Category Archives: All ages

Sports physicals – it’s time

Your kids are on the move – literally, and all the time! If they are involved in a fall sport at school, then it’s time for their sports physical. Don’t forget that there is tremendous benefit to getting these physicals at your child’s pediatric office, rather than at a clinic or a school-sponsored physical day. The pediatrician has all your records including vaccinations, allergies, and your individualized and family medical history. He or she can discuss important sports information with you, including nutrition. And, of course, follow-up is always readily available, whether one week or six months from now. We are delighted to be working, with you as our partner, to make a medical home for your family here with us. If your child has a physical at a clinic or the school, that physical is not a part of our records, and we end up with an incomplete picture of his or her development and needs. Read our previous blog post for more reasons on why it’s wise to bring your child to the pediatrician when it’s time for a physical.

Bug bites

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It’s summertime. Mosquitoes and other bugs are in hot pursuit of you and your family. What’s the best way to keep from being bitten? When should you be concerned about a bite?

If your kids spend any time at all outside— which they should, for the exercise and fresh air— they will be bitten from time to time. “Bugs,” of course, is not an accurate scientific term. Even so, we’re using it here as an all-inclusive word to refer to insects (mosquitoes, bees, wasps, chiggers, biting flies, etc.) and arachnids (spiders, ticks, etc.).

Most bites on most people are relatively harmless, causing irritation, itching, and redness. Different bug bites can result in different types of skin reactions, and not all people react the same. Rarely, even serious allergic reactions or illness can result.

The best medicine, as always, is prevention. Avoid times and places where mosquitoes and other biting bugs congregate.

Mosquitoes are most active around dawn and dusk. They love standing water in puddles and ponds. You are more likely to attract mosquitoes if you’re wearing dark clothing, including socks. They are attracted to your perspiration and sometimes to a scent to you may be wearing. Biting flies may be most common in wooded areas and around animals or garbage.

Repellents can be very helpful, especially against mosquitoes. However, you need to be cautious when choosing a repellent, especially for children. DEET is particularly effective against mosquitoes and some other bugs, but should be used with caution (see below). This is also true of permethrin, which is effective against ticks. Insect repellents should not be used at all on children younger than two months old.

There is terrific information in this article from the American Academy of Pediatrics. Here is their list of do’s and don’ts when you use insect repellents:

“Dos:

Read the label and follow all directions and precautions.
Only apply insect repellents on the outside of your child’s clothing and on exposed skin. Note: Permethrin-containing products should not be applied to skin.
Spray repellents in open areas to avoid breathing them in.
Use just enough repellent to cover your child’s clothing and exposed skin. Using more doesn’t make the repellent more effective. Avoid reapplying unless needed.
Help apply insect repellent on young children. Supervise older children when using these products.
Wash your children’s skin with soap and water to remove any repellent when they return indoors, and wash their clothing before they wear it again.

“Dont’s:

Never apply insect repellent to children younger than 2 months.
Never spray insect repellent directly onto your child’s face. Instead, spray a little on your hands first and then rub it on your child’s face. Avoid the eyes and mouth.
Do not spray insect repellent on cuts, wounds, or irritated skin.
Do not use products that combine DEET with sunscreen. The DEET may make the sun protection factor (SPF) less effective. These products can overexpose your child to DEET because the sunscreen needs to be reapplied often.”

To treat a bug bite, you may apply ice for a few minutes every hour or two. Calamine lotion may be applied to stop the itching. Some people also find that baking soda mixed with water decreases their itching.

When should you seek medical attention for a bug bite? If anaphylaxis (a severe allergic reaction, which may include difficulty breathing – see definition from the Mayo Clinic here) occurs, get to an emergency room immediately. Sudden hives are also a cause for concern and could be a sign of anaphylaxis. Otherwise, if the bite begins to look infected, or the reddened area around it is increasing in size larger than a quarter, keep an eye on it and check with your pediatrician’s office. You can use a Sharpie to mark the edges of the red area in order to note its progression.

Next time, more about stinging insects.

Diabetes testing and prediabetes

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Our last two blogs have been about diabetes, types 1 and 2. Now, let’s look at risk factors, testing, and what is called prediabetes.

Risk factors are slightly different for the two types of diabetes (see our previous two blogs to learn more about those types). We’ve gleaned these sets of factors from an article by the Mayo Clinic. Check out that article for more detailed explanation.

