An update for parents Spring 2016 Playground Safety and ...clarkstownpeds.com/ewExternalFiles/Spring 2016 Parentletter.pdfChronic, year-round allergy makes children more vulnerable

An update for parents

www.clarkstownpeds.com

by Erica Berg, MD With nice spring weather the playground is a first social circle for most kids. This is a crucial time for both social development and

healthy physical activity. But please remember it comes with a set of safety precautions and unspoken parent rules!

It’s important to let your child explore the playground on his or her own. With that said, don't take your eyes off your child! Put away the phone, and watch your kids. Know if your child is getting into a dangerous situation or has conflict with other children, and be there to prevent it or intervene. Your child is your responsibility even from a distance. Naturally, children will make mistakes. You should never touch or reprimand another person’s child. However, when you see another child behaving badly, you should alert their parent.

For their safety, please survey the playground before your child plays. The National Program for Playground Safety has provided us with a way to evaluate playgrounds at schools, parks and our own backyards. Each year over 200,000 children require treatment in the ER for injuries that occur on a playground. 40% of these injuries are due to inadequate supervision.

Playground Safety and Unspoken Parent Rules

So, as parents we should all agree to adhere to the age limit. A properly designed playground will have a separate area for children under 5 years of age. In addition, set rules about using the playground equipment properly. For example: Do not let a child climb up the slides when other children are around. Sit on the swing rather than laying or standing on it. Climb the ladders one at a time. Have them learn to check for other kids in their way before jumping off equipment. Teach them to watch out for the swings. The swinging child can’t control their momentum so the walking child has to learn not to walk near the swings.

For your own home playground and for evaluating public places, a safe swing set should have no more than two swings per bay, and should not be attached to any other equipment. It should be installed with soft lightweight seats (no metal, wood or “animal” seats). A soft “fall zone" should be placed in front and behind the swings measuring twice the height of the swing. All openings within equipment should be less than 3.5” or more than 9” to make sure their heads do not get trapped. The ground cover is an important factor in the severity and prevention of fall related injuries. Asphalt, concrete, grass, rocks and packed dirt are unacceptable. Mulch, sand and rubber matting are recommended. Of course maintenance is just as important. Be sure to check equipment for rust, loose fastenings, worn out parts and sharp pieces.

If we all follow these rules as a community, our children will all benefit. (Please refer to our website to read Dr. Berg's full article.)

Spring 2016

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by Monica Hamburgh, MD While we’ve been vaccinating with the HPV vaccine (Gardasil)for a full decade now, no one knew for sure what the impact

on cervical and other cancers would be. A recently completed study brings us wonderful news! This study in the journal Pediatrics has found that the number of girls aged 14-19 infected with HPV has been reduced by about two-thirds (63% to be exact!). This means it’s really helping! This decrease has occurred with only about 40% of girls receiving the vaccine at this time.

Human papilloma virus, HPV, is the leading cause of cervical cancer and the virus that Gardasil combats. In 2011 a total of 12,000 women developed cervical cancer in the US, and 4000 died from it. HPV also causes 7,000 cases per year of cancer in men, so the CDC also recommends vaccinating boys with HPV vaccine. About 14 million Americans become infected with HPV every year, males and females. Some strains cause genital warts as well as cervical, anal, penile, mouth and throat cancers.

Another exciting advancement in cancer prevention is the recent release of Gardasil-9 vaccine which protects against five additional strains of the virus. Previous vaccines covered the 4 deadliest strains of HPV. In December, 2014 this new vaccine was approved by the FDA and we have begun using it in our office.

With vaccination we are hoping to greatly reduce the burden of these cancers. So if you haven’t already, now is the best time to vaccinate your child age eleven or older against this deadly disease.

Why have only 40% of girls received the vaccine in the US? The vaccine is mandatory and free in some other countries, leading to a 92% vaccination rate in Australia, for example. While HPV vaccine is mandatory in the states of Rhode Island, Virginia and DC, it is optional in New York.

So why isn’t everyone accepting the vaccine? Part of this may be the connection some people make to sexual activity. Yes, HPV is a sexually transmitted virus. But did you know that prior to HPV vaccine half of adults in this country were infected with this virus? It is therefore extremely important to protect your child now.

Why do we give it so young? The current recommendation is to vaccinate at age 11 or 12 when your child’s immune response is more robust than at later ages and hopefully prior to any sexual activity.

Is it safe? The vaccine has been given routinely in this country for ten years and has been found to be both safe and effective. There have been over 178 million doses given worldwide! The most common side effect we have seen is fainting after receiving the vaccine, which is why we sometimes recommend your child sit for 10-15 min after receiving it.

Why does the anti-vaccine movement go crazy over this vaccine? Auto-immune fears, ovarian failure fears, sexual promiscuity fears have been carefully studied and disproven. The vaccine is safe!

Great News in the Battle Against Cervical Cancer!

Fear of vaccines has been a challenge for doctors since the introduction of smallpox vaccine in the 1800's.

When polio vaccine was invented in the 1950's many were distrustful.

In the 1970's there was great concern about the safety of DPT vaccine leading to epidemics of pertussis (whooping cough.)

In 1998, a small and fraudulent study lead to fears about MMR vaccine and measles epidemics occurred, especially in Europe.

Smallpox, polio, measles are among many diseases eliminted by safe vaccines.

Today, despite extensive review and confirmation of HPV vaccine safety and effectiveness, vaccine fears have landed on this vaccine.

