Tuesday, December 17, 2013

Your child's first visit to the dentist.

      Over the years, the recommendation has changed about when to first take your child to the dentist. One factor is that across the U.S. the number of cases of cavities and tooth decay (dental caries) has risen significantly. One of the big reasons for that is that more and more children are drinking bottled water. It is tap water that has fluoride. Bottled water usually has no significant amount of fluoride. Without that fluoride, more and more children are having early tooth decay, cavities, and/or dental caries.
     The current recommendation is for the children to see the dentist by 12 months of age. The complete recommendations are available here at the American Academy of Pediatric Dentistry's website. One thought: remember to add your child to your dental coverage during their first year so that they are covered by this age.
     There are many excellent dentists in the area. Two pediatric dentists that we recommend the most are Dr. JoJo Strickler (Hilliard Pediatric Dentistry at 5138 Norwich Street in Hilliard; 614-876-5500) and Dr. Robert Haring (100 N. High Street in Dublin; 614-761-3361). Call our office if you have further questions.

Note as of January 15th, 2014: We have heard feedback from parents and dentist offices to realize that each dentist office is handling this a little differently. If you have questions or concerns, having your child seen at 1 year of age for their first visit to the dentist makes perfect sense. However, if you do not have specific concerns before, make their first visit whenever the office you pick recommends.

Monday, December 16, 2013

What to do when your child will not wear a coat when it is cold outside.

     I am frequently asked this question: "What to do when my child will not wear their coat and hat when it is cold outside?" First, before I answer that question, let me give some background.
     If your child is not going to get hypothermia (a dangerously low temperature with being exposed to cold temperatures for a long time) or frost bite (skin damage due to cold exposure), how someone is dressed is really about their comfort. We all know people who, in the same house, are dressed very differently. One person is in shorts and a t-shirt. Their family member has a hoodie and jeans on that day. So comfortable temperature is certainly different for different people.
     Despite what our grandparents were told, we get sick from germs we are exposed to and not from being too cold. It was for many years that parents were told "they will get pneumonia if they do not have a coat and hat on!". This is not true. It is the exposure to the illness that causes us to become ill. I had a job one Winter before going to med school where I worked at a stone quarry in East Liberty, Ohio. That Winter, I was around very few germs but worked outside in very cold conditions. One day, when it was 20 below (!!), we would work outside for 20 minutes then go in and warm up in for 30-40 minutes. We kept us that cycle most of the day. I did not get sick because I simply was not around many ill kids or adults.
     Many children grumble around about wearing a coat and hat. I believe a lot of the "I do not need it!" from children is simply an issue of control. Children like to feel independence about many issues -- it gives them a sense of control and power in their life. And even if they ultimately do not get their way, they have frazzled you.
     So what to do when your child will not wear a coat when it is cold outside? Nothing. And if they say "I was cold today"? Calmly say something non-judgmental like "Maybe wear an something warmer next time". And if someone asks you "Why do you allow your child to dress that way?", say "If they feel cold, they will dress warmer".

Tuesday, December 3, 2013

Screening teenage girls for anemia at their annual well visit.

      We have traditionally checked teenage girls for anemia every year at their check-up once their menstrual periods have started. Although we have found some teens with anemia (for that age, a hemoglobin under 12.0), overall more than 90% of the teenagers have not been anemic. And most of those young women with anemia have had other signs, symptoms, or history that would make us suspicious: they are pale, they do not eat red meat, they are vegetarians, they are tired, they have heavy periods, or they have thalassemia minor.
      We have discussed at our office whether it was appropriate to continue checking those teen girls without any worrisome sign, symptom, or history for anemia each year. We have decided to start (as of know, Dec. 3, 2013) routinely checking teen girls at 15 years of age for anemia (with the finger prick that we do in the office and get the results in less than a minute) at their check-up. We will always want to check it annually if there is a history of anemia, heavy periods, tiredness, pale complexion, or a vegetarian diet. If you would like your child checked at their check-up at a different age or without any of these warning signs, please discuss it with the doctor.

