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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 Child

City Kids With Asthma Do Better Living Near a Park

2:00

The beauty of tall trees, open space and rows of lush flowers may not only offer a respite from cramped city living, but might reduce asthma symptoms in children as well, according to a new study.

An interesting, albeit small, study of urban children in Baltimore, Maryland, showed that the closer a child with asthma lived to a park or green space, the fewer symptoms they displayed compared to children with asthma that did not live near a park.

The new study included 196 inner-city children in Baltimore, aged 3 to 12 years, with persistent asthma. Some lived close to a park or other green space, while others were more than 0.6 miles away from one.

Researchers found that the farther the children lived from a park, the more asthma symptoms they experienced over a two-week period. For every 1,000 feet between their home and a park, children had symptoms one extra day.

"Living in a city environment increases the risk of childhood asthma, and factors associated with city-living -- such as air pollution -- are also known to contribute to high rates of poorly controlled asthma," study author Kelli DePriest said in a society news release.

Other studies have suggested that children with asthma benefit from exercise, and the presence of green spaces promotes physical activity and helps lower pollution, she said.

Children that were 6 years old or older benefited the most from being in the park.

DePriest said that's probably because they are freer to roam than younger kids.

DePriest suggested city planners should consider the health benefits of adding more parks to children’s environments.

In addition to policymakers and city planners, healthcare providers could also provide more information to parents and caregivers about the advantages of taking their children to parks and green spaces.

The study findings "will also help health care providers to take a more holistic view of their patients by understanding how access to green space might affect health," she concluded.

The study will be presented to a European Respiratory Society in Milan, Italy. Researched presented at meetings are typically considered preliminary until published in a peer-reviewed journal.

Story source: Robert Preidt, https://consumer.healthday.com/respiratory-and-allergy-information-2/asthma-news-47/for-city-kids-with-asthma-nearby-green-space-is-key-726293.html

 

Your Child

The Eczema, Allergies and Asthma March

1:45

Eczema refers to a number of different skin conditions in which the skin becomes red and irritated and sometimes has small, fluid filled bumps that ooze.

The most common cause of eczema is atopic dermatitis (sometimes called infantile eczema), which affects older kids as well as infants.

Children with eczema may eventually get food allergies, hay fever, or asthma. But you can take steps to soothe the itch and possibly cut the risk of allergies.

While most experts don't think eczema is purely allergic, it's clearly connected to allergic conditions like food allergies, hay fever, and asthma.

·      Up to 80% of kids with eczema get hay fever or asthma later in childhood.

·       35% of adults with asthma or nasal allergies had eczema as kids.

·      If a mom has allergies, there's almost a 1 in 3 chance that her baby will have eczema.

·      37% of kids with moderate to severe eczema also have food allergies.

For some kids, eczema and allergies develop in a specific order, as they get older. It starts with eczema, then food allergies, then asthma, and then hay fever. It's called the allergic march.

But just because your child has eczema doesn't mean they'll get these other conditions. It just means there's a higher risk.

There are several things that can increase a child’s risk of being part of the allergic march.  Kids who get eczema at a young age may be more likely to have allergies or asthma later. Kids with worse eczema symptoms may be more likely to get allergies or asthma.

You can do some things that might lower your child's chances of worsening eczema, asthma, or allergies. The evidence isn't clear, so talk to your doctor or your child's pediatrician. Depending on the situation, the doctor might recommend:

Breastfeeding your baby: It might lower the risk of eczema, later allergies, or asthma.

Diet changes: If your baby has a high risk of allergic problems, some doctors recommend changes in diet. Breastfeeding for at least 4 months can help protect your child. “Hydrolyzed” formula might help protect formula-fed babies.

Other ways to keep your child's eczema under control include:

Get allergy testing. If you can pin the problem on a specific allergen, you can figure out ways to avoid it.

Use a moisturizer. Go for thick creams and ointments that stop the skin from drying out.

Keep fingernails short. Your child will do less damage to the skin from scratching.

Avoid irritants. Always use unscented soap and laundry detergent. Stay away from cigarette smoke.

Watch for problems. If your child's eczema seems to be getting worse -- or if they get allergy symptoms, like congestion or a runny nose -- see a doctor. The sooner you get treatment, the sooner your child will feel better.

In many cases, eczema goes into remission and symptoms may disappear altogether for months or even years.

For many kids, it begins to improve by the age of 5 or 6; others may have flare-ups throughout adolescence and early adulthood.

In some kids, the condition may improve but then restart as they enter puberty, when hormones, stress, and irritating skin products or cosmetics are introduced. Some people will have some degree of dermatitis into adulthood, with areas of itching and a dry, scaly appearance.

