Confused about car seat safety? It’s time for a refresher.

By Tiffany Vitt, P.N.P. for Community Choice Pediatrics

Car Seat SafetyAs parents, we’ve all been there before: your eight year old is begging to come out of their booster seat because several of his or her friends are no longer sitting in them. Or, you’re contemplating if you should switch your 5 year old out of his or her 5 point harness to the high back booster with the seat belt because the drop off line at school would be SO much easier to handle if you did. And I know I’ve personally experienced buckling my 2 year old in his rear-facing convertible car seat, eyeing his feet that are now touching the back of the vehicle seat, and wondering if I should turn him forward-facing? It’s the parental struggle of balancing what’s convenient and most comfortable with what is also most safe.

Motor Vehicle Accidents Leading Cause of Childhood Death

Per the CDC, motor vehicle accidents are one of the leading causes of childhood death. That said, correct car seat use can reduce that risk by nearly 70%. The simple act of making sure your child is safely buckled into their car seat or booster seat every single day is truly one of the best ways parents can help prevent unnecessary injury or even death of their child. Sounds easy peasy right? Sure, except parents today are faced with having to navigate safety recommendations that seem to change every couple of years. Add the pressure of trying to purchase the right child safety seat from an overwhelming number of brands and styles and it’s no wonder parents feel like they don’t know what the heck they’re doing.

As with all things in my practice, I look to the American Academy of Pediatrics (AAP) for the best and most up to date recommendations regarding the health and safety of children. In 2018, the AAP released child safety seat recommendations that were revised to no longer focus solely on age parameters, but rather on a child’s height and weight.

Below is a quick overview of AAP child safety seat recommendations.

1) Make sure the car seat you have purchased is correctly installed in your vehicle. Unfortunately, almost half of car seats are NOT installed or used correctly. Each car seat’s owner’s manual should detail proper installation in addition to seat height and weight limits. For example, rear facing child safety seats will use a seat belt or lower anchors to secure it to the seat. Both can be safe options, but you should never use both at the same time.

Car Seat Safety2) Infants and toddlers (birth until age 2-4) should ride rear-facing in their car seat for as long as feasibly possible. And they are safest if they don’t turn forward-facing until they reach the weight or height limit detailed per the seat’s manufacturer.

3) Once a child has outgrown a rear-facing car seat, they should then move to a forward-facing car seat that utilizes a five-point harness for as long as feasibly possible also. Again, children are safest if they remain in this type of car seat till they have reached the highest manufacturer allowed height or weight.

4) After a child has outgrown their forward-facing child safety seat’s weight or height limit, they should be buckled into the car using a belt positioning booster seat.

5) In most vehicles, 4 foot 9 inches tall is the height a child will need to reach before they can come out of their booster seat and be properly secured in a seat with the seat belt alone. A properly secured seat belt is a lap belt that goes across the upper thighs (not over the abdomen) and a shoulder belt that crosses the chest (not the neck).

6) Lastly, it is recommended to hold off on allowing your child to ride in the front seat of the car until they are at least 13 years of age. If a child riding in the front seat is not heavy enough, the air bags may not deploy in an accident. And if they do deploy, the airbag can injure a child vs. save their life because of the force in which it deploys.

HealthyChildren.org

When in doubt, or just looking for information in general regarding car seat safety, I highly recommend going to healthychildren.org. This website is a parent friendly site that gives recommendations from the American Academy of Pediatrics and offers information on everything child safety seat related including car seat types, general safety guidelines, handy car seat installation tips, answers to common questions, things to consider when car seat shopping, airbag safety, and airplane safety.

RESOURCES

American Academy of Pediatrics. (2020, June 17). Car Seats: Information for Families. Retrieved September 4, 2020, from https://www.healthychildren.org/English/safety-prevention/on-the-go/Pages/Car-Safety-Seats-Information-for-Families.aspx

Car Seat Safety Tips. (n.d.). Retrieved September 4, 2020, from https://www.safekids.org/car-seat

Centers for Disease Control and Prevention. (2019, September 13). Child Passenger Safety: Get the Facts. Retrieved September 4, 2020, from https://www.cdc.gov/motorvehiclesafety/child_passenger_safety/cps-factsheet.html

Centers for Disease Control and Prevention. (2020, September 22). Child Passenger Safety. Retrieved October 13, 2020, from https://www.cdc.gov/injury/features/child-passenger-safety/index.html

Devitt, M. (2018, September 21). AAP Updates Car Safety Seat Recommendations for Children. Retrieved September 4, 2020, from https://www.aafp.org/news/health-of-the-public/20180921kidscarsafety.html

US Department of Transportation: National Highway Traffic Safety Administration. (n.d.). Keeping Kids Safe: A parent’s guide to protecting children in and around cars. Retrieved October 13, 2020, from https://www.nhtsa.gov/sites/nhtsa.dot.gov/files/documents/13237-parents_guide_playing_it_safe_tagged.pdf

Safe to Sleep Campaigns – Reducing SIDS/SUIDS through Education

By Dena Pepple, R.N. for Community Choice Pediatrics

I love my job! Every day I get to come to work and help take care of newborn babies. I talk to parents during their pregnancies and follow them for two months after their babies are born. I welcome these babies and their families to our practice, answering their questions and concerns. Some days, I make 40-50 of these phone calls, laughing with, comforting, educating, and empathizing with our new parents. One call that I rarely make (thank heavens) is a condolence call to parents of babies who have died of Sudden Unexplained Infant Death (SUID). These calls are difficult… to say the least.

I am not writing this to chastise these parents or any parents who have lost a child. Whether the cause is an accident or illness, preventable or not, I know firsthand that their grief is punishment enough. I am writing this to offer empathy and support to these parents and remind everyone how important the SAFE TO SLEEP CAMPAIGN is. My hope is to raise awareness so we can decrease and eventually eliminate these deaths altogether.

