Dr. Norris Sheldon Payne, M.D.

There are several different types of birthmarks. One of the most common in young children under 5 years is called a "strawberry" hemangioma. It starts out small as a newborn usually and then grows and enlarges to become a red raised unpleasant appearing lesion over the next 2-3 years and then it completely goes away usually by ages 4-6 years. To see if this is what your child has, go to Google images and type in "strawberry hemangioma" and you'll see if this is what your child has. If it's in a place that causes irritation, such as on the eyelid, in the genital area, etc., then a dermatologist may be able to remove it. If not uncomfortable, it will completely do away in a few years with no trace it was ever there.

Dear Mom,

You and I are of the generation when many parents did not feel comfortable talking to their teens about becoming an adult and all that entails. I’m a pediatrician of many years and have taken care of thousands of pre-teens and teens, both boys and girls. I always advice moms to find a private comfortable time with just the two of you, maybe at bedtime or a walk in
the park, etc., can talk.

You can say something like, “I just wanted to talk to you briefly about starting your periods. My mom never really talked to me about them so I didn’t know what to expect and it was a little scary for me and I don’t want you to feel like I did. Pretty soon, Your body will soon begin to change due to increased hormones which is totally and completely normal and natural. It’s the way we are made. So, when the time is right for you, you will notice a little bleeding from your vagina once a month or less and the bleeding will be slight the first day or two. When that happens, just tell me and we’ll make sure you have pads to line your underwear to absorb the blood. We don’t want to use tampons because they can cause serious infections sometimes. At first, you may just have a little staining for 2-3 days and that may only happen every few months. Sooner or later, you will have normal periods once a month which will cause increased vaginal bleeding for a few days and you will be very smart and prepared to manage your periods with ease and maturity. Most girls will not have a period every month to begin with and you might only have a period every few months at first and then in a year or so you will begin to have regular monthly periods for about 5-6 days. Girls usually start their periods about the age their mother’s did. Mine began at (fill in the blank) years. You will have some discomfort in your lower abdomen with your periods which you can treat with some over-the-counter pain meds. When you do first notice some mild vaginal bleeding, please tell me so I can help you make sure that you do not experience any unnecessary embarrassment, confusion or pain. I just wanted to tell you about all this because I love you so much. Do you have any questions?"

There is an immunization for TB called BCG. It has been used extensively in Mexico and other countries for decades, but it is not a good vaccine and it is not uncommon for exposed patients (including children) to develop TB in spite of the BCG vaccine. The BCG is not recommended or given in the USA because infectious disease experts and the CDC do not believe it is useful in preventing TB.

It is common for premature babies to develop respiratory distress syndrome (RDS). The more premature the baby, the higher the chances of getting RDS. Your doctor may elect to give you steroids IV if you are in the hospital and your delivery is believed to happen in the next few days. Steroids given to a mom who is about to deliver a premature baby helps to mature the lungs of the premature baby. After birth, if your baby is showing signs of RDS, the neonatologist may elect to give your baby a liquid called Surfactin directly into the lung via an endotrachial tube to lessen the chances of RDS developing into a more serious problem.

No, vaccines are NOT potentially harmful to your child. On the contrary, every vaccine recommended by the CDC and American Academy of Pediatrics prevent diseases that can can disability or even death to your child. There is NO chance of autism from any vaccine. Thank you for your question. It is a very important one.

