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Ask The Doctor:
Keeping your children well this winter...

"My mother-in-law told me that the only way to keep my three month old from getting sick this winter is to keep her home until March. Is that really necessary? I am a stay at home mom, but I still have to take care things like grocery shopping that require me to leave home. Any advice?"

The answer is simple.  Avoid sick people, practice good hygiene, get the necessary vaccines and practice good nutrition.  Now, performing all these, consistently, is not as easy as it sounds.

Regardless of what your mother told you, it's okay to take your baby out in the cold as long as they are dressed appropriately.  Exposure to cold or damp weather doesn't increase a child's likelihood of catching a cold.  They may not enjoy the trip however if it's bitterly cold, windy, and you're going to be running about all day.   Kids 12 months of age and older require the same amount of clothing as an adult, those younger need 1 more layer.  A warm cap is a must for those less than 12 months of age.  Young babies don't regulate their temperature well and can lose heat quickly.

Avoiding sick people by staying at home all winter is of course not practical, but there are some things to keep in mind when you and your infant venture outside.  Don't take your infant shopping with you when you know the store is going to be crowded.  If you need to be at that big sale, get a baby sitter.  You may save even more money later in your child's medical expenses, and of course the value of your child's well-being in general is priceless.  Don't take your infant to the hospital or physician's office unless they are the patient.  Can you think of area where more sick would be?  At least most pediatrician's offices do their best to separate the sick children from those who are in the office for a checkup.  When you and your precious bundle are out, try to stay at least 4-6 feet away from someone who is sick, but remember people are contagious even before they develop symptoms.  So just keeping away from these folks is still no guarantee.

You are lucky to be a stay at home mom and not have to worry about your infant getting exposed to other children at daycare.  For those who are not so fortunate, here are some suggestions to minimize their risks.  Check out the center's “sick kid” policy.  Talk to other parents and find out how strictly it's enforced.  Observe how the daycare is set up, see if the employees are cleaning their hands before they touch an infant or prepare their bottle, notice if there are obvious ill infants or toddlers present.  Remember, you can't have it both ways.  Don't expect all the infants with a cough and runny nose to be banned from daycare, yet it's okay for you to leave your little wet-nosed bundle who “just barely started coughing”.  So if you need to use a daycare, have a back-up plan.  A relative, trusted friend or some of your own saved sick days.   Be aware that an infant's immune system is weakest between 3-12 months of age.  They catch illnesses easier and it takes them longer to recover.  So minor ailments such as nasal congestion, runny nose, and an occasional cough may last days after the acute infection.  It is just not realistic to expect all these infants to stay out of daycare until all of those symptoms have resolved.

Practicing good hygiene in regard to illness comes down to washing hands frequently and properly.  When using soap, wet your hands, apply the soap, lather and scrub for at least 20 seconds (be sure to wash between your fingers and the tops of your hands) and rinse for 10 seconds before drying them on a clean towel, preferably a disposable paper towel.  If you are using a Germ-X style hand sanitizer, apply the product (at least 60% alcohol) to the palm of your hand and then rub it to all surfaces of your hands, again be sure to get it on top and between your fingers.  Then allow to dry.  Now I am not just speaking about cleaning mom's hands, but also dad's, all caregivers, siblings, and even the infant's own hands need to be frequently cleaned.  This should occur especially when anyone returns from daycare, school, outings, and before feedings. 

Necessary vaccines to keep your 3 month old infant healthy certainly include those recommended by the America Academy of Pediatrics at the 2 month old checkup.  Caretakers and family surrounding your child should also have their immunizations up to date.  In particular, they should have had a recent flu vaccine and pertussis (“whooping cough”) booster.  Both of these illness can be fatal in infants.  Current pertussis rates continue to climb, in fact, we haven't seen these numbers since the 1950's.  Most of the serious illnesses come from infants that are incompletely immune and then exposed to their infected family members, the one with the cough that won't go away, whose waning immunity has allowed them to contract the condition.

Good nutrition to prevent infections, without question, includes breastfeeding your infant.  Breastfeeding provides immunoglobulins that significantly boost the child's immunity.  Not only that, but the skin to skin bonding between the mother and child naturally bolster the immune system of the baby and the mother as well.  Breastfeeding moms should be supplementing the feedings with 400IU of vitamin D.  This vitamin strengthens our immune system, is in short supply in breast milk, and during the winter months there is little chance for the infant's skin to be exposed to sunlight where it can be produced naturally.

(Update Courtesy of the United States Center for Disease Control and Prevention - CDC - )

Measles is a highly contagious disease caused by a virus. Measles starts with a fever. Soon after, it causes a cough, runny nose, and red eyes. Then a rash of tiny, red spots breaks out. It starts at the head and spreads to the rest of the body. Measles can be serious for young children. It can lead to pneumonia, encephalitis (swelling of the brain), and death.

