Past Newsymails of 2017

Jan 3

Influenza is definitely on the rise now.  You will have high fever and BAD headache for 3 days.  Some will have cough that will last several weeks.  Tamiflu Medication only shortens the illness by 18 hours.  The main recommendations from the CDC is to treat high risk patients like those below 2 yr, pregnant women, elderly,  those with major health issues like bad asthma, cancer, diabetes, etc., and those ill enough to be hospitalized.  Some clinics give out Tamiflu to everyone in the family but it is expensive, many kids throw it up, and rare teen psychiatric complication.   The medication does not prevent bacterial pneumonia the following week and that is more deadly than the actual flu.  Any fevers after the 4^th day of illness is very serious and needs antibiotics.  To give everyone in the family Tamiflu is silly since after the 5 days of medication you still can catch the flu from those at school, work, church, etc.  You aren’t going to take Tamiflu all winter!  If there is an elderly grandparent who is bed ridden staying in the house, then that person should take it to keep from catching the flu. The test for the flu is not accurate and most tests only pick up 50% of the illnesses.  So the CDC recommends approaching the patient as if they have the flu when symptoms and the physical findings are typical during flu epidemics.  The test helps if positive but if it is negative, you still could have the flu.  If the test is not going to change what you are going to do for the patient, then why run the test? Wash your hands and kids… don’t share drinks with person who looks fine but will have fever that night.

 Roger Knapp MD

Jan 9

We went on a trip to Austin this weekend with our grandchildren.  The one year old was in the sun in her car seat.  So my wife pulls out some ShadeSox and put it over the car door blocking the sun.  Easy to put on and take off.  Worked great and you can still see out the window.  It did not make noise in the wind.  Worked great.  There are several brands on the market.

EZ-Slip Premium Adjustable Shade
ShadeSox
Window Sox
Komfortology sun shade

Jan 11

Itchy bottoms in 2-7 yr olds.  There are several causes and the one most people think of at first is pin worms. They can sure cause it and especially at night. Little white threads 1 cm and moving in the stool or see them outside anus at night.   The medication for them is PinX and is over the counter.  There are several other causes of itchy bottoms.  Not wiping well or using chemical wipes.  Just use paper or water and paper.  Coat the area with Vaseline, A&D ointment, or my Bobo cream concoction at my web site under diaper rash article.  The itchy bottom can also be caused by a strep infection around the anus called Perianal Strep infection. It looks like this picture.  It is irritated feeling and they scratch it.  It is treated by oral antibiotics.  It is uncommon but I see one a year in my practice. Some people think it is just a rash but it is an infection that needs treating. Then there are yeast rashes and body lice that can cause itchy bottoms as well.  Yucky topic but common in kids and rarely adults.

 Roger Knapp MD
 

Jan 24

There are many causes of cancer and one cause is viral infections.  The cat started vaccinations against the cancer with the feline leukemia vaccine 32 years ago.  That was before humans!!! The Hepatitis B vaccine was developed to prevent Hepatitis infection that caused liver damage and liver cancer.  That vaccine developed 30 years ago was started and liver cancer decreased 90%.  Now we have had the Human Papilloma Virus Vaccine (Gardasil) for 11 years.  It is safe no matter what you read on the internet.  Every time we come out with a new vaccine everyone wants to blame their ailments on it.  By 26 yr old 50% of the population are infected and 80% will be infected sometime in their lifetime.  It is a very important vaccine against cervical, anal, prostate, and oral cancers.  It also prevents warts in the groin area.  It is a series of 3 vaccines but studies now show if you start before 15 years old, you only have to have 2 shots. Yeah!  I strongly encourage you to get your teens vaccinated against cancer.

Roger Knapp MD

Jan 26

The next 3 months we will see a lot of cases of Noro Virus.  It is a stomach virus with vomiting and diarrhea.  The worst case is 3 days of 102 fever, 3 days of vomiting, and 7 days of diarrhea.  There are less severe cases. It takes 1000s of flu virus to catch the flu and it takes 5 or 10 virus units to catch Noro virus.  It lives on surfaces for a week and is only killed by dilute bleach.  Alcohol hand sanitizers do not kill it.  Washing hands in soap and water helps.  It is highly contagious and a nasty bug.  It is what makes cruise ships come back to port early because everyone is sick.  Call your doctor for vomiting medication if you catch it.  If one person catches it, then wipe down the house with dilute bleach.  I love bleach.  It smells good and it kills everything.

