Wednesday, March 18, 2015
Flatworms Minute Predators of the Rock Pool
One of the easiest ways to find the smallest animals that inhabit rock pools at the seaside is to collect fronds of red seaweed and examine them in a shallow dish of sea water under a low power microscope. I discovered this little flatworm this afternoon amongst the seaweed fronds from a rock pool on the Northumberland coast at Low Newton. It’s about two millimetres long and the images here were taken at magnifications of x40 (whole animal), x100 (head) and x400 (eye). Free-living flatworms, some tropical examples of which are over 30cm. long, belong to a very large phylum of animals called the Platyhelminthes that includes notorious parasites like liver flukes. These minute marine flatworms are predators on even smaller marine organisms. Their mouth is in the middle of the underside of the flattened body and opens into a highly branched digestive tract that you can see clearly as the dark brown network in the low power image of the whole animal (top). Flatworms are equipped with a pair of very simple eyes that are efficient at detecting the direction of light but don’t form images. They open via a ‘pinhole’ (just visible in the bottom photograph) and are lined with just a few light receptors attached to nerve endings. Flatworms glide around with the aid of thousands of rhythmically-beating cilia (see video) that cover a surface layer of large brick-like cells that you can see around the edge of the animal in the middle photograph. Freshwater flatworms that are very similar to this marine species, but are black rather than translucent, are present in every garden pond and can often be seen gliding around under the surface film.
Diverticulitis definition What is Diverticulitis – Symptoms Treatment
Diverticulitis is a common disease of the bowel, the main part of the large intestine. Diverticulitis develops from diverticulosis, which involves the formation of pouches (diverticula) on the outside of the colon. Diverticulitis results if one of these diverticula becomes inflamed.
Bacteria may subsequently infect the outside of the colon if an inflamed diverticula bursts open.
If the infection spreads to the lining of the abdominal cavity, (peritoneum), this can cause a potentially fatal illness (peritonitis).
Sometimes inflamed diverticula can cause narrowing of the bowel, leading to an obstruction.
Also, the affected part of the colon could adhere to the bladder or other organ in the pelvic area. Diverticulitis most often affects middle-aged and elderly persons.
Diverticulitis symptoms
The symptoms of diverticulitis include localized abdominal pain and tenderness, loose bowel movements or constipation, and fever.
A blood test shows an increased number of white blood cells.
Treatment for diverticulitis
An acute attack of diverticulitis is usually treated with antibiotics.
When the infection has been controlled, patients suffering from such an attack are also placed on a high-fiber diet.
However, recurring acute attacks or complications, such as peritonitis, require surgical treatment.
Chakkulathukavu Yethra Naryasthu Poojayante Remantha thathra Devatha
Chakulathu kavu temple, famous for the ceremonial Nari-pooja(worshipping the womanhood), is situated in between the rivers pamba and manimala.From the town of Thiruvalla it only takes a 15 min drive to reach here.
The ancient history of the temple has some divine connections with the story of Sumbha and Nishumbha referred to in the Devi Mahatmyam. The story goes that two demonic characters called Sumbha and Nishumbha derived super human powers through rigorous meditation of Lord Brahma. They received a boon that they could be killed only through a battle with a woman. Such a condition being almost impossible, Sumbha and Nishumbha conquered Indra and other Devas. They became the unquestioned monarchs of the three worlds. The helpless Devas had to flee and take shelter in remote jungles.
Saint Narada feeling pity at the misery of the Gods approaches his father Lord Brahma. Brahma reminds Narada that ups and downs are part of the life and that was what the Demi-Gods were experiencing. There was only one way out for this despicable state of affair. Only one power could restore power and prosperity to Gods and that power was none other than the very Goddess. Devas accordingly moved in search of Goddess. Reaching near Himavan, the epic King of the mountains, they started chanting powerful mantras to appease the Goddess. They plunged into a heartful eulogy of the Goddess who in herself was power, knowledge and creativity.Goddess Parvathy had just arrived on the banks of river Ganga and in the mean time echoes of the mantras reached her ear. Goddess Parvathy grasped the pitiable plight of Devas. There emerged another Goddess from within her. This was the incarnation of Goddess Durga, having taken a divine form to rescue the Devas from the hardships caused by the asuras. The story culminates in a terrible fight between the Goddess and Asuras under the leadership of Sumba and Nishumbha. It was an encounter unheard of ever before. Needless to specify, all the auras were annihilated by the Goddess. The Devas got back the early powers and prosperities. Sage Narada appears in front of them and exhaults them about the invincibility of goddess Durga. She was the cause as well as the witness for the creation, maintenance and destruction the universe as told by Narada.It is believed that the Goddess residing in Chakkulathukavu is the wholesome manifestation of this all-pervading Goddess namely Durga.
Before 3000 years, this area where the temple stands now has been a fearful forest full of trees which are touching the skies, serpents and reptiles with hissing noises and wild animals in barbaric freedom, together created an atmosphere one would shudder to think. Rays of the sun failed to look down through the trees. Afternoons were like midnights.
Into this forest came a hunter along with his wife and children, with an idea of collecting firewood. The hunter saw a serpent moving towards him. Its hood was erect and its noise was fearful. The hunter to ensure their safety attacked the snake with his axe. Without getting hurt, the snake managed to slip into the forest. An expert in the wild habits of animals, the hunter knew too well that an attacked snake is dangerous if spared. So he followed it. He searched through the forest frantically, still he couldn’t spot out the snake. Finally he reached by the side of a lake and near it an age-old Chithalputtu(A structure of sand made by insects) could also be distinctly seen. Upon it hunter saw the very snake that he was in search of. Without thinking much, the hunter thrust his axe again and again upon the serpent. But it was like cutting in the air. Surprisingly, the serpent vanished into thin air.The hunter had a touch of horror. The next second he saw that the shell upon which the snake coiled was broken. Water was oozing out of it. The hunter watched with much awe and wonder. Now there was ‘Akshatham’ (paddy and rice) and ‘Darbha’ (a peculiar type of grass used for pujas). Meanwhile the wife and kids of the hunter joined him. All were spell-bound at the unbelievable sight in front of them.
There appeared a hermit from nowhere with an inexpressible glow of holiness. The hermit informed them that the very Goddess who is the Mother of the Universe has been residing with full powers inside the shell of sand. He advised the hunter to respectfully break the shell. The idol of Goddess as Vanadurga was within it. Narada himself broke the shell and took out the idol. The hunter and his family bowed before it. Meanwhile the hermit had disappeared. The hunter brought flowers from the forest, offered garlands and prayed. That night he had a dream and it’s was in this dream that the hunter understood that the hermit was Narada.
As the sun sent down its gentle golden rays in the next morning, many had gathered near the hut of the hunter. They submitted many offerings to the Goddess. Henceforth that place turned out to be a spiritually exceptional one.Poojas of the temple were structured systematically and members of Pattamana Illam constructed a temple in that spot. The idol similar to that of Sivalainga, taken out by Narada was installed in the Sanctum sanctorum.
The water in the historical pond of the temple had the sweetness of jaggery. ‘Chakkarkulam’ became shortened in the long run and came to be known as Chakkulam. The temple was renovated in 1981. The resplendent idol of Vana Durga with eight hands was installed near the original idol. Lord Shiva, Sastha, Vishnu, Vinayaka, Muruka, Yakshi, Serpent Gods and Navagrahas are installed as ‘Upa Devas’.
How the Turtle Saved His Own Life Jataka tales in English
A king once had a lake made in the courtyard for the young princes to play in.
They swam about in it, and sailed their boats and rafts on it.
One day the king told them he had asked the men to put some fishes into the lake.
Off the boys ran to see the fishes.
Now, along with the fishes, there was a Turtle.
The boys were delighted with the fishes, but they had never seen a Turtle, and they were afraid of it, thinking it was a demon.
They ran back to their father, crying, "There is a demon on the bank of the lake."
The king ordered his men to catch the demon, and to bring it to the palace.
When the Turtle was brought in, the boys cried and ran away.
The king was very fond of his sons, so he ordered the men who had brought the Turtle to kill it.
"How shall we kill it?" they asked.
"Pound it to powder," said someone.
"Bake it in hot coals," said another.
So one plan after another was spoken of.
Then an old man who had always been afraid of the water said:
"Throw the thing into the lake where it flows out over the rocks into the river.
Then it will surely be killed."
When the Turtle heard what the old man said, he thrust out his head and asked:
"Friend, what have I done that you should do such a dreadful thing as that to me?
The other plans were bad enough, but to throw me into the lake! Dont speak of such a cruel thing!"
When the king heard what the Turtle said, he told his men to take the Turtle at once and throw it into the lake.
The Turtle laughed to himself as he slid away down the river to his old home.
"Good!" he said, "those people do not know how safe I am in the water!"
Read more »
They swam about in it, and sailed their boats and rafts on it.
One day the king told them he had asked the men to put some fishes into the lake.
Off the boys ran to see the fishes.
Now, along with the fishes, there was a Turtle.
The boys were delighted with the fishes, but they had never seen a Turtle, and they were afraid of it, thinking it was a demon.
They ran back to their father, crying, "There is a demon on the bank of the lake."
The king ordered his men to catch the demon, and to bring it to the palace.
When the Turtle was brought in, the boys cried and ran away.
The king was very fond of his sons, so he ordered the men who had brought the Turtle to kill it.
"How shall we kill it?" they asked.
"Pound it to powder," said someone.
"Bake it in hot coals," said another.
So one plan after another was spoken of.
Then an old man who had always been afraid of the water said:
"Throw the thing into the lake where it flows out over the rocks into the river.
Then it will surely be killed."
When the Turtle heard what the old man said, he thrust out his head and asked:
"Friend, what have I done that you should do such a dreadful thing as that to me?
The other plans were bad enough, but to throw me into the lake! Dont speak of such a cruel thing!"
When the king heard what the Turtle said, he told his men to take the Turtle at once and throw it into the lake.
The Turtle laughed to himself as he slid away down the river to his old home.
"Good!" he said, "those people do not know how safe I am in the water!"
WHAT IS WELLNESS
What is "Wellness"?
Wellness can mean different things to different people, depending
on their priorities, so I have picked out some general areas that
should appeal to all people. First I considered the "wellness" of the
body, that would allow your body to function well and last a long
time. To achieve that kind of wellness, you would have to follow
state-of-the-art preventive health practices.
Looking at what most affects the wellness of people living in
America, we must consider that keeping poisons out of our bodies is
the first priority. Without that, the other preventive health measures
would be futile. The two most common poisons in our cultural
environment are tobacco and fructose. [see health-bytes on tobacco
and fructose]
Next, I considered the wellness of the mind, which I will call
"spiritual health". For your mind (and spirit) to function well, you
must interact with others and your environment in ways that keep
your mind active, and your spirit in harmony with others. You should
also continue to learn as much as you can for your entire life. When
you stop learning, your mind ceases to function.
To take a broader view of spiritual health, we can consider ourselves
as part of a larger community, which must also maintain "wellness".
If there is suffering, conflict, or even war in the community, nation
or world that we live in, it is a threat to our personal wellness. We
all need to pitch in and do our part to promote the wellness of the
community (both local and world-wide). Of course that starts in our
own back yard. As they say, we need to think globally, but act
locally.
Finally, I have considered that the wellness that we enjoy today is
often based on preparation that we did in the past. Therefore, we
should start now to prepare for future wellness.
With these 4 broad areas in mind, I have summarized wellness
practices in the form of a screening test. If there are wellness
practices that you are missing out on, consider making a change,
and keep that healthy mind of yours constantly adapting and
learning!
Wellness Screen
Section I (Prevention Practices) Yes No
1. We look up evidence-based health info
on the internet
. .
2. We never breathe secondhand smoke . .
3. We avoid eating or drinking fructose
(sugar) whenever possible
. .
4. We use dental floss every day . .
5. We eat at least 5 fruits and vegetables
every day
. .
6. We each take a multivitamin pill every
day
. .
7. We wear our seatbelts in the car
(100%)
. .
8. Grandparents take an aspirin every
day, and colonoscopy after 50
. .
9. Adults never drink more than one
alcohol drink per day
(zero while pregnant!)
. .
10. We never smoke cigarettes (or use
other drugs)
. .
11. We each get 1 hour of exercise every
day (including parents)
. .
12. We get regular check-ups at the
doctor (Update your vaccines,
and keep our blood pressure under
120/80)
. .
13. We never talk on the cell phone while
driving
n n
Section II (Spiritual and Mental Health) . .
1. We participate in hobbies that interest
us
. .
2. Family fights never result in physical
injury
. .
3. We watch meaningful TV shows, but
limit TV to less than 2 hours/day
. .
4. Family is involved in church or
community projects
. .
5. We plan activities with friends . .
6. We do volunteer work . .
7. We set an example for our children by
rejecting hatred against minorities
(racial, gays and lesbians, overweight or
handicapped people, other cultures)
. .
Section III (Environmental Wellness) . .
1. We recycle paper, aluminum and
plastic
. .
2. We have checked our home for radon . .
3. We never allow people to smoke in our
home
. .
4. We use a filter for drinking water
(Brita, etc)
. .
5. We clean up trash on our block every
month (or more often)
. .
6. We always vote at election time . .
Section IV (Preparing for the Future) . .
1. We teach our children "life" skills
(cooking, washing, managing money)
. .
2. Each family member (including
parents) is learning and practicing
a lifetime fitness sport (tennis, disc
golf, swimming, etc)
. .
3. We save money in dedicated funds
(college, retirement, etc)
. .
4. We pay off credit cards in full every
month
. .
5. We preserve the heritage of our town
for future generations
to appreciate (historic
preservation)
. .
What is ADHD (Hyperactive Child)?
ADHD stands for Attention Deficit Hyperactivity Disorder. This
describes the brain defect that results in inabilty to "pay attention"
for more than a few seconds, which then results in the child acting
"hyper" because his mind keeps wandering around to other things.
Sometimes a child just phases out without acting hyper, so these
children are just ADD. About 9% of all school children have at least
some form of ADHD or ADD, more commonly in boys, but it is also
found in about 3% of girls.
What are the signs of ADHD?
Short Attention Span: daydreams, doesnt seem to listen, easily
distracted from both work and play, disorganized, forgets things,
loses important things, makes careless mistakes, does not finish
what he starts, doesnt seem to care about details.
Impulsive: acts and speaks without thinking, has trouble taking
turns, cannot wait for things, interrupts others, inappropriate
touching of others.
Hyper: constant motion, cannot play quietly, squirms and fidgets,
talks too much, cannot stay long in a chair, will not stay with a
group.
Is there a test for ADHD?
Unfortunately, no, but the signs listed above, and many other
signs, can be quantified by psychological tests. The scores on these
tests will tell how severely your child is affected, and which type of
ADHD it is. Your psychologist or psychiatrist can then recommend
the appropriate treatment. It is also important to test for other
conditions commonly found with ADHD, such as conduct disorder,
oppositional behavior, depression, anxiety disorder, and learning
disabilities.
What causes ADHD?
The exact cause is not known, but we do see a tendancy for it to
run in families. It can also result from exposure to toxins or from
brain injury. We do know that these children (and adults) with ADHD
have lower brain activity in areas of the brain that control the focus
of attention. As these children get older the ADHD seems to improve
in many cases, probably because they have learned to adapt and
compensate for the defect.
What treatments are available?
Since ADHD is a life-long condition, long-term planning is
essential. Each year, the school will hold a conference with the
parents, the child, the teacher(s), the principal, and the psychologist
to develop an IEP (Individualized Education Plan) for the whole
school year.
Behavior therapy is the main part of treatment, used at home and
at school. This mainly consists of setting goals, proving rewards and
consequences for certain behaviors, and continuing a consistent reinforcement
of these goals. This can get pretty complicated, so
usually requires ongoing help from the psychologist or psychiatrist.
Teachers at school will have to be constantly aware of these goals as
well.
In some cases, medications can be helpful to help a child with
ADHD to concentrate better in school. Many types of medications
have been tried, but the most commonly used are stimulants, such
as amphetamine or ritalin. There are several different forms of
these, with slightly different effects. In 2003, a new class of
medication was approved by the FDA, atomoxatine, which is a nonstimulant
effective in treating ADHD.
Medications are given in the lowest possible dose, then increased
(ONLY if necessary) to achieve a positive effect. We want to limit
side effects if at all possible. Some of the side effects include
decreased appetite, weight loss, sleep problems, headaches,
jitteriness, social withdrawal, and stomach ache. Less commonly, we
see dry mouth, dizziness, tics (involuntary movements), and
rebound effect after the medication wears off. Rarely seen side
effects are growth delay (shorter height), increased blood pressure,
and stuttering.
If your child is taking medication for ADHD, inform your doctor if
any of the above side effects occur. These can be lessened or
eliminated by changing the dose, or changing to a different
medication.
Beware of phony treatments!
There are tons of phony treatments for ADHD that you will see
advertised and on the internet. Several books claim other phony
treatments can help. If it sounds too good to be true, it probably
isnt true. If it sounds quite different from the techniques discussed
in health-bytes, it is probably not approved by the American
Academy of Pediatrics (my major source of information), and is
probably not backed by any scientific testing.
Diet therapies, such as avoiding sugar, or certain foods, have been
tested quite thoroughly, and the great majority of studies have
shown that dietary changes have no effect on ADHD.
What can I do at home to help my child with ADHD?
1. Keep your child on a daily schedule, doing things about the same
time every day.
2. Limit the distractions. Loud music, computer games and television
should not be on during meal times and homework times.
3. Organize your house, so that your child can find things easily, and
he can learn the proper place for things, such as backpack,
schoolwork, clothes, toys, etc.
4. Reward positive behavior. Your child has to deal with a lot of
negative feedback, so try to balance it with as much positive as
possible. A kind word, a hug, a treat will help to give him incentive
to keep trying.
5. Set small reachable goals. Be thankful for small improvements,
and know that these will add up to bigger improvement in the long
run.
6. Help your child stay on task. Use charts and checklists to track
progress with homework and chores. Keep each task as simple and
brief as possible. Make your reminders friendly and positive, but you
will have to give reminders frequently.
7. Limit choices. Offer choices whenever possible, to help him learn
to make good decisions, but limit the choices to two, maybe three.
Having too many choices is pushing the limits of his attention span.
8. Find activities where your child can succeed. Self-esteem is often
hard to come by for children with ADHD, because there are so many
failed attempts during each day. Sports or energetic physical
activities can be very rewarding. Every child is different, and your
child might find a certain activity that he can really relate to well.
9. Use calm discipline. Time out or just removing the child from the
situation is usually enough. Some behaviors are better ignored, as
they are affecting the parent more than the child. For example, loud
play which is not hurting any other children might be very annoying
to the parent, but could be just ignored with a little physical
separation (moving to another room). When discipline is given, use
a calm tone, apply known consequences in a consistent manner, and
avoid physical punishments like slapping or spanking.
Source: Clinical Practice Guideline: Attention-Deficit Hyperactivity
Disorder, Pediatrics, May 2000.
(Thanks for help from UK medical student Chris Johnner)
What Pets are Safe for Kids?
There are many diseases that can be transmitted to children from
animals, and some are serious, even life-threatening, such as rabies,
Clostridium, MRSA, and Lyme disease (through ticks they carry). Is
it safe for kids to be around animals?
Most families have pets of some kind, with dogs and cats at the top
of the list. These are the most recommended pets because disease
transmission is minimal, especially if the animals are over 6 months
old, and have been vaccinated for rabies. Kittens and puppies in the
first 6 months are more likely to carry disease, and are more likely
to bite and scratch a child handling the animal. Most cases of catscratch
disease are from handling a small kitten. If you get a puppy
or kitten for your child, keep exposure to a minimum during the first
6 months. The safest would be to get a dog or cat that is already
over 6 months old.
Pit bulls and other dogs bred for "protection" are not recommended
for children since children and even adults have been mauled or
killed in attacks. We all know families with a pit bull who plays well
with the children, but it only takes one incident when the animal has
a bad day, is caught off guard, or perceives a threat, to result in a
tragedy.
Fish are another popular pet, with very little chance of disease
exposure for children. They can be a beginner pet for teaching
children how to care for animals, since they have minimal
maintenance. A more motivated child could then learn how to care
for a hamster, parakeet or tame rabbit.
Wild rabbits, squirrels, raccoons, and other animals from the wild
are not considered safe pets since they could carry several
dangerous diseases, and would be more likely to bite a handler.
Other non-recommended pets include: reptiles, amphibians,
monkeys, hermit crabs, prairie dogs, and other exotic pets.
Even dogs and cats can carry serious diseases such as toxoplasmosis
and leptospirosis. And their normal germs, such as mouth bacteria,
can cause serious infections in children if bitten or scratched.
Prompt attention to childrens animal bites is important, and it is
also good to teach children to wash hands after handling a pet. Most
dog and cat worms are not transmitted to humans, but some types
could be transmitted through their feces, for example, round worms.
Dogs and cats can be treated for fleas and ticks to virtually eliminate
the chance of diseases carried by those pests (Lyme disease, plague,
Rocky Mountain Spotted Fever, and many others).
Asthma in Children
Asthma is a chronic disease in children (and adults) which causes
blockage of the smaller bronchial tubes ("small airways") which
branch out from the bronchial tree ("large airways"). The blockage
is caused by inflammation which then causes constriction of tiny
muscles which squeeze down on the bronchial tubes. The inflamed,
or irritated, inner lining of the bronchial tubes also produces mucus
which can also block the air flow. This makes it difficult to push air
out of your lungs, because the smaller airways collapse as you
breathe out. You might also hear wheezing, or whistling, noises on
breathing out. Sometimes there are wheezing noises as you breathe
in, due to mucus in the small or large airways.
By controlling inflammation during childhood, you can
greatly reduce asthma during adulthood!
Asthma has been called many names, including Small Airway
Disease, Reactive Airway Disease, Asthmatic Bronchitis, or just
Bronchitis. The last two terms are misleading, since asthma does not
involve the bronchi (large airways) at all! Some children "outgrow"
their asthma, but many keep it through adulthood. By controlling
inflammation (that means taking medicine every day!), children with
chronic asthma can greatly reduce their asthma symptoms as adults!
What is an Asthma Attack?
Children with asthma can get an "attack", or sudden onset of airway
obstruction, from many causes, including exposure to an allergen
(breathing pollens or eating peanuts, for example) or exercise
(exercise-induced asthma) or exposure to chemical irritants
(cigarette smoke, perfume, hair spray or cleaning solutions).
Sometimes an attack can be due to a subtle cause, such as a change
of weather, or a stressful encounter.
How Is Asthma Treated?
There are two basic approaches to the treatment of asthma: (1)
treat the muscle constriction with "broncho-dilator" medicines, and
(2) treat the inflammation with anti-inflammatory medicines.
Broncho-dilators are important in giving quick relief during an
attack, and may be the only medicine needed for mild asthma that
only occurs every few months or less. The anti-inflammatory
medicines are important in treating chronic asthma with more
frequent symptoms.
If your child has symptoms of asthma every month, your doctor will
prescribe a daily routine of anti-inflammatory medications. Examples
would include inhaled steroids, sodium cromolyn, or leukotiene
inhibitors. Oral steroids might be used for severe attacks, or more
severe chronic asthma. Daily broncho-dilators, such as albuterol,
might also be used in more severe cases.
Broncho-dilator medications are considered to be a "rescue
therapy", since they are used mostly for treatment of acute attacks.
They are also useful in pre-treating children with exercise-induced
asthma, when used 15 minutes prior to exercise.
Make sure the medicine is getting into the lungs, not
just sticking to the roof of your mouth!
