It is with great happiness that I update an earlier blog posted several months ago with the news that patients with food allergies now have a law that helps them afford their treatment. On Friday March 28th, Governor Jay Inslee signed a law that makes Washington the most recent state in the country to set a mandate for medical coverage of elemental formulas in the treatment of Eosinophilic GI disorders (EGIDs). EGIDs are a severe form of gastrointestinal inflammation that results from food allergy.
'Pediatric Specialty Care' Parentelligence posts
We all know that as a nation, we are getting bigger and heavier. Worse still, our future - our children- are becoming obese and unhealthy at increasingly younger ages. For decades, the scourge of obesity was blamed on a high calorie, high fat diet. Turns out, we have probably been doing it wrong all these years and our bulging waistline attests to this colossal failure. Research and the medical community now have increasing evidence that the real villain of the story is a very sweet little molecule called fructose. Fructose is what gives us the sweetness in table sugar (sucrose)…also in brown sugar, honey, agave, and of course, high fructose corn syrup. Call it by any name, but sugars are dangerous to our health. Fructose is addictive, much in the same way as alcohol and illicit drugs are. In fact, sugar (fructose) metabolism closely replicates alcohol metabolism except for the acute effects on brain. Sugar has been likened to alcohol without the buzz!
You may already have heard about First Lady Michelle Obama’s work with the FDA which has led to newly proposed changes to nutrition labels on packaged foods. The amount of sugars, specifically, “added sugars” will be part of that new label. I am not implying that a zero added sugar diet will be the panacea for the pandemic of obesity and ill health. We still need to eat healthy and exercise right. There is no magic pill, no startling new advice. Remember what our grandmothers used to say:
As a pediatric urologist, I am frequently asked to consult with parents whose newborn son has hypospadias.
Hypospadias is usually diagnosed during the physical exam right after the baby is born. When parents see the abnormal penile anatomy they naturally want to learn about the diagnosis and understand what, if anything, needs to be done. Answering these questions, discussing options, and performing reconstructive surgery to help restore normal penis appearance and function are some of the most rewarding things I do as a pediatric urologist.
I would like parents who have a son born with hypospadias to be reassured that the anatomy can be reconstructed, the surgery is well tolerated, and a good outcome with a normal, or near normal, penis appearance and function can be achieved.
It is not urgent to treat newborns with hypospadias because they can usually pee (urinate) just fine through their existing urinary opening.
In fact, when hypospadias is the only condition noted in a newborn physical exam there is a low chance of additional developmental abnormalities. Additional tests and studies on the baby are usually not necessary.
It is important to note that if any unusual shape of the penis or urethral opening (where the pee comes out) is present then circumcision (if desired) should not be performed until after the child is examined by a pediatric urologist. This is because the pediatric urologist may need to use the foreskin tissue for the surgical repair.
Here are answers to some commonly asked questions:
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 ...
Here's what you should know about antibiotics in these situations:
- Ear infections ...
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:
- 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.
- Eliminate protein supplements. A recent study by the American Academy of Pediatrics found ...
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:
- 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.
- 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!
- 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.
- 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.
- Allergy testing is not recommended. The type of allergy that ...