Roger Knapp MD

Feb 8

ACL injuries occur more than 200,000 US cases per year. ACL injury is usually a non-contact injury that occurs when an individual stops suddenly or plants his or her foot hard into the ground (cutting). Women in sports such as football, basketball, soccer, gymnastics, and tennis are significantly more prone to ACL injuries than men. The discrepancy has been attributed to gender differences in anatomy, general muscular strength, reaction time of muscle contraction and coordina...tion, and training techniques.

Of the four sports with the highest ACL injury rates, three were women's gymnastics, basketball and soccer. According to recent studies, female athletes are two to eight times more likely to strain their anterior cruciate ligament (ACL) in sports that involve cutting and jumping as compared to men.

Studies show that exercises to strengthen leg muscles and learning how to land and cut will lower ACL injuries 70%. Here is a link to my web site on how to tell if you are at risk and exercises to stop it.

http://www.rogerknapp.com/medical/ACLinjury.htm

Feb 12

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 (and especially moms) petitioning the baseball organization to require all players to wear them.  The boys and girls will not do it willingly.

Also be sure to wrap injuries with tape immediately and then later put ice on it.  See my video for good info on injuries like jammed fingers and sprang ankles.
https://www.youtube.com/watch?v=n4oxmyaLWNQ

Feb 25

Kids self-esteem.
When raising children we want them educated, moral, and happy. Some parents try hard to be a great parent and raise a great child but then become over critical.

In our effort to make them perfect, even though we are not perfect, we tend to find little faults and not appreciate the whole. I know I used to correct the minor errors when my kids drew pictures, or 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. They will make careless mistakes in their school work and chores around the house just like we make careless mistakes at our work or personal accounts.

One of our sons took violin lessons at age 5. The Suzuki instructor told us never to criticize only praise him that he is doing better. So at the first lesson he grabbed the violin and bow in his fists and scratched the strings. Sounded like a cat dieing. She clapped and said you are doing well. Im thinking I paid $10 dollars for this? We go to lessons once a week and a parent has to go learn what and how to instruct the child. We have to do the lessons the other 6 days. So as time goes my wife performs most of the lessons. Occasionally I would be off and do the lesson with him. Being a doctor and needing to be precise, I tended to be more critical. The violin is hard since just a few degrees off and you are on the wrong string. So I tended to fuss at him: You finger is on the wrong string! Move it over!!! and his reaction was to put it down and frown. Then I would remember the teachers instructions so I would say: you were close . Keep up the good work. You are doing better. After 6 months he was playing Twinkle Twinkle flawlessly and in 2 years playing Bach and Beethoven. Never being critical just encouraging him to do better. So when your child tries to pick up their room and misses some items on the floor, dont be critical of the errors and mistakes. He did do a good job for an 8 yr old. He isnt 25 yr old. (Although I know some 25 yr olds who dont do well either.) LOL Just ignore the minor mistakes and complement them. Go in there later and pick up the things he missed. Tell them what they can do to make it a better job. You might trying doing it this way or Lets move this over there and see if you like that better. Stay positive on how to do better rather than point out the mistakes.

Never say anything negative in your childs hearing range. They hear every word even though they look like they are not listening and just playing over there. The child thinks that if you do not think he is a good person then he must terrible. He then gets a low self esteem. And if you complement his work or behavior to other people in their presence, then they get a good self esteem. If you need to complain and gripe about the bad things, do it when they absolutely cannot hear you. So it is OK to tell your child they are wonderful and smart but it is more effective to tell others how good they are in their presence.

Also if the child is starting to lie or do things that are not proper and moral, then brag to everyone in their presence how they are honest and never lie. Now they have to try to live up to your expectations. And you are drilling into their mind that I am honest and dont lie. We tend to complain how the child lies all the time and you are instilling that attitude into their minds. You could try the reverse and brag how good they are to other people in their presence.

Dr. Knapp

March 18

Allergic reactions are common.  The most frequent is the child having hives or urticaria.  Hives are large whelps whereas viral rashes are small dots below pencil eraser size.  Typically the hives are caused by three things:  Medications, foods, and infections.  Of these three, the most common are infections.  Many people who become ill with fever and take an antibiotic and then develop hives are not allergic to the medication, but are allergic to the germ that caused the infection.  80-90% of adults who say they are allergic to a medication are not. 

For example a child will started running fever at home and the parent just wants to watch it at home.  Then after a few days the child breaks out in hives and that scares the parent and they bring the child in to see the doctor.  Had the doctor seen him the first day of the fever and gave antibiotics, then when he broke out in hives a few days later everyone would say Hes allergic to the medication.  In fact it was the infection that caused the rash.