Broncho-dilators, such as albuterol or lev-albuterol, can be given
orally, by inhaler, or by nebulizer. When using an inhaler, children
(and adults) must make sure that the medication is getting into the
small airways, and not just sticking to the roof of the mouth. There
are two ways to do this: (1) by using a spacer or large tube between
the inhaler and your mouth, or (2) by using a very small particle size
medication such as Maxair Autohaler.
A nebulizer puts the medicine into a fine mist so that a child can
breathe the mist into the lungs. Be careful to wash the medication
cup each time you use it, so that contaminants (such as dust or
animal dander) are not being put into your childs lungs.
Clean the nebulizer medication cup well! It might
contain dust or animal dander!
When using inhaled steroids, it is a good idea to rinse your mouth
afterwards, to avoid side effects such as candidiasis (fungus
infection in the mouth). Mouth wash with alcohol base, such as
Scope®, works the best, since the medicine is not water-soluble.
Monitoring Peak Flow Can Save Your Life
Children (and adults) with chronic asthma should monitor their
asthma by checking the airflow in their small airways. This is done
using an inexpensive "peak flow meter" you can use at home every
day. When the peak flow (of air from your lungs) gets below 75% of
usual, you will use a rescue therapy (the broncho-dilator) right away
before the attack becomes severe. This can save lives, and is a good
way to know how severe the inflammation is, and if more antiinflammatory
medication is needed.
Find Out the Latest Info on Asthma
Dr Stan Ting of the University of Texas has invented a color-coded
treatment guideline for the most effective treatments for asthma.
Check his website, Simplified Asthma Guidelines, to download these
guidelines in simple one-page forms. Over 1 million copies have
been sent to doctors around the world!
Bacterial Resistance
With the vast over-use of antibiotics in the last few decades in this
country, many bacteria are evolving to become resistant to most of
the known antibiotics. In a few years we may be heading for a new
era in medicine, the so-called Post-Antibiotic Era. It is predicted that
bacteria will become resistant to all antibiotics in the next few
decades, or sooner if the current trend of over-use continues. This
means that common infections like strep throat or pneumonia will
very commonly result in death, just as they did in the Pre-Antibiotic
Era.
Amazingly, a recent survey (2006) showed that 58% of adults are
totally unaware that over-using antibiotics poses a danger to
themselves and to their community.
Here are some scary recent developments:
1. Bacteria have learned to "use the net". Not on computers, but by
passing their DNA back and forth even different species of bacteria
can get the DNA code for antibiotic resistance, just as easily as we
get information off the net.
For example, normal bacteria in your intestines get exposed to all
the antibiotics that you have taken this year. The ones that evolved
to become resistant survive, while the others are killed off by the
antibiotics. Then you get a few pneumococci in your lungs for a mild
case of pneumonia. Ordinarily a short course of penicillin would cure
you. But your intestinal bacteria have shared DNA with these
pneumococci so they are resistant to most of the known antibiotics!
Now you are in trouble. If you are lucky enough to get a good
culture and sensitivity test, you might find a drug that will work, but
that may mean a long stay in the hospital and weeks of IV therapy
with more dangerous drugs.
Your own common germs can become resistant to antibiotics, then
pass that resistance to dangerous germs that you might catch in
the future.
2. Bacteria learn to get resistant quicker to related drugs. Once
resistant to one drug, it is easier for a certain group of bacteria to
get resistant to others. For example, many bacteria that are
resistant to penicillin are very quick to become resistant to the
cephalosporins (synthetetic penicillins) which used to be the main
"back-up" when bugs got resistant to penicillin.
3. Doctors are accelerating this process by prescribing antibiotics
when they are not necessary. Conditions like colds, flu, viral sore
throats, bronchitis and viral pneumonia are all caused by virus
infections. Antibiotics have no effect whatsoever against viruses.
Not even a very slight effect. They don’t help you get better a day
sooner, or an hour sooner or even one second sooner! They have
zero effect. Antibiotics should never be used for these conditions.
Every time you use an antibiotic for these conditions you are
accomplishing only one thing: you are making the bacteria in your
environment more resistant to antibiotics. Sadly, the vast majority
of prescriptions for antibiotics fall into this category.
4. Even though we know that using less antibiotics will reverse the
resistance problem, doctors refuse to stop over-prescribing. Recent
studies have shown that there are several factors influencing
doctors to over-prescribe. These include fear of being rejected by
their patients if they don’t order enough medicine, fear of being sued
(because they think it will make their patients angry if they don’t
prescribe enough), ignorance of the problem of bacterial resistance,
complacency (feeling that new antibiotics will save the day),
ignorance about the fact that very few new antibiotics are being
developed, fear that managed care systems will not pay them
enough if they don’t over-prescribe.
5. The recent trend toward "managed care" forces doctors to overprescibe
antibiotics. Doctors are forced to practice not high quality
medicine, but instead "high efficiency" medicine. This means
handing out prescriptions for antibiotics (two minutes) is much more
efficient than explaining to a patient why an antibiotic should not be
used (ten to twenty minutes). Managed care also rewards doctors
who get high approval ratings from their patients. Doctors feel that
if they explain the danger of antibiotic over-use to their patients, it
may make sense to some, but others will be dissatisfied, and that
minority of patients might ruin their approval ratings.
Even if you never take antibiotics, you could catch a resistant germ
from your neighbor who abused antibiotics!
6. The really bad thing about bacterial resistance, is you can’t stop it
by practicing good habits in your own family. You might never take
antibiotics, ever, then get a bad infection that needs treating with an
antibiotic. Guess what? It’s resistant to all known antibiotics! Why?
Because you caught it from your neighbor who took antibiotics every
time he got a cold or bronchitis. This is definitely a "community"
problem. To some extent, you will be much better off than your
neighbor who over-used antibiotics. He will get more infections and
more resistant ones, but you are still at risk of getting what he has.
Day care centers have more resistant bacteria!
7. Day care centers are breeding some of the worst resistant bugs,
such as MRSA. This is Multiply Resistant Staph Aureus. Formerly only
found in hospitals with high antibiotic use, it is now commonly found
in day care centers where so many kids are inappropriately treated
with antibiotics for their many viral colds. This germ is very deadly if
it gets into your lungs or bloodstream.
8. Government rules force doctors to over-prescribe antibiotics. In
the last 10 years, CLIA (Clinical Laboratory "Inhibitory" Act) has
severely limited the use of lab testing in doctors’ offices. Many
doctors have stopped doing labs altogether, so they are unable do
simple tests such as a throat culture. Instead, they just treat every
sore throat with antibiotics, just in case it might be strep throat.
Since only 10% of sore throats are due to strep, this means 90% of
sore throats are being treated unnecessarily, greatly adding to our
risk from resistant bacteria!
9. About half of the antibiotics used in the US are given to animals.
This has important implications, since many human infections are
caught from animals. We have heard a lot about Salmonella
infections from poorly cooked poultry. In the past these infections
could be treated with common antibiotics. Now, with the high use of
antibiotics given almost indiscriminately to poultry and other
animals, a high proportion of Salmonella is resistant to most
antibiotics. In 1996, 34% of Salmonella were resistant to
everything!
10. A recent report in the journal Clinical Infectious Diseases points
out that antibiotics are not benign medications! Adverse reactions to
antibiotics account for 25% of all ER visits for drug reactions, or
about 142,000 reactions per year in the United States. A severe
reaction such as anaphylaxis (a type of allergic reaction) can result
in death.
What can be done to reverse this alarming trend?
Parents and patients can have a positive effect by questioning any
use of antibiotics recommended by their doctors. Does the doctor
have reasonable proof that a bacterial infection is the cause of your
illness? Are there any other treatment options?
We also need to pass the word around to other parents (and all your
friends). Most parents have a slight idea that some bacteria are
becoming resistant to antibiotics, but almost none of them
understand how serious the problem is. In order to make any impact
on doctors’ prescribing practices, a very large percentage of patients
are going to have to start demanding better care from their own
doctors.
Good News: You Can Make a Difference! In Finland and Iceland, two
different studies have shown that drastically reducing the
unnecessary use of antibiotics led to a major reduction in the
percentage of resistant bacteria. At first this didn’t make sense to
me. Once a bacteria is resistant (a super-bug), why would it go back
to being normal again? The answer is that when no antibiotics are in
the germs’ environment, a super-bug has no advantage in survival
over all the normal germs. The normal ones are allowed to thrive
and have lots of germ-babies who are also "normal". The super-bugs
just get lost in the crowd, and their numbers drop off.
One last word of warning! If we wait too long to reverse the trend,
the super-bugs will be the majority, and THEY will be the "normal"
germs, and we will not be able to turn the tables as they have in
Iceland and Finland. Time is running out!
Behavioral Screen for Children
Childs Name: NEVER SOMETIMES OFTEN
Uncooperative, difficult to
manage
Lying or cheating
Sad, cries for no apparent
reason
Talks of suicide
Hyperactive, constantly
moving
Short attention span
Complains of aches and pains
Cruel to animals
Refuses to share
Shows anger with violent
actions, temper tantrums
Grades dropping in school
Slow to learn new things
Has trouble with a teacher
Experiments with alcohol or
drugs, including inhalants
(markers, gasoline, lighter
fluid)
Smokes cigarettes
Takes unnecessary risks
(playing with guns, sexually
active, etc)
Spends too much time alone
Difficulty making friends
Tires easily, very little energy
Worries, seems nervous
Preoccupied with fears or
phobias
Obsessive neatness or
routines
Fights with other children
Does not show feelings
Has trouble sleeping
Acts too young for age
Gets teased or bullied at
school
Threatens or bullies other
people
Is afraid of new situations
Gets sick a lot
Compiled by Rick Voakes, MD and William Pfohl, Psy D
Directions: Print this page on your printer, fill one out for each child,
and bring to your pediatrician. Your doctor can help with some of
these problems, and will tell you if further evaluation by a specialist
is needed.
Evolving Preventive Practices in Dental Health
It used to be "brush brush brush" for good dental health, but now
we are hearing that brushing actually damages your teeth! What are
we to do?
For young children, brushing is still the best prevention, so I still
recommend using a small soft toothbrush with a small dab of
toothpaste, twice a day starting at age 12 months. When children
are able to use dental floss, usually before age 8, they should begin
the adult routine: "Never use a toothbrush to clean your teeth!"
Brushing can damage your teeth!
Scrubbing with a brush damages the enamel of your teeth, and can
push down the gums causing them to recede. Instead, use dental
floss to clean your teeth, then use a soft toothbrush to gently brush
away what you pulled out with the floss. A little toothpaste is OK and
can provide some extra fluoride. Flossing efficiently takes some
training and practice, so get some lessons from your dentist at your
next check-up. You should see your dentist every 6-12 months.
Flossing will cause your gums to bleed at first. This means your
gums are not in good health, but continued flossing will make them
stronger. When you get more skilled at flossing, and your gums
improve, you will no longer have any bleeding. If there is a gap
between two teeth, be sure to floss each side of the gap. Keep in
mind that you are cleaning off every surface of every tooth. Develop
a routine that gets all your teeth completely clean, and stick to this
strategy every time until it becomes automatic. Then you will never
skip any teeth. I start on the uppers in the middle and go all the way
to the back on the right then left, then repeat this on the lowers.
Flossing might make your gums bleed at first, but this is good
because it makes them stronger!
Getting daily fluoride is another very important preventive measure.
All municipal water supplies in Kentucky (and most other states)
contain fluoride. Bottled water and spring water do not have
fluoride. Ready-to-feed formula does not contain fluoride, so use
either powder or concentrate mixed with fluoridated tap water.
Does eating sweets make your teeth rot? In a word, YES! Sugar is
food for bacteria on your teeth that cause tooth decay. The longer
you keep sugar in your mouth, the more decay you get.
Unfortunately, the sugar stays on your teeth for many hours after
you eat it, especially if it is sticky or gummy candy. Foods with sugar
and high acid content, such as honey or coke, are the most
damaging to your teeth. Gently brushing after sweets would be a
good strategy, and try to avoid eating between meals. Another
danger is sugar drinks, like pop, gatorade or fruit juice, especially
between meals.
Flossing makes you live longer!
In children under 8 years old, brushing twice a day is effective
prevention. After 12 months, a bottle should never be used. Bottles
are very damaging to teeth because the nipple holds harmful
bacteria and milk sugar or juice sugar against the surface of the
teeth and causes cavities. Switch to a sippy cup, but only for
mealtimes! Between meals, a child needs normal saliva in the mouth
which kills harmful bacteria that cause cavities. Constantly drinking
from a sippy cup between meals washes away saliva and replaces it
with sugar! The same applies to drinking and eating snacks during
the night, which removes your protective saliva.
Limit the use of sippy cups!
Dental health is an important part of your over-all health, so much
so that flossing increases your life span by at least 2 years. Plus you
will be able to enjoy eating with your own teeth (without pain) for
your entire life.
The Need for Calcium
Your body needs calcium every day in order for your muscles to
work properly, and to maintain the calcium in your bones (thats
what makes them strong and healthy).
But how much is enough calcium? The "conventional wisdom" is that
every person needs 800-1500 mg of calcium per day. While it is
important to get at least 400 mg every day, getting 2 or 3 times that
amount has not been shown to be better for your health in any way.
The World Health Organization recommends eating foods that
contain about 400 mg of calcium per day. There are many scientific
studies to support this recommendation.
Where should we get our dietary calcium from? The Dairy Council
ads seem to indicate that milk and dairy products are the best
source of calcium. However, dairy products also contain animal
protein and sodium that make your body actually lose calcium in the
urine. Studies show that increasing the intake of dairy products has
no effect on bone health. The best source of calcium is green leafy
vegetables (like spinach or turnip greens). You can also get calcium
from fortified orange juice, tofu (or other soy products), sweet
potatoes, broccoli, oats and beans, and several other foods (mostly
veggies).
A recent review article (Pediatrics, March 2005, Lanou et al)
compiled data from 58 scientific studies, and concluded that there is
little if any evidence to support increased dairy intake to promote
bone health and strength. There were a few studies that showed a
temporary increase in bone mineral density with increased dairy
intake, but after a few years, the effect disappeared.
Is it OK to drink milk? Dairy products are a good source of protein
and energy, and are healthy foods when eaten in moderation. Dairy
foods also supply a certain amount of calcium. Drinking skim milk is
much healthier for you than drinking too much juice or other sugarloaded
drinks. You just have to make sure that you are also eating
foods that will provide enough calcium to help your bones stay
strong, such as green leafy veggies!
Cure for the Common Cold?
Every few months another fad cure comes out for the common cold.
Unfortunately, none so far has held up to critical scientific testing.
The latest fad, the zinc lozenge, was shown by a study in JAMA
(Journal of the American Medical Association) to be completely
ineffective in relieving any of 9 symptoms of the common cold in
children. Even drugs claiming only "temporary relief of symptoms"
such as antihistamines and decongestants have not been shown to
work in children under 6 years of age.
Getting virus infections (like colds) is what keeps our immune
systems in top working condition!
Why is it so difficult to get a cure for an illness that affects all of us
so often? Maybe we should look at it a different way. Throughout our
millions of years of evolution, the features of our lives and health
that have stuck with us, have done so because they give us the
advantage of survival. Perhaps susceptibility to colds is one of these
survival advantages.
There are thousands of viruses in our environment, that our immune
systems must constantly deal with. Maybe it is an advantage for us
to have harmless cold viruses around to "practice on" every few
months to keep the immune system in tip-top shape. Imagine an
army that never ran drills or any kind of exercises, then suddenly
had to go out and fight a war. Would they be successful?
Care for Colds in Children
How can we help relieve cold symptoms in our children? Often
children get miserable with colds, and we can help them in a few
ways. A pain reliever like Tylenol® or Advil® can help, but use these
drugs carefully according to directions. Every year children die from
overdoses of these drugs.
Water vapor from a humidifier or vaporizer can be soothing to air
passages. Cool mist is safer because the child cannot be burned if
she touches it. However, the cool mist does not sterilize itself like a
vaporizer, so you must clean it often to prevent mold and bacteria
from growing in it.
Cold and cough medicines have very little advantage over placebo,
and have side effects like dry mouth and drowsiness. If you avoid
these medicines, you will be more alert to concentrate on other
projects to keep your mind off your cold symptoms. That is the best
relief I have found.
The old time remedy of honey (1 tsp for under 6, and 2 tsp every 4-6
hours for over 6 years of age) has been shown to be more effective
for cold and cough symptoms than over-the-counter medication.
Honey is fairly safe, EXCEPT under 1 year of age, as babies can get
botulism from eating honey. Do not give honey to a child under 12
months of age.
Fever is common with a cold, and is one of the body’s defenses
against viruses. If a fever continues for several days, it may be a
sign of complications of the cold, such as pneumonia or ear
infection. After 3 days of fever, you should take your child to the
doctor. You should go sooner if there are other worrisome signs like
wheezing or rapid breathing. If a child seems very ill the first day of
a cold, with high fevers, and it is during "flu season" (December to
March), you should call the doctor right away to get a flu test. If you
identify flu in the first few days, there is still time to take an antiviral
medication. If you wait over 2 days, it will be too late to use flu
medication. See the Health-byte on Flu.
So-called "fever reducers" are not intended to reduce fever.
The fever itself is not dangerous. It is just a sign to watch for. If
your child feels fine and has a high fever, there is no need to give
medicine. The "fever reducer" (such as Tylenol® etc) is just for
comfort. It is also important to give lots of fluids to children with
fevers to avoid dehydration. To learn more about treating fever, read
the Health-byte called "Fever is Good for You".
Children often get chest congestion and cough with a cold. This is
just the virus affecting the bronchial tubes in your chest. The cells in
the bronchial tubes produce mucus to kill the viruses, and you have
to cough the mucus out. Kids usually just swallow it, which is fine
because the stomach acid digests it along with the viruses. We can
help kids (and adults) to cough up the mucus by doing "percussion
treatments" on the chest and back. Also called chest physiotherapy,
this consists of patting the rib cage with your cupped hand, all over
the lung areas. A few minutes every hour is usually enough time. If
the chest muscles feel sore, you might need to be more gentle with
your percussion treatments.
Antibiotics should be avoided if you have a cold!
It is important to avoid taking antibiotics when you have a cold.
Antibiotics have absolutely zero effect on the cold viruses, but taking
them would make your bodys own bacteria resistant to antibiotics.
Later on, you might catch a dangerous bacterial infection, like
pneumonia, and the dangerous germs would learn to be resistant
from your own germs. In that case, antibiotics would not work, and
you would be at greater risk of dying from a possibly treatable
disease.
What about over-the-counter (OTC) cold and cough medicines? In
October 2007, the FDA advisory panels for pediatrics and
nonprescription drugs voted not to recommend OTC cold medicine
for any children under 6. They based their recommendation on
several reports of serious side effects of these drugs in children, and
the fact that there are no scientific studies showing that these
medicines actually work in children. Only one study has shown that
anything works for relief of cough and cold symptoms in children,
and that showed that honey is effective while dextromethorphan is
not effective in reducing cough. (Arch Ped and Adol Med, 2007)
Is there anything we can do to prevent complications of viral colds,
such as ear infections and pneumonia? There are not any
medications known to prevent complications, but we do know that
children exposed to tobacco smoke have a much higher risk of
complications. Completely eliminating any cigarette smoke from ALL
ROOMS of your house is the best way to prevent complic
Diarrhea in Children
Diarrhea is defined as loose or watery stools, in increased amounts,
and usually more frequent than usual (but not always). Increased
fluid in the intestines may be due to two reasons: (1) The intestines
are "sick" and can’t work normally to absorb the fluids that you
drink, and (2) some types of diarrhea can cause so much irritation
inside the intestines that they actually "secrete" more fluid than you
drink, robbing your body of vital fluids.
Fortunately, the second type ("secretory" diarrhea) is less common,
the classic cause being a bacteria called Cholera, mostly found in
India and Africa. However, other bacteria and some viruses can
cause secretory diarrhea to a lesser extent. This is why the main
goal of treatment is to keep fluids going in almost continually.
Avoid Antibiotics!
In the U.S., the major cause of diarrhea is virus infections, such as
rotavirus and other enteric viruses. As with other virus infections, it
is useless and even dangerous to use antibiotics to try to treat this
illness. Antibiotics kill the useful bacteria that normally live in the
intestines to help digest your food. Just killing your normal bacteria
can cause diarrhea, which is why diarrhea is a common side effect of
taking antibiotics.
Replacing the normal bacteria in the intestine can be done using
"probiotic therapy". Medications such as Lactinex and Floranex are
available in most drug stores over-the-counter. These are safe and
effective in reducing the duration of diarrhea symptoms for any type
of diarrhea, even if it was not caused by using antibiotics.
Other treatments often used for diarrhea in adults are Kaopectate
and Peptobismol. These are not safe to use in children because both
contain salicylate (aspirin) which can be very dangerous in children.
Diarrhea is the result of damage to the intestines.
In diarrhea, a virus infection in the intestines causes damage to the
inside lining (called the mucosa). It takes time for this damage to
heal so that the intestines can function normally again, and absorb
the fluids and foods that you drink and eat. The actual virus infection
goes away in a few days, but then we are left with the problem of
healing the damage left behind.
Treatment of Diarrhea
The major goal in treatment of diarrhea is to rest the intestines so
that they can heal, and to provide fluids and electolytes (the
chemicals normally found in the body) to prevent dehydration. Using
electrolyte solution (like Pedialyte) is a good way to do this. In older
children other clear liquids are generally adequate. Once the
diarrhea starts to improve, it is important to begin adding some mild
foods to provide nutrition for healing. In infants, this might mean
using a diarrhea formula (like Isomil-DF) or a pre-digested formula
(like Nutramigen or Alimentum).
Sometimes you get a set-back, and diarrhea gets worse after
starting foods. Just drop back to using clear liquids for 12-24 hours,
and start advancing again when the diarrhea starts to improve. This
can sometimes be tricky, and might take weeks before back to
normal. One study showed that biopsy of the mucosa does not get
back to normal until 1 month after a virus intestinal infection.
Signs of dehydration include dry mouth, no tears, weakness,
decreased urine output, and weight loss. If diarrhea continues more
than a few days, or if you think your child is dehydrated, you need to
call your doctor. Often a child will feel too weak or ill to drink much,
and you have to try to get at least an ounce or more of fluids in
every hour. If a baby refuses to drink from a bottle you might have
to give 5 or 6 tsp (about an ounce) of Pedialyte® on a spoon. This is
not too hard to do for a few hours, then the baby will start to feel
better and start drinking on her own.
Breastfed babies get less diarrhea, but it still can happen. Continue
breastfeeding, and add some Pedialyte in between feedings if the
baby will take it. Breastmilk has antibodies to help fight the
infection.
Probiotic therapy reduces diarrhea by 1-2 days!
If diarrhea does not improve in a few days, it is well worth getting
some probiotic therapy. Take some Lactinex or Floranex or Biotic
Buddies twice a day for 3 days. It can be mixed in any food or liquid.
Probiotic therapy replaces your normal bacteria in the intestines, to
force out abnormal bacteria and yeast, and help you digest your
food. Recently there is evidence that probiotics may help the
immune system by stimulating production of more IgA antibodies.
Bacterial intestinal infections (as opposed to virus) can cause
diarrhea which lasts much longer. Some of these might need to be
treated with antibiotics. Doctors usually will check a stool culture if
the diarrhea lasts over a week, or sooner if associated with bloody
or mucousy diarrhea and high fevers. A stool culture usually takes
about 2 days.