We hope our parents can see past internet pseudoscience on this issue and protect their preteens and teenagers! Doug Puder, MD

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We hope you find our Parentletter helpful and informative. Please keep in mind that receipt of this newsletter does not create a doctor/patient relationship and that it is not meant to serve as a substitute for professional medical advice. For particular pediatric medical concerns, including decisions about diagnoses, medications and other treatments, or if you have any questions after reading this newsletter, we encourage you to speak with your child's pediatrician.

©Clarkstown Pediatrics

The diagnosis of autism is becoming increasingly more common and is now estimated to affect 1 in 88 children, according to

the Centers for Disease Control (CDC). When a parent finds out that their child is affected it is easy to become overwhelmed. But after some time is taken to absorb the news, a parent is his or her child’s best advocate in seeking the latest treatment. Here are a few basic facts:

l Autism is a disability that affects three major developmental areas: social interaction, behavior, and communication.

l Autism is a spectrum, meaning it affects each individual in a different way and can range from very mild to very severe.

l Early intervention and intensive therapy using a team approach will offer the your child the best chance at progress.

How do I begin to help my child? There are a few basic steps that parents should take to embark on the road to treatment:

Make sure the you have the right diagnosis! Children with autism might be diagnosed by a pediatrician, through the school system, or often through the suspicion of parents and family members. It is important to speak with your doctor about consulting with a Child Neurologist or Developmental Pediatrician to confirm the diagnosis, especially since autism and other developmental conditions can look similar.

If your child is under age 3, contact the Rockland County Health Department Early Intervention Program. This program provides services to children between birth and age 3, either in-home or in a preschool setting. If your child is over age 3, contact the Committee on Preschool Special Education of your local school district.

Learn about the different modes of treatment. Applied Behavior Analysis (ABA) is one of the most common methods used, but there are other methods that have also shown promise. The health professionals at Early Intervention can help guide you

Become familiar with your child’s rights. You have to learn a whole new language including terms such as IEP (Individualized Education Plan), LRE (least restrictive environment), EI (Early Intervention), IDEA (Individuals with Disabilities Education Act), and FAPE (Free Appropriate Public Education). The more educated you become, the better you can advocate for your child.

Beware of therapies that have been disproven. Over the years autism has been blamed on vaccines*, dietary factors, vitamin deficiencies, gastrointestinal issues, and many other unrelated things. These have not been supported by research and have sometimes been used to prey upon parents desperate for a cure. Remember, there is no total cure for autism, but treatment can optimize a child to achieve his maximum social and communicative function.

What can I do if my child has Autism?by Jeffrey Karasik, MD

(*Our full article on how the fraudulent vaccine-autism link was disproven is on our website in the download section.)

All of our patients are screened carefully for

Autism at age 18 months and again at age 2 years.

This MCHAT form can also be

downloaded on our website

(Modified Checklist for Autism in Toddlers)

• Nanuet (845) 623-7100 • New City (Eckerson) 352-5511• Stony Point 786-5776

Although spring flowers, trees and grasses are beautiful, their pollen can cause misery for those who are allergic. Spring allergy is also

called allergic rhinitis, allergic conjunctivitis or "hay fever". It can cause runny nose, red itchy eyes, and an itchy throat. Asthmatic children may wheeze. Luckily, most allergies today can be controlled, and suffering greatly reduced.lHow do I know if my child has allergies?

A spring "cold that just won't go away" may well be allergy, especially if there is no fever. Spring allergies usually occur in more than one family member. They are rare in children under 3 years old (as it takes several seasons to develop).lCan "year-round" allergens make spring allergies worse?

Yes. Chronic, year-round allergy makes children more vulnerable to spring pollens. Eliminating some of these may help: Dust mites grow in mattresses and bedding. Cover your child's mattress and pillow with hypoallergenic covers, avoid down or other padded comforters or pillows, and remove bedroom carpeting if possible. To prevent molds, decrease humidity (use a dehumidifier if needed). Use bleach or lysol in bathrooms and cellars. Allergy to animals can be tested, and options discussed if tests are positive. Allergies get worse if anyone smokes in your home!lHow can spring allergy be treated?

Start with a "non-sedating" antihistamine. These are given by mouth and block the release of a chemical which causes many of the allergic symptoms. They are now available without prescription:

Loratadine: Claritin/Alavert/generics-pills and liquids once dailyFexofenadine: Allegra/generics-pills and liquids-once to twice dailyCetirizine: Zyrtec/generics-pills and liquids- once daily

April Breezes Bring May Sneezes...by Doug Puder,MD

Cortisone nasal sprays are very helpful in reducing inflammation, and provide tremendous relief (fluticasone, Flonase, Nasocort, Nasonex, Veramyst, Qnasal, Rhinocort, and others.). Many of these are now OTC (non-prescription)! Avoid vasoconstricting nasal sprays (Afrin, etc.) since they can become addicting and make things even worse when stopped.

Eye allergy responds well to allergy blocking drops such as Zaditor (OTC) or prescription Pataday (Patanol),Pazeo (high strength Pataday), or Optivar.lWhat else helps?

Minimize the use of fans. HEPA air cleaning devices help a little but may not be worth the expense. If you have airconditioning, keep windows closed during high pollen count days. lShould We See an Allergist?

Most children can tolerate the pollen season with these treatments. A child who is still miserable despite all we have discussed should be tested by an allergist, and may benefit from "allergy shots" (immunotherapy).

Clarkstown Parentletter: Douglas Puder, MD,FAAP, Editor,Illustrator, Monica Hamburgh, MD, FAAP, Asst EditorJeffrey Karasik,MD,FAAP Gregg Rockower, MD, FAAP Erica Berg, MD, FAAP

lWhat if antihistamines are not working?