Problem Solving Milestones

This category is one that most parents have some difficulty grasping.  It encompasses the cognitive domain.

By two months a child should be following things with his eyes and getting bored if activities don't change.  At 4 months a child should let you know if she is happy or sad, respond to affection and play peek a boo.  By 6 months a child should enjoy playing with others, recognize strangers and enjoy looking at himself in the mirror.  At 9 months a child should look at things as they fall and look for toys that she's seen you hide.  At 12 months a child should be able to look at a picture of a common object when you name it.

I hope that this has helped to demystify things for you.

Kevin M. Windisch MD, FAAP
Sparks Pediatric and Adolescent Medicine
975 Roberta Lane # 101B
Sparks NV 89431
775-359-7111

Social Milestones

Here are some common social milestones.  I hope that this helps you to understand where your baby is.  When in doubt ask your pediatrician to screen your child with one of the validated screening tools that are so widely available:

At 2 months your child should smile at you in response to your smile at 4 months your child should stare at his own hand and smile spontaneously.  At 6 months your child should reach out for a toy.  At 9 months  should be able to feed herself fingerfoods.  at 12 months, most babies can play pat-a-cake.  At 15 months most babies can begin to imitate work around the house and hold a cup.

I hope that this helps you to see what we are looking for with our patients.

Kevin M. Windisch MD, FAAP
Sparks Pediatric and Adolescent Medicine
975 Roberta Lane # 101 B
Sparks NV 89431
775-359-7111

Major Speech Milestones

Sorry I've been away for so long.

Many people are conerned about their child's speech.  Here are the major developmental milestones:

Babies should begin to coo at 4 months.  This is a consanant free sound "OOOEEEAAA".
They should be babbling by 4 months "BABBAABAGOO".
They typically have two words by 12 months Mama and one other.
We expect to see 3-5 words by 15 months and 15 words by 18 months.
At two years we hope to see at least 1 two word sentence such as "Mama, NO!" and a 50 word vocabulary.  Typically strangers can understand 1/2 of their speech at two.
By three they should have too many words to count and several prepositions such as over, under, in, out, on and should be understandable by strangers 2/3 of the time.

If your child isn't meeting these milestones, ask your physician for formal screening.

Kevin M. Windisch, MD, FAAP
Sparks Pediatric and Adolescent Medicine
975 Roberta Lane #101B
Sparks, NV 89431
775-359-7111

Major Gross Motor Milestones

Following on our last discussion of developmental testing lets look at each category and some of the major milestones we are interested in.

The category of gross motor includes the use of the large muscles of the trunk and extremities.

Children should be able to lift their head off the table for a second by 2 months and look around by 4 months.  Frequently children can roll front to back  by 4 months (but we some times don't see this now that we put children to sleep on their back).  They should be able to sit unsupported for 2-3 seconds or in a tripod position by 6 months.  They should begin to crawl, scoot or roll around by 6 months as well.  By 12 months your child should be able to stand and cruise around holding on to furniture and by 15 months should be able to take 1-2 steps unsupported.  By 18 months your child should be able to go up stairs with one hand held and by 24 months should be able to throw or kick a ball, climb and go up and down stairs without help.

I hope that this has helped

Kevin M. Windisch MD, FAAP
Sparks Pediatric and Adolescent Medicine
975 Roberta Lane # 101 B
Sparks, NV 89431
775-359-7111

Developmental Screening

Developmental screening should take place at the majority of well child/infant visits.  It consists of the usage of various statistically validated tools to monitor child development.  The most common tool that you will hear reference to is the Denver II Developmental Screen.  This tool is fameous because it was the first of it's kind but is not too useful since it has never been shown to be sensitive or specific.

We use a tool called the Ages and Stages Tool.  This tool breaks development up into 5 categories: Gross motor, Fine motor, problem solving, personal/social and speech.  We will discuss each domain in more detail including major milestones in future episodes.

I hope that this has shed some light on the subject of developmental screening and perhaps raised some questions for you.

