ClaireNeelyMD’s Blog

At this time of year, I have many families bringing in their children to make sure that they are healthy for the upcoming holidays.  No one wants their child passing illness on to relatives at the big family gathering.  But, there is not magic medicine that will guarantee health.  The all-important, simple hand washing is one of the best things you can do to stay healthy at this time of year.

The CDC has a few other reminders in their new holiday song.

Enjoy.

(Click picture)

A child was crying in the exam room across the hall. Crying loudly and long.   The patient I was seeing started to look a little worried and her mother said she hoped that the child was not hurt too badly.  But, having heard lots of different cries, I knew that child was not in pain.  That was the cry of a 6 month old who was complaining about being undressed and weighed.

A new app in the iPhone store is “Cry Translator”.  Evidently, you hold it new a crying baby/child and it will tell you why the child is crying within 5 categories (hungry, sleepy, annoyed, stressed or bored).  This is a bit like Shazam telling you the name of a song on the radio.  As  bonus, the app also gives you suggestions about what to do about the crying.

There is some science behind this.  Babies’ cries have commonalities across countries and cultures.   And the cry of a child in pain is quite different from a child who is mad.  Parents learn the language of their own child’s cry by 4-5 weeks old.  Will an iPhone app help this along?  I doubt it. 

I’d try it out, but it’s pricey and I already know what the cries mean.

This is National Influenza Vaccination Week, and today is the day dedicated to spreading the word about the importance of influenza vaccines in children and young adults-both seasonal influenza and H1N1. 

I continue to get questions about the safety of the H1N1 vaccine.  The H1N1 vaccine is made the same way seasonal flu vaccines are made every year. Extensive testing and monitoring have shown that the vaccine is not only safe, but also an excellent match for the H1N1 flu virus. No vaccine can be guarenteed to be completely risk-free, but remember that the choice not to vaccinate also carries a risk. 

Right now, there are not many cases of H1N1, or seasonal influenza in our community, but I expect that there will be another wave of illness starting in the next month or so. 

There is currently enough H1N1 vaccine for all children and adults to get the vaccine.

Google Flu Trends is an interesting and accurate way to keep track of influenza activity. 

Click here for Twin Cities Influenza trends.

In the past, they tracked only national trends, but now are tracking by major city.  The trend looks good for us right now, but you can see previous years’ influenza trends on the graph.  We have not seen the last of influenza this season.

Stay well.

Over 15 years ago, we learned that a major cause of acetaminophen overdose was using the wrong measuring spoon.  It is easy to mistake a tablespoon measure for a teaspoon, especially in the middle of the night.  While a single mistaken dose of many medications is not a big problem, a repeated overdose of acetaminophen can be a serious problem-causing liver failure. 

Since that time, pharmacists and pediatricians have strongly recommended using standard medicine spoons that are less confusing.  But still many people choose to use what they have at home.  A recent study looked at how well people could estimate what a teaspoonful (5 milliliters) looked like in standard spoons (soup spoons, serving spoons and others).  First, the researchers had a student pour out 5 milliliters (ml) of medicine into a 5 milliliter spoon, so they could see how much it was.  Then, they were asked to pour the same amount of liquid into other spoons, one that would hold 15ml and the other 45ml. 

When pouring into the 15ml spoon, the amount poured was 8% too little, and in the 45ml spoon, it was 12 % too much.   The pourers were confident that they had poured the correct amount.  (And this was in the day, imagine the increase in errors if they had been tired parents awakened in the night by a crying child with a fever.)

So, the next time you buy liquid medication for your child, also get a medicine spoon.  Please.

One of the saddest facial expressions is the look a baby gives her mother or father when she gets a shot.  This is what makes shots worse for parents.  Babies are very oriented in the present and once the pain from the shot has faded, they are ready to put it behind them.  Even though parents know that shots are very important for their child’s health, parents retain some piece of guilt for a while. 

So, what can be done to decrease pain with the infant vaccines?  Pediatricians and nurses are not heartless and recently there have been a number of studies looking at just this issue.

Two things seem to clearly help.

The first is sucrose/sugar water.  Small amounts of this (1 tablespoon or so), given right before the vaccines decreased the length of time that 2-month to 6-month olds cry after vaccines. (We have this in the clinic-if we forget to offer it, remind us!)

Choosing the order of giving the vaccines also makes a difference.  Giving DaTP/Hib (hemophilus influenza) before PCV (pneumococcal) decreases pain.

And of course, snuggling with Mom or Dad right after the shots remains the most important thing.

The smell of fresh cut grass is one of the pleasures of summer. Using a lawn mower is often as routine as bike riding or barbeques during the summer months. it is easy to take these machines for granted and forget how powerful they are.  In fact, 200,000 people – 16,000 of them children – are injured in lawn mower-related accidents each year, the U.S. Consumer Product Safety Commission reports.

