Daily Dose

Concussions Are on the Rise

As our children become more and more involved in competitive athletics the incidence of concussions is also on the rise.

Not surprisingly, football still has one of the highest rates of concussions, with one in five high school or college players experiencing a concussion each year. Cheerleading has also seen a rise in number of concussions reported, as cheerleading stunts become more about athleticism and tumbling, putting cheerleaders at risk for a head injury from a fall. A concussion is defined as a trauma induced alteration in mental status that may or may not cause loss of consciousness. A concussion is a functional rather than a structural brain injury. The injury, typically arising from a direct or indirect blow to the head sets off a cascade of neuro-pathological events leading to a confusional state or memory dysfunction. Because a concussion is more of a metabolic crisis of the brain, neuroimaging studies with CT scans and MRI are rarely helpful. Concussions are typically diagnosed based upon symptoms including amnesia, confusion, impaired level of consciousness, poor concentration, headache, dizziness, fatigue, nausea or vomiting. Many symptoms may be non-specific in nature, but impaired mental status of any degree is the hallmark of a concussion. Because young athletes want to continue playing, even after a concussion is suspected, it is important to assess the athlete’s mental status immediately after the injury. There are several tests that may be performed even while the athlete is on the field, including orientation to person, place and time; attention; memory and higher cognitive functions. It is also important to assess the athlete’s judgment, and mood. Both coaches and parents should be aware of the hazards of returning a student to play after even a mild “ringing of the athlete’s bell”. Recent studies have shown that the still developing brains of adolescents and children are slower to heal from concussions. The younger you are the longer it takes to recover from a concussion; the brain is just more vulnerable. Allowing a teen to re-enter a soccer or football game, or cheerleading stunt immediately after a head injury puts them at risk of second – impact syndrome, a rapidly progressive brain injury that can lead to brain swelling and death. Concussions may lead to one fatality for every 300,000 children participating in sports. Current guidelines regarding return to activity and athletics are tending to be more conservative as studies have shown that the likelihood of long term and permanent impairment in cognitive function increases with each concussion. While a simple concussion typically resolves in seven to 10 days and requires no further intervention than rest, a more significant injury may take more than two to four weeks to reach full recovery. Once the athlete has rested, meaning no exercise or exertion for at least a week and all symptoms of headache, “feeling foggy” and fatigue have resolved, they may begin light exercise, such as walking or riding a stationary bicycle. If there are no recurrence of symptoms with light exercise then running, and resistance training may begin. With each increase in activity level the athlete should remain asymptomatic and may gradually move toward full activity and return to competitive play. Parents and coaches must remind student athletes that while missed games may feel like an unnecessary restriction, it is really only a minor inconvenience, which will help maintain long-term brain health. That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

Swine Flu Isn't Going Away

Novel influenza H1N1 (swine flu) is not going away and seems to currently be spreading in the southern hemisphere with Australia, Chile and Argentina reporting a “significant number of cases” as their flu season beginsNovel influenza H1N1 (swine flu) is not going away and seems to currently be spreading in the Southern Hemisphere with Australia, Chile and Argentina reporting a “significant number of cases” as their flu season begins. The United States typically sees those strains of “flu” that circulate in the Southern Hemisphere during our summer months become the “flu” viruses for the winter months in the U.S. It is a cycle.

So, with that in mind and also knowing that we have already seen as estimated 1 million cases of swine flu in the United States since early spring (not a typical time for flu) it looks like this could be a very busy flu season. Remember, we will also have other influenza viruses circulating at the same time, typically an influenza A (not swine) and B strain each winter. Novel H1N1 also seems to be more prevalent in the younger age groups, especially those under the age of 25. Manufacturers are continuing to work on producing a “swine flu” vaccine and it is being reported that the vaccine is entering trials to test its effectiveness and to also determine if more than one dose will be required. Results of these trials are expected in August and if all goes well the vaccine may be ready for distribution by October. We will have to await further information on the trials. With that being said, and knowing that the younger population seems to be most affected, Kathleen Sebelius, the secretary of the Department of Health and Human Services, has announced that it may be important to partner with schools as sights for a large scale vaccination program. She stated that state and local health officials should “be prepared for a fall vaccination campaign” focusing on children, health care workers (I guess that means me), adults with underlying chronic diseases, and families with small children and infants. As more vaccine becomes available, more groups would be vaccinated. The Advisory Council on Immunization Practices (ACIP) will meet at the CDC in late July to also consider which age groups should get the vaccine. Typically flu vaccine is not given to infants under six months of age. This is going to be an ongoing issue and I think a VERY busy flu season. Make sure that you have plans to get your routine flu vaccine beginning in September and we will all wait to see if swine flu vaccine will be available later in the fall. This is NOT a year to miss you or your child’s routine flu vaccine. That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

Hello from Mexico!

