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Daily Dose

Penicillin Allergy

1:30 to read

Has your child ever been labelled “penicillin allergic”?  Interestingly, up to 10% of people (of all ages) report having a penicillin allergy, but only about 1% are truly allergic. I see this often in my own practice, especially when seeing a new patient and inquiring about drug allergies, and the parent replies, “ she is penicillin allergic, and developed a rash when she was younger”.  In many if not most of those cases the child is not allergic to penicillin.

 

Penicillins are a class of antibiotics known as beta-lactams and include not only penicillin but  amoxicillin, augmentin, oxacillin and nafcillin, just to name a few.  If you are incorrectly identified as penicillin allergic, when your doctor needs to prescribe an antibiotic they may resort to another class of antibiotic, which are not only more expensive but often may cause more side effects.  

 

Penicillins are the antibiotic of choice and the first line treatment for many pediatric bacterial illnesses including otitis ( ear infections ), strep throat, and sinus infections. They are not only effective, but they are typically inexpensive and have few side effects….which includes allergic reactions.

 

Penicillin allergy is an immune - mediated reaction which usually causes hives ( raised rash ), face or throat swelling, difficulty breathing and in some cases life threatening anaphylaxis.  Intolerance to penicillin is different than being allergic, and in this case symptoms are more likely nausea, diarrhea, headache or dizziness, which may make you uncomfortable but are not immune mediated. 

 

In pediatrics, many children present with a viral illness that includes several days of fever and upper respiratory symptoms, and are then also found to have an ear infection. They are given a prescription for amoxicillin and several days later develop a rash. Many viral infections in children also cause a rash, which is typically red, flat and covers the trunk, face and extremities and does not cause any other symptoms which are seen with a true penicillin allergy.  This rash is benign, but unfortunately many young children will be seen at an urgent care or even an ER due to the rash. The parents are told that their child is penicillin allergic and the antibiotic is changed…and the label “pen allergic” sticks….for many years or even life.  I even saw this rash occur in one of my own sons while on an antibiotic. He is NOT allergic!

 

The good news is that most children are truly not penicillin allergic, and if possible I try to see all of my patients who report a rash while they are on an antibiotic. At times this is not possible, and now with the advent of “smart phones” I have parents send me a picture of the child and the rash. This often helps in determining if the rash truly appears allergic and to identify if there are other symptoms.  Back to the “get a good history”. 

 

If I see an older patient who has had a rash on amoxil when they were little and had no other adverse effects (get a good history), I will sometimes try using a penicillin again, as most people also “outrgrow” their sensitivity after about 10 years. If it is my patient and I have seen the rash I tell the parents that this is not a “pen allergy” and I will use penicillins again.  Some  patients will report a “pen-allergy” but say I can take “augmentin” which is penicillin derivative, so that makes it easy to know they are not allergic.  If I am unsure if a child has had a true penicillin allergy I will refer them to a pediatric allergist for skin testing.  Skin testing is not painful and is an important method for documenting a true allergy. 

 

 

   

Your Baby

Weight Gain During Pregnancy

2.00 to read

Every pregnant woman wonders how much weight she could gain during pregnancy. For some women, being pregnant is an open invitation to eat whatever and whenever they like, while other woman worry what the weight gain will do to their figure. There is no absolute law about weight gain during pregnancy, but there are set of guidelines that can help you.

Weight gain should be based on your pre-pregnancy body mass index (BMI.) Your health and your baby’s health also play a role in how much weight you should gain.

Here’s a list of suggested pregnancy weigh gain related to a healthy woman’s BMI.

  • Underweight (BMI less than 18.5) – 28 to 40 pounds
  • Normal weight (BMI 18.5 to 24.9) – 25 to 35 pounds
  • Overweight (BMI 25 to 29.9) – 15 to 25 pounds
  • Obese (BMI 30 or more) – 11 to 20 pounds

Multiples are a different story. If you are carrying twins or other multiples you’re likely going to need to gain more than average weight. Your health care provider can help you determine what is right for you. Here are the recommended weight gain options.

  • Normal weight (BMI 18.5 to 24.9) – 37 to 54 pounds
  • Overweight (BMI 25 to 29.9) – 31 to 50 pounds
  • Obese (BMI 30 or more) – 25 to 42 pounds

If you are overweight when you become pregnant, pregnancy increases the risk of various complications including diabetes and high blood pressure. Of course, a certain amount of weight gain is normal, but too much adds to the possibility of dangerous health risks for the woman and the child.

