Delaware Modern Pediatrics Blog

We have been asked by several patients about the benefits of fenugreek in stimulating breastmilk.

Fenugreek is an herb, sold under several brands.  It is supposed to have several medicinal effects, including possible decreases in high blood sugar and cholesterol; but nothing has been proved.

Some people think that fenugreek might increase a nursing mother’s breastmilk supply.  Unfortunately, there is no data to support this.   One study noticed that new mothers of premature infants (24-38 weeks) had an increase in their breast milk production while taking fenugreek.  But there was no control group; their breast milk might have increased physiologically as the formal due date of their premies approached, so the role of fenugreek is only a guess.

Fenugreek should not be taken at all by a pregnant woman; it is known to make spontaneous abortion more likely.

Generally, I am leery of herbal supplements.  There is little oversight for safety, little verification for their effectiveness, and little confidence that what’s on the label actually matches the contents of the bottle.  A suggested dose may be listed on the label, but there’s usually little data showing what dose might be beneficial.  And many supplements contain unintended toxins.  (See my posting from December, 2010.)

However, a few of our patients have tried using fenugreek when their milk supply has lagged; they have had the feeling that the fenugreek may have improved their supply.

The bottom line is this:  if a nursing mother wants to try increasing her milk supply with fenugreek in limited doses, and she knows she’s not pregnant, there’s probably no harm.  But I’m not really eager to recommend it.

For more information, check the website of the NIH National Center for Complementary and Alternative Medicine.

–  David Epstein, MD

For the past year, “BabyCenter.com” has been a help for parents interested in following their child’s development.  It’s free, though there is advertising.  You can get notifications and age-appropriate advice sent to you by e-mail or text message.  Several of my staff have tried it, and found it useful.  You can look over their website at www.babycenter.com.

Other tools exist to help parents follow their infant’s milestones.  “Child Development” By Ben Davol Ph. D. is downloadable from iTunes.  I don’t know much about it, but it looks appropriate; I’d be interested in your experience.  You can find it in the iTunes store.

“PPod” is a new app for the iPad.  It appears to have beautiful graphics, and works interactively to assess your infant’s development.  Subscription is $10-$15 per year.  You can review their materials at www.myppod.com.

I haven’t used any of these myself, but I welcome you to try them; then post your comments here for everyone to see!

–  David Epstein MD

Two new options are available this year to treat head lice.

Natroba (r) (generic name spinosad) is a lotion, applied to the hair and rubbed in for 10 minutes, then rinsed out.  A second treatment may be given, 1 week later, to kill emerging lice not killed by the first application.  It is for use only for children 4 years old and over.

Sklice (r) is also a topical lotion, applied to the hair and rubbed in for 10 minutes, then rinsed out.  A second treatment may be given, 1 week later, to kill emerging lice not killed by the first application.  Sklice may be used for children 6 months and older.  The active ingredient is ivermectin, which has been used for several years as an oral treatment for head lice.

Both medicines are available by prescription only.  Because they are new, they may be hard to find, or expensive, and insurance coverage is not assured.  We still recommend Nix as the first line treatment.  For our complete handout about head lice, you are welcome to click here.

–  David Epstein, MD

It sounds like a crazy idea, doesn’t it?  An electric toothbrush sounds as pointless as an electric fork.  But in fact, electric toothbrushes have been shown to work better than a manual, hand-held one.  I recommend that you try one.  You’ll notice an improvement right away.

Dentists say that the regular use of an electric toothbrush reduces plaque, gum disease and cavities.  The improvement comes the very rapid vibratory motion of the bristles.  Electric toothbrushes also give a signal when you’ve brushed for a full two minutes, to make sure that you’ve brushed long enough.  The noise and vibration may put off very young children, but with time they can become accustomed to it.

The rechargeable type is more powerful and durable than battery-operated ones, and they do a better job.   Philips Sonicare makes a rechargeable electric brush for kids, available for about $50.  Older kids can use the rechargeable models intended for adults; Oral-B (made by Braun) make very good ones, available for $50-75.  But even the battery-operated electric brushes (about $20) are better than manual brushes.

It sounds like a lot of money for a toothbrush.  But if you can avoid the cost of filling even one cavity at the dentist’s, you’re way ahead!

–  Dr. Epstein

This week’s Sunday New York Times Magazine contains an article about treatment for ADHD (click here).  It is written by a well-known psychologist, L. Alan Sroufe.   Dr. Sroufe has published research about treatment for ADHD for many years; he is now about 70, and is Professor Emeritus of psychology at the University of Minnesota’s Institute of Child Development.  Dr. Sroufe claims that studies have not demonstrated long-term benefit from the treatment of ADHD with stimulants.

I am baffled by his article.  There has been no doubt about the effectiveness of stimulants, such as Ritalin, Adderal, Focalin, and other medications that have been successfully used for decades.  Dr. Sroufe does not quote any new studies or information, except one from 2009 (which I have not seen, and he does not reference).  He claims that there is no “long term” benefit, but he acknowledges that many studies have demonstrated benefit for 3-8 years or longer, which he calls “short term.”

Dr. Sroufe makes some puzzling claims:

1.  His claim that “to date, no study has found any long-term benefit of attention-deficit medication on academic performance, peer relationships or behavior problems” is simply not true.

2.  Properly prescribed stimulants are not “habit forming”.  They are chemically similar to amphetamine street drugs; so manufacture is regulated by the FDA to avoid illegal stockpiling and inappropriate administration to non-patients.  In fact, studies show that correct treatment of ADHD with prescribed stimulants actually protects kids from eventual drug addiction, because they help prevent school and social failure.

3.  Dr. Sroufe states: “Putting children on drugs does nothing to change the conditions that derail their development in the first place.”  I do agree with Dr. Sroufe that diagnosis and treatment of ADHD must include attention to the child’s home environment, learning environment, and other sources of stress.  This is the purpose of a proper workup and ongoing followup, which should include screening for stress at home, discipline techniques, sleep dysfunction, and other nonpharmacologic issues.  The pediatrician must also screen for conditions that might mimic ADHD, such as depression, anxiety, hearing loss, and a host of other medical conditions.  However, ADHD is a real and treatable condition.

Dr. Sroufe’s claim that as a society we’re “drugging” our children to avoid dealing with societal issues is years out of date.  Of course, some patients are given stimulants after an inadequate workup, either due to lack of resources or poor education (or attention) by the prescribing practitioner.  Many medications are similarly overused; antibiotics are another good example.  But this is no reason to completely stop using safe, effective medications that show clear and visible assistance to children who would otherwise struggle unneccesarily.

Parents should remain reassured that if they see their children succeeding because of their ADHD medication, that continuing this treatment is the right thing to do.

–  David M. Epstein, MD

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.)

—————————–

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