We are already experiencing requests for last minute emergency physicals; ‘he needs it today or he can’t play football’. We urge everyone to anticipate the need for exams, forms and vaccine records for camp and sport. We are trying to accommodate everyone but there does reach a point that we can’t overextend our quality of care. Notchview takes pride in comprehensive annual checkups and health maintenance. It does help if all forms are available for your appointments and properly filled out in sections designated ‘parent’ responsibility. Simple things like the child’s name and birth date transcribed on the forms are helpful and avoid confusion. All high school sport activities, including marching band and cheering, require a standardized statewide form referred to as PREPARTICIPATION PHYSICAL EVALUATION WITH CARDIAC ASSESSMENT. Also, all colleges require entry physical exam and vaccine records as do all preschool and kindergarten admissions. Don’t wait until the last minute. Be anticipatory, as pediatricians always suggest. We continue to have great accessibility for sickness and injury with our ‘no appointment/walk ins’ in the Clifton office from 7:30AM-8:30AM Monday through Friday. We are also available in the Clifton office 365 days a year; Saturdays, Sundays and Holidays for the emergent care of your children.
MIXED EVIDENCE FOR PROBIOTIC USE by Ruba Hanna, MD
Certain bacteria that are usually found in the intestines are termed ‘flora’ and are naturally occurring germs that are also referred to as ‘healthy’ bacteria. These germs help to maintain the natural balance of many bacteria in the gut, sort of living together in equilibrium to help maintain the correct environment for the digestive process. These germs don’t cause illness, but are germs nonetheless. One might think that taking these normal bacteria, so called ‘probiotics’, as you would a vitamin in a preventative fashion might help with a variety of stomach issues. The use of these agents in a primary care setting, as evidenced by medical studies, is limited and has restricted approval based on scientific studies. When considering purchasing these, one should look for labeling that lists probiotic bacteria type (certain ones are more important) and concentrations in colony-forming units. Patients can choose to consume food that contains probiotics e.g. yogurt, but probiotic supplements can give a higher dose with smaller volumes. Probiotics are not associated with any adverse effects and generally can shorten the duration of diarrhea e.g. rotavirus diarrhea. Probiotic use in prevention of antibiotics-associated diarrhea is well documented. Evidence for treating a child who presents with eczema, allergies, recurrent illness, and recurrent abdominal pain with these probiotics are mainly anecdotal. Patients must be aware of advertising that promotes many different products as “probiotics” especially surrounding claims of improved “gut health” or “balanced microbacteria”. The doctors at Notchview can guide you as to which products are more efficacious.
BELIEVE IT OR NOT- FLU VACCINE IS A HOT TOPIC ALREADY
We have been made aware of the new vaccine formulation for the 2018-19 flu season. There are marked changes compared to last year’s strain mix. There are two A strains and two B strains as before. H1N1remains but one new A and one new B will replace former strains. The new vaccine has A/Singapore replacing A/Hong Kong and new B/Colorado replacing the old B/Brisbane. This doesn’t mean much to you but hopefully it improves the efficacy of the vaccine. As before, Notchview will continue to use only quadivalent vaccine (the most effective) that is preservative free. The exciting change this year is also the reintroduction of Flu Mist (nasal flu vaccine) that has been available before. We will start vaccine administration in mid September. Remember, all preschool, nursery, and daycare children must be vaccinated for Influenza by December 31 by NJ State law.
Redeveloping Pertussis (Whooping Cough) Vaccine by Michael Lewis, MD
Pertussis is a respiratory disease caused by the bacteria Bordetella pertussis. Early symptoms include a runny nose, low-grade fever, a mild/occasional cough and apnea (pauses in breathing). As the illness progresses, patients can exhibit the rapid coughs and high pitched "whoops", hence the name "Whooping Cough". Whooping cough is more common in infants and children. It can be fatal particularly for children under 1 year of age. Vaccination remains the number one preventative measure against the illness. For children less then 6 years the DTaP vaccine ( Diptheria, Tetanus and Pertussis) is available, and the Tdap vaccine (same but modified) is available for those older. Recently there has been an increase in the annual number of pertussis cases in the U.S.A. Whole cell pertussis vaccines (DTP) were licensed in the USA in the 1940's and remained in play till the 1990's. Acellular pertussis vaccines (DTaP) replaced the whole cell pertussis vaccine (DTP) in order to reduce local and systemic reactions. However, recent studies have shown that there are differences between the two vaccines. In addition, they trigger different immune responses. In particular DTP still offers better protection than DTaP. These differences in vaccines may be partially responsible for the rise in pertussis cases. The next steps to help curb rising cases of pertussis need further investigation. Two proposed theories would be to either add an "adjuvant" (additive) to the acellular pertussis vaccine or perhaps to generate a live attenuated mucosal vaccine (nasal spray vaccine). Above all, it is still recommended that everyone be immunized in accordance with the current AAP and CDC guidelines.
