Pediatric health blog by Dr. Nancy M. Silva. #WorkingMom, Small World Pediatrics #Doctor sharing my Best Pediatrician #parenting advice, #medical info, #affirmations, #quotes, #TampaBay, #Disney & other fun stuff too!
On April 20, 2017, the FDA recalled Hyland's homeopathic teething tablets.
For many years now, many parents have asked me if I recommend teething tablets and if they even work. I always told them that didn't recommend them because the ingredient concentrations are not known or clear.
HPUS indicates the active ingredients are in the official Homeopathic Pharmacopia of the United States."
Belladonna is listed as 12X HPUS. How much is this? Is it really safe for our babies? In addition, in 2010, the FDA has also advised against these tablets due to inconsistent dosing of Belladonna alkaloids from bottle to bottle (http://www.cnn.com/2016/10/12/health/hylands-teething-tablets-discontinued-fda-warning/). If I didn't know what I was really giving to my baby, I wouldn't give it to my baby. Therefore, if I couldn't give it to my baby, I couldn't recommend it as a pediatrician.
In addition, I used to tell parents that based on parents' feedback, it seemed that these tablets worked about 50% of the time. Given that it wasn't consistently helpful, I didn't recommend them.
So the question remains, what to do to help relieve the pain? There are several recommendations:
(1) Use a cold wet wash cloth (kept in the fridge) that your baby can chew on.
(2) Have your child chew on a frozen bagel.
(3) Have your child chew on a frozen banana.
(4) Have your child chew on an ice cube.
Be careful with any of these items that your child can chew on. Always supervise your baby in order to prevent your child choking. In addition, chewing on a frozen item needs to be for a limited time to prevent physical injury due to prolonged cold. I recommend using a fresh food feeder. This is essentially a small mesh bag that your infant can chew on without choking. As always supervise that as well.
Teething is a painful time in infants' lives. However, teething tablets or bells that contain belladonna and/or benzocaine are not recommended.
The Blue Whale Game is an online interactive challenge game that starts with an assignment of tasks for the player. A series of tasks occur over a 50 day period to complete. Some tasks may be as simple as watching a horror movie. Gradually, the tasks are increasingly more severe involving self inflicted injuries. As each task is completed, the player posts a picture of the task on Instagram. Although this game has typically been played on Instagram, other social media platforms have been used as well. Some posts include pictures and videos of self inflicted wounds include a whale carving on an arm, balancing on a roof, or a pool of blood. The player wins at the end of the game, when they complete the final task of suicide. In some cases, this has involved posting "End" with a picture of a blue whale.
Instagram has begun to post a warning regarding the Blue Whale game when a search is done for the term "blue whale."
The game's creator, Phillip Budeikin, from Russia, is imprisoned. He started the game in 2013. He has stated that he was cleansing society of certain people that were biological waste. Even though he is imprisoned, other "death groups" have continued with the Blue Whale game. In addition, the creator receives love letters in prison.
Please discuss the Blue Whale game, its dangers, and its links to suicide with your children and their friends, especially if you have my concerns regarding depression or suicide in your children or notice my change in their behavior.
Of those children who committed suicide, 5 – 11 year olds were more likely to have Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD), as revealed in a recent study in Pediatrics revealed that. Teenagers 12 – 14 year olds, were more likely to suffer from depression or dysthymia, and one third (1/3) of children had a mental illness. In order to determine the cause of suicide of children 5 to 14 years old, the study reviewed data from the National Violent Death Reporting System from 2003 to 2012.
Of those children who committed suicide,young school aged children were more likely to have family or friend relationship problems. In contrast, teenagers were more likely to have boyfriends or girlfriend relationship problems. The study also revealed that there was a higher rate of suicides among black youth than young of other races. In addition, 29% of young children and teenagers told someone about their intention to commit suicide before they attempted to do so.
Suicide Warning Signs
Warning signs include, but are not limited to increased seclusion and alone time, increased time spent in their room alone, decreased time spent with friends, decreased time spent in school activities, poor grades or a drop in grades, poor communication, discussion of a desire to commit suicide, increased temper, increased frustration.
