Archive for November 2016

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HPV Vaccine On Time: Only 2 Doses

hpv-2-doseWelcomed news out this fall about immunizations. If children and teens get their HPV vaccine on-time between the age of 11 and 14 years, they won’t need to do 3 doses as previously recommended. HPV vaccine given, starting at age 11, can be just 2 doses now, spaced 6 months apart! Celebration.

This new HPV shot recommendation from the CDC is based on research that has found when younger children are immunized, their immune response is greater at younger ages (age 11 versus age 16, for example). It’s also based on data on durability of the vaccine response — data has found teens immunized in the “tween” years continue to be protected years and years after the vaccine is given. So don’t wait to get teens immunized! In fact, waiting isn’t safer in any way, just leaves your child open to exposure for a longer period of time and the vaccine has the same side effects (most notably pain at the injection site!). Plus, you’re now reducing the amount of shots your child needs from 3 –> 2. Huge win!

The hope in this new recommendation is three-fold: more teens will get immunized on-time, they’ll be better protected from HPV infections and cancer risks early, and it will be easier to complete the entire series. Last year, for example, about half of boys ages 13 to 17 had gotten at least one of the recommended three doses, while about 63 percent of girls had gotten at least one dose, according to the CDC. However, not all teens finish the series and the new recommendation may help. In some areas only about 1/3 complete it.

HPV vaccine is an anti-cancer vaccine.

If your child has started the HPV series but not completed it, there is no reason to re-start the series — those shots still count. Just schedule a visit to finish what they started. If your child is between age 11 and 15 and there has been 6 months since their last HPV shot, under the new recs they will only need one more dose.
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5 Ways To Fight Loneliness

img_1673It seems to me that some of the greatest suffering in life comes with loss. Loss has all sorts of shapes and various hues of intensity. Comparing one loss to another in unlikely to ever do anyone any good. What feels big to someone you love IS big. For you, for your children, for your mom, or for your friend. Perspective shaping is important at times but acknowledging pain in loss is tantamount. Losses we feel can be immense (the loss of a person’s life) or obscure (the loss of personal direction) or even simply burdensome (where are those *&$#-ing keys?!?!?). We humans, including our little ones, feel worst when we’re disconnected, when we feel we’re somehow disorganized with our community and don’t belong, or when we are enveloped with a sense of loneliness.

Bullies know this well, of course, in part because of their own isolation. But so does everyone who has ever felt love. Being lonesome is agonizing.

Loneliness is bad for your health. In some research it’s on par with the effects of obesity and heart disease, injuries or violence.

For some, holidays are like blood-letting when it comes to loneliness. When any single one of us suffers we all lose a little. Those of us who are feeling disconnected will only sense and experience solitude with greater fervor as families, groups, friends and co-workers join hands to celebrate this time of year. Look around and imagine.

Or think about a starling murmuration and its beauty. It’s the choreography that makes it a thing of elegance but it’s also the intimacy in knowing that all those birds fit — all of them have a dependence and place with each other. Those little birds feed on both the single bird next to them but the group, en mass, too. I have to think they feel they belong as they twirl in the sky and progress across it. They give to and take from the group. And it reminds me that those outside of the murmurations typically want in.

We can all make this better for ourselves and for those around us. As we ready to step earnestly into December, I say we do more for each other this month. Counteract the forces and gravitational pulls of loneliness and isolation around us. Teach our children they can help, too. At dinner tonight and tomorrow maybe bring it up?

5 Ways To Fight Loneliness

  1. ONE: We can talk with our families about who we could invite to our homes, to our parties, and to our celebrations. Just imagine making a goal to invite one person into your fold you may not have thought to include. Just one person to one day or one event you wouldn’t have thought to include before. Even if they don’t typically don’t “celebrate” what you do. Make an invitation to someone by Friday, December 2nd.
  2. TWO: If loneliness seeps into you on any of these days, grab your bearings by turning off the noise of the murmurations around you. I think of this in terms of making sure you don’t stare at the masses. Turn off social media for 12 hours (or 3 days!) and immerse yourself in something you love. Be fastidious with yourself — put the devices down or turn them OFF if they lead you only to those murmurations and inclusions you don’t feel a part.
  3. THREE: Practice gratitude. This can be brisk and powerful in the face of loneliness. Write a quick thank-you note this week or jot down in a journal 3 things for which you’re thankful every day, for a week. The minute you elevate those around you in import is the same minute we feel truthfully happier.
  4. FOUR: If you sense someone around you is lonely, call. Don’t just text. If they don’t pick up the phone, call again. Invite them to a quick walking meeting, coffee, or lunch. Just do it.
  5. FIVE: Get a good night’s sleep. However banal that sounds we know sleep deprivation has us look at the world with cloudy lenses. We also know it even has us remember improperly (we color our memories negatively when sleep deprived). I seriously believe we all feel less alone after 7 to 8 hours (more for children!) of sleep.