Kevin M. Windisch MD, FAAP
Sparks Pediatric and Adolescent Medicine
975 Roberta ste 101 B
Sparks NV 89431
(775) 359-7111

Hearing Screening

Did you know that hearing loss can be screened for in children too young to talk?  Using a device called an Otoacustic Emissions Screener or OAE screener we can do just that.  Hearing loss can come on at any time in childhood.  If detected early, we can protect the remaining hearing and start with adaptive devices like aids if necessary.  With those simple steps we can maintain improved childhood development.

If your child has not had her hearing checked in the last year, ask that it be done at the next well visit.

Kevin M. Windisch MD, FAAP
Sparks Pediatric and Adolescent Medicine
975 Roberta Lane #101B
Sparks NV 89431
775-359-7111

12 month well visit

This is a big one and very important exam not to miss.  We start by addressing ongoing problems, as usual.  We also examine growth and development.  Major milestones at this time include making sure that the child is cruising and saying at least 1-2 words.

As always we conduct a thourough physical exam and address vaccine issues.  At 12 months the children are due for several new vaccines including Measles and Chicken Pox.

At the 12 month visit we also recommend a check for anemia and screening for lead intoxication.

Finally we discuss safety regarding toddlers, introducing whole milk, removal of dietary restrictions and when to change to a forward facing car seat.

I hope that this helps you to see why we do what we do.

Kevin M. Windisch MD, FAAP
Sparks Pediatric and Adolescent Medicine
975 Roberta Lane Suite 101B
Sparks, NV 89431
(775) 359-7111

Sprains

The upcoming summer time means picnics and pick up football/soccer games.  With those games come ankle sprains.  What should you do?  Well first, make sure you don't have a fracture.  This probably means seeing your physician, sorry. 

Once you are sure that nothing is broken, start with some ice.  Apply it 15 minutes 4 times per day. 

Next start motrin 10 mg/kg/dose 3 times per day.  For adult sized kids that means 3-4 over the counter tabs 3 times per day no matter what.  Take this dose with food or it will irritate the stomach.

Wrap the injured limb with a tight compression wrap.  How tight?  Not so tight that you can't wiggle the toes, the goal here isn't to immobilize the foot but rather to apply compression the the swelling.

Finally rest the limb and elevate it above the level of the heart as much of the day as possible.  After 4-5 days start with simple nonweight bearing range of motion exercises to prevent the foot from becoming stiff.  This can be done by spelling the alphabet with your foot both small and capital letters 3 times per day.

If you aren't doing well in 2-3 weeks you may benefit from physical therapy, see your physician.

Kevin M. Windisch MD, FAAP
Sparks Pediatric and Adolescent Medicine
(775) 359-7111
975 Roberta Lane, suite 101 B, Sparks, NV 89431.
www.facebook.com/sparkspeds.nv

Summer time, sum sum summer tiime- tan

Tanning beds greatly increase your risks of skin cancer and sun induced aging.  These effects are more notable in children than in adults because children's skin is more sensitive to the ultraviolet rays of the beds.  It is our recommendation that all teens and children avoid tanning beds at all costs.

I hope that this has been enlightening.

Kevin M. Windisch MD FAAP
Sparks Pediatric and Adolescent Medicine
975 Roberta Lane # 101B
Sparks, NV 89431
(775) 359-7111

Smoke Exposure

With all the media attention to second hand smoke these days, many people are not aware of third hand smoke.  This is tobacco smoke that comes in on your clothing, skin and in furnature.  Recent studies show that risks of lung disease, cancer and death are as high from third hand smoke exposure as from second hand smoke exposure. 

So, even if you only smoke outside your children are being exposed and placed at risk.  I stongly encourage all smokers to see their physician for help with smoking cesation.

Kevin M. Windisch MD, FAAP
Sparks Pediatric and Adolescent Medicine
(775) 359-7111
975 Roberta Lane, suite 101 B, Sparks, NV 89431
www.facebook.com/sparkspeds.nv

Well Visit Schedule

Parents often are unsure of when children should come in for well visits.
The American Academy of Pediatrics recommends:
Shortly after birth
2 weeks
2 months
4 months
6 months
9 months
12 months
15 months
18 months
24 months
30 months
36 months
48 months.

