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Itís 2004 and Newsymail starts up for another year.


Infants turn yellow after 6 months of age. It is Carotene which is the yellow pigment in yellow vegetables. By 1 year old they are usually very yellow and this is not Jaundice. The whites of their eyes are not yellow and that is how you can tell it is "carotenemia" and not jaundice. This yellowness goes away between 1 and 2. Actually children very rarely turn jaundice with hepatitis A (contagious kind). It usually is a very mild illness in children. Adults however get very ill and 1/500 die. Children usually tolerate illnesses better since their healing power is great. Ever seen chicken pox in a adult versus a child? A similar comparison is SARS. The youngest to die of SARS last year was 30 years old. The children in the East are not immune to that new chest cold and probably 10,000 children had the SARS virus last year but they just did not get very sick. Since they did not get respiratory distress, we did not diagnose them since there wasnít a blood test for it. Also look at the Flu that was the big scare this year. (News people like to use scare to get viewers i.e. West Nile, SIDS, Lime Disease, Etc. It is good in a way to get people to protect themselves against Mosquitoes and Ticks.) There were 30-40 children 0-18 years old that died of the Flu, most of whom have severe medical problems. That is the save every year. But 35,000 adults died and adults are not any more immune to the Flu than children. That is why I went into Pediatrics because the heal better than us adults and they are more cute tooÖ.


The Flu rate is similar to 2 years ago and less than 4 years ago. 

Roger Knapp MD

Jan15, 2004


Newborn jaundice is not as dangerous as we thought 20 years ago. We used to start phototherapy at 12 where now we start treating it at 19 blood level of bilirubin (jaundice). It is more severe in breast fed babies and infants with uncommon blood disorders. It is helped by indirect light from a window. It hits itís peak usually around 3-4 days of age but there are exceptions. A small amount of jaundice can persist for 2 months with breast fed babies. There are rare liver disorders that can cause increased jaundice at 6-8 weeks of age. Then the babies get yellow around 9-15 months old from the yellow vegetables. Their eyes are not yellow and this in not jaundice. It is Carotenemia from the carotene (Vit. A) found in squash, carrots and sweet potatoes. This is not dangerous and does not need to be treated. Older children who get hepatitis A hardly ever turn jaundiced. They have an upset stomach for a week and get over it. The main reason I diagnose it in children is so I can give a shot to the parents to prevent them from getting it. Although a mild illness in children, it is very serious in adults and 1/500 die! Like many illnesses, it is usually worse in adults. Ever seen chicken pox in a child verses an adult. Just like the Flu: 30+ children die of the flu in all of America, but 35,000 adults die of the flu every year. The press can scare you more with the children than with adults dieing. We now recommend the vaccine of Hepatitis A for those living in the counties of Texas that boarder Mexico and those children and adults going to underdeveloped countries for a while.


Roger Knapp MD

Jan 21, 2004


Fever is of course a sign of infection and it is not teething. (Sorry Grandma!) The fevers from infections do not hurt children. That comes from the old days when the child had meningitis or Measles and the illness damaged them. It was not the fever. We have had children run 105 degrees for a week and the follow up in them is normal. We have a child with meningitis and only 101 degrees and he developed brain damage because of the illness, not the fever. Actually the higher temperature damages or kills the germs and is Godís way of helping us fight off the infection. Humans in the cave man days who did not run fever did not reproduce. Fever is there for a reason and to help us fight off the infection. So there are many specialists who say do not treat the fever. We tell the parent to treat the fever more for the body aches rather than to eliminate the fever. The Tylenol and Motrin are given so you do not have muscle aches and headaches with the fever. They do not eliminate fever but just cause you to have less fever. Instead of 104 you will have 102 degrees. The medicine is helping so do not fret if the temperature does not go down to normal. You do not have to alternate Tylenol and Ibuprofen. Many people say to alternate them to keep you busy, off the phone and have you feel like you are doing something. I recommend giving either one that works better for that person and not worry about giving both. Plus fever does not hurt you and is helping you. The only Grandma tale that was true said: "Bundle them up and let them sweat the fever off." What she did was bundle the child up and ran the fever up to 104; that killed the germs and the child got better. So do not worry about the height of the fever Ö. even 105 will not harm them. If you lock your child up in the van in the summer and they get heat stroke to 107 then yes. But fever from the infection will not harm them but we worry about what is causing the fever. Get the child checked out for the fever to see if it is a dangerous disease or just a virus. Donít sit at home with a febrile child and your relative saying "Itís just teething." NOT. So many times we do not take the childís temperature in the clinic if the parent has documented fever over 100 under the arm or mouth or 101 in the rectum. Once there is fever then knowing what the number is at any point in time is NOT helpful and only scares the child trying to take their temperature. If we take it in the office and it is normal (which usually it is normal the next morning) are we going to call you a liar and not evaluate them? No. So once you also have recorded a fever, then you do not have to take it again. If they feel hot, then give them Motrin. The number does not matter since when they are "burning hot" the temperature is up above 101 and they need to be seen in the morning. The height of the fever does not help us determine what is wrong with your child. Also some children can have a febrile seizure and that happens to one in a thousand children. It can occur at any temperature and keeping the fever down will not help prevent it. Plus the seizure, although the scariest thing a parent can observe, does not hurt them. It is usually 5 minutes or less and the follow up in them is normal. You do need to take them in or call for a medical team if you are too shook up to drive. Definitely the scariest thing to see but not preventable and not damaging. So stay cool when you child is hot.

