Flu Review

Flu season is here.  This is just a little review on the topic.

First, you cannot get flu from the injectable vaccine.  If you haven't gotten one you should.

Second, flu is a respiratory virus not stomach virus.  That being said, flu makes you have high fevers, achiness and cough, NOT vomit or have diarrhea.  If you have vomiting and diarrhea, you don't have the flu.

Third, there is medicine for the flu but typical antibiotics like azithromycin (zithromax) and amoxicillin don't treat viral illnesses.

Finally, flu is VERY conatgious.  Let me be clear, it is extremely contagious.  In other words, it is easy to get the disease.  Get my point.  If one person in the house gets it and you aren't vaccinated, everyone in the house will get it, so prevention is the key.

I hope that this dispells a few myths.

Kevin M. Windisch MD, FAAP
Sparks Pediatric and Adolescent Medicine
(775) 359-7111
975 Roberta Lane, suite 101 B, Sparks, NV 89431.
www.facebook.com/sparkspeds.nv

9 month well exam

So What happens at nine months- after all there are no shots?

First we weigh and measure your child.  We complete a thorough developmental exam.  9 months of age is right before a child starts to walk and talk so this is an important time to address developement.

Next we examine your child carefully.  Special attention is paid to developing teeth and dental care.  We often remind parents that they need to see a dentist at 1 year of age so they should start looking for one now.

After that we answer any questions that parents may have.  This is a great time to talk to your doctor since there aren't any vaccines coming (unless you are behind on something).

Finally we finish with our teaching regarding safety.  This includes preparing the house for a child who will soon be walking and very mobile.

I hope that you've found this educational and that this has answered some questions for you.

Kevin M. Windisch MD, FAAP
Sparks Pediatric and Adolescent Medicine
(775) 359-7111
975 Roberta Lane, suite 101 B, Sparks, NV 89431.
www.facebook.com/sparkspeds.nv

cold and flu season

now that cold and flu season is uppon us I think it is a good time to review some of our videos surrounding these issues:

Bronchiolitis:
http://www.youtube.com/watch?v=5Teb03hEIXw

Croup:
http://www.youtube.com/watch?v=BF5SxEHPGCk

Colds:
http://www.youtube.com/watch?v=AcGjy--gojE

Antibiotics and their risks:
http://www.youtube.com/watch?v=aYbvIaibT-c

Flu and Influenza:
http://www.youtube.com/watch?v=-DuLSdYMVFw


I hope that this helps.

Kevin M. Windisch MD, FAAP


Sparks Pediatric and Adolescent Medicine
(775) 359-7111
975 Roberta Lane, suite 101 B, Sparks, NV 89431
www.facebook.com/sparkspeds.nv

How to Take a Temperature

Now that we are in cold and flu season, it is time to review temperature taking.

In a child under 6 months of age, temperature is very important.  Because of that, if you think your child is sick, take his temperature with a Rectal Thermometer.  Under the arm, forehead and mouth temps are not accurate enough at this young age.  Over 6 months of age a forehead (temporal artery) or under the arm (axillary) temperature is usually sufficient.

Now, I recognize that for children over 6 months of age, it is common practice to feel the child's forehead and not to actually take a temperature.  This is probably okay UNLESS you are planning on seeing the doctor.  If the child is ill enough to see us, she is ill enough to have her temperature taken.

Under NO CIRCUMSTANCES should you feel the child's forehead and use that to report an actual temperature to your doctor.  You child's physician uses the degree of temperature to make medical decisions and this implies a false degree of accuracy which could result in harm to your child.  If you only took the temperature with the back of your hand (a tactile temperature), please say so.  At least we will know how to use that information safely.

Kevin M. Windisch MD, FAAP
Sparks Pediatric and Adolescent Medicine
(775) 359-7111
975 Roberta Lane, suite 101 B, Sparks, NV 89431
www.facebook.com/sparkspeds.nv

Diaper Rash

The other day one of my friends had a new baby.  In my care-package to my friend and his wife I sent some stuff to help with diaper rash.  What new, fancy expensive, magic compound did I send? 

