Category Archives: Pediatrics

imrs

More American Children Becoming Paralyzed

A polio-like illness is on the rise in the US, and its source and cause remain mysterious and unknown. The illness is a muscular condition called acute flaccid myelitis (AFM) and affects the nervous system, mostly the spinal cord, and in most cases causes paralysis. The symptoms of AFM are compared to the symptoms of polio.

According to the Centers for Disease Control and Prevention pediatrician Dr. Manisha Patel, there have been 50 reported cases in 24 different states since August 2016, which is more than half the reported cases in all of 2015 combined. Ninety percent of these cases are children.

Health officials believe the condition is occurring due to enteroviruses, and is possibly linked to West Nile and adenoviruses. The enterovirus is the most likely culprit because these viruses circulate the most between August and October, and that is when the rise of AFM has occurred this year. Also, there is a strain of enterovirus presently in circulation, and in 2014, a certain enterovirus strain paralyzed 120 children throughout the US. So doctors think this could be the same enterovirus strain now linked to AFM. An enterovirus is any of a group of RNA viruses that usually occur in the gastrointestinal tract, and sometimes spread to the central nervous system or other parts of the body. Usually they cause only mild illness in children, but when they spread to the central nervous system is when they become more dangerous, and can even cause inflammation of the brain. The affecting of the central nervous system is a clear link to AFM.

Before paralysis occurs, symptoms of AFM include sudden limb weakness and limping, loss of muscle tone and reflexes, difficulty swallowing, and slurred speech. Respiratory failure can also occur if the muscles needed for breathing are among the muscles weakened.

Though the condition is still very rare, scientists at the CDC are hard at work testing patients’ blood, nose, respiratory, and spinal cord specimens to figure out the cause and how to accurately treat and prevent the illness. The source of the illness may not even be a single infection, but could possibly be the outcome of complications from more than one viral infection.

While scientists attempt to develop a vaccine and treatment, taking steps for prevention is necessary, most importantly with children. The most effective ways to prevent acquiring an enterovirus is to remain vigilant about washing your and your children’s hands with soap and water, and using insect repellent when outdoors to prevent mosquito-borne illnesses. Additionally, covering your mouth when you cough and sneeze, and not going to work or school when you’re sick, are both very important things to remember for prevention.

Formula

Nestle Spends $100 Million to Test Baby Milk Allergies

By testing babies for milk intolerance, parents can decide to use non-allergenic formula before they have to deal with the hassle (and danger) of feeding cow’s milk to a baby with allergies.

Obviously, it’s not all for the common good – Nestle wants to sell more non-allergenic baby formula. That said, it’s hard to complain about a product that will help babies.

The test won’t be ready for a while. They have committed up to $112 million for it’s development and expect it to be ready in 5 years. It will likely be a skin patch that indicates an allergy or intolerance.

You can read more about it here.

Child Heart Donor

Parents: Meet the child that was saved by your son’s heart

(AL.com) These days, Davis Boswell of Auburn is a rosy-cheeked nine-month old with a head full of baby-fine hair.

But not that long ago, he was a boy living on borrowed time – tethered to lifesaving technology through a device called a Berlin heart that helped pump blood. Davis was the youngest patient in the United States to use a Berlin heart when doctors implanted it, said his mother, Amanda Boswell. He was less than three weeks old.

The device is used to stabilize children as they await a transplant, and Davis used it for more than four months as he and his family waited at Children’s of Alabama in Birmingham. An infection caused him to go into heart failure shortly after his birth.

“We never prayed for a heart,” Amanda Boswell said. “Because we knew that praying for a heart was praying for something tragic to happen to a baby.”

As the Boswells’ vigil entered its fourth month, something tragic did happen to a baby living hundreds of miles away in Monroe, La. John Clarke Perry, a six-month-old, began to run a mysterious fever, and doctors discovered bleeding on the brain.

