I usually don't cut and paste or forward too many medical spam articles, but this is a great synopsis of the articles that have addressed concerns regarding immunizations (specifically MMR) and autism. The consensus of multiple medical studies is that there is NO link between vaccines and autism.
Most physicians believe that vaccines have been associated or thought causal in the lay press solely because of timing -- many childhood vaccines are given in the 6-12 months prior to the development of classic signs and symptoms of autism.
If parents remain overly concerned about autism, they can choose to delay some vaccines (such as MMR or Varicella) until their children are 18-24 months old, the age at which symptoms of autism usually become apparent.
HealthyChildren.org - Vaccine Studies: Examine the Evidence
Wednesday, July 11, 2012
Friday, July 6, 2012
Help! My baby/toddler won't stay asleep!
This is a common topic that we address with parents -- probably because sleep issues are common AND distressing to parents, who are sometimes at a loss when it comes to solving the issues surrounding sleep and nighttime for young children.
Waking during the night is normal at 3-6 months old, and 30% of babies are "signalers" who cry and expect a parental response to their crying. By 8-9 months old, 60-70% of infants can self-soothe when they wake at night, giving them the ability to put themselves back to sleep. 20-30% of toddlers are night wakers. When problems are not addressed at this age (and self-soothing behaviors taught), sleep problems will continue for many children -- into early elementary school.
The goal when approaching any sleep issues is to help your infant/todder or child be able to fall asleep on their own without "props" or excessive parental strategies. All children need a bedtime routine, and this can be started and maintained from a young age. It is important to be consistent at bedtime - doing the same things every night, putting children to bed at the same time every night. We often refer to the "bedtime routine" and this is family specific - it may include a bath, bottle or feeding for young infants, cuddling, story time or soft music. It is very important to put your child to bed while sleepy BUT not completely asleep. I repeat: sleepy but NOT asleep. This is important. Do not let your baby or child fall asleep somewhere else and move them. Learning to fall asleep on their own is the most important skill your child needs to acquire.
Dr. Charles Zeanah, a professor of Pediatrics and Psychiatry at Tulane University, recently spoke at a pediatric meeting and outlined his approach which he called a "hardball strategy": Leave your child in the bed at bedtime. If they continue to cry, go in the room after 5 minutes, soothe the child by using words or gentle touch, but do not get them out of the bed. Leave again -- and repeat at 5 minute intervals if the child keeps crying. As your child adapts, these intervals can gradually be lengthened -- 10 min., then 15 min, etc. In my practice, this "crying it out" strategy takes 5-7 days to work. As a parent, you have to be "all in" and invested in this strategy and follow it to the letter for it to work. It is also very important that both parents (or caregivers) be consistent in the approach.
A more gentle strategy is to respond to the crying but to sit next to the child's bed soothing them - but again, not getting them out of the bed. You can sit next to the bed until your child falls asleep. The next night, sit farther away and gradually move farther away each night -- letting your child see you is important in alleviating some fear. I know personally that this strategy works - especially for toddlers who can either get out of the bed (and love to come to their parent's bed - if they can get away with it) or who continue to call out/cry/cajole for parents to come back in the room. My husband and I tried this approach when my daughter was 2 years old and bedtime avoidant. I tried to be as boring as possible in the 5-10 minutes I stayed in her room - I didn't engage with her, and spent the time lying on the floor reading. Eventually, she gave up needing us in her room in order to fall asleep.
Remember -- your goal is to help your child fall asleep without you :)
Waking during the night is normal at 3-6 months old, and 30% of babies are "signalers" who cry and expect a parental response to their crying. By 8-9 months old, 60-70% of infants can self-soothe when they wake at night, giving them the ability to put themselves back to sleep. 20-30% of toddlers are night wakers. When problems are not addressed at this age (and self-soothing behaviors taught), sleep problems will continue for many children -- into early elementary school.
