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When do kids need antibiotics?

Winter can seem like one long continuous “sick day” for families - kids pick up frequent infections at school or daycare and pass them around to everyone at home.  Often it feels like by the time the illness has worked its way through the household, a new one has started!  Even for physicians, it can sometimes be difficult to distinguish between viral and bacterial infections.  Since antibiotics cannot treat viruses, they are often over-prescribed - which can lead to significant side effects in children and also contributes bacteria becoming resistant to existing medications.  In November 2013, the American Academy of Pediatrics released an updated guidance regarding antibiotic treatment, helping answer the frequently asked question about when kids need antibiotics.

Here's what you should know about antibiotics in these situations:

  • Ear infections ...

FDA finally defines gluten free

On August 5th, 2013, the U.S. Food and Drug Administration (FDA) at long last published a formal rule regulating the use of the term "gluten free" on foods and beverages.  Even though this came with a big sigh of relief to the millions of people with celiac disease living in the US, consumers should be aware that the law gives manufacturers one year to be in full compliance (and goes into effect August 5, 2014).

As we head into the final months before the law’s final compliance date, I thought I’d highlight a few other key points about this brand new law:

1. No symbols needed.  The law does not require or recommend manufacturers use any particular symbol or food label, but if a label should include any of the following phrases, compliance must be ensured:
    •    “Gluten-free”
    •    “Free of gluten”
    •    “No gluten”
    •    “Without gluten”

2.  It’s voluntary.  A manufacturer may produce gluten-free foods, but just choose not to label them as such.   

3.  “Gluten-free” does not mean “zero gluten”. The new law defines "gluten-free" to mean that a food contains less than 20 parts per million (20 ppm) of gluten.  (This tiny amount can be visualized as less than a tenth of a grain of salt on a slice of bread, and is acceptable as the standard for people with celiac disease).

4.  As with any rule, there are exceptions.  Although ...

Jaundice in newborn babies

As a new parent, you’re understandably eager and excited to leave the hospital and settle into your new routine with your baby. Sometimes, that routine is delayed due to the baby’s blood test confirming hyperbilirubinemia, also known as jaundice.

Jaundice in newborns is caused by an excess of red blood cells. Jaundice is seen as a yellow color to the skin, appearing first at the head (skin and sclera – or “whites of the eyes”) then progressing to the feet. As it decreases, it lessens in reverse. Before birth, the placenta removes bilirubin from the baby’s system; after birth, the baby’s liver takes over. In breast-fed babies, an imbalance between mother’s milk supply and baby’s feeding can lead to a higher-than-expected bili level. In addition to ensuring the baby is feeding well and having enough wet/stool diapers, phototherapy or “bili lights” may be needed. Bili lights help speed up the process by breaking down the bilirubin in the skin.

For phototherapy, your baby will be ...

Food allergies and emergency epinephrine in Washington State schools

Food allergies have been on the rise in recent years.  Studies suggest that up to 1 in 13 children are affected by a food allergy.  Egg and cow’s milk are the most common food allergies for infants and toddlers.  Fortunately, most children will lose a milk or egg allergy by the time they enter school.  Peanut and tree nut allergies are also becoming more common.  Unfortunately, only 10-20% of children will ever outgrow a nut allergy.

Currently there is no cure for food allergies.  Instead, doctors rely on an accurate diagnosis, avoiding food triggers, and being prepared in the event of a severe reaction.  Making the situation more challenging, nearly half of children with a food allergy may be at risk for a potentially life-threatening reaction called anaphylaxis. 

Symptoms of anaphylaxis may include:

  • hives or itchy welts
  • swelling
  • vomiting or diarrhea
  • difficulty breathing (cough, wheeze or shortness of breath)
  • dizziness or passing out

During a severe food allergy reaction, epinephrine (“adrenaline”) can be a life-saving medication. Epinephrine is typically injected into a thigh muscle with an “auto-injector” device like EpiPen® or Auvi-Q™.  Oral antihistamines like Benadryl, Allegra, or Zyrtec can help with some anaphylaxis symptoms, but are not considered life-saving treatment.

Emergency Epinephrine in Schools

Until recently, only certain students in Washington State could receive a life-saving epinephrine injection while at school.  They needed to be diagnosed with a food allergy and already have an epinephrine injector in the health room.  However, some students may not have an injector at school, or they have their first serious allergic reaction while at school.  In that case, the school could only call 911 and hope they arrived in time to save a life.

In January 2013...

Kids with kidney disease and cold and flu season

With the summer winding down, the dreaded cold and flu season is just around the corner.  Parents with children who have a history of kidney disease need to keep in mind a few things during this season of stuffy noses and coughs.

  • Avoid NSAIDs (non-steroidal anti-inflammatory drugs) like ibuprofen, Motrin, Advil, naproxen, and Aleve.
    • NSAIDs are known to decrease blood flow to the kidneys and can cause more damage.
  • Avoid Pseudoephedrine or any medications that may contain similar ingredients.
    • Pseudoephedrine is usually an ingredient for decongestants like Sudafed and is known to increase blood pressure.
  • Say YES to the flu shot early.
    • Children with kidney disease ....

What to expect when your child is in the Pediatric ICU (PICU)

Just the mere mention of the Pediatric ICU (PICU) can be frightening to both kids and parents.  But having a basic understanding of what people and equipment can be found in the PICU can help to lessen the anxiety.

What is the PICU?

The PICU at Swedish is a section of the hospital that provides the highest level of medical care for your child (0 to 18 years).  The PICU is different than just the regular pediatric floor because it allows for more intensive nursing care of your child and advanced continuous monitoring of their blood pressure, heart rate, breathing and more.  Patients in the PICU may also require more intensive therapies such as ventilators (a breathing machine) and certain medications that require close monitoring.

Who is hospitalized in the PICU?

Kids who are seriously ill whose medical needs cannot be met on the regular Pediatric unit will be in the PICU.  PICU patients may have breathing problems such as asthma or pneumonia, have had a lengthy surgery, have seizures or any other physical condition.  Time spent in the PICU depends on....

Wheezing in children

Wheezing is one of the most common symptoms in children and adults. Wheezing refers to the high pitched, "musical" sounds generated from the respiratory tract. It may originate in multiple areas, from the nose, to the throat, to the lungs. When physicians use the term "wheezing", they are usually indicating the sounds produced by tightness in the lower airways ("bronchial tubes").

Wheezing is especially important in pediatrics because children have frequent respiratory infections. These infections are generally caused by viral infections which cause much irritation in the airways. In addition, the airways of children are small and more "sensitive," predisposing them to wheezing. The location of the irritation may be in the upper or lower respiratory tract. This means that wheezing can occur with just a cold as well as bronchitis or pneumonia.

Wheezing in most children will respond to treatment with ...

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