Q&A with a Bend Pediatrician
Q: My five-month-old is experiencing frequent diaper rashes, causing her pain when we change her. The redness and crying concerns me. Will this clear up or should I seek medical attention?
A: Diaper rashes are the most common skin rash in infants and have a vari- ety of causes. Most simple diaper rash- es are caused by trapped moisture in the diaper area that irritates the skin and makes it more sensitive to the friction of wearing a diaper. The mixture of stool and urine in a diaper creates urease, which is also a skin irritant. This type of simple irritation will resolve in 2-3 days with application of a barrier cream such as zinc oxide and with giving your child’s bottom some “fresh air.” The barrier creams can be hard to clean off, though. It is best to leave a thin layer on the skin or to use something oily to clean it off without rubbing the skin. After your child has had a diaper rash for three days or more, it is much more likely to be infected with yeast. An antifungal such as over-the-counter clotrimazole can be very effective. If the diaper rash keeps getting worse with these treatments, I would bring your child into the doctor for further evaluation.
Q My six-year-old son’s teacher says that during recess he does not seem to be interested in playing with the other children, and usually sits alone instead of participating. When I ask him about it, he just says he prefers to watch. Should I be concerned?
A: Well, maybe. Peer interactions are one of the most important aspects of attending school at his age. First, clarify with the teacher if your son’s desire to be alone is something she notices at other times of the day. Will he participate in group projects and play with other children in his class? Secondly, what have you noticed about his behavior at home? Does your child show interest in other children? Does he ask to have play dates with his classmates and friends? These questions will help you understand if the issue your son is having is specifically about recess or if social interactions are difficult for him overall. We used to believe a child was ready for school if he had an understanding of numbers and letters, but now we know that school success is more complex than just academic readiness. The way a child interacts with his or her peers in kindergarten sets the stage for his social skill development. Having self-confidence, showing interest in his peers, and learning to cooperate and communicate effectively are import- ant skills to develop early on in school. If your son is otherwise interested in playing with children, then I suspect there is something specific about recess that he finds intimidating or unpleasant. Discussing the emotions he is feeling that may be affecting his desire to participate, such as saying, “Sometimes I don’t want to do something because I am afraid, has that ever happened to you?” Or sharing an experience that you had as a child may open up a more specific conversation about what is happening at recess. If you are concerned, your pediatrician can help.
Q: Whenever my friends come over, my daughter, who is almost three, loves to talk. The problem is most people cannot understand her and are always looking for a translation. I understand most of her words, but just barely. Should we seek help from a speech pathologist?
A: This is a great question. Speech development is individual for every child and family. Many things affect language development: the number of languages spoken at home, the amount of reading your child does, hearing, even birth order can have an effect. The average expectation in speech development is that by the time a child is 3 years old, parents can understand 75-100% of what their toddler is saying, and strangers should be able to understand most of what your child says. Since it sounds like your friends, who are probably familiar with your daughter, are having trouble understanding any of her words, I would discuss it with your doctor. Most doctors’ offices have screening questionnaires such as the ASQ (Ages and Stages Questionnaire) that can help you decide if it is time for your daughter to have a speech evaluation by a speech and language pathologist. If you would like to have a general evaluation of her overall development, Healthy Beginnings is a local program that provides free screening (including vision, hearing, behavior, and development) to children from 0-5 years of age who live in Central Oregon. They have a great website at www.myhb.org that outlines the type of screening that they do, the times of the scheduled screenings, and local re- sources. Most children with hard to understand speech or mild speech delays respond very well to speech therapy. Research shows that if speech problems are treated early most children do very well with communication later in life.