The goal when approaching any sleep issues is to help your infant/todder or child be able to fall asleep on their own without "props" or excessive parental strategies. All children need a bedtime routine, and this can be started and maintained from a young age. It is important to be consistent at bedtime - doing the same things every night, putting children to bed at the same time every night. We often refer to the "bedtime routine" and this is family specific - it may include a bath, bottle or feeding for young infants, cuddling, story time or soft music. It is very important to put your child to bed while sleepy BUT not completely asleep. I repeat: sleepy but NOT asleep. This is important. Do not let your baby or child fall asleep somewhere else and move them. Learning to fall asleep on their own is the most important skill your child needs to acquire.
Dr. Charles Zeanah, a professor of Pediatrics and Psychiatry at Tulane University, recently spoke at a pediatric meeting and outlined his approach which he called a "hardball strategy": Leave your child in the bed at bedtime. If they continue to cry, go in the room after 5 minutes, soothe the child by using words or gentle touch, but do not get them out of the bed. Leave again -- and repeat at 5 minute intervals if the child keeps crying. As your child adapts, these intervals can gradually be lengthened -- 10 min., then 15 min, etc. In my practice, this "crying it out" strategy takes 5-7 days to work. As a parent, you have to be "all in" and invested in this strategy and follow it to the letter for it to work. It is also very important that both parents (or caregivers) be consistent in the approach.
A more gentle strategy is to respond to the crying but to sit next to the child's bed soothing them - but again, not getting them out of the bed. You can sit next to the bed until your child falls asleep. The next night, sit farther away and gradually move farther away each night -- letting your child see you is important in alleviating some fear. I know personally that this strategy works - especially for toddlers who can either get out of the bed (and love to come to their parent's bed - if they can get away with it) or who continue to call out/cry/cajole for parents to come back in the room. My husband and I tried this approach when my daughter was 2 years old and bedtime avoidant. I tried to be as boring as possible in the 5-10 minutes I stayed in her room - I didn't engage with her, and spent the time lying on the floor reading. Eventually, she gave up needing us in her room in order to fall asleep.
Remember -- your goal is to help your child fall asleep without you :)
Tuesday, June 12, 2012
RIsks of CT scans in Children
I just recently read two articles on the risks of radiation exposure through CT scans in children - one on-line via Fox News, and one in the local Washington Post newspaper.
A 20 year study was recently published combining data from the US, Canada and Great Britain. The results show that exposure in childhood to the radiation equivalent of 2-3 Head CT scans can triple the risk of developing brain cancer later in life, and a child exposed to 5-10 CT scans is three times as likely to develop leukemia than a child who had no scans done.
Children are more sensitive to radiation than adults due to growing bones and tissues, as well as their relatively lower body weights.
This is sobering information that doctors have been alerted to for awhile -- I have been to several conferences at which childhood radiation exposure was discussed, from X rays to CT scans. A CT scan gives great definition, and is useful in looking for bleeds (in the case of head trauma) and solid tumors. Many emergency rooms use CT scans as part of an evaluation of abdominal pain, when the diagnosis of appendicitis is entertained, but not clear cut. Yes, doctors do sometimes practice defensive medicine, but no one wants to miss the appendicitis, the brain tumor or a devestating bleed from a case of head trauma in an otherwise healthy child.
There are alternatives: ultrasound exams do not expose one to radiation, and an MRI (Magnetic Resonance imaging) exam may give great definition of some structures without radiation. An MRI is typically more expensive, may be denied by your insurance company, and requires your child to remain motionless for a more prolonged period of time.
Many experts have weighed in on either side. Per Dr. Raymond Sze at Children's Hospital in Washington DC, "If the benefit to the child is greater than the theoretical risk, then (the CT scan) is appropriate".
A campaign called Image Gently is designed to alleviate concerns of providers and parents, and reduce radiation exposure through greater education. In addition to recommending that scans only be performed when medical benefits are clear, it also recommends limited scanning -- only the area of the body absolutely necessary. Image Gently also recommends evaluation of other imaging modalities like ultrasound and MRI. Donald Frush, chairman of the American College of Radiology's pediatric radiology commission, has said "People need to ask: Is it necessary? Can you do another test, such as an MRI? Can you wait a couple of days?"
Doctors suggest parents discuss CTs with the ordering provider and act as advocates for the children by asking if facilities take steps to reduce radiation exposure in children.
