Category Archives: Pediatrics

Eczema: Scratching Beyond the Surface

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Posted by admin on May 11, 2011 – 1:53 pm
Filed under Pediatrics

Common in children and infants, eczema (atopic dermatitis) is a chronic and recurrent condition of the skin caused by hyper-sensitivity (immunoglobulin E-mediated response). Children with eczema typically have family members who have a history of allergies, asthma or eczema. Those with eczema are more prone to skin irritation, dryness, barrier abnormalities and infections. While some little ones will only have eczema during their childhood years, others will continue to have symptoms into adulthood.  

Key triggers for eczema include fabrics (especially wool), foods, alcohol, exposure to dry, cold weather, or very hot, humid conditions that cause sweating. Children with eczema have higher incidences of allergies and asthma. In 30 percent of infants with eczema, certain foods will lead to “flare ups.” Eczema can be mild, itchy, dry and localized or severe and extensive. Severe cases may be accompanied by unrelenting itching, sleepless nights and secondary bacterial infections.

Skin affected by eczema is usually dry and itchy, with red or salmon-colored patches. Known as the “itch that rashes,” eczema is often found on the neck, creases of the elbows and knees, ankles, wrists, and hands. The more a child itches, the worse the rash can become. Substances like perfumes, as well as dyes in lotions, moisturizers, soaps and detergents, can exacerbate the condition. If itching is very severe, open sores and infection can occur.

About Bathing

Keeping the skin clean is an important part of managing eczema. Luke-warm bath water is best. Because it helps remove crusts and irritants, provides pleasure, relieves stress and hydrates the skin, bathing should not be restricted. As an alternative to oral antibiotics and to decrease the possibility of secondary infections, some doctors recommend giving a bleach bath. (Only use one to two teaspoons of bleach in a tubful of water.)   

After bathing, towel dry and apply moisturizers or ointments within minutes. Lubriderm, Nivea, Aveeno, Cetaphil, Eucerin or Vaseline Intensive Care are ideal options. Above all, stick with moisturizers and lotions that are free of dyes and perfumes. If moisturizers aren’t enough, or there are red, dry patches, try applying an ointment (e.g., Vaseline or Aquaphor) twice a day. 

Preventing Infection

  • Keep fingernails cut short
  • Discourage scratching (it is okay to rub with the pads of the fingers)
  • Cover “problem areas” at night
  • Use Benadryl or Atarax at night to help prevent itching, which can lead to secondary infections

Medications

  • For mild eczema, over-the-counter hydrocortisone or itch-x can be used (available in 1/2 or 1 percent ointments and/or creams). Administer these once or twice a day. Stop when the skin looks clear. If symptoms don’t improve within a week, take your child to his/her primary health care provider for a visit. 
  • For severe eczema, a health care provider can prescribe a stronger steroid cream or ointment. Keep in mind: long-term use of stronger steroid creams may cause thinning of the skin. Steroids should be administered in small amounts, as directed by your child’s provider.
  • Other medications, such as Protopic or Elidel, may be used to block the inflammatory response caused by eczema. If your child has severe and/or chronic eczema, discuss these drugs with his/her provider.

Allergies

Allergies can make eczema flare up. If your child has seasonal allergies, his/her eczema may be worse during that season. If you notice that foods, clothing or detergents irritate your child’s skin, eliminate them. Common food triggers for eczema include eggs, milk, milk products, soy, peanuts and other nuts, wheat, and chocolate. Environmental irritants include dust, mold, stuffed toys, wool clothing or blankets, pets, feathers, some soaps and perfumes.

To Learn More

Children with severe and/or chronic eczema may benefit from an allergy/dermatology referral. To learn more about managing your child’s eczema, visit:

Genevieve Bastos, MSN, is a certified pediatric nurse practitioner (CPNP). For an appointment or more information, call ProMed Physicians-Pediatrics in Richland at (269) 552.2500.

Ready, Set, Read to Your Child

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Posted by admin on March 9, 2011 – 9:30 pm
Filed under Pediatrics

It has been said that we spend our first few years learning to read and the rest of our lives reading to learn. The earlier this learning starts, the better the outcome. Kindergartners who have been read to as young children are more likely to be rated by their teachers at the top of their class in learning and communication skills.

A study in the year 2000 showed that fourth-grade students who read for fun at least once a month had higher reading scores than kids who hardly ever read for fun. Children who are read to and exposed to books early on tend to read earlier and excel in school (compared to children who don’t get that exposure).

Why start young? Less than one month after conception, the basic structure of a child’s nervous system is established and brain cells begin to form. A child’s brain continues to grow rapidly, peaking in the early years of life. Exposure to spoken and written language helps a child’s brain and language skills develop. Research shows that the more words parents use when speaking to an 8-month-old, the larger the child’s vocabulary will be at age 3. Books have words that may not be common in everyday spoken language. Children’s books actually contain 50 percent more atypical words than primetime television or even college students’ conversations.

As babies grow into toddlers, they are expected to reach certain milestones as they get older. Just as there are motor milestones like rolling over, sitting unassisted, crawling and walking, there are language milestones that can be encouraged and celebrated.

