Author Archives: NYU Langone Medical Center

About NYU Langone Medical Center

At Hassenfeld Children’s Hospital at NYU Langone, we understand that caring for infants, children, and teenagers is a special privilege. That’s why we partner with our young patients and their families to offer expert medical and surgical care. Our specialists treat children with conditions ranging from minor illnesses to complex, more serious issues at locations throughout the New York metropolitan area.

Could Your Child’s Tummy Troubles Be Celiac Disease?

gluten-freeMy child came to the doctor’s office for constipation and was diagnosed with celiac disease, is this common?

This is a question we get a lot at the Pediatric Celiac Disease & Gluten-Related Disorders Program at NYU Langone Health. Constipation is one of the leading complaints that bring patients to our office, and it is often seen as a presenting symptom for celiac disease in children. Interestingly, a study looking specifically at children with celiac disease in Western NY highlighted that constipation was the second most common presenting complaint at the doctor’s office, following abdominal pain. Luckily for us, constipation usually improves as the inflammation in the small intestines begins to resolve. This is accomplished by being on a strict gluten-free diet.

While the gluten-free diet is absolutely essential for a child with celiac disease, it is highly recommended that patients and their parents work closely with a knowledgeable dietician to ensure that children meet their daily fiber recommendations. This is because fiber is very important for managing and preventing constipation. Although your child has removed a majority of whole grains from their diet, there are many other sources of dietary fiber that we can include such as those found in fruits and vegetables. There is also a variety of fiber supplements that can be used if you feel that making more changes to your child’s diet will not be successful.

Lastly, don’t forget to remind your children to drink plenty of liquids throughout the day! Liquids are very important to keep your child hydrated and to enhance the motility of their intestines. Liquids should be in the form of water and not sugary drinks such as sodas or juice. I always recommend sending your child with a water bottle to school and encouraging them to finish it prior to lunch and then refilling it again for the afternoon.

If you find that your child’s constipation is not resolving with strict adherence to the gluten-free diet please speak to your provider. They will be able to help tailor a specialized plan to manage your child’s symptoms.

NYULMC-2011_2CP_RGB_300dpiFrom the Real Experts at NYU Langone Medical Center:

Leora Hauptman, MS, RN, CPNP is a nurse practitioner in the Pediatric Celiac Disease & Gluten-Related Disorders Program, part of Hassenfeld Children’s Hospital at NYU Langone. Mrs. Hauptman has many years of experience working with children with gastrointestinal disorders and developmental disabilities.

Trick or (Sugar-Free) Treat? The Importance of Limiting Your Child’s Sugar Intake This Halloween

trick-or-treatMany families view Halloween as the biggest “cheat day” of the year, where they can binge on all the candy the kids collect from around the neighborhood. While trick-or-treating and snacking on the candy they collect is fun and exciting for your children, it’s important to remember that a massive influx of candy and sugary treats can often derail the hard work spent on limiting sugar intake the rest of the year. While a small amount of sugar may prove harmless for many kids, the difficulty in managing the sheer quantity the candy in one night is a challenge, and having a plan in place before Halloween night is key in managing expectations for both parents and kids.

-Think about whether you want to limit sugar or avoid it all together this Halloween. Consider that sugar intake increases your child’s risk for cavities, excessive weight gain, and of course belly aches.
-Want to limit sugar but stumped on what to replace it with? The pumpkin—a multipurpose tool on Halloween—is a great, healthy food choice. In addition to painting the outside, you can make use of the pumpkin flesh (or canned pumpkin puree) and seeds to cook with.
—Try sprinkling coconut oil, cinnamon, and nutmeg on pumpkin seeds, and baking in the oven on 400°F until warm and toasty (around 10 minutes).
—Use pumpkin puree to paint scary faces on apple slices and crackers. You might also try using raisins, dried fruit pieces, and peanut butter dollops to create some spooky faces and ghostly shapes.
-Finding a new and improved version of old school trick-or-treating may help with limiting the sugar rush as well. Maybe trick-or-treating this year is a backyard activity with your kids and their friends, or perhaps a costume competition with a few neighbors. Having the kids involved in the planning ramps up excitement and gives them ownership over creating this new tradition.
-Another way to go sugarless this Halloween is to focus on other sources of “treats” and rewards unrelated to food. Offer your kiddo the chance to trade candy in for movie tickets, favorite school supplies, flavored lip glosses or temporary tattoos.

