Newymail sent out
This is definitely the cough and cold season. We are
seeing a lot of children with a nasty cough that is usually “barky” or
croupy. Not always. Then it gets more congested cough at 1 week. The
cough lasts 3-4 weeks. Many of them are getting bronchitis or ear infection
at 1-2 weeks into the cough. Fever in the first 3 days of the starting of
the cough is the virus. Fever after the fourth day is trouble and usually
Give your children vitamins with zinc. Zinc every day
will decrease infections. Zinc lozenges will not help so don’t waste your
money with them. Vit C will not decrease or cure colds but it will not hurt
Vicks Vapor Rub will help the cough if you put it on
their feet. Yes I said their feet. Then put socks on them and tuck them
The older kids can take cough medication and I like
the ones that say Cough and Cold. Any brand like Triaminic or Tylenol
“cough and cold.”
They took pseudoephedrine off the market but now the
only decongestant is Phenylephrine. The only cough suppressant is
dextromethorphan. These are in the cough and cold medications. You do not
need an antihistamine since this is a viral cold and not allergy.
The night and early AM cough is usually an allergy.
There is not coughing all day and night. That cough at night lasts for
months. Then during that season that they are coughing allergy at night,
they can get a viral cold and start coughing all the time for a few weeks.
Then when the cold goes away, they drop down to their usual allergy night
cough. So you can have two causes of cough. Watch for fever and then we
see them for secondary infections like bronchitis.
If the cough or congestion is not severe, just wipe
their noses and watch it. If it is interfering with their sleep and
function, then treat with medications. We would prefer not to give
medications. For infants below 7 months old, you can sleep them all night
in the swing or infant seat. There will be less congestion or cough with
Have a good winter and clean hands frequently.
Roger Knapp MD
We always hear about Myspace and the risks of teenagers
on the internet. Here is a show on PBS that is very good at getting a good
picture of the problem.
Also good web sites about safety are these two:
I have sent other emails about programs that watch what
is visited on the computer without kids knowing. Don't be afraid to watch
what your kids are doing in the internet.
You may be hearing about Phthalates someday.
Phthalates are plasticizers …. chemicals to make
plastic softer. It is found in most soaps, lotions, perfumes, cosmetics,
plastic bottles, and even IV tubing. It is in almost 100% of mother’s
breast milk. It is in most newborn babies urine because they get it from
the mother via the placenta. Breast milk does not have toxic amounts.
Basically they are in almost everything we touch and probably eat.
Studies showed that it could in rats in-utero affect
the development of the male genital organs because it interferes with
testosterone metabolism. Human studies vary in their results. Nothing is
absolutely verified yet. But if there is an affect of Phthalates, it is
during pregnancy or during the first 6 months.
Don’t go crazy yet. We have not figured it all out or
what to do about it. The chemical is in almost everything. But what goes
on their skin can go into the blood stream so cut down the use of baby
lotion and I recommend Dove unscented soap that has less chemical than baby
soaps. I have always warned parents about putting chemicals from wipes on
their babies bottoms all the time. Use them as little as possible and
nothing is more natural as water and paper to clean them up. Also less
likely to get yeast or staph infections on their bottoms if you avoid
There is one site for this chemical:
This is not helpful since this site is run by the
plastic companies to make you think they are OK. I would not believe what
they say. There are also many sites that are against every chemical so
they tend to make it out as a horrible disaster. The truth is somewhere in
between the two extremes.
Just remember that no one knows the “safe” level of
these chemicals until more studies are done. Any comments based on
information older than a few years will not be accurate. Ignore any values
of the safe amount. And what is safe for the adult will not be necessarily
safe for the unborn infant.
For some more reading:
Roger Knapp MD
If a tooth gets knocked out, put it in cold milk, or
there is a solution from the drug store called Hank's Balanced Salt Solution
(Save a tooth kit) that you can soak the tooth in. Then get to the dentist
right away. Some of the teeth can be re-implanted and saved. If they are
older and can tolerate it, you can shove the tooth back into the socket and
held there until you see the dentist.
Roger Knapp MD
A study came out having over weight teenage girls enter
a program. They emphasized cutting down high calorie beverages, portion
sizes, and fast foods, but not count calories. In addition they had them do
30 min of video game "Dance Dance Revolution" They compared them with
matched controls that were not put on the program. The girls lost an
average of 15 lbs in the next 6 months. So I guess video games could be
used for our health. I know some of the kids are sweating after some of the
Wii games. In fact we are having some sore arms and wrists after Wii
p.s. Having exceeded smoking, being over weight is now
the number one cause of Cancer.