Dr. Knapp 


Recent studies came out and said there were less cancer, heart attack and stroke deaths if the patients had plenty of Folate. This is a B vitamin found naturally in many foods, including dry beans, peas, some fruits, most berries, and leafy green vegetables, such as spinach. Folic acid intake is recommended at 400 mircograms and it is safe to take up to 1000 mcg daily. In the US, folate also has been added to all grain products, such as breads, pastas, and cereals in the form of folic acid. The body is able to absorb folic acid (fortified in foods and in supplements) about twice as easily as the folate found naturally in foods. Folate has been added to some cereals (see list at: http://www.cdc.gov/doc.do?id=0900f3ec8000d561 ). There is a decrease intake of these foods when on low carbo diets. There definitely is half the rate of Spina bifida birth defects in women taking Folate. The studies on cancer, heart attack and strokes were crude and need to be verified. I recommend all of us take a regular daily vitamin and then the dietary intake will put us a little higher and possibly more protection.

See: http://www.cc.nih.gov/ccc/supplements/folate.html

Pediatric doses (very crude estimates)

  • Infants under 6 months: 65 mcg (adequate intake)
  • Infants 7 to 12 months: 80 mcg (adequate intake)
  • Children 1 to 3 years: 150 mcg (RDA)
  • Children 4 to 8 years: 200 mcg (RDA)
  • Children 9 to 13 years: 300 mcg (RDA)
  • Adolescents 14 to 18 years: 400 mcg (RDA)
  • Adult

  • 19 years and older: 400 mcg (RDA)
  • Pregnant women: 600 mcg (RDA)
  • Breastfeeding women: 500 mcg (RDA)
  • Roger Knapp MD


    We give the Prevnar vaccine to infants in the first year. It is a vaccine against Pneumococcal bacteria. It causes meningitis, bacteria sepsis (in the blood), and some ear infections. There are many serotypes of the germ but most illnesses are caused by 7 at which the vaccine is aimed. Diseases in the last several years were reduced dramatically 37-80%. I used to see weekly several infants with high fevers and extreme lethargy. Now I see 1 or 2 a year. I have not seen meningitis in over 10 years and now so rare it makes the news. This caused us to use less antibiotics. There is a shortage of Prevnar and we have been instructed to give only 2 of the usual 4 shots of this vaccine to infants until the supply returns in the Fall. Until then we will give only 2 shots and sometimes may not be able to give it if we are completely out of it. This notice is not to scare you but just alert you of the shortage. We will pick up the missed shots later as we get more supplies. This is a national shortage and the manufacturer is trying to correct the shortage. Considering the big scare of vaccines in the last few years, vaccines have saved millions while the risk of damage from them is 1 in a million.

    Dr. Knapp


    I had a newsymail years ago on Bats causing Rabies (which there is no cureÖ 100% die). It is rare with our animal control and active rabies vaccinations in people exposed to possible cases and there were only 32 cases between 1990 and 2000. Of these 24 were caused by bats. (They can tell by the type of rabies virus.) Only 2 of those victims felt a bite and the other 22 did not ever know they were bitten by anything. The bite of the bat is painless and if a bat is found in the house, everyone gets rabies shots. (It is only a few in the arm and not 21 in the stomach.) You cannot feel the bite. Donít handle bats and be careful when around bats in caves. If you can catch the bat safely you can bring it in to be tested. The incubation for rabies is 1-4 months so there is time. If the bat bumps you, you probably were bitten and should get the vaccinations.

    Happy Spring/Summer Ö.