I am writing this from a new venue, Mexico! Despite the warnings, I headed south of the border to a previously planned getaway and things seem OK from here.I am writing this from a new venue, Mexico. Despite the warnings I headed south of the border for a previously planned get away and I must tell you all seems well from here. Now, I am not in Mexico City, I flew to Leon and from there went to San Miguel. My flight only had 11 people on board, and I have to admit that I was the only person that even sneezed! I did use good hand hygiene and a Kleenex, but I felt like people were watching me. No one had on masks upon our arrival except the x-ray attendant as we went through customs.

I really did not see any other masks although my driver told me that the masks were being worn last week. The city is fairly quiet and the children on the street told me they had not been in school all week. Still, no masks. I am using good hand hygiene and staying close to the house. The Centers for Disease Control and Prevention today changed its recommendations about school closings, so it will be interesting to see what happens with the schools that had previously been closed. My son sent me an email from UT that stated they had had a case of presumptive swine flu at the student health center, but that school would continue as usual, and unfortunately for him, finals would be taking place next week. So, it seems that we all practiced all of the recommendations of the CDC and the swine flu epidemic has been averted, at least for now. We continue to be concerned about how this virus might affect us in the fall and winter during the regular flu season. We are still awaiting word about a possible swine flu vaccine, and that information will have to follow. The great news is, life is beginning to get back to normal for both those of us in the U.S. as well as our neighbors in Mexico. That's your daily dose, we'll chat again tomorrow.

Daily Dose

Another Case for Vaccinating Your Child

The American Academy of Pediatrics issued an alert last week that identified several more cases of invasive HIB disease in Pennsylvania and two deaths. One of the deaths occurred in an unimmunized child. Several months ago there were five cases of HIB disease in Minnesota, again resulting in one death, also in an unimmunized child. All of the cases involved unvaccinated or under-vaccinated children.

Prior to routine vaccination against HIB (H. flu) disease, which began in 1988, about 20,000 children developed infections each year, and 12,000 cases of HIB meningitis were diagnosed, with about five percent of children dying. Over the last 20 years the rates of HIB disease have decreased exponentially and deaths were no longer reported. The vaccine was a tremendous victory in preventing childhood meningitis and other serious infections. Over the last several years with parental anxiety related to vaccines, the number of unvaccinated children has been on the rise, especially in "pockets" throughout the country. At the same time, there has been a HIB vaccine shortage since December of 2007, which may have also resulted in children not completing their primary series at 2, 4, and 6 months of age. These two factors may have led to the cases of HIB disease and doctors are worried that we may see a recurrence of HIB disease and deaths. The community as a whole is often protected due to "herd immunity" and the herd must be immunized to provide maximum protection for everyone. This underscores the importance in vaccinating your children. If your child has missed any of their primary vaccine series, now is the time to update them. HIB disease is serious and unfortunately may be on the rise again. This is a vaccine preventable disease. That's your daily dose, we'll chat again soon.

Daily Dose

Helping a Child With Croup

With all of the illness going around that seems to be flu and RSV I was surprised to see a toddler today with symptoms more suggestive of viral croup. Croup is another one of those pesky viruses. Most children will experience croup at least once in their toddler years. Croup causes that "seal like" barking cough, and is very alarming when it awakens both you and your child in the middle of the night.

Croup causes swelling of the upper airway, which causes the voice to be hoarse and the airway to swell (not the lungs) and makes your child have that pronounced seal like cough. Children often seem perfectly well when they go to bed and then awaken coughing. The best treatment is to grab a book and your child and make a beeline to the bathroom and turn the shower on hot to fill the room with steam. Sit in the steam and read a book to calm your child down and help quiet the cough. If the steam treatment does not seem to be helping (and you are now out of hot water) try taking your child outside into the cool night air. Both the humidity from the steamy shower and the change in temperature from hot to cold will help reduce the airway swelling and calm your child's cough. Make sure that you look at your child's chest to how they are breathing. Despite the loud sound, they should look fairly comfortable and should not show signs of respiratory distress or stridor (a distinct sound made when you child breathes in). If they are having any respiratory distress, call the doctor as they may need to be seen and are sometimes given steroids to help with the upper airway swelling. Because this is a viral infection antibiotics won't help. Most children have the croupy cough for a night or two and then improve and will then have a little cold. When older children and adults get this virus they are usually only hoarse and develop a cold. That's your daily dose, we'll chat again tomorrow.

Daily Dose

Treating the Common Cold

Having a cold myself is a sobering reminder that the average cold lasts seven - 10 days and the cough may last up to two to three weeks.I have had this nasty fall cold for the last week, and I gotta say, " I am sick of it!" I am not really surprised that I finally succumbed to my first cold of the season. While I am seeing 20 -30 kids a day with colds, it's not hard to figure out why my own body just waved the white flag and joined the ranks of cold sufferers. But having a cold myself is a sobering reminder that the average cold lasts seven - 10 days and the cough may last up to two to three weeks. That being said, I still have a week to go and I just want to hibernate until it is gone. Unfortunately, that is not reality for most of us.

