Our Easter

I awoke early and went to Easter mass with Blake which was a sunrise service. Although I am not Catholic I must admit it was a rewarding experience. I actually have a problem going to church on Christmas and Easter if I have not been to the regular services. (I feel bad :(  After services we went to IHOP for breakfast. After we ate Blake was ready to go home to go back to sleep before our 2pm Easter brunch. 

  As soon as Blake dropped me off I worked out in my home gym, showered, and then sit down and checked my facebook and blogger pages.I started getting ready to go to to brunch. I then  finished up my dishes I prepared to take to our friends house and then started to get ready for "Easter Brunch" with friends and colleagues . 

The weather has actually been dreadful and raining so the kids had to hunt for eggs inside. They seemed so disappointed that they had to hunt for eggs inside, Then I remembered the few times when it rained when I was a child and I had to hurt eggs inside with my cousins and friends, and I was bound and determined I was going to make a "Easter Hunt Adventure" for these children. Everyone looked at me as if I was crazy and what was the point these kids had everything and one Easter Egg hunt would not kill them. I could only recruit Blake for help to hide the eggs. First I took a donation of all the adults pocket money and the plastic prize eggs were filled with mostly 20 dollar bills, there were 10's and 5's and even change. There were 14 children ranging from 6 months old to 12 years old. Blake and I gathered all the eggs including the boiled eggs and started to hide them down stairs so no one would get hurt on the stairs. When we counted the boiled eggs there was 108 we had 72 plastic eggs, but only filled some with candy and the surprises that was bought to go into the plastic eggs. We had 182.58 in cash and after filling and hiding the eggs. "Let the Hunt Began"

Blake and I took charge as we already had making a fun day for the children. I had a 6 and a 18 month old while Blake had a 2 and 3 year old helping them find eggs before all the big kids found all the eggs. Everything went great and all the eggs were found which is a must (no sticking eggs a week later and the occupants wondering where's that smell coming from? The kids all had so much fun and enjoyed all the eggs and surprises the Easter Bunny left for them. 

With all the work that the 2 Easter Bunnies did they realized on the way home that they had taken no pictures of the event. So please anyone who took pics please tag pics to our pages thanks. 

We were tired by the time we made it to my place, so we cut on the TV to chill and there was a heart breaking documentary on HBO titled "American Winter" and that will be my next blog. With our church service, all the good food we had to eat today I want to give a special prayer for those who had nothing today. I want to thank God for the TV being on a Chanel and American Winter just starting. I hope that everyone who has HBO will take the time to watch it. 

Treasured Feelings

You changed my world with a blink of an eye 

That is something that I can not deny 

You put my soul from worst to best 

That is why I treasure you my dearest Marites

You just don't know what you have done for me 

You even pushed me to the best that I can be 

You really are an angel sent from above 

To take care of me and shower with love

When I'm with you I will not cry even a single a tear 

And your touch have chased away all of my fear 

You have given me a life that I could live worthwhile 

It is even better every time you smile

It so magical those things you've made 

To bring back my faith that almost fade 

Now my life is a dream come true 

It all began when I was loved by you

Now I have found what I am looking for 

It's you and your love and nothing more 

Co'z you have given me this feeling of contentment 

In my life something I've not felt in a very long time

I wish I could talk 'til the end of day 

But now I'm running out of things to say 

So I'll end by the line you already know 

"I LOVE YOU" more than what I could show.

Happy Birthday Mama

Happy Birthday Mama I love and miss you so very much. Not a day goes by that I do not think of you. 

You are now gone, but never forgotten. There is no way I could ever be who I am today without you and your impact on my life. I have made mistakes at times, but they were never enough for you to stop loving me. Everyone says what a good girl I am and what a great daughter I was to you for taking care of you while you were sick, buy it was you that cared for me while I was a baby and I just returned the favor. That is the cycle of life you have children and care for them and in the end when you become sick or old and feeble the kids take care of you. Well that is how I see it, so I never did anything that you didn't do for me or that my children someday would not do for me or I should hope. I regret nothing of the 10 months I took off to care for you I was blessed to be able to be there everyday as you finally left this world better than how you found it, and put your mark on this world. I know it is there I can see it each time I look in the mirror. 

I think we look a lot alike, I love this picture and the story behind it

This was you wedding day and in this picture you were looking at the pearls daddy bought for you to wear I have heard this story a thousand times as you waited in one of the "Sunday School Rooms" of paw-paw's church. You had to wait 45 minutes for daddy to arrive and you were nervous that he had got cold feet and left you at the alter, but daddy woke up late from his bachelor party the night before and was rushing everyone. He made it mama and although he had false he loved you until the day you died and so did I

Mama you are everything I want to be in a woman. You rode your own bike when there were not many bikers. You never took any BS off of a man, but was kind and considerate to those you loved, you loved your bike, animals, mudding, 4-wheeling, hunting, fishing and you always stood up for your friends and family. But, though it all you were a eloquent lady, you were beautiful, sexy at parties and yes men turned there heads, but you could dress in leather or camo and look just as pretty. You mama were a true "Southern Belle"

I pray that you are looking down on us today and can feel the love coming your way.

To the best mom ever I love you. 

. 

K2, Spice linked to kidney failure in children

Synthetic marijuana known as K2 or Spice is appealing to teens. You can often go to the corner gas station and find it in pot pourri-like products and by smoking it you can get an intense high. It’s of course unregulated and who knows what’s in it.

Many teens have had serious adverse reactions to it including racing heart beat, high blood pressure, hallucinations, and paranoia. ERs have been inundated with kids who have been unwittingly exposed thinking it wasn't any different than pot or perhaps less risky because it was over the counter. In actuality, K2 may be riskier than pot.

Recently over a dozen teens who have had no history of kidney problems in the past and who had no other drug exposure besides Spice or K2 went into kidney failure after smoking it. A couple of the teens died and several others needed to undergo dialysis while their kidneys recovered from the assault.

I understand that teens are inherently stupid in this way: they don’t ever think that anything bad will happen to them even if they understand it can happen. They don’t think that if they text and drive they’ll get in an accident; they don’t think they’ll fail the test that they’ll fail since they sort of listened mostly in class. Teens are also known for experimentation. They try new hairstyles and music genres and attitudes, and sometimes they even want to try something dangerous just to see how it feels.

K2 or Spice is particularly dangerous. I encourage parents to talk to their teens about it realistically, but also with an understanding that some experimentation with something is likely to happen. Try to deflect it away from this and toward something else. Like a new hairstyle.

Changing TV content improves preschoolers' behavior, study finds

Preschoolers love to pretend. They play dress up or imagine they’re pirates or “cook” for you. They “fly” and “drive” and even are able to become “invisible. “Their powers are endless. Often they find it difficult to differentiate what is real from what is not, but by early grade school, most children have a pretty good understanding of reality and fiction.


It makes sense that what preschoolers hear and see in books and media can influence greatly how they play. It is fodder for their imaginations and feeds it. If they see certain types of behaviors over and over they begin to think that those behaviors are normal or at least desirable. It can be tricky as parents to choose content that is both interesting and imaginative but not scary or full of conflict, either physical or verbal, for preschoolers to watch. Many cartoons and other programs ostensibly geared for young children show “‘good guys” and “bad guys” or kids bad mouthing or putting another child down as part of the dynamic. Even if the “good guys” or “good kids” end up winning, the images viewed and words heard are those of conflict and/or aggression and that can affect behavior.