Remember that if you gain more than the recommended amount during pregnancy and you don't lose the weight after the baby is born, the excess pounds increase your lifelong health risks. Gaining too much weight during pregnancy can also increase your baby's risk of health problems at birth and childhood obesity.

If you're underweight, it's essential to gain a reasonable amount of weight while you're pregnant. Without the extra weight, your baby might be born earlier or smaller than expected.

Calculating your BMI is not difficult; you just need to know your height and weight. There are several online BMI calculators that will do the math for you. Your healthcare provider should also have a BMI chart that can show you your BMI.

So, how is the extra weight used by your body when your pregnant? Here’s a simple list to help you follow a normal weight gain.

  • Baby: 7 to 8 pounds
  • Larger breasts: 2 pounds
  • Larger uterus: 2 pounds
  • Placenta: 1 1/2 pounds
  • Amniotic fluid: 2 pounds
  • Increased blood volume: 3 to 4 pounds
  • Increased fluid volume: 3 to 4 pounds
  •  Fat stores: 6 to 8 pounds

During your first trimester, you probably won’t gain much weight. Steady weight gain is more important in the second and third trimesters, especially if you begin at a normal weight or are underweight.

Exercise is also important during pregnancy. Even a moderate amount of exercise will help keep your body strong as the extra pressure builds while you are carrying.

As your pregnancy develops, more than likely you’re appetite will increase. That’s not a bad thing. Just fill those hunger pains with healthy food choices!

Source: http://www.mayoclinic.org/pregnancy-weight-gain/art-20044360

 

 

Your Child

40% of Children 3 to 11 Are Exposed to Secondhand Smoke

2:00

The good news is that exposure to secondhand smoke dropped by half in the United States between 1999 and 2012. While more and more people are giving up the unhealthy habit, the amount of children being exposed to secondhand smoke is still significant – particularly in the African-American population. 

In a recent report, The Centers for Disease Control and Prevention (CDC) estimated that 58 million American nonsmokers are exposed to secondhand smoke.

In that group, the CDC suggests that 40 percent of children aged 3 to 11 are breathing in secondhand smoke and among black children, the number is much higher at 70 percent.

"Secondhand smoke can kill, and too many Americans -- and particularly too many children -- are still exposed to secondhand smoke," Dr. Tom Frieden, director of the CDC, said during a midday press conference.

Frieden, citing the U.S. Surgeon General, said, "There is no safe level of exposure to secondhand smoke." Tobacco smoke contains over 7,000 chemicals including about 70 that can cause cancer, he added.

The connection of secondhand smoke and illnesses in children has been widely studied and reported. In infants and children, secondhand smoke has been linked to sudden infant death syndrome (SIDS), respiratory infections, ear infections and asthma attacks.

In adult nonsmokers, passive smoke has been tied to heart disease, stroke and lung cancer, according to Frieden.

Each year, secondhand smoke kills more than 41,000 Americans from lung cancer and heart disease, and causes 400 deaths from SIDS, Frieden said. "These deaths are entirely preventable," he added.

Susan Liss, executive director of the Campaign for Tobacco-Free Kids, said in a statement: "The high level of child exposure to secondhand smoke also underscores the need for parents to take additional steps to protect children, such as ensuring that homes, cars and other places frequented by children are smoke-free. For parents who smoke, the best step to protect children is to quit smoking."

Smoking can become such a mindless habit that parents and caregivers forget that their children are breathing in the smoke they exhale. In nonsmoking homes, it can be difficult when friends or other family members want to light up when visiting. Asking people to either step outside or not smoke in the house has caused many a friends and family rift. But, standing your ground will protect your child from the influence of smoking and the polluted air that flows from a smoker.

Most restaurants, bars and workplaces have issued smoke-free policies but one's home and auto are open to personal choice. The number of U.S. households that are now smoke-free has increased in the past 20 years from 43 percent to 83 percent and that’s truly amazing considering our long love affair with cigarettes and cigars!

However, when 1 in 4 nonsmokers – including many children-are still being exposed, it’s going to take more parents, friends and family members to put down their cigarettes for good to finally stop children and adults from suffering the disastrous effects of breathing in secondhand smoke.

