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2012 Newsymail Archive


Jan 9

A recent report of Lipitor and other statins increasing your chances for type 2 Diabetes.  It turns out that most of the ones that developed it were those with high risks for diabetes anyway: over weight, high blood sugar, elevated triglycerides, and high blood pressure.  I would not be overly concerned over using the statins if you have high cholesterol and high LDL.  The news love to scare us.

 Also the withdrawal of formula last month because of an infant dying of a rare bacteria.  All formula that was recalled was tested negative for any bacteria and the CDC announced it safe.  The infant acquired the infection from some other source and not the formula.   Again hold your panic until the whole story is told.  The news is always in a hurry to be the first to scare people.

 While we are talking about rare things that can scare you.  There were several cases of the brain eating amoeba that people were getting in warm stagnant ponds in the summer.  Now two cases were caused by tap water used in the sinus-irrigating neti pot.  Using sterile bottle water is simple to do.


Roger Knapp MD

 Jan 12

An economics professor at a local college made a statement that he had never failed a single student before but had once failed an entire class. That class had insisted that socialism worked and that no one would be poor and no one would be rich, a great equalizer.

 The professor then said, "OK, we will have an experiment in this class on socialism. All grades would be averaged and everyone would receive the same grade so no one would fail and no one would receive an A.

 After the first test, the grades were averaged, and everyone got a B. The students who studied hard were upset, and the students who studied little were happy.

 As the second test rolled around, the students who studied little had studied even less, and the ones who studied hard decided they wanted a free ride too so they studied little. The second test average was a D! No one was happy.

 When the 3rd test rolled around, the average was an F. The scores never increased as bickering, blame and name-calling all resulted in hard feelings, and no one would study for the benefit of anyone else.


All failed, to their great surprise, and the professor told them that socialism would also ultimately fail, because when the reward is great, the effort to succeed is great, but when government takes all the reward away, no one will try or want to succeed.  Could not be any simpler than that.

 So I believe in giving grades in school instead of everyone getting a passing.  Yes some kids will not make first place in a sport but we learn to get over defeat.  Look how many times Edison failed to make the light bulb before succeeding.  Michael Jordan was cut from his high school basketball team. Jordan once observed, "I've failed over and over again in my life. That is why I succeed."  For many examples of famous people who failed first: see: Failures 

 Also many of the things we learn growing up we learned in the school of hard knocks.  Your parents did not teach you how to handle the bully on the playground or the guy who hit on you at your job.  We parents cannot teach our children everything and we are not responsible for everything.  We are the most important influence for making our children turn out to be good, kind, and honest human beings.  When your children get upset over failures it hurts us more than it hurts them.  When we protect our children from these heart breaking events, it seems we are protecting us more than our children from these hurting feelings.  I now realize what heart aches my parents went through while raising me!


 Helicopter Parents

 Roger Knapp MD

p.s.Walt Disney, producer, director, screenwriter, animator, developer of Disneyland. Winner of 26 Oscars and 7 Emmy awards. While attending McKinley High School, he also took night classes at the Chicago Art Institute. He dropped out of high school at the age of 16 to join the army. Rejected because he was underaged, he joined the Red Cross and was sent to war in Europe. Upon his return from war, he began his artistic career.


 Jan 17

The flu is starting mid January of every year and you can see this in the charts from the CDC. You can see these changes each week by bookmarking this site and logging on occasionally. The big spike in 2009 was the H1N1 epidemic.


 Here are the CDC recommendations for treatment of the flu. Basically we should be treating the patients in high risk areas mentioned below. I do not believe in treating every child with the flu. There are some bad complications of the medications although rare. Also note that the tests for the flu are not accurate and can miss on the average 50%. So many times I may see a high risk child and treat without doing a test. If the test is positive then I will treat and if negative I still will treat if the symptoms are just like the flu. So why run the test if I am going to treat no matter what. Also if the child is not high risk, then why run the test since I am not going to treat it whether it is positive or negative. I may run the test if the parent just wants to know and in the situation where there might be high risk people in the home who might need prophylaxis.

 Summary of Influenza Antiviral Treatment Recommendations

 Clinical and observational data show that early antiviral treatment can shorten the duration of fever and illness symptoms, and reduce the risk of complications from influenza (e.g., otitis media in young children, pneumonia, respiratory failure, and death) and shorten the duration of hospitalization.

 Antiviral treatment is recommended as early as possible for any patient with confirmed or suspected influenza who

o is hospitalized;

o has severe, complicated, or progressive illness; or

o is at higher risk for influenza complications.

 Persons at higher risk for influenza complications recommended for antiviral treatment include:

o children aged <2 years;*

o adults aged ‚‰•65 years;

o persons with chronic pulmonary (including asthma), cardiovascular (except hypertension alone), renal, hepatic, hematological (including sickle cell disease), metabolic disorders (including diabetes mellitus), or neurologic and neurodevelopment conditions (including disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy [seizure disorders], stroke, intellectual disability [mental retardation], moderate to severe developmental delay, muscular dystrophy, or spinal cord injury);

o persons with immunosuppression, including that caused by medications or by HIV infection;

o women who are pregnant or postpartum (within 2 weeks after delivery);

o persons aged <19 years who are receiving long-term aspirin therapy;

o American Indians/Alaska Natives;

o persons who are morbidly obese (i.e., body-mass index ‚‰•40); and

o residents of nursing homes and other chronic-care facilities.

Diagnostic Testing for Influenza

 Rapid Influenza Diagnostic Tests (RIDTs) can be useful to identify influenza virus infection as a cause of respiratory outbreaks in any setting. RIDTs produce very quick results, but the results may not be accurate. Sensitivities of RIDTs are generally 40-70%, but a range of 10-80% has been reported compared to viral culture or reverse transcription polymerase chain reaction (RT-PCR). In particular, false negative test results are common during influenza season. Clinicians should realize that a negative RIDT result does NOT exclude a diagnosis of influenza in a patient with suspected influenza. When there is clinical suspicion of influenza and antiviral treatment is indicated, antiviral treatment should be started as soon as possible without waiting for results of additional influenza testing.

