In the News: Vitamin D Deficiency in Infants

A new study is showing that a majority of infants, even those on formula, aren't getting enough vitamin D in their diet. Vitamin D is important for for strong bones and overall health. Read the following article to learn more about this study:

http://www.cnn.com/2010/HEALTH/03/22/vitamin.d.babies/index.html

As the article suggests, parents should talk to their pediatrician about vitamin D supplements and other ways to ensure their infants and children are getting enough vitamin D.

FAQs on Food Allergies

With food allergies in children becoming more common, I thought it would be useful to answer some of the most frequently asked questions parents have about food allergies.


What is a food allergy?
When someone has a food allergy, their body actually believes that a particular food is harming them. As a response, the body tries to attack the food by setting off an allergic response. Responses can be mild, from a rash to an upset stomach, or severe, which is actually called an anaphylactic reaction and can be deadly.

What causes food allergies?
It is hard to tell exactly what causes food allergies, but we do know that they tend to run in families. Parents that have any form of allergy are at higher risk for having children with food allergies.

What are the symptoms of food allergies?
There are a wide variety of symptoms related to food allergies ranging from mild to severe.

Some examples are:

• cramps, upset stomach
• nausea or diarrea
• itchy skin
• rash or hives
• tingling or swelling in the lips
• stuffy/runny nose

Symptoms usually begin within a couple of hours of eating the problem food. As a rule of thumb, the sooner the symptoms appear, the more severe the reaction.

The most serious symptoms are those related to anaphylaxis.

These symptoms include:

• throat and tongue that swell quickly
• wheezing and difficulty breathing
• vomiting
• fainting

If your child begins to experience these symptoms, call immediately for medical help.


What are the most common foods that children are allergic to?

The most common causes of food allergies in children are:

• eggs
• milk
• wheat
• soy
• peanuts

The good news is that many kids outgrow food allergies before the age of five. An estimated 80 percent of children with allergies to egg, milk, wheat, and soy will outgrow them. However, only 20 percent of children outgrow a peanut allergy.

What is the difference between a food allergy and food intolerance?
Many people confuse food intolerance with food allergies. Food intolerances are actually very common and can cause some of the same symptoms as a mild food allergy, such as upset stomach and diarrhea. A food intolerance is much less serious and does not involve the immune system like an allergy does. The symptoms of a food intolerance are digestive only and generally don't appear until several hours after a food is eaten.

How are food allergies diagnosed?
Your pediatrician will probably start with a simple history. He or she may have you keep a log of what the child eats and when certain symptoms occur to determine what food may be causing problems.

If your child has a serious food allergy, the pediatrician will probably do an allergy skin test. The doctor puts a little drop of liquid on the skin and then pricks the skin to see if the area swells and reacts to the liquid. The doctor may also do a blood test to look at chemicals in the blood that are triggering the allergic reaction.

How are food allergies treated?
The best and most common treatment is to quit eating foods that cause the allergic reaction. However, this can be difficult for parents who have to start reading food labels and readjust their family meals to accommodate the child. If the food is eaten, some children benefit from an over-the-counter antihistamine like Benadryl.

If your child has a severe food allergy, the pediatrician will often prescribe an allergy kit that contains an EpiPen. The pen gives the child a shot of epinepherine, which can slow down or stop the severe allergic reaction from happening. Children with serious food allergies should wear a medical alert bracelet and have the pen available to them to all times.

Can food allergies be prevented?
Research is showing that the only possible prevention is to hold off on introducing all solid foods until your baby is at least 4 to 6 months old. Your pediatrician can give you a schedule on when and how to introduce solid foods into your baby's diet, but it is important to remember to introduce foods one at a time, so that you are able to recognize if there are any foods that may cause problems.

Raising a Child with Food Allergies

The number of children being diagnosed with food allergies is rising. Adapting to daily life with a child who has food allergies can be a challenge for many parents. Today's post comes from Christine George, who shares her personal experience with raising a son with food allergies. Our next post will focus on diagnosing and treating children with food allergies.

