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Daily Dose

Mumps Outbreak!

1:30 to read

The latest infectious disease outbreak is in the Boston area where several colleges have reported cases of mumps. Mumps is a viral illness that causes swelling of the salivary glands as well as other symptoms of fever, fatigue, muscle aches and headache.    Harvard University has been hit the hardest and has now documented over 40 cases this spring.  Boston is a city with numerous colleges all in close proximity, and there are documented mumps cases at Boston University, University of Massachusetts  and Tufts as well.  These Boston area colleges are all in close proximity and are merely a walk, bike or train ride away from one another, so these students, while attending different universities may all co-mingle at parties and athletic events.

Mumps is spread via saliva (think kissing), or from sharing food, as well as via respiratory droplets being spread after coughing or sneezing. It may also be spread via contaminated surfaces that will harbor the virus. People may already be spreading the virus for  2 days before symptoms appear and may be contagious for up to 5 days after their salivary glands appear swollen….so in other words there is a long period of contagion where the virus may inadvertently be spread. It may also take up to 2-3 weeks after exposure before you come down with mumps.

All of the students who have come down with mumps had been vaccinated with the MMR vaccine (mumps, measles, rubella).  Unfortunately, the mumps vaccine is only about 88% effective in preventing the disease. Despite the fact that children get two doses of vaccine at the age of 1 and again at 4 or 5 years….there may be some waning of protection over time. This  may also contribute to the virus’s predilection for young adults in close quarters on college campuses. Something like the perfect infectious disease storm!

In the meantime there are some studies being undertaken to see if adolescents should receive a 3rd dose of the vaccine, but the results of the study are over a year away.

In the meantime, be alert for symptoms compatible with mumps and make sure to isolate yourself from others if you are sick.  Harvard is isolating all of the patients with mumps for 5 days….which could mean that some students might even miss commencement.  Doctors at Harvard and other schools with cases of mumps are still on the watch for more cases …stay tuned.

 

 

 

 

Daily Dose

Red Cheeks In Winter

1:15 to read

Why do children get red cheeks in winter?

It is the time of year for cold temperatures, low humidity and dry skin. It is funny, every year as the temperatures drop, I we start seeing these cute little babies and toddlers who have those bright red cheeks. I always say that they “look like British babies”.

Dry skin is just one of the many issues we see with colder temperatures, and babies red cheeks are one of the most evident. During the winter months we all experience dry skin and using moisturizer becomes very important.

I have written previous blogs about eczema, and while chapped skin is not synonymous with eczema, there are some similarities. The most important thing to prevent dry skin while the weather is cold is to use a moisturizer, and applying moisturizer is best on damp skin. After bathing your baby or child, pat them dry until they are just “a tad bit moist” and then take a moisturizer and apply it to the almost dry skin. The thicker the moisturizer the better, so a cream is preferable to a lotion. It will take a little more time to rub the cream in when the skin is a bit moist, but it will help the moisturizer penetrate the skin. The same thing goes for the face.

I always found that the best time for me to moisturize those rosy cheeks was really after the child had gone to sleep. When my children were younger I found that if I put the cream on when they were awake, that they either rubbed their faces more, or if they were verbal, complained about lotion on their faces. So…I decided that it worked best to have their bedtime routine, with baths, books, and prayers, and then once they were asleep I would slip in and lather up their faces and also even used Chap Stick on their dry little lips. Now, there is no science in this routine, but it seemed to work, and they were much more tolerant of lubricants when asleep than awake.

We are definitely in the low humidity season and the heat is on in the house (I am typing this as I sit by the fire with a blanket over my feet), so you can expect several months of dry skin and chapped cheeks. If moisturizers like Vanicream, Cerave, Aquaphor and Eucerin go on sale, stock up!!  April is a long way away.

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Daily Dose

Get Your Flu Shot!

1:30 to read

I just had my flu vaccine!  Guess what - my arm didn’t even hurt this year.  I have also been reminding all of the pregnant mothers that I see to get their flu vaccines as well.  The current recommendation is that pregnant women receive influenza vaccine as soon as possible beginning after their 28th week of pregnancy (3rd trimester). 

When a pregnant woman receives her flu vaccine she is not only protecting herself, but also her baby.  Infants cannot receive a flu vaccine until they are 6 months of age…and for babies born during the fall and winter season, that means they will not be vaccinated until the following year. But when a mother has received a flu vaccine the infant is also getting protection via antibody that the mother passes to her baby across the placenta. 

In a 2014 study, the authors reported that “immunization of pregnant women with trivalent inactivated influenza vaccine (IIV3) was safe, immunogenic, and partially protected the women with a vaccine efficacy of 50% and their infants with a vaccine efficacy of 49% against laboratory-confirmed influenza illness during a 6-month follow-up post delivery ”. In other words, the infants in the study had just as much protection as the mother.

