My Blog

Posts for: January, 2017

By contactus@priority-pediatrics.com
January 30, 2017
Category: Sleep

I recently had an opportunity to help a mother whose happy, healthy six-month old changed from a baby who awoke every 3-4 hours through the night for a nursing to a baby who wakes up hourly through the night, crying, requiring parental soothing and suckling even when not hungry. What to do? What to do!

My first suggestion is The Period of Purple Crying, http://www.purplecrying.info/sleeping.php, authored by Dr. Ronald G. Barr, MA, MDCM, FRCP(C).

Of special noted is Dr. Barr's Information for Dad's.

Dr. Barr and I share some history and as a result a common approach to many issues. Dr. Barr was a Fellow in Ambulatory Pediatrics at Boston's Children's Hospital Medical Center when I was Chief Resident in Ambulatory Pediatrics at the same hospital. I highly recommend your reading The Period of Purple Crying if your infant is troubled with bouts of crying or interrupted sleep overnight.

He makes these basic points:

 

  • There is nothing physically wrong with most infants who wake and signal parents in the night;
  • Except for continued sleeping problems, most infants who wake and signal in the night are normal in their long-term development.

He advises:

  • Quiet a baby thought to be sleepy in a crib or similar place, and avoid feeding or cuddling the baby to sleep at night-time.
  • Reduce light and social interaction at night, but make social interactions enjoyable in the day-time.
  • Once the baby is healthy, putting on weight and developing normally, begin to delay feeding for a few moments when the baby wakes at night. The short delay means that waking is not immediately rewarded by feeding. This is done gradually, using handling or diaper changing to add a short delay, but this does not involve leaving the baby to cry for a long time.

He notes two important principles of soothing crying:

  1. Some soothing behaviors work some of the time, but nothing works all of the time;
  2. Soothing can work preventively if the soothing activities are applied when the infant is not crying rather than just in response to crying.

Secondly, there are many books on troubled sleep and crying infants. This one, The Happiest Baby on the Block, by Dr. Harvey Karp is highly recommended.

Thirdly, I recommend Laura Swartz's website www.healthyhappysleep.com or her Facebook page, Healthy Happy Sleep, as a good source of basic information and sound principles.

And to help keep some sense of humor about this common area of parent sleep deprivation, I recommend that you view the episode "The Conversation" from the TV sitcom, "Mad About You" starring Helen Hunt and Paul Reiser on YouTube, You will laugh in empathy at this episode.

 

Lastly, many parents can be very creative as to how they exit the bedroom of their sleeping infant so as not wake the little sleeping "nitro-glycerin" crier: https://youtu.be/3qrrcjoJdBQ.

 

Dr. T


By contactus@priority-pediatrics.com
January 29, 2017
Category: Immunizations

Are Kids Getting Too Many Vaccines?

Political leaders and parents have expressed concerns that young children are getting too many vaccines, often for diseases that aren’t raging anymore.

01.29.17 12:01 AM ET from the daily beast

During the run up to the presidential election, several candidates expressed their concerns about vaccines.

Donald Trump, a businessman, said that the vaccine schedule was “meant for a horse, not for a child,” and that children should receive “smaller doses over a longer period of time.” Ben Carson, a pediatric neurosurgeon, said that while some vaccines “prevent death or crippling, others don’t fit that category. And there should be some discretion in those cases.” Chris Christie, governor of New Jersey, said, “not every vaccine is created equal, and not every disease type is as great a public-health threat as others.” And Rand Paul, a Kentucky Senator and ophthalmologist, said that “most” vaccines should be voluntary.

None of the candidates provided a list of the diseases that they were willing to grandfather in and all were criticized for their remarks. Nonetheless, each expressed a common fear among parents; specifically, that the vaccine schedule has become so intricate and burdensome that it’s starting to read like the tax code. Implicit in these politicians’ comments were three common concerns:

Children receive too many vaccines. One hundred years ago, children received a vaccine to prevent one disease—smallpox. This meant that children received only one inoculation in the first few years of life. Today children receive vaccines to prevent 14 different diseases; now they can receive as many as 26 inoculations early in life and 5 at one time. And while it is difficult to watch children receive so many injections, most parents would probably be surprised to learn that the immunological challenges from today’s 14 vaccines are less than the challenge from that one vaccine given a hundred years ago.

