Dr. Lyons has been practicing with WRFP since 1995. Between 2005 and 2007 he wrote articles for a local publication on pertinent health issues affecting the family.
- Acne: Every Teenagers’Worst Nightmare
- Bug Repellents for Kids
- Canker Sores
- Chapped Skin
- Child Obesity
- Cold Sores
- Diaper Rash
- Ear Infections
- Express Feelings
- Family Safety Tips
- Fluoride Supplementation
- Hay Fever
- Heat Rash
- How Loud is Too Loud
- Instant Messaging
- Sex Education
- Language Development
- Lessons from the Cow Barn
- Lice: A Real Head Scratcher (External link)
- Lice: Cute, but She’s Scratching Her Head
- Limiting TV and Computer Time
- Tick Bites/Lyme Disease
- Ouch! Splinters!
- Pink Eye
- Pneumococcal Vaccine
- Poison Ivy
- Restless Leg Syndrome
- School Colds
- Seasonal & Novel H1N1 Flu
- Skeletal Planning
- Sleep Needs
- Some Time Alone
- Sun Protection
- Swimmer’s Ear
- Teenage Knee Pain
- The Common Cold in Kids
- The Flu Shot
- The HPV Vaccine
- Thinking ahead: Peanut Allergies on the Rise
- Vaccination Boosters
- Water Safety
- West Nile Virus
- Women, Girls and Knee Injury
What causes acne?Hormones called “androgens” surge during puberty in both girls and boys. Androgens tell glands in the skin to produce more oil. At the same time, the cells that line the oil ducts swell and may clog the ducts. It’s the clogged oil duct that appears as a whitehead on the skin surface. When the cells lining the oil duct dry out, you get blackheads. Then, if bacterial germs get trapped in the plugged ducts they multiply quickly, causing red swollen pimples that really hurt. I still remember them – not to mention my older sister teasing me about them. Common misconceptions about acne:
- Acne is caused by particular foods, such as chocolate or potato chips.
- Dirt causes acne.
- Sexual thoughts cause acne.
- Acne is contagious.
- Abrasive facial cleansers;
- Some cosmetics;
- Menstrual periods;
- Things that rub on the skin, like athletic pads or a headband;
- Emotional stress;
- Squeezing the pimples (I can remember my older sister doing that, too).
What is asthma?Asthma is a disease of the airways of the lung. In people with asthma the airways have a tendency to become easily irritated and inflamed. The inflammation causes the airways to constrict and spasm, which the child experiences as coughing, wheezing, or in more severe cases, shortness of breath.
Who gets asthma?Asthma is a very common breathing problem. In fact, probably 5% of the children in our community have it. No one can predict who will have asthma, but children are more apt to get it if someone else in the family has it.
What causes asthma?Doctors still don’t know. We do know there are common factors that may trigger an episode in a susceptible person. Here are some examples of allergens or airway irritants that may trigger an asthma attack:
- Seasonal allergens like pollen
- Animal dander
- Dust mites and molds
- Cold viruses
- Cold air
- Dry air
- Noxious fumes like paint
- Cigarette smoke
- Household cleaners
- Heavy exercise
- Air pollutants
- Weather changes
- Sensitivity to drugs, certain foods, or food preservatives.
Is asthma serious?Yes and no. In some cases asthma can be life threatening if an attack isn’t taken care of right away. However, for many children asthma is never serious unless ignored, and with one or two preventative steps may rarely even bother them. Although your son’s asthma does not sound serious, your goal, as with all asthma patients, is to find a treatment strategy for eliminating his symptoms.
What about asthma medications?The most commonly prescribed asthma medications are inhalers. These come in two main types: “preventative” inhalers, which are taken daily to prevent airway inflammation and thus asthma attacks; and “rescue” inhalers, which relieve the airway spasm once an asthma attack starts. The treatment depends on the severity of the asthma. Some children with mild asthma might use their rescue inhaler once or twice a month. Other asthmatics need to use their rescue inhaler several times a week, despite being on a preventative inhaler. The treatment should be tailored to the child. I have one patient, an 11-year-old soccer player, who has asthma that is brought on by exercise. Usually exercise-induced asthma can be managed with a rescue inhaler. However, despite using her rescue inhaler appropriately, she was frequently coughing during and after her soccer games. Like many kids, she didn’t like the idea of using an inhaler every day. I eventually persuaded her to try a preventative inhaler, and now she uses it once a day, never needs her rescue inhaler, and breathes better during her soccer games.
