Dr. Knapp

Dr. Knapp

Dr. Knapp

Bug spray and Sunscreen

Use of Deet has been shown to be safe and effective in preventing insect bites.  It can be used down to 2 months of age in concentrations of up to 25%.  I prefer to keep it at 10-15% preparations and more start it’s use at 4-6 months old.  All concentrations are just as effective but the higher ones last longer time.  The 10% deet repels just as good as the 50% but they last a different length of time.  I like to put less on the skin but apply it more frequently.  10% lasts 2 hours, 30% lasts 5 hours, and 50% lasts 10 hours.  Older kids can use the higher concentrations and teens can use the 50% deet without worry.  Do not apply to the hands of infants and small children.  You can spray your hand and apply it to the face of infants.  Careful about applications of deet.  It can harm plastics (eyeglass frames) synthetic fibers like rayon and spandex, leather, some watch crystals.  It does not harm cotton or wool.

There are two other repellants without deet.  One is Picaridin is a synthetic safe repellant that does not harm fabrics like deet and it only lasts 2 hours.  It is available in 7% concentrations (Cutter Advanced) The other product is Oil of lemon eucalyptus which is a plant based repellent and lasts 90 minutes of protection. 

Sunscreen products are variable and act differently.  The SPF is confusing.  The higher number only lasts longer but does not protect any better.(Just like the deet.)  The SPF 15 will protect even very sensitive skin but only lasts 2 hours.  The SPF 30 would last 4 hours.  The mistake is not putting enough on the skin to get the full effect and less SPF 15 would result in an effect of SPF 7.  So put plenty on the skin.  So many people recommend 20-30 SPF because they figure you will not put enough on the skin.  You should use a sunscreen that protects both UVA and UVB rays.  Apply it 30 minutes before going out and apply it before you put Deet repellents on the same areas.  Do not use the combined products that have sunscreen and repellents in it.  Apply sunscreen every 2 hours.  The water resistant or sweat resistant products only last 40 minutes and the “very water resistant” products only last 80 minutes.  So you need to apply them when swimming very frequently.  Consider putting a small T-shirt on them when swimming a long time.  They are also starting to manufacture “wet suit” type tops for children to wear.  One study from Europe showed children whose parents always kept shirts on their children had far less moles as adults than those who did not wear shirts.  Tanning beds are worse than the sun so use the tanning chemicals, which are safer.

I raced into the grocery store, 8‑month‑old in my arms and 3‑year‑old in hand, to pick up Tylenol, a prescription and a few groceries. I was on my way home from the pediatrician's office, and my to‑do list was nowhere near done. There was dinner to cook as well as housework and dirty diapers waiting for me at home, and a meeting to attend that night.

I gathered up the things we needed and hit the checkout counter, impatiently waiting to get my change so I could dash out the door, when all of a sudden an older woman came up behind me. She stopped me and said, "Slow down and enjoy your boys while they're little. The time will go so fast! My two sons are grown and live on different coasts. How I miss them and wish I could see them and spend the day with them!"

The time didn't seem to be going fast. Those were the days when I could barely see over the stacks of dirty diapers, when I was cooped up with my children's bouts of bronchitis or ear infections, spilled milk and whines of "Mommy!" On those days, it seemed like I hadn't talked to an adult in what seemed like weeks. It didn't help that my husband worked long hours. Because we were newcomers to the city, I didn't know any other moms.

Yet I knew the woman was right. When I went home that day and days afterward, I slowed down enough to make Lego forts and castles with my boys and then stroll with them to the park to play.

Perhaps you've received similar advice from an older mom, too, but it bears pondering again. The truth is, your kids' childhood will pass so quickly. As Dorothy Evslin said, "It will be gone before you know it. The fingerprints on the wall will appear higher and higher, and then suddenly they disappear."

In the twinkling of an eye, they'll be taking off for college or career. Try this little exercise: Close your eyes and picture your child strolling down the aisle with his graduating class. Decked in cap and gown, he walks across the stage when his name is called and grasps his diploma. Then a few short months later, he piles all his stuff in his car and heads across the country for college. Graduation photos on the piano; Little League baseball trophies and GI Joes stored in the attic. No music blaring from his room.