Nurses at the hospital papered his room with Bible verses, and his parents prayed for a miracle.

During surgery to stop the bleeding, doctors discovered major malformations in the blood vessels around the brain that couldn’t be repaired. John Clarke’s parents, Jonathan and Holley, had one more decision to make before they removed their son from life support – whether or not to donate his organs.

Holley Perry said yes, and she pushed the transplant team to find a place for his heart. At first, team members weren’t sure they could find a baby close enough to receive the heart, but then they found Davis Boswell and rushed the organ to Birmingham.

Davis Boswell survived the surgery in late November and thrived, leaving the hospital in January – almost six months after he arrived.

On Tuesday night for the first time, the Boswell and Perry families met in Alabama, the night before a ceremony at East Alabama Medical Center in Opelika honoring organ donation.

“It’s not a situation you ever plan to be in,” Jonathan Perry said. “It’s hard to know what to say.”

Although Holley Perry and Amanda Boswell texted and sent messages over Facebook, meeting in person still made them nervous.

“I’ll admit, there were butterflies,” Amanda Boswell said. “It’s a meeting no parent can prepare for.”

The families talked about Davis Boswell, and how he was doing. They also have older children about the same age. John Clarke’s twin, Ella, is almost the same age as Davis.

“On both ends, there’s no rulebook, there’s nobody who can give you advice,” Amanda Boswell said.

Holley Perry agreed. She sought out the Boswell family after she learned that Davis might have received John Clarke’s heart.

“You don’t want anything to come off the wrong way,” Holley Perry said.

The Boswells are extremely grateful to the Perry family, but struggle with survivor’s guilt.

“We certainly want them to feel comfortable,” Amanda Boswell said. “It’s a lot easier for us because Davis is still here.”

The Perrys have also struggled to figure out the boundaries that define this new relationship. They want to know how Davis is doing and how his heart is holding up – but they don’t want to intrude.

“We don’t want them thinking we think that’s our son,” Jonathan Perry said.

Amanda Boswell said she can understand better than most the pain of losing a child, because Davis came so close to death when he was at the hospital. And the Perrys believe their son touched many souls in his short life – not just the Boswells.

“God didn’t take our son so Davis could live,” Jonathan Perry said. “He has brought many people closer to the Lord.”

One of Jonathan Perry’s fondest memories of John Clarke is watching football with his infant son before he got sick. If the family needed John Clarke to smile for a photograph, they would turn on a game, he said.

“I could watch LSU and the Saints, and he would just sit there on my knee,” Jonathan Perry said. “He could watch football forever.”

The Boswells cheer for Auburn, but at the ceremony, the Perrys gave Davis a shirt that said, “My heart bleeds purple and gold.”

Compared to his twin sister, John Clarke was the easy one, a happy baby who rarely fussed, Holley Perry said.

Both families have leaned heavily on faith and prayer since their babies fell ill, and say the experience has brought them closer to God.

“The world is not a fair place and bad things are going to happen to good people,” Jonathan Perry said. “There are a lot of people who are going to think this is a horrible thing, and it was. But there’s already good coming from it. If one person prayed for our son who never prayed before, then John Clarke brought someone closer to the Lord.”

By Amy Yurkanin

Spine Surgery

Infant’s Head is Reattached

They call it internal decapitation. Following a severe head-on collision, sixteen-month-old Jackson Taylor’s skull broke clean from his spine. The child was incredibly fortunate that his head was not completely separated from his body, and even more miraculous was that his spinal cord was still intact!

The accident occurred in Australia when the mother of the child, Rylea Taylor, her daughter, and infant Jackson were struck head-on by teenagers who were doing donuts and burning out. The mother was driving approximately 70 miles per hour.

Rylea Taylor was mostly uninjured but her daughter suffered abdominal injuries and her infant son was in life threatening condition. She says she immediately could tell that his neck was broken. The child was quickly airlifted to Brisbane.