  • 3 months: What’s out there? Babies begin to babble and imitate sounds. Human faces and expressions start to have more meaning, and as infants gain more motor control, they swipe their hands at objects, including books. Reading to a child at this age exposes he/she to the rhythm of language, as well as the idea that reading and books mean time with Mom or Dad.
  • 6 to 12 months: On the move! During this stage of development, the world opens up, as children learn to sit by themselves, and move where they want to go, when they want to move. The world can not only be seen and heard, it can also be felt, both with hands and in the mouth. Board books and bath books hold up best to baby drool and teething. Pictures with simple objects and lots of color, as well as photos of faces, will hold a short attention span the best. Reading at this age shows the child that reading can be fun.
  • 12 to 18 months: Look out world! Toddlers love to walk around and explore their environment. Favorite toys are never far away, and books have pictures to look at and pages to turn, rather than just to be slobbered on. They even have a “right side up” and “upside down.” Each page has something to be identified (What’s that?) or found (Where is the …?). Reading at this age is a favorite activity and a toddler may ask you to read by handing you a book.
  • 18 to 24 months: Thank you, but I can do it myself! As older toddlers gain more confidence, they want to take charge more often. They may sit with a book, “reading” as they turn pages. Pause before you finish a sentence in a favorite book and they will finish it for you. Repetition is “hard-wiring” the brain, providing consistent stimulation for language development. Reading at this age continues to be a fun activity, but now the child can be a more active participant.

Nurturing Love for Reading

Here are some quick tips for nurturing love for reading:

  • Invite your child to read with you every day. Even five minutes at bedtime will help keep your child interested in reading. It also promotes healthy sleep habits.
  • If the book has large print, point to the words as you read them. This shows your child that reading is left to right and that words carry the story.
  • Use funny voices for the characters. This will get your child excited about the story.
  • Repetition is good! Have your child join you or finish the sentence when the text gets repeated. Point to each word as you say it. This helps your child understand the word that he/she is saying is the word that he/she sees.
  • Stop and look at the pictures. Help your child “tell the story” based on the illustrations. Ask him or her, “What do you think will happen next?” Your child will be more involved in the story.
  • Don’t stop reading to your children, even after they can read alone. Children can understand stories with words that are too difficult to read on their own.

To read more about the value of reading to your kids, visit:

For more advice on reading, or to make an appointment with Lisa Kanwischer, PA-C, call ProMed Physicians-Pediatrics at (269) 329.0944.

Understanding Autism

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Posted by admin on February 15, 2011 – 8:39 pm
Filed under Pediatrics

Primary Characteristics

Autism results from a type of abnormal brain development. The main features of autism include poorly developed social interactions, difficulties with speech and communication, and repetitive and restrictive behaviors. Generally, these features are present before a child is 3-years-old.

Parents of autistic children often notice normal development at first, but then sudden regression. The regression in the development of autism is an expected aspect of the disorder.

Other Characteristics

While it isn’t always the case, autistic children usually have mild to severe cognitive impairments (developmental delays and mental retardation). They might also exhibit significant sensory symptoms, including eating disorders. Many children with autism suffer with heightened anxiety, with or without obsessive-compulsive behaviors (e.g., lining up toys in a strict row). Attention deficit hyperactivity disorder (ADHD) and learning problems are more prevalent in autistic kids than in the general population. Temper tantrums and moderate-to-severe behavioral problems (sometimes including the destruction of property) are common as well.

Other features may include:

  • Poor eye contact and facial recognition
  • Distress from loud noises
  • Failure to point at things that should offer interest
  • Finger, hand or arm flapping, especially when excited
  • Repetitive or rocking behaviors
  • Increased incidence of seizures with regressions in speech and other areas of development
  • Insomnia
  • Motor and vocal tics (signs of Tourette syndrome)
  • Narrowly focused interests, sometimes with the ability to greatly excel in the specific area of interest (i.e., “savantism”)

Since the signs of autism are highly variable, these secondary features aren’t seen in all autistic individuals. However, when they are present, these characteristics frequently create challenges.

Social Development

The social problems experienced by autistic patients may begin quite early and progress with the child’s development. Poor eye contact and lack of facial recognition may show up in infancy. There may be perceived attachment difficulties. Children may fail to turn to things pointed out to them. A child may have severe tantrums and act aggressively toward others.

Recognition of social cues may not develop on time. For example, the autistic child may not understand the concept of taking turns or rules for games. Autistic kids may not share well with others, and often have trouble making and keeping friends. As they gain awareness of their differences, autistic children can become very lonely.

Communication Problems

Difficulties in speech and communication may also show up quite early. Autistic children may fail to recognize their own name by 10 months of age. There may be delays in babbling or gesturing (e.g., pointing or waving bye-bye) until after 12 months. Normal back and forth in vocalizations between parent and child may not be present. There may be no single words until after 16 months and no two-word phrases uttered independently until after 24 months. Delay in language development is a serious warning sign, as is the regression of language or social skills at any age.

