Category: Pediatric Advice

Succulents that are at an undisclosed location at the HMO.

April 20, 2021

by drplasticpicker

This is my final word on Vitamin D deficiency. This is meant for my pediatric patients and their parents. If you are not my patient, than please read for entertainment and kindly go to your own doctor. I realize that I was spending a lot of yesterday following up on lab values yesterday and all my labs are almost down to one screen, but there were a lot of low vitamin D levels. Its important for me to check, but my advice is standard and the same now. Also I was overdue to put something in the Pediatric Advice column.

Did you know that Dr. Plastic Picker did two years of pediatric endocrine training? Yes I did! I did it at Man’s Greatest Hospital. I DID NOT GET KICKED OUT OF TRAINING. I left fellowship in good standing and with high marks on my inservice exams and good reviews. I left because we were trying to figure out life and Mr. Plastic Picker who is a doctor too found a job that he wanted as a specialist specialist in my home town. I had the option of finishing training here in San Diego and actually did talk to the program director, but also had a job offer at HMO San Diego. I had enjoyed endocrine training but it was mostly type 1 diabetics, and honestly being a general pediatrician paid more, I could start right away, no call, and it was easier. I was done taking super long exams after over 20 years of taking exams. I didn’t have a huge urge to memorize the synthetic pathway of cholesterol. I wanted to take care of kids, raise my own kids and I needed money. So $60K to be an endocrine fellow versus $160K to start a real job that was less hours and spend time with my children, seemed back them a no-brainer. And now looking back, not finishing fellowship was probably one of the best decisions I ever made. This is why I admire pediatric specialist so much (the ones that finished) because I promise you, they are not making the big big bucks relative to generalist at least in pediatrics. Maybe pediatric GI, pediatric allergy and intensivist but certainly NOT pediatric endocrinologists. Anytime we have an issue in our pediatric endocrinology department, I do feel guilty that I didn’t finish – but only for a second. Not finishing fellowship and starting work resulting in at least me being able to maximize my retirement contributions an extra 38K even one year earlier over the lifetime of my career until 65, is at least $378K in retirement savings accounting for compounding growth in a regular stock market. So if you ask me now do I regret not finishing pediatric endocrine fellowship, HECK NO! Remember Dr. Plastic Picker is all about the bottom line and the bottom line is that I had to make the decision that was right for my children and marriage at that point, and the higher paying easier job where I was still practicing medicine with more flexibility is the one I chose. After a few years in general practice, I realized I loved the variety of general pediatrics and the time came for me to decide to forgo the credit of the two years of endocrine training – and I without hesitation and I waved bye-bye!

Melatonin Gummies for Your Child? NO!!! Yoga and Moonbathing Please

November 29, 2020

This sight at Costco is scary. Life cannot be reduced to a gummy.

November 29, 2020

by drplasticpicker

I’ve been asked this question many times in clinic. I have relented at times and given parents the correct doses and timing for melatonin. I think I know more about melatonin than most pediatricians just because I’ve read two articles on it, and I used to work in a sleep research group. Being an endocrine research fellow in a sleep research group gave me more confidence to give advice on sleep.

Here are two articles I recommend you read on melatonin before you even consider giving it to your child. One, is from HealthyChildren.org and the American Academy of Pediatrics https://healthychildren.org/English/healthy-living/sleep/Pages/Melatonin-and-Childrens-Sleep.aspx and one is from Dr. Craig Canapari, my old friend from residency and a Nationally Recognized Pediatric Sleep Expert and Pediatric Pulmonologist https://drcraigcanapari.com/should-my-child-take-melatonin-a-guide-for-parents/. Here is the scientist that I worked with on sleep research, he is currently the chief medical officer at the FDA Office Division of Metabolism and Endocrine Products https://www.researchgate.net/profile/Giovanni_Cizza2 . That’s actually a really important position.

Dr. Plastic Picker’s Statement on Social Media and Home-Made Pesto

September 28, 2020

I actually recommend kids garden and not be on social media.

September 28, 2020

by drplasticpicker

Life is full of contradictions. As a pediatrician I worry about children being exposed to too much screen time, as this has been shown to disrupt sleep and has replaced some of the time children are interacting with real people or moving their bodies. Social Media has been a conduit for child exploitation as well, as adults who are evil-doers have made contact with children through the different platforms. Yet at the same time, Dr. Plastic Picker is a social media Instagram creature. I exist because of social media, Facebook and Instgram, although I think my heart belongs on this blog and in clinic. How can your social media semi-savy pediatrician advise you to limit your social media?

Are you 3-6 YO during COVID-19 Quarantine? Dr. Plastic Picker Suggested Activities

July 23, 2020

My few qualifications for giving advice is that my kids are happy. I found these post-its in our daughter’s room. She drew them for herself.

July 23, 2020

by drplasticpicker

I saw a set of siblings 4 and 5 years of age yesterday for their physicals and one set of vaccines, and mother expressed the same frustration that many parents are having. “How do I keep the kids brain developing?” Many parents are in the same position. School is moving on-line, and on-line school is supoptimal for the development of a 4-6 year olds. Many parents ask me for advice, and I am a doctor and not a teacher. I always direct parents to teachers and educators. But I understand, they trust me. I have made a lot of mistakes raising and still raising my children. But our teen and tween children are healthy, inquisitive people and generally considered good students. Most importantly they are happy and they have what I think most of my patients consider really good brains. So here are some suggestions from your pediatrician who is NOT A TEACHER. Are your children 3-6 years of age? How do you keep them stimulated?

