected with these viruses run the risk of developing abnormal cells along the lining of the cervix. These could lead to pre-cancerous or cancerous cells. Though not as common, HPV may also cause cancer of other genital areas.

Sexual abstinence, monogamous relationships, delayed sexual debut, and minimizing the number of sex partners are the best ways to reduce the risk of HPV infection. A new vaccine, Gardasil™, shows great promise in controlling the spread of HPV, reducing the cost, morbidity and mortality associated with cervical cancer. We recommend that girls are vaccinated as young as age 9 through 26 to protect against infection. The vaccine may be an effective preventative measure against HPV, but it is no substitute for regular gynecological visits and health screenings.

Gardasil™ may not fully protect all girls and women and does not prevent all types of cervical cancer. The vaccine does not replace your yearly pap smear, and it is important for women to continue regular cervical cancer screenings. However, this vaccine is a breakthrough in helping control the spread of HPV and offers women real relief in combating the virus.

Aparna Tamaskar, MD practices family medicine with a specialty in women’s health and gynecology at PMC Physician Associates: Family Medicine in Brodheadsville.

  

Q: I am 32 weeks pregnant and have a terrible case of poison ivy. What can I do?

Alan Westheim, MD

Poison ivy, poison oak, and poison sumac all contain an oil called ureshiol which causes an allergic reaction in susceptible people. The oil in these plants causes primarily a self-limited eruption that resolves within two to three weeks. While the reaction is certainly uncomfortable, the poison in these plants is not internally harmful. Most people appear to deal with this reaction without medical attention.

When the plant is contacted, our fingers will typically spread the oil to many parts of the body. After a few hours the damage is done, and the reaction will begin. It usually starts within 24 to 48 hours after contact and will vary depending upon the amount of oil contacted, the site of skin contacted, and the patient’s individual reaction. In fact, some areas on the skin may not show a reaction for up to a week after contact. Contrary to a common myth, scratching does not spread poison ivy.

During pregnancy, it is always important to exercise caution before taking any medication, however, there should be no issues with treating poison ivy. Typical home remedies include cold compresses on the affected areas, application of calamine lotion, or a baking soda paste. If these remedies don’t work, you can safely use benedryl orally. For patients who are severely uncomfortable and suffering from an extreme reaction, both topical and systemic corticosteroids can be safely prescribed for a short period of time. Check with your primary healthcare provider for an accurate diagnosis and to determine the best course of treatment for your condition.

Alan Westheim, MD, is a dermatologist with Medical Associates of Monroe County. He is Board certified in internal medicine and dermatology.

          

Q: My child is prone to ear infections, particularly in the summertime when he spends a lot of time swimming. Is there anything I can do to prevent this?

A: Ear infections are the most common illnesses in babies and young children and not a general cause for concern. In fact, three ear infections in six months is considered normal, however, it does approach the upper limit of acceptability for ear infections. There are a variety of ear infections including simple otitis media, acute otitis media (AOM), otitis media with effusion (OME), and otitis externa (OE), known as “Swimmer’s Ear.” Ear infections are caused by bacteria and viruses.

As with any medical issue, a proper diagnosis is the first step. A closer look at the variety of ear infections will help. With acute otitis media (AOM), parts of the middle ear can be infected and swollen. Fluid and mucous can also be trapped in the ear. Otitis media with effusion or fluid means the fluid or mucous stays trapped in the ear even after the infection has subsided. In this case, the child may hear the sound of fluid moving in the ear canal. In addition, the child may have a sore throat. Swimmer’s Ear, caused by bacterial infection, is generally confined to the ear and/or outer ear canal. Ears may itch or become red and inflamed, and movement or touching the ear is very painful. There may also be pus that drains from the ear.

Children are more prone to ear infections for a variety of reasons. Their immune systems are not yet fully developed. Some children have immunological deficiencies and are simply more prone to infections. A child’s anatomy is also conducive to ear infections. Their Eustachian tubes, which are located inside the ear, are smaller and straighter making it difficult for fluid to drain. Also, children’s adenoids are larger. Located near the throat, they may become swollen and infected, blocking the openings of Eustachian tubes.

