Category Archives: Pediatrics


Choosing the right flu vaccine for your family

26659299_BG1With flu season around the corner, Consumer Reports says it’s best to be vaccinated as early as possible.

You can walk into any pharmacy these days and get a flu shot. It’s worth it, says Dr. Sheila Nolan, to avoid the agony of the flu.

“You’re really on your back flat. You have high fever, body aches, muscles aches, severe headaches,” Dr. Shelia Nolan.

How effective is the vaccine?

“The vaccine prevents illness about 80 percent of the time for those under 60 and about half the time for those over 65. But even if you do get sick after the vaccine, your symptoms are usually milder,” Nolan said.

For the broadest protection, Consumer Reports says consider the new quadrivalent vaccine over the standard trivalent type.

“The trivalent vaccine protects against three strains of the flu virus, and the quadrivalent vaccine protects against four. But if that one isn’t covered under your insurance policy, you’ll have to pay about $38 out of pocket,” Dr. Orly Avitzur.

For children ages 2 to 8, the FluMist spray is better protection than a shot. They may need a second dose a month later.

“The nasal spray is made of a weakened but still active live virus. So it shouldn’t be given to people with a poor immune system or their caregivers, pregnant women, or anyone over 50,” Avitzur said.

If you do feel the flu coming on, ask your doctor within the first day or two about prescribing anti-viral drugs. Consumer Reports says if taken early, drugs like Tamiflu and Relenza can ease flu symptoms and reduce complications like pneumonia.


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Fitness may boost kids’ brainpower



G Exercise and brainpower in children may not seem closely related, but a small new study hints that fitness may supercharge kids’ minds.

The finding doesn’t prove that fitness actually makes children smarter, but it provides support for the idea, the researchers said.

“Our work suggests that aerobically fit and physically fit children have improved brain health and superior cognitive [thinking] skills than their less-fit peers,” said study author Laura Chaddock-Heyman, a postdoctoral researcher with the department of psychology at the University of Illinois at Urbana-Champaign. “Hopefully, these findings will reinforce the importance of aerobic fitness during development and lead to additional physical activity opportunities in and out of the school environment.”

The researchers launched their study to gain more insight into the connections between fitness and the brain in children. Other research has connected higher levels of fitness to better attention, memory and academic skills, Chaddock-Heyman said.

And two recent studies found that fit kids are more likely to have better language skills and to do better on standardized tests for math and reading.

But there are still mysteries. While moderate exercise boosts brainpower for a few hours — making it a good idea to work out before a test — it’s not clear how fitness affects the brain in the long term, said Bonita Marks, director of the Exercise Science Teaching Lab at the University of North Carolina at Chapel Hill. “The chronic impact is less certain and, for health, really the key for future research and health management,” she added.

The new study didn’t examine any thinking skills, but instead looked only at the brain’s “white matter,” which helps different brain regions communicate with each other. The researchers scanned the brains of 24 kids aged 9 and 10, and found that white matter was different in the fitter kids, potentially a sign of better-connected brains.

Higher levels of fitness may boost blood flow, increase the size of certain brain areas and improve the structure of white matter, Chaddock-Heyman said.

What do the findings mean in the big picture?

It’s hard to know for sure. Megan Herting, a postdoctoral fellow with the division of research on Children, Youth, and Families at Children’s Hospital of Los Angeles, pointed out that the kids with lower fitness levels also weighed more, “so it is unclear if it is actually fitness or ‘fatness’ that may be affecting the brain. “Studies show that individuals with obesity have different brains compared to their healthier-weight peers,” she said.

As for the stereotype of the 99-pound weakling nerd, Herting suggested it may be time for a rethink. “These findings do challenge that if you are aerobically fit, you are likely to be dumb. In fact, from an evolutionary perspective, we were made to move. So rather than fitness being ‘good’ for the brain and cognition, it is feasible that being sedentary may be ‘bad.'”

The researchers are now working on a study that assigns some kids to take part in exercise programs to see what happens to their brains over time when compared to other kids, Chaddock-Heyman said.

The study appears in the August issue of the journal Frontiers in Human Neuroscience.



Plastic Chemicals During Pregnancy Linked to 70% Increased Asthma Risk

pregnancyYou won’t easily find the word “phthalate” on a label, but the group of sticky chemicals that help make plastic flexible (and help make fragrances “stick” to your hair, face, or skin) may have unintended health consequences, finds a new study published in Environmental Health Perspectives.