In the United States, from 1934 through 1943 an annual average of 192,752 pertussis cases and 4,034 pertussis-related deaths were reported. Following the introduction of childhood pertussis vaccination during the 1940s, the number of reported pertussis cases declined dramatically to a historic low of 1,010 in 1976. However, since the 1980s the number of reported pertussis cases has been steadily increasing (see figure), especially among adolescents and adults. Reported cases in adolescents ages 11 to 18 years have increased from less than 200 cases per year in the early 1980s (incidence less than 1/100,000) to 4,144 cases in 2003 (incidence 12/100,000).

In 2004, provisional data show more than 18,000 reported cases. Numerous school and community outbreaks have occurred across multiple states. A repeating theme is that source cases and highest attack rate often are in middle schools (frequently in classrooms or gatherings related to school activities) with rapid spread throughout the school and into families and the community.

Reasons for the changing epidemiology of pertussis include waning immunity from a parenteral vaccine given in childhood against a mucosal respiratory tract disease years later, fewer natural boosts in immunity because of partial control of pertussis, an aging cohort who may have received less effective pertussis vaccine or no pertussis vaccine, and increased awareness of pertussis in older individuals.

The Whooping cough in adults does not kill you but you can give it to infants less than 6 months old and it is real bad for them.  Also you cough for 3 months as an adult and that is not fun.

2. The other change is the requirement of Hep A vaccine for preschool kids 2 and older.  We cannot give it until 2 yr so we will be giving the shots to 2 yr olds.  There is a second booster of Hep A that is given 6-12 months later also.  The Hep A is recommend for school age children but not required at this time.  I really don't push this vaccine for school kids unless they are going to live in foreign countries that have poor sanitation or live along the Mexico border.

We will be giving the TdP to teens 11-14 yr old and with the meningitis vaccine Menatra (Meningococcal Meningitis vaccine that is needed before College but can affect high school kids too). 

PS:  There is a really cool site for underwater pictures and even a live cam.
http://www.oceanexplorer.noaa.gov/explorations/05lostcity/welcome.html

Dr. Knapp

9/12/05

Calcium requirements for age are:

0-6 months old             200-400

6-12 months old       300-600

1-3 years old                500-800

4-8 years old                800

8-10 years old              800-1200

11-18 years old       1200-1500   

 

Food	Amount	Calcium
Yogurt, plain, low fat	8 oz	415
Collards, frozen, boiled	1 cup	357
Skim milk	1 cup	306
Spinach, frozen, boiled	1 cup	291
Yogurt, plain, whole milk	8 oz	275
Cheese food, pasteurized American	1 oz	162
Cottage cheese, 1% milk fat	1 cup	138
Baked beans, canned	1 cup	154
Iceberg lettuce	1 head	97
Canned salmon	3 oz	181
Oranges	1 cup	72
Trail mix (nuts, seeds, chocolate chips)	1 cup	159
Almonds	1 oz (24 nuts)	70
Blackeye peas, boiled	1 cup	211
Green peas, boiled	1 cup	94

 

So milk intake should be 12-24 oz a day by one year old and stay there for many

years.  By 8-10 years it increases if they are not taking in much other calcium. 

When they go into puberty, they recommend 1500 mg of calcium for females and

1200 for males.  That is a lot of milk so I recommend calcium for most teens.  Usually

500-1000 mg a day plus the milk and ice cream that they do eat. Then they will have less

Osteoporosis as an older adult.

 

Dr. Knapp

www.rogerknapp.com

 

Plus give vitamins to children at all ages.  We just do not eat right most days.

9/26/05

Focus on the Family

by Cheri Fuller

 

I raced into the grocery store, 8‑month‑old in my arms and 3‑year‑old in hand, to pick up Tylenol, a prescription and a few groceries. I was on my way home from the pediatrician's office, and my to‑do list was nowhere near done. There was dinner to cook as well as housework and dirty diapers waiting for me at home, and a meeting to attend that night.

 

I gathered up the things we needed and hit the checkout counter, impatiently waiting to get my change so I could dash out the door, when all of a sudden an older woman came up behind me. She stopped me and said, "Slow down and enjoy your boys while they're little. The time will go so fast! My two sons are grown and live on different coasts. How I miss them and wish I could see them and spend the day with them!"

