All posts by pedsblogger

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.

 

BACK TO SCHOOL ALREADY?!

BACK TO SCHOOL…ALREADY?!

We are in the midst of another summer. Some people have come back from their vacation, some are on vacation, others are preparing to get away during these next few weeks. Whatever the case, people have been keeping busy. There are lot of new babies- and new parents. Others are working through these warm months. It seems like only yesterday we were complaining about the frigid temperatures and how the threat of snow closed down schools for almost a week. Those days will be soon upon us again. “Back to school” sales seeks to remind us of the upcoming winter days.

Ever since I was little I always wondered one thing: why do back-to-school sales start one month before it’s time to go back to school. I was always enjoying my summer vacation, when the TV (not cable) started “talking” about all the sales. Even though it was almost a month until school started again, I had to be reminded of the end of summer. To this day, it still happens- except now it is on TV, in print, and online. Why do you need a month to get ready to go back to school? I wanted to enjoy my vacation, not worry about school supplies in August.

Christmas sales start around Columbus Day, seemingly earlier each year. Halloween candy seems to come out as soon as school starts. There always seems to be an upcoming holiday. It seems as if all the advertising companies like to focus on the future, but not on the present.. When you’re in school, there’s no time like the present. The future, whether one week or one year is a long time away. For certain things, adults should take a look at the world from the view of a child. You will see a different environment. (The Little Prince by Antoine de Saint Exupéry focuses on this matter. It is a children’s book which is not really a children’s book.)

As everybody getting ready to go back to school, savor these last few days of summer. Once they are gone, they will only remain as memories. Enjoy the time spent with your families. Try to save the back-to-school shopping for a little bit closer to when school starts- if possible. Have a great summer – it is still not over.
Andreas D Sideridis, MD

Medicine, Vaccines and Trust

Medicine, Vaccines and Trust

The practice of medicine is based on trust.

Children trust parents. Parents trust pediatricians.  Pediatricians trust the medical system.

To do my job as a pediatrician, I must trust my specialist colleagues.  I must trust the nurses caring for my patients in the hospital.  And I must trust expert scientific organizations, such as the American Academy of Pediatrics, the Centers for Disease Control and the National Institutes of Health, to review the most current research, form a consensus and create policies. It is my job to understand these policies and translate them into practice for my patients.

This system works.  Children are safer today than ever before.  They are safer from infections, from trauma, and from malnutrition. As new information becomes available, guidelines change, and practitioners adapt their practice to match emerging evidence.

When trust is breached, however, the system fails.

If I do not trust the CDC, I will form my own guidelines, outside the standard of care, that are based on the limited information that I can obtain and evaluate.  Doctors who form their own, independent guidelines put their patients, and themselves, at risk.

Similarly, if a family does not trust their pediatrician, they will also create their own guidelines.  They will form their own plan of care that relies on limited, often biased, information.  When they do this they put their child, and their community, at risk.

When parents decline vaccinations, it is because of a lack of trust.  In their doctor and the medical establishment.  When this happens, the system fails.  And children suffer.

