March 28, 2013

– There has been an outbreak of meningitis in Tijuana and San Diego, called meningococcal meningitis that typically affects older children, teens and young adults.  There was a recent case of this bacteria in a one year old here in San Diego and a death of a 39 year old.  This is a very serious and potentially deadly and rapidly progressive bacterial infection that affects healthy children and adults.  If your child is 11 years or older, they are eligible to receive the vaccine for this called Menactra.  If your child is current on well care visits and has not had this, you may walk in for the vaccine to B105 Monday-Friday from 9-4 to receive this.  Symptoms of this disease may include: fever, intense headache, lethargy, stiff neck, and a rash that does not blanch under pressure. Anyone with potential exposure who develops any of these symptoms should immediatelycontact a healthcare provider or emergency room for evaluation of possible meningococcal disease.

Meningococcal Vaccine

County Health Alerts

Meningococcal Disease CDC Page

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Well-child check up visits are the perfect time to provide vaccines to children.  This is especially true because immunizations are one of the most powerful tools we have to keep children healthy. But vaccines are only one of the many things that parents can do to protect their children and improve their health.

As a preventative measure (and prevention is always better than cure), immunizing against potentially lethal diseases has been one of mankind’s greatest achievements right up there with clean water and sewer systems.  In today’s world the horror of smallpox is not even considered because vaccination has eradicated the virus. In more recent years vaccines have dramatically changed the incidence of many serious childhood diseases. As a pediatric resident-in-training at the Children’s Hospital of Los Angeles in the early 1980′s, the diseases caused by HIB (Haemophilus influenza type B) were still prevalent.  The vaccine against HIB had only recently been approved and only for children over two years of age. Unfortunately, 70% of cases of HIB disease occur in under 2 year olds. I don’t believe a day went by without at least one child being admitted with HIB infection, most notably meningitis. Approximately 1/3 of these infants and toddlers did not survive and of the survivors almost 1/2 were left with permanent neurological damage! By the end of the eighties HIB vaccine was available for children 2 months and older and today this has thankfully become a rare disease. This bacterium has not been eradicated however and so HIB vaccine remains an extremely important way to protect your baby.

There have been concerns raised about the safety of vaccines and especially the association between MMR vaccine (against measles, mumps and rubella) and autism. The sad truth is that this particular scare was created by a man called Wakefield who, in 1998, motivated by greed, falsified data for personal gain. The data was published in a very reputable journal and was taken extremely seriously by the medical community. It took 6 years for the fraud to be uncovered but only in 2010 was Wakefield convicted. The article has been withdrawn and Wakefield’s license to practice medicine revoked but damage has been done. Hundreds, if not thousands, of children have not been immunized as a result of this scare and who knows how many have died as a result. In any event, there is now good data to show that vaccines do not cause autism.

But enough about vaccines, what about the well child check up itself? As mentioned earlier, there are other topics that should be covered.  This is the ideal time to talk about diet and nutrition, about play and exercise and about sleep and socialization. Each age and stage at which we, as pediatricians, plan to see children as they grow up is unique and has unique issues that are worth thinking about and discussing.  In addition to these discussions,  we examine each child thoroughly, and the focus of the exam is different to that performed at a well check. We examine for hernias  and scoliosis in older children and for things like heart murmurs  and organ enlargement. We have techniques for checking vision and hearing even in infants and for assessing lung function in children over ten.   It goes without saying that individual concerns will also be addressed at a well check although very complicated issues  may require a separate consultation.

I thought it might be fun to share just one tidbit of guidance relevant to each age group that will illustrate the diversity of information that can be gained at each well check. I will only do this up until the 2 year check and then perhaps do a second article at another time about interesting information for 3 year olds and up.