Source: Steven Reinberg, http://consumer.healthday.com/kids-health-information-23/adolescents-and-teen-health-news-719/58-million-americans-exposed-to-secondhand-smoke-cdc-696149.html

Your Teen

Teen Athletes Leading the Nation in Tommy John Surgeries

2:00

Teen athletes accounted for more than half of the Tommy John surgeries performed in the U.S. from 2007 to 2011 according to a new study. The surgery is actually an ulnar collateral ligament reconstruction (UCLR) graft procedure in which the ulnar collateral ligament in the elbow is replaced with a tendon from elsewhere in the body. Tommy John was the first Major League baseball pitcher to have the surgery and the nickname has now become common use.

 “Our results showed that 15- to 19-year-olds accounted for 56.7 percent of the Ulnar Collateral Ligament Reconstruction (UCLR) or Tommy John surgeries performed in the US between 2007 to 2011," said lead study author Brandon Erickson, MD, of Rush University Medical Center in Chicago, in a press release. "This is a significant increase over time with an average increase of 9.12 percent per year.”

Once a player has the surgery, he or she needs a good 12 to 15 months of recovery time before they are able to return to a high level of sport activity. Oftentimes, a second surgery may be required as the athlete continues to strain the ligament.

Baseball pitchers are the athletes that most often require the surgery because of the way they pitch; overhanded instead of underhanded. Many believe that the problems start in the teenage years with players who throw harder than ever and don't ever take a month off.

Dr. Erickson and his team looked at a private insurance database to identify patients who received UCLR surgeries throughout the US.

About 4 out of every 100,000 patients who had surgery between 2007 and 2011 had a UCLR surgery. These patients were overwhelmingly male, with 32 percent coming from the 15- to 17-year-old age group and 22 percent coming from the 20- to 24-year-old age group.

These surgeries grew at a rate of 4.2 percent each year between 2007 and 2011. And more than half were performed in the southern region of the US.

Another reason many teen athletes are susceptible to injury is that they play only one sport and play year-round, never giving their immature bodies enough time to rest and repair.

According to Dr. Erickson, more attention should be given to prevention because overuse injuries tend to occur in intensive training and high-performance games.

"The research numbers suggest that more young athletes believe that having an UCLR procedure performed earlier in their career may lead to the big leagues or a scholarship, even though only 1 in 200 kids who play high school baseball will make it to the MLB," Dr. Erickson said. "This paradigm shift needs to be evaluated further to help prevent overuse injuries in kids from the beginning of the season when most issues arise."

Some teens simply play through the pain without considering the possible long-term physical problems that could quickly end the career they worked so hard to attain. It’s up to the adults in their lives to watch over and give them the guidance they need to stay healthy. Parents and coaches need to make sure that their kids and students are following the safety rules established by the sport associations and organizations.

This study was presented at the American Orthopaedic Society for Sports Medicine's annual meeting. Research presented at conferences may not have been peer- reviewed.

Source: Beth Greenwood, http://www.dailyrx.com/tommy-john-surgeries-elbow-overuse-injuries-were-common-teen-athletes

 

 

 

 

Your Teen

FDA Proposes Ban on Tanning Beds for Minors

1:30

When warm summer days give way to cold gray skies, tanning beds can become the go-to alternative for a continuous tan. A 2014 study found that 59% of college students and 17% of teens use indoor tanning beds and a 2011 study reported that 32% of 12th graders had used a tanning bed.

Researchers have also found that people who use tanning devices before age 20 were twice as likely to develop a form of skin cancer called basal cell carcinoma by age 50, than those who had never used a tanning bed. Tanning beds are known to contribute to other skin cancers as well, including melanoma, the deadliest form of the disease.

Several studies from Europe have suggested that the radiation from a tanning bed can be up to 15 times more intense than the radiation from the midday sun.

After years of studies, the U.S. Food And Drug Administration (FDA) is proposing a ban on tanning beds for people under the age of 18, along with new preventive measures that reduce the risks from tanning to adults.

Using tanning beds at a young age can be particularly harmful, according to a statement from the FDA. The effects of UV radiation exposure add up over a lifetime, so exposure in children and teenagers puts them at greater risk for skin and eye damage later in life, according to the statement.

