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

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

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

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!

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. Taneja

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. Kraut

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

“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