Dr. Chad Perlyn (Host): Welcome to the For Peds Sake podcast, a Nicklaus Children's Hospital podcast that is all about putting children at the heart of healthcare. I'm your host, Dr. Chad Perlyn, a pediatric plastic surgeon here at Nicklaus Children's and also, a father of two boys. And I am so excited to welcome you to today's episode.

Today, we are joined by Dr. Melanie Suaris, a pediatrician here at Nicklaus Children's, to talk about everything related to pediatric healthcare. Doctor, thank you so much for joining us today.

Dr. Melanie Suaris: Thank you, Dr. Perlyn. Thanks for having me.

Host: Of course. And you're a mom as well to a little boy, is that right?

Dr. Melanie Suaris: Yes, a two-and-a-half-year old.

Host: A two-and-a-half-year old. And another on the way, I hear.

Dr. Melanie Suaris: Yes, in just a couple months. We're very excited. Thank you.

Host: A boy or a girl?

Dr. Melanie Suaris: A girl. So, a whole new territory for me.

Host: Well, congratulations. And I think your expertise, both as a pediatrician and as a mom of a young one and one on the way, will really shine through that expertise to our listeners today. So, thank you again for being here.

Today, we're going to do something a little bit different than we've done on some of our other podcasts. And for today's episode, We're going to be diving in to some of the most frequently asked questions that parents and caregivers have for their pediatricians. And these questions were submitted by all of you, our listeners, the audience, on Instagram. So, thank you to everyone who submitted a question, and we are going to try to answer all of them both through today's episode and the second one, the followup part two, to this really unique podcast we're doing.

Because we received so many great questions, as I said, we're going to split this up into part one and then part two. So if you don't hear your question answered in today's episode, don't worry, as we're going to include it in the next one, in the subsequent one. So, let's dive right in. We're going to run through six questions at record speed to get through it. But I know you're going to be able to give us the information that parents are looking for. Are you ready?

Dr. Melanie Suaris: Yep, let's go.

Host: Let's go. Okay. Question one.

Can babies get dandruff?

Dr. Melanie Suaris: So, the short answer to that is yes, but as pediatricians, we don't really call it dandruff. What we actually call it is cradle cap. That's probably what a lot of parents are gonna recognize this term as. This is something that's very common. We see this all the time in the office. Usually, we see this between maybe like two weeks of age and you could even get this up until one year of age. And essentially, there are these really fine white, scaly things on the scalp and sometimes they even become yellow, greasy. Some parents will even tell me that it's a little bit smelly too. Luckily, these are things that just go away on its own. The best treatment that I usually tell my parents is to put a little bit of oil, maybe some baby oil, coconut oil, and then you can take like a fine tooth comb and just slowly scrape at it. It's usually very satisfying for the parents to do it. But just remember not to do it too hard, you don't want to break the skin ever. And it just goes away on its own. Nothing too serious, but definitely very common.

Host: Perfect. Next question:

How do I know if my baby has reflux or if it's just spit up?

Dr. Melanie Suaris: And this is probably one of the most common questions that we get in the office, because any time you're seeing some sort of a spit up, it could look like a large amount of volume. Even when in reality, it's only just a little bit. Spit up is essentially a type of reflux where essentially some of the stomach contents are coming up and, you know, they dribble out a little bit throughout the mouth. But spit ups usually doesn't cause any sort of discomfort. Your baby, this may happen maybe just shortly after feeding, maybe they fed a little bit too much or they're getting really sleepy and they pooled some milk in their mouth. This is very common.

But the concerning signs for reflux is when it's a more forceful vomit and your baby starts crying. Maybe they're even going to look red or start becoming a little bit stiff. And even reflux, to some degree, is normal for many kids. The things that the pediatrician is going to be looking out for is the growth chart. Look, spit ups, even a little bit of reflux, like I said before, is normal, but if they're falling off the growth chart, that's when you should really speak to the pediatrician and maybe changing up the formula, maybe trying out some medications. That's definitely some shared decision-making you'll make with your doctor.

Host: Got it. So, just to recap on that one, if there's discomfort, think reflux. If it's just spit up coming out of the mouth, baby probably won't be fussy around it. Simplest way to explain it?

Dr. Melanie Suaris: Yeah, simple as that.

Host: Perfect. Okay. We got a lot of questions about fevers. So, we broke up two questions into three parts. So, roll with me as I ask it. But first thing:

At what point does a fever in babies become dangerous?