A vaccine against rotavirus has been developed, but it is currently
not available in the US. It was removed from the market after
several babies developed a rare bowel condition (called
intussusception) after taking the oral vaccine. If this problem can be
solved, the vaccine may again become available.
Summer Diarrhea
There are several viruses and a few bacteria that can contaminate
swimming pools, and are a common cause of summer diarrhea.
Viruses from a childs rectum enter the water, and spread to other
children. A child can give off viruses up to 2 weeks after having
diarrhea, so the CDC recommends not swimming in public pools for 2
weeks after having a diarrhea illness. Other people may not be as
considerate as you are, so be sure to shower well after swimming.
Never swallow pool water! When taking small children to the pool,
wash their bottoms well before you go, never change diapers at
poolside, use a bathroom instead.
Ear Infections in Children
Otitis media, an infection in the "middle ear", is one of the most
common infections in children. The middle ear is the space behind
the eardrum normally filled with air which allows the eardrum to
vibrate and transmit sounds to your brain via the cochlea. Air
normally gets into the middle ear through the eustachian tube,
which connects to the throat. When you feel your ears "pop" it is
from air moving through the eustachian tube either into or out of
your middle ear.
Otitis media is most commonly caused by pneumococcus germs that
normally live in the nose and throat. If the middle ear stays dry,
germs cannot live there. Sometimes fluid builds up allowing germs
to grow in the middle ear, causing otitis media. This often happens
after a virus cold, but may also result from allergies, or irritants (like
cigarette smoke) which cause swelling and blockage of the
eustachian tube. In fact, children exposed to cigarette smoke have 4
times as many ear infections as non-exposed children.
Another risk factor for ear infections is being in day care. This
exposes children to far more virus infections that could cause the
eustachian tubes to become blocked. Being in day care also allows
children to pass around several other types of bacteria that can
cause ear infections, as well as passing bacteria that have become
resistant to most antibiotics.
Antibiotic resistance is making the treatment of ear infections more
difficult. Fortunately, 80% of ear infections will clear up without
using antibiotics. New guidelines from the CDC (Centers for Disease
Control) warn doctors not to treat otitis media with the expensive
newer broad-spectrum antibiotics, but to use amoxicillin as the first
line drug. Many reasons are given for this choice, including the
effectiveness, safety and low cost of amoxicillin, as well as the
important effect of reducing antibiotic resistance.
Amoxicillin is the first-line drug for ear infections.
When should otitis media be treated with antibiotics? If the child is
not acutely ill, it is safe to treat with numbing ear drops to stop the
pain, and either observe for a few days (since 80% will go away
without using drugs) or else use a 10-day course of amoxicillin. In
older children, a shorter course (5 days) may be effective, but more
studies are needed to prove this. If the child was treated with
amoxicillin within the last month, a second choice drug should be
used.
Most cases of otitis media are actually not true infections but merely
fluid build-up inside the middle ear. These are known as Otitis Media
with Effusion (OME). The CDC is also warning doctors NOT to treat
OME with antibiotics, which of course will not help the problem at
all, but will contribute to bacterial resistance, and may harm the
patient if side effects occur. OME usually just requires time to clear
up, but can also be helped by popping your ears, to allow air to enter
the middle ear space. Doctors sometimes try using decongestant
medicines, which may help to relieve cold or allergy symptoms, but
otherwise have not been shown to be very effective in treating OME.
When do we recommend putting in EAR TUBES? If a child has more
than 5-6 separate ear infections in a year, we do recommend putting
a tiny plastic or steel tube into the eardrum. This allows air to enter
the middle ear space and keeps it dry. Ear tubes last about one to
four years, and fall out by themselves, usually without your knowing
it. It requires surgery (outpatient) and anesthesia, so putting in
tubes is the last resort for recurrent ear infections. Ear tubes may
also be considered if OME is lasting for over 6 months, and is
interfering with a child’s ability to hear.
Current strategies for preventing ear infections include: avoiding day
care centers (if possible), keeping the home smoke-free, providing
good nutrition, teaching your child good hand-washing practices,
and keeping immunizations up-to-date, including the new
pneumococcal vaccine.
Adults smoking in the home is a major risk factor for children
getting ear infections.
Exclusive breastfeeding during the first 6 months also reduces the
chances of getting ear infections. Antibodies in the breastmilk have a
protective effect. Also bottle-fed babies tend to have more chance of
getting milk into the eustachian tubes.
A study just published showed a 10% increase in ear infections in
babies who use pacifiers. Im not sure if this is due to altered
pressure in the eustachian tubes, or may have something to do with
bacteria on the pacifier (especially in the daycare setting where
resistant pneumococcus is found).
A previously used strategy for preventing ear infections used to be
putting kids on preventive antibiotics. This treatment is no longer
used, because of the serious risk of antibiotic resistance.
Fever is GOOD for you? ...YES!
Fever is a defense that the body uses to kill viruses and other germs.
We know that germs growing in cultures die if you turn up the
temperature too much. The same is happening in your body when
your brain turns up the temperature when you get sick. We also
know that the white blood cells and other protective mechanisms in
the body work more efficiently at higher temperatures. Getting a
fever is an important part of your bodys defense against infection.
So why do we try to stop fevers by using "fever reducers"?? The
concept of a medicine with the purpose of reducing fever is against
current medical knowledge (for the past 30 years!). Yet it has been
massively hyped up by the drug industry to sell more products. From
a medical standpoint, the ONLY reason to treat a fever with
medication is for comfort, not to reduce the temperature.
Fever is an important way your body fights infections.
All the exaggerated TV ads about reducing fever have led to a new
"disease" among parents, and among some medical personnel as
well, called fever phobia. This is the irrational fear of fever. Fever
phobia is made worse by hearing myths about children dying or
being brain damaged by having a high fever. This does not happen.
Many people know of children or adults that had a high fever and
ended up with some sort of injury, like brain damage, hearing loss or
other problems. These problems are never caused by fever. The
likely explanation is that they had a serious illness that gave them a
fever but it was the illness that caused the brain damage etc. The
fever was only trying to help fight the infection.
It is important to increase fluid intake when you have a fever, since
it increases evaporation of water from your body and you could get
dehydrated. In general it is a good idea to increase your fluid intake
whenever you get sick.
One result of fever phobia is a frantic desire to lower a childs
temperature! Parents have been known to alternate ibuprofen (Advil
or Motrin) with acetominophen (Tylenol) trying to get a better "fever
reducing" effect. This has resulted in overdoses that have caused
severe damage and even death to a few of these children. That is
why there is a national campaign now to stop parents from this
outdated practice. If you wish to give a medication to help your child
feel better when she has a fever, pick one medication, and follow the
directions carefully to avoid any overdosing. These medications do
have potentially serious and even fatal side effects.
The American Academy of Pediatrics recommends
NOT to alternate Tylenol with Advil! and repeated in the US last
year showing that there was a slightly lower temperature after
alternating Tylenol and Advil. Many pediatricians mistakenly
took this as an endorsement of this practice. However, when
asked if they felt this was a good medical practice, the authors
responded that they were merely bowing to parental and school
pressure to get around having to deal with "fever phobia".
This is a potentially dangerous practice that increases the
likelihood of an overdose.
Does fever cause convulsions? Some children (about 5-10% of all
children) have a tendency to get a short convulsion when their
temperature rises. It might be a sudden rise from 99 to 101, or it
might be with a higher fever. These convulsions are not dangerous,
never cause brain damage, and usually last less than 10 minutes.
Only about 50% of these children will ever have another convulsion.
All children outgrow these "febrile seizures" by the age of 6, most by
the age of 4. If your child has a febrile seizure, the doctor would still
want to check him, to make sure that is what it is, and not a serious
infection like meningitis.
Fever can be a sign that infection is present.
Fever is very useful as a SIGN of infection. If a child has a fever
lasting more than a few days, it tells us that the infection is not
going away, and the child should be seen by a doctor. Many people
ask me how high should a fever be to indicate a serious infection? It
is really more important to know the general condition of the child at
the time of the fever. A very ill appearing child with a fever of 101
would be much more concerning than a child who feels fine, is
drinking and playing but has a fever of 106. But if you are not sure
what is causing the fever, and your your child looks ill, you should
call your doctor.
Thus, fever itself IS good for you. It helps your body fight infection,
AND it can be an important sign that an infection is present, so it lets
you know when to alert your doctor if the cause is not known.
What You Eat Is Critically Important to Your Health
This is a very new concept!
In the past we have felt that your diet was semi-important to
health because you might eat too many calories and get fat, or not
get enough vitamins, but it wasnt a big deal. We had also found
that some foods contain dangerous bacteria or toxins, such as
salmonella or botulism. These are very rare cases, and often result
in the destruction of huge quantities of perfectly good food, but
usually only a few individuals were affected.
Many Common Foods Contain Simple but Dangerous Toxins
Just in the past few years, nutritional scientists have discovered
that two commonly eaten substances can be extremely toxic and can
ruin your health and eventually kill you. Specifically, these are
fructose and transfats.
The old way of looking at food was to count total calories, try to
get enough fiber and vitamins, and eat enough junk food to fill up
the rest of your caloric needs. Junk food is pretty easy for most
people to identify, and it usually is characterized by a high sugar
content. Now we know that junk food (high in transfat or sugar) is
actually toxic to the body.
Why do people consume so much sugar and fat? Partly because
fructose is addicting (see Health-Byte on fructose) and partly
because fructose is added to thousands of processed foods and we
dont even realize its there. (Who would guess that catsup is made
from high fructose corn syrup?) Another factor is that the fructose
industry is very sophisticated at selling its product. Advertising for
"sports drinks" is so intense that we have all grown up convinced
that Gatorade actually promotes health rather than destroying your
health (see the movie "Idiocracy"!).
Should we totally avoid eating any sugar or fat? Lets look at fat
first. Fat is food that is calorie-dense (9 calories per gram, compared
to 4 calories per gram for carbs) but it is not toxic. It is digested and
enters the metabolic pathways in your body in a controlled way.
Some types of fat (saturated fats and transfat) have been associated
with higher rates of heart disease in large population studies, but
this may be a secondary effect from the fructose that often
accompanies a high fat diet.
Now lets look at fructose. Regular table sugar, honey, brown
sugar, and high fructose corn syrup are the major sources of the
toxin fructose. Fructose is not regulated by our bodys metabolic
hormones, and generally degrades into free fatty acids and
triglycerides in the liver, which then fill up the bloodstream with
these dangerous forms of lipids. The body can tolerate small
amounts of fructose, such as the amount in fresh fruit, but the total
fructose intake can skyrocket when everything you eat has fructose
added. Plus you get an occasional giant blast of fructose from
drinking a soda, sports drink or fruit juice. Even a small glass of
orange juice has 6 times the amount of fructose as a whole orange,
but none of the beneficial fiber.
If your diet includes fructose on a regular basis, you are
putting yourself at high risk for diabetes, cardiovascular disease
such as stroke and heart attack, as well as liver disease and many
other diseases, as well as obesity.
Many foods are beneficial to your health, such as foods high in
vitamins, fiber and anti-oxidants. Just eating a diet with lots of
variety of fruits and vegetables will provide all these benefits. You
should also try to eat some foods that have healthy oils, such as
olive oil and fish. Other than that, you dont have to load up on blue
berries or drink excess omega this or that.
Bottom line: Fructose (found in all types of sugar and high
fructose corn syrup) is toxic to your body and can ruin your health.
Irregardless of your weight, you should avoid eating or drinking
fructose whenever possible. The easiest way to cut down on sugar is
to eliminate sugar from 100% of all beverages that you drink. This
includes drinks that may seem healthy such as fruit juice or sports
drinks. (These drinks are actually dangerous to your health because
of the high fructose content.)
Fructose is Poisoning our Children and Starving their Brains!
Major Breakthrough in Obesity Research
There has been a giant breakthrough in the understanding of obesity
since 2006! There is much more chemistry involved than we
originally thought. We have discovered that fructose, in the form of
high fructose corn syrup, table sugar, and fruit juice, has been been
poisoning our bodies by interfering with leptin, insulin and other
hormones. These food hormones control the amount of food that is
stored as fat, so when they are poisoned, the body stores energy in
fat cells, and very little is left over to use for activity. The brain is
deprived of energy too, so it produces other hormones that make
you hungry and you want to eat more high-energy foods.
Thus, your fat cells are stuffed, but your brain is starving, so it cant
function as well, plus it wants you to eat more!
In the past we already suspected that eating too much sugar was
bad, but we thought it was just the extra calories. Now it is known
that the fructose in sugar is poisoning our hormones. This effect
results in increased insulin, which makes the energy from the food
you eat go straight into fat cells, and even if you try to exercise to
lose weight, you dont have the energy available to do the exercise.
Fructose is processed by your liver, converting it to free fatty acids
and triglycerides (the "bad cholesterol"), putting you at risk for
heart disease, stroke, cancer, liver disease, diabetes and other
health risks, even if you eat a low fat diet.
Fructose Poisons the Fat and Energy Control Mechanisms
Fructose is quickly absorbed by the intestines and enters the liver
where it is converted to triglycerides and free fatty acids and other
fats. These are then released into the bloodstream. Free fatty acids
are known to make muscle cells insulin-resistant. Insulin resistance
means the cells do not respond to insulin, so the body keeps trying
to make more insulin to overcome the resistance. Excess insulin then
builds up throughout the body. (Sorry this is so complicated!)
Excess insulin blocks the effect of the hormone leptin on the
hypothalamus (an important part of your brain that controls energy
and basic body functions). Leptin is normally produced by your fat
cells and tells your brain when you have enough or too much fat. On
top of that, the triglycerides block the leptin from entering your
brain.
Leptin normally stimulates your hypothalamus to go into "energy
burning mode":
1. reduced appetite
2. increased thyroid hormone, with increased energy expenditure
3. increased stimulus to muscles, releasing heat
4. increased fat breakdown, to supply more energy
5. feeling of well-being, desire for activity
When leptin is blocked by too much insulin and triglycerides, the
hypothalamus goes into "energy saving mode":
1. slowing the heart rate, and decreasing energy use in your muscles
2. increasing the motion of your intestines (hungry growling
stomach) and increased food absorption
3. increased insulin production, which causes your body to store
energy in your fat cells
4. desire to be sedentary
When kids (or adults) get to this point, they start seeking more high
energy foods, like fats and sugars. They eat more fructose, and the
whole vicious cycle gets worse! This leads to a hyper-insulin state,
where too much insulin is produced, more energy goes into the fat
cells, and the brain is further starved. Excess insulin can also result
from eating too much fat or too little fiber, or from having a
sedentary lifestyle.
Why is there so much fructose in our diets?
Over the last few decades, high fructose corn syrup was discovered
to be a cheap source of food energy, which also had the marketing
advantage of being "addictive" because it makes you want more and
more. Today almost all sweet processed foods contain this, since it
very cheap to add, and increases sales since it starves our brains
and makes us want to eat more.
What is High Fructose Corn Syrup?
Natural corn syrup contains glucose, which is the simple sugar
used by our bodies. It does not taste very sweet, so food
manufacturers add enzymes to corn syrup to convert the glucose
to fructose which tastes very sweet. High fructose corn syrup is
55% fructose! Unfortunately, fructose is toxic to our bodies.
Reading labels to look for fructose or high fructose corn syrup can
help us spot the foods that should be avoided. Also realize that all
table sugar (sucrose) is half fructose, so cut back on regular sugar
as much as possible. Most of the food we recognize as "junk food"
probably is high in fructose or sucrose.
Another source of fructose is fruit juice. Many schools have made the
misguided choice to remove soft drinks from their vending machines
and replace them with fruit juice. The soft drinks have too much
fructose in the form of high fructose corn syrup, but even 100%
natural fruit juice has more fructose than full-sugar soft drinks! The
American Academy of Pediatrics has been advising children to
strictly limit juice intake for several years now.
What is safe for kids to drink?
Water is always the best fluid to drink, so doctors encourage
everyone to drink plenty of water. There are many sweet drinks that
are made with artificial sweeteners, such as aspartame, saccharin,
and sucralose. These do not have fructose, are very low in calories,
and have no known harmful effects on humans. There have been
some concerns raised about sweet drinks, that they may increase
the desire to eat or drink other sweet foods or drinks which may
contain fructose. There is also a concern that certain sweeteners
may have some of the insulin-increasing effects that fructose has,
but this has not yet been studied in humans. (There was a study in
rats which showed increased insulin from aspartame.)
There are some concerns that the long-term effects of sweeteners
have not been studied. We may be well to think of these as a
"nicotine patch" to wean us off our high sugar diet, but not to use
them heavily.
Bottom line: right now most doctors are recommending that diet
drinks are OK, since these are far less harmful than sugar drinks.
The best fluids to drink are water, and 2 or 3 cups a day of low fat
milk.
Preventing Foodborne Illness
There are several infections that we can catch from eating
contaminated food. Fresh fruits and veggies are an important part of
our diet, but we need to take precautions to prevent getting the
germs that often accompany them. Washing our produce well, and
keeping our hands washed are the first step. But there are many
other factors, and below is a list compiled by Contemporary
Pediatrics from recommendations of the FDA, CDC and USDA.
Hepatitis A
One important and potentially deadly infection from our food is
hepatitis A. I strongly urge all my patients to get the hepatitis A
vaccine. Much of our fresh produce is brought in from Mexico and
other countries where hepatitis A may be common, especially in the
winter months.
Treatment for the Flu
Flu virus typically strikes during the winter months. It often
gives symptoms similar to a bad cold, but most of the time also
includes muscle aches (aching all over), high fever, and cough. It
usually comes on very suddenly. Some children and adults will have
nausea, vomiting and diarrhea with the above symptoms.
Taking antibiotics for flu is not necessary, and may be
dangerous! Antibiotics can give unwanted side effects like rashes,
vomiting and diarrhea. They can also result in vaginal yeast
infections, and in babies a very bad yeast diaper rash. Many people
have died from severe allergic reactions to antibiotics. Another
serious side effect is the emerging problem of bacterial resistance.
This means that when antibiotics are over-used, or used for
unnecessary reasons, your normal bacteria become resistant to the
antibiotics. Later, when you might need an antibiotic to save you
from a bacterial infection, the antibiotics will not work, and you
could die from a bacterial infection.
Antibiotics are useless to treat the flu, and could cause dangerous
side effects.
Sometimes flu virus becomes complicated by a bacterial
infection, such as an ear infection or pneumonia. In this case, an
appropriate antibiotic should be used.
Treatment of flu symptoms includes rest, analgesics (such as
Tylenol® or Advil®), and lots of fluids. Sometimes decongestants
and antihistamines may help, but the effect is usually minimal. Flu
symptoms usually last about a week. If you have vomiting or
diarrhea, a clear liquid diet can help. Then progress to mild foods.
In the last few years, new medicines called "anti-virals" have
become available. These are prescription medicines, such as
Tamiflu® or Relenza®. These medicines cannot kill viruses, but they
can prevent their release from infected cells, thus preventing spread
to the rest of your body. If you wait until you have been sick for a
few days, the viruses are already spread to your entire body and
these medicines will not work at all.
Anti-viral medications must be given within 24 hours of the first
symptoms of the flu.
If you want to get the benefit of an anti-viral medicine to help
with your flu virus, you MUST call your doctor within the first 24
hours that you start to feel the symptoms. Then take the first dose
of the anti-viral as soon as you get it from the drugstore! After 48
hours, you will just be wasting your money on an anti-viral.
Prevention
The best prevention for flu illnesses is to keep physically fit.
This means avoiding harmful toxins like cigarette smoke, eating
healthy foods, and getting regular exercise. If your body is
physically fit, your immune system is far more likely to be working
at its best. Having a strong immune system is your very best defense
against flu and other viruses.
Another good prevention is to get a flu shot every year, around
November. These vaccines do not protect against all types of flu, but
they do protect from a few of the more common strains. The current
flu shot does not have any protection for the bird flu, but hopefully
in a few years, it will include that strain. (So far, efforts to create a
bird flu vaccine are not very successful!)
Another important prevention for flu is to avoid exposing
yourself to flu viruses, such as large crowds of people during the
winter. Also it really does help to wash your hands frequently, and
using alcohol-based handwash is even better at killing viruses.
Food Allergy in Children
Food allergies in children can be fatal, especially if they are the
immediate hypersensitivity type, which is characterized by hives,
wheezing and shock (very low blood pressure). If your child has
documented urticaria or anaphylaxis from eating a food, you will
need to alter your familys lifestyle in order to prevent a tragedy
from happening. This includes being very cautious about any traces
of the offending food being eaten. Even using cooking utensils that
have touched food allergens could give enough exposure to cause
death. Parents and older children will have to be complulsive about
reading labels on all foods eaten. Never eat foods that have
unknown ingredients.
A study in Food Allergy News in May 2007 reported 63 cases of fatal
reactions to foods. A great deal was learned and the following
conclusions were drawn:
The most common foods that cause deadly allergic reactions are
peanuts and tree nuts, accounting for 90%.
The other 10% were fish, shrimp and milk products.
75% of those who died were already known to have asthma.
Treating with an inhaler did not prevent death.
86% already knew they were allergic to the food they ate.
Fatal reactions occurred in many locations (restaurants, schools,
workplaces, festivals) but rarely at home.
Food came from other sources (restaurants, schools and homes of
friends), not from the family.
In some cases, parents and patients forgot to ask if the food
contained the food they are allergic to.
In other cases, they asked but were told incorrectly that the food
was not included.
Types of food included desserts and candy (35%) and Mexican
and Asian entrees (20%).
Epinephrine was given in a timely manner in only 13% of cases.
(This is important! Carry your epi-pen!!)
What Can Be Done?
Make sure your Epi-pen is not expired. If your child just passed 55
pounds, its time to graduate from Epi-pen Jr to to the adult Epi-pen.
Always carry it with you. An allergic reaction will always happen
when you least expect it!
When eating away from home: avoid desserts, or foods cooked in
sauces.
Food allergies can be fatal.
At restaurants, ask the manager if foods contain peanuts or peanut
oil (for example), dont rely on waiters or guessing from the menu.
Have an action plan ready in case food allergy is suspected. When
you decide that food allergy is possible, carry out the plan
immediately: give epinephrine, call 911. Dont delay.
If you are food allergic, and have an asthma attack after eating (!)
use epinephrine first, then your inhaler. It might be food allergy, not
just asthma!
Read all food labels all the time. Dont make assumptions if a food is
similar to what you usually eat!
Talk to the parents of your childs friends. Make sure they know
what your child is allergic to, and what to do in case of a reaction.
Join a food allergy support group, such as FEAST in the Bowling
Green area. You can learn a lot from the other families and the
allergy professionals who are involved.
Desserts and cookies were a common cause of deadly reactions.
Swollen Glands, Good or Bad?
When we get sick, we often notice sore lumps in our neck. These are
the lymph glands, or more accurately the "lymph nodes". They are
important organs in your body, which produce white blood cells to
fight infection. When you are sick, or injured, the lymph nodes work
harder to produce more white blood cells, so they get larger. This is
a good thing, because you need to have larger white blood cell
"factories" at a time when you need more white blood cells!
If you look carefully, almost all sick children will have lymph nodes
in the neck area, and often other areas, such as armpits, groin, and
several other places. The place depends on the site of the infection.
For example, we often see several pea-sized lymph nodes either
behind or in front of the ear with a swimmers ear infection. Often
lymph nodes will stay large for months, so they will be noticeable
even when the child (or adult) is not sick.
When should we worry about large lymph nodes?
