2012 Newsymail Archive
Jan 9
A recent report of Lipitor and other statins increasing your chances for
type 2 Diabetes. It turns out that most of the ones that developed it were
those with high risks for diabetes anyway: over weight, high blood sugar,
elevated triglycerides, and high blood pressure. I would not be overly
concerned over using the statins if you have high cholesterol and high LDL.
The news love to scare us.
Also the withdrawal of formula last month because of an infant dying of a
rare bacteria. All formula that was recalled was tested negative for any
bacteria and the CDC announced it safe. The infant acquired the infection
from some other source and not the formula. Again hold your panic until
the whole story is told. The news is always in a hurry to be the first to
scare people.
While we are talking about rare things that can scare you. There were
several cases of the brain eating amoeba that people were getting in warm
stagnant ponds in the summer. Now two cases were caused by tap water used
in the sinus-irrigating neti pot. Using sterile bottle water is simple to
do.
Roger Knapp MD
Jan 12
An economics professor at a local college made a statement that he
had never failed a single student before but had once failed an entire
class. That class had insisted that socialism worked and that no one would
be poor and no one would be rich, a great equalizer.
The professor then said, "OK, we will have an experiment in this
class on socialism. All grades would be averaged and everyone would receive
the same grade so no one would fail and no one would receive an A.
After the first test, the grades were averaged, and everyone got a
B. The students who studied hard were upset, and the students who studied
little were happy.
As the second test rolled around, the students who studied little
had studied even less, and the ones who studied hard decided they wanted a
free ride too so they studied little. The second test average was a D! No
one was happy.
When the 3rd test rolled around, the average was an F. The scores
never increased as bickering, blame and name-calling all resulted in hard
feelings, and no one would study for the benefit of anyone else.
All failed, to
their great surprise, and the professor told them that socialism would
also ultimately fail, because when the reward is great, the effort to
succeed is great, but when government takes all the reward away, no one
will try or want to succeed. Could not be any simpler than that.
So I believe in giving grades in school instead of everyone getting a
passing. Yes some kids will not make first place in a sport but we learn to
get over defeat. Look how many times Edison failed to make the light bulb
before succeeding. Michael Jordan was cut from
his high school basketball team. Jordan once observed, "I've failed over and
over again in my life. That is why I succeed." For many examples of famous
people who failed first: see:
Failures
Also many of the things we learn growing up we learned in the school of
hard knocks. Your parents did not teach you how to handle the bully on the
playground or the guy who hit on you at your job. We parents cannot teach
our children everything and we are not responsible for everything. We are
the most important influence for making our children turn out to be good,
kind, and honest human beings. When your children get upset over failures
it hurts us more than it hurts them. When we protect our children from
these heart breaking events, it seems we are protecting us more than our
children from these hurting feelings. I now realize what heart aches my
parents went through while raising me!
http://www.blogher.com/100-question-amy-taste-crazy-asks-if-children-should-be-guarded-failure
Helicopter
Parents
Roger Knapp MD
p.s.Walt Disney,
producer, director, screenwriter, animator, developer of Disneyland. Winner
of 26 Oscars and 7 Emmy awards. While attending McKinley High School, he
also took night classes at the Chicago Art Institute. He dropped out of high
school at the age of 16 to join the army. Rejected because he was underaged,
he joined the Red Cross and was sent to war in Europe. Upon his return from
war, he began his artistic career.
http://www.tooft.com/10-richest-people-who-didnt-finish-college/
Jan 17
The flu is starting mid January of every year and you can see this in the
charts from the CDC. You can see these changes each week by bookmarking this
site and logging on occasionally. The big spike in 2009 was the H1N1
epidemic.
http://www.cdc.gov/flu/weekly/
Here are the CDC recommendations for treatment of the flu. Basically we
should be treating the patients in high risk areas mentioned below. I do not
believe in treating every child with the flu. There are some bad
complications of the medications although rare. Also note that the tests for
the flu are not accurate and can miss on the average 50%. So many times I
may see a high risk child and treat without doing a test. If the test is
positive then I will treat and if negative I still will treat if the
symptoms are just like the flu. So why run the test if I am going to treat
no matter what. Also if the child is not high risk, then why run the test
since I am not going to treat it whether it is positive or negative. I may
run the test if the parent just wants to know and in the situation where
there might be high risk people in the home who might need prophylaxis.
Summary of Influenza Antiviral Treatment Recommendations
Clinical and observational data show that early antiviral treatment can
shorten the duration of fever and illness symptoms, and reduce the risk
of complications from influenza (e.g., otitis media in young children,
pneumonia, respiratory failure, and death) and shorten the duration of
hospitalization.
Antiviral treatment is recommended as early as possible for any
patient with confirmed or suspected influenza who
o is hospitalized;
o has severe, complicated, or progressive illness; or
o is at higher risk for influenza complications.
Persons at higher risk for influenza complications recommended for
antiviral treatment include:
o children aged <2 years;*
o adults aged ‰65 years;
o persons with chronic pulmonary (including asthma), cardiovascular (except
hypertension alone), renal, hepatic, hematological (including sickle cell
disease), metabolic disorders (including diabetes mellitus), or neurologic
and neurodevelopment conditions (including disorders of the brain, spinal
cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy [seizure
disorders], stroke, intellectual disability [mental retardation], moderate
to severe developmental delay, muscular dystrophy, or spinal cord injury);
o persons with immunosuppression, including that caused by medications or by
HIV infection;
o women who are pregnant or postpartum (within 2 weeks after delivery);
o persons aged <19 years who are receiving long-term aspirin therapy;
o
American Indians/Alaska Natives;
o
persons who are morbidly obese (i.e., body-mass index ‰40);
and
o residents of nursing homes and other chronic-care facilities.
Diagnostic Testing for Influenza
Rapid Influenza Diagnostic Tests (RIDTs) can be useful to identify
influenza virus infection as a cause of respiratory outbreaks in any
setting. RIDTs produce very quick results, but the results may not be
accurate. Sensitivities of RIDTs are generally 40-70%, but a range of 10-80%
has been reported compared to viral culture or reverse transcription
polymerase chain reaction (RT-PCR). In particular, false negative test
results are common during influenza season. Clinicians should realize that a
negative RIDT result does NOT exclude a diagnosis of influenza in a
patient with suspected influenza. When there is clinical suspicion of
influenza and antiviral treatment is indicated, antiviral treatment should
be started as soon as possible without waiting for results of additional
influenza testing.
