Hot Topics

The Media overwhelms us on a daily basis when it comes to health information making it difficult for parents and families to decide what to believe. We at East Bay Pediatrics would like to offer reliable information on some of the topics which you may hear about in the paper or on the news.

From the American Academy of Pediatrics (AAP): Healthy Children.org

Environmental Health Issues: Melamine | Plastics (BPA and phthalates) | Lead

HealthyChildren.org (added December 2009)

The American Academy of Pediatricds (AAP) recently launched HealthyChildren.org, an interactive website for parents. It has compiled information on over 300 health care topics from AAP guidelines, policies, parenting books and patient education materials. Knowing that the information comes from AAP experts allows you to trust that you are receiving information from an accurate and up-to-date resource.

Find information related to any age from prenatal through young adulthood. There are topics on anticipatory guidance, safety and prevention, family life, healthy living, immunizations, common childhood conditions and more.
Use the Symptom Checker to help you figure out if you should call your doctor.
The Hot Topics section contains frequent updates on current pediatric headlines whether it is a disease outbreak, a product recall or other AAP news.
Customizable and interactive! Create an account (if desired) and enter the ages of your children. The site then customizes the main Web page with age-specific information and sends you a monthly newsletter, also with age-specific information.
Tag information to your Facebook and social networking pages!

2012 Booster Seat Laws (added January 2012)

As of January 1, 2012 California requires children to ride in booster seats until at least 8 years of age or 4 feet 9 inches in height. This law updates California standards to those recommended by the National Highway and Traffic Safety Association and the American Academy of Pediatrics. Using booster seats until a height of 4 feet 9 inches will protect children better in the event of an auto accident as well as save children from harm caused by the seatbelts themselves. To learn more or read frequently asked questions, go to the CHP website or healthychildren.org, the American Academy of Pediatrics website for parents

Formula Not the Cause of Newborn Deaths (added January 2012)

Despite media hype and retailers pulling formula from the shelves, Enfamil brand formula is not the cause of infant deaths reported at the end of 2011. At least 2 infants have died because of infection from Cronobacter, a bacteria which can be found throughout your normal environment but only rarely causes disease. Mead Johnson, the company which produces Enfamil, has retested the batch of formula fed to the baby who died in Missouri - the formula does not contain the bacteria called Cronobacter. Four cases of Cronobacter infection have occurred recently, but none have been traced back to the powder-based formula by the formula companies or the Food and Drug Administration (FDA). The FDA and the Centers for Disease Control (CDC) continue to investigate why these infections are happening. A recent TIME Magazine article describes the facts well.

It is safe to continue to feed your baby Enfamil or other brand powdered formula products. The most important part of feeding your baby is the proper preparation of formula. Instructions are available on each can of infant formula.

If you have further questions, you can go the the Enfamil website, the CDC website, or the FDA website.

Teething Gels Pose Health Risk (added June 2011)

Recently, the FDA issued a warning to parents about the use of Anbesol, Baby Orajel and other over-the-counter gels for teething babies, saying such products pose a risk of a rare blood disorder. The FDA said parents should not give the products to children under age 2. To learn more, see the Drug Safety infomation on the FDA website.

Radiation Concerns after Japanese Earthquake (added March 2011)

At this time, there is no risk of radiation to those of us living here in the Bay Area. There is no reason to try to obtain iodine tablets. Follow the Alameda Public Health Department website for local updates. More information can also be found through the California Department of Public Health and the Center for Disease Control including FAQs about Radiation, what to do in the event of a radiation emergency, and Information about Potassium Iodide.

Pertussis Vaccine now required for School Entry (added January 2011)

Starting in 2011, California students in 7th -12th grade will be required to have a pertussis booster vaccine. This vaccine is given in the form of Tdap, which includes vaccines for tetanus, diptheria, and pertussis. It is given at age 11 years and lasts for 5 years. Your middle school or high school age child has likely already received the vaccine in our office. You can check your immunization record on the printout which we give you at your child's physical exam under "Tdap." For more information, see the California Department of Health website.

