Daily Dose

Start the New Year Stress Free

1:15 to read

With the start of another New Year and a long weekend ahead we have an extra few days of relaxation and reflection before "really" beginning 2016. The "down time" after the holidays is important for everyone and the best way to start the New Year is being well rested and less stressed. I envision 2009 starting off stressful enough due to the economy, job loss or salary cuts for many parents and all of the ensuing issues that brings. So this is a year to commit to ways to reduce stress, before it even starts. There are certain things we cannot control, but we can all improve our stress levels by doing things that have been proven to be stress reducers. This includes healthy eating, good bedtime routines and exercise.

For some people, these things are already their routine, but for most of us we can improve in any one, or maybe all of these areas. This is not only for parents but also for kids, as stress in children is also on the rise. Ask any pediatrician and they will probably agree that they see more kids today with anxiety manifesting as headaches, sleep disturbances, stomach aches, and adolescents who complain of chronic fatigue. The best medicine for this is teaching relaxation and stress reduction as a routine part of family life. Less medication and more meditation may be the best prescription that a doctor can give you. A new routine in the day may be family morning meditation or evening yoga and deep breathing exercises. Be creative and start the year with a plan.

As we all begin 2016 let's commit to time spent on family stress reduction. That's your daily dose, we'll chat again soon.

Daily Dose

Prebiotics and Probiotics

1:30 to read

There has been plenty of discussions about using prebiotics and probiotics in your child's diet. What is the difference between the two?There has been a lot of discussion lately (in both medical and lay literature) surrounding the use of prebiotics and probiotics.  The first question patients/parents often ask is what is the difference between the two “biotics”? Prebiotics are non-digestible nutrients that are found in foods such as legumes, fruits, and whole grains. They are also found in breast milk.  Prebiotics have also been called fermentable fiber. Once ingested, prebiotics may be used as an energy source for the good bacteria that live in the intestines. Probiotics are beneficial live bacteria that you actually ingest. These bacteria then pass from the stomach into the intestine to promote “gut health”. The gut is full of bacteria and these are the “good bacteria”.  

There are currently hundreds of different probiotics being marketed. The research on the value of using prebiotics and probiotics has been ongoing, but there are actually very few randomized, double blind, controlled studies to document that pre and pro-biotics provide any true benefit to treat many of the diseases that they are marketed to treat. There are several areas where probiotics have been shown to be beneficial. By beginning probiotics early in the course of a viral “tummy infection” in children the length of diarrhea may be reduced by one day. Probiotics have also been shown to be moderately effective in helping to prevent antibiotic associated diarrhea, but not for treatment of that diarrhea.

There are also studies that are looking at giving very low birth weight premies probitoics to help prevent a serious intestinal infection called necrotizing enterocolitis. To date there seems to be evidence to support this and there are currently more ongoing studies. Studies are also being done to look at the use of probiotics as an adjunct to the treatment of irritable bowel syndrome, infantile colic, and chronic ulcerative colitis as well as to possibly prevent eczema.  While preliminary results are “encouraging” there is not enough evidence to date to support their widespread use. In the meantime, there are so many different products available.  Prebiotics and probiotics are now often found in dietary supplements as well as in yogurts, drink mixes and meal replacement bars. It is important to read the label to see if these products are making claims that are not proven such as, “protects from common colds”,  or “good bacteria helps heal body”.  Many of the statements seem too good to be true!

Until further studies are done there is no evidence that these products will harm otherwise healthy children, but at the same time there is not a lot of data to recommend them. They should never be used in children who are immunocompromised,  or who have indwelling catheters as they may cause infection. This is a good topic to discuss with your doctor as well.

Daily Dose

Pet Turtles And Salmonella Risk?

The link between pet turtles and salmonella I was recently traveling to a medical meeting and often use my airplane time to catch up on my journal reading. An article from Pediatrics discussing the issue of pet turtles and salmonella infections caught my eye.

In this study of a multi-state outbreak of Salmonella (a bacteria that causes vomiting and diarrhea)
in 2007 and 2008, the long known link between turtles and salmonella was being reviewed.  Of 107 patients identified from 34 states, over 50% were less than 10 years of age, and 60% of 78 patients who were available for interviews reported exposure to turtles the week before they became ill. It also seems that small turtles (I had them when I was growing up), accounted for 87% of the exposures.