A research team from Columbia University followed a group of 300 moms and children in New York’s inner city for several years. Researchers compared the urine tests of the mothers’ during pregnancy—testing for concentrations of phthalates—to whether their children had asthma at ages 5-11.

“Virtually everyone in the U.S. is exposed to phthalates,” says study author Robin Whyatt, professor of environmental health sciences at Columbia’s Mailman School of Public Health. So in the absence of a true control, the researchers had to compare women with the lowest levels of exposure to women with the highest.

Children of women with higher levels of two types of phthalates—butylbenzyl phthalate (BBP) and di-n-butyl phthalate (DBP)—in their urine while pregnant had a 72% and 78% increase in the risk of asthma. And every single woman in the cohort had metabolites of both kinds of phthalates in their urine.

Phthalates are everywhere, from school supplies and nail polish to designer denim. They lurk in plastic and home materials, and since they hold scent, they’re extremely popular in all kinds of personal care products. In the study, researchers found a strong association between phthalate concentration and perfume, as well as vinyl flooring. “They’re volatile, so they get into the air,” Whyatt says. “Our data indicates that inhalation is a significant route of exposure.” Fetuses seems to be especially at risk; since their lungs develop so rapidly, they’re more susceptible to environmental exposures, she says. And phthalates are endocrine disruptors, meaning they mess with the body’s natural hormone system, which Whyatt says are key to fetal development.

Studies have linked phthalates to early-onset eczema, hormonal imbalances and respiratory problems.

Eliminating your exposure altogether is impossible, and limiting it is difficult, Whyatt says. But she and her fellow researchers have adopted some phthalate-reducing recommendations, like storing food in glass containers instead of plastic, never microwaving food in plastic, avoiding air fresheners and all scented products (look for ‘fragrance” or “parfum” on the label), buying scent-free laundry detergent and dishwashing soap, and avoiding use of plastic with recycling codes #3 and #7 (you can tell by the number in the triangle).

“We feel we have a real burden, particularly to the women in our cohort,” Whyatt says, some of whom she’s been following for 16 years. But you can only cut down exposure so much. “Because they’re so widespread and in so many different products, addressing this is up to the regulators.”



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When it comes to a growing child, the brain comes first

girl writingYoung children grow much more slowly than other mammals because their developing brains require so much energy to prepare for the challenges of later life, a new study contends.

Researchers analyzed data from PET and MRI brain scans and found that enormous amounts of energy are used by the human brain in the first few years of life, which means physical growth has to take a back seat during that time.

For example, a 5-year-old’s brain uses twice as much glucose (the energy that fuels the brain) as the brain of an adult. This “brain drain” of energy peaks at about age 4 and body growth slows to a minimum. At this age, the brain burns energy at a rate equal to two-thirds of what the entire body uses at rest, the study authors said.

The findings support a longstanding theory about why children grow so slowly, said the authors of the study, published this week in the journal Proceedings of the National Academy of Sciences.

“Our findings suggest that our bodies can’t afford to grow faster during the toddler and childhood years because a huge quantity of resources is required to fuel the developing human brain,” first author Christopher Kuzawa, a professor of anthropology at Northwestern University, said in a university news release.

“As humans we have so much to learn, and that learning requires a complex and energy-hungry brain,” he added.

The findings also explain some common observations made about young children, the researchers said.

“After a certain age it becomes difficult to guess a toddler or young child’s age by their size,” Kuzawa said. “Instead you have to listen to their speech and watch their behavior. Our study suggests that this is no accident. Body growth grinds nearly to a halt at the ages when brain development is happening at a lightning pace, because the brain is sapping up the available resources.”

It was previously thought that the brain’s demand for energy was highest at birth, when brain size relative to the body is greatest.

The study’s finding that the brain’s energy needs peak at age 4 “has to do with the fact that synapses, connections in the brain, max out at this age, when we learn so many of the things we need to know to be successful humans,” Kuzawa said.

The study was done in collaboration with researchers at Northwestern University, Wayne State University in Detroit, Children’s Hospital of Michigan, Icahn School of Medicine at Mount Sinai in New York City, the University of Illinois, George Washington University and Harvard Medical School.




Parents of obese kids often view them as healthy

ObeseParents of obese children often don’t view their kids as unhealthy or recognize the health consequences of excess weight or inactivity, according to a new study.

The children of the families surveyed for the new research were attending an obesity clinic at the Hasbro Children’s Hospital in Providence, R.I.

“A third categorized their child’s health as excellent or very good,” said study researcher Dr. Kyung Rhee, now an assistant professor of pediatrics at the University of California, San Diego.

