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Daily Dose

MMR Vaccine Changes Are Coming

There is always a lot of news about vaccines, especially this year with the need for two different flu vaccines to provide protection against both seasonal influenza and novel H1N1 (swine flu). But another newsworthy story involves the vaccines to prevent measles, mumps and rubella (MMR).

The MMR II vaccine is typically give given to infants at their 12 month check up. It has been given for over 30 years, and as a result, the incidence of these diseases has decreased dramatically since that time. But in recent years there had been “concern” by some that the MMR vaccine was one of the “causes” of autism. Due to this “unfounded and unsubstantiated” concern, some parents had opted not to give their children MMR vaccine, while others had decided to spread out the doses by giving individual components of the vaccine. In other words, the parents, and some doctors, gave mumps, measles, and rubella vaccine as individual vaccines separated by weeks to months. This decision puts more children at risk for acquiring these diseases that have not been eradicated, especially in other parts of the world and can be imported into the U.S. by international travel. Such was the case in 2006 when there was a mumps outbreak in the U.S. and in 2008 there was a measles outbreak across this country. In the measles outbreak, the first case was imported to California by an unvaccinated child who had been in Switzerland and acquired the measles virus and become ill upon his return to the U.S. This is again an example that the re-emergence of these diseases is always a threat in unvaccinated or partially vaccinated children. Due to the fact that there were different vaccines available, some being MMR combination and other single disease vaccines there was even more concern that children would not be adequately vaccinated, and that there could be widespread disease in this country. Merck had been the only distributor of single component vaccines, which had always been difficult to obtain. It seemed that there were often shortages of either the measles, the mumps or the rubella single dose vaccines, which again just delayed vaccination. After many meetings with both the American Academy of Pediatrics, the Centers for Disease Control and Prevention and the Committee on Infectious Diseases, Merck has announced that it will no longer produce single antigen component measles, mumps or rubella vaccines. Studies have confirmed that combination vaccines like MMR are not only safe, but are an important way to improve overall vaccine compliance and results in higher vaccine coverage. With the decision by Merck to stop producing single antigen vaccines, the MMR vaccine will become the only vaccine available for use and will help clear the “muddy” waters surrounding single antigen vaccine. That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

Teen Pregnancies

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Did you know that May is National Teen Pregnancy Prevention Month?  I really think that this should be a topic of interest to parents year round, but this is a good month to be reminded of the importance of educating our children about their sexuality.

The good news is that the teenage pregnancy rate is going DOWN! The bad news is that 750,000 teens in the United States experience a pregnancy each year and 400,000 will give birth.  That means that 70 young women out of every thousand become pregnant.  To continue to reduce these statistics requires improved education and continued dialogue about the risk of teen pregnancy. 

Although some teens think that becoming pregnant is a way to escape their own situation, the reality is that teens who become pregnant are less likely to finish high school or enter college, and are more likely to experience poverty.  Being a parent is a hard job for any one, but trying to be a teen parent is almost impossible, even with good support systems.  The effects of teen pregnancy are far reaching for all of society.

Studies show that teenagers who receive comprehensive sex education are 50% less likely to experience teen pregnancy compared to those who were taught abstinence only sex education. Other studies have recently shown that the decline in teen pregnancy rates are due to increased contraception use. But, 39% of sexually active teens did not use condoms when they last had sex, and only 23% of teen reported that they or their partner used hormonal birth control.  

Parental involvement in sex education should occur in every home. This begins with that first, “birds and bees” talk with your child. A comment from a recent young patient after reading “ Where Did I Come From” with her parents   “DISTURBING” !  (cue my laughter). 

The conversation needs to continue during the tween years and is not only about development and physiology, but about family values and teaching your child that they can talk to you about anything. Let them know that although they may feel embarrassed this SEX stuff is part of normal growing up and you are there for ANY and ALL questions. 