I then recommend being seen yearly after age 4.

Don't short change your child, come in for wellness checks.

Kevin M. Windisch MD, FAAP
Sparks Pediatric and Adolescent Medicine
975 Roberta Lane #101B
Sparks, NV 89431
775-359-7111

My child is orange!!!

I get this panicked call every so often.  We typically need to examine the child to make sure that the whites of their eyes are truly white and to make sure that their liver and spleen are normal.  once we have verified this we can typically diagnose hypercarotenemia.  This is from deposition of the pigment that makes carrots and yams orange into the skin.  It is harmless and typically gets better within a few days of stopping eating carrots, yams, etc.

I hope that this has been educational.

Kevin M. Windisch MD, FAAP
Sparks Pediatric and Adolescent Medicine
(775) 359-7111
975 Roberta Lane, suite 101 B, Sparks, NV 89431
www.facebook.com/sparkspeds.nv

obesity worry

So why all this worry about childhood obesity you ask?

Well... First, childhood obesity is epidemic in the year 2011.  Some estimates place the US rate of childhood obesity as high as 1 in three children.  Suych rates pose a multitude of problems for these young children.

 Unmitigated this will increase the risks of childhood type II diabetes.  People with type II diabetes onset before 16 years of age, die on average 20 years younger than nondiabetics.  In other words, those children typically die at 58 years of age instead of 78 years of age (the current US life expectancy).  Common causes of death for diabetics include kidney failure, heart attack and stroke.  Imagine being on dialysis at age 35...

Untreated childhood obesity also results in high blood pressure.  This also attacks the brain, kidneys and heart resulting in a double whammy for these organ systems.

Finally childhood obesity increases the risks of fatty deposition into the liver.  This is called NonAlcoholic SteatoHepatitis or NASH.  Nash destroys the liver in the same way that long term heavy alcohol use does.  These children can go on to require liver transplants just like old alcoholics do, not a pretty way to die, and completely preventable.

I hope that this has been enlightening.

Kevin M. Windisch MD, FAAP
Sparks Pediatric and Adolescent Medicine
(775) 359-7111
975 Roberta Lane, suite 101 B, Sparks, NV 89431
www.facebook.com/sparkspeds.nv

The "Meningitis vaccine"

Please have your children vaccinated against Niseria Meningiditis aka meningococcus.  I recently met Rayna DuBose.  She is an amazing girl who almost died from the disease.  http://www.youtube.com/watch?v=JKg05gesGi4  but realize that her disease could have been prevented.  Please listen to her message.  The vaccine has no serious risks but the disease kills one out of 5 affected individuals and the rest are left like Rayna.

Kevin M. Windisch MD, FAAP
Sparks Pediatric and Adolescent Medicine
(775) 359-7111
975 Roberta Lane, suite 101 B, Sparks, NV 89431.
www.facebook.com/sparkspeds.nv

Not all strep is created equal

A common source of confusion for patients is the inter-relation between the various species of streptococcus.  The genus streptococcus delineates a type of round bacteria in chains that stains as black on a special bacterial gram stain.  The various species of streptococcus vary dramatically in their degree of danger, in the places in the body in which they reside and in their antibiotic sensitivity.  For example, Streptococcus pneumoniae is related to Streptococcus pyogenes the same way that Canis lupus familiaris (the domestic dog) is related to Canis mesomelas (the black footed jackal http://en.wikipedia.org/wiki/Black-backed_Jackal)

Streptococcus (aka strep) pyogenes typicall lives in the throat and causes strep throat.  It can infect the skin and cause impetigo or cellulits or rarely and abscess.  It is almost always sensitive to beta lactam antibiotics including penicillin.

Strep pneumoniae (aka pneumococcus) frequently causes middle ear and sinus infections as well as pneumonias and infections between the lining of the lung and chest wall.  It is a common cause of meningitis as well.  Pneumococcus is frequently resistent to usual doses of amoxicillin requiring high doses of the drug or vancomycin to treat the meningitis.

