Village Pediatrics 
  Spring Newsletter
March, 2012- Vol 4, Issue 1 
In This Issue
Removing TIcks
Saying Goodbye to the Pacifier
Acetaminophen and Asthma- Is There a Link?
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Welcome Spring!

Did we even have a winter?  While the lack of snow has made this winter unusually mild, it may also result in a particularly intense spring allergy season.
 spring allergy

If your children tend to have spring allergies or asthma, remember to start their preventative medications as soon as the weather warms up and trees prepare to bloom.  

 

Now is also the time to book your child's school/camp physical, if they have not had one in the last year. The Academy of Pediatrics recommends your school-aged child have a well-child exam yearly.  Children grow dramatically quickly- not just physically but socially and emotionally.  Their yearly physical is a time for us to moniter their growth and development, as well as touch base with how they are feeling and functioning in school and at home.  Book now to avoid the school/camp form rush of late spring and summer.  Many insurance plans cover one exam per calendar year as opposed to one every 365 days- check with your particular company to confirm, and call us if you are unsure when your child last had a physical.

Please also remember to register your child on www.CHADIS.com, where you should complete a pre-physical developmental evaluation prior to your child's appointment.  Teens ages 13 and older should complete these confidential questionnaires themselves.  

Billing

Thank you all for bearing with us during our turnover in billing services. Our own Sophie has taken over billing responsibilities, and her attention to detail and careful oversight should result in a better experience for us all.  If you have a received a bill for services rendered several months ago, we apologize for the delay.  Please, as always, feel free to call the office if you have any questions. You can also email all billing questions to pedibilling@yahoo.com

Removing Ticks 

This year's warm winter means lots of ticks this year.  In Fairfield County it is impossible to avoid these little critters entirely.  Most importantly, when your children come in from playing outdoors make sure you thoroughly check their bodies for ticks.  Deer ticks are tiny, the size of a pinhead, and like to seek out warm areas of the body like the groin, underarms, between the toes and behind the ears.  If you find and remove ticks within 24-36 hours, it is very unlikely that they will have time to transmit the lyme bacterium which is found in the tick's salivary glands, as ticks don't start feeding immediately after latching on.

 removing tick

To effectively remove a tick:

  

1. Use flathead forceps or tweezers, push and get as close to the skin surface as possible, firmly pince, and lift...the probability is that the pincers will hold, and the skin will "tent" slightly, as you lift.

 

2. Hold it right there for 30 seconds to a minute...if the pincers do not release, slowly turn the forceps counter-clockwise and the pincers will release or snap, and you will have removed the tick.

 

3. Clean the surface well (hydrogen peroxide or soap and water will do), put a little topical antibiotic such as neosporin on, and mark date and area on your calendar.  The typical lyme rash can appear at the site anywhere from 2-30 days following a bite.  Please read this article for much more
 information on lyme disease- detection and diagnosis.
   

 

The Tick-Twister is a neat little device that makes removal of ticks fairly easy- we have a supply of them in the office for purchase, or you can get them from Amazon

 
Note that ticks don't embed their heads....they use twin pincers to grasp on, and then "bite" or "drill in" with mouth parts.
When the tick is removed, the small (one or two) black dots are not "heads" but remaining pieces of the pincers...which neither contain nor transmit the lyme spirochete. The small dots will, like most foreign bodies, come out on their own; there is no need to go digging or surgically trying to remove them, which typically can cause local infection, inflammation, or scarring. 

 


Saying Goodbye to the Pacifier
For newborns and infants, pacifiers can provide a much needed form of self-soothing, and their use is actually associated with a decrease in SIDS.  Until about the age of 2, they are also convenient "transition" devices, helping toddlers soothe themselves to sleep or deal with anxiety provoking situations (like coming to our office!)  However, by the age of two, prolonged use of a pacifier can affect a child's dentition and interfere with the acquision of spoken language.  Time for a different method of comforting...
pacifier

Pediatrician Natasha Burgert from the fabulous blog KCKidsDoc  has a nice list of  four effective ways for your child to get rid of his or her pacifier:

 

1.  Go shopping. Is there a toy, book, or treat that your kiddo would love to get his hands on?  Have your child "pay" for this item with all the pacifiers that he collects around the house.  When you are at the store where this item is sold, find a helpful face at the customer service desk.  Explain to the service clerk that your child would like to "pay" for a special item with his pacifiers.  As you pay the clerk for the item, allow your child to place all his pacifiers on the check-out counter in exchange for the new toy.  It is a quick, effective way to get the pacifiers out the house and provides a new item of distraction.  In addition, it is a tangible reminder of what the child accomplished.

