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Newymail sent out during 2008

Jan 15

This is definitely the cough and cold season.  We are seeing a lot of children with a nasty cough that is usually “barky” or croupy.  Not always.  Then it gets more congested cough at 1 week.  The cough lasts 3-4 weeks.  Many of them are getting bronchitis or ear infection at 1-2 weeks into the cough.  Fever in the first 3 days of the starting of the cough is the virus.  Fever after the fourth day is trouble and usually needs antibiotics.

 Give your children vitamins with zinc.  Zinc every day will decrease infections.  Zinc lozenges will not help so don’t waste your money with them.  Vit C will not decrease or cure colds but it will not hurt them.  

 Vicks Vapor Rub will help the cough if you put it on their feet.  Yes I said their feet.  Then put socks on them and tuck them into bed. 

 The older kids can take cough medication and I like the ones that say Cough and Cold.  Any brand like Triaminic or Tylenol “cough and cold.”

 They took pseudoephedrine off the market but now the only decongestant is Phenylephrine.  The only cough suppressant is dextromethorphan.  These are in the cough and cold medications.  You do not need an antihistamine since this is a viral cold and not allergy.

 The night and early AM cough is usually an allergy.  There is not coughing all day and night.  That cough at night lasts for months.  Then during that season that they are coughing allergy at night, they can get a viral cold and start coughing all the time for a few weeks.  Then when the cold goes away, they drop down to their usual allergy night cough.  So you can have two causes of cough.  Watch for fever and then we see them for secondary infections like bronchitis. 

 If the cough or congestion is not severe, just wipe their noses and watch it.  If it is interfering with their sleep and function, then treat with medications.  We would prefer not to give medications.  For infants below 7 months old, you can sleep them all night in the swing or infant seat.  There will be less congestion or cough with head elevated.
 Have a good winter and clean hands frequently.

Roger Knapp  MD


Jan 25

We always hear about Myspace and the risks of teenagers on the internet.  Here is a show on PBS that is very good at getting a good picture of the problem.

Also good web sites about safety are these two:


I have sent other emails about programs that watch what is visited on the computer without kids knowing.  Don't be afraid to watch what your kids are doing in the internet.

Dr. Knapp

Feb 7

You may be hearing about Phthalates someday. 

 Phthalates are plasticizers …. chemicals to make plastic softer.  It is found in most soaps, lotions, perfumes, cosmetics, plastic bottles, and even IV tubing.  It is in almost 100% of mother’s breast milk.  It is in most newborn babies urine because they get it from the mother via the placenta.  Breast milk does not have toxic amounts.  Basically they are in almost everything we touch and probably eat. 

 Studies showed that it could in rats in-utero affect the development of the male genital organs because it interferes with testosterone metabolism.   Human studies vary in their results.  Nothing is absolutely verified yet.  But if there is an affect of Phthalates, it is during pregnancy or during the first 6 months. 

 Don’t go crazy yet.  We have not figured it all out or what to do about it.   The chemical is in almost everything.  But what goes on their skin can go into the blood stream so cut down the use of baby lotion and I recommend Dove unscented soap that has less chemical than baby soaps.  I have always warned parents about putting chemicals from wipes on their babies bottoms all the time.  Use them as little as possible and nothing is more natural as water and paper to clean them up.  Also less likely to get yeast or staph infections on their bottoms if you avoid wipes. 

 There is one site for this chemical: http://www.phthalates.com/

This is not helpful since this site is run by the plastic companies to make you think they are OK.  I would not believe what they say.   There are also many sites that are against every chemical so they tend to make it out as a horrible disaster.  The truth is somewhere in between the two extremes.

 Just remember that no one knows the “safe” level of these chemicals until more studies are done.  Any comments based on information older than a few years will not be accurate.  Ignore any values of the safe amount.  And what is safe for the adult will not be necessarily safe for the unborn infant.

 For some more reading:




 Roger Knapp MD

 Feb 13

If a tooth gets knocked out, put it in cold milk, or there is a solution from the drug store called Hank's Balanced Salt Solution (Save a tooth kit) that you can soak the tooth in.  Then get to the dentist right away.  Some of the teeth can be re-implanted and saved.  If they are older and can tolerate it, you can shove the tooth back into the socket and held there until you see the dentist. 

 Roger Knapp MD

 Feb 19

A study came out having over weight teenage girls enter a program.  They emphasized cutting down high calorie beverages, portion sizes, and fast foods, but not count calories.  In addition they had them do 30 min of video game "Dance Dance Revolution"   They compared them with matched controls that were not put on the program.  The girls lost an average of 15 lbs in the next 6 months.  So I guess video games could be used for our health.  I know some of the kids are sweating after some of the Wii games.  In fact we are having some sore arms and wrists after Wii games. 

