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The National Institute of Health (NIH) studied programs to stop
repeat teen violence. The get tough programs like boot camps and
detention centers did not help. There were two that were shown by
external studies to help. They were Functional Family Therapy
(duh!... you mean the dysfunctional family has an affect on kids?)
and the other is Multisystemic Therapy. There were six other
programs that were not proven by outside studies to be effective but
they have numbers that suggest that they might help. They are Big
Brothers/Sisters, Multidimensional Treatment Foster Care,
Nurse-Family Partnership, Project Towards No Drug Abuse, Promoting
Alternative Thinking Strategies, and Brief Strategic Family
Therapy. See: http://consensus.nih.gov/ta/023/023youthviolencepostconfintro.htm
There is a new way to remove tonsils. Instead of an electric
cautery, there is a new device called coblation. The temperature
the old way is 300 degrees while the new coblation is only 30
degrees. So less damage to surrounding tissues. The recovery time
goes from an average 4 days to 1.5 days. Less pain is a good
thing. This instrument will be coming to the local hospitals for
the ENT doctors to use in the next few months. Yeah!
Things just keep getting younger and younger. There was a 14%
increase in cosmetic surgery in children below 18 last year. Ears,
nose and breast jobs. There were 3700 breast augmentation in
teenage girls and just as many breast reduction in teen boys. (I
guess we really are just a vain.) There are rare exceptions that
a defect you have make you repulsive ugly, then have it fixed. An
important thing we parents do is teach our children to accept what
God gave them like a bald head like mine. When you start down the
road of having this perfect body, then it is a sad road and you are
never happy with your body. Accept what you have. Everything will
eventually sag (darn gravity).
They just reported the first ever patient with Rabies living through
this terrible disease. They put the teenager into a coma, gave
antiviral drugs and vaccinations. The patient thought the bat just
brushed against her leg. And she thought sick bats would not fly. In
fact you cannot feel the bite of the bat so anyone coming in close
contact with a bat should get shots. It is better to prevent the
disease rather than trying to treat it, which is improving but you
probably will have some residual harm. So watch out for bats.
If you are thinking of government run health care, look to the
North. Canada's government-run health care reports that averaging
12 specialties in 10 provinces it takes 4 months to get a patient
into the hospital. It takes 1 year to get a hip replacement for
example. It has private clinics for the Mounted Police, workman's
comp cases, and prison inmates. There was a joke in the newspaper
up there about two prisoners talking. One prisoner asks the
cellmate "What are you in for?" Answer: "Hip replacement....." Our
system of healthcare in America is not perfect nor equal but it is
still the best in the world.
A friend of ours sat 5 rows behind Pres. Bush at the
inauguration. They passed the plate for donations at the prayer.
It is common knowledge that Pres. Bush does not carry any cash
money. So he whispered for some cash to put into the plate. V.P.
Chaney passed him some money and so did his father first Pres.
Bush. He took the money from his father and put the money into the
offering plate. The morals of this event are two: you never get too
old to ask for help from friends, and no matter how high in
society, your children never stop asking for money.... !!!!!!!!!
Dr. Roger Knapp
It is vogue and cool to
teach your infant/toddler sign language when you are teaching them to talk.
I worry about how good that is for them. Ten years ago we started teaching
the first graders “finger math” so that they could quickly figure addition
and multiplication problems easily using their fingers. But then they did
not memorize their math facts and were delayed in their ability to do
regular math problems on paper. So we quit it. I just worry that the
infant will rely on the hand language instead of learning to talk better.
In fact if the 2 year old is not talking well and getting everything he
wants by grunting and pointing, then I tell the parent to play like you do
not understand what he wants and don’t give it to him until he says it. It
will frustrate him but he will eventually understand that he is not going to
get what he wants until he communicates in the language that everyone
understands. There are quite a few children that learn both sign language
and verbal language but there are some that it slows them down.
Everyone has heard of the formulas with "Lipil".
This is an essential fatty acid called docosahexaenoic acid (DHA). This DHA
is needed in the development of the brain and retina of the eye. Studies
show improved development when there is higher intake of DHA in the diet of
infants. Also there is improvement if the mother takes in more DHA in her
diet the last trimester of the pregnancy. DHA you can get from fish oil and
fish but the risk of Mercury is too much. So pure extracts of DHA is
safer. The product Expecta is DHA that the pregnant mother can take every
day. Also if she takes it while breastfeeding her breast milk will have
more DHA and will be giving her infant "lipil breast milk". (You can make a
sticker and put it on your breast.. ha) The oriental mothers who eat alot
of fish have much more DHA than American mothers. Maybe that is why there
are many oriental children in the top of graduating high
school classes. Formulas have DHA added but Enfamil has the most. Good
Start has less and Similac has the least.
Iron is also needed for good brain development.
There is very little iron in breast milk compared with formula but we did
not see any anemic breast fed babies. But in studies coming out now show if
you compare breast fed babies who are given extra iron with those who are
not, the babies with iron developed better. So it would be better to give
breast fed infants vitamins with iron like Poly-Vi-Sol with iron or
Tri-Vi-Sol with iron.
causes blood infections and meningitis. This
meningococcal disease occurs at any age but is most common 15 to 24 yr old.
The 3000 cases that occur each year has an overall 10% mortality but the
15-24 has a mortality of 22% and 1/3 have major damage. We have been
recommending a meningococcal vaccine for many years for the seniors who are
going to college, but there is now a brand new meningococcal vaccine called
Menactra that is approved for 11-12 yr olds. At that age it will
protect them during high school as well as college, and also it eliminates
many carriers of the germ. Most insurance policies will not pay for it
since it is not required by high schools even though many colleges require
it. It is about $90 but I think it is worth it. It is a nasty germ and
even though not very frequent, it is a rapid and deadly infection.
and ulcers are mostly caused by a bacterial infection of the lining of the
stomach by a germ called H. pylori. Adults who were on antacids for years
were treated with medication to eradicate it from the stomach and then threw
away their antacids. It cured them (although it can relapse). China and
Japan have a much higher incidence of this problem and a higher incidence of
stomach cancer. A study just came out looking at 1500 patients. After 7
years there was 3% stomach cancer in the infected group and none in the
uninfected group. In another study those that were treated had 37% less
cancers. So there is not only a comfort issue in treating this but also a
health and longevity issue. Children can also have this infection and
sometimes is the cause of constant stomach aches in school children. This
germ can be detected by aspirating the stomach with a tube down the throat
(Ugh) or from a frozen stool specimen (less traumatic but more smelly!) or
blood test. (stool was the more accurate.) So if you are eating a lot of
antacids, get it checked out.
