Summer Safety 2017

With summer officially here, it’s time for families to head for the hills, the beach, the mountains, and the great outdoors.  With those treks come some real risks, as evidenced by recent news reports of a toddler perishing from a tick-borne illness, and another a victim of dry drowning and another with second degree burns from a sunscreen. So I wanted to provide some tips for all of you to help you enjoy a safer, healthier summer!

  

Ticks – WHAT: they thrive in the hot summer months, and with so much rain this year, their season for bugging us is prolonged. Ticks thrive in shaded cool moist areas like forest floors and also love to pole vault off of blades of grass. There is virtually no place in the continental US that doesn’t have ticks – WHY the worry? Ticks carry a variety of germs that can cause chronic illnesses like Lyme disease, acute life threatening illness like Rocky Mountain Spotted Fever, and many more. Ticks can also bite certain strains of livestock, then a human, and induce an allergy to beef! So it’s important not to let us be their feeding ground.

HOW to protect yourself?  When hiking, out in grassy or forested areas COVER UP! Wear long sleeves, lightweight long pants (tucked into your boots or socks) and put your hair up and wear a hat. Use DEET containing repellant on exposed areas – other preparations that claim efficacy simply do not. At the end of the day, it’s important to shower up, use a washcloth and rub down your skin (this can also dislodge a tick early), and have a loved one inspect your hair, scalp and backside for imbedded ticks. WHEN to be concerned:  if a fever, rash, joint aches or flu-like illness follows a tick bite by days to a few weeks, get thee to your doctor immediately. Tick borne illnesses are treatable when suspected, diagnosed, and treated early. PS: make sure your animals are up to date on their flea and tick treatments too. A once over after hiking is good for your dog too.

 

Water Safety – It goes without saying, but I’ll say it – NEVER turn your back on a child in a pool or near a body of water, even if it’s a wading pool, pond, or bucketful. That means NOT playing on YOUR screens, or spending time on the phone – both are distracting enough as many accidents in and around water happen in a heartbeat, and typically are quiet events. ALL pools in homes should be gated/covered safely until all children and adults, as well as neighbor’s children,  are water safe.  Discourage your children from wrestling and dunking each other under water. Accidental aspiration of pool, pond, or ocean water into the lungs can cause “dry drowning” hours later, long after playtime in the pool has finished. NEVER leave a body of water unattended once your children are out. Lock the pool gate, empty the buckets and kiddy pool. If out in the open water boating, paddleboarding, or tubing, make sure your children have and wear approved safety vests at all times – whether they are good swimmers or not.

  

Sun Safety – Let’s remember that 2 severe sunburns in childhood double a person’s risk of skin cancer/melanoma and those occurring in young to later adulthood multiply the risk even more. We know we should wear sunscreen daily, BUT not all sunscreens are alike, their individual active and inactive ingredients all have the potential to cause rashes or reactions. So as with any skin care product, especially if you are using it for the first time, testing a small amount on a patch of skin before anticipated use is a good thing. If your pre-verbal child screams or is irritable, even without a red reaction, wash it off and don’t use it on your child. Avoid lotions with bergamot, or citrus oils in them…it’s not unusual to see blistering reactions on the skin - this is called phyto-photo-dermatitis and can also happen if your child is on certain antibiotics or other medications and goes out in the sun. So, if your child is on medications, make sure you ask your pharmacist or pediatrician if playing in the sun is recommended.  Apply sunscreen several minutes before going outside, and if you or your loved ones are wet, sweaty, sandy, or toweling off, reapply at least every 2 hours. If skin starts reddening, get out of the sun immediately, and stay out to avoid more damage.

Best practice – UPF Swimsuits, rash guards, a cool pair of UVA/B blocking shades and a wide brimmed hat. And remember, some of the worst sunburns out there happen on foggy days.

  

Car Safety There’s a large bump in motor vehicle accidents and teen fatalities in the summer when kids hit the road, travel in packs, and have more opportunities to be distracted than ever. That’s why driving with safety in mind is so key. That means putting your kids in approved car seats in the back seat, and once they outgrow their car seat, using boosters to that their belts fall across their upper legs and mid clavicle.  I shuddered the other day when I saw a dad in a vintage Corvette convertible with his son riding shotgun – the kid was 3-4 years of age, wasn’t wearing a seatbelt, and kneeling in his seat and waving to passersby. This is a recipe for disaster – hitting one bump, that kid would be ejected from the car and a fatality. Parents, teach by example – wear your seatbelts religiously, and don’t even start the car until everyone is buckled in safely.

Carry water with you in the summer – cars heat up to well over 120 degrees when parked, so just hopping in the car is akin to taking a sauna – you can rapidly dehydrate, as can your children under these circumstances – so turn on the AC, cool off the car for a minute or 2, hydrate, hop in and enjoy the rest of your summer. NEVER, NEVER leave a person or a pet in a parked car in the summer, even just dashing into the dry cleaners. Within 2-3 minutes, heatstroke can take the life of a vulnerable child or pet. Find a drive through if you need to run errands with a sleeping child – whether market, for a quick meal or dropping off cleaning, it’s a life saving measure.

Crown Roast of Pork with Challah/Apple Stuffing

Serves 8-12

 

Ingredients: 

STUFFING: 

1 loaf egg bread, brioche or challah, cubed into 1” dice and crisped in a low oven until cubes are firm and dry

olive oil

Butter – 4 TB

3 apples, cored and cubed

1 medium onion, chopped

1 TB each fresh sage, thyme, rosemary

1 cup chopped parsley

2 egg yolks (optional)

Chicken or veggie stock - warmed – 2 cups

Salt and Pepper

 

Saute onions and apples slowly in olive or canola oil until translucent and sweet. Into a large buttered casserole add the cubed bread, herbs and apple/onion mixture. Mix with your hands and add egg yolk to bind and enrich it. Add 1-2 cups warm stock until mixture is moist but not soggy. Season with salt and pepper, dot with remaining butter and set aside.

 

ROAST

1 Pork Rib Roast 12-13 ribs (approx 10 lb)

Salt, Pepper, Olive Oil

Heavy duty butcher twine

Meat Thermometer

  

Have your butcher trim your roast, cut off the chine bone (vertebrae), and French the bones . You can either shape your roast into a crown (by slitting the underside of the rack between the bones to make it more pliable), tying it with butcher twine, or roast it whole (or in 2 halves) in the oven. The key here is the REVERSE SEAR METHOD. But first we’ll brine your roast to insure it is moist, juicy and flavorful.

 

BRINE

1 gallon water

1 cup salt

½ cup sugar

Handful of peppercorns

3 bay leaves

 

Dissolve salt and sugar in the water, add peppercorns and bay leaves. Put in a large plastic bag or clean 5 gallon bucket or cooler, add the pork, cover with ice (if using a bucket or cooler) and brine for 6-12 hours. Remove from solution , rinse briefly, and pat dry the roast.


Preheat your oven to 250 and remove upper racks to create room. Liberally sprinkle your roast with olive oil, salt and pepper. Tie into a crown or cut the roast in half and with bones in the middle, interlace the two mini-roasts so they stand up in your pan.


Roast at 250 for approximately 2 hours until internal temperature is 140. Take roast out to rest and tent with foil for 15-30 minutes. Turn oven up to 500F. At this point, while the oven is heating up more, cover your stuffing with foil and heat for 10 – 15 minutes until heated through. Once your crown has rested and the oven temp is 500, remove foil and place in oven for 10 minutes until browned and crisped. Remove from the oven, fill cavity with heated stuffing, and rest again for at least 10 minutes before serving.


Slice 1-1 ½ chops/person and serve atop stuffing. Garnish with the season’s bounty.

Enjoy!

SIDS - newest guidelines for prevention

The following is a Q&A with Dr. JJ on Hallmark's Home & Family re: Sudden Infant Death Syndrome and the newest guidelines published October 2016 from the American Academy of Pediatrics National Conference.

 

Q:  SUDDEN INFANT DEATH SYNDROME IS A VERY REAL AND TRAGIC PROBLEM THAT ALL FAMILIES FACE BUT THERE ARE SOME NEW WAYS TO HELP PREVENT THIS FROM HAPPENING?

Dr. JJ: Yes, approximately 3500 infants die annually in the United States from sleep-related infant deaths, including sudden infant death syndrome, ill-defined deaths and accidental suffocation and strangulation in bed. I recently attended the Academy of Pediatrics national conference where is it now strongly recommended that babies sleep in the parent’s room, in their own crib for at least 6 months, ideally 12 months. This can reduce SIDS related deaths by as much as 50%

 

Q: HOW DOES THIS REDUCE THE CHANCES?

Dr. JJ: The reason: parents are nearby and within earshot to detect changes in baby’s movement, breathing, or can hear a struggle for breathing sooner. There is evidence that sleeping in the parents’ room is most likely to prevent suffocation, strangulation, and entrapment that may occur when the infant is sleeping in the adult bed. The result, SIDS rates and unexpected events like respiratory distress, seizures, are attended to earlier, improving outcomes. That means the parents room should be smoke free, well ventilated, and the child should not, under any circumstances, sleep in the parent’s bed. Recommendations for the sleep environment remain the same. So for parents traveling with babies under a year, especially if staying at hotels or other locales, renting a crib or taking a pack and play for a safe sleep environment is key in keeping baby sleep-safe.

 

Q: BUT WHAT ABOUT THE OTHER 50 PERCENT?

Dr. JJ: Sadly, I know first-hand about losing a loved one. My nephew passed away when he was just 6 months old. It is important to realize there are many factors that can cause SIDS.

 

Q:  WHAT ARE SOME OF THE MAJOR CAUSES?

 Dr. JJ: A combination of physical and sleep environmental factors can make an infant more vulnerable to SIDS. These factors may vary from child to child. Physical factors associated with SIDS include: Brain abnormalities. Some infants are born with problems that make them more likely to die of SIDS. Low birth weight. Premature birth or being part of a multiple birth increases the likelihood that a baby's brain hasn't matured completely, so he or she has less control over such automatic processes as breathing and heart rate. Respiratory infection. Many infants who died of SIDS had recently had a cold, which may contribute to breathing problems. The items in a baby's crib and his or her sleeping position can combine with a baby's physical problems to increase the risk of SIDS. Examples include: Sleeping on the stomach or side. Babies who are placed on their stomachs or sides to sleep may have more difficulty breathing than those placed on their backs. Sleeping on a soft surface. Lying face down on a fluffy comforter or a waterbed can block an infant's airway. Draping a blanket over a baby's head also is risky. Sleeping with parents. While the risk of SIDS is lowered if an infant sleep in the same room as his or her parents, the risk increases if the baby sleeps in the same bed partly because there are more soft surfaces to impair breathing.

  

Q: AND IT IS IMPORTANT THAT A FAMILY MEMBER OR FRIEND WHO IS BABYSITTING KNOW THE CHILD CAN’T SLEEP IN THE SAME BED. 

Dr. JJ: Yes, be sure to let anyone who is going to watch your child for any period of time know ahead of time to try and reduce the risk of SIDS.

  

M: WHAT ARE OTHER WAYS TO REDUCE THE RISK OF SUDDEN INFANT DEATH SYNDROME?  

Dr. JJ: Back to sleep for every sleep. The supine sleep position does not increase the risk of choking and aspiration in infants, even those with gastroesophageal reflux, because infants have airway anatomy and mechanisms that protect against aspiration

 

Use a firm sleep surface. Infants should be placed on a firm sleep surface (eg, mattress in a safety- approved crib) covered by a fitted sheet with no other bedding or soft objects to reduce the risk of SIDS and suffocation. Infants should not be placed for sleep on beds, because of the risk of entrapment and suffocation.

 

Breastfeeding is recommended. Breastfeeding is associated with a reduced risk of SIDS

 

Keep soft objects and loose bedding away from the infant’s sleep area to reduce the risk of SIDS, suffocation, entrapment, and strangulation.

 

 

Consider offering a pacifier at nap time and bedtime. Although the mechanism is yet unclear, studies have reported a protective effect of pacifiers on the incidence of SIDS

 

Avoid smoke exposure during pregnancy and after birth. Both maternal smoking during pregnancy and smoke in the infant’s environment after birth are major risk factors for SIDS

 

Avoid overheating and head covering in infants

Banana Split Ice Cream Cake

BANANA SPLIT ICE CREAM CAKE - make 2 days before serving

 

1 package brownie mix

1 pint each strawberry, chocolate, and vanilla ice cream

2 bananas, chopped

Pint of strawberries (or 2c frozen berries, defrosted) sliced

8-10 inch springform pan

 

Following package instructions, make brownie mix and pour into a greased springform pan to a level of ½” (save remainder and bake off in a small pan) – bake until center is set. Remove from oven, and place into refrigerator until thoroughly chilled and set.

Next – soften chocolate ice cream in a bowl, and spread evenly over the brownie layer, place in freezer for 1-2 hours until firm. Next, soften strawberry ice cream and mix with sliced berries. Spread this on top of chocolate layer, and freeze for 1-2 hours until firm. Lastly mix softened vanilla ice cream with bananas and spread onto the top of the cake, cover with waxed paper, and freeze overnight until very firm.

 

 

MARSHMALLOW MERINGUE

4 egg whites

1cup sugar

1/2 tsp cream of tartar

1/2 tsp vanilla extract

Pinch sea salt

 

Instructions:

Put all ingredients in a heat proof bowl over gently simmering water and stir until sugar dissolves. Take off heat and whip either a hand held blender or your stand mixer with whisk attachment for 4-7 minutes until thick glossy stiff peaks form. Put meringue in pastry bag or in a ziploc bag.

 

Take cake out of the freezer just before serving. When ready to pipe, cut a 1/2" hole in corner of zip loc and pipe dollops evenly over top layer of ice cream cake. Brown the marshmallow with a hand held torch or place under the broiler for a minute or two, drizzle with chocolate and toppings, UNMOLD, then slice and serve!

EGGNOG ICE CREAM

Enjoy these holiday treats now....and year round! It's Christmas in July at Hallmark, but never too early to perfect these frozen fantasies!


EGG NOG ICE CREAM

Makes approx 1.5 quarts

  

INGREDIENTS

2c half and half

½ c corn syrup

pinch sea salt

9 egg yolks from large eggs

½ c sugar

2 c heavy or whipping cream

¼ c dark rum or whiskey (or 1tsp rum extract)

1 tsp vanilla extract

¼ tsp freshly grated nutmeg

 

 

What you will need: heavy saucepan, mixer, measuring cups and spoons, food thermometer, ice cream maker

  

Put half and half, corn syrup and a pinch of salt into a medium saucepan and simmer until 150 degrees. Meanwhile, whip up your egg yolks with ½ cup sugar until pale, and thick enough that a thick ribbon forms when the beater is held up.

When half and half mixture reaches 150 degrees, add it very slowly to the beaten eggs (keep mixer on low); place the entire mixture back in the saucepan, and on medium heat, stir constantly until 180 degrees and base coats the back of a spoon.

Pour hot mixture through a fine mesh strainer into a bowl, add in the cream, rum/whiskey and extract(s) and nutmeg. Cover with plastic wrap and chill at least 2 hours (preferably overnight). Freeze in your ice cream maker, adjust seasoning when ice cream is firm, then transfer to a freezer-safe container. Place a square of parchment paper or plastic wrap on the surface of the ice cream. Cover and put in the freezer to harder (at least 2-3 hours). Set out for 5 minutes before scooping and serving. Enjoy! Serving suggestion: dollop of rum-spiked whipped cream on top, dusted with nutmeg.

 

  

VEGAN “EGGNOG” FROZEN DESSERT (also gluten-free)

Makes approx 1.5 quarts

 

 

INGREDIENTS

 

4c unsweetened cashew milk

14 ounce can coconut cream

pinch sea salt

¾ c. coconut sugar

¾ c. chopped dates

2 level tsp agar agar

 

¼ c rum or whiskey (or 1 tsp rum extract)

1 tsp vanilla extract

¼ tsp freshly grated nutmeg

  

What you will need: heavy saucepan, mixer, whisk, measuring cups and spoons, food thermometer, ice cream maker

 

Put cashew milk, coconut cream, salt, coconut sugar and dates in a heavy saucepan and heat on medium until sugar is melted and coconut cream is incorporated. Bring up to a gentle boil and add the agar agar and gently boil for 4-5 minutes, stirring throughout. Remove and place in blender and process until dates are fully broken down. Add in vanilla extract and nutmeg, process briefly, put in a bowl, cover and place in the refrigerator until chilled.   As the mixture chills, the agar agar will set and your base may be gelatinous. Don’t worry! Pop it back in the blender or mix with your hand mixer, then place in your ice cream maker and freeze according to manufacturer’s directions. Shortly before removing add the rum or whisky (or rum extract), taste and adjust seasoning (ie nutmeg and salt) to taste. Place the Nog into a freezer safe container, and freeze for at least 2 hours. Enjoy your Vegan Nog!

Take Back the Night - a guide to getting your toddler back to sleep!

 

 

From the moment our first babies are born, we respond to every cry and squawk with parental love and attention, because it’s in us. Face it. And babies NEED us.

But when our angels start to manipulate us, especially at night, it’s sheer exhaustion.

 

So essentially from day 1, our babies become the boss of us. Why does that happen?

 

Out of necessity we must 100% meet our babies needs in those first few months. By 4-6 months they are intelligent enough to know how to use their cries very specifically when they need us – and they do, brilliantly.

 

It’s no wonder that they push back when we start to put up boundaries to protect them, say no, and all of a sudden have to become the boss of them! It’s the reason why toddlers sometimes cry and protest excessively – these rules, gates, boundaries and no’s weren’t asked for…..but are necessary to help structure their days and keep them safe.

 

And as those little tots get a little bigger and bolder, they pull out their old bag of tricks and start MANIPULATING to get their way. During daylight hours we can usually handle it and re-direct their attention…but at night, it’s brutal.

 

I certainly experienced this with my son Max. I was a resident in the hospital 16hours a day, barely saw him in the light of day, and when he showed up standing on the side of my bed every 2am breathing in my face, waiting for an invite, I said yes. I didn’t have the energy to sleep train him when I had to get up in 4 hours.

 

 

So how do we break this cycle with our little tykes?

 

Based on years of doing this here’s what works best

  1. Make sure your little one is healthy, no ear infections etc
  2. Make a PLAN and stick to it and share the plan – alternate who gets the duty each night to walk your angel back to bed.
    1. Make sure your child naps every day, without fail. A toddler who doesn’t nap goes into sleep overtired, overly wired, and fails to enter deeper phases of sleep
    2. Don’t keep your toddler up too late. Since most kids are up at the crack of dawn, a 7pm bedtime is very appropriate – even if one parent isn’t home.
    3. Start dinner earlier, and after the meal a soothing bath, NO MEDIA, quiet play dials down that active brain.
    4. As you are starting your bedtime routine tell your toddler what is going to happen – you are going to have dinner, a bath, a book, 2 kisses and lights off. You might be a little sad when we leave the room, but we’ll kiss you awake in the morning. If you get out of bed when it is dark, one of us will walk you back to bed and tuck you in.
      1. Under NO CIRCUMSTANCES give in to wishes for attention, milk, more books, water, playing, videos, etc. That secondary gain is the reason night waking often happens. Walk your tot back to bed without saying anything, tuck him in and walk out.
      2. Repeat.
  • Don’t give in.
  1. Make a big deal the next morning if he was successful. Point out how happy everyone is when they slept well! Encourage him for the next night…and stick to your plan.
  2. If your child wants his book to be an encyclopedia, don’t give in either. Get a small hourglass that counts down to 5 minutes – tell your tot when all the sand is at the bottom, it’s time for 2 kisses and lights out. It’s a concrete and sure way to end the routine.
  1. Hang in…he loves you so much and doesn’t realize the toll this takes on you…so you and your partner have to take back bedtime and take back the night.

 

Here is the link to the video from Home & Family: 

 

e-Cigarette Update!

WHAT’S THE LATEST ON E-CIGARETTES AND CHILDREN USE?

The Growing rates of use in kids are alarming .. E-cigarette use among middle- and high-school students soared over the past five years, surpassing use of regular cigarettes in 2014, according to CDC statistics. In 2015, e-cigarettes were the most commonly used tobacco product among middle and high school students. An estimated 3 million middle and high school students are current e-cigarette users! Big tobacco companies have invested huge dollars in marketing to youth, because to date, e-cigarettes were not considered a tobacco product. As a result 70% of youth have been presented with e-cigarette ads, and free samples and easy access over the internet have exploded the number of kids who now vape.

 

WHAT AN E-CIGARETTE IS AND HOW DOES IT WORK?

A typical battery-operated e-cigarette contains a cartridge of e-cig liquid, or juice, which usually contains nicotine and the chemical propylene glycol. The juices come in an array of flavors including cola, candy and fruit flavors. When used, the battery powers an atomizer that vaporizes the liquid in the cartridge for the user to inhale

 

WHAT ARE THE DANGERS OF USING E-CIGARETTES?

 

May cause nose and eye irritation

Asthma

Nicotine Addiction - nicotine is just as addictive as heroin or cocaine

Poisoning of children with nicotine liquid - over 3000 calls to Poison Control Centers last year alone!

Inhalation of formaldehyde with other solvents and heavy metals that are harmful to lungs - formaldehyde is a known human carcinogen

3x greater risk of smoking in youth if they start vaping

Potential explosion of the units due to the types of batteries used

 

 

WHAT NEW REGULATIONS IS THE FDA IMPLEMENTING NOW?

As of August 8TH e-cigarettes will be off-limits to people under the age of 18 under new regulations issued by the US Food and Drug Administration (FDA) in May. This brings all tobacco products under the agency's authority. Retailers must not sell any tobacco product, including e-cigarettes, to anyone younger than 18. As with traditional cigarettes, retailers must require age verification by photo ID from tobacco seekers.

Manufacturers are under new rules too. They must add health warning to product packages and advertisement, and must report ingredients and any harmful or potentially harmful constituents.

The FDA also has banned covered tobacco products in vending machines unless they are in an adult-only facility, as well as the distribution of free samples.


AND MY TAKE ON E-CIGARETTES ?

Curtailing nicotine access to youth is a start in shaping a tobacco product free generation, and I am relieved that the FDA has stepped in. There are so many unknowns with e-cigs’ impact on future health, especially in kids who are still growing and developing. I’m a fan of the FDA being part of the equation in cutting off marketing and sales to kids.

 

 

Zika Virus - what we know 5.23.2016

The Centers for Disease Control released the newest Zika Virus data last Friday, likely putting those who are pregnant, and those contemplating pregnancy, on alert. It's a good time to bring you up to speed with the latest.

The CDC just released the latest numbers of folks in the US and US Territories who tested positive for ZIKA virus. There were 544 in the US, 836 in Puerto Rico. Of those 157 in the US are pregnant, and in the US Territories 122.

None of the cases of Americans with Zika involved being bitten by mosquitos here in the US – they ALL were a result of either a history of travel to an endemic area OR having had sex with a person who travelled to an endemic area. It’s different for Puerto Rico – of the 836 infected, 832 acquired it locally and only 4 were infected outside of Puerto Rico.

Currently the CDC is reporting that less than a dozen of those 279 pregnant women being followed have had miscarriages or babies born with birth defects – however time, and the observing the remaining babies after birth will unfold the real story. Currently, that's about 4% of those pregnant affected negatively.

According to Dr. Anthony Fauci, the current head of the National Institute of Allergy and Immunology at the NIH, 30 US states harbor the Aedes aegyptii mosquito, and therefore have the potential for local outbreaks. The lower half of the US is at most risk straddling the borders over which this virus could cross.

IN ADDITION, and very important, is that travelers returning to the US, IF BIT by a “USA” A. egyptti mosquito could then have their virus spread by that mosquito to the local community. So humans infected with Zika abroad then become the source of virus spread distantly if they are bitten here and that mosquito then transmits the virus to others with its next bite.

How do we prevent this from becoming a major problem for innocent people in the US?

 Because we have no vaccine, certainly avoiding travel to suspect areas is ideal.

Preventing sexual transmission is also important:

The CDC tells us that Zika may live longer in semen than blood, so if a male has travelled to an endemic area and has NO SYMPTOMS, he should not have sex, or use condoms for all forms of sex, for 8 weeks after return.  If he has symptoms of Zika and has been diagnosed, he should avoid unprotected sex for 6 months - very important if he and his partner are contemplating pregnancy.  For women returning from an affected area, very important to get tested by your doctor IF you are trying to get pregnant or  you are pregnant - especially if you have a history of bites or had any symptoms indicative of possible Zika. 

If you return from travel, staying away from any mosquito contact in the US for 3 weeks is important too – that means cancelling plans that may involve mosquito contact. That way if you are infected, even if you have no symptoms, your body needs 3 weeks to clear the virus. You don't want any mosquitos transferring your virus to others.

If you have to travel to those higher risk areas, what should you do?

  • Wear long sleeves and long pants, and treat the surface of clothing with permethrin
  • Wear an EPA approved bug repellant - DEET, picaridin, IR3535 are safe for pregnant and breastfeeding moms, all others including children over the age of 2 months. Oil of Lemon Eucalyptus and Para-menthane-diol should only be used in those >3 years of age.
  • All children and adults should sleep and nap under mosquito netting, and doors and windows should be shut, and screens repaired – this mosquito LOVES the indoors and bites during the daytime hours 

 

What should we do, if anything, to prevent our chances here in the US?

A. aegyptti is known as the “cockroach of mosquitos” – it’s very hard to kill. Even eggs laid and dried out can revive with just a touch of water….and these mosquitos can bite (and potentially infect) several people during one meal….

