Delaware Modern Pediatrics Blog

New data shows that the chicken pox vaccine (Varivax®) prevents illness even better than we knew.

Death from chicken pox declined 88%, from 4.1 in ten million people to just 0.5 per ten million.  The study by the CDC was published in the August 2011 issue of the AAP journal Pediatrics, comparing death rates in the early ’90′s (before introduction of the vaccine) to the mid-2000′s.

This improvement occurred with a single injection.  Subsequently, a 2-dose regimen has been introduced, because other research has shown that 5% of children don’t achieve proper immunity to chickenpox from a single injection.

So we can expect even better numbers, the next time the numbers are run!

–  David Epstein, MD

Want to hear the latest on babyproofing your house?  Click on this New York Times article HERE.

There are some surprises.  Using plug-in outlet covers?  Most adults don’t plug them back in.  Video monitors?  There are reports of kids getting strangled on the cords.

But some old suggestions are still valid.  The best way to start babyproofing is to get down on your hands and knees, and look for trouble at your child’s level.  Then fix it.

–  David Epstein MD

Newspapers are reporting on a new study, released this morning:   Kids are watching more TV, and upper-income kids are playing more video games on cell phones.  (Read it here.)

No surprise, right?  But it’s not good, and not inevitable!

Here’s the comment I posted about this NY Times article.  (Or see the posting HERE.)

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As a pediatrician, I’m especially alarmed by 2 statistics in this article:

1.  Kids under 2 spend twice as much time being read to as they do watching TV.
2.  6 of 7 parents said that their doctor had never discussed “media”.

Where’s the anticipatory guidance from the pediatrician?

Pediatricians and other health professionals should be discussing regularly both reading and TV with patients.  We have overwhelming evidence that school performance, weight issues, attention problems, and interpersonal skills are all affected.  The issue is at least as important as issues like sugar intake and exercise, which doctors are expected to discuss routinely.

There are loads of well-funded programs (ReadAloud.org, ReachOutAndRead.org, etc.) which can assist doctors in encouraging their patients to choose books over TV (or cell phone apps).  There are many recommendations over 15 years, from respected medical organizations such as the AAP, encouraging doctors to discuss TV and media use by children.

But many doctors are slow to incorporate these resources and recommendations.  They may discuss reading and TV only as an afterthought, if at all.  They may even have TV or DVD’s playing continuously in their waiting room!

Why is this?  Are doctors dubious about the data? Are we worried about a backlash or resistance from their patients?  Or perhaps, are we reluctant to examine their own personal viewing habits?

In my practice, at every checkup starting from birth, I ask parents how much TV the kids are exposed to.  I also encourage reading, and I suggest specific books just to get started.  I also pay attention to our role modeling:  there is no TV in our office, but we have many children’s books available.  In my practice, parents accept these suggestions with gratitude, and they generally follow the advice – often changing their own TV viewing habits in the process.

Doctors should counsel parents, early and often, to avoid TV, and encourage reading.

–  David Epstein, MD

At this time of year, kids start getting colds and coughs.  Parents don’t like it!

For decades, cough and cold medications were sold freely, over the counter.  Drug stores and pharmaceutical companies sold brands like Dimetapp, Pediacare, Delsym, Robitussin, and many others; there was a huge market for these medications, and companies competed fiercely.  They contained antihistamines, decongestants, and sometimes acetaminophen or other fever reducers.

Parents relied on these medications to suppress the cough and congestion from colds and viruses.   However, it’s been hard to prove that they actually work.  And there were so many kinds, and so many dosing regimens, that occasionally parents would be confused into administering an incorrect dose; on occasion, a child would suffer.

A few years ago, the FDA took these medications off the market for kids under 4 years old, citing the health risks and lack of proof of efficacy.  The FDA also discourages using the prescription version of these medications, although some are still available.

But if your child is suffering from cold and cough symptoms, some simple remedies can still help.

Run a vaporiser in the child’s room at night. (In winter, a steam vaporiser will make the room less clammy than a cold-water humidifier.)

Hot tea, especially with honey (buckwheat if you can find it), is helpful for cough.

And lots of fluids will help suppress a cough, and make a sick child feel better.

You can find more suggestions in this handout; click here to read more.

–  Dr. Epstein

The AAP issued a new recommendation on Monday. Because of new crash data, they have strengthened their recommendations for protection of kids riding in cars.

Children are now recommended to stay in rear-facing car seats until age 2.  Booster seats for older kids are recommended until they reach 4′ 9″.  All kids should ride in the back seat until age 13.

Parents sometimes worry that growing toddlers will run out of leg room, but it doesn’t seem to be a problem with properly-designed car seats.  If needed, you should buy a new one.

It will take a while for state car seat laws to catch up, so what’s legal now may not be what’s recommended by the AAP.  (I’ll also have to update all my handouts!)

To read the AAP’s statement, click here.

–  David Epstein, MD

On March 2, the FDA removed about 500 cold and cough prescription medications from the market.

The move is aimed at prescription medications that contain Chlorpheniramine, Brompheniramine, Phenylephrine, Dextromethorphan, Guaiafenesin, Pseudoephedrine, and a couple of similar ingredients.

I have prescribed these medications for my patients for many years, and never heard of any serious problems.  Unfortunately, they will no longer be available.  There may be other medications that I can substitute, but I suspect that they may be in short supply until their manufacturers can catch up with the demand caused by their competitors being knocked off the market.

This move does not affect the over-the-counter cold and cough medications still available that contain the same ingredients.  You can still buy Pediacare, Delsym, and several other medications that are sold to treat the symptoms of upper respiratory infections.  But the FDA also changed the labeling on these medications several years ago, to remove recommendations to use these medications for kids under 4.