When Jackson Taylor arrived at the hospital, famous spinal surgeon Geoff Askin preformed the 6 hour surgery to stabilize and reattach the child’s skull.

Doctors expect the child to recover within 8 weeks! You can follow the story here. Additionally, the mother has started a petition to increase penalties for reckless driving in Australia.

Image Credit: 7 News

ChildLearning

Stress Harms Infants’ Learning Flexibility

(IFL) Children barely a year old learn differently when under stress, a newly published study suggests, becoming less flexible and creative. Although the study used a small sample and a fairly artificial learning set-up, the work adds to evidence that stressful environments favor repetitive learning over creativity.

Stressful situations are known to make adults act more habitually, holding onto familiar choices even when alternatives would serve them better. Sabine Seehagen of Ruhr University Bochum wanted to see whether the same applies for young children. Naturally, there are ethical limits on how stressful a lab environment can be made for young subjects, but even a situation children encounter often was potent enough.

The “stressed” infants were separated from their parents and familiar toys and were introduced to a strange person and toy. They were then shown two buttons that lit up and made noises when pushed. After being shown that both buttons worked, access to one button was blocked by a screen, leading the children to push the other repeatedly. Eventually the second button became available again, but neither button worked.

A control group got the same buttons, but had played with a parent and their favorite toys beforehand, not a stranger.

The levels of cortisol, a stress hormone, were notably higher in those who interacted with the stranger, and this groups showed other signs of stress, such as crying longer. Previous studies have produced inconsistent results as to whether infants have the same cortisol response to short-term psychological stress as seen in adults.

Seehagen’s more novel finding, reported in the journal PNAS, is that the stressed children continued to push the button they were familiar with, despite it no longer producing the desired result. More relaxed children, on the other hand, were much more likely to experiment with the button they didn’t know, once they established the other one didn’t. For the first twenty seconds the two groups’ behavior was quite similar, but subsequently the unstressed infants tried changing buttons, while the stressed ones just kept pushing the one they were used to.

The paper notes, “Infants in the stress condition did not engage to a lesser degree with the buttons during the test nor learn the actions generally more slowly than did infants in the no-stress condition. Thus, the effect of stress on infants’ behavior was highly specific.”

On its own the experiment’s power was quite limited, with only 26 infants involved. However, it adds to existing evidence that stressful environments discourage flexible learning. Old style teaching methods where children were encouraged to fear their teachers, or fellow pupils, may have been effective for the rigid rote learning favored at the time, but apparently don’t fit well with a world in which children need to learn to experiment.

While in this case Seehagen’s findings suggest that infants’ learning behavior resembles that of adults, she made headlines earlier this year with the finding that babies were more likely to remember information if they sleep immediately afterward, a situation less well understood in adults.

By: Stephen Luntz

Image credit: Gordon

Pills

FDA Approves OxyContin For Extremely Sick Kids

(HuffPost) The U.S. Food and Drug Association approved the painkiller OxyContin for children ages 11 to 16 with pain “severe enough to require daily, around-the-clock, long-term opioid treatment,” according to a statement released on Aug. 14.

Some experts expressed concern that the approval might lead to drug misuse among children or their family members, who may have access to the drugs. But doctors who treat dying children and those in chronic pain say that the move will be a boon to many of their patients.

“Although thankfully uncommon, some children can experience prolonged periods of substantial chronic pain from conditions like cancer,” said Dr. Chris Feudtner, director of the Department of Medical Ethics at the Children’s Hospital of Philadelphia, who has no connection to the drug.

“For these patients, strong pain medications can offer tremendous relief,” he said.

OxyContin, the extended time-release version of the generic narcotic oxycodone, has been all over the news in recent years for its role in the public health crisis of opioid addiction. Experts blame the rise of prescription painkiller use in the United States for the nation’s current heroin epidemic. As it stands, four out of five new heroin users abused prescription painkillers first, according to the Center for Behavioral Health Statistics and Quality.

