All posts by pedsblogger

How we beat Rotavirus

How we Beat Rotavirus

As a pediatric resident in 2000, winter meant Rotavirus. Every winter, miserable babies with fever, severe vomiting and watery diarrhea would fill our hospital wards. Anxious parents would watch and wait as we treated their weakened babies with intravenous fluids to prevent severe dehydration.

The babies I treated were not alone.  Before the vaccine, almost one in sixty-five babies were hospitalized for Rotavirus in the United States.  That meant 50,000 hospitalized babies, 500,000 seen in physicians’ offices and 160,000 treated in emergency rooms for the illness every year.  In countries with limited medical resources, Rotavirus is deadly.  In fact, it is more fatal than any other single infection, killing about 1,400 children every day.

Rotavirus is hard to control because it is extremely contagious. The virus gets taken in by mouth and is then excreted in the stool.  It lives a long time on surfaces like toys and changing tables, so young children who are constantly touching objects and putting them in their mouths are easily infected. The illness lasts days or weeks and can spread like wildfire through childcare centers. That’s why affected babies cannot return to childcare until all diarrhea is resolved.

This places a great deal of stress on parents.  The first stress of caring for a sick baby, and the second stress of prolonged absence from work.

In August 1998, a vaccine against Rotavirus, called RotaShield, was introduced to protect against this serious viral infection.   What happened over the ensuing decade is a remarkable story.

The RotaShield Story

Every vaccine undergoes extensive testing prior to introduction to the market to ensure that it is safe.   Sometimes, however, very rare side effects can only be detected once a vaccine or drug is given to hundreds of thousands of people.

Rotashield administration began in fall 1998, and by July 1999 about 800,000 children had received the vaccine.  It was only then that a concern emerged that more children may be getting a rare blockage of the intestine, called intussusception. Because the condition is so rare, it was hard to know if there was truly an increased number of cases.

It turns out that the vaccine was associated with about 1 extra case of intussusception per 10,000 vaccinated infants. This information led to the vaccine being taken off the market less than one year after it was introduced.

Scientists went back to the lab to try and develop a safer vaccine.  It took seven years!  Finally, in 2006, a new vaccine called RotaTeq was introduced, and a second vaccine, Rotarix, came out in 2008.

These vaccines have been a remarkable success story. While mild disease can still occur, severe Rotavirus infection in children has been virtually eliminated. Between 2007-2011, the vaccines prevented more than 176,000 hospitalizations, 242,000 emergency room visits, and 1.1 million outpatient visits.  I have only seen a couple of cases since 2006, versus dozens I saw every year in the early 2000’s.

A great deal of research has been done to determine if the new vaccines cause any increase in intussusception.  It is believed that the vaccine causes a very small number of extra cases, about 1 in 100,000 infants, primarily in the first week after vaccination. In summary, the risk of severe infection, about one in sixty five, far outweighs the risk of the vaccine.

The Rotavirus vaccine is a great success story of protecting babies from one of childhood’s most dangerous infections.  I don’t miss Rotavirus!

Pediatrics

July 2001, VOLUME 108 / ISSUE 1

Intussusception, Rotavirus Diarrhea, and Rotavirus Vaccine Use Among Children in New York State

Hwa-Gan H. Chang, Perry F. Smith, Joel Ackelsberg, Dale L. Morse, Roger I. Glass

Pediatrics

September 2016, VOLUME 138 / ISSUE 3

Intussusception Rates Before and After the Introduction of Rotavirus Vaccine

Jacqueline E. Tate, Catherine Yen, Claudia A. Steiner, Margaret M. Cortese, Umesh D. Parashar

http://media.chop.edu/data/files/pdfs/vaccine-education-center-rotavirus.pdf Accessed 11/15/2017

Flu Season is Coming!

Flu Season is Coming!

Keira was a 9-month-old baby girl when she came to my office last November.  I walked in the room, took one look at her and felt my pulse quicken.  This baby was sick.  She had a fever of 103, was lying weak in her mother’s arms, was extremely congested and coughing frequently.   She had classic influenza.

