Daily Dose

Why Vaccinate Your Child?

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Getting your child immunized against mumps, measles and rubella (MMR) may provide even more protection than previously thought. An interesting article was just published in the journal Science pointing out yet another reason to get your children vaccinated.  

While measles is still uncommon in the United States (but there have been over 170 cases this year), there are over 140,000 deaths around the world every year due to this disease. Studies have shown that once you have the measles you are more susceptible to other infections for up to 2 years.  But, in countries where most measles cases occur the researchers found that the children who had received the measles vaccine had a reduced death rate for up to 5 years, which suggests that the vaccine somehow provides protection against other illnesses.

A medical student at Emory University (bet he is going to be a great doctor) working with others from around the world found that the measles virus might cause “immunological amnesia”. It seems that the measles virus kills a large number of memory cells, which are white cells that prevent subsequent infections by the same disease. After the measles the body’s immune system somehow “forgets” to remember diseases  it has already beaten, which would then put you at increased risk of being susceptible to diseases you shouldn’t be vulnerable to.

While more research is necessary this secondary protection may be yet another reason to get vaccinated!! Good science continues to show us the value of vaccines....this study was funded in part by the Melinda and Bill Gates foundation which is doing incredible work around the world on vaccines and eradicating vaccine preventable diseases.  For this I am a grateful doctor.

Daily Dose

When Your Child Has RSV

Dr. Sue discusses what a parent can do if their baby has RSV, pneumonia and a double ear infection.I received a question from Brooke (via our new iPhone App). Her six month old has RSV, pneumonia and a double ear infection.

As we discussed yesterday, it is RSV season and children under one year of age seem to have the greatest problem handling the virus. It is not uncommon for a young child to develop an ear infection after developing RSV, and secondary pneumonias are also a problem . Unfortunately, there is not a vaccine to prevent RSV infection and only high risk infants are eligible to receive Synagis (a monoclonal antibody against RSV) to help prevent serious infection. The treatment for RSV is also supportive, with IV fluids and supplemental oxygen used for hospitalized infants. The use of bronchodilators and steroids has been controversial, and does not seem to be therapeutic. Antibiotics are used for secondary ear infections. Younger children have a higher incidence of secondary problems. There is not a “perfect” way to prevent RSV, but limiting your baby’s exposure to other children (daycare, public places) and to make sure that no one smokes around your child is helpful. The older your child is when they develop RSV (about 80% of children by 1 year of age) typically makes it easier for them to handle the virus.  Unfortunately, you can get  RSV more than once during RSV season. The season usually ends about April, so we are getting closer! That's your daily dose for today. We'll chat again tomorrow!

Daily Dose

Why Fever Is Your Child's Friend

Every parent is concerned about fever and why their child is running a fever.During the "sick season" I see 20 - 30 patients a day with a fever. Every parent is concerned about the fever and why their child is running a fever. Fever is one of the most common symptoms of childhood. Younger children run fevers quite frequently when they are sick. As we have talked about before, that may be four to eight times during the fall and winter season.

"Fever is our friend" has been one of my mantras for years. It is comforting for parents to understand that fever is a symptom that the body is fighting an infection. That is usually a viral infection that only lasts a few days, and lo and behold the fever is gone. The biggest myth is that fever, in and of itself, causes brain damage. Remember again, fever is simply a symptom.

The height of a fever does not correlate with severity of illness. Once again, higher fever does not necessarily mean you are sicker. Your child may feel awful with a fever of 101 or 104 degrees. Typically, once given either acetaminophen or ibuprofen for their fever, the temperature comes down a little and they symptomatically feel better for a while. Once the anti-pyretic (fever reducing) medications wear off, the fever will often return.

Children typically have more fever in the night, seems like darkness brings out the fever monster (that is the mother in me, but it was always true at my house) and those nights of fitful sleep, and hot little bodies seem very long. The other thing I have noticed, why do children who have had little sleep due to fever, coughs etc get up in the morning and do not long for a nap like their parents?

The other thing you need to keep in mind is that the higher the fever, the faster your child's heart will beat and the higher respiratory rate they will have. It is easy to climb into bed with your "hot" two year old and feel their heart pounding away, and know they have a high fever, even before the thermometer is out. This is the body's natural way of expending heat. Once the fever comes down you will notice that they are breathing less rapidly and their heart rate has come down too. Remember to offer plenty of fluids to a child with a fever, as they need extra fluids. They can eat too, but if not interested, a Popsicle or jell may be a good alternative. Just keep chanting, "fever is our friend." 

That's your daily dose, we'll chat again tomorrow.

Daily Dose

Car Seat Safety

With all of the news about car seats and recalls, I have gotten a lot of questions from parents. As you know, infants and toddlers under one year of age AND under 20 pounds need to be in a rear facing car seat in the back seat of the car. After the age of one (and 20 pounds) you may turn appropriate car seat around to forward face your child, still in the backseat.