Healthy Eating (added March 2011)

With today’s rise in obesity in children throughout the United States, the nutrition of our children has become a topic of interest for everyone, from individual parents to our First Lady. One school in Newburyport, MA developed a curriculum for its 4 and 5 year old preschoolers, called “Just Right Kids.” It focuses on healthy eating, teaches kids portion control and emphasizes the importance of cultivating community gardens to develop a “farm to table concept.” Visits during the school year include visits to local farms, as well as visits from community physicians and health care providers discussing healthy living. The children learn about the 4 food groups and the number of daily servings of fruits and vegetables required. For more information on what your child should be eating and appropriate serving sizes, visit: www.mypyramid.gov or www.healthychildren.org

Talking About Drugs and Alcohol with your Teens (added March 2011)

Startling statistics were recently released regarding drugs, alcohol and today’s teens. One in 3 of today’s eighth graders drinks alcohol and 1:5 binge drinks. In order to help combat this problem, The American College of Emergency Physicians, and Mothers Against Driving Drunk (MADD), recently partnered to develop a free handbook entitled: Power of Parents, It’s Your Influence. Kids that drink prior to age 21, are more likely to have problems in school, more likely to be a victim of assault and/or more likely to be involved in an alcohol related accident later in life. To request a copy and to learn to better talk with your teen, visit: www.emergencycareforyou.org

Internet Safety (added February 2011)

Online safety is one of the most difficult areas for parents to keep up with in today's digital age. Several resources exist, including the American Academy of Pediatrics' site: http://safetynet.aap.org which includes information for both parents and teens.

Of note, teen use of digital media is ALMOST as much as adult use. That means that we as parents can try to set an example for our children on how to use the internet properly. Here are a few examples of rules which you may want to consider for your home:

1. Maintain some "electronics-free" time each day. For example, no phones, email, or iPods during meals. If you answer a call during a meal, it shows that the phone call takes precedence over the family meal time.

2. Limit "screen time." Keep time limits for the amount of time your child can sit in front of a TV, computer, video game, iPad, etc. Keeping time limits both allows time to rest the eyes and brain and makes kids think of non-electronic things to play or do. Your brain needs breaks from both the lights and the information overload of many media sources. Don't always use your iPhone or TV as your break: read a book or better yet, get outside and play!

3. Open door policy. If a student is online, keep the door open. Or better yet, have the computer or other connected items in shared spaces in your home. This is a great way to help teach your teen that whatever they say online is public material. Nothing is secret. So why can't you have the door open? Remind your teen not to "say" anything online that he or she would not say in person.

4. No TV in the bedroom. If possible, no computer in the bedroom as well. Media exposure is 50% greater if a TV is in the bedroom and most of that time is unsupervised.

Resources:
Online (for those using more electronic media):
http://safetynet.aap.org – AAP site for parents, patients and providers on healthy media use
http://www.commonsensemedia.org – reviews websites, some recommendations
Child and Family Webguide: http://www.cfw.tufts.edu– more website reviews and recommendations on web use
Macarthur Foundation: http://www.macfound.org – several publications about media use and learning including Building the Field of Digital Media and Learning

Print (for the Kindle or on paper):
Generation M2: Media in the lives of 8-18 year olds from the Kaiser Family Foundation,Jan 2010
Born Digital: Understanding the First Generation of Digital Natives by John Palfrey and Urs Gasser
Convergence Culture: Where Old and New Media Collide by Henry Jenkins
Distracted by Maggie Jackson

H1N1 (swine flu) (updated February 2011)

H1N1 (swine flu or Novel Influenza) is a new influenza virus which started causing illness in people in the spring of 2009 in the United States. Although this illness is not causing as much of a media hype this year, it is still around. This season's flu vaccine contains an H1N1 protective component, so if your child has not received your H1N1 vaccine he or she can still get protection.

H1N1 causes an influenza illness, often characterized by fever, body aches, cough or sore throat, abdominal pain, and headache. It is spread the same way the seasonal (human) flu spreads: through coughing and sneezing or touching mouth nose or eyes after touching an infected surface. The best way to prevent the spread of flu is to wash your hands! Warm soapy water prior to eating and after being in public areas can decrease your exposure to all viral illnesses. Teach your child to cover his or her cough; remind him or her to keep hands away from eyes, nose and mouth. Keep your sick child out of school until fever-free for 24 hours.

