Is Tylenol safe to give to children with asthma?

Here are the facts:

• Nearly 9% of children in the U.S. suffered from asthma in 2005...that was likely an underrepresentation of the true number of cases and 6 years later, the numbers have undoubtedly risen.
• 13 million school days are missed each year due to asthma in children
• There are somewhere in the range of 3,000 deaths each year in the U.S. due to asthma
• The annual estimated economic cost of asthma in the U.S. is $19.7 billion.

If reading those statistics doesn't make a strong argument that we should be devoting more time to identifying better ways of treating asthma in children, then I don't know what does.  If you have a child with asthma, you know first-hand, how it impacts your entire family.

An article is published in the upcoming December issue of Pediatrics journal, that looks at a possible link between Tylenol (or generic acetaminophen) use and asthma in kids.  It has been a well-established fact that some people with asthma can have asthma flare-ups if they take aspirin.  Now, the most widely-given over-the-counter medication, acetaminophen, is being called into question, in terms of its safety for children with asthma.  The article looked at multiple studies that have been conducted in recent years, one of which involved over a half a million children in 54 different countries.  In some cases, when children took acetaminophen more than once a month, their risk of asthma was nearly tripled.  It's unclear to the researchers whether increased use of acetaminophen causes asthma in children, or whether children who are already predisposed to having asthma just tend to take acetaminophen more often.  It's also unclear whether taking acetaminphen less often (say, once or twice a year) has any impact on a child's risk of asthma.  Either way, it makes a strong argument to turn to alternative treatments for fever in chidren, like ibuprofen (Children's Motrin/Advil).  There does not appear to be that same association between ibuprofen and asthma in children.  (And no, I'm not getting paid by the makers of ibuprofen to say that!)

Those that know me well, know that I am not an alarmist, and I certainly wouldn't say that it's time to panic.  This is a no-brainer for me, though.  The alternative treatment sits right next to acetaminophen on the shelf at the pharmacy.  I'll be recommending ibuprofen for fever control in children with a history of asthma or a strong family history of asthma, from now on. 

When the doctor's kid is sick!

As I was standing in front of an open freezer door, with my croupy 4-year old in my arms last night around 1am, I realized what an interesting position it was to be in.  Although standing and staring at the frozen bag of edamame on the middle shelf of our freezer may seem like a bizarre thing to do in the middle of the night with a sick toddler, that's not actually what I'm referring to when I say that I felt like I was in an odd position! (Tip - cold freezer air is great for calming down airway distress from croup!)  What I realized, is that I tend to glide through my days, dishing out advice, prescriptions, and treatments, for a variety of childhood illnesses, and only when one of my own children gets sick, does it really hit home about how distressing it is for parents to see their children suffering.  I've always said that having children of my own, drastically changed how I practiced as a pediatrician, and last night was a reminder of how and why that still rings true for me.  Being awakened by a coughing, "barking" child, who's panicked because she feels like she can't breathe, trying desperately to calm her while inside I'm also trying to calm myself, feeling overjoyed when the noisy stridor begins to subside and a hint of a smile returns to her face, and making it ok to turn on an episode of Oobi (possibly one of the strangest shows on Nick Jr., but for some reason beloved by small children) at 2am, just to distract your child a little...all of these things add up, for me, to one big thing:  Understanding.  Understanding that when our kids are sick, the world seems to temporarily slow down.  Understanding that when our kids are sick, it takes superhuman parent strength to respond with calm, controlled action instead of worry and panic.  Understanding that parents will do just about anything on the planet to make their children feel better.  Understanding that when it's my child that's sick, it's the most important thing at that moment, and that's no less true for every other parent out there.  Understanding that having a sick child throws a wrench into the whole family's schedule, plans, expectations.  An understanding that I just don't think I'd have, if croup didn't occasionally come knocking on my own family's door from time to time at 1am!

Crib Safety - The Latest Guidelines

Earlier this year, the federal government released new safety standards for cribs in the US and just this week, the American Academy of Pediatrics released a consumer public safety announcement reflecting these new guiddlines.  The one that grabbed the headlines was a recall and strict prohibition of the manufacture and sale of cribs with drop side-rails.  This was an important change, due to at least 32 infant suffocation and strangulation deaths due to drop side-rail cribs since 2000.  This was a landmark in crib safety in this country, as federal crib safety standards had not been updated in over 30 years.  It's important for parents to be aware of the issue of drop side-rail cribs, but there are also several other pieces of the new federal crib safety guidelines that all parents should be aware of.

1.  Childcare centers, in-home child care facilities, and public domains that provide cribs like hotels, have until December 28, 2012 to comply with these guidelines.  With this in mind, if parents are aware that their children are going to be exposed to any of these settings, it's important to ask about the cribs that are provided.

2.  If you currently own a drop side-rail crib, the American Academy of Pediatrics and the Consumer Product Safety Commision are strongly urging parents to consider getting a new crib that meets the updated safety guidelines.  If this is not possible, the recommendation is to frequently check the integrity of the crib, including the hardware, making sure that all parts are secured tightly and that there are no missing or broken parts.  Consider having your child sleep in a pack-n-play (as long as it is not a model that has been recalled).

