Pediatric Postings

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2010-05-30T13:39:00.001-05:00

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2010-05-30T13:38:00.001-05:00

Pertussis Case are Up

2010-05-29T08:14:00.001-05:00

So far, this has been another good year for Pertussis: whopping cough cases in Washtenaw County and across the state are up. Roughly 20 cases are reported in a typical year in Washtenaw County; last year there were 81, and this year 37 have already been confirmed. In Michigan, the number of cases has risen to over 300; and tens of thousands of cases a year are reported, now, in the US.

Bordatella pertussis is a nasty bacterium. Symptoms start out like common cold symptoms, with runny nose and congestion; but after a week or two, infected adults and children cough so hard that they run out of air—ending with a characteristic gasp, or "whoop." It's most dangerous in babies: more than half of all infants with whooping cough end up in the hospital; and about 1 in 10 children with pertussis end up with pneumonia. 2% have convulsions. The cough lasts for months, and it's highly contagious.

The best defense against whooping cough is the vaccine. The CDC recommends, and we administer, 5 doses ofDTaP—the diptheria, tetanus and pertussis vaccine—one dose at each of the following ages: 2, 4, 6, and 15-18 months and 4-6 years. We follow with a dose of Tdap—the tetanus, diptheria and pertussis booster—at age 11 or 12. Adults immunized as children may need a pertussis booster. That includes child care workers, and new parents.

http://www.annarbor.com/news/whooping-cough-cases-still-at-record-numbers-in-washtenaw-county/index.php

http://www.michigan.gov/mdch/0,1607,7-132--219678--,00.html

http://www.cdc.gov/Features/Pertussis

Pertussis Cases are Up

2010-05-29T07:45:00.001-05:00

The best defense against whooping cough is the vaccine. The CDC recommends, and we administer, 5 doses of DTaP—the diptheria, tetanus and pertussis vaccine—one dose at each of the following ages: 2, 4, 6, and 15-18 months and 4-6 years. We follow with a dose of Tdap—the tetanus, diptheria and pertussis booster—at age 11 or 12. Adults immunized as children may need a pertussis booster. That includes child care workers, and new parents.

http://www.annarbor.com/news/whooping-cough-cases-still-at-record-numbers-in-washtenaw-county/index.php

http://www.michigan.gov/mdch/0,1607,7-132--219678--,00.html

http://www.cdc.gov/Features/Pertussis/

2 Things @ Milk

2010-04-18T16:01:00.001-05:00

Two news items came to my attention last week about leche.

The first was a warning from the FDA about dairy products. Don't drink raw cow's milk. There were 12 confirmed cases of illness in Michigan last month, after unpasteurized milk was consumed; and between 1998 and 2008, there were a total of 1614 reported illness, 187 hospitalizations and 2 deaths from drinking unpasteurized dairy products. Don't do it.

The second was from a new study in *Pediatrics* about breast milk. The lives of an estimated 900 babies would be saved every year, if 90% of US women would breast feed for the first 6 months. The risk of stomach viruses, ear infections, asthma, juvenile diabetes, SIDS and even childhood leukemia would dramatically decrease. The reasons: breast milk contains antibodies that help fight infections, and can affect blood insulin levels--making babies less likely to develop diabetes or obesity.

Get Up & Go!

2010-02-27T06:57:00.001-05:00

Last week, First Lady Michele Obama picked a new project: she's started a national initiative to fight childhood obesity. The goals are the usual two: 1) better diet, and 2) more exercise. "Let's Move" will be backed up with up to $1B in federal funding, and a national task force to deal with the problem. Among other things, it will pay for new sports clinics, new community playgrounds and bike paths, new public service announcements, and a new website (see the "letsmove" link, below).

If that sounds exorbitant, it may not be. The medical costs related to obesity in this country are estimated at around $150B a year, roughly half of that covered by Medicare or Medicaid. More than 1 in 10 children in the U.S. is now "obese," and the rates are going up (see the "Play Time" blog, below). The First Lady's initiative is a preemptive strike.