If the child does break out in hives during the course of a medication, I recommend stopping the medication, switch to another one but keep the original medication.  Then a few weeks later, give a day or two of the medication and if they break out in hives a second time, then call and have his medical record labeled allergic.  If he does not break out, then it was the infection that caused the hives. It is safe to re-challenge them with the medication if the original allergic reaction was just hives and not a more severe reaction. If the hives last for more than 2-3 days, then very likely it is not the medication which is out of your system quickly.  Also when they first break out in hives, stop all very allergic foods like dairy produce, nuts, peanut butter, and shell fish.  When the hives go away, then one at a time re-challenge the child with the medication, and the foods that were eliminated. Some parents nervous about giving the medication a second time will sit in the waiting room of the hospital ER or doctors office when re-challenging the child with the medication.

My wife makes a dog tag for our Toddler Grandchildren when going to Disney World or other parks.  
She pins it to their outfits incase they get lost.  It is cute and inexpensive.

April 2

We see viral fevers every Spring.  It usually is 101-102 for 1-2 days and not any other symptoms.  They usually are playful or a little tired.  A few might have mild headache or sore throat.  Frequently we see them to check for strep throat. 

In the old days they called it Spring fevers.  There were fevers we saw in the springtime and it made the kids tired and not do their school work.  And through the years that term was applied to kids not wanting to do their school work in the Spring.  But it started out as Spring Fevers.

They also blamed the fevers on the hay growing in the Spring.  And through the years the term hay fever was shifted to allergies and having hay fever.  But it started out as the child having Hay Fever.

So if your child has a fever this Spring with no other symptoms and does not seem very ill, you might give it a few days to see if it does not go away. 

Be sure to use insect repellant like Off.  The chemical deet has been well studied and safe for kids 6 month and older.  I see several cases of encephalitis with fever and bad headache every Summer from the mosquitoes. 

Roger Knapp MD

April 4

Ever have your children color Easter eggs but had to throw them away?  They were so cute and precious. It would be fun if you could keep them.  You can poke small holes in both ends of the raw eggs and blow the contents out.  Be sure to wash eggs since many have Salmonella on the surface.  The other option is to buy solid wooden eggs or porcelain eggs that the kids can color or decorate with colored sharpies.  Then put their initials and date on it.   Pull them out each year and put them on the mantle or egg tree every Easter like we do with Christmas ornaments.  Here is a place you can order them:

April 12

I love it when parents come and say their doctor predicted the adult height that their child will be in the future.  Doubling the childs height does not predict the height of the adult.  Graph growth charts for childrens height is for the group and not predict what happens to any individual in that group.  It is important for the child to grow up the growth lines but when they hit puberty. Look out.  See this chart.  The tall kids may go through puberty early and stop growing and some will start that later and end up tall.  And the short child my not hit puberty till high school and grow into college.  There are some like the child in the middle line who grew up the growth lines and was average height their whole life.  There is a formula for predicting childs height on the internet if you google it and it uses the parents heights . Not the childs. So most of the time the child will follow the family but 10% of the time they turn out different.  You have seen a tall family with one short child or visa versa.  The main concern is they grow up the similar percentile growth line from 2 years old till puberty.
Roger Knapp MD
www.rogerknapp.com

April 24

Weather getting warmer and outdoor/camping activities are increasing. Mosquitoes and Ticks are hungry and waiting for us to serve them dinner. Permethrin treated clothing has been shown to decrease bites dramatically. The active ingredient Permethrin is the synthetic version of pyrethrum, a natural insecticide from the Chrysanthemum flower. You can purchase clothing already treated or you can purchase sprays to treat your own clothing. It lasts through several washings. It is odorless and colorless and non-toxic to us.  We also use this in shampoos for head lice and cream for body lice.  This will decrease your chances of catching West Nile, Zika, Rocky Mountain Spotted Fever, Lyme Disease, and other bad illnesses.  And of course remember sun screen too.   I like to see kids outside getting dirty and they can do it more safely by using this.

Roger Knapp MD 

April 26

 There is an old book from many years ago called Im OK Youre OK.  It does not help you raise your children but understand the stages they go through.  The one year old child 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 Im not OK stage and important to do some backtalk to improve their self esteem.  Then by teens you are not OK and 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.  Interesting huh?  So tolerate the teens there is light at the end of the tunnel.

As a story by Adair Lara said:

I just realized that while children are dogs - loyal and affectionate - teen-agers are cats. It's so easy to be a dog owner. You feed it, train it, boss it around. It puts its head on your knee and gazes at you as if you were a Rembrandt painting. It bounds indoors with enthusiasm when you call it.

Then, around age 13, your adoring little puppy turns into a big old cat. When you tell it to come inside, it looks amazed, as if wondering who died and made you emperor. Instead of dogging your foot-steps, it disappears. You won't see it again until it gets hungry-then it pauses on its sprint through the kitchen long enough to turn its nose 
up at whatever you're serving. When you reach out to ruffle its head, in that old affectionate gesture, it twists away from you, then gives you a blank stare, as if trying to 
remember where it has seen you before.

