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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 Child

1 in 10 Kids Have an Alcoholic Parent

2.00 to read

Since the passing of singing legend, Whitney Houston, the public has heard almost non-stop about her battle with serious drinking and drug problems. We’ve also learned that her 18-year-old daughter has had her own trouble with drugs and alcohol. They may be celebrities, but they share one thing in common with many American families - the long-term effects of alcohol abuse.

More than 1 in 10 U.S. children are living with an alcoholic parent and are at increased risk of developing a host of health problems of their own, according to a new government study released on Thursday.

Researchers at the Substance Abuse and Mental Health Services Administration (SAMHSA) analyzed national survey data from 2005 through 2010. They found that on average, 7.5 million children, under the age of 18, lived with a parent abusing alcohol during any given year. That’s about 10.5 percent of the under 18 population.

About 6.1 million of the children, lived in a 2-parent household where one or both of the adults abused alcohol.

Researchers said that of the 1.4 million children who lived in a single parent home where the adult had a drinking issue, the overwhelming majority was in female-head of households. The figure given was 1.1 million households.

"The enormity of this public health problem goes well beyond these tragic numbers as studies have shown that the children of parents with untreated alcohol disorders are at far greater risk for developing alcohol and other problems in life," SAMHSA representative Pamela Hyde said in a statement.

The study said that children of alcoholics were at a greater risk for mental health problems including anxiety and depression.

Another not surprising discovery was that these children were at higher risk for being abused or neglected by their parents. They were also more likely to have thinking or language difficulties and four times more likely to develop alcohol problems of their own.

While this study looks at how many children live with an alcoholic parent, the American Academy of Child & Adolescent Psychiatry (AACAP) reports that if you substitute relative for parent then the statistic changes to one in five adult Americans have lived with an alcoholic relative while growing up.  Again, the statistic is pretty staggering.

What can be done to help children of alcoholics? There are support groups and resources available, but understanding family members, friends, teachers, coaches and counselors can also help lead these children down a more positive path.  

Children and adolescents of alcoholic parents can benefit from educational programs and mutual-help groups such as programs for children of alcoholics, Al-Anon, and Alateen. Early professional help is also important in preventing more serious problems for the child, including reducing risk for future alcoholism.  Child and adolescent psychiatrists can diagnose and treat problems in children of alcoholics. They can also help the child to understand they are not responsible for the drinking problems of their parents and that the child can be helped even if the parent is in denial and refusing to seek help.

Some resources for families dealing with alcohol abuse are:

1. National Association for Children of Alcoholics- www.nacoa.net

2. Al-Anon – www.al-anon.alateen.org

3. Adult Children of Alcoholics – www.adultchildren.org

4. The American Academy of Child & Adolescent Psychiatry- www.aacap.org

Sources: http://www.reuters.com/article/2012/02/16/us-usa-drinking-study-idUSTRE81F0CB20120216  / http://www.aacap.org/

Your Teen

More Teens Fall Victim to Dating Violence

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The teenage years are supposed to be filled with laughter, fun and testing the boundaries of parental control. It’s also a time when many boys and girls will start dating. For some teens, the beginning of couple relationships is about as far away from fun as it could possibly be.

Some teenagers may think that teasing and name-calling are somehow linked with a fondness for someone, and that might have been true when they were six or seven years old. However, by the time a young girl or boy reaches their teenage years, that kind of behavior can take on a much different tone. What was once an awkward attempt at gaining someone’s attention can turn into physical and sexual abuse.

According to a new study from the Centers for Disease Control and Prevention (CDC) that is happening more than you might think.

Twenty-one percent of high school girls have been physically or sexually assaulted by someone they dated -- a figure twice as high as previously estimated.

Ten percent of high school boys also reported being physically or sexually assaulted by someone they had dated.

The authors of the new report noted that the CDC has changed the way it phrases its questions about teen dating violence, leading more students to report assaults.