To see the FDA’s list of newly banned prescription cough medications, click here.

To read my usual recommendations for treating the symptoms of the common cold, click here to be transferred to our practice website.

–  David M. Epstein, MD

A new study shows that parents can protect their infants from getting sick, by getting flu shots themselves.

Over a thousand mothers and their infants on an Indian reservation were studied.  Infants whose mothers received flu vaccines were 40% less likely to catch influenza themselves, and 40% less likely to be hospitalized for it.

The effect of fathers’ flu shots on the health of their infants was not studied, but one can assume that it would benefit the kids as well.

Since 1997, experts have recommended that pregnant women should be given flu vaccine.  But acceptance of this advice has been very slow.  Many of the families in my practice are happy to have the infants vaccinated, but the parents are reluctant to be vaccinated themselves.

But, as an accompanying editorial says: “Maternal influenza vaccination targets 2 high-risk groups with 1 vaccine dose – we can’t afford not to act.”  Perhaps this study will reassure these parents, and encourage them to get their own flu shots every year!

–  David Epstein, MD

Archives of Pediatric and Adolescent Medicine.  Vol 165, No. 2, Feb 2011, p. 104-111.

A new study links regular diet soda use with strokes and heart attacks.

A study presented this week at the American Stroke Association International Stroke Conference (ISC) suggests a 61% increase in stroke for people who drink diet sodas regularly.  (Click here to read more.)

Does diet soda cause stroke?  Or does the association merely mean that people who choose diet soda also have other lifestyle habits that predispose to cardiovascular disease?

My view is that this study’s results are most likely due to an association with lifestyle habits.  The study authors tried to control for such associations, but that’s hard to do in a questionnaire-based study like this one.  I’d have guessed that if drinking diet soda caused stroke and heart disease, we’d have noticed it before now.  But I don’t agree with the American Beverage Association that this makes the study meaningless.

People who choose diet sodas don’t usually do so because they prefer the flavor to sugar; often they are trying to counterbalance other issues, such as obesity, which are already known to be related to stroke and heart disease.

Especially for children, my concern is that diet sodas may reinforce kids’ preference to drink other sweetened beverages, like juices, sports drinks and sugary sodas, which are clearly associated with obesity.

The best use for diet sodas for kids is probably for children whose weight is a concern, as a temporary or infrequent stepping stone to teach better lifestyle habits.  Diet sodas may not be harmful themselves, but it’s better to teach kids to drink water or milk.

Everyone “knows” that babies have trouble when they are teething.  But I think that teething doesn’t cause nearly as much trouble as its reputation suggests.

Babies start “gumming” and drooling on hard objects, starting at a few months of age.  This might be due to teething, or it might just be oral exploration.  You can try rubbing some teething medicine, such as Baby Anbesol or Baby Oragel, on the gums.  Ribbed teething rings, or a washcloth dipped in ice water, can give some relief.

Sometimes babies wake up fussy in the middle of the night.  If your baby has been fussy and gumming things during the day, then an occasional night waking might be due to teething.  You can try giving some acetaminophen or ibuprofen, in the usual dose for fever.  But if the waking is persistent, it’s probably not due to teething.

Some babies will pull on their ears when they’re teething;  you can try the usual teething remedies.   But if there are cold symptoms also, especially if persistent, an ear infection is also possible; give us a call if you’re concerned.

But I really doubt many of the other symptoms attributed to teething.  How could teething cause a diaper rash?  Or diarrhea?  Or a runny nose?  I can’t figure out what the mechanism would be!

Fever is supposed to be another symptom of teething.  I might believe that a low-grade fever, for an hour or two, might come from teething.  But a baby with a high fever for a day or more needs to be seen by the pediatrician.  It might be something like a virus or an ear infection, but I never find that such babies are simply teething.

Visually inspecting the gums doesn’t help much.  Generally, the white lumps under the mucous membranes lining the gums are just irregularities of the jaw bone, not new teeth.  This is especially true of lumps and irregularities on the sides of the jaw.

You can’t “feel” teeth coming in, unless they’re actually breaking through the mucous membrane.  If you see the actual surface of the tooth on the top of the jaw, then “teething” might explain a baby’s fussiness.  Sometimes there’s a little bleeding; that’s normal.  Occasionally, a dark-colored blood blister will develop over a tooth as it’s coming through; nothing needs to be done about this, since it will “pop” on its own.

But if your baby is sick, please don’t assume that teething is the cause.  It’s best to assume that a baby’s symptoms are due to a virus or other illness.  Please don’t hesitate to call us if you’re concerned.

The bottom line on teething?  I think its bark is worse than its “bite!”

–  David Epstein, MD

An arm of Congress has investigated herbal supplements, and found that most are contaminated.

The Government Accountability Office investigated commonly available supplements, and found heavy metals — including lead, mercury, cadmium and arsenic — in supplements available at drugstores and health food stores.

The FDA’s authority to regulate such supplements and treatments was rescinded during the Bush administration; since then, the sale of unregulated supplements has skyrocketed.

Sometimes I am asked about the value of various herbal or homeopathic treatments for children.  In general, there is no proof that they live up to their claims, nor is there supervision to ensure that they are free of foreign substances that might be harmful.

For my patients, I am skeptical that herbal and homeopathic supplements not regulated by the FDA are of benefit to children.  Labelling a treatment as “natural” does not assure us that it is effective, or safe.

Click here to read an article about the Congressional investigation from the New York Times.

–     David Epstein, MD