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Dr. Ted’s Blog

The CDC Addresses Vaccination Concerns

In my continuing effort to take information from other sources and make it available to the patients of Meyer Pediatrics, I have copied here the handout from the Centers for Disease Control (CDC) that addresses some of the common concerns that parents might have about the safety of routine childhood vaccines.

The bottom line is that NONE of the required vaccines for children contain mercury (thimerisol), there has NEVER been a single case of mercury toxicity from vaccines EVER reported, and autism is a genetic entity and there are NO well-done studies that suggest a link between vaccines and autism. Read on!

Common Concerns About Childhood Vaccinations

Infants and children get a lot of shots (vaccinations) to prevent against many different diseases. For this reason, parents or caregivers sometimes ask their healthcare provider to space apart, separate, or even not give some vaccines. Parents are worried that their child cannot handle so many shots at the same time. This is one of many concerns that parents may have about vaccinations. This handout provides the facts about vaccines, to help parents make an informed decision about what’s best for their child.

CONCERN
“Infants get too many shots at once.”
FACTS
Infants do get a lot of shots. But, they could handle even more. Each day, infants come into contact with millions of particles such as pollen, viruses, and bacteria that trigger their immune system. The “immune system triggers” in vaccines are only a very small amount compared to those found in your child’s environment. Vaccines will not “overload” your child’s immune system.
Some parents think that it would be better if their child didn’t get so many shots at the same time. But delaying or not giving some vaccinations is not a good idea. Doing this could leave your child unprotected against certain diseases. Many childhood diseases are dangerous for young children. So it’s best to make sure your baby is protected by not delaying their shots. Also, it is much easier to stay up to date with your child’s shots, than to try and catch up.

CONCERN
“Vaccines have too many side effects. Besides, vaccine-prevented illnesses are not that serious.”
FACTS
Before vaccines were available, many infants and children died from diseases we can now prevent. The diseases that vaccines prevent can be very dangerous. In fact, diseases such as whooping cough, polio, measles, etc. could be much worse and more dangerous for your child than the side effects of any vaccine. Even chickenpox can be serious. One in 200,000 unvaccinated infants who get chickenpox die…one in 100,000 older kids die…and one in 500 are hospitalized.

CONCERN
“Everyone else gets vaccines, so my child doesn’t need them.”
FACTS
It is true that your child has less of a chance of getting sick when your child plays with other children who have had their shots. But this doesn’t mean that your child can’t get sick. To be protected, your child must also get their shots. A good example of this is measles and whooping cough. Even though most children get vaccinated, children who do not get their shots have gotten measles or whopping cough, and some have even died.
Also, children who don’t get vaccines may get the disease, and then spread it to people who can’t be vaccinated or who could become seriously ill (e.g., newborn infants, pregnant women, older people).

CONCERN
“Vaccines are not tested enough.”
FACTS
Just like medicines, vaccines are tested in many children for a long time before they are given to all children. Most vaccines are tested in even more children and for an even longer time than most medicines that you give your child.

CONCERN
“Vaccines contain things which are not safe for my child.”
FACTS
Shots that are given to infants and children are safe. Shots for infants and children do not have mercury in them anymore. Some shots do have aluminum in them, but the amount of aluminum is much smaller than the amount of aluminum found in baby formula.

CONCERN
“Vaccines cause autism.”
FACTS
Some people think that the thimerosal or mercury in vaccines causes autism. But this has never been proven. Actually, common pediatric vaccines, with the exception of some flu shots, no longer contain thimerosal or mercury and haven’t since 2001. Those flu shots that do have thimerosal or mercury contain a very small amount, AND it’s a different form than the mercury that is linked with brain and nerve injury. One is methyl mercury, and the other is ethyl mercury. Different entities entirely.

PROTECT YOUR CHILD AND VACCINATE
Infants and children receive more vaccines than ever before. But, these vaccines are safe and protect our children from serious diseases. If you have concerns about any vaccine your child is to get, talk to Dr Ted or Nurse Kay. Remember, vaccines save lives! Do not let the extremists who mistakenly believe that ALL vaccines are bad trick you into making a dangerous mistake. Your child’s health literally is at stake.

Autism

This was taken from Medscape.com. It is an interview with Dr. Eric Hollander and reviews a lot of good information on what is currently known about autism. This interview IS nearly 5 years old, but if anything, the support for autism as a genetic entity and the complete lack of corroboration with vaccines as a cause is even stronger today. Read this and see for yourself, particularly if you are at all worried about vaccines and their refuted link to autism.

