Here's What We Want You to Know

Fall 2016 ~ Posted 11/7/2016

As a lactation consultant, I have helped many mothers with breastfeeding from birth

to weaning. Often, once weaning occurs, these mothers have asked, “What can I do

with all this extra frozen breast milk in my freezer?” One option is to donate the frozen

breast milk to a milk bank. Last fall, a milk bank opened in the Strip District of

Pittsburgh called, Three Rivers Mothers’ Milk Bank. There are a total of 19 milk

banks in the nation.

You may ask yourself what does this milk bank do, and what is the need for

this service? Pennsylvania and West Virginia have approximately 140,000 premature

infants born yearly. This frozen mothers’ milk is distributed to neonatal intensive

care units (NICU) where these infants are born. The reason premature infants

depend on mothers’ milk is not just for nourishment, but they are often susceptible

to life threatening diseases such as necrotizing enterocolitis (NEC). Studies have

shown that breast milk reduces the risk of this disease by 80%, and if the disease

occurs, there is a lower need for corrective surgery. Mothers’ milk also helps

premature infants experience less severe infections, and are often discharged

from hospital to home sooner.

This mothers’ milk is also available to babies outside of the hospital that

are diagnosed with conditions such as immune disorders, formula intolerance,

malabsorption disorders, post-surgical nutrition, short gut syndrome, organ

transplantation, and failure to thrive.

Three Rivers Mothers’ Milk Bank follows safety guidelines recommended

by the Human Milk Banking Association of North America regarding screening

of donor milk, processing and distribution. They use the Holder Method of

Pasteurization that keeps 70% of the important properties of mothers’ milk intact.

Each batch of milk is carefully monitored to ensure bacterial growth does not occur.

The milk is then frozen, and is available for distribution by prescription only.

All frozen mothers’ milk donations are on a volunteer basis. If you are

interested in donating your milk, several requirements are essential. Volunteers

must be meeting the nutritional needs of their own child, must be willing to

donate 150 ounces, are not taking unapproved medications or herbal supplements,

do not smoke or use any tobacco products. The first step in donation is to contact

Three Rivers Mothers’ Milk Bank at (412) 281-4400 for an initial interview,

completion of a screening packet, and provision of health information which may include blood

work.

Reference: www.threeriversmilkbank.org

Susan Pointer, CRNP ~ SVPAM Nurse Practitioner 11/7/16

Please note that this does not constitute specific & individualized medical advice; as always, if there are questions or concerns, specific to your child, please contact the office!

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Fall 2016 ~ Posted 10/6/2016

Care & Treatment of Head Lice

So – one of those “parent’s worst nightmare” moments. You just received a note from the school

that there has been head lice found in your child’s class.

OH NO!! WHAT TO DO?!?!

First, remain calm! Be aware that head lice requires close contact with hair that has been infested

with lice or nits – either by touching heads or using objects that have hair on them (headbands,

combs, brushes, hats, bedding) to be passed from person to person. Lice do not hop from one

person to the next. Lice do not live more than 2 days if they fall off a person & cannot feed.

Nits survive fewer than two weeks when off a human. You cannot catch head lice from dogs

& cats. Also, anybody cannot contract head lice. Head lice is not a sign of being dirty.

Also, head lice, while annoying, are not dangerous & do not spread disease.

Start

Look for lice or nits – you may find one of two signs of head lice infestation

 

 

 

 

 

 

Figure 1 - Nits

Nits are eggs that have been laid by lice on the hair shaft. They often look like small pieces of

lint, rice, dandruff or hairspray but are attached to the hair strand & cannot be easily removed

without grasping & pulling off of the hair strand. They are found less than ½ inch from the scalp

& are more often on the back of the head & neck.

Figure 2 - Lice

 

 

 

 

Lice are often very fast & can quickly hide as you search through the hair so it may be helpful to have good light & a nit comb or other fine toothed comb when searching through layers of hair. It can be helpful to start at the back of the neck & work up as this is where live lice are often found.

