Newsymail from 2011.
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Hyland’s Teething Tablets was called off the market. I never have
recommended it and most teething pain is mild and can be managed with
Acetaminophen or Ibuprofen. (And teething does not cause fever.) The
Teething Tablets contained varing amounts of a toxic chemical called
belladonna. It has been used for centuries as a poison or medication called
Deadly Nightshade. Belladonna alkaloids have anticholinergic effects such
as fast heart rate, increased body temperature, dry skin and dry mouth, skin
flushing, constipation, decreased urination, agitation, disorientation,
hallucinations, and dilated pupils. Drowsiness may also be seen in
infants. It probably quieted the infants through this mechanism. Like many
homeopathic herbs, these tablets were never evaluated by the FDA, and had no
proven benefit. The FDA now has issued an advisory warning for consumers to
stop using and discard them.
aside, the statistics for 2009 birth rates were finally announced and the
declined 3% in America. It is probably lower in 2010. I think it was the
economy. “Lets wait until we can better afford a child?” I guess it is
the reverse of the blackout of electricity years ago in NY.
Happy New Year.
interesting that the first president of America who was born in a hospital
was Jimmy Carter. Around the turn of the century most people were born at
home. Things have certainly changed … for the better.
study showed for the 5-year period 2000-2004 there were 1,237,129
in-hospital certified nurse midwife attended births; 17,389 in-hospital
'other' midwife attended births; 13,529 home certified nurse midwife
attended births; 42,375 home 'other' midwife attended births; and 25,319
birthing center certified nurse midwife attended births.
neonatal mortality rate per 1000 live births for each of these categories
Hospital/birthing center: 0.5, 0.4, and 0.6.
births:………………1.0, and 1.8
many for home births.
neonatal outcomes of interest in this analysis that showed significant
increases in risk for home births included the need for mechanical
ventilation for >30 min among women delivered by 'other' midwives, OR=1.63
(1.38, 1.94) (almost twice as many); and the risk for neonatal seizures,
OR=3.15 (2.25, 4.41) (twice as many). For home deliveries attended by both
CNMs and 'other' midwives the risk for 5 min Apgar scores <4 was
significantly increased compared with in-hospital deliveries by CNMs,
(respectively OR=7.83 and 3.39) ( 7 to 3 times as many ).
the problems of medical care in the hospital, but it is still better there
than at home.
study comparing pregnant women taking fish oil or DHA supplements with
controls who did not take them, did not show a difference in postpartum
depression or intelligence in the children. However there were half as many
preterm deliveries so keep taking the DHA.
an infection around the nail bed of the finger or toe will cause redness and
frequently an abscess beside the nail. See picture below. (Old fashion
name for this a “run around”. The infection runs around the nail. Ha.)
This infection is caused by trauma to the skin beside the nail and bacteria
getting under and inside the skin. It usually is staph (generally not the
bad kind called MRSA.) Treating it topically will not help. You can try
soaks and also drain the puss if a white or yellowish looking area occurs as
seen on this picture. Long ago we used to cut or poke the skin to drain it
but it is easier to push the cuticle back with a finger nail file or other
nail instrument. Then squeeze the pus out between the skin and nail.
Usually we also treat with antibiotics. If you drain it and it is not
better in a few days, then call your doctor for antibiotics. If it is the
big toe, you also may need to treat it for an ingrown nail also. Podiatrists
are great at treating ingrown nails.
come in commenting that this is their child's third illness this year. It
seams that we occasionally have a bad year. Even our appliances in our
homes do not break down one a year. In one year the air conditioner, the
disposal, and the washing machine goes out. Then nothing else breaks for 3
years. So machines do not break down one a year and humans do not either.
In one year they will have two ear aches, impetigo, and a viral fever. Then
they do not get ill for 3 years. As long as they become normal between
these illnesses, then there is nothing wrong deep inside, they are just
having a bad year.
frequent antibiotics does not weaken the immune system. But children with
weak immune systems died in the 1800s. In fact 10% died the first year and
the average life span of the human was approx. 35 years old. Now we have
antibiotics and these kids are growing older and their immune systems mature
enough to get them survive (and they are having more children with weak
immune systems. We interrupted survival of the fittest.). So it turns out
that the weak immune system forced us to give more antibiotics, not the
other way around.
frequently come in saying that there is strep throats or whooping cough in
the school. That is nice to know but we watch out for every child who comes
in to have strep, whooping cough, meningitis, or any disease. We check
every child for almost everything. So knowing they have been exposed to it
does not help as much as you would think. Just because there is strep in
the school does not mean your child has strep and not meningitis. Similarly
when the parent says "there is scoliosis in the family". This does not help
since we check every child for scoliosis. Because there is not a family
history of scoliosis does not mean we will not check the child for it. So
good doctors are looking at every patient for every thing.
are rare exceptions where some inherited problems are deadly and need to be
screened early. We now screen every newborn for Cystic Fibrosis.
a lot of flu and strep out there... One patient said the waiting time at
Cook's emergency room was 7 hours. And the other day they notified us that
30 patients were waiting in the ER for a bed in the hospital to open up.
Hopefully the flu and strep will be over soon. Vit C does not prevent or
treat illnesses. Use good hand precautions and take your Multivitamins with
Lack of Sleep Linked to Childhood Obesity
Children Who Sleep the Least at Increased Risk for Obesity, Study Finds
growing evidence for a link between sleep duration and childhood obesity.
What is new … is that perhaps even more important than sleep duration is the
effect of day to day variability of sleep wake timing on weight regulation."
talked recently about studies that show a correlation but not cause and
effect. Frequently it may be the reverse and the other factor caused the
original problem. For example a study came out showing prolong use of
infant walkers delayed their development. The actual situation is that the
children who had delayed development had to use the walkers longer because
they did not walk until very late.
is another problem of believing some doctors that have an agenda to prove
one thing when all they have shown is a correlation. It is not a cause and
effect. The news media also loves to dramatize the studies. Another study
was done by a group of doctors from Ohio who showed a correlation between
obesity in kids and the lack of routines in the house. Their conclusions
children exposed to the 3 household routines of regularly eating
the evening meal as a family, obtaining adequate nighttime sleep,
and having limited screen-viewing time had an
lower prevalence of obesity than those exposed to none of these
problem are the parents who are not in control of the house routines and
rules and do not make their children adhere to their rules. The children
are “running the house”. Parents are afraid to limit the kid’s desires.
