Category Archives: Pediatrics

Flu Shot Facts for Pregnant women

Posted on: October 16, 2014

Pregnancy, Your Immune System and the Flu Vaccine

By Maureen Varcasio, RN

NWHmaternalchild.orgPregnant women can protect themselves and their babies by getting the flu shot. The Centers for Disease Control and Prevention (CDC) and the American College of Obstetricians and Gynecologists recommend that all pregnant women get vaccinated with the Influenza (Flu) vaccine.

During pregnancy changes in the immune system, heart and lungs put women at an increased risk for severe illness, hospitalization or even death from the flu. Continue reading

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Sports Medicine Expert on Concussion Symptoms and Dangers

Posted on: October 14, 2014

Concussion Management. Assessing the Symptoms.

By Dr. Eric Small

While a headache is among the best-known and first symptoms of a concussion, there are often delayed symptoms that indicate ongoing mild brain damage and require treatment. Ten percent of symptoms don’t present for a week or more.

For this reason, it is essential that parents and teachers as well as emergency room physicians and pediatricians recognize the need to monitor a young injured athlete for the full spectrum of possible symptoms. In my experience, when the athlete gets over the initial headache, or perhaps never experiences this symptom, parents and youngster often push for a quick return to all activities. But that can put a young person at serious risk.

Today’s best concussion management involves assessing all symptoms – early and late, including many that can seem unrelated to the injury — to determine the proper timing of an athlete’s return to play and also to learning, that is, the resumption of a full academic load.

Often-overlooked symptoms of a concussion include sleep disturbances and personality changes, in which, for example, a very sociable teen becomes quiet. It’s also important to know that post-injury cognitive impairment often causes academic difficulties to emerge over time. For example, an A student in math becomes, two or three months later, a B student. I particularly advise parents to keep an eye on their child’s performance in math and foreign language. As both subjects require doing multiple mental tasks simultaneously, and rely heavily on memory, they are usually the most affected. When I see a young athlete who appears fine after a concussion, I ask two targeted questions: First, “How are you sleeping?” And always – “Are you having problems with math?”

Be aware that cognitive symptoms may not surface until triggered by a heavy cognitive stress, such as back-to-back tests in school – and that this delay in symptoms can lead to dangerously delayed treatment. A little-known fact about this type of injury is that an untreated concussion can keep getting worse.

Another surprising fact to most people is that a broken nose or broken tooth suffered during sports can also cause head trauma, causing the same set of often-delayed symptoms. This is why I strongly advise that even a symptom-free child see a doctor within 48 hours of the injury, and that visits continue as the child is watched for late-arriving symptoms.

It is now recognized that proper concussion rehabilitation often involves not only physical rest and rehabilitative therapies – but rest and rehab for the brain. Ideally, a physician prescribes personalized guidelines for modifying physical and mental activities. The guidelines typically encompass texting and computer screen time, both of which can add visual over-stimulation to the stress of cognitive processing.

For day one post-concussion, I typically recommend that the student go to school a few hours late. If they tolerate that, day two is a full day. But during non-core classes, such as gym and music, I recommend they rest in the nurse’s office. And no tests. Similarly, a return to play might start the student off with a little jogging, then add push-ups. What you don’t want is the old method of rehab where the athlete stays out of school for a period of time and then returns to a full regimen. A gradual progression is a must.

Editor’s Note: Dr. Eric Small is a past chairman of the AAP committee on Sports Medicine and is active in creating national policy regarding children and sports. He has been named Sports Medicine Best Doctor in New York Magazine and Westchester Magazine  since 2007, and has over 20 years of experience with athletes.

For more information on concussions, visit www.cdc.gov/concussion

 

Northern Westchester Hospital Pediatric Pulmonologist on Kids and Asthma

Posted on: September 22, 2014

Managing Childhood Asthma

by Lynne Quittell, MD

The soft wheeze or whistle as a child breathes. The chin tucked and chest pinched as he coughs incessantly. These are signs of childhood asthma, a maddening, frightening condition for kids and parents — and a leading cause of ER visits for children. While in the past asthma has been difficult to treat and manage, advancements in medications and methods have allowed doctors and families to tame this potentially dangerous condition in children.