The bad chest colds and flu that went thru this winter
should be on the down slope this month and there is still a slight chance of
RSV for the infants below 6 months old during even April. Try to keep the
little ones away from crowds for 30 more days. Now we should start seeing
allergies.... yuck. If it is not one thing it is another. (I guess it pays
my bills.. hee hee :-)
Careful about the small kids eating plants. There is a
great children's area on the Poison Control web site with a very good video
it would be good for us and the children 3-8 yr old to see.
Also watch out for sunburn when the air is cool but the
sun is still out to burn you. Keep the swim shirts on them that block the
UV radiation. Sunscreen on the areas that you cannot cover and as long as
there is SPF of 15 or more then that is good.
Roger Knapp MD
1. Get real postage stamps with your child's picture on
2. Gadget to allow electricity to any electronic device
for only certain hours on certain days to you can regulate how long your
older kids are using them.
This will help you control excessive games or TV. See Power Cop:
Well the year causes of death in kids came out.
1-4yr old: 5-9yr
Cancer 8% 17%
Homicide 7% 4%
Disease 3% 3%
Accidents 35% 48%
Cancer 13% 5%
Suicide 7% 11%
Homicide 5% 15%
higher 5 to 15 yr old.
stay high in all ages.
Suicide goes up
after age 10. That is tragic at any age but 10-14? Yuck.
Homicide is at
every age but higher after 15.
Many of these could be prevented.
Boy it is April and we are already seeing sunburns and
Put olive oil in their ear before swimming &/or a
solution of half alcohol half white vinegar after swimming to prevent
swimmer's ear. You can tell it is swimmer's ear because it hurts to move
their ear lobes.
I came across an article on a vaccine to prevent or
lesson recurrence of breast cancer:
A preventive HER2/neu peptide (E75) vaccine is
showing great promise in the prevention of breast cancer recurrence and
reducing mortality when recurrences do occur in women with HER2/neu-positive
breast cancer, researchers reported here at the American Association for
Cancer Research (AACR) Annual Meeting 2008.
You can google those terms and read more. Very
amazing. Of course we have a vaccine to prevent cervical cancer with the HPV
and I do recommend that. No it does not give them a license to go crazy out
In the news was a story about enterovirus 71 killing 24
children in China. It was estimated that over 1 million children probably
caught it. There are some children that will die from these viral illnesses
and actually are rare thank God. We don't have a vaccine for every virus.
China is trying to stop the cases because of the Olympics that are there
this year. I do not think it is a world pandemic and cases occur here
also. There were rare children who died of Chicken Pox so we give a vaccine
for that even though it is rare that they have severe complications....
thank God. As we develop more vaccines it means that the children are
getting more shots. But the life span of humans in the 1800s was 35 years
and 10% died the first year. Thank goodness for vaccines. (No they do not
Have a safe summer ....
Swimming lessons for infants
With summer coming up this question always comes up.
Also how old do they have to be to go into the pool.
It is not a problem of chlorine but a concern is for the body temperature.
They can get hypothermia fast. When 2-6 months then the water should be
luke-warm and take them out every 5-10 minutes to take their temp. If below
97 or shivering, then get them out and dry them off. If over 6 months then
they can go into cool water but watch the temperature frequently.
Personally I prefer a rubber blow up pool. Then let the hose sit in the sun
and warm up the water in the hose. When you fill the pool, the temperature
will be warmer than cold water from the tap.
I don’t recommend actually teaching the infant to
“swim” over to the edge of the pool and “save themselves.” The parent’s job
is to be certain that the infant does not drown, it is not the child’s job.
Teaching the infant to paddle will give the parent a false sense of security
that the baby will not drown and may be less vigil in watching them. Also
they swallow a lot of water that can lower their blood sodium level and
cause a seizure.
I think it is fun and OK to have “swimming” lessons
where the mom’s sit around in the kiddy pool and let the babies splash. It
is a social event and not really swimming. That is fine and great enjoyment
by all. Just watch the temperature and watch out for poop in the water.
Don’t let them drink the water. And use sunscreen!
Have a safe summer.
Dr. Roger Knapp
Well there are so many ancient medical therapies and
many false but some true. Chicken soup really did help colds in control
studies. Now a study came out verifying an old treatment of skin ulcers or
sores by putting Honey on it. The honey treated sores healed quicker than
traditional antibiotic ointments and bandages. Go figure??? You need raw
unprocessed honey. Sweet idea.