Dr. Melanie Suaris: So first off, I want to say that a fever is defined as anything that's over a 100.4 degrees Fahrenheit. For babies, particularly newborns, the best way to check a temperature is by rectum. And I like to tell parents don't be worried about checking it by the rectum. It doesn't hurt them at all. It is the best way for us to check a temperature. Better than, you know, a thermometer in the armpit or trying to use the one in the ears, especially when they're so small.

Usually, what I consider to be a medical emergency is when a baby that's less than one-month-old has a fever. Just because they're just kind of really brand new to the world, we don't really know what they were exposed to, especially if they're around a lot of people. So if you're having the true fever in less than one-month-old. That's when I say you should, of course, call us as pediatricians, but you should be going to the emergency room.

When they're a little bit older, fevers can definitely be treated at home. But what the warning signs are more so that if they're inconsolably crying. Like no matter what you do, you've given Tylenol, you've given Motrin, they're inconsolably crying. Those are reasons maybe to seek out the medical attention, go to your pediatrician, go to the emergency room.

If they seem that they're just very sleepy, that they're in bed, they're not feeling well, you're trying to arouse them and they're just not really responding to you, that's also really concerning. Especially again, as they get older, if they're complaining about some neck stiffness, or if you're just seeing that they're having signs that they're having difficulty breathing, that their chest is moving up and down really fast, these are all signs to me with a fever that you should be going to seek extra attention.

Host: That is great. Thank you. And I just want to follow up on one thing that you had mentioned about a pediatrician or emergency room. Urgent cares, okay, appropriate for fever? We have a large network of urgent cares, as you know.

Is the emergency room the right place for fever or urgent care? How do parents help decide between that?

Dr. Melanie Suaris: Yeah. And I think that's a great question and I think that urgent care is a great medium. I think that during office hours, a lot of the times I really do try to recommend, especially for my patients that I see in the office, many pediatricians want to be the ones who get called first. So during traditional office hours, you know, 8:00 a.m. to 4:00, 5:00 p.m., go ahead and give your pediatrician a call and they're going to be the ones to really guide you, because a lot of things do not need to be seen necessarily in the urgent care or the emergency room. A lot of pediatricians have a lot of tools in the office and, trust me, that cuts down on your wait times. You know, you get seen sooner. So, I would suggest if it's during office hour times, try to go ahead and call your pediatrician's office. When it gets a little bit later, I think that urgent care versus the emergency room. If it's just maybe one or two days of fever, they're still acting themselves, they're still eating, but you just want to get them checked out, maybe see if they got flu or, strep, something like that. I think that's when an urgent care is appropriate. But as parents, you know your child best. You know, when something just does not feel right and no one would ever ding a parent for bringing them to the emergency room just for extra care, for extra higher level.

Host: I think that's great advice. Always start with your pediatrician. They're going to be the folks who know your baby best. If it's a young child less than four weeks old with a high fever, probably best to head straight to the emergency room in consultation with your pediatrician if appropriate. And for an older child with a fever, If you can't get in touch with your pediatrician, urgent care may be a place to start.

Dr. Melanie Suaris: Perfect. That's exactly it.

Host: Perfect. Okay. Same topic.

What are some do's and don'ts for helping a child fight a fever?

Dr. Melanie Suaris: Yeah. So, as we had mentioned before, a lot of times fevers can be managed at home. So, the things that I do want parents to be doing is to always have children or infant Tylenol ready. If they're older than six months old, you could be using ibuprofen. So, you could be giving these medications at home, especially if fever is getting higher.

What I do want you, the parents, to also do is keeping them in some light clothing. You know, even though they may be having chills, maybe they're not feeling that great, try not to keep them super bundled up underneath a really thick blanket, long sleeves on, because that could just worsen the fever, it could get them overheated. And the thing that lands a lot of kids in the emergency room is the dehydration portion of the fevers, that they're not feeling that great, they're not hungry, they're not thirsty, but parents really need to be due diligent in offering them water, even if it's just a sip or the Pedialyte, even if it's a sip every couple minutes, that's important because that's what's going to keep you out of the emergency room.

When it comes to fevers, the things I don't want parents to do and what people used to do a long time ago is actually put their kids in a really cold shower or even an ice bath. That's definitely not recommended anymore. And as mentioned before, only Tylenol and Motrin. Aspirin is not recommended for children.

And then lastly, don't force them to eat. Children are very resilient. I like to tell parents that they can go days without eating. But as long as they're staying hydrated, as long as they're drinking enough fluids, going to the bathroom and, you know, so that's a sign that you know that they're being well hydrated, that's enough. So, because if you try to force them to eat, trust me, you really don't want, on top of a fever, for vomiting to start happening too.

