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Pediatric insider.

Good Posture

Q I'm worried about my daughter's posture. What can I do to get her to stand up straight?

A The common round-shoulder, hunched-forward posture of many children is called "postural kyphosis." With effort, most children can erase the forward bend and stand straighter. Rarely, there is a fixed spinal deformity called Scheuermann's Kyphosis that requires medical attention.

If you're not sure if your daughter can correct the slouch even if she tries, then see an orthopedic specialist.

The majority of slouching children don't have any kind of deformity. Their posture is probably caused by several factors: habit, rapid growth, social pressures, poorly balanced muscle tone, and perhaps a dash of childish rebellion.

Is your daughter especially tall, or an early developer? Some tall girls are shy about towering above their peers, and deliberately shrink down so they don't stand out. Girls who develop early or are well endowed sometimes try to minimize the appearance of their chest by hunching forward. Talk to your daughter if you think there is some deliberate slouching going on. Try to support her own self-esteem and pride in her body.

Exercising can help your daughter stand up straighter. Building strong core muscles and back extenders ought to pull back the shoulders and straighten posture. Stretching, pilates, or even light resistance work can all be helpful.


Some specific exercises to strengthen the back include:

Back Flys

Sit in a chair, holding two small weights or two cans of soup. Bend forward at the waist so your head is just about at the level of your knees, and lift the soup cans up as if you're using your arms to fly. Flap your "wings" slowly, staying in control both on the down-flap and up-flap, several times. Try to hold the soup up at the top of the flap for several seconds before the next down-flap.

Shoulder Blade Squeeze

Sit up straight in a chair. Draw your shoulder blades together, imagining that you're holding a little box between them. You can also do this exercise standing, or leaning over.

Remember: more time active means less time slouching in front of the computer or TV!


Q My now-five-year-old son was diagnosed with reflux when he was three or four years old. They found he had vocal nodules. Should I expect him to outgrow this reflux? Is there a danger in taking long-term maintenance medications? What might some alternatives be to treat the reflux?

A Reflux here refers to gastroesophageal reflux (GER), when acidic stomach contents come back upwards into the esophagus, or even farther up. It's found in almost everyone, at least occasionally, at every age, and if it occurs infrequently and without much pain, there's really no reason to "treat" it at all.

What you're talking about though takes the reflux one step farther, into genuine disease. It sounds like in your son, the acidic stomach contents are coming up far enough to damage the vocal cords, causing nodules. GER plus symptoms like pain, vocal cord nodules, breathing difficulties or poor growth = GER disease (GERD), and that's when treatment is a good idea.

Eating slower and chewing better will help, as will trying to sit upright, without jumping around, after a full meal (tough at age five!). The main medical therapies are medicines to remove or reduce the acid contents of the stomach.

Some of these include:

* Antacids like Turns or Mylanta. They work well but only for a short while.

* "H2-blockers" like Zantac and Tagamet. These work even better than antacids and have been on the market for a long time, with a long track record of safety. The pill versions of these are over-the-counter (OTC).

* "Proton pump inhibitors" (sometimes marketed as "acid blockers"), like Prilosec (omeprazole) and Prevacid. These are now OTC and are the most effective way to reduce stomach acid.

Though acid-blockers like Prevacid are labeled for short-term use only, that's to prevent the medicine from obscuring a more important diagnosis in an adult (like gastric cancer). In a child who has had an appropriate evaluation, long-term use of these medicines seems to be very safe.

The only long-term issue I know about with the use of these medicines is a reduction in bone mineralization among elderly adults who take them for a very long term. This hasn't been seen in children, but you should make sure your son is getting adequate dietary iron and vitamin D. Some studies have linked use of these medicines with increased infections in the intensive-care unit, but that really is a different situation than a normal child's ordinary life.

Will your child outgrow this? Maybe. It's worth a trial off of medicines at least every few years. As your child gets older, speech therapy may also help with the vocal nodules, which can worsen if your child has a loud or strong style of speech. I would keep in touch with the GI specialist or ENT who diagnosed the nodules for further input.

Frequent Colds

Q My six-year-old son gets sick with colds all the time. I think there is something wrong with his immune system. How many colds are too many?

A Ordinary children get a lot of upper respiratory infections. The average peaks at about twelve per year for pre-schoolers, then drops to about nine per year for kindergarteners like your son. Colds tend to occur more frequently once school starts in the fall, and continue at high frequency all winter. Since ordinary colds last at least 10 days, for the winter it might seem like even healthy kids are sick more days than they're well.

The majority of children who are often congested or who seem like they're getting too many colds are otherwise completely healthy. Though they get sick with cold symptoms a lot, they don't get other infections. Each individual cold does get better on its own. These kids are almost always in group care or in school, which explains their frequent cold virus exposures.

Many times, siblings also bring cold viruses home to share. These kids are healthy, and have no problems with their immune systems. The best way to ensure that your child fits into this common group--the "frequent fliers"--is to use a calendar to keep track of symptoms every day. If you see a pattern of cold symptoms that lasts about 10-14 days, followed by recovery, followed by another cold, then you know your child is recovering between colds. A child who's thriving and healthy and who recovers between every cold is perfectly normal and doesn't need to be otherwise evaluated. There's no immune problem here.

Another group of children that I see frequently are kids who "keep a cold." That is, they don't get better on their own. Cold symptoms linger, and eventually a sinus infection or ear infection develops. Some of these children have allergies that perpetuate their congested symptoms, and often there is a family history of frequent sinus or ear infections. Though these kids don't have an "immune problem" that you can find on blood tests, there is an underlying issue related to anatomy that prevents mucus from draining well. The best strategies for these children are to use methods to help prevent and clear out sticky mucus.

Very rarely, a child with frequent or lingering colds really does have an underlying immune disorder. The "red flags" to look out for are poor overall health, poor growth, and invasive or unusual infections that are difficult to treat. There is often chronic diarrhea and chronic skin rashes. Though this isn't common, kids in this group should be aggressively evaluated for an immune deficiency.

By Roy Benaroch, MD
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Author:Benaroch, Roy
Publication:Pediatrics for Parents
Geographic Code:1USA
Date:May 1, 2010
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