In a recent study published in Pediatrics, researchers in Ma  tried something new. Instead of just asking parents in one group to turn off their TVs or significantly limit the preschoolers’ screen time in the study (the AAP’s recommendation for children in this age group) they asked instead for half of the parents to change the content the children watched, leaving the amount of time the children were in front of a TV the same as it always had been. The other half of the study participants did not change the amount of time or the content they watched. The two halves were very similar in both the content and amount of TV watched prior to the intervention as well as other family characteristics, amount of time in daycare, etc. The intervention group was instructed to replace their content with the following shows: “Dora the Explorer,” “Sesame Street,” and “Super Why” and to a lesser extent “The Mickey Mouse Clubhouse,” “Sid the Science Kid,” and “Curious George.” These shows were chosen because of their prosocial behavioral messages. The first three shows strongly so and the latter three somewhat less strongly so. The study groups were then assessed 6 and 12 months later and the differences were significant between the two groups. The group exposed to prosocial TV had better social interactions and behaviors at home and in group settings. The preschoolers were less apt to be described as anxious, depressed, withdrawn, oppositional, aggressive, or angry compared to the control group. Low income boys were particularly likely to show a benefit.


To be honest, I've never been a big fan of TV for kids. I feel that there’s a whole bunch of other things that are more productive and creative that children can be doing with their time but I realize that most kids will be spending a couple of hours a day (at least apparently) watching television. These pediatricians did a great service then to investigate what content is best. If you’re going to have your preschooler watch TV, at least have him watch something prosocial at this age rather than something more pro-aggressive like Cartoon Network’s “Star Wars” or even more neutral like Nickelodeon’s “SpongeBob Squarepants.”

Tanning booths are risky

I know it’s obvious and yet I feel I needed to do a blog about it with Spring Break and prom approaching. Every year I seen teenagers in the office who are unnaturally tan before for this time of year and the only way that can happen around here is if they are visiting a tanning salon.


Let me let you know one thing: there is no ‘safe’ tanning. I like the sun as much as anyone, maybe more, but going to a tanning salon before prom or spring break is not a good idea. The good news is that at least Michigan requires parental consent for a minor to use a commercial tanning booth, 17 other states do not. Children as young as 10 can use tanning booths in states like Missouri without any parent consent at all.


When your teenager asks for consent to go to the local tanning salon before spring break or prom ‘look healthy’ or ‘get her base tan’ so she doesn't burn, remind her that this sort of exposure has risks. Even with sunscreen, melanoma, basal cell, and squamous cell cancers can all grow and the risk is cumulative. I understand that we don’t want to avoid the sun altogether, of course, but going indoors to a booth to sit in a coffin-like tube with lights to tan isn't at all the same as enjoying the water or a bike ride or a hike while you also happen to be in the sun (with sunscreen on!)


Be strong parents! Your teenager needs your consent to go in Michigan so you have the opportunity to minimize their risk!

  This parent went to jail for tanning her 6 year old daughter 

BE CAREFUL I TOO TAN, BUT WE MUST USE COMMON SENSE AND GUILD LINES TO 

PROTECT OURSELVES

Anyone can anonymously report suspected abuse

Recently we've had a couple of cases in the office that made me realize that parents don’t know that they can anonymously report concerns they have about child abuse or neglect just like I have to do as a pediatrician.

Here are some examples of situations that might warrant a parent calling the state to report a concern:

. Neighbor children ages 4 and 7 are often left alone for more than an hour at a time. They come over to your house to play with your children but don’t seem like they've had a bath in several days. Their clothes don’t seem clean and don’t fit too well. When they are over they often seem very hungry and want to stay as long as possible. The parents are hard to get a hold of. They seem nice enough when you walk the children back home but almost daily the children seem to end up at your house because their parents aren't around for some stretch of time.

. Your 4 year old tells you that an older child had repeatedly asked to see her private parts. She wasn't sure what to do and so she did what he said. The older child has touched her vagina on several occasions and has shown her his penis as well. You confront the 8 year old’s parents who don’t seem to think this is a big deal at all.

. You hear your neighbors repeatedly yelling at each other and swearing. You hear them calling each other names and yelling derogatory things at the children too. At one point you hear one of the children yelling in fear “Don’t hit me again! Please don’t hit me! I’ll stop! I’ll never do it again!”

All of these situations are pretty straightforward and in reality you don’t even need this much to go on. As an adult, if your radar is up and you are concerned about the well being of a child, you can call the state and anonymously report your concern. I know that we often don’t want to meddle or get involved in other people’s lives but when children’s lives and well being are at risk, you have a responsibility to do something. It truly is anonymous.

Unless the case goes to trial and you need to testify as to what you saw or heard, no one will know it was you who called. There is a hassle and headache for the family that has a case opened of course but if there is something amiss, it is an opportunity for them to get help if needed and if real dysfunction is present get the kids to a place of safety and care.

If you suspect a child is at risk of abuse or neglect, I encourage all adults — whether or not you’re a mandatory reporter like a doctor or a teacher

Starting foods earlier

Over the last 13 years so much has changed. Back in 2000, the AAP recommended that children not start milk or dairy until age 1, eggs until 2, and things like peanut butter and fish shouldn't be started until age 3 or later in the hopes of decreasing food allergy. Boy how times have changed.

Over the intervening years, food allergies in children have risen and we've also had the benefit of a ton of research which, in the end, has resulted in an almost complete reversal of the above recommendations. Both clinical experience and research has borne out that delaying highly allergenic foods actually increases the risk of food allergy it seems for most children. As a result, the American Academy of Allergy, Asthma, and Immunology came out this week with new recommendations that two highly allergenic foods, peanut butter and fish, be given between 4 and 6 months of age to decrease the chance of food allergy. By introducing these foods early and often, you build tolerance and familiarity which helps minimize risk of allergy.

It can be challenging as a parent when you go online or look in books to get guidance about introducing solids. Many sources still suggest waiting until 6 months for any foods while others suggests delaying all allergenic foods until a year of age at least. This advice is no longer up to date and may indeed be increasing the risk of food allergies.

The tide is changing when it comes to feeding infants. Starting early, giving a broad variety of foods and not avoiding allergenic foods is the new norm. It’s actually a return to old school….my baby book shows me eating cottage cheese at about 2 months old! (Well maybe we shouldn't go quite back to that.)

Proper Swaddling of Babies to Prevent Hip Dysplasia

In ten years of pediatrics I have only had a handful of cases of hip dysplasia. Hip dysplasia is when the hip joint (a ball and socket joint) does not develop appropriately and can lead to dislocation and improper development which in turn can lead to mobility issues in the future. Mostly, I have seen this occur in breech babies (legs are in funny positions in the womb), females (hip anatomy makes it have a higher propensity for issues than males), first born babies (the womb is tightest in the first pregnancy leaving less room for the baby and his/her hips), and low amniotic fluid (less room in the womb).

Recent evidence indicates that improper swaddling may contribute to hip dysplasia. Like other parts of the baby, the hip continues to develop and mature even after the baby is born. Proper assessment of the above risk factors and routine physical exams by your pediatrician can catch infants who have hip dysplasia. Parents can do their part in minimizing risks by using proper swaddling techniques which will allow for proper maturation of the hip joints.

The below information is from the International Hip Dysplasia Institute. There is a link embedded in the text that takes you to their web page where 3 different techniques for proper swaddling are demonstrated in a YouTube video. Although the risks with most current swaddling techniques are minimal, this intervention carries no side effects, incurs no costs, and is easy to do - so there is no reason not to try it!

Hip-Healthy Swaddling

Are you swaddling your baby properly?