Well what I sent was neither new, fancy nor expensive but it does work like magic.  I sent a packet of Domboro Powder.  Domboro solution goes back to the 1950's.  A single packet will last most newborns a lifetime and a box of 10 packets costs less than $10. 

All you need to do is to mix one packet into 16 ounces of water and shake.  When the child has a diaper rash, soak a gauze in the medicated water.  Stick the gauze on the rashy part of your child's bottom and change with each diaper change till the rash is gone.  Once resolved, apply Vaseline, desitin or zinc oxide paste to prevent a re-eruption of the rash.

Rashes that don't respond promptly may be something other than typical diaper rash so check with your doctor, some of these other rashes are dangerous so don't wait too long to seek proper medical attention.

Kevin M. Windisch MD, FAAP
Sparks Pediatric and Adolescent Medicine
(775) 359-7111
975 Roberta Lane, suite 101 B, Sparks, NV 89431.
www.facebook.com/sparkspeds.nv

Breast Feeding for adopted babies?

Attention all future adoptive mom's!!!  Did you know that there is a good chance that you will be able to breast feed your new baby?

Nothing in medicine is 100%, of course.  Assuming that your body reacts normally to horomones and that the ductwork to your breasts is intact (ie, you did not have breast reduction surgery or mastectomy), then there is a good chance that you can breast feed your adopted baby.  This is good for both mom and baby.  It will provide the baby with antibodies and complement, all of which fight off infection.  Breast feeding also hopes to promote bonding between mom and baby and help to limit any sense of loss that the baby might feel.

Here is how we do it.
1.  Start an Herb called Fenugreek.  This herb is available from GNC and Wholefoods Market.  I usually recommend starting at 2 caps 4 times per day then tapering the medication off when the breast milk comes in.  Fenugreek is a safe and effective herb that we all consume to some degree.  It is used as the active ingredient in artifical maple syrup and used extensively in Indian cooking.

2.  Place the baby to breast 10 minutes on each side every two hours.  This will stimulate breast milk production and let down.  If you are doing a directed adoption and the baby is not here yet, you can pump your breasts 10 minutes each side every two hours.  This is not as effective as placing a baby there but given enough time will allow most women to lactate by the time that the baby arives.

3.  While waiting for your breast milk to come in, Feed the baby formula.  While it is true that breast milk is best, it is also true that starvation is WORSE.

Kevin M. Windisch MD, FAAP
Sparks Pediatric and Adolescent Medicine
(775) 359-7111
975 Roberta Lane, suite 101 B, Sparks, NV 89431
www.facebook.com/sparkspeds.nv

Anemia and Infants

Why worry about a low iron in an infant, you ask???  The answer is somewhat complicated.  Iron is necessary to carry oxygen in the blood.  If your Iron is low, so is your blood's oxygen carrying capacity.  This then results in the brain, which is still growing in an infant, to be starved of oxygen.  When this happens, the child is at increased risk of permenant learning disability and mental retardation.

The body recognizes that it is low in iron, so it attempts to hold on to all dietary iron.  Unfortunately the body does not do such a good job of distinguishing between Iron and its close chemical cousin Lead, a poison.  As a result, iron deficient children are at increased risk of lead poisoning.  Lead intoxication causes lots of problems but the most profound is brain damage (made worse by the low oxygen carrying capacity of the low iron blood).

How to we prevent this?  We check your child's blood for iron and lead at 12 and 24 months.  If the blood is low in iron, we can begin oral iron supplementation and fix the problem before there is damage to the brain.

I hope that this sheds some light on what we do.

Kevin M. Windisch MD, FAAP

Sparks Pediatric and Adolescent Medicine
(775) 359-7111
975 Roberta Lane, suite 101 B, Sparks, NV 89431.
www.facebook.com/sparkspeds.nv

Stitches

There are a lot of myths about stitches (the medical term for this is sutures) floating around so let me clear a few up.

