Bright Steps Blog

Head Lice

September 10, 2013

MCj04319190000[1]  Now that the first week of school is over, your child is getting used to their new schedule and   new classroom.  Then you get a call from the school nurse and she utters this fearful statements, “Your child has lice”.  Now what?

Head lice have been living on humans for centuries.  The infestation is most common in children ages 3 to 12 years old, with an estimate of between 6-12 million cases each year in the US alone!


Lice  Here is some lice vocabulary:

  •   Lice: live bug, ~2 mm in length (sesame seed size), grey colored, able to survive ~3 weeks on the  scalp or 24 hours off the scalp
  •   Nits: white eggs, firmly attached to the hair shaft, unable to be brushed or shaken off, usually very numerous


Lice trivia:

  • What are the main symptoms? Scalp itching or scalp rash- often along the back of the neck.
  • What is the lifespan of lice? Live lice lay the eggs (nits) on the hair shaft, they hatch into baby lice after ~1 week, then they live in the scalp for ~3 weeks.
  • How are lice transmitted?  Only live lice can spread to another child, usually directly from head-to-head contact.  Indirect transmission- from hats, hairbrushes, headphones, is very uncommon.
  • Where are most lice transmitted?  Usually at home!  The majority spread through households with direct contact.  Other routes are sleepovers and bed sharing.
  • If my child is treated, when can they return to school?  Your child is not contagious and should not miss any school, but many schools have policies that your child needs one treatment first.
  • Are lice harmful?  No, they cause no medical harm, but are a nuisance.
  • Are lice a sign of poor hygiene?  No, and they do not spread any diseases.
  • Can lice jump?  No.  And they cannot fly either. They crawl on 6 legs.
  • How can I check for lice? Have your child sit in a bright room. Look along the scalp, especially behind the ears and along the nape of the neck, for nits attached to the hair shaft or live lice- which are more rare to find. You can also comb your child’s hair with a fine-toothed comb to see if you can remove any nits.
  • How can I prevent lice?  Check your child’s head before and after sleepovers or camps, treat all members of the family if one child is found to have lice.  Wash your child’s clothing, towels, bedding and hats in hot water and dry on high heat.
  • What do lice eat?  They eat small amounts of blood from the scalp, with the itching occurring from components in their saliva.

Lice treatments:

All people with lice should be treated. There are two types of methods:

  • Physical “comb-out” method: Use a fine-toothed comb on your child’s hair every day for 2 weeks, on damp hair.  This method often fails.
  • Chemical method: Often shampoos or rinses, which need to be repeated in 7 to 10 days after the first treatment to catch any new lice that have hatched from the nits.  Some treatments kill lice (pediculicides) and also the eggs (ovicidal), others only kill live lice. There are resistant groups of lice to every type of treatment, so speak with your physician if you have treated your child appropriately, usually 2 rounds of a topical agent, and still find live lice on your child’s scalp. They can recommend different treatments, including prescription products.

Here are a few approved treatments:

  • Permethrin 1% (Nix)- Least toxic treatment. Side effects include itching and scalp redness. Apply to damp hair (without using a conditioner first, as the chemical is not able to adhere to the hair shaft); leave on for 10 minutes, then rinse. Repeat in 7-10 days.
  • Pyrethrins plus piperonyl butoxide (RID, A-200, R&C, Pronto, Clear Lice Systems)- More resistance to these agents. Available as a shampoo or mousse- apply to dry hair and leave on for 10 minutes, then rinse off. Retreat at day 9 after first treatment. Avoid if allergic to chrysanthemums, caution with ragweed allergy.
  • Malathion 0.5% (Ovide)- Highly flammable, due to high alcohol content. Apply lotion to dry hair, leave hair to air dry, and leave on 8-12 hours.  Repeat in 7-9 days.  Avoid hair dryer, curling iron, flat iron or even smoking around your child until hair is rinsed.
  • Benzyl alcohol 5% (Ulesfia)- Kills lice by asphyxiation. Apply to hair, rinse after 10 minutes. Repeat in 7-9 days.
  • Lindane 1% (Kwell)- High resistance and risk of seizures with therapy, not first line treatment. Used as a shampoo, leave on for less than 4 minutes, rinse, and repeat in 9-10 days.
  • Ivermectin 0.5% (Sklice)- The newest agent, approved in 2012. Lotion applied to dry hair with no retreatment necessary.

