Top changes in pediatrics every parent should know: 2011

 

There is a saying we heard in medical school, “Half of what you learn now will change in ten years… you just don’t know which half.” In pediatrics, where we specialize in change, the saying certainly holds true.  We ring in the New Year by picking the top 2011 changes in pediatrics all parents should be aware of:

 

Car seats– keep children rear facing in car seats until two years old (or until they physically cannot fit rear-facing any more) and keep your child in a booster seat until a seat belt fits properly– across his chest and not his neck, and low on the waist across the hip bones, not across his belly. Sitting in the back seat is the safest spot for those 12 years and under.  For more information check out our post Buckle up: the latest in car seat safety.

 

Meningitis Vaccine– A booster dose for older teens is now recommended for the vaccine against the germ Neisserria meningitidis in addition to the dose routinely given to tweens.
 

Flu vaccine– Having an egg allergy is no longer an absolute contraindication to getting the flu vaccine. Turns out there is so little egg in the vaccine, most kids with egg allergies can safely receive the injectable form, though they still should not receive the spray-up-the-nose form. Ask your child’s pediatrician or allergist if your egg-allergic child is a candidate.

 

Bye-bye food pyramid– The difficult to understand food pyramid finally bit the dust and is replaced by My Plate .

 

SIDS prevention and safe sleep– keep soft bedding away from baby’s face- no crib bumpers! And continue to place your baby on his back to sleep. AAP Expands Guidelines for Infant Sleep Safety and SIDS Risk Reduction and Sleep Safety: How to decrease your baby’s risk of Sudden Infant Death Syndrome (SIDS)

 

An old recommendation gets reinforced: in 2011, Dr Wakefield’s paper suggesting a link between the Measles, Mumps and Rubella (MMR) vaccine and autism is reaffirmed as fraudulent. MMR vaccine schedule does not change.

 

Genital Wart and cancer from HPV prevention in males– HPV vaccine is now not only approved for boys, but recommended for boys, as well as girls, by the ACIP (vaccine branch of the CDC). With over 35 million people having received this vaccine, evidence supporting its safety has become well established.

 

All liquid acetaminophen products (Tylenol) are now the same strength. Watch out if you have the old formulation in your medicine cabinet, double check the dosing.

 

Changes in when and how to start solids foods: For about the last fifteen years, pediatricians advised delaying the start of solid foods and the start of commonly allergenic foods such as eggs or wheat to prevent food allergies. Unfortunately, food allergies have risen during this time. Current advice is back to the old advice. According to the National Institute of Allergy and Infectious Diseases sponsored guidelines (November 2011 Pediatrics), solid foods should be introduced by 4-6 months of age and any potentially allergenic foods may be introduced at this time as well.

 

We look forward to more advances in pediatrics for 2012. Please keep reading and tell parents about us.

 

Best wishes for a healthy New Year.

 

Your Two Peds,

Naline Lai, MD and Julie Kardos, MD

©2011 Two Peds in a Pod®

 

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December 29, 2011 by

Managing Moolah

 

As a new year rolls around and our pockets start to feel empty after the holidays, we look back at an older post for ways to penny-pinch without short-changing your kids: Save money: How to penny pinch without hurting your children. And whether your children receive gift cards, gelt, or cash gifts this season, we direct you to the popular post  Teaching kids money smarts for ideas on how to help them manage their new stash. 

 

Best wishes from your Two Peds,

 

Drs. Kardos and Lai
©2011 Two Peds in a Pod®

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December 22, 2011 by

Spotted on the horizon: Roseola

Your toddler wakes from his afternoon nap a tad grumpy and with flushed cheeks. You grab your thermometer and see that his temperature is… 104F! But, because you have read our prior posts about fever Part 1 and Part 2, you do not panic. He has no cough, no runny nose, no vomiting, no diarrhea, no rash. He is fully immunized. In fact, considering how well he was acting before his nap, you are very surprised to find fever. You give him Tylenol and and hour later he becomes a happy toddler. This pattern continues for three days. He has fever, but no new symptoms, and he continues to run about energetically.  On the fourth day, the  fever breaks. A rash pops up, and your pediatrician diagnoses your child with roseola.