Hearing Protection for Children

      I attend many concerts. I enjoy everything from quiet folk singers with an acoustic guitar to loud hard rock, and everything in between. I never leave for the show without hearing protection.
      I am not proud of some of my loud noise exposures earlier in life. For a few months one of my jobs before med school was operating stone crushing equipment and decided to not wear hearing protection (ear muff style). Also, I attended quite a few a few rock concerts without hearing protection where I left with loud ringing in my ears. Although an audiologist and ENT told me recently that my hearing is a little better than average for my age, I wish I could take back these loud noise exposures. I want to have good hearing into my retirement years!
      Protecting your children and their hearing from loud noise is important. Although the ringing in the ears might quiet down after a few hours or days, permanent slight damage happens with these loud exposures that can add up over time to hearing loss. Those events where this can happen include music concerts, air shows, monster truck shows, fireworks, and many others. Many an adult jumps when the cannon goes off when the Columbus Blue Jackets games!
      Certainly, one way to avoid these loud noises is simply to not go to those events where the loud noises are present. I realize this is not always desired or practical. So what else to do? Wear hearing protection. Ear muff style hearing protection is available for younger and older children. These typically cost about $15-30 dollars. For older children, ear plugs are available -- for 3 years and above if the kids are supervised well and tolerate the ear plugs. They are readily found on Amazon. The Banz website here has information and products available for different ages. The Ear Plug Superstore is available here and has products for different ages.
     Keep those ears protected and the hearing at it's best!

Tuesday, November 19, 2013

Generic medications for children

      Health care is really expensive. Despite the fact that I am a full time physician, I am constantly amazed at how expensive things are -- medications, hospital stays, tests, treatments, and many more. One way to reduce medical expenses is to use generic medications.
      Generic medications are the same active ingredients without the added cost of the name brand medication. In general, they work just as well. If you want to read more details, Wikipedia has a good article about generics here. Occasionally, we run into issues with patients not responding as well, but this is quite rare.
      A few things come to mind:
1. If the price is the same and it works the same, the only reason to buy the name brand liquid medication may be the taste. Although many generics taste just fine, often the name brand liquid medications for fever, cough and cold, and allergies, the name brands sometimes taste significantly better. The Teller twins still fondly talk about the blue raspberry Advil. So if your child is struggling with the taste of a liquid generic, I would try the name brand.
2. We have generally found no issue with generic creams, lotions, or gels not working as well as the name brand. For steroid creams (for eczema, poison ivy, and other rashes), acne medications, and anti-fungal creams for yeast infections (ringworm, athlete's foot, and jock itch), we have found that we have had generics work as well as the name brand. I would recommend saving some money and buying the generics if they are available.
     My dream would be for me to be able to look up the costs of different medication options and tell the family: "This medication would be free at your pharmacy, this one $4, and the other $40. All of them will work well -- which one would you prefer." Sadly, the pharmaceutical companies and the pharmacies will never let us have that information (unless there is a major uproar from consumers) as they would lose money if we consistently went with the cheapest medicine that was going to work. Just in my practice, families would save thousands and thousands of dollars every year having this information. Maybe one day...
      So to summarize: we certainly encourage you to use generic medications when they work for your child and you save some money in the process.

Should everyone with a positive Strep test be treated with antibiotics?

      I realize it can be frustrating to figure out when to bring your child with a sore throat into the office for a Strep test. Sadly, there is not a single "oh, THAT means you have Strep!" symptom or sign of illness. Although the classic quick-onset of a sore throat (felt fine then all of a sudden then "wow, my throat hurts!"), fever, headache, and a stomachache 2-5 days after a Strep exposure certainly can be Strep, many of these turn out to still be a viral illness that does not need an antibiotic. Having impressive cold and cough symptoms makes it less likely the child has Strep (but not impossible). In a large study looking at the size of the tonsils, red throat, mucous in the throat or on the tonsils, and palatal petechiae (small pin-point red dots on the back of the roof of the mouth) found that the only finding in your throat that made it more than a 50% chance that someone with it indeed had Strep was the palatal petechiae. It turned out that 80% (but not 100%!) of those kids with sore throats and palatal petechiae has Strep.
      I explain all of the above because I have many parents asking why we do not have an over the counter Strep test. The question then becomes would everyone who was found to have Strep on such a test need to be treated. Would not that make it easier on everyone? It turns out that many of the positive Strep tests would not need to be treated. Read on to find out why.
      At any one time, many people carry a few Strep bacteria in the back of their throat. Depending on the person and the time of year, it can be as high as 10-20%. So if you stood out in front of the library and swabbed every child that entered the library (that would not be popular at all!!) on one day, tested all those swabs for Strep, and then called the families who were positive for Strep in 4-6 weeks to see if anyone they knew had been diagnosed with Strep, the number would be really small. So, our worry would be that if there was an over the counter Strep test, it would turn out many of these folks would have positive Strep tests who in fact are carriers. And carriers are not routinely treated.
      Those kids (and adults) carrying Strep in the back of their throats can become ill with a viral illness, have a sore throat from the virus, but they would show Strep on a throat swab because of being a carrier. So a positive Strep test for them would not necessarily need to be treated with antibiotics -- and we seeing someone in the office for an ill visit will often clarify all these issues. Are there still times when we in the office treat someone that may actually be a carrier that really "just" has a viral sore throat? Yes, but an over the counter Strep test would certainly confuse us on this point.
      So ultimately, a test for Strep not done by the doctor or nurse practitioner who has examined them would prove to be not enough information to make a decision about treatment. Therefore, it will always be good practice to see those patients with a possible Strep throat.

