Its approval by the FDA allows for a much easier treatment procedure. The nits (sacs that contain the eggs) are killed very effectively (ovicidal) and thus it appears that combing the nits out of the hair will not be necessary. Nit removal has been difficult for many parents and children, sometimes necessitating cutting the hair back to a significant degree. The other usual cleaning and disinfecting measures for clothing, linens and playthings are still required.

The other prescription treatments are: Malathion lotion (Ovide) and benzyl alcohol lotion (Ulesfia). These products eliminate live lice and are effective at eliminating the nits (eggs or ova) to varying degrees. Directions for proper use should be discussed, including the possible need for re-treatment in 9-10 days, to retreat any missed eggs and to prevent newly hatched lice from producing new eggs.

Over the counter treatments are pediculicidal (kill live lice) but are not ovicidal (unable to kill eggs). They are:

Pyrethrins (brands Rid, Triple X, Pronto and others) derived from the chrysanthemum flower and Permethrin lotion (brand Nix) a synthetic compound similar to the naturally occurring pyrethrin.

Re-treatment is always required in 9-10 days for these OTC products.

Cedar season is here, once again.  Swollen, itchy, runny eyes are common nowadays.  Sore throat and feeling achy and tired go along with all the immune stimulation from this  central Texas pollen.

Juniper (cedar) are widespread across the rocky central Texas area and can crowd out other more desirable trees and vegetation in the competition for water.  The male plant will release a cloud of reddish pollen when agitated.

It is a relatively large pollen, high in carbohydrate and low in protein, which causes so much irritation primarily of the upper airway.  Mold is also high right now and is responsible for both upper airway symptoms as well as wheezing and asthma.

The single best common sense approach is to thoroughly wash your face, particularly around the eyes and nose with soap and cold water for relief.  Wearing a mask makes a difference when going outside.  Pollen counts vary throughout the day based on wind, temperature and humidity but generally are higher in the morning. The season peaks in January every year.

Neilmed is a brand of nasal wash that works well in children and is available in all drugstores.  Sterile saline (salt water) should  only be used to avoid introduction of any infection from tap water.  The pressure required for the flush can introduce bacteria/parasites deeper into the nasal cavities.  OTC antihistamines can be used at bedtime and during the day if the symptoms are especially severe.

Prescription nasal steroids are very effective.  They help nose, throat and eye symptoms and even cough.  They are comparable in effectiveness to each other.  They can vary widely in cost depending on insurance tier pricing.  There is one generic, fluticasone.

There are eight food groups that are implicated in allergic  reactions (anaphylaxis) in children:  cow’s milk, peanut, egg, wheat, soy, tree nuts, fish, and crustacean shellfish. Crustaceans that  we eat are mainly shrimp, crab, lobster and prawn.  Many thousands of related species exist, however, in fresh and salt water.

What can Happen?

Food allergy most commonly involves reaction in the skin (hives), lungs (bronchial constriction), gastrointestinal (vomiting and diarrhea), and angioedema (swelling of the tissues under the skin).  The most frightening and increasingly common reaction involves angioedema/swelling of the throat and areas around the vocal cords.  Any facial, lip or tongue swelling, or hoarseness and loss of voice, are areas of greatest concern for possible airway obstruction.  This requires immediate treatment with epinephrine injection (epipen).

Treatment

Evaluation by a pediatric allergist to determine the exact sensitivities is needed in all cases of anaphylaxis.  Preschool children may need annual re-testing whereas older children may only require re-testing every 3 years.

The epipen (adrenaline or epinephrine) is the only immediate treatment available for severe reactions.  1 Benadryl (diphenhydramine), by mouth, is sufficient for milder reactions.

Mothers “Be-Aware”

Researchers are looking at specific foods in the maternal diet that might be influencing the development of food allergy in their children.  History of problems with asthma, eczema, hay fever and food allergies in the mother, and the family as a whole, are being investigated as underlying triggers.

Since sole breastfeeding during the first 4-6 months of life is the standard for all babies, mom’s diet has come under focus.  How is mom’s diet during pregnancy and breast feeding affecting the future “allergic” immune system in her children? Some have advocated a restricted maternal diet in families with significant allergy.  When and how to introduce solids also continues to be an issue.  The oral route is a mechanism for the initiation of allergy but is being considered as a means to treat allergy as well.  These are some of the new directions in the study of allergic disease prevention and treatment.