NYULMC-2011_2CP_RGB_300dpiFrom the Real Experts at NYU Langone Medical Center:

Ayelet Goldhaber, MS, RD is a registered dietician in the Pediatric Gastroenterology Program at Hassenfeld Children’s Hospital at NYU Langone.

Does Your Baby Have Healthy Hips? (Part 2)

hips

Last week, we began a two-part series that aims to educate parents about hip dysplasia, a common disorder that, if not addressed in early infancy, can lead to serious problems later in life. Our first post discussed what hip dysplasia is and the importance of early detection. This week’s will focus on treatment and prevention.

As a pediatric orthopedic surgeon, I spent 10 years of my career in Mexico City, where my practice was dedicated to hip dysplasia. I operated on about 250 kids a year, very successfully, but if the dysplasia had been detected in time, they wouldn’t have needed surgery in the first place.

Hip dysplasia is an under-diagnosed condition that, if left untreated, can lead to pain, degenerative arthritis, and the need for hip replacement early in adulthood. It occurs due to abnormal growth of the hip joint, resulting in a mismatch in the way the head, or “ball,” of the thighbone fits into the socket of the pelvic bone.

Many people with hip dysplasia are born with it, but it can also develop in babies that are frequently positioned with the legs extended and thighs pressed together, which increases pressure on the hips. Early detection—within the first few months of life—gives kids the best chance for effective and simple treatment.

Treatment for Hip Dysplasia
When looking for an orthopedic specialist to treat hip dysplasia, parents should seek someone who has specific pediatric orthopedic training in addition to orthopedic surgery training. A well-trained pediatric orthopedic surgeon should be able to diagnose and easily treat early-stage hip dysplasia.

Orthotic treatment. In babies younger than four months, treatment generally consists of a simple orthotic called a Pavlik Harness, or a similar device, which is worn for up to four months. The harness consists of two shoulder straps; a belt, which goes around the chest; and two boots that are strapped to the legs. The child can move freely within this soft brace, which positions the hip so components of its joint can develop normally. Parents may feel overwhelmed at first, but once they’ve learned how to use it, they find it very simple to employ. It takes less than a minute to put on, and you can change a diaper while the baby is wearing it.

Surgical treatment. If hip dysplasia is detected after four to six months, treatment becomes more complicated and may include either minimally invasive or open surgery to put the ball of the hip back into its socket. Following surgery, some children require a body cast to hold the hip in the corrected position while the joint heals. Surgical methods are effective, but do not produce good results as consistently as orthotic treatment applied to younger babies.

Tips for Healthy Hips
Hip dysplasia that develops before birth cannot be avoided, but hip-healthy practices can encourage normal joint development and prevent hip dysplasia in babies who were not born with it.
­– Avoid swaddling with the thighs together, a position that is harmful for the hips. They should be in the abducted position (with the legs open) and allowed to move freely.
– If you use a baby carrier, make sure it permits the hips to be wide open, and avoid any that tend to push the legs together and restrict movement. Any kind of baby carrier that allows free motion of the hips is generally considered healthy.
– Visit the International Hip Dysplasia Institute (IHDI) website (hipdysplasia.org), a valuable resource for parents to learn more about hip dysplasia, proper swaddling, and specific products that IHDI deems hip-healthy.

The Bottom Line
If your child does develop hip dysplasia, treating it early with non-surgical methods is ideal. Still, if it’s not caught in time for orthotics, surgery to correct the problem as a young child is better than no treatment at all. In Mexico City, I operated on a girl whose hip dysplasia had been missed until her grandmother noticed a slight limp when she began to walk. We fixed her hip and she has done very well. I recently received a video from the family of her tenth birthday party, and she was running and playing and jumping. She’s a thriving and healthy girl with a near-normal hip that likely will never need to be replaced.

