Soon you will be rushing to buy clothes, school supplies and, oh yeah, get that health check-up done. Is it really all that important, you ask? Your children have been running around all summer and judging by their appetites and outgrown clothes, they seem very healthy.

The short answer is yes! The annual school physical for children is quite important. As school aged children tend not to need medical attention as much as when they were younger, most visits to the doctor during the school year are for focused problems such as a sore throat or injury. The annual pre-school check-up, then, is a great opportunity to take a comprehensive look at your child’s health.

Perhaps the most important decision you make about the pre-school health examination is where it takes place. Nowadays, there are many health care outlets that advertise and perform these evaluations quickly and cheaply. While they may be able to fill out a piece of paper and perform a basic exam, is it really what your child needs? Quite simply – no! 

Your child’s primary care physician provides continuity with records of growth, immunizations, medical history and ongoing care. This is indispensable in providing a comprehensive assessment of your child and is impossible to duplicate. If needed, your child’s doctor can plug into multiple resources to address. So, while there is certainly a time and benefit to taking advantage of urgent care center services, a clinic whose stated purpose is in urgent needs simply cannot provide this level of care for back to school physicals.

For example, a child or adolescent’s growth is measured along a standardized growth curve and most follow a pattern that your doctor can immediately analyze based on prior measurements. If there is a new trend to the growth that alerts your doctor to ask questions regarding nutrition and exercise in addition to symptoms, that might be related to an underlying medical condition.

Another important area is the determination of sports preparedness. Your child’s doctor will assess the physical and sexual maturity and help guide you on which types of activities are suitable. In recent years, there has been a large increase in sports related injuries in children. They usually occur because there is a mismatch between the physical maturity of the child and the type of sporting activity or activities. Many children want to ‘do it all’ and participate in multiple sports, but they might actually not be physically mature enough to do so. As a result, ‘overuse’ injuries are now common – and can be debilitating if not handled properly.

The assessment of emotional and behavioral health is as important as the physical elements of the pre-school evaluation. Paralleling their physical growth, children, especially adolescents, undergo changes in how they interact with the world around them. Assessing the emotional health and coping skills in conversations with the child as well as the parent, issues can be addressed quickly. Your child’s primary care doctor will have lots of resources available to help address these issues.

So, the bottom line is to schedule NOW for your child’s pre-school health evaluation with your trusted doctor. Don’t wait until the last minute and settle for getting a paper filled out by a stranger.

Some Things You Should Know About Asthma 

What is Asthma?

Asthma is an inflammatory condition of the very small airways of the lungs that is sometimes difficult to diagnose and difficult to treat.  During an asthma attack, the small airways become narrower due to muscle contraction around the airway wall, which thickened due to inflammation.  When breathing is labored, asthma is stressful for the child and the parents.

What's Happening During An Asthma Attack?

Asthma attacks are often characterized by wheezing which is a noisy sound heard primarily during exhaling or breathing out, (also called expiration).  Here's what happens: in a normal state, we breath oxygen into our lungs (or inspiration).  When we breath out (expiration), we expel waste gases such as carbon dioxide.  During an asthma attack the narrowed airways make it difficult to breath out, and exhaling takes much longer, thus giving you less time to breathe in the needed fresh oxygen. This causes your breathing rate to increase because you body is asking for more fresh oxygen. The problem is you have to get rid of your used up oxygen before you can take in more fresh oxygen. Aside from the wheezing sound during exhales, another thing you'll notice is that the child has little interest in eating or speaking because merely breathing has become their most important function.

Treatment

There are two primary types of medications used to treat an asthma attack: bronchodilators and anti-infammatories. The most common broncholdilator is Albuterol and is considereed a "rescue" medication because it offers immediate relief during an attack by narrowing the airways.   Anti-inflammatory medications are considered a "preventative" medication because they must be used 1 - 2 weeks before they become effective. In some cases after an asthma attack, oral anti-inflammatories such as Prednisone tablets or Prednisolone, (the liquid form of Prednisone) are used to speed up the anti-inflammatory process. What we do here at our office is give the child a treatment of Albuterol, which opens the airway and returns the child to normal breathing.

Caution

Despite the benefit provided by the rescue medication Albuterol, some caution still needs to be taken.  Albuterol overuse, especially by self-medicating teenagers can be dangerous.  Parents of younger children should also avoid using Albuterol more frequently than recommended, even though it provides temporary relief, since the underlying problem, inflammation, is not treated with rescue medications. 

