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Daily Dose

Flu Vaccine

1:30 to read

Even though the temperatures are topping out in the high 90’s around many parts of the country, it is still the time of year that pediatric offices are just receiving their flu vaccines for the 2017-2018 season.  Our office received our first shipments about 10 days ago and we have already started immunizing. This includes “my” precious 6 month old babies - all the way through to my college patients. 

 

There are 2 questions on parents and their kids minds:

 

#1 Is it too early to get a flu vaccine?

#2 Is there “flu-mist” available this year? 

 

I bet you can guess who is asking question #1 and who wants to know about question #2.

 

So here you go:

 

#1  It is NOT too early to start getting your flu vaccine. Once you receive the vaccine it takes several weeks to develop antibody levels and these antibodies have been shown to last throughout the flu season. Flu season is also temperamental….in that it sometimes decides to arrive sooner than is typical- which means you want to be prepared in case of an early influenza season. So, if you are in your pediatrician’s office, go ahead and opt in for the vaccine…and then you save yourself a trip back later in flu season…and in many cases another co-payment!

 

#2  Sorry kids and parents (and doctors too), there is not going to be a nasal mist influenza vaccine again this year.  The studies of the live attenuated influenza vaccine (FluMist) from the 2015-2016 flu season found that FluMist was only 5% effective in children ages 2-17, compared with 60% effectiveness for the inactivated (shot) flu vaccine.  While no one wants tears - pediatricians do want to give a vaccine that has been found to work - which means a shot.

 

Just to clarify…as parents often ask…”if the flu vaccine is not always 92-99% effective like our routine childhood vaccines, why should we get a shot?”.  My short answer, “would you buy a lottery ticket if you had a 60% chance of winning, rather than .000000001% chance?”. If you don’t get a flu vaccine it is guaranteed that you didn’t get any flu protection…I would rather go with the odds of it working (and winning the lottery which I would buy a ticket for with better odds).  We also have data that shows that those children who received flu vaccine had less chance of complications and hospitalization than those who were not vaccinated. 

 

Start scheduling your family's flu vaccine today.

 

 

 

 

 

 

 

 

  

Daily Dose

Is Fruit Juice Healthy?

1:30 to read

I remember when my children were small that it was “routine” to begin offering infants dilute juice around 6-9 months of age.  Over the years the AAP (American Academy of Pediatrics) continued to advise against offering fruit juice to children under the age of 6 months.  Now…decades later, the AAP has just issued new guidelines including the recommendation “not to offer juice to children under the age of 1 year”.

 

The new recommendations will be published in the June issue of Pediatrics in which they write, “while parents may perceive fruit juice as healthy, it is not a good substitute for fresh fruit and just packs in more sugar and calories.”  The article continues to state, “small amounts in moderation are fine for older kids, but are absolutely unnecessary for children under 1 year.”

 

I always diluted juice for my children, even when they were older.  I would just add a few cans of water to concentrated juice and they never even knew it. It just seemed logical to me at the time. But while 100 percent fresh or reconstituted juice may be healthy, it should still be limited depending on a child’s age.  The concern over steadily increasing obesity rates as well as dental health and the risk of cavities makes even fresh fruit juice a culprit for added calories and sugar.

 

The recommendations include:  toddlers should never be given juice from a bottle or in a sippy cup that allows them to consume juice (even diluted) throughout the day. I continue to recommend that the bottle “goes bye-bye” at the 1 year birthday party and a child only drinks from a sippy cup at meals and snacks after that.  

 

The child should also not have a sippy cup to “wag around all day”.   Parents often tell me that “their child drinks water all day long” but again that may keep them from eating a healthy meal if they drink throughout the day. You know how many adult diets recommend “drink tons of water all day” so you won’t feel hungry…same may be said for a toddler who is already a picky eater.  

Small children get plenty of fluids at meals and snacks and are not hydrating for athletics like my older patients. There are no recommendations that young children drink a certain amount of water everyday….although parents swear their child needs 16 ounces a day?

 

In reality children of all ages should be encouraged to eat whole fruits and be educated about the difference between the fruit they choose and juice.  With “juicing” being so popular, they need to know that even “green juice” lacks dietary fiber and may contribute to excessive weight gain.  I agree that fruit juice is better than no fruit…but for toddler ages 1-3 years, no more than 4 ounces of juice a day, children age 4-6 only 4-6 ounces a day and for children 7-18 years only 8 ounces (1 cup) of juice. The recommendation is that a child should have 2-2.5 cups of whole fruit per day. 

