Category Archives: infants

Measles

You’ve almost certainly heard about measles outbreaks in the news lately. Also called rubeola, measles is a highly contagious respiratory disease caused by a virus. It causes a rash over the entire body, a fever and runny nose. According to the Centers for Disease Control and Prevention, “About one out of 10 children with measles also gets an ear infection, and up to one out of 20 gets pneumonia.” Encephalitis is another severe complication that can occur. Measles can also, rarely, be fatal. Between one and two children in 1000 who get the disease will die from it. The disease can also strike adults.

Measles, as you can see, is more than just an annoying rash. It can be quite dangerous.

If you thought measles was a disease left in the past, think again. Outbreaks this year in New York and other states have health departments all over the country concerned, because such an event can happen anywhere. Over 1000 cases in nearly 30 states have been reported, the most cases since 1992—and this year is only half over. In 2000 the US was declared free of endemic measles, but this designation will soon be lost if the current epidemic is not brought under control.

Outbreaks typically begin when unvaccinated people travel abroad to places where measles is more common because a larger percentage of the population is unvaccinated.

It’s no coincidence that we used the word “unvaccinated” twice in that last sentence. The reason measles is spreading again in the United States is because of a drop in MMR (Measles, Mumps and Rubella) vaccinations.

Those who decide not to be vaccinated (or to have their children vaccinated) put themselves, their families and their communities at risk for dangerous diseases. As with most diseases, those at highest risk are the very young, the very old, and those with compromised immune systems.

The MMR vaccination is required for students in Scott County Schools, and HIGHLY recommended for all other children. The State of Kentucky requires two doses of the MMR vaccine before your child can enter school.

If you have concerns about vaccinations, talk to your pediatrician.

Remember that the extremely rare risk of a reaction to a vaccination is much smaller than the risk of being unvaccinated against a dangerous illness.

Georgetown Pediatrics welcomes Dr. Caitlyn Anglin to our practice

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We are pleased to announce the addition of a new physician at Georgetown Pediatrics.

Dr. Anglin 2 Dr. Caitlyn Anglin is returning to the place she fell in love with when she was an undergraduate at Georgetown College. Raised in Dry Ridge, KY (a small town between here and Cincinnati), she is thrilled to practice pediatrics in such a wonderful place!

Dr. Anglin sees how children bring fun and positive energy to any room, and loves working with the whole family unit to help them stay healthy and achieve a bright future. As a physician, her special interests are newborn care, ADHD, and combatting childhood obesity.

When she’s not working, Dr. Anglin enjoys running, camping, hiking, kayaking, attending concerts, and hanging out with family, friends, and her pup Pearl.

July 22 will mark Dr. Anglin’s first day in our practice. You may call our office any time to set an appointment with her for your child.

Please join us in welcoming Dr. Caitlyn Anglin to our practice and to the community!

New information about preventing peanut allergies

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An extensive study of children and peanut allergies has recently been released, and it encourages pediatricians to re-assess the recommendations that have been in place for some time. The study, called LEAP (Learning Early About Peanut Allergy), looked at children who have a severe or mild risk of developing peanut allergy and those who don’t.

Peanut allergies have been on the rise in recent years. Conventional wisdom has been that infants and toddlers should not be given peanuts or peanut products until they were older. That wisdom is now changing as a result of the LEAP study, conducted by the National Institute of Allergy and Infectious Diseases (NIAID).

The director of NIAID said in a recent press release: “We expect that widespread implementation of these guidelines by health care providers will prevent the development of peanut allergy in many susceptible children and ultimately reduce the prevalence of peanut allergy in the United States.”

So, what are the new guidelines, and what should parents do about introducing peanuts to the diets of their young children?

For babies who are considered to be at NO risk for developing a peanut allergy, parents can begin introducing peanut butter with solid foods at about six months of age. The LEAP study concludes that once peanut butter is introduced and tolerated with no allergic reaction, it should remain in the baby’s diet with some regularity.

There are different guidelines for babies and young children who are determined to be at moderate or severe risk of developing peanut allergy. How do you know whether or not your child is at risk? There are several factors that contribute to that risk, and it’s a conversation you should have with your child’s pediatrician in the office before introducing peanut butter into the diet.

Your concerns are our concerns, and we look forward to answering any questions you may have at your child’s next checkup.

The consequences of lead poisoning in children

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The tragic, preventable events in Flint, Michigan, have brought to the nation’s attention the results of lead poisoning, especially in children. It’s a good time to remember that lead poisoning can be a risk, no matter where you live.

How are children exposed to lead? Lead can be inhaled in polluted air (which is why lead was removed from gasoline decades ago). Children can be exposed through paint containing lead, either by eating paint chips or when lead paint is removed and is introduced into the air. They can also ingest lead through tainted drinking water, which is what has happened in Flint.

Children are at greater risk than adults because their bodies absorb higher percentages of lead. In addition, their developing bodies are more easily and irreversibly damaged.