First, dirty wounds cannot be sutured.  Such wounds will become infected and result in the sutures popping open.  Wounds must be properly cleaned out first.  We try hard not to suture bite wounds because the risk of infection is so high.  To this end, no wound older than 6-8 hours old can be stitched up.  If you think that your child needs stitches, seek immediate medical care.

We place skin sutures only to bring the skin together and to get a nice closure and to try to limit the size of the scar.  Deep or burried sutures provide any strength necessary to keep gaping wounds closed.  skin sutures are under little or no tension.

Sutures don't stop bleeding.  Cautery, direct pressure, ligation of bleeding vessles and vasoconstricting medications stop the bleeding.  If you suture up a seriously bleeding wound the bleeding will place the sutures under tension and they will pop open.

Sutures typically give better cosmetic closure than does superglue.  If it was my son's face we would be doing a running subcuticular suture not glue.  This is the type of suture used by most plastic surgeons for skin stitches for a reason.  You will note that plastic surgeons NEVER glue anything back together.

I hope that this demystifies some things for you.

Kevin M. Windisch MD, FAAP
Sparks Pediatric and Adolescent Medicine
775-359-7111
www.facebook.com/sparkspeds.nv

6 month old well child exam

Things start to ge complicated around 6 months of age.
We start as always, answering questions and watching the development of your child.  We are able to perform standardized screens of development at this age and have the parent complete this before we enter the room.  If your child shows delayed development we can address this early, while the child is still young enough to respond quickly.
Next we look at the growth of your child and perform our usual physical.  Special attention is paid to dental development at this time.
Finally we do our usual teaching.  This time we address upcoming mobility and the dangers that come with this.  We also talk about dental hygeine and, here in Nevada where we don't flouridate our water, prescribe vitamins with flouride to help keep the teeth strong.

We finish with vaccination pursuant with the CDC guidelines.

I hope that this helps to dispel many a myth for you.

Kevin M. Windisch MD, FAAP
www.facebook.com/sparkspeds.nv
Sparks pediatric and adolescent medicine
775-359-7111

Why does my child need a flu shot part 1

Why does my child need a seasonal flu shot when he got one at 2, 4 and 6 months with a promise of another one at 12 months? 

I hear this question regularly in my office.  The answer is somewhat complicated.  First you need to understand that the vaccine given at 2, 4, 6 and 12-15 months is not a seasonal flu vaccine.

Seasonal flu or influenza is a virus.  That means that it is a piece or several pieces of protein that surround some genetic material, DNA or RNA.  That viral particle is not capable of eating nor is it capable of breathing.

The vaccine your child received at 2,4, 6 and 12 months is against Haemophilus influenza or HIB.  The unfortunate last name makes people think that theser are the same thing.  HIB is a bacterium.  That means that it is a living, breathing, eating organism.

4 doses of the HIB vaccine protect for life.  The seasonal flu (viral) vaccine however, needs to be repeated yearly because the virus changes its genetic code yearly.

I hope that this clarifies things for you some.

Kevin M. Windisch MD, FAAP
Sparks Pediatric and Adolescent Medicine
775-359-7111

4 month well child exam

So what do we do at 4 months you ask?

First we again check height, weight and head size.  Are you seeing a theme here.  These parameters are critical for monitoring your child's health and brain development.

Next we again review developmental milestones.  In my office we now start to use a standardized screening tool for development called the ages and stages questionaire.  This test allows us to check for signs of developmental delay that are very subtle and if present allows us to intervene early.

We then perform the usual physical exam.  Close attention this time is paid to the tone of the muscles throughout.  This is the age when cerebral palsy first becomes easily noticed.

Next we discuss and administer the vaccines

Finally we provide guidance and safety teaching.  This is the age when we first introduce solids so alot of time is spent discussing what foods to introduce and how to introduce them.

