Gary A. Emmett
Gary A. Emmett, M.D., Pediatrics Professor- Thomas Jefferson Univ. & Director, Hospital Pediatrics- TJU Hospital
Prescribing drugs solely to boost thinking and memory functions in children and adolescents who do not have neurologic disorders should never occur. Practitioners should not let parents or patients bully them into prescribing stimulants and other psychoactive substances to improve academic performance, according to the American Academy of Neurology (AAN) in a paper earlier this month.
“Doctors caring for children and teens have a professional obligation to always protect the best interests of the child, to protect vulnerable populations, and prevent the misuse of medication,” said author William Graf, MD, of Yale University in New Haven, Conn. in a press release. “The practice of prescribing these drugs, called neuroenhancements, for healthy students is not justifiable.”
Gary A. Emmett, M.D., Pediatrics Professor- Thomas Jefferson Univ. & Director, Hospital Pediatrics- TJU Hospital
When should an infant get solid food? For over 20 years, we have been saying after four months. Last year, the American Academy of Pediatrics changed that to a recommendation that an infant should get nothing but breast milk for the first six months of life, or infant formula if breast milk is not available.
A new survey of over 1,300 mothers showed that 40 percent fed the baby solid food before four months and almost 10 percent before four weeks, according to researchers from the Centers for Disease Control and Prevention in the April issue of Pediatrics, released online today.
Why are pediatricians worried about early feeding? Babies that are fed too early are more likely to be obese when they get older - that is proven. Doctors also worry that children fed early develop abnormal bowel flora (the germs in our gut that help us digest our food and prevent diseases such as celiac and inflammatory bowel diseases) and are more likely to get severe self-allergy diseases such as eczema and asthma. The evidence for these is not as strong as for obesity, but is a very strong suspicion.
Azithromycin, a commonly prescribed antibiotic, could potentially cause a fatal irregular heart rhythm in some patients, the Food and Drug Administration warned last week.
This warning will now be reflected on the drug’s label which is known as Zithromax, Zmax or as a "Z-Pack." The drug manufacturers producing the product (primarily Pfizer) also agreed with the FDA’s recommendation.
It was first reported about a year ago that azithromycin, and some other antibiotics, but not penicillins such as amoxicillin, increased the rate of cardiovascular death, and actually increased the rate of death from all causes after this antibiotic was used in adults. The rate was not insignificant being 47 additional deaths per million doses used (about 1 in every 25,000 doses), according to an article in the New England Journal of Medicine in May 2012. The FDA warning also includes children, although children were not included in the original report.
Adolescents have sex, whether parents want to face it or not. Teens need to know that one serious consequence of having sex is acquiring sexually transmitted diseases. To make matters worse, some STDs aren’t easily treatable anymore.
Condoms help prevent STDs, but they are often not used (especially for oral sex) and therefore, these diseases can be easily spread. Fifty years ago, plain penicillin and sulfa would treat syphilis, gonorrhea and chlamydia, but mutating germs and the overuse of antibiotics have increasing diminished the effectiveness of these drugs.
The CDC recently announced the increasing presence of multidrug resistant gonorrhea in the United States. There are over 300,000 cases per year in the US. Some of the highest reported rates of infection are among sexually active teenagers in the US. Up to 12 percent of sexually active high school males have gonorrhea or chlamydia, and about 16 percent of sexually active females have either STD.
Although the American Academy of Pediatrics did not issue any radical new ideas on preventing middle ear infections in children in a new report released yesterday, they did emphasize three issues, two of which were lifestyle issues.
- Breastfed babies simply get less middle ear infections and so breastfeeding, especially with a strong family history of middle ear infection, is greatly encouraged for a minimum of 6 months.
- Any smoking in the house greatly adds to the incidence of middle ear infections in children in that house.
- In children over 24 months who mainly have pain in their ears and little else in symptoms, treating middle ear infections with pain medication such as acetaminophen and ibuprofen by mouth and lidocaine ear drops in the ear should be tried for 3 days before adding antibiotics. Such treatment has less side effects and works over 75 percent of the time.
Also, see my blog of 2 weeks ago on the different types of ear infection and their treatment. Similar to the recommendation in the report, my blog emphasizes not all ear infections require antibiotics and can get better on their own.
Gary A. Emmett, M.D., Pediatrics Professor- Thomas Jefferson Univ. & Director, Hospital Pediatrics- TJU Hospital
What exactly is an ear infection? Doctors are not always as precise in their language as they should be and this has lead to many different kinds of diseases being called “ear infections.”
An outer ear canal infection occurs when water that is too alkaline gets into the outer ear and causes irritation and/or bacterial infection. This often happens after swimming in a pool that did not have its acidity controlled well. This condition can be painful and may have a peculiar sweet odor and is also called a “swimmer’s ear.”
Outer ear infections are treated with antibiotic drops. They can be prevented with a combination of alcohol and vinegar drops in the ear after getting out of a pool. This is not the middle ear infection that pediatricians are usually looking for in their patients.
Parents expect almost miraculous cures when they take their sick child to the doctor. Why? The introduction of penicillin, the first really effective antibiotic 70 years ago, was a wonder drug that worked overnight.
Soldiers would be dying of pneumonia or a horribly infected leg. They would recover after 3 injections of penicillin and after 7 days they would be all better. Unfortunately, penicillin doesn't work well for pneumonias or wound infections anymore because of antibiotic overuse and growing bacterial antibiotic resistance.
It's important to understand that antibiotics aren't always the answer, and are intended to fight bacterial infections. Taking them for viral infections, such as a cold, most sore throats, acute bronchitis and many sinus or ear infections will not cure the infection, or keep others from getting sick, and may cause unnecessary and harmful side effects.
Kids are getting less time to simply play these days in school. More and more schools have cut recess, gym classes, and organized sports.
Here's why:
1) In times of less available money, ”extra-curricular” activities such as art, music (do not get me started on less music) and physical activity are cut first
Gary A. Emmett, M.D., Pediatrics Professor- Thomas Jefferson Univ. & Director, Hospital Pediatrics- TJU Hospital
by Gary A. Emmett, M.D.
Multiple studies show that when children witness or - even worse - are personally assaulted, there are long-term consequences for their health and behavior. Children caught up in the web of violence have much higher chances of:
- Poor school achievement
- Early sexual activity
- Depression
- Participating in violence themselves.
A recent New England Journal of Medicine study looked at the experiences of more than 5,000 fifth graders in three different urban areas - Birmingham, Ala., Houston and Los Angeles. It focused on health disparities between African-American, Latino and white children. One finding was the chances that a child witnessed the threat of injury, or saw actual injury caused by a gun, were four times higher in African-American children than in white children. When the researchers took socio-economic status into account, African-American kids were still twice as likely as white or Latino kids to have witnessed violence even when they lived in similar neighborhoods and had similar incomes.
by Gary Emmett, M.D.
I saw a 3 ½ year old boy in my office this week, and his father was very concerned about stuttering. The patient would get caught up in consonants with “hard” sounds such as ‘g’ or ‘k,’ and have trouble getting the words out. Doctors call anything that interferes with getting the sounds of speech out “dysfluency”. Otherwise he was a bright, friendly and articulate young man who was fun to have an office visit with. Should his father worry?
Only a little bit of worry is reasonable. About 5 percent of children have dysfluency (stuttering) between 2 and 5 years old. In over 90 percent of cases it just goes away by the fifth birthday with many getting better in just a few weeks. Dysfluency is more than just stuttering (repetition of the initial consonant), it also may include prolonging words, repeating words, having almost explosive speech, or injecting “nonce” words such as “well” or “uh” that do not add any meaning to your sentence.