After a proper diagnosis, your doctor can make a proper decision regarding treatment. In the event of a bacterial infection, antibiotics may be administered. If so, it is important to complete the prescription in its entirety. Your doctor may also prescribe child pain relievers. Some children may need surgery, called myringotomy, to place small tubes into the ear. These tubes help to relieve pressure in the ear and allow fluid to drain.

In the case of Swimmer’s Ear, prevention can help combat this common ear infection. Keep the ear dry by applying a few drops of alcohol into the ear after swimming. Also, take care to swim in properly chlorinated pools or in areas without pollution. When cleaning your ears, do not insert a cotton swab or other sharp into the ear canal. Clean only the outside of the ear. In all cases, in the event you suspect your child has an ear infection, consult your healthcare provider. 


Aparna Tamaskar, MD practices family medicine with a specialty in women’s health and gynecology at PMC Physician Associates: Family Medicine in Brodheadsville.

  

Q: Will using a tampon cause me to lose my virginity?

A: There are many myths surrounding the state of a female’s virginity that are shared and disseminated among teenagers and young adults. One of the persisting myths is that a young girl will lose her virginity when using a tampon during her menstrual cycle or because of the use of a speculum or pelvic examination during a gynecological exam.

To help dispel this myth, defining virgin in the context of your question is required. The word has many different definitions, but for clinical purposes, a virgin is a female who has not had sexual intercourse and is still considered in that state of maidenhood.

Most girls have a hymen, tissue that stretches across the opening of the vagina. This tissue is generally elastic and pliable enough to accommodate the insertion of a tampon. Some teenagers, and even older adults who have never been sexually active, can comfortably tolerate the use of a slender or narrow tampon in spite of the presence of this tissue.

Sometimes gynecologists need to perform a pelvic or speculum examination on girls or younger adults who have never had sexual intercourse. These exams are an important part of a women’s wellness routine and can rule out certain pathologies such as cancer, endometriosis, or other infections not related to sexually transmitted diseases. Small and narrow speculums are used to minimize the patient’s discomfort and avoid traumatizing the hymen.

To return to the original question, the answer is no, using a tampon will not cause a female to lose her virginity. A girl or woman who is a virgin is simply a female who has not had sexual intercourse. Using a tampon or having a gynecological examination has no effect on that status.

Cheryl Hamilton, MD, FACOG is a Board-certified obstetrician and gynecologist and member of the Medical Staff at Pocono Medical Center. She practices at PMC Physician Associates: Obstetrics and Gynecology in East Stroudsburg. 

 
Q: Do you know any techniques to help a teething infant?

Answer by Jose Bordas, MD, Pocono Medical Center:

If your baby is leaving teeth marks on objects or begins to gnaw excessively, this is a sure sign of teething. Contrary to popular belief, though, infants do not suddenly “cut” a tooth; each baby is born with a full set of teeth that slowly push their way through the gums. Nevertheless, the teething process can be a very painful process for your child.

Most infants begin teething at six months of age, a period known by medical professionals as dentition. During this time, you can expect your infant to experience irritability, pain and excess drooling. Due to the infant’s sensitive skin, the drool might also cause a small, raised rash to form around the chin and lip area. If a rash develops, gently wipe away excess saliva with lukewarm water and pat (don’t rub) dry. You may also want to apply a lubricant to the rash. As an added precaution, place a water-absorbing towel under the child’s sheets or a cotton diaper under the child’s chin while he or she sleeps. This will help stop rashes from forming by preventing the child’s sensitive skin from rubbing against a sheet wet with drool.

If your infant experiences other, more severe symptoms like diarrhea, fever or oral ulcers, this is usually the result of an infection, not teething, and you should contact your doctor right away. To avoid infection, it is important to maintain a high degree of hygiene in the infant’s environment.