Are there alternative treatments?Physicians and other health care providers try various approaches to treat asthma. A good place to start is to figure out what brings on your child’s asthma and how to avoid those triggers. Here are a few ideas to consider:
- Schedule a visit to an allergy specialist.
- Learn to control dust mites at home.
- Find a new home for the family pet.
- Don’t allow smoking in the house.
- Trade in the wood stove.
- Get an annual flu shot.
- Visit with a dietary expert to determine if certain food groups or food additives make the asthma flare up.
Does asthma ever go away?Asthma is a chronic condition. Sometimes children with mild cases of asthma seem to outgrow it as adolescents, only to have it reappear later in life. The important thing to remember is that most people who care for themselves and their asthma live normal lives, including professional athletes. No parent likes to be told that a child has asthma. Children don’t like to hear it either. But by accepting that your child has asthma, educating yourself about the disease, doing the detective work to discover what triggers the asthma, and helping your child adhere to a treatment plan, you’ll minimize doctor visits and medication use, and just make your child feel better. I hope that helps. I wish your son a cough-free winter. (First published in the Upper Valley Parent’s Paper in November 2001)
Nocturnal EnuresisThe medical term for bedwetting is “nocturnal enuresis.” It’s a very common condition. It occurs in 60 percent of three-year-old children, 40 percent of four-year-olds, 20 percent of five-year-olds, 10 percent of six-year-olds, and all the way through to 1 or 2 percent of 16-year-olds.
CauseWe do not know exactly what causes enuresis. We do know, however, that enuresis tends to run in families. If a seven-year-old child is wetting at night, most likely one of his parents or an aunt or uncle did, too. At some point he or she grew out of it, and so will your daughter. One thing for sure is that it’s not your child’s fault. Kids want to be dry at night, too, but their body is not physiologically ready.
Medical TheoriesThere are several theories as to why kids have enuresis, though none has yet been consistently supported by the research. One theory is that it occurs among deep sleepers. Many parents describe their youngsters with nocturnal enuresis as heavy sleepers. This seems like it would make sense, but when kids with enuresis have sleep studies done, the sleep patterns we know how to test for don’t look consistently different in the bed-wetters. Another theory concerns hormone levels. Our bodies make a hormone called ADH (antidiuretic hormone) that controls urine production. Studies have shown that some children who wet their bed produce less ADH. Many adults can probably empathize with the child who has low ADH, since alcohol blocks the secretion of ADH – which explains the extra urge to pee after an adult beverage. Other theories have to do with bladder size and maturity. Some kids with enuresis have small bladders. A lot of researchers believe that the nerves on the bladder have not matured enough to send a strong message back to the child’s brain saying, “Wake up! Your bladder is full!”
Treatment strategyThere are options for treating nocturnal enuresis. As you decide whether to treat your child, you need to balance several important points:
- The treatment should never be a negative experience for the child. This usually means they have to be old enough to be motivated to participate in the treatment plan.
- Children don’t like to wet the bed. Punishments or teasing will only make matters worse.
- For most kids it subsides with time.
- At some point bedwetting can lead to social isolation or low self-esteem. I think we’d all agree that treatment ideally starts before that point.
- Stress may contribute to enuresis. It might be anything from a new baby in the house to a divorce to adjusting to a new school. Treatment won’t likely be successful until the child has had a chance to adapt to that stress.
- Most treatments require a time commitment from the parents. The treatment often involves changes in routine, self-awakening exercises, a bed-wetting alarm, and sometimes a nightly medication.
When to see the doctor:
- If bed-wetting occurs after several months of dry nights. (A quarter of children who are initially dry at night will develop bed-wetting, but a simple urine test can rule out most medical concerns.)
- If your child has any trouble urinating during the day.
- If your child drinks excessively.
- If you’re concerned about a urinary tract infection.
- If your child also has bad constipation.
- And finally, if you and your child think it is time to look into a treatment plan.
Why use asthma medication?Asthmatics live with a level of chronic inflammation in their lungs, so that even mild triggers can induce bronchospasm. In non-asthmatic lungs like your daughter’s, the viral germs can create enough inflammation to cause a bronchospastic, or asthma-like, cough. The inhalers contain medication that stabilizes the airways and prevents bronchospasm and cough. I agree the inhalers can seem cumbersome, but the advantage is that they deliver the medicine to where you need it – directly to the lungs. That means less chance of side effects.
