Twitter Facebook RSS Feed Print
Play
1616 views in 2 years
Allergies

Fall Allergies & Your Kids

Daily Dose

Diagnosing Celiac Disease

How do you diagnose celiac disease. I received an email via our iPhone App from a mother who was concerned because her 2 year old son had skinny arms and legs, but a “big tummy” and she thought this might be a symptom of celiac disease.  Most toddlers have “big tummies” even if they are skinny kids as their abdominal musculature (future 6 pack) is not developed.

I often have questions from concerned parents whose children are growing perfectly normally, but their “belly sticks out”.  This is often a comment made about little girls (gender specific concerns already!) and I tell the parents that there are not many toddlers that don’t have protuberant little tummies. If you go to the pool in the next several months, check out the baby pool,  as this is not a good age to wear a bikini or “speedo” with that big tummy pushing down the bottoms,   save that look for later on. Now, what do you typically look for in  child who you suspect might have celiac disease?  Celiac disease typically causes failure to thrive in young children. I know this well,  as I got this question wrong on my oral boards many years ago, and have spent the last 20 years making sure never to miss a case. (maybe I should leave that little tidbit out?) At any rate, you see symptoms like persistent diarrhea, weight loss or failure to gain weight, a large protuberant abdomen, and a lack of appetite (no, being a picky eater does not count).   Because celiac disease is an auto-immune disease where the body responds abnormally to a protein (gluten) found in foods like wheat,  rye, barley and many other prepared foods, it differs from a food allergy.  A food allergy typically causes symptoms like hives, wheezing or vomiting. The first step in testing for possible celiac disease will be a blood test on your child.  This will show if there are elevated levels of antibodies, called tissue-trans-glutaminase (tTG), in the blood. If a child has high levels of these antibodies (tTG), then a biopsy of the small intestine may be taken to confirm the diagnosis. A small bowel biopsy is done while a child is sedated, through an endoscope, and actually takes a small piece of the lining of the intestine to see if the villi are flattened and damaged.  The gluten in the diet of a child with celiac disease causes these changes to the intestine, and once gluten is removed from the diet the villi will return to normal and normal absorption of food will take place. If a child is confirmed to have celiac disease (which is as lifelong problem) they have to remain on a gluten free diet, which means restricting many foods and drinks.  A gluten free diet, while seemingly difficult to adhere to at first, will allow the child to grow and develop normally and your child will typically have more energy and feel better in general.  After being on a gluten free diet another blood test may be done to confirm that the tTG level has come down. With the advent of more gluten free products it has become easier for parents and children to follow a gluten free diet. There are many websites that help teach a family to read labels (similar to those with a food allergy) and to also provide resources for recipes or products that are gluten free. Although I continue to look for a patient with celiac disease, I have yet to diagnose one, and remember to consider the diagnosis in any child who is having “failure to thrive”. That's your daily dose for today.  We'll chat again tomorrow! Send Dr. Sue your question now!

Your Baby

Starting Baby on Solid Foods

Your goal over the next few months is to introduce a wide variety of foods. If your baby doesn't seem to like a particular food, reintroduce it at later meals. It can take quite a few tries before kids warm up to certain foods.Starting baby on solid foods can be an exciting and perplexing time for parents. What foods should I start with? How much? How often?

