For years, our phone nurses have used Dr. Barton Schmitt's book of pediatric protocols to help advise families about a host of ailments.  Now, Dr. Schmitt has published a similar book geared towards parents entitled, "My Child is Sick!"  The book was selected by Library Journal as one of the 10 Best Parenting titles of 2011.  Dr. Schmitt's advice is very clear and practical.  This book makes for a great addition to your bookshelf, and it would also make a nice gift for a family expecting their first child.  To buy it, click here.  If an actual book made of paper is too old-school for you, check out HealthyChildren.org's KidsDoc Symptom Checker.

 

On October 25, the CDC’s Advisory Committee on Immunization Practices officially recommended that boys should receive Gardasil, a vaccine for Human Papillomavirus, at age 11 - 12.  (See New York Times article here.)  HPV causes cervical cancer in women and various other cancers in both genders.  The new recommendation is an important step in the effort to improve utilization of this cancer-preventing vaccine.  The HPV Vaccine has been recommended for girls since 2007, but many families have been slow or reluctant in vaccinating their girls.  Some families have a hard time thinking about this at age 11 or 12.   It is therefore worth mentioning a few plain facts about human papillomavirus, the HPV vaccine, and sexual activity:

• HPV is extremely common:  1 out of 4 adults have it
• HPV causes a variety of diseases; in addition to cervical cancer, it causes throat cancer, anal cancer, and genital warts
• The HPV vaccine works best when it is given before the age of sexual activity
• The vaccine gives the best immune response when given at age 11 – 12 (100-times better immune response compared to age 26)
• 43% of teenagers have been sexually active
• Only 78-85% of teenagers used contraception during their first sexual activity

 

So as you can see, this is an extremely common infection, and the vaccine works best when given at a younger age, well before the initiation of sexual activity.  To put it another way, would you advise your teenage driver to start wearing their seatbelt only after their first accident or two?  For any of the standard vaccines that we give, the goal is to protect our kids before they are exposed to the illness – the HPV vaccine is no different.    

Discussing the HPV vaccine is also an opportunity for you to begin an ongoing discussion about sexuality with your child.  Who do you want your child to learn about sex from?  If you are waiting to discuss it until puberty, or when you perceive that your child may be sexually active, you are waiting too late.  One resource in this discussion is Mary Flo Ridley, a local speaker and author who has become a nationally-recognized expert in advising parents on how to talk to their kids about sex.    

 

"Well, she has a runny nose,  and she has been fussy for 3-4 days, and we thought it was teething.  Now she has fever to 102.8, and she is more unconsolable and she can't sleep.  What do you think, doc?"

Teething can be an uncomfortable part of growing up that may affect babies off and on throughout the first two years of life.  Teething is unlikely, however, to be the explanation for more severe or serious symptoms.  A new study published in Pediatrics demonstrates this nicely -- the researchers followed a group of children and monitored them for symptoms in the days before, during, and after tooth eruption.  It turns out that fussiness, drooling, decreased appetite, loose stools, and sleep disturbance are common with teething, just like Grandma says.  Fever or more severe symptoms should not be attributed to teething, though -- such symptoms should prompt a search for some other cause.  The bottom line:  for fever of 100.0F or higher, some other illness should be suspected.  

 

Just in time for back-to-school checkups, we have received FluMist, the nasal spray form of the influenza vaccine.  The flu vaccine is recommended for everybody 6 months of age and older.  FluMist is only approved for those 2 years of age and older, but we anticipate receiving the injectable form of the vaccine approved for all ages soon.  Health Day reports here that children benefit from either form of the vaccine, but the nasal spray in particular gives a better immune response in kids.  The flu vaccine can be given at any well visit, at a nurse visit any time during the week, or during one of our special Saturday morning flu clinics to be scheduled throughout the fall.  We will be announcing dates soon for the Saturday vaccine clinics.  

A new feature debuts today on your friendly new-and-improved forestlanepediatrics.com -- the American Academy of Pediatrics' Patient Education Online database is now accessible through a purple search box on the right side of the home page.  Patient Education Online contains reliable, up-to-date health and safety information from the AAP.  You can type in any search term, say, "fever" or "temper tantrums" or "sunscreen", and helpful informational articles will pop up.  This can be a useful place to start if you are "Googling" about your child!  