Sales of small turtles have been banned by the FDA since 1975 (I am really showing my age), but are currently being sold over the internet, in flea markets and even in some retail stores, without any warnings of possible salmonella infection. In fact, some people will advertise “salmonella free” turtles which have never been bred. Due to this there has been an increase in small turtle ownership over the last 10 years and up to 6% of salmonella infections in the U.S. are due to reptile contact rather than from food -borne sources. In fact, those small turtles are not the only source of salmonella infections, but all reptiles may carry this organism including iguanas, other lizards and even snakes. (okay, I have to admit with three sons we had all of these during their childhood, not knowing they could cause illness). Another interesting fact is that you do not even have to touch the reptile, (which I hated to do), but cleaning the water and the aquarium (which WAS often my job!) is also a source of exposure. So, few parents and obviously this pediatricians are aware of the fact that salmonella infections from reptiles are actually on the rise. It’s not just those small turtles that live in the bowl with the palm tree, but all of those reptiles pose a risk for infection. As parents do know, it is hard to keep children from touching or playing with the turtle, or iguana and hand washing right after touching a pet often does not occur. No one likes vomiting and diarrhea, and it may not always be due to the food at the picnic! That's your daily dose for today.  We'll chat again tomorrow. Send your question to Dr. Sue now!

Daily Dose

Kids & Too Much TV

1:30 to read

Another recent study has just been released which confirms that children are getting close to 4 hours of background TV noise each day. While many parents are aware of the need to limit their children’s active screen time (which includes TV, video game, telephone texting and computer screens) to no more than 2 hours per day, background TV time may be equally important. The American Academy of Pediatrics also discourages any TV viewing for children under age 2 years. 

*The study from The University of Pennsylvania’s Annenberg School for Communication defines background TV as “TV that is on in the vicinity of the child that the child is not attending to”.  The research looked at TV exposure in 1,454 households with children aged 8 months-8 years. The study found that younger children and African-American kids were exposed to more background TV than other children.  Having background TV noise of any kind can disrupt mental tasks for all and may also interfere with language development in younger children. 

Those households that had the least background TV exposure were those that did not have a TV in the child’s room!! That doesn’t seem to be a surprising finding at all. Many parents leave the TV on in a child’s room to help them sleep, although there are numerous studies to show exactly the opposite effect, TV disrupts sleep. I now routinely ask every parent during their child’s check up if there is a TV in the child’s room. I also ask every older child the same question, and there are many teens who are not happy with me when I encourage their parents to take the TV out of the bedroom of their adolescent. There is just no need to have a TV in the bedroom of children of any age.  I have given up on this discussion with my college aged patients! 

While many parents are doing a good job of monitoring what their children are watching on TV, and how long they are watching, we may not be doing as well when it comes to background TV.  While older kids hear news stories or language that they needn’t be exposed to, a younger child’s language skills may be delayed due to background TV noise. 

So, the kitchen TV needn’t be on while you are making your children their breakfast before school or in the evening while eating dinner. Family dinner is one of the most important times of the day and conversation is the key. No one needs to try to talk over the TV, just turn it off! 

Lastly, keep reading those bedtime stories for children of all ages; this is key to language, and appropriate language at that. 

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

Daily Dose

Coxsackie Virus is Going Around

1.15 to read

Coxsackie virus is rampant once again! I have seen too many kids to count (TMKTC) with symptoms of coxsackie virus and the classic skin rash associated with “hand, foot and mouth disease”.  Many parents are telling me that their day care centers are having outbreaks which is what typically happens at this time of year.   

Like many viruses, coxsackie can make some children quite miserable, while others have very few symptoms but never the less are contagious and shed the virus to others. Viruses are just plain ‘ole contagious, even with the best precautions to help prevent spreading the illness. Best prevention continues to be hand washing! 

The classic symptoms of “hand, foot and mouth disease” are a fever, sore throat, and a rash which looks like small red spots or even a bit of a blister, occurring on a child’s palms, soles and often in their throats causing pain. We are also seeing many children who have a rash on their buttocks, and legs as well.  The rash is often confused for a diaper rash if there are no other associated symptoms.   

Coxsackie virus typically lasts from 3 -7 days.  While some children are terribly cranky and uncomfortable and will even drool rather than “swallow their own spit”, other seem to not even notice the rash on their hands or feet.  The treatment is totally symptomatic, which means acetaminophen or ibuprofen for fever and discomfort and keeping your child hydrated.   