Autism: An Interview With Eric Hollander MD

From Medscape Psychiatry & Mental Health

Autism: An Expert Interview With Eric Hollander, MD
Published: 02/03/2005

Editor’s Note:
Requests for services related to autism are increasing, although there is controversy over whether this reflects a change in the prevalence of the disorder, better detection, or differences in definition. What is autism? How common is it? What are the best ways to treat it? What makes doing research on autism spectrum disorders exciting today? Elizabeth Saenger, PhD, Medscape Psychiatry & Mental Health, interviewed Eric Hollander, MD, Professor of Psychiatry, Director, Seaver and New York Autism Center of Excellence, Mount Sinai School of Medicine, New York, NY.

Medscape: How would you define autism?
Dr. Hollander: Autism is a developmental disorder that presents before the age of 3 years. It’s characterized by impairment in 3 core symptom domains, which include social deficits, communication difficulties, narrow restricted interests, and repetitive behaviors. In addition to that, there are also other associated symptoms that frequently coexist.

Medscape: What are those other symptoms?
Dr. Hollander: The other associated symptom domains can include factors like inattention and motor hyperactivity, impulsivity and aggression, mood instability, EEG abnormalities or seizure related type problems, and cognitive difficulties.

Medscape: How common is this disorder?
Dr. Hollander: It used to be felt to be very rare. The best estimates now are that about 0.6% of the population, a little under 1%, may meet criteria for the broader autism phenotype, or an autism spectrum disorder. Within that spectrum, we include autism, the Asperger syndrome, and pervasive developmental disorder or PDD NOS — not otherwise specified.

Medscape: How do you treat autism spectrum disorders?
Dr. Hollander: There are a few different treatment approaches. There are behavioral approaches, educational approaches, and medication approaches. We intervene early. There is some evidence that the earlier you pick up the problem and start to intervene with behavioral, educational, speech, and occupational therapy, the better the long-term developmental trajectory. So the idea now is to start to identify people at around 18 months if possible and often to slide people into the educational programs that incorporate a lot of speech and occupational therapy plus behavioral interventions like acute ABA-type treatments — applied behavioral analysis. And there is evidence that these kinds of treatments actually can be associated with better long-term outcome.
We are also finding that medicines may be very helpful in 2 types of approaches. One is a targeted treatment approach where we select a group of individuals who score high on a particular target symptom like lots of narrow, restricted interests, repetitive behaviors, self-stimulation-type behaviors, and compulsive behaviors, and then treat them, for example, with very low doses of selective serotonin reuptake inhibitors like fluoxetine or fluoxetine in a liquid form. We found that will significantly improve the core symptom domain and improve overall functioning.
Other treatment approaches involve stratifying the population, picking up the subgroup with a lot of disruptive behavior, such as impulsivity and aggression, tantruming, self-injury, and treating them with low doses of atypical antipsychotics, such as risperidone. We also have treatment approaches using the mood-stabilizing, anticonvulsant-type treatments like valproic acid or levetiracetam, finding that these medicines may be helpful in a lot of mood instability, a lot of the disruptive behavior like impulsive, aggressive, or self-injurious behavior. Sometimes for language-related functioning, and particularly those with some abnormal EEGs, patients have a very robust response to the anticonvulsant-type medicines.

Medscape: How successful are these interventions in helping people become what society generally considers normal?
Dr. Hollander: It probably depends on the baseline characteristics of the patient, because it turns out that autism is pretty heterogeneous. You have some individuals who have very high IQs and others with severe mental retardation. You have some individuals who have really outstanding verbal skills and others who have no language at all. You have some people who have accompanying seizure problems or other neurologic problems and others who don’t.
So as a group it’s fairly heterogeneous. And we know that individuals who start off with a higher IQ and better speech and language tend to have a better long-term outcome than those who have more severe impairment at baseline.
But we know that with early interventions, both behavioral and pharmacologic, people really can do a lot better, that the symptoms that cause distress can be significantly reduced and their overall functional ability can improve.

