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Daily Dose

Wheezing Season is Here

1:30 to read

Have you ever heard your child wheeze?  With cough and cold season in full swing, I'm seeing more and more children and hearing many parents say, “I think my child is wheezing”.  Wheezing is a distinct sound that is heard during expiration and unfortunately is often not audible without a stethoscope. Many parents mistakenly hear the raspy upper airway noises from mucous in a child’s throat and think this is wheezing, which thankfully is not the case.

Wheezing is one of the most common reasons children are seen in the pediatric office during the winter months when RSV (respiratory syncitial virus), rhinovirus, and parainfluenza viruses all circulate...not to mention influenza.  Not all children who wheeze will go on to develop asthma but having a parent who wheezes and has allergies does put a child at greater risk for having asthma. 

Asthma is not a singular disease but rather a complex of symptoms which causes constriction of the airway smooth muscles, inflammation of the airway, mucous production and swelling that leads to air trapping.  This then results in coughing, wheezing, chest tightness,  prolonged exhalation and shortness of breath. For a young child the first symptoms of wheezing may be a persistent short, tight cough that occurs day and night without relief.

If you do think your child is wheezing you must always watch for ANY respiratory distress, or work of breathing!!!  You should never see your child’s ribs pulling in or out and they should always appear to be comfortable with breathing. You must look at their chest rather than just listen to their coughs.  Visual is just as important as the audible noise.

Like many things, there is not a specific test for diagnosing asthma. For a child who is initially found to be wheezing the first line of treatment is typically an inhaler or nebulizer with a bronchodilator to open up the tightened airways. For a young child it is often easier to use the nebulizer but once a child is older and a bit more cooperative an inhaler with a spacer is often less cumbersome and more convenient to use. When used appropriately the spacer/inhaler has been show to be equally effective.

If you are worried about your child’s breathing it is always a good idea to call your pediatrician to discuss. 

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.

Daily Dose

Wheezing Season Is Here

We are having our first really cool night of the fall season and boy is it wheezing season here. This is the time of year that many young kids will get their first colds and some will also start to wheeze. Weather changes also seem to provoke wheezing episodes, especially if you have had a child who has previously wheezed during a cold. So, we have all of the right conditions for another wheezing season.

Wheezing runs in families, so if parents wheezed their children may be more likely to wheeze too. Many parents don't even realize they wheezed until they probe their own history, as they may have outgrown their wheezing. The genetics of wheezing is not totally understood, but just like allergies, wheezing is on the rise. If your child seems to have a tight, persistent cough, a frequent night time cough, or coughs with exercise you should discuss these symptoms with your doctor. Some children will only have a persistent cough as their presentation, but with enough history you can figure out that their cough is due to cough variant asthma, and all of the cough medicines in the world are not going to stop that nighttime cough (remember don't be giving young children over the counter cough medicines). Much of the diagnosis is made through a good history and physical exam and appropriate medication will stop that recurrent cough. If your child has already been diagnosed with asthma or reactive airways disease, make sure you have your inhalers refilled and current. Wheezing season is here and won't go away quickly so be ready. Some children will need to be on preventative medicines too. That's another topic for discussion with your doctor. Enjoy the weather changes, it feels great outside! That's your daily dose, we'll chat tomorrow.

Your Baby

Special Baby Formulas Don’t Prevent Asthma, Allergies

2:00

Parents that have a baby at risk or allergies, asthma or type-1 Diabetes sometimes turn to hydrolyzed milk formulas in hopes of lowering their infant’s risk of developing these problems.

A new review of the data on hydrolyzed formulas finds that there is no evidence that they actually protect children from these types of autoimmune disorders.

"We found no consistent evidence to support a protective role for partially or extensively hydrolyzed formula," concluded a team led by Robert Boyle of Imperial College London in England.

"Our findings conflict with current international guidelines, in which hydrolyzed formula is widely recommended for young formula-fed infants with a family history of allergic disease," the study authors added.

In the study, Boyle's team looked at data from 37 studies that together included more than 19,000 participants and were conducted between 1946 and 2015.

The investigators found that infants who received hydrolyzed cow's milk formula did not have a lower risk of asthma, allergies (such as eczema, hay fever, food allergies) or type 1 diabetes compared to those who received human breast milk or a standard cow's milk formula.