During the child’s teething period, it is not recommended that you rub scotch, brandy or other alcohols on the child’s gums. Instead, use topical gel anesthetics (sold over-the-counter) or baby acetaminophen given according to the appropriate dosage as a pain reliever. The occasional use of a chilled teething ring or frozen food (i.e., a frozen waffle, bagel or popsicle) can also be comforting to your little one.

Jose Bordas, MD is a Board certified pediatrician and member of the Medical Staff of Pocono Medical Center. Dr. Bordas practices at PMC Physician Associates: Pediatrics in East Stroudsburg.

 
Q: How long should a parent wait to call the doctor when their child is sick? Should they call if the child has a fever and it disappears the next day?

Answer by Jose Bordas, MD, Pocono Medical Center:

The simple answer to this question is: it depends. Determining when your child should see a doctor depends on a number of factors, including the child’s medical history and current condition.

It is important to note, however, that the degree of fever does not necessarily reflect the severity of illness. A high fever could simply be the result of a mild viral infection, whereas a low fever could be an indication of a more serious illness, such as sepsis, pneumonia or other acute conditions. Therefore, you should not base your decision to call the doctor on the severity of the fever alone.

It is equally important to understand that the child’s appearance or physical condition is not always an accurate measure of their health. For instance, a very sick child can merely have a mild infection. In contrast, a child may look well, but still have a serious medical complication. As a result, the parent should not rely on the child’s looks to gauge the severity of illness or to determine whether a visit to the doctor is warranted.

You know your child best. When he or she is sick, you should rely on your knowledge of your child to decide if medical attention is necessary. There is no hard and fast rule that states how long you should wait to call the doctor. If, knowing your child, you truly feel that he or she is sick, then you should call the doctor. When in doubt, it is always best to air on the side caution by contacting the doctor.

This is especially true if the child develops recurring fevers. Even if your child’s fever disappears, it may return. If a pattern of fever develops, then you should contact your doctor immediately.  Likewise, if a rash, diarrhea, headache or neck pain accompanies the child’s fever, this is could be an indication that something is seriously wrong. In these cases, it is best to see a physician right away.

Jose Bordas, MD is a Board-certified pediatrician and member of the Medical Staff of Pocono Medical Center. Dr. Bordas practices at PMC Physician Associates: Pediatrics in East Stroudsburg.

 
Q: Why do children suck their thumbs? Is it dangerous and, if so, how can it be treated?

Answer by Christopher B. Lynch, DO of Pocono Medical Center:

Thumb sucking is as instinctive as breathing for infants, who have a natural urge to suck—be it on a thumb, a pacifier, or a toy. Typically, babies will continue to exhibit this behavior for the first six months by instinct and then it becomes habitual until the age of five. Because it provides a soothing quality, some children will even continue the behavior until the age of six. At that point, however, they normally stop the behavior on their own account.

While thumb sucking does not pose any imminent dangers for children under five, prolonged or extreme thumb sucking may eventually lead to dental or speech damage for older children.  In rare cases, excessive thumb sucking in toddlers may also be a sign of an affective disorder like anxiety. If your child is sucking his or her thumb in excess or is developing dental or speech problems as a result of thumb sucking, you should consult a healthcare professional.

Treatment for children with thumb sucking disorders generally involves behavior-based tactics that parents can use at home. Removing objects the child associates with thumb sucking and providing positive reinforcement or rewards for not thumb sucking are popular at-home remedies. Speaking with your child openly and directly about the problem is another effective way to resolve the behavior. If these techniques do not help, then your doctor may be able to employ other methods, such as oral devices or behavioral therapy to wean the child off of thumb sucking.

Dr. Lynch, FAAP is a Board-certified Pediatrician and member of the Medical Staff of Pocono Medical Center. Dr. Lynch practices at Pocono Pediatric Associates in East Stroudsburg.

 
Q: Why were children’s cold medications recently banned and, as a parent with two children under the age of five, what should I do when my child is sick?

