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Your Child

Never Use Q-Tips to Clean Your Child’s Ears

1:45

Parents and caregivers seem compelled to clean their child’s ears with a cotton swab. Despite repeated warnings to not put anything smaller than one’s elbow inside a child’s ear, more than 263,000 U.S. children had to be treated in emergency rooms for ear injuries related to cotton-tip applicators between 1990 and 2010, according to a new study.

Almost three-quarters of the cases — 73 percent — involved ear cleaning. About two-thirds of the patients in the study were younger than 8.

"There's this misconception that people need to clean their ears in the home setting and that this is the product to do that with," Dr. Kris Jatana, senior author of the study and a pediatric ear, nose and throat specialist at Nationwide Children’s Hospital, told TODAY.

"The ears themselves are typically self-cleaning... It is risky to use cotton-tip applicators in the ear canal across all age groups, and certainly we are seeing way too many injuries as a result of this practice."

The most common incident in the ER was the presence of a foreign body, such as part of the cotton swab and a perforated eardrum, researchers said.

"It's difficult for people to gauge how deep they're putting [the swab]," Jatana said. "Sometimes, it just takes a small movement to puncture the ear drum."

Physicians specializing in ear and throat diseases say that Q-tips and similar products should never be used for cleaning the ears. Not only can they cause ear canal injuries, but can also push ear wax deeper into the canal causing it to become trapped.

Studies have found 90 percent of people believe ears should be cleaned and say they regularly clean their ears or their children’s ears, according to the American Academy of Otolaryngology—Head and Neck Surgery Foundation. Kids also apparently learn to stick Q-tips into their ears by watching their parents: about 77 percent of the injuries in the study happened when the child was handling the swab himself.

If you see earwax on the outer part of your child’s ear, you can clean it with a washcloth or wipe, Jatana suggests. In most cases, earwax is actually beneficial for the ear. It protects, lubricates and cleans the ear canal. Occasionally, children and adults have excessive wax build-up, but a doctor should be consulted about removal.

Hearing loss, a feeling of fullness in the ear or ear pain are symptoms that should be checked out. An ear, nose and throat doctor can remove more stubborn excess wax.

Story source, A. Pawlowski, http://www.today.com/health/cotton-swabs-are-causing-ear-injuries-thousands-kids-t111296

 

Your Baby

Which Fish is Healthier for Pregnant Women?

1:45

New federal nutrition guidelines say that pregnant and breastfeeding women should eat 2 to 3 servings of fish every week. However, there are certain fish that should be eaten only once per week and other fish that should be avoided entirely by pregnant and nursing women.

One reason for the differentiation between certain types of fish is its likelihood of containing either very low or high levels of mercury.

Nearly all fish and shellfish contain traces of mercury. But some contain high levels.  A type of mercury called methylmercury is most easily accumulated in the body and is particularly dangerous.

Eating large amounts of these fish and shellfish can result in high levels of mercury in the human body. In a fetus or young child, this can damage the brain and nervous system.

The highest mercury concentration belongs to fish that typically live a long time. Pregnant and breastfeeding women should avoid King mackerel, Marlin, Orange roughy, Shark, Swordfish, Tilefish from the Gulf of Mexico and Bigeye Tuna. These are fish that usually contain high levels of mercury.

The new guidelines come with a handy chart that gives you the best choices of fish, good choices and fish to avoid.

Naturally, many pregnant women are concerned about eating fish after hearing about the possibility of consuming any mercury whatsoever. It’s important to remember that most of the fish consumed by Americans falls into the safe category.

Studies show that fish provide an array of nutrients that are important for your baby's early development. Most experts agree that the key nutrients are two omega-3 fatty acids – DHA and EPA – that are difficult to find in other foods. Fish is also low in saturated fat and high in protein, vitamin D, and other nutrients that are crucial for a developing baby and a healthy pregnancy.

How do fish end up consuming mercury? Some of the sources (such as volcanoes and forest fires) are natural. It's also released into the air by power plants, cement plants, and certain chemical and industrial manufacturers, landfills and farming runoff.

When mercury settles into water, bacteria convert it into a form called methylmercury. Fish absorb methylmercury from the water they swim in and the organisms they eat. Methylmercury binds tightly to the proteins in fish muscle and remains there even after the fish is cooked. Fish that live a long time consume more mercury.

There are many benefits to eating fish; you just need to be aware of the kinds of fish you eat. To help you make the best choices, the new chart released by the FDA and EPA is shown below.