Rhee surveyed slightly more than 200 families in 2008 and 2009 to evaluate their readiness to help their children lose weight. She found that 28 percent of the parents did not perceive their child’s weight as a health concern. But experts know that childhood obesity has both immediate and long-term ill effects on health, including risks for heart disease and type 2 diabetes.

Thirty-one percent of the parents thought their child’s health was excellent or very good.

Parents were more likely to try to improve their children’s eating habits than to increase exercise, Rhee found. While 61 percent said they were trying to improve eating habits, just 41 percent said they were increasing their child’s activity level.

If parents were obese, they were less likely to be helping their children change. Most of the children, 94 percent, were obese, and their pediatrician referred them to the clinic for help in slimming down. The other 6 percent were overweight.

The study was published online recently in the Journal of the Academy of Nutrition and Dietetics.

Rhee said the findings are similar to a study she did in 2005, asking about parents’ readiness to change their child’s behavior if the child needed to lose weight.

The parents’ own weight status affected how willing they were to make changes in their children’s eating habits. “The parents who thought their own weight was a health problem were less likely to make changes in a child’s diet,” Rhee said.

She can’t say why this is, because the survey did not ask. But Rhee suspects that the parents may have been discouraged by their own failed attempts at dieting.

In the study, the average age of the children and teens was about 14, but ranged from 5 to 20.

While income, race or ethnicity didn’t have a bearing on whether parents were trying to improve their child’s diet, income did play a role in whether parents encouraged exercise. Those who made less than $40,000 a year were less likely to encourage exercise. The survey didn’t ask the reasons why.

Dr. William Muinos, director of the weight management program at Miami Children’s Hospital, reviewed the findings of the study. “There is a lot of fact to this study that I experience every day [with parents],” he said.

Parents often tell Muinos their children will ”grow out” of their weight problem, and he tells them that is hazardous thinking. Research has found that children who are obese are likely to be obese as adults, according to the U.S. Centers for Disease Control and Prevention.

Muinos tells parents of overweight children that starting early with a good diet and a regular physical activity is crucial. “Early intervention is key both in establishing good eating habits and exercise,” he said.



Type A Flu Hitting Alabama Like a Fast Storm, and State Will be Watching Closely as Schools Reopen

14026303-mmmainStudents are returning to Alabama schools after the holiday break, and health officials will be watching next week’s absentee reports closely to track the spread of a Type A flu outbreak that hit Alabama like a fast-moving storm in mid-December.

H1N1 Type A is the flu strain “that makes you really sick,” Madison County Health Officer Dr. Lawrence Robey said Thursday. Robey confirmed that doctors’ offices and walk-in clinics across his county have seen a surge in flu patients. But that’s actually normal, Robey said, because this is the typical flu season. “This is when you see it,” Robey said. “It’s right on time.”

Statewide, flu reports are “high” and spreading, according to the Alabama Department of Public Health. The state is one of five reporting widespread flu as the official flu season gets started. The season continues through February. Read the department’s Dec. 30 statement below.

It’s not too late to get a flu shot, and the vaccines available this year do protect against the strain now spreading. It takes about two weeks after the vaccination for immunity to develop, Robey said, and it is possible to catch a milder case of the flu even after vaccination. Check local pharmacies and big box stores with in-house pharmacies to find vaccine, and expect to pay around $25 if you don’t have insurance or Medicare. “It definitely improves your odds,” the health officer said of the vaccine.

Type A is the flu same strain that caused a nationwide attack of nerves in 2009 when it was branded the “swine flu.”



Couple Finds Way to Improve Children’s Fitness

children-fitness-44ea3d9215fba78dMissy and Marvin Sexton recognized the signs.

Their sons Walker, 12, and Greg, 9, were spending more time with computers and electronics and less time playing outside.

The parents took action in January, setting up a system where the boys had to earn their electronics privileges through exercise.

“We decided it was getting too much,” Marvin said. “To stay physically healthy, I think you have to set a foundation for the kids going forward, to teach them that exercise is important and to stress it, to get them outside doing things.”

If the boys don’t earn the required exercise points, they don’t get to play computers.

“And they’ve never failed, every single month,” Missy said.

The system isn’t complicated. At the end of each day, Missy figures out what the kids have done and totals up the points. She also monitors the amount and kinds of food they consume.

The fitness and diet regimen isn’t just for the kids. The parents work to set a good example, and use activities with their sons as family bonding time.

