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Daily Dose

Diabetes On the Rise

1:30 to read

Diabetes continues to be a growing problem among our nation’s children.  Did you know that every year there are over 25,000 children diagnosed with diabetes?  

 

To begin with there are two different types of childhood diabetes, type 1 and type 2 and while both cause an elevated blood sugar, they also differ in many ways.

 

Type 1 diabetes was formerly called juvenile onset diabetes and is typically diagnosed in children and adolescents. Only 5% of those with diabetes have type 1 diabetes. Many parents worry that their child may develop diabetes because they eat too much sugar…and while eating sugar is not good for you, it does not directly cause type 1 diabetes.  Type 1 diabetes is an autoimmune disease in which the immune system attacks and destroys the beta cells ( insulin producing cells)  of the pancreas. Scientists are not exactly sure why this occurs, but it seems to be a combination of genetic and environmental factors, and actually has nothing to do with diet. 

 

Type 1 diabetes comes on suddenly and causes dependence on insulin for the rest of the child’s life. The symptoms of type 1 diabetes usually include extreme thirst, frequent urination (day and night), increased appetite and sudden weight loss. Children who develop type 1 diabetes appear tired, thin and sick. I tell many a parent who worry that their child is diabetic, that they really cannot miss the symptoms and just drinking a lot of water will not be the only symptom. 

 

Fortunately, the ways in which insulin is given continues to improve and most children now use an insulin pump which delivers insulin in a more consistent manner than in previous years.  But, even with new insulin delivery systems and the hopes for pancreas transplants, type 1 diabetes is challenging for a family to manage. 

 

Type 2 diabetes which was previously called “non insulin dependent diabetes” differs in that it was previously typically diagnosed in adults, but it is now rising in children.  In type 2 diabetes the body isn’t able to use insulin in the right way and the glucose in the blood stream is less able to enter the cells. This is called insulin resistance.  So, the pancreas tries to produce even more insulin to keep blood sugar levels normal. Over many years the pancreas may wear out completely. Type 2 diabetes is sometimes controlled with an oral medication rather than insulin.

 

Type 2 diabetes seems to develop more frequently in those children who are overweight, less active and often have a parent with diabetes. As more children in this country have developed obesity, the number of cases of type 2 diabetes has also continued to rise.  In many cases if a child changes their lifestyle and eats a healthy diet, loses weight and exercises the body may be able to restore normal insulin balance. In this way type 2 diabetes differs from type 1 diabetes.

 

If you are concerned that your child is showing any signs of diabetes make sure to consult your doctor.  Continue to promote healthy eating habits and daily exercise for all children!

 

 

Your Baby

Pregnant? Exercise is Good For You!

2:00

For years, the prevailing thought has been – if you didn’t exercise before, during pregnancy wasn’t the time to start. That’s no longer the case says, Alejandro Lucia, a professor of exercise physiology at the European University of Madrid.

A group of researchers want women to know that when it comes to exercise, there is a strong consensus of benefit for both the mother and developing fetus.

"Within reason, with adequate cautions, it's important for [everyone] to get over this fear," said Lucia.

According to the American College of Obstetricians and Gynecologists (ACOG), which updated its recommendations in 2015, women without major medical or obstetric complications should get at least 20 to 30 minutes of moderate-intensity aerobic exercise — enough to get you moving, while still being able to carry on a conversation — on most days of the week.

Lucia noted that evidence now suggests that starting an exercise program while pregnant can provide health benefits to both the mother and the growing fetus. Obviously, though, if you're new to exercise, take it slowly — you can work up to that 20 or 30 minutes.

The authors of the study say physical activity can prevent excessive weight gain, which can complicate the pregnancy and contribute to obesity. A review of existing research published in 2015 by the Cochrane Library found "high-quality evidence" that exercise during pregnancy can help prevent gaining too much weight, and may possibly lower the likelihood of a cesarean section, breathing problems in newborns, maternal hypertension and a baby that is significantly bigger than average. And of course, exercise promotes general cardiovascular and muscular health.

Other health problems can be helped such as chronic high blood pressure, gestational diabetes and women who are overweight or obese. Researchers say women with these conditions should be encouraged to exercise.

