tag:blogger.com,1999:blog-1068254349737798872024-03-06T14:02:24.376-06:00Quest for HealthDr. Stuppy, mother and pediatrician, shares her personal reflections on various topics related to pediatrics and keeping kids healthy. Writings and ideas do not constitute medical advice. Please see your doctor for specific medical advice. @pediatricskcKristen Stuppy, MDhttp://www.blogger.com/profile/10332172268371143329noreply@blogger.comBlogger212125tag:blogger.com,1999:blog-106825434973779887.post-68704243292684415292018-01-01T18:11:00.001-06:002022-12-27T08:45:21.326-06:00This Blog is Moving!I've been blogging at Quest for Health for nearly 5 years.<br />
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It's time for an updated look. <br />
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I've been contemplating making changes for awhile and am finally able to make a change.<br />
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My new site is called Quest for Health KC and will cover similar content to what you're used to seeing here, but there are many new features that will improve the site.<br />
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Visit me at <a href="https://drkristenstuppy.substack.com/">Quest for Health KC</a> Now on Substack!<br />
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<br />Kristen Stuppy, MDhttp://www.blogger.com/profile/10332172268371143329noreply@blogger.com0tag:blogger.com,1999:blog-106825434973779887.post-51763135493138314812017-12-22T06:54:00.000-06:002017-12-22T21:21:45.765-06:00Traveling with KidsMany families travel when school's out of session, which over the winter holiday season means traveling when illness is abound. I get a lot of questions this time of year about how to safely travel with kids.<br />
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Sleep disturbances</h4>
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Sleep deprivation can make everyone miserable, especially kids (and their parents). Make sure your kids are well rested prior to travel and try to keep them on a healthy sleep schedule during your trip. </div>
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Bring favorite comfort items, such as a stuffed animal or blankie, to help kids relax for sleep. If possible, travel with your own pillows.</div>
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If you're staying at a hotel, ask for a quiet room, such as one away from the pool and the elevator. </div>
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Be sure to verify that there will be safe sleeping areas for every child, especially infants, before you travel.</div>
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Try to keep kids on their regular sleep schedule. It's tempting to stay up late to enjoy the most of the vacation, but in reality that will only serve to make little monsters of your children if they're sleep deprived.<br />
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If your kids nap well in the car, plan on doing long stretches on the road during nap time. If kids don't sleep well in the car, be sure to plan to be at your hotel (or wherever you're staying) at sleep times so they can stay in their usual routine.<br />
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Some families leave on long trips at the child's bedtime to let them sleep through the drive. Just be sure the driver is well rested to make it a safe trip!</div>
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If you're changing time zones significantly, plan ahead. Jet lag can be worse when traveling east than when going west. Jet lag is more than just being tired from a change in sleep routine, it also involves changes to the eating schedule. Kids will often wake when they're used to eating because the body is hungry at that time. Try to feed everyone right before they go to sleep to try to prevent this. Breastfed infants might have a harder time adjusting because mother's milk production is also off schedule. </div>
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Tired, sick, and hungry all make for bad moods, so try to stay on track on all accounts. Sunlight helps regulate our circadian rhythm, so try to get everyone up and outside in the morning to help reset their inner clocks. Keep everyone active during the day so they are tired at the new night time.</div>
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Keeping track of littles</h4>
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Toddlers and young kids love to run and roam. Be sure that they are always within sight. Use strollers if they'll stay in them.<br />
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Consider toddler leashes. I know they seem awful at first thought, but they work and kids often love them! I never needed one for my first - he was attached to parents at the hip and never wandered. My second was fast. And fearless. She would run between people in crowds and it was impossible to keep up with her without pushing people out of the way. She hated holding hands. She always figured out ways to climb out of strollers - and once had a nasty bruise on her forehead when she fell face down climbing out as I pushed the stroller. She loved the leash. It had a cute monkey backpack. She loved the freedom of being able to wander around and I loved that she couldn't get too far.<br />
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Parents have a number of ways to put phone numbers on their kids in case they get separated. Some simply put in on a piece of paper and trust that it will stay in a pocket until it's needed. Others write it in sharpie inside a piece of clothing or even on a child's arm. You can have jewelry engraved with name and phone number, much like a medical alert bracelet. Just look at <a href="https://www.etsy.com/search?q=kids%20identification%20jewelry" target="_blank">Etsy</a> or <a href="https://www.pinterest.com/search/pins/?q=kids%20identification%20jewelry&rs=typed&term_meta[]=kids%7Ctyped&term_meta[]=identification%7Ctyped&term_meta[]=jewelry%7Ctyped" target="_blank">Pinterest</a> and you'll come up with ideas!<br />
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It's a great idea to take pictures of everyone each morning in case someone gets separated from the group. Not only will you have a current picture for authorities to see what they look like, but you will also know what they were wearing at the time they were lost.<br />
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Airplane issues</h4>
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The great news is that air travel is much safer from an infection standpoint than it used to be. Newer airplanes have HEPA filters that make a complete air change approximately 15 to 30 times per hour, or once every 2-4 minutes. The filters are said to remove 99.9% of bacteria, fungi and larger viruses. These germs can live on surfaces though, so I still recommend using common sense and bringing along a small hand sanitizer bottle and disinfectant wipes to use as needed. Wipe down arm rests, tray tables, seat pockets, windows, and other surfaces your kids will touch. After they touch unclean items sanitize their hands. Interestingly, sitting in an aisle seat is considered more dangerous, since people touch those seats during boarding and when going to the restroom, so if you're seated in the aisle pay attention to when surfaces need to be re-sanitized. Sitting next to a sick person increases your risk, so if there is an option to move if the person seated next to you is ill appearing, ask to be moved. </div>
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Most adults who have flown have experienced ear pain due to pressure changes when flying. Anyone with a cold, ear infection or congestion from allergies is more at risk of ear pain, so pre-medicating with a pain reliever (such as acetaminophen) might help. If you have <a href="https://pediatricpartners.blogspot.com/2017/12/new-allergy-guidelines-for-people-over.html" target="_blank">allergies</a> be sure to get control of them before air travel. The best allergy treatment is usually a nasal corticosteroid. </div>
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It has often been recommended to offer infants something to suck on (bottle, breast or a pacifier) during take off and landing to help with ear pressure. Start early in the landing - the higher you are, the more the pressure will change. Older toddlers and kids can be offered a drink since swallowing can help. Ask them to hold their nose closed and try to blow air out through the closed nostrils followed by a big yawn. If your kids can safely chew gum (usually only recommended for those over 4 years of age) you can allow them to chew during take off and landing. </div>
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Airplane cabin noise levels can range anywhere from 60 - 100 dB and tend to be louder during takeoff. (I've written about <a href="https://pediatricpartners.blogspot.com/2017/03/hearing-loss.html" target="_blank">Hearing Loss</a> from noise previously to help you understand what that means.) Use cotton balls or small earplugs to help decrease the exposure, especially if your kids are sensitive to loud noises.</div>
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The Car Seat Lady has a great page on <a href="http://thecarseatlady.com/before-you-fly-know-your-rights/" target="_blank">knowing your rights when flying with kids</a>.</div>
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Cruise ship issues</h4>
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Learn about cruise-specific opportunities for kids of various ages. Many will offer age-specific child care, "clubs" or areas to allow safe opportunities for everyone to hang out with people of their own age group. Cruises offer the opportunity for adventurous kids to be independent and separate from parents at times, allowing each to have a separate-yet-together vacation. Travel with another family with kids the same ages as yours so your child knows a friendly face, especially if siblings are in a different age group for the cruises "clubs".</div>
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Talk to kids about safety issues on the ship and make sure they follow your rules. They should always stay where they are supposed to be and not wander around. There's safety in numbers, so have them use a buddy system and stick with their buddy. Find out how you can get a hold of them and they can get a hold of you during the cruise. </div>
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Of course sunscreen is a must. Reapply often!</div>
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Be sure kids are properly supervised near water. That means an adult who is responsible for watching the kids should not be under the influence of alcohol, shouldn't read a book, or have other distractions. </div>
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Car seats (for planes, trains and automobiles)</h4>
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I know it's tempting to save money and not get a seat for your child under 2 years of age on a plane, but it is recommended that all children are seated in a proper child safety <a href="https://www.faa.gov/travelers/fly_children/" target="_blank">restraint system</a> (CRS). It must be approved for flight, but then you can then use the seat for land travel. </div>
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I always recommend age and size appropropriate <a href="http://thecarseatlady.com/top10/" target="_blank">car seats or boosters when traveling</a>, even if you're in a country that does not require them. Allowing kids to ride without a proper seat will probably lead to problems getting them back in their safe seat when they get back home. Besides, we use car seats and booster seats to protect our kids, not just to satisfy the law.</div>
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So... my section header was meant to be cute. Trains don't have seatbelts, so car seats won't work. But they are a safe way to travel. Car Seat for the Littles has a great explanation on <a href="https://csftl.org/travel-by-train/" target="_blank">Travel by Train</a>.</div>
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Motion sickness</h4>
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I have an entire blog dedicated to this common issue. See <a href="https://pediatricpartners.blogspot.com/2016/07/motion-sickness.html" target="_blank">Motion Sickness</a>. </div>
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Dr. Charmaine Gregory, an emergency physician, has written specifically about preventing seasickness at <a href="https://www.ferventlyfitwithcharmaine.com/7-top-tips-avoid-seasickness-cruising" target="_blank">7 Top Tips To Avoid Seasickness While Cruising</a>.</div>
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When should pregnant women and new babies avoid travel by air?</h4>
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A surprising number of families either must travel (due to a job transfer, death in the family, out of state adoption, or other important occasion) or choose to travel during pregnancy or with young infants. </div>
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Newborns need constant attention, which can be difficult if the seatbelt sign is on and needed items are in the overhead bin. New parents are already sleep deprived and sleeping on planes isn't easy. New moms might still have swollen feet and need to keep their feet up, which is difficult in flight. Newborns are at high risk of infection and the close contact with other travelers can be a concern. And traveling is hard on everyone. But the good news is that overall young infants tend to travel well. </div>
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It is advisable to not travel after 36 weeks of pregnancy because of concerns of preterm labor. Pregnant women should talk with their OB about travel plans. </div>
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Some airlines allow term babies as young as 48 hours of age to fly, but others require infants to be two weeks - so check with your airline if you'll be traveling in the first days of your newborn's life. There is no standard guideline, but my preference would be to wait until term babies are over 2 weeks of age due to heart circulation changes that occur the first two weeks. Waiting until after 6 weeks allows for newborns to get the first set of vaccines (other than the Hepatitis B vaccine) prior to flight would be even better. Infants ideally have their own seat so they can be placed in a car seat that is FAA approved. </div>
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Babies born before 36 weeks and those with special health issues should get clearance from their physicians before traveling.</div>
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Overall traveling with an infant is not as difficult as many parents fear. Toddlers are another story... they don't like to sit still for any amount of time and flights make that difficult. They also touch everything and put fingers in their mouth, so they are more likely to get exposed to germs.<br />
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Illness prevention</h4>
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Who wants to be sick on vacation? No one. It's easy to get exposed anywhere during the cold and flu season, so protect yourself and your family. </div>
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<li>Teach kids (and remind yourself) to not touch faces - your own or others. Our eyes, nose, and mouth are the portals of entry and exit for germs. </li>
<li>Wash hands </li>
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<li>before and after eating. </li>
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<li>after blowing your nose. </li>
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<li>before and after touching your eyes, nose, or mouth. </li>
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<li>before and after putting in contacts. </li>
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<li>after toileting or changing a diaper.</li>
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<li>Cover sneezes and coughs with your elbow unless you're cradling an infant in your arms. Infants have their head and face in your elbow, so you should use your hands to cover, then wash your hands well.</li>
<li>Make sure all family members are up to date on vaccines. </li>
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<li>Everyone over 6 months should have a flu shot if it's flu season (fall-winter). </li>
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<li>Kids and adults should have <a href="https://www.cdc.gov/vaccines/schedules/index.html" target="_blank">all their routine vaccines</a>. </li>
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<li>If you're traveling internationally, check out the <a href="https://wwwnc.cdc.gov/travel/" target="_blank">country-specific recommendations</a> for vaccines (and other interventions, such as insect repellents and prophylactic antibiotics). I've written more on this at <a href="https://pediatricpartners.blogspot.com/2016/02/travelling-around-world-stay-safe-and.html" target="_blank">Traveling Around the World. Stay Safe and Healthy!</a> For personal accounts of traveling with a baby internationally, see <a href="http://www.practicebalance.com/2016/11/international-travel-with-baby.html?m=1" target="_blank">International Travel with Baby</a> and <a href="http://www.practicebalance.com/2017/05/not-cruise.html?m=1" target="_blank">Not a Cruise</a> from Dr. Dawn Baker at Practice Balance.</li>
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Keep records</h4>
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Take pictures of your passport, vaccine record, medicines, insurance cards, and other important items to use if the originals are lost. Store the images so you have access to them from any computer in addition to your phone in case your phone is lost.<br />
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Have everyone, including young children, carry a form of identification that includes emergency contact information. <br />
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Create a medical history form that includes the following information for every member of your family that is travelling. Save a copy so you can easily find it on any computer in case of emergency.<br />
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<li>your name, address, and phone number</li>
<li>emergency contact name(s) and phone number(s)</li>
<li>immunization record</li>
<li>your doctor's name, address, and office and emergency phone numbers</li>
<li>the name, address, and phone number of your health insurance carrier, including your policy number</li>
<li>a list of any known health problems or recent illnesses</li>
<li>a list of current medications and supplements you are taking and pharmacy name and phone number</li>
<li>a list of allergies to medications, food, insects, and animals</li>
<li>a prescription for glasses or contact lenses</li>
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Enjoy!</h4>
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Last, but not least: Enjoy your vacation! </div>
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Be flexible. </div>
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Don't overschedule. Your kids will remember the experience, so make moments count - don't worry if you don't accomplish all there is to do!<br />
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Take a look at some of the <a href="https://www.pmpediatrics.com/dear-dr-christina/holiday-health-hazards-that-i-didnt-see-on-the-news-this-year/" target="_blank">Holiday Health Hazards</a> that come up at vacation times from Dr Christina at PMPediatrics so you can prevent accidents along the way. </div>
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Take pictures, but don't make the vacation about the pictures. Try to stay off your phone and enjoy the moments!</div>
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Kristen Stuppy, MDhttp://www.blogger.com/profile/10332172268371143329noreply@blogger.com0tag:blogger.com,1999:blog-106825434973779887.post-34138582569200101312017-12-12T18:16:00.000-06:002017-12-12T18:16:03.691-06:00Which Supplements Help Prevent and Treat Infections?I don't know anyone who wants to get sick, so most of us try our best to avoid illnesses. We do this by washing our hands and encouraging our kids to cover their coughs. We avoid sick people as much as possible (though we don't always stay home when we should). We should routinely get enough sleep (most Americans fail in this regard) and eat more fruits and vegetables (again, most of us fail to get the minimum recommended amounts of plants in our diets).<br />
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All of these measures can help, but can we get more help from nutritional supplements or other natural remedies? What will boost our immune system?<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh8SEVbzQmE05xVWduMvBz5OeibDmNKMfWPHYj-VvmZG5GUh7NbYcPxvjLRzLMGPTexGCBrbfSiCXHbDQZ-GEHJvqJxdhDMZ3PfEUKfwvi_7boJr0TUz-9WaVDjuB73D0aA_QlIy-Hwl69M/s1600/Which+Supplements+Help+Prevent+and+Treat+Infections_.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="supplements, illness, prevention, natural, essential oil, herb, homeopathic, treatment" border="0" data-original-height="1102" data-original-width="735" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh8SEVbzQmE05xVWduMvBz5OeibDmNKMfWPHYj-VvmZG5GUh7NbYcPxvjLRzLMGPTexGCBrbfSiCXHbDQZ-GEHJvqJxdhDMZ3PfEUKfwvi_7boJr0TUz-9WaVDjuB73D0aA_QlIy-Hwl69M/s400/Which+Supplements+Help+Prevent+and+Treat+Infections_.png" title="Which Supplements Help Prevent and Treat Infections?" width="266" /></a></div>
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I'm often asked if <a href="https://ods.od.nih.gov/factsheets/VitaminC-HealthProfessional/" target="_blank">vitamin C,</a> zinc, or essential oils will help various ailments or boost our immune system. I know that many people try natural products that are promoted to boost or support the immune system. They're hopeful that stimulating immune system activity will help the body fight off a virus. But research doesn't show that our immune system works that way. A virus can cause illness even in healthy people. If you want to read an in-depth summary of how our immune system works, the <a href="http://www.skepticalraptor.com/skepticalraptorblog.php/immune-system-myths-boost/" target="_blank">Skeptical Raptor</a> has done a nice job discussing the complexities and why it's not as easy as eating healthy and taking supplements. Not to mention the fact that we don't necessarily want an overactive immune system, which is associated with allergies and autoimmune diseases.<br />
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One thing we need to remember first and foremost in the discussion of supplements is that this is an <a href="https://www.fda.gov/Food/DietarySupplements/ucm2006892.htm" target="_blank">under-regulated industry</a>. The FDA is not authorized to review dietary supplement products for safety and effectiveness before they are marketed. For this reason I hesitate to recommend supplements at all. Even though I do recommend <a href="https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/" target="_blank">Vitamin D supplements</a> because studies support the need for additional Vitamin D in most people, I cannot endorse one particular product. Over the years many supplements, homeopathic products and herbs have been reported to have significant variances in amounts of product and unnamed contaminants, including lead and other hazards.</div>
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Summaries of supplement and other "natural treatment" effectiveness:<br />
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<li><a href="http://www.cochrane.org/CD006895/ARI_probiotics-live-micro-organisms-to-prevent-upper-respiratory-tract-infections-urtis-for-example-the-common-cold" target="_blank">Probiotics</a> may actually help prevent the number of infections. There are many, many types of probiotics, so <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4979858/" target="_blank">further studies are needed on how to choose the best strain</a>.</li>
<li><a href="https://nccih.nih.gov/health/providers/digest/cold-science#heading1" target="_blank">Zinc </a>has been shown to help prevent upper respiratory tract infections in children and teens and to decrease the duration of the common cold symptoms. It is best given as a lozenge to help with absorption. Intranasal zinc has been linked to a permanent loss of smell and should not be used. High doses can cause significant side effects, so talk to your doctor <i>and</i> pharmacist before supplementing.</li>
<li><a href="http://www.cochrane.org/CD006821/ARI_nasal-saline-irrigation-for-acute-upper-airway-infection-symptoms" target="_blank">Nasal saline rinses</a> show benefit in treating symptoms of upper respiratory tract infections. Learn how to do these correctly before trying it though. I often recommend <a href="http://www.nasopure.com/" target="_blank">Nasopure</a> products as an unpaid endorsement. They're a local company with a very helpful website. Use their library to learn how to properly use nasal rinses in kids as young as 2 years of age.</li>
<li><a href="https://www.ncbi.nlm.nih.gov/pubmed/25536086" target="_blank">Honey</a> may reduce the frequency of cough and improve the quality of sleep for children with the common cold. Honey should never be used in children younger than 1 year of age because of the risk of botulism.</li>
<li><a href="http://www.cochrane.org/CD000530/ARI_echinacea-for-preventing-and-treating-the-common-cold" target="_blank">Echinacea</a> has consistently been shown to be ineffective in many studies. I know that many people have heard of its benefits, so if you aren't convinced that you shouldn't waste money on it, see the <a href="https://nccih.nih.gov/health/echinacea/ataglance.htm" target="_blank">NCCIH's Echinacea</a> page.</li>
<li><a href="http://www.cochrane.org/CD006206/ARI_garlic-common-cold" target="_blank">Garlic</a> shows overall low evidence of benefit.</li>
<li><a href="http://www.cochrane.org/CD000980/ARI_vitamin-c-for-preventing-and-treating-the-common-cold" target="_blank">Vitamin C</a> can shorten the duration of illness mildly with daily supplementation. </li>
<li><a href="http://www.cochrane.org/CD004782/ARI_chinese-medicinal-herbs-to-treat-the-common-cold" target="_blank">Chinese herbal medicines</a> do not have high quality studies so effectiveness is unknown.</li>
<li><a href="https://www.ncbi.nlm.nih.gov/pubmed/24146345" target="_blank">Geranium extract</a> (Pelargonium sidoides) has insufficient evidence of benefit for cold and cough symptoms.</li>
<li><a href="https://nccih.nih.gov/health/turmeric/ataglance.htm" target="_blank">Turmeric</a>'s supposed anti-inflammatory properties have not been shown to be effective by research.</li>
<li><a href="https://nccih.nih.gov/research/results/spotlight/040108.htm" target="_blank">Essential oils</a> have the <a href="https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0032645/" target="_blank">potential for beneficial effects</a> – but they also have the potential for <a href="https://www.poison.org/articles/2014-jun/essential-oils" target="_blank">adverse reactions</a>. Although they are touted as a cure for many ailments, published studies regarding the uses of aromatherapy have generally focused on its psychological effects on stress and anxiety or its use as a topical treatment for skin conditions. Both <a href="https://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm416023.htm" target="_blank">Young Living</a> and <a href="https://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm415809.htm" target="_blank">dōTERRA</a> have received warning letters from the FDA about improper marketing and unsubstantiated claims for uses of their oils. While many people think essential oils are safe, they can lead to significant problems. Some people suffer from allergic reactions to oils. They can increase sensitivity to the sun when applied topically. Tea tree oil and lavender have estrogen-like effects and caution should be used with these. Some of these substances can even lead to seizures, liver damage, and death if used improperly. Ingestion of the oils is a growing concern - as more households have them, more children are ingesting them.</li>
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Alice Callahan's <a href="https://vitals.lifehacker.com/immune-boosting-supplements-won-t-protect-you-from-ba-1804490868" target="_blank">“Immune-Boosting” Supplements Won’t Protect You from Back-to-School Germs</a> is a great review of many of the supplements touted to prevent or treat illnesses. Her background in nutrition provides a solid base for reviewing claims that many of us don't understand completely. </div>
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Generally supplements are not recommended, but if you choose to use them, use them cautiously.</div>
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<li>Supplements contain a wide variety of ingredients - including vitamins, minerals, amino acids, and herbs. Research has confirmed health benefits of some dietary supplements but not others. The woo can be strong in this area, so be cautious where you get your information. </li>
<li>Supplements have been known to include unlisted ingredients and to have inconsistent levels of product. When they are <a href="https://www.fda.gov/Safety/Recalls/ArchiveRecalls/2017/default.htm" target="_blank">recalled</a>, there is no mechanism in place to identify and notify people who have purchased affected products. </li>
<li>Find a reliable source to evaluate effectiveness and risks. <a href="https://www.fda.gov/Food/ResourcesForYou/Consumers/ucm109760.htm" target="_blank">Some reports have shown that people who take supplements have higher risks</a> of cancer, liver damage, birth defects, bleeding, and other health problems. When looking for information, use noncommercial sites (<a href="https://www.nih.gov/" target="_blank">National Institutes of Health</a>, <a href="https://www.fda.gov/" target="_blank">Food and Drug Administration</a>, <a href="https://www.usda.gov/" target="_blank">US Department of Agriculture</a>, <a href="https://nccih.nih.gov/" target="_blank">National Center for Complementary Health</a>) rather than depending on information from sellers.</li>