The American Academy of Pediatrics currently recommends gradually introducing solid foods when a baby is about 6 months old. Your pediatrician, however, may recommend starting as early as 4 months depending on your baby's readiness and nutritional needs. Be sure to check with your pediatrician before starting any solid foods. Is your baby ready? Breast milk or formula is the only food your newborn needs. Within four to six months, however, your baby will begin to develop the coordination to move solid food from the front of the mouth to the back for swallowing. At the same time, your baby's head control will improve and he or she will learn to sit with support — essential skills for eating solid foods. If you're not sure whether your baby is ready, ask yourself these questions: •       Can your baby hold his or her head in a steady, upright position? •       Can your baby sit with support? •       Is your baby interested in what you're eating? If you answer yes to these questions and you have the OK from your baby's doctor or dietitian, you can begin supplementing your baby's liquid diet. What Foods to Start With. Continue feeding your baby breast milk or formula as usual. Then: •       Start with baby cereal. Mix 1 tablespoon (15 milliliters) of a single-grain, iron-fortified baby cereal with 4 to 5 tablespoons (60 to 75 milliliters) of breast milk or formula. Many parents start with rice cereal. Even if the cereal barely thickens the liquid, resist the temptation to serve it from a bottle. Instead, help your baby sit upright and offer the cereal with a small spoon once or twice a day. Once your baby gets the hang of swallowing runny cereal, mix it with less liquid. For variety, you might offer single-grain oatmeal or barley cereals. Your baby may take a little while to "learn" how to eat solids. During these months you'll still be providing the usual feedings of breast milk or formula, so don't be concerned if your baby refuses certain foods at first or doesn't seem interested. It may just take some time. Do not add cereal to your baby's bottle unless your doctor instructs you to do so, as this can cause babies to become overweight and doesn't help the baby learn how to eat solid foods •       Add pureed meat, vegetables and fruits. Once your baby masters cereal, gradually introduce pureed meat, vegetables and fruits. Offer single-ingredient foods at first, and wait three to five days between each new food. If your baby has a reaction to a particular food — such as diarrhea, a rash or vomiting — you'll know the culprit. •       Offer finely chopped finger foods. By ages 8 months to 10 months, most babies can handle small portions of finely chopped finger foods, such as soft fruits, well-cooked pasta, cheese, graham crackers and ground meat. As your baby approaches his or her first birthday, mashed or chopped versions of whatever the rest of the family is eating will become your baby's main fare. Continue to offer breast milk or formula with and between meals. Foods to Avoid for Now. Some foods are generally withheld until later. Do not give eggs, cow's milk, citrus fruits and juices, and honey until after a baby's first birthday. Eggs (especially the whites) may cause an allergic reaction, especially if given too early. Citrus is highly acidic and can cause painful diaper rashes for a baby. Honey may contain certain spores that, while harmless to adults, can cause botulism in babies. Regular cow's milk does not have the nutrition that infants need. Fish and seafood, peanuts and peanut butter, and tree nuts are also considered allergenic for infants, and shouldn't be given until after the child is 2 or 3 years old, depending on whether the child is at higher risk for developing food allergies. A child is at higher risk for food allergies if one or more close family members have allergies or allergy-related conditions, like food allergies, eczema, or asthma. Introducing Juice. Juice can be given after 6 months of age, which is also a good age to introduce your baby to a cup. Buy one with large handles and a lid (a "sippy cup"), and teach your baby how to maneuver and drink from it. You might need to try a few different cups to find one that works for your child. Use water at first to avoid messy clean-ups. Serve only 100% fruit juice, not juice drinks or powdered drink mixes. Do not give juice in a bottle and remember to limit the amount of juice your baby drinks to less than 4 total ounces (120 ml) a day. Too much juice adds extra calories without the nutrition of breast milk or formula. Drinking too much juice can contribute to obesity can cause diarrhea. Infants usually like fruits and sweeter vegetables, such as carrots and sweet potatoes, but don't neglect other vegetables. Your goal over the next few months is to introduce a wide variety of foods. If your baby doesn't seem to like a particular food, reintroduce it at later meals. It can take quite a few tries before kids warm up to certain foods.

Your Child

New Studies Look At Childhood Asthma

1.45 to read

2 new studies take a look at childhood asthma. One suggests that antibiotics given to babies in the first year of life may increase a child’s chances of getting asthma by age 18, while the other study cautions that childhood food allergies may be a predictor of asthma later in life.2 new studies take a look at childhood asthma. One suggests that antibiotics given to babies in the first year of life may increase a child’s chances of getting asthma by age 18, while the other study cautions that childhood food allergies may be a predictor of asthma later in life