I placed Keira on oseltamivir (Tamiflu) and saw her every day that week as her parents and I carefully monitored her breathing and hydration.  After five days of high fever, during which her parents anxiously pushed fluids and fever reducers, her temperature finally broke and her energy returned.  We had kept her out of the hospital and she was a happy, healthy baby again.  But it took her exhausted parents another week to recover!

Colds, many with fevers, affect kids all the time.  While most viral upper respiratory infections are mild and self-limited, influenza, or the real “flu”, is another story.

Influenza is a serious illness.  Affected people get high fever, muscle and headaches, sore throat, congestion and cough.  Fever can last five to seven days and affected patients feel much more sick than with most viral infections. Some groups are at greater risk of more serious illness, hospitalization or even death.

The elderly, those with chronic disease like asthma, diabetes or immunosuppression, and young children less than five, but particularly those less than two, are at highest risk.  People in these groups are more likely to develop a serious, and potentially life-threatening infection.

Every year in the United States, about 100-120 children die from influenza. 80% of pediatric deaths occur in unvaccinated children over six months.  Between 2010-2014, half of pediatric deaths occurred in children with at least one high-risk medical condition like asthma, but only one third of these children had been vaccinated.  In 2016, 104 children died, half of whom had no high-risk medical condition.

The flu shot is the best way to prevent the flu.  The shot is reformulated every year to cover the strains that are expected to circulate in the upcoming year.  How well the shot works varies due to the unpredictable nature of influenza each season.  Generally, the shot cuts medical visits for flu by 50-75%.

The only shot available today is the injection, as the nasal spray was found to be ineffective against current strains of the virus.  It is given to children over six months of age, and kids less than nine years old need two doses separated by four weeks the first year it is given. The shot should be given as soon as it becomes available, ideally before the end of October.
The shot is safe for pregnant woman at any time during pregnancy.  It also can be safely given to people with a history egg allergy, even those who have a severe reaction to eggs.

The most common side effects to the shot are pain and swelling at the injection site. Some children will feel drowsy, have muscle or headache or loss of appetite.  It is important to remember that the flu shot does not contain live influenza virus.  It cannot, therefore, cause influenza.  People who have had a previous severe allergic reaction requiring use of epinephrine following a flu shot should not receive the shot again.

When I talk to parents about vaccinating their children for influenza, I think of Keira, and how sick she was that November.  The shot may not be 100% effective, but 50-75% protection is a whole lot better than none!

Lyme Disease 101

LYME DISEASE 101

18-month-old Ryan came to my office in July after a family trip to Maine.  He had developed a round red rash, was diagnosed with Lyme Disease and treated with Amoxicillin.  He completed his treatment, his rash resolved and that was that.

As Lyme Disease has become increasingly common, it has become a cause of confusion and concern.  What is Lyme Disease?

BASIC FACTS

Lyme Disease is named after the town of Lyme, Connecticut, where it was identified in the 1970s.  It is caused by a bacteria, Borrelia Burgdorferi, and is carried by the Ixodes Scapularis, or “deer tick”.

Ticks generally become active in the spring. They live in the leaf litter of forest floors, on grasses and plants seeking warm bodies to feed on.  Once attached, it takes about 36-48 hours for an infected tick to pass the bacteria to its “host”.

Lyme is increasingly common in the Northeastern U.S. Its range has also expanded into Canada as a result of warming temperatures. Young children are particularly vulnerable.  There are three different phases of the illness:

Early Localized Lyme

About 80% of infected people get a bull’s eye rash at the site of the tick bite within one month, sometimes with fever and flu-like symptoms. The rash enlarges over days to a large size.  Early Lyme is treated with oral antibiotics for 10-21 days.

Early Disseminated Lyme

Some people get sick weeks to months after the tick bite.  They can then present with multiple round rashes, headache and stiff neck (meningitis), weakness of facial muscles, or (rarely) slowing of the heart rate.  People with this stage of Lyme need longer courses of oral or intravenous antibiotics.

Late Disseminated Lyme

Some people won’t have symptoms for months to years after a tick bite.  The most common symptom of late disease is pain and swelling in one or a few joints.  Patients with Lyme arthritis need to be treated for one month with oral antibiotics.

