A recent study in the journal found that consuming food from a fast-food restaurant was associated with an increase in 126 total calories for children and 310 daily calories for adolescents for that day. Consuming food from a regular full-service restaurant was associated with an increase of 160 calories for children and 267 calories for adolescents. So this means that, compared with a meal at home, eating at either a fast-food restaurant or a regular full-service restaurant means an increase in calories each day that kids eat out. This study also showed that eating a meal at a restaurant was associated with a higher intake of sugar, fat, and sodium, particularly when eating at a fast-food restaurant.

Winter is here and as the song says, “baby it’s cold outside”.  Here are
a few quick tips to avoid some health issues commonly assoicated with winter.
First of all, make sure you are dressed appropriately for the cold
weather.  That doesn’t just mean a warm coat or layering of your clothes.
Since we lose heat from the top of our heads, put on a hat.  Wear a scarf or
face mask and be sure to protect hands and fingers from getting wet and/or
cold.  Gloves help protect the skin on your hands which tends to get dry.
When skin becomes too dry, your hands may become cracked making the skin more
susceptible to infection.  Be aware of frostbite.  This is caused when the
skin has become so cold that the circulation to the fingers is compromised.
The skin becomes pale or grayish in color and my blister.  Next you may lose
feeling in your fingers.  If your are worried that this has happened place
your hands in warm water, about 104 degrees, which is average bath water.
Then carefully pat them dry and place them on dry warm cloths.  If this
happpens to your nose use warm, wet compresses initially, be careful not to
rub and then use warm dry compresses.  Call your doctor right away.
Often playing outside in the cold weather leaves your clothes wet.  Take
off the wet clothes as soon as you return inside, put on warm, dry clothes
and drink warm liquids, such as soup, hot chocolate.  If you are spending
extended periods of time outside, remember to keep yourself hydrated; drink
lots of fluids.
There are many outdoor activities to enjoy during the winter months,
such as skiing, ice skating and sledding.  Make sure your equipment (skis,
snowboards, blades on the ice skates or the runner of the sled) are in good
condition and that you have not outgrown them.  If you are taller this year
you might need longer ski poles.  Perhaps your feet have grown since last
year and your ski boots or ice skates are too small.  Does your helmet still
fit properly?  If you are going to use a sled, make sure the the steering
works and go down feet first, not head first.
Parents, when sending your children to the bus stop remember that it is
dark and cold outside.  Remind your children to stay on the sidewalk and look
both ways before crossing the street.  A brightly colored scarf, hat or gloves
is a great way to ensure that they are visible in the dark.
Winter is a fun time of the year.  Be safe and be smart.

Richard Lander, MD, FAAP

Despite everyone’s best efforts, there can be issues along the toilet training road. Here are 7 tips to help you navigate some of the potential obstacles and prevent complications.

1. Focus on what the child can do

Instead of focusing on what the child can’t or won’t do, start with what the child is able to do. Even for a child who has been a competent toileter, it may help to start at the beginning and break down toileting into small steps and reward each step. For instance, if a child is in pull-ups or back in diapers, do diaper changes in the bathroom or have the child help with clean-up. The child may simply practice sitting on the toilet either with or without a diaper.

2. Eliminate stress around toilet training

Don’t push a child who is resistant or who is not developmentally able. For a child who is very resistant to toilet training or who is trained to stool and/or urine and then is no longer able or willing to do so (regression), consider backing off or discontinuing toilet training temporarily. This may feel like a step backwards. Having an alternative plan will help so that backing off does not feel stagnating. An example plan may be to stop training but involve the child in another reward incentive program, such as cleaning up toys. In 4 weeks, reintroduce toilet training.

3. Have scheduled sitting times

These should occur even if the child does not feel the urge to go (which he or she may not). To take advantage of the gastrocolic reflex, it is best to have the child sit about 30 minutes after meals. The sitting time should last about 10 minutes (shorter times can be considered in younger children).

4. Use a reward incentive plan

This should be used for sitting and usually consists of stickers or treats that can be turned in for a prize. The rewards should match the task. For instance, a child should not receive a new toy for sitting on the toilet. However, the child may earn the same toy through involvement in a regular program: the child may earn 1 sticker or treat for each scheduled sitting time; after the child earns X number of stickers, he or she receives a new toy, special activity, or event. Token rewards (stickers) for involvement should be provided directly after the child participates. High-cost rewards (big presents or trips) should be avoided.

