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Your Child

“Holiday Asthma” and Children

2:00

Mix together a Christmas tree, decorations pulled out of dusty storage; perhaps a new kitten or puppy, plus dry heat in the house from cold temperatures and you’ve got a recipe for “Holiday Asthma.” Those are just a few of the things that can trigger a child’s asthma attack.

“Each individual‘s asthma triggers differ,” says Kristy Miller, a spokesperson for the Environment Protection Agency. "However, from an indoor environmental perspective, the primary asthma triggers include secondhand smoke, pet dander, mold, dust mites, and pest droppings. During the winter months, many people spend more time indoors, so steps should be taken to reduce or eliminate exposures to these environmental asthma triggers."

How you can you help your child avoid these common holiday triggers? We found helpful information when WebMD turned to an expert for advice.

One dangerous trigger is respiratory infection. Respiratory infections are rampant during the winter months, particularly during the holidays, when families travel around the country, with millions of other sneezing and coughing merry-makers.

“Asthma flair-ups are frequently due to infections,” says Richard Honsinger, MD, of the Los Alamos Medical Care Clinic. “And during the holidays, we see an increased number of respiratory infections with all the traveling and with people sharing their bugs that cause asthma symptoms to worsen.”

How can you avoid these harmful infections? One solution is to avoid traveling during one of the most contagious times of the year. The other is to make sure that your child and other family members properly wash their hands. That may sound too simple, but a good scrubbing with warm water and soap for at least 15 seconds--can reduce the number of germs your kids pick up over the course of the day, which in turn helps lowers the risk of catching a cold and triggering asthma.

Many families have switched from using real trees to artificial Christmas trees for convenience and to avoid allergies. However, the actual culprit may be the decorations.

“People get all their ornaments out of their basements and closets and they’re covered in dust,” Honsinger says.

The Christmas tree all lit up with warm lights and decorated with old bulbs is a perfect recipe for asthma trouble in kids, so wipe it down with a damp cloth before you set it up in the middle of your living room to remove outdoor allergens. Before you drag your holiday storage containers out of the basement, give them a good dusting so they’re free of mites, pest droppings and other unpleasant holiday treats, and wash decorations before you put them on the tree.

Roaring fireplaces not only provide a traditional backdrop for the holidays, but also come in handy for warming the house. Unfortunately, fireplaces can trigger asthma.

“Fireplaces and stoves and things that leak smoke are things that increase the asthma response,” says Honsinger. “It’s not a true allergy--you can’t test for smoke allergies on the skin--but we know that particulate matter or burning material in the air causes an increase in asthma symptoms.”

Particulate matter can also mean exhaust and cigarette smoke, explains Honsinger. So before you set off to visit family members or friends that smoke, remember to pack your child’s medicine – and be prepared to head home early if asthma symptoms flare up.

Then there is the new kitty or puppy issue. Giving your child a puppy or kitten for Christmas sounds like an enchanting idea, but don’t forget that that adorable little bundle is covered in dander--a common asthma trigger.

“Parents get their kids a new dog for Christmas, when they don’t know if the kids are allergic or not,” says Honsinger, who is a professor of clinical medicine at the University of New Mexico. “It’s a time of year when its cold, so pets are indoors more often than not, so their dander is inside as well and we see an influx of pet allergies and asthma symptoms.”

If your child has asthma, eczema or other allergies, it’s probably a good idea to have him or her skin tested for animal allergies -before you start picking out a puppy or kitten name.

During the winter months, cold air is something most people aren’t going to be to able to avoid unless you live in a warm region of the world and even then- surprises happen.

“We know that breathing cold, dry air will increase asthma symptoms,” says Honsinger. “It excites the receptors in the lung causing asthma to come on quickly.”

Cold air dries the lungs out, and makes the chest tighten, explains Honsinger. Warm, moist air, however, is just what a kid with asthma needs.

“During cold weather have your child wear a scarf when he’s outside,” says Honsinger. ”They breath through the cloth and it catches moisture. Then they breath back in through it and it warms the air and makes the air moist. Then they’re less likely to get that feeling of tightness.”

To be on the safe side, if your child is playing outside, monitor her peak flow every hour or so. 

“Use a peak flow meter so you can see how fast your child’s air is coming out,” says Honsinger. “Use a set of guidelines that you set up with your physician, so if the peak flow drops below a certain level, use medicine. If it drops further, you better seek help. It’s something to watch.”

