Dr. Nabong's Pediatric Blog

Is Strength Training Safe in Young Children?

2011-10-21T10:05:00.000-07:00

There are more than 40 million children in the United States who participate in different sports every year. This is encouraged for health reasons. Helps them become stronger and hopefully prevents obesity. But is strength training or resistance training safe for young children.
The American Academy of Pediatrics (AAP) Council on Sports Medicine and Fitness is supportive of strength training as an adjunct to sports participation and it does not advocate the sport of competitive weight lifting for the skeletally immature child.
Benefits of weight training:

increased muscular strength and endurance

prevention of injuries

enhancement of bone metabolism

improvements in self-esteem, self-confidence and body image

A literature review by Faigenbaum and colleagues indicates that resistance training, when performed appropriately, does not appear to lead to growth plate injuries or interfered with physical maturation.

Key Elements of a Successful Youth Strength Training Program

Guarantee close supervision

Ensure proper technique

Keep training environment safe

Foster a positive attitude

Individualize child's program based on ability

Always begin each workout with a 10-15 min warm-up and end with cooling-down period

Start with small loads (e.g. 1-lb weights for arm excercises)

Consider limiting the amount of weight for prepubescent children to only which they can lift for 6 or more repetittions

Increase resistance minimally, such as by 10%

Resource: Journal Consultant for Pediatricians Sept 2011 issue

CDC Says "Take 3" Actions to Fight the Flu

2011-09-27T10:14:00.000-07:00

This is the time of year that we urge everyone to take steps to fight the flu!

Sign and Symptoms of the flu

fever, cough, sore throat, runny or stuffy nose

body aches, headache, chills and fatigue

may have vomiting and diarrhea

some may have respiratory symptoms without the fever

#1 Get the flu vaccine

the 2011-2012 vaccine will protect against influenza B, H1N1 and the H3N2 virus

everyone 6 months and older should get the flu vaccine

vaccination of high risk persons (i.e. asthma, heart disease, kidney disease) is important to decrease the severity of their flu illness

vaccination of health care workers and other people who take care of infants younger than 6 months of age is recommended to have the flu vaccine

#2 Stop the spread of germs

wash your hands with soap and water of an alcohol-based hand rub

cover nose, mouth with tissues when coughing or sneezing and throw tissue in trash after use

avoid touching your eyes, nose and mouth, germs spread this way

avoid crowded areas when you are sick

when you are sick with the flu the CDC recommends to stay home at least 24 hours after your fever is gone (fever should be gone without using any fever-reducing medications)

#3 Go to your doctor - they may prescribe anti-viral drugs

antiviral drugs can make illness milder and shorten the time you are sick

it is very important to use the antiviral drugs within the first 2 days of symptoms

Tylenol will only be available in 1 formulation

2011-06-16T11:24:00.000-07:00

The FDA(Food Drug Administration) have passed a guideline recently that the Tylenol/Acetaminophen formulation will just be present in 1 concentration. This will help our parents avoid a lot of confusion The 80mg/0.8ml will be discontinued. This results in overdosage of tylenol and improper dosing. The only formulation that this will be available at would be 160mg/ml they will be including a measuring device inside the box so we can appropriately measure the amount an infant needs.

Tylenol/Acetaminophen concentration (160mg/5ml)

Dosage chart based on weight

6-11 lbs 1/4 tsp (1.25ml)

12-17 lbs 1/2 tsp (2.5ml)

18-23 lbs 3/4 tsp (3.75ml)

24-35 lbs 1 tsp (5 ml)

36-47 lbs 1.5 tsp (7.5ml)

48-59 lbs 2 tsp

60-71 lbs 2.5 tsp

72-95 lbs 3 tsp

>96 lbs 4 tsp

Cataracts

2011-05-25T15:23:00.000-07:00

A cataract is basically any kind of opacity on the lens which can be significant if it blocks the central vision resulting in amblyopia in children if not treated early. It can be present in some instances but if this is just at the periphery and does not cause obstruction they just watch it. Many cataracts are hereditary usually unassociated with other diseases and the most common mode of inheritance is autosomal dominant. Autosoma recessive pattern of inheritance also occurs but less frequently.

Source: Behrman et al: Nelson Textbook of Pediatrics 15th edition

Fast Facts on Influenza from the CDC 2010-2011

2011-05-24T11:51:00.000-07:00

A total of 3,306 new cases of influenza confirmed during
influenza season week 6.

Influenza A accounted for 78.6% of the influenza cases
Influenza B accounted for 21.4%

2011-2011 35 pediatric deaths

FDA approves meningococcal vaccine for infants

2011-05-23T16:27:00.000-07:00

The FDA has approved the use of the meningococcal vaccine for infants. Menactra was approved to prevent N. meningitidis for use in infants. The approval is for a 2 dose series to be administered 3 months apart. It is not yet officially included in the immunization schedule but we are definitely looking forward to its inclusion.

Measles spreading in Europe

2011-05-23T16:21:00.001-07:00

The WHO(World Health Organization) reported that there are approximately 6,500 cases of measle that have been report in 30 counties in the European Region in 2011. They have been attempting to immunize children at 9 months of age to prevent the spread of the disease. in lieu of this we can not but emphasize the importance of the MMR(measles-mumps-rubella) vaccine. It has been shown that the disease is still out there and is spreading. Vaccinate your child with the MMR vaccine at 1 year and 4 years.

Benzocaine products can cause Methemoglobinemia

2011-05-23T16:02:00.000-07:00

The Food and Drug Administration(FDA) alerted health care personnel on April 7, 2011 that benzocaine gels and liquids have been associated with a rare but fatal condition, methemoglobinemia, in which the amount of oxygen carried through the bloodstream is greatly reduced.

This occurs more in children younger than 2 years of age who have been treated for teething with the benzocaine gel. Babies usually teeth between 4-6 months of age and I usually advise the parents to start rubbing the gums first, use a cold washcloth to rub the gums, refrigerated teething rings, Acetaminophen for pain and rarely use the Orajel or Anbesol( I always tell my patient's parents to use it very sparingly if they have to) because of this rare condition.

watch for signs of pale, gray or blue skin, lips and nail beds; shortness of breath

symptoms may appear within minutes to 2 hours after exposure to benzocaine

can cause unreliable pulse oximetry

infants younger than 4 months of age are at a greater risk

patients with breathing problems are at a risk of complications

medications, food and water containing nitrites/nitrates may also induce methemoglobinemia

Allergic Rhinitis

2011-05-23T15:19:00.000-07:00

Once the beautiful Palo Verde trees start to bloom with those pretty yellow flowers then you will start noticing that there would be a lot of individuals starting to sneeze, have sore throats, itchy eyes, nasal congestion and coughing. Fever is not usually a part of this syndrome. Usually when fever happens there is a secondary bacterial infection that happens. Ear infection, sinusitis. There can also be a secondary to viral infection, pharyngitis. You would notice that they would have dark circles under their eyes (allergic shiners) and there is a line across their nose(nasal crease). This happens when they try to wipe their noses using the palms of their hands in an upward motion called the allergic salute. They would also complain of itchy eyes resulting in redness but with a clear discharge (allergic conjunctivitis). They are usually miserable because they do not get enough sleep at night because it is hard to breath when you are congested.

Treatment:
I usually advise the parents to limit pollen and mold exposure by the following suggestions:
1. do not open the windows at night (do not let the pollen in)
2. do not open the window cars
3. make sure you give the child a bath every night to include washing their hairs and change their clothes
4.avoid moist damp areas at home
5. vacuum the carpets regularly

Medications:
Claritin(loratadine), Zyrtec(cetirizine), Allegra (fexofenadine) works pretty well in decreasing the symptoms and this is good for 24 hours. Zyrtec causes the most drowsiness in individuals. If you want to get around it please give the medication at night. If the symptoms persists call your doctor. We usually prescribe a nasal steroid in combination with the antihistamine. Singulair(montelukast) can sometime help some patients with persistent symptoms.

Cryptorchidism (undescended testes)

2011-03-28T10:27:00.000-07:00

Cryptorchidism is the absence of a palpable testicle in the scrotal sac. The absent testes,undescended testes and the testes in an abnormal area can only be differentiated by surgical exploration by the urologist. Incidence of cryptorchidism:

0.7% of children ater 1 year old and in adults

3.4% in full-tern newborns

17% premature newborns (between 2000 - 2,500 gm)

100% premature newborns (less than 900 gm)

This shows that testicular descent takes place during the 7th month of gestation and spontaneous descent does not occur after 1 year of age.

Complications:

infertility in adult

tumor development in the undescended testicle usually during the 3rd and 4th decade of life

associated with hernias

tortion of the testes

psychological effects of an empty scrotum

Treatment:

some people try HCG to make the testicles descend to the scrotal sac

surgical exploration and removal done depending on where the testicle are located

Waardenburg Syndrome

2011-03-28T10:02:00.000-07:00

This is a pattern of malformation that includes some of the following features:

lateral displacement of the inner canthi with sort palpebral fissure

broad and high nasal bridge with hypoplastic alae nasi

medial flare of bushy eyebrows

partial albinism (hypopigmented ocular fundus, white forelock, premature graying, hypopigmented skin lesions hypochromic iridis)

deafness (aplasia of the semicircular canals noted on CT Scan)

This is one of the differentials if a child is deaf because it is the most serious feature of this syndrome and is usually both ears and is severe. Deafness is a feature in 25% of cases. It is transferred by an autosomal dominant pattern but there has been spontaneous mutations that has been noticed. Apparently older paternal age has been a factor in the fresh mutation cases.

Reference: Smith's Recognizable Patterns of Human Malformation 5th edition

Teenage Driving

2011-02-18T10:04:00.000-08:00

My son who is 16 years old has been very excited since yesterday because he finally got his driver's license. Me and my husband not too excited of course , like any other parent worried to the hilt. As everyone knows the #1 killer of teens are car crashes. That is 11 crashes a day and as a parent it is important to know that the reason for this crashes is basically driver's inexperience,but everyone needs to learn how to drive sometime.

As parents we play a leading role in prevention of this accidents:

talk to your teen about the dangers of driving, continue talking about it...
it is always best to lead by example
extend your teen's supervised driving period(remember practice makes perfect)
set the rules of the road

-make sure he uses the seat belt all the time

-limit teen's night time driving (fatal accidents happen twice as often during the night)

-limit number of other teens in the car to 0 to 1 only(keep this rule for at least 6 months)

-absolutely no phone calls/texting or listening to the ipod while driving

Enforce the rules with a parent-teen contract, sample provided at

www.cdc.gov/parentsarethekey

Booster for Meningitis Shot Recommended

2011-02-18T09:39:00.000-08:00

The American Academy of Pediatrics and the Centers for Disease Control for 2011 is recommending to give a booster to all teenagers who had the meningococcal vaccine.

Routine recommendation between 11-12 years of age and a booster at 16 years.
Adolescents who receive their first dose between 13-15 years of age should receive a booster between 16 to 18 years old.
If patient is at risk for meningococcal disease and are between 2-54 year of age a 2-dose primary series should be administered at least 2 months apart.

For more information please go to www.cdc.gov/vaccines/recs/provisional/default.htm

Shuddering Attacks

2011-01-21T10:33:00.000-08:00

"My 9 month old baby started shivering as if a cold water fell on his back. This just started 3 days ago and it seems like the shivering becomes worse and lasts for 5 seconds. No loss of consciousness is observed. This happens more when he is excited or tired." Denies any family history of essential tremors.

This is considered a non-epileptiform benign movement disorder that results in shuddering or shivering. This probably occurs in many children at 1 time or another. Described as rapid tremors involving the head and the arms. Consciousness is not altered during this episodes. This may start to occur in children from 4-7 months to 6-7 years old. The frequency varies and this can occur up to 100 episodes a day and may be precipitated by excitement, fear, anger, frustration and tiredness. EEG is shown as normal and no treatment is necessary. If the tremors affect daily living they recommend propranolol. Anticonvulsant therapy is not needed because this is not a seizure.

Congenital Cystic Adenomatoid Malformation of the Lung

2011-01-06T11:16:00.000-08:00

Since the advent of the prenatal ultrasonography we have been able to pick-up a lot of diseases while the baby is in the womb so we can be better prepared to handle them when they are born. CCAM(Congenital Cystic Adenomatoid Malformation) is a rare intrathoracic tumor that is present in the lungs. This occurs in 1 - 25,000 to 35,000 pregnancies. This is usually found during the 20 week gestation and they hare followed closely with repeat ultrasounds. The wonderful thing about this is that 60% resolve at birth. The ones that do not resolve are classified into types. The presenting symptoms at birth depends on the size of the cyst if it is encroaching on the blood vessels or the other organs.
Type I - isolated cyst present in the lungs during the neonatal period
Type II - the cyst in the lung is usually associated with other malformations on the baby
Type III - this is the worse kind because the baby would be born as a fetal hydrops and they do not survive.

If the cyst is significant that baby will be in respiratory distress at birth. The ultimate cure for this is surgical excision. If the baby is asymptomatic and the cyst is small. The pediatric surgeon will follow-up in a few weeks and determine when they are going to operate. Even if the cyst is small this can be a focus of recurrent pneumonia so most surgeons operate on the lesion.

Osteochondroma(Exostosis or Benign Bone tumor)

2010-10-28T15:15:00.000-07:00

Osteochondroma is a developmental abnormality where a part of the growth plate forms an outgrowth on the surface of the bone.

2 types of osteochondroma

Solitary-this is the most common tumor which accounts to 35% of all the benign tumors. This grows with a child or adolescent and usually stops at maturity. This is usually diagnosed in patients age 10 to 30 years old, it occurs equally in males and females. We do not know the cause of this and there is no way to prevent this from occurring in some patients.

Multiple Osteochondromatosis-this are multiple osteochondroma(more than 2) which is familial (it usually runs in families). It is 70% inherited and only 30% that occurs randomly. It usually occurs within the first three decades of life. Males are more often affected than females.

Symptoms
This can be affected depending where the lesions are located. A patient may have deformities of the forearms and a short stature. This is caused by abnormal growth from the growth plates.

Symptoms and signs of a tumor becoming cancerous

Growth of osteochondroma after puberty
Pain at the sight of an osteochondroma
A cartilage cap larger than two centimeters

Diagnosis:

x-ray of the affected long bone

if cancer is suspected MRI and CT Scan is indicated.

Treatment:

Nonsurgical treatment-tumors with no signs of cancer and are asymptomatic are just watched carefully

Surgical Treatment-if the tumor causes pain and deformity the portion of the bone need to be removed

This is usually monitored by the Orthopedic surgeon.

American Academy of Osteopathic Surgeons

What is Cholera?

2010-10-26T09:55:00.000-07:00

We have not seen this type of gastroenteritis for a long time but when we flip through the news it has been spreading in Haiti. It has caused several deaths because of severe dehydration.
Cholera is characterized by voluminous diarrhea without abdominal cramps or fever. Dehydration and shock can occur within 4-12 hours if fluids losses .are not replaced. Stools are colorless with small flecks of mucus "rice-water". Most infected people have no symptoms and some only have mild to moderate diarrhea lasting 3 to 7 days,fewer than 5% have severe watery stools with dehydration.

Humans are the only documented natural host in ingestion of contaminated water or undercooked/raw shellfish, raw or partially dried fish,moist grains,moist vegetables. Direct person to person contact has not been documented.

Treatment:
Oral or parenteral rehydration to correct dehydration and electrolyte abnormalities,
Oral rehydration solution is preferred unless the patient is obtunded or is in shock. The World Health Organization's oral rehydration solution has been the standard.
.
Antimicrobial therapy can eradicate the bacteria more quickly. The drug of choice is oral doxycycline as a single dose or a 3 day dose of tetracycline. This medications are not usually given to children younger than 8 years of age but if the patient has cholera the benefits might outweigh the risks in administering the medication. If strains are resistant to the tetracyclines you can give the ciprofloxacins, ofloxacins and the trimethoprim-sulfamethoxazoles.

Control Measures:

Hygiene - disinfection or boiling of water prevents transmission, appropriate hand washing after defecating is appropriate. Keep food promptly refrigerated.
Treatment of Contacts - administration of antibiotics within 24 hours of identification of cholera may prevent infection among household contacts
Vaccine -there is no vaccine currently available for cholera in the United states but there are 2 vaccines available but this are not proven to be effective at all, no country requires the cholera vaccine for entry

What is the Newborn Screening?

2010-10-26T09:30:00.000-07:00

This a program from the State of Arizona that screens all newborns for disorders that if diagnosed early enough can be treated. There are also different programs for the different states with regards to the newborn screeen.This comprise of a blood spot screening which detects 28 disorders and a hearing test. The blood spot specimens are analyzed by the State Laboratory. Most babies are born healthy and the screening can identify ones with problems. Approximately 300 newborns each year in Arizona has been identified to have some type of disorder. They can develop organ damage, developmental deal, mental retardation and even death. The disorders can not be cured but it can be treated to avoid or limit the complications.

The test must be timely. The first bloodspot test should be done between 24 and 36 hours of age or prior to discharge from the hospital. For some disorders, false negative results can occur with later testing. The second screen should be done at the first outpatient visit between 5 and 10 days of age.

The hearing test is done in the hospital and any re-screening should be done within 2 weeks and diagnostic testing should be done as soon as possible following the failed outpatient scree. Completing diagnostic testing before three months of age ensures that testing can be done without anesthesia or sedation.

The Arizona screening panel includes:

6 amino acid disorders
fatty acid oxidation disorders
9 organic acid disorders
Biotinidase deficiency
Classic galactosemia
Congenital Hypothyroidism
Congenital Adrenal Hyperplasia
3 hemoglobin diseases
Cystic Fibrosis
Hearing loss

The incidence in the population is rare, but the potential devastating results and the high costs of treating undiagnosed infants is thought to justify the mass screening. Hearing loss is the most common approximately 2-4 per 1000 births,

Arizona Newborn Screening Program Guidelines-August 2010

Gastroesophageal Reflux in Infants

2010-10-22T10:08:00.001-07:00

This is defined as the passage of gastric contents to the esophagus. Once the food reaches the stomach this will be mixed with acidic enzymes that help break down the food in smaller pieces. If the contents of the stomach goes to the esophagus this may cause problems in some babies, because the lining of the esophagus is not designed to hold acidic substances. Most babies have some kind of gastroesophageal reflux but are not bothered by it, they are what you call "happy spitters". Once the babies show symptoms this is called gastroesophageal reflux disease.
Reflux results from the transient relaxation of the lower esophageal sphincter.

Signs and symptoms of GERD (Gastroesophagel Reflux Disease):

recurrent vomiting
poor weight gain
weight loss
difficulty swallowing
abdominal pain
chest pain
coughing
regurgitation
apnea
wheezing
hoarseness
stridor
abnormal neck posturing (Sandifer syndrome)
refusal to eat

Diagnostic Approaches

1. Most of the diagnosis of GERD/GER can be obtained by a careful history and physical examination

2. Upper Gastrointestinal Series (UGIS) this is a series of abdominal x-rays which can rule out any anatomical reason for the symptoms

3. Esophageal pH monitoring-this is a useful, valid and reliable test to see the correlation of reflux with the symptoms. We usually hospitalize the baby and insert a probe close to the lower esophageal sphincter and monitor the heart rate, respiratory rate and oxygenation. This is also used to assess the response to treatment.

4. Endoscopy and Biopsy - this is done by a gastroenterologist, they put a tube down the esophagus and get a tissue sample to check if there is any type of inflammation that has been occurring in the area.

5. Empiric Medical Therapy - A trial of medication can be useful if the GER is causing and specific symptoms

Treatment options:

there is evidence to support a trial of a hypoallergenic formula for 1-2 weeks may work
may add 1 tsp of rice cereal to an ounce of formula this will of course will increase the caloric density of the formula
positioning the infant, elevate the head at a 45 degree angle when sleeping and do nor move the baby too much after feeding
Acid-Suppressant therapy-this blocks the production of acid which in turn relieves the symptoms
Prokinetic therapy - this reduces the incidence of regurgitation and vomiting but with the multiple side effects of the medications this has not been readily available in the market
surgical therapy - this is the last resort which generally results in a favorable outcome

What are enlarged adenoids?

2010-09-28T10:18:00.000-07:00

Adenoids are a collection of lymphoid tissue that runs through the nasal passages and to the back of the throat. This filters bacteria, viruses to prevent it from entering the body, while doing this it can grow big (hypertrophy). This can grow big enough resulting in blockage of the nose, obstruction of the eustachian tube and can block the clearance of mucous. The adenoids usually involute by 5 years of age but some persists beyond this age and cause problems.

Signs and Symptoms

mouth breathing
persistent cold symptoms that does not seem to get better
voice can be altered with a nasal, muffled quality to it
coughing worse a night from purulent drainage
chronic ear infections
loud snoring with periods of cessation of breaths (apnea)
chronic sinusitis
bad breath
impairment of taste and smell
can not sleep through the night, tosses and turns
seem to wake-up very tired
chronic sinus infections

Diagnosis:

The adenoids can only visualized indirectly by using mirrors. When a patient opens their mouth you see the tonsils but not the adenoids. Some doctors order an x-ray of the neck to see the size of the adenoids whether this encroaches the airway.

Treatment:

This can only be cured by surgical removal of the adenoids with or without the tonsils. This is done by a qualified Ear, Nose and Throat specialist. The patient undergoes general anesthesia and wakes up in the recovery room. They do not need to make any skin incision because they can go through the mouth. Healing takes a few weeks to occur but recovery is great. Patients are advised to eat soft, mush diet and cold foods are also recommended (ice pops, ice cream...)

Similac Recall

2010-09-24T10:12:00.000-07:00

Abbott the company that produces Similac is recalling some products following an internal review, which detected the presence of a small common beetle in the formula in one of their manufacturing factories. There is a possibility that infants who accidentally ingest this can have some stomach cramps and may refuse to eat.

The recall includes the following:

certain Similac powder product lines offered in plastic containers
certain Similac powder lines offered in 8-ounce, 12.4 ounce and 12.9-ounce cans

Please visit www.similac.com/recall/lookup to check if the product that you have included in the recall. You may also call 1-800-986-8850

Sleep Tight and Do not let the Bed Bugs Bite

2010-08-27T13:53:00.001-07:00

Bed bugs are small insects that feed on the blood of mammals and birds. They are sometimes referred as "red coats", "chinches" or "mahogany flats". They are usually active at night but when they are hungry they feed during the daytime. They usually populate human dwellings, birds nests or bat caves since this offers warmth a place to hide and a host to feed on. They usually populate human dwelling especially if it is crowded. They live in cracks, crevices in walls, furniture, behind wood paneling, behind wallpaper or under carpeting. They can be transferred from one place to another via clothing, luggage, bedding and furniture. They do not have the means to cling to hair, fur or feathers and are rarely found in hosts.

Bed Bugs do not carry any danger to man,it is basically a nuisance. They usually work at night when you are sleeping and the bite is painless. Most people do not react to them but there are a few individuals who will be allergic to their saliva resulting in welts, itching and swelling. The typical lifespan is 10 months and can survive for weeks without feeding.

How to get rid of "BED BUGS?"

wrapping in big plactic containers infected mattress or small items to suffocate the bed bugs
expose the mattress to intense cold or heat or you can wrap it in special plastic bags to get rid of the bedbugs
wash all bedsheets, clothes and curtains in hot water on a regular basis
vacuum and steam-clean carpets
use insecticides for household use only with "pyrethins" as an active ingredient
do not bring in old mattresses and box spring sets and old furniture which can harbor the bed bugs (if you must try to inspect the seams of the mattress inside the box)
seal all cracks and crevices in the house which are hiding places for the bug
using a hot blow dry aim this at the crevices to force the bugs out

They are one of the most difficult things to treat because they can hide very well. If all fails call the pest control guy.

Source:

cdc.gov

Salmonella from Eggs

2010-08-18T11:01:00.000-07:00

According to the Center's for Disease there is a countrywide recall of shelled eggs because they found out that it had caused several outbreaks of Salmonella in California, Colorado and Minnesota. On August 13, 2010, Wright County Egg of Galt, Iowa conducted a nationwide voluntary recall.

Tips to reduce the risk of getting Salmonella from eggs

keep eggs refrigerated at <45f(<7c)>
discard cracked or dirty eggs
wash hands, cooking utensils and food preparation surfaces with soap and water after contact with raw eggs
eggs should be cooked until both the white and the yolk are firm and need to be eaten promptly after cooking
do not keep eggs warm or at room temperature for more than 2 hours
refrigerate unused or leftover egg-containing food promptly
avoid restaurant dishes made with raw or undercooked, unpasteurized eggs
consumption of raw or undercooked eggs should be avoided especially by young children, elderly persons, persons with weakened immune systems or debilitating illness

Symptoms of Salmonella

diarrhea after 12-72 hours of ingestion of contaminated food or beverage
abdominal cramps with fever

illness may last for 4-7 days and most persons recover without antibiotic treatment.

Information for the Center's of Disease

Imperforate Anus

2010-08-18T09:57:00.000-07:00

This is a congenital anomaly where the rectum ends in a blind pouch and you might have an opening into the vulvovaginal area in females and urethra in males. This is considered a disorder which have occurred during embryogenesis in the hindgut. This occurs in 1 in 5000 livebirths with slight male preponderance. This are classified into two kinds a low lying and a high lying rectal pouch. The experts use the pubococcegeal line as a guide to determine if the lesion is high or low. High lesions usually come with an underlying fistula wither rectourinary or rectovginal fistula.

Symptomatology
This is present at birth and the first things that happens is that you would not notice stools in the first 24 hours and this could be associated with abdominal distention. In some cases where there is a fistula you can see the stools and the urine seem to come in the same opening. If you notice this the first thing to do is transfer the baby at a pediatric surgical center,do not feed the baby temporarily then administer IV fluids and IV antibiotics specially when there is a fistula through the urinary tract. We worry about t a urinary tract infection.
Diagnosis
Diagnosis can be done with a combination of physical examination and and x-rays.
this is associated with the VACTERL syndrome (vertebral anomalies, anal atresia, cardiac problems, Tracheoesophageal fistula, renal problems and limb abnormalithes.

Treatment
Need to watch for constipation as the child grows bigger and to take care of this problem medically. The surgeon is consulted for anoplasty and serial dilations will be done. colostomy is done for high lesions.

Puberty is the product of Change

2010-06-22T10:29:00.000-07:00

This is a stage in ones life that changes occur rapidly. Between early childhood and 8-9 years
of age the part of the brain that secretes the sex hormones are dormant. After this stage the hormones start to secrete and produce its effect. The onset of puberty is more related to skeletal maturity than to chronological age.

In girls, the breast bud is usually the first sign of puberty (10-11 year)
followed by the appearance of the pubic hair 6-12 months of age later and menarche will
follow between 2-2.5 years but may take as long as 6 years, In the United States the
peak age of menarche is 12.75 years old. There are however a wide variation in the stages
of development.

In boys, the first sign of puberty is testicular enlargement. Pubic hair then appears.
Growth acceleration in boys occur 2 years after the girls but can still continue till they are 18 years old. The pattern of sexual development follows parent's genetic pattern. If both parents develop early the chances that the children will also develop early is a highly likely.

What is considered pubertal delay?

no signs of pubertal development by age 14 years old, in girls
greater than 5 year interval between thelarche (breast development) and adrenarche (pubic and axillary hair development) in girls
no signs of testicular enlargement by age 14 years old
greater than 5 years for genital development
primary amenorrhea no menarche by 16 years old with presence of secondary sexual characteristics
primary amenorrhea no menarche by 14 years old without secondary sexual characteristics

What is defined as precocious puberty?

traditionally defined as any sign of secondary sexual maturation before 8 years old in girls and 9 year old in boys

**recent data suggest early puberty may not even warrant extensive work-up if it occurs after 6 years old in African American girls and after 7 years old in white girls**

Protect your child from the Sun's rays

2010-06-09T15:43:00.000-07:00

The temperature has been heating up again here in Arizona. The scorching heat went up to 110 degrees F last weekend and we can not but re-emphasize to everyone the importance of sun protection. It has been tempting to go dip in the pool during the middle of the day but that sun's rays are at its peak at this time

According to the American Academy of Pediatrics the sun's invisible ultraviolet rays are what cause damage to your child's skin even on foggy or hazy days . Hats and umbrellas do not completely protect children because UV lights reflect off the sand, water and other surfaces.

To protect against sun damage the AAP offers the following suggestions:

Keep children away from the sun between 10am to 4pm
use sunscreen with a sun protection factor(SPF) of at least 15. Apply 30 minutes before going outside and reapply every 1.5 to 2 hours especially while in water
dress your child in a light cotton outfit with long sleeves and long pants and a wide brimmed hat
use a beach umbrella to keep the child in the shade
keep babies under 6 months of age away from the sun. Sunscreen maybe used in small areas of the body such as the face and the back of the hands
the skin is not the only thing that needs protection but sunglasses are very important to protect your eyes

HAVE A SAFE AND FUN SUMMER!!

The Importance of Immunizing your Child

2010-06-09T14:53:00.000-07:00

Please take a look at the link from the American Academy of Pediatrics on the Importance of immunizing your child and following th recommended schedule. www.ProtectTomorrow.org.

Periorbital cellulitis and Orbital cellulitis

2010-06-07T11:36:00.000-07:00

Postorbital cellulitis

Periorbital cellulitis

Periorbital or preseptal cellulitis is the inflammation of the eyelids and the other soft tissues outside the orbit. This can be caused by trauma, or by an infected wound or an abscess in the lid. This can also be caused by a stye, conjunctivitis, infected blocked tear duct and insect bite. The most important thing to consider is to differentiate this with orbital cellulits which involves the inflammation of the tissues of the orbit with proptosis and limitations of eye movement. Sometimes it is hard to differentiate the two especially when the eyes are really swollen and it is hard to examine the movement of the eye. We then order a CT scan of the head and the orbits to determine if there is extension in the orbits. Orbital cellulitis follows a direct infection from a wound, deposition of organisms from the eyelids, conjunctiva, metastatic involvement from a tumor. The most common cause in children is paranasal sinusitis. Orbital cellulitis have complications which result in meningitis and cerebral abscess . Prompt hospitalization with intravenous antibiotic therapy and surgical drainage of the infected sinuses are part of the treatment.