I hope that this helps.

kevin m. windisch md, faap
sparks pediatric and adolescent medicine
775-359-7111

2 Month Well Child Exam

So What do we do at 2 months of age? 
Well, we start with checking your child's height and weight and make sure that they are growing okay.  We also check her head size and make sure that her hed is growing okay.  A small or large head could indicate some brain or skull abnormality.

We then check development.  We want to see that your child is starting to look around, lift her head up part way and smile, among other things.

Next, we do a complete head to toe physical.  Special attention is again given to the heart and examining the hips for dislocation.  To see how we do these exams you can go to http://www.youtube.com/watch?v=_5jDjBzXJYA (chest exam) and to http://www.youtube.com/watch?v=uPPkrS8ktp8&feature=related (hip exam).  While maneuvering your child around we also pay close attention to muscular tone (strength) as this could be an early sign of cerebral palsy.

After the exam comes parent teaching.  We will cover things pertinent to 2 month babies including preparation for rolling over, sleep positioning and fever management.

Finally we place the vaccines.  At this age your child will get DTAP, IPV, HIB, PCV-13, Rotavirus and Hepatitis B vaccine.

I hope that this helps to demystify what we are doing

2 week well child exam

So what do we do for the two week well child exam you ask?  After all, wasn't my child just there 2 weeks ago?

Well, first and foremost we check the child's weight.  At this time your child should be back to or above his or her birth weight.  If they have not regained their birthweight there is potential for several serious problems to be present.

Next we will address any concerns that the parents may have for the child.  By now many children have dry skin and the parents wonder what to do about this.  Many children are also spitting up and this raises many parental questions.

Finally we do a complete physical.  The artery pressures in the lungs have finally dropped to their normal adult levels making many murmurs not heard at birth now audible.  We check for liver and kidney size and recheck the hips since dysplastic hips can show up any time in the first 18 months of life.

We end with some safety recommendations for parents and set up the next visit.

I hope that this has helped to demistify what we do.

Kevin M. Windisch MD, FAAP
www.facebook.com/sparkspeds.nv

Whooping cough

This is why I'm so strict about children being up to date on vaccines.  (warning this is very graphic and disturbing)  http://www.youtube.com/watch?v=wuvn-vp5InE  There is a large whooping cough epidemic in Sacramento coming to a child near you.  We need to protect our children and vaccination is the only way.

Flu shots

Flu shots will be arriving shortly, stay tuned for updated on our Facebook page www.facebook.com/sparkspeds.nv  we will let you know when they are here.

Who should get the flu shot?  It is now recommened for all children.  We give 2 doses the first year or 2 doses to any child who did not complete the 2 dose series of swine flu vaccines last year.

Kevin M. Windisch MD FAAP
Sparks Pediatric and Adolescent Medicine
775-359-7111

Infant Hip Exam

Ever wonder what we are doing when we examine an infant's hips?  Ever wonder what we are looking for.  Here is your chance to learn how and why we do what we do.


http://www.youtube.com/watch?v=uPPkrS8ktp8

I hope that this is enlightening.
Kevin M. Windisch MD, FAAP
Sparks Pediatric and Adolescent Medicine
www.facebook.com/sparkspeds.nv
775-359-7111

Dosing liquid medications

When giving your child oral medications that come in liquid form, always use the eyedropper that came with the medication a calibrated oral syringe.  In a pinch a measuring spoon can be used.  Never, ever, ever just guess at the dose of medication.  The risks of over or underdosing your child on medication is too long to list here.

You wouldn't use a regular spoon from the kitchen table to measure the salt for your Nestle's Tollhouse cookies because this might make the cookies taste bad, so don't use a regular spoon to dose medications because this could have deadly results.  I know that this recommendation sounds very basic but you would be surprised how often I run across this.

I hope that this helps to keep your children safe.

Kevin M. Windisch MD, FAAP
Sparks Pediatric and Adolescent Medicine
http://www.sparkspeds.com/
www.facebook.com/sparkspeds.nv
775-359-7111

Smashed Fingernails

How many times did I smash my fingers in a car door as a child? Too many to count. These injuries, while usually mild, can result in amputation of the finger tip or destruction of the bone. If there is obvious deformity, please see your doctor.




