By contactus@westendpediatrics.org
September 16, 2013
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For the first time, certain vaccines will guard against four strains of flu rather than the usual three. Called quadrivalent vaccines, these brands may prove more popular for children than their parents. That's because kids tend to catch the newly added strain more often.

These four-in-one vaccines are so new that they'll make up only a fraction of the nation's supply of flu vaccine, so if you want a dose, better start looking early.

We're moving away from the one-size-fits-all to choosing the best possible vaccine for an individual's age and condition.

Federal health officials recommend a yearly flu vaccine for nearly everyone, starting at 6 months of age. On average, about 24,000 Americans die each flu season, according to the Centers for Disease Control and Prevention.

Some questions and answers about the different vaccine varieties to choose from:

Q: What's the difference between those new four-strain vaccines and the regular kind?

A: For more than 30 years, the vaccine has offered protection against three influenza strains – two common Type A strains called H1N1 and H3N2, and one strain of Type B. Flu strains continually evolve, and the recipe for each year's vaccine includes the subtypes of those strains that experts consider most likely to cause illness that winter.

Type A flu causes more serious disease and deaths, especially the H3N2 form that made last year such a nasty flu season. But the milder Type B flu does sicken people every year as well, and can kill. Two distinct Type B families circulate the globe, making it difficult to know which to include in each year's vaccine. Adding both solves the guesswork, and a CDC model estimates it could prevent as many as 485 deaths a year depending on how much Type B flu is spreading.

Q: How can I tell if I'm getting the four-strain vaccine?

A: All of the nasal spray version sold in the U.S. this year will be this new variety, called FluMist Quadrivalent. The catch is that the nasal vaccine is only for healthy people ages 2 to 49 who aren't pregnant.

If you prefer a flu shot, ask the doctor or pharmacist if the four-strain kind is available. Younger children, older adults, pregnant women and people with chronic health conditions all can use flu shots. Four-strain versions are sold under the names Fluzone Quadrivalent, Fluarix Quadrivalent and FluLaval Quadrivalent.

Manufacturers anticipate producing between 135 million and 139 million doses of flu vaccine this year. Only about 30 million doses will offer the four-strain protection.

Q: Who should seek it?

A: Type B flu tends to strike children more than the middle-aged. It's not a bad idea for seniors, who are more vulnerable to influenza in general.

Q: How soon should I be vaccinated?

A: Early fall is ideal, as it's impossible to predict when flu will start spreading and it takes about two weeks for protection to kick in. But later isn't too late; flu season typically peaks in January or February.

Q: How do I make an appointment?

A: Please call our office and a member of our front desk staff will schedule an appointment that works with your calendar. You can reach our uptown office at: 212-769-3070 or our downtown office at: 212-353-0072. 

 

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By contactus@westendpediatrics.org
May 31, 2013
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How to Start Potty Training

Your child is developmentally ready. The potty is waiting for action. Here's what to do once the diaper comes off.

 DO:


• Do switch to pull-ups. When your child is just starting out on the potty, play it safe with the disposable variety. He can pull them down like underpants, but in the event of an accident they absorb like diapers and can be ripped off rather than pulled over his feet. Once your little one has enjoyed a few successes on the potty, try switching to washable cotton training pants. 
 


• Do let him bare his bottom. To boost your child's awareness of his body's signals, allow him to scamper about (in a private yard or room with a washable floor) with his lower half unclad. Why this works: It's hard to ignore urine when there's no diaper to hold it in. Keep the potty close by so your child can act on his body's signals quickly. 
 


• Do choose easy-on, easy-off clothing. When nature calls, there won't be a moment to lose. As your toddler gets the hang of undressing, avoid togs with snaps, buttons, clasps, or zippers (elastic waists are a wonderful thing!). 
 


• Do watch closely. At this point, you might be better at detecting his body's signals than he is. Look for tell-tale signs (like fidgeting or straining) and gently ask when you suspect he has to go. Even if you're too late and he's already done the deed, have him sit on the potty anyway to reinforce the connection. 
 


