Know your numbers series – children

Our three-part series explores the numbers that are considered healthy during routine screenings. If you missed our first two installments, see Part I – men with Arthur Hong, M.D. and Part II – women with Simran Jit, M.D.

Part III includes expert advice from NCH Medical Group Pediatrician Kristina Mitton, M.D., who focuses on the pediatric patient and what parents and kids need to know.

5-4-3-2-1 Go!^®*

I like to tell my patients to remember the numbers 5-4-3-2-1 which come from the Consortium to Lower Obesity in Chicago Children. To promote a healthy lifestyle, children should have:

• 5 servings of fruits and vegetables per day (a serving is a half cup)
• 4 servings of water per day (one serving is 8 ounces)
• 3 servings of dairy – milk, yogurt or cheese – for the calcium they need
• 2 hours or less of screen time per day
• 1 hour of exercise per day

Exercise is important for your cardiovascular and physical health but also for your mental health.

Height/weight

I tell parents when we’re looking at height or weight that there’s a large range for kids. Anything between the 5th and 95th percentile is considered normal. We’re more interested that children are following along their percentiles and growing.

Bedtime/Sleep

I recommend turning off screens 30 minutes before bedtime. Studies have shown that the light from screens suppresses your body’s natural melatonin and makes it harder to fall asleep.

Children should get anywhere from 9 to 12 hours of sleep. It’s very important for kids because lack of sleep has been linked to attention and behavior issues. Kids who don’t get enough sleep can have problems with learning, memory and emotional regulation. They do a lot of their growing when they’re sleeping. I always tell kids, “If you’re concerned about how tall you’re going to be, then make sure you get enough sleep.”

Fevers

For babies 0 to 2 months, any temperature over 100.4 is a reason to call the pediatrician right away because they’re so small and their immune systems aren’t fully developed. Sometimes, fever is the only symptom they’re going to have when they’re sick.

From 2 months to 1 year, if they have a fever lasting more than 24 hours, I’d recommend parents call. It’s probably not an emergency, but we’d still like to know about it.

For any child over 1, I wouldn’t consider it emergent unless the fever is over 104. Call your doctor to discuss, but don’t necessarily go to the emergency department.

Babies

In the first 5 days, babies should have at least 1 wet diaper for the number of days old they are, and then they should be having anywhere from 5 to 10 wet diapers a day. Anywhere from 1 to 8 for bowel movements is normal per day for babies. After age 1, children should be having a bowel movement at least once per day.

Cholesterol

We start checking kids’ cholesterol levels at age 10. A normal total cholesterol is less than 200. Broken down, we like to see the HDL (good cholesterol) over 40 and the LDL to be less than 100. These are similar to the levels we like to see in adults.

Immunizations

There are 10 immunizations for children from birth to age 2. They include polio; measles/mumps/rubella (MMR); varicella (chicken pox); Haemophilus influenza Type B (called HIB); pneumococcal; tetanus and whooping cough; Hepatitis A and B; and the flu shot.

At age 4, there are 4 immunizations. These are boosters for polio; tetanus/pertussis; MMR; and varicella.

At age 11, there are 3 immunizations that include Tdap (tetanus, diphtheria and pertussis); meningitis; and the HPV series (to protect against sexually transmitted diseases).

Discipline

I sometimes get the question, “How long should my child be in a ‘time-out’?” I tell parents that about 1 minute per year of age is appropriate, so a 2-year-old child would sit for 2 minutes, and so on.

When to visit the pediatrician

Visits should take place shortly after birth, at 1, 2, 4 and 6 months of age, and then at 9, 12, 15, and 18 months. From there, children should visit at age 2, and then annually thereafter. We’re always reviewing growth, diet, exercise and the developmental milestones.

Car seats

The law did change recently. A child should be rear-facing in the car seat until age 2 now. There’s an infant car seat that’s used until age 1; then they switch to a toddler seat or convertible car seat until a minimum of 5 years old.

They’ll be in a booster seat until they reach the height of 4’ 9”. I remind families that it’s safest to be in a booster seat. You don’t want the seat belt to be at the child’s neck.

Children shouldn’t sit in the front seat until age 13 because airbags are strong, and children need to reach a certain height and weight for mature growth plates. With open growth plates, they can suffer more significant injuries than an adult would experience from an airbag. 

When should my child switch to a primary care physician?

I’d say over 22. I’m happy to see college students because I’ve seen them throughout their school years. Pediatricians are trained to treat teenagers, and I do enjoy seeing them. There are college campus-based clinics for when they’re sick, but for chronic issues and annual visits, I recommend continuing to see a pediatrician throughout the college years.

Dr. Mitton practices at the NCH Medical Group office at 135 N. Arlington Heights Road, Suite 152 in Buffalo Grove. Call 847-465-9600 to schedule an appointment.

*Learn more about the 5-4-3-2-1 Go!^® Health Promotion.