Probiotic Use in Children

Monika Pis, PhD, CPNP

In today’s medically savvy society, parents often seek "natural" remedies for health ailments, or to help their children feel better. They also reach for supplements in an attempt to improve health and seek "super foods" to promote wellness.

"Super foods," known as functional foods, describe foods or nutrients that promote health beyond providing nutrition. Probiotics are considered to be a functional food, and in the recent years they have received increased attention from the scientific and general communities.

The World Health Organization defines probiotics as live organisms, usually bacteria, that are used to change or re-establish the intestinal or gut flora and improve our health. In the early 20th century, a Russian scientist and Nobel laureate Eli Metchnikoff, PhD proposed that ingestion of certain bacteria, like those that come from fermented milk, had a beneficial impact on health. Today we have scientific evidence that certain bacteria, probiotics, play a beneficial role in certain diseases in adults and children. For example, there is compelling evidence that probiotics are effective in the treatment of viral and antibiotic induced diarrhea.

VIRAL DIARRHEA
Every year thousands of children become ill with gastroenteritis, or "the stomach flu." They experience a rapid onset of watery diarrhea with vomiting, nausea, abdominal pain, and fever. Research indicates that in the United States diarrhea is associated with 150,000 to 170,000 hospitalizations annually. According to the American Academy of Pediatrics, scientists estimate that 1 out of 23-27 children will be hospitalized with diarrhea by age 5.

Recent scientific findings indicate that probiotics are extremely effective in preventing acute diarrhea in children. They are also effective when administered during the early stages of viral diarrhea.

DIARRHEA DUE TO ANTIBIOTIC TREATMENT
Antibiotic treatments often lead to the disruption of intestinal flora and cause diarrhea. Studies show that the administration of probiotics to children taking antibiotics reduces the risk of diarrhea.

So far, the research on probiotic use in the treatment of irritable bowel disease (IBD), irritable bowel syndrome (IBS), or eczema shows no benefit of probiotic use to prevent or alleviate symptoms.

SAFETY
Most probiotics have been used in foods like yogurt and kefir and have a long-standing history of safety. Therefore, they are considered safe for use by healthy people. Individuals with compromised immune systems, such as those with chronic diseases or undergoing chemotherapy, should not take probiotics, as there have been reports of probiotic-associated sepsis and endocarditis.

One thing to remember is that probiotics are not regulated by the FDA, thus over-the-counter products may vary widely in quality. Infant formula containing B. lactis is the only exception. The FDA considers it safe to use in infants.

The bottom line is that probiotics may be beneficial for certain diseases, but may prove harmful for certain individuals. Therefore, before considering a probiotic supplement, talk to your health care provider.

When To Keep Your Child Home From School

Monika Pis, PhD, CPNP

Has your child ever been sent home from school because of "pink eye?" Did you know that conjunctivitis DOES NOT warrant immediate exclusion from school?

Recently, the American Academy of Pediatrics (AAP) updated its guidelines for school exclusion due to infectious diseases. Here is what you need to know about the recommendations on when your child should stay home when sick. Bear in mind that these are just recommendations and your school’s policy might differ.

FEVER
According to the AAP, children with fever should not be excluded from school unless they exhibit behavioral changes, or other signs and symptoms of illness. The exception is infants younger than 4 months of age with unexplained fever.

COLD
Most respiratory illnesses do not require exclusion. However, if there is a persistent cough or difficulties breathing, your child should be evaluated by her health care provider as soon as possible.

EAR PAIN WITHOUT FEVER
If your child is in pain, he/she should stay at home.

VOMITING
If your child is vomiting, you should keep her at home until she stops and has not vomited for 24 hours.

DIARRHEA
The AAP recommends that children in diapers who have diarrhea may remain in daycare if the diarrhea is contained in the diaper and the child has no more than two abnormal stools above what she normally has.

DRAINING SKIN INFECTIONS
This guideline includes ALL skin infections, including those caused by MRSA. Your child should be excluded from school only if the infection is accompanied by a fever or behavior change.

FIFTH DISEASE
Once the rash of fifth’s disease appears, your child is not contagious. Therefore, she should not be excluded from school.

HAND-FOOT-MOUTH DISEASE
According to the AAP, children should be excluded only if they have sores in the mouth and are drooling, or if they have a rash and a fever.

Guide to Seasonal Affective Disorder

Monika Pis, PhD, CPNP

Are you among the 10-20% of the U.S. population who experiences the winter blues? Many people develop “cabin fever” during winter months when it’s cold and gloomy outside, and the days get dark earlier. These are common and normal reactions to the changing seasons. However, if you feel depressed, fatigued, and hopeless, you may have a Seasonal Affective Disorder (SAD), or Seasonal Depression.

