Friday, May 25, 2012
Friday, May 6, 2011
Infant-Strength Acetaminophen to Be Discontinued Mid Year
Infant-Strength Acetaminophen to Be Discontinued, Just One Children's Concentration Will Be Available
For new moms you might want to go buy one bottle of infant tylenol if you anticipate using it in the next year.
For new moms you might want to go buy one bottle of infant tylenol if you anticipate using it in the next year.
Friday, January 28, 2011
Methamphetamine Exposure in Infants
From Pediatrics in Review:
Methamphetamines
Despite concerns about infants exposed to this drug as rates of usage in the United States increase, there is a general dearth of reports involving in utero exposure. Isolated cases of cardiac defects, cleft lip, and biliary atresia have been reported. Use during pregnancy also has been associated with increased rates of fetal distress and growth restriction, resulting in small-for-gestational age size at birth. Methamphetamine exposure has been associated with preterm birth, but this linkage has been disputed more recently. Neurobehavioral patterns of decreased arousal, increased stress, and poor quality of movement have been described, as has a withdrawal syndrome in a few infants (4%).
Methamphetamines
Despite concerns about infants exposed to this drug as rates of usage in the United States increase, there is a general dearth of reports involving in utero exposure. Isolated cases of cardiac defects, cleft lip, and biliary atresia have been reported. Use during pregnancy also has been associated with increased rates of fetal distress and growth restriction, resulting in small-for-gestational age size at birth. Methamphetamine exposure has been associated with preterm birth, but this linkage has been disputed more recently. Neurobehavioral patterns of decreased arousal, increased stress, and poor quality of movement have been described, as has a withdrawal syndrome in a few infants (4%).
Monday, January 10, 2011
Diarrhea that won't go away
Ulcerative Colitis and Crohn Disease
What is that?
Well simply put it is diarrhea and abdominal pain that lasts a long time. This is thought to be a result of your immune system overreacting in your digestive system.
How do you tell the difference between the two?
Ulcerative Colitis - like it sounds involves the colon. It is often associated with rectal bleeding.
Crohn's Disease. Children usually present with chronic tummy pain, diarrhea, and weight loss. Ulcers can present from the mouth to the bottom.
These two diseases can also present with skin or joint problems.
How do you diagnose it?
A Gastroenterologist will use a scope to take pictures of your insides and also do a biopsy.
How do you treat it?
Medicines that calm down the immune system are used like steroids. For severe Ulcerative Colitis a chance to cut is a chance to cure. Removal of the large intestine is often curative in UC.
Take Home Points
Most diarrhea is self limited and will resolve after about 2 weeks. If your diarrhea lasts longer you should see a specialist.
What is that?
Well simply put it is diarrhea and abdominal pain that lasts a long time. This is thought to be a result of your immune system overreacting in your digestive system.
How do you tell the difference between the two?
Ulcerative Colitis - like it sounds involves the colon. It is often associated with rectal bleeding.
Crohn's Disease. Children usually present with chronic tummy pain, diarrhea, and weight loss. Ulcers can present from the mouth to the bottom.
These two diseases can also present with skin or joint problems.
How do you diagnose it?
A Gastroenterologist will use a scope to take pictures of your insides and also do a biopsy.
How do you treat it?
Medicines that calm down the immune system are used like steroids. For severe Ulcerative Colitis a chance to cut is a chance to cure. Removal of the large intestine is often curative in UC.
Take Home Points
Most diarrhea is self limited and will resolve after about 2 weeks. If your diarrhea lasts longer you should see a specialist.
Saturday, January 1, 2011
What Can Prenatal Drugs Do To My Baby?
Prescription and non-Prescription drugs can influence how your baby thinks, behaves, and looks. The following are just a few examples.
Nicotene
Prenatally nicotine-exposed infants are at increased risk for preterm birth and sudden infant death syndrome as well as fetal growth restriction. There is a higher incidences of orofacial clefts, neural tube defects, and cryptorchidism.