Medscape: One thing I’m curious about is the paradox in a way of the idiot savant. Can you say something about that?
Dr. Hollander: What’s interesting is that within individuals you see a scattering of peaks and valleys in terms of skill levels. And you have some individuals who have extraordinary skills in certain areas. That may go along with their narrow restricted interests, where they become preoccupied with certain things and have all the information in the world about those things. And sometimes people can calculate statistics or memorize calendars or have some extraordinary mathematical or physics ability, or even certain visual/spatial abilities, musical abilities, verbal abilities. We think that there may be some positive attributes that may be coheritable with certain autism symptom domains. The idea is that either there are a number of these core and associated symptom domains that need to come together in order to produce the full syndrome of autism, and that in the first-degree family members, and even in the general population, we frequently see impairment in individual symptom domains. These individuals don’t have the full disorder, however, unless they get multiple domains coming together.
Some of the symptom domains that may make up the disorder may also be associated with high abilities in mathematical or visual, spatial, or musical abilities, and it’s not unusual to see in first-degree family members a high skill, for example, in physics, math, or computers. It’s also not unusual to see many family members who have extraordinary technical skills, for example. Within individuals with autism, you do see individuals with these islands of extraordinary skills also coupled with areas of the real impairment. And it seems that many people with autism have difficulties with the higher order of processing of information. They may be excellent in terms of their raw sensory information or their ability to manipulate the sensory information, but they have more difficulty with the higher-order processing or generating abstract conclusions from the sensory information.

Medscape: In other words, they would be like Raymond in the film, Rain Man, where Raymond could do difficult calculations involving the cards in the casino and win a lot of money or figure out how many toothpicks have been spilled on the floor, but in terms of figuring out how much change he would get if he went to the grocery store to buy something, he was a failure.
Dr. Hollander: Yes. I would say that often there are deficits in certain pragmatic skills — how to interact with the world in a social fashion to get what you want from the world — but that they can still have extraordinary specific skills.

Medscape: Can you tell us a little bit about your own research with people who have autism?
Dr. Hollander: Yes. Here at Mount Sinai we have the Seaver and New York Autism Center of Excellence. We have been doing business for over 10 years, initially funded by the Seaver Foundation and now funded by one of the NIH STAART Autism Centers of Excellence. We’re very focused on breaking autism down into the different core and associated symptom domains and finding relevant genes, understanding the specific brain circuits, and developing specific treatments for each of the different symptom domains. For example, we found genetic factors that may be associated with speech and language problems or with the repetitive behaviors. We’ve elucidated the metabolic activity in the limbic system associated with autism. And we have developed new treatments for the symptom domains, particularly the repetitive behaviors and the impulse of aggression. We’ve also been interested in peptides like oxytocin and the role that those peptides play in social attachment and in the repetitive behaviors; we have done some interesting alterations of that system and found that we can improve social attachment and repetitive behaviors by influencing the oxytocin system. We’ve also done research on immune abnormalities that may run in families, and related these immune abnormalities to different symptoms.
We’ve been very interested in the serotonin system and the role that that serotonin system plays in the repetitive behaviors and then how treatments for the serotonin system can improve the repetitive behaviors.

Medscape: This seems to tie into what you once said about the need to look at specific behaviors and then target them with specific medications to improve somebody’s behavior and life.
Dr. Hollander: That’s right. We think that there are basically 2 approaches with medicines. One is the targeted treatment approach where you stratify the population and you select individuals who have specific types of target behaviors that cause distress and interfere with functioning. You start with low doses of medicines and improve those target symptoms to see how that affects the overall level of functioning. Another approach that we’re starting to get into is early interventions to see if we can change the developmental trajectory. In a similar way, early behavioral interventions might improve IQ or social reciprocity with speech and language.

Medscape: The idea of improving IQ seems interesting. Can you tell us more about that?
Dr. Hollander: There are some behavioral treatment studies that suggest that early intervention with behavioral approaches will show an improvement in IQ if you follow individuals over long periods of time.
Some of those studies may be flawed because there wasn’t good randomization and people started with different IQ levels at baseline. But generally people feel that early intervention can be associated with improvement. And when you get clinical improvement, you also see a significant improvement in IQ.
Some of the studies that the STAART Centers are looking at now are early interventions with serotonin reuptake inhibitors that follow people over time to see if we can get improvement in IQ. Recently we’ve also been interested in looking at certain medicines that work on the glutamate system that are used specifically for cognition and memory to see if we can improve cognitive functioning and IQ with those approaches.