Winter SAD usually starts in fall or winter and ends in spring or summer. A rare form of SAD is summer SAD that begins in late spring or early summer and ends in the fall. An estimated 4-6% of the general population experience SAD.

SAD can occur at any age, even in children. However, it’s most common among adult women. Also, SAD is more prevalent among people living further away from the equator, where seasonal changes are more noticeable.

What causes SAD? 
It is unknown what causes SAD. However, changes in the availability of sunlight seem to be the likely culprit. Scientists postulate that decreased exposure to sunlight disrupts the circadian rhythm. This biological clock regulates mood, sleep, and hormones, so when it is disrupted, it may lead to depression.

Another theory proposes that winter depression arises from increased production of melatonin in winter months. Still, other research suggests that decreased sunlight exposure contributes to decreased production of serotonin, a neurotransmitter that affects mood, thus possibly leading to depression.

IF YOU THINK THAT YOU HAVE SAD, TALK TO YOUR HEALTH CARE PROVIDER ASAP. 

How is SAD treated?
There are three treatment modalities for SAD: light therapy, medications, and psychotherapy.

Since exposure to sunlight improves symptoms significantly, light therapy tends to be the main treatment for SAD.

Some people with SAD benefit from therapy with antidepressants or other medications, especially if symptoms are severe.

Psychotherapy may help to identify and change negative thoughts and behaviors that may be worsening symptoms.

If you think that you are SAD or depressed, contact your health care provider ASAP!

Breast-feeding & Cold Medications

Dr. Hillary

Breast-feeding prevalence has increased in recent years. Many mothers recognize its benefits in terms of an infants’ overall health, improved immunity, and better growth.

This flu and cold season, we all might need to reach for some cold & cough remedies to relieve symptoms of upper respiratory infections such as colds. Since medications taken by breast-feeding moms may adversely affect infants, it’s always very important for lactating women to consult with their health care providers before taking any medications.

As in pregnancy, many medications can be safely used during lactation. Consider these “ground rules” when taking a cold medication:

• Take the medication after breast-feeding
• Use short-acting medications
• Use the lowest effective dose
•  Use medication for a short duration
•  Use single-ingredient products to treat specific symptoms to avoid unnecessary ingredients

ANTIHISTAMINES
Antihistamines are not effective in the treatment of cold symptoms. They dry up all mucous membranes and may indeed worsen some symptoms.

DECONGESTANTS
Generally speaking, most decongestants penetrate breast milk poorly. Pseudoephedrine (e.g. Sudafed) can safely and effectively treat nasal congestion. However, it may decrease milk supply thus should be used short-term only.

A very effective and extremely safe alternative to oral decongestants is saline nasal spray. Saline solution moisturizes the nasal mucosa, eliminates dryness, and battles congestion.

COUGH SUPPRESSANTS
When cough interferes with daily activities and night sleep, a lactating woman may reach for Robitussin DM. Otherwise, coughs should be treated with chicken soup and other warm clear liquids that thin out mucus.

ANALGESICS
When a sinus headache strikes, a breastfeeding mom can safely use acetaminophen. However, before reaching for a medication, she should try a cold or warm compress first. It’s always better to get symptom relief without using medications.

For a list of medications compatible with breast-feeding click here.

DR. HILLARY Dr. Hillary is a pediatric nurse practitioner with a doctoral degree in health promotion and risk reduction. She has worked with children for well over a decade, and answers online pediatric questions at www.AskDoctorHillary.com. Before she became a pediatric clinician, Dr. Hillary taught high school. Her hobbies include gardening, cooking, and traveling.

Essentials of Dry Skin Care

Monika Pis, PhD, CPNP

Frigid, dry weather is here! By using heat to warm our houses, we decrease the relative humidity of our environment, drying it even further. Dry air and low humidity cause loss of moisture from the skin. Many of us like to indulge in long hot baths or showers during the chilly months, but we forget these practices do not promote healthy skin integrity, especially in those who have eczema.

What is eczema?
Eczema is a chronic recurrent skin inflammation that is often accompanied by excessive dryness (xerosis) and itching. Irritants, such as fragrances in soaps or laundry detergents, low humidity, heat, stress, or rough clothing, trigger eczema.

There are simple steps that you can take to prevent alligator-like skin this winter season! Here is how:

•  Take lukewarm showers/baths that last no longer than 7-10 minutes.

• Gently pat skin dry with a towel. Avoid rubbing motion, as rubbing can cause microscopic skin injury as thus contributing to irritation and providing entry points for germs.

• Moisturize your skin immediately after patting it dry with a towel to seal in left-over moisture.

• Get into a habit of moisturizing to your skin twice a day with scent-free moisturizer.

• If you suffer from chronic dry skin, avoid wearing clothes made from synthetic or rough fabrics (e.g. polyester, blue jean) as they will aggravate your condition. A good choice is 100% cotton wardrobe. 

Cleaning Products: Safe for Your Family & the Environment

Joanna Michaels

Meet Method: American people against dirty!

Have you thought about making your house chemical and fumes free? You can start by using cleaning products that are natural, thus safe for your family and our environment, but they are also made in the U.S.A.!

Method, a company based in California, has figured it out how to eliminate burning lungs, stinging eyes, and headaches that often accompany house cleaning. With the whole line of cleaning products developed by Method, you can clean your house without a worry that your child’s asthma will flare-up from the fumes, or your pet will get sick from coming in contact with the powerful (read: poisonous) cleaning agent.

Cleaning products by Method are powerful, yet made with plant-derived surfactants that absorb dirt instead of degrading it. They are made out of natural biodegradable ingredients, such as soy, coconut oil, and palm oils, and are never tested on animals. Also, all packaging of Method products is recyclable. 

My recently discovered favorite Method product is tub ’n tile bathroom cleaner. The days of me nearly suffocating while scrubbing my shower are over! I was amazed at the effective yet fume-free cleaning power of this product. An added benefit: the whole bathroom was infused with an invigorating eucalyptus mint aroma.

So check out Method's products here: www.methodhome.com

Allergy Survival Guide

Monika pis, PhD, CPNP

The incidence of allergic disease has grown tremendously in the past years. Allergic rhinitis affects about 20 percent of the U.S. population and results in a decreased quality of life.

Allergic rhinitis is a combination of sneezing, congestion, nasal itching, and runny nose. These are caused by inflammation resulting from the contact with allergens (i.e. pollen, mold, dust mites, animal dander or saliva, as well as chemicals found in medications, beauty products, or food). In addition, some people are prone to experiencing systemic symptoms in response to allergen exposure. They may be overly fatigued and sleepy.


With moldy leaves on the ground and ragweed in the air, you might need to take certain steps to improve your quality of life if you are among seasonal allergic rhinitis sufferers. Here are some helpful tips:

•  If you are allergic to ragweed, track the pollen count in your area. You may call the National Allergy Bureau at (800)-9-POLLEN, or reach it through the American Academy of Allergy, Asthma and Immunology website: www.aaaai.org. It will give you the pollen count for your region. 

• Avoid the peak pollen count times of the early morning between 5-10 a.m. 

• Ragweed pollen count is highest on hot, dry, and windy days. If you can, stay indoors on such days with your air conditioner on.

• Keep car windows closed when driving.

• Leave lawn mowing or leaf raking to someone else, but if you have to do yard work yourself, wear a mask.

• Do not forget that pets can carry pollen on their fur, so give your Fido a bath after coming home from a walk.

•  If you venture outside, change your clothes and consider a shower upon returning home (pollen likes to stick to hair!) 

• Avoid damp places or walking on rainy days, as moisture promotes mold growth.

Another thing to consider is the fact that with the cooler weather, you and your family will tend to stay inside more so than during summertime. Remember to keep indoor allergens under control to prevent or minimize your allergy flare-ups:

• Change furnace filters monthly.

• Install a filter over bedroom air vents to prevent animal dander and mold from being blown in from other parts of the house.

• Use window shades or curtains that can be washed more often than drapes.

• Minimize the number of plants in the house (wet soil promotes mold growth).

• Vacuum carpeted floors every other day to keep dust to minimum (use a HEPA vacuum filter to collect dust and dust mites).

• Using an air conditioner on hot/humid days will keep pollen and mold spores outside.

• Keep in mind that mold likes to grow in the shower, so regularly clean it in with a bleach solution. 

If allergy symptoms strike despite your efforts to control your and your family’s exposure to allergens, there are more options to ease your suffering. 

How Asthma Friendly Is Your Childcare Setting?

The Checklist is a seven-item list in a scorecard format that can be used by parents and child-care providers to help pinpoint specific areas that may cause problems for children with asthma. It is available in English and Spanish. It is accompanied by an extensive list of organizations that can serve as useful resources to child-care staff to make asthma-friendly changes in their environment.

Children with asthma need proper support in child-care settings to keep their asthma under control and be fully active. Use the checklist below to find out how well your child-care setting assists children with asthma:
• Is the child-care setting free of tobacco smoke at all times?
• Is there good ventilation in the child-care setting? Are allergens and irritants that can make asthma worse reduced or eliminated?

