New Bacterial Meningitis Vaccine for Pre-Teens and Teens

     One of the scariest bacterial infections in children, adolescents, and young adults is bacterial meningitis. It can come on suddenly. It can quickly progress to a deadly infection. Our Menveo vaccine for bacterial meningitis helps prevent cases of Neisseria meningitis due to strains A, C, W, and Y. Approximately 30% of all Neisseria meningitis cases in the U.S. were due to strain B, which is not in the Menveo vaccine.
     The FDA has now approved a vaccine called Trumenba that helps prevent cases of meningitis due to this B strain. It is currently approved for 10-25 year olds. It is a three shot series given at a doctor's visit then 2 months and 6 months after the first. The side effects are similar to other vaccines given to adolescents: soreness of the arm, tiredness, and headache. Generally, the vaccine has been well tolerated. The Advisory Committee on Immunization Practices, the national committee of vaccine specialists that make the recommendations we follow, is going to make a further recommendation on the Trumenba's routine use in February of 2015.
     I anticipate that in 2015, we will start to routinely recommend the vaccine series. I will keep you updated. For now at least, we do not stock the vaccine. I will definitely want my three teenage sons to receive the vaccine.

Can these medications be given together for my child?

      We are commonly asked if different medications can be given together. This is an appropriate question to ask because there are medications that should NOT be given together. The good news is so many of the medications given to children can safely be given together.

All of the following medications can safely be given together:

Antibiotics including amoxicillin, cefdinir/Omnicef®, amoxicillin-clavulanate/Augmentin®, azithromycin/Zithromax®, cephalexin/Keflex®, and trimethoprim-sulfamethoxazole/Bactrim®.

Antihistamines including Benadryl®/diphenhydramine, Claritin®/loratadine, Zyrtec®/cetirizine, and Allegra®/fexofenadine.

Decongestants including pseudoephedrine/Sudafed®.

Cough suppressants including dextromethoraphan, the active ingredient in over the counter cough medications including Delsym®.  It also includes codeine-containing cough medications that are prescription-only, such as Hycodan® (hydrocodone and homotropine)

Fever reducers/pain relievers including acetaminophen/Tylenol® and ibuprofen/Motrin® and Advil®.

Antacids such as calcium carbonate/Tums®, aluminum carbonate/Maalox® and Mylanta®, ranitidine/Zantac®, omeprazole/Prilosec®, lansoprazole/Prevacid®, and esomeprazole/Nexium®.

Medications used to treat ADD and ADHD including Concerta®, Vyvanse®, Adderall® and Adderall XR®, Focalin® and Focalin XR®, Intuniv®, Strattera®, Quillivant®, Daytrana®, and Kapvay®.

Medications used to treat anxiety, depression, and obsessive-compulsive disorder including Prozac®, Zoloft®, citalopram/Celexa®, Welbutrin®, and Paxil®.

Medications for asthma including albuterol, montelukast/Singulair®, and inhaled corticosteroids such as Qvar®, Flovent®, Pulmicort®, and others.

Nasal steroids for allergies such as Nasacort®, Nasonex®, Rhinocort®, Flonase®, and others.

     Any of the above medications can be given together at the same time or on the same day.

Nationwide Children's Hospital Sports Medicine Update

     Now that the Nationwide Children's Hospital Hilliard Close To Home is open with expanded services, including an Urgent Care, other services are being added. The Sports Medicine department, which we have found very helpful for our parents. is going to be adding 2 half day sessions in Hilliard at the Close To Home. In addition, Jessica Buschmann, Clinical Dietician with the Sports Medicine Department, is offering one-on-one, group, and team services with patients. We can refer, upon your request, to Sports Medicine physicians or the Dietician. You may also call yourself to their clinic at #355-6000.

New FDA sunscreen recommendations.