Improper swaddling may lead to hip dysplasia or developmental dysplasia of the hip. When in the womb the baby's legs are in a fetal position with the legs bent up and across each other. Sudden straightening of the legs to a standing position can loosen the joints and damage the soft cartilage of the socket.

Many parents find that swaddling can provide comfort for fussy babies, reduce crying, and develop more settled sleep patterns. When babies are swaddled, care should be taken to swaddle properly so the baby is safe and healthy.

There are many ways to swaddle babies by using blankets or commercial products designed for swaddling. In order for swaddling to allow healthy hip development, the legs should be able to bend up and out at the hips. This position allows for natural development of the hip joints.

The baby’s legs should not be tightly wrapped straight down and pressed together. Swaddling infants with the hips and knees in an extended position may increase the risk of hip dysplasia and dislocation.


Instructions on how to swaddle properly

Watch the video at this link to learn three, hip-healthy methods to swaddle your baby:

If you can't view the above video, here is one of the methods described in text:

1. If using a square cloth, fold back one corner creating a straight edge.

2. Place the baby on the cloth so that the top of the fabric is at shoulder level. If using a rectangular cloth, the baby's shoulders will be placed at the top of the long side.

3. Bring the left arm down. Wrap the cloth over the arm and chest. Tuck under the right side of the baby.

4. Bring the right arm down and wrap the cloth over the baby's arm and chest.

5. Tuck the cloth under the left side of the baby. The weight of the baby will hold the cloth firmly in place.

6. Twist or fold the bottom end of the cloth and tuck behind the baby, ensuring that both legs are bent up and out.

It is important to leave room for the hips to move.


What about sleep sacks and commercial products?

Some parents choose to wrap their babies in sleep sacks specifically designed for swaddling, instead of using a simple cloth or blanket. Commercial products for swaddling should have a loose pouch or sack for the baby’s legs and feet, allowing plenty of hip movement. However, even some of these commercial products can confine the legs if they are tightened around the thighs.

It's especially important to allow the hips to spread apart and bend up. In the womb the legs are in a fetal position with the legs bent up across each other. Sudden straightening of the legs to a standing position can loosen the joints and damage the soft cartilage of the socket.


Final Thoughts

When put down to sleep, a swaddled baby should be placed on his or her back, face up.

If the baby can roll onto his or her stomach this may increase the risk of suffocation. Seek the advice of your child’s healthcare provider if swaddling an older or more active baby.



http://www.hipdysplasia.org/Developmental-Dysplasia-Of-The-Hip/Hip-Healthy-Swaddling

When Should I Send My Sick Kid Back To School?

School and daycare criteria are often overly restrictive in their back to school policy for sick kids. This can unnecessarily hamper the education of your child without benefiting the health of the other kids in his/her classroom.

Below is an excellent article highlighting policy from the American Academy of Pediatrics that helps parents (and doctors) understand when exclusion does and does not make sense.

AAP Updates Guidelines for Infectious Disease Exclusions

Pediatric News Volume 44 Issue 2 February 2009

DIANA MAHONEY (New England Bureau)

Conjunctivitis: It's red, it's itchy, it's crusty, but it is not—repeat NOT—cause for automatic exclusion from day care or school, according to the latest edition of the American Academy of Pediatrics' “Managing Infectious Diseases in Child Care and Schools.”

The rationale behind this seemingly revolutionary recommendation is the fact that neither treatment nor exclusion of children with conjunctivitis from group settings reduces the spread of infection, Dr. Laura A. Jana discussed at the annual meeting of the American Academy of Pediatrics.

The same goes for many of the common childhood infections that incite knee-jerk reactions among schools, day care providers, and parents.

“Multiple studies have shown that most viruses are spread by children who seem well, which means that exposure happens before the school or day care facility can make the first phone call for the child to be picked up,” said Dr. Jana, a pediatrician and owner of a child care facility in Omaha, Neb.

So while conventional wisdom says that automatically excluding kids with conjunctivitis, fever, and stomachaches will prevent the spread of these infections, “the evidence doesn't back this up,” she said, noting that “hand and surface hygiene continue to be the best way to reduce infections in group care.”

The confusion regarding exclusion is understandable, said Dr. Jana. Unlike the best-practice guidelines issued in 2002 by the AAP, American Public Health Association, and others, state guidelines for exclusion from child care or school lack detail, are not based on medical evidence, and vary considerably by state.

“Most states do not require center and school policies to follow national guidelines, and individual exclusion policies must only comply with state licensing, which means children are often excluded for harmless conditions,” she said. The consequences of inappropriate exclusion policies and practices, she added, include excess health care visits, antibiotic-seeking behavior, and lost work and school time.

The one exclusion criterion from the national guidelines that is excluded most frequently, according to Dr. Jana, is the directive that a child should be excluded if the illness prevents him or her from participating comfortably in activities. “This child should really be at home,” she said. “Additionally, a child should be excluded from school or day care if the illness results in greater care than the staff can provide,” she noted, or if the illness poses a risk of spreading a harmful disease to others. (See box below.)

The common cold, for example, does not warrant exclusion, “unless the child is too uncomfortable to participate in routine daily activities,” Dr. Jana said. “The virus itself can be spread before, during, and well after the time of symptoms, so preventing a child's attendance won't significantly reduce the chance of spread.”

The updated “Managing Infectious Diseases in Child Care and Schools” (Elk Grove Village, Ill.: American Academy of Pediatrics, 2008), also recommends against exclusion for the following conditions that often incite red flags, according to Dr. Jana:

? Hand, foot, and mouth disease. “Children should not be excluded unless they have sores in their mouth with drooling or if the rash is associated with fever or behavior change,” Dr. Jana explained. “Good hygiene is the best way to minimize the opportunity for the spread of this common virus.”

? Fifth disease. Because there is little virus present when the telltale rash appears, exclusion has no preventive benefit.

? Draining skin infection, including methicillin-resistant Staphylococcus aureus (MRSA) infection. “Because of the media attention surrounding MRSA, there's a lot of anxiety about this, but the reality is, these children should be excluded only if the infection is accompanied by fever, pain, or behavior change,” said Dr. Jana. “There is no need for the caregiver to request a culture, because it won't affect how the infection will be handled. Some kids without symptoms have MRSA, and there is no good way to eradicate the germ yet from individuals, families, or classrooms.”

? Diarrhea. According to the revised guidelines, diapered children with diarrhea may remain in care if the diarrhea is contained in the diaper and the child has no more than two stools above normal baseline. “This is a departure from the previous recommendation that all diapered children be excluded until the diarrhea resolves or is deemed noninfectious,” said Dr. Jana. Children who are able to use the toilet may remain in care with good hand washing, as long as they don't have accidents. “Exclusion is appropriate for children with blood in their stool not explained by medication, hard stool, or diet,” she said.

? Vomiting. Exclusion is recommended for a child who has had two or more episodes of vomiting in the previous 24 hours and continuing exclusion until the vomiting resolves or a health care provider determines the cause is not contagious.

? Fever. “Children with fever should not be excluded automatically, unless the fever is accompanied by behavior change or other signs or symptoms of illness,” explained Dr. Jana. The exception to this is children younger than 4 months old with unexplained fever.

? Respiratory illness. Most respiratory illnesses do not require exclusion; however, a child with persistent coughing or trouble breathing should be evaluated for pneumonia, asthma, or serious respiratory infection, such as whooping cough.

? Earache, no fever. “This child should be excluded if he or she requires more care than the staff can reasonably provide,” said Dr. Jana. “Often, these kids are in a lot of pain and cannot participate in routine activities.”