Why not use antibiotics?Bronchitis is usually caused by viral germs, and antibiotics won’t kill viruses. It is true that people with bronchitis can have a secondary bacterial infection. Signs of a secondary infection include worsening symptoms after a week, such as increasing phlegm, fatigue and recurrent fever. It is sometimes hard to be sure that your child’s bronchitis isn’t bacterial, and that’s where a visit to the doctor can help. If the doctor prescribes an inhaler, you can be reassured that that is the right medicine. Studies show that when doctors diagnose viral bronchitis, patients on inhalers improve much faster than with an antibiotic. (First published in the Upper Valley Parent’s Paper in March 2001)
- Off! Skintastic for Kids
- Just for Kids
- Repel Soft – Scented
- Skeedaddle Insect Protection for Kids
- Permethrin Tick Repellent
- Outdoorsman Gear Guard
- Repel Permanone
What are canker sores?Canker sores are painful, crater-like ulcers that form in the mouth, the inner lip or on the tongue. They usually last 7-14 days. The medical name for canker sores is “apthous ulcers.” The sores occur only inside the mouth, and should not be confused with cold sores, or fever blisters, which are caused by a common herpes virus and recur on the outer lips and face. At least 20% of Americans have experienced the pain of canker sores, and the most common time to get them is during the teenage years.
What causes them?No one knows what causes canker sores. When canker sores are accompanied by diarrhea, belly pain, joint pain or rashes, then there is a small chance that the sores are a sign of a more serious illness. That’s a reason to check in with the doctor right away. But the overwhelming majority of canker sores are no more than just plain annoying. There are theories that the sores are caused by vitamin deficiencies, food sensitivities, viruses, menstruation, toothpaste, life stress, or minor cuts to the skin inside the mouth (like from braces). The only thing we really know is that they occur less often in people who are well rested, exercise, and eat a balanced diet – I’ll bet you’ve heard that before! The most likely patient is an adolescent with braces who has been staying up too late.
TreatmentThere are a range of treatments that help alleviate the pain, but nothing that cures canker sores or consistently shortens their life span. Home treatments include avoiding spicy, acidic or salty foods, gargling (Peridex or PeriGard oral solutions are worth a try), or applying an oral paste like Orabase or applying mouth salves like Cankaid. We doctors are always happy to see you in the office to review the symptoms, and we can offer a variety of things to provide relief. I polled my partners and learned that we most commonly prescribe Kenelog in Orabase, a prescription-strength anti-inflammatory (steroid) cream mixed in Orabase so help it adhere to the sores. Different topical agents or prescription mouthwashes might be favored by other doctors. If the number of ulcers is limited to one or two, doctors might apply a chemical abrasive called silver nitrate directly on the sore.
PreventionThe only sound advice for prevention I can give is to eat well, sleep well, exercise regularly, and be happy. I appreciate that this is a lofty goal for even the most together parent, much less an adolescent child. Various vitamins and supplements have been tried to prevent canker sores, but nothing that works well enough and consistently enough to pass muster in a clinical study. However, that doesn’t mean that there isn’t something out there to decrease the frequency of canker sore outbreaks in your son. For example, it won’t hurt to try lysine, an amino acid, or zinc supplements, eat live-culture yogurt everyday, and use a soft-bristle toothbrush. If your son is not a good fruit and vegetable eater you should convince him to become one. But in the meantime it seems logical to try a daily multivitamin and B complex vitamin. When my medical training doesn’t lead me to good answers to prevent common problems like recurring canker sores, I’m always curious what the alternative medicine providers have to say. When I was writing this article my closest naturopathic medicine colleague was away on a long vacation. So, I consulted four different textbooks for advice on herbs and dietary supplements. Unfortunately, there wasn’t a common thread of advice. If you want more input you might choose to schedule an appointment with a dietician or naturopathic doctor. After all my advice, “Go to bed early” might be the best words of wisdom for your teenage son. Good luck! And I hope this school year is canker sore free! (First published in the Upper Valley Parent’s Paper in September 2006)
- America leads the world in obesity, with 62% of the nation’s population seriously overweight, compared to 40% a decade ago.
- 13% of children are obese, and the rate is steadily rising.
- A quarter of obese children and adolescents already show signs of diabetes and heart disease.
- American parents are working more and they and their children are eating fewer meals at home.