Lastly, by the time you have teens in the house you realize that hormones are raging and with those hormonal changes come sexual feelings. This is time to reiterate values, expectations and at the same time to keep the conversation open.  Knowing that over 50% of high school seniors admit to having sex, it is crucial that parents have calm and rationale discussions about the importance of safe sex.  Just because you talk about safe sex does not mean that you condone it, but to ignore the subject may only mean that your child does not get the correct information or ends up being a statistic due to lack of education. No parent wants that for their child.

Daily Dose

Kids And Headaches

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A recent study suggests teens and chronic headaches go together. This interesting study revealed about 1-2% of adolescents have chronic daily headaches, defined as more than 15 headache days per month for greater than 3 months.

When school begins, teens stress levels increase with each week of school, and with that come more complaints of  chronic headaches.  It is not unusual for me to see several teens a  week  who complain that they have headaches every day. Despite these persistent headaches, the majority of se adolescents continue to participate in their school activities, sleep well once they fall asleep and spend their weekends doing whatever it is that teens all do. I see very few teens who look like they are in “severe” pain, although they state that their head is “killing” them while they chatter away about where it hurts, and how often it hurts etc. It is quite reassuring to watch their faces and expressions as they go into detail about their headaches.  In these cases it is important to obtain a good history to rule out any underlying pathology, as well as to inquire about family history of migraines. In this study, the authors followed adolescents ages 12–14 years who met criteria for chronic daily headaches. They followed the group after both 1 and 2 years, and then again after 8 years. The results showed that after 1 year, 40% of adolescents still complained of chronic headaches.

After 2 years, only 25% reported headaches.  After 8 years, only 12% reported chronic headaches. Most participants reported substantial or some improvement in headache intensity and frequency during the 8 year follow-up. The most significant predictor for ongoing problems with headaches was onset of chronic headaches before the age of 13 years.  For the most part 75% of adolescents with chronic daily headaches improved over the 8 year period which is quite reassuring. This study just seemed to confirm that teens and headaches go together.  If a good history and physical exam is performed and there seem to be no underlying problems that contribute to their headaches, it is best to discuss the natural history of chronic headaches.

I think it is important to spend time with adolescents to explore ways to alleviate stress as a trigger for chronic daily headaches. Basic changes in lifestyle such as healthy eating, regular exercise, and a good night’s sleep will often help reduce headaches.  Relaxation techniques and cognitive behavioral therapy may also be utilized. At least we know that the headaches reduce with time, maybe just a maturational process, like many things!

That's your daily dose for today.  We'll chat again tomorrow! Send your question or comment to Dr. Sue! Send your question or comment to Dr. Sue!

Daily Dose

War On Zika Virus

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There seem to be updates everyday on the latest cases of Zika virus both in the U.S. (to date all of which have been imported) and in more and more countries in the Caribbean. At the same time, there is more information being released  by the CDC and the World Health Organization on the virus, its effects, how to diagnose it, who should be tested and prevention.  There are also many scientists around the world who continue to work on diagnosing, treating, and preventing the Zika virus. Despite all of this there is still a lot to learn and many questions still remain about this rapidly spreading virus.

The CDC has just documented the first case of the Zika virus being transmitted sexually in this country.  The case was actually confirmed in Dallas after the patient had returned from a trip to Venezuela and was diagnosed with Zika virus. Subsequently his partner, who had had unprotected intercourse within 2 weeks of the initial patient’s return, was diagnosed with Zika virus. Fortunately, there was not a fetus involved in this case and both of the patients have recovered. Because of this the CDC has now issued new guidelines stating “men who live in or travel to areas of active Zika infections and who have a pregnant sexual partner should use latex condoms correctly, or refrain from sex until the pregnancy has come to term”.  Questions still remain about possible viral transmission from saliva and urine and further information will be forthcoming. 