Safe to Sleep Campaigns

Baby SleepingIn the early 1990’s, research began showing that a baby sleeping on his/her back, alone, in a firm, flat, empty crib is the safest place for a baby to sleep. The BACK TO SLEEP/SAFE TO SLEEP CAMPAIGNS have kept us up-to-date on safe sleeping for our babies. The incidence of SUIDS (this includes SIDS, and sleep accidents) has decreased almost 50% since the early 1990s in large part due to these guidelines. The bad news is that almost 45% of that decrease happened in that decade. Since 1999, we have only seen about a 7% drop in death events.

Per HealthyChildren.org, more than 3,500 babies still die in the United States each year due to SUID.

Several parent surveys give a glimpse into why this happens. In one survey, 78% of moms of infants said they fear SIDS, yet 28% of these parents put their baby to sleep on their stomach, and 65% shared a bed with their baby. In another study, 96% of the parents had been told a baby should sleep alone, on his/her back in a crib, yet only 66% agreed with that recommendation. There are a variety of reasons for this: tired or over-exerted parents, traditions (grandma put her babies to sleep on their tummies), inadequate education, or other fears. Regardless, we MUST do a better job with education and implementation of SAFE TO SLEEP!

Safe to Sleep Guidelines

These SAFE SLEEP GUIDELINES per the American Academy for Pediatrics should ideally be addressed at every newborn/infant well visit:

  1. ALWAYS PLACE BABY ON HIS/HER BACK FOR ALL SLEEP TIMES
  2. USE A FIRM, FLAT SLEEP SURFACE
  3. KEEP SOFT OR LOOSE OBJECTS/BEDDING OUT OF BABY’S SLEEP AREA
  4. SHARE A BEDROOM WITH THE BABY, NOT A BED (ABOUT 130 BABIES DIE EACH YEAR FROM BED SHARING)

Baby SleepingOther recommendations that may reduce the incidence of SUID include using a pacifier, fan in the room, breast-feeding the baby, avoiding tobacco smoking during and after pregnancy, and not using commercial products that claim to reduce SUIDs but are inconsistent with the safe sleep guidelines above.

Besides ongoing education of our parents, grandparents, childcare providers, etc., there is one more vital thing we can do. We can support the new parents.

Supporting New Parents

Whether it is your relative, neighbor or friend, offer your time to watch the baby, make a meal, run an errand, or mow the lawn. This may give mom or dad the extra nap they need to make it through another fussy night.

I talk to new parents daily and tell them it is okay not to be the “hostess with the mostess.” (I do actually say those words!) If baby is asleep, it is okay to tell your visitor this is not a good time for a visit so parents can get a nap too. If baby is awake, I tell parents to hand the visitor the baby and go take a nap. Baby is number one, but helping mom and dad is huge in taking care of number one!

Lastly, we must show compassion to parents who have lost babies due to SUIDs.

Unfortunately these deaths happens across all walks of life, from the pediatric cardiologist who started CHARLIE’S KIDS FOUNDATION and tells his story globally after he fell asleep on the couch trying to soothe his newborn back to sleep, to the young parent who was afraid their baby would choke if he was laid flat on his back. Rather than judge these grieving parents, we need to support them during their grief, and continue our education efforts. Every sleep time counts!

So, do I still love my job? Of course, I do! I am here for all our new parents, whether in sorrow or joy, need or support. However, I much prefer the call that starts out, “Hi, this is Dena, just checking on that beautiful baby.” I want to eliminate the phone calls that start out, “This is Dena, and I am so sorry………!”

Working together we can do just that!

Protect Your Child With The Flu Vaccine

Kelly Fritz, C-P.N.P.By Kelly Fritz, C-P.N.P. with Community Choice Pediatrics

The leaves are turning colors, the air is cooler, and football has started. What time is it?  It’s time to get your flu shot.

While researchers are racing to create a vaccine for COVID-19, there is already a safe, effective way to protect children and adults from another common and unpredictable infection–INFLUENZA. Many people don’t know that Influenza can cause mild illness as well as severe illness even death. There is concern more this fall than ever before about the health of our children and their families because of the simultaneous circulation of these two potentially deadly viruses in our communities.

CDC Flu Report

If the COVID-19 virus transmission remains high this fall in our communities,  health officials caution that our hospitals and emergency services could rapidly exceed capacity. The Centers for Disease Control and Prevention (CDC) issued a final flu report that 166 children and teens under 19 died of complications from influenza over the past flu season. Usually, about 80% of those children who die are not vaccinated. Antiviral medications are useful in the treatment and control of influenza but are not a replacement for the influenza vaccination.

A common misconception many people have is that the flu shot can give you the flu. Influenza vaccine cannot cause flu illness.

Flu Shot - Vaccinate!According to the CDC,  flu shots are made in two ways: the vaccine is made either with a) flu vaccine viruses that have been killed (inactivated) and are therefore not infectious, or b) this involves inserting the DNA encoding an antigen protein that stimulates an immune response into the cells, expressing the antigen in these cells and then purifying it from them.

Nasal spray vaccine is made with attenuated (weakened) live flu viruses, and also cannot cause flu illness. The weakened viruses are cold-adapted which means they are designed to only cause infection at the cooler temperature found within the nose. The viruses cannot infect the lungs or other areas where warmer temperatures exist.

Potential Flu Shot Side Effects

While the flu vaccine cannot cause you to get flu illness, there are some side effects that may be associated with getting a flu shot or a nasal spray flu vaccine. Usually, these possible side effects are mild and short-lasting, especially when compared to symptoms of a bad case of the flu. Some minor side effects from the flu shot that may occur are: soreness, redness, and/or swelling where the shot was given, headache, fever (low grade), muscle aches, nausea, fatigue. In children, some side effects from the nasal spray may include: runny nose, wheezing, headache, vomiting, muscle aches, fever (low grade). Just like with any immunization, there are potential side effects one might experience.

There are several different flu viruses and they are constantly changing.