Answer by Lindy Lee Cibischino, MD, Pocono Medical Center:

Recently, many were surprised to learn that an FDA advisory committee recommended that over-the-counter cold medicines should not be given to children between the ages of two and five. The committee claims that the drugs are both ineffective and unsafe for children within that age bracket.

The committee’s recommendation applies to cold and cough medicines that contain antihistamines, decongestants, expectorants and antitussives. The committee argues that antihistamines, or sedatives, can be harmful for very young children, especially those who have difficulty breathing. In addition, they maintain that the decongestant pseudoephedrine, a common ingredient in cold medicines, could be dangerous for children with cardiac conditions, even if these conditions are undiagnosed.

Recent studies showing that over-the-counter cold and cough medicines produced adverse reactions for some children prompted the committee to reevaluate the products. On October 19, the committee announced that the medicines should be banned from the market. Although the FDA is not required to follow the advisory committee’s recommendation, pharmaceutical companies have already voluntarily pulled cold and cough medicines for use in children under two from the market, concluding that the products were unsafe for infants.

It is important to note, however, that many of the recent problems associated with over-the-counter cold medicine use has resulted from unintentional overdose and that the majority of over-the-counter cold medications are safe in children above the age of two when used in the correct dose.

Until the FDA takes action on the issue, many of these children’s cough and cold medicines will remain on store shelves. If you decide to give your child these medications, be sure that you check with your pediatrician for the correct dose. As a rule of thumb, you should always consult your pediatrician before giving your child any medication, especially if the child is age two or younger.

In the meantime, there are some alternatives to cold and cough medicines when your child is sick. These include making sure your child drinks plenty of fluids, giving your child a non-aspirin pain reliever (i.e., Tylenol or ibuprofen) and/or saline nose spray, having the child rest, and using a cool air humidifier in your home.

When it comes to their children’s health, parents should always exercise extreme caution and speak with a pediatrician whenever they have questions or concerns.

Lindy Lee Cibischino, MD is a Board-certified Pediatrician and Chief of Pediatrics at Pocono Medical Center. Dr. Cibischino practices at Pocono Pediatric Associates, which is located in East Stroudsburg and Stroudsburg. 

 
Q: In light of the recent recalls of children’s toys and products that contain lead, what should I know about the dangers of lead? What can I do to protect my child?

Answer by Sushil Mody, MD, Pocono Medical Center:

The recent recall of millions of toys has fueled interest and concern over lead-containing products. Despite the recent news about recalled toys that were made overseas, environmental lead exposure has been an important pediatric concern for many years. 
Lead poisoning occurs when children are exposed to environmental lead, most commonly via deteriorating chips of older paint. Homes and childcare facilities most at risk would include any built before 1950, or any built before 1978 that are currently being renovated. Other sources of lead in the home can include vinyl mini-blinds made overseas before 1997; certain imported foods, cosmetics and herbal medicines; and imported pottery or metal containers that are used in food preparation. Other family risk factors can include frequent hunting or fishing (if leaded shot, lures or sinkers are used) and working with ceramics or stained glass.

If your child is less than six years old and has any of the above risk factors for lead exposure, then your child’s lead level should be tested by your healthcare provider. Testing can also be performed if you find that your child has been playing with one of the toys on the Consumer Product Safety Commission’s recall list (http://www.cpsc.gov/). Your child can often be tested in your family physician or pediatrician’s office with a simple finger-prick. While this test is convenient and easy, if the results are abnormal, then a more accurate venous lead test (with a full blood draw) should be arranged, as the finger-prick test can often be falsely positive.

A lead level greater than 10 micrograms per deciliter is considered high. Children with lead levels between 10 and 20 have been shown to have a slightly lower IQ (by two to seven or more points, depending on the studies) later in life than children with normal lead levels. If your child is found to have a lead level that is higher than 10, then it is important to talk to your physician about ways to reduce your child’s environmental exposure to lead. The lead test should then be repeated in three months. It is important to know that at these lead levels, most children will not have any symptoms of lead toxicity that are noticeable to the parents. As lead levels increase to 45 or higher, children may begin to complain of headaches, abdominal pain, loss of appetite, constipation, clumsiness, agitation or fatigue. Again, lead levels high enough to cause these symptoms are very rare.