Children will want what is not good for them for 20+ years. They will want
too much candy, too much TV, and stay out till 3 in the morning as
teenagers. So parents who do not enforce house routines do not limit their
child’s eating. Making your children sleep more is not the problem. It is
afraid to be consistent and firm. Your kids will actually feel safer and
more loved when the parent is in control.
The dog whisperer on TV says they same thing about pets. Funny
a change in the vaccine schedule for Menatra that is for Meningococcal
Meningitis. Kids mostly get this in their teens and early twenties. We
gave it for 15 years to seniors before college since that is the peak age
for it. But there were some cases in high school that we were missing. So
the vaccine was moved down to 12 yr old and now required for 7th
grade. Studies however showed the immunity did not last through college and
some of them were still getting sick or dieing. Now a recommendation came
out to rebooster a second dose of vaccine in their senior year of high
school. I strongly support this recommendation since this is a very deadly
disease. If you have a child already in college and they were given this
vaccine at 12, see the college doctor for a booster.
closed Wed morning (Feb 2nd ) and if we open Wed afternoon it
will be posted at my web site. I will also post there if we end up closed
Thursday or Friday. We may be able to handle some medical problems over the
phone. A nurse will be screening calls that come in during this winter
storm. We will reschedule you if you had a well exam scheduled during these
days. Sorry for the inconvenience.
like every parent gets a humidifier. Most of us use them with colds but
there are a few that run them all the time. Careful you don’t increase
molds by running them all the time. That is why most allergists do not
recommend them. We do not recommend putting Vicks or other smelly stuff in
them. Most of the time the humidifiers do not help. Sometimes the moister
precipitates in the nose and makes more mucous. They really help Croup
which is the seal bark cough. The moisture does not go far past the vocal
cords so these do not help lower chest problems. Be sure to use distilled
water in them. A rare complication is severe lung damage from “mineral
dust” which is the high concentration of minerals. I didn’t even know that
could happen. Gee!
parents coming in with their ill child informing me of “what is going
around in the school”. Most of the time we know what is going around
because we see them in our office. “There are 4 cases of strep in her
room.” That is nice to know but we check and look for all diseases that
cause fever. To assume the child’s fever is strep and miss pneumonia or
meningitis would be bad. So we should check all children for all things.
The same with knowing there is scoliosis in the family. We check every
child for this. The exception is when the child was exposed to a very rare
illness that we never see here (like Ebola) or a rare inherited disease that
nobody ever hears about and is one in every million children. But otherwise
knowing about common things does not help us decide what is wrong with the
new version of the recommended vaccine schedule is out and the main
difference is a second Meningococcal vaccine Menatra at 18yr old before
college. They get one at 12 yr and now a second one their senior year.
Academy of Pediatrics and the National Highway Traffic Safety Administration
now recommend keeping infants in car seats facing backwards until 2 years
old. It is because there are far less injuries and deaths if facing
backwards. Facing forwards their head is violently whipped forward and can
break their necks. They do not mind their legs being bent. They fuss
because they cannot see you. Put a large mirror there so you can see them
and they can see the front.
Dr. Roger Knapp
Infants and toddlers—rear-facing
The AAP recommends that all infants should ride rear-facing
starting with their first ride home from the hospital. All infants and
toddlers should ride in a Rear-Facing Car Safety Seat until they are
2 years of age or until they reach the highest weight or height allowed by
their car safety seat’s manufacturer.
Types of rear-facing car safety seats
There are 3 types of rear-facing car safety seats: infant-only
seats, convertible seats, and 3-in-1 seats. When children reach the highest
weight or length allowed by the manufacturer of their infant-only seat, they
should continue to ride rear-facing in a convertible seat or 3-in-1 seat.
Types of Car Safety Seats at a Glance
Type of Seat
Infant seats and rear-facing convertible seats
All infants and toddlers should ride in a Rear-Facing Car Safety
Seat until they are 2 years of age or until they reach the
highest weight or height allowed by their car safety seat’s
Convertible seats and forward-facing seats
All children 2 years or older, or those younger than 2 years who
have outgrown the rear-facing weight or height limit for their car
safety seat, should use a Forward-Facing Car Safety Seat with
a harness for as long as possible, up to the highest weight or
height allowed by their car safety seat’s manufacturer.
All children whose weight or height is above the forward-facing
limit for their car safety seat should use a Belt-Positioning
Booster Seat until the vehicle seat belt fits properly,
typically when they have reached 4 feet 9 inches in height and are
between 8 and 12 years of age.
When children are old enough and large enough to use the vehicle
seat belt alone, they should always use Lap and Shoulder Seat
Belts for optimal protection.
All children younger than 13 years should be restrained in the
Rear Seats of vehicles for optimal protection.
seats should be replaced if they are involved in a crash with the child
riding in them. The plastic shell and the harness absorb the impact of a
crash only once, and cannot be guaranteed a second time. Most insurance
companies pay for a new seat as part of repairing the vehicle. Parents must
be advised to contact their insurance agents and explore that possibility.
Also a study came out looking at the blood oxygen of newborns who where
strapped into car seats and other devices.
A consecutive series of 200 newborns was recruited on the second
day of life. Each subject was studied while placed in the
hospital crib (30 minutes),
car bed (60 minutes), and
car seat (60 minutes). Physiologic data, including oxygen
saturation, frequency, and type of apnea, hypopnea, and bradycardia
were obtained and analyzed in a blinded manner.