The Environmental Working Group, my favorite resource for sunscreen reviews and safety, has released their Sunscreen Guide for 2011.  They even have an iPhone app you can use in the store.  Take-home-messages for this year:  

• zinc oxide and titanium dioxide remain the safest and most effective ingredients
• avoid oxybenzone, a possible hormone-disrupting chemical sunscreen ingredient
• avoid retinyl palmitate, a vitamin A derivative that can heighten skin-cancer risk
• make sure your sunscreen has good protection for both UVA and UVB rays  

 It appears that there are more sunscreens on the market than ever before, but it can still be hard to find sunscreens that meet the above criteria.  At a certain local supermarket the other day (rhymes with Groger), I could only find one acceptable sunscreen out of the dozens on the shelf.  Over the past year, I have had the best luck with Blue Lizard (CVS, Walgreen's), California Baby (Target, Central Market, Whole Foods), and Badger (Whole Earth Provisions).  Sun-protective clothing and hats are always a good idea, too.  It is definitely the time for fun in the sun, so keep you and your little ones safe this year!  

 

First of all, welcome to the shiny new web design for Forest Lane Pediatrics!  In addition to just looking mighty sharp, we hope the functionality is better, too.  Soon we will be launching a new-and-improved Patient Portal, where you will be able to review and print your child's vaccine records, see when your next appointment is scheduled, and share other information with us.  More info coming soon about that, but first and foremost, I need to mention the CDC's new advice for how we should all prepare for a Zombie Apocalypse.  Who knew the Centers for Disease Control had such a sense of humor?  Beyond the initial shock value/comedic value of this post, there is actually some useful information about how to prepare you and your family for any type of emergency, zombie-related or not.  Natural disasters can strike at any time, so a little bit of preparation can be a good thing.  Especially if World War Z breaks out.  

When speaking with families about ways to combat childhood obesity, I sometimes struggle to find the right level of advice.  It is possible to be too simple ("Eat Less, Exercise More") or too complicated (a long list of "do this" and "don't do that").  The Wall Street Journal reports on "Let's Go!", a community initiative in Portland, Maine that increased awareness about healthy eating and exercise habits.  Since they started the program five years ago, they have seen some modest success in reducing the numbers of overweight and obese kids.  Their concept is simple enough to grasp and remember, but sophisticated enough to make a difference.  5-2-1-0 represents a daily scorecard of do's and don'ts:

5 servings of fruits or vegetables per day

2 hours or less of screen time per day (TV, computer, video games, etc.)

1 hour of exercise per day

0 sugary drinks (sodas, processed fruit juice, kool-aid, sports drinks, etc.)

 

See if these rules of thumb can help you set specific goals for your day!

 

The safety data have been accumulating for several years now, but this week the American Academy of Pediatrics changed their official recommendation to state that children should remain rear-facing in their car seats until age 2, or until they have reached the rear-facing weight and height limits for their car seat.  Additionally, older kids should remain in a belt-positioning booster seat until they are 4 feet 9 inches tall and are at least 8 years old.  The bottom line is that kids are safer in the rear-facing position:  under age 2, they are 75% less likely to die or be severely injured in a collision if they are rear-facing.  For every excuse that you can think of as to why your child would really rather face forward, please refer back to this statistic for your answer:  75% less likely to die or be severely injured.  The New York Times summarizes these recommendations nicely here, and the AAP provides more advice and specific car-seat information.

If you ask any pediatrician the most common reason for a middle-of-the-night call, I am sure it would be fever.  For obstetricians, the answer must surely be a mother in labor.  With fever, we do our best to identify the source of the fever, help with the child's comfort, and reassure parents that fever is not harmful.  In fact, fever is the body's natural, appropriate response to an illness.  This week, the American Academy of Pediatrics released helpful guidlines to educate physicians and families about "Fever Phobia," and the Wall Street Journal presents a nice summary here.

In modern times, obstetricians have managed some of their middle-of-the-night issues by recommending induction of labor during daylight hours.  The "discomforts of pregnancy" are admittedly substantial, so many moms are relieved to consider this option.  Induction of labor prior to 39 weeks gestation has proven to have some drawbacks, however, so there is a current push to limit these pre-term inductions.  The Journal summarizes this issue here.  An induction before 39 weeks increases the rate of complications for the baby, and also increases the rate of a "failed induction," leading to more C-Sections.  Ultimately, the Good Lord and Mother Nature know best, and they figured out this "40-week pregnancy" thing for a reason.  Waiting until the baby is good and ready ends up being better for both mom and baby.