Author : Nicole Keller, D.O.

Nicole Keller, D.O.

Happy New Year everyone! I know we are well into 2015, but, I am still feeling the aftershocks of the holiday season. Boy can all those holiday gatherings impact your life! I don’t know about you all, but my little guy (who is now just over 4 months old) had a hard time sleeping after all the excitement and my husband and I are still recovering from the sugar overload induced by every type of bread, cheese and candy we consumed over the last month or so. As we try to return to our everyday schedule we are also trying to remind our bodies (and our minds) what healthy eating is. So for this blog post, I want to talk about an important part of a healthy diet that often goes overlooked…your drinks!

The Illinois Chapter for the American Academy of Pediatrics (ICAAP) has recently launched a campaign to “Rethink your Drink.” Here’s what ICAAP is recommending (and what I would have to agree with!):

• “Red light” drinks – drink RARELY: regular soda, energy/sports drinks, sweetened coffee/tea, fruit drinks
• “Yellow light” drinks – drink OCCASIONALLY : diet soda, low-calorie/low-sugar drinks, 100% juice
• “Green light” drinks – drink PLENTY: water, seltzer water, skim or 1% milk

This got me thinking about how much my liquid consumption is part of my diet – and a part of all my patient’s diets! Fluids are one of the best ways to keep your body hydrated and healthy if you are choosing the right ones. In our grocery stores today, the juice and pop aisles take up a huge amount of space which points to how much we consume these items as a society. While juice and pop may seem like a good option to drink (they are fizzy, fruity and sweet of course!), they are some of the most common culprits for a lot of medical problems. Obesity, dental cavities, diabetes and other medical conditions can be brought on or worsened by what we drink.

Here are some tips to make sure your kids and your family are on the right track for choosing healthy drinks throughout the year:

• Water should be the primary drink you and your kids consume. You can offer water to infants starting at six months of age (in a bottle or preferably a sippy cup). Water should be available at all times of the day.
• Pop and juice should be reserved for special occasions. Holidays, birthdays, or other family celebrations (for example) should really be the only time these are offered to your kids.
• When offering juice, water it down. Cut the juice in half with water to make it less sugary.
• When you choose a juice, look for the 100% fruit juice label. This is still a very sugary drink and still should only be offered on occasion, but, if you are going to give it, this option would be best.
• Offer water or milk only with each meal. Remember infants one to two years old should be on whole milk (the extra fat helps their brain development) but milk in general should be limited to no more than 24 ounces in a day.
• Stay away from sports drinks. While those drinks are great for athletes who are exerting lots of energy during practices and games, they are not meant to be used on a regular basis. There are way too many carbs and sugars for frequent consumption.
• If you follow these guidelines you can easily make sure the beverage portion of your family’s healthy diet stays on track. As always, let your pediatrician know if you have any questions about healthy eating and drinking – we are always here to help!

I’m back! Maternity leave is over (so sad!) and I am back in the pediatrician saddle, so to speak. It was really hard leaving my little guy for the first few days but it is getting better every day. As a new mom I have been faced with all the struggles of lack of sleep, endless physical demands of a newborn, and learning how to be “me” in a whole new way. Most of my challenges now don’t come from what I’m going to wear to work or eat for dinner but rather how I’m going to keep my son, Leo, happy and healthy. With that said, I want to talk about car seat safety today as a sometimes overlooked area of your child’s well being.

Nicole Keller, D.O.

Let me start with a story. At first Leo loved being in the car seat – or so it seemed. He would easily doze off until we arrived at our destination and not make a peep. That didn’t last long. He now will get in the car seat, be content for a short time, and then…panic. If we don’t keep the car moving, he tells us! Every stop sign or red light his eyes flash open and the whimpers (and sometimes flat out screams) begin. I was picking up a prescription at the drive-thru one day and had to wait for about 15 minutes and he screamed the entire time!! It was awful! As a parent, I want to do everything possible to not hear my baby cry. So when he started disliking his car seat, my husband and I would wait until the last minute before we tightened the car seat straps in the hope that Leo would stay content as long as possible. We thought if we kept the straps loose, he wouldn’t feel restricted and therefore stay happy.