The mean oxygen saturation level was significantly different
among all of the positions (97.9% for the hospital crib, 96.3%
car bed, and 95.7% for the
car seat; P < .001). The mean minimal
oxygen saturation level was lower while in both safety devices
(83.7% for the
car bed and 83.6% for the
car seat) compared with in the hospital crib (87.4%) (P
< .001). The mean total time spent with an oxygen saturation
level of <95% was significantly higher (P = .003) in both
safety devices (car
car bed: 17.2%) when compared with the hospital
crib (6.5%). A second study of 50 subjects in which each
infant was placed in each position for 120 minutes
yielded similar results.
means that Ľ of their time they had low oxygen. See my web site about a
back support to keep their oxygen more normal.
that time of year with sun and mosquitoes. Just a reminder to use sunscreen
and repellants. Sunscreen is OK down to 2 months but watch out for
irritation rashes. I like the spray since it dries out quick and you can
spray your hand and wipe it on the face of infants. We already have seen
sunburns on the face of infants. You can burn in the shade from reflected
sunlight. (It is not wind burn like grandma said.) Use the SPF of 20 or
the repellants starting at 6 months old. The deet in Off has been well
studied but the other products have not. Mosquitoes carry bad diseases and
we see cases of encephalitis every summer. There is also a bad viral
disease called Dengue Fever that is in S. America and Mexico but headed
North toward us. If you are going to the park or camping, put long pants
and even long sleeve shirts on them.
sites I think are good:
Keep kids safe:
School Work Help:
seeing many cases of a chest cold with most having fever with it. It is
not the flu but I do not know what virus. You cough for 2 weeks and if you
have fever it is during the first 3-4 days. We can check the child over
during the first part of it but we can’t cure viruses. Keep them at home
and treat the symptoms. Bring them in if there is fever or ear pain after
the fourth day. I was booked solid Monday and could not see all my
patients it was that busy. Strep throat does not have a cough with it. You
generally don’t just get pneumonia from the outset. See previous Newsymail
about chest x-rays being read incorrectly. So watch for fever around 7 days
long has it been since you went out as a couple without the kids. Every few
weeks leave the kids with grandma and go out on a “date”. Do the fun things
you did when you were younger. Go bowling or play cards with friends down
the street. It does not have to be expensive. Laugh and enjoy each other.
That is good for the marriage and therefore good for the kids. If all you
do is eat and sleep together, there is a high probability of a divorce.
Also treat your spouse with respect. Instead of criticizing in an ugly way,
try asking nicely. If your spouse is asking you to do something over and
over, then try hard to do it. Just as you want them to do what you want
done. (except snoring, we can’t help that!)
March 4, 2011
The New Crib Standards
CPSC approved a new crib rule, your questions have been flowing into us.
While most questions have revolved around the drop side, it’s important for
you to know that the new standard affects far more than the drop side. The
new rules require crib’s mattress support, slats 2 3/8 inch gap, one finger
gap beside mattress, and hardware are now required to be more durable and
no drop side rails. There are not requirements for height of the side
rails. They figure if the child can climb out, the height won't stop them.
which apply to full-size and non full-size cribs, prohibit the manufacture
or sale of traditional drop-side rail cribs, strengthen crib slats and
mattress supports, slats with 2 3/8 inch gaps, one finger gap beside
mattress and rail, improve the quality of hardware and require more rigorous
testing. The details of the rule are available on CPSC’s website at
on June 28, 2011,
all cribs sold in the United States must meet the new federal requirements.
After that date, it will be illegal to manufacture, sell, garage sale,
contract to sell or resell, lease, sublet, offer, provide for use, or
otherwise place in the stream of commerce a crib that does not comply with
the CPSC’s new standards for full-size and non-full-size cribs. This
includes manufacturers, retail stores, Internet retailers, resale shops,
auction sites, garage sales, and consumers.
As a consumer, what can I
do if I have a drop-side crib?
Some drop-side crib manufacturers have immobilizers that fit their cribs.
Drop-side crib immobilizers are devices that are used to secure drop sides
to prevent dangerous situations in which the drop-side either partially or
fully separates from the crib. As part of a recall, CPSC staff works with
companies to provide fixes, or remedies, for products. For drop-side cribs,
that remedy has been immobilizers. These immobilizers were evaluated and
approved by CPSC staff for use with these particular drop-side cribs. If
your drop-side crib has not been recalled, you can call the manufacturer and
ask if they are making an immobilizer for your crib. (list of manufacturers
is at my web site or at the CPSC Site.) Remember, though, that those
particular immobilizers have not been tested or evaluated by CPSC staff for
use with your specific crib.
a drop side crib, even with an immobilizer installed, will not meet the new
CPSC crib standards.
Most parents move them out of the crib to a youth bed around 2 yr old. But
the age range is 18 months to 3yr. When the toddler starts climbing over,
move them out. You can use a youth bed or you can put the crib mattress on
the floor, have Dad get wood and nail a box around it, sand and paint
it, stick pictures on it. Cheaper. I like hand made. Also it is not child
abuse to contain them in their room. Get a gate or lock the wood door. If
the house catches fire, the smoke will not get to their room and they will
be saved. We have had 2-3 year olds light the stove, go out the front door,
and come in on parent's bedroom activities. So do not be afraid to contain
them in there.
were two cases of Measles this week in Tarrant County. They were adults who
were not fully immunized. There are usually around 60 cases in America
each year. There were 11 cases in America this last few weeks. The case in
Houston was an 11 month old infant who has not had a MMR yet. Minnesota had
15 cases and most were in a Somalia neighborhood who do not immunize. The
rate of vaccinated children in America is 90%. Texas has 84-86%. That area
in Minnesota only had 30% vaccinated. There needs to be 90% or more to
prevent outbreaks. Some kids will not make proper immunity after one MMR so
the county in Minnesota where the outbreak is located is recommending the
second MMR earlier than 4 yrs. old.
cases here in Texas and other states are acquired from foreigners who came
here sick. Most people who are immunized should not worry. Children below
1 year are susceptible and if there are more cases we will give the single
Measles vaccine to those over 6 months. We will let you know if these steps
are needed here.
last big outbreak occured in 1989 when 500 kids were hospitalized and 3
starts out as a cold and then higher fever and by day 3-4 there is a rash
all over with continued fever. It is contagious 5 days before the rash! It
is viral and no treatment.