However, there are some health conditions in pregnancy where exercise should be avoided. According to the ACOG guidelines, women should avoid aerobic exercise if they have significant heart disease, persistent bleeding in the second or third trimester, severe anemia and risk of premature labor, among other conditions. And certain symptoms, such as contractions or dizziness during exercise, should be checked out quickly.

The bottom line is that women need to make a plan with their physician, taking into account their exercise history, their health, and the risk of pregnancy complications, says James Pivarnik, a professor of kinesiology and epidemiology at Michigan State University. He wasn't an author of the viewpoint but has conducted research on exercise and pregnancy.

Moderation is the goal during any exercise program. Long distance running and heavy weight lifting are not recommended. ACOG also recommends against contact sports, hot yoga, and exercises done in the supine position, i.e. lying face up, starting in the second trimester.

There are always exceptions to the rule, particularly with women who are highly trained athletes before they become pregnant. These women should still form plan with their OB/GYN on how much and what kinds of exercises are safe for them.

Among the general population and pregnant women specifically, people will respond differently to an exercise program. "But we know if you do the kind of things they're talking about here, the odds are your risk will be lower," says. Pivarnik.

Story source: Katherine Hobson, http://www.npr.org/sections/health-shots/2017/03/21/520951610/exercising-while-pregnant-is-almost-always-a-good-idea

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Emergency

Head to the Emergency Room

Your Child

What to Do If Your Child Is Choking

2.30 to read

It’s more common than you probably think. On average over 12,000 children a year, under the age of 14, are treated in hospital emergency rooms for food-related choking. That’s about 34 kids a day according to a new study.

The most common choking hazards appear to be hard candy, followed by other types of candy, then meat and bones. The study noted that most of the young patients were treated and released, but around 10 per cent were hospitalized.

"These numbers are high," said Dr. Gary Smith, who worked on the study at Nationwide Children's Hospital in Columbus, Ohio.

What's more, he added, "This is an underestimate. This doesn't include children who were treated in urgent care, by a primary care physician or who had a serious choking incident and were able to expel the food and never sought care."

The estimated 12,435 children ages 14 and younger that were treated for choking on food each year also doesn't include the average 57 pediatric food-choking deaths reported by the U.S. Centers for Disease Control and Prevention annually, the researchers noted.

Smith and his colleagues analyzed injury surveillance data covering 2001 through 2009.

They found that babies one year old and younger accounted for about 38 percent of all childhood ER visits for choking on food. Many of those infants choked on formula or breast milk.

Children who choked on hotdogs, nuts and seeds were the most likely to be hospitalized.

"We know that because hot dogs are the shape and size of a child's airway that they can completely block a child's airway," Smith told Reuters Health, noting that seeds and nuts are also difficult to swallow when children put a lot in their mouths at once.

Supervision is the most important choking prevention. Parents or guardians should make sure that a small child’s food is cut up into manageable bites that can be easily chewed and swallowed. An example might be grapes and raisins. A whole raisin is probably okay to be given to a toddler, but a grape should be sliced.

What should you do if your child is choking?

For children ages 1 to 12:

1. Assess the situation quickly.

If a child is suddenly unable to cry, cough, or speak, something is probably blocking her airway, and you'll need to help her get it out. She may make odd noises or no sound at all while opening her mouth. Her skin may turn bright red or blue.

If she's coughing or gagging, it means her airway is only partially blocked. If that's the case, encourage her to cough. Coughing is the most effective way to dislodge a blockage. If the child isn't able to cough up the object, ask someone to call 911 or the local emergency number as you begin back blows and chest thrusts. If you're alone with the child, give two minutes of care, then call 911.

On the other hand, if you suspect that the child's airway is closed because her throat has swollen shut, call 911 immediately. She may be having an allergic reaction to the food.

Call 911 immediately is your child is turning blue, unconscious or appears to be in severe distress.