Medscape: You mentioned that early intervention in autism means catching a child or a baby at 18 months. How often is autism or potential autism recognized that early?
Dr. Hollander: It used to be very rare, so people usually identified it at around age 3 years when children weren’t talking. Nowadays, there’s a push to identify earlier problems like eye gaze, not interacting appropriately with other children or peers, or not having good joint attention with parents. And sometimes there can be subtle motor abnormalities that may be present at an earlier stage. There are suggested screening instruments, such as the Checklist For Autism in Toddlers — CHAT. Cure Autism Now has suggested that pediatricians routinely administer this to all children at 18 months to try to pick up people with developmental delays who should be screened more carefully afterwards.

Medscape: Are pediatricians doing that?
Dr. Hollander: I think that for the most part now, teachers, pediatricians, parents, and other mental health practitioners are doing a better job screening. There is a bit of a controversy in the field as to whether autism is dramatically increasing because the rates were much, much lower before. That may be because everybody is doing a better job screening, so we’re picking up the milder cases at an earlier stage. The alternative explanation is that there are environmental factors that interact with strong genetic factors to be associated with an increased risk for people presenting with these problems.

Medscape: I know that’s quite controversial. Can you tell us about some of the possible environmental factors that people are thinking about?
Dr. Hollander: Well, there’s been a lot of debate about vaccines — initially the MMR vaccine, and then more recently the thimerosal preservative, which is an ethylmercury preservative that was in certain multidose vials of vaccines. I think that the best available data really suggest that these vaccines are not associated specifically with an increased rate for autism. That’s because there have been good studies, for example, in England, shortly after the MMR vaccine was first introduced, that showed that there was no dramatic increase after it was introduced. The Institute of Medicine recently issued a report suggesting that it doesn’t look like vaccine played a role. It’s clear that mercury can be neurotoxic. It’s not good for the developing brain, but probably is not specifically related to the development of autism.
People have hypothesized all kinds of other factors. We were interested in the role that pitocin played in inducing labor and delivery as a possible risk factor. And other people have postulated that things like folate, for example, that are frequently given, may be an epigenetic factor that can turn on and turn off certain genes that could be associated with a greater risk.

Medscape: How did you get interested in this research area?
Dr. Hollander: Originally we were interested in other disorders that present with repetitive behaviors. And then we had the opportunity to partner with the Seaver Foundation and develop a new autism center.
Studying autism is really a great opportunity because if you understand what goes wrong in autism, you understand a little bit more about what makes people human. It gives you insight into issues around being able to see things from other people’s perspectives and issues around social attachment, which are really what make us human.

Medscape: What do you see on the horizon in terms of research on autism and social movements about autism?
Dr. Hollander: The media have been talking about autism a lot lately. There are a number of debates, for example, about funding issues in terms of ABA. It’s very costly. Does the existing database justify ABA, for example?
There are some controversies about whether autism — for example, Asperger’s disorder — is just an alternative way of being and whether trying to get rid of target symptoms is not allowing certain patients with Asperger’s to fully express who they are.My sense is that it’s pretty clear that if we can reduce certain target symptoms, then people will have significantly less distress and their overall level of functioning will improve.

Medscape: Is there anything else you would like to add?
Dr. Hollander: I think this is an exciting time now. The NIH has taken a big interest in autism and launched STAART Autism Centers of Excellence. Many centers are working together to develop important new treatments. And integrated treatments are probably one wave of the future, integrating the behavioral and the medication treatments together.I think there is a lot of exciting work coming out on genetic findings. Mt. Sinai and the Seaver Center have started to actually see specific genes that may play a role in autism. It’s clear that there’s no single gene, but it may be that if you have a few of these different genes interacting together, you’re going to be at high risk for getting the syndrome. Each of the genes may code for the different symptom domains that need to come together to get the full syndrome.
I think that there are new imaging techniques, like functional MRIs, that are allowing us to design specific kinds of experiments to understand the specific neurocircuits that are involved in the different symptom domains of the disorder.
And finally, there’s a good partnership between academic medical centers and autism advocacy groups. I think the autism advocacy groups have been extremely effective — Cure Autism Now (CAN), National Alliance for Autism Research (NAAR), and Autism Society of America (ASA), for example — in terms of increasing awareness and increasing support for this important area.

Medscape: Thank you very much for sharing your thoughts with Medscape.
Supported by an independent educational grant from Janssen

Myths About Aspartame (NutraSweet)

I stole this from Snopes.com but I think the information is very good.

http://www.snopes.com/medical/toxins/aspartame.asp

Aspartame

Claim:   The artificial sweetener aspartame has been proved responsible for an epidemic of cancer, brain tumors, and multiple sclerosis.

