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Kids and Screen Time

By Dr. John Maddox, Pediatrician
Pentucket Medical/ Haverhill

In every era, it seems that adults wring their hands over the new technologies to which their younger generations of children are exposed — the telephone, the TV and now the internet with all its many branches. New technologies obviously allow new capabilities and innovations for people of all ages, but pediatricians continue to try to tease out the good from the bad effects of “screen time” — as we counsel parents and youth about ways to prevent and correct some undeniable pitfalls of excessive use. Teens aged 13-17 spend an average of almost 9 hours per day using screen media. 45% of adolescents say they are online “almost constantly.” 54% of adolescents say they spend too much time on their cell phone.

Check out the following Family Media plan, relevant for all ages. If you think your child is using media too much, or becomes aggressive when you try to set limits on their media use, talk to their health care provider about your concerns, and ask for guidance on helping them cut back.
https://www.healthychildren.org/english/media/Pages/default.aspx#home

Mask Mythbusters: Five Common Misconceptions about Kids & Cloth Face Coverings

Submitted by Dr. John Maddox, Pediatrician, Pentucket Medical/ Haverhill

1.        Can wearing a mask make it harder for my child to breathe?

Recommended cloth face coverings do not block the exchange of oxygen or carbon dioxide.  The vast majority of children age 2 or older can safely wear a cloth face covering for extended periods of time; this includes children with many medical conditions.  Begin now having your child wear masks at home.  Start with short periods, when they are doing their favorite activities, and gradually increase the length of time, so they get used to it.  All schools will offer mask breaks.

2.       Can masks themselves spread germs?

Masks get damp over time, from the same respiratory droplets that spread COVID, flu and other germs, so face coverings should washed regularly.  It is important to have cloth face coverings that fit a child’s face well, so that they are not tampering with the mask.  You should perform hand hygiene before and after touching your face covering.

3.       Can a child with special health care needs, like the autism spectrum, wear a mask?

Some children will need extra attention to the way a mask feels and fits and smells.  Some kids will benefit from strategies like Social Story (see below), which help explain new situations with both descriptions and directives.  Schools are prepared for some students with special needs to be unable to wear masks full-time right away.  Occupational therapists and applied behavior therapists will work with students to teach them new and important skills.

4.      Should a kid wear a mask during sports?

Cloth face coverings help young athletes protect their teammates and themselves.  They also help protect the sports season.  Whenever safe and possible, athletes should wear a cloth face covering.  This includes on the sideline bench, in team chats and going to and from the field.  Exceptions include when they are actively exercising.

5.       Do masks really prevent the spread of COVID-19?

Cloth face coverings are one of the most effective ways to prevent the spread of COVID, flu and other germs.  Very early on in the pandemic, there was concern about having enough masks for health care workers, so widespread mask use was discouraged.  However, it is very clear now that states, communities, and schools that have contained COVID— despite imperfect social distancing, ventilation and hand hygiene— have used cloth face coverings to prevent spread, even in asymptomatic people.

 

https://www.healthychildren.org/English/health-issues/conditions/COVID-19/Pages/Cloth-Face-Coverings-for-Children-During-COVID-19.aspx

https://www.healthychildren.org/spanish/health-issues/conditions/covid-19/paginas/cloth-face-coverings-for-children-during-covid-19.aspx

https://drive.google.com/file/d/1R1lSbfZ8TRchbHCiK_4svK7WLH62lS

https://vkc.mc.vanderbilt.edu/assets/files/tipsheets/socialstoriestips.pdf

https://www.nytimes.com/interactive/2020/08/19/well/childrens-face-masks-comfort.html

Recognizing the Importance of Foster Parents

Dr. John Maddox, Pediatrician/ Pentucket Medical/ Haverhill

In my work as a pediatrician, few things are as inspirational and selfless as foster families that agree to take on the responsibilities of caring a child with nowhere else to go. (We should not lose sight of the substance abuse problems in our society: the primary root of neglect and mistreatment.)

Foster parents often have their own biological children, whose needs are being juggled, but — with amazing dexterity and balance — these homes, enriched with family love, are wonderful environments for the newly arrived foster child. Like a repotted plant that was once wilting, one can see a child in foster care begin to flourish in a matter of days. Furthermore, the foster parents go to extraordinary lengths to help DCF maintain children’s connections to their biological families. I realize that not every foster situation is a happy one, but many are and should be celebrated and exalted.

For more information visit:
https://www.healthychildren.org/…/Pag…/Foster-Parenting.aspx

Joy of Childhood through the eyes of a Pediatrician

Dr. John Maddox, Pediatrician

As I reflect on 20 years of being a pediatrician, during these uncertain and apprehensive times, encounters with children continue to bring joy.

Reviewing a child’s growth chart with a family is a particular delight.