<li>Natural does not mean safe. I've always said that I wouldn't give my picky eater marijuana to stimulate his appetite and encourage him to eat. Not even if it was organic. That usually gets the point across. You need to know the risks of a product, even if it's natural. </li>
<li>If supplements will be taken, talk to your doctor <i>and</i> pharmacist about <a href="https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm420349.htm" target="_blank">drug interactions</a>. Sometimes it's difficult to know the risks because not all ingredients are included on the label and not all ingredients have been well studied, especially in combination with other supplements and medications. </li>
<li>Most dietary supplements have not been tested in pregnant women, nursing mothers, or children. Remember just because something's natural doesn't mean it's safe. Arsenic is natural but I wouldn't advise taking it in high doses.</li>
<li>If something sounds too good to be true, it probably is. There are no miracle cures. Avoid being manipulated by advertising. It's easy to fall prey because we all want to feel better quickly and parents want their kids to be healthy. But if it claims to be 100% effective or to have no side effects, it's probably false advertising. Personal accounts of something working are as likely to be based on bias or coincidence as to be from real benefit. Rely on large clinical studies that have been reproduced by other researchers. Dr. Chad Hayes has a very long, but wonderful post on how many of the integrative medicines are not simply not beneficial but potentially dangerous - <a href="http://www.chadhayesmd.com/integrative/" target="_blank">Citations Needed: The curious “science” of integrative medicineMy experience at "Get Your Life Back NOW!"</a></li>
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This post isn't about antibiotics, but they don't work against viral illnesses any better than supplements. <a href="http://www.cochrane.org/CD007880/ARI_antibiotics-common-respiratory-infections-unclear-causes-and-undifferentiated-symptoms-children-five" target="_blank">They don't prevent the development of ear infections or pneumonia,</a> so even if your child seems to always develop these complications, your doctor should not prescribe them preventatively. Don't use antibiotics for routine upper respiratory infections, stomach bugs, and other viral illnesses. </div>
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Do you know what really boosts your immune system?<br />
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<a href="http://www.thescientificparent.org/immune-system-boost/" target="_blank">Vaccines</a></blockquote>
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Kristen Stuppy, MDhttp://www.blogger.com/profile/10332172268371143329noreply@blogger.com0tag:blogger.com,1999:blog-106825434973779887.post-47589467444294232692017-12-10T08:11:00.003-06:002017-12-10T10:02:33.030-06:00A Working Parent's Guide to Being ThereAs a working mom myself, I have at times struggled with the guilt of not being around for every new milestone, class party, or other occasion.<br />
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There are the stay-at-home vs working mom "Mommy Wars" that I don't want to get into because these options are unique to every family. I know that working is the right choice for me on many levels. I like that my kids have two hard-working parent role models that also spend quality time with the family.<br />
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Do things always flow smoothly?<br />
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Of course not. We have a crazy, hectic life. Every stage has had it's own problems to conquer, and once we get into a routine it settles for a bit. Then the life stage changes and we adapt. At this point I thought my life would be less crazy (my oldest is away at college and my youngest drives), but it's still crazy aligning schedules.<br />
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When my children were younger, it was really hard to get home, get dinner on the table, and get them to bed on time for a good night's sleep. Young children need 11-12 hours of sleep, and when we get home at 6:30 pm, it's really hard to do anything. I became the queen of 15 minute meals and love my crock pot. My quick cooking is probably even healthier than fancy casseroles because it's a basic heated frozen vegetable, stovetop cooked chicken or a quick fish, and noodles or rice. No fancy cream sauces or cheesy goodness weeknights. Sometimes my kids ate leftovers from the previous night so they could eat within minutes of getting home. Whatever worked at the time to get dinner served quickly so the bedtime routine could start was what happened.<br />
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We only have two kids, and are fortunate to have two parents, but sometimes we still needed help from friends to get kids to scheduled activities on time. I am a big believer in <a href="http://pediatricpartners.blogspot.com/2012/12/stepping-outside-my-comfort-zone.html">being there at games or shows</a>, but it's impossible with more than one child and overlapping schedules to be at everything. We tried to alternate which child's activity we do, though my husband went to more hockey games and I went to more dance activities because, well, we're human and he can only watch so many dances and I had a hard time watching my son get thrown against the boards.</div>
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It is important that kids know parents are there for them, even if they aren't physically able to be there all the time. The best way to do that is to show kids. When you're together, really be together. Don't keep checking your phone. Make conversation. Make eye contact. Have fun.<br />
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Sneak in quality time any way you can, even if it's just a minute or two.<br />
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<li>Talk on car rides. Make routine trips no-screen rides. On longer trips consider an audiobook that you can all listen to and discuss along the way.</li>
<li>Make eye contact when your kids ask for your attention. Even if you're busy making dinner or doing the dishes, be considerate enough to look at them when you're speaking to them. So often we get upset by our children's manners, but we forget who they're modeling after. </li>
<li>Bed time. Definitely at bedtime make the time to connect. Those night time stories, back rubs, and cuddles are the perfect time to bond. Even when your kids can read, take time to read to each other.</li>
<li>Find quick games to play after dinner. Many games list the time it takes to play right on the box. No one has time for Monopoly after dinner if they plan on getting the kids to bed on time, but family games are a great way to connect, and kids learn many skills from playing. </li>
<li>It sounds silly, but kill two birds with one stone. Have a family "clean time"- and make it fun. The house needs to be cleaned or picked up regularly and if everyone pitches in with age-appropriate chores, it gets done more quickly. Brag on your children's effort and build their confidence. </li>
<li>Try to be at activities as much as possible. If they're in a recital, they want you there. If they have a big game, they want you to see it. Even if they say, "it's okay" when you can't go, they want you there. I know it's not possible to be there for everything, especially if you have more than one child and you need to alternate between which activity you go to, but try to be at as many things as you can. Even when it's painful to watch the first season of kid-pitch baseball. And if you must take a pain reliever before going to the band concert for your 4th grader. Still go. </li>
<li>Make the time with them <i>with them</i>. Turn off your cell phone. Don't check e-mail. Set a good example and talk with the people you're with. So many studies are being done that show parents ignoring their kids due to electronics. You have time to check email after your kids go to bed when they're young. When they're older and their bedtime rivals yours, you can find time when they're doing homework or when they're at an activity. No need to ruin family time with work, social media, or other things that can be done when you're alone. I cannot stress the importance of this. Don't miss your real life and your children's lives by wasting time on screens.</li>
<li>Family meals are important. Study after study shows benefits. Take the time to talk. Turn off the tv. Keep the phones away from the table. If your family gets stuck with conversation, try some <a href="https://conversationstartersworld.com/250-conversation-starters/" target="_blank">conversation starters</a> or the story game where someone starts with a sentence, then the next person takes it from there.</li>
<li>Slow down. So often we have a list of tasks we know we must accomplish, but our kids can sense the rush. Take a deep breath and enjoy the moment with your kids.</li>
<li>Take 10 minutes to do whatever your child wants. Read a book. Run outside. Color a picture together. Just 10 minutes a day can make a difference. Make it a tradition, something your child looks forward to every day.</li>
<li>And finally, remember that no one is perfect. Some days just won't work out as planned. That's okay. Just don't let every day become that over-rushed day.</li>
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I see far too much guilt in parenting. Guilt because you choose to give baby a bottle. Guilt because you want your baby to sleep through the night. Guilt because... it never ends. I think one big driver of guilt is social media. We see into other people's lives on Facebook, Pinterest, Instagram or Twitter and compare it to our own. The posts are usually the best parts of their life, but we forget that everyone has the parts they aren't showing. Everyone wants to be like someone else on some level. We all have dreams and aspirations to improve. Great. Keep bettering yourself. But don't suffer from guilt of choices you've made. If they are working, great! Keep them. If they aren't working, investigate other options and make a positive change. In <a href="https://www.theprimarycarer.com/single-post/2017/10/30/3Ss-of-Being-a-Parent" target="_blank">4 S's of Being a Confident Parent</a>, Dr. Escalante discusses the trials parents face and errors parents make and why that's okay.<br />
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I came across this great post on the <a href="http://respectfulparent.com/ten-problems-attachment-parenting/">problems with Attachment Parenting</a>. I think that when people have such strong opinions about anything, it is a set up for failure. Attachment Parenting can lead parents to feel guilty because they aren't always there for a child. You know what? It's healthy to have alone time. Parents need to do things with other adults and leave the kids with a trusted adult or mature teen babysitter. It's just healthy. If you don't take care of yourself, you won't take as good of care of your family as you can if you are healthy in mind, body, and spirit.<br />
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Enjoy time with your kids. They won't be little forever. Make the time to be present in their lives.<br />
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One last thought... Here's an old song that I always think of when I think of busy lives: <a href="https://www.youtube.com/watch?v=KUwjNBjqR-c" target="_blank">Cats in the Cradle</a> from Harry Chapin. </div>
Kristen Stuppy, MDhttp://www.blogger.com/profile/10332172268371143329noreply@blogger.com0tag:blogger.com,1999:blog-106825434973779887.post-75634918945899281192017-12-03T14:52:00.000-06:002017-12-03T14:52:31.675-06:00New Allergy Guidelines for People Over 12 Years Old<div>
If you or your kids suffer from allergies, I'm sure you want to know how to best manage them. In addition to <a href="http://pediatricpartners.blogspot.com/2017/04/itchy-sneezy-puffy-all-signs-of-allergy.html" target="_blank">limiting exposure</a>, medications can be a big benefit. </div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjA4ZAH7Hf4jJ-h1dpCIQ-U-a2l8ZgfGta2Ee00C8adqf4pTPaW_b_-p-suIwr5Ctx4hswjsIn5rnU9a8kXl2yA6pABaOolDnOnEofyuoOWQN8ilg6-BdOTQDif5Aol0emR7QPOlkEUFWCO/s1600/New+Allergy+Guidelines.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="allergy, antihistamine, nasal steroid, nasal spray, corticosteroid, asthma" border="0" data-original-height="1102" data-original-width="735" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjA4ZAH7Hf4jJ-h1dpCIQ-U-a2l8ZgfGta2Ee00C8adqf4pTPaW_b_-p-suIwr5Ctx4hswjsIn5rnU9a8kXl2yA6pABaOolDnOnEofyuoOWQN8ilg6-BdOTQDif5Aol0emR7QPOlkEUFWCO/s320/New+Allergy+Guidelines.png" title="New Allergy Guidelines" width="213" /></a></div>
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The American Academy of Allergy, Asthma, and Immunology and the American College of Allergy, Asthma, and Immunology (AAAAI and ACAAI) have published new guidelines in the <a href="http://annals.org/aim/article-abstract/2664375/pharmacologic-treatment-seasonal-allergic-rhinitis-synopsis-guidance-from-2017-joint" target="_blank">Annals of Internal Medicine</a> for the initial medical treatment of seasonal allergies in people 12 years and older.<br /><br />The recommendations essentially state:<div>
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<li>Use steroid nasal sprays first without an oral or nasal antihistamine. Many intranasal steroids are available over the counter without a prescription. A great list is included on the <a href="https://www.aaaai.org/conditions-and-treatments/treatments/drug-guide/nasal-medication" target="_blank">AAAAI website</a>. (Be careful to not to confuse them with the nasal antihistamines, which are in the same chart but identified in the column titled "Class".) </li>
<li>In those over 15 years, the nasal steroid is preferred over a leukotriene receptor antagonist (ie Singulair or montelukast). For those with asthma, the leukotriene receptor antagonist might offer an additional benefit for asthma, but it is not the preferred treatment in either allergies or asthma. (I think the age change is simply due to the ages studied but it was not specified.)</li>
<li>In moderate to severe allergic conditions, a combination of nasal steroid and nasal antihistamine can be considered. </li>
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These recommendations are based on a review of many studies to show what treatments worked and what didn't. They also took into consideration the fact that oral antihistamines can cause sedation and the nasal antihistamines do not. In general the nasal steroids worked better than other treatments. They did note that for people who do not tolerate nasal sprays, alternates would be oral antihistamines or leukotriene receptor agonists.</div>
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Kristen Stuppy, MDhttp://www.blogger.com/profile/10332172268371143329noreply@blogger.com0tag:blogger.com,1999:blog-106825434973779887.post-46297914471165689752017-11-28T16:13:00.000-06:002017-11-28T16:13:03.825-06:00What Doctors Want You To Know About Treating Colds (but are afraid to say)<div style="background-color: white; color: #1d2129; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; margin-bottom: 6px;">
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This is a change from my usual blogging style because I want to share a Facebook post. I follow a few private Facebook Groups and in one for physicians the following post was shared. I tracked down the original author for permission to share publicly. He was not intending for this to reach a wide audience, but authorized me to share without his real name. He asked that I refer to him as Dr. Nate. </div>
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I did not write anything in the post or the comments I posted below, but I see value in it. It highlights the fears and desperation of many parents and the frustration that even doctors have in treating coughs and colds. </div>
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It might offend some because of its snarkiness, but it might help parents who are frustrated that their child is sick... again. </div>
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As you can see, Dr. Nate answers questions about treating a child's cold and cough rather bluntly, but from the many, many positive responses, rather accurately. It's a behind-the-scenes look at what doctors really want to say but can't.</div>
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I'll first post screenshots of the post and some of the replies (there were also GIFs and more comments of essentially the same "love it" responses) and then I copied the wording below for ease of reading.</div>
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Saw this posted over on ********* and figured this group would appreciate it the most given the snarkiness! <span class="_5mfr _47e3" style="font-family: inherit; line-height: 0; margin: 0px 1px; vertical-align: middle;"><img alt="" class="img" height="16" role="presentation" src="https://www.facebook.com/images/emoji.php/v9/f4/1/16/1f60f.png" style="border: 0px; vertical-align: -3px;" width="16" /><span class="_7oe" style="display: inline-block; font-family: inherit; font-size: 0px; width: 0px;">😏</span></span> <a class="_58cn" data-ft="{"tn":"*N","type":104}" href="https://www.facebook.com/hashtag/parentingishard?source=feed_text" style="color: #365899; cursor: pointer; font-family: inherit; text-decoration-line: none;"><span class="_5afx" style="direction: ltr; font-family: inherit;"><span aria-label="hashtag" class="_58cl _5afz" style="color: #4267b2; font-family: inherit; unicode-bidi: isolate;">#</span><span class="_58cm" style="font-family: inherit;">ParentingIsHard</span></span></a><a class="_58cn" data-ft="{"tn":"*N","type":104}" href="https://www.facebook.com/hashtag/truestory?source=feed_text" style="color: #365899; cursor: pointer; font-family: inherit; text-decoration-line: none;"><span class="_5afx" style="direction: ltr; font-family: inherit;"><span aria-label="hashtag" class="_58cl _5afz" style="color: #4267b2; font-family: inherit; unicode-bidi: isolate;">#</span><span class="_58cm" style="font-family: inherit;">TrueStory</span></span></a></div>
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"Shamelessly and unapologetically plagiarized from ***********:</div>
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And now, for a pediatric URI Q & A session with your friendly neighborhood doctor.</div>
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Q: My kid has had a cold for four days now, and he isn’t getting any better! What should I do?<br />
A: most colds spent 4-5 days getting worse and 4-5 days getting better. Call me if it’s been consistently worsening for a week, and we’ll talk. Otherwise, regular supportive care is all we do for a cold.</div>
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Q: He’s coughing up green and yellow junk! My friend Becky says that mean he needs antibiotics.<br />
A: normal viral colds involve a full rainbow of sputum colors. Green, yellow, and white junk tells you nothing about whether it’s viral or bacterial, especially in babies.</div>
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Q: My baby has had a cold for 3 weeks. What now?<br />
A: probably not really. Your kid can have a cough that lingers for up to 4-6 WEEKS after recovering from a viral infection like RSV. If there’s no fever, and no other symptoms of infection, a cough alone is expected.</div>
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Q: But he’s been coughing for 3 weeks!!!<br />
A: You will notice that 3 is less than 4-6. This does not surprise me.</div>
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Q: But that’s a long time!<br />
A: tough. #ParentingIsHard</div>
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Q: But it’s really interfering with his sleep!<br />
A: Oh, well in that case, let me go get the cure for the common cold and post viral cough that we doctors have been keeping secret. Lol, J/K - <a class="_58cn" data-ft="{"tn":"*N","type":104}" href="https://www.facebook.com/hashtag/pih?source=feed_text" style="color: #365899; cursor: pointer; font-family: inherit; text-decoration-line: none;"><span class="_5afx" style="direction: ltr; font-family: inherit;"><span aria-label="hashtag" class="_58cl _5afz" style="color: #4267b2; font-family: inherit; unicode-bidi: isolate;">#</span><span class="_58cm" style="font-family: inherit;">PIH</span></span></a></div>
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Q: My friend Becky told me to come to the hospital because my baby had a fever of 99 degrees.<br />
A: First off, in babies, a fever is 100.4 degrees. A temperature of 99 is not legally a fever. Second off, stop listening to Becky.</div>
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Q: does my child have a sinus infection?<br />
A: since kids don’t really have sinuses, probably not. They may have small ethmoid sinuses that don’t often get infected, but they don’t have fully formed adult sinuses until they’re middle school aged. Those are the ones that get sinus infections.</div>
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Q: does my baby have bronchitis?<br />
A: no. Just, no. Babies can get bronchIOLItis, but almost never get true bronchitis. And if they did, the treatment for bronchitis is not usually antibiotics.</div>
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Q: it’s been 30 days and he’s STILL coughing!<br />
A: Wow, parenting really does suck. Nothing to do about it though.</div>
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Q: I want antibiotics<br />
A: does your kid have strep, pneumonia, an ear infection, or a UTI? If not, tough.</div>
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Q: My kid has a runny nose, a sore throat, and a cough. Becky says it’s strep.<br />
A: WTF did I say about listening to Becky?! Strep doesn’t cause runny nose and cough (except in babies under a year, which is a different entity than strep throat).</div>
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Q: My toddler has been sick for the last two months.<br />
A: your kid, at this age, can get a dozen viral respiratory infections a year. Each one can last up to two weeks. You do the math - toddlers are sick almost just as often as they’re well.</div>
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Q: what about vitamin C and zinc?<br />
A: MAYBE vitamin C prevents colds in certain subsets of the population, but not for everyone, and once you have a cold they won’t stop it. And don’t give your kid zinc.</div>
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Q: (something something essential oils or coconut)<br />
A: the only natural treatment for a cough with good data is honey, and never give honey to a baby under 12 months.</div>
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Q: what over the counter medicine is best for a kid with a cold?<br />
A: none of them. They all suck for kids. Tylenol and Motrin are good for fevers in general, but stay away from “cold and flu” medicines.</div>
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Q: Well, _I_ had a different experience than one of the above scenarios. I actually DID need antibiotics/ have a kid with a sinus infection/ found a worrisome reason for a lingering cough / got better with essential oils.<br />
A: 1) that was likely a coincidence if it happened at all. 2) this is called an “outlier” and does not nullify the general rule 3) is this Becky? Go away Becky.</div>
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Q: All 6 of my kids are sick. What can I do?<br />
A: Mirena, Nexplanon, and Depo-Provera are all good options for you.</div>
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Q: You’re a mean pediatrician<br />
A: that’s not a question. But yes, yes I am."</div>
Kristen Stuppy, MDhttp://www.blogger.com/profile/10332172268371143329noreply@blogger.com0tag:blogger.com,1999:blog-106825434973779887.post-83229187885178163632017-11-26T12:34:00.001-06:002017-11-26T13:08:17.307-06:00New 2017 Generics for ConcertaDeja vu. I feel like I've been through this before.<br />
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Two of my <a href="http://pediatricpartners.blogspot.com/2013/04/generic-concerta-not-working-like-brand.html" target="_blank">most-read</a> <a href="http://pediatricpartners.blogspot.com/2013/12/update-on-generic-methylphenidate-hcl.html" target="_blank">blogs</a> were about generic forms of Concerta available in 2013-14. The FDA had allowed companies to manufacture and sell tablets that were not the same as Concerta. People across the country noticed the change immediately. I started seeing patients who had been well controlled on Concerta for a long time who suddenly were not able to focus, were more angry, and had other focus and behavior problems. Initially I had no idea there was a new generic, but one mother sent me a picture of the new pill and I knew instantly it could not be the same.<br />
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Now I've heard there will be new generics from <a href="https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=c45dc1de-adfa-4b3c-a7dc-cffbc8eac74f#section-12.3" target="_blank">Trigen Laboratories</a>, <a href="http://newsroom.mylan.com/2016-12-29-Mylan-Launches-Generic-Concerta-Tablets" target="_blank">Mylan</a> and <a href="https://www.prnewswire.com/news-releases/impax-announces-fda-approval-of-its-ab-rated-generic-concerta-methylphenidate-hydrochloride-extended-release-tablets-cii-300488895.html" target="_blank">Impax Laboratories</a> that do not use the special delivery system of Concerta once again. I'm worried because it took many many months of people filing reports with the FDA through <a href="https://www.accessdata.fda.gov/scripts/medwatch/index.cfm?action=reporting.home" target="_blank">MedWatch</a> before the <a href="https://www.fda.gov/Drugs/DrugSafety/ucm422568.htm" target="_blank">FDA finally stopped allowing the substitution</a>. I hope the newly approved versions work better than the previous editions, but am worried not only because they don't use OROS technology, but there are several new versions coming to market and each could be different.<br />
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I have heard that the previously available OROS generic (made in the same factory as the name brand Concerta and the same exact pill but with a different label) will no longer be available. If this is true, options will be to pay for the name brand or go with a new version of the medicine.<br />
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEimIO_GecgN6VE8a1kPn-VfRYUBCrIaF4haTdup_kD2aNUR0wD-QvkK2BoPovIB6kMfZIgttAyPS1LUGfO_OXYl6sFfaxGuvSPEwXbTgMEoawSxzqk7fV1UqkrEz9FaNUSdmJtOIcFvE538/s1600/New+2017+Generic+for+Concerta.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img alt="methylphenidate ER, Concerta, ADHD, stimulant, ritalin" border="0" data-original-height="1102" data-original-width="735" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEimIO_GecgN6VE8a1kPn-VfRYUBCrIaF4haTdup_kD2aNUR0wD-QvkK2BoPovIB6kMfZIgttAyPS1LUGfO_OXYl6sFfaxGuvSPEwXbTgMEoawSxzqk7fV1UqkrEz9FaNUSdmJtOIcFvE538/s400/New+2017+Generic+for+Concerta.png" title="New 2017 Generic for Concerta" width="266" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">These are all OROS type methylphenidate HCl ER (Concerta)</td></tr>
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What makes Concerta unique?</h4>
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Concerta is the branded formulation of methylphenidate HCl Extended Release that has a unique time release system. This time release technology is called OROS (osmotic controlled release oral delivery system). Unlike many slow releasing medications that are released as the capsule parts dissolve, the OROS capsule doesn't dissolve. There is a little active medicine that is released immediately and then the medicine is slowly released through a small hole in one end of the capsule. The pill works like a pump, pulling in water from the intestines, pushing the medicine out of the tube slowly throughout the day. This allows for a consistent drug release. See this photo from <a href="https://www.medscape.org/viewarticle/547415_10" target="_blank">Medscape</a>:<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEixCxKFv5-wPFP-4zX8xozYxi7qzABJ7FZGi19ztUD3nGzqY-tEw2cDoinbtTA3X8nLNZfu4R7sgyq1nQKaB2NA8xn7oWIflrFJ3mcS-ApKer_zgbx_MYhxfcjQnyqkFSM09Dt1HEEu-B74/s1600/Screen+Shot+2017-11-26+at+7.24.08+AM.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="534" data-original-width="709" height="241" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEixCxKFv5-wPFP-4zX8xozYxi7qzABJ7FZGi19ztUD3nGzqY-tEw2cDoinbtTA3X8nLNZfu4R7sgyq1nQKaB2NA8xn7oWIflrFJ3mcS-ApKer_zgbx_MYhxfcjQnyqkFSM09Dt1HEEu-B74/s320/Screen+Shot+2017-11-26+at+7.24.08+AM.png" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Source: https://www.medscape.org/viewarticle/547415_10</td></tr>
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You can tell if you have the OROS tablets if they have a small dimple in one end:<br />
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The new generics</h4>
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The same active ingredient (methylphenidate) is used in the new pills. I have heard that at least one version of the pills is round, so I know they don't use the OROS system. I cannot tell what type of delayed release they will have based on the information in their package inserts.</div>
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I find it very frustrating that each of the package inserts appear to be nearly identical to the one for Concerta (including the initial US approval date of 2000, which is not correct for this form). Older warnings, including a contraindication in those with tics, has been found in newer studies to not be a contraindication. The fact that they did not push to remove it makes me wonder if they did not want to have to change other parts of the document.</div>