 CDC does not recommend widespread or routine use of antiviral medications for chemoprophylaxis so as to limit the possibilities that antiviral resistant viruses could emerge. Indiscriminate use of chemoprophylaxis might promote resistance to antiviral medications, or reduce antiviral medication availability for treatment of persons at higher risk for influenza complications or those who are severely ill.

 Roger Knapp MD

Feb 16

The recent news talked about the EPA announcing high levels are Arsenic in the ‚€œNatural formulas‚€Ě for infants.  It was from the organic brown rice syrup that is used for the sweetener and is among the first few ingredients.  This is not found in Enfamil or Good Start. 

There is a lot of arsenic in some brands of apple juice.   At least one sample of apple juice from the following popular brands had levels of arsenic over 10 ppb: Apple & Eve, Great Value (Walmarts house label), and Motts.

MORE: Study: The Perils of a Heavy Bottled-Water Habit

Apple juice brands that had at least one sample surpassing 5 ppb of lead were: Americas Choice (A&P), Gerber, Gold Emblem (CVS), Great Value, Joe‚€™s Kids (Trader Joe™s), Minute Maid, Seneca and Walgreens.   The brands with very low levels were Natures Own 100% Apple Juice, Tropicana 100% Apple Juice and Red Jacket Orchards 100% Fuji Apple Juice.

Roger Knapp MD

Also:  Milk and milk products provide a wealth of nutrition benefits. But raw milk can harbor dangerous microorganisms that can pose serious health risks to you and your family. According to the Centers for Disease Control and Prevention, more than 800 people in the United States have gotten sick from drinking raw milk or eating cheese made from raw milk since 1998.  Raw milk is milk from cows, sheep, or goats that has not been pasteurized to kill harmful bacteria. This raw, unpasteurized milk can carry dangerous bacteria such as Salmonella, E. coli, and Listeria, which are responsible for causing numerous foodborne illnesses.

Feb 28

Zinc has been shown in many studies to improve the immune system.  The mortality of pneumonia is significantly lowered be giving zinc.  In third world countries studies would give zinc to children who were admitted to the hospital with pneumonia, as in contrast the developed countries give the zinc all year.  Most children in third world countries are zinc deficient.  The World Health Organization said that the two things that would help improve the survival of children‚€™s pneumonia would be breast feeding and zinc.  So I recommend all year giving vitamins with zinc and iron starting 9 ‚€“ 12 months of age.  Zinc and Iron only comes in a chewable like Flintstone complete.  The gummy vitamins are very weak, does not have iron, and can cause cavities from the sticky sugar.   Give ¬Ĺ chewable vit until 3-4 years old and then a whole one.   Crush them up in food until they can chew them up themselves.

 Dr. Knapp

March 7

We have many injuries from baseballs hitting the head and neck of players.  I had one pitcher who was hit in the throat/voice box and never talked right again. If you think about it, every player on the football team wears a helmet ‚€¶ not just the runner with the ball.  And they play better if they are not worried about getting hurt.  So every player in baseball should wear a light helmet like the batter and have two bars in front to block the ball.  They would stay in there and catch the ball better if not being afraid of getting hit by the ball.  It would take the parents petitioning the baseball organization to require all players to wear them.  The boys and girls will not do it willingly.



Another topic is BO.  Yes I said underarm odor.  It frequently starts close to 6 yr old.  Other changes do not start until around 9.  They can wear antiperspirant if needed.  There are different strengths of antiperspirants.  The concentration of aluminum chlorhydrate varies from 15 to 25 %.  Mitchum is the brand that has the higher concentration.  If your brand is not working very well, then get a higher percent.  Plus the feet can have excessive sweat glands with more odor and athlete‚€™s feet.  You can also apply antiperspirant on the feet after the bath.

 Roger Knapp MD

March 25

Spring is obviously here early.  Use swim shirts and sunscreen.  I like the sprays since they dry out fast and do not stay greasy.  Spray your hand and wipe on their face.  You can use sunscreen starting at 4-6 months old.  There are many farmers out in the sunny hot fields with long blue genes on and even long sleeve shirts.  So if you are going to the park or camping, cover their bodies.  If playing around the weeds and possible poison ivy, come in and take a sudsy bath and put the clothes in the washer.  That way you rarely develop a rash.  Also  the rash of poison ivy is not contagious and does not spread around the body.  That is an old wives tale.  Also keep the off on them.  We see several cases of encephalitis every summer.

 So lets have a fun and safe summer. 

Dr. Roger Knapp MD

PS: Inhaling very much helium from a balloon so you can talk high pitched and funny, will drain the oxygen from your lungs and you will die.  Do it once and stop.

See: http://familytimemagazine.blogspot.com/2012_03_01_archive.html

 April 9

This is summer and time for fun and injuries.  Remember  I have talked in the past about wrapping injuries instead of ice.  But let‚€™s talk about teeth being knocked out.  If loose but still in place then see the dentist to get it supported until it tightens back up again.  If it is out and swallowed‚€¶ it is gone and there is no chance of saving it.  If you have the tooth, time is critical.  There is a 90% chance of survival if the tooth can be reinserted back into its socket within 30 minutes.   If you are able to push it back in, then head to the dentist.  You may have to rinse out the socket if it has blood in it.  Have them bite on cloth to hold it in place.  It is not very painful to push it back in since the nerves are broken.  If the adult cannot put it back in the socket, then put the tooth into milk.  If that is not available, then put it into water.  Or if it is the parent, you can put it under your tongue until you see the dentist.  Many schools and clinics have a balanced salt solution called ‚€œSave-a-Tooth‚€Ě that you can put it into.  Handle the tooth by the crown only and not the root. 

