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Daily Dose

Treating Ear Infections

Plenty if ear infections going around, so what's the best treatment?It has been very busy in my office with plenty of ear infections going around.  Once you have taken your child to the pediatrician and they have indeed been diagnosed with an ear infection (otitis), what’s next?

Like many things in medicine there is not one right answer to that question and there continues to be a debate on the treatment of ear infections.  The many articles that have been published in past years have looked at the prevalence of certain bacteria in causing ear infections, the role of viruses as a cause of ear infections and even when and if to treat an ear infection. The articles did not seem to have a clear consensus.  You may have noticed that too if you have seen different doctors who have different opinions about otitis treatment. Now, two recent articles in the New England Journal of Medicine (Jan. 2011) once again looked at antibiotic use for the treatment of ear infections.  In two double blind, placebo controlled, randomized trials (the gold standard for studies) researchers defined otitis as the “acute onset and presence of middle-ear effusion (fluid), bulging tympanic membrane (ear drum), erythema (redness) and pain. The studies were done in Europe and the United States, and looked at whether children between 6 months and 35 months of age improved more quickly if they received an antibiotic rather than a placebo (no antibiotic). This debate had been ongoing, and both of these studies showed that the children who received antibiotics had symptom resolution more quickly than those who were given placebo.  The study also showed that those who received antibiotics were more likely to develop diarrhea. (bummer, hate those side effects!) Given these recent studies I think that the consensus would be that young children with documented ear infections should receive a course of antibiotics. That would typically mean children 2 and under. But, these studies did not look at the practice of what is called “watchful waiting” which has been advocated for older children. When a child over the age of two complains of ear pain, and is then examined and found to have an ear infection it may not always be necessary to prescribe an antibiotic. If the child is old enough to easily evaluate and does not appear ill it may be appropriate to be conservative about antibiotic use, and to provide pain relief with topical ear drops and oral pain relievers such as acetaminophen or ibuprofen. In many cases in an older child, the pain and infection will resolve over several days and an antibiotic will not be necessary. I often write a prescription for a parent to use if their child seems to become more uncomfortable, or the pain persists. In most cases these prescriptions have not been used. Doctors should take into account the history of previous ear infections, parental concerns as well as concerns about excessive use of antibiotics. “Watchful waiting” requires educating parents and having a discussion as to the pros and cons of antibiotic use. Each case may be a little different. Ear infections are still one of the most common reasons a child receives an antibiotic. These two articles now help clear up the debate about antibiotic use in younger children. “Watchful waiting” may still be appropriate for an older child with a simple ear infection. That’s your daily dose for today.  We’ll chat again tomorrow.

Your Baby

Preventing Peanut Allergies in High-Risk Children


New research suggests that, under clinical supervision, children that are at a high risk for developing a peanut allergy can build a lasting tolerance to the legume.

Children that participated in the new study were fed peanuts for years as part of a supervised clinical trial. Now, the researchers are reporting that those youngsters maintained their tolerance for at least a year, even if they didn't keep eating peanuts.

"The therapy persisted, and after 12 months of avoidance there was no increase in the rates of peanut allergy. They maintained their ability to tolerate peanuts, even though they hadn't been eating it," said Dr. Sherry Farzan, an allergist with Northwell Health in Great Neck, N.Y. Farzan wasn't involved in the research.

This suggests that the immune system "learns" that peanut is not a threat to the body, and kids won't have to keep eating peanuts for the rest of their lives to maintain their tolerance, said Dr. Scott Sicherer. He's a pediatric allergy specialist at Mount Sinai Hospital in New York City. Sicherer also wasn't part of the current study.

This study is an extension of the groundbreaking LEAP (Learning Early about Peanut Allergy) clinical trial. Last year, that trial found that feeding peanuts to at-risk babies for 60 months reduced their risk of developing a peanut allergy. The study determined an infant's risk of peanut allergy using an allergy skin test.

Before the original LEAP study results, physicians told parents to avoid exposing their child to allergic foods until they were older and their immune system were more developed.

But the LEAP trial found that exposing at-risk kids to peanuts regularly beginning in infancy actually prevented peanut allergies by the time they reached age 5, Sicherer said. Eating peanuts lowered the rate of peanut allergy by 80 percent in the now-preschoolers, according to the study authors.

