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Dr. Adebowale Adeyemi, aka Dr. Debo, is a pediatrician at Morgan Stanley Children's Hospital of New York-Presbyterian. We asked him to weigh in on some common questions that may affect your child's health and safety. Here's what he had to say.
Please note the following Medical Disclaimer: This site is designed to offer you general health information for educational purposes only. The health information provided on this site and any interactive responses are not intended to be professional advice and are not intended to replace personal consultation with a qualified healthcare professional. Dr. Debo is a volunteer. He is not an employee of HRA or the City of New York. The views expressed by Dr. Debo are entirely his own. HRA/NYC does not endorse any of the services offered by Dr. Debo. HRA/the City of New York cannot guarantee that the medical information provided on this site is appropriate for your needs. You must always seek the advice of a healthcare professional for questions related to any disease, symptoms and appropriate therapeutic treatments. If your child has or you suspect that your child has a medical problem or condition, please contact a qualified healthcare provider immediately. You should never disregard medical advice or delay in seeking it because of something you have read on this site. Your reliance upon information and content obtained through this site is solely at your own risk.
About the Doctor:
Adebowale "Debo" Adeyemi, M.D., is a clinical fellow in Pediatric Gastroenterology, Hepatology, and Nutrition at Morgan Stanley Children's Hospital of New York-Presbyterian. Originally from Nigeria, Dr. Debo graduated from Luis D. Brandeis High School in Manhattan before attending City College of New York in Harlem. He later earned his medical degree from the University of Connecticut School of Medicine, in Farmington, and completed his residency training at Jacobi Medical Center in the Bronx.
If a child coughs a lot right after crying, could that be a sign of asthma?
Yes. If you notice that your child continues to have persistent coughing after crying episodes, definitely mention it to your doctor and he'll do some more investigating to determine whether it is indeed asthma. Other things to look out for would be coughing with activity, like when a child can't catch their breath after running or some other type of exercise. Also, wheezing or coughing when they're exposed to things like dust, pollen, or pet dander. Even roach saliva and mice droppings can trigger asthma episodes. If your child is between 3 and 5 years old and is exhibiting symptoms such as chest tightness or breathlessness, that might also signal a problem with asthma.
It's hard to diagnose asthma in kids younger than 3, since they get a lot of respiratory tract infections and runny noses and things like that. There's also something called bronchiolitis, which causes babies and infants to cough or wheeze, but at that age we don't call it asthma. Your doctor will just watch them and if the symptoms become persistent, you'll probably be directed to a specialist to explore a diagnosis.
Asthma is especially common amongst minorities in the inner city, and in African-Americans and Latinos. There seems to be some correlation with socioeconomic status. As far as triggers go, if you're living in a crowded place and people are getting a lot of infections, if you're living in a community where there are garbage dumps and things like that, or there are a lot of cars and exhaust fumes present, those can all trigger asthma.
And for some reason, Puerto Ricans have one of the highest rates of asthma compared to any other ethnicity. We don't exactly know why that is, but it's something for the Puerto Rican community to know so they can be on the lookout for symptoms in their kids. The earlier a child is diagnosed, the earlier they can start treatment.
If your child does have asthma, know what triggers it and do all you can to avoid those things. Smoking around kids with asthma is definitely a bad idea. And if you're going to clean, have your child go outside while you vacuum and have all that dust in the air.
We saw a statistic that African-American babies are twice as likely to die of SIDS than white children. Is that true, and what are some things dads can to do to make sure their kid sleeps as safely as possible?
SIDS, short for Sudden Infant Death Syndrome, is when an infant that's apparently healthy suddenly dies, usually during sleep. While the exact cause of SIDS isn't known, it's true that African-Americans have a higher rate of it than most other ethnicities.
Some research indicates that African-Americans are more likely to put their children facedown on their bellies to go to sleep, going against the recommendation that you should put kids on their backs to sleep. Since the Back to Sleep campaign started in 1994, the number of SIDS cases we've seen has declined significantly. But a lot of parents say, "My kid doesn't like to go to sleep on their back," or, "Can I put them on their side?" Still, the recommendation is to put them on their backs when putting them down to nap or sleep. During the day, though, be sure to give kids a lot of tummy time so they can stretch and exercise their neck. It's extremely important, though, that tummy time is always well supervised by you or another adult.
