study looked at children who were allergic to eggs. 55% could tolerate eggs
in cooked food, and over half out grew their allergy by 7 years old. 45%
outgrew their allergy to milk. Very few outgrew their allergy to shellfish
or tree nuts. (Peanuts are not a nut. They are a legume in the roots of
plants. Allergy to nuts does not automatically mean they are allergic to
peanuts and visa versa.) There is no reason to delay giving certain foods
to children when the parent is allergic to it. There are more allergies to
these foods the later you introduce them into their diet.
vaccines contain eggs. But they are duct eggs and processed in the
production of the vaccine. Almost never is there an allergic reaction to
vaccines in persons allergic to eggs. In persons who allergic reaction to
eggs was only hives, then the CDC recommends giving the vaccine to the
patient and observe them for 20-30 minutes.
Outbreaks of acute gastroenteritis (AGE) often occur in closed populations,
such as institutionalized persons or cruise ship passengers as well and the
general community. Recent epidemiologic investigations of outbreaks of AGE
have confirmed that >95% of cruise ship AGE outbreaks and 50% of children’s
stomach bugs are caused by norovirus (NoV). Although the use of
alcohol-based hand rub has been promoted to limit the spread of NoV, alcohol
has limited effectiveness in killing calciviruses, suggesting this approach
NoV survives on stainless steel surfaces for weeks at ambient temperatures.
Recent studies in health care settings have documented opportunities to
improve environmental disinfection cleaning of toilet area surfaces that are
believed to play a role in the transmission of enteric pathogens. In light
of these considerations, we undertook a covert evaluation of environmental
hygiene practices related to public restrooms on commercial cruise ships and
in many public areas.
The thoroughness of environmental disinfection cleaning (TDC) of public
restrooms was evaluated in 56 large cruise ships. A transparent solution
that dries on surfaces rapidly and fluoresces when exposed to ultraviolet
light was used to evaluate the TDC. The standardized objects were toilet
seat, flush handle or button, toilet stall inner handhold, toilet stall
inner door handle or latching device, the baby changing table surface and
the restroom inner door handle. Twenty-four hours later, each object was
evaluated to determine whether the target had been removed.
An objective evaluation of public restroom environmental hygiene on 56
cruise ships found that only 37% of selected toilet area objects were
cleaned on a daily basis. It is probably less in stores and restaurant’s
restrooms. The effective solution for flu virus is the normal alcohol hand
sanitizers. But that does not stop or destroy the norovirus and it needs
bleach solutions to clean surfaces and soap and water for the hands. So
dilute bleach is better for vomiting and diarrhea viruses.
Roger Knapp MD
Also there is a very good web site for behavior in children called
of puberty has been decreasing for 100s of years. It is not from the
hormones in the food or milk. Studies showed no effect of Soy Formula. We
evolve as an animal race. We are faster and smarter with every generation.
The decrease in the age of puberty is more likely the health of the
population. Obesity seams to bring it on sooner also. Boys usually start
puberty age 11 to 13 and may grow way into college. Girls stop growing when
they start their cycles. The hormones in the males may cause some boys to
develop quarter size tender breast buds under one or both breasts. This is
common so do not bring them in for a doctor’s visit. Certain chemicals and
“natural” herbs can cause large breasts in the male (gynecomastia).
Lavender creams on the skin are a common cause. What goes on the skin does
go inside the body. What is natural does not mean it is healthy for us. I
do not recommend a lot of herbal remedies since they can have side effects
and frequently only have a placebo effect. There are hundreds of chemicals
in plants. Most are innert and have no effect. Some are good for us but in
such low and variable concentrations that they are not much help. Some of
the chemicals in herbs are not good for our health and can cause long term
problems (cancer?). I have not seen any reports of problems with melatonin.
The most natural approach is let God do it. The body will naturally heal
itself. My favorite question is “Is this bothering the child or the
parent?”. If the mild symptoms such as clear runny nose or dry skin are not
bothering the child, then leave it alone.
recent study showed that exercise does not help obesity. Exercise makes you
feel better and you have a better heart. I strongly recommend exercise and
sports for many reasons. But you can play 2 hours of soccer and burn up 200
calories but that is canceled by 1 chocolate donut.
healthy definitely comes from the home and parents. We set the example.
When our children are 2 years old we stop cussing because they will repeat
it. And in grade school they look over at the speedometer to see if you
are driving the speed limit. And when in high school we don’t drink in
front of them. We start looking at the example we set for our children. So
kids are good for us because they clean up our act. So eat healthy for
your sake… and your child’s sake.
“brainwashing” your children into your morals starting at 5 yr old. You do
not wait until 14 since it goes in one ear and out the other. Make
editorial statements about the bad things in life that you see. Instead of
hoping they did not see the bad event, turn it around into what not to do.
If you see someone speeding and cutting in and out of traffic, say: “I hate
people who drink and drive drunk. Isn’t that bad. They are not nice
people.” Your children do not get your morals out of the air. You have to
express them. Then by the time they are teens and also as adults they will
hopefully have some of your morals.
an AED to shock the heart into beating again is very important and time
imperative. See video on use of the AED:
There are a couple of things I
want to mention about the function of the family.
The family evening meal is very
important. We have moved away from that habit and eat in the front room
with the TV. Or going out too much. You need to turn the phones, ipads,
and TV off (yes off) and sit down together. If you do, then later there is
less divorce, less child obesity, less teen delinquency and pregnancy. Sit
down together and ask “How did your day go?”. If one child is not hungry,
then they can sip water and still sit with the rest of the family. And no
they should not have to finish their plate.
