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VACCINE UPDATE

Varivax (Chickenpox vaccine): There is now a new recommendation from the American Academy of Pediatrics (AAP) that we give a booster for the varicella (chickenpox) vaccine. The new schedule is as follows:

· first dose at 12-15 months of age (done at a routine physical)

· 2^nd dose at age 4-6 (done at a routine physical) or

· 2^nd dose at ages 6-21, for those who have had their first dose already

· 2 doses spaced 1-2 months apart for ages 13 and up (if they have not already had chickenpox or a first dose of vaccine).

If your child has had one dose of the vaccine and has already had their kindergarten physical or is between 6-21, please call the office to set up an appointment for a booster.

Hepatitis A: Hepatitis A is a liver disease caused by the Hepatitis A virus. The virus is spread by close personal contact and sometimes by eating food or drinking water contaminated by the virus. It is found in the stool of people with the disease. It can cause “flu-like” symptoms, jaundice (yellow skin or eyes), abdominal pain and diarrhea. It is quite contagious within households.

There is a vaccine for this virus, which has been given to people traveling to certain countries. There are now some new recommendations for this vaccine from the AAP. It is now recommended that the following people should routinely receive the vaccine:

· Children age 12 months- 23 months

· People 1 year and up traveling to high risk countries (see the CDC website at www.cdc.gov/travel)

· Children and adolescents in states where it is law to have the vaccine because of higher incidence of disease or if there is an outbreak of Hepatitis A.

The vaccine is given as 2 doses at least 6 months apart.

GASTROESOPHAGEAL REFLUX DISEASE (GERD)

Gastroesophageal reflux is defined as the contents of the stomach moving back up into the esophagus. This occurs naturally in many babies and can cause symptoms and pain or discomfort in older children and adolescents. Normally the sphincter (valve) between the esophagus and stomach closes after food passes through it. However, in some children, the valve is floppy, allowing the stomach contents to come back up into the esophagus.

In older children and adolescents the symptoms are regurgitation, chest pain, chronic cough, recurrent pneumonia and asthma. They may also have bleeding from tears and inflammation in the esophagus.

The diagnosis of GERD is mostly made by history and physical examination, but sometimes we may need to do some testing.

Once the diagnosis is made, we can begin treatment. For older children and adolescents the treatment involves dietary changes, such as eliminating caffeine, chocolate and spicy foods, and weight loss in an obese individual. Smoking and alcohol also exacerbate reflux and therefore should be avoided. If these measures don’t help, medication may be necessary. The first type of medication used is an acid blocker, such as Zantac or Pepcid, which block the effect of the acid on the esophagus. If that does not work, the next step is a class of medications called proton pump inhibitors. These medications, such as Prevacid, Prilosec and Nexium, lower the acid secretion in the stomach.

In babies, there is usually spitting up without any pain or other symptoms, which does not need treatment and is outgrown by 8-10 months of age. Occasionally the acid in the stomach does cause discomfort or pain in babies, although this is more common in the older child who has reflux.

Other symptoms of reflux in babies include upper airway congestion, irritability, weight loss, failure to thrive, and in more severe cases, recurrent pneumonia, asthma, and rarely apnea (not breathing). When these types of symptoms are present, the reflux may need to be treated.

For the infants, positioning after feeding, thickening formula feeds and observation may be enough. If there are more severe symptoms, we may prescribe medication, such as the acid blockers mentioned above.

If you think your child has symptoms of GERD or you have questions, call our office.

HEAD TRAUMA

Injuries to the head are very common in children and adolescents, especially at this time of year. Children are playing outside on playgrounds, riding bicycles, skateboarding, rollerblading and playing outdoor sports, often without the protective headgear/helmets that they should be wearing.

Most of the time the injuries are minor, resulting in bleeding or bruising of the scalp. The blood supply to the head is large, so even small cuts do bleed a lot. There is not much soft tissue (fat and muscle) to absorb the blood as there is in other parts of the body. Therefore large bumps also tend to form. To treat a small cut, clean it with soap and water and apply direct pressure to stop the bleeding. Apply ice if there is swelling. If the bleeding does not stop or you feel a depression beneath a bump, your child should be seen. Call our office and we will either see you here or we may direct you to the emergency room or a plastic surgeon.

Some head injuries result in concussion, of which there are different grades, ranging from no loss of consciousness, but with subsequent confusion or amnesia, to trauma with loss of consciousness.

Some other signs of concussion or more severe brain injury are:

· Vomiting more than 2-3 times

· Seizure

· Excessive sleepiness

· Blurred vision

· Blood or watery fluid from nose or ears

· Unequal pupils

If your child has evidence of a concussion or any of these signs, including being dazed, he or she should be examined. This will usually occur in the emergency room, especially if there has been loss of consciousness, in case there is the need for a CT scan. If you are unsure of whether your child should be seen in the emergency room or our office, please call and we will advise you.

To help prevent serious head injuries, follow a few simple rules:

· Always use car safety belts and car seats while driving.

· Never leave your infant alone on a raised surface.

· Don’t use baby walkers.

· Use gates at the tops and bottoms of stairs.

· Always use bike helmets for your child and yourselves; also use for any wheeled recreational item (roller blades, skateboards, scooters).

· Use ski helmets for skiing and snowboarding.

· Use car seats for young children on airplanes.

· Use helmets for certain sports; and encourage leagues to require helmets if they don’t already.

PREVENTING SPORTS INJURIES

In addition to head injuries, there are other injuries that occur in sports and are often preventable. Remind your child that it’s important not to begin strenuous exercise without a good warm-up. Even though children do not need as long as adults to get into shape, it does take time. They should stretch with supervision before each work out. Hopefully this will minimize the risks of strains and sprains.

As mentioned in the previous article, helmets can prevent many head injuries in sports. Some sports and leagues do require helmets (baseball, hockey, boys lacrosse); others do not (and perhaps should, i.e. girls lacrosse). Other protective gear includes polycarbonate sports goggles, chest protectors for catchers in baseball and softball (and may be considered for batting), shin guards for soccer, mouth guards, athletic supporters/groin cups for males and proper padding and protectors for football.

Your child should also know and follow the rules of the sport(s) they are playing, use athletic equipment properly, avoid playing when very tired or in pain, drink adequate water/fluids to prevent dehydration and use sunscreen for outdoor sports. Your child should also have a yearly/preseason physical.