Milk and Your Toddler

Many parents ask me questions about transitioning their child from mom's milk/formula to cow's milk. Here are some tips that you should remember as you and your child make the switch:

Milk should be stored in a refrigerator that is cooler than 40 deg F. Once milk temperature reaches 45 deg or higher, bacterial growth can occur. Milk temperature can go up fairly rapidly, especially in warm weather. Generally speaking, milk should be used within 1 hour of taking it out of the refrigerator and should never be re-refrigerated.

Milk should be served at meal or snack times, but remember that toddlers should not walk around with a cup or constantly sip throughout the day. Those who constantly snack or sip their drinks give acid-producing bacteria a longer time to create damage/cavities.

In order for milk to be classified as "USDA organic," farms must meet the following criteria: cows are exclusively given feed grown without the use of pesticides or commercial fertilizers; cows are given periodic access to pasture and direct sunlight; cows are not treated with supplemental hormones and cows have not been given certain medications to treat illness. If you choose to give your toddler organic milk, make sure that it is treated with the conventional pasteurization process. Raw, unpasteurized milk may contain a wide variety of harmful bacteria including Salmonella, E. coli, Listeria, Campylobacter, and Brucella. These can cause illness and possibly death. Raw milk-related illnesses can be especially severe in infants and young children.

A toddler generally needs about 3 cups (24 oz) of total dairy, including milk and yogurt, daily. In general, toddler's tend to be picky and it can sometimes be hard to get them to accept a well-balanced variety of foods. Drinking too much milk may fill them up and make it more difficult to get them to eat other foods. Drinking excessive amounts of milk (more than 40 0z daily) can also lead to Iron deficiency anemia in some children, because milk can interfere with iron absorption in the intestines and can cause irritation in the GI tract leading to microscopic blood loss.

Dr. Sumita Ram
Pediatrician
Meriter Middleton Pediatrics
meriterkids.com

Fever: What Parents Need to Know

When should a parent worry about a fever in their child? With the flu and cold season lurking just around the corner, now is a good time to know how to treat a temperature and when to report it.

First of all, some basic information is good to know. Fever is a normal response of the body’s immune system, and everything designed to kill infection works better when the core temperature of the body rises. When we sense a foreign invader, our “thermostat” resets to a higher temperature—101.5 taken rectally usually being the cut-off. (Remember that rectal temps are better indicators of core temperature and will generally run about a degree higher than one taken under the arm.)

It is important to note that very few fevers are dangerous, the rare exceptions being a “broken thermostat” which only happens in severe hyperthermia (heat stroke) and malignant hyperthermia (a rare condition brought on by anesthesia). As a matter of fact, many children go on with their normal routine and act happy.

So when do you treat fever? When the child is uncomfortable or it becomes difficult to determine just how sick they are. For instance, I only gave anti-pyretics to my kids when they looked sick—never simply in response to what the thermometer read. In these instances, Tylenol (acetaminophen) is the drug of choice, Ibuprofen as a second line drug. (Aspirin is never used in children because of the risk of Reye’s syndrome.)

It is important to be more aggressive when the diagnosis underlying the fever is in question—always in infants under two months of age. Also, because a child with a high fever can look very ill, observing what happens when the fever is brought down reassures us that nothing serious is going on in terms of infection. So, always call for fever in an infant under two months, and in children who don’t respond to anti-pyretics.

To Summarize:
• Most of the time fever is beneficial, helps us to get rid of the infection
• Treat only for comfort and to help aid in the diagnosis
• Call for any fever in children under two months, and also in children who you think may be ill (fever lasting more than a couple of days, or children who don’t respond when the fever comes down)
• While anti-pyretics such as Tylenol and ibuprofen are safe, they are not always necessary
• Always call if you are unsure about what to do!

Dr. Ron Grant
Pediatric Hospitalist
Meriter Hospital
meriterkids.com

Rotavirus (or the lack thereof): A vaccine success story

As a hospitalist, I see a sicker patient group. Only when a parent is very worried or a clinic provider feels they need ongoing attention do I see a child in the ED or in the hospital. Now, as we approach the end of summer, I can’t help but feel like something is missing. Five years ago, it was common in the spring and early summer to have children in the hospital for vomiting, diarrhea and dehydration from rotavirus. Rotavirus is a common virus that infects most children under 5 years of age and is most severe for children under 2 years of age. Every year there was a significant number of children who needed to stay in the hospital for IV fluids while they recovered from this virus. So, where did it go?

If your child is less than 4 years old then you may remember an oral vaccine received at the 2, 4 and 6 month visits. In 2006, the FDA approved the vaccine RotaTeq® and shortly thereafter, it was recommended routinely for infants. Since that time there have been other similar vaccines approved as well. This vaccine is not 100% effective in preventing rotavirus, but its goal was to reduce the severity of illness and prevent the need for hospitalization.

Recently, there have been some published studies on the effect this vaccine has had in the United States. One study showed a 46% decrease in need for hospitalization. Another study showed 100% effectiveness in preventing hospitalization compared to children who did not receive the vaccine. Wow! As a younger physician, it has been wonderful to see the impact vaccines can have on the health and well being of our children.