Check if any of the following are present:
◦ Cockroaches
◦ Dust mites (commonly found in humid climates in pillows, carpets, upholstery, and stuffed toys)
◦ Mold
◦ Furry pets
◦ Strong odors or fumes from art and craft supplies, pesticides, paint, perfumes, air fresheners, and cleaning chemicals

• Is there a medical or nursing consultant available to help child-care staff write policy and guidelines for managing medications in the child-care setting, reducing allergens and irritants, promoting safe physical activities, and planning field trips for students with asthma?
• Are child-care staff prepared to give medications as prescribed by each child's physician and authorized by each child's parent? May school-aged children carry their own asthma medicines when appropriate? Is there someone available to supervise children while taking asthma medicines and monitor correct inhaler use?
• Is there a written, asthma action plan for each child in case of a severe asthma episode (attack)? Does the plan make clear what action to take? Whom to call? When to call?
• Does a nurse, respiratory therapist, or other knowledgeable person teach child-care staff about asthma, asthma management plans, reducing allergens and irritants, and asthma medicines? Does someone teach all the older children about asthma and how to help a classmate who has it?
• Does the child-care provider help children with asthma participate safely in physical activities? For example, are children encouraged to be active? Can children take or be given their medicine before exercise? Are modified or alternative activities available when medically necessary?

If the answer to any question is "no," children in your child-care setting may be facing obstacles to controlling their asthma. Uncontrolled asthma can hinder a child's attendance, participation, and progress in school. Child-care staff, health professionals, and parents can work together to remove obstacles and promote children's health and development.
Contact the organizations listed for information about asthma and helpful ideas for making school policies and practices more asthma-friendly. Federal and State laws are in place to help children with asthma.

Resources for Families and School Staff

National Asthma Education and Prevention Program 
National Heart, Lung and Blood Institute Information Center
(301) 251-1222 
http://www.nhlbi.nih.gov

NAEPP School Materials 
http://www.nhlbi.nih.gov/health/prof/lung/

Allergy & Asthma Network 
Mothers of Asthmatics
(800) 878-4403 or (703) 641-9595 
www.breatherville.org

American Academy of Allergy, Asthma & Immunology 
(800) 822-ASMA or (414) 272-6071 
www.aaaai.org

American Academy of Pediatrics 
(800) 433-9016 or (847) 228-5005 
www.aap.org

American Association for Respiratory Care 
(972) 243-2272 
www.aarc.org

American Association of School Administrators
703-841-0700
 www.aasa.org

American College of Allergy, Asthma & Immunology 
(800) 842-7777 or (847) 427-1200 
http://www.acaai.org
American Lung Association 
For the affiliate nearest you, call 
(800) LUNG USA 
www.lungusa.org

American School Health Association
(330) 678-1601
www.ashaweb.org

Asthma and Allergy Foundation of America 
(800) 7-ASTHMA or (202) 466-7643 
www.aafa.org

Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion
Division of Adolescent and School Health
(800) CDC-INFO
 www.cdc.gov/HealthyYouth/asthma

Centers for Disease Control and Prevention
National Center for Environmental Health
Division of Environmental Hazards and Health Effects
(800) CDC-INFO 
www.cdc.gov/asthma

National Association of School Boards
(703) 838-6722
www.nsba.org/SchoolHealth

National Association of School Nurses
(866) 627-6767
www.nasn.org

National Association of State Boards of Education
(703) 684-4000 
www.nasbe.org

U.S. Department of Education 
Office for Civil Rights, Customer Service Team 
(800) 421-3481 or (202) 205-5413 
www.ed.gov/offices/OCR
U.S. Environmental Protection Agency
• Indoor Environments Division 
(202) 233-9370 
www.epa.gov/iaq/schools
• Indoor Air Quality Information Clearinghouse 
(800) 438-4318 
www.epa.gov/iaq

Asthma can be controlled; expect nothing less.

Reprinted with permission form the National Heart, Lung, and Blood Institute
http://www.nhlbi.nih.gov

Asthma at a Glance

Monika Pis, PhD, CPNP

The school year has begun.  If your child has asthma, he may be at a higher risk for asthma flare-ups at this time. According to one study, in which over 80,000 asthma related hospital records of children 5 to 15 years old were analyzed over a period of 13 years, more children were hospitalized for asthma exacerbations in September than at any other time of the year (Johnston, et al., 2006). The high incidence of asthma attacks in September might be related to several factors: the season change with more mold spores floating in the air, colder weather, and exposure to other children at school. However, do not be fooled, as asthma might strike at any time. 

Asthma is a chronic lung disease and even though it is unpredictable, you can gain control over it by working together with your health care provider. Asthma should not prevent anybody from doing what he or she wants, should, or enjoys doing! So, if your child's asthma is out of control, establish a partnership with you health care provider to devise a treatment plan that will improve your child's quality of life! Do not let asthma control you. Become its master.