CDC
does not recommend widespread or routine use of antiviral medications for
chemoprophylaxis so as to limit the possibilities that antiviral resistant
viruses could emerge. Indiscriminate use of chemoprophylaxis might promote
resistance to antiviral medications, or reduce antiviral medication
availability for treatment of persons at higher risk for influenza
complications or those who are severely ill.
Roger Knapp MD
Feb 16
The recent news talked about the EPA announcing high levels are Arsenic in
the €œNatural formulas€ for infants. It was from the organic brown rice
syrup that is used for the sweetener and is among the first few
ingredients. This is not found in Enfamil or Good Start.
There is
a lot of arsenic in some brands of apple juice.
At least
one sample of apple juice from the following popular brands had levels of
arsenic over 10 ppb: Apple & Eve, Great Value (Walmarts house label), and
Motts.
MORE:
Study: The Perils of a Heavy Bottled-Water Habit
Apple juice brands that had at least one sample surpassing 5 ppb of lead
were: Americas Choice (A&P), Gerber, Gold Emblem (CVS), Great Value, Joe€™s
Kids (Trader Joe™s), Minute Maid, Seneca and Walgreens. The brands with
very low levels were Natures Own 100% Apple Juice, Tropicana 100% Apple
Juice and Red Jacket Orchards 100% Fuji Apple Juice.
Roger Knapp MD
www.rogerknapp.com
Also: Milk and milk
products provide a wealth of nutrition benefits. But raw milk can harbor
dangerous microorganisms that can pose serious health risks to you and your
family. According to the Centers for Disease Control and Prevention, more
than 800 people in the United States have gotten sick from drinking raw milk
or eating cheese made from raw milk since 1998. Raw milk is milk from cows,
sheep, or goats that has not been pasteurized to kill harmful bacteria. This
raw, unpasteurized milk can carry dangerous bacteria such as Salmonella,
E. coli, and Listeria, which are responsible for causing
numerous foodborne illnesses.
Feb 28
Zinc has been shown in many studies to improve the immune system. The
mortality of pneumonia is significantly lowered be giving zinc. In third
world countries studies would give zinc to children who were admitted to the
hospital with pneumonia, as in contrast the developed countries give the
zinc all year. Most children in third world countries are zinc deficient.
The World Health Organization said that the two things that would help
improve the survival of children€™s pneumonia would be breast feeding and
zinc. So I recommend all year giving vitamins with zinc and iron starting 9
€“ 12 months of age. Zinc and Iron only comes in a chewable like
Flintstone complete. The gummy vitamins are very weak, does not have iron,
and can cause cavities from the sticky sugar. Give ½ chewable vit until
3-4 years old and then a whole one. Crush them up in food until they can
chew them up themselves.
Dr. Knapp
March 7
We have many injuries from baseballs hitting the head and neck of players.
I had one pitcher who was hit in the throat/voice box and never talked right
again. If you think about it, every player on the football team wears a
helmet € not just the runner with the ball. And they play better if they
are not worried about getting hurt. So every player in baseball should wear
a light helmet like the batter and have two bars in front to block the
ball. They would stay in there and catch the ball better if not being
afraid of getting hit by the ball. It would take the parents petitioning
the baseball organization to require all players to wear them. The boys and
girls will not do it willingly.
Another topic is BO. Yes I said underarm odor. It frequently starts close
to 6 yr old. Other changes do not start until around 9. They can wear
antiperspirant if needed. There are different strengths of
antiperspirants. The concentration of aluminum chlorhydrate varies from 15
to 25 %. Mitchum is the brand that has the higher concentration. If your
brand is not working very well, then get a higher percent. Plus the feet
can have excessive sweat glands with more odor and athlete€™s feet. You
can also apply antiperspirant on the feet after the bath.
Roger Knapp MD
March 25
Spring is obviously here early. Use swim shirts and sunscreen. I like the
sprays since they dry out fast and do not stay greasy. Spray your hand and
wipe on their face. You can use sunscreen starting at 4-6 months old.
There are many farmers out in the sunny hot fields with long blue genes on
and even long sleeve shirts. So if you are going to the park or camping,
cover their bodies. If playing around the weeds and possible poison ivy,
come in and take a sudsy bath and put the clothes in the washer. That way
you rarely develop a rash. Also the rash of poison ivy is not contagious
and does not spread around the body. That is an old wives tale. Also keep
the off on them. We see several cases of encephalitis every summer.
So lets have a fun and safe summer.
Dr. Roger Knapp MD
PS: Inhaling very much helium from a balloon so you can talk high pitched
and funny, will drain the oxygen from your lungs and you will die. Do it
once and stop.
See:
http://familytimemagazine.blogspot.com/2012_03_01_archive.html
April 9
This is summer and time
for fun and injuries. Remember I have talked in the past about wrapping
injuries instead of ice. But let€™s talk about teeth being knocked out.
If loose but still in place then see the dentist to get it supported until
it tightens back up again. If it is out and swallowed€ it is gone and
there is no chance of saving it. If you have the tooth, time is critical.
There is a 90% chance of survival if the tooth can be reinserted back into
its socket within 30 minutes. If you are able to push it back in, then
head to the dentist. You may have to rinse out the socket if it has blood
in it. Have them bite on cloth to hold it in place. It is not very painful
to push it back in since the nerves are broken. If the adult cannot put it
back in the socket, then put the tooth into milk. If that is not available,
then put it into water. Or if it is the parent, you can put it under your
tongue until you see the dentist. Many schools and clinics have a balanced
salt solution called €œSave-a-Tooth€ that you can put it into. Handle
the tooth by the crown only and not the root.
Roger Knapp MD
May 4
Well they
came out with another study showing a correlation between too much TV and
video games and poor performance in school. Also there have been studies
showing excessive TV viewing and a decrease in school work with more violent
content of the movies, more sexual behavior at a younger age if they watched
shows with more sexual content, delayed speech and language in toddlers, and
less exercise and more weight gain with too much TV. So be a mean parent and
keep it down. Of course that means we can't watch it either.... or record it
to see later. Play board games with the kids or walk around the block. Take
them to the park to play. Be sure to use sunscreen and insect repellant.
Put long pants like blue genes on them even though it is hot. They will
have less skinned knees, bug bites, sun, and itchy rashes from the grass.
They have
fireworks every Friday evening all summer at Grapevine Lake close to the
Gaylord. Very impressive show. Take some drinks, chairs, and snacks and
have a fun evening.
