Pedimedica Health Blog

Joining forces for the greater good of their patients!

2012-01-25T17:12:00.000-05:00

Partnering with Parents in Healthcare has always been the philosophy at Pedimedica, where the doctors and their staff are passionate in their belief that caring for your children is as important as caring for their own.

Sharing their passion for patient care and having a common vision for delivering the highest quality healthcare, Summit Pediatrics joined the Pedimedica family of pediatric practices in 2011. Located in Hackensack, NJ for over 25 years, Dr. Basil Bruno, Dr. Lisa O’Donnell and Dr. Mary Thomas still remain at their convenient location at 55 Summit Avenue along with Cynthia Angelica, R.N., C.P.N.P., who has been practicing pediatric nursing for over 16 years.

According to Dr. Bruno, he felt strongly that this merger of healthcare professionals was the perfect fit for the practice and the patients that server and would be an opportunity to expand their services to a wider community. “By merging with Pedimedica, we can now ensure that our patients throughout Bergen County will have access to the latest technologies, equipment and pediatric advancements right in each office, with offices open 365 days a year.”

The entire staff at the Pedimedica practice at Hackensack all agrees that their patients’ and parents’ voices are extremely important. “By listening to you and your child, we are able to help children achieve optimal heath and emotional well being.”

Please click here to learn more about the doctors at Pedimedica Hackensack and their staff.

On Call… with Dr. Mary Thomas

2012-01-02T10:14:00.000-05:00

HPV Vaccine: A Pediatricians Argument to Vaccinate Your Daughters AND Sons !

Although millions of dollars and man-hours have proven again and again that our vaccines are safe, many parents are still afraid. Each day that I am in my office I find myself making pleas to parents to vaccinate their children with routine vaccines recommended by the Centers for Disease Control (CDC) and the American Academy of Pediatrics (AAP) and that are also required by New Jersey schools. Imagine, then, how challenged I feel when faced with the task of vaccinating young girls, and even young boys with a vaccine that has garnered as much controversy as the HPV vaccine.

As a pediatrician, and a mom of three young kids I feel that one of my most important purposes in life is to protect children from illness and disease. My vaccines are my most powerful tool in doing so. I might even argue that the HPV vaccine is the sharpest tool in my belt because it is the only one that can protect our children from something that we all fear may sneak up on us – cancer.

If this article has caught your attention you must have wondered about the HPV vaccine once or twice. What is it and why is it so important? HPV (Human Papilloma Virus) is a sexually transmitted virus that infects more that half of sexually active people at one time or another. Usually it is a benign wart that may even be asymptomatic and will in many cases resolve without treatment. However, in the US, 15,000 women will develop cervical cancer from that virus; and of those 15,000 women, 4,000 will die.

Those statistics are very frightening, but for the first time in history, we can change them. The HPV vaccine prevents most cervical cancer if the vaccine is received before first sexual contact. This is why the optimal time to vaccinate is at age 11 or 12. This is also the time when the body is primed to create the best immunity.

The schedule is simple. The first dose is given and then the second will follow 1 to 2 months later. A third dose is indicated 6 months after the first dose was received. It seems easy, but we need to do better. At present, only 32 percent of girls receive all three vaccines and only 1% of boys.

Yes, boys. I guess you are thinking “Why should I vaccinate my son, who does NOT have a cervix?” It is a good question. On October 26^th the CDC recommended the vaccine for all males ages 11 to 12. For them it can prevent both genital warts and anal cancer. There is also evidence that it may prevent some types of head and neck cancer transmitted through oral sex by men who have sex with men. Don’t write me off at this point, this is not just an STD that affects homosexuals. At some point we all hope that our sons will find the perfect girl and marry. This vaccine protects her and helps prevent your son from caring for a wife with a cancer that can be potentially fatal.

These are things that are hard to think about as parents. They are even harder to talk about with our children. A recent study in pediatrics showed that daughters of women who have talked to their mothers about the risks of unprotected sex and the benefits of vaccination were more likely to elect for the vaccine. Talk to your kids. Protect them before sexual contact. You may be saving their life!

On-Call with Lisa O’Donnell, MD

2011-11-04T09:50:00.000-04:00

PEER PRESSURE TIPS FOR THE ADOLESCENT

It’s human nature to listen to and learn from other people in your age group. For teens it makes it difficult to know just what to listen to and what advice to avoid. Dr. Lisa O’Donnell shares her insight on peer pressure and offers her advice on how your adolescent can better navigate their way through those times when they feel the pressure is on.

What is peer pressure?

Peer pressure is the influence exerted by a peer or group which encourages a person to change his/her attitudes, behavior, values in order to conform to group norms.

Why do we “give in” to peer pressure? Is it okay to give in to peer pressure?

We constantly feel the need to fit in. Especially during the teen-age years, we strive to be like the cool kids. It is a great feeling to be liked. We agree to do or say things we don’t necessarily believe just to be liked by our peers. Sometimes, we may feel that if we don’t steal the lipstick in the store or don’t belittle the kid in gym who can’t throw the ball that our classmates will start mocking us. Or worse, they will avoid us and we will not have any friends.

It is okay to give in to peer pressure. We are all human and there are times when it may be too difficult to avoid it. If the peer pressure was negative and you did give in, pick yourself back up and tap into your self confidence. If you do this, the next time it may be easier to say no.

How do I stand up to peer pressure?

Listen to your inner voice. If you feel uncomfortable with the situation, even if your friends aren’t, it’s a red flag that something about what you are doing is wrong. Tap into that inner self and learn more about who you are.

Plan for possible pressure situations. If you know that everyone in the park is going to be smoking tonight, rehearse what you are going to say. Maybe you could put gum in your mouth so you have something to do. Then rehearse your answer: “I’m okay for now”. You can even blame your parents. “My mom would kill me if she smelled cigarettes/marijuana on my breath”.

Arrange a “bail-out “code. When you need to leave a bad situation, call your parents or relative/friend and use the code. For example when the smoking is getting out of hand in the park and you feel uncomfortable, call your mom and say “I have the worst headache”. Then she will know to pick you up with no questions asked.

Learn to feel comfortable saying “no”. If they are your true friends, it should not be difficult to say no. They will not need an explanation or an apology. However, if you are not surrounded by true friends, you can always use an excuse. “No way, my aunt just died of lung cancer from that stuff!”

Surround yourself with people who share your beliefs/values. Hang around with people who are willing to stand up for you. More importantly surround yourself with people who will stand up with you. Chances are if you are hearing a little voice in your head saying that something is not right, so are they.

Resisting peer pressure can be extremely difficult. However, if you use your inside voice and find the courage to stand up to it, you can change a situation for the better. Consider yourself a leader, and know that you have the potential to make a difference!

For more information about Dr. Lisa M. O'Donnell, Please visit http://www.pedimedica.com/pedimedica_hackensack/hackensack_doctors.html

On Call with Dr. Basil Bruno

2011-10-04T09:02:00.000-04:00

This month Pedimedica asks Dr. Bruno for his insight and recommendations on how to ease your child’s back to school anxiety.