Another article shows that African-Americans are more likely to share beds, or cosleep, with their babies. This isn't recommended, especially if you're a heavy sleeper or you take medications to help you go to sleep at night. And you should definitely not sleep on a couch with your baby.
Also, there is a correlation between smoking around babies and SIDS. When babies are born, they have a different kind of breathing pattern than adults. Smoking around them might affect the respiratory center in the brain, making them less likely to be aroused from sleep, especially if they're in a facedown position.
Some important precautions to take:
- Place infants on their backs to go to sleep on
a firm surface, and don't have a lot of excessive bedding that little
faces or noses can easily get caught in, which will compromise
breathing.
- Move stuffed animals out of the bed, and make
sure all sheets and bedding are well tucked in on all sides.
- Avoid heavy wrapping or overheating of your
baby, and keep their room at a temperature at which they'll be
comfortable in just a couple of layers of clothing.
- The safest place for a baby to sleep is in
their own crib in the parent's bedroom, or somewhere where you can
easily check on them frequently.
- Don't share a bed with your baby during sleep.
- Avoid exposure to tobacco smoke before and after birth. I can't stress this enough. Smoking always rears its ugly head with a lot of things that can go wrong with babies, including SIDS.
Get more information about how you can keep your baby safe
In general, how much exercise should kids get to make sure that they stay healthy and avoid becoming obese?
The more time kids spend in front of a TV or a video game, that's time they're not exercising, and that type of sedentary lifestyle causes weight gain. Kids really should only get two hours of TV or video games a day maximum. And that's combined TV and video games, not each. Some kids spend 6 to 8 hours a day in front of the TV, which is almost as much as they sleep. Add to that the snacks that kids are eating while they're sitting in front of a TV, and that's a huge problem. One of the recommendations I came across is that boys should be taking 15,000 steps a day, and girls should be taking 12,000 steps a day as exercise. A pedometer is a neat, inexpensive, and fun device that kids can wear to measure how many steps they're taking. So, to start, children should be active at least one hour a day.
The problem in a lot of inner city communities is that children might not have a place to go. They might not have an acceptable physical space close to them, and I don't expect people to send their kids out on the street. But something people can do is exercise with their kids. They can powerwalk around the neighborhood or to a park, where they can then throw a ball back and forth or just run around. If parents can afford it, they can have their kids play in an organized sports league or take karate classes. It helps to try to build exercise into some kind of a schedule. For example, when you go to the supermarket, powerwalk there, or maybe even walk a couple blocks past the supermarket first, and then come back. Parents need to get creative. Some parents get exercise DVDs or videos that they do at home, and that's a great idea. You don't have to be outside for it, and you can actually work up a good sweat, so if you can do that several times a week, that's great.
Just keep in mind that you need to set a good example and turn off the TV yourself. One little boy who is a patient tells me, "My daddy sits on the couch watching TV and he tells me to get him the potato chips." So you tell that child to exercise and he's going to say, "Well, you don't, why should I?" Obesity is a huge problem here in New York, and being overweight leads to a lot of problems like high cholesterol, high blood pressure, and joint pain, and so on. And diet is very important too. The best way to eat healthy is if the meals are made at home, so you know exactly what's going into your kids. Avoid junk food, avoid fatty foods, provide three healthy meals a day and good snacks, like fruits and vegetables, as opposed to chips and cookies and stuff. Once again, parents really need to model this for their kids. You can't eat potato chips and then tell your child to go eat a carrot. It doesn't work. So just don't have junk food at home. Instead of soda, drink water. The amount of soda kids drink is ridiculous, and it's a ton of sugar and empty calories.
Is there a difference between being lactose intolerant and allergic to milk? And do these conditions affect certain communities more than others?
Asian, African-American, and Mediterranean communities have a higher prevalence of lactose intolerance. And, yes, there is a difference between a milk allergy and being lactose intolerant.