Smallpox is the largest of the mammalian viruses. As a consequence, the smallpox vaccine contained about 200 viral proteins. The number of viral proteins, bacterial proteins, and bacterial polysaccharides (complex sugars on the surface of bacteria) contained in the 14 vaccines given today adds up to about 150. Total. In other words, with advances in protein chemistry, protein purification, and recombinant DNA technology, vaccines contain fewer immunological components today than a century ago.

Children are too young to be vaccinated. In the womb, babies live in a sterile environment. When they enter the birth canal and the world, however, they are bombarded with bacteria. People have about 100 trillion bacteria living on their skin as well as on the lining of their nose, throat, and intestines. Each of these bacteria contain between 2,000 and 6,000 immunological components—to which children make an immune response. If they didn’t, these bacteria could enter their bloodstream and cause harm. Indeed, children born without an immune system (called Severe Combined Immunodeficiency) often suffer sepsis caused by these bacteria. The food we eat isn’t sterile. The water we drink isn’t sterile. The dust we inhale isn’t sterile. In response, we make large quantities of immunoglobulins every day to prevent these colonizing bacteria from causing harm. Vaccines are a drop in the ocean of what children encounter and manage every day.

The reason that children are immunized early in life is to protect them against diseases that occur early in life. Fortunately, babies mount an excellent immune response from the moment they are born—given the challenges that they face, they would have to. The proof that young children can respond to these vaccines is evidenced by the fact that many of the diseases that commonly crippled or killed young children have been virtually eliminated.Which brings us to the next concern.

Not all vaccines are necessary. Viruses and bacteria like measles, mumps, pneumococcus, chickenpox, hepatitis A, hepatitis B, influenza, rotavirus, tetanus, and whooping cough are still common enough that a choice not to get a vaccine is a choice to risk getting those diseases. Some vaccine-preventable diseases, however, are extremely rare. Rubella, diphtheria, Haemophilus influenzae type b (Hib), and polio have either been completely or virtually eliminated from the United States. So why are we still giving vaccines to prevent them?

Take polio, for example. Polio was eliminated from the United States in 1979 and from the Western hemisphere in 1991. But polio still exists in the world; the virus continues to circulate in Pakistan, Afghanistan, and Nigeria. And, because international travel is common, cases of polio still occasionally pop up in other countries. It is likely that people who have been exposed to poliovirus travel to the United States. And because only 1 of every 200 people infected with polio has symptoms, it’s hard to know who is infected and potentially contagious. Poliovirus hasn’t spread in our country because immunization rates are high. If immunization rates drop, however, polio will be back. Which is exactly what happened in an undervaccinated Amish community in Minnesota in 2005 when five children came down with polio.5Or in an Amish community in Pennsylvania in 2001 when six children suffered meningitis caused by Hib.6 Or in states newly independent of the Soviet Union between 1990 and 1994 when 50,000 people, mostly children, were infected with diphtheria.7 Let your guard down, and these diseases will come back. So until these diseases have, like smallpox, been wiped off the face of the earth, it’s still important to shield against them. 

Despite claims by Carson, Christie, and Paul, every one of these vaccine-preventable diseases can cause permanent harm or death. So, choosing one vaccine over another wouldn’t be a reasonable choice; it would be an untenable choice—a Sophie’s Choice.

Paul A. Offit, MD is a professor of pediatrics and director of the Vaccine Education Center at the Children’s Hospital of Philadelphia. He is the author of Pandora’s Lab: Seven Stories of Science Gone Wrong (National Geographic Press, April 2017).

***

Bold, Underlined and/or in Red as per Dr. T, not Dr. Offit


By contactus@priority-pediatrics.com
January 29, 2017
Category: Safety

Head for the Hills With Sled Safety in Mind

Kids at higher risk for head and neck injuries while sledding, safety experts warn
 
By Mary Elizabeth Dallas at HealthDay News
Friday, January 13, 2017
HealthDay news image

FRIDAY, Jan. 13, 2017 (HealthDay News) -- When temperatures drop and snow falls, children are ready to reach for their hats, scarves -- and sleds.

Sledding and snow tubing are among the fun winter activities that families can enjoy together. But, there are steps parents should take to ensure their kids remain injury-free, the National Safety Council cautions.

Children can get hurt if their sled hits a stationary object, such as a rock or a tree. Falling off a sled can also result in injuries, including bruises, cuts and broken bones. Children younger than 6 years old are at particularly high risk for head and neck injuries, the council warned.

When choosing sleds, pick those that can be steered. These models are safer than flat sheets, snow discs and toboggans that don't provide kids with control over their direction, the council said.

