Category Archives: From the Real Experts at NYU

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.

 

Summer Safety: Helping Kids Avoid Broken Bones and Hurt Heads

brokenSchool is out, the weather is warm, and outdoor activities are in full swing. Summertime is a fun time for most children, but it’s also a season when New York-area hospitals see a spike in the number of kids who suffer fractures or concussions.

A fracture, which is a partial or complete break in a bone, can occur anywhere on the body. The most common sites are the wrist, elbow, and collarbone, as well as the ankle and femur (thighbone). A concussion is a type of brain injury that occurs from a blow to the head or body.

Any activity children participate in can lead to injuries: playing outside, swinging, climbing the monkey bars, jumping on trampolines, playing in bouncy castles. Falls and fractures are common in activities involving speed, like skateboarding, bicycling, or riding a scooter. Fireworks and climbing trees are a common cause of many summer injuries, too. At Hassenfeld Children’s Hospital at NYU Langone, we see many of these injuries every summer, in addition to injuries that might not be as obvious to parents. Oftentimes, youth who engage in activities such as contact sports or bicycling, or those who simply have a collision or fall when playing, might sustain a concussion, and may need to be seen by a specialist at our Concussion Center.

Of course, it’s impractical for children to avoid all of these activities. Kids will be kids, and outdoor recreation is beneficial to children’s physical, mental, and emotional health. That’s why it is important to take reasonable precautions to increase their safety as they enjoy their summer:

Wear proper protective equipment.
Helmets should always be worn for activities like bike riding and skateboarding, as well as for contact sports like football. When skateboarding, kids should be wearing elbow and kneepads, too.

Pay attention to playground surfaces. Rather than concrete, asphalt, or hard packed dirt, they should be made out of softer surfaces like shredded rubber or wood chips. These can better absorb the impact of a fall and are less likely to cause injuries.

Build strength and endurance. Being in proper physical condition is important for preventing injuries when participating in sports. Receiving appropriate instruction from athletic trainers is always recommended.

Always supervise kids around fireworks to prevent explosion injuries, which are common in the hands.

You can take steps to lessen the chances of broken bones and concussions, but you can’t avoid the risk altogether. Serious injuries may still occur as kids participate in typical summer activities. If your child has suffered a head injury or if an injury has caused pain out of proportion to a regular knock or “boo boo”:

• Immobilize the child.
• Do not move an affected limb or joint.
• Put ice on swollen areas.
• Call your doctor’s office for advice or go to the emergency room for evaluation by a physician.

Sometimes, children require specialist evaluation and treatment because their bones are still growing. For example, if the wrist looks obviously deformed, you can assume that would require a pediatric orthopedic surgeon. If you’re in doubt about the seriousness of an injury, there is no harm in coming to the ER to make sure everything is okay. Emergency room doctors are very good at distinguishing what needs to be seen by a specialist and what doesn’t.

Here’s to a happy, healthy and safe summer!

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

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

 

Preventing Summer Learning Loss

summer-homework

School’s out for summer, but learning shouldn’t be on vacation, too. “Summer slide” occurs when children forget skills they learned the previous school year, and it’s a concern for many parents, especially parents of children with learning difficulties. Here are some ways to engage and support children at any age to retain those skills and even give them a leg up for the next school year, while still having fun and enjoying their time off from school.

Elementary school:
• Try and find some time daily to read with your children. You can start a fun summer book club with a few of your children’s friends and rotate homes where you can meet and discuss the book of the week. You can also stop at the library before your summer road trip or longer vacations for books to take along with you. Set 20 minutes aside daily for some quiet reading or shared reading pleasure. Nothing like a great book for the beach for you and your child!
• If your younger child (pre-k to 1st grade) struggles with reading, it is even more important that you read to them every day. Have them try and pick out words they recognize (sight words) and begin to use their phonetic skills to “tap out” or sound out more challenging words.
• For this young age group, you should also review and practice the sequence of the alphabet. Sing or say the alphabet whenever you can – in the car, on a walk, while taking a bath. Fun activities include scrambling magnetic plastic letters of the alphabet and asking your child to sequence them as he or she says the letter names.
• You can also practice the alphabet with a game–it can be something as simple as jumping rope while reciting the alphabet, and coming up with a vocabulary word based on the letter you stop jumping at.
• Rhyming games can also be fun. Say four words and ask your child to tell you which word does not belong. Make up silly words to get them even more engaged!
• For slightly older children (first grade and onward) start to talk to your child about a book before you even get into the text with them. Ask them questions about the cover, read the chapter headings, and have them hypothesize what they think the story will be about. After reading a chapter, pause and have them reflect and predict what they think will happen next in the story. Review and discuss the different characters and have them start to form inferences about what will happen as you move along in the book with them.
• If engaging your child in a book is a struggle, try graphic novels instead. They have proven to be appealing to students who have not yet developed a love of reading.
• Strengthen your child’s number skills by incorporating fun math activities into your summer routine: count the seashells on the sand while you’re walking, or add up the number of birds you see flying overhead.
• You can include practice with measurement by having your child engage in cooking or baking and having them take charge in following the recipe.
• For kids who are having difficulty making their handwriting legible, summer is a great time to work on that skill, or learn to type. Look for programs or apps that can help make the process fun.