WHAT IS ASTHMA?
Asthma is a chronic inflammatory disease of the lungs. The airways get inflamed, swell up, and get plugged up with mucus in response to various triggers. When inflammation is present, you may notice symptoms such as coughing or wheezing at night or with physical activity. Additionally, in response to asthma triggers, you may experience bronchoconstriction, which is the tightening of muscles around the airway. Asthma is a chronic disease. Therefore, it is present at all times even though you may be symptom-free at times. Also, asthma’s severity may vary depending on what triggers the symptoms.

WHAT ARE ASTHMA TRIGGERS?
Asthma triggers are things that provoke an asthma attack. Those triggers are different for different people. Therefore, it is very important to recognize what triggers your or your child’s asthma attacks, so that you can avoid the causes of your asthma exacerbations. Common triggers of asthma attacks are pollen and outdoor molds, dust, animal hair or dander, cockroaches, indoor molds, cigarette smoke, wood smoke, or strong odors. In addition, upper respiratory infections, exercise, and weather changes may cause an asthma attack. Always be aware of what triggers your asthma!


WHAT ARE ASTHMA SYMPTOMS?
Asthma symptoms may range from coughing, wheezing, chest tightness, shortness of breath, to difficulties breathing.

HOW DO I KNOW WHEN MY ASTHMA IS OUT OF CONTROL?
Children and adults with uncontrolled asthma cough at night. They also cough and/or run out of breath with physical activity and while laughing or crying and cannot keep up with their friends, get tired quicker than their peers, and may complain of chest tightness. Also, your asthma is not adequately controlled if you have a need to use your rescue inhaler, such as albuterol, more than twice a week. If any of this is true for you or your family members, talk to your health care provider as soon as possible.

ASTHMA AND CHILDREN - THE FACTS

According to the Center of Disease Control, there were 5.1 million children with asthma in the United States in 2004. In 2003, 3.2 million had an asthma attack. On average, 3 out ten children have asthma.

Asthma is one of the leading causes of missed days at school. In 2003, an estimated 12.8 million school days were missed due to asthma.

Asthma treatment in children younger than 18 years costs an estimated $3.2 billion a year.

Asthma is the third-ranking cause of hospitalizations among children younger than 15 years. 

The MMR Vaccine and Autism: What’s the Connection?

Anna Tielsch-Goddard CPNP-PC

Worldwide vaccination of our children has provided major advantages to protecting against infectious diseases that in the past 100 years has claimed the lives of millions.

Diseases that are preventable by vaccines still occur throughout the United States. It is a myth though that just because we do not see these diseases as much anymore, we need to stop vaccinating against them.

One of the largest recent measles outbreaks took place in 2008 in San Francisco, California and was routed to one patient, an unvaccinated 7-year-old boy. He traveled to Switzerland where he contacted the measles and then returned to California. Subsequently, he infected 836 children. Vaccinating your children protects not only them, but also other kids who come in contact with them (a concept in epidemiology known as "herd immunity").

There is a common misconception that the MMR vaccine causes or is linked to Autism or the Autism Spectrum Disorder. This erroneous belief began after a physician, Dr. Wakefield, published a study in a journal called The Lancet (which was ran on the first page of the journal) that claimed that there was a correlation (meaning a connection, NOT a cause and effect) of the MMR vaccine with autism.  Dr. Wakefield was being paid money by a law firm to “prove” that vaccines caused harm to patients.  In 2004, the co-authors that published this article requested to take their names off the paper. Finally, in 2009, The Lancet retracted the article and Dr. Wakefield's medical license was revoked for falsifying data.  Both the retraction of an article by a distinguished journal and taking away a physician’s medical license are huge offenses that do not commonly happen in the health care field. Unfortunately, the article's retraction, the claims of data falsification, and the revocation of Dr. Wakefield's license for misconduct, was ran on the 12-th page of the journal and did not receive nearly as much press as the initial 1998 claim. This contributed to the continued public misconception and fear of the correlation of MMR vaccine and Autism.

Some parents might report seeing regressive autism symptoms shortly after the administration of the MMR vaccine. This is coincidental, because autism symptoms start to emerge around 12-18 months of age, and the MMR vaccine is administered right after the first birthday. Numerous research studies done by scientists, both nationally and internationally, have shown that autism symptoms are not caused by vaccines. The Center of Disease Control (CDC) has also stood behind these very thorough assessments and rigorous research efforts. More than 1,000 research articles have been published and reviewed by the Institute of Medicine that have not found vaccines to cause autism.

Many people argue that they have found “proof” and “claims” that vaccines cause autism from the Internet or Google research.  The public needs to be very careful when finding information in non-medical or non-health care sites or articles that are available through the World Wide Web, specifically if they have not been reviewed by medical professionals.  Although the Internet has provided society with instant access to information, not all of this information is correct, it can also be misleading and provide false claims.

