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-The American and European allergy expert committee guidelines recommend that solid foods be introduced between four to six months of age in all infants
-The most common food allergens in children in the United States and many other countries include cow's milk, egg, soy, wheat, peanut, tree nuts, and seafood (shellfish and fish).
Previous guidelines recommended delayed introduction of highly allergenic solid foods for the purpose of preventing allergic disease in high-risk infants. More recent evidence suggests that this practice may increase rather than decrease the incidence of food allergies.
-The current recommendations are early introduction of highly allergenic solid foods in high-risk infants. These infants should be at least four months of age, be developmentally ready, and have tolerated a few less allergenic complementary foods, such as rice cereal and pureed fruits or vegetables.
-The one exception is liquid, whole cow’s milk, which should be avoided in all infants less than one year of age for reasons unrelated to allergy. Cow’s milk formula and other cow’s milk products such as those in baked goods, cheese, and yogurt do not need to be restricted prior to age one year.
What you need to know about Measles:
The CDC considers you protected if:
*You have had 2 doses of a mesasles containing vaccine and are school aged (grades K-12) or an adult in a high risk setting.
*You receive 1 dose of a measeles containing vaccine and you are preschool age
*An adult in a non-high risk setting
If planning to travel internationally:
*You should have at least 1 dose of the mesasles vaccine for kids 6-11 months and 2 doses for ages 12 months and older.
Do you never need a booster vaccine?
*No, 2 doses is protection for life
How effective is the vaccine?
According to the CDC, the vaccine is very effective. Two doses is about 97% effective and 1 dose is about 93% effective.
How long does the vaccine take to work?
A person is usually considered protected 2-3 weeks after getting the vaccine
Where does the measles in the United States come from?
*Typically from traveler from any country where the disease still occurs
*Pockets of unvaccinated communites within the United States
Here are the top 4 things parents should know about measles:
1. Measles CAN be serious
-Signs and symptoms include: High fever, runny nose, red watery eyes, rash(3-5 days after inital symptoms begin)
2.Measles IS contagious
-It is spread through the air
3.Your child CAN still get the measles in the United States
4. You have the power to protect your child against the measles with a safe and effective vaccine
What is bronchiolitis? — Bronchiolitis is a common viral infection that affects a part of the lungs called the “bronchioles.” The bronchioles are the small, branching tubes that carry air in and out of the lungs. When these tubes are infected, they get swollen and full of mucus. That makes it hard to breathe. Bronchiolitis usually affects children younger than 2 years of age. In most children, bronchiolitis goes away on its own, but some children with bronchiolitis need to be seen by a doctor. The most common cause of bronchiolitis is a virus called “respiratory syncytial virus,” or “RSV.”
What are the symptoms of bronchiolitis? — Bronchiolitis usually begins like a regular cold. Children who get bronchiolitis usually start off with:
- A stuffy or runny nose
- A mild cough
- A fever (temperature higher than 100.4ºF or 38ºC)
- A decreased appetite
As bronchiolitis progresses, other symptoms may develop, including:
- Breathing fast or having trouble breathing. In infants, the first sign can be a pause in breathing that lasts more than 15 or 20 seconds.
- Wheezing, or a whistling sound when breathing (which usually lasts about 7 days)
- A severe cough (which can last for 14 days or longer)
- Trouble eating and drinking — because of the other symptoms
Should I take my child to see a doctor or nurse? Many children with bronchiolitis may not need to see a doctor. However, you should watch and arrange f/u for concerning symptoms that involve increase in difficulty breathing, including wheezing; increased congestion with problems with feeding, any signs of choking or severe gagging from increased mucus, and problems with maintaining adequate hydration and urine output.
