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By contactus@kidsfirstpediatrics.net
August 01, 2017
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This blog is devoted to play.


Who doesn’t remember hours of outdoor play, coming home briefly for lunch then heading back outside until dinner time?

Unfortunately, it seems that this childhood freedom to play outside all day has all but vanished from our society.  There are many reasons for this.   Parents are concerned about their child’s safety due to road traffic, bullies or possible predators. There may be no suitable yard or nearby parks to play in.  Parents are working long hours and have no one to watch their children play outside.  Some children, even in early grade school, have homework to do after school.

These are all very real concerns but the lack of free play affects our children’s emotional development and can cause problems later in life.  Therefore we recommend that parents work to put free play back into their children’s day.

Unstructured freely-chosen play is a testing ground for life. It provides critical life experiences that help young children develop into confident and competent adults. Free play is different than playing sports. Free play is play that a child undertakes by his or her self and which is self-directed and an end in itself rather than part of an organized activity.  Recess is free play while physical education is organized.



Here are some ways that free play benefits kids:

  1. Play gives children a chance to find and  develop a connection to their own self-identified and self-guided interests.
  2. It is through play that children first learn how to make decisions, solve problems, exert self-control and follow rules.
  3. Children learn how to handle their emotions, including anger and fear during play.
  4. Play helps children make friends and learn to get along with each other as equals.
  5. Play is a source of happiness.

The loss of play can be harmful in 2 ways.  First it takes away the joys associated with free play then it replaces them with emotionally stressful activities.

Real play is not associated with screen time. In fact, there is ample evidence that these “passive” forms of entertainment such as watching TV and playing video games do not have the benefits of free play and can actually have harmful effects.

It is possible to have free play indoors but much more beneficial if outside.  Play in an outdoor, natural environment allows children to explore both their world and their mind.  Nature places virtually no bounds on the imagination and engages all of the senses. For all children, this setting allows for the full blossoming of creativity, curiosity and associated developmental advances.

In addition, the outdoors provides an excellent opportunity for parents to interact with their children in a way that fosters both the development of the relationship and the child.  This can be accomplished by simply going on a walk and exploring the plants, bugs and rocks.  Children also benefit from fresh air, sunshine that provides Vitamin D and exercise.  This a win-win situation.

So, in conclusion, we all want what is best for our children.  Free play is a wonderful way for families to interact, receive health benefits and improve a child’s development and emotional help.

Article written by Sue Gaston, M.D.

KidsFirst Pediatrics


  1. Am Academy of Pediatrics, Ginsburg, K., and the Committee on Communications and the Committee on Psychosocial Aspects of Child and Family Health.  Clinical Report: The Importance of Play in Promoting Healthy Development and Maintaining Strong Parent-Child Bonds. Pediatrics 2007;119:182
  2. The Atlantic, “All Work and No Play: Why Your Kids Are More Anxious, Depressed, Esther Entin, Oct 12, 2011


By contactus@kidsfirstpediatrics.net
October 06, 2016
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     This month’s blog is sweet, really sweet.  We’re talking sugar, sugary drinks, Halloween candy, etc. Yes, hard to believe but Halloween is almost upon us!


Back to sugar.  Sugar is a simple carbohydrate.  Carbohydrates are essential ingredients of a healthy diet.  Carbohydrates come in several forms.  These include, sugar, fiber and starch.  They provided the body with glucose which is converted energy (calories).

Some types of carbohydrates are healthier than others.  The healthiest sources of carbohydrates (complex carbohydrates) are non-processed whole grains, vegetables and beans.  These foods deliver vitamins, minerals, fiber and other important nutrients.


Unhealthy sources of carbohydrates (simple carbohydrates) include white bread, pastries, candy, sodas and other processed food. These foods contain easily digested carbohydrates that may contribute to weight gain and promote diabetes and heart disease.

The average American consumes 22 teaspoons of added sugar a day.  This accounts for an added 350 calories. Most added sugar comes from processed and prepared foods.  Sugar-sweetened beverages and breakfast cereals are two of the most serious offenders.

Here are some tips for adding healthy carbohydrates to your child’s diet:

  1. Whole grains for breakfast—old fashioned oatmeal, cold cereal with whole grains/low sugar (less than 8 grams of sugar per serving).
  2. Use whole grain bread
  3. Use brown rice or quinoa instead of white rice or bread.
  4. Serve whole fruit instead of fruit juice.  An orange has twice as much fiber and half as much sugar as 12 oz. of orange juice.
  5. Pass on potatoes.  Substitute beans which provide protein and fiber.


Later this month many of our children will participate in an activity where the main goal is to obtain as many high carbohydrate foods as possible.  This activity is called
“Trick or Treating”.