 Roger Knapp MD

May 4

Well they came out with another study showing a correlation between too much TV and video games and poor performance in school. Also there have been studies showing excessive TV viewing and a decrease in school work with more violent content of the movies, more sexual behavior at a younger age if they watched shows with more sexual content, delayed speech and language in toddlers, and less exercise and more weight gain with too much TV. So be a mean parent and keep it down. Of course that means we can't watch it either.... or record it to see later. Play board games with the kids or walk around the block.  Take them to the park to play.  Be sure to use sunscreen and insect repellant.  Put long pants like blue genes on them even though it is hot.  They will have less skinned knees, bug bites, sun, and itchy rashes from the grass. 

They have fireworks every Friday evening all summer at Grapevine Lake close to the Gaylord.  Very impressive show.  Take some drinks, chairs, and snacks and have a fun evening.

 Dr. Knapp MD

May 13

Summer problems are already starting.  Swimmer‚€™s ear infection is caused by the water changing the pH of the ear canal so putting ¬Ĺ alcohol and ¬Ĺ vinegar solution in their ears after swimming will help prevent it.  Swimmer‚€™s ears hurt to move the outer earlobe.  Once infected you will need to get some antibiotic drops to put into the ear canal. 

 If you or your child work out in the weeds and vines, you can get a rash like poison ivy since many plants can cause the same rash.  Also the rash is not contagious and you cannot spread it from the skin rash.  Treat with steroid creams and if more severe you can come in and get a stronger Rx.  But if you wear long pants, sleeves and gloves and then take a bath right away, you likely will not break out.

 Ticks have to be on you for more than 48 hours to cause diseases like Lyme Disease.  Check yourself and the kids after going out where you might be in contact with them.

 Sports or other injuries will cause a swelling quickly.  Example is a sprang ankle.  It bleeds in the tissues and joint.  Immediately wrap it with tape and leave on for 24 hours.  Ice will not help very much.

 Have a safe and fun summer.

 Dr. Knapp

If you are going to Disney World, get the Disney World Magic Guide app for your phone. It has maps, wait times for all rides, Park hours, and dining information like menus and prices. If you have reservations it will keep them for you and remind you.  It is worth the price.

May 21

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 cooler water but watch the temperature frequently. Personally I prefer a rubber blow up pool. Then let the hose sit in the sun where the water in the hose gets very hot.   Then add that to the water in the pool and that will warm up the water some.

 I don't recommend actually teaching the infant to "swim"Ě over to the edge of the pool and "save themselves".Ě 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 or keep from going under immediately 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 swimmingĚ lessons where the moms 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 and swim shirts!

 Dr. Knapp MD

See http://www.rogerknapp.com/medical/swimmerear.htm on how to prevent swimmer‚€™s ear infection.

 Also if you want to see what melanoma looks like, See:


May 23

Breast development occurs many times while growing up.

There can be breasts in 1-2 months old from the hormones in the breast milk.

They can put out milk and it was called Witches Milk in the old days.

There is Premature Thelarche at around 1 year of age that is not abnormal.

See: http://www.rogerknapp.com/medical/prematurethelarche.htm

There is breast development at puberty obviously in females but males at 11-13 years can

also have a breast bud.  Usually a quarter size lump under the nipple that stays there for a

year or so and is tender like someone hurt it.  It is normal.  It does not happen to all boys.

And then there are old men breasts too.

 So don't be alarmed at these stages.


R. Knapp MD

May 29

Many medications that are purchased/manufactured in other countries can be counterfit.

The price of medications can be high in the US because the FDA has strict requirements.

Drugs sold from Canada, Asia, and Europe, frequently are fake‚€¶ as much at 50% of them.



Avastin cancer drug

Malaria drug

Vicodin pain med.

Emergency birth control


Weightloss medicines like Alli and Phentermine.


 See for more information:




 Signs of a trustworthy website

  • It's located in the United States.
  • It's licensed by the state board of pharmacy where the website is operating. A list of these boards is available at the website of the National Association of Boards of Pharmacy4.
  • It has a licensed pharmacist available to answer your questions.
  • It requires a prescription for prescription medicines from your doctor or another health care professional who is licensed to prescribe medicines.
  • It provides contact information and allows you to talk to a person if you have problems or questions.

Signs of an unsafe website

  • It sends you drugs with unknown quality or origin.
  • It gives you the wrong drug or another dangerous product for your illness.
  • It doesn't provide a way to contact the website by phone.
  • It offers prices that are dramatically lower than the competition.
  • It may offer to sell prescription drugs without a prescription‚€”this is against the law!
  • It may not protect your personal information.

Dr. Knapp

 June 17

A new study published in the Journal of Early Adolescence found that dads are in a unique position to instill persistence and hope in their children, particularly in the pre-teen and teen years.  Researchers from Brigham Young University analyzed 325 families over a four-year period, when fathers responded to questionnaires regarding their parenting style, and children ages 11 to 14 responded to questions about school performance and attaining goals. Fathers who practiced authoritative parenting, defined as providing feelings of love, granting autonomy and emphasizing accountability to a child, were more likely to have kids who developed the art of persistence, which led to better outcomes in school and lower instances of misbehavior.  "It's important to say that moms can do this, too, but it turns out that when fathers use authoritative parenting, they have an impact on how their adolescents perceive themselves and how persistent they are in their lives."

See: http://abcnews.go.com/Health/persistence-learned-fathers-study/story?id=16571927

So Happy Father's Day to all you Dads.  The best results of raising children comes from both parents contributing to raising the children. 

 Dr. Knapp

 Like Marry Poppins said in the song:

A Spoonful of sugar helps the medicine go down
The medicine go down
The medicine go down
Just a spoonful of sugar helps the medicine go down
In a most delightful way


Getting kids to take medicine sometimes can be a challenge.  I don‚€™t recommend holding them down and forcing it unless all other options have been tried.  Here are some suggestions to help the medicine go down.

 Put the medicine into the cheek and have them drink something they really like.