NYULMC-2011_2CP_RGB_300dpiFrom the Real Experts at NYU Langone Medical Center:

Pablo G. Castañeda, MD, is the Division Chief of Pediatric Orthopaedic Surgery at Hassenfeld Children’s Hospital at NYU Langone.

Does Your Baby Have Healthy Hips? (Part 1)

hipsThis is the first post of a two-part series that aims to educate parents about hip dysplasia, a common disorder in infants that, if not addressed early, can lead to serious problems later in life.

Many adults with hip replacements might have avoided much pain and major surgery had they simply been diagnosed with hip dysplasia as a baby. Hip dysplasia is the most common congenital anomaly, or a disorder that a child is born with. The condition usually goes unrecognized until adulthood, when people develop degenerative wear of the joint that affects their movement and quality of life. According to the International Hip Dysplasia Institute, approximately one out of six newborns will have some type of hip instability and two to 3 out of every 1,000 infants will require treatment. The good news, however, is that it can be treated easily if it is detected early in childhood.

What is hip dysplasia?
Hip dysplasia occurs when the ball-and-socket hip joint grows abnormally. This produces a mismatch between the head of the femur, or thighbone, which is normally rounded, and the acetabulum, or pelvic bone, the socket into which the head fits.

The ideal time to diagnose and treat hip dysplasia is when infants are younger than four months, when treatment—wearing an orthotic harness—is simple and effective. When detected in older babies, hip dysplasia often requires more complicated treatment, which for some may include surgery.

What causes hip dysplasia?
Several factors can contribute to the development of hip dysplasia. We know there is a genetic component because it tends to run in families and affects nine times more girls than boys. Hormones may play a role, too. It can also be a “packing,” or mechanical, issue, as hip dyplasia is associated with certain womb positions like breech presentation (when a baby is situated to be delivered buttocks or feet first). Being swaddled with the thighs together in the months after birth is a proven and preventable risk factor for developing dysplasia, and therefore is not recommended.

What happens if hip dyplasia is not detected and treated?
If hip dysplasia goes untreated and the hip dislocates, it will result in a limp and leg-length discrepancy, causing pain in early adolescence or young adulthood. Untreated dysplasia is also the most common cause of early degenerative arthritis, which can lead to hip replacement in one’s 50s or earlier. Normal hip joints do not wear with use and will seldom require a hip replacement, barring damage from conditions like hip dysplasia, traumatic injury or rheumatoid arthritis (a joint disease of the immune system).

Why is hip dyplasia usually not recognized until adulthood?
Unfortunately, hip dysplasia frequently goes undiagnosed in part because it is not painful at birth or in early childhood. And the most common and mildest form, called subtle dysplasia, where the socket is just a little too shallow, produces no symptoms at first. Kids develop normally through childhood, adolescence, and young adulthood, but as they grow older, the abnormal wear across the joint develops into early degenerative arthritis.

The next level on the severity spectrum is hip instability, and the most severe form is dislocation. One in 1,000 babies are born with a dislocated hip, where the thighbone is situated completely outside of the joint. Pediatricians are generally good at detecting dislocation, but should they miss it, parents will eventually notice a limp or difference in leg length. But by then, the child is walking and it is too late for early treatment.

How is hip dysplasia detected?
Pediatricians normally screen for this condition with a physical examination. Still, minor or subtle dysplasia is very difficult to detect with just a physical exam. That is why I strongly believe all newborns should have an ultrasound test, which is the best method of identifying hip dysplasia.

Certain countries in Europe conduct universal ultrasound screening in newborns, but current U.S. guidelines do not support it due to concerns about false diagnosis and over-treatment. Ultimately, parents should have a conversation with their doctor the risks and benefits about obtaining such a test for their newborn. Ultrasound is a low-cost and no-risk exam that could save many people from a future of arthritis pain and even hip replacement.

How can I make sure hip dysplasia gets diagnosed and treated early if my baby has it?

Look for signs. Hip dysplasia is usually symptom-free, but sometimes more severe forms cause a clicking sound in the baby’s hips as they move; asymmetry in the fat rolls of the thighs; or an uneven range of motion in the hips.

