How to maximize your infant's immunity

This article from TheScientificParent.org does a great job explaining how maternal vaccinations during pregnancy, infant vaccinations and breastfeeding all play important roles in optimizing a baby's immune system. 

http://thescientificparent.org/passive-immunity-101-will-breast-milk-protect-my-baby-from-getting-sick/

Early introduction of peanut protein probably reduces peanut allergy risk

Does eating peanut protein in infancy reduce peanut allergy risk later?

This New England Journal of Medicine article published online today seems to indicate yes.  As the NYT article below explains, there has been mounting published data over the last decade to support this theory.

http://well.blogs.nytimes.com/2015/02/23/feeding-infants-peanut-products-could-prevent-allergies-study-suggests/?smprod=nytcore-iphone&smid=nytcore-iphone-share

Why you should still get the flu vaccine if you haven't already

Flu activity is still high across most of the country with flu illnesses, hospitalizations and deaths elevated. Flu season will probably continue for at least several more weeks to months. While the flu vaccine may not work as well as usual against some H3N2 viruses, vaccination can still protect some people and reduce hospitalizations and deaths, and will protect against other flu viruses. 6 months old is the minimum age for the first dose of the flu vaccine. Don't forget that, in order to be well-protected, children under 9 years old are supposed to get 2 doses of the flu vaccine at least 28 days apart. Influenza antiviral drugs (Tamiflu) can treat flu illness. The CDC recommends these drugs be used to treat people who are very sick or who are at high risk of serious flu complications (for instance all children under 2 years old) who have flu symptoms, even with a negative flu test. Early antiviral treatment works best. Take a look at this great blog post written by the mother of two of my former patients in Houston. The embedded video is particularly moving. www.texaschildrensblog.org/2015/01/its-that-time-of-year-why-getting-your-flu-shot-is-still-important/

Consider adding Forest Lane Pediatrics to your Facebook News Feed

Over the last several months I have posted topics on the Forest Lane Pediatrics Facebook page that I would have posted on this blog in the past. "Liking" the Forest Lane Pediatrics Facebook page at www.facebook.com/forestlanepedi is an easy way to get pediatric health suggestions and articles sent to you on your FaceBook News Feed that were selected by me and my colleagues. 

Thanks to all who have continued to follow my blog.  My current plan is to continue to post in both places when I can. 

-Dr. Clarke

Preparing for the 2014-15 Respiratory Virus Season

Here is a good blog post from Texas Children's Hospital that summarizes how you can prepare your children for the next few months of respiratory viruses. 

Take home message:

-Keep hands clean

-Get the flu vaccine

-Monitor for more serious symptoms

-Cold medicines are largely ineffective and potentially dangerous. 

http://www.texaschildrensblog.org/2014/10/get-ready-for-cold-and-flu-season/

Relocating to Dallas

Written by: Dr. Adrian Clarke

Dear Patient Families,

As many of you already have already read or heard, I am relocating to Dallas and will no longer be practicing at Blue Fish Pediatrics, effective December 21, 2013. All of my patients should receive a letter of notification via US mail in the next few weeks.

I have thoroughly enjoyed my three years at Blue Fish and, although it will be difficult to leave my practice, patients and colleagues, I am confident that your child will continue to receive the highest level of care at Blue Fish Pediatrics.

As part of the effort to ensure a smooth transition for your family, Blue Fish is pleased to announce that Dr. Eric Lindsay will be joining the Memorial office in January 2014. For a complete bio please click on this link: http://bit.ly/1bZAS2N. I am thrilled that such an outstanding pediatrician has been lined up to accept any of my patients who wish to continue at Blue Fish. Dr. Lindsay will be available to accept my patients to the extent that his schedule allows.

I will honor all of my visits scheduled through December 20, 2013. All visits currently scheduled after December 20, 2013 will be receiving a phone call to either reschedule or to keep your appointment and be seen by Dr. Lindsay.