Call 9-1-1 for an ambulance if your child:
- Stops breathing
- Starts to turn blue or very pale
- Has a very hard time breathing
- Starts grunting
- Looks like he or she is getting tired of having to work so hard to breathe
Call our clinic if you have any questions or concerns about your child, or if:
- The skin and muscles between your child’s ribs or below your child’s ribcage look like they are caving in and there is struggling with breathing
- Your child’s nostrils flare (get bigger) when he or she takes a breath
- Worsening cough and congestion
- Your infant younger than 3 months has a fever (temperature greater than 100.4ºF or 38ºC)
- Your child older than 3 months has a fever (temperature greater than 100.4ºF or 38ºC) for more than 3 days
- Your infant has fewer wet diapers than normal
How is bronchiolitis treated? — The main treatments for bronchiolitis are aimed at making sure that your child is getting enough oxygen, and able to breathe well despite the increased mucus that this virus produces. To do that, your child may need to receive:
- Moist air or oxygen to breathe
- Medicines to help open up the airways
- Deep suctioning of the airways
Bronchiolitis does not need to be treated with antibiotics because it is a virus, however children may develop complications from the virus including ear infections or pneumonia. If your child has a persistent fever or if he was getting better and then gets sick again, please call for an appointment.
Is there anything I can do on my own to help my child feel better? — Yes. You can:
- Make sure your child gets enough fluids. Call our office if your infant has fewer wet diapers than normal.
- Use a humidifier in your child's bedroom
- Treat your child's fever with non-prescription medicines, such as acetaminophen or ibuprofen (if your child is over 6 months of age).
- Suction the mucus from your child’s nose with a suction bulb
- If your child is older than 12 months, feed him or her warm, clear liquids to soothe the throat and to help loosen mucus
- Prop your child's head up on pillows or with the help of a car seat. Do not use pillows if your child is younger than 12 months old.
- Sleep in the same room as your child, so that you know right away if he or she starts having trouble breathing
How did my child get bronchiolitis? — Bronchiolitis is caused by viruses that spread easily from person to person. These viruses live in the droplets that go into the air when a sick person coughs or sneezes.
Can bronchiolitis be prevented? — You can reduce the chances that your child will get bronchiolitis by:
- Washing your hands and your child’s hands often with soap and water, or using alcohol hand rubs
- Staying away from other adults and children who are sick
Adapted from UptoDate.com
ITCHY SKIN: DEALING WITH ECZEMA/ATOPIC DERMATITS
NATHAN RENDLER, MD
VALLE VERDE PEDIATRICS
Atopic dermatitis is the most common type of dry, itchy skin known as eczema. It affects 10-20 percent of kids and from 1-3 percent of adults.
Patients may scratch uncontrollably leading to redness, swelling and cracking of the skin, with crusting and scaling, and even “weeping” of clear fluid. Patches of the affected skin may be widespread and the constant scratching can lead to skin damage, secondary infection and loss of sleep.
In kids, we often see this condition develop in the first year of life, and it develops in 80 percent of those affected before age 5. In infants, itchy patches are often noted on the scalp, forehead, and cheeks. Many of these younger children get better with time, but it may be a clue for the “allergic march”, with a risk for the development of allergy and asthma. Therefore, we carefully monitor for any associated wheezing and persistent congestion, and at times, test for associated food allergies, including milk products, nuts and shellfish. Controlling asthma symptoms and environmental allergies and hay fever will also help clear up the skin. If the condition doesn’t resolve early on, a childhood phase develops with skin involvement that usually appears on the inside of the elbows or the back of the knees. We often see this in older children and teens, and they may also show patches on the face, hands, feet, wrists and ankles, and neck and upper chest. With time, the patches may become discolored, scaly and thick, as well as emotionally distressing. Fortunately, the itchy skin tends to improve with time, but it may be a lifelong condition for those severely affected. For example, hand eczema is an especially bothersome form of dry skin that can become chronic and interfere with everyday activities. The use of prescription ointments and creams with frequent use of moisturizers is helpful, but it is especially important to avoid harsh soaps and irritating cleansers, and even use gloves for protection. This presents a good example of the effectiveness of combining of good medical treatment with environmental control.
While the treatment and control of atopic dermatitis may be challenging, it is very rewarding to see patients improve when we educate them and their families about controlling the condition. I recently attended a medical conference with lectures from a noted dermatologist who taught us that the use of bleach scrubs for certain challenging cases is helpful, and I’ve had some good success with this treatment. By working together with patients and their families, we look to identify and avoid allergen and environmental triggers, and develop an effective long-term treatment and prevention plan, including the use of approved corticosteroid creams and ointments, breaking the itch cycle with non-sedating antihistamines, and the use of aggressive moisturization. We can make a difference and stop the “itch cycle” in our patients with eczema.
Adapted from the pamphlet:
Eczema/Atopic Dermatitis, a 2009 publication of the American Academy of Dermatology.