Reactive / Reversible

The term "asthma" does little to explain the condition.  The phrases "reactive airway disease" or "reversible airway disease" provide a better way to describe what causes asthma symptoms.  "Reactive" refers to the airways' response to an offending agent, like pollen, cigarette smoke, dust, even cold air.  "Reversible" tells us that by using certain medications we can reverse the breathing difficulty.

Emergency Symptoms Not to Miss

You would not overlook or underestimate the seriousness of major bleeding, not breathing, severe choking, a seizure, or a coma (can’t wake up). These are life-threatening emergencies and you would rightfully call 911. For a poisoning, you would call 1-800-222-1222. Some emergency symptoms, however, are either difficult to recognize or are not always considered serious. If your child has any of the following symptoms, call your child's doctor immediately or go to the nearest ER.

Sick newborn

• Your baby is less than 1 month old and looks sick (vomiting, cough, poor color) or acts abnormal (poor feeding or excessive sleeping) in any way. At this age, these symptoms are serious until proven otherwise. During the first month of life, infections can progress quickly.

Severe lethargy

• Your child stares into space, won't smile, won't play at all or hardly responds to you. Your child is too weak to cry, floppy, or hard to awaken. These are serious symptoms. Note: sleeping more when sick is normal, but when awake your child should be alert.

Confusion

• The sudden onset of confusion (delirium). Your child is awake but says strange things, sees things and doesn’t recognize you. Note: Transient delirium can be seen for 5 minutes or so with higher fevers. However, if not brief, confusion can have some serious causes.

Severe pain

• Severe pain is incapacitating. It interferes with all normal activities. The child just wants to be left alone. If your child cries when you try to hold him or move him, this can be a symptom of meningitis or appendicitis. Children also are unable to sleep or can only fall asleep briefly.

Inconsolable crying

• Inconsolable constant crying is due to severe pain until proven otherwise. Suspect this in children who are unable to sleep or will only fall asleep briefly, and when awake, will not engage in any normal activities. Caution: Instead of constant crying, severe pain may also cause your child to groan, moan or whimper.

Can't walk

• If your child has learned to walk and then loses the ability to stand or walk, he may have a serious injury to the legs or a problem with balance. If your child walks bent over, holding his belly, he may have a serious problem such as appendicitis.

Tender abdomen

• Press on your child's belly while she is sitting on your lap and looking at a book. You should be able to press an inch or so in with your fingers in all parts of the belly without a problem. If your child winces or screams, it suggests a serious cause. If the belly is also bloated and hard along with the pain, the problem is even more worrisome. Note: if your child just pushes your hand away, it probably means you haven’t distracted her enough.

Tender testicle or scrotum

• Sudden pain in the groin area can be from twisting (torsion) of the testicle. This requires surgery within 8 hours to save the testicle.

Hard time breathing

• Breathing is essential for life. Most childhood deaths are due to severe breathing problems. If your child has trouble breathing, tight croup (harsh sound when breathing in called stridor), obvious wheezing or grunting with each breath, she needs to be seen immediately. Other signs of respiratory distress are fast breathing, bluish lips, or retractions (skin pulling in between the ribs). Children with severe respiratory distress, can’t drink, talk or cry. Note: Nasal congestion causes vibrations and some noisy breathing, but usually without any trouble breathing. Check the breathing after you clean out the nose with nasal washes and nasal suction.

Bluish lips

• Bluish lips, tongue, or gums (cyanosis) can mean a reduced amount of oxygen in the bloodstream. Note: blueness only present around the mouth (but not the lips) can be caused by being cold.

Drooling

• The sudden onset of drooling or spitting when your child is ill means your child is having trouble swallowing.  The cause can be a serious infection of the tonsils, throat, or epiglottis (top part of the windpipe). A serious allergic reaction can also cause trouble swallowing.  Swelling in the throat could close off the airway.

Dehydration

• Dehydration means that your child's body fluids are low. Dehydration usually follows severe vomiting and/or diarrhea. Suspect dehydration if your child has not urinated in 8 hours (more than 12 hours if over 1 year old); crying produces no tears; the inside of the mouth is dry rather than moist; or the soft spot in the skull is sunken. Dehydrated children are also tired and weak. If your child is alert and active but not making much urine, he is not yet dehydrated. Children with severe dehydration become dizzy when they stand. Dehydration requires immediate fluid replacement by mouth or vein.