Post-Lyme Disease Syndrome

A small number of people can have persistent symptoms such as headache, fatigue and joint pain, which persist within the 6 months after treatment of confirmed Lyme. Others with confirmed Lyme arthritis can have persistent joint pain after completing therapy. It is important to note that persistent symptoms are rare, gradually resolve, and the vast majority of people treated with antibiotics make a full recovery.

Testing for Lyme Disease

Blood testing for Lyme is not helpful for the early stage of Lyme, when diagnosis is made by exam and tests can be falsely negative.  Blood testing of patients with specific late Lyme symptoms is important to confirm or rule out the diagnosis.

What is “Chronic Lyme Disease”?

There is growing conversation regarding “Chronic Lyme”.  This term has come into use by advocacy groups such as the International Lyme and Associated Disease Society. It describes a condition of nonspecific symptoms that are attributed to persistent infection.  “Chronic Lyme”, however, has not been clearly defined and is not recognized by established medical organizations.

Patients falsely diagnosed with this condition may have illness that goes untreated, such as a thyroid abnormality or cancer.  Dangerous therapies may be prescribed by “Lyme literate” doctors who charge large amounts of money for treatments that are not approved or covered by insurance, such as prolonged courses of antibiotics or “malariotherapy” (injecting malaria to “burn off” Lyme bacteria).

Be Cautious, Not Scared

Prevention is the best approach.  Wear long pants, socks and shoes, apply insect repellent and perform thorough tick checks in the evening.  If infection does occur, Lyme disease is generally easily recognized and treated.  Persistent symptoms are rare and resolve over time.  Be cautious, but don’t let Lyme Disease take away your family’s enjoyment of the outdoors!

The Dirt on Artificial Turf

The Dirt on Artificial Turf

If your child plays sports, you know them well.  Those little black crumbs that you have poured out from her soccer cleats, vacuumed off the floor or pulled off of his skin.

Artificial turf has become a part of every day life for today’s young athletes and their parents, both at home and on the field.

With all this exposure, parents have rightly wondered, what is in this stuff?  And is it safe?

What is an artificial turf field?

Today’s artificial turf fields have come a long way since 1960’s  Astroturf.
Since the 1990’s, artificial fields have been improved for safety, playability and durability.  They are made of three basic layers:

  1. The top layer is a long-pile “carpet” of plastic artificial grass fibers.
  2. A second layer of infill material lies within the carpet, to support the “grass” and provide cushioning. It can be made of sand, recycled rubber crumbs (“crumb rubber”) or an alternate material.
  3. Underneath is a woven backing holding the carpet in place.

Underlying drainage systems prevent these fields from becoming waterlogged.

What are the benefits of artificial turf over natural grass?

  1. Waste Reduction– Scrap tires are a major waste disposal challenge. According to the Rubber Manufacturers Association, in 2007, artificial fields kept 300 million pounds of tires out of landfills. However, infill must be replaced every 5-10 years.
  2. Improved hours of playability– It has been estimated that an artificial field offers 2,000-3,000 playable hours, versus a natural field’s 300-816 hours.
  3. No need to mow, water or fertilize-According to a University of California Berkeley study in 2010, a 1,000 square foot natural field requires 70,000 gallons of water each week and 15-20 pounds of fertilizer each year, plus herbicides and pesticides. New natural fields, however, can require less input.
  4. Increased access to sports– Artificial fields can be placed on historically contaminated soils, increasing access to field spaces.

What are the health concerns for artificial turf?

  1. They are hot. Artificial fields are much hotter than natural grass. This increases risk of injury like heat blisters, or illness like heat-stroke.
  2. They contain numerous concerning chemicals. Artificial turf made from recycled tires contain numerous concerning chemicals that can irritate the nose and throat, cause nervous system and organ damage or cause cancer.

To date, limited research shows that these fields do not present dangerous exposure levels, but studies are small and involve no long-term follow up of exposed children.

There therefore remains some uncertainty about how much these chemicals enter the bodies of active children. Additionally, risk may depend on environmental conditions and field age.