Karen returned to Kangos Pediatrics on September 4, 2011, as clinical coordinator, after an 8 month leave of absence. Karen is now anchoring all our services and we are delighted to have her back! Her presence was greatly missed by everyone associated with our practice.

Linda and I appreciate how much of the “quality” in pediatric office care is delivered by a caring and expert staff. I am sorry that our interim staff from January-August was a disappointment for many patients.

Carrie is the knowledgable and energetic voice you hear when you call the office. Simply put, she and Karen are a great team for our patients. Crystal coordinates office care in her calm and professional manner on each and every Saturday morning.

Bridget Shen is a pediatric nurse practitioner who has been with us on a part-time basis since September 2011. She trained at the University of Texas at Austin and has years of experience in general pediatrics. She is a bright and wonderful addition to our practice and has been extremely well received by our patients.

Karen, Carrie, Crystal, Bridget, Linda and I enjoy our practice tremendously.

At this time, we extend a sincere welcome and thank you to all of our patients.

Best personal regards,

Dr. Kangos

Most of the increase was due to a 28% rise in home births among caucasian women. 1% of all births in this group were at home. States with the highest rates were Montana, Vermont and then Oregon, all coming in around 2%.

Although not directly responsible for food allergy (anaphylaxis), gluten is a food component that can cause serious long-term problems in sensitive children and adults. Gluten is a protein found in various grains, such as wheat, barley and rye. Oats can contain gluten if they are grown on the same fields! It allows for bread products to retain their shape while rising. The associated elasticity allows for products such as pizza and bagels to be more chewy.

Restricting the diet from gluten is required to reverse the complications. Gluten is obviously found in pasta, breads, crackers and breading. It is a filler in many processed foods, such as hot dogs and chicken fingers. It is also in marinades, spices, chocolates and french fries.

Furthermore, the general practice of avoiding gluten has been gaining popularity in some circles. Some of the perceived benefit may be in the coincident avoidance of other substances found in processed foods that are affecting children’s behavior and immune system.

“I think it’s just teething” is a view held off and on by many parents.  It has led to confusion regarding when to bring the child in for a visit and how long to wait at home with mild symptoms.

Symptoms of Teething

A recently published article studying 5-15 month olds assessed the association of symptoms with primary tooth eruption.  13 signs and symptoms were evaluated.  The most common signs and symptoms were slight elevation in temperature (not enough for “fever” designation), irritability, increased salivation (drooling!), runny nose and diminished appetite.

Diarrhea, sleep disturbance and even rash were also associated.  These were less commonly observed among the infants and toddlers in the study.

Your At-Home Assessment

If mild changes in your child’s appetite, sleep, personality or energy level persist, I would recommend that your child be seen in the office.  Parents’ intuition and attachment to their children almost always lead to the correct decision for each particular family.  Board certified and experienced doctors and nurses are resources available for help and support.

I have great respect for the events that families experience around illness and unusual behavior/symptoms in their children.  “I may have over-reacted” is always a reflection of the healthy parental bond with their child.  It provides a way for Linda and myself to develop trust and collaboration in a very meaningful way.

The Importance of Getting Vaccinated

The CDC reports that 115 children died of flu-related illnesses in 2010. It appears that the majority of these deaths could have been prevented because: 1) only ¼ of these children received the flu vaccine and 2) only ½ of them received antiviral drugs prior to hospitalization.

How Do I Know If the Flu Vaccine is the Best Thing for My Child?

A lot of people are skeptical of the flu vaccine. Various illnesses have been attributed to the vaccine and “the flu” is not considered, by some, to be that significant an illness. Furthermore, experienced physicians that have been in practice for a long time can tell you that: “Any drug can do anything to anyone!” Well, then, what about vaccines? No one has all the answers. Each procedure, like vaccine administration, is an informed decision that parents must make. I promote full vaccination according to the recommended schedule, including the annual flu vaccine. I will respect and honor your viewpoint regarding immunization of your children. An honest in-office discussion is welcome and is a great way to engage each other and learn.

At your request, we will evaluate any problem on the day that you contact our office. There is always room for a sick child! Come on in for your annual well check or for any illness…..we’ll see you the same day, every day. If specialty care is called for, we’ll pick up the phone and call the pediatric specialists to get you in as fast as possible. Karen, Linda and I will arrange for lab and/or specialist consultation the same day as your visit. Our greatest reward is to ensure the trust that families have in us.