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Your Child

Antibiotics Often Prescribed When Not Needed

2.00 to read

By now, most parents understand that antibiotics are not effective for viral infections, only for illnesses caused by bacteria.

However, that hasn’t deterred many physicians from over-prescribing antibiotics for children with ear and throat infections.

More than 11 million antibiotic prescriptions written each year for children and teens may be unnecessary, according to researchers from University of Washington and Seattle Children's Hospital. This excess antibiotic use not only fails to eradicate children's viral illnesses, researchers said, but also supports the dangerous evolution of bacteria toward antibiotic resistance.

"I think it's well-known that we prescribers overprescribe antibiotics, and our intent was to put a number on how often we're doing that," said study author Dr. Matthew Kronman, an assistant professor of infectious diseases at Seattle Children's Hospital.

"But as we found out, there's really been no change in this [situation] over the last decade," added Kronman. "And we don't have easily available tools in the real-world setting to discriminate between infections caused by bacteria or viruses."

 Doctors have limited resources when it comes to differentiating between bacterial or viral infections. Physicians can use the rapid step test to determine if the streptococcus bacteria is the cause of a child’s sore throat, but that is about it for immediate diagnostic tools.

Most colds are virus related and one of the first symptoms will be a sore or scratchy throat. It will typically go away after the first day or so and other cold symptoms will continue. Strep throat is often more severe and persistent.

A virus often causes ear infection as well. Many doctors treat ear infections as though they are bacterial to be on the safe side and avoid serious middle ear infections.

To determine antibiotic prescribing rates, Kronman and his colleagues analyzed a group of English-language studies published between 2000 and 2011 and data on children 18 and younger who were examined in outpatient clinics.

Based on the prevalence of bacteria in ear and throat infections and the introduction of a pneumococcal vaccine that prevents many bacterial infections, the researchers estimated that about 27 percent of U.S. children with infections of the ear, sinus area, throat or upper respiratory tract had illnesses caused by bacteria.

But antibiotics were prescribed for nearly 57 percent of doctors' visits for these infections, the study found.

Kronan hopes that the study’s results will encourage the development of more diagnostic tools and will spur doctors to think more critically about prescribing antibiotics unless clearly needed.

Previous research has shown that parents often pressure their doctor to prescribe an antibiotic to treat their child’s ear or sore throat symptoms. However, when parents are given other suggestions on how to alleviate the symptoms they have been much more receptive than when their doctor just flat out says he won’t prescribe antibiotics.

Many physicians and researchers are concerned that the amount of antibiotics being prescribed these days is setting us all up for future problems when dealing with bacterial infections. Bacteria are adaptable and mutate over time becoming less responsive to antibiotics. When possible, it’s much healthier in the long run to treat your child’s symptoms with simpler therapies. Ask your physican ways you can make your little one more comfortable until the symptoms pass. 

The study was published online in the journal Pediatrics.

Source: Maureen Salamon, http://consumer.healthday.com/infectious-disease-information-21/antibiotics-news-30/antibiotics-prescribed-twice-as-often-as-needed-in-children-study-says-691686.html

Daily Dose

No Screen Time for a Week!

Kids are spending over 7 hours a day in front a screen: TV, watching video, playing games event texting. How much is too much?So, how much screen time does your child have?  You know what I mean, TV time, computer time, playing video games, using a cell phone (including texting). The list goes on and on!