Ventricular Septal Defect (VSD)

2010-05-10T11:26:00.000-07:00

VSD is the most common congenital anomaly of the heart and it accounts for 15-25% of congenital heart disease. This is described as a "hole in the heart". The heart is made of 4 chambers the right and left atrium on top of the right and left ventricles. Unoxygenated blood comes from all the body and is channeled into the right atrium this then goes to the right ventricle and this gets oxygenated through the lungs then passes the left atrium to the left ventricle and this becomes oxygenated blood that gets distributed through the aorta to the rest of the body. The VSD is basically a hole in between the chambers of the ventricles that result in mixing of the oxygenated and unoxygenated blood.

Usually for the first few weeks of life a heart murmur can be heard by your doctor and most of the babies will be asymptomatic especially when the VSD is small. In some cases when the VSD is moderate or large the babies will not be gaining enough weight. They will be breathing faster than usual and sometimes their color looks dusky from time to time.

Treatment:
Small VSD usually close over time. This will be followed-up by the baby's cardiologist Moderate to large VSDs might need surgical intervention but they do not do the surgery till the baby is about 6 months of age. They want the baby to be gaining enough weight by giving them a high caloric diet at 24 to 26 kcal per ounce and putting some feeding tube to help them gain weight.They also start them on some diuretics or heart medicine to help maintain them and try to control their symptoms.

The great thing about this ventricular septal defects is that most of them resolve on its own and it is easily correctable by surgery.

What is Bell's Palsy?

2010-05-04T15:03:00.001-07:00

The chief complaint that you would hear most of the time would be "one side of my child's face does not seem to be moving, this is more noticeable when he cries, laughs or screams". The child will be unable to close the eye on the affected side and the corner of the mouth will droop. This is considered a common disorder in infancy to adolescence. Taste on the front of the tongue might be lost but there should be no numbness to the area. The most important thing you want to prevent is dryness of the affected are which will result in keratitis. Your doctor will prescribe some eye drops to prevent this from happening. The facial nerve on the affected side is considered to be swollen thus this symptoms appear.

The most common reason for this palsy is that the child had some type of viral infection approximately 2 weeks prior to the event. Most common cause is the Epstein-Barr virus, Lyme disease (you usually see this in the Northeast area), herpesvirus and mumps virus. This has excellent prognosis because 85% will resolve completely without residuals, 10% with very mild residual weakness and only 5% are left with severe facial weakness.

Steroids do not induce remission and is not recommended but since the pathophysiology is swelling of the facial nerve some people think that this might help a little bit. If palsy seems to be chronic or persistent you need to consider other facial nerve tumors that can impinge on the nerve to present with the symptoms. Physical therapy might help a little bit in the recovery process.

Measles

2010-04-05T15:34:00.000-07:00

Koplik's Spot

Measles Rash

Measles remains the most common disease in other parts of the world and this is the leading cause of vaccine preventable deaths among young children. There has been pockets of epidemics in Europe and South Africa in the last year according to the Centers for Disease Control and Prevention. Immigration can not be avoided and exposure to the measles virus is inevitable in the United States. The problem is with the scare that "MMR is linked to autism" there are a number of families who refuse to vaccinate their children and it will only be time before we see this spread all over the country. Since most physicians have not seen measles for a long time they may not be familiar with how it presents.

Signs and Symptoms

fever

runny nose

cough

watery eyes/conjunctivitis

erythematous maculopapular rash

Koplik's spot (rash noticed in the inner cheek area)

Complications

croup
ear infections
pneumonia
diarrhea
encephalitis (Infection of the brain)
subacute sclerosing panencephalitis (SSPE) a rare degenerative central nervous disease characterized by behavioral and intellectual deterioration and seizures

The only natural hosts of the measles are humans and is transmitted by direct contact with infectious oral droplets. Incubation period is from 8 to 12 days from exposure to onset of symptoms. There is a specific antibody test for measles IgM antibody to test for the infection.

Treatment

There is no specific treatment for measles, it is mostly symptomatic . The vaccine is most most effective in preventing this from occurring.

Resource: cdc.gov and the redbook

What to do with my Biting Toddler?

2010-03-22T15:55:00.000-07:00

Biting behavior in toddlers is a developmental response to frustration and anger. Remember that the communication skills at this age is very limited and they do not know how to respond to their environment. Toddlers who bite do not do this purposefully or maliciously. You can not assume that the child is willfully misbehaving. If you know that this is a developmental response we can intervene and teach him the right way to react to what he feels.

Do not bite him back because this is sending him a wrong message that biting is okay and he will be repeating it again.
Watch and re-direct - if he is at home and you are in the vicinity you can pretty much predict when he starts getting upset and will start to bite, try to re-direct his attention by showing him a different activity or a different toy, try to distract him. You can instruct the people at the daycare to do the same thing.
Teach - when a biting episode happens look into his eye sternly and talk in short sentences "biting is not good", "do not bite". Long winding explanations do not work with toddlers the meaning will be lost after a few seconds. Try to go and console the victim and make sure to let him go close to the victim to show him what he has done to cause harm.
Avoid playful biting - this can send mixed signals to the toddler that it is alright to bite
Time outs - If biting becomes worse we need to result to timeouts. One minute for each year of age. You look into their eyes and tell them in short sentences what they did wrong and go to the time out chair. This may take awhile before they understand it. Do not do this longer than the recommended time because if they stay there longer they might forget what was the reason they were put in timeout in the first place.
Change Day cares - you can try to look for a daycare with smaller class sizes, sometimes toddlers get frustrated when they do not get the attention so they will try to do things to get it whether it is good or bad.

First Aid for Bites:

after a bite wash the area very well with soap and water
call your pediatrician if there is a break in the skin because this might warrant prophylactic antibiotics, the mouth has a lot of bacteria which might result in infection

New Car Seat Recommendations

2010-03-22T09:57:00.000-07:00

The newest recommendation by the American Academy of Pediatrics is that the infant needs to be rear-facing in a car seat till they turn 2 years of age. Multiple studies have shown that infants survive the accident better with less injuries facing backwards than forwards.

birth to 2 years of age up to 35 lbs rear-facing

(get a rear-facing convertible seat for children up to 35 pounds)

over 2 year of age forward facing car-seat with a harness
under 4 feet 9 inches tall booster seat
over 4 feet 9 inches tall-safety belt in the back seat
All children under the age of 13 years old should ride in the back seat

What is the Arizona law?

The Arizona Child Passenger Restraint Law says that children under 5 years of age need to be in a child passenger restraint device when in a moving vehicle.

As you can see what is lawful in Arizona may not be safe for the children. Children older than 5 years of age and under 4 feet 9 inches still needs to be in a booster seat.

Hepatitis C

2010-02-10T08:36:00.000-08:00

This is a virus that is indistinguishable from the signs and symptoms of Hepatitis A and B. The only way to differentiate this is to obtain a blood work for the hepatitis panel.

Signs and Symptoms:

fever
malaise
anorexia
nausea
vomiting
jaundice
hepatitis
asymptomatic

They noticed that jaundice secondary to Hepatitis C occurs less than 20% of the time and abnormalities in liver function is less pronounced as compared to Hepatitis B. Persistent infection in children occur 50-60% of the time but most children are asymptomatic. Studies on therapy has been limited and the available mode of treatment is only effective half of the time. With advancing age people who have chronic hepatitis C infection are a a risk of developing chronic hepatitis and possible cirrhosis or hepatocellular carcinoma. Children with chronic infection should be screened periodically.

There is a 5% chance an infant of an infected mother would acquire the infection. The anti-HCV test should not be performed until after 18 months of age because it might result in a false positive because of passive maternal antibody which is present in their bloodstream.

Resource: The Redbook by the American Academy of Pediatrics

What is Intussusception?

2010-02-01T11:43:00.000-08:00

This is the most common cause of intestinal obstruction from 3 months of age to 6 years old. This usually involves the lower gastrointestinal tract resulting in a telescoping of the more proximal part into the distal portion of the gut. There is a male to female predominance as 4:1. As a pediatrician this is one of the differential diagnosis we think of once babies are inconsolable .

Signs and Symptoms:

sudden onset of severe paroxysmal colicky pain
infant looks normal in between episodes
this can be accompanied by straining and loud cries
if this is not reduced the infant will become progressively weak and lethargic
vomiting may occur early in the course
blood may start passing within the first 12 hours which is called the currant jelly stool because mucous and blood are intermixed together, but this might not occur in 1-2 days in some cases

Diagnosis:

The history and physical is usually sufficient to diagnose this entity. Plain abdominal x-ray maybe warranted to show signs of obstruction. Barium enema will show a filling defect resulting from the obstruction.

Differential Diagnosis:

It is particularly difficult to sometimes differentiate this from gastroenteritis. Meckel's diverticulm is usually painless with bloody stools. The bloody stools from Henoch-Schonlein Purpura usually have joint pains.

Treatment:

This is considered an emergency procedure once diagnosis is certain and if there are no signs of shock or dehydration reduction by using an air enema is thetreatment of choice if not exploratory laparotomy with manual reduction by the surgeon is indicated.

My baby has ACNE!

2010-01-20T10:44:00.001-08:00

Neonatal Acne

This usually appears after a few days after birth. You will notice small papules usually on the nose, cheeks of full term infants. This is a normal response to mother's hormones which stimulate the glands on the face. You do not have to do anything because this resolves spontaneously by 4 to 6 months of age. Just clean face with plain water. Do not put any lotions, soaps on the area. This might just irritate your baby's face.

My Newborn Has a Rash

2010-01-19T14:04:00.000-08:00

Erythema Toxicum

This rash usually appears after 24-48 hours after birth and can appear up to the 10th day of life. This is a benign and self-limiting condition with the cause unknown. This was called as "flea bites of the newborn"because it is very similar to how flea bites look like. The rash are usually 2 to 3cm in diameter and you can have vary from a few lesions to a hundred and when you look closely you will see a central pustule or papule. This can be found on the face, arms, back, chest and abdominal area. The palms and soles of the feet are spared. This usually resolves in 5-7 days of age and no treatment is necessary.

Doctor My Baby has an "outie"!!

2010-01-08T13:39:00.000-08:00

We often hear parents tell us that their baby has an outie and grandmother would recommend putting a coin on the umbilicus to strap it down to help make this better. An outie is a bulge on the umbilicus which is more prominent when the baby cries, coughs or strains. We call this an"umbilical hernia". This is due to the imperfect closure or weakness of the muscles in the umbilical ring. The size of the defect ranges from 1cm to 5cm but larger ones are rare. Most umbilical hernia that appear before 6 months of age will resolve by 1 year of age. Even large ones at 5-6cm spontaneously resolve by 5-6 years of age. The chances of the intestinal contents be trapped through the defect is rare. Surgery is only indicated if the defect progressively becomes large after the age of 2 or if this is greater than 2cm big. This is less likely to resolve spontaneously and if it persists by the age of 3-4 years old. The other indication for surgery is that if the hernia is strangulated. So now we now know that putting a coin on the umbilicus would not help in the treatment of an umbilical hernia.

Childproofing Checklist

2010-01-05T13:52:00.000-08:00

first things first get all the poisonous substances(detergent, bathroom cleaners...) and put on higher ground (so children can not reach)
make sure the sharp edges of the tables and corners are protected by edge bumpers
door stops and door holders are essential
do not put the cribs close to the blinds with the strings hanging, babies can get strangulated on these cords
smoke detectors (make sure you have one at each level of the house)
all swimming pools at home should be gated accordingly adhering to the federal standards
safety latches and locks (especially for the kitchen and the bathroom cabinets and drawers)
safety gates (preferably the ones that screws on the walls)
window guards(bars in guard should not be more than 4 inches apart)-make sure you have a window that can be used as a fire escape
outlet covers (make sure you get the ones that the child can not remove)
carbon monoxide detectors
when you visit someone or when you have visitors, make sure all the purses are out of reach (they can have a different kinds of medications in their purse that you do not want your child to get into)

Once everything is in place the last thing you need to do is get down on your knees and crawl all over the house to see what else your child might be interested in to get to it and do something to make your house safe. Try to do the childproofing of your house as early as 4-6 months of age and re-evaluate every few months to see if it is still effective protection according to your child's developmental stage. Remember children can outgrow the way you childproof your house. Re-evaluate from time to time.

Head Injury

2010-01-05T13:23:00.000-08:00

Once your child turns 6 month to 5 years of age you need to be very careful about minor head injuries. Babies' heads are a little bit big compared to their bodies so basically they are top heavy. Their coordination is not very good but they are very brave and go were no adult would boldly go because they do not know better. Most minor head injury in infants and young children are preventable and close adult supervision can not replace any state-of-the-art childproofing equipment that you might use.

What are the signs and symptoms of a mild head injury?

child crying but consolable
minor scalp swelling
minor cut or laceration of the scalp
mild headaches
vomiting 2 to 3 times

What are signs and symptoms of a potential serious injury?

crying non-stop and inconsolable
on feeling the scalp area you might feel a cracking sound there might be a fracture
blood or clear fluid coming from the nose or ears
obvious serious wound i.e. a big laceration or swelling
seizures
loss of consciousness
vomiting more than 2-3 times after the injury
changes in behavior such as increased sleepiness, agitation, confusion or sluggishness
headaches are getting worse

Call you doctor or 911 if you see any of the signs and symptoms of a potential serious injury.

Prevention is the Key:

avoid letting your baby sleep on the bed (they tend to roll over and fall), I can not but emphasize this so many times but still a lot of the parents are letting toddlers/infants sleep with them.
do not use walkers (they become a little more mobile than what their development can handle so they tend to pull on things resulting in furniture falling on them), they tend to fall on steps (it is actually a good thing here in Arizona that we mostly have 1 story houses with no basements)
childproof the house
can not emphasize more the need for close adult supervision ( the most important tool is prevention) but sometimes those babies are pretty quick just a few seconds that you do not look at them, accidents happen.

Teething

2009-12-30T14:44:00.000-08:00

Teething is a process by which the first set of teeth pushes through the gum line. Some babies do not seem to mind this at all but other babies can be very fussy every time a tooth comes through. They refuse to eat and sometimes may just take the bottle or nurse. They will be waking-up several times at night because of discomfort.They can also be grabbing at their ears because of referred pain, same nerve fibers innervate the gum and the ears.This may be associated with low grade fever but once the temperature is more than 101.5F this is most likely not secondary to teething. Teething is not associated with diarrhea or congestion. Most mother's believe that it is the case. Studies have not shown a correlation between this two symptoms. Teething happens from 3 months to 3 years of age. They should have their first set of teeth, 20 in all, by 3 years of age. What to do if your baby is teething? You will notice some swelling in the gum line with the white teeth coming through, this process can occur for several weeks.

you can use your clean fingers to massage the area of the gum that is swollen
give your baby something to chew on, a wet washcloth that has been put in the freezer for 30 minutes should soothe him, teething rings are good too, just make sure it is not hard as ice because this can cause bruising in the gums
acetaminophen is good to help at night when they go to sleep and should last for 4 hours
sometimes we can try some baby Oragel or Anbesol only if the baby is very irritable this does not usually last long and I rarely recommend it because it is a topical anesthetic
lots of hugs and kisses should work great

I always tell my parents that this is a "rite of passage" and this too shall pass before you know it (after a few sleepless nights).

