Physical therapist Laura Reed, left, is working with 6-month-old Kaeden Beck to stretch and strengthen his neck muscles because he suffers from flat-head syndrome. At right is grandmother Rhonda Beck. Photo by Gordon King.

By Laura Reed

Physical therapists at Children’s Village see up to six new babies every month who are sent by their doctor because they have flat heads. It is estimated that one out of every 50 babies will experience this condition, called plagiocephaly.

Although there are many reasons why a baby’s head may become flat, many cases are preventable. In all cases, it’s important to seek treatment because plagiocephaly can negatively affect your baby’s developing vision, hearing and movement.

Why is my baby’s head flat?
There are many reasons why a baby’s head becomes flat. Twins or triplets are more at risk due to the limited space they have to change position in utero. Premature birth, low muscle tone or birth complications may place a baby at higher risk. Sometimes babies have medical or skeletal issues that have caused this.

Unfortunately, some of the things that give us convenience are also to blame for many cases of plagiocephaly. Babies now spend much of their time in infant carriers, baby swings and bouncy seats. You can imagine how a baby rests the back or side of his head when sitting in one of these devices. Prolonged pressure quickly causes a baby’s head shape to change; skull bones not yet fused together actually shift, causing his head to become flat.

What are the symptoms of this condition?
By the time a baby begins physical therapy at 6 to 12 weeks of age, the flatness often is very noticeable and the baby also has uneven eyes, ears, nose cheeks, forehead and jaw.

Muscles in the baby’s neck may also become tight, making it hard for her to turn her head one way, a condition called torticollis. The combination of these conditions makes it difficult for your baby to look to both directions, reach with both arms, and roll to both directions. It makes it difficult for your baby to raise his or her head when on his or her tummy.

If untreated, a baby could experience a “head tilt” posture that does not go away. Alignment of the eyes, ears and jaw may be affected as well as the shape of the skull. Vision and hearing also may be impacted, as well as motor coordination and balance.

How can I keep my baby from getting a flat head?
Prevention is the easiest treatment. It’s really pretty simple!

First, to decrease the risk of SIDS, always, always have your baby sleep on his back. And, always have your baby secure in his car seat when riding in a vehicle. However, when the baby is not sleeping or riding in a vehicle, here’s what you can do:

• Give your baby lots of time on her tummy when you can closely supervise her. Place your baby on her tummy, helping her to prop on her elbows several times a day, for short periods of time.
• Use a front pack or baby sling for baby-wearing, versus a bouncy seat, swing or infant carrier. Limit time spent in car seats to only those times when your baby is riding in a vehicle.
• Change the way your baby’s head is positioned when sleeping. For one nap, turn his head toward the left. For the next nap, position his head in the middle. For the next nap, to the right.
• Encourage your baby to look to the right and the left by giving her lots of things to watch with her eyes.

What should I do if my baby’s head seems flat?
You should talk to your doctor immediately if you notice that your baby’s head is flat, or if she prefers to turn her head one way more than the other.

Your baby will be evaluated for any tightness of neck muscles, limitations of movement and abnormalities of the skull.  The therapist will provide you with stretching and positioning exercises to perform several times each day.

Depending on the severity of your baby’s torticollis and plagiocephaly, weekly therapy may be recommended. In addition, some babies will need to wear a helmet to re-shape their head.

Laura Reed is a pediatric physical therapist at Children’s Village in Yakima.

ASK THE DOCTORS If you have a health question, we’ll find the answer. Write to the doctors at talkback@playdateyakima.com.

Dr. Robel says: Probiotics, or friendly bacteria that reside in our gut, may increase fertility and reduce early miscarriage as well as help prevent eczema and allergies in infants, according to several recent studies.

Probiotics are found in yogurt and other fermented foods. They serve to protect us from infection and help prevent a wide range of health problems including constipation, diarrhea, colitis, irritable bowel syndrome, allergies and various skin problems.