How Measles Spreads
Measles spreads through the air when an infected person coughs or sneezes. It is so contagious that if one person has it, 90% of the people around him or her will also become infected if they are not protected.

People in the United States still get measles, but it's not very common. That's because most people in this country are protected against measles through vaccination. However, since measles is still common in parts of Europe, Asia, the Pacific, and Africa, measles is brought into the United States by people who get infected while they are abroad.

Your child's doctor may offer the MMRV vaccine, a combination vaccine that protects against measles, mumps, rubella, and varicella (chickenpox).

Protect Your Child – at Home and when Traveling – with Measles Vaccine
You can protect your child against measles with a combination vaccine that provides protection against three diseases: measles, mumps, and rubella (MMR). The MMR vaccine is proven to be very safe and effective.

Protect Yourself Against Measles
Some adults need measles vaccine too. For more information, see Measles Vaccination: Who Needs It?

Paying for Measles Vaccine
Most health insurance plans cover the cost of vaccines. But you may want to check with your health insurance provider before going to the doctor. Learn how to pay for vaccines.

If you don't have insurance or if your insurance does not cover vaccines for your child, the Vaccines for Children Program may be able to help. This program helps families of eligible children who might not otherwise have access to vaccines. To find out if your child is eligible, visit the VFC website or ask your child's doctor. You can also contact your state VFC coordinator.

Measles is a respiratory disease caused by a virus. The disease of measles and the virus that causes it share the same name. The disease is also called rubeola. Measles virus normally grows in the cells that line the back of the throat and lungs.

Measles causes fever, runny nose, cough and a rash all over the body. Visit the Signs and Symptoms page for more information, and the Photos of Measles page to see pictures of people with the measles rash.

About one out of 10 children with measles also gets an ear infection, and up to one out of 20 gets pneumonia. About one out of 1,000 gets encephalitis, and one or two out of 1,000 die. Other rash-causing diseases often confused with measles include roseola (roseola infantum) and rubella (German measles).
While measles is almost gone from the United States, it still kills an estimated 164,000 people each year around the world. Measles can also make a pregnant woman have a miscarriage or give birth prematurely. For more information, visit the Complications page.

Measles spreads through the air by breathing, coughing or sneezing. It is so contagious that any child who is exposed to it and is not immune will probably get the disease. See the Transmission page for more information.

Measles Incidence
Measles is very rare in countries and regions of the world that are able to keep vaccination coverage high. In North and South America, Finland, and some other areas, endemic measles transmission is considered to have been interrupted through vaccination. There are still sporadic cases of measles in the United States because visitors from other countries or US citizens traveling abroad can become infected before or during travel and spread the infection to unvaccinated or unprotected persons.
Worldwide, there are estimated to be 20 million cases and 164,000 deaths each year. More than half of the deaths occur in India. For more information on measles in the United States and worldwide, visit the Global Elimination page.

Measles History
One of the earliest written descriptions of measles as a disease was provided by an Arab physician in the 9th century who described differences between measles and smallpox in his medical notes.
A Scottish physician, Francis Home, demonstrated in 1757 that measles was caused by an infectious agent present in the blood of patients. In 1954 the virus that causes measles was isolated in Boston, Massachusetts, by John F. Enders and Thomas C. Peebles. Before measles vaccine, nearly all children got measles by the time they were 15 years of age. Each year in the United States about 450-500 people died because of measles, 48,000 were hospitalized, 7,000 had seizures, and about 1,000 suffered permanent brain damage or deafness. Today there are only about 60 cases a year reported in the United States, and most of these originate outside the country.

More information:

Measles Vaccination:

Learn more about MMRV vaccine.

Learn more about MMR vaccine.

May 11, 2017
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Ask The Doctor:
Pets & Allergies...

"My otherwise healthy kid has been sniffling since we brought a hamster into our previously pet-free home. He is already attached to his furry friend, but I'm afraid he might be allergic. What do we do?"