What is the scaly lesion on my child's scalp?

2009-12-22T13:01:00.000-08:00

Patient is a 2 year old female who was noticed to have a scaly round patch on the left side of her scalp. She was prescribed several shampoos and was given steroid creams to put on the area but mother noticed that this seem to be persistent for 1 year now and not getting any better. She was then prescribed some Nizoral shampoo which she can buy over the counter and told to follow-up in 1 month. On follow-up apparently the lesion seem to have gotten a lot better but still persistent. Otherwise, she has been a healthy young girl with no other problems. She was them prescribed some Griseofulvin to follow-up in 2 months.

She has "ringworm of the scalp" known as tinea capitis. This is from a group of fungi which invades the layer of the skin, hair and nails. This can be transmitted from animals such as cats or dogs directly or indirectly. This can also be transferred from person to person. The treatment takes a long time because this is a slow growing microorganism. The first line of treatment is Griseofulvin by mouth with Nizoral shampoo twice a week. If we encounter resistance Ketoconazole is another alternative for treatment. Most patients respond well to the medications.
We usually tell parents to make sure child does not share combs, towels with any one, because this can be contagious.

Is it a common cold or allergies?

2009-12-08T10:35:00.000-08:00

The most common infection in children in the common cold but the significance of this is attributed to the possible complications that it can cause. Children usually have 5-8 infections a year and this is more common in children younger than 2 years of age. 1/3 of the common colds is caused by the rhinovirus but there are 200 different strains of viruses that can also cause this infection. Colds is usually more severe in younger children because it can result is some fever. They can have ear infections with this and if the discharge is more purulent they can have a sinus infection with this. This is very contagious so it is really hard to quarantine children with this illness. Period of infectivity starts a few hours prior to the appearance of symptoms to 1-2 days after the illness appeared.

Babies younger than 3 months of age start with fever, irritability, restlessness and sneezing. Nasal discharge start which can lead to nasal obstuction. They will then have a hard time breathing or eating so it is very important that we help clear their airway by applying some normal saline to the area with some suctioning. In older children, they feel dryness in their throat some nasal discharge with coughing and some fever. They may complain of some muscle aches too. In most cases, the acute phase lasts for 2-4 days.

Allergic rhinitis can be differentiated from the common cold because it is not usually accompanied by a fever and the nasal discharge is usually clear. They have persistent sneezing and itchy eyes.

How your Baby Develops? (3 years old)

2009-11-13T14:21:00.000-08:00

3 year old

They are pretty much ready for pre-school. They should be talking in sentences and can start to tell stories. They can draw a line and pretty much a circle. They know some of their numbers and letters and they can identify 2-3 colors. The temper tantrums still might persist but has markedly gotten better at this age. They can climb, kick a ball, remove their clothes and most toddlers are pretty much toilet trained at this age.

To Vaccinate or Not to Vaccinate your Child with the H1N1

2009-11-10T14:12:00.000-08:00

The H1N1 is a new mutation that emerged last August 2009 and the flu vaccine was already in production when the new mutation occurred so they have to make it separately from the rest of the flu vaccine , hopefully next year they would incorporate this in the seasonal flu vaccine. Many parents are worried because this is something new. Remember the H1N1 vaccine is produced exactly the way the regular flu vaccine is produced. Exactly the same manufacturing steps and the same companies who produce the flu vaccine produce the H1N1 vaccine. Since this is a new strain most the young population do not have any antibody to the virus. We do not really know the full extent of what this new virus can do but preliminary results show that this can cause significant morbidity especially to the pediatric population. I urge all the parents to have their children vaccinated. I had all my 4 boys vaccinated too and of course myself and so far everyone is fine.

How your Baby Develops? ( 2years old)

2009-10-22T14:05:00.001-07:00

2 year old

Most people call it the "terrible-twos" , I call it the "awesome twos". They are starting to develop more independence and they tend to say no a lot. They do develop temper tantrums at this age or even a few months earlier. When you as a parent say no make sure it is a real no. 2 year olds are smart and if they know they can get what they want the temper tantrums become longer and more dramatic.

They can definitely walk up and down the stairs, socialize, use a fork and spoon. They usually start to dress themselves, they can stack blocks, scribble with crayons. They can start to talk in 2-word phrases and name body parts. They are the awesome twos.

How your Baby Develops? (18 months)

2009-10-22T13:41:00.001-07:00

18 month old

They are starting to be a handful ,but fun. They definitely can walk up the stairs with some help. You see some children beginning to run. They also start to kick a ball and throw a ball overhand. They are starting to be more independent and they can feed themselves with a spoon and they can start to remove their clothes especially the diapers. Most toddlers have 5-10 words and sometimes can combine this into short phrases. They can definitely follow directions and point to body parts and pictures.

How your Baby Develops? (15 months)

2009-09-28T16:21:00.000-07:00

15 month old

Most babies will be walking alone at this point. They will be starting to learn how to remove their clothes. Scared or shy of strangers. Their vocabulary will be much more around 5-10 single words. They can follow simple commands. Point to body parts. Start crawling up the stairs. Make sure your baby is off the bottle and the pacifier by this age. Make sure baby is safe around water. Adult supervision is the utmost importance at this age. Remember their heads are bigger than their bodies and they are definitely top heavy. When they fall the head falls first and it will be harder for them to pick it up.

How your Baby Develops? (12 month old)

2009-09-16T15:02:00.001-07:00

12 month old

Before you know it 1 year has passed and you are celebrating your baby's first birthday. He will be starting to walk all over the place. So beware, make sure the surroundings are safe for this curious little one. Most babies can pull to a stand and at least stand alone at this time. They start to finger feed themselves and drink from a cup. The are able to grab on to small objects with a precise pincer grasp. They start playing pat-a-cake and peek-a-boo. They point to desired objects. They can say "mama" or "Dada" specifically ,h! how sweet that sounds. They say 1-2 words by this time.

How your Baby Develops? (9 months)

2009-09-15T10:28:00.000-07:00

9 month old

9 month old babies can start to pull to a stand and cruise on furniture. The world is a great big playground and they are starting to discover new things. They will try to put everything in their mouths. Some babies will be crawling all over the place at this time. They will be grabbing objects using a pincer grasp. They love to play peek-a-boo. They will start to imitate speech and they understand "no" and "bye". They can say mama and dada randomly. If you build a bond with them they will start to show stranger anxiety. Hopefully by this time your house is fully childproofed.

How your Baby Develops? (6 months)

2009-09-15T10:07:00.000-07:00

6 month old

Your baby will be moving a lot more at 6 months. She will start to sit with minimal support. Most babies can now roll from back to front and front to back at the same time. Since they are starting to be mobile at this ]time , I tell parents to start childproofing the house. Make sure they have the POISON CONTROL (1-800-222-1222) number at a visible location. She will start to transfer objects from hand to hand. Turns to sounds and you will hear babbling with somewhat different intonations. At this age, she can definitely communicate if she likes or dislikes something. I usually tell the parents to advance her diet as tolerated. Prevention is the key to avoid a lot of accidents at this age. We do not recommend walkers because the baby is more mobile than they can handle. They tend to grab onto things which falls on them. They can fall onto the staircase. As long as we can prevent this things from happening enjoy your 6 month old.

How your Baby Develops? ( 4 month)

2009-09-11T11:26:00.001-07:00

4 month old

4 month old babies really start to be more aware of the world. They start cooing and laughing at you. They sometimes scream when they are happy. They start putting everything in their mouth and they can see you and track you as you walk across the room. Some babies can start rolling over from their backs to their bellies and the other way around. We start to recommend introducing cereals between 4-6 months of age when your baby is ready. Their necks are a little bit more stable. You would not see a lot of tongue thrusting at this point. Parents it is time to start child-proofing your house at this age while you still have time before they become more mobile.

How your Baby Develops? (2 months)

2009-09-10T16:24:00.001-07:00

2 month old

They start being more aware of their surroundings. The best part of this age is starting to smile at you. No accidental or random smiles. Their head control is much stronger but we still see a slight head lag when we are trying to lift them holding their arms from a lying position. On their stomachs they lift their head at a 45 degree angle and move it from side to side. The moro reflex is not as reactive but is still present. They still sleep a lot at this age. Nursing every 2-3 hours and if they are bottle fed 4-6 ounces every 3-4 hours.

How your Baby Develops? (1 month)

2009-09-10T16:10:00.000-07:00

1 month old

Your baby is starting to be a little aware of the world. They startle or widen their eyes to sound and seem to quiet down or be calm to voice especially mother's voice. Noticed to start blinking their eyes to sound. You might see a random smile from time to time but this is still not directed to anyone. Everybody finally seem to fit into a schedule around this age. Mother is a little bit rested compared to the prior weeks.. You finally would at least know the kinds of cry your baby have. The hungry cry, the sleepy cry, the wet cry and the fussy cry. They still nurse very often every 2-3 hours and if you are bottle feeding approximately 2-4 ounces every 3-4 hours. Feeding amounts vary also secondary to the size of the baby. They usually gain 1/2 ounce to 1 ounce a day during the first few months.

Limit exposure to crowded areas. When babies get a fever it is hard to say if they are just sick from a cold or from meningitis. We usually work-up the babies when they are younger than 2 months of age to look for any source of infection. Prevention is still the best.

How Your Baby Develops? (Newborn)

2009-08-27T15:13:00.000-07:00

Newborn

Once you have your newborn at home, they just seem to stare blankly at you and they sleep all the time. They can move their heads from sided to side but barely can lift it. They just eat, sleep, "poo" and "pee". Sometimes it is frustrating for parents because the baby does not seem to recognize your presence but needs you all the time for its basic needs,

Nursing babies usually feed every 2-3 hours. Formula fed babies anywhere from 2-4 ounces every 3-4 hours. Bigger babies eat more. Bowel movement usually one every diaper change wet diapers are approximately 6-8 times a day.

moro reflex, both arms and legs will flail symmetrically and sometimes they will cry
they can smile spontaneously but not specifically
they move their head from side to side on prone position

this is the first of a series on discussion of development at different ages of your baby

Getting Ready for the H1N1 Virus Fall 2009

2009-08-18T10:48:00.000-07:00

The World Health Organization(WHO) has raised the pandemic alert to Phase 6 in response to the global spread of H1N1. This just means it has spread all over but the severity of the disease remains the same. In order to prevent this from spreading the CDC recommends some of this practical guidelines.

cover your nose and mouth with a tissue when you cough and sneeze
instruct children to cough on their sleeves and not on their hands to decrease transfer of the virus
do not leave used tissue all over the place, instruct minors to throw this in the trash can
wash hands after coughing or sneezing with soap or water or any available hand sanitizers
avoid touching your eyes, nose and mouth
if you are sick try to say home from work or school and limit contact with others. Make sure you stay at home till you are fever free for 24 hours without any fever-reducing .

If you suspect your child has influenza. Call your pediatrician.

Persons diagnosed with swine influenza are contagious for up to 7 days following the onset of the illness and this could be longer if the symptoms are persistent or has not resolved.

Heat Exhaustion and Heat Stroke

2009-07-21T23:29:00.000-07:00

In the sweltering heat of Arizona were the temperatures outside have been climbing in the 110-118F it is no surprise that the incidence of heat exhaustion and heat stroke is on the rise. There comes a time when the body will be unable to maintain normal temperature when exposed to excessive heat. We have normal mechanisms that prevent this from happening. We become very thirsty and we start to sweat to help bring our core temperature down. Sometime people do not notice this especially children because they are having so much fun under the sun.

Signs and Symptoms of Heat Exhaustion

mild dehydration

core temperature from 100.4 to 104F

profuse sweating

thirst, nausea, vomiting

confusion

headaches

feels faint or has collapsed

Signs and Symptoms of Heat Stroke

usually with severe dehydration

core temperature greater than 104F

flushed with hot dry skin

dizziness, vertigo, fainting, confusion, delirium

loss of consciousness

may be in shock

First Aid for Heat Exhaustion and Heat Stroke

bring child/adult indoors

undress

have them lie down and elevate the feet slightly

put the child is awake place cool bath water or sponge bath the child immediately if outside spray with mist from a garden hose

if the child is alert give frequent sips of cool, clear fluids

if child is vomiting turn to side to prevent aspiration

monitor the child's temperature

call the doctor if this is not resolving

Prevention is the best medicine

teach children to drink lots of fluids before and after playing outside even it they are not thirsty

make sure they wear light-colored loose fitting clothes

hats , eye wear for protection

only participate in heavy activity before 10 am in the morning and after 6pm

tell children to come indoors immediately if they feel overheated

Sunburn

2009-07-06T10:24:00.000-07:00

The most common photosensitive reaction in children is acute sunburn and the best treatment for sunburn is prevention.

The sun is one of the most important things that keep our planet alive. We get our vitamin D from the sun from its conversion of cholesterol in our body, this helps absorb calcium for healthier teeth and bones. As we say too much of a good thing is not too good either, it does not take long of sun exposure to cause damage. This can cause skin damage, eye damage, immunosuppression and cancer.

The invisible ultraviolet rays of the sun can cause tanning, burning and other skin damage.

Ultraviolet A causes skin aging, wrinkling and skin cancer such as melanoma

Ultraviolet B causes sunburns, cataracts and immune system damage, they contribute to cancer

Ultraviolet C are most dangerous but fortunately it is totally blocked by the ozone layer

Melanin: Our protection from the Sun

Melanin is our defense from the sun because it absorbs the dangerous UV light before it can cause serious damage resulting in a darker color or a tan but with constant exposure this can still result in a sunburn. Children vary in susceptibility to UV light depending upon their skin tone the lighter they are the less melanin they have.

Sun-reactive Skin Types

Type Demographics Sunburn, Tanning History

I red hair, freckles and Celtic origin Always burns easily with no tanning

II fair skin, fair-haired, blue-eyed and white usually burns with minimal tanning

III darker skinned white sometimes burns, gradual light

brown tan

IV Mediterranean backgrounds minimal to no burning, always tans

V Middle eastern white, Mexican rarely burns, tans profusely dark

Oriental brown

VI Black Never burns, pigmented black

Avoidance is the best Prevention

Avoid the most intense heat of the sun between 10:00am to 4:00pm. Make sure to apply sunscreen if they are exposed to sunlight. Try to avoid exposure of infants to the sun because they burn more easily because of their thinner skins. Make sure you cover-up infants and you may put sunblock on the exposed areas. Make sure you have umbrellas to cover everyone from the sun exposure from time to time.