- Restaurant meal portions have increased as much as 40% over the past 15 years. Did you know that a “kid’s meal” at McDonald’s has as many calories as the standard adult meal (burger, soda, and fries) had in the 1950′s?
- Since 1985 12 medical studies have linked TV watching to childhood obesity.
- During 4 hours of Saturday morning cartoons there are more than 200 ads for junk food.
- Look into what your child’s nursery school or daycare serves for snacks.
- Bring alternatives to food – flowers, pens, balls – to reward or celebrate an event with your child’s class.
- Require more P.E. in school or at home.
- Develop government-funded programs to provide fresh fruits and vegetables to school kids (and we could help local farmers while we’re at it).
- Question whether a school milk program makes sense. Could we make it skim milk?
- Eliminate the sale of junk food in schools. Texas and California have already started; other states should make it a priority.
- Put time limits on sedentary pursuits such as television, video games, and computer use.
- Begin a public health campaign that educates children and their parents about healthy choices in eating.
- Fund the campaign by taxing the fast food industry. Have the likes of Taco Bell and Frito Lay pay for it.
- Consider class-action lawsuits. Some of the same lawyers who went after Joe Camel and the tobacco industry are setting their sights on Twinkies and Burger King.
Not due to colds at all, but they’ll give anybody a chilly feeling come picture-taking timeQ: Your article last month gave me an education on “canker sores.” Now I know my oldest daughter suffers from “cold sores” as opposed to canker sores. She clearly gets the blisters on the outside of her mouth, for all to see. So, I want to know: what can you tell me about treating my daughter’s awful cold sores? A: You are right! Cold sores come out on the face whereas the canker sores are inside the mouth. Sometimes called fever blisters, cold sores are usually on the outer edge of the lip, and they are as likely to come at an inopportune time, like right before school pictures, but no one knows exactly what brings them on. People who get them say they feel a prickly or light tickling sensation on their lip within the day before the spots appear on the skin. The sores are not necessarily accompanied by a “cold,” but they are most definitely sore. And, although there is no “fever” when they recur, the sores frequently blister for a day or two before drying up and going away, usually after 7 – 12 days. Cold sores are very common, and from the standpoint of physical health, they aren’t serious. But they are annoying to the children and adults who get them.
CauseUnlike canker sores, we do know what causes cold sores: they are caused by herpes simplex viruses. Herpes simplex is one of the most common viral infections in the world. Estimates suggest that 50 – 80% of Americans have been infected. People catch herpes by kissing a person with a cold sore, or by sharing a drinking glass or utensils. Believe it or not, most children who have herpes picked up the virus from a parent, grandparent, or another loved one who unintentionally transmitted the virus while giving the child a kiss. Some infected people get cold sore outbreaks once a month while others get outbreaks once every 5 years, or never at all. Once herpes invades the body, the viruses stay dormant in a nerve ending until something – illness, stress, sunburn, menses, or an unknown factor (maybe bad luck) – causes the virus to awaken and replicate. We really don’t know why the viruses take permanent shelter in the nerve cells in some people or why they frequently replicate and become an aggravating cold sore in others.
PreventionPrimary prevention is obvious – avoid kissing or sharing drinks, washcloths, or eating utensils with someone who has or gets cold sores. Obvious yes, but not always easy or practical. When patients ask me about prevention it is usually because they already have the herpes simplex virus, but want to “prevent” getting multiple recurrences. Over the years I’ve heard many patients report benefit from topical treatments or daily oral supplements that help. The two that come up most are Lysine supplements and a Vitamin B-complex. I can’t promise they will help, but it won’t hurt to try.
TreatmentTreatment is tailored to each individual. Some patients aren’t bothered that much, do nothing, and wait for the cold sores to go away. Others find that ice, or an over-the-counter ointment such as Campho-Phenique, Herpecin-L, Blistex, or Abreva cream, offer adequate relief. For those adolescents like your daughter who experience more severe symptoms, I recommend a visit to the doctor’s office. Although there is no cure for cold sores, antiviral medications like Zovirax, Famvir and Valtex, when taken early, can substantially shorten the course and severity of the cold sore outbreak. I hope that helps and that she’s happy with her high school picture. (First published in the Upper Valley Parent’s Paper in October 2006)
CryingAll babies cry. In fact, years ago a pediatrician studied babies to see what amount of crying was normal. He came up with 1.75 hours a day of crying for a two-week-old and 2.75 hours a day for a six-week-old baby. Why do they cry? Crying is the baby’s one means of communication. It’s how she tells us she’s hungry, wet or lonely. We need to accept that babies cry and try to meet their needs and comfort them when we can. Colicky babies, on the other hand, do more than cry. They aren’t just fussy, they’re frantic. I think most parents of a colicky baby would rate the crying as more of a screaming marathon than a crying spell.