The best way to ensure your child’s safety from lead-containing toys is to review the recalls posted on the Consumer Product Safety Commission’s Web site, and, if applicable, remove any of those products from your home. You should also periodically examine your child’s toys for any chipped paint. If any toys contain chipped paint, you should discard those toys as well. It is also important to routinely clean and dust your child’s toys and your household, as lead will concentrate in areas where dust accumulates. Regular household cleaning is especially critical in homes that were built prior to 1978, as these structures are more likely to contain lead-based paint.

Sushil Mody, MD is a Board-certified pediatrician and member of the Medical Staff at Pocono Medical Center. Dr. Mody practices at PMC Physician Associates: Pediatrics at the Clementine Ableoff Community Health Center in East Stroudsburg, PA.


Q: My child just started school. What are the most common illnesses that I should expect and how can those illnesses be treated?

A: By and large, the most common illnesses for children are ear infections and tonsillitis.

Ear infections are especially common for younger children and are typically caused by bacteria. At times, enlarged adenoids and allergies are also factors. The onset of an ear infection usually produces cold-like symptoms (i.e., fever and congestion). Other characteristics of an ear infection could include pressure behind the eye, headache and, of course, ear pain.  If your child exhibits these symptoms, or if he or she is seen incessantly tugging at or fidgeting with the ear, this is usually a sign of an ear infection.

Children who attend school or daycare are more prone to developing ear infections, due to the increased interaction with other children. Complications from an ear infection could include short-term hearing loss and possible damage to the eardrum. It is therefore essential to seek medical treatment, preferably from an Ear, Nose and Throat (ENT) specialist, as soon as possible. It is especially important to consult an ENT specialist if your child has multiple ear infections, as this could be a sign of structural damage or an abnormality.

Another common ailment for children, tonsillitis, is an inflammation of the tonsils that is caused by bacteria.  Once the tonsils, which are meant to fight off germs that enter the body via the mouth, become infected, they become swollen and can exhibit a red, white or yellowish color. Other symptoms of tonsillitis include fever, sore throat and difficulty swallowing. Tonsillitis can be caused by either a bacteria (streptococci, more commonly known as “strep throat”) or a virus. While tonsillitis can be treated with antibiotics, children who experience recurring tonsillitis may need a tonsillectomy, or the surgical removal of the tonsils. In this case, you should consult an ENT specialist.

Unfortunately, all types of tonsillitis are contagious and can be easily passed through contact with an infected person’s nasal or throat fluids. To help protect your child against tonsillitis, be sure to teach them proper hand washing habits and regularly clean their school and at-home clothes, utensils and supplies. If you think your child has tonsillitis or has come into contact with a tonsillitis carrier, be sure to see your physician right away.

Drupad Bhatt, MD is a Board-certified Otolaryngologist and Chief of Surgery at Pocono Medical Center. Dr. Bhatt practices at the Monroe Ear, Nose, Throat & Facial Plastic Surgery in East Stroudsburg.

 
Q: Is it all right to spank a child? What are some alternatives to spanking?

A: The old adage "spare the rod and spoil the child" was one that most people believed for many years. As recently as the 1970s, many thought a child who was misbehaving would probably benefit from "a good, hard licking." That philosophy has changed for the most part; however, your question is the most frequently asked one a pediatrician hears.

The American Academy of Pediatrics strongly opposes striking a child. It believes that while spanking may relieve the parent's frustration and halt an undesirable behavior momentarily, it is the least effective way to discipline.

In addition to possibly causing physical harm, spanking teaches a child that violence is an acceptable way to express anger. Spanking also interferes with the development of trust, the sense of security and effective communication.

Nevertheless, most parents do occasionally lose their patience usually out of anger or fear and resort to spanking. If a child runs into the street, for example, a parent may scoop up the youngster and give an immediate spanking.

