Article in the Dispatch on youth weight lifting.

     I recently posted on this blog about growing children doing weight lifting. The Columbus Dispatch had an article in the Sunday edition on October 28th, 2012 that is also online here. We, at this point, feel confident in saying that if weight training is done properly, that it is safe.

Earlier onset of puberty for boys

     A study by the American Academy of Pediatrics, the largest professional group of pediatricians in the United States, recently completed a study on the onset of puberty in boys. The article is available here on the AAP website. More research is needed to answer the "Why is this happening?" question. With girls, it is thought that some combination of health changes and nutrition have pushed the onset of puberty into earlier years compared to the past.
     One thing this research does help is to provide us with an expected baseline for when it is "normal" for boys to start puberty. In an otherwise-healthy boy with the start of puberty at 10-11 years of age, we can now consider this in the normal range. Meaning it is not likely some bigger health issue is happening.

Pertussis (whooping cough)

     The number of cases of pertussis (whooping cough) are on the rise in the United States. There have been over 4000 cases in the State of Washington (when the usual number would be about 50 cases by this time in the year). The vaccine to protect against whooping cough is good but not perfect. The sad thing is that many children are going unprotected because their parents are deferring or declining the vaccine. This has left many children vulnerable to the illness. There have been at least 16 deaths in the United States this year. This number is going to continue to rise if a larger number of children and adults are not vaccinated.
     There is a new recommendation that all pregnant women should receive the vaccine (DTaP) in the 2nd or 3rd trimester. This helps protect mom and infant. The infant then is better protected while they themselves receive the vaccine and develop better immunity. Here is the CDC information.

Constipation update

     We have a handout and protocol about constipation on our website here. I realize there are more products available on the market. One website that I think is helpful for parents and families is the Pedialax website. It has good information on their products and how to help kids with constipation.
     I have had confidence in the safety for long-term use of propylene glycol ("PEG"; Miralax(r) by Merck) over the years. In fact, one of my sons uses it regularly (almost daily) to keep the bowel movements regular. The head of the gastroenterology department at Nationwide Children's Hospital, Dr. Carlo Di Lorenzo, M.D., is quoted in an article from the New York Times. I feel comfortable with children being on the medication long-term at this point. Having said that, further research needs to be done to ensure the safety. Ask your pediatrician if you have further questions.

Arsenic in rice.

     The November 2012 issue of Consumer Reports has a fascinating and scary article about arsenic in rice. After reading the article, I think it is clear this issue needs more study and further action in the future. Because of the long-term increased risk for certain types of cancer after exposure to arsenic, it is wise to make some changes now. The most important is to limit infants to one serving of infant rice cereal per day. Infants can be offered other single grain cereals instead of the rice (oat cereal is the other big single grain cereal available for infants). We will certainly have more information on this topic as time goes by. If you have questions, ask your child's pediatrician.

Pollen counts for allergy sufferers.

     For those with known or suspected allergies, knowing the pollen counts for the various seasonal pollens can be very helpful. The website I have bookmarked on my computer is the American Academy of Allergy Asthma and Immunology ("quad A-I" as my wife and other allergists say!) website. They list updated pollen counts for different regions. Our closest reporting station is in Dayton, Ohio. You can trust that whatever they find in Dayton would apply to Columbus and Central Ohio. You may find this helpful to see what pollens are "misbehaving" if you are having allergy symptoms act up. Here is the link to the Dayton pollen count report.

Nursemaid's Elbow

     A common injury for toddlers and pre-schoolers is "nursemaid's elbow" (also called subluxed radial head -- aren't you glad we call it nursemaid's elbow?). It typically occurs when the arm is tugged or pulled (lifting a child up by the hands or wrist, swinging them around by the hands or wrist, etc.). The child will have sudden pain in the elbow region. Often they will hold the arm to their side with their elbow bent, not wanting to move the arm. There is a terrific review article about it for parents here at Healthy Children. If you suspect your child has this condition, we want to see your child in the office or have them seen at Nationwide Children's Hospital. There are some children that have this happen once only. Other children have it happen a few times -- yet the orthopedic specialists will so often tell us that they will grow out of this once their elbow strengthens up over a few years. Discuss this with us if your child has this happens more than once.
     One note: if I help a four year old up onto our exam tables here in the office, I always reach under their underarms to lift the child. When asked why, I always explain that I am not wanting to lift by the hands or wrist so that I do not cause a nursemaid's elbow. I encourage you to lift your young children by lifting under their underarms.

