Author : Nicole Keller, D.O.

Nicole Keller, D.O.

I hope everyone is enjoying their summer and staying safe and healthy! Something I’ve been talking to parents a lot about recently is dental care. There is a lot of confusion about when to start brushing your child’s teeth, when to use a fluoride toothpaste and when to go to the dentist. As a first time mom, I still am trying to get better at making tooth brushing a regular thing for my son – it is something I’m going to work on for sure! Hopefully this post will help clear up some of the misinformation out there and brighten some smiles too!

Tooth brushing: In theory, you can start brushing your child’s teeth as soon as they erupt. Buy a baby toothbrush or a finger toothbrush and let your child chew on it and then follow with you brushing their teeth. Getting in this habit early is a great way to ensure good dental hygiene down the road. Even before tooth eruption, you can clean a baby’s gums with a damp washcloth after feeds to make sure residual sugar is wiped away. This helps prevent growth of germs that might cause infections like thrush. In my mommy experience I found that hard to stick to, but, if you can get in the habit it’s a good thing to do.

Fluoride use: In early 2014, the American Academy of Pediatrics (AAP) came out with a new article about fluoride use. It helped clear things up a bit for us as pediatricians as well. Fluoride helps protect and strengthen teeth but it can be dangerous if consumed in large quantities. Fluoride is present in city water (what most of you use) and many bottled waters as well – this is a good thing and is safe to use for your baby. In addition, it is OK for you to start using a fluoride toothpaste as soon as your baby has teeth. There is still some debate on whether this should be a universal recommendation (or just for kids at high risk of dental disease), but, if you use the correct amount, it is safe regardless. In children 3 years and younger, a grain of rice size or “smear” on the toothbrush is all that’s needed, two times per day. This is well below the safe amount for a child to ingest even if they swallow it. In kids 3-8 years old, a pea-sized amount is good to use and in kids over 8 years old (or when they can spit reliably), a full line of toothpaste on their brush is appropriate. Of note, there are no toothpastes out there that have fluoride marketed for kids less than 2 years old, so you’ll have to buy the “2 years +” toothpaste even for your younger kids. There are lots of fun flavors like berry and bubble gum!

How to brush: Tooth brushing should ideally be done 2 times per day for 2 minutes each time. If any of you can get your toddler to do this for 2 minutes I commend you! It is hard work! Adults should help kids generally under 5-6 years old but after that, kids may be reliable enough to brush their teeth well on their own. Gentle circular strokes are recommended to not damage the gums or enamel. Rinsing is NOT recommended (no matter your child’s age) for a couple reasons; first, it actually increases the amount of fluoride swallowed (which in theory could lead to unsafe levels of fluoride ingestion) and secondly, it washes all that wonderful fluoride off the teeth. Ideally we want the fluoride to stay on their teeth (without consuming food or beverage) for 30 minutes. That’s why it is best to brush your teeth at least 30 minutes prior to breakfast or after you’ve eaten breakfast and as the last thing you do before going to bed.

Dental visits: The AAP recommends that kids at high risk for cavities see a dentist at around 1 year of age. Otherwise, if your child is healthy and brushes their teeth regularly, you can wait until 2-3 years of age to make your first dental appointments. Once begun, a child should see the dentist every 6 months. Call your dentist’s office to see what they recommend for first visits as well.

Tooth tips: Make sure to wean from bottles and pacifiers as soon as you can. I recommend to most of my patients to try to have both these items gone by around 1 year old. Also, try not to give too much juice – it is liquid sugar and does nothing good for nutrition or your teeth. If you are offering juice, water it down (a lot) and only give it on special occasions. Pop should not be given either. Lastly, keep away from sugary, sticky candies that can get stuck in teeth. Crunchy healthy snacks like apples, pears, carrots and celery are much better for your teeth (and nutrition overall)!

I hope these guidelines help you decide what is right for your child’s dental care. If you have any questions, talk to your pediatrician who knows your family and your child best to give you individualized recommendations. Thanks for reading!

Nicole Keller, D.O.