Autistic children may repeat what others say without meaningful interaction. They may mix up pronouns, or talk nonstop and repetitively about an area of narrow interest without pause or meaningful two-way conversation. Typically, they don’t understand jokes or sarcasm. Autistic kids frequently just “don’t get” other people, leading to difficulties in making friends.

Repetitive Behaviors

The repetitive behaviors of autism may have many manifestations, such as rocking back and forth, or finger/hand/arm flapping.

Autistic children may strongly dislike change in routine, preferring ritual and sameness. They can be compulsive, lining toys up or drumming fingers or spoons. Sometimes autistic children injure themselves with behaviors like repetitive head banging or picking at their skin.

Sub-Types of Autism

Asperger’s syndrome is a sub-type of autism in which speech and cognitive (thinking) difficulties are not as severe. As a group, patients with Asperger’s are found to have a higher level of functioning. Pervasive developmental disorder (PDD) is a term reserved for children who have many of the features of autism, but who do not meet strict criteria.

Incidence

The incidence of all forms of autism combined in the U.S. is now observed to be about 1 in 110 children, representing a significant rise over the last few generations. This perceived increase in incidence might be due to better techniques for recognizing the disorder or factors not yet identified (or perhaps both of these reasons).

Causes

While the exact cause of autism is unknown, progress has been made in understanding its roots. Most likely, there isn’t a single cause, but rather, autism should be thought of as a final common pathway that is entered by a variety of means.

For example, it is likely autism has a strong genetic component (there is increased incidence within family units and in twins). With greater detail possible from gene mapping, an increasing number of autistic children have been shown to have one of a variety of genetic defects. Abnormalities in specific genes reveal deletions (a copy or copies of the gene are missing), duplications (there are extra copies of the gene on one or more chromosomes) and inversions (the gene is basically upside down on the chromosome). These defects can be found in autistic patients for an increasing number of genes.

Some toxins, including lead and other heavy metals, and ingestion of alcohol and certain seizure medications during pregnancy, have also been implicated as possible causes of autism. Fetal alcohol syndrome patients seem to share many behavioral features with autistic patients.

The theory that some vaccines or their preservatives cause autism has been thoroughly and completely ruled out. According to an article published in The Wall Street Journal in January 2011, the original research implicating vaccines as a cause of autism was fabricated by a British scientist who was subsequently stripped of his medical license.  Many of the other original authors have withdrawn their names from the study and The Lancet  (the medical journal where the study was published) has issued a formal retraction. The damage to the reputation of vaccines and the resulting public health problems are truly unfortunate.

An older theory that autism is caused by cold-hearted, unfeeling mothers has also been debunked. Parents of autistic children are typically kind, caring and concerned people who love their kids very much.

The Importance of Early Screening

On average, kids in the U.S. are officially diagnosed with autism at around 5 or 6-years-old.  However, many autistic children are formally diagnosed even later. Because the earlier the diagnosis, the better the outcome, the American Academy of Pediatrics recommends an autistic screening for all children at their 18 and 24-month or 30-month physical examinations.

When autism is suspected, children should be tested with an age-appropriate screening tool (regardless of their age). Psychologists trained in diagnosing autism should complete extensive follow-up testing if screening tests show any signs of the disorder.

The Value of Treatment

Placing a child in an intensive special education program with personnel specially trained to teach autistic children is one of the most valuable and important treatment options. Special education programs may offer applied behavioral analysis (ABA), structured teaching in very small classroom settings, frequent and intensive speech therapy, occupational therapy, social skills classes, play therapy, and counseling. If the school doesn’t provide complete services

or is unable to offer services on a regular basis, parents might wish to consider evaluating a private center for autism (e.g., The Envision Center in Battle Creek).

Currently, there are only two medications approved by the U.S. Food and Drug Administration (FDA) to treat autism: Abilify and Risperdal. Both of these drugs are powerful anti-psychotic medications that have side effects. They are generally used in autistic children to help control aggression and severe behavioral problems. Abilify and Risperdal may stabilize mood, decrease anxiety and depression, alleviate motor and vocal tics, and improve sleep. As with all medications, your health care provider should help you weigh the risks and the benefits.

Other medications may sometimes be used in a targeted fashion to treat specific, associated conditions (called co-morbidities). For example, ADHD is treated with ADHD medications. Non-stimulants, such as Strattera and Intuniv, are preferred for the treatment of ADHD symptoms in autistic patients, as stimulant medications (e.g., Ritalin and Adderall) can sometimes make anxiety worse.

Autistic children also have an increased incidence of depression and may require specific medication to treat this aspect of the disorder. Antidepressants like Prozac, Celexa and Zoloft are used most commonly for depression, as well as moderate-to-severe difficulties with anxiety and obsessive-compulsion problems. Melatonin and Clonidine may be used to relieve insomnia.

Outcomes

Predictors of better outcomes include early age at diagnosis, IQ above 50 and acquisition of language by 6 years of age. Most autistic patients will need significant help befriending others, holding down a job and living semi-independently. However, the range of outcomes is broad, from requiring full-time institutional care to living in a more sheltered environment to becoming a fully functional member of society. Each autistic child needs and deserves intensive, personalized therapy, so that he/she can reach his/her maximum potential.