Flu Season AheadThe composition of the flu vaccine is reviewed annually and updated as needed to match the predicted most common circulating flu viruses. For this reason. the American Academy of Pediatrics (AAP) recommends yearly that everyone over 6 months old be vaccinated against the seasonal flu viruses. Vaccination is the best thing you can do to protect your child and yourself. Also by maintaining COVID-19 precautions, including social distancing , face masks, and frequent hand washing or hand sanitizing, risks of infections and spread of illness to others will be reduced.

Therefore, when you see the leaves start to turn those fall colors, notice the weather is cooler, and “Go Chiefs” is heard throughout KC, it’s time to vaccinate for the flu!

COVID-19 and GRANDMAS and SCHOOL, OH MY!

By Dr. Marquelle Dean and Dena Pepple, R.N. for Lee’s Summit Physicians Group

COVID-19 AND GRANDMAS AND SCHOOL, OH MY!COVID-19, Grandmas and Schools. What do these three things have in common you ask? Besides questions about the disease COVID-19 itself, two of the most frequent questions we’ve been asked this summer about COVID-19 are: Should I let grandma (relative, friend, etc) near the baby? And should I send my kids to school?

These are certainly valid concerns, especially in our media overloaded world for parents who are trying to do what’s best for their children. The bad news is that there’s no absolute or “crystal ball” to tell us what will happen. The good news though, is that we do know the statistics on the children who do get COVID-19. We also know what to do to minimize the risk of contracting COVID-19 in the first place.

Dr. Angela Myers, Children’s Mercy Hospital Infectious Disease Specialist states, “recent data have shown that SARS-CoV-2 (COVID-19) transmission among children is low, children are not the main drivers of this disease.” As of 8/7/2020, Children’s Mercy Hospital (CMH) had tested 10,748 patients with 345 testing positive. This means that only about 3.4% of those tested were positive. According to a joint report from the Children’s Hospital Association and the American Academy of Pediatrics, as of July 30, 2020 about 8.8% of total confirmed COVID-19 patients are age 0-19 years. For those under 19 years who do test positive, symptoms are usually mild.

The risk of COVID-19 infection may never be zero, however there are some things we can do to slow or prevent the spread of this disease right now.

Preventing and Slowing the Spread

  1. Wash hands frequently for 20-30 seconds per washing
  2. Wear a mask at all times in public places if 2 years of age or older
  3. Social distancing – stay at least 6 feet apart
  4. Avoid anyone who is sick, has had a positive COVID-19 exposure or is positive with COVID-19
  5. 14 day quarantine – the incubation period for COVID-19 is up to 14 days, this can be a guideline for parents considering a visit from outsiders

Question 1: Can grandma visit the newborn or grands?

COVID-19 AND GRANDMAS AND SCHOOL, OH MY!The answer here is a big fat MAYBE! Parents can ask themselves several questions… Does grandma follow the guidelines listed above? Is grandma’s and/or baby’s health at risk? (breathing issues, cancer, preemie, NICU, etc.) Does the parent NEED the grandma or other helper near? (parent health issues, older siblings, other parent deployed, etc.) Every situation is different, and you as the parent have every right and responsibility to protect your child.

Caitlin Rivers, PhD, epidemiologist at John Hopkins Center for Health Security states, “we are all going to have to start making these tough decisions based on our own risk tolerance and circumstance priorities.” Decide on your needs, priorities, and risks and you, the parent, ultimately decides.

If your answer is yes to grandma’s visit, everybody is happy… most of the time! (That was a joke!) But what if your answer is no? That is OKAY as well. Grandmas and others need to be respectful and supportive of your decision to protect your children. They may not like it, but in today’s world of technology, they can still get their grandma fix.

FaceTime, Skype, and Zoom calls can offer face to face and voice to voice contact. Grandparents and grandchildren can meet outdoors. Six feet apart may not put that baby in your arms, but it’s still a great view! For older grandkids, a social distance walk, parade, phone calls and writing letters are great options as well.

Dr. Angie Myers states, “It’s very important for kids to see their grandparents, but perhaps it is not the best time for hugs and kisses.” Air hugs and a little creativity can get us through this.

Question 2: Can Johnny go to school?

COVID-19 AND GRANDMAS AND SCHOOL, OH MY!The simple answer is YES! According to recent recommendations by both the American Academy of Pediatrics and local infectious disease experts at Children’s Mercy Hospital, schools in Missouri and Kansas should reopen. Why? Because not being in school is riskier for most kids than the Coronavirus (COVID-19).

According to the CDC, the current evidence indicates that children and adolescents are less likely to be symptomatic and less likely to have severe disease from Coronavirus (COVID-19) infection. The AAP statement in support of school opening states, “Schools are fundamental to child and adolescent development and well-being and provide our children and adolescents with academic instruction, social and emotional skills, safety, reliable nutrition, physical/speech and mental health therapy, and opportunities or physical activity, among other benefits.”

There, of course, will be extra precautions required to make sure it is a safe and successful return to school.

Extra Precautions

Handwashing

Handwashing should be done often and for at least 20 seconds, this can help to remove any germs that could contribute to infection when kids touch their face, nose and mouth. We know the virus is primarily transmitted by respiratory droplets, but other than the air, our hands are a primary source of respiratory droplet contamination!

Social distancing

Desks should be spaced 6 feet apart, congestion in common spaces such as entryways and hallways should be minimized so kids can maintain a 6 foot distance as much as possible. Parents and visitors should be discouraged from entering the building to help accommodate the physical distancing measures.

Face masks

Face masks are a safe and effective way to slow the spread of the virus. Schools should follow the CDC guidelines for face masks.

Cohort groups

Cohort classes helps to minimize crossover among children and adults within the school. In addition, schools should be in close communication with state and/or local public health authorities and develop adaptive strategies to address the level of local viral transmission in their community.

The one constant with COVID-19/Grandmas/School is that we need to stay as updated as we can on this disease and make the best decisions for our children with that information. This can change daily depending on our family needs, research, and COVID-19 statistics. (Where is that “Crystal Ball” when you need it?!!) The CDC and Children’s Mercy Hospital are great resources for you.

