Tag Archives: infants

Fluoride varnish: a new treatment for very young children

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.

How to save money on your prescription medications!

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If you are buying any prescription medications for your child, your teen, or yourself, then you know how pricey they can be. Sometimes they are covered by insurance; sometimes insurance only pays a fraction; and there are drugs that are not covered by insurance and families that don’t have prescription coverage at all.

No matter your situation, there are still ways you can save, even as prescription drug prices continue to rise.

Buy a generic drug alternative. Not all drugs have generic versions, but when they do the generic is usually quite a bit less expensive. Ask your physician or pharmacist if there is a generic available for a particular drug.

Talk to the doctor. In addition to knowing about generic alternatives, your pediatrician may know of a less expensive option for the drug your child is taking. There won’t always be another alternative, but it’s certainly worth asking about.

Look for cheaper prices. If you think the drug prices at your pharmacy are too high, call around. Sometimes there can be quite a difference from one pharmacy to another.

Look online for coupons or other resources. Some pharmaceutical companies have special programs for uninsured patients, or for patients who have difficulty paying even with insurance. In addition, you can often find coupons for particular drugs from a pharmaceutical company.

Drugs aren’t likely to get cheaper anytime soon, and yet they are often necessary. We want to help you find less expensive alternatives. Please ask us.

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.

Sunburned!

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As the summer gets going into full swing with Independence Day weekend, days by the pool and in the backyard, and lots of sports, sun exposure is always a concern.

How do you keep your kids healthy, happy and sunburn-free while still giving them lots of time outdoors? And when sunburn does occur, how should you treat it?

Prevention. Check out our blog from last summer about sunscreens here. Bottom line: use sunscreen liberally and limit sun exposure. You don’t have to get a sunburn to cause long-term skin damage.

Babies and toddlers. See this detailed article from the American Academy of Pediatrics (AAP). Very young children are especially vulnerable to sunburn and heat stroke. Under 6 months they should be kept out of direct sunlight and in the shade as much as possible. Use the sun cover on the stroller. Take a canopy to the older kids’ soccer games—it’s not only a good place to put the infant, but the rest of the family can get out of the sun, too. Be aware that reflective surfaces, like sand or the concrete around pools, can still allow for sunburn even when you’re under an umbrella or other cover, no matter what your age.

In addition to limiting time outside in the hot part of the day, here are other considerations for the very young:

Dress them in lightweight, light colored clothing that covers arms, legs and the head.
Use sunscreen on any exposed skin. There are several types that are appropriate for tender baby skin. Don’t ever spray directly onto the face, but into your hand first.
Put a brimmed hat on babies and toddlers, or spray their scalps with sunscreen. A fully-brimmed hat can protect scalp, ears, and partially protect face and neck.

Possible skin damage. Don’t forget that everyone, even those with darker skin, are at risk of skin damage from the sun. Exposure over time can lead to skin cancers later.

Treatment. Sooner or later, most everyone will have a sunburn no matter how hard you try to prevent it. What to do? It depends on the severity.

Minor burns (red, warm to the touch) can be treated with cool compresses, acetaminophen and rest.
More serious burns can cause blisters, fever and chills, headache or other feelings of malaise, even infection. If the burn is very serious, call your pediatrician.

So, by all means enjoy the summer sun, just be careful of getting too much exposure!

Our own dietician on staff!

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Did you know that Georgetown Pediatrics has our very own dietician? Amy Crist has been with us for about 9 months and is available by appointment through our office.

Working part-time for us, Amy is a registered dietician (RD) with a master’s degree, has also worked at Georgetown Community hospital, and makes her home right here in Georgetown.

Amy loves working with infants, children, adolescents and their parents in developing healthy eating habits, including those who have dietary restrictions. She is a frequent speaker at local elementary schools to teach children about healthy eating and nutrition. She’s even led a support group on breast feeding. She is happy to have an appointment with you and your child or teen to discuss:

breast feeding,
dietary restrictions and planning as a result of disease or condition (diabetes, drug therapies, etc.),
concerns about weight or eating disorders,
helping the whole family develop healthy eating habits,
diet and sports,
picky eaters,
and anything else you want to talk over with a dietician.

Call our office and set up an appointment soon!