Dr.
Knapp MD
May 13
Summer problems are already starting. Swimmer€™s ear infection is caused
by the water changing the pH of the ear canal so putting ½ alcohol and ½
vinegar solution in their ears after swimming will help prevent it.
Swimmer€™s ears hurt to move the outer earlobe. Once infected you will
need to get some antibiotic drops to put into the ear canal.
If you or your child work out in the weeds and vines, you can get a rash
like poison ivy since many plants can cause the same rash. Also the rash is
not contagious and you cannot spread it from the skin rash. Treat with
steroid creams and if more severe you can come in and get a stronger Rx.
But if you wear long pants, sleeves and gloves and then take a bath right
away, you likely will not break out.
Ticks have to be on you for more than 48 hours to cause diseases like Lyme
Disease. Check yourself and the kids after going out where you might be in
contact with them.
Sports or other injuries will cause a swelling quickly. Example is a
sprang ankle. It bleeds in the tissues and joint. Immediately wrap it with
tape and leave on for 24 hours. Ice will not help very much.
Have a safe and fun summer.
Dr. Knapp
If you are going to Disney World, get the Disney World Magic Guide app for
your phone. It has maps, wait times for all rides, Park hours, and dining
information like menus and prices. If you have reservations it will keep
them for you and remind you. It is worth the price.
May 21
Swimming
lessons for infants With summer coming up this question always comes up.
Also how old
do they have to be to go into the pool. It is not a problem of chlorine but
a concern is for the body temperature. They can get hypothermia fast. When
2-6 months then the water should be luke-warm and take them out every 5-10
minutes to take their temp. If below 97 or shivering, then get them out and
dry them off. If over 6 months then they can go into cooler water but watch
the temperature frequently. Personally I prefer a rubber blow up pool. Then
let the hose sit in the sun where the water in the hose gets very hot.
Then add that to the water in the pool and that will warm up the water some.
I don't
recommend actually teaching the infant to "swim" over to the edge of the
pool and "save themselves". The parent's job is to be certain that the
infant does not drown, it is not the child's job. Teaching the infant to
paddle or keep from going under immediately will give the parent a false
sense of security that the baby will not drown and may be less vigil in
watching them. Also they swallow a lot of water that can lower their blood
sodium level and cause a seizure.
I think it
is fun and OK to have swimming lessons where the moms sit around in the
kiddy pool and let the babies splash. It is a social event and not really
swimming. That is fine and great enjoyment by all. Just watch the
temperature and watch out for poop in the water. Don't let them drink the
water. And use sunscreen and swim shirts!
Dr. Knapp MD
See
http://www.rogerknapp.com/medical/swimmerear.htm
on how to prevent swimmer€™s ear infection.
Also
if you want to see what melanoma looks like, See:
http://www.cbsnews.com/2300-204_162-10006772.html?tag=contentMain;contentBody
May 23
Breast development occurs many times while growing up.
There can be breasts in 1-2 months old from the hormones in the breast milk.
They can put out milk and it was called Witches Milk in the old days.
There is Premature Thelarche at around 1 year of age that is not abnormal.
See:
http://www.rogerknapp.com/medical/prematurethelarche.htm
There is breast development at puberty obviously in females but males at
11-13 years can
also have a breast bud. Usually a quarter size lump under the nipple that
stays there for a
year or so and is tender like someone hurt it. It is normal. It does not
happen to all boys.
And then there are old men breasts too.
So don't be alarmed at these stages.
R. Knapp MD
May 29
Many medications that are purchased/manufactured in other countries can be
counterfit.
The price of medications can be high in the US because the FDA has strict
requirements.
Drugs sold from Canada, Asia, and Europe, frequently are fake€ as much at
50% of them.
Examples:
Avastin cancer drug
Malaria drug
Vicodin pain med.
Emergency birth control
Tamiflu
Weightloss medicines like Alli and Phentermine.
Viagra
See for more information:
http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm048396.htm
http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/CounterfeitMedicine/default.htm
http://allafrica.com/stories/201205230095.html
Signs
of a trustworthy website
-
It's
located in the United States.
-
It's
licensed by the state board of pharmacy where the website is operating.
A list of these boards is available at the website of the
National
Association of Boards of Pharmacy4.
-
It has a
licensed pharmacist available to answer your questions.
-
It
requires a prescription for prescription medicines from your doctor or
another health care professional who is licensed to prescribe medicines.
-
It
provides contact information and allows you to talk to a person if you
have problems or questions.
Signs of an
unsafe website
-
It sends
you drugs with unknown quality or origin.
-
It gives
you the wrong drug or another dangerous product for your illness.
-
It
doesn't provide a way to contact the website by phone.
-
It offers
prices that are dramatically lower than the competition.
-
It may
offer to sell prescription drugs without a prescription€”this is
against the law!
-
It may
not protect your personal information.
Dr. Knapp
June 17
A new study published in the
Journal of Early Adolescence
found that dads are in a unique position to instill persistence and hope in
their children, particularly in the pre-teen and teen years. Researchers
from Brigham Young University analyzed 325 families over a four-year period,
when fathers responded to questionnaires regarding their parenting style,
and children ages 11 to 14 responded to questions about school performance
and attaining goals. Fathers who practiced authoritative parenting, defined
as providing feelings of love, granting autonomy and emphasizing
accountability to a child, were more likely to have kids who developed the
art of persistence, which led to better outcomes in school and lower
instances of misbehavior.
"It's important to say that moms can do this, too, but it turns out that
when fathers use authoritative parenting, they have an impact on how their
adolescents perceive themselves and how persistent they are in their lives."
See:
http://abcnews.go.com/Health/persistence-learned-fathers-study/story?id=16571927
So Happy Father's Day to all you Dads. The best results of raising children
comes from both parents contributing to raising the children.
Dr. Knapp
Like Marry Poppins said in
the song:
A Spoonful of sugar helps the medicine go down
The medicine go down
The medicine go down
Just a spoonful of sugar helps the medicine go down
In a most delightful way
http://www.youtube.com/watch?v=3IBvtuZNgAM
Getting kids to take
medicine sometimes can be a challenge. I don€™t recommend holding them
down and forcing it unless all other options have been tried. Here are some
suggestions to help the medicine go down.
Put the medicine into the
cheek and have them drink something they really like.