  1. New fields appear to have similar rates of injury as natural grass, though the types of injury may vary.
  2. Artificial turf may have lower concentrations of bacteria but cause more skin abrasions that could lead to infection. The sum of these effects is not certain.
  3. The risk is low from new fields, but older and aging fields remain a concern.

What are the environmental concerns for artificial turf?

  1. Contamination of waterways. These fields can leach toxic zinc into waterways, harming aquatic life.
  2. Heat island effect. These fields may retain even more heat than paved surfaces, worsening the “heat island” effect of cities and communities.
  3. Displacement of natural environments. Natural environments offer many physical and psychological benefits. Artificial fields can reduce these natural settings.

Summary

Limited research shows that new artificial turf is probably safe, though uncertainties remain. Further research and improvement of natural and artificial fields should further reduce health and environmental risks.

Play Outside to Protect Kids Eyes

Play Outside to Protect Kids Eyes

In the 1960’s, a dramatic increase in nearsightedness, or myopia, was noticed in an Inuit community in northern Alaska.  While virtually none of the parents or grandparents in the community had vision loss, approximately 58% of their children needed glasses. A 1969 study noted that, with the introduction of American education requirements to the region, the children were spending their days in school, while their parents had not.  The authors hypothesized that this environmental change may have led to decreased vision in the children.

During the half century since that study, nearsightedness has been spreading dramatically across the world.  In Europe and the U.S., the prevalence has doubled, and now affects about half of young adults.  In Asia, meanwhile, the rate has skyrocketed. Up to 90% of teens and young adults are near-sighted in China, while in Seoul the prevalence is over 95% of in some groups.

What is the cause of this increase? 

For years, we have learned that too much time staring at books and screens hurts kids’ eyes.  Parents today warn their children not to stare too long at screens, and our parents told us not to watch too much TV.  It now appears, however, not to be the books or screens that cause the problem.  It is being indoors.

Starting in the 2000’s, researchers started looking at children with normal vision and following them over time for the development of myopia.   A study in California found, almost accidentally, that kids who spent more time outside had a lower risk.  Another study in Australia found the same result.

Studies were then done on children in China and Taiwan. Groups of children were assigned to outdoor classes or mandatory outdoor recess and compared to children who spent these time periods indoors over the course of one to three years.  In both studies, kids who were outside more had a lower chance of developing nearsightedness. The more time outside the better the protection.

In these studies, it didn’t matter if the kids were playing sports or reading books in an outdoor class under a tree.  As long as they were outside, they were protected.

How does being outdoors protect eyes?

The light that we experience outside is generally much more intense than the light we experience indoors.  Light intensity can be measured in “lux”.  Generally, indoor classrooms and offices provide about 500 lux, while sitting outdoors provides closer to 10,000 lux.

It is thought that the higher light intensity is needed to stimulate normal eye development in childhood.  Lower intensity light disrupts healthy eye growth and leads to decreased vision in adulthood. It is thought that about 3 hours of time outdoors is needed to protect the eyes.

“Go outside and play!”

 Time outside is good for kids’ hearts, muscles, minds, and, it turns out, their eyes. Parents in 2017 have yet another reason to continue the age-old mantra to our children- “Go outside and play”!

Reference

“The myopia boom- Short-sightedness is reaching epidemic proportions. Some scientists think they have found a reason why”. Nature, News Feature. Elie Dolgin, 18 March 2015

 

 

 

 

 

 

Summer Safety

Summer Safety

The school year is coming to an end and summer vacation is almost upon us. Summer break is a great time for kids to be active and reconnect with the outdoors. It’s important, however, to take steps that keep kids safe, whether it’s during trips to the beach, hikes in the woods or afternoons at the pool.

Sun Safety

Direct exposure to the sun’s rays helps kids produce much needed Vitamin D.  During the peak hours, however, it’s important to protect against sunburns.  Sunburns are not only painful, they can increase the risk of some skin cancers later in life.

The best way to protect children is through seeking shade and wearing lightweight clothing with a tight weave that covers the body.  Wide-brimmed hats that shield the face, ears and neck are ideal, as are sunglasses with at least 99% UV protection.

