The Pediatric Group Newsletter Fall 1997

The Pediatric Group, P.A.

66 Mount Lucas Road, Princeton, NJ 08540-2733, USA

tel 609-924-4892, fax 609-921-9380

Fall 1997 Newsletter

(text copy)

Mark B. Levin, M.D., F.A.A.P.

John M. Cotton, M.D., F.A.A.P.

Timothy J. Patrick-Miller, M.D., F.A.A.P

Louis J. Tesoro, M.D., F.A.A.P.

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Dr. Levin: levin@pedgroup.com
Dr. Cotton: cotton@pedgroup.com
Dr. Patrick-Miller: pmiller@pedgroup.com
Dr. Tesoro: tesoro@pedgroup.com
Billing: billing@pedgroup.com
Information: information@pedgroup.com

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Greetings! Before we knew what was happening, Fall came upon us! We thought we would take this opportunity to bring you this newsletter with information we hope you will find helpful.

Sharon H. Rosenberg, MD

For those of you who have not heard, we are delighted to introduce Sharon H. Rosenberg, MD, the newest member to the Pediatric Group's family of doctors. Sharon joined us formally on July 14th of this year, shortly after completing her Pediatric training at the Albert Einstein Medical School complex in New York City. She is originally from Connecticut, and earned a Bachelor of Arts degree in our own backyard--Princeton University. After graduating, she attended New York University School of Medicine, before moving on to Albert Einstein. We are excited to have Sharon and hope you will welcome her.

Office Notes: Yearly Check-ups

We wanted to take this opportunity to remind you that we are available to see your children until they reach the age of twenty-two, graduate from college, or feel they are ready to move on to an internist for their care, whichever comes first! We recommend that children have yearly checkups after the age of three years. If you think your child may be overdue for a physical exam, please call our office and check with our receptionists. We will do our utmost to schedule an exam at a convenient time for you.

Lyme Disease: Keep Watching!

People can contract a number of illnesses from the bite of an infected tick. In our area of central New Jersey, the most important of these illnesses is Lyme Disease. Although ticks come in all sizes and shapes, the small deer tick is the most common carrier of Lyme Disease. The adult female is about 1/4 inch long and black and brick red in color. Nymph and larval forms, which more frequently transmit the disease, are much smaller ("moving freckle" or "poppy seed"). Ticks become infected with the Lyme Disease spirochete (cork screw shaped bacteria) when they feed on an infected animal (deer, mouse). People, in turn, get Lyme Disease when an infected tick takes a blood meal from them, transferring the spirochete into their bloodstream. It takes time (12 to 24 hours) for the tick to attach and begin feeding, so frequent "tick checks" can help prevent Lyme Disease.
The most common sign of Lyme Disease in its initial stage is a distinct red rash. It begins days or weeks after the tick bite and expands into a circular or oval shape with central clearing (a bull's eye). It may be itchy, warm or tender, and may be associated with fever, malaise, headache, and muscle or joint pains. A blood test can be done to confirm Lyme Disease. When diagnosed at this early stage, it can be easily and thoroughly treated with oral antibiotics. Long term side effects such as arthritis, heart and nervous system problems, may be prevented by early treatment.
If you should find a tick on your child, the best way to remove it is with forceps (tweezers). Grasp the tick as close to the skin as possible and apply firm and steady pressure directly away from the skin. Don't use a hot match or gasoline as this may irritate the skin. Clean the area with soap and hot water and then apply topical antibiotic.
We live in a tick-infested area, but there are several things you can do to minimize the risks. Check family members and pets at bedtime for ticks. Tuck pants legs into socks or boots, and keep shirts tucked into pants when outside. Wear light colored clothes so ticks are easier to see. Stay near the center of trails and avoid walking through the shrub layer of the of the forest when hiking. Insect repellents which contain permethrin, such as Permanone®, Duranon® or Coulstons Tick spray®, may be helpful if used as directed. A vaccine to prevent Lyme disease may be available as early as next year. We will contact you when we know more about it. Please feel free to call us if you have any questions.

Winter Hazards

Not only do kids love to play outside in the cooler months, but it is good for them. It gets them out of the house and away from the t.v. set and their computer games. Free play outside balances the often harrowing and exhausting, very structured day that they have at school. To help assure that your children's play outside is safe as well as entertaining and useful, we have assembled this article on winter safety tips.
The first thing to remember when children are playing outside is that they should dress appropriately. Children should dress in layers to retain the heat, and when appropriate, wear waterproofed clothing. Depending on the weather, a hat, earmuffs, scarf, gloves or mittens, pants, leggings, heavy socks and waterproof boots may be appropriate. Limit the amount of time children play outside, especially on very cold days. Watch for severe weather and wind chill information. When the children come in, have them promptly remove wet clothing, and give them something warm to eat or drink. When traveling in the winter, bring extra clothing and a blanket for the car. A stranded car can become an icebox.
Winter sports, although fun for all, can also have hidden dangers. Don't allow children to participate in sports before they are ready. Most children can safely begin skiing at age five and ice-skating at five or six after taking lessons. They are usually not ready for ice hockey until age eight or nine. Be sure they have the proper equipment for their sport. Small children who ski, ice skate or sled should wear helmets and should be supervised by adults. Equipment should fit snugly but comfortably. Older children playing ice hockey should be properly equipped with helmets, face masks and padding. Be sure they are skating on ice that is properly frozen (six to twelve inches thick) if on a lake.
Although we don't always think about it in the winter, sun exposure can present a problem. Both direct sunlight as well as sun glare reflected off the snow can lead to sunburn. Sun block as well as goggles or sunglasses to protect the eyes should be used by those participating in snow sports. Likewise, the wind can produce hazards such as windburn and wind chill. To protect your children, use moisturizer or emollient creams and wear clothing that is both wind and water proof.
The final winter hazard to guard against is frostbite. Frostbite occurs when tissue actually freezes. The most common form of frostbite is frostnip, an injury that tends to occur on the cheeks, ears and the tip of the nose. In frostuip, the skin becomes white or yellowish gray and cold. Upon rewarming, the site becomes red, slightly swollen and may blister. Although easy enough to avoid, frostbite can be difficult to recognize, because there is not always a strong sensation of pain. The most effective first aid measure in treating frostbite is to re-warm the frostbitten area using body heat. Dry, radiant heat such as a campfire, heat lamp or electric radiator, and rubbing the injured skin should be avoided since frostbitten skin is easily burned or damaged. For severe or extensive frostbite (severe pain initially followed by numbness and "blackberry" skin), notify a physician
immediately.