All current evidence shows that vaccines do not cause autism, so delaying or withholding vaccines will not lessen the risk of autism; it will only increase the period of time during which children are at risk for vaccine-preventable diseases.

Article References and to Find More Information, visit:

Andrews N, Miller E, Grant A, Stowe J, Osborne V, Taylor B. (2004). Thimerosal exposure in infants and developmental disorders: a retrospective cohort study in the United Kingdom does not support a causal association. Pediatrics. 114:584-591.

Centers of Disease Control (CDC): Immunization Safety and Autism – Thimerosal and Autism Research Chart. Available at: http://www.cdc.gov/vaccinesafety/00_pdf/VSD_Chart_of_Autism_Studies-Updated_Sep_27_2010.pdf

Center for Disease Control (CDC). Measles, Mumps, and Rubella (MMR) Vaccine Safety: Available at: http://www.cdc.gov/vaccinesafety/Vaccines/MMR/MMR.html

Center for Disease Control (CDC). Vaccine Safety Centers of Disease Control and Prevention: Available at: http://www.cdc.gov/vaccinesafety/Concerns/thimerosal

Center of Disease Control (CDC). Outbreak of Measles --- San Diego, California, January--February 2008 MMWR February 22, 2008 / 57 (Early Release);1-44. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm57e222a1.htm

DeStefano F, Bhasin TK, Thompson WW, Yeargin-Allsopp M, Boyle C. (2004). Age at first measles-mumps-rubella vaccination in children with autism and school-matched control subjects: a population-based study in metropolitan Atlanta. Pediatrics; 113:259-266.

DeStefano F, Chen RT. (1999). Negative association between MMR and autism. Lancet. 353: 1986-1987.

Farrington CP, Miller E, Taylor B.(2001).  MMR and autism: further evidence against a causal association. Vaccine. 19: 3632-3635.

Fombonne E, Chakrabarti S. (2001). No evidence for a new variant of measles-mumps-rubella-induced autism. Pediatrics. 108: E58.

Honda H, Shimizu Y, Rutter M. (2005). No effect of MMR withdrawal on the incidence of autism: a total population study. J Child Psychology Psychiatry. 46:  572-579.

Heron J, Golding J. Thimerosal exposure in infants and developmental disorders: a prospective cohort study in the United Kingdom does not support a causal association.
Pediatrics. 2004; 114: 577-583.

Hubbard, S. (2011). Autism and Vaccine Details. The Kids Dr. Available at: http://www.kidsdr.com/your-baby/autism-vaccine-report

Infectious Diseases in Children. October 2011. IOM: Vaccines do not cause autism. Available at: http://www.pediatricsupersite.com/view.aspx?rid=87016

Kimerblin, D. (Oct 2011).  The wars of the world: Saving lives through vaccination.  Infectious Diseases in Children.  Available at: http://www.pediatricsupersite.com/view.aspx?rid=87076

Stehr-Green P, Tull P, Stellfeld M, Mortenson PB, Simpson D. (2003). Autism and thimerosal-containing vaccines: lack of consistent evidence for an association.

American Journal of Preventive Medicine.  25: 101-106.
Vaccine Education Center at the University of Pennsylvania: Vaccines and Autism. Available at:  http://www.chop.edu/export/download/pdfs/articles/vaccine-education-center/autism.pdf

Vaccine Adverse Event Reporting System (VAERS). Available at:http://vaers.hhs.gov/index

ANNA TIELSCH-GODDARD CPNP-PC Anna Tielsch-Goddard CPNP-PC is a Pediatric Nurse Practitioner for Children’s Medical Center Dallas at Legacy. She practices on the Perioperative Surgery teams in both presurgical assessment and pediatric-surgery.

MRSA: What You Need to Know

Anna Tielsch Goddard, MSN, CPNP-PC 

What is MRSA?
Many people have heard of “MRSA” from the news or other media sources.  Several years ago, magazines and news-stations began to call drug-resistant bacteria, such as MRSA and VRE (Vancomycin resistant Enterococcus) “superbugs” or “superinfections.” When a child is diagnosed with a MRSA infection, many caregivers and parents may feel panicked, scared, or both.  

The acronym “MRSA” stands for methicillin-resistant Staphylococcus aureus.  Staphylococcus is a type of germ (bacteria) that commonly lives on the skin and is sometimes referred to as “staph.”  These staph bacteria that live on the skin are harmless unless they enter the body through an open cut or wound.  Methicillin is a type of antibiotic that is used to treat Staphylococcus aureus skin infections.  Therefore, a MRSA infection refers to a germ that will not get better with certain antibiotics because the germ is “resistant” to the antibiotic.  

What are Signs of an MRSA Infection?