 

The time didn't seem to be going fast. Those were the days when I could barely see over the stacks of dirty diapers, when I was cooped up with my children's bouts of bronchitis or ear infections, spilled milk and whines of "Mommy!" On those days, it seemed like I hadn't talked to an adult in what seemed like weeks. It didn't help that my husband worked long hours. Because we were newcomers to the city, I didn't know any other moms.

 

Yet I knew the woman was right. When I went home that day and days afterward, I slowed down enough to make Lego forts and castles with my boys and then stroll with them to the park to play.

 

Perhaps you've received similar advice from an older mom, too, but it bears pondering again. The truth is, your kids' childhood will pass so quickly. As Dorothy Evslin said, "It will be gone before you know it. The fingerprints on the wall will appear higher and higher, and then suddenly they disappear."

 

In the twinkling of an eye, they'll be taking off for college or career. Try this little exercise: Close your eyes and picture your child strolling down the aisle with his graduating class. Decked in cap and gown, he walks across the stage when his name is called and grasps his diploma. Then a few short months later, he piles all his stuff in his car and heads across the country for college. Graduation photos on the piano; Little League baseball trophies and GI Joes stored in the attic. No music blaring from his room.

 

When that happens, you won't be thinking, I wish I’d spent more time at the office or polishing the floors.

 

Perhaps your home is still filled with the footsteps of little or big kids that run, skip or jump but rarely walk. Lucky you! Or you're on the verge of your kids flying from the nest. As my friend Melina told me one summer, "In two years Tim will be gone to college! I wish I could make time stop! It's moving too fast!"

 

While we can't make time stop as life proceeds and our children grow, what can we do to savor and enjoy the time we do have together? How can a mother make the most of those fleeting and sometimes exhausting yet sweet years of childrearing?

 

Don't put off joy. "When my little girl gets potty trained, when I lose the extra weight I gained in pregnancy, I'm going to be so much happier," a young mom told me recently. When our finances aren't so tight, if my husband’s not so stressed, if I get my house redecorated, when my prodigal teen starts loving God and makes better choices.... If we stake our joy on the “whens and ifs," we'll miss out on the joys and blessings God has for us in each season of parenting, even those that are difficult and filled with unfinished projects, toddlers resisting potty training or challenging teens.

 

Instead we can focus on living life fully today and realize there is something in every season to enjoy: Picking strawberries and camping out in the backyard in summer, baking gingerbread cookies and drinking hot chocolate in winter, having a "color walk" in the spring as you walk around the block and have them name all the red (or green or yellow) things they see. You can even see sick days as a time to fill up your kids' emotional tanks, a time to hug, sip hot apple juice, cuddle up and read books together. Every day there are miracles and things to celebrate: a purple‑and‑rose sunset, your child's first sentence, a sticky kiss or even a goldfinch at your bird feeder.

 

Find your own "Slowdown spots of time" together. As moms, we can get so focused on getting everything done that we begin to look at our children as interruptions instead of our priority. We get so busy and overcommitted; we and our kids continually rush from one place to another. When you take time to lie on a quilt and look up at the stars in the night sky, time slows down a little. And moments to sit on the edge of your child's bed to listen and pray for her, to fly a kite or blow bubbles in the spring breeze are precious.  (Go on a Scout Campout.)

 

Make time for what really matters. Whatever the most important things in your life‑the love of husband, kids, friends; the joy of knowing God; helping a friend in the hospital; opening your door in hospitality; or teaching your kids about Jesus‑ask yourself, Am I using my time to do these things? Talk with your family about the one thing you don't want to miss doing this spring or summer and then just do it.

 

Life is a gift. Our children are a gift, and each day together is a gift. As we give our time to God each day, don't put off joy, and keep in mind what's most important.

10/5/05

Head lice crops it's "head" up each year.  There were some recent studies that showed that many head lice are becoming resistant to antibiotic shampoos like Rid and such.  In the past we have talked about smothering the lice with olive oil on the hair.  Recent studies have shown that using a rinse conditioner in the hair and combing with a "nit" comb would remove most lice.  But you have to get them as they hatch and repeat the conditioner and combing once every 3 days for 2 weeks.  If you combined that with soaking the hair in olive oil the next day and the third day use the Rid rinse, then we should be able to get them all and cure it without bad chemicals.