If you have any questions please contact Denny Yu, Practice Manager, by phone at 713-467-1741 or by email at bluefish@bluefishmd.com.

If you would like access to your medical records, please contact Blue Fish Pediatrics for forms and instructions.

I would like to thank you for your continued support and confidence. This is a bittersweet transition for me since I have been in practice in the Houston area for over 11 years. Serving as your family's pediatrician has been a privilege, an honor and a distinct pleasure.

In January 2014, I will be joining Forest Lane Pediatrics at their Medical City location in Dallas. You may contact at:

Forest Lane Pediatrics
7777 Forest Lane,
Building B, Suite 445
Dallas TX, 75230
Phone: 972-284-7770
Fax: 972-284-7780
www.forestlanepediatrics.com

Very truly yours,
R. Adrian Clarke, MD

Avoid codeine after tonsillectomy surgery

Written by: Dr. Adrian Clarke

Earlier this year the FDA issued a warning and changed the label on pain medications that contain codeine because of unpredictable serious adverse effects including death in children.

Codeine is metabolized into morphine and some children are genetically predisposed to be "ultra-rapid  metabolizers". Some of these children have had fatal or life-threatening morphine overdoses after taking typically safe codeine doses for post-op pain management after tonsillectomy. 

The most common codeine-containing medication is acetaminophen with codeine (aka Tylenol #3). 

The FDA now "strongly recommends" against codeine use in post-op tonsillectomy pain management. 

http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm315497.htm

Flu vaccine common misconceptions

This March 2013 New York Times health blog entry does a good job summarizing and answering common myths about the flu vaccine. 

http://nyti.ms/VZer7M

How to be prepared before, during, and after the shots

Pediatricians are often asked how to treat vaccine injection anxiety, how to recognize abnormal post-vaccine reactions, and how to treat a reaction if it occurs.

Here are 2 links to parent-oriented handouts on this topic:
www.cdc.gov/vaccines/parents/tools/tips-factsheet.pdf
www.immunize.org/catg.d/p4015.pdf

In summary:
1. Don't pre-medicate with a pain/fever reducer unless there has been a history of prior adverse reaction.  At least one recent study suggests that pre-medicating may alter the immune response of the vaccine.  It is not clear if this is clinically significant. 
2.  Stay calm and help your child deal with the immediate discomfort of the injection with techniques such as swaddling and nursing for infants and distraction techniques for older children.
3. If a reaction such as painful redness and swelling does occur, use pain/fever reducers and cool compresses.
4. For specific information about any particular vaccine and its typical post-vaccine reaction symptoms,  review that vaccine's Vaccine Information Statement (VIS) handout.  At our office, we give you a VIS packet with all of the VIS's at your first vaccine visit (usually 2 months old).  Individual VIS's are available at our office and at www.goo.gl/6kiGV. 

Answers to Expecting Parents' Frequently Asked Questions

What’s the big deal about pertussis? (www.cdc.gov/pertussis)

Pertussis (aka whooping cough) is a highly contagious bacterial respiratory illness that causes severe cough and/or trouble breathing in young children and infants.

Pertussis vaccines are effective, but not perfect.

- Protective immunity from the current (post-1990s) childhood vaccine wanes after 5 to 10 years and rarely lasts more than 12 years.  This is why booster vaccination has been recommended for adolescents and adults since 2005.  

- Before pertussis vaccines became widely available in the US in the 1940s, about 200,000 children were infected each year and about 9,000 died as a result of the infection. 

2012 had the most reported cases since 1955 with over 41,000 cases and 18 deaths (15 deaths under 1 year old).  In more typical years there are ~10,000-25,000 cases reported and ~10-20 deaths.

Infants are at greatest risk for getting pertussis and then having severe complications from it, including death (even when appropriately treated).

- About 50% of infants < 1 year old who get pertussis are hospitalized

- 1-2% of hospitalized infants die.  Most deaths < 6 months old.