Give a cold treat (eg,
frozen slushy drink, ice pop, or ice chips) immediately before and after the
medication in order to numb the taste buds and minimize the aftertaste of
the medication;
Add such sweeteners as
chocolate syrup, strawberry syrup, maple syrup, or sweetened soft-drink mix
(eg, Kool-Aid®) to the child's dose of liquid medication;
Give the child a lollipop
or other hard candy after taking medication to overpower the aftertaste;
Add a flavoring agent,
such as FLAVORx®, to the liquid medication when a prescription is filled.
FLAVORx flavoring options are available for many commonly used
pediatric medications. The subsequent impact on the stability of the
resultant product must be considered and communicated to caregivers;
Add chocolate syrup or
concentrated frozen orange juice to bitter or salty-tasting liquids (eg,
promethazine, diphenhydramine).
What about swallowing pills? I could not swallow them until I was a high
school senior. For years I used food. The teenager can swallow a big bite
of hamburger but that little pill gags them. So bite off a big hunk of
food, chew it up and when you are ready to swallow it, push the pill into
the big wad of food that is in your mouth and swallow. Then gradually put
it into less and less food until you can just swallow the pill.
Just a reminder: keep all meds locked up. Poison Control number:
800-222-1222
http://www.poisoncontrol.org/
July 10
Dramatic news! For healthier kids, get a cat or dog, study suggests.
http://vitals.msnbc.msn.com/_news/2012/07/09/12641955-for-healthier-kids-get-a-cat-or-dog-study-suggests?lite
I love dogs and have two of them. One sleeps on my bed. There are many
benefits to pet cats and dogs. One study showed less allergies in kids who
grew up with a cat. There is an old wise tale that a Chihuahua will stop
the kid’s asthma. This study is poorly done and the author even states it
shows a correlation and not cause and effect. But the news probably does
not read much of the details of the study and reports this stuff. They
dramatize it as if there is a huge benefit and every one should go out and
get a dog. Here are the actual numbers of healthy weeks for the kids in the
study with bars showing cats and dogs. Not a big difference.
See Bar Graph on page 4 in the article:
http://pediatrics.aappublications.org/content/early/2012/07/03/peds.2011-2825.full.pdf+html
It always helps to actually look at the study details. The best way to get
good medical information (rather than some web site put up by somebody that
wants to sell you an education program or vitamins or some great discovery
product) then go to Google Scholar Search. That will give you scientific
medical studies. But still read them with a critical eye.
Roger Knapp MD
July 21
Well the news was talking about a big epidemic of whooping cough (Pertussis).
18,000 cases and nine deaths so far this year.
http://romenews-tribune.com/view/full_story/19465409/article-CDC-reporting-highest-cases-of-whooping-cough-since-1959?instance=home_news_lead_story
There is an increase but this occurs every 3-4 years.
Year Reported Cases*
2000
7,867
2001
7,580
2002
9,771
2003
11,647
2004
25,827
2005
25,616
2006
15,632
2007
10,454
2008
13,278
2009
16,858
2010
27,550
2011
15,216
2012
18,000 so far this year.
http://www.cdc.gov/pertussis/surv-reporting.html
It is hard to say if this year€™s cases will continue at this rate or die
off and be the same as 2005 or 2010. Texas had a very tiny increase in
cases. Here are the ones that had the big increase.
States
with incidence of pertussis the same or higher than the national incidence
(as of July 5, 2012), which is 5.24/100,000 persons
Wisconsin
50.7 Utah 14.2 New York
State 7.3
Washington
39.2 Maine 14.1
Illinois 6.7
Montana
32.7 Oregon 13.4
Pennsylvania 6.3
Vermont
23.7 New Mexico 11.7
Missouri 5.8
Minnesota
23.4 Arizona 8.3
Idaho 5.7
Iowa
21.0 Colorado 8.2
Alaska 5.2
I think all these vaccines do not last a lifetime. We have known a long
time that tetanus had to be repeated every 10 years. The adult DPT vaccine
was released and recommended in 2005 to prevent adults from getting whooping
cough and giving it to infants. When that vaccine came out, I went and got
it because I don€™t want to cough my head off for 3 months and not give
whooping cough to my patients or grandchildren. I recommend it to all
adults and especially to pregnant and postpartum mothers, fathers, and
grandparents.
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5704a1.htm
I also recommend those over 50 get the shingles vaccine (which is chicken
pox€ even the real disease may not last a lifetime.)
There needs to be 90% of the community vaccinated to prevent major
outbreaks. There is no vaccine that works 100% but if every one gets the
vaccine and less than 10% fail to develop immunity, then we still do a good
job of controlling a deadly disease. But if there are 8% failures of the
vaccine and 8% idiots who refuse vaccines, then there is an outbreak.
Yes I called parents who do not vaccinate Idiots. They are paranoid
gullible people who believe what they read on the internet. Vaccines do not
cause autism and I do not believe there is an increase in autism.
In
2009, nearly 17,000 cases of whooping cough and 14 deaths were reported
nationally. Worldwide, there are 30-50 million cases of whooping cough and
about 300,000 deaths per year.
Roger Knapp MD
August 20
There was a study reported lately :
http://healthland.time.com/2012/08/20/study-shows-anesthesia-may-lead-to-language-deficits-in-children/
that linked
exposure to anesthesia to learning disabilities, finding that exposed kids
had lower scores on standardized tests of reading, writing, math and
reasoning, and were more likely to have behavioral issues at school. Another
study
in 2012 found that children who underwent multiple exposures to anesthesia
early on were twice as likely to be diagnosed with attention
deficit/hyperactivity disorder as teenagers, compared with children with
fewer exposures to such drugs.
But some studies reported no effect €. Some researchers are looking for an
effect to prove their point and some want to prove no effect.
Same with the effect of ear infections and fluid on speech development.
One showing an effect and another showing none.
One study showed
none to very small negative associations of OME and associated hearing loss
to children€™s later speech and language development.
http://pediatrics.aappublications.org/content/113/3/e238.short
Still
another showing no help with tubes:
http://www.nejm.org/doi/full/10.1056/NEJM200104193441601
So I tend to be rather conservative about putting PE tubes in infant€™s
ears. I do sometimes recommend it but only when they are very frequent.
Every doctor has their limit when they recommend tubes. Some do it with
very few infections and some after too many. The scar from the tubes lowers
the hearing rarely just like fluid in the ears.
Many children get tubes about when their speech is about to improve and
take off and the tubes get credit for doing it.