The average American child spends 7 hours a day involved with some type of media, which is more than any other activity besides SLEEP! With that being said, this is National Turn Off Week!  My colleagues at the American Academy of Pediatrics are supporting an effort to encourage parents to implement a “screen free week” in their home. If the average child spends over 1000 hours a year involved in some type of media but only 900 hours a year in school it seems obvious that we are doing something wrong. The solution is to start limiting screen time beginning at the earliest ages. With so many parents believing that Baby Einstein videos will make their infant smarter (there is no proof), and parents who are teaching their children to use a computer or I-phone or I-pad by the age of two, early guidelines regarding time spend “on screen” are exceedingly important. The AAP endorses a “no TV for children under the age of two” rule and limiting TV/media time to 2 hours per day for children and teens.  Unfortunately, many parents may know that their children are home, but are not clear about what they are doing while at home, which often involves screen time in the “privacy” of their own rooms. I ask every patient and or parent about media time and if there is a TV or computer in the child’s room. I am continually amazed at how often the answer is yes, even for the elementary school set. Parents often view putting a TV in their child’s room as a “right of passage” despite the fact that there are really good studies to show that having a TV in a child’s room contributes to poor sleep habits which may impact children in many negative ways. I must say, there isn’t a teenager that I take care of that is “happy” that we are discussing media time, but just like other subjects that need to be addressed during a pediatric visit, this one may be more important than previously thought. For all of this interactive screen time may actually be becoming new “peer group” for a child, rather than having face to face time with their peers. So by turning off the “screens” and spending some time enjoying one another, a new normal could be started.  Families cooking together after the homework is finished, or going outside for a family walk or quick game, or reading together, or even playing board games, the list seems endless.  What a treat to get back 2, 3 or even 4 hours a day with your child.  Think about the  benefits that come from decreasing screen time, which include better academics, better sleep, less depression and anxiety and even an impact on obesity. I know it is challenging for all of us, but this is a “do-able” task for a week. While all of the screen are in the “OFF” mode, talk about new guidelines for when the screens go back on.  In this case the adage “less is more” seems appropriate. That's your daily dsoe for today.  We'll chat again tomorrow. Send your question or comment to  Dr. Sue!

Your Child

Super-Lice Resistant to OTC Treatment

1:45

Well, this certainly isn’t good news.

The American Chemical Society recently reported a new study shows that certain lice in at least 25 states are now resistant to over-the-counter (OTC) treatments.

Study author Kyong S. Yoon, PhD, assistant professor in the Biological Sciences and Environmental Sciences Program at Southern Illinois University, has been researching lice since 2000. His research is still ongoing, but what he’s found so far in 109 samples from 30 states is startling: the vast majority of lice now carry genes that are super-resistant to the OTC treatment used against them.

Permethrin, part of the pyrethroid class of insecticides, is the active ingredient in some OTC treatments. Certain lice have developed a trio of mutations that make it resistant to the pyrethroids. What happens is you end up with a new kind of super-lice that doesn’t respond to typical treatment any longer.

“It’s a really, really serious problem right now in the U.S.,” Yoon says.

Six million to 12 million U.S. children are infested with head lice every year, "with parents spending about $350 million dollars annually on permethrin-laced over-the-counter and prescription treatments," Yoon said. Lice infestations occur in rich neighborhoods as well as poor ones.

Currently, there are 25 states, including Arizona, California, the Carolinas, Connecticut, Florida, Georgia, Illinois, Maine, Massachusetts, Texas and Virginia where lice have what Yoon calls "knock-down resistant mutations". This involves a triple whammy of genetic alterations that render them immune to OTC permethrin treatments.

Lice in four states, New Jersey, New Mexico, New York and Oregon, have developed partial resistance, the researchers found.

Michigan's lice have no resistance as yet. Why that is remains unclear.

Fortunately, there are prescription medications that still work in treating lice. They are more expensive than over-the-counter formulas and do not contain permethrin. These prescriptions may contain benzyl alcohol, ivermectin, malathion and spinosad; all powerful agents or insecticides. Lindane shampoo is another alternative for difficult-to-treat cases.

If your child has head lice and OTC medicines haven’t worked, you can check with your pediatrician or family doctor for a prescription treatment. 

Sources: Mandy Oaklander, http://time.com/4000857/lice-treatment/

Alan Mozes, http://health.usnews.com/health-news/articles/2015/08/18/head-lice-now-resistant-to-common-meds-in-25-states

 

Your Baby

Can More Fruit Consumed During Pregnancy Raise Baby’s IQ?

1:30

The USDA recommends that women consume 2 cups of fruit daily. This can include fruits that are fresh, canned, dried or frozen, as well as 100-percent fruit juice.

Fruit not only contains important vitamins, minerals and fiber but may also provide benefits for the children of moms-to-be who consume more fruit during pregnancy.