Recommend rinsing agents from hair over the sink to reduce skin exposure in the shower or bath.

Other “off-label” products are available if your child has a stubborn case of lice.  And a few locations have the “LouseBuster”, similar to a dryer chair at a hair salon, which uses hot air to desiccate the lice.  The closest one to Rochester is in Buffalo at:!lousebuster

So breathe a sigh of relief, purchase an over-the-counter treatment , like Nix or RID, and treat your child before they return to school the next day.  And try not to itch your scalp…

For more information on treatments:

Bike Safety Month

May 20, 2013



The weather in upstate NY is finally improving- do you know where your child’s bike is? May is National Bike Safety month and it’s the perfect time to dust off the training wheels and readjust those helmet straps.



Here are a few tips and rules for a safe summer of biking:

  • Make sure your child (even teenagers!) wears their helmet- more children between 5-14 years are seen in the ER for biking injuries than any other sport. Helmets reduce the risk of severe brain injury by 88%! The helmet should fit snuggly and not block your child’s vision.
  • Ride on the right side of the road, with traffic, not against it. Teach your child to use hand signals and the “rules of the road”. Bikers must stop at all stop signs and signals, just like other drivers.
  • Use reflective clothing and lights if riding near dusk or dawn.  Lots of jackets have reflective materials that make it easier for your child to be seen.
  • Buy the right sized bike for your child, not one they’ll “grow into”. They need to be able to reach the pedals and brakes, and the ground!, to have a safe trip.
  • Check to make sure the seat is adjusted, the tires inflated, and the handlebars are in the correct position.
  • Always wear sneakers!  No flip-flops or sandals.
  • Your child can ride as a passenger on a bike once they can hold their head up with a helmet, around age 1. Until around age 5, they should ride in a child seat, not on their own bike for trips longer than a brief trip around the block with a parent.
  • Enjoy teaching your child to ride a bike- use training wheels, practice balancing, signaling, starting and stopping.  It takes lots of practice, but it’s a skill they’ll never forget!


Nothing compares to the simple pleasure of a bike ride.

~John F. Kennedy, U.S. president


Earth Day 2013

April 22, 2013

eday5April 22nd– Happy Earth Day!

Earth Day started in the US in 1970 as a day to increase public awareness and concern for the environment and living things. Since then, it has been a day to fight pollution, oil spills, toxic dumps, pesticides, and the loss of wilderness.  The first Earth Day helped to create the US Environmental Protection Agency and the passage of the Clean Air, Clean Water and Endangered Species Acts.  In 1990, Earth Day went global- reaching 141 countries and over 200 million people!

To celebrate Earth Day today with your family, talk about recycling, using less energy and water, and ways to have a “greener” family!

Here are some projects and suggestions you can try:

  1. Get outside and clean up your yard- the weather is warmer, so look around for trash and debris that has blown in from the winter.
  2. Talk about recycling- set aside plastic containers and newspaper and show your children the recycling bins for each.  Did you know all sort of things can be made from recycled plastic and paper?
  3. Make a pinecone birdfeeder using peanut butter and birdseed.
  4. Start your garden inside- using eggshells, fill with dirt and plant seeds and water.  When the seedlings sprout, you can place the shell in the ground with the plant and it will turn into compost.
  5. Plant a tree.
  6. Talk about the water cycle.  Try turning off your faucet while brushing teeth and washing dishes to save water.  Put out a container in your yard to collect rain water to use to water plants- including your seedlings and new tree!
  7. Turn off lights when not in the room to save energy.

Need other suggestions?

Try: or

Why do I need a pediatrician?

March 28, 2013

41C2H+Vr0OL._SX300_  Why do I need a pediatrician?