Diarrhea kills 600,000 children every year in the world. It is not
number one killer. Unsanitary drinking water kills 3,900 children every
day. The most important thing we could do for the underdeveloped
countries is to get them a water treatment system. Rotovirus is one of
the more common causes of severe vomiting and diarrhea around the world
and here in America. We should have a vaccine for it next year.
There will be 132,000 cases of Milignant Melanoma yearly and 66,000
deaths. Keep sunscreen on you and your children. Exposure to UV
rays below 18 yr old is worse and below 30 is bad. Tanning beds are
just as dangerous as sunbathing. Keep at least 20 SPF sunscreen or
higher on them when outdoors in the mid day. If the teens just have
to have the dark skin then use the tanning oils that are safe. I
thought shirts stopped most of the UV rays but they say they do not
and they recommend sunscreen below the shirts!!
Children are not born with most of their moles so don't be worried
that they start popping up with a lot of moles between 4 yr old and
Take photos with your digital cameras of the big moles on you and
your children so you know what they looked like last year and you
can show the dermatologist what they looked like. Make a file in
your documents for mole pictures.
Contact allergic reactions can occur with just about anything.
Every one knows about poison ivy. Whereas laundry detergents are
very rare. Actually what is very common is an allergy to Nickel.
It is in many kinds of jewelry and in snaps of clothing. Nichel
allergies can be as high as 14% of the population. That can be seen
in pierced earrings, snaps, coins before 65, deys, sools, school
chairs, orthodonic braces, and even foods.
Also antibiotic ointments can cause an allergic reaction. Some are:
Bacitracin, Neomycin Polysporin, and triple antibiotic Ointment.
Another allergen is fragrences like perfumes, personal care and
household products, opys, cosmetics, medications, diaper wipes.
Then there was the baby that was allergic to the plastic in the
pacifier and had a rash around the mouth all the time. Lanolin can
cause a reaction and that is in cosmetics, lotions, medications,
leather, furs, and also Eucerin and Aquaphor.
I guess anything can cause it so watch the rashes and watch what
they get around and watch for a coorelation.
You treat it with hydrocortisone cream or call us for a stornger
The rapid strep test that comes back in 4-5 minutes is fairly
accruate. A follow up culture was only positive 2% of the time when
there is a negative rapid test. So the rapid test is adequate.
Studies also showed that 5 days of Cephalosporin like Keflex had
only 8% failures where Penicillin had 16% failures. They did not
compare Amoxacillin but probably is similar. Sometimes we prefer
Amoxacillin since it helps sinus green mucous better than Keflex.
To make things more confusing, 4% of the population carry strep
around all the time in their throat so they have a sore throat from
allergies or something else then they do a culture and it is
positive for strep that has been in there all year. Plus the
culture is only accurate 90-95% of the time so you could have honest
to goodnest Strep throat and have a negative culture and not get
antibiotics. So the culture is not as accurate as you think.
There is a rare condition after strep infection where the child has
sudden onset of Obsessive Compulsive Disorder and nervous tics. It is
called Pandas and is a weird neurological condition after a strep
Kinda strange huh?
The most common source that infants get Whooping Cough is from the
adults that are in the house. In adults it is just a bad cough that
lasts for 3 months. But it can be dangerous for the infant. We
give DPT (P is for Pertussis or Whopping Cough) and the last time
they get it is at 4 years old. Then the immunity wears off and they
get it as a late teen or adult. There will be a vaccine this
summer for the 14 year olds that instead of just dT it will be a
Tdap with some pertussis in it. That way the adult will not cough
for 3 months and they will not give it to some infant.
of Circum. is rare and the benefits out weigh them:
2000 infections or
bleeding which are treated.
300 shaft repairs
which are not bad.
2 loss of falus
which is horrible.
Illnesses that are
prevented with Circ:
7000+ cases of HIV
that cannot be cured.
10,000+ cases of
Syphilis that usually can be treated.
20,000 cases of
kidney infections that can be treated but leave scars.
1000 cases of falus
cancer and loss of falus which is horrible.
200,000 cases of
phimosis (stricture) which can be treated buy painful.
500,000 cases of
infected foreskin that can be treated but is painful
The statin drugs like Lipitor are
very important advances in lowering cholesterol and are important to use
if you have high levels at any age. We are sometimes even testing 14-18
yr olds to treat if they have high levels. These statin drugs can cause
birth defects up to 40% of the babies and it is very important not to
take them when getting pregnant. The ones with Cerivstatin, Simvastatin,
Lovastatin and Atorvastatin are very bad. But one that does not go to
the baby and not cause birth defects is Pravastatin. I would not take
any of them if I were getting pregnant (?) but if one just has to take
one, then take the pravastatin.
Ten ways for Parents to help their teens avoid
1. Set a good example.
2. Know your child's whereabouts, activities,
3. Eat dinner together regularly
4. Set fair rules and hold your child to them.
5. Be caring, supportive and maintain open lines
6. Have a strict dress code and don't let them
wear clothes that the "bad" kids wear.
7. Surround your child with positive role
8. Incorporate religion or spirituality into
9. Learn the signs and symptoms of teen
substance abuse and conditions that increase risk.