For children older than 6 months, sunscreens, when used correctly, are another important part of skin protection. The best sunscreens are “broad spectrum”, protecting against both UVA and UVB rays, and should be SPF 15-30.  Higher levels of SPF do not necessarily work better, and have higher concentrations of chemicals.

Thick white creams should be used, rather than sprays or dry powders that are often inhaled.

Look for sunscreens containing active ingredients zinc oxide or titanium dioxide, rather than oxybenzone.   Oxybenzone may have mild effects on the hormone system and are best avoided.  A good guide to safe sunscreens for kids is produced by the Environmental Working Group and can be found on their website, ewg.org.

Insect Protection

Mosquito and tick bites are part of life outdoors, and usually are just a nuisance. Sometimes, however, insect bites can become infected, can transmit diseases like Lyme or West Nile Disease, or cause allergic reactions.

As with sunburns, the best protection is lightweight clothing that covers the body.  Screens on windows and nets over strollers keep insects away, while avoiding perfumes and flowery clothing may also limit attracting insects.

When you expect your child to be amongst biting insects, insect repellents can be valuable.  DEET containing products are the most effective.  DEET has a long history and has been shown to be quite safe, even in babies down to 2 months of age.

Products of 15-20% DEET are best.  Avoid concentrations over 30%, which are not more effective.  They should be applied directly to exposed areas of skin or to overlying clothing, but not onto irritated skin, the hands of young children or directly onto the face.  It should be applied only once per day and washed off in the evening.

Products containing 20% Picaridin may work as well as 10% DEET.  Essential oil products may be valuable for shorter times against some but not all insects, and may cause allergic reactions.

Permethin products kill ticks on contact, and can be applied to clothing or camping equipment.  You can also buy clothes containing permethrin. However, it can stay on clothes even after washings, and should not be applied directly to the skin.

Never use a sunscreen and insect repellent combination product.  Sunscreens need to be applied much more frequently than insect repellent, and combining the chemicals may reduce the efficacy of the sun protection.

All in all, keep kids skin protected with clothes and hats, appropriate sunscreens and safe insect sprays when needed. Then go have fun!

Taking a Shot Against Cancer

Taking a Shot Against Cancer

Smoking cigarettes and getting sunburns are well known risks for cancer. Many people don’t know, however, that some viruses can cause cancer.

The Hepatitis B virus, which is spread by sharing contaminated needles (IV drug use), unprotected sex or childbirth, can cause liver cancer. It is recommended that all children receive the Hepatitis B vaccine for lifelong protection against the virus.

Another virus that causes cancer is the Human Papilloma Virus (HPV). HPV is the most common sexually transmitted infection. According to Children’s Hospital of Philadelphia, twenty million Americans are currently infected with HPV, and 6 million are newly infected each year, half of whom are 15-24 years old. Most of the time, HPV goes away on its own and does not cause any health problems.

Sometimes, however, it sticks around. There are about 100 different strains of HPV that can cause different health problems. Some strains, called “low- risk”, can cause genital warts. These warts are raised bumps that can be treated with topical therapies. About 1 in every 100 sexually active adults has HPV warts at any time in the US.

Other strains of the virus are more dangerous. These can cause cancer, including cancers of the genital tract in men and women, as well as cancer of the throat, tongue and tonsils (“oropharynx”). These cancers can take years or even decades to develop.

HPV cancers are not rare. According to the CDC, between 2008-2012, about 38,793 HPV-associated cancers were diagnosed every year in the US, with about 59% occurring in females. The most common types were cancers of the cervix and oropharynx.

Treatment of HPV-related infections also costs a lot of money. About 8 billion dollars is spent yearly in the US on HPV, more than any other sexually transmitted infection except HIV.

The good news is, because these cancers are caused by a virus, they can be prevented by a vaccine!

The first vaccine against HPV came out in 2006 and protected against 4 strains of the virus. In 2014, this vaccine was improved to cover 9 strains, including those responsible for most cancers. These vaccines are recommended for boys and girls. Another vaccine protects against 2 strains of the virus and is recommended for girls only.