Parents should make sure their children are dressed warmly before they head out into the snow. While sledding, kids should not only wear gloves and boots but also a helmet to help prevent head injuries. Children shouldn't sled alone. An adult should always be present to supervise and help when necessary, the council advised.

Parents should also teach kids about sledding safety. The council provided the following tips:

  • Only sled in areas that are clear of trees and other obstacles, such as fences, light poles and rocks.
  • Teach children how to stop and turn their sled with their feet.
  • Don't overload a sled. Only the recommended number of passengers should ride at one time.
  • Never sled in the street.
  • Never ride a sled that's being pulled by a car, ATV, snowmobile or other motorized vehicle.
  • Avoid sledding on hills that drop off into a street, parking lot or body of water.
  • Tubes are safest when used at tubing parks, often found at ski resorts.

SOURCE: National Safety Council


By contactus@priority-pediatrics.com
January 29, 2017
Category: Motherhood

From Familydoctor.org

Whether you’re actively planning to become pregnant or not thinking about it quite yet, preconception care during your childbearing years is essential. One reason is because about half of all pregnancies in this country are unplanned. And unplanned pregnancies are at higher risk for preterm birth and low-birth weight babies.

And besides, anyone can benefit from preconception care. Essentially, it means taking good care of your body and mind during the period when you can have a child. And healthy living is good for everyone.

If you’re trying to have a baby or just have an inkling you might want to in the near future, here are some of the things you should focus on.

Path to improved well being

Whether this is your first, second, or sixth baby, the following are important steps to help you get ready for the healthiest pregnancy possible.

Up your folic acid. Folic acid is a B vitamin that our bodies use to make new cells. Folic acid is especially important during times when the cells are dividing and growing rapidly, such as during pregnancy. Getting adequate folic acid can help prevent two common and very serious neural tube defects (NTDs): spina bifida and anencephaly. Both occur very early in pregnancy (as early as 3 to 4 weeks after conception), which is before many women even know they’re pregnant.

  • Anencephaly is when a baby is born without the front part of the brain (forebrain) and the thinking and coordinating part of the brain (cerebrum). The remaining parts of the brain are often not covered by bone or skin.
  • Spina bifida can happen anywhere along the spine if the backbone that protects the spinal cord does not form and close properly. This often results in damage to the spinal cord and nerves. Spina bifida might cause physical and intellectual disabilities that range from mild to severe.

The U.S. Public Health Service and Centers for Disease Control and Prevention recommend that all women of childbearing age (between 15 and 45 years of age) consume 0.4 mg (400 micrograms) of folic acid every day.

Schedule a preconception checkup. It’s important to get any chronic conditions under control before you become pregnant. Identifying them now can help up your chances of having a healthy pregnancy for both you and your baby. Your visit should include discussions of:

  • Your medical and family history. If you have certain conditions, such as diabetes, hypertension, asthma, seizure disorders, or maternal phenylketonuria, you’ll need to learn how to manage them during your pregnancy.
  • Any vaccines or boosters you may need. Some vaccines can be given during pregnancy, but the rubella (German measles) and varicella (chicken pox) vaccines should be given before you get pregnant.
  • All over-the-counter and prescription medicines you take, including dietary or herbal supplements. Certain medications can cause serious birth defects, so be sure to mention everything you’re taking.

Stop smoking and drinking alcohol. Both can increase the risk for preterm birth, NTDs, fetal alcohol spectrum disorders, and sudden infant death syndrome (SIDS). If you need help to stop, speak to your healthcare provider about what types of supports are in your area. You can also call 1-800-QUIT-NOW to be connected to your state’s “quitline.” For help with drug abuse, 1-800-662-HELP (4357) provides referrals to local treatment facilities, support groups, and community-based organizations. Having supports in place will increase your chances of quitting successfully.

Get to a healthy weight. Being overweight can make it more difficult to conceive. It also increases your risk of certain issues during pregnancy, including high blood pressure, gestational diabetes, having a stillbirth, and increasing the chances of needing a cesarean delivery. Shedding the weight before becoming pregnant can help improve your chances of conceiving and delivering a healthy baby.

The Centers for Disease Control and Prevention’s adult body mass index (BMI) calculator can help you determine your BMI and figure out whether you’re in the healthy range. If not, speak to your healthcare provider about the best way to achieve your weight loss goals.