The American Academy of Pediatrics (AAP), the American Academy of Orthopaedic Surgeons (AAOS), the American Society of Maxillofacial Surgeons (ASMS), the American Society of Plastic Surgeons (ASPS), and the American Society for Reconstructive Microsurgery (ASRM) have teamed up to prevent injuries and to educate adults and children about the importance of lawn mower safety.

“No parent wants a beautiful summer day to turn into a tragedy for a child. Yet we see the results of children operating lawn mowers in an unsafe manner every year. As pediatricians, it is part of our job to be sure parents and children know how to be safe around these machines,” said AAP president David T. Tayloe, Jr, MD, FAAP.

The AAP, AAOS, ASMA, ASPS and ASRM offer the following tips to help prevent lawn mower-related injuries:

• Children should be at least 12 years old before they operate any lawn mower, and at least 16 years old for a ride-on mower.

• Children should never be passengers on ride-on mowers.

• Always wear sturdy shoes while mowing – not sandals.

• Young children should be at a safe distance from the mowing area.

• Pick up stones, toys and debris first from the lawn to prevent injuries from flying objects.

• Always wear eye and hearing protection.

• Use a mower with a control that stops it from moving forward if the handle is released.

• Never pull backward or mow in reverse unless absolutely necessary – always look for others behind you when you do.

• Start and refuel mowers outdoors – not in a garage.  Refuel with the motor turned off and cool.

• Blade settings should be set by an adult only.

• Wait for blades to stop completely before removing the grass catcher, unclogging the discharge chute, or crossing gravel roads. (As a safety feature, some newer models have a blade/brake clutch that stops the blade each time the operator releases the handle.)

Many lawn mower-related injuries require a team of physicians from various specialties – plastic surgery, microsurgery, maxillofacial surgery, pediatrics, and orthopaedics – to properly repair them.  Often, patients must endure painful reconstructive operations for months, sometimes years, to restore form and function.

LawnMowerSafety

Higher gas prices mean “sharing the road” with more bicycles. Bicycles are legal vehicles on Minnesota roads and bicyclists have the same rights as motorists. This means they share equally the responsibilities of bicycle safety and reducing bicycle/motor vehicle crashes. The top factor contributing to these crashes is failure of both bicyclists and motorists to yield the right-of-way.

Motorists should be aware of bicyclists on the road. The law requires a three-foot clearance when passing a bicycle. Bicyclists may ride  on the roadway even if there is a parallel bike trail. Most bike trails have a speed limit and faster moving bicyclists can be a safety hazard to other trail users. Bicyclists also may ride two abreast on the road as long as it does not impede normal and reasonable movement of traffic.

Bicyclists, you are a vehicle, so ride in the same direction as traffic, obey all traffic control signs and signals and signal your turns.

To learn more about bicycle safety in Minnesota, visit www.sharetheroadmn.org.

Chlamydia is one of the most commonly reported infectious diseases in the US.  It is a sexually transmitted disease, but is less well known than others.  It generally causes no symptoms, though at times can cause minor, non-specific problems in women and men.  It is one of the leading causes of infertility in women.

It is easily treated with antibiotics-the hard part is getting young adults tested.  There are misconceptions about the testing and a social stigma that continues to keep patients and parents from discussing these diseases. There is now a urine test that is easy and accurate.

The Wall Street Journal recently did a nice piece on this.

An informative site for teens is GYT09.org.

Ask about getting tested. We will be asking you.

I am a BIG fan of fireworks.  One of my favorite childhood memories is the summer my father worked in North Carolina for 2 months, and the house where we stayed was near 6 Flags.  Every night, we could sit on the front steps and watch the fireworks just before park closing.

Every year, I have to make the hard choice about which display to see.  (This year, downtown Minneapolis.  It’s great over the river with the bridges.)

I am NOT a big fan of consumer fireworks.  These are the cause of too many injuries to children and teens each year.

There are many excellent fireworks displays around the Twin Cities.  Choose one of these instead of buying your own.

A study was presented yesterday at the American College of Sports Medicine meeting in Seattle that chocolate milk helped more with muscle recovery after exercise than sports drinks.  This was a small study out of James Madison Univeristy of 13 male college soccer players, but the results are interesting.  They measured the blood level of creatine kinase which is a marker for muscle injury.  They found that the chocolate milk-drinkers had lower levels of this enzyme after intense training.

This is one of a handful of studies looking at chocolate milk and muscle recovery in athletes.  The first studies were done in cyclists and low fat chocolate milk now has a fan base in this sport.

It’s a little hard to know how to interpret these studies as they have looked at a really small number of athletes, but the thinking is, that the mixture of protein and carbohydrates is a key factor.   I think it’s interesting that low fat chocolate milk stands up so well to “high tech”, expensive, designer sports drinks.

There is not a proposed theory about why chocolate milk is better than plain milk, but then, chocolate is almost always a good thing.