Sometimes the lymph nodes themselves get infected. This is called
"lymphadenitis", and is usually caused by common germs such as
Staph and Strep. Sometimes, lymphadenitis is caused by more exotic
germs such as cat scratch disease (from cats) or brucellosis (from
rabbits) or others. Most of these can be treated with the same
antibiotics that kill Staph and Strep, so we usually start with a
common antibiotic such as cephalexin or trimethoprim-sulfa, to treat
lymphadenitis.
The signs of lymph node infection include: persisting fevers, nodes
that keep getting larger, very painful nodes, or nodes that are red or
draining pus. Most lymph nodes are less than three-quarters of an
inch across when they are healthy, so larger than that for more than
a few days, or any of the above signs, should suggest a visit to the
doctor.
How common is lymph node cancer?
Cancer in the lymph nodes can originate in the nodes (lymphoma) or
can start anywhere else and spread to the lymph nodes. Fortunately,
both lymphoma and metastatic (spreading) cancer are rare in
children. If an enlarged lymph node does not improve after two
courses of antibiotics, it is recommended that the node be removed
for a biopsy. The vast majority of these biopsies show cat scratch or
some other infection, but rarely will detect a lymphoma. Then the
child would be referred to an oncologist for treatment. Signs of
lymphoma include nodes that keep getting larger, usually not
painful, weight loss, and lethargy.
How often would a child have to get a biopsy of his lymph nodes?
Fortunately, almost never! Even though we commonly see 3/4 inch
and larger nodes with a sore throat or even a cold, they usually cool
off quickly when the infection is over. After a week, if a node is still
larger than 3/4 inch, you should call the doctor. Be sure to tell the
doctor if your child has been scratched by a cat or kitten, since this
would increase the chance of it being cat scratch disease. Most of
the time our hard-working lymph nodes return to a more normal size
of 1/2 inch or less, once their work is done.
What To Do About Headlice
Headlice is a common school-acquired problem. Once they get
established in the hair, it can be very challenging to get them out.
Most common insecticides are no longer effective in killing them.
Just like resistant bacteria, the "resistant" headlice are the ones
who live on and have more lice-babies who are resistant just like
their parents.
Headlice lay eggs, called nits, on the hair shaft. They are attached so
strongly, the only way to get them off is to slide them off the end of
each hair shaft. Use your fingernail against your thumb while
holding the hairshaft with your other hand. Once removed, they can
be dropped on the floor where they will die in a few days. Lice live
off your blood, and must be close to the scalp to get more blood for
food.
Most nits are laid close to the scalp, so look there first, especially
around the ears and nape of the neck. They look like tiny oval grains
of sand, firmly attached to the hair. If they fall off, they are not nits.
The adult lice look like tiny furry brown or beige bugs. They crawl
through the hair quickly, and come in various sizes.
The most important part of treatment is getting all the nits out,
which means 100% of them! I usually treat with an insecticide the
first time, then work hard on removing all the nits. A magnifying
glass can be helpful, and be sure to have good light. If bugs come
back, it might be resistance to the insecticide, but is often reinfestation
from school, or just not getting 100% of the nits out.
Nix is usually about 90-95% effective in killing lice, while the other
products are generally less effective, in the 50-75% range. A new
prescription insecticide called Ovide contains malathione, and is also
quite effective.
An interesting article a few years ago, tested several toxic
substances on nits, including insecticides, WD-40, oven cleaner,
hydrochloric acid, among others. Nothing killed them, and the
hydrochloric acid dissolved the hair, and left the nits to hatch
healthy new lice.
Another often used treatment is putting mayonaise on the hair for 3-
4 hours, holding it on with a plastic shower cap. Then rinse it out
and start working on the nits. The mayonaise suffocates the live
bugs, and softens the nits, making it easier to remove them. But it
does not kill the nits! Vaseline can also be used, but is much more
difficult to remove from the hair. Mayonaise is high in protein and is
a good hair conditioner.
Injury Prevention in Children
The first year of life is a time of active exploring of a whole new
world of things, some of which are potentially dangerous. We can do
a great deal to protect our children from most of these dangers.
Use your carseat 100% of the time, and only in the back seat.
Infants and toddlers should use rear-facing carseats until the age of
24 months. Children should not ride in the front seat in cars with
airbags, since the force of an airbag can kill a child.
Use a safe crib, with bars too close to allow the baby’s head to get
caught.
Cold running water is the best treatment for burns!
Let baby sleep on her back as much as possible, to avoid suffocation
or SIDS (sudden infant death syndrome).
Keep a smoke-free home. Any smoking inside the house will get to
the baby (see Second Hand Smoke). Also, cigarettes are the #1
leading cause of house fires.
Test your water heater temperature, and turn it down if over 120 F.
It takes only 1 second to cause third degree burns (needs skin graft)
if the water temp is over 120 F. The most effective first aid for a
burn is to run lots of cold water over the burn. This works even
better than ice, since the flowing water transfers the heat away
quicker.
Make sure you have working smoke detectors in every area of your
house. 6000 Americans die from smoke inhalation every year. Most
would have been saved if they had a smoke alarm.
Do not give the baby any honey during the first year. Babies can get
infant botulism (paralysis) from bacteria in the honey. After a year,
your immune system can protect you from traces of botulism found
in honey, but you could still get sick from bad food. Dont eat
refrigerated food that has been left out for several hours. Dont give
the baby any small hard chunks of food that she could choke on (like
a peanut, or popcorn).
Keep a bottle of activated charcoal in your medicine cabinet. It will
last for at least 10 years, and only costs a few dollars at any
drugstore. Always call the ER, the doctor, or the poison hotline to
find out what to do in a given situation. If in doubt, give the
charcoal; it cant hurt you.
Keep small objects (choking hazard) and plastic bags out of reach of
babies and small children.
Avoid too much sun; babies can burn easily. Sunscreen is OK for
babies, but will not prevent a burn if there is prolonged exposure
(more than one hour). Try to stay out of direct sunlight during the
middle of the day, 11 AM to 2 PM.
Baby walkers cause thousands of serious injuries every year. If used
for prolonged periods of time, they also slow down your baby’s
development. Many pediatricians recommend not to use them. If you
do use one, be certain it is in a safe area away from steps or ledges,
and use it no more than a few times per day.
Under a year, avoid foods that a child could choke on, such as hard
candy, popcorn, peanuts, whole grapes, raisins, etc.
Never leave a water-filled bucket in the house. Curious toddlers
often stick their heads into the bucket, fall in head first, and cannot
get out. The water then drowns them. It is amazing how often this
tragedy occurs.
Coffee table corners cause many head injuries and permanent facial
scars. During your childs toddler years, either store them, or apply
padding on the corners.
Internet Use and Your Family
The Internet is a network that connects people and information
all over the world through their computers. Search tools on your
computer allow you to find information, music, people, products, and
all sorts of things. The Internet is a great tool for children and adults
to learn about the world and find out all sorts of information.
However, much of the information and content on the Internet is not
reliable, and may even present a danger to children and vulnerable
adults. Children might be vulnerable to sexual predators,
inappropriate content on web pages, and fraudulent scams. Read
below to make sure your family gets the most out of the Internet
while minimizing the risks.
Internet Facts
1. What you type on your computer while you are online
automatically becomes public information. You cannot keep secrets
on the Internet! When you type anything online it is transmitted to
"servers" all over the world and copied millions of times. Your email
has literally millions of opportunities to be intercepted and read by
someone else!
2. People online are not always who they say they are. Children can
be easy prey to sexual predators who communicate through chat
rooms. There is no reason for a child or teen to chat online with
anyone who they dont know personally. This should be a strict rule.
3. Anyone can put information on the Internet. This means that
some of the information may be coming from criminals, con artists,
or even just from people who think they know everything but are
actually poorly informed. Bottom line: you cant trust everything you
read on the Internet.
4. The information on the Internet is not well organized, and you
might stumble on material that is offensive, pornographic, obscene,
violent, or racist. This is why younger children need to be monitored
while surfing the Internet.
Time Limits
The Internet is so vast and interesting that it can be addicting in a
way. Surfing the Internet should not take the place of other
important activities such as homework, playing outside, physical
activities, and spending time with friends. This goes for adults too.
The American Academy of Pediatrics recommends limiting total
screen time (including TV, video games, and Internet) to less than 2
hours a day. A digital timer might help you keep track of the total
time spent.
Safety First!
Here are some rules to teach your children. Let them know that
these rules are meant to protect them.
NEVER give out personal information. This includes your name,
address, phone number, age, race, school name or location, or
friends names or other personal information of theirs.
NEVER share passwords, even with friends.
NEVER meet with someone from the Internet that you dont already
know. (Adults sometimes meet other people online, but even then,
you should be very careful about a first meeting. Make sure you
bring a friend, and meet in a public place.)
NEVER respond to messages that hurt your feelings or make you feel
uncomfortable. Do not write back. Tell a parent right away.
NEVER send mean messages online. Bullying is wrong, whether in
person or online.
NEVER use the Internet to harm another person.
NEVER write email from another persons address pretending to be
them. This could get both of you in big trouble!
NEVER plagiarize. Its illegal to copy information from the Internet
(or anywhere else) and say that you wrote it. Its OK to use that
information (for example, in a school project) and give credit to the
person who really wrote it.
CyberTipline
There are several organizations dedicated to protecting children
from harm they might encounter on the internet. The CyberTipline
coordinates many of these, and you can reach them through the
CyberTipline at www.CyberTipline.com.
Another great website is NetSmartz at www.netsmartz.org, which
also has lots of other very useful information about health and other
topics.
AAP Recommendations
The American Academy of Pediatrics recommends these additional
ways to safeguard your childrens internet experience:
1. Surf the web with your children.
2. Put the computer in a room where you can monitor your children.
Computers should never be placed in a room where a door can be
closed and a parent excluded.
3. Use tracking software. Its a simple way to keep track of where
your children have been on the web. However, nothing can replace
supervision.
4. Install software or services that can filter or block offensive
websites and material. Be aware however, that children are smart
enough to find ways around the filters. Also, you may find that the
filters may be more restrictive than you want.
5. Find out what the internet use policies are at your childs school
or library.
Surfing the Net
Using a search engine such as Yahoo or Google can find thousands of
web sites on just about any subject. Remember that anyone can put
information on the internet, and not all of it is reliable. There is lots
of printed material that is totally false information, and the internet
is far less reliable than print. Some sites actually give false
information on purpose. Others may give false information to further
their cause, and they dont verify the information since they want to
believe that it is true.
If you start your search with known reliable sites, this will give you
basic information to build on. If other sites contradict that
information, be very suspicious. Be sure to check the Health-byte
about "voodoo science" to find out the warning signs of false
information.
Lactose Intolerance
Lactose intolerance is a condition where the inability to digest
milk sugar (lactose) leads to one or more of these symptoms:
abdominal pain, bloating, diarrhea, nausea, and flatulence (passing
gas). The symptoms usually hit within several minutes of ingesting a
food that contains lactose, a type of sugar found in most dairy
products (milk, ice cream, yogurt, cheese, cottage cheese, etc).
The most common cause of lactose intolerance is "primary
lactase deficiency". This form is hereditary, but may not show up
until later childhood or adolescence. As the child gets older he loses
the ability to produce the enzyme ("lactase") which digests lactose.
Sometimes the onset of symptoms is gradual, and worsens with age.
Children often learn by experience to avoid dairy products most of
the time, so the association with dairy foods is not always obvious to
the parents.
Secondary lactase deficiency, the non-hereditary form, can
happen to anyone, usually from an injury to the intestines. Several
types of injury could cause this, including severe diarrhea, diarrhea
that lasts a long time, chemotherapy, harmful bacteria, and other
causes. The symptoms are the same, since both types result in
excess lactose build-up in the intestines.
Your doctor can affirm the diagnosis of lactose intolerance by
doing a biopsy of your small intestine or by running an expensive
hydrogen analysis of your breath. However, most of the time, the
history of symptoms following lactose ingestion will be enough
proof. Try a lactose-free diet for 2 weeks, and see if the symptoms
stop. Then try drinking milk again and see if the symptoms return.
Then try using Lactaid® before ingesting dairy products, and you
will know for sure if the treatment stops your symptoms.
Symptoms of lactose intolerance can be completely controlled!
The treatment consists of taking a small amount of lactase
enzyme supplement at the time you eat a dairy food. Several
products such as Lactaid® can be taken just before eating dairy
foods. The vanilla-flavored tabs are very easy to chew and taste like
candy. There is a new lactase supplement that can last for 12 hours.
Some milk products, such as Lactaid Milk, have the enzyme already
added.
Children with lactose intolerance sometimes can get enough
dairy products to supply their calcium needs, but parents should
make sure they also get green vegetables and other sources of
calcium. They may even need to take a calcium supplement.
Make sure lactose intolerant children (and adults) are getting
enough calcium!
How to Get the Most Out of Your Nasal Steroids
Nasal steroid medications are one of the most effective means of
controlling nasal allergies. Yet, many people try them and get no
improvement. They have a miracle drug in their hands, and don’t
know how to use it!
A good medicine might be useless if it cant get to the right
place.
A common practice in using nasal sprays is to "spray and sniff"
thinking this will suck the medicine up into the nose. Wrong! This
merely sucks all the medicine into your throat where it does no
good, and gives you an annoying taste. Do not sniff!
Here’s how to get your miracle drug to perform its miracle:
1) Hold your breath or breathe through your mouth. Practice not
sniffing.
2) Sit upright, and pump one spray into each nostril. Do not sniff.
3) Quickly lie down on your back and tilt your head back.
4) Place your index fingers on both sides of your nose and massage
your nose back and forth, swishing the medication around inside
your nose.
Sniffing your nasal spray will suck it down your throat.
5) Then tilt your head to the left and right to get the medication into
your sinus cavities, and continue to massage with your fingers.
6) After 30 seconds, you can get up, sniff, blow your nose or do
anything you like. The medicine is already in your sinuses.
Repeat the whole process once or twice every day. Within a day or
two you will start to benefit from this extremely effective
medication.
Cure for Sensitive Teeth
What causes teeth to be sensitive to hot or cold foods and liquids? It
could be dental caries (cavities) or a tooth abscess, so be sure to see
your dentist on a regular basis to rule out this cause. No cavities?
Then you just have "sensitive teeth". This is a condition caused by
tiny (even microscopic) cracks in the tooth enamel, which allows the
heat or cold to penetrate to the nerve. It is more common with
increasing age, but could start at any age.
One possible cause is excess acid in your diet that erodes the enamel
of your teeth. Drinks with acid are the major culprit, including citrus
juices, especially lemonade, and colas with high phosphoric acid
content. Eliminating these from your diet could make a big
difference, and you should notice an improvement in a few weeks.
There are several products, such as toothpaste, which attempt to
numb the pain, but these are only a temporary fix, and usually not
very effective.
Seal up the cracks!
If eliminating acidic drinks does not work, a great "cure" involves
actually sealing up the cracks. Sometimes the dentist can apply a
coating which seals the cracks to some extent. I have found this to
wear off pretty quickly, or not be effective at all. Most sealants
would only cover the opening of the crack, so when it wears off, the
entire crack is opened up again.
My dentist recommended a product called "Gel-Kam" (Colgate)
which has proved to be a "miracle cure" for me. It is concentrated
fluoride, which seals the cracks at a molecular level. The tiny
fluoride atoms can fill in the microscopic cracks completely, so they
fill the crack all the way to the bottom.
Another cause of sensitive teeth is receding gums. Be sure you are
brushing away from the gums, not down onto them (which makes
them recede).
Controlled randomized studies have shown that fluoride gel or
solution is effective in reducing tooth sensitivity. Where exposed
nerve roots are the cause, a more concentrated solution was more
effective. Check with your dentist if you feel this to be the case.
Use carefully!
It does take a bit of effort to make this cure work! Too much fluoride
can make you sick (fluorosis). It must be applied slowly over a
period of weeks.
Here is how you do it:
1. Floss and gently brush your teeth at bedtime.
2. Rinse your mouth out well.
3. Put Gel-Kam (a slimy gel) on about half of your toothbrush and
gently apply that one small dose to all your teeth. Gently brush it on,
and be sure to get the sides and backs of all your teeth. Dont
swallow it!
4. Immediately spit out all the residue. But DO NOT RINSE ! The trick
is to keep that coating of Gel-Kam on your teeth all night long!
5. It is OK to swallow saliva during the night. It will not contain
enough fluoride to hurt you.
If you notice any side effects, stop the treatments and report your
side effects to your doctor or dentist. Side effects of too much
fluoride include: White spots on the teeth, nausea and vomiting,
diarrhea, stomach ache, excessive salivation, muscle cramps or
convulsions.Using the gel properly should not give any side effects.
You should notice improvement in a week or so, and a maximum
effect in a few months. You can then stop the treatments, but it is
OK to repeat the treatment any time you get any sensitivity. It is
also OK to use Gel-Kam in a preventive way, once a week, to stave
off sensitivity.
Sinusitis in Children
Sinusitis means "inflammation in the nasal sinuses" and is usually
caused either by virus infections, like colds or flu, or by allergies.
There is no treatment for virus colds, other than temporary relief of
symptoms. There are many treatments for allergies, which can be
tailored to meet the specific needs of each patient by the doctor.
Sometimes, children get a bacterial infection in their sinuses. It is
not easy to diagnose this condition, since cultures will always show
growth of common normal germs, such as strep pneumo. Sinus
xrays are not helpful either, because they usually show sinus fluid
and inflammation during normal colds, so there would be no
difference on xray to distinguish a bacterial infection.
Green nasal mucus is a normal phase of a virus cold.
The diagnosis can only be made clinically, by meeting one of two
criteria. The first is termed "severe acute sinusitis", and consists of
thick pus-like nasal discharge, high fever, headache and sinus
tenderness that lasts at least 4 days. In a regular cold the fever
usually goes away after 4-5 days (or sooner), and the greenish
mucous usually signals improvement in other symptoms. Severe
acute sinusitis is sometimes called purulent rhinitis, but should not
be confused with the normal greenish nasal discharge that is part of
a regular cold.
The second and more common type of bacterial sinusitis is termed
"persistent acute sinusitis". This means it must persist for over 10-
14 days, without starting to improve. Most colds will start to
improve before 10-14 days. They might hang on for several weeks,
but at least be starting to improve by 10-14 days. Symptoms of
persistent acute sinusitis include thick nasal discharge, cough both
day and night, bad breath, but not usually much fever.
A cold that does not improve after 10-14 days should be treated
with an antibiotic.
Many doctors treat colds before 10 days, trying to prevent or "head
off" a bacterial sinusitis. This is a very dangerous practice, since it
has no effect whatsoever on preventing sinusitis, but is one of the
major reasons for the serious problem of bacterial resistance. (Be
sure to read the health-byte on "bacterial resistance"!!)
Sinusitis is usually caused by the same bacteria that cause ear
infections, so similar antibiotics can be used. They are usually used
for longer courses because of the difficulty in getting the drugs from
the bloodstream into the nasal sinuses.
Sleep Disorders in Children
Is my child getting enough sleep?
Here are some warning signs that children are not getting enough
sleep:
Trouble awakening and getting up in the morning.Crying or
becoming angry too easily.
Unwillingness to behave or follow expectations.
Falling asleep at inappropriate times (for example, during a movie)
Difficulty concentrating or performing tasks.
Difficulty going to sleep at bedtime.
Why is Sleep So Important?
Children and adults who are deprived of adequate sleep are at high
risk of serious health problems, including accidents, poor learning at
school, poor job performance, depression and other mental health
problems, and a poor quality of life.
Sleep is needed for Good Health!
Children up to ten years old need at least 9 hours of sleep every
night. When children get less than that, they have trouble paying
attention, learning, and just doing everyday tasks. Even teens and
adults need at least 8 hours of sleep every night.
Tips to get better sleep:
** Make sure your bedroom is dark and quiet. A night-light is OK,
but not shining in your childs face!
** Dont over-heat the room. You sleep better when the room is
cooler. Get a thermostat that sets a cooler temperature at night, and
this will also save money in the winter time.
** Try to go to bed the same time every night. Your childs internal
clock will learn to get her sleepy at the same time each night. This
includes weekends! (Staying up late, and sleeping in on weekends
does a lot of damage to your childs "internal clock"!)
** Getting lots of exercise can help you sleep better, but dont
exercise for 2 hours prior to bed-time. This will just "wind up" your
child and make it harder to sleep.
** A light snack, such as a serving of fruit, is OK at bedtime, but
dont eat too much.
** Its good to establish a routine that alerts your body to know that
it is time to sleep. A bed-time routine might include a bath, brushing
teeth, soothing music, or a bed-time story.
** Avoid caffeine drinks, like sodas, especially in the afternoon or
evening.
Caffeine can keep you awake! (duh!)
Physical Problems
Sometimes physical problems such as allergies or large tonsils can
cause disturbed sleep, or even sleep apnea (breathing stops for
more than 20 seconds at a time). A sleep lab can determine if there
is significant sleep disturbance. Check with your doctor if you think
this is the case.
Strep Throat
Strep (short for group A Streptococcus) is a bacteria that can cause
sore throats in both adults and children. It is no different than any
other type of sore throat, and comes in mild, medium and severe
cases. Most sore throats are caused by viruses, so they go away
without any treatment. Strep throat is the only type of sore throat
that needs antibiotic treatment, because strep might lead to
complications that could be severe or life-threatening.
Sore throats caused by other bacteria, or by viruses, should (almost)
never be treated with antibiotics. Many good studies have shown
that using antibiotics for non-strep sore throats ONLY leads to side
effects, bacterial resistance, and absolutely zero effect on the the
sore throat.
Signs of strep throat include throat pain, pus on the tonsils, fever,
headache, vomiting, stomach ache, and tiredness. These could also
be signs of viral sore throat, so you really can’t tell if it is strep
without doing a strep test. Two common tests are the throat culture
(takes 24 hours, 95% accurate) and the strep antigen test (takes 5
minutes, 95% accurate).
If it is not true strep, a sore throat should not be treated with
antibiotics.
Many experts recommend doing both tests for increased accuracy,
which would be the ideal situation. However, most doctors’ offices
are restricted from doing cultures by federal regulations, called
CLIA, which prevents doctors from doing most lab tests in their
offices. CLIA allows me to do only strep antigen tests, hemoglobins,
urinalysis and a few other tests. CLIA is one example of extreme
government over-regulation of medicine that is making the cost of
medical care soar in the last few years.
Back to strep, once you prove that group A strep is the cause of the
sore throat, you should treat it with a specific antibiotic that is
effective against strep. Penicillin (the really yucky tasting stuff) is
most effective, so that is the preferred treatment if you are taking
pills. Macrolides (like azithromycin or erythromycin) are the first
choice for anyone allergic to penicillin. Other drugs similar to
penicillin, like amoxicillin, are also effective. Tetracycline and sulfatype
drugs are NOT effective.
Sometimes the strep infection is still there after taking all the
antibiotic. There are several possible reasons for this. The
widespread abuse of antibiotics has led to bacterial resistance in all
of our normal germs (that we carry around in our bodies all the
time). These germs produce chemicals that destroy penicillin, so
your normal germs might be "protecting" the strep germs by
destroying the penicillin. To prevent this, NEVER take antibiotics for
viral infections, when they are completely unnecessary. Over half of
antibiotics prescribed in the USA are given for inappropriate reasons,
and should not be used. Be sure to read the health-byte about
"bacterial resistance"!!
Even a mild case of strep throat could lead to heart damage from
rheumatic fever, if not treated.
