10 embarrassing questions about children

In this series of articles, well-known experts answer questions that are usually awkward to ask: it seems that everyone already knows about it, and the questioner will look stupid.

Today we will talk with a famous pediatrician, one of the most cited specialists in evidence-based medicine, Sergei Butriy, about whether it is necessary to lower the temperature, why children cry and whether it is possible to wet manta rays.

Sergey Butriy

Pediatrician at the Docdeti clinic . Author of the blog about modern pediatrics “ Notes from a pediatrician ” and popular books.

1. Is it dangerous for a child to eat boogers? What should you do if your child puts everything in his mouth?

Eating boogers is not harmful. From a medical point of view, this does not lead to anything bad.

But with the habit of putting everything in your mouth, things are different. It is necessary to ensure that there are no medications in the child’s mouth that can cause poisoning, household chemicals that can easily cause poisoning and burns, as well as foreign bodies that can enter the respiratory tract or digestive tract and threaten health and life. For example, swallowing neodymium magnetic balls is very dangerous.

The habit of putting everything in your mouth goes away. Therefore, all that remains is to monitor hygiene and ensure that the child does not harm himself. But do it with patience and care.

2. Is it possible to rub with vodka to relieve fever? Is it necessary to lower the temperature at all?

The temperature must be reduced if it exceeds 42 degrees. This temperature causes denaturation of brain proteins and sometimes leads to irreversible consequences. But it almost never happens due to infectious causes; usually it is a consequence of overheating.

With infections, as a rule, the temperature does not exceed 39–39.5 degrees. Such an increase in itself is not dangerous, but can cause severe discomfort to the child, so lowering the temperature is justified.

But it is worth reducing it correctly, only with ibuprofen and paracetamol every 6-8 hours. At the same time, there is no goal to bring it down to 36.6. The goal is to reduce it by at least a degree so that the child becomes more comfortable and the parents feel calmer.

It has been proven that the best way to treat ARVI is to do nothing. But this makes it hard for parents, and they lower their temperature. This is the most obvious help that is difficult to refuse.

It’s better not to rub it with vodka, as its effect is small. The logic behind rubbing is that alcohol evaporates faster than water and carries heat with it—it’s a physical method of cooling. But such methods are quite poorly tolerated by children. They cause discomfort, and there is also a risk of poisoning. The skin can absorb significant amounts of alcohol, and the child may vomit and become unwell. This is usually not dangerous, but it will add to your child’s discomfort.

If the medicine has no effect at all or the temperature is frightening, then it is better to use a shower rather than vodka : stand with the child under warm water, and then gradually reduce the temperature to cool. You can stand under such a shower for 2–5 minutes: this will be enough to lower the temperature by a couple of degrees.

3. Do small children really need to be dressed warmer than adults?

Small children should ideally be dressed the same as us, or a little warmer, and then be guided by their well-being. If they are so small that they don’t move much, imagine how you would have to dress if you were being pushed down the street in a wheelchair. You would move less and cool down faster.

If a child actively runs and jumps around the playground, then you need to dress him lighter than yourself, because you are standing, and he moves more and sweats.

But all these rules will come in handy for the first walks , and then any attentive parent will experiment with clothes: somewhere to take off a jacket, somewhere, on the contrary, to put on a hat, avoiding obvious signs of hypothermia or excessive sweating.

You are mistaken if you think that the child must be hot, and if he is sweating, then you need to add even more layers of clothing, otherwise it will blow out.

In fact, it is better to dress in such a way that the child does not sweat at all. At most, I got a little wet at the peak of physical activity, but nothing more.

4. If you don’t establish a diet for your child, will he have gastritis? What if he doesn’t want to eat when he needs to?

To better understand this issue, it is worth reading Ellin Satter’s book “Feeding and Nutrition of a Child from 0 to 5 Years with Love and Common Sense.” The author explains in great detail and carefully what responsive feeding is and how to properly instill healthy eating habits in a child without forcing him.

Eating habits are needed for many reasons. Firstly, so that they give mom and dad the feeling that they are good parents and satisfy them. This is an important feeling and should not be neglected.

Secondly, so that the child does not develop gross food addictions. For example, a sweet tooth or deviations from the Harvard plate and the Mediterranean diet.

The Harvard Plate is an eating system in which vegetables and fruits make up one half of the diet, and the other half is divided equally between whole grains and proteins. Healthy vegetable oils (olive, rapeseed, corn, sunflower, peanut and others) are also important in moderate quantities, with enough water.

The Mediterranean food system is reflected in a pyramid, the basis of which is dishes recommended for daily consumption. These are vegetable and fermented milk products, olive oil. The middle is protein foods, which should be eaten 1-4 times a week. It includes fish, seafood, white meat and eggs. The top are foods that it is advisable to consume no more than 1-2 times a month. This is red meat and sweets.

What happens if you deviate from a certain nutritional standard? What is traditionally called “gastritis” in Russia is a hodgepodge of all abdominal pains and an almost non-existent diagnosis. Suboptimal nutrition is more likely to lead to obesity, nutritional deficiencies, anemia and constipation. For these reasons, the child should establish a diet, but at the same time not suppress his personality with harsh educational strategies.

5. How to teach a child to eat everything and not be picky? Is it necessary to completely deprive a small child of sweets?

Again, you can look into Ellyn Satter’s book. But something else is important here. In this question one can hear the desire to make the child comfortable. And if you look at this issue from this perspective, there are two cardinal strategies.

The first is suppression, blackmail, punishment, that is, rather crude methods that humiliate the child’s personality and force him to do everything that mom and dad say, without realizing the benefit for himself.