National Suicide Prevention Line
An excellent resource is The National Suicide Prevention Line. There are many tools available on their website, suicidepreventionlifeline.org. In addition, their Lifeline is 1-800-273-TALK (8255). Online Chat is also available. If Chat is unavailable, then please call the Lifeline, as help is available 24/7. It is anonymous and confidential.
Positivity during depression can be helpful, so that the child at risk does not feel so helpless and alone. For older children, they can call the hotline. They can text HOME to the Crisis Text Line at 741741. Also, consider having a professional and/or you do affirmation work with your child. Daily affirmations can be one of many tools that help. Lastly, a professional psychologist and/or psychiatrist may be beneficial as well.
It is important to (1) know the warning signs for suicide among young children and teens, (2) be aware that ADD, ADHD and depression place these children at a higher suicide risk, and (3) know where to call for help.
Children develop sleep problems when they use portable media devices, such as tablets or smartphones, before bed. They have more difficulty falling asleep, staying asleep, are more sleepy during the daytime, and are twice more likely to sleep less than children without access to their devices before bedtime. A JAMA Pediatrics review (reut.rs/2fkjL1j) of 20 studies that involved children using these portable media devices. The review excluded their use of PCs and TVs before bed. It included over 125,000 children between the ages of 6 and 19 years old.
Even more interesting, is the fact that sleep problems are also more likely in children who had their portable media device near them at bedtime, even if they didn’t use it before bedtime. If they receive texts or use social media, then they are more likely to check their devices throughout the night. Before you know it, after checking the texts, Facebook, Twitter, Snapchat & other social media, several hours of precious sleep may have been lost.
So many of us are guilty of using out smartphones in the middle of the night. We’ve commonly woken up, after a deep sleep REM cycle, checked our smartphone, and interrupted our sleep. A good amount of sleep for most children is 10 hours per night, for teens it lowers to 9 hours per night. For a child, this has a huge impact on their education the next day as well. If sleep problems exist, learning difficulties are more likely to occur when they are sleepy during the daytime.
Next time you use your smartphone before bed, think about how it could negatively impact your own sleep. Poor sleep is linked to many potential negative health consequences, including dementia.
Please consider protecting your child’s sleep by making sure they don’t use their smartphones or tablets before bedtime, turn them off or remove them from their bedroom at night.
Zika Virus | International Public Health Emergency
Zika Virus is a global health scare, especially for pregnant women. Due to the October 2015 cluster of 524 cases of newborns in Brazil diagnosed with microcephaly and other neurological disorders reported in Brazil, World Health Organization (WHO) has stated that it is as a Public Health Emergency of International Concern. (bit.ly/1PYrRKs)
What are the symptoms of the Zika Virus?
When humans become infected, they may develop symptoms which include fever, itchy rash, headache, red eyes, joint pain, muscle pain, and temporary paralysis. Typically, symptoms last for 2 to 7 days. Incubation period is unknown, but ranges from a few days to a week.
There has also been an increase in incidence of Guillain-Barré syndrome that has coincided with increased incidence of Zika Virus. (bit.ly/22Tg8mx)
Pregnant women infected with the virus have had newborns with microcephaly and brain damage. It is believed that the virus has spread from the infected mother to baby in utero and during delivery. Zika virus has been found in the brain tissue of these infected babies.
Where Did Zika Virus Start?
According to WHO, it was originally detected in a rhesus monkey in Zika Forest, Uganda in 1947 and in humans in Nigeria in 1954 (bit.ly/1QeAEcO). Before 2015, the virus was found in Africa, Southeast Asia, and the Pacific Islands. Currently, there are many countries around the world with local mosquito-borne Zika virus disease cases as noted on the CDC website at 1.usa.gov/1Mv4zhb Currently, countries affected by local transmission include Aruba, Barbados, Bolivia, Bonaire, Brazil, Colombia, Puerto Rico, Costa Rica, Cuba, Curacao, Dominica, Dominican Republic, Ecuador, El Salvador, French Guiana, Guadeloupe, Guatemala, Guyana, Haiti, Honduras, Jamaica, Martinique, Mexico, Nicaragua, Panama, Paraguay, Saint Martin, Saint Vincent and the Grenadines, Sint Maarten, Suriname, Trinidad & Tobago, U.S. Virgin Islands, and Venezuela).
Is Zika Virus in the United States?
Yes. However, only travel associated cases have been reported in the United States. However, "local mosquito-borne transmission of Zika virus has been reported in the Commonwealth of Puerto Rico, the US Virgin Islands, and America Samoa." (1.usa.gov/1RvWNAq) As of March 28, there have been 273 travel associated cases have been found in the U.S., including in Hawaii. There have been 258 locally acquired cases in Puerto Rico, 10 in the U.S. Virgin Islands & 14 cases in the American Samoas.
How is Zika Virus Transmitted?
It is most commonly transmitted by a mosquito bite. It can also be sexually transmitted and via blood transfusion. It is unknown how common sexual or blood transmission is among humans.
Can Zika Virus Be Sexually Transmitted?
Yes. The CDC recently reported on February 2, that this virus was sexually transmitted in Texas, USA (cnn.it/1WSuiRd). In addition, Florida confirmed on March 9 & California confirmed on March 25, that they too have had their first case of sexually transmitted Zika Virus. As a result of confirmed sexual transmission of the virus, the CDC now recommends that if you are a pregnant women whose "male sexual partner has traveled to or lives in an area with active Zika virus transmission, you should abstain from sex or use condoms the right way every time you have vaginal, anal, and oral sex for the duration of the pregnancy." The case in Texas did not involve pregnancy. However, keep in mind that this illness can infect anyone.
Other countries, confirmed that they too have had their first case of sexually transmitted Zika Virus. France confirmed this occurred on February 27. Chile confirmed firmed this on March 27. Be aware that more cases and countries are confirming sexual transmission of the virus.
What Can I Do to Prevent Zika Virus?
Use insect repellent, especially when outdoors. Avoid travel to areas with active Zika Virus transmission. If you cannot avoid travel to an area with active transmission, then practice abstinence or use birth control while traveling in that area. Abstain from sex if your partner has traveled to an area with active transmission.
What Insect Repellent is Best to Zika Virus Infection?
The CDC recommends the use of insect repellents with active ingredients registered with the U.S. Environmental Protection Agency (EPA) for use to be applied to skin and clothing. EPA registered insect repellents contain DEET, picaridin, IR3535, and some oil of lemon eucalyptus and para-menthane-diol. Insect repellents with these active ingredients products offer longer-lasting protection. Insect repellents containing oil of lemon eucalyptus should not to be used on children under the age of three years. Insect repellents can be used by pregnant and nursing women. The CDC has many details about use, efficacy, and safety of insect repellents available at 1.usa.gov/25rRxr1.
I'm Worried Myself or My Child Might Have Zika Virus. What Should I Do?
First, know the symptoms. Typically, at a minimum, an infected person may have a low grade fever which is frequently accompanied by and a rash. Next, contact your doctor. If your doctor is concerned that you or your child might be infected with Zika Virus, they will advise you to schedule an appointment for a more detailed evaluation. Lastly, if your doctor thinks that you may need to be tested for Zika Virus, then your doctor will refer you to your local health department. Currently, only local health departments have testing for the Zika Virus.
Is There a Travel Advisory Due to Zika Virus?
Yes. There is a Alert Level 2, Practice Enhanced Precautions in areas with active transmission (1.usa.gov/1MMaER1). There is not yet a Warning Level 3, Avoid Nonessential Travel for areas with active transmission.
I'm Not Pregnant & Plan to Travel to an Area with Zika Virus. Is There Anything I Should Do?