 

  • Standing water needs to be eliminated – that means emptying saucers under plants, dumping wading pools after use, emptying buckets and birdbaths, and tires. Scrub birdbaths and wading pools weekly to rid them of eggs.
  • If you have a septic system, where mosquitos LOVE to breed and hatch, repair the outside if any rips or tears, and cover the vent with mesh that has at least 156 holes/square inch to prevent mosquitoes from getting in, or out.
  • Tightly cover cisterns and other storage devices outside
  • Keep your screens in good repair, and leave doors and windows closed with the AC on, especially if you have reported Zika in your area.
  • Wear repellant daily if you are getting bitten

If we all participate in preventive strategies, it's less likely that this virus will become a nightmare in the US....until we have more answers to the problem, we all should participate in the solution!

 

 

What has the government done to help with prevention? 

President Obama asked Congress for 1.9B to support mosquito protection and eradication. The Senate approved 1.1B but the House only approved 622m – and those funds were appropriated initially for Ebola. So each state may have to dig deep to assist the populace with preventive strategies. The CDCs website is also rich with lots of tips and great information that is updated weekly.

This story will evolve as our weather gets warmer, as participants and travelers to the Olympics return, and the potential of US acquired Zika becomes a reality. We all need to take responsibility for reducing the chances that these mosquitos can attack by adhering to the CDC’s guidelines and keeping ears open for new information.

For video linked to this topic go to: https://youtu.be/_SAVN5xh-RM

Hot Cars and Children don't mix!

When a child is forgotten in the car, a few minutes may turn into a lifetime of regret.   I will discuss how we can prevent this tragic occurrence.

 

 

Each year 49 cases of hot car deaths occur in the US – that’s one every 9 days, and countless other children who fortunately are found in time. 

 With over 2500 kids dying each year from unintentional injuries, hot car deaths are completely preventable. Lots of press in the last 5-10 years has brought this issue to the forefront. But what hasn’t changed are the pressures encountered by working families and caregivers who are rushed, distracted or sleep deprived.

What is startling is that 65% are college educated, 35% with more than a bachelor’s degree. The average age of caregiver involved is 22-30. He or she is typically working within a career, owns a home. 55% of children affected are under the age of 2. Catalyst/trigger for forgetting the child is typically a change in schedule. A parent switching off duties with another parent or caregiver during times of change like: end of school year, beginning of vacation, going in to work unexpectantly and having to switch gears.

 

  • 54% of children are forgotten by the caregiver
  • 29% of children are left playing in an unattended vehicle
  • 17% are intentionally left in a vehicle by an adult
  • 1% circumstances are unknown

  

An affected infant or child suffers heatstroke – which is clinically defined as the body temperature exceeding 104 degrees or more without relief. Symptoms include dizziness, disorientation, agitation/confusion, seizures, hot dry skin without sweat, loss of consciousness, rapid heart beat and hallucinations. Once the core body temperature reaches 107 degrees F or greater, cells are damaged and internal organs start to shut down. This cascade can lead rapidly to death.

Young children in hot cars are especially vulnerable – their ability to cool through perspiration is less efficient than adults and they are not able to adjust their behavior in response to the heat, such as removing clothing or exiting from a car seat or from the car. Also, because the surface area of a child compared with their weight is greater, their bodies absorb more energy from the environment than an adult. So kid’s body temperature warms at a rate 3-5 times FASTER THAN AN ADULT!

 Why do cars get so hot inside?  Even though the windows of a car don’t heat up significantly, the shortwave radiation from sunlight does heat up objects inside the car – most notably the dashboard, steering wheel, seats and carseats. Once heated these objects throw off longwave radiation that warms the air trapped inside a vehicle. VERY quickly a car, even with windows cracked, can achieve life threatening temperatures within a few minutes – and the hotter it is outside, the shorter time it takes to reach critical life-threatening heat in the car. You can see from the chart that even on a modestly warm day of 70 degrees, it takes just 40 minutes in a car to be in danger, and less than 10 minutes when temperatures hover in the 90s – that’s a quick dash in and out of the house when baby is sleeping in the car!

 

Estimated Vehicle Interior Air Temperature v. Elapsed Time

 

Elapsed time

Outside Air Temperature (F)

 

70

75

80

85

90

95

 

0 minutes

70

75

80

85

90

95

 

10 minutes

89

94

99

104

109

114

 

20 minutes

99

104

109

114

119

124

 

30 minutes

104

109

114

119

124

129

 

40 minutes

108

113

118

123

128

133

 

50 minutes

111

116

121

126

131

136

 

60 minutes

113

118

123

128

133

138

 

> 1 hour

115

120

125

130

135

140

 

 

These are horrible accidents, but some parents may be neglectful. What has happened in terms of the law?

 An Associated Press (AP) study found "Wide disparity exists in sentences for leaving kids to die in hot cars". It examined both the frequency of prosecutions and length of sentences in hyperthermia death

That study found that charges were filed in 49% of all the deaths and 81% of those resulted in convictions.
-  In cases with paid caregivers (i.e., childcare workers, babysitters) 84% were charged and 96% convicted
-  Only 7% of the cases involved drugs or alcohol

 

 

So what can we do to prevent hot car deaths?

 An innovator in Silicon Valley invented the iRemind alarm – it’s a small pad you place beneath the lining of your child’s carseat. It detects weight down to one pound. Using either an app or a key fob, if you walk away from your car with the child still in there, your smartphone or keyfob will start to alarm and continue to wail the further away you are. This signals a caregiver to return to the car to retrieve a passenger. My opinion is that this technology would be great to use beneath the seats of older disabled, non-verbal or autistic children who may snooze in the car, and have tired, distracted caregivers as well.

Retails for $99. Available on iRemindalarm.com, Amazon and Walmart. Use the code HALLMARK20 for $20 off on Amazon and iRemindalarm.com

 

In addition, Evenflo, a trusted brand of baby products, also makes a carseat with a special sensor in the chest clip. A receiver, paired to the seat, is plugged into the car’s diagnostic system and when the car comes to a halt or the chest clip is unbuckled, the device starts to chime, signaling to the driver to retrieve the little passenger. The seats come with SensorSafe Technology and retail for $149 on Amazon, Target, Toys R Us. Currently this technology is only available on rear-facing carseats rated up to 35 pounds.

 

And here are some common sense but VERY important rules to follow:

 

Parents and other caregivers need to be educated that a vehicle is not a babysitter or play area ... but it can easily become tragedy

NEVER LEAVE A CHILD UNATTENDED IN A VEHICLE.  NOT EVEN FOR A MINUTE !

IF YOU SEE A CHILD UNATTENDED IN A HOT VEHICLE CALL 9-1-1. If you can get the child out, do so.

Be sure that all occupants leave the vehicle when unloading. Don't overlook sleeping babies.


Always lock your car and ensure children do not have access to keys or remote entry devices. Teach children that vehicles are never to be used as a play area.

IF A CHILD IS MISSING, ALWAYS CHECK THE POOL FIRST, AND THEN THE CAR, INCLUDING THE TRUNK

Keep a stuffed animal, pacifier or child's toyt in the car seat and when the child is put in the seat place that object in the front with the driver. Or place your purse, briefcase, work ID or cell phone in the back seat as a reminder that you have your child in the car.

Make "look before you lock" a routine whenever you get out of the car.

Have a plan that your childcare provider will call you if your child does not show up on time.

For a link to the episode which aired on Home & Family, please click on this link: https://youtu.be/e-LJCttV9q8

How to prepare your kids for the arrival of a new baby

Hi All! This is likely first in a series of QA I will do with Kristin Smith, as she anticipates the arrival of Baby #2 in October.

 

 

How do you get your firstborn to understand Mommy's growing belly?

 

As your belly grows, and you are out with Kingston, point out when you see families with babies in arms, in strollers, or obvious siblings. Tell him: look that mommy has a baby, that boy has a sister, there’s a new baby in the family….you get the drift….as he ask him to point out families, babies, sibs as well…as he starts to get the connection….then in a moment where it’s perfect, point to your belly, and tell him that mommy and daddy are growing a baby inside of you just for him. Tell him your belly will get bigger and bigger as the baby grows and that later on the baby will come out and join the family. You can also incorporate reading (as I know he loves books) – look for titles about being a big brother, a growing family, etc. Make sure there are plenty of visuals so he can return to the book over and over again, without your help, and remember there is a baby coming. Kids his age rely on books as anchors of their reality, so this is a great strategy for him.

 If your OB says it's OK, bring him to a visit to look at the baby on ultrasound, hear its heartbeat. If the baby is moving or kicking, let him listen and feel.

 

What are your suggestions for getting your firstborn ready for baby #2?

 

So once Kingston “gets” that you are growing a baby, ask him if he wants to feed the baby, through you. If he offers you bites of food or something to drink, thank him and acknowledge that he is sending food to the baby, and how wonderful that is. Buy him a baby doll all his own, complete with blankets, a little stroller, and let him enjoy playing and preparing.

 

  • Try not to overdue the big brother  Sprinkle it in his vocabulary, but at his age, Kingston will always want to be your baby…and once baby is here, important to ask him daily, “do you want to be a big brother today, or mommy’s first love?? and treat his answer accordingly - he can help choose clothing for the baby (put it on, even if the baby looks like a clown), fetch diapers, sing and play….OR if he just needs a good old dose of being #1…when the baby is fed and asleep, scoop him in your arms, sing to him alone and remind him he is your first love, and always will be….Many around him may overwhelm him with the ?Big Brother” concept and you’ll have to see how well he can handle that title…..

 

  • Well before you are due, make sure that there is a gift chosen by, FROM THE BABY, that you will present to Kingston after the baby is born.  When he comes to see you in the hospital (and he should)…if you have a vaginal delivery make sure the baby is in the bassinet and not in your arms when Kingston is brought in. Scoop him up in the arms and give him some love, all his own.  When he’s ready, ask him if he would like to meet his sibling, and have the gift inside the bassinet with the baby. Bring him up close to the baby (if asleep leave her be) and then present the gift. If he is well, ask if he wants to hold or kiss the baby, and let that all happen. Newborns exude bonding pheromones from their skin, so if he can get a good whiff of the baby, he’s off to a great start!

 

  • If you have a c-section, you probably should wait to see Kingston when your IVs are out, and your haze has cleared…..so on the second day is better….have your hubby get several very large bandaids…and when Kingston comes to see you put the bandaids on the outside of your hospital gown over your belly. Kids his age easily understand booboos and this will indicate to him not to hop on that area, but rather lay beside you. Once home you wear the bandaids on your shirt or pants as a visual reminder. It works…believe it or not.

 

  • Practically speaking each of you should try to give Kingston 15 minutes of completely uninterrupted time a day that is just for him….Label it “Kingston’s Special Time”….to do whatever he wants…but with zero interruption from the baby, doorbells, cell phones, etc….clearly that is a short period of time, but very realistic as you balance the needs of the baby with his. Set a timer to indicate the end of that time…and once it rings continue your time together but remind him it’s now “family time” so if the baby cries or phone rings we now do things for our family.

 

  • Keep Kingston in his routine…don’t start something new (like school or daycare) on the heels of the birth…if you want to do it, do it now so routine is in place before the birth. Same goes with potty training, or losing the pacifier or bottle.

 

  • If you anticipate that the new baby is going to need Kingston’s crib, make the change now to a toddler bed. Let him keep his mattress and bed sheets and coverings. Safest is to put the bed directly on the floor – if he rolls off it’s just a few inches. Snug the bed into a corner of his room so he feels a little containment. If you want, plunk the mattress into a toddler bed or bed of his choosing. Put away the crib for a couple of months so it’s out of sight. Then when the baby comes, you can remind him that he slept there, but now the baby will sleep there, with his/her own sheets, etc.

 For a link to the episode on Home & Family go to: https://youtu.be/C7MT4PYo_m0

  • Get out some pictures of you pregnant with Kingston, and photos of him growing from infant to toddler. Tell him the new baby will do that too, and from his book on Big Brothering, remind him it will be a while before the baby is ready to play with him. But he can make her smile, help with her clothing, help comfort and entertain her until she is ready to play full on as a sibling (hint hint, I think you are having a girl) : )

ALLERGY TESTING

 

Allergies are a major topic of conversation these days. Sometimes it’s very clear what is provoking symptoms, and sometimes it’s about as clear as mud. I wanted to shed some light on the subject, and here are several FAQs to help.

 

Q: Can you summarize for us what types of allergies are out there?

 

A: Typically there are 4 categories of allergies that we see often.

 

Environmental allergies – from grasses, pollens, etc are common seasonally, and sometimes year-round. Sufferers endure symptoms ranging from itchy watery eyes, runny noses, sneezing, to wheezing, hives and chronic congestion.

 

Food allergies – certainly a hot topic now. Sufferers typically may have hives, itching, nausea or vomiting, and in the worse case scenarios wheezing, swelling of the airway or anaphylaxis.

 

Venom allergies – we see these more often in the Spring and summer when bees and wasps and mosquitos are more prevalent. These reactions can range from intense local itching, to swelling of the bitten area, and in extreme cases, systemic reactions leading to anaphylaxis.

 

Lastly, contact allergies – these typically occur as rashes or skin eruptions associated with direct contact from metals, latex, occupational or environmental agents. Those affected have chronic itching, typically local, and these rarely progress to serious symptoms.

 

 

Q: What is the single most important thing to help your doctor make a diagnosis?

 

A: HISTORY HISTORY HISTORY. We ask many questions to get a complete understanding of the circumstances surrounding a reaction and possible causes. So bringing notes, photos or video to your visit, as well as food labels or packaging from suspected allergens can help us do the detective work together. When the answers are not crystal clear (as in the case with some food allergies) or if symptoms of environmental allergies can’t be well controlled with available medications or avoidance, then testing may be indicated.

  

 

Q: Let’s walk through them then. First, Hay Fever and environmental allergies.

How are they diagnosed and do we always need testing?

 

A: If an individual has a pattern of environmental allergies – like typical hay fever every spring, we have a few options. First we treat with available tools like non-sedating antihistamines, perhaps a nasal or eye allergy preparation, and other strategies to reduce pollen entering the home. Despite our best efforts if allergies are still difficult to control and interfere with quality of life then skin testing is done.

 

Small amounts of allergen representing the LOCAL grasses, trees, pollens, and animal danders etc are placed on the skin and pricked with a tiny needle. Those areas are observed for several minutes. A NEGATIVE test usually means you are not allergic – however a POSITIVE TEST may not be completely predictive of true allergy.

 

Depending on the severity of the skin prick test’s reaction, allergists may recommend another layer of allergy medications or even immunotherapy (allergy shots) – especially if these environmental allergens cause severe symptoms like severe asthma.

 

 babypatchtest.jpeg

 

 

Q: What about contact allergies?

 

A:  These are fairly common. I saw many kids in my practice with local areas of itch and redness, typically at the wrist, belly button area, earlobes or the back of the neck. My son had rashes beneath each of the snaps of his infant pajamas. The culprit – Nickel - an inexpensive metal used in watch casings, earrings, jewelry, snaps and belt buckles. Direct contact with skin causes a very itchy uncomfortable rash that doesn’t go away unless the offender is removed. But if the rash’s source is in question, we can do Patch Testing. This is typically done also when babies have “mystery rashes” and working folks have rashes on hands or skin that may be related to contact with a workplace allergen.

 

 

Based on history, small amounts of suspect allergens are placed on the skin, and covered with an occlusive bandage for 48 -96 hours. The bandages are removed and those areas are examined for redness and inflammation. If there is redness, you have a contact allergy. Typically treatment involves avoidance of the offending agent moving forward and the rashes will resolve on their own, or with a topical steroids.

 

 

Q: And food allergies – we hear about so many tests. How do we know for sure?

 

A: If there is a reproducible reaction each and every time a food is eaten, it’s easy to implicate that food as the culprit. When the diagnosis is crystal clear by history, your doctor will educate you about avoidance and develop an allergy action plan for your child for home, daycare or school. This may or may not include an epinephrine auto-injector depending on the severity of symptoms.

 

However, if a child has had a reaction that is unclear, or the history fails to reveal the cause then testing may be indicated. In addition, if a child has a significant allergy to a peanut (a legume) or a tree nut, more testing needs to be done as there are several proteins that peanuts and treenuts have in common, placing a child at risk for other nut allergies.

 

Skin prick testing is typically done looking at the suspect allergens a week or 2 after the event (as the body needs time to restore it’s source of IgE – that immune chemical we make in larger amounts that helps trigger a positive skin test but gets depleted after an allergic reaction). Patients are asked to NOT take antihistamines so that the sensitivity of the test is greater. If there is a significant reaction to a specific allergen your allergist may then recommend a direct food challenge in his/her office to verify if that food truly is your enemy. This is the gold standard of testing for food allergies. That said, if you have had a history of anaphylaxis to an allergen, with a positive skin prick test, you and your allergist may elect to not have a food challenge, as this may be risky for you.

 

Q: What about blood tests for food allergies?

 

A: If a patient has a skin condition where skin testing isn’t reliable, or is taking medication that interferes with skinprick testing, or in the case of kids who may not tolerate the pricks, then specific IGE blood tests are done. The lab adds the suspected allergen to your blood sample and then measures the amount of antibodies your blood produces to attack the allergens. It’s not a good screening test due to high false positive results. If there is a significant elevation of IgE against a food, your doctor will likely recommend a direct food challenge in the office to verify or not.

 

Q: Are there any tests out there we shouldn’t have?

A:  Measurements for allergen(food)-specific IgG are often performed by alternative health practitioners in the context of food allergies. It is normal to have specific IgG to individual foods, because a patient has eaten them, so testing will yield multiple positive results. This test does not predict food hypersensitivity or allergy.

 

Other types of testing not validated by good science include kinesiology, cytotoxic tests, electrodermal testing and provocation/neutralization tests. They result in unnecessary testing, and inappropriate advice.

 

 

Q: Insect stings?

 

A: It’s very common for kids and adults to have local, sometimes impressive reactions to mosquito, bee and wasp stings. However, if there are systemic reactions like hives, wheezing, or anaphylaxis, your allergist likely will prescribe an epinephrine auto injector. Immunotherapy (allergy shots) may be prescribed under these circumstances. This would only be for bee or wasps – fortunately mosquito reactions, although impressive, rarely lead to dangerous consequences.

 

 

Q: Last thoughts?

 

A: There is no single test out there that predicts the severity of an allergic reaction. And as is the case, especially with food allergies, reactions can vary from incident to incident. So if your healthcare provider encourages you to have an epinephrine auto-injector nearby at all times, take that piece of advice seriously. Stick with your allergy action plan, and if it fails you, re-visit your plan with your healthcare provider or allergist!


For a clip of the episode on Home & Family go to: https://youtu.be/dAEp9vRqxM0

Optimizing your skin care during pregnancy


Navigating a pregnancy is a tough journey. Face it, from the moment you announce you’ve got a bun in the oven, advice from friends, family, even perfect strangers, is unending, and often unsolicited. Couple that overload with what we read on the internet and social media, and, well, it’s just overwhelming.

 

Since our skin is our largest immune organ, and an ever-changing tapestry as a result of the hormonal and physical changes once pregnant, it’s important to treat it gently, and safely on a daily basis, including the time we breast feed and are recovering from childbirth.

 

As a physician, but also a mom/entrepreneur who innovated in the skin care arena for 9 years, it’s especially important to follow the science when it comes to ingredients and products. Anecdote and story-telling should carry no weight when it comes to your health and safety, or the well-being of your baby.

 

So here is a brief summary of what you absolutely SHOULD avoid during pregnancy and breast feeding, and what you might ELECT to avoid, based on the fact that we don’t have enough science to endorse use without some reservation.

 

 

FRAGRANCES/OILS/NATURAL TREATMENTS

 

Essential oils, fragrances, and homeopathic treatments during pregnancy must be chosen very carefully. Some essential oils, especially in higher concentrations, are “emmenagogues” – compounds that can promote the uterus to empty its contents, causing premature labor or miscarriage. Pennyroyal, parsley seed, wormwood, rue, oak moss and lavandula are common emmenagogues. Some essential oils can be dermal irritants – causing “pregnant” skin to react in a negative way. Included in this category are essential oils of cinnamon, marjoram, myrrh, peppermint, rose, jasmine, cedarwood, chamomile, clary sage, ginger and juniper. Eating these in herb and spice form aren’t problematic, but the highly concentrated oils from each respective plant are potentially irritating when applied directly to skin. So look for those ingredients in your perfumes and lotions, as well.

 

Check with your OB if you are taking any herbal supplements or homeopathic medications, just to make sure they are not interacting with, cancelling out, or making more potent any medications or supplements prescribed during your pregnancy. Herbs like Saw Palmetto, goldenseal (common in herbal cold remedies), dong quai, ephedra and yohimbe are absolute no-no’s! And if you choose to breast feed, get the OK from your doctor or midwife if you incorporate herbs into your daily routine – some can interfere with successful lactation.

 

HAIR PRODUCTS

Single process hair coloring (color that sits in the hair and on the scalp for a period of time before washing out) has come under fire due to concerns that potential carcinogens (like Arylamines) may be absorbed during the process and circulate to the baby. Although not proven in studies, most OBs will object to this beauty practice. Best to stick with highlights (that don’t make contact with the scalp), or use powdered products that mask your roots while waiting for your little one to make an appearance!

 

As for shampoos, SLS (sodium lauryl sulfate), may cause irritation during pregnancy, when even our scalp can be more sensitive. And fragrance in some shampoos may just turn your stomach, especially in the first trimester. So consider these when purchasing shampoo. This may be the time you want to try out some gentle products for your baby, and use them yourself! Consider it a pre-bonding experience.

 

 

 

 

COSMETICS

 

As for makeup, you may have read that parabens are a no-no. Parabens have been used for over 80 years as very successful preservatives in the food, cosmetics and personal care industry, with a track record of gentleness and effectiveness in miniscule doses.

 

However, a study that kicked parabens into the controversy pool was conducted in Japan several years ago, supposedly linking parabens found in breast cancer tissue to parabens in the maternal environment. What the study didn’t do was look at normal tissue to see if there was the same phenomenon. This study was kicked to the curb and refuted once follow up studies showed that all humans do accumulate parabens in both malignant and healthy tissue, and also excrete them in the urine.

 

To date there are no DIRECT studies that implicate parabens cause endocrine disruption or cancer in children – only animal studies. And those studied animals received doses of parabens orders of magnitude greater than any possible human exposure. Unfortunately, the lore propagated by the Japan study lives on, and fear of parabens continues to be perpetuated.

 

Because the seeds of doubt that have been planted are so deep, many manufacturers have now opted to use other preservatives for cosmetics, many of which have the potential to be more irritating to the skin, and may not protect from anti-bacterial growth over the long haul. So patch test any new cosmetic on a couple of inches of your forearm skin for at least an hour or 2, before using on your face. If any redness, itch or irritation, don’t use it. What you applied before pregnancy may not interact in the same way with your “new” skin, so patch test your familiar products as well.

 

Avoid any cosmetics containing kohl, a deep pigment present in some liners. It can contain lead, which can be absorbed into the mucous membranes and cross the placenta.

 

 

ACNE and BREAKOUTS/MELASMA/STRETCH MARKS/DRY SKIN

 

You thought you were done with acne, right? Those same hormones that confirm a healthy pregnancy also wreak havoc with our oil glands, the balance of bacteria on our skin and in our pores, our skin pigments and skin elasticity.

 

Acne and Breakouts – certainly never use any oral Accutane or other retinoid compounds – they have been proven, albeit rarely, to contribute to birth defect risk. Topical retinoids are also discouraged due to their oral counterpart’s bad rap – a risk not worth taking. In addition, your exfoliation routine may include Salicylic Acid or other Beta-Hydroxy acids(BHA). What we know is that these medications taken orally can compromise the integrity of clotting and could lead to fetal loss. If used topically, they should applied only for spot treatments or in rinse off facial washed, and not used extensively (like in chemical peels) when pregnant. A safe and effective alternative is using glycolic acid for exfoliation. Sera with vitamin C or lactic acids are considered non-toxic and effective for some. Azaleic acid is also a viable alternative for tough breakouts, as are some topical antibiotics like clindamycin or erythromycin. Avoid TETRACYCLINE – taken orally it can discolor your baby’s teeth, and even lead to congenital defects and cataracts.

 

The key here, in managing your skin, is to make sure you get the OK from your derm or OB before using your pre-pregnancy regime, and don’t assume over the counter acne medications are safe- always check with your doctor first.

 

Melasma, also known as the “mask of pregnancy” is a temporary darkening of pigmented cells of the face from UV exposure. Hydroquinones are a class of chemicals used to whiten areas like this, and are known to be absorbed through the skin. Although their use during pregnancy does not appear to be associated with increased risk of congenital defects, the study that generated this conclusion had a small sample size. With little statistical power, best to avoid hydroxyquinones. Your melasma will clear on its own, and just amp up your facial spf during pregnancy (*See below) and wear a hat on those sunny days.

 

Stretch Marks – no miracles here. Your rate of your weight gain during pregnancy, coupled with your genetics, determines to what extent you develop striae, or stretch marks. That said, skin that rapidly expands does tend to get irritated, itch and using gentle moisturizers on a regular basis will keep you more comfortable. The stretch mark miracle creams out there don’t work, so don’t waste your time. Invest your time in a little more exercise and conscious awareness of your diet to keep your weight gain modest and healthy.

 

For Dry Skin – use cleanser instead of soap, that way your skin will retain more of its natural oils. Moisturize immediately after bathing, and try to avoid prolonged contact with hot water – it strips your skin of even more natural moisture. Creams and balms tend to cling to and moisturize more effectively, whereas lotions need to be applied more frequently. Look for the seal of the National Eczema Association on skin products – they tend to have the safest, most effective ingredients, especially for our more reactive skin during pregnancy.

 

 

AT YOUR SALON/AESTHETICIAN

 

The protein in nails is called keratin, and basically is as impenetrable as a rhino horn. So nail polishes and lacquers can be safely applied during pregnancy. What may put you at risk is vigorous cutting and removal of cuticle and callous – putting you at risk for secondary bacterial infections. So have your nail gal gently push your cuticles back, opt for well-buffed nails if you don’t want polish, and sit in the most well-ventilated area of the salon to avoid inhaling fumes. Periodically ask for a foot massage to help stimulate blood flow in your lower legs – that’s the best treat at your salon!

