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.

It’s flu season!  That means runny noses, body aches, fevers/chills, cough for seven to 10 days…ick!  Lucky for you, influenza shots are now available so you can be armed and ready for the next few months.  A lot of people wonder whether or not they should get the flu shot.  Well, let me share some statistics with you:

Vrinda Kumar, M.D.

– Between 5 to 20 percent of Americans get the flu each year.

– An average of 200,000 people are hospitalized every year because of the flu.

– 3,000 to 49,000 people will die each year due to flu-related complications.

– In 2009, influenza and related pneumonia was the 8th leading cause of death in American men.

– Flu season usually peaks in January and February.

– It takes about two weeks after the shot to develop antibodies against the flu.

How effective is the flu shot?  Every year, there is a very smart group of people at the CDC (Center for Disease Control) that tries to guess (a very educated, heavily researched guess!) which strain of flu is most likely to cause most cases of flu for the following season.  They take the four (or three, depending on which type of flu shot you get) most likely strains, and put it in the vaccine.  Luckily for us, even different strains of influenza tend to be related to each other, so even if the strain in the vaccine is not the exact same strain that is spreading through the community, chances are pretty good that you will still have some protection against the flu. Even though it is still possible to get the flu after receiving the flu shot, your chances of having serious complications (bronchitis, pneumonia, death) is decreased significantly.

The majority of people who will have life threatening complications of the flu are people over 65 and also babies under six months.  It is highly recommended that if you spend a lot of time with anyone who meet these criteria, you should be vaccinated to protect your loved ones!  Children under six months are too young to be vaccinated with the flu shot, so it is especially important that if you live with a a sweet little peanut under six months old, you should be vaccinated to protect them!

Caution: myth debunking ahead!  The flu shot CANNOT give you the flu.  I repeat, the flu shot CANNOT give you the flu.  If you happen to get sick soon after getting the flu shot, it’s probably purely coincidence.  This is the fall and winter season and there are lot of other viruses floating around that can give you cold symptoms and fever.  If you get the flu after getting the flu shot, you were probably one of the few unlucky ones who picked up a different strain than what is covered in this year’s flu shot.

The CDC recommends everyone over the age of six months get their flu shot. It is protective and may save your life or the life of someone you love.  Remember to stay away from people with symptoms of influenza, and wash your hands frequently!  Stay healthy, get your flu shot!

The seasonal flu vaccine for both adults and children is now available at Rush-Copley Medical Group offices.  Schedule yours today with your physician!  If you want any more information on the flu vaccine or influenza in general, please visit www.rushcopley.com/rcmg/services/flu-vaccination/ or www.cdc.gov.

Source: www.cdc.gov

Happy back to school!  Many schools have a program or a “talk” on puberty for both boys and girls.  However, many families still have a lot of questions.

Puberty starts at 12 years old on average. It can start as early as age nine. T here are differences among ethnic groups, with African American males starting earlier than other backgrounds.  Puberty in a boy starts with the increase in size of the testicles. A s a boy develops, penis size increases along with growth of pubic hair.  “Wet dreams” may occur. Boys will have a growth spurt about two years into puberty.  The voice “cracks” and “zits” start popping up. Some boys develop faster than others.  Puberty is considered late if the boy is 14 years old.

Puberty can be a very scary time for a young man.  There are so many changes happening! If you would like more info, I will be giving a presentation on puberty in boys. It will be on October 15, 2014 at 6:30 p.m. This presentation is for parents and sons to attend together. The program is free, but you do have to reserve a seat. Please visit rushcopley.com or call 1-866-4COPLEY (1-866-426-7539) for more details!

Have a great school year!

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!

Eva Alessia, D.O.

Before you became a parent, you probably never thought that you would fixate on the quality of another individual’s poop. Yet, here you are: My child’s poop is blue. My baby has loose, like diarrhea, poops. My toddler is passing poop that looks like balls. Is this ok?

A newborn’s poop is called “meconium”: it is thick, very sticky and dark green, practically black. You could probably use it to spackle your walls or mortar bricks together.

This poop goes away in about 3 to 5 days. The newborn’s poop will change to a loose/mushy stool that can be yellow, orange or even green in color.

A breastfed baby’s poop will be a little looser than a formula fed baby’s and can have little chunks of solid poop within the “liquidy” stool that can remind you of curds in cottage cheese. This is called a “seedy stool” and is normal.

An infant’s poop should not look like it is thicker than peanut butter. If so, then your child may be constipated. Likewise, an older child should not be passing pellets, balls, anything hard and/or dry or a poop that you remark “I can’t believe that came out of my child!”

As you start adding solid foods to your baby’s diet, the color of the poop will change. The color will depend on what you are feeding your child. Pretty much, any color of poop is ok (yes, even blue!), except white, black and red. If you see any of these colors, talk to your child’s doctor.

Seeing mucous in the stool here and there is ok; there could be more when your child is sick. If you notice that your child is passing mucous with every bowel movement and your child is not sick with a cold or tummy flu, call your child’s doctor.

Now you have the scoop on poop!