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OFFICE NOTES

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 now.

Flu vaccine: We still have some Fluzone (the injectable Influenza vaccine) here in the office. Some patients, for whom we had ordered one, have received it elsewhere. If you would like your child to receive the vaccine this year, it’s not too late; please call the office to make an appointment.

Ear piercing: We periodically get inquiries from patients asking if we do ear piercing here. Dr. Ungerleider does this procedure for patients in our office. There are several advantages to having it done in our office. Most importantly, we use sterile prepackaged earrings and sterile procedures to protect against infection. The second is that we use hypoallergenic surgical steel earrings plated directly with pure 24-karat gold, with no intermediate layer of nickel (which some people are allergic to). We also use a local anesthetic cream, called EMLA, which is applied 1 hour prior to the procedure. We only recommend piercing the actual ear lobe, not the upper cartilaginous part of the ear. The cartilage doesn’t heal in the same way and is prone to infections.

Website: Be sure to visit our website www.yankusandungerleider.com for periodic health updates and for access to our current and past newsletters.

ROTAVIRUS VACCINE (ROTATEQ)

Rotavirus is a virus that causes severe diarrhea, often with vomiting and fever, mostly in babies and young children. It occurs mainly between November and May. It can cause severe dehydration, leading to hospitalization and occasionally death. It is very contagious and although good handwashing and hygiene may help to prevent spread of the disease, it has not been effective enough.

There is now a vaccine which can protect children from rotavirus disease. It is given orally, not by injection. The vaccine is only given to babies and the series should be completed by 32 weeks of age. It is a series of 3 doses, at 2 months, 4 months and 6 months of age.

There are no significant side effects to the vaccine. Children are slightly (1-3%) more likely to have mild, temporary diarrhea or vomiting within 7 days of getting the rotavirus vaccine than children who have not gotten the vaccine.

If your child or a household member is immunocompromised, your child may not be able to receive this vaccine as it is a live vaccine.

SAFETY

Ski helmets: Although skiing and snowboarding are certainly fun family sports, they also have their safety risks. The most serious is head trauma, leading to concussion, intracranial bleeding and possible death. We urge all children and adults to wear a helmet for skiing and snowboarding. It should be a helmet made specifically for these sports, not a bicycle helmet.

Shopping carts: Injuries to children riding in shopping carts are not uncommon. The American Academy of Pediatrics reports that about 23,000 children are treated in emergency rooms for injuries from shopping carts each year. They usually occur from falls from the cart or the cart toppling over. The injuries are often to the head and neck and can be serious, sometimes fatal.

Some safety tips to avoid those injuries are:

Use the safety harness/belt in the shopping cart.
Do not leave your child unattended in the cart.
Never let your child stand up in the cart.
Do not place an infant carrier on top of the cart.
Do not let your child ride in the basket.
Never allow your child to ride on the outside of the cart.
Don’t allow an older child to climb on the cart or push the cart; they tip over very easily.

EPISTAXIS

Epistaxis (nosebleed) occurs quite commonly in children. The cause can be trauma to the nose, structural abnormalities, bleeding abnormalities or tumors. However, the most common cause is digital manipulation (picking or scratching the nose).

Nosebleeds often start in the middle of the night, without trauma or nose-picking. Dry heat is sometimes responsible—it dries out the usually warm, moist nasal passages, which makes them more susceptible to bleeding. The inflammation of allergy or upper respiratory infection with nasal congestion causes increased epistaxis also, because these conditions increase the blood flow to the nasal passages.

The bleeding is most commonly from the anterior (front) part of the nose. Many blood vessels meet in the anterior septum, and this area is more exposed than other areas to finger manipulation and dry air.

The best way to stop a nosebleed at home is to pinch the front of the nose and hold the nostrils shut for at least five minutes. It is best not to check to see if the bleeding has stopped during this time; if you do, the clots will break up and the bleeding will begin again. After five to ten minutes, slowly release the pressure and check to see if the bleeding has stopped. If it has, the child should be kept quiet and instructed not to touch his/her nose for a period of time. If it hasn’t, try the technique again. If you are still unable to stop the bleeding , call our office. We may need to refer you to an ENT (ear, nose and throat) specialist, who may need to cauterize the bleeding site.

ACNE

Most teenagers develop acne at some point. Pimples are caused by oil ducts in the skin getting plugged up and then rupturing, causing redness and swelling. The main factors causing acne are hormones, heredity and plugged oil ducts.

At the beginning of puberty, hormones called androgens increase (in males and females). The androgens trigger oil ducts on the face, upper chest and back to produce oil, which can lead to acne in some people. Some families have more of a tendency to develop acne than others.

In many teens, the cells that line the oil ducts in the skin get larger, produce more oil and then plug the ducts. This traps the oil and then blackheads or whiteheads form. The plugged ducts allow bacteria in the skin to multiply and produce chemicals that cause redness and swelling.

Acne is not caused by food or dirt.

There are also some things that can make acne worse:

· Some makeup, which can block oil ducts and aggravate acne

· Popping or pinching pimples, which causes the oil into the skin around the pimple, causing redness and swelling

· Scrubbing too much, which irritates the skin

· Some medications

· Hormonal changes during menstrual periods

· Stress

These should be avoided if possible.

Although there is no cure for acne, there are some treatments, in addition to paying attention to the above factors. Benzoyl peroxide, which is a topical lotion or gel, helps to kill skin bacteria, unplug the oil ducts and heal pimples. You can get this medication over-the-counter. It should be started at 2.5 % and gradually increased if not working to 5% one-two times per day. It should be applied to the entire area where acne occurs, not just the individual pimples. It can be drying, so decrease the frequency if that occurs.

If that does not work, you should call us. We may be able to prescribe a topical tretinoin (Retin-A) cream, a topical antibiotic or an oral antibiotic. We also may recommend that your child see a dermatologist. They may use the above medications or prescribe Accutane or a birth control pill (for the girls). Both of these medications have potential side effects, which can be discussed with the prescribing dermatologist.

We hope the above information is helpful. If anyone has any topics they would like covered in future PedNotes, let us know.