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Figure 1 and Table 6 are identical with the exception of changing the word "CONCERTA" to "methylphenidate hydrochloride extended-release" and Trigen added an easy-to-read table format: </div>
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Concerta</div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0FidtsozeJE8MhDXeJgOp2IWyYeACHI7QLG6NZAYn1MReBSUOOJ26JcOnZIFc6e8fcRqyuIb06FE88CnV_frgR-xybZQ47oJGKnqReHrReF6ui2QwZfI1mbMdEvDk9-oN04D07o2rxTQr/s1600/Screen+Shot+2017-11-26+at+11.16.08+AM.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="661" data-original-width="913" height="231" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0FidtsozeJE8MhDXeJgOp2IWyYeACHI7QLG6NZAYn1MReBSUOOJ26JcOnZIFc6e8fcRqyuIb06FE88CnV_frgR-xybZQ47oJGKnqReHrReF6ui2QwZfI1mbMdEvDk9-oN04D07o2rxTQr/s320/Screen+Shot+2017-11-26+at+11.16.08+AM.png" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">https://www.janssenmd.com/pdf/concerta/concerta_pi.pdf</td></tr>
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Trigen's Methylphenidate HCl ER</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-MbK4yO_ZBwNkLLwTdPHtmiteKM-uyUOk_bDPop_amnTIdaHZNLjz-1VSflzcD6FhDtlJaMCOqZ4IU2_UZGsOevymtAMk-ZQjySYh1YsEHmeKcDwYWIP32aYsXlVfN6KEpkmpsYqkADs_/s1600/Screen+Shot+2017-11-26+at+11.16.44+AM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="721" data-original-width="707" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-MbK4yO_ZBwNkLLwTdPHtmiteKM-uyUOk_bDPop_amnTIdaHZNLjz-1VSflzcD6FhDtlJaMCOqZ4IU2_UZGsOevymtAMk-ZQjySYh1YsEHmeKcDwYWIP32aYsXlVfN6KEpkmpsYqkADs_/s320/Screen+Shot+2017-11-26+at+11.16.44+AM.png" width="313" /></a></div>
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Impax's Methylphenidate HCl ER</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhwAUf8rC4OOHAIO-U_57TS5TP45eMJa1Fx7Vb10pn0XfdTcBBmX6UKkUXuPyDjuUlaXrlufsjRXv_Qp_F5H2tzCTfcfcPqFwHkrq3aN0eGGKKTM_BtzMBICg3KE6eXuru4A_QXOwd-c6jw/s1600/Screen+Shot+2017-11-26+at+11.57.33+AM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="591" data-original-width="674" height="280" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhwAUf8rC4OOHAIO-U_57TS5TP45eMJa1Fx7Vb10pn0XfdTcBBmX6UKkUXuPyDjuUlaXrlufsjRXv_Qp_F5H2tzCTfcfcPqFwHkrq3aN0eGGKKTM_BtzMBICg3KE6eXuru4A_QXOwd-c6jw/s320/Screen+Shot+2017-11-26+at+11.57.33+AM.png" width="320" /></a></div>
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This makes me wonder if they were somehow able to get permission to make their new tablets based on Concerta's data, not their own. </div>
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We'll see how it works in people who have previously taken OROS methylphenidate ER. Sadly, one version might work better than another, so you will have to keep track of which brand you are using.</div>
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What's good about the new generics?</h4>
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If it's true that the currently available generic OROS form of methylphenidate ER is no longer going to be available, it's good that there will be other options to help keep costs down. Maybe. Sometimes insurance companies prefer branded products. It's all how they contract the cost. If you don't know how to use your insurance company's prescription <a href="http://pediatricpartners.blogspot.com/2012/11/know-your-insurance-formulary.html" target="_blank">formulary</a>, you should learn. Also check out <a href="http://www.goodrx.com/" target="_blank">GoodRx</a> for pricing information.</div>
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One might work as well (or better) than the OROS formulation in any individual. You won't know until you try it. </div>
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<b>One benefit I am excited about if these work: </b></div>
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The Trigen version is available as a 72 mg tablet. The original Concerta is not able to be made at that strength. You can see from the photos above that the pills get bigger with increasing dosages, and the OROS system has limits to how much it can hold. For people who need 72 mg, they must take two of the 36 mg OROS tablets. Since patients pay by the pill and they need 60 pills/month instead of 30, this can be quite a bit more expensive.</blockquote>
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What should you do if the pills change - especially if they don't work? </h4>
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Check each bottle when you pick up new medicine and ask if you can return unused tablets if they don't work for any reason. </div>
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Keep track of what each pill looks like and the brand (which should be on the label) so you know which versions work and which don't. </div>
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Talk to your kids about how they think and feel on and off their medicine - some will be more in tune with themselves than others.<br />
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Keep in touch with teachers as the pills change so you know if there are school-related issues you're not seeing at home.</div>
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If the pills don't work or have new or worsening side effects:</div>
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<li>Talk to your HR representative who deals with the insurance company. </li>
<li>Call your insurance company directly. Send them e-mails and snail mail. </li>
<li>Ask your physician to write a letter on your behalf. </li>
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In each of the above situations, include why your family member needs the OROS technology. Give examples of how it works better than the other extended release methylphenidates and why the amphetamine class of medication failed (if tried). </blockquote>
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<li>People were able to get the FDA to look into the issue the last time a different tablet was substituted by submitting complaints to <a href="https://www.accessdata.fda.gov/scripts/medwatch/index.cfm?action=reporting.home" target="_blank">MedWatch</a>. It took a long time, but the <a href="https://www.fda.gov/Drugs/DrugSafety/ucm422568.htm" target="_blank">FDA finally agreed that there are significant differences and the other substitutions were no longer allowed</a>. It's easy and free. Please submit to <a href="https://www.accessdata.fda.gov/scripts/medwatch/index.cfm?action=reporting.home" target="_blank">MedWatch</a> if you have any concerns!</li>
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If you need to change medications because the new generics don't work well, it helps to know what other medicines are in the same class so you can look up your formulary coverage. <a href="http://adhdmedicationguide.com/" target="_blank">The ADHD Medication Guide</a> has an easy-to-read format of ADHD medicines. Just look for other medicines in the same colored box as Concerta to find similar drugs. (To limit plagiarism of this wonderful chart, you must click on the user agreement in the center of the page. It is free and easy.) Medications have been arranged on the card for ease of display and comparison, but dosing equivalence cannot be assumed. Talk with your doctor about what medicines will be best for your child (or yourself). *<span style="font-size: x-small;">The ADHD Medication Guide was created by Dr. Andrew Adesman of the North Shore-LIJ Health System.</span><br />
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Related Posts:</h4>
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<a href="http://pediatricpartners.blogspot.com/2013/04/generic-concerta-not-working-like-brand.html" target="_blank">Generic Concerta Not Working Like It Used To?</a></div>
<a href="http://pediatricpartners.blogspot.com/2013/12/update-on-generic-methylphenidate-hcl.html" target="_blank">Update on generic Methylphenidate HCl ER (name brand = Concerta)</a></div>
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Kristen Stuppy, MDhttp://www.blogger.com/profile/10332172268371143329noreply@blogger.com0tag:blogger.com,1999:blog-106825434973779887.post-36130812476199906982017-11-12T12:55:00.000-06:002017-11-19T07:18:15.516-06:00Sleep Deprived Teens: Health, Safety, & Mental Well Being Are At Significant RiskTeens do not get enough sleep. Most teens need 8.5-10 hours of sleep each night. Not 6 hours. Not even 8 hours. Most don't get even close to meeting their needs and that's a bigger deal than many realize. Sleep is very undervalued, but we need to prioritize it.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRczDGEgw0gnuIY8n9Dw8zHNNaa1uBE4LGwUbI2BQJivIIV1Idfbb0QkrW6mlN7EV3dByw1Xh6tpM4Ji9eD-6ybHYz6PH2x8ytzzMihWDNZl44JNXi-VouxAfYovE5LrS77h3SSRynN0tj/s1600/Sleep+Deprived+Teens.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="sleep, insomnia, screen time, teens, circadian rhythm, school start times" border="0" data-original-height="1102" data-original-width="735" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRczDGEgw0gnuIY8n9Dw8zHNNaa1uBE4LGwUbI2BQJivIIV1Idfbb0QkrW6mlN7EV3dByw1Xh6tpM4Ji9eD-6ybHYz6PH2x8ytzzMihWDNZl44JNXi-VouxAfYovE5LrS77h3SSRynN0tj/s320/Sleep+Deprived+Teens.png" title="Sleep Deprived Teens: Health, Safety, & Mental Well Being Are At Significant Risk" width="213" /></a></div>
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Why don't teens get enough sleep? </h4>
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One of the most common reasons is that their <b>biological clock (AKA circadian rhythm)</b> makes it hard to fall asleep before 11 pm and school starts too early to allow them to sleep until 8 am, which would allow for 9 hours.<br />
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In addition to their circadian rhythm, some of their habits and activities can interfere with a healthy bedtime.<br />
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<li><b>Screens are a big problem.</b> The light interferes with our natural melatonin rising. I regularly ask teens (and parents) to limit screen use for at least an hour before bedtime, but most teens say that's impossible because they have to finish their homework at that time and they need their computer or tablet to do homework. If you can't turn off the screen, at least use a program that limits the blue light that prevents the rise of melatonin. I personally use <a href="https://justgetflux.com/" target="_blank">f.lux</a>. (It's free and works on PC, Mac, ipad, android, and Linux). I find that it really helps. (This is not a paid endorsement, just a personal statement.)</li>
<li><b>Phones.</b> On a similar note, phones distract kids from what they're doing, delaying falling asleep. It takes longer to finish homework when there are distractions from the phone. Kids often are tempted to check in one more time on all their social channels, which delays sleep time. And then friends who are still up will text to see who's up (or who they can wake up). </li>
<li><b>Activities are too late. </b>I'm not talking about kids just out and about on a school night. I'm talking about regularly scheduled activities that otherwise help build a well rounded person. It's not uncommon for activities to be scheduled to run until 9:30 or 10 on school nights for middle and high school aged kids. They get home and are hungry, need a shower, and are ramped up so not ready for sleep. </li>
<li><b>Activities start too early.</b> I know many kids who must be at school before school actually starts. Whether it's band practice, church study groups, sports, or taking a missed test before school, they all interfere with sleeping in, which is what teens need.</li>
<li><b>School starts too early</b>. Most school districts around the country start school well before the recommended 8:30 earliest start time. School districts that have initiated later start times have shown improved test scores, fewer absences and tardies, less depression, improved athletic performance, and better graduation rates. Unfortunately, those schools are still in the minority. </li>
<li><b>Medical causes of sleep deprivation and fatigue can also occur. </b>If you suspect any of these, you should schedule a visit with your doctor.</li>
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<li>Anxiety </li>
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<li>Restless leg syndrome </li>
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<li>Sleep apnea - pausing of breath, often associated with snoring </li>
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<li>Medications that affect sleep cycles</li>
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<li>Heartburn or acid reflux </li>
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<li>Hormone imbalances, such as thyroid problems </li>
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<li>Anemia, or low red blood cell counts </li>
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<li>Depression </li>
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<li>Nutrition: not eating enough, or eating foods that are not nutritious. If you eat foods that cause spikes in your blood sugar, as those sugars drop you feel fatigued.</li>
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<li>Infections </li>
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<li>Celiac disease </li>
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<li>Chronic pain conditions </li>
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<li>Chronic sleep deprivation - I know this is counter-intuitive, but being tired can make it harder to sleep.</li>
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What happens with too little sleep?</h4>
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Sleep deprivation can lead to many problems that are often not attributed to poor sleep, such as irritability, poor academic performance, accidents, obesity and more.<br />
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<li><b>Moodiness.</b> We all associate the teen years with angst, so we can easily attribute a teen's moodiness to just being a teen. But being chronically tired can lead to emotional dysregulation. This will look like irritability, frustration and anger. </li>
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<li><b>School problems. </b>It has been well established that getting proper amounts of sleep can help with focus and learning. <span style="font-size: 1em;">When our teens fail to get enough sleep, they often report problems with attention, memory, decision making, reaction time, and creativity. It's no surprise that teens report problems paying attention to a lecture or trouble completing homework in a reasonable time with full accuracy. Grades can easily fall, which leads to anxiety and depression, which in turn leads to more moodiness and trouble sleeping. </span></li>
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<li>Sleep deprivation mimics ADHD. Whenever I see a teen who wants to be evaluated for ADHD because of new loss of focus, falling grades, problems with behavior, or similar issues, I always look at sleep. Most often they don't have ADHD if this is a new problem. They need more sleep, not a stimulant medication. You can't put a band aide on a broken bone. Fix the problem, not the symptoms! (The same goes for a teen with ADHD who thinks the medicine that's worked for years suddenly isn't sufficient. Unless the medicine recently changed, they need sleep.)</li>
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<li><b>Injuries.</b> Teens with chronic sleep deprivation are more likely to be accidentally injured. </li>
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<li>Drowsy driving is comparable to drunk driving. Teens are at the highest risk for falling asleep at the wheel. Drowsy driving is the most likely to occur in the middle of the night (2-4 am), but also in mid-afternoon (3- 4pm) as teens drive home from school. </li>
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<li>Athletes are more likely to be injured while playing their sport, so it is in the best interest of the team to let players sleep. </li>
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<li><b>Risky behaviors. </b>Teens with chronic sleep deprivation have been shown to participate in more risk taking behaviors, such as driving without a seatbelt, drinking alcohol, skipping the bike helmet and tobacco use. </li>
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Pros and Cons of later school start times for our economy</h4>
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There are many temporary issues with changing school start times. Parents might have to find solutions to child care of younger kids if they rely on teens babysitting after school. New bus schedules need to be started. Sports programs will need to change practice times. After school job availabilities will change.</div>
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Despite these common arguments, economic analysis from the <a href="https://www.brookings.edu/opinions/ring-the-school-bell-later/" target="_blank">Brookings Institution</a> shows that a one hour delay of school start times could lead to a $17,500 earnings gain for students, compared to a cost of $1,950 during the student's school days. </div>
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Another <a href="https://www.rand.org/pubs/research_reports/RR2109.html" target="_blank">study that presumed all students start school at 8:30</a>, with a year-by-year economic effect. The study did not take into account other potential benefits of later school start times, such as decreased depression and obesity rates. They found an average annual gain of about $9.3 billion due to fewer automotive accidents, improved graduation rates, and other factors. </div>
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What can teens do to get more zzzz's?</h4>
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<li style="background-color: white;"><b>Go to bed when tired at night.</b> Fighting sleep initially will make it harder to go to sleep when you finally go to bed. </li>
<li style="background-color: white;"><b>Attempt to follow a regular sleep schedule.</b> Going to bed and getting up at about the same time every day helps. While sleeping in on weekends can help repair a sleep deficit, it can make it harder to get to sleep Sunday night and getting sufficient sleep every night is better than just getting more sleep a few days/week. Try to sleep in no more than 2 hours past your school day wake up time.</li>
<li style="background-color: white;"><b>Follow the same routine each night at bedtime.</b> Brush teeth, read a book or color, take a bath or shower -- do whatever helps you wind down and relax. Repeating this every night can help your brain get ready for bed. </li>
<li style="background-color: white;"><b>Nap to help make up missed sleep.</b> A short 15-20 minute nap after school can help revitalize the brain to get homework done. Just don't sleep too long or it can interfere with bedtime.</li>
<li style="background-color: white;"><b>Turn off the screens an hour before bedtime.</b> This includes tv, computer games, computer/tablet use for homework, and smartphones for socializing. Use night mode screen lighting and apps that dim the screen (like the <a href="http://www.justgetflux.com/" target="_blank">f.lux app</a> I mentioned above). </li>
<li style="background-color: white;"><b>Avoid caffeine in the later afternoon.</b> The time it takes half of the caffeine to be removed from your body is 5-6 hours. Ideally teens would sleep and never drink caffeine, but I know that isn't reality. Any caffeine in the later afternoon can make it harder to fall to sleep. Don't forget "hidden" sources of caffeine, such as chocolate, energy bars, and workout supplements.</li>
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<li style="background-color: white;">One interesting concept that has scientific backing (but goes against the "no caffeine after 3 pm" rule) is the <a href="https://sleepjunkies.com/tips/the-caffeine-nap/" target="_blank">coffee nap</a>. Basically, you drink coffee then quickly nap for 15-20 minutes. Sodas and teas don't work as well as coffee due to too much sugar and too little caffeine. The coffee nap has been shown to be more effective than either a nap or caffeine alone. Don't do this often -- use it at times you really need it. Don't do this too late in the day or the caffeine will inhibit your regular night's sleep.</li>
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<li style="background-color: white;"><b>Skip the snooze button.</b> Set your alarm for the last possible moment you can, which allows your body to get those extra minutes of sleep. If you need to get out of bed by 6:45, but set your alarm for 6:15 and hit snooze several times, you aren't sleeping those 30 minutes. Set your alarm for 6:45!</li>
<li style="background-color: white;"><b>Skip the late night studying.</b> Studying too late is ineffective. When the brain's tired it won't learn as well and you will make mistakes more readily. It takes a lot longer to get anything done when you're tired. Go to bed and get up a little earlier to get the work finished if needed. Of course you should also look at your time management if this happens too often. Are you involved in too many activities? Do you work or volunteer too many hours? Did you waste too much time on tv, games, or socializing? Do you put off big projects until the last minute? Homework needs to take priority when you're more alert in the afternoon and evening. If you have problems with this, talk to parents and teachers about what you can do.</li>
<li style="background-color: white;"><b>If you lay awake for hours or wake frequently, try these techniques to help fall asleep: </b></li>
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<li style="background-color: white;">mindfulness (see my <a href="https://www.pinterest.com/kstuppy/mindfulness/" target="_blank">Mindfulness Pinterest page</a> with many free apps) </li>
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<li style="background-color: white;"><a href="https://www.wikihow.com/Do-Abdominal-Breathing" target="_blank">deep breathing</a> </li>
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<li style="background-color: white;">a sound machine </li>
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<li style="background-color: white;">listen to <a href="https://www.youtube.com/watch?time_continue=1&v=UfcAVejslrU" target="_blank">Weightless</a> - music that's been shown to help initiate sleep </li>
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<li style="background-color: white;">coloring </li>
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<li style="background-color: white;">journaling </li>
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<li style="background-color: white;">If these fail, talk to your parents and doctor to help find a solution.</li>
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<li style="background-color: white;"><b>Charge your phone in another room. </b>Friends who decide to text in the middle of the night keep you from sleeping. Even phones on silent have blinking lights that can spark your curiosity. It's too tempting to look at your social media apps one more time. </li>
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<li style="background-color: white;">Don't use the excuse that you need your phone as an alarm. Alarm clocks are cheap. Get one and put your phone elsewhere!</li>
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<li style="background-color: white;"><b>Use your bed for sleep only.</b> Stop doing homework in bed. Stop watching YouTube and Netflix in bed. Train your brain that your bed is where you sleep.</li>
<li style="background-color: white;"><b>Exercise.</b> Exercise helps our bodies sleep better, but it should ideally be earlier in the day. Too close to bedtime (which is common with athletes and dancers) wires us up.</li>
<li style="background-color: white;"><b>Get natural sunlight in the morning. </b>This helps to set your circadian rhythm. </li>
<li style="background-color: white;"><b>Keep the bedroom cool and dark.</b> </li>
<li style="background-color: white;"><b>Keep pets out of the bedroom. </b>Your animals might love you and you love them, but if they keep you up, it's just not worth having them around at night.</li>
<li><span style="background-color: white;"><b>Nicotine and alcohol affect sleep.</b> These should not be used by teens in an ideal world, but I know teens will not always follow the rules. Teens should know that if they are using nicotine or alcohol, their quality of sleep will be affected. </span></li>
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<li><span style="background-color: white;">Nicotine is a stimulant (like caffeine), which leads to </span>more time sleeping lightly and less time in deep sleep. And yes, vaping and chewing lead to this problem too, since it's the nicotine that causes the problem. </li>
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<li>Alcohol reduces the time it takes to fall asleep but it increases sleep disturbances in the second half of the night, often leading to early wakening. Alcohol relaxes muscles, which can lead to sleep apnea (often noted as snoring). Sleep apnea does not allow the body to have restful sleep. Alcohol is also a diuretic, which might increase the need to wake to go to the bathroom during the night.</li>
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<span style="background-color: white; font-family: "open sans"; font-weight: normal;"><br /></span></h4>
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We all need to prioritize sleep: for our kids and for ourselves. Our bodies and minds will thank us. </h4>
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<span style="background-color: white; font-family: "open sans";"><br /></span></h4>
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<span style="background-color: white; font-family: "open sans";">Resources:</span></h3>
<ul style="margin: 0px 10px 10px; padding: 0px 0px 0px 10px;"><br />
<li><a href="https://www.rand.org/pubs/research_reports/RR2109.html" target="_blank">Later school start times in the U.S.: An economic analysis</a></li>
<li><a href="https://www.cdc.gov/mmwr/volumes/65/wr/mm6513a1.htm" target="_blank">Sleep Duration and Injury-Related Risk Behaviors Among High School Students — United States, 2007–2013</a></li>
<li><a href="http://pediatrics.aappublications.org/content/early/2014/08/19/peds.2014-1697" target="_blank">School Start Times for Adolescents: (AAP) ADOLESCENT SLEEP WORKING GROUP, COMMITTEE ON ADOLESCENCE, AND COUNCIL ON SCHOOL HEALTH</a></li>
<li><a href="https://drcraigcanapari.com/should-my-child-take-melatonin-a-guide-for-parents/" target="_blank">Melatonin for Children? A guide for parents</a> by Dr. Craig Canapari</li>
<li style="box-sizing: border-box;"><a href="http://www.heysigmund.com/just-want-go-sleep-sleep-better-according-science/" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: 0px 0px; background-repeat: initial; background-size: initial; box-sizing: border-box; color: #428bca;" target="_blank">I Just Want To Go To Sleep! How to Sleep Better (According to Science)I Just Want To Go To Sleep! How to Sleep Better (According to Science)</a> by "Hey Sigmund"</li>
<li style="box-sizing: border-box;"><a href="http://www.startschoollater.net/" target="_blank">Start School Later, Inc.</a></li>
<li style="box-sizing: border-box;"><a href="https://drmelissawelby.com/cant-sleep-back-basics/" target="_blank">Back to Sleep Basics</a> by Dr. Melissa Welby</li>
</ul>
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Kristen Stuppy, MDhttp://www.blogger.com/profile/10332172268371143329noreply@blogger.com0tag:blogger.com,1999:blog-106825434973779887.post-70461471578100522522017-11-07T21:23:00.000-06:002017-11-10T19:29:33.850-06:00Active Shooters: Reflections and Talking to Kids<script type="text/javascript" src="//downloads.mailchimp.com/js/signup-forms/popup/embed.js" data-dojo-config="usePlainJson: true, isDebug: false"></script><script type="text/javascript">require(["mojo/signup-forms/Loader"], function(L) { L.start({"baseUrl":"mc.us17.list-manage.com","uuid":"a0905acc12f10c4129cf49935","lid":"696644206b"}) })</script>
Area flags are at half mast today as we are mourning the loss of innocent lives from another <a href="https://www.usatoday.com/story/news/nation/2017/11/07/families-couples-children-these-lives-we-lost-texas-church-shooting/839550001/" target="_blank">mass shooting at a Texas church</a> over the weekend. We are sad for grieving families once again. What we can do to protect ourselves and our loved ones from random violence and acts of hate?<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWheKcQ0_bCZHwHuetXOOSWe0Bd_ybkDoHNtkdPOla_qJ1BEtJTwH1A2BFkY-Auzi-A2N8Ui398wRcDoQlEEqpAtugSuys-199ihSnxTySmsUNLWrK_bZkfJcCINll2oI_1quZ7jYio_uq/s1600/Active+Shooter.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1102" data-original-width="735" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWheKcQ0_bCZHwHuetXOOSWe0Bd_ybkDoHNtkdPOla_qJ1BEtJTwH1A2BFkY-Auzi-A2N8Ui398wRcDoQlEEqpAtugSuys-199ihSnxTySmsUNLWrK_bZkfJcCINll2oI_1quZ7jYio_uq/s320/Active+Shooter.png" width="213" /></a></div>
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My generally safe town has had two incidents of violence that have made national news in recent years. A man opened fire at a <a href="https://en.wikipedia.org/wiki/Overland_Park_Jewish_Community_Center_shooting" target="_blank">Jewish Community Center and a Jewish Retirement Home</a> and killed three innocent people. Another man shot <a href="http://www.kansascity.com/news/local/crime/article134776369.html" target="_blank">two men eating at a local restaurant</a> after yelling racial slurs and telling them to leave his country. One of the men died.<br />