For more information on autism, or to make an appointment with Eric Slosberg, MD, call ProMed Physicians-Pediatrics at (269) 552.2500.

‘Tis The Season to Stay Warm and Rememberrr Safety

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Posted by admin on January 18, 2011 – 8:30 pm
Filed under Pediatrics

Before your child hits the slopes or the ice rink, or braves that big hill with his/her sled, it’s important to take certain precautions. Here are some tips for keeping your kids safe and warm throughout the winter season:

How to Dress Your Child

  • Infants and young children should always be dressed warm for outdoor activities. Wrap your kids in several layers, and remember warm boots, gloves/mittens and a hat.
  • Older babies and young children should generally wear one more layer of clothing than an adult in the same conditions.
  • Keep in mind that blankets, quilts, pillows, sheepskins and other loose bedding my contribute to Sudden Infant Death Syndrome (SIDS). These items should be kept out of an infant’s sleeping environment. One-piece sleepers are preferred. If a blanket must be used to keep a sleeping infant warm, tuck it around the crib mattress. The blanket should reach only as far as your baby’s chest, so his/her face is less likely to become covered.

Hypothermia and Frostbite

  • Hypothermia is a condition that occurs when a person’s temperature falls below normal due to exposure to cold temperatures. Hypothermia can happen more quickly in kids than in adults. Symptoms in children may include shivering, fatigue/lethargy, clumsiness, and in more extreme cases, slurred speech.
  • If you think your child has hypothermia, call 9-1-1 right away. Until emergency help arrives, take your child inside, remove wet clothing, and wrap him/her in blankets and warm clothes.
  • Frostbite occurs when the skin and outer tissues become frozen. It often involves the fingers, toes, ears and nose, which can become pale, gray or blistered. A child experiencing frostbite may complain that his/her skin burns or is numb.
  • If you suspect frostbite, bring your child indoors. Place the frostbitten parts in warm (no higher than 104 degrees Fahrenheit) water. Warm washcloths may be placed on a frostbitten nose, ears and/or lips. Do not rub the frozen areas. After a few minutes, give the child something warm to drink, and dry and cover him/her with clothing or blankets. Call your doctor if the numbness continues for more than a few minutes.

Winter Sports and Activities

  • Never allow your child to go it alone. Whatever winter activity they decide to tackle, make sure they bring someone else with them, preferably at least one supervising adult.
  • Have your kids drink plenty of water before, during and after their chosen activity.
  • Kids should be dressed in layers of light, water- and wind-resistant clothing for optimal warmth and protection. Along with clothing, feet should also be kept dry, secure and warm by wearing proper footwear.
  • Remember that your children can still get sunburned during the winter. Because the sun’s rays can reflect off snow, make sure to apply sunscreen to your child’s exposed skin.
  • Be sure your kids wear appropriate safety gear, such as goggles, gloves, padding, and most of all, a helmet. Equipment should be checked for proper fit at least once a year.
  • Make sure your child’s equipment (whether a sled or pair of skis) is in good working order.
  • If your child is interested in skiing or snowboarding, take him/her to receive a lesson from a qualified ski or snowboard instructor. Learning to fall correctly and safely can decrease their risk of injury. Slopes should fit the ability and experience of the skier/snowboarder. Crowded areas with trees and other obstacles should be avoided.
  • If ice skating, allow kids to skate only on approved surfaces. Instruct your child to skate in the same direction as the crowd and to avoid darting across the ice.
  • When sledding, make certain all sledders are away from motor vehicles. Avoid sledding in crowded areas or down slopes with trees or fences. To prevent head injury, your child should sled feet first (or sitting up) instead of lying down (headfirst).
  • Children under the age of 16 should not operate snowmobiles and children under age 6 should not ride on snowmobiles. Never use a snowmobile to pull a sled or skiers. Snowmobilers should travel at safe speeds, never use alcohol or other drugs before/during snowmobiling, and stay on designated trails away from roads, water, railroads and pedestrians.
  • Always be mindful of the weather. Keep an eye out for warnings about upcoming storms and severe drops in temperature. Set reasonable time limits for playing outside to help your child dodge hypothermia and frostbite.
  • Know how and where to quickly get help if your child does experience an injury.

Fire Protection

Winter is an excellent time to buy and install smoke alarms on every floor of your home, test these devices on a monthly basis, and practice fire drills with your kids. You should also install a carbon monoxide detector outside bedrooms.

Sources: American Academy of Pediatrics, SafeKids. To learn more, visit healthychildren.org.

Car Seat Safety: Protecting Your Precious Cargo

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Posted by admin on November 9, 2010 – 4:26 am
Filed under Pediatrics

Motor vehicle crashes remain the leading cause of accidental injury-related death among children ages 14 and under. While this is a scary statistic, there’s good news. When used the right way, child restraints and safety belts are 50 to 75 percent effective in preventing fatalities, as well as reducing serious injuries.