Treat

So you have found lice or new nits. It is time to treat. Only people with live lice or nits found less than ½ inch from the scalp or close contacts with those people (shared beds, pillows, combs, brushes, hats) should be treated.

Over-the-counter Treatments

It is recommended to start by using over-the-counter (OTC) lice treatments. Due to increasing resistance, it is recommended that at least 2 different over-the-counter treatments be tried before moving to prescription lice treatments, even if OTC treatments have not worked in the past.

Never use more than one OTC treatment at a time.

There are 2 major over-the-counter lice medications –

1) Pyrethrins (e.g. A-200, Rid, Pronto, Triple X) – approved for children over 2 years

2) Permetherin lotion 1% (Nix) – approved for children over 2 months

Follow package directions; no conditioner should be used before application; no shampoo or conditionershould be used for 1 – 2 days after application. Hair may be washed & conditioner applied starting 2 days after treatment. Some life lice may persist the day after treatment but their movements should be slowed as the treatment works

Nit & Lice Removal Hair should be combed through daily w/ fine tooth or special nit comb. This should be continued daily for 2 weeks after treatment. Any live lice & nits should be removed. (While this is a tedious process, many schools have no nit policies so it may be essential to have all nits removed before the child returns to school the next day). If any live lice remain 48 hours after treatment, retreating with the other OTC medicine should take place.

Retreatment The OTC treatments kill live lice but do not kill the eggs which hatch in 7 – 9 days after being laid. To assure that these new lice do not survive to lay more eggs & continue the cycle, a second treatment should be repeated in 7 – 9 days after the first.

Family Contact – all family contacts should be checked for lice & nits & be treated at the same time if infested. In general, treatment is only recommended that those household members who have live lice or nits or who share beds with those w/ lice should be treated.

Cleaning – expensive products & fumigation is not recommended but some general cleaning should be done to avoid re-infestation.

- Clean clothes should be put on after the lice treatment is applied.

- Bedding & any clothes worn in the past 48 hours should be washed in hot water & dried

in a hot dryer.

- Clothing that cannot be washed may be dry cleaned or sealed in a plastic bag for 2 weeks.

- Combs, brushes, headbands or other hair care items should be soaked in hot water

(130 degrees F) for 5 – 10 min.

- Floors & furniture should be vacuumed or scrubbed, especially places where the infested

person has laid.

Other Treatment – Some people have used oils (tea tree oil), mayonnaise, lotions, creams & vinegar to prevent lice. While attempting these is not harmful, there is also no proof that they are helpful. Never use kerosene or gasoline!

What if Treatment Does not Work? There are a variety of reasons that treatment may not have worked.

- Wrong diagnosis – Perhaps what you were seeing was not nits but dandruff or hair spray.

- New lice - Perhaps the child got lice again from a playmate or family member who was not treated.

- Time – As noted above, it may take a few days for the lice to die; Make sure to give the treatment adequate time to be effective.

- Poor treatment - Did the person using the medication follow the directions accurately? Was the product washed from the hair before it had time to be effective? Was there conditioner or other hair care products on the hair that caused the product to be less effective?

- Resistance – if after 14 days of OTC treatment, live lice are still present, contact Sewickley Valley Pediatrics

Other Resources

https://www.idph.iowa.gov?Portals/1/Files/CADE/head_lice%20brochure(10-08)%20lighter%20green%20reviewed%205%202010.pdf

https://www.cdc.gov/parasites/lice/head

Gail Warner, CRNP ~ SVPAM Nurse Practitioner 10/6/16

Please note that this does not constitute specific & individualized medical advice; as always, if there are questions or concerns, specific to your child, please contact the office!