Bulging soft spot

• The soft spot in your baby's head is tense and bulging. This means the brain is under pressure.

Stiff neck

• To test for a stiff neck, lay your child down, then lift his head until the chin touches the middle of the chest. If he is resistant, place a toy or other object of interest on the belly so he will have to look down to see it. Older children can simply be asked to look at their belly button. A stiff neck can be an early sign of meningitis.

Injured neck

• Talk to your child's doctor about any neck injury, regardless of the symptoms. Neck injuries carry a risk of damage to the spinal cord.

Purple or blood-red spots or dots

• Unexplained purple or blood-red spots or dots on the skin could be a sign of a serious bloodstream infection, especially if your child also has a fever. Note: Bumps and bruises on the shins from active play are different.

Any fever (over 100.4°F or 38 °C) in the first 3 months

• Bacterial infections in young infants can cause serious complications. All children less than 3 months of age with a fever need to be examined as soon as possible to determine if the cause is viral or bacterial.

Fever over 105° F (40.6° C)

• All the preceding symptoms are stronger indicators of serious illness than the level of fever. All of them can occur with low grade fevers as well as high ones. Fevers alone are considered serious only when the temperature rises above 105°F (40.6°C).

Chronic Diseases

• Most active chronic diseases can have some complications. If your child has a chronic disease, be sure to find out what those complications are and how to recognize them. The chronic diseases at highest risk for serious infections are those that weaken the immune system (such as sickle cell disease, HIV, chemotherapy, organ transplant, chronic steroids, etc). If you are talking with a doctor or nurse who doesn’t normally see your child, always tell them about your child’s chronic disease (such as asthma). Never assume they already know this.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information. 

Mental Health and Teens: Watch for Danger Signs 

21 Healthy New Year's Resolutions for Kids All Ages

Preschoolers

• I will clean up my toys and put them where they belong.
• I will brush my teeth twice a day, and wash my hands after going to the bathroom and before eating.
• I won’t tease dogs or other pets – even friendly ones. I will avoid being bitten by keeping my fingers and face away from their mouths.

Kids, 5- to 12-years-old

• I will drink 2% milk and water three times each day, and limit soda and fruit drinks to once each day.
• I will apply sunscreen before I go outdoors on bright sunny days. I will try to stay in the shade whenever possible and wear a hat and sunglasses, especially when I’m playing sports.
• I will try to find a sport (like basketball or soccer) or an activity (like playing tag, jumping rope, dancing or riding my bike) that I like and do it at least three times a week!
• I will always wear a helmet when bicycling.
• I will wear my seat belt every time I get in a car. I’ll sit in the back seat and use a booster seat until I am tall enough to use a lap/shoulder seat belt.
• I’ll be nice to other kids. I’ll be friendly to kids who need friends – like someone who is shy, or is new to my school.
• I’ll never give out personal information such as my name, home address, school name or telephone number on the Internet. Also, I’ll never send a picture of myself to someone I chat with on the computer without my parent’s permission.

Kids, 13-years-old and up

• I will eat at least one fruit and one vegetable every day, and I will limit the amount of soda I drink to one glass daily.
• I will take care of my body through physical activity and nutrition.
• I will choose non-violent television shows and video games, and I will spend only one to two hours each day – at the most – on these activities.
• I will help out in my community – through volunteering, working with community groups or by joining a group that helps people in need.
• When I feel angry or stressed out, I will take a break and find constructive ways to deal with the stress, such as exercising, reading, writing in a journal or discussing my problem with a parent or friend.
• When faced with a difficult decision, I will talk about my choices with an adult whom I can trust.
• When I notice my friends are struggling or engaging in risky behaviors, I will talk with a trusted adult and attempt to find a way that I can help them.
• I will be careful about whom I choose to date, and always treat the other person with respect and without coercion or violence. I will expect the same good behavior in return.
• I will resist peer pressure to try drugs and alcohol.
• I agree not to use a cell phone or text message while driving and to always use a seat belt.

Busy High School Model Shows How Diseases Spread

 Last January several hundred bleary eyed students filed into an unnamed American high school to accept an unusual assignment: wear a matchbox-sized device around their neck for the day.