"For this high-risk group, waiting longer and longer to eat peanut isn't good," Sicherer said. "It's better to get it into your diet as soon as possible."

Both Farzan and Sicherer warned that this type of preventive strategy should only be given under a doctor’s supervision.

And, this prevention therapy is only for kids at risk of peanut allergy, not for kids who already have developed the allergy, Sicherer warned.

"If you have someone who already had a peanut allergy and gave them peanuts, then they'd get sick and maybe end up in an emergency room," he said.

After the initial study, researchers wanted to know if the children who were successful at building a tolerance to peanuts would have to eat them regularly for the rest of their lives.

To answer this question, the researchers followed more than 500 of the original 640 children for a one-year period of peanut avoidance. Half of this group included previous peanut consumers. The other half had always avoided peanuts.


After 12 months of peanut avoidance, only 5 percent of the original peanut consumers were found to be allergic, compared to 19 percent of the original peanut avoiders, the findings showed.

"This study offers reassurance that eating peanut-containing foods as part of a normal diet -- with occasional periods of time without peanut -- will be a safe practice for most children following successful tolerance therapy," said Dr. Gerald Nepom. He is director of the Immune Tolerance Network (ITN), the consortium behind the LEAP trial.

"The immune system appears to remember and sustain its tolerant state, even without continuous regular exposure to peanuts," he added in an ITN news release.

Farzan said there appears to be a "critical period" between 4 and 11 months where "we can push the immune system around a little."

Farzan and Sicherer both said that by the time kids reach age 5, the immune system appears to have accepted that peanuts aren't a danger to the body.

"After following this pattern, it may not be that important anymore, at least after age 5, to worry if someone isn't keeping up," Sicherer said. "It may not be necessary to keep up with such consistent ingestion."

According to the John Hopkins Bloomberg School of Public health, food allergies affect between 2 and 10 percent of U.S. children. Peanut allergy is considered the most fatal food allergy. 

The LEAP study, and now with the results from its extended research, may offer a new generation of children a chance at preventing this problematic allergy altogether.

Story source: HealthDay reporter Dennis Thompson,


Your Baby

“Hard” Tap Water and Eczema in Infants


Previous studies have noted an association between “hard” tap water and eczema in schoolchildren, but a new study out of the U.K. suggests it may be linked to eczema in babies as well.

Water described as “hard” contains a high degree of minerals - specifically calcium, magnesium and manganese. It’s not considered hazardous, but it comes with a variety of unpleasant effects such as soap scum in sinks and bathtubs, spots on dishes and shower glass, clogged pipes from buildup and clothes that are left dingy after washing.

By some accounts, 85% of U.S. households have hard water.

If your child has eczema, then you know that it is a chronic condition marked by itchiness and rashes. It typically starts at about 6 months old and can last into adulthood.

The study included 1,300 3-month old infants from across the United Kingdom. Researchers checked hardness -- the water's mineral content -- and chlorine levels in the water supply where the babies lived.

Babies who lived in areas with hard water were up to 87% more likely to have eczema, the study found.

"Our study builds on growing evidence of a link between exposure to hard water and the risk of developing eczema in childhood," said lead author Dr. Carsten Flohr, from the Institute of Dermatology at King's College London.

One way to change the composition of hard water is by adding a water softener system to your household

There are several types of systems including salt-based Ion exchange softeners, salt-free softeners, dual tank and magnetic water softeners plus others.

While the other studies focused on school aged children, this is the first to look at the connection with eczema, hard water and babies, the researchers said.

The study wasn't designed to prove a cause-and-effect relationship, so further research is needed to learn more about this apparent link, Flohr added.

"We are about to launch a feasibility trial to assess whether installing a water softener in the homes of high-risk children around the time of birth may reduce the risk of eczema and whether reducing chlorine levels brings any additional benefits," Flohr said in a college news release.

The study was published recently in the Journal of Allergy and Clinical Immunology.

Story sources: Robert Preidt,



Your Baby

Should Pregnant Women Buckle-Up?

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Should expectant mothers buckle up and make sure the air bag is turned on before driving or riding in a car?  Absolutely say researchers in a recent study by the Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC.

Many women are concerned that, in case of an accident, seat belts and /or air bags might harm their unborn child, but according to the study, expectant mothers who are not restrained during a car crash are more likely to lose the pregnancy than those who are.