A viral illness seen in kids typically between six months and two years of age, roseola usually runs a course similar to your toddler’s illness and requires no specific treatment.  Many kids remain relatively cheerful despite the fever, and those who become fretful regain their good moods after a fever reducer medication such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) is administered. The associated light-pink rash may cover a child from head to toe as seen in our photo. The rash does not itch or hurt. Once the rash appears, the child is no longer contagious. If you press on the rash and lift up, the redness will momentarily turn white (blanches). It lasts for hours to a few days, and then fades. Up to 50% of affected kids never even get the rash. 

My twins had roseola at age 18 months. I remember one had fever for three days, the other had fever for two days, and both acted quite well despite their high temperatures. I kept waiting for more symptoms, dreading what I thought would turn out to be twin colds or worse, twin stomach viruses (double diarrhea really stinks), but no other symptoms emerged. When one broke out in a rash, I remember thinking “Oh finally, I know what you both have… roseola.” My other twin never did get the rash.  Thus, I suppose my family shows that 50% of affected kids really don’t get the rash.

What else causes fever for a few days and no other symptoms in a young child? In girls and uncircumcised boys, we mainly worry fever alone can be the sole sign of a urinary tract infection. 

In general, if your child seems especially ill, refuses to drink, becomes difficult to console, has any new rash WITH FEVER, or has fever alone for MORE than a few days, then you should call your child’s doctor. For more information on when to call your child’s physician, please see our “How sick is sick” post.

Now that you’ve learned about the symptoms, if you recognize Roseola, you’ll be “spot on”.

Julie Kardos, MD with Naline Lai, MD

©2011 Two Peds in a Pod®

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December 15, 2011 by

Food For Thought with Janet Zappala


Join Two Peds in a Pod as we chat with Janet Zappala, certified nutritional consultant/Emmy award winning television host, on her new internet radio show Food For Thought on Tuesday, Dec. 6th, at 2pm Pacific Time, 5 p.m. EST.  We’ll have useful parenting tips and holiday nutrition suggestions for getting your kids to eat better. Log in to listen live  www.voiceamerica.com

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December 6, 2011 by

Newborn eyes: blocked tear ducts, crossed-eyes, vision, and eye color



newborn eyes: a blocked tear duct

This post was inspired by a newborn whose mom asked me about his eyes. “Here’s looking at you, kid!”

What is this goop in my baby’s eye?

Blocked tear ducts: About 25 percent of infants, by the second or third week of life, develop some slightly yellow or clear eye discharge from one or both eyes.  The discharge looks worse when the infants first awaken. At this age, they start to produce some tears (although they do not “cry tears” until closer to three months old). But because newborn tear ducts, the drainage system for tears, are not completely open, tears either spill over, causing a watery discharge, or accumulate in the eyes during sleep and become slightly thicker “goop” that wipes away easily.

Babies with blocked tear ducts have normal appearing sclera (the whites of the eyes) and normal vision. Blocked tear ducts are not painful. Fortunately, the tear ducts open up spontaneously in most babies without intervention. This process, which is usually complete by three month of age, can take up to one year of age. An infection in the eye causes a baby’s eye to become painful, red on the inside, and sensitive to light. The discharge becomes pus-like and increases in amount. If you are not sure if your baby’s eye discharge is from an infection or a blocked duct, consult your pediatrician.

Why do my baby’s eyes cross?

Young infants’ eyes may cross as they gaze at an object. This crossing is a result of an immature nervous system. By three to four months of age, a baby’s eyes should always move in concert when she gazes or follows an object with her eyes. If your baby’s eyes cross after this age, alert your child’s pediatrician, who will likely refer your baby for an exam by an ophthalmologist who is comfortable examining babies. It is important to make sure the eyes are both seeing equally and adequately, as well as to make sure the eye muscles work properly. See our previous post on crossed-eyes.

What is normal vision for a newborn?

Babies are born nearsighted. They see clearly the distance to a face when being held. Some newborns will stick out their tongues in response to seeing their parents do the same. So, be sure to look at your infant when you are feeding or rocking her. Far vision develops gradually over months to years. A child’s vision is not 20/20 until about five-years old.

When will my baby’s eyes change color?

The color of a baby’s eyes generally becomes established during the first year. Some stay the same color from birth. My own children were all born with either blue or grey eyes but now all are brown, much to the delight of their blue-eyed grandmother. My oldest was nine months before his eyes turned brown. Some of my patients did not develop their permanent eye color until two years.