 

2.  Go to Build-A-Bear Workshop. Have your child grab all of her pacifiers and head to the mall!  Have her pick out a new "best friend" from the Build-A-Bear collection.  Before the stuffing is placed in the bear, have her put all her pacifiers in the bear.  Now, she will have a new friend to sleep with, and her pacifiers will also be there! (I have no vested interest in Build-A-Bear.)

 

3.  Pick a night for the Pacifier Fairy. Have your child collect all of his pacifiers and place them in a special sack near his bed.  Let him know that the Pacifier Fairy is going to leave a special treat in the morning in place of his pacifiers.

 

4.  Bring them to us!   Bring along all the pacifiers to your child's 2-year-old checkup along with a new "surprise" for your child.  Give the surprise to our staff as you are checking in (or we can allow them a visit to our "treasure box.)  During the visit, I will be happy to take all the pacifiers from her in exchange for the new surprise.  You can remind her later that our office is using the old pacifiers with her patient babies who did not have a pacifier.  Promote the example of "big kid" generosity.

 

Some more quick tips:

  • Any behavior modification with a 2-year-old works best when the message is simple and clear.  That is why these techniques work.  The pacifiers are gone.  Period.  This is why "weaning" a pacifier becomes so difficult.  The message is not clear from day-to-day, and this leads to confusion.  Stay firm with your decision, and don't talk or "explain" too much.  Once the pacifier gone - it is GONE!  No turning back - no explanations needed. This is just something that happens to all big kids, and the time is now.
  • Make sure that your child has not hid any pacifiers around the house.  
  • You know your child best, but I would argue 20-22 months is the sweet spot for most kids to successfully make this transition.
  • Regardless of how, where, or how much the pacifier was used; be prepared for 3 bad days.  That is the average time it takes to dissociate the pacifier from your child's lifestyle.  Consider those 3 days short-term inconvenience for tremendous long-term gain.

 

Acetaminophen and Asthma- Is There a Link?

 

In the December issue of the journal Pediatrics, Dr. John T. McBride published a paper arguing that there is now strong evidence for a link between acetaminophen (brand name Tylenol) and asthma. The incidence of asthma has increased steadily since the 1980's, which happens to be when aspirin use in childhood was linked to a rare neurological condition called Reye's syndrome.  Since that time, the use of acetaminophen (APAP) has steadily increased.  While this time link does not establish causality, there is now a plausible explanation for how acetaminophen might provoke or worsen asthma, a chronic inflammatory condition of the lungs. Even a single dose of acetaminophen can reduce the body's levels of glutathione, a peptide that helps repair oxidative damage that can acetaminophendrive inflammation in the airways.

 

 Dr. McBride's article discusses a large number of studies suggesting that giving children acetaminophen is associated with their development of asthma. Researchers have studied this association in multiple ways. Some examples include analyzing asthma rates in areas with high and low acetaminophen sales, studying the increased rates of asthma since acetaminophen has become more widely used, and comparing asthma rates in individuals who use various amounts of the medication.  Many of these studies suggest that the timing and amount of exposure to APAP is associated with the increased incidence of asthma in children. If that is true AND exposure to APAP could be avoided in children with a strong risk of developing asthma, the rates of asthma in the U.S. could decline.

 

However, many factors can increase a person's risk of developing asthma, including a family history of allergies and/or asthma and exposure to second-hand smoke. In addition, finding a connection between two items does not mean that one causes the other.  For example, homes with small children in them are often messy, but that does not mean the children necessarily cause the mess. "Children who take acetaminophen are usually getting it for fever control, and they get fevers because they have viral infections, which on their own are associated with developing asthma."  There are many such confounding variables that need to be sorted out in future studies.  

 

So what should parents do?

  1. Medicate only when necessary. Low grade fevers, teething and minor injuries can often be treated with ice packs, teething toys, rest and a little extra TLC.  
  2. If your child has significant fever or pain, don't hesistate to give them medication. For children over 6 months of age, who do not have any stomach upset, we recommend starting with ibuprofen (brand names are Advil and Motrin, though generic is just fine.) For infants 2-6 months of age, the only appropriate medication to use it APAP unless we have directed otherwise.  APAP and ibuprofen dosage charts can be found here
  3. Do not give acetaminophen before vaccinations as some research suggests giving APAP before vaccines decreases their effectiveness - you can offer a breastfeeding, bottle or taste of sugar water during the immunization to both distract and help relieve any discomfort.

If you have friends who might enjoy our newsletter or website, please feel free to forward this along.  Have a safe and healthy spring!

Dr. Jenn, Dr. Nikki & Dr. Robin
Village Pediatrics LLC

 
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Village Pediatrics | 156 Kings Highway North | Westport | CT | 06880