Adjusting Your Child's Sleep Schedule

Fall brings school, and with it, trying to adjust your child's sleep schedule.  For many of us, we become a little more lax in the summer time with bedtimes -- it stays light longer in the summer, and for some of us, that means that we allow our children to stay up a bit later and sleep in a little longer.  Sleep experts recommend keeping a regular bedtime that is the same on week nights AND weekends, but many of us don't do that - for our kids or ourselves.  This means for many families that we have to work to adjust our children's bedtimes since they will have to get up earlier for school once the school year begins.


 Start by adjusting your children's bedtimes back by 30 min. every few days until you get to your desired bedtime. Have a relaxing bedtime routine every night starting 30 min. before bedtime - this may include bath or shower, reading a book, etc. Limit screen time (TV, tablets, video games, cellphones) as the blue light from devices can interfere with sleep.


Average numbers for total hours of sleep per day based on ages (naps count too):
newborns 14-17 hours
infants/babies 4-11 months 12-15 hours
toddlers 1-2 yrs old 11-14 hours
preschoolers 3-5 yrs old 10-13 hours
school age kids 6-13 yrs old 9-11 hours


Many adolescents do not get the recommended amount of sleep.  The recent AAP policy recommends that teenagers get at least 8.5 hours of sleep per night, but this is a general recommendation and each child is different as far as how much sleep they need - some may seem to need 10 hours a night, and some as little as 7 hours.  A recent study showed that 59% of 6th-8th graders and 87% of high school students obtained less than the recommended 8.5 hours.  Natural changes occur in adolescents' circadian rhythm, resulting in decreased secretion of melatonin and delayed onset of sleep.  The AAP also advocates for later public and private school start times, allowing adolescents to get an extra hour of sleep.


I have previously addressed sleep hygiene on this blog, and will stress the importance of a relaxing bedtime routine for about 30 minutes before bed.  This can include a bath/shower, reading and "winding down" relaxation activities.  It is important to limit "blue screen" time such as computer use, video games, tablets, or cell phone use.  The blue light from devices such as these can decrease your natural melatonin production, and can make falling asleep difficult.
Lack of sleep in teenagers can also cause increases in their caffeine intake.  People who drink excessive amounts of caffeine are twice as likely to have sleep issues and shortened REM sleep.  Your teen should avoid caffeine (especially later in the day and evening) and eating at late hours to improve their sleep quality.

Salmonella Disease Associated with Backyard Poultry

The CDC has recently reported a multistate Salmonella food poisoning outbreak associated with live poultry.  Many ill people reported purchasing live poultry for backyard flocks from feed supply stores and hatcheries.  Many ill people reported bringing live poultry into their homes, and others reported kissing or cuddling with the live chicks.  According to the CDC, these behaviors can definitely increase your chance of becoming ill. 


If you have livestock of any type, including backyard chicks, make sure you wash your hands well before and after handling them.  I would also recommend that you use certain shoes when outside with livestock, clean them regularly, and leave them outside the house when you come inside.

Information about Teenage vaccines: Recommended vaccines and the diseases they prevent

Information about Teenage vaccines: Recommended vaccines and the diseases they prevent

 

Human Papillomavirus (HPV) – HPV is a common virus, and can be sexually transmitted.  It is most common in people in their teens and early 20s, and is a major cause of cervical cancer.  The HPV vaccine protects against the strains of the virus that cause genital warts and cervical changes that can lead to cancer.  The vaccine, originally recommended for girls, is now recommended for both girls and boys; the vaccine should be given before a teen or young adult becomes sexually active.  The HPV vaccine is given as a three dose series, and can be started as young as 11-12 years old.

Meningococcal disease (a common cause of bacterial meningitis) – Meningococcal meningitis is a very serious infection of the lining around the brain and spinal cord.  It can cause death, and it is a bacteria commonly seen in outbreaks of meningitis on college campuses.  Meningococcal bloodstream infections can also occur, and can cause loss of an arm or leg and even death.  The meningococcal conjugate vaccine protects against these infections, and it is given as a two dose series.  The first dose is recommended at 11-12 years old, with a second dose at 15-17 years old.

Pertussis (Whooping Cough) – Pertussis is a highly contagious respiratory infection with a prolonged cough that can last for several months.  It is very serious and can cause worse infections in young infants.  The pertussis vaccine is given together with a tetanus shot; the combination is commonly referred to as the Tdap vaccine.   Children should receive a single dose of Tdap at age 11-12.

Pertussis

What is Pertussis?


 Pertussis, or whooping cough, is caused by a bacterial infection. The disease occurs in three stages. The first stage appears similar to the common cold, with runny nose, low grade fever and a cough. After 1-2 weeks, the second stage begins, where the cough worsens, may be accompanied by coughing spells or "fits" and the cough may be followed by a large intake of air, or a "whoop" noise. Infants can be severely affected, and may turn blue during coughing spells due to lack of oxygen. This second stage can last up to two months. During the final stage, which can also last weeks or months, coughing spells will gradually decrease in frequency and intensity. Pertussis used to be called the "100-day cough" because of how long the cough lasted.