 Dr. Knapp

 p.s. Having exceeded smoking, being over weight is now the number one cause of Cancer.

 Mar 8

The bad chest colds and flu that went thru this winter should be on the down slope this month and there is still a slight chance of RSV for the infants below 6 months old during even April.  Try to keep the little ones away from crowds for 30 more days.  Now we should start seeing allergies.... yuck.  If it is not one thing it is another.  (I guess it pays my bills.. hee hee :-) 

Careful about the small kids eating plants.  There is a great children's area on the Poison Control web site with a very good video it would be good for us and the children 3-8 yr old to see.  http://www.poisoncontrol.org/kids.html

Also watch out for sunburn when the air is cool but the sun is still out to burn you.  Keep the swim shirts on them that block the UV radiation.  Sunscreen on the areas that you cannot cover and as long as there is SPF of 15 or more then that is good. 

Roger Knapp MD

1. Get real postage stamps with your child's picture on them:     http://photo.stamps.com/Store/?source=si10130222

2. Gadget to allow electricity to any electronic device for only certain hours on certain days to you can regulate how long your older kids are using them.
This will help you control excessive games or TV.   See Power Cop:   http://www.emspowercop.com/features.htm

 April 5

Well the year causes of death in kids came out.

    1-4yr old:      5-9yr   

Accidents                                 34%                 37%

Congenital malformations          10%                 7%

Cancer                                     8%                   17%

Homicide                                  7%                   4%

Heart Disease                           3%                   3%


    10-14yr        15-19yr

Accidents                                 35%                 48%

Cancer                                     13%                 5%

Suicide                                     7%                   11%

Homicide                                  5%                   15%

Congenital Malformations         5%                              

Heart Disease                                                   2%


Cancer is higher 5 to 15 yr old.

Accidents still stay high in all ages. 

Suicide goes up after age 10.  That is tragic at any age but 10-14?  Yuck.

Homicide is at every age but higher after 15. 

 Many of these could be prevented. 

 Dr. Knapp

 May 5

Boy it is April and we are already seeing sunburns and swimmer's ear.

Put olive oil in their ear before swimming &/or a solution of half alcohol half white vinegar after swimming to prevent swimmer's ear.  You can tell it is swimmer's ear because it hurts to move their ear lobes.

I came across an article on a vaccine to prevent or lesson recurrence of breast cancer:

  A preventive HER2/neu peptide (E75) vaccine is showing great promise in the prevention of breast cancer recurrence and reducing mortality when recurrences do occur in women with HER2/neu-positive breast cancer, researchers reported here at the American Association for Cancer Research (AACR) Annual Meeting 2008.

You can google those terms and read more.  Very amazing. Of course we have a vaccine to prevent cervical cancer with the HPV and I do recommend that.  No it does not give them a license to go crazy out there. 

In the news was a story about enterovirus 71 killing 24 children in China.  It was estimated that over 1 million children probably caught it.  There are some children that will die from these viral illnesses and actually are rare thank God.  We don't have a vaccine for every virus.  China is trying to stop the cases because of the Olympics that are there this year.  I do not think it is a world pandemic and cases occur here also.  There were rare children who died of Chicken Pox so we give a vaccine for that even though it is rare that they have severe complications.... thank God.  As we develop more vaccines it means that the children are getting more shots.  But the life span of humans in the 1800s was 35 years and 10% died the first year.  Thank goodness for vaccines. (No they do not cause Autism.)

Have a safe summer ....

Dr. Knapp

May 19

Swimming lessons for infants

With summer coming up this question always comes up. 

Also how old do they have to be to go into the pool.  It is not a problem of chlorine but a concern is for the body temperature.  They can get hypothermia fast.  When 2-6 months then the water should be luke-warm and take them out every 5-10 minutes to take their temp.  If below 97 or shivering, then get them out and dry them off.  If over 6 months then they can go into cool water but watch the temperature frequently.  Personally I prefer a rubber blow up pool.  Then let the hose sit in the sun and warm up the water in the hose.  When you fill the pool, the temperature will be warmer than cold water from the tap.

 I don’t recommend actually teaching the infant to “swim” over to the edge of the pool and “save themselves.”  The parent’s job is to be certain that the infant does not drown, it is not the child’s job.  Teaching the infant to paddle will give the parent a false sense of security that the baby will not drown and may be less vigil in watching them.  Also they swallow a lot of water that can lower their blood sodium level and cause a seizure. 

 I think it is fun and OK to have “swimming” lessons where the mom’s sit around in the kiddy pool and let the babies splash.  It is a social event and not really swimming.  That is fine and great enjoyment by all.  Just watch the temperature and watch out for poop in the water.  Don’t let them drink the water.  And use sunscreen!

Have a safe summer.