It is advised to not travel to areas with the Zika Virus. However, if you do travel to an area where Zika Virus is present, then use insect repellent at all times, especially when outdoors. It is also recommended that if you are a women that is not currently pregnant, that you take birth control as it is estimated that 50% of all pregnancies are estimated to be unplanned.
I'm Pregnant and I've Traveled to an Area with Zika Virus. What Should I Do?
Talk to your OB/GYN doctor before any travel, especially if you are traveling to an area with active Zika Virus transmission. Follow up with a phone call with your doctor immediately upon return. Depending upon your experience or exposure, they may have additional recommendations for you and your unborn baby.
Is a Vaccine for Zika Virus Available?
Not yet. However, there is work on a vaccine. As of February, the National Institutes for Health (NIH) has stated that Zika Virus Vaccine trials will begin this summer (wapo.st/1pTCPZO). They have built upon research on similar viruses, Dengue and West Nile. They are likely to be able to do a small scale trial of about 20 to 30 people in Summer 2016 with large scale trials likely to occur in 2017. Until a Zika Virus Vaccine is available, use insect repellent, travel with caution, if pregnant prevent exposure in your travel and with your sexual partner.
I am proud and very pleased to announce the new logo for Dr. Silva: Tots, Tweens & Teens. The tree demonstrates the blessed and special journey that we are able to share with our children. A tree is a symbol of life. The strong roots represent the growth in our children and our inner selves. The colorful and vibrant leaves represent the bustling energy and potential in our children and ourselves. The yellow leaf is the brightest leaf which is reaching upwards as is the most special and positive aspect of every child inside.
Ebola is a virus that was first discovered in 1976 near the Ebola River in Africa. Sporadic outbreaks have occurred in Africa since then. There are five (5) strains of Ebola that infect animals in Africa. Four of the strains infect humans.
What are the Signs & Symptoms of Ebola?
Symptoms include fever, headache, muscle aches, vomiting, diarrhea, abdominal pain, unexplained bleeding or bruising. Ebola can only be spread when symptoms begin. Symptoms typically occur between 8 to 10 days after infection. However, symptoms may occur as late as 21 days after exposure to Ebola.
How is Ebola Spread?
If a person is ill with Ebola virus, they can spread it by blood, body fluids (urine, saliva, sweat, feces, vomit, breast milk, and semen). It can also be transmitted via objects contaminated with the virus (like needles and syringes). Lastly, it can spread via infected bats, apes, gorillas, and monkeys. (http://1.usa.gov/1rCptdl)
Where is the Ebola Outbreak? Where Has Ebola Spread?
This year is the largest Ebola outbreak in history. It has taken place largely in West Africa. Currently, areas designated by the U.S. Centers for Disease Control and Prevention (CDC) as having widespread transmission of Ebola are in West Africa, specifically Guinea, Liberia, and Sierra Leone. Countries that have had travel associated transmission and local transmission are (Port Harcourt and Lagos) Nigeria, (Madrid) Spain, and (Dallas and New York City), New York. Countries that have had travel associated transmission are (Kayes) Mali and (Dakar) Senegal.
Are there are recent updates in Florida?
As of October 26, 2014, Florida Governor Scott issued an order mandating the Department of Health to have a 21 day monitoring of anyone who has returned from areas where individuals have been infected by Ebola virus, as designated by the CDC. (http://bit.ly/1wH4o6M) New York, New Jersey, Illinois and now Florida have instituted a 21 day health evaluation plan. Twice daily monitoring is to include measuring temperature twice daily. Gov. Scott also stated that if individuals monitored are assessed to be high-risk, then a mandatory quarantine will be required.
Are There U.S. Guidelines for Healthcare Workers Caring for Patients with Ebola?
The CDC has issued guidelines for healthcare workers and healthcare settings for those caring for patients infected with, suspected to be infected with, or having died of Ebola. (http://1.usa.gov/1yJblVf) There are also CDC Ebola waste management guidelines. On October 14, 2014, the CDC admitted that they were unprepared for Ebola in the U.S. (http://bit.ly/1E4V6F4) Since then, the CDC has formed the previously mentioned guidelines.