How to Overcome School Anxiety

Going to school offers a wide range of emotions for parents as well as children. Whether it's dread or excitement, fear or euphoria, all of these feelings can be bottled up inside our kids. Remember that any one symptom of distress does not cement a child's fate or mean that their school year will be a failure. All kids, at some point in their academic career, will struggle, so try hard not to view their setbacks or anxiety as a permanent threat to their school career. Every year that your child goes through school will be filled with highs and lows, good moments and devastating ones. The emotions your child experiences before the start of school can also lead to a general sense of anxiety-a feeling most children won't be able to articulate.
As parents, we have to realize that our children rarely will open up to us if they are experiencing any problems or anxiety, whether at home or at school. This can be due to embarrassment, fears of being punished, or retribution from siblings or classmates. And sometimes they just can’t figure out what is bothering them, a common sign of anxiety. Sometimes there are signs that we can pick up on that may help us decide if there is a problem. Significant changes in behavior sleep patterns, homework or grade patterns, and friendships may be signs that your child is experiencing school issues or anxiety. As parents, it’s our instinct to want to jump right in to protect and help our children. Although it’s fine to initially address the situation with your child, it’s important to not be overbearing and to back off if you are met with resistance. It might be helpful to talk to your pediatrician if this occurs.

It's important to remember that when placed in any new situation, all children (and parents, too) are going to need to take time to adjust. Realize that your child will require a period of time to figure out their comfort zone and what's required for them to fit in to their new environment. Fortunately, there are steps you can take as a parent to make the prospect less daunting-the key is to prepare your child both emotionally and physically so that they can have the best start possible this school year.

Proactive parents can help their kids overcome school anxiety. Dr. Bruno lists several tips for parents to employ:

Identify and address anxieties you have about your struggling child.
Set a time and place to discuss the issue when your child is most relaxed.
Start the discussion with hopeful empathy.
Help your child remember past successes.
Form a plan.
Familiarize your child with the school.
Talk to your pediatrician if you notice any significant changes in behavior.

For Learn more about Pedimedica Hackensack Office, Please visit, www.pedimedica.com

On Call with Dr. Lona Yegen, Pedimedica, Closter Office

2011-08-01T19:11:00.000-04:00

Understanding ADD and ADHD and their treatment options from a medical and behavioral approach.

Q.What is ADD and ADHD?
A. Attention Deficit (Hyperactivity) Disorder is a condition in which the child has the following symptoms that may or not be accompanied by hyperactivity:
1. Difficulty in paying attention and focusing.
2. Difficulty with impulsivity.
3. A lack of organizational skills.

Q.How do we diagnose ADD?
A.This is a clinical diagnosis. It is usually diagnosed after a child enters school and because he/she is having difficulties there. A child should have a complete physical exam with a Pediatrician to confirm that there are no medical problems that could be causing these symptoms including testing a child's vision and hearing. There should be an evaluation by the child's' teachers and parents using guidelines to evaluate behavior. The child may be evaluated by a Neurologist, developmental Pediatrician, or a Psychiatrist to make certain the child fits the categories for ADD/ADHD and make sure there are no other concerns e.g. learning disabilities.

Q.How do we treat ADD/ADHD?
A.The medical therapies fall into three categories:
1. Stimulant medication e.g. Ritalin, Concerta, Focalin, Daytrana
2. Non stimulant medication e.g. Straterra
3. Anti-depressants e.g. Wellbutrin
Stimulant medications are the most commonly used medications. There are side effects to all three classes of medication. For example, stimulant medications can suppress appetite and growth and can cause difficulty with falling asleep. Therefore, they must be used with supervision by a medical professional to make sure they are well tolerated. The medical therapies will be managed by your pediatrician, neurologist, or psychologist so let us talks about behavioral therapies.

Behavioral therapies are multiple.
1. In managing behaviors there are technologies to improve memory and focus. For example, while riding in a car, tell the child you are going to play a game. You are going to name three things and you are going to ask the child to name them later. So, at the beginning of the ride, name three items, e.g. ice cream, bicycle, mountain and at the end of the ride, ask the child to list them. If the child can name three things consistently, then go to five things. There is also a board game called Memory which works on the same skills.

2. We also want to teach the child organizational skills. Organizational skills can start at the beginning of the day. Ask the child to list “what do I need for the day in school?” and make a check list of all items and assemble books, assignments, clothes e.g. gym clothes, lunch so that he/she is ready for the day. If the morning is too hectic this can be done at night. Organizational skills should be done throughout the day. Give the child a notepad so he/she can write down assignments and a check list for all books so the child is prepared when he/she gets home. Organizational skill should continue after school.Teach the child to make a schedule for what homework and chores need to be done that day and allot specific times for each subject and task with scheduled breaks for sports, play dates, and hobbies like music lessons.

3. School strategies include placing the child with ADD/ADHD in the front of the class so it is easier to focus on the teacher. Also, the teacher and child can have a special signal that they choose to remind the child to stay on task. For example, the teacher can raise her right thumb up as a sign so the child needs to look and listen to her. No one else will know this special signal.

4. Homework should be done in a quiet place without distractions.

5. Goal setting should be clear and concise. When a goal or assignment is completed there should be verbal rewards or approval with extra time for a pleasurable activity.

6. There are Psychologists and social skills courses for children who need help with their behavior or relationships.

Q.When should we use medication?

A.Consider the following indicators:

When all the behavioral and psychological therapies are not working.
When the child's school performance is below expectations due to his/her inability to concentrate on set skills.
When the child is not able to control impulsive behaviors leading to relationship problems or when the child is disruptive to others in class.
When there are concerns that poor academic performance is leading to low self esteem.

Q.When should we not use medication?

A.Consider the following indicators:

The child is doing well academically in school.
The child's behavior is not disruptive in class.
The child's peer and family relationships are good.
When the parents are concerned about long term use of medication.

On Call with Dr. Kolsky

2011-07-05T16:18:00.000-04:00

It’s summer and we all love to be outside and enjoy the great outdoors, but take precaution with your children’s delicate skin.

Infants through teens must be careful when it comes to sun exposure. Dr. Kolsky has researched and posted an extremely informative article from Healthykids.org on this topic and has even included a sun burn instruction sheet that you should print out and keep handy during the lazy, hazy days of summer. Also, remember to check back on this site next week to hear Dr. Suldane’s radio show on this very relevant topic!

So as you slather in the suntan lotion make sure to read these important guidelines:

“We all need some sun exposure; it's our primary source of vitamin D, which helps us absorb calciufor stronger, healthier bones. But it doesn't take much time in the sun for most people to get the vitamin D they need, and repeated unprotected exposure to the sun's ultraviolet rays can cause skin damage, eye damage, immune system suppression, and skin cancer. Even people in their twenties can develop skin cancer.

Most kids rack up between 50% and 80% of their lifetime sun exposure before age 18, so it's important that parents teach their children how to enjoy fun in the sun safely. With the right precautions, you can greatly reduce your child's chance of developing skin cancer.

Facts About Sun Exposure

The sun radiates light to the earth, and part of that light consists of invisible ultraviolet (UV) rays. When these rays reach the skin, they cause tanning, burning, and other skin damage.

Sunlight contains three types of ultraviolet rays: UVA, UVB, and UVC.