Type 1 risk factors

Family history
Environmental factors (such as exposure to certain illnesses)
The presence of damaging immune system cells (autoantibodies)
Dietary factors—though studies don’t show a direct cause and effect, there seems to be some relation to things like early consumption of cow’s milk and cereals, for example
Geography—people who live in some northern European countries have greater risks

Type 2 and prediabetes risk factors

Being overweight or obese
Inactivity
Family history
Race—it’s unclear why certain races (including blacks, Hispanics, American Indians and Asian-Americans) are at higher risk
Age—although type 2 diabetes is increasing at alarming rates among children and youth, risk increases with age
High blood pressure
Abnormal cholesterol and triglyceride levels

Other risk factors in the article pertain to adults.

Prediabetes is a condition that means your blood sugar levels are higher than normal but not yet in the “diabetic” range. It also means that you are at an increased risk of developing type 2 diabetes.

The American Diabetes Association has an online test you can take to determine possible risk. If you believe your child is at risk, talk to your pediatrician.

Please note that the top two risk factors for type 2 diabetes are things over which you likely have a great deal of control. A healthy diet and age-appropriate activity are your best tools for prevention, for your child and for you.

Diabetes overview, type 2

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Last time we reviewed some general information about diabetes in children and adolescents, and focused in on type 1. Today we look at type 2.

Type 2 diabetes has become much more prevalent in teens and children over the age of 10 in the last few decades. This is believed to be directly related to the increasing number of young people who are overweight, obese, and/or inactive.

This diabetes type often comes from insulin resistance, meaning that the body does not effectively use the insulin produced by the pancreas. (Insulin is the hormone that regulates glucose levels in the blood.) If insulin resistance is detected early enough, type 2 diabetes may be prevented or forestalled with appropriate action.

According to this article on the National Institutes of Health website, from which we’ve drawn material for this blog, insulin resistance is tied to such things as inactivity and obesity, including belly fat in particular. Losing excess weight and increasing activity to age-appropriate levels can help to prevent or delay the onset of type 2 diabetes.

Another NIH website article states, “A youth may feel very tired, thirsty, or nauseated and have to urinate often. Other symptoms may include weight loss, blurred vision, frequent infections, and slow healing of wounds or sores. Some youth may present with vaginal yeast infection or burning on urination due to yeast infection. Some may have extreme elevation of the blood glucose level associated with severe dehydration and coma.” Others may have no symptoms at all.

If your child has diabetes, his pediatrician will have recommendations for an exercise regimen, diet, and medication.

If you think your child is at risk for diabetes, she should be tested by the pediatrician and you should be alert for symptoms. Both types of diabetes are serious, with symptoms that can come on quickly, and possible problems that can last a lifetime. While hoping for a cure, today we rely on good management techniques. Call on us if you have questions or concerns.

Diabetes overview, type 1

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Diabetes is a disease that can hit at any time of life from childhood to old age. It can be a scary diagnosis, and it’s certainly not one a parent wants to hear. Even so, new medical advances are constantly being made that can limit the bad effects of diabetes, and early diagnosis and treatment are always important.

Diabetes is not uncommon among children and teens. According to the National Institutes of Health (and the National Diabetes Education Program—NDEP) article from which we have drawn much of the information for today’s blog, “About 208,000 young people in the US under age 20 had diabetes in 2012.” Those numbers are growing.

The disease is classified into two categories, called type 1 and type 2. Both types mean there is an elevated glucose (sugar) level in the blood, which is caused by problems with insulin production in the pancreas, and/or how that insulin acts on the body.

Type 1 diabetes, though only 5% of all diabetes cases, accounts for nearly all diagnoses in children under age 10. It’s actually an autoimmune disease, in which the child’s own immune system destroys the beta cells of the pancreas that produce insulin. (Insulin is the hormone that regulates the metabolism of carbohydrates, including sugars, and fats.)

Usually, symptoms of type 1 diabetes don’t appear until the disease has destroyed most of the beta cells. According to the same article cited above, “Early symptoms, which are mainly due to hyperglycemia, include increased thirst and urination, constant hunger, weight loss, and blurred vision. Children also may feel very tired.” If you are suspicious that your child has type 1 diabetes, seek medical attention immediately.

So far, there is no cure, but type 1 diabetes is managed through careful monitoring of blood sugar levels, and insulin administration by pump or injection. The amount and timing of insulin doses is determined by taking into account food and beverage intake, physical activity, and the presence of any illness. This management must be under the care of a physician who understands diabetes.

