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Daily Dose

Dry Drowning

1:30 to read

It seems that at least once a week this summer I have seen a child in my office with a concern of “dry drowning”. In each case the child (anywhere from 2-6 years old) has been swimming and has had not had any issues…just a fun day in the pool.  But, the following day they “seemed tired, and didn’t want to play”, but were content to watch cartoons or play video games. A few of the children I have seen were sitting on my exam table eating a lollipop and playing on their mother’s I-phones.Thankfully, none were having any difficulty with breathing!

 

So…their concerned parents have seen media reports and are worried that this “fatigue and lethargy” is the presentation of “dry drowning”. In most cases they have also searched “dry drowning” on the internet and the first thing they see is WebMD’s definition of “dry drowning” which would concern most parents!  The article at the top of the Google search includes this.. “putting your child to bed after swimming and they never wake up in the morning”???  Who wouldn’t be worried….

 

But, if you ask most doctors (certainly all of the ones I know) they do not understand what “dry drowning” is, and have never seen a case like the one described by WebMD.  This small survey of mine included pediatric ER docs as well.  Actually “dry drowning” is not even mentioned in pediatric textbooks, and it is difficult to find the term in medical literature when doing a journal search. It is more likely to be found in media articles. 

 

As I understand it, the term “dry drowning” was first discussed in animal studies from years ago, in which animals died after ingesting water and experiencing laryngospasm, and it occurred 1-2 minutes after the immersion in water. None of the articles discussed “dry drowning” in children….but articles did discuss drownings!

 

In a pediatric study looking at data from over 15 years and “immersion related deaths- drownings” it was found that most drownings occurred at home and over 90% were due to lack of supervision.  There were no deaths reported from “dry drowning”. 

 

I am not concerned about any of my patients and “dry drowning”, but I am concerned about drowning!! 

 

Take home message….take your children to swim but be vigilant in watching them…..and you will not need to worry about any immersions or drownings!!  Drowning is preventable. 

 

 

 

 

 

 

 

Daily Dose

HPV Vaccine

1:30 to read

I recently read an interesting article in JAMA in which a study was done suggesting that “HPV vaccine does not lead to risky behaviors in teen girls”. This seemed to be a timely study as Merck has just recently received FDA approval for their new Gardasil vaccine which will now protect against 9 serotypes of HPV (human papilloma virus) which causes the majority of cervical cancer ( as well as other genital cancers) and genital warts.

Since the vaccines against HPV were released in this country about 8-9 years ago, the uptake of the vaccine among tween/teen girls and boys has been less than hoped for.  Like many vaccines, there were those parents who were “worried or skeptical” about giving their children a new vaccine - despite the fact that it is the first vaccine against a virus that was known to cause cancer..actually a great deal of cancers.  The CDC reports that about 57% of preteen/teen girls have received one dose of HPV vaccine, while only 35% of boys in the same age group. The completion rate for completing all 3 vaccines is only 37% for girls and 14% for boys. 

But while many parents believe in the benefit of the vaccine a common concern has been, “giving the vaccine to a pre-teen may lead girls to engage in sexual activity at younger ages”.  In my personal experience I have not found that to be at all true. In fact, educating these tweens and teens about the risk of infection and cancer is “scary enough” for some to be even more wary.  I am pretty direct with this group as they get into their true teen years and are experimenting in all sorts of ways...not only sexually. I truly do not think that a vaccine does “promotes” becoming sexually active....hormones do a good job in that area. 

So, the study looked at 21,000 vaccinated girls who were matched with more than 186,000 non vaccinated girls. Researchers then compared rates of sexually transmitted infections (STI) including herpes, chlamydia, gonorrhea, syphilis and HIV. They found that the “rate of STI’s overall were equal among the vaccinated and unvaccinated groups”, which suggests that the HPV vaccine does not impact sexual behaviors. 

With an even more protective HPV vaccine now available I encourage you to read the literature and talk to your own doctor about getting your adolescent vaccinated.  The vaccine is protective but does not treat HPV if you have already been exposed....there will be 14 million new cases of HPV in the U.S. this year...and that statistic is not one you want your adolescent to be among.