1. UVA rays cause skin aging and wrinkling and contribute to skin cancer, such as melanoma. Because UVA rays pass effortlessly through the ozone layer (the protective layer of atmosphere, or shield, surrounding the earth), they make up the majority of our sun exposure. Beware of tanning beds because they use UVA rays as well as UVB rays. A UVA tan does not help protect the skin from further sun damage; it merely produces color and a false sense of protection from the sun.

2. UVB rays are also dangerous, causing sunburns, cataracts (clouding of the eye lens), and effects on the immune system. They also contribute to skin cancer. Melanoma, the most dangerous form of skin cancer, is thought to be associated with severe UVB sunburns that occur before the age of 20. Most UVB rays are absorbed by the ozone layer, but enough of these rays pass through to cause serious damage.

3. UVC rays are the most dangerous, but fortunately, these rays are blocked by the ozone layer and don't reach the earth.

Melanin: The Body's First Line of Defense

UV rays react with a chemical called melanin that's found in skin. Melanin is the first defense against the sun because it absorbs dangerous UV rays before they do serious skin damage. Melanin is found in different concentrations and colors, resulting in different skin colors. The lighter someone's natural skin color, the less melanin it has to absorb UV rays and protect itself. The darker a person's natural skin color, the more melanin it has to protect itself. (But both dark- and light-skinned kids need protection from UV rays because any tanning or burning causes skin damage.)

Also, anyone with a fair complexion — lighter skin and eye color — is more likely to have freckles because there's less melanin in the skin. Although freckles are harmless, being outside in the sun may help cause them or make them darker.

As the melanin increases in response to sun exposure, the skin tans. But even that "healthy" tan may be a sign of sun damage. The risk of damage increases with the amount and intensity of exposure. Those who are chronically exposed to the sun, such as farmers, boaters, and sunbathers, are at much greater risk. A sunburn develops when the amount of UV exposure is greater than what can be protected against by the skin's melanin.

Unprotected sun exposure is even more dangerous for kids with:

moles on their skin (or whose parents have a tendency to develop moles)
very fair skin and hair
a family history of skin cancer, including melanoma

You should be especially careful about sun protection if your child has one or more of these high-risk characteristics.

Also, not all sunlight is "equal" in UV concentration. The intensity of the sun's rays depends upon the time of year, as well as the altitude and latitude of your location. UV rays are strongest during summer. Remember that the timing of this season varies by location; if you travel to a foreign country during its summer season, you'll need to pack the strongest sun protection you can find.

Extra protection is also required near the equator, where the sun is strongest, and at high altitudes, where the air and cloud cover are thinner, allowing more damaging UV rays to get through the atmosphere. Even during winter months, if your family goes skiing in the mountains, be sure to apply plenty of sunscreen; UV rays reflect off both snow and water, increasing the probability of sunburn What's important is to protect your family from exposure to UVA and UVB, the rays that cause skin damage.

With the right precautions, kids can safely play in the sun. Here are the most effective strategies:

Avoid the Strongest Rays of the Day

First, seek shade when the sun is at its highest overhead and therefore strongest (usually 10 a.m. until 4 p.m. in the northern hemisphere). If kids must be in the sun between these hours, be sure to apply and reapply protective sunscreen — even if they're just playing in the backyard. Most sun damage occurs as a result of incidental exposure during day-to-day activities, not at the beach.

Even on cloudy, cool, or overcast days, UV rays travel through the clouds and reflect off sand, water, and even concrete. Clouds and pollution don't filter out UV rays, and they can give a false sense of protection. This "invisible sun" can cause unexpected sunburn and skin damage. Often, kids are unaware that they're developing a sunburn on cooler or windy days because the temperature or breeze keeps skin feeling cool on the surface.

Make sure your kids don't use tanning beds at any time, even to "prepare" for a trip to a warm climate. Both UVA and UVA/UVB tanning beds produce sunburn. And there is an increase in the risk of melanoma in people who have used tanning beds before the age of 35.

Cover Up

One of the best ways to protect your family from the sun is to cover up and shield skin from UV rays. Ensure that clothes will screen out harmful UV rays by placing your hand inside the garments and making sure you can't see it through them.
Because infants have thinner skin and underdeveloped melanin, their skin burns more easily than that of older kids. But sunscreen should not be applied to babies under 6 months of age, so they absolutely must be kept out of the sun whenever possible. If your infant must be in the sun, dress him or her in clothing that covers the body, including hats with wide brims to shadow the face. Use an umbrella to create shade.

Even older kids need to escape the sun. For all-day outdoor affairs, bring along a wide umbrella or a pop-up tent to play in. If it's not too hot outside and won't make kids even more uncomfortable, have them wear light long-sleeved shirts and/or long pants. Before heading to the beach or park, call ahead to find out if certain areas offer rentals of umbrellas, tents, and other sun-protective gear.

With the right precautions, kids can safely play in the sun. Here are the most effective strategies:

Avoid the Strongest Rays of the Day

Use Protective Eyewear for Kids

Sun exposure damages the eyes as well as the skin. Even 1 day in the sun can result in a burned cornea (the outermost, clear membrane layer of the eye). Cumulative exposure can lead to cataracts (clouding of the eye lens, which leads to blurred vision) later in life. The best way to protect eyes is to wear sunglasses.

Not all sunglasses provide the same level of ultraviolet protection; darkened plastic or glass lenses without special UV filters just trick the eyes into a false sense of safety. Purchase sunglasses with labels ensuring that they provide 100% UV protection.

But not all kids enjoy wearing sunglasses, especially the first few times. To encourage them to wear them, let kids select a style they like — many manufacturers make fun, multicolored frames or ones embossed with cartoon characters. And don't forget that kids want to be like grown-ups. If you wear sunglasses regularly, your kids may be willing to follow your example. Providing sunglasses early in childhood will encourage the habit of wearing them in the future.

Double-Check Medications

Some medications increase the skin's sensitivity to UV rays. As a result, even kids with skin that tends not to burn easily can develop a severe sunburn in just minutes when taking certain medications. Fair-skinned kids, of course, are even more vulnerable.

Ask your doctor or pharmacist if any prescription (especially antibiotics and acne medications) and over-the-counter medications your child is taking can increase sun sensitivity. If so, always take extra sun precautions. The best protection is simply covering up or staying indoors; even sunscreen can't always protect skin from sun sensitivity caused by medications.

If Your Child Gets a Sunburn

A sunburn can sneak up on kids, especially after a long day at the beach or park. Often, they seem fine during the day but then gradually develop an "after-burn" later that evening that can be painful and hot and even make them feel sick.

When kids get sunburned, they usually experience pain and a sensation of heat — symptoms that tend to become more severe several hours after sun exposure. Some also develop chills. Because the sun has dried their skin, it can become itchy and tight. Sunburned skin begins to peel about a week after the sunburn. Encourage your child not to scratch or peel off loose skin because skin underneath the sunburn is vulnerable to infection.

If your child does get a sunburn, these tips may help:

Have your child take a cool (not cold) bath, or gently apply cool, wet compresses to the skin to help alleviate pain and heat.
To ease discomfort, apply pure aloe vera gel (available in most pharmacies) to any sunburned areas.
Give your child an anti-inflammatory medication like ibuprofen or use acetaminophen to lessen the pain and itching. (Do not, however, give aspirin to children or teens.) Over-the-counter diphenhydramine may also help reduce itching and swelling.
Apply topical moisturizing cream to rehydrate the skin and treat itching. For the more seriously sunburned areas, apply a thin layer of 1% hydrocortisone cream to help with pain. (Do not use petroleum-based products, because they prevent excess heat and sweat from escaping. Also, avoid first-aid products that contain benzocaine, which may cause skin irritation or allergy.)

