Pure Direct Pediatrics

Holidays can be a busy time for all of us, but as a parent, that doesn't mean we neglect our health!

If you haven't had your annual checkup, I highly recommend it and make sure to ask your doctor about the hepatitis B vaccine to get protection against the hepatitis B virus.

Hepatitis B has no cure, but it can be prevented with a vaccine. It's caused by a virus that affects the liver, that may cause health complications that can be lifelong or even fatal.

Many of you may correctly link the vaccination to your newborn as it's been the standard of care for infants, since 1991.

However, those born before 1991 may still be living unprotected against the hepatitis B virus. 

Now the CDC recommends adults aged 19-59 years get caught up on their hepatitis B vaccination.

Please read through all the slides, including the disclaimer.

I hope the comment section remains insightful and focused on the overall health and well-being of children.

I also hope even if you aren’t at all interested in adoption, you walk away learning something new.

This post does not focus on child trafficking which is another problem and post altogether.

It’s not my usual posting time, but I’m not sleeping well anyway. I was asked to share this story again so it could be easily reshared.

Also, sitting here wondering how it feels to be part of a country that looks on while babies are denied clean drinking water.

Children deserve better.

This has sat with me since yesterday.

We health care workers speak a universal medical language. The plight and trauma of HCW’s, especially after 2020, is something we acknowledge and need to understand.

If you’ve even worked in healthcare (or maybe even been a patient) in the ER or ICU for even a day, you know how important pain control is.

Practicing medicine like this in 2023 on children?

Chills. Nightmares. Medical terror.

Ok so we are going there!

Lice.
Super common in school age children.

Swipe through and let’s answer all the questions you didn't know you had on head lice!

➡️We typically diagnose lice by visual inspection which I will discuss more in stories today.

➡️Super important-Children should not be excluded from school based upon the presence of live lice or nits. Why?

Lice are often present for WEEKS prior to detection, plus majority of children with nits may not develop active infestation.

➡️That being said, anyone who has had close contact (for example in the house), should be inspected and if a sibling shares a bed with someone who has head lice, they should be treated prophylactically.

Ok who's gonna be super brave and admit they had lice? I did once as a kid and it was super resistant to therapy! My sisters and I all had to be treated at home twice.😅

Tis the season to share sunscreen knowledge!

But actually- you should be focusing on sun protection year round! In fact, May is Skin Cancer Awareness month.

↔️Swipe through to learn the difference between mineral and chemical sunscreens, common sunscreen myths, and some of my personal faves!

Last slide has a couple of different brands, formulations, and types of sunscreen so feel free to SAVE, share, and screenshot. 💚💙

Let's talk dental trauma😬

A bit morbid for Dental Health month, no?

Well here's my reasoning-

We've talked alot on this page about baby dental health-
when to see a dentist,
fluoride containing toothpaste, troubleshooting sucking thumbs, and more.

But what about trauma to the those little one's teeth? Those things we randomly need to remember when we least expect it

Sharing my top 3 common dental trauma questions I've answered in my years as a pediatrician. Grinding is a super common one and not exactly acutely traumatic in my opinion because it’s so common and almost expected but parents can consider it trauma to the teeth so addressing it here!

Of course, this post does not to take the place of a dental assessment by your child’s pediatrician dentist in case of any of these situations!

And now sharing my own little dental trauma…(more like traumatic experience)😅

I once had a silver crown (ie silver capped tooth) on one of my back molars at the age of 8, and I was eating DOTS candy. You see where this is going…

The candy legit stuck to the crown, and the whole thing came off!

I went to the dentist and all was taken care of.

Yes I still eat DOTS candy, and yes, I still like them!

Moral of the story-not all candy is created equal and some candies can def be worse and do more trauma to those little teeth!

SAVE THIS POST in the unfortunate event you need it, and regardless of what happens, try not to panic. Children mirror the reactions of adults, so the more calm you remain, the more calm your child will be.

Such a complex topic. Hopefully, this helps. I will say, no solution- daycare or nanny- goes without issues.

If you’re not sure pros or cons of either, check out my YouTube video which can help set a foundation of things to think of and questions to ask yourself on the childcare journey.

GUYS, this is me.

To the point that I've even pestered a fair amount of pediatric dentists about Minnie's finger sucking habit which at 18mos is still going VERY strong.

Make sure to watch this one if this is your child! LINK IN BIO💚💙

Antibiotics 101

Ok so this is not really the 101- antibiotics are some of the most complicated topics in medical school pharmacology. Seriously- I still have nightmares about it.