Daily Dose

Back to School Vaccines

1:30 to read

August is here and that means back to school across the country. When I think of kids heading back to school I also think about their immunization history.  I want to make sure that everyone is up to date on their vaccines, because what better place to be exposed to disease and germs than in a school full of children!

 

Vaccines continue to save lives…and vaccines are one of the greatest medical achievements in history. But, despite the continued data on the safety and efficacy of vaccines there are those who prefer to “ignore” the data and either “decline to vaccinate” their children or want to vaccinate with an “alternative vaccine schedule”.  

 

Most recently, I was a guest in a Facebook Live segment discussing back to school vaccines and I was amazed at some of the comments that were posted after the segment. It seems that there are many people who are reading “fake news” to make decisions about vaccines and their children and they are a vocal group. 

 

There are also those who will continue to believe discredited physicians who wrote “fake” articles which have been retracted and resulted in a doctor having his license taken away. But,  this one “former doctor” has caused so much parental anxiety that I find myself discussing the safety of the MMR vaccine on a regular basis. I am always ready to discuss vaccines, their safety and efficacy with my patients, but I also rely on science and data and not anecdote to make a point.

 

Vaccine preventable diseases are just that….preventable but not eradicated!  This means that although the latest generation of parents may have never had the disease or even seen the disease, these diseases are still present.  Measles, meningitis, polio, mumps are still circulating around the world and may “drop in “ to visit our country at any time. This is evident in the recent measles outbreak in an unvaccinated population in Wisconsin and prior to that a measles outbreak in CA several years ago.  We currently have mumps in Texas and are on the look out for more cases.

 

The Advisory Committee on Immunization Practices (ACIP) publishes the immunization schedules based on a plethora of science and input by some of the smartest minds in immunology, microbiology, infectious disease and medicine.  The vaccines that are recommended are given in a certain order and at certain intervals because they have been well studied to show that this is how the vaccines “work” and protect.  It is not arbitrary as some parents seem to think and want to do a “cafeteria plan” of vaccines when they “want” to give them. That really makes no sense…how do you know that your “plan” actually protects your child?  In my own experience this also leads to a lot of confusion in what has or has not been given and in some cases missed vaccines due to the wrong intervals between vaccines or age limits for vaccines.

 

Lastly, when parents “choose” not to vaccinate their child they are not only putting their own child at risk (they tell me it is a personal choice), but they are also putting others around them at risk of getting sick from a vaccine preventable disease. Does that seem fair??  Should we all immunize our own children so that their unvaccinated children are protected?  The word “selfish” comes to mind…as I am now immunizing my own grandchildren and don’t want them “hanging out” with un-immunized children.

I am happy to point anyone to online science and websites with reliable information on vaccines. Just let me know….

Daily Dose

Plants That Cause Summer Rashes

1:15 to read

Now that summer is upon us and everyone is enjoying being outside I am seeing patients with contact dermatitis (rashes) after coming into contact with poisonous plants.  While allergies are slowing down a bit with the hotter weather, plants like poison ivy, oak and sumac (depending where you live) are full of leaves.  About 50% of people who come into contact with the leaves of these plants will have a reaction.

The adage “leaves of three, let them be” continues to be the best way to prevent getting a rash. That also means wearing long sleeves, and pants...and gloves. But what child goes off to play in the yard, or by the creek dressed like that for summer?  Sunscreen yes, gloves, probably not. 

If you realize you have been exposed to the plant leaves and therefore the urushiol (oil on leaf) , wash all areas of exposed skin as soon as possible with some products that are available like Tecru, Sanfel and Goop Hand Cleaner....if you don’t have those use dish washing soap.  

It may take up to 4 days after exposure to develop the rash and lesions may also appear at different times depending on the location and length of exposure to the urushiol.  The rash is usually really itchy and is often is linear clusters or little vesicles or blisters.  The rash does not spread by scratching or from the fluid inside the blisters, that is a myth. You cannot give anyone else poison ivy if you have washed off the urushiol.  