What I really wanted to talk about, though, was what to do for the bruise that then results under the finger nail. First is to ice the finger to reduce the swelling. You can give motrin as well for pain. Finally, if you bring in your child to see your doctor, we can drill some small holes in the nail to relieve the pressure and thus protect the underlying nail bed. The small holes will also help to decrease the pain by getting the pressure down.



I hope that this helps. Stay safe.

Kevin M. Windisch MD, FAAP

Sparks Pediatric and Adolescent Medicine



www.facebook.com/sparkspeds.nv

Boat and boater safety

Here are some tips for boating with children.

http://sparkspeds.wordpress.com/2010/08/04/boats-and-kids/

the infant hip exam

ever wonder what the doctor was doing when he checked your infant's hips?  Here is a complete guide to the ortolani and barlow maneuver used to assess for developmental dysplasia of the hip.

http://www.youtube.com/watch?v=uPPkrS8ktp8

Cold Sores, What a pain.

Ever wonder about cold sores?  Everyone gets them but nobody understands them.  Hopefully this will help

http://www.youtube.com/watch?v=G_dDZe_D_x8

Hope that this helps.

Kevin M. Windisch MD, FAAP
Sparks Pediatric and Adolescent Medicine
775-359-7111
www.facebook.com/sparkspeds.nv

Vita-vegamix

A question about the value of vitamins has arisen, so I thought I'd address this for everyone.  the Nobel Prize winning chemist Linus Pauling believed that huge doses of vitamin C would cure most disease.  While Dr. Pauling was one of the most brilliant men who ever graced Cal Tech, I think he missed the boat on this one.  There is no research to suggest that huge doses of any vitamin prevent cancer, death or any other serious disease.

Having said that, most Americans don't get enough vitamin D.  It is recommended by the American Academy of Pediatrics that all children not eating substantial quantities of formula (which is supplemented with vitamin D) receive 400 IU of vitamin D, daily.  To that end, we recommend a multivitamin daily for all of our patients.  Anything will do- chewable, swallowable, liquid (icky tasting but whatever floats your boat) or gummy.  We recommend that it be taken with some food because vitamin D requires fat for absorption. 

We also recommend 500-1000 mg daily of Calcium Carbonate (tums or oscal) split into two doses for all girls.  Women pack on the majority of their bone mineral mass before age 35 so now is the time to optomize this, in order to prevent the old lady back hump.  Boys might also benefit from this but the benefit has been well demonstrated in girls.


Here's to your health.

Whoopting cough for parents?

Today a parent asked me if she should receive the whooping cough vaccine before leaving the hospital with her newborn.

The shor answer is Absolutely.  Whooping cough is devestating to newborns and the only way to protect them is to vaccinate those close to them.  Let's protect our new borns.

Fever Phobia

When should I worry about fever, Doctor? 

I get this question daily in my office.  In patients over 60 days of age, with no other medical problems, I don't worry about fever unless it has lasted more than 3-4 days.  I worry about other symptoms such as vomiting, lethargy, stiff neck, etc. regardless of fever.  Generally in these children, we don't worry much about the height of the fever.

Finally, remember that fever is defined as a temperature of 100.5. or more.  We don't even consider it to be a "High" fever until it is over 103.5 F.

Fever

Let's Define Fever for everyone.  Fever is defined as temperature greater than or equal to 100.5 F.  Temperatures of 99, 100.1, etc. are normal and nothing to worry about.

When should you worry about fever?  In an infant 0-60 days we worry about any fever.  for a child over 60 days of age we worry about the other symptoms that go with fever or fevers that last more than 2-3 days.

Good luck.

iron supplements

Did you know that there are dozens of iron supplements available over the counter.  Overdoses of iron are very difficult  to treat and may be fatal so please use only the supplement your physician has recommended.  Do NOT start an iron supplement for your child unless your pediatrician has recommended one!