 Give a cold treat (eg, frozen slushy drink, ice pop, or ice chips) immediately before and after the medication in order to numb the taste buds and minimize the aftertaste of the medication;

 Add such sweeteners as chocolate syrup, strawberry syrup, maple syrup, or sweetened soft-drink mix (eg, Kool-Aid¬ģ) to the child's dose of liquid medication;

Give the child a lollipop or other hard candy after taking medication to overpower the aftertaste;

 Add a flavoring agent, such as FLAVORx¬ģ, to the liquid medication when a prescription is filled.  FLAVORx flavoring options are available for many commonly used pediatric medications. The subsequent impact on the stability of the resultant product must be considered and communicated to caregivers;

 Add chocolate syrup or concentrated frozen orange juice to bitter or salty-tasting liquids (eg, promethazine, diphenhydramine).

 What about swallowing pills?  I could not swallow them until I was a high school senior.  For years I used food.  The teenager can swallow a big bite of hamburger but that little pill gags them.   So bite off a big hunk of food, chew it up and when you are ready to swallow it, push the pill into the big wad of food that is in your mouth and swallow.  Then gradually put it into less and less food until you can just swallow the pill. 

 Just a reminder: keep all meds locked up. Poison Control number: 800-222-1222



July 10

Dramatic news!   For healthier kids, get a cat or dog, study suggests.Ě


I love dogs and have two of them.  One sleeps on my bed.  There are many benefits to pet  cats and dogs.  One study showed less allergies in kids who grew up with a cat.  There is an old wise tale that a Chihuahua will stop the kid’s asthma.  This study is poorly done and the author even states it shows a correlation and not cause and effect.  But the news probably does not read much of the details of the study and reports this stuff.   They dramatize it as if there is a huge benefit and every one should go out and get a dog.  Here are the actual numbers of healthy weeks for the kids in the study with bars showing cats and dogs.  Not a big difference. 

 See Bar Graph on page 4 in the article: http://pediatrics.aappublications.org/content/early/2012/07/03/peds.2011-2825.full.pdf+html 

 It always helps to actually look at the study details. The best way to get good medical information (rather than some web site put up by somebody that wants to sell you an education program or vitamins or some great discovery product) then go to Google Scholar Search. That will give you scientific medical studies. But still read them with a critical eye.

 Roger Knapp MD


July 21

Well the news was talking about a big epidemic of whooping cough (Pertussis).  18,000 cases and nine deaths so far this year.


There is an increase but this occurs every 3-4 years. 


Year                             Reported Cases*

2000                             7,867

2001                             7,580

2002                             9,771

2003                             11,647

2004                             25,827

2005                             25,616

2006                             15,632

2007                             10,454

2008                             13,278

2009                             16,858

2010                             27,550

2011                             15,216

2012                           18,000 so far this year.


 It is hard to say if this year‚€™s cases will continue at this rate or die off and be the same as 2005 or 2010.   Texas had a very tiny increase in cases.  Here are the ones that had the big increase.

 States with incidence of pertussis the same or higher than the national incidence (as of July 5, 2012), which is 5.24/100,000 persons

Wisconsin                   50.7     Utah                         14.2     New York State                7.3

Washington                39.2     Maine                       14.1     Illinois                                 6.7

Montana                      32.7     Oregon                    13.4     Pennsylvania                    6.3

Vermont                       23.7     New Mexico           11.7     Missouri                             5.8

Minnesota                   23.4     Arizona                   8.3       Idaho                                   5.7

Iowa                              21.0     Colorado                8.2       Alaska                                 5.2

 I think all these vaccines do not last a lifetime.  We have known a long time that tetanus had to be repeated every 10 years.  The adult DPT vaccine was released and recommended in 2005 to prevent adults from getting whooping cough and giving it to infants.  When that vaccine came out, I went and got it because I don‚€™t want to cough my head off for 3 months and not give whooping cough to my patients or grandchildren.  I recommend it to all adults and especially to pregnant and postpartum mothers, fathers, and grandparents.


 I also recommend those over 50 get the shingles vaccine (which is chicken pox‚€¶ even the real disease may not last a lifetime.) 

 There needs to be 90% of the community vaccinated to prevent major outbreaks.  There is no vaccine that works 100% but if every one gets the vaccine and less than 10% fail to develop immunity, then we still do a good job of controlling a deadly disease.  But if there are 8% failures of the vaccine and 8% idiots who refuse vaccines, then there is an outbreak. 

 Yes I called parents who do not vaccinate Idiots.  They are paranoid  gullible people who believe what they read on the internet.  Vaccines do not cause autism and I do not believe there is an increase in autism.

  In 2009, nearly 17,000 cases of whooping cough and 14 deaths were reported nationally. Worldwide, there are 30-50 million cases of whooping cough and about 300,000 deaths per year.

 Roger Knapp MD


August 20

There was a study reported lately : http://healthland.time.com/2012/08/20/study-shows-anesthesia-may-lead-to-language-deficits-in-children/  that linked exposure to anesthesia to learning disabilities, finding that exposed kids had lower scores on standardized tests of reading, writing, math and reasoning, and were more likely to have behavioral issues at school. Another study in 2012 found that children who underwent multiple exposures to anesthesia early on were twice as likely to be diagnosed with attention deficit/hyperactivity disorder as teenagers, compared with children with fewer exposures to such drugs.

But some studies reported no effect ‚€¶. Some researchers are looking for an effect to prove their point  and some want to prove no effect. 

 Same with the effect of ear infections and fluid on speech development.  One showing an effect and another showing none.

 One study showed none to very small negative associations of OME and associated hearing loss to children‚€™s later speech and language development.  http://pediatrics.aappublications.org/content/113/3/e238.short

 Still another showing no help with tubes: http://www.nejm.org/doi/full/10.1056/NEJM200104193441601

 So I tend to be rather conservative about putting PE tubes in infant‚€™s ears.  I do sometimes recommend it but only when they are very frequent.  Every doctor has their limit when they recommend tubes.  Some do it with very few infections and some after too many.  The scar from the tubes lowers the hearing rarely just like fluid in the ears. 

 Many children get tubes about when their speech is about to improve and take off and the tubes get credit for doing it.  