The reasons why a child develops asthma can be murky. Potential triggers can be allergies, exposure to secondhand smoke, or a family history of asthma. Premature babies who spend time on a ventilator appear to be at higher risk.

The reason a child struggles to breathe is that the airways can easily become inflamed, muscles that support the airways can constrict, and mucus production can increase. Some kids will have exercise-induced asthma while others may find allergy season to be the source of troubles. Even a sudden change  in temperature or a rise in humidity can set off an attack.

Parents and children should work with their doctor to develop a treatment and medication plan. This is the aspect of asthma treatment that has really changed over the years. The medications have improved greatly. We teach children and parents to recognize the earliest signs of an attack, and encourage them to treat symptoms promptly — before they worsen. I like to use the analogy of smoke in the kitchen… You wouldn’t just let it go — you’d address it immediately. Asthma is the same: Stop the attack before the symptoms become more difficult to control.

When setting up a plan, a doctor must take into consideration the child’s triggers and needs. During the spring or fall allergy season, some children will require a daily preventive medication to minimize airway inflammation, while others may be okay using an inhaler to treat occasional flare ups linked to exercise. The next step is managing more serious flare ups, and then knowing when to seek emergency help. No one leaves my office without a written treatment plan. “It’s one of the most important aspects of asthma care.

Children whose asthma isn’t responding to treatment can benefit from pulmonary exercise program, similar to what is offered at Northern Westchester Hospital. An effective program would involve exercise and respiratory therapists who would create a program for your child to help him or her build physical strength and exercise capacity. The plan should be specifically tailored to your child’s needs and include education and advice for caregivers. The goal? To get your child to the point where they can play and partake in activities with their peers, without limitations.

With the excellent treatment available, I expect my patients to be able to take part in all age-appropriate activities with no restrictions.

Editor’s Notes:
Lynne Quittell, MD, is a pediatric pulmonologist who specializes in pediatric asthma at Northern Westchester Hospital

Did you know…
Asthma affects 7 million children under the age of 18.*
*Centers for Disease Control and Prevention

Northern Westchester Hospital Chief of Pediatrics Discusses New Vaccination Requirements in New York

Posted on: July 22, 2014

Back-to-School Preparations May Need to Include Vaccinations
By Dr. Pete Richel

Your child may need a new vaccination before classes start this fall. For the first time in more than a decade, New York State has updated its school immunization requirements, and now children must be vaccinated twice against varicella—chicken pox.

Image courtesy of Sura Nualpradid / FreeDigitalPhotos.net

Image courtesy of Sura Nualpradid / FreeDigitalPhotos.net

Prior to July of this year, parents could opt out of the second chicken pox vaccine. Why the shift? After all, many adults may remember chicken pox parties from their youth: Mothers would take children to visit a sick kid so that their children would be exposed, get ill, and gain immunity. Although chicken pox can be relatively mild, it can also cause permanent scarring and in some cases turn deadly. As recently as 10 years ago—before use of the vaccine was widespread—the US had as many as 100 deaths a year from chicken pox. From a public health perspective and from mine as a doctor, one death is too many. If we can eliminate this risk, we should seize that opportunity.

There have been some other minor changes to the immunization requirements, such as stipulating a schedule of three to five polio vaccinations before starting school. This has to do with timing. If your child has received the required three polio vaccines in infancy, they must still receive one at the time of school entrance. Three are required, and four are recommended for complete immunization. In either case, one must be received between the ages of 4 and 6. The new requirements—which will be phased in over the next seven years—apply to students starting daycare, Head Start, nursery, pre-kindergarten, and grades kindergarten through 12. If you’ve already taken your children for their wellness visit and vaccinations—or you’re not sure if your child is vaccinated against chicken pox—contact your pediatrician.

Editor’s Note: Dr. Peter Richel, MD, FAAP is Chief of Pediatrics at Northern Westchester Hospital.

Chief of Emergency Medicine on Summer Safety

Posted on: July 10, 2014

Summer Safety Tips

By Dr. Jim Dwyer

Young Family Parents and Boy Son CyclingNow that summer’s here, you and your family are hopefully spending a lot more time outdoors, enjoying a variety of activities. That’s great for your health and state of mind, but you’ll want to take a few precautions to make sure you all stay safe. Continue reading