2. Try to dislodge the object with back blows and abdominal thrusts.

If a child is conscious but can't cough, talk, or breathe, or is beginning to turn blue, stand or kneel slightly behind him. Provide support by placing one arm diagonally across his chest and lean him forward.
Firmly strike the child between the shoulder blades with the heel of your other hand. Each back blow should be a separate and distinct attempt to dislodge the obstruction.

Give five of these back blows.

Then do abdominal thrusts

Stand or kneel behind the child and wrap your arms around his waist.

Locate his belly button with one or two fingers. Make a fist with the other hand and place the thumb side against the middle of the child's abdomen, just above the navel and well below the lower tip of his breastbone.
Grab your fist with your other hand and give five quick, upward thrusts into the abdomen. Each abdominal thrust should be a separate and distinct attempt to dislodge the obstruction.

Repeat back blows and abdominal thrusts Continue alternating five back blows and five abdominal thrusts until the object is forced out or the child starts to cough forcefully. If he's coughing, encourage him to cough up the object.

If the child becomes unconscious If a child who is choking on something becomes unconscious, you'll need to do what's called modified CPR. Here's how to do modified CPR on a child:

Place the child on his back on a firm, flat surface. Kneel beside his upper chest. Place the heel of one hand on his sternum (breastbone), at the center of his chest. Place your other hand directly on top of the first hand. Try to keep your fingers off the chest by interlacing them or holding them upward.

Perform 30 compressions by pushing the child's sternum down about 2 inches. Allow the chest to return to its normal position before starting the next compression.

Open the child's mouth and look for an object. If you see something, remove it with your fingers. Next, give him two rescue breaths. If the breaths don't go in (you don't see his chest rise), repeat the cycle of giving 30 compressions, checking for the object, and trying to give two rescue breaths until the object is removed, the child starts to breathe on his own, or help arrives.

A good rule of thumb for parents and guardians is to take a CPR class. Many hospitals and clinics also offer classes on what to do if your child is choking.

Sources: Genevra Pittman, http://www.reuters.com/article/2013/07/29/us-choking-food-idUSBRE96S04K20130729

http://www.babycenter.com/0_first-aid-for-choking-and-cpr-an-illustrated-guide-for-child_11241.bc

 

Your Child

Kid’s With Partial Deafness Should be Treated

2:00

Many parents that have a child with partial deafness do not get the condition treated according to new research.

“Traditionally, asymmetric deafness in childhood, particularly when only one ear is affected, has been overlooked or dismissed as a concern because the children have had some access to sound,” said lead author Karen Gordon of Archie’s Cochlear Implant Laboratory at The Hospital for Sick Children in Toronto, Canada.

“The problem is that children with asymmetric hearing still have a hearing loss,” Gordon said in an email to Rueters Health. “Without normal hearing from both ears, they experience deficits locating sounds around them.”

While a child with partial hearing can hear sounds, the task is more difficult when there are other noises in the room or other people speaking at the same time, Gordon said.

One of the main issues is lack of information,” said Dayse Tavora-Vieira of the University of Western Australia n West Perth, who was not part of the new review. “The implications of unilateral hearing loss/deafness have been historically underestimated by professionals and this has reflected on how they counsel parents.”

Also, the children may not show a handicap until educational, social and emotional concerns become clear later in life, she told Reuters Health in an email.

The researchers noted that newborns and young children with deafness in one ear should be treated early to help minimize long-term problems such as delayed speech and language development as well as being at risk of poor academic performance, usually with poorer vocabulary and simpler sentence structure than their normal-hearing peers, Tavora-Vieira said.  

Gordon and her colleagues reviewed research from neuroscience, audiology and clinical settings “that points to the existence of an impairment of the central representation of the poorer hearing ear if developmental asymmetric hearing is left untreated for years,” they write.

“We suggest that asymmetric hearing in children be reduced by providing appropriate auditory prostheses in each ear with limited delay,” Gordon noted. “The type of auditory prosthesis will depend on the degree and type of hearing loss.”

According to the 2009 Centers for Disease Control and Prevention survey, almost two in every 1,000 babies have some form of deafness discovered by early life screening.

