Swimmer's Ear

     Swimmer's ear is a common summer time condition where a bacterial infection of the ear canal occurs. We want to see those kids for walk-ins or an appointment if you are suspicious of a swimmer's ear with pain in the ear and discomfort when the ear is touched or moved. Often these kids have been swimming recently. These infections are more common with untreated water (lakes, ponds, rivers, ocean), but often happen in treated water (pools, waterparks). See our website's protocol about ear aches for information about prevention and treatment of swimmer's ear here.

Hand, Foot, and Mouth Disease

     One of the common childhood illnesses that we see is Hand, Foot, and Mouth (HFM) disease. Many years, it is a later warm-weather illness (August, September), but this year we have seen cases throughout the Spring and still see cases nearly every day in the office. Nationwide, it has been reported that other doctors are seeing similar cases.
     HFM disease is a illness causes by a virus in the enterovirus family called Coxsackie virus. It runs it course without special treatment, but typically the fever and mouth discomfort will be helped by using fever-reducers and a combination of liquid diphenhydramine (Benadryl) and Maalox or Mylanta. See our website here for more information about the illness and its treatment.  
     On a personal note, my parents recall very well that I ruined a vacation to New York City with a bad case of Hand, Foot, and Mouth disease when I was little. And, fittingly, two of my children had the illness when we took a vacation they were toddlers. It is NOT a fun illness. But it will pass with a rough few days to a week.

Human Papillomavirus (HPV) -- warning: some mature content!

     We have now had the human papillomavirus vaccine available for the last 5 years. The ongoing research into the vaccine has shown excellent protection for those young women who were first vaccinated 11 years ago when it was first being studied. We have actively recommended the vaccine to pre-teen and teen females over the last few years. Now there is an added recommendation to vaccinate the boys. We recommend this for our pre-teen and teen boys in the office. We have recently found that the insurance coverage is now very good and the vast majority of insurance plans are covering it for girls and boys. There are two vaccines, Gardisil and Cervarix. Based on many factors, we now recommend (as many national experts do) that the girls receive the Cervarix and the boys the Gardisil. Vaccinating the boys protects them from genital warts and their partners and spouses from possible cervical cancer. For boys and girls, the vaccine is a three part vaccine: one initially, one 2 months later, and the final dose 6 months after the first.
     More background on human papillomavirus (HPV): HPV is a family of viruses with different types. The different types infect the skin or mucous membranes. They cause genital warts, cervical cancer, throat and mouth cancers, and other cancers of the private parts. HPV is the most common sexually transmitted infection in the US. It is estimated 75-90% of sexually active people will become infected some time in their lives. It has been shown that between 20-25% of all women who are virgins at marriage become infected with the virus through their spouse. HPV is passed from one person to another through genital contact, usually during sex.
     Most people with HPV do not develop symptoms or health problems (with no symptoms, it can be hard to avoid passing to someone else). The body's immune system clears the HPV infection 90% of the time within 2 years. If it does not clear the infection, it may be months or years later that a pre-cancerous or cancerous change occurs. During this time, the vast majority of these people have no symptoms or signs of a problem (no warts, no pain, no abnormal bleeding or sores). Most people with cervical pre-cancer or cancer find out with their Pap smear by their gynecologist at their annual visit. Cervical cancer causes 300,000 worldwide deaths every year. Some women with cervical cancer require a hysterectomy and then are unable to have children.
     Occasionally families ask me if I believe that vaccinating the teenager against HPV is sending a wrong message. I do not believe this is true. Although the virus is spread through sexual contact, I do not believe protecting someone against HPV is sending the wrong message. I often will tell teens "we hope you are not sexually active until you are in a long-term, committed relationship, ideally marriage". And I do not believe anyone has ever abstained from sexual activity due to a fear of cervical cancer.
     So we remain big advocates for the vaccine to prevent cervical cancer. If you have questions, please discuss it with your physician. The following websites contain lots of good information.
Gardisil
Cervarix
CDC's information

Fluoride

     Fluoride is important for helping to prevent dental caries. Fluoride is available in city water supplies, some bottled water, over the counter fluoride rinses, treatments at the dentist office, and prescription drops and dissolvable tabs. Too little fluoride in your system and the teeth are prone to tooth decay. Too much fluoride and your teeth (and bones!) will become speckled or permanently stained with a discoloration.
     The need to supplement with fluoride is based on wanting to protect the teeth from both tooth decay (caries) and too much fluoride. Over the 18 years I have been a pediatrician, the recommendation has changed in trying to make sure we find the right balance. These are the current recommendations as of now for daily adequate intake:
0-6 months: 0.0 1mg/day AND additional supplementation is not recommended at this time
7-12 month: 0.5 mg/day
1-3 years: 0.7 mg/day
4-8 years: 1 mg/day
9-13 years: 2 mg/day
14-18 years: 3mg/day

The recommended daily fluoride dose of supplement, if needed, is adjusted in proportion to the fluoride content of drinking water.
Fluoride content of water  ==> Daily dose of oral fluoride (mg)
<0.3 ppm
Birth-6 months ==> 0
6 mo-35 mo ==> 0.25 mg
3-6 yr ==> 0.5 mg
6-16 yr ==> 1 mg
0.3-0.6 ppm
Birth-3 yr ==> 0
3-6 yr ==> 0.25 mg
6-18 yr ==> 0.5 mg
>0.6 ppm
All ages ==> 0

Commonly prescribed forms of fluoride include the following:
Luride(r) Drops (0.5mg/ml -- comes in 50ml. bottle)
Luride Lozi-Tab (0.25, 0.5, and 1mg -- comes in a bottle with 120 tabs)

     If you have well water, it is important to check the fluoride content of the well water before supplementing. There are families with wells that happen to contain a high amount of fluoride and supplementing these kids will just stain their teeth. For families with no fluoride in their well [we have well water at our home and we found it has no fluoride], we can discuss when you are in the office if your child needs a fluoride supplement. For families who do not drink tap or well water and primarily get water from bottled water, we can discuss at their check-up whether your child needs a fluoride supplement.

A good concussion reference.

     The Healthy Children website has a very good information page about concussions. I am adding a concussion protocol and information sheet to our Hilliard Peds website in the near future. Here is a link to the Healthy Children website information page on concussions.

Summer Check Ups

     Many children, especially school aged kids, have summer time check ups. We can complete sports physicals for the new year, update vaccines, check on growth and development, and discuss other issues as needed. As these appointments tend to quickly fill up as we get closer to the summer season, now is the time to call your doctor's office and set up the appointment.
     Remember that we at Hilliard Pediatrics are welcoming our new physician, Dr. Beth Schloss, M.D., to the practice. She is starting the first week of July 2012. She is now completing a chief residency year after completing her pediatric training at Nationwide Children's Hospital. Dr. Beth and the other physicians are scheduling for the summer check up season. We, as always, will be available for sick visits throughout the summer also. Our terrific nurse practitioner, Lisa Canini, CNP, also can do check ups throughout the summer.
     Call now to schedule a time that is convenient for you and your family!