Prevent Anemia: Baby Eat Beans

June 12, 2020

June 12, 2020

by drplasticpicker

One of the proudest professional moments of my life was during the year I was chief resident, the pediatric senior class at Man’s Greatest Hospital had a 100% pass rate on the pediatric boards. It never made sense to me that the hallowed institution that I trained at did not have 100% pass rate. Indeed the occupants of the chief residency position were known to make markedly less than 100%. But the year I was Chief Resident, the senior class had a 100% pass rate and I passed well over a few standard deviations as well. This was in large part because I had to delay my boards because I had a baby during Junior Year and made up some rotations. I took my exam with the senior class which was below me. So I studied with them. While I had more time and was studying and completed four years worth of PREP questions sitting in the the chief residency office, I created Pediatric Board Review power points from my notes. When there was any empty lecture time during Morning or Noon conference when the lecturing attending showed up late or the admitting team was stuck on the floor, I had multiple power points ready to go. I am proud of the legacy of that 100% pass rate.

But can you believe that in the entire 2015-2019 AAP Prep Questions there is only 1 question about iron deficiency anemia? This is the most common issue we encounter as general outpatient pediatricians and there is one question! Well this former Chief Resident and current Assistant Boss and now eco-warrior Dr. Plastic Picker is going will rectify this situation.

Five High Fiber/Plastic-Free Breakfast Ideas for Toddlers

May 17, 2020

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Chia Seed/Oatmeal Pudding. Low sugar and can be a breakfast! Cooking and photo credit by Daughter Plastic Picker (age 12).

May 21, 2020

by drplasticpicker (with daughter Plastic Picker’s help)

Parents are cooking more meals for their children during COVID-19 quarantine. We have continued to do well child visits for kids that require vaccines, and several parents in my practice asked me for breakfast ideas. I think the combination of more inactivity due to quarantine and more screen time, has worsened the pediatric constipation crisis and widenened the pediatric fiber deficit. In addition, when we are scared to browse through the grocery store – I think parents are falling back on more processed foods and that as you know leads to Taste-Bud Dysfunction https://drplasticpicker.com/taste-bud-dysfunction-lets-dial-down-the-salt-and-sugar-in-snacks/.

Teenager – Your Blood Pressure Is a Bit High: What Should You Do? What did we do?

May 3, 2020

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Screenshot of a slide for a Pediatric Hypertension Lecture I attended at the AAP NCE 2019.

May 3, 2020

by drplasticpicker

Back in October, I attended the American Academy of Pediatric National Conference in New Orleans with Dr. Dear Friend. We were there with a group of pediatricians from our health-care system, and it was a high-yield conference. Part of it was because we actually traveled to the conference and it was a fun destination. We had too much fun attending the lectures during the day, exploring new Orleans at night and also trying to reduce our plastic use! One of the talks we attended was on Pediatric Hypertension.

Five Steps to Prepare Your Family for Puberty

April 14, 2020

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April 14, 2020

by drplasticpicker

This is definitely one of those topics that Dr. Plastic Picker is a much better pediatrician now than I was at the beginning of my career. It helps that I myself have gone through puberty, completed a clinical year of pediatric endocrinology, and am semi-successfully guiding my own two children through this process.

This can be both a stressful and wonderful time in life. There is a sense of loss for the littleness of your children. I had this profound sense of loss because I worked so much when they were little. I miss the warmth of those young bodies snuggling up to me at night. The promise of that time would often get me through the long overnight calls or urgent care shifts. Our daughter had a profound sense of loss as well. When her body began changing she said that she did not want to grow up. Our son was very nonchalant about the whole thing, which is true to his easy going personality.

But as I tell my children and my patients, puberty is a wonderful thing because it means the body is working! It means that your hypothalamic-pituitary-gonadal axis is functioning as it should and you’ve reached this milestone. If you didn’t go through puberty by a certain time, it would be a medical problem. I would have to start getting blood work, radiographs and maybe MRI your brain. As a pediatrician, I am aware of the dangers of being little as well. You are more susceptible to diseases which is why there are more vaccines when you are young. Little children can’t physically protect themselves as well. So I look at puberty, as a wonderful time that children are gaining bodily strength. They are developing themselves to be adult people. Because in the end the purpose of raising children and protected them while they are young is to get adults, and then they can protect and fend for themselves. And now my own teenagers can get things I need from the upper shelves that I can’t reach! Score!

How To Care for Your Child with Atopic Dermatitis (aka Eczema)

March 29, 2020

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This is a picture of Mylar baloons in the desert from one of our Dr. Plastic Picker friends. Does the heat aleve or exacerbate eczema? How should you bathe your atopic child when the weather changes?

March 29, 2020

by drplasticpicker

Today the politicians are again arguing about who is to blame for the skyrocketing COVID-19 cases. But in California, there is a glimmer of hope. We began mandatory quaratining relatively early, and in our community our local leaders have been working together across the aisle to help our homeless communities and provide rent relief to our population. Beaches are closed and our local friends the Police were driving calmly up and down the beach telling our relaxed San Diegans to disperse. I was born and raised in San Diego, and I have a great love for my homeworld (Star Trek reference). In this increasingly polarized world, there is still a sense of civic responsibility and engagement in my hometown. I am hoping this helps us #flattenthecurve. Looking at the prediction models, it looks like we will likely have enough ICU beds for our county. So I am still vigilant but hopeful. I wrote yestserday that the best way I can help, is by doing the job I am qualified to do – a general outpatient pediatrician who middle-manages a department and is responsible for a few actual outpatient clinics https://drplasticpicker.com/be-like-a-tree-during-the-covid-19-cytokine-storm/.

So in that vein, I will be an outpatient pediatrician and give general advice about eczema! This is such a common problem and I hope this gives you some relief since we are trying to keep these “minor” issues at home. But minor issues are important to deal with as well.