10. If problems occur, get help sooner rather
Bug spray and Sunscreen
Use of Deet has been shown to be safe
and effective in preventing insect bites. It can be used down to 2 months
of age in concentrations of up to 25%. I prefer to keep it at 10-15%
preparations and more start it’s use at 4-6 months old. All concentrations
are just as effective but the higher ones last longer time. The 10% deet
repels just as good as the 50% but they last a different length of time. I
like to put less on the skin but apply it more frequently. 10% lasts 2
hours, 30% lasts 5 hours, and 50% lasts 10 hours. Older kids can use the
higher concentrations and teens can use the 50% deet without worry. Do not
apply to the hands of infants and small children. You can spray your hand
and apply it to the face of infants. Careful about applications of deet.
It can harm plastics (eyeglass frames) synthetic fibers like rayon and
spandex, leather, some watch crystals. It does not harm cotton or wool.
There are two other repellants without
deet. One is Picaridin is a synthetic safe repellant that does not harm
fabrics like deet and it only lasts 2 hours. It is available in 7%
concentrations (Cutter Advanced) The other product is Oil of lemon
eucalyptus which is a plant based repellent and lasts 90 minutes of
Sunscreen products are variable and
act differently. The SPF is confusing. The higher number only lasts longer
but does not protect any better.(Just like the deet.) The SPF 15 will
protect even very sensitive skin but only lasts 2 hours. The SPF 30 would
last 4 hours. The mistake is not putting enough on the skin to get the full
effect and less SPF 15 would result in an effect of SPF 7. So put plenty on
the skin. So many people recommend 20-30 SPF because they figure you will
not put enough on the skin. You should use a sunscreen that protects both
UVA and UVB rays. Apply it 30 minutes before going out and apply it before
you put Deet repellents on the same areas. Do not use the combined products
that have sunscreen and repellents in it. Apply sunscreen every 2 hours.
The water resistant or sweat resistant products only last 40 minutes and the
“very water resistant” products only last 80 minutes. So you need to apply
them when swimming very frequently. Consider putting a small T-shirt on
them when swimming a long time. They are also starting to manufacture “wet
suit” type tops for children to wear. One study from Europe showed children
whose parents always kept shirts on their children had far less moles as
adults than those who did not wear shirts. Tanning beds are worse than the
sun so use the tanning chemicals, which are safer.
We still see
sunburns in children even though we warn that 2 sunburns will double
your chance of Melanoma later. 80% of our lifetime sun exposure occurs
before 18 yr of age. So keep them covered with this stuff. Just like
buckling up in the car, think before you go and keep them safe.
I raced into the grocery
store, 8‑month‑old in my arms and 3‑year‑old in hand, to pick up Tylenol, a
prescription and a few groceries. I was on my way home from the
pediatrician's office, and my to‑do list was nowhere near done. There was
dinner to cook as well as housework and dirty diapers waiting for me at
home, and a meeting to attend that night.
I gathered up the things
we needed and hit the checkout counter, impatiently waiting to get my change
so I could dash out the door, when all of a sudden an older woman came up
behind me. She stopped me and said, "Slow down and enjoy your boys while
they're little. The time will go so fast! My two sons are grown and live on
different coasts. How I miss them and wish I could see them and spend the
day with them!"
The time didn't seem to be
going fast. Those were the days when I could barely see over the stacks of
dirty diapers, when I was cooped up with my children's bouts of bronchitis
or ear infections, spilled milk and whines of "Mommy!" On those days, it
seemed like I hadn't talked to an adult in what seemed like weeks. It didn't
help that my husband worked long hours. Because we were newcomers to the
city, I didn't know any other moms.
Yet I knew the woman was
right. When I went home that day and days afterward, I slowed down enough to
make Lego forts and castles with my boys and then stroll with them to the
park to play.
Perhaps you've received
similar advice from an older mom, too, but it bears pondering again. The
truth is, your kids' childhood will pass so quickly. As Dorothy Evslin said,
"It will be gone before you know it. The fingerprints on the wall will
appear higher and higher, and then suddenly they disappear."
In the twinkling of an
eye, they'll be taking off for college or career. Try this little exercise:
Close your eyes and picture your child strolling down the aisle with his
graduating class. Decked in cap and gown, he walks across the stage when his
name is called and grasps his diploma. Then a few short months later, he
piles all his stuff in his car and heads across the country for college.
Graduation photos on the piano; Little League baseball trophies and GI Joes
stored in the attic. No music blaring from his room.
When that happens, you
won't be thinking, I wish I’d spent more time at the office or polishing
Focus on the Family by Cheri Fuller
The baby is teething-the children are fighting. My husband just
called and said to eat dinner without him. Okay, one of these days
you'll shout: "Why don't you grow up and act your age!" and
they will, or "You guys get outside and find yourselves something
to do...and don't slam the door!"...and they won't.
You'll straighten up their rooms neat and tidy...bumper stickers
discarded...spreads tucked and smooth ... toys displayed on the
shelves...hangars in the closet...animals caged, and you'll say
outloud: "Now I want it to stay that way!" and it
will...You'll prepare a perfect dinner with a salad that hasn't been
picked to death and a cake with no finger traces in it and you'll
say, "Now there's a meal for a company." and you'll eat it
You'll say, "I want complete privacy on the phone. No dancing
around, no pantomimes, no demolition crews. Silence! Do you hear?"...and
you'll have it. No more plastic tablecloths stained with spaghetti,
no more anxious nights under a vaporizer tent, no more dandelion
bouquets, no more iron-on patches, knotted shoestrings, or tight
Imagine, a lipstick with a point, no babysitter for New Year's
Eve, washing clothes only once a week, no P.T.A. meetings, carpools,
blaring radios, Christmas presents out of toothpicks and paste. No
more "Wet Oatmeal Kisses". No more toothfairy giggles in the dark,
or knees to heal.
Only a voice crying..."Why don't you grow up?"... and the
silence echoing ......."I did."