In the last 30 years, the incidence of rheumatic fever, the most
severe strep complication, has dropped to very low levels. Checking
for strep will prevent this complication, because any strep infection
treated within 2-3 weeks will not lead to rheumatic fever. Most
cases of rheumatic fever arise from strep throats that did not get
checked. You have to remember that strep throat might be a mild
case, and might go away in a few days without treatment (but could
then go on to rheumatic fever 2 months later!). If in doubt, it is
better to get a strep test to know for sure.
The Miracle of Vaccines
We often take for granted the protection from horrible diseases that
we get from vaccines: polio, meningitis, diphtheria! If you saw the
bird flu movie, or other movies about deadly viruses that can wipe
out huge populations, that could be happening now if it were not for
the miracle of the vaccines that are available to us today.
We are sorry to have to poke babies and make them cry, but the pain
is just a few minutes, and can protect them from horrible disease
and death. As technology advances, we are able to make vaccines
against more and more illnesses. This means more shots and more
expense. But it also means a better life in the future for our children.
How Vaccines Work
Vaccines work by stimulating your own immune system to produce
antibodies against dangerous viruses or bacteria. When your
immune cells are exposed to foreign material, they start to produce
antibodies to attack it. A vaccine would expose your immune cells to
pieces of these dangerous germs, or milder forms of the germs
which are harmless. This way, you dont have to go through the
actual serious illness to become immune to it.
New Vaccines
Several new vaccines are now available. One exciting new vaccine
protects children and adults from many strains of human papilloma
virus (HPV) which causes cervical cancer in women, and causes
genital warts in both men and women. It is recommended for all
girls at the 6th grade checkup. It is now covered on the state
vaccine program for all girls over age 9.
There is also a new and improved version of the rotavirus vaccine
(diarrhea virus) which so far has a very good safety record. It is an
oral vaccine and is given at the 2, 4 and 6 month checkups.
Most children are already protected from Hepatitis B, but a different
hepatitis virus (Hepatitis A) is much more contagious and can be
transmitted by food. Hepatitis A virus is fairly common in Mexico,
and we are importing more and more food from Mexico these days.
There have been reports of Hepatitis A outbreaks due to food
contamination in many states all over the USA. States which border
Mexico (Texas, New Mexico, Arizona and California) have used the
Hepatitis A vaccine for several years, and have virtually eliminated
this disease in those states. The American Academy of Pediatrics
now recommends that all children in the USA be vaccinated for
Hepatitis A.
The most contagious form of meningitis is caused by bacteria called
meningococcus. It can be prevented with a new vaccine which is
given at the 6th grade checkup (age 11). It requires only one dose
and is very safe.
Safety of Vaccines
As parents and physicians our first concern is for the safety of our
children. Could vaccines cause damage or endanger our children? As
with any other treatment or medication, there could be rare side
effects that are not expected. For vaccines, these are called "adverse
events", and are reported to the CDC (Centers for Disease Control)
by every doctor who recognizes one. Fortunately, these are on the
order of one-in-a-million. When adverse events exceed the one-in-amillion
level, the CDC and FDA react quickly to investigate and
discontinue the vaccine if a connection is established, such as the
first rotavirus vaccine in the 1990s (which was linked to 17 cases of
intestinal blockage called "intussusception"---out of millions of
doses given).
False Alarms
There have also been several "false alarms", where there seemed to
be a connection between vaccines and something else. An example
is the apparent increase in autism in the last ten to fifteen years.
Could this be due to something in vaccines? The CDC has looked very
hard at this question, and there have been literally hundreds of
studies to see if this is the case. So far, there is absolutely no
evidence to support such a connection. Here are the major points of
interest:
(1) The "increase" in autism is actually due to an increase in
diagnosing autism. In the past there were the same number of
children with autism, but they were called by different names. New
methods of categorizing the disease have caused the apparent
increase in the statistics.
(2) A preservative containing trace amounts of mercury (thimerosal)
was used in many vaccines to prevent bacterial growth. There has
been concern that the mercury could have caused autism or other
adverse effects. However, there has never been shown to be an
increase autism or any other behavior problems among children who
got thimerosal vs those who didnt. Furthermore, when thimerosal
was removed from almost all vaccines in the last 5 years, there was
no change in the incidence of autism or other behavior problems.
Additionally, there have never been any reports of mercury toxicity
in any children receiving thimerosal.
Misconceptions
There are many misconceptions that both doctors and parents have
about when and when not to give vaccines. If you are allergic to
actual components of the vaccine or have had a serious reaction,
such as anaphylaxis (shock, wheezing, passing out), then you should
not get the vaccine.
Otherwise, you should NOT delay getting vaccine for these "lame"
reasons:
(1) having a minor illness or fever under 102.
(2) getting over an illness.
(3) taking antibiotics.
(4) fever from a previous DPT shot, if fever was less than 105.
(5) mother or other family member is pregnant.
(6) child was premature.
(7) recent exposure to a disease.
(8) having allergies in general.
(9) allergies to duck meat or feathers, or to chicken eggs.
(10) family member had a vaccine reaction.
Another misconception is that vaccines are safer or work better if
given separately. Giving many vaccines at once is not only much
more humane (why force a child to endure the pain over and over
again?) but each vaccine in a combination works just as effectively.
Read more »
Wellness can mean different things to different people, depending
on their priorities, so I have picked out some general areas that
should appeal to all people. First I considered the "wellness" of the
body, that would allow your body to function well and last a long
time. To achieve that kind of wellness, you would have to follow
state-of-the-art preventive health practices.
Looking at what most affects the wellness of people living in
America, we must consider that keeping poisons out of our bodies is
the first priority. Without that, the other preventive health measures
would be futile. The two most common poisons in our cultural
environment are tobacco and fructose. [see health-bytes on tobacco
and fructose]
Next, I considered the wellness of the mind, which I will call
"spiritual health". For your mind (and spirit) to function well, you
must interact with others and your environment in ways that keep
your mind active, and your spirit in harmony with others. You should
also continue to learn as much as you can for your entire life. When
you stop learning, your mind ceases to function.
To take a broader view of spiritual health, we can consider ourselves
as part of a larger community, which must also maintain "wellness".
If there is suffering, conflict, or even war in the community, nation
or world that we live in, it is a threat to our personal wellness. We
all need to pitch in and do our part to promote the wellness of the
community (both local and world-wide). Of course that starts in our
own back yard. As they say, we need to think globally, but act
locally.
Finally, I have considered that the wellness that we enjoy today is
often based on preparation that we did in the past. Therefore, we
should start now to prepare for future wellness.
With these 4 broad areas in mind, I have summarized wellness
practices in the form of a screening test. If there are wellness
practices that you are missing out on, consider making a change,
and keep that healthy mind of yours constantly adapting and
learning!
Wellness Screen
Section I (Prevention Practices) Yes No
1. We look up evidence-based health info
on the internet
. .
2. We never breathe secondhand smoke . .
3. We avoid eating or drinking fructose
(sugar) whenever possible
. .
4. We use dental floss every day . .
5. We eat at least 5 fruits and vegetables
every day
. .
6. We each take a multivitamin pill every
day
. .
7. We wear our seatbelts in the car
(100%)
. .
8. Grandparents take an aspirin every
day, and colonoscopy after 50
. .
9. Adults never drink more than one
alcohol drink per day
(zero while pregnant!)
. .
10. We never smoke cigarettes (or use
other drugs)
. .
11. We each get 1 hour of exercise every
day (including parents)
. .
12. We get regular check-ups at the
doctor (Update your vaccines,
and keep our blood pressure under
120/80)
. .
13. We never talk on the cell phone while
driving
n n
Section II (Spiritual and Mental Health) . .
1. We participate in hobbies that interest
us
. .
2. Family fights never result in physical
injury
. .
3. We watch meaningful TV shows, but
limit TV to less than 2 hours/day
. .
4. Family is involved in church or
community projects
. .
5. We plan activities with friends . .
6. We do volunteer work . .
7. We set an example for our children by
rejecting hatred against minorities
(racial, gays and lesbians, overweight or
handicapped people, other cultures)
. .
Section III (Environmental Wellness) . .
1. We recycle paper, aluminum and
plastic
. .
2. We have checked our home for radon . .
3. We never allow people to smoke in our
home
. .
4. We use a filter for drinking water
(Brita, etc)
. .
5. We clean up trash on our block every
month (or more often)
. .
6. We always vote at election time . .
Section IV (Preparing for the Future) . .
1. We teach our children "life" skills
(cooking, washing, managing money)
. .
2. Each family member (including
parents) is learning and practicing
a lifetime fitness sport (tennis, disc
golf, swimming, etc)
. .
3. We save money in dedicated funds
(college, retirement, etc)
. .
4. We pay off credit cards in full every
month
. .
5. We preserve the heritage of our town
for future generations
to appreciate (historic
preservation)
. .
What is ADHD (Hyperactive Child)?
ADHD stands for Attention Deficit Hyperactivity Disorder. This
describes the brain defect that results in inabilty to "pay attention"
for more than a few seconds, which then results in the child acting
"hyper" because his mind keeps wandering around to other things.
Sometimes a child just phases out without acting hyper, so these
children are just ADD. About 9% of all school children have at least
some form of ADHD or ADD, more commonly in boys, but it is also
found in about 3% of girls.
What are the signs of ADHD?
Short Attention Span: daydreams, doesnt seem to listen, easily
distracted from both work and play, disorganized, forgets things,
loses important things, makes careless mistakes, does not finish
what he starts, doesnt seem to care about details.
Impulsive: acts and speaks without thinking, has trouble taking
turns, cannot wait for things, interrupts others, inappropriate
touching of others.
Hyper: constant motion, cannot play quietly, squirms and fidgets,
talks too much, cannot stay long in a chair, will not stay with a
group.
Is there a test for ADHD?
Unfortunately, no, but the signs listed above, and many other
signs, can be quantified by psychological tests. The scores on these
tests will tell how severely your child is affected, and which type of
ADHD it is. Your psychologist or psychiatrist can then recommend
the appropriate treatment. It is also important to test for other
conditions commonly found with ADHD, such as conduct disorder,
oppositional behavior, depression, anxiety disorder, and learning
disabilities.
What causes ADHD?
The exact cause is not known, but we do see a tendancy for it to
run in families. It can also result from exposure to toxins or from
brain injury. We do know that these children (and adults) with ADHD
have lower brain activity in areas of the brain that control the focus
of attention. As these children get older the ADHD seems to improve
in many cases, probably because they have learned to adapt and
compensate for the defect.
What treatments are available?
Since ADHD is a life-long condition, long-term planning is
essential. Each year, the school will hold a conference with the
parents, the child, the teacher(s), the principal, and the psychologist
to develop an IEP (Individualized Education Plan) for the whole
school year.
Behavior therapy is the main part of treatment, used at home and
at school. This mainly consists of setting goals, proving rewards and
consequences for certain behaviors, and continuing a consistent reinforcement
of these goals. This can get pretty complicated, so
usually requires ongoing help from the psychologist or psychiatrist.
Teachers at school will have to be constantly aware of these goals as
well.
In some cases, medications can be helpful to help a child with
ADHD to concentrate better in school. Many types of medications
have been tried, but the most commonly used are stimulants, such
as amphetamine or ritalin. There are several different forms of
these, with slightly different effects. In 2003, a new class of
medication was approved by the FDA, atomoxatine, which is a nonstimulant
effective in treating ADHD.
Medications are given in the lowest possible dose, then increased
(ONLY if necessary) to achieve a positive effect. We want to limit
side effects if at all possible. Some of the side effects include
decreased appetite, weight loss, sleep problems, headaches,
jitteriness, social withdrawal, and stomach ache. Less commonly, we
see dry mouth, dizziness, tics (involuntary movements), and
rebound effect after the medication wears off. Rarely seen side
effects are growth delay (shorter height), increased blood pressure,
and stuttering.
If your child is taking medication for ADHD, inform your doctor if
any of the above side effects occur. These can be lessened or
eliminated by changing the dose, or changing to a different
medication.
Beware of phony treatments!
There are tons of phony treatments for ADHD that you will see
advertised and on the internet. Several books claim other phony
treatments can help. If it sounds too good to be true, it probably
isnt true. If it sounds quite different from the techniques discussed
in health-bytes, it is probably not approved by the American
Academy of Pediatrics (my major source of information), and is
probably not backed by any scientific testing.
Diet therapies, such as avoiding sugar, or certain foods, have been
tested quite thoroughly, and the great majority of studies have
shown that dietary changes have no effect on ADHD.
What can I do at home to help my child with ADHD?
1. Keep your child on a daily schedule, doing things about the same
time every day.
2. Limit the distractions. Loud music, computer games and television
should not be on during meal times and homework times.
3. Organize your house, so that your child can find things easily, and
he can learn the proper place for things, such as backpack,
schoolwork, clothes, toys, etc.
4. Reward positive behavior. Your child has to deal with a lot of
negative feedback, so try to balance it with as much positive as
possible. A kind word, a hug, a treat will help to give him incentive
to keep trying.
5. Set small reachable goals. Be thankful for small improvements,
and know that these will add up to bigger improvement in the long
run.
6. Help your child stay on task. Use charts and checklists to track
progress with homework and chores. Keep each task as simple and
brief as possible. Make your reminders friendly and positive, but you
will have to give reminders frequently.
7. Limit choices. Offer choices whenever possible, to help him learn
to make good decisions, but limit the choices to two, maybe three.
Having too many choices is pushing the limits of his attention span.
8. Find activities where your child can succeed. Self-esteem is often
hard to come by for children with ADHD, because there are so many
failed attempts during each day. Sports or energetic physical
activities can be very rewarding. Every child is different, and your
child might find a certain activity that he can really relate to well.
9. Use calm discipline. Time out or just removing the child from the
situation is usually enough. Some behaviors are better ignored, as
they are affecting the parent more than the child. For example, loud
play which is not hurting any other children might be very annoying
to the parent, but could be just ignored with a little physical
separation (moving to another room). When discipline is given, use
a calm tone, apply known consequences in a consistent manner, and
avoid physical punishments like slapping or spanking.
Source: Clinical Practice Guideline: Attention-Deficit Hyperactivity
Disorder, Pediatrics, May 2000.
(Thanks for help from UK medical student Chris Johnner)
What Pets are Safe for Kids?
There are many diseases that can be transmitted to children from
animals, and some are serious, even life-threatening, such as rabies,
Clostridium, MRSA, and Lyme disease (through ticks they carry). Is
it safe for kids to be around animals?
Most families have pets of some kind, with dogs and cats at the top
of the list. These are the most recommended pets because disease
transmission is minimal, especially if the animals are over 6 months
old, and have been vaccinated for rabies. Kittens and puppies in the
first 6 months are more likely to carry disease, and are more likely
to bite and scratch a child handling the animal. Most cases of catscratch
disease are from handling a small kitten. If you get a puppy
or kitten for your child, keep exposure to a minimum during the first
6 months. The safest would be to get a dog or cat that is already
over 6 months old.
Pit bulls and other dogs bred for "protection" are not recommended
for children since children and even adults have been mauled or
killed in attacks. We all know families with a pit bull who plays well
with the children, but it only takes one incident when the animal has
a bad day, is caught off guard, or perceives a threat, to result in a
tragedy.
Fish are another popular pet, with very little chance of disease
exposure for children. They can be a beginner pet for teaching
children how to care for animals, since they have minimal
maintenance. A more motivated child could then learn how to care
for a hamster, parakeet or tame rabbit.
Wild rabbits, squirrels, raccoons, and other animals from the wild
are not considered safe pets since they could carry several
dangerous diseases, and would be more likely to bite a handler.
Other non-recommended pets include: reptiles, amphibians,
monkeys, hermit crabs, prairie dogs, and other exotic pets.
Even dogs and cats can carry serious diseases such as toxoplasmosis
and leptospirosis. And their normal germs, such as mouth bacteria,
can cause serious infections in children if bitten or scratched.
Prompt attention to childrens animal bites is important, and it is
also good to teach children to wash hands after handling a pet. Most
dog and cat worms are not transmitted to humans, but some types
could be transmitted through their feces, for example, round worms.
Dogs and cats can be treated for fleas and ticks to virtually eliminate
the chance of diseases carried by those pests (Lyme disease, plague,
Rocky Mountain Spotted Fever, and many others).
Asthma in Children
Asthma is a chronic disease in children (and adults) which causes
blockage of the smaller bronchial tubes ("small airways") which
branch out from the bronchial tree ("large airways"). The blockage
is caused by inflammation which then causes constriction of tiny
muscles which squeeze down on the bronchial tubes. The inflamed,
or irritated, inner lining of the bronchial tubes also produces mucus
which can also block the air flow. This makes it difficult to push air
out of your lungs, because the smaller airways collapse as you
breathe out. You might also hear wheezing, or whistling, noises on
breathing out. Sometimes there are wheezing noises as you breathe
in, due to mucus in the small or large airways.
By controlling inflammation during childhood, you can
greatly reduce asthma during adulthood!
Asthma has been called many names, including Small Airway
Disease, Reactive Airway Disease, Asthmatic Bronchitis, or just
Bronchitis. The last two terms are misleading, since asthma does not
involve the bronchi (large airways) at all! Some children "outgrow"
their asthma, but many keep it through adulthood. By controlling
inflammation (that means taking medicine every day!), children with
chronic asthma can greatly reduce their asthma symptoms as adults!
What is an Asthma Attack?
Children with asthma can get an "attack", or sudden onset of airway
obstruction, from many causes, including exposure to an allergen
(breathing pollens or eating peanuts, for example) or exercise
(exercise-induced asthma) or exposure to chemical irritants
(cigarette smoke, perfume, hair spray or cleaning solutions).
Sometimes an attack can be due to a subtle cause, such as a change
of weather, or a stressful encounter.
How Is Asthma Treated?
There are two basic approaches to the treatment of asthma: (1)
treat the muscle constriction with "broncho-dilator" medicines, and
(2) treat the inflammation with anti-inflammatory medicines.
Broncho-dilators are important in giving quick relief during an
attack, and may be the only medicine needed for mild asthma that
only occurs every few months or less. The anti-inflammatory
medicines are important in treating chronic asthma with more
frequent symptoms.
If your child has symptoms of asthma every month, your doctor will
prescribe a daily routine of anti-inflammatory medications. Examples
would include inhaled steroids, sodium cromolyn, or leukotiene
inhibitors. Oral steroids might be used for severe attacks, or more
severe chronic asthma. Daily broncho-dilators, such as albuterol,
might also be used in more severe cases.
Broncho-dilator medications are considered to be a "rescue
therapy", since they are used mostly for treatment of acute attacks.
They are also useful in pre-treating children with exercise-induced
asthma, when used 15 minutes prior to exercise.
Make sure the medicine is getting into the lungs, not
just sticking to the roof of your mouth!
Broncho-dilators, such as albuterol or lev-albuterol, can be given
orally, by inhaler, or by nebulizer. When using an inhaler, children
(and adults) must make sure that the medication is getting into the
small airways, and not just sticking to the roof of the mouth. There
are two ways to do this: (1) by using a spacer or large tube between
the inhaler and your mouth, or (2) by using a very small particle size
medication such as Maxair Autohaler.
A nebulizer puts the medicine into a fine mist so that a child can
breathe the mist into the lungs. Be careful to wash the medication
cup each time you use it, so that contaminants (such as dust or
animal dander) are not being put into your childs lungs.
Clean the nebulizer medication cup well! It might
contain dust or animal dander!
When using inhaled steroids, it is a good idea to rinse your mouth
afterwards, to avoid side effects such as candidiasis (fungus
infection in the mouth). Mouth wash with alcohol base, such as
Scope®, works the best, since the medicine is not water-soluble.
Monitoring Peak Flow Can Save Your Life
Children (and adults) with chronic asthma should monitor their
asthma by checking the airflow in their small airways. This is done
using an inexpensive "peak flow meter" you can use at home every
day. When the peak flow (of air from your lungs) gets below 75% of
usual, you will use a rescue therapy (the broncho-dilator) right away
before the attack becomes severe. This can save lives, and is a good
way to know how severe the inflammation is, and if more antiinflammatory
medication is needed.
Find Out the Latest Info on Asthma
Dr Stan Ting of the University of Texas has invented a color-coded
treatment guideline for the most effective treatments for asthma.
Check his website, Simplified Asthma Guidelines, to download these
guidelines in simple one-page forms. Over 1 million copies have
been sent to doctors around the world!
Bacterial Resistance
With the vast over-use of antibiotics in the last few decades in this
country, many bacteria are evolving to become resistant to most of
the known antibiotics. In a few years we may be heading for a new
era in medicine, the so-called Post-Antibiotic Era. It is predicted that
bacteria will become resistant to all antibiotics in the next few
decades, or sooner if the current trend of over-use continues. This
means that common infections like strep throat or pneumonia will
very commonly result in death, just as they did in the Pre-Antibiotic
Era.
Amazingly, a recent survey (2006) showed that 58% of adults are
totally unaware that over-using antibiotics poses a danger to
themselves and to their community.
Here are some scary recent developments:
1. Bacteria have learned to "use the net". Not on computers, but by
passing their DNA back and forth even different species of bacteria
can get the DNA code for antibiotic resistance, just as easily as we
get information off the net.
For example, normal bacteria in your intestines get exposed to all
the antibiotics that you have taken this year. The ones that evolved
to become resistant survive, while the others are killed off by the
antibiotics. Then you get a few pneumococci in your lungs for a mild
case of pneumonia. Ordinarily a short course of penicillin would cure
you. But your intestinal bacteria have shared DNA with these
pneumococci so they are resistant to most of the known antibiotics!
Now you are in trouble. If you are lucky enough to get a good
culture and sensitivity test, you might find a drug that will work, but
that may mean a long stay in the hospital and weeks of IV therapy
with more dangerous drugs.
Your own common germs can become resistant to antibiotics, then
pass that resistance to dangerous germs that you might catch in
the future.
2. Bacteria learn to get resistant quicker to related drugs. Once
resistant to one drug, it is easier for a certain group of bacteria to
get resistant to others. For example, many bacteria that are
resistant to penicillin are very quick to become resistant to the
cephalosporins (synthetetic penicillins) which used to be the main
"back-up" when bugs got resistant to penicillin.
3. Doctors are accelerating this process by prescribing antibiotics
when they are not necessary. Conditions like colds, flu, viral sore
throats, bronchitis and viral pneumonia are all caused by virus
infections. Antibiotics have no effect whatsoever against viruses.
Not even a very slight effect. They don’t help you get better a day
sooner, or an hour sooner or even one second sooner! They have
zero effect. Antibiotics should never be used for these conditions.
Every time you use an antibiotic for these conditions you are
accomplishing only one thing: you are making the bacteria in your
environment more resistant to antibiotics. Sadly, the vast majority
of prescriptions for antibiotics fall into this category.
4. Even though we know that using less antibiotics will reverse the
resistance problem, doctors refuse to stop over-prescribing. Recent
studies have shown that there are several factors influencing
doctors to over-prescribe. These include fear of being rejected by
their patients if they don’t order enough medicine, fear of being sued
(because they think it will make their patients angry if they don’t
prescribe enough), ignorance of the problem of bacterial resistance,
complacency (feeling that new antibiotics will save the day),
ignorance about the fact that very few new antibiotics are being
developed, fear that managed care systems will not pay them
enough if they don’t over-prescribe.
5. The recent trend toward "managed care" forces doctors to overprescibe
antibiotics. Doctors are forced to practice not high quality
medicine, but instead "high efficiency" medicine. This means
handing out prescriptions for antibiotics (two minutes) is much more
efficient than explaining to a patient why an antibiotic should not be
used (ten to twenty minutes). Managed care also rewards doctors
who get high approval ratings from their patients. Doctors feel that
if they explain the danger of antibiotic over-use to their patients, it
may make sense to some, but others will be dissatisfied, and that
minority of patients might ruin their approval ratings.