This is more of a 101 to understanding what they do and why they need to be taken as needed. I’ll discuss more in stories today too!

With the talk of strep across the UK, and the fact that some protracted viral infections can lead to bacterial super infections, let’s discuss some commonly asked antibiotic questions and concerns both on parents’ end but also what pediatricians want you to know!

If you work in healthcare, stop scrolling!

If you’re a parent, consider reading on as well bc this is important stuff!

In today’s post, I’m sharing some open-ended conversational techniques that appear to work best when it comes to communicating about vaccines.

In healthcare, refocus a lot on teaching the importance of open-ended questions. It helps us learn more history through the patient’s words.

That being said, in pediatrics, we may not ask a 3yo what the cough feels like and instead ask more direct yes/no questions- ie, does the cough hurt in your chest?

However, when it comes to communicating with parents, open ended questions and phrases still seem to work the best and this is true for vaccine hesitancy as well. Note I said HESITANCY.

Using these phrases help us to learn about where those hesitations lie, what is real information vs urban myth, and how we can help our patients make the best decisions for their health and public health. This is SO IMPORTANT given what we’ve seen in New York re: polio and now Ohio re: measles.

What’s your favorite thing about the way your pediatrician communicates about vaccines?

Popularly requested topic- swipe through slides to see info!

First off, I’m really not a fan of completely restricting a food. I believe food restrictions can cause children to overeat restricted items when given access. There are studies which show this as well

https://pubmed.ncbi.nlm.nih.gov/10799366/
https://pubmed.ncbi.nlm.nih.gov/23142562/

Second, when sugar-containing foods are restricted, children may eat less at first BUT over time they will become more preoccupied with food. 

I want my kids to not grow up with an all or nothing mindset.

I don’t mind Asiya eating a treat here and there after a meal, but our rule is you have to eat some fruit first.
Sometimes I’ll often get toddler negotiation with wanting multiple treats a day with the bargaining chip “but I was a good girl!”

Yeah, kiddo— sometimes you just have to be a good person without a sweet edible incentive😅

I often get a lot of questions about what to do for time changes. In reality, for me the answer depends on how long you’re going to be traveling to the new time zone. Because we were going for a few days (>3-4 days) to the West Coast, I took the steps to try to make a transition a little bit easier for the kids.

Sharing some tips here. Let me know what’s worked for you and your family!💙💚

This week, I was a little surprised that Minnie‘s pediatrician wanted to give her her vaccines in her legs for the 12 month and then now the 15th month check up.

At the 15th month check up, she seemed confused why I would not want the arms.

Because legs are the recommended site for intramuscular shots at this age!

I’ve received tons of these questions in the last few months asking

“Is it ok my child got the Covid vaccine in his leg/her arm?”

Straight from the CDC itself, I am sharing this resource for practicing pediatricians, family medicine physicians, and other healthcare workers who give kids vaccines and/or other INTRAMUSCULAR injections on tips for where to give them and at what age.

Remember, some vaccines are also given subcutaneous and those have slightly different preferential sites for children over 12 months.

Parents, feel free to screenshot this as well and keep on hand!

Source

By popular request! 
↔️Swipe to read more! 
 
Night terrors can be very alarming for parents to see and witness.  
 
They can also make you feel a little helpless since you have to wait for it to pass vs nightmares in which we are able to awaken our kids. 
 
From a pediatrician's perspective, it’s all about history when it comes to diagnosing the episode.  
 
Some conditions that we see night terrors in include sleep apnea, asthma, reflux, baseline anxiety…all things that can be disruptive to sleep to begin with.  
 
You may be aware that large stressful events can trigger nightmares, but they can also cause night terrors. 
 
Generally, if occurring 1-2 times per month, night terrors may not need to be treated since they’re benign and self-limiting.  
 
One of the treatments that can be helpful include scheduled awakenings.  
 
⭐️Important to know-  
An increase in these events can indicate poor quality or inadequate sleep. If you see an uptick in the frequency or severity of these events, touch base with your pediatrician for a re-evaluation. 
 

I’ve gotten a lot of questions on this topic. We will be traveling next week, and you can check out todays stories to see what we are doing! No matter your choice-Please remember the following below-

👉🏼If you are eligible, get vaccinated. We know more and have more tools than we did at this time last year. Getting vaccinated is the best way to protect yourself and your family.

👉🏼Stay home if you are sick. Just do it.

👉🏼Lastly, if you are so nervous traveling that it is weighing on your ability to enjoy the holidays, then reconsider.