Remember how to do first aid for injuries? The weather is nicer and we are
starting to see more booboos. See:
reactions are common. The most frequent is the child having hives or
urticaria. Hives are large whelps where viral rashes are small dots below
pencil eraser size. Typically the hives are caused by three things:
Medications, foods, and infections. Of these three, the most common are
infections. Many people who become ill with fever and take an antibiotic
and then develop hives are not allergic to the medication, but are allergic
to the germ that caused the infection. 75% of adults who say they are
allergic to a medication are not.
example a child will started running fever and the parent just wants to
watch it at home. Then after a few days the child breaks out in hives and
that scares the parent and they bring him in to see me. Had I seen him the
first day of the fever and gave antibiotics, then when he broke out in hives
a few days later everyone would say “He’s allergic to the medication.”
child does break out in hives during the course of a medication, I recommend
stopping the medication, switch to another one but keep the original
medication. Then a few weeks later give a day or two of the medication and
if they break out in hives a second time, then call and have his medical
record labeled allergic. If he does not break out, then it was the
infection that caused the hives. It is safe to rechallenge them with the
medication if the orginal allergic reaction was just hives and not a more
severe reaction. If the hives last for more than 2-3 days, then very likely
it is not the medication which is out of your system quickly. Also when
they first break out in hives, stop all very allergic foods like dairy,
nuts, peanut butter, shell fish. If the hives go away, then one at a time
rechallenge the child with the medication, and the foods that were
hives last more than a week, then remove other foods by eliminating food
groups. Stop all vegatables for a week and if it continues, then put them
back in the diet and eliminate all fruits, then all meats. If the hives
stop during one of these food group eliminations, then put them back in the
diet one at a time. If you put them all back in the diet and the hives do
not recur, then it was nothing in the diet and the hives just happen to stop
during those days.
Remember, if someone injures your body, like a spranged ankle, wrap it with
tape for 24 hours. Wrap it immedicately before it swells. Not with an ace
bandage…. Use athletic tape or duct tape. And ice is OK if you want to put
it on your boo boo later but the first thing coming off the field is
is not cool. It is not only cruel but also now days can get you in a law
suit. Here are some web sites that help kids understand and help cope.
for families in this North Texas area near Bedford, Southlake, and
Colleyville, a very good psychologist Susan Gifford is having group social
skills sessions this summer. They learn to explore social challenges and
how to modify their thoughts and behaviors. It equips them to reduce
meltdowns and fear while increasing their repertoire of social skills.
These sessions last most of the summer.
seems that people who leave ratings on the internet are mostly those
who had a negative experience. We need to leave more ratings for
products and professionals when we have good comments.
are some sites that rate MDs and your comments about your
doctors can help give a better picture of them to others who may
be looking around for a new doctor.
are others also. Thanks...
Kids become picky eaters between 1 and
2 yr. old. They are really picky between 2 and 6 yr. and somewhat picky
after that. In all age groups some will be pickier than others. They start
to not want their vegetables and want more junk. They only gain 3-4 lbs. per
year after 2 yr. old so they only need one meal a day, and nibble at the
other meals. That is only 1 lb. every 3-4 months …. I can gain 1 lb. in 3-4
minutes! So they can easily get by with very little food.
You can work this picky eater problem
in three different ways.
could outwait them. If you start off with meat and vegetables (proper foods)
and they refuse it, put it in the refrigerator and pull it out again the
next morning, and again at noon. After going a few days hungry then they
will eat anything. The kids stranded in the Super Dome in New Orleans during
Katrina ate anything off the floor. They get hungry they will eat the dog
food.(probably try that anyway.) So you could outwait them and after going
hungry for a day or so they will eat anything. The problem is that they need
very little food so they outwait you. I have done this with a few of my
grandkids when staying with us.
can disguise the food. Grind up the proper foods and put the ground up stuff
into the macaroni and cheese, spaghetti sauce, or in the peanut butter.
There is carrot cake and zucchini bread. Seinfeld’s wife wrote a book about
this called “Deceptively Delicious”. Put the proper foods into whatever they
are eating. If your kid likes sour things like pickles, then put the raw
vegetables into the pickle jar. Buy dehydrated peas that have BBQ powder on
them. Dip the vegetables into Ranch dressing or cheese wiz. Get creative.
Most kid’s taste buds are not geared for the flavor of vegetables.
the last way is to let them eat whatever they want, give them multivitamins,
and 12 oz of milk ….. and they will grow up fine. (Give the vitamins to all
The problem is that you let them eat
what they want one day and the next you are fussing at them to eat the
proper foods. YOU are not being consistent. Pick which one of these three
methods and BE CONSISTENT! (I prefer a combination of the first and second
method. Disguise and flavor up the proper foods and then outwait them.)
Other things to think about:
healthy balanced meals yourself and set the example. Control how much junk
food is in the house and how much everyone eats.
2. Do not
force them to eat. If they eat so much proper food, then they get a
proportional amount of desert. But to make them finish their plate to get
the cookie is forcing them to eat too much and leads to obesity. “Feel
guilty about leaving food on the plate.” “Love that stuffed engorged
stomach.” Those are bad habits we fight. Leftovers are the same whether they
are on our plate or in a pot on the stove. Leaving food on the plate is not
being wasteful; cooking too much food is being wasteful. Most families cook
too much food so no one will go hungry. So you will have leftovers every
meal. Whether they are on my plate or on the stove, I would like to mail it
to Haite or Japan, but I can’t. Being wasteful is cooking too much food.