Antibiotic Use and Childhood Asthma Pediatricians have cautioned parents about taking antibiotics, and giving their children antibiotics, without a true medical need. Now a study appearing online in the journal Pediatrics, suggests that infants who take antibiotics during the first year of life may be at a slightly increased risk of developing asthma by age 18. In a separate analysis, the children of women who took antibiotics during pregnancy were nearly 25% more likely to have asthma compared to mothers who did not take the drug. Asthma can be a life threatening condition. Nine million children under age 18 in the U.S. have asthma, according to the American Academy of Allergy, Asthma & Immunology. Here’s how the study was conducted. Researchers gathered data from 22 previous studies between 1950 and 2010. Two of the 22 studies looked at antibiotic exposure during pregnancy while 19 studies evaluated antibiotic exposure during the first year of life. One study assessed antibiotic exposure during both time periods. Other studies have shown that infants who receive antibiotics are at an increased risk for developing asthma by age 7, and the more courses of the drug given that first year, the greater the risk. This review analyzed the results of studies using over 600,000 participants. It also grouped studies according to design type to see how the results were affected. When all 20 studies were grouped together, researchers found that infants who took antibiotics during their first year of life were about 50% more likely than babies who never received the drugs to be diagnosed with asthma. Researchers also analyzed studies where children who were treated with antibiotics for respiratory infections, were removed.  The respiratory infections skewed the overall results because of the possibility that the infections themselves might be a precursor to asthma. In studies that adjusted for these respiratory infections, a child who took antibiotics was 13% more likely to be diagnosed with asthma than a child who never took the medication. The researchers say they are not suggesting that early antibiotic exposure causes childhood asthma, but that even a slight increase in risk may be a good enough reason to avoid the unnecessary use of antibiotics during pregnancy and the first year of life. Food Allergies and Childhood Asthma Infants and toddlers often have some type of food allergy, while teens and adults are more prone to dust, ragweed and mold allergies according to U.S. researchers. A preliminary release of the Quest Diagnostics Health Trends Report, Allergies Across America, is based on laboratory testing from more than 2 million U.S. patient visits. In this report the findings reveal a pattern of allergen sensitivity consistent with the "allergy march," a medical condition by which allergies to foods in early childhood heighten the risk for the development of additional and more severe allergy-related conditions - including asthma- later in life. "Allergy and asthma often go hand in hand, and the development of asthma is often linked to allergies in childhood via the allergy march," Study investigator Dr. Harvey W. Kaufman says in a statement. "Given the growing incidence of asthma in the United States, our study underscores the need for clinicians to evaluate and treat patients, particularly young children, suspected of having food allergies in order to minimize the prospect that more severe allergic conditions and asthma will develop with age." The most common foods responsible for allergic reactions are eggs, cow's milk, peanuts, soya, fish and shellfish in children and peanuts, tree nuts, shellfish and fish in adults. Substances that are used as food additives and preservatives can also affect individuals. Although a causal link has not been determined, increased awareness of the heightened risks of having both childhood asthma and allergen sensitivity plus good patient-parent education and management of both conditions, can lead to improved health and medical outcomes.

Daily Dose

What Causes Circles Under a Baby's Eyes?

I received an email from a patient who had just weaned her your-baby from breast milk to formula. She was concerned because the your-baby sometimes looked as if she had circles under her eyes.I recently received an email from a patient who had just weaned her your-baby from breast milk to formula. She has a beautiful eight-month-old daughter and she was concerned because she thought the your-baby sometimes looked as if she had circles under her eyes. She felt like the your-baby was getting plenty of sleep, did not seem sick or tired but was concerned about the circles. She thought it might be allergies from changing from breast milk to formula. She was also concerned that she might have seasonal allergies.

In looking at her your-baby I really did not notice the circles, as you know mothers are the most critical about their own children. (Sorry Mom, I think my own Mother talks about my circles too!) At any rate, infants do not manifest symptoms of milk allergy with circles beneath their eyes. They have diarrhea, or vomiting or blood in their stools or failure to thrive. I do not think that the change in milk was the cause of the discoloration she described. Infants also do not develop seasonal airborne allergies until they are over the age of two or three and then they may present with the classic "allergic shiners" beneath their eyes, and the crease of the allergic salute across their nose, clear runny nose and often itchy eyes. I think this precious your-baby just had familial thin skin beneath her eyes with superficial veins that led to the appearance of circles. They were not always visible, and it would also depend on the position the your-baby slept in etc ...as to how much you might notice them. Will have to see if they bother her as she gets older, as there is always concealer and I use a lot of it when around my own Mom. That's your daily dose, we'll chat again tomorrow.