In a more recent study the authors now looked at how long the immunity lasted in the infants born to the flu vaccinated mothers. Surprisingly, the immunity was not as long lived as had been thought. The infants involved in the study were born an average of 81 days after their mothers were vaccinated with flu vaccine, and were monitored for influenza infection for about 172 days after birth.

Infants born to mothers who had a longer interval between vaccination and delivery had higher antibody titers. The infants’ antibody levels did drop off after birth and by 8 weeks of age the babies did not have significant antibody. Ideally, In order for babies to have better protection a mother would be vaccinated even earlier in her pregnancy, and studies are being done to look at this possibility.

Infants are especially susceptible to influenza and have a higher rate of complications as well as hospitalizations.  While the current recommendations for vaccinating pregnant women may not confer as much immunity to the newborn as was previously thought , there is very high protection for the first 8 weeks after birth. Any protection is preferable to none!.

Get your flu vaccine and if you are pregnant ask your doctor to give it to you as soon as you are in your 28th week.  The longer the baby is getting placental antibody the better!!

 

 

 

 

 

Daily Dose

Teach Your Kids Good Manners

1.15 to read

Spring is always a busy time of year with end of school parties, proms, graduations, and lots of invitations.  These invitations are often sent not only to parents but many times they are sent to the kids as well. Some invitations have a reply card or say “please reply” or RSVP.   

Do your kids know what RSVP means?  Although it is French, surely everyone still knows it means “reply if you please”. Has RSVP been replaced by LOL and OMG? It is a common courtesy to respond to an invitation and one that all children need to learn (maybe some adults as well). 

Over the years I have had to explain this courtesy to my own children. Sometimes they just did not understand why I bugged them to reply in a timely matter.  After looking at the bulletin board where I would put check marks and dates by our response, I would often ask them if they had replied as well? This question was often answered with, “Not yet, trying to decide, or “ They know that I am coming ” or lastly “ I’ll do it later”.  Such answers did not seem to be exactly what I had hoped to hear. Of course, I couldn’t relent until we had closure on this issue and I knew that they had responded.  I was the bothersome mother after all!

For many years they seemed clueless as to head counts and party prep. I would re-iterate that by getting an idea of how many people are going to attend any event the hosts can make sure that there are enough seats for everyone coming, or enough food to eat and drinks for all. Otherwise, you either spend way too much over buying or end of scrounging as you didn’t plan on that many people. “Whatever”, right? 

Well, now that they are older, they were just complaining to me that they had not heard from guests for a party that they were planning. “How do I know how much food to order?”, “How do you rent tables and chairs if you don’t have a head count?”  “Why do people wait till the last minute to reply?”  “Didn’t their parents bug them about replying?”  And finally, music to my ears, “Mom you should write a blog about learning to reply to invitations”! 

So...here it is. Teach your kids (beginning at early ages) how to reply to a party. Have them pick up the phone to reply to the 5 year old birthday party, or learn to write an email response when they are accepting an invitation to attend an event. Teach them to reply in a timely manner, and if something does change, let the hosts know.  Lastly, I still don’t see any reply messages that say “text me if you are coming”, but I am sure that is just around the corner.  

Good manners are ageless and timeless.

Daily Dose

How to Treat Croup

1.15 to read

Now that the weather seems to change daily, croup season is here. Have you heard the sounds of raspy, throaty voices in your house lately? This "noise" is ushering in croup season! Croup is an infection that causes swelling of the larynx (vocal box) and trachea (windpipe) that in turn makes the airway just beneath the vocal cords become swollen and narrow. When you have swelling and narrowing of the airway breathing becomes more difficult and noisy and the sound that is made, almost like that of a seal barking, is called being “croupy”. Croup is quite common in young children, but the sound the emanates from that child when they cough, can be scary and concerning for both parent and child. Children are most likely to get croup between the ages of six months and three years. As a child gets older croup is not as common as the trachea gets larger with age and therefore the swelling does not cause as much compromise. When you awaken in the middle of the night to hear your child “barking” in the next room you need to know what to do. Most croup is caused by a common virus, so croup is not treated with antibiotics. The mainstay for the treatment of croup is try and calm you child, as they may be scared both from the tight feeling in their chest, as well as the sound that is made when they are breathing and coughing. The best treatment for croup seems to be taking your child into the bathroom and turning the shower on hot. Let the steam from the hot water fill the room and sit in there and read a book or two to your child. Typically within five to 10 minutes (before the hot water runs out) the moist hot air should help your child’s breathing. They may still have the barking, croupy cough, but they should be more comfortable and will not look like they are having trouble breathing. If the moist steam does not work, and it is a cool fall night, go outside. That is right, taking your “croupy” child from the moist heat in the bathroom, outside to cool night air may also help open their airways. If your child is showing signs of respiratory distress, with color change with coughing (turning blue while coughing, red is always good), is retracting (using their chest muscles between the ribs to help them breath), is grunting with each breath, or seems quite anxious and having trouble breathing you should call for emergency help. If a child is having real difficulty breathing they may be admitted to the hospital to have supplemental oxygen or breathing treatments. Steroids have also been helpful when used for the correct patient population. Steroids may be used in both an outpatient and inpatient setting. Steroids help to reduce inflammation in the trachea and the symptoms lessen over several days. Steroids used in a short burst are not harmful to your child, and are indicated in a child who may have mild respiratory distress due their croup symptoms. Your child may have symptoms of croup for several days, and for some reason they always seem to be worse at night. Put your child to bed with a cool mist humidifier in their room for the next several nights, this will also help to provide moisture to their airway. It is not uncommon for some children to seem more “prone to croup” and may get it recurrently all fall and winter. Have the humidifier handy and in working order! That’s your daily dose, we’ll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