AAP Video on Strength Training in Young Athletes

     I am excited about a new DVD and flash cards set available through the American Academy of Pediatrics here that emphasises the proper way for young, still-growing athletes to safely build muscle. Our recommendation is that if the weight is low enough that the child can do 8-15 reps at least once (2-3 sets of reps is best), it is a safe weight. This set from the AAP is designed to help with specific instruction and exercises. This is the AAP's first go at this -- I think that is great.

HPV Vaccine Update

     The American Academy of Pediatrics published an article in the November 2012 Pediatrics issue that looks at the issue of whether sexual behavior changes in pre-teens and teens after they have received the HPV (cervical cancer) vaccine series. The results are available here. The good news was that the study did not find any increase in sexual behaviors for pre-teens and teens after the vaccine series. I hope these results reassure those families that have been concerned that we are sending the wrong message (that we expect them to be sexually active before marriage) by vaccinating pre-teens.
     And remember that the vaccine is now recommended for the boys, also.

Good article from Parade Magazine about vaccine refusal.

     Adulthood often confronts us with balancing risks and rewards in life. One of those is vaccinating ourselves and our children. I strongly believe that the recommended vaccines are life-saving, safe, and critical to protecting our children's health. I strongly believe deferring them or refusing them is life-threatening, unsafe, and dangerous. Four years of college, four years of medical school, three years of pediatric training, 18 years of medical practice, and lots of reading and studying have taught me this and reinforced the facts.
     There is an excellent article in the new Parade Magazine. It reviews how the come-backs of diseases (including approximately 4000 cases of whooping cough in the state of Washington) are related to large numbers of vaccine refusals.
     Protect your children! Vaccinate!

Should kids play different sports or specialize with one?

     An interesting topic to me is whether it is better for young athletes to play one sport only or to play different sports in different seasons. I had not thought about this for awhile but was reminded of the topic by Michael Arace's article here in the Columbus Dispatch. I also found this article on a site for coaches. I think one of the interesting points in Arace's article is that spending so much time doing the same activity likely increases the risk for injury as the same muscle groups are used again and again.
     I admire my nephew's attitude. He is a Wyatt Teller, 4 star high school defensive end recruit from Bealton, Virginia who has committed to Virginia Tech for 2013. He is the youngest of 5 children for my brother and sister-in-law. Although he may have dreams about playing in the NFL, I have not heard him speak of that possibility. He talks about going into law enforcement. Although many athletes dream of playing professionally, the realty is that the vast majority of athletes do not get a scholarship to play in college and so many fewer ever get paid to play professionally.
     The first time I coached youth soccer, my team of 6 year olds scored one goal the entire season but went 0-10. At the end of the season, they seemed to have learned a lot about soccer, had a number of hours of good exercise, and (probably most importantly) had a ton of fun. For the vast majority of youth athletes, those are the important things: the exercise, learning the sport, playing with team members, and having fun.
     I am all for pursuing one sport if that is what your child enjoys, they are not having excessive injuries with it, and it otherwise works for the family. But many children benefit from participating in multiple sports throughout the year.

Supplementing Breast Infants with Vitamin D

     Back in 2008, the American Academy of Pediatrics began recommending supplementing vitamin D in breast fed infants. The original report is here. For quite some time, the only form of vitamin D supplement was a drop with the vitamin D combined with vitamin A and C (TriViSol or ViDaylin ADC). However, newer forms of drops are available that allow us to just do vitamin D by itself. The recommendation is for 400 IU (international units) each day. Enfamil D-Vi-Sol, with 400 IU per ml, is available and is 1 ml by mouth once a day. The other option is Baby D Drops, which are 400 IU per drop. Therefore the dose for the Baby D Drops is 1 drop by mouth once a day.
     If a baby takes formula, it is 16 ounces per day that would supply 400 IU in a day. Therefore, if an infant is breast feeding but supplements with formula, it is 16 ounces a day that are needed to supplement to skip doing the vitamin D drops.
     We do recommend supplementing breast fed (or breast fed plus formula supplemented infants who take less than 16 ounces of formula per day) infants with vitamin D.