Host: Perfect advice. And all those alcohol rubdowns that my mom gave us when we were kids? No more of that?

Dr. Melanie Suaris: No more, no more.

Host: All right. Mom, I hope you're listening. Okay. So, we've gone through dandruff, spit up, fevers. Let's jump into colic. Tips for parents with a baby that has colic. Good luck in answering this one in two minutes. But give us what you got.

Dr. Melanie Suaris: First and foremost, I want to give any parent with a colicky baby, a huge hug it's definitely very difficult to have a colicky baby. And essentially, what colic is, the short answer is we don't know what it is but it's essentially whenever, you know, a child cries for seemingly no obvious reason. And it usually happens around three or four months.

The thing that I tell parents is to have a mental checklist. When your baby starts having that really bad colicky cry, you check if there's a fever, you check if is it time to eat? Did they wet themselves? Do you have to change the diaper? Once you have that mental checklist down, then you move over to calming methods. Some parents, honestly, you need to bring them into the car. You need to drive them around a little bit. Sometimes you have to just rock them and do shushing motions. And it seems like it takes forever, but this is the best way.

But the more important thing is that this can be a very difficult time for parents. It's hard to hear your baby cry. Just know that it's okay to put your baby down whenever you're feeling very stressed out or hand the baby over to someone else so that you make sure that you are in the right mental space to be taking care of your baby. But definitely, a colicky baby, there really is no silver bullet unfortunately. It's just all about calming methods and making sure that nothing else is going on.

Host: And I think you make a great point about mom's welfare, dad's welfare as well. The family who's going through having a baby who is colicky and some of the stresses and challenges that that can put on the whole family as everybody worries about the baby. So certainly, an important topic there and one to absolutely reach out to your pediatrician for our listeners who will have much more in depth advice there. Okay, last question for part one of this week's podcast.

How do I know if my child should get their tonsils removed?

Dr. Melanie Suaris: Great question. I usually refer a child to an ENT specialist to possibly get their tonsils removed. Once they've reached about five or six strep throat or tonsillitis infections within a year, that's usually kind of the guidelines that we generally follow. Another reason to get them removed is if parents are saying that, you know, my child's not really getting good quality sleep because they're snoring a lot because they're mouth breathing. And then when you look in there, the tonsils are huge. And so, sometimes that could even give you a risk factor for sleep apnea or otherwise known as having periods of breathing being paused while you're sleeping, which obviously is not great. So, these are all reasons to go to an ENT, and they will make the ultimate decision whether or not it's appropriate to take them out.

Host: Makes sense. One of my little ones when they were maybe six or so had their tonsils out for the sleep obstruction you were talking about. It made a huge, huge difference. I'm going to throw in one quick bonus question while we're talking about ENT and things in the mouth. Tongue tie. Lots of questions always about tongue tie. How do you know when a baby needs a tongue tie released? What's your thoughts on that as a pediatrician? I know lots of different theories out there, but from your point of view.

Dr. Melanie Suaris: Yeah. And it's interesting. And I think that's very cultural in terms of like where you're practicing. So where I did medical school, when I was training up in New York and New Jersey, tongue tie release just was not a thing. It's just like unless the tongue tie is interfering with feeding, causing really bad pain, that it's, again, everything goes back to the growth chart. If the growth chart is not looking good and we think it's due to the tongue tie, then that's pretty much the only indication for me to get it released. Just having one in general, in my opinion, you don't need it. If the baby is feeding and growing, why do an unnecessary procedure?

Host: Got it. There was just a big article in the New York Times about this the other day that caught my attention.

Dr. Melanie Suaris: Yeah, I read it.

Host: So, more reference for families interested in that. Okay, that was fun. Six plus the bonus, seven questions. From dandruff, fever, colic, tonsils, tongue tie, and so forth, it was great having you. And thank you for giving such concise answers over this broad variety of topics.

Dr. Melanie Suaris: Thanks, Dr. Perlyn.

Host: Of course. So, that's all for today's episode. Thank you for listening and be sure to tune in for part two of this, in which we're going to do the same thing with another round of questions with Dr. Suaris for our next bi-weekly upload.

Make sure to stay tuned for that episode. And in the meantime, be sure to follow us on all social media channels. You can find Nicklaus Children's Hospital on Instagram, Facebook, TikTok, and YouTube. See you next time.