It's one every parent should take. Spring is just around the corner: it's time to start eating more local fruits and vegetables, and to get out and play--or work. Tell your son or daughter to go fly a kite, ride a bike, mow the lawn or take out the trash. They'll be so glad you did.

http://www.letsmove.gov/

http://content.healthaffairs.org/cgi/content/short/hlthaff.28.5.w822

Flu Shot Update

2009-12-10T08:12:00.001-05:00

Turke & Thomashow's offices in Ann Arbor and Chelsea are ready for the flu: we have both the swine flu and seasonal flu vaccines available now. The H1N1, or "swine" flu, hit our area hard this fall; but the usual, "seasonal," flu has yet to come through. It's important to know that the viruses that cause these influenzas are different. Having had an H1N1 flu shot, or having had the H1N1 flu, will not offer protection against the seasonal flu. Call our offices to make appointments. Our nurses are ready and willing to get our patients immunized.

http://www.cdc.gov/flu/about/disease/

http://www.webmd.com/cold-and-flu/flu-guide/what-is-flu

We've Got the Swine Flu Vaccine!

2009-10-22T18:33:00.001-05:00

Thanks to the dogged and determined efforts of our staff, we've just got our first shipment of H1N1 vaccine in our Ann Arbor and Chelsea offices. The first batch is small, but we are in line for more as it becomes available. Call when you can, and we'll set up an appointment.

As we're all painfully aware, the swine flu arrived in Michigan before the vaccine did. Schools across the state—from Flint to Grand Rapids—have closed this week; and we're seeing more and more patients with flu symptoms.

It's a good idea to get the vaccine if you haven't already gotten sick with the swine flu. Roughly two-thirds of the US population is predicted to get infected this year with the H1N1 virus. The vaccine provides protection as early as two weeks after administration. It's also important to get the seasonal flu vaccine. Children are at risk for both forms of the flu this year. Adults are usually hardest hit with the seasonal flu but are also at risk for the H1N1 flu; and so far, over half of all hospitalized swine flu sufferers have been under the age of 25. Swine flu will be with us all winter, and into the spring. It's important to get children vaccinated as soon as we can.

http://www.mlive.com/news/index.ssf/2009/10/flu_illnesses_including_h1n1_c.html

http://news.aol.com/article/h1n1-flu-spreading-fast-across-the/730687

Here Comes the Swine Flu

2009-09-07T18:46:00.001-05:00

School starts tomorrow. Kids all over the state, who haven't seen each other since last spring, will be together on playgrounds and in classrooms this week. And the H1N1 virus is ready to spread. Students in colleges all over the country have been coming down with the swine flu in the past month—from 26 cases reported at Carnegie Mellon in Pittsburgh after the first few days of class, to at least 2000 reported cases in Pullman at Washington State last week. Parents should be ready to keep this virus from spreading. Again, that means:

· Arming your children with hand sanitizers, and encouraging them to wash their hands often

· Equipping your children with tissues, and encouraging them to cover their noses and mouths whenever they cough

· Encouraging your children to come home from school as soon as they feel don't feel well

· Using prescription antivirals as soon as flu symptoms—fever, aches, cough, sore throat and runny nose—appear

· Getting your children vaccinated as soon as possible: the vaccine should be available in our offices sometime this fall

Effects of this flu are apparently no more severe than effects of other flus have been; but, because H1N1 is a new virus, it's more likely to spread. And children—whose immune systems are less likely to have been exposed to a similar flu virus—are most likely to come down with symptoms. Let's do all we can to keep them healthy!