Because pharmacies and pediatricians may have irregular hours during the holidays, be prepared in advance. “If your child has asthma, have your medicine supply intact over the holidays when everything closes down,” says Honsinger. “If your child uses an inhaler or a nebulizer, make sure you have these on hand, so if asthma symptoms flare up in the middle of Christmas, you have something at home to start treatment right away.”

If your child doesn’t respond to available treatment, take him or her to the emergency room. Asthma isn’t something you want to let get the upper hand.

By applying some of these tips, your child may be able to escape “Holiday asthma!”

Merry Christmas and Happy Holidays from the Kids Doctor!

Story source: Heather Hatfield, https://www.webmd.com/asthma/features/holiday-asthma-triggers-for-kids#1

Daily Dose

Wheezing Season is Here

1:30 to read

Have you ever heard your child wheeze?  With cough and cold season in full swing, I'm seeing more and more children and hearing many parents say, “I think my child is wheezing”.  Wheezing is a distinct sound that is heard during expiration and unfortunately is often not audible without a stethoscope. Many parents mistakenly hear the raspy upper airway noises from mucous in a child’s throat and think this is wheezing, which thankfully is not the case.

Wheezing is one of the most common reasons children are seen in the pediatric office during the winter months when RSV (respiratory syncitial virus), rhinovirus, and parainfluenza viruses all circulate...not to mention influenza.  Not all children who wheeze will go on to develop asthma but having a parent who wheezes and has allergies does put a child at greater risk for having asthma. 

Asthma is not a singular disease but rather a complex of symptoms which causes constriction of the airway smooth muscles, inflammation of the airway, mucous production and swelling that leads to air trapping.  This then results in coughing, wheezing, chest tightness,  prolonged exhalation and shortness of breath. For a young child the first symptoms of wheezing may be a persistent short, tight cough that occurs day and night without relief.

If you do think your child is wheezing you must always watch for ANY respiratory distress, or work of breathing!!!  You should never see your child’s ribs pulling in or out and they should always appear to be comfortable with breathing. You must look at their chest rather than just listen to their coughs.  Visual is just as important as the audible noise.

Like many things, there is not a specific test for diagnosing asthma. For a child who is initially found to be wheezing the first line of treatment is typically an inhaler or nebulizer with a bronchodilator to open up the tightened airways. For a young child it is often easier to use the nebulizer but once a child is older and a bit more cooperative an inhaler with a spacer is often less cumbersome and more convenient to use. When used appropriately the spacer/inhaler has been show to be equally effective.

If you are worried about your child’s breathing it is always a good idea to call your pediatrician to discuss. 

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Asthma

Asthma Season is Here!

Your Child

Kid’s Asthma: Test For Pollutants Inside the Home

1:45

If your child suffers from asthma, he or she should be tested to see if they are allergic to indoor pollutants such as dust mites, insects, pet dander, molds, secondhand cigarette smoke and certain household cleaning supplies says a new clinical report released by the American Academy of Pediatrics (AAP).

Controlling the triggers of asthma in the home may work as well as or reduce the need for medications wrote Elizabeth C. Matsui, MD, MHS, FAAP,  of Johns Hopkins Hospital in Baltimore and colleagues, authors of the new guidance in the November issue of Pediatrics.

"We know that targeting all exposures that can trigger a child's asthma is more likely to be successful and to result in significant improvement than targeting only one or two of them, and can help reduce asthma attacks and the need for medication," Matsui said.

According to the report, an assessment of a child's individual environmental history should be an integral part of asthma management. The authors urged pediatricians to ask families about exposure to the following common triggers:

·      Dust mites and mold: An estimated 30-62% of children with persistent asthma are allergic to dust mites, and about half are sensitive and exposed to mold.

·      Furry pets: Cats and dogs are common furry pets found in homes, yet up to 65% of children with persistent asthma report being allergic.

·      Presence or evidence of pests such as cockroaches and rodents: Cockroach allergen exposure was first linked to asthma morbidity in children in 1997, and the link has been replicated ever since. Nearly 75-80% of U.S. homes contain detectable amounts of mouse allergen. Concentrations in homes in neighborhoods with high poverty rates are up to 1,000-fold higher than those found in suburban homes.