Signs of staph skin infections are red, swollen, painful boil or abscess on the skin.  It is not uncommon to have pus or drainage from the boil.  Staph infections can start from very minor skin sores such as an insect bite, cuts, scrapes, or pimples.  Many staph infections are very minor and can be treated in your primary care provider’s office.  MRSA infections are most often spread through touching or skin-to-skin contact.   

Is MRSA dangerous?

Many people are carrying MRSA germs on their skin and will never get an infection or any symptoms. This is referred to as “being colonized” with MRSA.  In fact, the Centers for Disease Control and Prevention (the CDC), estimates that approximately 1% of the population are carriers of MRSA.  However, if you are “colonized” with MRSA, you can spread the germ to other people.  

Anyone can get a MRSA infection, even if you are otherwise healthy.  MRSA infections are most commonly found on the skin, especially if someone is “colonized” or have been exposed to MRSA and also have a break or cut in the skin.  

Once a person gets a staph infection, the germ can spread to other organs, joints, or bones.  Some people are at an increased risk of contacting MRSA, particularly if they have a weakened immune system (such as cancer or HIV), recent surgery, or are on kidney dialysis.  MRSA infections can be very self-limiting and treated with antibiotics that are NOT resistant to the staph germ.  Many of these infections are treated on an outpatient-basis (by your regular pediatric primary care provider).  

Some MRSA infections can become very severe and cause more serious symptoms such as: high fever, shortness of breath, headaches, rashes, or a wound that won’t heal.  When the Staph aureus germs spread, they can start to affect the bones, joints, and then enter the bloodstream.  Once the germs are in the blood, they can spread to the heart valves, lungs, and brain.  Surgical wounds are especially susceptible to the spread of MRSA since Staph aureus regularly lives on the skin and the skin is cut open during a surgical procedure.  

How do you treat a MRSA infection?

Your pediatric nurse practitioner or pediatrician will most likely order a culture to diagnose the MRSA infection.  A culture can be taken from the wound itself, from drainage or pus from the wound, or sometimes from nasal secretions inside the nose.  The results from a culture will usually take 1 to 2 days.  

Sometimes your provider will recommend draining the boil or skin abscess, often referred to as an “incision and drainage” or “I&D.”  This should only be done by a health care provider. In some circumstances, your provider will recommend an I&D be performed under sedation or anesthesia.   The nurse practitioner or pediatrician will prescribe an antibiotic for your child based on their individual health history.  If the wound starts to get worse, even after treatment and antibiotics, you should bring your child back to their health care provider.  

Make sure that your child continues to take the prescribed antibiotic as prescribed.  Even though the skin or infection looks healed, antibiotics need to be used for the entire recommended dosage (which can be anywhere from a few days up to 2 weeks). 

Most “super infections” have started because of the overuse and misuse of antibiotics in our culture.  In the past, health care providers prescribed antibiotics for the common cold, flu, and viral infections that we know now will not respond to these drugs.  Furthermore, just as human beings have changed and adapted over the years, germs have also adapted and became resistant to antibiotics.  These germs have built “resistance” to certain antibiotics and now we have “super-bugs,” such as MRSA, which are harder to treat and can cause more severe skin infections.  

How do I prevent the spread of MRSA?

The most important way to prevent a staph infection is to wash your hands.  Children will sometimes need hand-washing to be supervised.  You can teach your child to wash their hands by singing the “happy birthday song” or the “ABCs” while they are rubbing their hands with soap and water.  When you are at the hospital or a physician’s office, make sure that all health care workers or hospital employees wash their hands before they touch your child.  You can also carry a bottle of hand sanitizer when you or your child do not have access to soap and water. 

If your child has a wound, make sure to keep it clean and covered with a bandage or 4X4 gauze until the wound is healed.  Pus or drainage from the wound can spread MRSA. 

Avoid sharing personal items. If you have a teenage son or daughter, instruct them not to share towels with one another and always wipe down shared athletic gear.  

References and resources: 

U.S. National Library of Medicine.  Methicillin-resistant Staphylococcus aureus; Hospital-acquired MRSA (HA-MRSA).  http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004520/, http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004520/  

Centers for Disease Control and Prevention.  Methicillin-resistant Staphylococcus aureus (MRSA) infections.   http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004520/, http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004520/ 

Mayo Clinic. MRSA infection.  http://www.mayoclinic.com/health/mrsa/DS00735, http://www.mayoclinic.com/health/mrsa/DS00735 

American Academy of Pediatrics (2006). Staphylococcal infections. In LK Pickering et al., eds., Red Book: 2006 Report of the Committee on Infectious Diseases, 27th ed., pp. 598–610. Elk Grove Village, IL: American Academy of Pediatrics.