Just keep the desert in proportion to how much proper food they eat.
healthy choices. Sometimes let them pick what the family will have for that
meal if it is within reason.
going back to the kitchen and prepare something different for the child.
5. If the
child is not hungry at that time, and we all are hungry at different times,
put the dinner in the refrigerator and when they are hungry later, pull it
out and warm it up again for them.
It is important to have a sit down
family meal. There are less drugs and pregnancy in the teens and less
divorces in the parents. Turn off the TV and phones and visit. If the child
is not hungry, then sit and visit while we eat.
parents are talked into saving their baby’s cord blood for their baby.
There might be a need for it in case their baby has cancer or some disease
that would need a bone marrow transplant. The problem is that many bone
marrow failure, anemia, and cancers are from a defect in the DNA. The
doctors do not really want to use the same DNA blood. They are very good at
getting DNA matched cord blood from some other baby and use it for the bone
marrow transplant. The American Academy of Pediatrics does not recommend
saving your baby’s cord blood for your baby. It is expensive and will
hardly ever be used.
can donate your baby’s cord blood for free to the national cord blood bank
to help other babies. And many other parents give their baby’s cord blood
for you to use if the need should arise. Here is the web site that you can
read up and get contact information to donate it.
Children’s social security number are being stolen and Identity Theft with
their name. But the parent does not know it until the child becomes an
adult and tries to buy a car or house.
don’t need Life Lock or other companies. Just contact the three credit
agencies and lock up your credit with a one time small fee. Lock up your
children’s and your credit so no one can scam you even if they get your SSN.
get a credit report. Just Freeze your credit. It is easy to unfreeze it
for a few weeks if you do need to apply for a loan.
Acetaminophen (Tylenol)will not come in concentrated drops for infants in
the next few months. The only liquid will be the children’s liquid with
160mg / tsp. It will still be the same dose as our chart in our clinic or
at my web site. It will come along with a syringe to give more accurate
Ivy is around every summer. If you are allergic to it then it will cause a
blistery itchy rash a few days later. If you get around it and come in
right away, take a sudsy bath and put the clothes in the washer, then you
will not break out much. If you do get a rash, it is not contagious. We
thought it spread but we could not intentionally spread it. What happened
is that one area broke out in 1 day, another in 3days, and another in 5
days. We thought we were spreading it but didn’t. Or you get out in more
of it. There are 10 plants out there that can give you the allergic rash
but Poison Ivy is the most common. Treat the rash with hydrocortisone. If
worse then get a Rx for stronger Steroid creams. If all over and on the
face, then call to get oral steroids. Attached are pictures of the rash and
Outbreak Notice E. coli 0104:H4 infections in Germany
June 02, 2011
health authorities have reported an outbreak of a severe illness called
hemolytic-uremic syndrome (HUS) in Germany since May 2, 2011. In this
outbreak, HUS is being caused by an infection with a Shiga toxin-producing
Escherichia coli (STEC) bacteria. Many people have been hospitalized,
several requiring intensive care, and some people have died. New cases are
still being reported. The organism causing the outbreak has been identified
as E. coli O104:H4, producing Shiga toxin. This strain of E. coli
causes an illness similar to infection with E. coli O157:H7 here in
infections have been reported in people in northern Germany (mainly Bremen,
Hamburg, Lower Saxony, and Schleswig-Holstein) or in people who have
recently traveled to these areas. Cases in travelers to northern Germany
have been reported in Denmark, the Netherlands, Spain, Sweden, and the
suspect that the source is contaminated food, possibly raw vegetables.
Advice for US Travelers to Germany
health authorities recommend that people in Germany, especially in the
northern part of the country avoid eating raw tomatoes, fresh cucumbers, and
leafy salads, until further notice. Also raw meats. How about any raw
food. If you have traveled to Germany and have bloody diarrhea and stomach
cramps or symptoms of HUS, go to a doctor right away and tell him or her
about your recent travel.
infections can cause different gastrointestinal symptoms, but often include
severe stomach cramps, diarrhea (often bloody), and vomiting. If there is
fever, it is generally not very high (less than 101˚F [38.3˚C]). HUS is a
disorder that usually occurs when an infection in the digestive system (such
as STEC) produces toxic substances that destroy red blood cells and cause
kidney injury. Signs of HUS typically start 5–7 days after the start of
diarrhea, and diarrhea or bloody stools may no longer be present when HUS
have heard on the news about this germ. Do not be overly concerned with the
news media hype. This is a new strain of the E coli O157 that we have had
here for years. This new germ has a little more toxin in it but the one
here is deadly also. In Germany about 1000 people have become ill, 477
have developed HUS, and 17 have died. Those numbers may increase. To put
this in perspective, the US had 1,420 cases in 1994, 3,840 in 2000, 2,621 in
2005, and 4,600 cases reported in 2009. Around 250 cases are reported (many
more that are not reported) in Texas every year. It is here and you need to
be careful to clean all lettuce and vegetables, cook meats, and be careful
of surfaces and utensils that come in contact with the raw meats and
vegetables before cooking.
are already seeing swimmer’s ear. There is advice at my web site on how to
at healthy fruit juice that we all give our children.
Recommended intake for Children 1-6 yr take 4-6oz a day of juice.
Fruit Juice (10oz=74 cal)
Apple Juice (10oz=175cal)
100% Grape Juice (10oz=175cal)
Tropicana 100% Orange Juice (10oz=216cal)
Cranberry 100% juice no sugar added (10oz=145cal)
fructose sugar from fruit!
and Musselman’s juice is from the USA and not from China.
Arsenic or mercury that we know about.
you are giving most juices to your kids it is similar to giving them a coke
(they are all fructose) or even more. For comparison of 10 oz:
100% juice …………..145cal
100% Grape ………….175cal
100% Orange juice 216cal.
go crazy when someone gives your child a sip of coke,
you are giving a lot more “coke” in the form of
natural juice. Same stuff!
vitamins in these juices are for 2000 cal adult diet.
then in half to figure the vitamins for 1000 cal todler’s diet.
might look at fruit rollups. Similar to gummy candy???
and give your children juice but keep it down to 4-6 oz a day.