Story sources: Megan Thielking, https://www.statnews.com/2017/01/19/fda-guidelines-fish/

http://www.babycenter.com/0_eating-fish-during-pregnancy-how-to-avoid-mercury-and-still_10319861.bc

http://www.fda.gov/downloads/Food/FoodborneIllnessContaminants/Metals/UCM536321.pdf

Your Baby

Higher ADHD Risks Linked to Premature Births

2:00

The risk that a child will have Attention Deficit Hyperactivity Disorder (ADHD) is relatively low among the general population. However, a new study suggests that the more premature a baby is when born; the risk for ADHD increases significantly.

Finnish researchers led by Dr. Minna Sucksdorff of the University of Turku compared more than 10,000 children with ADHD against more than 38,000 children without ADHD but similar in terms of gender, birth date and place of birth.

The researchers used birth medical records to see how far along in the pregnancy the mother was when the child was born. They also looked at whether the children were underweight or overweight for what is expected at that gestational age.

The study results showed that the risk of ADHD increased for each week earlier that a child was born. A full-term pregnancy is considered to be 40 weeks.

The odds of children with ADHD were 10 times greater when they were born during the 23rd to 24th week of pregnancy. Children born between the 27th and 33rd week of pregnancy were twice as likely to have ADHD compared to those without ADHD.

Other factors that affect gestational age and ADHD were also taken in account such as the mother’s age and whether she smoked or used drugs or alcohol. After these considerations, the findings remained the same.

In regards to birth weight, researchers found that infants born at very low or very high weight percentages were also at a higher risk for ADHD.

These findings imply that the pathways in the fetal brain may develop differently in children who are not adequately nourished, or are over-nourished, in the womb, or once a child is delivered prematurely, said Dr. Glen Elliott, chief psychiatrist and medical director of Children's Health Council in Palo Alto, Calif.

However, he added, this type of study cannot show that premature birth or growth rate in the womb actually causes ADHD. Symptoms of the common brain disorder include inattention, impulsive behavior and hyperactivity, which can affect a child's ability to learn and make friends.

Most early cesarean births happen because a mother and / or her infant are in distress and surgery is needed to protect one or the other or both of their health. Planned cesareans are typically scheduled close to the original due date and are unlikely to be associated to ADHD risk. However, the findings may give doctors something to consider when making a decision about cesarean birth.

"Since both gestational weight and gestational age have marked effects, clinicians may face difficult choices if a fetus is not thriving in the womb at an early gestational age," Elliott said. "Does one deliver the child early to enhance nutrition or delay to minimize the effects of premature delivery?"

The risk is still low overall that a child will have ADHD, and these findings are based on a child's relative risk of having the condition compared to others, Elliott added. The study suggests that the chance for ADHD appears to be greatest among the very premature babies.

The findings were published in the August 24th online edition of  the journal Pediatrics.

Source: Tara Haelle, http://www.webmd.com/baby/news/20150824/adhd-risk-rises-for-each-week-a-preemie-is-born-early

Daily Dose

HPV Vaccine

1:30 to read

I don’t think I have posted the latest good news about vaccines. As you know I am a huge proponent of vaccinating children (and ourselves), and remind patients that there continue to be ongoing studies regarding vaccine safety, as well as efficacy.  The CDC and ACIP recently announced that the HPV vaccine may be protective and effective after just 2 doses of vaccine rather than the previous recommendation of a series of 3 vaccines.  That is good news for teens, especially those that are “needle phobic”!  

 

The ACIP (Advisory Committee on Immunization Practices  recommended  a 2 dose HPV vaccine series for young adolescents, those that begin the vaccine series between 11 and 14 years.  For adolescents who begin the HPV vaccine series at the age 15 or older, the 3 dose series is still recommended.

 

This recommendation was based upon data presented to the ACIP and CDC from clinical trials which showed that two doses of HPV vaccine in younger adolescents (11-14 years old) produced an immune response similar or higher than the response in older adolescents (15 yrs or older). 

 

The HPV vaccine, which prevents many different types of cancer caused by human papilloma virus, has been routinely recommended beginning at age 11 years  approved to use as young as 9 years), but unfortunately only about 42% of girls and 28% of teenage boys has completed the 3 dose series.  

 

By showing that a 2 dose series (when started at younger ages) is effective and protective the hope is that more and more young adolescents will complete the series.  The two doses now must be spaced at least 6 months apart and may even be given at the 11 year and then 12 year check up which would not require as many visit to the pediatrician.