The next step is a good forward facing car seat with a five point harness that your child may stay in until they reach 40 - 80 pounds, depending on which car seat you buy, and manufacturers recommendations. Many parents ask me about a booster seat, and the longer your child can safely stay in a car seat the better. When choosing a booster seat, make sure you have one that has both lap and shoulder harness and that they are also safety tested. Your child should really stay in a car seat/booster until age eight and over 4'-9" tall and can sit with their back against the seat and have knees bend comfortably over the seat. Never put your child in the front passenger seat if you have an airbag, until over the age of 11, and in my opinion the back seat is still safer. It also keeps siblings from fighting about the front seat privilege and "I call shotgun" which often leads to slammed fingers as they race to the front seat. The best time to put them in the front passenger seat is when they are a young teen and makes for better conversation, which you know they love. Keep your kids safe and buckled up. That's your daily dose, we'll chat tomorrow! More Information:Car Safety Seats: A Guide for Families 2008 (American Academy of Pediatrics) More Information: National Highway Traffic Safety Administration

Daily Dose

Happy Thanksgiving

Wishing each of you a healthy and happy holiday with your family. I am thankful for the many blessings of friends and family. A special prayer and thank you for those men and women who are not with their families today as they are overseas protecting our values and freedom. Happy Thanksgiving from Dr. Sue and everyone at The Kid's Doctor!

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Daily Dose

New Laws for Teen Drivers

I woke up and realized that the first week of September would bring a lot of changes for teen drivers, at least in Texas and I am sure changes are in the air all around the country. The statistics related to accidents among teen drivers, especially within the first 12 months of driving are alarming.

One of the most proud and yet difficult moments in any parent’s parenting life is the day that their child gets their driver’s license. I can still recall the “gut” feeling as my new driver backed out of the driveway in the family car after getting their driver’s license. I can shut my eyes and feel my dry mouth, churning stomach and rapid heartbeat as if it was yesterday. I can also recall pacing on the porch for 10 minutes prior to their curfew as I heard sirens from who knows where as I was sure they had been in an accident. I will admit that even after getting through one new driver, I made my husband drive around during a thunderstorm, in the middle of the day, and follow fire engines and an ambulance as I just had this “mother feeling” that somehow these emergency vehicles may have been headed to an accident involving our second newly licensed driver. Thankfully, I was totally wrong, and of course my children thought I was crazy.   But, as a pediatrician, I know that the leading cause of death for 15 – 20 year olds is a motor vehicle accident. Driving is a privilege, teens often need to be reminded of that, and with that privilege comes a huge amount of responsibility, not only for themselves but eventually the passengers they are allowed to have in the car.   Beginning September 1, Texas now requires that teens must continue to receive classroom driver’s education while increasing behind the wheel driving instruction from 14 to 34 hours. I say the more practice the better! And that practice goes for parents who must commit to mentoring their child’s behind the wheel driving while they have their learner’s permit. Have your teen drive EVERYWHERE with you. The grocery store, school, doctor’s appointments, and after school events. They may not want to go those “boring” places with you, but they will be going there on their own one day and repetition is good. Remind them that teen drivers under 18 are banned from using cell phones while driving, so that includes dialing, talking and TEXTING. Lead by example.   Secondly, there is now a behind the wheel driving skills exams, just like the “old days” for drivers under 18 years of age. I am already hearing that the lines for this are horrible, but these lines may indeed save lives. Some kids may not be ready to drive alone despite the fact they finished driver’s ed, and this will help to keep them from “automatically” getting a license. I was just amazed that you could actually take these pieces of paper that said you had taken driver’s ed, completed your hours behind the wheel, show a document that you were enrolled in high school and walk away with a license No more….   Lastly, they have extended the graduated driver’s license restrictions from six months to one year. This means that your new driver has limited night driving privileges, and a limited number of passengers (specifically one non family passenger). But parents must enforce these rules.   Despite the fact that these laws vary from state to state, the restrictions surrounding new drivers are becoming greater. If your child is in this age range, review your state laws and have a dialogue with your child. With new laws for newly licensed drivers we can hopefully save lives.   That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

Why Vitamin D Is Important For Your Kids

As I am headed to the medicine cabinet to take my evening dose of calcium and vitamin D, I am also multitasking and reading an article in Pediatrics regarding vitamin D levels in children.As I am headed to the medicine cabinet to take my evening dose of calcium and vitamin D, I am also multitasking and reading an article in Pediatrics regarding vitamin D levels in children.

