Enterovirus D68
Enterovirus D68 (EV-D68) was first identified in California is 1968. It is one of more than 100 non-polio enteroviruses.  The virus can cause mild symptoms such as fever, runny nose, cough, and body aches.  It can also cause more severe symptoms such as wheezing or difficulty breathing.  These symptoms may be more common in individuals with other risk factors such as asthma or prematurity.  The virus is found in an infected person’s respiratory secretions. Therefore, EV-D68 likely spreads when a person sneezes, coughs, or touches a surface, and the secretions are passed from person to person.  There is no specific treatment for EV-D68 other than symptomatic care.  Some people with severe symptoms may need to be hospitalized.  It is important to head to your doctor if you are concerned your child is having increased work of breathing and respiratory difficulties associated to their respiratory virus.

For more details please visit the CDC’s website: http://www.cdc.gov/non-polio-enterovirus/about/ev-d68.html

Reference:

Center for Disease Control and Prevention (CDC). (2014, October 21). Enterovirus D68. Retrieved from http://www.cdc.gov/non-polio-enterovirus/about/ev-d68.html

It's that time of year again... Flu Season!

Seasonal flu activity may begin as early as October and can occur as late as May (CDC, 2012), so it’s important to get vaccinated early!  Here are a few reminders and information on Influenza: 

Influenza viruses are constantly changing.  In fact, they can change from one season to the next.  Each year, experts pick the virus strains to be included in the vaccine that they anticipate will be the most common during the given flu season (CDC, 2012). There is no way to predict how mild or severe the flu season will be, but ensuring you and your children are vaccinated is the best protection.  Receiving the flu vaccine does not guarantee you will not get the flu and it does not protect you against other viruses.  Rather, it will decrease your chance of getting the most common flu strains; and if you are infected, you may experience a milder case.

Children from infancy to about 14 years of age have the highest incidence of getting the illness. (Burns, Dunn, Brady, Starr, & Blosser, 2009).  Almost everyone who is at least 6 months of age should receive a flu vaccine.   There are a few groups who should not receive the flu vaccine: those who suffer from severe egg allergy, people who have experienced a previous severe allergic reaction to the flu vaccine, and people with a history of Guillian-Barre syndrome (CDC, 2012).  Guillian-Barre syndrome (GBS) is a rare disorder that causes muscle weakness and sometimes paralysis.  It is often preceded by an illness and most people have a full recovery (CDC, 2009).

Symptoms of the flu include a sudden onset of high fever, headache, chills, cold-like symptoms, dizziness, sore throat, pain in the back and extremities, and a dry cough.  In young children, vomiting, diarrhea, and croup may occur.  In severe infection, there may be complications involving the lungs and the heart, such as pneumonia (Burn et al., 2009).  Children with chronic conditions such as asthma and heart disease may be at greater risk for these complications from the flu (CDC, 2012).

Treatment includes supportive therapy such as bed rest, fluids, and fever reducers such as Tylenol or ibuprofen (Burns et al., 2009).  Antiviral medications may occasionally be used as treatment, but in general are used only for children with moderate to severe infection and those with complicating medical conditions.

Hurry in and get your flu vaccine today!  It takes 2 weeks after the vaccine for antibodies to develop in the body and provide protection against influenza. The CDC recommends vaccination as soon as the vaccine is available to provide protection for as many people as possible prior to the start of flu season (CDC, 2012).

Please visit the CDC website for more details about this year’s influenza vaccine:
http://www.cdc.gov/flu/about/season/flu-season-2012-2013.htm

References

Burns, C.E., Dunn, A.M., Brady, M.A., Starr, N.B., 7 Blosser, C.G. (2009). Pediatric primary care (4^th ed.). St. Louis, MO: Saunders Elsevier.