New research is finding that probiotics may also be beneficial to women trying to conceive. In a study done in Belgium, supplementing with a probiotic while women underwent in vitro fertilization increased the rate of conception compared to women not taking the supplement. Likewise, several studies have found that women given a probiotic at the onset of pregnancy have lower rates of spontaneous miscarriage in the first trimester.

Besides the benefits to mom, there are benefits to your infant. Taking a probiotic supplement for the last three to four weeks of pregnancy may reduce rates of eczema and allergies by as much as 50 percent, according to a study published in The Journal of Allergy and Clinical Immunology.

Probiotics can be obtained by eating yogurt labeled as containing “live and active cultures.” Also, there are various supplements that can be taken.

Always speak with your health care provider before taking any supplements, including a probiotic, to decide if it is right for you. Also, not all supplements are created equal so it’s important to get a recommendation to ensure you are getting what your body needs.

— Heidi Robel, ND, is a naturopathic physician and acupuncturist in private practice in Yakima.
She’s expecting her first little one in August.

Will thumb-sucking harm my child’s teeth?

ASK THE DOCTORS If you have a health question, we’ll find the answer. Write to the doctors at talkback@playdateyakima.com.

Dr. Tercero says: Non-nutritive sucking habits (finger or pacifier sucking) are normal in infants and toddlers. These habits help address a child’s need to feel secure.

Although normal and harmless for young children, non-nutritive sucking can result in long-term problems if persistent. Prolonged finger or pacifier sucking can lead to a permanent open bite and other dental and jaw deformities.

In order to prevent these problems, the habit must stop by age 5. However, the difficulty of ceasing this habit increases with age, so it’s best to stop the habit before age 3. If the habit persists beyond the age of 3, it’s recommended to see a dentist for professional evaluation.

— Ashley Tercero, DDS, is a children’s dentist at Yakima Pediatric Dentistry.
Her 7-month-old daughter, Kya, doesn’t have any teeth.

What is postpartum depression?

ASK THE DOCTORS If you have a health question, we’ll find the answer. Write to the doctors at talkback@playdateyakima.com.

You’ve just had a baby. You’re not sleeping, your hormones are completely confused, your body hurts and there is this constant crying noise in your ear. Who wouldn’t be a little depressed?

The “baby blues” are common, and usually develop within the first few days after birth. You might experience mood swings, anxiety, sadness and insomnia. This is a transient phenomenon and usually resolves without treatment within two weeks.

Postpartum depression is also common, developing in up to 10 percent of mothers, but often goes unrecognized. The symptoms can be nonspecific, including fatigue, sadness and crying, insomnia, feeling guilty or inadequate, being overwhelmed, poor concentration, decreased libido, anxiety and not wanting to do usually enjoyable activities. In rare and extreme cases, a woman can develop psychosis (a loss of contact with reality).

Treatment usually involves a combination of counseling, medication, exercise and spiritual or emotional support. Some women are more prone to developing PPD, so if you have a previous history of depression or other mental health issues, you may want to talk to your doctor before the baby arrives. Usually, a mother doesn’t have a follow up appointment with her doctor until six weeks after delivery. It’s important to seek help sooner if there are any concerns for PPD.

— Ryan Moultray, DO, is an osteopath at Selah Family Medicine. Will and Owen call him Dad.

Do children need to take vitamins?

ASK THE DOCTORS If you have a health question, we’ll find the answer. Write to the doctors at talkback@playdateyakima.com.

DR. MOULTRAY SAYS: A multibillion dollar industry, vitamins. Why? Because we like to think that even though we don’t eat a well-balanced diet, we can take a little pill and it will bring our health into perfect equilibrium. And the benefits of vitamins are extremely difficult to quantify, therefore difficult to disprove. In fact, certain vitamins, such as K, A, D, and E, can accumulate in the body and cause toxicities if consumed in excess.