In a case such as that, parents should later explain, calmly, why they did it, the behavior that provoked it, and that they were worried about the child's safety. Parents may even apologize for losing control, which usually helps the child understand and accept the spanking.

Parenting is filled with challenges, so it is important to remember who is the adult and who is the child. As the adult, you have the ability to reason, whereas a child of 2 or 3 does not. Rather than spanking, it's best to praise positive behavior and not berate a child when he or she does not do what you expect. Most youngsters want to please their parents, so try to foster that.

One tool you can use for children ages 2 to 5 is the time-out program. First choose a specific "time out" location in your home, where the child will be isolated, but you can still see/hear him. Next explain the behaviors that you deem inappropriate, such as hitting, biting and kicking.

Be very specific; generalizations, such as "not listening to Mommy and Daddy," are much too broad for a child of that age to understand. When the youngster does not comply with the expected behavior, he then goes to the time-out location for several minutes.

The minutes should coincide with his age; for example, two minutes for a 2-year-old, three minutes for a 3-year-old, etc. In order for a time-out to be effective, the child should not be permitted to interact with anyone or entertain himself during the time-out.

Consistently following through with time-outs when a child does not do what's expected and praising good behavior will pay off. The teenage years will be less challenging if you have established a good rapport with your child early on.

Once children reach adolescence, an effective way to modify behavior is to deprive them of the things they like to do. Explain what you expect from them, and when they disobey, explain why they are losing privileges.

While it may seem that children would love to have free reign, they actually thrive when they have guidelines to follow.

- Dr. GARRY HAMILTON

 

Q: Both my son and daughter play high school basketball. What are the most common injuries?

A: The most common injury in basketball for males and females is, by far, a sprained ankle. That's because it's an injury that occurs when a player lands after jumping. It's common for players to land on someone else's foot, or be bumped while in the air and then twist an ankle as they land.

Sprained ankles can take anywhere from two to 12 weeks to heal; however, if an athlete is still having a great deal of pain after three to four weeks, he or she should have an MRI to be sure there are no hidden cartilage injuries.

A more serious injury is a torn ACL, or anterior cruciate ligament, which is in the middle of the knee. The ACL keeps the knee stable when a player suddenly changes direction. This move is common in basketball and is referred to as a cutting maneuver. Usually when the ACL tears, the player will hear or feel a pop, and his or her knee swells quickly, within 20 or 25 minutes.

ACL tears are four times more common in women than men, and while no one is exactly sure why, researchers believe it could be due to differences in the female and male anatomy of the knee. Cyclical hormonal changes that occur in women have also been blamed, as well as the fact that female players have been shown to have a slower reaction time when their knees are under the same sudden stress as that of men.

Young athletes are usually devastated when they sustain a torn ACL, since the injury puts an abrupt end to their season. But most doctors agree that the best treatment is an ACL reconstruction, which will put the athlete back in the game and prevent debilitating arthritis from developing later on.

- Dr. MAURIZIO CIBISCHINO


Q: My daughter is going to camp this summer for a week. She has never been gone from home that long. What advice do you have for helping reduce her homesickness while she’s away?




A:
First, be confident enough in your own judgment about when your daughter is ready for camp. If she is ready now, great. If you find that waiting a couple of years is right for her, that’s also fine. You—and she—can both make that call.

Every so often, a question is raised that reminds us that children are individuals, and that what can be a completely enjoyable situation for one child can be a very stressful situation for another. A weeklong camp for a six-year-old is such a question.

When considering if she is ready, it is important to understand that all children grow up with different experiences of being separated from their parents. Some children are used to several hours of separation from their parent(s) at Day Care from as early as they can remember. For some children, the first experience of separation from their parent(s) is the first day of school. Often times, there has been an overnight separation from the parent(s) by spending time with grandparents. Usually, the grandparents are already familiar fixtures in the child’s life, or the parent(s) is joining the child in visiting grandparents who may live a distance away.