Everyone may have a different risk tolerance and as parents to young potentially non vaccine eligible children, do not feel you have to explain your choices if others are coaxing you to do something you don’t feel comfortable. Your anxiety is understandable.

We can all take steps together to keep our families safe this holiday season.

I’ll admit, I don’t think I ever formally got schooled on how to stay safe with strangers by my parents. It’s awkward &unnerving to talk abt to your kids. These are things we never want to think of happening. 
 
As a parent, I 100% get this. 
 
Kids are pieces of our heart walking outside our body. We don’t want them ever to experience harm. We want them to keep that innocence as long as they can. 
 
It's up to us protect them, but also give them the tools &knowledge to protect themselves. In the digital age, reviewing security &safety is still incredibly important.  
 
I talk about this topic very openly with my parents of toddlers. Whether we are consider putting them in school or just teaching them to be friendly to others, I believe we have to discuss this with our kids. How you choose to discuss it is completely up to you as the parent, but here are some Do’s and Dont’s I like to guide my parents with: 
 
✅DO review when it’s ok to be loud. We often teach our kids to use indoor voices, but if safety is an issue, our kids may need to yell or shout to get others’ attention. 
 
❌DON’T teach strangers are mean. 
Strangers are regular-looking people, and they can look friendly! So, instead of judging a person by appearance, I review examples of strangers and people who wouldn’t be considered strangers. (See today’s stories on more on this). 
 
✅DO revisit this convo. It will continue to evolve as your child matures, and develops. Like many things in parenting, this is not a one & done talk, but something I encourage parents to re-visit esp as circle of friends, peers, and mentors expands. 
 
❌DONT keep it one sided. It’s very easy for us to do the talking, but I strongly recommend asking open ended questions &listening to what your child says and understands. You can even practice “what if” scenarios so kids can practice what to do & how to respond in difft situations.(Our allergist does this with Asiya frequently when it comes to her food allergens) 
 
Personally-We’ve been talking to our toddler for some time abt strangers-what a stranger is, what to be aware of, etc. It’s hard!  

❓I’d love to hear how you all have approached this topic with your kids!

Weaning isn’t always an easy decision.  
 
In fact, in my experience with patients (and personally), it almost never is.  
 
With my first child, as an exclusive pumper, I weaned earlier than I imagined I would…but my mental health needed it. Exclusive pumping wasn’t bringing me joy, and my daughter didn’t care what was in the bottle: breast milk or formula. 
 
With my second little one, breastfeeding has gone well *knock on wood,* but as baby is eating more solids and becoming a more efficient nurser, our typical feeding patterns are changing.  
 
I made the decision a few months ago to begin weaning slowly from the pump. I’m still nursing baby for each feeding when I can, but no longer waking at 5am just to pump. 
 
Not exactly easy since that early morning pump was GOLD, but my freezer stash didn’t need it. I also wanted a chance to “sleep in” past 5am since baby was giving me sleep in those early hours! 
 
I first started with dropping the pump that produced the least amount of milk and consolidating it with another pump break at work.  
 
This actually seemed to work really well for my productivity and patient scheduling at work too. 
 
I then began to tackle that morning pump, decreasing each session by a few minutes every few weeks.  
 
This has been a VERY SLOW process for me to avoid issues with clogged ducts. I’ve also been very carefully following baby’s feeding cues and signs of satiation.  
 
At this time, I haven’t started cutting nursing time or breastfeeding frequency, but simply pump time and pump frequency, because neither of us is ready to let go of breastfeeding just yet.  
 
When that time comes, I’ll definitely share more of how we go about doing so. 
 
I get questions weekly on weaning advice so do let me know if this is helpful!💚💙

🍁Happy Thanksgiving🦃!

Last year at this time, and I were recovering from Covid. This year, I’m grateful to vaccines for this time with my parents and sisters in NC, reunited after 22 months

Today, I’m teaming up with Carlene Link | Medicine Mama] to discuss anaphylaxis, its causes, and its first line treatment of choice-epinephrine.

Anaphylaxis is a severe, life-threatening allergic reaction that involves more than one organ system (skin, GI, respiratory, cardiovascular) and usually occurs within minutes of exposure to an allergen.

In kids, foods and stings make up the most common causes of anaphylaxis.
Food allergies are becoming increasingly prevalent in our children, presenting in approx 10% of kids.

Common myths regarding anaphylaxis treatment:

❌Steroids are neccessary. False. Steroids typically take hours to work and there’s no concrete data to show that it prevents delayed reactions

❌Antihistamine stop anaphylaxis. False. Not only are antihistamines slower to act, but they also do not treat vasodilation or bronchospasm (common anaphylaxis symptoms).