If your daughter continues to have symptoms of ear infections that frequently, then first a physician needs to see them and document that it's her ears that are truly infected and not her throat. Strep throat has been very common this past year and often presents with earache symptoms in young children instead of complaints of sore throat. I know, nobody believes me until I diagnose the strep throat with a rapid strep test and show the parents that the ears are fine. Forty years of practicing pediatrics has taught me a thing or two that I didn't know as a younger physician. A strep throat infection causes the ears to hurt because inside the head, the throat is so very close to the inner ear that the throat infection does cause earache even though ears are not actually infected. There is ear inflammation due to being so close to the throat but not infection. Also throat infections will cause deep glands just below the ears to swell a bit causing earache. Also, bad colds can clog up the inner ears and cause ear pain though not truly infected. True ear infections almost always come after a few days of a very bad cold and usually cause so much pain at night that the child cries and if the ears are infected and not treated with antibiotics, they may take a long time (3-4 weeks or more) to resolve on their own. If strep throat is the culprit, then that needs to be diagnosed and treated to prevent rheumatic fever and heart diseases. If your daughter is having mild earaches that resolve on their own, then the ears may not actually be infected. It would also be unusual for a 4 year old to have four actual ear infections in one year. If she is seen by her physician and true ear infections are documented so often as four times a year, then it might become necessary to see an ear, nose and throat specialist to put very small tubes through the ear drums to prevent or lesson the infections and prevent permanent hearing loss which will put her at risk for school problems due to loss of hearing from repeated untreated ear infections.

I don't know of any natural products or home remedies that have consistently been shown to improve a child's immune system but there are some basic time tested practices that have been shown to improve your child's immunity, as follows:

1) A healthy diet filled with lots of fruits and vegetables of all sorts and colors ingested daily.

2) Avoid packaged foods or drinks with sugar, fat and preservatives particularly nitrites and artificial colors.

3) Most children are low in Vitamin D because we live our lives mostly indoors and Vit D comes from exposure to the sun. Low vitamin D decreases immunity. Consume healthy products with added vitamin D such as orange juice or milk and when weather permits get 20 minutes a day of sun without sunscreen (only for those 20 minutes) and expose the face, legs, and arms to the sun between 10AM and 2PM. Your doctor can do a blood test to check for Vit D levels.

4) Eat lots of fish such as salmon but avoid shellfish.

5) Take a chewable multivitamin of choice every day year round.

6) Exercise on a regular basis at least one hour a day five days a week.

7) Get enough sleep! (VERY important for good immunity.

8) Get all vaccines recommended.

9) Eliminate stress at home and at school as much as possible. Happy children have much less illness than unhappy ones.

10) Do not expose to cigarette smoke.

11) Drink plenty of liquids every day.

13 years of age is a common time for girls to put on extra weight. It is important to realize that teens will not lose weight until THEY REALLY WANT TO. I haven't found anything to help lose weight in teens until they are serious about losing weight. So until she is ready to lose weight, you can help her understand what it takes to lose weight as follows:

1) See a physician for her 13 year well check so her doctor can rule out any medical problems that may be making it difficult for her to lose weight, such as hypothyroidism. At the well check, her doctor can also graph her weight, height and BMI to see about where her weight should be for a girl her age so that she knows what her goal would be.

2) When she is ready, make an appointment with a dietitian to discuss healthy eating habits and outline a concrete plan to help her be knowledgeable about what a healthy diet really
consists of.

3) Excess weight in teens is commonly associated with depression or anxiety though it may not be obvious. Talk with your child and see if a visit with an adolescent psychologist might be helpful. The mind/body connection is powerful and talking to a nonjudgemental professional alone in a safe space usually helps set the stage for weight loss.

4) Make sure she gets enough sleep. Lack of sleep is associated with being overweight.

5) You and her father must set a great example. Over time, kids will end up eating like their parents. When shopping, do not bring temptations into the house such as sodas, ice cream, cookies and pastries, chips and fried foods in general. Try to have family dinners together in the evening as much as possible and prepare dishes that are healthy and not high in fats or sugar.

6) Encourage her to exercise in some sort of activity at least one hour a day for 5 days a week.

7) Do not focus and complain about her weight. She needs love and acceptance for who she is. Complaining about her weight only decreases self esteem. Think of ways to increase her self esteem.

8) Getting down to ideal weight takes time, 1-2 years. Do not put her on any kind of diet, just encourage a healthy lifestyle by example.

9) Be patient. When she is ready, she will lose the excess weight.

Good luck!