One Mom from New York City decided to tally up the calories in her child’s Halloween candy.  The grand total was 7238 calories!  Wow!  That’s a lot of sugar. 

Here’s a way to avoid that sugar overload.  Donate the candy.  There are several organizations that will accept individually wrapped candy.

Here are a few:

  1. Operation Shoe Box—sends candy to our troops

          8360 East Highway 25

          Belleview, FL 34420

  1. Operation Gratitude—check the website since a donation form is required
  2. Food Banks—call first to see if they are accepting candy donations
  3. Local dentists/orthodontists---some will pay to buy candy form children.

Check the website, www.halloweencandybuyback.com for more information.

Have a safe and healthy Halloween!

Article written by Sue Gaston, M.D.

KidsFirst Pediatrics

By contactus@kidsfirstpediatrics.net
June 27, 2016
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    It’s wonderful when the weather gets warm and children can enjoy the outdoors.  Your backyard can be a great place to play.  Here are a few suggestions for keeping your yard safe for children.


If your yard is not fenced, teach your children the boundaries where it is safe to play.  Always have a responsible person supervise outdoor play.


Teach your child never to pick up and eat anything they find outdoors (even if it is from your garden) without checking with you first.  You should also check to see if any of the plants in your yard are poisonous.  Don’t allow children to play on a lawn that has been treated with pesticides or herbicides for at least 48 hours.  Read the instructions on all such products before using.  Your local Poison Help Line (1-800-222-1222) should be able to provide a list of poisonous plants common to your area.              


Never use a power lawn mower when young children are around.  The mower may throw sticks or stones with enough force to injure them.  Never have your child sit on your lap while you are driving.  Keep young children inside when the lawn is being mowed.


Keep children away from outdoor grills and explain that it is hot like the kitchen stove.  Never leave the grill unattended when young children are around.  Store propane grills so your child cannot reach the knobs.        Be sure charcoal is cold before being disposed of.


Keep swing sets, slides and other play equipment in good repair.  Injuries might occur from contact with broken plastic, exposed nails, splintered wood.  Young children should always be supervised when playing on this equipment.  The surface below play equipment should be soft enough to absorb a fall.  Use safety tested mats or shredded rubber, sand, woodchips or bark.  The material should be at least 9 inches deep and extend at least 6 feet from equipment.

Keep all lawn chemicals, gas and oil containers, pesticides and fertilizers locked.  All lawn equipment, saws, rakes, shovels, hammers should also be inaccessible to children.

Clothing should be appropriate for the weather and closed toe shoes should be worn with socks.  Clogs and sandals are easy to trip in and do not provide adequate protection from bugs and splinters. 


Finally, be sure that your child is wearing sunscreen when outside.  




Also provide frequent water breaks on hot days.



Backyards are wonderful places to be enjoyed by children.  Please keep yours safe.

Article written by Sue Gaston, M.D.

KidsFirst Pediatrics

By contactus@kidsfirstpediatrics.net
December 09, 2015
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This month’s blog is on winter and its effect on skin.  Winter is a difficult time for skin.  The cold, dry air outside and the warmer dry air inside can cause significant skin irritation.  Children with eczema can have frequent skin “flare ups” in the winter.

Let’s start with some information about eczema.  Eczema is a chronic itchy skin condition.  Eczema usually starts in the first few years of life, often before a child’s first birthday.  Eczema symptoms seem to wax and wane.  Some children have mild eczema while others have severe symptoms.  Infants usually have eczema rashes on their cheeks, foreheads and scalp.  It may affect most of the body but usually spares the diaper area since this area is moist.  Once an infant begins crawling the rash might mostly affect the knees and elbows.  Toddlers usually have eczema rashes in the knee and elbow creases as well as wrists, ankles and hands.It may also affect the skin around the mouth and eyelids.  Older children might only have isolated eczema patches.                                   

.What triggers a flare of eczema?  Eczema often flares when the skin is very dry, when it comes into contact with irritating substances or allergic triggers, or when the skin is infected.  In infants, saliva from drooling can cause worsening symptoms, especially on cheeks, chin and neck.  Triggers can vary from child to child and can include pets, carpets, dust mites and certain fabrics and possibly some foods.

There is no cure for eczema but in most cases eczema becomes less severe with time.  Eczema can usually be controlled with appropriate therapy.

So what “therapy” is used to treat eczema?  Most dermatologists recommend that children with eczema should bathe daily.  Baths are preferred over showers.  Baths should be warm, not hot and limited to 10 minutes.    Soap use should be limited to “dirty areas” such as the diaper area or areas that appear dirty. Soaps for sensitive skin should be used.


The skin should not be scrubbed but cleansed gently with a soft washcloth. Once out of the tub the skin should be patted dry, not rubbed.  A moisturizer should be applied immediately after bathing.


