The American Academy of Pediatrics just released new guidelines for diagnosing and treating children with attention deficit hyperactivity disorder (ADHD). The new guidelines recommend that pediatricians assess patients between the ages of 4 - 18 for signs of ADHD.
The previous recommendations, published in 2000, recommended diagnosing children between the ages of 6 -12 years and did not address younger or older children. According to the CDC, somewhere between 6 - 9% of children/adolescents have ADHD, with a higher rate seen in the adolescent population.
ADHD symptoms including, difficulty with focusing, paying attention, in- attentiveness, behavioral problems or hyperactivity, may begin in early childhood and may persist into adolescence and even adulthood. It is important to address behavioral issues in younger children as they are entering school and to look for learning disabilities as well as school becomes more academic.
By definition, the symptoms of ADHD must exist at both school, at home, as well as in peer relationships. In other words, it manifests itself across all areas of a child's life.
As your child enters pres-school and elementary school, your pediatrician should routinely be asking about your child's behavior and school progress. While some symptoms of ADHD may appear in pre-school, these behaviors may change as a child matures.
The diagnosis of ADHD is often made over time and is a process. ADHD cannot be diagnosed by a "blood test", but rather is diagnosed by interviews, parent/teacher questionnaires and observation of a child. In my experience it is not uncommon for some preschoolers (especially boys) to have some inattention and even hyperactivity that they may "outgrow" as they get older. Boys may be identified earlier than girls because they are more active, while girls are often found to be inattentive and may not be seen to be a behavior problem in the early school years.
Early behavior modification has been shown to be important for a younger child who is suspected of having ADHD and parents and teachers should work together to use similar behavioral strategies. Reinforcement at both home and school is equally important. (This is really true for all age children).
For children who have been followed and continue to have symptoms of ADHD, medication as well as behavior modification may be the most effective strategy for controlling their symptoms. Before starting any age child on medication I think it is important to have both parents and teachers involved. Your child is "under the care" of their teacher for 6 - 8 hours a day, and who better to comment on your child's behavior/attention/mood.
For the teenage population it is also important to look for other conditions that may be seen in conjunction with ADHD. These would include drug or alcohol abuse, anxiety and depression. Treating underlying issues is a priority as well in a teen with ADHD.
Treatment for ADHD should be individually tailored for each child and this requires that the parent/doctor/teacher work together to ensure the best possible treatment.
That's your daily dose for today. I'm Dr. Sue Hubbard from The Kid's Doctor.
The surge in allergies this year has been due to a very wet winter and the weather this spring has brought erratic temperatures and lots of wind. The perfect storm for the "allergic cascade" to on a...
You know there really isn't as they are both due to seborrheic dermatitis, an inflammatory condition of the skin in which the skin overproduces skin cells and sebum (the skins natural oil).
Cradle cap is the term used for the scaly dermatitis seen on the scalp in infants. It is also seen on the eyelids, eyebrows, and behind the ears. It is typically seen after about three months of age and will often resolve on its own by the time a baby is eight to 12 months old. It is usually simply a cosmetic problem for a baby as it looks like a yellowish plaque on a baby's scalp and is often not even noticed by anyone other than the parents.
Unlike seborrheic dermatitis in adults, cradle cap typically doesn't itch. It is thought that cradle cap may occur in infancy due to hormonal influences from the mother that were passed across the placenta to the baby.
These hormones cause the sebaceous glands to become over active. In some severe cases an infant's scalp becomes really scaly and inflamed and causes even more parental concern, as it appears that the infant is uncomfortable and may be trying to scratch their head by rubbing it on surfaces.
The treatment for cradle cap is to wash the baby's scalp daily with a mild shampoo and then to use a soft comb or brush to help remove the scales once they have been loosened with washing. When washing the head make sure to get the shampoo behind the ears and in the brows (keeping the soap out of baby's eyes).
This is usually sufficient treatment for most cradle cap. In situations where the greasy scales seem to be worsening it may help to put a small amount of mineral oil or olive oil on the baby's head and let it sit (I left a small amount on my children's heads overnight) and then to shampoo the following day. The oil will help the scales to loosen up and come off more easily.
