Hand sanitizer is a helpful way to maintain good hygiene, but when ingested, it is very potent alcohol. Kids who do so can get highly intoxicated, potentially leading to trips to the emergency room. I came across this news story that has some quotes from a toxicologist—a friend who I did residency with—that discusses this trend and the related dangers.

So, if you notice that your hand sanitizer bottles are disappearing at an alarming rate, it’s time to have a serious conversation with your children.

A big thanks to all the moms out there including my wife.

Have a great Mother’s Day this weekend.

And so it goes nearly every evening in the Nohle household. It doesn’t matter how many times I read those words, my son can’t hear them enough. Green Eggs and Ham is his favorite book for read-aloud time at the moment. My daughter had her own favorite when she was younger: Andiamo Weasel. Now she reads her chapter books.

I must have read Andiamo Weasel a thousand times, partly because it was a mainstay of the bedtime routine, and partly because I just loved the story, not to mention all things Italian. It was just one of those books that I did not get tired of reading again and again. With Dr. Seuss, I tell my son that he was the last good doctor out there. The silliness of the book just makes me laugh. I try to read it from cover to cover without making a mistake, which is quite a challenge if you have not tried.

In clinic, I often talk about the many benefits of reading aloud to kids. When you read to your kids, you’re helping to orient them to language—teaching them basic speech skills and vocabulary. Behind the language, you’re helping them to learn logical thinking skills such as cause and effect. Studies show that children who are exposed to reading before preschool do better academically when they enter school. This is why many of our clinics are part of the Reach Out and Read program which gives away books to young children at their well visit.

Read-aloud time can be an important part of a child’s daily life. I sometimes wonder why my kids can tolerate hearing the same story every evening for weeks at a time, but I realize it’s one of many facets of their daily routine that helps them feel secure and comforted.

Maybe even more importantly, when you spend time reading aloud to your kids you’re building a loving relationship with them. Sharing uninterrupted time, and a story you both enjoy, can be nurturing for both parent and child. My kids love to have this special time I spend just with them, and I also look forward to a chance to slow down and have a quiet segment of the day with my kids.

A reminder to everyone out there to make sure that you are up to date on your tetanus pertussis vaccine (Tdap).

Those of us living in the Northwest do not see the sun often enough to make enough vitamin D, and thus need to supplement. The problem here is that although the sun helps our bodies make vitamin D, we just don’t see that yellow ball in the sky for nine months of the year. When it is out in the summer, you should be applying sunscreen, which protects you from the sun but unfortunately decreases your natural vitamin D production at the same time.

Most children and adults with a typical healthy diet will take in adequate amounts of the other nutrients, but with vitamin D, it’s challenging. In 2010, the Institute of Medicine increased the recommended dose of vitamin D to 600 IU for all people who are more than 12 months in age. This is up from the prior recommended dose of 200 IU. A glass of milk or fortified orange juice has about 100 IU per serving. We typically do not recommend children drink more than 2 glasses of milk a day. Cheese does not have vitamin D. Things like yogurt contain only about 40 IU per serving. Herring has about 1300 units for a small serving, but I doubt you will get your child to eat it on a regular basis. Salmon and Halibut are fantastic sources with a small serving getting us very close to our daily need but it is too costly for most households to eat on a regular basis. That leaves us with the need to supplement.

Vitamin D is important for healthy bone strength as it plays a role in calcium and phosphate regulation. This is where there is the best evidence for its benefits. It’s a fat-soluble vitamin, which means that your body stores it and thus it’s possible to get too much if excess doses are taken for a prolonged period of time, causing symptoms such as irritability, muscle weakness, elevated blood pressure or kidney stones. It’s the in-vogue vitamin these days and gets mentioned for other indications such as prevention of multiple sclerosis, cancer, and heart disease, but the evidence thus far is not as strong. More studies are necessary to really tease this out. Time will tell if it lives up to the hype, but at least we can encourage strong bones in future by getting an adequate amount now.

Parents often ask me what I think is the best way for kids to learn to ride a bike. They wonder if it is better to start kids off with the newer pedaless bikes, scooting along with their feet on the ground for locomotion. The short answer is that I don’t know. I’ve reviewed the medical literature to see if there was anything studied on this topic and found nothing.

Balance is a skill that children learn over time and one that requires practice, whether it be riding a bike or walking the balance beam on the playground. Let’s face it, some children are more coordinated than others, but practice is critical. This can be done by encouraging fun activities like setting up an obstacle course, balancing on objects on the playground, playing games like hopscotch, or even yoga.