Know your family history. Tell your pediatrician if your family has a history of hip dysplasia, hip dislocation, or early hip replacement. If Grandma had a hip replacement when she was 55, which is considered young, we know that she most likely had dysplasia in her hip.

Talk to your pediatrician. Ask your pediatrician if they did a complete exam of the hips. You can also ask to have an ultrasound test performed. If asked, most pediatricians will agree to ultrasound. If the pediatrician has any doubt, they should refer your baby to a pediatric orthopedic specialist for further testing.

Stay tuned for our second post on hip dysplasia, which will discuss treatment and prevention.

NYULMC-2011_2CP_RGB_300dpiFrom the Real Experts at NYU Langone Medical Center:

Pablo G. Castañeda, MD, is the Division Chief of Pediatric Orthopaedic Surgery at Hassenfeld Children’s Hospital at NYU Langone.

A Pediatrician’s “Back to School” Checklist

AdobeStock_52157424As your child is starting a new school year, here are some important things to think about for a smooth and healthy transition for the whole family.

Check with your pediatrician to make sure your child is all caught up on required immunizations and that he or she has had a routine check-up with your pediatrician within the past year.

Notify your school of any medical conditions or special needs that your child may have. Find out if the school requires any forms to be filled out by your pediatrician if your child does require specific accommodations for a medical condition.

Get organized and informed. Ask your child’s teachers if he or she will need any special school supplies. Find out if there are any ways for you to volunteer or get involved in school events. Children often do much better in school when their parents or caregivers get to know their teachers and are involved in school activities.

Re-establish a healthy sleep schedule. Kids often have slightly altered sleep schedules during the summer months due to vacation and other factors. If your children have gotten used to a later bedtime during the summer, gradually move bedtime up by 30 minutes every few nights for 1-2 weeks in anticipation of an earlier bedtime during the school year.

Discuss how you will handle meals during the busy school year. Decide if your child will be eating breakfast and/or lunch that is provided by the school or if you will preparing those meals from home. If your child will be eating meals at school, find out what kind of healthy foods are available. Notify your school of any food allergies that your child may have. Make a list of easy to prepare, healthy snacks that you can have on hand for a quick snack after your child returns home from a busy school day. Some examples of healthy snacks that require little preparation include carrots and hummus, sliced apples and peanut butter, popcorn (lightly salted with no butter), or low-fat cheese and cut fruit.

Make plans for after school arrangements and transportation for your child. Decide if your child will need to be in an afterschool program or look into other after school child care options if required. Plan on carpool arrangements if needed.

Plan to be active! Choose 1-2 extracurricular activities that your child will enjoy participating in during the school year. Encourage your child to find something they will look forward to and feel passionate about. Avoid overscheduling too many commitments during the year.

Help your child work out back-to-school jitters with an open conversation. Talk to your child about how they are feeling about starting the new year, what to expect, and back-to-school safety. Read about how to manage potential concerns such as bullying, stress and burnout, and peer pressure. If you have questions about how to recognize or handle any of these issues, ask your pediatrician.

NYULMC-2011_2CP_RGB_300dpiFrom the Real Experts at NYU Langone Medical Center:

Madhavi Kapoor, MD, is a clinical assistant professor in the Department of Pediatrics at Hassenfeld Children’s Hospital at NYU Langone and a pediatrician at NYU Langone at Trinity.

 

The Top 5 Summer Emergencies and What to Do (Part 5 of 5)

bugsWarmer weather invites activities and adventures. But what happens when things go awry? In this special five-part series, the real experts at NYU Langone Medical Center provide valuable tips to serve as your guide. Part 5:

Bug Bites

When outdoors in the summer, avoid areas where insects are more likely to be present, such as areas with stagnant water, uncovered food, or flowers in bloom. Dress your children in long sleeves and pants, avoid brightly colored clothing, and use insect repellent to help prevent bites or stings. For those with severe allergies, always carry an Epipen, if one is prescribed, when traveling to places where you might be stung. Before leaving for any outdoor activities, check to make sure that it is not expired.