 

Or you could shave your head bald like me... ha ha! 

 

Dr. Knapp

10/13/05

Although childhood malignant melanomas are rare, physicians and parents must keep an eye out for them.  About 2% of all melanomas appear in children, but the types that commonly oc­cur in children are different from those found in adults. Melanomas in children arise from three things: 1. congenital nevi (moles that are there at birth),  2. de novo nodu­lar nevi (moles that come up new as they grow older), and 3. superficial spreading melanomas that are sun induced from moles that have been there for years.

 

Although 70% of melanomas in adults are sun induced and are superficial spreading melanomas, about 80% in children arise from congenital moles or de novo nodular lesions. There are very dif­ferent concepts of melanoma in child­hood.

 

1. Congenital moles that occur in 2% of children arise during the first 4 months of life. Most are small, less than 1.5 cm.  Excision of congenital moles is not nec­essary in infancy.  It is suggested that children with these moles be followed close­ly by parents and physicians. In children, these are more important than the other moles.  Melanomas in small congenital moles usually occur at or after puberty so they should be removed before puberty, espe­cially if the mole is on the scalp, face, or trunk.  Giant moles in children and those over 6 cm in a newborn, have a 5%-8% chance of melanoma risk. Many of these nevi are too large to totally excise.

 

2. The second most common type in chil­dren is nodular melanoma, constituting 40% of the melanomas in childhood. The nodules are rapidly growing and a red, bluish purple in color. They often ulcerate and, at times, bleed.  This is a highly fatal type.  The nodules are thick at the time of diagnosis.

 

3. And, in third place are the superficial spreading malignant melanomas. Here the ABCD rule applies: asymmetry, border irregularity, color variation, and diameter over 6 mm. However, the idea that the le­sion in a child has to be more than 6 mm is not reality.  This type is increasing because of the sun exposure of kids.

 

In adults, melanomas start out as a speck, and only 20%-40% start in preexisting moles. About 60%-80% start in de novo moles (new moles that are just beginning).  It's the new kid on the block, the new mole that can get you into trouble.  All moles have some potential to develop melanoma, but it is very low.  Congenital nevi have the most potential.

 

If a person has more than 100 moles, a family history of melanoma, and several large atypical nevi, there is a 50% chance of melanoma.  These individuals have to be followed carefully. Teenagers that fit this category should be fol­lowed like a hawk.

 

Early recognition and referral is essen­tial, followed by biopsy and surgical exci­sion. Adjunctive therapies have marginal additional value. The depth of the lesion is extremely important, with a depth of less than 1 mm being 95% cur­able and up to 3 mm being 40% curable.

 

There has been a 20-fold increase in the incidence of melanoma since 1930. This was  about the time that people decided to get silly and take off their clothes for recreational sun.

 

Dr. Knapp

10/30/05

A study came out showing lower birth weight of children of mothers who had dental x-rays during their pregnancy.  Even small amounts of radiation can cause small babies.  Wait 9 months to get the x-rays if they really are needed.  I would not get them anyway unless there are compelling reasons.  X-rays should not be a routine part of the routine visit to the dentist or emergency room.

 

Dr. Knapp

11/09/05

From the Wall Street Journal, July 2005:

We are a nation of take-outers and drive-throughers, eating our meals on the go, dining by ourselves and laughing alone. The family dinner has become an endangered species. .. . These days, fewer than one-third of all children sit down to eat dinner with both parents on any given night. The statistics are worse if both parents are working and the family is Caucasian (Latino families have the highest rate of sharing a meal). The decline in the family dinner has been blamed for the rise in obesity, drug abuse, behavioral problems, promiscuity, poor school performance, illegal file sharing and a host of other ills. A recent study at the Harvard Medical School, for example, concluded that the odds of being overweight were 15% lower among those who ate dinner with their family on 'most days' or 'every day' compared with those who ate with their family 'never' or on 'some days.' The National Center on Addiction and Substance Abuse at Columbia University found that teens from families that almost never eat dinner together are 72% more likely to use illegal drugs, cigarettes and alcohol than the average teen.

