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Parenting

Most Parents Give Their Child the Wrong Medicine Dose

1:30

According to a new study, most parents accidently give their child the wrong dose of liquid medication – sometimes, as much as twice the amount they should have.

The study, conducted at pediatric clinics in New York, Atlanta and Stanford, Calif., also found that most dosing errors occurred when parents used a measuring cup. There were fewer errors when parents measured the dose with an oral syringe.

Pediatric medicines generally rely on liquid formulations, and parents have to decipher a sometimes, bewildering assortment of instructions in different units with varying abbreviations — milliliters, mL, teaspoon, tsp., tablespoon. Some medicines come with a measuring tool, but often the units on the label are different from those on the tool. It can be very confusing, especially for a parent trying to treat a sick child.

The Food and Drug Administration (FDA) recommended in 2013 that over-the-counter products use a standard dosing tool with consistent labeling. The changes however, were not required.

The American Academy of Pediatrics (AAP) also recommended standard dosing tools for OTC products last year.

For this study, Dr. H. Shonna Yin and her colleagues ran an experiment to see what combination of tools and instructions would produce the fewest errors in dispensing liquid medication. They randomly assigned 2,110 parents to one of five pairings of the many possible combinations of tools and label instructions.

In nine trials, 84.4 percent of the parents made at least one dosing error, and more than 68 percent of the errors were overdoses. About 21 percent of parents at least once measured out more than twice the proper dose. Smaller doses produced more errors. When the dose was 2.5 milliliters, there were more than four times as many errors as when it was 5 milliliters.

The difference in errors was the tool used to give the medication. When a cup was used, there were four times as many errors as when an oral syringe was used.

“If the parents don’t have an oral syringe, the provider should give one to the parents to take home,” said Dr. Yin, who is an associate professor of pediatrics at New York University. “Especially for smaller doses, using the syringe made a big difference in accuracy.”

If you don’t have an oral syringe at your home, you can check with your pediatrician or pharmacist and they should be able to help you choose the right one for your child.

The study was published online in the journal, Pediatrics.

Story source: Nicholas Bakalar, http://www.nytimes.com/2016/09/13/well/family/most-parents-give-the-wrong-dose-of-liquid-medication.html?WT.mc_id=SmartBriefs-Newsletter&WT.mc_ev=click&ad-keywords=smartbriefsnl&_r=0

Your Toddler

Uncut Grapes Can Choke Young Children

1:30

While good nutrition involves plenty of fresh fruits and vegetables, there’s one fruit that should not be given to children 5 and under; grapes.

Uncut grapes are dangerous for young children because their size and smooth texture can cause choking and even death.

There have already been three choking cases in Scotland, out of which two turned out to be fatal, involving boys who were 5 or younger.

A report published in the journal Archives of Disease in Childhood notes that food is responsible for more than half of the choking incidents, which end in deaths when it comes to children under the age of 5.

"There is general awareness of the need to supervise young children when they are eating ... but knowledge of the dangers posed by grapes and other similar foods is not widespread," noted Dr. Jamie Cooper, co-author of the report, from the emergency department at Royal Aberdeen Children's Hospital.

According to the same report, there is no awareness concerning the specific risks that soft fruits raise, and the relatively small numbers of cases per hospital, which occur every year, don't fully reflect the extent to which this issue can affect young children.

Kids that have choked on grapes don’t often make the news, but according to research conducted in the United States and Canada, grapes occupy third place when it comes to deaths caused by food-related incidents, after hotdogs and sweets.

There are two reasons why grapes are so dangerous, especially in very young children: first, because the airways of the children are small and their swallow reflex is not fully developed, and second due to the smooth texture of the fruit.

Other foods with similar texture can pose a choking hazard, such as tomatoes.  Health experts suggest that grapes and tomatoes be cut in half twice. Anytime a child (or an adult for that matter) is eating uncut grapes or small tomatoes they should pay attention to their eating and not mechanically pop them into their mouths – like when watching TV or playing video games.

Grapes and tomatoes are good sources of fiber and healthy nutrients, just make sure that your little one has his or hers’ cut up so they are not easily choked when eating them.

