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Your Child

Antibiotics Often Prescribed When Not Needed

2.00 to read

By now, most parents understand that antibiotics are not effective for viral infections, only for illnesses caused by bacteria.

However, that hasn’t deterred many physicians from over-prescribing antibiotics for children with ear and throat infections.

More than 11 million antibiotic prescriptions written each year for children and teens may be unnecessary, according to researchers from University of Washington and Seattle Children's Hospital. This excess antibiotic use not only fails to eradicate children's viral illnesses, researchers said, but also supports the dangerous evolution of bacteria toward antibiotic resistance.

"I think it's well-known that we prescribers overprescribe antibiotics, and our intent was to put a number on how often we're doing that," said study author Dr. Matthew Kronman, an assistant professor of infectious diseases at Seattle Children's Hospital.

"But as we found out, there's really been no change in this [situation] over the last decade," added Kronman. "And we don't have easily available tools in the real-world setting to discriminate between infections caused by bacteria or viruses."

 Doctors have limited resources when it comes to differentiating between bacterial or viral infections. Physicians can use the rapid step test to determine if the streptococcus bacteria is the cause of a child’s sore throat, but that is about it for immediate diagnostic tools.

Most colds are virus related and one of the first symptoms will be a sore or scratchy throat. It will typically go away after the first day or so and other cold symptoms will continue. Strep throat is often more severe and persistent.

A virus often causes ear infection as well. Many doctors treat ear infections as though they are bacterial to be on the safe side and avoid serious middle ear infections.

To determine antibiotic prescribing rates, Kronman and his colleagues analyzed a group of English-language studies published between 2000 and 2011 and data on children 18 and younger who were examined in outpatient clinics.

Based on the prevalence of bacteria in ear and throat infections and the introduction of a pneumococcal vaccine that prevents many bacterial infections, the researchers estimated that about 27 percent of U.S. children with infections of the ear, sinus area, throat or upper respiratory tract had illnesses caused by bacteria.

But antibiotics were prescribed for nearly 57 percent of doctors' visits for these infections, the study found.

Kronan hopes that the study’s results will encourage the development of more diagnostic tools and will spur doctors to think more critically about prescribing antibiotics unless clearly needed.

Previous research has shown that parents often pressure their doctor to prescribe an antibiotic to treat their child’s ear or sore throat symptoms. However, when parents are given other suggestions on how to alleviate the symptoms they have been much more receptive than when their doctor just flat out says he won’t prescribe antibiotics.

Many physicians and researchers are concerned that the amount of antibiotics being prescribed these days is setting us all up for future problems when dealing with bacterial infections. Bacteria are adaptable and mutate over time becoming less responsive to antibiotics. When possible, it’s much healthier in the long run to treat your child’s symptoms with simpler therapies. Ask your physican ways you can make your little one more comfortable until the symptoms pass. 

The study was published online in the journal Pediatrics.

Source: Maureen Salamon, http://consumer.healthday.com/infectious-disease-information-21/antibiotics-news-30/antibiotics-prescribed-twice-as-often-as-needed-in-children-study-says-691686.html

Your Baby

Kids of Obese Mothers at Higher Risk for Autism, ADHD

1:45

A new study points out another reason that obesity and pregnancy can be a bad combination not only for the mother but for her future child as well.

Researchers found that six-year-olds whose mothers were severely obese before pregnancy are more likely to have developmental or emotional problems than kids of healthy-weight mothers.

The lead author of the study, Heejoo Jo of the Centers for Disease Control and Prevention (CDC), and her team reviewed data on 1,311 mother-child pairs collected between 2005 and 2012, including the mothers’ body mass index (BMI, a height-to-weight ratio) before pregnancy and their reports of the children’s psychosocial difficulties at age six.

The researchers also incorporated the children’s developmental diagnoses and receipt of special needs services.

Kids of moms who were severely obese, with a BMI greater than 35, were twice as likely to have emotional symptoms, problems with peers and total psychosocial difficulties compared to kids of moms who had a healthy BMI, between 18.5 and 25.

Their children were three times as likely to have a diagnosis of autism spectrum disorder and more than four time as likely to have attention-deficit/hyperactivity disorder (ADHD), as reported in the journal Pediatrics.

Previous studies have shown a connection with autism and maternal diabetes and obesity.

Researchers took into account pregnancy weight gain, gestational diabetes, breastfeeding duration, postpartum depression and infant birth weight. None of these explained the apparent association.