A smooth philtrum — The divot between the nose and upper lip flattens
Thin vermilion — The upper lip thins
Small palpebral fissures — Eye width decreases
Benzodiazepines
"Withdrawal phenomena have been reported in exposed infants. Signs include hypoventilation, irritability, hypertonicity, and "floppy infant syndrome," particularly after use in late gestation. These symptoms can appear within a few days to 3 weeks after birth and can last for several months."
Lauren M. Jansson and Martha L. Velez
Infants of Drug-dependent Mothers
Pediatr. Rev. 2011 32: 5-13.
Nicotene
Prenatally nicotine-exposed infants are at increased risk for preterm birth and sudden infant death syndrome as well as fetal growth restriction. There is a higher incidences of orofacial clefts, neural tube defects, and cryptorchidism.
Alcohol
can produce preterm birth, Low Birth Weight, and fetal alcohol spectrum disorder which affects brain and facial features. A smooth philtrum — The divot between the nose and upper lip flattens
Thin vermilion — The upper lip thins
Small palpebral fissures — Eye width decreases
Opioids
The most notable opioid effects may include tonal problems, tachypnea, feeding and sleeping problems, fever, and seizures.Benzodiazepines
"Withdrawal phenomena have been reported in exposed infants. Signs include hypoventilation, irritability, hypertonicity, and "floppy infant syndrome," particularly after use in late gestation. These symptoms can appear within a few days to 3 weeks after birth and can last for several months."
Lauren M. Jansson and Martha L. Velez
Infants of Drug-dependent Mothers
Pediatr. Rev. 2011 32: 5-13.
Doctor Means Teacher
The word "doctor" means "teacher," in Latin. The best primary care physicians will be master teachers and students.
From Pediatrics in Review Jan 2011:
"When performing health maintenance or managing chronic illness, teaching becomes a major component of care. Patients, parents, and caregivers are the students (although the complete physician will be learning constantly from those folks as well)."
Look for a physician that helps you learn and also is willing to listen to you.
From Pediatrics in Review Jan 2011:
"When performing health maintenance or managing chronic illness, teaching becomes a major component of care. Patients, parents, and caregivers are the students (although the complete physician will be learning constantly from those folks as well)."
Look for a physician that helps you learn and also is willing to listen to you.
Thursday, December 23, 2010
Inception - The Power of an Idea
With a new year coming many of us will want to help encourage change in ourselves, our spouse, or our friend's behavior.
First we can ask what we want to change.
Then follow with four simple questions:
Desire - Do you want to change?
Ability - How can you change? What do you need to do?
Reasons - What are some reasons to change?
Need - How important is this to you?
By merely thinking about changing for the better we plant a seed that might sprout and change who we are and change who we will become.
First we can ask what we want to change.
Then follow with four simple questions:
Desire - Do you want to change?
Ability - How can you change? What do you need to do?
Reasons - What are some reasons to change?
Need - How important is this to you?
By merely thinking about changing for the better we plant a seed that might sprout and change who we are and change who we will become.
Thursday, November 18, 2010
Do you have itchy dry skin?
Check out www.nationaleczema.org
Eczema equals dry damaged skin. This is a chronic condition that improves with daily skin care.
Following are a few non-soap cleanser suggestions:
Eczema equals dry damaged skin. This is a chronic condition that improves with daily skin care.
Following are a few non-soap cleanser suggestions:
- Aquaphor® Gentle Wash
- AVEENO® Advanced Care Wash
- Basis® Sensitive Skin Bar
- CeraVe™ Hydrating Cleanser
- Cetaphil® Gentle Cleansing Bar
- Dove® Sensitive Skin Unscented Beauty Bar
- Mustela® Stelatopia Cream Cleanser
- Oilatum® Cleansing Bar
What moisturizer should I use?