How to help your child with
homework: Get to know your child's teacher. Attend school events, such as
parent-teacher conferences, to meet your child's teacher. Ask about his or
her homework policy and how you should be involved. Set up a
homework-friendly area. Make sure your child has a well-lit place to
complete homework. Place supplies - paper, pencils, glue, scissors - within
reach. Schedule a regular study time. Some children work best in the
afternoon, following a snack and play period; others may prefer to wait
until after dinner. Keep the distractions to a minimum. This means no
television, no loud music, and no phone calls. (Occasionally, though, a
phone call to a classmate about an assignment could prove helpful.) Make
sure your child does his own work. Children will not learn if they don't
think for themselves and make their own mistakes. Parents can make
suggestions and help children with directions. We want to each year have
your child do more of the learning on their own. Set a good homework
example. Does your child see you reading the newspaper,
writing letters, or reading a book? Children are more likely to follow their
parents' examples than their advice. A good rule is to have the child do an
assignment that they did not do or turn in. Even if it is not for credit,
it is the learning that is important. That way the child will have to do
it some day so they might as well go ahead and do it on time and get credit
for it. I don’t believe in reviewing your child’s homework and correcting
mistakes to improve their grade. I think the parent should make sure they
get it done. If you correct their mistakes, that is you’re “A” and not
their “B”. You do not sit by them at school during a test and correct their
mistakes. If they obviously do not know how to do the paper or problem,
then it is OK to “re-teach” the material so they know it. And also show
them how to memorize facts.
The husband and wife will most of the time have
different opinions about many things are run in the family. For example one
likes to party more than the other. The one that likes to get out more
probably should not go so much and the one that likes to stay at home should
get out more often. The appropriate amount is between the two opinions. If
both partners spend too much money, then they will go broke. So the one who
spends too much should decrease their spending and the one that is miserly
should spend more. Neither one is right. The proper amount is the compromise
in between. And the parents will not agree on the discipline of their
children. One will be harder and the other softer on the child. Neither one
is right. The proper balance is the middle. That is not the problems of the
marriage but the checks and balances of the marriage. Don’t look at these
differences as a problem of your marriage. It is the good thing that you
are different and both bring something special to the table to have a
balanced child. "Neither one of you are right… find that happy middle
between you two."
Never say anything negative in
your child’s hearing range. They hear every word even though they look like
they are not listening and just playing over there. It really is more
effective to improve the child’s self esteem by what you say to others in
your child’s presence rather than what you say directly to them. And you
should tell them you think they are smart, etc. But if you are talking to
Grandma on the phone or in person telling the bad things you child has done,
they are getting the impression of poor self-esteem. But if you are
bragging about things they did well, then they are over there thinking that
they are a wonderful person. If you need to complain and gripe about the
bad things, do it when they absolutely cannot hear you.
Also if the child is starting to lie or do things that
are not proper and moral, then brag to everyone in their presence how they
are honest and never lie. Now they have to try to live up to your
expectations. And you are drilling into their mind that “I am honest and
don’t lie”. We tend to complain how the child lies all the time and you are
instilling that attitude into their minds. You could try the reverse and
brag how good they are to other people in their presence. It can’t hurt to
Dr. Roger Knapp
Sleep apnea is a common problem and the most common indication for
tonsillectomy and adenoidectomy. The other indication for removal is the
child has 6 strep throats or tonsillitis in 12 months, then they need them
out also. You do not need fancy tests because if your child has severe noisy
breathing and pauses his breathing for even 5 seconds, you need to video it
and take it to your local ENT.
See example of it:https://www.youtube.com/watch?v=IjUeIwSb5aM
are starting to do in home testing for sleep apnea:
is now a home pulse oximeter to measure blood oxygen at $30-$100. The
price has come way down…. here is a good one on Amazon.
is also good for kids with asthma and having trouble. Our oxygen is
usually above 95%. If it is 85-95% then that is not good but not life or
death. We increase our heart rate and blood flow to compensate for less
oxygen. Below 85% bad and head in to the ER if it does not come up quickly.
p.s. The Dallas Perot Museum is Awesome. http://www.perotmuseum.org/
It is very reasonable and they only allow a certain number of people in so
it does not get overwhelmed with too many attending. Get your tickets ahead
of time online. Birthday parties are great also and only costs $200 for 15
kids plus 15 adults.
a lot of companies advertising testing your DNA for diseases. Examples:
Informed Decisions About Your Health w/ Genetic Testing. Only $99”
DNA Predisposition test will reveal your genetic predisposition for 25
diseases and conditions.”
“Establish a legal chain of custody with our $230 paternity test.”
These are not very accurate and can give more worry about what might happen
and frequently does not. It also labels the child as a potential to have a
disease and will affect them getting jobs, insurance, or even possible
marriage. The American Academy of Pediatrics and the
College of Medical Genetics and Genomics have made an official statement
that does not recommending random testing.
child has an illness that might be diagnosed with genetic testing then test
for just that disease. Or if a certain disease is in the family and it is a
disease that can be addressed early to save the child, then test for that
is not recommended to save your babies cord blood. In most cases it will
not be used.
p.s. The weather is starting to get better. But remember sunscreen even
when it is cold. Snow skiers can even sunburn. Babies can sunburn even in
the shade. At least SPF of 20.
things I added to Miscellaneous section of my web site.
is a very good person for hair cuts in Southlake if you are in my area.
is kind, quick, and reassuring to kids who are scared.
a coupon for $3 off the first visit.
only works on Fridays and Saturdays.
in Southlake at 114 and 1709 between Kohls and Old Navy
other is a musical medley of old TV theme songs.
are two groups. Don’t peak at the answser until you guess.
a large increase in Whooping Cough in school age children.
Centers for Disease Control and Prevention (CDC) recommends a booster shot
for tetanus and whooping cough at age 11 or 12. But researchers found that
slightly younger kids may be at risk of developing whooping cough before
then, as their original immunity declines.
What has become apparent is there's an
increase in pertussis in children in the 7-10 year old age group. Meissner
and other researchers think that trend results from a change in the 1990s to
a new type of pertussis vaccine, called an acellular vaccine, which comes
with fewer side effects than the original whole-cell version. Although the
acellular vaccine works well, experts said it might end up providing shorter
Kids born between 1998 and 2003 and received
the recommended series of five DTaP shots, the last of which is given at
ages four to six. Over the following six years, 458 kids from Minnesota
came down with whooping cough. The rate of new cases rose from 16 per
100,000 children in the first year after their most recent DTaP shot to 138
per 100,000 in year six. That is only an increase from approximately
1/10,000 to 1/1000. That is a 10 fold increase but still uncommon. We do
need a better vaccine.
options that are on the table are:
Switching back to the whole-cell pertussis vaccine, at least for the
first shot or two, could improve protection as kids get older …. but
there is no evidence that it would make a difference.
CDC could also move up the booster shot to ages 8-10, but it's harder to
get kids into the office at that point.