At Community Choice Pediatrics (formerly Lee’s Summit Physicians Group, Raintree Pediatrics, and Blue Springs Pediatrics) are here to help too. This season will pass, but the more we can do now to promote healthy children, a healthy community and family peace, the easier this crisis will be on all of us.

Happy 4th of July! Let’s talk about Summer Safety.

Robin Dyson, M.D.By Robin Dyson, M.D. at Lee’s Summit Physicians Group

Covid-19 is throwing this summer for a curve. Family trips, baseball games, amusement parks, local hangouts, and even public pools are either closed or limited access. Trying to find creative ways to enjoy this time off can be challenging. But it definitely has slowed the pace of life and reduced the stressful rush of having a zillion things scheduled and little time to get them all done. As a Pediatrician, I’m always concerned with keeping my patients safe while they enjoy being kids.

The number one killer of children is unintentional injury and some of our favorite summer activities top those lists:

Motor Vehicle Accidents

Summer SafetyWho doesn’t love a good summer vacation road trip, or just a visit to your local custard stand? Babies and toddlers have a larger head-to-body ratio which means that when forward facing, that bigger head can cause more head and neck injuries. So keep those littles facing back for as long as possible and make sure their straps are fitting correctly. My 2 year and older children need those 5-point harnesses to keep them safely strapped in, and my elementary kiddos need booster seats to make sure the shoulder strap doesn’t wrap around their neck and strangle them in accidents.

Kids should sit in the back seat until at least 13 years old due to the hazard of air bags which can cause crush injuries. Kids should know to stay strapped in the entire time the vehicle is in motion. Parents, please be defensive drivers and try not to be too distracted by the kids. Being an occupant in a motor vehicle is the leading cause of injury death in kids 5-19 years of age!

Pedestrian and Bike Accidents

Please teach your children to be safe on their bikes and in the roads and parking lots. Children should wear helmets on bikes, scooters, trikes and other vehicles. This will help protect from brain damage. They need to ride safely and not out into traffic. In addition, teach kids to avoid running into the street after a toy/ball. They should not be playing in the street either. Parking lots are like streets, and drivers may not see a smaller child behind them—hold hands and do not let children run through parking lots.

 

Drowning

Summer SafetyMy favorite thing to do during the summertime when I was a child was swimming. Splashing around a cool pool on a hot summer day is the bomb, but not without risks. Little baby pools are a drowning risk and do not require a 4’ fence around them like other pools. This means that if they are left out, and a toddler sees some water in it (maybe after it rained, or it was not emptied after last time), then they might wander out to the pool unattended and potentially drown. In backyard pools, we need to make sure that kids are being supervised and don’t rough house or try to dive in a shallow pool.

Remember floaties and noodles and other inflatables are only toys. They do not teach our kids to be good swimmers—in fact they can hold children more upright (the drowning position) vs. horizontal (the floating position) which gives children a false sense that they are safe. Children are best with parents in the pool with them, helping them feel comfortable floating, getting their face under water and blowing bubbles, and learning to kick to the side to get out.  Certainly, everyone needs to be wearing a life vest on open water—even the best swimmers can die when knocked unconscious from falling off a water vehicle. Drowning is the leading cause of injury death in ages 1 to 4 years of age!

Suffocation

Although not necessarily seasonal, it’s worth talking about suffocation because it is the #1 cause of injury death in children less than 1 year old. Co-sleeping is a huge risk of suffocation for babies—which is why they need their own sleeping environment. Babies can’t always push themselves away from pillows, fluffy blankets, bumpers, and even the parent sleeping next to them on a couch or bed. Watch those lazy summer afternoon naps and evenings and put those babies in their own cribs please!

 

Burn Injuries

Summer SafetyWe’ll be celebrating our country’s independence with fireworks. And wouldn’t you know, kids get burned every year! Sparklers are the leading cause of injury. They should not be pointed at or touched to anyone else. Kids should not touch the burning end or they will hurt their fingers. And they should not be lighting them or playing with lighters and matches. Adults should make sure they are properly disposed of to avoid catching something/someone on fire.

Kids should also stay away from any of the other fireworks being lit—some of the rocket fireworks travel 150 miles per hour and can cause severe injuries. Many places recommend that kids should avoid playing with any fireworks altogether—doing glow sticks and watching professional fireworks displays instead.

And when discussing burns, don’t forget sunscreen! Skin cancer risk increases with each childhood sunburn.

Hope you all have a fun Summer this year, despite restrictions, and BE SAFE out there!

The Dreaded Pink Eye

Bryan L. Phillips, M.D.By Bryan Phillips, M.D. for Lee’s Summit Physicians Group

What is pink eye?

In medical lingo it’s called Conjunctivitis. Pink eye is a broad term – pretty much anything that turns your eye pink. It could be viral, bacterial, allergic, chemical or mechanical (getting poked in the eye). Today we’ll focus on allergic, viral & bacterial causes.

Allergic

Allergic is more common in the warmer months. It will cause a pink to red eye with watery to mucousy discharge. The hallmark of allergic conjunctivitis is that it’s itchy! It can be treated with oral antihistamines (Claritin, Zyrtec), nasal steroids (Flonase) and/or eye drops (patanol, zaditor). Trying to avoid the thing you’re allergic to is useful too, if possible.

Viral

Viral conjunctivitis looks a lot like allergic but is not itchy. It is usually without other eye symptoms or maybe a gritty sensation in the eye. A clue to this type of Conjunctivitis is that it often accompanies uri (cold) symptoms (runny nose, cough, maybe a fever). It can be one or both eyes. You may have a fair bit of dried discharge gluing the lashes together in the morning. The watery discharge can also cause chapping around the eye from being wet all day. Both of these problems can be helped by putting Vaseline on the eyes a couple times a day. This will protect the surrounding skin and stop the discharge from gluing the lashes together – a quick wipe with a wet cloth in the morning and you’re good to go.