Bug bites and/or stings should always be cleaned to help prevent infection. Seek medical treatment if the site of the bite is warm, tender, growing in size, is getting more painful, or, if there is any red streaking, which is a warning of a serious infection.

Dress your child in long sleeves and pants when hiking to prevent ticks. If your child does get a tick bite, do not squeeze the tick to try to get it out. This could actually cause more saliva to be released and could cause an infection. The tick should be removed with tweezers by someone who has experience to ensure that the mouth parts that are attached to the skin are completely removed. After identifying a tick bite, watch for signs of a bullseye rash or fever, which could signal Lyme disease. Call your child’s doctor if you can’t remove the tick or the tick’s head, your child develops fever or rash within 2 weeks after the bite, if the bite looks infected, or if you have any other concerns.

When choosing an insect repellent, look for products such as DEET, picaridin, IR3535, or oil of lemon eucalyptus. With regards to tick repellents, DEET products can be used, but permethrin products–a synthetic insect repellent–are applied to clothing, and are more effective against ticks compared to DEET. Most insect repellents are safe to use on children older than 2 months of age. Oil of lemon eucalyptus should not be used on children younger than 3 years of age. Products containing more than 30% DEET are not recommended for children. Do not reapply insect repellents due to the risk of toxicity.

NYULMC-2011_2CP_RGB_300dpiFrom the Real Experts at NYU Langone Medical Center:

Madhavi Kapoor, MD, is a clinical assistant professor in the Department of Pediatrics at Hassenfeld Children’s Hospital at NYU Langone and a pediatrician at NYU Langone at Trinity.

 

The Top 5 Summer Emergencies and What to Do (Part 4 of 5)

campfireWarmer weather invites activities and adventures. But what happens when things go awry? In this special five-part series, the real experts at NYU Langone Medical Center provide valuable tips to serve as your guide. Part 4:

Burns

Summer often means campfires, fireworks, and sun. So what should you do if you get burned?

If the burn is from a flame or hot object, run it under cool water to reduce the severity of the burn, clean the area with a mild soap and water, and apply an antibacterial ointment or cream. Similarly, for sunburns, you should treat it by applying a cool compress, washing the area with a mild soap and water, and apply an antibacterial ointment or cream. If symptoms do not improve after several days, or if an infection develops, seek medical attention.

To prevent sunburn, provide shade and dress your child in protective clothing such as wide-brimmed hats and lightweight long-sleeved shirts and long pants to limit sun exposure. If adequate shade or protective clothing are unavailable, for babies under 6 months of age, apply sunscreen that protects against UVA and UVB rays with at least SPF 15 to small, exposed areas (i.e. face, hands, etc). For children over 6 months of age, apply sunscreen with at least SPF 30 to exposed skin.  Remember to reapply sunscreen every two hours and after swimming or sweating.

NYULMC-2011_2CP_RGB_300dpiFrom the Real Experts at NYU Langone Medical Center:

Madhavi Kapoor, MD, is a clinical assistant professor in the Department of Pediatrics at Hassenfeld Children’s Hospital at NYU Langone and a pediatrician at NYU Langone at Trinity.

 

The Top 5 Summer Emergencies and What to Do (Part 3 of 5)

helmetWarmer weather invites activities and adventures. But what happens when things go awry? In this special five-part series, the real experts at NYU Langone Medical Center provide valuable tips to serve as your guide. Part 3:

Trauma

As the weather gets warmer, trauma incidences rise since there is typically a lot more physical activity this time of year.

The best way to treat a concussion is to prevent a concussion. Always have your children wear the right protective gear for the chosen activity, including knee pads, elbow pads, eye protection, and a helmet—every time. It’s very important to check your helmet to make sure it fits properly and there is no structural damage to it. If a head injury is sustained, monitor for headaches as this could be a sign of concussion.

When riding a bicycle, skateboard, or scooter, children should be taught to ride only as fast as they can also feel comfortable slowing down in a controlled manner. Never ride a skateboard or scooter in or near open, moving traffic.