“We already do know that obesity is related to health problems during pregnancy and throughout the lifetime,” Jo said. “I think this adds to that by suggesting that not only does severe obesity affect a woman’s health but the health of her future children.”

This study could not analyze the mechanism linking severe obesity and later risk for developmental problems, Jo noted.

“One theory that we could not look at and needs further research was some small studies have linked maternal obesity to increased inflammation, which might affect fetal brain development,” she told Reuters Health by phone.

While it sounds cliché because we’ve heard it so much; obesity in America has reached epidemic status. Almost 30 percent of Americans are obese and the prevalence of maternal obesity has risen rapidly in the last two decades.

In the USA, approximately 64% of women of reproductive age are overweight and 35% obese.

Women’s health specialists recommend that obese women considering pregnancy lose weight before they conceive to help reduce health risks for themselves as well as their child.

The Academy of Pediatrics recommends that all children be screened for developmental delay or disability at nine, 18 and 24 or 30 months of age.

Health experts strongly suggest that women who were obese or severely obese when they became pregnant make sure that their children receive these developmental screenings.

Sources: Kathryn Doyle, http://www.reuters.com/article/2015/04/28/us-obese-pregnancy-adhd-kids-idUSKBN0NJ2FC20150428

James R. O'Reilly, Rebecca M. Reynolds, http://www.medscape.com/viewarticle/776504

Your Child

New Flu Vaccine for 2015-2016

1:45

Last year’s flu vaccine wasn’t as effective as previous vaccines, but this year’s vaccine should be a much better match according to Dr. Tom Frieden, Director of the U.S. Centers for Disease Control and Prevention.   

Typically, the vaccine is 50 to 60 percent effective, making your chances of getting the flu reduced by as much as 60 percent if you get a flu shot.

This year’s flu vaccine contains the H3N2 strain, Frieden said. Last year's vaccine was only 13 percent effective against the H3N2 strain. As a result, "more seniors were hospitalized for the flu than ever before."

What's more, 145 children died from the flu, Frieden said, adding that the actual number was "probably much higher since many flu deaths aren't reported."

About 50 percent of the American population gets vaccinated every flu season. That includes pregnant women. More people, including pregnant women, need to be vaccinated, Frieden said.

The CDC recommends that everyone 6 months of age and older get the flu shot every year.

Frieden said there's an adequate supply of flu vaccine this year. Companies are expected to make 170 million doses of vaccine, of which 40 million have already been distributed, he said.

People at risk of flu-related complications include young children, especially those younger than 2 years; people over 65; pregnant women; and people with chronic health problems, such as asthma, heart disease and diabetes, as well as those with weakened immune systems, according to the CDC.

Most seasonal flu activity typically occurs between October and May. Flu activity most commonly peaks in the United States between December and February.

Children younger than 6 months are at higher risk of serious flu complications, but are too young to get a flu vaccine. Because of this, safeguarding them from flu is especially important. If you live with or care for an infant younger than 6 months of age you should get a flu vaccine to help protect them from flu.

It takes about two weeks after vaccination for antibodies to develop in the body and provide protection against the flu.

The CDC encourages people to get a flu shot preferably by October. Those children aged 6 months through 8 years who need two doses of vaccine should receive the first dose as soon as possible to allow time to get the second dose before the start of flu season. The two doses should be given at least four weeks apart.

During this flu season:

•       Intramuscular (IM) vaccines will be available in both trivalent and quadrivalent formulations. (High dose vaccines, which are IM vaccines, will all be trivalent this season.)

•       For people who are 18 through 64 years old, a jet injector can be used for delivery of one particular trivalent flu vaccine.

•       Nasal spray vaccines will all be quadrivalent this season.

•       Intradermal vaccine will all be quadrivalent.

The quadrivalent flu vaccine is designed to protect against four different flu viruses; two influenza A viruses and two influenza B viruses.

It’s hard to believe that we’re about to head into the flu season, particularly with so many states still experiencing summer like weather. But we are, and getting a flu shot early can help protect you and your family from a virus no one wants to get.

Sources: Steven Reinberg, http://consumer.healthday.com/infectious-disease-information-21/flu-news-314/no-embargo-this-year-s-flu-vaccine-better-match-703392.html

http://www.cdc.gov/flu/about/season/flu-season-2015-2016.htm

Parenting

“Live Long and Prosper”

2:00

Leonard Nimoy, the actor who played the iconic character Spock in the Star Trek television series and films, passed away last week from chronic pulmonary obstructive disease, also known as COPD.  He was 83.