Dr. Roger Knapp MD
A study just came out looking at fatal falls in
children. Basically they had to fall from 4ft or higher to damage them. We
don't want them to fall and get hurt at all but when they do fall, you
generally do not have to worry about falls of less than 4 ft. So
approximately waist high or grocery cart handle height. See my web site for
4 misconceptions about injury to the head:
Roger Knapp MD
Also protect them from swimmer's ear by putting Olive
oil in their ears before they swim or a solution of half alcohol and half
vinegar in their ears after they swim. We are already seeing a lot of
The growing children need calcium from milk. If they
cannot drink milk then they can get calcium from supplements but it is
better from vit D Milk and formula before one yr old. The formula companies
would like you to give follow-up formulas until 2 yr old but there are no
studies showing any benefit from that. So I recommend switching to cow’s
milk at one yr old … whole milk until 2 and then low fat afterward. Too
much of anything is bad for them. Too much salt or too much sunlight is
bad. So milk intake should be 12-24 oz a day after 1 yr old. I just had to
put a twenty month old in the hospital with extreme anemia and get
transfused with blood. The child was drinking excessive amounts of milk and
not much food. Then we also have infants that start to not like and drink
enough milk. In that situation you flavor the milk and out wait them.
Nothing else to drink until they put away 12 oz. Then they need a lot more
calcium in their teens when they hit puberty.
Also keep up giving them vitamins with iron and zinc
after 1 yr old.
I love 4-6 month olds… they are usually over the colic
and not throwing temper tantrums yet. And I love 4-6 yr olds who are
usually over the temper tantrums and not the teenage smart mouth…. which
usually starts around 6 yr old. (These ages may vary a bit) You have to
tolerate some smart mouth since it is normal for the age. It hits a peak in
teens and then a lot better in the 20s.
There is an old book called I’m OK You’re OK.
It does not help you raise your children but understand the stages they go
through. The one year old is happy and the world is a nice place. He is OK
and you are OK. Then he gets into trouble and goes through terrible twos
and you have to discipline him so he is a civilized human and not a wild
animal in the forest. But then by 6 yr old the child has a decreased self
image and he thinks he is not OK but you are still OK. As they go through
grade school he realizes he does know something and his opinion is worth
something. He has a smart mouth but that is getting out of the “I’m not OK”
stage and important to do some backtalk. Then by teens you are not OK but
he has become OK and knows it all. Eventually he gets into his 20s and
realizes you are smart and comes full circle where he is OK and you are OK.
So some smart-mouth back talk is to be tolerated. The
degree of this will vary with how much the parent can tolerate. And would
you talk to your friend the way we talk to our spouse? NO. We tend to
behave worse for the ones we love the most .... our family. Our children
also let out frustrations on us just as we let our tension out on others in
our family. In fact we treat other children that come to visit us better
than we treat our own children. So if your child visits other families and
when they come home the other parent complements your child saying he was
nice and well behaved. That is proof that you are raising a good kid. They
just don’t behave that way for us.
There was a policy released this month July 2008 for
Cholesterol screening and treatment in children. You may have heard it on
the news this week. For the full policy if you want to read it is at this
The summary recommendations were:
The population approach to a healthful diet should be
recommended to all children older than 2 years according to
Dietary Guidelines for Americans. This approach includes the use
of low-fat dairy products. For children between 12 months and 2
years of age for whom overweight or obesity is a concern or who
have a family history of obesity, dyslipidemia, or CVD, the use
of reduced-fat milk would be appropriate.
The individual approach for children and
adolescents at higher risk for CVD and with a high concentration
of LDL includes recommended changes in diet with
nutritional counseling and other lifestyle
interventions such as increased physical activity.
The most current recommendation is to screen
children and adolescents with a positive family history of
dyslipidemia or premature (55 years of age for men and 65 years of age for women) CVD or
dyslipidemia. It is also recommended that pediatric patients
for whom family history is not known or those with other
CVD risk factors, such as overweight (BMI 85th percentile, <95th percentile),
obesity (BMI 95th percentile), hypertension (blood
pressure 95th percentile), cigarette smoking, or diabetes
mellitus, be screened with a fasting lipid profile.
For these children, the first screening
should take place after 2 years of age but no later
than 10 years of age. Screening before 2 years of age
is not recommended.
A fasting lipid profile is the recommended
approach to screening, because there is no currently
available noninvasive method to assess atherosclerotic CVD in
children. This screening should occur in the context of
well-child and health maintenance visits. If values
are within the reference range on initial screening,
the patient should be retested in 3 to 5 years.
For pediatric patients who are overweight or
obese and have a high triglyceride concentration or low HDL
concentration, weight management is the primary treatment,
which includes improvement of diet with nutritional
counseling and increased physical activity to produce
improved energy balance.
