Ask the Doctor
Each week, we will choose 2 questions to be answered by one of our pediatric care providers and it will be posted in this forum. For questions about a specific illness, please call our office. For general questions click here
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are those of their authors and not of their employer. Information provided here is intended for informational and educational purposes only. Do not use the information on this website for diagnosing or treating any medical or health condition. It is not intended as and does not substitute for medical advice. If you have an acute medical problem, we urge you to seek the advice of your physician or medical professional directly. For patients of Senders Pediatrics, please call the office at 216-291-9210. As a recipient of information from this website, you are not establishing a doctor/patient relationship with any physician. There is no replacement for personal medical treatment and advice from your personal physician. Under no circumstances will the authors be liable to you for any direct or indirect damages arising in connection with use of this web site. Patient data published on this web site is modified and information from several cases may be compiled into one posting for teaching purposes and to protect patient confidentiality.
Okay, my husband and I are having a debate. When is the appropriate time to turn a carseat to the rear facing position?
Answered by Dr. Andy Mann
The Ohio Law states the following:
o If your child is under 1 year and under 20 pounds, he must be in a rear-facing child seat.
o If your child is at least 1 and weighs more than 20 pounds, he can ride in a forward-facing seat until he grows out of that seat.
However, in April of 2011, the American Academy of Pediatrics released new recommendations on child car seats. â€œThe AAP advises parents to keep their toddlers in rear-facing car seats until age 2, or until they reach the maximum height and weight for their seat.â€ Dennis Durbin, MD, FAAP, lead author of the policy statement and accompanying technical report states, â€œA rear-facing child safety seat does a better job of supporting the head, neck and spine of infants and toddlers in a crash, because it distributes the force of the collision over the entire body,â€
In summary, the law and AAP recommendations are not quite in sync. we recommend that parents should always keep their children rear facing at least one year and 20 pounds. And, because of the new recommendation by the AAP, we encourage them to remain rear facing beyond the first year of life as long as they are sitting comfortably in that position. However, for long, lean kids whose legs are being crumpled by the back seat or in families with previous children who have been turned around at one year, we are comfortable sticking with the Ohio Law recommendations and allowing those children to be forward facing.
With the research on the potential link between asthma and Tylenol becoming more widely accepted, should there be similar concerns about other fever reducer/pain relievers, e.g. Motrin or aspirin?
Answered by Dr. Zizzy Bucchieri
The following excerpt from our January 2012 newsletter explains the link between acetaminophen (active ingredient in Tylenol) and asthma:
There is possibly a strong link between asthma and the use of Tylenol (acetaminophen). Akron Children's Hospital pediatrician, Dr. John McBride, reports that the data connected acetaminophen with asthma is so strong that it is possible that much of the dramatic increase in childhood asthma may be related to the use of acetaminophen. The theory is that acetaminophen increases airway inflammation in patients predisposed to developing asthma. In a study of over 200,000 children, those who took acetaminophen between 1-11 times a year had a 1.6x greater chance of developing asthma and those who took it 12 or more times had a 3.2x greater chance. The prevalence of childhood wheezing in 36 countries around the world can be predicted by each of those countries acetaminophen sales.
Senders Says: The data is so convincing, that we are no longer recommending the routine use of acetaminophen at the time of vaccines (see above) and recommending that patients with asthma or a family history of asthma, use ibuprofen instead for fever and pain.
We are recommending the use of ibuprofen (motin and advil) for fever or pain. We do not recommend the use of aspirin in children under the age of 19 years because of an association of the use of aspirin and Reyeâ€™s Syndrome (swelling of the liver and brain).
With that said I want to talk about fever. First a disclaimer: If your child is less than 3 months old and has a fever please call us as we will want to know about that, and let you know when we want to see your child. No matter how old your child is or what his/her temperature is if he/she is looking very sick or concerning to you please let us know.
Now for the rest of the children with fever. Fever is evidence of an active immune system and spurs the production of germ fighting white blood cells. Fevers can help the body fight infection by making it harder for microbes to reproduce. Letting a fever run its course may reduce the length and severity of the illness. Studies have shown that children who ran a fever in the first year of life were less likely than those without fever to develop allergies. Other studies have shown that fever after vaccines increases the childâ€™s immune response to the bacteria/virus for which the child is being immunized. Many parents are concerned about fever causing brain damage. Fevers under 107 do not cause brain damage.
Here are some things you can do to keep your child with a fever comfortable without medication. You can offer cool drinks and popsicles. You can put a warm (not cold) wash cloth on your childâ€™s head, this helps to dissipate heat out of the head. You can set up a fan near your sick child. You can also do what comes naturally, do lots of snuggling and reading and give lots of hugs and kisses.