Although I love meeting the children and their families, I am glad more kids are at home. Staying in the hospital is no fun for anyone. To rotavirus, I say good riddance and you won’t be missed.

Dr. Jim Bencivenga

Pediatric Hospitalist

Meriter Hospital

meriterkids.com

What Every Parent Should Know About Concussions

As a parent, it is exciting to watch your young athlete from the side-lines, making a great catch or kicking a goal. Also, as a parent, safety is always something that is in the back of our minds. One injury I would like to address is a concussion. It has brought recent media attention due to famous athletes or movie stars sustaining an injury to the head. However, it can affect any athlete.

What is a concussion?
A concussion is any injury to the head that potentially affects the function of the brain. It is usually the result of a blow or jolt to the head. However, it is important to know that it can also be secondary to a blow to any part of the body that causes the brain in the head to move back and forth, as per definition from the CDC. It is important to be aware of this because an athlete can sustain a serious concussion without a blow to the head. For example, imagine a hit to the shoulder, causing your head to move back and forth like whip lash.

A CDC study found that among youth ages 5 to 18 years old, the sports and recreation activities that generated the greatest number of emergency department visits for Traumatic Brain Injury were popular activities such as bicycling, football, basketball, playground activities and soccer.

What are some signs of a concussion?
After a blow to the head, talk to your doctor if you have any of the following signs of concussion:

• Headache
• Vision disturbance
• Dizziness
• Loss of balance
• Confusion
• Memory loss (called amnesia)
• Ringing in the ears
• Difficulty concentrating
• Nausea
• Feeling foggy or groggy
• Sensitivity to light or noise

However, some athletes may just say that they “don’t feel right.” This could be a sign of a concussion as well. Remember, you do not need to have loss of consciousness in order to have a concussion. If an athlete has been suspected to have a concussion, they should be evaluated by a physician. Secondly, due to new rules and regulations, the athlete will not be able to play that day and will need medical clearance by a physician in order to return to play for future games.

Recovery and safe return to play:
It is crucial to allow enough healing and recovery time following a concussion to prevent further damage. Research suggests that the effects of repeated concussion are cumulative over time.

Most athletes who experience an initial concussion can recover completely as long as they do not return to contact sports too soon. Following a concussion, there is a period of change in brain function that may last anywhere from 24 hours to 10 days. During this time, the brain may be vulnerable to more severe or permanent injury. If the athlete sustains a second concussion during this time period, the risk of permanent brain injury increases.

I encourage you to visit the CDC Web site to understand more about concussions.

Meriter Pediatrics now offers ImPACT concussion management baseline testing. Think of it as a pre-season physical for the brain!

Dr. Viren Bavishi
Pediatrician
Meriter Middleton Pediatrics
608.417.8388
meriterkids.com

The New Rules of Head Lice: Part 2

Continued from yesterday's post ...

What should you do if your child has head lice? First, all other household members should be checked. So should any kids who were likely to have direct head-to-head contact. Anyone with live lice or eggs close to the scalp should be treated. Anyone who shares a bed with the infested person should also be treated.

Hair care items and bedding that have been in contact with the infested person in the 48 hours prior to treatment should be cleaned. (If it’s been longer than 48 hours, any lice will already be dead.) A temperature of 130 degrees or more (by washing or drying) will kill lice and eggs. Furniture, carpeting, and other fabric covered items can be vacuumed. Pediculicide sprays are not necessary. If there is a concern about eggs surviving and hatching, items that cannot be washed may be placed in a plastic bag for 2 weeks.

Unless there is known resistance in the community, the first step in treatment is permethrin 1% or pyrethrins which are available over-the-counter. Permethrin 1% is the most studied and the least toxic of the pediculicides (lice-killers). Conditioners and silicone-based additives will interfere with permethrin, as will vinegar which is often used in an attempt to loosen nits from the hair shaft. When rinsing off pediculicides, use a sink instead of a shower or bath in order to reduce skin exposure. Using warm instead of hot water will minimize absorption. There are many other prescription medications that can be used if these over-the-counter products fail.
For those who cannot afford or who would prefer not to use pediculicides, wet combing or using suffocation methods can be attempted. An example of suffocation would be applying petroleum jelly to the hair and scalp and leaving it on overnight under a shower cap.

Misapplication is the leading cause of treatment failure. No treatment will kill all the eggs, so retreatment at specific intervals is recommended. Shaving, although effective, is not recommended. Any product that is meant to loosen nits can also damage the hair itself. Acetone, bleach, vodka, and WD-40 do not loosen nits. Please do NOT use kerosene, gasoline, or any other such flammable or toxic substance. They are not effective; they are just dangerous. Do not use products that are meant for animals.

Infested kids should definitely get treated, but they should not be kept out of school. The chance of transmission may not be zero, but it is lower than in other settings where head-to-head contact is more likely. One study at a school where over 14,000 live lice were found showed zero lice in the classroom carpeting. In another study, infested people spread lice to pillowcases only 4% of the time. And remember, head lice don’t carry any diseases, unlike mosquitoes which transmit a large number of diseases.