A milk allergy means that your child's body reacts against the protein in milk, so they can develop a rash, experience abdominal pain, or have blood in their stool. Lactose intolerance, however, happens when dairy or milk is consumed, and the sugar in it can't be digested properly. When your body doesn't have the proper enzymes to digest it, you get a lot of gas, you feel bloated, you can have abdominal discomfort or diarrhea, and stuff like that. Some of these symptoms are similar, which is why there's sometimes confusion between the two. A milk protein allergy generally gets better, so if there's a 2 or 3 month old baby with bad eczema, rash, or crankiness when feeding due to a milk protein allergy, it will often lessen with time. A lot of these children may even be able to tolerate milk in the future. With lactose intolerance, though, the condition is likely to stay the same or get worse. Another difference is that babies and infants may get a milk protein allergy, but we don't generally see lactose intolerance until kids are about 6 years old or older.
If you're concerned your child might have one or the other, check in with your pediatrician. Once a diagnosis is made, sometimes by a simple breath test we do in the office, the goal isn't always to eliminate dairy from the diet. In the case of lactose intolerance, there are pills that are sold over the counter that'll give your child the enzyme needed to digest the lactose, so your child can still get the calcium they need. But for those children who still can't tolerate dairy even with the help of pills, be sure to give them foods that are high in calcium, like collard greens, broccoli, okra, tuna, salmon, yogurt with live cultures, and calcium-fortified juices or soy milk.
Is it all right to put our baby to bed with a bottle, or is this bad for the teeth?
There's a lot of literature that says that babies that are put to bed with a bottle, especially with sugary drinks inside, will develop dental caries, which means cavities or tooth decay. It exposes the teeth to a lot of sugars and bacteria and creates an acidic environment. The recommendation from the American Association of Pediatrics is to not put babies to bed with bottles. If you absolutely must put your baby to bed with a bottle, put water in it because any fluid that has any form of sugar will be a risk factor.
Dental caries is another thing that is pretty common in inner city minority communities, especially if there's not good access to dental care. It's recommended that once a baby's first tooth appears, you should try to see a dentist within the next six months. And again, parents should provide the model for their children. Kids are more likely to do something if the parents really model it for them as opposed to telling them to just do it. Kids should absolutely brush their teeth in the morning and before going to bed. And it's never too early to start brushing a child's teeth. Even as soon as a tooth comes out in a baby, you can use a soft cloth to clean it. And as soon as there is space between two teeth that is hard to clean, you can start flossing! So brush a minimum of twice a day, but you can certainly brush more.
You must supervise young children when they brush, though, because they may swallow the toothpaste. And the younger they are, the more difficulty they'll have with being able to spit out. They only know to swallow, so it's important to use a small amount of toothpaste and to monitor them, especially since kids' toothpastes are made to be fun colors and flavors to appeal to children. But too much of a good thing is not always a good thing, and swallowing too much paste could be dangerous.
If a father is told that his child is a carrier for sickle cell anemia, does that mean that the child is going to get sick?
Sickle cell anemia is a blood disease that parents can pass on to their child. It affects how the red blood cells function. In times of stress or dehydration, or if there's an infection, the red blood cells in kids with sickle cell anemia basically form an abnormal shape. And that abnormal shape doesn't carry oxygen very well. It clogs up the blood vessels, and it cuts off circulation to vital organs and bones, which causes kids to experience a lot of pain.
When a child is labeled a carrier, it's called sickle cell trait, which means they've inherited the sickle cell gene from one parent, but not from the other parent. To have sickle cell disease, a child would have to inherit the trait from both parents. So kids with sickle cell trait essentially live a normal life without getting sick. They don't have the pain crisis, they don't have the problems with the spleen or the growth problems that kids with the disease have.
In New York State, when a baby is born, it's required to have its blood checked for a number of disorders, including sickle cell anemia, before leaving the hospital. If both parents know that they have the sickle cell trait, they'll want to know early on if their child has sickle cell disease. That way they can look out for some of the complications when the child is still an infant, such as their hands and feet swelling up and causing the child pain. Immunizations are very important, so make sure that your child is immunized against common bacteria that can cause problems for those with sickle cell, because their spleen doesn't function as well to help get rid of bacteria.
African-Americans have the highest rate of children born with sickle cell anemia: one in 650. Eight percent of African-Americans are carriers. Latin Americans have about a one in 1,400 prevalence of sickle cell disease.
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