Proper Installation

First and foremost, never place a child in the front seat due to the possibility of airbag deployment. Michigan law states that children under age 8 must ride in the back seat in a properly installed car safety or booster seat, unless 4’9” tall. In general, the safest place for all children is in the back seat.

Always follow and keep the instructions with your car seat. When properly installed, a car seat should never move more than one inch from side to side or toward the front of the vehicle. Check your vehicle owner’s manual to see if you need a locking clip (not all safety belts will secure your car seat without it.) When installing a car seat, kneel in the seat to press it down and eliminate all of the slack.

A LATCH (Lower Anchors and Tethers for Children) system removes the need to use seat belts to secure the car seat. Anchors are located in the vehicle’s back seat. Car safety seats that come with this system have attachments that fasten to these anchors. Keep in mind that nearly all cars and car seats made on or after September 1, 2002, are equipped with the LATCH system.

Infant Rear-Facing Car Seats

Infants should ride in rear-facing car seats as long as possible or until they are at least 12

months old and weigh at least 20 pounds. If your car seat allows it, keep children in rear-facing seats until they weigh 30 to 35 pounds.

  • Harness straps should be snug and routed at or below shoulder level.
  • Clips should be fastened at armpit level.
  • Make sure the seat is at the correct angle, so your infant’s head doesn’t flop forward. To prevent this problem, many seats have angle indicators or adjusters. If your seat doesn’t have an angle adjuster, tilt the safety seat back by putting a rolled towel or other firm padding (e.g., swimming pool noodle) under the base near the point where the back and bottom of the vehicle seat meet.
  • 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.

Front-Facing Car Seats

Michigan law requires that all children up to age 4 be properly buckled in a car seat while riding in a motor vehicle. Children who are at least 1-year-old, weigh 20 to 40 pounds and can no longer ride in rear-facing seats should ride in forward-facing car seats secured with harnesses.

  • Shoulder harness should be snug and at or above the level of the shoulder.
  • Harness clips should be fastened at armpit level.
  • A tether is a strap that attaches to the top of a safety seat and to an anchor point in your vehicle (see your owner’s manual to find where the tether anchors are in your vehicle). Tethers give important extra protection by keeping the safety seat and the child’s head from moving too far forward in a crash or sudden stop. All new cars, minivans and light trucks have been required to have tether anchors since September 2000. New forward-facing safety seats come with tethers. For older seats or if your tether is missing, special kits are available. You can also check with your safety seat manufacturer to find out how you can get a tether.

Booster Seats

Children more than 40 pounds should be secured in a belt-positioning booster seat or other appropriate child restraint until the adult seat belt fits correctly. They should also pass this safety belt test:

1.  Have your child sit all the way back on the vehicle seat. Do his or her knees bend at the front edge of the seat? If they don’t, return the child to the booster seat.

2.  Buckle the lap and shoulder belt. Be sure the lap belt rests on the upper legs and hips. If it rests on the stomach, return the child to the booster seat.

3.  Make sure the shoulder belt rests on the shoulder or collarbone. If it rests on the face or neck, return the child to the booster seat. Never put the shoulder belt under the child’s arm or behind the child’s back.

4.  Check whether your child maintains correct seating position for as long as you’re in the car. If your child slouches or shifts so the safety belt touches the face, neck or stomach, return your child to the booster seat.

Booster seats should be installed (according to the manual) in the back seat, NEVER in the front seat with an airbag. Booster seats must be used with a lap and shoulder safety belt. Make sure the belt is properly buckled. When using a booster seat, the lap belt should be low and snug across your child’s upper thighs and the shoulder belt should cross the middle of your child’s chest and shoulder.

Recalls

  • To check for recalled car seats, visit recalls.gov.
  • To receive notification of recalls, remember to return product registration forms for all new car seats to the manufacturer.
  • Only use a car seat that has all parts, instructions and labels.
  • Any car seat that has been involved in an accident should be replaced.

Upcoming Car Seat Checks

  • Saturday, December 4, 12 p.m. to 4 p.m. at Cole Nissan-3003 Stadium Drive, Kalamazoo
  • Saturday, February 12, 2011, 10 a.m. to 2 p.m. at Orrin B. Hayes-543 W. Michigan Avenue,  Kalamazoo
  • Saturday, April 16, 2011, 10 a.m. to 2 p.m. at Cole Krum-343 W. Prairie Street, Vicksburg
  • Friday, June 24, 2011, 1 p.m. to 5 p.m. at Target-5350 W. Main Street, Kalamazoo

To learn more about car seat safety, check out these Web sites:

  • American Academy of Pediatrics [link to aap.org]
  • Safe Kids Kalamazoo County [link to safekidskalamazoo.org]
  • Michigan State Police [link to michigan.gov/msp/0,1607,7-123-1593_3504_22774-113709--,00.html]

Asthma: How Parents Can Help Their Kids Breathe Easier

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Posted by admin on October 12, 2010 – 12:19 am
Filed under Pediatrics

Does your child wheeze? Do you have a medicine cabinet for “wheezing” and aren’t sure what to use when your child is having trouble breathing? Are you frustrated by feeling like your child is constantly coughing? 