If the sunburn is severe and blisters develop, call your doctor. Until you can see your doctor, tell your child not to scratch, pop, or squeeze the blisters, which can become easily infected and can result in scarring. Keep your child in the shade until the sunburn is healed. Any additional sun exposure will only increase the severity of the burn and increase pain.

Be Sun Safe Yourself
Don't forget: Be a good role model by consistently wearing sunscreen with SPF 30 or greater, using sunglasses, and limiting your time in the sun. These preventive behaviors not only reduce your risk of sun damage, but teach your kids good sun sense.

Reviewed by: Kate M. Cronan, MD

Date reviewed: August 2010

PEDIMEDICA in Honduras as part of a Humanitarian Medical Brigade.

2011-06-15T20:58:00.000-04:00

During April, Members of Pedimedica once again travelled to Honduras as part of a humanitarian medical brigade. For Clare DeBlasio RN, it was her 9th trip, for Dr. Kolsky his 7th, and for medical assistant Carmen Mercado her 3rd.

Always a very rewarding trip, this particular brigade treated over 3000 patients, including more than 1600 pediatric patients.

The pediatric problems treated include a pot pourri of common and some complex medical issues, including, but not limited to, asthma, parasitic infections, skin infections, hepatitis, other respiratory ailments, etc.

On these brigades we are able to recognize previously undiagnosed medical conditions, and refer these patients for further treatment.

Treating these patients is always a pleasure, as they are in such need of medical care. They receive very little care, other than what is provided by the rare medical teams that visit these remote villages. Most of these people have never seen a physician, other than those we provide.

We look forward to our return next year.

On-Call with Dr. Rosenberg…Find out the facts on HPV

2011-04-01T20:14:00.000-04:00

HPV will affect an estimated 75% to 80% of males and females in their lifetime. For most, HPV clears on its own. But, for others, certain HPV diseases—such as cervical, vaginal, and vulvar cancers and genital warts—can develop. There is no way to predict who will or won't clear the virus. As a parent of a pre-teen, you need to know the facts.

What is HPV?

Genital human papillomavirus is the most common sexually transmitted virus in the United States. There are more than 40 HPV types that can infect the genital areas of males and females. These HPV types can also infect the mouth and throat. Most people who become infected with HPV do not even know they have it. HPV is spread mostly through sexual contact.

How do I know if I have HPV? What are the signs?
Most HPV infections do not cause any signs and 90% go away spontaneously within two years. More than half of sexually active males and females are infected with HPV at some times in their lives.

What happens to the 10% that contract the virus that do not resolve on their own?

Certain types of HPV can cause genital warts in males and females. Rarely, these types can also cause warts in the throat or upper respiratory tract. Other HPV types can cause cervical cancer. These types can also cause other, less common but serious cancers, including cancers of the vulva, vagina, penis, anus, and head and neck (tongue, tonsils and throat).
The types of HPV that can cause genital warts are not the same as the types that can cause cancer. There is no way to know which people who get HPV will go on to develop cancer or other health problems.

How does one get HPV?

HPV is passed on by genital contact, most often during intercourse (vaginal as well as anal). HPV may also be passed on during oral sex and genital-to-genital contact. HPV can be passed on between straight and same-sex partners—even when the infected partner has no signs or symptoms.
One can have HPV even if years have gone by since he or she had sexual contact with an infected person. Most infected people do not realize they are infected or that they are passing the virus to their partner. It is also possible to get more than one type of HPV.
Very rarely, a pregnant woman with genital HPV can pass HPV to her baby during delivery. In these cases, the child can develop warts in their respiratory tract.

How does one prevent HPV?

Vaccines can prevent both men and women from some of the most common types of HPV. The vaccines are administered in a three dose series over a matter of months.Gardasil is recommended from ages 9 to 26 years of age. The first dose is given, the second is two months later and the third is six months from the first. It protects against two types of HPV that can cause genital warts and two types that can cause cervical cancer. Cervarix is another type of HPV vaccine that is given in a series of three shots at dose one, one month from the first and six months from the first. Cervarix protects against two types of HPV that can cause cervical cancer.Only Gardasil is currently available for boys between the ages of 9 to 26 years, for the revention of genital warts. It is FDA approved, but not yet recommended by the American Academy of Pediatrics as part of the routine immunization schedule for males.It is important to complete the entire vaccine series to get the optimal protection. The vaccines are most effective when given before a person's first sexual contact, when he or she could be exposed to HPV.For those who choose to be sexually active, condoms are important to lower against the risk of HPV. To insure optimal protection, they should be used with every sex act from beginning to end. HPV is so virulent that it can affect areas that are not covered by a condom, and therefore even condoms are not 100% protective. Thus, abstinence is the best way to prevent against HPV and all sexually transmitted diseases.

Why is HPV vaccine given to such a young age group?

It is important for girls to get HPV vaccine before their first sexual contact--prior to being exposed to the disease. For this crowd, the vaccines can prevent almost 100% of the types of HPV targeted by the vaccines. If a woman is already infected with a type of HPV, the vaccine will not provide protection against that type.

What are the risks from the HPV vaccine?

The HPV vaccine is an inactivated (not live) vaccine protecting against HPV. It does not give the HPV virus. Protection from the HPV vaccine is expected to be long lasting.
The most common side effects after the vaccine is administered are very mild: soreness, redness and swelling at the injection site. It can also cause mild to moderate fever and itching at the site, nausea and dizziness. These side effects have been known to dissipate quickly.
While serious events, including death and Guillain-Barre syndrome, have been reported among women who had recently received HPV vaccine, CDC follow-up on these reports found that the events had not occurred more frequently among vaccines recipients than among the general population, and no pattern was detected that would indicate an association with the vaccine.

Who should not receive the HPV vaccine?

Anyone who has had a life-threatening allergic reaction to yeast, to any other component of the HPV vaccine, or a previous dose of the HPV vaccine should not get the vaccine.

How does one treat HPV?

There is no treatment for HPV, but the conditions it causes can be treated. Genital warts can be treated by health care professionals and cervical cancer can be contained if diagnosed and treated early; with annual Pap smears and regular visits to the gynecologist. The best
treatment is prevention.

For more information on HPV, go to www.cdc.gov/std/hpv

On Call with Dr. Dora Suldan, MD

2011-02-11T19:27:00.000-05:00

Breastfeeding, the most natural way to nurture your baby, can pose challenges for first timers!

Dr. Dora Suldan, Pedimedica’s “parent resource” for breast feeding families and mother of three, can coach you through the ins and outs and get you over any bumps along the way.

As a resident in pediatric training, before having kids of my own, I had an idea that I would breastfeed my kids, because it would be the healthier choice for them. I didn't realize, until my first child was born, however, that breastfeeding her would become so important to me on a personal level. Intellectually, I can talk about the fact that breastfed babies are better protected from infection, may have better fat metabolism, and therefore, healthier cholesterol levels in later life, have decreased risk of chronic conditions such as diabetes, celiac disease, allergies and some cancers, or even do better in school. There have been studies showing that breastfeeding for at least two years over a woman's lifetime, can lower her own breast cancer risk as well. There are no guarantees, however. My own twins, never tasted formula and were home with a nanny, but still got their first ear infections at 5 months. Nevertheless, the benefits of breastfeeding are well known and documented in numerous studies, and since we want what's best for our kids, we choose to breastfeed.