Center for Disease Control and Prevention (CDC). (2012, June 14). What you should know for the 2012-2013 influenza season. Retrieved from http://www.cdc.gov/flu/about/season/flu-season-2012-2013.htm

Center for disease Control and Prevention (2009, December 15). General answers and questions about Guillain-Barre Syndrome (GBS). Retrieved from http://www.cdc.gov/h1n1flu/vaccination/gbs_qa.htm

We have just launched a Weight Management Program at PPA.  Dr. Faccenda, Dr. Dolha, and Kate, CRNP have teamed up to provide consults and long-term management of children with abnormal weight gain. The program includes an individualized care plan and a family-centered approach to treat and manage childhood obesity.  Read below to learn more about obesity and help determine if your child is at risk!  Please call the front desk for appointment details.

GET THE FACTS (CDC, 2014)

• In the past 30 years, childhood obesity has at least doubled and adolescent obesity has quadrupled.
  • Children ages 6-11: The percentage of obesity has risen from 7% in 1980 to 18% in 2012.
  • Adolescents ages 12-19: The percentage of obesity has risen from 5% in 1980 to almost 21% in 2012.
  • 20% of children ages 2-5 are overweight or obese.
• Being overweight and obese is affected by various genetic, behavioral, and environmental factors.
• Children and adolescents who are overweight or obese as preschoolers are 5x more likely than normal weight children to be overweight or obese as adults.
  • Short term effects of obesity:  Bone and joint problems, sleep apnea, social, and psychological problems
  • Long term effects of obesity: Heart disease, stroke, type 2 diabetes, osteoarthritis, and cancers.
• A BMI >85% is classified as overweight.
• A BMI >95% is classified as obese.
   

WHAT WE KNOW (Hassink, 2014)

• Children are not eating enough fruits and vegetables (Recommendation 4-5 servings/day).
• Vegetables children do eat are usually the starchy ones (potatoes and corn).
• Many consume sugary drinks, cereal, and snacks on a daily basis.
• Children sleep less than the recommended amount.
• Children spend more time in front of a screen than other generations.
• 60-75% of 1-2 year olds consumed dessert, ice cream, and/or candy once/day.
   

RECOMMENDED BEHAVIORS (Hassink, 2014)

• Limit consumption of sugary sweetened beverages
• Eat breakfast daily
• Limit eating out
• Limit portion sizes
• Get 1 hour or more of physical activity every day
• Do not use food as a reward, comfort, or relief of boredom
• Watch cues for fullness
• Have structured meal time- no grazing
• Be consistent will all caregivers throughout the day in terms of diet and play activity.  Older caregivers tend to be more inactive.
   

THOUGHTS ABOUT TV (Hassink, 2014)

• Food is the most commonly advertised product on children’s TV
• 90% of children <2 watch TV regularly.
• By age 5, the average child has seen more than 4,000 TV commercials for food annually.
• During Saturday morning cartoons, children see an average of one food ad every 5 minutes. Up to 95% of these food ads are for foods with poor nutritional value.
• Commercial viewing is significantly associated with higher BMI and has a stronger effect on children <7 years old.
• Try non-commercial viewing TV viewing such as DVDs or educational programming.
• TV should be limited
  • Recommendation is no TV for children <2 and <2 hours of TV/day for children >2 years old.
• Remove TV from child’s bedroom or sleeping area.
   

3 HOURSEHOLD ROUTINES THAT WERE ASSOCIATED WITH A REDUCTION IN THE RISK OF OBESITY (Hassink, 2014)

1. Eating a family dinner 6-7x/week.
2. Obtaining >10.5 hours of nighttime sleep.
3. Limiting screen time to 2 hours or less/day.

References:

Centers for disease control and prevention (CDC). (2014, February 27). Childhood obesity facts. Retrieved from http://www.cdc.gov/healthyyouth/obesity/facts.htm

Hassink, S. (April, 2014). The state of pediatric obesity. PowerPoint presentation at the PA MHI spring conference on pediatric obesity. Grantville, PA. 