This is not a drug that I would substitute for something that I thought was similar without first asking a pharmacist.  I would also recommend not using foreign medications for this one because of the risk of liver failure and death in the event of accidental overdose.

What do you mean Ringworm isn't caused by a Worm?

Ringworm is the common name for tinea corporis.  Tinea corporis is an an infection of the skin caused by any of a number of fungi.  It is sort of like athlete's foot, tinea pedis, of the body.  Usually this infection responds quickly to any of a number of topical antiyeast creams as long as the patient has a normal immune system.

Winter illness Rx

As we head into a major cough and cold epidemic this month I just wanted to remind everyone of some simple things to make your child feel better.  First, run a humidifier.  Any time your child has mucus in the chest, a humidifier helps to improve the situation.  Second, salt water drops like little noses or ocean drops can be put in the nose and suctioned back out.  Next, elevate the head of the bed.  This will help keep your child from choking on dripping mucus.  Finally, encourage your child to drink.  She does not need to eat and can go several days without food but liquids are essential to keep the kidneys healthy.

New Vaccine

Here is some exciting news for us.  The replacement for Prevnar, called Prevnar-13, has been released.  Prevnar protects against the 7 most common strains of a severe bacterial infection called Pneumococcus.  Prevnar-13 adds to the older drug with 6 more strains providing improved protection against this common and unplesant disease.  The new vaccine will ship in several weeks and hopefully be available for administration in a month or two.

Does your body become immune to antibiotics?

This is a question I hear daily in my office.  The answer is- sort of.  Your body does not become immune to the antibiotic but what does happen is that the bacteria in your body can ve selected to be antibiotic resistent.

Think of it this way:  Imagine you have a yard filled with rats.  Imagine that one out of 10 rats will not be killed by a particular rat poison.  Imagine also that the children of these 1 out of 10 rats  will also be immune to the poison.  Imagine now that you leave rat poison in your yard every day for a year.  Finally imagine that your house gets invaded after a year by several rats.  If you try to use rat poison to kill the rats the poison will have no effect.

Let's look at a different scenario.  Imagine that you still have 1 out of 10 rats immune to your poison and the offspring of these surviving rats will also be immune to rat poison.  Imagine now that your house if infested with fatal disease carrying rats.  What do you do?  You lay down rat poison, of course.  You take the chance that you may select for resistent rats because what other choice do you have.

This is how physicians think about antibiotics.  We certainly hope that we don't have to use antibiotics but when the risks of the disease outweigh the risks of the aintibiotics and the risks of future resistance we do what we have to in order to protect our patients and preserve the life of our patients.

I hope that this helps.

Till next time.

Chicken soup for the Common cold.

So, what can we do about his cold, Doctor? 

I hear this regularly regarding the care of young children.  For children under 6 years of age there is not alot of medication approved for use.  The meds that used to be available didn't really do much anyway.  Currently the best options include elevating the head of the bed, using a humidifier or vaporizor, and using nasal saline drops with or without suctioning for nose congestion.  If your child has a fever and is above 2 months of age, you can use tylenol or motrin.  I don't recommend alternating tylenol and motrin, however, because this has been associated with a high risk of medication overdose.

We would like to see your child if he has difficulty breathing, is turning blue, is using the muscles of her neck to breathe, has fever for more than 3-5 days or has cough more than 2 weeks or is a known asthmatic.

Good luck, this is frustrating.

Anemia- what is it?

Anemia describes any of many disorders that decrease your red blood cell quantity (referred to as hematocrit or packed red cell volume).  In toddlers this is most commonly due to insufficient iron in the diet.  Commonly this iron deficience occurs because of too much cow's milk in the diet (we recommend limiting your child's cow's milk to 16 ounces daily in order to supply sufficient calcium without pushing iron out of the diet).

We routinely screen all children at 1 year of age for anemia.  This is a common age for anemia to develop.  If undiagnosed and untreated, at this age, it can lead to permenant learning disability, mental retardation or even heart failure.  Anemia is screened with a simple complete blood count (CBC) or even a hemoglobin or hematocrit which can be done in your doctor's office.