For patients 8 years and older with an LDL
concentration of 190 mg/dL, pharmacologic intervention should be
considered. The initial goal is to lower LDL concentration to
<160 mg/dL. However, targets as low as 130 mg/dL or even 110 mg/dL
may be warranted when there is a strong family history of CVD,
especially with other risk factors including obesity, diabetes
mellitus, the metabolic syndrome, and other higher-risk
Dyslipidemia is high cholesterol, low HDL, and high LDL.
CVD is Cardiovascular Disease. HDL is High Density Lipoprotein, LDL is Low
Density Lipoprotein. It is easy to remember that you want the good HDL to
be high and the bad LDL to be low… so H in the HDL means you want it Higher
and L stands for Lower.
Synopsis of the article:
Autopsy studies on people who died of
accidental causes, have demonstrated that the atherosclerotic process begins
in childhood. They reported that the extent of the arterial
surface covered with fatty streaks and fibrous plaques increased
with age with almost 70% by young adulthood. In the Child and
Adolescent Trial for Cardiovascular Health, 13.3% of children
in the 4th grade had total cholesterol concentrations of >200
Obesity in adolescence and young adulthood,
cigarette smoking, and use of oral contraceptives by women may
have deleterious effects on adult concentrations of lipids and
Their recommendations is for screening children with a
family history of premature CVD or high blood concentrations of
cholesterol. Some have maintained that the evidence is
insufficient to recommend for or against routine screening for
all children. Unfortunately, family history may not be known or
inaccurate and the studies of screening have also shown that 30%
to 60% of children and adolescents with high cholesterol levels
will be missed by the targeted strategy. Therefore some
recommend screening all children.
Who to treat?
The NCEP pediatric report recommended the cut points
presented below: It is worth noting that the same values are
used for all children, from 2 to 18 years of age.
Cholesterol >200 mg/dL LDL >130 mg/dL
top normal value
There is a condition called metabolic syndrome which is
a clustering of risk factors for CVD and diabetes mellitus that
seems to be related to obesity and insulin resistance.
TABLE 3 Definition of Metabolic Syndrome for
Three of these five criteria:
1. Waist >102cm, or 40 inches in Men, >88cm, or 34.5
inches in Women
2. Triglycerides >150
3. HDL <40 in Men and <50 in Women
4. BP >130/85
5. Fasting Glucose >100
Note the waist measurements. This can be more of a
predictor of CVD and Diabetes than anything. This syndrome frequently has
acanthosis nigrans (dark area around the neck) and some schools and most
Pediatricians screen your teenagers for this. Large waist to height is a
better predictor. If the waist is more than 50% of the height in over 8yr
olds, then they are more likely to have this syndrome. But there are no
currently accepted definitions of metabolic syndrome in children.
Dietary changes not recommended for children
younger than 2 years, because younger children are thought to
require a relatively high intake of total fat to support rapid
growth and development. However, some studies have examined
dietary intervention at a younger age. One study beginning at approximately
7 months of age showed the children in the intervention group were
maintained on a diet with total fat of <30% of calories,
saturated fat of <10% of calories, and cholesterol intake of <200
mg/day, using 1.5% cow milk after 12 months of age. Outcomes in
this study showed no adverse effects of the
intervention diet on growth or neurological outcomes.
The American Heart Association recently provided
updated dietary recommendations based on the new US Department of
Agriculture dietary guidelines for children (older than 2 years)
and adolescents, which have been endorsed by the AAP. See:
Realize that there is a wide range of normal and the values presented by any
chart based on age may not apply to your child exactly. There is a broad
range of “normal” intake. The new guidelines recommend that
intake of trans fatty acids be limited to <1% of total calories.
Children and adolescents at high risk require a higher
level of intervention. If the intervention focusing on changing
the diet does not lower LDL to an acceptable concentration, these
children may be candidates for medication.
The recommended diet for the high-risk group is similar
to that recommended for the population but restricts saturated
fat to 7% of total calories and dietary cholesterol to 200 mg/day
For these children with a genetic cause of
dyslipidemia and LDL concentration of 190 mg/dL, it is unlikely that diet alone will achieve
appropriate concentrations of LDL. Nevertheless, it is important
to implement dietary changes and is likely to require
involvement of a dietitian. The home environment is very important
to help children and adolescents make the best choices and Dietitians
can also help children and their families navigate the food
environment outside the house.