Bacterial

Bacterial conjunctivitis is often isolated (no cold symptoms) and the discharge will tend to be more purulent (green or yellow, thicker) – sometimes it looks like the child is crying pus. It can look bad but doesn’t cause the child much discomfort. The eye may be glued shut in the morning as in the viral description above. In spite of the daycare & schools being alarmed, this is not very worrisome outside of the newborn period. There really aren’t any common complications and the symptoms will tend to resolve spontaneously in a few days (no more than 5-7 days). You can treat as viral above.

The role of eye drops for pink eye is a lot more fraught than years ago.

Pink Eye EmojiThere really isn’t much evidence that antibiotic drops do much – either shortening the course of the illness or making it less contagious. The downside to the drops is expense (they aren’t cheap!), they can actually cause irritation to the eye, and even more worrisome, they have been linked to the increase of MRSA (methicillin resistant staph) in the community. Apparently a round of antibiotic eye drops increases the risk of your nose being colonized with MRSA for a few weeks.

With weak evidence of any benefit but definite downsides to treatment for a mild self-limited illness, it is not wise to prescribe antibiotic eye drops for routine pink eye.

Good handwashing & some Vaseline on the eyes before bed is really all that’s required. I would only recommend an office visit if you are worried about other symptoms – like ruling out an ear infection or pneumonia, especially in light of the COVID-19 situation. I often still have to write a note for daycare or school to avoid the child being excluded – basically explaining pink eye is generally part of a simple cold and can be treated as such.

Reference: 2013 AAP managing infectious ds in child care & schools, quick referral guide, 3rd edition

Congenital Heart Defect Awareness: Izzy B’s Story

By Abbie Engelhardt, R.N. for Lee’s Summit Physicians Group

This is a personal story about my niece and congenital heart defect awareness. I wanted to share this story to raise awareness… congenital heart defects week is February 7- 14. 

My sister, Lori and I were both going to blessed with baby girls around the same time, how exciting!

Everything seemed to be fine.

Isabella RoseMy beautiful niece, Isabella Rose (aka Izzy B), came early at only 33 weeks, born on September 17, 2009. She weighed 3 lbs 6 oz. I visited her in the NICU before leaving for a cruise and she was doing well.

Upon returning to American soil a few days later, I had heartbreaking messages from my family. Isabella was diagnosed with a congenital heart defect called Hypoplastic Left Heart Syndrome (HLHS).

She now had 3 options.

1. Comfort care.
2. A series of three heart surgeries to correct the defect.
3. A heart transplant.

This was devastating news. She was only 13 days old when it was discovered.

At that time, there was no cardiac screening for newborns.

Luckily, she was premature and being monitored in the NICU or she would’ve died before they found out she had HLHS.

Beginning January 1, 2014, Chloe’s law came into effect, which required all babies in Missouri to have mandatory screening for critical congenital heart disease (CCHD).  CCHD screening is a simple bedside test to determine the amount of oxygen in a baby’s blood. Low oxygen levels can be a sign of CCHD. The test is done using a machine called a pulse oximeter. It’s painless and takes just a few minutes.

Isabella’s parents chose the surgical route.

Since she was so tiny, she spent three months in the NICU at Children’s Mercy with a feeding tube to help her gain weight. She needed to gain weight before she could have her first surgery. She had to be 7 lbs before they could do the Hybrid Norwood procedure. Surgery was done on December 9th, 2009 and everything went well. We spent the day in the Ronald McDonald room, which is a huge blessing for families. She spent about two weeks on the vent while her body rested and recovered, she came off it on Christmas Eve.

Isabella Rose and AddilynnThere were setbacks, but she finally made it home for the first time in January 2010, just days after I had my baby girl, Addilynn. The girls met and bonded (as much as infants bond.)

Isabella’s family tried to have some normalcy, which was hard with numerous appointments (at Lee’s Summit Physicians Group and Children’s Mercy), home health, feeding tubes, medications, etc. She was a fighter, and continued to grow and make an impact on those around her.

She was able to go on vacations, go to the zoo, try ice cream for the first time (her dad snuck it to her) and get some snuggles. She was spunky. I’ll never forget the sound of her cry. We enjoyed watching the girls play together (they loved their Johnny Jumpers), along with their cousin, Blake, who was glad he was no longer the only grandchild.

Another Surgery

Time went by and the second surgery was booked for July 6, 2010. It was scary leading up to surgery as you never know what the outcome will be. We soaked up every moment we could with her. This surgery is called the Hybrid Glenn and is an open heart surgery. We again spent the day in the Ronald McDonald room waiting for updates.

Isabella Rose

Isabella made it through surgery but had some rough moments. After surgery, she wasn’t tolerating movement, her oxygen was lower than they wanted, and her heart rhythm was more irregular. Over the next few days, while her chest remained open, they made more adjustments. She was so swollen. On July 15, 2010 I got a call that she was crashing. The rest was a blur.

We all headed to the hospital. When we arrived, they said she was stable on ECMO (life support). Their plan was to keep her on ECMO for a few days to let her body rest. While she was lying there struggling, my daughter was winning a baby contest at the Cass County fair. It was so hard to be happy for my daughter and glad that she was healthy while Isabella wasn’t. They were supposed to be healthy and grow up together.

On July 19, 2010 they began to wean Isabella from ECMO. They were able to get her completely off ECMO on July 21st at 9:47 a.m. They said she was doing well. Later that evening, my sister and her husband went to the cafeteria for a brief time. When they came back to the PICU, they were coding Isabella. Her sweet little body couldn’t take it anymore. She earned her angel wings on July 21, 2010.

We all held her and cried. It was too soon. She was only 10 months old, but her story doesn’t stop there. She touched so many lives in her short time on earth. She will always be remembered, and I’m so thankful that more people are becoming aware of Congenital Heart Defects. There has been more than a 33% decline in infant deaths from states mandating screening. And as of 2018, all US states have policies supporting newborn screening for CCHD.

Fly high Izzy B! You will always be loved and missed.

Isabella Rose

 

More Information on HLHS

HLHS is a birth defect that affects normal blood flow through the heart. As a baby develops during pregnancy, the left side of the heart does not form correctly. It affects a number of structures on the left side of the heart that do not fully develop.