One problem, I find, is that people have expectations for their breastfeeding experience that may be unrealistic. It's natural, right? So it must be easy! Nothing could be further from the truth. It hurts the first two weeks, even if the baby latches on properly. The first month or so, you are exhausted from a baby that wakes frequently (breastfed or not) and there doesn't usually seem to be enough of a schedule to let you catch up. Oh, and the advice to sleep when your newborn does, isn't particularly helpful, if you are home alone with a toddler too. When is mom supposed to eat, get dressed, take a shower, feel like her own person again? Just wait. If you get to the two month mark, and latch, supply, and growth issues have been resolved, when you catch that adorable milky smile as the baby finishes a feed, you'll never want to stop. OK so I exaggerate the part about never stopping, but I think you know what I mean.

Lets address some troubleshooting issues with the nursing experience. It starts before the baby is born. Reading about breastfeeding helps. I would recommend reading several books. If you do that, you will realize that each may have a slightly different point of view. That knowledge alone, is helpful when the baby is born, and you start to hear different advice from various sources: doctors, nurses, relatives, and friends. Not everything is dogma, and if you hear different bits of advice, you won't panic that you are not doing things exactly so.

My experience as a pediatrician is that most babies that receive formula in the hospital tend to wean earlier than their parents may have intended. Often it is an issue of supply. Normal nursing involves feeding TEN times a day. Too often, I see a mom that nurses 3 or 4 times, then gives formula, because, “There isn't enough milk.” The way your body knows to produce the milk, is through release of oxytocin in the brain, alerting the breast milk glands to produce more milk and to later release it through the milk ducts. The breast has receptors that are stimulated when the baby feeds. Thus, when the baby nurses more often, more milk will be produced. If the baby is offered formula, he or she doesn't feed as often on the breast, and you miss the opportunity to stimulate the supply. Unless you are going to pump at the same time that you give a bottle, your body won't know that there is a baby that needs more milk. Why sit hooked up to a pump, when you can have your adorable infant in your arms instead?

Some moms have been advised to pump to see how much milk they have. I don't recommend this in most cases. Pumping and only seeing a few drops of colostrum would tend to discourage most people. Also, a baby that latches well can more efficiently get milk out of mom than even the best of pumps. The colostrum that arrives initially is lower in volume than the milk that arrives later, but it is packed with all the nutrients the baby needs. As long as the baby has at least 1 wet (urine) diaper the first day, increasing by one a day, and at least one bowel movement daily, your newborn will get enough milk. Babies are born with excess water weight. They can lose up to ten percent of their birth weight in the first few days, but generally gain it back by two weeks of age. Rest assured, that your doctor will monitor the weight gain and feel free to discuss your concern at those frequent newborn visits.

Finally, remember that you will produce enough as long as you feed frequently. Thus, a mother of twins can produce enough to exclusively nurse the twins, because the body gets double the stimulation when she nurses twins. It is helpful to switch sides. With a single baby, nurse longer on one side, then “top off” on the other. Next feeding will start on that second side. With twins, you might want to feed each twin per side then switch for next feeding. Don't be scared to ask for help. A lactation consultant can help by working with you if there is a supply or latch problem. Sometimes a little intervention early on can make a huge difference in the overall experience and ability to nurse for a longer time period.

So what's Dad's role in all of this? Remember, Mom just gave birth and her body needs to recover from not just the childbirth itself (abdominal surgery in case of a cesarean delivery), but the 9 month gestation as well. Now she is also producing milk for your baby. Fathers are instrumental in the breastfeeding process. Avoid company that will not actually help you. If someone will come over to cook a meal, fold laundry, and you are not uncomfortable nursing in their presence, welcome them with open arms. If, however, Mom will feel pressured to entertain the guests while they hold the baby, and she thereby misses opportunities to feed, that will be counterproductive. Dads can run interference with the friends and relatives. Fathers can also pick up the slack on things Moms may otherwise feel obligated to do. If pumping is necessary, Dad can give the bottle, and/or change diapers while Mom pumps. That way there is some chance to “rest” during this hectic time. Mom nurtures the baby with her milk; dad nurtures the whole family with his help in the process.

As for the older siblings, breastfeeding the newborn provides important learning opportunities. We want our older kids to eat healthy, and we model this by showing that Mom and Dad are doing everything possible to make sure the new baby gets the healthiest nutrition as well. Even toddlers can be enlisted to help “their” baby by bringing a burp cloth, sitting with Mom or otherwise “helping,” by alerting you if the baby spits up. Having sibling involvement can improve their relationship with the baby. Just as, “It takes a village to raise a child,” it takes a family to nurture a newborn.

For More information about Dr. Suldan, Please go to http://www.pedimedica.com/pedimedica_teaneck/teaneck_doctors.html

On Call with Dr. George Azzariti, MD

2011-01-09T22:21:00.000-05:00

Childhood Obesity and Overweight Kids

Obesity in kids has reached epidemic levels. Experts estimate (according to the National Health and Nutrition Examination Survey)"an estimated 16 percent of children and adolescents ages 6-19 years are overweight) and another 15% are at risk of becoming overweight. It is also predicted that two thirds of these overweight kids will become overweight adults. This is why so many health experts talk about the childhood obesity epidemic.

Understanding the causes of childhood obesity can guide parents in creating a healthy lifestyle for their children minimizing their risk of obesity and related diseases. Of course genetics can also play a role in the cause of obesity and although genetics can’t be changed, other risk factors can be managed.

Preventing Childhood Obesity

Nutrition: Poor food choices and lack of portion control. Teach your children “right from wrong” even when it come to food selection. Make it educational and fun. Empower them to make their own decisions from a pre-approved list that’s full of choices for meals and snacks.

Exercise: Lack of physical activity, be it through play, individual or team sports. Get your kids engaged at an early age with one of the many children in motion classes in your community and encourage them as they enter elementary school to try different sports to find the best fit. Participating in sports has the added benefit of not only building strong healthy bodies but teaches children the importance of cooperation; the concept of team effort and greatly contributes to their self esteem.

Rest: Sleep is critical to your child’s health and growth. There have been numerous studies that correlate lack of sleep to increased risk of childhood obesity. A minimum of 10 hours of sleep for growing children age 6-12 is recommended and at least 9 hours for teenagers.

How Do You Know Your Child Is Overweight?

The person you need to speak with to help you determine the proper weight for your child’s height, body frame and age is your pediatrician. Your doctor will calculate your child’s BMI (Body Mass Index) which is a formula which will determine if your child is overweight, underweight or within the appropriate weight range.

Weight Loss

If the doctor determines that your child’s health requires weight reduction that he/she will work with you and your child to develop a healthy eating and exercise program to accomplish that goal. It is important for parents not to stress the fact that the child needs to diet, rather the child needs participate in a program that will enable him/her to become healthier and feel fit. Children need to feel empowered in the process, therefore getting their buy-in from the start and providing them with many healthy choices to pick from when designing their personal eating plan is very important in achieving their weight loss goals.