Just to put things in perspective, dust mites (see photo) thrive in bedding, mattresses, carpets, furniture…anyplace where there are tiny flakes of shedded human skin. Their fecal matter is a leading cause of allergies and asthma exacerbations. They are much more insidious than lice, but they don’t keep kids out of school.

Dr. Tracy Lee
Pediatric Hospitalist
Meriter Hospital
meriterkids.com

The Importance of Vaccinating Parents and Siblings to Protect Babies

“Whoop” This is the awful high-pitched inhaling sound people can make after a burst of coughing associated with pertussis. This sound is what gives it the common name: “Whooping Cough.” It has also been called the "100-day cough" due to the duration of the cough.

For adults, getting a case of whooping cough is annoying and sometimes painful given the severity of the cough, but usually only slightly worse than the common cold, especially early on. Many adolescents and adults don’t even develop the stereotypical “whoop.” For children, especially infants, this illness can be deadly. 85% of the deaths associated with pertussis occur in infants less than 3 months of age.

The good news is that we have a vaccine for pertussis. Fortunately, there has been a dramatic decrease in the number of pertussis cases since the introduction of the vaccine in the 1940’s, but we continue to see outbreaks every couple of years. Currently, California is experiencing an outbreak and there have been cases in Wisconsin as well.

The vaccine is given in a combination vaccine with diphtheria and tetanus, usually at ages 2, 4, 6 months, 12-18 months and 4-5 years. The vaccine is not fully effective until 3 doses are given, so children that are less than 6 months are at higher risk of getting the illness. Teenagers and adults tend to be those that spread the disease, because their illness is not as severe and many do not even know that pertussis is what is causing their illness. They also have waning immunity from the vaccines they received as a young child. Fortunately in 2005, a booster vaccine was developed.

This vaccine should be used in place of one tetanus booster. It contains tetanus, diphtheria and acellular pertussis (Tdap). Anyone that is around small children, especially new parents, should make sure they have received the Tdap vaccine. It is recommended that any new mother that is not immunized should receive it during the immediate postpartum period. If she is around children less than 12 months old during her pregnancy, she should receive it during the pregnancy.

If you have questions about your or your child(ren)’s immunization status, please be sure to discuss them with your primary care provider.

Dr. Dana Johnson
Pediatrician
Meriter McKee
3102 Meriter Way
Madison, WI
608.417.8388
meriter.com/pediatrics

Too Much Sugar - Part 2

(...continued from Tuesday's post...)

The kinds of calories that we eat affect are bodies in different ways. For example, fat in the diet has no effect on our insulin levels. Protein generally does not have much impact on insulin levels either, but in excess amounts protein can also be stored as fat. Carbohydrates exist in many forms such as complex carbohydrates and simple sugars. The rate at which a carbohydrate is absorbed into the blood affects the body's insulin response. In general, carbohydrates that are absorbed rapidly will cause higher increases in insulin levels. This can be a problem because insulin is a storage hormone. Broadly speaking, it promotes fat storage and inhibits our ability to burn fat. People who have chronically high insulin levels tend to hold on to their fat and will actually burn their muscle for energy when their glycogen stores are low. If you are insulin resistant, you are in a tough hole because you have decreased muscle mass (muscle at rest is metabolically active and burns more calories than fat) and your body has a hard time burning fat. That is why so many obese people have a hard time losing weight.

Glycemic index takes the body's insulin response into account. High glycemic index foods tend to lead to higher blood sugar levels, higher insulin levels, insulin resistance, and over time, lead to higher body fat levels and increased risk for obesity, heart disease and diabetes. Some high glycemic index foods include: white bread, pasta, rice, many cereals, foods containing a lot of simple sugar (candy and most desserts), sweetened beverages and low fiber baked goods. Low glycemic index foods include: vegetables, most fruits, minimally processed grains, legumes, lean meats and natural fats. You can “Google” glycemic index and easily find references on the internet. But a simpler rule to follow is avoiding processed food. Processed food is mostly that stuff in the middle of the grocery store. You know what I'm talking about. Man-made food. Stuff that comes in a box that you add boiling water to, or that you get in the freezer section and you throw in the microwave or heat up in the oven. Ready to eat. That's what I call factory food. It tends to have all sorts of stabilizers and preservatives in it. If the bacteria and mold won't eat it, why should you?

Soft drinks, juices and sports drinks are basically sugar water. Remember the 4.2 grams of glucose in your bloodstream. Well, a 12 ounce can of Coca Cola contains 39 grams of sugar (high fructose corn syrup - we'll save that battle for another day). Sorry to beat up on you Coke, it could just as easily be Pepsi. But let's face it, I had to dig around on your website for 10 minutes and bounce my way through 5 pop-up pages just to get to your nutritional information. Are you trying to hide something? I don't know many teenagers who limit themselves to a mere 12 ounces of a soft drink. So the average 12 ounces of soda contains almost 10 times your body's active glucose load.