Increasing the intake of soluble fiber can be helpful
in reducing plasma LDL concentration. Some studies have shown a
modest reduction of LDL concentration by approximately 7%. This
often requires supplements of fiber. An appropriate dose of
supplemental fiber is calculated as the child's age plus 5 g/day,
up to a dose of 20 g/day at 15 years of age
Classes of Medication for Treatment of Dyslipidemia in
Children and Adolescents
1. Bile acid sequestrant …………… GI upset,
2. Cholesterol blocker ……………. GI upset and
3. Statin Drugs …………………… Muscle inflammation and
“rhabdomyolysis”. Liver inflammation, and possible teratogenicity. Can lower
cholesterol 20-50 %.
The main choice is the statin drugs. There have been a number of clinical
trials of statins in children and adolescents have shown statins
to be safe and effective in short-term studies.
Wiegman and other doctors showed that children with
hypercholesterolemia treated with placebo had an increase in
carotid thickening over 2 years, whereas children treated with a
statin medication had regression of carotid thickening. The
results of these studies are encouraging in that these
noninvasive vascular measurements are thought to provide an
assessment of the extent of the atherosclerotic process.
Furthermore, this study included prepubertal children as young as
8 years of age, and on the basis of these results and reassuring
safety data, the US Food and Drug Administration has approved the
use of pravastatin for children with familial
hypercholesterolemia who are 8 years and older, regardless of
I have sent information about rabies before but here it
Rabies is rare in dogs and more common in cats. But in
other countries around the world there are many dogs with rabies and
frequent cases of human rabies. Rodents do not get rabies so donâ€™t worry
about rats and squirrels. The more common source of rabies is bats and you
cannot feel the bite.
There are about 16,000 to 39,000 exposures to rabid
There were 34 cases of bat-associated rabies from 1990
to 2007. A bite was only reported in 6 cases. Contact with a bat and
possible bite in 2 cases. Physical contact removing the bat from the home
or workplace or presence of a bat in the room were a person had been asleep
occurred in 15 cases with no evidence of a bite. No encounter with a bat
was reported in 11 cases.
So stay away from bats and if one is found in the home,
get the shots. It is 5 shots in the arm and not 21 in the stomach like in
the grandpa days.
As I have also sent Newsymail about obesity and there
is an article at my web site on this
The American Academy of Pediatrics has given their
Specific recommendations of The Expert Committee on
the Assessment, Prevention, and Treatment of Child and Adolescent Overweight
and Obesity, and their accompanying level of evidence, are as follows:
At least once a year, measure height and weight and
calculate percentile for all children.
To achieve or maintain a healthy weight, encourage all
children to participate in at least 60 minutes of moderate to vigorous
physical activity on most, and preferably all, days of the week.
Advise children not to drink more than 1 serving per
day of sweetened beverages, such as fruit juice, fruit drinks,
regular-calorie soft drinks, sports drinks, energy drinks, sweetened or
flavored milk, or sweetened iced tea.
Advise families to limit their children's television
viewing and other screen time to 2 hours per day or less.
Recommend that children's fast-food consumption be
limited to no more than once per week.
Advise families with children to eat meals together as
often as possible, on most, and preferably all, days of the week.
I do not have a problem using diet drinks with children
in moderation. Splenda is fine since it is only a sugar molecule with a
hydrogen and Oxygen molecule on the side. It makes it 500 times sweeter and
80% is not absorbed. I think it is real safe.
Roger Knapp MD
p.s.: why do you sing to your children when they are
going to sleep? See this video:
Dogs singing to sleep
The most commonly used sweetener in the U.S. diet is
the disaccharide sucrose tie, table sugar), which contains 50% fructose and
50% glucose. However, in North America and many other countries, non-diet
soft drinks are sweetened with high-fructose corn syrup (HFCS), which
contains up to 55% of the mono-saccharide fructose. Thanks to its abun-dance,
sweetness, and low price, HFCS has become the most common sweetener used in
processed foods. It's not that HFCS is biologically more ominous than
sucrose; it's that its low cost has made it available to everyone,
especially low socioeconomic groups. HFCS is found in processed foods
ranging from soft drinks and candy bars to crackers to hot dog buns to
ketchup. Average daily fructose consumption has increased by over 25% over
the past 30 years. The growing dependence on fructose in the Western diet
may be fueling the obesity and type 2 diabetes mellitus epidemics. Animal
models demonstrate that high-fructose diets lead to increased energy intake,
de-creased resting energy expenditure, excess fat deposition, and insulin
resistance, which suggest that fructose consumption is playing a role in the
epidemics of insulin resistance and obesity and type 2 diabetes mellitus in
humans. The metabolism of fructose differs significantly from glucose.