“We jump on our bikes together and have adventures,” Missy said. “Remember that 12-mile adventure down at Panama City?”

They pedaled through creeks and racked up memories.

“This past summer we went up to Chattanooga and all we did was hike every day,” she said. Climbing over boulders, talking and playing helps them make a healthy lifestyle both workable and fun.

As a pulmonologist, Marvin sees the problems when kids don’t develop good habits on diet and exercise.

“Kids that have never gone outside and played and exercised in a structured fashion, they’ll never get that,” Marvin said. “I see that all the time in my practice, people 20 years old who weigh 500 pounds, and it’s solely through lifestyle issues.”

Missy said kids pick up cues about food and fitness from their parents. “They didn’t see their parents exercise so they don’t understand,” she said.

Pulmonary (lung) fitness is tied to cardiovascular fitness – the ability to exercise vigorously for a long time, such as running laps on a track. Increases in fat mass usually are mirrored by declines in running performance.

Research presented last month at the American Heart Association’s Scientific Sessions 2013 concluded that children’s cardiovascular fitness worldwide has declined 5 percent per decade since 1975 for children ages 9 to 17.

Kids don’t run as far or as fast as their parents did, and that may indicate worse health in adulthood.

The findings are no surprise to Dr. Ted Williams and other doctors at Southeastern Pediatric Associates.

“This is something we’ve seen coming in pediatrics for the last three decades,” Williams said. “We’ve become a fast-food generation. There’s no family dinner table. We have no portion control. We’re eating a diet that predisposes itself to obesity, and we know a significant number of children are obese.”

Williams sees multiple factors at work. “Our diet has drastically worsened over the last 30 years,” he said. Kids are getting much less exercise than they used to and are spending more time in front of television and computer screens.

“Those kids who are less fit now have significant health issues as they go along,” Williams said. “Twenty to 30 years ago, we never heard of type 2 diabetes in children. That’s diabetes caused by insulin resistance, and now that’s a leading cause of diabetes in children.”

He said it’s directly related to obesity, which is directly related to lack of exercise and improper diet. “So we have a generation of children that are going to be more at risk for cardiovascular disease, high blood pressure, elevated cholesterol and diabetes, and almost all of this is preventable,” he said.

“We call it in pediatrics the new morbidity,” he said. “We used to be concerned about measles, chickenpox, whooping cough, tetanus, polio, all these diseases. Well, we have vaccines now for those diseases, and so now parents aren’t faced so much with those challenges as they are with the challenges of diet, exercise and how you manage this electronic age.”

Williams said computers and other technological advancements are a great aid to education and parents, but like food must be taken in moderation.

“I see a lot of children eat the right foods, they just eat twice as much as they need,” he said.

Williams said parents need to provide leadership on health and nutrition.

“I talk about this every day in my office because we see so many kids who are significantly overweight who don’t necessarily want to be that way, but they have to eat what’s put on the table, they can’t go out and get their own diet,” Williams said. “So I try to approach the parents, saying let’s make our diet as nutritious as we can and let’s lead by example. If they see you out there walking or riding a bicycle, then they’re more likely to do that.”

Doctors and parents can provide guidance to lead children toward a healthier lifestyle, but there are other kinds of help available.

Rosalind James, a regional Extension agent with the Alabama Cooperative Extension System, said ACES is partnering with Dothan City Schools to hold a Teen Health Fair on March 7 at the National Peanut Festival Fairgrounds.

Starting in January, 32 Northview High School students who are 4-H club members in the Health Education Leadership Program will be visiting elementary schools to teach third to fifth-grade students how to eat properly and increase their physical activity.

James said the national 4-H council believes the program will be effective because young students are likely to listen to older students who have gone through the same problems.

“You have one body and you’ve got to take care of that one body,” James said. “When you don’t feed the body the right foods (like fresh fruits and vegetables) and you’re not exercising, you’re going to be subjected to all these chronic diseases.”

Becky Tew, a physical education teacher at Honeysuckle Middle School, said she has seen a decline in cardiovascular fitness among students during the nearly 30 years she has been teaching.

“The challenge I find is it is more challenging to motivate students to play and participate, whereas in earlier years that really wasn’t a problem, you might have one or two,” Tew said. “We’re having a larger majority of kids, they would rather just sit down and play games on the computer or just talk.”

She said the problem is worse among girls than boys.

At the middle school level, the instruction focuses on fitness, conditioning, introduction to different activities, warmup, sportsmanship and basic rules. “At seventh and eighth grade they can start participating on the athletic teams,” Tew said.