Eczema is not contagious, so there's no need to keep a baby or child who has it away from siblings, other kids, or anyone else.

Story sources; http://www.webmd.com/skin-problems-and-treatments/eczema/child-eczema-14/allergies?ecd=wnl_prg_050116&ctr=wnl-prg-050116_nsl-promo-4_title&mb=HJinmVxrQQBBWXaWABbkR%40HnVev1imbCiW2HnNaB9FE%3d

http://kidshealth.org/en/parents/eczema-atopic-dermatitis.html#

 

 

 

Your Baby

High-Sugar Intake During Mom’s Pregnancy May Double Child’s Risk of Asthma

2:00

It’s no secret that moms-to-be often develop a sweet tooth during pregnancy, but new information suggests high-sugar foods and drinks may double their child’s risk for developing asthma and allergies later in life.

Researchers from Queen Mary University of London used data gathered from nearly 9,000 mother-child pairs in the Avon Longitudinal Study of Parents and Children, an ongoing research project that tracks the health of families with children born between April 1, 1991, and December 31, 1992.

During the study, the participating pregnant women were asked about their weekly intake of certain foods and specific food items including sugar, coffee and tea. Their responses were used to calculate their intake of added sugar.

The researchers only saw weak evidence to suggest a link between women’s added sugar intake and their children’s chances of developing asthma overall. But when they looked specifically at allergic asthma—in which an asthma diagnosis is accompanied by a positive skin test for allergens—the link was much stronger. Children whose moms were in the top fifth for added sugar during pregnancy were twice as likely to have allergic asthma when compared to children whose moms were in the bottom fifth.

Children of mothers with the high-sugar diets were 38% more likely to test positive for an allergen and 73% more likely to test positive for more than one allergen, compared to those kids whose moms stayed away from added sugar.

"The dramatic 'epidemic' of asthma and allergies in the West in the last 50 years is still largely unexplained -- one potential culprit is a change in diet," said Annabelle Bedard, lead author and a postdoctoral fellow at Queen Mary's Centre for Primary Care and Public Health Blizard Institute. "Intake of free sugar and high fructose corn syrup has increased substantially over this period."

As with most studies, a cause and effect was not established, only an association. The study’s authors believe that the association is strong enough to warrant further investigation.

Lead researcher Professor Seif Shaheen  said: "We cannot say on the basis of these observations that a high intake of sugar by mothers in pregnancy is definitely causing allergy and allergic asthma in their offspring.

"However, given the extremely high consumption of sugar in the West, we will certainly be investigating this hypothesis further with some urgency.”

There are many health reasons why pregnant women should limit their intake of high-calorie and sugary foods and drinks. This research suggests that it may be prudent for the health of their unborn child as well.

Story sources: Susan Scutti, http://edition.cnn.com/2017/07/05/health/sugar-pregnancy-child-allergy-asthma-study/index.html

 Henry Bodkin, http://www.telegraph.co.uk/science/2017/07/06/high-sugar-intake-pregnancy-linked-double-risk-child-asthma/

Your Child

Recall: More Than 590,000 Albuterol Inhalers

1:30

Adults and children with breathing problems often rely on metered dose inhalers to open their airways, allowing them to breathe more easily. Albuterol (Proventil, Proair, Ventolin) is a medication called a bronchodilator, commonly found in rescue inhalers for acute asthma attacks.

GlaxoSmithKline is recalling more than 590,000 albuterol inhalers. Three lots of Ventolin HFA 200D inhalers have been voluntarily recalled due to a potential issue with the delivery system, a spokesman for the British pharmaceutical company said.

The affected lot numbers are 6ZP0003, 6ZP9944 and 6ZP9848. The devices have been recalled from hospitals, pharmacies, retailers and wholesalers in the United States.

The recalled inhalers may not release the correct dose of medication due to a defective delivery system. Albuterol opens airways in the lungs to treat common conditions such as asthma and chronic obstructive pulmonary disease.

The company said it had received an elevated number of product complaints about a bulging of the outside wrapper, indicating a leak of the propellant that delivers the medicine.

The U.S. Food and Drug Administration has approved the voluntary "Level 2" recall, which only affects products in the United States, GSK spokesman Juan Carlos Molina said.

The defect does not pose a danger to patients, so they are not being asked to return inhalers they have already purchased. However, if the devices are not relieving symptoms, patients should seek medical attention right away.