If the child is having a few infections during the winter, that is
typical. If they continue to have them in the summer when most will stop
having them, then you need to consider tubes.
Dr. Knapp
August 24
Car seats as you know saves lives. Here are the requirements or
recommendations in the Texas car seat law:
Child Passenger Safety Best Practice Recommendations
Phase 1 Rear-Facing Seats
Infants: Birth - 35 pounds. Rear-facing infant or rear-facing convertible
safety seat as long as possible,up to the rear-facing height or weight limit
of the seat. Properly install rear-facing in the back seat.
Phase 2 Forward-facing Seats
When children outgrow the rear-facing safety seat, they should ride in a
forward-facing safety seat as long as possible, up to the upper height or
weight limit (40 - 80 pounds) of the harnesses. Usually 4+ years old.
Properly installed forward-facing in the back seat. NEVER turn
forward-facing before 1 year old AND 20-22 pounds.
Phase 3 Booster Seats
After age 4 and 40+ pounds, children can ride in a booster seat with the
adult lap and shoulder belt until the adult safety belt will fit them
properly (usually when the child is 4'9" tall).
MUST have a lap/shoulder belt to use a booster seat.
Phase 4 Adult Safety Belt
Once children outgrow their booster seat (usually at 4'9", 100 pounds) they
can use the adult safety belt if it fits them properly.
Lap portion low over the hips/tops of thighs and shoulder belt crosses the
center of the shoulder and center of the chest.
You notice the mostly have age or weight until they say 4€™9€ can be in
an adult seat. But there is a two fold difference in the size and age of
children. A large 1 year old can be the same size as a small 2 year old. A
large 3 year old can be the same size as a small 6 year old. And it is the
height of the child that is important because it is the location of the
straps on the body that hold them in. It is not the weight. So if your
child has outgrown the seat and they fit the next size car seat, move them
up regardless of their weight or age. The shoulder strap should go
straight back off the top of the shoulder to the insert in the back of the
seat.
BabiesRus has a sale until Sept 16 for 25% off if you bring in your old
item: car seat, stroller, Travel System, high chair, play yard, bassinet,
swing, bouncer, entertainer, walker and jumper.
http://www.toysrus.com/shop/index.jsp?categoryId=4346706&camp=CME:EM082412I%20BRU%20Great%20Trade%20In
Roger Knapp MD
September 12
There are injuries from batteries frequently. The sad thing is that small
children swallow batteries… especially the small button batteries.
Of particular concern is the ingestion of button
batteries, especially those ≥20 mm in diameter (coin size), which can
lodge in the esophagus, leading to serious complications or death. Watch
out for kids and those small batteries. Many injuries, endoscopies, and
deaths occur because they swallow one.
For more info:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6134a1.htm#tab2
http://www.poison.org/battery/guideline.asp
Dr. Knapp
September 15
Iron and zinc are important for our bodies … both for anemia and neurologic
development.
http://www.ncbi.nlm.nih.gov/pubmed/10742372?dopt=Abstract
Iron deficiency anemia is the most frequent micronutrient deficiency in the
developing countries like India especially affecting pregnant women and
young children. Iron is an essential element involved in myelin formation,
neurotransmitter synthesis and neuro-metabolism. Several behavioural
disturbances have been reported in iron deficient children. In the present
study, we determined the prevalence of iron deficiency anemia in children
with behavioural disorders and assessed the improvement in terms of symptoms
…… significant improvement in the clinical features, haematological profile
and iron status. The presence of iron deficiency in children with
behavioural disorders and subsequent improvement in clinical features,
haematological profile and iron status suggests a possible causal
relationship between iron deficiency and behavioural disorders.
http://www.ncbi.nlm.nih.gov/pubmed/10742372?dopt=Abstract
Of
the original 191 participants, 87% were reevaluated at 11 to 14 years old.
The children were free of iron deficiency and growing normally by US
standards. Those who had chronic, severe iron deficiency in infancy were
compared with those who had good iron status before and/or after iron
therapy in infancy.
OUTCOME
MEASURES:
Comprehensive
set of cognitive, socioemotional, and motor tests and measures of school
functioning.
RESULTS:
Children who had severe, chronic iron deficiency in infancy scored lower on
measures of mental and motor functioning. After control for background
factors, differences remained statistically significant in arithmetic
achievement and written expression, motor functioning, and some specific
cognitive processes (spatial memory, selective recall, and tachistoscopic
threshold). More of the formerly iron-deficient children had repeated a
grade and/or been referred for special services or tutoring. Their parents
and teachers rated their behavior as more problematic in several areas,
agreeing in increased concerns about anxiety/depression, social problems,
and attention problems.
CONCLUSIONS:
Chronic
iron deficiency in infancy identifies children who continue at developmental
and behavioral risk >10 years after iron treatment.
And Zinc has been shown to improve the immune system and decrease severity
and mortality of diseases.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2277319/
Some studies suggest a slight effect on development.
That is why I recommend supplement of vitamins with zinc and iron. We
should start it between 9-12 months and continue till 100 years old. We
have such active life styles that we don’t eat right every day. Liquid
does not have zinc and stains the teeth brown. Gummy vitamins do not have
iron and is too much sugar for the teeth. The main food from which we get
these is Red Meat.. which we eat less of these days.
Roger Knapp MD
September 19
Well the press is at it again. They reported: “CBS/AP)
A new study from Consumer Reports claims samples of white rice, brown rice
and rice breakfast cereals that many U.S. adults and children eat may
contain worrisome levels of arsenic. The magazine
tested
more than 200 samples
of rice products - including popular brands, store brands and even organic
ones - and found measurable amounts of arsenic in "virtually every product
tested." "We found significant levels of inorganic arsenic, which is a
carcinogen, in almost every product category, along with organic arsenic,
which is less toxic but still of concern," the authors wrote.”
The actual numbers of arsenic in each brand of rice can be found
here:
http://www.consumerreports.org/cro/magazine/2012/11/arsenic-in-your-food/index.htm#chart
Here
are some numbers from that chart:
Whole foods Brown Rice:
210-282 ppb and 7.4-8.4 micrograms/serving of inorganic arsenic.