The HPV vaccine is given as a 2 or 3 shot series, starting at 11 or 12 years of age. It can be given as young as 9, and as late as 26 in females and 21 in males. Younger people have a stronger response to the vaccines. As a result, adolescents who receive the first dose before their 15th birthday need only 2 shots at least 6 months apart. When begun on or after the 15th birthday, adolescents require a 3 dose series.

HPV vaccines are highly effective and result in strong immunity to the virus and lower risk of cancer. The CDC estimates that 28,500 of the annual 38.793 HPV cancers would be prevented by the HPV-9 vaccine.

HPV vaccines have also proven very safe. As of 2014, more than 67 million doses had been distributed and millions more have been administered since then. There have been no associations with serious side effects. The most common side effects are soreness at the injection site, as well as redness and/or swelling. Some adolescents feel light-headed immediately after receiving HPV, as well as other vaccines. For that reason, it is best to be given the shot while lying down, and to remain seated for 15 minutes after the shot.

Some families have heard that the HPV vaccine is dangerous or risky. This is untrue and unfortunate, as young people have missed the opportunity to be protected from HPV cancers as a result.

The HPV vaccine is just a shot against a virus, like many other vaccines. Like the Hepatitis B vaccine, this shot protects children from cancer, a chance parents don’t get very often. Pediatricians strongly recommend that parents choose this shot against cancer for their kids. They will be grateful you did!

References and Further Reading
https://www.cdc.gov/std/hpv/default.htm
http://www.chop.edu/news/feature-article-get-answers-your-hpv-questions
https://www.healthychildren.org/English/health-issues/vaccine-preventable-diseases/Pages/Human-Papillomavirus-(HPV).aspx

Summer Tips

Summer Tips

Written by: Casie Tavares-Stoeckel, CPNP

Summer is slowly ending, but here in the greater Washington area the warm weather will be sticking around until October.

Here are a few summer tips that can help you stay safe.

The Sun:

  • Sunscreen is not recommended for infants under 6 month, sun avoidance is recommended.   Try to use stroller covers, umbrellas and find cover under trees.
  • Hats can be more than an accessory.   Hats with a 3-inch brim to shield the face, ears, and back of the neck.

Sunscreen:

  • Use a sunscreen that says “broad-spectrum” on the label; that means it will screen out both UVB and UVA rays.
  • Use Sunscreens that are SPF 15-50.   Most children will do fine with sunscreen that is 30-50 SPF.
  • Remember that sunscreen is not effective if you don’t reapply. Sunscreen needs to be reapplied every two hours after swimming or sweating.
  • Look for sunscreens with zinc oxide or titanium dioxide. This is most helpful in areas of the nose, ears, face, and shoulders.

Sunburns:

  • If the child is under one, it is best to bring the baby in to be seen for any sunburns.
  • Older children should be seen for sunburns that cause pain, blistering or fever.
  • After a sunburn, good fluid intake is important. Encourage water, Pedialyte or water mixed with juice.
  • Can give Tylenol or Ibuprofen for pain. For infants under the age of 6 M only use Tylenol for pain control.
  • Cool water bath can be soothing for sunburns.
  • After sunburn heals, good sunscreen coverage for the area that was burned is very important.

Bugs:

  • Try to avoid areas of stagnant water or gardens with flowers to reduce risk of getting bit by insects.
  • It is now recommended to use insect repellent with DEET. American Academy of Pediatrics recommends DEET up to 30%. This is safe for children older than 2 months.
  • Avoid going out in the early morning and late evening.
  • When outside in evening, when mosquitoes are most prevalent, wear long sleeves and pants.