3.  If you are unsure whether or not the crib that you currently own has been recalled, go to http://www.cpsc.gov/ and click on infant/child recalls.

4.  This safety guideline applies to all cribs, even those sold at resale locations like garage sales and consignment sales.  Additionally, drop side-rail cribs may not be donated to thrift stores or child care facilities/nurseries.  Any cribs that do not meet current safety guidelines should be broken down and disposed of.

Musings from my Minivan

It's always entertaining for me, when people find out what I do for a living.  It usually goes something like this: 
Them..."What do you do for a living?"
Me...."I'm a pediatrician."
Them..."Really, that's great!  Where do you practice?"
Me, smiling..."Out of my minivan!"
That is usually met with some confused stares and silence, at which point, I explain my housecalls practice to them.  The fun part is hearing the variety of responses.  I've met several new families this week, and in honor of these new relationships, I thought I'd share a few of my favorite moments over the course of the first 7 months in the life of Pediatric Housecalls.
1.  Child..."Mommy, when is the doctor going to be here?"
     Mother..."Honey, this is the doctor."
     Child...(silently looking me up and down)..."No mommy, the real doctor."
2.  I am not sure why, but for some reason, I have about an 80% rate of kids asking me to come see their
     playroom after I'm done examining them.  This is usually followed by about a 99% rate of horrified looks
     on their parents' faces, as the thought of a pediatrician walking unannounced into their playroom dashes
     through their mind in slow-motion.  Since the playroom in my own house always looks like a page out of
     the Pottery Barn Kids catalog, complete with organized and labeled baskets (not!), and only filled with
     uber-educational books, games, and puzzles (not!), I typically politely decline the offer.  And then
     exchange silent smiles of relief with the mother.
3.  I always let the kids pick where they'd like to be examined.  Usually they choose the couch, a
     comfortable chair, the floor, their bed...but not this 5 year old little boy...no, he had a sense of humor
     way beyond his years, as he stared me dead-serious in the eyes and said, "How 'bout inside my firetruck
     tent?"  I could hear his mom laughing behind me as we climbed inside.
4.  And lastly, here's my true modern-day 2011 version of an episode on Little House on the Prarie.
     At 7:50pm on a Tuesday night, a mom called me to see if I could come see her son, who had fallen
     asleep earlier that evening, but who had now awoken in tears, complaining of ear pain.  Within 15
     minutes, I was on her doorstep, tiptoed upstairs to his bedroom, diagnosed an ear infection, gave him
     some pain reliever and his first dose of antibiotic, and emailed his prescription to the pharmacy, all
     while he never got out of his bed, his little sister was still happily sleeping down the hallway, and his
     mother didn't have to get out of her sweats to drag 2 kids out of bed (her husband was out of town) to 
     go to an urgent care. I have to admit, I felt a little like Doc Baker, pulling up in a rainstorm on his
     horse and carriage, to take care of sick little Nellie Olsen.  OK, so there were a few minor differences,
     like the fact that Doc Baker didn't have a GPS system (or a car, for that matter), Nellie's dad was in the
     barn throwing hay, not in Japan on business, and the treatment of choice was something like quinine
     and rubbing alcohol instead of a bubblegum-flavored antibiotic, but hey, it was close enough!
I truly LOVE what I do for a living, and it's stories like these that make it all the more fun!  I may have an
unconventional practice, and I may throw people for a loop when they hear what I do, but I wouldn't go back to traditional practice ever again.  This is way too entertaining!
 

Second-hand smoke around kids: One more reason it's BAD NEWS!

As we were leaving the grocery store yesterday afternoon, my 4 year old noticed two people standing outside the store smoking.  In a most genuine display of admonishiment and judgement that only a preschooler can display without being considered politically incorrect, she says to me wide-eyed, "Look Mom!  Those people have SMOKERS!"  Smokers, of course, being her term for cigarettes.  Being within earshot, they glanced over at her, and we exchanged sheepish grins.  I didn't proceed into a long-winded lecture, and I fought back the temptation to follow up her comment with some audible remark about how smoking is very bad for a person's health.  No, in that moment, I took the high road, kept my opinions to myself, and let the words of a 4 year old speak for themselves...in the end, probably much more poignant than any disapproving glance or stare from me would have accomplished.
This week, a new study was published in the journal, Pediatrics, that reveals that children who are exposed to second-hand smoke have a 50% increased likelihood of suffering from things like ADHD, learning disabilities, and other neurobehavioral problems.  It's not rocket science that smoking is bad for your health, but now we have yet one more reason to back up what we've been saying for years:  Adults' smoking is BAD FOR OUR CHILDREN'S HEALTH!  Arm yourself and your kids with this news, and feel free to share the endearing comments that your own children deal out to smokers everywhere!

Vasovagal Syndrome - a.k.a. When Kids Pass Out!