 

Also, if you suffer from nail fungus, avoid oral anti-fungals during pregnancy. Unfortunately topical agents aren’t hugely effective, and are glacial in their ability to show improvement, so best to stop any anti-fungal intervention when it comes to your nails until after you stop breastfeeding.

 

As for waxing, especially if involving large areas, or the bikini area, you do run a slight risk of secondary infection or painful ingrown hairs. So assess the cleanliness and hygiene of your salon treatment areas, and march right out if you see the aesthetician double dip into the wax (a new stick should be used each time).

 

You are beautiful. Avoid injecting your face or body with botox or fillers during pregnancy. We have no data to know whether they are safe to use during pregnancy, so hold off until after your little bun is outta the oven!

 

 

WHEN OUT IN THE SUN

 

So many of my young moms developed skin cancer in their 30’s – having spent many years outside without protection from UVA and UVB rays. I can’t emphasize enough how protecting your skin, whether you are pregnant or not, is the single most effective cancer-prevention intervention you can take. Chemical sunscreens, although effective and inexpensive, are much more irritating to skin, especially when pregnant. Much like parabens, the chemicals commonly used like oxybenzone, have been shown to cause endocrine disruption in animal models in the lab. There are no human studies to date to correlate with animal models. That said, there are very safe and effective alternatives to chemical sunscreens – specifically mineral based products.

You should aim for an spf of 30, and can achieve that with either a solely Zinc based product (for it to have both UVA and UVB protection, it must be present in a high %), or alternately a Zinc Oxide and Titanium dioxide combination which can achieve the same. Look for Broad Spectrum (UVA and UVB) protection, water resistance up to 40-80 minutes, and if your skin is super sensitive, use a product designed for baby, or one that is hypoallergenic.

 

 

Love your skin like you will love your baby, and you will both live long and prosper. All the best to you new moms out there!

For a YouTube link to the Home & Family segment on this topic go to: https://youtu.be/AnTPrVOn9AU


Spring Berry Pavlova - for Easter AND Passover

SPRING PAVLOVA

 

The key to making a successful meringue is to use egg whites that have been previously frozen – they whip so much better and are more stable when baked. Use the yolks to make pasta, or a fresh citrus curd.

This is a celebration pavlova, with 2 layers of meringue sandwiching a beautiful cream center spiked with lemon curd, and topped with seasonal berries.

 

10 egg whites from large eggs, chilled
Pinch kosher salt
2 cup sugar
4 teaspoons cornstarch
2 teaspoon white wine vinegar
1 teaspoon vanilla extract

 

 

2 cups fresh berries – Cut up 1 ½ cups, and puree the remaining ½ c.

Prepared Lemon Curd

1 cup heavy cream – cold**

2 TB powdered sugar

 

**alternately you can use 2 cups of non-dairy whipped topping, and mix with the curd

 

2 sheets parchment paper

2 sheet pans

pencil

offset spatula

 

 

 

First, prepare your template. Fold parchment paper in half and trace half a heart. Turn over and draw the remaining half of a heart. Then lay your second parchment over the first and trace the heart. Place on sheet pans with pencil side down.

 

Preheat oven to 180 degrees.

 

Meringues: Put the egg whites and salt in the bowl of a stand mixer with the whisk, and beat on high until firm – about a minute. Turn mixer down to low and slowly add the sugar, and beat until you see firm shiny peaks – about 2 minutes. Remove bowl from mixer and sift cornstarch onto the white, add the vinegar and vanilla, and fold with a rubber spatula.

 

Mound half the mixture onto the middle of the hearts and with an offset spatula smooth the eggwhites out to the edges of the heart and level the top. Bake for 1.5 hours, turn off the oven and let set until cool – about an hour. The meringues will be crispy on the outside and soft and chewy inside.

 

Whip cream with sugar until soft peaks form. Gently fold in 2-3 TB of lemon curd – if you like tart, add more.

 

When ready to serve: Mix cut up berries with berry puree. Place one meringue on a platter (flat side down), top with whipped cream/curd mixture spread to edges, top with second heart. Drizzle with lemon curd and serve with berries on top!

 

 

Couple of hints: if it’s raining or very humid, these meringues may “sweat” and deflate a bit. So choose a dry day to bake. Do NOT refrigerate as they will leach fluid/sweat. Keep meringues at room temperature in a dry area until ready to serve.  Take meringues off parchment 2 hours after baking and invert onto wax paper - the bottoms, if a little moist, will then have a chance to dry and not stick to your parchment or platters!

 

There. Will. Be. Nothing. Left. Guaranteed!

 

Here's the link to YouTube: https://youtu.be/90kVMxCI1Jg 




 

SCOLIOSIS

 

Scoliosis affects 7 million people yearly in the US and is fairly common in kids – especially adolescence. Here are some FAQs about it.

 

First what is scoliosis?

 

Scoliosis is a common condition that affects many children and adolescents. Simply defined, scoliosis is a sideways curve of the spine that measures greater than 10 degrees. Instead of a straight line down the middle of the back, a spine with scoliosis curves, sometimes looking like a letter "C" or "S." Some of the bones in a scoliotic spine also may have rotated slightly, making the person’s waist or shoulders appear uneven.

 

Are there different types of Scoliosis?

 

There are 3 kinds:

 

CONGENITAL scoliosis is present at birth and is caused by a failure of the vertebrae to form individually and separate from each other

 

NEUROMUSCULAR – is generally caused by conditions that place unequal forces on the muscles supporting the spine or abnormalities of the spine itself. Examples are cerebral palsy, muscular dystrophy or spina bifida.

 

IDIOPATHIC – means the cause is unknown. It is thought to arise from a combination of abnormalities and is complex in nature. It most commonly affects adolescents between 11-17 years of, but can develop in younger children as well.

 

 

How common is it?

 

Scoliosis affects about 7 million people in the US – that’s 3-5% of the population but only a tenth of those may need treatment. During adolescence, it’s 5-8 times more common in females, and larger curves are more apt to happen in females. Progression is most common during the growing years, but severe curves can continue to progress into adulthood.

 

And about 30% of adolescents with idiopathic scoliosis have a family history. It’s considered a partially genetic condition.

 

Why are adolescents at risk?


During periods of rapid growth, like that which occurs during puberty, the bones of the vertebrae and surrounding tissues are amped up for growth, resulting in a situation where growth of the vertebrae may be uneven or abnormal in one or multiple directions. This is termed AIS – Adolescent Idiopathic Scoliosis.

 

How do we know if our kids have it?

 

Typically it may first be identified by a family member, school screening or your teen’s healthcare provider. It’s typically painless, so things that are typically seen that raise suspicion are:

  • One shoulder may be higher than the other.
  • One scapula (shoulder blade) may be higher or more prominent than the other.
  • With the arms hanging loosely at the side, there may be more space between the arm and the body on one side.
  • One hip may appear to be higher or more prominent than the other.
  • The head may not be exactly centered over the pelvis.
  • The waist may be flattened on one side; skin creases may be present on one side of the waist.

 

           

When should we screen kids?

 

The Scoliosis Research Society recommends that girls be screened twice, at 10 and 12 years of age (grades 5 and 7) and boys once at 12-13 years of age. Screening is best done in the physicians office. I used to bend kids over from the time they could stand and look at the symmetry in their backs. This happened at each physical, so if there was a change, I would be on it early!

Schools here in Southern California screen girls typically in 7th grade, because their puberty and growth spurts occur earlier than boys, who are screened in 8th grade. 

Some school districts don’t screen at all, so it’s particularly important that your rapidly growing child be examined yearly, or sooner if you notice the back changing.

 

How do you diagnose it?

 

The prominence or rib hump can be measured using a small level called a scoliometer. It measures the angle that the trunk is rotated at the peak of the hump (I’ll show a picture here). This is called the Adam’s Bendover Test.

If we see an angle close to 10 degrees, we refer to a scoliosis specialist (an orthopedic doctor) for more thorough evaluation.

A history and physical is taken, xray studies are done with the patient standing and include front, side and bending positions. Occasionally it’s found that the legs of the child are uneven length, and when a lift is placed under the heel, the “curve” goes away.

 

Are there symptoms?

 

Typically, there are none. HOWEVER, if there are then other conditions need to be ruled out like neuromuscular weakness, structural abnormalities of the spine, or other conditions associated with symptoms.

  

What are the treatments?

In a kid with a small curve who is almost fully grown, observation is the treatment. In an adolescent with a curve between 0-20 degrees with substantial growth left, periodic assessments for progression are done with xrays – if progression past 20 -25 degrees, BRACING is done to prevent further progression. For kids initially with curve of 25-40 degrees bracing is always done if growth remains, and all kids with curves in excess of 50 degrees with require surgery – with fusion of the bones and placement of rods and pins to straighten the spine in order to stabilize the curve.

There is NO evidence that electrical stimulation, chiropractic care or other options have any impact on scoliosis curves.

 

Why the bracing or surgery?

 With significant curves, back pain could occur and progress over time, placing undue stress on the muscles, discs and surrounding structures. Severe curves can also be associated with diminished lung function due to distortion and stiffness of the rib cage.

 

 

COLOR BLINDNESS - It's not just for grownups!

Color blindness is often not recognized until later in life when applying for jobs that rely on being able to distinguish colors clearly. I wanted to help you with insights into color blindness, as it can be diagnosed early, and accomodations for your child can be made before school entry.

 

First, how early in life can children see in color?

 

Roughly around 4-6 months – as children start to pick up objects in the distance, and see clearly up close, their world also transforms to full living color – sort of like how Dorothy started in black and white Kansas, and then saw Oz glimmering in the distance in color!

 

When can kids start to distinguish colors? And how can we best teach them?

 

 First, In order to actively teach our children colors we should start as they start acquiring language. Some interesting studies at Stanford University revealed that kids will learn colors sooner and more accurately, if the object of interest is of interest to them.

 

For example saying “Blue sky” may not evoke memory of Blue to a kid who could care less about the sky – but the Balloon (fun!) that is blue might. So naming an object of interest, followed by “Yes, that is a balloon that is blue will imprint on their brains more significantly. Most kids can name 1 color or 2 by 2-3 years of age, and certainly by 5-6 should be able to run through the usual Crayola 8 basic colors without too much problem.

 

 

How common is color blindness?

 

It affects 1/12 males and 1/200 females worldwide. In the US that would translate to 12,650,000 males opposed to 785,000 females.

 

 

What causes color blindness?

The retina of the eye has two types of light-sensitive cells called rods and cones. Both are found in the retina which is the layer at the back of your eye which processes images. Rods work in low light conditions to help night vision, and are more in the periphery of the retina; but cones work in daylight and are responsible for colour discrimination and are directly in the path of most light coming in to the center of the retina.

There are three types of cone cells and each type has a different sensitivity to light wavelengths. One type of cone perceives blue light, another perceives green and the third perceives red. When you look at an object, light enters your eye and stimulates the cone cells. Your brain then interprets the signals from the cones cells so that you can see the color of the object. The red, green and blue cones all work together allowing you to see the whole spectrum of colors.

 

People with normal color vision have all three types of cone/pathway working correctly but color blindness occurs when one or more of the cone types are faulty. Typically these defects run in families – are more typical in males, but passed down on the maternal side of the family.

 

So when do we suspect a child is color blind, and by what age?

 

Typically by 5-6 years of age, and here are some typical observations in children who are color blind:

  • using the wrong colors for an object – e.g. purple leaves on trees, particularly using dark colors inappropriately
  • frustration or poor attention when coloring – it’s just not that interesting
  • problems in identifying red or green or other colors with those tones – ie purple and brown
  • when lights are dim, trouble distinguishing colors
  • smelling food before eating – it’s hard to tell what veggie is what!
  • excellent sense of smell
  • excellent night vision – as the rods are very strong
  • sensitivity to bright lights
  • trouble reading colored letters
  • head or eye-ache when looking at red or green backgrounds
  • difficulty grouping objects with similar/overlapping colors

 

How can we test for it?

Now there are visual cards called “Color Vision Testing Made Easy” that are highly sensitive to recognizing color visual deficits - they are geared to 3-6 year olds but very useful for those with developmental handicaps and for those who have trouble with numbers. This tests relies on recognition of common shapes – circles, stars , squares, etc.. Results of studies have shown high sensitivity of detection.

 

And if a child is color blind, what can you do?

It is important that the specific type of color blind condition is diagnosed professionally because 

(i) support provided in school needs to be tailored to suit each specific condition – ie a child with color blindness shouldn’t be penalized academically if color-oriented tasks are not passed) and 

(ii) the type of color blind condition someone has may affect their ability to pursue certain careers – like aviation, electrical work, bomb squads, firefighting, operating motor vehicles, baggage handling, peace officers (police), and painters

 

CHOCOLATE!

Chocolate is one of the most popular food types in the world, and yet, throughout the years, it has gotten a lot of bad press with its consumption associated with everything from high blood pressure to tooth decay. But lets talk about the positives – arrived at with GOOD science, and giving us hope that one of our favorite “food groups” can help us live longer, and happier!

 

 

What has accounted for the bad press about chocolate?

 

In 1893 Milton Hershey revolutionized the process of making milk chocolate, and introduced mass production techniques that resulted in chocolate’s popularity as a sweet treat. Over the years, as more nuts, caramel and other components have been added to chocolate, the calorie count and sugar content has skyrocketed. So the large amount of sugars in most commercial chocolates can cause gum disease, tooth decay – and yes, excessive consumption of high caloric candy can lead to obesity, a higher risk of diabetes and cardiovascular disease.

 

So what has changed our understanding of chocolate today?

 

Cocoa beans, the base ingredient of chocolates, are believed to contain more than 300 compounds that are beneficial to health. High on the list are plant nutrients called flavanoids and flavanols – called anthocyanidins and epicatechins. These antioxidants protect plants from environmental toxins and help repair damage – it appears that we also benefit from their antioxidant power. Antioxidants repair DNA and capture free radicals in the body that are responsible for accelerating aging, cancer, and a host of other disease states.

Cocoa beans also contain dopamine, phenylethlamine and serotonin - compounds known to enhance a positive mood and promote feelings of well being.

 

So lets get to the benefits:

 

Cholesterol first! Low Density Lipoprotein, or LDL, is known as our “bad” cholesterol. When there is increased oxidation in the body, free radicals can cause LDL to deposit on artery walls and develop plaques. Over time these plaques can cut off blood supply to the heart, arteries to other organs, and contribute to stroke risk.

 

A well conducted study published in the journal Nutrition demonstrated that regular consumption of cocoa flavanol-containing chocolate bars significantly lowered serum total and LOL levels over a four week trial. Harvard researchers analyzed 24 studies involving over 1000 people and found some evidence for a small decrease in LDL and a significant increase in HDL cholesterol.

 

Blood pressure and heart disease!

 

Research published in the British Medical Journal has suggested that consuming chocolate could help lower the risk of developing heart disease by one third. Canadian scientists studied over 44,000 people and that that those who ate chocolate were 22% less likely to suffer a stroke than those who didn’t. And for those who DID eat chocolate, but had a stroke, they were 46% less likely to die as a result.

 

Studies at the University of California San Diego in 2012 found that dark chocolate may benefit patients with advanced heart failure by enhancing the structure of mitochondria – the cell’s powerhouse – and another study showed that blood pressure was lowered.

 

And a recent study in the Journal of the American Heart Association added evidence that eating dark chocolate helps those with peripheral artery disease to walk further.

 

Memory and Cognition!

In 2013 a study by researchers from Harvard Medical School claimed that drinking two cups of hot chocolate each day may stave off memory decline in older age. Thinking and memory tests were done at the start of the study, and the elderly who participated and drank the chocolate performed better than the control group. Using ultrasound before and after the study, researchers were also able to directly visualize increased blood flow to the brain of those who drank the chocolate – this is called neurovascular coupling – the blood flow response to brain activity. It was actually IMPROVED in those who drank the chocolate.

 

In a further study published in 2014 a cocoa extract called lavado, may reduce or block damage to nerve pathways found in patients with Alzheimer’s disease – an exciting development that is provoking more study in this area.

 

Pregnancy! 

Eating chocolate during pregnancy may benefit fetal growth and development when pregnant moms eat 30g of chocolate a day – this study just published in 2016.

  

Any other studies?

 

One that got a lot of press was a study published in the New England Journal of Medicine. The investigator demonstrated a surprisingly strong correlation between chocolate consumption per capita and the number of Nobel laureates per 10 million people in 23 countries. Although it is VERY tempting to assume that chocolate is responsible for superior intellect, let’s step back and remember that there are other factors in play here – for example…thinking broadly – since chocolate is a luxury in most societies, we must assume that the per capita incomes are higher in the nations on the right. And with higher income comes the liklihood of a more obtainable higher education, and more opportunities. Those might be more important factors in why more Laureates come from those areas of the world. There was a lot of press about this study – especially because it was published in such a prestigious journal – and much criticism. But in concluding, it allows me to caution our audience that not every study’s conclusion is the truth. Well conducted studies are hard to find – and many studies that hit the press and the internet aren’t.

  

So what SHOULD we eat?

 

It’s reasonable to assume that a diet rich in plant flavanoids confers benefit to humans – but processing of even dark chocolate can wash out at least 80% of the original flavonoids from the cocoa beans. So here’s what to look for:

Choose dark chocolate with the lowest amount of sugar and the highest amount of cocoa. Choose brands that are at least 70% cocoa, and if there is an indication that Flavanoids/Flavanols are added, grab those. If brands claim to have minimal processing, those are good too.

 

Eat one small square a day (30 gram), and remember to enrich your life with walking, exercise, and a healthy lifestyle. Stimulate your brain with lots of reading and learning.

February is Burn Awareness Month

Each year, over 450,000 burn injuries occur in the United States serious enough to require medical treatment. That’s one burn injury every 70 seconds. So here are some injury prevention facts/life-saving tips to keep your young children safe! 

You might not know that more children are burned each year with liquids, rather than flames!  And here's the lowdown on what it takes to get a scalding burn:

Hot coffee at your corner shop is typically served at 175 degrees.

Liquid at 156 degrees scalds in ONE SECOND, at 149-2 seconds, at 140-5 seconds, and at 133 degrees - 15 seconds.

A great HOT shower for an adult is typically about 110 degrees.

A SAFE warm bath for a baby/child should never exceed 100 degrees.

 

What is the scope of the problem?

 Most alarming is that between 2007 and 2013, the number of individuals admitted to burn centers for scald burns increased by 5%, and about 2/3 of those burns occured in children less than 5 years old. Children are at particularly high risk for burn injuries due to their immature motor and cognitive skills, inability to self-rescue, and dependence on adults for supervision and danger-avoidance interventions. The elderly are similarly more vulnerable due to decreased reaction time, impaired mobility, and effects of pre-existing health conditions.

  

Why such a disproportionate number of little ones?

Infants/toddlers and elderly adults have thinner dermal layers compared to persons of other ages, leading to deeper burn injuries at lower temperatures or shorter exposure times. When exposed to the same quantity of hot liquid, a child will sustain burns over a larger percentage of their total body surface area than an adult (due to a child’s overall smaller body size). The Formula for Disaster is the following:  Thin dermis + Small body = Large, deep burns

 

Where and when do most burns occur?

85 – 90% of scald burns are related to cooking/drinking/serving hot liquids. Coffee is often served at 175°F/79°C, making it high-risk for causing immediate severe scald burns when spilled or pulled down. It wasn’t unusual for a parent in my practice to stop for a coffee with child in tow, and end up in the ER having spilled coffee on the child.

An estimated 9 – 20% of cooking-related burn injuries occur to young children while pulling hot food/liquids from microwave ovens.A prospective study found that 90% of 2-year-olds can turn-on microwaves, open the door, and remove hot contents.

An overwhelming 84% majority of scald burns occur in the home, compared to 73% for other types of burns. And, in children under 5 years of age, the in-home injury rate increases to 95%.

  

What are the typical scenarios under which burns occur in kids?

  • Lack of or inadequate supervision –  parents or caregivers may be distracted, asleep, impaired, not home
  • Danger is not perceived by the caregiver, and therefore protective measures are not implemented
  • Responsibility has been given to a child above their developmental ability, such as: delegating tasks involving hot water to children incapable of supervising
  • Abuse, such as intentional injuries from pouring onto or submerging into hot water

 

 

So, here are some tips to keep your home safe, your water temperature comfortable, and have more piece of mind!

  • Set your water heater at 120 degrees F/48 degrees C or just below the medium setting. You’ll get a nice hot shower, but it would take several seconds longer to scald a child turning on the hot water.
  • Use a thermometer to test the water coming out of your bath water tap.
  •  There are many inexpensive devices available at baby stores and on line that indicate when water is too hot.
  • Run your hand through bath water to test for hot spots. Our human “thermometer “ is very sensitive.
  • Use back burners and turn pot handles toward the back of the stove so children cannot pull them down. Train yourself to do this during your pregnancy – make it a habit for all in the household. Put active crockpots or even potpourri pots up and away from little hands.
  • Use oven mitts when cooking or handling hot food and drinks. Make sure they aren’t wet.
  • Stir and test food cooked in the microwave before serving. Open heated containers away from you from back to front. Be mindful that steam from microwave popcorn is 180 degrees – hot enough to scald a child.
  • Keep children away from the stove when cooking by using a safety gate for younger children and marking with tape a 3-foot “no-kid zone” for older children.
  • Keep hot drinks away from the edge of tables and counters and avoid using tablecloths, runners and placemats.
  • Use a “travel mug” with a tight-fitting lid for all hot drinks.
  •  Never hold or carry a child while you have a hot drink in your hand.


 

 

For more information about burn prevention go to www.flashsplash.org

For a link to the original segment on Home and Family go to: https://youtu.be/092raARRPeE

 

GETTING THE LEAD OUT!

 

Lead poisoning has been, and continues to be, a significant public health threat to children nationwide. However, recently dangerous levels of lead in the drinking water supply of Flint, Mich., have prompted outrage and calls for action, and importantly, raised awareness that this issue exists.  How important a problem is it? Here’s the rundown on lead – a more common risk than you might have thought.

 

What IS Lead? And why is it in our environment?

Lead is a naturally occurring bluish-gray metal found in small amounts in the earth's crust. Lead can be found almost everywhere in our world.

Much of it comes from human activities including burning fossil fuels, mining, and manufacturing. It is used in the production of batteries, ammunition, solder and pipes & devices to shield xrays. It can be found in homes built before 1978, in the soil, in house dust, in artificial turf, toys, candies, natural remedies, and even some cosmetics.

It used to be very common to see lead in paints used for homes and toys, solder in canned goods, and additives to gasoline - but in the US those sources of lead have been banned. However, in older homes, lead based paint and lead contaminated dust continue to be the most hazardous sources of lead for US children. And lead residue from lead based gasoline exhaust (banned in the US in 1995) continues to be found in dirt near busy freeways.

In addition, since we import so many toys, painted goods, foodstuffs and canned goods into the US from other countries, we continue to see lead work its way into our homes from offshore sources.

 

 

Why is lead toxic?

Lead is a powerful neurotoxin that can cause irreparable harm to a child’s developing brain. A child who swallows large amounts of lead by chewing on lead-laden baseboards, inhaling lead in house dust, or even playing in contaminated soil may develop severe anemia, colicy stomach ache, muscle weakness, and brain damage, and even death. Even at much lower levels of exposure, lead can affect a child's mental and physical growth. Lead can work its way into the nervous system, and cause damage that is irreversible.

Unborn children can be exposed to lead through their mothers. Harmful effects include premature births, smaller babies, decreased mental ability in the infant, learning difficulties, and reduced growth in young children. These effects are more common if the mother or baby was exposed to high levels of lead as in Flint, MI. Some of these effects may persist beyond childhood.

For adults who have lead toxicity (typically from inhaling contaminated renovation dust or occupational exposures like auto repair construction battery manufacturing, firing range instructors and gunsmiths, and artists), lead exposure can cause miscarriages and stillbirths. And prolonged exposure to lead may also put adults at risk for infertility, high blood pressure, heart disease and kidney disease. Long-term lead exposure can also cause non-specific symptoms such as abdominal pain, constipation, and feeling distracted, forgetful, irritable or depressed. Lead can deposit in the growth plates of bones, stunting that growth, and lead lines (called Burton’s lines) can be seen in adults who have had significant exposures.

 

How much is too much – what is considered a safe level?

Today at least 4 million households have children living in them that are being exposed to high levels of lead. There are approximately half a million U.S. children ages 1-5 with blood lead levels above 5 micrograms per deciliter (µg/dL), the reference level at which CDC recommends public health actions be initiated.

Data collected by the CDC shows that over 40% of the states that reported lead test results in 2014 have higher rates of lead poisoning among children than in Flint. In Flint, 4% of children aged 5 and under tested positive for lead in the blood, while 12 other states report a greater incidence - the most egregiously occurring in Pennsylvania where 8.5% of children tested were found to have dangerously high levels of lead in their blood.

In 2012, the CDC received reports of more than 27,000 adults who had blood-lead levels of 10 or higher, according to data published in October by the agency’s National Institute for Occupational Safety and Health.

But the ultimate goal of the CDC is to declare “ZERO LEAD” as the normal level, with anything detectable above it a concern. Why? Because lead that enters a body may migrate to the brain or bone marrow, and leave very little behind in the blood to be detected in a test. In the meantime it’s doing its damage, even though blood levels may be 5 or below.

 

How do you test for it?

Pediatricians now have simple, in office tests, where levels can be ascertained with just a prick of the finger. Typically we test all children at 1 and 2 years of age – and may test kids younger or older depending on risk. At Well Child visits we ask about potential lead exposures, home renovations, occupation history, and if children present with anemia, constipation, sluggishness, we dig even deeper.