Some of the worst and most obvious problems that result from lead poisoning occur in the central nervous system. Brain development can be greatly affected, especially in those under the age of two. Such problems are permanent.

Other severe effects can include anemia, kidney problems, endocrine issues (including the inhibiting of normal growth), and gastrointestinal concerns (like vomiting and constipation). Both small motor and large motor skills suffer from lead poisoning.

Because lead so severely affects the central nervous system, children often exhibit serious behavioral problems like aggression, impulsive behavior, and difficulty with attention—problems that don’t end with childhood. Later in life, these individuals experience a much higher than normal incidence of substance abuse.

The growing understanding of the severity of the consequences of lead poisoning has caused the Centers for Disease Control and prevention to modify its definition of toxic lead levels over the past several decades to one twelfth of its former measurement (from 60 micrograms/deciliter in 1970 to 5 mcg/dL in the current definition).

So, what can we and you do to prevent lead poisoning? First, make sure you limit your child’s exposure to lead. If you’re concerned because you live in an older home, you can have your water tested to be certain that no lead is leeching into the system from pipes. Make sure that any lead paint has been removed.

In our office, we assess lead levels at the one year checkup. In addition, we have increased our frequency of using a verbal questionnaire to screen for risks, starting at six months of age.

Together, we can reduce or eliminate your child’s risk of toxic lead exposure.

***Much of the information in today’s blog was gleaned from “Pediatric News,” Vol. 50, number 3, March 2016.

Fluoride varnish: a new treatment for very young children

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Tooth decay, as you know, continues to be a growing problem among children and adolescents. Sugary diets and infrequent brushing can lead to cavities at young ages. And tooth decay at a young age almost always is a sign of more tooth decay as the child grows.

How to get ahead of the problem early? The American Academy of Pediatrics (AAP) recommends a fluoride varnish two to four times per year for very young children who have yet to visit a dentist. We will begin offering a fluoride varnish in our office soon.

Will insurance cover such an important treatment? You bet. All insurances are required to cover fluoride varnish, but some have a limit on how many treatments per year, even though it is a recommended service as often as every 3 months.

We’ve written before about the importance of fluoride in protecting the enamel of children’s teeth. New guidelines emerged from the AAP to stress brushing with a tiny amount of fluoride toothpaste even in the very young, although previous guidelines had recommended no fluoride before the age of 2.

Now the guidelines have been strengthened further to encourage a fluoride varnish.

Fluoride is a mineral that strengthens tooth enamel, which covers each tooth. Yes, there is fluoride in public water systems, but it may not be enough. In addition, many in our community drink water from wells and cisterns, or drink bottled water.

A fluoride varnish is simple to apply in the pediatrician’s office, with a small brush to coat the top and sides of each tooth. It’s a liquid that hardens quickly, and the teeth should be brushed about 4 to 12 hours afterwards at home. The treatment is painless, and most children like the taste. The varnish may temporarily leave a dull or yellowed appearance, but the teeth will return to a normal color after the varnish is brushed off.

This article from the AAP contains more information about fluoride varnish, including how to care for your child’s teeth immediately after the varnish is applied:

“Your child can eat and drink right after the fluoride varnish is applied. But only give your child soft foods and cold or warm (not hot) foods or liquids.
Do not brush or floss teeth for at least 4 to 6 hours. Your child’s doctor may tell you to wait until the next morning to brush or floss. Remind your child to spit when rinsing, if he knows how to spit.”

Dental health can’t start too early. Talk to your pediatrician soon about a fluoride varnish to protect your child’s teeth in the years to come.

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.

Roseola

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Let’s say this first: anytime your infant or young child has a fever of 102°F for twenty-four hours, call the pediatrician. The issue may be minor or serious, and the doctor should help you determine what it might be.

One possibility is roseola, usually not a series condition, which is yet another in the herpes family of viruses. (It is not the same as the herpes strains that cause genital herpes or cold sores.) It’s human herpes virus 6 (HHV-6) and is relatively common in children aged six months to two years.

Symptoms, in addition to the fever (which may last up to a week), may include a cough and runny nose, less appetite and mild diarrhea. Finally, after the fever is gone, generally a slightly raised red rash will appear. It usually starts on the torso before spreading to the rest of the body.

Roseola is contagious, and a child with a fever should be kept away from other youngsters until the fever is gone. Once roseola is at the rash stage the child is no longer contagious and can return to daycare. The incubation period is one to two weeks.

If the pediatrician suspects roseola in your child, you might be asked to treat the fever with age-appropriate doses of acetaminophen (always be sure to check dosing instructions and note that they have changed in the last few years) and keep him hydrated. The doctor may want to talk to you again to make sure the child isn’t sick with something more serious.

You can find out more about roseola in the two articles from which our research was drawn, here and here. Both articles were published by the American Academy of Pediatrics.

Vitamin K: a very necessary injection for newborns

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An injection of vitamin K for newborns has been recommended by the American Academy of Pediatrics (AAP) since 1961. Routinely, it is given a few hours after birth for the prevention of very serious bleeding.

