Trampolines

     My wife and I were once attending a play with friends. When the play was over, we were walking out. They have a son who is friends with my oldest son. We happened to be walking by Dr. Gary Smith, MD (a national specialist in children's safety) of Nationwide Children's Hospital. When they asked if we thought trampolines are safe, I introduced them to Dr. Smith and repeated the question. Dr. Smith said "No, do not buy one or let your child use one. They are dangerous". I said thanks and kept walking. That in a nutshell is how pediatricians feel about trampolines.
      There is a good review of this here at Shots the NPR Medical Blog. The American Academy of Pediatrics has again released an updated statement about trampolines and is available here. We know there is a "thrill" factor that attracts everybody to trampolines. And we have kids that jumping on a trampoline keeps them active when they may struggle to be physically active in other ways. But we urge you to have your children avoid trampolines, even those with safety features and when limiting the trampoline to one person at a time, to avoid the serious and not-too-serious injuries that can occur with their use.

Croup

     Croup is a viral upper respiratory illness. It is known to spike seasonally in how frequently we see it. Traditionally that is when we see a change from a steady (warmer or colder) temperature to a different temperature. So we can almost predict that we will hear more about this cough is the Fall and the Spring. It also goes on throughout the rest of the year. We have had dozens of cases in the office recently. Sometimes to rule-out Strep if there is a sore throat, sometimes to discuss treatment for stridor if that has occurred, and sometimes to check the ears and chest. Because croup is viral, it does not respond to antibiotics.
     We have an extensive description of croup, when to be seen, and when to just treat at home here on our website for Hilliard Pediatrics. Remember the vast majority of cases of croup do not need to be seen in the office and will pass soon in a few days at home. Also, some children and adults frequently get a croupy, barky cough or laryngitis (loosing your voice). One of my sons has had it at least two times a year since he was very little. He has not gotten terribly sick with the croup (although we have many a night where his barky cough has disrupted every one's sleep), but it is frustrating. If your child has had croup quite a few times, discuss it with us in the office.

When to see an allergist.

     Allergies are a big topic in my life. I have allergies. My wife and children have allergies. I have many family members and friends with allergies. As a pediatrician, I see many children with allergies of all sorts. My wife is a pediatric and adult allergist. A common question is when to see an allergist. The American Academy of Allergies Asthma and Immunology has a good website here with lots of excellent information, including when to see an allergist. Our website at www.hilliardpeds.com has a handout about Allergic Rhinitis. My wife's practice is Midwest Allergy. Their website is here and has a list of conditions in which it is recommended to see an allergist. Here is the list:

Anyone who has reacted to a food

Anyone who has reacted to a stinging insect

Anyone with moderate to severe eczema

Anyone with persistent asthma (on a controller medication)

Any asthmatic who requires more that one course of systemic steroids per year or who requires more than one canister of albuterol per year

Anyone with rhinitis who fails pharmacotherapy or desires to minimize medication use

Anyone with chronic or recurrent sinusitis/otitis

Anyone with recurrent infections of any type

My list of reasons to refer includes:
1. Allergic rhinitis symptoms that do not respond well to over-the-counter or prescription medications.
2. Allergic reactions to foods.
3. Allergic reactions to stinging insects (bees, wasps, hornets).
4. Difficult to treat eczema that may be triggered by allergies.
5. Persistent or difficult to control asthma.
6. Recurrent or unusual infections that may be a sign of an immune problem.
7. Recurrent sinusitis that does not respond to other treatments.
8. Finally, if someone is struggling with allergy symptoms that may be from a pet (cat, dog, gerbils, hamster, etc.) and would consider having the pet live somewhere else, I would confirm the allergy with testing first.

Certainly discuss with your primary care physician if you have concerns about the above issues.

2012-2013 Seasonal Flu Vaccines

     Many offices, including our own, have received the seasonal influenza (flu) vaccine for the coming season. The Centers for Disease Control has excellent information about the flu vaccine here. It is now routinely recommended that all children 6 months to 18 years of age receive the vaccine each year. We have both the nasal spray and the shot available. For children less than 24 months of age and those with a history of asthma, heart conditions, diabetes, and kidney disease, it is recommended to do the flu shot (not the spray). Children less than 9 years of age, if this is the first year they have received the vaccine, it is recommended to received two doses of the vaccine one month apart. We offer the flu vaccine at both well visits, sick visits (if not "too sick" -- we can discuss it), and walk-in flu vaccine clinics. The dates for our flu vaccine clinics are on our website here. It is not too soon to start receiving the vaccine now -- the CDC site has good information on that topic (when to receive the vaccine).

Swine flu and the fair

     As reported in the Dispatch, pigs from the Ohio State Fair have tested positive for the swine flu. There are at least 41 cases (almost all in children) of swine flu confirmed in fair-goers. The basic message is a common one: wash your hands or use hand sanitizer after touching animals. Especially before you eat (where you can pass germs from your hand to your mouth through the food)!
     Remember that despite all the different names for different types of "flu" (influenza), they essentially cause the same classic flu symptoms: fever, aches, cough, cold, stomach upset, and sore throat. Here is a good review of what to watch for with the swine flu and common symptoms.
     Bottom line: your mother was right -- wash your hands!

Sudden Cardiac Death among young athletes

     An ongoing discussion in this country amongst physicians, families, insurance companies, and others involves how to better prevent sudden cardiac death among young athletes. Many times these teenagers collapse suddenly and die unexpectedly on the playing or practice field. Since someone with a heart condition that would predispose them to this often has no symptoms and a normal exam, the question then is: Can we prevent these tragedies? It is possible to find these athletes before tragedy strikes with an electrocardiogram (EKG) and echocardiogram (ultrasound of the heart). One major issue is the expense and who will pay for it. These tests are not cheap and can cost more than $1000. If they are done for screening (not because there is already a problem -- dizziness with exercising, fainting with exercise, family history, etc.), insurance companies often do not cover the expense. One study estimated it would cost over a million dollars of money spent screening many athletes to prevent one episode of sudden cardiac death amongst young athletes. As much as it is easy to feel as a caring parent that this expense should be covered by insurance, remember insurance works as "shared risk" -- the more routine tests, the more expense for everyone. And with health care so expensive at this point, more of the cost of "not everyone needs that test" will fall on the people that use that care.
     One intriguing new option is mCore. There was an article in the Columbus Dispatch this week discussing the issue and mCore's ability to provide cost-effective screening. I think this is an exciting option. I hope these kind of screenings allow us to prevent more episodes of Sudden Cardiac Death.

Pediatricians and formula samples.

     Last week, the American Academy of Pediatrics Committee on Breastfeeding issued a "resolution" to encourage pediatricians to stop distributing formula samples at prenatal visits and upon discharge from the hospital. There are good studies that show that these samples decrease the number of infants fed breast milk exclusively and the number of infants fed any breast milk. The specific resolution is here.
     I and my partners at Hilliard Pediatrics have mixed feelings about this issue. As much as we want infants to successfully breast feed, we know many families find the samples helpful. We want to do what we can to encourage infants to have breast milk the first year of life. We also want to encourage infants who are going to receive formula to receive the best formula.
     We will continue to discuss the issue here at the office. I suspect there is going to be an ongoing discussion for many in the coming months and years. I will keep you posted!