Asthma is a common chronic illness in children. Chronic refers to a disease or condition that does not go away, but instead, has times when it is better and times when it is worse. The good news is that working closely with your physician will increase your chances of finding the medicines that work best for your child.

A Closer Look at Asthma

If your child is under 2-years-old, he or she may have wheezed or used a nebulizer machine a few times, but your provider still may have avoided using the term “asthma” to describe his/her symptoms. For example, a baby may wheeze with a bad cold the first winter, but may never wheeze again. This isn’t asthma. Another baby may wheeze for the first time at 4-months-old, and then continue to wheeze every time he/she has a cold. This is more characteristic of asthma.  

Common asthma triggers (things that tend to make children wheeze, cough or have trouble breathing) include:

  • Colds (upper respiratory infections)
  • Allergies (e.g., to mold or pets)
  • Being around smoke
  • Cold air
  • Exercise

If you feel confident knowing your child has asthma, answering the following questions will be helpful:

  1. Do you know how to use the medicines your child has been prescribed? Can you name them and the amount he/she needs?
  2. Do you have an Asthma Action Plan? This is a written out plan (or instructions) on what medicines are needed for times when breathing is easy and for times when breathing is difficult.
  3. Has your child received his/her annual flu shot? It is VERY important that all asthmatics receive a flu shot each year. If they get influenza, children with asthma are much more likely to have severe breathing problems. Protect your child. Schedule his/her flu shot today!
  4. Have you provided your child’s school or other caregiver/care facility with his/her asthma medicine? You never know when your child may have trouble breathing. He or she should have access to asthma medication at all times.
  5. Children with asthma should be seen by a pediatric health care provider at least TWICE a year, even if they seem to be well and not having trouble breathing. Has your child had his/her asthma check-up this season? At this visit, we will review how your child has been breathing, what medicines he/she is using and what else needs to be done to ensure optimal breathing.

For more information on asthma, or to make an appointment with Melissa Reffitt, pediatric nurse practitioner (CPNP), call ProMed Physicians-Pediatrics at (269) 329.0944.

Influenza, Pertussis and Why You Should Immunize Your Child

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Posted by admin on September 1, 2010 – 1:55 am
Filed under Pediatrics

As fall approaches, now is the perfect time to schedule your influenza vaccine. The influenza vaccine is recommended annually for all children over 6-months-old.

Influenza is a viral infection that causes sudden onset of high fever, chills, body aches and cough. Sometimes serious infections may develop following a case of influenza, especially in infants and children with serious health conditions like lung disease, heart disease, a weakened immune system or cancer. A child with asthma who contracts influenza is at higher risk of developing a more severe and complicated illness. 

An influenza infection also has serious health consequences for adults and older adults, particularly those who have chronic breathing problems, are going through chemotherapy or who have other chronic health conditions.

Warding Off Whooping Cough

You may have recently heard information in the news about pertussis (also known as whooping cough), which has led to the death of six infants in California this year. Pertussis causes a terrible cough that can prevent babies from eating, and in some cases, breathing. Like influenza, adults and seniors who contract this disease may also have severe complications. 

Babies are immunized against whooping cough as part of their regular immunization schedule. A pertussis booster is also recommended at 11-years-old to give teens and young adults a “boost” in their immunity as they grow into adulthood. The outbreak of pertussis in California reminds us to be diligent about vaccinating our tweens and teens.

A Few Words About Safety

Vaccines are safe and they work. In fact, vaccinating children and young adults may be the most important intervention we do as health care providers, and that you, as parents, can perform.

There will likely always be controversy surrounding vaccination. However, the vaccine campaign is truly a victim of its own success. It is because vaccines are so effective at preventing illness that we even discuss whether or not they should be given. Because of vaccines, most of us have never seen a child with polio, tetanus, whooping cough, bacterial meningitis or even chickenpox. Because of vaccines, most of us have never known a friend or family member whose child died from one of these diseases. 

If you still have doubts, keep in mind that thousands of our brightest scientists and physicians have studied the safety and effectiveness of vaccinations for many years. They are confident in recommending these vaccines and the schedule for when they should be given. You can also talk to people whose lives have been forever changed by vaccine-preventable diseases—like my grandmother who lost her father when she was 4-years-old to the influenza pandemic of 1918. Talk to people who were crippled by polio in the 1950s. Talk to the families of children who unfortunately die every year from the complications of influenza. 

In the end, bad things unfortunately do happen to good people. But we should take comfort knowing we have the power to prevent serious or life-threatening illnesses from striking those we love through simple vaccination.

For more on the importance of vaccination, visit:

Potty Time? Tips and Pitfalls of Toilet Training

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Posted by admin on August 3, 2010 – 12:38 pm
Filed under Pediatrics

While toilet training is an important milestone in the early childhood years, it can also be a confusing time, filled with plenty of questions. For example, you may wonder, when is the right time to toilet train my child? How do I know if he or she is ready? How long will it take? What are the best methods to use? 