With those kinds of numbers, what types of treatments are available for a child’s hearing loss? Currently, there is the cochlear implant for profound deafness, a hearing aid, a bone anchored hearing aid or a personal listening device like a radio-enabled ear-bud in the hearing ear. For the last treatment, a speaking source, like a teacher, speaks into a microphone, which transmits sound by FM signal to the ear-bud.

“Appropriate recommendations can be made by otolaryngologists and audiologists,” Gordon said.

Parents should seek a second opinion if a diagnosis is made and no options for rehabilitation are offered, Tavora-Vieira noted.

The research was published in the June online edition of Pediatrics.

Source: Kathryn Doyle, http://www.reuters.com/article/2015/06/10/us-child-deafness-diagnosis-treatment-idUSKBN0OQ29A20150610

 

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

 

 

 

 

Your Child

Stuttering and Kids

1:45

Does your child stutter? If so, he or she is not alone. More than 70 million people worldwide stutter.  Many famous people have been stutters such as musician and singer, Ann Wilson, from the band Heart, Prime Minister Winston Churchill and actor and orator James Earl Jones, to name just a few.

Stuttering is a common communication disorder that affects more boys than girls. No one knows the exact cause of stuttering, but there are four factors that most likely contribute:

  • Genetics: About 60 percent of those that stutter have a family member that stutters.
  • Neurophysiology: People that stutter may process speech and language slightly differently than those who do not stutter.  Stroke, head trauma or any other type of brain injury can also contribute to stuttering.
  • Child development: Developmental stuttering occurs in young children while they are still learning speech and language skills. It is the most common form of stuttering. Some scientists and clinicians believe that developmental stuttering occurs when children’s speech and language abilities are unable to meet the child’s verbal demands.
  • Family dynamics: Pressure, tension, fast paced lifestyles and stress within the family unit can make it difficult for a child to communicate.

There’s no miracle cure for stuttering but there are therapies that, over time, can help children and teens make significant progress towards fluency.

It’s important to remember that it’s normal for kids to stutter occasionally.

A child may stutter for a few weeks or several months, and the stuttering may be sporadic. Most kids, who begin stuttering before the age of 5, stop without any need for interventions such as speech or language therapy.

If your child is 5-years-old and still stuttering, you might want to have him or her tested by a speech pathologist or you can talk with your pediatrician for more information.

Kidshealth.org offers these tips for parents looking to help to help their child. How you communicate with your child when they stutter can have an important impact on how they see themselves.

  • Don't require your child to speak precisely or correctly at all times. Allow talking to be fun and enjoyable.
  • Use family meals as a conversation time. Avoid distractions such as radio or TV.
  • Avoid corrections or criticisms such as "slow down," "take your time," or "take a deep breath." These comments, however well intentioned, will only make your child feel more self-conscious.
  • Avoid having your child speak or read aloud when uncomfortable or when the stuttering increases. Instead, during these times encourage activities that do not require a lot of talking.
  • Don't interrupt your child or tell him or her to start over.
  • Don't tell your child to think before speaking.
  • Provide a calm atmosphere in the home. Try to slow down the pace of family life.
  • Speak slowly and clearly when talking to your child or others in his or her presence.
  • Maintain natural eye contact with your child. Try not to look away or show signs of being upset.
  • Let your child speak for himself or herself and to finish thoughts and sentences. Pause before responding to your child's questions or comments.
  • Talk slowly to your child. This takes practice! Modeling a slow rate of speech will help with your child's fluency.

Many successful adults were stutterers when they were young, some - even into adulthood. However, they have persevered and with the support of others and therapies, have brought their stuttering under control. If your child stutters, it doesn’t mean they have a lifetime disability; many children grow out of stuttering. If you’re concerned about your child, talk with your pediatrician or family physician.

Story sources: http://www.stutteringhelp.org

http://kidshealth.org/en/parents/stutter.html#

 

Daily Dose

Milk vs. Non Cow's Milk

1:00 to read

Once your child turns one, the AAP recommends that they transition from formula to milk…cow’s milk that is. But, more and more of my patients state that they prefer to drink almond milk, soy milk, rice milk, coconut milk, hemp milk and even goat’s milk. I am constantly having to look up the calcium, protein or fat content of all of these “cow’s milk alternatives”.  In the majority of the cases there is not a medical issue driving the choice of milk, but rather parental preference for non dairy, lactose free etc. etc.  