The CDC also changed the guidelines for pregnant women who have traveled to areas with known Zika virus and are concerned about possible exposure.  While they had previously recommended that only those with at least 2 symptoms of the virus (which include rash, fever, joint pain or conjunctivitis) be tested, they now have more data on the accuracy of the tests and the new guidance states “pregnant women without symptoms can be offered testing between two to 12 weeks after travel.” So if you are concerned consult your Ob-Gyn. 

I am also getting questions from young woman who have been “trying to get pregnant” or who are even “thinking about getting pregnant” and they want to know if they should “delay getting pregnant”?  While I am concerned about the spread of the Zika virus, I do not think that women in the U.S. should alter their plans to become pregnant.  But, at the same time, I am advising these women to change their plans and to cancel any and all travel to the Caribbean, Central and South American countries with known Zika virus until after they have conceived and given birth…so in other words for at least 9 -12 months and maybe more. Why risk an exposure when not necessary? 

While this virus is expected to spread to the U.S. this summer there is some thought that it may be our southern states with hotter and more humid weather who will have the greatest likelihood of seeing significant Zika virus. Again, this is based on historical as well as ongoing research.  What is known, is that the Aedes mosquito (the type that carries Zika) has previously been found in most states in the United States. I have had one mother who is pregnant call and ask if I thought she should leave the state of Texas this summer, and move north to a cooler climate!  While that seems a bit extreme,  no one knows what impact Zika will have here until the temperatures warm up. In the meantime I advised her to start wearing insect repellant that contains DEET or picardin, as well as to wear long sleeves and pants and to try and stay inside during peak mosquito hours (dawn and dusk), as we still have mosquitos in Texas even at this time of year.  Might as well get in the routine now.

Stay tuned…

Daily Dose

Being a Dad

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Seeing that this is the week of Father’s Day (have you made your card or shopped yet?), I thought this was a good time to discuss some recent data that might be of interest to men….especially those who may be planning a family in the near future. 

For years research has shown that maternal age may contribute to birth defects and chromosomal abnormalities, including Down’s syndrome.. It has also been known that a pregnant woman’s health and habits may also affect their unborn baby’s health, therefore  woman are instructed to stop smoking and drinking alcohol while trying to get pregnant as well as throughout their pregnancy.

Dr. Joanna Kitlinska a researcher from Georgetown University has been studying how men’s age as well as their habits might also impact a child.  Her findings have shown a link between men who are over 40 years- “advanced paternal age”  and the incidence of autism as compared to fathers under 30 years of age.  Studies have also found that older fathers are more  likely to have children who develop schizophrenia.  Researchers wonder if this link may be due to changes in a father’s genes as they age….but to date this is unclear. “Biological clocks” and a woman’s decision to delay a pregnancy until their career is established (or for a myriad of reasons) may now be a decision that men will face as well.  Could both aging eggs and sperm play a role in genetic abnormalities? 

Smoking seems to be another habit that may somehow affect a man’s sperm and could potentially lead to genetic abnormalities in a child. 

While fetal alcohol spectrum disorders are known to be found in women who have consumed alcohol throughout their pregnancy,  researchers have also noted that 3 out of 4 children diagnosed with FAS also have alcoholic fathers.   Could their father’s excessive use of alcohol have also played a role in their developing brain?  This association has been found even if the mother did not drink alcohol during her pregnancy. Again, did the alcohol affect a father’s sperm and genes which was passed on to their child?

So…bottom line, it is important that “fathers to be” are equally invested in a healthy lifestyle when they are planning on having children.  It goes without saying that smoking, drinking, and even obesity and stress are not good choices for anyone …..but the fact that these choices may affect a future child are good reasons for both fathers, and mothers to be aware of this research when they are planning a family. 


Daily Dose

Measles Outbreak Getting Worse

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How can it be possible that we have over 100 cases of measles in this country and I bet there will still be more to come.  Why?  The real reason boils down to decreased vaccination rates for the MMR (mumps, measles, rubella) vaccine, most of which is driven by the choice “to not vaccinate”.