For babies that have very inflamed irritated cradle cap a visit to your pediatrician may be warranted to confirm the diagnosis. In persistent cases I often recommend shampooing several times a week with a dandruff shampoo that has either selenium (Selsun) or zinc pyrithione (Head and Shoulders) making sure not to get any in the infant's eyes. I may then also use a hydrocortisone cream or foam on the scalp that will lessen the inflammation and itching. In these cases it may take several weeks to totally clear up the problem.
As children get older, especially during puberty, you may see a return of seborrhea as dandruff. Again you can use dandruff shampoos. It also seems that with the overproduction of sebum there is an overgrowth of a fungus called malessizia so using a shampoo for dandruff as well as a antifungal shampoo (Nizoral) often works.
I have teens alternate different shampoos, as sometimes it seems to work better than always using the same shampoo for months on end. Teens don't like white flakes falling from their scalp and unlike a baby, a teen is worried about the cosmetic issues of seborrhea!
That's your daily dose, we'll chat again tomorrow.
Send your question to Dr. Sue!
Here is another one of the can't believe what I hear at the office! I was on call the other night and it was around bedtime when I walked in the exam room to see 2 little girls (actually they are part of a triplet set but their brother was home). Their dad had brought them in because they had rashes and bug bites. Nothing too serious. They are adorable 2 years old and very well behaved.
So, after examining the rashes and bites and determining that they could be dealt with a bit of cortisone cream, the dad and I were discussing a few more things. Of course the girls got bored, and as you know a bored 2 year old typically doesn't sit still, especially when it is time for bed. So as the girls jumped up and down off the table and picked out more stickers their Dad was getting tired as well. By the way, he is a great father and he and has wife have handled having triplets with such ease. They were meant to have multiples.
Well, before we could finish up the appointment the girls had gotten into the diaper bag, pulled out snacks and were enjoying themselves. As much as he was ready to go, they were not ready to pack up and leave and he was having a hard time getting them to listen.
Here comes the line of the night! He turns to the girls in a moment of what to do next and says,if you don't behave and listen to me, Dr. Sue is going to make you sick! LOL! I have heard a lot of Dr. Sue will give you a shot if you don't behave, but I have never heard this one. While I don't believe in threatening kids with shots at the doctors, this was a new one.
After I stopped laughing I told the girls that this was not true, doctors would and could not make them sick, but they did need to listen to their dad!!
I know that we all say things out of desperation, but please don't use the lines the doctor will give you a shot to try and change a child's behavior. We docs seem to give enough shots when needed and not for bad behavior. This also includes the doctor will make you sick! there's always a new one.
The surge in allergies this year has been due to a very wet winter and the weather this spring has brought erratic temperatures and lots of wind. The perfect storm for the "allergic cascade" to inflict itself on everyone's nasal mucosa.
The best preventative for nasal allergy symptoms (allergic rhinitis) has been the use of intranasal steroids. These steroid sprays have been used for the past 15 years and clinical studies have shown that intranasal steroids are superior to oral antihistamines.
Intranasal steroids function by inhibiting the production of chemical mediators such as histamine and prostaglandin that cause inflammation and mucous production. In other words they are more of a preventative medication, while an antihistamine is treating the histamine that was released once you inhaled the offending tree or grass pollen. Intranasal steroids may also help eye allergy symptoms too.
The problem is getting young kids to let you use a nose spray on them. The same holds true for the older tween and teen crowd who complain that they "just don't have the time to use it everyday" (it must take all of 15 seconds to use on yourself!) They have been shown to be effective within 3-12 hours, although will reach their maximum effectiveness after several days to weeks of use, so using it daily and throughout the allergy season is going to give you the maximum therapeutic effect.
There are many different brands available and everyone seems to have their favorite. If one spray seems to bother your child due to scent, or intensity of the spray ask your doctor to try another brand. Many times they will have a sample and give you several to try and then prescribe the one that is easiest to get your child to use. It may be trial and error, but finding the right nasal steroid may just change your allergy season.
That's your daily dose, we'll chat again tomorrow. Oh, God Bless You!
Send your question to Dr. Sue!