Tuesday, November 12, 2013

Hilliard Pediatrics New Overnight Strep Testing

     For 23 years, Hilliard Pediatrics did our over-night Strep cultures in our office. We did this when the quick Rapid Strep test that we do in the office and just takes 5-6 minutes did not show Strep throat. Our cultures were read each day by the doctors and we then treated anyone who we found had Strep throat on the culture.
     For the last few years, anyone seen by Nationwide Children's Hospital and most other pediatrician offices in Central Ohio who had a negative quick test was tested through Nationwide Children's Hospital with a Gen Probe test. The results are quicker than a culture and more accurate. 
     About a month ago, we decided to switch to doing the over-night tests to confirm that someone does not have Strep from our own culture plates to Nationwide Children's ChildLab's Gen Probe. So far, we like it very much. The results come the next day into our inbox on our computerized records. We can often call the families and call in the antibiotics earlier than before (by 9:00 or 9:30 a.m.). We have felt the number of positive Gen Probe tests fits for what "seems right" (about 7-15% of the Gen Probes are positive for Strep). 
     We do not want this more accurate and quicker test to be a financial burden to our families, however. We understand you may get a separate charge/bill from ChildLab through Nationwide Children's Hospital. As we are no longer doing the culture tests in our office, we as an office are saving some expense. Understand that the vast majority of pediatrics offices in Central Ohio are now doing exactly as we are doing. We are monitoring this cost issue and will, as always, keep you posted if we change how we handle this issue.

Why don't pediatricians just treat everyone with a sore throat for Strep throat?

      We are asked on occasion why we pediatricians do not "just treat with antibiotics" everyone with a sore throat. I want to answer that question. I feel pretty strongly about it.
      1. Antibiotics only treat bacterial infections -- not viral infections.
Most sore throats are not caused by bacterial infections. Less than 1 in 7 of our rapid strep tests done in the office show strep. And 1 in 14 of our over-night strep tests (through Nationwide Children's Hospital ChildLab) are positive for strep. So for the vast majority of sore throats, antibiotics will not help. They will not help because the sore throats are caused by viral illnesses.
      2. The overuse of antibiotics is causing bacteria to evolve to become more resistant.
Many antibiotics are losing their strength against the usual bacteria we treat. As important it is to take an antibiotic when you need it, taking one if you do not need it is bad. This will kill healthy bacteria. Any bacteria that do survive through your course of antibiotics will now be resistant to the antibiotics. Many common infections (ear infections, sinus infections, pneumonia, skin infections, urinary tract infections) are caused by more resistant bacteria requiring stronger and stronger antibiotics. This is very worrisome.
      3. Although scientists are studying new antibiotics all the time, no new antibiotics for common infections are coming anytime soon.
New medications are being studied and tested all the time. New medications are available for many conditions. However, there are no new antibiotics "coming down the pipeline" that will help treat common bacterial infections. In fact, the antibiotics that are taken by mouth available for use in children have not changed since 1997. The commonly used antibiotics (amoxicillin, cefdinir/Omnicef, amoxicillin-clavulanate/Augmentin, azithromycin/Zithromax, and sulfamethoxazole-trimethoprim/Bactrim) are the same ones used for 16 years. Thank goodness they work for the common bacterial illnesses so far!
      4. The chances of "missing a Strep infection" and something bad happening is tiny.
Although there are brief sore throats that are not tested (for strep throat) that do turn out to be strep, it is very rare to have someone tested, miss a strep infection, and have an untreated strep throat complication -- such as rheumatic fever.