Our advice for when to see a doctor matches our advice for any other illness. Please call us (925)254-9203, option 6 for any of the following reasons :

Your baby less than 12 weeks old has a fever greater than 100.4 F (call any time of night)
Your child over 12 weeks old has a fever for three days or more
Your child’s fever returns after a 12-24 hour period.
Your child is not passing urine or making tears for more than 6 hours
Your child does not smile or show interest in playing for several consecutive hours

Generally there is no reason to rush to the emergency room. However, you should take your child to the emergency room or Call 911 for any of the following reasons:

Your child cannot speak while trying to breathe
Your child has blue or dark purple color to the nail beds, lips, or gums
Your child is not responding to you because he is tired or weak

Tylenol (updated January 2011)

Liquid tylenol is finally back on the shelves. You may remember that McNeil Consumer Healthcare recalled the over the counter pain and fever medication in the fall of 2009 and again in the summer of 2010. If you still have Tylenol, Motrin, Zyrtec or Benadryl products from before the recall, check your medications against the McNeil website: http://www.mcneilproductrecall.com and http://www.fda.gov/medwatch

Vaccines (updated January 2011)

Vaccinations have been a hot topic in the media for the last few years. Most recently, the media has picked up on Wakefield's article on vaccines and autism being revoked by the journal which initially published it. The focus of the media is now turning to vaccine-preventable diseases and what is the true cause of autism.

East Bay Pediatrics supports vaccinating all children as recommended by the American Academy of Pediatrics (AAP) and the American Committee on Immunization Practices (ACIP). Our office policy on vaccines reflects our commitment to protecting children from vaccine-preventable diseases. Last year, the California Department of Public Health has recently issued two Health Advisories: one for measles and one for pertussis.

Reliable resources on vaccines, their effects, and side effects are sometimes difficult to find in the media, even after the news that Wakefield's studies were falsified. Listed here are a few links to websites which may answer some of your questions about vaccines.

American Academy of Pediatrics In addition to policy on vaccines, the AAP's new Immunization Page contains up-to-date information on vaccines for parents. Or check out the Sound Advice audio information on the HealthyChildren.org website.

Centers for Disease Control and Prevention (CDC) The CDC provides Vaccine Information sheets (links available on our vaccine schedule page). The parent information page provides several articles on topics including understanding vaccines, questioning vaccines, myths about vaccines, and risks of not vaccinating.

Paul Offit Dr. Offit has written several books about vaccines and the myths which surround vaccines. Check them out at your local library or bookstore:

Vaccines: What Every Parent Should Know
Autism's False Prophets: Bad Science, Risky Medicine, and the Search for a Cure

Immunization Action Coalition The most thorough website in regards to the latest information on vaccines and safety. Check out Dr. Ari Brown's article Clear Answers & Smart Advice about your Baby's Shots. The Vaccines in the News section lists recent articles in the media regarding vaccines.

Parents of Kids with Infectious Diseases (PKIDs) can tell you more about preventing the spread of diseases, from handwashing to vaccines. This organization also provides support for parents whose children have fallen ill to certain diseases.

Vaccine Preventable Diseases Sanofi Pasteur has developed a comprehensive review of vaccine preventable diseases with information from the World Health Organization (WHO). Their brochure is available in our offices.

Medicine and the Economy (added April 2009)

The downturn in the economy is affecting all of us. Medicine is much more entwined with the economy than in the past because of the rising cost of health care, health coverage and employer-based health insurance. Many employers are choosing less expensive health care plans which may not cover health costs, including preventive care and vaccines for children. Those who lose their jobs may not be able to afford COBRA coverage or may need to change to individual coverage plans.

East Bay Pediatrics strives to continue to provide comprehensive health care to all of our patients. We offer several options for families with financial limitations and would like to remind you of those services here. Please contact our business office if you have any questions at (925)438-1100 option 8.

claim submission As always, our business office submits claims to your insurance so that you don't have to. If you are owed a refund, you will be notified at your next visit.
assistance with claim disputes Our business office automatically disputes some unpaid cliams. If you have a dispute regarding a claim to the insurance company, our business office can offer you advice, including conference calling with you and the insurance company to help you get your questions answered and your claim processed correctly.
payment plans If you cannot afford to pay for your child's health care at this time, we are willing to set up a payment plan that meets your needs. Please notify the business office as soon as possible if you are having financial difficulties. We will do our best to make payments easier.
negotiations with insurance companies The physicians of East Bay Pediatrics are continually communicating with insurance companies to establish reasonable payment for services. We are currently in negotiation with Blue Cross PPO, the only major provider with whom we are not contracted.