·      Indoor air pollution: Cigarette smoke is a major indoor trigger, with nearly 30% of all U.S. children and 40-60% of U.S. children in low-income households exposed to second-hand smoke in their homes. Additionally, the use of older wood-burning stoves, unvented space heaters, and other sources of combustion can produce nitrogen dioxide and other pollutants that are known to exacerbate asthma symptoms.

·      Household chemicals: Common household items such as air fresheners and cleaning agents include chemicals that can be respiratory irritants and trigger asthma symptoms.

The report recommended seeing an allergist to identify which allergens may be triggering your child’s asthma.

By asking specific questions, Matsui noted that pediatricians can play an important role in helping parents recognize something in the house may be making their child’s asthma worse.

"Which exposures to focus on will be informed by questions the pediatrician asks of the family," Matsui said. "Asking about pets will identify children who may have pet allergen exposure contributing to their asthma. Similarly, asking about signs of mouse or cockroach infestation will indicate which children might be at risk from these exposures."

Additionally, pediatricians should routinely ask about second-hand smoke exposure as this will guide further discussion about ways to eliminate or reduce a child's exposure to smoke, she said.

Dust mites are the most common indoor pollutant, however, you won’t see these pests crawling around your house. They are so tiny - a microscope is needed to actually see them. They feed mainly on the tiny flakes of human skin that people shed each day. These flakes work their way deep into the inner layers of furniture, carpets, bedding and even stuffed toys. These are the places where mites thrive. An average adult person may shed up to 1.5 grams of skin in a day. This is enough to feed one million dust mites!

Having dust mites doesn’t mean your house isn’t clean. Even the cleanest of houses can harbor these unwelcomed creatures. You can find out more about dust mites at http://www.aafa.org/page/dust-mite-allergy.aspx.

Indoor allergens can definitely make your child’s asthma worse and although many insurers do not currently cover environmental assessments and control measures, there are both public and private resources available to aid pediatricians, specialists, and patients with environmental remediation efforts.

Story source: Alexandria Bachert, http://www.medpagetoday.com/pediatrics/asthma/61125

Daily Dose

Asthma

1:30 to read

May is Asthma Awareness Month and I am certainly seeing many patients whose asthma and wheezing is getting the best of them right now. With all of the major weather changes across the country, pollen counts through the roof, and upper respiratory viruses still circulating, there are quite a few triggers to set off wheezing.

 

Asthma is a chronic lung disease and affects more than 6 million children in the United States. Asthma causes wheezing and chest tightness in some, while it may only cause nighttime cough and cough with exercise in others. There is not one single presentation to asthma and the diagnosis is best made with a good history and physical exam.  Although asthma is a chronic disease you may only have attacks when something is bothering your lungs (triggers).

 

The biggest challenge I see as a pediatrician is teaching both parents and children to recognize their triggers and to know what their medications are. Every patient should have an asthma action plan, but in some cases, a child may have only wheezed once..and their parents received an inhaler or a nebulizer but really does not know what to do if their child wheezes again.

 

If your child has wheezed before, and you have a family history of wheezing, your child has a greater chance of wheezing again.  You should have a discussion with your pediatrician about how to recognize wheezing in your child. At the same time, if you have ever received a medication for wheezing, make sure you know the name or names of the medication. I see many parents who come in to the office and they may have been seen at an ER or urgent care when they were noted to be wheezing. They received an “inhaler”, but the parent has no clue as to the name of the inhaler (they may say, “it is blue”), and they don’t understand how the medications work.

 

The two points I try to make with every patient I see with wheezing:  

#1  Know the names of the medications that you have

#2  Know what the medications do

 

There are two issues with asthma, lung inflammation and broncho spasm (narrowing of the airways). So…there are two medications commonly used to treat these issues.  Inhaled steroids (there are tons of brands) are used as a preventative and decrease inflammation, while albuterol (again tons of brands) is a broncho-dilator and opens up the narrowed airways.  I see too many patients that bring in a bag full of medications, from numerous doctors and still don’t understand what their medications are used for, when to use them and that several of their inhalers, while having different names, are actually the same medicine.

 

Lastly, children with divorced parents need to have inhalers available at both homes. I think it is too complicated to try and have parents hand the inhaler or medication back and forth and think they will not forget or lose the medication.  Ask your doctor to have meds for both houses.