    Dr. Knapp


    Gun safety is taught to children and especially in families with guns in the house. (We donít recommend it but adults are that way. Most guns are used on each other rather than defending your home.) Controlled studies with intensive training of children showed that most children when later exposed to a gun went ahead and picked it up. Same with courses to teach children not to get into cars with strangers, every one of them went with the test strangers. Children below 14 and especially below 8 are not reliable to be trusted in such matters. It needs parental supervision. Keep those guns locked up. Better yet locked up at some other building rather than the home.

    Dr. Knapp


    There is a big business in herbs and natural stuff to treat illnesses. A well run study came out this week proving that Echinacea did not improve cold symptoms. I donít recommend most of these products but they are advertised to non medical people with convincing arguments how they are supposed to work. Rarely some can actually cause trouble. Trust me if they did work, the drug companies would be all of them to market them. Most do not help and that is why the drug companies could not get them past the FDA since studies would show them as useless. But herbs and dietary supplements do not have to prove they are effective.

    We are not born with all the immunity to these germs and viruses that causes colds and other illnesses. Kids get a lot of colds the first years of life because we all have to get immune to them sooner or later. We are not born with this immunity and so every one has to get sick and build up antibodies to the viruses. If you keep the child in a plastic bubble until grade school, then they will miss most of First grade being ill. I would rather they get these illnesses at 3 or 4 yr old rather than 6 months old. They are better home with mom, grandma or babysitter for the first 2 years. Then get their immunity when going to preschool.

    Dr. Knapp


    Recently there was an article about TV correlating with Hyperactivity/ADD. It was reported on television (ironic huh?) as causing it but the poorly run study only showed a "correlation". I finally read the article and was not impressed. But too much of anything is bad for us. The American Academy of Pediatrics recommends no TV until 2 years old. I really donít think 1-2 hours of TV hurts a child and they learn from it. Just donít let them sit there for 6+ hours every day. The study may have shown that ADD kids will not sit and read a book so the parent let them watch TV which would hold their attention better. It may be that ADD kids watch TV more and not that it caused it. But still watch how much TV they watch and the violent show do rub off on them. There is a TV turn off week April 19-25 and a link to them is at the web site or www.tvturnoff.org . It does not hurt to occasionally do without and I prefer more board games after 4 yr old. This topic was even on one of the Simpsonís episodes where the TV in town stopped and all the kids came out to play and ride bikes. Pretty funny. One mother wanted the kids to read more and read better so she turned off the sound and put on closed caption. Everyoneís reading improved. Wow what a tough mother!

    Roger Knapp MD


    Two vaccines are being developed against genital viruses. One is against Herpes (HSV) type 1 and 2 and if given to teens who are not infected, it dramatically decreases the chances of them acquiring it. This will decrease the illnesses in the female and therefore in their partners. The pregnant female, if positive for HSV at delivery, has to have a C Section because she can give it to the newborn who can die later if they acquire it during birth. The vaccine would prevent the infant from exposure and decrease the need for C Sections.

    The second vaccine is for Human Papillomavirus (HPV) infection. That virus causes venereal warts and causes cervical cancer and especially in young females. Both HSV and HPV are acquired during adult relationships but when the vaccine is given at puberty, it prevents 90% of the cases of HPV. This would dramatically prevent malignancies in the vulva, pennis, larynx, nasopharynx, nail bed, conjunctiva and cervix.

    Both vaccines are in their stages of development and approval. The sooner the better.

    Dr. Knapp


    It seams like all these things we were taught through the years turns out not to be true or helpful.  Teething does not cause fever and fever does not hurt you; now sleep babies on their backs and don't give them honey; etc. etc.   So now the study comes out saying that ice does not help a sprained ankle.  The cold only goes skin deep and not down to the joints.  I previously had an email about do not put ice on the head when bumped but hold pressure.  Now it does not seam that we put ice on anything.  Wrap the ankle or injured site (like putting pressure on the head bump) to keep it from swelling.  The less it swells the better it heals and shorter recovery time.  First wrap with material that does not stretch since you should not move the joint.  (One more use of Duct Tape! YES!)  The next day use stretchy stuff like ace wrap.  It is OK to use the ace wrap initially if that is all you have but the idea is to keep it from swelling as much as possible.  Then elevate it.  It won't hurt to put ice on the injury but it won't help it.

    Dr. Knapp

    Remember you emails are safe with me since I keep them in a word file and not in any email program.


    Wonder what your daycare, doctor or grandparents nursing home rates??????  Here are the sites to investigate it.