Dr. Roger Knapp

 May 25

Well there are so many ancient medical therapies and many false but some true.  Chicken soup really did help colds in control studies.  Now a study came out verifying an old treatment of skin ulcers or sores by putting Honey on it.  The honey treated sores healed quicker than traditional antibiotic ointments and bandages.  Go figure???  You need raw unprocessed honey.  Sweet idea.

Dr. Roger Knapp MD

Jun 8

A study just came out looking at fatal falls in children.  Basically they had to fall from 4ft or higher to damage them.  We don't want them to fall and get hurt at all but when they do fall, you generally do not have to worry about falls of less than 4 ft.  So approximately waist high or grocery cart handle height.  See my web site for 4 misconceptions about injury to the head: http://www.rogerknapp.com/medical/HeadInjury.htm

Roger Knapp MD

Also protect them from swimmer's ear by putting Olive oil in their ears before they swim or a solution of half alcohol and half vinegar in their ears after they swim.  We are already seeing a lot of swimmer's ear.

Jun 10

The growing children need calcium from milk.  If they cannot drink milk then they can get calcium from supplements but it is better from vit D Milk and formula before one yr old.  The formula companies would like you to give follow-up formulas until 2 yr old but there are no studies showing any benefit from that.  So I recommend switching to cow’s milk at one yr old … whole milk until 2 and then low fat afterward.  Too much of anything is bad for them.  Too much salt or too much sunlight is bad.  So milk intake should be 12-24 oz a day after 1 yr old.  I just had to put a twenty month old in the hospital with extreme anemia and get transfused with blood.  The child was drinking excessive amounts of milk and not much food.  Then we also have infants that start to not like and drink enough milk.  In that situation you flavor the milk and out wait them. Nothing else to drink until they put away 12 oz.  Then they need a lot more calcium in their teens when they hit puberty.

 Also keep up giving them vitamins with iron and zinc after 1 yr old.  

 Dr. Knapp

 July 2

I love 4-6 month olds… they are usually over the colic and not throwing temper tantrums  yet.  And I love 4-6 yr olds who are usually over the temper tantrums and not the teenage smart mouth…. which usually starts around 6 yr old. (These ages may vary a bit)  You have to tolerate some smart mouth since it is normal for the age.  It hits a peak in teens and then a lot better in the 20s. 

 There is an old book called I’m OK You’re OK.  It does not help you raise your children but understand the stages they go through.  The one year old is happy and the world is a nice place.  He is OK and you are OK.  Then he gets into trouble and goes through terrible twos and you have to discipline him so he is a civilized human and not a wild animal in the forest.  But then by 6 yr old the child has a decreased self image and he thinks he is not OK but you are still OK.  As they go through grade school he realizes he does know something and his opinion is worth something.  He has a smart mouth but that is getting out of the “I’m not OK” stage and important to do some backtalk.  Then by teens you are not OK but he has become OK and knows it all.  Eventually he gets into his 20s and realizes you are smart and comes full circle where he is OK and you are OK. 

 So some smart-mouth back talk is to be tolerated.  The degree of this will vary with how much the parent can tolerate.  And would you talk to your friend the way we talk to our spouse?  NO.  We tend to behave worse for the ones we love the most .... our family.  Our children also let out frustrations on us just as we let our tension out on others in our family.  In fact we treat other children that come to visit us better than we treat our own children.  So if your child visits other families and when they come home the other parent complements your child saying he was nice and well behaved.  That is proof that you are raising a good kid.  They just don’t behave that way for us.

 Dr. Knapp

 July 9

There was a policy released this month July 2008 for Cholesterol screening and treatment in children.  You may have heard it on the news this week. For the full policy if you want to read it is at this web site:


The summary recommendations were:

The population approach to a healthful diet should be recommended to all children older than 2 years according to Dietary Guidelines for Americans. This approach includes the use of low-fat dairy products. For children between 12 months and 2 years of age for whom overweight or obesity is a concern or who have a family history of obesity, dyslipidemia, or CVD, the use of reduced-fat milk would be appropriate.

The individual approach for children and adolescents at higher risk for CVD and with a high concentration of LDL includes recommended changes in diet with nutritional counseling and other lifestyle interventions such as increased physical activity.

The most current recommendation is to screen children and adolescents with a positive family history of dyslipidemia or premature (55 years of age for men and 65 years of age for women) CVD or dyslipidemia. It is also recommended that pediatric patients for whom family history is not known or those with other CVD risk factors, such as overweight (BMI 85th percentile, <95th percentile), obesity (BMI 95th percentile), hypertension (blood pressure 95th percentile), cigarette smoking, or diabetes mellitus, be screened with a fasting lipid profile.

For these children, the first screening should take place after 2 years of age but no later than 10 years of age. Screening before 2 years of age is not recommended.