GSK said it was trying to identify the root cause of the problem and would take corrective action. Patients whose inhalers are among the affected lots can contact GSK’s customer service center at 1-888-825-5249.

Story sources: Robert Jimison, http://www.cnn.com/2017/04/06/health/albuterol-inhaler-recall/

Daily Dose

Asthma

1:30 to read

May is Asthma Awareness Month and I am certainly seeing many patients whose asthma and wheezing is getting the best of them right now. With all of the major weather changes across the country, pollen counts through the roof, and upper respiratory viruses still circulating, there are quite a few triggers to set off wheezing.

 

Asthma is a chronic lung disease and affects more than 6 million children in the United States. Asthma causes wheezing and chest tightness in some, while it may only cause nighttime cough and cough with exercise in others. There is not one single presentation to asthma and the diagnosis is best made with a good history and physical exam.  Although asthma is a chronic disease you may only have attacks when something is bothering your lungs (triggers).

 

The biggest challenge I see as a pediatrician is teaching both parents and children to recognize their triggers and to know what their medications are. Every patient should have an asthma action plan, but in some cases, a child may have only wheezed once..and their parents received an inhaler or a nebulizer but really does not know what to do if their child wheezes again.

 

If your child has wheezed before, and you have a family history of wheezing, your child has a greater chance of wheezing again.  You should have a discussion with your pediatrician about how to recognize wheezing in your child. At the same time, if you have ever received a medication for wheezing, make sure you know the name or names of the medication. I see many parents who come in to the office and they may have been seen at an ER or urgent care when they were noted to be wheezing. They received an “inhaler”, but the parent has no clue as to the name of the inhaler (they may say, “it is blue”), and they don’t understand how the medications work.

 

The two points I try to make with every patient I see with wheezing:  

#1  Know the names of the medications that you have

#2  Know what the medications do

 

There are two issues with asthma, lung inflammation and broncho spasm (narrowing of the airways). So…there are two medications commonly used to treat these issues.  Inhaled steroids (there are tons of brands) are used as a preventative and decrease inflammation, while albuterol (again tons of brands) is a broncho-dilator and opens up the narrowed airways.  I see too many patients that bring in a bag full of medications, from numerous doctors and still don’t understand what their medications are used for, when to use them and that several of their inhalers, while having different names, are actually the same medicine.

 

Lastly, children with divorced parents need to have inhalers available at both homes. I think it is too complicated to try and have parents hand the inhaler or medication back and forth and think they will not forget or lose the medication.  Ask your doctor to have meds for both houses.

Seeing that is is Asthma Awareness month, get your medications out and make sure that they are not expired and if you don’t understand how or when to use them, make an appointment with your pediatrician and get an asthma action plan in place. Be prepared!  

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Managing Asthma

Your Child

Kid’s Asthma: Test For Pollutants Inside the Home

1:45

If your child suffers from asthma, he or she should be tested to see if they are allergic to indoor pollutants such as dust mites, insects, pet dander, molds, secondhand cigarette smoke and certain household cleaning supplies says a new clinical report released by the American Academy of Pediatrics (AAP).

Controlling the triggers of asthma in the home may work as well as or reduce the need for medications wrote Elizabeth C. Matsui, MD, MHS, FAAP,  of Johns Hopkins Hospital in Baltimore and colleagues, authors of the new guidance in the November issue of Pediatrics.

"We know that targeting all exposures that can trigger a child's asthma is more likely to be successful and to result in significant improvement than targeting only one or two of them, and can help reduce asthma attacks and the need for medication," Matsui said.

According to the report, an assessment of a child's individual environmental history should be an integral part of asthma management. The authors urged pediatricians to ask families about exposure to the following common triggers:

·      Dust mites and mold: An estimated 30-62% of children with persistent asthma are allergic to dust mites, and about half are sensitive and exposed to mold.

·      Furry pets: Cats and dogs are common furry pets found in homes, yet up to 65% of children with persistent asthma report being allergic.

·      Presence or evidence of pests such as cockroaches and rodents: Cockroach allergen exposure was first linked to asthma morbidity in children in 1997, and the link has been replicated ever since. Nearly 75-80% of U.S. homes contain detectable amounts of mouse allergen. Concentrations in homes in neighborhoods with high poverty rates are up to 1,000-fold higher than those found in suburban homes.

·      Indoor air pollution: Cigarette smoke is a major indoor trigger, with nearly 30% of all U.S. children and 40-60% of U.S. children in low-income households exposed to second-hand smoke in their homes. Additionally, the use of older wood-burning stoves, unvented space heaters, and other sources of combustion can produce nitrogen dioxide and other pollutants that are known to exacerbate asthma symptoms.