 

According to the CDC more HPV - related cancers have been diagnosed in recent years, and reported more than 31,000 new cases of cancer each year (from 2008 - 2012) were attributable to HPV, and that routine vaccination could potentially prevent about 29,000 cases of those cancers from occurring.  But, in order to see these numbers shrink, more and more adolescents need to be immunized…before they are ever exposed to the virus. Remember, the HPV vaccine is protective against certain strains of HPV, but does not treat HPV disease.

 

So..once again a good example of using science based evidence to provide the best protection against a serious disease…with less shots too!! Win - Win!!

 

 

Parenting

Is Your Child Becoming an Emotional Eater?

2:00

You may be tempted to appease your child with food after a fall or tears for short-term relief, but this could actually set your child up for long-term unhealthy eating patterns.

What happens is that children begin to identify eating with self-comforting or relieving boredom instead of nutrition or eating when they’re actually hungry.

Almost all children, teens, and adults may engage in emotional eating at one time or another.

Hunger associated with emotional eating comes on quickly and feels urgent. It's often triggered by a specific event or mood. It's not like typical physical hunger, which gradually builds and is a result of an empty stomach. Physical hunger can be satisfied by a number of different foods, but cravings usually involve particular foods. Examples might be ice cream or candy after a fight with a friend or a tough day at school.

Why is emotional eating unhealthy? Emotional eating isn’t really about hunger or nutrition; it’s about filling an emotional need. It can lead to overeating and over time, lead to extra weight gain or obesity. It also sets up a pattern of handling uncomfortable situations by eating instead of by learning how to solve social and psychological problems.

There are lots of reasons kids may seek out food for comfort such as:

  • Anger
  • Boredom
  • Change
  • Confusion
  • Depression
  • Frustration
  • Loneliness
  • Loss
  • Resentment
  • Stress

Even positive emotions such as excitement and happiness can result in emotional eating once it becomes a go-to as a reward. 

If you notice signs of emotional eating in your child, talk to him or her about your concerns. Be gentle. Stay positive. Helping your child might be as simple as having a warm and loving conversation.

Help your child develop a healthy response to his or her problems, such as focusing on solutions. Encourage your child to talk about the emotions that trigger his or her emotional eating. Brainstorm other ways to deal with those emotions. For example, your child could exercise or become involved in sports when he or she feels stressed out, or call a friend when he or she is bored.

Emotional eating can be learned, so your influence as a parent or primary caregiver is one key to prevention. Be sure to model healthy eating habits for your child. Also, avoid using food to celebrate occasions or to reward your child for good behavior. Instead, use verbal praise and give other types of rewards (for example, stickers for a young child or a fun activity with an older child).

There are signs you can look for in children to let you know if your child is an emotional eater. They are:

  • Eating in response to emotions or situations, not to satisfy hunger
  • Feeling an urgent need to eat
  • Craving a specific food or type of food
  • Eating a larger amount of food than usual
  • Eating at unusual times of day (for example, late at night)
  • Gaining excess weight
  • Feeling embarrassed or guilty about eating
  • "Sneaking" food during high-stress times
  • Hiding empty containers of food

A recent study from Norway found that kids offered food for comfort at ages 4 and 6 displayed more emotional eating at ages 8 and 10.

Also, the researchers found signs that kids who felt more easily comforted by food were fed more by parents for that purpose.

Emotional eating typically starts early in life but can really begin at any age; it seems like an easy fix for anxiety at the time, but can lead to health problems if not brought under control.

Story source: https://familydoctor.org/emotional-eating-in-children-and-teens/

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Parenting

Winter at Home: Managing Dry Indoor Heat

1:45

Once winter starts settling in, the home furnaces are cranked on, followed by itchy skin, upset sinuses and cracked lips. What fun.

It’s also when the home is sealed tight, trying to prevent heat loss.

While some areas of the country are still experiencing warmer weather, many are feeling the effects of old man winter.

Dry winter air leeches moisture, leaving your family’s skin as dry and cracked as a salt flat and sinuses as parched as the Sahara in summer. Adults and kids may wake up with a bit of a bloody nose as well.

You also start noticing static electricity while brushing your hair or petting the family pet.  Clothes start acting funny as well, sticking to you like saran wrap. It’s literally shocking.

Here are a few tips to help you combat dry indoor air, preserve the moisture in your family’s skin and nasal passages, and avoid pet-induced static shocks this winter.

In the winter, the cold air that seeps into your home from the outside has a lower humidity -- meaning that it carries very little moisture. You crank up the heat inside your house, which adds warmth but doesn't increase the amount of moisture in the air.