Medicine is an ever changing topic. We are constantly learning new things that make us change our old recommendations. I’m sure to parents with multiple kids, it may seem frustrating to have been told one thing with your first child and then given a new piece of advice with the next. We promise we’re not trying to be wishy-washy, rather, we want to make sure we give you the best and most updated recommendations at all times! Sometimes doctors even need to update each other to make sure we are staying on top of new developments as well.

Regarding this, I read a great article in the Chicago Tribune back in early January (1/9/2015 to be exact) written by Danielle Braff detailing some of the newer pediatric recommendations out there. The article really did a good job of dispersing needed updates on important topics. So for this blog, I’d like to detail some of these recommendations for you if you haven’t already heard them at your child’s most recent doctor’s visit.

1. Children need to be in a rear-facing car seat until 2 years of age.

The old recommendation and Illinois law state that kids should be rear facing until they are one year old, but, we have found keeping kids rear facing as long as possible is the safest thing to do. Make sure that your child is within the limits for their car seat’s height and weight restrictions in addition to following this prolonged rear-facing rule.

2. There are little to no food restrictions when starting your baby on foods at 6 months of age.

There are two new recommendations here: the first is to start solid foods at six months of age instead of at four months like you might have previously heard. This decreases the risk of multiple infections and makes sure your baby is developmentally ready to swallow thicker foods as well. Secondly, you don’t have to start with just cereal anymore – fruits, veggies, even meats are OK as long as they are pureed and given one ingredient at a time. In addition, there is no need to wait to offer allergenic foods (like peanut butter, eggs, strawberries, etc) – as long as the food isn’t a choking hazard, feel free to offer it! Please make sure to offer one ingredient at a time and wait two to three days before introducing a new ingredient. That way, in case there is a reaction to a food, we know what it is from. Lastly, still no honey should be offered until one year of age.

3. As soon as your child has teeth, you can brush them twice a day with fluoride toothpaste.

We used to say that young children shouldn’t have fluoride in their toothpaste for risk of overdosing on the fluoride since they don’t know how to spit. The thing is, you would have to consume A LOT of fluoride for that to happen. Infants three years and younger  should have a grain of rice size amount of toothpaste. Children older than three can have a pea-sized amount. Speaking of dental hygiene, pregnant women can and should continue to get dental work during their pregnancy – it is safe and highly recommended to keep your oral cavity clean and free of germs that may travel to the rest of the body.

4. You can use tap water to mix formula and to offer your child to drink.

We used to say that bottled water or nursery water was the better water to use for babies. Now, though, the recommendation is that tap water is safe to use – and better because of the fluoride found in it. The only exception to this rule may be if you are on well water. Then you should have your water tested to make sure it has safe amounts of minerals for your child to consume. If you aren’t sure, you can always boil your tap water and wait for it to cool before using it for your child. Remember, free water shouldn’t be given to babies until they are six months old unless your pediatrician suggests it.

5. Picky eaters may always be picky, so make sure you start them right with a healthy variety of foods in infancy.

New research has told us that many children don’t outgrow their picky eating habits that they develop in the toddler years. For this reason, it is especially important to start your children eating a healthy variety of foods. When kids don’t have these healthy fruits, vegetables, meats and starches as babies or young infants, it is less likely they’ll like them as older kids. It can take kids multiple attempts to like a food – so keep trying! Sometimes it can take 12 to 20 times of tasting a food before we know for sure they don’t like it. Wait a couple weeks, and then go for it again!

I hope this has helped clear up some of the new recommendations in the childhood years. As always, make sure to talk to your pediatrician if you aren’t sure if something is right for you, your child or your family.  Cheers!

Nicole Keller, D.O.

It is 12:31 a.m. I just finished nursing my son and I can’t turn my racing mind off. All I can think about are the families who tonight are “nursing” their children who have contracted measles. I can’t imagine the fear and sadness they are feeling as their child battles this preventable illness. I’m thinking about how I work in healthcare and could potentially expose my beautiful little boy to a preventable and sometimes deadly disease if the measles cases continue to spread – which they will.  I’m also thinking how to help all my patients and how to protect them all during this time. In light of this, I thought I’d make my sleeplessness worthwhile and write this blog.