Seeing that is is Asthma Awareness month, get your medications out and make sure that they are not expired and if you don’t understand how or when to use them, make an appointment with your pediatrician and get an asthma action plan in place. Be prepared!  

Daily Dose

Asthmatic Kids & Colds

2.00 to read

Cold season continues to hang on and for anyone who has a child with asthma, you are aware that wheezing will often accompany winter colds.

I have spent a lot of time in the last week listening to wheezy chest, lots of coughing and seeing many children who need to be using their asthma medications. After a quiet summer of no coughing it is a good time to review asthma and the medications to use to treat as “wheezy season” is here!

Many children will wheeze once in their lifetime and I tell parents, “everyone gets one free wheezing episode”. But if a child wheezes on several occasions and responds to bronchodilators they probably have asthma. If you throw in a positive family history of wheezing as well as wheezing that begins each time a child gets a cold it is time to discuss the diagnosis of asthma and the treatments that go along with the diagnosis.

The good news about asthma is that there are a lot of great medications available for treatment. With that being said I think it is important to teach parents about the pathophysiology of asthma and then talk about treatment. I tell my patients/parents that understanding wheezing is somewhat analogous to being a medical intern. You have to see the symptoms for a while and then you finally “learn it, and know it” and then can begin to understand treatment.

For a parent with a child with asthma it is the same process. Each repeated wheezing episode should get easier for a parent to know what they are dealing with and when and how to start treatment. Many times they will not need the doctor to be involved once they are comfortable with the medications.

In fairly simplistic terms, there are really two components to asthma, airway narrowing (brochospasm) and airway inflammation. In most cases it is important to be treating both symptoms. The most common trigger for asthma in children is a viral upper respiratory infection. When you get a viral upper respiratory infection the virus causes airway inflammation and irritation in all of us. That is one reason we all cough with a cold.

For an asthmatic child it also causes bronchospasm and resultant wheezing. By the time you audibly hear your child wheezing they are what we pediatricians refer to as “being tight”. The goal is therefore to treat the asthmatic episode early and aggressively; you never want to hear audible wheezing.

An asthmatic cough is often short, frequent, non productive and occurs throughout the day and often all night long. I love to walk into a room and hear a child with a productive, “phlegmy” cough, as these children are typically not wheezers but are good coughers! It is that dry little recurrent pesky cough that occurs incessantly that is often the hallmark of a child who is wheezing.

In severe cases of wheezing and bronchospasm the child will also show signs of respiratory distress, where their chest may show retractions (pulling in between ribs) or using their abdominal muscles to help them breath. These children look uncomfortable and are usually not running around the exam room as they are having a hard time getting air exchanged.

Some other children may not be in any respiratory distress but when listened to with the stethoscope you can hear the high pitched noise on expiration and sometimes on inspiration as well. You just have to get used to listening. Practice, practice and then a parent with a stethoscope gets better at understanding asthma.

When a child is actively wheezing it is time to start medications to relieve their symptoms. More on treatment coming.  Stay tuned.

Your Baby

High-Sugar Intake During Mom’s Pregnancy May Double Child’s Risk of Asthma

2:00

It’s no secret that moms-to-be often develop a sweet tooth during pregnancy, but new information suggests high-sugar foods and drinks may double their child’s risk for developing asthma and allergies later in life.

Researchers from Queen Mary University of London used data gathered from nearly 9,000 mother-child pairs in the Avon Longitudinal Study of Parents and Children, an ongoing research project that tracks the health of families with children born between April 1, 1991, and December 31, 1992.

During the study, the participating pregnant women were asked about their weekly intake of certain foods and specific food items including sugar, coffee and tea. Their responses were used to calculate their intake of added sugar.

The researchers only saw weak evidence to suggest a link between women’s added sugar intake and their children’s chances of developing asthma overall. But when they looked specifically at allergic asthma—in which an asthma diagnosis is accompanied by a positive skin test for allergens—the link was much stronger. Children whose moms were in the top fifth for added sugar during pregnancy were twice as likely to have allergic asthma when compared to children whose moms were in the bottom fifth.

Children of mothers with the high-sugar diets were 38% more likely to test positive for an allergen and 73% more likely to test positive for more than one allergen, compared to those kids whose moms stayed away from added sugar.