 

Interestingly, I just read an article from the American Journal of Clinical Nutrition that found that children that drink non-cow’s milk may be “slightly shorter” than those children of the same age who drink cow’s milk. There is an ongoing research project which studied about 5,000 children between the ages of 2 and 6, and looked for height differences between those children “who consumed about 8 ounces of non-cow’s milk per day compared to those who drank the same amount of cow’s milk”. 

 

The children who drank non-cow’s milk were about 0.15 inches shorter than average for their age. Although this is just one study,  it will be important to continue to evaluate this data to see if the height differences continue into adolescence. This is a good study to keep following.

 

While I am always concerned about the calcium intake in children and their long term bone health, here is yet another concern.

 

It may be time to re-think your family’s milk choice and unless there is a medical reason to avoid dairy…..try good old cow’s milk…it may actually make you a bit taller?  

Your Child

More Myths About the Measles Vaccine

2:00

As measles cases continue to climb, people are taking notice. Public health officials as well as a growing list of politicians are asking parents to make sure that their child or children get the MMR vaccine.

While support is growing to have all children immunized against the highly contagious disease, anti-vaccination groups are also speaking out through media outlets, emails, social media and blogs.

In the 1990s, a now discredited study linked the MMR vaccine to autism. Parents reacted with fear throughout world and began opting out of getting their children vaccinated against measles, mumps and rubella.

Since that time, dozens of medical studies have been conducted and found no connection between the vaccine and autism. The doctor, Andrew Wakefield, was stripped of his license and the British Medical Journal called his research “fraudulent.”

That hasn’t stopped people from continuing to quote his discredited findings.

With so much attention being given to measles these days, new myths have popped up from people who continue to spread fear about the MMR vaccine.

Two myths in particular are making the rounds:

1. The vaccine doesn’t work because it protects against a different strain.

The first concern, which has been posted on anti-vaccination blogs, is that the vaccine protects against an “A” type of measles virus, while the kind that’s making everyone sick is a “B”-type virus. Therefore, the vaccine doesn’t protect against the kind of measles that’s making everyone sick.

It’s true that are different strains of the measles virus, but it doesn’t act like the flu virus – where different strains can overpower a particular vaccine. Each measles virus is given a letter and a number, for example B3 or D4. They refer to the genetic fingerprint of the virus. Since 1990, 19 different strains, or fingerprints, have been identified, according to the CDC, and scientists use these fingerprints to link infections during an outbreak.

However, the measles virus doesn’t change as much as the flu virus. Once the current vaccine and boosters are in the body’s system – the vaccine protects against all strains of measles.

2. It’s vaccinated people who are spreading measles, not those that are unvaccinated.

The thought behind this myth is that the measles shot, which contains a weakened but live form of the virus, can give people infections that allow them to pass on the disease to others.

It’s an interesting twist according to William Schaffner, MD, an infectious disease specialist at Vanderbilt University in Nashville, TN.

“The vaccine virus, can, on occasion, spread to others,” Schaffner says. “That gives them protection. It doesn’t give them disease.”

But, he says, to be clear: "On occasion" means the possibility is so remote that it’s highly unlikely.

If that were to happen, Schaffner says, it would actually be a good thing because the person who “caught” the vaccine virus would get the protection, but not the illness. Most likely, they wouldn’t even know it occurred. Other experts say this is more theory than anything else.

Some parents believe measles is a somewhat minor disease that may cause a short period of illness and doesn’t have any long-term effects. There are even groups that have “measles parties” so their children can build a “natural” immunity.

Measles can be fatal to children, adults with suppressed immune systems and the elderly – that’s a very long-term side effect. It can cause encephalitis (an inflammation of the brain) and require intensive care in the hospital. Complications from measles can cause permanent hearing loss. Measles is not something you want to mess with. Medical experts agree that parents need to get the real facts and have their children vaccinated. 

Source: Brenda Goodman MA, http://www.webmd.com/children/vaccines/news/20150210/measles-vaccine-myths

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