Ticks:

  • Use DEET repellent to help prevent tick bites.
  • Treat All Animals for Fleas and Ticks.
  • When in wooded areas, dress your child in long selves, pants and a hat.
  • Perform family wide tick checks daily. Remove all ticks that are seen. Can soak ticks in rubbing alcohol to kill them before disposing of them.
  • Know the signs and symptoms of tick borne illnesses. ( Such and a bulls-eye rash, fatigue, fever, swelling of the joints)

Reference and More Information

Healthy Children.Org: (https://healthychildren.org)

American Academy of Pediatrics (https://aap.org)

Baby’s First Foods

Baby’s First Foods

Peanut-free cafeterias, Epipens, gluten-free bakeries. Parents today are facing an increasingly treacherous world when it comes to introducing their babies to solid foods. What is the best way to start complementary foods? What can parents do to protect their children from a serious food allergy?
This is a hot area of research, and recommendations are evolving as we understand more about food allergies and their origins. Currently, there are a few key guidelines that can guide parents as to the safest feeding practices. These are based on the evidence we have today, and will likely be modified as we learn more about this emerging issue.

Guidelines to feeding your baby

1. Complementary foods should be introduced between 4-6 months. For nursing babies, the World Health Organization recommends exclusive breastfeeding for 6 months, due to concerns about the safety and nutritional value of food and water in many regions of the world. In the United States, there is no evidence that introducing foods after 4 months is harmful.

2. Signs that your baby is ready to eat solids include being very interested in what you are eating, becoming harder to satisfy with milk alone, and being able to hold up her head and chest without support.

3. Start with very small volumes once a day, given by spoon. Your baby may only take a taste initially, then a few spoonfuls. As he gets accustomed to eating, he will eat larger amounts, and you can increase to 2 and then 3 meals a day. This increase usually occurs over a few weeks.

4. First foods should be pureed until very smooth and thin. Baby cereals, fruits and vegetables are all fine first foods. There is no exact order you need to follow, but babies usually take to sweeter foods faster. Jarred foods are fine, as are homemade foods, which should include no added spice/sugar or salt. Homemade foods can be frozen in covered ice cube trays and then stored in freezer bags.

5. Foods should be introduced one at a time, usually one every 3 days.

6. After 6 months, foods become thicker, then with small soft pieces. A seven month old may be eating blended lentil soup with carrots, an 8 month old can eat a piece of soft scrambled egg, and a 9 month old can eat a soft, cooked noodle or piece of toast with peanut butter.

7. The ONLY food that a baby cannot eat is honey. This should NEVER be given before 12 months, due to the risk of botulism. All other foods, including peanut butter, whole eggs, fish and soy, can be given after 4 months. Delaying their introduction does not decrease the risk of allergy.

8. There is some evidence that introducing highly allergenic foods early may DECREASE the chance of your child having an allergy to that food. Early introduction of wheat may also DECREASE your child’s chance of having gluten intolerance. When first introducing nuts, soy, eggs or seafood, start with a tiny amount, and do it while you are at home, not on vacation! First allergic reactions are almost always mild, and usually present with a skin rash or hives. The chance of having a severe reaction after first exposure is very low. If tolerated, you can increase the volume slowly in subsequent servings.

9. Let your baby decide when they are done. There is no prescribed amount of food babies should be given. When they are opening their mouth wide and looking for that next bite, they are still hungry. When they are looking all around and not paying attention, resist the urge to keep shoveling it in. They are done!

10. Keep up good eating habits as your baby becomes a toddler. Toddlers become more interested in running around than sitting and eating. Try to avoid giving them too much of the foods they will always eat, such as chicken nuggets or pizza. If they eat these too often, they will lose their appreciation of more natural foods.

Introducing solids to your baby is an exciting experience for both of you. By following the guidelines above, you will do all you can to protect your baby from allergy and start a habit of lifelong, healthy eating. Have fun, and stay tuned!

Dr. Samantha Ahdoot

Address causes of climate change to help alleviate effects on children: AAP

 

October 26, 2015

An 8-year-old girl with severe allergic rhinitis is admitted for an asthma attack in May. A 17-year-old football player practicing on a 95-degree August afternoon is treated in the emergency department for heat exhaustion. A 6-year-old has aggressive behavior in a new school and city after her home and community were destroyed by a hurricane. A 9-year-old boy with a swollen knee is diagnosed with Lyme disease in Maine.

These children’s conditions seemingly are unrelated. Yet they share an underlying association with the rising public health threat presented by climate change.