 If the child is having a few infections during the winter, that is typical.   If they continue to have them in the summer when most will stop having them, then you need to consider tubes.

 Dr. Knapp


 August 24

Car seats as you know saves lives.  Here are the requirements or recommendations in the Texas car seat law:

Child Passenger Safety Best Practice Recommendations

Phase 1   Rear-Facing Seats

Infants: Birth - 35 pounds. Rear-facing infant or rear-facing convertible safety seat as long as possible,up to the rear-facing height or weight limit of the seat. Properly install rear-facing in the back seat.

Phase 2  Forward-facing Seats

When children outgrow the rear-facing safety seat, they should ride in a forward-facing safety seat as long as possible, up to the upper height or weight limit (40 - 80 pounds) of the harnesses. Usually 4+ years old. Properly installed forward-facing in the back seat. NEVER turn forward-facing before 1 year old AND 20-22 pounds.

Phase 3  Booster Seats

After age 4 and 40+ pounds, children can ride in a booster seat with the adult lap and shoulder belt until the adult safety belt will fit them properly (usually when the child is 4'9" tall).
MUST have a lap/shoulder belt to use a booster seat.

Phase 4  Adult Safety Belt

Once children outgrow their booster seat (usually at 4'9", 100 pounds) they can use the adult safety belt if it fits them properly.
Lap portion low over the hips/tops of thighs and shoulder belt crosses the center of the shoulder and center of the chest.

 You notice the mostly have age or weight until they say 4‚€™9‚€Ě can be in an adult seat.  But there is a two fold difference in the size and age of children.  A large 1 year old can be the same size as a small 2 year old.  A large 3 year old can be the same size as a small 6 year old.  And it is the height of the child that is important because it is the location of the straps on the body that hold them in.    It is not the weight.  So if your child has outgrown the seat and they fit the next size car seat, move them up regardless of their weight or age.   The shoulder strap should go straight back off the top of the shoulder to the insert in the back of the seat. 

 BabiesRus has a sale until Sept 16 for 25% off if you bring in your old item: car seat, stroller, Travel System, high chair, play yard, bassinet, swing, bouncer, entertainer, walker and jumper. 


 Roger Knapp MD

September 12

There are injuries from batteries frequently.  The sad thing is that small children swallow batteries… especially the small button batteries.  Of particular concern is the ingestion of button batteries, especially those ≥20 mm in diameter (coin size), which can lodge in the esophagus, leading to serious complications or death.  Watch out for kids and those small batteries.   Many injuries, endoscopies, and deaths occur because they swallow one. 

For more info:



Dr. Knapp

 September 15

Iron and zinc are important for our bodies … both for anemia and neurologic development.


 Iron deficiency anemia is the most frequent micronutrient deficiency in the developing countries like India especially affecting pregnant women and young children. Iron is an essential element involved in myelin formation, neurotransmitter synthesis and neuro-metabolism. Several behavioural disturbances have been reported in iron deficient children. In the present study, we determined the prevalence of iron deficiency anemia in children with behavioural disorders and assessed the improvement in terms of symptoms …… significant improvement in the clinical features, haematological profile and iron status. The presence of iron deficiency in children with behavioural disorders and subsequent improvement in clinical features, haematological profile and iron status suggests a possible causal relationship between iron deficiency and behavioural disorders.


 Of the original 191 participants, 87% were reevaluated at 11 to 14 years old. The children were free of iron deficiency and growing normally by US standards. Those who had chronic, severe iron deficiency in infancy were compared with those who had good iron status before and/or after iron therapy in infancy.

OUTCOME MEASURES: Comprehensive set of cognitive, socioemotional, and motor tests and measures of school functioning.

RESULTS: Children who had severe, chronic iron deficiency in infancy scored lower on measures of mental and motor functioning. After control for background factors, differences remained statistically significant in arithmetic achievement and written expression, motor functioning, and some specific cognitive processes (spatial memory, selective recall, and tachistoscopic threshold). More of the formerly iron-deficient children had repeated a grade and/or been referred for special services or tutoring. Their parents and teachers rated their behavior as more problematic in several areas, agreeing in increased concerns about anxiety/depression, social problems, and attention problems.

CONCLUSIONS: Chronic iron deficiency in infancy identifies children who continue at developmental and behavioral risk >10 years after iron treatment.

 And Zinc has been shown to improve the immune system and decrease severity and mortality of diseases.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2277319/  Some studies suggest a slight effect on development. 

 That is why I recommend supplement of vitamins with zinc and iron.  We should start it between 9-12 months and continue till 100 years old.   We have such active life styles that we don’t eat right every day.   Liquid does not have zinc and stains the teeth brown.  Gummy vitamins do not have iron and is too much sugar for the teeth.  The main food from which we get these is Red Meat.. which we eat less of these days.

 Roger Knapp MD

 September 19

Well the press is at it again.  They reported: CBS/AP) A new study from Consumer Reports claims samples of white rice, brown rice and rice breakfast cereals that many U.S. adults and children eat may contain worrisome levels of arsenic. The magazine tested more than 200 samples of rice products - including popular brands, store brands and even organic ones - and found measurable amounts of arsenic in "virtually every product tested."  "We found significant levels of inorganic arsenic, which is a carcinogen, in almost every product category, along with organic arsenic, which is less toxic but still of concern," the authors wrote.”

 The actual numbers of arsenic in each brand of rice can be found here:


 Here are some numbers from that chart:

Whole foods Brown Rice:   210-282 ppb and 7.4-8.4 micrograms/serving of inorganic arsenic.

Archer Farms Target white: 54-81 ppb and 1.3-2.2 micrograms/serving

Infant Cereal beech-Nut:    110-130 ppb and 0.8-1.0 micrograms/serving

Infant Gerber rice cereal:    97-329 ppb and 0.8-1.3 micrograms/serving

 Their statement was: “We also discovered that some infant rice cereals, which are often a baby’s first solid food, had levels of inorganic arsenic at least five times more than has been found in alternatives such as oatmeal.”  Well if oatmeal has 0.7 micrograms then five times that is 3.5 micrograms in rice … still low levels.  Why did they not compare the levels to what is in a rock so they could report it was 1000 times the amout!