The best treatments relieve the itching and irritation.  Keeps nails short and hands clean so that scratching will not cause a secondary bacterial infection.  You can use oatmeal baths (Aveeno) or cool compresses (Dommeboro) to help control itching. An over the counter steroid cream is a good place to start to help the inflammation, but it may be a stronger prescription steroid cream will be needed. 

I also try calamine lotion or astringent to soothe the irritation. Sarna is another good lotion for itching....Oral antihistamines like diphenhydramine (Benadryl) really don’t help with the itching as it is not due to histamines, but may cause a bit of sedation so a child can sleep.

If the rash is getting worse, spreading to the face and around the eyes or begins to look infected it is time for a visit to the pediatrician. For severe cases oral steroids may be necessary.

It sometimes takes 10-14 days for the rash to go away.  Oh, and getting overheated only makes you itch more.

Daily Dose

Science & Vaccines

1:30 to read

August is National Immunization Awareness Month and it seems appropriate that while heading to NYC for business I managed to watch the in flight movie “The Immortal Life of Henrietta Lacks”.  I had read the book years ago and I have recommended it to many, as it is such a great “read” about an incredible woman who unknowingly changed medicine and science. The movie was produced by Harpo Productions and Oprah Winfrey stars….that alone is enough to get you hooked!

 

The story is sad but true. Unfortunately in the 1950’s we did not have laws to protect patient rights…but Henrietta’s life and her story changed all of ours.  Why?  Because the cells that doctors at Johns Hopkins took from her during her treatment for cervical cancer were ultimately used to grow more cells…which would be used over and over again in developing vaccines and so many other medical break throughs!!!  It is incredible that these cells which are named HeLa cells (after the initials of her first and last name) literally changed the world of medicine. I know not everyone knew her story when studying HeLa cells…but I am hopeful more and more remember her due to this excellent book and now HBO movie. 

 

I was amazed by this story which demonstrates the science (albeit from unfortunate circumstances) that enabled scientists to begin to develop vaccines.  I continue to be amazed at those who “don’t believe in vaccines”. Just as Henrietta’s HeLa cells have changed our medical and scientific world, so have vaccines.  During Henrietta’s life the United States was in a state of panic as  countless children and adults came down with polio and many died or were paralyzed.  But after HeLa cells were found to propagate, the cell cultures were used to meet the needs of researchers working on the development of a polio vaccine. A HeLa factory was opened at theTuskegee Institute to manufacture HeLa cells.  This cell line was ultimately instrumental in  testing the vaccine and demonstrating the development of antibodies against polio. Subsequently, Dr. Jonas Salk’s vaccine was approved and given to children and the polio epidemic was stopped in the United States.

 

Pure, eloquent science - which reduced disease and save lives. The panic against polio subsided…but we are now “too complacent” about infectious disease. We even take vaccines for granted, while some choose not to be protected by a vaccine??  Hundreds and hundreds of researchers have come and gone since the first HeLa cells were used…but Henrietta’s legacy and her “gift” to science remain.  We all need to know more about the woman from whom those precious cells had come….and say thank you.

 

Talk to your doctor and make sure your children are protected!

 

 

 

  

 

Daily Dose

Shingles in Childhood?

1:30 to read

Is it possible for children to come down with shingles? I recently saw a 2 year old with a most interesting history who then developed a weird rash.   Funny thing, I read an article shortly after seeing this child that described his case perfectly, only wish I had seen this the week before.

So, this 2 year old complained that his leg hurt. Enough pain that he limped and woke up at night crying that his thigh hurt. He had no history of trauma and also was otherwise well, in other words no fever, vomiting, cold symptoms etc.

After several days of watching him without resolution of his pain the mother noticed 3 little spots on his thigh, which she thought might be a bite. The little boy was seen and the diagnosis of herpes zoster (shingles) was considered.  In children the differential diagnosis of localized leg pain in the absence of a rash would not normally include shingles.

According to the pedi dermatologist (that I consulted) shingles in children occurs more frequently on their lower extremities (not for adults) and may involve the back on the same side.   Unlike adults, most cases of zoster in children are only mildly painful and resolve fairly quickly.