Archer Farms Target white:
54-81 ppb and 1.3-2.2 micrograms/serving
Infant Cereal
beech-Nut: 110-130 ppb and 0.8-1.0 micrograms/serving
Infant Gerber rice
cereal: 97-329 ppb and 0.8-1.3 micrograms/serving
Their statement was: “We also discovered that some infant rice
cereals, which are often a baby’s first solid food, had levels of inorganic
arsenic at least five times more than has been found in alternatives such as
oatmeal.” Well if oatmeal has 0.7 micrograms then five times that is
3.5 micrograms in rice … still low levels. Why did they not compare the
levels to what is in a rock so they could report it was 1000 times the amout!
The articles reported: “So far, both studies show relatively similar
levels of arsenic in rice. The FDA's analysis, including 200 samples, showed
average levels of 3.5 to 6.7 micrograms of inorganic arsenic per serving.
Consumer Reports, with 223 samples, found levels up to 8.7 micrograms. A
microgram is one billionth of a kilogram.”
You notice they reported to the press
“up to
8.7 micrograms” when in fact if you look at the levels they
found, most were 3-5 micrograms. They put the highest number up there and
said how it is 1 times the limit… and they used the lowest water limit in
the country of 5ppb when EPA said the limit was 10. Here is what they said:
“No federal limit exists for arsenic in most
foods, but the standard for drinking water is 10 parts per billion (ppb).
Keep in mind: That level is twice the 5 ppb that the EPA originally proposed
and that New Jersey actually established. Using the 5-ppb standard in our
study, we found that a single serving of some rices could give an average
adult almost one and a half times the inorganic arsenic he or she would get
from a whole day’s consumption of water, about 1 liter.”
If you are paranoid, you may be able to cut your exposure to
inorganic arsenic in rice by rinsing raw rice thoroughly before cooking,
using a ratio of 6 cups water to 1 cup rice for cooking and draining the
excess water afterward.
I don’t think there should be any arsenic in the food and water
but there is no way to exterminate every mosquitoe in DFW and there is no
way to have zero arsenic in water, rice, vegetables, and fruit. It is also
in weather treated wood in children’s playground equipment. We just need to
keep it down as low as we can in foods and eat a variety of foods… too much
of any one food is bad for us. I will wait to see what the FDA decides when
they finish their evaluation. Go ahead and give some rice cereal. If you
are giving rice cereal to 2 month old or older infants, alternate it with
oatmeal if you are concerned. No wheat or barley until 6 months.
See:
http://www.consumerreports.org/cro/arsenic1112.htm
http://www.cbsnews.com/8301-504763_162-57516150-10391704/consumer-reports-study-finds-concerning-levels-of-arsenic-in-rice/
Roger Knapp MD
www.rogerknapp.com
p.s. Same scare with BPA. here is one study: Bisphenol A (BPA) is a
widely used chemical. We examined the association between urinary BPA levels
and obesity in the National Health and Nutritional Examination Survey (NHANES)
2003–2008. The main outcome of interest was obesity defined as (1) body mass
index (BMI) ≥ 30
Kg/m2
and (2) waist circumference (WC) ≥ 102cm
in men and ≥ 88cm
in women. Urinary BPA levels were examined in quartiles. Overall, we
observed a positive association between increasing levels of urinary BPA and
both measures of obesity, independent of potential confounding factors
including, smoking, alcohol consumption, and serum cholesterol levels.
Compared to quartile 1 (referent), the multivariate-adjusted odds ratio (95%
confidence interval) associated with quartile 4 for BMI-based obesity was
1.69 (1.30–2.20);
P-trend
< 0.0001 and for WC-based obesity was 1.59 (1.21–2.09);
P-trend
= 0.0009. This association between BPA and both measures of obesity was
consistently present across gender and race-ethnic groups (all
P-trend
< 0.05). Elevated levels of urinary BPA are associated with measures of
obesity independent of traditional risk factors. This association is
consistently present across gender and race-ethnic groups. Future
prospective studies are needed to confirm or disprove this finding.
Now when you look at their actual numbers, they could not get a statistical
difference when they used the whole group so they divided them up into
fourths. The lower fourth for some reason had less obesity but the upper
3/4ths were all the same amount of obesity. So if you compared the next to
the lowest quarter of patients to the highest quarter, there was no
difference. They try to present the numbers so it looks like a big
difference.
Again I hope they take the stuff out of our plastic bottles but I can't see
it causing massive obesity in the population. Could it be all the cokes they
are drinking?
http://www.foxnews.com/health/2012/09/18/chemical-found-in-soda-cans-linked-to-childhood-obesity/
October 12
In January of this year, Agriculture Secretary Tom Vilsack and First Lady
Michelle Obama revealed new standards for school lunches, in order to reduce
calorie intake and help kids eat healthier. The new meal requirements were
the first in over 15 years to improve meal plan programs for the millions of
kids around the world who take part in school meal plans.
The new standards came after the Healthy, Hunger-Free Kids Act, which was
advocated by Michelle Obama as a component of her Let's Move! drive, and
made law by President Obama in 2010. The new standards are now in place this
Fall in all public schools.
I personally think offering a healthier meal and then educating the kids to
make better choices will work better. Studies show that stopping sugar
drinks at school did not help since they went home from school and drank
them at home. Educating kids, parents, and society to eat healthier should
be our main goal instead of legislating all of us to be healthy. This is
America with freedoms and not a socialistic or communistic country. There
has been a decrease in teen pregnancies, drugs, and bullying with
education. Not everyone in society will follow guidelines set and we cannot
legislate morality. There will always be people who do not care of
themselves or their kids. But we can improve our society through parents
setting good examples and the teachers giving lessons on better health.
The guidelines for school meals, included:
Lowering the amount of sodium, trans fat, and saturated fat
Only serving fat free and low-fat milk
Reducing calorie intake & making sure portion size is appropriate,
according to the children's ages
Making certain that kids are offered vegetables and fruit every
day of the week
According to the United States Department of Agriculture, $3.2 billion will
be spent in the next 5 years, in order to keep the standards in place.
The new guidelines for school meals across the nation are:
Kindergarten to 5th grade - 650 calories
6th to 8th grade - 700 calories
9 to 12th grade - 850 calories
I think these numbers are too small for many kids. Some parents are saying
that kids are coming home hungrier than before, and teachers are claiming
that kids are hungry an hour after their lunch break, making them sleepy and
unfocused. Many argue that even 850 calories (which are being given to high
school aged children) are not enough for some growing adolescents, saying
all children are different and need varying amount of calories a day,
depending on their bodies.