Fructose is absorbed in the intestine and enters the liver without insulin
regulation. There, fructose is converted to fructose- 1-phosphate and enters
the glycolytic pathway without regulation. This leads to an excess
accumulation of acetyl-CoA in the hepatocyte, which cannot be metabolized
through the Krebs cycle; therefore it is then reassembled into free fatty
acids (which promote insulin resistance), very low-density lipoproteins (VLDL,
which promote atherogenesis and serve as a substrate for obesity), and
triglycerides (some of which precipitate in the liver and cause
non-alcoholic steatohepatitis). Fructose also does not sup-press secretion
of the so-called "hunger hormone" ghrelin, levels of which correlate with
perceived hunger. In sum, fructose consumption has metabolic and hormonal
consequences that facilitate development of obesity and its complications.
The highest fructose loads are soda (1.7 gm/oz) and juice (1.8 gm/oz).
Simple solution for Obese teenagers
Here are some simple guidelines for
diet and exercise I would like to share with you.
Eat only 6 things for breakfast, lunch and dinner:
2- Grains and Vegetables (careful with corn and potatoes)
4- Chicken (turkey ok)
Big breakfast, medium lunch, small
dinner. Nothing after 6 pm except water.
No fast food. Eat half of what
restaurants give you.
Do not eat anything that comes in a
No white foods (bread,starches,corn,pasta,rice).
This provides carbs in their natural
form. This is how our great-great-great-great grandparents ate. You can give
alternatives: corn tortillas, brown rice, whole grain bread
The catch is that carb addiction is
almost an "all or none" phenomenon. If someone is dieting but decides to
have a piece of cake, this transitory hyperglycemia will release endorphins
that will require his/her body to "ask" for more.
Use a pedometer and get at least
10,000 steps daily. Limit the video games and TV. Get those teens one of
those dance dance revolution video game dance pads-- that will help them
break a sweat....
Drink 8-10 glasses/day only water or diet drinks. No regular sodas or
fruit juices. Teenagers are consuming 1000+ calories (mostly carbs) in the
form of drinks (gatorade, kool aid, sodas, etc). When your fluid intake is
only water then you cut down 1000+ cal/day. That is 1 pound in 3 days only
Sometimes we are thirsty instead of
hungry. When we drink water we cut some cravings. Water also helps
constipation. It flushes your toxins. Also you may have an acid heartburn
stomach feeling and think that you are hungry. Take an antacid with the
water and that can help that craving.
On this diet kids can lose 10 lbs/ month and so are their parents. Diets
work if the whole family participate. It's not about dieting for short term
results, rather lifestyle change for sustained improvement in health ...
every day the rest of your life.
You can cut back eating for one week
and loose 1 lb and eat too much for just one day and put 1 lb back on. So
people think they starve all the time and not loose weight because they
forget about the one day they ate too much. You change your way of eating
Loosing weight is like a marrathon
race. You don’t run the first mile as fast as you can go or else you get
tired too soon and stop running. If you try to loose too much weight too
fast, then you will get exhausted and quit. Cut back the calories so you
are loosing it 1-2 lb a week. It will take a long time to get your weight
down but since we are going to change the way we eat for the rest of our
lives…. Then it does not matter how long it takes.
Dietary Fructose Consumption Among US Children and
Adults: The Third National Health and Nutrition Examination Survey
Miriam B. Vos, MD, MSPH; Joel E. Kimmons; Cathleen
Gillespie, MS; Jean Welsh, MPH, RN; Heidi Michels Blanck, PhD
Context: High fructose intake has been
associated with increased de novo lipogenesis in the liver as well as
increased plasma triglycerides, insulin resistance, and obesity. Fructose
occurs naturally in fruits and vegetables; however, it is added to many
processed foods as table sugar (sucrose) and high-fructose corn syrup.
Dietary data from a nationally representative sample in 1977-1978 estimated
that mean consumption of fructose was 37 g/day (8% of total intake). Little
is known about more recent fructose consumption patterns.
Objective: We determined the amount and sources of dietary
fructose among US adults and children.
Design: We examined fructose consumption patterns by sex,
age group, race/ethnicity, socioeconomic status, and body mass index for
21,483 children and adults. We used a single 24-hour dietary recall
administered in the third National Health and Examination Survey (NHANES).
Main Outcome Measure: Weighted estimates of fructose intake
were tested for significant differences (P < .05) between groups.
Results: The mean consumption of fructose was estimated to
be 54.7g/day (range, 38.4-72.8) and accounted for 10.2% of total caloric
intake. Consumption was highest among adolescents (12-18 years) at 72.8
g/day (12.1% of total calories). One fourth of adolescents consumed at least
15% of calories from fructose. The largest source of fructose was
sugar-sweetened beverages (30%) followed by grains (22%) and fruit or fruit
Conclusions: Over 10% of Americans' daily calories were
from fructose. These results, when compared with a previous nationally
representative study, suggest that fructose consumption has increased.