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Summer 2016 ~ Posted 8/3/2016

For Our Breastfeeding Moms ~ good article!

https://blogs.unicef.org.uk/2016/08/01/infant-feeding-interval/

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Summer 2016 ~ Posted 8/3/2016

The Importance of Sunscreen Use and Choosing the “Best” Sunscreen

I’m reminded of this subject on a daily basis as I notice at the ever increasing number of dark

“sunspots” on and progressively more leathery appearance of my own early aging arms; and, also

whenever I glance at popular TV shows like The Bachelor, a show that parades “perfectly” tanned

women in their early to mid-20s whose skin will have aesthetic qualities closely resembling that of a

60 year old by the time they turn 35 or perhaps even earlier. While early aging and, of course

sunburn are definitely concerning, more alarming to me is the American Academy of Dermatology’s

estimate that 1 in 5 Americans will develop skin cancer at some point in their lives regardless of age,

gender or race. Adverse skin changes from sun exposure (and exposure from other sources of UV

light such as tanning beds) occur cumulatively starting at the earliest ages, gradually increasing a

person’s chance of developing skin cancer and underscoring the need for everyone to protect their skin.

Central to skin protection is consistent use of sunscreen whenever outdoors making choosing the

right sunscreen essential. A recent study found that 40% of the most widely used popular

sunscreens did not adhere to American Academy of Dermatology (AAD) guidelines for providing

adequate protection from the sun.¹ Characteristics of the ideal sunscreen include the following:

1. Broad Spectrum – it should protect from both UVA and UVB rays, both of which can cause cancer
2. SPF 30 or higher
3. Water Resistant or Very Water Resistant: providing protection for 40 and 80 minutes respectively

during activities that involve water and/or sweating.

The FDA requires that the label on each sunscreen bottle provide information about each of these criteria.

In addition to sunscreen use, it is also recommended whenever possible to avoid sunlight as much

as possible between the hours of 10am and 2pm, when the sun’s rays are the strongest. Wearing

clothing such as long pants, sleeves, wide-brimmed hat and sunglasses minimizes skin exposure to the

sun. An estimated 24% of US Adolescents report using indoor tanning beds, ² a scary number considering

1 in 20 cases of melanoma, the most deadly form of skin cancer, can be directly linked to tanning bed

use³. With these numbers in mind, tanning bed use as well as tanning in general is highly discouraged.

I hope this information has been helpful. The American Academy of Dermatology provides a wealth of

information on how to prevent sun-induced skin damage on its “Sunscreen FAQ “page: https://www.aad.org/media/stats/prevention-and-care/sunscreen-faqs.

¹ Xu S, Kwa M, Agarwal A, et al. Sunscreen product performance and other determinants of consumer

preferences [published online July 6, 2016]. JAMA Dermatol. doi:10.1001/jamadermatol.2016.2344.

²Jeannette R. Wong, Jenine K. Harris, Carlos Rodriguez-Galindo, Kimberly J. Johnson. Pediatrics. Apr 2013, peds.2012-2520.

³BMJ 2012;345:e4757

Robert Schwartz, MD ~ SVPAM Partner Physician 8/3/16

Please note that this does not constitute specific & individualized medical advice; as always, if there are questions or concerns, specific to your child, please contact the office!

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Summer 2016 ~ Posted 7/19/2016

Immunizations

Vaccines are one of the essential components of good pediatric healthcare. Vaccines are given on

a schedule that has been worked out by a group of physicians from the American Academy of

Pediatrics as well as other healthcare provider groups. It is based on years of careful observation

about diseases that affect children. It is constantly reviewed and updated.

There are really no vaccines that are given unnecessarily. They make your child healthier as well as

more likely to grow up without any lifelong problems that many infectious diseases can cause.

There have been controversies about vaccines in recent years that are based on inaccurate and

even fraudulent ideas. The most common one was that MMR was associated with autism. That

has been completely disproven. The vaccine has been studied extensively and found to be safe in

virtually all children. Altering the vaccine schedule will also put a child at risk. There are no vaccines

that are given at the time of life that are inappropriate.

All of the pediatricians and nurse practitioners in our practice strongly endorse vaccines on the

schedule that we have provided. If you have any questions about your child’s vaccines, please discuss

them when you come to the office. We know that your child will benefit greatly from the vaccines

we give. Remember that no one can recall getting polio or diphtheria or many other diseases due

to good vaccines.