You, not realizing that the dog is now a cat, think something must be desperately wrong with it. It seems so antisocial, so distant, sort of depressed. It won't go on family outings.

Since you're the one who raised it, taught it to fetch and stay and sit on command, you assume that you did something wrong. Flooded with guilt and fear, you redouble your 
efforts to make your pet behave.

Only now you're dealing with a cat, so everything that worked before now produces the opposite of the desired result. Call it, and it runs away. Tell it to sit, and it jumps on the counter. The more you go toward it, wringing your hands, the more it moves away.

Instead of continuing to act like a dog owner, you can learn to behave like a cat owner. Put a dish of food near the door, and let it come to you. But remember that a cat needs your help and your affection too. Sit still, and it will come, seeking that warm, comforting lap it has not entirely forgotten. Be there to open the door for it.

One day, your grown-up child will walk into the kitchen, give you a big kiss and say, "You've been on your feet all day. Let me get those dishes for you." Then you'll realize your cat is a dog again. 

Dr. Knapp 

April 28

Approximately 4.5 million dog bites occur each year in the United States.  The most common dogs that bite (non-fatal):  Wolf Dog Hybrid, Husky, German Shepherd, Bullmastiff, Tosa Inu, Rottweiler, Cocker Spaniel, Pit Bull, Chihuahuas, Bulldogs, Bull Terriers, and Pekingese.  Just because you have one of these and they have not bitten YOU, it does not mean they are not among the most often biting dogs.

There were 31 U.S. dog bite-related fatalities in 2016. Pit Bulls contributed to 71% while they make up only 6% of the total U.S. dog population.  Rottweilers are the second most lethal dog.  Over the last 11 years they killed 254 Americans one every 17 days. Annual data from 2016 shows that 42% of the fatality victims were children. In 2016, infants 3 to 6 days old (yes days old) accounted for 31% of all child deaths. In one case, a pit bull-mix was lying in bed with the baby and its parents when it attacked. The family had adopted the dog 5-months earlier from the Humane Society. 42% of all dog bite fatality victims in 2016 were either visiting or living temporarily with the dog's owner. 

 Nearly 1 out of 5 bites becomes infected.  It is standard to treat the dog bites that are severe with opened skin with antibiotic Augmenten.

 Teach your children:

1.            Never approach a dog they dont know.  Be especially wary if the dog is behind a physical fence.  Never tease a dog that is behind a fence.

2.            Always ask the owner before they pet a dog.  Teach them to then ask how the dog prefers to be petted (behind the ears, on his back, etc).

3.            Slowly put their hand in front of the dogs nose before they pet a dog.  This way the dog can get their scent and it will help to put the dog at ease.

4.            Never put their face in the face of an unknown dog.  Bites to the face are the most heartbreaking.

5.            Never attempt to hug or pick up a dog. 

6.            Avoid eye contact with an unknown dog.  In dog talk that means a challenge of authority.

7.            Always approach a dog so they can see you.  Never surprise a dog from behind as a scared dog is more likely to.

8.            Signs that a dog may not want to be approached their ears are back, the hair on his neck may be raised, his teeth may be showing, and he may be growling or skittish.

9.            The signs of a friendly dog are a wagging tail, tongue lolling out of his mouth, a dog smile if you will, eagerness to interact, and ears perked are all signs that a dog is ready to be approached.

10.         Never approach a dog that is off leash without an owner present. This is doubly important if the dog appears skittish.

11.         Never run from a dog even if it is charging them.  It is far better (though harder) to stop and stand with your arms in and head down.  Avoid eye contact so that the dog does not feel threatened. The child will no longer seem like a threat to a dog if they are still and quiet and the hope is they will not attack.  If the child continues to run, the dog will pursue until the prey is caught.

 https://www.youtube.com/watch?v=6q-JUZzAJtE

May 3

Ever heard of Commotio Cordis?

 It is from the result of a blow to the chest at a critical time at a precise millisecond between heart contractions that throws the heart into lethal ventricular fibrillation(VF).  It is not of the force of the blow and causes no identifiable structural injury to the ribs, sternum or to the heart itself.