✅So what can stop anaphylaxis? Epinephrine. Head over to Carlene Link | Medicine Mama] ‘s page for info on epi and the effects it has on the body to treat anaphylaxis!

𝘽𝙞𝙜 𝙙𝙖𝙮 𝙩𝙤𝙙𝙖𝙮.

Parents, pediatricians, caregivers of young children. We’ve been waiting for this for 19 months. 1 year after the vaccine was released for adults, we can now protect part of our young vulnerable population.

Evidence continues to show the vaccine is safe and effective, subject to the same multistep testing and approval process as all other COVID 19 and non-COVID 19 vaccines.

Pediatricians are the backbone of childhood immunizations in this country, and this vaccine is no different. Parents trust us to care for their kids. To date, 745 children under the age of 18 have died from COVID. For comparison sake: Flu deaths amongst children typically are 150-200 per year.

𝗔𝘀𝗸𝗲𝗱 𝗳𝗿𝗲𝗾𝘂𝗲𝗻𝘁𝗹𝘆 𝗮𝗻𝗱 𝗽𝗼𝘀𝘁𝗶𝗻𝗴 𝘀𝗼 𝗽𝘂𝗯𝗹𝗶𝗰𝗹𝘆, 𝘆𝗲𝘀 𝗶𝗳 𝗜 𝗰𝗼𝘂𝗹𝗱 𝘃𝗮𝗰𝗰𝗶𝗻𝗮𝘁𝗲 𝗺𝘆 𝟰𝘆𝗼 𝗮𝗻𝗱 𝟰 𝗺𝗼 𝗼𝗹𝗱, 𝗜 𝘄𝗼𝘂𝗹𝗱 𝗱𝗼 𝘀𝗼. 𝗜'𝗺 𝗿𝗲𝗰𝗼𝗺𝗺𝗲𝗻𝗱𝗶𝗻𝗴 𝘃𝗮𝗰𝗰𝗶𝗻𝗮𝘁𝗶𝗼𝗻 𝘁𝗼 𝗮𝗹𝗹 𝗺𝘆 𝗲𝗹𝗶𝗴𝗶𝗯𝗹𝗲 𝗻𝗶𝗲𝗰𝗲𝘀 𝗮𝗻𝗱 𝗻𝗲𝗽𝗵𝗲𝘄𝘀.

𝗪𝗵𝗲𝗻 𝘄𝗶𝗹𝗹 𝘁𝗵𝗲 𝘃𝗮𝗰𝗰𝗶𝗻𝗲 𝗳𝗼𝗿 𝗰𝗵𝗶𝗹𝗱𝗿𝗲𝗻 𝘂𝗻𝗱𝗲𝗿 𝟱 𝗯𝗲 𝗮𝘃𝗮𝗶𝗹𝗮𝗯𝗹𝗲?

Pfizer reported that it expects to report results of its clinical trail on younger kids aged 2-5 years and 6months to 2 years, before the end of the year. Thereafter, the data will be considered by the FDA and CDC for potential authorization.

𝗬𝗼𝘂𝗿 𝗽𝗲𝗱𝗶𝗮𝘁𝗿𝗶𝗰𝗶𝗮𝗻’𝘀 𝗼𝗳𝗳𝗶𝗰𝗲 𝗺𝗮𝘆 𝗯𝗲 𝗼𝗳𝗳𝗲𝗿𝗶𝗻𝗴 𝘁𝗵𝗲 𝘃𝗮𝗰𝗰𝗶𝗻𝗲.
Reach out and ask. As of now, I will only be offering it to my patients and not the general community just yet.

𝙋𝙖𝙧𝙚𝙣𝙩𝙨- 𝙏𝙧𝙪𝙨𝙩 𝙩𝙝𝙖𝙩 𝙬𝙚 𝙘𝙖𝙧𝙚 𝙛𝙤𝙧 𝙮𝙤𝙪𝙧 𝙘𝙝𝙞𝙡𝙙𝙧𝙚𝙣.

𝙒𝙚 𝙖𝙧𝙚 𝙧𝙚𝙖𝙙𝙮 𝙩𝙤 𝙙𝙤 𝙬𝙝𝙖𝙩 𝙬𝙚’𝙫𝙚 𝙖𝙡𝙬𝙖𝙮𝙨 𝙙𝙤𝙣𝙚-𝙘𝙤𝙪𝙣𝙨𝙚𝙡 𝙤𝙪𝙧 𝙛𝙖𝙢𝙞𝙡𝙞𝙚𝙨 𝙖𝙣𝙙 𝙥𝙧𝙤𝙩𝙚𝙘𝙩 𝙤𝙪𝙧 𝙥𝙖𝙩𝙞𝙚𝙣𝙩𝙨.

