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Lymph nodes in children

One of the most common referrals to my pediatric surgery practice is (in the parents’ words) “to check out this lump and make sure it’s nothing to worry about.”  Lymph nodes are part of the less publicized part of the circulatory system: the lymphatics.  Lymphatics play a key role in our body’s immune system, and lymph nodes grow in response to an infection in the “neighborhood” to produce cells necessary to hopefully resolve the infection. 

About half of all children will develop enlarged lymph nodes (cervical lymphadenitis) in the neck for example, and the vast majority of these are in response to a minor infection in the area (sore throat, sinus infection, ear infection, etc.).  Often the infection is quite subtle and might not be identified.  These nodes typically go through a pattern of growing and then receding in size once the infection resolves.  This process can take several weeks to months.  The nodes may become tender, warm, and there may be some redness of the overlying skin.  Your child might complain of pain in the area, be fussier, have fever, and/or have decreased appetite.  If the node itself becomes infected, it can turn into an abscess and would require antibiotics and a drainage procedure.  Any possibly infected lymph node should be evaluated by your doctor.
 
Some enlarged lymph nodes ...

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 ...

Parent's guide to newborn testing, screening, and prevention measures

When picturing the first days of an infant’s life, what we look forward to the most is love. We express our love in so many ways: skin-to-skin, breastfeeding, swaddling and snuggling. 
 
Love also means keeping them safe. 
 
Advances in maternal-infant health are one of the greatest success stories of the 20th century, with a drop in the death rate of 99%. But some of those dangers only stay in the past through constant vigilance. Behind every screening test and preventive measure is a careful, research-driven rationale. Here are seven newborn tests, screenings, and prevention measures you should know about:
 
Vitamin K injection 
Vitamin K is vital for blood to clot properly. Newborns cannot make Vitamin K and it is poorly transferred in breast milk. Without this injection, babies are at risk for spontaneous bleeding from the umbilical cord, mucus membranes, even in the brain. Giving Vitamin K has greatly reduced this "hemorrhagic disease of the newborn," but rates are increasing as more parents refuse it. Oral Vitamin K has not been shown to prevent this potentially devastating disease. 
 
Hepatitis B vaccine
This is an anti-cancer vaccine. Before this vaccine existed, approximately 10,000 kids under age 10 contracted hepatitis B each year. Most had no known exposure to it. Kids are more likely than adults to get very sick and to have complications. Vaccination at birth has greatly reduced rates of pediatric liver cancer due to hepatitis B. 
 
Antibiotic eye ointment
This prevents bacterial eye infections. Some of these infections are associated with sexually transmitted bacteria, but not all of them are. Negative testing or a monogamous relationship does not ...

Tips for keeping young athletes safe and healthy

We all know exercise is an important factor in maintaining an active and healthy life. However, over-exercising can lead to a rare, but serious complication known as rhabdomyolysis – a medical team that literally means ‘dissolution or destruction of skeletal muscle’. There has been a recent increase in rhabdomyolysis amongst teen athletes so it is important to recognize the warning signs and learn how to prevent them.

The classic triad of rhabdomyolysis is dark urine, muscle weakness or fatigue, and muscle pain. Although exercise can be the primary factor, other key contributing elements such as dehydration, genetic conditions (e.g. sickle cell), metabolic disorders, nutritional supplements, drug use, and heat stress can exacerbate muscle damage. Without appropriate medical evaluation and care, rhabdomyolysis can cause permanent damage to the kidneys and may even be life-threatening in severe cases. Here are some tips to help your young athlete remain active and healthy:

  1. Maintain adequate hydration – preferably with plain water.  Sports and energy drinks may often contain caffeine and excessive amounts of sugar which can cause dehydration.  On average, children that are 6-10 years old should have about 1L of fluid a day, children 10-14 years old should have 1.5L/day and teens over 14 years should have at least 2L of fluid a day. It is important to increase fluids with increased activity due to the additional fluid losses that occur.
  2. Eliminate protein supplements. A recent study by the American Academy of Pediatrics found ...

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 ...

Infants with Milk Allergy

A 4 week-old infant and his mother came to my office last week.  The mother had started seeing small flecks of blood and stringy mucous in the infant’s diapers a week prior.  The baby was fine in every other way, breast feeding normally, and looked quite healthy when I examined him.

I diagnosed the infant as having cow’s milk protein-induced proctocolitis, the term referring to allergic inflammation of the lower gastrointestinal tract from exposure to cow’s milk. 

This is a diagnosis I make often. Here's what you should know about infants with milk allergies:

  1. It’s more common than you think. 2-3% of infants in the U.S. are allergic to cow’s milk protein. It is even more common in infants with eczema or who have parents or siblings with allergies.
  2. It’s seen in breast fed babies.  Over 50% of infants with this condition are breast milk-fed infants.  But remember, the babies are allergic to the dairy in their moms’ diets, not to their mothers’ breast milk per se!
  3. Switching to soy or goat’s milk doesn’t work.  Over two-thirds of infants with cow’s milk protein allergy “cross-react” to soy protein (which means that they may not be truly allergic to soy protein, but their immune systems are just too “immature” to know the difference between the two).  Similarly, if a mother switches from drinking cow’s milk to goat’s milk, it won’t help, because the source is still a “different species”; the infant’s immune system will still respond to the “foreign” protein.
  4. Treatment takes time. The inflammation resolves when all traces of cow’s milk (and soy), are  removed from the infant’s diet.  In the case of formula-fed infants, we switch to special hypoallergenic formulas.  Typically after a successful switch, the bleeding stops within a week.  However, with breast fed infants, the improvement can be a little slower.  Since it can take up to 2 weeks for the dairy in a mother’s diet to circulate into her breast milk, the full effects may not been seen for up to a couple weeks.
  5. Allergy testing is not recommended.  The type of allergy that ...

What parents and teens should know about marijuana

In 2012, Washington passed legislation to legalize marijuana use for people 21 and over.  While still illegal for those under 21, it is important to understand how this might affect adolescents and children.

Facts about marijuana and teens:

  • In a 2009 national study, 32.8% of 12th graders had used marijuana in the last year, and 20.6% within the last month.
  • One in eight adolescents who start using marijuana by age 14 become dependent.
  • When prolonged marijuana use starts in the teen years it is linked to a significant drop in IQ points - and the decrease is irreparable.
  • Marijuana can affect memory and concentration, cause or exacerbate depression/anxiety/hallucinations, and negatively affect asthma and other chronic lung diseases.
  • Marijuana is much more potent now than in the past.  In 2012 the average concentration of THC in marijuana was 15% (compared to just 4% in the 1980s).
  • Harmful effects occur whether marijuana is smoked, ingested, or vaporized.  “Edibles” are becoming more popular, and present unique risks.  It may take longer to feel the effects when ingested rather than smoked - this often leads to users consuming more than intended and experiencing severe side effects.
  • Adults cannot “share” with teens - it is felony to provide marijuana to a minor.

What you can do as a parent:

  • Start the conversation early - begin talking to your child about marijuana and other substances by about age 10.
  • Set clear expectations that marijuana is like any other drug, and is illegal for anyone under 21.  For example ...
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