Even if you never take antibiotics, you could catch a resistant germ
from your neighbor who abused antibiotics!
6. The really bad thing about bacterial resistance, is you can’t stop it
by practicing good habits in your own family. You might never take
antibiotics, ever, then get a bad infection that needs treating with an
antibiotic. Guess what? It’s resistant to all known antibiotics! Why?
Because you caught it from your neighbor who took antibiotics every
time he got a cold or bronchitis. This is definitely a "community"
problem. To some extent, you will be much better off than your
neighbor who over-used antibiotics. He will get more infections and
more resistant ones, but you are still at risk of getting what he has.
Day care centers have more resistant bacteria!
7. Day care centers are breeding some of the worst resistant bugs,
such as MRSA. This is Multiply Resistant Staph Aureus. Formerly only
found in hospitals with high antibiotic use, it is now commonly found
in day care centers where so many kids are inappropriately treated
with antibiotics for their many viral colds. This germ is very deadly if
it gets into your lungs or bloodstream.
8. Government rules force doctors to over-prescribe antibiotics. In
the last 10 years, CLIA (Clinical Laboratory "Inhibitory" Act) has
severely limited the use of lab testing in doctors’ offices. Many
doctors have stopped doing labs altogether, so they are unable do
simple tests such as a throat culture. Instead, they just treat every
sore throat with antibiotics, just in case it might be strep throat.
Since only 10% of sore throats are due to strep, this means 90% of
sore throats are being treated unnecessarily, greatly adding to our
risk from resistant bacteria!
9. About half of the antibiotics used in the US are given to animals.
This has important implications, since many human infections are
caught from animals. We have heard a lot about Salmonella
infections from poorly cooked poultry. In the past these infections
could be treated with common antibiotics. Now, with the high use of
antibiotics given almost indiscriminately to poultry and other
animals, a high proportion of Salmonella is resistant to most
antibiotics. In 1996, 34% of Salmonella were resistant to
everything!
10. A recent report in the journal Clinical Infectious Diseases points
out that antibiotics are not benign medications! Adverse reactions to
antibiotics account for 25% of all ER visits for drug reactions, or
about 142,000 reactions per year in the United States. A severe
reaction such as anaphylaxis (a type of allergic reaction) can result
in death.
What can be done to reverse this alarming trend?
Parents and patients can have a positive effect by questioning any
use of antibiotics recommended by their doctors. Does the doctor
have reasonable proof that a bacterial infection is the cause of your
illness? Are there any other treatment options?
We also need to pass the word around to other parents (and all your
friends). Most parents have a slight idea that some bacteria are
becoming resistant to antibiotics, but almost none of them
understand how serious the problem is. In order to make any impact
on doctors’ prescribing practices, a very large percentage of patients
are going to have to start demanding better care from their own
doctors.
Good News: You Can Make a Difference! In Finland and Iceland, two
different studies have shown that drastically reducing the
unnecessary use of antibiotics led to a major reduction in the
percentage of resistant bacteria. At first this didn’t make sense to
me. Once a bacteria is resistant (a super-bug), why would it go back
to being normal again? The answer is that when no antibiotics are in
the germs’ environment, a super-bug has no advantage in survival
over all the normal germs. The normal ones are allowed to thrive
and have lots of germ-babies who are also "normal". The super-bugs
just get lost in the crowd, and their numbers drop off.
One last word of warning! If we wait too long to reverse the trend,
the super-bugs will be the majority, and THEY will be the "normal"
germs, and we will not be able to turn the tables as they have in
Iceland and Finland. Time is running out!
Behavioral Screen for Children
Childs Name: NEVER SOMETIMES OFTEN
Uncooperative, difficult to
manage
Lying or cheating
Sad, cries for no apparent
reason
Talks of suicide
Hyperactive, constantly
moving
Short attention span
Complains of aches and pains
Cruel to animals
Refuses to share
Shows anger with violent
actions, temper tantrums
Grades dropping in school
Slow to learn new things
Has trouble with a teacher
Experiments with alcohol or
drugs, including inhalants
(markers, gasoline, lighter
fluid)
Smokes cigarettes
Takes unnecessary risks
(playing with guns, sexually
active, etc)
Spends too much time alone
Difficulty making friends
Tires easily, very little energy
Worries, seems nervous
Preoccupied with fears or
phobias
Obsessive neatness or
routines
Fights with other children
Does not show feelings
Has trouble sleeping
Acts too young for age
Gets teased or bullied at
school
Threatens or bullies other
people
Is afraid of new situations
Gets sick a lot
Compiled by Rick Voakes, MD and William Pfohl, Psy D
Directions: Print this page on your printer, fill one out for each child,
and bring to your pediatrician. Your doctor can help with some of
these problems, and will tell you if further evaluation by a specialist
is needed.
Evolving Preventive Practices in Dental Health
It used to be "brush brush brush" for good dental health, but now
we are hearing that brushing actually damages your teeth! What are
we to do?
For young children, brushing is still the best prevention, so I still
recommend using a small soft toothbrush with a small dab of
toothpaste, twice a day starting at age 12 months. When children
are able to use dental floss, usually before age 8, they should begin
the adult routine: "Never use a toothbrush to clean your teeth!"
Brushing can damage your teeth!
Scrubbing with a brush damages the enamel of your teeth, and can
push down the gums causing them to recede. Instead, use dental
floss to clean your teeth, then use a soft toothbrush to gently brush
away what you pulled out with the floss. A little toothpaste is OK and
can provide some extra fluoride. Flossing efficiently takes some
training and practice, so get some lessons from your dentist at your
next check-up. You should see your dentist every 6-12 months.
Flossing will cause your gums to bleed at first. This means your
gums are not in good health, but continued flossing will make them
stronger. When you get more skilled at flossing, and your gums
improve, you will no longer have any bleeding. If there is a gap
between two teeth, be sure to floss each side of the gap. Keep in
mind that you are cleaning off every surface of every tooth. Develop
a routine that gets all your teeth completely clean, and stick to this
strategy every time until it becomes automatic. Then you will never
skip any teeth. I start on the uppers in the middle and go all the way
to the back on the right then left, then repeat this on the lowers.
Flossing might make your gums bleed at first, but this is good
because it makes them stronger!
Getting daily fluoride is another very important preventive measure.
All municipal water supplies in Kentucky (and most other states)
contain fluoride. Bottled water and spring water do not have
fluoride. Ready-to-feed formula does not contain fluoride, so use
either powder or concentrate mixed with fluoridated tap water.
Does eating sweets make your teeth rot? In a word, YES! Sugar is
food for bacteria on your teeth that cause tooth decay. The longer
you keep sugar in your mouth, the more decay you get.
Unfortunately, the sugar stays on your teeth for many hours after
you eat it, especially if it is sticky or gummy candy. Foods with sugar
and high acid content, such as honey or coke, are the most
damaging to your teeth. Gently brushing after sweets would be a
good strategy, and try to avoid eating between meals. Another
danger is sugar drinks, like pop, gatorade or fruit juice, especially
between meals.
Flossing makes you live longer!
In children under 8 years old, brushing twice a day is effective
prevention. After 12 months, a bottle should never be used. Bottles
are very damaging to teeth because the nipple holds harmful
bacteria and milk sugar or juice sugar against the surface of the
teeth and causes cavities. Switch to a sippy cup, but only for
mealtimes! Between meals, a child needs normal saliva in the mouth
which kills harmful bacteria that cause cavities. Constantly drinking
from a sippy cup between meals washes away saliva and replaces it
with sugar! The same applies to drinking and eating snacks during
the night, which removes your protective saliva.
Limit the use of sippy cups!
Dental health is an important part of your over-all health, so much
so that flossing increases your life span by at least 2 years. Plus you
will be able to enjoy eating with your own teeth (without pain) for
your entire life.
The Need for Calcium
Your body needs calcium every day in order for your muscles to
work properly, and to maintain the calcium in your bones (thats
what makes them strong and healthy).
But how much is enough calcium? The "conventional wisdom" is that
every person needs 800-1500 mg of calcium per day. While it is
important to get at least 400 mg every day, getting 2 or 3 times that
amount has not been shown to be better for your health in any way.
The World Health Organization recommends eating foods that
contain about 400 mg of calcium per day. There are many scientific
studies to support this recommendation.
Where should we get our dietary calcium from? The Dairy Council
ads seem to indicate that milk and dairy products are the best
source of calcium. However, dairy products also contain animal
protein and sodium that make your body actually lose calcium in the
urine. Studies show that increasing the intake of dairy products has
no effect on bone health. The best source of calcium is green leafy
vegetables (like spinach or turnip greens). You can also get calcium
from fortified orange juice, tofu (or other soy products), sweet
potatoes, broccoli, oats and beans, and several other foods (mostly
veggies).
A recent review article (Pediatrics, March 2005, Lanou et al)
compiled data from 58 scientific studies, and concluded that there is
little if any evidence to support increased dairy intake to promote
bone health and strength. There were a few studies that showed a
temporary increase in bone mineral density with increased dairy
intake, but after a few years, the effect disappeared.
Is it OK to drink milk? Dairy products are a good source of protein
and energy, and are healthy foods when eaten in moderation. Dairy
foods also supply a certain amount of calcium. Drinking skim milk is
much healthier for you than drinking too much juice or other sugarloaded
drinks. You just have to make sure that you are also eating
foods that will provide enough calcium to help your bones stay
strong, such as green leafy veggies!
Cure for the Common Cold?
Every few months another fad cure comes out for the common cold.
Unfortunately, none so far has held up to critical scientific testing.
The latest fad, the zinc lozenge, was shown by a study in JAMA
(Journal of the American Medical Association) to be completely
ineffective in relieving any of 9 symptoms of the common cold in
children. Even drugs claiming only "temporary relief of symptoms"
such as antihistamines and decongestants have not been shown to
work in children under 6 years of age.
Getting virus infections (like colds) is what keeps our immune
systems in top working condition!
Why is it so difficult to get a cure for an illness that affects all of us
so often? Maybe we should look at it a different way. Throughout our
millions of years of evolution, the features of our lives and health
that have stuck with us, have done so because they give us the
advantage of survival. Perhaps susceptibility to colds is one of these
survival advantages.
There are thousands of viruses in our environment, that our immune
systems must constantly deal with. Maybe it is an advantage for us
to have harmless cold viruses around to "practice on" every few
months to keep the immune system in tip-top shape. Imagine an
army that never ran drills or any kind of exercises, then suddenly
had to go out and fight a war. Would they be successful?
Care for Colds in Children
How can we help relieve cold symptoms in our children? Often
children get miserable with colds, and we can help them in a few
ways. A pain reliever like Tylenol® or Advil® can help, but use these
drugs carefully according to directions. Every year children die from
overdoses of these drugs.
Water vapor from a humidifier or vaporizer can be soothing to air
passages. Cool mist is safer because the child cannot be burned if
she touches it. However, the cool mist does not sterilize itself like a
vaporizer, so you must clean it often to prevent mold and bacteria
from growing in it.
Cold and cough medicines have very little advantage over placebo,
and have side effects like dry mouth and drowsiness. If you avoid
these medicines, you will be more alert to concentrate on other
projects to keep your mind off your cold symptoms. That is the best
relief I have found.
The old time remedy of honey (1 tsp for under 6, and 2 tsp every 4-6
hours for over 6 years of age) has been shown to be more effective
for cold and cough symptoms than over-the-counter medication.
Honey is fairly safe, EXCEPT under 1 year of age, as babies can get
botulism from eating honey. Do not give honey to a child under 12
months of age.
Fever is common with a cold, and is one of the body’s defenses
against viruses. If a fever continues for several days, it may be a
sign of complications of the cold, such as pneumonia or ear
infection. After 3 days of fever, you should take your child to the
doctor. You should go sooner if there are other worrisome signs like
wheezing or rapid breathing. If a child seems very ill the first day of
a cold, with high fevers, and it is during "flu season" (December to
March), you should call the doctor right away to get a flu test. If you
identify flu in the first few days, there is still time to take an antiviral
medication. If you wait over 2 days, it will be too late to use flu
medication. See the Health-byte on Flu.
So-called "fever reducers" are not intended to reduce fever.
The fever itself is not dangerous. It is just a sign to watch for. If
your child feels fine and has a high fever, there is no need to give
medicine. The "fever reducer" (such as Tylenol® etc) is just for
comfort. It is also important to give lots of fluids to children with
fevers to avoid dehydration. To learn more about treating fever, read
the Health-byte called "Fever is Good for You".
Children often get chest congestion and cough with a cold. This is
just the virus affecting the bronchial tubes in your chest. The cells in
the bronchial tubes produce mucus to kill the viruses, and you have
to cough the mucus out. Kids usually just swallow it, which is fine
because the stomach acid digests it along with the viruses. We can
help kids (and adults) to cough up the mucus by doing "percussion
treatments" on the chest and back. Also called chest physiotherapy,
this consists of patting the rib cage with your cupped hand, all over
the lung areas. A few minutes every hour is usually enough time. If
the chest muscles feel sore, you might need to be more gentle with
your percussion treatments.
Antibiotics should be avoided if you have a cold!
It is important to avoid taking antibiotics when you have a cold.
Antibiotics have absolutely zero effect on the cold viruses, but taking
them would make your bodys own bacteria resistant to antibiotics.
Later on, you might catch a dangerous bacterial infection, like
pneumonia, and the dangerous germs would learn to be resistant
from your own germs. In that case, antibiotics would not work, and
you would be at greater risk of dying from a possibly treatable
disease.
What about over-the-counter (OTC) cold and cough medicines? In
October 2007, the FDA advisory panels for pediatrics and
nonprescription drugs voted not to recommend OTC cold medicine
for any children under 6. They based their recommendation on
several reports of serious side effects of these drugs in children, and
the fact that there are no scientific studies showing that these
medicines actually work in children. Only one study has shown that
anything works for relief of cough and cold symptoms in children,
and that showed that honey is effective while dextromethorphan is
not effective in reducing cough. (Arch Ped and Adol Med, 2007)
Is there anything we can do to prevent complications of viral colds,
such as ear infections and pneumonia? There are not any
medications known to prevent complications, but we do know that
children exposed to tobacco smoke have a much higher risk of
complications. Completely eliminating any cigarette smoke from ALL
ROOMS of your house is the best way to prevent complic
Diarrhea in Children
Diarrhea is defined as loose or watery stools, in increased amounts,
and usually more frequent than usual (but not always). Increased
fluid in the intestines may be due to two reasons: (1) The intestines
are "sick" and can’t work normally to absorb the fluids that you
drink, and (2) some types of diarrhea can cause so much irritation
inside the intestines that they actually "secrete" more fluid than you
drink, robbing your body of vital fluids.
Fortunately, the second type ("secretory" diarrhea) is less common,
the classic cause being a bacteria called Cholera, mostly found in
India and Africa. However, other bacteria and some viruses can
cause secretory diarrhea to a lesser extent. This is why the main
goal of treatment is to keep fluids going in almost continually.
Avoid Antibiotics!
In the U.S., the major cause of diarrhea is virus infections, such as
rotavirus and other enteric viruses. As with other virus infections, it
is useless and even dangerous to use antibiotics to try to treat this
illness. Antibiotics kill the useful bacteria that normally live in the
intestines to help digest your food. Just killing your normal bacteria
can cause diarrhea, which is why diarrhea is a common side effect of
taking antibiotics.
Replacing the normal bacteria in the intestine can be done using
"probiotic therapy". Medications such as Lactinex and Floranex are
available in most drug stores over-the-counter. These are safe and
effective in reducing the duration of diarrhea symptoms for any type
of diarrhea, even if it was not caused by using antibiotics.
Other treatments often used for diarrhea in adults are Kaopectate
and Peptobismol. These are not safe to use in children because both
contain salicylate (aspirin) which can be very dangerous in children.
Diarrhea is the result of damage to the intestines.
In diarrhea, a virus infection in the intestines causes damage to the
inside lining (called the mucosa). It takes time for this damage to
heal so that the intestines can function normally again, and absorb
the fluids and foods that you drink and eat. The actual virus infection
goes away in a few days, but then we are left with the problem of
healing the damage left behind.
Treatment of Diarrhea
The major goal in treatment of diarrhea is to rest the intestines so
that they can heal, and to provide fluids and electolytes (the
chemicals normally found in the body) to prevent dehydration. Using
electrolyte solution (like Pedialyte) is a good way to do this. In older
children other clear liquids are generally adequate. Once the
diarrhea starts to improve, it is important to begin adding some mild
foods to provide nutrition for healing. In infants, this might mean
using a diarrhea formula (like Isomil-DF) or a pre-digested formula
(like Nutramigen or Alimentum).
Sometimes you get a set-back, and diarrhea gets worse after
starting foods. Just drop back to using clear liquids for 12-24 hours,
and start advancing again when the diarrhea starts to improve. This
can sometimes be tricky, and might take weeks before back to
normal. One study showed that biopsy of the mucosa does not get
back to normal until 1 month after a virus intestinal infection.
Signs of dehydration include dry mouth, no tears, weakness,
decreased urine output, and weight loss. If diarrhea continues more
than a few days, or if you think your child is dehydrated, you need to
call your doctor. Often a child will feel too weak or ill to drink much,
and you have to try to get at least an ounce or more of fluids in
every hour. If a baby refuses to drink from a bottle you might have
to give 5 or 6 tsp (about an ounce) of Pedialyte® on a spoon. This is
not too hard to do for a few hours, then the baby will start to feel
better and start drinking on her own.
Breastfed babies get less diarrhea, but it still can happen. Continue
breastfeeding, and add some Pedialyte in between feedings if the
baby will take it. Breastmilk has antibodies to help fight the
infection.
Probiotic therapy reduces diarrhea by 1-2 days!
If diarrhea does not improve in a few days, it is well worth getting
some probiotic therapy. Take some Lactinex or Floranex or Biotic
Buddies twice a day for 3 days. It can be mixed in any food or liquid.
Probiotic therapy replaces your normal bacteria in the intestines, to
force out abnormal bacteria and yeast, and help you digest your
food. Recently there is evidence that probiotics may help the
immune system by stimulating production of more IgA antibodies.
Bacterial intestinal infections (as opposed to virus) can cause
diarrhea which lasts much longer. Some of these might need to be
treated with antibiotics. Doctors usually will check a stool culture if
the diarrhea lasts over a week, or sooner if associated with bloody
or mucousy diarrhea and high fevers. A stool culture usually takes
about 2 days.
A vaccine against rotavirus has been developed, but it is currently
not available in the US. It was removed from the market after
several babies developed a rare bowel condition (called
intussusception) after taking the oral vaccine. If this problem can be
solved, the vaccine may again become available.
Summer Diarrhea
There are several viruses and a few bacteria that can contaminate
swimming pools, and are a common cause of summer diarrhea.
Viruses from a childs rectum enter the water, and spread to other
children. A child can give off viruses up to 2 weeks after having
diarrhea, so the CDC recommends not swimming in public pools for 2
weeks after having a diarrhea illness. Other people may not be as
considerate as you are, so be sure to shower well after swimming.
Never swallow pool water! When taking small children to the pool,
wash their bottoms well before you go, never change diapers at
poolside, use a bathroom instead.
Ear Infections in Children
Otitis media, an infection in the "middle ear", is one of the most
common infections in children. The middle ear is the space behind
the eardrum normally filled with air which allows the eardrum to
vibrate and transmit sounds to your brain via the cochlea. Air
normally gets into the middle ear through the eustachian tube,
which connects to the throat. When you feel your ears "pop" it is
from air moving through the eustachian tube either into or out of
your middle ear.
Otitis media is most commonly caused by pneumococcus germs that
normally live in the nose and throat. If the middle ear stays dry,
germs cannot live there. Sometimes fluid builds up allowing germs
to grow in the middle ear, causing otitis media. This often happens
after a virus cold, but may also result from allergies, or irritants (like
cigarette smoke) which cause swelling and blockage of the
eustachian tube. In fact, children exposed to cigarette smoke have 4
times as many ear infections as non-exposed children.
Another risk factor for ear infections is being in day care. This
exposes children to far more virus infections that could cause the
eustachian tubes to become blocked. Being in day care also allows
children to pass around several other types of bacteria that can
cause ear infections, as well as passing bacteria that have become
resistant to most antibiotics.
Antibiotic resistance is making the treatment of ear infections more
difficult. Fortunately, 80% of ear infections will clear up without
using antibiotics. New guidelines from the CDC (Centers for Disease
Control) warn doctors not to treat otitis media with the expensive
newer broad-spectrum antibiotics, but to use amoxicillin as the first
line drug. Many reasons are given for this choice, including the
effectiveness, safety and low cost of amoxicillin, as well as the
important effect of reducing antibiotic resistance.
Amoxicillin is the first-line drug for ear infections.
When should otitis media be treated with antibiotics? If the child is
not acutely ill, it is safe to treat with numbing ear drops to stop the
pain, and either observe for a few days (since 80% will go away
without using drugs) or else use a 10-day course of amoxicillin. In
older children, a shorter course (5 days) may be effective, but more
studies are needed to prove this. If the child was treated with
amoxicillin within the last month, a second choice drug should be
used.
Most cases of otitis media are actually not true infections but merely
fluid build-up inside the middle ear. These are known as Otitis Media
with Effusion (OME). The CDC is also warning doctors NOT to treat
OME with antibiotics, which of course will not help the problem at
all, but will contribute to bacterial resistance, and may harm the
patient if side effects occur. OME usually just requires time to clear
up, but can also be helped by popping your ears, to allow air to enter
the middle ear space. Doctors sometimes try using decongestant
medicines, which may help to relieve cold or allergy symptoms, but
otherwise have not been shown to be very effective in treating OME.
When do we recommend putting in EAR TUBES? If a child has more
than 5-6 separate ear infections in a year, we do recommend putting
a tiny plastic or steel tube into the eardrum. This allows air to enter
the middle ear space and keeps it dry. Ear tubes last about one to
four years, and fall out by themselves, usually without your knowing
it. It requires surgery (outpatient) and anesthesia, so putting in
tubes is the last resort for recurrent ear infections. Ear tubes may
also be considered if OME is lasting for over 6 months, and is
interfering with a child’s ability to hear.
Current strategies for preventing ear infections include: avoiding day
care centers (if possible), keeping the home smoke-free, providing
good nutrition, teaching your child good hand-washing practices,
and keeping immunizations up-to-date, including the new
pneumococcal vaccine.
Adults smoking in the home is a major risk factor for children
getting ear infections.
Exclusive breastfeeding during the first 6 months also reduces the
chances of getting ear infections. Antibodies in the breastmilk have a
protective effect. Also bottle-fed babies tend to have more chance of
getting milk into the eustachian tubes.
A study just published showed a 10% increase in ear infections in
babies who use pacifiers. Im not sure if this is due to altered
pressure in the eustachian tubes, or may have something to do with
bacteria on the pacifier (especially in the daycare setting where
resistant pneumococcus is found).
A previously used strategy for preventing ear infections used to be
putting kids on preventive antibiotics. This treatment is no longer
used, because of the serious risk of antibiotic resistance.
Fever is GOOD for you? ...YES!
Fever is a defense that the body uses to kill viruses and other germs.
We know that germs growing in cultures die if you turn up the
temperature too much. The same is happening in your body when
your brain turns up the temperature when you get sick. We also
know that the white blood cells and other protective mechanisms in
the body work more efficiently at higher temperatures. Getting a
fever is an important part of your bodys defense against infection.