 There is a vaccine to prevent pertussis - DTaP for young children and Tdap for adolescents and adults. DTaP vaccine is usually given at 2, 4 and 6 months of age, with a booster at 15-18 months of age and at 4-5 years of age. Immunity can decrease over time, and a booster is recommended again at 11-12 years of age.
Young infants under 6 months of age, especially if they have not received all three doses of DTaP, are particularly vulnerable to severe infection and are at higher risk of needing hospitalization if they contract pertussis. 


 Approximately 15-20 babies die in the United States every year from pertussis. Almost all are younger than 4 months of age - too early to have been fully protected by the DTaP vaccine. Because young babies get sick from pertussis and because they are not fully protected until they have had several doses of the vaccine, healthcare providers recommend that older children and adults who will be around newborns be protected; this is known as cocooning. Mothers should request the Tdap vaccine between 27-36 weeks of gestational age during each pregnancy, or before leaving the hospital if they did not receive Tdap during pregnancy.

Sunscreen update - the latest ratings from Consumer Reports

This month's Consumer Reports magazine (available also at www.consumerreports.org) has a great review on sunscreens. A synopsis of the "5 things you must know about sunscreen":
1. You can't always trust the claimed SPF - many sunscreens tested fell short of their actual level of protection. Dermatologists recommend using a sunscreen with at least an SPF of 30, and to frequently re-apply the sunscreen while outside.
2. Your sunscreen may only be doing half of its job - "br...oad spectrum" sunscreens protect against both UVB and UVA rays. Unlike UVB rays, which are more prevalent in the summer and between 10 am and 4 pm, UVA rays are always present and they can pass through glass and clouds. UVA rays have a deeper penetration in the skin, and can accelerate skin damage and the chance of melanoma. You should look for "broad spectrum" coverage against both types of rays.
3. "Natural" and mineral sunscreens did not work as well - according to the consumer reports evaluation.
4. You don't have to spend a lot to get excellent sunscreen protection (ratings to follow)
5. Sunscreen doesn't have to be "sticky or stinky"

Consumer reports recent ratings for sunscreen:
Here are the highest rated, according to their testing -
1. Vichy Capital Soleil 50 Light Weight Foaming lotion
2. Coppertone Water Babies SPF 50
3. Equate (Walmart) Ultra protection SPF 50...
4. No-Ad Sport SPF 50
5. Banana Boat SunComfort Continuous Spray SPF 50+
6. L'Oreal Quick Dry Sheer Finish SPF 50+
7. Coppertone Sport High Performance AccuSpray SPF 30
8. La-Roche-Posay Anthelios 60 Melt-in Sunscreen Milk
9. Coppertone UltraGuard SPF 70+
10. Neutrogena Beach Defense Water + Sun Protection SPF 70
11. Avon Sun+Sunscreen Face Lotion SPF 40

A caution about "spray" sunscreen and children - do not spray directly on your child; spray into your hand and then apply to your child

Possible risks associated with Muscle-Building Supplements

Many teenagers and young men used muscle-building supplements like Creatine. Creatine is thought by most sports medicine physicians to be safe; however, a recent article sites an increased risk of testicular cancer in young men using muscle-building supplements containing creatine and androstendione.
"Men who use muscle-building supplements (MBSs) that contain creatine or androstenedione may have up to 65% increased risk of developing testicular cancer", according to a case-control study published online March 31 in the British Journal of Cancer.

This risk increased even more among men who began using MBSs before age 25, who used various kinds of MBSs, or who used them for a long duration.
The study is the first to look at the epidemiologic associations between MBSs and testicular cancer, the researchers note.
Young people, in particular, use MBSs, and the number of users is increasing, according to senior author Tong Zhang Zheng, MB, ScD, who led the study at Yale University before joining the Brown University School of Public Health as a professor of epidemiology.
"Although no population survey data exist to suggest just what percentage of young people use MBSs, we do know that the MBS business rakes in billions of dollars," Dr Zheng commented in an interview.
Testicular germ cell cancer (TGCC) is the most common solid cancer in men aged 15 to 39 years. The incidence of TGCC has risen in recent decades, climbing from 3.7 of 100,000 in 1975 to 5.9 of 100,000, according to background information in the article.

More on Measles

 The outbreak originating at Disneyland has proven to be a valuable case study on Measles. Since Disneyland attracts many people from around the world, it is well suited as an incubator for some transmissible diseases. Experts from the CDC have been involved in analyzing the outbreak. It is believed that unvaccinated individuals who had traveled to the Philippines and contracted measles then visited Disneyland. That led to an outbreak involving over 100 people in 14 states.

 "The index patient or patients could easily have spread the extremely infectious measles virus via sneezing and coughing. The people around him then inhaled or touched a surface where the droplets landed." Not only can measles survive up to 2 hours on a surface or in the air, and it also takes less of it to cause disease than any other infectious agent. "If you were in a room that a patient with Ebola was in 2 hours ago, you'd have to actually touch the patient's bodily secretions to get infected - the Ebola virus is not airborne." However, after a patient with measles coughs or sneezes, "the virus is still at high enough concentration 2 hours later that the next person who hasn't had measles or been vaccinated has a 90% chance of catching it."

