The return of fall means back to school and back to busy sched- We also review the basics of eczema,

czema, that chronic dry skin that

ules and hectic lifestyles. In this issue we have some advice on tends to worsen at this time of year as the air becomes drier and
how to eat healthfully, even on the go and how to maintain that cooler and heating systems get turned on in the house.
increasingly important structure and routine in your childs day.

Hungry in a Hurry: Food for Fast Times

In our fast-paced world in which adults and children alike kingsize portions, that can sabotage your childs best efforts to
often seem to have too much squeezed into their days, we can control her weight. Also, fast foods often dont supply a healthy
be tempted to give in to the convenience of the local fast-food balance of vitamins and minerals and are frequently very high
restaurant. in salt.
Unfortunately many of the choices are high in fat, sugar, and However it is possible to make more nutritious selections when
calories, from hamburgers to fries to shakes, often served in you are on the go.

Try these options:

A grilled or charbroiled chicken sandwich It is wise to steer clear of buffets that can tempt everyone
(without the skin and mayonnaise) to eating too large of portions and second helpings.
A regular-sized hamburger Portion sizes served at restaurants tend to be very large.
(not the large one with all the fixings) Consider splitting portions among the family or take
Instead of fries on the side, have some fruit or a salad with leftovers home for the next day. A proper portion size
a small amount of salad dressing of meat or grain is the size of ones own fist.
A plain baked potato For grab-and go meals from the supermarket, try ready-
(perhaps topped with vegetables from the salad bar) made deli sandwiches (made with reduced-fat deli meats)
Skim or 1% (low-fat) milk or orange juice or roasted chicken served with fresh fruits and vegetables
(rather than a highfat shake or soda) from the salad bar.
If your child must have fries, divide a single order among Source
several members of the family. A Parents Guide to Childhood Obesity: A Road Map to Health
(Copyright 2006 American Academy of Pediatrics)

1275 Summer Street 36 Old Kings Highway South

Suite 301 Darien, CT 06820
Stamford, CT 06905
P: 203-324-4109 P: 203-655-3307
F: 203-969-1271 F: 203-655-9607

www.StamfordPediatrics.com FALL 2012



Why are family routines Eczema

so important to Eczema (also known as atopic dermatitis) is due to a hypersen-
sitivity reaction (similar to an allergy) in the skin, which leads to
children? long-term swelling and redness (inflammation) of the skin. It usu-
ally appears as reddened skin that is dry and peeling or may start
Every family needs routines. They help to organize life and
oozing, occasionally resulting in small, fluid-filled bumps. When
keep it from becoming too chaotic. Children do best when rou-
eczema becomes chronic (persists for a long time), the skin tends
tines are regular, predictable, and consistent.
to thicken, dry out, and become scaly with coarse lines.
As a parent, review the routines in your household to ensure
Atopic dermatitis often occurs in infants and children who have
that they accomplish what you want.
allergies or a family history of allergy or eczema, although the
Weekday Mornings problem is not necessarily or always caused by an allergy.
To make the household function well in the morning, everyone Eczema usually develops in three different phases. The first occurs
needs to know what has to be done to get ready for the day. between two and six months of age, with itching, redness, and the
Try the following: appearance of small bumps on the cheeks, forehead, or scalp. This
Put as many things in order as possible the night before. rash then may spread to the arms or trunk. Although eczema often
Keep wake-up routines cheerful and positive. is confused with other types of dermatitis, especially seborrheic
Be sure your child eats breakfast, even if she is not dermatitis, severe itching and additional allergy problems are clues
hungry in the morning, have her get some food in her that atopic dermatitis is the problem. In many cases the rash disap-
system to start the day. pears or improves by two or three years of age.
Finally, round out each morning by saying goodbye to
your youngster. A simple hug and a wave as she heads
out the front door or slides out of the car are extremely
important. They will give her a positive feeling with
which to begin the days activities.
After School
During middle childhood, children need adult supervision.
While some parents have their children return each afternoon
to an empty home, these latchkey kids are more susceptible
to misbehavior, risk-taking, and anxiety. For this age group,
the American Academy of Pediatrics recommends that a child
come home to a parent, other adult, or a responsible adolescent.
Evenings
Dinner should be an important time for your family. As often as
possible, all family members should eat together at the dinner
table, without the distraction of television or radio. During dinner
the family can share the days activities and participate in enjoy-
able conversation. Everyone should be encouraged to take part,
and negative comments and criticism should be discouraged. Fun Facts About Eye Color
Bedtime Iris color, just like hair and skin color, depends on a protein
On school nights, children need a regular time to go to sleep. called melanin. We have specialized cells in our bodies called
Lights can go out at different times for different children in the melanocytes whose job it is to go around secreting melanin
family, depending on how much sleep each youngster needs. where its needed, including in the iris. When your baby is
Nighttime rituals can help ease a youngster to sleep. These ritu- born his eyes will be gray or blue, as melanocytes respond to
als can include storytelling, reading aloud, conversation, and light, and he has spent his whole life in the dark.
songs. Try to avoid exciting play and activities before bedtime. Over time, if melanocytes only secrete a little melanin, your
baby will have blue eyes. If they secrete a bit more, his eyes
Source will look green or hazel. When melanocytes get really busy,
Dad to Dad: Parenting Like a Pro eyes look brown (the most common eye color), and in some
(Copyright American Academy of Pediatrics 2012) cases they may appear very dark indeed. Because it takes about
a year for melanocytes to finish their work it can be a dicey
business calling eye color before the babys first birthday.
The second phase of this skin problem occurs most often between- To do this:
the ages of four and ten years, and is characterized by circular, Give your child frequent soaking baths in lukewarm water.
slightly raised, itchy, and scaly eruptions on the face or trunk. These After a bath, rinse twice to remove any residual soap (which
are less oozy and more scaly than the first phase of eczema, and the might be an irritant). Then apply cream or ointment within
skin tends to appear somewhat thickened. The most frequent loca- three minutes of getting out of the bath to lock in the moisture.
tions for this rash are in the bends of the elbows, behind the knees, Avoid any triggers, including harsh or irritating clothing
and on the backs of the wrists and ankles. All types are very itchy, (wool or coarse-weave material).
and the skin generally tends to be very dry. Avoid scratching the rash or skin: Keep your childs finger
The third phase, characterized by areas of itching skin and a dry, nails cut short. Consider light gloves if nighttime scratching is
scaly appearance, begins at about age twelve and occasionally con- a problem.
tinues on into early adulthood. Use skin moisturizers (e.g., creams or ointments) regularly
The condition tends to get worse when the person is exposed to and frequently (up to 2-3 times per day) to decrease the
certain triggers. dryness and itchiness. Moisturizers should be free of alcohol,
scents, dyes, fragrances, or other chemicals.
The following can make atopic dermatitis symptoms worse:

Allergies to pollen, mold, dust mites, or animals
There are many types of medicated prescription creams and oint-
Cold and dry air in the winter
ments available, so ask your pediatrician to suggest one that he
Colds or the flu prefers to control inflammation and itching. These preparations
Contact with irritants and chemicals often contain a form of cortisone, but there are also several types
Contact with rough materials, such as wool of nonsteroidal medications. These creams or ointments should be
Dry skin used on an as-needed or daily basis, but only under the direction of
Emotions and stress your childs doctor. In addition, other lotions or bath oils might be
Exposure to too much water, such as taking too many baths or prescribed. Its important to continue to apply the medications for as
showers and swimming too often long as your pediatrician recommends their use. Stopping too soon
Feeling too hot or too cold, as well as sudden temperature will cause the condition to recur.
changes In addition to the skin preparations, your child also may need to take
Fragrances or dyes added to skin lotions or soaps an antihistamine by mouth to control the itching and antibiotics if
the skin becomes infected.
Treatment
Although there is no cure for eczema, it generally can be well Source
controlled and often will go away after several months or years. The Immunizations & Infectious Diseases: An Informed Parents Guide
most effective treatment is to prevent the skin from becoming dry (Copyright 2005 American Academy of Pediatrics)
and itchy and to avoid substances that cause the condition to flare.

The color change does slow down some after the first 6 months Source
of life, but there can be plenty of change left at that point. Dad to Dad: Parenting Like a Pro (Copyright American Academy of
Eye color is a genetic property, Pediatrics 2012)
Two blue-eyed parents are very likely to have a blue-eyed
child, but it wont happen every single time.
Two brown-eyed parents are likely (but not guaranteed) to
have a child with brown eyes.
If you notice one of the grandparents
has blue eyes, the chances of having
a blue-eyed baby go up a bit.
If one parent has brown eyes and the
other has blue eyes, odds are about
even on eye color.
Keep Kids Safe while Traveling
To and From School
Whatever the mode of transportation to and safe. Avoid heavy traffic, hills, sharp turns Teach your children to be safe while board-
from school, parents should teach children and streets with many bumps or potholes. ing and riding the bus.
how to be safe. Tips from the AAP: Remember to obey the rules of the road and Stop at the curb and wait for the bus to come
Walking use hand signals to communicate turns and to a complete stop.
Walking to school is a great form of exercise. stops. If allowed children should ride on the Look both ways before crossing the street to
Teach your child to be safe when crossing sidewalk away from cars. get to or from the bus.
the street. Stop at the curb and look left- Driving Listen to the bus drivers instructions at
right-left for traffic before stepping into the Parents should require everyone in the car all times.
street and watch for other cars as you cross. to wear a seatbelt at all times. Younger chil-
Look for signs that a car is about to move dren should be secured in an age-appropriate
from a parking space or driveway, such as car seat or booster seat and children under
rear lights, exhaust smoke, sound of a motor, age 13 should always ride in the back seat.
or wheels turning. Help keep your teen safe while driving by
Listen to the directions of the crossing guard. setting restrictions on the number of passen-
Biking gers and eliminating distractions.
Before heading out on a bike, make sure it Riding a bus
is in working condition and that the rider is According to the National Highway Traffic
wearing a helmet. Safety Administration, riding a school bus is
Make sure the route to and from school is the safest way for a child to get to school.

Maura Angiello-Smith, M.D. Jennifer F. Henkind, M.D.

Amy E. Cram, M.D. Heather M. Larson, M.D.
Lambros G. Geotes, M.D. Rebecca L. LePage, M.D.
Debra K. Gotz, M.D. Amy E. Lief, M.D., M.S.
Andrew S. Hart, M.D. Jamie Roach Murray, M.D.