     It is well known that sun exposure leads to skin damage. The skin damage raises the risk of skin cancer and premature aging. Sadly, despite this knowledge, the rate of skin cancer is growing rapidly. Melanoma, the most serious (dangerous) type of skin cancer, has had it's incidence (the number of cases in a given year in the group of people studied) increase. In fact, the number of cases are doubling every 10 years. Melanoma is the most common cancer in the U.S. It is thought 1 in 5 persons will be diagnosed with a skin cancer in their lifetime.
     Protecting everyone with sunscreen when they are sun exposed is an excellent way to help prevent skin damage. Reading labels on sunscreen can be difficult. The SPF on the label stands for sun protection factor. Originally, we were all informed that an SPF of 16 was twice as protective as an 8 -- it turns out this was not true. In fact, these are the new regulations:
1. The highest SPF you should see will be "50+".
2. There is no evidence that says that an SPF greater than 50 is more sun protective.
3. Sunscreens with SPF greater than 15 are more sun protective than those with an SPF of less than 15.
4. "Broad Spectrum" sun screens will need to have both UVA protection (against skin cancer and premature skin aging) and UVB protection (against sunburn).
5. The terms "waterproof" and "sweatproof" will no longer be allowed.
     My recommendations:
1. Use sunscreen with both UVA and UVB protection whenever you are being exposed to the sun.
2. Look for products with an SPF of 30 or above. But realize it is not likely you are getting more (or much more) sun protection if the SPF is over 30. If the higher-than-SPF-30 sunscreen is more expensive, consider purchasing the SPF 30 sunscreen instead.
3. Reapply sunscreen every 2 hours. Reapply more often if sweating or in and out of water.
4. Covering up with sunglasses, hat, and covering exposed skin helps limit sun damage.
5. Limit sun exposure from 10 a.m. to 2 p.m. when the ultraviolet rays are the strongest.
6. For infants less than 6 months of age: a. avoid sun exposure, b. dress infants with a hat and long clothing if out in the sun, c. if adequate clothing and shade are not possible, apply a small amount of SPF 15-30 sunscreen to small areas (exposed areas on the face, arms, or legs).
Resources used: FDA report and 'FDA's Sunscreen Recommendations' in October 2014 Contemporary Pediatrics by Mary Beth Nierengarten, MA.

Pediatric Psychiatrists

     We know many of our families battle mental health issues and have a need for the services of pediatric psychiatrists. There is a need for more mental health professionals in many communities in the U.S., including here in Central Ohio. Here is our list of mental health professionals we frequently refer to on our website.
     I just became aware of two pediatric psychiatrists that are accepting new patients. They are Drs. Nathaniel Johns, MD and Walter Stearns, MD. They are with UMCH Family Services at 1033 High Street, Worthington, Ohio. The office requests that we fax them a referral with the necessary information. If you are interested in a referral, contact our office during routine office hours Monday through Friday.

Chapped Lips and Rashes Around the Mouth

     We have entered the chapped lips time of year Fall and Winter. When the weather gets cooler and everyone turns their heat on in their home, our skin and lips naturally get more dry. Many young children lick their lips more often in reaction to the dryness. The excessively licking the lips results in even more dryness once the saliva dries on the lips and the skin around the mouth. Not drinking enough causes increased dryness. So try increase the child's water intake. Although there are many, many products that help dry lips, you will frequently hear us recommend Aquaphor Healing Ointment or the new Aquaphor Lip Repair by Biersdorf. More information is available on these over the counter items here. It is important to have the proper expectations about these products: you will likely have to apply them multiple times per day, remind your child to not lick (instead, ask for more lip ointment!), and do this for many days until the Spring season arrives. The peak years for this licking/chapped/licking/chapped cycle is 2-8 years of age.
     Being outside in the cold weather often makes lips chapped. In the coming months, when your children are out on cold weather adventures such as making a snowman, skiing, snowboarding, and sledding, putting on Aquaphor or another similar product ahead of time sure can help prevent chapped lips. Applying it again when your child arrives inside will also help. Older kids can put a stick of ChapStick or Blistex in their pocket of their coat so they can reapply when they need it.
     Thumb sucking and pacifier use increase the chances of having not just dry lips but a rash around the mouth. The rashes often look chapped and irritated. It is not likely, unless things have gotten more complicated (read below), that it will look scabbed, very red, or show much peeling. I personally do not think you should stress about this rash because it is so difficult to get it to look much better until your child cuts back or stops sucking their thumb or using their pacifier. It is fine to apply some Aquaphor Healing Ointment to this area. The small amount that your child might get into their mouth after you do this is not worrisome.
     There are times when just coating the dryness will not help. If the above measures do not help, especially if the rash around the lips is quite painful, itchy, peeling, blistered, or scabbed, we should see your child at walk-ins or a scheduled appointment to better assess what is going on and how to help. There are cases of yeast (or ringworm or fungal -- all mean the same thing here), bacterial (impetigo, others), or viral (herpes simplex virus) infections that will need further treatment. We also see some children who have eczema (atopic dermatitis) who have rashes around the mouth that need something besides just moisturizing the area.

Staying Safe in an Electronically Connected World

     I recently discovered a very helpful resource called "OnGuard Online" to help all of us stay safe in this electronically connected world that we live in. It has terrific information about many topics. Near and dear to a pediatrician's heart are the sections on Keeping Kids Safe Online. The full site is available at OnGuard Online. I hope you find it helpful.