? Lice. “Lice are a nuisance, but they're not a health hazard,” said Dr. Jana. “Children with lice should be excluded, but they don't have to be sent home right away. It can wait until the end of the day, and they can return once treatment occurs,” she said.

“Of course, all of these are recommendations, and while they are based in evidence, they are not binding,” Dr. Jana concluded.

Revised ‘When to Exclude’ Criteria

With the exception of the noted updates, most of the exclusion criteria outlined in the revised “Managing Infectious Diseases in Child Care and Schools” are consistent with the national illness exclusion guidelines published jointly in 2002 by the AAP, APHA, the Maternal and Child Health Bureau, and the National Resource Center for Health and Safety in Child Care. These include:

? Tuberculosis, until an appropriate health care provider or health official certifies that the child is in appropriate therapy and can attend care.

? Impetigo, until 24 hours after treatment has been initiated.

? Chickenpox until all sores have dried and crusted (usually 6 days).

? Mumps, until 9 days after an onset of parotid gland swelling.

? Hepatitis A virus, until 1 week after an onset of illness or jaundice or as directed by the health department.

? Measles, until 4 days after an onset of rash.

? Rubella, until 6 days after an onset of rash.

? Fever, when accompanied by behavior changes or other symptoms such as a sore throat, rash, vomiting, diarrhea, earache, etc.

? Diarrhea (frequent, runny, watery stools).

? Blood in the stool not explained by dietary change, medication, or hard stool.

? Vomiting two or more times in a 24-hour period.

? Body rash with fever.

? Sore throat with fever and swollen glands or mouth sores with drooling.

? Severe coughing with the child getting red or blue in the face or making a high-pitched whooping sound after coughing.

? Persistent abdominal pain (more than 2 hours) or intermittent pain with other signs and symptoms.

? Signs of possible severe illness such as irritability, unusual tiredness, or neediness that compromises caregivers' ability to care for others.

? Uncontrolled coughing or wheezing, continuous crying, or difficulty breathing.

Fever Phobia Deconstructed

An excellent article detailing how parents and pediatricians should approach fever. I absolutely agree that the comfort of the child supersedes the fear-driven need to bring the number of the fever down.

My motto in the office is "treat the child, not the fever". In fact this motto can be extended to almost any other symptom, i.e. "treat the child, not the cough". As with all symptoms, it is far more important to elucidate the source of the fever rather than to focus on the fever itself.

The same goes with cough, runny nose, rashes, etc. If the source is benign then one need not worry about the symptom itself. Which does not mean you shouldn't treat the symptom - if there is discomfort it should be addressed.

On the other hand, if a pediatrician suspects that the source may be of concern, i.e. pneumonia, meningitis, kidney infections - a more extensive evaluation, closer monitoring and treatment will be called for.

Sweating Out a Fever
Focus on Symptoms, Not Just the Number on the Thermometer, Doctors Advise

When a child's temperature begins to rise, worried parents often spring into action, marshaling cool washcloths and pain relievers, making frantic calls to the doctor or even visiting an emergency room.

Now, the American Academy of Pediatrics is telling parents that the number the thermometer displays is just a number—and that making a feverish child comfortable is far more important than bringing his temperature to 98.6 on the dot.

Fevers are the main reason for one-third of calls and visits to pediatricians.

"The signs and symptoms provide much more information than just the fever itself," says Janice E. Sullivan, a professor of pediatric critical care at the University of Louisville School of Medicine in Kentucky and co-author of an AAP report on fevers, released Monday.

The report, aimed at calming what it calls "fever phobia," also says there is no evidence that lowering a fever will help a child get well faster, or that leaving a fever untreated could cause seizures, brain damage or death, as some caregivers fear.

Many pediatricians have given parents a similar message for decades, but it hasn't sunken in. There's widespread confusion over what fevers in both children and adults signify, when to treat them—even what constitutes an official "fever" (100 degrees Fahrenheit? 100.4?) Many parents also rely on the thermometer to tell them how sick a child is when he's too young to talk. To some, it's an objective measure, which can't be faked, of whether an older child should be packed off to school or sent back to bed.

Fevers are the main reason for one-third of calls and visits to pediatricians, the report notes. Yet many beliefs about them are based more on culture, tradition and playground chatter than scientific evidence. Ads showing parents fretting over thermometers confuse things further.

Drugstore Dangers
These days, navigating the world of children's pain relievers is almost as tricky as interpreting a child's temperature.

Johnson & Johnson's McNeil Consumer Healthcare unit recalled 136 million bottles of liquid Tylenol, Motrin, Zyrtec and Benadryl for infants and children last year after federal investigators found bacterial contamination and other problems at a plant in Pennsylvania. Subsequent recalls included Children's Tylenol Meltaway strips in bubblegum flavor, Junior Strength Motrin caplets and Children's Benadryl Allergy Fast Melt tablets in cherry and grape.

Problems ranged from moldy smells to floating metal particles to the possibility of excess concentrations of an ingredient. In a legal filing last week, Johnson & Johnson said alternative supplies are expected to be available in the second half of this year.

In their absence, many parents have turned to generics and drugstore brands, children's Advil or Triaminic, another liquid acetaminophen for children.

Experts are still concerned about combination cough-and-cold syrups. Manufacturers voluntarily withdrew those labeled for children under age 2 in 2007 after pediatricians complained that they didn't work well and posed a risk of accidental overdose. But this week's American Academy of Pediatrics report warns that parents should not give cough-and-cold


Fevers are the main reason for one-third of calls and visits to pediatricians.

"The signs and symptoms provide much more information than just the fever itself," says Janice E. Sullivan, a professor of pediatric critical care at the University of Louisville School of Medicine in Kentucky and co-author of an AAP report on fevers, released Monday.

The report, aimed at calming what it calls "fever phobia," also says there is no evidence that lowering a fever will help a child get well faster, or that leaving a fever untreated could cause seizures, brain damage or death, as some caregivers fear.

Many pediatricians have given parents a similar message for decades, but it hasn't sunken in. There's widespread confusion over what fevers in both children and adults signify, when to treat them—even what constitutes an official "fever" (100 degrees Fahrenheit? 100.4?) Many parents also rely on the thermometer to tell them how sick a child is when he's too young to talk. To some, it's an objective measure, which can't be faked, of whether an older child should be packed off to school or sent back to bed.

Fevers are the main reason for one-third of calls and visits to pediatricians, the report notes. Yet many beliefs about them are based more on culture, tradition and playground chatter than scientific evidence. Ads showing parents fretting over thermometers confuse things further.

Drugstore Dangers
These days, navigating the world of children's pain relievers is almost as tricky as interpreting a child's temperature.

Johnson & Johnson's McNeil Consumer Healthcare unit recalled 136 million bottles of liquid Tylenol, Motrin, Zyrtec and Benadryl for infants and children last year after federal investigators found bacterial contamination and other problems at a plant in Pennsylvania. Subsequent recalls included Children's Tylenol Meltaway strips in bubblegum flavor, Junior Strength Motrin caplets and Children's Benadryl Allergy Fast Melt tablets in cherry and grape.

Problems ranged from moldy smells to floating metal particles to the possibility of excess concentrations of an ingredient. In a legal filing last week, Johnson & Johnson said alternative supplies are expected to be available in the second half of this year.

In their absence, many parents have turned to generics and drugstore brands, children's Advil or Triaminic, another liquid acetaminophen for children.