The video "We are Hungry" was filmed by high school students and teachers in
Kansas. Kansas Representative Tim Huelskamp said, "This is a great product
of some small town students and their teachers."
http://www.youtube.com/watch?v=2IB7NDUSBOo
It
takes time to get kids to learn to like new foods. Here are some tips to
help your children eat healthy foods:
Make time
to join your child for lunch in the school cafeteria.
When your
child gets home from school, ask what he/she ate for lunch.
Eat meals
with your child as much as you can. Let your child see you eating fruits,
vegetables, and whole grains at meals and snacks.
Grocery
shopping can teach your children about healthy eating. Talk to them about
where vegetables, fruits and grains, and milk and meat come from. Let your
children make healthy choices.
Try new
foods yourself. Describe how they smell, feel and taste. Offer one new food
at a time. Serve something your child likes with the new food.
The
School Day Just Got Healthier. Together we can help our kids learn healthy
habits that last forever.
What can parents do to help the whole family eat healthier?
1.
switch to fat-free or low-fat (1%) milk
They
have the same amount of calcium and other essential nutrients as whole milk,
but fewer calories and less saturated fat.
2.
make half your grains whole grains
To eat
more whole grains, substitute a whole-grain product for a refined
product—such as eating wholewheat bread instead of white bread or brown rice
instead of white rice.
3.
foods to eat less often
Cut
back on foods high in solid fats, added sugars, and salt. They include
cakes, cookies, ice cream, candies, sweetened drinks, pizza, and fatty meats
like ribs, sausages, bacon, and hot dogs. Use these foods as occasional
treats, not everyday foods.
4.
compare sodium in foods
Use the
Nutrition Facts label to choose lower sodium versions of foods like soup,
bread, and frozen meals. Select canned foods labeled “low sodium,” ”reduced
sodium,” or “no salt added.”
5.
drink water instead of sugary drinks
Cut
calories by drinking water or unsweetened beverages. Soda, energy drinks,
and sports drinks are a major source of added sugar, and calories, in
American diets.
6.
balance calories
Find
out how many calories YOU need for a day as a first step in managing your
weight. Go to
www.ChooseMyPlate.gov
to find your calorie level. Being physically active also helps you balance
calories.
7.
enjoy your food, but eat less
Take
the time to fully enjoy your food as you eat it. Eating too fast or when
your attention is elsewhere may lead to eating too many calories. Pay
attention to hunger and fullness cues before, during, and after meals. Use
them to recognize when to eat and when you’ve had enough.
8.
avoid oversized portions
Use a
smaller plate, bowl, and glass. Portion out foods before you eat. When
eating out, choose a smaller size option, share a dish, or take home part of
your meal.
9.
foods to eat more often
Eat
more vegetables, fruits, whole grains, and fat-free or 1% milk and dairy
products. These foods have the nutrients you need for health—including
potassium, calcium, vitamin D, and fiber. Make them the basis for meals and
snacks.
10.make half your plate fruits and vegetables
Choose
red, orange, and dark-green vegetables like tomatoes, sweet potatoes, and
broccoli, along with other vegetables for your meals. Add fruit to meals as
part of main or side dishes or as dessert.
Enough
of this… I’m going to go get a bowl of ice-cream.
Have a
good weekend.
Roger
Knapp MD
October 17
The news reported that the 11 yr study showed 8% less cancers in men who
took a regular multiple vitamins daily. There are several reasons why I
recommend a chewable vitamin for kids that have iron and zinc but maybe this
is another good reason to take on. I take one every day.
The meningitis lately on the news is a fungus that contaminated medications
that doctors injected into the back of patients. It is not contagious like
regular meningitis. I have not seen a case of meningitis for the last 15
years since the HIB and Prevnar vaccines have come out. We went from 20,000
cases a year to now 30. Half are brain damaged and 10% die no matter what
treatment. Refusing vaccines is insane and child neglect.
I and the American Accademy of Pediatrics do not recommend saving your
infant’s cord blood. The DNA still has the problem of that congenital
anemia, immune deficiency, or caner so most transplant doctors will not want
your infants stem cells. The state of Texas has a cord blood bank free for
all patients to donate to and get stem cells from it. I do not recommend
paying money to these private cord blood banks.
Roger Knapp
The holidays are coming:
For those in our area:
1.
There is
a great activity at the state fair if you are planning to go during this
last weekend. It is the peewee Stampede. For 3-6 yr olds… what a fun
time. Not many people know of it. It is close to the Childrens Med. Center
Petting zoo.
See a
video of it:
http://www.youtube.com/watch?v=CKWbOByPqQA
Here are the times.
http://bigtex.ntelligentsystems.com/ns/PressRelease/ViewPressRelease.asp?PRelId=255
2.
Great pumpkin patches are great fun, cheap, and great photo opportunities.
Two of the better ones are:
Colleyville Halls Farm:
http://www.grapevinetxonline.com/2009/10/halls-pumpkin-farm/
And in
Flower Mound:
http://www.flowermoundpumpkinpatch.com/
3.
Best place for Santa pictures are at Bass Pro near the Grapevine Mall.
Free picture and fun activities. During the busy times they will give you a
“ticket” to come back at a certain time to get right in. We get one and go
eat and come back so you can get right in.
November 14
The news is full this week about the flu and Autism.
Some
of this Newsymail is taken from :
Infection-Autism Link: Is It Real?
By Nancy Walsh, MedPage Today
Published: November 12, 2012
Atladttir and
colleagues analyzed data from the Danish National Birth Cohort, which
enrolled 101,033 pregnant women between 1996 and 2002. Among their
offspring, 976 were diagnosed with autism spectrum disorder and 342 with
infantile autism. Mean follow-up was about 10 years.
Overall, no associations
were seen for infections and autism spectrum disorder, although a twofold
increased risk was seen for the more severe subtype of infantile autism
following maternal influenza infection, according to Hjrdis sk Atladttir,
MD, PhD, of the University of Aarhus in Denmark, and colleagues.
The problems with the study: The analysis was exploratory and involved multiple testing, so
the findings could have resulted from chance, they cautioned, noting that
this was a "great limitation" of the study.
But they urged caution with the new findings, especially because of
statistical limitations in their number-crunching. "I really want to
emphasize that this is not something you should worry about," said lead
author Dr. Hjordis Osk Atladottir, from the University of Aarhus.
"Ninety-nine percent of women with influenza do not have a child with
autism," she told Reuters Health. "If it were me that was pregnant, I
wouldn't do anything different from before, because our research is so early
and exploratory."