Furry and feathered pets are among the most common and potent triggers of allergy symptoms.  Most animals will secret oils and shed skin particles (dander) that contain proteins (the allergens) that cause the allergic response.  The allergies can cause any combination of sneezing, coughing, wheezing, nasal congestion, watery eyes, hives and itching of the nose, mouth or throat.  These allergens are tiny and easily become airborne.  This is why some people can merely walk into a room and develop allergy symptoms even when the offending animal is not in the house.  It can take months for these tiny traces of animal dander to decompose to the point where they no longer trigger someone's allergies.  If a pet allergy is suspected, your child's doctor can help by getting a good medical history and testing the child's blood.  Sometimes a referral to an allergist may even be necessary to rule out pet allergies.  The best treatment for this condition is to find a new home for the pet.  For families with a member having these allergies, the idea of sending it to another home is often hard to accept.  Many prefer to keep the animal and then battle with the problem.  If you decide to keep the pet then there are several recommendations to help minimize the child's exposure to the allergy triggers.  If possible, keep the pet outside.  If the animal is going to be in the house, then keep it out of the child's bedroom.   Vacuum frequently and consider the use of a HEPA filter air purifier to trap as much airborne particles as possible.  Antihistamines are medications which can block the allergic reaction.  These are the mainstay of medical treatment.  These can be either taken by mouth or sprayed into the nose.  Nasal steroid sprays and oral montelukast (Singulair) are used as well, often in combination with the antihistamines.  So if your child is prone to allergies, think long and hard before bringing a pet into your home.


May 11, 2017
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Ask The Doctor:
Teenage Sleepiness & Fatigue...

"I know teenagers need several hours of sleep, but my kid is tired all the time. He falls asleep in class, on the bus, watching TV. He's even fallen asleep at the dinner table. He goes to bed early, too. What's going on?"

Pediatricians frequently encounter teenagers with symptoms of sleepiness and fatigue.  Up to 40% of healthy teens experience regular daytime sleepiness (a tendency to fall asleep).  Fatigue, the perception of low energy following normal activity, is reported by up to 30% of well teens.

Not surprisingly, the usual cause of excessive sleepiness during the day is not getting enough quantity or quality of sleep at night.

Most teens need 9 to 10 hours of sleep per night to maintain normal daytime alertness.

Puberty changes a teen's internal clock, delaying the time he or she starts to feel sleepy and awaken.

The adolescent described in this week's question is said to be going to bed early, implying that they are getting plenty of sleep.  But before working this teen up for chronic fatigue, there are several issues that need to be addressed first.

Even though they are going to bed early, are they actually going to sleep?  Are they actually on the internet or on the phone and texting when you think they are sleeping?  Are they having trouble falling asleep despite their best efforts to relax in a dark, quiet bedroom?  Do they wake frequently during the night?  Do they snore loudly with pauses in their breathing at night consistent with obstructive sleep apnea?  Are they taking any prescribed medications that can interfere with quality sleep?

So assuming he is indeed going to bed and falling asleep in a reasonable amount of time (less than 30 minutes) then one of the following causes may explain his daytime sleepiness.  Obstructive sleep apnea is very common.  This causes sometimes several hundred times during the night, interrupting sleep.  Narcolepsy is a disorder that can make people feel severely tired during the day, often falling asleep suddenly, anytime, anyplace.  Depression can cause disrupted sleep patterns, resulting in poor quality sleep and daytime fatigue. 

Medical conditions like epilepsy and asthma can cause teens to sleep poor as well.

Because of these serious potential issues, persistent daytime fatigue, despite the appearance of getting plenty of sleep, needs to be evaluated by your child's physician.


May 11, 2017
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Ask The Doctor:
Understanding Night Terrors...

Our five year old is having night terrors and my wife is really concerned that something is wrong. While of course her sleep disruptions are concerning, won't she just grow out of?

Night errors typically occur in children between 3-12 years of age and about 5-10% of children experience night terrors at some time, boys and girls are equally effected.  Usually they resolve before adolescence.
Night terrors occur early in the night, about 60-90 minutes after the child falls asleep.  A child experiencing a night terror usually will sit up in bed and scream, appearing awake but is confused and unresponsive to stimulus.  The child my thrash around the bed and even get up and run about the room or house.  Most episodes last 1-2 minutes but can last as long as 30 minutes before the child quickly relaxes and returns to normal sleep.  Nightmares are scary dreams that occur during sleep, usually in the latter half of the night.  Typically the child will remember the nightmare, whereas they will have no memory of the night terror.

The cause of night terrors is not clear, but it seems to be associated more with stress, illness, insufficient sleep or an erratic sleep schedule.

When your child is having a night terror it is best not to try to wake them.  Attempts won't work and may only prolong the event.  Just make sure the child doesn't hurt themselves with their thrashing.  In the instances they run about, protect them from the windows.
Sometimes you may be able to temporarily prevent these events by waking the child about an hour after they go to sleep, or 15 minutes before the night terror usually begins.  By doing this 2-3 nights in a row, the episodes will often stop for a while.  In general you can help prevent them by establishing a good bedtime routine that is simple and relaxing and make sure they are getting enough rest.

Understanding night terrors can reduce your worry and help you both to get a good night's sleep.  However if the night terrors occur repeatedly, talk to your doctor to be sure there is not something else going on or if a referral to a sleep specialist is needed.