When the source can be identified, ~80% of infants with pertussis catch it from someone at home:

a.     55% parents (mom 30-40%; dad 15%)

b.     15-20% siblings

c.      10-25% friends, cousins, others

d.     10% aunts or uncles

e.     5% grandparents

f.      2% other caretakers

What’s the big deal about the flu? (www.cdc.gov/flu)

Influenza (aka the flu) is a highly contagious viral respiratory illness with annual Fall/Winter seasonal peaks.

The annual flu vaccine varies in its effectiveness; therefore flu infection will occur among some individuals who received the flu vaccine that season.

6 months old is the minimum age to get the flu vaccine.

15-40% of preschool and school-aged children catch the flu each year.

Infants younger than 6 months are at the highest risk for flu-related hospitalization and death.

In the 2012-2013 flu season, there were over 100 pediatric deaths:

- 90% had not received the flu vaccine for the current season.

- 60% had identifiable risk factors for flu-related complications.

I knew the baby needed shots, but we probably need them too? (www.vaccine.chop.edu)

Confirm that all future household contacts (such as older siblings) and all potential caregivers (grandparents, close friends, nannies, etc.) are up-to-date on all of the recommended adult vaccines (www.goo.gl/W6GJM).

Pertussis booster: One booster dose of tetanus, diphtheria, and pertussis (Tdap) vaccine if you have not previously had this vaccine.  Starting in 2013, pregnant women should get a Tdap during each pregnancy.  Tdap may be given regardless of when the last tetanus and diphtheria (Td) dose was given.  

It takes about 2 weeks for the pertussis vaccine to produce immunity.  (www.goo.gl/JF8Pg)

Influenza: once per flu season (each school year, i.e. Fall/Winter).  The flu vaccine is especially recommended for household contacts of infants under 6 months old.

International Travelers:  specific travel vaccines and/or malaria prevention medications may be required. 

Do your own research: www.cdc.gov/travel.

Get vaccinated and/or get prophylactic meds for malaria via an international travel medicine clinic or your doctor.

What info should I make sure to bring/know about my baby's birth when we go to the first pediatrician appointment?

In a perfect world, all of your baby's essential medical records would seamlessly and legibly arrive at your pediatrician's office well before your first appointment.   This does not always happen.

 Do your best to gather the following minimum information for that first appointment:

- Birth weight

- Gestational age

- If the baby was born by C-section, why?

- Was the baby in the breech position at birth? In the third trimester?

- Were there any problems with jaundice?

- Was the hepatitis B vaccine given, and if so when?

           

How and what should I feed her?

All pediatricians strongly encourage and support giving human breast milk as the exclusive source of nutrition for newborns.  I have listed the numerous health benefits in a prior blog post.

If it turns out that exclusive breast feeding is not possible and/or is not your choice, the following link from the AAP gives useful guidance on choosing the right formula, bottles and nipples for your infant: www.goo.gl/QDdTP

She’s been fed and changed, but she’s still upset.  Now what? (www.goo.gl/rEW5n)

Taking care of a newborn is challenging. 

Newborns eat, sleep, pee, poop, hiccup, sneeze, burp, pass gas, spit up, cry and fuss.

Happiest Baby on The Block (see the resource section at end of this post) is an excellent summary of well-established calming techniques to help with excessive crying and fussing.

What do I need in my medicine cabinet?

Diaper cream, fragrance-free moisturizing cream/ointment, thick diaper cream, vaseline, water soluble lubricant (KY jelly), small gauze pads, infant rectal thermometer, alcohol wipes, infant acetaminophen (newborn dosing is not always on the package), 1% hydrocortisone cream, 1% clotrimazole cream, NoseFrida (preferred over the regular bulb suction aspirator), infant fingernail clippers, small tweezers, and a small emery board.

How do I minimize the risk of SIDS? (www.cdc.gov/sids)

Sudden infant death syndrome (SIDS) is defined as the "sudden death of an infant younger than one year of age, which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history."

SIDS is the leading cause of death 1- 12 months of age and is most common 1- 4 months old, with 90% of cases occurring before 6 months old.