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My kids have been on lockdowns at their schools on several occasions over the years. Our kids are getting used to lockdown drills and even real events. Thankfully none of the local school lockdowns turned tragic. Being a parent who cannot do anything while a school is in lockdown is stressful. Not knowing what is happening during a lockdown when my children are most likely sitting on a floor of a crowded dark room is terrifying. My kids have never felt that scared, even when it's a real lockdown, probably because they've practiced and feel prepared. For many kids this seems to be the case, but I'm sure there are some who start having separation anxiety or other manifestations of trauma-related stress. </div>
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Today my front office staff saw policemen with weapons in hand enter our building and run down the hall. They did not come into our office. </div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjS3PrYI7w0oi08IwfNkl2cQvKjplRXqW8MSKgFuJT1IUOXQIAkiePg8jikmo3ysEZskCdpqbkp5B0RvH2DTB4iYOYLO53NS_D2bxF8dNavwYGGp81eupg0il3cBvY9Z4NNk7f3ZlFMo1jc/s1600/Screen+Shot+2017-11-07+at+4.45.04+PM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="487" data-original-width="580" height="268" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjS3PrYI7w0oi08IwfNkl2cQvKjplRXqW8MSKgFuJT1IUOXQIAkiePg8jikmo3ysEZskCdpqbkp5B0RvH2DTB4iYOYLO53NS_D2bxF8dNavwYGGp81eupg0il3cBvY9Z4NNk7f3ZlFMo1jc/s320/Screen+Shot+2017-11-07+at+4.45.04+PM.png" width="320" /></a></div>
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We locked our front door, closed the blinds, and kept patients in exam rooms. We saw several police cars in the parking lot for our building and those near ours. </div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj7f3eGIGSLJVelX6qbmyjeeaYnDVSZeYVvOEydVRaKephyphenhyphen9RwvoPUoMvKnJyZper_bTdc_40pQCK2SmX9K6f6GqQn1wwrU37bDt-U-Y0LSuRaA9IicORlpBCvzwOkma4ZaQxhnRE9oBAig/s1600/Screen+Shot+2017-11-07+at+5.12.46+PM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="431" data-original-width="496" height="278" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj7f3eGIGSLJVelX6qbmyjeeaYnDVSZeYVvOEydVRaKephyphenhyphen9RwvoPUoMvKnJyZper_bTdc_40pQCK2SmX9K6f6GqQn1wwrU37bDt-U-Y0LSuRaA9IicORlpBCvzwOkma4ZaQxhnRE9oBAig/s320/Screen+Shot+2017-11-07+at+5.12.46+PM.png" width="320" /></a></div>
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Our office manager called the police department to find out what was happening and not a lot was learned, but there was a <a href="http://www.kctv5.com/story/36786253/police-respond-to-reports-of-possible-threat-in-overland-park" target="_blank">potential active shooter in the area, so they recommended lockdown</a>. </div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNL6Yn-YIOnphiy5tR3GimGYmPsAZED0lfBnv6Hr1Yr5EJLd5OktQqjdBgEjDPEVKg4tpoQI77N4jjC-_hkUoaU7CtjuawJIzEUxBlXg_A52jFvBEYjmUDYfbtXYxNSxv0KD3vktJBOPxW/s1600/Screen+Shot+2017-11-07+at+4.42.45+PM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="569" data-original-width="582" height="312" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNL6Yn-YIOnphiy5tR3GimGYmPsAZED0lfBnv6Hr1Yr5EJLd5OktQqjdBgEjDPEVKg4tpoQI77N4jjC-_hkUoaU7CtjuawJIzEUxBlXg_A52jFvBEYjmUDYfbtXYxNSxv0KD3vktJBOPxW/s320/Screen+Shot+2017-11-07+at+4.42.45+PM.png" width="320" /></a></div>
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Because I was only in the office for meetings on my "day off" I was able to help tell staff and patients what we knew. I helped bring some of the families into the office. I checked Facebook and Twitter repeatedly to find out what was going on. (But I didn't grab these screenshots until hours later.)</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgVwG0Ek9PJ7z_uBDXo2ulJsnetkK6qXlTTFEhXLPOhCpSpsqWTpO28B984A05NBTTHl64Bfa-DQfiY0zXW55MATk4-89u79Aar4-MUwa795MxK5gIjsu834pYIak5h-TK2DNo9ptVi1D2B/s1600/Screen+Shot+2017-11-07+at+4.41.32+PM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="438" data-original-width="576" height="243" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgVwG0Ek9PJ7z_uBDXo2ulJsnetkK6qXlTTFEhXLPOhCpSpsqWTpO28B984A05NBTTHl64Bfa-DQfiY0zXW55MATk4-89u79Aar4-MUwa795MxK5gIjsu834pYIak5h-TK2DNo9ptVi1D2B/s320/Screen+Shot+2017-11-07+at+4.41.32+PM.png" width="320" /></a></div>
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I had planned on updating our social media, but couldn't find any real information to post.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhqgI20cWCh5M835eCd6Wbia4mLdZ5q4HzNavpLtTV0Z46iLgY-B5SLD6rCyE_wY3VxDLeAQ3w4yBeMqcRlNIqlICEkoXiUZDKFmFZtKky-j9WTXEwerg8OGH36_fBwigSEDzBu2jQuFYSR/s1600/Screen+Shot+2017-11-07+at+5.18.22+PM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="495" data-original-width="500" height="316" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhqgI20cWCh5M835eCd6Wbia4mLdZ5q4HzNavpLtTV0Z46iLgY-B5SLD6rCyE_wY3VxDLeAQ3w4yBeMqcRlNIqlICEkoXiUZDKFmFZtKky-j9WTXEwerg8OGH36_fBwigSEDzBu2jQuFYSR/s320/Screen+Shot+2017-11-07+at+5.18.22+PM.png" width="320" /></a></div>
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At one point we were told they apprehended someone in a creek area behind our building and got the all clear to open back up and let people leave. </div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEikslY6PRD23U6s5VIbNLDfDc38tkmkZX3dHi4XCERTpEnC1mcxAvS0uOjEOocfbsmkcqjDvPDsAEtO7n1wRREI2Yvytiihut23AJqIXEu0zCUVMYtgeCPKQK4zdrm179RgeJ548JOv4-OZ/s1600/Screen+Shot+2017-11-07+at+5.28.17+PM.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="375" data-original-width="696" height="172" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEikslY6PRD23U6s5VIbNLDfDc38tkmkZX3dHi4XCERTpEnC1mcxAvS0uOjEOocfbsmkcqjDvPDsAEtO7n1wRREI2Yvytiihut23AJqIXEu0zCUVMYtgeCPKQK4zdrm179RgeJ548JOv4-OZ/s320/Screen+Shot+2017-11-07+at+5.28.17+PM.png" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><a href="http://www.kshb.com/news/region-kansas/overland-park/overland-park-police-clear-reported-threat-near-135th-and-metcalf" target="_blank">41ActionNews</a></td></tr>
</tbody></table>
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A few minutes later we were told to put our building back on lockdown. No one knew what was going on.</div>
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Our receptionists covertly monitored the parking lot for patients so they could get the door for them - we didn't want families stuck in a potentially dangerous parking lot. Several patients called that they would be late to their appointments because police had blocked one of the roads into our parking area. </div>
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I am very proud of my staff and the families that were in the building. Everyone remained calm. No one complained that they were told to not leave the building. I didn't hear anyone complain when the rooms started to fill, which affected the flow of seeing patients. I must admit that I didn't really feel scared during all of this, since it seemed like police were all over and our office felt secure. It was frustrating not knowing what was going on, but the anxiety was much worse when the potential shooter was near my children's school and they were on lockdown.</div>
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It is sad that a false alarm like this must be taken seriously. I've heard that it was just a man with a stick. Or maybe it was just a prank. No one really knows at this time.</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkdSygm5PiAfWjXxLOARo5_Eyloo7-z3vyHPvy8eYb7TE-brC2btu2C-Zw_Yj-ILMdFZszcyO6O_W_ir0FP7FVdTy755-NgepN1FXWFie6hpapeP8m0ljHJZXzJlDuhaVUXu3pjXFEvlgz/s1600/Screen+Shot+2017-11-07+at+5.11.03+PM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="469" data-original-width="495" height="303" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkdSygm5PiAfWjXxLOARo5_Eyloo7-z3vyHPvy8eYb7TE-brC2btu2C-Zw_Yj-ILMdFZszcyO6O_W_ir0FP7FVdTy755-NgepN1FXWFie6hpapeP8m0ljHJZXzJlDuhaVUXu3pjXFEvlgz/s320/Screen+Shot+2017-11-07+at+5.11.03+PM.png" width="320" /></a></div>
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But what I do know is that there are many good people in this world. We can help each other in times of need. We can support one another. Mr. Rogers says: </div>
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<i style="background-color: white; color: #545454; font-family: arial, sans-serif; font-size: small;">When I was a boy and I would see scary things in the news, my mother would say to me, “Look for the helpers. You will always find people who are helping.”</i></blockquote>
When you have to explain these things to your children, remember to keep it simple. Answer their questions, but don't go deeper than they're ready to go. Find out what they already know and help them to understand it in ways that mean something to them. Try to keep the news off when kids are in earshot and monitor their screen time online. It's okay to share your feelings, but try to reassure their safety and list some positives, like Mr. Rodger's mother did.<br />
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<h4>
Resources for parents to talk to kids about tragic news: </h4>
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Common Sense Media: <a href="https://www.commonsensemedia.org/blog/explaining-the-news-to-our-kids" target="_blank">Explaining the News to Our Kids</a><br />
PBS: <a href="http://www.pbs.org/parents/talkingwithkids/news/agebyage.html" target="_blank">Talking with Kids About News</a> - sorted by ages<br />
HealthyChildren: <a href="https://www.healthychildren.org/English/family-life/Media/Pages/Talking-To-Children-About-Tragedies-and-Other-News-Events.aspx" target="_blank">Talking to Children About Tragedies & Other News Events</a><br />
American Psychological Association: <a href="http://www.apa.org/helpcenter/talking-to-children.aspx" target="_blank">How to talk to children about difficult news</a></div>
Kristen Stuppy, MDhttp://www.blogger.com/profile/10332172268371143329noreply@blogger.com0tag:blogger.com,1999:blog-106825434973779887.post-74651469241287820632017-10-29T12:21:00.000-05:002017-11-10T19:35:31.448-06:0010 Reasons Not To Get the Flu Vaccine, Reconsidered: Fight Flu!Influenza is not a just a bad cold. People sick with with the flu can suffer from fevers, cough, sore throat and body aches. It can lead to complications, many of them severe, and death. Complications include pneumonia, ear infections, and sinus infections. <a href="https://www.cdc.gov/flu/about/disease/burden.htm" target="_blank">Since 2010, influenza has resulted in between 9.2 and 35.6 million illnesses, between 140,000 and 710,000 hospitalizations and between 12,000 and 56,000 deaths each year. </a><br />
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There's good news though. There's a vaccine to help prevent the flu.<br />
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There are many reasons people don't get the flu vaccine, but many of those reasons deserve a second thought.</h3>
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1. The flu vaccine doesn't work. </h4>
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While it's true that the vaccine has <a href="https://www.cdc.gov/flu/professionals/vaccination/effectiveness-studies.htm" target="_blank">variable efficacy</a>, it's important to get the vaccine each year. The more people vaccinated, the less likely the flu will spread through a community. Take a look at this really cool representation of <a href="https://www.reddit.com/r/dataisbeautiful/comments/5v72fw/how_herd_immunity_works_oc/" target="_blank">how herd immunity works</a>. How it was developed is described on <a href="http://www.iflscience.com/health-and-medicine/this-gif-only-takes-6-seconds-to-show-how-herd-immunity-works/" target="_blank">IFLS</a>.<br />
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No one claims that the vaccines against influenza work perfectly. The influenza virus can mutate by <a href="https://www.khanacademy.org/partner-content/stanford-medicine/stanford-influenza/v/genetic-shift-and-drift" target="_blank">shifting and drifting</a>. Until there's a <a href="https://www.reuters.com/article/us-health-flu-vaccine/oxford-team-to-test-universal-flu-vaccine-in-world-first-idUSKCN1C80NI" target="_blank">universal flu vaccine</a>, we must rely on experts to look at the viral patterns and predict the strains that will be most predominant in the upcoming season and make a vaccine against those strains.<br />
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Despite not working 100% of the time, the flu vaccine has been shown to lessen the severity of illness and <a href="https://www.cdc.gov/flu/spotlights/vaccine-reduces-severe-outcomes.htm" target="_blank">decrease hospitalizations</a> and <a href="https://www.cdc.gov/media/releases/2017/p0403-flu-vaccine.html" target="_blank">deaths</a>. Even if there's not a perfect match, it can still help those who are vaccinated have a lesser illness. That's worth something.<br />
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2. I got the flu from the vaccine.</h4>
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The influenza vaccine that is currently available <b>cannot</b> cause the flu. Only live virus vaccines can lead to forms of the disease. The vaccines available in the US this season are either an inactivated or a recombinant vaccine. These do not cause flu symptoms. The vaccines cannot mutate to cause symptoms. They simply don't work that way.<br />
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There are many reasons you could have gotten sick after a flu vaccine that were not due to the vaccine.<br />
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<ol>
<li>You were exposed to influenza before the vaccine had time to take effect and protect. </li>
<li>You caught a strain of influenza that wasn't covered in the vaccine. </li>
<li>You caught one of a number of other viruses that cause flu - like illness. </li>
<li>The vaccine did cover the type of virus you have but your body didn't make the proper protection from the vaccine so you were still susceptible. </li>
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In each of these scenarios, you still would have gotten sick if you hadn't had the vaccine, but if you recently had the vaccine it's easy to understand the concern that the vaccine caused the illness.<br />
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The FluMist is a live virus vaccine, so it could cause mild symptoms of influenza viruses, but it is not recommended for use in the US this year.<br />
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3. I can prevent the flu by being healthy.</h4>
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It is important to eat right, exercise, get the proper amount of sleep, and wash hands. All of these things help keep us healthy, but they don't prevent the flu reliably.<br />
<br />
We cannot <a href="http://www.thescientificparent.org/immune-system-boost/" target="_blank">boost our immune system</a> with megadoses of vitamins. (Vaccines are the best way to boost our immune system.)<br />
<br />
Organic and non-GMO foods don't offer any benefit to our immune system over other healthy foods. If these things did as some claim, people generations ago would have been healthier since they ate locally grown organic foods, got plenty of fresh air, and exercised more in their day to day life than we do these days. Instead of being healthier, they were much more likely to die from infections. <a href="https://www.ncbi.nlm.nih.gov/pubmed/11099582" target="_blank">The risk of death between the first and 20th birthday had decreased from over 3 in 100 children in 1900, to less than 2 in 1000 children today</a>. One of the major causes of death historically (and still today) is from influenza, but it has been shown that the flu vaccine reduces the risk of death. Why not help your body prepare for flu season with the vaccine?<br />
<br />
<h4>
4. Flu vaccines shouldn't be used during pregnancy -- they've never been tested and can lead to miscarriage.</h4>
<div>
<br /></div>
Pregnancy is considered a high risk condition for severe complications of influenza disease and the vaccine can help prevent those complications. It is <a href="http://immunizationforwomen.org/2017-2018-influenza-season" target="_blank">recommended that all pregnant women get vaccinated against influenza</a>. If a pregnant mother gets the vaccine, it not only helps to prevent complications during pregnancy, but it also helps prevent influenza in newborns since they can't be vaccinated until 6 months of age.<br />
<div>
<br />
There are some who assert that since the package inserts state the vaccines have not been studied in pregnancy that they aren't safe, but in the next breath they say that they aren't safe because a study showed a high rate of miscarriage after the vaccine.<br />
<blockquote class="tr_bq">
The first part of the argument is one of the many ways the package insert is misused. Discussions about using package inserts properly are found at <a href="https://thelogicofscience.com/2016/07/25/vaers-package-inserts-and-the-vicp-do-not-prove-that-vaccines-are-dangerous/" target="_blank">The Logic of Science</a>, another at <a href="https://thelogicofscience.com/2017/04/11/the-vaccine-package-insert-paradox/" target="_blank">The Logic of Science</a>, <a href="http://www.skepticalraptor.com/skepticalraptorblog.php/vaccine-package-inserts-debunking-myths/" target="_blank">Skeptical Raptor</a>, <a href="http://www.harpocratesspeaks.com/2014/09/package-inserts-understanding-what-they.html" target="_blank">Harpocrates Speaks</a>, and even this <a href="https://luckylosing.com/2012/01/18/vaccine-package-inserts-not-all-you-should-be-reading/" target="_blank">analogy of Package Insert Airline to vaccine package inserts</a>.</blockquote>
<blockquote class="tr_bq">
Think about it... you can't argue that it's never been studied and then quote a study. It's been studied. A lot. The <a href="https://www.cdc.gov/vaccinesafety/ensuringsafety/monitoring/vsd/index.html" target="_blank">Vaccine Safety Datalink</a> is a huge database designed to document adverse events associated with vaccination, allowing researchers access to a large amount of data. </blockquote>
</div>
The flu vaccine has been safely given to pregnant women for over 50 years. Despite a recent small study suggesting a potential risk of miscarriage, the flu vaccine has been <a href="https://www.thedailybeast.com/the-pregnancy-vaccine-scare-that-should-have-never-been" target="_blank">studied</a> extensively around the globe and found to be not only safe but effective at decreasing the risk of influenza disease during pregnancy and beyond.<br />
<br />
<h4>
5. I have a chronic illness and don't want to get sick from the shot.</h4>
<br />
People with chronic illnesses (including diabetes, heart conditions, and asthma) are more at risk from serious illness from influenza disease. The influenza vaccine can prevent hospitalizations and death among those with chronic diseases. People with chronic diseases should be vaccinated, as should those around them to protect with herd immunity.<br />
<br />
The flu shot <b>cannot</b> make anyone sick, even those who are immunocompromised. You do not need to avoid being around someone who is sick or immunocompromised if you've recently been vaccinated.<br />
<br />
<h4>
6. If I get the flu I'll just take medicine to feel better.</h4>
<br />
There is no medicine that makes people with influenza feel better reliably.<br />
<br />
There is no medicine that decreases the spread of influenza to friends and family of those infected.<br />
<br />
We can take fever reducers and pain relievers, but they don't treat the underlying virus. They suppress our immune system so we don't make as much inflammation against the virus, which decreases the symptoms and our body's natural defenses.<br />
<br />
<a href="http://pediatricpartners.blogspot.com/2013/10/cough-medicine-which-ones-best.html" target="_blank">Cough and cold medicines</a> simply don't work well.<br />
<br />
As for antiviral medicines, I have written about <a href="http://pediatricpartners.blogspot.com/2013/10/to-tamiflu-or-not-to-tamiflu.html" target="_blank">Tamiflu</a> previously and why I rarely recommend it.<br />
<br />
Megadoses of vitamin C or other vitamins, homeopathic treatments, essential oils, and other at home treatments have not been shown to significantly help.<br />
<br />
It is important if you get sick, you should limit contact with others. This means missed school and work for at least several days with influenza. Prevention with the vaccine simply is better than trying to treat the symptoms.<br />
<br />
<h4>
7. I don't like shots. (Or my child doesn't like shots.)</h4>
<br />
I'm a pediatrician. Most of my younger patients hate shots. Like <i>really</i> hate shots. They cry, scream, kick, try to run and hide -- you name it, they've tried it to try to avoid shots. They fear shots, but we can help them with techniques that lessen the pain, and they often say "it wasn't that bad" afterwards. For more on how we can help lessen the pain, check out <a href="http://pediatricpartners.blogspot.com/2016/09/vaccines-dont-have-to-hurt-as-much-as.html" target="_blank">Vaccines don't have to hurt as much as some fear</a>.<br />
<br />
<h4>
8. I have an egg allergy so can't get flu shots.</h4>
<br />
In previous years there was a concern that people with egg allergy would have a reaction from the vaccine so it was not recommended, but it has been found to be safer and still <a href="https://www.cdc.gov/flu/protect/vaccine/egg-allergies.htm" target="_blank">appropriate to vaccinate with proper precautions</a>.<br />
<br />
People who have had only hives after egg exposure can safely get flu vaccines following standard protocols.<br />
<br />
People who have symptoms of anaphylaxis with egg exposure that requires epinephrine (respiratory distress, lightheadedness, recurrent vomiting, swelling - such as eyes or lips) should still get the vaccine, but they should be monitored at the appropriate facility (doctor's office, hospital, health department) for 30 minutes to monitor for reactions.<br />
<br />
<br />
<h4>
9. Vaccines are only promoted to make people money. Doctors are shills.</h4>
<br />
<a href="https://shotofprevention.com/2014/10/22/are-doctors-vaccine-recommendations-motivated-by-profits/" target="_blank">Very little profit is made from any vaccine</a>. Really. Some doctors and clinics <a href="http://kidoctr.blogspot.com/2016/07/pediatricians-paid-to-vaccinate-another.html?m=1" target="_blank">lose money by giving vaccines</a>. I often tell my own patients that I don't care if they get the vaccine at my office, the local pharmacy, or at the parent's office - whatever works for them best. I just want everyone vaccinated. This in the end will decrease my revenue because they will not come to the office seeking treatments for a preventable illness. But I am a pediatrician to take care of the health of children, not to make money. Pediatricians are consistently on the bottom of the list of physician salaries. If I was in it for the money, I would have gone into orthopedics or another surgical specialty.<br />
<br />
There are many things to consider when addressing this argument and the <a href="http://www.skepticalraptor.com/skepticalraptorblog.php/big-pharma-vaccine-profits-myth-debunked/" target="_blank">Skeptical Raptor</a> does it well, including links to more information.<br />
<br />
<h4>
10. The flu vaccine contains mercury.</h4>
<br />
While it is true that <a href="https://www.cdc.gov/flu/about/qa/vaxsupply.htm" target="_blank">some flu vaccines contain thimerosal, not all do</a>. Thimerosal was removed from the majority of childhood vaccines in 2001 due to lawmakers responding to constituent demands, not because it was shown to be a risk medically. Since the flu vaccine is not only for children, there are multidose vials that contain thimerosal. If that really bothers you, ask for a version without thimerosal. But since it was removed because people thought thimerosal caused autism and the rates of autism haven't gone down since it was removed, that's pretty strong evidence that it never caused autism. Just like the scientists said. It's a preservative that is effective. I would gladly get a flu vaccine with thimerosal, and have over the years, but the <a href="https://www.cdc.gov/flu/protect/vaccine/thimerosal.htm" target="_blank">majority of flu vaccines given to children in the US are thimerosal free</a>. Just ask.<br />
<br />
<h3>
Flu Vaccine Information and Recommendations for the 2017-2018 Season</h3>
<br />
<ul style="background-color: white; margin: 0px 0px 10px 25px; padding: 0px;">
<li>Both trivalent (3 strain) and quadrivalent (4 strain) vaccines are approved for use this year. There is no preference officially of one over the other, but the vaccine should be appropriate for age.</li>
<li>No FluMist Nasal Spray flu vaccine is recommended. The nasal spray did not work well in the last few seasons it was used in the US. Until it is understood why it wasn't effective then how to make it effective, it will not be recommended.</li>
<li>Pregnant women should be vaccinated to protect themselves and their baby. </li>
<li>Everyone over 6 months of age should be vaccinated. Children 6 months to 8 years who have only had one flu vaccine in their past will need two doses this season. This is because the first dose acts as a primer dose, then a booster dose boosts the immune system. Once the body has had a boost, it only needs a boost each year to improve immunity. </li>
<li>Infants under 6 months of age can gain protection if their mother is vaccinated during pregnancy and if everyone around them is vaccinated. They cannot get the flu vaccine until 6 months of age.</li>
<li>People with egg allergy can be vaccinated. If there is a history of anaphylaxis to egg, they should be monitored for 30 minutes.</li>
<li>The CDC is encouraging everyone to be vaccinated by Halloween if possible, but it's not too late to be vaccinated after that if not yet done this season. It takes up to 2 weeks for the vaccine to be effective. Flu season typically starts in January, but the peak can be as early as November and as late as March.</li>
<li>It is acceptable and encouraged to give the flu vaccine along with other recommended vaccines needed.</li>
</ul>
<a href="https://blogs.cdc.gov/publichealthmatters?s_cid=seasonalflu-btn-090" title="CDC Blog-a-thon"><img alt="CDC Blog-a-thon" src="https://www.cdc.gov/flu/images/resource-center/blog-a-thon-badge.jpg" style="border: 0px; height: 250px; width: 300px;" /></a>
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<span id="goog_1013689565"></span><script type="text/javascript" src="//downloads.mailchimp.com/js/signup-forms/popup/embed.js" data-dojo-config="usePlainJson: true, isDebug: false"></script><script type="text/javascript">require(["mojo/signup-forms/Loader"], function(L) { L.start({"baseUrl":"mc.us17.list-manage.com","uuid":"a0905acc12f10c4129cf49935","lid":"696644206b"}) })</script>Kristen Stuppy, MDhttp://www.blogger.com/profile/10332172268371143329noreply@blogger.com0tag:blogger.com,1999:blog-106825434973779887.post-47463286174540094852017-10-17T14:13:00.000-05:002017-10-17T14:13:16.881-05:007 Vitamin K Myths Busted<div class="tr_bq">
Social media has allowed the sharing of misinformation about many things, especially medically related things. When the specifics of something are unknown to a person, pretty much anything that's said can sound reasonable, so people believe what they hear. This happens with many things, such as vaccine risks, chelation, and vitamin K.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEigchGKNajMc9G0w9GJD0ABDDycUB-dJgUM6P33wEBTEl7MBznFSaBZsimtCKW4V9tZ0Mya9vgd2qnlaeE9nR30bV4SKfjJuPe9o6qK_T1S9yFYogZyJeeu9ba2U7OCbo16ALz8UC4fAHRm/s1600/7+Vitamin+K+Myths+Busted.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="vitamin K, newborn, bleeding, clotting, VKDB, safety, hemorrhagic disease of the newborn, infant" border="0" data-original-height="1102" data-original-width="735" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEigchGKNajMc9G0w9GJD0ABDDycUB-dJgUM6P33wEBTEl7MBznFSaBZsimtCKW4V9tZ0Mya9vgd2qnlaeE9nR30bV4SKfjJuPe9o6qK_T1S9yFYogZyJeeu9ba2U7OCbo16ALz8UC4fAHRm/s400/7+Vitamin+K+Myths+Busted.png" title="7 Vitamin K Myths Busted" width="266" /></a></div>
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I am especially frustrated when parents refuse to give their newborns vitamin K after birth. Since 1961, the American Academy of Pediatrics has recommended giving every newborn a single shot of vitamin K given at birth.<em style="font-family: Lato, "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; font-weight: 700;"> </em>This is a life saving treatment to prevent bleeding. <i>Life saving.</i><br />
<br />
Vitamin K works to help our blood clot. Insufficient levels can lead to bleeding in the brain or other vital organs. Vitamin K deficiency bleeding or VKDB, can occur any time in the first 6 months of life. There are three types of VKDB, based on the age of the baby when the bleeding problems start: early, classical and late. Unfortunately there are usually no warning signs that a baby will have significant bleeding, so when the bleeding happens, it's too late to do anything about it. Why parents don't want to give this preventative life saving treatment is usually based on incorrect information.<br />
<br />
This is a matter of a fairly low risk of bleeding if you don't give vitamin K: 250-1700 per 100,000 within the first week, and 4-7 per 100,000 between 2 and 12 weeks. You might notice that the number is variable - it's hard to study since the large majority of babies have gotten vitamin K over the years and the risk is low even without vitamin K. However, when there is bleeding it has significant consequences: lifelong disability or death. And we also know that there's very low risk from the vitamin K and it works very well to prevent bleeding. So why take the chance of not giving it?<br />
<br />
<h3>
Conspiracy Theories, Misunderstandings, and Science</h3>
<br />
This is not a governmental conspiracy to somehow kill children. It's a world wide attempt to help children survive and thrive. The <a href="http://www.who.int/maternal_child_adolescent/documents/guidelines-recommendations-newborn-health.pdf" target="_blank">World Health Organization (WHO) guidelines</a>:<br />
<br />
<br />
<ul>
<li>All newborns should be given 1 mg of vitamin K intramuscularly [IM] after birth [after the first hour
during which the infant should be in skin-to-skin contact with the mother and breastfeeding
should be initiated].
(Strong recommendation, moderate quality evidence) </li>
</ul>
<br />
<br />
Most people look at scientific information and can't make heads or tails of what it means.<br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgeeDR_qEMjB5WoxTdZzBxwHkNwG5GbaXX0FwUZ97-s2DCF13NHgg2wCfdH_tkgFlHkZxoUMBJimbXOBSah74YCc3tXRcL76Tad-xfTzlmjWeHz1afbMHy_AAVmNs2-dLvTyEqMQT5ZKDm-/s1600/Screen+Shot+2017-06-20+at+11.46.18+AM.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="382" data-original-width="479" height="255" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgeeDR_qEMjB5WoxTdZzBxwHkNwG5GbaXX0FwUZ97-s2DCF13NHgg2wCfdH_tkgFlHkZxoUMBJimbXOBSah74YCc3tXRcL76Tad-xfTzlmjWeHz1afbMHy_AAVmNs2-dLvTyEqMQT5ZKDm-/s320/Screen+Shot+2017-06-20+at+11.46.18+AM.png" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Photo Source: <a href="http://emedicine.medscape.com/article/974489-overview" target="_blank">Hemorrhagic Disease of the Newborn</a></td></tr>
</tbody></table>
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That coupled with the fact that things we read that make us react emotionally (such as fear that something will harm our child) makes us remember and associate with the information that created the emotion, whether it is right or wrong. This can lead parents to make dangerous decisions for their children while trying to do the right thing.<br />
<br />
<h3>
Myth Busting</h3>
<br />
I'm going to attempt to de-bunk the most common concerns I've heard because the best way to combat misinformation is to help explain the facts as we know them.<br />
<br />
<b>1. If every baby's born with too little vitamin K, that's the way we're supposed to be.</b><br />
<blockquote class="tr_bq">
Babies are born with very little vitamin K in their body. If they don't get it with a shot, they need to either eat it or make it. Breast milk has very little vitamin K and babies won't be eating leafy greens for quite awhile. Formula does have it, but it takes several days for vitamin K to rise to protective levels with formula and the highest risk of bleeding is during that first week of life. (Of course if you're using this argument because you want babies to be all natural, you probably won't be giving formula at this point.) </blockquote>
<blockquote class="tr_bq">
Bacteria help us make vitamin K, but babies aren't colonized at birth with these gut bacteria. </blockquote>
<blockquote class="tr_bq">
Just because they're born that way doesn't mean they're supposed to stay that way. Inside the mother the baby is in a very different situation. They don't breathe air. They don't eat. They don't have gut bacteria. Their heart has a bypass tract to avoid pumping blood to the lungs. This all works well in utero, but must change once they leave the womb. Change takes time, and during this time they are at risk. <i>Why not minimize the risk if we know a safe way to do it?</i></blockquote>
<br />
<b>2. The package insert has a big warning at the top that it can kill.</b><br />
<blockquote class="tr_bq">
There are many reasons why we should not use the package insert of a medicine or vaccine to make healthcare decisions. These have been discussed before so I won't go into all the details but please see these great blogs on how to read and use package inserts:</blockquote>
<br />
<blockquote class="tr_bq">
<ul>
<li> <a href="https://www.chrisjohnsonmd.com/2017/05/28/vaccine-skeptics-obsession-with-drug-package-inserts/" target="_blank">ChristopherJohnsonMD</a> </li>
</ul>
</blockquote>
<blockquote class="tr_bq">
<ul>
<li><a href="http://www.harpocratesspeaks.com/2014/09/package-inserts-understanding-what-they.html" target="_blank">HarpocratesSpeaks</a> </li>
</ul>
</blockquote>
<blockquote class="tr_bq">
<ul>
<li><a href="https://thelogicofscience.com/2016/07/25/vaers-package-inserts-and-the-vicp-do-not-prove-that-vaccines-are-dangerous/" target="_blank">TheLogicOfScience</a> </li>
</ul>
</blockquote>
<blockquote class="tr_bq">
<ul>
<li><a href="https://www.skepticalraptor.com/skepticalraptorblog.php/vaccine-package-inserts-debunking-myths/" target="_blank">SkepticalRaptor</a> </li>
</ul>
</blockquote>
<blockquote class="tr_bq">
<ul>
<li><a href="http://scienceblogs.com/insolence/2014/06/03/adams-turns-his-mad-science-skillz-to-analyzing-a-flu-vaccine/" target="_blank">ScienceBlogs</a></li>
</ul>
</blockquote>
<br />
<blockquote class="tr_bq">
</blockquote>
<blockquote class="tr_bq">
It is true that there is a black box warning on the top of the vitamin K package insert. This has scared some parents from wanting to get the vitamin K shot for their newborn. </blockquote>
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<blockquote>
Reactions to IV (intravenous) vitamin K are much more common than IM (intramuscular) injections. The difference is anything given by IV goes directly into the bloodstream and back to the heart. But we don't give vitamin K by IV to newborns. </blockquote>
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IM injections go into the muscle, allowing very slow absorption of the medicine. This not only decreases reactions to the injected vitamin, but also helps the level of vitamin K stay elevated for a prolonged time after a single injection. </blockquote>
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I only found <a href="https://www.ncbi.nlm.nih.gov/pubmed/24059412" target="_blank">one report of a newborn with a significant reaction to vitamin K</a>. The authors of the paper did note that IM vitamin K has been given for many years to babies all over the world without significant reactions and could not explain why the one infant had such a significant reaction. </blockquote>
<blockquote>
Since we must always look at risk vs benefit, the very, very low risk of a serious reaction from receiving vitamin K IM is preferable to the benefit of the prevention of VKDB.</blockquote>
<blockquote class="tr_bq">
Another great resource on this topic is Dr. Vincent Iannelli's <a href="https://keepkidshealthy.com/2017/07/11/that-black-box-warning-on-vitamin-k-shots/" target="_blank">That Black Box Warning on Vitamin K Shots</a>. </blockquote>
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<b>3. Vitamin K causes cancer.</b><br />
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Many years ago there was a small study that suggested vitamin K led to childhood cancers. This issue has been extensively studied since then and no link has been found. </blockquote>
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Vitamin K does not cause cancer. </blockquote>
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Rates of cancer have not increased in the years since vitamin K has been given to the large majority of newborns worldwide. This is reported in the Vitamin K Ad Hoc Task Force of the American Academy of Pediatrics report <a href="http://pediatrics.aappublications.org/content/pediatrics/91/5/1001.full.pdf" target="_blank">Controversies Concerning Vitamin K and the Newborn</a>.</blockquote>
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<b>4. Bleeding from vitamin K deficiency is rare or mild.</b><br />
<blockquote class="tr_bq">
In the US bleeding from vitamin K deficiency is rare because most babies get the vitamin K shot soon after birth. In countries where vitamin K is not used routinely, bleeding is not rare at all. <a href="https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6245a4.htm?s_cid=mm6245a4_w" target="_blank">Some communities of the US</a> where vitamin K is being refused by parents are seeing an increase in newborn bleeding.</blockquote>
<blockquote class="tr_bq">
Early VKDB occurs within 24 hours of birth and is almost exclusively seen in infants of mothers taking drugs which inhibit vitamin K. These drugs include anticonvulsants, anti-tuberculosis drugs, some antibiotics (cephalosporins) and blood thinners to prevent clots. Early VKDB is typically severe bleeding in the brain or gut.<br />
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Classic VKDB typically occurs during the first week of life. The incidence of classic VKDB ranges from 0.25-1.7 cases per 100 births.<br />
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Late onset VKDB occurs between 2 and 12 weeks usually, but is possible up to 6 months after birth. Late VKDB has fallen from 4.4-7.2 cases per 100,000 births to 1.4-6.4 cases per 100,000 births in reports from Asia and Europe after routine prophylaxis was started.</blockquote>
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One out of five babies with VKDB dies. Of the infants who have late VKDB, about half have bleeding into their brains, which can lead to permanent brain damage if they survive. Others bleed in their stomach or intestines, or other vital organs. Many need blood transfusions or surgeries to help correct the problems from the bleeding. </blockquote>
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<b>5. It's just as good to use oral vitamin K.</b><br />
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Early onset VKDB is prevented well with the oral vitamin K in countries that have oral vitamin K available, but late onset VKDB is an issue. Children with liver or gall bladder problems will not absorb oral vitamin K well. These problems might be undiagnosed early in life, putting these kids at risk for VKDB if they are on an oral vitamin K regimen.</blockquote>
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There is no liquid form of vitamin K that is proven to be effective for babies in the US. That is a huge issue. Some families will order vitamin K online, but it's not guaranteed to be safe or even what it claims to be. This is an unregulated industry. It is possible to use the vitamin K solution that is typically given intramuscularly by mouth, but this requires a prescription and the taste is questionable, so baby might not take the full dose. It would be an off-label use so physicians might not feel comfortable writing a prescription. The other issue that might worry physicians is with compliance in remembering to give the oral vitamin K as directed, since most studies include babies with late onset bleeding who had missed doses. </blockquote>
<blockquote class="tr_bq">
Most of us get vitamin K from gut bacteria and eating leafy green vegetables. Newborns don't have the gut bacteria established yet so they won't make any vitamin K themselves. They may get vitamin K through their diet, but breastmilk is very low in vitamin K, so unless baby is getting formula, they will not get enough vitamin K without a supplement. It is possible for mothers who breastfeed to increase their vitamin K intake to increase the amount in breast milk, but not to sufficient levels to protect the baby without additional vitamin K.</blockquote>
<blockquote class="tr_bq">
Many countries that have used an oral vitamin K protocol, such as <a href="file:///Users/kristenstuppy/Downloads/e20154222.full.pdf" target="_blank">Denmark</a> and Holland, have changed to an intramuscular regimen because the oral vitamin K that was previously used became no longer available. </blockquote>
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<a href="https://www.ncbi.nlm.nih.gov/pubmed/9039517" target="_blank">There are various oral vitamin K dosing strategies</a> that can be reviewed in the linked abstract. In short:</blockquote>
<blockquote class="tr_bq">
<ul>
<li> Australia and Germany: 3 oral doses of 1 mg vitamin K are less effective than a single IM vitamin K dose. (In 1994 Australia changed to a single IM dose and their rate went to zero after the change.) </li>
</ul>
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<ul>
<li>Netherlands: A 1mg oral dose after birth followed by a daily oral dose of 25 mcg vitamin K1may be as effective as parenteral vitamin K prophylaxis.</li>
</ul>
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<ul>
<li><a href="https://www.ncbi.nlm.nih.gov/pubmed/23192459" target="_blank">Sweden:</a> (a later study) 2 mg of mixed micellar VK given orally at birth, 4 days, and 1 month has a failure rate of one case of early and four cases of late VKDB out of 458,184 babies. Of the failures, 4 had an undiagnosed liver issue, one baby's parents forgot the last dose.</li>
</ul>
</blockquote>
<blockquote class="tr_bq">
When vitamin K is given IM, the chance of late VKDB is near zero. Oral vitamin K simply doesn't prevent both early and late bleeding as well -- especially if there is an unknown malabsorption disorder, regardless of which dosing regimen is used. </blockquote>
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<b>6. My baby's birth was not traumatic, so he doesn't need the vitamin K.</b><br />
<blockquote class="tr_bq">
Birth trauma can certainly lead to bleeding, but the absence of trauma does not exclude it. Late vitamin K deficient bleeding (VKDB) cannot be explained by any birth traumas since they can occur months later. </blockquote>
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<b>7. We're delaying cord clamping to help prevent anemia and bleeding. Isn't that enough?</b><br />
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<blockquote class="tr_bq">
Delayed cord clamping can have benefits, but decreasing the risk of bleeding is not one of them. There is very little vitamin K in the placenta or newborn, so delaying the cord clamping cannot allow more vitamin K into the baby. </blockquote>
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<h3>
Still not convinced?</h3>
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Read stories about babies whose parents chose to not give vitamin K:</div>
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<ul>
<li><a href="https://www.cdc.gov/ncbddd/vitamink/judah-stories.html" target="_blank">Judah's story</a></li>
<li><a href="https://cestsibonblog.wordpress.com/2014/02/28/the-story-of-a-miracle-the-first-24-hours/" target="_blank">Olive's story</a>, <a href="https://cestsibonblog.wordpress.com/2014/03/02/the-story-of-a-miracle-getting-out-of-the-woods/" target="_blank">more on Olive</a>, and the <a href="https://cestsibonblog.wordpress.com/2014/03/07/why-it-happened-the-truth-about-vitamin-k-deficiency-bleeding/" target="_blank">final words on Olive's story</a></li>
<li><a href="https://www.usatoday.com/story/news/nation/2013/08/30/babies-suffer-bleeding-disorder-after-parents-refuse-shots-/2750023/" target="_blank">Tennessee babies</a></li>
</ul>
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<h3>
For More Information:</h3>
<a href="https://evidencebasedbirth.com/evidence-for-the-vitamin-k-shot-in-newborns/" target="_blank">Evidence on: The Vitamin K Shot in Newborns</a> (Evidenced Based Birth)<br />
<div>
<a href="https://www.cdc.gov/ncbddd/vitamink/faqs.html" target="_blank">Frequently Asked Questions (FAQ’s): Vitamin K and the Vitamin K Shot Given at Birth</a> (CDC)<br />
<div>
<a href="http://emedicine.medscape.com/article/974489-overview" target="_blank">Hemorrhagic Disease of the Newborn</a> (eMedicine)<br />
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<a href="https://www.nurseandnourish.com/single-post/2017/04/20/Vitamin-K-in-Breast-Milk---Can-it-replace-the-shot" target="_blank">Vitamin K in Breast Milk - Can it Replace the Shot?</a> (Nurse and Nourish)<br />
<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3021393/" target="_blank">Vitamin K in neonates: facts and myth</a> (NCBI)<a href="https://www.cdc.gov/ncbddd/vitamink/faqs.html" target="_blank"> </a></div>
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Kristen Stuppy, MDhttp://www.blogger.com/profile/10332172268371143329noreply@blogger.com0tag:blogger.com,1999:blog-106825434973779887.post-63522385353918121342017-10-17T06:43:00.001-05:002017-10-17T06:43:57.951-05:00Lead by exampleWe've all heard the saying: kids will do what they're shown, not as they're told.<br />
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It is so true. Think about all the times your kids are watching you. They are learning from you. </div>
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What can you do to help them have healthy habits?</div>
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<li>Eat your vegetables.</li>
<li>Get daily exercise.</li>
<li>Wear your seatbelt. </li>
<li>Stop at stop signs.</li>
<li>Don't use your phone while driving.</li>
<li>Wear a life vest near a lake or river.</li>
<li>Maintain your composure during times of stress.</li>
<li>No phones at the dinner table.</li>
<li>Don't tell lies- even little ones.</li>
<li>Get enough sleep.</li>
<li>Be kind to others.</li>
<li>Call home- your parents and siblings would love to hear from you.</li>
<li>Don't permit violence in your presence.</li>
<li>Give your time and talents to others.</li>
<li>Take care of your things.</li>
<li>Limit screen time.</li>
<li>Brush your teeth at least twice a day and floss daily.</li>
<li>Wear a helmet when on a bike.</li>
<li>Don't mow the lawn without proper shoes. </li>
<li>Make time for family.</li>
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Kristen Stuppy, MDhttp://www.blogger.com/profile/10332172268371143329noreply@blogger.com0tag:blogger.com,1999:blog-106825434973779887.post-6032914239416344612017-10-10T12:52:00.000-05:002017-10-17T06:40:32.769-05:00Breast is Best... Unless it's NotWe've all heard the well-intentioned slogan "Breast Is Best" in reference to supporting breastfeeding. Breastmilk is made just for our babies, so yes, it is a great source of nutrition. But it isn't the only option and there are many reasons mothers give formula and even with exclusive breastfeeding there comes a time that infants need additional sources of nutrition.<br />
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I decided to write on this topic because I see so many mothers struggle to feed their baby and they feel like a failure if they don't exclusively breastfeed. And then to top it off I saw a blog that encouraged exclusive breastfeeding without any foods or supplements until one year of age. I knew someone had to counter that thought before it becomes popular. It shouldn't be a badge of honor to breastfeed to the point of potential harm to the infant, and some ultra-crunchy moms are bragging about it as if it is.<br />
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<b>You're not a failure if you feed your baby</b>, regardless of what you feed your baby as long as it's age appropriate. Your baby needs nutrition and hydration. While most babies under 6 months of age can get all their nutrition from breastmilk, some need a boost, especially at the beginning of life. If you’re not producing enough milk, you’ll need to give your baby some formula as well (or use a milk donor). Usually this is temporary - just until your own milk supply increases or until your baby starts enough solid foods that the supplement isn’t needed. I'm not suggesting that every newborn who struggles at the breast should be supplemented, but if your doctor says the baby's blood sugar is low or the <a href="https://www.newbornweight.org/" target="_blank">baby is losing too much weight</a>, it's not only okay, but it's necessary to supplement.<br />
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<h3>
Benefits of Breast Milk</h3>
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Most of us have heard by now the many benefits of breastfeeding for the baby, including:<br />
<ul>
<li>Immune system benefits. (Which means fewer infections, meaning not only helping babies stay healthy, but also leading to fewer lost work days for working parents and fewer sleepless nights for all parents.)</li>
<li>Decreased risk of Sudden Infant Death Syndrome.</li>
<li>Decreased risk of asthma in a child who has breastfed.</li>
<li>Decreased risk of diabetes when the baby grows up.</li>
<li>Decreased risk of obesity as the baby grows up.</li>
<li>Decreased risk of certain cancers in the child, such as leukemia.</li>
<li>Improved cognitive development of the child.</li>
</ul>
Benefits for mothers include:<br />
<ul>
<li>Less bleeding, both in the immediate postpartum period from contracting the uterus after birth, and fewer menstrual cycles during breastfeeding. </li>
<li>Decreased risk of getting pregnant while breastfeeding - though this is not 100% effective! If you're not wanting to get pregnant don't rely on breastfeeding alone.</li>
<li>Easier return to pre-pregnancy weight.</li>
<li>Decreased risk of ovarian and breast cancers.</li>
<li>Decreased risk of Type II diabetes.</li>
<li>Decreased risk of postpartum depression.</li>
<li>Decreased risk of heart disease.</li>
<li>Less missed work (see immune system benefits above).</li>
<li>Cost - breastmilk is free and formula is expensive. Breast pumps should be covered by insurance. </li>
</ul>
<h3>
When Breast Milk Isn't Enough, Isn't Desired, or Isn't Safe</h3>
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Despite the benefits, breastfeeding not always possible or desired. In the US, 8 out of 10 mothers start breastfeeding during the newborn period. Only half are still nursing at 6 months, and less than a third are still nursing at 12 months.<br />
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The <a href="https://www.healthychildren.org/English/ages-stages/baby/feeding-nutrition/Pages/Switching-To-Solid-Foods.aspx" target="_blank">American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for approximately 6 months</a>, followed by continued breastfeeding for 1 year or longer, as mutually desired by mother and child. Some <a href="http://pediatrics.aappublications.org/content/106/Supplement_4/1274.1" target="_blank">AAP sources indicate starting foods at 4-6 months</a>. The <a href="https://www.aaaai.org/conditions-and-treatments/library/at-a-glance/prevention-of-allergies-and-asthma-in-children" target="_blank">American Academy of Allergy, Asthma & Immunology (AAAAI) recommends introducing foods between 4 and 6 months to prevent certain allergies</a>.<br />
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<b>There are very few contraindications to breastfeeding:</b><br />
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<ul>
<li>Classic galactosemia. Classic galactosemia is a rare genetic condition in which a baby is unable to metabolize galactose. It is one of the conditions we screen on the newborn screen. Galactose is the sugar made from the lactose in milk. When galactose is not metabolized, it will reach high levels in the blood and become toxic, causing cataracts in the eyes, damage to the liver and kidneys, and brain damage. The galactosemic baby will fail to thrive on breast milk or formula based on cow's milk. The treatment for this condition is to remove all sources of lactose from the baby's diet and give soy formula.</li>
<li>HIV. Mothers who have HIV and are able to feed formula made with safe water should not breastfeed according to current guidelines. However, there is growing evidence that <a href="https://www.nih.gov/news-events/news-releases/hiv-therapy-breastfeeding-mothers-can-virtually-eliminate-transmission-babies" target="_blank">HIV positive mothers who take proper medications can safely breastfeed</a>.</li>
<li>Untreated active tuberculosis.</li>
<li>Chemotherapy or radiation treatment.</li>
<li>Certain drugs. Most medications are compatible with breastfeeding. You can look on <a href="https://toxnet.nlm.nih.gov/newtoxnet/lactmed.htm" target="_blank">Lactmed</a> to learn if a particular medicine is safe or what other options are recommended. </li>
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<b>Some mothers do not want to breastfeed for various reasons.</b> That's okay. It isn't for everyone. No one should say things that make these mothers feel guilty. They brought new life into the world. That alone is an amazing feat. As long as the baby is fed age-appropriate and formula that has been approved for use in infants, it is great.<br />
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Babies can thrive on formula. Just be careful of the many alternate formulas and milks that are advertised online. Discuss with your child's pediatrician if you plan on making your own formula or giving another alternative milk. There are many concerns with these, as discussed in <a href="https://www.thescientificparent.org/please-dont-feed-your-baby-homemade-formula/">Please Don’t Feed Your Baby Homemade Formula!</a><br />
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<b>Some mothers really want to exclusively breastfeed but they have problems.</b> Working with a lactation consultant and physicians (both mother's and baby's doctors) might help if there is a correctable condition, such as<br />
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<ul>
<li>insufficient breastfeeding attempts per 24 hours - not feeding frequently decreases supply</li>
<li><a href="http://pediatricpartnerskc.com/Education/Newborns/Tongue-Tie.aspx" target="_blank">tongue tie</a> treatment can improve latch and milk transfer from the breast into baby</li>
<li>jaundice, which makes baby sleepy and not feed as effectively</li>
<li>identifying and treating hormonal problems in mother</li>
<li>identifying and stopping medicines or herbs that might be inhibiting milk supply</li>
<li>stopping nipple shields as soon as possible - the use of nipple shields can decrease breast stimulation and lower supply</li>
<li>avoid unnecessary supplements - supplementing with formula can decrease supply overall because the mother's breast makes milk based on how much is used (This does not mean you should avoid formula if it is medically necessary.)</li>
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<b>Even when breastfeeding goes well for both Mother and Baby, it is not sufficient to be the sole source of nutrition for the entire first year of life.</b> There are some mom blogs that support exclusive breastfeeding for the first year of life, and that is not safe. I'm not linking any of them here because I don't want to promote them, but if you don't believe me just do a quick search and you will find some.<br />
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While breast milk is fantastic for young infants, it does not have the nutritional components to exclusively feed for the second half of the first year. Feeding with food from fingers or a spoon also encourages healthy development of fine motor skills.</div>
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It is important for older infants to learn to eat from a developmental standpoint. Once they can sit fairly well, turn away from food or open their mouth in response to food, they are showing signs that they are ready to start eating. They don't need teeth to move foods around in their mouth and make chewing motions. </div>
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They are much less averse to new things typically when they're younger, so if babies are delayed past a year they are much more likely to be picky eaters and not get the nutrition they need during childhood.</div>
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Then there's the research that shows that delaying certain foods past a year increases the risk of allergy. If you've ever seen a child with anaphylaxis to peanuts, you won't want to increase this risk for your child! See the <a href="http://www.aappublications.org/news/2017/01/05/PeanutAllergy010517?utm_source=TrendMD&utm_medium=TrendMD&utm_campaign=AAPNews_TrendMD_0" target="_blank">AAP's guidance on introduction of high-risk allergenic foods</a>. </div>
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Babies need a source of <a href="http://pediatricpartnerskc.com/Education/Nutrition/Iron-Supplementation-Recommendations.aspx" target="_blank">iron after about 4-6 months of age</a>. If they are not eating foods rich in iron (meats, legumes, egg yolk, leafy greens) they will need an iron supplement. Many of the bloggers who support exclusive breastfeeding do not want any supplements at all. Just breast milk. It simply isn't enough to support the older infant's growing brain and body. </div>
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<a href="http://pediatricpartnerskc.com/Education/Nutrition/Vitamin-D-Recommendations.aspx" target="_blank">Vitamin D</a> is important for us all, but it is not passed through breast milk well unless a mother is taking at least 6400 IU/day. Historically we could make vitamin D with the help of the sun, but we now know that sun damages our skin so it is safer to protect against excessive sun exposure. This puts us at risk for vitamin D deficiency. The AAP recommends that newborns begin supplementing with 400 IU/day of vitamin D soon after birth, and increase to 600 IU/day at 6 months of age. The supplement should continue even if they transition to Vitamin D fortified cow's milk at 1 year of age.<br />
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<h4>
Any problems feeding should be discussed with your child's doctor</h4>
<div>
If your baby struggles with feeding, whether it's breastfeeding, formula feeding, or eating foods, please discuss it with your child's doctor. There are many reasons feeding might not go well, and we need to insure that your baby is being adequately fed. We will look at your baby's overall growth and development in addition to discussing the specific details of the problems. </div>
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<h4>
Resources</h4>
<div>
<a href="https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Breastfeeding/Pages/default.aspx" target="_blank">Breastfeeding landing page for the American Academy of Pediatrics</a><br />
<a href="https://www.healthychildren.org/English/ages-stages/baby/feeding-nutrition/Pages/Vitamin-Iron-Supplements.aspx" target="_blank">Vitamin D & Iron Supplements for Babies: AAP Recommendations</a></div>
<div>
<br /></div>
<h4>
Related Blogs on Quest for Health</h4>
</div>
<a href="http://pediatricpartners.blogspot.com/2016/09/over-and-under-supply-of-breast-milk.html" target="_blank">Over and Under Supply of Breast Milk</a><br />
<div>
<a href="http://pediatricpartners.blogspot.com/2013/04/feeding-your-newborn.html" target="_blank">Feeding Your Newborn</a></div>
<a href="http://pediatricpartners.blogspot.com/2012/09/breastfeeding-easier-for-working-moms.html" target="_blank">Breastfeeding: Easier for Working Moms with New Insurance Rules</a><br />
<div>
<a href="http://pediatricpartners.blogspot.com/2011/11/new-sids-prevention-guidelines.html" target="_blank">New SIDS Prevention Guidelines</a></div>
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Kristen Stuppy, MDhttp://www.blogger.com/profile/10332172268371143329noreply@blogger.com0tag:blogger.com,1999:blog-106825434973779887.post-71568021993054983122017-09-19T16:41:00.000-05:002017-10-10T12:59:11.047-05:00Car Seats for SafetyIt's been years since I've written about <a href="http://pediatricpartners.blogspot.com/2012/04/car-seat-confusion-and-booster-boo-boos.html" target="_blank">car seat safety</a> and since September 17-23, 2017, is Child Passenger Safety Week I thought I'd take a moment to review car seat safety basics and share some of my favorite car seat safety links.<br />
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Most parents are now aware that all infants must be in a rear facing car seat, but many turn their toddlers around too early or let older kids move to the next level too soon.<br />
<br />
I tell kids all the time that the state law is the bare minimum, but it isn't necessarily the safest way to ride. I use the example that in my state an adult can ride a motorcycle without a helmet, but that's not safe. They usually agree, and I think it helps them understand that just because it's legal to do something, it doesn't make it safe to do.<br />
<br />
Kids learn from the behaviors they see their parents display, so all parents should buckle up for safety!<br />
<br />
When looking for a car seat or booster seat, don't assume spending more money will buy a better seat. You need to be sure it fits your vehicle and your child.<br />
<br />
<b>Infants and children under 2 years</b> should ride rear facing unless they are bigger than the height or weight maximum for the seat. Children over 2 years who still fit in the height and weight requirements of the rear facing car seat can still ride rear facing safely. Young children often fall asleep in the car. If sleep deprived (no parent is ever really well rested) and in a hurry, even the best parent can be distracted and forget about the sleeping baby. <a href="http://thestir.cafemom.com/baby/174521/7_tips_to_ensure_you" target="_blank">There are many tips to follow to be sure you don't leave your baby unattended in the car.</a><br />
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<b>Children who are 2 years old or older</b> (and those less than 2 years but larger than the rear facing car seat maximum height or weight) should use a forward facing car seat with a 5 point harness until they are capable of staying seated during the duration of the drive and meet the minimum height and weight requirements for a booster seat. Learn to use the <a href="https://www.safekids.org/infographic/tethers-make-difference" target="_blank">tether</a> properly with your forward facing car seat.<br />
<br />
<b>Children should remain in a booster seat</b> until the vehicle's lap and shoulder seat belt fits them properly. This is generally between 10 and 12 years of age and about 4 foot 9 inches, but varies based on the size of the vehicle's seat. Everyone should always use the vehicle's seat belt (or car seat harness) when riding. Have your kids take the <a href="http://thecarseatlady.com/who-should-use-a-booster/" target="_blank">5 Step Test</a> to see if kids can safely ride without a booster.<br />
<br />
<b>Only teens and adults should sit in the front seat.</b> It's always safer in the back seat. If you look at the sticker on the passenger side visor, it will say something to the effect that children 12 and under are safer in the back seat. That means wait until 13 years of age to sit up front. Airbags can be dangerous if a passenger is too short for it to hit properly in the chest. The force of the airbag can cause significant injury to the face or neck. If the airbag is turned off, the passenger is at risk of hitting the dashboard or being ejected from the car. Even big kids don't have the muscle or bone strength to be safe up front. They aren't mini-adults.<br />
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<b>In the winter months</b> it's important to avoid over bundling infants and children in car seats. The added layers and padding of clothing can increase the amount a child can move in the force of a crash or sudden stop. <a href="http://thecarseatlady.com/warmandsafe/" target="_blank">The Car Seat Lady has great tips to keep kids warm and safe in the cold weather</a>.<br />
<b><br /></b>
<a href="https://csftl.org/non-regulated-products/" target="_blank"><b>Don't use car seat attachments and accessories</b></a> that were not sold with the seat. They may look cute or seem to make your child more comfortable, but if they haven't been tested with the seat they may not be safe - even if they claim to be safety tested. This includes neck rolls, shoulder pads, winter covers that go between the child and the seat, dangling toys, and more. If you're in an accident and have these additions they might void the warranty of the seat.<br />
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<b>Do you have a Houdini?</b> If your toddler or preschooler is able to weasel out of the car seat harness, try this <a href="http://thecarseatlady.com/tips-and-tricks/houdini/" target="_blank">button down shirt trick</a>.<br />
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<b>Take your kids to a certified car seat installer </b>to see if they're buckled in properly. <a href="https://csftl.org/finding-a-cpst/" target="_blank">Car Seats for the Littles has information about how to find an installer near you.</a><br />
<br />
<a href="https://www.safekids.org/other-resource/register-your-car-seat" target="_blank"><b>Register your car seats</b></a> so you can be alerted if they are recalled.<br />
<b><br /></b>
<b>Car Seat Stickers</b> are a great way to notify first responders who to call if you've been in an accident and aren't able to communicate. I recommend putting them under the cloth part of infant seats so they aren't visible when you're carrying the seat in public. You can put a small sticker on the handle to let emergency personnel know to look under the padding for emergency contact information. Once kids are out of the infant seat you can put the sticker on the outside of the seat, just not over any important information (such as the height/weight max information). My office gives stickers from the <a href="http://www.whaleprogram.org/" target="_blank">W.H.A.L.E. Program</a> to patients, but you can print your own at home and attach them to your seat with wide clear tape. Information to include would be:<br />
<br />
<ul>
<li>Child's name, birth date, address, allergies, important health history, medications</li>
<li>Parent's names and phone numbers (cell and work)</li>
<li>One emergency contact name and phone number (not a parent) </li>
<li>Doctor's name and number</li>
<li>Childcare provider name and number if applicable </li>
</ul>
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<br />
<b>Remember that if you're in an accident</b>, your car seats might need to be replaced. Talk to your insurance company.<br />
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<b><a href="http://thecarseatlady.com/used-and-borrowed-car-seats/" target="_blank">Used and borrowed seats cautions</a>: </b><br />
<br />
<ul>
<li>Be sure to know when your seats expire. The seats typically expire about 6 years after manufacturing due to unseen breakdown in the materials used to make the seat. </li>
<li>Never buy a used seat from someone you do not know. A friend or family member should verify that it hasn't been in an accident and it's not expired before you use it. </li>
<li>Don't just throw your old car seat away. Someone might try to use it past its expiration date. You can break it down into pieces to make it unusable or you can see if you can <a href="http://recycleyourcarseat.org/" target="_blank">recycle it</a>. </li>
</ul>
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<h4>
For more information:</h4>
<br />
<ul>
<li><a href="https://www.nhtsa.gov/equipment/car-seats-and-booster-seats" target="_blank">National Highway Traffic Safety Administration</a></li>
<li><a href="http://thecarseatlady.com/" target="_blank">The Car Seat Lady</a></li>
<li><a href="https://csftl.org/" target="_blank">Car Seats for the Littles</a></li>
<li><a href="https://www.safekids.org/car-seat" target="_blank">Safe Kids Car Seat Information</a></li>
<li><a href="https://www.safekids.org/safetytips/field_risks/booster-seat" target="_blank">Safe Kids Booster Seat Information</a></li>
<li>LATCH information from <a href="http://thecarseatlady.com/latch-101-the-basics-you-need-to-know/" target="_blank">The Car Seat Lady</a>, <a href="https://www.safekids.org/infographic/tethers-make-difference" target="_blank">Safe Kids</a>, and <a href="https://csftl.org/whats-the-deal-with-weight-limits/" target="_blank">Car Seats for the Littles</a></li>
<li><a href="https://www.healthychildren.org/English/safety-prevention/on-the-go/Pages/Car-Safety-Seats-Information-for-Families.aspx" target="_blank">HealthyChildren.org</a></li>
<li><a href="https://www.healthychildren.org/English/safety-prevention/on-the-go/Pages/Car-Safety-Seats-and-Obese-Children-Suggestions-for-Parents.aspx" target="_blank">Car seats for obese children</a></li>
<li><a href="https://www.healthychildren.org/English/safety-prevention/on-the-go/pages/Car-Safety-Seats-Product-Listing.aspx" target="_blank">2017 Car Seat List</a></li>
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<span id="goog_468624065"></span><span id="goog_468624066"></span><br />Kristen Stuppy, MDhttp://www.blogger.com/profile/10332172268371143329noreply@blogger.com0tag:blogger.com,1999:blog-106825434973779887.post-60326939412598284922017-08-26T07:47:00.001-05:002017-09-19T14:26:50.451-05:00HPV vaccine concernsThe large majority of the parents who bring their children to my office want their children to be vaccinated against any disease we can protect them against. The HPV vaccine is one exception. While most of my patients are given the Gardasil at their 11 or 12 year check up, some parents still "want to do their research" or "have heard things" so they decline to protect their kids at those visits. Sadly they often return year after year and say that they still haven't done their research, so their child remains unprotected. Sometimes they'll say that they will let their child decide at 18 years of age. Sadly, by that age many will have already been infected.<br />
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I recently had a parent share <a href="https://cbhd.org/content/hpv-vaccine-panacea-or-pandora%E2%80%99s-box-costs-and-deceptiveness-new-technology" target="_blank">HPV Vaccine: Panacea or Pandora’s Box? The Costs and Deceptiveness of the New Technology</a> with me. She had concerns based on the information in this article. The first thing I noted was that it is from 2011. This is outdated, since we have learned so much in the six years since it was published, yet like many anti-vax articles, it continues to circulate online.<br />
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<o:p> The f</o:p><span style="font-size: 12pt;">irst argument is that it won’t last long enough. </span></div>
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<span style="background-color: white; color: #494949; font-family: "verdana" , sans-serif; font-size: 12px;">It is therefore possible that the protective effects of the vaccination will wane at the time when women are most susceptible to the oncogenic effects of the virus (those over 30), providing protection to those who do not need it (adolescents) and failing to provide protection to those who do (women over 30).</span></blockquote>
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<span style="font-size: 12pt;">Studies show
protection lasts 10 years and hasn’t dropped by that time. If future studies
show a booster is needed, we can add that. That in no way should mean to not
give protection for the years it is really needed – adolescence and young adult
life. I cannot agree with the statement that providing protection "to those who do not need it (adolescents)" at all. Yes teens need protection. I'll get more into their risks below. And the fact that women over 30 are more likely to develop the cancer does not mean that is when they come into contact with the virus. It's kind of like saying that kids don't need to brush their teeth because they don't have cavities. If you wait for the cavities to develop, it's too late!</span></div>
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The second argument is based on old version of the vaccine. We
now use the 9 valent variety, which covers the large majority of cancer causing
strains. Again, even if there are other strains, why not protect against what
we have?<br />
<o:p></o:p></div>
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The argument that natural immunity will last longer than the
vaccine immunity is not a valid argument. Natural immunity can wane with some
diseases too, and if we can protect against the disease, it is preferable.
Boosters for many vaccines are needed when we know immunity wanes. That’s okay.
Some parents advocate to not vaccinate and get the real disease. When their
kids get whooping cough they’re miserable. Many are hospitalized. Some even die. I’d
rather do boosters! (This may be a bad example because I don’t think our
booster for whooping cough lasts long enough and there are complications with
giving boosters more often, but ongoing surveillance and research will continue and hopefully improve the situation.)<o:p></o:p></div>
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The cost issue is interesting. If it was not cost effective
in the long run, insurance companies wouldn’t pay for it. It’s that simple.
They’ve done the math. <a href="http://www.cancer.org.au/news/blog/prevention/australian-study-first-to-assess-real-world-impact-of-hpv-vaccine-on-cervical-cancer.html" target="_blank">Australia is a great example</a>. Their cancer rates are
down because HPV is a mandatory vaccine. <o:p></o:p></div>
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The risks listed have all been shown to not be as risky as
once shown.<o:p></o:p></div>
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<br />
<ul>
<li><a href="http://www.medicalnewstoday.com/articles/240897.php" target="_blank">HPV Vaccine Not Linked To Autoimmune Disorders, Study</a></li>
<li><a href="https://shotofprevention.com/2016/01/21/questioning-whether-to-get-your-child-the-hpv-vaccine-read-this/" target="_blank">Questioning Whether To Get Your Child the HPV Vaccine? Read This</a></li>
<li><a href="http://www.informationisbeautiful.net/2011/is-the-hpv-vaccine-safe-v-2-0/" target="_blank">Is The HPV Vaccine Safe? v 2.0</a></li>
<li><a href="https://www.forbes.com/sites/tarahaelle/2015/07/15/gardasil-hpv-vaccine-safety-assessed-in-most-comprehensive-study-to-date/%234f4e44ff222d" target="_blank">Gardasil HPV Vaccine Safety Assessed In Most Comprehensive Study To Date</a></li>
</ul>
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The article also alludes to this being a sexually
transmitted disease so we can just teach abstinence until marriage. There are
so many things wrong with this. First, <a href="http://www.publish.csiro.au/SH/SH15089" target="_blank">this virus can spread through non-intercourse activities</a>, which can be part of a normal and healthy teen relationship. Second, even if your child is a virgin at marriage, their spouse might not be.
Or the spouse could die and they remarry. Or there could be infidelity in
marriage. There may not be signs of this virus during an infection. <a href="https://www.cancer.org/cancer/cancer-causes/infectious-agents/hpv/hpv-and-hpv-testing.html" target="_blank">Testing for HPV</a> is recommended for women over 30 years of age, but is not available for men at any age, so teens and young adults will not know if they have the virus or not. And we know that abstinence only teaching fails. Some people raised in strict Christian households have sex outside of marriage. Teaching kids to
protect themselves is much more effective to prevent many sexually transmitted infections, but condoms don't always protect against HPV transmission. And there’s always rape. One out of four women has been sexually
assaulted. One in four! What a horrible thing to be raped. Then to find out you
get cancer from that…<br />
<o:p></o:p></div>
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They argue it hasn’t been tested in males. <a href="http://www.hpvvaccine.org.au/the-hpv-vaccine/how-was-it-tested.aspx" target="_blank">It has</a>. And <a href="https://www.cdc.gov/std/hpv/stdfact-hpv-and-men.htm" target="_blank">it cuts cancer rates in men too</a>. They’re not just vectors as stated in the
article.</div>
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This article is several years old. It didn’t yet know that
the cancer rates in Australia would fall like we now know. We’ve learned much
more information than they knew in 2011 when it was written. We know the HPV
vaccine is safe. It is best given before the teen years to induce the best
immune response and to get kids protected before the risk of catching the virus
becomes more likely. It isn’t a lifestyle choice to get this virus, as it seems
the author claims. People have sex. This virus and other infections can spread
through sex. But this virus is also spread without intercourse (such as through
oral sex or skin to skin contact without sex), which is why 80% of the adult
population has had the virus at some point.<br />
<br />
<a href="http://www.hpvepidemic.com/" target="_blank">Someone You Love</a> is a documentary that follows several women with HPV related cancer. If you still think the vaccine isn't worth it for your child, watch it. I am not paid in any way to recommend this. It simply is a powerful documentary that shows the devastation of HPV disease and you should see that before saying your child doesn't need protection.<o:p></o:p><br />
<br />
I strongly feel this is a safe and effective vaccine. So much so that my own teens received three doses of the original Gardasil and one dose of Gardasil 9 despite no official recommendations for this booster. I want to protect them in any way that I can. If I had any concerns about its safety I would not have given it to my own children. I don't think I can list any study or give any argument stronger than that.</div>
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Kristen Stuppy, MDhttp://www.blogger.com/profile/10332172268371143329noreply@blogger.com0tag:blogger.com,1999:blog-106825434973779887.post-4858301575975331032017-08-08T12:55:00.002-05:002017-10-10T12:59:32.124-05:00Tamiflu status downgraded!Those of you who follow my blog or are my patients know that I've never been a fan of Tamiflu. I've written <a href="http://pediatricpartners.blogspot.com/2013/10/to-tamiflu-or-not-to-tamiflu.html" target="_blank">To Tamiflu or Not To Tamiflu</a> and I've posted <a href="http://pediatricpartners.blogspot.com/2014/01/tamiflu-guest-blogger-dr-mark-helm.html" target="_blank">Tamiflu</a> from guest blogger, Dr. Mark Helm. Despite the CDC's recommendation to use Tamiflu frequently, I rarely prescribe it. And when I do, I often find that the whole course isn't completed because the kids don't tolerate it well - usually vomiting, but occasionally they've had scary hallucinations. I haven't seen very much benefit, especially given the cost (and often the difficulty of finding it during peak flu season).<br />
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The <a href="http://www.bmj.com/content/358/bmj.j3266" target="_blank">World Health Organization (WHO) has recently downgraded the status of Tamiflu</a>. The CDC and FDA will have to chime in for the US recommendations, but the WHO is a respected source of medical guidelines and I look forward to a response from the CDC.<br />
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As I've said before, Tamiflu doesn't seem to work as well as needed and it has significant side effects. Not all studies done on Tamiflu were published. Only studies showing a little benefit and minimal side effects were considered in making the recommendations to use it. If many studies show no benefit but aren't published, it makes it seem better than it is. Most studies are done in adults, but <a href="http://www.cochrane.org/CD002744/ARI_neuraminidase-inhibitors-for-preventing-and-treating-influenza-in-children" target="_blank">studies in children for prevention of flu</a> and<a href="http://www.cochrane.org/CD002744/ARI_neuraminidase-inhibitors-for-preventing-and-treating-influenza-in-children" target="_blank"> treatment of flu</a> also fail to show much benefit.<br />
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A <a href="https://academic.oup.com/fampra/article-lookup/doi/10.1093/fampra/cms059" target="_blank">2013 review</a> of all the studies done in adults found only a 20.7 hour reduction in symptoms (yes, less than one day). In the elderly and those with chronic diseases (among the highest risk adults) no reduction was found. They also found no evidence of decreasing the risks of pneumonia, hospital admission, or complications requiring an antibiotic. This same review also showed more side effects than commonly reported. Nausea, vomiting, and psychiatric side effects are common.<br />
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I hope that the CDC reviews its recommendations for antiviral use before the influenza season hits this year. Until then, plan on getting your family protected with the flu vaccine. It isn't perfect, but it does help keep us from getting sick and it can help save lives!<br />
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Kristen Stuppy, MDhttp://www.blogger.com/profile/10332172268371143329noreply@blogger.com0tag:blogger.com,1999:blog-106825434973779887.post-14628754489565125402017-08-06T11:30:00.003-05:002017-10-10T13:00:54.227-05:00It's Back to School Time, Time to Think Safety!Walking to school is wonderful for kids because they get exercise, which can help with focus at school and their overall health. It can be also be a time to talk with friends or family and build community bonds.<br />
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But it also can pose dangers, especially if drivers are distracted talking to their own children or texting. Please stop texting and driving. Don't touch your phone at all while driving. Calls and texts can wait. If they can't, pull over and check the message while parked. Really.<br />
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Talk to your kids about safety.<br />
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<ul>
<li>Kids should walk with an adult until they show the maturity to walk safely without direct supervision. The specific age will depend on the area as well as the child's maturity. Are there safe sidewalks? Are there busy roads to cross? Are there other kids walking the same route? Are there homes along the way they can go to in case of emergency? How long is the walk?</li>
<li>Find the safest route: Choose sidewalks wherever possible, even if that means the trip will be longer. If there are no sidewalks, walk as far from vehicles as possible, on the side of the street facing traffic. If possible, avoid areas near high schools, where there are more teen drivers.</li>
<li>Cross streets safely. If there are crossing guards, use those intersections. If there are street lights, wait until the "walk" symbol appears. Never cross in the middle of a block, use intersections. Look both ways twice before crossing. Do not text or play games when in the street. </li>
<li>Remind kids that if they are crossing a street, they should make eye contact with a stopped driver before crossing, even if there's a "walk" symbol. Drivers turning right might turn on red and not notice small pedestrians.</li>
<li>Teach kids to use the same route every day or discuss which route they will take each day if they use different routes. If they don't arrive to school or home as planned, you know the route to search. Walk the routes with them until they know how to safely navigate each.</li>
<li>Have kids stay in groups or with a walking buddy as much as possible. </li>
<li>Avoid distractions. Listening to music (especially with earbuds), playing video games, watching videos, and texting all keep kids from paying attention to their surroundings. Even talking on the phone is distracting, so don't assume they are safer if they talk to you all the way home when you're at work. They are more likely to trip and fall, step into a street without looking first, or not notice that they're being followed if they're distracted. They should be aware of their surroundings at all times.</li>
<li>Remind kids to never accept a ride from anyone unless you pre-plan it. Rain, snow, and cold weather make it tempting to hop in a car, so have kids dress appropriately for the weather and arrange safe rides as needed. </li>
<li>Have kids keep important contact information in their backpacks in case of emergency. At least two people should be on this list. People on the list could include a parent, grandparent, or trusted adult friend/neighbor. Names and phone numbers should be included.</li>
<li>Related: If they are riding a bike, scooter, or skateboard to school, they should follow the rules of the road and proper <a href="http://www.hopkinsmedicine.org/healthlibrary/conditions/non-traumatic_emergencies/for_parents_bicycle_in-line_skating_skateboard_safety_85,p00818/" target="_blank">safety</a>.</li>
</ul>
See if your school can help arrange <a href="http://www.walkingschoolbus.org/" target="_blank">walking buses</a>, where kids all walk the same route to school with adult walk leaders.<br />
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Suggestions for adults:<br />
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<ul>
<li>Be extra cautious when driving in the before and after school times, especially near schools and in neighborhoods.</li>
<li>Be nice and don't use your sprinklers in the before and after school times so kids can stay on the sidewalks and not wander into the street to avoid getting wet.</li>
<li>Never text and drive. Put your phone on silent and in a place you can't reach it while driving. Texts can wait.</li>
<li>If kids are in your car, make sure they are properly buckled. Only teens and adults should be in the front seat. Use an appropriate <a href="http://thecarseatlady.com/pediatricianprimer/" target="_blank">car seat</a> or <a href="http://thecarseatlady.com/who-should-use-a-booster/" target="_blank">booster seat</a>. Kids shouldn't wear their backpack in the car, nor should they unbuckle while in a drop off line to get their backpack on before the car is stopped. </li>
<li>If your kids will carpool with other families, be sure they are in proper seats at all times. It's tempting to not use boosters for short drives, but it's never safe to have kids improperly restrained. Find <a href="https://csftl.org/carpooling-options-for-big-kids/" target="_blank">boosters that are easy to move between cars</a>.</li>
</ul>
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Kristen Stuppy, MDhttp://www.blogger.com/profile/10332172268371143329noreply@blogger.com0tag:blogger.com,1999:blog-106825434973779887.post-84528940304513251972017-06-26T19:18:00.000-05:002017-10-10T13:00:25.116-05:00Neutropenia... What?It is recommended to screen for anemia (low red blood cell levels) around one year of age. Our office orders a complete blood count (CBC), which checks for red blood cells, white blood cells, and platelets - the main components of our blood.<br />
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One relatively frequent abnormal lab we see (especially during the winter months) is a low absolute neutrophil count (ANC). Neutrophils are a type of white blood cells that fights bacterial infections. When their numbers get too low, it can increase the risk of serious bacterial infections. While some people have low ANCs that cause significant immune deficiencies and can lead to infection, the most commonly seen low ANC we see are brief dips after a viral infection. A low ANC is called neutropenia.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh60SCr7LyXSJjbsZVWTxOhA41KNadiRS6wjs25FAeOTMlrNWicwiEOj5Wi3354jZWaPDATS09zW8CCBi_Pd8m_TCDhxv5z2Fw5XqAbdwTvQBwYv86rFwSXNL1xdUA3zb-tt1S6MWJ8e2VF/s1600/Blausen_0676_Neutrophil.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh60SCr7LyXSJjbsZVWTxOhA41KNadiRS6wjs25FAeOTMlrNWicwiEOj5Wi3354jZWaPDATS09zW8CCBi_Pd8m_TCDhxv5z2Fw5XqAbdwTvQBwYv86rFwSXNL1xdUA3zb-tt1S6MWJ8e2VF/s1600/Blausen_0676_Neutrophil.png" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Photo source: <a href="https://commons.wikimedia.org/wiki/File%3ABlausen_0676_Neutrophil.png" target="_blank">Wikimedia. Blausen.</a></td></tr>
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The large majority of kids with neutropenia have only mild drops in their ANC and are not at significant risk of illness. In general the more severe the drop, the more significant the infection risk. <br />
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Most causes of neutropenia are due to infection, drugs, severe malnutrition or immune disorders. The most common cause of neutropenia we see is after an infection. In most cases this type of neutropenia quickly resolves without any treatment. Some viruses, such as hepatitis B, Epstein-Barr, and HIV, are associated with prolonged neutropenias. The drugs that can cause neutropenia are not commonly used medications and routine testing for neutropenia would be done when those medications are used. Vitamin B12, folate, and copper deficiencies are very uncommon in children, but can lead to abnormal blood counts.<br />
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There are three levels of neutropenia:<br />
<div id="stcpDiv" style="left: -1988px; position: absolute; top: -1999px;">
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<br />
<li>Mild neutropenia: The ANC ranges between 1000-1500/μL </li>
<li>Moderate neutropenia: The ANC ranges between 500-1000/μL </li>
<li>Severe neutropenia: The ANC is less than 500/μL </li>
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<ul>
<li>Mild: ANC 1000-1500</li>
<li>Moderate: ANC 500-1000</li>
<li>Severe: ANC less than 500</li>
</ul>
<div id="stcpDiv" style="left: -1988px; position: absolute; top: -1999px;">
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<br />
<li>Mild neutropenia: The ANC ranges between 1000-1500/μL </li>
<li>Moderate neutropenia: The ANC ranges between 500-1000/μL </li>
<li>Severe neutropenia: The ANC is less than 500/μL </li>
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Since most mild cases of neutropenia self-resolve, it is not usually anything for parents to worry about. I used to recheck all of these, but found that many kids needed several rechecks because they always had a mild viral infection and they never got significantly sick. I have changed my personal protocol because if kids start getting sick, they will end up being rechecked and if they're healthy, there was no need to recheck.<br />
<ul>
<li>If a child is overall healthy and growing well, the level is only mildly low (above 1000) I do not recheck the level -- though if your doctor wants to recheck it (or if you want it rechecked), that is appropriate to do.</li>
<li>If the level is in the mid-range (500-1000) or if the child has had problems with recurrent infections or growth, I will usually recommend a confirmation (repeat test) and possible further evaluation. </li>
<li>If the level is in the severe range (less than 500), it should be rechecked and the child should be closely monitored due to high risk of severe bacterial infections.</li>
<li>Some physicians recommend repeating a blood count with any fever for a year in kids who have had any degree of neutropenia, so you'll have to talk to your child's doctor for a plan.</li>
</ul>
<h4>
What symptoms might happen if the ANC is low?</h4>
<div>
<br /></div>
Most children with a temporarily and mildly low ANC will have no symptoms and need no treatment. Children with chronically low ANCs will have more infections that require antibiotics, such as pneumonia, skin infections (abscesses, cellulitis) and lymph node infections. They might also have chronic gum disease, mouth sores, or vaginal or rectal ulcers. A common cold or cough is NOT from a low ANC, since these are viral illnesses and a different type of white blood cell targets viruses.<br />
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<div id="stcpDiv" style="left: -1988px; position: absolute; top: -1999px;">
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<li>Frequent infections </li>
<li>Serious respiratory infections, including pneumonia or sinus infections </li>
<li>Skin infections (e.g. cellulitis, abscesses) </li>
<li>Multiple serious infections (e.g. meningitis, bone infections) </li>
<li>Lymph node infections </li>
<li>Gum disease </li>
<li>Mouth sores/ulcers </li>
<li>Vaginal, urethral rectal ulcers </li>
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<h4>
When do we worry?</h4>
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The level of ANC as well as the cause both determine the risk level of an overwhelming infection. An example would be when people are immune suppressed from chemotherapy, they are at very high risk of bacterial infections. On the other hand, an otherwise healthy person with a mildly low ANC is not more likely to get a bacterial infection than another person with a normal ANC.<br />
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We are concerned if the child has recurrent infections, poor growth, or a very low level. Each case must be evaluated by the person who ordered the test and who has recently seen your child.<br />
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<h4>
What treatment is done for a low ANC? </h4>
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Most children do not need any specific treatment. They are monitored for recurrent infections, especially infections that require antibiotics. They are also monitored for growth, since if a body is chronically sick, it often doesn't grow well.<br />
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Each infection that requires antibiotics is treated and blood counts might be checked to see how low they are at the time.<br />
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In children who have a chronically low ANC, I usually refer them to a hematologist (blood specialist) to evaluate why they have it and if it requires a special treatment that stimulates the bone marrow to make more neutrophils. <br />
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<h4>
For more information:</h4>
<a href="https://www.ncbi.nlm.nih.gov/pubmed/3181399" target="_blank">Benign familial leukopenia and neutropenia in different ethnic groups.</a><br />
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<a href="http://emedicine.medscape.com/article/954781-overview?pa=YA0%2BMGYoRTA5SbtjV7R9YHJssVmIiVsZg7BTr%2B%2BSLVx6hxdTXgE2OTgygO4K%2F5aJ8SIvl8zjYv73GUyW5rsbWA%3D%3D" target="_blank">Pediatric Autoimmune and Chronic Benign Neutropenia</a><br />
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Kristen Stuppy, MDhttp://www.blogger.com/profile/10332172268371143329noreply@blogger.com0tag:blogger.com,1999:blog-106825434973779887.post-43705442853970014692017-06-11T11:10:00.000-05:002017-10-10T13:43:55.051-05:00Dry Drowning - What Parents Need To KnowI thought about titling this one "We're drowning in dry drowning phone calls" because we are getting many worried calls about dry drowning, but that's overly dramatic and I hate headlines that make things seem like the sky is falling...<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjt5HVCu-9yn09duMnqjlfxm9K1jPxGeQRhPEKZ8rFLiLVdNED38AQPzw2xcd0t04MPX0pf_dlnpKB9LzoxwraXEDON4ZByk4LX2B4Mz_Z_ZykaSH2AhmVjrUxRv_GTq7YNlmS0yKZe3Xq6/s1600/Dry+Drowning%253A+What+Parents+Need+to+Know.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="drowning, dry drowning, water safety" border="0" data-original-height="434" data-original-width="289" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjt5HVCu-9yn09duMnqjlfxm9K1jPxGeQRhPEKZ8rFLiLVdNED38AQPzw2xcd0t04MPX0pf_dlnpKB9LzoxwraXEDON4ZByk4LX2B4Mz_Z_ZykaSH2AhmVjrUxRv_GTq7YNlmS0yKZe3Xq6/s400/Dry+Drowning%253A+What+Parents+Need+to+Know.png" title="Dry Drowning: What Parents Need To Know" width="266" /></a></div>
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I had never heard of dry drowning until social media picked it up a couple of summers ago. Maybe I did as a resident, but since I've never seen it, I'd forgotten the term. Either way, it isn't very common at all, but it is an emergency when it happens, so it's good that we all know that it can happen. People also use the term secondary drowning and some experts differentiate the two by whether or not water actually gets into the lungs, causing swelling of the lung tissue, or if water irritates the vocal cords, causing them to spasm and close off. Either situation is potentially life threatening and they have similar symptoms. <span style="color: red;">Note: Please see the addendum at the bottom. Several articles have emerged since the original writing of this post that clearly indicate there is no such thing as dry drowning.</span><br />
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One of the reasons I think so many parents are worried is that it is common for kids to go under water: in the tub and in the pool. Many get water in their mouth or complain that it went up their nose. Few actually get any into their lungs, which is where it can cause problems. How can you know when you need to worry?<br />
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Most of us recall a time we coughed briefly after inhaling liquid, and we were fine. So when is it worrisome? It's when the water that gets into the lungs causes inflammation within the next day or two. This inflammation makes it hard for the lungs to work - the air tubes are swollen, so air can't get through. Treatment is giving oxygen, sometimes with a ventilator (breathing tube and machine) until the inflammation goes down.<br />
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<h4>
Symptoms you need to recognize and act upon by taking your child to an ER:</h4>
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<ul>
<li>Cough: If your child has coughing for a minute or more after being in water, he's at risk. This indicates that the child is trying to clear the airways. If water got down there and they cough most up, some can remain behind and lead to inflammation over time. Watching your child carefully for the next 3-4 days is important. This can be hard to recognize initially, so a complete evaluation is important if any other symptoms develop.</li>
<li>Difficulty breathing: Anyone who is struggling to breathe needs further evaluation. Signs can be rapid breathing, sucking in the ribs or the stomach, difficulty talking, or even a look of fear from difficult breathing.</li>
<li>Near drowning: If your child had to be pulled out of the water, he should be evaluated in an ER. Even if he seems fine afterwards. The reaction is delayed, so they can seem to be 100% better and then go downhill.</li>
<li>Behavior changes or confusion: If a child is confused, lethargic** or has a change in ability to recognize people, he should go to the ER. Serious illnesses can present with a change in mental status, including significant infections, concussion, heat exhaustion, brain tumors, and drowning. The ER doctor will ask what else has been going on to help identify the cause of confusion. **Many people misuse the term lethargic. Lethargic isn't the same thing as being tired after a long day. The <a href="http://www.medilexicon.com/dictionary/48960" target="_blank">medical definition</a> is "Relatively mild impairment of consciousness resulting in reduced alertness and awareness; this condition has many causes but is ultimately due to generalized brain dysfunction."</li>
<li>Vomiting: Vomiting after a day at the pool can be due to infection (from swallowing contaminated pool water), food poisoning (from food left in the heat too long) or dry drowning. It's best to check it out in the ER.</li>
</ul>
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<h4>
What will happen in the ER?</h4>
<div>
Many parents don't want to go to the ER because of high co-pays. We try to keep kids out of the ER as much as possible. But some issues are better taken care of in an ER. Most offices don't have the equipment or staff to manage these issues well. Dry drowning can be life threatening, and the evaluation and treatment should start in the ER. I cannot say exactly what the doctor will do, since that will depend on your child's symptoms and exam. There is no specific treatment for this, only supporting your child's airway and breathing as the swelling goes down.<br />
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<ul>
<li>If the doctor thinks your child may have swelling of the airways, he might order a chest x-ray to look for pulmonary edema (lung tissue swelling). </li>
<li>An iv might be started to be able to give adequate fluids, since your child might not be up to drinking well. </li>
<li>Oxygen levels will be monitored and extra oxygen might be given. </li>
<li>Since the swelling worsens before it gets better, if there is a strong suspicion of dry drowning your child will be admitted for further observation.</li>
<li>Some kids need help breathing and are put on a ventilator (breathing machine) until the swelling goes down.</li>
</ul>
<h4>
Prevention is important!</h4>
<div>
As with many things, we should do all we can to be sure our kids are safe around water. This includes the bathtub and toilet as well as swimming pools, lakes, and ponds. </div>
<div>
<br /></div>
<div>
<ul>
<li>Childproof your home when you have little ones who might play in a pet water bowl or the toilet. </li>
<li>Teach your kids water safety. Swimming lessons can help them learn skills. Tell them to never try to dunk each other. They shouldn't pretend they're drowning because it might distract a lifeguard from a true emergency. </li>
<li>Learn infant and child CPR.</li>
<li>If you have a pool or pond at home, be sure there is a fence limiting access from your house.</li>
<li>Watch your kids closely and keep them within reach when they're in water until they are strong swimmers. When they are strong swimmers you can let them swim outside your reach as long as lifeguards are present. </li>
<li>Learn what distress in the water looks like. The movie depiction of drowning with a lot of yelling and thrashing around is not what usually happens. If someone can verbalize that they're okay, they probably are. Drowning victims can't ask for help. <a href="http://mariovittone.com/2010/05/154/" target="_blank">There is a video linked to this page of what to look for with drowning that shows an actual rescue</a>. From this site, signs of drowning:</li>
</ul>
<blockquote class="tr_bq">
<ul>
<li>Head low in the water, mouth at water level</li>
</ul>
<ul>
<li>Head tilted back with mouth open</li>
</ul>
<ul>
<li>Eyes glassy and empty, unable to focus</li>
</ul>
<ul>
<li>Eyes closed</li>
</ul>
<ul>
<li>Hair over forehead or eyes</li>
</ul>
<ul>
<li>Not using legs – Vertical</li>
</ul>
<ul>
<li>Hyperventilating or gasping</li>
</ul>
<ul>
<li>Trying to swim in a particular direction but not making headway</li>
</ul>
<ul>
<li>Trying to roll over on the back</li>
</ul>
<ul>
<li>Appear to be climbing an invisible ladder</li>
</ul>
</blockquote>
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Addendum:</h3>
I just read this post that gives references regarding drowning definitions. It appears I didn't forget learning about dry drowning in medical school. It isn't really a thing. The symptoms listed above that I recommend getting evaluated are still concerning symptoms, but they might be from another cause. Check this out: <a href="http://www.drowninglit.com/2017/06/on-dry-drowning.html?m=1" target="_blank">On "Dry Drowning"</a><br />
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Another: <a href="http://journals.lww.com/em-news/blog/BreakingNews/pages/post.aspx?PostID=377" target="_blank">Drowning in a Sea of Misinformation: Dry Drowning and Secondary Drowning</a><br />
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Kristen Stuppy, MDhttp://www.blogger.com/profile/10332172268371143329noreply@blogger.com0tag:blogger.com,1999:blog-106825434973779887.post-47750304237549497172017-05-22T07:17:00.000-05:002017-10-10T13:39:23.905-05:00New Juice Guidelines!The American Academy of Pediatrics is releasing new guidelines for introducing and giving fruit juice today.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhF9rmm939IJvNF4oz80OrgyMWS7DZlx4p0o69aH-C-OsB8Kjcpo-eFKgY4i7S72K7NkF-d54Kt2_gIbiV6YR5may5eJcB9EFckj1CxWlnF96Yqs9uTubFgkOavJHFoywFabWbm-RIfBZbj/s1600/New+Juice+Guidelines.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="juice, nutrition, AAP" border="0" data-original-height="435" data-original-width="287" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhF9rmm939IJvNF4oz80OrgyMWS7DZlx4p0o69aH-C-OsB8Kjcpo-eFKgY4i7S72K7NkF-d54Kt2_gIbiV6YR5may5eJcB9EFckj1CxWlnF96Yqs9uTubFgkOavJHFoywFabWbm-RIfBZbj/s400/New+Juice+Guidelines.png" title="New Juice Guidelines" width="263" /></a></div>
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Juice that comes from fruit is not the same thing as eating fruit. It's missing the fiber and even the feeling of fullness that comes from eating foods rather than drinking. Too many kids drink excessive juice, which fills them with empty calories and can contribute to obesity and tooth decay.<br />
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How much juice should kids have?<br />
<br />
<ul>
<li>Juice is not recommended at all under 1 year of age in the new guidelines. </li>
<li>Toddlers from 1-3 years can have up to 4 ounces of 100% juice a day. </li>
<li>Children ages 4-6 years can have 4-6 ounces (half to three-quarters of a cup). </li>
<li>Children ages 7-18 years can have up to 8 ounces (1 cup) of 100% fruit juice as part of the recommended 2 to 2 ½ cups of fruit servings per day. </li>
</ul>
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<br />
<h4>
General tips and tricks:</h4>
<br />
<ul>
<li>Offer only 100% juice if you're giving juice at all. Fruit flavored drinks are not the same thing as juice.</li>
<li>Water is always healthy! If your kids want it flavored, cut up fruit and put it in the water. There are many <a href="http://www.foodnetwork.com/healthy/packages/healthy-every-week/healthy-tips/12-ways-to-make-water-the-most-delicious-thing-ever" target="_blank">recipes</a> online to get ideas, but kids don't need anything fancy - just put cut up pieces of their favorite fruit with water in a glass container. Put the container in the refrigerator for 2-4 hours and then pour the infused water into their cup without the fruit (which could pose a choking risk). The infused water will stay fresh in the refrigerator for up to 2 days.</li>
<li>Some kids like to start the day with a frozen water bottle. Simply put a 1/2 to 3/4 full water bottle in the freezer overnight - don't fill it too much because ice expands! Add a bit of water in the morning to help it start melting so it's drinkable when they want a sip. Adjust the amount of water to freeze as needed depending on how insulated your water bottle is.</li>
<li>If your kids demand more than the recommended amount of juice for their age per day, water it down. By mixing water (or sparkling water for a bit of zip) with juice, you decrease the amount of sugar in every serving. You can give 1/2 the recommended daily maximum amount of juice with water twice and still stay within the daily limit. </li>
<li>Never let kids drink juice out of a bottle.</li>
<li>Never put kids to bed with juice. They should brush teeth before bed and be allowed only water until morning.</li>
<li>Offer only pasteurized juice. Unpasteurized juice can cause severe illness.</li>
<li>Give kids real fruits and/or vegetables with every meal and snack.</li>
<li>Make smoothies! Putting fruits and vegetables in a blender to make a smoothie is a great way to give the full fruit or vegetable instead of juice. Consider adding plain yogurt**, chia, flax, oats, nuts, and other healthy additions to increase the nutritional components of the smoothie! **Flavored yogurts often have added sugars. Look for just milk and cultures in your yogurt. </li>
<li>Most juice boxes have more than a day's supply of juice. Don't use juice boxes. Offer juice in cups so you can limit to the age appropriate amount. </li>
<li>Organic juice is not healthier than other juice. Many parents presume it has less sugar or more nutrients, but it doesn't.</li>
<li>Vegetable juices may have less sugar and fewer calories than in the fruit juice, but are often mixed with fruit juices so you must read ingredients. They also lack the fiber of the actual vegetable, so eating the vegetable (or pureeing veggies into a smoothie) is healthier. </li>
<li>Beware of labels that look like juice but aren't 100% juice. The label might say "juice cocktail," "juice-flavored beverage" or "juice drink." Most of these have only small amounts of real juice. Their main ingredients are usually water, small amounts of juice, and some type of sweetener, such as high-fructose corn syrup. Nutritionally, these drinks are similar to most soft drinks: rich in sugar and calories, but low in nutrients. Avoid them.</li>
<li>Sports drinks are not healthy substitutes for water. They are sugar-sweetened beverages that contain sodium and other electrolytes. Unless one is doing high intensity exercise for over an hour (such as running a marathon, <i>not</i> playing in a baseball tournament), water and a regular healthy diet provide all the calories and electrolytes we need.</li>
<li>Water's the best drink for our bodies. Buy fun reusable water bottles and challenge your kids to empty them throughout the day. The old rule of "8 cups a day" is outdated, but we should get enough water (from the water content in foods + drinks) to keep our urine pale. We need more water when it's hot, when we exercise, when we're sick and when the air's really dry. Once we feel thirsty we're already mildly dehydrated, so drink water to prevent dehydration.</li>
</ul>
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Kristen Stuppy, MDhttp://www.blogger.com/profile/10332172268371143329noreply@blogger.com0tag:blogger.com,1999:blog-106825434973779887.post-12733569643522323242017-04-23T07:21:00.000-05:002017-10-10T13:01:23.547-05:00Itchy, sneezy, puffy - All signs of allergy. What can you do?<span style="background-color: white; color: #222222; font-family: "arial" , "tahoma" , "helvetica" , "freesans" , sans-serif; font-size: 13.2px;">It's allergy season! Prevention and treatment is important if you have seasonal allergies so you can enjoy the great outdoors. This is an update to a previous blog I wrote on the subject, since there are many more medicines now available over the counter.</span><br />
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<b style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13.2px;">Symptoms of Allergies: </b><br />
<br style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13.2px;" />
<span style="background-color: white; color: #222222; font-family: "arial" , "tahoma" , "helvetica" , "freesans" , sans-serif; font-size: 13.2px;">Allergies can impair sleep (leading to all the problems associated with not enough sleep) and can lead to the annoying symptoms of itching, coughing, sneezing, runny nose, and watery eyes. Some kids get a crease across their nose from wiping. Others get purple circles under their eyes called allergic shiners. These symptoms last longer than the typical cold, which usually resolves after 1-3 weeks. Fever is a sign of infection, not allergies. Other than fever, it is very difficult sometimes to decide if it is a virus or allergies until a seasonal pattern really develops. Even then it is possible to get colds during allergy season some years!</span><br />
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<b style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13.2px;">Treatments: </b><br />
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<span style="background-color: white; color: #222222; font-family: "arial" , "tahoma" , "helvetica" , "freesans" , sans-serif; font-size: 13.2px;">It is best to treat before the symptoms get bad. It is easy to monitor pollen counts online to know what's out there and start treatment before symptoms make you (or your child) miserable. </span><span style="background-color: white; color: #222222; font-family: "arial" , "tahoma" , "helvetica" , "freesans" , sans-serif; font-size: 13.2px;">Treatments include medicines and limiting exposure.</span><br />
<br style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13.2px;" />
<b style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13.2px;">Medications:</b><br />
<br style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13.2px;" />
<span style="background-color: white; color: #222222; font-family: "arial" , "tahoma" , "helvetica" , "freesans" , sans-serif; font-size: 13.2px;">I don't want kids with outdoor allergies to be afraid to go outside, so taking medicines to keep the symptoms at bay while out can help. Types of medicines:</span><br />
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<ul style="line-height: 1.4; margin: 0.5em 0px; padding: 0px 2.5em;">
<li style="margin: 0px 0px 0.25em; padding: 0px;"><b><a href="https://www.aaaai.org/conditions-and-treatments/treatments/drug-guide/allergy-medications" target="_blank">Antihistamines</a></b> work to block histamine in the body. Histamine causes the symptoms of allergies, so an antihistamine can help stop the symptoms. Some people respond well to one antihistamine but not others. In general I prefer the 24 hour antihistamines simply because it is impossible to cover the full day with a medicine that only lasts 4-6 hours. Different antihistamines work better for some than others. Personally loratadine does nothing for me, fexofenadine is okay, but cetirizine is best. I have seen many patients with opposite benefits. You will have to do a trial period of a medicine to see which works best. If they make your child sleepy, giving at bedtime instead of the morning might help. Prescription antihistamines are available, but usually an over the counter type works just as well and is less expensive. Insurance companies rarely cover the cost of antihistamines these days.</li>
</ul>
</blockquote>
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<ul style="line-height: 1.4; margin: 0.5em 0px; padding: 0px 2.5em;">
<li style="margin: 0px 0px 0.25em; padding: 0px;"><b>Antihistamine and decongestant combinations</b> are available but are not usually recommended by me. Once control of the mucus is achieved, a decongestant isn't needed. If you need a decongestant initially, you can use one with your usual antihistamine. Most decongestants on the market are ineffective. If you ask the pharmacist for pseudoephedrine, it is available behind the counter. It was replaced by phenylephrine years ago due to concerns of methamphetamine production, but works a little better than phenylephrine. Decongestants do NOT fix a cold, they only dry up some of the mucus. Decongestants can cause dizziness, heart flutters, dry mouth, and sleep problems, so use them sparingly and only in children over 4 years of age. </li>
</ul>
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<li style="margin: 0px 0px 0.25em; padding: 0px;"><b><a href="https://www.aaaai.org/conditions-and-treatments/treatments/drug-guide/nasal-medication" target="_blank">Nasal spray steroids and antihistamines</a></b> are available over the counter or as a prescription. An office visit to discuss the value of these for your child and proper use is recommended. </li>
</ul>
</blockquote>
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<ul style="line-height: 1.4; margin: 0.5em 0px; padding: 0px 2.5em;">
<li style="margin: 0px 0px 0.25em; padding: 0px;"><b><a href="https://www.aaaai.org/conditions-and-treatments/treatments/drug-guide/eye-medications" target="_blank">Eye drops</a></b> can help alleviate eye symptoms. They are available both as over the counter allergy drops and prescription allergy eye drops. If over the counter drops fail, make an appointment to discuss if a prescription might help better. Most insurance companies don't cover prescription allergy eye drops well, so you might want to check your <a href="http://pediatricpartners.blogspot.com/2014/08/formulary-fun.html" target="_blank">formulary</a> before asking for a prescription. This is usually available on your insurance website after you log in. Tips to administer eye drops include washing hands before using eye drops, put the drop on the corner of the closed eye (nose side) and then have the child open his eyes to allow the drop to enter the eye. </li>
</ul>
</blockquote>
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<li style="margin: 0px 0px 0.25em; padding: 0px;"><b><a href="https://www.aaaai.org/conditions-and-treatments/drug-guide/montelukast" target="_blank">Singulair (Montelukast)</a> </b>works to stop histamine from being released into the body. It helps control both allergies and asthma and is best taken in the evening. Once a person has been on montelukast for a couple weeks, they usually don't need an antihistamine any longer. It is available only by prescription, so make an appointment to discuss this if your child might benefit.</li>
</ul>
</blockquote>
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<li style="margin: 0px 0px 0.25em; padding: 0px;"><b>Steroids</b> decrease allergic inflammation well. These can include both oral steroids for severe reactions (such as poison ivy on the face or an asthma attack) and inhaled corticosteroids for the nose (or lungs in asthma). These require a prescription, so a visit to your provider is recommended to discuss proper use.</li>
</ul>
</blockquote>
<br style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13.2px;" />
<b style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13.2px;">Limiting Exposure: </b><span style="background-color: white; color: #222222; font-family: "arial" , "tahoma" , "helvetica" , "freesans" , sans-serif; font-size: 13.2px;">The longer your airway is exposed to the allergen (pollen, grass, mold, etc) the more inflammation you will have.</span><br />
<br />
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<ul style="line-height: 1.4; margin: 0.5em 0px; padding: 0px 2.5em;">
<li style="margin: 0px 0px 0.25em; padding: 0px;">Wash hair, eyelashes, and nose after exposures -- especially before sleep. They all trap allergens and increase the time your body reacts to them. I have found the information and videos on <a href="http://nasopure.com/" style="color: #888888; text-decoration-line: none;">Nasopure.com</a> very helpful to teach kids as young as 2 years to wash their noses. (Note: I have no financial ties to Nasopure... I just love the product and website!)</li>