While our intent was good, one time we forgot to tighten him and didn’t realize it until we were already on the road. Yikes! We pulled over right away and tightened those straps up but boy did that event strike fear in me – much more fear than his crying could ever scare me. What if we had gotten in a collision? Would he have been OK? Would he have stayed in his car seat? How could I ever forgive myself if he had gotten hurt just because we didn’t want to hear him cry?! I tell you this for a couple reasons; first, because I want you to know that we all make mistakes.  Secondly, because I don’t want you to make the same mistake!

Car seats are incredible items that help us run around town with our little bundles of joy as safely as possible. They are meant to be used in very specific ways to ensure safety. Here are some tips for you to remember to keep your little ones safe when in the car:

– Straps should be snug, straight and flat.

– The harness chest clip should be located at armpit level.

– Keep your child rear-facing as long as possible! The AAP recommends until at least two years of age to maximize safety.

– Know your car seats limits. Each car seat has certain weight and height restrictions that should be followed strictly.

– No bulky winter jackets under car seat straps! When kids wear winter jackets/suits under their car seat straps it is almost impossible to get them secure and tight in their seats. Keep them in a warm but thin clothing layer and then cover with blankets as needed to keep them toasty.

– Get your car seat checked out by a professional:  Visit http://cert.safekids.org/ or www.nhtsa.dot.gov or call the DOT Vehicle Safety Hotline at 888-327-4236 to find a professional car seat examiner near you. Many local fire/police stations have trained professionals ready to help you.

– Keep your kids in the back seat until at least 12 years old.

These are just a few quick tips to keep your kids safe. Visit www.nhtsa.dot.gov for more info on keeping your children as safe as possible when riding in a car. Please, buckle up and have a safe, happy and healthy holiday season!

Nicole Keller, D.O.

On September 11, 2014 at 9:14 p.m. my life as I knew it changed forever. After 40 weeks and 5 days of waiting, I welcomed my first child, a son who we named Leo. Just like that, I was a parent. It has been almost 4 weeks since that day and this blog post is dedicated to the adventure that the last 4 weeks have been…..thanks to you, my son, Leo.

Towards the end of my pregnancy, everyone asked me if I was ready for parenthood. I would always respond, “I’m as ready as I’m going to be!” While this statement is still true for me, being “ready for parenthood” is something that I have learned is just not possible! I talk to new moms all the time as part of my job. New babies and their parents are some of my favorite patients. I tell them about sleeping, feeding, peeing and pooping and walk out of the exam room feeling pretty good about my advice. Even though I know all the answers to the “is this normal” questions, having my own baby at home showed me that even though I have had my questions answered, I still constantly question myself with every whimper, spit-up and muscle twitch. To explain, let me tell you a story…

About day 4 after birth, Leo seemed to be crying anywhere from 20 minutes to 1 hour after eating. My husband, my mom, and I would rock him, shush him, sway, swaddle and do anything else we thought would work with little to no change. We kept saying, “He can’t be hungry – he just ate 40 min ago!” Then it hit me – cluster feeding!! I let him nurse and the crying stopped. It was like magic. And then he cluster fed for the next 2 weeks for what seemed like all day and all night. Then one night in between one of these feeds as I was changing a diaper, he wet his outfit. So I changed the outfit and the diaper again. Then as I was finishing that new outfit and diaper, he pooped all over…this went on for 5 outfit changes. Of course during this time Leo was ravenous again and was screaming for food. I yelled for my husband to come help as I was at my wits end! There was nothing me as a pediatrician could have done/known to make that night any better. This was Leo’s show and I was just the food supply and the maid.

While that was one of the hardest nights, they have since gotten better – for the most part. I am still exhausted every time he wakes me to feed. Nursing still is painful on occasion, although it has improved greatly, thank goodness. But through the pain, the exhaustion, the dirty diapers and costume changes I have continued to learn about being a parent – and I have experienced the love for a child that is unparalleled and worth every ounce of anguish.

I want my newborn parents to know that it is OK to question yourself all the time. It is what makes you a parent – and a good parent at that! I also want you to know that you WILL cry (lack of sleep, hormones, breastfeeding soreness, etc), you WILL have moments of doubt (why won’t you stop crying?! What am I doing wrong?!) and you WILL wonder if you are ever going to sleep again (after the longest 4-6 months of your life, you will get better sleep again, I promise). Along with these feelings, though, you WILL succeed and you will be a great parent to your little bundle of poop…I mean joy!!