How many minors are using tanning beds? According to a 2013 National Youth Risk Behavior Study, about 1.6 million adolescents.

The "action is intended to help protect young people from a known and preventable cause of skin cancer and other harms," Dr. Stephen Ostroff, the acting FDA commissioner, said in the statement.

The American Academy of Pediatrics responded to the FDA's proposal with a statement of support.

"The FDA's action today is part of ensuring a safe environment for every child and adolescent, and sends a loud and clear message: Tanning beds are dangerous and should not be used by anyone under age 18," said the academy. "Pediatricians welcome FDA's action and will continue to urge parents and our young patients to protect their skin from ultraviolet radiation and to avoid tanning beds altogether."

In addition to restricting minors, the FDA is proposing that before a person's first tanning bed session and every six months thereafter, they sign a "risk acknowledge certification" that states they have been informed of the health risks that may result from indoor tanning. The hope is that people will think twice about using a tanning bed of they are reminded and have to sign off on the health dangers.

The FDA is also proposing a second rule that would require sunlamp manufacturers and tanning facilities take extra steps to improve the overall safety of the devices. Some of the proposed measures would include making warnings more prominent on the devices, requiring an emergency off switch or "panic button" and improving eye safety equipment, according to the statement.

"The FDA understands that some adults may continue to use [tanning beds]," Ostroff said in the statement. "These proposed rules are meant to help adults make their decisions based on truthful information," he said.

The new proposed rules are available for public comment for 90 days. The rules were recommended on December 21, 2015.  To comment you can log onto http://www.fda.gov/forconsumers/consumerupdates/ucm350790.htm#Proposed

Source: Sara G. Miller, http://www.livescience.com/53159-fda-proposes-tanning-bed-restrictions.html

 

 

 

 

Parenting

Backyard Chickens and Salmonella Bacteria

1:45

Chicken coops are springing up in backyards around the country. People are into raising chickens for fresh eggs and some are even developing close bonds with their feathered producers.  Unfortunately, many of the new chicken owners don’t have any experience with safely handling and keeping fowl.

While fresh eggs from the backyard may make breakfast more satisfying, there’s also a downside to raising chickens; salmonella bacteria.

The Centers for Disease Control and Prevention (CDC) says eight ongoing outbreaks of salmonella are linked to backyard chickens. These outbreaks have sickened 611 people, including 195 children under the age of 5, across 45 states since Jan. 4. Because most cases go unreported, the actual number of illnesses may be as high as 10,000, according to the CDC.

“Direct contact with chicks, chickens, ducklings, ducks, geese, and turkeys or contact with their environment can make people sick with salmonella infections,” says Megin Nichols, DVM, a veterinarian with the CDC. “Poultry can have salmonella in their droppings and on their feathers, feet, and beak, even though they appear healthy and clean.”

Salmonella can make you very ill. Symptoms include diarrhea, stomach cramps and fever. If you’re basically healthy, you’ll most likely get better without treatment.  However, children under the age of 5, adults over 65, people with chronic illnesses, people with weakened immune systems, and pregnant women have a higher risk of severe salmonella infections.

Experts say salmonella cases are increasing. The CDC says the 2016 outbreaks "involve the largest number of sick people linked to live poultry that we've seen."

The CDC is trying to pinpoint what types of contact caused the most illnesses in the recent outbreaks. In the past, baby chicks have been the source. Keeping baby chicks in the house, snuggling them, and kissing them are no-nos.

Experts say since you can’t be sure that your flock does not harbor salmonella, you should treat it as if it does.

Salmonella is part of chicken and other live poultry’s gut bacteria.  They shed it in droppings as well as onto their feathers and feet. It’s going to be anywhere you keep your birds.

Washing your hands is one of the top ways experts suggest to protect yourself.

After you handle live poultry, feed live poultry, or touch its backyard coop or living space, wash your hands vigorously for 20 seconds or more with soap and water, then dry them with a clean towel. Have an alcohol-based hand sanitizer handy in case you can’t get to a sink right away, says Elizabeth Scott, PhD, co-director of the Center for Hygiene and Health at Simmons College in Boston.

“If possible, wash your hands outdoors, not at the kitchen sink,” Scott says. “You do not want to be rinsing salmonella off your hands and into the kitchen sink, and you don’t want to use the kitchen sponge or dishrag either. The salmonella can proliferate in both.”