White Patches on the Skin

1:30 to read

I saw a 10 year old patient last week for her routine physical. One of her mother’s concerns was that her daughter had “white patches” under both of her arms.  Once I examined her I told her mother that the “white patches” were actually due to Vitiligo, which is an acquired disorder of pigment loss. 

Vitiligo is caused by a reduction in functional melanocytes, the cells that cause pigmentation in the skin. Vitiligo often develops before the age of 20 and there is no difference in predilection for male over female cases.  In children the hypopigmented areas are often first noted on sun exposed areas like the face (around the eyes and mouth) and well as on the hands.  The underarm area (axilla) is often involved, as are areas around the genitalia. In many cases the depigmentation is symmetrical (both arm pits, or hands or knees). 

Although the exact cause of Vitiligo is not clear, it is known that it has an immunogenetic basis, as there is a positive family history of others with vitiligo in 30 -40 % of patients. There are numerous theories as to different reasons that the melanocytes (pigment cells) are not working. The genetics of vitiligo is also being studied with changes seen on certain chromosomes. 

So why doctors are not clear as to how and why Vitiligo occurs, in most cases it does seem to be slowly progressive. There is spontaneous repigmentation in 10-20% of patients, especially in sun exposed areas of young patients. 

The problem with Vitiligo is that treatment is often lengthy and is frequently unrewarding. There is not “one way” to treat Vitiligo that will ensure repigmentation and resolution. Dermatologists have used phototherapy for treatment, but facial areas and small patches seem to be most responsive. A recent study showed that narrow band UVB therapy was superior to UVA therapy, but studies continue. 

Potent topical corticosteroids are also used to help promote re-pigmentation.  Topical immune modulators such as Tacrolimus have also been tried. 

With all of this being said, a referral to a dermatologist that is familiar with treating Vitiligo is of upmost importance. The sooner the treatment for these “white patches” the better. 

That’s your daily dose for today.  We’ll chat again tomorrow. 

Daily Dose

The Difference Between Cradle Cap And Dandruff

1.15 to read

I recently received a question from a Twitter follower related to cradle cap and dandruff. She wanted to know if there was a difference in the two.

You know there really isn’t as they are both due to seborrheic dermatitis, an inflammatory condition of the skin in which the skin overproduces skin cells and sebum (the skins natural oil). Cradle cap is the term used for the scaly dermatitis seen on the scalp in infants. It is also seen on the eyelids, eyebrows, and behind the ears. It is typically seen after about three months of age and will often resolve on its own by the time a baby is eight to 12 months old. It is usually simply a “cosmetic” problem for a baby as it looks like a yellowish plaque on a baby’s scalp and is often not even noticed by anyone other than the parents. Unlike seborrheic dermatitis in adults, cradle cap typically doesn’t itch. It is thought that cradle cap may occur in infancy due to hormonal influences from the mother that were passed across the placenta to the baby. These hormones cause the sebaceous glands to become over active. In some severe cases an infant’s scalp becomes really scaly and inflamed and causes even more parental concern, as it appears that the infant is uncomfortable and may be trying to scratch their head by rubbing it on surfaces. The treatment for cradle cap is to wash the baby’s scalp daily with a mild shampoo and then to use a soft comb or brush to help remove the scales once they have been loosened with washing. When washing the head make sure to get the shampoo behind the ears and in the brows (keeping the soap out of baby’s eyes). This is usually sufficient treatment for most cradle cap. In situations where the greasy scales seem to be worsening it may help to put a small amount of mineral oil or olive oil on the baby’s head and let it sit (I left a small amount on my children’s heads overnight) and then to shampoo the following day. The oil will help the scales to loosen up and come off more easily. For babies that have very inflamed irritated cradle cap a visit to your pediatrician may be warranted to confirm the diagnosis. In persistent cases I often recommend shampooing several times a week with a dandruff shampoo that has either selenium (Selsun) or zinc pyrithione (Head and Shoulders) making sure not to get any in the infant’s eyes. I may then also use a hydrocortisone cream or foam on the scalp that will lessen the inflammation and itching. In these cases it may take several weeks to totally clear up the problem. As children get older, especially during puberty, you may see a return of seborrhea as dandruff. Again you can use dandruff shampoos. It also seems that with the overproduction of sebum there is an overgrowth of a fungus called “malessizia” so using a shampoo for dandruff as well as a antifungal shampoo (Nizoral) often works. I have teens alternate different shampoos, as sometimes it seems to work better than always using the same shampoo for months on end. Teens don’t like white flakes falling from their scalp and unlike a baby, a teen is worried about the cosmetic issues of seborrhea! That’s your daily dose, we’ll chat again tomorrow. Send your question to Dr. Sue!