Researchers agree the best thing to do is follow the CDC's current vaccine
schedule. Kids who do receive all five doses on time generally have milder
whooping cough than those who are under-vaccinated, but the problem is that
they expose infants below 1 yr of age who are more seriously affected.
let you know what the “experts” agree on what change if any is needed.
David Bloom. He was a news reporter in Iraq that died from a blood clot
and pulmonary embolus. This is his 10 yr anniversary of his death and his
wife continues to put out the word about Deep Vein Thrombosis. There are
many factors that increase your chances of getting DVT. Watch out for long
airplane trips. Get up and stretch every 30-60 minutes. See this article
about the condition:
There is an inherited
condition that makes people prone to this. It is called Factor V Leiden
Thrombophilia. (Thrombophilia is increase clotting.) Many specialists feel
it increases (two to three times) miscarriages or possibly some pregnancy
loss in the second trimester. Factor V
Leiden is the most common inherited form of thrombophilia. Between 3 and 8
percent of people with European ancestry carry one copy of the factor V
Leiden mutation in each cell, and about 1 in 5,000 people have two copies of
the mutation. The mutation is less common in other populations.
chance of developing an abnormal blood clot depends on whether a person has
one or two copies of the factor V Leiden mutation in each cell. People who
inherit two copies of the mutation, one from each parent, have a higher risk
of developing a clot than people who inherit one copy of the mutation.
Considering that about 1 in 1,000 people per year in the general population
will develop an abnormal blood clot, the presence of one copy of the factor
V Leiden mutation increases that risk to 3 to 8 in 1,000, and having two
copies of the mutation may raise the risk to as high as 80 in 1,000 (8
you have a family or parent with increase clots, consider having them
checked for this condition and then have the children checked to see if they
p.s. In the news: the FDA is starting to regulate AEDs that restart your
heart. That is good since there are 45,000 reports of AEDs failing to
work. Yieks! Especially with baseball season starting and the rare
incidence of commotio cordis about which I have sent newsymails in
news came out this week saying the American Academy of Pediatrics does not
recommend any foods and only milk for the first six months of life. But we
still recommend a few things. Rice Cereal for reflux or if not satisfied by
just liquids in the evenings. They actually make a formula with cereal in
it.... Enfamil AR. AR stands for added rice! And also we give fruit or
juice that is non-citric acid for constipation. And if they do not need
cereal or juice, then don’t give it. I do recommend waiting on vegetables
and meats until 6 months.
AAP recommends no TV until 2 yrs old. I think one or maybe two hours a day
below 2 yrs old is OK but they just don’t want 8 hours a day. But the AAP
does not trust parents to regulate it so they say NO TV until 2 yrs old.
Same with the bottle and pacifier. If you keep it restricted to less use,
the it is not hurting the toddler. A sippy cup is a bottle with a hard
nipple. Same thing. We just don’t want them going to bed with it and mess
up their teeth or walking around all day sipping juice and causing
cavities. But using the rubber nipple bottle past 1 yr is OK as long as we
do not over use it. So same with starting foods below 6 months old. It is
OK but keep it limited.
the American Academy of Pediatrics recommends cereal and juice at their web
recommends giving infants
juice for constipation.
recommends giving infants
for Gastric Reflux.
Boston Children’s Hospital, Mayo Clinic for Children, and WebMD. And me
the vegetables and meats until 6 months.
the media has it wrong as usual.
reported a large increase this year of Valley Fever.
heck is that!!!!
It is a
Coccidioidomycosis that causes fever and body aches. Actually most people
have no symptoms since 50% of people living in the southwest have positive
antibodies to it. I lived in Arizona 3 years in the Army and saw some
cases. It starts after a few weeks of staying in or passing through those
states and if you have fever, it is usually only a few weeks. There are
some severe cases in those people who have a weakened immune system, are of
African-American or Filipino descent, or are pregnant in their third
trimester. If you are traveling through Arizona or California where 97% of
the cases occur, and you start having fever and aches a few weeks later,
remind your doctor you were in those states. The number of cases climbed
from less than 2,300 in 1998 to more than 22,000 in 2011.
see “Spring Fever” during the next two months. There are some
fevers here every spring. 3-4 days of fever and aches. No cough or sore
throat. The kids with this were tired and did not do their school work.
Through the years the term was converted to not caring about school in the
spring, but it came from the spring fevers. Grandma also blamed these
fevers on the hay growing and called it Hay Fever. Through the years that
term was converted to your hay fever allergies but it originally was the
to use Deet bug repellants soon and they are safe down to 6 months old. We
had a big increase of West Nile illnesses last year. I think we will see
fewer cases this year since so many people are now immune to it. See my
article on West Nile:
Fever does not harm the body. It is the disease that damages it. I do not
recommend alternating Tylenol with ibuprofen because that is too many
chemicals to your liver and it can be damaged by that.
Recently the news was talking about Skin Cancer Melanoma has a 2% increase
each year over the last few decades. See article in
But Melanoma is only 1 per million children. Do not be frightened by the
news media since it is still extremely rare in kids. However the sun damage
over many years causes cancers more in adults. So protect your kids with
sunscreen and swimming shirts to block sun damage. It only takes a few
sunburns to double your chance of cancer. Another study showed 25% of
adults with melanoma continued to not use sunscreen and even used tanning
beds. No we do not recommend tanning beds for children… much less adults.
Still another study showed less melanoma in adult women who took aspirin
daily. Cover up your kids this summer. Many a farmer is out working in the
fields with long pants and long sleeves. Watch the highway construction
crews this summer with long pants and sleeves.
cancers are rare in kids with a rate of around 15 per 100,000. Survival of
all kinds of Cancer in kids is improving. In the 1970s it was 58% survival
and now it is 80% survival. Here is a chart of the causes of death by age
reports talk about
being prescribed by doctors.
know some of my patients hate to hear the words “it’s a virus” but it is
true. You bring in your child to see what is causing the fever and there is
pressure on the doctor to give you something for spending the time and money
to make an appointment. I think most of my patients understand we and they
do not want to over use antibiotics. Quick clinics like CareNow and other
after-hour clinics tend to give more antibiotics since they do not know the
patients as well. They also tend to run more tests like x-rays and blood
tests. If the clinic or doctor owns the lab and x-ray, then there is
financial incentive to order more tests.