 

I still recommend that my young patients only consume milk (low fat is fine) and water on an everyday basis and add juice later on…when their friends happen to tell them about juice boxes etc. If I am going to buy juice at all I recommend 100% fresh fruit juice and if you can, get juices with added calcium (a little extra never hurts!).

Lastly, juice is not appropriate for re-hydration or for the treatment of diarrhea. For those instances it is necessary to use an “oral re-hydration solution”.

Parenting

Recent Hurricane Disasters May Have Lasting Impact on Kids

2:15

Children may experience long lasting trauma from either living through or even viewing images of natural disasters such as hurricanes, Harvey and Irma, experts say.

"Compared to adults, children suffer more from exposure to disasters, including psychological, behavioral and physical problems, as well as difficulties learning in school," Jessica Dym Bartlett, a senior research scientist at Child Trends, said in that organization's news release.

It’s reasonable to think that children who have actually had to live through the devastation of being in a hurricane could be traumatized and suffer post-traumatic stress syndrome, (PTSD.) But child mental health experts say that even kids who have seen pictures of the damage and watched news reports can also be traumatized and may develop similar symptoms of PTSD such as depression and anxiety.

"Understand that trauma reactions vary widely. Children may regress, demand extra attention and think about their own needs before those of others -- natural responses that should not be met with anger or punishment," Dym Bartlett said.

To help children through this difficult time, parents should create a comforting and safe environment where their child’s basic needs are met. Keep to regular schedules and other routines that provide children with a sense of safety and predictability.

Children that stay busy are also less likely to have continuing negative thoughts; boredom can worsen adverse thoughts and behaviors. Youngsters are less likely to feel distress if they play and interact with others, Dym Bartlett noted.

Limiting your child’s exposure to the continuous images and descriptions of disasters coming from news reports is also helpful, but it’s not necessary to try and eliminate everything pertaining to catastrophes. It’s better to help children understand what has happened in age-appropriate language and to empathize hope and positivity. Reassurance that you are there for them and will do all that is humanly possible to protect them can ease some of the fear associated with disasters.

"Find age-appropriate ways for children to help. Even very young children benefit from being able to make a positive difference in others' lives while learning important lessons about empathy, compassion and gratitude," Dym Bartlett said.

If a child continues to have difficulties coping for longer than six weeks after an event, like the hurricanes, the National Child Traumatic Stress Network recommends seeking professional help.

Parents and caregivers should also make sure that they take care of their own emotional health during these trying and sad times.

Story source: Health Day News, https://www.upi.com/Health_News/2017/09/12/Hurricanes-may-take-lasting-emotional-toll-on-kids/4141505232381/?utm_source=sec&utm_campaign=sl&utm_medium=14

Daily Dose

CPR

1:00 to read

I was seeing a newborn the other day and the parents had a great idea. Their baby had spit up and they were concerned about how to clear his airway.  When we discussed how to hold the baby to clear the airway they had the great idea of having a CPR “teaching party” for a group of their friends who also had young babies!

 

I do encourage new parents (actually all parents and even grandparents) to take a CPR class. I am fortunate that we have yearly CPR class in our office which keeps us all up to date. 

 

It is fairly easy to find local CPR classes either through the YMCA, the American Heart Association and often through the hospital where you deliver your baby.  But, in these cases you have to take the class on “their schedule”. What a great idea to host a party with your friends and hire a certified CPR instructor to come to you!!

 

You know I do like to “isolate” my newborn patients from crowds (for 6-8 weeks), but it is fun to gather with other parents of newborns to get some social interaction. If everyone brought their baby, and a dish for dinner, it could be a mini dinner party followed by CPR training….ending with wine!

 

So…let’s start planning CPR parties, I may even do one for my friends who are becoming grandparents!

 

 

Your Teen

Are Today’s Teens Avoiding Adulthood?

2:30

Are today’s teens riding a slow boat to maturity? Compared to teens in the 1980s and 90s, this generation of teenagers are not in any hurry to grow-up, according to a new study.

In some ways, that’s a good thing. High school kids today are less likely to drink alcohol or have sex, compared to their counterparts a couple of decades ago.

However, they are also less likely to go on dates, have a part-time job or learn to drive – all conventional steps to adulthood.