A fasting lipid profile is the recommended approach to screening, because there is no currently available noninvasive method to assess atherosclerotic CVD in children. This screening should occur in the context of well-child and health maintenance visits. If values are within the reference range on initial screening, the patient should be retested in 3 to 5 years.

For pediatric patients who are overweight or obese and have a high triglyceride concentration or low HDL concentration, weight management is the primary treatment, which includes improvement of diet with nutritional counseling and increased physical activity to produce improved energy balance.

For patients 8 years and older with an LDL concentration of 190 mg/dL, pharmacologic intervention should be considered. The initial goal is to lower LDL concentration to <160 mg/dL. However, targets as low as 130 mg/dL or even 110 mg/dL may be warranted when there is a strong family history of CVD, especially with other risk factors including obesity, diabetes mellitus, the metabolic syndrome, and other higher-risk situations.


Dyslipidemia is high cholesterol, low HDL, and high LDL.  CVD is Cardiovascular Disease.  HDL is High Density Lipoprotein, LDL is Low Density Lipoprotein.  It is easy to remember that you want  the good HDL to be high and the bad LDL to be low… so H in the HDL means you want it Higher and L stands for Lower.

 Dr. Knapp


 Synopsis of the article:

 Autopsy studies on people who died of accidental causes, have demonstrated that the atherosclerotic process begins in childhood. They reported that the extent of the arterial surface covered with fatty streaks and fibrous plaques increased with age with almost 70% by young adulthood.  In the Child and Adolescent Trial for Cardiovascular Health, 13.3% of children in the 4th grade had total cholesterol concentrations of >200 mg/dL. 

 Obesity in adolescence and young adulthood, cigarette smoking, and use of oral contraceptives by women may have deleterious effects on adult concentrations of lipids and lipoproteins.

 Their recommendations is for screening children with a family history of premature CVD or high blood concentrations of cholesterol. Some have maintained that the evidence is insufficient to recommend for or against routine screening for all children.  Unfortunately, family history may not be known or inaccurate and the studies of screening have also shown that 30% to 60% of children and adolescents with high cholesterol levels will be missed by the targeted strategy.  Therefore  some recommend screening all children.

 Who to treat?

The NCEP pediatric report recommended the cut points presented below:  It is worth noting that the same values are used for all children, from 2 to 18 years of age.

            Cholesterol >200 mg/dL        LDL >130 mg/dL





top normal value







Total Chol





























There is a condition called metabolic syndrome which is a clustering of risk factors for CVD and diabetes mellitus that seems to be related to obesity and insulin resistance.

 TABLE 3 Definition of Metabolic Syndrome for Adults25

Three of these five criteria:

1. Waist >102cm, or 40 inches in Men,   >88cm, or 34.5 inches in Women

2. Triglycerides >150

3. HDL <40 in Men and <50 in Women

4. BP >130/85

5. Fasting Glucose >100

Note the waist measurements.  This can be more of a predictor of CVD and Diabetes than anything.  This syndrome frequently has acanthosis nigrans (dark area around the neck) and some schools and most Pediatricians screen your teenagers for this.  Large waist to height is a better predictor.  If the waist is more than 50% of the height in over 8yr olds, then they are more likely to have this syndrome.  But there are no currently accepted definitions of metabolic syndrome in children.

Dietary changes not recommended for children younger than 2 years, because younger children are thought to require a relatively high intake of total fat to support rapid growth and development. However, some studies have examined dietary intervention at a younger age. One study beginning at approximately 7 months of age showed the children in the intervention group were maintained on a diet with total fat of <30% of calories, saturated fat of <10% of calories, and cholesterol intake of <200 mg/day, using 1.5% cow milk after 12 months of age.  Outcomes in this study showed no adverse effects of the intervention diet on growth or neurological outcomes.

The American Heart Association recently provided updated dietary recommendations based on the new US Department of Agriculture dietary guidelines for children (older than 2 years) and adolescents, which have been endorsed by the AAP. See: http://aappolicy.aappublications.org/cgi/content/full/pediatrics;122/1/198/T4  Realize that there is a wide range of normal and the values presented by any chart based on age may not apply to your child exactly.  There is a broad range of “normal” intake.  The new guidelines recommend that intake of trans fatty acids be limited to <1% of total calories. 

Children and adolescents at high risk require a higher level of intervention.  If the intervention focusing on changing the diet does not lower LDL to an acceptable concentration, these children may be candidates for medication.

The recommended diet for the high-risk group is similar to that recommended for the population but restricts saturated fat to 7% of total calories and dietary cholesterol to 200 mg/day

For these children with a genetic cause of dyslipidemia and LDL concentration of 190 mg/dL, it is unlikely that diet alone will achieve appropriate concentrations of LDL. Nevertheless, it is important to implement dietary changes and is likely to require involvement of a dietitian.  The home environment is very important to help children and adolescents make the best choices and Dietitians can also help children and their families navigate the food environment outside the house.