I typically also screen at 2 years of age because I find too many children who were missed at 1 year of age.

Realize that not all anemia's are due to low iron and that ONLY iron deficient anemia's should be treated with iron.  Overdoses of iron need to be avoided at all costs because of the risk of a complication of iron overload called hemosiderosis which is potentially fatal.  Iron replacement needs to be monitored carefully with frequent checks of hemoglobin and serum iron and feratin (a measure of total body iron stores) levels.

Iron deficient infants need to be carefully examined to rule out signs of heart failure as well.

What is this Mycoplasma thing?

Mycoplasma pneumonia is the most commom cause of walking pneumonia, a very common form of pneumonia for school aged children. Normally this does not make you too sick but rarely can really nock a kid for a loop. It tends to be responsive to erythromycin, azithromycin (zithromax) and clarithromycin (biaxin) and for older kids to doxycycline. Usually 5 days of zithromax or 14 days of biaxin or doxy is all you need. Rarely the kids don't respond well and will need 1-3 months of medication (I get about 1 of these nonresponsive cases each year). Close followup is always important but these kids usually do very well and have complete resolution after a time.


Mycoplasma many times will mimic asthma.  This can delay diagnosis for quite a while, unfortunately.  Mycoplasma may or may not be associated with a fever and occasionally results in a rash.  We are seeing several cases per day of this bug right now.  Call us if you are concerned.

Recommendations for the overweight child

Here are some simple tips if you are concerned regarding your child's weight.

1.  Limit TV to 90 minutes daily
2. Encourage exercise to be 90 minutes daily regardless of the weather.  It is never too cold, here in Reno, to go outside to play.

If you do these 2 things then your child will do well.  Here are some additional suggestions:
1.  Limit to 16 oz of 2% milk
2. Eliminate juice and soda from diet.
3.  Limit Fast food to one time per week.
4.  Bring your lunch to school at least 4 days per week (school lunches tend to be high fat and high calorie.

If you are concerned regarding your child's weight please see us.

Choking Hazards

We recommend that children under 6 years of age not be given nuts, whole grapes or slices of hot dogs (unless they are cut up into pieces small enough to swallow whole).  Children younger than 6 years of age lack the molar teeth necessary to grind up these foods.  This then leads the child to increased risk of aspiration (inhalation of food).  If your child aspirates food the only solution is to surgically remove the food through a scope in the opperating room.  Needless to say, this is something we hope to avoid for your child.

The "Mono" monster

One of the most common causes of sore throat is Epstein Bar Virus.  This is one of the 3 major causes for the syndrome known as acute mononucleosis or mono.  Today I want to dispell mono's undeserved reputation.

By 18 years of age most people have already contracted mono.  It was just one of those flu syndromes that were suffered through as a child with no particular name.  Unlike the typical flu, after your immune system kicks in and tries to kill the infection, the virus causing this one goes into hiding until some time in the future.  In college under the influence of no sleep and the stress of being away from home people can have a reactivation of the virus.  Like any virus most people get better in a few days, but if you don't rest (like most college students with classes, jobs and social lives) it can take a long time to get better.

As you see it isn't the monster it is cracked up to be.  You don't need to drop out of school or quit all your activities if you get mono (again) but you do need to rest or you won't get better.

Till next time.

Strep- won't jump out and get you.

Most cases of "strep throat" turn out to be viral syndromes like mononucleosis and adenovirus.  You cannot really tell strep from a viral syndrome without either a culture or rapid test.  Most of the day care epidemics are due to people whe were never accurately diagnosed resulting in alot of unnecessary antibiotic use.

As a result of this, many dangerous kidney infections are missed resulting in kidney scarring and failure.  My recommendation is to insist that your doctor perform some sort of test before diagnosing your child with "strep throat"

Asthma preventers- a daily medicine

we use asthma preventers to Prevent asthma attacks.  These preventers include oral singulair (pill), and inhaled steroids including pulmicort, flovent, advair and asmanex.  These drugs are intended to be used every day whether you are having symptoms or not.