The first and most important thing to realize about toilet training is that no two children are exactly alike, and only you should decide what’s best for your child and your family. To make that decision a little easier, here are some basic guidelines and answers to frequently asked questions:

Is your child ready?

In general, most children are physiologically ready for toilet training in terms of digestive system and bladder maturity around 18 months of age, but may not be mentally or emotionally ready until well after their second birthday. According to the American Academy of Pediatrics, some early signs of readiness for toilet training include:

  • Your child stays dry for at least two hours at a time or wakes up dry after naps.
  • You can tell when your child is about to urinate or have a bowel movement because of his/her facial expressions, squatting or posture, or your child is verbally able to tell you.
  • Your child can follow simple instructions, including walking to the bathroom and helping undress.
  • Your child asks to use the potty or asks to wear “big-kid” underwear.
  • Your child seems uncomfortable with a soiled or wet diaper and asks to be changed.

Your child seems ready, so what’s next?

As most parents realize, simply obtaining a potty chair is not enough, but it is an important first step. Make this a special event for your child.

  • Take him/her with you to buy a potty. Explain to him/her what a potty chair is used for and let him/her help choose which one to buy.
  • Once you have brought the chair home and set it up, write your child’s name on it. Let your child play with it and make it his/her own.
  • When he/she has become familiar with the potty, keep in mind that it will take frequent reinforcement and reminders to help your child understand what it is actually used for.
  • Remind your child that the potty is where he or she goes to the bathroom. Encourage him/her to sit on the potty while fully clothed.
  • If you see straining or squatting, or other signs your child might be having a bowel movement, persuade him/her to do so while sitting on the potty in a diaper. Then you can remove the diaper and let the child “help” you move the stool into the potty. This will help reinforce the association between the potty and elimination.
  • Switch from diapers to underwear. Allow your child to participate in this step by having him/her pick out the underwear at the store.
  • Make sure that your child is wearing clothing that’s easy to take off when he/she does need to use the potty. Avoid dressing your child in overalls and complicated buttons, zippers, belts or tights.
  • Praise your child every time he/she is successful in using the potty. A small reward, such as a sticker, can be a useful tool. If your child has an accident, do not use negative reinforcement or punishment.

A few words about accidents

Accidents are a normal and expected part of potty training, so it’s always a good idea to be prepared. For the first few months after potty training is complete, bring along diapers, wipes and a change of clothing to any outings with your child. If your child has an accident, help him/her understand what to do differently next time, and remember that the best way to respond is with support and encouragement. Quickly help your child change into dry clothing, and let him/her know that whenever he/she needs to go, it’s okay to tell an adult right away.

To learn more

As always, please don’t hesitate to ask your health care provider about potty training.  We’re always happy to help. Here are some additional books/resources that might also be of benefit to you and your child:

For children

  • Once Upon a Potty by Alona Frankel, Harper Collins, 1999
  • Everyone Poops by Gomi Taro, Kane Miller Book Publishers, 1993
  • Flush the Potty by Ken Wison-Max and Liza Baker, Cartwheel Books, 2000

 For parents

  • Guide to Toilet Training by Mark L. Wolraich with Sherrill Tippins, Bantam Publishing with the American Academy of Pediatrics, 2003

American Academy of Pediatrics Web site: www.aap.org

Ringworm

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Posted by admin on June 2, 2010 – 7:47 pm
Filed under Pediatrics

Ringworm is not caused by a worm but, rather, is a fungal (yeast) infection.  It may occur anywhere on the body surface or on the scalp.  

Ringworm of the skin is known as Tinea corpus.  It occurs from the neck down and on the face.  Classic ringworm begins as a flat scaly spot that then develops a raised border.  The border extends out at variable rates in all directions.  The advancing edge may have a red, raised border while the central area clears. 

This type of ringworm usually responds to anti-fungal creams. The spots become non-contagious after several days of treatment.  It takes 2 – 3 weeks to clear the rash, but occasionally the rash may persist for up to 6 weeks.  Medication should be continued for one week after rash is gone to insure the very tiny organisms you cannot see are all killed.

Lotrimin is available over-the-counter.  Lotrimin comes under several names: Lotrimin, Lotrimin AF, or Clortrimazole.  

Please see your pediatrician if over-the –counter Medications do not resolve the rash.  Oxistat , Nystatin, and Spectazole are examples of prescription medications which may be prescribed by your provider.

Ringworm of the scalp is known as Tinea capitis.  It is a fungal infection of the hair and scalp.  It attacks the hair at its root.

The main symptom is loss of hair with patchy baldness.  There may appear to be black dots representing broken hair shafts within the area of baldness.  It may be complicated by an inflammatory reaction that exudes pus called a kerion.  This represents an allergic reaction to the fungus.  The kerion will heal, but some scarring and hair loss can occasionally occur. 

The diagnosis of tinea of the scalp is confirmed with a fungal culture of the scalp sent to the laboratory.  However, because the fungus is slow growing, it takes two to three weeks for the cultures to turn positive.  Tinea capitis must be distinguished from a bacterial infection of the scalp, as the treatment is very different.