ColicIt’s hard to define colic, but it’s easy to recognize when parents describe it. A few months ago, I met the parents of a six-week-old boy who had been crying almost every day at suppertime. Despite reporting a normal, happy baby during the day, they described him pulling his legs up and twisting while he screamed for a couple of hours each evening. Then one day, almost miraculously, the crying stopped. The mother said her son was 12 weeks and four days old. That baby boy had textbook colic. What Causes Colic? When colicky babies tense their tummies and cry like they hurt, grandmothers and parents alike usually suspect they are gassy. I think “gas” is a good guess. I often wonder if these unhappy babies aren’t having trouble adjusting to being nourished through their mouths and guts instead of through their umbilical cord. But to be truthful, no one knows what causes colic. What are the remedies? If there were an answer for colic, you’d already know about it. Still, there are several things you can try. My first recommendation is for parents to take care of themselves, and this especially goes for mom. Listening to a screaming baby is exhausting. And I suspect there is something about being a mother that makes caring for a colicky baby especially daunting: you’re the one who carried the child, with an innate instinct to nurture and protect. Parents need a break. So call in the troops – grandparents, other relatives or friends to spot you during the crying hours. Get out of the house or at least out of ear shot. Go for a walk, go out to dinner, take a nap, do whatever will make it a restful and enjoyable time. Keep in mind that the crying will stop again, and your baby will be fine. You may need to reassure yourself periodically that your baby is not hurt or sick. Check that the diaper isn’t wet or chaffing, look at the skin for a rash or a hair wrapped tightly around a finger, make sure he doesn’t have a fever. If you haven’t done so already, talk with a doctor. Your doctor can help you be certain there isn’t some other medical reason for the crying. With breast-fed babies, most moms can’t help but analyze what they have been eating and guess at what might contribute to the fussiness. The usual suspects are caffeine, chocolate, broccoli, cabbage and other cruciferous vegetables. Occasionally, mothers report a change in diet that clearly helps. In my experience, though, it is difficult for mothers to figure out which foods bother the baby. Often, before the mother really knows what might irritate her baby, the baby has matured and seems able to handle everything mom is eating. In the case of bottle-fed infants, parents desperate to find a solution usually try several different formula brands, but studies indicate that changing the formula doesn’t help the colic. Frequently, I recommend massage. This is mostly for the baby, but it also helps the mother. One of my colleagues recommends starting baby massage when the baby is two or three weeks old, whether he seems fussy or not. She believes the massage may prevent colic. Although it is hard to study the effects of massage on colic, it certainly can’t hurt. If nothing else, it is something to do that might relieve the baby’s discomfort. As stressful as it seems to parents of a newborn when their baby cries, we can take comfort in knowing that crying is something babies do – we’re not bad parents just because they cry. If your baby has colic, my heart goes out to you; it’s challenging enough simply starting parenthood. The good news is that colicky babies, like all babies, continue to grow. Their inconsolable crying stops, they mature into normal infants and toddlers, and most parents eventually forget the crying as new issues arise to remind us that raising children is never free of challenges. (First published in the Upper Valley Parent’s Paper in December 2001)
- Leave the diaper off whenever possible. Put the baby on an old towel. That may not seem like practical advice, especially if your baby is mobile and it’s cold outside (like November in the Upper Valley), but believe it or not, societies that don’t use diapers don’t have diaper rash.
- Use a hairdryer. Turn it on while you change the diaper, and it will ensure that the baby’s skin is totally dry, at least until she pees again. It also serves as a distraction to babies who don’t like cool air on their bottoms, or simply don’t like getting their diaper changed.
- Try poking holes in the waterproof outer cover of disposable diapers so they breathe better. This will remind you to change them more too.
- Don’t cover a cloth diaper with a plastic diaper wrap, because the wrap will hold in moisture.
- Prevention starts with breastfeeding. Studies show breastfed babies get fewer ear infections.
- If your baby is bottle fed, don’t allow him to fall asleep with a bottle, and wean the baby from the bottle at 12 months.
- Avoid exposing children to cigarette smoke.
- Teach your kids to blow their noses gently.
- And most important, wash their hands frequently.