So, the short answer to the question: No. Most children who eat a diverse diet, with the right combination of fruit, vegetables, fortified cereals, grains and meat, are not at risk for any nutritional deficits, and therefore really don’t need to take a vitamin.
But, do my 4- and 2-year-old children eat perfectly balanced diets, or would they prefer to eat crackers and fruit snacks all day long? In my opinion, a basic multivitamin (we like Flintstones) about every other day is sufficient.

There are definitely some caveats to this simple perspective. Particularly, there are a few nutritional deficiencies to be aware of with babies and young children. Iron deficiency can lead to anemia and developmental delays. Most formulas are supplemented with iron. Some breastfed babies (which is the recommended diet for most babies) can be at risk for this deficiency when they reach 4-6 months of age. Making sure they consume cereals fortified with iron will help alleviate this risk, and screening blood work can also be performed.

Fluoride, which helps combat tooth decay, is another nutrient they may need. Most homes that receive city water will have access to water that is supported with an appropriate amount of fluoride, provided that the child drinks it. Some wells and bottled water have fluoride in them, but this is more difficult to quantify. Your doctor can help you determine if supplementation is needed.

A problem we don’t think about very often in the sunny Yakima Valley is vitamin D deficiency. This is because exposure to sunlight helps your body produce vitamin D. Infant formula and most store-bought milk is fortified with sufficient vitamin D, however breastfed infants could potentially be at risk for a deficiency.

Finally, in some selected populations of children vitamins may play a more essential role. These include breastfed babies of vegan mothers (vitamin B-12 deficiency), and children with chronic medical conditions such as liver or bowel disease.

So, to play the broken record that we hear constantly: “Make sure your child eats a well-balanced, diverse diet.” And if you can figure out how to get your 2-year-old to eat cauliflower, please let me know.

• When he’s not sipping soy milk with sons Will and Owen, Ryan Moultray works as an osteopathic doctor at Selah Family Medicine.

DR. ROBEL SAYS: I feel that most of our children should be supplementing their diets with a multivitamin/multimineral for several reasons. Most of us, especially our children, are not eating the recommended minimum servings of fruits and vegetables a day. If we are not getting our fruits and veggies, we are losing out on important vitamins and minerals our body needs.

Second, our soils are becoming deficient in trace elements due to decades of agriculture overwork. This means that many of our food crops are depleted of nutrients.

Finally, our children are exposed to far more air pollution and stress then most of us were as kids. This exposure increases our children’s need for certain vitamins, especially C, E and B.

Not all multivitamins are created equally. It is important to read the labels when purchasing your child’s multi. Always look at the supplement fact sheet on the back of the bottle and avoid anything containing artificial flavor and sweeteners or blue, red, or yellow dyes. Also, never take more then the recommended dose that is on the bottle.

Remember, adding a multivitamin/mineral is not a substitute for proper nutrition. It is important that your child eat a well-balanced diet that’s adequate in fruits and vegetables. If your child isn’t eating well, add the multivitamin but also work on improving her nutrition.

Adding a multivitamin just in time for the cold and flu season can decrease the number of days spent at home with a sick child.

• Heidi Robel is an aunt to three delightful children and a naturopathic physician and acupuncturist in private practice in Yakima.

Do you recommend any vaccines for teenagers?

ASK THE DOCTORS If you have a health question, we’ll find the answer. Write to the doctors at talkback@playdateyakima.com.

DR. MOULTRAY SAYS: It’s easy to overlook immunizations in the teenage population. They are generally healthy and do everything within their power to avoid going to the doctor’s office, where they are apt to get stuck by a needle, or made to turn their heads and cough.

Lucky for us, they do invariably come in for a sports physical, sinus infection or the occasional skateboard accident. It is within these rare encounters that we, as health-care providers, try to squeeze in a little preventative medicine. Immunizations are an important part of this, and there are several that are recommended for teenagers specifically.