According to a new study from Alberta, Canada, the children of mothers that consumed higher levels of fruit during pregnancy, had better cognitive development by the time they were one-year-old.

Researchers said the effects of eating more fruit on test scores were significant.

"It's quite a substantial difference," Dr. Piush Mandhane, an associate professor of pediatrics at the University of Alberta, said in a press release.  "We know that the longer a child is in the womb, the further they develop -- and having one more serving of fruit per day in a mother's diet provides her baby with the same benefit as being born a whole week later."

For the study, researchers analyzed data on 688 one-year-old children collected as part of the Canadian Healthy Infant Longitudinal Development study, and considered the amount of fruit their mothers consumed during pregnancy, gestational age at birth, parental lifestyle factors, including income and education, and cognitive tests given to the children.

Two-thirds of the population falls between 85 and 115 on the traditional IQ scale, with the average at about 100. The researchers found if pregnant mothers ate six or seven servings of fruit or fruit juice per day, their children scored six or seven points higher on IQ tests at one year old. There was no improvement in learning when only the babies were fed fruit.

The researchers noted that future studies will explore longer-term benefits of increased fruit consumption during pregnancy beyond one year of life, as well as whether higher intake of fruit affects development of other parts of the brain.

"We found that one of the biggest predictors of cognitive development was how much fruit moms consumed during pregnancy. The more fruit moms had, the higher their child's cognitive development," Mandhane said.

Experts recommend that pregnant women eat a variety of foods throughout the day to make sure they and their baby get the nutrients they need. A balanced diet contains fruits and vegetables, breads and grains, protein and dairy. Doctors often prescribe prenatal vitamins just in case a mom-to-be isn’t able to get all the nutrients she needs by diet alone.

While fruit is important to one’s overall diet, pregnant women should consult with their OB/GYN about their intake if they are diabetic or susceptible to gestational diabetes.

The study was published in the online edition of EBioMedicine,

Story source: Stephen Feller, http://www.upi.com/Health_News/2016/05/26/Eating-fruit-while-pregnant-helps-babys-cognitive-development-study-says/3311464273928/?spt=sec&or=hn

Your Child

Exercise Boosts Kids’ Grades!

2:00 to read

We all know that exercise is good for the heart, lungs, weight-control and now a new study suggests that it’s good for increasing academic performance as well.

The Dutch researchers reviewed several prior studies conducted in the United States, one from Canada and another out of South Africa. What they discovered was that all the studies showed that the more physically active students are, the better they do in the classroom.

"We found strong evidence of a significant positive relationship between physical activity and academic performance," the researchers, led by Amika Singh of the Vrije Universiteit University Medical Center at the EMGO Institute for Health and Care Research in Amsterdam, the Netherlands, said in a journal news release.

"The findings of one high-quality intervention study and one high-quality observational study suggest that being more physically active is positively related to improved academic performance in children," the authors noted.

A total of 14 studies were reviewed. They involved students between the ages of 6 and 18. Some studies were smaller, working with 50 students, while another study had as many as 12,000 students. 

Researchers noted that students who exercised had increased blood flow and oxygen to the brain. These school-age children did better in the schoolroom. The analysis suggests that exercise also increases the levels of hormones responsible for curtailing stress and boosting mood, while at the same time establishing new nerve cells and synapse flexibility.

In recent years, there has been increasing evidence that has shown that many functions of the brain are highly dynamic, or “plastic”, meaning that the brain is able to continually change in response to stimulus and experience. This flexibility is thought to be a key property in allowing the nervous system to support short-term and sustained changes in output, associated with learning and memory.

Other studies have shown that people with early dementia benefit from exercise. Again, the increased blood flow and oxygen to the brain helps improve memory and learning function.

So, getting the kids off the couch and onto the playground (no matter whether it’s a public playground or the backyard) can help children stay physically fit and mentally alert.

The Dutch researchers would like to see more high quality studies conducted in this area of investigation.

"Relatively few studies of high methodological quality have explored the relationship between physical activity and academic performance," they acknowledged. "More high-quality studies are needed on the dose-response relationship between physical activity and academic performance and on the explanatory mechanisms, using reliable and valid measurement instruments to assess this relationship accurately."