    Daycare standards: http://www.daycare.com/texas/

    Daycare: Ratings for inspection results for daycares.  Check your daycare for inspection results: http://www.dfps.state.tx.us/CHILD_CARE/SEARCH_TEXAS_CHILD_CARE/ppFacilitySearchDayCare.asp

    Check doctor's for problems with their state license with the state.  Is your doctor under probation?  See:


    Nursing care facilities ratings.  http://www.carepathways.com/nhg-2.cfm?St=TX&State=Texas

    Roger Knapp M.D.


    Iron is important for your blood and preventing anemia. It also is needed for proper brain development and function. Deficiency in iron in infancy has long ago shown to cause slower development and later poor performance in school. There was a recent study showing a slight increase in febrile convulsions in children who were iron deficient. There are also studies showing children with breath holding spells having a dramatic decrease or totally stopping spells in those treated with iron. There are also studies suggesting strokes in children (yes they rarely can have them.) are caused by a deficiency in iron. So iron is important for us in many things but especially the brain. It is just that you do not think about it being important for that organ. There is iron in the breast milk and formula. That is why we supplement vitamins with zinc and iron when they go onto whole milk at 1 yr old. Give them vitamins until they go to college and we should be taking them too since our diet is not great every day.

    Dr. Knapp


    Several studies have shown that sucking on a pacifier with 30% sugar solution on it decreases pain for circumcisions, blood drawing, and other medical procedures. It stimulates a release of natural opioids from our own body. Studies showed that if you give an opioid blocker, then sucking on the sucrose sugar does not stop pain. Too much of anything is bad for us so you do not want to give it 6 times a day to the baby but occasional use it beneficial. You could use it for teething, blood tests, or even bring some bring it in for use with vaccinations. We do not want to use honey in the first year of life but add a tsp. of table sugar and dissolve it into a bottle of distilled water. Your baby thanks you.

    Dr. Knapp


    Oh! I got something in my eye. Scratched cornea used to be treated with medicine and then patch the eye closed so it could heal.  Studies coming out now showed it did not help to patch and now we just give antibiotic drops to keep it from getting infected while it heals. No more patching. Plus Iíd like to see the parent keep it on the little 2 year old. Good luck!. We do patch the eyes for lazy eye to force the child to use the weaker eye. Letís play pirate!

    Also the latest news about Rabies from organ transplants reminds us about the past Newsymail where I warned you that you cannot feel the bite of the bat.  It is the more common cause of Rabies and if you come in close contact with a bat, get the vaccination shots.  Thank goodness it now is 5 in the arm and not 21 in the stomach. 

    Dr. Knapp


    There is a 57% decrease in allergies in children at 7 yr old if they were exposed to 2 or more dogs or cats as infants in the first year of life. We used to worry about exposure to antigens early but there seems to be a protective correlation. Also if infants are fed oatmeal cereal between 4-6 months of age, there were fewer allergies to foods and less diabetes later. There were more cases if the cereal was started younger than 4 months or later than 6 months. Strange? Also while discussing dogs and allergies, I have had many families swear that when they got a Chihuahua dog their childrenís and parentís asthma when down dramatically. Pretty weird, huh? If you have asthma and shopping for a dog, might as well get one and see. (Yo Quiero Taco Bell? Here Lee-zard Lee-zard!)

    Dr. Knapp


    Breast feeding is best and decreases many things. It is not 100% so donít be upset if your child still have ear infections if you breast feed. Now a study proved that breast feeding does not change the risk of getting Asthma or Eczema. So I keep encouraging breast feeding but donít think it is a panacea for all ailments. It did not cure my bald head.

    Everyone knows the benefits of breast feeding for the infant. The benefit to the mother is less breast cancer. There is a 7% decrease for every infant she breast feeds and an additional 4% decrease for each year she nurses the child. Countries in the world that have larger families and breast feed longer have less breast cancer the more developed countries that do not.

    There is a protein called "cyclin E" that has been looked at in recent studies that causes the breast cancer to be very aggressive. In stages I, II, and III, patients who had low levels of cyclin E had 95-100 % survival in 10 years. If the levels were high, the survival was ZERO! No patient lived past 10 years even in the stage I group. Hopefully the test for this protein will become commercially available and a treatment to counter the protein will save many lives. Something for the future.