http://www.mayoclinic.com/health/swine-flu/ds01144

http://www.healthmap.org/swineflu/

Here Comes the Swine Flu Vaccine

2009-08-13T07:39:00.001-05:00

Last week, the Center for Disease Control's ACIP—or Advisory Committee on Immunization Practices—met to decide who should receive the new swine flu vaccinewhen it becomes available this fall, probably sometime in September or October. The CDC isn't expecting a shortage of the new H1N1 vaccine; but because availability and demand are unpredictable, they've come up with a priority list. From high priority to low, they recommended the vaccine be given to:

Pregnant women
Household contacts and caregivers for children under 6 months of age
Healthcare and emergency services personnel
Children 6 months through 18 years of age
Young adults 19 through 25 years of age
Adults 26 through 64 years of age who have health complications associated with high influenza risk
Other adults 26 through 64
Adults 65 and over

The swine flu vaccine won't replace the flu vaccine already in use—they're meant to be used together. And for people who do come down with flu symptoms, or are in contact with a sick person, prescription anti-virals—like Tamiflu and Relenza—should be readily available.

http://www.cdc.gov/h1n1flu/vaccination/acip.htm

No Herd Immunity for Whooping Cough

2009-06-27T08:25:00.001-05:00

Last May, the Washtenaw County Department of Public Health sent home a letter to parents in Dexter, after a Wylie Elementary School student had been diagnosed with pertussis or "whooping cough." A new study, published in the journal Pediatrics this month, shows that children whose parents had declined pertussis immunizations were at higher risk: of the hundreds of Colorado kids studied, those whose parents had decided against vaccination were 23 times more likely than vaccinated children to get the infection. Pertussis is caused by a bacterium in the mouth, nose and throat; symptoms include low grade fever, runny nose, sneezing and cough—sometimes followed by a high pitched "whoop." That cough makes it difficult to breathe, and it often persists for months. Though mortality risk is low, infants are most likely to suffer, and the number of reported cases is on the rise: there have been over 10,000 a year in the US. Pertussis is highly contagious, and remains one of the leading vaccine-preventable diseases world-wide. Parents should consider the risks of any medical treatment, including vaccinations, for their children. And they should be aware of the benefits.

References:

James Glanz et al, 2009, Pediatrics 123: 1446-1451.

Stephanie Skernivitz, 2009, Contemporary Pediatrics, May 27.

http://contemporarypediatrics.modernmedicine.com/contpes/Welcome+to+ModernMedicine/The-unwelcome-return-of-whooping-cough/ArticleStandard/Article/detail/600160

Play Time!

2009-05-30T07:18:00.001-05:00

It's summer! Time to get out and run, ride a bike, throw a ball, jump in a lake. It will make you happier, it will make you healthier, and it will help you lose weight.

A large and growing number of US kids are overweight: since 1980, obesity rates have tripled in children; around 14% of all 15-year-old boys, and around 15% of all 15-year-old girls, are now overweight. In the vast majority of those cases, the causes are simple: they eat too much, and they don't exercise enough. The health risks of obesity are serious. Being heavy raises the risk factors for cardiovascular disease--like high cholesterol, high blood pressure, and abnormal glucose tolerance; and it raises the risk of type 2 diabetes--once seen only in adults. Overweight kids are more likely to develop cancers, liver and gallblader disease, sleep apnea and other respiratory problems, stroke, osteoarthritis, and gynecological problems like irregular periods or infertility as they grow up.

The good news is, losing weight can be fun! An average, 100 pound girl or boy can burn roughly:

200 calories an hour walking or riding a bike
250 calories an hour playing badminton or golf
300 calories an hour playing tennis or dancing
350 calories an hour playing basketball
400 calories an hour swimming
500 calories an hour running

And as other studies show, kids who run, swim, play ball or ride bikes are more likely to be happy.

http://www.mayoclinic.com/health/childhood-obesity/DS00698

http://www.americanheart.org/presenter.jhtml?identifier=4596

Swine Flu Alert

2009-04-27T15:12:00.001-05:00

On Sunday, April 26, 2009 US health officials declared swine flu a public health emergency. As of Sunday, 20 cases had been confirmed in the US and as of Monday, April 27, the number of cases reported in the US had doubled to 40. Only 26 cases of swine flu in Mexico have been confirmed, though over 1300 people are in hospitals with flu symptoms, and over 100 have died.