       We are all frustrated with sore throats. Especially when they are accompanied by headache, fever, and upset stomach, we hope someone with a sore throat has strep so that we can treat them with an antibiotic and they will quickly feel better, they will be not contagious quickly, and complications (such as rheumatic fever) will not occur. But if you do not have strep throat, taking an antibiotic will not help -- and can be dangerous.

Fiber in children's diets

     Fiber is not a very glamorous topic. But is important for your health. It helps keep our bowels moving in a healthy way. And it helps make us feel "full", an important part of maintaining a healthy weight. Healthy Children, sponsored by the American Academy of Pediatrics, has a very good article on fiber in children's diets here. As it says, a good guideline on how many grams of fiber per day for children: your age + 5 (so a 10 year old needs 10 (their age) + 5 = 15), up to 25 grams per day. Eat healthy!

Wednesday, November 6, 2013

Your child going off to college.

     My oldest son Sam headed to Otterbein University this year to start college. Sam is a mature, responsible teenager. We are very proud of him.
     No matter how you feel about your child's maturity level and history of responsible behavior, it is good to have a discussion with them before college about all the things they will face in college. Taking care of themselves, in all the meanings of the phrase, is an important part of transitioning to higher education. Tread lightly as you do not want to sound too preachy or overbearing. I think the average high school graduate wants some advice and wants to know you are there to help, but they do not want you telling them "never do this".
      Nutrition: You have spent years trying to help your child become a healthy eater. Remind them about eating a well-rounded diet, eating breakfast (even a protein or cereal bar), and avoiding over-eating and excess snacking. Encourage calcium intake with milk, cheese, and yogurt.
      Sleep: Your child in college is likely not going to get enough sleep! I would love it if they did get plenty of sleep, but college students will stay up too late and be sleep deprived. Part of this is socializing and part of it is staying up to study. Good time management will help them from having to stay up until 2:30 a.m. completing that paper that is due tomorrow. Encourage your child to get enough sleep so they are not overly tired.
      Socializing: College is, of course, a huge opportunity to meet and become friends with a huge new group of young people. Many college students find this exciting. Some more reserved or shy students find this distressing. It is like life after school: your child will need to learn to interact with people from all walks of life, with different interests and backgrounds. For those college students dreading the "getting along with roommate"/"meeting new people" issues, giving them a pep talk about the fact that meeting one or two people with similar interests will help with the transition. Many times at college orientation, some upperclassmen students will mention that it was hard to balance the socializing with academics that first year of school. You hope that your children hear this message and they themselves find a good balance.
      Alcohol and drugs: Despite it not being a good idea or legal, many freshman have access to alcohol and drugs at college. Talking through with your child how to handle this will help. Review with them the dangers of drunk driving or riding with someone who is intoxicated. Remind them how they can get into legal trouble or trouble with the university for public use of alcohol or drugs or public intoxication. Please tell your daughters to NEVER leave any beverage unattended -- there are far too many cases of an acquaintance or stranger adding a date rape drug to young women's drink.
      Sexual activity: Although I tell patients to wait until they are in a committed, long-term relationship (ideally marriage) for sexual activity, many college students are sexually active. Besides the possible emotional and social consequences, the big issues we worry about for sexually active young adults are sexually transmitted diseases and pregnancy. You know your comfort level and your child, but it is a good time to discuss these issues with your son or daughter. Consider taking your daughter to the gynecologist to discuss birth control.
      Money: Not only will your college student learn to budget time, but they will learn to budget money. I had a time in college where I could not send my girlfriend a letter at her college because I could not afford the stamp. Although it helped me learn to appreciate when you can afford those things you do not absolutely need, I do not wish this situation on anyone. Many college students learn about budgeting their money because they have more control over their spending when they are away from home. Whether they have their own debit card, a check book, or some other arrangement, discuss before they go off to college how you as a family are going to keep track of spending, whether parents can have access to online account information, and what to do if there is an issue.
      Good luck!

Tuesday, October 29, 2013

Happy and Safe Halloween

     Halloween is almost upon us. You probably have the candy and costumes all ready. I think it is good to be reminded of safety tips for Halloween. The American Academy of Pediatrics has a wonderful list to help make Halloween safe for everyone. Here is a link. I hope it is a happy and safe Trick or Treat for all!