Because wintertime humidity is so low, what little moisture that is around is quickly sucked up into the air. Moisture also evaporates from your body, leaving your skin, nose, and throat parched.

One way to combat all this dry air is using a humidifier. Running a humidifier in your home will add moisture to dry, heated air. The moist air will help keep your skin, mouth,  and nose lubricated, and helps prevent those nasty static shocks. Your goal is to aim for a comfortable home humidity level of between 30% and 50%. Don't crank up the humidifier higher than that, though, or you could develop another problem – mold, fungi, dust mites,  and other tiny critters. Make sure to keep your humidifier clean so that it doesn't send dust and germs spewing into your house.

Sinuses often take a beating during the winter. Cold, dry air pulls moisture from your mouth, and nose, leaving your nasal passages dried out and your throat dry. Dry nostrils are more likely to crack and give you a nosebleed.

Why do kids and adults get sick more often during the winter months? Because your nose needs gooey mucus to trap viruses and other icky invaders before they can get you sick, dry nostrils can also make you more vulnerable to colds, sinus infections, and the flu. That's especially a problem in winter, when bacteria and viruses can tend to linger longer in the dry air after someone coughs or sneezes.

When you turn up the thermostat in your home, your heating system kicks up clouds of dust, pollen, and other allergens that can inflame your sinuses. Cold, dry air plus those allergens can also irritate your airways. For some kids with asthma, cold and dry air can lead to a narrowing of breathing passages and trigger an attack.

One way to help add moisture back is by keeping hydrated. Keep your skin and mouth moist by drinking water throughout the day. Don’t like water? Try putting in a little tea or juice to add flavor. It’s a little easier to drink more water in the summer, because …well… you’re sweating more, triggering a thirst attack. It takes a little more effort in the winter to keep hydrated but the pay-off is just as valuable.

You may also find yours or little ones fingers developing cracks and dealing with dry itchy skin in the winter because cold air sucks out the skin’s moisture. While it’s tempting, taking hot showers can worsen dry, itchy skin by removing the natural layer of oil that preserves and protects the skin's moisture. Something we seem to have plenty of in the summer.

To help your skin out, shorten your shower time. Make sure that your child’s bath water or shower is warm, but not hot and he or she is using a gentle soap. Fifteen minutes should be the maximum time spent in the shower and even shorter if you’re clean sooner.

Alas, don’t forget to put a moisturizer on your child or have some available for your older kids. A thick oil-based moisturizer is best. The oil in the product will lock moisture into the skin and keep it from drying out. Moisturizers come in different forms, but ointments will provide the most protection for dry skin.  Make sure to apply moisturizing sunscreen with a minimum SPF 30 to exposed skin before going outside. Also apply a lip balm or petroleum jelly to protect against chapped lips. Help keep the nasal passageways moist by using saltwater (saline) drops or rubbing a little petroleum jelly into each nostril gently with a cotton swab.

There are some advantages to winter – you can dress in layers (you can only take so much off in the summer), walking is easier than when you’re dripping sweat and snow covered trees have a certain mystique and beauty to them. Other than that, winter is pretty brutal to our skin and nasal passages- but we can fight back by keeping hydrated, using creams to soften our skin and adding more moisture to the air while we hunker down; cozy and warm with our family indoors.

Story source: Lisa Bernstein, MD, http://www.webmd.com/women/home-health-and-safety-9/dry-indoor-air?page=2

Your Baby

FDA Warning: No Homeopathic Teething Tablets or Gels

1:45

Some babies have little to no symptoms during teething, while others experience quite a bit of pain for months. When teething pain occurs, infants may cry and be irritable until they find relief.

Homeopathic tablets and gels aimed at helping soothe babies’ pain may be dangerous for infants and toddlers, the Food and Drug Administration (FDA) recently announced in a statement. 

The FDA is investigating reports of seizures in infants and small children who were given homeopathic teething products, which may contain "natural" compounds but are not regulated as drugs by the FDA.

In addition, the FDA said in the statement that "consumers should seek medical care immediately if their child experiences seizures, difficulty breathing, lethargy, excessive sleepiness, muscle weakness, skin flushing, constipation, difficulty urinating or agitation" after using homeopathic teething tablets and gels.

According to the National Center for Complimentary and Integrated Health, homeopathy relies on two theories: “like cures like”—the notion that a disease can be cured by a substance that produces similar symptoms in healthy people; and “law of minimum dose”—the notion that the lower the dose of the medication, the greater its effectiveness.

