There are some surprises.  Using plug-in outlet covers?  Most adults don’t plug them back in.  Video monitors?  There are reports of kids getting strangled on the cords.

But some old suggestions are still valid.  The best way to start babyproofing is to get down on your hands and knees, and look for trouble at your child’s level.  Then fix it.

–  David Epstein MD

But now, we read in the news that the Institute of Medicine is about to publish a rebuttal to some recommendations for super-high doses.  (Click here for the Washington Post article, or here for the New York Times report.)

In fact, as far as I can tell, there’s not much disagreement between the Institute of Medicine and the AAP’s recommendations.  IOM recommends that all infants receive 400 International Units (IU) per day, and children over 1 year should receive 600 mg; the AAP recommends 400 IU for all infants and children. The AAP and the IOM agree that there is little evidence to support recommendations for huge doses of vitamin D (2000 IU or more).

Breast milk contains little Vitamin D, so all infants who get most of their milk from breastfeeding should be given Vitamin D supplement drops (with iron if possible).  For older kids, cow milk is fortified to give 400 IU per quart; so unless the kids drink a quart of milk every day, they need other sources as well, so I recommend daily vitamin supplements for them as well.  (Any brand-name or store-brand kids’ vitamin supplement will do; look for ones that also contain iron.  I’d stay away from any supplement made in China!)

So I still recommend once-daily vitamin supplements (with iron) for all children.  Don’t be put off by the news reports this week; the IOM is simply debunking claims for mega-doses of Vitamin D.

–  David Epstein, MD

The “classic” in this series is “Caring for your Baby and Young Child, Birth to Age 5″.  The advice is reasonable, easy to read and follow.   (It’s not alarmist, unlike the “What to expect …” series which I do not recommend.)

–  David Epstein, MD

We’ve only received 100 doses of the shot for infants and toddlers so far.  We hope to have further shipments soon, so that we can vaccinate everybody, but it’s possible we’ll run out temporarily.  Remember that you need 2 doses (at least 3 weeks apart) for the best immunity (estimated at 85%), but the first shot gives some useful protection (estimated at 75%).  So we’ll try to give everybody the first dose before we start giving boosters.  Once we have received enough vaccine, we’ll start administering the boosters.

We have also received a second shipment of the H1N1 shot for older kids (with preservative).  So now we have enough H1N1 vaccine to vaccinate all our high-risk patients for their first vaccine.  If your child has asthma (or other high risk illness), you should be on our schedule now to receive the first dose.  I’ll post a note here when we have enough for boosters.  We now have enough seasonal flu vaccine for all our patients as well; all kids should be given both.

To give you some perspective, Delaware Modern Pediatrics has received only 300 of the 2300 doses of H1N1 we ordered for our patients.  Obviously, supplies are still tight.  This is not the fault of the Division of Public Health; the manufacturing process for flu vaccine is antiquated and slow.  We have similar supply problems with the seasonal flu vaccine in most years (though not this year); but the shortages haven’t been as noticeable because demand for flu shots has never been this high.

Should you have your kids vaccinated through school?  Yes, absolutely, if you can!  The only exception is for kids with asthma (or other serious underlying disease) who are being offered only the nasal flu vaccine at school; those patients should be given the injection (available through our office for our current patients).

Kids usually begin to identify colors by age 3 or 4.  A 4 year old child who can identify some but not all colors might be normal, but it’s worth knowing if he has a physical impairment in recognizing colors.  He’ll be frustrated if the adults try to teach him something that he might be physically incapable of learning!

Red-Green color blindness is the most common type, but Blue-Yellow color blindness also occurs; about 20 different types of color blindness have been described.  Several genetic types exist; Wikipedia has a very complete description. Most color-blind people are male, but some females also suffer from it.

A person who has Red-Green colorblindness sees red and green as the same hue.  He can tell the difference between dark red and light red, but red and green colors of the same intensity both look gray.  Other colors (such as olive-green and brown) might also be hard to distinguish.  This is a minor inconvenience most of the time, but it can cause a safety problem on occasion.  (Traffic signals are always arranged with red on the top, for the benefit of color blind drivers and pedestrians.)  It is not true that everything looks black-and-white to color blind people; they can see many different colors, but not quite as many as a person with normal color sight.

Simple tests are available.  On-line screens, like this one (good for younger kids who can identify shapes) or this one (good for kids who can identify numbers), can give  you an indication of color blindness; but if your computer screen doesn’t have perfect color rendition, the test might be thrown off.

–  Copyright 2009, David M. Epstein MD

This is not surprising, because the skills required are different.  Daytime bladder control is under voluntary control, and can be taught.  (This is why it’s best to wait for potty training until your child is interested in staying dry.)  At night, though, the child is (hopefully) asleep, and has no voluntary bladder control.

Nighttime dryness is an unconscious act; it happens when the child’s brain becomes sufficiently mature.  Everyone achieves this state eventually, except in the rare event of a medical problem.  We label bedwetting as a problem only when it becomes a social issue, usually after age 6 or so when many children start to receive invitations for sleepovers at friends’ homes.  The medical term for this is “primary eneuresis,” indicating that the eneuresis or bedwetting does not have another medical cause.

Bedwetting often runs in the family.  Many children with prolonged bedwetting will have relatives who have also suffered with it (though some family members may be reluctant to discuss it).  These children generally are dry during the day, but they wet the bed several times per month, in some cases nightly, throughout childhood until they grow out of their bedwetting.  Limiting fluids in the hours before bedtime, and planned night awakenings for bathroom trips, can help.  Electronic beeper-style alarms, available for under $100, can teach kids to wake themselves over time.  If these measures are ineffective, there are safe and effective prescriptions available.

If a child begins bedwetting repeatedly after a dry period of months or years, it may be a sign of a different medical disorder requiring treatment.  This is called “secondary eneuresis,” and is less common than the inherited primary eneuresis.  A urine infection would be the most frequent culprit.

–  David Epstein, MD

Migraine headaches may be one-sided, and they are often associated with visual disturbances, nausea and vomiting, and sensitivity to light.  Often, the best treatment is sleep.  But if this is not practical or sufficient, non-prescription pain relief medications such as acetaminophen or ibuprofen often are helpful.  Prescription medication is helpful to abort more severe migraines, or to lessen the frequency if they occur more than a few times a month.

Migraines should be taken seriously; they can be quite debilitating, but proper treatment is very effective; children don’t have to suffer with them.

–  David Epstein, MD