 

Roger Knapp MD

11/16/05

Here are the American Pediatric Recommendations for decreasing SIDS.

Have a great Thanksgiving..... Dr. Knapp

 

RECOMMENDATIONS to Prevent SIDS

 

The recommendations outlined here were developed to reduce the risk of SIDS in the general population. As it is defined by epidemiologists, risk refers to the probability that an outcome will occur given the presence of a particular factor or set of factors. Scientifically identified associations between risk factors (eg, socioeconomic characteristics, behaviors, or environmental exposures) and outcomes such as SIDS do not necessarily denote causality. Furthermore, the best current working model of SIDS suggests that more than 1 scenario of preexisting conditions and initiating events may lead to SIDS. Therefore, when considering the recommendations in this report, it is fundamentally misguided to focus on a single risk factor or to attempt to quantify risk for an individual infant. Individual medical conditions may warrant a physician to recommend otherwise after weighing the relative risks and benefits.

 

1.  Back to sleep: Infants should be placed for sleep in a supine position (wholly on the back) for every sleep. Side sleeping is not as safe as supine sleeping and is not advised.

 

2.  Use a firm sleep surface: Soft materials or objects such as pillows, quilts, comforters, or sheepskins should not be placed under a sleeping infant. A firm crib mattress, covered by a sheet, is the recommended sleeping surface.

 

3.     Keep soft objects and loose bedding out of the crib: Soft objects such as pillows, quilts, comforters, sheepskins, stuffed toys, and other soft objects should be kept out of an infant's sleeping environment. If bumper pads are used in cribs, they should be thin, firm, well secured, and not “pillow like.”  In addition, loose bedding such as blankets and sheets may be hazardous.  If blankets are to be used, they should be tucked in around the crib mattress so that the infant's face is less likely to become covered by bedding. One strategy is to make up the bedding so that the infant's feet are able to reach the foot of the crib (feet to foot), with the blankets tucked in around the crib mattress and reaching only to the level of the infant's chest. Another strategy is to use sleep clothing with no other covering over the infant or infant sleep sacks that are designed to keep the infant warm without the possible hazard of head covering.

 

4.  Do not smoke during pregnancy: Maternal smoking during pregnancy has emerged as a major risk factor in almost every epidemiologic study of SIDS. Smoke in the infant's environment after birth has emerged as a separate risk factor in a few studies, although separating this variable from maternal smoking before birth is problematic. Avoiding an infant's exposure to second‑hand smoke is advisable for numerous reasons in addition to SIDS risk.

 

5.  A separate but proximate sleeping environment is recommended: The risk of SIDS has been shown to be reduced when the infant sleeps 'in the same room as the mother. A crib, bassinet, or cradle that conforms to the safety standards of the Consumer Product Safety Commission and ASTM (formerly the American Society for Testing and Materials) is recommended. "Cosleepers" (infant beds that attach to the mother's bed) provide easy access for the mother to the infant, especially for breastfeeding, but safety standards for these devices have not yet been established by the Consumer Product Safety Commission.

 

Although bed‑sharing rates are increasing in the United States for a number of reasons, including facilitation of breastfeeding, the task force concludes that the evidence is growing that bed sharing, as practiced in the United States and other Western countries, is more hazardous than the infant sleeping on a separate sleep surface and, therefore, recommends that infants not bed share during sleep. Infants may be brought into bed for nursing or comforting but should be returned to their own crib or bassinet when the parent is ready to return to sleep. The infant should not be brought into bed when the parent is excessively tired or using medications or substances that could impair his or her alertness. The task force recommends that the infant's crib or bassinet be placed in the parents' bedroom, which, when placed close to their bed, will allow for more convenient breastfeeding and contact. Infants should not bed share with other children. Because it is very dangerous to sleep with an infant on a couch or armchair, no one should sleep with an infant on these surfaces.

 

6.  Consider offering a pacifier at nap time and bedtime: Although the mechanism is not known, the reduced risk of SIDS associated with pacifier use during sleep is compelling, and the evidence that pacifier use inhibits breastfeeding or causes later dental complications is not. Until evidence dictates otherwise, the task force recommends use of a pacifier throughout the first year of life according to the following procedures:

 

·      The pacifier should be used when placing the infant down for sleep and not be reinserted once the infant falls asleep. If the infant refuses the pacifier, he or she should not be forced to take it.