About the Author:

Anna Tielsch-Goddard CPNP-PC is a Pediatric Nurse Practitioner for Children’s Medical Center Dallas at Legacy.  She practices on the Perioperative Surgery teams in presurgical assessment. Mrs. Goddard is currently working on her PhD at Vanderbilt University School of Nursing. 

Hippotherapy: A New Therapy for Autism

Monika Pis, PhD, CPNP

The word hippotherapy is derived from the Greek word "hippo," which means "horse." It describes physical, occupational, or speech therapy that uses the multidimensional movement of a walking horse to stimulate the rider and help enhance balance, good posture, mobility, coordination, and strength. Often, hippotherapy aids mental functioning, improves mood and self-confidence as well.

The rhythmic and multidimensional movement of the horse provides variable yet repetitive sensory stimulation to patients. That stimulation can be varied and manipulated by a trained therapist to fit a patient's needs and stimulate improved functioning of daily living. For example, physical therapists can use a variety of horse movements to improve gross motor abilities, such as sitting, standing, and walking.

According to the American Hippotherapy Association, hippotherapy is indicated for children and adults with mild to severe neuromuscular dysfunction. It aids impairments such as abnormal muscle tone; impaired balance, coordination, and sensory function; postural asymmetry; poor postural control; and decreased mobility. Hippotherapy has been used for conditions such as cerebral palsy (CP), developmental delays, traumatic brain injury, stroke, and autism.

Hippotherapy has been used in the U.S. since the 1970’s. However, it is still considered an experimental and investigational treatment because there is insufficient scientific evidence for its effectiveness in the treatment of CP, autism, and other conditions characterized by motor dysfunction.

A recent study by Bass, Duchowny, and Llabre (2009) examined the effects of a 12-week-long therapeutic horseback intervention on social functioning in children with autistic spectrum disorder. The results showed improved social interaction and less inattention and distractibility in autistic children. These findings indicate that hippotherapy may have a place in the treatment of children with autism. However, more studies need to demonstrate its therapeutic effectiveness before hippotherapy is widely recommended as a treatment for autism.

Photography by Joanna Jodko


References:
Bass, M., Duchowny, C., & Llabre, M. (2009). Journal of Autism and Developmental Disorders, 39(9), 1261-7.

Joanna Jodko Photography http://www.jjodkophoto.exposuremanager.com/

Does my toddler have a bladder infection?

Q:
My toddler has been potty trained for a while. Now, all of a sudden, he started to have accidents during the day. He pees in his pants several time during the day. He does not appear to be in any discomfort, but he pees more often and in his pants. Could he have a bladder infection?

A:

"Accidents" in potty trained children may indicate a bladder infection or diabetes. You should schedule an appointment with your child's health care provider as soon as possible.

Natural Mosquito Repellant

Monika Pis, PhD, CPNP

My property is situated in the woods with a lake on one side and a swamp on the other. It's the perfect breeding ground for bloodthirsty mosquitoes. For years, I have been using various mosquito repellents with little results, and I always frowned on the continuous exposure to DEET, the most common ingredient of many mosquito repellents. So when a colleague of mine mentioned using a natural mosquito repellent and expressed his satisfaction with the results, I decided to do some research on the product. 

Mosquito Barrier, a natural mosquito repellent, is a strong liquid garlic made with garlic cloves. Turns out that using garlic as an insect repellent is not new. It has been used for years to repel mosquitoes, ticks, fleas, and even black flies. The magic ingredient in garlic that makes it so effective is sulfur. Garlic is not toxic to humans, pets, and it does not destroy plants, thus it seems like a perfect product for families to use in their backyards.

Mosquito Barrier kills mosquitoes on contact, suffocates mosquito larvae in standing water such as puddles, under a deck, or depressions in your lawn, and last but not least, garlic-coated plants keep mosquitoes out of the area. 

According to the manufacturer, four applications of Mosquito Barrier should be sufficient for the entire mosquito/tick season. However, that may vary depending on the terrain of a property.

After hearing about such great results, I decided to give Mosquito Barrier a try. I mixed it with water and liquid soap in a garden sprayer according to the manufacturer’s directions and sprayed the areas of the yard that are immediate to the house, including under the deck. A distinct garlic aroma hung over the house for the rest of the night, but it was gone by morning. The following afternoon, when I took a stroll among my flowerbeds, I did not seem to be bothered by mosquitoes as much as before. I re-sprayed the yard a week later and was pleased to notice the lack of mosquito frenzy. 

Three weeks have passed now and the mosquitoes are back. It’s time to spray again if I want to enjoy summer evenings in my garden. I will continue using Mosquito Barrier because it is effective, natural, and safe around children and pets. A big plus is that Mosquito Barrier can be safely used around people with respiratory disease, such as asthma. 

More information on Mosquito Barrier is available at MosquitoBarrier.com.