The researchers also found no evidence to support an FDA-approved claim that a partially hydrolyzed formula could reduce the risk of the skin disorder eczema, or another conclusion that hydrolyzed formula could prevent an allergy to cow's milk.

Other experts in the United States said that the finding casts doubt on the usefulness of these kinds of specialized products.

"Allergies and autoimmune diseases [such as asthma, and type 1 diabetes] are on the rise and it would be nice if we did have a clear route to preventing them," said Dr. Ron Marino, associate chair of pediatrics at Winthrop-University Hospital in Mineola, N.Y.

"Unfortunately, despite U.S. Food and Drug Administration support [for hydrolyzed formula], the data are not compelling," he said.

Dr. Punita Ponda is assistant chief of allergy and immunology at Northwell Health in Great Neck, N.Y. She stressed that when it comes to infant feeding, breast milk is by far the healthiest option.

However, "current mainstream guidelines for infant formula do recommend that parents consider using hypoallergenic formula if a close family member -- like an older brother or sister -- has a food allergy," she said. That was based on prior studies supporting some kind of protective effect, Ponda said.

Protein hydrolysate formulas were first introduced in the 1940s for babies who could not tolerate the milk protein in cow’s milk.

Protein hydrolyzed formulas are formulas composed of proteins that are partially broken down or “hydrolyzed.” They are also called hydrolysates.

There are two broad categories of protein hydrolysates:

•       Partially hydrolyzed formulas (pHF)

•       Extensively hydrolyzed formulas (eHF)

Both partially and extensively hydrolyzed protein formulas are based on casein or whey, which are proteins found in milk.  

Hydrolyzed formulas have had the protein chains broken down into shorter and more easy-to -digest chains. The more extensively hydrolyzed the formula, the fewer potentially allergenic compounds remain.

Hydrolyzed formulas are also more expensive than regular cow’s milk formulas and often harder to find.

The researchers review was published March 08, 2016 in the BMJ.

Story sources: Robert Preidt, http://www.webmd.com/parenting/baby/news/20160308/special-infant-formulas-dont-shield-against-asthma-allergies-study

Victoria Groce, http://foodallergies.about.com/od/adultfoodallergies/p/hypoallergenic.htm

 

Your Child

Low Pollen Levels Can Trigger Asthma

2.00 to read

Asthma in children has been on the increase since the 80s and the current estimated number of American children with asthma is between 6 and 9 million. It is the leading cause of chronic illness in kids under 18 years old. If your child is sensitive to pollen, a new study suggests that even low levels can increase the chances of an asthma attack. . 

Yale and Brown University researchers tracked more than 400 children with asthma, as well as the daily pollen levels near each child's home, over the course of five years. Researchers found that there was a 37% increase in respiratory symptoms in children who were sensitive to pollen- even though pollen levels were very low- and they were taking daily medications to control their asthma.

“In some respects, it's common sense that if a child is asthmatic and allergic to pollen, when they're exposed to pollen, they would bear some risk of asthmatic symptoms," said lead author Curt DellaValle, of the Yale School of Forestry and Environmental Studies.

"The biggest thing, though, is seeing these effects even with the lowest levels of pollen," he told Reuters Health. "It leads us to believe that parents of these asthmatic children should be aware that even when pollen levels are low, their children will experience asthmatic symptoms."

The study also revealed data that surprised researchers. Pollen-sensitive kids that were part of the study had fewer symptoms when ragweed – a major irritant- was at high levels. DellaValle said it may mean that the children's parents reacted to high pollen reports and took extra precautions.

"It suggested that they modified their children's behavior by keeping them inside, in air conditioning or by using air filters," DellaValle said.

Here’s how the study worked:

DellaValle's team recruited 430 children with asthma between the ages of four and 12 in New York, Connecticut and Massachusetts between 2000 and 2003. Each kid's mother kept a calendar tracking her child's asthma symptoms and use of asthma medications. The researchers also tested the children's blood for sensitivity to pollens from trees, grass and weeds.

To get a better picture of realistic pollen exposures, every year during the Northeast's pollen season -- generally from late March to early October -- the researchers used a model to analyze the amount of pollen within 1.2 miles of each child's home. They also tracked daily and seasonal weather, foliage, when pollen seasons began and ended and peak pollen periods.

Among kids with sensitivities to particular types of pollen, even small amounts in the air could trigger asthma symptoms.

Children not on maintenance medication who were sensitive to grass pollen, for example, wheezed, coughed and had trouble breathing and other nighttime symptoms when they were exposed to more than two grains per cubic meter of grass pollen.

Kids on daily maintenance therapy and sensitive to weed pollen could have similar symptoms and a need for rescue medication at pollen levels above six to nine grains per cubic meter.

Among the kids sensitive to weed pollen, low-level exposures raised their risk of symptoms by 37 percent. That compared to a 23 percent rise in risk during the highest weed-pollen periods -- hinting that kids may have stayed indoors when pollen levels were known to be high, the researchers note.

Pollen levels were not tied to an increase in asthma symptoms in kids without allergies to specific pollens.

Parents with asthmatic children often follow pollen reports and adjust their children’s outdoor activity accordingly. This study shows that even low levels of pollen can affect a sensitive child’s breathing and general health.

Although there is no cure for asthma, it can be managed with proper prevention and treatment. There is often a genetic compound.

Asthma symptoms can be mild or severe, and many children’s symptoms become worse at night.

Symptoms may include:

- Frequent, intermittent coughing.

- A whistling or wheezing sound when exhaling.

- Shortness of breath.

- Chest congestion or tightness.

- Chest pain, particularly in younger children.

- Trouble sleeping caused by shortness of breath, coughing or wheezing.

- Bouts of coughing or wheezing that get worse with a respiratory infection, such as a cold or the flu.

- Delayed recovery or bronchitis after a respiratory infection.

- Trouble breathing that may limit play or exercise.

- Fatigue, which can be caused by poor sleep.

If your child experiences any of the above symptoms, make sure he or she is seen by a pediatrician or family doctor. 

 

 

Sources:

http://www.reuters.com/article/2011/12/01/us-pollen-levels-idUSTRE7B02HG...

http://www.mayoclinic.com

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 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.

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Asthma

Asthma Season is Here!

Your Teen

Acetaminophen, No Threat To Child's Liver

2.00 to read

With more than eight million American kids taking the drug every week, acetaminophen is the nation's most popular drug in children. It's toxic to the liver in high doses, and can be fatal if taken in excess. Very rarely, adults may also get liver damage at normal doses, so doctors had worried if the same was true for kids. Concerns about liver injuries in children who take the common painkiller acetaminophen, sold as Tylenol in the U.S. are unfounded, researchers said on Monday. "None of the 32,000 children in this study were reported to have symptoms of obvious liver disease," said Dr. Eric Lavonas of the Rocky Mountain Poison and Drug Center in Denver. "The only hint of harm we found was some lab abnormalities." With more than eight million American kids taking the drug every week, acetaminophen is the nation's most popular drug in children. It's toxic to the liver in high doses, and can be fatal if taken in excess. Very rarely, adults may also get liver damage at normal doses, so doctors had worried if the same was true for kids. "This drug is used so commonly that even a very rare safety concern is a big concern," said Lavonas, whose findings appear in the journal Pediatrics. Some researchers suspect there is a link between long-term use of acetaminophen and the global rise in asthma and allergies, but the evidence is far from clear at this point. For the new report, researchers pooled earlier studies that followed kids who had been given acetaminophen for at least 24 hours. There were no reports of liver injuries leading to symptoms such as stomachache, nausea or vomiting, in the 62 reports they found. Ten kids, or about three in 10,000, had high levels of liver enzymes in their blood, which usually means their livers have been damaged. In most cases, however, those elevations were unrelated to acetaminophen. And even if they were caused by the drug, they don't indicate lasting damage, according to Lavonas. "Acetaminophen is extremely safe for children when given correctly," he said. "Parents should not be afraid to give acetaminophen to their children when they need it, but they should be very careful about giving the right dose." "If you suspect that you have given a child an overdose, call your state's poison center," he added. The Rocky Mountain Poison and Drug Center receives funding from McNeil Consumer Healthcare, the Johnson & Johnson subsidiary that sells Tylenol, but the researchers said the company did not support this study.

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