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OFFICE NOTES

Our adolescent patients often come to their appointments alone. Please inform the front desk that they will be coming alone so that we can obtain the proper consent for treatment. We would also appreciate it if you would provide a method of payment for the visit. We accept checks or credit cards.

VOLT

If you’re receiving this, you also should have received a separate email about the event we are co-hosting at VOLT FITNESS℠, a gym with a fitness circuit for children and adults. The event will be on February 28, 2009. VOLT FITNESS℠ will open its doors for us to tour the facility and sample the fitness circuit and we (Drs. Yankus and Ungerleider) will be there from 12:30 - 5:00 pm. To receive a copy of the flyer, if you have not, please call the office and we will email it to you.

ECZEMA

Eczema, which is also called atopic dermatitis, is excessively dry skin, which usually occurs in patches. It can occur at any age. The skin is usually red, scaly, inflamed and itchy. Sometimes it begins in infancy and can last throughout life, and other times it can occur during other times of life and be limited to a few years. It tends to be worse in the winter, but can occur during any season. Sometimes there is an underlying allergy, such as a milk or other food allergy. It also often runs in families.

The treatment is avoidance of allergens, if there are any, or other exacerbating things such as harsh soaps or detergents. Moisturizers are very important and may be all that is needed. We recommend any of the white, unscented lotions or an ointment such as Aquaphor. If that does not help, call us; we may recommend a hydrocortisone cream, either over-the-counter or by prescription.

ADHD

(ATTENTION DEFICIT HYPERACTIVITY DISORDER)

ADHD or Attention Deficit Hyperactivity Disorder is a clinical diagnosis requiring evaluation of behavior across multiple settings (family, school, and social groups). The usual patient is male (but it can also occur in females) and the diagnosis is usually made in elementary school with symptoms appearing by age 7.

The five criteria for ADHD are:

1. Some inattention or hyperactivity-impulsive symptoms present before age 7.

2. Some impairment from symptoms present in 2 or more settings (homework, school, social).

3. Clear evidence of clinically significant impairment in academic, social, or occupational functioning.

4. Symptoms do not occur exclusively during other mental illness.

5. Inattention, impulsivity, or hyperactivity.

The assessment includes a history and physical examination. A screening neurological exam is done with personal and classroom evaluation. Inventories of behavior are done by teachers, parents and if old enough, the patient himself or herself.

Patients should also be evaluated for learning disabilities and speech and language disorders.

Once a therapeutic alliance is established between student, parent and school, treatment can begin. The decision to treat with behavioral therapy will almost always include medication. The goals should be realistic, attainable, and measurable. A 504 or federal entitlement can be invoked in school to offer the student some assistance.

Medication should be monitored quarterly for student success and for evaluation of growth. Parents should be aware this is not a “quick fix” and may mean life long treatment, including during college and career. Some 37% of all children with ADHD have an additional condition such as oppositional defiant behavior, mood disorders, anxiety, or depression.

Much research and study is being done on ADHD and its variants with a promising future for these young people.

CHOLESTEROL

Cardiovascular disease is the leading cause of death and disease in this country. There are both genetic risk factors and environmental risk factors. As pediatricians we can help to change the environmental risk factors by educating and counseling. The risk factors for cardiovascular disease are high blood pressure, diabetes, cigarette smoking, obesity and high cholesterol. The total cholesterol being elevated, as well as the LDL portion being elevated and the HDL (“good cholesterol”) being low are also strong risk factors. For a child, it is recommended that the total cholesterol be less than 200, but preferably less than 170, the LDL be less than 130, but preferably less than 110, and the HDL be higher than 35, but preferably higher than 50.

For high risk patients, such as those with a family history of high cholesterol, obesity or cardiovascular disease, it is recommended that screening be done somewhere between the ages of 2 and 10. If the family history is unknown, the same recommendation should be followed. The most accurate testing is a fasting lipid profile. In our office we generally screen all children at 3-4 years of age with a fingerstick total cholesterol right in the office and follow up with a lipid profile if the total cholesterol in our office is elevated. The high risk patients should have their screening repeated in 3-5 years.

To reduce the risk of cardiovascular disease, children should eat a healthy diet, which should include low fat or non fat dairy products. They should also eat more fruits, vegetables, fish and whole grains. The intake of fruit juice, sugar-sweetened beverages and foods and salt should also be lowered. The new recommendations also include limiting the intake of trans fatty acids to 1% of the total calories. Physical activity is also extremely important. It helps to control obesity, raises the HDL, lowers the triglycerides and may also lower the LDL.

If we find that your child’s cholesterol is very high or going up, we may recommend a consult with a pediatric cardiologist. Most children do not require medication for high cholesterol, but this is occasionally necessary, a determination which would be made by the specialist.