I looked at the doctor with wide eyes as he pulled out an EpiPen without the needle and demonstrated how to use it on his own thigh. “If you know he has eaten a peanut, you give him the EpiPen right away and take him straight to the ER. If he doesn’t have any reaction, or if his symptoms subside, you can wait outside the ER for up to an hour to be sure he’s okay before you take him home.”

Three years ago I never thought to ask someone if they had food allergies before I brought over a plate of cookies or gave some kids a snack. It wasn’t until our first child was 7 months old that I was introduced to the world of food allergies. Our baby screamed and broke out in bright red hives when we tried to give him milk-based formula. The same thing happened on another occasion the first time he tried eggs. We decided to visit an allergist. Tests indicated he was allergic to milk, eggs, peanuts, and several tree nuts. The allergist told us to avoid these foods entirely.

I remember walking out of the allergist’s office feeling overwhelmed. I didn’t even know where to start asking questions. What on earth was I supposed to feed this child?? I spent a lot of time on the computer researching food allergies and trying to understand how to work with our new family challenge. While there was a lot of information about what food allergies were and what foods to avoid, it was much harder to find helpful information about what foods were okay for my son to eat.

As our son got older, family meals became more of a problem. He began eating more and was very interested in whatever we were eating. I didn’t have time to cook two different meals every day, and I didn’t have the heart to tell him no every time he asked for something. I started searching for recipes that would accommodate his existing allergies but would also work for the rest of us. While it was fairly easy to find recipes that were free of dairy or nuts, it was very difficult to find recipes free of dairy, eggs, and nuts. I resorted to vegan recipes for a while, but my family wasn’t very fond of tofu or cheese alternatives—they just don’t taste good! Over time we learned to alter our own recipes and adopted new ones that passed the family test. It has taken a lot of effort, but we’ve finally found enough recipes that we can eat together as a family.

Eating out is still a challenge. We don’t go out to eat very often because of the difficulty in finding allergy-free food for our son, especially since he’s a picky toddler in addition to his food allergies! However, many large restaurants have recently created menus for people with food allergies so you can easily find something without having to ask the waiter about every ingredient in the dish.

Social eating has been our biggest struggle. In nearly every gathering, event, or celebration, there is food. Our son is now three and doesn’t quite understand why he can’t have what everyone else has. In many cases I am able to find out ahead of time what food will be at a social event we are going to attend, and I make the same item and bring it with us. It is a lot of work, but it’s worth it for him to feel included.

My husband and I have spent so much time trying to understand our son’s food allergies and learning how to deal with the social implications. I wanted to share what I have learned with others so maybe a few parents out there would have an easier time adjusting to the lifestyle change required by a family member with food allergies. We developed a Web site called EatAllergyFree.com, where you can share recipes, look up allergy-free products, get ingredient substitutions, find allergy-free menus for many restaurants, and share comments and ideas with others in the same situation. It’s a resource we wished we had since the beginning, and we hope it will be of use to others struggling with adjusting to a food-allergy life.

Ask a Nurse

What do I do if my baby has bad breath?

Halitosis (bad breath) is not a problem we expect to find in our little ones. Thankfully, it is usually not an indication of a serious medical condition. In kids, bad breath is most often caused by bacteria in the mouth or in the nasal cavity. Poor dental hygiene causes bacteria to feed on stagnant saliva and food particles in the mouth.

Many parents are unaware that good dental hygiene actually begins before your child's first tooth ever comes in. Even before your baby’s teeth come, in you should start cleaning his/her gums twice a day using a clean, soft cloth. Good times to do this are after a morning feeding and before bedtime. When the child’s first teeth come in, you should continue cleaning with a cloth or use a baby’s toothbrush and water.

For age-appropriate tips on how to take of your child's smile (and breath), check out our post on oral hygiene.

If you have a question you would like Nurse Brittany to answer, e-mail it to healthyhappychildren@gmail.com.

Diaper Rash

The term is pretty self explanatory. Diaper rash is an area of redness or small bumps in the diaper region—the genitals, the buttocks, upper thighs, and lower abdomen. The rash is almost always caused by leaving a soiled diaper on for too long. The moisture and chemicals in urine irritate the skin and cause it to break down. Stool is even worse because the digestive agents in the stool attack the skin. Once the surface of the skin is damaged, it is even more susceptible to diaper irritation. As a result, it is much easier to prevent diaper rash from ever developing than to treat it. Proper care is essential in protecting the integrity of your baby's skin.