• Newborn check: It is impossible to spoil a newborn. Newborns are developing trust and need to be picked up when they cry. This does not teach them to cry or make them into “crybabies”.
• 2 week check: Introducing a small amount (say ½ an ounce once a day) of freshly pumped breast milk in a bottle to a breast feeding baby will get the baby used to the bottle. If this is done at the beginning of a feeding about once a day, baby will take a bottle easily and when they are older mom may get a little freedom. Don’t be complacent though. A two week old will easily take a bottle but, unless it’s an almost daily occurrence, they will often refuse it when they reach about 4 months.
• 2 month check: Baby is just about to start developing memory and will become attached to the place and manner in which they find themselves falling asleep. Teaching baby to fall asleep in their “own space” will create good sleep habits that are life-long. This should not include allowing the baby to cry.
• 4 month check: Baby can now put her hands in her mouth and therefore can put things in her mouth and choke. Be very aware what she is grabbing hold of and also what other small children nearby might give her.
• 6 month check: Baby has now developed “object permanence” and now knows that things out of sight still exist. (You will see your baby looking for a dropped toy). Be aware that anything you drop or leave lying around might be searched for and found!
• 9 month check: Baby has now become extremely quick and will put anything and everything into his mouth. Make sure to keep anything poisonous out of reach and have the poison control phone number handy.
• 1 year check: This is the perfect time to discontinue the bottle. If you simply throw it away (and I generally recommend the outside trash can so that you are not tempted to retrieve it) it will be barely missed. If you wait until baby is 15 months old you will have a completely different experience. A firm spouted sippy-cup is the best type and the amount of milk (now organic whole milk) should be between 8 and 20 ounces a day. Make sure that before bed time you are brushing or wiping any teeth that baby may have (some will have none and others may have 12!)
• 15 month check: Toddler is now beginning to explore (emotionally as well as physically) and will start to test the limits and the boundaries. This is a good age to start to introduce discipline. Ask your pediatrician how to go about this.
• 18 month check: Toddlers start to notice the TV at this age, not just as light and sound but as specific events. They do not separate fantasy and reality, however, (and won’t until closer to 5) and so may become very frightened by what they see. No TV is best but if there is any exposure make sure it is entirely benign. Even commercials during sporting events can be very scary.
• 2 year old check: Toddlers at this age tend to get frustrated because they understand a lot about how the world works but cannot do things for themselves. My favorite example of this is when she asks for “water” but what she really wants is water from the fridge in her pink cup and put onto the table. When mom puts water from the sink into a blue cup and puts it on the floor she “loses it”. If you can figure out what she wanted done differently and change it for her you are not spoiling her. Better still, when she asks for something that you know she understands, give her choices and let her guide you through it.

I hope that these few ideas show how pediatricians can make parenting more fun and help to keep both children and parents happy and rested. While we do encourage vaccination of all children, bringing them in for well check appointments is not just about vaccines.

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3rd Place: Peni with It’s a Small World

2nd Place: Reagen with Thomas the Train

1st Place: Taleah with Santa Clause

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November 27, 2012 — This time of year, with colds and flu on the rise, children with known asthma can struggle with more bouts of their asthma. Triggers for asthma can include many things including:

• Allergens such as house dust mites, animal dander, mold and pollens
• Viral or bacterial infections like colds, flu, sinusitis, or pneumonia
• Environmental irritants such as smoke (fires or cigarettes), air pollution, fragrances, sprays or cleaning products
• Exercise-induced
• Stress

Natalie McNally, PNP is our Certified Asthma Educator and she is available for asthma education, evaluation and training on inhalers and other asthma gadgets.

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• WHERE: In front of the main office at El Camino Pediatrics, Suite B105
• WHEN: Thursday, November 1 between 2-5 PM

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Here are some guidelines and links to information about the flu vaccine:

• Annual flu vaccine is recommended for all children who are 6 months of age and older.
• Children aged 6 months through 8 years require 2 doses of influenza vaccine (minimum of 4 weeks apart).  Two doses of  the vaccine for children between 6 months and 8 years of age who have not received 2 or more doses of seasonal vaccine since July 1, 2010 are the recommendations. This second dose should be delivered at least 4 weeks after the first dose.
• Children over age 8 years only need one vaccine for the season.
• Patients with severe egg allergy reactions (those with swelling, trouble breathing, severe vomiting), should discuss with their physician as they may need referral to an allergist.  Patients who only have a rash with hives from eggs, may still be able to receive  the vaccination, but please discuss with your child’s physician.

There are 3 types of flu vaccines available and it is helpful if you read the Vaccine Information Sheets (VIS) from the CDC ahead of time.

• Inactivated Flu Vaccine – (Click here for the VIS  to read more information and side effects of the vaccine)  This vaccine is a “killed” vaccine and can be given to children 6 months and older.
• Live Nasal Flumist Vaccine – (Click here for the VIS to read more information and side effects of the vaccine)  This vaccine is sprayed into the nostrils.  It is approved for children over 2 years of age.  If a child is under 5 years of age with asthma or one or more episodes of wheezing within the past year, they should NOT get this vaccine.  Also those with certain muscle or nerve disorders, weakened immune system or who is in close contact with someone with a weakened immune system, or those on long-term aspirin therapy should NOT receive this vaccine.
• Intradermal Inactivated Flu Vaccine – this has been newly licensed this year for adults 18 to 64 years of age.  It uses a smaller needle and less antigen needs to be delivered.  Side effects are the same as the Inactivated Flu Vaccine.  We are offering this in our office while we have supplies for adult parents of our children.  There is a fee of $25 payable at the time of service and we are unable to bill insurance for parents.  Read more here.

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Please note that some school districts are not accepting a nurse practitioner to sign the forms solely, so some of the quick physicals offered at pharmacies may not be acceptable for your sports physicals!!  Our nurse practitioner and physician’s assistant in our office are supervised by MD physicians, who can co-sign the forms and so will be accepted.

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