Get Rid Of Constipation In Children

Children's legs hanging down from a chamber-potConstipation is really, very truly, no fun for anyone. No fun for baby or child, no fun for the parent who worries and watches and cleans the clogged toilet, and clearly nothing wonderful for the sister or brother who waits while a family supports a child in the room next door. In general, constipation is a frustrating, sometimes hugely embarrassing, and often a chronic problem for young children. In my experience, parents worry a lot about hard infant or toddler poop in the diaper (goal is always peanut butter consistency or softer) but it’s when constipation sneaks up on many families in school-aged children that BIG suffering ensues.

I can’t say this loud enough: if you’re worried about constipation in your child do consider seeing your pediatrician, nurse, family doc or physician assistant to make a long-term plan. Constipation DOES get better but do know it’s over weeks to months. When your child’s intestinal tubing is stretched out for weeks it takes weeks to re-configure sometimes — quick fixes won’t be long term solutions. More below on which remedies to use and how.

Constipation sneaks up because after children are toilet trained and wiping themselves (around age 4 or 5) many parents no longer gaze in the toilet bowl so gone are the days of tracking daily poops. Before you reach for OTC medications, consider what is normal and what is not normal when it comes to poop (below). I usually break this down for children (and parents) in visual terms. I talk about things you find outside:

In general, poop in the toilet can look like a pond, a snakea log, or a pebble. When it comes to poop, we’re always looking for snakes. It seems to me that framed this way, school age children can do a better job knowing if they’re constipated or not. We’re looking for  Snakes in the Lake, people! Frame it this way with your child and perhaps they will be more likely to get a glimpse of what they produce in the toilet? Or at least a report?

Lots of foods, hydration and OTC medicines can quickly change the game with constipation. Before I detail more specifics on constipation and highlight some remedies, I do want to call attention to some potential concerns of polyethylene glycol (PEG 3350). The medicine PEG 3350 is an odorless, tasteless laxative that can be easily diluted in juice or water. It’s a big polymer and can’t be absorbed by the intestine so it works by binding to water so that water ingested can’t leave the intestines, colon, and rectum. The great news is it doesn’t cause cramping or more pain and isn’t addictive. Used daily (often for days or weeks) the powder binds to water and disallows the colon to dehydrate the poop so it just doesn’t get hard. Therefore the poop that comes out is soft and often helps produce less painful pooping — and often it comes out more often! It’s commonly sold under both brand (Miralax) and various generic names. However, the Food and Drug Administration (FDA) has only approved its use in adults, not children. Currently, PEG 3350 is being studied as well as the bi-products of PEG 3350, specifically ethylene glycol (EG) and diethylene glycol (DEG), to determine whether it might be absorbed by children and whether use of the laxatives is linked to development of psychiatric or neurodevelopmental problems. The New York Times has done 2 stories on this topic: one in 2012 and one more recently in 2015, both worth a read if you are debating giving your child PEG3350. For children and families with severe constipation often the benefits of using it far outweigh the concerns.

What Is Constipation And Why?

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Give Children Probiotics When Taking Antibiotics

Probiotics are a little bit the rage these days. The more we learn about the microbiome (all the bacteria that happily live in and on us to support digestion and immune function), the more we learn we want to preserve them. Probiotics are supplements (not medicines) so the data on their use is in the early stages but taking probiotics while taking antibiotics really does make medical sense. New data out in JAMA Pediatrics makes this more compelling. Taken orally, probiotics re-populate your gastrointestinal tract with “good” bacteria to help aid in digestion — so using them at the time you are taking antibiotics for an infection may help alleviate side effects like diarrhea that result after the “good” bacteria are killed off.

Antibiotics are the most commonly prescribed medication to children yet estimates show that 1 in 3 to half of antibiotics prescribed are unnecessary. Typically that means that antibiotics are prescribed when they won’t do any good for a viral infection or when a child will recover from an infection without intervention. Trouble is, antibiotics kill BOTH the good and bad bacteria in our bodies. Sometimes this is necessary when it comes to treating things like whooping cough, strep throat and urinary tract infections, while others it is not (colds, bronchitis and fluid in the ear). Of course in addition to using antibiotics more than we’d like to, antibiotics also cause side effects like: diarrhea, abdominal cramping, hives and nausea.

The estimated incidence of antibiotic-associated diarrhea among children is 11%  among outpatients and 21% among inpatients — Probiotics and Prevention of Antibiotic Associated Diarrhea in Infants and Children, JAMA Pediatrics

The recent JAMA Pediatrics  clinical synopsis (summary of a larger Cochrane review) provides us new insights on how we can help children who may be struggling with side effects caused by antibiotics. The study found that providing children with probiotics during antibiotic use can reduce both the chance of diarrhea and the number of days it lasts. Probiotics are live bacteria and yeasts that can help replenish the bacteria in our guts that antibiotics kill. Probiotics often come in capsules you can open up in your children’s food or bottle or they come in packets you can sprinkle.

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