SUMMER 2007 NEWSLETTER

PRACTICE NOTES

Helen Rose, MD, who joined us in January, is off to a strong start. Helen attended medical school at Temple University and completed her residency training at New York University. Prior to joining us, she helped patients in private practice in Virginia for six years. She has provided service to organizations that promote the development of children, medical research, quality medical education of pediatricians, and prevention of sexual abuse. In addition to her regular hours, Dr. Rose will be available to perform pelvic and gynecologic exams on teenage girls in the fall, though select appointments will be available this summer.

Norman Katz, M.D., who retired after the 2005 year, is doing very well. He spends time traveling, playing golf and tennis, pursuing his personal interests and keeping up with pediatrics. He sends everyone in the practice his best wishes.

David Atkin, MD, who retired in 1994, is also well and pursuing his interests in neurodevelopmental testing of children and bicycle riding.

OBESITY

Obesity in children in the United States is a rapidly expanding epidemic with numerous, negative health consequences: increased risk for arthritis, diabetes, high blood pressure, early heart attacks, certain cancers and early death. As pediatricians, we take the problem of obesity seriously, as should parents.

While the causes of increased obesity are complicated, controversial, and probably multi-factorial—genetic, learned and cultural (fast food, super-sizing, TV and a more sedentary lifestyle.) — the best treatment is simple: exercise. Exercise thirty minutes five times a week can reduce many of the negative effects of obesity. For any individual, exercise will also, along with reasonable portion size, decrease the percentage of body fat.

Exercise and better nutrition should be life-long. For a child to stay motivated through a lifetime, exercise should be fun and be a shared family or social ritual that is instituted at a young age. Exercise need not be formal or fancy, but one needs to carve out time and make it part of a daily routine. The entire family should learn better nutrition … it is never too late to start.

Some programs that we think can help families plan better exercise or nutrition programs for their children include:

BALANCE: THE WEIGHT LOSS MENTORING PROGRAM, Princeton Fitness and Wellness Center, Joanne Gordon, DTR, Nutritionist and Counselor 609-683-7888

NUTRITION PROGRAM, University Medical Center at Princeton, Sabina Beesley, MS, RD 609-497-4251

PRINCETON WEIGHT MANAGEMENT, Ned M. Weiss, MD, 609-924-4770

EATING MATTERS, Jill Shaffer, RD, Nutrition Therapist, 609-818-0020

THE NATIONAL INSTITUTE OF HEALTH WEBSITE (Obesity Education Initiative): www.nhlbi.nih.gov/about/oei/index.htm

For "AIM FOR A HEALTHY WEIGHT" www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/patmats.htm

For "PORTION CONTROL" http://hp2010.nhlbihin.net/portion/index.htm

NEW VACCINES

The last two years have brought many changes to our vaccine program. Even since last summer when our newsletter described new immunizations, there have been additional recommendations. These are summarized for you below.

Human Papilloma Virus vaccine: Preliminary observations from the use of this vaccine to prevent cervical cancer in our young patients is promising. The vaccine has proven to be safe and efficacious. However, we don’t know how long immunity will last or whether or not a booster will be needed. Currently, the American Academy of Pediatrics recommends the vaccine for girls older than 11. We concur, especially for girls of high school age, and have the vaccine available in our office.

Hepatitis A vaccine: An estimated 250,000 cases of hepatitis A infection occur in the United States annually. While many cases, particularly among the youngest children, are asymptomatic, symptoms are seen more often with increasing age. Typically, an infected individual expresses extreme fatigue, stomachache, nausea, vomiting and diarrhea, and develops jaundice or yellow skin. The average duration of symptoms is six to eight weeks; adults with hepatitis A infection miss an average of 27 days of work. The vaccine is effective with few side effects. We recommend that all children over 1 year of age receive the vaccine. Previous recommendations for immunization prior to foreign travel have been supplemented with a recommendation that immunization be accomplished before college entry. Simultaneous use of dormitory bathroom facilities with an international student population appears to enhance the risk of infection with hepatitis A virus. Two doses of the vaccine confer prolonged protection.

Pertussis vaccine: The tetanus and diphtheria booster got a face-lift last year. Replaced by the Tdap (tetanus, diphtheria and acellular pertussis) vaccine, the new "tetanus booster" is now given at 11-12 years of age. Why this change? The pertussis vaccine (the "p" in "dpt") that children receive at 5 years-old offers an average of only seven years of protection. By age 12, most children are no longer protected against pertussis ("whooping cough"). Why is this important? Pertussis is usually not a serious infection in a teenager, though infected teens can cough for as long as three months. Susceptible infants and toddlers can become extremely ill or succumb to pertussis and are often infected by adolescents. We recommend that teens 11 and older receive the Tdap vaccine and a Td booster every ten years thereafter.

Chicken Pox vaccine: Recent findings published in the New England Journal of Medicine suggest that immunity from the chicken pox vaccine wanes over time, and up to 30% of children will develop a mild case of chicken pox despite being vaccinated. Although serious complications are unlikely, breakthrough chicken pox is a contagious disease. Therefore, the American Academy recommends that all children receive two doses of the vaccine—at 12-15 months and four years of age. The State of New Jersey, which requires all children to receive one dose of chicken pox vaccine before entering school, has thus far been silent about the second dose. Our view is that we should wait for the state to act before suggesting a policy for young children. In the meantime, patients over 13 years of age who have received a single dose, can be revaccinated at their next checkup.

