Tag Archives: handwashing

The Runt of my Litter. Why I Worry About my Smallest Child and When You Should Worry about Yours.

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CharlottesWebEvery day in the office at least one parent expresses concern over their smallest child: “His siblings were so much bigger at this age”; “Why is she sick all the time?”.

I can completely relate to their concerns. My 4 year old daughter is a runt1. Like Wilbur the pig2,3, she is sweet and brilliant, but small and often sickly. My husband and I are both tall, athletic people. Her sister has always been in the 95th percentile for her height and weight. Little E is taller than average, but she is scrawny, and she gets sick… a lot. Her sister didn’t have a cold until she was 2 years old. E had her first cold at a few weeks of life and seemed to be sick constantly for her first 3 years.

Why do I worry? Since I first entered medical school 18 years ago I have studied everything that can go right with a child’s health and everything that can go wrong. I have seen innumerable children who have suffered from accidents, cancer, infections, genetic disorders, and autoimmune diseases. When I was in training we used to say “the sweeter the child, the more horrific the diagnosis will be”. There was no truth in our statement. It was just a reaction to the heartbreak we felt; time after time we had to share devastating news about a child to the family that cherished him.

Unfortunately I have kept that superstition with me. My little E is a cup-half-full kind of girl. She dances around the house singing “Let It Go”, yells “wheeeee” the whole time she is flying down the trail on her bike, and shows more determination and grit than almost any child or adult I know. She is also prone to covering me with thousands of kisses and 10 second bear hugs on a daily basis. I have tears in my eyes when I write this because my overwhelming love and admiration for this child is matched by my overwhelming fear that something bad will happen to her. I try to reassure myself by remembering that many of my friends, and parents I see in the office, share my neurosis about their littlest child.

So when do we really need to worry?

  1. Is my child continuing to grow? Your child may be in the 3rd or 30th percentile on her growth curve. What really matters is if she is continuing to follow that percentile (normal) or if she is continuing to drop off the curve (concerning).
  2. Is my child reaching his developmental milestones appropriately (or is he doing well academically)? Check here for more information on developmental milestones.
  3. Does my child get frequent infections requiring antibiotics or hospitalizations? Frequent ear infections in the first year of life are often due to anatomy (small, flat eustachian tubes that don’t drain the middle ear space well), but frequent ear infections are unusual after the age of 2. Recurring bacterial pneumonia, frequent skin infections, or blood infections are more concerning for an immune deficiency.
  4. Does my child have bloody stools or frequent cramping and diarrhea? These can be signs of inflammatory bowel disease or celiac disease.

So how do you protect your runt? Fortunately there are a few great things you can do to keep your children healthier: good hand washing, proper nutrition, consistent sleep schedules, limiting screen/TV time, regular exercise, and vaccines. We do all of these things in our home but my baby still get sick. If your child is in daycare or preschool (or his older sibling attends school) then he may get 10-12 viral respiratory infections per year. Exposure to second-hand smoke will also significantly increase his risk of frequent infections.

Thankfully now that E is 4 years old, her illnesses are less frequent and less severe. Hopefully her physical composition will eventually match her emotional one. In the meantime I will still snuggle up next to her when she has a fever, and I will hold her all night when she has a cough. It makes us both feel better.

1. runt (definition from http://dictionary.reference.com/browse/runt)

– an animal that is small or stunted as compared with others of its kind.

– the smallest or weakest of a litter, especially of pigs or puppies.

2. E.B. White, Charlotte’s Web, (New York: Harper and Bros, 1952).

3. No children or animals were harmed in the writing of this post. Both Wilbur and my 4 year old can’t read yet. If little E does read this in the future I am fairly certain she will forgive her mommy for calling her a “runt”.


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BoogersDinner conversation at our house last night:
My 3 year old daughter E:”Remember when I was sick that time?”
Me: “Yes baby. You were sick all the time when you were a baby”
My 5 year old daughter M: “I wasn’t. But now I am sick all the time. You want to know why?”
Me: “Why?”
5 yr old M: “It’s because I eat my boogers every night”

Ewwwww. Is there a better way to start a blog then a conversation about boogers? As a pediatrician I thought about how this simple conversation revealed 2 very important points about keeping children healthy:

1-    It is so much easier to keep a first born healthy. My oldest didn’t even have her first cold until she was 2 years old. My youngest was about 2 weeks old! I was able to protect M because I had the luxury of grandparents instead of daycare, and no snot nose siblings to get her sick. We were a little obsessed with washing our hands and we spent a lot of time outdoors instead of crowded indoor places. E was sadly not so lucky. She was born in October (right at the onset of cold and flu season), and her older sister was bringing home every flavor of germs from her preschool and play dates. Poor E didn’t stand a chance. Luckily after a year of constant colds she was a little stronger and her immune system was revved up enough to start fighting back. She has had a much healthier toddlerhood.

2-    Fingers up the nose and in the mouth are loaded with bacteria and viruses. Germs are everywhere, but they especially like to gather in our noses and mouths. In fact the human mouth carries more bacteria than a dog’s mouth (and you know what they like to lick!). There is no better vehicle than a finger to transport those germs from our outsides to our insides. Of course keeping a child from spreading boogers and snot to all of their friends and foes is an impossible quest (and a battle that I don’t choose to fight). I do talk about germs and what is considered polite in front of others, and we move on. We also focus on good hand washing in home and school. I am a proud mama when I hear them belting out the “Happy Birthday song” when they are washing up in the bathroom. If you sing it twice it is about 20 seconds long, which is the minimum length of time recommended by the CDC to reduce the transfer of germs. I may only get one rendition out of them each time, but 10 seconds is better than nothing right? Just don’t peek under their fingernails!


Do you have any tricks for keeping your kids healthy this winter?