 Measles was eradicated in the US in 2000, but 19 states in the US allow parents to opt out of vaccination for personal beliefs. Old beliefs about measles vaccine being linked to autism cited a European study that has been discredited. Investigators reexamined the children involved in the study, and found that the purported link to autism was a lie; the doctor was discredited and lost his medical license, though people still talk about measles and a possible link to autism. 

In 2014, there were 644 cases of measles in the US. We have already had more than 100 in 2015. Measles can cause pneumonia, encephalitis (inflammation and infection of the brain), eye problems, and ear infections that can cause permanent hearing loss. Encephalitis, though rare, is devastating.
The MMR vaccine (Measles Mumps Rubella) has been proven in study after study to be extremely safe. Independent bodies including the CDC, the Institute of Medicine and European experts have used databases going back into the 1980s, and have analyzed millions of vaccine records. They have found no hint of serious adverse events.
MMR vaccine is recommended at 1 year old, with a booster at age 4-6 years. The first shot confers around 90% protection, and the second dose raises it to 99%.

Caffeinated Kids - How Much is Too Much?

We've all seen the news articles on the harmful effects of high doses of caffeine in teenagers and college students.  Energy drinks are marketed for teenagers, and I see many teenagers in my practice who drink them. 
A recent study looking at the caffeine content of popular beverages (and foods) yielded some startling results.  The results indicate that children, who are especially vulnerable due to their lower weight and body mass, can easily consume enough caffeine to leave them jittery and anxious, or cause physical symptoms like abdominal pain and headaches.
The common culprits - dark-colored sodas and energy drinks, as well as Mountain Dew (well known on college campuses everywhere) and Sunkist orange soda.  Listed with mg of Caffeine per 8 oz. serving:
Red Fusion - 38 mg
Mountain Dew - 37
Pepsi - 27
Coca-Cola classic - 24
Sunkist orange soda - 23
Vanilla Coke - 21
Barq's Root Beer - 15
Some sodas that are caffeine free include: Minute Maid Orange, Slice, Sprite, 7-Up, Mug Root Beer.


In comparison, coffee drinks and other beverages:
Starbucks Coffee Frappuccino - 83 mg
AMP Energy drink - 77
Red Bull Energy drink - 70
Elements Atomic Jacked Apple Juice - 33
Sobe Energy Citrus - 25
Glaceau Vitaminwater Energy Tropical - 21
Snapple Lemon Ice Tea - 10


Most energy drinks (and some fortified waters) also include guarana, a caffeine-containing herb, and ginsing, which may intensify the effects of caffeine.


Some other surprising sources of caffeine:
Dannon Natural Flavors Low Fat Coffee yogurt - 36 mg
Starbucks Coffee Java chip ice cream, 1/2 cup - 28 mg
Haagen-Dazs Coffee ice cream, 1/2 cup - 24


Caffeine seems to have the same effects on kids and teens as it does on adults.  "At low doses, it produces an increase in wakefulness, alertness, feelings of energy and sociability", according to Roland Griffiths, a professor at Johns Hopkins University.  "As you increase the dose, you get into anxiety, insomnia, and tension.  Raise it further and you get things like nausea and upset stomach."
Some experts suggest "upper limits" for kids - no more than 45 mg per day for 4-6 year olds, 62.5 mg per day for 7-9 year olds, and 85 mg per day for 10-12 year olds.  However, there are a lack of studies on "safe" caffeine intake for any children, and no warning labels exist on many common caffeinated beverages.
It is far safer to avoid caffeine in children altogether, especially if you child seems sensitive to caffeine side effects.  In addition, as I have covered in my blog previously, there are serious concerns about soda in general (secondary to artificial coloring, sugar and non-sugar sweeteners) - enough concern, I think, to avoid giving your children soda in general.

How to tell the difference between strep throat and a virus? Some clues ...

How to tell the difference between a viral sore throat and strep? 

 It is common to have a sore throat with a viral infection, but there are some symptoms that are more suspicious for strep, a bacterial infection. Looking inside the throat might offer important clues - strep often produces white patches in the throat and on the tonsils, as well as red swollen tonsils or many red spots on the roof ...of the mouth above the tonsils. Coughing and post-nasal drainage can make your throat feel bad, but these symptoms are less likely to occur with strep. When congestion, runny nose, and other cold symptoms accompany a sore throat, a cold virus is usually to blame. 

 Colds and respiratory infections can cause fever, but it is generally low grade. A sore throat with a fever above 101 Fahrenheit raises the likelihood of strep. However, strep can be present even with little or no fever. Strep throat may cause the lymph nodes in the neck to become swollen and tender. Strep throat pain may be severe and cause difficulty swallowing. Strep can also be accompanied by headache, nausea, abdominal pain or vomiting. 

 A less common sign of strep infection is a rash appearing on the neck and chest, eventually spreading to the rest of the body. When this rough, sandpaper-like rash develops, the infection is known as scarlet fever. The rash may be alarming, but it will start to fade after several days. Antibiotic treatment can help protect against complications of strep infections. Many medical offices can do a "quick strep" right in the office, and start antibiotic treatment for strep if needed.