So far, cases in the US have been relatively mild, and no one has died. But children, and their parents, should keep their eyes open for signs of swine flu virus, and try not to contract it.

Look for these symptoms in children:

Fever with a rash
Dehydration
Fast breathing
Bluish skin coloration
Slow to wake or sluggish interaction
Flu-like symptoms improve, but then return and cough worsens
Severe irritability

Look for these symptoms in adults:

Difficulty breathing
Dizziness
Confusion
Severe or persistent vomiting
Pain or pressure in the chest or stomach

To prevent the spread of swine flu, or any other flu, the US Center for Disease Control recommends:

Wash your hands often with soap and water
Avoid touching your eyes, nose or mouth--places where germs enter your body
Try to avoid contact with sick people
If you are sick, cover your nose and mouth with a tissue when you sneeze or cough

http://www.cdc.gov/swineflu/

Booster Seat Booster Lesson

2009-04-04T14:34:00.010-05:00

Our patients often ask, what's the Michigan law on booster seats?

As of July 1, 2008, that law changed. Under the old law, all children under 4 were required to ride in an infant or child car seat. Under the new law, all children who are under 8, or less than 4' 9" tall, have to be "properly" secured. So the new rules, as set up by the National Highway Traffic Administration, together with the State of Michigan, say this:

Infants under 1 year old, and up to around 20 pounds, must use rear-facing car seats, placed in the car's back seat.
Children from ages 1-4, weighing roughly 20-40 pounds, must use front-facing car seats, also placed in the car's back seat.
Children from ages 4-8, who are less than 4' 9" tall, must use either booster seats—no-back or high-back—or child safety seats with harness straps, again in the car's back seat. No-back boosters are recommended for seats with head rests, and high-back boosters for seats without head rests; both must be secured with BOTH lap and shoulder belts.
Children 8-12 must use safety belts, and should ride in the back seat.

All safety systems must be used in accordance with both the seat manufacturer's and car manufacturer's standards. Noncompliant drivers can be fined $25, for a civil infraction.

Booster Seat Law (pdf document)

National Highway Traffic Safety Administration on child passenger safety

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Baby Bottles and Bisphenol A

2009-04-04T07:18:00.004-05:00

Even heard of bisphenol A?

It's an organic compound used to harden clear plastics in, among other things, thermoses, food containers, sippy cups and baby bottles. As of today, Representative Edward Markey (D-Mass), and Senators Dianne Feinstein (D-Cal) and Chuck Schumer (D-NY) introduced legislation to ban BPA from all food and beverage containers. BPA has been used for half a century, in what were considered safe doses; but recent studies have linked it with early onset of puberty, obesity, breast cancer, brain disorders, heart disease and diabetes. Canada banned the sale of BPA baby bottles last October; and in the US, bottles have been given BPA-free labels lately. Attorney Generals from Connecticut, Delaware and New Jersey have asked 6 major baby bottle manufacturers--Avent, Disney First Years, Gerber, Dr Brown, Playtex and Evenflow--to stop using BPA, and they've agreed.

Contemporary Pediatrics: No more BPA in baby bottles

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On October 1 2007 a case of Measles was confirmed in Ann Arbor Michigan

2007-10-05T15:40:00.000-05:00

For most of us, it's been a long time since we've thought about the measles. As a refresher, measles is one of the most contagious infectious diseases. The measles virus causes a distinct clinical syndrome characterized by fever, watery eyes, runny nose, cough, rash and white "Koplick's" spots in the mouth. Measles occurs throughout the world, and was once considered "as inevitable as death and taxes". The overall complication rate in measles is about 25% and often results in hospitalization and in some cases death.