Are these changes in development good or bad?  Actually, they are both, researchers said.  It depends on how you look at it.

Jean Twenge, a professor of Psychology at San Diego State University, said there are “trade offs’ to each path.

"The upside of slower development is that teens aren't growing up before they are ready," she said. "But the downside is, they go to college and into the workplace without as much experience with independence."

Being unprepared for work or college is definitely a problem for many of today’s adolescents, according to one specialist in teen mental health.

"I think if you ask any college professor, they'll tell you students these days are woefully unprepared in basic life skills," said Yamalis Diaz.

Diaz, who was not involved in the study, is a clinical assistant professor of child and adolescent psychiatry at NYU Langone Medical Center, in New York City.

Today's students may be sharp academically, Diaz said -- but they often have trouble with basics like planning, time management and problem solving.

The findings, published online in the journal Child Development, are based on nationally representative surveys done between 1976 and 2016. Together, they involved over 8 million U.S. kids aged 13 to 19.

On the upside, many of today’s teens aren’t attracted to activities that can be destructive such as drinking alcohol, drug and tobacco use and having sex at an early age. Those are important changes that bode well for young adults and make parents happy.

So why the change in attitude and priorities? It’s complicated. Technology has altered how many people, particularly teens, communicate. Many are spending less time in face-to- face conversations, choosing to text or post on social media.

Parenting styles have also seen a transformation. The “helicopter” or “hovering” parental style has gained in popularity. Some parents are involved so heavily in their kids’ lives that they make all the decisions for them and try to keep their kids from experiencing any type of failure.

In recent years, Diaz said, parents have become much more "child-centric," compared with the days when parents would send their kids outside with instructions to be back by dinner.

And while that is well-intended, Diaz said, kids today may have few chances to deal with relationships, work through their own problems -- and otherwise "stand on their own two feet."

"On one hand," Diaz said, "today's parents should be commended for sending their kids the right messages about what's appropriate for their age."

But, she added, "sometimes parents want to keep doing everything for their kids."

Diaz suggests that parents give kids the space they need to develop necessary skills, like problem-solving, time management and the ability to hold down a part-time job. She also advised parents to create some "no phone" time every day at home -- and to encourage their kids to do the same when they're with their friends.

Story source: Amy Norton, https://consumer.healthday.com/kids-health-information-23/adolescents-and-teen-health-news-719/are-today-s-teens-putting-the-brakes-on-adulthood-726634.html

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Your Baby

Should Newborns Sleep in Yours or Their Own Room?

2:00

It’s an age-old question, should your newborn sleep in his or her own bed in the parents’ bedroom for a while or start their sleeping habits in their own room?

A new study suggests infants benefit from sleeping in their own room, but the American Academy of Pediatrics (AAP) says the dangers may offset the benefit.

Recent research from a hospital in Philadelphia says babies go to sleep earlier, take less time to fall asleep, get more total sleep over the course of 24 hours, and spend more time asleep at night when they don’t share a bedroom with their parents. Parents also report that they get more rest as well.

“There are a number of possible reasons that babies sleep better in their own room,” said lead study author Jodi Mindell, associate director of the Sleep Center at the Children’s Hospital of Philadelphia. 

“One main reason is that they are more likely to self-soothe to sleep,” Mindell said by email.

During the study, researchers found that parents who put babies to sleep in a separate room were less likely to feed infants to help them fall asleep at bedtime or when they awoke during the night.

When babies had their own rooms, parents also perceived bedtime to be less difficult.

The study focused on infants 6 to 12 months old. Researchers examined data from a questionnaire completed by parents of 6,236 infants in the U.S. and 3,798 babies in an international sample from Australia, Brazil, Canada, Great Britain and New Zealand. All participants were users of a publicly available smartphone app for baby sleep. The researchers noted that because of the use of the smartphone app, results might not be the same for a larger population of households.

The AAP recommends that newborns sleep in their own bed in their parents’ bedroom till the infant is at least 6 months of age to minimize the risk of sleep-related death. Ideally, babies should stay in their parents’ rooms at night for a full year, AAP advised 

The reason for the AAP recommendation is because babies sleeping in the same room as parents, but not the same bed, may have a lower risk of sudden infant death syndrome (SIDS).

The safest spot for infant sleep is on a firm surface such as a crib or bassinet without any soft bedding, bumpers or pillows, the guidelines stressed. 