• Do offer praise when he reports bodily functions. Even a belated mention is praiseworthy — after all, it takes practice for kids to recognize signs of impending bladder and bowel movements and make it to the potty in time.




• Do keep him motivated. Remind him that using the potty means he's growing up. In the beginning, a small, tangible incentive can help, too — for every success, try putting a sticker on the calendar or a penny in the piggy bank. As he becomes more comfortable using the potty, it's best to phase out the rewards and let his inner motivation take over. 
 


• Do teach to check for dryness. This offers him an added sense of control. If he's dry, give him a pat on the back (or a big hug), but don't criticize him if he's wet. 

 DON'T:


• Don't expect too much too soon. Even the most enthusiastic toddler can take several weeks to master potty proficiency — often with as many steps backward as forward. If your expectations are unrealistic, you could diminish his self-confidence. 
 


• Don't scold, punish, or shame. No parent enjoys mopping up a puddle of pee, but try to stay cool. If you overreact, you might discourage your toddler's future attempts. 
 


• Don't deny drinks. Many parents reason that by rationing fluids, they'll cut their toddler's chances of having an accident. But this approach is unfair and unhealthy — not to mention ineffective. In fact, the better tactic is to step up your child's fluid intake to give him more opportunities to succeed. 
 


• Don't nag or force. Keep it casual when reminding your tot about using the potty — nagging will only provoke resistance. Similarly, don't force him to sit or stay on the potty — even if you know he's about to void. (Hey, you can lead your pony to the potty, but ultimately it's his decision to use it.) 
 


• Don't start a bathroom battle. Squabbling over pottying is sure to prolong the struggle. If you meet with total resistance, it's best to throw in the towel (and the toilet paper!) for a few weeks. Be patient. As you wait for your child to come around, don't bring up the subject or compare him to peers who are already in underpants. 
 


• Don't lose hope. This process might seem endless, but sooner or later your toddler will realize that it really is better to use the potty than wear diapers.

 

Work cited

"Potty Training: How to Start Potty Training." WhattoExpect, n.d. Web. 31 May 2013

 

     

Works Cited

"Potty Training: How to Start Potty Training." WhattoExpect. WhattoExpect, n.d. Web. 31 May 2013. 

"Potty Training: How to Start Potty Training." WhattoExpect. WhattoExpect, n.d. Web. 31 May 2013. 

  

By contactus@westendpediatrics.org
April 19, 2013
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Urinary Incontinence in Children

Toilet training is not an exact science, and many kids have bedwetting episodes. Learn about the causes of urinary incontinence in children and when to be concerned about a bladder problem

 

 

What’s Behind Bedwetting

Getting through the night without an accident can take a little longer to master than daytime incontinence. It’s more common for children to wet the bed after age five than it is for them to have accidents during the day. Here’s what could be happening if your child is experiencing bedwetting:

  • It’s in the genes. If both parents experienced bedwetting, a child has an 80 percent chance of having problems staying dry at night.
  • Deep sleeper. Nighttime incontinence is also related to a child being a deep sleeper.
  • A smaller bladder. Your child’s bladder may simply be smaller than other children her age, which makes it easier for the bladder to become full and spill over.
  • Fluid retention. Children who wet the bed tend to retain more fluid than other children, Dr. Atala says. Our bodies retain fluid for our organs, such as our heart. But when you lie down, your heart doesn’t need to work as hard and your body gets rid of the extra fluid. Children who are more active during the day retain more fluid than children who aren’t as active.
  • The internal alarm is still developing. We all have an internal alarm that wakes us when our bladder needs to be emptied. The alarm becomes stronger as the child gets older.
  • Hormones aren’t lowering urine levels. Antidiuretic hormone is released at night to slow down the production of urine, but some children may not be producing enough of the hormone to stay dry while they sleep.
  • Anxiety. Anxiety and stressful events, such as a new baby sibling, can cause a child to take a longer time to potty train at night or cause a child who’s already potty trained to start having bladder problems.
  • Sleep apnea. If she’s having trouble breathing at night due to inflammation or an enlargement of her tonsils or adenoids, it could be causing nighttime incontinence. Often, treating the sleep apnea can also help keep her dry.
  • Physical problems. For only a small number of children, the cause of nighttime incontinence may be a blockage in the bladder or the urethra. For children with spina bifida, a birth defect of the spinal cord, nerve damage can also result in bedwetting.

