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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 ...

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 ...

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 ...

Why pregnant women should receive flu vaccine and pertussis booster

Why do we recommend that pregnant women receive both the flu vaccine and the pertussis booster during pregnancy? Here are a few reasons:
 
The influenza virus, better known as the flu, has been proven over and over to have the potential to cause serious disease in pregnancy.  That includes an increased risk that when pregnant women “catch” the flu, they may require admission to the intensive care unit, require a ventilator and, less commonly, even death.  It’s serious.   Babies of women who are infected with the flu during pregnancy are more likely to be born prematurely and are at increased risk for stillbirth.

We recommend the flu vaccine at any point in pregnancy and offer the single dose, preservative free vaccine in our office to all pregnant women (with the exception of those who have a medical reason not to get it.)  A common misconception is that the vaccine causes the flu - it does not.  Another misconception is that it is not safe for the developing baby to be exposed to the vaccine itself or the immune response it generates.  There is no evidence to support this fear in almost 50 years of administrating this vaccine and close follow up of those receiving it.

We recommend the flu shot, which is an inactivated virus. The Flumist is a live attenuated virus that is not recommended in pregnancy.

Your family members should also receive the vaccine as they can pass the flu on to a newborn who has not yet gotten the vaccine.  Babies can suffer severe complications if they are infected with the virus before they can receive the vaccine.
 
The other vaccine we recommend during pregnancy is the Tdap booster.  The benefit of the pertussis booster outweighs any perceived risk.  Pertussis, or the whooping cough, is at epidemic levels especially on the west coast including Washington State.  That may be  ...

Swedish Babies in 2013

Odds are that if you live in or around Seattle, either you or your children were born at a Swedish hospital. And after last year, those odds are even greater after our nurses and doctors delivered a record 9,014 babies in 2013.

Last year included a record number of births at Swedish Issaquah (1,149) and Swedish Ballard (1,022).

We attribute last year’s growth to our excellent reputation in the community as well as our outstanding ability to provide our patients with a safe, convenient and comfortable birthing experience. Last year we expanded our range of offerings for families when we opened our new Lytle Center for Pregnancy & Newborns and our Level II nursery at Swedish/Issaquah.

Now for some fun facts:

  • August saw ...

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 ...

How to give safe gifts to children during the holidays

As the holidays approach, parents often wonder what toys are safe for their little ones.  When making your list and checking it twice, here are some tips to ensure that toys are appropriate for the age and developmental stage of your giftees.

For younger children/infants:

  • Make sure all parts are larger than the child’s mouth.  Most children age 3 and under consistently put toys in their mouth, and some older children do as well.  A small-parts tester, or “no-choke tube” is about the size of a small child’s airway and can be purchased to test parts if you are unsure.  If a part or toy fits inside the tube, it’s too small to be safe.
  • When buying stuffed toys, look for embroidered or secured parts rather than pieces (such as eyes or noses) that could be removed and swallowed.  Remove all loose strings and ribbons.  Avoid animals with stuffing made of small pellets or material that could cause choking. Be aware that stuffed toys given away at carnivals, fairs, or in vending machines are not required to meet safety standards, so be especially careful with these!
  • When buying hanging toys for cribs, ensure that the child cannot grab any portion, and that strings or wires are short.  These types of toys should be removed when the infant can push up onto his or her hands and knees.
  • Keep plush toys and loose, soft bedding out of the cribs of infants and young children as these can cause suffocation.

For all children:

  • Look for labeling on the package that indicates what ages the toy is appropriate for.  Remember that this doesn’t have to do with how smart your child is, it is based on physical and developmental skills for his or her age group and should be followed.
  • Ensure that batteries are  ....
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