Meningitis vaccine: Infection from meningococcus is an unusual occurrence, affecting approximately 1-3 non-college students per 100,000 per year and roughly 6 per 100,000 first year college students and military recruits. But because of the severity of the illness (10-15% mortality and up to 60% morbidity), vaccination is recommended prior to college entrance. Since Menactra®, the meningococcal vaccine, protects recipients for at least 8 years and high school students are also subject to this disease, we recommend the vaccine for children over 13 years old or upon entrance to high school.

Rotavirus vaccine: Rotavirus is a common intestinal infection that affects millions of American children each year, some with devastating outcomes. Vomiting, diarrhea, lethargy, loss of appetite and dehydration (most often in infants) are the hallmarks of this disease. This disease is responsible for most cases of infant dehydration requiring hospitalization in the winter for intravenous fluid replacement. The oral rotavirus vaccine, Rotateq®, has proven to be effective and safe. We now recommend that all infants receive the vaccine at 2 months, 4 months and 7 months.

SUMMERTIME SAFETY

Sun and Heat Exposure

There are a few tips that will protect your child’s skin in the summertime. In babies, skin is thinner and more sensitive, so keep them in the shade. Dress infants in lightweight long pants, long-sleeved shirts, and brimmed hats. For children, apply sunscreen/block of >SPF 15 at least 30 minutes prior to exposure and every 2 hours. Attempt to avoid sun at peak times, between 10 a.m. and 4 p.m. Remind teenagers of the danger of sun, and that "pre-tanning" is not shown to decrease the risk of skin cancer. Choose sunglasses that block 99-100% of ultraviolet rays.

The most effective way to prevent overheating is to keep children very well-hydrated when humidity and temperature are high (non-caffeinated drinks and water are best). Encourage periodic drinking during activity and limit intensity of activity when it is for more than 15 minutes. Clothing should be light-colored, lightweight and limited to one layer of absorbent material to facilitate evaporation. Babies overheat faster than older children and adults, so watch them closely for overheating and don’t leave babies (and children) alone in a car. Watch for signs/symptoms of heat stroke/exhaustion (change in mental status, temp above 105, lack of sweating, loss of consciousness), and call your pediatrician if you are concerned.

Bicycle and Lawnmower Safety

Bicycle riding is a wonderful way for children to get exercise! To be safe they should always wear helmets and protective equipment. The bike should be the right size for your child, not a size that your child will grow into. Training wheels should stay on until your child is ready for removal, at around 5-6 y.o. and foot brakes are safer than hand brakes for the younger and less experienced rider. Young children should avoid traffic, and older children should ride with the traffic, in bike lanes if able, and follow traffic laws.

Lawnmowers can be a hazard if not used with care. It is very important that children don’t ride as passengers on riding mowers and that children under 16 y.o. don’t drive. While mowing, sturdy shoes, eye, and hearing protection should be worn. Pick up objects on lawn before mowing to avoid the danger of projectiles. Do not reverse mower if possible and of course, do not put a hand near moving blades

Preventing Insect Bites

Prevention is key! Do not use scented soaps, perfumes or hair sprays on your child. Avoid areas that attract insects - stagnant pools of water, uncovered foods, and gardens with blooming flowers - and avoid clothing with bright colors or flowery prints. Use insect repellent (30 % DEET is most effective, do not use on babies) but do not use combinations of DEET & Sunscreen (apply DEET separately first) as sunscreen is applied more often. Mosquito netting over a baby’s crib/stroller is a cheap and easy way to protect babies in buggy areas. There are many ticks in the Princeton area. Remember to check children and infants for ticks on days when they are out in grass or under trees. Have kids wear shoes when outside – splinters and lacerations are not fun either!

Plant Irritants and Dangers

Plants can cause an itchy, uncomfortable contact dermatitis or can even be dangerous if ingested. Learn to recognize poison ivy, etc (Google® it!) and teach your kids to avoid it. Check which plants are in your yard and in areas where your young children play. Some perennial plants are poisonous to people, investigate if you have young children. Have children wash with warm water and soap after gardening or playing in woods – this may prevent the rash that poison ivy can cause.

See your doctor if poison ivy rash is on the face, otherwise symptomatic treatment (Benadryl®, topical Cortaid®, oatmeal bath, ibuprofen) is often helpful.

Miscellaneous

Fireworks are not safe! Fireworks can result in severe burns, scars and disfigurement and those that are often thought to be safe (sparklers) can reach temps above 1000 degrees F. Parents should attend professional fireworks displays rather than using fireworks at home.

If you are going on a long trip, consider bringing a First Aid Kit. Consider including an information card (age, weightt, allergies, medical history, doctor phone number), pain reliever, all prescription medications (daily and as needed), lip balm, rehydration solution (Pedialyte), antibacterial and hydrocortisone ointments, insect repellent with DEET, sunscreen, tweezers, nail clipper, saline solution (for eye irrigation), hydrogen peroxide, and dressing/adhesive bandages. (See www.pedgroup.com/trvlinfo.htm for a more complete packing list and helpful suggestions.)