First, a “tetanus booster” is usually given around the age of 11 or 12. This vaccination also has a diphtheria booster, and pertussis was recently added to the booster for teenagers and adults because the vaccine’s protection decreases after five to eight years. Pertussis causes whooping cough, which is on the rise in our country. We have seen many cases here in the Yakima Valley as of late, as well. All three bacteria can cause serious infections, which is a compelling reason to keep it up to date.

Next, the meningococcus vaccine, or MCV-4, is recommended for all children at 11-12 years of age. This protects against a bacteria that is the most common cause of meningitis, a dangerous infection of the brain. It can also cause a serious infection in the blood stream. About 2,500 to 3,500 cases occur per year in the U.S., and up to 15 percent of people die from it; another 10 to 20 percent have long term complications. Most of these infections occur in young children and teenagers, and it is spread by respiratory secretions (spit and snot).

Finally, one that’s a little controversial is the human papillomavirus, or HPV, vaccine. This protects against four of the most common strains of the HPV virus, which we now know cause 99 percent of all cervical cancer in women.

It is controversial because the main way that you contract the virus is by sexual contact, and of course, none of our daughters will ever engage in this type of activity until they are properly married. So the vaccine should be unnecessary, right? I guess it depends on how much you trust your daughter (and her boyfriend).

Three others that are recommended in higher risk groups are the pneumoccocal vaccine (pneumonia), influenza and Hepatitis A. If your teen has some chronic medical issues, you should ask your provider if these are necessary.

Vaccinations are an effective way to prevent serious infections, and they’re not just for little kids. So, teens, if you thought you were past the agony of the nurse’s needle, think again!

• Ryan Moultray is an osteopathic doctor at Selah Family Medicine. Learn more about him at selahfamilymed.com.

DR. ROBEL SAYS: Vaccinations offer many benefits including prevention of serious illnesses as well as the spread of these diseases, as Dr. Moultray mentioned. Vaccines work by injecting a weakened form of a virus or bacteria into the body. The body then forms proteins, called antibodies, that recognize and attack the disease.

It is important to remember that many vaccines do not give permanent immunity to the person receiving the vaccine and thus boosters in later years are necessary. A vaccine does not always provide complete immunity to a disease. Some individuals receiving a vaccine may later on develop that disease, if exposed.

Also, vaccines don’t always come risk free. Side effects may include soreness, redness or swelling at the sight of injection (often temporary), and rarely, serious allergic reactions or certain neurological disorders.

Finally, the HPV vaccine protects against only four common strains of HPV. However, there are about 40 different strains, some of which may also lead to cervical cancer.

Talk to your provider about the benefits of your teen getting vaccinated, the risk of the disease and the risk of the vaccination so you can make an informed decision when choosing to vaccinate.

• Heidi Robel is a naturopathic doctor in private practice in Yakima. She has a Web site, too: drheidirobel.com.

I need to find a new family doctor. What’s the difference between an M.D., a D.O. and an N.D.?

ASK THE DOCTORS If you have a health question, we’ll find the answer. Write to the doctors at talkback@playdateyakima.com.

DR. MOULTRAY SAYS: Great question. I’ll tackle the first two: D.O. stands for Doctor of Osteopathic Medicine, an “osteopathic” or therapeutic approach to health care. M.D. is short for Medical Doctor, an “allopathic” approach that focuses on treatment of injuries or disease. There are many of each in the Yakima Valley, and they are very similar.

In most offices and hospitals, D.O.s and M.D.s work side by side (with very few cat fights, I might add). Both are fully qualified physicians, licensed to prescribe medication and perform surgery. Each can choose to practice in any medical specialty, from family practice to neurosurgery.

One of the aspects of osteopathy that attracted me was the philosophy of practicing “whole person” medicine — that is, discovering and treating the root of the disease, rather than simply treating the symptoms of illness. It’s an approach that strives to help the human body heal itself (it’s usually very good at healing if you put good things into it and move a lot).

