Holiday Safety

Happy Holidays to all! As a Jewish American, I still, like everybody else, so enjoy seeing all of the holiday decorations coming out. Who doesn’t get excited about this time of year?

Let’s review some highlights for indoor holiday decoration safety.  My advise about outdoor decorations is actually very simple–the younger the child, the less involved in the decorating process, the better.

1. Trees

• if using “artificial” make sure they are “fire resistant”
• For live trees–fresh trees are green, have some sticky resin on the trunk, needles don’t snap in half when bent and don’t fall off if the tree is shaken.
• Cut off approximately 2″ from the base and keep in water
• Keep away from fire or heat source like heaters, radiators
• Keep away from traffic areas like doorways.
• Secure to walls with thin wire for stability

2. Trimmings

• use only non-flammable
• avoid sharp or breakable objects
• avoid leaded materials (note–besides patriotism, “Made in America” is usually, but NOT ALWAYS, best)
• Avoid small parts
• avoid artificial candy or food

3. Candles

• Keep away from trees
• Keep away from paper
• Non-flammable holders
• Extinguish all flames if you go out or retire for the evening (this means YOU, fellow Jews celebrating with the Hannukah menorah!)

4. Lights

• Check for broken or cracked sockets
• Check wires
• Never use electric light on metal tree–the tree can conduct electricity causing shocks or fires
• Shut off all electric ornaments upon retiring for the evening
• Do not overload sockets–no more than 3 standard light sets per extension cord

5. Paper

• Don’t keep paper by open flame like fireplace or candles (DUH!!)
• Do not burn used wrapping paper in fireplace

6. Spun glass–“angel hair” decorations of sprayed artificial snow can be inhaled and              cause serious lung injury

7. Poinsettias are poisonous–is it really necessary to include them in decorating your              house when there are young children around?

Bottom line that I remind all patients : Christmas decorations, and in particular, the tree, are the definition of “attractive nuisance”–little kids are drawn to them.  I mean–that’s the point, isn’t it?  So you cannot keep the child away from the tree.  You must endeavor to keep the tree away from the kid.

Please keep all of these things in mind.  And let’s make this the Happiest and HEALTHIEST Holiday Season yet!!

Send along questions and comments and thanks for following.

 

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Safety Update

Let’s take note of 2 consumer products with troubled safety records for children.

The first is instant soup/”ramen” noodle preparations for microwave ovens.  An 11 year study finds that 20% of all scald burn injuries presenting to the ER, 9500 children aged 4-12 each year, are caused by microwaved soup containers.  The peak age is 7 years; girls make up 57% of injuries.  Most burns occurred when the small package was opened after heating, spilling contents on the child, causing burns to the torso (40% of all injuries).  The added water can quickly overheat and when tipped over can cause a scald wound.  While most incidents result in only mild burns with full and uneventful recovery, still up to 10% were more severe, including those requiring scar management and skin grafting.  So prudence is still the order of the day.

The authors recommend that improved product design, like smaller opening and wider base, will help to limit risk here.  But, of course, there is no substitute for common sense: Don’t let younger children handle these products; close supervision for adolescents. Counsel them to focus on the task at hand–PUT THE DARN PHONE DOWN when using microwave and handling hot food.

The other warning references hover boards.  Between 2015-16 researchers report almost 27,000 youth injuries treated in US Emergency Departments.  As one might expect, boys predominate here (52%) wth peak incidence at age 12.  Most injuries involved the upper extremity(34%) with fractures making up 40% of those problems; head injuries were second  but the most common to result in hospitalization (14%). Burns from the board spontaneously catching fire was actually a rare occurrence.  A frequent risk factor was “multitasking” involving–you guessed it–the child trying to use a smart phone or listen to music while operating the hover board.  Wouldn’t it be at least a small  welcome change if reading a book while hover boarding caused some of this problem(sorry, couldn’t resist)?

One added comment: this same study reported >120,000 skateboard injuries in the ED over the same 2 year period; 75% of those among boys.  One word: HELMETS!!

Send along questions and comments, and thanks for following.

The Measles Outbreak

By now I hope most of you are aware of the evolving measles outbreak right here in Ocean County--4 confirmed cases SO FAR.  The “index (first) case” is an unimmunized child who contracted measles while visiting family in Israel. That nation itself has its own epidemic–1200 cases in 2018, including the death of an 18 mo old, the first Israeli measles fatality since 2003.  Israel’s public health system is state of the art and had previously maintained strong 2 dose compliance but recently has seen its immunization rate slip, mostly among a few groups of ultra-Orthodox worshippers. That problem has been imported to Rockland County NY and now here.

