A Word on Immunizations

Up to now I had avoided wading into the subject of immunization safety.  It’s such a large topic and so fraught emotionally that I thought it would be difficult to do any justice to it in this short space.  But the recent events in California demand attention.  Please refer here and here for the latest information on the subject.  I encourage you to pay particular attention to statistics on the rate of infection and complications from this disease pre and post introduction of measles immunization (1963).  Because “one picture is worth 1,000 words”(in this case 2) you can get a little sense of how bad measles can be below:

(above pics from en.wikipedia.net and http://www.soft.org)

Measles is one of the most infectious illnesses know to mankind.  One measles patient can infect 12-18 others compared to 1 flu patient infecting 4 others and 1/2-3 for Ebola(remember the fevered stories about the dangers of Ebola spread from just a few months ago?)  And measles is severe–1/3 of measles cases will result in serious complications like pneumonia or encephalitis.

And another very important point about the current measles outbreak in California: 17 of the infected people (from as far away as Mexico) had no contact with Disneyland.  So consider how easily that indicates that the disease can spread.  Now check out this picture:

(above from www.richardbradley.net)

This is a polio ward from prior to the licensing of the modern polio vaccines.  All of those children are in “iron lungs”–old style ventilators for those who cannot breathe due to paralasis of respiratory muscles and diaphragm.  I have never diagnosed polio in my 30 year professional career as there have been no new cases in the Western Hemisphere since 1979.  Feel safe in “Fortress America?” Given the spread of measles out west, maybe we shouldn’t.

The eradication of these major infections is a major public health triumph of modern medical science and is responsible for saving millions and millions of lives worldwide.  Call me with questions about immunizing your child.  By all means, please do your own research online if you wish, but be sure to utilize only reputable websites maintained by fully trained and established experts in the field of childrens’ infections.  I recommend the following:

http://vec.chop.edu/service/vaccine-education-center/vaccine-safety/vaccine-safety.html

http://www.cdc.gov/vaccines/

Thanks for following.

“Return to learn” after concussion

Concussions have been back in the news recently.  A detailed discussion of concussion is far too involved to fully review in this limited space. Quick definition: if your child sustains a head injury with loss of consciousness or has subsequent persistent headache or neck pains, dizziness, memory problems, nausea, vomiting or fatigue, then he or she has suffered a concussion.

As it happens not infrequently in medicine, the pendulum swings back and forth with respect to management of this problem.  So while a long time ago you might have tried to “walk it off”, more recently it had been advised to keep inactive and maintain almost complete rest until symptom resolution. Now a new article strongly suggests that early if gradual return to school may be best. This is called “return to learn”. Strategies I employ to assist my patients in that process include:

• No video games or social media. They can do that after return to all other life activities.
• No sports – that’s next to last.
• If it hurts, stop doing it and rest.
• Limit TV viewing, reading and homework. As above, if it hurts stop and rest. Perform these activities for shorter periods.
• Listening to music (not playing an instrument) or drawing may be ok.
• Take regular rest while attempting homework; gradually increase the homework session time
• At school:
  • Your child may transition by attending school part time and gradually increasing duration in class.
  • Allow child to rest head on desk or retire to nurse’s office when symptoms increase. The amount of rest necessary may vary with the challenge that class presents to your child.
  • To ease eye strain, turn down computer screen brightness and use sunglasses or baseball cap to shield eyes from the bright light.
  • Your child might need to avoid noisy rooms like the gymnasium, cafeteria, or music hall.
  • Note taking may be problematic. Your child may record lessons, the teacher may give him or her the lesson notes, or a classmate might share his or her notes.
  • Obviously, testing should be postponed until resolution of symptoms.

The duration of the concussion symptoms varies with children and with the situation. We should keep in close contact  to monitor your child’s progress through the process of transitioning back to his or her full life’s activities.

Please contact me with questions, comments, or requests for future posts. Thanks for following.

