TakeHomePediatrics

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Lanolin was chosen as the Contact Allergen of the Year. How are the winners picked? There is usually an increase in prevalence or new reports. Lanolin has long been used and recommended as an emollient for dry irritated skin and even for cracked nipples for breastfeeding moms. It is a fat derived from sheep wool so should be avoided if allergic to wool.  Incidence of allergy is still low and reaction is a local contact dermatitis so look for red, irritated, itching skin. Of course, that is the reason we use the lanolin as an emollient, so if you see worsening symptoms with use of lanolin, stop and seek medical attention.

COVID 19, a word that continues to resonate since Jan 2020.  What effects have we seen in children? From vaccination rates to illness rates, complications, psychosocial consequences, we cannot deny that our society and youth have dramatically changed.  The pandemic even created some controversies on school attendance. A survey showed over 25% of parents lied about either illness, vaccine status or following quarantine protocol to the schools to avoid affecting school attendance and job absences.  Schools were turned upside down with complete shutdown and then constant changing quarantine protocols and surges of new variants.  With all this strain on the system, we are hoping to return to some sort of norm.

Growing pains is a common terminology used by both parents and doctors, but what is it actually?  A recent study on the term showed that there is no real strong consensus on the definition.  However, healthcare providers do have guidance to a diagnosis. It should be a diagnosis of exclusion.  Most common presentation is pain in legs likely on the front of thighs, shins or back of knees, occurring on both legs. It presents mainly in the evening or night even waking your child up at night, and usually occurs off and on over months and years.  There should be no joint pain, swelling or redness, no fevers, not limping, no daytime pain, and no interference of daily activity.  Treatment is supportive care with pain reliever or massaging the area.  Even though it is called growing pains, there is no definitive association with growth spurts.  Please seek medical attention if the pain persists, occurs during the day, there is joint involvement, fevers, limping, bruising or fatigue. Let your provider examine your child and run tests if needed to rule out other causes of pain such as joint inflammation, injury, autoimmune disease, leukemia, or viral illness. 

Sudden unexpected infant death (SUID) is the leading cause of death in infants in the US. This includes accidental deaths plus SIDS (Sudden infant death syndrome). SIDS is determined after no known cause (examination, autopsy, review of medical records) can be found for the death of a healthy infant (1 month to 1 yrs)   Sudden Infant death rates increased in certain populations during the pandemic.  Historically risk factors included age (infancy), exposure to smoke, use of soft mattresses, items in the crib that can cause suffocation, and co-sleeping. A small study in 2022 showed a possible link to decreased levels of the blood enzyme butyrylcholinesterase (BChE) activity in those infants. This enzyme plays a role in the brain sending a "wakeup" signal when needing to arouse; so if it is deficient, the infant does not get the signal to wake up in dangerous positions. As more research is being done, we will continue to recommend American Academy of Pediatrics SIDS precautions: Have infant sleep on back at all times; Give awake tummy time so infant develops motor strength; Use firm mattress;  No loose objects in crib such as blankets, sheets, soft toys, bumpers; Breastfeeding recommended; Infant to sleep in parent room until 6 months of age (but not in your bed); Offer pacifier; Avoid smoking, drug and alcohol use; No co-sleeping; Have infant immunized on recommended schedule; Avoid overheating and covering head of infant; Do not rely on commercial home heart and breathing devices to monitor for SIDS.

Don't forget to check out these recalls and alerts. Just click on each to get more details... Stroller, Blanket, Frozen Strawberries, Formula, Greek Yogurt Snack, Chicken Salad, Pasta Sauce , Chocolate Candy.

Dear Dr. Bhumi, I get concerned that my 12 month old child may have autism. What do I need to look for and what should I discuss with my pediatrician?

Dear Reader, autism rates have increased over the years, one reason is more screening and awareness.  Luckily, developmental screenings are now part of every pediatric well visit. Your provider will ask age appropriate developmental questions or have you fill out forms. A common screening developmental questionnaire is the ASQ-3 which is available from 2 months to 5 yrs old. You can access it online for your records but should always discuss results with your provider.  The ASQ assesses social, communication, fine motor and gross motor progress. More specific autism screening questionnaire is given at 18 months to 3 yrs old called the MCHAT. This too can be found online for personal use but discuss the results with your provider. As a parent, if you see certain behaviors that concern you, talk to your provider. Here are a few common behaviors consistent with autism.  If by 6 months, you do not notice good eye contact or by 9 months, you don't see a consistent responsive smiling, talk to your doctor. If by 12 months, your child is not babbling, pointing or responding to own name, you may want further evaluation. Other common signs with older age include, persistent speech delay, continued poor eye contact, unable to understand other's feelings, prefers to be alone, dislikes closeness or touching, repetitive behavior (rocking or hand flapping),  repeating phrases or words, resistant to even small changes in routine, intense reactions to change or to sensory things (smell, noise), and regression in speech development.  Again, your doctor will be able to put all these together and explain if some are isolated symptoms or age appropriate or if a full evaluation will be needed.  Even though few signs can be present early at 12 months, most will be diagnosed after 18 months of age when symptoms are more consistent to distinguish isolated delays vs autism.  Full evaluations are done by developmental pediatricians. Speech therapy and occupational therapy is usually started while awaiting ABA (applied behavior analysis) therapy.  Early diagnosis and early intervention with therapies predict improved functioning in the future.

Send your questions here!  Dear Dr. Bhumi

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