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 New Rules for Head Lice: Part 1

On July 26, the American Academy of Pediatrics updated its clinical report on head lice. It is common in school-aged kids, and it can be found all over the world. It affects all socioeconomic groups, and it can affect anyone regardless of hygiene. Mere mention of it can cause itchiness. It seems that resistance to standard treatments is on the rise. And yet, the AAP is pushing for kids to stay in school despite having lice. What’s going on?

Head lice are tan to grayish-white, and they are 2-3 mm long. Their eggs are even smaller. Their life cycle is about 3 weeks long. They feed by sucking tiny amounts of blood. Sensitization to their saliva as they feed is what makes us itchy, but this can take 4-6 weeks to develop. This means that by the time the diagnosis has been made, a kid in school has already been around other kids for a month. The good news is lice can only crawl; that means that they can only spread by direct contact. They cannot jump from head to head. This is also why brushing your hair will not prevent you from getting lice; it will only reduce the number of lice you are infested with. You are better off not sharing personal items (like hats, combs, brushes, etc.), but this is NOT an excuse to refuse to wear protective headgear. Lice that fall off or are combed off are usually injured or dead. Live lice and nits need our body heat to survive, so they are found close to the scalp (within 4-10mm). Farther than that, live lice only survive up to 48 hours, and eggs cannot hatch.

Many cases of “lice” are actually misdiagnosed. Dandruff, hair debris, dirt, and other insects have been mistaken for lice. This adds to the number of “resistant” cases. School screenings and forcing kids to stay home doesn’t reduce the incidence of live lice. Instead it means lost days in education and missed work days for the parents.

So what are we to do? The AAP does encourage parents to check their kids’ heads regularly and whenever the kids are itchy. Especially after sharing sleeping quarters, like at a camp, child care center, or sleepover. Using a louse comb on hair that is wet (with water, oil, or conditioner) is the easiest way to go about it. Eggs are most easily seen at the nape of the neck or behind the ears. Remember to look close to the scalp!

Please check back tomorrow, as I'll talk more about what to do if you find lice in your child's hair.

Dr. Tracy Lee
Pediatric Hospitalist
Meriter Hospital
meriterkids.com

Feeding your Baby: The Transition to Solids, Part 2

(This post is continued from yesterday's Part 1 segment)

So, when do you start your baby on solids? My advice is to watch your baby and see when he wants to start solids. It should not be until she has developed enough body and head control to be able to sit up in a high chair, but babies vary on when they can do this. It’s generally in the four to six month range. For my first daughter, it was at five months that she could sit in a chair, but she didn’t eat solids until six months of age. After your baby can sit up in the high chair, you’ll naturally start putting him there, likely with some toys on the tray, when you have things you need to do (like eat your own dinner!)

There will come a day when you see your baby watching the food make its way from the plate to your mouth with great interest. Then she’ll give you a look like “I’d like some of that!” This is when you need to convince him, at your next sit-down together, that what you were eating was mom’s milk (or formula) mixed with a small amount of rice cereal and "sure, you can have some." Just put a small amount in, and keep in mind that you want it to be runny at first, and the mixture will continue to thicken for a couple of minutes as the flakes absorb moisture. Put a small amount on a spoon and hold it up in front of baby. If she’s ready, she’ll lean forward and take the spoon into her mouth. If he doesn’t seem all that interested, it’s no big deal. The essential source of nutrition for a baby is human milk (or formula) from birth to six months, and from six months to one year, it’s still the major source for nutrition. You can try again later.

I do recommend starting solids by nine months, because by that time we’re talking about picking things up (like Cheerios) and learning to eat various things is an important part of brain development. Nutritionally speaking, a baby can do just fine on nothing but mom’s milk (or formula) until one year of age. Generally, everybody can’t wait to feed the baby, and I can recall only one time I’ve ever had to urge a mother to start solids with her baby at a nine month well child check.