I think I can say with a degree of certainty that we consume too much sugar. In fact, the average American consumes 300 to 600 grams of carbohydrate in all its forms on a daily basis. It is no wonder so many of us are overweight. For healthy weight management I recommend between 100 to 150 grams of carbohydrate daily (that's for an adult). It should come in the form of vegetables and fruits (yes, vegetables and fruits are nature's carbs). If you read Dr. Grant's post and are running regularly (please give it a try - you'll only have yourself and Dr. Grant to thank) you can allow yourself more. Read his excellent introduction to running for novices.

Endurance athletes can burn through a lot of glucose. But please try to avoid processed foods and sugary/high glycemic foods in your diet, and I promise you it will be easier to maintain a healthy weight. Eat foods that are as unprocessed as possible and avoid anything that is "modified" "processed" "trans" "partially trans" "inverted" or any other industrial sounding word.

Dr. George Idarraga
Pediatrician
Meriter McKee
3102 Meriter Way, Madison
6008.417.8388
meriterkids.com

Too Much Sugar – Part 1

I recently read that the average adult has about 1 teaspoon of glucose (sugar) in his or her bloodstream at one time. That's a normal size adult with a normal blood glucose level. So that's about 4.2 grams of sugar dissolved in the bloodstream at any time. It doesn't seem like very much but even a small excess of sugar (glucose) in the blood, if present for a long time, can start to cause all sorts of damage.

People with poor blood glucose control, be they type 1 or type 2 diabetic, or even pre-diabetic, are at risk for all sorts of medical problems: kidney disease, heart disease, hardening of the blood vessels, loss of vision, nerve damage, poor blood circulation - to name a few. That is why when we consume sugar, in any of its forms, the pancreas secretes insulin to transport the sugar (glucose) out of the bloodstream and into cells where it won't cause harm.

So what does our body do with the sugar we consume? Some of it will be used as fuel to support our immediate metabolic needs. Some of it will be stored as glycogen in the liver and muscles. Our brain will burn a significant portion of it and store a small fraction of it in glial cells (a type of nerve cell). The average brain can go through about 500 Calories of glucose a day. You may have heard that the brain runs only on glucose. Well, that's not entirely true. The brain needs a minimum of about 20 percent of its Calories from glucose, but it can actually run mostly on ketones, another type of fuel that our body can use. Our red blood cells run exclusively on glucose. If there is excess sugar present after all this it will be stored as - fat. Yes. Fat. It's important to remember that this is a dynamic process. We are constantly consuming and expending energy, and hopefully if the intake matches the output, our weight stays constant and we don't get fat.

So why are so many of us overweight and obese? Well. While inactivity definitely contributes to obesity, it turns out that the answer is a little more complicated than “calories in = calories out.” Visit again on Thursday when I’ll post “part 2” to answer this question.

Dr. George Idarraga
Pediatrician
Meriter McKee
3102 Meriter Way, Madison
608.417.8388
meriterkids.com

The Importance of Family Time

When I was growing up, my parents always made it a point to sit down and eat dinner as a family. Although like most siblings, my sister and I would often end up arguing or bothering each other, it was our family time to catch up and talk at the end of the day. If I had a good day, it was my chance to share my happiness with my family. If my day wasn't so good, it was my chance to unburden myself at the end of a long day. Sometimes I did not talk, but instead listened. I listened to my sister talk about her plans for the weekend with her friends, or about the teacher who she was sure hated her. I heard about my father’s day at work or about something interesting my mom had heard from her friends. Sometimes, on occasion, I even heard stories from my parents about their childhood.

Flash forward many years later, I have two children, a great wife, and a wonderfully hectic life. Between work and extracurricular activities, we seem to always be on the go. However, despite the occasional craziness, we try to maintain one constant--the family dinner. Of course, due to busy schedules, it isn't always possible for all of us to eat together. So, we've created another family tradition, sharing time before bed. We spend a few minutes before bed talking about what made us happy during our day and what made us feel not so happy. And if there's time, my wife and I take a few minutes to tell family stories, either about our children when they were smaller, or about our own childhoods.

I truly believe that it is important for families to consistently take the time to talk at the end of the day. Families may choose dinner or bedtime, or even some other time that works best for them, but regardless of what they do, the end results is the same--bringing the family closer and bringing security to our children. In fact, studies have suggested that teens that engage in family dinners more than 5 times a week were less likely to engage in smoking, drinking or using drugs, and in fact, performed better in school.

Now being a parent, I completely understand why my parents made this a routine. Times are different now, compared to then, but the need to connect as a family still remains. I'd be interested to hear what "family-time routines" you've started - please leave me a comment on Facebook.

Viren Bavishi, D.O.

Pediatrician

Meriter Pediatrics

2275 Deming Way, Suite 220

Middleton, WI 53562

608.417.8388

meriterkids.com

Swimming Safety

Summer break is finally here and kids will soon be spending more time in and around water. Swimming is a great way for kids to get exercise and stay cool during the summer, but it is important to swim safely.

Remember to protect children from the sun. Sunburn is a risk factor for skin cancer. In 2003, a total of 45,625 new cases of melanoma were diagnosed in the U.S., and 7,818 people died from the disease. Check out Dr. Johnson’s Sun Safety blog (March 22, 2010).