Increasing the intake of soluble fiber can be helpful in reducing plasma LDL concentration. Some studies have shown a modest reduction of LDL concentration by approximately 7%. This often requires supplements of fiber. An appropriate dose of supplemental fiber is calculated as the child's age plus 5 g/day, up to a dose of 20 g/day at 15 years of age

Classes of Medication for Treatment of Dyslipidemia in Children and Adolescents

1.      Bile acid sequestrant …………… GI upset, constipation,

2.      Cholesterol blocker …………….   GI upset and cramps

3.      Statin Drugs ……………………   Muscle inflammation and “rhabdomyolysis”. Liver inflammation, and possible teratogenicity. Can lower cholesterol 20-50 %.

The main choice is the statin drugs.  There have been a number of clinical trials of statins in children and adolescents have shown statins to be safe and effective in short-term studies.

Wiegman and other doctors showed that children with hypercholesterolemia treated with placebo had an increase in carotid thickening over 2 years, whereas children treated with a statin medication had regression of carotid thickening. The results of these studies are encouraging in that these noninvasive vascular measurements are thought to provide an assessment of the extent of the atherosclerotic process. Furthermore, this study included prepubertal children as young as 8 years of age, and on the basis of these results and reassuring safety data, the US Food and Drug Administration has approved the use of pravastatin for children with familial hypercholesterolemia who are 8 years and older, regardless of pubertal status.

July 22

I have sent information about rabies before but here it is again.

Rabies is rare in dogs and more common in cats.  But in other countries around the world there are many dogs with rabies and frequent cases of human rabies.  Rodents do not get rabies so don’t worry about rats and squirrels.  The more common source of rabies is bats and you cannot feel the bite. 

There are about 16,000 to 39,000 exposures to rabid animals yearly.

There were 34 cases of bat-associated rabies from 1990 to 2007.  A bite was only reported in 6 cases.  Contact with a bat and possible bite in 2 cases.  Physical contact removing the bat from the home or workplace or presence of a bat in the room were a person had been asleep occurred in 15 cases with no evidence of a bite.  No encounter with a bat was reported in 11 cases.

So stay away from bats and if one is found in the home, get the shots.  It is 5 shots in the arm and not 21 in the stomach like in the grandpa days.

 Dr. Knapp

 July 25

As I have also sent Newsymail about obesity and there is an article at my web site on this

The American Academy of Pediatrics has given their recommendations.:

 Specific recommendations of The Expert Committee on the Assessment, Prevention, and Treatment of Child and Adolescent Overweight and Obesity, and their accompanying level of evidence, are as follows:

At least once a year, measure height and weight and calculate percentile for all children.

To achieve or maintain a healthy weight, encourage all children to participate in at least 60 minutes of moderate to vigorous physical activity on most, and preferably all, days of the week.

Advise children not to drink more than 1 serving per day of sweetened beverages, such as fruit juice, fruit drinks, regular-calorie soft drinks, sports drinks, energy drinks, sweetened or flavored milk, or sweetened iced tea.

Advise families to limit their children's television viewing and other screen time to 2 hours per day or less.

Recommend that children's fast-food consumption be limited to no more than once per week.

Advise families with children to eat meals together as often as possible, on most, and preferably all, days of the week.

I do not have a problem using diet drinks with children in moderation.  Splenda is fine since it is only a sugar molecule with a hydrogen and Oxygen molecule on the side.  It makes it 500 times sweeter and 80% is not absorbed.  I think it is real safe.

Roger Knapp MD   

p.s.: why do you sing to your children when they are going to sleep? See this video:
Dogs singing to sleep

Aug 5

The most commonly used sweetener in the U.S. diet is the disaccharide sucrose tie, table sugar), which contains 50% fructose and 50% glucose. However, in North America and many other countries, non-diet soft drinks are sweetened with high-fructose corn syrup (HFCS), which contains up to 55% of the mono-saccharide fructose. Thanks to its abun-dance, sweetness, and low price, HFCS has become the most common sweetener used in processed foods. It's not that HFCS is biologically more ominous than sucrose; it's that its low cost has made it available to everyone, especially low socioeconomic groups. HFCS is found in processed foods ranging from soft drinks and candy bars to crackers to hot dog buns to ketchup. Average daily fructose consumption has increased by over 25% over the past 30 years. The growing dependence on fructose in the Western diet may be fueling the obesity and type 2 diabetes mellitus epidemics. Animal models demonstrate that high-fructose diets lead to increased energy intake, de-creased resting energy expenditure, excess fat deposition, and insulin resistance, which suggest that fructose consumption is playing a role in the epidemics of insulin resistance and obesity and type 2 diabetes mellitus in humans. The metabolism of fructose differs significantly from glucose. Fructose is absorbed in the intestine and enters the liver without insulin regulation. There, fructose is converted to fructose- 1-phosphate and enters the glycolytic pathway without regulation. This leads to an excess accumulation of acetyl-CoA in the hepatocyte, which cannot be metabolized through the Krebs cycle; therefore it is then reassembled into free fatty acids (which promote insulin resistance), very low-density lipoproteins (VLDL, which promote atherogenesis and serve as a substrate for obesity), and triglycerides (some of which precipitate in the liver and cause non-alcoholic steatohepatitis). Fructose also does not sup-press secretion of the so-called "hunger hormone" ghrelin, levels of which correlate with perceived hunger. In sum, fructose consumption has metabolic and hormonal consequences that facilitate development of obesity and its complications. The highest fructose loads are soda (1.7 gm/oz) and juice (1.8 gm/oz).