There are many ongoing studies into type 1 diabetes. Perhaps in the not-too-distant future there will be a cure, or at least a way of pre-determining who is at risk and finding ways to treat the disease before it has destroyed the body’s ability to produce its own insulin. The future is promising.

Younger children—don’t just focus on one sport

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Summertime is just around the corner, and it’s time for kids to be outside enjoying themselves. Organized sports are often a part of that. Whether you have big dreams for your child’s sports future (college scholarship, pro career) or she has dreams for herself, it’s important not to push too hard too soon. Doing so can cause injury and, perhaps more importantly, can decrease the all-important fun factor.

Most children love to play with a ball even before they can walk. As their bodies mature, they’ll enjoy learning to swim, running short distances, playing physical games like tag in the backyard. Activities like these are great for children’s physical health and for helping them grow into well-rounded people. Staying active prevents obesity, gives a boost to the immune system, improves mental outlook, and fosters the development of social skills (learning to play fair, settling disputes, taking turns, sharing).

Parents should be cautious by not encouraging a child to play one sport to the exclusion of others. Focusing on one sport, whether it’s swimming, soccer, baseball, gymnastics or something else, can lead to specific injuries. Swimmers may develop shoulder problems; gymnasts can damage joints; runners might get shin splints. Keeping a variety of physical activities in a young child’s life enables the whole body to develop, get stronger and more flexible, and decrease the risk for injury.

Eventually your child may decide to specialize in one sport, but doing so too early goes against the recommendations of the American Academy of Pediatrics (AAP) Council on Sports Medicine and Fitness. There’s a great article on the subject here. It’s best for your child’s physical, mental and social development to generalize, try a lot of different sports and activities, and to simply have fun.

Batter up!

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Baseball is here for the summer, for kids of all ages. Grownups, too, for that matter. If you’ve ever had a pitcher in the family, you know that shoulder injuries are common, and if you’ve ever watched a slow motion video of a pitcher’s action, you can see why. It’s not an entirely natural motion, and done repetitively, it can cause injury. Pain and swelling may occur and sometimes even surgery is required if the damage is severe.

Little League Baseball has guidelines in place, designed to prevent injury. These rules govern both the number of pitches allowed per day, and the number of days rest required after pitching. You can read their entire list of pitching rules here.

Both the number of pitches and the number of rest days are regulated by age. Here is their list of pitching limits per day:

17-18 105 pitches per day

13-16 95 pitches per day

11-12 85 pitches per day

9-10 75 pitches per day

7-8 50 pitches per day

And the rest day requirements, again quoting from their website:

Pitchers league age 14 and under

• If a player pitches 66 or more pitches in a day, four calendar days of rest must be observed.

• If a player pitches 51-65 pitches in a day, three calendar days of rest must be observed.

• If a player pitches 36-50 pitches in a day, two calendar days of rest must be observed.

• If a player pitches 21-35 pitches in a day, one calendar day of rest must be observed.

• If a player pitches 1-20 pitches in a day, no calendar day of rest is required.

Pitchers league age 15-18

• If a player pitches 76 or more pitches in a day, four calendar days of rest must be observed.

• If a player pitches 61-75 pitches in a day, three calendar days of rest must be observed.

• If a player pitches 46-60 pitches in a day, two calendar days of rest must be observed.

• If a player pitches 31-45 pitches in a day, one calendar day of rest must be observed.

• If a player pitches 1-30 pitches in a day, no calendar day of rest is required.

A game official is required to keep the pitch counts for every pitcher in the game and to let the head umpire know when a pitcher has reached his/her limit.

For other notes on safety and required equipment for ALL baseball players at different positions, please read Little League’s equipment checklist here.

Fun and safety are the twins of any sport. Insuring your child’s safety and health increases the fun quotient!

Fifth disease: What is it? When to call the doctor.

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Fifth disease was given its name because it’s the fifth in a list of viruses that can cause rashes in children (the other four are chicken pox, rubella, measles and roseola). Its other name is Parvovirus B19. This might sound a little scary to you, since you may have heard of a canine parvovirus that is very serious for dogs. While in the same family as the canine virus, Parvovirus B19 is only a human virus and cannot be transmitted either from dogs to people or from people to dogs. In children, Parvovirus B19—fifth disease—is relatively common and generally quite benign.

Fifth disease in children is not usually dangerous, unless the child has anemia or an autoimmune disease. It’s contagious through the droplets of coughing and sneezing or through saliva (or from a pregnant mother to her fetus), and can show up 4 to14 days after exposure. Frequent hand washing is the best way to reduce the spread of viruses.