Not to scare you but just so you can put things
In the whole world newborn deaths:
3 % Diarrhea
7 % Other
8 % Congenital
23% Asphyxia (Not breathing)
28% Preterm (preme)
The death rate in the world in children less
than 5 yrs:
Justs reminds us how lucky we are to live in the
For a long time conventional wisdom has
been that it is good for teenagers to work after school. There are more than 5
million teens less than 18 working in America. Two different organizations
studying this found teens working more than 20 hours a week, had lowers grades,
higher alcohol use, and too little time with their parents and families.
Between 16 and 19 yrs. old, the percent teens working are: 53% Americans, 30%
Germany, and 18% Japan. But then how can they pay for their car and stuff. You
might think about limiting the hours they work!
Well the new Harry Potter Book came out and
I have had several patients who have already read it. One 11 yr old
said she read it in 24 hours!!! Kids are starting to read and this book
has inspired many children to read more. It has improved their reading
skills. In 2001 75% of children 11-13 yr old and 20% of adults said
that they had read at least one of the books. But there has been a
decline in reading over the last several decades. The number of 17 year
olds who reported never or hardly ever reading for fun rose from 9% in
1984 to 19% in 2004. Hopefully these books will begin a new trend in
children reading novels for fun and we will see an improvement in the
future. I personally do not think these books are "bad" because it
deals with Magic and witches. It is not any worse than star wars that
has more violence in it and they use magic light swords. What about
sleeping beauty with the witch and the apple. Harry Potter deals with
good over evil. And it helps children want to read more. 60% of UK
children say that the books have made them a better reader. If you have
not read them, get the potter books on CD. The man who reads it is
wonderful and it sure does make the trip to work go quick. They are
great books for adults too.
Roger Knapp MD
You also might get the series of books:
Artemis Fowl . They are just as good but no witches.
Well we are doing better in some areas and not so good in others:
Unintentional Injuries: 1-4 yr old:
36.8 10.7 per 100,000
Homicide: 1-4 yr 0.6
15-24 yr 6.3
Suicide: 1-4 yr __
So we get hung up in the stress of making our children perfect that we
loose sight of the end goal. Note this:
"He didn't look like much at first. He was
too fat and his head was so big his mother feared it was misshapen or
damaged. He didn't speak until he was well past 2, and even then with a
strange echolalia that reinforced his parents' fears. He threw a small
bowling ball at his little sister and chased his first violin teacher
from the house by throwing a chair at her. There was in short, no sign,
other than the patience to build card houses 14 stories high, that
little Albert Einstein would grow up to be 'the new Copernicus,'
proclaiming a new theory of nature, in which matter and energy swapped
faces, light beams bent, the stars danced and space and time were as
flexible and elastic as bubblegum. No clue to suggest that he would help
send humanity lurching down the road to the atomic age, with all its
promise and dread, with the stroke of his pen on a letter to President
Franklin D. Roosevelt in 1939, certainly no reason to suspect that his
image would be on T‑shirts, coffee mugs, posters and dolls."
I think my main complaint of our education
system is that we put huge amounts of money and effort into our
weaknesses and very little into our strengths and talents. But that is
where we will end up as far as our jobs and hobbies. So Michael Angelo
could not go to art class because he was slow in reading. Albert
Einstein could not go to Physics because he was Dyslexic and could
barely read. He failed his college admission test. And look at his
hand writing... Oh my God!! The loop did not go up to the line!!! So
keep the big picture in mind when raising our kids and work on their
strengths.... and it is amazing how some of the most troublesome kids
turn out good. Keep on "Keeping on". Yea for Helen Keller who kept on
trying.... and Mrs. Sullivan who probably wondered every day how the end
result would be.
There are some changes in the vaccine
1. Instead of giving the 12-14 yr olds the
Td (tetanus and diptheria) it will be replaced this next week with TdP
which includes pertussis (Whooping Cough). The reasoning:
In the United States, from 1934 through 1943 an annual average
of 192,752 pertussis cases and 4,034 pertussis-related deaths
were reported. Following the introduction of childhood
pertussis vaccination during the 1940s, the number of
reported pertussis cases declined dramatically to a
historic low of 1,010 in 1976. However, since the 1980s
the number of reported pertussis cases has been steadily
increasing (see figure), especially among adolescents and
adults. Reported cases in adolescents ages 11 to 18 years
have increased from less than 200 cases per year in the early
1980s (incidence less than 1/100,000) to 4,144 cases in 2003
In 2004, provisional data show more than 18,000 reported
cases. Numerous school and community outbreaks have
occurred across multiple states. A repeating theme is
that source cases and highest attack rate often are in
middle schools (frequently in classrooms or gatherings
related to school activities) with rapid spread
throughout the school and into families and the community.
Reasons for the changing epidemiology of pertussis include
waning immunity from a parenteral vaccine given in
childhood against a mucosal respiratory tract disease
years later, fewer natural boosts in immunity because of
partial control of pertussis, an aging cohort who may
have received less effective pertussis vaccine or no
pertussis vaccine, and increased awareness of pertussis
in older individuals.
The Whooping cough in adults does not kill you but you can give
it to infants less than 6 months old and it is real bad for them. Also you
cough for 3 months as an adult and that is not fun.
2. The other change is the requirement of Hep A vaccine for
preschool kids 2 and older. We cannot give it until 2 yr so we will be
giving the shots to 2 yr olds. There is a second booster of Hep A that is
given 6-12 months later also. The Hep A is recommend for school age
children but not required at this time. I really don't push this vaccine
for school kids unless they are going to live in foreign countries that have
poor sanitation or live along the Mexico border.
We will be giving the TdP to teens 11-14 yr old and with the
meningitis vaccine Menatra (Meningococcal Meningitis vaccine that is needed
before College but can affect high school kids too).
PS: There is a really cool
site for underwater pictures and even a live cam.