Most kids don’t have a great appetite when they have a sore throat (do you?), so I am a big believer in popsicles, Slurpees, ice cream, fozen yogurt, shaved ice.....the list is long. You just want to make sure your child is hydrated during the illness so “food rules” get thrown out for a few days.  If they have a fever they need to stay home until they have been fever free for 24 hours, and they may then return to school,  day care, and other activities. 

Thankfully, adults rarely get this illness, as we have developed some immunity over the years.  Interestingly, there was just an article about a trial of coxsackie virus vaccine given to children in China which proved to be quite successful in preventing serious coxsackie disease......stay tuned for more about this in the coming years.  

Daily Dose

Toddler Constipation

1:30 to read

I get so many questions about toddlers and constipation.  Constipation relates to stool frequency and consistency.  It is important to understand that everyone has different bowel habits and not all children will have a stool every day.  While some children will have several stools a day another may have a stool every 2 -3 days. Both of these scenarios may be normal and not an indicator of problem.  At the same time, stool consistency is important. If your child has  hard, dry, pebble like stools ( rocks rather than softer snakes or blobs ) this may be an indicator of constipation. Everyone will occasionally have a hard stool, but this should not occur consistently. Lastly, it should not be painful to pass the stool. While toddlers may grunt or push, or even start to “hide” to poop, it should not cause real pain.

With all of that being said, it is not uncommon for toddlers to become constipated as they often are also becoming picky eaters. Due to this “phase”,  some young children will drink too much milk in place of eating meals and this may lead to constipation. Your toddler should be drinking somewhere between 12 -18 ounces of milk per day.  Many children also load up on other dairy products like cheese, yogurt and cottage cheese, which while healthy, may also lead to too much dairy intake and contribute to constipation.

Water intake is also important to help prevent constipation. If your child is drinking too much milk, substitute some water as well.  It is a balancing act to make sure your child is getting both milk and water. If necessary I will also put the smallest amount of apple or prune juice in the water. By the age of 1 year, your child should no longer have a bottle as their main source of nutrition is no longer in the liquid form!

Fiber is also important so offer plenty of whole grains and limit the “white foods” that toddlers love (yes, the bread, cereal, pasta). If you always buy whole wheat pasta and whole grain breads your children will never know the difference. Stay away from processed white foods whenever possible.  It is also easy to throw flax seed or bran into muffins or smoothies (disguising fiber). I also sometimes use Metamucil cookies (they are pre made) and may even resort to dot of icing smeared on it and offer it as a cookie for snack, along with a big glass of water.

Fruits and veggies are a must…even if you think your child won’t eat them! Your toddler needs 2 servings of fruits and veggies every day and rotate what you offer them.  You will be surprised at how one day they may refuse something and they next they will eat it. Don’t give up on fruits and veggies,  it may literally take years for your child to eat peas…but if they aren’t offered a food repetitively they will probably never it eat. I know a lot may get thrown to the floor but just clean it up and persevere.  Not only will this help their stools but their long term healthy eating habits as well.

Movement is also important to help keep the bowels healthy and “moving”.  Making sure that your toddler is moving seems crazy, as they are on the go all of the time.  But with an older child make sure they are getting plenty of time for play and exercise outside or in…and not just sitting in front of a screen.

Lastly, for short term issues with constipation it is also okay to try using milk of magnesia (MOM) or even Miralax….but ask your doctor about dosing in toddlers.   

Daily Dose

HPV & Risky Sexual Behavior

1.30 to read

I have written many articles on the HPV vaccine and have been a big advocate for giving this vaccine to all adolescents . I let my patients know that I even gave it to all of my sons in their teen and early adult years (off label at the time, as it was not initially approved for males in the U.S.), as I had looked at the European data as to HPV vaccine efficacy in both males and females. 

At any rate, some parents, while proponents of vaccines, did not want to vaccinate their children during their teen years, “for fear that it might promote early sexual behaviors”.  I myself had not been concerned about that issue, as I have seen too many teens who never gave getting a sexually transmitted disease a second thought (though they should), prior to having their first sexual experience. I told parents, “I just wish they were thinking with their brains rather than with hormones and genitalia”. 

My own impression was that by giving the HPV vaccine while re-iterating to teens and young adults the ongoing risks about STI (sexually transmitted infections), we might see more “thinking” before engaging in pre-marital sex. My hope was that by providing information about developing a STI  (including those not covered by the HPV vaccine such as chlamydia, herpes, gonorrhea etc) doctors and parents could also be influential in helping adolescents realize that even with HPV vaccine, “there is no safe sex”. Double win, right?