The first symptoms are similar to those of a cold: runny nose; mild fever; itching; soreness; headache. A few children experience achy joints.

After a week or so, a red rash may appear on the cheeks. It may, over the next few days, also appear on the torso and arms, buttocks and thighs. Within another week, the rash will likely fade. It might return, even months later, when the child gets overheated. By the time the rash appears, the child is no longer contagious.

When should you call our office? If your child has anemia, especially sickle cell anemia, or an autoimmune condition, call right away. Fifth disease can be dangerous for these patients. Also, if your child develops joint swelling or if symptoms worsen over time instead of improving, call us.

In normal cases, we treat symptoms with acetaminophen to reduce fever, or antihistamines to control itching. However, sickle cell patients and some others may need to be hospitalized because the blood counts can be seriously compromised. A pregnant woman with fifth disease should also be seen by a physician, because serious complications can occur.

Most of the information in this article came from the American Academy of Pediatrics article on the subject, which you can read here.

Fifth disease is more common late winter through spring, so you may want to keep an eye out for it this time of year. The good news is that most children will develop only mild symptoms that will go away without treatment.

Are your children and teens getting enough vitamin D?

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Vitamin D: it helps build strong bones, may be protective of some diseases both now and in later life, and very few people get enough of it.

Generally, you hear about vitamin D in relation to milk (it often has vitamin D added to it) and time in the sunlight because UV rays trigger vitamin D production.

However, nearly everyone is short of the recommended dosages of vitamin D. This time of year, for example, there is precious little sunshine, and on sunny days we apply sunscreen to prevent the skin damage and sunburn those same UV rays cause. As much as we promote sunscreen for those very good reasons, it limits the production of vitamin D in our bodies.

The only way for most of us to get all the vitamin D we need is through supplements. They are inexpensive, easily available, and easy to administer.

An article by the AAP (American Academy of Pediatrics) announces their new recommendations that all ages should take vitamin D supplements to ensure bone and immune system health, both now and in the future.

Infants. Since breast milk doesn’t usually contain enough vitamin D, a supplement of 400 IU (international units) is recommended daily for breastfed babies. The recommendation is the same for formula-fed babies, unless they are receiving 32 ounces of formula per day (formulas contain vitamin D). Liquid supplements are best for infants.
Children. By the age of three, when children can chew hard foods, a chewable multivitamin that contains 400 IU of vitamin D is the daily recommendation. If your child is drinking 32 ounces of vitamin-fortified milk each day, she should be getting enough vitamin D without a supplement.
Teens. The recommendation holds for teens: 400 IU of vitamin D daily, whether through diet (though few get enough through food alone) or supplement.

Remember to keep all supplements and medications out of reach for a child.

Build a stronger skeletal and immune system now, and let your child reap the benefits both now and later.

Patient-centered Medical Home, Part 2: Your Part

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Remember that you will get the most from your PCMH, Georgetown Pediatrics, if you participate with the team.

What your PCMH team should do:

Learn about your child.
- Get to know your family, your child, your life situation, and preferences. Remember these details about you every time you seek care for your child and suggest treatments that work for YOUR CHILD.
- Treat you and your child as a full team member in your child’s care.
Communicate with you and your child.
- Give you time to ask questions and answer them in a way you understand.
- Make sure you know and understand all of your options for your child’s care.
- Help you decide what care is best for your child. Sometimes more care is not better care.
- Ask your feedback about your child’s experience getting care.
Support you in caring for your child.
- Make sure you leave the office with a clear idea of how to care for your child.
- Help you set goals for your child’s care and help your child meet those goals one step at a time.
- Give you information about classes, support groups, or other types of services to help you learn more about your child’s condition and keep them healthy.

What you can do.

Learn about caring for your child.
- Know that you are a full team member in your child’s care.
- Learn about your child’s condition and what you can do to help them stay as healthy as possible.
- As best you can, follow the plan that you, your child, and your PCMH team have agreed is important for your child’s health. If you have questions, ask!
Communicate with your child’s PCMH care team.
- Always bring a list of questions to each of your child’s appointments. Also, bring a list of any medicines, vitamins, or remedies your child uses.
- Always tell your child’s PCMH team when you don’t understand something they said. Ask them to explain it in a different way.
- Always tell your child’s PCMH team if your child gets care from other health care professionals, so they can help coordinate the best care possible.
- Always talk openly with your child’s PCMH team about you and your child’s experience and getting care from the medical home so they can make care better.

Together, you and we will make Georgetown Pediatrics the medical practice that works best for your family.