kids have more illnesses than others. Giving a lot of antibiotics to a
child does not weaken their immune system. Kids who are born with weaker
immune systems get more illnesses and are therefore given more antibiotics.
news came out and announced that the FDA will allow girls down to 15 yr old
buy Emergency Contraception pills over the counter without a parent. I
don’t think that is good but everyone has an opinion. There is a slight
decrease in pregnancies but a huge increase in venereal diseases. HPV is a
large portion of them. See for amazing numbers:
“morning after” pill prevents the egg release and not “abortion” causing
fertilized egg loss. But it only works before ovulation. It does not work
at all if the egg has been released so it does not work the second two weeks
of the cycle. Too many people think it works anytime.
new paper in the journal Pediatrics has found that early limited
formula feeding actually increases the rate of long term exclusive
breastfeeding. The difference was quite dramatic. 79 % of 3 month old
infants who received early supplementation were being breastfed exclusively,
while only 42% of babies who received no supplements were still being
exclusively breastfed at 3 months. The study involved only a small number of
infants but it certainly did not hurt breast feeding. I think in many cases
it helps so that the breasts are less painful from a lot of nursing on an
activists have long argued that supplemention is detrimental to
breast-feeding. What’s interesting to note is the fact that many other
cultures in India, China, Nigeria and Saudi
Arabia, some with much higher breast-feeding rates than ours, infants
are given other liquids until a mother’s milk comes in.
Let us stop
making women feel guilty about combining breastfeeding and supplementation
if that’s what works for her baby and herself.
Roger Knapp MD
that she had a preventive double mastectomy
raised both awareness and questions about the gene that led to her decision
-- BRCA1. She is 37 yr old but had her breasts removed before cancer
developed. Many women have chosen that road who have this cancer gene.
BRCA1 and BRCA 2
(stands for BReast CAncer genes) are types of
tumor-suppressing genes that help stabilize the cell's DNA and help prevent
uncontrollable cell growth.
12% of all women will develop breast cancer sometime in their lives. But
for women with a harmful BRCA mutation, the risk of breast cancer quintuples
to 60% and some say as high as 87%.
As for ovarian
cancer, about 1.4% of women will have the disease sometime in their lives,
according to the National Cancer Institute. But the risk for women with a
harmful BRCA mutation increases to 15% to 40%.
Only 3 to 5% of
women who develop breast cancer have a BRCA mutation, and about 10% to 15%
of women with ovarian cancer have a BRCA mutation. It is higher if these
cancers were in very young patients.
Adults with these
cancers can be screened for the genes. Then their daughters can be screened
if they are positive. It is not a concern for teens and children but some
parents want their daughters tested. I think that is a good idea when older
but labeling the child at a young age that would worry parents and the child
themselves is not a good idea to do in my opinion. I would think of
testing them in their young 20s. It complicates future spouse choices,
their pregnancy choices, and insurance availability. There are pros and
cons to testing kids.
risk assessment is recommended for women who have more than a 20%-25% chance
of having an inherited predisposition to breast or ovarian cancer. These
Women with a personal
history of both breast cancer and ovarian cancer
Women with ovarian cancer
and a close relative—defined as mother, sister, daughter, grandmother,
granddaughter, aunt—with ovarian cancer, premenopausal breast cancer, or
Women of Ashkenazi Jewish
decent with breast cancer who were diagnosed at age 40 or younger or who
have ovarian cancer
Women with breast cancer at
50 or younger and who have a close relative with ovarian cancer or male
breast cancer at any age
Women with a close relative
with a known BRCA mutation
assessment may also be appropriate for women with a 5%-10% chance of having
hereditary risk, including:
Women with breast cancer by
Women with ovarian cancer,
primary peritoneal cancer, or fallopian tube cancer or high grade,
serous histology at any age
Women with cancer in both
breasts (particularly if the first cancer was diagnosed by age 50)
Women with breast cancer by
age 50 and a close relative with breast cancer by age 50
Women with breast cancer at
any age and two or more close relatives with breast cancer at any age
(particularly if at least one case of breast cancer was diagnosed by age
Unaffected women with a
close relative that meets one of the previous criteria
U.S. researchers looked at 9,424 children and teens who were taken to an
emergency department for abdominal pain and found that nearly 20% of them
were diagnosed with constipation. Sometimes stomach pain can be severe and
the parent is not sure about appendicitis. The best trick to test them for
appendicitis is what we call rebound pain. Anything that giggles the
stomach will cause pain…. Kind of like after an operation. If you notice a
person after an operation cough, they have a grimace on their face and bend
over a little. You do not have to ask them if it hurts since you can see
how they react. So ask you kid to cough big or jump and if you do not see
any reaction, then it is hardly ever appendicitis. But the parent usually
pushes on their stomach and the child says ouch. And where it hurts will
generally not help you since early on it may be sore in the middle. So use
the cough trick to assess the need for an emergency visit.
Also in the news was a report of the
pertussis vaccine. We have been watching this for several years and it
turns out more cases of whooping cough are from the “acellular” DaPT. The
old whole cell DPT was harsh with severe pain and high fever. But the
milder DaPT did not cause antibodies for very many years.
Overall, the effectiveness of the vaccine fell from 98.1 percent within a
year of finishing it to 71.2 percent five or more years later, according to
the Centers for Disease Control. So there is discussion about moving the 12
yr old TdaP down to 8-9 years old. The experts are still debating and we
will let you know when the new recommendations come out. We promised a
bunch of kids the next shot was not until 12 years old…. Sorry. So don’t
promise no-vaccine when coming in to your checkups about then.
Have a safe Memorial Weekend.
Roger Knapp MD
Sunscreen for the summer. I recommend covering your body with clothing.
Many farmers in the fields wear long blue jeans and long sleeve shirts.
Same with the men on the highway construction. Kids with long pants have
less rashes from grass, less skinned knees, less bug bites, and less sun.
If you put sunscreen on, using a SPF higher than 20 does not give much more
protection. But since the actual SPF in the products are frequently less
than the label, and because you do not put a thick enough layer of sunscreen
on the skin, a higher SPF is recommended…. 30-50. Tests by Consumer Reports
showed inexpensive store brands just as effective and cheaper:
Six got recommended ratings:
- Target's Up & Up Sport, at the top
spot, costs $1.16 an ounce.