    Dr. Knapp


    Some girls may develop small breasts at age 1-2 yr old but no other signs of puberty characteristics like pubic hair. This is called Premature Thelarche and Adrenarche and is not abnormal. When there is premature puberty physical signs (breasts and hair) before 8 yr old in females, then it is abnormal and needs to be worked up. They have up to 16 yr old to start their monthly cycles and they need to be evaluated if not started by 16. The cycle may be irregular for one year but if it continues to be erratic after 1 year, then she needs to me evaluated. When they start their monthly cycles, then that is the end of their growth spurt and one usually only grows a few more inches. The older they start the taller they will grow. There is not such an end point in males and some may continue growing into college (but they donít "grow up" until 30+ :).

    Dr. Knapp


    The facts: Many people dread using a public toilet.  But the researchers say that of all the areas in the bathroom, the toilet seat is probably the least germ-infested.  Experts say catching any venereal disease is highly unlikely.  You are more likely to encounter common bacteria like E. coli and cold viruses on a faucet than on a toilet seat.   Failing to wash your hands after touching a flush handle, faucet, or doorknob poses a far more greater health threat than sitting on a toilet.  (Women's bathrooms have twice as many germs as men's.)  A study earlier this year found that office workstations contain 400 times as many germs as toilet seats.  I personally think the dirtiest thing in town is the grocery cart handle.  Yuck.  Use that hand sterilizer liquid stuff to clean the handle.  After all that news, I want to clean my hands before I sit and wipe rather than after I go on it.  :)

    Dr. Knapp

    p.s. Flu shots are recommended for 6-12 months and over 2 if they have heart or lung disease, cancer or immune diseases.  Or if the parents want them to get them.  I recommend teens get it especially so they do not miss a week of school and try to make up work.  You adults all need the flu shot.  You get 2 of them one month apart unless you have had at least one in the years past, then you only need one.  We will be giving shots at checkups and certain afternoons in Oct. and Nov.  Call now for appointments.


    When there is a crushing injury of the fingernail (almost every time I use the hammer.) we used to drill a hole in the nail to let blood out and ease the pain. It does not help and the hole can give the bacteria an opening to infect the nail. Just treat it with TLC. IF the nail comes off, leave it on as long as you can so it acts like a covering as the new nail grows underneath it. Trim the old nail so it does not get caught and get pulled off.(OUCH!) Put tape over the old nail or use a  Band-Aid over it will keep it from catching on anything. If it gets infected, the whole finger will get red and swollen past the joint of the finger.

    Dr. Knapp


    Ever wonder if your child may have swallowed a penny or coin? Just take them outside and lay them on the ground without any metal on them. Then take a metal detector and scan their chest and stomach. It has been written up in medical journals as a way to find out if there might be a metal object swallowed. Iím sure you will get some laughs in the neighborhood anyway.  They will pass most coins but some can get stuck in the esophagus or stomach.  If they swallow a small battery, that needs to come out right away.

    Have a happy and safe holidays

    Dr. Knapp


    You have heard about recent reports of mercury in fish. Methylmercury is toxic in high amounts and especially bad the younger you are. The Ethylmercury in vaccines did not hurt anyone and is secreted in less than a week where methylmercury is more harmful and stays in you a very long time. Fish that have a large amount of mercury are large fish that eat smaller ones and live a long time. The highest amounts are found in the king mackerel, tilefish, swordfish and shark. There is very little or none in catfish, shrimp, crab and salmon. Yeah! Canned light tuna has very little but Albacore canned Tuna and fresh Tuna has a moderate amount. See this site for a complete list of fish mercury:



     Dr. Knapp

    p.s. Mercury was used in England to convert beaver pelts to beaver top hats. The mercury exposure in the workers caused them to go insane. Such was the expression "mad as a hatter." Remember Alice in Wonderland?


    Sleeping with your baby.  Most animals sleep with their offspring for years.  Most humans in the world sleep with their offspring for years.  We are the civilized world and sleep our infants in the next room?  I think most parents like sleeping with their infant and most babies love sleeping with their parents.  It is a very natural thing to do.  But there is an increased risk of SIDS in bed with parents.  These are most of the time smokers, intoxicated with alcohol, overweight (mom over 160 lbs) and in waterbeds.  Sleeping face to face increases the carbondioxide in the baby.  So if you sleep with your baby realize that it increases in the SIDS from one in 158,000 and in their crib it is one in 252,000.  So it is rare but one must weigh the slight increased risk of SIDS with the benefits of sleeping with the baby.  That is for you to decide.  If you do chose to sleep with the baby, keep the blankets and such away from the face so there is plenty of fresh air in their face. 

    Dr. Roger Knapp