It’s a pretty safe bet though, that the more a family exercises together, the healthier everyone will be.

The findings are published in the January issue of the Archives of Pediatrics & Adolescent Medicine.

Sources: http://consumer.healthday.com/Article.asp?AID=660288 / http://www.sussex.ac.uk/aboutus/annualreview/2011/mindandbrain

Your Child

Household Bleach Causing Flu and Infections in Kids?

1:30

One of the most popular disinfectants used in household cleaning is bleach. From cleaning wipes to straight out of the bottle, bleach is used to clean surfaces, remove mold and brighten clothes.

As far back as 3000 B.C. a form of bleach was used to brighten white clothes. Shakespeare even made reference to bleaching in 1598. But it was around 1913 that bleach was touted as a disinfectant. In many of today’s households, products containing bleach are used as a surface sanitizer to kill bacteria.

A new study from the Netherlands says the cleaning agent may increase children’s risk for flu, tonsillitis and other infections. The study did not prove cause and effect, but suggested that bleach and other similar cleaning products may be contributors to these types of illnesses.

The study was led by Lidia Casas, of the Center for Environment and Health at KU Leuven in Leuven, the Netherlands. Her team looked at more than 9,000 children, aged 6 to 12, in the Netherlands, Finland and Spain.

Those whose parents used bleach to clean their homes at least once a week had higher rates of respiratory and other types of infections. Specifically, Casas and colleagues found that these children had a 20 percent higher risk of having the flu at least once in the previous year, a 35 percent higher risk of recurrent tonsillitis and an 18 percent higher risk for any recurrent infection.

According to the study’s authors, airborne components of bleach and similar products may irritate the lining of children's lungs, triggering inflammation and making it easier for infections to take hold. Or, bleach may somehow suppress the immune system, making infections more likely, the team said.

The American Cleaning Institute (ACI), which represents makers of bleach and bleach products, responded quickly to the study.

"Since there was no data presented on the children's actual exposure to bleach -- nor any diagnoses of actual diseases -- the authors are merely speculating," the ACI said in a statement. The group also said that disinfecting household surfaces with bleach can protect people from bacterial infection.

Responses to the study from medical specialists have been mixed.

"While this study observes higher respiratory effects of bleach on children, it is not a cause-and-effect study, and other factors or household cleaners may be involved," said Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City.

"There is evidence that high concentrations of bleach can cause asthmatic reactions when ventilation is not adequate, but the leap to increased incidence of infections is less clear," he said.

Dr. Jacqueline Moline, vice president of population health at North Shore-LIJ Health System in Great Neck, N.Y., noted, "These results are in line with other studies that show the impact of cleaning products on the health of young children."

Moline also said that parents might want to consider using a different product for household cleaning, "the take-home message from this study is that one should be prudent in the use of harsh household cleaners with bleach or other chemicals, especially in homes with young children, and seek out less toxic or harsh products to clean the home."

The study was published online in the April edition of the journal Occupational & Environmental Medicine.

Source: Robert Preidt, http://consumer.healthday.com/respiratory-and-allergy-information-2/asthma-news-47/could-household-bleach-raise-kids-risk-for-flu-other-infections-698036.html

Parenting

Any Benefits From Eating Your Own Placenta?

2:00

Here’s a medical study I never thought I’d read –“Are there health benefits associated with eating your own placenta after giving birth”?

Well…no, according to a research team from Northwestern University in Chicago. In fact, there may be a few health risks associated with ingesting placenta.

As I read the study’s findings, I began to wonder; who thought this was a good idea in the first place?

It turns out that throughout history there have been some cultures in which women ate the placenta after giving birth. It’s called placentophagy.

Some animals are known to also eat their afterbirth.

Apparently its’ also become the thing among a few celebrity mothers. While some believe that fresh placenta provides the most benefits, others elect to make a smoothie or have it dried, processed and made into pills.

However, the question still remains – is there any real benefit from eating placenta whether it’s raw, processed, made into a smoothie or pill, grilled or baked?

Scientists from Northwestern University pored over accumulated research that has been done on the topic.  The bottom line is that they could not find any evidence that there are any health benefits to placentophagy and that there may be unknown risks to mothers and their infants.