</ul>
</blockquote>
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<ul style="line-height: 1.4; margin: 0.5em 0px; padding: 0px 2.5em;">
<li style="margin: 0px 0px 0.25em; padding: 0px;">Remove clothing and shoes that have pollen on them when entering the house to keep pollen off the couch, beds, and carpet.</li>
</ul>
</blockquote>
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<li style="margin: 0px 0px 0.25em; padding: 0px;">Wash towels and sheets weekly in hot water. </li>
</ul>
</blockquote>
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<ul style="line-height: 1.4; margin: 0.5em 0px; padding: 0px 2.5em;">
<li style="margin: 0px 0px 0.25em; padding: 0px;">Vacuum and dust weekly. Consider <a href="http://www.epa.gov/iaq/pubs/airduct.html" style="color: #888888; text-decoration-line: none;" target="_blank">cleaning home vents</a>. Consider hard flooring in bedrooms instead of carpeting. </li>
</ul>
</blockquote>
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<ul style="line-height: 1.4; margin: 0.5em 0px; padding: 0px 2.5em;">
<li style="margin: 0px 0px 0.25em; padding: 0px;">Wash stuffed animals and other toys regularly and discourage allergic children from sleeping with them. </li>
</ul>
</blockquote>
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<ul style="line-height: 1.4; margin: 0.5em 0px; padding: 0px 2.5em;">
<li style="margin: 0px 0px 0.25em; padding: 0px;">There are many types of air filters that have varying benefits and costs. For information on air filters see this pdf from the Environmental Protection Agency: <a href="http://www.epa.gov/iaq/pdfs/aircleaners.pdf" style="color: #888888; text-decoration-line: none;" target="_blank">Aircleaner</a>s. </li>
</ul>
</blockquote>
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<ul style="line-height: 1.4; margin: 0.5em 0px; padding: 0px 2.5em;">
<li style="margin: 0px 0px 0.25em; padding: 0px;">Keep the windows closed. Sorry to those who love the "fresh air" in the house. For those who suffer from allergies, this is just too much exposure! </li>
</ul>
</blockquote>
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<ul style="line-height: 1.4; margin: 0.5em 0px; padding: 0px 2.5em;">
<li style="margin: 0px 0px 0.25em; padding: 0px;">Keep pets out of bedrooms. If you know a family member is allergic to an animal, don't get a new pet of this type! If you already have a loved pet someone in the home is allergic to, consider allergy shots against this type of animal. </li>
</ul>
</blockquote>
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<ul style="line-height: 1.4; margin: 0.5em 0px; padding: 0px 2.5em;">
<li style="color: #222222; font-family: arial, tahoma, helvetica, freesans, sans-serif; font-size: 13.2px; margin: 0px 0px 0.25em; padding: 0px;">If itchy eyes are a problem for contact lens wearers, a break from the contacts may help. Talk with your eye doctor if eye symptoms cause problems with your contacts. </li>
<li>Keep smoke away. Smoke is an airway irritant and can exacerbate allergy symptoms. Remember that the smoke dust remaining on hair, clothing, upholstery, and other surfaces can cause problems too, so kids can be affected even if you don't smoke near them. </li>
</ul>
</blockquote>
<br />
<b style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13.2px;">What if all of the above isn't helping?</b><br />
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<li style="margin: 0px 0px 0.25em; padding: 0px;">Maybe it's really not allergies. </li>
</ul>
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<ul style="line-height: 1.4; margin: 0.5em 0px; padding: 0px 2.5em;">
<li style="margin: 0px 0px 0.25em; padding: 0px;">Allergies to things other than foods are rare before 2 years of age.</li>
</ul>
</blockquote>
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<ul style="line-height: 1.4; margin: 0.5em 0px; padding: 0px 2.5em;">
<li style="margin: 0px 0px 0.25em; padding: 0px;">Viruses can cause very similar symptoms to allergies. </li>
</ul>
</blockquote>
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<ul style="line-height: 1.4; margin: 0.5em 0px; padding: 0px 2.5em;">
<li style="margin: 0px 0px 0.25em; padding: 0px;">Allergy testing is possible by blood or skin prick testing, but can be costly. In most cases I don't find it very helpful for environmental allergens because you can't avoid them entirely and you can always limit exposures as above. I think that tracking seasonal patterns over a few years can identify many of the allergens. You can still treat as needed during this time. Reports of pollen and mold counts are found on <a href="http://pollen.com/" style="color: #888888; text-decoration-line: none;">Pollen.com</a>. Note also animal exposures and household conditions. Write symptoms and exposures weekly (or daily). It often doesn't take long to see patterns. Testing is important if allergy shots are being considered. </li>
</ul>
</blockquote>
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<ul style="line-height: 1.4; margin: 0.5em 0px; padding: 0px 2.5em;">
<li style="margin: 0px 0px 0.25em; padding: 0px;">Need help tracking allergy symptoms? There's an app for that! Here's one <a href="http://mashable.com/2012/04/13/mobile-apps-seasonal-allergy-sufferers/" style="color: #888888; text-decoration-line: none;" target="_blank">review I found of allergy apps</a>. I don't have any personal experience of any, so please put your favorite in the comments below to help others!</li>
</ul>
</blockquote>
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<li style="margin: 0px 0px 0.25em; padding: 0px;">Wrong medicine or wrong dose. </li>
</ul>
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<ul style="line-height: 1.4; margin: 0.5em 0px; padding: 0px 2.5em;">
<li style="margin: 0px 0px 0.25em; padding: 0px;">Some people have more severe allergies and need more than one treatment. Allergies tend to worsen as kids get older. Switching types of medication or adding another type of medicine might help. If you need help deciding which medicine(s) are best for your child, an office visit for an exam and discussion of symptoms is advised.</li>
</ul>
</blockquote>
<blockquote class="tr_bq" style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13.2px;">
<ul style="line-height: 1.4; margin: 0.5em 0px; padding: 0px 2.5em;">
<li style="margin: 0px 0px 0.25em; padding: 0px;">Some kids outgrow a dose and simply need a higher dose of medicine as they grow. </li>
</ul>
</blockquote>
<ul style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13.2px; line-height: 1.4; margin: 0.5em 0px; padding: 0px 2.5em;">
<li style="margin: 0px 0px 0.25em; padding: 0px;">Consider allergy shots (immunotherapy) to desensitize against allergens if symptoms persist despite your best efforts as above. Schedule an appointment to discuss if this is an option for your allergy sufferer.</li>
</ul>
<div>
<h3 style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; margin: 0px; position: relative;">
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Kristen Stuppy, MDhttp://www.blogger.com/profile/10332172268371143329noreply@blogger.com0tag:blogger.com,1999:blog-106825434973779887.post-82458995223132961352017-03-15T11:00:00.002-05:002017-03-15T11:04:10.973-05:00Hearing LossMost of us associate hearing loss with old age, but it is increasingly common for children and teens to suffer from mild to moderate hearing loss. <a href="https://www.cdc.gov/ncbddd/hearingloss/data.html" target="_blank">Nearly 15% of kids have hearing loss</a> according to the CDC. Hearing loss can be due to many things that are difficult to control, such as heredity, infection, and medications. In kids and teens it is oven due to a preventable cause: noise.<br />
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<br />
<h4>
Where does the excessive noise come from?</h4>
<br />
Even young children are exposed to more loud noises through toys, television, and gaming devices than children of years past.<br />
<br />
Widespread use of ear buds for prolonged periods can take its toll on hearing. Unlike the bulky headphones used when I was a child, earbuds deliver sound directly into the ear canal without any sound buffering in between. Most often the earbuds are used with iPods and other mp3 players are low to mediocre quality, so they are unable to transit the bass as effectively. Many kids turn the music up to hear the bass. If others can hear the music coming from ear buds, they are too loud!<br />
<br />
Loud concerts or sporting events can also expose our ears to excessive volumes for a prolonged period of time.<br />
<br />
Not all excessive noise is from kids being undisciplined - some kids are helping out the family or trying to earn extra cash by mowing lawns or using power tools, which puts them at increased risk.<br />
<br />
<h4>
How much is too much?</h4>
<div>
<br /></div>
According to the Centers for Disease Control and Prevention (CDC), being exposed to more than 85 decibels (dB) of sound for eight hours can damage your hearing. At 105 dB, hearing loss is possible after a mere 5 minutes.<br />
<div>
<br /></div>
<div>
If you're like me, that means nothing because how much is 85 dB? There is a great chart of common sounds and how loud they are on this page from the <a href="https://www.cdc.gov/nceh/hearing_loss/what_noises_cause_hearing_loss.html" target="_blank">CDC</a>. There are also several free apps available for download on smartphones and tablets - search "sound meter" or "decibel" and read reviews before downloading. Take advantage of these -- and because it's in the phone, kids might actually have fun playing around with them and learning about their environmental risks at the same time!<br />
<br />
<h4>
Signs of hearing loss</h4>
<br />
One early sign of excessive noise is ringing in the ears, but most people with hearing loss never realize it's happening because it's slowly progressive. If you notice your child asking "what" more often or complaining that the television is too quiet when others hear it well, it is a good idea to have their hearing tested.<br />
<br />
<h4>
Consequences of hearing loss </h4>
<br />
There are many potential consequences to hearing loss:<br />
<br />
<ul>
<li>Learning - you have to be able to hear the lecture. </li>
<li>Behaviors - if directions and instructions are missed, a child might incorrectly be seen as misbehaving. </li>
<li>Friendships and social skills - if a child can't follow a conversation they aren't easy to talk to or play with.</li>
<li>Job availability - many jobs require hearing at a certain level. </li>
</ul>
<br />
<h4>
Prevention</h4>
<div>
<br /></div>
<div>
Talk to your kids about the risks of their habits that involve loud sounds. Unfortunately kids won't always take parental advice to heart because they have a feeling of invincibility, but studies show if they learn about hearing loss they are more likely to use protection. Even more so, what their friends are doing alters their behavior. Teach not only your kids, but also their friends. If they're all going to a loud event, consider giving them all ear plugs. Once hearing is damaged they can't gain the hearing back, so prevention is key.</div>
<div>
<br /></div>
<div>
Ways to protect include:</div>
<div>
<ul>
<li>Wear hearing protection (earplugs) when mowing the grass and attending loud events, such as concerts or sporting events.</li>
<li>Turn down your music! Some music players have alerts when the volume goes too loud, but those can be ignored if the child doesn't understand why it's important to lower the volume. If others can hear the music you're listening to through earbuds, turn it down.</li>
<li>Lower the maximum volume setting on your iPod or mp3 player. To do this, go to "Settings" and select "Volume Limit" under Music. Set it at about 60% of the full volume, that way you can't accidentally turn your music too high.</li>
<li>Use big headphones instead of earbuds. They offer more external noise cancelling, which allows the music to be heard better at lower volumes. They are also physically further from your eardrum, which helps.</li>
<li>If you must use earbuds, use high quality buds that transmit bass if you are tempted to turn music up to hear the bass.</li>
<li>Follow the 60/60 rule: No more than 60 minutes of listening at a time, and no higher than 60 percent of maximum volume. If you go under "settings," you can actually set your iPod for maximum volume setting of 60 percent, so you can't accidentally turn your music up too loud.</li>
<li>Higher pitched sounds have greater potential to damage your ears than lower pitched sounds. Turn down the volume when a high-pitched song comes on.</li>
<li>Try not to fall asleep with earbuds or headphones on. The time of exposure matters and why waste sleep time damaging your ears? </li>
<li>If you need "white noise" to fall to sleep, put together a playlist of soft songs or sounds and have it play at a low volume from a speaker on your bedside table. Use your clock's "sleep" function, which will automatically turn off your music after a set amount of time to ensure the music doesn't end up playing all night long, which saves energy in addition to your hearing.</li>
<li>As always: model these behaviors for your children. If they see you mowing the grass with loud music blaring in your ears, they will grow up to do the same. If you wear ear buds many hours of the day, they will see that as a normal and acceptable behavior. </li>
</ul>
<h4>
</h4>
<h4>
What happens that hurts our hearing?</h4>
</div>
<div>
<br /></div>
<div>
<a href="https://www.youtube.com/watch?v=krqGja-pDcc" target="_blank">Keep the volume down – Too loud and too long can damage your hearing </a>shows a man listening to music. Below it the music soundtrack and volume levels are shown. The video then breaks to showing what happens to the hair cells in our ear with these volumes, which makes the damage more understandable because you can see it happening. </div>
<div>
<br /></div>
<h4>
Resources:</h4>
<div>
<a href="http://www.jahonline.org/article/S1054-139X(16)30163-X/fulltext" target="_blank">Hearing Screening and Prevention of Hearing Loss in Adolescents</a></div>
</div>
<div>
<br /></div>
<div>
CDC's <a href="https://www.cdc.gov/ncbddd/hearingloss/facts.html" target="_blank">Hearing Loss</a> main page</div>
Kristen Stuppy, MDhttp://www.blogger.com/profile/10332172268371143329noreply@blogger.com0tag:blogger.com,1999:blog-106825434973779887.post-65378828646766204932017-02-19T07:14:00.000-06:002017-10-10T13:01:56.598-05:00Flat heads in babiesWe have significantly decreased the risk of SIDS by placing babies on their backs to sleep, but have seen a rise in flat heads due to their positioning. Prevention of the flatness involves several positioning strategies.<br />
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<tr><td class="tr-caption" style="text-align: center;">Supervise tummy time when Baby's awake!</td></tr>
</tbody></table>
<br />
It's important for babies to sleep on their back, but they tend to have their head facing one direction or another. They should alternate which side they face, but many babies have a stiff neck and favor looking to one side. Think of when you wake with a stiff neck - probably from positioning overnight. Many babies are in the same position for quite awhile at the end of pregnancy - of course they're stiff!<br />
<br />
If Baby's neck is stiff, you can massage his or her neck and shoulder muscles gently and then slowly move the head right and left (chin to each shoulder) and side to side (ear to shoulder). Don't quickly force the head movement, but think of what you do if you have a stiff and sore neck. The more frequently you stretch it out, the better it feels, right? I recommend stretching Baby's neck with each diaper change (before the change or after you wash your hands!) until it isn't stiff for several days and Baby moves his or her head easily without your help.<br />
<br />
Start supervised tummy time early on - the longer you wait to start, the more Baby might resist it. I see so many parents who are hesitant to put Baby on his or her stomach. Concerns range from the umbilical cord stump still being on and bothering the baby (it won't) to spitting up will worsen (test it out, for many babies it's actually better) to "I thought babies should never be on their stomachs" (only when sleeping or not supervised).<br />
<br />
Tummy time is an important time for baby to develop muscle strength. It needs to be supervised, but it can be a fun time to interact with Baby. Lay face to face and talk to Baby, encouraging him or her to look up. Grab a brightly colored object and move it around for Baby to watch. Enjoy your play time.<br />
<br />
<br />
For more information on issues related to stiff necks in babies and how to treat the stiffness, see this <a href="http://www.pediatricpartnerskc.com/torticollis-stiff-neck.html" target="_blank">Torticollis</a> information.<br />
<br />
AAP <a href="http://pediatrics.aappublications.org/content/early/2011/11/22/peds.2011-2220">article </a>on how to prevent flat heads in babies.<br />
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<br />Kristen Stuppy, MDhttp://www.blogger.com/profile/10332172268371143329noreply@blogger.com0tag:blogger.com,1999:blog-106825434973779887.post-55823120924040874732017-02-04T11:56:00.000-06:002017-10-10T13:02:17.305-05:00Rashes in kids... a few case studies for parentsI am not a dermatologist, but I see rashes all the time. Some are easy to identify, others I'm not sure what the cause is. In general physicians are taught to treat the symptoms of a rash. The standard dermatology lecture in a nutshell is: If it's wet, dry it. If it's dry, wet it. If it itches, use steroids. If it's infected, use antibiotics.<br />
<br />
I'll go over a few made up case studies -- each one is a conglomeration of kids I've seen.<br />
<br />
Case 1<br />
<br />
Parents bring Itchy in for a well visit but mention that her skin has rashes on her elbow creases and behind her knees. Sometimes she scratches them to the point where they bleed. They've tried applying a pink fragrant lotion that they got as a baby gift, but she says it burns and didn't help.<br />
<br />
Advice for this family would <i>not</i> include which of the following?<br />
<br />
<ol>
<li>Use the lotion more often since the skin is dry</li>
<li>Stop the lotion because fragrant lotions can worsen this condition</li>
<li>This type of dry skin can be related to allergies and asthma, having one makes it more likely to have another</li>
<li>Controlling the itch is important because scratching worsens the rash</li>
</ol>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgCL0o053zL_sQrqSdPFfGMDhpRVFRdrPkswCFLNImZzYM2BovvsWjf1Dxrgrjd0UPpuSnQvECGlvKEbSKfRCe8F9s78XFknNZTRtkm0x7Of1dtyebVJh0KBNph-23N5DfG8f3lTDmsA7Oc/s1600/Depositphotos_101280758_original.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgCL0o053zL_sQrqSdPFfGMDhpRVFRdrPkswCFLNImZzYM2BovvsWjf1Dxrgrjd0UPpuSnQvECGlvKEbSKfRCe8F9s78XFknNZTRtkm0x7Of1dtyebVJh0KBNph-23N5DfG8f3lTDmsA7Oc/s320/Depositphotos_101280758_original.jpg" width="320" /></a></div>
<div>
<br /></div>
<div>
The answer is #1. This rash is most likely <a href="http://kidshealth.org/en/parents/eczema-atopic-dermatitis.html" target="_blank">eczema</a>, a fancy term for dry skin. It often develops in infants but improves as a child gets older. It is more common in kids with allergies and/or asthma. It can worsen with exposure to irritants (such as a fragranced lotion or soap) and allergens (food allergies and seasonal allergies). I've often heard this called "the itch that rashes". Scratching damages the skin, which allows water to escape, which dries the skin more, leading to more itching. This itch/scratch cycle worsens the rash and can lead to secondary infections. This can be a very frustrating condition because it will come and go for years in some kids. It's important to avoid irritants and use proper skin care. For more treatment, visit <a href="http://pediatricpartnerskc.com/dry-skin-eczema-atopic-dermatitis.html" target="_blank">Dry Skin / Eczema / Atopic Dermatitis</a>.</div>
<div>
<br /></div>
<div>
Case 2</div>
<div>
<br /></div>
<div>
Parents bring their infant in for her well visit and ask about a rash that's been there "for awhile" but doesn't seem to bother Baby. They aren't sure when it started. They can't recall any new soaps, lotions, foods, or other potential triggers. They describe it as red spots and they aren't sure if they're changing over time. Baby is eating well, gaining weight well, sleeping well, and not fussy. On exam, they show me the rash on the abdomen and arm, but I cannot see any red spots. </div>
<div>
<br /></div>
<div>
What further questions might I ask and what advice might I give?</div>
<div>
<br /></div>
<br />
<div>
<ol>
<li>If this rash would be on your own skin, how would you treat it?</li>
<li>Treatment of the rash should be based on symptoms, and since there are no symptoms, no treatment is needed</li>
<li>Monitor for signs of itching, fussiness, fever, poor feeding, and other concerns</li>
<li>All of the above</li>
</ol>
</div>
<br />
<div>
<br /></div>
<div>
The answer is #4 and yes, I see this non-existent rash all the time. It's not just my old eyes that can't see it -- I hear from pediatrician friends about this phantom rash too. I know parents worry more about their children than they worry about themselves, but sometimes they can realize the unfounded concern when I simply ask what they would do if this rash was on their own skin. Most say they wouldn't worry about it. Enough said. </div>
<div>
<br /></div>
<div>
Case 3</div>
<div>
<br /></div>
<div>
Parents ask about a rash that appears sometimes after their school aged child showers. It doesn't itch or hurt. It is always on the chest and abdomen and sometimes on the legs. It looks like red splotches. They've tried various soaps and shampoos, but changing them doesn't seem to affect the rash. It isn't present on exam because it only happens after showers and lasts less than 30 minutes. They are concerned because it returns so frequently.</div>
<div>
<br /></div>
<div>
My advice to parents includes which the following?</div>
<div>
<br /></div>
<div>
<ol>
<li>Treatment of a rash should be based on symptoms, and since there are no symptoms, no treatment is needed</li>
<li>Use only cleansing products made for babies since your child is obviously sensitive to something</li>
<li>Turn down the temperature of the water in the shower to see if the rash "resolves"</li>
<li>1 and 3</li>
</ol>
<div>
The answer is # 4. Again, I've been asked this type of question more than once. It also falls into the category of "What would you do if you had this rash?" Most parents would admit they wouldn't do anything since it didn't cause any problems and was brief. If they really think about it, they probably have had this "rash" after a hot shower. It's just flushed skin. If you enjoy a hot shower, it's okay if your skin flushes a bit.</div>
</div>
<div>
<br /></div>
<div>
<br /></div>
<div>
Case 4</div>
<div>
<br /></div>
<div>
Mom brings Kiddo in because her nails are growing "funny." They have a horizontal crack and the tips are peeling off. They don't seem to hurt or bother Kiddo.</div>
<div>
<br /></div>
<div>
What further information would be important to know?</div>
<div>
<ol>
<li>Was there any trauma to the nails?</li>
<li>Has your child been sick in the past 2 months?</li>
<li>Does kiddo use nail polish or fake nails?</li>
<li>Does your child pick at her nails regularly?</li>
<li>All of the above.</li>
</ol>
<div>
The answer is #5. The answer is usually in the patient history with this one. I've seen a number of kids with peeling nails recently because we had hand, foot, and mouth in the area about a month ago. Not all kids with that infection lose their nails, but it can happen. For more on this, including pictures, see <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4252687/" target="_blank">Four Cases of Onychomadesis after Hand-Foot-Mouth Disease</a>. Other causes of peeling nails include trauma and nail picking, nutritional deficiencies, nail products, chemical irritants, certain medications, infections, and chronic diseases. </div>
</div>
<div>
<br /></div>
<div>
Case 5</div>
<div>
<br /></div>
<div>
Mom brings Snotty in because he's had a runny nose all week. On exam, he's found to have what mom thought was dried mucus under his nose, but the underlying skin is red and it's actually more of a crusting, not mucus. </div>
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<br /></div>
<div class="separator" style="clear: both; text-align: left;">
Treatment of this includes all except:</div>
<div class="separator" style="clear: both; text-align: left;">
</div>
<ol>
<li>Using rubbing alcohol to rub off the crust</li>
<li>Antibiotic ointment</li>
<li>Washing the area</li>
<li>Avoid touching the area</li>
<li>Oral antibiotics</li>
</ol>
<div>
The answer is #1. That would hurt! This is a classic case of <a href="http://kidshealth.org/en/parents/impetigo.html#" target="_blank">impetigo</a>. Impetigo is a bacterial skin infection. It often happens when the skin is damaged (in this case from Snotty wiping his nose constantly) and if bacteria from the nose or mouth get into the skin. It can be treated with prescription topical antibiotic ointment in most cases, but some cases require oral (by mouth) antibiotics. Wash the area gently and soak crusts with warm wet cloths to help remove the crust. Complete removal of the crust isn't necessary though - that will happen naturally as the infection resolves. Touching the area can spread the infection, so avoid touching it and wash hands well after touching it!</div>
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<br /></div>
<div>
<br /></div>
Kristen Stuppy, MDhttp://www.blogger.com/profile/10332172268371143329noreply@blogger.com0tag:blogger.com,1999:blog-106825434973779887.post-63115251407512812712017-01-31T07:07:00.000-06:002017-01-31T07:07:11.849-06:00Cough 'til you puke...This is the time of year it seems everyone's coughing. I've heard from more than one worried parent that their child coughs to the point of vomiting. In the medical world, we call this post-tussive emesis.<br />
<br />
Post = after, tussive = cough, emesis = vomit<br />
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Kids tend to have a very active gag reflex, so they sometimes gag themselves and vomit with cough. This can be good, since it gets the mucus out of the back of the throat. You can try to teach older kids to hack and spit it out, cough and spit it out, gargle with salt water, and <a href="http://pediatricpartners.blogspot.com/2013/12/but-snot-is-green-or-how-can-we-treat.html" target="_blank">rinse mucus out of the nose</a>.<br />
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Of course it's not fun to vomit after coughing because everything in the stomach comes up and makes a huge mess. Sometimes the vomit comes out of the nose, which can burn from the stomach acid. And vomiting can be very scary to kids.<br />
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Are there serious concerns when kids vomit from coughing? </h4>
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Yes. In medical school I learned that when kids cough to the point of vomiting we should consider whooping cough, pneumonia and asthma. In reality, I find that many kids with regular cough and colds can gag from cough, but I always consider the more serious options.<br />
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What should I do if my child vomits from a cough?</h4>
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First, keep your cool. If a parent starts to get flustered, it makes the child more worried, which never helps.</div>
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Make sure your child's breathing is okay. Obviously he is coughing, but between coughs if the breathing rate is too fast or labored, he should be evaluated ASAP.</div>
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Rinse out your child's mouth (and nose if needed- saline drops or rinses work well for this). Vomit is just nasty tasting and can burn in the nose.</div>
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Treat the cough. If your child has asthma, give a breathing treatment or their rescue inhaler. If your child is over a year of age, you can use honey to help a cough. A tsp usually does the trick. Humidify the air with a vaporizer or humidifier. For more treatments see <a href="http://pediatricpartners.blogspot.com/2013/10/cough-medicine-which-ones-best.html" target="_blank">Cough Medicine: Which one's best</a>.</div>
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When should my child be seen?</h4>
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If your infant is under a year of age or your child has not had the whooping cough vaccines, he should be evaluated. Some babies with whooping cough stop breathing so many are hospitalized to monitor for complications. </div>
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After a single episode of vomiting if your child's breathing is comfortable, just continue to manage at home.</div>
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If your child develops difficulty breathing or dehydration, he should be seen as soon as possible.</div>
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If your child continues to vomit after coughing but is comfortable between episodes, he should be seen during normal business hours at his regular doctor's office. </div>
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<br />Kristen Stuppy, MDhttp://www.blogger.com/profile/10332172268371143329noreply@blogger.com0