How to Treat Incontinence in Children

Luckily, bladder problems tend to go away on their own — if you give them time. Here’s what you can do in the meantime:

  • Schedule potty visits. If your child is suppressing the urge to go during the day, Atala recommends taking your child to the bathroom about every two hours. To prevent bedwetting, have your child lie down to read a book to help mobilize the fluid, and then have her get up to use the bathroom before going to sleep. Also, limit the amount of fluid she drinks at night.
  • Reset the clock. If your child has an overactive bladder, a doctor can prescribe medication that will help get the bladder back on schedule.
  • Consider a "wet alarm." You can use a wet alarm, or a moisture alarm, in which your child wears a pad in her pajamas that connects to an alarm that goes off as soon as there’s any moisture. It can help your child learn to wake up before wetting the bed. Wet alarms work best for children who are already waking up dry a couple of nights a week and who aren’t deep sleepers, Atala says. You can purchase a wet alarm at a local or online pharmacy.

 Treat conditions that could be causing it. Getting treatment for sleep apnea can help cure bedwetting. It’s also important to be sure your child doesn’t have a UTI or a condition such as diabetes that leads to an increase in fluids.

 

Suszynski, Marie. "Urinary Incontinence in Children." EverydayHealth.com. N.p., n.d. Web. 19 Apr. 2013. 

By contactus@westendpediatrics.org
March 19, 2013
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Squeezable pouches of organic baby food are as omnipresent on some American playgrounds as runny noses, diaper bags and overpriced strollers. Organic baby food can cost up to twice as much as conventionally grown baby food, and it comes in such gourmet blends as "blueberry, oats and quinoa" and " spinach, apple and rutabaga."

Parents go organic for a variety of reasons, including environmental concerns and a desire to avoid pesticide residue. And in some cases, they just want a status symbol. According to the consumer market research firm Mintel, organic baby food made up about 10 percent of the $1.4 billion U.S. baby food and snacks market in 2011.

But studies show that parents who are aiming to buy the best food for their infants may not need to spring for the expensive organics.

"The variety of foods and nutrients that babies take in will have a much larger impact on their health than whether they’re fed organic or not," says Tiffani Hays, the director of pediatric nutrition at the Johns Hopkins Children’s Center. "Vitamins, minerals and fiber have much better research and documented health benefits than does choosing organic."

A 2012 study in the Annals of Internal Medicine considered the question "Are Organic Foods Safer or Healthier Than Conventional Alternatives?" After analyzing hundreds of previous studies, including some that involved pregnant women and children, the authors found no strong evidence in favor of the organics.

No nutritional difference

Stanford University physician Crystal Smith-Spangler and her co-authors did not find consistent differences in nutrient levels between the two options. There was a 30 percent lower risk of pesticide contamination in organic than in conventional food, but it was rare for food from either group to exceed limits set by the Environmental Protection Agency, she said.

"Despite the widespread perception that organically produced foods are more nutritious than conventional alternatives, we did not find robust evidence supporting this perception," the authors noted.

"The purpose of the study was not to tell people what to buy and eat, but to give people the information about the difference," Smith-Spangler says. "I can see smart, rational people making different decisions. It’s a complex decision."

A 2000 study, meanwhile, compared pesticide levels in three brands of baby food, two of them conventional and one organic. The authors didn’t detect pesticide residues in any of the samples.