If you feel the fever is making your child uncomfortable (usually this comes from a fever over 102) feel free to give a dose of ibuprofen.
What is your opinion of the blood type diet and the vegan/no oil diet AKA skinny vegan diet?
Answered by Dr. Doug Fleck
Developed by a naturopathic physician, the blood type diet is a diet based on your blood type. According to this diet, if your blood type is A, you should eat a primarily vegetarian diet, if itâ€™s type O, you should eat mostly meat and avoid grains, and if itâ€™s type B, you can eat a variety of food, including dairy, which is excluded for type As and Os.
The theory that our blood type determines what we should eat or what kind of exercise we should do is not supported by scientific evidence. In addition, by eliminating whole groups of food, you may have a lot of initial weight loss, but you are also missing out on a lot of essential vitamins, nutrients and minerals, which are not supplemented if you eat a well balanced diet. Eating a well balanced diet with a healthy exercise routine is still the best way to go.
The vegan diet can also be called "strict" vegetarianism that excludes meat and fish, eggs, honey and milk products. They also abstain from use of all animal products such as clothing, products, etc. While a vegetarian diet can be healthy, it does not guarantee a healthy and balanced diet. A lot of nutritionists feel the vegan-no oil diet AKA â€œskinny veganâ€ diet may be lacking in many essential vitamins and nutrients. So, yes, you will lose weight from less calories, however you may develop many nutritional deficiencies by totally eliminating certain groups of foods. These diets can be lacking in protein, iron, zinc, calcium, vitamin D, riboflavin, vitamin B12, omega 3 fatty acids, and iodine. The American Dietetic Association approves of carefully planned vegetarian and vegan diets, but recommends consulting a registered dietitian to be sure your plan meets your nutritional needs.
Should I be concerned about a lot of flatulence in our 3 year old?
Answered By Julia Caschera, CPNP
Did you know that a healthy person passes gas 8 to 20 times a day?! Most of time gas is normal event.
The main culprit?
Foods like beans, whole grain cereal, eggs, fatty foods, fried foods, milk, and milk products. See if you can think back of what your child ate 2-3 hours before the gas and that is likely the culprit.
Keep in mind that extreme gassiness with a really strong odor combined with not having regular bowel movements may be constipation. Or if the gas is painful, food allergies or intolerances might be considered.
My best advice on managing gas is to make sure you encourage your child to chew properly before ingesting, to not eat rapidly, avoid carbonated beverages, and drink lots of water.
What was the dosage of zinc for children with ADHD?
Answered by Dr. Ann Witt and Dr. Shelly Senders
Zinc deficiency in the United States is rare. Moreover, there are no strong data to support supplementing routine patients with ADHD with zinc. Furthermore, excessive zinc levels can impact on the immune system, cause fever, vomiting, diarrhea and abdominal pain and at extremely high levels has been associated with a doubling in the incidence of prostate cancer. As with Vitamin D, the supplement darling of the year, when a child is deficient, there is much benefit to supplementation. When the levels are normal or high, there is little benefit and some harm to supplementation.
The Institute of Medicine has established Adequate Intake (AI) levels of zinc for infants birth to 6 months is 2 mg/day. For older infants, children, and adults, Recommended Dietary Allowance (RDA) quantities of zinc have been established: infants and children 7 months to 3 years, 3 mg/day; 4 to 8 years, 5 mg/day; 9 to 13 years, 8 mg/day; girls 14 to 18 years, 9 mg/day; boys and men age 14 and older, 11 mg/day; women 19 and older, 8 mg/day; pregnant women 14 to 18, 13 mg/day; pregnant women 19 and older, 11 mg/day; lactating women 14 to 18, 14 mg/day; lactating women 19 and older, 12 mg/day.
All these doses are of elemental zinc. Different formulations provide different amounts of elemental zinc. Zinc sulfate contains 23% elemental zinc (220 mg zinc sulfate contains 50 mg elemental zinc). Zinc gluconate contains 14.3% elemental zinc (10 mg zinc gluconate contains 1.43 mg zinc).
The Tolerable Upper Intake Levels (UL) of zinc for people who are not receiving zinc under medical supervision: Infants birth to 6 months, 4 mg/day; 7 to 12 months, 5 mg/day; children 1 to 3 years, 7 mg/day; 4 to 8 years, 12 mg/day; 9 to 13 years, 23 mg/day; 14 to 18 years (including pregnancy and lactation), 34 mg/day; adults 19 years and older (including pregnancy and lactation), 40 mg/day.
If you are concerned about your childâ€™s zinc levels in a patient with ADHD, please come in, we will measure levels and advise you accordingly