"The dramatic 'epidemic' of asthma and allergies in the West in the last 50 years is still largely unexplained -- one potential culprit is a change in diet," said Annabelle Bedard, lead author and a postdoctoral fellow at Queen Mary's Centre for Primary Care and Public Health Blizard Institute. "Intake of free sugar and high fructose corn syrup has increased substantially over this period."

As with most studies, a cause and effect was not established, only an association. The study’s authors believe that the association is strong enough to warrant further investigation.

Lead researcher Professor Seif Shaheen  said: "We cannot say on the basis of these observations that a high intake of sugar by mothers in pregnancy is definitely causing allergy and allergic asthma in their offspring.

"However, given the extremely high consumption of sugar in the West, we will certainly be investigating this hypothesis further with some urgency.”

There are many health reasons why pregnant women should limit their intake of high-calorie and sugary foods and drinks. This research suggests that it may be prudent for the health of their unborn child as well.

Story sources: Susan Scutti, http://edition.cnn.com/2017/07/05/health/sugar-pregnancy-child-allergy-asthma-study/index.html

 Henry Bodkin, http://www.telegraph.co.uk/science/2017/07/06/high-sugar-intake-pregnancy-linked-double-risk-child-asthma/

Daily Dose

Wheezing Season Is Here

We are having our first really cool night of the fall season and boy is it wheezing season here. This is the time of year that many young kids will get their first colds and some will also start to wheeze. Weather changes also seem to provoke wheezing episodes, especially if you have had a child who has previously wheezed during a cold. So, we have all of the right conditions for another wheezing season.

Wheezing runs in families, so if parents wheezed their children may be more likely to wheeze too. Many parents don't even realize they wheezed until they probe their own history, as they may have outgrown their wheezing. The genetics of wheezing is not totally understood, but just like allergies, wheezing is on the rise. If your child seems to have a tight, persistent cough, a frequent night time cough, or coughs with exercise you should discuss these symptoms with your doctor. Some children will only have a persistent cough as their presentation, but with enough history you can figure out that their cough is due to cough variant asthma, and all of the cough medicines in the world are not going to stop that nighttime cough (remember don't be giving young children over the counter cough medicines). Much of the diagnosis is made through a good history and physical exam and appropriate medication will stop that recurrent cough. If your child has already been diagnosed with asthma or reactive airways disease, make sure you have your inhalers refilled and current. Wheezing season is here and won't go away quickly so be ready. Some children will need to be on preventative medicines too. That's another topic for discussion with your doctor. Enjoy the weather changes, it feels great outside! That's your daily dose, we'll chat tomorrow.

Your Child

City Kids With Asthma Do Better Living Near a Park

2:00

The beauty of tall trees, open space and rows of lush flowers may not only offer a respite from cramped city living, but might reduce asthma symptoms in children as well, according to a new study.

An interesting, albeit small, study of urban children in Baltimore, Maryland, showed that the closer a child with asthma lived to a park or green space, the fewer symptoms they displayed compared to children with asthma that did not live near a park.

The new study included 196 inner-city children in Baltimore, aged 3 to 12 years, with persistent asthma. Some lived close to a park or other green space, while others were more than 0.6 miles away from one.

Researchers found that the farther the children lived from a park, the more asthma symptoms they experienced over a two-week period. For every 1,000 feet between their home and a park, children had symptoms one extra day.

"Living in a city environment increases the risk of childhood asthma, and factors associated with city-living -- such as air pollution -- are also known to contribute to high rates of poorly controlled asthma," study author Kelli DePriest said in a society news release.

Other studies have suggested that children with asthma benefit from exercise, and the presence of green spaces promotes physical activity and helps lower pollution, she said.

Children that were 6 years old or older benefited the most from being in the park.

DePriest said that's probably because they are freer to roam than younger kids.

DePriest suggested city planners should consider the health benefits of adding more parks to children’s environments.

In addition to policymakers and city planners, healthcare providers could also provide more information to parents and caregivers about the advantages of taking their children to parks and green spaces.

The study findings "will also help health care providers to take a more holistic view of their patients by understanding how access to green space might affect health," she concluded.

The study will be presented to a European Respiratory Society in Milan, Italy. Researched presented at meetings are typically considered preliminary until published in a peer-reviewed journal.

Story source: Robert Preidt, https://consumer.healthday.com/respiratory-and-allergy-information-2/asthma-news-47/for-city-kids-with-asthma-nearby-green-space-is-key-726293.html

 

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