Classes are about 50 minutes long, but some of that time is spent in the dressing room or in warmup activities. In class the students can get just more than half of the 60 minutes of daily moderately vigorous activity recommended by health experts for children age 6 and older.

Brittany Melvin, store manager at Love 2 Run, said people who come to the store are usually already motivated to get more active.

Ages range from young to old. “Some people, their doctor recommends that they need to get in shape,” she said. Others have been diagnosed with diabetes or heart disease.

Melvin said employees listen to people to assess their needs. “We don’t want to make them think that they have to run because we want to still promote fitness, even if it does mean walking,” she said.

Setting goals, like putting in a set number of miles per week or running or walking in a 5K, is important. “When you feel like you have to meet a goal, you don’t want to let yourself down or anybody else that knows that you’re going to try to meet that goal,” she said.

Working exercise into a schedule is sometimes the biggest challenge. With parents working so much and kids sometimes kept indoors because of unsafe neighborhoods or lack of supervision, it can be difficult for children to get enough exercise.

Dr. Williams said the research indicates the fitness decline probably has flattened out in the last two or three years in this country. “People are becoming a little more concerned about it, everything from the first lady to school officials are seeing the need for more vigorous exercise programs and really putting emphasis back on being fit,” he said.

Battling the convenience of cheap, high-calorie foods and finding the time to instill good habits in children is the challenge. How the situation will play out for the world’s population is anyone’s guess.



Important Facts About Sudden Infant Death Syndrome (SIDS)

Blue-Eyes-Cute-Baby-HD-Wallpaper1For new parents especially, thinking about SIDS is difficult. But to keep our babies safe, we must think about it and take precautions to reduce the likelihood of it occurring.

Defined as “the sudden death of an infant younger than one that remains unexplained after a thorough case investigation,” SIDS is the leading cause of death among babies between 1 month and 1 year of age. The age group at the highest risk are those in the 1 month – 4 month range.

SIDS is a sudden, silent medical disorder that can happen to a seemingly healthy baby. Because it occurs while the baby is asleep, it’s sometimes called “crib death.” Currently, Alabama is #2 in the nation in SIDS deaths, behind Mississippi.

According to Dr. Terri Coco, associate professor of pediatrics for Children’s of Alabama, the best thing a parent can do to prevent SIDS is to provide a safe sleep environment that includes:

– A firm mattress with the correct fitted sheet that’s snug, not loose;

– A safety-approved crib;

– No pillows, stuffed animals, blankets, or crib bumpers (the American Academy of Pediatrics added bumpers to this list last year due to the risk of babies getting caught between the crib slat and bedding);

– Placing your baby on their BACK to sleep;

– No smoking in your home;

– No covering up your baby’s head;

– Dressing your baby in light clothing (one-piece sleeper);

– No letting the baby sleep on adult beds, couches, or chairs; and

– No co-sleeping.

“Co-sleeping is the leading cause of sleep-related deaths,” Dr. Coco says. “Babies need to be in a crib or bassinet.” The risks babies face when sleeping with parents include SIDS, suffocation, and strangulation. Parents may roll onto their child as they’re sleeping, or the baby may get tangled in sheets or blankets.

Dr. Coco adds that both breastfeeding and pacifiers (without strings) help reduce the risk of SIDS. Practicing “tummy time” when the baby’s awake and someone is watching is also important because it builds the baby’s neck strength.

While there are products on the market advertised to prevent SIDS – i.e. cardio-respiratory monitors, wedges, specialized sleep surfaces – none have been shown to reduce the risk of SIDS. In some cases, infants have suffocated while using products designed to hold them in position.

Thanks to public awareness and initiatives like Back to Sleep – a campaign launched in 1994 to encourage parents to have their infants sleep on their back to reduce the risk of SIDS – SIDS deaths have since declined more than 50 percent nationally. Back to Sleep is now called Safe to Sleep to build on the success of Back to Sleep and add actions that parents and caregivers can take to reduce the risk of other sleep-related causes of infant death, such as suffocation.

The numbers are declining, but there’s still work to be done. Not until the SIDS toll is zero can anyone rest easy. With October being SIDS Awareness Month, let’s spread the word about preventative measures and encourage new parents everywhere to outfit their homes with the safest sleeping environments possible for their beloved babies.

For more information on SIDS, visit, and

Kari Kampakis is a Birmingham mom of four girls and freelance writer. Visit her blog at, find her on Facebook  at “Kari Kampakis, writer,” or follow her on Twitter at @karikampakis. Email: