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Daily Dose

Homeopathic Medicine

1:30 to read

I am sitting here writing this while “sucking” on a honey-lemon throat lozenge and drinking hot tea…as it is certainly cough and cold season and unfortunately I woke up with a scratchy throat. I am trying to “pray” it away and drink enough tea to drown it out. While I am not sure it will work, drinking hot tea all day will not hurt you!

 

At the same time (multi-tasking) I am also reading an email from a mother with a 4 month old baby, and they are out of town. Her baby now has a fever and runny nose and she sent me a picture of a homeopathic product for “mucus and cold relief” and wonders if it is safe to give to her infant.  The short answer is NO…even though the product says BABY on the label and has a picture of an infant.

 

Although homeopathic medicines were first used in the 18th century and are “probably safe” it is still unclear if they really work. Unfortunately,  there have been adverse events and deaths associated with some products ( see articles on teething tablets). The principle of homeopathy is that “ailments can be cured by taking small amounts of products that, in large amounts, would cause the very symptom you are treating. In other words, “like cures like” as these products contain “natural ingredients” that cause the symptoms that you are trying to treat, but that have been so diluted as to hopefully stimulate your body’s immune system to fight that very symptom. In this case, congestion and runny nose due to a cold.

 

So…I looked at all of the ingredients which included Byronia, Euphrasia, Hepar and Natrum…to name a few. Byronia is used as a laxative for constipation, Euphrasia is supposed to help with inflammation, Hepar is for people who tend to get “cold and therefore cranky and irritable” and Natrum is used for inflammation due to “too much lactic acid”.  This is the short version. The bottle also says contains less than 0.1% alcohol, but it has alcohol! 

 

While the FDA does monitor how homeopathic medications are made, they do not require these companies to show proof that these medications do what they say they do, as they are “natural”.   With that being said, natural does not always mean effective or safe.  Just as over the counter cold and cough medications are not recommended for children under the age of 2, I too would not recommend homeopathic products be given to an infant.

 

Best treatment for a cold and cough in young children?  Use a saline nasal spray followed by nasal suctioning to relieve the nasal congestion and mucus. I would also use a cool mist humidifier in the baby’s room to keep moisture in the air and help thin the mucus ( especially once the heat is on in the house). Make sure the baby is still taking fluids (breast or bottle) but you may also add some electrolyte solution to give your baby extra fluids if you feel as if they are not eating as well.  Lastly, always watch for any respiratory distress or prolonged fever and check in with your pediatrician!

Daily Dose

Teaching Kids How To Swallow A Pill

Teach your child how to swallow a pillLife would be a bit easier (when your child is sick) if your child knew how to swallow a pill.

I am continually reminded about the number of kids and teens that don't swallow pills, and ask, "does that medication come as a liquid?" Even some of my "adult" patients (code for friends over 40) call and ask if their cholesterol lowering medication is available as a liquid as they just can't swallow a pill! These are people that can run companies! So...due to that fact, I am convinced, like many things in life, the younger you learn to do something, the easier it is. The old adage, "can't teach an old dog new tricks" is true, young children are excited about trying new things and accomplishing milestones, so put pill swallowing on the list.

I started teaching my own children how to swallow pills when they were around four-years-old. It really came out of necessity when we were on a trip and one of them developed a fever and I did not have any liquid Tylenol with me. Being the novice "parent pediatrician" at the time, I thought I could just "push the pill down their throat", like the dog. Guess what? It doesn't work, as they just gagged and threw up all over me! Lesson learned. I have found the best way to teach a younger child to swallow a pill is to make it a game. I took the boys to the nearest 7-Eleven where we bought their favorite tic-tacs (coated on the outside like a caplet so won't stick) and then let them pick their favorite sugary horrible never allowed drink. I think it was a Coke or 7-Up at the time (forbidden fruit at home). We went home with candy and drinks in hand (mini M&M’s also work well) and began the tutorial. It helps to have a little friendly competition too. Show your child how to put the tic-tac on the back of their tongue (not on the tip) and then have them "GUZZLE" the drink.  That is why you need to use their favorite drink so they really want to drink it robustly. You can't learn to swallow a pill with a small amount of liquid, you need a "big gulp" to wash it down. When kids are younger they usually don't worry about "choking" or gagging, but once they are older they start analyzing and worrying about how the pill will get stuck or gag them and their anxiety gets in the way. Look at it like going down a slide for the first time, or jumping into the pool, younger kids are usually less fearful (not always a good thing). For many children it will take several tries before the tic-tac is miraculously washed down!! They are so proud and excited and want to show you that they can do it again and again (therefore practice with candy and NOT real medication). By the time they are really becoming proficient they will often say, "look, I can do three at a time!!). Once they are swallowing it is very easy to use junior strength Tylenol or Motrin, which are smaller and coated. Again, once they are swallowing pills the size of the pill really doesn't matter as they all "wash down" the same way. I use the analogy of learning to ride a bike, once you can do a two-wheeler, you can probably ride your friends bike that may have a little bigger tires, if need be. They all pedal the same way and require balance. Pills are pills, just pop and swallow! I also jokingly tell all of my young patients that it is "Dr. Sue rule" that they are able to swallow a pill before they can drive a car!! Come on, putting a teen behind the wheel of a car is HUGE, and swallowing a pill seems much easier compared to learning to drive. I must say that the majority of my patients can swallow a pill by early elementary school, and many even younger. Learning to swallow a pill is a right of passage during childhood. Make it fun and cross this off of the "to do list"! That’s your daily dose, we’ll chat again tomorrow. Send your question to Dr. Sue!

Daily Dose

Giving Your Child Medicine

1:15 to read

Since I recently wrote an article about teaching young children to swallow pills, here is another reason to teach this to children sooner than later. The American Academy of Pediatrics has a new policy statement encouraging parents, physicians and pharmacists to use only metric measurements on prescriptions,medication labels and dosing cups to ensure that kids receive the correct dose of medication.

In other words, no measuring medications with teaspoons or tablespoons and especially not the ones in the cereal drawer.  Because spoons come in many sizes, they are not precise enough to measure a child’s medication.  For infants, toddlers and young children, a small error in dosing, especially if repeated for many doses, may be toxic.  

These recommendations also mean that doctors, like myself, need to prescribe medications in metric units like milliliters rather than teaspoons. We also need to instruct parents to use metric dosing devices, and not any measuring devices that have confusing markings with both teaspoons, tablespoons and milliliters. The medication should also come with an appropriate sized dosing device to avoid the possibility of two and three fold dosing errors.

The recommendations also call for manufacturers of over the counter medications to eliminate labeling, instructions and dosing devices that contain units other than metric units...no more 1 teaspoon, but rather 5 milliliters.

I am going to make a conscious effort to make sure that I am now writing my prescriptions with the correct units and help make dosing errors less of a problem and all medications safer for my “little” patients.

No more kitchen spoons!!!

Your Child

Antibiotic Resistance Rising in Kids with Urinary Tract Infections

2:00

Urinary Tract Infections (UTI) affect about 3 percent of children in the United States each year and account for more than 1 million visits to a pediatrician.

The most common cause of a UTI is the bacterium E.coli, which normally lives in the large intestine and are present in a child’s stool. The bacterium enters the urethra and travels up the urinary tract causing an infection. Typical ways for an infection to occur is when a child’s bottom isn’t properly wiped or the bladder doesn’t completely empty.

Problems with the structure or function of the urinary tract commonly contribute to UTIs in infants and young children.

UTIs are usually treated with antibiotics but a new scientific review warns that many kids are failing to respond to antibiotic treatment.

The reason, according to the researchers, is drug resistance following years of over-prescribing and misusing antibiotics.

"Antimicrobial resistance is an internationally recognized threat to health," noted study author Ashley Bryce, a doctoral fellow at the Center for Academic Primary Care at the University of Bristol in the U.K.

The threat is of particular concern among the younger patients, the authors said, especially because UTIs are the most common form of pediatric bacterial infections.

Young children are more vulnerable to complications including kidney scarring and kidney failure, so they require prompt, appropriate treatment, added Bryce and co-author Ceire Costelloe. Costelloe is a fellow in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London, also in the U.K.

"Bacterial infections resistant to antibiotics can limit the availability of effective treatment options," ultimately doubling a patient's risk of death, they noted.

The study team reviewed 58 prior investigations conducted in 26 countries that collectively looked at more than 77,000 E. coli samples.

Researchers found that in wealthier countries, such as the U.S., 53 percent of pediatric UTI cases were found to be resistant to amoxicillin, one of the most commonly prescribed primary care antibiotics. Other antibiotics such as trimethoprim and co-amoxiclav (Augmentin) were also found to be non-effective with a quarter of young patients resistant and 8 percent resistant respectively.

In poorer developing countries, resistance was even higher at 80 percent, 60 percent respectively and more than a quarter of the patients were resistant to ciprofloxacin (Cipro), and 17 percent to nitrofurantoin (Macrobid)).

The study team said they couldn’t give a definitive reason about cause and effect but said the problem in wealthier countries probably relates to primary care doctors' routine and excessive prescription of antibiotics to children.

In poorer nations, "one possible explanation is the availability of antibiotics over the counter," they said, making the medications too easy to access and abuse.

"If left unaddressed, antibiotic resistance could re-create a world in which invasive surgeries are impossible and people routinely die from simple bacterial infections," they added.

In an accompanying editorial, Grant Russell, head of the School of Primary Health Care at Monash University in Melbourne, Australia, said the only surprise was the extent of the resistance and how many first-line antibiotics were likely to be ineffective.

If current trends persist, he warned, it could lead to a serious situation in which relatively cheap and easy-to-administer oral antibiotics will no longer be of practical benefit to young UTI patients. The result would be a greater reliance on much more costly intravenous medications.

The problem of antibiotic resistance for bacterial infections has been on the minds of scientist for some time now.  Cases are increasing at an unprecedented rate causing alarm and a call for more public education and due diligence on the part of physicians that prescribes antibiotics.

Story source: Alan Mozes, http://www.webmd.com/children/news/20160316/antibiotic-resistance-common-in-kids-urinary-tract-infections

 

 

Daily Dose

Over The Counter Products

1:30 to read

So, if you have read my daily doses you are aware that my “news watching” comes from morning TV while I am getting ready for work!!  I often find myself talking to the TV, especially when it is a medical segment which includes pediatrics.  While I am excited that morning TV is covering health topics, some of the information may be a bit “misguided” when a pediatrician is not the one discussing a pediatric topic.

I “heard” another example of this the other morning when the morning shows were discussing the “top pharmacist picks for over the counter products”.  It seems they surveyed pharmacists  and then compiled a list of “favorite” name brand OTC products in numerous categories - I don’t  think there was much science behind this. At any rate, we all have our “favorite” go to “OTC” products which for one reason or another we prefer. Does that actually mean they are better?

So, here are a few that I had issue with:

Allergy medications: They picked Claritin, but why not Zyrtec or Allegra?  They are all second generation anti-histamines and there is not a great deal of data that one is better than another. If push came to shove and I could only pick one antihistamine it would be Benadryl (diphenhydramine) - despite its sedating properties it is still a great drug.

Topical antibacterial medication: They picked neosporin and I would pick polysporin. Neosporin contains neomycin which may cause an allergic contact reaction. Other than neomycin they are quite similar and both contain topical lidocaine for pain relief.  Guess what -  they are made by the same company!!  

Pain relief:  They picked Advil, but why not Motrin or generic ibuprofen.  I am frugal and buy whatever is on sale, same drug.  I always remind parents of this as sometimes they get confused and say, “Advil didn’t work so I gave them Motrin” double dosing them with same drug. Be careful.

GI complaints:  Pharmacists picked Pepto-Bismol. I do not recommend Pepto-Bismol to  children as it contains  bismuth subsalicylate which is related to aspirin and has been associated with Reye’s Syndrome.  The bottle is labelled “do not use under the age of 12 years” due to this concern, but parents may not read the fine print. There is a Children’s Pepto that contains only calcium carbonate and may be given to children as young as 2 years….really important to read the labels as there are many choices with similar names.

Lip balm: Their choice was Carmex. I do not recommend lip balm/gloss that contains menthol or camphor as it may actually damage the lips and cause more drying…so you apply more then it is a vicious cycle.  You want to use lip balm with bees wax or petrolatum and no fragrance. I like Aquaphor, Burt’s Bees and Vaseline.  

Formula: Their choice was Enfamil.  I recommend any of the formula brands including Simliac and Gerber as well as some Organic Formulas if my patients desire.  I don’t know why they would pick only one brand…no data on that either.

Sunscreen:  Their choice Neutrogena, which I also love. They make good products that are hypoallergenic and PABA free, and they have many different vehicles (spray, lotion, stick) to choose from. I am also a fan of Cerave products and they now have sunscreen for babies.  But the most important fact is to use a sunscreen of any brand with an SPF of at least 30 and one that contains zinc or titanium dioxide and no PABA or oxybenzone. 

Those are just a few of my comments and favorites.

 

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Flavored Spray May Help Pills Go Down A Little Easier!

1:45

When your child is sick, chances are you have a difficult time getting him or her to swallow their prescription pills. It’s a problem parents and caregivers have in common- getting a child’s medication into their body. Liquids typically come in several flavors, which can be helpful, but pills are another matter.

Some pills are tiny and smooth – making the job easier. But others can be large powdery and oddly shaped. To make things worse, they may need to be taken throughout the day. So, what’s a parent to do?

The results of a small study may be just what the doctor ordered. Researchers have found that a flavored spray, called Pill Glide, may make pill taking a lot more flavorful -- and maybe even enjoyable.

"There was a significant decrease in the difficulty of taking medicine with these sprays," said Dr. Catherine Tuleu, a pharmaceuticals researcher at University College London, who conducted the research with colleagues at Great Ormond Street Hospital in the UK. "The kids liked to be in charge and to change the flavor."

What is Pill Glide? It’s a spray that is squirted into the mouth to lubricate and add flavor to tablets and capsules to make them easier to swallow. It's available in five flavors: strawberry, peach, grape, bubble gum and orange, with strawberry coming through as the favorite in the trial. Its ingredients include artificial flavors and sweeteners. This spray was used in the trial study with results published in the journal Pediatrics.

Tuleu and her team tried it among 25 children ages 6 to 17 that were receiving long-term therapies for HIV or organ transplants and who were transitioning from liquid medication to solids or were known to struggle with swallowing pills.

Keeping diaries, the study participants used a six-point scale to note the levels of difficulty they experienced when taking their regular tablets for two weeks and then using the Pill Glide sprays for one week. The final analysis was conducted on 10 children who had kept complete diary entries.

The flavored sprays were found to decrease the level of difficulty by a score of 0.93, almost one full level on the scale used by the team.

"The swallowing of medicine in the form of pills often poses a real challenge for a good many children, making this study of definite interest," said Dr. Laura Jana, a pediatrician and director of innovation at the University of Nebraska Medical Center College of Public Health, who was not involved in the research. "Something as seemingly simple as improving the taste and ease of swallowing a pill can have a significant impact on the proper and effective use of medicines."

The trial was very small and limited especially when you look at the number of participants, their health issues and the age group. But it may still be a process worth considering.

Tuleu acknowledges these limitations, and in addition to trying Pill Glide among larger groups, she wants to test its benefits in children who are less familiar with taking pills and who start out on solid pills, rather than transitioning from liquids.

"It would be interesting to try it with more naïve patients," she said. "If swallowing is not the challenge anymore, giving medication could be a lot easier."

Will this product make it easier for all kids to take a pill? Probably not. But this new approach may help some kids get past their difficulty with swallowing larger, more uncomfortable pills. It’s worth a try!

Story source: Meera Senthilingam, http://www.cnn.com/2016/11/01/health/kids-swallowing-pills-spray/

Daily Dose

Confusion Over Cough & Cold Medicines

The confusion over cough and cold medications continues and I must admit I am a little confused too. The Consumer Healthcare Products Association recently announced changes to the labeling of over-the-counter (OTC) cold products to state "do not use in children under 4 years of age". The FDA monograph still states "do not use in children under 2 years". The American Academy of Pediatrics recommends not using OTC cough and cold preparations in children under six years.

Looking at the little research on these products two things come to mind:

  1. There have been multiple studies done on these products (in adults) that do not show them to be efficacious for treating common cough and cold symptoms.
  2. The research among children using these products show that dosing errors and accidental ingestions are the leading cause of adverse events.

This kind of leaves me thinking why use them at all in children? I really have never been much of a cold medicine giver in general, as I personally did not see my patients getting better any faster nor my own children. We continued to use the good old grandmother tested remedies of lots of rest, fresh squeezed orange juice (sometimes in pays to be sick), chicken noodle soup (canned or home made), and a vaporizer or humidifier in their rooms at night. I also know that younger children get more colds than anyone and no matter what you do you have to get through that too. But miraculously, as kids get older they get less colds and seem to tolerate them a little better. So... for this winter in our practice we are not recommending the use of any of these products for kids and trying the gold standards rest, fluids, cool mist humidifier and tincture of time. We'll see how it goes. That's your daily dose, we'll chat tomorrow.

Daily Dose

Cough Medicine Alert

Should the FDA limit cough medicines for kids?With cough and cold season already here and only getting worse as winter arrives, many parents are asking whether they should use over-the-counter (OTC) cough and cold preparations. There are many studies that show that these products really do not help treat the common cold. On top of that they may actually have adverse effects when used in children and there have even been deaths reported due to inappropriate dosing of these medications.

The American Academy of Pediatrics does not recommend using OTC cold remedies in children under six and the FDA says not to use in children under two. There are so many products out there and most contain the same ingredients causing even more confusion for parents. The longer I practice, as well as taking care of my own children, I agree that these medicines really don't do much of anything for a cold. The best medicine still seems to be the tried and true remedies of rest, fluids, nasal saline irrigation and a box of kleenex. So....throw away any leftover cough and cold preps and get ready for winter with your latest recipe for chicken noodle soup. That's your daily dose. We'll chat tomorrow.

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