- Walmart's Equate Ultra Protection
SPF 50, is just 47 cents an ounce. It won the CR Best Buy award
of the dozen.
- Coppertone Water Babies SPF 50, at
$1.38 an ounce.
- Walgreens Continuous Spray Sport
SPF 50, at $1.33 an ounce.
- Hawaiian Tropic Sheer Touch SPF
30, at $1.38 an ounce.
- Coppertone Sport High Performance
SPF 30, at $1.67 an ounce.
The six that didn't get recommended
- California Baby SPF 30+, at $6.90
an ounce (discontinued, but may still be available).
- No-Ad with Avobenzone, Aloe, and
Vitamin E SPF 45, at 63 cents an ounce.
- Neutrogena Wet Skin SPF 45+, at
$3.67 an ounce.
- Kiss My Face with Hydresia SPF 40,
at $5.33 an ounce.
- Badger Unscented SPF 34, at $5.52
an ounce (discontinued, but may still be available).
- All Terrain AquaSport SPF 30, at
$4.33 an ounce
who used sunscreen every morning had less melanoma and less wrinkled skin.
There are rumors of side effects of sunscreens but no actual reports of harm
from them. The benefits outweigh any possible harm. Plus the less you use
stuff then the less it affects you. So cover with cloth. Look at my left
hand where I wear a golf glove and the right hand where I use sunscreen.
More sun spots on the right. Put swim shirts on the kids. Have a safe fun
already seeing some swimmer’s ear infection. It is very tender ear and it
hurts when you move the ear lobe. It occurs more often after swimming in
lake or ocean water. To prevent it you put 2 drops of olive oil in their
ears before swimming or put 2 drops of a solution of ½ alcohol and ½ white
vinegar. The products in stores like “ear dry” do not have the vinegar to
keep the normal acid state of the ear canal.
Remember, the day goes by slowly and the years go by fast!
ways to raise children to use drugs.
them to be persistent…. to keep trying. Let them make mistakes and
encourage them to do better next time. By
choices and taking risks is that sometimes your child is bound to make
mistakes. These are valuable lessons to build your child's confidence. We
certainly made mistakes. If your child is trying to tell you something,
stop and listen to what he has to say. The best is to face them eye to eye
and really listen. It is important to them even though it may seem silly to
been an increase in penile injuries from toilet seats… No this is no joke.
Health) - Ouch: Boys know that toilet seats are an occupational hazard of
potty training, but a new study suggests the number of genital injuries
caused by falling toilet toppers is growing. Researchers found the number
of emergency room visits for toilet-related injuries to the penis, while
still rare, increased by about 100 visits each year between 2002 and 2010.
Usually, the injuries happen
when boys are learning how to urinate into the toilet while standing up and
the seat falls unexpectedly - although a few adults did get snagged by the
seat, too. Breyer's team was "pretty surprised" to learn that one in 30
genitourinary injuries showing up to the ER involved toilets.
Using a national database of
injuries caused by household products that
were treated by U.S. ERs between 2002 and 2010, the researchers found 13,175
genital injuries related to the toilet seat.
About 68 percent were so-called
crush injuries, which is when the penis gets trapped between the seat and
the bowl. Of those, about 97 percent were in children seven years old and
younger. Only five adults were caught by falling lids. What!!!
Fortunately, it doesn't look
like falling toilet seats lead to too much physical damage, but there may be
some lingering mental trauma. But parents of boys going through potty
training may choose more male-friendly options, Breyer added. For example,
parents may want to invest in a U-shaped or "slow close" models. Those,
however, can be more expensive than traditional lids.
model has an insert for small toddlers learning to be potty trained.
child is considered toilet-trained when he or she knows that it is time to
go to the bathroom, is able to hold it until they get to the toilet, and is
able to climb onto and use the toilet when they want to let it go. In a
study of children who started training between 22 and 30 months of age, boys
were fully trained at an average age of 38 months, while girls were trained
slightly earlier. Just wait. They understand what to do by watching others,
we have to wait until they have neurologic control. And who cares… when
were you or I or President Obama potty trained????? It does not really
matter. It is more important to work on Language, vocabulary, behavior, and
Disney I-Phone App if you are going to Disney World... it is great. I
recommend the "Disney Magic Guide" but there are several different Apps.
Academy of Otolaryngology came out with some recommendations on who should
get PE tubes in their ears for fluid or infections in the middle ears. They
mention that many children get tubes who do not need them. Around 670,000
PE tube surgeries are done each year. By age 3 yrs. old around one in 15
children have had this surgery. I am conservative in medications, X-rays
and surgery. Many children get tubes who have only had a few infections.
If we average ear infections, they typically have 3-4 the first winter, 1-2
the second winter, and rarely have them the third winter. Around 2-3 years
of age their immune system matures and their muscles in their throat are
able to “yawn and pop open their ears” letting the fluid out. Parents do
not cause the infections. The fluid does not decrease the hearing
significantly in most children and does not slow down their speech. But
around 18-36 months of age many kids start talking and the parents think it
is because they put tubes in their ears. My opinion is that if the infant
is having ear infections in the summer when they should have stopped, or if
we are not able to clear up the infections at all, then put in tubes.
In a new
finding the researchers at the University of Nevada Las Vegas on 25 different brands of hot sauces
from Mexico and South America, they noticed some brands carried excessive
lead content. The four brands are Salsa Picante de, El Pato Salsa Picante,
Salsa Habanera, Chile Habanero and Bufalo Salsa Clasica. The new
investigation revealed that the four brands had shocking levels of lead that
surpass the current FDS standard of 0.1 parts per million.
Work by UNLV
researchers and the Southern Nevada Health District led to the removal of
imported candies from local store shelves in 2006. In 2010, the FDA issued
an alert for lead in candy in 39 types of candies from China, Mexico, and
They closed down a national park in California this week because they found
the plague in a squirrel. The squirrel carries fleas which actually have
the plague. Not to worry since it is easy to treat it if you get a sore on
your arm from playing with a wild squirrel… like you are going to catch
one. Plague is endemic and all year round in wild rodents mostly in the
southwest states. West Texas ranchers do not like prairie dog villages
because the horse will hurt his leg if he steps in the hole. So if the
rancher finds a dead prairie dog he throws in down a hole. Then when more
dead ones show up he throws them down holes to eventually wipe out the group
from plague. But sometimes the flea gets on him and bites his arm and he
comes down with a sore. It is easily treated with antibiotics. So the
plague lives on but not a concern. There are many diseases you can catch
from dead or dying animals or birds. In our compassion we try to save them
but most of the time you cannot save them and we put our family’s health at
risk. Leave them alone.