Understanding Your Childs Nutritional Needs

Proper nutrition begins at infancy, and at each stage of your child’s growth nutritional requirements will vary so it is very important to be informed of their needs and adapt their diet accordingly. Keeping these guidelines in mind will allow you to create the pathway to a healthy lifestyle for your child that will carry forward into their adulthood. Remember, good habits start young!

Guidelines

Newborns

There are many decisions to make about feeding you newborn; breastfeeding versus formulas, homemade babyfood versus store bought, when to start baby cereal, when to begin finger food and when and how to encourage self-feeding. Your pediatrician can guide you in making these decisions as you progress through the first year of your baby’s life.

The Toddler Years

Toddlers can be very picky eaters and often only eat 1 full meal a day while they pick at other foods through the day. However, toddlers really only need about 1300 calories a day, so make sure to include 16 ounces of low fat milk, 4-6 ounces of 100%natural juice, 2 healthy snacks (around 200-300 calories) and 2-3 meals consisting of protein and vegetables equaling 700-900 calories. Remember, keeping your child physically active is key to developing a healthy and active lifestyle.

Elementary School Years, Tweens and Teens

Generally the most important thing to remember about your growing child’s diet is to keep it balanced. Balance the food your child eats with physical activity and balance your child’s diet by eating a three meals and 2 nutritious snacks per day limiting high- sugar and high-fat foods, eating fruits, vegetables, lean meats and low-fat dairy products, including 3 servings of cheese or yogurt to meet your child's calcium needs.

On Call with Dr. Martha Miqueo, DDS, Pediatric and Adolescent Dentistry, Orthodontics and friend to Pedimedica!

2010-11-10T09:52:00.000-05:00

Dr. Miqueo is a leading authority in pediatric dentistry and orthodontics and is president of Vizstara Dental for Children and Orthodontics. Dr. Miqueo is also on staff as Attending Pediatric dentist at Hackensack University Medical Center, where she covers oral trauma and dental emergencies. Dr. Miqueo is an expert in the management of patients with cleft lip and palate, as well as the application of the laser technique for both soft and hard tissue.

Dr. Miqueo loves children and has three of her own. She feels that being a parent has made her a better practitioner because she is more understanding of parental anxieties towards treatment of their children.

The American Academy of Pediatric Dentistry recommends that infants see the dentist for their first dental exam within 6 months of getting his/her first tooth or by their first birthda., but Dr. Miqueo believes that good oral health begins at birth!

Good Oral health Begins at Infancy

Babies are born with their primary (first) set of teeth formed underneath the gums. These teeth do not usually start to grow into the mouth until the child is six to eight months old. By age three, all 20 primary teeth should be in the mouth. A child's primary (first) set of teeth is very important. These teeth help a child eat and speak. They hold space for the permanent teeth and are very important for the child’s self image.

Around the age of six, a child's mouth will begin to grow to make space for the permanent teeth. Each baby tooth will be replaced by a permanent tooth. The permanent teeth begin to come into the mouth between the age of five and six and will continue to about age twenty one, when the third molars erupt.

It is important for children to develop good oral health habits at an early age. Practicing healthy habits can prevent or reduce tooth decay (cavities) in infants and children. Dr. Miqueo is happy to provide Pedimedica parents with answers to frequently asked question regarding children’s oral health as well as suggestion to implement good hygiene and preventative care.

FAQ’s

When should I select a “Dental Home” for my child?

It is important to select a dental home early so that you can prevent problems from developing rather than treating them. The American Academy of Pediatric Dentistry recommends that you see a pediatric dentist by the age of 1.

What should I look for when selecting a dentist?

Check listings for practitioners in your area. Call and make an appointment to meet them even before your baby is born. Ask questions and inform yourself of preventive practices that are established before the teeth grow into the mouth.

Is it important to go to a Pediatric dentist or can I take my child to our family’s general dentist?

Your child should see a pediatric dentist, just like your child sees a pediatrician. A pediatric dentist has 2– 3 years of training beyond dental school. It is very important that your child feels comfortable and has a pleasant first experience.

How often does my child need to see the dentist? Is there a schedule of visits like there is with my pediatrician?

Your child should visit the dentist 2 times a year to receive an examination, cleaning, and fluoride treatment.

How do I know when my child needs to see an orthodontist?

It is recommended that a child see an orthodontist between the ages of 7-9, depending on the child’s dental age. Sometimes problems such as impacted canines can be prevented if detected early.

I heard it is important to brush my baby’s gums. Is that true, and why?

YES! It is important to brush the baby’s gums. That cleans the mouth and soothes the gums. It helps when teething and trains the baby for when it is time to start using a toothbrush.

Is there a difference between breast fed babies and bottle fed babies in regards to the child’s oral health?

In regards to oral health, neither the breast or the bottle should be used as pacifiers. Babies should be fed and detached. You want to set these habits early so that as the teeth start to grow in they are protected. When milk pools in the mouth for long periods of time and is exposed to bacteria, cavities can develop.

Tips on implementing good oral health from birth-adulthood:

Learn how to take care of your baby’s mouth while you are pregnant.

Find a Pediatric Dentist early on before a problem develops.

Visit your Pediatric Dentist twice a year for check-ups.

See an Orthodontist when your child is between the ages of 7-9.

For more information on regarding questions you may have on your child’s oral health you can contact Dr. Miqueo at Vizstara dental, 201-816-4000 or visit her website at http://www.vizstara.com/.

On Call with Dr. Kumar

2010-09-15T14:23:00.000-04:00

Flu season is here and Dr. Kumar has answers to questions you might have about influenza virus and vaccine.

How do I know my child has the flu?

Influenza is a viral illness. It presents with fever, cough, sore throat, headache, chills, fatigue and muscle aches. If children have other chronic illnesses and are younger than one year of age, they can also get pneumonia and high fever. It usually infects from October to May.

What should I expect from the 2010-2011 flu season?

Every year the flu season is different. In 2009-2010 we saw the H1N1 or “swine flu” pandemic. This season it is possible that H1N1 may continue to infect kids. Therefore, this year the flu vaccine will protect against three flu viruses: H1N1, an H3N2 virus and an influenza B virus. The viruses are chosen based on research that shows that these strains are most likely to cause illness this season. However, since new strains arise and the flu virus is constantly changing it is difficult to predict the severity of the flu season.

Should I get my child vaccinated?

Because these viruses are always changing, the vaccine needs to be given every year. It is recommended that all children from 6 months through 18 years of age receive the flu vaccine. Children less than 9 years old who never received the vaccine need to receive two doses at least 1 month apart. Children under 6 months cannot receive the vaccine but all caregivers of young infants should get the influenza vaccine.

What if my child got the H1N1 vaccine last year?

The American Academy of Pediatrics is recommending that for this season, if your child is less that 9 years old and did not get two doses of H1N1 in 2009 then he or she receive two doses of the seasonal flu vaccine four weeks apart.

What is the difference between the shot and the nasal spray?

The influenza injection(shot) is an inactivated or killed virus, whereas the nasal spray is a live attenuated or weakened vaccine. The live vaccine should not be given if your child is under 2 years old, has asthma, on aspirin treatment or younger than 5 years old with a history of wheezing.