Sadly, teens that have experienced dating violence are at risk for other serious problems as well. Research has shown that they are more than twice as likely to consider suicide. They are also more likely to get into fights, carry a weapon, use alcohol, marijuana or cocaine and to have sex with multiple partners. Not the kind of life any parent would want for their teenager or the one that they would truly want for themselves.  

Researchers don't know if any of these events causes the others. While it's possible that dating violence could cause thoughts of suicide, it's also possible that children who are depressed are more likely than others to fall into abusive relationships, says Adiaha Spinks-Franklin, a developmental and behavioral pediatrician at Texas Children's Hospital in Houston who was not involved in the study.

Assaults by romantic partners often aren't isolated events. Many teens reported being assaulted multiple times, according to the study, based on the CDC's Youth Behavior Risk Surveillance System using questionnaires answered by more than 13,000 high school students.

"If there is violence once, there is likely to be violence again," Spinks-Franklin says. "It has to be taken very seriously."

Spinks-Franklin says she has seen violence even among relationships between 10- and 11-year-olds.

"If a parent is concerned that a child is in an unhealthy relationship, they need to address it, but do it in a way that doesn't make the child shut down," she says. "They need to feel safe telling a parent."

Teens often hide the abuse from their parents, Spinks-Franklin says. Teens may not be able to confide in friends, either, because abusers sometimes isolate their victims from loved ones. Teens are sometimes more willing to talk to doctors, especially if their parents are not in the room.

Some schools have taken the lead in promoting awareness of and education on teen dating violence. Pediatricians can also discuss this important topic with their patients and parents. If time is limited, brochures in the waiting room can offer information and open the door for questions.

"This study makes it even more important for parents to ask lots of questions and get to know their teen's friends and significant others, and not ignore anything that makes them uncomfortable," says McCarthy, a pediatrician at Boston Children's Hospital. "They also shouldn't ignore any changes in their teen's behavior."

Dating violence may never be eliminated one hundred percent, but can be considerably lessoned when teens, families, organizations, and communities work together to implement effective prevention strategies.

One of the best strategies for prevention is for parents and teens to be able to communicate about serious topics without judgmental attitudes or closed-minded opinions. Your teen wants your help even if he or she doesn’t know how to ask. They'll appreciate you being there before and when they need you.

The new study was published in JAMA Pediatrics.

Sources: Liz Szabo, http://www.usatoday.com/story/news/2015/03/02/teen-dating-violence-study/24127121/

http://www.cdc.gov/violenceprevention/intimatepartnerviolence/teen_dating_violence.html

Your Baby

New Guidelines To Help Prevent Peanut Allergies

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Peanut allergy is one of the most common food allergies. Even trace amounts can cause a severe reaction in a child that is allergic to the legume. Parents may be able to reduce the chance that their children will develop peanut allergies by introducing the food early on, as young as four to six months of age, experts now say.

The results of several studies on the positive benefits of introducing peanuts into a child’s diet, early in their life, are encouraging new recommendations from allergy experts.

“Guidance regarding when to introduce peanut into the diet of an infant is changing, based on new research that shows that early introduction around 4-6 months of life, after a few other foods have been introduced into the infant’s diet, is associated with a significantly reduced risk of such infants developing peanut allergy,” said Dr. Matthew Greenhawt, a pediatrician and co-director of the Food Challenge and Research Unit at Children’s Hospital Colorado in Aurora, Colorado, who coauthored the update.

“This is an amazing opportunity to help potentially reduce the number of cases of peanut allergy, but this can only be done with the cooperation of parents and healthcare providers,” Greenhawt told Reuters Health.

Research used for the restructured recommendations comes from the Learning Early about Peanut Allergy (LEAP) study. In that trial, infants at high risk for peanut allergies who were exposed to peanuts early were less likely to develop an allergy by the time they reached five years of age. The findings from that study were published last year in The New England Journal of Medicine.

The guidelines offer three approaches to introducing peanuts to infants- depending on their risk of allergy.