Tuesday, October 22, 2013

Update on Arsenic in Rice

     I wrote earlier this year about arsenic levels in rice. I have followed the Consumer Reports recommendations and told families to consider limiting the amount of rice cereal to one serving per day for infants. The report from Consumer Reports is here. The Food and Drug Administration (FDA) released new information in September of this year after their investigation into the levels of arsenic in rice and rice products. Their report is at this link. In addition, here is a blog post written by an FDA scientist.
      Some facts: 1. There are no federal limits (agreed upon safe levels) for arsenic in most foods. 2. To cut arsenic risk, both the American Academy of Pediatrics (AAP) and the Food and Drug Administration (FDA) recommend families eat a well balanced diet with a variety of grains, including wheat, barley and oats. 3. The chair of the AAP Committee on Nutrition feels the latest information from the FDA is "reassuring". In addition, Dr. Stephen Daniels stated for the AAP News that "While there is inorganic arsenic in rice and rice products, it is a level that should be safe for consumption across the population." 4. The FDA plans to do additional testing of rice products made for infants and toddlers in the coming months.
       For now, I do not think my recommendation has changed. I would follow the Consumer Reports recommendations.  That includes limiting rice cereal to no more than one serving per day for infants. It is fine to do oat cereal instead of rice cereal for infants, and avoid the rice cereal all together. As further research happens, I will update my blog.

Tuesday, September 3, 2013

Latest Food Allergy Care Plan

     FARE (Food Allergy Resources & Education) has updated their Food Allergy Care Plan. I had gone to their website to print out more copies of the form when I realized (3 months since the last update), they have significantly updated and changed their form. Here is a link to their latest form. I like the way the new form puts a lot of the instructions in visual form. We want it to be easy to figure out what to do if your child ever has a reaction to food.

Tuesday, August 27, 2013

The 2013-2014 Flu Vaccines

     Yet again we are in the time of the year where we are headed into the influenza "flu" season. Our recommendations from past years remain the same: 1. Everyone 6 months and above should get the flu vaccine each year (with very few exceptions -- the most common one is a history of anaphylaxis to egg). 2. The flu shot can be given to anyone 6 months and above. It is the only flu vaccine recommended for those with a history of diabetes, asthma, and a serious heart condition. 3. The flu nasal spray ("Flu Mist) is available for 2 years of age and above who are in otherwise good health. It is still not approved for usage below 2 years of age or with children with asthma, diabetes, or a serious heart condition.
     This year, you will hear more about the "quadrivalent" vaccine. This means that there are four strains in the vaccine (not the usually three). About half of the time in the last 11 years, there has been a two strains of the B influenza virus in the community. Nationwide, on average, this will help prevent an extra 300,000 cases of influenza each year by adding the fourth strain into the vaccine.
     Our Flu Mist vaccine is quadrivalent this year. It has two A strains and two B strains. The flu shot we purchased this year is not quadrivalent -- it is the 3 strain trivalent vaccine. We decided to order this because there was a significant increased cost to the quadrivalent shot, the quadrivalent shot was approved for "just" 3 years of age and above, and there was a chance our supply of the quadrivalent vaccine might not be ideal. We believe the 3 strain trivalent vaccine will very likely give good protection. It is likely we will have the quadrivalent flu shot in future years.
     Our website has the dates for our flu vaccine walk-in clinics for the Fall of 2013. We actively encourage all of our patients to receive the flu vaccine at our office this Fall.

September is a peak asthma month

     We will see many children with a history of asthma in the office with worsening symptoms in September. The Fall allergies are bad at this time of year (ragweed, other weeds, and molds), the weather changes frequently, and children are back in school getting more illness exposures. It is easy for many children to get off of their normal preventative medication during the warm weather months. All of these factors make it more likely for us to notice a dramatic increase in wheezing during the back to school time of year.
     We cannot do much about the weather and you cannot stay inside in air conditioning all the time to avoid the allergies. And despite our best efforts to avoid the illnesses with back to school time, this is also difficult. So what to do?
     The most important thing to do is to make sure that your child is taking their daily preventative medication (inhaled steroids, Singulair(r), etc.). Starting this now or before this season starts is very important. It takes a couple weeks to get the most benefit from these medications. It is also time to get a flu shot. This helps prevent a case of flu which can cause a worsening of the asthma.
     Please call the office if you have questions.