Spock’s Vulcan salute, accompanied with the phrase “live long and prosper”(LLAP), was recognized around the world as a symbol of friendship and good wishes.

So what does the passing of an elderly movie star have to do with kid’s health?  Kids, teens and adults were fans of Nimoy’s beloved character, Mr. Spock. In his final months, he reached out to his fans with a farewell warning. 

Nimoy attributed his COPD to years of smoking, even though he quit three decades ago around the age of 50.  A few months ago he tweeted a simple but cautionary warning to young adults and teens, “Don’t smoke. I did. Wish I never had. LLAP.”

According to the Centers for Disease Control & Prevention, chronic lower respiratory disease, most of it COPD, killed 149,205 Americans in 2013, making it the third-leading cause of death after heart disease and cancer. Chronic respiratory disease killed more people than accidents, stroke, or Alzheimer’s disease. And that’s only the tip of the iceberg.

I personally know how COPD can slip into your life and kill you, even years after you’ve crushed out your last cigarette butt. My mother died of COPD 20 years after she quit smoking. She smoked from the time she was in her teens till her 60s. While she did live to be in her 80s, many of those years were spent gasping for air and hooked to an oxygen tank. She also warned her kids and grandkids not to smoke. Like so many other teens, they didn’t listen.  Now, they wish they had.

An online article by Forbes’ Matthew Herper, eloquently states the difference in the fictional character of Spock and the man, Leonard Nimoy, and how we can honor both.

“It’s ironic — bitterly so — that a man who became famous playing a character who was the epitome of logic and clear thinking died because of one of humanity’s most illogical flaws: our propensity toward addiction and for risking our health for momentary pleasure. It would be a fitting way to honor him if we could approach the problem of smoking with the kind of logic that Spock would have. As we deal with a whole lot of tobacco-related issues, including how to deal with e-cigarettes which are putatively safer than traditional cigarettes but whose manufacturers seem intent on proving no such thing, we could use some Vulcan clarity.”

As much as the phrase “ this is a teaching moment” has been misused and over used, I think it applies in this case. Many pre-teens, teens and young adults know and appreciate the Spock character and the man who played him all these years. What they probably don’t know much about is what killed him.

As they say, the door is open and this might be an excellent time to talk about smoking with your child. Whether it’s cigarettes, e-cigarettes or chewing tobacco. They are all highly addictive and each holds it’s own serious health issues.  E-cigarettes are still being studied for health complications. More in-depth research is beginning to expose the chemicals used to vaporize the nicotine that is inhaled into a user’s lungs.  The findings are not good.

It’s hard for many kids to care about the possible long-term health effects of something that feels so good at the moment. But irritating symptoms such as coughing, shortness of breath and loss of stamina will start adding up. If you smoke, you will experience all of these symptoms at some time.

COPD is incurable. There is nothing that can reverse it. Typically it occurs in people 65 and older, however, 2 percent of COPD cases involve men aged 18 to 24 and 3 percent involve women in the same age group. The numbers increase slightly for people aged 25 to 44 with 2 percent of cases in men and 4.1 percent of cases in women.

My niece-in-law died from COPD at the age of 48. She first showed symptoms at age 22 – she started smoking at age 12.

People who have never smoked can develop COPD from second-hand smoke, air pollution, chemicals or dust. However, smoking accounts for 9 out of 10 COPD –related deaths.

Now is a good time to use some of Spock’s clarity of details to talk with your child about smoking, whether it’s with cigarettes, e-cigarettes, paperless tobacco, hookahs or anything else that is inhaled into the lungs.

Nimoy’s last tweet reminds us that life is bittersweet, “"A life is like a garden," he wrote. "Perfect moments can be had, but not preserved, except in memory. LLAP"

Not smoking doesn’t guarantee a long life, but it certainly helps one live a healthier life and that’s a blessing every child deserves. 

Sources: Matthew Herper, http://www.forbes.com/sites/matthewherper/2015/02/27/want-to-live-long-and-prosper-dont-smoke/

Kristeen Cherney, http://www.healthline.com/health/copd/age-of-onset#Overview1

 

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College health

College Health

Daily Dose

Booster Shots

1:00 to read

Under the heading “kids say the smartest things” comes one of the latest entries!! I was seeing a 4 year old for their check up...this is a great age as most kids are very conversational and engaged and most are over their fear of the doctor.  I think “Doc McStuffins” has helped this out as well. Thank you Doc!