We should pause and note that this is becoming something of a worldwide phenomenon–its happening in Europe too.  In 2018 there are 41,000 cases of measles SO FAR including 41 deaths.  We can all recall other recent outbreaks–2013 383 Amish children in Ohio,  2014 starting with an un-immunized child in Disneyland in California, and in 2015 among un-immunized Somali immigrants in Minnesota.  Furthermore, latest data here in the US are that the rate of un-immunized children, while still low,  has quadrupled in the last 15 years–from 0.3% to 1.3%. It is also important to recall statistics from prior to measles vaccine licensure in 1963.  In the preceding decades, virtually all Americans contracted measles in childhood (3-4 million cases) with 48,000 hospitalizations, over 1,000 children with encephalitis complications and 400-500 deaths every year.  By  2,000, US measles was essentially eradicated, with no instances of epidemic spread reported domestically anywhere.

So, unfortunately, it would seem that this developing problem is very predictable and largely self inflicted–we are doing it to ourselves.  We have taken note of the effects locally of  recent social media posts which are very emotional, very sympathetic, but also very wrong.  Additionally, the current infected Ocean County individuals–and large segments of the so called “anti-vaxxers”– site “religious exemptions” as their justification.  But a review of established US religious groups demonstrates only one smaller denomination–Dutch Reformed–which includes vaccine refusal as an accepted tenant of faith.  All other groups official position is to actively encourage their congregants to be immunized.  So this rational is simply untrue; its mostly a myth.  Their is essentially NO organized US religious group basis to decline to immunize.

But here we are in 2014 and, like “Poltergeist”–“their BA-ack…”  I urge you all to keep these things in mind the next time someone tries to convince you of the “dangers” of vaccines.

Thank you for following.

 

 

Formula Feeding Your Baby

Let’s really go back to the very beginning and review some basics of baby formula preparation.  Of course, we pediatricians still advise that the best infant nutrition is breastfeeding, but at some point most babies’ diets will likely include some formula.   The AAP recommends the following:

1. Prepare the formula according to the manufacturer’s directions ONLY.  DO NOT dilute the formula (to save money) or concentrate it (to increase calorie concentration).  Both can cause diarrhea at least and sometimes disruption of blood electrolyte levels like sodium and potassium which can lead to severe problems with normal nerve or heart function.
2. Make sure the water source is safe.  If your home has well water, it’s best to boil the water for 1 minute (“rolling boil”) and then allow 30 minutes to cool before mixing your formula.
3. Be careful to maintain proper formula temperature.  Use a bottle warmer or place the bottle in a container of hot water for 5-10 minutes.  It is best not to microwave the bottle.  Microwaving can heat the insides of any container in an uneven fashion which can cause burns, and also it can disrupt the nutritional value of some formula ingredients.  At any rate, its best to always check the formula temperature on yourself prior to giving it to the baby.
4. “Cleanliness is next to Gdliness.”  Always wash your hands prior to preparing or feeding your baby.  Wash all countertops and surfaces carefully.  A dishwasher will not clean the inside of a long, thin bottle very well, so wash by hand using a bottle brush for the inside.  Bottles and nipples should all be cleaned with hot, soapy water and be sure to rinse all soap off thoroughly.  By the way, best to boil nipples for approximately 10 minutes prior to using for the first time.  This is not for cleanliness as much as to boil off residue of chemicals used to soften the rubber.
5. Be aware of proper storage times.  All leftover formula should be discarded 1 hour after feeding to the baby.  Powder based preparations can be refrigerated for 24 hours; bottles of unused concentrate can be refrigerated for 48 hours prior to usage.

As stated initially, breastfeeding is still best and what I and all pediatricians recommend as the first line nutritional source for your baby’s best health.  This seems like a good place for me to give a shout out to Dr. Rose St. Fleur and my colleagues at the Center for Breastfeeding at Jersey Shore Medical Center.  They can be reached at 732-776-3329 and are an excellent resource/clearinghouse for questions from nursing mothers.  Tell them Dr. G sent you (they won’t care).

Thanks for following.

Hand Foot and Mouth Disease

Hand foot and mouth disease (HFMD) is a well known and common illness. Let’s review.

Curiously, when I was a resident, this was mostly a summertime/early fall illness, but now I diagnose it almost year round.  I do not have a good explanation for that development.

HFMD was first identified in 1957 in New Zealand and Canada.  Initially, due to the mouth blisters,  HFMD was assumed to be caused by herpes virus, which explains one of its common names–“herpangina.”  However, we now know that it is caused by a different virus, called “coxsackie.”  This is a member of the “enterovirus” family, which means that its a GI virus and spread via hand/mouth contact from body fluids–not from “droplet” contact like from coughing and sneezing. Therefore lets note that best preventive measure is careful hand washing, as well as cleaning home surfaces and toys.  Many different strains of coxsackie can cause HFMD which explains why we keep seeing kids getting it year after year, and why your child can get it multiple times. HFMD incubates for 3-5 days after exposure, then may cause symptoms like fever, white or red spots in the mouth, throat, or lips as well as blister like lesions on the palms and soles and red spots on the rest of the body.  Any combination of the above is possible–a child does not have to have all of the above to have an HFMD coxsackie infection. Spread in public or nursery schools, day care/babysitting centers is universal.