With that said, I’m here to offer my story as a way to tell you that you are not alone at that 3 a.m. feed or when your baby won’t stop crying or when you’ve changed 5 diapers in a row because the poops just don’t stop coming! I feel you. WE feel you as your pediatricians, fellow parents, families and friends and we are here for you! Make sure as a parent of a newborn you have support when you need it. Support can be a person to hand off a crying baby to, a person to talk to, or a person that will let you shower while they hold your little one. Make sure to ask your partner for help when you need it as well – they may not know when or how to help, so, vocalizing your need for their support is important. As a new parent you also need to make time for YOU. Whether that be a date night with your partner, time to go grocery shopping, or just an hour to nap (and yes you NEED to sleep when your baby sleeps whenever possible)! While you can’t predict your baby, you can make your life easier by having these support systems in place to get you through the tough times. Remember that it is always darkest before the dawn (literally – I have seen this dark hour nightly for the last 4 weeks!) but the sun will rise and you will be a great parent to your great newborn.

Cheers from the land of parenthood! Thanks for reading.

One of the more common childhood complaints we get in clinic has to do with ear pain. In fact, when I was little and dreamed about being a pediatrician, I always pictured myself treating children’s ear infections! That dream worked out pretty well for me!

Nicole Keller, D.O.

At some point of your child’s life, there’s a good chance they too will complain of ear pain (medically known as “otalgia”). While middle/inner ear infections (otherwise known as “otitis media”) are the most commonly thought of problem causing ear pain, there are a lot of other things that could also be the culprit. Here’s some common ear ailments other than your typical ear infection that present to us and how you might be able to spot them…everyone, “all ears?”

Teething

• Babies starting at age 4 to 6 months up until around 2 years old are getting their first set of teeth. Many times, the pressure and swelling from incoming teeth can be referred to the ears. You baby may be tugging on their ears a lot but not necessarily have a lot of other symptoms. This ear tugging may be solely from teething!

Congestion

• When we get a cold, or upper respiratory infection, congestion is one of the more common symptoms. Since our ears, nose, mouth and throat are all essentially connected, congestion in one area can lead to congestion in another. So if your child is fighting off a cold and feels pressure in their ears, it may be from congestion. This is similar to the pain/pressure you might feel when flying on an airplane. Incidentally, ear infections are also a common secondary infection during or after the tail end of a cold. So if that ear pressure or pain changes, gets worse, or is associated with fever, having your child seen to diagnose a possible secondary ear infection would be smart.

Swimmer’s ear

• Swimmer’s ear is the common name for what we call “otitis externa” – an outer ear infection located in the ear canal. This type of ear pain tends to be seen after a child has been swimming a lot or has been exposed to water more than usual. Usually water that gets in the outer ear canal (when showering or bathing for example) dries on its own and doesn’t cause much problem. When there is excess water in the outer ear canal, that extra dampness sticks around and makes a great environment for bacteria to grow. This can create an outer ear infection. This type of infection usually presents with pain when moving the external ear (the pinna), sleeping on the ear or other movement that involves the outer ear canal. This infection does usually require an antibiotic ear drop and should be evaluated and treated by your child’s doctor. There is an over the counter product that helps dry out the outer ear canal and can be used in children doing a lot of swimming. Make sure to check with your doctor to make sure it is alright to use – it should not be used if your child has had ear tubes placed, for example.

Foreign body

• Believe it or not, I’ve found some odd things in ears…beads and Barbie shoes are a couple of my funniest finds. If your child is complaining of ear pain without any other symptoms, a foreign body is a possibility. You want to make sure to have your child seen by their doctor right away if you suspect an object might have been placed in the ear. Removal of that object is necessary to prevent further trauma.