There is now an article in Pediatrics (February 2014) which confirms that HPV vaccine was not tied to initiation of riskier sexual behavior.  A study done at Cincinnati Children’s Hospital surveyed 339 female adolescents and young adults aged 13- 21 years following HPV vaccination. They also did follow up questionnaires 2 and 6 months post vaccine.  The study showed that giving a young girl HPV vaccine did not lead to the perception that she was protected against STI’s nor did it promote sexual activity. The study did show that the girls that received HPV vaccine understood that it only protected them against HPV related disease and the possibility of developing a HPV-related wart or cancer.

Another finding in the study, was that most girls held appropriate perceptions that there was still a need to practice safe sex even after HPV vaccine, including the use of a condom.

So, if a parent is worried that HPV vaccine may lead their teen to initiate earlier sexual behavior, at least there is one study confirming that there is no association in girls. Further studies including boys should also be undertaken.

Could there be an association between not discussing risky sexual behavior, not giving the HPV vaccine and early initiation of sex?  Food for thought.

Daily Dose

Binge Drinking

As a parent of college-aged children one of the biggest concerns of the fall is also binge drinking.College football is in the air and with the season comes the ritual of pre-game tailgates and post-game celebrations. As a parent of college-aged children one of the biggest concerns of the fall is also binge drinking. Watching televised football games this season only reinforced concerns as every other ad seemed to be alcohol related and really geared to the humor of an adolescent, they were definitely not targeting a middle aged woman.

Alcohol is the number one health risk facing college students and according to a study by Harvard School of Public Health about 44 percent of college students binge drink. Than means that they drink more than five drinks in a row for a man and four drinks for a woman in the past two weeks. Many college students do this three to four nights a week and don't perceive this as a problem. Thursday is the new Friday and for many Wednesday is the new Thursday. If you have a college student, I know you have talked to them about alcohol and binge drinking, but it may be the time of year to re-visit that discussion. Winning a big game is a cause for celebration, but not necessarily for binge drinking. That's your daily dose, we'll chat tomorrow.

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Daily Dose

Ebola in U.S.

1:30

It was only a matter of time before a case of Ebola virus was diagnosed in the United States. It just so happens to be at the hospital that I practice in which is also directly across the street from my office.  I can already tell you that there is a lot of concern from our patient families as well as from friends who were at the hospital today including my daughter in law. Concern is one word, but hysteria and misinformation are also words that come to mind.

When I first heard the news I too was skeptical that the person admitted to Presbyterian Hospital of Dallas would actually have Ebola virus. We have been on the “alert” for enterovirus D-68, which has also been making headlines, but Ebola was not on my “radar:.  The moment that the CDC announced that the patient had indeed tested positive for Ebola virus, the news helicopters started circling above the office (not quite a many as there were for George Clooney’s wedding), but a considerable number (and noisy!).

I have fielded emails, texts and phones calls beginning this afternoon and into the night from concerned parents.  The first thing to know is that Ebola virus is not transmitted as a respiratory pathogen like flu, or a cold or even enterovirus.  (My daughter in law did not have a mask on as she went to her appointment this morning and she too was a bit concerned until we spoke). 

The Ebola virus is transmitted when you come into contact with body fluids like saliva, blood, urines, or feces from the patient and then can enter your body through micro-abrasions or cuts.  It is not a virus that you will catch if you walked by the patient or passed the patient in the hallway or the airport.  Again, you must come into contact with body fluids to catch this virus.

This patient is in strict isolation within the hospital which means only certain medical personnel will even be in contact with him.  The area that I practice in and the babies that we see in that hospital are in no risk for exposure to the virus. There are always infection control procedures within the hospital and they will continue to be followed.  

So, there is no reason to panic.  I am not afraid or concerned about continuing to work within the hospital. We will continue our regular days in the office and reassure families that they are not at risk. We pediatricians are still more concerned about airborne viruses such as RSV and flu that will cause considerable illness, and will soon begin circulating.  Get your flu vaccines, wash your hands, get enough sleep, exercise and continue to have healthy family meals. Remember, keep your child ( or yourself) home from day care or school if they have a fever.  This is still the best prescription to stay healthy.

 

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