The FDA said in the statement that the agency is not aware of any proven health benefit of using homeopathic teething tablets and gels.

In 2010, the FDA issued a safety alert about a homeopathic teething tablet that contained belladonna. Belladonna — also called deadly nightshade — is a poisonous plant that contains a chemical called atropine. At high levels, atropine can be deadly. In homeopathy, it is used to treat redness and inflammation.

At the time, the FDA found that the teething tablets contained inconsistent amounts of belladonna. The company that made the tablets, Hyland, subsequently recalled the product.

Hyland issued a statement and video in response to the current FDA warning against the use of homeopathic teething remedies.

"As you may have seen, on September 30, 2016, the Food and Drug Administration issued a surprise statement recommending that consumers discontinue use of homeopathic teething tablets and gels because they may pose a risk," Hyland's stated. "We are fully cooperating with FDA’s inquiry and we’re providing them with all the data we have. We also hope to learn from FDA what facts, if any, the Agency has based its action on."

Hyland also noted “The safety and effectiveness of Hyland’s natural homeopathic medicines is our top priority. That’s why we work with regulators to ensure that our products meet the highest standards. If we ever had reason to be concerned of that safety, we would act immediately."

"Teething can be managed without prescription or over-the-counter remedies," Dr. Janet Woodcock, director of the FDA's Center for Drug Evaluation and Research, said in the FDA statement. 

The American Academy of Pediatrics (AAP) recommends teething rings or hard, unsweetened teething crackers. Do not use frozen teething toys because they can cause more discomfort by injuring a baby's mouth, the AAP advises.

Be sure and check with your pediatrician about teething pain relief if your little one is having a hard time getting through the teething process.

Story sources: Sara G. Miller, http://www.livescience.com/56352-fda-warning-homeopathic-teething-tablets.html

Michael Johnsen, http://www.drugstorenews.com/article/hylands-responds-fda-teething-tablet-warning

 

Your Baby

“Furry Pets” May Help Kids Avoid Some Allergies

2:00

You might think that having pets would be a nightmare if you have small children with a family history of allergies. A new study says that furry pets may actually help protect children against some allergies.

The infants’ mothers had a history of allergy, so the babies were at increased risk too, and it was once thought that pets might be a trigger for allergies in such children, the authors point out in the Journal of Allergy and Clinical Immunology.

“Earlier it was thought that exposure to pets early in childhood was a risk factor for developing allergic disease,” said Dr. Merja Nermes of the University of Turku in Finland, who coauthored the research letter. “Later epidemiologic studies have given contradictory results and even suggested that early exposure to pets may be protective against allergies, though the mechanisms of this protective effect have remained elusive.”

Adding pet microbes to the infant intestinal biome may strengthen the immune system, she told Reuters Health by email.

The study team collected fecal samples from diapers when the babies were one month of age and these were tested for the DNA of two types of Bifidobacteria that are found specifically in animal guts: B. thermophilum and B. pseudolongum.

One third of infants from the pet-exposed group had animal-specific bifidobacteria in their fecal samples, compared to 14 percent of the comparison group. It’s not clear where the infants without furry pets at home acquired their gut bacteria, the authors write.

When the babies were six months old they had skin prick tests to assess allergies to cow’s milk, egg white, flours, cod, soybeans, birch, grasses, cat, dog, potato, banana and other allergens.

At six months of age, 19 infants had reactions to at least one of the allergens tested. None of these infants had B. thermophilum bacteria in their fecal samples.

Other studies have pointed out the connection between kids exposed to farm animals and household pets and building a better immune system.

“When infants and furry pets live in a close contact in the same household, transfer of microbiota between pets and infants occurs,” Nermes said. “For example, when a dog licks the infant´s face or hand, the pet-derived microbiota can end up via the mouth into the infant´s intestine.”

Human-specific Bifidobacteria have beneficial health effects, and animal-specific strains may also be beneficial, she said. It is still unclear, however, if exposure to these bacteria protects against allergies later in life, she said.

“Future research is needed to assess if these infants develop less atopic dermatitis, asthma or allergic rhinitis later,” she said.

Nermes also noted that she believes pediatricians should not discourage pregnant women or parents of infants from having pets in order to prevent allergies.

“If a family with a pregnant mother or an infant wants to have a pet, the family can be encouraged to have one, because the development of allergic disease cannot be prevented by avoiding pets,” she said.

Source: Kathryn Doyle, http://www.reuters.com/article/2015/09/10/us-health-allergy-pet-microbes-idUSKCN0RA2CK20150910

 

 

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