October 1 issue of Clinical Infectious Diseases
this information and recommendations.
Pediatric Infectious Diseases Society (PIDS) and the Infectious Diseases
Society of America (IDSA) convened an expert panel to review the management
of Community acquired Pneumonia (CAP). The PubMed database was reviewed
through May 2010. The expert panel included clinicians and investigators who
represented community pediatrics, public health, critical care, emergency
medicine, hospitalist medicine, infectious diseases, pulmonology, and
surgery. The first-ever guidelines on the diagnosis and treatment of CAP
in infants and children, from PIDS and IDSA, emphasize the importance of
immunizations (Prevnar), including a yearly influenza vaccine, to protect
children from life-threatening pneumonia. A 13-member panel, led by John S.
Bradley, MD, with the Department of Pediatrics, University of California San
Diego School of Medicine and Rady Children's Hospital of San Diego, in
California, authored the new guidelines published online August 30 and to
appear in the print October 1 issue of Clinical Infectious Diseases.
The document presents 92 specific recommendations in all, each with varying
levels of evidence.
Recommendations for Diagnosis
"Diagnostic methods and treatments that work well in adults may be too risky
and not have the desired result in children," Regarding diagnosis, the
guidelines state that blood cultures should not be routinely performed in
nontoxic, fully immunized children with CAP treated in the outpatient
setting. "In these cases, there is no need to perform unnecessary medical
interventions such as using x-rays (which expose the child to radiation
needlessly) or prescribing antibiotics (which kill bacteria, not viruses,
and may foster drug-resistant bacteria)," the written release states. The
guidelines also recommend that infants 3 to 6 months old with suspected
bacterial pneumonia be hospitalized.
Amoxicillin Sufficient for First-Line Therapy
addition, amoxicillin should be used as first-line therapy for bacterial
pneumonia, but more powerful antibiotics are not needed. Methicillin-resistant
Staphylococcus aureus should be considered as a cause of pneumonia
if first-line treatment is unsuccessful. According to the guidelines,
overtreatment is a critical concern. Most cases of pneumonia in
preschool-aged children are of viral origin and will therefore not develop
into life-threatening bacterial pneumonia.
these guidelines, we are hopeful that the standard and quality of care
children receive for community-acquired pneumonia will be consistent
from doctor to doctor — providing much better treatment outcomes," Dr.
Bradley indicates. "Pneumonia is one of the most common reasons for
hospitalization for children in the United States, and there's a huge
variation in the care that's delivered to children," "Often the care
of children is not evidence based and result in both over- and
undertreatment of children and less than ideal outcomes.”
It is interesting that they do not recommend x-rays. When you take an x-ray
the cloudy area that one sees is called pneumonia but in fact is just
“congestion”. It is mucous. The mucous can be sterile as in allergies and
asthma, it can be viral with a chest cold, or bacterial as with bronchitis
or pneumonia. The x-ray does not tell you which but is reported
“pneumonia”. Then the doctor faced with a x-ray report of pneumonia has to
treat it as if it is bacterial pneumonia so that he does not “miss”
pneumonia and get sued if the patient later comes in the secondary bacterial
pneumonia after the chest cold. We have discussed in previous articles
about the chest viral cold with fever and cough at the beginning is usually
viral and a recurrence of fever and lethargy after the fifth day is
secondary bacterial infection. That is when we need to see the patient.
But many people are treated for pneumonia who have a viral chest cold or
allergy. Everyone who is coughing and goes into the walk-in emergency
clinics gets a chest x-ray and many get treated for their “pneumonia”. I
don’t take a lot of x-rays for this reason. It does not affect your medical
decision that much.
we are talking about false diagnosis with tests, let’s talk about strep
tests. 10% of strep cultures and rapid tests are negative when there
actually is strep throat. And 5% of the population carries strep around in
their throat all year. They are carriers. So you can have a strep throat
and a negative test and not get treated. Then you can have a viral/allergy
sore throat and positive test and get treated for a strep that has been in
there all year and had nothing to do with the sore throat. That is why your
friend says their child had a strep throat and did not even run fever. Or
the doctor started antibiotics for “strep throat” and the patient was not
well in a few days so they changed antibiotics. There are no strep
resistant to Amoxicillin. When they changed antibiotics then the viral sore
throat finally went away and it seems like it was from the changing of the
think of Urinary tract infections. Most girls below 5 yrs. old who have
burning do not have an infection but just irritation. There is what is
called asymptomatic bactiuria. There are bacteria in many females bladder
and it is in there all year. It does not harm them and does not need to be
treated. But the child gets irritation from a bubble bath and the culture
comes out “positive”. Those may have been bacteria that were in there all
month. They still get treated to be on the safe side. (no bubbles and use
Dove soap in the bath.)
I am saying is that it is not exact and gets confusing as to what is real or
not. A lot of clinical judgment, experience, and common sense goes a long
have been some recent cases of tuberculosis in the news. Students in Ellis
county and suspected case in Denton county. TB is so rare in the US that
they stopped giving routine skin tests to everyone in 1987. If a person
with TB disease of the lung who is ill with coughing can spread it to
others. You have to be in contact with that person 40 hours a week or
more. You won’t catch it walking through a store. If a person gets the
bacteria in their lung it is generally dormant for many years. Your skin
test becomes positive after 8 weeks but you do not have lung disease and are
not contagious. The germ can become active and cause lung disease years
later. Diseases such as HIV and diabetes can increase your chance of
catching TB or having lung disease. Smoking increases the chances also.