Drowning is the second leading cause of unintentional injury deaths for children ages 1 to 14.

• Never – even for a moment – leave small children alone while in bathtubs, pools, spas or wading pools, or near standing water. With infants, toddlers and weak swimmers, an adult should be within an arm’s length.


• If you have a pool, install a four-sided fence. This includes inflatable and above ground pools.


• Children need to learn to swim. AAP supports swimming lessons for most children 4 years and older. New studies suggest classes may reduce the risk of drowning in younger children aged 1-4 as well.


• Parents, caregivers and pool owners should learn CPR.


• Do not use air-filled swimming aids (such as inflatable arm bands) in place of life jackets.


• Counsel teenagers about the increased risk of drowning when alcohol is involved.

Check out the American Academy of Pediatrics (AAP) updated guidelines on water safety and drowning prevention: http://www.aap.org/advocacy/releases/may2410studies.htm#drowning

Learn basic facts about recreational water illnesses.
The number of recreational water-associated outbreaks is increasing with a total of 78 outbreaks affecting 4,412 people reported for 2005-2006. The CDC recommends the following steps to prevent outbreaks:

• Never let your child swim when they’re not feeling well.


• Don’t let them swallow pool water.


• Practice good hygiene. Shower with soap before swimming and wash your hands after using the toilet or changing diapers.


• Take your kids on bathroom breaks or check diapers often.

Public and pool users can test water at their local pool or hot tub. Free test strip kits can be ordered at: http://healthypools.org/freeteststrips/

You can check the quality of water at local lakes and beaches at the following sites:
http://www.wibeaches.us/apex/f?p=BEACH:HOME:620813377447211 and http://dnr.wi.gov/lakes/

Stay cool!

Dr. Sumita Ram
Pediatrician
Meriter Pediatrics
2275 Deming Way, Suite 220
Middleton, WI 53562
608.417.8388
meriterkids.com

Get Rid of Your Unwanted Medications at MedDrop

With the recent voluntary recall on Infants’ and Children’s Tylenol, Motrin, Benadryl, and Zyrtec, you may have some bottles sitting around in the cabinet gathering dust. (For more information about the recall and to get a refund or product coupon, please see http://www.mcneilproductrecall.com/.) Maybe there are some nearly empty vitamin drops, unfinished antibiotics, old inhalers, or even unused pain pills? Maybe there are medications that have expired, and you just haven’t gotten around to disposing them?

There’s no point in keeping them in the house. Expired medications can be ineffective. Leftover meds can be a safety risk with kids or pets in the house. But, throwing medications into the trash or flushing them down the toilet can harm the environment, affect our water supply, and in the end, come back to us in ways we don’t want.

MedDrop is a volunteer run program where you can drive through with your meds, answer some very basic questions (e.g., what is your zip code; is the drop-off place a good location for you), and feel good that the meds will be disposed of in a safe manner.

Saturday, June 5, from 9am to 1pm, volunteers will be at three locations: LaFollette HS, Middleton HS, and the Sun Prairie Recycling Center. You can bring prescription meds, over-the-counter meds, meds for pets, inhalers, vitamins, and even illegal drugs (which will be taken with no questions asked). If possible, please keep them in their original containers. The meds and their containers will be disposed of in a way that will maintain patient confidentiality, but feel free to cross off your name and other personal info if you like. Just leave the name of the medication visible, so the volunteers can properly dispose them.

For addresses, detailed instructions, background information on the program, volunteer opportunities, and lots more, please check out their Web site.

Dr. Tracy Lee
Pediatric Hospitalist
Meriter Hospital
meriterkids.com

What is the Meriter Pediatric Center?

I am so excited! Not only is this my first opportunity to write a blog, but also the long-awaited opening of the Meriter Pediatric Center is only a day away! On Tuesday, May 18th, the hard work of so many over the past two years will finally come to life. A Pediatric Center is a new concept for many of us, so I thought I would take this opportunity to explain what you can expect of a visit to the Meriter Pediatric Center.

The Meriter Pediatric Center is an 8-bed unit, located adjacent to the Emergency Department, which is staffed by Nurses, Physician Assistants, Pediatricians, and Emergency Physicians, all of whom are trained to care for children. The Center was designed specifically with children and their families in mind, and will centralize care for the majority of children receiving emergency and inpatient services at Meriter Hospital. For children 17 years of age and younger who come to Meriter for non-life-threatening emergency visits, there are 5 exam rooms dedicated to their care, along with a pediatric-only waiting area. There are also three inpatient beds which will be reserved for children 15 years of age and younger who require hospital admission for observation, further treatment or post-surgical care.

Outside of the Pediatric Center, children will continue to be cared for across the entire hospital for a host of other services, including outpatient surgical procedures, medical imaging procedures, and therapy visits. In addition, patients with severe illness and injury will continue to be cared for in the main emergency department. Children ages 16 and 17 years who require hospitalization will be admitted to the appropriate specialty unit, but will be cared for by pediatricians, surgeons or family medicine physicians.