Simple solution for Obese teenagers

 Here are some simple guidelines for diet and exercise I would like to share with you.

Eat only 6 things for breakfast, lunch and dinner:

 1- Fruits

2- Grains and Vegetables (careful with corn and potatoes)

3- Meat

4- Chicken (turkey ok)

5- Fish

6- Eggs 

 Big breakfast, medium lunch, small dinner. Nothing after 6 pm except water.

No fast food. Eat half of what restaurants give you.

Do not eat anything that comes in a box.

No white foods (bread,starches,corn,pasta,rice).

This provides carbs in their natural form. This is how our great-great-great-great grandparents ate. You can give alternatives: corn tortillas, brown rice, whole grain bread

 The catch is that carb addiction is almost an "all or none" phenomenon. If someone is dieting but decides to have a piece of cake, this transitory hyperglycemia will release endorphins that will require his/her body to "ask" for more.

 Use a pedometer and get at least 10,000 steps daily. Limit the video games and TV.  Get those teens one of those dance dance revolution video game dance pads-- that will help them break a sweat....

Drink  8-10 glasses/day only water or diet drinks.  No regular sodas or fruit juices. Teenagers are consuming 1000+ calories (mostly carbs) in the form of drinks (gatorade, kool aid, sodas, etc). When your fluid intake is only water then you cut down 1000+ cal/day. That is 1 pound in 3 days only from drinks.

 Sometimes we are thirsty instead of hungry. When we drink water we cut some cravings. Water also helps constipation. It flushes your toxins.   Also you may have an acid heartburn stomach feeling and think that you are hungry.  Take an antacid with the water and that can help that craving.
 On this diet kids can lose 10 lbs/ month and so are their parents.  Diets work if the whole family participate. It's not about dieting for short term results, rather lifestyle change for sustained improvement in health ... every day the rest of your life.

 You can cut back eating for one week and loose 1 lb and eat too much for just one day and put 1 lb back on.  So people think they starve all the time and not loose weight because they forget about the one day they ate too much.  You change your way of eating every day!

 Loosing weight is like a marrathon race.  You don’t run the first mile as fast as you can go or else you get tired too soon and stop running.  If you try to loose too much weight too fast, then you will get exhausted and quit.  Cut back the calories so you are loosing it 1-2 lb a week.  It will take a long time to get your weight down but since we are going to change the way we eat for the rest of our lives…. Then it does not matter how long it takes.


 Dietary Fructose Consumption Among US Children and Adults: The Third National Health and Nutrition Examination Survey  CME

Posted 07/9/2008

Miriam B. Vos, MD, MSPH; Joel E. Kimmons; Cathleen Gillespie, MS; Jean Welsh, MPH, RN; Heidi Michels Blanck, PhD


Context: High fructose intake has been associated with increased de novo lipogenesis in the liver as well as increased plasma triglycerides, insulin resistance, and obesity. Fructose occurs naturally in fruits and vegetables; however, it is added to many processed foods as table sugar (sucrose) and high-fructose corn syrup. Dietary data from a nationally representative sample in 1977-1978 estimated that mean consumption of fructose was 37 g/day (8% of total intake). Little is known about more recent fructose consumption patterns.
Objective: We determined the amount and sources of dietary fructose among US adults and children.
Design: We examined fructose consumption patterns by sex, age group, race/ethnicity, socioeconomic status, and body mass index for 21,483 children and adults. We used a single 24-hour dietary recall administered in the third National Health and Examination Survey (NHANES).
Main Outcome Measure: Weighted estimates of fructose intake were tested for significant differences (P < .05) between groups.
Results: The mean consumption of fructose was estimated to be 54.7g/day (range, 38.4-72.8) and accounted for 10.2% of total caloric intake. Consumption was highest among adolescents (12-18 years) at 72.8 g/day (12.1% of total calories). One fourth of adolescents consumed at least 15% of calories from fructose. The largest source of fructose was sugar-sweetened beverages (30%) followed by grains (22%) and fruit or fruit juice (19%).
Conclusions: Over 10% of Americans' daily calories were from fructose. These results, when compared with a previous nationally representative study, suggest that fructose consumption has increased. Further research is needed to understand the impact of increased intake of fructose on human health.