This is definitely a public health issue for all of us but particularly for young children.  There are truly some children who are either too young to receive the MMR shot (under 12 months) or have underlying health reasons which makes it impossible for them to receive the MMR vaccine. For everyone else vaccinating children is imperative in order that “herd immunity” continues to protect everyone.

While this should not be a political issue even President Obama weighed in during a recent interview on the need for families to vaccinate their children as he said, “the science is there to prove that vaccines are safe”, “parent’s need to have their children immunized”.

The issue of choosing not vaccinate or to follow an alternative vaccine schedule has been a hot topic provoking a lot of emotion and very heated discussions. Some of the discussions revolved around the fact that vaccine preventable diseases, while not prevalent, had not been eradicated. If “we” don’t see the disease...why vaccinate our children. This in fact turns out to be short sighted.

Do those who believe in their “right to not vaccinate”  not feel at all “guilty” that their choices are putting other people at risk, not just their own children. Is that fair?  For years this has been a hypothetical question...but as vaccine rates in certain areas have dropped, this is no longer hypothetical.  There are many analogies that come to mind...but if an infant should die due to a vaccine preventable disease such as measles, which they were exposed to by an unvaccinated this any different than a drunk driver killing an innocent person on the road?

Lots to think about. To date there have not been any measles deaths.  Surely we can get people to get their child their MMR vaccine before there are cases throughout the country.

Daily Dose

New Sleep Recommendations

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SLEEP! Who can get enough of it?  More and more studies point to the need for a good night’s sleep. But, as a new parent, you are sleep deprived, and then when your children get older they may sleep through the night,  but they want to wake up at the crack of dawn.  Once your children are adolescents their days and nights are totally up side down,  they often want to stay up too late and sleep half the day away.

Sleep is an important way to rest our brains and reset our bodies for another day.  Circadian rhythm helps to regulate sleep/wake cycles.  But trying to make sure that your children get enough sleep seems to be a never ending battle (at least in many houses). It is also one of the most frequent concerns of many of my patient’s parents.  

A recent study which was undertaken by the National Sleep Foundation reviewed over 300 articles published in peer reviewed journals between 2004-2014. Based upon their review here are the updated sleep recommendations:

Newborns (0- 3 months) 14 - 17 hours

Infants (4 -11 months) 12 - 15 hour

Toddlers (1- 2- years) 11 - 14 hours

Preschoolers (3 - 5) 10 - 13 hours

School aged children ( 6 - 13) 9 - 11 hours

Teens (14- 17)  8 - 10 hours

Young adults (18 - 25) 7 - 9 hours

So, how do your children stack up with their sleep?  Parents with newborns complain that their children may sleep 15 hours/ day, but not in the increments that they would like, while parents with children over the age of 13 rarely report that their children are getting  8 - 10 hours of sleep.

One mother recently was exasperated as her daughter age 7 would go to bed at 7:30 pm but woke up everyday at 6 am. I explained to her that her daughter was getting enough sleep, and that unfortunately her biological clock was set and that short of making her stay in her room until 6:45 when she wanted her to get up, there was not much to do.  The problem is that many parents cannot go to bed when their children do, (dishes, laundry, work emails, etc to get done while the children sleep.) So while their children may be getting enough sleep the parents are often sleep deprived!

While a good night’s sleep is important for mood and focus there is a lot of data suggesting that children who get enough sleep are less obese, are less likely to get into trouble and are certainly more pleasant to be around.

So, have a good nighttime routine beginning with a regular bedtime for your children. Commit to no electronics in their bedrooms and turn off any electronics at least an hour before bed.  We parents need to do the same!

Daily Dose

Mom Judging

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This whole “mommy judging” is really becoming too much!  The latest involves Christy Teigen and her decision to go out to dinner 2 weeks after the birth of her daughter.  Why is she being judged about going out with her husband?  Even a new mother needs to eat!