Stay away from certain fish. Some fish, including swordfish, tilefish, king mackerel, and shark, contain a metal called methylmercury. Exposure to this metal can be harmful to a developing fetus. If you regularly eat these fish, methylmercury can build up in your bloodstream. Since it may take awhile to drop to a safe level, stay away from these four fish while you’re thinking of getting pregnant.

Other cooked fish and seafood are fine as long as you eat a variety of different kinds of fish. Choose up to 12 ounces (2 average meals) a week of an assortment of fish and shellfish that are lower in methylmercury. These include shrimp, canned light tuna, salmon, pollock, and catfish. Keep in mind, albacore (“white”) tuna has more methylmercury than canned “light” tuna. So, when choosing your 2 meals, you may eat up to 6 ounces of albacore tuna per week.

Things to consider

Genetic counseling may be something you want to think about if certain conditions run in your family or your partner’s family. You will also want to know if a member of your family was born with a genetic condition, birth defect, chromosomal disorder, or cancer. Other reasons to see a genetic counselor include having had trouble getting pregnant, experiencing several miscarriages, infant deaths, or a birth defect with a previous pregnancy. Or if you or your partner are over age 35.

A genetic counselor can meet with you to discuss potential genetic risks. At your appointment, you’ll discuss your medical, family, and pregnancy history. The counselor will explain what genetic conditions your future children may be at risk for depending on your history, and recommend tests that can help diagnose any conditions. Once you gather all the information, you and your partner can make an informed decision about whether or not genetic testing is warranted.

Questions for your doctor

  • What kinds of vitamins should I take that include enough folic acid?
  • Are there any foods I should not be eating while trying to get pregnant?
  • Are there any activities I should not be doing while trying to get pregnant?
  • Could any of my current health conditions affect my pregnancy?
  • Could any of my past history (STDs, miscarriages, abortions) affect my future pregnancy?
  • When should I stop using birth control?

Resources

Centers for Disease Control and Prevention, BMI Calculator


By contactus@priority-pediatrics.com
January 29, 2017
Tags: repellents   ticks   travel   vacation   Lyme Disease   DEET  

Ticks Carrying Lyme Disease Confirmed in Eastern National Parks

U.S. National Park Service and CDC advise using insect repellents on clothes and skin by Randy Dotinga Tuesday, January 17, 2017.

(HealthDay News) ‑‑ Planning a hiking trip in an eastern U.S. national park? Better pack tick repellent ‑‑ a new study found these parks are home to ticks that carry Lyme disease. Blacklegged ticks ‑‑ also known as deer ticks ‑‑ carrying Lyme disease were found in nine national parks: Acadia National Park in Maine; Catoctin Mountain Park and Monocacy National Battlefield in Maryland; Fire Island National Seashore in Long Island, N.Y.; Gettysburg National Military Park in Pennsylvania; Rock Creek Park in Washington, D.C., and Manassas National Battlefield Park, Prince William Forest Park and Shenandoah National Park in Virginia.

This is the first time researchers have confirmed that the ticks are living at the parks, although it's long been suspected that the ticks were there because of human Lyme disease infections. "We know Lyme disease is increasing both in numbers of infections and in geographic range in the United States," said researcher Tammi Johnson in a news National Institutes of Health / U.S. National Library of Medicine release from the Entomological Society of America. Johnson is with the U.S. Centers for Disease Control and Prevention. "This is the first large‑scale survey in multiple national parks, and though suspected, it had not been previously confirmed that ticks in many of these parks were infected. It's quite likely that ticks infected with Lyme disease spirochetes are present in other parks in Lyme disease endemic areas, too," she explained.

Lyme disease symptoms include fever, headache and rash. Left untreated, the infection can spread to the heart, joints and nervous system, according to the CDC. Visitors to the parks can reduce their risk of infection by following these guidelines, according to the U.S. National Park Service and the CDC: Use insect repellents that contain 20‑30 percent DEET. Apply them to exposed skin and clothing. You can use permethrin‑containing products on clothing as well. Don't sit or lean on logs when you're out on the trail. Check yourself for ticks ‑‑ and check pets and gear. Remove any ticks you find attached.

Once you leave an area that's home to ticks, shower within two hours. This will help rid your body of ticks. To kill ticks on your clothing, put your clothes in a dryer and heat them on high setting for 10 minutes.

"The results of this study serve as a reminder that while enjoying the parks, visitors can and should take steps to help protect themselves and their loved ones from tick and other bites," Johnson said. The study findings were published in the Journal of Medical Entomology. SOURCE: Entomological Society of America, news release, Jan. 3, 2017