 A few of my patients and their families have commented recently that they had never thought about the difference between pediatricians and other providers for their child.

Pediatricians spend at least three years after medical school in residency, learning about the physical,  emotional and social development of children from birth to early adulthood.  In comparison, family  medicine doctors spend about ½ of a year in pediatric training.

We’re trained in illness and injury prevention and spend a large amount of our time working hard to keep your child healthy, including talking about risks at different ages and stages in your child’s development.

Our approach to your family’s visits, as a whole, is different from when you see your own doctor. We talk to you, your child, and even your child’s stuffed animal, and are aware of your child’s comfort in separating from you during the exam.

We understand the expression “children are not small adults”. Children often present differently than adults with the same disease.  They need different treatments, including medications, than adults.  My approach to a “goopy eye” is different than a doctor seeing adult patients, who may not have seen a newborn with a plugged tear duct. A youngster with anxiety or depression may not have the same symptoms as a teenager or older adult and we’re trained to be able to counsel behavioral issues in our population of patients.

Pediatricians are required to stay up-to-date on current treatments, vaccines, and well-child care for children from birth to their early twenties, concentrating our energy in changes in medicine affecting children.

My favorite part of my job is the well-child exam, offering advice and guidance in your child’s growth and development, and keeping them safe and healthy.

And we usually have stickers for our patients after their exam.

National Poison Prevention Week, March 17th-23rd

March 19, 2013

Did you know that more than 2 million poisonings are reported across the country every year?  That’s nearly one every 15 seconds! Most happen in the household and more than half are in children younger than age 6!

The local poison control center works around the clock, every day of the year, to respond to your needs and questions about poisonings and potential hazards.  Most poisonings are unintentional and can be prevented.

This week is National Poison Prevention Week, and it is a good time to take a look around your house for potential hazards for your child.  Children, by nature, are curious and often touch or taste everything they see.

Tips for your family:

  • Keep household products out of reach or locked in cabinets, away from curious children.
    • Kitchen and bath cleaners, laundry soap, and bleach should be in high cabinets
    • Car maintenance items, such as anti-freeze and windshield washer fluid should be out of reach
    • Insect sprays and poisons should also be locked away from children
    • Even beauty products- nail polish remover, hairspray, rubbing alcohol, mouthwash, etc.- are harmful!
    • Keep prescription medications out of reach- and never refer to a medication as “candy”.
    • Medications for your pets should also be locked away, like flea medication, flea shampoo and powders, and heartworm medication.
  • Store items in their original container.
    • Use child-proof containers, many medications are brightly colored and shaped like candy
    • Keep pill boxes out of reach, especially when visiting relatives
    • Never put chemicals in bowls, sippy cups, soft drink bottles that your children may mistake for their use
  • Read dosage labels to avoid overdosing children with commonly used medications.
    • Check how soon you can give pain medications or fever reducers
    • Make sure your cough/cold medication does not have a pain/fever reducer in it if also using a pain/fever reducer
    • Keep multivitamins, especially if they contain iron, away from your child
  • Safely dispose of old or expired medications and chemicals, including cosmetics.
    • Many counties have cleanup days in the spring, which often include disposal of household chemicals, including medications.
    • If no local programs, mix medications with coffee grounds or kitty litter and place in a zip-lock bag in your trash to deter children and animals from getting into the mixture.

If you think your child has been exposed to a chemical or has ingested something poisonous, call the poison center immediately, 1-800-222-1222.

For more information, check out:

National Cervical Health Month

January 14, 2013

hpv-vaccineJanuary is National Cervical Health Awareness Month

Each year, in the US, ~12,000 women are diagnosed with cervical cancer. Of those, ~4,000 die from the disease. Of the young women eligible for the HPV vaccine to prevent cervical cancer, only ~35% have completed the 3-dose series. We can do better!

HPV is a common virus, more than half of sexually active men and women are infected with the virus at some point in their lifetime. The virus spreads through skin to skin contact and can remain dormant, causing no signs or symptoms, and be passed to other partners. Six million new infections occur each year in the US!  And 20 million people have active infections at any given time, including genital warts and cervical infections. The body will clear most infections on its own, but in the process, the virus can cause pre-cancerous changes in the cervix. Those changes are usually found with yearly gynecologic testing, before it progresses into cancer.  Without screenings, the early signs may be missed and the cancer can progress.

