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Southern Ocean County Hospital would like to thank everyone who e-mailed questions for this edition of Ask-The-Expert and would like to especially thank Dr. Bleiman for taking part in the program.

February: Caring for your Child, What Defines a Pediatric Emergency, How to Keep Your Child Healthy and more

Question 1
What's the latest on the chicken pox vaccination? I've heard that it might not be as effective as experts thought. Do you recommend that kids be vaccinated for chicken pox?

I am not aware of any recent research that discusses the Varicella - chicken pox being less effective than once thought. I do know that Varicella is the leading infectious cause of death in children that is preventable through vaccination. The Japanese have used the Varicella vaccine for 25 years and they have not needed a booster vaccine. I absolutely recommend the Varicella vaccine for my kids. Remember, fewer children are getting the chicken pox because of the vaccine. Because of this, children that are un-immunized are exposed less often to the Varicella virus. Therefore, they are at increased risk of getting the chicken pox as an older child or as an adolescent. This can be extremely dangerous and can leave scars. Additional information can be found at www.immunize.org and at www.vaccine.chop.edu.

Question 2
My 22-month old is an eating machine. Should I be worried that he may be eating too much and will become overweight? The foods he eats are fairly healthy - I never allow him to eat fast food or soda.

I am happy to read that this is a concern of yours. 33% of our kids are overweight and the percentage is increasing dramatically. I would recommend a healthy lifestyle that not only includes your children but the entire family. A healthy lifestyle includes a healthy diet which may include fast food, sodas and such at times, but in moderation. But, it also includes exercise – activity. Your child is probably experiencing a growth spurt and it is probably normal. The best measure is to make sure that your child’s weight and height are proportional. For example, if your child is the 75th percentile for both height and weight then this is normal. If your child is 25th percentile for height and 75th percentile for weight then this may not be normal. During a child’s routine well visit – height and weight should be plotted and discussed with you.

Question 3
My 12-year old refuses to wear a helmet while biking. She pretends to take off with it, but I have found it hidden in the garage while she is out. How can I drive the message home that is important for her to wear it?

This is a difficult question to answer – I am not sure that there is a definitive answer. But, this is what I would tell my child. I would stress the need to wear the helmet and the dangers of not wearing the helmet. I would make sure the helmet is the color and style that the child prefers. I would make sure that the child only rides with children that are helmeted. Then, if the child refuses to follow your rules – the bike needs to be taken away for a few days to stress the need for wearing a helmet.

Question 4
I'm expecting my first baby in June and am weighing whether I want to breastfeed. I know that the baby gets some immunity from mother's milk, but what other benefits are there to breastfeeding? Can breastfeeding reduce the risk of ear infections, or is that a myth?

There are a lot of benefits to breast feeding, including medical and social benefits. It is true that immunoglobulins pass from the mother to the child through breast milk. Immunoglobulins help protect infants from infections and even ear infections. However, there are infants that are breastfed that get ear infections and there are infants that are formula fed that do not get ear infections. Breast feeding is encouraged, but all parents should know that it is not absolutely necessary. Parents should do what is right for their family and newborn. Children need love not necessarily breast milk.

Question 5
How can I tell if my son has ADHD? He is in fifth grade, is super-active throughout the day, constantly singing or making silly noises, gets good grades, but never can seem to remember the little requests I make like "brush your teeth," and "make your bed." Typical kid or frustrated mom?

This is a problem that many parents are dealing with on a regular basis. Does my child have selective hearing or the inability to organize and follow directions? If you are only having problems at home, your child is doing well in school and teachers are not complaining about bad behavior, I think you should be reassured. Children with Attention Deficit Hyperactivity Disorder (ADHD) typically have trouble with structured and prolonged tasks that a typical 5th grader would experience daily. A conference with his teachers would probably be helpful to reassure you.

Question 6
My newborn (3 months old) has dry patches of skin on her legs and hands. I keep her well-bundled when we go out during the day. What could be causing her skin to dry out? Is there an over-the-counter lotion I can try?

Many children have mild atopic dermatitis – eczema. It is caused by many factors including soaps and fragrances and hereditary – genetics. I encourage parents to use as little soap as possible and use mild detergents without fragrances. Moisturizers used multiple times a day maybe helpful – ointments and creams work best without fragrances. You can also buy a mild steroid cream – 1% hydrocortisone (over the counter) used a few times a day on small local areas of the body. It should not be used for prolonged periods or diffusely. A physician can prescribe stronger creams if warranted.

Question 7
Can you recommend a great book for kids about sex? We have talked to our kids about the issue all throughout their childhood in little bits and pieces. I want to offer them another useful resource where they can look for
additional information -- and have it back up what I've been telling them all along. My kids are in middle school.

I need to do some research for you. I am not familiar with any books at this time. I posed this question to my partner who recommended “Sex and Babies” the publisher is Magination – the book is for pre-teens. I will do some additional research and get additional titles.

Question 8
My son wants a skateboard for his 10th birthday. I want to encourage him to be active, but skateboards and skate parks, and the injuries that come with them, scare me. Can you put my mind at ease?

I believe that skateboarding can be safe if the proper safety equipment is used. If helmets, knee pads and elbow pads are used and limits are set and understood – then skateboarding can be safe. A 10-year-old should understand these requirements. It is my opinion that a parent or guardian should accompany their children at a skateboard park. There are many other dangers and risks at many of these parks.

Question 9
When a child has the flu, at what point should I be concerned about dehydration? My daughter vomited six times in a four-hour period. My neighbor said I should have taken her to the ER. Was I wrong to keep her home with me?

The flu is the influenza virus which is often confused with many other viruses. Any viral infection can lead to serious complications though most do not. The clinical signs of dehydration are dry eyes, no tears, dry mouth and lips, no urination or significantly reduced urine output. The best way to re-hydrate an infant or child is to give the child a break – possibly one hour for the vomiting to stop. Then, offer small frequent amounts of fluids – Pedialyte, Gatorade or other electrolyte products. I often use a syringe or teaspoon at first then advance to larger volumes slowly as tolerated. Solids are not as important but should be introduced slowly. A BRAT diet is best to initiate after fluids are tolerated – bananas, rice apple sauce and toast – low fat foods.

Dr. Bleiman's answers are informational only and should not be used as a diagnosis or for treatment. Please talk to your physician about official diagnosis of your condition and treatment.