Following are a few suggestions: - Aquaphor® Healing Ointment
- AVEENO® Advanced Care Cream
- Crisco Regular Shortening
- CeraVe™ Moisturizing Cream
- Cetaphil® Moisturizing Cream
- Eucerin® Original Creme
- Moisturel® Therapeutic Cream
- Mustela® Stelatopia Moisturizing Cream
- Vanicream™ Moisturizing Skin Cream
- Vaseline® Petroleum Jelly
Monday, October 25, 2010
Homeopathic Teething Tablets May Pose Risk for Children, FDA Warns
From Journal Watch:
"Hyland's Teething Tablets, which are sold over-the-counter and used for relieving symptoms of teething, are being recalled because they contain inconsistent amounts of belladonna, which can be harmful to children in large doses.
According to the FDA, which has been conducting an ongoing inspection of the product's manufacturer, Standard Homeopathic Company, there have also been reports of children consuming too many of the tablets because the caps on the bottles are not childproof.
Symptoms of belladonna toxicity in children can include skin flushing, dry skin and mouth, increased body temperature, dilated pupils, difficulty breathing, excessive sleepiness, disorientation, and seizures. The agency urges consumers to stop giving the tablets to their children; unused portions should be discarded or returned."
According to the FDA, which has been conducting an ongoing inspection of the product's manufacturer, Standard Homeopathic Company, there have also been reports of children consuming too many of the tablets because the caps on the bottles are not childproof.
Symptoms of belladonna toxicity in children can include skin flushing, dry skin and mouth, increased body temperature, dilated pupils, difficulty breathing, excessive sleepiness, disorientation, and seizures. The agency urges consumers to stop giving the tablets to their children; unused portions should be discarded or returned."
Thursday, October 7, 2010
Congenital Adrenal Hyperplasia CAH: My body isn't making the right steroid.
Steroids are produced naturally in our bodies. Steroids help us cope with stress, keep the right balance of salts in our body, and help us mature into boys (testosterone) and girls (estrogen). Sometimes children inherit problems with the enzymes that make these steroids.
Where are the steroids made? Some of the steroids are made in the adrenal glands which sit on top of the kidneys. The adrenal glands look a little bit like scoops of ice cream on the kidneys. The outside of the adrenal glands make steroids.
Think of steroid production like irrigation. If one row is blocked, water will flow to other rows. If one of the ways to make specific steroids are blocked, the ingredients get pushed down different rows and make different steroids.
The most common problem in CAH is one enzyme doesn't work and so too much "boy" steroid is made. This can lead to little girls' genitals that look male. This also leads to not enough specific steroid to help that child's body balance salt and stress which can make them very sick.
The way to treat this is to give the child steroids that replace what the body needs and can't make. This allows the body to get back in balance with managing salt, stress, and "boy" steroids (yes girls have a little bit of boy "steroids" or hormones too).
Note, when children are born in many states the hospitals and doctor's offices screen for these and many other problems.
If you want more info check out CAH at the Mayo Clinic or google CAH and emedicine.
Where are the steroids made? Some of the steroids are made in the adrenal glands which sit on top of the kidneys. The adrenal glands look a little bit like scoops of ice cream on the kidneys. The outside of the adrenal glands make steroids.
Think of steroid production like irrigation. If one row is blocked, water will flow to other rows. If one of the ways to make specific steroids are blocked, the ingredients get pushed down different rows and make different steroids.
The most common problem in CAH is one enzyme doesn't work and so too much "boy" steroid is made. This can lead to little girls' genitals that look male. This also leads to not enough specific steroid to help that child's body balance salt and stress which can make them very sick.
The way to treat this is to give the child steroids that replace what the body needs and can't make. This allows the body to get back in balance with managing salt, stress, and "boy" steroids (yes girls have a little bit of boy "steroids" or hormones too).
Note, when children are born in many states the hospitals and doctor's offices screen for these and many other problems.
If you want more info check out CAH at the Mayo Clinic or google CAH and emedicine.