Breath holding spells:
This occurs in children starting 1-2 yrs old
and usually gone by 4 yr old. It is where the child is usually hurt
physically or emotionally and when crying they hold their breath, turn
blue and pass out. When they pass out they start breathing again and
get up OK and the follow up in these children are normal. It is
associated in many children with iron deficiency anemia and when treated
with iron the spells stop. It is quite frightening to the parents and
must not be confused with a seizure. There also can be a very few
children who have a pale episode of passing out without holding their
breath and not turning blue. They are pale and white. There is a minor
head trauma that triggers a brief stopping of the heart with a temporary
drop in blood pressure. There is no crying and not holding their
breath. They need to be tested with an ECG to see if they have a short
QT Interval Syndrome. These are not as common.I recommend iron and
vitamins and Zinc to all children at 1 yr old and I hardly ever see this
problem. Give your kids vitamins with iron and zinc the whole time you
have them with you ...until 19 yr ...(or 29).
What is it?
Sever's disease or Calcaneal apophysitis
is a condition that affects children between the ages of 10 and 13
years. It is characterized by pain in one or both heels with
walking. During this phase of life, growth of the bone is taking
place at a faster rate than the tendons. Hence there is a relative
shortening of the heel-cord compared to the leg bones. As a result,
the tension the heel-cord applies to the heel bone at its insertion
is very great. Moreover, the heel cord is attached to a portion of
the calcaneus (heel bone) that is still immature, consisting of a
mixture of bone and growing cartilage, called the calcaneal
apophysis, which is prone to injury. Compounding to this is the fact
that all these changes are happening in a very active child, prone
to overuse. The end result is therefore an overuse syndrome of
injury and inflammation at the heel where the heel cord (Achilles
Tendonitis) inserts into the heel bone (Calcaneal apophysitis).
What are the symptoms?
The typical patient is a child between 10 and 13 years of age,
complaining of pain in one or both heels with running and walking.
The pain is localized to the point of the heel where the tendo-Achilles
inserts into the calcaneus, and is tender to deep pressure at that
site. Walking on his toes relieves the pain.
What does your doctor do about it?
X-rays are normal in Sever's disease, but your doctor will
probably get X-rays to rule out other problems. Treatment consists
of non-steroidal anti-inflammatory medications and use of a heel
lift to relieve tension on the calcaneal apophysis. In more severe
cases, phycical therapy consisting of modalities to relieve the
pain, and stretching exercises may be helpful. In extreme cases,
castings have been used.
What can be expected of the future?
Sever's disease is an overuse syndrome involving an immature part
of the skeleton. Pain goes away when the overuse is over, or when
the growing is done. Hence, the disease is self-limited, in that the
pain goes away eventually when growth in the heel bone is complete
at about age 13. Even if the child is hurting, as long as he can
tolerate it, he may continue to take part in sports. No long term
disability is expected from this problem.
Calcium requirements for
0-6 months old
6-12 months old
1-3 years old
4-8 years old
8-10 years old
11-18 years old
Yogurt, plain, low fat
Collards, frozen, boiled
Spinach, frozen, boiled
Yogurt, plain, whole milk
Cheese food, pasteurized
Cottage cheese, 1% milk fat
Baked beans, canned
Trail mix (nuts, seeds,
1 oz (24 nuts)
Blackeye peas, boiled
Green peas, boiled
So milk intake should be
12-24 oz a day by one year old and stay there for many
years. By 8-10 years it
increases if they are not taking in much other calcium.
When they go into puberty,
they recommend 1500 mg of calcium for females and
1200 for males. That is a
lot of milk so I recommend calcium for most teens. Usually
500-1000 mg a day plus the
milk and ice cream that they do eat. Then they will have less
Osteoporosis as an older
Plus give vitamins to
children at all ages. We just do not eat right most days.
Focus on the
by Cheri Fuller
I raced into the
grocery store, 8‑month‑old in my arms and 3‑year‑old in hand, to
pick up Tylenol, a prescription and a few groceries. I was on my way
home from the pediatrician's office, and my to‑do list was nowhere
near done. There was dinner to cook as well as housework and dirty
diapers waiting for me at home, and a meeting to attend that night.
I gathered up the
things we needed and hit the checkout counter, impatiently waiting
to get my change so I could dash out the door, when all of a sudden
an older woman came up behind me. She stopped me and said, "Slow
down and enjoy your boys while they're little. The time will go so
fast! My two sons are grown and live on different coasts. How I miss
them and wish I could see them and spend the day with them!"
The time didn't
seem to be going fast. Those were the days when I could barely see
over the stacks of dirty diapers, when I was cooped up with my
children's bouts of bronchitis or ear infections, spilled milk and
whines of "Mommy!" On those days, it seemed like I hadn't talked to
an adult in what seemed like weeks. It didn't help that my husband
worked long hours. Because we were newcomers to the city, I didn't
know any other moms.
Yet I knew the
woman was right. When I went home that day and days afterward, I
slowed down enough to make Lego forts and castles with my boys and
then stroll with them to the park to play.
received similar advice from an older mom, too, but it bears
pondering again. The truth is, your kids' childhood will pass so
quickly. As Dorothy Evslin said, "It will be gone before you know
it. The fingerprints on the wall will appear higher and higher, and
then suddenly they disappear."
In the twinkling
of an eye, they'll be taking off for college or career. Try this
little exercise: Close your eyes and picture your child strolling
down the aisle with his graduating class. Decked in cap and gown, he
walks across the stage when his name is called and grasps his
diploma. Then a few short months later, he piles all his stuff in
his car and heads across the country for college. Graduation photos
on the piano; Little League baseball trophies and GI Joes stored in
the attic. No music blaring from his room.
When that happens,
you won't be thinking, I wish I’d spent more time at the office or
polishing the floors.
Perhaps your home
is still filled with the footsteps of little or big kids that run,
skip or jump but rarely walk. Lucky you! Or you're on the verge of
your kids flying from the nest. As my friend Melina told me one
summer, "In two years Tim will be gone to college! I wish I could
make time stop! It's moving too fast!"
While we can't
make time stop as life proceeds and our children grow, what can we
do to savor and enjoy the time we do have together? How can a mother
make the most of those fleeting and sometimes exhausting yet sweet
years of childrearing?
Don't put off joy.
