Category Archives: Ask an Expert

Dr. Pia Fenimore, of Lancaster Pediatric Associates, answers questions about children’s health on the Ask the Expert feature at LancMoms.com.

It’s spring, which means all the little critters of the world hatch and come out … and that makes pediatricians think of pinworms. That’s what you were thinking of, right?

Pinworms, or Enterbiasis Vermicularis, are a parasite for which humans are the only host. This means you cannot get them from the dirt, your cat or your dog. You can, however, get them from your children and your friends. Infection occurs most commonly in children ages 5-10 and does not discriminate among race or socioeconomic backgrounds.

You become infected by ingesting (eating, swallowing, breathing in) eggs or larvae. These eggs are most commonly found in the fingernails and bed linens of an infected person. At night, the female worms migrate from the small intestine, outside of the body to the anal skin folds. They do this to lay their eggs (our body temperature would kill the eggs if laid inside and, like a good mom, she is just protecting her young). The eggs become “infective” within a few hours and when they do, they become very itchy. The infected person scratches, gets the eggs under their fingernails and on their fingers, touches their mouth or eyes and — just like that — the life cycle of the pinworm has been propagated.

The eggs are able to survive for several hours on surfaces and linens (several weeks in cool, humid environments). This means that an unsuspecting family member or friend can then acquire them on their fingers and infect themselves.

Savvy little things, aren’t they?

The No. 1 symptom of infection is a very itchy bottom at nighttime. This affects sleep and can even lead to skin infections from scratching. While most pediatricians will make the diagnosis based on history alone, you can confirm the presence of pinworms by doing a “Scotch Tape test.” This is performed by taking a clear piece of tape and pressing it against the anal skin folds, thus picking up the eggs on to the tape. The tape is then placed under a microscope, where it is very easy to see them and confirm the diagnosis.

Dr. Pia Fenimore

Q:  My grandson will be 5 years old in August. In the afternoon he says “I need a bottle.” He drinks milk out of it. He doesn’t drink milk from any other source. What do you think about this? His grandpa and I think mom and dad should just say no more bottles.

A:  I agree with Grandpa and Grandma.  He is way too old for a bottle.  It is recommended that parents begin taking away bottles at age one and be completely finished with bottles by age two.  This is based on several health and developmental needs.  Once  children have the oral motor skills to chew and speak they do not need to suck down their nutrition.   It is better for them to eat a variety of foods and avoid filling themselves up with large volumes of milk.  As teeth come in it is important to begin phasing out bottles because the nipple places milk on the upper back side of teeth which can promote the development of “bottle rot” or decayed front teeth.  And finally it is vital that children move beyond using a bottle for comfort: this is part of developing a normal independence.

Q: My 6 year old son has just recently begun to tell me that he feels his heart tingle. When I ask more about it he says it’s when he’s nervous, excited, worried or about to “attack” the girls clubhouse at recess.  He says it’s not thumping and not like a sleeping foot waking up but more like tickling from the inside. I know not to mess around with heart issues but is this an issue I need to worry about or just him getting excited/nervous?

A: Chest pain, tingling, or pressure in a child is something that should always be seen by a health care provider.   That said, most of the time, the cause is completely benign.  Symptoms in the chest cause much anxiety among parents because they think of heart disease.  However, in children chest symptoms are very rarely cardiac in origin.  Let’s think about all of things that are located in our chests: the esophagus and stomach, ribs and muscles, the lungs, the breasts, and oh yeah the heart too.  And we cannot forget the almighty brain who when nervous or stressed sends signals to the chest.

To pin down the source of the pain, it’s helpful to think in terms of these systems and the things that go wrong in them.  In preparation for the appointment with your pediatrician think about answers to the following questions:

Is this a chronic problem that comes and goes or is this something that came on fast and is persistent?  Does the pain occur during exercise?  Does the child describe the sensation of

Q:  Hi. My daughter is almost 7 weeks old and is exclusively breast fed.  I’m currently feeding her every 3 hours during the day, and she goes anywhere between 5.5 to 7 hours at night (typically I aim to feed her with a 6 hour stretch at night, but sometimes have to wake her to do so). She’s a healthy weight (9lbs 6oz at 1 month; was 6lbs 15oz at birth) and eats and sleeps well. In fact, lately, I’ve had to wake her from a deep sleep for many of her daytime feedings. When should I start lengthening the time between her daytime feeds (what is the typical schedule of time between feedings for each month/age for breast fed babies) and how long can/should I be letting her go at night? Thanks!

A: Congratulations!  I am so glad breast feeding is going well.  Pediatricians recommend that the first 2 weeks of life you strictly adhere to the every 2-3 hour feeding schedule, even through the night.  However, once you have cemented breast feeding and it has been proven that the newborn is going to gain weight adequately we loosen up considerably.  It is much better for a child your daughter’s age to feed “on demand” as they know what they need better than we do!

You can start now letting her sleep as long as she will at night.  What works for most moms is to do a feeding in the later evening (between 9-11pm) and then

Q:  I have a 6 year old daughter that is a patient at Lancaster Pediatric, and she is having an issue with her scalp. She has this powdery-dry whitepatches(sometimes red) on her sides of her scalp( that is the only place I see it) that can sometimes flake if you touch it and sometimes not. I messed with it one time, and her scalp bled in the places I was trying to remove it. When I comb or brush her hair she says it hurts( that’s also when I do not touch it at all, she complains it itches). At first glance, I thought it was dandruff, but I suspect its something else. I brought her a special dandruff shampoo( it helps with other scalp issues) that helps, but it still comes back within a few days. Its a bit frustrating because sometimes its there and sometimes its not. When its there it looks bad. I use a bit of oil which makes it disappear for a bit. I do not put harsh products in her hair. I use a kiddie shampoo , conditioner, and a lite moisturizer. Sometimes, I wash her hair with baking soda and apple cigar vinegar. Recently, I been using a dandruff shampoo.

We are going to be traveling with our 4 month old soon. We have been using well water for his formula. We will have to use bottled water while traveling. Do we need to boil it first? Also, do you recommend a certain brand? We’ve read Evian is suppose to be good but can’t find a clear answer if it needs to be boiled or not.

When you are traveling to places where clean water supply is not reliable we recommend that you mix formula with bottled water.  You do not need to boil it first as contaminated bottled water is very rare.  Evian has been around for a long time and is widely available and would certainly be a good choice, however, you may find a local version to be a bit more affordable and probably just as safe.

Happy Travels!

My son goes to daycare and I feel like he is always sick! I try to wash his hands and face as soon as he gets home. Is there anything  else I can do? Or is this now part of my life?

I know how frustrating this can be as both my kids went to daycare at a very young age.  First of all Mom to Mom let me tell you that you should not have any guilt about this.  Statistically children who attend daycare do not have more severe health problems than other children.  You are not harming your son with this exposure in anyway.

Now as  a pediatrician I will try to shed a little light on this frustrating problem.
A child who is not in daycare and does not have siblings will get 6-7 infections per year.  Children in daycare get 10-12 infections per year.  Interestingly this number is the same for children who are not in daycare but have siblings. It takes only two children spending a lot of time in close quarters to make infection rates increase.  So there is very little benefit in terms of infection prevention in choosing a smaller more intimate daycare.