Monday, June 24, 2013

Food Allergy Action Plan

      The Food Allergy and Anaphylaxis Network (FAAN) has a terrific Food Allergy Action Plan form. In the case of a child having an exposure to the food or foods they are allergic to, it provides clear-cut instructions on what to do and when to do it. A link here connects you to the website and their form, the Action Plan.
      When the child has a food allergy and needs to have school or preschool prepared, they will have a form to be completed and signed by the physician. Many times, they will appreciate and we will strongly recommend that in addition the FAAN Food Allergy Action Plan also be completed. This provides more precise information. The school forms will essentially allow us to say "if there is a food allergy reaction, give Benadryl and epinephrine". However, the Action Plan allows us to say more accurate information such as "if they are wheezing, pale, and dizzy, give epinephrine and then do these other steps". We have the Action Plan available in the office to complete at your child's appointment or you can print out at home and bring in at your child's appointment.
      One other point: it is strongly recommended to have two epinephrine injectors (EpiPen or Auvi-Q) available with the child at all times. There are two injectors in the "twin pack" so that a second injection is available if needed if a reaction occurs. Over the years, it has been found at least 1 out of 5 times (20%), a second dose is needed soon after the first. And there are many occasions when someone did not have a second dose and died because of a severe reaction that could have been avoided with a second dose of epinephrine.

Wednesday, June 19, 2013

Swaddling Infants

     Swaddling infants is something of a controversial topic recently. It is done from the start at the hospital for newborns. There is a new article from the American Academy of Pediatrics here that has an excellent discussion of the topic.
     What do I recommend? It is fine to swaddle from birth until 8 weeks of age, make sure there is room at the chest for the infant to comfortably breath (you should be able to get your hand between the blanket and the infant), and make sure the swaddling is looser around the hips.

Wednesday, May 22, 2013

Dog Bite Prevention Week

     The week of May 19th through 25th is dog bite prevention week. The American Academy of Pediatrics has a good two page information sheet about preventing dog bites. With more outdoor time, the warm weather months are always when we see and hear more about children suffering from dog bites. Here is a link to the AAP page on preventing dog bites. Help your children be safe out there!

Tuesday, May 21, 2013

Natural disasters.

     The horrible tragedy in Oklahoma this week makes me wonder how children recover from these events. My children were recently in a car accident that resulted in significant car damage but only dings and scratches to my children. And it was very stressful for my family.
     The American Academy of Pediatrics has a webpage with many good resources for dealing with these tragedies. You may find it helpful, whether you are thinking about how to discuss these with your children or you yourself are responding to catastrophic event. Here is a link to the American Academy of Pediatrics webpage.

Saturday, May 18, 2013

Medications for colds, allergies, and sinus infections that are safe during breastfeeding.

     We are often asked for our advice regarding medications that breastfeeding mother's may take while they have symptoms of colds, allergies, and sinus infections. We generally advise to avoid medications as much as possible while breastfeeding. However, we recognize breastfeeding mom's may want to take a medication to help with their symptoms.
     Based on our experience, what we have read, and scientific research, this is what we want you to know:
1. Know that decongestants (such as Sudafed) and antihistamines (such as Zyrtec, Claritin, Benadryl, and Allegra) sometimes decrease a mother's milk supply. This is hard to know if this is going to happen to you, but be especially cautious if you struggle with your milk supply.
2. Side effects for infants can include drowsiness, wakefulness, and irritability. If they happen with one dose, they are likely going to happen each time you take the medication. If worrisome, stop taking the medication. Your infant may not show any sign of side effects, however.
3. Sudafed (decongestant) or Benadryl (antihistamine) are generally considered safe to take and are options for you to take.
4. The less-sedating antihistamines for allergies (Claritin, Zyrtec, and Allegra) are also fine.
      As always, I like what the website Kelly Mom has to say about this issue. Please call if you have questions!

Swaddling Infants

     Swaddling infants is a hot topic. We as pediatricians are often asked about swaddling. Many factors apply in my opinion of swaddling: comfort of the infant, safely of the infant, how it impacts SIDS risk, and how it impacts the sleep. I believe the American Academy of Pediatrics statement is the best advice on swaddling. On this link to an article at Healthy Children is an article about swaddling and good advice on swaddling.