 The articles reported:   “So far, both studies show relatively similar levels of arsenic in rice. The FDA's analysis, including 200 samples, showed average levels of 3.5 to 6.7 micrograms of inorganic arsenic per serving. Consumer Reports, with 223 samples, found levels up to 8.7 micrograms. A microgram is one billionth of a kilogram.”

 You notice they reported to the press “up to 8.7 micrograms” when in fact if you look at the levels they found, most were 3-5 micrograms.  They put the highest number up there and said how it is 1 Ĺ times the limit… and they used the lowest water limit in the country of 5ppb when EPA said the limit was 10.  Here is what they said:

No federal limit exists for arsenic in most foods, but the standard for drinking water is 10 parts per billion (ppb). Keep in mind: That level is twice the 5 ppb that the EPA originally proposed and that New Jersey actually established. Using the 5-ppb standard in our study, we found that a single serving of some rices could give an average adult almost one and a half times the inorganic arsenic he or she would get from a whole day’s consumption of water, about 1 liter.”

 If you are paranoid, you may be able to cut your exposure to inorganic arsenic in rice by rinsing raw rice thoroughly before cooking, using a ratio of 6 cups water to 1 cup rice for cooking and draining the excess water afterward.

 I don’t think there should be any arsenic in the food and water but there is no way to exterminate every mosquitoe in DFW and there is no way to have zero arsenic in water, rice, vegetables, and fruit.  It is also in weather treated wood in children’s playground equipment.  We just need to keep it down as low as we can in foods and eat a variety of foods… too much of any one food is bad for us. I will wait to see what the FDA decides when they finish their evaluation.  Go ahead and give some rice cereal.  If you are giving rice cereal to 2 month old or older infants, alternate it with oatmeal if you are concerned.  No wheat or barley until 6 months. 




 Roger Knapp MD


 p.s.  Same scare with BPA.  here is one study: Bisphenol A (BPA) is a widely used chemical. We examined the association between urinary BPA levels and obesity in the National Health and Nutritional Examination Survey (NHANES) 2003–2008. The main outcome of interest was obesity defined as (1) body mass index (BMI) ≥ 30 Kg/m2 and (2) waist circumference (WC) ≥ 102 cm in men and ≥ 88 cm in women. Urinary BPA levels were examined in quartiles. Overall, we observed a positive association between increasing levels of urinary BPA and both measures of obesity, independent of potential confounding factors including, smoking, alcohol consumption, and serum cholesterol levels. Compared to quartile 1 (referent), the multivariate-adjusted odds ratio (95% confidence interval) associated with quartile 4 for BMI-based obesity was 1.69 (1.30–2.20); P-trend < 0.0001 and for WC-based obesity was 1.59 (1.21–2.09); P-trend = 0.0009. This association between BPA and both measures of obesity was consistently present across gender and race-ethnic groups (all P-trend < 0.05). Elevated levels of urinary BPA are associated with measures of obesity independent of traditional risk factors. This association is consistently present across gender and race-ethnic groups. Future prospective studies are needed to confirm or disprove this finding.  

 Now when you look at their actual numbers, they could not get a statistical difference when they used the whole group so they divided them up into fourths. The lower fourth for some reason had less obesity but the upper 3/4ths were all the same amount of obesity.  So if you compared the next to the lowest quarter of patients to the highest quarter, there was no difference.  They try to present the numbers so it looks like a big difference. 

 Again I hope they take the stuff out of our plastic bottles but I can't see it causing massive obesity in the population. Could it be all the cokes they are drinking?



October 12

In January of this year, Agriculture Secretary Tom Vilsack and First Lady Michelle Obama revealed new standards for school lunches, in order to reduce calorie intake and help kids eat healthier. The new meal requirements were the first in over 15 years to improve meal plan programs for the millions of kids around the world who take part in school meal plans.

The new standards came after the Healthy, Hunger-Free Kids Act, which was advocated by Michelle Obama as a component of her Let's Move! drive, and made law by President Obama in 2010. The new standards are now in place this Fall in all public schools.

I personally think offering a healthier meal and then educating the kids to make better choices will work better.   Studies show that stopping sugar drinks at school did not help since they went home from school and drank them at home.  Educating kids, parents, and society to eat healthier should be our main goal instead of legislating all of us to be healthy.  This is America with freedoms and not a socialistic or communistic country.  There has been a decrease in teen pregnancies, drugs, and bullying with education.  Not everyone in society will follow guidelines set and we cannot legislate morality.  There will always be people who do not care of themselves or their kids. But we can improve our society through parents setting good examples and the teachers giving lessons on better health.

The guidelines for school meals, included:

         Lowering the amount of sodium, trans fat, and saturated fat

         Only serving fat free and low-fat milk

         Reducing calorie intake & making sure portion size is appropriate, according to the children's ages

         Making certain that kids are offered vegetables and fruit every day of the week

According to the United States Department of Agriculture, $3.2 billion will be spent in the next 5 years, in order to keep the standards in place.

The new guidelines for school meals across the nation are:

         Kindergarten to 5th grade - 650 calories

         6th to 8th grade - 700 calories

         9 to 12th grade - 850 calories

I think these numbers are too small for many kids.  Some parents are saying that kids are coming home hungrier than before, and teachers are claiming that kids are hungry an hour after their lunch break, making them sleepy and unfocused. Many argue that even 850 calories (which are being given to high school aged children) are not enough for some growing adolescents, saying all children are different and need varying amount of calories a day, depending on their bodies.

The video "We are Hungry" was filmed by high school students and teachers in Kansas. Kansas Representative Tim Huelskamp said, "This is a great product of some small town students and their teachers."


 It takes time to get kids to learn to like new foods. Here are some tips to help your children eat healthy foods:

         Make time to join your child for lunch in the school cafeteria.