David Hennessey, MD ~ SVPAM Partner Physician 7/19/16

Please note that this does not constitute specific & individualized medical advice; as always, if there are questions or concerns, specific to your child, please contact the office!

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Summer 2016 ~ Posted 6/23/2016

Overcoming Veggie-Phobia

Most parents (and babies!) are excited for those first bites of foods from a spoon.

At the beginning, it seems easy. Most babies are accepting of new flavors and

textures as spoon feeding progresses. Getting your child to accept a variety of fruits

and vegetables happens with little effort. Yet somewhere after those first bites

around 6 months of age the course veers off track. It is not unusual at the

one year old checkup for a parent to, somewhat guiltily, admit that their child

eats no vegetables. This is not bad parenting. Obviously mom and dad want

their child to eat their veggies and have a healthy, varied diet. So what can we do?

First and foremost, offer whole veggies and fruits to your child regularly!

Regardless of whether you think your child will eat them or not, there should

be a fruit and/or vegetable on their plates at every meal. Model healthy

eating behaviors by eating whole fruits and vegetables regularly. Familiarity

helps with acceptance of new foods. Studies show that it can take TWENTY

exposures to a new food before a child will accept it easily. That is every day

for almost THREE WEEKS!! In real life this means that it may be helpful to

choose one fruit or vegetable to work on at a time. Place a small amount

of that food on your child’s plate every day for three weeks. It can be a

tablespoon of frozen peas that you cooked in the microwave or a few slices

of cucumber. The important part is that you do it every day. Talk about it

with your child- name the food, let them know it is yummy, demonstrate

taking a bite yourself! Do not force them to eat it, do not stress out if they

don’t eat it the first few times- or even the next few times after that! Once

a child accepts a new food, make sure to offer it regularly so they don’t forget

they like it.

A final word on fruit and veggie pouches. They are a masterpiece of

marketing which preys on parents’ desire to get their child to eat vegetables.

The problem with these pouches is that they are often very high in sugar

content (natural sugars from fruits are still sugars). Your child is getting

lots of fruit sugars with none of the beneficial fiber from whole fruits.

They are getting some of the nutritional benefits of vegetables, but not

building any of the healthy habits which will help them have good eating

habits as they grow. You should think of these pouches in the “juice”

category and save them for special snacks, not as a staple in your child’s diet.

Jackie Saladino, MD ~ SVPAM Partner Physician 6/23/16

Please note that this does not constitute specific & individualized medical advice; as always, if there are questions or concerns, specific to your child, please contact the office!

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Summer 2016 ~ Posted 6/14/2016

Children MUST ride rear-facing until age 2 years!

Yesterday Gov. Tom Wolfe signed into law Senate Bill 1152.

There is a 60 grace period for compliance - all families will be subject to the law starting in mid-August.

There is a verbal warning period of 1 year, after that one year families will face fines for violations.

Here are the highlights:

1) All children under 4 years of age anywhere in a vehicle must be securely in a child passenger restraint system

2) All children under 2 years of age must be in a rear facing child passenger restraint system (and it must be appropriate for their height and weight)

3) All children between the ages of 4yrs and 8yrs must be in an appropriately fitting booster seat

4) All children between the ages of 8years and 18years must be secured in the safety seat belt system of the vehicle regardless of position in the vehicle.

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Spring 2016 ~ Posted 4/14/2016

Tick Bites

With the arrival of spring comes picnics, baseball, soccer, and more fun times outside. The warmer weather also brings out the hungry ticks. While ticks may come out to feed anytime the temperatures are above freezing, there is an increased incident of tick bites in warmer weather because we spend more time outdoors. Ticks are sneaky and can hitch rides on clothing, pets, as well as people.

The ticks we generally worry about in Pennsylvania because of their association with Lyme Disease are deer ticks. Deer ticks are brownish-orange in color and the size of a sesame seed. They are about half the size of dog ticks (apple seed size) even when engorged. Tick bites are painless and most people do not even know they were bitten until they find an attached tick.