-       Infants with severe eczema, egg allergy or both are at high risk for peanut allergy. They should be exposed to peanuts as early as four to six months to reduce the risk of allergy. Beforehand, however, these infants should undergo a skin prick test. If the test yields no welt or a small welt of up to 2mm, parents can introduce peanuts at home. But if the test yields a welt of 3mm or larger, peanuts should be introduced in the doctor’s office - or not at all if the welt is large and an allergist recommends avoidance.

-       Infants with mild to moderate eczema who have already started solid foods should be exposed to peanuts at six months of age.

-       Infants without eczema or any food allergy are at low risk, and parents can introduce peanuts in an age-appropriate form at any time starting at age six months.

Giving an infant a whole peanut is not recommended because they can choke on them. However, there are ways to prepare peanuts that can be introduced safely.

Another coauthor of the new guidelines, Dr. Amal Assa’ad, a pediatrician and director of the FARE Food Allergy Center of Excellence at the Cincinnati Children’s Hospital Medical Center in Ohio, told Reuters Health, “Several appropriate forms of peanut-containing foods are creamy peanut butter that can be made softer or more liquefied by adding warm water and let it cool, or serving corn puffs containing peanut. For older infants, peanut butter can be added to apple sauce or other fruit purees.”

Parents should consult with an allergist or their pediatrician before giving their infant peanuts in any form.

While the news about early peanut allergy intervention has been noted by various medical, media and social networks, reliable strategies for how to determine who should and should not get the therapy and when to start it, have not been available. These new guidelines help answer those questions.

The updated guidelines will be published online in January on the National Institute of Allergy and Infectious Diseases website; in the meantime, the site provides the current 2010 guidelines on peanut and other food allergies.

Story source: Rob Goodler, http://www.reuters.com/article/us-health-allergies-peanuts-idUSKBN1361VW

 

Your Teen

Concussions: Boys and Girls May Have Different Symptoms

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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 Baby

Babies Can Tell the Difference and Sameness of Objects

1:45

How old are we when we begin to learn to tell when objects are alike or different?  Scientists involved in a new study say that with a little training, babies as young as seven months can discern whether objects are similar or not.

Previous studies have shown that toddlers have this ability, but researchers at Northwestern University, wanted to see if children could actually determine the difference at an even earlier age.  The scientists were the first to discover that infants can actually make this remarkable determination – long before they have the language skills to express abstract ideas.

“This suggests that a skill key to human intelligence is present very early in human development, and that language skills are not necessary for learning abstract relations,” said study author, Alissa Ferry, a brain development researcher.

To accomplish this, the scientists started out to see if seven--month-old infants could comprehend sameness and difference between two objects by showing them either two Elmo dolls or an Elmo doll and a toy camel until their observation time ran out.

They then had the infants look longer at pairs that were either the “same” or “different,” including test pairs composed of new items. The team saw infants who had learned the “same” relation looked longer at test pairs showing the “different” relation and vice versa. The team said this indicates the infants had figured out the abstract relation and recognized when the relation changed.

“We found that infants are capable of learning these relations,” Ferry said. “Additionally, infants exhibit the same patterns of learning as older children and adults — relational learning benefits from seeing multiple examples of the relation and is impeded when attention is drawn to the individual objects composing the relation.”

The researchers also believe that because the infants could learn the difference and the sameness of objects before they could speak, that this is a separate skill that humans need and develop early in their existence.

“The infants in our study were able to form an abstract same or different relation after seeing only 6-9 examples,” said study author Dedre Gentner, a professor of psychology at Northwestern. “It appears that relational learning is something that humans, even very young humans, are much better at than other primates.”

Source: Brett Smith, http://www.redorbit.com/news/health/1113398144/infants-can-compare-and-contrast-objects-study-052715/

 

 

Your Teen

HPV Vaccine, Proving Effective in Teenage Girls

2:00

While the controversy over the HPV vaccine may continue in some circles, a new study says the vaccine is proving effective in teenage girls.

The human papillomavirus (HPV) vaccine was introduced 10 years ago and its use immediately became a hot topic. The vaccine is recommended for young girls and boys ages 11 and 12, to protect them from the sexually transmitted virus that can cause cervical as well as anal, penile, mouth and throat cancers. 