According to the March of Dimes, nearly 170,000 pregnant women are involved in a motor vehicle accident each year.

"One thing we're always concerned about is (educating) patients on seatbelt use," said Dr. Haywood Brown, the chair of Obstetrics and Gynecology at Duke University Medical Center and senior author of the new study.

"Nonetheless, like all individuals, some choose and some do not choose to wear their seatbelt," he added.

For the study, Brown and his colleagues searched through the trauma registry at Duke University Hospital. They found 126 cases of women in their 2nd and 3rd trimesters that had been in a car crash and were cared for at the hospital between 1994 and 2010.

What they discovered was that 86 mothers were wearing a seat belt when the crash occurred. Of that group, 3.5 percent or (3) fetuses died.

12 mothers were not wearing a seat belt. Of the unrestrained group, 25 percent or (3) fetuses died. 

"The bottom line is, you've got to wear your restraint because it decreases the risk not only for your injuries but injury to your child," Brown told Reuters Health.

Where should the seat belt be placed? The American College of Obstetricians and Gynecologists recommends that the seat belt be fitted low across the hipbones and below the belly.

The March of Dimes offers more seat belt and air bag guidelines for pregnant women:

  • Always wear both the lap and shoulder belt.
  • Never place the lap belt across your belly.
  • Rest the shoulder belt between your breasts and off to the side of your belly.
  • Never place the shoulder belt under your arm.
  • If possible, adjust the shoulder belt height to fit you correctly.
  • Make sure the seat belt fits snugly.
  • Driving can be tiring for anyone. Try to limit driving to no more than 5-6 hours per day.
  • Never turn off the air bags if your car has them. Instead, tilt your car seat and move it as far as possible from the dashboard or steering wheel.
  • If you are in a crash, get treatment right away to protect yourself and your baby.
  • Call your health provider at once if you have contractions, pain in your belly, or blood or fluid leaking from your vagina.

Researchers found that first time mothers were the least likely to use a seat belt. Brown noted it's possible that the habit of buckling in children might prompt mothers to put on their own seatbelt.

Mothers-to-be also worry about airbags and whether they could harm the fetus if a crash causes deployment.

In the study, airbags came out in 17 of the accidents, and in those cases the mother was more likely to experience the placenta separating from the uterus - a condition that can be fatal for the mother or the fetus.

Another researcher, not involved in the study, suggested to Reuters Health that the severity of the accidents, and not the airbags, might have been the cause of the serious consequences.

Brown said some women will disarm the airbag for fear that it will damage the baby in case of a crash, but "it's not the smart thing to do because it will save your life if the airbag comes out."

A study, from researchers in Washington State, found that airbags did not increase the risk of most pregnancy-related injuries.

No one likes to think about the damage a car accident can cause, but the reality is that seat belts and air bags save lives. Mothers-to-be, like everyone else, should use theirs when driving or riding in a car. You may need to make some adjustments so that your seat belt fits safely and correctly and the air bag is not right up next to your stomach, but taking those few extra steps could mean the difference between life and death.