Wednesday, October 6, 2010
Three Missed Menstrual Cycles = Time for a check up.
Regular cycles mean that the ovaries are working normally. Ovaries produce estrogen. The main estrogen that our bodies produce is Estradiol. Yes, even for men.
When to get a check up?
1. Menses absent for 90 days.
2. Menses not started by 15.
3. No sign of puberty by 13.
4. Menses not started within 3 years of breast development.
So I missed three periods what can that mean? The fancy name is secondary amenorrhea. That means that your periods have stopped. Most stop for 4 reasons: High levels of prolactin, low thyroid, low estrogen because of the ovary, and Polycystic Ovarian Syndrome or PCOS.
High prolactin, low thyroid, and ovary problems lead to low estradiol. The average normal level of estradiol is 100 pg/mL.
When to get a check up?
1. Menses absent for 90 days.
2. Menses not started by 15.
3. No sign of puberty by 13.
4. Menses not started within 3 years of breast development.
So I missed three periods what can that mean? The fancy name is secondary amenorrhea. That means that your periods have stopped. Most stop for 4 reasons: High levels of prolactin, low thyroid, low estrogen because of the ovary, and Polycystic Ovarian Syndrome or PCOS.
High prolactin, low thyroid, and ovary problems lead to low estradiol. The average normal level of estradiol is 100 pg/mL.
Compression-Only CPR by Bystanders Raises Rates of Survival
This is an update from Journal Watch
"Compression-only CPR by lay rescuers modestly increases survival over conventional resuscitation, a JAMA study finds.
Researchers prospectively studied rates of survival to hospital discharge in some 4400 adult victims of out-of-hospital cardiac arrest not witnessed by emergency medical personnel. All episodes occurred over a 5-year period in Arizona during a public campaign to encourage bystander intervention with compression-only CPR.
Among the principal findings:
* The overall annual rate of bystander CPR increased during the 5-year period, from 28% to 40%.
* Compression-only CPR increased from 20% to 76%.
* Overall survival increased from 4% to 10%; survival was 13% in the compression-only group.
* Good neurological status at discharge, however, did not differ significantly between those getting compression-only versus conventional CPR."
"Compression-only CPR by lay rescuers modestly increases survival over conventional resuscitation, a JAMA study finds.
Researchers prospectively studied rates of survival to hospital discharge in some 4400 adult victims of out-of-hospital cardiac arrest not witnessed by emergency medical personnel. All episodes occurred over a 5-year period in Arizona during a public campaign to encourage bystander intervention with compression-only CPR.
Among the principal findings:
* The overall annual rate of bystander CPR increased during the 5-year period, from 28% to 40%.
* Compression-only CPR increased from 20% to 76%.
* Overall survival increased from 4% to 10%; survival was 13% in the compression-only group.
* Good neurological status at discharge, however, did not differ significantly between those getting compression-only versus conventional CPR."
Sunday, October 3, 2010
Pregnant Women Should Get Flu Shots
The American College of Obstetricians and Gynecologists recommends that all women who are pregnant during flu season receive inactivated influenza vaccinations.
Morning Only prep for Afternoon Colonoscopies
October 1, 2010 | Douglas K. Rex, MD
Compared with split dosing, morning-only preparation offered equivalent cleansing and better tolerability.
Reviewing: Matro R et al. Am J Gastroenterol 2010 Sep 105:1954
Dogs might help protect children from eczema.
Study: Dogs might help protect children from eczema
A study found that children who lived with a dog at age 1 had significantly reduced rates of eczema at age 4 compared with those without a dog, while children who lived with a cat had significantly higher rates of eczema. The researchers also found that living with a dog protected children against becoming allergic to cats.
A study found that children who lived with a dog at age 1 had significantly reduced rates of eczema at age 4 compared with those without a dog, while children who lived with a cat had significantly higher rates of eczema. The researchers also found that living with a dog protected children against becoming allergic to cats.