Autism (updated April 2009)

The diagnosis of Autism Spectrum Disorders (ASD) now ranges from severe autism (non-communicative, fully dependent, sometimes combative) to mild autism (able to function in mainstream school and work with some behavioral intervention) and includes disorders such as Asperger's syndrome and Pervasive Developmental Disorder (PDD). These are lifelong diseases with no cure. Briefly, autism is a disorder of social, emotional and communication skills. Patients with autism may not show affection, may not look at something when you point to it, or know when to speak during a conversation.

We don't know what causes autism: research continues to try to reveal why the rates of autism specturm disorders are increasing. (See the above section on vaccines to learn more about why we don't think vaccines are the cause of autism.) We do, however, know that some interventions can help a child with autism spectrum disorders be more successful in society. Early detection is key to assisting children and families with coping with the disorder. Our practice offers the screening tool M-CHAT at the 18 and 24 month well visits. If you are worried that your child is losing developmental milestones or has difficulty with non-verbal cues such as pointing, making eye contact or showing affection, speak to your doctor. You do not need to wait for your next scheduled well visit.

Resources for Autism Spectrum Disorders:

American Academy of Pediatrics (AAP) Refer to the AAP website page on autism for parent-friendly information about the disorder. The page includes a fact sheet on Autism published by the CDC
Regional Center The Regional Center of the East Bay (RCEB) serves both Alameda and Contra Costa Counties. It offers evaluations and services for children with developmental disabilities including Autism and Autism Spectrum Disorders. You can contact them yourself or have your physician refer you to the Regional Center for an evaluation.
Quest Camps The Quest Camp offers a safe setting for children with behavioral, emotional or social difficulties.
Music Therapy Behavioral intervention comes in all forms. We have a local music therapist who specializes in children with autism.

Testicular Cancer (added April 2009)

Testicular Cancer made a big hit in the media when biking expert Lance Armstrong was diagnosed and treated for the disease then continued on to win the Tour de France (again). This disease affects young men mostly age 18-40 with a tendency toward the younger age group. The disease is asymptomatic so testicular self exam is essential to early detection and treatment. Testicular exam by a physician is part of the routine physical. We also teach teens how to perform a testicular self exam. WebMD offers a useful guide to testicular exams for young men.

Melamine

Some infant formulas in China were found to be contaminated with melamine, a component of certain types of plastics. This chemical may have caused renal failure and even death in some children in China. Formulas in the United States have not been found to contain this chemical and should be safe to feed your child.

The Pediatric Environmental Health Specialty Units (PEHSU) are regionally based environmental health experts who are the most reliable source of information regarding environmental health issues in children. The unit for our region (includes California, Arizona, Nevada, Hawaii and the Pacific Islands) is based here in San Francisco. Their fact sheet on melamine may help to clarify who is at risk and what foods may be contaminated.

Plastics (BPA and phthalates)

Plastics contain Bisphenol A (may have estrogen effects) and phthalates (may have anti-androgen effects). Both of these chemicals are found in many other products (phthalates are in products such as lotions) and levels are rising in the human population. There are no regulations about either of these chemicals but many companies are producing consumer goods which are Bisphenol A-free (BornFree baby bottles) and phthalate-free (California baby). Hard, clear plastics have more Bisphenol A and items which are more scratched up (your old Nalgene bottle) or are microwaved are more likely to release the chemical.

The Pediatric Environmental Health Specialty Units (PEHSU) are regionally based environmental health experts who are the most reliable source of information regarding environmental health issues in children. The unit for our region (includes California, Arizona, Nevada, Hawaii and the Pacific Islands) is based here in San Francisco. Their fact sheet on plastics may help to clarify the risks and how to protect yourself and your child.