Apr 18, 2014 fbook icon twitter icon rss icon

health

Teenage Growing Pains: What's Normal and What's Not

The Pediatric Insider

© 2011 Roy Benaroch, MD

Heather wrote in, “I am a 14 year old girl that has joint pain in the morning. The pain might be in my knees, elbows, wrists and hands, ankles, or my lower back. The pain is usually mild but can become severe. I am active in sports so the joint pains are really slowing me down. Is this growing pains or something more?”

While it might be OK for grandma to wake up with achy joints, I don’t think this is something that I’d call normal or expected in a teenager. Heather needs to think about other things, and get a more-thorough evaluation from her own physician.

Morning joint stiffness is quite characteristic of many kinds of arthritis, or inflammation of joints. Overall, the most common forms or arthritis are called “osteoarthritis,” and are a condition of aging. That’s my grandpa takes a little while to get going in the morning, and awakes with pops and creaks and moans. Hopefully, we’ll all live long enough to enjoy some degree of osteoarthritis as we age—but under ordinary circumstances, 14 year old girls should not have this.

Some kids really do overdo it, and may have symptoms of joint overuse at a young age. This is especially seen in year-round athletes, who play one sport for many months without giving their bodies a chance to rest. These kinds of pains are seen as part of “overuse” syndromes, especially when the same sort of action is done over and over again. Think about a baseball pitcher’s shoulder, or a runner’s knee: over and over, the same forces applied in the same way across a joint. Eventually, you’ve got pain and damage. Contrast that to a baseball player who varies position, or a runner who swims or cycles on some days. It is not a good idea for anyone, young or old, to repeat the same exercise over and over, especially for months at a time.

Heather, though, isn’t talking about one joint: she’s achy all over. This makes it possible that she has another kind of arthritis, perhaps one in a family of immune or inflammatory arthritis. I’d especially be concerned about this if Heather reported joint swelling or stiffness in the morning, even more so than pain.

There are also musculoskeletal conditions that can lead to chronic joint aches, most commonly conditions where the joints are too lax and flexible. Many of these conditions can be helped by working with a physical therapist to work on strengthening and coordination.

So while I don’t have an exact answer for Heather, I would say that no, that sort of pain in a teenager isn’t normal, and she ought to go for a thorough evaluation by her pediatrician, an orthopedist, or a sports-medicine doctor. She should bring along a log book of a few weeks’ history: what was her exercise routine, and how much pain was there each morning? What joints hurt the worst, which day? If there’s swelling, take a photograph to bring to the doctor (or make the appointment early in the AM, so the doc can see it.) I think with a good evaluation and some guidance, Heather ought to be able to get some relief and get back to enjoying being an active teenager. It’s not time to be grandma, yet!


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Swedish Meatball MedCare & Scottish Non-Care

Over the years, we've chronicled the (mis)doings of the MVNHS© and CanuckCare. Some critics have asked why we don't focus as well on more...ahem..."successful" national health care systems, such as Sweden's. Aside from the fact that America is more culturally akin to Great Britain and Our Neighbors to the North©, there's the rather striking fact that Sweden's health care scheme is not exactly a paragon of virtue.

And now, the Swedes have proven once again that their system is, in fact, broken:

"After sustaining an open chest wound of 10cm long while trimming her horse’s mane, Sweden’s emergency response services refused to send an ambulance, suggesting the 11-year-old girl take aspirin instead." [ed: 10cm~4"]

The girl's mother called the Swedish equivalent of 911; the dispatcher refused to send an emergency response team and instead suggested that mom simply dress the gaping, bleeding wound and give her daughter an aspirin.

Great bikini team, not-so-great health care.

And speaking of the MVNHS©, we would be remiss if we missed noting the sage wisdom of Dr Brian Keighley, who chairs the British Medical Association Scotland. Which is nice for him, but maybe not so nice for his (and/or his colleagues') patients:

"The leader of Scotland's doctors has questioned whether society can afford to pay thousands of pounds to keep terminally-ill people alive for weeks or months ... the GP said the country had to debate the merits of these kinds of aggressive treatments and the effects they had on the NHS budget."

Indeed.

But don't you dare say "Death Panels."

Or else.

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Embarrassing Problem: What to do About Warts

The Pediatric Insider

© 2011 Roy Benaroch, MD

Allison wants to know: “What do you do for warts on young children (say, 6 years old)? Can you use over the counter remedies?”

You could, sure, but they don’t work very well. Come to think of it, nothing else works really well either. So, sure, give the OTCs a try.