I hope that you and your child never need the services of the Meriter Pediatric Center. But if you do, know that your child will be in the excellent hands of caring and professional staff who are all dedicated to providing the best care possible for children.

Have a Happy and Healthy Summer!

Dr. Nicole Baumann-Blackmore
Medical Director, Pediatric Hospitalist Program
Meriter Hospital
meriterkids.com

Bug Off!

It’s so exciting that spring is finally here after our long Wisconsin winter! Continuing on the summer theme, I’d like to talk about protecting kids from those pesky mosquitoes. Ordinarily, the bites of mosquitoes are just a nuisance. The bite may cause itching or swelling (a lot more swelling in some people than in others — and, yes mosquitoes definitely prefer some of us more than others).

Here are some tips to avoid mosquito bites when outdoors:
- Don't use scented soaps, perfumes or hair sprays on your child.
- Avoid areas where insects nest or congregate, such as stagnant pools of water, uncovered foods and gardens where flowers are in bloom.
- Avoid times when mosquitoes bite. Generally, the peak biting periods occur just before and after sunset and again just before dawn.
- Wear appropriate clothing. Long-sleeved tops and long pants made of tightly woven materials keep mosquitoes away from the skin. Be sure, too, that your clothing is light colored. Keep trouser legs tucked into boots or socks.

You will also need to use an insect repellant. DEET-containing products are the most effective mosquito repellents available. DEET has been used for over fifty years with a very good safety profile. Other products have not necessarily been as thoroughly studied as DEET, and may not be safer for use on children. The American Academy of Pediatrics Committee on Environmental Health feels that products containing DEET up to concentrations of up to 30% are safe for use in children 2 months and above. In choosing the strength of DEET to use, keep in mind that the more DEET a product contains, the longer the repellant can protect against mosquito bites.

Products containing citronella, lavender, mineral oil and soybean oil generally do not last very long. Herbal products containing lemon eucalyptus oil as a repellant are the only ones found to have effectiveness similar to DEET containing products. Those are only recommended in children above the age of 3 years old.

When using DEET containing repellants in children, keep in mind the following safety tips:
- Select the lowest concentration effective for the amount of time spent outdoors. It is generally agreed that DEET should not be applied more than once a day.
- Apply the product to your own hands and then rub them on your child. Avoid children's eyes and mouth.
- Do not apply repellent to children's hands. (which often end up in their mouth)
- To make sure your child’s skin will not react to the repellent, apply the product to a small area of skin, arm or leg before general use.
- Use just enough repellent to cover exposed skin and/or clothing. Do not use under clothing.
- After returning indoors, wash treated skin with soap and water. Wash treated clothing before wearing again.
- Do not apply over cuts, wounds or irritated skin.
- Do not spray DEET-containing products in enclosed areas. DEET products will NOT repel stinging insects such as wasps and bees.

Questions or comments? Please post them on our Meriter Facebook Page.

Enjoy your time outdoors,

Dr. Sumita Ram
Pediatrician
Meriter Pediatrics
2275 Deming Way, Suite 220
Middleton, WI 53562
608.417.8388
meriterkids.com

Keeping Summer Fun

Whoever thought that age four would be the time to start worrying about extracurricular activities? The arrival of the YMCA and MSCR summer guides began my internal debate.

Perusing through the pages of both guides peaked my interest in many activities. I haven’t played tennis is over five years, and the adult tennis class sounds like fun. If only I was ten again, I could go to summer camp. . . Okay, back to my four-year-old. Up until this year, he was too young for many activities. Promoting a healthy lifestyle (including physical activity) at this age is very important for life-long health, but do I sign him up for karate or swimming or gymnastics or yoga or outdoor soccer or a soccer camp or a multi-sport camp or . . . The list goes on and on, and it will only get longer as he gets older.

As with all families, our time is limited, and I want to make the most of the time we are together. I also look forward to having trips to the library, zoo, park and many of the other amenities offered by living in Madison. We also want to take short weekend trips to explore new places and if I fill the summer with scheduled activities, when will we go exploring? My son has taught me that spontaneity can be the most fun. Children benefit from structure in some activities, but also need time to explore the world on their own and create their own adventures. My husband and I thought it was a great idea to go see the St. Patrick’s Day parade. My son enjoyed the parade, but had just as much fun running around the Capital lawn playing hide-and-go-seek. I don’t want to limit these opportunities to create his own fun (and mine, for that fact) by scheduling away all our free time.

The American Academy of Pediatrics has a good article to help guide parents: http://www.healthychildren.org/English/healthy-living/fitness/Pages/Physical-Activity-Make-the-Right-Choice-for-Your-Child.aspx.

So, I continue to have the internal debate, but for the time being, my son is only scheduled in 1-2 activities per week. I am planning to keep all weekends free in the summer for exploring and discovering what fun we can have on our own. The most important thing is for us to figure out what works for our family, stay active and have fun.