The Centers for Disease Control and Prevention (CDC) recommends that states test children at ages 1 and 2 years. Children should be tested at ages 3-6 years if they have never been tested for lead, if they receive services from public assistance programs for the poor such as Medicaid or the Supplemental Food Program for Women, Infants, and Children, if they live in a building or frequently visit a house built before 1950; if they visit a home (house or apartment) built before 1978 that has been recently remodeled; and/or if they have a brother, sister, or playmate who has had lead poisoning.

 

Is lead poisoning treatable?

Yes, and no. Yes, if levels above 5 and below 45 are detectable in a child or adult, a thorough environmental, occupational and social history is taken to determine the potential sources of lead – and then removing them from daily life is the next step. Serial blood tests are done until we are assured the child is back in the “safe” range of under 5. For levels of 45 and above, “chelation agents” are given intra-venously in the hospital to grab circulating lead in the bloodstream and eject it into the urine. However, if lead has entered the child’s nervous system in the womb or in early life, chelation therapy cannot reverse any neurologic damage already done. So of course, the best treatment is….PREVENTION or EARLY DETECTION.

 

So how do we prevent lead accumulation?

  • Talk to your state or local health department about testing paint and dust from your home for lead.
  • Make sure your child does not have access to peeling paint or chewable surfaces painted with lead-based paint. That includes exposure to clothing worn during renovation, construction, or high risk occupations.
  • Children and pregnant women should not be present in housing built before 1978 that is undergoing renovation.
  • Create barriers between living/play areas and lead sources, until the work is done.
  • If you have a home with lead in the plumbing (solder or lead pipes), run your water COLD for 30 seconds in the morning before using it for consumption. HOT water, water sitting overnight in pipes, or acidic water increases the lead levels remarkably!
  • Regularly wash children’s hands and toys. Household dust and outdoor soil commonly have detectable lead.
  • Regularly wet-mop floors and wet-wipe window components 
  • Take off shoes when entering the house to prevent bringing lead-contaminated soil in from outside.
  • Prevent children from playing in bare soil; if possible, provide them with sandboxes.
  • Purchase toys for your children that are made in the USA – brightly painted toys typically from Asia may be painted with lead paint – and lead-based paint tastes sweet – increasing the risk a child might put the toy in the mouth 
  • Don’t eat off of plates and dishes that bear the label “Not food safe”and if your ceramics or plates from other countries are chipped or cracked, do not serve or eat food off of them
  • Don’t buy candies from Mexico from street vendors – especially those with tamarind or chili - often the labels themselves contain lead as well as the candy
  • Don’t buy colic or other remedies in ethnic pharmacies – often they contain lead
  • Don’t play on artificial turf that looks worn down or degrading – older versions leach lead into the turf.
  • Read labels on cosmetics – avoid kohl, a black coloring agent used in many countries as eye liner or for decorative skin drawings
  • Avoid purchasing canned goods from offshore – the solder may contain lead

 For video of this segment from Home & Family go to:

https://youtu.be/xeKl_8zP-mY

 

 

NEWS UPDATE: Face your tot REAR-FACING in a Carseat until at least 2!

From my colleagues at SafetyBeltSafe USA, here's what you need to know!

"According to a 2008 article in the professional journal Pediatrics, children under age two are 75% less likely to be killed or suffer severe injuries in a crash if they are riding rear facing rather than forward facing. In fact, for children 1–2 years of age, facing the rear is five times safer.


If a child is riding in a rear-facing-only seat (the type that usually has a handle and detachable base), it should be replaced with a rear–facing convertible seat before the child reaches the maximum weight specified (22-35 pounds) or if the top of the head is
within an inch of the top edge of the seat. Most children outgrow the typical rear–facing– only seat before they are two years old, but they are not ready for a forward–facing seat. New convertible seats available today allow children to remain rear facing until they weigh 30-50 pounds, depending on the model.


Young children have heavy heads and fragile necks. In a crash, an infant’s soft spinal column can stretch, leading to spinal cord damage if he is riding facing forward. The baby could die or be paralyzed permanently. This is true even for babies who have strong neck muscles and good head control. The neck bones are flexible, and the ligaments are loose to allow for growth.

 

If the child is facing forward in a frontal crash, which is the most common and most severe type, the body is held back by the straps — but the head is not. The head is thrust forward, stretching the neck and the easily injured spinal cord. Older children in forward– facing safety seats or safety belts may end up with temporary neck injuries or fracturesthat will heal. But a young child’s neck bones actually separate during a crash, which can allow the spinal cord to be ripped apart. Picture what happens if someone yanks an electrical plug out of a socket by the cord, causing the wires to break.


In contrast, when a child rides facing rearward, the whole body — head, neck, and torso —is cradled by the back of the safety seat in a frontal crash. Riding in a rear–facing safetyseat also protects the child better in other types of crashes, particularly side impacts, which are extremely dangerous, if not quite so common.


Children in Sweden ride rear facing until they are three to five years old, lowering traffic death and injury rates substantially. Although not all safety seats sold in the U.S. are designed to be used rear facing as long as those in Sweden, safety experts recommend that children ride rear facing as long as possible, at least until they are two years old.

A Note from SafetyBeltSafe USA

Some current seats have a recline indicator that shows two angles, one for newborns and one for larger babies and toddlers.  As babies develop, the muscles and ligaments in their necks grow stronger, and they are able to sit more upright.  Not all seats have indicators with two levels.  However as long as the child is comfortable and the head does not flop forward, it is safe for a rear-facing seat to be more upright.  In fact, the seat is even more protective in a crash when it is less reclined.  Today, because of product improvements due to increased awareness of the benefits of facing rearward, many children are riding rear facing longer than 2 years. They may prefer to be more upright so they can sit up and look out the window.  In addition, it is easier to make a tall, rear facing safety seat fit in the back seat of a small car if it is more upright.

For more GREAT info about keeping everyone safe in your vehicle, go to www.carseat.org

 For video of this segment go to: 

https://youtu.be/sPrVZz2UIsw


 

ZIKA VIRUS

 

In the news the last several weeks, have been reports of a new germ called the Zika virus that has been found to cause birth defects – and today, February 1, Zika virus infection has been designated by the World Health Organization to be a Global Health Emergency. So here are some facts, as we understand them today!

 

First, what is the Zika Virus, and how does a person get it? 

This mosquito-borne virus, related to West Nile and Dengue viruses, is carried by 2 varieties of the AEDES mosquito. These are small mosquitos with stripes on their backs, and bite during the day (rather than at night like other varieties).When the mosquito bites a human, the Zika virus is passed, and if the person is pregnant, the virus passes to the fetus and can cause microcephaly – essentially a smaller than normal head and brain. With the exception of pregnancy, humans don’t pass it to other humans. However, if a person is in the first week of infection, if a mosquito bites him, that mosquito can carry the active virus to another human, or even infect other mosquitos, that will eventually infect other humans.

  

Where did this virus come from? 

It was first discovered in Uganda in 1947 – but a recent outbreak which began May of 2015 in Brazil raised the public’s attention. Why? Because over 3500 babies were born with microcephaly, when only 150 had the same condition the year before. Babies born with microcephaly (small heads, and thus smaller brains) will most likely experience developmental delays and other health problems as they grow.

The Zika virus link to these rising cases of microcephaly seemed to be more than a coincidence. Mothers and babies affected were tested, and some, but not all, showed evidence of the virus.

Since that time cases have been described in all over South America, the Caribbean, Western Africa and in the South Pacific. It’s estimated that 1-2 million infections have occurred already in South and Central America, and now a growing number of cases have been described in TX, CA, IL – however they are ALL in persons who have travelled to the suspect areas.


What are the symptoms?

In those who have symptoms typically fever, rash, joint aches, muscle aches, pain behind the eyes, vomiting, and red eyes are typical symptoms. Symptoms last from a few days to about a week. After illness, a person develops immunity. However, only 20% of infected individuals have symptoms. The other 80% may carry the virus but not know it.

Babies born to infected women may be born prematurely, may be stillborn, or may be born with microcephaly and have developmental delays.

Last week, it was also reported that some infected individuals developed Guillain-Barre syndrome – a temporary ascending paralysis that is associated with several viruses, and now Zika.

 

How many have been infected?

Currently it’s estimated between 1-2 million people have caught the virus outside of our borders. However, 80% may have no symptoms and may not know that the virus is present in their bodies. This is especially worrisome for women who are pregnant or contemplating pregnancy.

 

 

How is it diagnosed?

If there is a history of travel to a high risk area, and a woman is pregnant, her doctor should do one of the following: if she has symptoms, then a blood sample is sent to the CDC in the first week of illness; if she has no symptoms 2 weeks after returning from travel, an ultrasound of the baby is performed. If head growth is slowing or calcifications are seen in the brain, then bloodwork is sent to see if Zika is the reason. 

Clinically a person with typical symptoms and history of travel to those areas would warrant a blood test as well. However there are no quickly available tests in doctor’s offices, and treatment is supportive as there is no anti-viral for this germ, nor a vaccine at this early stage of the outbreak.

 

 

Have governments stepped in?

The World Health Organization and the Centers for Disease Control are all over this. Currently there are recommendations that if you are pregnant or contemplating pregnancy, you should avoid travelling to suspect areas until the outbreaks are under control. If you can’t avoid travel or live in those areas, then strict measures should be taken to avoid mosquito bites. Today the WHO declared Zika a global emergency – by doing so governments can more rapidly initiate measure to contain mosquito larvae, educate the population, and enact policies to reduce the incidence of this dangerous virus.

 

 

With the Summer Olympics coming up in a few months, this is a major problem!

United and American airlines are allowing ticket changes to high risk areas without cost, and likely other carriers will follow suit. For those who have booked tickets for travel, best to notify your carriers, especially if pregnant. If you are contemplating pregnancy, the CDC and WHO advise it’s best to delay that choice until a few months after travel to high risk areas. Here are the guidelines as of TODAY, that are also recommended:

  • If travelling to a high risk area, use Permethrin infused clothing and socks, boots and tents, wear long pants and shirts, use mosquito netting at night and close all windows and doors, and turn on the AC
  • Use ONLY the repellants recommended by the CDC and WHO – which include DEET, Picaridin, Lemon Oil of Eucalyptus or IR3535
  • VERY IMPORTANT: Oil of Eucalyptus and IR 3535 should NOT be used in children under 3 years of age. DEET and Picaridin can be used in children down to the age of 2 months – Picaridin has a higher safety profile than DEET
  • Once inside, make sure repellants are washed off thoroughly.
  • Use mosquito netting if camping, sleeping outdoors, or no window or door screens to keep mosquitos out.

 

Do we risk seeing Zika transmitted in the US?

  • It is entirely possible. Here’s the concern: If you have returned to the US and your Doctor thinks you have been infected, you should remain inside and away from mosquitos for a week until you are well. Local American Aedes mosquitos could bite you outside and transmit Zika to others via a bite. As spring and summer are approaching, this will become a bigger risk. So the answer – AVOID TRAVEL to those areas if possible, cover up and use repellants religiously.
  • The hard part here is that if you have travelled to high risk areas, and have no symptoms, you could still be infected and not know it. So control over the outbreaks in high risk countries is key, as is avoidance of travel to those areas. What does this mean? Lakes, streams, ponds, bodies of water and areas of high mosquito density likely will be sprayed with Larvicidal agents, and public health authorities will educate the public abroad about how to reduce mosquito breeding in their home surroundings.
  • Here in the US, we have a social responsibility to gain control of standing water around our homes - it is key to reduce the chances we are bitten by mosquitos – emptying out pots, ponds, and monitoring our properties for standing water is essential. Keeping swimming pools appropriately treated and not letting them go “green” is a wise strategy. Aedes mosquito surveillance in the western hemisphere will be starting in full swing with a goal of global eradication. But this will take time, and we all need to do our part not to invite more mosquitos into our worlds!

 

Stay tuned, as daily we have new information, and I’ll provide updates as necessary.

Bedwetting AKA Nocturnal Enuresis


IN THE PAST, MANY PARENTS HAVE THOUGHT BEDWETTING WAS A BEHAVIORAL DISORDER, AND SOME HAVE ACTUALLY PUNISHED THEIR CHILDREN. SOME CHILDREN HAVE BEEN FATALLY ABUSED BY PARENTS AND OTHER CAREGIVERS, AND BEDWETTING WAS CONSIDERED A “TRIGGER” FOR ABUSE IN SOME SITUATIONS. IT CAN BE ASSOCIATED WITH SIGNIFICANT FAMILY STRESS AND PUNISHMENT IS CURRENTLY CONSIDERED A MORBID CONSEQUENCE OF ENURESIS. IN ADDITION, SEVERAL KIDS OUT THERE WITH DAY OR NIGHTTIME WETTING AREN’T EVALUATED PROPERLY, AND TREATABLE CAUSES OF BEDWETTING ARE OVERLOOKED OR MISSED. IT’S WHY THIS INFORMATION IS SO IMPORTANT!

 

 

WHAT IS ENURESIS?

 

  • Repeated voiding of urine into bed or clothes, whether involuntary or intentional
  • The behavior either (a) occurs at least twice a week for at least 3 consecutive months or (b) results in clinically significant distress or social, functional, or academic impairment
  • The behavior occurs in a child who is at least 5 years old (or has reached the equivalent developmental level)
  • The behavior cannot be attributed to the physiologic effects of a substance or other medical condition

 

 

ARE THERE DIFFERENT TYPES (OPTIONAL QUESTION)

 

PE Primary Enuresis – where a child has never been continent – these cases are NEVER ascribed to psychological causes; and in children, are almost always benign.

SE Secondary – where a child has been continent at night for at least 6 months, then becomes enuretic. In these cases psychosocial considerations may be part of the issue.

 

 

HOW COMMON IS IT

More common in males

Age 4-5: 25% of kids still wet Primary accounts for 75% of cases.

Age 7: 5-10%

Age 10: <5%

Worldwide prevalence about the same

 

WHEN DO KIDS OUTGROW IT

15% of kids become dry each year with very few continuing to be wet into the teens.

 

 

WHAT DO WE KNOW CURRENTLY ABOUT WHY?

Nocturnal enuresis was once thought to be a psychologic condition. It now appears that psychologic problems are the result of enuresis and not the cause. Children with nocturnal enuresis have not been found to have an increased incidence of emotional problems.3 For most children, bed-wetting is not an act of rebellion.

 

It is multi-factorial with a strong genetic component.

Transmitted GENETICALLY – several chromosomes have been identified

 

Enuresis is reported in 43% of children of enuretic fathers, 44% of children of enuretic mothers, and 77% of children when both the mother and father had enuresis. 15% risk even if NEITHER parent or sib had it.

 

 

CAUSES

 

Idiopathic – no cause identified, no family history

Disorder of Sleep Arousal – these kids don’t wake up normally in response to noise – they are the “deep sleepers” who can sleep through a tornado

Noctural Polyuria – overproduction of urine at night

  • due to either excessive afternoon/evening fluid or solid ingestion (kidneys are forced to make liquid in response to more solid waste), and more liquid if drinking more in the late afternoon/evening
  • more thirst in the afternoon/evening from not drinking well during the day, leading to drinking more at night
  • or low nocturnal secretion of ADH (anti-diuretic hormone ) – ADH essentially throws the switch on the kidneys, shutting them off at night; if a child's brain doesn't make enough ADH, or he/she goes to bed overly hydrated, the brain doesn't release enough of this hormone to turn off the kidneys.

Small nocturnal bladder capacity – since bladder holds less, has to empty more frequently through the night

Overactive bladder with dysfunctional voiding – more common in girls, usually with a daytime component  byof some accidents, accompanied by frequency of urination, urgency, and squatting behaviors.

Bladder Infection – occurs at any age – more common in kids with accompanying neurologic or anatomic abnormalities

Constipation -   this is a big one. Essentially collected stool in the rectum bangs against the back of the bladder and causes it to empty before it's full.

Sleep Disordered Breathing – most typically in kids with huge tonsils and adenoids (peaks at 2-5years of age) – causes decreased ADH production. 

Other: Neurologically weak bladder, urethral obstruction or abnormalities, Seizure Disorders, Diabetes are other causes. Children who were previously dry, then become wet are a bit more concerning - emotional issues, sexual abuse, new internal anatomic or other issues then are possible causes.

 

 

 


IF A CHILD IS A BEDWETTER, WHAT SHOULD A PARENT DO?

 

 

WORKUP

The first step here is a consultation with your child’s doctor. A thorough history should be taken to look at factors like fluid/food intake, sleep history, bowel habits, signs of bladder overactivity, infection, and FAMILY and SOCIAL HISTORY. A urinalysis is usually performed, but blood tests are rarely helpful. If anatomic or neurologic issues are suspected, imaging or a urologic workup of bladder function may be considered.

 

TREATMENT

One study1 found that 23 to 36 percent of parents had used punishment as their primary means of dealing with bed-wetting. Hence, family education is crucial. Parents and the affected child need to know that bed-wetting is a common problem, and parents should be instructed not to blame or shame the child. The physician can foster a sense of optimism about the potential for improvement while at the same time giving the child responsibility for achieving urinary control at night. The timing of treatment should be individualized, and most importantly involve the cooperation and motivation of the child.

 

 

Alarm therapy – has the HIGHEST CURE RATE (75%) AND LOWEST RELAPSE RATE (41%)….a wetness alarm is attached to nighttime undergarments and when a child starts to void, the alarm vibrates, signaling the child to go the bathroom. Typically takes up to 4 months for success so dropout rates of 10-30% are reported.

 

MEDICATION

 

DDAVP -– this is the dryness hormone that is required to turn off urine production at the kidney. It is released by the brain into the circulation when a child is on the “dry side”, thus keeping fluids in the body for hydration, rather than releasing them.

If a child doesn’t make enough ADH, or if the child is well hydrated going into sleep so that the brain releases less, the kidneys continue to churn out urine overnight. Giving ADH orally or intranasally at night, in addition to modest fluid restriction, will often result in dryness for a child. For older children, especially, DDAVP has become a game-changer. Studies show this works better in children 9 years of age or over.

 

The combination of DDAVP and Alarms has helped children who might not have responded to either of those modalities alone.

 

Imipramine (Tofranil) – mechanism poorly understood – relaxes bladder enough so it holds more and doesn’t expel urine as readily. Higher side effect profile compared with DDAVP.

 

 

 

LAST THOUGHTS/TAKEAWAYS

 

Punishment has no role in the treatment of enuresis. The impact of enuresis on the child’s self-esteem and emotional health of the child is already sizable enough without the added insult of punishment for a problem beyond the child’s control.

 

Punishment is not always overt and intentional; it can be subtle and unrecognized by an otherwise well-meaning parent. A child easily interprets fluid restriction and requests to wear diaper training pants or to launder sheets and clothes as punishment. Accordingly, parents benefit from education regarding how to present such requests sensitively so as to minimize any sense of being punished on the part of the child.


For a link to the Video segment on Home & Family head to: 

https://youtu.be/e6yjQAwcCCI


What NOT to order when you go to a fast food restaurant.

With the recent spate of news reports implicating Norovirus as the source of diarrhea outbreaks at a national fast food chain, I thought I’d weigh in with some facts about this nasty bug.

 

What is Norovirus?

 

Norovirus is the most common cause of acute gastroenteritis in the United States. Each year, it causes 19-21 million illnesses and contributes to 56,000-71,000 hospitalizations and 570-800 deaths. Norovirus is also the most common cause of foodborne-disease outbreaks in the United States. The virus causes your stomach or intestines or both to get inflamed (acute gastroenteritis). This leads you to have stomach pain, nausea, and diarrhea and to throw up.

 

 

How do you contract it?

 

Norovirus is a very contagious virus. You can get Norovirus from an infected person, contaminated food or water, or by touching contaminated surfaces.

Anyone can be infected with norovirus and get sick. Also, you can have Norovirus illness many times in your life. Norovirus illness can be serious, especially for young children and older adults.

 

 

How long does it usually last?

 

Incubation periods are short, so you can be perfectly fine one day, and have severe nausea, vomiting and diarrhea with belly cramping the next. Low grade fever, muscle aches, fatigue, chills and headache can also be part of the symptoms. Of course, the biggest concern with Norovirus is dehydration from excessive fluid and electrolyte losses. In healthy individuals Norovirus runs its course in 2-3 days.

 

Both the very young, the elderly, and any person with chronic health issues are especially vulnerable to more complications.

 

 

Other ways to alleviate discomfort?

 

Treatment is symptomatic for Norovirus and the majority of other intestinal viruses, as there is no antibiotic for this virus, nor is there currently a vaccine (except for Rotavirus – this vaccine is given to babies in the first 6 months of life). Drinking plenty of fluids (for adults electrolyte drinks, water, and juices and for kids oral rehydration solutions (like Pedialyte) is key to keeping hydrated. Avoidance of sugary drinks and those with caffeine (which can cause even more dehydration) is advised. Once vomiting stops, it’s key to begin to restore calories to assist the healing process, so eating simple, easy to digest foods such as rice, pasta, eggs, chicken, soups, bread, bananas and applesauce will give your body some fuel to fight and heal. Taking probiotics may shorten the course of the diarrhea.

 

 

What are some preventative measures families should be taking on a day-to-day? 

 

  • Wash hands vigorously for 20-30 seconds with soap and water before eating or snacking
  • If hand sanitizer or wipes are used on the road, then 15 seconds of vigorous application can discourage Noroviruses from hitch hiking on hands
  • Wash raw foods and veggies thoroughly (even if pre-washed and bagged for convenience)
  • Cook shellfish thoroughly before eating – if any shells don’t open with cooking, dispose of those
  • If a family member is ill, clean and disinfect surfaces they touch with bleach wipes or a mixture of 1 cup of bleach per 1 gallon of soapy water. Bag up contaminated diapers or towels and wash your hands after
  • Don’t prepare food for your family for at least 2-3 days after YOU have been sick, to reduce chances of contagion, and don’t eat food prepared by someone who is currently sick.
  • Wash soiled clothing and bed linens in hot water for the maximum time your washer offers, wear gloves when handling, and don’t shake out the clothes (the viruses can pole vault onto new surfaces). Machine dry infected linens.
  • Try to avoid reaching into common food bowls at parties and gatherings – instead, if you are the host, hand out single serving packages to the kids – and avoid sampling food at big box stores during the winter – you don’t know who has touched or sneezed on that food before you

 

 

Is Norovirus seasonal?

 

Although winter is the time this bad bug flourishes, the truth is that Noroviruses can cause illness year-round. So it’s especially important to keep all these preventive strategies in the back of your mind in the event this bug comes knocking at your door!

 

 

What are some indicators that it’s time to see a doctor?

 

If affected individuals are dizzy, if urination has dwindled or stopped, or the mouth feels puckered and dry, it’s time to hydrate more aggressively, and if still vomiting or having lots of diarrhea, best to go to the emergency room or your doctor for hydration. In babies and tots, lack of tears, listlessness (not wanting to play, inactivity out of character), pale cool skin, dry mouth, and persistent symptoms should trigger an immediate call to your health care provider or a visit (pronto!) to the ER.

How to keep our (tater) Tots at the table!

 

 

Every parent wants an easy-going, stress free nutritious family mealtime, but that can go South pretty quickly unless we understand the capabilities of our little ones.  Here's a primer on how to optimize mealtime with your kids.

 

 

Family mealtime provides a wealth of developmental benefits for toddlers – helping to promote more language, improved social skills, and better nutrition. But we have to have realistic expectations for our little humans

  • 2 year old – may last 5 minutes
  • 3 year old – 5-10 minutes
  • 4 years – 10-15 minutes
  • 5-6 year olds – 15-20 minutes

 The length of stay will depend upon many things, including how hungry the child is, how tired, how his day went, and whether he is engaged in the process.

 

So what do you do  if your kid is starving at 4pm and the family doesn’t sit down to eat until later?

Tots are grazers by nature – they have high energy output and small stomachs, so eating small meals all day long fuels their engines and satisfies their appetites. That said, for thirsty kids avoid juice or milk between meals – they both spoil the appetite. Serve your child a mini snack at 4pm, and invite him to the family meal for dinner. Alternately serving dinner at 4 or 5, followed by a sitdown with the family with a bowl of cut up fruit, his glass of milk will provide him with that valuable teaching time. If you have time making that fruit or meal look fun and enticing creates an opportunity for conversation (we’ll show ezpz mats here) – you can talk about what is on the plate, and like us, kids eat with their eyes. And these mats can’t be dumped on the floor – removing another potential mess and stressor.

 

Let's face it - mealtime is often battlefield. Why is that? 

Put yourselves in the shoes of toddlers and here’s their day – WE decide when they wake up, what they wear, what they do, where they go, and when they go to bed. And developmentally they are naturally acquiring autonomy and independence, but how can you do that without some independent decision making? Well, resisting at the table is one way, setting the stage for a power struggle. Dawdling or refusing to eat = power. Also, in the rapidly changing world of a toddler, eating the same food every day is often a coping mechanism linking each day to the next. So new or novel foods may not be accepted until after 8-10 tries.

  

So how do we remedy this?

Involve your children in the meal – whether it’s placing napkins on the table, participating in some food preparation in the kitchen (even tots can stir or operate a rotary cheese grater), and then inviting them to the meal they helped prepare, or the table they just set should result in a gleam of pride.

Make sure your independent tot has utensils made for his size (show Munchkin utensils here). Great pride comes from feeding yourself. Pre-cut food so he can eat at his own pace.

 

How can we get toddlers to actually COME to the table….?

Transitions are very tough for young ones. So abruptly stopping playtime for mealtime will result in a meltdown in some kids. Set a timer for 3 minutes, and notify your child that when the bell rings, playtime will need to stop and dinner will come next. This will give your child a little time to separate emotionally from play. Use of role playing smocks can help as well.