As a parent, I do understand the concerns of exposing one's child to radiation unnecessarily. At the same time, I am a doctor, and need to weigh the risks and benefits with my parents whenever I am ordering studies of any kind.
A 20 year study was recently published combining data from the US, Canada and Great Britain. The results show that exposure in childhood to the radiation equivalent of 2-3 Head CT scans can triple the risk of developing brain cancer later in life, and a child exposed to 5-10 CT scans is three times as likely to develop leukemia than a child who had no scans done.
Children are more sensitive to radiation than adults due to growing bones and tissues, as well as their relatively lower body weights.
This is sobering information that doctors have been alerted to for awhile -- I have been to several conferences at which childhood radiation exposure was discussed, from X rays to CT scans. A CT scan gives great definition, and is useful in looking for bleeds (in the case of head trauma) and solid tumors. Many emergency rooms use CT scans as part of an evaluation of abdominal pain, when the diagnosis of appendicitis is entertained, but not clear cut. Yes, doctors do sometimes practice defensive medicine, but no one wants to miss the appendicitis, the brain tumor or a devestating bleed from a case of head trauma in an otherwise healthy child.
There are alternatives: ultrasound exams do not expose one to radiation, and an MRI (Magnetic Resonance imaging) exam may give great definition of some structures without radiation. An MRI is typically more expensive, may be denied by your insurance company, and requires your child to remain motionless for a more prolonged period of time.
Many experts have weighed in on either side. Per Dr. Raymond Sze at Children's Hospital in Washington DC, "If the benefit to the child is greater than the theoretical risk, then (the CT scan) is appropriate".
A campaign called Image Gently is designed to alleviate concerns of providers and parents, and reduce radiation exposure through greater education. In addition to recommending that scans only be performed when medical benefits are clear, it also recommends limited scanning -- only the area of the body absolutely necessary. Image Gently also recommends evaluation of other imaging modalities like ultrasound and MRI. Donald Frush, chairman of the American College of Radiology's pediatric radiology commission, has said "People need to ask: Is it necessary? Can you do another test, such as an MRI? Can you wait a couple of days?"
Doctors suggest parents discuss CTs with the ordering provider and act as advocates for the children by asking if facilities take steps to reduce radiation exposure in children.
As a parent, I do understand the concerns of exposing one's child to radiation unnecessarily. At the same time, I am a doctor, and need to weigh the risks and benefits with my parents whenever I am ordering studies of any kind.
Thursday, May 10, 2012
Sports Physicals
It is the time of year that we Pediatricians start seeing more kids for school and sports physicals. Here in Virginia, any sports physical done after May 1st is good for the following school year (so fall, winter and spring sports are covered). I admit that I have a bias toward having your regular pediatrician do your child's physical. I have seen too many kids go to "Urgent Care" facilities or "School Physical day" at various schools (staffed by volunteers) in which important things were missed or possible medical problems were not addressed.
Here are some things that are covered by a sports physical:
Growth parameters - weight, height; if your child has lost or gained a significant amount of weight (again, previous weights/heights are important info that your pediatrician's office has in your child's medical record). Children grow quickly, and weight gain may not be worrisome if there is also a corresponding growth in height. We can calculate a Body Mass Index (BMI) that takes both weight and height into account together.
Vision screening - if your child wears glasses or contacts, we may want to know what their vision is both with and without their corrective lenses; we may recommend that your child wear corrective lenses while playing sports, depending on their eyesight.
Assessment of pubertal development, screening for hernias or testicular problems in boys
Assessment of menstrual history for girls
Screening labwork - including blood counts, urinalysis, cholesterol; we may be able to perform these tests in our office.
Blood pressure measurement - If your child has an elevated blood pressure (or high cholesterol), this will be something that we want to continue monitoring
Cardiac (heart) screening for risk factors leading to heart disease including assessment of heart murmurs
Assessment of any sports-related injuries that you may have sustained in the previous year; ideally, a sports physical should be done 6 weeks prior to beginning sports in order to determine if any physical therapy or rehab is needed in the interim; for example, ankle sprains are common injuries, and athletes may need to wear an ankle brace or sports splint to prevent re-injury
Assessment of current diet and nutritional intake - some teens skip meals or do not get enough calcium or iron; we can make recommendations based on our interview with you
This is also the time to mention any issues that you are worried about with your child. A teen who has a relationship with their pediatrician is more likely to be honest with us about sensitive topics, which they may not mention to someone they have never seen before.
Get into the habit of scheduling well visits for your children. As physicians, we feel that this is important.
Here are some things that are covered by a sports physical:
Growth parameters - weight, height; if your child has lost or gained a significant amount of weight (again, previous weights/heights are important info that your pediatrician's office has in your child's medical record). Children grow quickly, and weight gain may not be worrisome if there is also a corresponding growth in height. We can calculate a Body Mass Index (BMI) that takes both weight and height into account together.
Vision screening - if your child wears glasses or contacts, we may want to know what their vision is both with and without their corrective lenses; we may recommend that your child wear corrective lenses while playing sports, depending on their eyesight.
Assessment of pubertal development, screening for hernias or testicular problems in boys
Assessment of menstrual history for girls
Screening labwork - including blood counts, urinalysis, cholesterol; we may be able to perform these tests in our office.
Blood pressure measurement - If your child has an elevated blood pressure (or high cholesterol), this will be something that we want to continue monitoring
Cardiac (heart) screening for risk factors leading to heart disease including assessment of heart murmurs
Assessment of any sports-related injuries that you may have sustained in the previous year; ideally, a sports physical should be done 6 weeks prior to beginning sports in order to determine if any physical therapy or rehab is needed in the interim; for example, ankle sprains are common injuries, and athletes may need to wear an ankle brace or sports splint to prevent re-injury
Assessment of current diet and nutritional intake - some teens skip meals or do not get enough calcium or iron; we can make recommendations based on our interview with you
This is also the time to mention any issues that you are worried about with your child. A teen who has a relationship with their pediatrician is more likely to be honest with us about sensitive topics, which they may not mention to someone they have never seen before.
Get into the habit of scheduling well visits for your children. As physicians, we feel that this is important.
Tuesday, April 10, 2012
Video Games and Kids
I discuss video games a lot when I see kids for well child visits. There are definitely positives and negatives about video games, and I think it is important to know what your kids are playing. I have three kids and a husband that I play games with at home. At our house, we have "game night" every Saturday night. I don't have the manual dexterity of my husband or stepson, but I can sing Journey songs on Rock Band 3 with the best of them :)
I read an article recently discussing Internet/video game addiction by Mike Rich, who runs the Center on Media and Child Health in Boston. This is a link to his website, which is pretty informative:
http://cmch.typepad.com/mediatrician
I read an article recently discussing Internet/video game addiction by Mike Rich, who runs the Center on Media and Child Health in Boston. This is a link to his website, which is pretty informative:
http://cmch.typepad.com/mediatrician
Thursday, March 22, 2012
Is Ground Beef Safe to Eat?
Much ado lately about "pink slime" - ground beef filler found in many brands of ground beef sold commercially. Here is the latest from CNN about chain grocery stores making the decision not to carry ground beef that contains fillers:
http://www.cnn.com/video/#/video/health/2012/03/21/exp-cohen-and-pink-slime-in-ground-beef.cnn
Many years ago, when mad cow disease was a concern, I stopped eating ground beef altogether. The last few years I admit I have slacked. I don't buy ground beef often at the store, and when I do, I tend to choose organic meat. However, my family eats out a fair amount and I admit a nicely done burger can be pretty tasty. The latest information on pink slime has me worried though - think I will stay away from ground beef again. With our children eating at school, and eating out on their own with friends, it makes me concerned about their consumption too.
Has anyone else out there changed their eating patterns based on what they are reading about ground beef? Staying informed makes you more educated about what you choose to eat, and that is a good thing.
http://www.cnn.com/video/#/video/health/2012/03/21/exp-cohen-and-pink-slime-in-ground-beef.cnn
Many years ago, when mad cow disease was a concern, I stopped eating ground beef altogether. The last few years I admit I have slacked. I don't buy ground beef often at the store, and when I do, I tend to choose organic meat. However, my family eats out a fair amount and I admit a nicely done burger can be pretty tasty. The latest information on pink slime has me worried though - think I will stay away from ground beef again. With our children eating at school, and eating out on their own with friends, it makes me concerned about their consumption too.