You should also clean any feeding dishes or other equipment outside. Do not bring them indoors.

Experts also offer these tips to prevent infection:

Wear proper clothes: Pick out clothing and a pair of boots or shoes that you will wear only when tending your flock, advises Scott, who grew up on a farm. Keep it outside. After cleaning your coop, separately wash the clothes you wore in your machine’s hot water cycle. (Wash yourself as well! A hot shower will do the trick.)

Set barriers: Chickens and other live poultry belong in the yard, not in the house, and especially not in the kitchen or any room where you store, prepare, and serve food, Scott says.

Says Nichols: “The poultry have their area, you have your area, and you keep it that way. That will definitely help prevent infection.”

Supervise your children: Children under the age of 5 should not have any direct contact with live poultry, Nichols says. Their immune systems cannot protect them enough from infection. Also, they are much more likely to put their fingers in their mouths.

Keep a close eye on older children to be sure that they don’t put their fingers in their mouths and that they wash their hands thoroughly after handling poultry.

No kissing: Don’t let a baby chick’s cuteness fool you into thinking it’s free of disease, Scott warns. “It’s better not to kiss them.”

Handle eggs properly: When you collect your flock’s eggs, which you should do at least once a day, rinse them in water that’s warmer than the eggs themselves. The warm water causes the shell to expand slightly, which helps push dirt out of pores on the shell. Don’t let them sit in the water. Use a detergent made for egg washing if your eggs are dirty. Dry them and store large side up in the refrigerator.

When you’re ready to eat, make sure to cook your eggs thoroughly. “The salmonella bacteria are actually in the yolk,” Scott says. “That’s why we shouldn’t eat raw or undercooked eggs.”

Story source: Matt McMillen, http://www.webmd.com/food-recipes/food-poisoning/20160719/backyard-chicken-salmonella

Your Child

ATV Accidents Causing Serious Chest Injuries in Kids

1:45

From rural America to the suburbs, you can count on the sound of children and their new ATV buzzing up and down the street on Christmas morning. All-terrain vehicles are a popular gift during the holidays, and more often than not, you’ll see children with a safety helmet on to reduce the risk of head trauma – should they have an accident.

What parents may not know is that these vehicles also pose a high risk for severe chest injuries, according to a new study.

"I believe that many parents are unaware of how serious ATV-related injuries can be," said the study's author, Dr. Kelly Hagedorn, a radiology resident at McGovern Medical School at the University of Texas Health Science Center at Houston.

"Some parents view ATVs as being more similar to bicycles. However, many of the injury patterns are more similar to those sustained in motor vehicle collisions," Hagedorn explained.

ATVs are motorized recreational vehicles with three or four tires, designed for off-road use. Because they can weigh 300 to 400 pounds and travel at speeds of up to 75 miles an hour, ATVs can often be involved in serious accidents, including crashes, rollovers and ejections, the researchers said.

The good news is that ATV-related injuries have declined since 2007. As public safety awareness about ATVs increases, more parents are making sure that helmets, protective clothing and personal oversight safeguard their children.

However, nearly 25,000 children under the age of 16 were treated for ATV-related injuries in hospital emergency rooms nationwide in 2014, according to the U.S. Consumer Product Safety Commission (CPSC).

Researchers suspect that one of the reasons children’s ATV-related chest injuries are becoming more severe and frequent is that the newer vehicles are larger and weigh more than their predecessors. 

"As ATVs have gotten bigger and heavier, riders have a harder time separating from the vehicle in a crash," said Gerene Denning. She's director of emergency medicine research at the University of Iowa Carver College of Medicine.

"The increasing size and weight of ATVs leads to more cases of the vehicle striking the rider. There is also a growing trend of riders being pinned by the vehicle, which can lead to compression asphyxia [a condition where the body doesn't get enough oxygen]," said Denning, who wasn't involved in this study.

The new study included records from 455 patients, 18 years old and younger. All had chest imaging at a trauma center in Houston after ATV-related incidents. The accidents occurred between 1992 and 2013. Of those admitted, 102 (22%) suffered a chest injury.

The researchers said that 40% of patients with chest injuries were treated in an intensive care unit (ICU), compared to 22% of patients without chest injuries. On average, patients with chest injuries were 13 years old.