The Gardasil HPV (Human Papilloma virus) vaccine is approved not only for females, but males too!  It is recommended starting at age 11 years, but can start as young as 9 years old. It fights the HPV types that most commonly cause cervical cancer. Cervarix is another HPV vaccine, which is only approved for females.

For females, vaccinate early, get regular Pap tests, and have HPV tests if recommended by your gynecologist.  For males, you also need the vaccine! Your pediatrician is a great resource to provide the HPV vaccine and answer any questions.

For more information about the HPV vaccine, see:

DIY First-Aid Kit: What to Carry

October 3, 2012

Now that the school year has begun, families will be spending more time in the car as they travel to and from after school activities and other various stops around the neighborhood.  It’s good to have a first-aid kit on hand in the car, stocked with essentials that will come in handy in the event of an injury or minor illness. Take some time this month to build (or re-stock!) your own kit. Here are a few suggestions for a first-aid kit to keep in the car:

  • Adhesive tape
  • Antibiotic ointment
  • Antihistamine: Benadryl or diphenhydramine
  • Band-aids: various sizes and shapes
  • Few small garbage bags (you never know when the stomach bug or motion sickness will strike!)
  • Gauze pads
  • Hand sanitizer
  • Kleenex
  • Moist wipes
  • Pain reliever: Acetaminophen or ibuprofen (no aspirin for children!)
  • Small scissors
  • Small thermometer
  • Tweezers
  • Vaseline or other petroleum jelly
  • Water bottle

Do you have any other ideas for items to include in your family’s first-aid kit? Things that have come in handy? Leave them in the comments below!

Childhood Obesity Month: What Parents Need to Know

September 10, 2012

September is here! Along with the month most children return to school, September is National Childhood Obesity Awareness Month.

Obesity is not just an adult condition. Childhood rates of obesity are increasing at an alarming rate in the U.S. Currently, more than 23 million children and teenagers being classified as overweight or obese. That’s 1 in 3 children!

Obese children have an 80 percent risk of being obese adults. Health problems normally seen in adults are starting to be seen in younger and younger patients–things like Type 2 diabetes, high blood pressure, heart disease and stroke. Obesity increases your child’s risk for developing bone and joint problems, sleep apnea, arthritis, psychological problems and even bullying.

What You Can Do

During the month of September, take a look at your family and ask your older relatives if they have any health problems, like high blood pressure or diabetes.  Start learning about your family history and find out what you and your children are at risk to develop.

Lifestyle changes are the key!  To start the weight loss process and promote years of healthier food choices, the whole family needs to participate.  Simple changes often make a big difference! Here are a few easy things to start doing this month:

  • Try water or skim/low fat milk instead of soda or juice
  • Try whole grain breads and cereals instead of processed grains
  • Try offering fruits and vegetables for snacks instead of chips or cookies
  • Try to decrease fast-food meals and order smaller portions when you do visit restaurants
  • Try to get the whole family out for a walk after dinner instead of dessert

See for more information about the 3rd annual National Childhood Obesity Awareness Month.

Summer Skin Check-up: 5 Warning Signs

August 13, 2012

With the warm summer weather and bathing suit season in full gear, it’s a good time to take a few minutes and look over your child’s skin.  Check for rashes, new moles or birthmarks or changes in existing spots.

Here are 5 warning signs for moles or nevi that should be brought to your doctor’s attention:


  • A: Asymmetry — one half not looking like the other side
  • B: Border — an irregular or poorly defined border
  • C: Color — uneven; some areas can even be black, red, white or blue!
  • D: Diameter — greater than 5mm (the size of the eraser on a pencil)
  • Or any changes in size, shape or color.