                                                       Winter Sports Injuries
Winter sports can be tons of fun for you and your children!  There are many to choose from including skiing, snowboarding, snow tubing, sledding, ice skating, and ice hockey.  We encourage outside play all year long, but remember with any sport, there is risk for fall and injury.  In fact, studies show that each year 2-3% of five-to-seven year olds, and 5-10% of nine-and-ten year olds will sustain injuries that require more than a few days of rest to recover (AAP, 2003).  Some of these injuries may include a fracture, sprain, strain, or bruise.  So, what do you do when you think your child has sustained one of these injuries?  Read the descriptions below for some helpful tips!

                                                    Helpful Tips (Schmitt, 2012)
A sprain is a stretch or tear of a ligament (a band of tissue that connects one bone to another).  They are typically caused by a twisting motion and often involve the knee or ankle.  Your healthcare provider should check most of these injuries.  Immediately after the injury, the joint should be wrapped in an elastic bandage and treated with the R.I.C.E. technique (Rest, Ice, Compress, and Elevate) for the first 24-48 hours.  Ice should be applied for 20 minutes every 4 hours.  This will help reduce the swelling and pain to the area.  Ibuprofen or acetaminophen may be given for pain management.

A strain is a tear or pull of a muscle or tendon (tissue that connects muscle to bone).  They are usually caused by over-extension and most of these injuries can be safely cared for at home.  Ice should be applied to the area for 20 minutes 3-4 times on the first day.  If stiffness continues beyond 48 hours, then heat should be applied for 10 minutes a few times a day until it improves.  Ibuprofen or acetaminophen may be used for pain.  Remember to reinforce good stretching prior to exercise and gradual return to play!

A fracture is a break or crack in the bone and needs to be treated by a clinician.  Stabilizing the area is critical until a medical professional sees your child.  If a shoulder or arm fracture is suspected, use a sling made of cloth to keep the area stable.  If the leg is injured then a board should be used to hold it still.  Your child should not bear weight on the injured leg. 

A bruise may occur to the muscle or bone.  After the injury, blood gets trapped under the skin forming a purplish mark that may be tender.  A bone bruise typically occurs when there is a direct blow to an area such as a knee, elbow, or hip.  Apply ice to the area for 20 minutes 3-4 times on the first day. If pain persists beyond 48 hours, switch to heat for 10 minutes a few times a day until it improves.  Ibuprofen or acetaminophen may be used for pain.  Pain typically improves after 48 hours but discomfort may persist for up to 2 weeks. 

                                     More Reminders for Winter Safety! (AAP, 2013)

1. Even though it’s not summer, remember sunscreen!  The sun reflects off the snow and ice, so you can still get sunburn.  Use a sunscreen with SPF of at least 15 that is made for children, and apply it to your children’s skin 15-30 minutes prior to heading outdoors.

2. Think layers and moisture-wicking fabric, when bundling up for trips outside.  Younger children do not regulate their body temperature as well as adults.  Therefore, they are at greater risk for hypothermia or frostbite.  In addition, a good rule of thumb is to dress your infant in one more layer of clothing than you wear.

3. Please be careful with long scarves, strings, and cords from jackets.  Strangulation is a real possibility, as the loose ends may get caught in sled blades or around slides in the playground.  Hoods on a sweatshirt can also block peripheral view for young children who are not paying attention to their surroundings.

4. Avoid reckless play when outside.  Always wear your helmet when snowboarding, skiing, sledding, or playing ice hockey.  Other protective wear (appropriate for particular sports) includes mouth guards, padding, eye-gear, face guard, and a protective cup.  Make sure that the hills you sled down don’t end with a pond that is not frozen solid or onto a street with motor vehicles.   Children should never ski, snowboard, sled ride, or ice skate alone. â€¨

5. If your child gets winter nosebleeds, consider using a cool air humidifier in his/her bedroom.  Also, saline drops and petroleum jelly may be helpful to keep the nasal tissue moist.