Circling back to the balance-bike question, there is no right answer. Every child is different. One would think that by allowing a child to focus on the balance part of learning to ride, instead of pedaling, it would speed up the process, but this hasn’t been the case for our family thus far. The most important thing is that your child is active and having a great time riding no matter what type of bike they are using.

Don’t forget the helmet please.

As any parent who has witnessed a febrile seizure knows, they are frightening. Even we pediatricians do not like to see them. As frightening as they are, it’s important for parents to know that they do not cause a subsequent seizure disorder or lead to epilepsy. The typical age for febrile seizures is between 6 months and 6 years of age with the peak incidence being around 18 months. Any illness causing a fever can cause this and to put things into perspective, the majority of children that have a febrile seizure will have them due to a viral illness.

I do not see this as any big controversy or anything groundbreaking but as an example of how we try to use evidence-based data to make better decisions when it comes to vaccines or for that matter, other aspects of how we practice medicine.

At least a few times a week, I have a conversation with parents about allergy testing for seasonal allergies. The conversation predictably goes something like this: the child is having allergy symptoms this time of year due to something in the air and the parents are interested in testing for that allergy but have not tried any typical treatments first. I’m not sure why parents can be so willing to subject their kids to skin prick tests, which can involve upwards of 20-plus pinpricks.

When it comes to most allergies, I prefer a try-and-see, broad-spectrum approach before going for testing that can be uncomfortable for the child, and expensive depending on your coverage. Don’t get me wrong, there is clearly a role for allergy testing, but I like to have parents try medications containing cetirazine or loratadine first prior to testing, to see if they bring some relief. Even if the testing does show results, the treatment still might be over-the-counter medications. For most of us, it matters less what we are allergic to and more how we can alleviate our symptoms.

I do recommend allergy testing when medical therapy isn’t doing the job or allergy shots are the preferred mode of treatment because the parent or child simply does not want to use a medication. Food allergies are a different topic for another day.

As examples, I’m much less inclined to do a test that involves pain such as a blood draw or allergy test unless it’s really necessary. When it is necessary, I don’t think twice about it.

I can think of countless other examples where I think we show a sensitivity in the pediatric arena that you sometimes don’t see in adult medicine.  Pain with urination comes to mind. We would never make a child wait until tomorrow to get a urine sample to evaluate for a bladder infection, yet I can recall times in the past when the adult would be told “we can get you in tomorrow.” That just wouldn’t fly in my world. As many parents can relate, that mommy- or daddy-bear instinct just kicks in when it comes to our children and we expect more and thus we as pediatricians also want to deliver more. Ultimately we all deserve to be treated with care, compassion, and dignity.

I also had a great relationship with my pediatrician growing up and it definitely shaped why I chose to go into the field. He is still in practice in the Tacoma region.

The short answer to this reader’s question is no, you’re not expecting too much and you shouldn’t settle for less. Most of us who choose pediatrics do so because of our love for children and want a career where we can watch children grow up over time. This is the most rewarding part of the job. This is the person who’s going to be caring for your child and you need to be able to have trust in this relationship. This does not always mean you will see things eye-to-eye, but there should be mutual respect for each others’ opinions. I really do see myself as part of the family for the first 21 years of your child’s life.

It’s true that it can be harder for physicians at this time to deliver on this kind of relationship looking at the medical field as a whole. Medicine has evolved and it is clearly a business. The majority of the country is still in the fee-for-service world. Basically, this is an antiquated system based on the premise that the more visits and procedures providers do, the more money they make. It’s a broken system that ignores quality in the equation. As reimbursements from various payers have declined, many physicians need to see much larger numbers of patients in a day in order to survive and cover their overhead. This clearly can make it challenging to deliver on a meaningful positive experience in a short time period. The bright spot is that there are systems that are finding ways to buck this no-win cycle and improve both the patient-physician relationship and the quality of care. I’m proud to say this recent show on PBS cites Group Health among these breakout systems. It’s not impossible, but it takes work.

Ultimately, you should seek out a pediatrician that both you and your child feel comfortable with and one that embodies the traits of good medical knowledge, excellent listening skills, and compassion. There are a lot of these fine doctors out there. Sometimes you find the right fit from the start, and sometimes you have to try a few doctors to find that relationship that will last.

Here’s a post I wrote a while ago that talks about what I look for when I’m hiring doctors at Group Health.