This is not to be confused with resuce medicines like xopenex, proair, ventolin or proventil.  these are rescue drugs and intended to be used only when having troubble- unlike the preventers which are supposed to be used every day whether you need it or not.

Hope that this helps

Asthma in Young Children

welcome back. 

Did you know that young children with asthma often times don't wheeze.  I hear time and time again patients who were told by the ER or some other doc that since their infant wasn't wheezing they could not have asthma.  Young children (under 2-4 years of age in particular) have floppy air ways that often collapse when they try to move air across an obstruction.  This means that they are not capable of generating the sound known as a wheeze.  Instead they cough.

If your child has had chonic cough- greater than 1-2 months or has a cough or bronchitis with every cold they get this could, in fact, be asthma.  Ask your health care provider to evaluate for asthma or request a referral to a pulmonologist (lung doctor) if you have concerns.

Eczema the itch that rashes

okay, I vowed to post weekly and I know that this one is a little early but hey, who cares.

Lets talk about eczema.  Now eczema is in reality, a wastebasket diagnosis.  Most eczema is either atopic dermatitis or sebhorrheic dermatitis.  I want to focus on atopic derm since this is most common to my patients here in the desert.

Atopic derm usually starts as dry skin that then becomes red and itchy, and occasionally flaky.  It can appear on the cheeks but typically appears in the inner folds to the elbows and the back of the knee.  In severe cases the entire body is involved.

First and foremost the skin must be hydrated.  This is best accomplished with vaseline 4-5 times per day.  If this is to greasy then aquaphore or eucerin cream (not the lotion) can often accomplish this for us.  If this step is skipped the eczema will never get any better.

For red itchy spots, steroid creams can be applied but these have significant side effects and should be used as little as possible.

Bathing should be limited to every other day.  After a bath the cream/vaseline should be applied immediately to the still wet skin.

If the eczema persists then infectious processes should be considered.  This includes staph which, as a localized infection, can produece the so called "stap superantigen" which can insite an immune response which casues eczema to flare across the body.  This can be treated with topical or oral antibiotics as appropriate.

Finally if all else fails consider allergies as a cause.  As the skin breaks down it becomes sensitized to many things and food items can be among them.  Certain blood tests to look at allergic response (called RAST or Immunocap tests) or scratch tests at the allergist's office can be helpful here.

If you are afraid that your child has eczema know that this is a very common occurance especially here in the desert.  Call us to look at your child if you are concerned- (775)- 395-7111

Inhalers and spacers

Did you know that without a spacing tube over 85% of the medication in an inhlaer is swallowed.  For patients who have asthma and require the use of a metered dose inhaler, a spacer is a must.  By preventing the swallowing of the medication we can result in better lung deposition and better efficacy of the medication while minimizing the bad taste and side effects.  Spacers are recommended for all patients regardless of age by most pulmonologists (lung doctors).

What topics interest you?

strep in places other than the throat

Did you know that you can get strep in places other than the throat?  Strep infections in the genitals (private parts) and anal area are not unusual (I've seen 3 in the last month).  These infections appear as bright red marks on the skin.  They may be associated with fever, soreness, discharge in the underware and pain stooling (pooping) or urinating (peeing).

These infections are frequently confused for fungal infections but are something that a physician can easily tell appart.  These infections respond very quickly to amoxicillin or penicillin.

If not treated these infections can spread or go on to involve the kidneys (with something called post streptococcal glomerulonephritis) or the heart (with something called rheumatic heart disease).

If you think your child has this infection, please give us a call so we can see your child-  (775) 359-7111

Welcome

In an attempt to place some written material to complement my videos I've started this blog. You can see my videos on youtube or facebook- friend my practica at sparks pediatric and adolescent medicine or check out our website at www.sparkspeds.com.

I'll try to post weekly on topics of child healthcare with both materials for professionals and parents.