Author : Nicole Keller, D.O.

Nicole Keller, D.O.

Hello spring! It is so nice to finally get some nice weather and be able to get outside. I hope you are all enjoying the break in the cold as well. Even so, while the weather is nicer, this brings a whole new slew of seasonal allergies to deal with. I’m going to take this opportunity to help you identify and treat environmental allergies to hopefully keep you and your family sniffle free as the flowers bloom.

Identifying allergies can be tricky – they many times look similar to a cold. Runny nose, congestion and sneezing are common signs as well as eye watering and itching and sometimes even puffy red eyes. Allergies tend to be worse when exposed to the allergen and get better when the exposure is gone. This isn’t so with a virus causing a cold. Also, with a cold, typically your symptoms worsen until peaking at 3 to 5 days into the illness before then improving over the next week. Allergies will many times stay steady with continued exposure to that allergen. In addition, many people with allergies have what we call “allergic shiners” which are dark circles under the eyes from blood vessel congestion. You might also notice your child doing the “allergic salute” where they are constantly rubbing their nose from their constant allergic drip. Some people describe allergic runny nose like a faucet dripping as well. Sneezing and eye watering are common with both allergies and colds but tend to worsen abruptly when exposed to an allergen. Allergies rarely come with fevers which may also clue you in to what is causing your symptoms.

If you think your child might have allergies, there are lots of over the counter remedies. Most are safe for kids two years old and older and some are safe for younger kids as well (ask your pediatrician if your child is younger than two years old). Most of these formulations are not marketed for those under two years old because your body needs several years of exposure to actually develop an allergy – so we really don’t commonly see seasonal allergies until at least two to three years old. Anti-histamines are one way to treat allergies. This helps one component of what is causing allergies. They come in liquid and pill forms – such as benadryl (diphenhydramine), claritin (loratadine), zyrtec (cetirizine), or allegra (fexofenadine). Benadryl can be taken three to four times per day but the other options are usually a daily regimen. This makes them easy to take and typically have little side effect if taken appropriately. Another option for allergy sufferers is a nasal spray. There are nasal saline sprays or saline sinus rinses – these are a good way to cleanse the nasal passages and help relieve congestion. You can also try eye washes to help rinse your eyes free of allergens that may be causing itching and irritation. Additionally, there is a nasal steroid spray that can help relieve nasal symptoms, congestion, and itchy eyes called flonase (fluticasone) that can also be tried. Typically this takes a little longer to kick in (a few days) but has more focused symptom relief. While all of these medications are safe to be sold over the counter, if you have questions or aren’t sure about dosing, please call your pediatrician to make sure you give your child the right medication for the right issue at the right dose.

Beyond taking medications, one of the best things you can do is avoid the allergen you or your kids are reacting to. Sometimes this is hard! Especially when we all want to get outside and enjoy the sunshine! You can follow pollen counts on the news or weather apps on your phone to help you know when you might run into more allergy issues. You can also try to stay inside on windy days when allergens are being blown about more heavily. Keeping windows closed in your house and making sure carpets are cleaned regularly and dust is kept to a minimum is helpful too (easy to say…harder to do!). Indoor allergens can be just as annoying so making sure you have dust mite covers on your bedding and your house is mold free is also important.

Allergies are no fun but they can be dealt with. I hope this information helps you navigate through the weedy season of pollens and enjoy the beauty of spring and summer!

Nicole Keller, D.O.

Today I’m going to discuss a topic for tweens and teens, especially the athletes. Being active and involved in sports is a great way to stay healthy. But sometimes, the stress to do well in sports can encourage teens, coaches and parents to turn to supplements to optimize performance. Supplements can be part of a healthy, active lifestyle…but they have to be used in the right way. In this blog I have teamed with our sports medicine physician, Dr. Deepak Patel, to give you the background info on more commonly used supplements so you can decide what is best for your child.

Deepak Patel, M.D. is a board-certified family medicine and sports medicine physician with Rush-Copley Medical Group. He has convenient office locations in Aurora and Yorkville.