·      Household chemicals: Common household items such as air fresheners and cleaning agents include chemicals that can be respiratory irritants and trigger asthma symptoms.

The report recommended seeing an allergist to identify which allergens may be triggering your child’s asthma.

By asking specific questions, Matsui noted that pediatricians can play an important role in helping parents recognize something in the house may be making their child’s asthma worse.

"Which exposures to focus on will be informed by questions the pediatrician asks of the family," Matsui said. "Asking about pets will identify children who may have pet allergen exposure contributing to their asthma. Similarly, asking about signs of mouse or cockroach infestation will indicate which children might be at risk from these exposures."

Additionally, pediatricians should routinely ask about second-hand smoke exposure as this will guide further discussion about ways to eliminate or reduce a child's exposure to smoke, she said.

Dust mites are the most common indoor pollutant, however, you won’t see these pests crawling around your house. They are so tiny - a microscope is needed to actually see them. They feed mainly on the tiny flakes of human skin that people shed each day. These flakes work their way deep into the inner layers of furniture, carpets, bedding and even stuffed toys. These are the places where mites thrive. An average adult person may shed up to 1.5 grams of skin in a day. This is enough to feed one million dust mites!

Having dust mites doesn’t mean your house isn’t clean. Even the cleanest of houses can harbor these unwelcomed creatures. You can find out more about dust mites at http://www.aafa.org/page/dust-mite-allergy.aspx.

Indoor allergens can definitely make your child’s asthma worse and although many insurers do not currently cover environmental assessments and control measures, there are both public and private resources available to aid pediatricians, specialists, and patients with environmental remediation efforts.

Story source: Alexandria Bachert, http://www.medpagetoday.com/pediatrics/asthma/61125

Daily Dose

Asthmatic Kids & Colds

2.00 to read

Cold season continues to hang on and for anyone who has a child with asthma, you are aware that wheezing will often accompany winter colds.

I have spent a lot of time in the last week listening to wheezy chest, lots of coughing and seeing many children who need to be using their asthma medications. After a quiet summer of no coughing it is a good time to review asthma and the medications to use to treat as “wheezy season” is here!

Many children will wheeze once in their lifetime and I tell parents, “everyone gets one free wheezing episode”. But if a child wheezes on several occasions and responds to bronchodilators they probably have asthma. If you throw in a positive family history of wheezing as well as wheezing that begins each time a child gets a cold it is time to discuss the diagnosis of asthma and the treatments that go along with the diagnosis.

The good news about asthma is that there are a lot of great medications available for treatment. With that being said I think it is important to teach parents about the pathophysiology of asthma and then talk about treatment. I tell my patients/parents that understanding wheezing is somewhat analogous to being a medical intern. You have to see the symptoms for a while and then you finally “learn it, and know it” and then can begin to understand treatment.

For a parent with a child with asthma it is the same process. Each repeated wheezing episode should get easier for a parent to know what they are dealing with and when and how to start treatment. Many times they will not need the doctor to be involved once they are comfortable with the medications.

In fairly simplistic terms, there are really two components to asthma, airway narrowing (brochospasm) and airway inflammation. In most cases it is important to be treating both symptoms. The most common trigger for asthma in children is a viral upper respiratory infection. When you get a viral upper respiratory infection the virus causes airway inflammation and irritation in all of us. That is one reason we all cough with a cold.

For an asthmatic child it also causes bronchospasm and resultant wheezing. By the time you audibly hear your child wheezing they are what we pediatricians refer to as “being tight”. The goal is therefore to treat the asthmatic episode early and aggressively; you never want to hear audible wheezing.

An asthmatic cough is often short, frequent, non productive and occurs throughout the day and often all night long. I love to walk into a room and hear a child with a productive, “phlegmy” cough, as these children are typically not wheezers but are good coughers! It is that dry little recurrent pesky cough that occurs incessantly that is often the hallmark of a child who is wheezing.

In severe cases of wheezing and bronchospasm the child will also show signs of respiratory distress, where their chest may show retractions (pulling in between ribs) or using their abdominal muscles to help them breath. These children look uncomfortable and are usually not running around the exam room as they are having a hard time getting air exchanged.

Some other children may not be in any respiratory distress but when listened to with the stethoscope you can hear the high pitched noise on expiration and sometimes on inspiration as well. You just have to get used to listening. Practice, practice and then a parent with a stethoscope gets better at understanding asthma.

When a child is actively wheezing it is time to start medications to relieve their symptoms. More on treatment coming.  Stay tuned.

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