Common questions at a doctor visit

Posted January 21, 2015,

Throughout my day I find myself repeatedly answering the same questions over and over again. For the most part, my answers are always the same and sometimes I feel like a broken record. I’m at the point where I have so many “stock” answers that I just have to share them! Below is a few topics I have selected to share. If you can think of any other topics you would like to hear about, please let me known.

Dry skin

This time of year everyone is battling dry winter skin. For babies who already have sensitive skin, this can become troubling to parents. These are my typical suggestions, keeping in mind that I am not paid to recommend any specific products but I do have favorites.

Babies can be bathed nightly in warm water (not hot) but do not need soap every night. When using soap, stick with plain Dove soap or a wash that is fragrance freeand dye free. (i.e. Aveeno baby, California baby)
Pat your baby/child after the bath but leave the skin a tad wet.
Apply a thick cream or ointment over wet skin. Also reapply throughout the day. Try Eucerin, Aquaphor, Cetaphil or baby oil/coconut oil.

I generally recommend fragrance free and dye free soap, detergent and lotion for kids with dry or sensitive skin. Parents do not have to use organic products but these do tend to be a little gentler. (i.e. California Baby or Honest) Keep in mind that all chemicals, whether from a plant or a lab, can be irritating. Therefore, just because something is plant-based does not mean it is harmless. Anyone who has had poison ivy knows how bad plant exposure can be! Sometimes lavender can cause irritation so be careful when using the purple or “night-time” baby washes.

Cough and cold

Treatment for coughs and colds will vary by age. For children under 6 years old, the FDA does not recommend any over the counter medication. This is because these medications are minimally effective, have lots of side effects and don’t alter the course of the virus. So what should you do when your child is stuffy?

Nasal saline is my favorite! You can put drops in a baby’s stuffed nose, or use spray on a toddler and then teach him or her to blow, or use the sinus rinse for older kids. The saline breaks up the mucous and washes viruses and bacteria out of the nose along with the boogers. It is perfectly ok for your child to swallow it too.
Humidifiers can be helpful to moisten the air to help with those crusty noses, but also to help ease a sore throat if your child is mouth breathing all night. Don’t forget to keep it clean and read all instructions. The recommendation is to use a cool mist humidifier to reduce the risk of burns if it spills.
Vick’s Vapor Rub can be used by rubbing it on your child’s feet. That’s right, the feet. I don’t know why this works but my parents swear by it. I don’t suggest it directly on the chest for young babies, but applying some to mom’s chest before nursing or feeding can be helpful for baby’s with a stuffy nose.
Honey at bedtime has shown to be effective against coughing but is ONLY SAFE FOR CHILDREN OVER 1 YEAR OLD. Try it on a teaspoon or in some warm herbal tea or warm apple juice. Just don’t forget to brush the teeth after .

Vomiting

This is a common complaint that we see in the office, but honestly there isn’t much we can do for it. Kids will throw up for a variety of reasons including from a stomach virus (gastroenteritis), from gagging on phlegm or coughing, during an ear infection, and sometimes if they have a urinary tract infection (along with other reasons). In general, the best thing to do if your child throws up is to allow the stomach to rest. Don’t let your child chug a big cup of water because it will come right back out. After waiting 20-30 minutes, slowly allow your child to sip on clear fluids like water or Pedialyte. You can also try ice chips or a Pedialyte freezer pop. Give a small amount at a time and then wait. After another 15-20 minutes you can give a little more and gradually increase the volume as you go. If the vomiting has stopped for over 8 hours and your child is taking in decent volumes of clear fluids, you can start to add some solid foods like crackers. Signs of dehydration include dry mouth, lack of tears, poor urine output and cool or pale finger tips. Please consult a medical professional if you have any concerns about your child’s hydration status.

Diaper Rash

Diaper rashes are common because the warm, moist environment of the diaper is a great set up for skin irritation, as well as candida yeast growth. Sometimes there is skin breakdown after diarrhea so bacteria can also cause problems. Here are some steps you can take to help with your baby’s diaper rash:

Try to use chlorine free diapers and wash cloths instead of wipes. This will reduce exposure to irritants.
Keep a barrier on the skin to prevent exposure to the elements. Try Aquaphor, A&D, or vaseline.
If the skin is red, use a diaper cream with zinc. Zinc helps to heal the skin.
If you see thickening of the skin with red surrounding bumps, this may be a yeast infection so try over the counter lotrimin (anti-fungal cream).
If there is open or bleeding skin, apply some antibiotic ointment like Polysporin and then cover with diaper cream.

My favorite diaper cream is Triple Paste because it is an ointment with zinc that also incorporates corn starch. Corn starch absorbs excess fluid and can keep it away from baby’s skin. Regular corn starch that you have in your kitchen can be a great addition to your regimen.

Ear Wax

This one is easy. Wax is a normal part of the body. It protects the ears and does not need to be cleaned out on a regular basis. Therefore, don’t use Q-tips. It can push the wax in and potentially traumatize the ear. If you see wax working its way out of the ear, just grab it or clean it with a washcloth.

As a San Diego pediatrician, I am also regularly giving advice on sleep, starting solids, behavior and many more topics. In the interest of time and space I will stop here, but look for more in the future!

As always, if you have any concerns about your child, please see your pediatrician.

And if you’d like to see more of my blog posts, visit www.drjaimefriedman.com and also www.staging.cpmgsandiego.flywheelsites.com.

cold, cough, diaper rash, dry skin, ear wax, honey, humidifiers, medications, nasal saline, vomiting

Jaime Friedman, M.D., F.A.A.P.

Dr. Friedman has been practicing pediatrics in San Diego for over ten years, initially working at Rady Children’s Hospital in its Urgent Care and then moving to Children’s Primary Care Medical Group in 2004. She is now the lead physician of the new CPCMG 4S Ranch office. Dr. Friedman is Board Certified and a Fellow of the American Academy of Pediatrics. She has been one of San Diego Magazine’s Top Docs for the past 8 years and was elected Best Doctor in East County by The Californian in 2011. Dr. Friedman went to medical school in Baltimore, Maryland, where she grew up, and did her pediatric residency in Portland, Oregon, at Doernbecher Children’s Hospital. She is still a very loyal Baltimore Ravens fan and loves football. On a professional level, Dr. Friedman’s interests include literacy, breastfeeding, and fitness. While at the CPCMG El Cajon office, she started a new Reach Out and Read location,, and is working on providing books for patients at all CPCMG locations. She also plans to organize regular kid-friendly hikes for the 4S Ranch community. Personally, she has walked in three Breast Cancer 3-Day walks, volunteers at her children’s school, and has been active on the PTA. She also volunteers as the camp doctor every summer at Camp Mountain Chai. When she isn’t working, Dr. Friedman enjoys every minute she can with her husband and two children. Together, they love to ride bikes, spend time with friends, and play with their 2 Australian Shepherds, Luna and Lucy.

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