 The actual number every year is really unknown since many are misdiagnosed. One estimate was 62/yr.  It occurs during several different sports and activities.  One list reported having 53=Baseball, 14=Softball, 10=Hockey pucks, 8=Fists and boxing, 5=Knee or foot, 5=Elbows, 5=Lacross balls, 5=Parent Disciplining Child, 4=Shoulder, 2=Cricket balls, 2=Football helmet.  As you can see most are from baseball and even very slow speed balls can cause it.  The chest protectors do not prevent this.  Survival after a commotio cordis event has increased over the years from when there was 5% survival.  Survival has usually been associated with effective and timely CPR efforts and defibrillation that occur within 3 minutes of the collapse.  Current estimates are 70-90% survival.   Although efforts at resuscitation occur frequently, the onset of CPR is often delayed because observers underestimate the severity of the trauma or condition. The survival rate is only 5% or less in cases in which resuscitative efforts were delayed longer than 3 minutes.

 The most common cause of sudden death in athletes is hypertrophic cardiomyopathy.  It is a heart condition of very thick wall muscle of the heart.  Again there are not accurate estimates but it is uncommon one in 5,000??  Many have no symptoms before cardiac arrest but some have irregular heart beats or passing out while exercising/running.  The doctors physical exam can pick up maybe around 10% who are likely to have this condition.  An ECG picks up around 90%. (More accurate than us.) Europe has been screening teenagers for many years and the incidence has greatly decreased there.  America does not recommend screening them here because of cost and the rareness of the condition.  Cook Childrens cardiology performs the sports ECG for $25.  That is like going out to eat now days. So I ask the parents to get the sports ECG done around 12 years old. 

So for both of these conditions it is critical to act IMMEDIATELY with CPR and AED shock.  You can also first slap the chest hard with the palm of your hand and deliver a shock that can restart the heart rhythm.  Cant hurt to do that as you start CPR and run for the AED.  This is rare!  You probably wont need this information.  But many new parents learn CPR just in case. Please dont worry about your child but it is nice to know this information. 

 Here are some examples:

 commotio cordis

https://www.youtube.com/watch?v=sff0_njY_lQ

Saved by AED

https://www.youtube.com/watch?v=dgYeUyIOzhk&t=6s

Implanted defibrillator saves soccer player.

https://www.youtube.com/watch?v=v8fwQCygr4E

 Roger Knapp MD

May 7

I had an Aunt Fay, my moms sister.  She is not with us anymore but our relatives advice comes back to us every week when we are older.  The advice you give your kids will stay with them later also.  She used to say that people who say they are bored all the time are boring people.   People who are interesting and life of the party can entertain themselves in an empty room.  People who are bored all the time want others to entertain them.  Spend time with your children.  We want you to give them some adult stimulation reading and playing with them and playing board games.  Also some electronic stimulation 1 to 2 hours a day of videos and games screen time.  But part of the day turn everything off and go find something to do.  We used to tell our parents we are bored and they said go find something to do.  If they have constant input, then they have difficulty outputting.   Go play with your dolls, trucks or swing on the swing.  Go find something to do.  You have to force them to use their own imagination because they want us to entertain them constantly.  Then hopefully they will not become a bored adult.   

Dr. Knapp

May 22

New advice from the American Academy of Pediatrics:

The new advice indicates that fruit juice should not be provided to children younger than 1 year of age unless there is a strong clinical basis for it in the management of constipation. For older children, maximum daily intakes of 100% juice products should be 4 ounces for children ages 1-3 years, 4-6 ounces for children ages 4-6 years and 8 ounces for those 7 and older.

 There is no nutritional indication to give fruit juice to infants younger than 6 months.

 A more recent study suggested that varying intakes of 100% juice were not associated with obesity.

 A variety of fruit juices, provided in appropriate amounts for a childs age, are not likely to cause any significant clinical symptoms.

 Calcium-fortified juices provide a bioavailable source of calcium and often vitamin D but lack other nutrients present in human milk, infant formula, or cow milk.

 Children should be encouraged to eat whole fruit to meet their recommended daily fruit intake and should be educated regarding the benefit of fiber intake and the longer time to consume the same kilocalories when consuming whole fruit compared with fruit juice.

 The AAPs recommendations for constipation are:

After the first month of life, if you think your baby is constipated, you can try giving him or her a little apple or pear juice.

 Like everything else a little is good and too much is bad for you.  Too much water, sunlight, salt, and too much fruit/juice is not good.  So the AAP came out in their mighty wisdom to not recommend any juice in the first year.  They instead recommend fruit.  But fruit has just as much carbohydrates as juice. 

 The grams of carbohydrates in 8oz of these products are listed below:

Milk, breast milk, formula   12-18gm

Coke               26

Apple Juice    28

Applesauce      27

Orange juice     20

Grape juice      38

Grapes              27

Pineapple juice  34

Pineapples        28

Blueberries       21

Peaches         30

Watermelon    10.    Yeah. Love watermelon.