Status:   False.

Origins:

To date, FDA has not determined any consistent pattern of symptoms that can be attributed to the use of aspartame, nor is the agency aware of any recent studies that clearly show safety problems.

Aspartame and the Internet   (The Lancet):
Our research revealed over 6000 web sites that mention aspartame, with many hundreds alleging aspartame to be the cause of multiple sclerosis, lupus erythematosis, Gulf War Syndrome, chronic fatigue syndrome, brain tumours, and diabetes mellitus, among many others. Virtually all of the information offered is anecdotal, from anonymous sources and is scientifically implausible.

ACSH Debunks Internet Health Hoax   (American Council on Science and Health):
Health scare artists have found a whole new medium for terrorizing the public — the Internet. Individuals in search of accurate health information may literally become caught in the Web, where health hoaxes and urban medical myths run rampant. The health scare messages are always the same — whatever it is, it will make you sick.

Beware The E-Mail Hoax: The Evils Of Nutrasweet (Aspartame)   (Dr. Dean Edell):
A highly inaccurate “chain letter” is being circulated via e-mail warning the reader of the health dangers of aspartame (Nutrasweet) diet drinks. There is so much scientific untruth in it, it’s scary. Be careful, because others know how to manipulate you by this. Just because something is beyond your comprehension doesn’t mean it is scientific.

FDA Statement on Aspartame   (FDA):
Analysis of the National Cancer Institute’s public data base on cancer incidence in the United States — the SEER Program — does not support an association between the use of aspartame and increased incidence of brain tumors.

Study Reaffirms Safety of Aspartame   (MIT News):
Even daily large doses of the high-intensity sweetener aspartame, also known as NutraSweet, had no adverse effect on study subjects’ health and well-being, a visiting scientist at MIT reported in the American Journal of Clinical Nutrition last week. “We conclude that aspartame is safe for the general population,” said Paul A. Spiers, visiting scientist in the Clinical Research Center (CRC).

A Web of Deceit   (TIME magazine):
A widely disseminated e-mail by a “Nancy Markle” links aspartame to Alzheimer’s, birth defects, brain cancer, diabetes, Gulf War syndrome, lupus, multiple sclerosis and seizures. Right away, the long list warrants skepticism. Just as no single chemical cures everything, none causes everything.

Last updated:   25 September 2007
The URL for this page is http://www.snopes.com/medical/toxins/aspartame.asp

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This material may not be reproduced without permission.
snopes and the snopes.com logo are registered service marks of snopes.com.

A Snapshot of ADHD in the US

Denise Mann
Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine.

CINCINNATI, Sept.4 — Almost 9% of U.S. children ages 8 to 15 meet standard diagnostic criteria for attention-deficit/hyperactivity disorder (ADHD), but less than half of them receive treatment.
Only 47.9% of the 2.4 million who met Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria for ADHD had reportedly had their conditions diagnosed by a health care professional or been treated with medication, according to a report in the September issue of the Archives of Pediatrics & Adolescent Medicine.
A research team led by Tanya E. Froehlich, M.D., of Cincinnati Children’s Hospital Medical Center did a cross-sectional phone survey of the parents or caregivers of 3,082 eight- to 15-year old children who were participants in the National Health and Nutrition Examination Survey.
Survey respondents provided information about each child’s ADHD symptoms between 2001 and 2004. They also provided sociodemographic information and information about whether the child had ever been diagnosed with ADHD or taken medicine to treat the disorder.
The researchers found that 8.7% (95% CI; 7.3%-10.1%) met the DSM-IV criteria for ADHD in the year before the survey took place. An additional 3.3% of children did not meet the criteria, but had a parent-reported prior diagnosis and had been treated with an ADHD medication at some point during the previous year. The latter group, however, was not included in the main analysis.
More boys than girls met the diagnostic criteria for ADHD, 11.8% versus 5.4%, respectively (P<0.001), but girls were less likely than boys to have had the disorder recognized.
There were also discrepancies in ADHD rates by race and ethnicity. Non-Hispanic white children were more likely to meet criteria for ADHD than were Mexican-American children or children of other races/ethnicities, the study showed. These findings held in both bivariate and multivariate analyses.
The study authors could not explain why Mexican-American children had lower rates of ADHD, but they speculate that this may be related to “differences in the prevalence of causal risk factors, genetic susceptibility, and/or rates of reporting ADHD symptoms across cultures.”
Of the children who met the diagnostic criteria for ADHD, 38.8% had received medication to treat inattention, hyperactivity, or overactivity in the prior year and 32.0% had been taking medication for most of that year.
Regular medication use was more likely to be reported for older children than younger ones, the study showed.
Money also mattered in the new study. Children in the poorest quintile were more likely than those in the wealthiest quintile to have been diagnosed with ADHD (adjusted odds ratio [AOR] for PIR, first quintile vs fifth quintile, 2.3; 95% CI, 1.4-3.9)).
“Reasons for the increased likelihood of ADHD in poorer children may include the elevated prevalence of ADHD risk factors (i.e., premature birth and in utero or childhood exposures to toxic substances) in this group,” the study authors write.
“In addition, given the high heritability of ADHD and its negative impact on social, academic and career outcomes, it is plausible that families with ADHD may cluster within the lower socioeconomic strata.”
Although poor children were more likely to have ADHD, the poorest children were three to five times less likely to consistently receive medication when compared with their counterparts in other income groups, the researchers noted.
This finding “warrants further investigation and possible intervention to ensure that all children with ADHD have equitable access to treatment when appropriate,” the authors conclude.
The researchers also analyzed ADHD by subtypes. Specifically, 4.4% of the children met the criteria for ADHD-1A, 2.2% for ADHD-CT and 3.0% for ADHD-HI.
The poorest children were more likely to have ADHD-HI than their wealthier counterparts (AOR for PIR, first vs fifth quintile, 3.1; 95% CI, 1.2-8.3
In addition, African Americans and Mexican Americans were less likely to have ADHD-1A, compared to their non-Hispanic white counterparts, the study showed.