For example:

  • The left ventricle is underdeveloped and too small.
  • The mitral valve and/or aortic valve is not formed or is very small.
  • The ascending portion of the aorta is underdeveloped or is too small.

The CDC estimates that each year 1,025 babies in the United States are born with HLHS. In other words, 1 in every 3,841 babies born in the US annually is born with HLHS.

Hypoplastic left heart syndrome, along with other CHDs, are a hidden condition and most kids look completely healthy.

As I mentioned previously, cardiac screening is simple and inexpensive. If the results are negative, the baby’s test results didn’t show signs of CHD. This type of screening doesn’t detect all CHDs, so it’s possible to still have a CHD with a negative screening result.

If the results are positive (fail or out of range), it means that the baby’s test results showed low levels of oxygen in the blood, which can be a sign of CHD. This doesn’t always mean that the baby has a CHD, it just means that more testing is needed.

Pulse oximetry screening is most likely to detect seven specific CHDs.

These include:

  • Hypoplastic left heart syndrome
  • Pulmonary atresia
  • Tetralogy of fallot
  • Total anomalous pulmonary venous return
  • Transposition of the great arteries
  • Tricuspid atresia
  • Truncus arteriosus

Resources:

Car Seat Safety: Protecting Your Precious Cargo

By Abbie Engelhardt, R.N. for Lee’s Summit Physicians Group

Our children are our greatest blessings, so we need to keep them safe. Car seat safety is a great place to start.

Specifications for your car seat and state car seat laws are thing every parent must know. Laws, like anything else, do change over time, so it’s important that you’re up-to-date on the current laws in the state of Missouri.

Current Missouri Car Seat Laws

  • Children under the age of 4 or that weigh less than 40 pounds must be placed in an appropriate child safety seat.
  • Children ages 4-7, or that weigh less than 80 pounds, must sit in an appropriate safety or booster seat unless they are taller than 4’9” or over the weight limit.
  • All children over the age of 8, that weigh at least 80 pounds, and are at least 4’9” tall must be secured with a safety belt at all times.

Car Seat Safety: Protecting Your Precious Cargo

Types of Acceptable Restraints for Children in Missouri

  • Rear-facing seats – This type of child safety seat has the child restrained and turned to face the rear of the car. This type of safety seat provides head, neck, and back support. This will also reduce stress to the infant’s body in the event of a crash. These are often “infant-only” seats. These are used for children that are less than a year old and weighing less than 20 pounds.
  • Forward-facing seats – As the name implies, these safety seats have the child facing towards the front of the car. They are designed for toddlers that are at least 1 year old and 20 pounds.
  • Convertible seats – This is a type of safety seat that can be converted from a rear-facing seat for infants to a forward-facing seat for older or larger children. You change the type of seat when the child reaches a year old and over 20 pounds.
  • Booster seats – This type of seat, as the name implies, gives the child a boost so that they can be in the right position to wear a seat belt. The booster seat must be low enough to allow for the seat belt to fit snugly across the hips, shoulders, and chest, without resting against the face or neck, which can be dangerous. These are for children that are between 40-80 pounds and under 4’9”.
  • Safety belts – this is what older children and adults must rely on for car safety. Missouri has strict seat belt laws to help ensure that both children and adults are securely held in their seats. This type of restraint is used for children that weigh more than 80 pounds and are above 4’9” tall. Children 12 and under should always be buckled into the back seat of the car.

Penalties

Car Seat Safety: Protecting Your Precious CargoThese laws are in place to help ensure the safety and security of children riding in motor vehicles. Failure to properly restrain your child can have negative legal consequences. In Missouri, parents can face fines of $50 for failure to properly comply with car seat laws. In many cases, charges will be dropped if the parent shows that they have obtained a proper car seat for the child.

Proper Safety Seat Usage

Proper use of the safety seat is imperative for it to do its job properly. You need to make sure the safety seat is NOT placed in front of an airbag. And you need to make sure the car seat is tightly secured and anchored in place. The child must ALWAYS be buckled into the car seat.

Make sure you use the proper safety seat for the age, height, and weight of your child. One common mistake is putting a child that is too small in a front-facing seat or putting a child who is too big into a car seat that is meant for a smaller or younger child.

Infants should never ride in a forward-facing seat.

Bulky outerwear and blankets can prevent harness straps from snugly securing your child. Buckle the harness, and then place a coat or blanket over the harness to keep your baby warm. Only use aftermarket covers, essentially fitted blankets, designed to give additional warmth that are approved by the car seat manufacturer for your specific car seat. Such covers have been tested with the seat and won’t compromise your child’s safety.

For a bigger child, after securing him or her into the car seat, turn the coat around and put it on backward (with the arms through the armholes), so the back of the coat serves as a blanket resting on the top of the harness.

If you’re considering a used car seat for your child, make sure it comes with instructions and a label showing the manufacture date and model number. Make sure it hasn’t been recalled, isn’t expired or more than 6 years old and has no visible damage or missing parts. Confirm that it has never been in a moderate or severe crash. If you don’t know the history of the seat, don’t use it.

References

 

Happy Spitter or Acid Reflux?

Lisa B. Fletcher, M.D.By Lisa B. Fletcher, M.D. with Blue Springs Pediatrics

As an expectant parent, we envision a beautiful, chubby, happy bundle of love that nurses every 3-4 hours and sleeps and smiles in between. And then they start puking on you!!! What’s this you ask? It’s making you smell sour and exponentially increasing your laundry efforts. Though your pets might appreciate it, every parent just wants it to stop! WE DO TOO!!!

Pediatricians are commonly asked about spitting up in newborns and infants.

This is probably one of the most common problems we evaluate in this age group. It’s a problem that can cause a lot of parental distress. So what are the differences in a child with simple spitting up, GER: gastroesophageal reflux, and a child who actually has GERD: gastroesophageal reflux disease? Let’s discuss the characteristics of both.

GER

This is the passage of gastric contents into the esophagus and is a normal physiologic process that occurs in healthy infants, children, and adults. Most episodes are brief and do not cause symptoms or esophageal injury or result in other complications.