This philosophy also considers how illness is affecting a person’s state of well being, emotionally and spiritually.

Osteopathic medical schools emphasize training students to be primary care physicians, which are in great need in our country. Approximately 65 percent of practicing osteopaths specialize in primary care, such as pediatrics, family practice, OB/Gyn and internal medicine.

Osteopathic physicians receive extra training in the musculoskeletal system — your body’s interconnected system of nerves, muscles and bones. This training provides a better understanding of the ways that an illness or injury in one part of your body can affect another.

Osteopaths also receive training in a technique called osteopathic manipulative treatment (OMT), a hands-on approach to diagnosing and treating illness and injury, which encourages the body’s healing ability.

In your search to find a doctor, I think you will find that the truly exceptional ones, regardless of whether they are M.D., D.O. or N.D., will be the ones who take the time to listen to you with empathy, and approach your health concerns with consideration of mind, body and spirit.

• Ryan Moultray is the proud papa of two boys, Will and Owen. He’s an osteopath at Selah Family Medicine.

DR. ROBEL SAYS: Finding a family physician can be a daunting task. An ideal family physician is someone with whom you will form a lasting relationship over the years, someone you trust, and someone who will listen to your needs.

N.D. stands for Doctor of Naturopathic Medicine. Naturopathic medicine is guided by treating the whole person, including the body, mind and spirit — not just symptoms of a disease— using treatments that work with the body’s natural healing mechanisms, treating the cause of the disease and not just managing symptoms as well as promoting prevention. Naturopathic physicians also hold the belief that doctors are teachers and thus spend time educating their patients.

Naturopaths have had four years of graduate education, and are educated in all of the basic sciences like D.O.s and M.D.s. However, naturopaths also study holistic and nontoxic approaches to treatment with a strong emphasis on disease prevention and wellness. N.D.s are highly trained in Western science as well as alternative medicine, thus providing a very unique perspective to family medicine.

Naturopathic physicians receive extensive training in clinical nutrition, diet and lifestyle changes, homeopathy, herbal medicine, counseling, and physical medicine including naturopathic manipulation.

Naturopathic physicians also perform minor surgery and prescribe some drugs when necessary.

There are many factors to take into account when finding a family doctor. Whether it be a D.O., M.D., or N.D., hopefully this information will help you find a physician that will resonant with you and your family’s needs.

• Heidi Robel is a naturopathic physician and acupuncturist in private practice in Yakima. She’s also auntie to three delightful children.

I am the parent of an overweight child (age 10). We have been actively looking for some type of class for children with this problem. I have called doctors’ offices, the YMCA and various gyms. I have been turned away at all places. With obesity beginning to be out of control for our youth, Yakima needs to start offering things. I know I am not alone. Children do much better when interacting with children their own age and who have the same problem. I am beginning to see her self-esteem go down. Is there any help you can offer? Or maybe you know of somewhere I haven’t looked.

ASK THE DOCTORS If you have a health question, we’ll find the answer. Write to the doctors at talkback@playdateyakima.com.

DR. MOULTRAY SAYS: This is a great question. I still remember my own experience of being overweight as a child, and how self-conscious I felt. It truly affects a person’s self-esteem in a profound manner, especially teenagers.

There are several definitions of “obese,” but a fairly standard measurement is the BMI, or body mass index, which uses a combination of height and weight to establish a value. A value of 25-30 is considered overweight, and greater than 30 obese.

I had a difficult time finding some concrete community resources for this problem, so I turned to pediatrician Dr. Kerry Harthcock of Yakima Pediatrics, who I would consider a local expert on the subject. He reiterates that this is a substantial problem nationwide, but especially in the Yakima Valley. He also laments that there are not a lot of current programs to support these kids.

Dr. Harthcock explains that there are different stages of obesity based on age, but it is particularly important to correct the problem at a young age. Once children have established a pattern of obesity into their teen years, they will probably carry it through the rest of their adult lives.