Allergies and "Allergic Shiners"

Hi Again,

I was also asked by Jennifer, one of our Moms here at Meyer Pediatrics, about allergic shiners, those dark and puffy circles under kid’s eyes that are often mistakenly thought to be due to lack of sleep. The’re not related to sleep at all. They are a sign of allergies, as are the creases under the eyes called Denny’s Lines and the raised pink bumps on the back wall of the throat called cobblestoning. If one parent has allergies, each child has about a 50% chance of having allergies (although what your child is allergic to is NOT inherited; that they have to do for themselves. Just because you are allergic to penicillin does not mean that your child is, or even ever will be). If both parents have allergies, then each child has about a 75% chance of having allergies.

I’m often asked when, or even if, a child should be tested for allergies. My short answer is that I would go through the relative trauma of skin testing (far more accurate than blood testing) only if the child’s life is being changed by the allergies. If they can’t go to a friends house because the friend has a dog, that may be a good reason to investigate.

There won’t be just one or 2 things that your child is allergic to and therefore you could just avoid. It likely will be a dozen or more things. In most cases, you could just treat the allergies and skip the whole testing phase. Obviously, if you think that your child has had a serious reaction to something, or perhaps may even have had a potentially fatal reaction to something such as having had difficulty breathing after eating shellfish, then of course you would want to have this checked by an allergist so that you can know for sure.

It depends on the child, but I often find that for kids with significant allergies it usually takes a combination of Singulair (a prescription medication for airway inflammation) plus an allergy nasal spray such as Omnaris or Nasonex or Nasocort, plus a once-a-day, non-sedating antihistamine (such as Allegra or Clarinex) to control the allergy symptoms well. One or two of those medications just doesn’t seem to work as well, in my experience.

I know that most parents don’t like the idea of their children taking mutliple medications, and I do prefer just letting the child live with mild symptoms, but if we’ve made the decision to treat allergies with medication, I think we might as well do it the right way. Go for the win.

As a preventative, Singulair once a day can often be used as a maintenance plan during the time of year when your child is most symptomatic, with antihistamines used on an “as needed” basis. When your child is fully symptomatic, however, you’re going to want to do everything, or nothing at all, in my opinion.

I hope that this little overview answered some of your questions about allergies. If not, or if there are other topics that you’d like to see me address, write me here at Dr. Ted’s Blog and I’ll try to get something written as soon as possible.

Does Your Four Year Old Still Wet the Bed?

I was asked about this in one of the comments, and I found that it is difficult to find my answer unless you already know where to look. So, I’m repeating myself here as a post to make it easier for everyone to find this information. We just started this blog about a month ago, and I’m still playing around with it to see how it all works. Below is my answer to Jennifer, one of our Moms here at Meyer Pediatrics who asked me about children who are late to get dry at night (and have never been dry before).