More than 95% of SIDS cases are associated with one or more risk factor.   

Major Pre-natal SIDS Risk Factors:

a.     Young maternal age (less than 20 years old)

b.     Maternal smoking during pregnancy

c.      Late or no prenatal care

d.     Preterm birth and/or low birth weight

Major Post-natal SIDS Risk Factors:

a.     Sleeping on stomach

b.     Sleeping on a soft surface and/or with bedding accessories such as loose blankets and pillows (www.goo.gl/nbes3)

c.      Bed-sharing (aka co-sleeping)

d.     Overheating

SIDS Risk Reducers

The following factors are somewhat protective against SIDS, but they are outweighed by the modifiable risk factors described above:

a.     Breastfeeding

b.     Room-sharing without bed-sharing

c.      Pacifier use that does not interfere with breastfeeding.

d.     Fan use

Do not use infant sleep positioners in order to keep baby on his/her back.

Do not put your baby down in a crib with crib bumpers, no matter how nice they make the crib look.

Resources:

Happiest Baby on The Block by Harvey Karp (Book, DVD, or iTunes/Amazon download)

Heading Home With Your Newborn by Laura Jana and Jennifer Shu.

www.healthychildren.org

http://newborns.stanford.edu
www.vaccine.chop.edu

www.vaccine.texaschildrens.org

www.dhhs.ne.gov/publichealth/Pages/sids_environment.asp

www.fda.gov/downloads/ForConsumers/ConsumerUpdates/UCM227719.pdf

www.cdc.gov/sids

www.cdc.gov/pertussis

www.cdc.gov/flu

www.cdc.gov/travel

www.fridababy.com/shop/nosefrida

www.mayoclinic.com/health/induced-lactation/AN01882

www.webmd.com/parenting/baby/bottle-feeding-9/choosing-a-bottle

www.youtube.com/watch?v=VCYWqni0TeM

Don't minimize the importance of the Hepatitis B Vaccine

As all of my patients know and any readers of this blog can tell, I strongly believe in the importance of sticking to the AAP-endorsed pediatric vaccine schedule.

Occasionally, I have parents who wish to delay the Hepatitis B virus (HBV) vaccine.  The typical rationale is that they know that mom doesn't have Hep B disease (therefore there is/was no risk of vertical transmission during the birthing process) and they are not concerned about their infant and/or young child exhibiting the types of high-risk behaviors that can expose humans to blood and bodily fluids.

Unfortunately, this strategy is not supported by the evidence.  Take a look at the following link on the HBV vaccine from the Children's Hospital of Philadelphia Vaccine Education Center (bit.ly/ynJrve).  

Before the HBV vaccine was available, 50% of the 18,000 annual pediatric cases of HBV under 10 yrs old did not come from mother-to-newborn vertical transmission during birth. 

The most likely causes of non-vertical transmission are incidental exposures to microscopic amounts of infected blood from asymptomatic (but still infected and contagious) close contacts.  This could happen innocently via toothbrushes, razors and washcloths or towels.  

The bottom line is that "being careful" is not enough to prevent these kinds of cases, the best protection is infant HBV vaccination starting at birth.

SIDS: How to minimize your infant's risk

Sudden infant death syndrome (SIDS) is defined as the "sudden death of an infant younger than one year of age, which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history."

SIDS is the leading cause of death for infants between 1 month and 12 months of age and is most common between 1 to 4 months old, with 90% of cases occurring before 6 months old.

Fortunately, the SIDS rate in the United States has dropped significantly over the last 30 years. The greatest reduction occurred in the first 10 years after the American Academy of Pediatrics (AAP) started the "Back to Sleep" campaign to reduce the risk of SIDS which recommends placing infants in a supine position (on the back) for sleep. Between 1992 and 2001, the SIDS rate in the United States fell from 0.12% to 0.06%, while the proportion of infants sleeping in the supine position increased from 13% to 72%.