Good advice I could not say better.... Dr.
7 Tasks Kids Should Do for Themselves
Fewer people in America's largest cities are being murdered by guns, but the
rate of suicide by gun has increased in recent years, U.S. health officials
The rate of gun murders at the hands of teenagers accounted for nearly
3,400 firearm killings in 2009-2010. More than 1,500 teens and preteens took
their own lives by gun in that time period, according to the findings from
the CDC. But in 2009 the total for all ages, there were 22,500 gun murders
and 38,000 gun suicides were recorded.
Keep the guns locked up since there are more suicides.
Roger Knapp MD
they are coming up with something interesting and sad to say necessary. A
glass or straw that can detect if there is a date rape drug in you drink.
It will be coming out in 2014 and looks interesting. A good idea especially
if you are a young female in the college prep scene.
for more info:
still recommend the HPV vaccine and as
was on the news lately about his throat cancer, it is for the guys also.
some good parenting advice, see:
outbreak of Measles in Tarrant County totals 15 now. Measles is a bad
disease and 1 out of 20 get pneumonia and 1 per 500 die. All but one of
these cases are members of the 1500 member Eagle Mountain International
Church. An adult brought the disease from overseas and exposed everyone
since it is highly contagious. There are many in the church who do not
believe in vaccinations and trust their faith to protect them. Now 200 of
them have gotten the Measles Vaccine. It is not a worry for adults born
before 1957 and those who have been vaccinated. There were a few cases in
people who were vaccinated but they either received only one vaccine or
falsified their shot records. It is a reminder for parents to give their
children the MMR and not delay it. It does not cause Autism. I worry about
children less than 1 yr old who have not received their vaccine yet. There
is no cause for panic for infants below 1 year old but just be careful of
people in public places with a bad cough and runny nose during the next
several weeks until this blows over.
As parents we have to make some difficult decisions raising our children.
Some decisions are black and white but many are confusing gray areas. Do we
send them to public or private schools? Do we let them have a phone at what
age? Do let them go to a sleep over at another’s house and at what age?
What I recommend is to get as much information as you can, sit back in a
recliner, close your eyes, and do what your heart feels is the best choice
for that child. You cannot go back and replay life. You will never know if
it was the best decision. You can look back in your life and wonder “maybe
I should have married that other person or taken a different job.” But how
do you know that other person or job might have turned out horrible. We
never know. If you follow your heart, that is God telling you what to do.
Women are better at this than men… sorry guys. That decision was the best
one at that time with that information. What you don’t want to do is have
someone talk you into a choice that you do not feel was right and you kick
yourself for years. Follow your heart and don’t look back since we never
know if it was the best choice.
Roger Knapp MD
P.S.: The introduction of a hepatitis B vaccination program for babies in
Taiwan in 1984 was linked to a 90% decline in the number of hepatitis
B-related deaths, a study showed. Among individuals born between 1977 and
2004, the overall number of liver cancer cases dropped by 80%, while the
proportion of deaths caused by chronic liver disease and liver cancer
declined by more than 90%. HPV now out for 7 years has already caused
a 50% decrease in those infections and long term will dramatically decrease
cancer of the cervix and throat. Some vaccines are actually vaccines
against cancer. Hopefully we will have more of them in the future. Not
getting vaccines is like driving without a seat belt for you and your
children. Yes the seat belt will rarely cause a death but it will save you
99+% of the time.
“croup” every year at this time. It is a viral cough cold with head
congestion. Some will have a low fever with it. The throat hurts a
little with swallowing but hurts more the windpipe below the vocal cords
when you cough. In small children it causes a croup seal bark sounding
cough and we treat it with steroids. Older children and adults can get it
but they do not make the seal bark sound. It also causes hoarseness to the
voice. It is viral and we can’t cure it. Give ibuprofen and maybe cough
medication. The kids below 3 yr old we treat with steroids so it does not
cause breathing problems. Humidity helps so run a vaporizer. We are happy
to see the older kids with this but we can’t treat it. Save money and stay
home till no fever. Strep throat generally does not have a cough with it.
If there is severe sore throat with swallowing and no cough, then we need
to see them. Watch for sinus or ear infections the week after croup.
the news likes to scare us and a good example is the most recent case of the
recent death of the 4 yr old in Louisiana from the
fowleri amoeba in the brain. He acquired it while playing on a slip and
slide at a birthday. The water was untreated. Chlorine kills the amoeba
but many water systems in Louisiana are not treated. It is very rare…. only
31 cases were reported in the last 10 years in America. Six of them were in
Arizona where the well water is not treated with chlorine and it is warm.
10% of the well waters in Arizona contain them. There is no risk if your
water system is from the city that treats it with chlorine. I would rather
have too much chlorine (you can smell it) rather than not enough. There are
a lot more germs that the chlorine prevents. The majority of the cases are
from summertime freshwater ponds and lakes. You have to get the
contaminated water way up in your nose and a few cases were from people
irrigating their sinuses with untreated water. You CANNOT get it from
drinking water containing the amoeba and you cannot get it from bathing as
long as you do not get it way up in your nose. There is no reason for
panic. Wear a nose clip when swimming in small ponds and see your doctor if
there is fever, headache, and stiff neck. (Duh!)
P.S. With football and other sports getting into full swing, remember to
wrap injuries immediately with tape and then later on put ice on it. See
George Nissen, a competitive gymnast, patented the modern
trampoline as a “tumbling device” in 1945. Nissen initially designed the
trampoline as a training tool for acrobats and gymnasts and subsequently
promoted it for military aviator training. Recreational use of trampolines
is a more recent phenomenon, driven primarily by the increased availability
of relatively inexpensive trampolines marketed for home use.