The most common chest injury (61%) was pulmonary contusion, or bruising of the lung. About 45% of patients had a collapsed lung and 34% had rib fractures. Eight deaths occurred among the 102 patients who had chest trauma, the study found.

The study authors found that the biggest cause of chest injury was rollover (43%), followed by collision with landscape (2 %) and falls (16%).

In 41 cases, the injured child had been driving the ATV. In 33 cases, he or she had been riding along as a passenger. In the remaining 28 cases, it wasn't known whether the injured child was the driver or passenger.

While many parents are being more vigilant about ATV safety, some still believe bigger is better and are still allowing their children to operate adult-size vehicles.

"This increases both the risk of crashing and the severity of vehicle-related trauma," Denning said. "A group called Concerned Families for ATV Safety have story after story of children killed in ATV crashes. A common thread through those stories is a parent saying they didn't know how dangerous these vehicles were for their children."

ATV laws are not consistent nationwide. In many states, children younger than 16 can drive ATVs designed for adults, according to the CPSC. The American Academy of Pediatrics (AAP) recommends that children under that age be prohibited from riding ATVs.

Hagedorn is scheduled to present the study results at the annual meeting of the Radiological Society of North America, in Chicago. Findings presented at meetings are generally viewed as preliminary until they've been published in a peer-reviewed journal.

Concerned Families for ATV Safety, mentioned above, offers educational resources, news and ATV safety tips for parents. It also shares family stories of children injured or killed in an ATV accident. Their website is: http://www.cfatvsafety.org

Story source: Don Rauf, https://consumer.healthday.com/kids-health-information-23/child-safety-news-587/atv-accidents-can-cause-serious-chest-injuries-in-children-717207.html

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Your Child

Naps Help Preschoolers Learn Better

2.00 to read

There are two things adults envy about youngsters – their bountiful energy and their naps.

A new study says that those afternoon siestas that many preschoolers enjoy are not a waste of time.  In fact, a daily nap may improve their ability to learn by improving their memory skills.

Preschooler’s brains are busy. On a daily basis they are processing new and exciting information. Their brains are storing the input from these experiences in short-term storage areas said Rebecca Spencer, lead study author and a neuroscientist at the University of Massachusetts, Amherst.

"A nap allows information to move from temporary storage to more permanent storage, from the hippocampus to the cortical areas of the brain," she said. "You've heard the phrase, 'You should sleep on it.' Well, that's what we're talking about: Children need to process some of the input from the day."

Many of the nation's preschoolers put in longer days than do their working parents, arriving at school as early as 6:30 a.m. and getting picked up after 5 p.m., Spencer said. "We're all short on sleep, and the kid's sleep is affected by the parents' schedules," she said.

For the study, the researchers taught 40 children from six preschools in western Massachusetts a visual-spatial memory game in the morning. The children were asked to remember where nine to 12 different pictures were located on a grid.

During the afternoon, children were either encouraged to nap or to stay awake. Naps lasted about 80 minutes. Later in the afternoon and the following morning, delayed recall was tested between both groups -- children who were encouraged to sleep and those who were kept awake.

The researchers found that although the children performed similarly in the morning, when their retention was fresh, children forgot significantly more when they had not taken a nap. Those who had slept remembered 10 percent more than those who were kept awake. The next day, the kids who had napped the previous afternoon scored better than those who hadn't napped. The data showed that a child doesn't recover the memory benefit from nighttime sleep, the researchers said.

To better understand whether memories were actively processed during naps, the researchers took 14 preschoolers to a sleep lab for polysomnography, a sleep study that shows changes in the brain. The children took naps for about 70 minutes. The napping children showed signs of signals being sent to long-term memory from the brain's hippocampus.

"Thus, there was evidence of a cause-and effect relationship between signs that the brain is integrating new information and the memory benefit of a nap," Spencer said.

The study was published in the September issue of the journal Proceedings of the National Academy of Sciences.

Spencer is concerned about the trend in many public preschools to discontinue naps. She said naps need to be put back into the preschool day, and she wants to see exploration of ways to enhance the napping experience -- with darkened rooms and comfortable cots or pads, for example.

What’s the bottom line? "Naps are not wasted time," Spencer said.

Source: http://www.nlm.nih.gov/medlineplus/news/fullstory_140919.html

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