5. Change rewards or prizes frequently

Given that toilet training can be a long process, it is essential to change rewards or prizes frequently to maintain motivation. Rewards should be adjusted depending on the child’s age. Visual systems, such as sticker or check charts, are helpful in keeping track of successes and prizes. Rewards should be given for effort in the process (ie, sitting on the toilet) not just for reaching a specific toilet training goal.

6. Consider other motivators

Keeping a special toy in the bathroom may be useful. While sitting on the toilet, the child can practice exercises that involve the Valsalva maneuver (blowing on a balloon or pinwheel). This can encourage stool evacuation.

7. Stay positive

Staying positive can be challenging even under the best of circumstances. You can take comfort in the fact that most children achieve daytime continence by 30 to 36 months of age. Be aware that certain medical conditions (eg, constipation) can complicate the toilet training process. It is important to seek help as soon as a concern arises, even if it is earlier than a regular scheduled visit. In children with constipation, relapses during the treatment process are common and can occur during times of stress.

Richard Lander M.D.,F.A.A.P.

Ear infections are very common in children’s; these infections are often called middle ear diseases and include:

• Acute otitis media: Children with acute otitis
  media have signs and symptoms of infection, such as ear pain and fever. Acute
  otitis media is very common in children; more than 5million cases occur each
  year in the United States.

• Otitis media with effusion: Children otitis
  media with effusion have extra fluid in the middle ear, so symptoms may include
  feeling like the ear is plugged or difficulty hearing. Children often get otits
  media with effusion after having a cold or viral infection. About 90% of
  children have otits media with effusion before starting school, most often
  between ages 6 months and 4 years.

Even though these infections are common, they can have serious consequences. Children who have repeated ear infections sometimes need surgery, which has risks. Children who have middle ear effusions are as risk for hearing loss, which can delay speech development.

Many parents are interested in ways to prevent ear infections in their children. A recent review in the Archives evaluated a large number of research studies. The major finding was that having any family member who smoked raised the risk of ear infections for their children. The review study calculated that every year 292 950 frequent ear infections, meaning having 3 or more ear infections in the past year, are directly caused by a child being exposed to tobacco smoke.

______________________________________________________________________________________

Some parents try to cut down smoking and some try smoking outside. These can be good steps on the path to quitting smoking, which is the best way to prevent ear
infections in your child. Many parents who smoke are inspired to quit so that they can improve their children’s health as well as their own.

MY CHILD HAS ALREADY HAS SOME EAR INFECTIONS; IS IT TOO LATE FOR ME TO QUIT SMOKING?

Even if your child has had some ear infections, quitting smoking will still help to prevent future ear infections and their potential risks.

_______________________________________________________________________________________

Many people are not able to quit smoking on the first try. There are many resources to help with the difficulties in quitting smoking; some of these include http://www.smokefree.gov/ and http://www.becomeanex.org/.

_______________________________________________________________________________________

For more information: American Academy of Pediatrics http://www.aap.org/healthtopics/earinfections.cfm

Inform Yourself: To find this and other Advice for Patients articles, go to the Advice for parents link on the Archives of Pediatrics & Adolescent Medicine Web site at http://www.archpediatrics.com.

Source: American Academy of Pediatrics

Let’s talk about Pertussis also known as Whooping Cough.

Who gets Pertussis?

Many people do-all ages and from all walks of life including:  young children, teenagers, adults in middle age and senior citizens.

What is pertussis?

Pertussis is an infectious disease caused by bacteria.  Sometimes referred to as the hundred day cough, it can be quite debilitating.  The cough is persistent and recurs day in and day out.  Once you hear this cough, you will never forget it.  The cough is repetitive, easily lasting 30 seconds or more and has a whoop sound at the end of it.  This whoop is what gives rise to its popular name whooping cough.  If you are curious, you can hear the whoop sound on the internet. 

Is Pertussis contagious?

Yes it is.  I have seen Pertussis several times in my practice this year.  I have seen it spread from mother to child, among siblings and even from teacher to students.

Treatment of Pertussis

There are different phases of Pertussis.  When the diagnosis is made during the first phase of the illness, it can be treated with antibiotics.  This may shorten the duration of the disease.  Otherwise physicians can offer supportive care and medication to help the patient sleep.