Here a few more eye facts: The part of the eye with color is called the iris.  The hole in the center of the iris is called the pupil. Pupils should always look black. In a photograph they can look red from a flash. However, if you ever see white, yellow, or grey reflected in the pupils, alert your baby’s doctor.

Julie Kardos, MD and Naline Lai, MD
©2011 Two Peds in a Pod®

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December 3, 2011 by

We give thanks for parental sanity savers



We give thanks for the opportunity to parent our children always. With the many challenges of raising children, this Thanksgiving we give thanks for things that save our sanity. We heave a huge sigh of relief for:



carpools
the neighbor who will meet your child at the bus stop when you are running late
double strollers
pizza
ability to Skype with your teen the first time he is way from home


those folding sports chairs you lug along to all of your children’s sports games
pacifiers


training wheels


Elmo


ketchup


Band aids—a sure cure-all


a same day laundry machine repair person


 


Happy Thanksgiving from your two Peds,


Naline Lai, MD and Julie Kardos, MD


 


©2011 Two Peds in a Pod®

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November 20, 2011 by

What you need to know about Whooping Cough

 

whooping coughPertussis is “whooping cough,” also known as the “100 day cough.” In children and adults, the disease starts out looking like a garden-variety cold, complete with runny nose, runny eyes, and mild cough. Sometimes fever is present, sometimes not. However, after a few days, coughing spasms emerge – severe, persistent coughing spasms that go on and on and on.  In between coughing fits, children may appear okay. 

There is no treatment except to “ride it out” and the cough can last up to three months. Doctors prescribe antibiotics to a child with pertussis because  antibiotics can decrease how much a person with whooping cough will spread it to others. Close contacts of kids with pertussis may also receive antibiotics to reduce their chance of getting pertussis.  

Whooping cough gets its name from the “whoop” noise kids make after a coughing fit. The fits leave them so breathless that it’s difficult to take a breath in again after the coughing spell. To hear the “whoop” with coughing fit, visit www.whoopingcough.net.

Teens and adults with whooping cough don’t tend to make the whoop sound because their airways are bigger, but the coughing spasms can leave them feeling like they might throw up or pass out. Some in fact do end a coughing fit with vomiting or fainting.

Babies don’t make the whoop either. Instead, babies with pertussis simply cannot catch their breath and stop breathing. That is why babies are the ones who tend to die from this illness. Dr. Lai and I both have watched over hospitalized infants blue from pertussis.

Thankfully, we have a vaccine that is effective at preventing pertussis. The “P” in pertussis is the “P” in the DtaP vaccine that children receive as babies, usually at two, four, and six months of age. The DtaP vaccine is then next given after the first birthday, another between ages four and six years old, and another at age eleven years. Teens who have not received the pertussis vaccine since they were in preschool, and adults who care for infants also should also get the vaccine. For more specific up-to-date recommendations: www.vaccineinformation.org/pertuss/.

As we enter the season for catching snowflakes and coughs, we hope none of your children catch whooping cough.

Julie Kardos, MD with Naline Lai, MD
©2011 Two Peds in a Pod®

revised Nov 16, 2011 to reflect the indications for antibiotic prophylaxis

 

 

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November 16, 2011 by

Not cute as a button: Babes and button batteries

In a couple of weeks my 16 month old nephew will visit my non-baby proofed house. Chances are, he will find things in my house to chew on besides turkey. The first items I am hiding are the devices which contain the tiny round batteries called button batteries. Below, Kristen Casavale of The Battery Controlled reminds us about the hidden hazards of button batteries.

Electronic devices are a part of daily life. And they’re getting smaller, slimmer and sleeker. But inside the battery compartment of mini remote controls, small calculators, watches, key fobs, flameless candles, singing greeting cards, and other electronics, is a very powerful coin-sized button battery. When swallowed, these batteries can get stuck in the throat and food pipe, causing severe burns in as few as two hours.

“Our trauma surgeon told us that they see 10 ingestions a month. Unfortunately, I didn’t really think twice about Emmett playing with the remote control,” said Karla Rausch, mom of son Emmett, age two.

Small children often have easy access to these devices; parents often don’t know about the risk, and little ones can’t always communicate with adults. Grown-ups may be unaware of an ingestion until the battery starts to erode through a child’s food pipe. The Battery Controlled is a partnership to raise awareness about the severity of the issue and share information with parents, caregivers and the medical community. Launched by Energizer and Safe Kids USA, this effort is committed to helping parents prevent children from swallowing coin-sized button batteries.