 So I differ from the AAP.  There is really not much difference in fruit vs fruit juice (or coke!) as you can see above.  I only recommend juice for constipation when less than 6 months.  I think a small amount of fruit or juice after 6 months is not bad but keep the amount down.  Mostly give breast milk or formula and water.  Do not have them walk around all day with juice or milk in any container which can cause cavities in their teeth.   And no milk or juice in bed!!! Give them a pacifier or water in bed. Its summer time let the watermelon flow!

 Dr. Knapp

May 26

Hopefully your child will not get swimmers ear infection this summer. It will hurt the ear when you grab the ear lobe and move it around. It is more common after swimming in lake or gulf water than swimming pools. It is caused by the water changing the pH of the ear canal more than by the wetness. There are two ways to prevent it. One is to put a solution of half alcohol and half white vinegar in the ears after swimming. Drug store bottles only have alcohol. The other way is to put 2-3 drops of olive oil in the ears before swimming. The oil does not have to go in right before swimming and can be put in the ears that morning. And the alcohol/vinegar can be put in that evening and does not have to be applied right out of the pool. Have a safe summer.

Roger Knapp MD

June 20

I (and the American Academy of Pediatrics) do not recommend infant/toddler swimming lessons to drown proof you child. There is no evidence that infant/toddler aquatic programs decrease the likelihood of drowning. Programs that claim to make children safe in water or safe from drowning are not truthful and giving parents a false sense of security about their child's safety in the water.  In Arizona, California, Florida, and Texas, drowning is a common cause of death in this age group.  2010-2015 there were 70-80 deaths in Texas alone.  Last year 2016 there were 107 deaths in Texas.  Other reported medical risks to infants and toddlers that involve being in water include hypothermia, water intoxication, and the spread of communicable diseases. Having children begin swimming lessons at an earlier age does not translate to a more rapid mastery of aquatic skills. It is not the childs job to keep from drowning, it is the parents job.

 Until more clear-cut scientific evidence exists, the AAP recommends the following:

1.            Children are generally not developmentally ready for formal swimming lessons until after their fourth birthday.
2.            Aquatic programs for infants and toddlers should not be promoted as a way to decrease the risk of drowning and parents should not feel more secure.
3.            Whenever infants and toddlers are in or around water, an adult should be within an arm's length, providing touch supervision.

Playing in the water is just fine but watch the body temperature.  They cant stay in cold water very long without getting hypothermia.

Roger Knapp MD

July 6

Poison Ivy is around every summer.  If you are allergic to it then it will cause a blistery itchy rash a few days later.  If you get around it and come in right away, take a sudsy bath and put the clothes in the washer, then you will not break out much.  If you do get a rash, it is not contagious.  We thought it spread but we could not intentionally spread it.  What happened is that one area broke out in 1 day, another in 3days, and another in 5 days.  Or you get out in more of it.  We thought we were spreading it but didnt.  There are 10 plants out there that can give you the allergic rash but Poison Ivy is the most common.   Treat the rash with hydrocortisone.  If worse call the doctor and get a Rx for stronger Steroid creams.  If all over and on the face, then contact your doctor to get oral steroids. 

 Roger Knapp MD

July 30

Lets look at healthy fruit juice that we all give our children.

Recommended intake for Children 1-6 yr take 4-6oz a day of juice.

For 10oz of these juices:

 Motts Fruit Juice  74 cal  13gm fructose

 Martinellis Apple Juice  175cal  31gm fructose

 Welches 100% Grape Juice 175cal  36 gm fructose

 Tropicana 100% Orange Juice 216cal   30gm fructose

 Cranberry 100% juice 145cal 31gm fructose

 Coke  116cal  39gm fructose sugar from fruit!

 Martinellis and Musselmans juice is from the USA and not from China.

No Arsenic or mercury that we know about.

So when you are giving most juices to your kids it is similar to giving them a coke

Motts juice  74cal

Coke   ..116cal

Cranberry 100% juice ..145cal

Welchs 100% Grape .175cal

Tropicana 100% Orange juice  216cal.

When you go crazy when someone gives your child a sip of coke,

There is not enough vitamins in Juice. Give them a childs chewable vit.

 Go ahead and give your children juice but keep it down to 4-6 oz a day or just water.