Several other methodologic limitations included the possibility
of bias in participation, the general nature of the questions asked of the
mothers, and the likely inaccurate reporting of influenza.
But no significant associations were seen for either autism
spectrum disorder or infantile autism according to the trimester in which a
maternal infection occurred.
It could also be "a
coincidental finding," they noted.
"Our results do not
suggest that mild infections, febrile episodes, or use of antibiotics during
pregnancy are strong risk factors for autism spectrum disorder and infantile
autism," Atladttir and colleagues stated.
However, they were
unable to rule out the possibility of an association, and called for
"further research on this important topic."
In summary:
It remains
unclear whether mothers who develop common infections during pregnancy are
more likely to have autistic children.
Note that no
significant associations were seen for either autism spectrum disorder or
infantile autism according to the trimester in which a maternal infection
occurred.
It remains unclear whether mothers who develop common infections during
pregnancy are more likely to have autistic children, Danish researchers
said.
For more info see:
http://www.foxnews.com/health/2012/11/12/study-tentatively-links-flu-in-pregnancy-and-autism/
Of course Fox News have a more reasonable
reporting than the other major channels who like to make the news sound
horrible to get viewers.
Previous studies looking
at risks in women and their offspring have turned in conflicting results and
have not considered specific infections or timing of the infection.
Also many
studies have blamed autism on different things… such as age or prematurity.
The
Journal of Pediatrics
Volume 161, Issue 5 , Pages 830-836, November 2012 “Risk of Autism Spectrum
Disorders in Low Birth Weight and Small for Gestational Age Infants”
There is no need for high concern here. Even though I am not sure there
is an increase in Autism with the flu, please get your flu shots even
though you are pregnant… there is no risks with the shot and there is a
higher maternal mortality with flu during pregnancy.
Roger Knapp MD
November 18
All of us parents look for help with disciplining our kids. Here is a
fairly good article.
http://www.pediatricnews.com/index.php?id=7791&tx_ttnews%5Btt_news%5D=137447&cHash=cb5899d9fc2d78c46785cd4947788cd1
Try to discipline your child in the same tone and demeanor as you would
someone at your work whom you are correcting. Use a firm yet respectful
tone. If you use a derogatory hateful belittling tone, then it harms your
relationship with the child, harms their self-esteem, and they will
sometimes do some more bad stuff just to spite you. Would you want someone
to talk to you the way you talk to your child?
Read:
http://www.rogerknapp.com/medical/behaveworse.htm
Happy Thanksgiving.
Roger Knapp MD
November 29
The incidence of Whooping Cough has increased since the 1990s because the
DaPT is weaker than the old fashion DPT. The Old DPT had the whole cell
pertussis with 54 proteins. It caused fever , crying for days, and hot sore
legs. The new acellular pertussis had only a few proteins and caused very
little side effects. But the immunity did not last long and older kids are
now getting whooping cough and giving it to infants who can die from it. We
have been reboostering the 12 yr olds and pregnant mothers/dads with DaPT
but it still is not working well. The CDC is not sure what to do. I think
they should give the old DPT to the 4 yr olds who are older and bigger and
should not have as severe reaction. That would hopefully stimulate enough
immunity to last longer. The link below shows the age incidence and the
older adults did not get whooping cough since they were given the old
vaccine DPT.
2000 7,867
2001 7,580
2002 9,771
2003 11,647
2004 25,827
2005 25,616
2006 15,632
2007 10,454
2008 13,278
2009 16,858
2010 27,550
2011 18,719
2012 37,000
For age incidence See:
http://www.cdc.gov/pertussis/images/incidence-graph-age.jpg
For outbreak information see:
http://www.cdc.gov/pertussis/outbreaks.html
Roger Knapp MD
December 12, 2012
It is interesting how
we want to get a certain diagnosis. We go to the doctor and he says it is a
certain diagnosis. For example he says it is a viral chest cold. Then we
think it must be pneumonia and we go see another doctor who takes an xray
and says “Oh it is pneumonia and we must treat this or horrible things will
happen.” Who was right? The first doctor may have been right but we want
to believe there is pneumonia so we think the second one is correct. The
first doctor just did not know what he was talking about.
We
have discussed in the past that the xray shows mucous… it can be asthma,
viral chest cold, or bacterial infection. But the Xray does not know the
difference. Also some doctors want to “steal patients” so they find things
that your doctor must have missed and dramatize it. The hope is that you
will become their patient and also gives them an ego boost.
Care
now clinics xray every one that comes in the door with a cough. They make
money on it and they over diagnose bronchitis and pneumonia. At least they
over treat things and are less likely to miss something. Many doctors
practice “defensive” medicine and run too many tests and give too many
medications like antibiotics.
We
are seeing some flu and a lot of common viral chest colds. Croup that is
viral is usually in Sept and Oct but this year it was late and we saw most
of it in Nov and Dec. The fever in the first 4 days of the cough is
generally the viral cold and fever after day 5 is bacterial secondary
infections. That is when we should see them… fever or crying with ear pain
after the 5th day.
Dr.
Knapp
p.s. Study shows A few days in
nature improves mental clarity and reasoning. See:
http://www.sltrib.com/sltrib/news/55444364-78/nature-louv-strayer-technology.html.csp
Yea for the Boy and Girl Scout Campouts. I know when I go hiking or
camping I come back refreshed.
December 17, 2012
What a terrible thing
in Connecticut last week. How do we look for emotional problems in our kids
where they might be at risk for either suicide or mass murder like last
week.
Irritability,
pervasive sadness, decrease in academic performance, behavioral problems,
appetite and sleep changes, and frequent physical complaints. Loner and not
many friends.
There
is a big increase in suicide or shooting others during teen and early 20 yr.
olds.
Monitor
their online social sites and emails. Monitor text messages. Ask their
school mates what they think about your child.
Counseling
and medication best long term results. Cognitive behavior is the best
counseling.
Get them into
activities or groups where they can make friends and feel better about
themselves.
After
tragedies on the national news, answer their questions in a calm manner. Do
not let them see your anxiety and fears. Decrease the amount of TV shows.
Do not let them join groups that “share feelings and fears” since it just
heightens their anxieties. A few weeks of anxiety and questions and fear in
the child is normal. If it continues after 2 weeks then seek advice or
counseling.
Dr.
Knapp
There is a big
increase in flu now. See charts at my web site:
http://www.rogerknapp.com/medical/flu.htm