Dr. Dana Johnson
Pediatrician
Meriter Pediatrics
2275 Deming Way, Suite 220
Middleton, WI 53562
608.417.8388
meriter.com/pediatrics

When April showers bring more than May flowers

Yes, spring is finally here … I always look forward to this season. You can see the grass turn green, flowers starting to bloom. Ah, fresh air. But for some people it may be a season that brings misery. Seasonal allergies are common at this time of the year. According to the Asthma and Allergy Foundation of America, more than 40 million Americans suffer from indoor/outdoor allergies. Unfortunately, kids can suffer from seasonal allergies as well. In fact, if a parent has allergies, the risk is higher for the child to develop them. I guess my kids can blame my wife and me for theirs.

What are the symptoms? Sneezing, clear nasal discharge and itchy eyes, are typical complaints. Sometimes a pattern of chronic colds may occur at the same time of the year as well. Other complaints may include throat clearing, stuffy nose, itchy nose and throat. In some individuals, a cough may be present. Children with allergies may have dark circles under their eyes, called "allergic shiners." And everyone has seen the classic "allergic salute." My son can demonstrate this very well. (It’s the process of itching or rubbing the nose upward with their palm.) Untreated allergies may also affect a child’s sleep patterns as well, which in turn, may affect their school or sports performance.

Sometimes the symptoms of a cold may be mistaken for allergies and vice versa. But, duration, fevers, color of discharge, as well as other symptoms can be used to differentiate between the two. For example, a fever may accompany a cold, but you would not expect that with seasonal allergies. If you are not certain, my advice would be to discuss this with your child’s doctor.

Treatment:
· Limit the time spent outside or during the peak times of pollen count
· Change clothes and wash your child’s hair after they play outside
· Keep the windows closed, or turn the air conditioner on (assuming it’s warm outside)
· Tree pollen counts may be high early in the morning during spring. During the summer, try to avoid the afternoons or early evening, to avoid grass pollen. Ragweed allergy is prevalent in the fall season and high during midday.

Medications: There are many medications to treat allergies, ranging from over the counter anti-histamines to prescription nasal sprays and medications. I’m certain you have seen the commercials. The variety of medications in the pharmacy can be quite overwhelming. My advice would be to talk to your child's doctor. You want to make certain the symptoms are consistent with seasonal allergies and not any other condition, and you also want to make sure they are age-appropriate. Allergy medications and homeopathic remedies may also have side-effects that can cause drug interaction, serious and dangerous side-effects and cause injury.

I hope that you and your family are able to enjoy this vibrant time of year.

Viren Bavishi, D.O.

Pediatrician

Meriter Pediatrics

2275 Deming Way, Suite 220

Middleton, WI 53562

608.417.8388

meriter.com/pediatrics

To fly or not to fly … with a toddler

A number of years ago, my wife and I decided to take a trip to California with our 22-month old daughter, Sophia. We reserved a hotel, arranged for a rental car, and booked the 4 hour flight to San Diego. Like anyone else, I was looking forward to vacation. I imagined showing Sophia the ocean, visiting the zoo, and just getting away from the every day routine. It was all good until a friend questioned my sanity, saying to me “Flying with a toddler is crazy. She’ll probably cry the whole flight.”

Happy visions of strolling along the beach were replaced with nightmare-ish visions of my daughter screaming the entire flight, or throwing sippy cups and toys at the heads of the passengers in front of us. Determined to get our vacation off to a good start, my wife and I came up with a plan. We made lists of what we needed to bring on the plane and armed ourselves with books, toys, games, food and plenty of diapers.

Finally the day came. Sophia ran from window to window looking at all the airplanes. I boarded first and installed the car seat, and my wife waited until the end to board, letting Sophia burn off a little extra energy. At first, things were great. Sophia sat happily in her car seat, drank some juice and ate cheerios. Then, about an hour in, she got squirmy and we read some books and colored. Two hours in, the fussiness started. We got out the toys and she played happily for a while. About three hours into the flight, we reached the level of desperation and brought out...the finger puppets. Yes, one for each finger. My wife sang songs and I made the finger puppets dance. Sophia laughed and all was right in the world. Of course, she fell asleep just as the pilot started the descent.

Overall, it was a successful flight—minimal ear pain for Sophia, minimal angry looks from fellow passengers (people around us were very nice) and minimal tears. Truly, flying with a child does not have to be stressful, especially if you set realistic expectations and plan ahead.

Here are a few tips on flying with babies and young children:

Dealing with ear pain: Babies and young children may cry in response to the sudden change in cabin pressure, which can cause ear discomfort. Usually this occurs during take-off and landing. The act of sucking, by nursing, bottle feeding, or using a pacifier, may help alleviate some of this pain.

Do not use Benadryl or cough and cold remedies: I often get asked about giving Benadryl or cough and cold medications prior to flying. I usually do not recommend them because 1) they are not approved for children under two years of age and 2) some children actually have the reverse effect and become “hyper.” Also, even if it does make your child sleepy, it may make them more irritable after they wake up. I highly recommend talking with your child’s doctor if you have questions about this.