Additives in food, such as dyes and preservatives, have been studied and found to be safe, though some parents still worry that there are negative effects, especially for infants and young children, Hays says. Cancer, immune diseases, gastrointestinal symptoms and even behavioral problems such as attention-deficit hyperactivity disorder have all been blamed on food additives, she says, adding that there are no data behind these suspicions.

"These only remain concerns in theory, not something that has been documented and supported by controlled research studies or anything like that," she says.

The squeezable pouches of organic baby food hit the market about five years ago and have exploded in popularity since, according to organic baby food manufacturer Happy Family.

Parents love the pouches for the convenience: They can squirt the puree onto a spoon for the baby; when the child gets older, he or she can suck the food straight out of the pouch. There is very little mess. In the last few years, Gerber and other power players in the baby food market added pouches to their product lines, and not just for organics, according to Mintel. And just as conventional baby foods come in pouches these days, some organics are sold in jars. (While the pouches are parent-friendly, they are not so planet-friendly. The plastic cap is the only part that’s recyclable. The pouch is made of foil and plastic and is therefore headed for the landfill, according to Shazi Visram, the founder and chief executive of Happy Family.)

Paying a premium

Parents opting for organics pay a premium. At a Wegmans grocery in Fairfax recently, for example, a four-ounce jar of Gerber non-organic sweet potatoes cost 65 cents while the organic version, made by Earth’s Best, was 85 cents. A 4.2-ounce pouch of Earth’s Best sweet potato and apple puree cost $1.49. Yet Mintel reports that four in 10 mothers are willing to pay the premium for organics.

Jarred baby food is typically considered the domain of infants, but it’s common to see toddlers eating from pouches, and some companies have introduced squeeze pouches for adults.

Most babies need to eat super-smooth baby food for the first few weeks after introducing solids, Hays says. After that, she says, their oral motor skills advance quickly and parents should watch to see when their kids are ready to move from simple purees to more complex mixtures and eventually finger foods and table foods.

"Having a positive eating experience with a variety of foods, testing for allergic reactions and advancing textures are the most important parts of early feeding, not whether they’re getting organic or not," Hays says.

How popular are the organic pouches? Visram started the company in 2006 with $115,000 in sales; by 2011, she said, she was up to $35 million. ("I pinch myself a lot," she says.) The company’s top pouch is the spinach, mango and pear flavor, at 3.5 ounces and 60 calories. Parents are smitten with the idea of getting their kids to eat spinach, "one of the holy-grail, top-10 foods you want your baby to develop a taste for," Visram says. While spinach is listed first on the front of the pouch, it’s actually the third ingredient listed in the official "Nutrition Facts" label on the back, behind pear and mango.

"Parents are looking for ways to get more vegetables into their children," Visram says. "Our philosophy is: You do all you can, and it’s about repetition."

Jessica Wolff, a Leesburg mother who works for a nonprofit medical society, feeds her 1-year-old daughter only organic food, though she and her husband eat conventional food. She’s hoping to keep pesticides and hormones out of her daughter’s diet.

"Across the board, everything for the baby has to be pure and good and better. I’m a little neurotic about it," she says.

When her daughter started eating solids, Wolff bought organic foods at the farmers market and spent an entire day cooking them, pureeing it all and freezing some of the bounty in one-ounce portions. Once, when she tried to puree a free-range chicken, the baby food processor started to smoke. That was the end of "the whole horrible Sunday situation," she says.

Now, her daughter eats prepackaged organic purees and meals from brands such as Ella’s, Plum Organics and Happy Family, sometimes mixed with organic yogurt, plus finger foods and fresh produce such as avocado.

"She has a really advanced palate, and I hope it sticks," Wolff says. "It looks like we have a food snob living in the house."

The organic craze has gotten so intense that even parents of very sick children have been asking Hays and doctors at Johns Hopkins Children’s Center about replacing the hospital-provided liquids delivered by feeding tube with organic and homemade mixtures. "They couldn’t believe a liquid formula was as nutritious," Hays says.