Flu Vaccine: Who Should Get It?

Not long after the leaves stop falling, physicians and patients alike gear up for an unfriendly visitor-the yearly influenza endemic. Beginning in November or December each year and affecting millions of children and adults annually, the flu is characterized by sudden onset of fever with chills, headache, malaise, aches, and a dry cough. Subsequently, sore throat, nasal congestion, and cough become more prominent. Other symptoms such as pink eye, abdominal pain, nausea, and vomiting occur less frequently. In children, the symptoms may appear as a simple upper respiratory tract infection or as an illness with fever but little else. Infants with influenza can become very ill, and sometimes develop signs of croup (barky cough) or pneumonia. Of the two types of flu, influenza A and influenza B, only influenza A can be treated with the new antiviral agents that recently became available. However, since relief of symptoms with these agents is marginal, and
there is little experience with these drugs in children, we cannot safely recommend them for use in routine cases of flu at this time. The only proven treatment for flu remains prevention.
Influenza can cause numerous complications including pneumonia, bronchiolitis, Reye syndrome (a post-influenza neurologic disorder), myositis (a muscle inflammation), other central nervous system complications, and death. While influenza can affect ten to forty percent of healthy children in the community each year, certain individuals are at increased risk of suffering from complications. These high risk individuals should receive the flu vaccine. Pediatric patients in this group include: 1) residents of chronic care facilities; 2) children who have chronic disorders of the pulmonary or cardiovascular systems, including children with significant asthma; 3) children with active chronic metabolic diseases (including diabetes mellitus), renal dysfunction, hemoglobinopathies, or immuno-suppression whether from disease (i.e., AIDS) or medication (i.e., cancer chemotherapy, corticosteroids); 4) children and teenagers who are receiving long-term aspirin therapy and therefore might be at risk for developing Reye syndrome after influenza.
It is further recommended that groups that can transmit influenza to immunosuppressed individuals--health care givers, employees of chronic care facilities, providers of home care, and household members--receive the flu vaccine to further reduce the likelihood of influenza exposure to these high risk individuals. Another group that might benefit from the vaccine includes students or others in institutional settings, for example, dormitories, to minimize the disruption of routine activities in these settings that have a very high likelihood of epidemic.
During the Autumn months, our nursing staff will contact those patients in the practice that we have identified as fulfilling the recommendations for the flu vaccine. If you believe your child should be on the list but were not contacted by mid October, please call our office and speak to one of the physicians or nurses. Also please contact us if you have any other questions.

Hepatitis B Virus: Is Your Child Protected?

Hepatitis B is one of several viruses that can infect the liver causing hepatitis--acute fever with jaundice (yellowing) of the skin, loss of appetite, nausea, and malaise. Contact with body fluids such as blood or sexual secretions is usually but not always required for transmission of the illness. Some individuals have asymptomatic infections, while others develop fulminant hepatitis from which they succumb. Most, however, have a relatively mild infection with the symptoms noted above.
It is not the acute symptoms but the chronic conditions that give this disease its notoriety. Between six and ten percent of adults, and up to ninety percent of newborns that contract the disease never completely recover. Twenty-five percent of these chronically infected individuals will eventually die of their disease. High risk behaviors for acquisition of this virus include sexual contact, intravenous drug abuse, and participation in prostitution. However, forty percent of patients with hepatitis B infection deny these behaviors. There is no known curative treatment available for this infection. This is why prevention is so important.
The Hepatitis B Vaccine is a synthetic recombinant vaccine that is usually given in three doses over a six to eighteen month period. It is safe causing only mild symptoms infrequently, and very effective, particularly when immunization is started in the newborn period. The vaccine is recommended by the Centers for Disease Control and the American Academy of Pediatrics. We support and recommend its use for all of our children.
If your child has not received this vaccine, please call and speak with one of the doctors about it. We are happy to answer any of your questions.

Office News: Phone Hour Every Day!

Many patients forget that the Pediatric Group physicians host a call-in hour every day of the year between 8:00a.m. and 9:00 a.m.! That means that even on Sundays and holidays, you can call and speak with a physician. Also, on Sundays and holidays, a doctor is in the office in the morning to see patients who have acute problems.

Wishing you a safe, healthy and enjoyable winter and holiday season!

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