Experts are still concerned about combination cough-and-cold syrups. Manufacturers voluntarily withdrew those labeled for children under age 2 in 2007 after pediatricians complained that they didn't work well and posed a risk of accidental overdose. But this week's American Academy of Pediatrics report warns that parents should not give cough-and-cold products containing acetaminophen even to older children, given the risk that they might unknowingly take other products with acetaminophen, which can cause fatal liver damage at high doses.

Many liquid medications for children still on the market have confusing dosing information, according to a study in the Journal of the American Medical Association in December. For example: a label calling for a one-teaspoon dose packaged with a cup marked in milliliters. Since the study was conducted, the Food and Drug Administration issued voluntary guidelines for making children's medication labels easier to understand. The researchers, from New York University, plan to repeat the study to see if the guidelines have made a difference.

In the meantime, experts say, parents should pay very careful attention to dosing information since even small errors can have big consequences in children.

"There's a huge desire to do the right thing, but when we think we're healing the child, we may be really treating ourselves" by taking action, says Glen Stream, president-elect of the American Association of Family Physicians.

Experts stress that a fever isn't an illness, it's a response, probably an evolutionary adaptation to help fight infection. Setting the body's thermostat (the hypothalamus gland in the brain) a few degrees higher slows the reproduction of bacteria and viruses and boosts white blood cells.

There's some evidence that illnesses may resolve faster when fevers are left untreated, the report notes. At the same time, elevated temperatures themselves can cause discomfort in children by interfering with sleep, appetite and activities.

"If your child looks uncomfortable, then treat the discomfort with acetaminophen or ibuprofen," says Dr. Sullivan. But she says a fever alone with no other symptoms doesn't need treating. "The fever itself doesn't tell us how ill the child is. There isn't a good correlation."

The report, which is aimed at pediatricians, not parents, doesn't specify other ways to make a sick child more comfortable. But Dr. Sullivan says parents should be on the lookout for rashes, irritability and altered mental status. 

"Anytime you have a significant change in behavior, you need to talk to your doctor," says Henry Farrar, who practices pediatric emergency medicine at Arkansas Children's Hospital and co-authored the report. It also stresses the need for rest and proper fluid intake. 

If a fever-reducing medicine is warranted to make a sick child more comfortable, the report says there is no substantial difference between acetaminophen and ibuprofen in safety or effectiveness. But it warns against combining them or alternating them—which some doctors recommend—because it compounds the risk of errors. 

COMMON AILMENTS ASSOCIATED WITH FEVERS

Some temperatures are cause for concern all by themselves. But going strictly by the numbers on a thermometer can be misleading, since people can react differently to the same infections.

The report also stresses the importance of checking package labels for the correct dosages, which are based on weight and age in children. As many as half of all U.S. parents give children incorrect doses, according to the report. 

And if a child is asleep, he shouldn't be awakened just for medication, the report notes. In one study, 85% of parents said they had done so. 

There are some cases where a fever alone can be worrisome. Parents should contact a doctor immediately if an infant under 3-months old has a fever of 100.4 or higher, which could signal a serious infection. Children with underlying conditions, such as weak heart muscles, may not be able to tolerate a fever and should get medical attention if one appears. 

Children and adults can spike fevers as high as 106 due to hyperthermia, or "heat stroke," a malfunction in the body's ability to cool itself, often after physical exertion in hot weather. Drinking fluids and being immersed in cool water can help; fever-reducing drugs don't.

Fevers can occur in children and adults for many other reasons, including auto-immune diseases like lupus, cancers like leukemia and lymphoma and just normal teething. Some people routinely run fevers even with minor illnesses, and some people seldom get them. (Rare fevers that last for weeks with no apparent reason are known as FUOs—fevers of undetermined origin.)

Even the classic 98.6 isn't so much "normal" as "average," experts note. A healthy person's temperature varies much as a full degree during the day, reaching highest in the evening and lowest between about 6 a.m. and 9 a.m. (just when tough school-or-bed decisions are being made.)

Given all that variability, does it make sense to check the thermometer at all? 

Yes, doctors say. Since most fevers accompany viral infections, experts agree that children with temperatures above 100.4 should stay home until they are fever free, without medication, for at least 24 hours, whether they have symptoms or not.

The same goes for adults—and they shouldn't be under the illusion that lowering a fever with medication also lowers their chance of infecting coworkers, experts say. "We really don't want people with fevers to be in the workplace," says Robert Hopkins, a University of Arkansas professor of internal medicine who serves on the American College of Physician's clinical guidelines committee. 

The illnesses with little or no fever pose more of a dilemma. Some viruses are most contagious in the early stages, before a fever has developed. Others, like last year's H1N1 virus, made many people miserable but seldom caused fevers.

That can make for tough calls for parents and school nurses when it comes to deciding whether a child who complains of illness, but doesn't have a fever, should be in school. 

"Sorting out the difference between a math-anxiety headache and an illness that could be contagious or prevent a child from learning is a judgment call," says Amy Garcia, executive director of the National Association of School Nurses. It helps to know the child very well, she says. "I had three boys myself, so I know the drill pretty well."

GAC FRUIT

Yes, it has a strange name. No, you most likely haven’t heard of it before. And yes, it is definitely a fruit you need to know. It’s Gac fruit (Momordica cochinchinensis), a strange and beautiful red fruit originating from Vietnam, where it is harvested in December and January. The fruit is cultivated throughout Southeast Asia and China, often as an ornamental plant due to its magnificent color. Also known as Chinese bitter cucumber, cundeamor and bhat karela, Gac fruit is rich in the antioxidants beta-carotene, lycopene (seventy times more than in tomatoes), and zeaxanthin. It contains the highest concentration of beta carotene of any known fruit or vegetable (ten times as much as carrots). Beta carotene is a reddish antioxidant that shows up in a host of fruits and vegetables, from apricots to pumpkins.

It converts to vitamin A in the body, and has a variety of protective properties.Gac fruit is traditionally cooked into glutinous rice to produce a brilliant orange rice dish known as xoi gac. The fruit and various preparations made from it are served as special dishes at New Year celebrations, and at weddings. As a traditional medicine, Gac fruit has been employed to treat conditions of the eyes, burns, skin problems and wounds. The juice of the fruit is consumed as a healthy beverage that is good for the eyes, immunity, reproduction, skin, heart health, and the prostate. Today Gac fruit extracts are making their way into supplement products in the US and abroad.

The zeaxanthin in Gac fruit protects the tissues of the eyes against exposure to ultraviolet rays, and helps to reduce oxidation of eye tissue, thereby enhancing overall eye health. Additionally, the betacarotene in Gac fruit helps to maintain good night vision, and reduces the risk of blindness.

For immune system enhancement, beta-carotene from Gac fruit converts in the body to vitamin A, and helps in the healthy development of white blood cells, including lymphocytes, which are important “foot soldiers” in the immune system, enabling the body to defend itself against disease.

Gac fruit’s beta-carotene supports healthy reproductive function by enhancing sperm production. Converted into vitamin A, this important nutrient also plays a key role in healthy embryonic development. The lycopene and beta-carotene in Gac fruit enhance skin health by mitigating oxidative damage in tissue. Think of oxidation as the“rusting” of our cells. These ingredients in Gac reduce that rusting process, and contribute to better-looking and healthier skin. The various antioxidants in Gac fruit enhance heart health by specifically combating atherosclerosis, or hardening of the arteries. Additionally, both lycopene and beta-carotene show protective activity against the risk of heart attack.