Teaching points for parents:

1. Keep out of reach. Devices with coin lithium “button” batteries have no place in unsupervised hands or toy boxes.
2. Get help fast. Life-threatening damage can happen in as few as 2 hours.
3. Tell others.

We, and my nephew, thank Kristen for her safety alert.

Naline Lai, MD and Julie Kardos, MD
©2011 Two Peds in a Pod®

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November 10, 2011 by

Those stinky kitchen sponges: how germy are they?

Dr. Lai and her husband had a running debate about when to replace kitchen sponges. Today we thank guest blogger Dr. Karina Martino, Food Safety Engineer, for exposing the germs in our kitchens. We certainly learned a lot, and Dr. Lai’s husband lost a bet.
Naline Lai, MD and Julie Kardos, MD

WHO’S THE WORST OFFENDER IN THE KITCHEN???

The winner is…….the kitchen sponge (and dishcloth)! The next worst offender is your kitchen sink. This is where vegetarians have a definite advantage since they don’t bring raw meat into their homes. There’s less chance of E. coli and Salmonella spreading, but vegetarians still have to be on the lookout for viruses and parasites. 

What are the kitchen’s hot germ zones?

In descending order by highest bacterial count, these are:

1. Sponges and dishcloths

2. Sink drain area

3. Faucet handles

4. Cutting boards

5. Refrigerator handles

Here are simple steps that you can follow to create a healthier kitchen environment:

Dip sponges after every use in dilute sanitizer water (1 teaspoon bleach per quart of water); boil them for 3 minutes on a weekly basis.

• Change dish cloths daily, especially after wiping up raw meat juices.

• Wash sinks with hot soapy water prior to food preparation and before washing dishes.

• Wipe down refrigerator handles daily with dilute sanitizer water.

• Choose non-porous cutting boards that are easy to clean.

• Avoid rinsing raw meats. It contaminates the sink. If you cook meat at the correct temperature for enough time, bacteria on raw meat will be killed.

When we are handling food products everything in the kitchen must be clean, especially ourselves. It is vital to wash our hands with soap and hot water for at least 20 seconds before han­dling any food product. Each time you re-enter the kitchen from outdoors or any other place in the house where you might have contaminated your hands, you should wash your hands again.

Clean clothing, including aprons, is also an important part of personal hygiene. Dirty clothes and dish towels are a good place for bacteria to hide and grow. Sneezing and coughing spreads germs from our lungs, throats, and noses. When handling food, we must control the spread of germs from these natural occurrences by covering our mouths with dispos­able tissues and then rewashing our hands.  

While the Centers for Disease Control (CDC) provides information about illness from food in homes, it does not yet offer statistics about how many people become ill from their kitchen sponges. However, here are some facts for you to keep in mind:

• The kitchen environment can be more heavily contaminated with fecal bacteria (those bacterial species associated with feces) than the bathroom, suggesting that the risk of spreading infection in the home may be highest in the kitchen-the area in the home where food is prepared.

• Microbiological surveys of domestic kitchens have found significant contamination from a variety of bacterial contaminants, including E. coli, Campylobacter, and Salmonella.

• Pathogenic organisms (germs that cause disease) have been shown to be introduced in the home by people, food, water, pets and insects.

• The domestic kitchen is not used only for food preparation, but may serve as a laundry, a workroom, and a living area for family pets. Each of these functions can serve to introduce bacterial contamination into the kitchen environment.

Moreover, research focusing specifically on the kitchen environment has found:

 

• 67% of kitchen sponges may be contaminated with fecal bacteria

• Contaminated cloth towels serve to transfer bacteria to dishes during drying

• 82% of sink faucet handles are contaminated during food preparation

• 60% of people do not wash the cutting board after cutting raw meat or poultry and before cutting fresh vegetables for salads

• 9% do not wash the work surface at all after cutting raw chicken

So, please don’t duplicate these mistakes! The next time that you get ready to do your dishes with your six-month-old sponge… think again!… either toss it or get your Clorox immediately!

Karina G. Martino, PhD

 

Dr. Martino received her Masters degree and her PhD in Food Safety Engineering from Michigan State University. A former professor at University of Georgia, she now has her own consulting business (www.kgminnovations.com) and is the mom of two children. 

©2011 Two Peds in a Pod®

 

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November 2, 2011 by