Sunscreen

Select a sunscreen with at least a SPF(Sun protection factor) of 15 or higher to prevent sunburn and tanning. Select one that is broad-spectrum that protects from UVA and UVB rays. If your child have sensitive skin avoid sunscreens with PABA and instead look for one with titanium dioxide as an active ingredient.

do not skimp on sunscreen make sure you got good coverage, experts suggest to start of on a lotion as a base and you can use the spray for reapplication every 2-3 hours

apply sunscreen 30 minutes before sun exposure

apply a waterproof sunscreen and do not forget the eyelids, back of the neck, lips, hands,ears, feet and shoulders

need to wear sun-glasses with both UVA and UVB protection

First Aid for Sunburn

keep away from the sun into a cool shaded area, additional sun exposure will aggravate the burn

have your child take a cool bath

apply pure aloe vera gel to any sunburned areas

pain reliever (acetaminophen or ibuprofen) do not give aspirin to children and teens this can result in liver problems

apply 1% hydrocortisone to inflammed areas (do not use topical benzocaine, this can cause skin irritation or petroleum-based products, they prevent excess heat and sweat from escaping)

Call your pediatrician if:

Sunburn is severe resulting in blisters

child has unexplained fever of higher than 102F

the skin looks infected

trouble looking at the light(sunburn in the cornea)

fever or chills after sunburn

signs of dehydration (increased thirst or dry eyes and mouth)

sunburn covering a large area

facial swelling from sunburn

Newborn Care 101

2009-07-02T15:43:00.000-07:00

Feeding and Nutrition
Breastmilk or formula should be your baby's major source of nutrition for the first year of life. We usually introduce solids around 4-6 months of age. There will be a period of time that your baby will undergo growth spurts. They will start to nurse and eat more often than usual and they seem to be hungry all the time. Do not worry this just occurs in spurts and they go back to their normal routine. You know you are overfeeding your baby because they will be spitting-up a whole lot. Make sure you burp them often in between feedings.

You are underfeeding your baby if:

he has less than 4 wet diapers a day
not nursing at least 10 minutes at the breast
appears hungry looking for the breast
appears more yellow
does not seem to be gaining weight

(for the first few weeks of like we expect the babies to be gaining at least 1/2 ounce a day)

Bowel Movement

The initial bowel movement of babies are called the meconium stools . They start of as black and tarry then we see the transition stools which are greenish yellow and the normal seedy mustard looking stools that is slightly watery. Formula fed babies have more formed stools. They can move their bowels everytime they eat to once a week there is a wide variation of normal. They are considered constipated if the stools are rock hard and come out as pellets.

Wet Diapers

We need to know the number of wet diapers a baby has to ensure the baby is taking enough breastmilk or formula. This is usually between 6-8 diapers a day.

Crying

Babies can not express themselves very well and they tend to cry for everything. It will take you a few weeks to learn what cry is for what. You can not spoil a baby by carrying and hugging them. Make sure the baby is not hungry or wet. Sometimes they just need cuddling.

According to Dr. Karp think of the 4S

S - swaddle the baby this helps them feel comfortable, remember they were inside the uterus in a tight spot which is a comfort for them

S - Stomach try to lay them across your arms on their stomach they seem to quiet down with this position

S - Shh... silence or darkness can calm them, overstimulated babies are cranky babies

S - swinging not to much just gently, they like monotonous noises like the sound of the blow dryer, the vacuum cleaner

Burping

If you do not burp your baby they will become fussy and inconsolable. Try burping in between feeding. you can burp them over your shoulders, across your lap or sitting-up, make sure you pat their backs gently

Hiccups

This is totally normal in newborns. Try to feed them before they get too hungry when they start gulpin the milk down they tend to swallow a lot of air. make sure the nipple airflow is not too fast.

You can never spoil your baby during the first few months of life. This is the perfect time to attend to their needs closely and you will realize that they can communicate to you what they need and want very effectively.

Starting Solid Foods

2009-06-08T10:17:00.000-07:00

Newborns up to 4 months of age are fed on breastmilk and/or formula. They are ready for solids if they manifest the following:

drinks more than 35-40 ounces of formula a day
seem to be nursing all the time and does not seem to be satisfied
when propped up make sure that the baby's neck is stable and not very wobbly
make sure the baby does not have a lot of tongue-thrusting (tongue reflex that seems to push the food outwards)
they will be drooling a lot

Once they are ready and able you can start them with 1 tablespoon of rice cereal to 5 tbsp of breastmilk or formula. Make sure you try to sit them up so they do not choke. Give the cereal in a spoon if your baby does not seem to like it try again another time. Try to add less of the milk and more of the cereal until the consistency is thicker. Try a new food for 3-4 days before introducing a new one. Make sure your baby is not allergic to the food. Reactions result in diarrhea, vomiting or a hive like rash all over the body.

cereals(rice, barley and oats)
vegetables (yellow/orange veggies before green) the yellow vegetables is more easily digestible than the green
fruits
meats (not until 8-9 months of age)
give eggs around 1 year of age
stay away from any shellfish(shrimps and crabs) for possible allergic reactions
do not give baby anything that can choke(nuts, grapes,apple skins...)

Once solid foods has started you will notice that the consistency and odor of the stools will changed. If the food is not strained you will see bits and pieces of food in the stool. Feed the baby solid foods before giving their milk. you will notice that the amount of milk will markedly decrease.

Juice is not needed for infants less than 6 months of age. You can give up to 4 ounces of juice once a day during mealtimes for babies 6 months and older. Juice is not needed.

Introducing new foods should be an enjoyable process. Talk and interact with your child while feeding them.

Fun in the Sun

2009-06-04T10:48:00.000-07:00

Summer is here and finally everyone wants to go outside, smell the breath of fresh air and swim in the cool waters of your swimming pool. It is very important to protect yourself from the intense heat of the sun. Here are a few reminders from the American Academy of Pediatrics.

First things first, since we live in Arizona and the temperatures really go up, up and up to 120F. We should not get outside. The less exposure to the sun the better for our skin. If you can not help it, sunglasses, hats and clothes are good to protect yourself. Avoid the intense heat of the sun from 10am in the morning to 4pm in the afternoon.

Infants less than 6 months should be protected from the sunlight. put them under an umbrella or under a shade. You can apply some sunscreen to small areas of their body such as the hands, face and feet.
Make sure to put on sunblock on children with sun exposure, hats and sunglasses are a must.
Get a sunblock which reads "broad-spectrum" this means it is good coverage for ultraviolet A and ultraviolet B with at least an SPF(sun protection factor) of 15.
Make sure to reapply the sunblock every hour, especially when they swim or they sweat a lot
Minimize sun exposure by swimming before 10am and after 4pm,
Cloudy days only reduce the UV rays by only 20%-40% of the time, kids still need to wear sunblock.

Start the kids with good habits and they will grow up to be adults with good habits. enjoy your summer and be safe!

Birth of you Newborn

2009-05-19T14:56:00.000-07:00

Once your baby is born the umbilical cord will still be attached to the placenta and the doctor will put a clamp to it. He may cut it or let Dad cut the cord, if he is not too squeamish.The clamp is kept for 24-48 hours till it has dried and upon discharge they take it off. The umbilical stump usually falls off with 1-3 weeks. They will then bring the baby to the warmer to dry and stimulate your baby till he/she cries. Vital signs will be checked to make sure baby is stable. An eye ointment will be applied to the baby to prevent infections that he/she might be exposed in transit through the birth canal. Since babies have low vitamin K level which results in clotting. Your baby will be given a shot of Vitamin K to prevent baby from bleeding. If everything is good and mother is awake they give the baby to mother so she can try to nurse.

Another more important thing they will do is to put some matching bracelets on the baby and the mom. Making sure that it is the right baby for the right mom.They also would get some baby footprints for documentation. They will then call the pediatrician who will then check the baby within 24 hours of birth. They then would check the baby everyday that the mom will still be in the hospital. An alarm will be applied either to the baby's umbilical clamp or the ankles. This is what you call a "baby low-jack". if somebody attempts to get your baby without permission the elevators would not close or the alarms on the doors will be set off. This is a great way of protecting your babies from abductions.

You have the nurses in the hospital for support. Ask a lot of questions because they are very knowledgeable. Get their help as much as you can then you can go home more confident.

What to Prepare for the Birth of Your Newborn?

2009-04-20T09:31:00.000-07:00

Things to think about before delivery:

If you have a boy, Should we circumcise or not? The American Academy of Pediatrics is not recommending this across the board. but parents can decide to have this done. It decreased the incidence of a urinary tract infection and penile carcinoma 1% of the time. It prevents incidence of infection of the foreskin. The most common reason for this is the resemblance to the majority of the males in the United States.

Breastfeed or Bottle feed? Both methods are safe for the baby but the American Academy of Pediatrics advocates nursing up to 1 year of age.

Should I store My Newborn's cord blood?Some genetic diseases can be cured by stem cell transplant. The storage of cord blood is not recommended at this point unless there is a member of the family that would need transplant or a hereditary disorder that may warrant transplant.

Preparing your home and family for the baby's arrival:

choosing a layette (baby's clothes)

3 or 4 pajama sets (with feet), 6-8 t-shirts, 3 newborn sacks, 2 sweaters, 2 bonnets/hats, 4 pairs of socks or booties, 4-6 receiving blankets, 1 set of baby washcloths and towels, 3-4 dozen of newborn-size diapers, 3-4 onesies with snaps.

This is just a suggestion for the most basic wardrobe. Make sure to buy big and flame retardant sleepwear. Read washing instructions. Wash clothes before putting them on your baby.

Buying Furniture and Equipment

Crib

Crib manufactured after 1985 should adhere to new safety standards
Slats should not be more than 2 1/2 inches apart, so the baby's head can not be trapped inside
There should be no cutouts in the headboard and the foot board. Baby's head can also be trapped in this areas.
Corner post on the cribs should be removed because as the baby gets bigger they can start pulling this out and they can choke on this posts.
The mattress should be snug to the crib so there should be no space for which the baby gets trapped
Crib bumpers-make sure the strings are not longer than 6 inches. They can get strangulated with this if it is long.

Car Seats

New car seats should meet guidelines. If you are using a hand me down , you can go to the local fire department so they can check it for you. Please do not use a car seat that has been in an accident.

Changing Tables

It should be on a carpet or in a padded area against a wall and not on a window so there is no danger for a baby to fall
Put all things away from a baby's reach. It should have shelves underneath for easy access
Make sure the table is sturdy with handrails.

Diaper Pail with deodorizer

Need this for disposing the diapers.

Washtub

You can use a plastic washtub for bathing the baby or you can use the kitchen sink provided you can swing the faucet out of the way and the dishwasher is off.

Everything in the nursery should be clean and well dusted

Mother's preparation for the delivery

make a list of people for birth announcements
contact numbers of childcare and housekeeping
have the name, address and phone number of the hospital
name,address and phone numbers of the doctors who will be delivering your baby
know the quickest route to the hospital
know the entrance to the emergency room
phone number of the person who will be accompanying you to the hospital
phone number of the ambulance service (do not drive while having the baby! Some do!)
pack a bag for essentials, toiletries, clothes, an outfit for the newborn to go home in, phone charger

Resource; Your Baby's First Year by Steven Shelov, M.D.

Rear-facing Car seats safer for children until they are 2

2009-04-07T12:59:00.000-07:00

Children under the age of 12-23 months riding in a rear-facing car seat are more than 5 times safer than children of the same age on a front-facing car seat. According to the first US data riding rear facing up to 2 years of age is safer for children. (Henary N, Inj Prev 2007;13:398-402). This is in accordance with the American Academy of Pediatrics.

All infants should ride rear-facing in an infant car seat
the infant should be switched to a rear-facing convertible car seat once the maximum height(within 1 inch from the head to the top of the seat) and weight(usually 22-32 pounds) have been reached.
Toddlers should be rear-facing till they reach the maximum height,weight(recommended by the manufacturer), or at least 2 years of age.

In Sweden, children are rear-facing in the car until they are 4 years old. This has been proven to be 90% effective in protecting the children from accidents. However they have seats that are designed to accommodate a 4 year old.

Advise for Pregnant Moms

2009-04-06T11:21:00.000-07:00

Pregnancy is one of the most fulling and exciting experience as a woman. For new parents, there is some nagging fear at the back of your mind and you ask the questions "Will I be a good parent?","Will my baby be healthy?" but 9 months of pregnancy will hopefully help you think through the process and be prepared for the birth of your newborn.

Virtually everything you consume, inhale or expose yourself to can be transmitted to the fetus. You need to be on a well-balanced diet, not smoke including exposure to second hand smoking, do not drink alcohol (this can result in some birth defects) and please inform your physician of any medications prescription or otherwise, so you will know which ones would be safe for the pregnancy.
Get the best prenatal care. Follow-up regularly with your obstetrician so they can monitor the pregnancy and catch any problems that might start to develop.
Nutrition - The obstetrician will be prescribing some prenatal vitamins which will contain iron, folic acid and other minerals which can prevent some birth defects prior to the second trimester.
Eating for Two - You will need to be eating more than 300 calories more than your normal. This is not a time to diet. You will be needing the extra calories to carry your baby and the breastfeeding after delivery.
Exercise - Is also important during pregnancy. discuss a fitness program with your doctor. Avoid jumping and jarring movements.

Tests during Pregnancy

fetal ultrasound is the most common test done in pregnancy, it checks for fetal growth and development and can detect abnormalities
Non-stress test monitors the fetal heart rate. This is usually performed during the last trimester.
Stress test monitors the fetal heart rate in response to uterine contractions. This occurs when the birth of the baby commences.
Oral glucose tolerance test is done to check for gestational diabetes towards the latter part or the second trimester and the beginning of the third trimester
Blood test is obtained to check for the alpha feto protein levels, HCG and estrogen. This triple screen can detect fetal abnormalities early in the pregnancy.

Source: Your Baby's First Year by Steven Shelov

Your Colicky Baby

2009-03-31T10:29:00.000-07:00

Colic is the most frustrating thing a baby can have. You know as a parent that you did everything in your power to take care of your baby and still he/she is crying incessantly.
Colic is defined as excessive crying for more than 3 hours a day at least 3 days a week for 3 weeks or more in an otherwise healthy baby. One in 4 infants have colic making this condition of of the most common reasons for visits to their pediatrician. Since no one knows the cause of this condition it is really hard to treat. This usually starts at 2 weeks of age and resolves by 4 months of age.

Treating Colic
There is no single treatment that has been proven to alleviate colic but the following are some suggestions that you can try which works for some babies.

Make sure the baby is fed, diaper is clean and he/she is not tired.
Try soothing the baby by walking with him, sitting and rocking, you can not spoil them at this age
Make sure you burp them often in between feedings and try to feed them a little bit at a time between burps
Swings might help, anything soothing and vibrating
You can also try car rides
Play some music
Any continuous sound (i.e the sound of the blow dryer, the sound of the vacuum cleaner)
Try swaddling the baby in a darkened room with decreased stimulation
Mother needs to have a time-out period without the baby for a few hours a day to de-stress, this helps with stress reduction

Changes in diet is one of the few potential preventive and therapeutic options. Breastfeeding exclusively do not prevent colic but it has been observed that staying aways from certain foods improve the symptoms. Foods to avoid for breastfeeding mothers.

chocolate
caffeine (coffee, tea, caffeinated sodas)
cow's milk (dairy products)
orange juice
soy, wheat, eggs, peanuts, tree nuts and fish
broccoli, cabbages

Hypoallergenic formulas (Nutramigen, Alimentum) has been shown to decrease crying times due to colic. The American Academy of Pediatrics recommend trial of hypoallergenic formula for severe colic.

Some parents and pediatricians result to Complementary Alternative Medicine(CAM) for the relief of colic. An article in the Pediatrics in Review Journal (2007:28:381-385) reviewed the existing studies to see if these are efficacious.