Yes, of course. Most pediatricians can and will give vaccinations to children of all ages including adolescents. It is recommended that the vaccines be given at the child's regular Well Visits at the following ages: 2 mos, 4 mos, 6 mos, 9 mos, 12 mos, 15 mos, 18 mos, 24 mos, 30 mos, 3 yrs and every year after that. Well checks monitor growth and development and make sure the physical exam is normal and answer all your questions as well as giving vaccines.

A child with persistent fever (fever being 100.5 or above) should be followed frequently by a physician until a diagnosis is made or until the fever resolves. Some physicians will do many tests at the first visit with fever and other physicians will do tests in a stepwise fashion.

He may return after about 7 days, or when all the lesions are scabbed over.

A cold shower would not cause any damage, but it would be very uncomfortable for the child and will not bring the fever down very much. It is better to give a lukewarm bath and at the same time give acetaminophen (such as Tylenol) or Ibuprofen (such as Motrin). The medicines will help more than anything. Also dress the child lightly and do not cover with many blankets as it will be more difficult to lower the fever.

There are many medical diseases that may cause hair loss, but the primary reason is alopecia areata, which is loss of hair by an autoimmune process in which the body mistakes hair follicles as foreign invaders. It will usually come back in a year or so, but I would recommend seeing a pediatric dermatologist to make sure you have the correct diagnosis and then seek treatment options.

Being underweight may be normal due to the teen's genetic makeup or it could be a sign of disease. She needs to be seen by a physician for a history and physical and some lab tests which will likely tell you whether your daughter's weight is normal for her or not.

If you've tried everything, then your daughter needs to see a pediatric pulmonologist for testing to see if she actually has asthma or if there is a disease mimicking asthma. If she really has asthma, then there are excellent safe meds which can be given to control her asthma. If asthma, she can certainly be controlled by the right meds so that she can have a normal life which is important.

Your son needs to see a physician trained in asthma treatment which could be his pediatrician, a pulmonary doctor or allergist for children. He will need a bronchodilator (such as Albuterol) to use when his asthma is causing coughing or wheezing and also one or two "maintenance" meds given daily year round to prevent coughing and wheezing and to allow the inflammation of his lungs to heal.

Children who have been vaccinated usually do not get chickenpox and if they do, it is usually a very mild case with only a few lesions. Your baby is not likely to get chickenpox and if so it would be a mild case. There is a prescription medicine called Acyclovir that can be given for a week to prevent the baby from breaking out, but it is not recommended since the chances are low your baby will get sick.

Potty training varies by culture. Some cultures will have their children potty trained by 1-2 years but it takes a lot of work and continuous effort. Americans traditionally allow their children to potty train at their own pace and some boys are especially difficult. Most boys and girls will train on their own with parental encouragement by age 3 yrs. However, some boys in particular can be very resistant to training and that is not uncommon. Some don't train until 3 1/2 years and a few not until 4 yrs. So, yes, it is not uncommon for boys to still wear diapers at 3 yrs of age. When it gets to the point of confrontation with your son over this issue, you're probably not going to get far. It's a game of wills...yours vs. his. He CAN train, but he doesn't want to, so you have to give him an incentive. I tell my patients to tell a child like yours to express your deep sadness (not anger) and say, "Oh...I am SO disappointed you are still acting like a baby. You can feign crying even. If he EVER does it right, then act EXTREMELY EXCITED and praise him to high heavens. Also, this may be one time you can bribe your son by going to any superstore and buying a bag of toy cars or something he really likes, even candy and then putting the prize items high up on a shelf where he can see them, but not get them. Continually tell him that when he poops in the potty, he will get a treat! And continuously tell him how happy and proud you will be when he acts like a BIG BOY and not a little baby because BIG BOYS get to do special things like go for ice cream or to pick out a toy at a store, but BABIES can't do things like that.
Good luck!

Yes, giving daily Zyrtec in the proper dosage is a very safe and effective way to manage allergies in most children. Be careful not to overdose and keep the medicine out of her reach to avoid overdosing.

Your baby needs an office visit for a complete history and exam with your pediatrician to see if the eye blinking is part of a larger problem or just a normal variant.