Amy Crist, our dietician

Whooping cough–don’t take it lightly

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Whooping cough. It sounds like one of those old-fashioned diseases that shouldn’t be around anymore. In reality, it’s as modern as today’s news, and more common than you might think.

The good news is that it’s mostly preventable and treatable; the bad news is that it’s still a dangerous disease, especially for the very young.

A few confirmed cases of whooping cough (pertussis) in the Scott County Schools have spurred us to remind you of the dangers of this disease.

Whooping cough is a bacterial infection whose most striking symptom is described in its name—a loud, persistent cough that doesn’t easily go away. In an older child, there is a “whooping” sound made as the child tries to catch her breath between coughs. Infants may not “whoop,” but you should call the pediatrician if your infant has a persistent cough that seems to exhaust him, and his appetite has decreased.

This disease affects the lining of the bronchial tubes , and is very contagious because the vigorous coughing disperses the bacteria into the air. Anyone of any age can get it, but it’s most dangerous among the very young.

Infants and young children, in particular, can develop life-threatening illnesses from whooping cough, including pneumonia. Hospitalization is often required. This means that they, and the people around them, should be immunized.

We cannot stress enough the importance of getting the appropriate immunizations at the right ages. The pertussis vaccine doesn’t last forever, and must be taken at intervals to be effective.

Children should have a total of 5 pertussis (whooping cough) vaccines before they start school.
The youngest children are at highest risk and the most vulnerable to this disease, and should have vaccines at 2 months, 4 months, and 6 months of age.
Booster shots are given at 12-18 months, and
again at 4-5 years of age.
The College of Gynecology and Obstetrics recommends that pregnant women receive a pertussis vaccine with each pregnancy to reduce the chances of whooping cough in their newborn.
Caregivers and other adults who live or work with infants should also be re-immunized, because they’ve lost immunity from their childhood vaccines. They may not even realize they have whooping cough, because symptoms are not as severe. It may simply feel like a lingering cough from a cold, but they can transmit it to the children in their care.

When should you bring your child to the pediatrician for whooping cough? If he has cold symptoms, and you notice that the cough is worsening at about the time when it should be getting better, call our office for an immediate appointment.

There is a test we can do in the office, but it has to be sent to a lab, which takes several days. In the meantime, if the pediatrician suspects pertussis, your child will be started on a five-day course of antibiotics. The child is considered contagious and should not return to school or daycare until the five-day course has been completed.

To read more, check out this article from the American Academy of Pediatrics. Also, see our Facebook November 8 reposting of an article from two years ago by our own Dr. Hambrick. The experience of one of his own children having been made dangerously sick by this disease makes him particularly diligent in trying to keep your child healthy. artwork by Macy

: artwork by Macy

When is a fever something to be concerned about?

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That’s a great question, because we probably get more calls about fevers than about anything else.

The American Academy of Pediatrics published a brief article about fever and treating it, reminding parents that fever is the body’s way of fighting an illness, and the reason to treat it is to make the child more comfortable. They emphasize:

watching for signs of serious illness;
being careful of dosage amount based on the child’s weight;
keeping the child well-hydrated;
storing the medication in a safe place;
not waking the child up to administer the medication.

So, what should you be watching for, and when do you call the pediatrician? Here we’ve quoted a list from the same article that we think is quite helpful:

“Call your child’s doctor right away if your child has a fever and

Looks very ill, is unusually drowsy, or is very fussy.
Has been in a very hot place, such as an overheated car.
Has other symptoms, such as a stiff neck, severe headache, severe sore throat, severe ear pain, an unexplained rash, or repeated vomiting or diarrhea.
Has immune system problems, such as sickle cell disease or cancer, or is taking steroids.
Has had a seizure.
Is younger than 3 months (12 weeks) and has a temperature of 100.4°F (38.0°C) or higher.
Fever rises above 104°F (40°C) repeatedly for a child of any age.

“Also call your child’s doctor if

Your child still “acts sick” once his fever is brought down.
Your child seems to be getting worse.
The fever persists for more than 24 hours in a child younger than 2 years.
The fever persists for more than 3 days (72 hours) in a child 2 years of age or older.”

Don’t forget: since a fever is a sign of an illness, do NOT send your child back to school/daycare until his temperature has been under 101 for 24 hours.

Together, we’ll work at keeping your child healthy.

Artwork by Tori