Further research is needed to understand the impact of increased intake of
fructose on human health.
I think most of us parents worry about our children’s
morals and for them to grow up into fine honest respectful adults. In our
effort to make them perfect, even though we are not perfect, we tend to be
too critical of our kids. I know I used to correct the minor errors when my
kids drew pictures, cleaned up their rooms and such. They would bring home
a school paper that they were proud of doing. I would say what a great job
but then point out the minor errors. If they do a job that is good for
their age, then praise them and drop it.
I worry about our schools lowering the kids self
esteem also. It seems you have to be perfect in everything there also. We
send them to classes and have extra tutoring after school and all summer in
areas that they are weak. We put most of the time and money into their
weaknesses and not enough into their strengths. That lowers their
self-esteem. They will probably migrate to their strengths and find a job
as an adult that involves those areas. So in today’s schools, Michael
Angelo, the great painter, could not go to art class because he was a little
slow in math. And Louis Armstrong, the great musician, could not go to
music because he was slow in reading. We need to work on their weaker areas
but not so much that we hurt their self-esteem and neglect their strengths.
I am not for “No pass no play” policy since now sports is a profession.
They make more money than I make. I understand the effort is to make them
better students by keeping them from playing but we are preventing them from
becoming a great professional ball player some day. We need to continue to
work on their academics but not hold them back from learning their potential
profession. Anyway there is a good article on this at Pediatric News:
A combination vaccine was released this summer called
Pentacel. It has in one shot three vaccines: DaPT, IPV, and HIB. So that
means less needle shots at many of the visits.
We have had some teenagers (and there are probably some
adults) who swallow their pills like antibiotics for acne every day without
washing them down with water or food. The pill sits half way down the
esophagus and dissolves. Then it causes a chemical burn to the lining and
erodes it. Then there is chest pain and pain with eating. Be sure to eat
or drink liquids if they cannot be taken with food after taking
Be careful on this busy weekend of Labor Day. By the
way, there is a product going through the FDA for eventual approval. It is
a patch to “vaccinate” people against traveler’s diarrhea. Many people when
going to other countries of the world develop diarrhea. This patch you put
on your skin 2 weeks before you leave and studies show it prevented 90% of
cases. Weird huh? Why can’t they develop regular vaccines by doing a patch
and not have to have a shot? Who knows ….. maybe someday. (And vaccines DO
NOT cause Autism.:-)
Roger Knapp MD
If you take Singulair for allergies, you can print out
a coupon for $20 off if you are from Texas, have private insurance and do
not use mail in pharmacy.
Also Merck has a neat site with 3D medical animations
for many illnesses like asthma and ear infections.
www.mercksource.com and click on 3D medical animations on the left side.
We are scheduling flu shots now and your pediatrician
is probably doing the same. Call for appointments early.
Roger Knapp MD
The year after Scotland banned smoking in public areas,
there was a 14% decrease in hospital admissions for smokers and a 20%
decrease for non-smokers. I know this inconveniences some people (smokers)
but the health benefits are great. Just like the hassle of making your kids
wear helmets but there was a 50% decrease in bicycling deaths per year after
helmets were required and encouraged. After awhile it becomes habit and I
feel weird if I am not buckled up in the car. Just keep telling your kids
not to text message while driving. It looks like the engineer of the train
that ran the red light was text messaging just before he crashed headlong
into the commuter train last week.
I was up on my daughter’s roof in Houston last weekend
covering a hole with tarps and I had a rope around my waist. Thank goodness
since I almost fell off and it saved me. Falls are the most common cause of
death in the home so be careful. All these safety measures do help.
By the way, here are some neat pictures of hurricane
Roger Knapp MD
There are several plants that can be poisonous to
children. Always call Poison control if there is any question.
Neil Sperry has a page that lists the plants in North
A study just came out showing infants who wore a
stocking hat had more sudden infant deaths. There was also another study
showing that if there was a fan in the room there was less SIDS. I have
always told parents that a fan was OK as long as it did not blow right on
the baby. So take their hat off when you go home and turn on the fan.
Sleep them on their backs and have less chance of SIDS.
Roger Knapp MD
You heard of the chemical Melamine that was in China’s
milk and baby formula that killed 4 children and sickened 53,000. The
United State’s FDA screens products here and there are no Chinese companies
that are approved to sell formula in America. That is not to say some Asian
specialty stores might have sneaked some in and sell it. The FDA warns
consumers not to eat White Rabbit Creamy Candy or certain coffee and tea
products under the brand name “Mr. Brown” which do contain Melamine.