Be vigilant in sunscreen use for your youngster! Just one bad sunburn before the age of 20 doubles his or her risk of melanoma. Here are some guidelines and good skin protection practices:

  • Seek shade when able; the sun’s rays are strongest between 10am and 2pm.
  • Wear protective clothing, including a hat and sunglasses.
  • Use a broad-spectrum, water-resistant sunscreen with an SPF of at least 30. Make sure to reapply–especially after swimming or sweating or toweling off–at and least every 2 hours.
  • Be extra careful around the water–it can reflect the rays from the sun and increase the risk for sunburn.
  • Always avoid tanning beds.

Get outside and enjoy the summer season! The start of school is just around the corner…


Image courtesy of flickr user lorensztajer.

Ask Dr. Lloyd: The Low-down on Alternative Milks

July 23, 2012

 “Alternative milks” are a hot topic recently. Between all of the new “health” drinks, like rice milk and even hemp milk, how can you choose what is best for your child?

We’ll start with some basic nutrition information:

Starting at age 12 months, your child is ready to wean off formula or breast milk, his or her main source of nutrition for the first year of life.  Your child is growing and developing rapidly and needs many building blocks from their diet to meet the needs of their body. Toddlers need 1000-1400 calories a day, split between 3 meals and 2-3 snacks. Your toddler only needs 16-24 ounces of milk each day, so they have room for a wide variety of other foods, which provide key nutrients for their active bodies.


  • Protein is what your body is made of!  It is the scaffolding of your bones, muscles, cartilage, skin and blood. It is also full of B vitamins, vitamin E, iron, zinc and magnesium. These help your body’s nervous system and metabolism. The nutrients also help your body release energy, protect from anemia, and build up a strong immune system.
  • Examples include meat, poultry, seafood, beans and peas (but not green peas, green lima beans or green string beans), eggs, soy (including tofu), and nuts and seeds.


  • Grains are full of fiber, B vitamins, and lots of essential minerals (like iron) that your body needs to grow. Just like in the protein food group, these minerals help your body’s nervous system and metabolism and also help your body release energy, protect from anemia, and build up a strong immune system.
  • Try to provide at least half of the grains as whole grains in your toddler’s meals.
  • Examples include wheat, rice, oats, cornmeal and barley.


  • Fruits are low-calorie, low in fat and low in sodium. They are also cholesterol-free! They help provide potassium, fiber, vitamin C and folic acid.  Benefits include helping produce red blood cells, helping with overall body healing, keeping your teeth and gums healthy, and helping with heart health. (And the fiber helps with bowel health, too!)
  • Vegetables are also low in calories and fat and are cholesterol-free. They, too, provide fiber, folic acid, potassium, vitamin A and vitamin C. They help with many of the same things that fruits do–and also keep eyes and skin healthy!
  • Try to fill at least half your toddler’s plate with fruits and vegetables.
  • Examples include seasonal fruits and vegetables, frozen fruits and vegetables and 100% juices. Beans and peas are also vegetables, along with potatoes (but French fries don’t really count as a serving of vegetables!).


  • Full of calcium, potassium, vitamin D and protein!  Dairy, especially the calcium, helps with bone health and bone and teeth growth. In adults, if reduces the risk of osteoporosis, heart disease, and type 2 diabetes and lowers blood pressure.
  • Examples: milk, pudding, ice cream, cheese, yogurt and calcium-fortified soy drinks.

(**For more info on dietary guidelines, check out this downloadable “my plate” diagram at

So what makes milk special?

  • True milk is only made by mammals and is easy to digest and nutrient rich.
  • It contains calcium to build strong teeth and bones.
  • It is fortified with vitamin D, to help your child absorb and use the calcium.
  • There’s lots of protein for building muscle and bone, and for providing energy.
  • There’s also lots of carbohydrates for energy from the lactose, a type of sugar.
  • Whole cow’s milk also has good fat–necessary for your toddler’s growing brain.
    • Continue to use whole milk until your child is 2-3 years old.
    •  Low-fat milk can be started after that, but no skim milk until age 5 years.

One more fact about milk: It does not make mucous. It does, however, leave a coating in the mouth and throat after drinking, but it only lasts a short time after drinking it. So, it’s perfectly safe for your child to drink if he or she has a cold or respiratory illness.