                        Don't give bubble bath, as it will irritate skin! 

Frequent application of moisturizers is the main therapy for eczema.  Moisturizers should be applied at least twice a day in a thick layer over the skin.  Creams and ointments are much better than lotions.  Lotions are mostly water and are not very effective.  If a child complains of burning with application of a cream switching to an ointment might help.      

What if you are using moisturizers regularly and your child has an eczema flare?  First, it’s important to be sure that the flare is not due to infection.  Skin is our largest organ and protects our body from infection.  If the skin is cracked or irritated (as it often can be with eczema), the protective skin layer is compromised and might allow bacteria to invade.  Think infection if the affected skin is red, raw, weeping or crusted.  In this case your child should be seen by a pediatrician to determine if oral or topical antibiotics are required.  If the skin is mostly dry with “rough” areas but no redness or crusting then using a steroid cream or ointment might be advised.  It’s best to discuss this with your child’s physician to determine if an over-the-counter steroid (1% Hydrocortisone cream/ointment) should be tried or if a prescription strength topical steroid is necessary. Topical steroids should only be used on affected skin and use should be limited to 1-2 weeks unless advised otherwise by a physician.

Does diet affect eczema?  Significant eczema symptoms in an infant or toddler might be related to food allergies although this is not common.  If treatment with appropriate bathing, frequent application of moisturizers and occasional use of topical steroids helps control eczema symptoms then a food allergy is unlikely.  If eczema does not improve with appropriate therapy then it might be advisable to have an allergy evaluation.

So, in conclusion, there is no way to prevent eczema but good skin care and frequent use of moisturizers can strengthen the skin against all kinds of irritants.  Avoidance of known eczema triggers is important.  If flare-ups occur it is important to step up therapy right away before symptoms become severe.  

Article written by Sue Gaston, M.D.

KidsFirst Pediatrics




By contactus@kidsfirstpediatrics.net
October 22, 2015
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Nosebleed (Epistaxis)

It can be very frightening when blood is flowing from your child’s nose.  Nosebleeds are very common and rarely serious.  They are usually caused by dry air (cold outside air/air conditioned air/dry heat) or by nose picking.

The inside of the nose has lots of blood vessels that are close to the surface so it’s easy for these blood vessels to be irritated or injured, resulting in a nosebleed.

Nosebleeds can occur during a cold or with allergy symptoms when the nasal tissue has become raw and inflamed.  Other times nosebleeds happen after any injury to the face, perhaps after a fall.  Rarely are nosebleeds caused by a serious medical problem.

Medications that are used as blood thinners can cause nosebleeds but these medications are seldom used in children.

Certain nasal sprays that contain steroids can have nosebleeds as a side effect.  These nosebleeds are usually mild and resolve if the spray is discontinued for a week or two.

Nosebleed Care

With the right care most nosebleeds stop on their own.  Here’s what you should do:

  1. Have your child sit bending forward at the waist.  Do not have them lie down or tilt their head back.  This might cause them to swallow blood and can lead to nausea and vomiting since blood is very irritating to the GI tract.
  2. Grip the soft part of both nostrils at the bottom of the nose and apply pressure.
  3. Squeeze nose for at least 5 minutes.  If you release the pressure before 5 minutes the bleeding may recur and you will need to hold for another 5 minutes.
  4. You may also apply a cold compress to the bridge of the nose.  This will help the blood vessels to constrict and slow the bleeding.

If you follow these steps and your child’s nose continues to bleed, repeat all steps and apply pressure for up to 30 minutes.  If the bleeding continues after this then emergency care is needed.

If your child’s nosebleeds are very frequent or prolonged there might be an underlying problem. There might be a large blood vessel near the surface of the nasal tissue.  If this is the case the bleeding is often from only one side of the nose.  In this case a referral to an Ear, Nose and Throat specialist might be needed.  These specialists have the equipment to visualize the upper part of the nose to locate and treat the offending blood vessel.

Another less common problem causing prolonged frequent nosebleeds is a bleeding disorder called “Von Willebrand’s Disease”.  In this case the bleeding should be from both nostrils and there might be a family history of nosebleeds or heavy periods in female relatives.  This disorder can be diagnosed with a blood test, preferable at the time of the bleeding.  Patients with this disorder are referred to a hematologist (blood doctor) for treatment and do very well with medication.

Nosebleed Prevention

Here are some measures to try to prevent nosebleeds:

  1. Use a humidifier in the bedroom, especially in winter when the dry heat is turned on.
  2. Keep inside of nose moist using nasal saline spray or gel or applying Vaseline to inside of nose at bedtime.
  3. Avoid nose picking and keep fingernails short

Article written by Sue Gaston, M.D.

KidsFirst Pediatrics


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