Although OxyContin, is just one of many painkillers on the market, it took particular criticism because representatives promised officials and doctors that the drug was safe and effective for patients with chronic pain. In actuality, its time-release formula made it more likely to result in abuse.

The company’s top executives pleaded guilty to misleading doctors, regulators and the public

OxyContin is made by Purdu Pharma, a drug company with a tarnished reputation after three of the company’s top executives pleaded guilty to misleading doctors, regulators and the public about OxyContin’s addiction risk in 2007. The company agreed to pay $600 million in fines. Following the trial, the FDA banned the original OxyContin formula and in 2010, the company developed an uncrushable tablet that was more difficult to snort or inject than the original.

But despite OxyContin’s rocky track record among adults, doctors who treat extremely sick children note that these powerful drugs aren’t as likely to result in abuse.

“Children rarely get ‘hooked’ on these medications the way that adults can,” Feudtner said, noting that all strong pain medications have the potential be misused by friends or family members of the patient.

It’s a question of “actively managing and monitoring the use of these medications,” Feudtner said. “So that children in need get what they need and everyone stays as safe as possible.”

“Children rarely get ‘hooked’ on these medications the way that adults can,” Feudtner said

“Everybody gets all excited about OxyContin, but we forget that there are a large number of children and adolescents who suffer from chronic pain,” said Dr. Lonnie Zeltzer, a professor of pediatrics and the director of the Mattel Children’s Hospital’s Pediatric Pain and Palliative Care Program at UCLA.

Zeltzer, an outside scientist who was a paid committee member of the data safety and monitoring board that oversaw the Purdu trials, said that she’s long been a proponent of encouraging companies to do studies of drugs like OxyContin on children.

“They are being used anyway, but without the data,” she said, noting that doctors and pediatricians will prescribe off-label drugs to chronically ill children, or children in palliative care, if they don’t have other options. “There was so little that was evaluated in children that physicians were using medication that wasn’t studied,” she said.

And as for the risk of opioid abuse by friends of family members, Zeltzer doesn’t think kids should suffer for adults’ mistakes. “Diverted use in adults doesn’t mean that children should be deprived of the proper studies and safety parameters.”

By: Erin Schumaker

babies2

Extended breastfeeding linked to higher IQ and income in study

(CNN)”Breast is best” — you could call it a mantra of sorts that sums up much of today’s research on breastfeeding.

Not only does breastfeeding have clear short-term benefits, such as protection from infectious diseases and a reduction in mortality, it’s also been shown to be associated with an increase in intelligence.

Prior studies have shown an increase of up to 7.5 IQ points in elementary age children who were breastfed, as well as an increase in verbal, performance and comprehensive IQ in adults.

the study interviewed 5,914 new mothers and then followed up 30 years later

The latest addition to this perspective is a long-term study of infants born in Pelotas, Brazil, in 1982. Published in Lancet, the study interviewed 5,914 new mothers about their plans for breastfeeding and then followed up to see how they did.

“Information on breastfeeding duration was collected very close to the time when weaning happened, so we had a very precise information on the duration of breastfeeding,” said study author, Dr. Bernardo Lessa Horta, in a podcast on Lancet.

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What makes this study unique is that it followed the subjects all the way to age 30.

“We were able to follow about 68% of the participants, which is a very good follow-up rate,” said Lessa Horta. “We observed that breastfeeding was positively associated with performance and intelligence at 30 years old, as well as with education, school achievement and higher monthly incomes.”

subjects who had been breastfed for 12 months or longer had a higher IQ (about 3.7 points)

In fact, Lessa Horta said the subjects who had been breastfed for 12 months or longer had a higher IQ (about 3.7 points), more years of education and earned roughly 20% more than the average income level.

“It’s suggesting that the positive effect of breastfeeding on IQ leads to a higher income,” he said. “This is our main finding at this moment.”