I was at my daughter's swimteam practice the other morning, when I overheard a conversation between two moms about one of their sons who had passed out during a painful office procedure at a doctor's office the previous day.  He was fine, but it sounded pretty scary. 
About 3 weeks ago, I made a houescall to a sweet little 8 year old girl who had passed out while playing miniature golf with her family.  She, too, was fine, but as you can imagine, the family was more than a little distressed over the event.
While at a monthly bunco girls' night gathering a while back, one of my friends passed out.  Granted, we had been enjoying an awesome bottle of red wine (okay, and someone also brought a pitcher of margaritas), but trust me...the half a glass of wine that she had sipped on at that point in the night certainly had nothing to do with her passing out.  (Although we laughed later that to a casual observer, seeing a bunch of women flittering about in a panic, one passed out on the couch, another knocking over her wine, some in tears, and another rushing off to call her husband the surgeon on his cell phone, the scene probably would have looked like something off of Housewives!)
Just last night, while having a conversation with some running buddies, I learned that one of them had a tendency to pass out for no apparent reason.  His doctor had told him he had some "condition" but he couldn't remember the name of it.
"Vasovagal syndrome" I exclaimed!  "That's it!"  he said.
And so....since it seems like every friend, child's playmate, patient, or neighbor I know has had some experience with this, I figured that it might be a worthwhile topic to post about!  If you have a child that has had something like this happen and can relate, or if you know of someone who has, feel free to chime in with your own input! 

The term, "vasovagal syndrome" comes from the vagus nerve, which is a large nerve running the length of the body, that when stimulated, causes a person's blood vessels to suddenly relax, and good-old-fashioned gravity takes over, pulling blood downward, away from a person's brain, and presto, they are on the floor!  Often children will describe "tunnel vision" right before they pass out.  They usually "come to" within a matter of seconds, but the alarming part is that sometimes as their nervous system is "re-setting", they will have little twitches and eye movements, that can be mistaken for a seizure.  With vasovagal syndrome, the person awakens pretty quickly, and other than feeling a little tired, they're usually feeling fine a short time later. 
If it happens, the most important thing for observers to do, is to remain calm.  Once the child begins to wake up, ask them if they are hurt anywhere, and have them lie on their left side for a few minutes before they try to sit up.  Contact your pediatrician, to let them know that it happened, but most likely, there won't be any need for testing unless it starts to happen fairly frequently.  Vasovagal syndrome is not serious and is extremely common.  Sometimes it can occur if children haven't been drinking enough in the summer heat, and their blood pressure drops a little.  My oldest daughter had it happen in the middle of Harris Teeter, right after she accidentally pinched her finger in the cart.  (Pain is often a trigger).  Sometimes extreme emotion will trigger a person to pass out.  (Think Scarlet O'Hara).  And sometimes, it happens for no good reason, which is the most frustrating scenario of all!  The bottom line, however, is that scary as it may be to witness, it isn't dangerous, and it's certainly no cause for panic. 
Happy 4th to everyone!!

Food Allergies - The Latest Buzz

I can't turn on the news or look at my homepage the last day or so, without reading the headline "Food allergies more common than previously thought!"  Gee, do you think so?  Well, if my kids' classrooms are a reflection of the rest of the country, I'd say this study sort of stated the obvious, right?  This past year, each of my 3 children had at least one, and in one classroom there were six kids with food allergies.  Peanut is certainly the most common, and the most talked about, but the other ones ranged from milk to eggs to wheat to treenuts.  All the while througout the school year, the other parents and I would remark to each other about how none of us remembers having this many kids with food allergies when we were growing up. 

The recent study that's making all the headlines was the biggest food allergy study to date in the U.S.  It included 36,000 kids and revealed that about 8% of kids in the U.S. suffer from food allergies.  This is double what was previously found in older studies.  What's even more interesting than the flat statistic, is examining how the data was collected.  Survey phonecalls were placed randomly to families asking about whether or not their children had food allergies.  If parents answered "yes" to this question, then the researchers followed up by asking "to what foods".  Parents were also asked if their child's food allergy had ever been diagnosed by a physician, and they were also asked to list what their child's symptoms were.  From there, researchers "weeded out" any answers that seemed less than valid.  (Example:  If a parent stated that their child became bloated after drinking milk, but had never been tested or formally diagnosed with a milk allergy, this child was not counted.) 

So, what should we take away from this study?  It's really hard to know.  Since the information was based on parent-report only, it's impossible to know if all of the food allergies reported were accurate.  Some say that the method of collected the data makes the results of the study skewed, overestimating the prevalence of food allergies in children.  In my world, it almost doesn't matter whether the national prevalence of food allergies is 8% or 4%, if my child is one of the ones with food allergies.  These families suffer tremendous burden, whether it be having to be their child's advocate at school, to ensure the classroom and the lunchroom is a safe place for their child to be, or whether it's the burden of having to be mindful at every restaurant, birthday party, and neighborhood cook-out.  There are lots of theories floating around about why there seems to be an increasing prevalence of food allergies from one generation to the next.  No definite explanation has been agreed upon.  One thing that we can all agree upon, however, is that food allergies constitute a real, serious health issue for the children in this country.