Help is on the way, however, as a grant has been given to the Yakima School District earlier in the year to set up programs to help with this very problem.

Another good resource is the YMCA. They have many programs to help kids of different ages become active physically, which is an important part of combating obesity.

You may also want to check out the Yakima Health District’s Web site, particularly the section titled “Chronic Disease Prevention,” for some other ideas.

For special situations, Children’s Village has a dietitian. Finally, your child’s physician can help assess the magnitude of the problem, and provide recommendations as well.

My feeling is that if you truly are serious about helping your child escape the clutches of obesity, and all the medical complications and social implications it can cause, look no further than the mirror. Young children can eat only what you give to them. If they are given foods that are nutritious, and not allowed to overeat, this will become a lifestyle habit.

Likewise, if their time in front of the TV or computer is limited, and they are made to go outside and play, this will also become part of their lifestyle.

I cannot stress enough the importance of modeling this behavior for them as well. They should see you exercising at least every other day, and eating appropriately. Easier said than done, but your children’s health is definitely worth it.

• Ryan Moultray is Will and Owen’s dad. He’s also an osteopathic doctor at Selah Family Medicine.

DR. ROBEL SAYS: During my research on this question, I too was very disappointed in the lack of opportunities for overweight children in the Yakima Valley. With childhood obesity on the rise, it is something that we as a community should strive to prevent.

It is estimated that approximately 20-25 percent of children in the United States are overweight or obese. Not only is being overweight hard on a child’s developing self-esteem, but it also increases our children’s risk of diabetes, high cholesterol, growth issues, high blood pressure, sleep problems, liver disease, depression, learning disabilities and early puberty.

The only way to reduce these risks is to lose the weight. Weight loss should be slow and steady — about one pound per week.

Encourage involvement in an after-school activity and less time in front of the television.

Don’t allow your child to skip breakfast, which should be providing one-third of the nutrients needed for the day. Opt for high-protein foods in the morning to stabilize blood sugar so you don’t feel sleepy and provide plenty of energy to take on the day. Eggs are a good source of protein but they should be boiled or poached, not fried. Seeds, nuts or even protein powder can be added to oatmeal or smoothies.

A protein-packed lunch and afternoon snack can help kids get through the day more alert and able to focus on school, and reduce cravings for sweets and refined carbohydrates. Fiber is also very beneficial for weight loss and can be found in whole grains, fruits and vegetables. Breads and flour-based foods should be served very little, but when they are, they should have at least 4-5 grams of fiber per serving.

Finally, to increase your child’s self-esteem, praise her for the small achievements she makes in her weight loss journey. Never use food as a reward or punishment. During difficult times, let your child know that you love and support them no matter what.

Work with your child to set goals and follow through with them. Keep them small and short in the beginning to help build self-confidence.

And as Dr. Moultray said, be a role model for healthy living and invite your child to join you in the process.

• Heidi Robel is an aunt to three delightful children and a naturopathic physician and acupuncturist in private practice in Yakima.

A few weeks ago, I heard that you shouldn’t give peanut products to young children because of allergies. I’d never heard about this before and I give my kids peanut butter sandwiches all the time! What other foods should I know about?

ASK THE DOCTORS If you have a health question, we’ll find the answer. Write to the doctors at talkback@playdateyakima.com.

DR. MOULTRAY SAYS: I can still remember the time my wife brought our oldest son into my office, panic on her face, with his first allergic reaction. A patchwork of hives was swirled across his red, swollen face and he and my wife were terrified.

Only 6 months old, he had never eaten anything but breast milk up to that point. We would come to discover that he has an allergy to dairy products.

Food allergies are a common concern of parents. Some of the most common culprits are peanuts, cow’s milk and other dairy products, soy, eggs, tree nuts (such as walnuts and cashews), wheat, fish and shellfish.