Excess ear wax

• Occasionally ear pain or pressure can be caused by excess ear wax (medically known as “cerumen”) occluding the ear canal. Many times this is accompanied by a complaint of hearing changes as well. While it might seem smart to try and clean the ear canal yourself, it is never smart to use cotton swabs (or “q-tips”) in the inner ear. All this does is push ear wax further in the canal making it more likely to get clogged and increasing your chances of traumatizing the ear canal or ear drum. This complaint should be evaluated by a medical team for possible ear flushing to dislodge excess ear wax. You can also use an over the counter product called “Debrox” to help soften the ear wax and help it come out easier on its own or during a flushing.

Lastly, a word on ear cleaning. Many parents will ask how often or how to clean their child’s ear. I usually tell people that the ear is like a self-cleaning oven – there really isn’t a lot you need to do.  Have your child wipe clean the outer ear with cotton balls or washcloths on a regular basis during baths/showers. The ear canal itself doesn’t need regular cleaning and should be dried with a washcloth, externally only, after bathing. Ear wax is produced as a protective coating for the ear and should typically be left alone – the old saying, “you should never stick anything smaller than your elbow in your ear” is pretty true! The more you try to take out ear wax, the more the body produces which can lead to a cycle of excess ear wax production and further problems. Let water run in and out of the ear during baths to flush out lose/dislodged particles and leave the rest to your body to push out when it is ready.

As always, if you aren’t sure what your child’s ear tugging, pain or pressure is caused by, give your doctor’s office a call. We’ll always be happy to take a look in the ears and answer any questions you might have. Thanks for reading!

As pediatricians, one of the common topics of discussion we face is in regards to vaccinations. As a group, Dr. Ababio, Dr. Kumar, Dr. Alessia, Dr. Granoff and I whole-heartedly believe in the necessity, safety and effectiveness of vaccines. We want you as parents to have reliable, scientific, unbiased and ACCURATE information about how to keep your child safe and healthy. Together we hope in this blog post we can answer some common questions, dispel some myths and make you feel confident in your choice to vaccinate your children.

Nicole Keller, D.O.

Why vaccinate?

Vaccines originated as a way to offer the body protection from a disease without getting the illness. Ultimately, they save lives and prevent diseases from spreading. Vaccines mostly protect against sicknesses that are deadly (or have a possibility of being deadly) or can have severe consequences during or after the illness.

Is injecting a disease via vaccination into my child’s body safe?

Yes.

Starting at birth, your child likely comes in contact with thousands (2,000 to 5,000 to be exact) of antigens – “bugs” or “germs” that cause disease – each day.  The entire vaccine schedule put together gives your child about 150 antigens total; way less than what your child fights off on a daily basis (AAP Oct 2008).  Even though we are injecting the vaccine antigens into the body as opposed to passive exposure in the environment, the amount and form of the vaccine antigens are safe and in no way overwhelm the immune system regardless of your child’s age. Your immune system doesn’t know the difference between an antigen that was acquired from chewing on the grocery cart handle versus one that was injected in the body from a vaccine.

In addition, all vaccines are rigorously tested (on thousands of people over years of research) before they are given. It is true that that process is not perfect either – for example, when the first version of the rotavirus vaccine came out it was noted that an increase number of intussusceptions (when the bowel telescopes into itself) were occurring. The vaccine was pulled immediately and re-formulated. We now have a new safe version of this vaccine. I share this example with you to show you that even though the process of testing may not be perfect, our medical system is constantly testing and re-examining the formulations, schedule and effectiveness of vaccines to make sure they are the best they can be.

Once a vaccine or vaccine schedule is introduced, it is only recommended to the public after being approved by the Centers for Disease Control (CDC), the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP). That’s a lot of approvals needed from a lot of experts on disease.

There are so many vaccinations – can’t I space them out so I don’t overwhelm my child’s body?

The vaccine schedule is there for a reason – it gives your children the most protection as early as possible in their lives at a time when their immune system can best incorporate the added protection.

The schedule is created to account for when the immune system will best respond to a vaccine as well as the need to protect children at the earliest age possible. The booster shots are there to offer the most immunity possible to a certain disease(s) and work best when spaced out a certain amount – kind of like when you work out a certain muscle group, you need to give it a rest before working it again. We give the body a dose of vaccine, give it a break to account for the new “strength” the immune system is building, and then give another dose to keep boosting the strength of the immunity. We have figured out how many boosters are needed of specific vaccines after years of studies and research determining long-term effectiveness of each vaccine.