Most cases in the US are imported from other countries where there is a lot
of TB disease. These countries are Latin America, Caribbean, Africa, Asia,
Eastern Europe, and Russia. We in the health care field are still required
to have yearly TB tests. If these students who were exposed to TB have a
positive test, they will take medication for months to kill the germ. They
are not contagious themselves. Since the test takes 8 weeks to become
positive, they really should retest them in 2 months. There is no reason
for panic here and health officials just need to identify cases and treat
them. Don’t be afraid of every one you hear coughing. It is still very
question is “do we need to put PE tubes in the infant’s ears” because of the
ear infections this year. Line up 10 different ENTs, Pediatricians, or
parents and you will get many different answers. Age of the infant, time of
the year, how frequent, and other factors go into the decision. Here are
some facts that you might think about.
studies showing the ear infections and fluid decreases the hearing to some
degree. Just as many studies show this slows down the speech of the child
and just as many show it does not affect the speech. A few studies came out
that showed it was the quality of the daycare that affected the speech and
not the infections. There are many more ear infections among infants in
daycare than those at home or with grandma.
study showed infants who underwent anesthesia for any surgery had a higher
number with learning disabilities …. Controls 21%, one anesthesia 23%, and
more than one 36%.
There were more learning disabilities in the children if the mother had
general anesthesia for C-section rather than if the mother had an epidural.
in the ear drum from the tubes can decrease the hearing later on just as
much as the fluid and infections. The hearing is better while the tube is
in the ear drum.
tubes fall out in 1 year. There are a very few that come out in a few
months and some go for years and have to be removed. Some babies will
continue to have ear or sinus infections despite the tubes. And by the
way, surgery on the tonsils and adenoids will not help these ear
I tend to
be on the conservative side of things but I still occasionally recommend
I am not
worried about the miniscule amount of formaldehyde in the Johnson’s baby
shampoo that was on the news. You put far more chemicals into your baby
using the diaper wipes. Read the list of those chemicals.
came out showing a correlation between using Facebook and use of alcohol,
tobacco and marijuana. Half of 12 yr. olds use Facebook and 20% of 10 yr.
olds. It is 70% by late teens. Of those adolescents who frequented the
social network sites, 26% used alcohol, 10% used tobacco, and 13% used
marijuana. Among those who did not use these sites 9% used alcohol, 2%
tobacco, and 7% marijuana. This is not necessarily a cause and effect but a
correlation. It may be influencing some but I think it is a reflection of
good strict parents who are involved with their kids and monitor what they
are doing. Would you let your child hang out with neighbor kids who are
alcoholics and drug users? Then why would you let them hang out on the
internet with them and have their words influencing your kids. Multiple
studies have also shown that kids that watch TV shows like “Gossip Girl”,
“16 and Pregnant” or “Skins” that contain smoking, sex and drinking are more
likely to do those things. Again it may be parents lack of monitoring.
There also was a study that just came out showing that outlawing soft drinks
in schools did not decrease the number of those drinks consumed by
adolescents during the whole week. They made up for it after school and at
home. Again parenting! Not to put all the blame on parents but we are a
major factor in their outcome. It is important that they get out and have
friends but moderation is a good thing in all things. Have more family time
and activities. And decrease our use of Facebook and texting.
has been testing for arsenic contamination in juice products for several
years as part of FDA programs that look for harmful substances in food, and
have not found evidence that juice is unsafe for consumers young or old.
FDA monitoring has found that total arsenic levels
in apple juice are typically low.
this year The Dr. Oz Show publicized results of private tests showing
arsenic levels higher than the FDA level of concern (23 parts per billion)
in a number of popular brands of apple juice. FDA officials publicly
rebutted those claims. Arsenic and apple juice have become a recurring
theme in food safety politics. Consumer groups point out that most U.S.
apple juice is imported from China and other countries, and they fear some
of it may be tainted with arsenic and other heavy metals. The FDA has
increased its monitoring of imported juices. In one recent sampling, all 74
samples collected had originated in China. But only one of those samples
tested slightly above 23 ppb of total arsenic, and 95 percent tested below
10 ppb total arsenic. The FDA tested juice from the same Nestle/Gerber lot
that the TV program had shown to contain 36 ppb total arsenic, but the FDA
tests showed arsenic levels ranging from 2 to 6 ppb. I think there are
exaggerations and lies on both sides for political gains. These levels show
the TOTAL arsenic and does not mention the amount of inorganic form. See:
for levels reported.
There is an important difference between organic and inorganic arsenic.
Organic arsenic is considered part of the natural environment, present in
small amounts in drinking water and foods and essentially harmless, while
inorganic arsenic is the poison made famous by mystery writer Agatha
Christie. Most studies report the total amount.
I agree with the FDA. The apple juice sold across the U.S. is safe to
drink, with naturally occurring arsenic levels well below the agency's
"level of concern." It needs to set new guidelines on an appropriate level
for inorganic arsenic. The rare juice that might have a high level will be
1% of the juice a child will drink and not enough to harm them since the
arsenic ingested will average out in the safe range. There are other
reasons not to drink too much juiceâ€¦. less eating health foods and
obesity. Like everything elseâ€¦ moderation!
Since we are talking about arsenic, did you know it is in treated wood for
playgrounds. They stopped using it in 2004 but playgrounds built before
that have arsenic in the surface of the wood. So donâ€™t let your kids lick
or bite we wood of old playgrounds or they will get more arsenic than the
apple juice. And do not burn treated wood because if you breath the smoke,
you will get very high levels of arsenic.
Roger Knapp MD
typically an allergic reaction to something that is inside your body.
Topical substances almost never cause hives but instead causes rashes.
Hives are large circular rashes that are larger than pencil eraser size. If
the child has tiny red spots smaller than eraser size and usually 2-3 mm
size, then that is a viral rash and not allergic hives. Some infants with
Roseola who have fever and then a few days later get tiny spots on their
chest and back get labeled allergic to an antibiotic that was given by their
doctor. The doctor gave an antibiotic for a possible ear infection when the
problem was a viral fever. Then the infant gets labeled allergic when the
whole thing was just a common viral illness that every child gets in the
first 2 years.
are many causes of hives. The three most common causes that come to the
pediatrician office are listed below. The others like stress and pollens
are seen by the allergist since they persist for long times and more
difficult to figure out.