         When your child gets home from school, ask what he/she ate for lunch.

         Eat meals with your child as much as you can. Let your child see you eating fruits, vegetables, and whole grains at meals and snacks.

         Grocery shopping can teach your children about healthy eating. Talk to them about where vegetables, fruits and grains, and milk and meat come from. Let your children make healthy choices.

         Try new foods yourself. Describe how they smell, feel and taste. Offer one new food at a time. Serve something your child likes with the new food.

         The School Day Just Got Healthier. Together we can help our kids learn healthy habits that last forever.


What can parents do to help the whole family eat healthier?

 1.    switch to fat-free or low-fat (1%) milk

They have the same amount of calcium and other essential nutrients as whole milk, but fewer calories and less saturated fat.

2.    make half your grains whole grains

To eat more whole grains, substitute a whole-grain product for a refined product—such as eating wholewheat bread instead of white bread or brown rice instead of white rice.

3.    foods to eat less often

Cut back on foods high in solid fats, added sugars, and salt. They include cakes, cookies, ice cream, candies, sweetened drinks, pizza, and fatty meats like ribs, sausages, bacon, and hot dogs. Use these foods as occasional treats, not everyday foods.

4.    compare sodium in foods

Use the Nutrition Facts label to choose lower sodium versions of foods like soup, bread, and frozen meals. Select canned foods labeled “low sodium,” ”reduced sodium,” or “no salt added.”

5.    drink water instead of sugary drinks

Cut calories by drinking water or unsweetened beverages. Soda, energy drinks, and sports drinks are a major source of added sugar, and calories, in American diets.

6.    balance calories

Find out how many calories YOU need for a day as a first step in managing your weight. Go to www.ChooseMyPlate.gov to find your calorie level. Being physically active also helps you balance calories.

7.    enjoy your food, but eat less

Take the time to fully enjoy your food as you eat it. Eating too fast or when your attention is elsewhere may lead to eating too many calories. Pay attention to hunger and fullness cues before, during, and after meals. Use them to recognize when to eat and when you’ve had enough.

8.    avoid oversized portions

Use a smaller plate, bowl, and glass. Portion out foods before you eat. When eating out, choose a smaller size option, share a dish, or take home part of your meal.

9.    foods to eat more often

Eat more vegetables, fruits, whole grains, and fat-free or 1% milk and dairy products. These foods have  the nutrients you need for health—including potassium, calcium, vitamin D, and fiber. Make them the basis for meals and snacks.

10.make half your plate fruits and vegetables

Choose red, orange, and dark-green vegetables like tomatoes, sweet potatoes, and broccoli, along with other vegetables for your meals. Add fruit to meals as part of main or side dishes or as dessert.

 Enough of this… I’m going to go get a bowl of ice-cream.

Have a good weekend.

 Roger Knapp MD


October 17

The news reported that the 11 yr study showed 8% less cancers in men who took a regular multiple vitamins daily.  There are several reasons why I recommend a chewable vitamin for kids that have iron and zinc but maybe this is another good reason to take on.  I take one every day.

 The meningitis lately on the news is a fungus that contaminated medications that doctors injected into the back of patients.  It is not contagious like regular meningitis.  I have not seen a case of meningitis for the last 15 years since the HIB and Prevnar vaccines have come out.  We went from 20,000 cases a year to now 30.  Half are brain damaged and 10% die no matter what treatment.  Refusing vaccines is insane and child neglect.

 I and the American Accademy of Pediatrics do not recommend saving your infant’s cord blood.  The DNA still has the problem of that congenital anemia, immune deficiency, or caner so most transplant doctors will not want your infants stem cells.   The state of Texas has a cord blood bank free for all patients to donate to and get stem cells from it.   I do not recommend paying money to these private cord blood banks. 

 Roger Knapp

 The holidays are coming:

For those in our area:

1.       There is a great activity at the state fair if you are planning to go  during this last weekend.  It is the peewee Stampede.  For 3-6 yr olds… what a fun time.  Not many people know of it.  It is close to the Childrens Med. Center Petting zoo.

See a video of it:


 Here are the times.



2.       Great pumpkin patches are great fun, cheap, and great photo opportunities.   Two of the better ones are:

Colleyville Halls Farm:


And in Flower Mound:



3.       Best place for Santa pictures are at Bass Pro near the Grapevine Mall.   Free picture and fun activities.  During the busy times they will give you a “ticket” to come back at a certain time to get right in.  We get one and go eat and come back so you can get right in.


November 14

The news is full this week about the flu and Autism.

 Some of this Newsymail is taken from :
Infection-Autism Link: Is It Real?

By Nancy Walsh, MedPage Today Published: November 12, 2012

Atladůttir and colleagues analyzed data from the Danish National Birth Cohort, which enrolled 101,033 pregnant women between 1996 and 2002.  Among their offspring, 976 were diagnosed with autism spectrum disorder and 342 with infantile autism.  Mean follow-up was about 10 years.

Overall, no associations were seen for infections and autism spectrum disorder, although a twofold increased risk was seen for the more severe subtype of infantile autism following maternal influenza infection, according to HjŲrdis ”sk Atladůttir, MD, PhD, of the University of Aarhus in Denmark, and colleagues.

The problems with the study:  The analysis was exploratory and involved multiple testing, so the findings could have resulted from chance, they cautioned, noting that this was a "great limitation" of the study.  But they urged caution with the new findings, especially because of statistical limitations in their number-crunching.  "I really want to emphasize that this is not something you should worry about," said lead author Dr. Hjordis Osk Atladottir, from the University of Aarhus.  "Ninety-nine percent of women with influenza do not have a child with autism," she told Reuters Health. "If it were me that was pregnant, I wouldn't do anything different from before, because our research is so early and exploratory."  Several other methodologic limitations included the possibility of bias in participation, the general nature of the questions asked of the mothers, and the likely inaccurate reporting of influenza.

