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

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.

The “classic” in this series is “Caring for your Baby and Young Child, Birth to Age 5″.  The advice is reasonable, easy to read and follow.   (It’s not alarmist, unlike the “What to expect …” series which I do not recommend.)

–  David Epstein, MD

–  David Epstein, MD

The most important technique is to expose the base of the cord.  If the base is not exposed to air, then bacteria can thrive in the wet, low oxygen environment; this may lead to infection.

Hydrogen peroxide, wetted on a gauze or cotton ball, is perhaps the best choice for cleaning.  Rubbing alcohol was recommended in the past, but it tends to cause rashes.  A little mildly soapy water can also be used.

Grasp the cord with your fingers, and pull up gently.  At the same time, pull the skin away from the cord, all around the cord, to expose the yellow base.  Then you can clean, all around, with the gauze wetted with hydrogen peroxide.  If the cord smells bad or seems infected, you can smear a little antibiotic ointment (such as neosporin) around and on the base of the cord.

You can clean the cord as often as needed, perhaps 3 or 4 times a day.  You may be instructed not to bathe your baby in the tub until the cord falls off; but I don’t feel strongly about this.  If your baby seems dirty or sticky, you may give a quick (warm) tub bath, then dry the infant thoroughly; then open up the base of the cord (as above) to allow drying.

Textbooks say that the umbilical cord usually falls off by two weeks of age.  But my experience is that the cord may stay attached longer, sometimes as long as 4 weeks.  I suspect the reason is that patients take such good care of the umbilical cord that it takes a while to deteriorate!

If you see the skin around the umbilical cord getting red, he should be examined to rule out infection.  But this is unusual.

–  David Epstein, MD

A new feature is my pediatric blog.  From time to time, I’ll post some thoughts about timely topics affecting your children’s health.  Sometime’s I’ll write about seasonal issues; current news reports may also get some attention here.  Post your comments, and check back to see what’s new!  If you have an interest in a special topic that you’d like me to consider for the blog, please call us, speak to one of the staff, or email via the “Contact Us” page.  I’m always looking for interesting topics.  Thanks!

–  David Epstein, MD