Additionally, lycopene, which is super-abundant in Gac fruit, helps to reduce BPH, also known as benign prostatic hyperplasia, a five dollar term for enlargement of the prostate. There is also good evidence that lycopene can help to reduce the risk of prostate cancer. Gac fruit grows on vines. As Gac fruit matures, it goes from a bright neon green to a lush, deep red. The fruit appears spikey and dangerous, and indeed the outer layer of the fruit (the pericarp) is toxic. But this is not the part that is eaten. Only the squiggley insides of Gac fruit (called the arils), which look strangely like red intestines, are consumed.

One Japanese study reported in the International Journal of Oncology suggested that Gac fruit may be a cancer-fighter. In this lab study, a water extract of the fruit inhibited the growth of certain tumor cells. This does not mean that Gac fruit is a cancer cure, but it almost surely will help to reduce the risk of some types of cancer. No doubt more science on the anti-cancer properties of Gac fruit will be conducted over time.
Because of its unusually high concentration of beta-carotene, Gac fruit is a valuable aid in preventing or treating vitamin A deficiency. One study of children conducted in Vietnam measured blood plasma levels of vitamin A before and after the consumption of a Gac fruit extract. The study showed that vitamin A levels increased with supplementation. In many developing countries, vitamin A deficiency is epidemic. Such deficiency can cause poor night vision, blindness, reduced ability to fight infections, higher rates of maternal mortality, poor embryonic growth, and reduced lactation. Supplementation with Gac fruit extract can alleviate chronic vitamin A deficiency, and help to reduce these health problems.

You are not likely to encounter a stack of cantaloupe-sized Gac fruits in your local supermarket any time soon. Likewise, you will not readily find Gac juice in the cold case at your corner store. But you will see this ingredient show up in more supplements, as health experts embrace the nutritious and healing virtues of this exotic fruit.

Answers about what I think about Richard Samuel's (Jodi Arias)

Since I am a pediatrician friends and family seem to think I have the answers to everything, yet I do not always. But, they know if they ask me about a topic I will research the topic and give them my honest opinion. Some then agree with me and some do not.

I was asked by several people what I thought of the defenses expert in the Jodi Arias trial. Yes, I have watch as much of the trial as I possible could, but I admit I have not followed it as intensely as I followed the Casey Anthony trial.  

But here is my take on Richard Samuel's. But, first let me explain his areas of expertise: 

First of all Richard Samuel's is a psychologist and not a psychiatrist (meaning he does not have a MD following his name). He can not prescribe medications for patients.

 A psychologist performs research and therapy on the mind. There are a number of specialists in this profession, ranging from clinical therapists to sports counselors, but almost all focus on practice, research, teaching, or a combination of all three. Though people often confuse the two, psychologists and psychiatrists are very different.

Specializations

  Psychologists have three main areas of focus: practice, research, and teaching. Most are trained in at least the first two, though they may emphasize one area more than the other in their work. Practice is the interaction with patients, and includes things like diagnosing conditions and creating treatment plans that often include counseling or cognitive behavioral therapy. Research consists of performing experiments and gathering information about why people or animals have certain behaviors and think the way they do, and generally includes things like interviews, experiments both in labs and in other settings, surveys, and studies on the physical aspects of how the brain works. In addition to these two focal areas, many people in this field also teach at the university level.

Training

The training to become a psychologist varies slightly based on specialization, but almost all have to have either a Doctor of Philosophy (PhD) in psychology or a related field or a Doctor of Psychology (PsyD). After getting the doctorate, a person usually has to complete a one to two year internship and get a few years of professional experience or residency before he or she can apply for licensure. Most people also get board certification in their area of specialization, though it's usually not required to practice. Those who work in schools or with children usually need special certification and licensure, and their training is more focused on education and childhood development.

As Compared to Psychiatrists

The main difference between psychiatrists and psychologists is their underlying focus. While psychiatrists are licensed doctors and have a medical focus, psychologists work with more non-medical means of treatment, like therapy and cognitive testing. Also, psychiatrists can prescribe medicine, while psychologists usually can't, though there are a few exceptions in certain regions. The type of training needed for each is slightly different as well: psychiatrists have to get a Doctor of Medicine (MD) degree, and then complete four or five years of residency training before they can become licensed to practice.

"Here is my take on Richard Samuel's assessment of Jodi Arias" 

(1  Was it really only an assessment of Arias and the findings and diagnosis there of? I think not.Thus being his job inside the jail is to assess inmates by interviewing them and rendering a bias diagnosis. I would say Samuel's should have only visited Arias no more than 3 or 4 times and then reported back his findings of said inmate (thus remaining bias).His ethics were already questionable from his bartering with the dentist as trade of services. I believe this is why Richard Samuel's moved to Arizona from I believe it was New Jersey. His ethics were already questionable and he paid a fine and had to take classes, although he lied and down played the incident as (having to read a book). 

( 2 Prosecutor Juan Martinez has been right to question Richard Samuel's evaluation of Jodi Arias and his ethics in how long he saw her (Why so many visits?) Then Richard Samuel's motives for purchasing a self help book for Arias. Should Samuel's had been the treating doctor then and only then could had referred Arias to the book, but not purchased the book for her.You can most certainly be helpful to someone, yet not show bias. If Samuel's referred this book to everyone (mother/brother) as Samuel's so stated that he did why did he not purchase (mother/ brothers) books also? But, I never heard him say that he purchased their books. Not only did Samuel's purchase a book, but also greeting cards for Arias. Bias? I think not. 

( 3. Then we come to Arias' DSM test for PTSD why are there 3 scores and only 1 test administered? Then the test was administered on the story (Lie) of the 2 Ninja's dressed all in black. I feel that Samuel's ethics came in question yet again with the 3 different scores. I have actually done my research and the DSM scoring is (simple) addition. How could someone make so many mistakes on simply adding numbers together?  Only my opinion, but I do not believe that Samuel's was at all bias and I also feel he had a underlying agenda. 

( 4. I think if it comes down to Samuel's (So Called) expert testimony to get Arias off that she will have a needle in her arm in a few years. I do not feel that Samuel's has conducted himself with professionalism.

This Bloggers Note: "Hurry Up And Get This Trial Over With" 

(Q&A) About Asthma

I have asthma. Does this mean my child will have it too?

There is definitely a genetic component to asthma, but how big a role genes play is unclear. While there isn't a specific asthma gene, it is more likely that your child will inherit the tendency to develop asthma.
Why does asthma seem to come and go? Asthma is inflammatory in nature, and there are certain things (triggers) that can cause a flare up.
I don't like the thought of my child being on daily medication. I also worry about the medication losing its effectiveness, and then not working when we really need it to.  Can't he just have meds when he's having symptoms? Regular use of preventative medications is the best way to calm and prevent flare-ups. If everybody with asthma used the proper medications, the number of hospitalizations and deaths would decrease. Remember, preventative asthma medications are only helpful when used before symptoms begin.  Remember, sun block only works if you put it on before the sunburn actually occurs.
Will my child outgrow asthma? Many children will eventually outgrow the propensity to have asthma flare-ups as their lungs mature and their bodies get bigger.  Even then, children who get better with age have a recurrence in adulthood. There is no cure for asthma, although it can be managed and controlled with medication.  The bottom line is that the factors which make a lung asthma-prone can still be present as an adult but the likelihood of flare-ups go down as the lung matures and grows physically larger.
Can food allergies cause asthma? While asthma is more common in children with food allergies, the presence of food allergies do not guarantee a child will have asthma.
Can the use of asthma medications prevent remodeling changes in the lungs? Unfortunately the answer is probably not.  More research is needed, but it appears that remodeling changes in the lungs cannot be stopped by diligent use of preventative medications such as corticosteroids - much of this is genetically predetermined.  However, responsible use of asthma medications can decrease the number of bad wheezing episodes and significantly improve the overall quality of life.  How much remodeling matters to overall asthma issues is unclear but we do know that in most children symptoms will improve as they get older.
What is the difference between Albuterol and Xopenex? Scientifically speaking, Xopenex is just the R-enantiomer of Albuterol, while Albuterol is both a R-enantiomer and S-enantiomer 50:50 mixture.  Practically speaking either medication works as a rescue medication and both are very safe.  Xopenex produces less tachycardia (fast heart rate), however the difference is likely modest.  In children with severe heart conditions it may be necessary to use Xopenex, but for most children either is fine and cost-effectiveness should guide which version of the medication to use.