Daily Dose

Omega-3 Fatty Acids

1:30 to read

Many of the patients that I see who have problems with attention and focus as well as other behavioral and learning issues have been started on all sorts of different medications. For some children their medications seem to be “working well”. But, for some children it has been difficult to find the “right” medication to alleviate all of their symptoms.  Studies have shown that anywhere from 10%- 30% of children with ADHD do not respond favorably to stimulant medications. Therefore,  it is not uncommon for their parents to inquire about the use of alternative or complementary medications. In several cases their parents have already started “dietary supplements”, which at times they are reluctant to admit to, or ask for my opinion.  

Interestingly, there is recent data regarding dietary supplements that parents and pediatricians should be paying attention to…and open to discussing.  A study that was presented last fall at the American Academy of Child and Adolescent Psychiatry showed that omega-3’s “could augment the response in children aged 7-14 years who were receiving psychotherapy for depression and bipolar disorders”. There have been  studies as well that have shown “significant improvements with Omega-3’s relative to placebo for problems including aggression as well as depression and anxiety symptoms”.  There are also numerous studies looking at ADHD symptom improvement in those using Omega-3’s, and again the results have been mixed, made even more difficult by the fact that ADHD is a subjective diagnosis.  

Another issue that requires more study is how these fatty acids actually work within the body and brain. Omega-3’s are an important building block of the brain and it is present in the brain's cell membranes, where it is thought to facilitate the transmission of neural signals.  Current thought is that these fatty acids may change the cell membrane fluidity and may also have anti-inflammatory effects….but a lot of research continues on the issue of mechanism of action. 

Several of the studies looked at dosage of the Omega 3 fatty acid supplements and “it seemed that there were more positive trials related to higher daily doses of  certain omega 3 fatty acids including eicosapentaenoic acid (EPA) and docosahexanoic acid (DHA).  There need to be further studies to address the amount and ratio of these Omega-3’s as they are used for supplements. 

So while the research continues as to the effectiveness of Omega 3’s on focus, mood, behavior and learning it is important for all children to consume enough Omega-3 fatty acids in their diet. Eating fatty fish a few times a week would be beneficial for the health of all children - and the decision to supplement beyond that may be a topic for discussion with your own physician. 

 

Daily Dose

Favorite Christmas Songs

1.00 to read

I have been taking a poll among my patients as to their favorite Christmas carols. This means I have asked patients from the ages of 3-22 years to weigh in. It is such fun to hear all of the different responses.  So this is “TKD” Christmas play list presented by my patients. 

When I asked a 3 year old what Christmas song he liked he quickly said, “Twinkle Twinkle Little Star”. I agree it does sound like a Christmas song...the star, right?  

The younger set likes “Frosty the Snowman”,  “Rudolph the Red Nose Reindeer”, “Santa Claus is Coming to Town”, as well as “Silent Night” which many of them are signing for their school Christmas programs.  I can still remember watching my own children perform these songs and “Silent Night” with elementary school voices could bring me to tears!!  Such sweet and innocent voices. 

Some of the other favorites have been “I Saw Mommy Kissing Santa Claus”, “Alvin and The Chipmunks”, “Rockin’ Around the Christmas Tree”, and “Jingle Bells”. 

The older kids like “All I Want for Christmas is You”, “Let it Snow, Let it Snow” (maybe wishing for a white Christmas here in Texas), and Santa Baby”. 

And for me.....I still love “Oh Holy Night” and “Ave Maria”, they just make the season. Christmas Eve always ends with the beautiful hymn “Joy to the World”. 

I can confess that by Christmas, my family is a bit over my continuous stream of carols......but I promise I will turn them back on again next year. 

 

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