So why do we try to stop fevers by using "fever reducers"?? The
concept of a medicine with the purpose of reducing fever is against
current medical knowledge (for the past 30 years!). Yet it has been
massively hyped up by the drug industry to sell more products. From
a medical standpoint, the ONLY reason to treat a fever with
medication is for comfort, not to reduce the temperature.
Fever is an important way your body fights infections.
All the exaggerated TV ads about reducing fever have led to a new
"disease" among parents, and among some medical personnel as
well, called fever phobia. This is the irrational fear of fever. Fever
phobia is made worse by hearing myths about children dying or
being brain damaged by having a high fever. This does not happen.
Many people know of children or adults that had a high fever and
ended up with some sort of injury, like brain damage, hearing loss or
other problems. These problems are never caused by fever. The
likely explanation is that they had a serious illness that gave them a
fever but it was the illness that caused the brain damage etc. The
fever was only trying to help fight the infection.
It is important to increase fluid intake when you have a fever, since
it increases evaporation of water from your body and you could get
dehydrated. In general it is a good idea to increase your fluid intake
whenever you get sick.
One result of fever phobia is a frantic desire to lower a childs
temperature! Parents have been known to alternate ibuprofen (Advil
or Motrin) with acetominophen (Tylenol) trying to get a better "fever
reducing" effect. This has resulted in overdoses that have caused
severe damage and even death to a few of these children. That is
why there is a national campaign now to stop parents from this
outdated practice. If you wish to give a medication to help your child
feel better when she has a fever, pick one medication, and follow the
directions carefully to avoid any overdosing. These medications do
have potentially serious and even fatal side effects.
The American Academy of Pediatrics recommends
NOT to alternate Tylenol with Advil! and repeated in the US last
year showing that there was a slightly lower temperature after
alternating Tylenol and Advil. Many pediatricians mistakenly
took this as an endorsement of this practice. However, when
asked if they felt this was a good medical practice, the authors
responded that they were merely bowing to parental and school
pressure to get around having to deal with "fever phobia".
This is a potentially dangerous practice that increases the
likelihood of an overdose.
Does fever cause convulsions? Some children (about 5-10% of all
children) have a tendency to get a short convulsion when their
temperature rises. It might be a sudden rise from 99 to 101, or it
might be with a higher fever. These convulsions are not dangerous,
never cause brain damage, and usually last less than 10 minutes.
Only about 50% of these children will ever have another convulsion.
All children outgrow these "febrile seizures" by the age of 6, most by
the age of 4. If your child has a febrile seizure, the doctor would still
want to check him, to make sure that is what it is, and not a serious
infection like meningitis.
Fever can be a sign that infection is present.
Fever is very useful as a SIGN of infection. If a child has a fever
lasting more than a few days, it tells us that the infection is not
going away, and the child should be seen by a doctor. Many people
ask me how high should a fever be to indicate a serious infection? It
is really more important to know the general condition of the child at
the time of the fever. A very ill appearing child with a fever of 101
would be much more concerning than a child who feels fine, is
drinking and playing but has a fever of 106. But if you are not sure
what is causing the fever, and your your child looks ill, you should
call your doctor.
Thus, fever itself IS good for you. It helps your body fight infection,
AND it can be an important sign that an infection is present, so it lets
you know when to alert your doctor if the cause is not known.
What You Eat Is Critically Important to Your Health
This is a very new concept!
In the past we have felt that your diet was semi-important to
health because you might eat too many calories and get fat, or not
get enough vitamins, but it wasnt a big deal. We had also found
that some foods contain dangerous bacteria or toxins, such as
salmonella or botulism. These are very rare cases, and often result
in the destruction of huge quantities of perfectly good food, but
usually only a few individuals were affected.
Many Common Foods Contain Simple but Dangerous Toxins
Just in the past few years, nutritional scientists have discovered
that two commonly eaten substances can be extremely toxic and can
ruin your health and eventually kill you. Specifically, these are
fructose and transfats.
The old way of looking at food was to count total calories, try to
get enough fiber and vitamins, and eat enough junk food to fill up
the rest of your caloric needs. Junk food is pretty easy for most
people to identify, and it usually is characterized by a high sugar
content. Now we know that junk food (high in transfat or sugar) is
actually toxic to the body.
Why do people consume so much sugar and fat? Partly because
fructose is addicting (see Health-Byte on fructose) and partly
because fructose is added to thousands of processed foods and we
dont even realize its there. (Who would guess that catsup is made
from high fructose corn syrup?) Another factor is that the fructose
industry is very sophisticated at selling its product. Advertising for
"sports drinks" is so intense that we have all grown up convinced
that Gatorade actually promotes health rather than destroying your
health (see the movie "Idiocracy"!).
Should we totally avoid eating any sugar or fat? Lets look at fat
first. Fat is food that is calorie-dense (9 calories per gram, compared
to 4 calories per gram for carbs) but it is not toxic. It is digested and
enters the metabolic pathways in your body in a controlled way.
Some types of fat (saturated fats and transfat) have been associated
with higher rates of heart disease in large population studies, but
this may be a secondary effect from the fructose that often
accompanies a high fat diet.
Now lets look at fructose. Regular table sugar, honey, brown
sugar, and high fructose corn syrup are the major sources of the
toxin fructose. Fructose is not regulated by our bodys metabolic
hormones, and generally degrades into free fatty acids and
triglycerides in the liver, which then fill up the bloodstream with
these dangerous forms of lipids. The body can tolerate small
amounts of fructose, such as the amount in fresh fruit, but the total
fructose intake can skyrocket when everything you eat has fructose
added. Plus you get an occasional giant blast of fructose from
drinking a soda, sports drink or fruit juice. Even a small glass of
orange juice has 6 times the amount of fructose as a whole orange,
but none of the beneficial fiber.
If your diet includes fructose on a regular basis, you are
putting yourself at high risk for diabetes, cardiovascular disease
such as stroke and heart attack, as well as liver disease and many
other diseases, as well as obesity.
Many foods are beneficial to your health, such as foods high in
vitamins, fiber and anti-oxidants. Just eating a diet with lots of
variety of fruits and vegetables will provide all these benefits. You
should also try to eat some foods that have healthy oils, such as
olive oil and fish. Other than that, you dont have to load up on blue
berries or drink excess omega this or that.
Bottom line: Fructose (found in all types of sugar and high
fructose corn syrup) is toxic to your body and can ruin your health.
Irregardless of your weight, you should avoid eating or drinking
fructose whenever possible. The easiest way to cut down on sugar is
to eliminate sugar from 100% of all beverages that you drink. This
includes drinks that may seem healthy such as fruit juice or sports
drinks. (These drinks are actually dangerous to your health because
of the high fructose content.)
Fructose is Poisoning our Children and Starving their Brains!
Major Breakthrough in Obesity Research
There has been a giant breakthrough in the understanding of obesity
since 2006! There is much more chemistry involved than we
originally thought. We have discovered that fructose, in the form of
high fructose corn syrup, table sugar, and fruit juice, has been been
poisoning our bodies by interfering with leptin, insulin and other
hormones. These food hormones control the amount of food that is
stored as fat, so when they are poisoned, the body stores energy in
fat cells, and very little is left over to use for activity. The brain is
deprived of energy too, so it produces other hormones that make
you hungry and you want to eat more high-energy foods.
Thus, your fat cells are stuffed, but your brain is starving, so it cant
function as well, plus it wants you to eat more!
In the past we already suspected that eating too much sugar was
bad, but we thought it was just the extra calories. Now it is known
that the fructose in sugar is poisoning our hormones. This effect
results in increased insulin, which makes the energy from the food
you eat go straight into fat cells, and even if you try to exercise to
lose weight, you dont have the energy available to do the exercise.
Fructose is processed by your liver, converting it to free fatty acids
and triglycerides (the "bad cholesterol"), putting you at risk for
heart disease, stroke, cancer, liver disease, diabetes and other
health risks, even if you eat a low fat diet.
Fructose Poisons the Fat and Energy Control Mechanisms
Fructose is quickly absorbed by the intestines and enters the liver
where it is converted to triglycerides and free fatty acids and other
fats. These are then released into the bloodstream. Free fatty acids
are known to make muscle cells insulin-resistant. Insulin resistance
means the cells do not respond to insulin, so the body keeps trying
to make more insulin to overcome the resistance. Excess insulin then
builds up throughout the body. (Sorry this is so complicated!)
Excess insulin blocks the effect of the hormone leptin on the
hypothalamus (an important part of your brain that controls energy
and basic body functions). Leptin is normally produced by your fat
cells and tells your brain when you have enough or too much fat. On
top of that, the triglycerides block the leptin from entering your
brain.
Leptin normally stimulates your hypothalamus to go into "energy
burning mode":
1. reduced appetite
2. increased thyroid hormone, with increased energy expenditure
3. increased stimulus to muscles, releasing heat
4. increased fat breakdown, to supply more energy
5. feeling of well-being, desire for activity
When leptin is blocked by too much insulin and triglycerides, the
hypothalamus goes into "energy saving mode":
1. slowing the heart rate, and decreasing energy use in your muscles
2. increasing the motion of your intestines (hungry growling
stomach) and increased food absorption
3. increased insulin production, which causes your body to store
energy in your fat cells
4. desire to be sedentary
When kids (or adults) get to this point, they start seeking more high
energy foods, like fats and sugars. They eat more fructose, and the
whole vicious cycle gets worse! This leads to a hyper-insulin state,
where too much insulin is produced, more energy goes into the fat
cells, and the brain is further starved. Excess insulin can also result
from eating too much fat or too little fiber, or from having a
sedentary lifestyle.
Why is there so much fructose in our diets?
Over the last few decades, high fructose corn syrup was discovered
to be a cheap source of food energy, which also had the marketing
advantage of being "addictive" because it makes you want more and
more. Today almost all sweet processed foods contain this, since it
very cheap to add, and increases sales since it starves our brains
and makes us want to eat more.
What is High Fructose Corn Syrup?
Natural corn syrup contains glucose, which is the simple sugar
used by our bodies. It does not taste very sweet, so food
manufacturers add enzymes to corn syrup to convert the glucose
to fructose which tastes very sweet. High fructose corn syrup is
55% fructose! Unfortunately, fructose is toxic to our bodies.
Reading labels to look for fructose or high fructose corn syrup can
help us spot the foods that should be avoided. Also realize that all
table sugar (sucrose) is half fructose, so cut back on regular sugar
as much as possible. Most of the food we recognize as "junk food"
probably is high in fructose or sucrose.
Another source of fructose is fruit juice. Many schools have made the
misguided choice to remove soft drinks from their vending machines
and replace them with fruit juice. The soft drinks have too much
fructose in the form of high fructose corn syrup, but even 100%
natural fruit juice has more fructose than full-sugar soft drinks! The
American Academy of Pediatrics has been advising children to
strictly limit juice intake for several years now.
What is safe for kids to drink?
Water is always the best fluid to drink, so doctors encourage
everyone to drink plenty of water. There are many sweet drinks that
are made with artificial sweeteners, such as aspartame, saccharin,
and sucralose. These do not have fructose, are very low in calories,
and have no known harmful effects on humans. There have been
some concerns raised about sweet drinks, that they may increase
the desire to eat or drink other sweet foods or drinks which may
contain fructose. There is also a concern that certain sweeteners
may have some of the insulin-increasing effects that fructose has,
but this has not yet been studied in humans. (There was a study in
rats which showed increased insulin from aspartame.)
There are some concerns that the long-term effects of sweeteners
have not been studied. We may be well to think of these as a
"nicotine patch" to wean us off our high sugar diet, but not to use
them heavily.
Bottom line: right now most doctors are recommending that diet
drinks are OK, since these are far less harmful than sugar drinks.
The best fluids to drink are water, and 2 or 3 cups a day of low fat
milk.
Preventing Foodborne Illness
There are several infections that we can catch from eating
contaminated food. Fresh fruits and veggies are an important part of
our diet, but we need to take precautions to prevent getting the
germs that often accompany them. Washing our produce well, and
keeping our hands washed are the first step. But there are many
other factors, and below is a list compiled by Contemporary
Pediatrics from recommendations of the FDA, CDC and USDA.
Hepatitis A
One important and potentially deadly infection from our food is
hepatitis A. I strongly urge all my patients to get the hepatitis A
vaccine. Much of our fresh produce is brought in from Mexico and
other countries where hepatitis A may be common, especially in the
winter months.
Treatment for the Flu
Flu virus typically strikes during the winter months. It often
gives symptoms similar to a bad cold, but most of the time also
includes muscle aches (aching all over), high fever, and cough. It
usually comes on very suddenly. Some children and adults will have
nausea, vomiting and diarrhea with the above symptoms.
Taking antibiotics for flu is not necessary, and may be
dangerous! Antibiotics can give unwanted side effects like rashes,
vomiting and diarrhea. They can also result in vaginal yeast
infections, and in babies a very bad yeast diaper rash. Many people
have died from severe allergic reactions to antibiotics. Another
serious side effect is the emerging problem of bacterial resistance.
This means that when antibiotics are over-used, or used for
unnecessary reasons, your normal bacteria become resistant to the
antibiotics. Later, when you might need an antibiotic to save you
from a bacterial infection, the antibiotics will not work, and you
could die from a bacterial infection.
Antibiotics are useless to treat the flu, and could cause dangerous
side effects.
Sometimes flu virus becomes complicated by a bacterial
infection, such as an ear infection or pneumonia. In this case, an
appropriate antibiotic should be used.
Treatment of flu symptoms includes rest, analgesics (such as
Tylenol® or Advil®), and lots of fluids. Sometimes decongestants
and antihistamines may help, but the effect is usually minimal. Flu
symptoms usually last about a week. If you have vomiting or
diarrhea, a clear liquid diet can help. Then progress to mild foods.
In the last few years, new medicines called "anti-virals" have
become available. These are prescription medicines, such as
Tamiflu® or Relenza®. These medicines cannot kill viruses, but they
can prevent their release from infected cells, thus preventing spread
to the rest of your body. If you wait until you have been sick for a
few days, the viruses are already spread to your entire body and
these medicines will not work at all.
Anti-viral medications must be given within 24 hours of the first
symptoms of the flu.
If you want to get the benefit of an anti-viral medicine to help
with your flu virus, you MUST call your doctor within the first 24
hours that you start to feel the symptoms. Then take the first dose
of the anti-viral as soon as you get it from the drugstore! After 48
hours, you will just be wasting your money on an anti-viral.
Prevention
The best prevention for flu illnesses is to keep physically fit.
This means avoiding harmful toxins like cigarette smoke, eating
healthy foods, and getting regular exercise. If your body is
physically fit, your immune system is far more likely to be working
at its best. Having a strong immune system is your very best defense
against flu and other viruses.
Another good prevention is to get a flu shot every year, around
November. These vaccines do not protect against all types of flu, but
they do protect from a few of the more common strains. The current
flu shot does not have any protection for the bird flu, but hopefully
in a few years, it will include that strain. (So far, efforts to create a
bird flu vaccine are not very successful!)
Another important prevention for flu is to avoid exposing
yourself to flu viruses, such as large crowds of people during the
winter. Also it really does help to wash your hands frequently, and
using alcohol-based handwash is even better at killing viruses.
Food Allergy in Children
Food allergies in children can be fatal, especially if they are the
immediate hypersensitivity type, which is characterized by hives,
wheezing and shock (very low blood pressure). If your child has
documented urticaria or anaphylaxis from eating a food, you will
need to alter your familys lifestyle in order to prevent a tragedy
from happening. This includes being very cautious about any traces
of the offending food being eaten. Even using cooking utensils that
have touched food allergens could give enough exposure to cause
death. Parents and older children will have to be complulsive about
reading labels on all foods eaten. Never eat foods that have
unknown ingredients.
A study in Food Allergy News in May 2007 reported 63 cases of fatal
reactions to foods. A great deal was learned and the following
conclusions were drawn:
The most common foods that cause deadly allergic reactions are
peanuts and tree nuts, accounting for 90%.
The other 10% were fish, shrimp and milk products.
75% of those who died were already known to have asthma.
Treating with an inhaler did not prevent death.
86% already knew they were allergic to the food they ate.
Fatal reactions occurred in many locations (restaurants, schools,
workplaces, festivals) but rarely at home.
Food came from other sources (restaurants, schools and homes of
friends), not from the family.
In some cases, parents and patients forgot to ask if the food
contained the food they are allergic to.
In other cases, they asked but were told incorrectly that the food
was not included.
Types of food included desserts and candy (35%) and Mexican
and Asian entrees (20%).
Epinephrine was given in a timely manner in only 13% of cases.
(This is important! Carry your epi-pen!!)
What Can Be Done?
Make sure your Epi-pen is not expired. If your child just passed 55
pounds, its time to graduate from Epi-pen Jr to to the adult Epi-pen.
Always carry it with you. An allergic reaction will always happen
when you least expect it!
When eating away from home: avoid desserts, or foods cooked in
sauces.
Food allergies can be fatal.
At restaurants, ask the manager if foods contain peanuts or peanut
oil (for example), dont rely on waiters or guessing from the menu.
Have an action plan ready in case food allergy is suspected. When
you decide that food allergy is possible, carry out the plan
immediately: give epinephrine, call 911. Dont delay.
If you are food allergic, and have an asthma attack after eating (!)
use epinephrine first, then your inhaler. It might be food allergy, not
just asthma!
Read all food labels all the time. Dont make assumptions if a food is
similar to what you usually eat!
Talk to the parents of your childs friends. Make sure they know
what your child is allergic to, and what to do in case of a reaction.
Join a food allergy support group, such as FEAST in the Bowling
Green area. You can learn a lot from the other families and the
allergy professionals who are involved.
Desserts and cookies were a common cause of deadly reactions.
Swollen Glands, Good or Bad?
When we get sick, we often notice sore lumps in our neck. These are
the lymph glands, or more accurately the "lymph nodes". They are
important organs in your body, which produce white blood cells to
fight infection. When you are sick, or injured, the lymph nodes work
harder to produce more white blood cells, so they get larger. This is
a good thing, because you need to have larger white blood cell
"factories" at a time when you need more white blood cells!
If you look carefully, almost all sick children will have lymph nodes
in the neck area, and often other areas, such as armpits, groin, and
several other places. The place depends on the site of the infection.
For example, we often see several pea-sized lymph nodes either
behind or in front of the ear with a swimmers ear infection. Often
lymph nodes will stay large for months, so they will be noticeable
even when the child (or adult) is not sick.
When should we worry about large lymph nodes?
Sometimes the lymph nodes themselves get infected. This is called
"lymphadenitis", and is usually caused by common germs such as
Staph and Strep. Sometimes, lymphadenitis is caused by more exotic
germs such as cat scratch disease (from cats) or brucellosis (from
rabbits) or others. Most of these can be treated with the same
antibiotics that kill Staph and Strep, so we usually start with a
common antibiotic such as cephalexin or trimethoprim-sulfa, to treat
lymphadenitis.
The signs of lymph node infection include: persisting fevers, nodes
that keep getting larger, very painful nodes, or nodes that are red or
draining pus. Most lymph nodes are less than three-quarters of an
inch across when they are healthy, so larger than that for more than
a few days, or any of the above signs, should suggest a visit to the
doctor.
How common is lymph node cancer?
Cancer in the lymph nodes can originate in the nodes (lymphoma) or
can start anywhere else and spread to the lymph nodes. Fortunately,
both lymphoma and metastatic (spreading) cancer are rare in
children. If an enlarged lymph node does not improve after two
courses of antibiotics, it is recommended that the node be removed
for a biopsy. The vast majority of these biopsies show cat scratch or
some other infection, but rarely will detect a lymphoma. Then the
child would be referred to an oncologist for treatment. Signs of
lymphoma include nodes that keep getting larger, usually not
painful, weight loss, and lethargy.
How often would a child have to get a biopsy of his lymph nodes?
Fortunately, almost never! Even though we commonly see 3/4 inch
and larger nodes with a sore throat or even a cold, they usually cool
off quickly when the infection is over. After a week, if a node is still
larger than 3/4 inch, you should call the doctor. Be sure to tell the
doctor if your child has been scratched by a cat or kitten, since this
would increase the chance of it being cat scratch disease. Most of
the time our hard-working lymph nodes return to a more normal size
of 1/2 inch or less, once their work is done.
What To Do About Headlice
Headlice is a common school-acquired problem. Once they get
established in the hair, it can be very challenging to get them out.
Most common insecticides are no longer effective in killing them.
Just like resistant bacteria, the "resistant" headlice are the ones
who live on and have more lice-babies who are resistant just like
their parents.
Headlice lay eggs, called nits, on the hair shaft. They are attached so
strongly, the only way to get them off is to slide them off the end of
each hair shaft. Use your fingernail against your thumb while
holding the hairshaft with your other hand. Once removed, they can
be dropped on the floor where they will die in a few days. Lice live
off your blood, and must be close to the scalp to get more blood for
food.
Most nits are laid close to the scalp, so look there first, especially
around the ears and nape of the neck. They look like tiny oval grains
of sand, firmly attached to the hair. If they fall off, they are not nits.
The adult lice look like tiny furry brown or beige bugs. They crawl
through the hair quickly, and come in various sizes.
The most important part of treatment is getting all the nits out,
which means 100% of them! I usually treat with an insecticide the
first time, then work hard on removing all the nits. A magnifying
glass can be helpful, and be sure to have good light. If bugs come
back, it might be resistance to the insecticide, but is often reinfestation
from school, or just not getting 100% of the nits out.
Nix is usually about 90-95% effective in killing lice, while the other
products are generally less effective, in the 50-75% range. A new
prescription insecticide called Ovide contains malathione, and is also
quite effective.
An interesting article a few years ago, tested several toxic
substances on nits, including insecticides, WD-40, oven cleaner,
hydrochloric acid, among others. Nothing killed them, and the
hydrochloric acid dissolved the hair, and left the nits to hatch
healthy new lice.
Another often used treatment is putting mayonaise on the hair for 3-
4 hours, holding it on with a plastic shower cap. Then rinse it out
and start working on the nits. The mayonaise suffocates the live
bugs, and softens the nits, making it easier to remove them. But it
does not kill the nits! Vaseline can also be used, but is much more
difficult to remove from the hair. Mayonaise is high in protein and is
a good hair conditioner.
Injury Prevention in Children
The first year of life is a time of active exploring of a whole new
world of things, some of which are potentially dangerous. We can do
a great deal to protect our children from most of these dangers.
Use your carseat 100% of the time, and only in the back seat.
Infants and toddlers should use rear-facing carseats until the age of
24 months. Children should not ride in the front seat in cars with
airbags, since the force of an airbag can kill a child.
Use a safe crib, with bars too close to allow the baby’s head to get
caught.
Cold running water is the best treatment for burns!
Let baby sleep on her back as much as possible, to avoid suffocation
or SIDS (sudden infant death syndrome).
Keep a smoke-free home. Any smoking inside the house will get to
the baby (see Second Hand Smoke). Also, cigarettes are the #1
leading cause of house fires.
Test your water heater temperature, and turn it down if over 120 F.
It takes only 1 second to cause third degree burns (needs skin graft)
if the water temp is over 120 F. The most effective first aid for a
burn is to run lots of cold water over the burn. This works even
better than ice, since the flowing water transfers the heat away
quicker.
Make sure you have working smoke detectors in every area of your
house. 6000 Americans die from smoke inhalation every year. Most
would have been saved if they had a smoke alarm.