Let’s go through the different sources of milk, and the benefits and potential drawbacks of each type.

Animal sources:

  • Cow’s milk
    • Benefits: High in calcium, vitamins D and A and B-12, protein, carbohydrates and fats.
    • Cons: Low in iron. Difficult to handle in large amounts if lactose-intolerant.
  • Goat’s milk
    • Benefits: Similar to breast milk, easy to digest, high in protein and calcium.
    • Cons: Lower folic acid. No iron or B-12. Must be pasteurized to be safe to drink. Can have allergy if allergic to cow’s milk. Strong odor and flavor.

Nut/bean/seed “milks”–made by soaking the nut or bean in water

  • Soy milk
    • Benefits: Lots of protein, calcium and vitamin D, if fortified. Also cholesterol-free. Look for full-fat (regular) preparation for your toddler.
    • Cons: Children with cow’s milk allergy/sensitivity can have an allergy to soy products too. No B-12. Contains isoflavones, which “mimic” estrogen in the body, so avoid consuming large amounts of soy.
  • Almond milk
    • Benefits: High in calcium, and vitamin D if fortified. Lots of vitamin E.
    • Cons: Low in protein.  Low in fat (good for adults but not for your youngster’s growing brain!). Low in vitamin B-12. Made with a thickener which may contain wheat–unsafe for those with gluten or nut allergies.
  • Coconut milk
    • Benefits: High in saturated fat, low carbohydrates and sugars.
    • Cons: Low protein. High calorie. Low B-12. Unsafe for those with nut allergies.  Not a good substitute for other more nutritious types of milk.
  • Hemp milk
    • Benefits: High in omega-3 and 6 fatty acids, low carbohydrates and sugars. Some protein.
    • Cons: Expensive. Made with thickener. Not for children with nut and seed allergies.

Grain sources

  • Rice milk
    • Benefits: Contains no lactose, the sugar implicated in most cow’s milk sensitivities or allergies. High in calcium and vitamin D, if fortified. Also has vitamins A and B and iron. Good source of calcium for adults with soy or nut allergies.
    • Cons: Low in protein and fat- both needed for growth. High in carbohydrates and sugar. No B-12. Ok for the occasional drink, but not a good substitute for more nutritious milks.
  • Oat milk
    • Benefits: Moderate amount of protein and some fiber. Ok for those with soy/nut/seed sensitivity.
    • Cons: Very high in carbohydrates. Also uses a thickener. Unsafe for those with gluten sensitivity.

Now that we’ve walked through the 3 main types, here’s a handy table with all the nutritional information for a sample of each type of “milk”: (click to enlarge)

The Low-Down

In summary, cow’s milk is not a necessity of your toddler’s diet, but it is a great source of protein, fat, vitamin D and calcium.

Cow’s milk is a major source of calcium for your child’s growing body. If there’s a milk allergy or lactose-intolerance, soy milk (if calcium-fortified), tofu, calcium-fortified orange juice and cereals are other options for calcium. Calcium supplements can also be considered.

If you continue to breastfeed your toddler after the ages of 12 months, make sure he or she gets plenty of iron and vitamin D from other foods.

For protein, beans, eggs, and peanut butter are other examples of foods which provide that vital building block.

To obtain the same nutrients and vitamins and minerals from other sources, it takes a bit more meal planning but it can be done for situations like allergies, lactose intolerance or a vegan diet. The alternative “milks” can provide some of the nutrients, but not all. Use care in reading labels if you decide to try other beverages and make sure the missing parts are provided from other foods in your toddler’s diet.

Do you have other questions you’d like Dr. Lloyd to tackle? Let us know by emailing


Image credit: Flick user mowiekay

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Dr. Lloyd is moving!

On May 21st, 2018, she joined Portland Pediatrics! Her new office is located at:
Portland Pediatrics- Webster Office
(behind the Holt Road Wegmans)
1110 Crosspointe Lane, Suite D
Webster, NY 14580
Phone: 585.872.3390

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