Daily Dose

Allergy Season is Here

Allergy season is really upon us and after interviewing a pediatric allergist on our show I realize how prevalent seasonal allergies are, and how they definitely do run in families. If both parents have seasonal allergies there is a greater than 50% chance that their children will also be affected. So, ask your prospective mate not only the all important questions regarding family, finances and children, but ask about their history of allergies and asthma.

Who would have known this 10 years ago? We are definitely seeing more children with asthma and allergies and most have a significant family history. At the same time, the allergist emphasized that most toddlers, especially those in daycare or preschool, who have had intermittent "green snotty noses", cough, and low-grade fevers probably are not dealing with allergies but rather recurrent upper respiratory infections, due to viruses. I often overhear young mothers as they drop off their children in the church nursery classes say, "he is not really sick he just has allergies", knowing that their precious child really has yet another cold. There is nothing wrong with having six colds a winter, we have talked about that before, and colds should not keep you from going to preschool, gymnastics, church, or music class. But the reality is those "allergies" are really cold viruses and so technically are contagious, and so it goes in the toddler set everyone shares the germs. The best treatment if you suspect your child has occasional allergies is to use an over the counter antihistamine to combat the watery, itchy eyes, and constant drippy nose. It will also help the sneezing and scratchy throat symptoms. If your child is having persistent seasonal allergy symptoms, usually due to trees and grasses during the spring, the best medication may be preventative in the form of a prescription nasal steroid spray used daily. This daily spray in conjunction with an antihistamine on especially bad days proves to be the best way to treat seasonal allergies. The only problem is convincing your child, or 'tween or teen to use a daily nose spray. In my experience it is right up there with trying to get them to take out the trash. Why does something so simple prove to be so hard? That's your daily dose, we'll chat again tomorrow.

Tags: 
Daily Dose

Allergic to a Baby Wipe?

1.15 to read

Most parents with young children find themselves wiping their children’s faces several times a day, at the minimum. In the “olden days” I remember my own mother wiping my face with a bit of “her spit” on her finger which she used as as a washcloth, when there was nothing else available. (I swore I would never do that myself, but of course, never say never).  But in this century, most parents have the luxury of using a wet wipe/baby wipe rather than a mother’s spit.

Interestingly, there are now several reports of an allergic contact rash developing in some children who have had their faces wiped with wet wipes.  Not only are children having their bottoms wiped, it seems that people of all ages are now using wet wipes for washing hands and faces.  They travel well and are being heavily marketed for their convenience.

It seems that the culprit in these new cases is methylisothiazolinone (MI) a chemical found in certain brands of wet wipes. Previously, baby wipes contained a lower percentage of MI, but in recent times the concentration of MI has increased by more than 25 times, as it was not thought to cause sensitization.

This small study of 8 children, and another study from Australia also showed that once the children stopped using the wipes, their “mystery” rash resolved.

The American Contact Dermatitis Society has named the chemical MI the contact allergen of the year. Somewhat like being named “most likely to succeed”

So, doctors and parents need to be on the lookout for unusual rashes that appear to be red, eczematous and sometimes impetiginous, that do not resolve with usual treatment.  It might be worth looking at what kinds of wipes a family is using and if they contain the chemical MI (which may also be found in some soaps and shampoos).  In the study, all of the patients had rapid resolution of their rash, within about 2 days after discontinuing the use of wipes. Most of the children had experience symptoms for 1-12 months before being appropriately diagnosed.  

Hmmm..who knew spit would be better tolerated.  

Daily Dose

Summer Series: How to Treat Common Insect Bites

From May/June until fall I consistently see children who are brought to my office for me to look at their insect bites.As we continue our summer series, it’s time to talk about pesky insect bites.  From May/June until Fall, I consistently see children who are brought to my office for me to look at their insect bites.  Just last week a mother brought in a 7 year old that she thought had chickenpox, but in reality it was numerous bug bites, which were located on the child’s arms and legs (exposed skin) rather than on the trunk which is seen with early chickenpox.  