Proper care includes the following:
• Always change your baby's diaper immediately after a bowel movement. Make sure the skin is thoroughly cleansed, and take special precautions if your child has diarrhea.
• Be sure to change your baby's diaper frequently (every 3-4 hours). You may change it less often during the night if your child's skin tolerates it.
• Assess your baby's skin every time you change a diaper. If you notice any redness or irritated areas, apply ointment and make a note to change diapers more frequently. It is much easier to remedy a problem when it is small, and regular assessments are key to noticing the development of a rash before it gets too serious.
• If your child does develop a rash, keep the area as clean and dry as possible. Apply a thick layer of ointment or cream, like Desitin. This acts as a barrier and helps protect the skin.
• Call your pediatrician if the rash does not go away in 2-3 days or if you feel like it is getting worse.

Fractures

Our kids can be very active, and, unfortunately, accidents do happen. One of the most common injuries in school-age children is fractures. Broken bones in children are generally not too serious (bones in young children are more flexible and have a thicker covering than bones in adults), and they generally heal quickly with proper diagnosis and treatment.

It can be difficult to tell whether or not your child has a broken bone. As a general rule of thumb, if the bone is broken, your child will experience pain and will be unable/unwilling to move the affected limb. However, some children are too young to tell you they are in pain, and just because a child is able to move the limb, doesn't always mean the bone isn't fractured. If you suspect the bone is broken, it never hurts to take your child to the doctor to have it examined.

The first thing the doctor will do if a fracture is suspected is order x-rays in order to see the extent of the injury. Most of the time a simple cast that immobilizes the area is all that is needed for the fracture to heal. If the fracture is more serious, bones that are displaced may need to be realigned by an orthopedic surgeon.

Here are a few tips if your child does appear to have a fracture injury:
1) Try to immobilize the area with use of a sling or splint.
2) If your child is older, place an ice pack on the area to reduce swelling and relieve pain. Never use ice with babies or toddlers because their skin is delicate and the extreme cold can cause injury.
3) Don't give your child anything by mouth; no food, drink, or medication for pain.
4) If your child has a broken leg, don't try to move him/her yourself. You may cause further injury. Instead call for medical help.
5) If bone is protruding through the skin, use firm pressure on the wound to control the bleeding, and then cover the area with clean gauze to help prevent infection.

Ask a Nurse

Today's ask-a-nurse question is a follow-up on last week's vaccine question:

How do I know my baby isn't getting too large of a dose of a vaccine?

Vaccine doses for infants are different from the doses for children and the doses for adults. It is important to note that it requires at least 10 years of FDA testing before a vaccine can even be licensed. Before they are even in use, vaccines are thoroughly tested for proper dosing, safety, and effectiveness, so you can be certain that the right amount is being given to your child to provide immunity to the disease without causing serious adverse effects.

Once a vaccines is licensed, the Centers for Disease Control and the FDA continue to monitor for safety and effectiveness of the vaccine. Any hint of a problem will lead to an in-depth investigation and appropriate actions will be taken including even revoking the vaccine's license if necessary.

If you have a question you would like Nurse Brittany to answer, e-mail it to healthyhappychildren@gmail.com.

In the News: Bath Toys

Recently I was watching The Today Show, and there was a segment on children's bathtub toys that I knew I had to share on the blog. As I watched the segment, I was appalled. The topic was something I had never thought about before, but it makes perfect sense—the combination of stagnant water, warmth, darkness, and an already-prone-to-bacteria bathroom setting is the perfect breeding ground for bacteria growth on and in your child's bath toys.

Watch the video here or read the news story here.

Scoliosis

You may remember getting a scoliosis health screening in junior high school—the one in which you bend over and touch your toes while the examiner looks at your back. Scoliosis is a common condition that develops during adolescence. One in 25 teenage girls and one in 200 boys are affected. It is called scoliosis because the person’s spine, which runs in a fairly straight line down the back in a normal individual, instead curves in an s-shape.