Paul Weiner, a Bethesda pediatrician, does not recommend organic baby food to patients because "there’s no definitive data that it’s better," he says. He has gotten a lot of questions about arsenic in rice ever since last fall, when Consumer Reports found "worrisome levels" of the element in a variety of products, including infant rice cereal. The report led the Food and Drug Administration to test about 200 food samples. That produced similar results, but the agency did not recommend that consumers change their rice-eating habits. "We are not aware of any acute health risks linked with the consumption of infant rice in the U.S.," the agency said in a message to consumers.

Weiner encourages parents to rotate rice cereal with barley cereal and oatmeal so that children don’t consume too much of it.

"If an adult were to eat that amount of arsenic, it wouldn’t necessarily be a problem, but for a baby’s small body size, it adds up," he says.

Hays hopes that parents will refocus their good intentions for children’s nutrition.

"My hope is that any parent that is going to be diligent to make sure their child doesn’t get pesticides and hormones would be diligent that their child avoided obesity, because that effort would trump anything that we could do to avoid the side effects of additives," Hays says.

Saslow is a former Post staff writer. 

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By Westend Pediatrics
March 13, 2013
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Breastfeeding does not seem to protect babies against becoming overweight or obese kids, a large, new study says.

"It's just a reality check that in itself, promoting breastfeeding, while a good thing and will have other health benefits, is unlikely to have any effects on stemming the obesity epidemic," said the study's lead author, Richard Martin, from the University of Bristol, UK.

Past research has suggested babies who are breastfed are less likely to grow up to be obese children. But those studies compared mothers who chose whether or not to breastfeed - so they and their kids could have been different in other important ways, researchers said.

The new study included 17,000 mothers and their infants in Belarus. About half of the babies were born at maternity hospitals that used a World Health Organization-designed initiative to promote breastfeeding.

All mothers originally breastfed their babies, so the study was meant to compare how long infants were breastfed, rather than whether they were breastfed at all, Martin noted.

The program to encourage breastfeeding seemed to work - by three months out, 43 percent of mothers who gave birth at intervention hospitals were still exclusively breastfeeding, compared to six percent of women in the comparison group.

Martin said that over the years, his team's study has found fewer stomach infections and eczema and better thinking and memory skills among kids in the breastfeeding-promotion group.

In this stage of the trial, however, the researchers compared weight and body fat in about 14,000 children who were tracked through age 11 and found no differences tied to breastfeeding. Between 14 and 16 percent of all the kids were overweight and about five percent were obese, the team reported Tuesday in the Journal of the American Medical Association.

Dr. Ruth Lawrence, a breastfeeding researcher from the University of Rochester Medical Center in New York, said she still believes that starting breastfeeding in the first place can help ward off obesity. She said past studies have shown breastfed babies have more appetite control than those started on formula, for example.

"Of course it's disappointing that there wasn't a dramatic difference," Lawrence, who wasn't involved in the new study, told Reuters Health.

Researchers said the study doesn't detract from the importance of breastfeeding, given its other known benefits for mothers and babies.

"There's no evidence from this to say you shouldn't continue to follow current recommendations, which are to breastfeed for six months, and breastfeed exclusively," Martin told Reuters Health.

Alison Ventura, a nutrition scientist at Drexel University in Philadelphia, agreed.

"Maybe we shouldn't be touting breastfeeding as an obesity prevention method, but it's still important," Ventura, who wasn't part of the research team, told Reuters Health.

She recommended that new parents learn about when they should introduce certain foods to their baby's diet, and in what portions, as part of thinking about promoting healthy growth long-term.

"Breastfeeding is just one factor," she said, "and maybe studies like this suggest that it's not just one factor that is going to reduce obesity rates, it's probably more the combination of factors."

SOURCE: Journal of the American Medical Association, online March 12, 2013.





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