Sources: Kerry Grens,

Your Teen

Concussions: Boys and Girls May Have Different Symptoms


The findings suggest that boys are more likely to report amnesia and confusion/disorientation, whereas girls tend to report drowsiness and greater sensitivity to noise more often.A new study of high school athletes, finds that boys and girls who suffer concussions, may differ in their symptoms. The findings suggest that boys are more likely to report amnesia and confusion/disorientation, whereas girls tend to report drowsiness and greater sensitivity to noise more often. "The take-home message is that coaches, parents, athletic trainers, and physicians must be observant for all signs and symptoms of concussion, and should recognize that young male and female athletes may present with different symptoms," said R. Dawn Comstock, an author of the study and an associate professor of pediatrics at the Ohio State University College of Medicine in Columbus. More than 60,000 brain injuries occur among high school athletes every year, according to the U.S. Centers for Disease Control and Prevention. Although more males than females participate in sports, female athletes are more likely to suffer sports-related concussions, the researchers note. For instance, girls who play high school soccer suffer almost 40 percent more concussions than their male counterparts, according to NATA. The findings suggest that girls who suffer concussions might sometimes go undiagnosed since symptoms such as drowsiness or sensitivity to noise "may be overlooked on sideline assessments or they may be attributed to other conditions," Comstock said. For the study, Comstock and her co-authors at the University of Virginia, Charlottesville, and the University of California, Santa Barbara, examined data from an Internet-based surveillance system for high school sports-related injuries. The researchers looked at concussions involved in interscholastic sports practice or competition in nine sports (boys' football, soccer, basketball, wrestling and baseball and girls' soccer, volleyball, basketball and softball) during the 2005-2006 and 2006-2007 school years at a representative sample of 100 high schools. During that time, 812 concussions (610 in boys and 202 in girls) were reported. During the first year of the study, the surveillance system included only the primary concussion symptom for each athlete. In the second year, high school athletic trainers were able to record all the symptoms reported by the concussed athlete. In both years, headache was the most commonly reported symptom and no difference was noted between the sexes. However, in year one, 13 percent of the males reported confusion/disorientation as their primary symptom versus 6 percent of the girls. Also in the first year, amnesia was the primary symptom of 9 percent of the males but only 3 percent of the females. In the second year, amnesia and confusion/disorientation continued to be more common among males than females. In addition, 31 percent of the concussed females complained of drowsiness versus 20 percent of the males, and 14 percent of the females said they were sensitive to noise, compared with just 5 percent of the males. Concussion researcher Gerard A. Gioia, chief of pediatric neuropsychology at Children's National Medical Center in Washington, D.C., called the findings "relatively subtle" and "at best hypothesis-generating, meaning they are suggestive but in no way conclusive." Gioia said one of the study's limitations is that the reporting system didn't explain about how the injuries occurred. "The presence of increased amnesia and confusion, two early injury characteristics, in the males suggests that the injuries between the males and females may have been different," he said. Future studies will likely address this theory, said Comstock, now that the surveillance system has been expanded to include much more detailed information. Preliminary data suggest, for instance, that football players tend to get hit on the front of the head, while girls who play soccer or basketball often suffer a blow to the side of the head, she said. The findings will also be published in the January issue of the Journal of Athletic Training.

Your Child

Study: Bedtime Routine Offers Kids Many Benefits


If your child doesn’t have a nightly bedtime routine, he or she is missing out on a tremendous amount of health and behavioral benefits according to a new study. And you’re not alone.

A multinational study consisting of over 10,000 mothers from 14 counties reported that less than 50 percent of their infants, toddlers and preschoolers had a regular bedtime routine every night.

Researchers determined that the participant’s children who did have a regular bedtime routine benefitted on many levels. The study found that children with a consistent bedtime routine had better sleep outcomes, including earlier bedtimes, shorter amount of time in bed before falling asleep, reduced night waking, and increased sleep duration. Children with a bedtime routine every night slept for an average of more than an hour longer per night than children who never had a bedtime routine. Institution of a regular bedtime routine also was associated with decreased sleep problems and daytime behavior problems, as perceived by mothers.

“Creating a bedtime routine for a child is a simple step that every family can do,” said principal investigator and lead author Jodi Mindell, PhD, professor of psychology at Saint Joseph’s University and associate director of the Sleep Center at Children’s Hospital of Philadelphia. “It can pay off to not only make bedtime easier, but also that a child is likely to sleep better throughout the entire night.”

According to the American Academy of Sleep Medicine, positive bedtime routines involve the institution of a set sequence of pleasurable and calming activities preceding a child’s bedtime. The goal is to establish a behavioral chain leading up to sleep onset. Activities may include giving your child a soothing bath, brushing teeth and reading a bedtime story.

“It’s important that parents create a consistent sleep schedule, relaxing bedtime routine and soothing sleep environment to help their child achieve healthy sleep,” said American Academy of Sleep Medicine President Dr. Timothy Morgenthaler.

Researchers found that consistency was an important factor in helping children sleep well

“For each additional night that a family is able to institute a bedtime routine, and the younger that the routine is started, the better their child is likely to sleep,” said Mindell. “It’s like other healthy practices:  Doing something just one day a week is good, doing it for three days a week is better, and doing it every day is best.”

Mothers participated in the study by completing a validated, online questionnaire that included specific questions about their child’s daytime and nighttime sleep patterns, bedtime routines and behavior. The questionnaire was translated into each language and back-translated to check for accuracy.

“The other surprising finding is that we found that this effect was universal,” said Mindell.  “It doesn’t matter if you are a parent of a young child in the United States, India, or China, having a bedtime routine makes a difference.”

Sleep deprivation is becoming an all too common problem with today’s children and adults. The earlier a good sleep routine can be established and practiced, the better for a child in the long run.

Study results are published in the May issue of the journal Sleep.


Your Child

The Benefits of Being Bilingual

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Do children who speak more than one language score higher on cognitive tests? Yes, according to a new Canadian study. Researchers say that bilingual students develop a deeper understanding of the structure of language, an important skill in learning to read and write.

Cognitive tests study the mental processes that allow us to perform daily functions such as paying attention, solving problems, producing and understanding language appropriately and making decisions.

Does being bilingual make a child smarter? Not necessarily, but previous studies have shown that children who learn two languages from birth are able to concentrate on the meaning of words better than monolingual children and have an advantage in developing multi-tasking skills.

In the Canadian study, researchers compared 104 six-year olds to measure their cognitive development. Some children were English speaking only. Others were Chinese-English bilinguals, French-English bilinguals, and Spanish-English bilinguals.

The experiments investigated the effects of language similarity, cultural background and educational experience on verbal and non-verbal abilities.

The children did a battery of tests that measured verbal development and one non-verbal task that measured executive control, in this case, the ability to focus attention where necessary without being distracted and then shift attention when required. The bilingual children demonstrated a superior ability to switch tasks.

"The results endorse the conclusion that bilingualism itself is responsible for the increased levels of executive control previously reported," the study's authors wrote.

To acquire language, bilingualism where the languages are similar in origin may have slight advantages, the researchers found. For example, Spanish-English bilinguals outperformed Chinese-English bilinguals and monolinguals on a test of awareness of the sound structure of spoken English.

Dr. Ellen Bialystok, one of the world's foremost experts on bilingualism among children, led the group of researchers from York University in analyzing the effects of bilingualism. Summarizing the results, Dr. Bialystok commented, "Our research has shown that reading progress amongst all bilingual children is improved" over monolingual children. In a separate statement, she said, "I think there's a lot of worry out there about other languages conflicting with a child's ability to learn to read in English, but that's absolutely not the case. Parents should not hesitate to share their native tongue with their children—it's a gift."

Because bilingualism is often tied to other factors such as culture, socioeconomic status, immigration history and language, the researchers partly took those into account by enrolling participants who all attended public schools and came from similar socio-economic backgrounds.

During the study, the children learned to read in both languages at the same time. Dr. Bialystok and her team thought that the additional time spent learning two languages might give the children an advantage. But, results showed that the advantages garnered by the children were independent of the instruction time in the other language.

Researchers noted in the online issue of the journal Child Development that "People always ask if the languages themselves matter and now we can definitively say no," study co-author, Dr. Bialystok, said in a release.

Learning a second language teaches children more about their first language. They understand the intricacies of grammar and acquire an additional awareness of how language is used to express thoughts.

The Canadian study was published in the February 8th, online issue of the journal Child DevelopmentThe study was funded by the U.S. National Institutes of Health.


Your Teen

Teens Getting Less and Less Sleep


Today’s American teens are getting a whole lot less sleep than they did in the 90s according to a new study. Too little sleep makes focusing difficult and depletes one’s energy. As a result, school performance often suffers and unhealthy and/or unwise decisions are much easier to make.

Just 63 percent of 15-year-olds reported getting seven or more hours of sleep a night in 2012. That number is down from 72 percent in 1991, according to the study.

Between the ages of 13 and 18, teens getting 7 hours or more of sleep a night plummets. At 13, roughly two-thirds of teens get at least seven hours of sleep a night; by 18 that percentage drops to about one-third.

"After age 16, the majority are not meeting the recommended guidelines," said study author Katherine Keyes, an assistant professor of epidemiology at Columbia University's Mailman School of Public Health in New York City.

Why is it so important that teens get enough sleep? A lack of sleep can impact just about every part of their life. Hormones are escalating, social interactions are fragile, school demands are heightened, self-image is developing and many begin testing boundaries with parents, teachers and each other. It can be a rugged time for teens and those around them.

For the study, researchers from Columbia University looked at sleep data from a national survey of more than 270,000 teens from 1991 to 2012. Each year, teens reported how often they got seven or more hours of sleep, as well as how often they got less sleep than they need.