From the child’s perspective, there are several aspects about a one-week camp that are either fun or frightening, as children deal with independence-dependence issues: Mom is not around to hassle me, but Mom is not around to hug me, either. Either there are a lot of new friends, or there aren’t any friends around at all. Either camping is a terrific adventure or a scary ordeal. And as the day progresses and the child becomes physically tired, the urge for adventure decreases and the longing for familiarity increases.

If you both feel she is ready, where your child will fit in on adapting to camp depends on her temperament, over which you have limited influence, and on her experiences in dealing with similar situations, over which you have a great deal of influence. There are several learned experiences in which you could participate that will make going to camp easier.

Learning to make friends at Day Care, excursions with you away from home, and an experience with camping will give you the opportunity to do something else before a week-long camp: talk with your daughter about what she may feel and experience at camp, before she is actually having those experiences. You can talk about all the fun she will have at camp, with new friends and new experiences. If you either have pictures of the camp or if you can visit the camp beforehand, all the better. And you can approach subjects like missing her bed or her pet when she is at camp, or that one week is a long time when you’re six-years-old, as normal feelings that everybody has, but always reassure her that everything will be waiting for her when she returns.

Telephone contact at camp is a two-edge sword. If everything at camp is perfectly fine, then it is a pleasant conversation. But if things at camp are less than perfect, you may find yourself trying to comfort a homesick child while trying to explain to her why leaving camp early would defeat all the goals of developing self-reliance and independence that an overnight camp promotes. Here is a place where postal or “snail” mail can be very helpful. A day or two before she leaves, you can begin mailing a quick note, a card, a picture of her pet, etc. to her at the camp address, so that one will arrive each day that she is at camp. You can also pack self-addressed, stamped envelopes and ask her to draw a picture of what she did at camp that day and mail it back to you.

What has been referred to as a “transitional object,” such as a favorite stuffed animal, can also be very helpful. When your daughter is at camp, her “transitional object” will be within reach when she misses home and can be an icebreaker in making new friends at the beginning of the camp week.

Again, trust your judgment about whether this is the right year to have your daughter begin overnight camp adventures.

-         Christopher B. Lynch, DO, FAAP

 
Q: My child has been diagnosed with ADHD. Besides taking medication, what else can my child do to help with the condition?



A: For those who do not know, Attention Deficit Hyper Activity Disorder (ADHD) is a behavioral condition in which individuals, typically children, have difficulty paying attention and controlling their behavior. According to the National Institute of Mental Health (NIMH), the most common symptoms of ADHD include inattention, hyperactivity, and impulsivity. The NIHM also estimates that between 3 and 5 percent of children, or approximately 2 million children in the United States, have ADHD.

While medication is recommended for most ADHD patients, there are non-pharmacological techniques that are very useful for the treatment of ADHD. The ones that have been demonstrated as most useful in scientific studies are those involving behavior modification. Some behavior-based techniques you, as a parent, can employ include:

  • Rewarding your child’s positive behavior
  • Maintaining a daily schedule for your child
  • Using a task list for all of your child’s activities
  • Implementing calm, but effective discipline techniques (i.e., assigning time out and removing the child from any overly agitating or stressful situations)
  • Keeping distractions to a minimum
  • Setting small, reachable goals for your child
  • Providing logical, organized placement of the child’s schoolwork, toys and clothes

As a parent, the most important thing you can do for your ADHD child is to set the right example: provide consistent and persistent discipline, while maintaining a stable parent-child relationship.

For parents, I also recommend attending classes or therapy sessions that teach effective parental skills for children with ADHD. Parents of children with ADHD may also find it helpful to join local or online support groups. By participating in ADHD support groups, parents might have the opportunity to hear lectures from experts on ADHD and even obtain referrals for qualified specialists. Moreover, connecting with parents who have similar problems or concerns enables parents to exchange valuable advice and information on ADHD. Most importantly, though, the support groups remind parents that they are not alone.

-         Jose Bordas, MD is a Board certified pediatrician and a member of the Medical Staff at Pocono Medical Center. Dr. Bordas practices at PMC Physician Associates: Pediatrics in East Stroudsburg.

 

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