Protein supplements: Protein is taken by athletes to help enhance speed and strength and to increase muscle mass. Even so, research studies have shown that protein supplementation in general has not been shown to be of any benefit in regards to athletic performance. In addition to these findings, the majority of our everyday diets provide sufficient amount of protein for normal healthy children and adults without the need for extra supplementation regardless. This would also include athletes. Restrictive diets such as vegan or vegetarian may require some slight protein supplementation but only under certain circumstances. In athletes who are vegetarian or vegan and wish to gain muscle mass, Dr. Patel encourages consuming a plant based or some other dietary protein rather than a supplement. Protein intake just after weight lifting may aid in some slight increase muscle mass, but, that is a small benefit. Considering this, Dr. Patel typically encourages athletes who are not wishing to gain mass to avoid taking extra protein supplements especially shortly after strengthening workouts. Beyond the lack of benefit from these supplements, many protein supplements available contain added chemicals and nutrients, for which the safety and long-term effects may not be known. In regards to excessive protein intake, you can cause harm as well. For example, excessive amounts of protein can affect kidney function. Taking all of this into account, both Dr. Patel and I would encourage everyone to only take protein supplements with caution and under supervision (of a doctor or other health professional) and only if absolutely needed.

Creatine supplements: This is a common supplement taken by athletes and weight-lifters. It has been shown to produce a slight benefit in rapid short duration movements such as power lifting. Therefore for endurance athletes, such as runners, swimmers or soccer players, it is of little value. It has also been thought to increase muscle size and muscle gains for with weight lifting. Studies have shown that most of the weight gain is likely related to water weight than true muscle mass gained. In younger athletes there have been a few cases reported of muscle tears and ruptures which have been linked to creatine use. Once again, the risks of this supplement may outweigh the benefits in most athletes. Because of this, Dr. Patel and I would encourage you to use creatine with caution and to have it be taken only in specific athletes with a focused benefit in mind.

Supplemental vitamins and minerals: Many parents ask about taking a multi-vitamin or a specific vitamin in supplemental quantities. As mentioned when discussing protein, the typical American diet does offer us most of the vitamins and minerals that our bodies need to function properly. Eating a healthy, well-balance diet is the best way to assure you are getting enough of these micronutrients as well. New studies are starting to come out saying that many of us are over-doing vitamins, too. For the most part, if you get too much of a certain vitamin or mineral, your body will get rid of it (usually in urine). But, you can get too much of a good thing. With this in mind, I would recommend talking to your health care professional before starting a regimen of vitamins or minerals for your child. Calcium and vitamin D are both vitamins that typically are safe and healthy to take extra of, but, not every supplemental vitamin is this way. This also goes for the more natural supplements like ginseng and glucosamine. Many of these supplements are poorly studied and not as closely regulated which also questions their safety for everyday use.

If you or your child hear about a supplement that you think may be of benefit to them, come talk to us! We’d love to help your family stay healthy and educate you on the best vitamins, minerals, and supplements that may be good for you. Remember, a healthy balanced diet with five servings of fruits and vegetables each day is one of the best ways to give your body what it needs – without any need for additional pills or powders! I hope this helped clear some things up – thanks for reading!

Nicole Keller, D.O.

Recently I’ve had a lot of families come to the office with sleep woes. Whether it is the six-month old who is still waking up every 2 to 3 hours, the nine-month old with sleep regression, or the toddler who doesn’t want to stay asleep, all of these situations can run a family ragged! I myself didn’t get a full night’s sleep until my son was 10- months old (and that was just until 3 to 4 a.m.!) and didn’t sleep until past 4 a.m. until he was 14-months old. So, I have full appreciation for how hard it is when your child isn’t sleeping. Some kids are just not good sleepers to start – but that doesn’t mean that they (or you) won’t ever get good sleep! Beyond this, there is no “one size fits all” for sleep – every family and household is different. If you ask me, getting good sleep is finding a set of healthy and safe routines that works in YOUR house for YOUR family and YOUR schedule. Below are some tips and tricks that hopefully you can make work for your unique child and family.