Pretend play and role playing is beneficial to all kids development, so if your child’s late afternoon playtime centers around role-playing and imaginary play, and if that smock doubles as a bib, you can just invite your young astronaut, chef, parrot or panda to join you for dinner, all the whilst keeping him in “play” mode. And his doll or bear can join you.

Let’s face it, it’s tough to come up with conversation at the table with a 2 or 3 year old, so a role playing smock creates an opportunity to delve more deeply into the life of an animal, what space is like, what a chef does, etc. etc.

 

And lastly....stay focused on your kids at dinner time – talk about their day, what adventures they had, praise them for helping with dinner prep. If all your tot hears is a conversation about your stressful day, senses that you are upset or not engaged, all bets are off for a meaningful meal. Take the brief time you have with your child at the table and make it as fun, easygoing and adventurous as you can. You’ll have achieved your goal and the whole family will be better for it as a result!

 

Bon Appetit!

 

For more info on the products shown today go to:

 

www.ezpzfun.com

www.munchkin.com

www.mixedpears.com

 

For the video link to this segment go to: https://youtu.be/g2MimOHB3-M

 

 

 

HOVERBOARDS

HOVERBOARDS – Hot! Hot! Hot! 

No doubt a Hoverboard was on many a Christmas list this year….and they are hot hot hot! And full of controversy, so I'm here to give you the latest.

First of all, what are they? They are self balancing sets of wheels that have become very quickly popular with kids, college students, athletes, and even politicians worldwide. They are typically powered by Lithium carbonate batteries, and depending where you are, land somewhere between between and toy and a transportation device.

As quickly as they have become popular, they’ve also become a source of concern worldwide.  There are several issues that have come up- the first issue is injuries.

Because they rely on very subtle movements of the feet and good balance of the user, injuries like fractures, sprains, contusions and head injuries have spiked – witness Mike Tyson and congressman Carlo Curbelo, as well as countless others visiting the ER on Christmas night. Adults might be at greater risk with a higher center of gravity (and alcohol might impair performance as well), compared with nimble smaller kids.


Secondly, fires are a problem. Why?

The lithium batteries in these devices are directly beneath the foot plate – an area of the board that incurs the most bumps and nicks – if the delicate covering of the battery is “injured”, the liquid within it leaks, and is extremely flammable. Because there has been a huge rush to get these devices to market, many manufacturers in China have used lower quality batteries, connections and wiring that may increase the risk of fire. We’ve seen reports of this happening spontaneously, in transit, and when plugged in. Homes have been lost, and property damages from these fires is a growing concern. A major issue here is that the batteries, when charging, don’t cut off when fully charged (like our smartphones and tablet devices), so a supercharged or overheated unit can also combust.

But aren't there regulations in place to make sure these are safe?

 These devices came to market so quickly that a standards for safe manufacturing, batteries and operations were not set. Huge numbers of factories in China knocked each other off, and no standards for safety seem to have been created abroad, or here in the US, where this novel item had no predecessor. It was all about getting as many out worldwide, for the least $$$ to attract a hot consumer market.

 So what is being done currently?

The Consumer Product Safety commission is currently investigating 22 hoverboard fires – what is frustrating is that the exact mechanism of fires may vary from unit to unit, and there is no safety standard set….yet. Efforts are being made to identify why the fires are happening, and what standards can be set to assure consumers their purchase is safe.

In response to the risk of spontaneous combustion, the US airline industry has already decided not to take any chances: American, Alaska, Virgin,Delta, Hawaiian, JetBlue, Southwest and United Airlines have banned hoverboards on passenger flights, and the US Postal Service has stopped shipping hoverboards by air as well. Amazon and Target both temporarily suspended sales, and Overstock.com has stopped selling hoverboards at all.

Are they a toy or a vehicle? and if considered a vehicle are they legal? 

It depends where you are. They have been banned entirely in the UK unless used on private property. In New York, there is legislation pending that would allow them on sidewalks, playgrounds and parks, but forbid their use in bike lanes and on streets. On the opposite end of the spectrum, beginning January 1 in California, hoverboards are being treated like motor vehicles. Along with motorized skateboards, they can ONLY be used on private property or in bike lanes, the user must be at least 16 years of age, and MUST wear a helmet. Their use on sidewalks is banned.

 So, if Santa brought one into the house, how can we be as safe as possible?

  • Don't buy cheap (less than $300) hoverboards; invest in higher-quality brands.
  • Look for a model with a UL-certified charger or battery pack - these don’t guarantee that fire won’t happen, however
  • Check manufacturer's warranty before you buy and look for recall notifications
  • Avoid purchasing at kiosks - you want to know where the vendor is if there is a problem
  • Unplug the hoverboard when it's completely charged to avoid overcharging
  • Let the unit cool for an hour after use, before plugging in to re-charge
  • Do not leave the hoverboard unattended while it's charging - and most certainly don't charge it overnight when all are sleeping
  • Protect yourself – at the very least wear a helmet, and encourage use of elbow and wrist pads
  • Follow local laws and respect pedestrians and those in your path
  • NEVER operate a hoverboard when under the influence
  • To avoid all instances of hoverboard self-destruction and personal injury, just don’t buy one.

 

And lastly...... 

I know these are super popular, but now we have yet another “toy” that prevents the user from getting real exercise. I’d rather see kids on skates and bikes than these devices. After all, we’re trying to promote a healthy safe lifestyle for all. Much like lawn darts and magnetized bucky balls, there are just some toys that might just need to go!

 For a link to the video of the segment go to: https://youtu.be/WLRoPMOmp-M

 

Car Seats and Car Coats....

If there ever was a place to dot your I’s and cross your T’s, your child’s car seat is certainly the place – it could literally save your child’s life. For most of you out there, bundling up your kids, getting them into the car, and heading to your destination is a big chore in the winter. So I am here with some surprising new information about car seats, and car coats.

 

First, it's important to know that, in addition to being a pediatrician, I am also a Certified Car Passenger Safety Technician. I took a rigorous 40 hour course learning about the physics of crashes, the intricacies of automobiles and how they are set up to accept car seats, the current laws and recommendations for passenger safety, and of course, car seat installation.

What I want to inform you all about is some surprising information about kids wearing bulky clothing while strapped in a car seat.

 

But first, here's a little primer on proper use and fit of car seats.  

ALL children under the age of 12 should ride in the back seat of the car to be safest, and ride in a seat with a 5 point harness until 50-80 pounds, and then switch to a belt-positioning booster based on the weight/height recommendation of each individual seat. The harness straps should have no gaps, so attempts to pinch them at the shoulder reveals no slack. The straps should emerge from the seat AT OR ABOVE the child’s shoulders and the chest clip/anchor should be at the level of the child’s armpits. 

For maximum protection in a crash, you want the harness or seat belt as close to the child as possible. The more layers between a child and the harness, the harder it is to actually fit the restraint to the child. You end up fitting the restraints to the coat, and in the event of a crash, all that extra air is forced out between the layers and leaves the harness too loose to protect the child. The clip we will roll on the show (see link at bottom of article) shows a crash test dummy with a puffy winter coat correctly strapped into its car seat. AT 30 MPH the jacket compresses and the “child” is ejected from the seat.

 In studies at the University of Michigan, there was as much as 4 inches of slack present when coats were removed. This practice not only puts kids at risk, but also older children in boosters, and adolescents and adults in seatbelts.

4 inches is easily the difference between your child’s head hitting the back of the seat in front of them – something that is definitely known to cause serious head injuries to real kids in real crashes. And the head would impact lower on the front seat in an area that isn’t required to have extra padding.

So what can we recommend when's subzero outside and cold in the car?

First, put your child in normal clothes and a winter coat to get to the car. Once in the car here are a few options: 

  • First take off the coat, and then reapply it backwards so chest and arms are covered. When the car warms up your child can easily shed the coat and be comfortable
  • Put a blanket on your child (warm one quickly in the dryer, fold it tightly, and apply to your child after strapped in the seat with coat off)
  • If you have a large poncho, but it over your child’s head, and let the back half lay over the top of the seat
  • For smaller babies and tots, several car seat companies sell zip up “boots” designed especially for this purpose.
  • For infants, bringing a heavier swaddle blanket to the car, securing your baby in the seat, and then tucking in the swaddle once in the seat, along with a warm beanie, can keep baby nice and toasty.
  • Or use a thin fleece one-piece outfit like Carter’s or Columbia fleece – make sure the fit is good so there isn’t excessive bulk.
  • For older kids, open the coat, apply the seatbelt, then zip the coat up – so there is close contact of the belt with his chest and shoulder

It's hazardous enough driving in winter, so we want everyone inside the car to be as safe, and comfortable as possible!

 

 

For more information please go to: www.carseat.org and for a video link to this segment go to: 

https://youtu.be/P1qHuZ6mnNY


EATING TOGETHER AS A FAMILY

Sitting down at the table daily with your family is not only nourishing for the body, but there are other benefits that make family meal time a must. That’s right. For many years, people have asked my husband Bruce and I why our son Max “turned out so well.” Despite the fact I was in the office well past 5pm almost every day, we did manage to sit down almost every night and have dinner together. Believe it or not there is tons of research out there that demonstrates this process of eating together does build a better child, and family.

So here are the facts: 

How many families DO eat together?

The average American eats 1/5 meals in the car; ¼ Americans eat a fast food meal at least ONCE A DAY, and the majority of American families report eating a single meal together less than 5 days per week.

 First, let’s focus on the brain:

  • Studies have shown that toddlers who participate in mealtime acquire 1000 rare words (these are words not in a tot’s general vocabulary), compared with 143 from parents just reading storybooks out loud.
  • Kids with larger vocabularies read earlier and easier
  • School-aged children with regular mealtimes have higher achievement in school, homework, playing sports and doing art
  • Adolescents who ate family meals 5-7 times a week were twice as likely to get A’s as those kids who ate fewer than 2 family meals/week

We are definitely a fast food nation, with many parents working and kids on different schedules. Tell us how family meals can help bodies.

  • Kids consume more fruits, vegetables, vitamins and micronutrients when dining with family, and fewer fried foods and soft drinks. Children are 40% more likely to become overweight if they do not eat dinner with their family at least twice a week.
  • Research shows that simple meals are all that’s necessary to provide what children need and the nutritional benefits are obvious – less obesity, and a greater chance of choosing healthier foods once kids are on their own.
  • Some research has shown a reduction of symptoms in medical disorders like asthma and diabetes when children eat with their families – the mechanisms likely are lowering anxiety, and the ability to check in with compliance with medications and diet.
  • VERY IMPORTANTLY, all these benefits disappear if media is turned on during mealtime – kids are more likely to be overweight by third grade if TV is one during dinner – these studies have been conducted in the US, Sweden, Finland and Portugal.

Socially there are benefits, right?

  • Conversations during mealtime provide opportunities for a family to connect and learn from each other, to relay stories about family, life, and what’s in the news, and provide an opportunity to give extra attention to the kids. Anticipation of regular mealtimes can foster security, grow love, and give kids a voice that is heard.
  • Acquisition of table manners, and learning how to take turns in conversation, delay gratification by listening and responding, and building social skills happens very dynamically at the table – it doesn’t matter which meal!
  • Tons of studies link regular family dinners with lowering high risk teenage behaviors
    • Smoking, binge drinking, marijuana use, violence, school problems, eating disorders, and sexual activity
    • In a study of 5000 teens from MN, there were lower rates of depression and suicidal thoughts
    • A recent study showed that kids who had been cyberbullied bounced back more readily if they had regular family dinners.
    • Family dinners are a more powerful deterrent against high risk teen behaviors than church attendance or good grades…
  • And eating together puts the brakes on for EVERYONE AT THE TABLE – we can slow down, take time to really listen to each other, problem solve, laugh, and share our thoughts.

 So when we are dealing with really young children, how long can we expect them to stay at the table?

  • A two-year-old child may actually be able to sit longer than a four-year-old child, as he will be a slower and more distracted eater, entertained by having everyone there together. Consider five minutes a success.
  • It is reasonable to expect a three-year-old child to sit at a dinner table for five to ten minutes. Some will have much greater staying power than others.
  • A four year-old should make it to ten to fifteen minutes.
  • A five year-old usually can last fifteen to twenty minutes, and the same is true for a six year-old.
  • Needless to say, the length of the stay will depend upon variables such as how tired the child may be, what the day was like, and what is next on the agenda

 What are some ways we can entice our young children and keep them at the table to maximize the family experience?

  • Make sure they are actually hungry – if they are grazing with snacks all afternoon, all bets are off that they will want to sit and just play with their food
  • Young children should still have an afternoon nap or downtime so they are not exhausted at the dinner table
  • Using fun play smocks/bibs can not only keep food off your little ones, but the “role” the child is playing that day can provide an opportunity for a parent to ask questions about that role, and for a child to explore with imagination
  • Using some inventive plates and presenting food in a colorful and whimsical fashion can also draw a child to the table, provide a conversational opportunity and make mealtime fun (and nutritious to boot)

PNEUMONIA

PNEUMONIA…the word itself is frightening to parents.  Just saying it makes most parents

shudder, and fear the worst.  I’m here to give you some info, perspectives, and suggestions for prevention!

WHAT IS PNEUMONIA? The best way to explain pneumonia is the following.  Imagine your lungs as an upside-down huge oak tree.  The trunk, and all branches are the bronchi, and their smaller branches, and the leaves are the alveoli – where the critical entry of oxygen into the bloodstream happens and the release of carbon dioxide, our waste gas, occurs.  Pneumonia attacks those critical areas of gas exchange – also known as air space disease. Pus collects there, essentially blocking off oxygen flow and trapping waste gas in the body. When too many alveoli are infected, we get breathless, we breathe faster, and feel sicker. Our body’s oxygen supply is threatened, and some germs responsible for pneumonia can cause toxic reactions and changes in blood pressure and heart stability.

HOW OFTEN DOES IT OCCUR? Globally, about a million children younger than 5 years die of pneumonia each year, representing  about 20% of all deaths in children within this age group.

Pneumonia isn't just a public health issue in developing countries though. Each year in the United States, about 1 million people have to seek care in a hospital due to pneumonia, and about 50,000 people die from the disease. Most of the people affected by pneumonia in the United States are adults.

So why do we worry about kids?

In the US that translates to roughly 7-9% of children under 2 and 3-5% of children 3-6 years of age visiting the doctor for Pneumonia each year.  On average infants under a year will be hospitalized 15x more frequently than older children and about 500 children yearly die in the US alone.

WHAT ARE THE SYMPTOMS?

Doctors usually suspect pneumonia in children when breathing rates increase, cough becomes a prominent symptom, or respiratory distress is evident – especially during RSV/Flu season.  Some children may manifest with just prolonged fever alone, or just look very ill. Older children may complain of shortness of breath, may have chest pain, or lack of movement of one side of the chest compared with the other. In adults, cough, fever, chest pain, and difficulty breathing are typical symptoms.

WHAT CAUSES IT? Pneumonia can be caused by many common viruses, bacteria, atypical bacteria and less commonly by fungi and other organisms.

WHAT ARE THE DIFFERENT TYPES? In broad strokes there are 2 types – Community Acquired pneumonia CAP), and health-care associated pneumonia (HCAP) (those variants found in hospitalized patients or those in long-term care facilities).

CAP:  We’ll commonly see the RSV virus cause pneumonia in infants and small children, whereas it’s more common to see bacteria like Pneumococcal pneumonia (a common serious form, that often complicates the Flu), Mycoplasma (known as atypical or walking pneumonia) or other bacteria that may be picked up environmentally like Legionalla (causing Legionnaire’s disease) staph or MRSA as culprits.

HCAP: In people who are chronically hospitalized or in long term care, we see more complex and often difficult to treat pneumonias.

WHAT ARE THE COMPLICATIONS? They can be serious – ranging from local complications like abscesses, or collections of pus around the lungs, or respiratory failure to distant complications like meningitis, bone, heart or blood infections requiring intensive therapies.

WHAT ARE THE TREATMENTS?

Viral pneumonias, typically seen in young children, are treated supportively with fluids and rest and Tamiflu if the virus in question is influenza.  In the hospital setting, oxygen and IV fluids as supportive therapy may be necessary.  For CAP treatments are typically carefully chosen antibiotics – with younger children if bacterial pneumonia is suspected, Amoxicillin is usually first line therapy, and in older children, where atypical pneumonias are more common, Zithromax or its relatives are typical prescribed.  If bacterial pneumonia is treated in the hospital, often multiple antibiotics may be used, along with supportive measures like oxygen, IV fluids, breathing treatments, and under the most severe conditions, ICU care.

WHO IS AT RISK? Clearly we see more illness and complications in those individuals at the extremes of age – children under 5 (especially infants) and adults aged 65 and above (their rates account for about a million cases in the US yearly). People who have underlying medical conditions like asthma, diabetes or heart disease, and those who smoke cigarettes are also at increased risk.

HOW CAN WE PREVENT IT? YES, we can prevent many causes.

In children, we immunize against pneumococcal disease with the PCV 13 vaccine, H. flu, influenza, Measles, chicken pox and whooping cough – all diseases have the potential to cause pneumonia.

High-risk infants who were preemies, or who have heart or lung disease should be provided with immune prevention vs. RSV with Respigam.

Pregnant women should be immunized against the flu and whooping cough. 

And very importantly our dear parents and grandparents, 65 and older should have pneumococcal vaccine, as well as high risk people 2-64 years of age. Check with your doctors to find out what you might need.

Altitude Sickness

With many families traveling to the mountains for fun and recreation this winter, every moment counts! But altitude sickness can strike and ruin a vacation.  So here's a quick primer with all the info you need.

First of all what is altitude sickness (AS)?

AS refers to a combination of symptoms that can result when you take in less oxygen than your body is used to.  This typically happens when travelling to elevations of 8000 feet or higher, but can occur sometimes at lower altitudes.  It’s especially prevalent with those who change elevations quickly, are physically active, or who have health conditions increasing risk.

What causes it? Less oxygen?

Contrary to popular belief, there is the same concentration of oxygen in the air at elevation as there is at sea level (ie 21%).  However, the AIR PRESSURE is much lower at elevation. As a result the number of oxygen molecules per breath is reduced. In order to compensate for the oxygen shortfall the person has to breathe faster and their heart has to beat faster too. Rising to even higher altitudes can cause fluid to leak from tiny blood capillaries into either the lungs or the brain.

Who is at risk for AS?

People at any age  – babies, children, and adults are all at risk – despite fitness level. Some people are genetically more susceptible. People who have had prior AS are more at risk. And what we know, especially in babies and children, is that AS can strike more often under certain conditions like with chronic heart or lung disease, or even after recovery from a viral illness – where inflammation increases risk. Children with Down Syndrome are more at risk for high altitude pulmonary edema. And for infants under 6 weeks of age, it’s especially important to check with your doctor as their young lungs and brains are more susceptible to the ill effects of travel to a higher altitude.


What are the symptoms of AS?

There are 3 types of AS – Acute mountain sickness (AMS) is the mildest, most common type. Less common and much more serious forms occur when AMS progresses, or when someone with AMS continues to ascend without giving his body a chance to adjust.

These conditions cause fluid to accumulate in the brain – known as high altitude cerebral edema (HACE) – or in the lungs, known as high altitude pulmonary edema (HAPE).

AMS is the most common form of altitude illness, affecting, about 25% of those traveling to 8000 or greater feet. It's not easy to identify altitude sickness because the symptoms are pretty nonspecific at first. They can show up as early as one or two hours after arrival at the higher elevation, but typically they begin to appear eight to 36 hours after arrival.

You may notice a change in your child's normal behavior. For example: He may have trouble eating or sleeping. He may become unusually irritable. He may have headache dizziness, or fatigue. He may have difficulty breathing when he exerts himself. He may also have nausea and vomiting. Babies typically are irritable, fussy, inconsolable, and may look pale.

HACE can cause confusion, change in gait, very severe headache, dizziness and profound fatigue.  HAPE can manifest in rapid, labored breathing, pale or blue lips and hands, cough, shortness of breath, even at rest.

How do you treat it?

With AMS typically descending from your elevation and acclimatizing more gradually is an affective strategy.  If that’s not possible resting at your current altitude for a day or 2 before ascending again is a must. Offering more fluids than usual to prevent dehydration is key, especially if your child is vomiting.  Using acetaminophen or ibuprofen to alleviate headache is reasonable.

If your child has trouble breathing or turns blue, or shows anything more than minor discomfort, take him to the nearest ER for evaluation. His oxygen saturation can be measured and he can be examined and monitored and treated for more severe symptoms.

Is there any way to prevent it?

Slow ascent, especially if travelling above 8000 feet is key, so that bodies and brains can acclimate gradually. For example, if you are driving, stopping halfway for a night or 2, then proceeding to your destination is a good idea. Then allow one day of rest and quiet time for every 1000 feet you travel beyond 8000 feet (this is especially pertinent if trekking in Peru or a very high altitude). 

Our respiratory drive is important to help us breathe fast enough to compensate – so medications and substances that suppress breathing are not recommended – like alcohol, tobacco, sleeping pills, and some prescription pain medications.  Drinking lots of water is important as risk of dehydration exists at higher altitudes and worsens AMS. Some doctors may prescribe a medication called Diamox when high altitude travel is anticipated in order to help alleviate risk of HACE and HAPE, or for those with prior history of severe AMS.


For a video link to this segment go to: https://youtu.be/WPdu7iuclwo

​Cinnamon Pull Apart Bread

Ingredients for two loaves – baked in 9x5x3-inch bread pans (for gluten free, this makes one large pan of bread)

For the dough:

5½ cups all purpose flour (for gluten free, use a whole box of King Arthur Gluten-Free Baking Mix)

½ cup sugar

4½ teaspoons active dry yeast (for gluten free - use 5 1/2 tsp)

1 tsp salt

1 stick (4oz) butter

⅔ cup whole milk

½ cup water

2 teaspoons vanilla extract

4 large eggs, at room temperature, beaten (for gluten free use 5 eggs)

For the Filling:

1 c. raw (turbinado or demerera) sugar mixed with ½ c. white sugar

2 heaping tsp ground cinnamon

1/2 tsp fresh ground nutmeg

1 stick butter, melted

Preparation:

1.    In the bowl of your stand mixer, mix together 4 cups of the flour, sugar, yeast and salt. Set aside.

2.    In a small saucepan, melt together the butter and milk on medium heat until the butter is just melted. Remove from heat and add the water and vanilla extract. Let mixture cool for 2 minutes.

3.    Pour the milk mixture into the dry ingredients and mix on medium low. Add the eggs and continue to stir until the eggs are incorporated into the batter. The batter will be quite sticky at this point.

4.    Add the remaining 1.5 cups of flour and continue to mix for an additional 1-2 minutes, until ingredients are well combined. The dough will still be a little sticky.

5.    Place the dough in a large, buttered bowl and cover with plastic wrap and set in the warmest corner of your kitchen.  Let rise until doubled in size (about an hour). For gluten free, you may only see a mild rise at an hour, and that's ok!

6.    Once the dough has risen, punch the dough down, cover with a clean kitchen towel and let it rest for about 5 minutes. For gluten-free, no need to punch down. Meanwhile, mix together the sugars, cinnamon and nutmeg for the filling. Butter your loaf pans and preheat your oven to 350 degrees.

7.    Cut the dough into two equal pieces, and place one piece back into a bowl and cover with the towel. Working on a generously floured surface, roll out one piece of dough to about 12 inches x20 inches (the size of a large cookie sheet). Since the dough may be sticky, flour your rolling pin and dust the top of the dough with flour, if needed.

For gluten free, dust your work surface with rice flour, turn out the dough, and GENTLY roll to 12x20. Butter a square or round baking pan. Butter the surface, spread the sugar, cut the strips, and using a large spatula, gently lift each strip onto the next. Cut as described above, and stack in your pan. 

8.    Use a brush to generously spread half of the melted butter across the dough. Sprinkle with half of the cinnamon and sugar mixture. Cut the dough vertically into six equal strips. Stack the strips one on top of another and slice the stack into six equal slices. You should have six stacks of six squares. Don’t worry if they are uneven!

9.    Place the squares into the buttered loaf pans, so that they are standing up. Repeat with the second piece of dough.

10. Coverloaf pans with a kitchen towel and allow to rise for 30-45 minutes, until doubled in size. (For gluten free, again expect a modest rise). Brush with a little melted butter and sprinkle the tops with the remaining sugar mixture.

11. Bake for 30-35 minutes, until the top of each loaf is very golden brown. The center will be a bit soft. Cool on a rack for 20 minutes before serving (if you can last that long!)

AHHHHH.....CHOO!

Ready or not, it’s here. . . cold and flu season. Ugh.  While it’s tough to control what goes on at preschool or on the playground, there’s plenty you can do at home to prevent (and if you have to, treat) the sickies.

How does influenza impact kids each winter?

It’s estimated that more than 20,000 children under the age of 5 are hospitalized each year due to the flu. And last year 145 of those children died, many with no prior health problems –  and 90% of those who passed away were not vaccinated.

Who is at most risk for complications from the flu?

Young children under the age of 5, the elderly, pregnant women and healthcare workers exposed to sick patients are especially vulnerable.  In addition, children (and adults) with asthma, developmental disorders, CF, chronic lung or heart disease, diabetes, blood diseases, children on long term Aspirin therapy, liver, kidney or metabolic disorders, or weakened immune systems are much more likely to have complicated courses with the flu.

What are the symptoms of the flu?

In layman’s terms, you feel like a truck hit you – high fever, body aches, cough, and hypersensitivity to being touched, to light, to sound are just a few of the classic symptoms.  Some individuals also have nausea and vomiting. A typical course of flu lasts from 5-10 days – and often is complicated in little ones with dehydration, pneumonia, sinus and ear infections, and exacerbations of asthma. Since it is an airborne virus, it can spread very quickly within a daycare, classroom, or a family home.

What can we do to prevent the flu?