In the last several decades there has been a lot of discussion in the adult literature about osteopenia and osteoporosis as well as the prevention and treatment of these conditions. The latest studies involving vitamin D and calcium metabolism are now appearing in the pediatric literature as newer information about the long-term health effects of vitamin D continues to evolve.  It is certainly a hot topic these days, with more studies to come. The association between low levels of calcium and vitamin D has long been known as a cause of rickets. But rickets was thought to have been a bone disease of years ago (at least that was what I was taught) until recent studies showed that there were indeed still children who were developing rickets. An editorial in Pediatrics stated that the strongest evidence about the effects of vitamin D deficiency was related to the risk of developing rickets. Upon further evaluation it was found that rickets could be prevented and treated by increasing the daily amount of vitamin D a child received and subsequent recommendations were made that all children should receive 400 units of vitamin D daily. It was previously thought to be about half that much. The current study in Pediatrics shows that only one in five children between the ages of one and 11 receive adequate daily vitamin D. In African American and Hispanic children as many as 80 to 90 percent may be vitamin D deficient. Not only is vitamin D important in bone metabolism and heath, other studies have suggested that vitamin D may play a role in preventing infectious diseases, diabetes and even some types of cancer. Some other pediatric studies have shown that teens with low vitamin D levels had higher blood pressure and cholesterol levels, and also had a greater tendency to be overweight. I am sure there will be continued investigational studies into all of the above. How does all of this fit together? As a child’s diet changes and they no longer receive formula, their daily milk intake may be reduced and in turn their calcium and vitamin D intake is inadequate. In my personal experience and practice I find many children do not “like” milk and are allowed to choose other beverages, such as water, juice and even soft drinks. Although many parents think their children are getting their dietary calcium and vitamin D from other dairy products (yogurt cheeses, fortified juices), it is difficult to do without some daily milk intake. Even two glasses a day needs to be supplemented by other dairy products and many children have no milk. Additionally, vitamin D is made after our skin is exposed to sunlight. Due to the recommendations for routine sunscreen use in children and adults, we may not make as much vitamin D from sun exposure. It is also known that dark skinned children, especially in more northern latitudes are more likely to be vitamin D deficient. At the same time, children do not play outside as often and this too may contribute to obesity and lower vitamin D levels. All of these variables need further study and may be somehow intertwined. While the data continues to be accumulated and additional studies determine age appropriate blood levels of vitamin D, one thing is for sure: daily milk intake and dairy intake is vital to our growing children for a multitude of reasons. It is far easier to remember to pour your child, tween or teen a glass of milk than to remind them to take a vitamin or two every day for the rest of their childhood. I can barely remember to take my own! That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

Flu Season Isn't Over Yet

Just when you least expect it, those nasty viruses can rear their angry heads and guess what, they seem to be back.This has certainly been a weird end of winter and early spring in our office. I have always been very protective of my newborns and try to keep them "isolated" from all of those terrible winter viruses and germs for the first six to eight weeks of the infant's life. Especially for those newborns born during the winter months. Because we are fortunate to live in a temperate climate, we have lots of sunny days in the winter which allows for parents and babies to get out for walks in their neighborhood and even strolls in the park.

Even so, many of the parents (and they say their babies too) are getting a little cabin fever and are ready to head out to the mall, church and restaurants (the list seems endless). All of these venues are all full of crowds, so it is a given that germs are lurking there. By this time it had seemed that flu was long gone in our area and we had not seen RSV for months. Just when you least expect it, those nasty viruses can rear their angry heads and guess what, they seem to be back? I saw several cases of Influenza B last week, and yes they were documented! I was so skeptical that I had the lab techs pull out the boxes of flu tests to just check for checking sake and what do you know?! At the same time I saw several cases of RSV and even had to hospitalize one infant due to respiratory distress, the first child I had hospitalized all winter! Even the hospital was out of the rapid screening kits that had not been used recently, so it took us a day to document RSV. I am happy to report that both the your-baby with RSV and the adolescent with the flu are now doing well. I guess the moral of the story is, we cannot always predict the "official" end of the winter viral season. So keeping infants isolated seems like a good practice for at least several more weeks, until it is hard to find a coughing, sneezing, feverish, person among us. By June it will be a memory until winter of 2009 - 2010 and unfortunately the cycle begins again. That's your daily dose, we'll chat again tomorrow.

Daily Dose

How to Treat Poison Ivy

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With the long weekend here, many families are enjoying the outdoors. But with outdoor activity, your children may develop summer rashes like poison ivy, poison oak or poison sumac. Each plant is endemic to different areas of the country, but unfortunately all 50 states have one of these pesky plants. Teach your children the adage “leaves of three, let it be”, so they come to recognize the typical leaves of the poison ivy.

The rash of poison ivy (we will use this as the prototype) is caused by exposure of the skin to the plant sap urushiol, and the subsequent allergic reaction. Like most allergies, this reaction requires previous exposure to the plant, and upon re-exposure your child will develop an allergic contact dermatitis. This reaction may occur anywhere from hours to days after exposure, but typically occurs one to three days after the sap has come into contact with your child’s skin and they may then develop the typical linear rash with vesicles and papules that are itchy, red and swollen. Poison ivy is most common in people ages four to 30. During the spring and summer months I often see children who have a history of playing in the yard, down by a creek, exploring in the woods etc, who then develop a rash. I love the kids playing outside, but the rash of poison ivy may be extremely painful especially if it is on multiple surface areas, as in children who are in shorts and sleeveless clothes at this time of year. The typical fluid filled vesicles (blisters) of poison ivy will rupture (after scratching), ooze and will ultimately crust over and dry up, although this may take days to weeks. The fluid from the vesicles is NOT contagious and you cannot give the poison ivy to others once you have bathed and washed off the sap. You can get poison ivy from contact with your pet, toys, or your clothes etc. that came in contact with the sap, and have not have been washed off. If you know your child has come into contact with poison ivy try to bath them immediately and wash vigorously with soap and water within 5

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