So, if you didn’t know it, 4-5 year olds get immunized before they start kindergarten.  I give 4 year olds their DTaP, IPV, MMR and Varicella vaccine, all in preparation for school.After a wonderful chatty and interactive visit, I always find it hard to now tell this precious child that at the end of the visit they are going to get some “vaccinations”.  Many times, in fact most, the idea of shots does not go over well.

Last week I saw this 4 year old, had a great visit, talked all about school and his soccer team and his new bike and bike helmet, only to end with “you are going to get several shots to keep you healthy”.  Then you wait for the reaction, right?

So, this little boy looked me right in the eye and said, “I get shots to protect and help my immune system!”.  What a smart kid! I think he is going to be an immunologist one day and save the world. I couldn’t be happier that he already understands re-boosting immunity.  

Your Baby

Hearing Test May Help With Autism Diagnosis

1:45

Hearing well is crucial to speech development in young children. A new study suggests that a simple hearing test may help identify children at risk for autism.

Researchers from the University of Rochester in Rochester, N.Y., say they've identified an inner-ear problem in children with autism that may impair their ability to recognize speech.

"This study identifies a simple, safe and noninvasive method to screen young children for hearing deficits that are associated with autism,” said study co-author Anne Luebke, an associate professor in the departments of biomedical engineering and neuroscience.

"This technique may provide clinicians a new window into the disorder and enable us to intervene earlier and help achieve optimal outcomes," she said in a university news release.

There are several methods for testing a child’s hearing depending on their age, development and health status.

For the study, Luebke and her colleagues tested the hearing of children between ages 6 and 17 with and without autism. Those with autism had hearing difficulty in a specific frequency (1-2 kilohertz, or kHz) that is important for processing speech.

The degree of hearing impairment was associated with the severity of autism symptoms, according to the study.

Hearing "impairment has long been associated with developmental delay and other problems, such as language deficits," said study co-author Loisa Bennetto, an associate professor of clinical and social sciences in psychology.

"While there is no association between hearing problems and autism, difficulty in processing speech may contribute to some of the core symptoms of the disease," Bennetto said.

If future research confirms the findings, the study authors say the screening could help identify children at risk for autism earlier and perhaps get them services sooner.

The researchers suggested that if treatments could start sooner, they might have a larger impact, as the child grows older.

"Additionally, these findings can inform the development of approaches to correct auditory impairment with hearing aids or other devices that can improve the range of sounds the ear can process," Bennetto said.

According to kidshealth.org, there are symptoms of hearing loss you can look for in newborns and older children:

Even if your newborn passes the hearing screening, continue to watch for signs that hearing is normal. Some hearing milestones your child should reach in the first year of life:

•       Most newborn infants startle or "jump" to sudden loud noises.

•       By 3 months, a baby usually recognizes a parent's voice.

•       By 6 months, a baby can usually turn his or her eyes or head toward a sound.

•       By 12 months, a baby can usually imitate some sounds and produce a few words, such as "Mama" or "bye-bye."

As your baby grows into a toddler, signs of a hearing loss may include:

•       Limited, poor, or no speech

•       Frequently inattentive

•       Difficulty learning

•       Seems to need higher TV volume

•       Fails to respond to conversation-level speech or answers inappropriately to speech

•       Fails to respond to his or her name or easily frustrated when there's a lot of background noise 

The hearing test is noninvasive, inexpensive and does not require a child to respond verbally, so it could be adapted to screen infants, the researchers said.

The study was published in the journal Autism Research.

Story sources: Robert Preidt, http://www.webmd.com/brain/autism/news/20160801/hearing-test-may-predict-autism-risk-sooner-study

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

Your Child

Sweet Potatoes May Help Prevent Diarrhea in Children

1:45

Orange sweet potatoes get high approval ratings from many pediatricians and family doctors because they offer a lot of health benefits and they taste good, so kids are more likely to eat them.

Recent research suggests they may also be helpful in reducing the cases of diarrhea in some young children by more than 50 percent.

Erick Boy, head of nutrition at HarvestPlus, said that the body converts the beta-carotene in the sweet potatoes to vitamin A the same day the food is eaten. That vitamin A is then used in the outer lining of the human gut, forming a barrier against different types of bacteria. Boy further explained that the gut uses surplus vitamin A from time to time to replace worn-out cells with healthy ones.