Practice playground safety when taking your children to a park or playground. Children should be supervised by an adult when using play equipment.  Make sure to keep your child out of reach of any moving parts that could pinch or trap any body part. Plastic, metal, and rubber play equipment can become hot quickly in the summer heat, so check that slides and swing seats are cool to prevent burns. Do not allow children to play barefoot in playgrounds.

NYULMC-2011_2CP_RGB_300dpiFrom the Real Experts at NYU Langone Medical Center:

Madhavi Kapoor, MD, is a clinical assistant professor in the Department of Pediatrics at Hassenfeld Children’s Hospital at NYU Langone and a pediatrician at NYU Langone at Trinity.

 

The Top 5 Summer Emergencies and What to Do (Part 2 of 5)

swimWarmer weather invites activities and adventures. But what happens when things go awry? In this special five-part series, the real experts at NYU Langone Medical Center provide valuable tips to serve as your guide. Part 2:

Water Related Injuries

According to the U.S. Centers for Disease Control and Prevention, about one in five people who die from drowning are children aged 14 and younger. But for every child who dies from drowning, another five receive emergency department care for nonfatal submersion injuries.

It’s important to keep children in sight at all times. It can take less than a minute to drown, especially if a child is a beginner swimmer. Children can even drown in a wading pool if there is enough water to cover the nose and mouth.

If there is a water emergency, immediately pull the individual out of the pool, and if there is no other trauma, you can roll them onto their side to help drain the water. Then call 9-1-1.

When it comes to diving, make sure your child knows to never dive into water without the permission of an adult who knows that the water is deep enough and clear of underwater objects.

NYULMC-2011_2CP_RGB_300dpiFrom the Real Experts at NYU Langone Medical Center:

Madhavi Kapoor, MD, is a clinical assistant professor in the Department of Pediatrics at Hassenfeld Children’s Hospital at NYU Langone and a pediatrician at NYU Langone at Trinity.

 

The Top 5 Summer Emergencies and What to Do (Part 1 of 5)

hot-summerWarmer weather invites activities and adventures. But what happens when things go awry? In this special five-part series, the real experts at NYU Langone Medical Center provide valuable tips to serve as your guide. Part 1:

Exposure to Extreme Temperatures

Rising temperatures and humidity can cause a range of symptoms including dehydration, heat exhaustion and heat stroke. Most are familiar with dehydration, which is a loss of body fluids through sweating and physical exertion. Signs of dehydration in infants and children can include decreased urination or wet diapers, fewer or no tears when crying, dry or parched mouth, a sunken soft spot of the head in infants or toddlers, and decreased energy.

If early signs are not heeded, dehydration can lead to heat exhaustion. This form of more severe dehydration is characterized by weakness, muscle cramps, pale skin, profuse sweating, dizziness, and nausea. If symptoms are not resolving with fluids and rest at home or become very severe (such as fainting), these children should be brought to an emergency department to get evaluated and treated.

The next progression of heat exhaustion is heat stroke, which is when the body stops being able to release its own heat. The body becomes so dehydrated it can’t sweat anymore, causing the body temperature to reach dangerous levels. This can lead to confusion, kidney damage, heart problems and, in the most extreme cases, fatality. Symptoms also include hot, flushed skin with high fever over 105 degrees Fahrenheit. Every patient with heat stroke needs to be brought to the emergency room so they can be rapidly cooled and a thorough physical examination can be performed to determine if there is any organ damage.

To protect your child from extreme heat this summer: Plan to allow your child more time to rest when playing outside. Encourage your child to drink water or a sports drink frequently while playing in the heat. Try to find a cool (ideally air-conditioned) place to take breaks from playing outside. Don’t forget to apply sunscreen when outdoors. Never leave your child in a car or other closed vehicle, even if you plan to come back soon as temperatures inside a closed vehicle can rise to dangerous levels quickly.

NYULMC-2011_2CP_RGB_300dpiFrom the Real Experts at NYU Langone Medical Center:

Madhavi Kapoor, MD, is a clinical assistant professor in the Department of Pediatrics at Hassenfeld Children’s Hospital at NYU Langone and a pediatrician at NYU Langone at Trinity.