If you were to space out the vaccines onto a different schedule you are increasing the risk that your child could get or spread a vaccine preventable illness. Longer time than recommended between vaccines is longer time without protection. And again, remember you are in no way “overwhelming the immune system” by giving vaccines – give your immune system some credit here!

But, I had _____ (insert disease here – chicken pox, measles, the flu, etc) as a child and did just fine – why should my child be vaccinated against this illness that was no big deal for me?

The vaccines we have created came about because there is a risk, no matter how small, of morbidity (getting the disease and its consequences) or mortality (death). The risk of getting a vaccine preventable disease and its possible consequences is much higher than the risk of significant side effects from vaccines – i.e. vaccines are safer than the disease itself.

Even though you, or a family member or friend, might have gotten chicken pox or measles or rubella or WHATEVER illness as a child and recovered without consequence, there are children who don’t fare as well. I think one of the saddest things I have seen as a pediatrician is a child in an ICU with a vaccine preventable illness with their parents hoping, wishing and praying for their child’s recovery. I wouldn’t wish that on anyone and that is why vaccinating is so important to us.  These illnesses are preventable!

I’m still scared about the risk of autism – wasn’t that related to a preservative in the vaccines too?

We can conclusively say that there is no link regarding vaccines or their preservative components and autism.

The “vaccines causing autism” scare started years ago after an article was cited stating this correlation. That article has since been debunked – the physician who wrote it falsified evidence and has since has his medical license stripped. Even so, since the scare started, numerous studies have been done to analyze the risk of autism in relation to vaccines – and every study has found no link – zero, zip, zilch! It is true that the number of cases of autism is on the rise. The medical community is actively working on finding a reason for this. What we do know at this point, though, is that vaccines have not been the reason for the increase in the incidence of autism.

This autism scare changed the way the public viewed vaccines and really has altered medicine, in a very unfortunate way. The good that came out of this, though, is that we have now conducted even more, large population, long-term, scientific research studies on the safety of vaccines; and we keep finding that vaccines are safe and they save lives.

Of note, there was a fear of thimerosal (a preservative in some vaccines) being the cause of autism as well. Also found to not be true – but regardless, this component was taken out of routine childhood vaccines in 2001 while the research was being conducted. So no worries there either.

Can’t my child just rely on herd immunity to stay healthy?

No.

This is unreliable and defeats the purpose of herd immunity. To keep herd immunity intact, >95 percent of the population has to be vaccinated. That remaining 5 percent should be reserved for children who cannot receive vaccines for reasons of severe medical consequence (for example, they don’t have working immune systems, post-chemotherapy, transplant recipients, etc). If people started relying on herd immunity that 95 percent would start to drop quickly and place everyone at increased risk of acquiring a vaccine preventable illness.

These diseases aren’t around anymore – why does my child need to get vaccinated against them?

They are around!

Data from the CDC – these are reported cases and there are likely more that go unreported.

Measles cases in the US in 2014: 288 thus far (highest number since 2000), 90 percent are among unvaccinated

Mumps cases in the US in 2014: 796 thus far

Pertussis (whooping cough) cases in the US in 2014: 9,964 thus far

I could go on, but you get the point. Even if in the US these illnesses didn’t exist, there is always a threat of acquiring them from travel – either traveling to a country where the disease is present (England, for example, has a huge risk for mumps) or people traveling to/visiting/immigrating to our country and bringing the disease to us.

True or False: My pediatrician gets a monetary bonus for giving my child vaccines.

False!

We became pediatricians because we want to help kids stay healthy. Our recommendation to vaccinate your kids is based solely on what we as medical experts in pediatric healthcare think is best for your child’s health. That’s it! (Oh, and we all vaccinate our own kids by the way – we wouldn’t do that if we thought they were bad!)

If you would like more information on vaccines we recommend you visit one of these reliable sources: the CDC website http://www.cdc.gov/vaccines/default.htm, the AAP website www.AAP.org or the AAP’s website for parents www.healthychildren.org.

Of course, you can always ask your pediatrician at any visit about vaccines as well – we do believe in them and would like to educate you on the truths and benefits of vaccinating your child. Please let us know if you have any questions.

Thanks for reading!