Due to its highly contagious nature and severity, children are routinely vaccinated against the measles in the United States. The recommendation is for one dose of MMR (mumps/measles/rubella) at age 12 to 15 months and a second dose at age 4. This provides long-term immunity against the disease. Prior to the availability of the safe and effective measles vaccine in 1963, the number of cases in the United States was between 500,000 and 1,000,000 per year. In the prevaccine era, 90 percent or more of children developed measles by age 15.

What is puzzling is how, in the era of measles vaccination, did a youngster from Ann Arbor ever get the measles? This is the Big Question. The child must have been exposed to someone contagious. Every year there are millions of cases of measles worldwide. Travel to Europe may have been the exposure link in this child. On 9/28/07, the Evening Standard U.K. reported that "Measles is soaring across London," with a citywide warning that an outbreak could spread "like wildfire" because immunization rates are so low. Part of the problem in London is that only half of children have been fully immunized against the measles. Measles is still an ongoing and active disease. In 1995 there were 44 million cases of measles with 1.1 million deaths due to the disease worldwide. In the United States, where most children are vaccinated, fewer than 100 cases of measles have been reported annually in recent years. Good job US!

But, if the youngster was vaccinated, how exactly did he/she get the measles??? This is where it gets a little confusing. In a very large majority of children the vaccine provides perfect protection, but in a very small number of children, the vaccine provides a little less than 100% protection. In these few children, a 'mild' case of the measles can develop. This appears to be the case in the Ann Arbor youngster. Fortunately the child will probably have a mild or 'modified' case. Unfortunately, the child was contagious for a period of time, which puts others at risk. The risk is greatest for the 20 schoolmates who have not been immunized. These children have been advised not to attend school to avoid exposure and the potential serious complications of the full measles disease.

Details and updates can be found at www.ewashtenaw.org, The Washtenaw County web site.

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British Medical Journal Medical Milestones: Antibiotics and Vaccines

2007-01-25T14:49:00.001-05:00

BMJ poll results of the most important medical advances since 1840 were released in January 2007. Antibiotics (#2) and vaccines (#4) ranked among the top advances together with sanitation (#1) and anesthesia (#3). The results certainly ring true in the field of pediatrics. My grandmother is 97 years old and still healthy due to an amazing constitution. However, her oldest sister Mary was not so lucky; she died at the age of 13 from scarlet fever. Her youngest sister Anna almost lost her life to diphtheria and her illness kept her quarantined for many months; she was one of the lucky few to survive. In today's world of medicine, childhood would be thankfully different for Mary and Anna because many diseases of the past are now prevented by immunization or readily treated with antibiotics, medical tools that were not yet discovered in the early 1900's. In 1900, one third of deaths were due to infectious diseases such as diarrhea, diphtheria, measles, pneumonia, influenza, scarlet fever, tuberculosis, and whooping cough. In 1900,>3 percent of children died between their first and 20^th birthday. Fortunately, parents are no longer faced with these forbidding statistics. Between 1900 and 1998, the percentage of childhooddeaths attributable to infectious disease declined from 61.6%to 2% in large part due to immunizations and antibiotics. Today we focus on disease prevention. Pediatricians use an immunization schedule that protects against 16 different diseases. The DTP vaccine of today would have prevented Anna from contracting diphtheria. In addition, we judiciously use antibiotics to treat infections. Penicillin, the 'first antibiotic' was discovered in 1928 and developed for medical use in the 1940's to treat sick and wounded soldiers. Antibiotics are used to treat and cure many infections including scarlet fever, the disease that resulted in Mary's untimely death. These advances translate into a remarkably different landscape for pediatricians today. It is no longer commonplace for parents to lose their children to infectious disease as it was in my great-grandparents' day. When it comes to our children, these medical milestones give us a great deal to be thankful for. The BMJ poll results can be viewed in detail at: http://www.bmj.com