Are there are side effects of the flu vaccine?

Your child can get redness, swelling, and soreness at the site of the vaccine. Also in the first one to two days there may be fever and aches. Life threatening allergic reactions are very rare. Children who have had only severe reaction to eggs or the flu shot (like Guillain-Barre Syndrome) should not get the vaccine. The flu vaccine does not cause the flu. Reasons why you can get flu-like symptoms after the flu are recent exposure or illness secondary to non-flu viruses or influenza viruses that are not included in the vaccine for this season.

Besides the vaccine, what else can I do to protect against the flu?

The most important step to prevention is hand washing/sanitizing. Also, if your children are sick, it is crucial to keep them home so they do not spread the flu to others.

What if my child gets the flu? Is there a treatment?

There are antivirals like Tamiflu (Oseltamivir) that treat the flu. These are recommended for severe illness or for children who are at higher risk of complications. It is best that treatment be started within 48 hours after onset of illness. Therefore, if your child has sudden onset of fever and flu-like symptoms, see your doctor as soon as possible.

On Call with Dr. Taneja

2010-07-21T18:06:00.000-04:00

Fun outdoor kids’ activities such a as swimming can also bring earaches!
Dr. Taneja would like to share some useful information on how to treat and prevent what is commonly called “Swimmers Ear”.

Swimmers Ear (otitis externa)

Symptoms:
Patient has intense pain when the ear is touched or pulled. Currently swimming pain when the tab of the earlobe overlying the ear canal is pushed in the ear feels plugged up and drainage is clear white, foul smelling or bloody.

Cause:
Swimmer's ear is an infection of the skin lining the ear canal. It is caused by excessive moisture in the ear canal from swimming. When water gets trapped in the ear canal it alters the acidic environment of the canal and allows bacteria to invade the canal. The most common bacteria responsible for outer ear infections are staphlococcus aureus and pseudomonas aerginosa.
Children are more likely to get swimmer's ear from swimming pools than from lakes. The chlorine in the pool kills the good bacteria in the ear canal, and harmful bacteria tend to take over.

Treatment:
Over-the-counter drops temporarily control the pain, but are not strong enough to cure the infection.Antibiotic drops are needed to cure the infection. You should also apply heat to the ear for some relief and take over the counter ibuprofen.

Expected Course:
With treatment, symptoms should be better in 3 days.

Prevention:
The key to prevention is keeping the ear canals dry when your child is not swimming. After swimming get all the water out of the ear canals by turning the head to the side and pulling the earlobe in different directions so the water runs out. If recurrences are a problem, rinse the ear canals with rubbing alcohol for 1 minute each time he/she finishes swimming. This is not a cure, this is only for prevention.

Common Mistakes:Don't use earplugs of any kind for prevention or treatment, as they jam ear wax back into the ear canal and wax buildup traps water behind it and increases the risk of swimmer's ear.
When to call the doctor:Call our office if the symptoms are not cleared in 3 days a fever occurs the ear becomes severely painful and/or if lymph node behind the earlobe becomes swollen and tender.

On Call with Dr. Zigelman

2010-06-01T08:10:00.000-04:00

"An Important Mump in The Road"

By now many of you have heard on TV, radio, or in the newspapers that a new epidemic is approaching Bergen County. Now that the H1N1 “swine flu” crisis seems to have calmed down, we have already seen several cases of mumps, or parotitis, in our area. Many cases have already been reported in nearby New York towns, as well as in Brooklyn.

Mumps is a viral, contagious illness that causes fever, headache, joint and muscle pains, and swollen, painful salivary glands – the parotid glands – on the side of the face, just at and above the jaw. The swelling may occur on one side of the face or may involve both sides. The throat may feel dry because the salivary glands have temporarily stopped producing saliva. Pickles, lemons, and other sour foods can cause pain in the swollen area. Occasionally, within two weeks after a boy (or girl) has developed mumps, the testes (or ovaries) may swell, causing pain. It is extremely rare for these patients to become sterile.

Mumps is spread by infected droplets in the air. The child is contagious from 1-2 days before the onset of symptoms until 3-5 days after the symptoms are gone. Once exposed, the incubation period is three weeks. While most children fully recover there are occasional serious complications, such as encephalitis, meningitis, deafness, and others. Lifelong immunity is obtained after a child contracts the disease. The child should not be sent back to school until five days after the facial swelling has gone down. Treatment is based on supportive care for the symptoms the child presents with, as there is no specific cure for mumps.

The success of immunizations in controlling many childhood diseases, like mumps, is one of the most important pediatric developments in recent history. In 1968, there were 152,209 reported cases of mumps in the United States. In, 1991, there were only 4,031 cases reported.

Tips:
1. Treat the fever with acetaminophen or ibuprofen.
2. Encourage the child to drink extra fluids.
Let him/her use straws if this is easier for him. Give him/her ice chips or ice pops to suck. Milkshakes and yogurt are easy to swallow. Avoid fruit juices, tart beverages, and spicy foods.
3. Encourage him/her to rinse his mouth, if it is dry.
4. Cold compresses to the side of the face/may be soothing.
5. Antibiotics are not used for this or other viral illnesses.
6. Protect your children by being up –to- date with their immunizations
7. Wash hands frequently and don’t share eating/drinking utensils. Clean frequently used surfaces.

Instead of a ”mumpy” ride, we hope yours is smooth and healthy.

Dr. David Zigelman

On Call with Dr. Kraut

2010-04-21T13:43:00.000-04:00

With the spring season well underway many parents are wondering if their child could be suffering from seasonal allergies and how should they best treat it. Dr Kraut answers the most common questions parents ask regarding this topic.

How do I know if my child is suffering from seasonal allergies and what’s the best way to treat it?

If your child seems to having a stuffy or runny nose with clear drainage, sneezing, itchy eyes and nose, throat clearing and a cough this time of year, chances are seasonal allergies could be the cause. If symptoms increase after being outside, that should give you another hint. Also, children suffering from allergies generally do not run fevers.

What is rose fever?

Rose fever is the name commonly given to people who have allergic symptoms this time of year. People mistakenly thought that symptoms were due to the roses that were blooming. Actually, allergic symptoms in the spring are caused by tree and grass pollens.

What happens if allergies go untreated?

Children whose allergies are not treated can go on to develop ear and sinus problems. Fluid in the ear can affect hearing, sinus pressure can cause headaches, nasal congestion very often interferes with sleep which can lead to behavioral and school issues. In some cases, untreated nasal allergies can develop into allergic asthma.

What is the best treatment for seasonal allergies?

There is no one best treatment. Depending on symptoms, your child might benefit from antihistamines, eye drops and or nose sprays. There are many prescription and over-the-counter preparations available and it can get very confusing! Consultation with your doctor is the best place to start. In all cases, if you suspect your child might have allergies, keep your windows closed and use your air-conditioning. Also, make sure your child showers and washes his/her hair every night.

Should I start medication before the onset of seasonal allergies?

Yes, the ideal time to start medication is before symptoms start.

What do I do if my child doesn’t improve from the medications?

If they don't improve, check with your doctor to see if you are using the appropriate medications. An allergy consult might be recommended.

When should I get my child tested for allergies?