The Centers for Disease Control and Prevention (CDC) has produced an online brochure describing the need for a vitamin K injection.

According to the brochure, babies are born with a vitamin K deficiency because they have not yet developed the good bacteria in their digestive tract that produce the vitamin, and they can’t get enough of it from their mother’s milk or while they are in the uterus. Since vitamin K is essential in the clotting of blood, babies can get what is called vitamin K deficiency bleeding (VKDB). VKDB is very dangerous. “Without enough vitamin K, your baby has a chance of bleeding into his or her intestines, and brain, which can lead to brain damage and even death. Infants who do not receive the vitamin K shot at birth can develop VKDB up to 6 months of age. The good news is that VKDB is easily prevented. The easiest and most reliable way to give babies vitamin K is by a shot into a muscle in the leg. One shot given after birth will protect your baby from VKDB.”

Are there any dangers? One 20-year-old study seemed to find a link between vitamin K injections and childhood cancers. However, follow up studies have never been able to show such a link. (Read the CDC’s brochure for more detail.)

This is an essential, one-time injection that could save your baby’s life.

When to start fighting tooth decay? When the baby’s FIRST TOOTH starts to come in.

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You are so excited about your child’s first teeth that it doesn’t occur to you to think about tooth decay yet. But the fight against tooth decay, according the American Academy of Pediatrics (AAP), starts from the first baby tooth. That is also when they recommend starting to brush with a tiny amount of fluoride toothpaste.

You may be thinking, “What?! My pediatrician (or dentist) told me no fluoride before the age of two years.” You’d be right. This is a BIG change in recommendations, and it is indeed new.

Dental health is important for overall health, and tooth decay can start early. Decay in a young child’s teeth “is the single greatest risk factor” for decay in permanent teeth, according to a recent article by the AAP, which also states that “59% of 12- to 19-year-olds” have at least one cavity.

The administration of fluoride in a proper amount is still one of the best ways to prevent tooth decay, as it preserves the enamel that coats the tooth. Many children and teens don’t get enough fluoride to act against tooth decay.

How to make sure your child is getting enough fluoride:

Start at the very beginning. As soon as you see the first tooth erupting from the gum, you should brush it with a fluoride toothpaste, but only a very small amount. The AAP guidelines, which you can find here, recommend a “smear” about the size of a grain of rice until the age of three.
For 3- to 6-year-olds, increase the amount to pea-sized. Brush teeth twice a day, with adult assistance, and make sure that the child doesn’t swallow the toothpaste. It’s even best if they don’t rinse with water.
Drink tap water. In Scott County the public water is fluoridated, but if you use a well or cistern your water will only contain minimal amounts of fluoride. Bottled water typically doesn’t contain much, if any, fluoride. If you worry about tap water, use a filter.
Check with your pediatrician or dentist especially if you don’t have public water to make sure your child or teen is getting enough fluoride.

Are there any downsides to using fluoride? Yes, it’s possible to get too much and create a rare condition called fluorosis, that causes discoloration of the teeth. You can read about fluorosis here. Again, this is rare, but if you’re concerned about it, speak to your pediatrician or dentist.

For other information on preventing tooth decay, check out these AAP articles:

“Brushing Up on Oral Health: Never Too Early to Start” about dental health in babies.
“Preventing Tooth Decay in Children.”
“Toothbrushing Tips for Young Children.”

Take good care of your child’s teeth for beautiful smiles throughout their lives.

Probiotics

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You’ve likely heard the term “probiotics”. Maybe you’ve also wondered what it means and what, if any, benefit probiotics could provide for your family’s health.

What are probiotics? According to the Centers for Disease Control and Prevention, “Probiotics are defined by the Food and Agriculture Organization of the World Health Organization as live microorganisms that, when administered in adequate amounts, confer a health benefit on the host.” Sound appetizing?

Every human intestinal tract contains beneficial bacteria that helps break down food products into compounds that are more easily absorbed into the body. Sometimes the beneficial bacteria need a boost over the harmful bacteria that share the same space, or during or after a round of antibiotics that may kill the good bacteria along with the bad.

Probiotics contain the helpful bacteria. According to the American Academy of Pediatrics, giving probiotics early in the course of “acute viral gastroenteritis can reduce its duration by one day. Probiotics also have been found to be modestly effective in preventing antibiotic-associated diarrhea in otherwise healthy children, though there is no evidence probiotics are effective at treating this type of diarrhea.” [Italics ours.] Note the term “healthy children.” Probiotics don’t have any proven effects on treating chronic diarrhea, Crohn’s Disease or other chronic illnesses.

When a mother cannot breastfeed, special probiotics can be introduced to the formula that will help to replace the natural ones found in breast milk. Ask your pediatrician about this before trying these products.

Where do you get probiotics? They are available over the counter in drug stores and healthcare departments of grocery and discount stores. They come in foods or as supplements. Buy from a manufacturer you trust, remembering that probiotics are not regulated the same way prescription drugs are.

As always, eat a balanced diet, which is the best road to gastrointestinal health.