1. Get a good routine. This is key! By keeping a consistent routine, your child will start to associate the SAME book, the SAME sounds, the SAME lullaby, (etc) with sleep. This can take time, so, don’t get discouraged. Make sure you put them to bed at roughly the same time of day each night as well. Good bed times to shoot for are: 0-2 months: 8-9 p.m., 3-6 months: 7-8 p.m., 7-12 months: 6:30-8 p.m., older than 1 year: 7-8 p.m. This routine will serve you well when life gets hectic too. For example when you are on vacation, when your child is sick, or at hectic times of the year. Your kids will already be programmed to be ready for sleep no matter their location, illness, or busy day. My son’s sleep routine goes as follows (feel free to use this if it works for you!): 5:30 p.m. dinner, 6:30 p.m. bath and brush teeth, 7 p.m. read same 3 to 4 books, turn on his fan, say goodnight and turn off lights together, “I love you” and down in his crib (by 7:15ish) with his horsey thumbie blanket. He’s so used to this that once we are getting towards the end of the last books he is pointing to his crib. He even puts his arms out to hold his thumbie blanket after being put down – it is so sweet! *Of note, no stuffed toys, blankets or pillows should be in your child’s bed until they are 9 to 15 months old. Safe sleep first!*
2. Put your child down drowsy, but awake. This is a hard rule to follow. Let me explain why this is important. If you put your little one down asleep (after nursing, bottle, rocking, etc), they learn to need you to fall asleep. If they are put down awake (but drowsy), they then teach themselves to fall asleep on their own. Sometimes this involves a little crying (which is really hard to hear!), but, try to think of it as you teaching them to learn to fall asleep. You don’t ever have to let your child cry it out, but, I do feel that sometimes those short periods of crying are helpful in giving your child the opportunity to figure things out for themselves. In addition, try to not have feeding be the last thing you do before putting your child down. Rearrange the bedtime routine to have feeding be at the beginning followed by bath, book, then bed. This way they don’t associate needing a bottle or nursing with bedtime – it will really help you wean off bottles and nursing when the time comes!
3. Keep visits during middle of the night wakings non-existent or as short as possible. Kids are smart. They know if they cry for mommy, mommy will come. They then expect this. If they get fed, their body learns to be hungry. Considering this, try to keep the middle of the night visits short and boring. After four months old, babies can self soothe. You can allow them to fuss/whine/cry in their crib for a little to see if they’ll fall asleep on their own. If you have to go to them, try to keep them in their crib, offer a short pat on the back and be gone within a minute. If you are already feeding them when they wake up, wean that slowly – one minute at a time every 3 to 5 days. That way you know hunger isn’t the reason they are waking. Most of these middle of the night waking are behavioral – a bad habit really. It’s no one’s fault that they began, but, you can work to slowly eliminate them to help you and your little one get more restful sleep at night. Plus, the older they get, the harder it is to stop these frequent night time disturbances.

These tips are brief but I feel are the most important when trying to get sleep back on track in your household. There will always be good nights and “less good” nights too…but hopefully by getting some good habits in place you’ll be able to get more good nights on a regular basis. If you need more help, you can always look to a sleep book, sleep consultants, or of course your pediatrician. There are lots of different ways to work sleep – you just need to find what works for you! Many times it is a blending of several sleep styles and recommendations.

Here are some of the references I found helpful and I hope that help you too:

Healthy Sleep Habits, Happy Child (By Dr. Marc Weissbluth)

The Happiest Baby: Guide to Great Sleep (By Dr. Harvey Karp)

The Sleep Sense Program (online program by Dana Obleman)

I wish you all lots of zzz’s! Cheers! Thanks for reading!

Nicole Keller, D.O.

My little man turned one year old last month! An entire year has gone by with lots of adventures. When I look back on the year I feel pretty proud for getting through it. There were some tough times but I think with the help of my husband (who is amazing), my family (my side and my hubby’s side – both incredible), and my friends (thank you fellow mommies) it was overall successful.

I have changed how I think about the newborn period in some ways. Don’t get me wrong – I still think a lot of what I learned in my pediatric training was helpful – but there were some real life stuff that I learned that can only be taught by experience. The first months were hard for me. I’ve made it no secret that my transition into motherhood was a little rocky. Breastfeeding was painful and intense at first. Being up at all hours of the night for the first months also took a toll. I had some dark times in those first months that I hope have made me a better pediatrician (and mom of course!). I can better relate to the physical and emotional struggles now and I have really made it a goal of mine to always discuss these hard times with my parents at their visits. Sometimes I think we focus so much on the babies that we forget about the parents! So moms and dads, if you are feeling lousy, you are not alone! Please make sure to call on your support group (family, friends, or your doctor) to help in whatever way you need. Moms and dads need just as much help in this as the kids! It takes a village to raise a child after all.

Once the first few months flew by we dealt with sleep troubles. My happy little boy just did not want to sleep through the night! I read (what felt like) every book on sleep to try to find a way to encourage our little Leo to sleep better. No cry, graduated cry it out, full on cry it out…it was hard! I hated hearing him cry! Just before his 10 month birthday though, after a weekend away, we came back and BOOM! He slept through the night! I’m not sure how this happened – baby sleep mystifies me to be honest! Maybe it was our sleep routine/habits finally working? Maybe he just was old enough to not need me in the night anymore? I don’t think that I’ll ever know. Even so, I learned a lot and have firsthand experience now that I can share with you all. Every child, family, and household is different but at least we can discuss options for sleep and work together to keep getting “zzz’s!”