Reading

A recent article adds further evidence of the many advantages of reading to your child. This latest study indicates that those benefits extend even to reading to school age, literate children.  So don’t stop reading with them just because they themselves have learned to read.  Keep doing so, and EVERY DAY.

There are other steps that I recommend employing:

1) The American Academy of Pediatrics recommends that children under age 2 be shielded from all video media but rather you should read exclusively to them.  I believe this may be a bit over the top–watching some limited TV or videos with your young toddler can be fun and educational AS LONG AS you are watching with him or her; talking, teaching, asking questions to engage and stimulate their eager little minds.  It is the tendency to use the TV as an “electronic babysitter,” making the child only the passive receptacle of what’s occuring in front of them that is intellectually unhelpful.(In my day, the TV was nicknamed “the idiot box.”)

2) Read and sing to your child daily.  Look at them.  Speak slowly and clearly (not like me!) and allow your child to see how your mouth forms the words.

3) As above, ask age appropriate questions about what you are reading (“Do you see the boy running?”  “Where is the red ball?” “How many doggies can you count on the page?” )

4) For older toddlers, use your finger to scroll along the lines as you read them so your child sees how you progress across the page.

5) Associate words with pictures–say the word then point to the picture of the object (“see the cat?”)

6) Also for older toddlers, make “theme days” for letters or numbers–eg, highlight all words beginning with “S”, feature that sound, challenge your child to think of words starting with the letter “S”.  Sesame Street uses this technique to great effect(remember, “Today’s show is brought to you by the letter “S”?)

7) Play rhyming games–challenge your child to think of words that rhyme with a word on that page

8) Involve older children.  If older sister reads to little brother, she gets to stay up later (for example).  More reading time for sister, bonding time for siblings, and a few precious free minutes for parents!!

9) Be a good role model–read books yourself, and talk about the books you are reading with your child.  That’s a great stimulus–as you child grows she will more likely follow your lead.

Please feel free to comment or ask quesitons, and thanks for following.

croup

Since I’ve seen several cases of croup this week, I thought it would be a good time to say a word about that condition.

Croup occurs mostly in children aged 6 mo-3 years.  The problem localizes in the subglottic airway(below the vocal cords).  Some but not all children have fever.  The most common symptom is stridor–a harsh cough sometimes described as “barky”, “brassy,” or “seal-like.” Stridor often worsens when the child is upset and crying.  Some children will also develop bronchospasm–wheezing–at the same time, but, again, not invariably.  So, what can be done?

What you can do:

• Acetaminophen or ibuprofen for fever or discomfort
• Lots of fluids
• Cool mist humidifier or vaporizer by head of your child’s bed
• For attacks of breathing difficulty, bring your child into the bathroom, close the doors and windows, and run the shower good and hot to fill the room with steam; stay in there for 15-30 minutes to loosen the tight cough
• Often 10-15 minutes of breathing cool air after the above will finish the job and bring relief.  Bundle your child up and walk outside for a few minutes after the shower routine above if she is still symptomatic
• Cough treatments as I’ve discussed previously

What I do:

• Steroids–usually one dose only is enough and most studies indicate that oral administration is just as effective as injections
• Inhaled epinephrine
• Bronchodilators like albuterol may help with wheezing but not stridor.

Croup is usually a mild, if uncomfortable, illness.  Infrequently, a child’s difficulties may necessitate hospital admission for serial breathing treatments, IV fluids, or supplemental oxygen.  However, please note that even in these cases, croup will usually resolve on its own in 3-4 days.  Croup is almost always caused by viruses so antibiotics are of no use.  Some children have spasmodic croup–recurring episodes of abrupt onset of stridorous coughing.  This is more allergic in nature.  The treatment is the same as above and the symptoms are usually very responsive to these interventions.

You should call promptly if you notice:

• Cyanosis (blue lips or tongue)
• Retractions (skin sucks in outlining the ribcage while inhaling)
• Excessive drooling
• Rapid breathing–1 breath per second that does not improve within one hour

Please forward questions or comments, and thanks for following.