Foods. A person can become allergic to something at any time and
it is common to become allergic to eggs or some food/medication at any
time. So you can eat strawberries your whole life and then when 20 yrs old
you start having hives from them. Usually the parent figures this out when
the child breaks out multiple times after they give a certain food. The
usual foods are Nuts like almonds, peanut/peanut butter (the peanut is not a
nut but a legume from the ground), seafood, strawberries, and eggs. But a
person can be allergic to anything so it could be their breakfast cereal or
anything. The first thing parents think of are the new foods but it more
likely will be the old things that the child has eaten since 6 months old.
Medications. The same applies to meds â€¦. It may be an
antibiotic that the child has taken many times and to which they are now
allergic. So it can be after 1 or 9 days of taking the medication. When
stopping the medication the hives should go away in 2 days and if the hives
go away a week later then probably not the medication causing it.
Infections. Did you know 75% of adults who say they are allergic
to a medication are not. 25% are but 75% were mislabeled allergic. For
example I will see a child who had been running fever for a few days at home
and the parent was just watching it. Then the child breaks out in hives all
over from the infection and that scares the parent and they bring them in.
Had I seen them in the office during the first day of the fever and given
penicillin and broke out in hives a few days later from the infection, then
we might have blamed it on the antibiotic. The more common infection
causing it is strep but any germ can do it.
the child comes in with hives with or without fever and/or cough-cold, I
generally stop the allergenic foods and medications, give Benadryl, and give
it a week to go away. If they go away, then the parent restarts one at a
time the foods and meds that were stopped. If the hives continue 10 days or
more then go see the allergist for tests.
child was on an antibiotic for an infection, the medication is stopped, a
different antibiotic is given. The parent is asked to save the first
medication and in a few weeks when nothing else is going on , then give 2
more days of that antibiotic and watch for hives. Studies show this is
safe if the allergic reaction was only hives. If they break out a second
time, then call and we label them allergic to the medication. Some parents
are anxious about giving it again and they want to park outside of an ER or
the doctorâ€™s office and give the medication. Some parents prefer going to
the allergist and having them skin tested and that is OK if that is what
they are comfortable doing. I almost never hear from the parents about the
child being allergic.
are allergic to peanut butter, nuts or eggs, then we give epipen for the
parents or grandparents or school to have on hand in case of allergic
Poison ivy is a topical allergic reaction. The lesions on the skin are NOT
contagious. You cannot spread it around your body or to other people. We
used to think that but doctors tried to experimentally spread it but could
not. It happened that one area broke out in 1 day, another in 3 days and
another in 5 days. We thought it was spreading around from the first
lesion. Or the person just got out in more of it. But the areas are not
contagious. Put hydrocortisone cream on it and if worse, come in for
stronger steroid treatments.
nutritional supplements sold over the counter contain small amounts of
substances that can give an athleteâ€™s test for â€śdopingâ€ť with steroids
a positive test. Several successful athletes reputation and income have
been damaged from using supplements that contain these small amounts of
steroids or steroid precursors.
or just Google supplements containing doping substances.
are the actual precursors to anabolic steroids in high concentration. Here
is an excerpt from testimony from Terry Madden:
last year, we conducted more than 7,000 tests for steroids and other
prohibited doping substances. I am here today to speak to you about the
increasing number of products sold over-the-counter in the United States
that contain anabolic steroid precursors. These products, marketed and sold
as dietary supplements, contain substances, such as androstenedione and
norandrostenedione. These substances are one chemical step away from
anabolic steroids. Once ingested these products are converted within the
body into anabolic steroids.
perils of anabolic steroid use are well known.. In the body, androstenedione
metabolizes into the anabolic steroid, testosterone, and other steroids. The
documented side effects of steroids and steroid precursors among these East
German athletes, particularly women athletes, are severe and include effects
on the liver and reproductive system, susceptibility to cancers, and
permanent masculinization of women. Other side effects include growth arrest
in adolescents, and shrinking of testicles and impotence in men.
American consumers can walk into their corner nutrition store and buy
products containing androstenedione. After professional athletes
acknowledged that they used androstenedione, sales of these
supplements in the United States dramatically increased. This
phenomenal demand, particularly among teenagers, led to the mass marketing
of other steroid precursors like 19-norandrostenedione, which metabolizes in
the body into the steroid nandrolone, another controlled substance. Now the
nutrition store shelves, and the internet, are flooded with products
containing these steroid precursors. Further, the manufacturers of these
substances attempt to take advantage of DSHEA by touting these substances as
"natural," and implying in their advertising that "natural" equals safe.
current regulatory scheme, a manufacturer is not required to test its
steroid precursor product for either side effects or purity prior to putting
it on the shelf. This is of particular concern when adolescents are
considered. Instead, the burden rests on the government agencies to prove
that a particular product is harmful. However, by the time action is taken
against a specific product, an unscrupulous manufacturer could simply make a
minor chemical change and reintroduce the product.
marketers of these products glorify the muscle-building qualities of these
substances and do everything possible to reinforce the association between
these products and controlled anabolic steroids. These products are marketed
under names that reinforce their connection to anabolic steroids, including
"Cycloroid," "Masterbolan," "Anabol-X," "Paradrol," and "Animal Stak." These
products are advertised as equal to or better than the "real steroids" and
promise the user huge gains in muscle mass. The advertising also stresses
that these products are "legal" in order to raise the implication that they
must be safe.
society where high school athletes can sign multi-million dollar endorsement
contracts, we cannot expect teenagers to ignore advertisements claiming that
these products are "safe alternatives" to steroids and will make them
"ripped," "huge," improve their athletic performance and give them the body
of their dreams.
supplements over the counter have no quality control. I stay away from
happy and safe New Year.
way, more DWI auto accidents occur on Super Bowl Weekend rather than New