Pediasure versus Ensure - what's the difference ?

A fellow pediatrician complained about the Medical Representative of Pediasure/ Ensure asking him actively to stop prescribing Ensure for kids. However they were apparently unable to provide evidence to back their claims. So, I did a little bit if digging up to see if there was any significant difference between the two. This is what I found.

Pediasure is recommended for kids between 2-12 years, while Ensure is for adults. The good news is that substituting one for another is not likely to cause any serious problems for most normal kids / adults, as per my net based research.

Here are the main differences:

Pediasure has:

9 g of fat

3 g of saturated fat

90 mg sodium

310 mg potassium

18 g sugar

7 g protein

Ensure has:

7 g of fat

1 g saturated fat

190 mg sodium (big jump!!!)

390 mg potassium

22 g sugar

9 g protein

Source: http://www.ratshackforum.com/forum/viewtopic.php?f=38&t=9333

This suggests that Pediasure has more fats including saturated fats (possibly omega 3 etc. for brain growth), and lower protein & sugar content.

On the other hand, the high sodium in Ensure would be a negative for renal/ cardiac patients too.

Overall though, given the relatively small difference in the various ingredients, it is likely that for most individuals you can probably use either one, especially in regard to picky eaters who may like the taste of a particular brand.
Source:

http://www.justmommies.com/forums/f113-ftt-and-weight-gain-issues/1233340-pediasure-vs-ensure-other.html

http://forum.baby-gaga.com/about1754910.html

For someone wanting to do more research the following links give detailed information

http://nutritiondata.self.com/facts/baby-foods/466/2

http://nutritiondata.self.com/facts/dairy-and-egg-products/7708/2

I would like to reiterate that this is my personal opinion based solely on Internet search. I would encourage you to discuss your nutritional questions with your pediatrician or a nutritionist, especially if there is some special concerns.

How much sleep does my toddler/ preschooler / school going child need ?

This is a question that I get asked many times as a pediatrician.

Here is a chart that provides information about the same - please remember that each child is different, and the amount of sleep may vary between different children. This is just a general guideline.

Age	Nighttime sleep	Daytime sleep	Average total sleep
2 years	10 to 12 hours	1 to 3 hours (1 nap)	13 hours
3 years	9 to 12 hours	1 to 3 hours (1 nap)	12 to 13 hours
4 years	9 to 12 hours	0 to 2.5 hours (1 or no nap)	11 to 12 hours
5 years	8 to 11 hours	0 to 2.5 hours (1 or no nap)	10 to 11 hours
6 years	10 to 11 hours	none	10 to 11 hours
7 years	10 to 11 hours	none	10 to 11 hours
8 years	10 to 11 hours	none	10 to 11 hours
*Note: The two sets of numbers don't always add up because children who take longer naps tend to sleep fewer hours at night, and vice versa.

Keep in mind that most kids need a lot of sleep – usually more than parents allow for.

So what are the signs that a child may not be getting enough sleep. 

·         Does my child frequently fall asleep while riding in the car?

·         Do I have to wake him almost every morning?

·         Does he seem cranky, irritable, or overtired during the day?

It is an interesting paradox that if a child has poor sleep habits or refuses to nap or go to bed before 10 at night, his parents will assume that he just doesn't need much sleep. That's probably not the case – in fact, it's likely that such a child is actually sleep-deprived, resulting in hyper, overtired behavior at bedtime.

Source

 Most children will stop having two naps by 1.5 to two years, and may completely stop napping anytime between 4-6 years.

Here are some tips to keep help toddlers sleep...

Have a sleep routine

Keep the sleep routine short and sweet

Fussiness, whininess, fighting with siblings — all have their root in the lack of a good night's sleep. If your child has any of these, move up bedtime.

Exert control and set an early bedtime, preferably between 7 and 8 p.m

A consistent wake-up routine is just as important as a regular bedtime. Children should get up at roughly the same time every day (give or take 30 minutes), even on weekends.

Source

So get a good sleep routine, and enjoy the pleasures of getting a good night's sleep yourself too :)

A 20 second neonatal neurological assessment in the ER !

Here are some great pointers from an ER Pediatrician for general specialists (& of course Pediatricians) on how to figure out if a neonate has possible neurological problems, within 20 seconds of reporting to the ER.

The most important thing that is different between a baby and an adult is that you get a ton of information just from picking up the baby. It's the first thing you are going to do when you see a neonate with one of these complaints or concerns — when the caregiver says, "I think he had a seizure," or "I think he stopped breathing," or "He threw up and changed color."

You undress them from top to bottom so you can see everything. Then you pick them up so that you can feel whether that baby is in respiratory distress. You're going to feel whether they have the right tone. They may be curled up, kind of in a little ball, with some flexor tone, which means their arms are curled in a little bit, their head's a little bit tucked, their legs are drawn up a little bit, kind of as if they had just come out of the womb. And if they are floppy, you're going to feel that. You're going to get a sense that this baby is not where he or she needs to be.

Then you lay them back down and you pull up on their arms, and you see at the very end of that if they can get their head a little bit righted. By about 3 weeks of age, they should have a nice increase in their head control and be able to pull it up a little bit on their own.

The third thing — and these things all take under 20 seconds to do — is to check whether they can visually fix on an object and follow it a full 180 degrees from left to right.

With those 3 things — tone, head control, and visual fix and follow — you're going to have a really good preliminary idea of what your baby's neurological exam is. If it's not normal, that's going to open up a whole different evaluation than if it's normal.

Source

Comments: This is by no means a comprehensive neurological examination, and should be supplemented by further tests as appropriate if the above examination is equivocal / abnormal. But by doing the above, you are unlikely to miss a gross neurological problem in a newborn.