“Pediatric providers have been struggling with what to tell parents since the release of the AAP recommendations,” Mindell said. “Once a baby is past the risk of SIDS, by 6 months of age, parents need to decide what works best for them and their family, which enables everyone in the family to get the sleep they need.”

SIDS deaths occur most often from birth to six months but can also happen in older babies that were the focus on the study, said Dr. Lori Feldman-Winter, a coauthor of the AAP guidelines and pediatrics researcher at Cooper Medical School of Rowan University in Camden, New Jersey. 

“If the only goal is to increase sleep, then the results may be compelling,” Feldman-Winter said in an email to Reuters Health. “However, since we don’t know the causes of SIDS and evidence supports room sharing as a method to decrease SIDS, giving up some sleep may be worth it.”

The study was published online in the journal Sleep Medicine.

Story source: https://www.reuters.com/article/us-sleep-infants-location/parents-find-older-babies-sleep-better-in-their-own-room-idUSKCN1BC5QI

 

Your Baby

High Lead Levels in Baby Bracelet

2:00

After an infant girl in Connecticut developed lead poisoning, the cause was found to be a bracelet made with lead beads. Doctors discovered that the 9-month-old had abnormally high blood lead levels during a routine checkup.

Her blood lead level was 41 micrograms per deciliter (ug/dL); anything over 5 ug/dL is considered abnormal, according to a recent report by the Centers for Disease Control and Prevention (CDC).

Health investigators visited the infant’s home to try and determine where the lead originated. They found lead based paint on windows in the home; however, the child would not have been able to reach the windows. There were also 3 siblings in the house between 3-5 years old whose lead levels tests came back normal.

Investigators also found a homemade bracelet that the infant was given to chew on to relieve teething pain. The beads on the bracelet contained extremely high levels of lead; 17,000 parts per million (ppm). The amount of lead that's considered safe for children's products is 90 ppm or 100 ppm, depending on the type of product, according to the U.S. Consumer Product Safety Commission (CPSC).

Investigators were unable to track down the manufacturer of the beads in the Connecticut case or the bracelet maker, according to the report.

In 2003 and 2006, there were several cases of severe lead poisoning and death linked to lead-containing jewelry and charms marketed to children, the report said. After these instances, the CPSC set limits on the amount of lead allowed in products marketed to kids, and each year, there are recalls of children's jewelry that exceed those limits. However, the limits do not apply to products that aren't intended for use by children, the report noted.

There's no safe amount of lead exposure for children, according to the CDC, and the toxic heavy metal can affect nearly every part of the body. In many cases, lead exposure can occur with no obvious symptoms. Symptoms of severe lead poisoning can include confusion, seizures, coma and death.

Lead in the body is distributed to the brain, liver, kidney and bones. It is stored in the teeth and bones, where it accumulates over time.

For severe cases of lead poisonings, doctors will sometimes recommend Chelation therapy or EDTA chelation therapy.

There are safe non-toxic ways to treat teething pain in infants. The American Academy of Pediatrics (AAP) suggests using a chilled teething ring or “gently rubbing or massaging the gums with one of your fingers.”[3] However, there are safety concerns about plastic teething rings.  A 2015 study found chemicals that can affect the child’s hormones (also called endocrine-disrupting chemicals, or EDCs) in several types of plastic baby “teethers..”For this reason, parents may want to avoid using teethers made of any kind of plastic. While there are several non-plastic alternatives on the market which claim to be safe, some of these products may not have been adequately tested. In addition, some teething products could break or leak, presenting other safety concerns.

Safe ways to help your infant through the teething period include gum massage, a chilled spoon from the refrigerator (not the freezer!) to suck on, a chilled wet washcloth dipped in water, breast milk or chamomile tea to chew on, or chilled foods such as applesauce or yogurt to soothe pain.

Talk to your pediatrician first before applying any over-the-counter products for teething. Never put Lidocaine on your child’s gums.

In 2016, the FDA urged parents to avoid homeopathic teething rings that contain Belladonna. Belladonna comes from the deadly nightshade plant and can be poisonous.

The bottom line on easing teething pain in infants is to talk with your pediatrician about ways to help your little one can get through this sometimes challenging time.

Story sources: Sara G. Miller, https://www.livescience.com/60287-teething-bracelet-causes-lead-poisoning.html

 

 

 

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DR SUE'S DAILY DOSE

When should you get your flu shot?

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