One possible reason for the advantage of breast milk, Lessa Horta added, is that it is “rich in long-chain polyunsaturated fatty acids which are important to brain growth and development.” Called LCPUFA for short, these essential fatty acids are found in salmon and shellfish and have been added to infant formulas since the 1990s. However, the benefit to mental or psychomotor development from adding LCPUFA to infant formula is unclear.

For Lessa Horta, the implications of his study are clear: “The finding supports the promotion of breastfeeding.

Because the study did not measure home life, intellectual stimulation or bonding between mother and child, it was not able to tease out whether these factors may have also contributed to the increase in IQ. That leaves it open to critics, such as Texas A&M Professor Joan Wolf, author of “Is Breast Best?

“This study does not address the very real possibility that mothers who choose to breastfeed, regardless of income or education, distinguish themselves from those who bottle-feed in all kinds of ways that are likely to promote intelligence,” Wolf wrote CNN.

For Lessa Horta, the implications of his study are clear: “The finding supports the promotion of breastfeeding. It’s more evidence that besides the clear short term benefits, breastfeeding also has long term consequences in terms of human potential.”

By: Sandee LaMotte, Source

Acne facial care teenager woman squeezing pimple

How can you help your child with acne?

(Dr. Seiler) Many teens and young adults suffer from different forms and severities of acne.  Unfortunately, the “old school” philosophy of treating acne with topical and oral antibiotics and even Accutane is not always the best or even necessary for the child, adolescent or young adult.  Kids are too often diagnosed with “acne” and are prescribed some form of antibiotic or Accutane when simply addressing skin health and cleanliness may be all that is necessary to significantly improve their acne.

Kids are too often diagnosed with “acne” and are prescribed some form of antibiotic or Accutane when simply addressing skin health and cleanliness may be all that is necessary to significantly improve their acne.

Here is what we will address in the consult:
  • We will take a full medical and lifestyle history of the child.  This goes beyond the medical part of the history by addressing skin health and daily routine.
  • How does the patient clean his/her skin?
  • Does the patient have any undiagnosed allergies or abnormal hormone levels that can be treated?
  • What are the patient’s daily activities that may cause the skin to be dirty (touching the skin, studying with hands touching the lower face, picking the skin, sports activities)?
Most of the time, the patient can be successfully treated with better medical grade skincare, twice daily skin cleansing, minimal time between “sweat producing” activities (sports and exercise) and skin cleansing, sunblock, and careful attention to everything that might touch the skin (clothes, shampoos, fabric softeners and detergents, sports equipment like helmet straps, and the patient’s own fingers and hands).   My approach is education on skin cleanliness, habits and medical grade skincare.  Antibiotics and/or Accutane (which can have significant short and especially long term side effects) are almost never necessary.

Antibiotics and/or Accutane (which can have significant short and especially long term side effects) are almost never necessary.

One great example in my practice is a cosmetic patient of mine who brought in her 16 year old son.  He had significant acne and had seen multiple dermatologists in the past few years.  He had been prescribed many topical and oral antibiotics and even had Accutane suggested.  He had not seen significant improvement with any of the drugs and luckily he did not take Accutane.
I spent some time with him asking him detailed questions about everything that he did during the day.  He was a very healthy and athletic kid who got up early in the morning and showered.  He would go all day (school, sports activities, etc.) and not wash his face before bed.  He also would keep sweat drenched clothes on for hours and he never cleaned his sports equipment (especially his helmet chin strap).
I educated him about these things and told him to shower more often, especially after each type of exercise and to clean his equipment.  I also encouraged him to try to not touch his face during the day and not lean on his hand to study.  We put him on Seiler Skin’s recommended acne treatment plan without any type of antibiotic.  He came in for his first two week follow-up and his mom was in tears about how much his skin improved.  He just needed to be educated about cleaning his skin and using better medical grade skincare and sunblock!
By: Dr. Seiler Source