When I am seeing a newborn for their first visit to the pediatrician I spend a great deal of time talking with the baby’s parents about the stress of having a newborn. While there are so many “highs” after bringing a new baby home, there are also the “lows” of feeling overwhelmed, sleep deprived, and feeling as if you aren’t prepared to be a parent (even after taking every class and reading every book).  For many parents just hearing that they are experiencing “normal” emotions is reassuring.  

During these discussions (while I am usually rocking that sweet newborn) I also inquire as to whether there are family or friends nearby,  or any other help in the home…knowing that “all hands on deck” can be a wonderful feeling when you just need a break, and yes, every parent, especially new parents need to have “a break”.  Whether that is a nap, or a long shower, or a quick trip to the store to pick up that special “sleep sack” you know will help your baby sleep…a break is healthy.  

A new mother also needs to eat and sleep to ensure that she is making milk in order to successfully breastfeed her newborn.  I remember being a new mother, even 30 years ago, and skipping meals because I was either “too tired”  to eat or “too busy” and my husband being wonderful and saying, “your Mom is going to keep the baby for an hour or two while we go out for a quick dinner!”.  While I am sure that I had a bit of trepidation about leaving our son,  and also figuring out how to nurse him just before we darted out the door,  I went!  The good news was that there were no cell phones or social media to interfere with our “new parent” quiet dinner out. i did not have to call home or text every 30 seconds to check on the baby, and my mother was quite capable of babysitting for an hour or two. No one was posting a picture of us leaving our baby, or commenting that I was “ a bad mother” for leaving my home….in fact, the whole event went unnoticed.  What I also remember is the feeling of re-connecting with my husband (who was also a new father), and having a quiet, nutritious dinner which re-energized us for another long day or night….

But now fast forward to 2016 and the CONSTANT connection with the world!!  Add in a celebrity who is being photographed day and night and whose every move is discussed and dissected. In this case being judged as a new mother for going out to dinner.  Christy did not take her new baby out to a crowded restaurant (you know how I feel about that), nor did she leave her baby home unattended.  She did not put her baby at risk at all. What she did do, was go out for dinner with her husband, albeit with lots of paparazzi following her. Going to dinner does not mean she “is an unfit mother”, it has nothing to do “with bonding with her baby” or “neglecting a newborn”.  So, she didn’t get to make a choice on her own, she didn’t put the issue out there for public comment either….she simply went out to dinner. Enough…leave her and other new mothers alone.



Daily Dose

Kids Who Snore

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Does your child snore?  If so, have you discussed their snoring with your pediatrician.  A recent study published in Pediatrics supported the routine screening and tracking of snoring among preschoolers.  Pediatricians should routinely be inquiring about your child’s sleep habits, as well as any snoring that occurs on a regular basis, during your child’s routine visits.  

Snoring may be a sign of obstructive sleep apnea and/or sleep disordered breathing (SDB), and habitual snoring has been associated with both learning and behavioral problems in older children. But this study was the first to look at preschool children between the ages of 2-3 years.

The study looked at 249 children from birth until 3 years of age, and parents were asked report how often their child snored on a weekly basis at both 2 and 3 years of age.  Persistent snorers were defined as those children who snored more than 2x/week at both ages 2 and 3.  Persistent loud snoring occurred in 9% of the children who were studied.

The study then looked at behavior and as had been expected persistent snorers had significantly worse overall behavioral scores.  This was noted as hyperactivity, depression and attentional difficulties.  Motor development did not seem to be impacted by snoring.

So, intermittent snoring is  common in the 2 to 3 year old set and does not seem to be associated with any long term behavioral issues. It is quite common for a young child to snore during an upper respiratory illness as well .  But persistent snoring needs to be evaluated and may need to be treated with the removal of a child’s adenoids and tonsils.

If you are worried about snoring, talk to your doctor. More studies are being done on this subject as well, so stay tuned.


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