"Our sense is that women choosing placentophagy, who may otherwise be very careful about what they are putting into their bodies during pregnancy and nursing, are willing to ingest something without evidence of its benefits and, more importantly, of its potential risks to themselves and their nursing infants," study lead author and psychologist Cynthia Coyle said in a Northwestern news release.

In the study, Coyle's team reviewed data from 10 published studies. They found no data to support that eating the placenta -- either raw, cooked or in pill form -- protects against postpartum depression, reduces pain after childbirth, increases a woman's energy, helps with lactation, improves mother-child bonding, replenishes iron in the body, or improves skin elasticity. All touted as reasons many of the celebrity moms chose to give it a try.

The researchers also said that there are no studies examining the risks associated with eating the placenta, which acts as a filter to absorb and protect fetuses from toxins and pollutants.

Coyle noted that "there are no regulations as to how the placenta is stored and prepared, and the dosing is inconsistent. Women really don't know what they are ingesting."

If placentophagy appeals to you, be sure and check with your hospital or birthing center first. Many hospitals dispose of the placenta as bio-hazardous waste along with the other medical waste that occurs during birth (needles, blood, gloves etc.). You’ll most likely have to make arrangements ahead of time or find a more accommodating provider.

Source: Robert Preidt, http://www.webmd.com/baby/news/20150604/new-moms-gain-no-benefit-from-eating-placenta-studies-show

Your Child

Study: Exercise, Once Again, Improves Kid’s Learning Skills

2:00

While the debate on whether to bring back recess to school curriculums continues across the U.S., a small study from the Netherlands once again shows that adding exercise to a child’s school day can improve their learning skills.

Researchers worked with 500 children in second and third grade, giving half of them traditional lessons while the rest received instruction supplemented with physical activity designed to reinforce math and language lessons.

The approach was a creative and unique way to helping children better comprehend math and spelling.  Instead of taking a recess break – exercise was actually incorporated into the lesson.

After two years, children who got the physically active lessons had significantly higher scores in math and spelling than their peers who didn't exercise during class.

"Previous research showed effects of recess and physical activity breaks," said lead study author Marijke Mullender-Wijnsma, of the University of Gronigen in The Netherlands.

"However, we think that the integration of physical activity into academic lessons will result in bigger effects on academic achievement," Mullender-Wijnsma added in an email to Reuters Heath.

Mullender-Wijnsma and colleagues developed a curriculum that matched typical lessons in academic subject matter but added physical activity as part of instruction. They tested it in 12 elementary schools.

Here’s how it worked.

Lessons involved constant practice and repetition reinforced by body movements. For example, children jumped in place eight times to solve the multiplication problem 2 x 4.

Children in the exercise group received 22 weeks of instruction three times a week during two school years. These lessons were up to 30 minutes long, and evenly split between math and spelling instruction.

During the first year of the study, there wasn’t a great deal of difference found between the students receiving exercise during the class and those that didn’t, when speed was the focus in the math tests.

However, after two years, children who received exercise-based instruction had significantly higher scores on the math speed exams than students who didn't. The difference over two years equated to more than four months of additional learning for the students who had physically active lessons.

When the focus was on lesson comprehension, students receiving exercise outperformed students who did not receive the exercise instruction in both the first and second year. Again, the progress amounted to about four more months of learning.

For spelling, there wasn't a significant difference between the student groups after one year. But by the end of the second year they did have significantly better test scores, once again, adding an additional four more months of learning.

For reading, there wasn’t much difference between the two groups. It's possible that physical activities may be more beneficial to learning that involves repetition, memorization and practice of lessons from previous classes, the researchers conclude.

Researchers did point out that there were limitations that could have impacted the results of the study during the first year. The exercise group received specially trained teachers and individual schools administered the tests.

The research team did not examine why exercise might have helped students do better during tests.

 Sara Benjamin Neelon, of Johns Hopkins University and colleagues write in an accompanying editorial that it’s not clear whether these types of classes would work in countries where the population is larger, more diverse and students come from different socioeconomic backgrounds.