Aug 10

Kid’s self-esteem.

I think most of us parents worry about our children’s morals and for them to grow up into fine honest respectful adults.  In our effort to make them perfect, even though we are not perfect, we tend to be too critical of our kids.  I know I used to correct the minor errors when my kids drew pictures, cleaned up their rooms and such.  They would bring home a school paper that they were proud of doing.  I would say what a great job but then point out the minor errors.  If they do a job that is good for their age, then praise them and drop it. 

 I worry about our schools lowering the kids self esteem also.  It seems you have to be perfect in everything there also.  We send them to classes and have extra tutoring after school and all summer in areas that they are weak.  We put most of the time and money into their weaknesses and not enough into their strengths.  That lowers their self-esteem.  They will probably migrate to their strengths and find a job as an adult that involves those areas.  So in today’s schools, Michael Angelo, the great painter, could not go to art class because he was a little slow in math.  And Louis Armstrong, the great musician, could not go to music because he was slow in reading.  We need to work on their weaker areas but not so much that we hurt their self-esteem and neglect their strengths.  I am not for “No pass no play” policy since now sports is a profession.  They make more money than I make.  I understand the effort is to make them better students by keeping them from playing but we are preventing them from becoming a great professional ball player some day.  We need to continue to work on their academics but not hold them back from learning their potential profession.  Anyway there is a good article on this at Pediatric News:  http://www.pediatricnews.com/article/S0031-398X(08)70312-6/fulltext

 Dr. Knapp

 Aug 12

A combination vaccine was released this summer called Pentacel.  It has in one shot three vaccines: DaPT, IPV, and HIB.  So that means less needle shots at many of the visits. 


Dr. Knapp

Aug 27

We have had some teenagers (and there are probably some adults) who swallow their pills like antibiotics for acne every day without washing them down with water or food.  The pill sits half way down the esophagus and dissolves.  Then it causes a chemical burn to the lining and erodes it.  Then there is chest pain and pain with eating.  Be sure to eat or drink liquids if they cannot be taken with food after taking medications. 

 Be careful on this busy weekend of Labor Day.  By the way, there is a product going through the FDA for eventual approval.  It is a patch to “vaccinate” people against traveler’s diarrhea.  Many people when going to other countries of the world develop diarrhea.  This patch you put on your skin 2 weeks before you leave and studies show it prevented 90% of cases.  Weird huh?  Why can’t they develop regular vaccines by doing a patch and not have to have a shot?  Who knows ….. maybe someday. (And vaccines DO NOT cause Autism.:-)

 Roger Knapp MD

 Sept 9

If you take Singulair for allergies, you can print out a coupon for $20 off if you are from Texas, have private insurance and do not use mail in pharmacy.
See: www.singulair.com/coupon

Also Merck has a neat site with 3D medical animations for many illnesses like asthma and ear infections.
See: www.mercksource.com and click on 3D medical animations on the left side.

We are scheduling flu shots now and your pediatrician is probably doing the same. Call for appointments early.

Roger Knapp MD

Sept 17

The year after Scotland banned smoking in public areas, there was a 14% decrease in hospital admissions for smokers and a 20% decrease for non-smokers. I know this inconveniences some people (smokers) but the health benefits are great.  Just like the hassle of making your kids wear helmets but there was a 50% decrease in bicycling deaths per year after helmets were required and encouraged.  After awhile it becomes habit and I feel weird if I am not buckled up in the car.  Just keep telling your kids not to text message while driving.  It looks like the engineer of the train that ran the red light was text messaging just before he crashed headlong into the commuter train last week.

 I was up on my daughter’s roof in Houston last weekend covering a hole with tarps and I had a rope around my waist.  Thank goodness since I almost fell off and it saved me.  Falls are the most common cause of death in the home so be careful.  All these safety measures do help.

 By the way, here are some neat pictures of hurricane Ike:


 Roger Knapp MD

 Sept 30

There are several plants that can be poisonous to children.  Always call Poison control if there is any question.

Neil Sperry has a page that lists the plants in North Texas:

Dr. Knapp

Oct 9

A study just came out showing infants who wore a stocking hat had more sudden infant deaths.  There was also another study showing that if there was a fan in the room there was less SIDS.  I have always told parents that a fan was OK as long as it did not blow right on the baby.  So take their hat off when you go home and turn on the fan.  Sleep them on their backs and have less chance of SIDS.

 Roger Knapp MD

Nov 13

You heard of the chemical Melamine that was in China’s milk and baby formula that killed 4 children  and sickened 53,000.  The United State’s FDA screens products here and there are no Chinese companies that are approved to sell formula in America.  That is not to say some Asian specialty stores might have sneaked some in and sell it.   The FDA warns consumers not to eat White Rabbit Creamy Candy or certain coffee and tea products under the brand name “Mr. Brown” which do contain Melamine.