Immunization against the flu is our strongest weapon.  Every year, as most of you know, the strains of flu have the potential to change…and since the next season’s flu vaccine is based on the prior year’s strains, occasionally we hit the nail on the head if minor changes the next season, and sometimes we don’t when new strains emerge, as they did last year.  For the 2015-16 season, we anticipate we’ll have stronger coverage than in past seasons. Handwashing before eating and when coming in from outdoors is important, and limiting where we take little babies, young children and kids with chronic diseases is very important during flu season.

Is it too late to vaccinate now?

No – Flu tends to really ramp up after Thanksgiving (as we travel more, and gather more, despite feeling a bit punky) and usually peaks late January/February. So vaccinating now will start to protect you about 2 weeks after getting your flu shot.

Who should be vaccinated?

The AAP recommends that ALL children aged 6 months and older receive flu vaccine yearly.  And all family members and caregivers should immunize as well – especially if there is a baby under the age of 6 months, or a family member with chronic illness – the “village” around those individuals should be protected, in order to protect the most vulnerable.  Healthcare workers also have a responsibility to stay as healthy as possible to protect vulnerable patients, and clearly everyone not allergic to components of the vaccine should strongly consider yearly protection.

What is the treatment for the flu if it does occur?

Rest, fluids and supportive care are the cornerstones of treatment. Children should not return to school or daycare until they are fever-free for at least 24 hours AND are functioning normally in terms of energy and appetite. Under certain circumstances your doctor may prescribe Tamiflu if your child’s case is particularly severe or if a child at high risk.  Tamiflu is given twice daily for 5 days, and can be given to children as young as 2 weeks if needed.  Despite the fact that it can shorten a course of flu, the medication itself often makes you feel miserable, is expensive, and is not covered by many insurers. So the best strategy is to prevent the flu with vaccination.

Anything else new about the flu this season?

Yes!  What we know about giving flu vaccine to children 6 months to 8 years of age is the following: the FIRST time vaccine is given it should be given in 2 doses 4 weeks apart.  If for any reason the second dose isn’t given, the child is vulnerable to flu.  So in this season, it is recommended that children age 6 months – 8 years who never got that 2nd dose last season, receive 2 doses this year. Also, if your child is under 9, AND if the last time your child got the flu vaccine was before the 2010-2011 flu season, 2 doses are recommended for this season.

Additionally it’s important to emphasize that you can’t get the flu from the flu shot, and it takes about 2 weeks for the vaccine to kick in. So if you have been exposed to the flu before or after you receive your vaccine, potentially you could become ill, and blame the shot, rather than the exposure. That’s why it’s best to immunize before the season hits – ie in October. That said, if you haven’t already, go for it. There’s a lot of the season left.

To view the Home & Family video segment attached to this go to: https://youtu.be/6exDEAyw398

Magical Holiday Spice Cake with Eggnog Buttercream

This spice cake reminds me of the one my grandmother used to make when I was a child. The recipe was lost years ago, and I make this cake now to remind me of her TLC in the kitchen, and the eggnog she loved to drink during the holidays!


Dr. JJ’s Brown Butter Spice Cake with Eggnog Buttercream

Browned Butter Spice Cake Ingredients

1 ½ cup (3 sticks) unsalted butter

1 ½  cups granulated sugar

¼  cup brown sugar - packed

4 eggs

2 teaspoons vanilla extract

3 cups cake (pastry) flour

1 tablespoon baking powder

¾ teaspoon salt

2 ½  teaspoons cinnamon

1 ½  teaspoons ginger

1/2 teaspoon nutmeg

1/4 teaspoon cloves

1 1/4 cups eggnog


To Make the Brown Butter Spice Cake:

The night before baking the cake, melt the butter in a medium saucepan over medium-high heat.  Swirling occasionally, continue to cook until fragrant and browned.  The butter will foam up a bit and little bits of browned butter will sit at the bottom of the pan when done.  Remove from heat and transfer to a heat-safe container.  Chill overnight or until the consistency of softened butter. When ready to start baking take 1 cup of the browned butter out of the refrigerator and set out until soft. Reserve the remainder for the frosting. Pre-heat oven to 350 degrees.  Grease and flour three 8-inch cake pans and set aside. Sift together the flour, baking powder, salt and spices and set aside. Place browned butter in the bowl of an electric mixer.  Using the paddle attachment, mix until smooth. Add in the white and brown sugar and increase speed to medium-high.  Continue to mix for about 3-5 minutes. Stop the mixer and scrape down the sides and bottom of the bowl. With the mixer on medium-low, add in the vanilla and the eggs, one at a time.  Once incorporated, stop the mixer and scrape down the bowl. With the mixer on low, add in the dry ingredients and eggnog in three alternating additions – starting and ending with the flour mixture.  Mix on medium-low for 30 seconds or until combined. Evenly distribute the batter between the three pans.  Bake for about 23-25 minutes or until a toothpick inserted into the center of the cakes comes out clean or with few crumbs.  Cool on a wire rack for 10-15 minutes before removing the cakes from their pans.


Eggnog Buttercream Frosting Ingredients

8 ounces cream cheese (1 package), softened

Remainder of softened brown butter PLUS 1 cup (2 sticks) softened unsalted butter

8 cups confectioner’s (powdered) sugar

3 ounces eggnog

1  teaspoon cinnamon

Scant 1/2 teaspoon (preferably freshly grated) nutmeg

2 1/2 teaspoons vanilla extract or bourbon - your choice!


To Make Eggnog Buttercream:

Place the cream cheese and butters in the bowl of an electric mixer.  Mix until smooth.  With the mixer on low, gradually add in the remaining ingredients until incorporated.  Turn up the mixer to medium-high and mix until light and fluffy.

Spread a thick layer of Eggnog Buttercream on top of 2 cakes and stack all 3.  Next, add a thin “crumb coat” of frosting to entire cake and put in the refrigerator for an hour or 2 to set.  Remove and frost entire cake with remainder of Eggnog Buttercream (there may be enough left over for a small batch of cupcakes, or a gaggle of grandkids - just make sure you have enough beaters to go around!).


Do-Ahead Decorations

Fresh sprigs of Rosemary, 10-12 cranberries

2 egg whites – beaten lightly

pastry brush

sanding or white sugar

1 small bag raw slivered almonds

1 bag semi-sweet chocolate chips

1 dozen truffles or pieces of fudge at room temperature

1.            Pine cones – take 10-12 chocolate truffles, soften to room temperature and roll each between hands into an oval shape with a tapered tip. Carefully insert raw slivered almonds into each truffle, layering one line over another, until it resembles a pine cone. Once all are assembled, refrigerate until ready to use.

2.     Christmas trees – melt semisweet chocolate chips over a double boiler or in a microwave until soft. Pour into an icing bag with a small tip or into a ziplock bag (then seal – cut a tiny corner off the bag when ready to pipe). With a pencil, draw pine trees of various sizes onto the back of wax or parchment paper. Put parchment on to a cookie sheet and pipe chocolate onto the reverse side of the wax or parchment paper. Refrigerate until set. Carefully peel off trees and adhere to side of freshly iced cake.

3.    Branches and berries – wash and dry rosemary sprigs and cranberries. Brush lightly with egg white using a pastry brush.  Roll into sanding or white sugar, shake gently, and let dry at room temperature.

To Assemble

Place cake on a platter lined with either coconut (snowy) or coarsely ground chocolate cookies or graham crackers (like a forest floor). Unmold chocolate trees and apply to the sides of the cake. Place truffle pinecones at bases of trees, and a few atop the cake. Embellish branches with sugared cranberries. Enjoy!

Cranberry Pepita Artisan Bread

Dr. JJ’s Cranberry Pumpkin Seed Artisan Bread

The simplicity of this recipe is in the proportions!  You can use any combination of flours (although I recommend that for a tender, lighter bread, you use at least half all purpose flour), AND you have the option of adding any toasted nuts or  seeds, and any dried fruit (larger fruit will need to be chopped to more bite size pieces).

The proportion of flour:water:starter is 2:1:1

Sea Salt : 2 tsp for every 1000g of bread dough

Seeds or nuts: 1 cup for every 1000g of bread dough

Dried Fruit:  1 cup for every 1000 g of bread dough

If you are using rye flour, add 2 TB molasses to your water/loaf – it gives the bread a deeper color and flavor.


Ingredients: (makes 1000g dough, producing one large artisan loaf)

500g flour (I used 100 g whole wheat, 50g rye and 350g all purpose)

250 g water

250 g starter***(you can use your own sourdough starter, or the one below, which will produce a less sour, but very flavorful bread)

2 tsp (20g) fine sea salt

½ tsp dry active yeast

2 TB molasses

1 cup dried cranberries

1 cup roasted pumpkin seeds (can be purchased or recycled from your Halloween pumpkin)

Large bowl, sprayed with neutral oil (like canola or grapeseed)

Clean large cotton napkin or thin cotton dishtowel

Cast iron pot and lid (or heavy metal casserole and lid)

Food scale

Rice flour

Directions:

·      Put the flour, water, molasses, yeast and starter in the bowl of a stand mixer and mix on medium low until dough pulls together (about 2-3 minutes).

·      Add salt, and mix on low speed for 15 minutes. 

·      Stop machine and add cranberries and pumpkin seeds, and mix for another 3-5 minutes to incorporate. 

·      Turn dough out onto lightly floured counter.  Pat into a rectangle, and fold sides over into thirds.  Rotate bread 90 degrees, pat and fold into thirds again.

·      Place into oiled bowl, cover with plastic wrap, and let rest for an hour.

·      Turn rested dough out onto a lightly floured counter, and repeat the patting and folding steps.

·      Then, starting at the edge of the dough, grab the dough, bring into the center, and while rotating the bread, eventually all the edges meet in the middle.

·      Prepare a large bowl by lining with a flour sack towel or large cotton napkin, dredge bottom with rice flour, turn over the shaped loaf so seams are down, and place in the bowl. 

·      Dredge top of loaf with more rice flour and cover and put in a warm place and set a timer for 2 hours.

·      When the timer rings, put on your oven to 475, and heat up either a cast iron pot and lid, or heavy stainless pot and lid for an hour.

·      Prior to baking score the top of the loaf with a razor blade or tip of a sharp knife. 

·      Place the loaf seam sides down into the hot pot, cover and bake in preheated oven for 24 minutes.  Remove the cover and bake for an additional 22-24 minutes, until internal temperature is 210 degrees, or crust is deep mahogany brown, and remove from oven.  Cool the loaf for at least an hour, if you can last that long!

Enjoy! And serve with Roasted Pumpkin Butter



***Home-made Starter

The night before baking your bread put in a large bowl:

3 cups all purpose flour

3 cups warm water

1 tsp active dry yeast

Mix well and cover with saran wrap.  Leave in the warmest place in your kitchen overnight. Make sure the bowl is large enough that if the mixture doubles, you won’t have a mess!

You will have starter left over.  You can freeze what you have, or continue to feed it daily with ½ cup water, ½ cup flour, cover again, and over time bubbles and a sour smell will evolve to make it truly a sourdough starter.  Share the excess with friends.  If you need to put your starter to sleep, put it covered in the refrigerator or freeze it.  To wake it up, set out overnight (pour off any liquid on top) and re-feed, cover, and it should be bubbly and ready by morning.

Dr. JJ’s Roasted Pumpkin Butter – delicious AND nutritious!

Ingredients:

2 cups pumpkin meat cubed, peeled, seeds removed (or can substitute butternut squash or other winter squash)

1 tsp pumpkin pie spice

¼ cup maple syrup

¼ tsp (pinch) salt

2-3 TB lemon, pomegranate or orange

Directions:

·      Lightly oil a sheet pan and place cubed pumpkin on it. 

·      Roast at 350 degrees until fork tender (about 20-30 minutes). Let cool.

·      Place cooled, cooked pumpkin in a food processor, add pumpkin pie spice, maple syrup, a pinch of salt and 1 tablespoon of the juice.  Puree until smooth, and adjust the taste by adding more lemon, pomegranate or orange juice until perfect for you.  Cover and refrigerate until used.

To serve:

·      Spread a generous amount of pumpkin butter onto a slice of Cranberry Pumpkin Seed bread. 

·      If desired, top with a dollop of ricotta or cream cheese, drizzle with maple syrup and top with pomegranate or pumpkin seeds.

Ice Ice Baby.....

As the cold weather approaches, winter sports will become increasingly more popular among children. As children are heading outdoors to join in seasonal sports such as skiing, sledding, snowboarding, ice-skating, and more, it’s important that they wear the correct protective gear for each sport. Why?

According to the National Pediatric Trauma Registry, almost 1/2 of winter sports result in head-related injuries. Traumatic brain injuries are the leading cause of death and disability in children and young adults.

So what do you do if your child hits his head, falls, or bangs into a person or object with his noggin?

If there is any obvious external injury like a laceration or puncture wound, that should be attended to immediately. However a forceful blow, bump or jolt to the head or body can result in rapid movement to the head without any external clues.  So a parent should watch for evidence of that kind of incident combined with any change in the child’s behavior, thinking, or physical functioning. Often symptoms are not immediate, can be delayed, so it’s important to take the child out of the activity and observe to see if there are concussive symptoms arising.

What signs should you look out for?

A parent should look to see if the child is  dazed or acts stunned, if there is any confusion, forgetfulness, unsure about his surroundings, moving clumsily, answers questions slowly or even a brief Loss of Consciousness, amnesia for the event prior to or after the hit or fall, or a change in mood, behavior or personality. 

If the child is reporting any headache or pressure in the head, nausea/vomiting, balance problems or dizziness, changes in vision, sensitivity to light/noise, hazy/foggy/groggy, trouble concentrating or with memory, confusion, or just doesn’t feel right – these are symptoms that are significant.

How do I know if am over-reacting to a bump or bruise?

Typically if a child sustains a bruise to the head that rises like a goose egg, and is otherwise fine (besides the local discomfort), cool compresses and pain relief can be provided, and the child observed by parents for the remainder of the day.  The child should be removed from the activity and rest for the remainder of the day.

However, if there is a blow to the side of the head above the ear, especially if forceful, or with a large bruise, that child should be examined. That part of the skull is particularly vulnerable to injury as the bones are thinner and there is a very important artery lying beneath that part of the skull.

When should I take my child to the ER?

Someone with a concussion may be knocked unconscious, but this doesn't happen in every case. In fact, a brief loss of consciousness or "blacking out" doesn't mean a concussion is any more or less serious than one where a person didn't black out.

If your child might have had a concussion, go to the emergency room if he or she has any of these symptoms:

·       loss of consciousness

·       severe headache, including a headache that gets worse

·       blurred vision

·       trouble walking

·       confusion and saying things that don't make sense

·       slurred speech

·       unresponsiveness (you're unable to wake your child)

Call your doctor right away to report other problems, such as vomiting, dizziness, headache, or trouble concentrating. Then you can get advice on what to do next. For milder symptoms, the doctor may recommend rest and ask you to watch your child closely for changes, such as a headache that gets worse.

How can I keep my child safer during the winter months?   

We know that helmet use during skiing, snowboarding and ice hockey reduces the risk of injury to the head by at least 44% (that translates to 7700 annually) and that about 53% of all head injuries in children could have been lessened with helmet use. That’s a no-brainer.

·      Use of a mouth guard for hockey may also reduce the force of impact when a puck or another player hits the helmet. 

·      Kids should have lessons before skiing and snowboarding, adequate adult supervision, and should come off the mountain when tired or fatigued – that’s when most injuries happen. 

·      In addition children under 6 shouldn’t ride snowmobiles, and those under 16 shouldn’t drive them.

·      If children are sledding, a helmet is a good idea, knowing the terrain of their sledding hill is important, and making them sit up in the sled rather than laying down head first will reduce head injuries.

·      For young children on the ice, helmets and knee/elbow pads aren’t a bad idea.

To see the video of this segment from Home & Family go to: https://youtu.be/8tHzq_CjiEA

Cutest legs ever!

It's so common for parents to be concerned about baby's feet and legs during the first 3 years of life. Why, you ask? Because little ones are all over the map in the way they walk until the muscles and supporting structures necessary to carry them fully through life develop.  After all, baby spends 9 months in the womb in a pretty confined position, and it takes time, walking and weight bearing to "unwind" those positions the feet and legs so naturally fall into! So, I wanted to give you all a good primer on Baby Feet and Legs....and obviously, if you have concerns, please bring them to your health care provider! 

What are some of the major motor milestones in babies and toddlers?

Normal motor milestones (and these are averages only - some babes achieve them earlier and some, later)

Sits without support - 6-8 months

Creeps on hands and knees - 9-11 months

Cruising or shuffling on the bottom - 11-12 months

Walk independently - 12-14 months

Climb up stairs on hands and knees - 15 months

Run stiffly - 16 months

Walk down steps (one step at a time) - 20-24 months

Walk up steps (alternate feet) - 3 years

Hop on one foot, broad jump - 4 years

Skipping - 5 years


Why do babies walk so funny? 

There is a considerable variation in normal gait patterns and the ages at which the changes occur, and these appear to be family-history related.

·       Until a child is approximately 3 years old, their normal gait doesn't resemble that of an adult. Initially there is a wide-based stance with rapid cadence (rate of steps/minute) and short steps.

·       Toddlers have a broad-based gait for support, and appear to be high-stepped (bringing knees up) and flat-footed, with arms outstretched for balance. Legs are externally rotated (turned out), with a degree of bowing. I call this the "orangutan phase."

·       Heel strike develops at around 15-18 months with reciprocal arm swing. So instead of walking on toes with arms up,  all parts of the foot impact the ground while walking, with arms now at the sides.

·       Running and change of direction occur after the age of 2 years. A tot can now pivot and turn pretty quickly.

·       In the school-aged child, the step length increases and step frequency slows (ie the stride is longer, resulting in the need to take fewer steps).

·       Adult gait and posture occur around the age of 8 years.


What are the most common parental concerns?

The following are considered normal variations of gait in children, but parents will often consult us for advice:

·       (Habitual) TOE WALKING is common up to 3 years. The solution: time. That said, if a child can't walk with the heel touching the ground, this may indicate tight muscles or increased tone in the legs - a possible cause for concern.

·       INTOEING can be due to persisting femoral anteversion. This condition is due to an inward twist of the femur (upper thigh bone) causing the whole leg to rotate inward. Children walk with knees and feet pointing inwards (this is most common between ages 3-8 years and may look most prominent between 4-6 years of age). These are the kids who sit in a “W” and may have some laxity in the  muscles that typically rotate the entire leg out. The solution: sitting cross legged (which encourages strengthening those bootie muscles), and promoting activities like yoga, skating, ballet. This way the external muscles on the sides of the hips and legs get a chance to strengthen, thus rotating the leg and lower leg out. Even without intervention, the majority of kids with femoral anteversion self correct.  For extreme cases when tripping impairs function into the teens, the femur is cut and rotated outward - but this is a rare, and extreme fix.

·       INTERNAL TIBIAL TORSION is also common. This condition occurs when the shin bones (tibias) rotate inward causing the knees point forwards but the feet to point in.  All babies are born with this condition due to uterine positioning, but when it persists beyond a year of age, it's called internal tibial torsion or ITT.  75% of the time both legs are affected, but typically one more than the other.  This condition self resolves without intervention (back in the day kids had to wear shoes with a rigid bar attached at night - not any more).  Extreme cases that don't resolve may require surgery (cutting and rotating the tibias) - but again this is a rare event.

·       METATARSUS ADDUCTUS is a flexible 'C-shaped' lateral border of the foot resulting in a foot that resembles a kidney-shape. Most resolve by the age of 6 years. The solution: time, no special shoes as long as the lateral border of the foot is flexible. Doctors may recommend gentle massage in the first several months of life. With weight bearing and strengthening of the muscles of the feet with crawling and walking, this self resolves.  However, if the curvature is rigid (can't be straightened), a child may need orthopedic intervention, typically involving serial casting to gradually correct the deformity.

·       KNOCK KNEES (genu valgus) are common and associated with in-toeing. Most resolve by the age of 7 years. Again with muscle development and activities like biking, skating, ballet, and field sports the balance of muscles and rotation tend to fall into place.

·       BOW LEGS (genu varus) are common from birth to early toddler-hood, maximum at age 1 year, often with out-toeing. Most resolve by 18 months. In the womb, babies sit cross legged, knees up like yogis. Until they are weight bearing the medial muscles of the legs aren’t well developed, giving a “scooped out appearance” to the legs. The bonus? - room to walk with a diaper on! With squatting, climbing, and time those muscles develop more, balance the legs and start to rotate the ankle and foot into a more neutral position. Progressive bowing or asymmetric (unequal) bowing require investigation. If symmetric there may be metabolic reasons (like rickets) or genetic reasons, and asymmetric bowing may indicate that the growth plate of one shinbone is growing unevenly. These conditions require input from both orthopedists, and if metabolic or genetic, experts in those realms.

·       FLAT FEET (pes planus) are common. Most children have a flexible foot with a normal arch on tiptoeing. Flat feet usually resolve by the age of 6 -8 years. It’s rare that orthotics(supports within the shoe) are needed in the shoe (they won’t cause an arch to form - so don't buy into that if promised by a provider)…unless there is pain with sports or excessive pronation of the ankle (collapsing toward the center) inserts aren't necessary.

·       CROOKED TOES. Most resolve with weight-bearing and are a result of the cramped condition in the womb.

Here's the important point!  If these normal variations persist beyond the expected age range, are progressive or asymmetric (only occur on one side), or if there is pain and functional limitation (or evidence of neurological disease) then referral is needed.  Similarly, if your child's way of walking (gait) changes literally overnight or over a few days, this is a reason to seek immediate consultation.

An accurate diagnosis can be made with careful history and physical examination. Treatment of the majority of conditions is usually conservative - meaning that watching and waiting, with a few tips for exercise and activities, are usually all that is needed. Special shoes, casts, or braces are rarely beneficial and have no proven efficacy for developmentally normal variations. Surgery is reserved for older children with deformity that severely impairs function.

Again, follow your gut....if something feels wrong or worries you, or if a gait change abruptly impacts your child's comfort or ability to function, to your doctor you go!


For links to the segment on Home & Family and the Facebook followup go to:


https://youtu.be/sw92h2mz460

and https://youtu.be/Al4hqBCTZF0

How your child breathes during sleep can affect academic performance

A New Zealand team of researchers reviewed the results of 16 studies dealing with sleep apnea or related disorders in children and academic achievement. The findings were published last month in the journal Pediatrics. The investigators found that children with sleep-disordered breathing did worse in language arts, math and science tests compared to those without such conditions.

So what exactly what is sleep disordered breathing?


Sleep-disordered breathing (SDB) in children covers a spectrum of breathing abnormalities ranging from habitual snoring, to upper airway resistance syndrome, to frank obstructive sleep apnea (OSA).

·      Typical snoring is rhythmic, and usually has more to do with minor airway blockage like what is seen with nasal allergies or slight enlargement of the tonsils or adenoids.

·      Upper Airway resistance syndrome occurs during sleep when the muscles of the airway become relaxed. The relaxation of these muscles in turn reduces the diameter of the airway. Typically, the airway of a person with UARS is already restricted or reduced in size, and this natural relaxation reduces the airway further. Therefore, breathing becomes labored. It can be likened to breathing through a straw. These kids snore, sometimes with a higher pitch, and have excessive daytime sleepiness.

·      Obstructive Sleep Apnea is much more obvious – this happens when tonsils or adenoids, alone or in combination with an abnormal airway, almost completely block the airway when a child lies down. Typically OSA involves thrashing, multiple awakenings, gasping, choking sounds, startles and snoring with no rhythm.

Is sleep disordered breathing dangerous?

We know that disordered breathing during sleep places stress on the heart and lungs of children and adults, and can lead to behavioral and academic difficulties. According to the NIH, sleep apnea can also increase the risk of heart attack, hypertension and type 2 diabetes.  So identifying which children have obstructive sleep apnea and intervening has health benefits beyond school performance.


How can a parent tell if a child has sleep disordered breathing?

 If a child wakes refreshed in the morning, is alert and attentive during school and has consistent academic performance, likely there is low risk.  However if a child is irritable, tired, showing signs of difficulty in school, or his snoring is audible to parents at night, it’s time to bring this to his doctor’s attention. I’ve even had parents place a tape recorder or MP3 player near the bed to record snoring. Another observation, especially with OSA, is a bed that is trashed the next morning. Kids with OSA thrash all night and their bed is evidence!

 Are there tests for worrisome snoring?

Yes.  There are now sleep centers available to perform sleep studies on children and adults with suspected sleep apnea.  A child is hooked up to oxygen, CO2 and heart monitors, and as sleep progresses measures of breathing, interruption and apnea are taken. It’s important to have proof positive of sleep apnea before considering adenotonsillectomy. If there are concerns about craniofacial/orthodontic/airway issues, there are specialty orthodontists and ENTs (ear, nose and throat physicians) who can assess if orthodontia, tonsillectomy/adenoidectomy or jaw surgery are the answers.


How common is sleep disordered breathing?

Based on parent reporting, 1.5% to 27.6% of their children are reported to snore, but best research estimates that number is closer to 6% to 12%. Obstructive sleep apnea is estimated to affect up to 1% to 4% of children. Larger than normal adenoids and tonsils are the major contributors to sleep disordered breathing in children, and removing these (adenotonsillectomy) leads to significant improvement in sleep disordered breathing symptoms for most children. However, further research is necessary to tell us whether the correction of OSA will reverse the effects of academic impairment seen in some children.  It's also important to realize that obesity, craniofacial genetics, abnormally shaped airways and nervous system control mechanisms keeping the upper airways open are other contributory factors.

So what did the New Zealand study show?

The data from 16 large studies from worldwide sources were collected and examined to see if sleep disordered breathing affected academic performance in school aged children.

Academic performance was measured in several ways in the literature and categorized broadly as follows: (1) general performance (2) language arts  (3) math (4) science; and (5) unsatisfactory progress (learning problem, grade failure, poor school performance).