"When my little girl gets potty trained, when I lose the extra
weight I gained in pregnancy, I'm going to be so much happier," a
young mom told me recently. When our finances aren't so tight, if my
husband’s not so stressed, if I get my house redecorated, when my
prodigal teen starts loving God and makes better choices.... If we
stake our joy on the “whens and ifs," we'll miss out on the joys and
blessings God has for us in each season of parenting, even those
that are difficult and filled with unfinished projects, toddlers
resisting potty training or challenging teens.
Instead we can
focus on living life fully today and realize there is something in
every season to enjoy: Picking strawberries and camping out in the
backyard in summer, baking gingerbread cookies and drinking hot
chocolate in winter, having a "color walk" in the spring as you walk
around the block and have them name all the red (or green or yellow)
things they see. You can even see sick days as a time to fill up
your kids' emotional tanks, a time to hug, sip hot apple juice,
cuddle up and read books together. Every day there are miracles and
things to celebrate: a purple‑and‑rose sunset, your child's first
sentence, a sticky kiss or even a goldfinch at your bird feeder.
Find your own
"Slowdown spots of time" together. As moms, we can get so focused on
getting everything done that we begin to look at our children as
interruptions instead of our priority. We get so busy and
overcommitted; we and our kids continually rush from one place to
another. When you take time to lie on a quilt and look up at the
stars in the night sky, time slows down a little. And moments to sit
on the edge of your child's bed to listen and pray for her, to fly a
kite or blow bubbles in the spring breeze are precious. (Go on a
Make time for what
really matters. Whatever the most important things in your life‑the
love of husband, kids, friends; the joy of knowing God; helping a
friend in the hospital; opening your door in hospitality; or
teaching your kids about Jesus‑ask yourself, Am I using my time to
do these things? Talk with your family about the one thing you don't
want to miss doing this spring or summer and then just do it.
Life is a gift.
Our children are a gift, and each day together is a gift. As we give
our time to God each day, don't put off joy, and keep in mind what's
Head lice crops it's "head" up each
year. There were some recent studies that showed that many head
lice are becoming resistant to antibiotic shampoos like Rid and
such. In the past we have talked about smothering the lice with
olive oil on the hair. Recent studies have shown that using a
rinse conditioner in the hair and combing with a "nit" comb
would remove most lice. But you have to get them as they hatch
and repeat the conditioner and combing once every 3 days for 2
weeks. If you combined that with soaking the hair in olive oil
the next day and the third day use the Rid rinse, then we should
be able to get them all and cure it without bad chemicals.
Or you could shave your head bald
like me... ha ha!
Although childhood malignant melanomas are rare, physicians and
parents must keep an eye out for them. About 2% of all
melanomas appear in children, but the types that commonly occur
in children are different from those found in adults. Melanomas
in children arise from three things: 1. congenital nevi (moles
that are there at birth), 2. de novo nodular nevi (moles that
come up new as they grow older), and 3. superficial spreading
melanomas that are sun induced from moles that have been there
Although 70% of melanomas in adults are sun induced and are
superficial spreading melanomas, about 80% in children arise
from congenital moles or de novo nodular lesions. There are very
different concepts of melanoma in childhood.
Congenital moles that occur in 2% of children arise during the
first 4 months of life. Most are small, less than 1.5 cm.
Excision of congenital moles is not necessary in infancy. It
is suggested that children with these moles be followed closely
by parents and physicians. In children, these are more important
than the other moles. Melanomas in small congenital moles
usually occur at or after puberty so they should be removed
before puberty, especially if the mole is on the scalp, face,
or trunk. Giant moles in children and those over 6 cm in a
newborn, have a 5%-8% chance of melanoma risk. Many of these
nevi are too large to totally excise.
The second most common type in children is nodular melanoma,
constituting 40% of the melanomas in childhood. The nodules are
rapidly growing and a red, bluish purple in color. They often
ulcerate and, at times, bleed. This is a highly fatal type.
The nodules are thick at the time of diagnosis.
And, in third place are the superficial spreading malignant
melanomas. Here the ABCD rule applies: asymmetry, border
irregularity, color variation, and diameter over 6 mm. However,
the idea that the lesion in a child has to be more than 6 mm is
not reality. This type is increasing because of the sun
exposure of kids.
adults, melanomas start out as a speck, and only 20%-40% start
in preexisting moles. About 60%-80% start in de novo moles (new
moles that are just beginning). It's the new kid on the block,
the new mole that can get you into trouble. All moles have some
potential to develop melanoma, but it is very low. Congenital
nevi have the most potential.
person has more than 100 moles, a family history of melanoma,
and several large atypical nevi, there is a 50% chance of
melanoma. These individuals have to be followed carefully.
Teenagers that fit this category should be followed like a
recognition and referral is essential, followed by biopsy and
surgical excision. Adjunctive therapies have marginal
additional value. The depth of the lesion is extremely
important, with a depth of less than 1 mm being 95% curable and
up to 3 mm being 40% curable.
has been a 20-fold increase in the incidence of melanoma since
1930. This was about the time that people decided to get silly
and take off their clothes for recreational sun.
A study came
out showing lower birth weight of children of mothers who had
dental x-rays during their pregnancy. Even small amounts of
radiation can cause small babies. Wait 9 months to get the
x-rays if they really are needed. I would not get them anyway
unless there are compelling reasons. X-rays should not be a
routine part of the routine visit to the dentist or emergency
From the Wall Street Journal, July 2005:
We are a nation of take-outers and drive-throughers, eating our
meals on the go, dining by ourselves and laughing alone. The
family dinner has become an endangered species. .. . These days,
fewer than one-third of all children sit down to eat dinner with
both parents on any given night. The statistics are worse if
both parents are working and the family is Caucasian (Latino
families have the highest rate of sharing a meal). The decline
in the family dinner has been blamed for the rise in obesity,
drug abuse, behavioral problems, promiscuity, poor school
performance, illegal file sharing and a host of other ills. A
recent study at the Harvard Medical School, for example,
concluded that the odds of being overweight were 15% lower among
those who ate dinner with their family on 'most days' or 'every
day' compared with those who ate with their family 'never' or on
'some days.' The National Center on Addiction and Substance
Abuse at Columbia University found that teens from families that
almost never eat dinner together are 72% more likely to use
illegal drugs, cigarettes and alcohol than the average teen.