But no significant associations were seen for either autism spectrum disorder or infantile autism according to the trimester in which a maternal infection occurred.

It could also be "a coincidental finding," they noted.

"Our results do not suggest that mild infections, febrile episodes, or use of antibiotics during pregnancy are strong risk factors for autism spectrum disorder and infantile autism," Atladůttir and colleagues stated.

However, they were unable to rule out the possibility of an association, and called for "further research on this important topic."

 In summary:

It remains unclear whether mothers who develop common infections during pregnancy are more likely to have autistic children.

Note that no significant associations were seen for either autism spectrum disorder or infantile autism according to the trimester in which a maternal infection occurred.

It remains unclear whether mothers who develop common infections during pregnancy are more likely to have autistic children, Danish researchers said.

 For more info see: http://www.foxnews.com/health/2012/11/12/study-tentatively-links-flu-in-pregnancy-and-autism/ Of course Fox News have a more reasonable reporting than the other major channels who like to make the news sound horrible to get viewers.

Previous studies looking at risks in women and their offspring have turned in conflicting results and have not considered specific infections or timing of the infection.  Also many studies have blamed autism on different things… such as age or prematurity.

The Journal of Pediatrics  Volume 161, Issue 5 , Pages 830-836, November 2012  “Risk of Autism Spectrum Disorders in Low Birth Weight and Small for Gestational Age Infants”

 There is no need for high concern here.   Even though I am not sure there is an increase in Autism with the flu,  please get your flu shots even though you are pregnant… there is no risks with the shot and there is a higher maternal mortality with flu during pregnancy. 

 Roger Knapp MD


November 18

All of us parents look for help with disciplining our kids.  Here is a fairly good article.


 Try to discipline your child in the same tone and demeanor as you would someone at your work whom you are correcting.  Use a firm yet respectful tone. If you use a derogatory hateful belittling tone, then it harms your relationship with the child, harms their self-esteem, and they will sometimes do some more bad stuff just to spite you.  Would you want someone to talk to you the way you talk to your child?

 Read: http://www.rogerknapp.com/medical/behaveworse.htm

 Happy Thanksgiving.

Roger Knapp MD

November 29

The incidence of Whooping Cough has increased since the 1990s because the DaPT is weaker than the old fashion DPT.  The Old DPT had the whole cell pertussis with 54 proteins.  It caused fever , crying for days, and hot sore legs.  The new acellular pertussis had only a few proteins and caused very little side effects.  But the immunity did not last long and older kids are now getting whooping cough and giving it to infants who can die from it.  We have been reboostering the 12 yr olds and pregnant mothers/dads  with DaPT but it still is not working well.  The CDC is not sure what to do.  I think they should give the old DPT to the 4 yr olds who are older and bigger and should not have as severe reaction.  That would hopefully stimulate enough immunity to last longer.  The link below shows the age incidence and the older adults did not get whooping cough since they were given the old vaccine DPT.

 2000   7,867

2001   7,580

2002   9,771

2003   11,647

2004   25,827

2005   25,616

2006   15,632

2007   10,454

2008   13,278

2009   16,858

2010   27,550

2011   18,719

2012   37,000

 For age incidence See:  http://www.cdc.gov/pertussis/images/incidence-graph-age.jpg

For outbreak information see: http://www.cdc.gov/pertussis/outbreaks.html

 Roger Knapp MD

December 12, 2012

It is interesting how we want to get a certain diagnosis.  We go to the doctor and he says it is a certain diagnosis.  For example he says it is a viral chest cold.  Then we think it must be pneumonia and we go see another doctor who takes an xray and says “Oh it is pneumonia and we must treat this or horrible things will happen.”   Who was right?  The first doctor may have been right but we want to believe there is pneumonia so we think the second one is correct.  The first doctor just did not know what he was talking about. 

 We have discussed in the past that the xray shows mucous… it can be asthma, viral chest cold, or bacterial infection.  But the Xray does not know the difference.  Also some doctors want to “steal patients” so they find things that your doctor must have missed and dramatize it.  The hope is that you will become their patient and also gives them an ego boost. 

 Care now clinics xray every one that comes in the door with a cough.  They make money on it and they over diagnose bronchitis and pneumonia.  At least they over treat things and are less likely to miss something.  Many doctors practice “defensive” medicine and run too many tests and give too many medications like antibiotics.

 We are seeing some flu and a lot of common viral chest colds.  Croup that is viral is usually in Sept and Oct but this year it was late and we saw most of it in Nov and Dec.  The fever in the first 4 days of the cough is generally the viral cold and fever after day 5 is bacterial secondary infections.  That is when we should see them… fever or crying with ear pain after the 5th day. 

 Dr. Knapp

 p.s.  Study shows A few days in nature improves mental clarity and reasoning.  See: http://www.sltrib.com/sltrib/news/55444364-78/nature-louv-strayer-technology.html.csp
Yea for the Boy and Girl Scout Campouts.   I know when I go hiking or camping I come back refreshed.

December 17, 2012

What a terrible thing in Connecticut last week. How do we look for emotional problems in our kids where they might be at risk for either suicide or mass murder like last week.

 Irritability, pervasive sadness, decrease in academic performance, behavioral problems, appetite and sleep changes, and frequent physical complaints.  Loner and not many friends.

 There is a big increase in suicide or shooting others during teen and early 20 yr. olds.

 Monitor their online social sites and emails.  Monitor text messages.  Ask their school mates what they think about your child.

 Counseling and medication best long term results.  Cognitive behavior is the best counseling.

Get them into activities or groups where they can make friends and feel better about themselves.

 After tragedies on the national news, answer their questions in a calm manner.  Do not let them see your anxiety and fears.  Decrease the amount of TV shows. Do not let them join groups that “share feelings and fears” since it just heightens their anxieties.  A few weeks of anxiety and questions and fear in the child is normal.  If it continues after 2 weeks then seek advice or counseling.

 Dr. Knapp

There is a big increase in flu now.  See charts at my web site:  http://www.rogerknapp.com/medical/flu.htm