To best illustrate the results: if a large sample of children without sleep-disordered breathing achieved an average 70% score for a test examination a comparable sample of children of the same age with sleep-disordered breathing would be estimated to achieve an average score of 59%. Hence for those children with sleep disordered breathing, the potential exists to cross percentiles academically that may make the difference between passing, and failing.

The results of this review combined evidence in the literature to show that Sleep Disordered Breathing in children is significantly associated with poorer academic performance. As a result, screening for SDB should be included in pediatric and multidisciplinary assessments of children’s learning difficulties, with appropriate medical follow-up as indicated.


For a link to the segment on Home & Family go to: https://youtu.be/uQX7kx5Y674

Compression Hose 101

What are compression hose?

They are specially woven hose with either spandex or latex used for medical purposes

Why are they used?

They are used primarily in the hospital setting to prevent blood clots (venous thrombosis) in patients who are on bed rest or recovering from surgery.  In outpatient settings compression hose are used for those at risk blood clots, ankle swelling due to venous stasis (venous blood sluggishly returning to the heart), and after sclerotherapy (vein decompression) procedures, and lymph edema.

What are the different types?

Low pressure hose, also known as TED (ThromboEmbolicDeterrent) or anti-embolism stockings, have an even amount of pressure woven throughout the hose. They are used to support the venous and lymphatic systems of the leg. This compression, when combined with the muscle pump effect of the calf, aids in circulating blood and lymph fluid through the legs. These are typically in the pressure range of 10-15 mm Hg (mercury) and are worn 24/7 in the hospital until a patient is ambulatory. Additionally they can be worn during air flight for long distance travel, and for minor varicose veins. Compression wear has also been adopted by the sports science industry with various garments developed to improve the efficiency of muscles by stabilizing them with pressure and improving circulation and lactic acid removal. These are LOW PRESSURE garments only. They are typically marketed "over the counter" for those with minor issues - tired legs, small varicose veins, athletes, and for prevention of blood clots during prolonged air travel or hospitalization.

High pressure hose, known as JOBST stockings or Gradient Compression Stockings, have a gradient of pressure woven in with the highest pressures around the ankles and gradually lower pressure as the sock rises to the knee. They typically are sold as 22-30 mm Hg or 30-40 mm Hg. Doctors will typically recommend these stockings for those who are prone to getting blood clots, edema (significant swelling) and blood pooling in the legs and feet from prolonged periods of sitting or inactivity. In these folks the veins are incapable of moving venous blood back to the heart, so blood collects in the dependent areas of the foot and ankle, causes local stretching and damage to the veins, setting a person up for venous stasis ulcers (the hardest in medicine to heal)  and blood clots. These stockings are worn during the day and put on first thing in the morning when feet and ankles are less swollen and removed at night.

Although these stockings are non-prescriptive, there are several CRUCIAL cautionary steps that need to be taken before “self prescribing”. Your doctor must assess your ABI (ankle brachial index - a measure of whether your arterial blood supply to your legs is adequate) for both legs and it must be >1 to wear such stockings – otherwise they may obstruct your arterial flow. It’s also CRUCIAL these be properly sized.

Who should NOT wear them?

It's very important for your doctors to make sure that your arteries to your feet and legs are competent and working before using these hose, otherwise they would cut off this essential blood supply.  Patients should not wear these hose if allergic to latex (if latex in the weave) nor should they be worn with active wounds in the process of healing. Additionally, patients with uncompensated congestive heart failure (ie the heart can't handle additional blood volume if stockings push it into the circulation) shouldn't wear these without specific OK from your doctor!

News about Strep Throat

Up until now our current practice has been to keep children at home for at least 24 hours after testing positive for strep and beginning antibiotics.  However, now a recent study published in the Pediatric Infectious Disease Journal demonstrated that children treated with amoxicillin can return to school the next day without putting other children at risk!

Here’s some info about sore throats in general:

Sore throats are one of the most common maladies in school aged children.  In fact 12 million annual visits to the doctor are made annually, the majority of them are caused by viruses, and these are self limited, don't require antibiotics, and always accompanied by other symptoms like runny nose, cough, congestion and sometimes fever.  However, those children with strep throat, a bacterial cause of pharyngitis, present differently. Their symptoms appear rapidly with sore throat, swollen glands, often a belly ache or vomiting (but no diarrhea), headache, and occasionally a sand papery rash called scarlatina. Although strep throat can resolve on its own after 3 days, it is ALWAYS treated with antibiotics.

How do you catch it?

It is spread from person to person through large droplets....ie with coughs, kisses, sharing food. It's even speculated, and I have seen, that it can be chronically carried on toothbrushes and even orthodontic appliances. Even your pets can carry strep and facilitate its spread.  So you can imagine those in close quarters are at greater risk. Family members of those with strep carry a 40% risk of becoming infected.


Why does it need to be treated even if it self resolves?

Strep is a unique bacteria in that it contains proteins that confuse the immune system, and left untreated can trigger a cascade of events that can lead to local and distant complications that can cause long term health problems.

On a local level strep can cause abscesses in the tonsils and surrounding structures, sinus infections, ear infection, and flesh eating infection (necrotizing fasciitis) or erysipelas...a painful deep skin infection.  On a distant level strep that is untreated can cause inflammation of the heart, joints, skin (called Rheumatic Fever) and even toxic shock syndrome and nephritis.

How is it detected?

Your doctor will test for it either by rapid strep tests or overnight culture.  If the rapid test is positive and the history and exam support the diagnosis then antibiotics can be started that day and continued for 10 days.  If your doctor only has overnight culture available, and the patient history and physical make the likelihood of strep greater, antibiotics are typically started, but may be withdrawn if the culture turns out negative. Keep in mind you should never ask for antibiotics for what your doc believes to be a viral sore throat....they won't get you better any faster and you will run the real risk of developing antibiotic resistance or drug allergy when using antibiotics unnecessarily.

How is Strep treated?

If a patient is not penicillin allergic, then penicillin or amoxicillin are used.  To date all strep is responsive to these simple and inexpensive medications.  For those who are allergic, there are many other options. And now that good science has shown us that ONCE DAILY oral amoxicillin is as effective as twice daily or penicillin 4 times daily, patients are likely to complete a full course of antibiotics, and now be able to return to school the next day.

So the guidelines are……

If your kid has had their once daily amoxicillin by 5 pm, they can return to school the next day, if no fever and feeling ok.  Of course if fever or pain is still present, keep him home another day. But with these new guidelines we will get more kids back to school earlier, and more working parents will be able to stay at work, as well.  That's a good thing!!

And lastly, a good practice after a viral or strep throat is to either discard your toothbrush, or give it a few minutes soak in some boiling water to kill off the germs.  With orthodontic appliances, soaking in alcohol for several minutes should do the trick.  Don’t let your kid’s toothbrushes “live” together in the same cup as yours or siblings…..the possible contact could lead to spread of germs in the family!

​If the shoe fits…..should a child wear it?

Do babies need shoes?

Socks or booties are just fine to keep little piggies warm.  And once babies start to crawl, pull to stand, and eventually walk, being barefoot is beneficial in many ways.

Why?

·      Feedback from the ground directly to the foot means a baby can continue to look up. Looking down throws a little one off balance, putting him at risk for falling

·      Walking barefoot develops the tiny muscles that connect all the foot bones and allows the larger muscles around the ankle to strengthen

·      Walking barefoot also develops the structure of the arch – although 100% of babies have flat feet, and don’t develop true arches until 6-8 years of age

·      Most importantly, walking barefoot improves proprioception – that ability of our brain to “read” where our bodies are in space, and contributes to good posture.

So when a baby goes outside what kind of shoe is best?

Toddlers need shoes to protect their feet.  Here are the ideal features of a toddler shoe:

·      A shoe with a little bit of sole protects the foot and helps to avoid slips and falls. However, the front of the sole should be flexible, so little toes can bend.

·      The toe box should be round so there is no pressure on the toes.

·      The material in the shoe should breathe – little action feet sweat a lot!

·      The shoe doesn’t have to be expensive – in fact canvas tennies are great choices.  They mold easily to the child’s foot and is breathable. After all, most kids go up a size every 2-3 months

·      Shoe fit is critical for ideal development and prevention of discomfort

o   The toe area should extend about ½” from the toes

o   The tongue of the shoe should be parallel to the laces or Velcro – that tells you the shoe is wide enough

o   The back of the shoe should allow a little wiggle room, but be supported so that the heel stays in the shoe – you should be able to fit your pinky in the heel area, but only up to the first knuckle

o   Under no circumstances should a young child wear a heeled shoe – this leads to shortening of the Achilles tendon and toe-walking.

Lastly, if a shoe is hard to get on, or your tot is constantly removing shoes, it may be time to shop for new ones. Avoid hand me downs, as it is key that the shoe molds to your child’s foot.  Treat every trip to the shoe store as if it’s your first, and aim for proper sizing with each and every shoe purchase.  And remember that expensive doesn’t necessarily mean a good shoe!  

For a link to the segment on Home & Family go to: https://youtu.be/cdist9bSMT8

School’s Back – and the third week of September is Asthma Peak week!

For most school-aged children, September marks the beginning of the new school year. For kids, returning to the classroom is a time for learning, making friends and play.

However, for parents of children with asthma, the arrival of a new school year may bring a sense of dread.  Why?

Because asthma flareups increase markedly in the first month or 2 of school, typically peaking around the 3rd week of September through early October. Hospital admissions for asthma throughout North America also ramp up.  It is known that increased contact with other children is a contributing factor - face it, upper respiratory infections run rampant in classrooms.  And for those kids with asthma, viral URI’s are potent triggers. More than 60% of kids landing in emergency rooms with asthma have rhinovirus - the virus responsible for the common cold.

In addition, for those kids with ragweed pollen sensitivity, the high levels present nationwide in September also can trigger asthma in some kids.

As the weather cools and windows close in classrooms, dust mites, molds and animal dander make their way into homes and classrooms and accumulate to levels that again, can trigger asthma.

So, if your child has asthma it is essential to know how to keep it under control as they return to school. Proper preparation to keep asthma well-controlled are as important as purchasing school supplies and new clothes. With the right planning kids can control their asthma – instead of having asthma control them.

The goal is to have your child’s asthma well controlled, so that your child should not experience any symptoms. That way, a child can function normally in the classroom, with physical activities, and also sleep comfortably and soundly.

So what’s a parent to do?

· Speak to your child’s school about their asthma policy and inhaler use - make sure your child can carry an asthma inhaler AND a spacer device at all times, and that one is in the nurses’ office or with the teacher.

· Develop a written Asthma Action Plan with your allergist or pediatrician and make sure the school has a copy of it

· Consult your child’s doctor NOW to find out which asthma medications are

appropriate for your child given the season, his/her physical activities and environmental exposures

· It’s especially important not to let down your guard - if your child is symptom free through the Fall and Winter and early spring, it’s because their medications and your environmental controls are working. Talk with your child’s doctor about taking medication vacations - and when that is advised

· Monitor your child’s symptoms daily, helping them to pay attention to them

· Identify triggers that make their asthma worse and teach your child how to best avoid them. If there are triggers within your home, do your best to eliminate them - no second hand smoke, controlling dust and animal dander, and living and eating as healthfully as possible.

· And of course, speak with your child about the importance of hand washing and not sharing food in order to avoid catching a cold.

Asthma is a condition that can be managed and controlled when we are educated with a strategy for living a healthy and symptom free life. With Asthma Peak Week rapidly approaching September 13, the time to start planning is now!

Is your child safe in a seat belt?

Kids are now in full swing returning to school, and often parents are driving more than just their own children to and from school and extracurricular activities.

Passenger safety is important at all ages, and I wanted discuss how to determine if your child needs a booster seat vs. a seat belt.  And by the way, you may not know this, but I am also a certified Child Passenger Safety Technician!

What is a booster seat, and who needs to use it?

A booster seat is a middle step between a car seat with a harness and a seatbelt. They protect kids who are too large for a car seat and too small for just the seatbelt.

Some have high backs with slots that place the lap/shoulder belt in just the right position for safety.  Others are just backless bases kids sit on that help the belts fit correctly and typically have a guiding slot for the lap belt. They are easily moved from car to car and should be used if your young passengers can’t pass the 5 point test.

When is a child ready for a seatbelt?

This is often tricky because the fit of the seatbelt may be different for each vehicle, or even which seat is used.  Additionally, it’s so common for parents to assume a child is ready way too early.  Studies have shown that only 10% of 8 year olds, 30% of 9 year olds, and just 50% of 10 year olds actually are safely restrained in a seatbelt.  And because children in boosters are half as likely to be injured in a crash, compared with kids in seatbelts, it’s especially important to know what it means to be seatbelt-ready.

So here is a life-saving tool to use with their kids.  It’s  a 5-point test that helps easily determine if a child is safely restrained by a seatbelt.

How does a child pass?

All FIVE questions must be answered yes, otherwise your child (or a passenger in your carpool) has to use a booster.

#1  Are you sitting all the way back against the auto seat? The belts will only work if they are tight across the shoulders. In the event of a crash, slack in the belt by a child sitting forward won’t protect the head and neck – increasing risk of critical brain injury.

#2  Do your child’s knees bend comfortably at the edge of the auto seat? If they don’t a child will literally slip under the seatbelt and ”submarine” into the front seat, incurring severe injury in a crash.

#3 Does the belt cross your shoulder between your child’s neck and arm (mid collarbone)?  If it doesn’t, it can cause strangulation if too near the neck, or place the brain at risk if the shoulder belt is held under the arm.

#4  Is the lap belt as low as possible, touching your child’s thighs (NOT around your waist)? In a crash, if the lap belt is around the waist, critical internal injuries occur from compression of the abdominal contents, liver and spleen.

#5  Can your child stay seated like this the whole trip? Do you have a fidgety child, one with hyperactivity, or developmentally just not able to maintain a safe position during a ride. If so, a booster seat or higher weight ca rseat with 5 point harness is the safest way to go.

What if you have a car full of kids….who goes in the front seat?

Children under 13 years of age should ride in the back seat. They are safer from injury if properly restrained. If a child must sit in the front, due to space considerations, let it be the oldest child, capable of belting in properly.  If a child is in the front seat, the vehicle seat must be moved back as far as possible from the dashboard – otherwise airbag deployment in a child can result in facial and chest injuries.

For more information on best practices for safely securing your children in vehicles, please go to www.nhtsa.gov (the National Highway and Transportation Safety Association)

Oxycontin for kids????

On August 13, it was reported that the FDA approved the powerful painkiller, OxyContin, for a new use – in children ages 11-16 who suffer from severe, long-term pain.  

Given that “oxy”, in the adult world, is notorious for its risk for addiction and illicit use, the news that it was approved for youth may have shaken and worried many of you. 

I wanted to provide information and balance about this news to reassure you all that the FDA is not trickling down addiction risk to our kids, but rather supplying an additional effective medication for those kids who require long term relief from severe pain.

First, what is Oxycontin?

OxyContin is an extended-release version of the opioid medicine, oxycodone. Opioids are powerful medications that can help manage pain when they are prescribed and used properly. Most oral opioid products are also available as extended-release versions. The reason for this is 2 fold:  1) so that patients don’t have to take medications round the clock 2) that pain relief is steady rather than returning every 4 – 6 hours

How is it typically used?

In the U.S., extended-release opioids are used to manage chronic pain in adults; typical uses involve pain relief after extensive surgery, relief of chronic severe back or limb pain, cancer-related pain, and end of life palliative pain relief.  Keep in mind that patients with long-term pain relief needs have failed to achieve comfort with other medications, and thus oxycontin may be prescribed.

Why was it approved for kids?

The Best Pharmaceuticals for Children Act of 2002 provided incentives to drug companies that study medications in pediatric patients. The reason centers around the fact that the metabolism and activity of medications is different in kids than in adults.  With pain medications, in particular, pediatricians and surgeons often have had to “wing it” using adult medications on children,  that weren’t tested in kids. Because there wasn’t sufficient evidence to safely prescribe drugs like oxycontin, the FDA asked the manufacturer to study the drug in kids, specifically.

The studies supported the addition of a pediatric indication to the OxyContin label for patients 11 to 16 years old, and provided the much-needed data to health care providers.

Who will prescribe it? And under what conditions?

Thankfully, not many children experience the types of cancer pain, extensive trauma or surgeries that require long-term pain management.

The new study data and resulting pediatric indication for OxyContin give doctors more specific information on how to safely manage pain in their pediatric patients. The majority of medication will be prescribed in the inpatient environment, but some children may require ongoing pain management at home. There is a specific protocol designed for initiating oxycontin dosing, and pain management specialists/pediatricians/members of the health care team are urged to discuss the pros and cons, safety and storage, dosing and expectations with both patients and families.

What are the big cautions?

Parents and caregivers should follow all the usual safeguards for storing powerful medications when OxyContin is in their home, making sure the medications are stored securely (under LOCK AND KEY!) so young children never have direct access and also so that no one else in the household such as older children, siblings, friends, or other visitors have direct access. Also, it is extremely important to safely and properly dispose of unused OxyContin as soon as it is no longer needed. As with all opioid drugs, OxyContin shouldn't be kept casually in the bathroom medicine cabinet; it should always be secured.

A child must be able to swallow the dose whole, as the pills are long-acting, and not designed to be broken, crushed, or compounded.

As for patients, pregnant and nursing women are discouraged from using it as it can cause respiratory depression in infants. Those with chronic lung disease, allergies to components of the medication, or those who have never taken opiod pain relief are not candidates for oxycontin.


For a link to the segment on home and family click here: http://youtu.be/gTE7bFWwY-k

Transitioning from Summer to School

For many parents, back to school is bittersweet. Parents can often reclaim a little "me" time, but that ends quickly with the return of homework, assignments, practices, and all other obligations related to school.  Here are several tips to help that transition be easier.

Ease back into scheduled days. 

To ease the transition, about a week or two before the first day of school, start their bedtime routine about 10 minutes earlier each night and wake them up 10 minutes earlier each morning, every day, until they’re back on track. Discourage TV and encourage board games, puzzles, and reading before bed. Offer meals at more regular times during the day.

Get back to healthy eating. 

Start integrating healthier items into your snacks and meals, and stock your freezer with healthy options for breakfast – ziplocks with chunks of frozen fruit for smoothies, quesadillas cooked, cut and frozen, and breakfast burritos. Stock your pantry with nuts, dried fruit, healthy whole grain crackers and your fridge with low sugar yoghurts, low fat cheeses, and healthy proteins. Freeze a few healthy meals in the event you run late and want to keep the family on track (and avoid the fast food trap).

Anticipate and address your child’s anxiety and manage your own. 

Have a few school mates over before school starts so socially your child eases back in…and chat up your own positive experiences about school.

Review the student handbook.

Know policies and procedures, and dress code, and shop accordingly.

Health.

Make sure annual physical exam is done, forms filled out, vaccines are up to date, and any meds/forms for sports, or meds at school filled and ready. Place all in a folder, ready to go. Make copies of your child’s forms and vaccine record in case they are lost.

Buy supplies early.

Check with school if any unique supplies needed for your child’s grade.  Fill and organize your child’s backpack with him, decide where it should be kept for pickup in the morning.

Bring out the fall clothes.

Make repairs, adjust hems, polish shoes, and clean all and organize. Toss outgrown clothing, and organize a couple of drawers for school clothing only. Have your child put together a few outfits and fold them together in that drawer.

Carve out a study area.

This spot needs to be free of clutter, distraction or media. Stock it with school supplies, a good light, and even earplugs or headphones to minimize noise.

Make a test run to school.

Especially if it’s a new school – plan your route and an alternate. Visit school with your child, map out the classroom, gym, bathrooms, cubbies, lockers, etc….then your child can navigate day 1 with more confidence.

Start a school year calendar.

Fill in dates for field trips, school events, family obligations, vacations, sports and activity practices. Knowing what is coming up is essential for the family to stay organized and plan some free time.

Establish a tradition for Day 1 that your child looks forward to.

Whether it’s taking a photo in front of the door (as we did), to breakfast at a local diner, or dinner out, make “Day 1” something your child looks forward to!

For a link to this segment on Home & Family click on this:  http://youtu.be/-3tjfWWmtac

Swimmer's Ear

Affecting the outer ear canal (not the inner or middle ear), swimmer’s ear (also called acute otitis externa or AOE) is a painful condition resulting from inflammation, irritation, or infection of the skin in the ear canal.

WHAT CAUSES SWIMMER’S EAR?

Increased moisture trapped in the ear canal, from baths, showers, swimming, or moist environments is the most common culprit. When moisture is trapped in the ear canal, bacteria that normally inhabit the skin and ear canal multiply, causing infection of the ear canal. Swimmer’s ear often affects children and teenagers, but can also affect those with eczema (a condition that causes the skin to itch), or those with excessive earwax (trapping moisture beneath). Swimmer’s ear needs to be treated to reduce pain and eliminate any effect it may have on your hearing, as well as to prevent the spread of infection.

Other factors that may contribute to swimmer’s ear include:

•Contact with excessive bacteria that may be present in hot tubs or polluted water (like lakes and oceans)

•Excessive cleaning of the ear canal with cotton swabs or anything else (removing the protective natural barriers)

•Contact with certain chemicals such as hair spray or hair dye (Avoid this by placing cotton balls in your ears when using these products.)

•Damage to the skin of the ear canal following  irrigation to remove wax

•A cut in the skin of the ear canal

•Other skin conditions affecting the ear canal, such as eczema or seborrhea

WHAT ARE THE SIGNS AND SYMPTOMS?

The most common symptoms of swimmer’s ear are itching inside the ear and  pain (often very severe) that gets worse when you tug on the auricle (outer ear). Other signs and symptoms may include any of the following:

•Sensation that the ear is blocked or full

•Drainage

•Fever

•Decreased hearing

•Intense pain that may spread to the neck, face, or side of the head

•Swollen glands around the ear or in the  upper neck or redness and swelling of the skin around the ear

WHAT CAN HAPPEN WITH SWIMMER’S EAR?

Hearing loss. When the infection clears up, hearing usually returns to normal. Left untreated, temporary hearing loss can occur.

Recurring ear infections (chronic otitis externa). Without treatment, infection can continue and lead to chronic pain, drainage, and discomfort.

Bone and cartilage damage (malignant otitis externa). External ear infections, when not treated, can spread to the base of your skull, brain, or cranial nerves. Diabetics and older adults are at higher risk for such dangerous complications.

HOW IS IT DIAGNOSED?

To evaluate you for swimmer’s ear, your doctor will look for redness and swelling in your ear canal. Your doctor also may take a sample of any abnormal fluid or discharge in your ear to test for the presence of bacteria or fungus (ear culture) if you have recurrent or severe infections.  

HOW IS SWIMMER’S EAR TREATED?

Treatment includes careful cleaning of the ear canal and use of eardrops that inhibit bacterial or fungal growth and reduce inflammation. Mildly acidic solutions containing boric or acetic acid are effective for early infections. Antibiotic and anti-inflammatory drops may be prescribed for more severe infections. With proper treatment, most infections should clear up in 7-10 days.


HOW SHOULD PRESCRIPTION EAR DROPS BE APPLIED?

•Drops are more easily administered if done by someone other than the patient.

•The patient should lie down with the affected ear facing upwards.

•Drops should be placed in the ear until the ear is full.

•After drops are administered, the patient should remain lying down for a few minutes so the drops can be absorbed.

*If the ear canal is swollen shut, a sponge or wick may be placed in the canal so the antibiotic drops will enter the swollen canal more effectively.  Pain medication may also be prescribed.

HOW CAN YOU PREVENT SWIMMER’S EAR?

You can make your own eardrops using rubbing alcohol or a mixture of half alcohol and half vinegar. These eardrops will evaporate excess water and keep your ears dry. After swimming, shake out any moisture in your ear canal, instill 4-5 drops of vinegar or alcohol solution, and leave in for a minute or two.   You can also blow dry your ear canals with cool air, on a low speed, to dry out wet ear canals.

ARE THERE ANY MORE TIPS FOR PREVENTION?

•Use ear plugs when swimming   - a dry ear is at less risk •Have your ears cleaned periodically by an otolaryngologist if you have itchy, flaky or scaly ears, or extensive earwax

•Don’t use cotton swabs to remove earwax. They may pack earwax and dirt deeper into the ear canal, remove the layer of earwax that protects your ear, and irritate the thin skin of the ear canal. This creates an ideal environment for infection.

When to Call the Doctor

Call your doctor immediately if your child has any of the following: pain in the ear with or without fever, decreased hearing in one or both ears, or abnormal discharge from the ear.

For a link to the segment on this subject go to: http://youtu.be/GmeTHVCsptg

When your child gets sick....while travelling!

Planning is everything when you take a trip, especially when you have a child.  When you are on the road (or in a plane, train or boat) it’s important to be prepared for the possibility that illness may strike any family member.  It’s hard enough to manage your child being ill at home….it’s even more challenging when you are away. So here are a few tips, before, during, and after travel, that will help you manage this challenge successfully.

BEFORE YOUR TRIP:

·      Identify where the nearest emergency room and  children’s hospital is, close to your destination or along your route, if you are taking a road trip.

·      Check with your insurance company what coverage your child has, especially if out of state or out of the country, or if local hospitals are out of network. Also ask, if a dire or surgical emergency, what the policy is on airlifting your child out/emergency transport. Also, check to see if a participating pharmacy in your insurance plan is nearby your destination.