Story source: Livia Rusu, http://www.techtimes.com/articles/189851/20161224/grapes-as-a-choking-hazard-doctors-say-lack-of-awareness-puts-young-children-at-risk.htm

 

 

Daily Dose

Jaundice in Newborns

1:30 to read

It is not at all uncommon for a healthy newborn to develop jaundice in the first several days of life. Bilirubin is produced when red blood cells are broken down. It is a yellow pigment that we all metabolize in the liver and then it is excreted in urine and stools. In an newborn, the body produces almost 2-3 times the bilirubin that an adult does. Because newborns are also “immature” their liver cannot keep up with the bilirubin production and therefore bilirubin levels rise. In some cases the bilirubin is high enough to cause a yellowing of the skin (jaundice), and this is termed physiologic jaundice of the newborn. 

 

Your infant will have their bilirubin level checked while they are in the hospital and your pediatrician will follow any bilirubin levels that seem to be rising. In most hospitals the bilirubin is tested transcutaneously (through the skin), and you may never know that you baby has been tested. If bilirubin levels seem to be high, a blood test will be performed to more accurately assess the bilirubin level. If bilirubin levels continue to rise a baby may then be put under phototherapy (special blue lights that breaks down bilirubin in the skin and help it to be eliminated). Phototherapy prevents extremely high levels of bilirubin which may get into the brain and could be toxic to the baby and cause brain damage.

 

When a baby is put under phototherapy they may be in a basinette or wrapped in a “bili-blanket”  and they will wear sunglasses to prevent any damage to their eyes from light. They are usually naked or only in a diaper so that as much skin is exposed as possible. In most cases the bilirubin levels have peaked by day of life 3 or 4 and the baby will no longer need phototherapy. While the baby is under the “bili-lights” they will continue to have blood tests (from their heels) to follow the bilirubin levels.

 

As babies are now being discharged in 24-48 hours after delivery some babies will develop jaundice after they have already gone home…so you your doctor will plan on seeing you 1 to 2 days after your are discharged. But, should you notice that your baby seems to be getting more jaundiced you should call you doctor and be seen sooner.  

 

Just this week I saw a baby who continued to become more jaundiced after he went home. At times I see this when a mother is breast feeding and her milk has not yet “come in”.  If a baby is not getting a lot of milk then they cannot poop and pee out bilirubin…somethings just take time to get going with feeding, peeing, pooping and liver maturation. So…this baby boy was started o home phototherapy. Rather than re-admitting him to the hospital, a pediatric home health care company sent out a nurse with a bill blanket who instructed the parents on the use of it. The baby was then able to feed at home every 2-3 hours, and the bili-blanket was used throughout the day and night. The parents lived so close to the office that they would bring the baby in for bilirubin tests, while in other cases the nurse will go to the home to do the testing.  Home phototherapy in an otherwise healthy infant does not disrupt the new family and really helps the mother establish her breast feeding and lets “everyone” sleep in their own beds!

 

This baby only required phototherapy for 24 hours…in some babies it may be longer. Once the bilirubin was back in a “safe range” the lights were discontinued and he will continue to process the bilirubin on his own. His little yellow face and eyes will be the last evidence of his newborn jaundice and “one for the baby books” as it should never be a problem again.

 

Your Baby

Spit-Cleaning Your Infant’s Binky

1.45 to read

Have you ever sucked on your baby’s pacifier to clean it? Many parents have. Babies drop their binkies all the time and if you’re in a hurry or just figure a little spit-cleaning won’t hurt, you’re more likely to stick it in your own mouth and give it a quick once over.

A new study out of Sweden says the spit-cleaning technique may actually help your infant avoid eczema and asthma.

“It was surprising that the effect was so strong,” says pediatric allergist Dr. Bill Hesselmar of Queen Silvia Children’s Hospital in Gothenburg, Sweden, lead author of the study published Monday in the journal Pediatrics.

The study involved 136 infants who used a pacifier in their first 6 months. 65 of the infants had parents that reported sucking the pacifier to clean it. In those children, both eczema and asthma were strongly reduced when they were examined at 18 months of age. At 36 months of age, the protective effect remained for eczema but not for asthma.

Scientists didn’t know why the sucking on the baby’s pacifier acted as a protector or whether it was filtering out germs. The technique didn’t have any impact on respiratory illness, meaning that the babies were not more likely to get a cold or the flu from their parents. Common sense would dictate that if you have a cold or the flu or any other contagious condition, then it’s not a good idea to suck on your baby’s binky. Otherwise, maybe it’s not such a bad idea.

Why is sucking on your infant’s pacifier possibly helpful in preventing asthma or eczema in your child? Scientists hypothesize that tiny organisms in the saliva of the parents may be why. Parent’s saliva introduces gut micoflora that live in the digestive tract of the baby. “We know that if infants have diverse microflora in the gut, then children will have less allergy and less eczema,” says Hesselmar. “When parents suck on the pacifier, they are transferring microflora to the child.”