Roger Knapp MD
Here are the American
Pediatric Recommendations for decreasing SIDS.
Have a great
Thanksgiving..... Dr. Knapp
RECOMMENDATIONS to Prevent SIDS
The recommendations outlined here
were developed to reduce the risk of SIDS in the general
population. As it is defined by epidemiologists, risk refers to
the probability that an outcome will occur given the presence of
a particular factor or set of factors. Scientifically identified
associations between risk factors (eg, socioeconomic
characteristics, behaviors, or environmental exposures) and
outcomes such as SIDS do not necessarily denote causality.
Furthermore, the best current working model of SIDS suggests
that more than 1 scenario of preexisting conditions and
initiating events may lead to SIDS. Therefore, when considering
the recommendations in this report, it is fundamentally
misguided to focus on a single risk factor or to attempt to
quantify risk for an individual infant. Individual medical
conditions may warrant a physician to recommend otherwise after
weighing the relative risks and benefits.
1. Back to sleep: Infants should
be placed for sleep in a supine position (wholly on the back)
for every sleep. Side sleeping is not as safe as supine sleeping
and is not advised.
2. Use a firm sleep surface: Soft
materials or objects such as pillows, quilts, comforters, or
sheepskins should not be placed under a sleeping infant. A firm
crib mattress, covered by a sheet, is the recommended sleeping
Keep soft objects and loose bedding out of the crib: Soft
objects such as pillows, quilts, comforters, sheepskins, stuffed
toys, and other soft objects should be kept out of an infant's
sleeping environment. If bumper pads are used in cribs, they
should be thin, firm, well secured, and not “pillow like.” In
addition, loose bedding such as blankets and sheets may be
hazardous. If blankets are to be used, they should be tucked in
around the crib mattress so that the infant's face is less
likely to become covered by bedding. One strategy is to make up
the bedding so that the infant's feet are able to reach the foot
of the crib (feet to foot), with the blankets tucked in around
the crib mattress and reaching only to the level of the infant's
chest. Another strategy is to use sleep clothing with no other
covering over the infant or infant sleep sacks that are designed
to keep the infant warm without the possible hazard of head
4. Do not smoke during pregnancy:
Maternal smoking during pregnancy has emerged as a major risk
factor in almost every epidemiologic study of SIDS. Smoke in the
infant's environment after birth has emerged as a separate risk
factor in a few studies, although separating this variable from
maternal smoking before birth is problematic. Avoiding an
infant's exposure to second‑hand smoke is advisable for numerous
reasons in addition to SIDS risk.
5. A separate but proximate
sleeping environment is recommended: The risk of SIDS has been
shown to be reduced when the infant sleeps 'in the same room as
the mother. A crib, bassinet, or cradle that conforms to the
safety standards of the Consumer Product Safety Commission and
ASTM (formerly the American Society for Testing and Materials)
is recommended. "Cosleepers" (infant beds that attach to the
mother's bed) provide easy access for the mother to the infant,
especially for breastfeeding, but safety standards for these
devices have not yet been established by the Consumer Product
Although bed‑sharing rates are
increasing in the United States for a number of reasons,
including facilitation of breastfeeding, the task force
concludes that the evidence is growing that bed sharing, as
practiced in the United States and other Western countries, is
more hazardous than the infant sleeping on a separate sleep
surface and, therefore, recommends that infants not bed share
during sleep. Infants may be brought into bed for nursing or
comforting but should be returned to their own crib or bassinet
when the parent is ready to return to sleep. The infant should
not be brought into bed when the parent is excessively tired or
using medications or substances that could impair his or her
alertness. The task force recommends that the infant's crib or
bassinet be placed in the parents' bedroom, which, when placed
close to their bed, will allow for more convenient breastfeeding
and contact. Infants should not bed share with other children.
Because it is very dangerous to sleep with an infant on a couch
or armchair, no one should sleep with an infant on these
6. Consider offering a pacifier at
nap time and bedtime: Although the mechanism is not known, the
reduced risk of SIDS associated with pacifier use during sleep
is compelling, and the evidence that pacifier use inhibits
breastfeeding or causes later dental complications is not. Until
evidence dictates otherwise, the task force recommends use of a
pacifier throughout the first year of life according to the
The pacifier should
be used when placing the infant down for sleep and not be
reinserted once the infant falls asleep. If the infant refuses
the pacifier, he or she should not be forced to take it.
Pacifiers should not
be coated in any sweet solution.
Pacifiers should be
cleaned often and replaced regularly.
infants, delay pacifier introduction until 1 month of age to
ensure that breastfeeding is firmly established.
7. Avoid overheating: The infant
should be lightly clothed for sleep, and the bedroom temperature
should be kept comfortable for a lightly clothed adult.
Overbundling should be avoided, and the infant should not feel
hot to the touch.
8. Avoid commercial devices
marketed to reduce the risk of SIDS: Although various devices
have been developed to maintain sleep position or to reduce the
risk of rebreathing, none have been tested sufficiently to show
efficacy or safety.
9. Do not use home monitors as a
strategy to reduce the risk of SIDS: Electronic respiratory and
cardiac monitors are available to detect cardiorespiratory
arrest and may be of value for home monitoring of selected
infants who are deemed to have extreme cardiorespiratory
instability. However, there is no evidence that use of such home
monitors decreases the incidence of SIDS. Furthermore, there is
no evidence that infants at increased risk of SIDS can be
identified by inhospital respiratory or cardiac monitoring.
10. Avoid development of positional
time" when the infant is awake and observed. This will also
enhance motor development.
Avoid having the
infant spend excessive time in car‑seat carriers and "bouncers,"
in which pressure is applied to the occiput. Upright "cuddle
time" should be encouraged.