Well, this little boy didn’t read the book and his rash continued to get worse and spread, and was quite painful for days. Prior to this, he was a perfectly healthy little boy and had received his first varicella vaccine when he was 1.  

Since the widespread use of the varicella vaccine (chickenpox vaccine, see old post), the incidence of chickenpox has decreased dramatically, and vaccination should also reduce the risk of developing shingles later in life. In otherwise healthy children shingles (zoster) tends to develop at a younger age among vaccinated children than in those who have had a “natural” chickenpox infection.  When shingles occurs after vaccination it represents either a new infection with wild-type virus (an exposure to chickenpox or shingles) or reactivation of the vaccine virus.

Once a child has received 2 doses of varicella vaccine as recommended, the immunity is “boosted” and should further reduce the risk of developing shingles. Varicella–zoster virus can be transmitted via contact with skin lesions of those who have either chickenpox or shingles.  Infection is less likely after exposure to shingles. Transmission of the virus occurs until all lesions have crusted over. In this case, the little boy was ultimately started on an oral anti-viral therapy with slow resolution of his rash and pain and a return to normal around his house.

Note to self: “weird” pain may precede the rash in herpes zoster by several days.  Even though unusual, herpes zoster may occur in a healthy child who no history of varicella exposure and who has received all or part of their chickenpox vaccine.

That’s your daily dose for today. We’ll chat again tomorrow.

Daily Dose

Hip Dysplasia In Newborns

1:30 to read

Developmental Hip Dysplasia (DDH) occurs in 1 in 1000 births.  In a normal hip the upper end (ball) of the femur (thigh bone) fits firmly into the hip socket.   DDH refers to different abnormalities of the hip noted in infancy when the hip joint has not formed normally. This may   range from a mildly unstable hip in an infant to an infant that is born with a completely dislocated hip.   DDH is screened for from the time an infant is born until they are walking, in hopes of picking up any abnormality at a young age. 

 

The majority of babies with DDH are female (75%), and it is also more common in infants who are in the breech (butt down) position during the 3rd trimester of a woman’s pregnancy.  Other risk factors for DDH include: a family history of DDH and improper swaddling of an infant. 

 

You may notice that your pediatrician examines your baby’s hips at every visit.  They will perform the Ortolani maneuver and the Barlow test where the doctor is trying to see if they can feel a dislocated or unstable hip. In these tests they are actually putting pressure on the hip to check for a “click or clunk” which suggests a hip problem or instability.

 

For female babies who have been breech it is recommended that they not only have a physical exam checking for DDH, but that they also undergo an ultrasound of the hips after 6 weeks of age and prior to 6 months.  Ultrasound for male babies who have been breech is not “routinely recommended” but may be ordered if the baby has any signs of hip instability.

 

The incidence of hip instability and dysplasia seems to have also increased since parents began routinely swaddling their babies. It is now recommended that babies sleep in a sack rather than having them swaddled with their legs extended. For the hips to develop normally a baby needs to be able to move their legs around which will drive the femur into the hip socket, so that the socket gets deeper. A shallow, flat hip socket may lead to hip dysplasia.

 

In most cases that are detected early the treatment is a brace called a Pavlik harness that will hold the femur into position within the hip socket. A baby stays in the harness for 6-12 weeks in order that the hip joint will develop normally. For babies that may develop hip dysplasia after 6 months of age an orthopedist will probably recommend closed reduction to put the hip back into place. This is done under anesthesia and then the baby is placed in a cast that also pushes the femur into the hip socket.  The baby may have to wear this cast for 4 - 5 months. 

 

Every time your pediatrician takes off your baby’s diaper during their exam it is not really about a diaper change. That hip exam is really important!

 

Daily Dose

Your Kids Need Protein!

1:30 to read

Nutrition and healthy eating habits are always a topic of discussion during my patient’s check-ups.  Interestingly, I hear many tweens and teens tell me, “I am now a vegetarian”.  While I am thrilled that my patients are developing an awareness about their nutrition, I am equally amazed by what they think a vegetarian diet is.