𝗛𝗮𝗽𝗽𝘆 𝗛𝗮𝗹𝗹𝗼𝘄𝗲𝗲𝗻 𝗳𝗿𝗼𝗺 𝗗𝗶𝘀𝗻𝗲𝘆+!  
(God knows we’ve all watched enough of it this year!)  🤪 
  
🤠Woody from Pixar   
💫Rey from Star Wars (shame on y’all who said I was Jesse on the question box!)  
👑Aurora from of course, Disney   
🦇And Batgirl from Marvel (actually DC comics but let’s not focus on that, mmkay?)

𝐓𝐫𝐢𝐜𝐤 𝐨𝐫 𝐓𝐫𝐞𝐚𝐭𝐢𝐧𝐠 𝐰𝐢𝐭𝐡 𝐅𝐨𝐨𝐝 𝐀𝐥𝐥𝐞𝐫𝐠𝐢𝐞𝐬

As a mother of a child with food allergies, I can definitely relate to this first hand.

Holiday times can be challenging for children if they feel like they’re being restricted by what they can eat.

Peanut, egg, and milk represent a large majority of the most common childhood food allergies, and these allergens are often found in some of the most popular candies and chocolates.

A couple of my favorite tips before events like trick or treating:

🎃Be proactive and talk to your child early on

If you have a child who is recently diagnosed with a food allergy or is just beginning to learn what a food allergy is (like my almost 4 year old Aisya) and how it can affect them, what they eat, and the way they live, make sure you sit down with your child prior to trick or treating.

Continue to focus on which treats they can eat or activities they can partake in and enjoy. You want your child to feel included but aware of their allergens. Make sure to focus on the fun so they can still feel excited about the holiday and celebrations!

🎃Try to make it a habit to not to eat while trick or treating

Trust me, I KNOW how difficult this is. I used to dig into my own candy while trick or treating as a child.

Do your best to enforce a policy that you or another trusted adult (ie: nanny, teacher, caregiver, etc) needs to carefully review all labels and ingredients of the treats at home so that your child can enjoy their goodies safely, and you are able to monitor for any potential reactions. 

✨Generally, I also recommend parents avoid treats with no ingredient labeling. This is a strict policy in many nut free schools as well. That way, we can be careful not to eat any home-baked goodies or treats that may have a child’s allergens in them.

🎃Have an emergency backup plan
Lastly, make sure if you’re going trick or treating with your child, that you have at least two auto-injectable epi-pens available at all times in the event of an accidental ingestion.

Trick or treating with your child who has food allergies can be challenging but not impossible!

Happy Halloween!!

𝗘𝗣𝗜𝗖 𝗘𝗖𝗭𝗘𝗠𝗔 𝗣𝗢𝗦𝗧 
 
⭐️SAVE THIS ONE!⭐️ 
 
October is Eczema Awareness Month, and personally, I love educating families on childhood eczema. 
 
As someone who’s had eczema as a child, I can truly appreciate how far we come in diagnosis, therapy, and management. I have distinct memories of my mom coating me with vaseline after bath time and absolutely hated how sticky I I felt!  
 
Since growing older, my eczema has definitely improved but does flare with stress, changes in temperature, and most recently, both pregnancies. 
 
While eczema is definitely not contagious, it can run in families. Family history of eczema, food allergies, asthma, and allergic rhinitis can play a role, as does your immune system. 
 
I like to think of management as two-pronged: barrier and therapeutic. We have to restore the skin barrier and deal therapeutically with any flares that may appear.  
 
Eczema or atopic dermatitis is a complex disease, and I’m hoping this post answers a lot of questions.  
 
✨Make sure to share with others carrying for children with eczema.

🎉Big announcement! 🎉

I did it!
I wrote a book!

I’m so excited that one of my three(!) books will be launched this year – and this one is extra special.

It’s a children’s book focused on bedtime. Along with it I’ll be releasing a lot of great sleep focused content -stay tuned for the launch in the fall!

If you’ve been a follower from the beginning or just joined my small corner-please feel free to show your support by hopping over to the link below and purchasing a copy:

https://mascotbooks.com/mascot-marketplace/buy-books/childrens/picture-books/its-time-to-say-good-night/

Thank you in advance for all your support 🥰