The concern is not only falls off the trampoline to the ground
but also the force created in the trampoline. There is just as much Gs of
force on the body and joints at the bottom of the spring as there are if you
fell off the roof. It is not a sudden impact but the ligaments and bones
can still tear or break. Approximately 1/1000 children are injured on them
every tear… but that is the total population of children. It is more
realistically 1/50 kids who use trampolines. The problem is that just
jumping straight up and down by yourself is boring fast. The injuries are
when they summersault, flip, or jump with more than one child on the
trampoline. The fence around the trampoline to prevent falling off helps
some. The padding has not been shown to decrease injuries.
The injuries are ankle sprain or fracture, fracture of the arms,
head and/or neck injuries (accounted for 15% of all injuries, and 0.5%
resulted in permanent neurologic damage), cervical spine injuries, back
strains with constant back pain, breast bone fracture or dislocation,
vertebral artery dissections, and fracture of the tibia bone.
There are now trampoline parks which are not regulated at all.
There is no fence around them as you can see in this web site.
The AAP and myself do not recommend any use of the trampoline.
Want a fun calculator on how tall your child will become…. Not super
accurate but interesting.
About as accurate as doubling their height at 2 yr.
goodness my grandkids love chicken nuggets. But what about healthy diets?
children to take in 20-35% of their diet in fat. I am not going to address
the kinds of fats that are best in this email. Most Pizzas have 25% fat but
most fast food places have 36% fat in their chicken nuggets. Chick-fil-e
nuggets have 26% fat and their grilled nuggets have only 6% fat. I love
their cool wraps and it has 12% fat and more fiber. So actually pizza is
better than MacDonald’s nuggets.
they have a study that came out showing most fast food nuggets have only
40-50% chicken meat. The rest is ground up skin, nerves and blood
That is why I recommend Chick-fil-e and especially their grilled chicken
biggest problem with overweight is the amount of food and calories. Teach
you kids to not finish their plates. Keep desert in proportion the amount
of proper food eaten. Many times kids and we have heart burn and translate
that into hungry. We neutralize the acid with food. Try an antacid and
glass of water instead of snack. Sugars stimulate insulin and it increases
hunger, and drives the calories into the fat cells. So cut out the sweets
and sugar drinks, eat more at home or take a sack meal from home with you,
and split a meal at the restaurant. See
obesity article at my web site.
A study came out looking at visits where immunizations
were given at a sick visit. Many years ago they did not recommend vaccines
if the patient was ill. We proved that was wrong 25 years ago and you will
still hear it today from your friends. Unless there is major illness like
pneumonia, then it is recommended we give vaccines in spite of colds, ear
infections, or even fever. I don’t give vaccines if there is fever 101 or
more since it confuses the picture but we are allowed to give them. The CDC
even came out and said if you have a parent that does not bring them in for
well checkups to get vaccines, then give them the vaccine while you have
them in the office for an ear infection. That resulted in the parents
coming in even less frequently for well checkups as shown in this article.
Sick-Visit Immunizations and Delayed Well-Baby
Visits in Pediatrics. 2013;132:44-48
If your doctor wants to give the vaccine at checkups
and your child has a cold…. Go ahead and give the vaccine.
Roger Knapp MD
p.s. Parents should monitor
their children to make sure they are not playing the
Knockout Challenge. The game, commonly played by middle-school-age
youths, entails taking several quick breaths to become dizzy and then being
pressed in the chest for a few seconds by a peer to temporarily lose
consciousness. "A student who does this risks his or her health and could
die from the challenge or the fall."
This study from the Institute of Child Health in London, United Kingdom,
looked at how rates of autism diagnosis have changed in the UK over the past
few decades compared it to the data released last year by the US CDC. The
researchers calculated how many new children had been diagnosed each year
with autism when the children were between the ages of 2 and 8. The number
who had autism in the UK had not changed much from the 1990s up through 2004
to 2010…. 4 autistic boys out of every 1,000 boys and 1 autistic girl out of
every 1,000 girls.
These numbers contrast with the US CDC numbers in 2012 that found one in 88
children had autism …. Approximately 12 per 1000. That is more than 1
We certainly are not seeing that number of autistic kids. The increase in
autism in America is greatly exaggerated. Disorders like Downs syndrome
have been added to Autism spectrum and any child with reading problems are
labeled autistic to get extra help.
A recent study showed children who received iron supplements demonstrated
significant improvement in IQ scores and other cognitive tests. Other
differences included being slightly taller for their age, as well as
improved weight for age.
is why I recommend Flintstone Complete with iron and zinc instead of gummy
vit without Iron.
p.s. Shopping for Christmas Gifts? Here are a few suggestions.
teenager: The Lego Minecraft Village
gradeschool age: Magic Jinn Game
Boom Boom Balloon
preschool age: Princess Sofia Surprise Slides
been sleeping babies on their backs for many years now and the incidence of
crib death has dramatically decreased.
also stopped most pigeon toed… toeing in. When we slept the kids on the
stomach their feet were curled in and under as in this picture.
twisted their lower leg Tibia bone in ward and bent the front half of the
foot inward. The terms for these are Tibia Torsion and Metatarsus
Adductus. These conditions had to be treated and we had to put them in a
splints as shown.
tell if it is Tibial Torsion from another condition that is Femoral
Antiversion because the outside ankle bone is in front of the inside ankle
kids tend to sit on the floor legs outward with Femoral Antiversion.
Encourage them to sit cross legged.
don’t treat the Femoral antiversion but they used to put them in this
contraption to make it look better.
will generally grow out of it and these devises did not make a difference.
almost never have to treat these conditions since the mild forms will go
away through the years of running and playing.
hardly ever see severe forms since we sleep them on their backs.
The HPV virus is so correlated to cervical cancer (and other cancers) that
it is more accurate to test for HPV than to do pap smears.