The most recent recommendation from the National Sleep Foundation says teens aged 14 to 17 need eight to 10 hours a night and people aged 18 to 25 need seven to nine hours.

The largest declines in those getting enough sleep occurred between 1991 through 2000; then the problem plateaued, Keyes said.

Researchers also found that girls were less likely to get an adequate amount of sleep compared to boys.

So what’s causing the decline? There a several theories about what may be contributing to this downward slide in teen sleep.

Keyes did not have access to information about the teens' use of electronic media, a factor often blamed for lack of sleep as teens text, check social media, play video games and work on laptops late into the night. However, that might be a factor, she said.

"On an individual level, excessive use of technology may impair an adolescent's ability to sleep," Keyes said.

Caffeine may also be a culprit. It’s estimated that about 30 percent of adolescents report consuming energy drinks which are packed with caffeine. Many teens drink specialty coffees as well.

Another issue may be early school start times. Some sleep disorder experts believe that starting school – even an hour later- could help teens get more valuable sleep. Starting school, for instance at 8:30 a.m., is an approach favored by the American Academy of Pediatrics.

Other studies have noted that a lack of sleep is linked with many other teen health problems including obesity, car accidents, depression and a drop in school performance.

When kids are younger, parents are more likely to set limits on bedtime behavior as well as bedtimes. Once kids reach their teens, some of those limits may get a little lax, but this is the time when they are needed most.

Parents still have the authority to set a bedtime and require that computers, tablets and phones are off at least an hour before bedtime. Many kids (and adults) are addicted to their smartphones, so it’s a tough rule to set; it takes a strong commitment and a good example for it to work.

Lack of sleep is hard on everyone, but teens really need the extra help to stay healthy and function well in school. It has such a big impact not only on their present but for their future as well.

Source: Kathleen Doheny,

Your Child

Kid’s Head Injury Linked to Long Term Attention Problems


Even mild brain injuries may cause children to have momentary gaps in attention long after an accident occurs, according to a new study.

The study of 6- to 13-year-olds found these attention lapses led to lower behavior and intelligence ratings by their parents and teachers.

"Parents, teachers and doctors should be aware that attention impairment after traumatic brain injury can manifest as very short lapses in focus, causing children to be slower," said study researcher Marsh Konigs, a doctoral candidate at VU University Amsterdam in the Netherlands.

This loss of focus was apparent even when brain scans showed no obvious damage, the researchers said.

The study’s results are being released as schools gear up for a new academic year combined with some sports programs that can put children at risk for head injuries.

Traumatic brain injury can occur from a blow to the head caused by a fall, traffic accident, and assault or sports injury.

Concussion is one type of traumatic brain injury. In 2009, more than 248,000 teens and children were treated in U.S. emergency rooms for sports- and recreation-related traumatic brain injuries or concussions, according to the U.S. Centers for Disease Control and Prevention.

Here’s how the study was conducted.  Researchers compared 113 children who had been hospitalized with a traumatic brain injury with 53 children who had a trauma injury not involving the head. The injuries, which ranged from mild to severe, occurred more than 18 months earlier on average.

The researchers tested mental functioning and evaluated questionnaires completed by parents and teachers at least two months after the injuries.

The head-injured group had slower processing speed, the researchers found. And their attention lapses were longer than those noted in the other children. But unlike other research, no differences were reported in other types of attention, such as executive attention -- the ability to resolve conflict between competing responses.

As is typical with most studies, the results do not prove a cause and effect relationship, but an association.

The take-home message from this study is that even mild head injury can lead to problems, said Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Cohen Children's Medical Center of New York in New Hyde Park, N.Y. He was not involved with the research.

"This study provides further evidence of the importance of trying to minimize brain trauma, since even when there is no visible damage on CAT scans or MRIs, there can still be a significant adverse effect on attention span and behavior," Adesman said.

This research underscores the need to protect children from head injuries through proper supervision, consistent use of child car seats and seat belts, as well as headgear when bike riding and playing contact sports, he added.

The study was published in the journal Pediatrics.

More information on brain injury in children can be found at the Brain Injury Association of America’s website,

Source: Kathleen Doheny,


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Struggling with feeding your kids healthy (er) meals. Rule of thumb: don't stress over it!


Struggling with feeding your kids healthy (er) meals. Rule of thumb: don't stress over it!

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