In many cases, the offending biting insect is not accurately identified, as it could be the ubiquitous mosquito, or biting flies, gnats or fleas. Systemic reactions from insect bites are much less common that systemic reactions to insect stings. The immediate reaction to the insect bite usually occurs in 10–15 minutes with local swelling and itching, and may disappear in an hour or less.  The delayed reaction may appear in 12–24 hours with the development of an itchy red papule (bump) which may persist for days to even weeks. This is the reason that some people do not remember being bitten while they were outside, but the following day may present with the bites all over their arms and legs or chest, depending on what part of the body was exposed. Large local reactions to mosquito bites are common in children. For some reason it seems to me that “baby fat”  reacts more to the bite of the mosquito. (No science here).  The toddler set will often have itchy, red, are warm swellings appearing within minutes of the bites and they may even go on to develop bruising, and spontaneous blistering in 2–6 hours after being bitten. These bites then may persist for days or weeks, so in theory their little legs will be affected for most of the summer.  Severe local reactions are called “sweeter syndrome” and occur within hours of being bitten and may involve swelling of an entire body part such as the hand, face or extremity.  These are often misdiagnosed as cellulitis, but with a good history, the rapidity with which the area developed redness, swelling, warmth to touch and tenderness,  would be uncommon for a bacterial infection. Systemic reactions to mosquito bites including generalized hives, swelling of the lips and mouth, nausea, vomiting and wheezing have been reported due to a true allergy to the mosquito salivary proteins but are extremely rare. The treatment of local reactions to bites involves the use of topical anti-itching preparations like Calamine lotion,  Sarna lotion, Dommeboro soaks etc.  This may be supplemented by topical steroid creams (either over the counter or prescription) which may be used several times a day for a week or so to minimize scarring. An oral antihistamine (Benadryl)  may also reduce some of the swelling and itching.  Do not use topical antihistamines.  It is also important to try and prevent secondary infection (by scratching and picking) by using antibacterial soaps, trimming fingernails and applying an antibiotic cream like Polysporin to open bites. The best treatment is actually prevention. Using a DEET preparation before going outside (lowest concentration that is effective) may be used in children over the age of 6 months.  Mosquito netting may be used for infants. Try to avoid going outside at dawn and dusk and make sure that you check pots etc for standing water that may be breeding areas for mosquitoes. Wearing long sleeves and long pants will also help (can’t imagine when it is 105 degrees !) That's your daily dose for today.  We'll chat again tomorrow! Send your question to Dr. Sue right now!

Daily Dose

Diagnosing Food Allergies

1.15 to read

Food allergies continue to be a problem in the pediatric population and I often get calls or see a patient for an office visit with a parent who has a concern that their child “may have” reacted to something they ate. Their question is, are they allergic?  

There is a great resource for physicians entitled “The Guidelines for the Diagnosis and Management of Food Allergy in the United States”.  Not all adverse reactions to foods are allergic and it sometimes takes a bit of “detective work”, which is a good history and physical exam, to begin to determine if a child has a food allergy.   

So, when a parent tells me that their child gets a rash on their chin or cheek after eating “xyz” food the questions begin.  Was it the first time they had ever been exposed to that food? Describe the rash and how the child was acting?  Did they have other symptoms with the rash? Was the rash just on a cheek or was it all over? Was it hives? This list of questions go on and on.   

The most common food allergens are egg, milk, peanut, tree nuts, wheat, shellfish and soy. I also ask if this was a one time occurrence, and  If they have tried the food again did it happen every time? Many times hard to tease out what a child has had to eat when they have a mish-mash of food on their plate and nothing is new!  

Is there a family history of allergy or asthma?  Does your child have eczema as well?  If so there is a greater chance of developing a food allergy.  

After a detailed history, and if I do think that the child has a good history for a food allergy, there are tests (skin prick and blood) that may help determine if an allergy may exist.  BUT, with that being said, there are several caveats.  Number one, your doctor should not test for “every” food allergen, only for the suspected food or foods, as there are many false positive tests when you just check all of the boxes for testing IGE levels for an allergy.  For example, if your child eats eggs and has had no problem but the IGE level comes back a bit high for egg allergy, what does that really mean?  In other words, I just test for the suspected culprit. So, I do not test for tree nuts if the parents only had concerns with a peanut product.   More to come on this topic. 

Pages

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.

 

DR SUE'S DAILY DOSE

No tech summer: enjoy the outdoors!

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.

 

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.