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'pediatric' posts

What causes bedwetting and when to be concerned

Bedwetting (also called nocturnal enuresis) is a very common childhood problem.  The number of children with this problem varies by age. For example, at five years of age, an average of 16% of children will have a bedwetting accident.  By 15 years of age and older, 1-2 % continue to wet the bed.  For most children, this will improve or resolve without any treatment as they get older.

What can cause bedwetting?

Bedwetting may be related to one or more of the following:

  • The child’s bladder holds a smaller than normal amount
  • Genetics (parents who had nocturnal enuresis as a child are more likely to have children with the same concern)
  • Diminished levels of vasopressin (a hormone that reduces urine production at night)
  • The mechanism for the bladder and brain to talk to each other is “off line”
  • Underlying medical/emotional concerns (i.e. diabetes, urinary tract infection, ADHD, etc)

When does a child achieve dryness at night?

Typically, children will learn to stay dry during the daytime first, then they will achieve night time dryness. This whole process generally can take up age 4-5.

When is bedwetting a concern? 

Typically, when ...

Dirt is good for kids

I remember one day during my pediatric gastroenterology fellowship, a mother and child were walking in front of my professor and me, as we made our daily rounds in the hospital.  When the pacifier fell out of the toddler’s mouth and the mother picked it up and put it right back into the child's mouth, my professor remarked to me, "mark my words....that child will never get Crohn’s disease!"   My professor was referring to the theory of the "Hygiene Hypothesis".  This theory  is thought to explain (at least in part) why so many more people in developed nations become afflicted with autoimmune diseases such as Inflammatory Bowel Disease (IBD - Crohn's disease and Ulcerative Colitis) as well as food allergies, compared to people in non-developed nations. 

In non-developed countries, where children are...

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...

Dozens of Swedish-Affiliated Physicians Recognized as 'Top Doctors' by Their Peers



SEATTLE, August 16, 2013 - Now in its 13th year, Seattle magazine recently published the results of their annual 'Top Doctors' survey in the July issue. As in past years, dozens of Swedish-affiliated (or credentialed) physicians were recognized in the popular issue due to being nominated by their peers.

Additionally, Seattle Metropolitan magazine published the results of its 'Top Doctors' survey in the August issue, in which dozens of Swedish-affiliated (or credentialed) physicians were also featured

 

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 ....

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