Alter the supine head
position during sleep. Techniques for accomplishing this include
placing the infant to sleep with the head to one side for a week
and then changing to the other and periodically changing the
orientation of the infant to outside activity (eg, the door of
should be taken to implement the aforementioned recommendations
for infants with neurologic injury or suspected developmental
be given to early referral of infants with plagiocephaly when it
is evident that conservative measures have been ineffective. In
some cases, orthotic devices may help avoid the need for
11. Continue the Back to Sleep
campaign: Public education should be intensified for secondary
caregivers (child care providers, grandparents, foster parents,
and babysitters). The campaign should continue to have a special
focus on the black and American Indian/Alaska Native
populations. Health care professionals in intensive care
nurseries, as well as those in well‑infant nurseries, should
implement these recommendations well before an anticipated
Calcium requirements for
0-6 months old
6-12 months old
1-3 years old
4-8 years old
8-10 years old
11-18 years old
Yogurt, plain, low fat
Spinach, frozen, boiled
Yogurt, plain, whole
Cottage cheese, 1% milk
Baked beans, canned
Trail mix (nuts, seeds,
1 oz (24 nuts)
Blackeye peas, boiled
Green peas, boiled
So milk intake should be
12-24 oz a day by one year old and stay there for many years.
Too much milk
and they get anemic and
will not eat a proper solid food diet. The children usually are
in that range of 12-24 oz
where their height/weight
is on the growth curves. For example if they are at the 50%
then they would usually
take in about 18oz a day.
If they are big and at the 90% height/weight, then they would be
taking in 24 oz a day.
Then they get the few
hundred mg of Calcium from cheese, ice cream, and other foods
that have calcium.
IF they are allergic to
milk then they can drink SILK (non-dairy milk) or the Orange
Juice with calcium.
Or they can take a 500 mg
chewable calcium from the stores.
By 8-10 years requirements
increase and it goes higher at puberty. When they go into
recommendations are 1500
mg of calcium for females and 1200 for males. That is a lot of
(three 8 oz glasses) so I
recommend calcium supplements (and multiple vitamins) for most
1000 mg supplement a day
plus the milk and ice cream that they do eat. The average teen
300 mg a day.
We can load up their bones
with calcium during their rapid growing years and prevent
in their later years.
Plus give vitamins to children at all ages past one year.
We just do not eat right most days. Plus we eat less red
meat. Any vitamin that has Iron and Zinc.
Dental Caries by Michele Sullivan
Altering the oral flora
by dietary management and dental in-tervention
can alter the cariogenic process
in young children, lessening
the chance of decay in
primary and permanent teeth,
said at the annual
meeting of the American Academy
"We can address this as preventive medicine,"
said Dr. Hale, a pediatric dentist in
Brighton, Mich., and a member
of AAP's executive
committee on pediatric dentistry.
"Don't wait until kids have a
Managing the population of oral bacteria,
both in the child and the mother, is the
key to preventing caries in children. "We
want to decrease the percentage of cariogenic bacteria, and increase
strains," Dr. Hale said.
Humans don't have an established
oral bacteria population until they get a
tooth, Dr. Hale said. Mothers are the primary source of bacterial
their infants. If a mother has active decay,
she also has many cariogenic and few non-cariogenic
strains. This is the ratio she will pass on to her infant.
There are several steps to managing
maternal oral flora: removing active decay,
changing diet, and improving dental hygiene.
All of these will decrease the
amount of cariogenic bacteria," he said.
"This is important because the longer
these bacteria sit on the teeth, the more acid they produce, which
growth of noncariogenic flora."
Xylitol gum can be an important part of this strategy, he said. The
growth because bacteria can't
process it. The action of chewing
increases salivary production
and helps remove plaque.
Finnish study looked at the effect
of xylitol gum on
maternal and child levels of
compared with women
who chewed fluoride or chlorhexidine
gum. None of the children received
any of the treatments.
whose mothers chewed xylitol
gum had 70%
fewer cavities than those in
the other groups (J. Dent. Res.
These strategies are useful for children
as well, Dr. Hale said, with diet of primary
importance. "The main problem is carbonated
beverages. You should be counseling
your patients to drink milk and
water between meals, and only 4-6
of undiluted fruit juice per day, [and] only
Remind parents that bottles of milk or
juice at bedtime promote decay-causing bacteria. Children who cruise
cups" of juice throughout the day also are
at risk. Older children who chew gum
should chew the xylitol variety.
Children's teeth should be brushed
twice a day and flossed once a day (yea … Right!), even if
they only have one
or two teeth (How do you floss one tooth?). Fluoride
supplements can be useful in
teeth and reducing bacteria, but it's
important to do a very thorough
prescribing these, he stressed.
"Even if they have fluoride in the water,
the kids may be drinking bottled water
without fluoride," Dr. Hale said. Conversely,
children may live in an area without
fluoridated water but attend day care
in an area that has it, or be drinking bottled
beverages made with fluoridated water.
Over dosages of fluoride can cause
brown spots on developing
teeth, he said.
Pediatricians should be checking the
teeth at every visit. Sometimes an exam
will reveal chalky-looking white marks
near the gum line. "Using an otoscope to
examine the teeth can help you see this."
The white areas are acid-etched enamel, a
sign of impending decay, Dr. Hale said.
Check the teeth for plaque accumulation
and the gums for inflammation. To
check for inflammation, wiggle the bristles
of a soft toothbrush between the teeth; if the gums are inflamed,
blood will ooze a
few seconds after brushing stops.
If there is no
plaque and no inflammation,
patients are doing a good job with hygiene.
If you see inflammation without
plaque, you are looking at a
case of "performance
brushing," Dr Hale said. "These
are the kids who get their
teeth brushed real well
before they come in to see you,
but who don't do it regularly
If you see plaque without inflammation, the child probably has poor
and is drinking a lot of sugary liquids. Restrict
amounts of juice to only with meals.
So Mommys... keep your teeth in good condition.