Monday, April 29, 2013

New book by the AAP about Autism Spectrum Disorders

     Many of our patients have autism spectrum disorders. I know many families with a child with these conditions struggle to find good, helpful, scientifically sound information. The American Academy of Pediatrics has a new book, Autism Spectrum Disorders: What Every Parent Needs to Know. It is edited by Drs. Rosenblatt, MD, and Carbone, MD. Both of these doctors are considered experts in autism and one is a parent of a child with autism.
     So if you are looking for more information about autism spectrum disorders, I highly recommend this book. It is available at www.aap.org/bookstore and other retailers. Another excellent source for information and support is www.autismspeaks.org.

Monday, March 11, 2013

Tanning Beds

     The official position from the American Academy of Pediatrics is that anyone under 18 years of age should never use a tanning bed. I certainly agree with this recommendation.
     People who use tanning beds when less than 35 years of age are 75% more likely to develop melanoma (skin cancer). There are 68,000 cases of melanoma in the US every year, and 1 in 8 of these people die from the skin cancer.
     Ohio requires parental permission for children less than 18 years of age using a tanning bed. I wish that Ohio would ban their use for children less than 18 years of age as I am that concerned about the use of a tanning bed for children.
     Tanning beds damage the skin, cause cause cancer, and can cause dry skin, eye problems, and make you more likely to get sick. Remember, the "healthy glow" is actually is not healthy at all -- it is skin damage. Please avoid tanning beds and skin damage from the sun.

Tuesday, February 12, 2013

KellyMom Website

     A nurse at the Riverside Methodist Hospital nursery referred me to a website that I want to pass onto others. It is really helpful! It is called KellyMom and is a website with terrific information about breastfeeding and breast milk. I consider it a great resource with accurate and up to date information. A link to their website can be found here. I hope others find it helpful.

Thursday, February 7, 2013

EpiPens in Schools

     Food allergies are on the rise in this country. A study from Pediatrics in July 2011 found that 1 of 13 children suffer from a food allergy in the U.S. More than 1 out of 3 of these children had a history of a severe reaction. And 3 out of 10 children had allergies to multiple foods.
     Mylan Specialty created the EpiPen4Schools(r) program to help schools have improved access to epinephrine if a life-threatening allergic reaction occurs at school. Although we want each child who has a known food allergy to have two EpiPens at the school, there are times in which a child may have a reaction and a non-expired EpiPen is not available. EpiPens are not cheap. And Mylan Specialty's program will offer four free EpiPens or EpiPen Jrs to the schools. More information is available at this website.
     In our state of Ohio, there is no law allowing EpiPens to be in the school and "undesignated". That means the schools cannot currently have "extra" EpiPens on hand to use in an emergency. The only EpiPens allowed are those that were prescribed for a specific child. That means children that have a known allergy and children that could develop their first reaction at school would be potentially unprotected. I am a strong advocate for legislation in Ohio that allows undesignated EpiPens in the schools. Having said that, my wife the allergist, Dr. Grace Ryu, M.D., makes a very good point about this issue. If your child has a known food allergy, you need to make sure your child has a non-expired EpiPen 2-Pak at the school to ensure that if they needed the medicine at school it would always be available. Do not rely on the school having extras. If the school just used their EpiPens for another child and has ordered more, they may not be available. It is possible the school's EpiPens could be expired. Children and adults need to have two pens available because 20-25% of the time, a second dose is required. A wonderful website with information on food allergies is here, the Food Allergy Network. Be safe!

Tuesday, January 29, 2013

New hospital follow-up schedule

     Doctors are creatures of habit. We get used to doing things a certain way. Here at Hilliard Pediatrics, we have had the same follow-up schedule for newborns since we opened over 20 years ago. But now we are changing this schedule. Our new partner, Dr. Beth, has convinced us it is time to update to the latest recommended schedule by the American Academy of Pediatrics. And we have listened.
     For years, we had the infant's family call us the day after discharge and routinely saw the infant in the office at 2 weeks (10-14 days of age) and then at 2 months of age. The latest recommendation and our new policy is to have you call when you have spent a night at home to give us an update about how the infant is doing. Then we will routinely see the infants 2-3 days after discharge from the hospital. Our next routine appointment will be at 4 weeks (one month) of age. Then we will see the infants at 2 months of age and continue our normal schedule after that 2 month well-check. As always, we will be happy to see those infants with feeding or weight concerns, jaundice concerns, or when other issues arise. Some of the infants seen 2-3 days after discharge will need a visit to check their weight gain. Call with questions!