Middle and high school:
• If your child struggles in a particular subject, like math, try to find out what’s coming up in the class next year. That way you can start previewing the upcoming new concepts early.
• Writing demands increase as we enter the higher grades. Finding opportunities when older students would be interested and willing to engage in writing practice can be hard. One way to incorporate writing exercises is by coupling them with fun adventures. Visiting local museums, finding a fun landmark to research while on a trip, and even conducting an interview with a relative or someone in the neighborhood can be used as opportunities to foster journaling and writing.
• As your children transition into middle and high school, organizational skills and independence become even more important. Help your child get a head start on organizing their notebooks for different subjects and scheduling due dates for assignments.
• If your child is anxious about starting at a new school, use the summer to engage in helpful social activities. Look for ways they can meet peers early on, visit and walk around new school grounds to diminish anxiety and increase confidence.

The most important thing to keep in mind is that helping your child keep up over the summer shouldn’t be costly, either in terms of a financial burden or by straining your relationship with your child. There are so many resources in our environment to employ and ways to continue to promote and foster learning that are present as long as we’re creative in thinking about how to include them.

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

Daniela Montalto, PhD, is a clinical assistant professor in the Department of Child and Adolescent Psychiatry at NYU Langone’s Child Study Center, a part of Hassenfeld Children’s Hospital. She is the Clinical Director of the Child Study Center’s Institute for Learning and Academic Achievement.

 

When Fido Meets Baby: A Primer for Pet Parents Expecting a Newborn

babydog

The birth of a new baby is a joyous moment for parents, as well as a transition for the entire family, including pets. Many pet owners think of their pets as family, and are eager to ensure a safe, healthy connection with the new baby.  Expectant parents who are pet owners may have questions about circumstances that commonly arise where babies and pets coexist. Here are some things to consider and helpful tips for preparing your dog for a new baby:

• Don’t make assumptions about a dog’s breed being more or less suitable for a baby. Much of what ensures safety between dog and baby stems from learned behavior and reinforcement.
• It’s important for your dog to recognize and respect your role as family leader. Start early to instill and/or correct a leadership dynamic with your dog helps to set healthy boundaries and ensure comfort and safety for everyone.
• Prepare your dog for baby’s arrival by establishing physical boundaries in your home. For example, it is a good idea to keep your dog’s toys in a distinct location away from the baby’s toys. It may also be a good idea to train your dog to stay out of your baby’s nursery, or to set limits for access.
• Establish a “go to” place for your dog, and train him/her to follow your “go to place” command.
• Make a safe zone or space for your dog to be able to escape to if he/she needs to get away from new stresses and stimuli.
• Manage the introduction of your dog to your baby and take things slowly. It may be a good idea to walk the dog first, for example, giving the dog an opportunity to discharge energy before greeting baby.
Always supervise your dog and baby when they are together; never leave them alone.
• Remember to make time for your dog and try as much as possible to ease the dog into changes in his routine. Doing so can help to minimize the stress of change.
• As your baby grows, be sure to teach him or her good manners towards your dog (i.e. no yanking or pulling on its ears or tail). Dogs are often very patient with displays of affection, but learn to recognize early signs of stress in your dog to prevent an escalation to aggression.

The Center for Perinatal Education and Lactation at NYU Langone offers a monthly, two-hour-long information session called Dogs and Storks for expectant women and partners to help prepare the family pet for a new baby.  The session is taught by a licensed dog trainer, certified by Family Paws.

Receiving expert guidance on concerns such as those outlined above can make all family members, including our furry ones, to feel safe, happy and comfortable together.

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

Elizabeth Moore, BSN, RN, is the coordinator for Parent Education and Community Outreach in NYU Langone’s Parent Education Program. As a doula and childbirth educator, she has worked as a maternal-child health nurse and educator for over 20 years.