HFMD can be sporadic, but I very typically see it in epidemics: when one case comes in I expect to be inundated.  Epidemics as large as 1.5 million cases are not uncommon.  Most infections occur in children < 10 years old.  Symptoms may last 7-10 days but generally resolve in < 1 week.  There is no specific treatment to shorten its course.  Use acetaminophen or ibuprofen for pain or fever. Cold compresses like ice pops are very helpful.  Honey or topical treatments like Abreva or Blistex can relieve the sore throat pain.  The only common complication is dehydration due to poor fluid intake caused by pain from numerous mouth lesions.  Those children may require ER or admission for IV fluids, but again, they almost always recover nicely.  There are numerous more severe but rare complications which have been reported.  In 33 years of practice I have never seen one personally, so there’s no reason to list them here just to make you folks nervous.

One last point.  HFMD affects children.  “Hoof and Mouth” disease infects cattle and is a completely different problem.  They have nothing whatsoever to do with each other.

Please send along questions or comments, and thanks for following.

Youth Tackle Football

OK, I may make some enemies in our community with what I am about to say, but here goes.  There is a growing consensus among health professionals who care for children–including pediatricians like me, neurologists, radiologists, and others–that organized tackle football should be avoided in younger players.  Children have larger heads and weaker neck muscles compared to adults, making collisions riskier.  Moreover, younger, less experienced players more often utilize poorer tackling technique which also raises the risk threshold.  While hard shell helmets do limit skull fractures, the evidence regarding concussion prevention is actually quite poor.

Of course, at these younger ages the brain is still developing.  Researchers at Wake Forest Medical School recently followed children 8-13 yrs during football season with MRI scans.  None of the boys had developed concussion symptoms during the study period, yet their scans showed subtle but clear disruptions of normal brain metabolism from pre to post season.  Related studies done at Boston University Medical School looked at former NFL players and found that those who had started in the sport <12 years old had a significantly higher incidence of “white matter” brain changes and more frequent difficulties with depression, cognitive impairment and behavioral problems in later life.  There are additional studies reporting similar patterns in people playing other contact sports from an early age compared to those who did not.

So where does that leave us?  Well, I am certainly NOT “anti-football”(well, maybe anti-NE Patriots, but anyway…).  > 1 million boys play high school football.  As I spend a good part of my time begging/yelling at my teen patients to get off their darn phones and to be more active, I strongly support this and all high school sports.  Presently there are approximately 1.2 million US 9-12 year olds playing youth football (numbers have decreased in the last few years because of these concerns) and those kids sustain approximately 240-585 head hits each season.  Note that youth football is a relatively recent phenomenon–when I was growing up in the 1960’s-70’s it hardly existed.  Back then, tackle football was something we played on weekends in the park if we could collect enough guys to make 2 teams.  There were no non-HS football “leagues”–tackle or otherwise– to speak of.

We need a new paradigm, and I believe this is where flag football comes in.  The nonpartisan Aspen Institute recently issued a White Paper advocating for flag only <14 years.  Here in NJ, Assemblywoman Valerie Vainieri-Huttle (D-Bergen) has introduced a bill (A-3760) that would allow flag football but ban tackle statewide <12 yrs.  Given the above, the arguments against–that teaching younger boys proper tackling technique improves safety–are, at best, unconvincing.  I believe this bill deserves serious consideration; personally (and professionally) I support it.

Don’t all yell at me at once– but send along questions and comments, and thanks for following.

Flu Shots 2018

Our flu shots are in, so it’s time to get in and get vaccinated. I have discussed this before here, here and here.

The flu is not just a bad cold. Last year, 179 U.S. children died of influenza, which is the second most annual deaths ever (2009 was the worst). 80% of those deaths occurred in unimmunized children, and 49% of those deaths were in children who were previously healthy. The American Academy of Pediatrics recommends that everyone over age 6 months be immunized against the flu.

• All healthcare and law enforcement personnel, and all who work with children should be immunized.
• Pregnant women should be immunized. The immunity can pass across the placenta to the unborn baby and provide useful immunity in the first 6 months of life.
• Children with egg allergy can safely receive flu shots. No special precautions are required.
• Vaccination is safe for breastfeeding mothers and infants.
• Children under age 3 should receive 2 doses of 0.25 cc vaccine at least 1 month apart in their first month immunized. In subsequent years, only one 0.25 cc dose is required less than 3 years.
• Children 3-9 years should receive two doses of 0.5 cc at least 1 month apart the first year immunized. In subsequent years, they only need one 0.5 cc dose.
• Above age 9, people required one dose 0.5 cc each year.
• Injected, inactivated vaccine (“IIV4”) is the vaccine of choice. Note that since this is inactivated, there is no risk of infection from this shot.
• Live, attenuated “quadrivalent” vaccine (“LA4”)–nasal spray–can be used in selected situations (greater than 2 years of age, no health problems). As this vaccine is less effective against H1N1, I have chosen to not stock this form.

As flu season is very unpredictable, AAP recommendations stress that the earlier the better to be immunized. If possible, by the end of October.

So give us a call.

Thanks for following.