Fennel Seed Oil - 5ml-20ml of 0.1% fennel seed oil emulsion give up to 4 times a day for 1 week. The study showed significant improvement fewer than 9 hours of crying in 1 week. Patient can have allergic reactions resulting in a rash and difficulty of breathing. Fennel is reported to cause seizures. But long-term safety is unknown.
Botanical Blend -herbal tea (fennel, chamomile,vervain,licorice and lemon balm) up to 150ml dose of herbal tea for a maximum of three times a day. Study shows that this decreased the crying to 3 hours daily. Long term safety of this herbal combination is unknown.
Probiotics - Study results in a trial of Lactobacillus reuteri(10 to the 8 bacteria/day) results in 95% were considered to be responders and no adverse reaction was reported.
Chiropractic manipulation- Studies that were reviewed contradict each other and at this point this is not recommended as an effective treatment for colic.
Osteopathy-individualized cranial osteopathic manipulation once a week for 4 weeks. No adverse events were reported but this seem to help some infants with colic. Larger clinical trial need to be done before this can be recommended. We do not recommend this at this point.
Massage-Studies show that there is effectiveness of infant massage in promoting physical and mental health in infants but further studies need to be done before this can be recommended as treatment for colic.

Choosing a Pediatrician

2009-03-23T14:21:00.000-07:00

Every pediatrician is trained to take care of your baby. However different individuals have different ways of approaching the problem. It is recommended that you at least interview 2-3 pediatricians so you can see who fits your needs. Conduct the interviews around the second or third trimester of pregnancy so the pediatrician you chose could examine your baby in the hospital when he/she is born. It is recommended that both parents are present during the interview.

Questions to Ask:

Is the pediatrician accepting new patients, please make sure the pediatrician accepts your insurance plan.
What are the office hours?
What is the best time to call for routine questions?
Does the pediatrician have privileges with the hospital you will be having your baby?
How often are the well baby exams?
How long does it take to set-up routine well child care?
How long does it take to set-up urgent appointments?
How many pediatricians are in a group? Are there any nurse practitioners or physician's assistant?
How does the office handle the billing and insurance claims?
Is payment due at the time of visit?
How soon after birth will the pediatrician see your baby?

-as long as the pediatrician has been informed of the birth, he/she will see the baby within 24 hours and everyday until discharge

Is the doctor available by phone?e-mail?
What hospital does the doctor prefer to use?
What happens if there is an emergency?
Who "covers" your doctor when she/he is unavailable?

Two deaths reported from unvaccinated children in PA

2009-03-19T13:21:00.000-07:00

We can not but re-emphasize the importance of vaccination in children. The Philadelphia Department of Public Health announces that 5 cases of Haemophilus influenza type b (Hib) invasive disease occurred in children in Pennsylvania since October 2008 resulting in 2 deaths. All of these cases were in unvaccinated or undervaccinated children. We have told the parents of our patients time and again the importance of these vaccines. The sad part is the deaths could have been totally prevented by vaccinating their children. We have a growing population here in Scottsdale, Arizona of mothers not wanting to vaccinate their children. They do not see the diseases around and are very worried that the vaccines could do harm to their babies. Since the majority of the kids are vaccinated these pockets of individuals are partially protected from herd immunity. Do we have to experience these epidemics before people start vaccinating again? There has been hundred of studies proving the efficacy and the safety of the vaccines and the problems is that vaccines work so wonderfully that nobody remembers how the diseases look like, because it has protected our children so well. Hope the big scare on the link of autism with thimerasol will be dwarfed compared to the bigger scare of causing deaths in our children.

Sleep Baby Sleep

2009-03-17T11:10:00.000-07:00

Adjusting to a new baby is a new profound experience. Your priorities change, the little creature in your arms definitely rocks your world and to top it all, you do not get enough sleep. Sleep is very important to all humans of every age. If we do not get enough sleep we get cranky, inattentive, we make mistakes, we get aggressive and we may be predisposed to illnesses. Babies are the same way if they do not get enough sleep they can be fussy and very irritable. a 2004 National Sleep Foundation Sleep in America poll showed that the average infants are sleeping only 12.7 hours per 24 hours periods. infants from 3-11 months of age should be sleeping 14-15 hours a day.

The Nature of Infant Sleep
The alertness rhythms in babies are shorter compared to adults. We can stay sleeping for a full 8 hours while babies wake-up every 3-4 hours and this is why exhaustion happens. Like adults babies have 2 stages of sleep the REM(rapid eye movement) stage - grimacing, crying, kicking of arms and legs(dream stage) and the non-REM stage - motionless in a deep sleep. This REM and non-REM cycles in babies are shorter, it goes into 90 minute cycles. As the baby grows older this cycles become longer.

Does your baby get enough sleep?
(hints that an infant is not well rested)

baby can only sleep in a car, stroller or mechanical swing
motion always trigger sleep in your baby
baby catnaps a lot at 20-30 minute at a time
baby sleeps less than 3 hours a day
baby can only fall asleep while nursing
no regular schedule from day to day

Frequently Asked Questions?

What age will my baby no longer need nighttime feedings?

There is no magic age because babies are different. During the first few weeks of life baby eats round the clock every 3-4 hours. You will notice that the night time feedings go longer or become more spaced out. All babies like adults have wake and sleep cycles throughout the night. Adults have learned to put ourselves to sleep but babies look for something to help them (i.e. nighttime feedings, rocking, parents putting them back to sleep), they are considered poor sleepers. Sometimes it is best to leave baby alone to cry at night so they learn to go back to sleep as long as you know that they are fine. Baby rarely refuses a feeding at night but as long as they are gaining good weight they do not need the night time feeding when they are a little older than 4 months of age.

What age is best for trying to get babies to sleep on their own?

Different babies achieve this milestone at different ages but a general rule of thumb is around 6 months of age. Between 5-7 months of age for babies who have adequate sleep during the day and is well rested at night.

How do I get my baby to fall asleep on his own and stay asleep?

The most tried and tested method is by Dr. Ferber-also know as the extinction or "cry it out" method is highly effective. If the baby cries in the middle of the night let them cry it out as long as you make sure they are not sick or in any danger. This usually takes 2-3 sleepless nights but usually babies learn how to put themselves back to sleep.

Once your baby learns how to go to sleep by himself everyone will have more peaceful and restful night.

Consultant for Pediatricians: Infant Sleep: answers to Common Questions from Parents page 81 to 86

Hemophilus Influenza Serotype B

2009-03-10T16:26:00.000-07:00

There has been an outbreak of Hemophilus Influeza Serotype B infection in Minnesota. This involved 5 underimmunized children younger than 3 years old, including one death. This serious disease has benn uncommon since we started the routine use of the Hib vaccine which began in 1990. There has been a Hib shortage in December 2007 and it was suggested to hold off on the immunization of the Hib for children from 12-15 months of age. The shortage should be expected to last till the mid-2009. We can not but emphasize the importance that vaccines protect our children from these serious diseases.

Invasive Hemophilus disease can cause pneumonia, meningitis, epiglottitis( I graduated in 1998 and I have not seen a single case of epiglottitis), septic arthritis, cellulitis, ear infections and affects other organ systems.Since the vaccine was instituted the rates of disease among children younger than 5 years old has declined by more than 95%. Please make sure your children get the required immunizations at the appropriate time.

Salmonella Outbreak

2009-02-17T09:29:00.000-08:00

According to the CDC, there has been an outbreak of Salmonella infection in the 44 states and the infected individuals to date is 600 cases. Illness started from Sept 1, 2008 to January 23, 2009 and there has been 13 cases in Arizona.This has been traced to peanuts contaminated with Salmonella that has been produced by the Peanut Corporation of America. There has been a recall on the products that has been distributed by this company and please refer to http://www.fda.gov/ for a list of products that are recalled or call 1-800-CDC-INFO.

Signs and Symptoms

diarrhea

fever

abdominal cramps 12-72 hours after infection

bone infection (osteomyelitis) rare

meningitis rare

Symptoms usually lasts for 4-7 days, most individuals recover without treatment but sometimes severe infections occur especially in the very young, the very old and immunocompromised individuals.

Salmonella is diagnosed by stool cultures. They start treating with antibiotics if the patient is immunocompromised or symptoms are severe.

Please call your doctor if your child is suffering from these symptoms.

Gastreoesophageal Reflux (GERD) in Infants

2009-02-03T14:56:00.000-08:00

It is very common for infants to spit-up a lot after eating. This is the upward movement of stomach contents towards the esophagus and out of their mouths and nostrils. This sometimes cause some distress in the infant and the parents when they start choking on the milk. A baby's immature digestive system is usually to blame. The esophageal sphincter's opening and closing is very uncoordinated during the first few months of life and the acidic contents of the stomach go up the esophageal tract resulting in discomfort.

Symptoms:

recurrent vomiting
frequent or persistent cough
refusing to eat or difficulty eating(choking or gagging with feeding)
colicky behavior (frequent crying and fussiness)
regurgitation and frequent swallowing

Most babies outgrow GERD by 1-2 years of age. If the babies are happy and growing well. No treatment is needed. We tend to start worrying if they do not gain enough weight because of the reflux.

Treatment:

elevating the head on the crib or bassinet
holding the baby upright for 30 minutes after feeding and avoid moving the baby
thicken bottle feedings (need doctor's supervision)
change feeding schedules
make sure the nipple hole in the bottle is not too big
burp in between feedings
solid foods once baby is around 4-6 months of age

Sometimes this things do not work and medications are prescribed.

histamine-2 blockers such as Zantac
Proton-pump inhibitors such as Prevacid is commonly used
Reglan-is sometimes prescribed and it helps with intestinal coordination

Tests for GERD

-most of the time GERD can be diagnosed by history and physical but sometimes tests are ordered to support the diagnosis and to rule out other causes of the vomiting/spitting-up.

Barium swallow or Upper GI series - serial x-rays to check for any anatomical problems
pH probe - a tube with a probe tip is swallowed to the lower esophagus which measures acidity. It helps determine breathing problems as a result of reflux
Upper GI Endoscopy - this is usually done by a gastroenterologist, they use a small tube with a small camera at the tip that the patients swallows the doctor can see the lining of the gut if it has been affected by reflux, they usually get a biopsy to see the extent of the damage.
Milk Scans - gastric emptying study, child drinks milk mixed with radioactive substance so they can trace how the milk travels through the gut. Slow gastric empyting time contributes to the reflux.

Fifth Disease (Erythema Infectiosum)

2009-01-20T14:09:00.000-08:00

Fifth Disease(Erythema Infectiiosum) is secondary to Parvovirus B19. This starts of with a distinctive rash on the cheeks that looks like a "slapped cheek appearance" that can be preceded with a mild cough or congestion and fever 15% to 30% of the time. The rash progresses to the trunk and the extremities and may involve the arms, buttocks and thighs. The rash appears lacy-like and often pruritic. This can not be passed to animals and vice versa. It may take 1-3 weeks before the rash to completely clear. sometimes sunlight, heat, exercise and stress can make the rash worse.

Contagiousness

A person with Fifth Disease is most contagious before the rash appears. Once rash appears patient can go back to school or daycare.

This is more of a problem in immunocompromised patients and pregnant women. If there is exposure call your doctor. If patient is healthy, this just gets better on its own without any complications. Incubation period ( the time of infection and the onset of symptoms) is between 16-17 days.

Prevention

There is no vaccine for fifth disease. Practicing good hygiene, especially frequent hand washing, is always a good idea since it can help prevent the spread of infection.

Information from the American Academy of Pediatrics RedBook

Fever

2009-01-15T14:38:00.000-08:00

Every parent's concern is fever in their child. Fever is a symptom and not a disease. This occurs secondary to various infectious and non-infectious causes that interact with the body's host mechanism. High fever in children is their own way of trying to kill the organisms that is invading their systems. The part of our brain called the hypothalamus is responsible for changing the temperature set point of our body. Normal temperature ranges from 97 F to 100.4F. Anything higher than 100.4F is considered a fever. Treatment is rarely required for children more than 3 months old who has a mild fever with no other symptoms. If your infant is younger than 3 months of age with a fever, then you need to see your pediatrician as soon as possible.

Make sure you have a good thermometer to measure the temperature. For children younger than 6 months of age ,t is recommended that you use a digital rectal thermometer. This is more accurate because you are measuring the core temperature. If you use an axillary or an oral temperature please tell your pediatrician that you did so, adding or subtracting a degree to the measurements is highly inaccurate. Just mention that the temperature is 100.6 axillary or orally. Older children you can just use and oral or axillary thermometer. We have gone away from the mercury thermometer which are very accurate but when it breaks it is detrimental to the environment and is toxic to inhale or ingest.

High fever do not cause brain damage. Our body fights off infection by raising our temperature. Fever is not an enemy but is our friend. The reason we give the medications for fever is not really to cure the infection but this helps make the patients more comfortable. I do not even recommend Acetaminophen or Ibuprofen unless the temperature is higher than 101.5F.
Tepid baths are great in bringing down the temperature to a more comfortable level so the child can sleep.

Sometimes the temperatures are consistently high 103F-105F and at this point is there is a lot of coughing with shortness of breath then patient has pneumonia. Antibiotics are recommended in this case.

Another serious infection is meningitis which can cause high fever, photophobia, refuses to move their neck. The infection causes inflammation of the cover of the brain or the meninges.

It is not how high the temperature is, it is how the child looks like. A child with a 104F but runs around and plays in between the fever free episodes do not concern me. They usually get better on their own but a child who just lays down lethargic with a 101F temperature is more of a concern.

Torticollis

2009-01-04T17:26:00.000-08:00

Torticollis or "wry neck" meaning twisted neck. This is an involuntary contraction of neck muscles leading to abnormal postures and movements of the head.

Congenital Torticollis
This is present during the first few weeks of life and the most common cause is congenital muscular torticollis. The cause is unknown but it is thought that birth trauma or intrauterine factors could contribute to the fibrosis of the neck muscles.

Acquired Torticollis
Neck muscle spasm can be secondary to different underlying problems.

Most common presentation is when the patient wakes-up after sleeping in an awkward position. This develops overnight and is painful and uncomfortable. Palpation of the neck spasms can be felt and this usually lasts for a few days but not more than 1-2 weeks. Treatment is symptomatic with analgesics, massage, heat compresses and physical therapy.

This is common when infants are put to sleep in a car seat and they tend to lean on one side resulting in neck spasms. Parents are advised to make sure that the infant is sleeping midline and make sure to put support on both sides of the neck to prevent this from happening.

History of trauma should be elicited because any sprains/strains, fractures, dislocation, subluxations, spinal epidural hematomas. Torticollis rarely can be secondary to intervetebral dick calcifications, cervical spine tumors, spondylitis, arteriovenous malformation and other bony abnormalities. Your doctor may decide to orde a neck x-ray to rule-out this causes.

Upper respiratory and soft tissue infections of the neck can cause inflammation in the neck muscles resulting in torticollis. Swelling of the lymph nodes, tonsillitis. This can also be associated with retropharyngeal abscesses commonly seen in children 2-4 years of age. Patient will have neck discomfort, fever, stridor, dysphagia, drooling, odynophagia and respiratory distress.