Measles is here. On January 27, 2015, we had a case confirmed in Cook County and now there are two confirmed cases of children less than one year old having the illness who attend the same daycare in Palatine. We are awaiting another three blood tests from kids at that same daycare. Let me put this in perspective: in the last five years in Illinois we have had 10 total confirmed measles cases. Pending the lab results of the other three daycare children, we are over half-way to 10 cases within one week. Measles is extremely contagious and is a virus that has a mortality rate of one to three in 1,000 cases (majority in kids less than five years old) with more than that experiencing serious lifelong complications of the illness.

Parents, with tears in my eyes, I urge you to make sure your children are vaccinated. Not only with the measles vaccine (aka the MMR vaccine) but with all the vaccines we have available. Please follow the recommended schedule to allow your child to receive as much immunity as possible as soon as possible. These vaccines, given at intervals suggested by the CDC’s recommended schedule, save children’s lives. Vaccines are safe. Vaccines are effective. Please make sure to protect your child, your family and everyone around you by choosing to vaccinate.

In addition, educate yourself and others with the following information about measles. If you have been exposed to a confirmed case or are showing the worrisome symptoms (fevers >101F, cough, red eyes, runny nose, with or without rash), you should contact your local health department. Do NOT go to the ER or your provider’s office without calling first if you fear you may have been exposed or are showing symptoms. As always, please call your physician’s office if you have any questions or concerns.

Below are the facts about measles:

Measles (aka Rubeola) is a highly contagious virus. It will infect nine out of 10 non-immunized who get exposed. It typically affects children. The illness begins on average 14 days after exposure.

Symptoms: cough, runny nose, red eyes, spots in the mouth along with a rash that spreads from head to toe and includes the palms and soles. Fever associated with illness starts 10 to 14 days after exposure, is 101 degrees F or higher, lasts for three to five days, then improves along with the rash improving at a similar time.

Contagious period: four days before rash appears until four days after rash appearance

Transmission route: secretions from the mouth/throat or nose usually spread by coughing or sneezing. The virus can also remain airborne for up to two hours in a closed space.

Diagnosis: usually clinical (by symptoms and patient history), but, to confirm the disease a blood test must be drawn.

Treatment: supportive care. This means fluids, fever reducers, pain control, rest and TLC.

Prevention: vaccination. First vaccine (confers approximately 94 to 98% immunity) given at 12 months old, booster (confers 99% immunity) given at four years old.

Possible exposure: A person who was potentially exposed and is experiencing symptoms a fever of 101 F or higher, cough, runny nose and red eyes with or without rash, should call the Department of Public Health as well as their healthcare provider. These individuals should not go to their doctor’s office or the emergency room as they could infect others around them.

Nicole Keller, D.O.

Hello parents! Has anyone seen The Mother ‘Hood Official Video being circulated on social media? It is a really heartwarming ‘welcome to parenthood’ skit expressed in a unique way.

In the video it shows groups of moms (and dads) who have different beliefs all meeting on a playground getting ready to “brawl” over their different beliefs (breast feeding moms vs. formula feeding moms, stay at home moms vs. working moms, dads vs. moms, etc!). In the end while everyone is focusing on their own “superior” way of parenting, a mom accidentally lets go of her stroller and it goes rolling down the hill. At this point you would think that each opposing group might not go to rescue the runaway baby, but, instead, all the groups come together and chase after the stroller ultimately saving the stroller and keeping the baby out of harm’s way.

I think it is a really good example of how each family and parenting style is different, but, in the end we are all parents trying to raise our kids in the best way possible. No matter your beliefs, we can all agree that what we want is what is best for our kids.

I hope you all know that that is also true of your pediatricians! We all do this because we love kids and want to help families grow in a safe, happy and healthy environment. Our recommendations are our best effort to achieve that goal. In the end, what works for one family/child may not work for another and that’s ok! There are a lot of right ways to do things and we as parents and as pediatricians hope to continue to help you all find the “right way” for you and your family. Please know we are always here for you to answer your questions about your child’s overall health, growth and development. I fully appreciate this now as a new mom and have a new understanding of making things work for each individual family and child.

Happy parenting to you all!