Common sensitivity reactions include symptoms such as a runny, itchy nose, sneezing and coughing, skin rashes and even facial swelling. Remember Will Smith in the movie “Hitch”? Your child could look like that.

Other symptoms include stomach pain, cramping or diarrhea, and most severely, anaphylactic reactions can occur in which blood pressure drops, swelling of the breathing tubes can occur, and even death. These reactions usually occur right after your child eats a certain food, but they can happen hours or even days later.

So now that I have you terrified to give anything but rice and tofu — whoops, that contains soy — to your child, here’s the good news: A person’s odds of dying from a food allergy are roughly equal to dying of a lightning strike, about 200 people per year.

Also, most kids outgrow their food allergies. Unfortunately, certain allergies tend to persist, such as those to fish, shellfish, peanuts and tree nuts.

The bottom line is that many doctors feel you should not feed your child highly allergic foods, such as fish and peanuts, until age 2. If you have family history of allergies, some recommend waiting until 3 years.

One thought is that the delay in introduction of these foods will decrease the odds of developing the allergy, however recent research doesn’t seem to support this.

Probably a better reason to delay is that if your child does have a true allergy to one of these foods, she will be more equipped to deal with it at an older age.

At our house, my wife and I waited until the boys were a year old before introducing them to peanut butter. But they’ve been living on it ever since!

• When he’s not sipping soy milk with sons Will and Owen, Ryan Moultray works as an osteopathic doctor at Selah Family Medicine.

DR. ROBEL SAYS: Food allergies can cause a whole multitude of symptoms in your child, not always as obvious as Will Smith’s reaction in “Hitch.” Besides those Dr. Moultray mentioned, other signs that your child may be experiencing an allergy or intolerance to food include constipation, eczema or rashes around her mouth or anus, frequent ear infections, hyperactivity, acid reflux (heart burn), frequent bed wetting and asthma.

Peanuts are considered highly allergic because they contain a mold called Aspergillus viavus that may trigger an allergic reaction in 1-2 percent of the population. It is often recommended to avoid highly allergic foods like peanuts until your child is 2 to 3 years old because that is the age that her immune system is completely developed.

When introducing foods to your infant, start with foods that are less likely to cause reactions, such as bananas, apples, blueberries, avocados, pumpkin, beets, yams and pears. Try one new food at a time and look for any signs of reactions to the food. If your child develops a reaction, eliminate that food for 3-6 months then retry.

If you suspect food allergies, talk with your doctor about following an allergy elimination diet or a blood test to find the culprits. Often, a three-week trial of eliminating the suspected food from the diet will give you a clear picture; the symptoms she is experiencing will clear up if they are due to that food.

Finally, if she has had an anaphylactic reaction in the past to a certain food, it is important to talk with your physician about carrying an epinephrine pen and to avoid the food at all times. Remember, this is in extreme cases and peanut allergies are rare but being in the know about all possible allergies allows our little ones to enjoy their favorite treats!

• Heidi Robel is an aunt to three delightful children and a naturopathic physician and acupuncturist in private practice in Yakima.

I’m confused about the news regarding cold medicine for children. I have two preschoolers who have already had several colds this season. Is it OK to give them cold medicine? What else can I do to help them feel better? Thanks.

ASK THE DOCTORS If you have a health question, we’ll find the answer. Write to the doctors at talkback@playdateyakima.com.

DR. MOULTRAY SAYS: Well, here we are again right in the thick of it. Literally. Snot, phlegm, custard-like crud coughed with relentless hacking from the depths a child’s chest, noses raw from free-flowing mucous. Yes, cold season is here again.

What is a parent to do when their child feels awful, yet recent news reports tell us to avoid medications which might relieve some of the suffering?

The “common cold” is one of the most frequent infections in the United States. It’s a viral infection (remember from last issue, this means antibiotics are useless against them), and usually involves a cough, runny nose with congestion, watery eyes, sore throat, headache, low grade fever and a general feeling of lousiness.