Some medications can cause torticollis. Haloperidol, carbamazepine and phenytoin to name a few. These are called dystonic reactions. This can be treated by diphenhydramine(Benadryl) or benzodiasepines.

Head tilt in pediatric patients may be secondary to compensate for double vision secondary to eye muscle or nerve weakness. They need a thorough eye exam by an opthalmologist.

Benign paroxysmal torticollis is a self-limited condition common in infants characterized by repetitive episodes of head tilting with vomiting, pallor, irritability, ataxia or drowsiness which usually presents in the first few months of life. This is thought of as similar to a migraine disorder.

Sandifer syndrome is an abnormal posturing of patients with gastrointestinal reflux, resulting in hyperextension of the upper body with torticollis. Treatment is anti-reflux medications.

Atlantoaxial rotary subluxations is important to consider. Patients with Down syndrome have atlantoaxial instability and torticollis may be an initial presentation.

Most causes of torticollis are benign and can be treated symptomatically. If torticollis is persistent and is more than two weeks or is associated with other symptoms it is important look into it further.

What is Croup?

2008-12-11T10:58:00.000-08:00

Croup is an inflammation of the upper airway that causes narrowing of the voicebox resulting in a cough that sounds like a bark particularly when the child is crying. The cough sounds like a seal barking with associated hoarseness of the voice and stridor.

Causes of Croup:

Viral cause - secondary to the cold viruses most common is the parainfluenza virus, respiratory syncytial virus, influenza and measles
Spasmodic croup - can be from a mild upper respiratory infection or allergies
Bacterial causes - are very rare

Croup is common in children younger than 3 years old because the diameter of their airway is smaller. If the child has history of being a premature baby and was on a ventilator the airway might have been scarred from being intubated resulting in increased risk of having croup.

Treatment:

If the child wakes-up in the middle of the night with croup , take him/her to the bathroom. Close the door and turn on the hot shower, steam the bathroom and let your child sit in it for 10-15 minutes till he has calmed down. You can also try exposing your child to the cold winter air which can help with the symptoms. Call your pediatrician if nothing helps. They can prescribe a steroid that will help decrease the swelling and may give your child a breathing treatment to open up the airway.

Call 911 if your child is struggling to breath and is turning blue.

Treatment for croup is basically symptomatic and usually this gets better in 3-5 days up to 1 week. Like the common cold this is highly contagious but not everyone who has the virus will exhibit the croup-like symptoms.

Middle Ear Infections

2008-12-08T09:45:00.000-08:00

Ear infections are the most commonly diagnosed childhood illness in the United States next to the common cold. More that 3 out of 4 kids will have at least an ear infection before they turn three years of age. Kids do develop more ear infections than an adult because of several reasons:

kids' eustachian tubes are shorter and more horizontal in orientation compared to adults, this is basically "poor plumbing", because the secretions will have a hard time draining at the back of the throat .
Adenoids are large in children and this can interefere with the opening of the Eustachian tubes.
Exposure to cigarette smoking, bottle-feeding and day-care attendance increases the chances of having an ear infection

Symptoms

Pain/Trouble sleeping - older children can tell you where it hurts, younger children will just be very fussy
Loss of Appetite - ear pain can cause decreased appetite
Fever - since the eardrums are inflamed fever can happen
Trouble hearing - If the middle ear is filled with fluid, child will have trouble hearing
Ear Drainage - you can notice white, yellow, greenish fluid from the ear canal, possibly blood tinged, the eardrums most likely have ruptured, and usually the pain would have subsided at this time

Diagnosis

The best way to diagnose an ear infection is by looking at it with an otoscope. Your pediatrician or doctor can do this for you.

Treatment

The most important supportive care is pain control. You can give some analgesics(motrin/tylenol) as needed. Apply warm compresses to the affected ear. Yopur pediatrician can prescribe a topical anesthetic for the ear to help, please make sure there is no discharge in the ear before applying the medication.
You need to see your pediatrician so an antibiotic can be prescribed. This can help shorten the course of the disease process.
If symptoms persists after 3 days being on the antibiotics, please call your doctor to follow-up the antibiotics that was prescribed might not be strong enough.

Ear Infections are not contagious. Having a common cold is highly contagious.

The Common Cold

2008-11-14T20:57:00.000-08:00

This is the time of the year when most kids seem to have the cold every time. Statistics have shown that each child has a cold 8 to 10 times a year or one every 6 weeks. This is increased when they are in a daycare setting and during the winter season. This is the most common infectious disease in the United States and the number one reason parents bring their children to the doctor.

The common cold (nasopharyngitis) is caused by a virus (the most common ones are the rhinovirus, corona virus, parainfluenza virus and the respiratory syncytial virus with different strains (at least 100). It is very difficult to make a vaccine against this because of the number of different strains and the fact that they mutate readily.

Signs and Symptoms

runny nose
nasal congestion
cough
low grade fever
occasional sneezing
scratchy throat
chills

Contagiousness

Most contagious 2 to 4 days after the symptoms appear
can persist for 1 week
some cough and congestion can persist for 2 weeks
it is transferred by respiratory droplet
when a child touches their nose and touches a toy, the next person can get it by touching the toy

Prevention

make sure you wash your hands as often as possible
try to stay away from people with a cold, if they sneeze the particles can fly 12-feet from the source
try to avoid second hand smoking because the incidence of the cold is higher when exposed to smoke

Treatment

The common cold is from a virus so antibiotics could not cure the problem
Mostly self-limiting "time heals"
treat symptomatically
cool mist humidifier
elevate head when sleeping
vaseline under the nostrils if raw and chapped
steam shower and warm bath can make them comfortable
it is not recommended to give any over the counter cough and cold medications for children younger than 6 years old
May give Acetaminophen or ibuprofen-do not give Aspirin

When to call your Doctor?

if symptoms persists for more than 2 weeks
fever higher than 102F consistently
throat pain
sore throat
shortness of breath
decreased appetite
decreased fluid intake
increased mucous production

MYTH or FACT

If you are not wearing your jacket or sweater in the cold weather you will get a cold.
If you sleep in a place with a draft you will get a cold the next day.
If you get out in the cold weather with your hair wet you will get a cold

All the above is FALSE, you get a cold from being exposed to a cold virus.

Are plastic infant bottles harmful?

2008-10-31T14:33:00.000-07:00

You must have heard in the news that the compound BPA(Bisphenol A) might possibly have harmful effects in young infants. Bisphenol A (BPA) is a chemical compound they use in plastic bottles(used to harden plastic) and the lining of metal containers to prevent from rusting. According to the AAP (American Academy of Pediatrics) the amount of BPA is low enough in the plastic bottles that this would not post a risk to the infants but further studies need to be done before anything is conclusive.

Advice to Parents (from the American Academy of Pediatrics)

Breastfeeding is one way to reduce the potential BPA exposure. Recommends nursing of a minimum of 4 months to 6 months of age up to 1 year

avoid clear plastic bottles or containers with the #7 imprinted in them. Many contain BPA
consider using certified or identified BPA-free plastic bottles
use bottles made of opaque plastic.These bottles do not contain BPA.
glass bottles be an alternative, but be aware of the risk of injury
heat releases the BPA from plastic:

do not boil polycarbonate bottles
do not put them in the microwave
do not wash in a dishwasher
risks associated with giving baby's inappropriate milk are still far greater than the potential effects of BPA.

Head Lice

2008-10-30T15:12:00.001-07:00

We have been seeing some pockets of infestation in the local school district and they have been sending e-mails to the parents regarding head lice. Head lice is not associated with any major illnesses but it causes a high level of anxiety among the parents of school-aged children.

Head lice

is a common infestation among children from 3 years to 12 years old

this is not considered a health hazard

this is not a sign of uncleanliness

this is not responsible for the spread of any disease

most common symptoms is scalp itching and may rarely cause a secondary bacterial infection from scratching

Diagnosis

The way to diagnose head lice is finding them on the scalp. Tiny eggs or nits are easier to spot especially at the nape and behind the ears. It is important to differentiate nits from dandruff, benign hair casts and hair debris

Prevention

tell children to to share personal items such as combs, brushes, hats and towels

treat promptly to minimize spread

Treatment

We should start with over-the counter medication for head lice 1% permethrin, This can be repeated in 7-10 days. Resistant is common , call your doctor for a prescription of malathion for treatment failures.

Control measures

Examine close contacts and treat them if they are infested.Parents of affected children should be notifies and informed that children should be treated before returning to school on the day after treatment. "No-nit" policies requiring the children to be free of nits before they return to school have not been effective in controlling head lice transmission.

They need to disinfect head gears, pillow cases, bedsheets by washing in hot water and machine drying in hot cycle.

(the information came from The American Academy of Pediatrics Red Book of infectious diseases)

What is RSV?

2008-10-27T11:24:00.000-07:00

Respiratory Syncytial Virus (RSV) is one of the most common virus that infects most children at least once before they turn 2 years old. The symptoms are very much like a common cold but sometimes this can be worse. They can be especially very serious in premature babies born younger than 32 weeks who have chronic lung problems or heart problems. This usually peaks during fall up to spring (October to May) in the United States.

Prevention:

(like most viruses this is very contagious)

make sure everyone washes their hands with soap and water before touching the baby
keep baby away from anyone with a cold, fever or runny nose
keep your baby away from crowded areas
keep your baby away from tobacco smoke which increases the likelihood of upper respiratory infections
for infants younger than 32 weeks (high -risk infants) participation in daycares should be restricted during the RSV season
all high risk infants should have contacts immunized against influenza starting at 6 months of age

(Suggestions from the American Academy of Pediatrics 2008)

Signs and Symptoms:

cough, congestion and runny nose
fever
worsening cough
increase in nasal discharge
apnea (pause in breathing for more than 15 seconds resulting in a dusky or pale color)
bronchiolitis ( results in wheezing from narrowing of the tubes of the airway)

Diagnosis and Treatment:

If the child is generally healthy and full-term we usually do not order a diagnostic test because they usually fight the infection themselves with no problem unless this seem to be getting worse. For premature infants a nasal swab can be done to detect the RSV virus. RSV antibodies are available for the high risk infants with lung scarring or any type of lung problems.

The RSV is a virus ,antibiotics can not help with symptoms. Treatment is largely supportive.

lots of fluids
lots of rest
lots of "tender loving care"
use cool mist humidifiers
nasal aspirator for infants
give acetaminophen for fevers

(call your doctor if child is less than 2 months of age)

Call your doctor if:

fever goes up to more than 102F
wheezing gets worse
any episodes of apnea cal 911
decreased fluid intake
decreased number of wet diapers( no wet diapers for more than 8 hours)
coughing seem to be worse and baby seem out of breath.

Like any other infectious disease entity prevention is the key. Since this is very contagious try to protect your baby from exposure so you do not have to deal with the symptoms.

What are Allergies?

2008-10-17T15:24:00.000-07:00

Allergies is an abnormal immune system reaction to things that are harmless to other people. The body mistakes the allergens as harmful to the body resulting in production of antibodies. this in turn tells the body to secrete chemical substances like histamines which acts on the different organ systems of the body resulting in symptoms of allergies. The tendency to have allergies is basically hereditary.

Common Allergens:

Foods-most common in babies which they can usually outgrow. Most common food allergens are eggs, wheat, soy, peanuts, tree nuts and seafood

Insect bites and stings-this can be severe and may require a patient to carry an epinephrine injection

Airborne particles-most common are mold spores, animal dander, pollen from grass, ragweed and trees.

Medicines-most common are the antibiotics but any medication can cause an allergic reaction

Chemicals-may result in an itchy rash

Signs & Symptoms:

Nose/eyes/ears : runny nose, sneezing, itchy eyes

Throat/Lungs: wheezing, difficulty swallowing, swelling of lips and tongue

Gastrointestinal: vomiting and abdominal pain

Skin: hives or urticaria, itchy rash

Generalized: fainting and dizziness

How do we treat them?

Avoidance:

keep family pets out of certain rooms

remove carpers or rugs

avoid hanging heavy drapery that accumulate dust

use special covers to seal the dust mites on the pillows and the beddings

keep windows closed in the house and in your cars

avoid damp area

Medications: Anti-histamines(i.e.loratadine,cetirizine) Anti-leukotrienes(i.e. singulair) and nasal corticosteroids (i.e. flonas, nasonex) help to alleviate the symptoms.

Halloween Safety Tips

2008-09-30T14:59:00.001-07:00

Halloween

by Myra Cohen Livingston

Green cats eyes

in midnight gloom

fly with the witch on her ragged broom

Over dark hills where

bonfires loom

Before you know it the weather is starting to get a little cooler, I mean from the triple digits down to the 80's here in Arizona.

It 's Halloween time! My kids, especially Alex who is 9 years old is excited about the holiday because he really has fun dressing-up and to top it off he gets to have lots of candies. He always tells me every year that this is his most favorite Holiday besides Christmas of course.

Well fun time equal safety time as we say. Here are some recommendations from the American Academy of Pediatrics.

Plan for costumes that are bright and reflective, make sure the shoes are tight-fitting and the costumes should be short to prevent tripping
Non-toxic make-up is better than masks that block your vision, decorative hats are a safer alternative
make sure the costumes and accessories are flame resistant
any weapons as part of the costume must be soft and not sharp
Teach children to call 911 if they get lost
For older children, make sure they have their cellphone
a parent should always accompany young children in the neighborhood
For older children agree on a curfew and make sure parents know which route they will take
Always stay in groups
Remain on well lit streets and sidewalks
A good meal prior to trick-or-treating will discourage youngsters from filling up with Halloween treats.
consider purchasing non-food items (i.e. coloring book, pens and pencils)
Try to ration the treats. Candy has a long shelf life. You can put the it in a freezer or the refrigerator.

Have a fun and safe Halloween!

What is MRSA?

2008-09-26T16:02:00.001-07:00

MRSA stands for Methicillin Resistant Staphylococcal aureus. Staphylococcal aureus was the most common cause of skin infections before the emergence of this superbug. Most antibiotics work for Staphylococcal aureus but MRSA is resistant to the most common antibiotics that we use. This gives everybody a big scare because with the continued over use of all the antibiotics they might start to be resistant to it too and we would end up with nothing to use against these superbugs.

A few years ago MRSA can only be found in hospital settings but in the last 5 years we have seen this occur in the community. We have patients in the practice have this from time to time and they can also spread this to their family members. We find them to be recurrent too. Most healthy individuals can have an incidence of this with no problems. This is more a discomfort and nuisance to others. Immunocompromised patients exposed to this may have devastating results.

Signs and Symptoms:

Redness

Swelling

tenderness

warm to touch

full of pus or drainage

may be accompanied by a fever

What to do?

Cover the area with a gauze or bandage and call your physician.

Insect Bites

2008-09-16T11:13:00.000-07:00

The weather outside is getting a little cooler and the kids have been playing outside. The last few weeks we have seen several patients with infected bug bites. Most of the bug bites that occur in young children is usually benign and does not cause any life threatening problems. A few of the insects can cause life threatening problems especially when they are severely allergic to them.

