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'Pediatric Specialty Care' Parentelligence posts

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...

Beware: Magnets May Be Hazardous To Health!

Magnets, a common household object with which we are all familiar, can be surprisingly dangerous, especially to children.  If this statement is startling to you, here’s what you need to know. 

Beginning in the 1970s and 80s, scientists discovered a new type of magnet, the so-called “rare-earth magnet”.  Made from some of the “rare earth” metals of the periodic table such as “Neodymium”, these new magnets are not only the strongest, most powerful magnets known to man (magnetic forces up to ten times that of other magnets), they are also permanent and relatively inexpensive to manufacture.  These properties revolutionized the production of many household products, even toys.  Basically, magnets we find in everyday items today are no longer made using old-fashioned magnets from a generation ago!

As a pediatric gastroenterologist, I am writing this blog to warn you of the dangers, should these powerful magnets be accidentally swallowed.  If more than one magnet is swallowed, or if a magnet is ingested along with another metallic object, the formidable strength of these magnets can attract 2 pieces of bowel to stick together with such great strength, it results in serious injury, even death.

This video ...

Handling stress with kids in the hospital

As the back to school sales begin, we are reminded that soon our kids will be back on the bus and returning to school routines.  As adults we may look forward to the return of a consistent routine or dread the increased activity that comes with sports, homework and friends.  For our children school can be both exciting and anxiety producing as well.

Stress can be a contributor to many illnesses and is something that we all can use help managing. (Want to find out how much you know about stress and your kids? Take this 5 question quiz here.) The questions bring up some great ways to manage stress daily for our kids; but what about the stresses of chronic illness or hospitalization?  What can you do for your child to decrease their anxiety in the hospital?

Advocating for Children with Severe Food Allergies

Eosinophilic Gastrointestinal Disorders (“EGIDs”) are a severe form of gastrointestinal inflammation that results from food allergy.  Children and adults in the U.S. are increasingly being diagnosed with this condition that unfortunately requires strict elimination diets, and many times, a life-long inability to eat foods that most of us take for granted each day, including dairy, wheat, soy, and eggs. 

For children requiring such restrictive diets, pediatric gastroenterologists like me work hard to find adequate alternate sources of nutrition.  For my patients with EGIDs, I often prescribe special “elemental formulas” as a treatment to both heal the intestinal inflammation and prevent further harm.  These formulas are completely allergen-free while meeting 100% of a child’s nutritional needs. 

However, in the state of Washington, most ....

Worrying about your child's growth

The above letters reflect many of our children’s feelings when they are first seen by Dr. Kletter. They and their families arrive to the Pediatric Endocrinology clinic with hope that something can be done.

Children are usually followed by their pediatrician or primary care provider. The following questions are guidelines for parents who are worried about their child’s growth. While any “yes” to the questions may not indicate a problem, it warrants a discussion with your child’s healthcare provider.

  • Is my child the shortest or tallest in the class?
  • Is my child unable to keep up with children of the same age in play?
  • Is my child growing less than 2 inches or more than 3 inches a year?
  • Is my child showing signs of early sexual development (before age 7 in girls and before age 9 in boys)?
  • Has my 13 year old girl or 15 year old boy failed to show signs of sexual development?

An experienced pediatric endocrinologist will evaluate the following possible causes of short stature and growth failure:

Ketogenic diet as a treatment for seizures

The ketogenic diet is a high-fat, low-carbohydrate diet that has proven to be effective in the treatment of seizures. In fact, the ketogenic diet is one of the oldest and most effective treatments available for patients with seizures regardless of age, from infancy through adulthood. The ketogenic diet must only be started under direct medical supervision.

Here are some frequently asked questions about the ketogenic diet:

What is the ketogenic diet?
The ketogenic diet is a special high-fat diet that often includes heavy cream, butter and vegetable oils to provide the necessary fat. The diet eliminates carbohydrate rich foods such as bread, rice, cereals, pasta, cookies, and cakes.

How effective is the diet at controlling or eliminating seizures?
Studies that have followed children on the diet for long periods reveal that at least 2/3 of all children on the diet have a significant reduction in seizures by over half. 1/3 of children on the diet will have a greater than 90% reduction in seizures, with half of these children ....

Child’s Belly Discomfort Caused By Allergies

This is one of the most common questions that I get asked in the office. Allergic diseases are certainly becoming more and more prevalent in the developed world. General pediatricians and specialists are on ‘high-alert’ for this when evaluating a child that may be sick. Within the realm of intestinal diseases, however, a true allergy is actually not very common. To understand this, we must first understand what ‘allergy’ means.

An allergy is a biologic response from our body’s immune system. When our body senses a foreign invader, our army of immune cells attacks it. It does this by releasing chemicals into the blood stream and/or in to the organs where the threat may lie. Those chemicals are meant to destroy the invader, but often hurt our healthy organs as well. For example, airborn pollen may land in your eye, the immune system senses that pollen, releases those chemicals, and as a consequence we get itchy, puffy, watery eyes. The same thing can happen in the bowel if we ingest food that we are allergic to.

Intestinal manifestations of food allergies

One of the more common sites of an allergic response to food is in the esophagus—the food pipe. When the esophagus gets inflamed, it can manifest in a few different ways: heartburn symptoms, chest pain, chronic dry cough, upper abdominal pain, frequent regurgitation, or food that is stuck the chest. The name of this is Eosinophilic Esophagitis. Food allergies lower in the bowels can cause diarrhea, blood in the stool, abdominal pain, weight loss, anemia, and fatigue.

There are usually other red flags

One of the most important things to remember is ....

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