More than 95% of SIDS cases are associated with one or more risk factors, and in many cases, the risk factors are modifiable (usually sleeping position, sleep environment, or parental co-sleeping).

Major Pre-natal SIDS Risk Factors:
-Young maternal age (less than 20 years old)
-Maternal smoking during pregnancy
-Late or no prenatal care
-Preterm birth and/or low birth weight

MajorPost-natal SIDS Risk Factors
-Sleeping on stomach
-Sleeping on a soft surface and/or with bedding accessories such as loose blankets and pillows
-Bed-sharing (sleeping in parents’ bed)
-Overheating

SIDS Risk Reducers
The following factors are somewhat protective against SIDS. However, these effects are outweighed by the modifiable risk factors described above:
-Breastfeeding (36% lower risk of SIDS, if BF lasts more than 1 mo)
-Room-sharing without bed-sharing
-Pacifier use that does not interfere with the establishment of breastfeeding.
-Fan use

In summary, infants whose mothers received appropriate prenatal care and who sleep on their backs in an appropriate sleep environment (see first link below for picture), are breastfed beyond 1 month old, and have never been exposed prenatally or postnatally to tobacco smoke are at the lowest risk for SIDS.

Take a look at the following links for more information:

http://dhhs.ne.gov/publichealth/Pages/sids_environment.aspx

http://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx

http://www.cdc.gov/sids/

http://www.uptodate.com/contents/sudden-infant-death-syndrome-sids-beyond-the-basics?source=search_result&search=Sids&selectedTitle=1%7E4&view=outline



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5/7/13 Addendum

Here is a link to the recent FDA warning to NOT use infant sleep positioners because of the risk of death by suffocation.
http://www.fda.gov/downloads/ForConsumers/ConsumerUpdates/UCM227719.pdf

Autism risk is not related to more vaccines under 2 years old

A new study published on 3/29/13 is the latest of more than 20 studies showing no connection between autism and vaccines.

What is noteworthy about this study is that it is the first to prove that neither the total number of early vaccines nor the total number of vaccine antigens (the proteins in vaccines that trigger an immune response) lead to an increased risk of autism.

This is an important study because it should help address the fear that pediatricians frequently hear from parents (and grandparents) that the modern multiple vaccine schedule will "overwhelm" their (grand)child's immune system.
This study concludes that children who receive the full schedule of vaccinations in the first two years of life have no increased risk of autism. "Splitting them up" is not going to lower the risk of autism and it delays protection against life-threatening infections in vulnerable infants and young children.

Also of note, in order to fully vaccinate a 2 year old the 2012 CDC vaccine schedule uses 315 total antigens, whereas in the late 1990s it took several thousand antigens to do the same job. This is because modern vaccines need fewer antigens to stimulate adequate immune responses.
To state it plainly, while we don't know why there had been an increase in autism prevalence over the last two decades, we do know that it is not due to a increased antigen load overwhelming the immune system. On the contrary, we have been able to add protection against more bacteria and viruses over the last 20 years while at the same time decreasing the antigen load.

Here is the NPR blog post about the Journal of Pediatrics paper:
http://www.npr.org/blogs/health/2013/03/29/175626824/the-number-of-early-childhood-vaccines-not-linked-to-autism

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Vaccines during pregnancy

As all of my patient families know, I strongly agree with the AAP and CDC recommended vaccine schedule for children.
In addition to these recommendations for the direct protection of our pediatric patients, pediatricians also support specific vaccinations for household and other close contacts of our pediatric patients.

I really like this recent blog entry written by Rachel Cunningham, MPH, a vaccine expert at Texas Children's Hospital Immunization Project.  In addition to her professional expertise, the article includes her parental perspective as a mother of two young children: http://www.texaschildrensblog.org/2013/03/what-vaccines-to-expect-when-youre-expecting/

The CDC's webpage on this topic also has specific and useful information: http://www.cdc.gov/vaccines/parents/pregnant.html.


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AAP Drowning Prevention tips

With the weather getting nicer and many of my patients having access to swimming pools, I thought I should post some info on pediatric drowning prevention and overall water safety.