The study found that in teenage girls, the virus’s prevalence has been reduced by two-thirds.

Even for women in their early 20s, a group with lower vaccination rates, the most dangerous strains of HPV have still been reduced by more than a third.

“We’re seeing the impact of the vaccine as it marches down the line for age groups, and that’s incredibly exciting,” said Dr. Amy B. Middleman, the chief of adolescent medicine at the University of Oklahoma Health Sciences Center, who was not involved in the study. “A minority of females in this country have been immunized, but we’re seeing a public health impact that is quite expansive.”

HPV vaccinations rates, in young girls and boys, have slowly been increasing, since the vaccine was introduced, but 4 out of 10 adolescent girls and 6 out of 10 adolescent boys have not started the recommended HPV vaccine series, leaving them vulnerable to cancers caused by HPV infections.

That is partly because of the implicit association of the vaccine with adolescent sexual activity, rather than with its explicit purpose: cancer prevention. Only Virginia, Rhode Island and the District of Columbia require the HPV vaccine.

The latest research examined HPV immunization and infection rates through 2012, but just in girls. The recommendation to vaccinate boys became widespread only in 2011; they will be included in subsequent studies.

Using data from a survey by the Center for Disease Control and Prevention (CDC), the study examined the prevalence of the virus in women and girls of different age groups during the pre-vaccine years of 2003 through 2006. (The vaccine was recommended for girls later in 2006.) Researchers then looked at the prevalence in the same age groups between 2009 and 2012.

By those later years, the prevalence of the four strains of HPV covered by the vaccine had decreased by 64 percent in girls ages 14 to 19. Among women ages 20 to 24, the prevalence of those strains had declined 34 percent. The rates of HPV in women 25 and older had not fallen.

“The vaccine is more effective than we thought,” said Debbie Saslow, a public health expert in HPV vaccination and cervical cancer at the American Cancer Society. As vaccinated teenagers become sexually active, they are not spreading the virus, so “they also protect the people who haven’t been vaccinated,” she said.

Many doctors are pressing for primary care providers to strongly recommend the HPV vaccine in tandem with the other two that preteen children now typically receive.

Many health experts are hoping that the positive results from this study will encourage more pediatricians and primary care physicians to discuss getting the vaccine with parents of young children.

The study was published in the online journal Pediatrics.

Source: Jan Hofman, http://www.nytimes.com/2016/02/22/health/vaccine-has-sharply-reduced-hpv-in-teenage-girls-study-says.html?ref=health

Your Child

Are You Making Your Child More Anxious?

2.00 to read

When a child shows that he or she is anxious or in distress, a natural response is for a parent to want to remove whatever is causing the discomfort. However, according to a new study, it may not be the best reaction for your child in the long run.

Researchers call it the “protection trap.” Basically it means smothering children with too much attention or making the menace go away.

The research showed that certain parental coddling behaviors might actually boost anxiety in a child, although the study doesn't prove a cause-and-effect relationship.

"We found evidence that when parents try to help their anxious children they do a lot of things," said study co-author Armando Pina, an associate professor of child developmental psychology at Arizona State University. "Some of them are good, like promoting courage with warmth and kindness. Others are less helpful, like promoting avoidance by overprotecting, which many times leads to more anxiety."

Other experts have also weighed in on this topic.

"Left untreated, anxiety disorders in youth are associated with greater risk for other psychological problems such as depression and substance use problems," said Donna Pincus, director of research at the Child and Adolescent Fear and Anxiety Treatment Program at Boston University. Anxiety problems can also disrupt families and cause kids to perform worse in school, she added.

So what should a parent do or not do?

"When children are in distress or upset they need parental comfort, reassurance and extra love. This is good," said study lead author Lindsay Holly, a graduate student at Arizona State University. "Sometimes, however, parents end up providing excessive reassurance and doing things for the child, like making excuses for why a child who is anxious in social situations won't go to a birthday party or talking for the child by ordering at restaurants."