You may have seen the report put forth by the FDA, in regards to over-the-counter cough and cold drug product use in children: “Questions have been raised about the safety of these products and whether the benefits justify any potential risks from the use of these products in children, especially in children under 2 years of age.”

There have been many cases of harm to children, even death, from some of these over-the-counter products. Most of them, however, were the result of improper dosing of the medication. I think the question we need to ask ourselves is, are we really helping our children by treating these symptoms?

The evidence actually suggests that the medications are not very effective in treating symptoms of cough, runny nose and congestion. We should also remember that these medications do nothing to shorten the course or severity of the illness.

The fact is, the symptoms of a cold usually are not harmful to children, they are just uncomfortable. For parents, it’s hard to see your child suffering, and the symptoms can be quite inconvenient and frustrating as you listen to your child cough and gurgle all night long. So often we look to pills and syrups to alleviate the misery. Parents and doctors alike want to feel like they are doing something for the child, as both genuinely want to ease suffering.

Here’s what you can do that is safe, and actually effective: First, be certain that your child only has a cold. Have they had a fever for more than three days? Are they struggling to breathe? If you aren’t certain or have other concerns, have your doctor evaluate them. If not, Tylenol (acetaminophen) or ibuprofen (in kids over 6 months) can definitely be used to help with a fever.

Encourage plenty of liquids.

Humidifying the air and saline nasal drops or spray to unclog the nose also could be helpful.

My mom gave me Lipton’s noodle soup, gentle back rubs, and soothing songs — and I’m quite certain this helped me heal a little faster.

The conclusion I would draw from the recent concerns regarding over-the-counter cold remedies is this: They can be potentially harmful, and they may or may not be helpful at eliminating symptoms. They certainly do nothing to shorten the course of the illness.

If you’re unsure about the dosing or proper use of these medicines, or wonder if your child could have a more serious infection, call your doctor’s office. We have a doctor on call 24 hours a day, seven days a week, and when it comes to the health of your child, there are no dumb questions.

• Ryan Moultray is the father of two tots and an osteopathic doctor at Selah Family Medicine.

DR. HARVEY SAYS: Dr. Moultray is right! It’s hard for a parent to see her child miserable. Moms and dads would do anything to make their little one better.

Babies under a year old are especially bothered by nasal congestion. Babies with a plugged-up nose cannot take the breast or bottle and cry to let everyone know.

Nasal saline drops then gentle suction with a bulb syringe can help keep their little nose open at feeding time. BUT if the baby is just snuffly and can take a breast or bottle, leave the nose alone.

An upper respiratory virus usually starts with a fever for a day or two, followed by congestion and cough. The cough can last a few weeks. Sometimes a child will start to look better, then suddenly get a fever again. This fever may signal that the child has developed an ear infection or some other secondary infection and should be evaluated.

Parents often worry about strep throat when a child has a fever and sore throat. A good rule of thumb is if the child is coughing and has a runny nose, the sore throat is viral. Fever and sore throat without the cough or runny nose should be evaluated.

The Ocean-brand nasal saline is available over the counter, or try the generic equivalent. Make your own by mixing 1/2 cup warm water with 1/4 teaspoon salt. Mix it fresh every time. It’s cheap.

Parents ask me “why are cold remedies on the market if they don’t work?” People will buy anything that might help when they are hurting. In 2005, Americans spent $3.6 BILLION dollars on over the counter cold remedies. It’s big business.

Prevention is every bit as important as treatment. Sneeze in your elbow, not your hands. Wash hands frequently, especially before — and after! — picking up a little one. Breast-feed infants if possible, this way baby gets mom’s antibodies.

Finally, it’s not too late to get your flu shot!

• Judy Harvey is mom to Leslie, 23; Christopher, 21; Rachel, 18; and Daniel, 16. Somehow, she also finds time to work at Family Medicine of Yakima.