In May 2010, the American Acedemy of Pediatrics revised the minimum age that pediatricians recommend swim/water safety lessons down from 4yo to 1yo, in developmentally appropriate children.

Take a look at following summary of the May 2010 updated recs: http://tinyurl.com/ce3ojgf

Busy 2012-2013 Flu Season

As I'm sure almost everyone is aware, this has turned into a heavy flu season. Here are a couple of web links to info on what to look out for if you suspect or know that your child has the flu.

http://www.cdc.gov/flu/pdf/freeresources/updated/fluguideforparents_brochure.pdf

http://www.texaschildrensblog.org/2013/01/flu-symptoms-when-to-bring-your-child-into-the-emergency-center/


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Breastfeeding Infant Health Statistics

In my experience, nearly all parents and/or expectant parents are aware of the fact that pediatricians heavily favor breast milk as the best nutrition source for infants.
However, I'm not so sure we always do a great job explaining what evidence we have to support our strong preference or what factors lead to successful breastfeeding. 

Here is a slightly updated version of my 2013 blog post on the same topic.   

Current American Academy of Pediatrics (AAP) recommendation:
Exclusive breastfeeding for "about 6 months", then continued breastfeeding while complementary solid foods are introduced, and then continued breastfeeding until at least 1 year old, or as long as it is mutually desired by mother or infant.

So what is the evidence behind the current AAP recommendation?

ANY breastfeeding is associated with...
64% lower risk of gastroenteritis (viral vomiting/diarrhea infection)
40% lower risk of type 2 diabetes
40% lower risk of asthma, if any BF lasts > 3 mo AND there is a positive FH of asthma/eczema/allergies
36% lower risk of SIDS (sudden infant death syndrome), if any BF lasts > 1mo
31% lower risk of IBD (ulcerative colitis or Crohn's disease)
26% lower risk of Acute Lymphoblastic Leukemia (ALL), if any BF lasts > 6mo
26% lower risk of asthma, if any BF lasts > 3 mo AND no FH of asthma/eczema/allergies
24% lower risk of obesity (teen and adult)
23% lower risk of otitis media (ear infection)
15% lower risk of AML leukemia, if BF lasts > 6mo

EXCLUSIVE breastfeeding is associated with...
63% lower risk of URI (common cold), if 100% BF lasts > 6mo
52% lower risk of celiac disease, if gluten-containing foods are introduced before infant formula or cow's milk are started.
50% lower risk of otitis media, if 100% BF lasts > 3 mo.
42% lower risk of eczema, if 100% BF lasts > 3mo AND positive FH of eczema
30% lower risk of type 1 diabetes, if 100% BF lasts > 3 mo
27% lower risk of eczema, if 100% BF lasts > 3mo and no FH of eczema

So how are we doing in the US as far as breastfeeding rates?
75% initiate any BF.
44% continue any BF at 6 mo.
22% continue any BF at 12 mo.
34% continue exclusive BF at 3 mo.
14% continue exclusive BF at 6 mo.

What can we do to get mothers off to a better start with breastfeeding?
1. Encourage and promote breastfeeding and skin-to-skin contact within the first hour of life.
2. Avoid supplementing with any formula, water, or any other fluid besides human breast milk in the hospital.
3. Minimize separation of mother and newborn in the hospital (aka "rooming-in").
4. Avoid all pacifiers except when necessary to soothe during painful procedures such as male circumcision.
5. Provide written resources for post-hospital discharge breastfeeding support such as lactation consultant list with contact info before hospital discharge.

Take home messages:
1. Even just a partial diet of breastmilk through 1 mo lowers the SIDS risk by 36% and reduces the risk of gastroenteritis, type 2 diabetes, asthma, leukemia and obesity to varying degrees.
2. An infant diet of 100% breast milk until 3 mo lowers the risk of ear infections, eczema, type 1 diabetes.
3. The closer an infant can get to 6 months old without any other nutrition besides breast milk, the better.
4.  Infants who are introduced to gluten-containing foods before infant formula or cow's milk are introduced are substantially less likely to develop celiac disease.