Many pediatricians and family doctors are concerned that children are being “excessively cleaned” into illness. With anti-bacterial soaps and swipes being used on everything, and kids not allowed to get dirty, their immune system isn’t getting the workout it needs to help fight off common illnesses. The bacterial microorganisms provided in the parent’s saliva might help stimulate the baby’s immune system.

“The most exciting result was the eczema,” says Christine Johnson, chair of the public health department at Detroit’s Henry Ford Hospital. “I’m a bit more skeptical about the asthma findings because asthma is hard to measure before a child is five or six years old.”

Hesselmar also urges moms to lick the baby’s pacifier if their child was delivered by C-section. Vaginal delivered babies receive quite a bit of microbes during delivery. C-section babies can be more prone to allergies. “If they are using a pacifier and those parents think it’s OK to suck on the pacifier, then yes, I would recommend it,” Hesselmar says.

Some parents may find the idea of picking up a pacifier that’s fallen on the floor and putting it in their mouth kind of disgusting. That’s fine, there’s no need to worry about it. If the idea doesn’t bother you, all the better says Hesselmar, “I haven’t heard of anyone getting ill from it,” he says. “There isn’t much bacteria on the floor.”

Source: Barbara Mantel, http://www.today.com/moms/why-it-may-be-ok-spit-clean-your-babys-binkie-6C9773378

Your Baby

Preparing for Twins or Triplets

1:45

The number of U.S. parents expecting twins and triplets has reached an all-time high according to the National Center for Health Statistics. Multiple births make up a small portion of births in general, but since 1980, multiples numbers have been on the rise.

The number of twins born in the U.S. has increased the most. Along with twice the cuteness comes twice the workload. The American Academy of Pediatrics (AAP) offers parents of multiples some handy preparation tips:

Keep in mind that "multiples" are often born early and tend to be smaller than the average newborn. The AAP says parents may need to visit with their pediatrician more often than usual and reach out for help with feeding concerns or strategies.

And then there are the diapers- lots and lots of diapers! Go ahead and start purchasing your diapers ahead of time. The more you have stocked away before your little ones are born, the less worries you’ll have about running out when you need them most. Also, you’ll be able to gage about how many you’ll need when you start shopping again.

Having multiples also means fitting more safety seats into the car, more clothing, more food and possibly even a larger home! Check out how well your home is going to work for a larger family and plan accordingly.

One of the most important things for parents to consider is making sure that each child has their own identity. Multiples may share everything, but they are individuals and should be raised as such, the AAP advises. Identical twins, in particular, may seem like a duo, and parents might be tempted to give them the same things and the same amount of attention. But even genetically identical children have different personalities, thoughts and emotions. The AAP urges parents to acknowledge and support their differences to help them become happy and secure individuals.

If you have other children, remember they need special attention too. It’s easy to overlook the older kids when the new kids on the block are demanding so much attention.

As multiples grow, they may form exclusive bonds and may even communicate in a way only they can understand. Sometimes, they become unwilling to seek out other friendships. Giving multiples some time apart can help them develop friendships and ensure that other siblings aren't left out, the academy says.

And efforts to encourage multiples to spend time apart should start early to head off resistance. Most elementary schools place multiples in separate classes, the news release noted. Parents who are concerned about preventing separation anxiety can turn to their pediatrician for advice.

Don’t be afraid to ask for help! Multiples demand a lot of attention. If your budget allows, hire someone to clean the house a few days a week. Grandparents, uncles and aunts, brothers and sisters may be willing to pitch in and give you some much needed down time or date time.  Don’t forget about your friends – while you may think it’s too much of an imposition, they may love being able to spend some quality time with your children – then turn them back over to you!

Take turns getting up at night for feedings and changings. Giving your spouse a few hours of uninterrupted sleep will do wonders for your relationship.

There’s a lot to prepare for when multiples are involved but the rewards are great. It may feel a little overwhelming at first, but eventually you will figure out a routine that works for everyone.

Story source: Mary Elizabeth Dallas, https://consumer.healthday.com/women-s-health-information-34/birth-health-news-61/having-twins-or-triplets-what-you-need-to-know-before-they-arrive-715653.html

http://www.pewresearch.org/fact-tank/2015/12/11/twins-triplets-and-more-more-u-s-births-are-multiples-than-ever-before/

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 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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