Conundrum of cause

According to a 2010 National Health Interview Survey by the Centers for Disease Control, more than 10 million U.S. children aged 17 years and under have ever been diagnosed with asthma, and 7 million still have it.
The study shows that boys were more likely than girls to become diagnosed with asthma.
Furthermore, asthma cases in children under 4-years-old increased by 160 percent between 1980 and 1994. And there's been a steady increase in the nearly two decades since then.
An analysis by the U.S. Agency for Healthcare Research and Quality states that the percentage of children who use prescription medications for asthma has nearly doubled from 29 percent in 1997 to 58 percent in 2007.
While that could simply mean we're better at diagnosing asthma and have access to better medications, it's still easy to see why asthma is considered the leading chronic illness in kids.
But we don't really know why.
There is definitely a genetic component to asthma.  How big a role genes play isn't clear, nor is it obvious whether or not the environment is a factor – and if so, to what extent.
The "hygiene hypothesis," says that early exposure to the dirtiness of life helps prevent asthma.  If your child isn't exposed to dirt, other kids, and cold viruses early on, it leads to an imbalance in the immune system that in turn increases the risk of developing asthma.
One real-life example of this is the fact that country boys have less asthma and allergy issues than city boys.  They grow up around animals and are exposed early on to lots of thing, thus the immune system is more balanced and less prone to asthma and allergies later on.  However, keep in mind that even country boys get asthma, just less so than city boys.  It seems that early exposure to “life” reduces the risk of asthma - but doesn't entirely prevent it.
That's because the overall likelihood of developing asthma is multi-variable:  Environment, genetics, number of early colds, allergies, and other factors all play a part.  Sometimes the genetics are too strong to overcome.  But just because asthma runs in the family does not guarantee your child will develop it, although they do have a higher risk.
Should asthma actually manifest itself, it's important to avoid the triggers that exacerbate it. Therein is the "Catch 22."  Early on, when there is no asthma, let your kids be exposed to stuff and hopefully they will never develop asthma.  Yet should your child eventually get diagnosed with asthma, from that point on you may need to avoid the things that trigger it.
Triggers are things that make asthma worse or can cause an asthma attack – defined as any acute change in symptoms that interrupts your child's normal routine or requires medical intervention.

Triggers
Exercise:  The majority of children with asthma will present symptoms when they exercise such as coughing and wheezing.
Pollen:  This is a common allergen.  Most children with asthma have allergies, and allergies are a major trigger of asthma symptoms.
Animals with fur or hair:  Keep pets out of your child's bedroom, remove carpeting, and install a HEPA filter.
Mold:  Control indoor humidity.  Repair water leaks no matter how small.
Dust mites:  These critters live in mattresses, pillows, upholstered furniture, and carpets.  Get allergy-proof bedding and pillowcases.  Frequently wash bedding in hot water.  Avoid stuffed toys.  Vacuum and dust often.
Weather changes:  When air quality is poor, keep your children indoors and make sure they are compliant with asthma medications.
Airborne chemicals or dusts:  Try to avoid things like scented candles and air fresheners.
Menstrual cycles:  Monthly hormone fluctuations can trigger symptoms.  Make sure your daughter is compliant with asthma medications.
Viral infection:  Symptoms may flare with a cold.
Smoke:  Avoid tobacco and wood burning.

While parents do their best to make sure the home environment is asthma friendly, don't forget to check daycares, school and relatives' homes. Some triggers can't be avoided, which is why it's important to make sure your child is compliant with his or her medication regime.
That being said, there is no guarantee that an asthma outbreak or attack can be foiled by regular preventative medicine.
There are many different strengths of preventative medicine, and these are tailored-based on the severity of the asthma.  The hope is that as kids get older, they outgrow their propensity to have asthma flare-ups and can eventually be weaned off medications.
Nearly half of children will have a decrease in asthma symptoms by the time they hit adolescence, but about half of those will develop symptoms again when they're adults.
So even though asthma cannot be cured, both you and your child can breathe easier knowing that it can be controlled – and that even after a diagnosis of asthma, he can get back to the business of being a kid.


Tenets of treatment

Inhaled medications are the mainstay of therapy, and are delivered two different ways. The first is a nebulizer, which is a machine that emits humidified air combined with medication. The child inhales the air through a mask.
The other way to receive inhaled medication is through "Metered Dose Inhalers." MDIs are the puffers that most people are familiar with. Medication is sprayed directly into the mouth, but a contraption called a "spacer" helps make sure the medication goes directly into the lungs. Using an MDI without a spacer leads to half of the medication missing its mark – a waste of money that also comes with the risk of under medicating.  In general, MDIs (as opposed to nebulizers) are cheaper, more portable, and quicker and are therefore becoming the modality of choice in pediatrics.
So what's in the medication? The two most common groups of meds are preventative medications of which corticosteroids are the mainstay and rescue medications of which albuterol is the mainstay.
Inhaled corticosteroids are used on a daily basis, whether the child has symptoms or not, to prevent future episodes of wheezing. Think of it as sunblock for the lungs. The child puts it on every day to prevent future troubles.
Beta-agonists are the Aloe vera that soothes the sunburn once it happens. Albuterol is the most commonly used beta-agonist. It works by relaxing the muscles of the airways in the lungs, helping them open to let more air through. The effects of Albuterol are short lived. It needs to be given again and again, usually every four hours, until symptoms subside. The Albuterol, or aloe Vera, makes one feel better after the burn, but does not prevent future episodes. Only sunblock, or inhaled corticosteroids, can do that.

Some parents get freaked out by the word "steroids," picturing pumped-up athletes risking illegal consumption just to make their muscles bigger. Rest assured that corticosteroids are not the same thing. Corticosteroids are similar to steroids that already occur naturally in the body.
That being said, corticosteroids can affect your child's height by causing temporary growth delay. But if that’s the case, it's very minimal, and should resolve through catch-up growth once the medication is stopped. It will not prevent your child from reaching his or her genetic potential in height. And, keep in mind that the side effects of corticosteroids are considerably less serious than the side effects of poorly-controlled asthma – which includes stunted growth overall, even death.