Breastfeeding also has multiple known maternal health benefits such as decreased postpartum depression, decreased risk of maternal type 2 diabetes, and maternal cardiovascular disease.

Therefore, unless there is a medical contraindication to breastfeeding or the mother has a strong preference against breastfeeding, it makes sense to try breastfeeding and see how long it continues to make sense for both baby and mother.

Most US Measles Cases are Travel Related

In 2011 there were 222 cases of measles reported in the US which was the highest number since 1996. This included 72 imported cases, mainly from Western Europe. Most importantly, over 60% of the 2011 US cases occurred in patients who were eligible for the vaccine and therefore were likely preventable.

So which patients should get the MMR vaccine?
Current recommendations include a first MMR at 12-15 mo and a second MMR at 4-6 yo. The majority of my patients follow this recommendation. However, fewer families follow the recommendation that infants 6-12 mo who are traveling internationally also get at least one dose of MMR in addition to the other two MMR doses already mentioned. I think this is because many parents are not aware of the international travel recommendation for measles protection, especially when planning to travel to Western Europe, Canada, or Mexico.

The take home message is that parents should start the process for appropriate travel health planning as soon as possible after booking the travel. I suggest that parents first review the current US government recs for travel to the specific country or countries on their itinerary by looking it up on www.cdc.gov/travel and then contact our office or bring it up at the next well check (if time allows) so we can help make appropriate plans. These plans will include confirmation that maximum MMR protection is achieved.





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Great website for breastfeeding and other newborn topics

Stanford University School of Medicine has an excellent website with explanations, pictures and videos on the do's and don'ts of breastfeeding.
I don't think it can replace a live lactation consultant, but it's very instructive and free.

http://newborns.stanford.edu/Breastfeeding/

Other newborn issues (especially dermatology) are also reviewed with excellent images and explanations.

http://newborns.stanford.edu


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An update on pediatric concussions

Think of a concussion as a blow or jolt to the brain that causes (temporary) brain dysfunction. In the acute setting, the symptoms usually include at least one of the following: confusion, memory loss (amnesia), or loss of consciousness (LOC).  LOC is NOT a requirement to diagnose a concussion.

As an avid sports fan and a parent of two young children, I have been particularly disturbed by the recent data on head injuries in sports.  As we learn more about both the short-term and long-term effects of concussions (aka minor traumatic brain injury or mTBI), parents, health care providers, coaches and especially young athletes themselves need to learn how to prevent concussions, how to recognize the concussions that do occur, and how to resist the temptation of too rapid return to learn (RTL) and play (RTP). Not knowing enough about these brain injuries can have catastrophic consequences. For example, failure to follow the guidelines for appropriate return to play can result in death by a process known as "second impact syndrome".

There are many resources on this topic, but one of the best places to look is www.cdc.gov/concussion. This is a rich resource (partially funded by the NFL) of written and multimedia information on concussion prevention, recognition, and appropriate management.
For individual stories about concussions and concussion management, check out: www.cdc.gov/concussion/sports/stories.html
Other sources of quality and continually updated information on this topic are: www.healthychildren.org; www.uptodate.com/patients; and www.chop.edu/service/concussion-care-for-kids/home.html.
Fortunately, we have a growing number of resources for the management of concussions in Houston, West Houston, and Katy. Contact our office at 713-467-1741 for more info on local pediatric sports medicine, neuropsychology, and neurology resources that focus on the age-appropriate management of these potentially life-altering injuries.

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March 26, 2013
Here is an interesting addendum to my original blog post above. The link is to a November 2012 blog entry on youth football safety by Dr. Jorge Gomez, a Sports Medicine Specialist at TCH West Campus and an assistant team physician for the University of Houston Cougars. www.texaschildrensblog.org/2012/11/is-youth-football-safe/