LYME AND TICKS: A PARENT NIGHTMARE-Confusing and Alarming
During the spring through the late fall, we are inundated with calls and visits regarding tick bites and Lyme disease risk. Recent studies have indicated that routine physician success as to predicting the risk of Lyme disease after tick exposure many times is inaccurate. The studies looked at emergency visits related to tick bites and ER physicians and their diagnoses. Everyone agrees that the classic rash associated with Lyme i.e. erythema migrans, notably referred to as the ‘bulls eye’ is diagnostic of the infection. But history of bite, type of tick, location of bite, seasonal timing, attachment time, local reaction, deer infestation in the community, and news reports of escalating Lyme disease in areas are generally very unhelpful in ascertaining a valid diagnosis. The only tried and true method is serology, i.e. blood testing usually 10-14 days after removal or exposure. The new lab testing available is more accurate and can guide us as to an appropriate treatment plan. The doctors at Notchview are your medical resources for a suitable approach.
THE E.N.D. IS NEAR by Bolanle Akingboye, DO
Juuls, pronounced “jewels” and Phixes, pronounced “fixes” are far from being pretty gems or solutions to a problem. They are electronic nicotine delivery systems (E.N.D.S) developed by Juul Labs Inc. and PhixVapor, two companies based in California. These devices use electricity to vaporize concentrated liquid nicotine into an inhalant form. They resemble thin flash drives, are charged by a USB connection, and can be personalized with decorative designs. So they seem familiar and can easily insinuate themselves into adolescent life. Each Juul contains the nicotine equivalent of 1 pack of traditional cigarettes which equals 200 puffs. Each Phix contains double that amount of nicotine. So what could be inhaled over the period of a full week can now be inhaled in one day. Although the number of adolescents smoking traditional cigarettes is at an all time low, there are increasing numbers of teens using E.N.D.S. Adolescents need to be made aware of the dangers lurking within these devices. Scientific research has found the nicotine solution in Juuls and Phixes contains heavy metals, respiratory irritants, and volatile organic compounds. These carcinogens can damage brain development in our teens. Physicians and parents must not allow these pretty Juuls and quick Phixes to fool the adolescents of our community. Clear the air of nicotine and speak to your children about the danger of E.N.D.S. For further information on how to speak to your children about this issue please refer to www.healthychildren.org.
Mothers Continue to Place Infants in Unsafe Sleep Positions by Lai Ping Lew, MD
The Back to Sleep Campaign began in 1994 to decrease the risk of sudden infant death syndrome by placing babies to sleep on their back for all naps and bedtimes on a firm and flat surface with only a fitted sheet. Soft toys and beddings such as heavy blankets and crib bumpers are not permitted in the sleeping area. Room sharing with a separate sleeping surface that is specifically designed for infants is recommended and not bed sharing. There was an initial significant reduction of sleep related deaths in infants in the early 1990s as compared to the latter years. Unfortunately, the CDC has reported that one in five mothers continue to place their baby to sleep on their stomach or side. Furthermore, two in five mothers use soft bedding in the infant’s sleeping area and more than fifty percent practice bed sharing. Mothers who reported placing their babies on their stomach were most commonly found in non-Hispanic blacks, less than 25 years of age, and having 12 or less years of education. It is important to discuss these effective safe sleep recommendations, especially to certain groups where the babies are at a higher risk of sleep related deaths. These discussions should start in the Nursery and be reinforced at every well care visit.
Important Disclaimer: The information on notchviewpediatrics.com is provided as a supportive service to Notchview Pediatrics, LLC and is not meant to replace the advice of the physicians and nurses who care for your child. All medical advice, information, and recommendations should be considered to be incomplete without a comprehensive evaluation by the physicians at Notchview Pediatrics, LLC.