Now that the mothers in China are afraid of their
formulas, the old practice of Wet Nurse in coming back. A mother over there
can produce extra breast milk and nurse other babies in the town, she can
increase her monthly income from 1000 yuan ($146) to 12,000 yuan. It is
hard to say how many diseases will be transmitted with this practice. I
think I would buy a goat instead. Interesting huh?
Have a Happy Thanksgiving
Dr. Roger Knapp
also: You Tube is fun but there are videos there that are not for children.
A child safe video site is
There was a vote by the FDA about a medication Serevent
that is for opening airways in asthmatics. They some people using it too
much and not using inhaled steroids with it. By itself the patients would
rely on it alone but have to use it too much. When used with inhaled
steroids, it is not much problem. I think it is safe when used as directed
(like all meds) in combination with steroids like the medication Advair. I
will continue to use Advair with my patients. Here is a summary of the
Happy Holidays and Merry Christmas
see this site for a great Christmas Carol: http://ecard.ashland.edu/2004admission/index.html
Dec. 11, 2008 - An
expert panel said Thursday that the benefits of two inhaler drugs are not
worth the risks and should no longer be used to treat asthma.
The vote does not
mean the two drugs, Serevent and Foradil, will be pulled from the market.
Instead, the panel strongly urged the FDA to tell doctors not to prescribe
the drugs to children or adults as a standalone asthma treatment.
The drugs are also
widely prescribed for chronic obstructive pulmonary disease. That use was
not affected by Thursday's deliberations of a 27-member FDA advisory
At the same time,
the experts backed two other popular asthma drugs, saying their benefits
outweigh their risks.
Foradil are in a class of drugs known as beta-agonists. They help control
and prevent airway spasms during asthma attacks. But the drugs have also
been associated with a small but significant increase in the risk of
hospitalization and death from asthma.
and the drugs' labeling recommend that beta-agonists only be used in
combination with inhaled steroids that cut down on airway inflammation
leading to attacks. The combination lowers the risks to a level most experts
believed is justified by their benefits.
But studies show
that many patients do not use inhaled steroids as directed when taking them
separately from beta-agonists. At the same time, patients often feel
physical relief from labored breathing when they use their beta-agonist
inhaler. The difference can lead to many patients using the beta-agonist
alone (called monotherapy), which raises the risk of dangerous side effects,
according to FDA analyses presented this week.
"I think the label
should be greatly strengthened to say that monotherapy for asthma should
basically be contraindicated" for Serevent and Foradil, said Daniel
Notterman, MD, a member of the advisory panel from the department of
molecular biology at Princeton University.
The rest of the
advisors agreed. In a 17-to-10 vote, the panel said the risks of long-term
Serevent and Foradil use outweigh the benefits when used alone. The panel
cast a similar vote for adolescents with asthma and voted unanimously that
the drugs are not worth the risk in children 4 to 11 years old.
"The data is that
single use is dangerous," said David Schoenfeld, PhD, a panelist and
professor of medicine from Massachusetts General Hospital.
The panel gave
broad backing to two other asthma drugs, Advair and Symbicort, in adults.
Those products contain a combination of beta-agonist and steroid drugs, thus
guaranteeing that patients get both drugs each time they take a puff.
The group was
split on whether Advair should be used in children. Thirteen panelists said
Advair's benefits outweigh its risks in children, while 11 said they did
not. Three abstained.
Experts said they
were uneasy with how few studies had been performed showing Advair's safety
and efficacy in children.
"I think there's a
paucity of data," Notterman said.
generally not used in children.
John Jenkins, MD,
who heads FDA's Office of New Drugs, said the agency would consider ordering
manufacturers to conduct more safety studies in children, which it can do
under new authority granted by Congress.
MD, the chief medical officer of GlaxoSmithKline, which makes both Advair
and Serevent, said the company was pleased with the committee's backing of
Advair. But she also said the company was "concerned" that the panel's vote
to restrict Serevent could "deny patients needed treatment for optimal care
of their asthma."
A statement from
Novartis and Schering-Plough said the companies "strongly disagree" with the
panel's rejection of Foradil, which they market in a joint venture.
"We believe this
opinion is inconsistent with clinical evidence supporting the benefit/risk
profile of Foradil in patients not adequately controlled on other
asthma-controller treatments," the statement read.
The FDA now has to
go back and consider whether to change product labeling or indicated uses
for Serevent and Foradil. It will also consider ordering new safety studies,
that patients currently taking Serevent or Foradil "should not stop taking
your asthma medications without talking to your physician."