 

·      Pacifiers should not be coated in any sweet solution.

 

·      Pacifiers should be cleaned often and replaced regularly.

 

·      For breastfed infants, delay pacifier introduction until 1 month of age to ensure that breastfeeding is firmly established.

 

7. Avoid overheating: The infant should be lightly clothed for sleep, and the bedroom temperature should be kept comfortable for a lightly clothed adult. Overbundling should be avoided, and the infant should not feel hot to the touch.

 

8. Avoid commercial devices marketed to reduce the risk of SIDS: Although various devices have been developed to maintain sleep position or to reduce the risk of rebreathing, none have been tested sufficiently to show efficacy or safety.

 

9. Do not use home monitors as a strategy to reduce the risk of SIDS: Electronic respiratory and cardiac monitors are available to detect cardiorespiratory arrest and may be of value for home monitoring of selected infants who are deemed to have extreme cardiorespiratory instability. However, there is no evidence that use of such home monitors decreases the incidence of SIDS. Furthermore, there is no evidence that infants at increased risk of SIDS can be identified by inhospital respiratory or cardiac monitoring.

 

10. Avoid development of positional plagiocephaly:

 

·      Encourage "tummy time" when the infant is awake and observed. This will also enhance motor development.

 

·      Avoid having the infant spend excessive time in car‑seat carriers and "bouncers," in which pressure is applied to the occiput. Upright "cuddle time" should be encouraged.

 

·      Alter the supine head position during sleep. Techniques for accomplishing this include placing the infant to sleep with the head to one side for a week and then changing to the other and periodically changing the orientation of the infant to outside activity (eg, the door of the room).

 

·      Particular care should be taken to implement the aforementioned recommendations for infants with neurologic injury or suspected developmental delay.

 

·      Consideration should be given to early referral of infants with plagiocephaly when it is evident that conservative measures have been ineffective. In some cases, orthotic devices may help avoid the need for surgery.

 

11. Continue the Back to Sleep campaign: Public education should be intensified for secondary caregivers (child care providers, grandparents, foster parents, and babysitters). The campaign should continue to have a special focus on the black and American Indian/Alaska Native populations. Health care professionals in intensive care nurseries, as well as those in well‑infant nurseries, should implement these recommendations well before an anticipated discharge.

11/28/05

Calcium requirements for age are:

0-6 months old             200-400

6-12 months old       300-600

1-3 years old                500-800

4-8 years old                800

8-10 years old              800-1200

11-18 years old       1200-1500   

 

Food	Amount	Calcium
Yogurt, plain, low fat	8 oz	415
Collards, frozen, boiled	1 cup	357
Skim milk	12 oz	500
Spinach, frozen, boiled	1 cup	291
Yogurt, plain, whole milk	8 oz	275
Cheese food, pasteurized American	1 oz	162
Cottage cheese, 1% milk fat	1 cup	138
Baked beans, canned	1 cup	154
Iceberg lettuce	1 head	97
Canned salmon	3 oz	181
Oranges	1 cup	72
Trail mix (nuts, seeds, chocolate chips)	1 cup	159
Almonds	1 oz (24 nuts)	70
Blackeye peas, boiled	1 cup	211
Green peas, boiled	1 cup	94

 

So milk intake should be 12-24 oz a day by one year old and stay there for many years.  Too much milk

 and they get anemic and will not eat a proper solid food diet.  The children usually are in that range of 12-24 oz

where their height/weight is on the growth curves.  For example if they are at the 50% then they would usually

take in about 18oz a day.  If they are big and at the 90% height/weight, then they would be taking in 24 oz a day.

  Then they get the few hundred mg of Calcium from cheese, ice cream, and other foods that have calcium. 

IF they are allergic to milk then they can drink SILK (non-dairy milk) or the Orange Juice with calcium. 

Or they can take a 500 mg chewable calcium from the stores.

 

By 8-10 years requirements increase and it goes higher at puberty.  When they go into puberty, the

recommendations are 1500 mg of calcium for females and 1200 for males.  That is a lot of milk

(three 8 oz glasses) so I recommend calcium supplements (and multiple vitamins) for most teens….usually

1000 mg supplement a day plus the milk and ice cream that they do eat.  The average teen only gets

300 mg a day.