6. Remember, loose blankets, quilts, and pillows should be kept out of the infant’s crib, as this can lead to Sudden Infant Death Syndrome (SIDS).  One-piece sleepers are a good alternative option.  If a blanket must be used, it should be tucked in around the crib mattress and reach no higher than the baby’s chest, so the face is less likely to become covered.

References

American Academy of Pediatrics (AAP). (2013, December). Chillin’ with winter safety. Retrieved from http://www.healthychildren.org/English/safety-prevention/at-play/Pages/Chillin-With-Winter-Safety.aspx

American Academy of Pediatrics (AAP). (2003). Sports injury prevention. Retrieved from http://www.healthychildren.org/English/health-issues/injuries-emergencies/sports-injuries/Pages/Sports-Injury-Prevention.aspx

Schmitt, B.D. (2012, May 15). Bone, muscle, or joint injury. Retrieved from http://www.childrenshealthnetwork.org/CRS/CRS/pa_bonetrau_hhg.htm

2013 Flu Season

Seasonal flu activity may begin as early as October and can occur as late as May (CDC, 2012), so it’s important to get vaccinated early!  Here are a few tips and information on the upcoming flu season:

Influenza viruses are constantly changing.  In fact, they can change from one season to the next.  Each year, experts pick the virus strains to be included in the vaccine that they anticipate will be the most common during the given flu season (CDC, 2012). There is no way to predict how mild or severe the flu season will be, but ensuring you and your children are vaccinated is the best protection.  Receiving the flu vaccine does not guarantee you will not get the flu and it does not protect you against other viruses.  Rather, it will decrease your chance of getting the most common flu strains; and if you are infected, you may experience a milder case.

Children from infancy to about 14 years of age have the highest incidence of getting the illness. (Burns, Dunn, Brady, Starr, & Blosser, 2009).  Almost everyone who is at least 6 months of age should receive a flu vaccine.   There are a few groups who should not receive the flu vaccine: those who suffer from severe egg allergy, people who have experienced a previous severe allergic reaction to the flu vaccine, and people with a history of Guillian-Barre syndrome (CDC, 2012).  Guillian-Barre syndrome (GBS) is a rare disorder that causes muscle weakness and sometimes paralysis.  It is often preceded by an illness and most people have a full recovery (CDC, 2009).

Symptoms of the flu include a sudden onset of high fever, headache, chills, cold-like symptoms, dizziness, sore throat, pain in the back and extremities, and a dry cough.  In young children, vomiting, diarrhea, and croup may occur.  In severe infection, there may be complications involving the lungs and the heart, such as pneumonia (Burn et al., 2009).  Children with chronic conditions such as asthma and heart disease may be at greater risk for these complications from the flu (CDC, 2012).

Treatment includes supportive therapy such as bed rest, fluids, and fever reducers such as Tylenol or ibuprofen (Burns et al., 2009).  Antiviral medications may occasionally be used as treatment, but in general are used only for children with moderate to severe infection and those with complicating medical conditions.

FluMist is available now for most of our patients, and the injectable flu vaccine will be available soon.  Check out our Announcements page for more details.  It takes 2 weeks after the vaccine for antibodies to develop in the body and provide protection against influenza. The CDC recommends vaccination as soon as the vaccine is available to provide protection for as many people as possible prior to the start of flu season (CDC, 2012).

Please visit the CDC website for more details about this year’s influenza vaccine.

References

Burns, C.E., Dunn, A.M., Brady, M.A., Starr, N.B., 7 Blosser, C.G. (2009). Pediatric primary care (4^th ed.). St. Louis, MO: Saunders Elsevier.

Center for Disease Control and Prevention (CDC). (2012, June 14). What you should know for the 2012-2013 influenza season. Retrieved from http://www.cdc.gov/flu/about/season/flu-season-2012-2013.htm

Center for disease Control and Prevention (2009, December 15). General answers and questions about Guillain-Barre Syndrome (GBS). Retrieved from http://www.cdc.gov/h1n1flu/vaccination/gbs_qa.htm