The AAP Council on Environmental Health has released a policy statement and technical report on Global Climate Change and Child Health (see resources). These documents, updated from 2007, describe the current understanding of climate change and how changing conditions affect the health of U.S. children. Available online, they will appear in the November issue of Pediatrics.

It is clear from a range of indicators that our climate is changing. The planet is, unequivocally, warming. This warming is associated with a worldwide shrinkage of glaciers and decreased snow cover, sea level rise, more frequent and prolonged heat waves, increased heavy precipitation events, and more frequent and severe wildfires. There is wide consensus among scientific organizations and 97% of climate scientists that recent changes in our climate can only be explained by increases in the concentration of heat-trapping gases in our atmosphere over the past century, and not by the natural drivers that altered earth’s climate in the past.

Diverse health effects

Climate change poses significant threats to human health to which children are uniquely susceptible. The World Health Organization estimates that more than 88% of the existing burden of disease attributable to climate change occurs in children younger than 5 years. The diverse health effects of climate change can be classified as primary, secondary and tertiary.

Primary effects are those most directly attributable to climate. Extreme weather events are increasing in frequency and severity. Children’s unique needs place them at risk of injury, death, separation from caregivers and a high risk of mental health consequences following these events. Worsening heat waves threaten children, particularly high school athletes and young infants, with increasing heat illness.

Secondary effects are those that affect children indirectly through shifts in natural systems. Increased plant pollen concentrations and allergy season duration, wildfire smoke and temperature-associated increases in ground-level ozone all can reduce air quality and precipitate asthma attacks and/or allergic disease.

The hosts, vectors and organisms that cause some pediatric infections are influenced by climate conditions. Climate warming has been linked to the northern range expansion of Lyme disease and is projected to increase the burden of child diarrheal illness in vulnerable regions. Child nutrition is threatened by altered agricultural conditions affecting food availability and cost, as well as rising atmospheric carbon dioxide concentrations, which may alter the protein, iron and zinc content of some major crops.

Tertiary effects are those that could result from broad societal impacts of unchecked climate change. Sea level rise, decreased biologic diversity, water scarcity and famine, mass migrations and decreased global stability threaten the social foundations of children’s mental and physical health and well-being. Communities already at socioeconomic disadvantage are most vulnerable to these effects.

What can be done?

Because of past and present emissions, some continued changes to our climate are inevitable. However, the most severe effects still may be prevented if greenhouse gas emissions are significantly reduced in the upcoming decades.

Addressing the causes of climate change also presents an opportunity for pediatricians to improve child health through immediate, associated health benefits. For example, encouraging active modes of transport like walking and biking helps reduce carbon emissions and promotes child health. What is good for the climate also is good for children.

Informed by an understanding of the health threats posed to children by climate change, the following recommendations can allow pediatricians to play a valuable role in the societal response to this challenge:

  • Work to promote medical educational opportunities regarding the effects of climate change on the environment and child health.

  • Seek ways to reduce the carbon and environmental footprint of health facilities, including hospitals, medical offices and transport services.

  • Discuss climate change with families, using existing anticipatory guidance as a framework.

  • Educate children, families and communities on emergency and disaster readiness using the AAP Children and Disasters site (http://bit.ly/1JmG9hE) as a guide.

Advocate for policies that reduce greenhouse gas emissions and that improve preparedness for anticipated climate-associated effects. Climate policy is health policy.

The policy also offers recommendations to government, including the need to fund research on climate-associated health effects; to promote energy efficiency and renewable energy production while decreasing incentives for continued production and consumption of carbon-intensive fuels; and to support education of the threats from climate change for public and children’s health.

Climate change is not just a daunting problem. It is a golden opportunity for pediatricians to protect the health and welfare of all current and future children.

Resources

Global Climate Change and Children’s Health policy: www.pediatrics.org/cgi/doi/10.15.42/peds.2015-3232; technical report: www.pediatrics.org/cgi/doi/10.15.42/peds.2015-3233

Footnotes

  • Dr. Ahdoot is a lead author of the policy statement and technical report. She is a member of the AAP Council on Environmental Health Executive Committee.