Prevention

Pertussis is preventable by a vaccine.  This vaccine, DPT (Diptheria, Pertussis and Tetanus) is typically given during childhood.  The vaccine is given as a series of three injections in the first year of life, a booster during the second year of life and another booster before the start of elementary school.  An additional booster is given at 11 year of age.  Because this last vaccine is relatively new, many children older than 11 year of age will be receiving it.  Additionally the Tetanus booster which has always been recommended to be given every ten years has been change to include the Pertussis vaccine.  Therefore, adults of almost all ages are urged to obtain it even if you received a Tetanus booster a year ago.  Many hospitals across the country are giving the vaccine to new mothers right after delivery and in some progressive hospitals the vaccine is being offered to new dads and to grandparents. With this approach the State of California, which had seen deaths from Pertussis in the last few years, has dramatically decreased their rate of Pertussis.  These dramatic results have persuaded many pediatricians to offer this vaccine to parents and grandparents of their patients.

Why talk about Pertussis now?

     Pertussis is on the rise in the United States.  From January through March in 2012 there were seven times the number of cases seen in Washington, D.C. than in the same time frame the year before in 2011.  So why you might wonder:  why this rise in Pertussis now?  Several years ago we experienced a number of parents refusing to have their children vaccinated against childhood diseases including Pertussis.  These refusals were based on fears of the vaccines and components of the vaccines such as aluminum or mercury.  Thankfully, these fears have been proven to have been unfounded. Unfortunately, once people stopped vaccinating their children, herd immunity was lost.  Herd immunity is gained when a majority of people in a geographic area receive a vaccine.  These vaccines then protect even the few who were not vaccinated.  As the number of vaccine refusers climbed, we lost herd immunity.  Hopefully today with increased knowledge through education, the number of vaccine refusers is beginning to decline and more people are again protected against infectious diseases such as Pertussis.  Scientists are working tirelessly looking for clues to currently unanswerable medical questions.  Every day they race the clock in an effort to look for a treatment for currently untreatable medical conditions and diseases.  Pertussis is not one of them.  Pertussis is preventable with a vaccine   It is criminal that there are people living in the United States in 2012 suffering from a disease they did not have to have.  Please don’t be one of them.  Ensure that you and your loved ones do not get Pertussis.  Get vaccinated!  Get vaccinated now!

Richard Lander

The days are beginning to grow longer and we can feel the end of winter fast approaching. We long to shed our winter coats, hats and gloves. The idea of spring is comforting and ennervating. Here at the Essex-Morris Pediatrics, warm weather makes us think- summer and summer makes us think-

FORMS!

If your child will be participating in any spring/summer activity, get your forms in to us as soon as possible. Please be sure that your child has had a physical exam and labwork performed after last spring/summer so that we can expedite the completion of your forms. All forms are completed in the order in which we receive them. Meanwhile, smile and enjoy!

SPRING IS ALMOST HERE

Written by Richard Lander MD FAAP

As a pediatrician I am sometimes asked, “When should my child start seeing my adult physician?”

My answer is not until their early 20′s.

Pediatricians are trained to treat babies, toddlers, children, adolescents and young adults. Pediatric training encompasses four years of medical school and a minimum of three years of residency in pediatrics.

Throughout our career, we are constantly attending conferences and reading journals or medical literature to ensure that we are always current and apprised of cutting-edge pediatric medicine.

Your pediatrician helps you deal with your baby’s acid reflux, guides you on how and when to introduce solid foods and thrills with you when your baby speaks his/her first words.

At your well visits, your pediatrician asks questions to determine if your infant/child is developing properly and if not, you will be directed to the proper place for evaluation. You are counseled on proper nutrition and exercise for your child and encouraged to expose your child to a range of cultural and educational experiences.

When your child is wheezing or crouping in the middle of the night, it’s your pediatrician you call on for help. When your child has a 104 degree fever on a Sunday morning your pediatrician tells you to come over to the office to be examined. It is your pediatrician who is there with you as your child becomes an adolescent and together we deal with adolescent issues such as acne or uncomfortable menstrual cycles.

With some of you, we traverse the difficult terrain of painful adolescent anxieties or drug and alcohol problems. It is your pediatrician you consult for concussions and sprains from sports. When your child begins thinking of college and a future career, your pediatrician is as excited as you are, because your pediatrician has been there with you as your child has grown into a young adult.