Because tinea capitis is a deeper infection, topical anti-fungal agents or shampoos are not effective alone for treating tinea capitis.  The treatment for tinea of the scalp is prescription medication, either Griseofulvin or Ketoconazole. 

Griseofulvin is used most often.  It requires a daily dose for a period of 6 or 8 weeks.   Give the Griseofulvin with fatty foods as milk or ice cream.   

If kerions are present, then oral steroids such as

Prednisone may also be necessary to hasten healing and reduce scarring.  In addition, the use of Selsun Blue shampoo is recommended twice weekly to prevent the spread of the spores to others.  Alternatively, your healthcare provider may prescribe Nizoral,  a prescription shampoo.

Tinea capitis is contagious.  Combs, brushes, and some hair products such as gels and mousse spread it.   The tinea spores remain alive on furniture too.  Meticulous cleaning of all possibly contaminated objects may help prevent re-infection.  Pay special attention to cleaning combs and brushes.  

In addition, all family members should be examined carefully for evidence of ringworm.  Cutting the hair, shaving the head or wearing a cap is not necessary when the patient is treated as outlined above.  The patient may return to school several days after treatment has begun.

Call your pediatrician during regular office hours if:

The ringworm becomes infected with pus or yellow crust or the ringworm continues to spread after two weeks of treatment.

Sports Injuries: Prevention and Treatment

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Posted by admin on June 2, 2010 – 2:59 pm
Filed under Pediatrics

Playing sports can be a big part of a child’s life.  Sports help kids stay active and fit and can boost self-esteem.  While all sports have a risk of injury, proper preparation can help to limit that risk.  Some ways to reduce injuries include:

  • Wear gear that is appropriate for the sport and that fits properly.  This includes pads like soccer shin guards and football shoulder pads, chest and leg protection for catchers, helmets for football and batting, mouthpieces and face guards and protective cups and eyewear.
  • Strengthen muscles – conditioning exercises before games and during practice strengthens muscles used in play.
  • Increase flexibility – stretching exercises before and after games and practice can increase flexibility.
  • Use the proper technique – learning basic skills and techniques should be more important than winning and should be reinforced during the playing season.
  • Take breaks – rest periods during practices and games allow the body to recuperate and can reduce the risk of injury.
  • Play safe – rules against actions that can cause injury such as headfirst sliding in baseball and softball, spearing in football, and body checking in ice hockey should be strictly enforced.
  • Listen to your body – stop if there is any pain. 
  • Avoid heat injury – drink plenty of liquids before, during, and after exercise; wear light clothing; decrease or stop activities if the heat or humidity is high.

Sports related injury can be caused by trauma or by overuse.  An overuse injury, like a stress fracture or tendonitis, usually occurs from repetitive motions without enough rest to allow for healing.  They can occur from overdoing a single motion, such as “pitcher’s elbow” tendonitis caused by too many pitches without enough rest and from too many activities using the same joint, such as a shoulder injury in someone who plays volleyball, softball and swims.  The most common sign of an overuse injury is pain – after a practice or game, during the activity (whether or not the athlete can still play) or constant or chronic pain, even when not playing.  Treatment of overuse injuries generally requires rest and some physical therapy as well as adjustments in training techniques and limited repetitions of the overused motion.  Overuse injuries can be prevented by stopping at the first sign of pain and by avoiding over training.  The best way to prevent over training is to monitor the amount of time spent doing an activity.  Limit sports to one per season and limit training to no more than five days per week.  Encourage varying training exercises from day to day, such as formal skills training one day and general conditioning the next.

Injuries can involve soft tissue and or bones.  Soft tissue injuries can be strains, sprains, or contusions.  A strain is when a muscle or tendon is stretched or torn.  A sprain involves a ligament and occurs when a joint is forced beyond its normal motion.  A contusion is a bruise within a muscle.  Bleeding inside the muscle can lead to swelling, pain, spasm, and restricted movement.  An injured bone can be bruised or broken.

Any joint can be sprained; ankle and finger sprains are common.  Signs that a joint may be sprained include pain, swelling around the joint and being unable to move the joint.  A broken bone can have the same symptoms, and an x-ray is often ordered to look at the bones.  Rest, ice on the injured site and elevation of the injured area to help prevent swelling can be started right after any injury.  After an x-ray is done to look at the injured area, a more targeted treatment can be started.  A fractured bone or a complete tearing of a ligament may require a referral to a specialist for casting and further treatment.  If the x-ray does not show a fracture, a sprain needs protection and immobilization.  An uninjured finger can be used to splint the injured finger by “buddy taping” them together.  An injured ankle can be wrapped with an elastic bandage or splinted.  After a week or two, once the joint is no longer painful or tender, stretching and resistance exercises can be done to loosen the joint, strengthen the surrounding muscles, and restore function.

Sports learned in childhood can become life-long activities.  Proper training and preparation can limit injuries and maximize fun.

Sources: www.healthychildren.org