Are there flight Restrictions from Africa?
As of October 21, 2014, the U.S. Homeland security Department announced that travelers from Guinea, Liberia, and Sierra Leone have limited airport entry into the U.S. They are limited to five (5) international airports in New York, New Jersey, Atlanta, Chicago, and Washington, DC. These airports will have extra screening of passengers for possible Ebola exposure, which include taking temperatures and other assessments as well. All U.S. airports are screen for possible Ebola exposure. (http://www.cdc.gov/vhf/ebola/pdf/ebola-algorithm.pdf) Currently, there is no travel ban from or to Guinea, Liberia, and Sierra Leone to U.S. due to Ebola.
It is highly unlikely that Ebola will spread in the U.S. as it has in endemic West Africa. However, we must keep a vigilant eye on developments, travel screenings are necessary, and healthcare workers must follow CDC guidelines to prevent spread of this disease.
Enterovirus is a non-polio virus that was first discovered in California in 1962. (http://1.usa.gov/1rVzPYU) It typically exists during the Summer and Fall, with frequency of the virus decreasing in late Fall.
Where is Enterovirus D68 in the United States in 2014?
Update 10/8/14: Enterovirus D68 appears to be winding down. Fewer severe respiratory illnesses reported last week. Peak was three (3) weeks ago. (http://usat./1vUOJPz)
Update 10/16/14: CDC new rRT-PCR test for Enterovirus D68 allows more rapid test for the more than 1,000 remaining specimens from since mid-Sept. (http://bit.ly/ZC9JzW). This will result in an increased number of positive results. However, this will be for past infections, not recent ones. Enterovirus D68 still appears to be winding down.
What Are the Symptoms of Enterovirus D68?
Enterovirus is typically misdiagnosed as a common cold, rhinovirus, RSV, or the flu. Typical symptoms include those of cold symptoms, runny nose, cough, sneezing, and achiness. In more severe cases, wheezing and difficulty breathing has occurred. There have been four (4) deaths associated with Enterovirus. In addition, the Colorado Health Department reports that partial paralysis has occurred in 12 Colorado children infected with Enterovirus D68. (http://dpo.st/1CTtJgp) The CDC is investigating the deaths and the potential paralysis link.
Who's at Highest Risk for Contracting Enterovirus D68?
Infants, children, and teenagers are at highest risk for contracting the disease as they have not had sufficient exposure and therefore immunity against this virus. Those who have asthma and reactive airway disease are at higher risk to have more severe symptoms and illness from the virus.
How Do I Prevent Enterovirus D68?
•Hand washing, hand washing, and hand washing! Hand sanitizers are not effective in prevention. This virus spreads by cough, sneeze, or touching an infected surface.
•Non-alcohol disinfectants are effective. However, hand washing is still the best.
•Keep your sick child home. This is very important to prevent the spread of this virus. Remember, in some, this virus acts like the common cold. However, if your child spreads it to someone else, the child may develop more severe symptoms.
•Cough and sneeze into your elbow.
•Clean commonly used surfaces (countertops, door knobs, toys, etc) with bleach water.
When Should I See a Doctor?
If you or your child have asthma or reactive airway disease, develop cold symptoms, fever, wheezing or shortness of breath, then go see a doctor.
What is the Treatment for Enterovirus D68?
There is no cure for this virus. There is supportive care. The sooner you or your child receive supportive care, the better the outcome. That being said, it doesn't mean that the moment you or your child gets sick, you should run to the pediatrician. However, if you or your child has asthma or reactive airway disease, become ill with fever, cold symptoms, is wheezing or short of breath, your pediatrician should examine your child.
Enterovirus D68 is most commonly a mild disease. However, this year, it has become a scary one. Knowing your child's health, closely observing them if they are ill, and follow-up care with your pediatrician will help in the treatment of Enteovirus D68, so it won't terrify you.