It is your pediatrician who takes your child’s phone calls from college to help with a health issue or an emotional problem. When it becomes time to move on to an internist, it is a happy but also sad parting of the ways.

And then of course the fun begins again as your pediatrician begins to care for your child’s child: a very special pleasure for your pediatrician — the second generation.

As you can see, there is no other healthcare professional who knows your child the way your pediatrician knows your child.

The walk-in clinic has no frame of reference; they have not treated your child throughout the years. Many internists and family practitioners do not treat large numbers of children and are therefore not equipped to handle the range of issues involved in treating children and adolescents.

Many non-pediatrician physicians do not have the vaccines needed to keep your child properly immunized. Most do not see patients after hours; they send patients to the emergency department.

With your pediatrician you have grown accustomed to being seen right away and in the office where you are comfortable. Your pediatrician has been trained to deal with your child’s health issues from birth until they are young adults. We know your family and we know your child’s history. We know you and we are always there for you.

Written by Richard Lander MD

Why should I bring my child to the pediatrician when he/she is sick? It is so much easier to run over to the local retail-based clinic (RBC) at the pharmacy where there is lots of parking, I don’t need an appointment and while I’m there I can pick up tissues, milk and medicine. Right?

Here are six reasons why going to a RBC may not be in the best interest of your child’s health.

1 – Most RBCs are not Staffed with Board-Certified Pediatricians

Your child will probably be diagnosed and treated by a nurse practitioner or physician’s assistant. Imagine that you are concerned about your child and therefore a little distracted and forget to mention that your child has allergy to an antibiotic. This could have a bad outcome. If you are at your pediatrician’s office, that allergy information is kept in your child’s chart.

2 – You Can’t Call The RBC in the Middle of the Night

Now imagine that your child’s condition worsens at midnight. The RBC you visited earlier is now closed and so you can’t ask for further advice. On the other hand, had you called your doctor earlier and then required additional help later in the evening, you would be able to receive consistent medical advice because your doctor or a covering doctor is on call 24/7. The American Academy of Pediatrics has always stressed the importance of continuity of care. It’s what I want for my children; it’s what I want for your children.

3 – RBCs Have Age Restrictions

Many RBCs have an age below which they will not treat a patient. What will you do if two of your children are sick — take one to your doctor and the other to the RBC?

4 – RBCs Can’t Handle Complex Medical Issues?

Worse still, the RBC cannot deal with complex medical issues. If you visit the RBC with a problem that is beyond the scope of their training and knowledge, they will tell you to see your doctor or send you to the emergency room.

5 – RBC Provides No Continuity of Care

Let’s think about vaccines. Your child needs a flu vaccine as well as one or two other immunizations. Many of the RBCs are only prepared to give the flu vaccine. If you are receiving the flu vaccine at the RBC and all other immunizations at your pediatrician’s office, no one will complete your [child’s] vaccination record. Again this speaks to a lack of continuity of care. This fragmented record keeping could cause trouble in the future.

6 – An RBC’s Not Your Medical Home

Your pediatrician’s office should be your child’s medical home. Your pediatrician has cared for your child’s physical and mental well being since birth. At your pediatrician’s office you received vision and hearing screening, and we assessed your child’s fine and gross motor skills. Your pediatrician has checked for autism and ADHD, asked you questions relating to your child’s growth and development and if there was a concern, and addressed it. When a behavioral problem at school or home arose, it is your pediatrician who thought about the possible medical conditions that could cause these behavioral changes. Will your RBC help you with your child who is crying out for attention secondary to a new baby at home or to parental discord? Will your RBC talk to your teenager about depression, alcohol, drugs or tobacco use? If your child has a GI problem, a broken arm, a heart condition or a blood disorder, will your RBC recognize the problem and send you to an appropriate specialist? Would you want the recommendation of a competent specialist to come from your RBC or from your doctor who knows you and your family’s medical history?

Your pediatrician provides your children with vaccines after they have looked at the medical research. He/she does not give vaccines because a corporate entity (RBC) made the decision to do so. Your pediatrician went to medical school for four years and then did a pediatric residency for an additional three years and continues to both attend medical conferences and read the medical literature to make ensure that he/she remains current and ahead of the curve. One of the national RBC chains has the tag line “You’re sick, we’re quick.” Is that the kind of medicine your loved ones deserve?