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OFFICE NOTES

New website: We have just launched a new website: www.yankusandungerleider.com.

We will have basic office information for new and current patients, as well as past newsletters and current ones. We’d love for you to check it out and give us any feedback.

Flumist: We still have a supply of the nasal flu vaccine for this year’s use. If you would like your child to have a Flumist, please call our office to see if he/she is eligible.

Flu vaccine: If anyone is interested in having their child receive the flu vaccine next year, either the injection or the intranasal (see INFLUENZA VACCINE article later in newsletter), please let us know as soon as possible. We need to order the vaccines by January 31. You do not need to call if you wish your child to have the same vaccine they had this year. Those children are already on our list. If you prebook a vaccine for your child and decide not to get the vaccine once we’ve ordered, you will be charged for the vaccine. We regret needing to do this, however, we ordered many vaccines for patients this year, who are now declining the vaccine and we cannot return the vaccines and have already paid for them.

Physicals: Spring and summer are not far off and with them come the need for camp, school and sports physicals. To avoid the last minute summer time crunch, please think about making those appointments soon.

WINTER TIPS

Safety: All seasons have specific safety concerns. The winter is no different. Many children are skiing and snowboarding. The most serious injury that can occur with these sports is a head injury. We therefore strongly recommend helmet use for your children (and yourselves) when participating in these activities.

Hydration: Wintertime is typically a dry weather time with humidity in the 40% or lower ranges. Drinking water replaces the water we lose through sweating, breathing, and being exposed to outside air. In the winter it is just as important for your children to stay hydrated for their health. It will improve eczema, scalp and skin conditions, improve nasal dryness, and help prevent illness. We recommend that children and adolescents drink water as often as possible during this season.

INFLUENZA VACCINE

There are currently two types of influenza (flu) vaccine that we use in Pediatrics. One is an injectable vaccine (shot), called Fluzone. This is recommended for children who are 6 months to 24 months old, children with underlying medical illnesses (i.e., asthma, diabetes, cardiac disease) and children in households where there is an immunocompromised person.

The other is Flumist, which is given intranasally. This vaccine, which has been shown to be even more effective than the shot, can be given to children 5 years old and up, who do not have any of the risk factors listed above. We would encourage people, for next year, to consider ordering the Flumist for their child, if they want them to have a flu vaccine and they are eligible. This vaccine has not been in short supply this year, as compared with the Fluzone, which we can only order in a limited amount.

TDAP (Tetanus/diphtheria/pertussis) vaccine)

This is a new combination vaccine which will be replacing the Td (Tetanus/diphtheria) booster for most patients 11 years old and up. It now contains a component which will protect patients against pertussis (whooping cough). We will be giving this vaccine to those patients 11 and up who have not had a tetanus vaccine within 5 years.

Pertussis causes coughing spells which can make it difficult to eat, drink and sometimes causes respiratory difficulty. It also can cause pneumonia, seizures and, rarely, death. These more serious complications occur mostly in infants or the elderly.

The reason for the newly licensed vaccine is that there were more than 25,000 cases of whooping cough in the U.S. in 2004. More than 8000 of these were in adolescents, age 11-18. It has been found that the immunity received from the initial series of pertussis vaccines in early childhood does not last through adolescence. This will help protect those who are at increased risk from pertussis as well as the longer lasting coughs in the adolescents. We would also encourage parents to ask their physician about getting the vaccine at their office for themselves.

FAMILY COUNSELING

This winter we invited the Family Counseling Service of Ridgewood, which is part of Children’s Aid and Family Services to station a family counselor in our office one day a week. This will enable us to provide patients and their families with the ability to ask direct questions of a therapist, discuss family issues and strategies, and to be available in a familiar place for those patients who would prefer their sessions here. Family Counseling will handle issues of behavior, attention, negotiation, and social skills as well as personal parent or child issues. Their services are available by calling Family Counseling at 201-445-7015 and requesting evaluation in our office.

EATING DISORDERS

Over the past few years, we have been seeing an increasing number of patients with eating disorders. Most of these children are adolescent females, but we have also seen younger patients and males. This trend has been attributed to a number of factors, such as the prevalence of obesity in children and adolescents, which has led to an unhealthy emphasis on dieting and weight loss in children, especially in the suburbs, and the media, which often portrays women as extremely thin.

There are three subclasses of eating disorders, Anorexia Nervosa, Bulimia, and for those patients who do not meet all the diagnostic criteria, a classification called Eating Disorder Not Otherwise Specified. Anorexia nervosa involves an intense fear of becoming fat or gaining weight, refusal to maintain body weight at or above a normal weight for age and height, disturbed body image and amenorrhea (absence of at least 3 menstrual cycles). Bulimia has recurrent episodes of binge eating (eating substantially larger amounts of food in a shorter period of time than would be eaten by most people in similar circumstances and lack of control of the eating during the binge), recurrent inappropriate behavior to compensate for the binge (self-induced vomiting, laxative use, diuretics, excessive exercising) and disturbed body image. The binges occur at least twice weekly for at least 3 months.

The complications of these eating disorders can be electrolyte abnormalities, cardiovascular (low blood pressure and arrhythmias, intestinal malfunction, liver abnormalities, kidney problems, anemia, amenorrhea, seizures and death, among other problems. Some of these adolescents need to be hospitalized for these complications and for treatment. If they have minimal nutritional, medical and psychosocial issues, they may be treated as an outpatient.

As always in pediatrics, prevention is key. There are usually self esteem issues, so attention to improving that is extremely important. If a child/adolescent wants to lose weight, it’s important to do so only when he/she is truly overweight and then be done with supervision, appropriately. As part of our ongoing health care here, we monitor weight, height, body mass index and ask screening questions about eating patterns and body image. If there are concerns which are addressed early, we may be able to prevent the complications and psychological consequences.

If we suspect that there may be an incipient eating disorder or there are obvious eating or weight issues, we will first address them here with a complete history and physical exam. We then often do a laboratory evaluation and possibly a cardiogram (EKG). We do some initial counseling here, with probable referral to a nutritionist, mental health professional (psychologist, psychiatrist, therapist) and follow up visits here.

If you have any concerns that your child has an eating disorder, even if it’s early, you should discuss it with us and have your child evaluated by us.

44 Godwin Avenue, Midland Park, NJ 07432 (201) 444-8389

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