 Now that the mothers in China are afraid of their formulas, the old practice of Wet Nurse in coming back.  A mother over there can produce extra breast milk and nurse other babies in the town, she can increase her monthly income from 1000 yuan ($146) to 12,000 yuan.  It is hard to say how many diseases will be transmitted with this practice.  I think I would buy a goat instead.  Interesting huh?

Have a Happy Thanksgiving

Dr. Roger Knapp
also: You Tube is fun but there are videos there that are not for children.  A child safe video site is http://www.totlol.com/

 Dec 12

There was a vote by the FDA about a medication Serevent that is for opening airways in asthmatics.  They some people using it too much and not using inhaled steroids with it.  By itself the patients would rely on it alone but have to use it too much.  When used with inhaled steroids, it is not much problem.  I think it is safe when used as directed (like all meds) in combination with steroids like the medication Advair.  I will continue to use Advair with my patients. Here is a summary of the information.

Happy Holidays and Merry Christmas
see this site for a great Christmas Carol:      http://ecard.ashland.edu/2004admission/index.html

Dr. Knapp

Dec. 11, 2008 - An expert panel said Thursday that the benefits of two inhaler drugs are not worth the risks and should no longer be used to treat asthma.

The vote does not mean the two drugs, Serevent and Foradil, will be pulled from the market. Instead, the panel strongly urged the FDA to tell doctors not to prescribe the drugs to children or adults as a standalone asthma treatment.

The drugs are also widely prescribed for chronic obstructive pulmonary disease. That use was not affected by Thursday's deliberations of a 27-member FDA advisory committee.

At the same time, the experts backed two other popular asthma drugs, saying their benefits outweigh their risks.

Serevent and Foradil are in a class of drugs known as beta-agonists. They help control and prevent airway spasms during asthma attacks. But the drugs have also been associated with a small but significant increase in the risk of hospitalization and death from asthma.

Medical guidelines and the drugs' labeling recommend that beta-agonists only be used in combination with inhaled steroids that cut down on airway inflammation leading to attacks. The combination lowers the risks to a level most experts believed is justified by their benefits.

But studies show that many patients do not use inhaled steroids as directed when taking them separately from beta-agonists. At the same time, patients often feel physical relief from labored breathing when they use their beta-agonist inhaler. The difference can lead to many patients using the beta-agonist alone (called monotherapy), which raises the risk of dangerous side effects, according to FDA analyses presented this week.

"I think the label should be greatly strengthened to say that monotherapy for asthma should basically be contraindicated" for Serevent and Foradil, said Daniel Notterman, MD, a member of the advisory panel from the department of molecular biology at Princeton University.

The rest of the advisors agreed. In a 17-to-10 vote, the panel said the risks of long-term Serevent and Foradil use outweigh the benefits when used alone. The panel cast a similar vote for adolescents with asthma and voted unanimously that the drugs are not worth the risk in children 4 to 11 years old.

"The data is that single use is dangerous," said David Schoenfeld, PhD, a panelist and professor of medicine from Massachusetts General Hospital.

The panel gave broad backing to two other asthma drugs, Advair and Symbicort, in adults. Those products contain a combination of beta-agonist and steroid drugs, thus guaranteeing that patients get both drugs each time they take a puff.

The group was split on whether Advair should be used in children. Thirteen panelists said Advair's benefits outweigh its risks in children, while 11 said they did not. Three abstained.

Experts said they were uneasy with how few studies had been performed showing Advair's safety and efficacy in children.

"I think there's a paucity of data," Notterman said.

Symbicort is generally not used in children.

John Jenkins, MD, who heads FDA's Office of New Drugs, said the agency would consider ordering manufacturers to conduct more safety studies in children, which it can do under new authority granted by Congress.

Ellen Strahlman, MD, the chief medical officer of GlaxoSmithKline, which makes both Advair and Serevent, said the company was pleased with the committee's backing of Advair. But she also said the company was "concerned" that the panel's vote to restrict Serevent could "deny patients needed treatment for optimal care of their asthma."

A statement from Novartis and Schering-Plough said the companies "strongly disagree" with the panel's rejection of Foradil, which they market in a joint venture.

"We believe this opinion is inconsistent with clinical evidence supporting the benefit/risk profile of Foradil in patients not adequately controlled on other asthma-controller treatments," the statement read.

The FDA now has to go back and consider whether to change product labeling or indicated uses for Serevent and Foradil. It will also consider ordering new safety studies, Jenkins said.

Jenkins emphasized that patients currently taking Serevent or Foradil "should not stop taking your asthma medications without talking to your physician."