"However, the take-home message for parents and teachers is that physically active lessons may be a novel way to increase physical activity and improve academic performance – at the same time," Benjamin Neelon said by email.

More and more studies show that exercise appears to help the brain function better in children and adults. Whether all U.S. school administrations will see adding recess or exercise back into school curriculums is anybody’s guess, but according to science – it sure couldn’t hurt and might even help students develop stronger learning skills.

The study was published in the online journal Pediatrics.

Story source: Lisa Rapaport, http://www.reuters.com/article/us-health-children-fitness-learning-idUSKCN0VX26V

Your Baby

Chubby Baby = Obese Child?

2.00 to read

“Look at those cute little rolls of fat and chubby cheeks.” “It’s just baby-fat, he’ll grow out of it.” Common comments when people see a chubby baby. But, what was once thought of as a well-fed and healthy infant might prove to be just the opposite.

Researchers say they’ve found a way to determine if a rapid growing baby will become obese later in life. A new study says that if your baby has passed two key milestones, on a doctor’s growth chart by the age of two, then he or she has double the risk of being obese by the age of 5.  Rapid growers were also more likely to be obese at age 10, and infants whose chart numbers climbed that much during their first 6 months faced the greatest risks.

Children who grew more slowly were less likely to be obese by the same age.

That kind of rapid growth should be a red flag to doctors, and a sign to parents that babies might be overfed or spending too much time in strollers and not enough crawling around, said pediatrician Dr. Elsie Taveras, the study's lead author and an obesity researcher at Harvard Medical School.

Contrary to the idea that chubby babies are the picture of health, the study bolsters evidence that "bigger is not better" in infants, she said.

In an online article on healthland.time.com Dr. Michelle Lampl, director of Emory University's Center for the Study of Human Health, expressed concerns.

“It’s a bad idea that could backfire in the long run,” said Lampl.

"It reads like a very handy rule and sounds like it would be very useful _ and that's my concern," Lampl said. The guide would be easy to use to justify feeding infants less and to unfairly label them as fat. It could also prompt feeding patterns that could lead to obesity later, she said.

Lampl noted that many infants studied crossed at least two key points on growth charts; yet only 12 percent were obese at age 5 and slightly more at age 10. Nationally, about 10 percent of preschool-aged children are obese, versus about 19 percent of those aged 6 to 11.

Taveras said the rapid growth shown in the study should be used to raise awareness and not to put babies on a diet.

The study involved 45,000 infants and children younger than age 11 who had routine growth measurements during doctor checkups in the Boston area from 1980 through 2008.

Growth charts help pediatricians plot weight, length in babies and height in older kids in relation to other children their same age and sex. Pediatricians sometimes combine an infant's measures to calculate weight-for-length _ the equivalent of body-mass index, or BMI, a height-to-weight ratio used in older children and adults.

The charts are organized into percentiles. For example, infants at the 75th percentile for weight are heavier than 75 percent of their peers.

An infant whose weight-for-length jumped from the 19th percentile at 1 month to the 77th at 6 months crossed three major percentiles _ the 25th, 50th and 75th _ and would be at risk for obesity later in childhood, the authors said.

Larger infants were most at risk for obesity later on, but even smaller babies whose growth crossed at least two percentiles were at greater risk than those who grew more slowly.

About 40 percent of infants crossed at least two percentiles by age 6 months. An analysis of more than one-third of the study children found that 64 percent grew that rapidly by age 2.

Dr. Joanna Lewis, a pediatrician at Advocate Lutheran General Hospital in Park Ridge, Ill., said she supports the idea that infancy is not too young to start thinking about obesity.

Still, she emphasized that rapid growth in infancy doesn't mean babies are doomed to become obese. "It's not a life sentence," and there are steps parents can take to keep their babies at a healthy weight without restrictive diets, she said.

Lewis said many of her patients are large babies whose parents feed them juice or solid food despite guidelines recommending nothing but breast milk or formula in the first six months.

"The study reinforces what we try to tell parents already: Delay starting solids and don't put juice in a bottle," Lewis said.

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DR SUE'S DAILY DOSE

Count your blessings this Thanksgiving!

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