Now, I just described using rice cereal mixed with human milk or formula because that’s been the most common first food advised over the past 40 years, and it’s what I gave my own kids. I should note, however, that not everybody agrees with this. Some feel that pureed meat should be the first food, because it is an excellent source of bio-available iron and zinc, for which some older babies have deficiencies. One thing is certain: do not give honey to a baby less than one year of age, due to the small, but real risk of infant botulism. If you’ve been nursing your baby, she’s been exposed to the variety of flavors that is in your own diet, so adding a little dried spice or herbs could be o.k., but don’t add salt or sugar to your baby’s food.

That’s all we have space for today — ask questions in the comment section and I’ll try to address them!

Dr. Julia Mason
Pediatric Hospitalist
Meriter Hospital
meriterkids.com

Feeding your Baby: The Transition to Solids, Part 1

If you have a baby, you’re probably getting advice (from all corners!) on how to feed her. Everybody can agree these days that mom’s own milk is the best food for babies, but after that, there can be a lot of confusion. I’m going to focus today on the transition from human milk or formula to “solid foods.”

Some new parents are being advised by relatives that they should start the baby on solids, (which usually means baby rice cereal) basically, as soon as possible. This may be because several years ago mothers were actually being advised by their pediatricians to start rice cereal at earlier and earlier ages. The hope was that adding rice cereal to the bottle (and that’s what we’re talking about, because a typical baby less than four months old is not going to slurp food off a spoon) would help the baby sleep through the night, or eat less often, or have less spit-up. This advice is no longer being given, except by the well-meaning grandmothers who are passing on what they were told. Still, you can find “infant feeders” in the baby section of stores which are basically just bottles with an extra large hole in the nipple, to allow the thicker cereal mixture to come through. (Just because something is sold in stores doesn’t mean it’s a good idea to buy and use, even with baby supplies.)

Giving a baby solid foods early is not going to make him sleep through the night at a younger age. Babies do tend to sleep longer periods of time as they get older, and they start solids when they get older, but giving solids to a three month old is not going to turn her into a seven month old. Babies sleep through the night when they sleep through the night (and you should know that the technical definition of this is "greater than five hours of sleep," not the eight hours you’re dreaming of). There are things you can do to encourage this behavior, but that will have to be the topic of another post. Feeding solids to a baby less than four months old is not going to get them to sleep for longer periods. It may help with spitting up, but I wouldn’t advise it unless the problem is severe. It will lead to weight gain, and I think we’ve all figured out that this is not necessarily a good thing. For many babies, rice cereal will cause constipation.

Visit again tomorrow for part 2, when I'll discuss the appropriate time to start the transition to solids.

Dr. Julia Mason

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

Getting the Okay to Play

Summer vacation has just started, but soon enough the annual mad dash to get those pre-participation sports physicals will begin. The state of WI requires that all students participating in organized sports have a physical examination by a qualified provider every two years to make sure they are healthy enough to participate in sports. These can be done as early as April first.

Keep in mind that the earlier the the exam is performed, the more time your doctor may have to investigate any problems that may be found. It is rare to find a condition such as a congenital heart disease or arrythmia that would completely disqualify an athlete. The pre-participation physical more often discloses issues that require follow up such as physical therapy, nutritional counseling, or referral for previous undiagnosed hypertension. It gives the opportunity for prevention of injury with effective conditioning programs. And it gives the opportunity to get certain conditions, such as asthma, better controlled before sports season begins. In addition, the sports physical is an opportunity for adolescents to develop a relationship with their physician who can also address issues not directly related to sports such as “high risk” behaviors (e.g. drug and alcohol use, use of sports enhancing substances, unsafe sexual practice).

Medical histoy is one of the most important parts of the sports physical and family history is a very good indicator of any potential conditions your child may be at risk for. Medical history questions are on the WIAA form that you can bring home. Please take the time to obtain your family’s medical history and answer the questions as well as you can.

Make a list of the following items:

• Chronic medical problems such as asthma, diabetes, seizures
• Previous hospitalizations and surgeries
• Past orthopedic problems/injuries/fractures
• Current medications
• Allergies
• Family history of any heart disorder (especially family members under 50) or any unexplained sudden death in the family history of concussions or head injuries (even if no one called it a concussion)
• Whether you’ve ever passed out, felt dizzy, had chest pain or significant trouble breathing during exercise/sports

Have fun, enjoy your summer. Don’t forget to schedule your sports physicals early!

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

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