My sweet patients are always concerned about my health, and then wonder, "What do you do for your cold, Dr. Sue?" That just makes me giggle, as I know they have heard me say a million times, "there is really not much to do for a cold except rest, fluids, throat lozenges, and tincture of time." I wish I had been hiding the secret potion that only doctors can take to make their colds go away in a day. So for the last week I have sucked on any lozenge that people hand me (I personally think lemon helps the most), have had enough hot tea to float a boat, and really tried to get to bed at a reasonable hour, right after that warm bath with eucalyptus oil. Guess what? My cold is still here. If anyone else has the recipe for that "secret cold potion" I am open to suggestions, but figure at least I am half way through it and hope it will stay away until the spring? In the meantime, I am still washing my hands. That's your daily dose, we'll chat again tomorrow.

Daily Dose

Cold Season is Here

School starts and colds start almost simultaneously no matter how old your child is.School starts and colds start almost simultaneously. It even amazes me to see kids with their first cold of the season within 15 minutes of starting school, whether it is Mother's Day Out or high school, it affects every age.

The worst part of a having a cold is knowing that it is going to last seven to 10 days, no matter what you do. The old adage of rest, fluids and nasal irrigation is still the mainstay of treatment. Remember that over the counter cough and cold medicines are not recommended for use in children under the age of 2 and really are not very effective in the overall scheme of things. There has been some renewed interest in zinc and reduction of symptoms and decreased duration of colds so stay tuned for more info on that. In the meantime, keep up hand washing and good cough hygiene to try and prevent getting one of the first colds of the season. That's your daily dose, we'll chat tomorrow!

Daily Dose

Over The Top Birthday parties

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Birthday parties are getting to be quite a big deal...even for a one year old. I have had several parents in with their children for their 1 year old check up and they often bring along birthday party pictures. WOW!

Some of these bashes look like they could be a swee” sixteen or a wedding.  No kidding. I thought I had hit the jackpot when I started printing birthday invitations on my color printer....but these days some of the invitations are printed and delivered to other “1 year olds” who I assume cannot read yet. Thankfully their parents are also included as +2. 

These parents are very clever and most of the parties had themes....with the invitation, cake and party favors all coordinating. Looked like a ton of work for the parents to put this all together. If anything, this is not a “last minute” event...lots of planning and executing. I wonder if second or third children have such elaborate “bashes”.

I know I seemed to be able to throw together a birthday party at the last minute when necessary, but I am sure that was for child number 2 or 3. My husband did remind me of our first child’s 1st birthday when we had many friends and their toddlers over. He also reminded me that it was about 110 degrees in June, and that we had a plastic baby pool that we put a bunch of hot sweaty kids in, with parents who wished that they could have fit as well.  Not sure where those pictures are.

But it seems that petting zoos, bounce houses (maybe for the adults), magicians, and even super heroes arrive to celebrate this latest group of 1 year olds.  There are themed cakes with a miniature one for the birthday child too so that they may fully indulge in their “first sweet” A few of my moms had gluten free cakes made, just because. There are often tons of gifts as well, but many parents are opting to then donate them to one of our local children’s hospitals....a wonderful idea.

Lastly, with all of the fancy new apps and iPhone photos, many of the parties look like they have been professionally photographed (some of course had been).  Some of the precious 1 year old birthday children even had several wardrobe changes to celebrate the big day (yes, those were mostly little girls), I guess to get an early start on future occasions like the wedding.

What do you think about first birthday parties... I just think it might be worth waiting till your child can appreciate it as well?

Daily Dose

Baby Bling Can Be Dangerous!

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I recently saw a TV segment on “blinging” your baby and toddler. It seems that the latest craze is decking out not only little girls, but also little boys. Being the mother of three sons I can understand wanting to “dress up” boys as well (little boy clothes can be a bit boring) but a few of the models on TV were wearing necklaces. 

Now, a boy wearing a necklace doesn’t bother me at all, but a baby or toddler with a necklace worries me!  This isn’t about gender, rather about safety.  

A necklace is a real choking and strangling danger for babies and young children. I know that many parents receive necklaces for their babies on the occasion of a baptism and in some cultures an infant is given a necklace made of string or beads to wear soon after birth. 

But, whenever a baby comes into my office with a necklace on I discuss the possibility, even if remote, of the child suffocating if the necklace gets caught or twisted around the child’s neck. There is no reason to even risk it! 

Baby bling is great if you want to put your child in cute shirts, hats, or even trendy jeans. Go for it!  But I would never put a necklace on a child. It is akin to the adage about peanuts...when should a child be allowed to eat peanuts?  When they can spell the word!  

We pediatricians are no longer worried about peanut allergies in the young child, it is the choking hazard that is the real concern. It’s the same for a necklace. Let your child wear it when they can spell the word, or put it on when your 3 year old plays dress up, but take it off once finished. There is no need to ever have a young child sleep in anything like a necklace, or anything that has a cord until they are much older. 

Children ages 4 and under, and especially those under the age of 1 year, are at the greatest risk for airway obstruction and suffocation.  So, put the necklace back in the jewelry box for awhile. You can re-wrap for re-gifting and re-wearing at a later date. Safety before bling! 


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