Here’s how the study was conducted.

Researchers examined the results of a survey of 70 kids aged 6 to 16 who were treated for anxiety and/or depression at a clinic. The kids were equally divided among boys and girls and among whites and Hispanic/Latinos.

The investigators found that some kids were more likely to have anxiety and depression symptoms if their parents reinforced or punished their anxiety through various approaches. Among the two ethnic groups, "the only difference was that Latino parents seemed to attend more frequently to their children's anxiety," Holly said.

Pina noted that previous research has indicated that a certain kind of therapy can help kids become less anxious and more resilient by teaching the importance of facing fears. One of the goals of the therapy is to teach parents how to promote courage in the kids through a combination of warmth and kindness, Pina said.

Some experts believe that by exposing children to anxious situations in a controlled, supportive environment, they can learn how to handle their anxiety better.

Holly suggests that parents encourage their children "to do brave things that are small and manageable." A child who's afraid of speaking in public, for instance, might be urged to answer a question about whether they want fries with their meal at a restaurant.

While every child is going to be anxious at one time or another, a more difficult situation is when children suffer from an anxiety disorder. That is a more serious problem where someone experiences fear, nervousness, and shyness so much so that they start to avoid places and activities.

According to the Anxiety and Depression Association of America, anxiety disorders affect one in eight children. Research shows that untreated children with anxiety disorders are at higher risk to perform poorly in school, miss out on important social experiences, and engage in substance abuse. Anxiety disorder often shows up alongside other disorders such as depression, eating disorders, and ADHD.

The good news is that with treatment and support, a child can learn how to successfully manage the symptoms and live a normal childhood.

The study conducted at Arizona State University, looked at typical child anxieties and how parent’s interactions either helped or prolonged the anxiousness.

The study was published recently in the journal Child Psychiatry and Human Development.

Sources: http://www.cbsnews.com/news/overprotective-parenting-could-worsen-kids-anxiety/

http://www.adaa.org/living-with-anxiety/children/childhood-anxiety-disorders

Daily Dose

Acetaminophen & Vaccines

1:30 to read

A recent article in Lancet was quite thought provoking as it studied the common practice of giving infants a dose of acetaminophen (Tylenol) with their routine immunizations.

Many parents and some pediatricians routinely dose their infants with acetaminophen prior to receiving their vaccines at two, four and six months of age. In the study of 459 infants from 10 different centers in the Czech Republic, patients were randomized to either receive three doses of acetaminophen every six to eight hours at the time of vaccination or no acetaminophen. The researchers then looked at both the reduction of febrile reactions post vaccination and at antibody titers among the two groups. Interestingly, there were both some expected and some not so expected results. Not surprisingly, the group that received acetaminophen had a lower incidence of fever post immunization. Of those that received acetaminophen 94 out of 226 (42 percent) developed a fever, compared to 154 out of 233 (66 percent) in the non-treated group after their primary immunization series. After booster vaccination 64 out of 178 (36 percent) in the treated group and 100 out of 172 (58 percent) developed fever. So the widespread perception by both many parents and doctors that routine acetaminophen use with vaccination does reduce the incidence of fever was supported.

The most interesting result of this study was the vaccine antibody response in the acetaminophen treated group. Surprisingly, antibody responses to several of the routinely administered vaccines (including tetanus, diphtheria, h. flu, and pneumococcal serotypes) were lower in the group who received routine acetaminophen. This was also seen after booster doses of the same vaccines between 15 to 18 months of age. The hypothesis is that acetaminophen may reduce the inflammatory response and that this may also induce less of an immune response. So, it would seem prudent to no longer encourage routine use of acetaminophen with vaccines unless a baby develops significant fever, or is at risk for fever and febrile seizures. As a parent you are always trying to “protect” you child, and this would include any pain or fever that might develop with vaccination. Now we have science to show how this may actually provide less protection, against disease. Thought provoking!

That’s your daily dose, we’ll chat again tomorrow.

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