Separate seat vs. lap child: If at all possible, purchase a seat for your infant or child (children under 2 years of age fly free as a “lap child” on most airlines). You’ll have more room to move, and more importantly, your child will be safer. When turbulence kicks in or an emergency landing takes place, it can be very difficult to keep the child safely in your lap, regardless of how tightly you hold them. According to the American Academy of Pediatrics, “Preventable injuries and deaths have occurred in children younger than 2 years who were unrestrained in aircraft during survivable crashes and conditions of turbulence.” Also, check with your airlines for discounted seats for infants. You can use a car seat on the airplane. Just make sure that is an FAA approved car seat.

Wait to board the plane: While many airlines allow families with small children to board first, this often means that your child will be sitting in the seat for quite a while before the plane actually departs. If you are flying with another adult, one can board first and get everything settled (including car seat installation), and the second can follow later with the child.

Keeping the seat belt on: For older children who have not flown before who will not be using a car seat, have a few play sessions at home, pretending to be on a flight . Use an old belt, or anything you have that can be buckled. Have a few discussion prior to the trip about the importance of keeping the belt on, and stress that the plane will not take off unless everyone is buckled up.

Be prepared. Flights are often delayed, so bring plenty of food and drinks (check the TSA Web site to see what is allowed), plenty of extra diapers and several changes of clothes (including a spare short for each parent in case of “accidents”). Also, bring familiar and favorite toys or games. While new toys might be a good distraction for older children, babies and younger children often prefer playing with the toys they use everyday.

Allow ample time: The process from checking in your bags to the arriving at your gate may be long. Allow yourself enough time to get through the security screening process as well. If you have older children, it is important to talk about the screening process ahead of time. Their personal belongings such as dolls, toys and games, will be placed under an x-ray screen, but will return to them after they walk through the security screen themselves.

Have realistic expectations: Your child will probably cry at some point during the flight. Accidents and spills may happen. You probably won’t have much time to read that magazine you picked up at the airport. But, with a little preparation and planning, you can make flying a great experience for the whole family!

More than 7 years later, my daughter is a seasoned traveler. She even packs her own carry on bag and entertains herself on flights by reading or drawing. I’ll admit, it’s nice to have some time to myself to catch up on reading during the flight, but there is a part of me that misses the songs and the finger puppets.

Safe travels……
Viren Bavishi, D.O.
Pediatrician
Meriter Pediatrics
2275 Deming Way, Suite 220
Middleton, WI 53562
608.417.8388
meriter.com/pediatrics

The Truth about Meningitis

By now, you may have read or heard about the young University of Madison senior and the Mt. Horeb High school girl who recently died from bacterial meningitis. It’s pretty scary to hear of such stories in otherwise healthy young people. The good news is, you don’t have to panic. Fortunately bacterial meningitis is very rare. There is also a vaccine available to help prevent the most common type of bacterial meningitis that occurs in teenagers and young adults.

So what is meningitis? It is a disease caused by the swelling or inflammation of the protective covering of the brain and spinal cord known as the meninges. This inflammation is most commonly caused by an infection of the fluid surrounding the brain and spinal cord usually by a bacteria or a virus. Symptoms of meningitis are fever, severe headache, stiff neck, sensitivity to light, altered mental status, nausea and vomiting.

Meningitis caused by viruses is the most common type of meningitis. It usually tends to be less severe and it clears up on its own without any specific treatment. There are usually no long term consequences. Bacterial meningitis, on the other hand, can be quite severe and can cause long term damage and even death if not treated immediately with antibiotics. Although it can be serious, routine vaccinations given to all children has reduced the numbers of three of the most common types of bacterial meningitis.

The type of bacterial meningitis most commonly seen in teenagers and young adults is caused by a bacteria called Neisseria meningitis and is what the two young girls mentioned above had. This type of meningitis is not spread by casual contact. It is spread by direct contact with oral secretions. So just being in the same school or just breathing the same air that a person with meningitis had been would not give it to you. On the other hand, kissing; sharing the same utensils or toothbrush; frequently having slept in the same dwelling as the infected person; or sitting very close to a person (such as in airline travel) for more that 8 hours could put you at risk for getting Neisseria meningitis. If you have had this type of close contact within seven days with someone who developed meningitis, you should talk to your health care provider about getting antibiotics to prevent illness.

In order to prevent infection with Neisseria meningitis, it is also recommended that all all pre-teens between the ages of 11 to 12 get the meningococcal vaccine which prevents against most, but not all strains of Neisseria meningitis. It is also recommended for all college freshmen living in a dormitory or if you are a military recruit because this disease is more common in young adults and infectious diseases tend to spread quickly wherever larger groups of people gather together. There are also other high risk groups in which the vaccine is recommended such as in people who have problems which affect their immune system.

So, remember, bacterial meningitis is rare but can be very serious and even life-threatening. It can be treated successfully if dealt with promptly. It is important to get routine vaccinations. Know the signs of meningitis and if you suspect that you or your child has the illness or has been exposed to the illness, seek medical care right away.

Dr. Sumita Ram
Pediatrician
Meriter Pediatrics
2275 Deming Way, Suite 220
Middleton, WI 53562
608.417.8388
meriter.com/pediatrics