As the students passed each other in the halls, lined up for lunch, and listened to their teachers and administrators (who also sported the boxy jewelry), the devices recorded every encounter, or occasion when the devices came within 10 feet of each other. Ten feet is considered the maximum distance that spit, phlegm, or snot infected with influenza can travel.

By the end of the school day the devices had recorded an astonishing 762,868 encounters among the students, staff, teachers and administrators of the high school, far more than the scientists from Stanford University were expecting or had been reported before.

"It was clear that there were a lot of interactions going on," said Marcel Salathe, a co-author on a new paper that appears in the Proceedings of the National Academy of Sciences. "But the sheer numbers were amazing."

By tracking the comings and goings of an entire high school, the scientists from Stanford have collected the most detailed information to date of how diseases like influenza can spread between individuals. With this knowledge public health officials hope to improve their predictions about how infectious diseases spread through cities or countries and devise new ways to slow or stop the spread of infectious diseases.

The Stanford scientists studied a high school because of schools' key role in spreading infections.

"A school connects an entire community," said Salathe.

Once an infection gets into a high school, an environment packed with so many people in such a small space for such long periods of time day after day, a pathogen readily spreads to parents, siblings and then the parents' coworkers and other people.

But who exactly is doing the spreading? Or, in other words, which students or staff members are popular, both among other students and staff and among pathogens? If Salathe and his colleagues could identify those individuals with the most encounters, then they might consider selectively vaccinating those people first to slow the spread of a disease, said Salathe.

"If you ask people who are the most popular students, and those are the people that we identify as the ones with the most interactions, then finding the people with the most interactions is relatively easy; you just ask who is popular," said Salathe.

Salathe can't say whether the boys and girls who are popular among their peers are a modern-day version of "Typoid Mary" just yet though. (Typhoid Mary was a cook in the mid-1800's who was a healthy carrier of typhoid fever and who unwittingly infected dozens of people.) The high school data was collected completely anonymously, so the scientists have no way to connect a particular device to a particular individual. But it is one question they hope to answer in the future.

And the research will have to be repeated at other schools, said Stephen Eubank, a professor of at the Virginia Bioinformatics Institute, which is part of Virginia Tech.

If the Stanford scientists can identify that a particular cafeteria worker, popular student, or well-connected administrator has the most contacts, then, in the event of a pandemic with a limited amount of vaccine, those people could be vaccinated, have antivirals administered, or told to stay home during an outbreak to limit its spread, said Eubank.

By understanding how the flu or other pathogens spread between people, scientists can also extrapolate how it will spread among far larger populations using sophisticated computer models.

"You can actually create a network" with this new research, said Marc Lipsitch, a professor of epidemiology at Harvard University. "You get another level of resolution that you can add to those larger models" and improve their predictions.

Ira Longini, a professor of biostatistics at the University of Washington School of Public Health, agreed that the research will help improve the computer models scientists use to predict the spread of diseases.

"I think that for something like the flu, if we had this kind of information on households, schools, day care centers, and workplaces, then we could string it together in our models, and that would be useful," in determining whether or when schools should be closed or who should be vaccinated or treated with antivirals so they don't get infected in the first place, said Longini.

Gathering that kind of data will be difficult though, said Salathe. It was hard enough getting an entire high school to wear the devices for a single day. Getting an entire company or office building to wear the device will be even harder. And using cell phone records to track a population isn't really an option either; cell phone signals just aren't precise enough for the needs of the scientists.

People are making the best recommendations with the best available research, but until we have more studies like this we won't really know what the best interventions are, said Eubank.

Read full story here:

http://news.discovery.com/human/disease-spread-high-school-model101213.html#mkcpgn=hknws1

Tips On Antibiotic Use

The American Academy of Pediatrics says it's Get Smart About Antibiotics week and it's offering advice on how to avoid overusing these important medicines.

With the arrival of cold and flu season, the academy has partnered with the federal Centers for Disease Control and Prevention in raising awareness about appropriate antibiotic use.

The drugs work against bacteria but not illnesses caused by viruses. That includes colds and the flu, and also most coughs and sore throats. Using antibiotics for those illnesses can be dangerous because it can help make germs more resistant to the drugs.

Illnesses that antibiotics can treat include bacterial pneumonia, some sinus infections and sore throats caused by strep bacteria.