Tuesday, September 21, 2010
Autism Resources - Online
About 1 in 100 children will be diagnosed with autism. About 1 in 70 boys will be affected. Children with Autism struggle with social and personal skills. Here are resources online that can help.
Autism Resources:
Autism Speaks - www.autismspeaks.org
National Center on Birth Defects - www.cdc.gov/ncbddd/autism
Organization for Autism Research - www.researchautism.org
Autism Society of America - www.autism-society.org
Future Horizons - www.fhautism.com
Wrightslaw - www.wrightslaw.com
The National Academies Press - www.nap.edu
Autism Resources:
Autism Speaks - www.autismspeaks.org
National Center on Birth Defects - www.cdc.gov/ncbddd/autism
Organization for Autism Research - www.researchautism.org
Autism Society of America - www.autism-society.org
Future Horizons - www.fhautism.com
Wrightslaw - www.wrightslaw.com
The National Academies Press - www.nap.edu
Friday, September 17, 2010
Colic - Fussy Baby
Infants communicate by crying. They have a different cry for pain, hunger, and attention. Most infants cry in the evening. This seems to peak at about 6 weeks. If the baby calms after about 2 hours and seems happy during the rest of the day their is no reason to worry.
If your infant cries longer than 3 hours a day you should look at other reasons for the fussiness.
Gas
One common reason is gas. Sometimes mom's diet can affect the child if she is breast feeding. If nursing, you might try to eliminate caffeine, dairy, cabbage, cauliflower, broccoli, beans, spicy foods, citrus, and chocolate one at a time. Try to discover if one food makes your baby gassy. Some moms like to try gripe water.
Reflux
If your baby spits a lot your baby may have heartburn. The most important thing is to elevate your baby about 30 degrees. This includes sleeping position (elevate the head of the mattress) and after feeding make sure the baby is elevated. If this does not help, talk with your doctor about trying "heartburn" or reflux medicine like Zantac or Prevacid.
Probiotics
Some research suggests that probiotics may help colic. Our NICU uses probiotics like culturelle or Align.
Milk Intolerance
Some babies actually cannot tolerate mothers breast milk or regular formula. These infants need to try a special formula like Nutramigen or Alimentum.
See Your Doctor
If your baby has a rectal temperature of 100, refuses to eat, has a lot of pain, or if you have other concerns you should see your doctor.
Calming
Car rides, swings, rocking, pacifiers, back rubs, and swaddling can calm a baby.
Let someone else take over for a time.
It's hard listening to your baby cry for long periods, so give yourself a break. There are plenty of people that would love to hold a baby.
If your infant cries longer than 3 hours a day you should look at other reasons for the fussiness.
Gas
One common reason is gas. Sometimes mom's diet can affect the child if she is breast feeding. If nursing, you might try to eliminate caffeine, dairy, cabbage, cauliflower, broccoli, beans, spicy foods, citrus, and chocolate one at a time. Try to discover if one food makes your baby gassy. Some moms like to try gripe water.
Reflux
If your baby spits a lot your baby may have heartburn. The most important thing is to elevate your baby about 30 degrees. This includes sleeping position (elevate the head of the mattress) and after feeding make sure the baby is elevated. If this does not help, talk with your doctor about trying "heartburn" or reflux medicine like Zantac or Prevacid.
Probiotics
Some research suggests that probiotics may help colic. Our NICU uses probiotics like culturelle or Align.
Milk Intolerance
Some babies actually cannot tolerate mothers breast milk or regular formula. These infants need to try a special formula like Nutramigen or Alimentum.
See Your Doctor
If your baby has a rectal temperature of 100, refuses to eat, has a lot of pain, or if you have other concerns you should see your doctor.
Calming
Car rides, swings, rocking, pacifiers, back rubs, and swaddling can calm a baby.
Let someone else take over for a time.
It's hard listening to your baby cry for long periods, so give yourself a break. There are plenty of people that would love to hold a baby.
Tuesday, September 14, 2010
How do I know if I have Strep Throat?
With school back in full swing kids will start to come home with a sore throat. When should I be worried about strep?
Strep throat usually looks red with white patches on the tonsils. There can also be small red/brown spots on the upper soft palate. Most children have sore throat, stomach ache, headache, and fever. Some children have fine bumps on their torso ("gooseflesh"). Strep is not usually associated with cough and runny nose.
How accurate is the Rapid Strep test? The rapid test picks up about 95% of the cases. If you really feel that it might be strep ask that they send the swab for "culture". Call the office in about 48 hours for culture results. If it is positive the office can call in an antibiotic for you. Common antibiotics that are used are: Amoxicillin (the pink stuff for 10 days), Keflex (Cephalosporin antibiotic for 10 days), or Zithromax (if you are allergic to penicillin and cephalosporin and it is only 5 days). You can also do one shot of Bicillin but most children are not excited about it.
Summary:
Sore throat with headache, stomach ache, fever, and rash = probably strep
Sore throat with runny nose, cough or sneezing = probably virus or allergies
Strep throat usually looks red with white patches on the tonsils. There can also be small red/brown spots on the upper soft palate. Most children have sore throat, stomach ache, headache, and fever. Some children have fine bumps on their torso ("gooseflesh"). Strep is not usually associated with cough and runny nose.
How accurate is the Rapid Strep test? The rapid test picks up about 95% of the cases. If you really feel that it might be strep ask that they send the swab for "culture". Call the office in about 48 hours for culture results. If it is positive the office can call in an antibiotic for you. Common antibiotics that are used are: Amoxicillin (the pink stuff for 10 days), Keflex (Cephalosporin antibiotic for 10 days), or Zithromax (if you are allergic to penicillin and cephalosporin and it is only 5 days). You can also do one shot of Bicillin but most children are not excited about it.
Summary:
Sore throat with headache, stomach ache, fever, and rash = probably strep
Sore throat with runny nose, cough or sneezing = probably virus or allergies
Monday, September 13, 2010
Can you store Breast Milk?
Yes you can.
Mom's Milk storage guide from www.ameda.com
The NICU stores the milk until needed and then measures out enough for one feeding. Any left over in the bottle is discarded.
Mom's Milk storage guide from www.ameda.com
| Storage Time for Human Milk* | Deep Freeze (0°F/ -18°C) | Refrigerator Freezer (variable 0°F/-18°C) | Refrigerator | Cooler with Ice Packs Frozen | Room Temperature | |
| Fresh | Up to 12 Months | 3-4 Months | 8 Days | 24 Hours | 4 Hours | |
| Frozen, Thawed in Fridge | Do Not Refreeze | Do Not Refreeze | 24 Hours | Do Not Store | 4 Hours | |
| Thawed, Warmed, Not Fed | Do Not Refreeze | Do Not Refreeze | 4 Hours | Do Not Store | Until Feeding Ends | |
| Warmed, Fed | Discard | Discard | Discard | Discard | Until Feeding Ends | |
The NICU stores the milk until needed and then measures out enough for one feeding. Any left over in the bottle is discarded.
Friday, September 10, 2010
How many flu shots this year?
This year's "flu" vaccine has three antigen groups in one vaccine:
H1N1
H3N2
Influenza B
Children 6 months to 8 years old who have received in the past:
1 dose of H1N1 + 2 doses of seasonal flu = 1 dose this year
All other children 6 months to 8 yr should get 2 doses of the 2010-2011 flu vaccine.
All children 9 years and older get 1 dose.
H1N1
H3N2
Influenza B
Children 6 months to 8 years old who have received in the past:
1 dose of H1N1 + 2 doses of seasonal flu = 1 dose this year
All other children 6 months to 8 yr should get 2 doses of the 2010-2011 flu vaccine.
All children 9 years and older get 1 dose.
Subscribe to:
Posts (Atom)