Detection of the most dangerous HPV-16 and HPV-18 types predicted high-grade
cervical intraepithelial neoplasia with 92% sensitivity compared with
cytology's 53.3%. "HPV testing with separate HPV-16 and HPV-18 detection
could provide an alternative, more sensitive, and efficient strategy for
cervical cancer screening than do methods based solely on cytology," the
group concluded in the paper. Combining HPV testing with liquid-based
cytology held little advantage over HPV testing alone, according to the
results of the ATHENA trial published in the September issue of the
Couric Promotes Anticancer Vaccine Alarmism
It is unfortunate that someone like Ms. Couric, who did so much to promote
awareness of colon cancer, did a show last week that scares people away
from a cancer preventing vaccine.
plural, actually, given that,
according to University of California law professor Dorit Reiss,
HPV is responsible for nearly all the cervical cancers in the United States
and for “90% of anal cancers, 40% of vulvar, vaginal, or penile cancers, and
12% of oral and pharyngeal cancers.”
published in the British Medical Journal in October evaluated
997,000 girls, 296,000 of whom had received at least one dose of the HPV
vaccine. More than 150,000 of those girls received all three doses. The
results show absolutely no link to short- or long-term
HPV didn’t carry the dual emotional and cultural baggage of being a vaccine
that prevents a sexually transmitted viral infection and being initially
rolled out for tweenage girls, we wouldn’t be having this discussion.
husband died of colon cancer at a terribly young age. If this discussion
were about a vaccine that prevented colon cancer, Couric’s segment would
have been very different.
focused on anecdote and emotion
and failed to highlight what the evidence shows in favor of the safety and
effectiveness of the HPV vaccine.
study shows HPV vaccine helping lower HPV infection rates in teen girls
A new study looking
at the prevalence of human papillomavirus (HPV) infections in girls and
women before and after the introduction of the HPV vaccine shows a
significant reduction in vaccine-type HPV in U.S. teens. The study,
published in [the June issue of] The Journal of Infectious Diseases
reveals that since the vaccine was introduced in 2006, vaccine-type HPV
prevalence decreased 56 percent among female teenagers 14-19 years of age.
79 million Americans, most in their late teens and early 20s, are infected
with HPV. Each year, about 14 million people become newly infected.
only one third of girls aged 13-17 have been fully vaccinated with HPV
vaccine. Countries such as Rwanda have vaccinated more than 80 percent of
their teen girls. Our low vaccination rates represent 50,000 preventable
tragedies – 50,000 girls alive today will develop cervical cancer over their
lifetime that would have been prevented if we reach 80 percent vaccination
rates. For every year we delay in doing so, another 4,400 girls will
develop cervical cancer in their lifetimes.
to CDC, each year in the United States, about 19,000 cancers caused by HPV
occur in women, and cervical cancer is the most common. About 8,000 cancers
caused by HPV occur each year in men in the United States, and oropharyngeal
(throat) cancers are the most common.
vaccines have been developed for cancer. Liver cancer has decreased 80% in
many Asian countries after the Hep B vaccine was started in the 1980s.
recommend the HPV vaccine. It is safe and I would want it if I were a
The news came out this week saying don’t take vitamins.
first article reported the results of vitamin supplements for disease
prevention in adults with no nutritional deficiency. The second evaluated
the efficacy of multivitamins in preventing cognitive decline in men over
65. The third measured the effects of a high-dose multivitamin on people
with a previous cardiac event. Each concluded that there were no benefits
from the supplements on those populations, and the editorial said: "The
message is simple. Most supplements do not prevent chronic disease or death,
their use is not justified and they should be avoided. This message is
especially true for the general population with no clear evidence of
micronutrient deficiencies, who represent most supplement users in the
United States and in other countries." It wasn't the first time it has been
suggested that vitamins and supplements are not helpful. "This is not new
information if anyone follows this," said nutritionist Heidi Skolnik, who
runs Nutrition Conditioning, which has an office Englewood Cliffs Not new,
but once again studies create debate instead of a definitive answer. While
Skolnik largely agrees with the editorial — particularly that healthy people
don't need supplements — others find flaws in the method and message. “
recommend vitamins in most people. We eat healthier and eat less red meat.
Then we do not get enough Zinc and Iron. The news came out this week saying
vitamins should not be taken since studies show they do not prevent chronic
disease, cognitive decline, or cardiac events. But they do help keep us
healthy. I disagree with their statement that you should not take
vitamins. Many studies show it helps:
you want to research medical stuff on the internet, use Google’s scholar ….
Click on the list of search engines, then click the bottom where it says
“more”. Then at the bottom of that list, click on the “even more” and you
will have all the search engines of Google. In the lower right area is
“scholar”. Click on it and search for actual medical articles. You may
not have the full article but you will have the abstract. Many internet
sites have some whacko who has an agenda against any authoritative group.
news article this week talking about the government making the makers of
antibacterial soaps prove they were better than just plain soap. We wash
with just soap in the hospital. I never recommended antibacterial soaps and
the chemicals they have in them. Even if they kill bacteria, the chemical
is not in contact with the germs long enough to kill them. And the
chemicals are being absorbed into your body. Just use soap (I like Dove and
Oil of Olay). And if there is a vomiting and diarrhea bug in the house, the
hand sanitizers do not help. Use soap and water for hands during those
illnesses in the house.
a Merry Christmas… Hanukkah, …or whatever your religion celebrates.
Roger Knapp MD.
Here is another disease the news media will probably scare you about this
coming year. It is Chikungunya. I don’t know how to pronounce it! It is
a virus like West Nile that is from mosquitos. It normally is restricted to
Africa and Asia but now has been detected for the first time in the Western
Hemisphere, with 10 confirmed cases in the Caribbean island of St. Martin.
The CDC has issued a travel advisory for this tourist playground.
chikungunya virus in spread by the bite of infected mosquitoes and can cause
most often characterized by fever,
fatigue, nausea, vomiting, muscle pain, rash and joint pain but is rarely
deadly. Chikungunya means "that which bends up" in the Kimakonde language
has the potential to spread in the Caribbean, South and Central America, and
Southern United States, but this could take years or possibly quicker. The
St. Martin authorities are already fighting an outbreak of Dengue fever,
spread by the same Aedes aegypti mosquito that carries the chikungunya
virus. Dengue fever is spreading North from Central America and Mexico and
has been reported in Southern Florida and Texas. Dengue Hemorrhagic Fever
is more severe than Chikungunya and 1-2 % die. I mentioned Dengue before in
my West Nile article. So there are many diseases spread by mosquitoes so
try to use the normal precautions this coming year.
of viral infections, we are starting to see some cases of the Flu. The
vaccine only prevents it 65% of the time. High fever and head ache in every
patient. Some with cough and some with vomiting. Not every person should
be treated with Tamiflu and the test misses 50% of cases. Read my article
on the Flu at my web site.
a happy and safe holiday
Roger Knapp MD