 

We can load up their bones with calcium during their rapid growing years and prevent Osteoporosis

in their later years.

 

Dr. Knapp

www.rogerknapp.com

 

Plus give vitamins to children at all ages past one year.  We just do not eat right most days.  Plus we eat less red meat.  Any vitamin that has Iron and Zinc.

12/23/05

Dental Caries by Michele Sullivan

 

Altering the oral flora by dietary management and dental in-tervention can alter the cariogenic process in young children, lessening the chance of decay in primary and permanent teeth, Kevin Hale, D.D.S., said at the annual meeting of the American Academy of Pediatrics.

"We can address this as preventive medicine," said Dr. Hale, a pediatric dentist in Brighton, Mich., and a member of AAP's executive committee on pediatric dentistry. "Don't wait until kids have a problem."

Managing the population of oral bacteria, both in the child and the mother, is the key to preventing caries in children. "We want to decrease the percentage of cariogenic bacteria, and increase the noncariogenic strains," Dr. Hale said.

Humans don't have an established oral bacteria population until they get a tooth, Dr. Hale said. Mothers are the primary source of bacterial colonization for their infants. If a mother has active decay, she also has many cariogenic and few non-cariogenic strains. This is the ratio she will pass on to her infant.

There are several steps to managing maternal oral flora: removing active decay, changing diet, and improving dental hygiene. All of these will decrease the amount of cariogenic bacteria," he said. "This is important because the longer these bacteria sit on the teeth, the more acid they produce, which inhibits the growth of noncariogenic flora."

Xylitol gum can be an important part of this strategy, he said. The sugar doesn't promote bacterial growth because bacteria can't process it. The action of chewing increases salivary production and helps remove plaque.

A 2000 Finnish study looked at the effect of xylitol gum on maternal and child levels of Streptococcus mutans, compared with women who chewed fluoride or chlorhexidine gum. None of the children received any of the treatments. By 5 years, children whose mothers chewed xylitol gum had 70% fewer cavities than those in the other groups (J. Dent. Res. 2000;79:1885-9).

These strategies are useful for children as well, Dr. Hale said, with diet of primary importance. "The main problem is carbonated beverages. You should be counseling your patients to drink milk and water between meals, and only 4-6 ounces of undiluted fruit juice per day, [and] only with meals."

Remind parents that bottles of milk or juice at bedtime promote decay-causing bacteria. Children who cruise with "sippy cups" of juice throughout the day also are at risk. Older children who chew gum should chew the xylitol variety.

Children's teeth should be brushed twice a day and flossed once a day (yea … Right!), even if they only have one or two teeth (How do you floss one tooth?). Fluoride supplements can be useful in remineralizing the teeth and reducing bacteria, but it's important to do a very thorough history before prescribing these, he stressed.

"Even if they have fluoride in the water, the kids may be drinking bottled water without fluoride," Dr. Hale said. Conversely, children may live in an area without fluoridated water but attend day care in an area that has it, or be drinking bottled beverages made with fluoridated water. Over dosages of fluoride can cause brown spots on developing teeth, he said.

Pediatricians should be checking the teeth at every visit. Sometimes an exam will reveal chalky-looking white marks near the gum line. "Using an otoscope to examine the teeth can help you see this." The white areas are acid-etched enamel, a sign of impending decay, Dr. Hale said.

Check the teeth for plaque accumulation and the gums for inflammation. To check for inflammation, wiggle the bristles of a soft toothbrush between the teeth; if the gums are inflamed, blood will ooze a few seconds after brushing stops.

If there is no plaque and no inflammation, patients are doing a good job with hygiene. If you see inflammation without plaque, you are looking at a case of "performance brushing," Dr Hale said. "These are the kids who get their teeth brushed real well before they come in to see you, but who don't do it regularly otherwise."

If you see plaque without inflammation, the child probably has poor dietary habits and is drinking a lot of sugary liquids. Restrict the amounts of juice to only with meals.

 

So Mommys... keep your teeth in good condition.

Happy Holidays.

Dr. Knapp