We see croup every year at this time.   We see a few cases all year but most will be this Fall.   It is a viral cough cold with head congestion.   Some will have a low fever with it.   The throat hurts a little with swallowing but hurts more in the area of the windpipe below the vocal cords when you cough.  Tylenol or Ibuprofen will help the pain and they sleep a little more. In small children it causes a croup seal bark sounding cough and we treat it with steroids.  Older children and adults can get it but they do not make the seal bark sound.  They have a bad cough that hurts the windpipe and hoarseness to the voice.  It is viral and we cant cure it.   Give ibuprofen and maybe cough medication.  The kids below 3 yrs. old we treat with steroids so it does not cause breathing problems.  The second and third nights can be more severe so bring in small children the first day.  Humidity helps so run a vaporizer or humidifier.  Also the cool night air will help.  Some parents take them into the bathroom and steam it up not cold but good humidity.  We are happy to see the older kids with this but we cant treat it.  Strep throat generally does not have a cough with it.  If there is severe sore throat with swallowing and no cough, then we need to see them.  Watch for sinus or ear infections the week after croup.  If they have deep retractions when breathing and every breath sounds like the barky cough, then take them into the ER for a breathing treatment. 

 Our office will start flu shots in September.  I recommend them even though they only protect you 50% of the time.  Older kids can get them at pharmacies.  The first time infants get the flu vaccine they need two of them a month apart.

 Joke:  Which candies go to school?    Nerds, dum dums and smarties.

 Roger Knapp MD

Aug 28

I recommend flu vaccines even though it protects only 50% of the time.  Some feel it makes it less severe.  The nasal Flumist did not work so it is only shots. Pharmacies will give them to older children and teens.  Remember the first year you get them you need 2 doses a month apart.  Our clinic is starting to give them in September.  If your teenager gets the flu they will miss a week of school, not just one day.

CDC:   GROUPS RECOMMENDED FOR VACCINATION

Routine annual influenza vaccination is recommended for all persons aged =6 months who do not have contraindications.

Emphasis should be placed on vaccination of high-risk groups and their contacts and caregivers (no hierarchy is implied by order of listing):

1.     Children aged 6-59 months;

2.    Adults aged =50 years;

3.    Persons with chronic pulmonary (including asthma), cardiovascular (except isolated hypertension), renal, hepatic, neurologic, hematologic, or metabolic disorders (including diabetes mellitus);

4.    Persons who are immunocompromised due to any cause, (including medications or HIV infection);

5.    Women who are or will be pregnant during the influenza season;

6.    Children and adolescents (aged 6 months through 18 years) receiving daily aspirin- or salicylate-containing medications and who might be at risk for Reye syndrome;

7.    Residents of nursing homes and other long-term care facilities;

8.    American Indians/Alaska Natives;

9.    Persons who are extremely obese (BMI =40); and

10. Caregivers and contacts of those at risk:

a.    Health care personnel in inpatient and outpatient care settings, medical emergency-response workers, employees of nursing home and long-term care facilities who have contact with patients or residents, and students in these professions who will have contact with patients;

b.     Household contacts and caregivers of children aged =59 months (i.e., <5 years), particularly contacts of children aged <6 months, and adults aged =50 years; and

c.    Household contacts and caregivers of persons who are in one of the high-risk categories listed above.

If allergic to eggs you may still be able to receive the vaccine:

1.    Persons who are able to eat lightly cooked egg (e.g., scrambled egg) without reaction are unlikely to be egg-allergic.

2.    Persons who have experienced only hives after exposure to egg should receive any licensed, recommended influenza vaccine age appropriate influenza vaccine (i.e., IIV or RIV).

3.    Persons reporting symptoms other than hives, such as angioedema, respiratory distress, lightheadedness, or recurrent emesis; or who required epinephrine or another emergency medical intervention, may also receive any licensed and recommended influenza vaccine that is otherwise appropriate.

Over prescribing antibiotics is a problem.  You really do not want to see a doctor who gives antibiotics for every cough, sore throat, runny nose, or even fever.  That is why these medications are prescription to keep from over doing them.  At the beginning of a cough and cold, the fever during the first few days is the virus.  Any fever after the 5^th day is secondary bacterial infection and needs antibiotics. There is an old saying that you gave so many antibiotics it weakened the immune system. Other way around.  The weak immune system caused the person to have more infections and get more antibiotics.  Kids with weak immune systems died in the 1800s. 10% the first year of life.  Now we have antibiotics and vaccines so kids with weak immune systems are surviving, growing up, and having more kids with weak immune systems.  We interrupted Darwins selection of the fittest.  That is a good thing but also not so good.  Same with pregnant women.  Many women died in child birth in the 1800s.  Now we have C sections and women with small pelvises are growing up and having more daughters with small pelvises.  Look at most photographs of women in the 1800s wide hips!  We interrupted evolution.  Interesting Huh?  So antibiotics do not weaken the immune system. We will give them if needed but not to everyone who walks into our office.

Oct 23

If you may have seen in the news they have a new approved vaccine for Shingles in adults.