GER is extremely common in healthy infants. Studies show that stomach contents may reflux into the esophagus 30 or more times daily in infants. Many, but not all, of these reflux episodes result in spitting up or vomiting. Studies show that 50% of infants birth to age 3 months reflux, 60% of infants 4 months of age reflux, and 20% of infants age 6-7 months reflux. GER decreases near the end of the first year of life and is not common in children over 18 months of age.

GERD: Happy Spitter or Acid Reflux?

So, when your read the results of these studies you realize that you are not alone in your experience! Many parents have lived through the same thing.

GERD

In contrast, gastroesophageal reflux disease (GERD) occurs when the reflux episodes are associated with complications such as esophagitis or poor weight gain. The range of symptoms and complications of GERD in children vary with the age of the child. The evaluation of an infant with frequent regurgitation focuses on determining if an underlying disease is causing the symptom and/or if the reflux is causing secondary complications.

To generalize: the baby with true GERD is having bad heart burn all of the time. It hurts to eat, and it hurts when they spit up. Sometimes these babies have other special health circumstances: prematurity, genetic abnormalities or anatomic differences. These are things we are looking for to determine if the baby is at risk.

Common complications include the following:

  • Irritability
  • Poor weight gain
  • Recurrent pneumonia
  • Barrett’s esophagus (inflamed distal esophagus)
  • Esophageal Stricture

So how can we tell which diagnosis is correct?

Uncomplicated GER can be diagnosed in infants who have no warning signs, good weight gain, feeding well, not unusually irritable, and have a normal physical examination. Most infants presenting with frequent GER will fall into this category; they are sometimes referred to as “happy spitters.” The history and physical examination usually are sufficient for establishing the diagnosis, and specific laboratory testing is not required.

Some of the Warning Signs that would trigger further investigation are as follows:

  • Nonspecific symptoms
    • Prolonged vomiting
    • Profound lethargy
    • Significant weight loss
  • Symptoms of gastrointestinal obstruction or disease
    • Vomiting bile
    • Projectile vomiting in an infant three to six weeks of age
    • Bloody vomiting
    • Rectal bleeding
    • Significant abdominal bloating and tenderness
  • Symptoms or signs suggesting a brain abnormality or systemic disease
    • Bulging fontanel
    • Headache, positional triggers for vomiting or vomiting on awakening
    • Altered consciousness, seizures, or focal neurologic abnormalities
    • History of head trauma

Evaluation of the infant with Warning Signs

Depending on the history and physical exam, evaluations could include radiographic imaging, blood work, and referrals to different pediatric specialists.

Treatment of GER

Lifestyle measures that may be helpful include feeding breast milk as much as possible to infants who are fed both breast milk and formula, avoiding tobacco smoke, and avoiding overfeeding. Other conservative measures to improve the symptoms that may be worthwhile include a trial of thickened feeds, upright positioning after feeds, or a limited two-week trial of a hypoallergenic diet (intolerance of cow’s milk or other dietary protein may have similar symptoms).

Pharmacotherapy is not indicated for infants with uncomplicated reflux (GER) based on lack of efficacy and several safety concerns. Studies show that acid-suppressing medications are not effective in infants for treatment of symptoms such as regurgitation and irritability. Even in infants with frequent regurgitation, prone positioning for sleep is not recommended, because of an increased risk for sudden infant death syndrome (SIDS).

Treatment of GERD

GERD: Diet mattersAvoidance of cow’s milk and soy protein: Food protein intolerance (typically to cow’s milk) sometimes has a clinical presentation that mimics GERD. Breastfed infants can be treated with careful elimination of all cow’s milk proteins and beef from the mother’s diet. Major sources of soy protein may need to be eliminated as well.

In formula-fed infants, we suggest switching to an extensively hydrolyzed formula. If there is a strong suspicion of a food protein intolerance (because of bloody stools or symptoms of eczema) and the infant does not respond to a hydrolyzed formula, a trial of an amino acid-based (“elemental”) formula or elimination of other dietary proteins may be necessary.

Infants who respond to the dietary change are generally maintained on a milk-free diet until one year of age, at which time many (although not all) infants will have become tolerant to the protein. Infants who do not respond to dietary restriction initially may respond to a trial of other lifestyle changes as outlined below.

Thickening feeds – A trial of thickening feeds is worthwhile for most infants with problematic reflux, except perhaps in infants who are preterm or overweight.

Positioning therapy – Keeping an infant upright (on a parent’s shoulder) for 20 to 30 minutes after a feed seems to reduce the likelihood of regurgitation

Pharmacotherapy  – Acid-suppressing medications are indicated in the following situations:

A limited trial of acid suppression (e.g. two weeks) is recommended for infants with mild esophagitis on endoscopic biopsies in addition to the lifestyle changes described.

A three- to six-month course of acid suppression for infants with moderate or severe esophagitis documented by endoscopic biopsies, in addition to the lifestyle changes described.

Medicines used for GERD

  1. Proton pump inhibitors: PPI’s are drugs that decrease acid production in the stomach by inhibiting the proton pump in the stomach.The PPIs omeprazole, lansprazole, esomeprazole and pantoprazole have all been studied in young children. Omeprazole and esomeprazole are approved by the FDA for use in infants older than one month of age with erosive esophagitis. However, there are safety concerns about the use of PPIs. These include short-term acid rebound after stopping the drug and increased risks for diarrhea, and possibly pneumonia.In addition, a large study found an association between the use of acid-suppressing medications (H2RAs or PPIs) in young infants less than six months old and later development of allergic disease. Moreover, there are theoretical reasons to consider vitamin B12 and iron deficiency in children chronically taking PPIs. Finally, studies in adults have raised theoretical concerns that long-term use of PPIs may be associated with increased risk for osteoporosis.
  1. Histamine 2 receptor antagonists – H2RA’s are medicines that decrease acid production in the stomach by competitively binding a histamine receptor. This includes Axid, Pepcid, Tagamet, and Zantac. H2RAs are a reasonable alternative to PPIs for a short-term trial of acid suppression. They are less effective than PPIs in reducing gastric acidity but more effective than placebo. The safety concerns mentioned above also apply here.
  2. Antacids – Antacids are alkaline drugs that neutralize the acidic pH of the stomach. Antacids are not generally useful in the treatment of GER in infants. Chronic use of antacids in infants can be associated with aluminum toxicity, milk-alkali syndrome, or rickets and should be avoided.
  3. Prokinetic agents – Prokinetic drugs increase the speed at which food leaves the stomach. Prokinetic agents currently have a minimal role in the treatment of GER in infants.  The few prokinetic agents with any established efficacy also have significant safety concerns, including central nervous system side effects for metoclopramide and cardiac arrhythmias for cisapride, which resulted in its removal from the market in the United States and Canada.