Do not give the baby any honey during the first year. Babies can get
infant botulism (paralysis) from bacteria in the honey. After a year,
your immune system can protect you from traces of botulism found
in honey, but you could still get sick from bad food. Dont eat
refrigerated food that has been left out for several hours. Dont give
the baby any small hard chunks of food that she could choke on (like
a peanut, or popcorn).
Keep a bottle of activated charcoal in your medicine cabinet. It will
last for at least 10 years, and only costs a few dollars at any
drugstore. Always call the ER, the doctor, or the poison hotline to
find out what to do in a given situation. If in doubt, give the
charcoal; it cant hurt you.
Keep small objects (choking hazard) and plastic bags out of reach of
babies and small children.
Avoid too much sun; babies can burn easily. Sunscreen is OK for
babies, but will not prevent a burn if there is prolonged exposure
(more than one hour). Try to stay out of direct sunlight during the
middle of the day, 11 AM to 2 PM.
Baby walkers cause thousands of serious injuries every year. If used
for prolonged periods of time, they also slow down your baby’s
development. Many pediatricians recommend not to use them. If you
do use one, be certain it is in a safe area away from steps or ledges,
and use it no more than a few times per day.
Under a year, avoid foods that a child could choke on, such as hard
candy, popcorn, peanuts, whole grapes, raisins, etc.
Never leave a water-filled bucket in the house. Curious toddlers
often stick their heads into the bucket, fall in head first, and cannot
get out. The water then drowns them. It is amazing how often this
tragedy occurs.
Coffee table corners cause many head injuries and permanent facial
scars. During your childs toddler years, either store them, or apply
padding on the corners.
Internet Use and Your Family
The Internet is a network that connects people and information
all over the world through their computers. Search tools on your
computer allow you to find information, music, people, products, and
all sorts of things. The Internet is a great tool for children and adults
to learn about the world and find out all sorts of information.
However, much of the information and content on the Internet is not
reliable, and may even present a danger to children and vulnerable
adults. Children might be vulnerable to sexual predators,
inappropriate content on web pages, and fraudulent scams. Read
below to make sure your family gets the most out of the Internet
while minimizing the risks.
Internet Facts
1. What you type on your computer while you are online
automatically becomes public information. You cannot keep secrets
on the Internet! When you type anything online it is transmitted to
"servers" all over the world and copied millions of times. Your email
has literally millions of opportunities to be intercepted and read by
someone else!
2. People online are not always who they say they are. Children can
be easy prey to sexual predators who communicate through chat
rooms. There is no reason for a child or teen to chat online with
anyone who they dont know personally. This should be a strict rule.
3. Anyone can put information on the Internet. This means that
some of the information may be coming from criminals, con artists,
or even just from people who think they know everything but are
actually poorly informed. Bottom line: you cant trust everything you
read on the Internet.
4. The information on the Internet is not well organized, and you
might stumble on material that is offensive, pornographic, obscene,
violent, or racist. This is why younger children need to be monitored
while surfing the Internet.
Time Limits
The Internet is so vast and interesting that it can be addicting in a
way. Surfing the Internet should not take the place of other
important activities such as homework, playing outside, physical
activities, and spending time with friends. This goes for adults too.
The American Academy of Pediatrics recommends limiting total
screen time (including TV, video games, and Internet) to less than 2
hours a day. A digital timer might help you keep track of the total
time spent.
Safety First!
Here are some rules to teach your children. Let them know that
these rules are meant to protect them.
NEVER give out personal information. This includes your name,
address, phone number, age, race, school name or location, or
friends names or other personal information of theirs.
NEVER share passwords, even with friends.
NEVER meet with someone from the Internet that you dont already
know. (Adults sometimes meet other people online, but even then,
you should be very careful about a first meeting. Make sure you
bring a friend, and meet in a public place.)
NEVER respond to messages that hurt your feelings or make you feel
uncomfortable. Do not write back. Tell a parent right away.
NEVER send mean messages online. Bullying is wrong, whether in
person or online.
NEVER use the Internet to harm another person.
NEVER write email from another persons address pretending to be
them. This could get both of you in big trouble!
NEVER plagiarize. Its illegal to copy information from the Internet
(or anywhere else) and say that you wrote it. Its OK to use that
information (for example, in a school project) and give credit to the
person who really wrote it.
CyberTipline
There are several organizations dedicated to protecting children
from harm they might encounter on the internet. The CyberTipline
coordinates many of these, and you can reach them through the
CyberTipline at www.CyberTipline.com.
Another great website is NetSmartz at www.netsmartz.org, which
also has lots of other very useful information about health and other
topics.
AAP Recommendations
The American Academy of Pediatrics recommends these additional
ways to safeguard your childrens internet experience:
1. Surf the web with your children.
2. Put the computer in a room where you can monitor your children.
Computers should never be placed in a room where a door can be
closed and a parent excluded.
3. Use tracking software. Its a simple way to keep track of where
your children have been on the web. However, nothing can replace
supervision.
4. Install software or services that can filter or block offensive
websites and material. Be aware however, that children are smart
enough to find ways around the filters. Also, you may find that the
filters may be more restrictive than you want.
5. Find out what the internet use policies are at your childs school
or library.
Surfing the Net
Using a search engine such as Yahoo or Google can find thousands of
web sites on just about any subject. Remember that anyone can put
information on the internet, and not all of it is reliable. There is lots
of printed material that is totally false information, and the internet
is far less reliable than print. Some sites actually give false
information on purpose. Others may give false information to further
their cause, and they dont verify the information since they want to
believe that it is true.
If you start your search with known reliable sites, this will give you
basic information to build on. If other sites contradict that
information, be very suspicious. Be sure to check the Health-byte
about "voodoo science" to find out the warning signs of false
information.
Lactose Intolerance
Lactose intolerance is a condition where the inability to digest
milk sugar (lactose) leads to one or more of these symptoms:
abdominal pain, bloating, diarrhea, nausea, and flatulence (passing
gas). The symptoms usually hit within several minutes of ingesting a
food that contains lactose, a type of sugar found in most dairy
products (milk, ice cream, yogurt, cheese, cottage cheese, etc).
The most common cause of lactose intolerance is "primary
lactase deficiency". This form is hereditary, but may not show up
until later childhood or adolescence. As the child gets older he loses
the ability to produce the enzyme ("lactase") which digests lactose.
Sometimes the onset of symptoms is gradual, and worsens with age.
Children often learn by experience to avoid dairy products most of
the time, so the association with dairy foods is not always obvious to
the parents.
Secondary lactase deficiency, the non-hereditary form, can
happen to anyone, usually from an injury to the intestines. Several
types of injury could cause this, including severe diarrhea, diarrhea
that lasts a long time, chemotherapy, harmful bacteria, and other
causes. The symptoms are the same, since both types result in
excess lactose build-up in the intestines.
Your doctor can affirm the diagnosis of lactose intolerance by
doing a biopsy of your small intestine or by running an expensive
hydrogen analysis of your breath. However, most of the time, the
history of symptoms following lactose ingestion will be enough
proof. Try a lactose-free diet for 2 weeks, and see if the symptoms
stop. Then try drinking milk again and see if the symptoms return.
Then try using Lactaid® before ingesting dairy products, and you
will know for sure if the treatment stops your symptoms.
Symptoms of lactose intolerance can be completely controlled!
The treatment consists of taking a small amount of lactase
enzyme supplement at the time you eat a dairy food. Several
products such as Lactaid® can be taken just before eating dairy
foods. The vanilla-flavored tabs are very easy to chew and taste like
candy. There is a new lactase supplement that can last for 12 hours.
Some milk products, such as Lactaid Milk, have the enzyme already
added.
Children with lactose intolerance sometimes can get enough
dairy products to supply their calcium needs, but parents should
make sure they also get green vegetables and other sources of
calcium. They may even need to take a calcium supplement.
Make sure lactose intolerant children (and adults) are getting
enough calcium!
How to Get the Most Out of Your Nasal Steroids
Nasal steroid medications are one of the most effective means of
controlling nasal allergies. Yet, many people try them and get no
improvement. They have a miracle drug in their hands, and don’t
know how to use it!
A good medicine might be useless if it cant get to the right
place.
A common practice in using nasal sprays is to "spray and sniff"
thinking this will suck the medicine up into the nose. Wrong! This
merely sucks all the medicine into your throat where it does no
good, and gives you an annoying taste. Do not sniff!
Here’s how to get your miracle drug to perform its miracle:
1) Hold your breath or breathe through your mouth. Practice not
sniffing.
2) Sit upright, and pump one spray into each nostril. Do not sniff.
3) Quickly lie down on your back and tilt your head back.
4) Place your index fingers on both sides of your nose and massage
your nose back and forth, swishing the medication around inside
your nose.
Sniffing your nasal spray will suck it down your throat.
5) Then tilt your head to the left and right to get the medication into
your sinus cavities, and continue to massage with your fingers.
6) After 30 seconds, you can get up, sniff, blow your nose or do
anything you like. The medicine is already in your sinuses.
Repeat the whole process once or twice every day. Within a day or
two you will start to benefit from this extremely effective
medication.
Cure for Sensitive Teeth
What causes teeth to be sensitive to hot or cold foods and liquids? It
could be dental caries (cavities) or a tooth abscess, so be sure to see
your dentist on a regular basis to rule out this cause. No cavities?
Then you just have "sensitive teeth". This is a condition caused by
tiny (even microscopic) cracks in the tooth enamel, which allows the
heat or cold to penetrate to the nerve. It is more common with
increasing age, but could start at any age.
One possible cause is excess acid in your diet that erodes the enamel
of your teeth. Drinks with acid are the major culprit, including citrus
juices, especially lemonade, and colas with high phosphoric acid
content. Eliminating these from your diet could make a big
difference, and you should notice an improvement in a few weeks.
There are several products, such as toothpaste, which attempt to
numb the pain, but these are only a temporary fix, and usually not
very effective.
Seal up the cracks!
If eliminating acidic drinks does not work, a great "cure" involves
actually sealing up the cracks. Sometimes the dentist can apply a
coating which seals the cracks to some extent. I have found this to
wear off pretty quickly, or not be effective at all. Most sealants
would only cover the opening of the crack, so when it wears off, the
entire crack is opened up again.
My dentist recommended a product called "Gel-Kam" (Colgate)
which has proved to be a "miracle cure" for me. It is concentrated
fluoride, which seals the cracks at a molecular level. The tiny
fluoride atoms can fill in the microscopic cracks completely, so they
fill the crack all the way to the bottom.
Another cause of sensitive teeth is receding gums. Be sure you are
brushing away from the gums, not down onto them (which makes
them recede).
Controlled randomized studies have shown that fluoride gel or
solution is effective in reducing tooth sensitivity. Where exposed
nerve roots are the cause, a more concentrated solution was more
effective. Check with your dentist if you feel this to be the case.
Use carefully!
It does take a bit of effort to make this cure work! Too much fluoride
can make you sick (fluorosis). It must be applied slowly over a
period of weeks.
Here is how you do it:
1. Floss and gently brush your teeth at bedtime.
2. Rinse your mouth out well.
3. Put Gel-Kam (a slimy gel) on about half of your toothbrush and
gently apply that one small dose to all your teeth. Gently brush it on,
and be sure to get the sides and backs of all your teeth. Dont
swallow it!
4. Immediately spit out all the residue. But DO NOT RINSE ! The trick
is to keep that coating of Gel-Kam on your teeth all night long!
5. It is OK to swallow saliva during the night. It will not contain
enough fluoride to hurt you.
If you notice any side effects, stop the treatments and report your
side effects to your doctor or dentist. Side effects of too much
fluoride include: White spots on the teeth, nausea and vomiting,
diarrhea, stomach ache, excessive salivation, muscle cramps or
convulsions.Using the gel properly should not give any side effects.
You should notice improvement in a week or so, and a maximum
effect in a few months. You can then stop the treatments, but it is
OK to repeat the treatment any time you get any sensitivity. It is
also OK to use Gel-Kam in a preventive way, once a week, to stave
off sensitivity.
Sinusitis in Children
Sinusitis means "inflammation in the nasal sinuses" and is usually
caused either by virus infections, like colds or flu, or by allergies.
There is no treatment for virus colds, other than temporary relief of
symptoms. There are many treatments for allergies, which can be
tailored to meet the specific needs of each patient by the doctor.
Sometimes, children get a bacterial infection in their sinuses. It is
not easy to diagnose this condition, since cultures will always show
growth of common normal germs, such as strep pneumo. Sinus
xrays are not helpful either, because they usually show sinus fluid
and inflammation during normal colds, so there would be no
difference on xray to distinguish a bacterial infection.
Green nasal mucus is a normal phase of a virus cold.
The diagnosis can only be made clinically, by meeting one of two
criteria. The first is termed "severe acute sinusitis", and consists of
thick pus-like nasal discharge, high fever, headache and sinus
tenderness that lasts at least 4 days. In a regular cold the fever
usually goes away after 4-5 days (or sooner), and the greenish
mucous usually signals improvement in other symptoms. Severe
acute sinusitis is sometimes called purulent rhinitis, but should not
be confused with the normal greenish nasal discharge that is part of
a regular cold.
The second and more common type of bacterial sinusitis is termed
"persistent acute sinusitis". This means it must persist for over 10-
14 days, without starting to improve. Most colds will start to
improve before 10-14 days. They might hang on for several weeks,
but at least be starting to improve by 10-14 days. Symptoms of
persistent acute sinusitis include thick nasal discharge, cough both
day and night, bad breath, but not usually much fever.
A cold that does not improve after 10-14 days should be treated
with an antibiotic.
Many doctors treat colds before 10 days, trying to prevent or "head
off" a bacterial sinusitis. This is a very dangerous practice, since it
has no effect whatsoever on preventing sinusitis, but is one of the
major reasons for the serious problem of bacterial resistance. (Be
sure to read the health-byte on "bacterial resistance"!!)
Sinusitis is usually caused by the same bacteria that cause ear
infections, so similar antibiotics can be used. They are usually used
for longer courses because of the difficulty in getting the drugs from
the bloodstream into the nasal sinuses.
Sleep Disorders in Children
Is my child getting enough sleep?
Here are some warning signs that children are not getting enough
sleep:
Trouble awakening and getting up in the morning.Crying or
becoming angry too easily.
Unwillingness to behave or follow expectations.
Falling asleep at inappropriate times (for example, during a movie)
Difficulty concentrating or performing tasks.
Difficulty going to sleep at bedtime.
Why is Sleep So Important?
Children and adults who are deprived of adequate sleep are at high
risk of serious health problems, including accidents, poor learning at
school, poor job performance, depression and other mental health
problems, and a poor quality of life.
Sleep is needed for Good Health!
Children up to ten years old need at least 9 hours of sleep every
night. When children get less than that, they have trouble paying
attention, learning, and just doing everyday tasks. Even teens and
adults need at least 8 hours of sleep every night.
Tips to get better sleep:
** Make sure your bedroom is dark and quiet. A night-light is OK,
but not shining in your childs face!
** Dont over-heat the room. You sleep better when the room is
cooler. Get a thermostat that sets a cooler temperature at night, and
this will also save money in the winter time.
** Try to go to bed the same time every night. Your childs internal
clock will learn to get her sleepy at the same time each night. This
includes weekends! (Staying up late, and sleeping in on weekends
does a lot of damage to your childs "internal clock"!)
** Getting lots of exercise can help you sleep better, but dont
exercise for 2 hours prior to bed-time. This will just "wind up" your
child and make it harder to sleep.
** A light snack, such as a serving of fruit, is OK at bedtime, but
dont eat too much.
** Its good to establish a routine that alerts your body to know that
it is time to sleep. A bed-time routine might include a bath, brushing
teeth, soothing music, or a bed-time story.
** Avoid caffeine drinks, like sodas, especially in the afternoon or
evening.
Caffeine can keep you awake! (duh!)
Physical Problems
Sometimes physical problems such as allergies or large tonsils can
cause disturbed sleep, or even sleep apnea (breathing stops for
more than 20 seconds at a time). A sleep lab can determine if there
is significant sleep disturbance. Check with your doctor if you think
this is the case.
Strep Throat
Strep (short for group A Streptococcus) is a bacteria that can cause
sore throats in both adults and children. It is no different than any
other type of sore throat, and comes in mild, medium and severe
cases. Most sore throats are caused by viruses, so they go away
without any treatment. Strep throat is the only type of sore throat
that needs antibiotic treatment, because strep might lead to
complications that could be severe or life-threatening.
Sore throats caused by other bacteria, or by viruses, should (almost)
never be treated with antibiotics. Many good studies have shown
that using antibiotics for non-strep sore throats ONLY leads to side
effects, bacterial resistance, and absolutely zero effect on the the
sore throat.
Signs of strep throat include throat pain, pus on the tonsils, fever,
headache, vomiting, stomach ache, and tiredness. These could also
be signs of viral sore throat, so you really can’t tell if it is strep
without doing a strep test. Two common tests are the throat culture
(takes 24 hours, 95% accurate) and the strep antigen test (takes 5
minutes, 95% accurate).
If it is not true strep, a sore throat should not be treated with
antibiotics.
Many experts recommend doing both tests for increased accuracy,
which would be the ideal situation. However, most doctors’ offices
are restricted from doing cultures by federal regulations, called
CLIA, which prevents doctors from doing most lab tests in their
offices. CLIA allows me to do only strep antigen tests, hemoglobins,
urinalysis and a few other tests. CLIA is one example of extreme
government over-regulation of medicine that is making the cost of
medical care soar in the last few years.
Back to strep, once you prove that group A strep is the cause of the
sore throat, you should treat it with a specific antibiotic that is
effective against strep. Penicillin (the really yucky tasting stuff) is
most effective, so that is the preferred treatment if you are taking
pills. Macrolides (like azithromycin or erythromycin) are the first
choice for anyone allergic to penicillin. Other drugs similar to
penicillin, like amoxicillin, are also effective. Tetracycline and sulfatype
drugs are NOT effective.
Sometimes the strep infection is still there after taking all the
antibiotic. There are several possible reasons for this. The
widespread abuse of antibiotics has led to bacterial resistance in all
of our normal germs (that we carry around in our bodies all the
time). These germs produce chemicals that destroy penicillin, so
your normal germs might be "protecting" the strep germs by
destroying the penicillin. To prevent this, NEVER take antibiotics for
viral infections, when they are completely unnecessary. Over half of
antibiotics prescribed in the USA are given for inappropriate reasons,
and should not be used. Be sure to read the health-byte about
"bacterial resistance"!!
Even a mild case of strep throat could lead to heart damage from
rheumatic fever, if not treated.
In the last 30 years, the incidence of rheumatic fever, the most
severe strep complication, has dropped to very low levels. Checking
for strep will prevent this complication, because any strep infection
treated within 2-3 weeks will not lead to rheumatic fever. Most
cases of rheumatic fever arise from strep throats that did not get
checked. You have to remember that strep throat might be a mild
case, and might go away in a few days without treatment (but could
then go on to rheumatic fever 2 months later!). If in doubt, it is
better to get a strep test to know for sure.
The Miracle of Vaccines
We often take for granted the protection from horrible diseases that
we get from vaccines: polio, meningitis, diphtheria! If you saw the
bird flu movie, or other movies about deadly viruses that can wipe
out huge populations, that could be happening now if it were not for
the miracle of the vaccines that are available to us today.
We are sorry to have to poke babies and make them cry, but the pain
is just a few minutes, and can protect them from horrible disease
and death. As technology advances, we are able to make vaccines
against more and more illnesses. This means more shots and more
expense. But it also means a better life in the future for our children.
How Vaccines Work
Vaccines work by stimulating your own immune system to produce
antibodies against dangerous viruses or bacteria. When your
immune cells are exposed to foreign material, they start to produce
antibodies to attack it. A vaccine would expose your immune cells to
pieces of these dangerous germs, or milder forms of the germs
which are harmless. This way, you dont have to go through the
actual serious illness to become immune to it.
New Vaccines
Several new vaccines are now available. One exciting new vaccine
protects children and adults from many strains of human papilloma
virus (HPV) which causes cervical cancer in women, and causes
genital warts in both men and women. It is recommended for all
girls at the 6th grade checkup. It is now covered on the state
vaccine program for all girls over age 9.
There is also a new and improved version of the rotavirus vaccine
(diarrhea virus) which so far has a very good safety record. It is an
oral vaccine and is given at the 2, 4 and 6 month checkups.
Most children are already protected from Hepatitis B, but a different
hepatitis virus (Hepatitis A) is much more contagious and can be
transmitted by food. Hepatitis A virus is fairly common in Mexico,
and we are importing more and more food from Mexico these days.
There have been reports of Hepatitis A outbreaks due to food
contamination in many states all over the USA. States which border
Mexico (Texas, New Mexico, Arizona and California) have used the
Hepatitis A vaccine for several years, and have virtually eliminated
this disease in those states. The American Academy of Pediatrics
now recommends that all children in the USA be vaccinated for
Hepatitis A.
The most contagious form of meningitis is caused by bacteria called
meningococcus. It can be prevented with a new vaccine which is
given at the 6th grade checkup (age 11). It requires only one dose
and is very safe.
Safety of Vaccines
As parents and physicians our first concern is for the safety of our
children. Could vaccines cause damage or endanger our children? As
with any other treatment or medication, there could be rare side
effects that are not expected. For vaccines, these are called "adverse
events", and are reported to the CDC (Centers for Disease Control)
by every doctor who recognizes one. Fortunately, these are on the
order of one-in-a-million. When adverse events exceed the one-in-amillion
level, the CDC and FDA react quickly to investigate and
discontinue the vaccine if a connection is established, such as the
first rotavirus vaccine in the 1990s (which was linked to 17 cases of
intestinal blockage called "intussusception"---out of millions of
doses given).
False Alarms
There have also been several "false alarms", where there seemed to
be a connection between vaccines and something else. An example
is the apparent increase in autism in the last ten to fifteen years.
Could this be due to something in vaccines? The CDC has looked very
hard at this question, and there have been literally hundreds of
studies to see if this is the case. So far, there is absolutely no
evidence to support such a connection. Here are the major points of
interest:
(1) The "increase" in autism is actually due to an increase in
diagnosing autism. In the past there were the same number of
children with autism, but they were called by different names. New
methods of categorizing the disease have caused the apparent
increase in the statistics.
(2) A preservative containing trace amounts of mercury (thimerosal)
was used in many vaccines to prevent bacterial growth. There has
been concern that the mercury could have caused autism or other
adverse effects. However, there has never been shown to be an
increase autism or any other behavior problems among children who
got thimerosal vs those who didnt. Furthermore, when thimerosal
was removed from almost all vaccines in the last 5 years, there was
no change in the incidence of autism or other behavior problems.
Additionally, there have never been any reports of mercury toxicity
in any children receiving thimerosal.
Misconceptions
There are many misconceptions that both doctors and parents have
about when and when not to give vaccines. If you are allergic to
actual components of the vaccine or have had a serious reaction,
such as anaphylaxis (shock, wheezing, passing out), then you should
not get the vaccine.
Otherwise, you should NOT delay getting vaccine for these "lame"
reasons:
(1) having a minor illness or fever under 102.
(2) getting over an illness.
(3) taking antibiotics.
(4) fever from a previous DPT shot, if fever was less than 105.
(5) mother or other family member is pregnant.
(6) child was premature.
(7) recent exposure to a disease.
(8) having allergies in general.
(9) allergies to duck meat or feathers, or to chicken eggs.
(10) family member had a vaccine reaction.
Another misconception is that vaccines are safer or work better if
given separately. Giving many vaccines at once is not only much
more humane (why force a child to endure the pain over and over
again?) but each vaccine in a combination works just as effectively.
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