Zostavax is the old live virus vaccine out for 11 years now.
Studies with nearly 2,000,000 persons has shown there were 9.4% shingles in control and close to 6% in vaccine group. Protecting roughly 3 ½ % of the population. So the efficacy was 50-60% and this decreased to 37% by 11 years. There was mild soreness and redness for 1-2 days and no loss of function.

Shingrix is the new killed virus vaccine just approved by the FDA.
Study with only 6000 participants showed 90% difference in Shingles. Cases were 7% in control and close to 1% in vaccine individuals. That is helping approximately 6% of the population. We dont know the long term % protection for this vaccine. There are higher incidence side effects (79%) of fever, sore muscle, headache, feeling ill. 15% will not be able to use the arm effectively for 3 days.

The news quotes 50% vs. 90% effectiveness of the vaccines but the actual % of the population helped and the difference in the numbers was not huge. We dont know the effectiveness long term for Shingrix and may decrease like Zostavax or stay high. Let you know in 10-20 years. The side effects of Shingrix are worse so plan on possibly being out of commission for 3 days. It requires 2 shots for $280. Just like the nasal Flumist, after giving it to millions of patients they found out Flumist was effective only 10% of the time and not the higher % shown in studies. So time will tell how effective Shingrix really is and how many years it stays effective.

Have children with a phone? Here is one app that is good.

Screen Time app:
Get web and app reports everyday receive a daily summary showing you which websites and apps your child used, and for how long. See which apps your child downloaded and approve before install and used. Block specific inappropriate apps from your kids. Use one account for your family, unlimited devices. Manage your childs device via the Screen Time app or via the website using any device with a browser and make screen time changes on the go. Screen Time requires a secure password in order to be uninstalled. For added safety, you can also block access to settings. Compatible with Apple, Android and Amazon devices

Nov 17

Warts and Molluscum contagiosum are bothersome and difficult to treat. However studies show that they can be treated with two medications by mouth. One is an antacid Tagamet (cimetidine). It is prescription and one takes it for 2 months. Dosage is 20mg/lb/day maximum of 1200mg. The other is taking Zinc. Zinc gluconate has less impurities. Take 5mg/lb/day for 2 months. Zinc is very important to your immune system and why I recommend everyone take a vitamin with zinc. Extra Vit C does not help! Zinc worked better and 86% of patients lost all their warts.

Dec 7

A recent study came out claiming that spanking as a child caused dating violence as a teenager.  There are a lot of problems with this study and conclusions.  The American Academy of Pediatrics does not recommend spanking.  This study asked 20 yr olds to remember if they were spanked never, rarely, sometimes or often as a child.  Then they were asked if they had dating violence pushed, kicked, shoved, slapped, throwing things. 19% of the group said they had remembered (?) dating violence.  The study reported 68% of the group remembered (?) spankings.  Of their numbers, 32% had no spankings and 71% had no or rare spankings.  There was also a higher correlation with teen dating violence and the  level of parent education.  

 The problem is asking a 20 yr old to remember their childhood when they cant remember what they got for their birthday 2 yr ago.  Also the authors mentioned that role modeling with violence between the parents of the child would be a more influential factor.  Again studies are produced by people with an agenda to prove something.  More likely children (as mentioned in the study) whom have a genetic predisposition to violence commit more teen dating violence.  Children who have a violent personality would be spanked more often and have more dating temper outbursts than calm gentle children.  In other words it is a chicken and the egg question.  If parents had not disciplined the childs behavior would the number of teen dating violence have been even higher?  Is stopping spanking going to change that childs genetic makeup?  If you die the red hair brown is that going to change the temper of that person? 

 I believe the childs angry and violence prone personality caused the parent to spank more and caused them to have more teen dating temper outbursts.  I dont think the spankings caused it and I have no problem with parents using corporal punishment within reason.  I recommend more timeout starting at 18 months of age and using restrictions during school age.  Take the phone away from a teenager will devastate them.  No matter what form of punishment you use, be a strong but loving parent.

Are you having a problem with your children not eating well and being a "picky eater"?
See this video:
https://www.youtube.com/watch?v=W8mf_VOJ1fM
Roger Knapp MD

Dec 21

Luxturna, a form of gene therapy treats retinal dystrophy just approved by the FDA.  This is the first of several gene therapies that are in the development. The live virus injects DNA into retinal cells to correct the genetic birth defect and prevent or restore blindness.  This is only changing the DNA of the retina.  But Im sure many purists will come out against it we are manipulating nature.  But if they were going blind I bet they would get the treatment.  I personally think this kind of gene therapy is fine.  We certainly do not want to use this technology in the wrong way so it will be very closely scrutinized by the FDA.  If your child was going deaf would you want it cured? 

Roger Knapp MD