13 tips for tackling parental concerns

1. Body mass index (BMI) percentile in tall children is sometimes overestimated. That is, a child who is aged 12 years with a BMI of 19.7 is at the 75th percentile, but a 10-year-old the same height and weight will be above the 85th percentile. Similarly, BMI percentile in short people is sometimes underestimated.

2. Glycerin, baking soda, and hydrogen peroxide have all been reported to be effective at treating cerumen buildup,¹ but I have not been that impressed by the results in my patients.

3. I like doing warm compresses for the eye by making a cup of hot water, dipping the washcloth tip in, and then, when the washcloth cools, redipping a different corner. This provides ongoing heat and a sufficient length of time.

4. Stroking down firmly along the spine can induce voiding in infants, if you are waiting around for a bagged specimen. Tapping rapidly for 30 seconds over the bladder has also been reported to help.

5. Phenazopyridine (Azo Standard), now available over the counter, can be used for dysuria in bladder infections in children until the antibiotic kicks in. For children in obvious pain, I usually suggest half a pill, crushed, every 8 hours as needed. Remind parents that it turns urine and tears orange.

6. For girls with urethritis, in addition to having them stop bubble baths, remind the parents to shampoo the child as the last thing before getting out of the tub, so she is not sitting in soapy material throughout the bath.

7. Some girls with dampness in their underwear are not incontinent, but leaking urine that has pooled in the vagina. Voiding while facing backwards on the toilet, forcing the legs apart, can help.

8. I have been staying away from rice cereal for infants because of reports of arsenic contamination. That having been said, I am not aware of any studies showing rice cereal causes harm, so parents need not feel guilty if they have been serving it.

9. Growing pains are almost certainly muscular. Stretching exercises may be helpful.²

10. Nine-month-olds have trouble letting go of objects. Giving a child this age 2 blocks to hold will usually allow you to use your stethoscope/otoscope without the infant grabbing it.

11. Buying time is very helpful. For example, a patient with a mild cough for 2 weeks may come in with the parents wanting an antibiotic. The books do say one can start an antibiotic now for a possible sinus infection, but I am not convinced and I usually prefer to wait. If you tell parents you want to give it another week to see if the cough resolves on its own, and that you will phone in an antibiotic if the child is not better - without having to see him or her again- they will usually be satisfied with that.

12. In the above scenario, when I do start with the antiobiotic, I tell parents it often does not work, and to stop it if the child is not better after 3 to 4 days. There is no point in a full 10-day course in this setting.

13. I had a parent who, when she wanted her child to give up pacifiers, had the child bring them in so I could donate them to other children. This solved the pacifier problem while also encouraging altruism, and I was happy to go along with mild deception.

REFERENCES

1. Soy FK, Ozbay C, Kulduk E, Dundar R, Yazıcı H, Sakarya EU. A new approach for cerumenolytic treatment in children: in vivo and in vitro study. Int J Pediatr Otorhinolaryngol. 2015;79(7):1096-1100.

2. Baxter MP, Dulberg C. "Growing pains" in childhood--a proposal for treatment. J PediatrOrthop. 1988;8(4):402-4066.