After Leo started sleeping through the night, things got really fun at our house. My husband and I were re-energized (amazing what 6 to7 hours of straight sleep will do) and ready to absorb all of Leo’s new developments. He was an early walker (at 10 months) so we have had to move quickly with our child proofing and safe new toys. He just wants to be a big kid! At this point, Leo is 13 months old and a walking machine! He points at things, knows what a horse says and dances. It is so fun! Don’t get me wrong, I am exhausted at the end of the day…but what a great way to get so tuckered out. Now I just have to figure out how people do it with multiple kids!

I give all of you parents out there a virtual high five. Keep up the good work – it is hard work, but, the best work, too. Together we’ll keep figuring out how to keep our kids healthy and safe. I’d love to hear from any of you about your kid’s accomplishments and trials. Feel free to respond to this blog or we can always chat at the next visit.

Thanks as always for reading. Happy parenting to you all!

Nicole Keller, D.O.

It’s getting to be the middle of the night. The last time I wrote a blog post in the middle of the night was when measles was going around. This time, I find my mind circling the same subject secondary to the recent remarks made by politicians. So, here I am again – writing about vaccines. I hesitate to broach the topic once more to avoid being a broken record, but, at the same time, it is so important – a matter of life and death in many ways. So here goes.

Vaccines are safe. Vaccines are effective. Vaccines save lives.

Decades ago (not so long that our parents and possibly you and me don’t have memories of that time) people across the world were plagued with illness from polio virus, measles virus, smallpox, chicken pox, pneumococcus, Haemophilus influenzae type B, diphtheria and others. Brilliant minds came together to find a way to rid us of these illnesses that had potential to cause severe illness or even death. The vaccine came about. Over the next decades, vaccines were refined, redesigned and researched to provide the best immune effect with the least side effect. Slowly, these illnesses began to disappear. In fact, when was the last time you heard of a case of smallpox? You haven’t because the vaccine eliminated this disease.

My son, Leo, after his 4 month vaccinations.

In the recent past, vaccines have been put to the test. Even before the autism-vaccine scare (but even more since), immunizations have been repeatedly and rigorously examined. Thousands of patients have been studied. The vaccine schedule has been adjusted to offer the most protection as early as the body could safely handle that load. Scientific research studies testing the vaccines themselves and schedules they were administered on were conducted. The results have been unanimous – vaccines are safe, vaccines are effective, vaccines save lives.

Don’t get me wrong, anything and everything has potential for side effect. Did you know if you eat too many carrots your skin might start to turn orange? Vaccines have potential for less than ideal side effects as well; fevers, redness, swelling and welts are the most common effects we see. Seizures are also a possibility. There are other side effects possible too. Scary, I agree. Even so, every possible side effect is much rarer (and in a huge majority of the cases less severe) than the possible effects of the disease it protects against.

What about autism then, right? There are countless stories about families having a seemingly normal child who happened to get vaccines and then later be diagnosed with this condition. These stories are true in their timing of vaccines and autism. What isn’t true is the vaccines causing the autism. Correlation (two events happening at a similar time) does not equal causation. Of all the myths about vaccines this may be the biggest one. Even myself as a pediatrician was scared at the possible diagnosis of autism as my child grew and developed. But you know what I was even more scared of? Losing him to a vaccine preventable illness for good.

Leo after his 6 month vaccinations.

Raising a child is hard. You want nothing but the best for that child. I fully understand and appreciate that. In fact, that is part of the reason I became a pediatrician. With that said, please believe me when I say vaccines are safe, they are effective and they save lives.

On second thought, don’t believe me. Science is not a belief system. Science is not opinion. Science is fact. The facts are that vaccines are safe, they are effective and they save lives. As a parent who wants nothing but the best for my child, that is something I can believe in.

If you want more information please talk to your local expert in vaccines – your pediatrician – or visit a reliable website such as the American Academy of Pediatrics (www.aap.org), the Centers for Disease Control and Prevention (www.cdc.gov), or even Autism speaks (www.autismspeaks.org).

Thanks as always for reading. Stay healthy!