Has anyone else out there changed their eating patterns based on what they are reading about ground beef? Staying informed makes you more educated about what you choose to eat, and that is a good thing.
Wednesday, March 14, 2012
Allergy Treatment
It is the time of year that brings many people in with questions about allergies and the medications used to treat them. Here is the rundown on available treatments for seasonal allergies:
1. Daily antihistamines (brand names Claritin, Zyrtec, Allegra) - usually the first line treatment; all of these medications are available over the counter, can be given once a day, and usually do not cause sleepiness (unlike our old standby, Benadryl). The exception to this is Zyrtec, which can cause sedation in some children. I usually dose these medications in the evening before bed to minimize this side effect.
2. Steroid nasal spray (brand names Fluticasone, Flonase, Nasonex) - anti-inflammatory medication that blocks the body's allergic response to environmental allergens; the first choice of many doctors due to their potency and the rapid onset of relief of symptoms. I usually recommend these if patients have not gotten better with antihistamines or if parents want to avoid antihistamine side effects. The major side effects of steroid nasal sprays are nasal membrane dryness and nosebleeds. Steroid nasal sprays are prescription-only, so your child will need to be evaluated by his/her doctor to see if nasal spray would be beneficial. Your child would have to be able to tolerate a nasal spray - this is a drawback for some kids.
3. Mucinex - mucolytic medication that thins nasal mucus to decrease postnasal drip; also helps with cough associated with postnasal drip. I sometimes add this medicaiton for night-time cough associated with allergies.
4. Singulair/ class of medication called leukotriene inhibitors - originally developed as an asthma medication, decreases the inflammatory response in the airways to allergens. These medications are sometimes used as an adjunct to the above allergy medications. I find this most helpful for children who have BOTH allergies and asthma, since it treats both conditions. As an allergy medication alone, it is not as powerful at controlling symptoms as steroid nasal spray or antihistamines. These medications also have side effects including behavior/mood changes, so any use should be discussed with your child's pediatrician.
If allergy medications do not control the symptoms, consider making an appointment with an allergist for an evaluation and possible allergy testing.
1. Daily antihistamines (brand names Claritin, Zyrtec, Allegra) - usually the first line treatment; all of these medications are available over the counter, can be given once a day, and usually do not cause sleepiness (unlike our old standby, Benadryl). The exception to this is Zyrtec, which can cause sedation in some children. I usually dose these medications in the evening before bed to minimize this side effect.
2. Steroid nasal spray (brand names Fluticasone, Flonase, Nasonex) - anti-inflammatory medication that blocks the body's allergic response to environmental allergens; the first choice of many doctors due to their potency and the rapid onset of relief of symptoms. I usually recommend these if patients have not gotten better with antihistamines or if parents want to avoid antihistamine side effects. The major side effects of steroid nasal sprays are nasal membrane dryness and nosebleeds. Steroid nasal sprays are prescription-only, so your child will need to be evaluated by his/her doctor to see if nasal spray would be beneficial. Your child would have to be able to tolerate a nasal spray - this is a drawback for some kids.
3. Mucinex - mucolytic medication that thins nasal mucus to decrease postnasal drip; also helps with cough associated with postnasal drip. I sometimes add this medicaiton for night-time cough associated with allergies.
4. Singulair/ class of medication called leukotriene inhibitors - originally developed as an asthma medication, decreases the inflammatory response in the airways to allergens. These medications are sometimes used as an adjunct to the above allergy medications. I find this most helpful for children who have BOTH allergies and asthma, since it treats both conditions. As an allergy medication alone, it is not as powerful at controlling symptoms as steroid nasal spray or antihistamines. These medications also have side effects including behavior/mood changes, so any use should be discussed with your child's pediatrician.
If allergy medications do not control the symptoms, consider making an appointment with an allergist for an evaluation and possible allergy testing.
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