The second strategy is to understand why the child does this, what it even means to be “picky.” A child behaves well when he can – this is a well-known maxim. And he behaves badly not because he wants to, but because he has some kind of developmental deficit, a problem in communication, or something else that needs to be sorted out. Because by nature, children want to please their parents and receive their approval.

Therefore, it is important to seek a balance between completely allowing everything that comes into the child’s head and suppressing his will.

In this matter, consistency and care are important, which is more important than a complete refusal of sweets.

As for completely giving up something, this is a family decision. But often such prohibitions end in an instant, when the child becomes unbearable, he becomes capricious and is finally allowed to do something forbidden. Or he comes to his grandmother in the village, where he was fed and everything was allowed, after which it is difficult to completely prohibit something.

Therefore, it is quite possible to give sweets to children, but set some rules, time and quantitative limits. It will be more useful and much more respectful to the child. This will be an agreement with him, from which more benefits can be derived than from a stupid ban.

6. What happens if baby teeth are not treated? If they’re all decayed, can you just wait for them to fall out? Especially if the child is terrified of dentists.

Baby teeth need to be treated . If there are serious problems with fear, you can usually wait a while with treatment and prepare the child, say, within a month. The point is to gradually adapt the child to the fact that he comes to the clinic, then enters the office, and gets used to seeing a doctor. It is free or almost free, you can negotiate this with almost any adequate dentistry.

If baby teeth are not treated, it may happen that pulpitis , gumboil or fistula occurs suddenly and will lead to an emergency visit to the dentist or maxillofacial surgeon. And this is no longer so gentle towards the child simply because of the lack of time and the seriousness of the problem.

If you put something off endlessly, it will happen at a time when the family is not ready for it.

The second thing that can happen is that the tooth needs to be removed ahead of time. If for several years there is a large gap between the teeth (at the site of the extracted tooth), then the neighboring milk teeth begin to converge on each other, and then the new molar has nowhere to grow.

Also, the infection can affect the buds of the molars, and they will not come out or will come out already deformed. And these are not all the risks.

Parents are often afraid of anesthesia, even local anesthesia. I would act on the principle “if you are afraid, don’t do it, if you do, don’t be afraid.” Anesthesia has risks, but so does tooth decay, so you always have to choose the lesser evil. If a child has no obvious contraindications to anesthesia, it should not be avoided.

7. Can a child have non-alcoholic beer?

In general, it is possible. But why should he drink it?

If everyone around drinks beer and the child is worried about this, you can probably offer him non-alcoholic beer once . But you shouldn’t do this regularly, at least so as not to normalize this process.

In general, this is a question of flexibility in upbringing and readiness for the fact that situations can be changed in different directions and not provoke unnecessary difficulties by being too categorical.

8. Is it possible to wet Mantu? What about vaccinations?

The Mantoux test is not a vaccination, it is a skin allergy test. The result of such tests, if they are intradermal, like Mantoux, does not depend on whether moisture got on them or not. The old Pirquet skin test is now almost never performed. It was recommended not to get it wet. The modern Mantoux sample can be wetted.

You can also get vaccinations wet, just like you can shower after them. It is advisable not to steam the injection site for a long time, because this may increase the skin reaction, but no more.

Here it is important to say what we risk, even if we steam the vaccine injection site: these are not some kind of disabling complications. We can simply lengthen or brighten the local post-vaccination reaction for the second day or two, when the site of vaccine administration swells .

It looks painful and scary, but does not cause any harm to the child’s health.

It is also important to emphasize the difference between adverse events and complications of vaccination. Adverse events are those that cause discomfort and frightening, but do not cause long-term harm to health. A swollen injection site after steaming is just an undesirable reaction.

And complications are much more serious symptoms that occur less frequently and certainly do not depend on whether you wet the vaccination site or not.

9. Why do children cry so often?

Because in them the processes of excitation prevail over the processes of inhibition. This is a typical feature of children. They are emotionally unstable and are just learning to control their emotions.

At every age, a child has his own reasons for being emotionally unstable, starting from birth, when, for example, he is hungry, and ending with emotional leaps in adolescents .

Baby crying is not dangerous and does not depend on gender: boys can cry too, and this is normal.

10. If a child’s legs hurt and ache so much at night every six months or a year that he cannot sleep, and then everything goes away, is it because he is growing?

Most likely because of this. There are four main problems that could cause this to happen.

The first is growing pains. They are functional and are not associated with damage to bones and joints. They do not cause lameness, changes in joint configuration, fever, malaise, and so on, but they cause inconvenience to the child and anxiety to parents.

In such cases, we advise you to be patient, it will go away on its own. As a last resort, give Nurofen or perform distracting procedures such as rubbing the legs with a shawl or a contrast shower.

The second problem is restless legs syndrome , when there is no pain as such, but there is tingling, scratching, as if something is tickling. The child is forced to change the position of his legs: this way the unpleasant sensations go away for 20 seconds, and then accumulate again.

The need to constantly change the position of your legs interferes with sleep and is annoying.

The third problem is transient synovitis. It occurs after a recent acute respiratory viral infection, when the joint swells, hurts, and the child limps. This usually goes away in three to five days.

The fourth is cramps, which are close to restless legs syndrome. This is a convulsive contraction of muscles, which is visible externally and to the touch. Unlike the above, cramps leave behind muscle soreness (this is muscle pain, as if you had overtrained) and, as a rule, do not go away with age.

All four of these reasons are quite safe. But if we see persistent lameness, morning stiffness in the joints, objective changes in the soft tissues over the joint, limited range of passive movements in the joints, and so on, especially if all this lasts more than 2 weeks in a row, this is a serious reason to consult a doctor as soon as possible.