Dr. Samantha Ahdoot

Children need the EPA’s carbon pollution standard

Every day, parents protect their children from a myriad of risks. By strapping them in car seats, placing them on their backs to sleep and cutting their grapes into quarters, parents do everything in their power to insure their children against harm. President Obama’s Clean Power Plan will be called many things in the upcoming months, but it is ultimately an insurance plan. It is insurance for our children against the dangers of carbon pollution and resulting climate change.
Carbon pollution presents a major risk to the health, safety and security of current and future children. Rising atmospheric carbon is making our planet hotter. While skeptics may say this remains uncertain, our major scientific organizations (NASA, NOAA, IPCC) tell us it is at least very, very likely. With this increased heat, many other climactic changes are already occurring, including melting glaciers, rising sea levels and worsening storms. These fundamental changes ultimately impact human health, and children are amongst the most vulnerable to these changes. Some impacts are already affecting children today and are being seen by pediatricians like myself.
Allergic rhinitis, for example, affects about 10 percent of American children. With later first frost and earlier spring thaw due to rising global temperature, the allergy season has become longer. In the Northern Virginia region, where I practice, it has lengthened by about two weeks. More northern regions of the country have experienced greater lengthening. Higher carbon dioxide in the atmosphere also causes ragweed plants today to produce more pollen than in preindustrial times. Allergy season is therefore both longer and more severe.
Some infectious disease patterns have already been impacted by climactic changes. As global temperatures rise, many plants and animals are migrating poleward. They are bringing diseases, like Lyme disease, with them. There is now Lyme disease in Canada, and large increases in reported cases of Lyme have occurred in the northern U.S. Maine had 175 cases in 2003 and 1300 cases in 2013, while New Hampshire had 262 cases in 2002 and greater than 1300 cases in 2013. Children under five years old, who spend the most time outside playing in high-risk areas, have the highest incidence of Lyme disease.
Increasingly long and severe heat waves also place children at risk of heat-related illness. While the elderly are at highest risk from extreme heat, some groups of children also appear to be vulnerable. Infants less than one year, for example, have immature thermoregulation, and infant mortality has been found to increase due to extreme heat. A study from MIT found that by the end of the 21st century, under a “business as usual” scenario, infant mortality rates would increase by 5.5 percent in females and 7.8 percent in males due to heat-related deaths. U.S. student athletes are a high-risk group for heat injury. Teenage boys, most commonly football players, made up 35 percent of the roughly 5,900 people treated yearly in emergency rooms for exertional heat illness between 2001 and 2009. According to the CDC, heat illness is a leading cause of disability in high school athletes, with a national estimate of 9,237 illnesses annually.
Health impacts on individuals and communities will grow significantly if we allow carbon emissions, and global temperatures, to rise unchecked. Power plants contribute approximately one-third of U.S. greenhouse gas pollution. Reducing emissions from existing fossil fuel-fired power plants represents a major step towards altering our emissions, and climate, trajectory. Obama’s Clean Power Plan is, ultimately, like a car seat- an insurance plan for our children against a significant risk of harm. The road of climate change will be long and hazardous. Our children deserve to be strapped in.
Dr. Samantha Ahdoot is pediatrician in Alexandria. She is a Fellow of the American Academy of Pediatrics (AAP), and a member of the Executive Committee of the AAP’s Council on Environmental Health.

Dr. Samantha Ahdoot

“The City That Never Sleeps”

“The City That Never Sleeps”

Growing up in New York, I was (and still am) proud of the motto that describes my city. It was great! You could get anything you wanted at anytime. A decent pizza was only a phone call away. Then everything changed— I went to medical school. “The city that never sleeps” became a whole new meaning for me.

Medical emergencies/issues/questions know no time. It is amazing what can actually happen in the middle of the night. The most extreme event in my experience was witnessing an emergency open heart procedure at a patient’s bedside. That is not a normal occurrence- but it makes the night interesting (the patient did well). My call last weekend brought back memories, as it was unusually busy. Each call was a personal emergency for a parent and their child. For every night you mange to sleep well, many of your fellow parents are not- whether it is for medical concerns with their children or personal concerns with their in-laws (we do not handle those calls), amongst other things. We are all glad to be there to help in any way we can.

As the holidays approach, remember to be extra cautious with your children. Illness is going to be coming with all those relatives bearing gifts. Remember to use hand sanitizer frequently, especially in public places (when Santa visits Tysons, he has his own bottle next to him). Have a special “quarantine room” for those family members that are ill- or the ones of which you are not quite fond. Be especially careful with newborns. An adult’s common cold can be quite serious for them. Pass their picture around, not the actual baby.

Accidents also seem to happen more around the holidays. Children can get into trouble in an instant, which always seems to be at an inconvenient time. Be careful with stairs, windows, etc. Make sure the house- including any holiday decorations- are child-proof. Keep medicines out-of-reach and/or in child-proof containers, especially those from any guests.

The Holidays are a time for celebrating- and not just for the credit card companies. But, should anything at anytime ever arise, we are always here to help- something we enjoying doing. After all, PAA “never sleeps.”

Andreas Siderdis, MD

PS
If anyone is looking for a decent slice of pizza don’t lose sleep over it- there is none in this area.