Group B streptococcus lives harmlessly in the genitourinary tract of women of child bearing age.  If transmitted to a newborn it causes blood and brain infections.  Some people think that this was responsible for the death of Elvis' twin, Jesse Garon Prelsey. 

Group D strep aka strep viridans lives in the mouth.  It is responsible for many dental cavities but is generally harmless unless you have a bad heart valve or hardware inserted into the body surgically.  In those cases it can colonize the heart or hardware resulting in serious illness.

I hope that this has been enlightening.

Kevin M. Windisch MD, FAAP
Sparks Pediatric and Adolescent Medicine
974 Roberta Lane #101 B
Sparks NV 89431
775-359-7111

Strep Throat Rx

A little known fact is that medication for strep does very little to eliminate the pain of strep.  Treated patients get better only one day earlier than untreated patients.

So, why do we treat???

We treat in order to prevent rheumatic heart damage.  That complication only comes on 10-14 days after initial infection so we have time to wait for culture results to come back.

I hope that this has been educational.

Kevin M. Windisch MD, FAAP
Sparks Pediatric and Adolescent Medicine
(775) 359-7111
975 Roberta Lane, suite 101 B, Sparks, NV 89431.
www.facebook.com/sparkspeds.nv

Impetigo

Impetigo is a common superficial skin infection.  The schools would have you think that this stuff is the plague but the good news is, in reality, the disease is usually quite limited.  It results in a yellow-honey colored encrusted sore.  This sore is typically on the face near the nose but can be anywhere on the body.  These sores are contagious and can spread.  They are caused by staph or strep (the same strep that lives in your throat).  Usually the sores don't hurt.

We can treat them with prescription creams if the sores are small.  If they cover a huge portion of skin, like in my wrestler patients, we use oral medication for a couple of weeks.

Usually with proper treatment the sores heal without any complications.

I hope that this helps.

Kevin M. Windisch MD, FAAP
Sparks Pediatric and Adolescent Medicine
(775) 359-7111
975 Roberta Lane, suite 101 B, Sparks, NV 89431
www.facebook.com/sparkspeds.nv

Ear Infections

After a brief delay dealing with hacker issues on our facebook page we are now back to our regularly scheduled programing.

The ear can be divided into three compartments, the inner, the middle and the outer ear.  Infections can occur in all three parts.

Inner ear infections are quite rare.  These are usually viral in nature and associated with decreased hearing and dizziness.  They only rarely respond to antibiotics.

Middle ear infections are behind the ear drum.  They are occasionally viral in nature but may be bacterial in nature as well.  These are what most people are refering to when they say that they have "an ear infection".  The pus may drain out of the ear through a small hole in the drum created by rupture or a surgical insertion of a needle by a doctor.  The outer ear infections are commonly refered to as swimmer's ear and treated with antibiotic and steroid drops often with the insertion of a wick.

I hope that this serves to clear up some confusion for everyone.

Kevin M. Windisch MD, FAAP
Sparks Pediatric and Adolescent Medicine
(775) 359-7111
975 Roberta Lane, suite 101 B, Sparks, NV 89431.
www.facebook.com/sparkspeds.nv

Talk about Tonsils

When should she have her tonsils out doctor?  I hear this regularly in my office.

Let's start with a description of tonsils.  Tonsils are lymph nodal tissue in the back of the throat.  They contain immune cells are are responsible for immune surveillance in the mouth and throat.  Tonsils in young children may be a big as a large marble but typically shrink down and are not noticeable after 6-10 years of age.

We worry about tonsils when they cause airway obstruction, especially with sleep.  This is evidenced by loud snoring or breath holding during sleep.  We also worry when the child has had 5-6 tonsil infections in one year.  These might be reasons to have tonsils removed.

If you are concerned about your child's tonsils, see your pediatrician.

Kevin M. Windisch MD, FAAP
Sparks Pediatric and Adolescent Medicine
(775) 359-7111
975 Roberta Lane, suite 101 B, Sparks, NV 89431.
www.facebook.com/sparkspeds.nv