Warts are annoying little bumps, most often found on hands and feet. Though they’re triggered by a virus, they’re not really considered contagious—children with warts, for instance, are not instructed to stay home from school. That’s because virtually all of us have already been infected with numerous common wart viruses, even if we don’t have any warts. Why do some people get warts, and some not, even though we’ve all got the virus? No one knows.

FrogChildren are more susceptible to warts than adults, but there is a bright side: most warts in children will go away on their own, whether treated or not. So, naturally, there are probably a hundred or more approaches that are commonly tried. Here’s a list of 50 home remedies to get you started! Since warts will usually go away in kids, all of these are at least fairly likely to “work,” if you wait long enough. My personal favorite is to rub a wart the a cut half of a potato, then bury the potato in the backyard. Not only will the wart go away, but you might end up with your own potato plant! (Health tip: don’t eat the fresh grown potatoes if they have warts.)

From my point of view, reasonable choices for wart therapy include:

  1. Do nothing. This is especially suitable if the wart isn’t hurting or bothering anybody.
  2. OTC products, like “Compound W”. These can work, but have to be used every day for at least several weeks. Keep the medicine off of surrounding normal skin—just barely dab it on the wart itself. I wouldn’t try this on sensitive areas (genital, face) at any age, but for hands and feet these products are safe if used carefully.
  3. The “duct tape method,” described in detail here. The first published study on this had excellent results; followup studies have been less impressive. Still, it’s cheap and safe and painless.
  4. More aggressive doctor-therapies—I am not very keen on these, and in fact no longer do these myself in my office. They can be painful and may leave more scarring and problems behind. Choices tried by doctors include blistering agents (which sometimes trigger a big reaction) and freezing warts (which can be quite painful the next day.)
  5. Off-label but safe medications. These require a prescription, and aren’t FDA-approved for wart removal, but some topicals (imiquimod) and oral medications (cimetidine or griseofulvin) seem effective at least sometimes at quickly knocking out warts. I try these occasionally, when there are many warts of when a family has had it with waiting. Get more details from your own doctor, and choose the safest alternative.

Annoying they may be, but keep in mind that warts (at least in children) will usually go away on their own if you just leave them alone. If you must treat warts, choose something safe and easy and painless, at least at first. Patience, honestly, is the best cure.

PS. All of this is about ordinary, common warts seen in children. Genital warts are another matter entirely—they are spread through sexual contact, and can be associated with cervical and other cancers. Genital warts and cervical cancer can be prevented via safe sexual practices and vaccination—more about that here and here.

PPS. I’m putting little clip photos in my posts lately to make the blog look cooler when viewed via an iPad. I choose the froggie today because, well, you do NOT want to see the pics that show up when you do a google image search on warts. Trust me on this.


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11Dangerous? 9 Percent of US Infants Given Herbal Medicine

By Kate Wharmby Seldman

Nine percent of infants have been given herbal supplements and teas, according to a large FDA study whose results have just been released.

The study was conducted by the University Hospitals Case Medical Center in Cleveland, Ohio, by Dr. Yuanting Zhang and his colleagues at the US Food and Drug Administration. Its results were published online in the journal Pediatrics.

From 2005 to 2007, Dr. Zhang et al. surveyed more than 2600 mothers in the US to find out how many of them had given their baby one or more herbal supplement or tea in their baby’s first year of life. The researchers said they had oversampled white mothers, which means their results need to be adjusted in terms of national prevalence – rather than nine percent, the real percentage of US moms who’ve given their babies these products is more likely to be between three and 10 percent.

One of the most common herbal remedies mothers used was gripe water, a natural colic remedy containing ginger and fennel. Other remedies used included chamomile tea, probiotics, and homeopathic teething tablets whose ingredients included calcium and chamomile. The ailments moms most used natural remedies to treat: colic, fussiness, teething or digestive issues.

Studies don’t indicate that these natural preparations are very helpful, however. Pediatrics also recently published a review of 15 studies of herbal medicines for infant ailments, and there wasn’t very much evidence to suggest they worked well. In fact, because these remedies aren’t regulated in the same way as traditional medicine, they may be contaminated with harmful ingredients. Ayurvedic medicines have sometimes been found to contain toxic levels of lead. In 2007, one brand of gripe water was found to be contaminated with the bacteria cryptosporidium, which can cause intestinal problems.

The FDA team conducting the research suggests that these medicines should not be used for the first four to six months of a baby’s life, especially teas and other liquids, because they could potentially satiate a baby’s appetite to the point that he or she turns down breast milk or formula.

The study also found that moms who breastfed as opposed to formula fed were more likely to give their babies herbal medicines.

Read more at GrannyMed


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