Ticks prefer warm, moist body sites. Attached tickes are most commonly found under the hairline on the neck, behind ears, in armpits, and the groin (under the scrotum in boys). It is important to check these areas daily on your child to help with the prevention of Lyme Disease. For the Lyme bacteria to be transmitted, the tick needs to be attached at least 24-48 hours. If checked daily, it is nearly impossible for your child to develop Lyme Disease. Unfortunately, the majority of people who do contract Lyme have no idea when they were bitten because the tick attached, fed and then released.

To remove a tick, wash your hands and clean the area with alcohol. Take clean tweezers or one of the newer tick removal devices and firmly grasp the tick without twisting or crushing the insect. Gently life up on the tick and allow the tick to release on its own. This may take several minutes of patience efore it “let’s go”. Afterwards, clean the bite site with soap and water; you can then apply an antibiotic ointment. A red mark may be left behind and persist for several days. Please call the office if you are uncomfortable attempting removal at home or a piece of the tick remains after removal.

Signs and symptoms of Lyme Disease typically present 1-2 weeks after exposure and include a rash, nonspecific fatigue, joint aches/swelling, fever and more seriously, meningitis with headache, neck stiffness, and light sensitivity. The characteristic rash is not painful or itchy and will look like a target or Bull’s eye. Unfortunately, not everyone will present with a rash so if your child has vague symptoms that persist for several weeks, it is good to schedule an appointment for evaluation and appropriate blood work can be ordered. Lyme Disease is very easily treated with antibiotics once the diagnosis is made.

Dr. Vida Kaniecki ~ SVPAM Partner Physician 4/14/16

Please note that this does not constitute specific & individualized medical advice; as always, if there are questions or concerns, specific to your child, please contact the office!

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Spring 2016 ~ Posted 3/28/16

Spring allergies

Springtime is upon us and along with all the fun, be careful to watch for a bad tick season, early sunburns and poison ivy. Our spring allergy sufferers can expect their eyes, noses and breathing to possibly be effected-so here are some tips that may help…

Consider starting useful medicines now, getting at least a week’s start prevents many a bad allergy attack which otherwise may set kids back in school, ruin their sleep patterns and spoil family plans and togetherness. Some children get so bad they may miss school, sports and be misdiagnosed as having Attention Deficit Disorder. I subscribe to pollen maps through the Weather Channel App but they’re also available on TV. These help us to understand and pinpoint the cause of our problems much more accurately and can teach you how weather patterns can effect our health.

Some tips: Consider switching bathing routines to evening or right after playing outdoors to decrease pollen in your hair. Consider changing pillow cases more often during the allergy season. Remove your shoes and change your clothing when you come indoors if you’re really suffering. Consider wearing a mask for outdoor chores and some sunglasses to protect your eyes from flying pollen and for safety.

Close windows, have the kids play outside later in the day when pollen counts are lower, use air conditioning more liberally and get inside well before windy storms and lawn mowers kick pollen into the air. If your furnace has quality filters, keep the fan going to filter your air even when the furnace is off. Don’t dry your clothes outdoors.

Reduce odor creators around pollen sufferers: smoke, perfume and body sprays can add to their grief in about 30% of cases. Don’t dust when they’re in the same area.

Try nasal saline washes or eye drops twice daily if your pills aren’t helping. This also prepares children to more easily accept medicines that go directly to the problem area which we may prescribe.

Herbal medicines have been used but are untested for safety and dosage in children. They can cause allergic reactions themselves and may interfere with other medicines, but many people feel relief from Butterbur or the Chinese remedy Biminne which contains ginkgo and chinese skullcap.

Please call us to discuss allergies if you can’t decide what to do and you’re suffering. We have options not mentioned above, can allergy test anyone either by skin or blood testing, and have lots of experience for difficult cases. Many of our families don’t know that we’ve specialized in children’s allergies and asthma for 50 years and have a great record of success and safety.
Have a great season and enjoy your spring more this year!

Dr. Daniel Graff ~ SVPAM Managing Partner Physician 3/28/16

Please note that this does not constitute specific & individualized medical advice; as always, if there are questions or concerns, specific to your child, please contact the office!