The researchers claimed that if a child below age 5 has consumed orange sweet potatoes in the past week, then the chances were 42 percent less that child would suffer from diarrhea. In children below age 3, the likelihood of developing the condition reduced by 52 percent.

Regular consumption of orange sweet potatoes also helps decrease the duration of diarrhea, the researchers claimed. The team observed that the duration was reduced by 10 percent among 5-year-olds and 25 percent in 3-year-olds.

This could be extremely helpful in countries like Africa, where 40 percent of the children are vitamin A deficient. This increases their risk of diseases such as diarrhea, which is one of the leading causes of mortality in children, taking more than 350,000 lives of children under five in Africa every year.

Vitamin A deficiency is rare n America, however, diarrhea in U.S. children is fairly common; typically related to viral infections or tainted food sources.

Sweet potatoes are easy to prepare and can be baked as fries or tater-tots, veggie muffins, made into soup, and mashed like regular potatoes. Many kids like their orange color and sweet taste. Besides being high in vitamin A, they contain vitamin B5, B6, thiamin, niacin, and riboflavin and are high in carotenoids. They are lower in calories than white potatoes – but a little higher in sugar.

For as sweet as they are, sweet potatoes have a low glycemic index (which means they release sugar slowly into the bloodstream).

The study was published in the journal World Development.

Sources: Guneet Bhatia,  http://www.universityherald.com/articles/20051/20150615/sweet-potatoes-may-reduce-diarrhea-in-children.htm#ixzz3djHgM93e

 

 

 

Your Baby

Does Your Baby Spit Up A Lot?

1:30

About half of infants spit up on a regular basis, and usually it’s not an indication that there’s a medical problem. More than likely, your little one has either more food in his or her tummy than it can hold or they have taken in too much air with the breast milk or formula. 

Watching their newborn spit up frequently can be kind of scary for new parents but experts agree that for the most part, there’s nothing to worry about- it’s normal.

"Seventy percent of infants under 3 months will spit up three times a day, and it's even perfectly normal for them to be spitting up as often as 10 or 12 times," says William Byrne, MD, chief of pediatric gastroenterology at Doernbecher Children's Hospital, in Portland, Oregon.

The most common reason is that the muscle at the bottom of the esophagus, which opens and closes to let food into the stomach, is still very weak at this age -- so it's easy for stomach contents to escape and come back up. Your baby is most likely to spit up after a feeding, but this can also happen when she cries or coughs forcefully.

By 6 months babies have mostly outgrown spitting up especially when they start eating more solid foods and sitting up.

There are things you can do to help reduce baby’s spitting up. Start by making sure you’re not overfeeding your baby. If breastfeeding, check to see if your infant is latched on correctly so that less air goes down with the milk.

If she's formula-fed, consider using a product that reduces bottle-induced gas, such as a bottle with liners that collapse as your baby sucks. If your baby is 4 months or older and your pediatrician approves, you can try thickening the formula to help it sit better in his stomach (mix in a tablespoon of rice cereal for every 4 ounces of formula).

Keep your baby in an upright position and as still as possible for at least 30 minutes following each feeding so that the food can travel out of the stomach and into the small intestine.

You can reduce spitting up by burping your baby after every 1 to 2 ounces or 5 to 10 minutes of feeding. If you don’t get a burp within a few minutes, then baby probably just doesn’t need to burp.

There are times when spitting up can indicate that there is a medical problem. It’s normal for infants to experience gastroesophageal reflux (GER), usually referred to as reflux. However, gastroesophageal reflux disease, or GERD is different. GERD is a more serious condition that can cause a baby a lot of pain. If your baby won't eat, isn't gaining weight, is extremely irritable, suffers from forceful projectile vomiting, or develops respiratory problems from aspirating food, he may have GERD.

If your baby is having symptoms of GERD take him or her to your pediatrician for a true diagnosis. Your doctor will be able to recommend the correct treatment.

If your newborn is spitting up frequently, don’t panic- it’s normal. Just keep those washcloths and burping pads handy to protect your clothing!

Sources: Parents Magazine, http://www.parents.com/baby/feeding/problems/spit-up-faqs/

http://consumer.healthday.com/vitamins-and-nutrition-information-27/food-and-nutrition-news-316/when-babies-spit-up-don-t-panic-696541.html

http://www.babycenter.com/0_why-babies-spit-up_1765.bc?page=1

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