The following are insects that can cause severe allergic reactions in some children:

Vespids (yellow jackets, wasps, hornets)

Bees (honeybees and the bumblebees)

Stinging ants (black and red fire ants)

Most bug bites are transient and localized pain and itchiness are the most common reactions. This types of reactions do not require any allergic evaluation. Some reactions can be larger and can last for 24-48 hours. This often involve the extremities and can be over a joint, this can persist for 3-10 days and can get better without any medication. Sometimes young children would scratch on the lesion resulting in cellulitis after a few days. Some reactions result in systemic symptoms resulting in flushing, rash all over the body, swelling, difficulty of breathing, nausea, vomiting, wheezing. There usually is a specific history if insect exposure.

What to do for bug bites?

Bees and Wasp Stings

A bee will leave behind a stinger attached to the venom sac. Try to remove it as quickly as possible. (Wasps don't leave their stingers , which means they can sting more than once)

Wash the area carefully with soap and water three times a day till it has healed. You can give them some Ibuprofen or Acetaminophen for the pain.

For itching use some over-the-counter anti-histamines should help. you can apply a corticosteroid or calamine to the affected area.

Call 911 when you notice the following symptoms:

wheezing or difficulty breathing

tightness in throat or chest

swelling of the face or mouth

difficulty in swallowing

abdominal pain

nausea or vomiting

Think Prevention:

Avoid wearing flower printed or bright colored clothes, perfumes, cologne or hair spray.

Avoid drinking from soda cans outside. Make sure outside garbage has a tight-fitting lid, food should be covered when eating outside

Avoid stagnant water

Ants

Wash the area carefully with soap and water three times a day till it has healed. You can give them some Ibuprofen or Acetaminophen for the pain.
For itching use some over-the-counter anti-histamines should help. you can apply a corticosteroid or calamine to the affected area.

Think Prevention:

Make sure all cracks are properly sealed

Cut trees that go close to your house (this prevents carpenter ants from entering the house)

sprinkle baby powder in your garden, under the sinks ( this clogs the pores so ants can not enter the areas)

Spider Bites

Wash the area carefully with soap and water three times a day till it has healed. You can give them some Ibuprofen or Acetaminophen for the pain. For itching use some over-the-counter anti-histamines should help. you can apply a corticosteroid or calamine to the affected area.

Apply cool compresses on the affected area. Most spider bites are harmless except the black widow spider and the brown recluse spider.

The brown recluse spider - has a tiny oval brown spider with a small shape like a violin on its back. Initially the bite does not hurt but this can cause swelling, then the skin changes color then blisters. Need to go to the emergency room.

The black widow spider - has a shiny black body and an orange hourglass shape on its underbelly. Poison can cause painful cramps that can show-up after a few hours after the bite. need to go to the nearest emergency room.

Scorpions

The only medically significant one is the bark scorpion. They tend to be tiny and one of the few species that can climb walls. You can have localized numbness in the area which seem to spread as the neurotoxin spreads. Need to go to the emergency room if this is apparent.

What is strep throat?

2008-09-05T10:49:00.000-07:00

School just started a few weeks ago and we are starting to see different infections that seem to spread pretty frequently. One of the most common one is strep throat. 15% of sore throats is secondary to group A hemolytic streptococcus. The reason we treat this aggressively is because it can cause other problems such as rheumatic fever, toxic shock syndrome and post-strep glomerulonephritis. Since the advent of aggressive antibiotic therapy the incidence of acute rheumatic fever has decreased sharply over the decades here in the United States.

Signs and Symptoms

sore throat

pus in the throat

red swollen patches

loss of appetite, nausea

pain on swallowing

fever

enlarged lymph nodes

abdominal pain

vomiting

headache

general discomfort

rash

When you go to your doctor's office they would do a throat swab if you present with any of the above symptoms. The initial work-up is a rapid antigen test. You usually will have the results in 5 minutes. If this turns out to be positive an antibiotic will be prescribed. If the test turns out to be negative they will be sending the sample for a throat culture. 85% of throat pain is secondary to a viral cause so it is very important to do the test so we can cut down on unnecessary antibiotics. Penicillin or Amoxicillin are the drugs of choice to treat strep throat. Once the child start taking the antibiotics they should be feeling better in 2-3 days. They need to be on antibiotics for at least 24 hours before they are deemed to be not contagious. Make sure your child does not have fever for 24 hours without any anti-pyretics(acetaminophen, ibuprofen) before sending the child back to school. To decrease the spread of infection good hand washing still works the best. It is recommended that there should be no sharing of drinking cups or utensils. You need a brand new toothbrush after 2-3 days on the antibiotics to decrease the chances of re-infection. Make sure your child is drinking lots of fluids. Stay away from fluids that are acidic such as orange juice, lemonade, apple juice because it can irritate the throat. Drink cold, cool drinks,it will help soothe your child's throat.

Get your Flu Shot

2008-08-26T13:40:00.000-07:00

It is still triple digits on the thermometer scale here in Arizona but it is not too early to think about the flu. In the United States the annual epidemics occur typically late fall through early spring and this is more of a serious infection in younger children. On average 226,000 people are hospitalized every year because of influenza.

What are the signs and symptoms of influenza?

fever

cough

sore throat

headache

chills

muscle aches

fatigue

How can we prevent this from spreading?

This is highly contagious and good old hand washing still cuts down on the transfer of the virus but it is really hard for young children to understand this fact.

Why get vaccinated from the flu shot?

Preventing the disease is the best way in stopping the spread. The influenza virus is always changing every year and because of this a yearly vaccine is recommended. Protection lasts for 1 year and it takes up to two weeks to develop protection.

There are two types of influenza vaccine:

1. inactivated (killed) vaccine or the flu shot is given by injection into the muscle

2. Live attenuated (weakened) influenza vaccine is sprayed in the nostril. It has been approved for administration to 2-49 year old.

2008 Updates on Recommendation for the Influenza Vaccine

Annual vaccination of all children aged 5-18 years is recommended, the vaccination should start September or as soon as vaccine is available for the 2008-2009 Influenza season

Annual vaccination of all children from 6 months to 4 years of age should continue

Wither the shot or the Flumist can be used for healthy individuals from 2-39 years old

6 months - 8 year old need 2 doses at 4 weeks apart (if previous year patient only had 1 dose, he needs 2 doses this year).

Lesser shots for your baby

2008-08-14T14:14:00.000-07:00

There are three vaccines that were recently licensed by the Food and Drug Administration for use. This are basically combination vaccines wherein the individual components have been used for many years. This is a win-win situation for both the patient, doctor and the parents because this will markedly decrease the number of vaccines that will be administered.

PENTACEL (Dtap-IPV/Hib)Sanofi Pasteur - This combination vaccine has been licensed in Canada for the past 10 years and it shows efficacy with similar side effects observed following separate administration of the individual vaccine components.

Instead of the usual 4 shots at your baby's visit this will cut it into 2.

KINRIX (Dtap-IPV) GlaxoSmithKline - This is a combination vaccine licensed for the 4-6 year old booster.

ROTARIX (rotavirus)(GlaxoSmithKline) - Licensed this April of 2008 is a 2-dose rotavirus instead of the 3 dose, this is to be given a 2 and 4 months of age. The first dose of the rotavirus protects the baby 90% against the gastroenteritis secondary to rotavirus.

Get your Meningitis and Pertussis shot

2008-08-12T15:49:00.000-07:00

Starting this fall all 6th grade students who are 11 years or older need to be vaccinated against meningitis and pertussis(whooping cough). This is the recommendation of the Arizona Department of Health Services and the American Academy of Pediatrics.

What you need to know about meningitis

meningitis is an infection of the fluid that surrounds the brain and the spinal cord

meningococcal disease is a serious illness caused by a bacteria

Meningococcal disease is the number one cause of bacterial meningitis in children from 2-18 years of age in the United States
College freshman who live in dorms are at increased risk

Meningococcal infections can be treated with antibiotics but still 1 out of every 10 people who get the disease die

2 meningococcal vaccines are licensed in the United States

1.Meningococcal polysaccharide vaccine has been available since 1970s

2. Meningococcal conjugate vaccine was licensed in 2005

the vaccine prevents the disease from spreading from person to person

What you need to know about Pertussis, Tetanus and Diphtheria

Tetanus - causes painful tightening of muscles all over the body. This leads to death in 2 out of 10 cases

Diphtheria - causes a thick covering in the back of the throat. This can lead to breathing problems , paralysis, heart failure and death
Pertussis (Whooping Cough) - causes severe coughing spells, vomiting and disturbed sleep. In 2004 there were 25,000 cases of pertussis in the US and 8,000 of these cases were among adolescents and more than 7,000 are adults. There has been a resurgence of Pertussis in the past few years. The CDC has recommended giving booster doses at 11 years of age to help control the epidemic.

Tdap was licensed in 2005 the first vaccine for adolescents that protects against the three diseases

Back to School TIPS

2008-07-25T15:57:00.000-07:00

Well here we are again! Summer is almost over and school days are here. Whether you had a busy summer or a summer of complete relaxation and boredom everyone needs to start a routine.

SLEEP - kids tend to sleep late and wake-up late during the summer months. 2 weeks before school start put them to sleep a little earlier so they wake-up a little earlier too! Children need 8-10 hours of sleep a night.

EATING HEALTHY - everybody is in a hurry in the morning time, make sure they eat some breakfast so they have energy for the brain to work all day. Packing healthy snacks would be good and make sure they have there fix of fruits and vegetables for the day.

STAYING HEALTHY - once they arrive from school, make sure they wash there hands very well. Once school starts the incidence of viral, bacterial infections increase because of close contact with other children.

BACKPACKS - make sure that the weight of the bag is not more than 15% of your child's weight.

Use all the compartments in the backpack, put the heaviest books close to your child's back and the lighter items in the pockets. Padded straps are recommended for support. Most common cause of back pain in children is the improper use of backpacks.

SAFETY - tell your children to stay at cross-walks when they walk to and from school, do not entertain any strangers (for the teens do no "text message" while walking!)

- if they ride their bicycles, make sure they wear their helmets and follow the bike trail

- if you take the bus, make sure you put on your seat belt, avoid walking around the bus while it is in motion

- if you take the car, follow school rules in loading and unloading your vehicle, make sure everybody wears their seat belt all the time

ROUTINE - Homework routine is a great habit to learn. Make sure they have a place at home that they can do their homework with minimal distractions.

Hopefully with this tips, transition to start of school will be smooth and uneventful. Have fun for the upcoming school year.

(excerpts from the American Academy of Pediatrics-aap.org -Back to School Tips)

How to Childproof your Home

2008-07-23T22:08:00.000-07:00

Accidents are very common in children younger than 5 years of age but most causes can be prevented. The best time to childproof the house is when the child is 6 months of age, he is just starting to be mobile. It is advisable to re-check your childproofing efforts every 6 months to see if it is still appropriate for your child's development. There is still no substitute for close supervision.

1. get the plastic outlet covers, the guards for the drawers, the protectors for the sharp edges of furniture and install

2. put all poisonous chemicals(cleaning materials, detergents...), medications beyond the child's reach or lock it carefully

3. try crawling all over your house to go down to your baby's point of view and look for interesting things that might result in trouble for your child. Remove anything that can pass in a roll of toilet paper, that means it is too small

4. make sure the strings from the blinds or drapery are not close to the crib , your baby can hang their necks on it

5. the crib should be as bare as possible, try to avoid crib bumpers, stuffed toys, extra comforters,your baby can be suffocated

6. make sure all appliance cords are tucked away that they can not be pulled on

7. make sure houseplants are out of your child's reach, there are certain ones that are poisonous

8. make sure you have the POISON control number handy (on the refrigerator ,your speed dial, home phone) 1-800-222-1222

You can get some of the items for babyproofing your house from the babystore.

Scorpion 101

2008-07-16T22:57:00.000-07:00

there are 40 species of scorpions in Arizona
only one specie is of major medical importance and that is the bark scorpion
the bark scorpion is small light brown to tan in color the male is approximately 3.14in(8 cm) in length and the female is 2.75 inches ( 7 cm)
they feed on crickets, roaches and small insects
this is the only specie that is peculiar because they can climb walls, trees and rough surfaces
they avoid extreme temperatures, they usually move around if temperatures are 70 Fahrenheit
they like moist environments so you can find them mostly in houses or the underside of rocks, bark of trees on the ground, boards and logs

Prevention

the key to lessen morbidity is prevention
if you control the insect population(food source) you control the scorpion population
it is hard to kill them with pesticides but you can catch them in glass jars(they would not be able to climb on slippery surfaces
they glow in the dark with Ultraviolet light (easy to catch once seen
do not leave shoes, boots, clothing, wet towels outdoors where scorpion can hide

Checklist to protect your home:

remove all trash, logs, boards, stones bricks and objects around the foundation of the house
prune overhanging tree branches away from the house
do not store firewood inside the house
install weatherstripping around loose-fitting doors and windows
caulk around roof eaves, pipes and any other cracks that allow entrance in the home
make sure window screens fit tightly,no gaping openings

(there are companies that you can hire to have your house sealed but remember this is not foolproof especially when the doors are open all the time)

Envenomenation

there are more than 7,000 calls/year at the Banner Poison Control Center(Arizona)
most cases can be managed at home
most cases result in localized pain
children tend to be more severely affected
the venom are neurotoxins(poison that affects the nervous system) and does not cause tissue damage

Symptoms

Grade I

-localized pain with numbnes

-absence of wound inflammation on puncture site

Grade II

-local symptoms and pain on other part of the body

-incessant crying in infants with, rubbing of nose, eyes and ear

Grade III

-blurred vision, roving eyes, slurred speech, drooling a lot

-restless with jerking motions(can be mistaken for seizures)

-they are awake and alert

Grade IV
-respiratory failure may occur

Natural course of symptoms

-the onset of symptoms may be immediate or may progress up to 5 hours

-if only with pain this resolves fairly quickly

-for more progressive symptoms this may last for 24 hours

-numbness may persist for weeks

First Aide

-ice on the side of the pain may help with the symptoms temporarily

-if pain is unbearable patient needs to be admitted in the hospital for supportive care

-antivenom rapidly reverses the symptoms

-Benadryl would not be helpful because the envenomation is not an allergic reaction

-the best treatment is prevention.

Fun in the Sun

2008-07-01T16:31:00.000-07:00

(Yes even in the sweltering heat of Arizona)

School is done and the kids are home getting bored and anxious and they want to go outside and play. What should you do?

Things I tell moms and dads:

less than 6 months

Avoid sun exposure is still the key (this is the recommendation of the American Academy of Pediatrics)

Protective Clothing (wide-brimmed hats, light long sleeves shirts, light weight long pants)

Sunscreen (at least SPF 15), this can be applied to small areas such as the infant's face and the back of the hands

young children

Avoid sun exposure during the intense heat (between 10am - 4pm)

Protective clothing

Sunscreen need to be applied at least 30 minutes before going outside and needs to be re-applied every hour if the child is swimming or sweating profusely

older children

Avoidance to sun exposure is still the first line of defense

Protective clothing (wide-brimmed hat, sunglasses and cotton clothing)

Sunscreen at least an SPF 15 (older children need to apply at least an ounce at a sitting)

Make sure to drink lots of fluids even if you are not sweating.

We can still enjoy summer in Arizona, like the animals we need to adapt to our environment and adjust our activities accordingly and then we can have fun and be safe.