Diagnosis is in the details

Asthma is a disease that is diagnosed by history.  In other words, one cannot make a diagnosis of asthma the very first time a child wheezes.  It's like your friend who show up late to your home for dinner; it would be premature to label them "tardy" after one episode, but if they come late multiple dinners in a row, they are likely "tardy" friends.  With every subsequent wheezing episode, the more likely these are not one time events but a sign that there is underlying asthma.
If asthma is suspected, your child may be referred to a lung specialist for a series of pulmonary function tests - this is typically needed in the more severe cases while the milder cases can be handled by an experienced pediatrician.   Not only will this confirm the diagnosis, it will help define the severity of the disease.
These tests are designed to measure lung volume and respiratory muscle function, but must be performed correctly in order to be accurate. It's not very easy to measure lung function in small children, which is why pediatricians rely heavily on history. The more episodes of wheezing and shortness of breath a child experiences, the more likely the child is asthmatic.
Another way to diagnose asthma is to start children on asthma medications and see if they respond. If they respond positively, meaning they experience an easing of symptoms, they probably have asthma. If the medication does not help, the wheezing and coughing is probably secondary to a cold virus.
The diagnosis of asthma can be tricky, and while there are tools to help, it requires the combination of history, tests, and serial exams to be as precise as possible.


Asthma: A Pedi Perspective

It's difficult to diagnose, can attack without warning, and unfortunately we don't know exactly what causes it.

It's said to be the most common chronic medical problem in children, fortunately it's manageable with medication.
Asthma is a lung disease that causes inflammation and narrowing of the airways, making it hard to breathe.
While it affects people of all ages, it most often starts in childhood. According to the American Academy of Pediatrics, between 80 to 90 percent of people with asthma develop symptoms by the age of 4 or 5.
Parents tend to worry at the first sign of a cough or wheeze, but in reality, a one-time episode is not indicative of asthma. That would be like labeling a friend of yours "tardy" just because she showed up late one time.
Further coloring the diagnosis of asthma in shades of gray is that children with asthma can present with different symptoms at different times.


When to wonder?

The most common symptoms of asthma are coughing, wheezing, chest tightness, shortness of breath and difficulty breathing.
Coughing is a protective mechanism designed to move mucus through the respiratory track. In a child with or without asthma, coughing can be worse at night because during the day gravity and activity helps mucus drain and clear from the airways; however at night, laying horizontal and the lack of movement allows mucus to pool in the airways thus increasing the coughing bouts.
Coughs caused by a virus can last anywhere from two to six weeks or sometimes even longer, but chronic coughing - coughing for more than eight weeks - should be brought to the attention of a doctor.  Although asthma can present with just coughing, an experienced doctor can help distinguish between a cough caused by a cold virus (or other germs) versus a cough secondary to asthma.  It should be noted however that in a child with asthma, cough is often initiated by a cold virus and exacerbated by the underlying asthma producing a mixed picture, hence it may take a few visits to delineate whether asthma is a true player or not.
Often the easiest way to differentiate the two is a trial run of asthma medications to see if there is a response to the medications or not. If there is a response, the good news is there is something you can do for the cough. The bad news is your child may have asthma. If there is no response to the medicine, the good news is your child is unlikely to have asthma. The bad news is there's not much you can do about the cough.  Keep in mind that in children with asthma, there is usually a mixed picture of a cold virus triggering asthma symptoms; in other words the asthma medications will help control the asthma but not the symptoms brought on by the cold virus itself, so a positive response may not be a complete response.
Although asthma can present with just coughing, a child with true asthma will typically have a chronic cough combined with wheezing.  However, note that what most moms call wheezing and what most doctors call wheezing often differ.  There are many sound-a-likes to wheezing that can be best distinguished by an experienced clinician.
Wheezing occurs when the muscles in the airway tense up or clamp down due to inflammation. The result is decreased diameter in the airways, making it more difficult to move air. Just like you make a whistling sound when you purse your lips and breathe, the airways also make a wheezing sound when the diameter is narrowed.
Just as a chronic cough on its own does not mean your child has asthma, a wheezing episode alone is not necessarily indicative of it either, since both of these things can happen in response to a bad cold. A cold virus may cause just enough inflammation in the lungs to cause a one-time wheezing episode.
That being said, kids with asthma will not only wheeze chronically but their lungs will actually show changes that can be seen under a microscope. This is called "remodeling."
Airway remodeling is a response to long-term airway inflammation that can lead to permanent structural changes.
Asthma is more likely to manifest itself in long-term changes if it shows up before age 3, with the child displaying obvious symptoms of these changes by age 6.  Asthma that starts after age 6 is less likely to become a long-term problem.
Flu Vaccine Update 2013

How is the flu vaccine formulated?
Flu viruses are always changing. Each year, experts study thousands of flu virus samples from around the world to figure out which viruses are making people sick and how these viruses are changing. With this information, they forecast which three viruses are most likely to make the most people sick during the next flu season. These strains are then used to make the flu vaccine for the next flu season.

On February 23, 2012 the WHO recommended that the Northern Hemisphere’s 2012-2013 seasonal influenza vaccine be made from the following three vaccine viruses:

*an A/California/7/2009 (H1N1)pdm09-like virus
*an A/Victoria/361/2011 (H3N2)-like virus
*a B/Wisconsin/1/2010-like virus (from the B/Yamagata lineage of viruses)

While the H1N1 virus used to make the 2012-2013 flu vaccine is the same virus that was included in the 2011-2012 vaccine, the recommended influenza H3N2 and B vaccine viruses are different from those in the 2011-2012 influenza vaccine for the Northern Hemisphere.


When to get vaccinated?
Yearly flu vaccination should begin in September or as soon as the vaccine is available and continue throughout the influenza season, as late as March or beyond. The timing and duration of influenza seasons vary.

While influenza outbreaks can happen as early as October, most of the time influenza activity peaks in February or later. About 2 weeks after vaccination, antibodies that provide protection against influenza virus infection develop in the body.


How many shots will my child need?
This year's seasonal flu vaccine will again include the Novel 2009 H1N1 vaccine which was used during the global pandemic and which was also included in the 2010-2011 and 2011-2012 seasonal flu vaccines. This means your child will only need to get vaccinated with ONE TYPE of flu immunization this year.

If your child is 9 years or older, regardless of what flu immunizations have been given in the past, they will only need ONE immunization this flu season.

However, if your child is under 9 years of age, they may need TWO immunizations this year. See the chart below to assist you in knowing how many shots your child will need this flu season.


Please note that the decision tree sponsored by the CDC (Centers for Disease Control) and ACIP (Advisory Committee on Immunization Practices) are slightly different this year. Our office has decided to use the ACIP decision tree as it is more conservative.

If your child needs 2 flu vaccines this year, they should be spaced apart by a minimum of 4 weeks (28 days). There is no deadline by which the 2nd flu vaccine needs to be completed, but once the minimum 4 weeks has passed, the sooner the better as your child will have optimal protection only after the 2nd immunization.

0 flu shots since July 2011 1 flu shot since July 2011 2 flu shots since July 2011
Under 9 years of age 2 flu shots needed 2 flu shots needed 1 flu shot needed
9 years of age or older 1 flu shot needed 1 flu shot needed 1 flu shot needed


If your child is under 6 months of age, they are too young to receive the flu vaccine.  It is imperative then for all surrounding family members (and caretakers) to receive the flu vaccine as soon as possible to create herd immunity.  Essentially, if everyone surrounding the infant is protected, it decreases the risk that the baby will be exposed to the live flu virus.


Will a quadrivalent vaccine be available for the 2012-2013 season?
Traditionally, the flu vaccine covers 3 different strands of the flu virus and is labeled a trivalent vaccine.  Starting next year some pharmaceutical companies will produce a flu vaccine that will be expanded to include 4 different strands of the flu virus thus adding 33% more protection.

Flu vaccine for the US market is produced and distributed by the private sector. While some manufacturers are planning to produce a quadrivalent (four component) vaccine in the future, quadrivalent vaccine is not expected to be available for the 2012-2013 season.