OK, at age 4, about 80% of all kids are dry at night. Those that aren’t are the “late” group, and they will slowly become dry over the next 10 or so years, at the rate of about 10% per year. SO, at 5 years old, about 90% of them are still wetting, and at 6 about 80% and so on. It’s NOT laziness or anything like that. It’s because, for reasons unknown to me, these kids are slow to get the night-time rise in a hormone called ADH (Anti-Diuretic Hormone, which is naturally secreted by our brains) that those of us who stay dry get. Ultimately, just about all of them WILL get this night-time surge and they will become dry.

There ARE rare other causes of night-time wetting (and I am ONLY describing kids who have ALWAYS wet the bed here, not kids who WERE dry and then started wetting later). At any rate, these kids should have a good physical exam one time to be sure that there is nothing else causing the enuresis (the medical term for night-time wetting) as there are several treatments available, at least for sporadic use, such as when your child wants to have a spend-the-night party without others finding out. In these cases, there is a prescription medication called DDAVP that is a chewable pill taken before bedtime that in over 80% of cases is successfully able to keep a child dry for that night.

Therefore, to answer your question, I would recommend the pullups until they aren’t needed anymore, whatever age that might happen to be. My patient who was the latest to get permanently dry was about 16 or 17. For the routine changeover from pull-ups to underwear, “big kid” underwear should be a reward, NOT an inducement. They should only be allowed to wear “big girl panties” when they can go a whole week without wetting.

Potty Training

Hi,

I was asked by Jennifer, one of our Moms, about potty training. Since I get asked about that a lot, I thought it made a good topic for a post. I often tell parents who ask that there are basically two ways to potty train a child; the slow and easy way or the fast but difficult way.

The slow but easy way is to wait until your child shows an interest in wearing “big kid underwear.” These should be a REWARD for staying dry, NOT an inducement to get dry, which does NOT work. The only downside of this approach is that the motivation for the kids to stop wearing pullups is being teased by their friends (“you’re a little baby wearing diapers”) which is obviously painful and embarrassing to your child.

The fast but difficult way involves removing yourself from the diaper equation. A child over 3 years of age is perfectly capable of being dry at night. They are choosing to be in diapers or pullups because it’s the “hot line” to Mommy. They can commandeer your time and attention simply by saying, “I gotta go NOW.” SO, to force the issue, tell the child that you no longer do diapers (as long as they at least 3 years old) and that you will only help them if they go on the potty. This ONLY works, by the way, if you NEVER cave in and help them with pullups. Say to the child, “Here are the pullups, here’s the toilet paper, here’s where the dirty diapers go. Knock yourself out, but don’t call me for ANY help unless you want to go on the potty. I don’t do diapers now that you are three. I only will come help if you go on the potty.”

This works because the child is not attached to the pullups so much as attached to you and using the pullups to command your time and attention. From a young child’s perspective, NO ONE has EVER had enough attention, no matter how much they really get (and believe me, my patients typically get attention by the boat load). When forced to choose between you and diapers, a child will ALWAYS choose you, once they become convinced that you really mean it.

They will, of course, test you to see if you really mean it, but if you don’t cave, they likely will voluntarily switch over to “big boy underwear” within a day or so. I promise that this works IF you stick to your guns! Good luck!

Seasonal Flu shot for ages 3 years and older have arrived!

We have recieved the Seasonal Flu shots for ages 3 years and older. If you want to have your child recieve this vaccine please call the office to schedule an appointment. We also still have H1N1 (Swine Flu) vaccines available for ages 6 months and up. It is recommended that children recieve both the Seasonal and H1N1 vaccines.

Thanksgiving Holiday Hours

Meyer Pediatrics will be closed on Thursday, November 26th and Friday, November 27th. We will reopen at 8.30a.m. Saturday, November 28th. We are always available 24 hours a day by phone/answering service. I hope everyone enjoys the Thanksgiving Holiday!

Update for Patients with Cigna Insurance

Please note patients, if you have Cigna insurance you are required to have your laboratory tests sent to Lab Corp, Cigna’s preferred vendor. Labs included are Rapid Strep, Rapid Influenza A, Rapid Influenza B. However, you may choose to have the tests in our office with immediate results if you elect to self pay for the services. Rapid Strep is $25.00, Influenza A & B are $20.00 each.

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