Conclusions:

Reflux and vomiting are common occurrences in infants less than one year of age. This is a normal physiologic process that occurs in healthy infants. Most episodes are brief and do not cause symptoms or esophageal injury or result in other complications.

Increased research in the past decade has supported a more supportive approach to refluxing infants with no warning signs. Infants with warning signs may need a more in depth evaluation with radiography, lab studies, and a referral to the appropriate pediatric specialist. Lifestyle changes, avoidance of cow milk and soy proteins in the infant’s diet, thickening of feeds, and positioning after feeds are safe and been shown to offer significant improvement in symptoms.

Studies on pharmacotherapy, (PPI’s and H2RA’s), have identified associated complications and side effects which has led to more vigilant stewardship of their use.

The take home message is if your baby is growing well and reasonably happy, then avoiding medicine is the goal. Ultimately, we are trying to help this baby grow into the strongest, healthiest, smartest, happiest, most successful and independent adult possible with no late effects of medicine that we may not have needed to use. In the practice of medicine, symptoms often require less intervention and I believe this is a good example.

So here’s to smelling like sour milk, wearing baby puke to work like a badge of honor, surviving the mountain of laundry, and knowing that after they turn a year you will be home free… or at least done with the reflux and on to other toddler adventures!!!

What you need to know about RSV – Respiratory Syncytial Virus

Amanda Martin, M.D.

Amanda Martin, M.D.

By Amanda Martin, M.D.

What is RSV?

Respiratory Syncytial Virus (RSV) is a common lower respiratory infection. In infants and toddlers, it causes bronchiolitis, which is swelling and mucous production of the small airways in the lungs, or pneumonia. In infants and toddlers, the most common symptoms are cough, runny nose, difficulty breathing, and fever. In rare cases, it can cause apnea (not breathing for more than 15-20 seconds).

RSV can be particularly dangerous for very young infants or infants and toddlers with underlying medical problems such as chronic lung disease, congenital heart disease, born before 35 weeks, or conditions causing them to have a weakened immune system. It is possible (and likely) to get RSV multiple times during your lifetime; but the good news is, repeat infections are usually not as severe. In healthy older children and adults, RSV often causes cold-like symptoms. RSV most often occurs from October to February.

How is RSV spread?

RSV is spread by bodily secretions (snot, saliva, or coughing) from someone with the virus or objects contaminated with the virus coming into contact with the eyes, nose, or mouth. RSV can survive for several hours on your hands or objects, so hand washing is very important to prevent spread.

Can RSV be tested for?

RSV - Respiratory Syncytial VirusThere is a test available for RSV. However your provider may not recommend that the test be performed, as bronchiolitis is diagnosed by the symptoms your child is having and how their lungs sound during the exam. Since there is no medication to treat RSV, whether your child has bronchiolitis due to RSV or another virus, the test would not change the treatment.

My child was diagnosed with bronchiolitis (caused by RSV or another virus). What now?

Take a deep breath. You will probably get even less sleep than usual, but most infants and children will do fine at home and do not need to be hospitalized. Younger babies breathe through their nose, unless they are crying.

With bronchiolitis, a lot of times there’s a lot of snot in the nose, and suctioning their nose with a bulb suction can help make it easier for them to breath and make them more comfortable. Most of the time when infants are sick, they eat less than usual, and it’s very important to make sure they stay hydrated. This can be achieved by feeding them more frequently. If they are not able to take formula or breast milk, then Pedialyte can be given in its place.

Since bronchiolitis is caused by a virus, there is no medicine that will help. The illness usually will last 7-9 days, with the worst occurring on or about day 5. The cough will often last for 2-3 weeks.

Important signs/symptoms to watch for

How hard your infant/child is working to breathe – When your infant/child is calm (not crying or running around) and the skin under their ribs, between their ribs or above their collar bone is going in and out with their breathing, their nostrils are flaring, or they are breathing more than 60 times a minute, then they are working hard to breath. Try suctioning out their nose and if their labored breathing does not improve, then they need to be seen right away by a health care provider.

Are they hydrated? – Ensure your infant/child has at least 3 wet diapers in 24 hours (about one every 8 hours). Other signs of dehydration include a sunken soft spot, crying without tears, and dry mouth. If there are any signs of dehydration, then they need to be seen by a healthcare provider.

Is their oxygen saturation normal? – When your infant/child is seen in our office, we will check their oxygen saturation. There are devices that can check it at home, but they are often not accurate and unless they are prescribed by a doctor, I would not recommend using them. If you check the oxygen saturation at home and it is less then 92%, then your child needs to be seen right away.

References

Piedra, MD, P. A. & Stark, MD, A. R. (June 12, 2019), Patient education: Bronchiolitis (and RSV) in infants and children (Beyond the Basics).
Retrieved from https://www.uptodate.com/contents/bronchiolitis-and-rsv-in-infants-and-children-beyond-the-basics/print

Barr, MD, F.E. & Graham, MD, PhD, B.S. (August 8, 2019) Respiratory syncytial virus infection: Clinical features and diagnosis.
Retrieved from https://www.uptodate.com/contents/respiratory-syncytial-virus-infection-clinical-features-and-diagnosis