Many a parent has cornered me before their child’s check up concerned about their child’s recent announcement that they are vegetarians and it has actually caused some heated family discussions surrounding nutrition and dietary requirements. The parents say that their child just decided that they no longer wanted to “eat meat” and that they were vegetarians. 

So…many of these new “vegetarians” don’t even like vegetables, and a few are confused by the difference between a vegetable and a fruit. When I ask them if they eat broccoli, cauliflower, green beans, asparagus, eggplant and potatoes, I find that more than a few turn their noses up at most of those suggestions and simply eat potatoes as their vegetable of preference. They also eat avocados, and are surprised to find out that it is a fruit, but it is a good source of healthy mono unsaturated fats.  A few are a bit more adventuresome and actually eat a wide variety of vegetables including lentils and black beans as a source of protein.  

The same thing goes for fruits although for the most part they do admit to having a broader palate when it comes to fruits that they will eat.  Apples, bananas, berries, grapes are all favorites and many of these kids will eat fruit all day long.  Fruit is healthy for sure, but also contains sugars (far preferable to the sugar in the M & M’s I am eating while writing). 

The biggest problem with their “vegetarian diet”?   They just eat carbs! So I have coined the term “carbohydratarian” to describe them. Most of these patients are female and they eat carbs all day long.  They have cereal, toast, bagels for breakfast, followed by grilled cheese, french fries or a quesadilla for lunch and then dinner is pizza or pasta, and maybe a salad (lettuce only).  They like crackers, bread and almost all pasta (rarely whole wheat ). Rice is another favorite.

I too could probably eat a lot of these carbs every day….I think many people enjoy their carbs. But these kids are not meeting many of their nutritional requirements. They are getting very little protein! They are also growing…some at their most rapid rate during puberty. When I talk about adding protein to their diet they are often reticent to add eggs, fish or beans to their food choices. 

If your child decides that they want to change their lifestyle and might consider becoming a vegetarian or vegan, I would encourage you to have them meet with a certified nutritionist to explore their likes and dislikes as well as to educate them as to their nutritional needs.

I must say…..very few of these patients have maintained their vegetarian lifestyle, but if they choose to, they need to know the difference between a fruit and a veggie!

 

Daily Dose

Parents Get Sick Too!

1.15 to read

I know you must be tired of hearing all the talk about illnesses, but unfortunately it is THAT time of year, and a few more weeks of sick season is still ahead of us. 

I am seeing plenty of coughs and colds and it is not only among the children in my office. Many parents who are bringing in their children are just as sick as their kids.  They often ask me why they are getting sick.  Most of these parents have small children typically between the ages of 1-3   years. The sickest of the parents seem to be those who have toddlers, especially when it is their first child.

Now, I love toddlers, but one thing they have in common is that they are like little petri dishes full of germs. I affectionately call them, “snotty nosed toddlers”. Before I was a parent myself I swore that I would “never have a child with a green snotty nose”. Well, after 3 children who had more snotty noses than I dare to count I now know that this too is a phase of life, that will pass.  But before it passes that precious “snotty” toddler will manage to give their parents lots of germs. 

Many parent tells me that they have already had 2 terrible colds, 1 mystery fever, and some vomiting and diarrhea, and their child is just 2!  “How much longer will this go on”, they ask?  Or I hear, “this couldn’t be normal, we all must have a problem with our immune system?” This is probably not an immune problem, it is just yet another perk of parenting. It actually means you are a good parent as you are spending time with that precious toddler, who is often coughing in your face as you play piggy back or tell them a bedtime story.

The only way to help prevent this plethora of viral illnesses is to practice good hand washing, begin to teach that toddler how to cover their mouth when they cough and know that this “normal”.  But even with that advice expect the first several years of parenting to involve illness for both child and parent.

Rule of thumb seems to be, once the last child in the family turns 3, the illness roller coaster will slow down!  There will be other issues ahead but not as many colds.

That’s your daily dose for today.  We’ll chat again tomorrow.

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