Dr. Hillary

Dr. Hillary is a pediatric nurse practitioner with a doctoral degree in health promotion and risk reduction.

She knows when it comes to family, everyone has questions that can't wait for the next available doctor's appointment. She also knows some questions are too personal to ask a doctor face-to-face. For these reasons, Dr. Hillary is here for you.

Here are a few of Dr. Hillary's recent questions and answers!

NEW!
Q: When should I take my baby for her first dental exam?

A: The American Academy of Pediatric Dentistry recommends your baby has her first dental exam by 1 year of age.

The U.S. Centers for Disease Control and Prevention report that dental decay is one of the most common chronic infectious diseases among U.S. children. Research indicates that 17% of children 2-4 years of age have tooth decay. In addition, by 8 years of age, about 52%, and by age 17 years, 78% of children experience tooth decay.

Since an ounce of prevention can make a difference, start to brush your child’s teeth as soon as they erupt. Use soft baby toothbrush and baby toothpaste without fluoride. Your child may start to use toothpaste with fluoride when she learns to spit it out reliably. Should she swallow fluoride-containing toothpaste, she would end up with permanent white spots on her teeth.

Q: My children (2 and 4 years old) almost always get constipated. What should I do? What are the right foods to eat to prevent constipation?

A:Constipation is frequent in childhood. Most likely it is due to diet, although other factors might be at play. Often excessive intake of dairy products, such as milk and cheese, are to blame. Also, most of the time children do not eat enough fiber, which comes from fruits, vegetables, oatmeal, and cereal (Coco Puffs do not count!). Fiber is crucial to healthy bathroom habits.

Your children should not drink more than 2-3 cups of milk a day and eat no more than a slice of cheese daily. Offer them fruits and vegetables with every meal and snack. Note that bananas might constipate some people, so watch how many your children eat a day. When they have a hard time going to the bathroom, you can give them prune juice that can be mixed half-and-half with their favorite juice. If that fails to soften their bowel movements, talk with their regular health care provider.

Suggested reading: Childhood Constipation

Q: If my child’s runny nose turns green, does it mean she has a bacterial infection?

A:Green nasal discharge does not necessarily mean a bacterial infection. In the normal course of a cold, the drainage may change colors. It may run clear one minute, then change to yellow and green, and then go back to clear. As long as the colors change back and forth, there should be no concern. However, if the nasal drainage turns green and persistently stays green for a couple of day, perhaps accompanied by a fever, headache, or worsening cough, your child should be evaluated by her health care provider as she may have a sinus infection.

Q: Is it safe to put my 4 months old baby in a baby walker? I personally against it, but my mom insist. I feel helpless and need some professional advice.

A: The American Academy of Pediatrics recommends that babies do not use walkers.

Every year many injuries happen to children who walk in walkers. They can fall off the stairs, get to places where they can get injured, and are definitely too fast for parents to protect them. For your baby's safety and your piece of mind, get a saucer, a stationary station, where your child can enjoy the world from an upright and stationary position.

Q: Q: My 4-year-old daughter refuses to give up her pacifiers. Usage is limited to her bedtime, but she is really dependent on them to go to sleep. We’ve tried bribes, gifts, stories about going to needy babies, the pacifier fairy, etc. She says she wants to give them up, but when it comes down to it, she seems to physically need them to sleep. How do I wean her from these? I have been waiting for her to say she is done with them but it is not happening. Plus, she has a younger brother who uses them too. Any advice?

A: The best time to wean a child off a pacifier is around the first birthday. After that, pacifiers become security objects and every month parents wait to get rid of them adds several months to the weaning process.

Your daughter derives comfort in sucking on a pacifier at bedtime, and that is probably the only way that she knows how to fall asleep. At this point, the best approach would be to either “lose” the pacifier one day, or start cutting off a piece of the rubber every day until there is only the plastic shield left. In the first approach, your daughter will be very upset for a couple of nights. Provide her with a substitute “security object” like a blanket or her favorite toy. She should get over her loss fairy quickly. The most important thing is that you do not give in and "find" it later. Once you make a decision to go with either plan, follow through. If you give in, your child might end up with dental and speech problems. Good luck!

Q: At what age should I introduce juices to my daughter? She is 4 months old now.

A: Juice can be introduced to infants at 6 months of age. But remember that even 100% juice is high in sugar, thus resulting in empty calories. Therefore, offer your infant just 2-3 ounces of juice a day and dilute it with equal parts water. Using juice to flavor drinking water will help your child maintain a healthy weight and prevent cavities.

Q: My son has a yeast infection in the diaper area (in the front). It's approximately the size of a nickel, but it will not clear up. We have been using an anti-fungal cream with each diaper change and it doesn't seem to be working. Do I need to change the cream? He has never had problem with diaper rash before, but it was diagnosed (at his 1 year well-baby check) to be yeast.

A: Yeast infections in the diaper area are very responsive to nystatin, an antifungal cream. However, sometimes it does not work, and trying another cream, such as clotrimazole, can do the trick. Should a cream change bring no improvement, other diagnoses need to be considered. For example, a condition called nummular eczema may often be mistaken for ringworm and responds well to hydrocortisone or other steroid creams. Talk to your health care provider for suggestions on how to improve your son’s skin condition.

Q: My child’s pediatrician told me not to use Q-tips to clean my baby’s ears. Why?

A: Q-tips tend to push wax down the ear canal, and eventually lead to wax impaction. In addition, it is virtually impossible to safely use Q-tips in squirming babies or toddlers, thus they are not recommended. You would be surprised how many broken Q-tips or pieces of cotton I have removed from my patients’ ears! Some of these patients sustained an eardrum injury during ear cleaning with a Q-tip.

The safest and most effective way to clean children's ears is to wipe the ear canal with a wet washcloth. Wrap the washcloth around your finger, insert it into your child’s ear canal as far as it goes, and wipe.

Rule of thumb: nothing smaller than an elbow goes into an ear! This essentially means that ear wax is beneficial to our ears, and its best left alone to do its job.

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Dr. HillaryDr. Hillary is a pediatric nurse practitioner with a doctoral degree in health promotion and risk...Read more >>
Anna Tielsch-Goddard CPNP-PCAnna Tielsch-Goddard CPNP-PC is a Pediatric Nurse Practitioner for Children’s Medical Center Dallas at...Read more >>
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