Most cases of scoliosis are idiopathic, meaning there is no known cause for the curvature. Researchers have found, however, that there does seem to be some familial tendency associated with the condition, which suggests there may be a genetic component. They have also found that scoliosis is more common in tall, thin women and tends to develop during rapid periods of growth.

Symptoms of scoliosis you should look for in your children/adolescents are:

uneven or rounded shoulders
curving of the upper body
leaning to one side
complaints of back pain


Scoliosis screenings are usually done in school, but your pediatrician can also do it during your child's yearly visit. A curvature greater than 10 degrees is considered scoliosis and is often referred for evaluation.

Six out of seven people with diagnosed scoliosis never receive treatment. In fact, it is only when the curvature gets severe (around 25 degrees) that the doctor will suggest either bracing or surgery. The purpose of bracing is not to fix the curvature of the spine but to prevent it from getting worse, so the brace is usually worn full-time until growth is complete. The only way to actually correct scoliosis is through spinal surgery.

Ask a Nurse

Today's ask-a-nurse question is from Angie in Michigan:

Is there still mercury in vaccines?

In the 1930s thimerosal, an organic compound containing mercury, started being widely used in vaccines and other drug products as a preservative. Although there was never evidence that the small doses of mercury in the preservative caused any harm to patients, in July of 1999 the American Academy of Pediatrics, along with several other public health organizations, began working with vaccine manufacturers to reduce or eliminate the use of thimerosal in vaccines simply as a precautionary measure.

To date, thimerosal has been removed or reduced to trace amounts in all vaccines recommended for children under the age of six. For older children and adults, there are now many vaccines that are available in thimerosal-free formulas.

If you have a question you would like Nurse Brittany to answer, e-mail it to healthyhappychildren@gmail.com.

Vision Problems in Children

Middle childhood (ages 6 to right before adolescence) is the time when many children begin to develop problems with their vision. The most common visual problems are myopia, hyperopia and astigmatism.


Myopia is also called nearsightedness. This condition occurs because the eyeball is too long, which causes light that enters the eye through the lens to focus in front of the retina. As a result, these children can see close objects clearly, but distant objects appear blurry.


Hyperopia is farsightedness. In this condition, the eyeball is shortened, so light is focused behind the retina, causing close objects to be out of focus. These children can see street signs a mile away but may have difficulty reading or seeing clearly close objects.


Astigmatism is another condition that affects vision. This happens because the front surface of the eye has an irregular shape—it is shaped is more like a football than a basketball. This leads to distorted vision, both near and far.

All three of these conditions can be inherited, so children of parents that wear glasses are at greater risk for developing visual problems.

The good news is that all three of these visual problems can usually be corrected with eyeglasses. If your child complains of having difficulty seeing the board in school or reading the words in a book or if you notice your child squinting or sitting close to the TV, you should make an appointment with an eye doctor to get your child's vision tested.

Choking Prevention

Choking is a common form of injury and death among children. The risk of choking is high among children under the age of five, with children under one being at the greatest risk. Here are several things parents can do to help prevent choking accidents from happening:

* Food is responsible for most choking accidents, so supervise your children during mealtime. Encourage your child to chew completely before swallowing, and never allow your child to run and play while eating.
* Cut food, especially hard or round food, into small, bite-size pieces no more than 1/2 inch in size. Hot dogs are the number-one choking culprit among children.
* Don't give your young child hard, smooth foods like raw vegetables. These foods must be chewed with a grinding motion, and children don't develop that skill until around the age of 4. As a result, young children will often attempt to swallow these foods whole, therefore increasing the risk of choking.
* Keep your home clean. Remember that young children will put anything they find in their mouth. Small objects found around the house are often responsible for choking accidents.
* Beware of items associated with choking accidents: balloons, safety pins, coins, marbles, pen/marker caps, buttons, hard or sticky candy, chewing gum.
* Look at manufacturers' guidelines when selecting toys for your children, but also use your own judgment. If there are small parts associated with a play item, it could be a choking hazard. Select toys with parts larger than 1 3/4 inches, which is about the diameter of a toilet paper roll.

And because accidents can happen to anyone at anytime, I recommend that all parents take an infant/child CPR class, which includes instructions on what to do if a choking accident does occur.