Allergists can help diagnose exactly what your child is allergic to so you and s/he will be better prepared next year. They use detailed histories, physical exams, skin tests and other tests to help determine what the best course of therapy should be. They can help choose those medications that will be of benefit to your child. Under some circumstances, immunotherapy (or allergy shots) might be recommended.

On Call with Dr. Kolsky

2010-03-10T12:48:00.000-05:00

“My teenager has been unusually tired lately and is now experiencing and a very sore throat. Could my child have mono?”

Dr. Kolsky answers the most frequently asked questions on this topic

"Infectious Mononucleosis or “Mono” as it is called by most people is a viral infection characterized by the triad of fever, tonsillitis or pharyngitis and swollen glands.. It is an extremely common cause of “sore throat” and is usually caused by the virus specifically known as Epstein-Barr virus (EBV).

Many, if not most children, have a sub-clinical infection (i.e. they either don’t know that they are ill or they have a very mild sore throat). By age 18 years, it is estimated that about 80% of the world’s population has had EBV infection, and that by age 40 years, 90-95% of adults have had it.”

How is Mono Diagnosed?

EBV infection during early childhood is often sub-clinical (i.e. no apparent symptoms). During adolescence thru adult years, the incidence of symptomatic infection rises, with the peak incidence in the 15-24 year age group. The typical features in this age group include the above mentioned fever, sore throat, swollen glands, and also fatigue.

Blood work reveals elevation of a certain type of white blood cell called atypical lymphocytes. Other lab data that support the diagnosis include the “Mono spot test” and measurement of specific EBV antibodies. Sometimes, especially during the 1st week of the illness, the Mono spot test can be negative, and needs to be repeated in week 2 or 3 if symptoms of Mono persist.

Rarely Mono is caused by a different agent other than EBV. This includes cytomegalovirus, toxoplasmosis, and human herpes virus.

How is Mono spread?

After developing infectious mono, the virus can be transmitted from the saliva for many weeks.

Although the virus spreads primarily through saliva, it is NOT a very contagious illness. The virus can persist in the mouths of patients for as long as 18 months following recovery from the illness. This may explain why only a small number of patients with Mono recall any previous contact with an infected individual. Also spread within a family is UNCOMMON, again demonstrating that it is NOT a particularly contagious illness.

What is the treatment of Mono?

The most important part of treatment is supportive care and there are NO specific medications to cure Mono.

Acetaminophen or Ibuprofen is recommended for the treatment of fever, sore throat, and general malaise. Giving plenty of fluids and proper nutrition are also important. Plenty of rest helps the symptoms, BUT absolute bed rest is NOT necessary.

There are times when steroids are used, especially if the patient is having great difficulty swallowing fluids and is at risk of becoming dehydrated. Steroids are also used if the patient is experiencing breathing problems from the enlarged tonsils.

Does Mono Have Complications?

Most patients have an unremarkable recovery and are back to regular activities within a few weeks after the illness. Sports are often delayed for a period of time (usually 4 weeks) and for contact sports a bit longer (4-8 weeks).

Possible complications from Mono include:

Anemia which is a low red blood cell count

Low platelet count (thrombocytopenia)

Airway obstruction from markedly swollen tonsils

Rupture of spleen, especially in those athletes who return to contact sports too soon after the illness

On Call with Dr. Wolloch

2010-02-09T11:19:00.000-05:00

Many parents have great concerns over vaccinating their child. Dr. Wolloch answers the most frequently asked questions parents have on this topic.

“Giving vaccines to patients is one of the most important acts we as pediatricians can perform to prevent illness within our community. For many of us shots are a source of great fear, but are they worth the pain? Perhaps the information below will help answer that question”.

How safe are vaccines?
All vaccines in the US are thoroughly tested by the Food and Drug Administration. Data from the testing is examined by the Centers for Disease Control and the American Academy of Pediatrics to see how safe and effective they are. Vaccines are approved for use only after these agencies have given their approval. It is a vigorous process that ensures effective and safe vaccines. After approval, vaccine lots are inspected regularly to ensure that they continue to be safe.

Do vaccines always work?
Not always, but definitely better than 90% of the time.

Why should I have my child immunized?
Vaccines prevent potentially life-threatening diseases such as meningitis from affecting patients and the community at large. Vaccines can also prevent epidemics from spiraling out of control, as we saw with H1N1 earlier this year. Many illnesses that were once devastating, such as diphtheria, smallpox and polio, are essentially unseen due to our use of vaccines.

What about the association of vaccines and autism?
Several years ago a British doctor, Andrew Wakefield, published an article in the Lancet (a British medical journal) claiming a direct connection between the MMR vaccine and autism. Several celebrities, such as Jenny McCarthy, claimed that their children developed autism after an MMR vaccine as well. However, just this past week the Lancet invalidated the article from Dr. Wakefield, claiming that the data was not properly collected, and therefore not valid.
In addition to this recent conclusion, there have been several studies conducted that clearly show no connection between vaccines, thimerosal (a mercury-based vaccine additive) and autism. In fact, a study in Scandinavia in the late 1990's looked at rates of autism before and after thimerosal was removed from their vaccines. Their results showed that the rate of autism actually rose over the several years after thimerosal was stopped (this probably reflected better ability to detect autism).

Kaiser Permanente, a large California HMO, recently studied the mental and neurologic development of children who did and did not receive the MMR vaccine. They found no difference in the development of either group, at least up to 10 years old. Finally, studies were done to analyze how much thimerosal entered into the blood after a vaccine. It was found that trace amounts were found only up to 11 days after vaccination. Experts in mercury exposure determined that the duration and amount of mercury exposure was not enough to cause developmental or neurologic problems. Clearly, this issue has been carefully studied and no connection does exist between vaccines and autism.

Why are vaccines given at such an early age?
The body's immune system is best able to develop protective responses at a young age. We also know that young babies and children are much more likely to suffer severe, even life-threatening, effects of diseases.

How can the pain of vaccination be eased?
Numbing creams such as lidocaine can be applied at least 1/2 hour before the shots are given. Coughing, singing and various distractions can help as well. Interestingly, research shows that trying to reassure your child that they will "be OK" seems to have the opposite effect on children!For infants, breastfeeding or giving sucrose solution seems to have a soothing effect as well.

What if my child misses a dose of a vaccine?
Simply come in to the office as soon as possible to do it.

To whom should I report any adverse reactions and what happens to the information I give to the doctor?
Report any adverse reactions to your doctor about what happened. Your doctor will then send the information to the Vaccine Adverse Event Reporting System. Trained vaccine safety professionals can study the data from yours and any other reactions to a vaccine and then decide whether a vaccine is still safe to use. If it is still safe, they may note new precautions that need to be considered when using the vaccine. The CDC also studies data from insurance company vaccine injury compensation cases for information on serious vaccine reactions as well. All in all, vaccines are closely watched to ensure your child's safety.

Should I keep a record of my child's vaccines?
Yes, so that no duplicate shots are given, and for forms for school and camp. Next time you come to the office for a visit you can ask one of the nurses to provide you with a vaccination chart so you can record your child’s vaccinations for your personal records.
For further information on vaccines go to the American Academy of Pediatric website at http://www.aap.org/

View Dr. Daniel Wolloch's profile at Pedimedica, Bergen county's best pediatricians group.