·      Purchase travel insurance – in the event of illness delaying a leg of the trip, this may come in quite handy. Find out if minor illness that precludes comfortable travel (like an ear infection) is covered

·      If your child has a chronic illness or is on medications, ask your pediatrician or specialist for the name and contact information of a local doctor in the event there is an issue

·      If your child is on medications, make sure you take along a daily supply plus an extra week’s worth, in the event you get stuck or stranded

o   If those medications are in bottles greater than 3.4 ounces, ask your pharmacist to transfer them to smaller bottles so the TSA doesn’t question your carryon. And DO carry on your child’s medications.

o   Pack a couple extra quart sized zip lock bags in the event yours are lost or damaged

·      Assemble a mini-emergency kit, especially if you are in a very rural or distant location

o   KaoLectrolyte or Pedialyte Powder packs – just add water and you have a replenishing clear liquid in the event of vomiting or diarrhea

o   Topicals – 1% hydrocortisone for itchy rashes or bug bites and topical Neosporin or Bacitracin for scrapes and cuts

o   Bandaids

o   Diphenhydramine (Benadryl) for hives, allergy symptoms

o   Epi-Pen (Jr) – bring 6 if you are traveling and your child has food allergies/history of anaphylaxis

o   Pain/fever relief – check with your doctor before travel for the most up to date dosing of acetaminophen or ibuprofen for your child, based on weight, and write it down! Buy bottles less than 3.4 ounces.

o   If your child has asthma, bring an inhaler/spacer with you, especially if on a plane. Check with the airline whether there are plugs available in the event your child requires a nebulizer treatment on board (and make sure you bring on tubing, mask, meds along with your nebulizer)

o   If you are travelling with a baby, take saline drops and a device like the SnotSucker to empty the nose of mucous, especially to facilitate drinking/hydration

o   If your child is prone to ear infections, and you are flying, your doctor may want you to bring a prescription antibiotic with you, as well as ear drops for pain, and others for swimmers ear

o   Ask your doctor about medications for motion sickness or nausea/vomiting and pack those with you.

·      Make sure your child’s vaccines are up to date, especially with international travel

DURING YOUR TRIP

·      Make sure, especially if visiting public venues, that you wash your hands and your child’s frequently, with soap and water

·      Use only bottled water for your child

·      Check with your hotel about availability of a physician/local clinic in the event your child is ill.  If your child contracts a moderate to severe cold before a return flight, it might be good to have ears checked, especially if pain

·      If your child is hospitalized,  check with your hotel about extended stay, and discounted rates, if you can’t stay at the hospital with your little one

·      If your child is seen by a local doctor or hospital, make sure to get copies of the medical record – for your insurance company, and also for your child’s doctor (so a copy can be put into his/her medical record)

·      Ask for followup instructions from the local doctor or hospital, how medication should be stored or administered.

·      If the local doc/hospital is willing, connect them with your child’s doc for a conversation

·      And make sure, even if you are miles from home, that you let your child REST and suspend your itinerary for a day or 2….

COMING HOME

·      If your child may have potential pain during flight, make sure pain medication is given an hour before takeoff, and every 4 hours after

o   If your child has ear pain, have them suck or chew/eat. 

o   Bring a change of clothes for you and your child, as well as ample wipes – in the event of vomiting or diarrhea. Pack a large plastic bag to store soiled garments

·      Arrange for an appointment for your child to be seen the next day or two after travel for follow up

·      Be prepared to buy a drink or snack for fellow passengers who likely might feel  a bit inconvenienced if your child is very upset.

to view a clip of this segment from Home & Family go to: http://youtu.be/RShHcMqjhdE

Decoding the FDA’s new labeling for NSAIDS

When a medication is sold over the counter, many Americans assume they are 100% safe, and yet recent health research and decades of use have revealed that one class of medications, non-steroidal anti-inflammatory agents, leads to an increased risk of heart attack and strokes.  I wanted to shed some light, and perspective on this topic so here are some FAQS to help you all.

WHAT MEDICATIONS ARE WE TALKING ABOUT?

NSAIDs, or non-steroidal anti-inflammatory drugs, over the counter and prescription, include ibuprofen, naproxen sodium and celecoxib. Common brands include Advil, Motrin, Aleve, Naprosyn and Celebrex and Voltaren. These medications are used for everything from fever and pain,  headaches, colds, and flu in kids to alleviating discomfort from menstrual cramps, sports-related pain and injuries, chronic or long-lasting conditions like arthritis, back pain and muscle strains in older kids and adults.

WHAT ARE THE NEW WARNINGS? WHAT’S GOING TO CHANGE?

Although NSAIDS have helped millions with acute and chronic symptoms, the FDA now recommends changing the current labeling that has been in use since 2005.  Current labels state that NSAIDS MAY cause increased risk of heart attacks and strokes.  Now manufacturers of prescription NSAIDS will be required to state: that NSAIDS CAUSE and increased risk of heart attacks and strokes.

WILL THE LABELING BE ON ALL NSAIDS, EVEN THOSE FOR KIDS?

Yes. Any non-steroidal medication in prescription form, whether pill, liquid or chewable, will be affected, as the active ingredients must comply specifically with FDA labeling. Manufacturers of OTC products have the option of voluntarily complying with the FDA’s recommendation so we are likely to see these warnings show up in the near future on products we easily can buy in the drugstore.

WHAT HAS THE NEW RESEARCH SHOWN?

1.     That those who have taken NSAIDS within a year of a first heart attack have a greater chance of death

2.     That the risk of heart attack or stroke can occur as early as the first weeks of using an NSAID and may increase with longer use

3.     Risk appears greater at higher doses

4.     NSAIDS can increase the risk of heart attack or stroke in patients with AND without heart disease or risk factors

NOTE: Studies find that many people use them in larger doses than recommended and often like they are long-term medications. People with chronic pain or inflammation often take several NSAIDs daily, despite label warnings that the drugs should not be used longer than 10 days for pain or three days for fever.

SO WHAT SHOULD PARENTS AND KIDS DO?

First off, adhere to the recommendations for appropriate dosing on the label – whether using adult or kid versions.

1. Use no more than 10 days for pain, and no more than 3 days for fever

2. Talk with your health care provider about reasonable alternatives, especially if you or your child have been taking NSAIDS chronically.

3.  Children are born with brain or heart defects that place them at risk, or have blood conditions that pose risks for excessive clotting.  These patients, especially, need specific guidance from their doctors about the use of NSAIDS.

4.  And if parents opt to use NSAIDS for fever or pain relief, using the lowest dose possible that does the job, for the shortest amount of time, is advised.

For the average child,  we certainly want to promote an active lifestyle, a healthy diet, and minimize the use of any medication, unless absolutely necessary.  Hopefully this will grow a generation of healthier adults with less obesity, diabetes, and high blood pressure that would place them at risk for NSAID related issues.

NOTE: With all said and done, the specific concerns about heart attacks and strokes currently  center around adults, especially those with histories of heart attack, heart disease, bypass surgery and stroke, and elevated blood pressure.  The higher the dose of NSAIDs,  and the longer taken, the greater the risk, although risk can occur within the first weeks of starting NSAIDS.  NSAIDS can also reverse or lower the protective effects of a baby aspirin daily.

For a video link to this segment, go to: https://youtu.be/NABGFxqkcr8

Parking Lot Drowning

If you are like most parents, you probably think once your kid is out of the water and done swimming for the day, his risk of drowning is over.  But for a small percentage of children and adults, drowning can happen on dry land.

Every year in the US, hundreds of children, big and small, die from drowning, and thousands more survive near-drowning, often with long-term complications.  The focus of this article is to inform you about secondary drowning, a little known, but very important type of drowning – often described by lifeguards as a “parking lot” drowning.

What is it?

When a person is in the water, perhaps struggles with swimming, a forceful tide,  or takes a breath while submerged, pool, lake or seawater enters the airway (ie goes down the wrong pipe). Another common scenario when a sudden rush of water gets past the vocal cords into the lungs – like when jumping from a height or exiting a water slide.  Typically, that person coughs, and seemingly recovers and moves on with the day.  However, even small amounts of water can cause an inflammatory reaction in the lung’s air spaces, causing swelling or edema – especially if the water is contaminated or full of chemicals.

But lots of kids sputter and cough when playing in the pool.  How do we know who is in trouble?

Generally within 24 hours of submersion, a person with secondary drowning will experience cough, chest pain, shortness of breath or trouble breathing, fatigue.  Smaller children may have behavioral changes like irritability, inconsolability or stop playing –signs that the brain isn’t receiving enough oxygen.

If you saw this happen to a family member, what would you do?

Certainly if there was a witnessed struggle with water that day, you would definitely be more vigilant checking your child.  If there were any of these symptoms arising, you should proceed immediately to the emergency room – waiting until the next morning could put your child at much greater risk.  Additionally, all those who have been rescued from the water or have no memory for the water struggle, should be seen, even if looking well.

How is this treated?

For some children with mild symptoms, generally oxygen therapy and observation are sufficient, as the body clears the swelling on its own.  However, when the edema is more severe, often diuretics to dry out the lungs are given, in addition to oxygen delivered under pressure or by tube, in order to push the edema back into the circulation.  On rare occasions medications to raise blood pressure are given and, certainly secondary drowning can be fatal. The worst cases are those who are put to bed, and never wake up.

How can we prevent this from happening?

The key here is to help your child build strong swimming skills, enforce good pool safety (supervision to minimize really rough play), pay attention to beach warnings re: riptides, and make sure you keep a close eye on your children for the 24 hours after he or she has had any problems in the water – i.e. you shouldn’t send them to a play date, camp, or travel remotely in the day following.

For a video link to this episode on Home & Family go to: http://youtu.be/05-nuX0WEc4

​Roasted Pear Cinnamon Ice Cream with Ginger Caramel Swirl

Nothing is better than the smells of cinnamon, caramel, gingerbread and fall fruits.  Let’s translate that into a cool and creamy treat that you can make year round – even for Christmas in July!  The secret – pears don’t have to be ripe to become sweet.  After slow roasting them in the oven, you concentrate their buttery flavor and when added to the cinnamon and ginger caramel, you’ve got a winner.

This recipe makes 2 quarts (because one will not be enough! )

For the Cinnamon Ice Cream Base:

2 ¼ c. half and half

2 ¼ c. heavy cream

7 egg yolks (from large eggs)

1 vanilla bean – slit open, beans scraped out *

1.5 cup sugar (divide into 1c. and ½ c. portions)

2 TB cinnamon

Over low-medium heat, simmer half and half, vanilla bean and seeds, 1 c. sugar and 2 generous TB cinnamon – turn to lowest setting for flavors to steep (about 10 minutes)

Meanwhile, beat egg yolks with ½ a cup of the sugar until pale and thick. Set aside.

Turn heat up on milk mixture to medium low and SLOWLY pour about 1-1.5 cup of the heated mixture into the bowl with the egg yolks, whisking frequently (your goal is to feel the outside of the bowl get really warm). Then take tempered egg mixture, add it back to remaining base,  and remove the vanilla bean. Stir constantly with a wooden spoon or silicone spatula until the mixture coats the back of a wooden spoon. (if you have a kitchen thermometer, this happens around 178-180 degrees). Don’t rush or you will have scrambled eggs.

Strain the mixture into a bowl, add the heavy cream, cover, and refrigerate overnight(the mixture should be very cold – this gives a creamier, less “crystal-laden” ice cream).

*if you don’t have a vanilla bean, a 2 tsp vanilla extract or vanilla paste.

For the Roasted Pears (or apples) (make these 1-2 days before)

2 medium pears, peeled, cored, and cut into small dice (they should be underripe)

2 tsp fresh grated ginger (or 1 tsp dried)

½ c. brown sugar

pinch of salt

1 pat butter, cut in small dice

Put pears in a baking dish, sprinkle with sugar, ginger, salt and butter and mix. Put in the oven at 350 for about 45 minutes until browned on the edges and most liquid has evaporated.  Let cool and refrigerate until ready to use.

For the Ginger Caramel (can make this up to a month ahead)

Heavy cream 1/2 c. + 2 TB (5oz)

1 heaping tsp powdered ginger (or 2 tsp finely grated fresh ginger)

1 tsp pumpkin pie spice

2 grounds (1/8 tsp) white pepper

1 c sugar

1 tsp lemon juice

Large pinch of kosher salt

In a small saucepan, simmer the heavy cream with the ginger, pumpkin pie spice and white pepper for about 10 minutes. Set aside. In another small heavy saucepan, cook the sugar with the lemon juice over low heat, stirring frequently, until the sugar caramelizes to a light brown color and turns clear, 10 to 15 minutes. Being careful to avoid splatters, whisk in the spiced cream into the caramel until incorporated, boil for about 15 seconds, then remove from the heat.

If using fresh ginger, strain the caramel into a bowl and refrigerate until use.

And finally………

Churn ½ the mixture in your ice cream maker according to manufacturer’s instructions. When ice cream is clinging to the paddles, add in ½ the pears and 3-4 TB of the caramel into the base until mixed. Transfer the ice cream to a freezer container .

Do the same with the remaining half.

When you are ready to serve, warm up any remaining caramel and drizzle on top.

Merry Christmas, in July! For the video link on Home and Family, click here: http://youtu.be/aAKL5K33uco

Having fun in the Sun...and not becoming a statistic!

According to the American Cancer Society, nearly 74,000 melanomas will be diagnosed this year in the United States, and 1 in 50 people will get melanoma, the deadliest of the skin cancers, some time in their life.

With that in mind, there are several new studies that are showing some troublesome trends in sun protection in the US, and also revealing that most Americans don’t know how to decode labeling in sunscreens on the market.

In an effort to put it all in perspective, and give you some lifetime tips, here is the current state of knowledge Summer 2015.

What are the research findings?

New research published in the Journal of the American Academy of Dermatology shows that many Americans aren’t protecting their skin as much as they should. Researchers from the CDC asked people how often they use sunscreen when out in the sun for over an hour, and only 14% of men said they regularly slathered on sunscreen. Women, at 30%, were twice as diligent about putting on sunscreen—while men were more likely than women to report never using sunscreen. And another recent study showed that only 1 in 4 children are routinely protected with sunscreen on a daily basis.

What other factors that increase skin cancer risk?

What we know is the following: 2 serious (blistering) sunburns in childhood doubles the risk of melanoma in a person’s lifetime. And new research shows that every sunburn after childhood continues to raise that risk with each and every episode! Many teens seek tanning in the outdoors or in tanning booths, increasing that risk even more. So we have work  to do people! And education to spread!

Help us understand the current labeling on sunscreen!

Despite recent efforts by the FDA to clarify labels on sunscreen, they remain a mystery to many, according to recent surveys.

So here’s the low down:

SPF values tell us about protection from UVB rays – those that cause sunburn, and can increase skin cancer risk. Studies have shown that the majority of the public buy sunscreen primarily based on SPF. What we do know that any SPF ratings of 50 or above are costly and really don’t add significant protection, are more expensive, and are misleading to the public.

However, it’s also important to protect our skin against UVA rays – these are rays from the sun that penetrate car windows, clouds, and are present year round and throughout the day. UVA rays penetrate much deeper below the surface, and are responsible for aging the skin, and also contribute to skin cancer risk.

 We know if sunscreens protect against UVA and UVB if they are labeled BROAD SPECTRUM.

TIP:  look for BROAD SPECTRUM spf hovering around 30. Don’t pay for spf exceeding 50 – 80% of those fail to protect at that level and cost so much more!

We hear a lot about worrisome ingredients. Tell us more.

Oxybenzone is a chemical that potentially can interfere with hormone system, and it has been shown to cause skin irritation and local allergic reactions when included in sunscreens. There is also some concern that adding vitamin A (retinol, retinyl palmitate) to a sunscreen could heighten sun sensitivity and create inflammation. So it’s best to avoid these ingredients, especially if you have sensitive skin. With up to 80% of current sunscreens containing these ingredients, it’s imperative to be a diligent label reader, especially if you are applying sunscreen to young children.

So what are the safest ingredients to put on kids (and adults), and how early can we do so?

The American Academy of Pediatrics and the American College of Dermatology recommend using mineral sunscreen ingredients (titanium dioxide and zinc oxide) for broad spectrum coverage.  Zinc alone only provides great UVA protection (spf) but limited UVB protection. To achieve ‘broad spectrum efficacy”,  Zinc is often combined with either chemical sunscreens or titanium dioxide, a very effective UVB screen.  Mineral sunscreens are gentle, effective, immediately active after application and less likely to cause irritation or local allergic reactions.

The American Academy of Pediatrics recommends that children under the age of 6 months stay out of the sun entirely, but if that is impossible, cover a baby as much as possible with lightweight breathable clothing, and apply mineral sunscreen to exposed areas frequently.

Tip:  with any child (or adult) apply a small amount of new sunscreen to the inner wrist, leave on for at least an hour. If no redness or irritation feel free to use on the rest of the body.  This is called a “patch test.”

So how much should we put on, and how often?

If using a spray, you should put on enough spray sunscreen that “an even sheen appears on the skin.” When you use lotion sunscreen, you should use about 2 tablespoons, or the equivalent of a shot glass, to exposed areas -- about a nickel-sized portion for your face alone. For a child, a palm-full is recommended.

It’s important to reapply it, too. If you are dry, every 2 hours SS should be reapplied – if wet, toweling off or sweating, at least every 90 minutes. If your skin is turning red, call it a day and get out of the sun.

Consider sunscreen use as important as using a carseat….every application counts, and protecting your child’s (and your) skin against harmful UVA/UVB rays can be a lifesaver!

And last thoughts:

DON’T FORGET

Put on sunglasses rated for UVA/UVB to protect little eyes

Seek shade between 10am-4pm

Wear tightly woven UPF or loose fitting clothing to cover as much as possible

Wear a hat with at least a 3” brim

Apply sunscreen to the scalp of little ones, and also on to the part in your hair

If your skin is reddening – your day in the sun is done!


For a video link to this segment on Home & Family go to: https://youtu.be/Dx5wCcqm8iw

Kitchen Confidential

Recently, a tragic story was reported out of Kentucky.  A 4 year old boy got a hold of a mouthful of cinnamon, started coughing violently, and an hour and a half later was pronounced dead. From cinnamon. Yes. Cinnamon.

This incident prompted me to take a critical look around my own kitchen, and look more deeply into some potential risks that may exist in a typical cupboard, and come up with solutions to make your kitchen pantry safer.   Here’s a sampling of what I found.

PITS – cherries, apricots, peaches and apples all contain either seeds or kernels that have cyanide or cyanide producing chemicals within.  Clearly we don’t typically eat the seeds of stone fruit, but with many folks juicing with whole fruits, the potential for eating some of these seeds does exist.  Adventurous bakers may grind bitter apricot kernels (which resemble small almonds) to make amaretti cookies or liqueurs, and health food addicts may tout that the kernels within stone fruit pits prevent or treat cancer!

Our bodies are capable of neutralizing small amounts of cyanide; however, larger amounts overwhelm the body and can cause minor symptoms like headache, dizziness, confusion, and vomiting, and progress to shortness of breath, elevated blood pressure, fast heart rate, kidney failure, and death.

The solution: enjoy these beautiful fruits, but core your apples, and remove and discard all pits and seeds before eating!

CINNAMON – it’s the second most common seasoning (behind pepper) used in the USA. 

Cinnamon comes from the inner layer of bark derived from dozens of varieties of evergreen trees that belong to the genus Cinnamomum. When applied to moist surfaces (like the inside of the mouth or lungs) the cellulose within the bark essentially sops up all local moisture, including mucous that is essential for its removal, and causes asphyxiation at the level of the lung. Loose cinnamon ingested in even small amounts, is capable of catastrophic reactions, as was the case with the little boy in Kentucky.

Additionally, Cassia cinnamon (cheaper, used in most commercial applications) contains a compound called coumarin that is liver toxic. Although some tout the blood sugar lowering effects of cassia cinnamon as helpful in diabetics, cassia can also interact with antibiotics, diabetes drugs, blood thinners, cardiac medications, among others.

Saigon cinnamon, popular with gourmet chefs, contains the highest amounts of coumarin. 

The solution:  it’s best to measure what cinnamon is needed in a recipe, and keep it up and away from small children to avoid accidental ingestion. Ceylon has the least and is the safest alternative in the kitchen. Check with your doctor FIRST if you are contemplating using cinnamon for a health condition and discuss your options.

NUTMEG – it’s the seed of Myristica fragrans, an evergreen tree native to the Molucca Islands. It’s use in baked goods, specialty cocktails and other cuisine is common in the US.  Nutmeg is sold as whole seeds (that require grating) or loosely ground.  It contains the chemical myristicin, which, if ingested  in amounts of just 0.2 oz (about 2 tsp ground) can cause convulsions, confusion, psychosis and seizures. Additionally, a whole or partially grated nutmeg also poses a huge choking risk if aspirated into the airway of a child or adult. The solution: It’s wise to not have piles of nutmeg within the reach of small children, and if perusing the open spice bins at the market, don’t let your kids reach in for a taste. Also, keep whole nutmeg in a sealed jar out of reach of small children AND pets.

EXTRACTS – the majority of flavoring extracts we use on a regular basis contain approximately 35% alcohol (that’s 70 proof, folks!). Alcohol is typically used in the manufacturing process to extract those volatile and delicious compounds that flavor our foods and drinks. Just like your bar contents, it’s wise to keep extracts up and out of reach of small children, especially since they don’t have child-proof caps.  If you are any medications that react with alcohol, even in small amounts, then be mindful that extracts could potentially cause a problem.  

The solution: purchase alcohol-free flavorings, or in the case of vanilla, vanilla powder (no alcohol). The cost may be more, but the risk, much less.

RAW UNPASTEURIZED HONEY – three risks exist.  Honey of any type can potentially cause botulism in children under the age of one year due to Clostridia botulina spores within the honey releasing botunlina toxin into the gut of babies.  Secondly, raw unpasteurized honey contains varying levels of pollen – those who use it for treatment of seasonal allergies may have unexpected adverse reactions if the pollen count in the honey is high. There is no requirement to disclose or quantifying this. And lastly, unpasteurized honey can contain grayonotoxins – compounds which can cause dizziness, weakness, nausea and vomiting in all age groups.  

The solution: buy pasteurized honey, and make sure to avoid giving any type of honey to children under one year of age.

GREEN SPROUTED POTATOES – we’ve all had them. Potatoes exposed to excessive light develop a green tinge (that’s chlorphyll), but more importantly that means the potato has accumulated solanine (a glycoalkaloid toxin) in greater amounts than are safe. Solanine is the potato’s defense system – keeping it alive in nature, and repelling those insects, diseases and predators that want to eat it.  If we were to eat green potatoes, we’d run the risk of nausea, cramping, diarrhea, or in the worst case scenario, coma and death.

The solution: keep potatoes in a cool dry place, discard green or sprouted potatoes (or cut those in half, and plant them!).

LOOSE BEANS, LENTILS, GRAINS, & NUTS – the beautiful and colorful, nutritious goodies we stock in our pantries can be a hazard for little ones. Countless times I have had to extract a swollen bean from the nose or ear of a little explorer cut loose in the kitchen. Worse yet, spilling the beans puts your little one at choking risk (also your animals).  Raw red beans can also cause GI upset (unless soaked for at least 5 hours in water).  

The solution: Bag up your fibre rich staples, and keep them out of reach of children.  If you literally do spill the beans, vacuum them up promptly!

Hopefully this small list of suggestions will get you on the road to a safer kitchen! Here's a link to the segment I did on Home & Family: http://youtu.be/3hgk0tWbHPs

The LEAP Study

Why is there Peanut Panic currently in the US?

The prevalence of peanut allergy has doubled over the past 10 years in countries that advocate avoidance of peanuts during pregnancy, lactation and infancy. The US and UK are perfect examples!  Our best science reveals that peanut allergy now affects approximately 1.5% of young children.  A recent poll, however, showed that US parent think up to 25% of people are peanut allergic, thus flaming the fan?

Why are peanut allergies so worrisome?

While there are many types of food allergies, peanut allergies are particularly troublesome, for a number of reasons. Foremost is the fact that peanut allergy often results in more severe reactions than other food allergies, up to and including sudden death. Importantly, its symptoms can occur following exposure to only very tiny (or 'trace') amounts of peanut protein. Peanuts are used in a wide variety of food products, thus trace amounts of peanut protein can be found in many foods - from chocolate bars to fruit snacks.

What is the LEAP Study?

LEAP (Learning Early About Peanut allergy) is a groundbreaking study, published in the New England Journal fo Medicine in February 2015, that looked at the EARLY (rather than late) introduction of peanut protein to see if tolerance to this high risk protein could be induced in babies likely to develop more food allergies. 

What was found?

Young babies with egg allergy or eczema were given peanut protein regularly from the age of 4 months until 5 years.  These kids were then compared with a similar high risk group who had no peanut protein for 5 years.  What was found was that there was an 86% reduction in risk of developing peanut allergy in the group fed peanut protein since infancy.

This study has paved the way for confirming that tolerance (ie food is your friend, rather than enemy)  to high risk foods (allergens) occurs earlier than previously thought, and that prevention of food allergies, especially in families with asthma, food allergies, and eczema may be possible by introducing high risk foods in the first year of life.

So how can we apply the findings of the study to real life?

The key thing is that rigorous studies with other allergens will need to be conducted in a similar fashion.  For now, here are a few guidelines for you parents:

1)   If parents have histories of food allergies, asthma or eczema or if your baby has eczema or egg allergy, do NOT give peanut protein until an allergist has determined with skin testing, that your baby doesn’t have a large reaction.  If  given the go-ahead your allergist will supervise giving peanut protein to your little one as early as 4 months of age.

2)   If you are pregnant, and not allergic to peanuts, DO eat them. Besides being nutrient rich, good science tells us that eating them does not increase your child’s risk of developing food allergies.

3)   If your family does not have a history of asthma, allergies or eczema, work with your pediatrician to incorporate higher risk foods, including peanut protein, into your baby’s diet sooner, rather than later.

4)  Breast feed, if you can, for at least 6 months. Good science tells us this may delay the onset of asthma in susceptible babies.

For a video link to the segment aired on Home and Family on Hallmark Channel go to: http://youtu.be/JN_tZYSRia8