There is such fascination in asking, “How tall will I be?” Whether the answer is four ten or six-ten, the essential question is, what is my full potential and how can I reach for that?   Like rings of a tree that testify to years of abundance and of adversity, height and health require the right mix of nature and nurture.

While DNA and diet are important, more than anything is, every child needs supportive relationships, within the family and the community, to weather tough times and resiliently thrive.

Transcendent of daily headlines and stresses, it is a privilege to be part of each young person’s journey, hopeful for all that lies ahead.

 

The Facts about Flu Shots

 

Seasonal flu activity typically occurs between October and May. The CDC recommends getting vaccinated as soon as the vaccine is available.

The American Academy of Pediatrics recommends that everyone six months of age and older get a flu shot for the 2019-2020 season as soon as it is available (which is now).

Influenza is dangerous – much more dangerous than the common cold. It can lead to hospitalization, ICU admission or even death. In the 2018-2019 flu season, 116 kids died. Of those children, 70 percent did not receive that year’s flu vaccine, and 50 percent were healthy before they got the flu. That is why getting the vaccine is so important.

Seasonal flu activity typically occurs between October and May. The CDC recommends getting vaccinated as soon as the vaccine is available, if possible by October. However, getting vaccinated later can still be beneficial.

What is the difference between a cold and the flu?

Influenza (the flu) is a contagious respiratory illness caused by influenza viruses. Viruses also cause colds but generally; do not make the patient as ill. Your health care provider may make the diagnosis based on symptoms and exam or can do a flu swab in the nose. Since viruses cause both types of illness, antibiotics won’t help.

How does the flu spread?

The flu spreads through droplets – sneezing, coughing, blowing your nose – and can stay on surfaces for a period of time. If someone with the flu touches a surface and you touch it a short time after them, you could get it. That’s why hand washing and covering your/your child’s mouth when you/they sneeze or cough is so important.

What are the symptoms of the flu?

Many symptoms of the flu are similar to other viruses. You can have fever, chills, sore throat, cough, runny/stuffy nose, headache, stomachache and body aches. The flu is more of a respiratory virus, not so much a vomiting/diarrhea one. Symptoms can last for up to a week. You can also get complications from the flu, such as pneumonia, sinus infections, ear infections, and even blood infections.

My child was tested and has the flu. What now?

The most important thing you can do is keep them comfortable and hydrated. If they don’t want to eat, that is okay – most of us don’t want to eat when we’re sick. However, it is important to stay hydrated. Be sure to push fluids – Pedialyte is a good choice for children and even comes in popsicles. With kids two years and older, ensure they are peeing at least three times in 24 hours. In kids who are two years and younger, ensure they are peeing at least four times in 24 hours.

Why do we have to get a flu shot every season?

The flu viruses are constantly changing to get around our defenses and make us sick. The CDC works year round collecting data to figure out which strains of flu will be most prevalent year to year.

I heard the flu shot does not really work. Why should I get it?

There are many misconceptions about the flu shot. Is it 100% effective at preventing the flu? No. Scientists do their best to create a vaccine each year based on the research they have done on the previous year’s flu strains. Although effectiveness does vary from year to year, the CDC estimates the flu vaccine reduces your risk of getting the flu by 40-60% when the vaccine is well matched to circulating viruses. A bigger point is that the flu vaccine has been shown to significantly reduce the risk of death in children. A study published in Pediatrics in 2017 showed that between 2010 and 2014, the flu vaccine reduced the risk of flu-related death by 51% (half!) among children with other high-risk medical conditions. It also reduced the risk of death in healthy children by 65%.  It is also important to note that if you get the flu shot and still end up getting the flu, symptoms will last for a shorter period and will not be as severe.

Which kids have to get two doses of the flu shot and why?

If it is your child’s first flu season receiving the vaccine and they are nine years old or younger, they will receive two doses of the vaccine four weeks apart. This helps prime their immune system. The first shot shows their body what the flu viruses looks like and the second shot is a reminder to make antibodies that are even more protective.  Once they get two doses of the flu shot their first season, they only need one dose each season after that.

My baby is under six months old. How can I protect them from getting sick?

The best things you can do is have everyone else in the house (or who will be around your baby) vaccinated and practice good hand washing. If you have older kids in the house, teach them about hand washing, sneezing/coughing into their arm, and avoid kissing the baby if they are sick.

My child is healthy. Do they still need the flu shot?

Unfortunately, every year there are healthy kids and adults who die from influenza. Getting a flu shot reduces the risk of your child being hospitalized due to the flu and/or its complications. Additionally, it protects those around them – older adults who have weakened immune systems, people with cancer, and babies who are too young to be vaccinated.

I get sick every time I get the flu shot. Why should I get it?

If you feel crummy after you get a shot that can be a good thing! It means your immune system is up and running, working to create antibodies to protect you in the future. When you get a shot, it triggers an inflammatory response in your body, a very similar type of response that is triggered when you get an infection. It is the same reason kids sometimes get a fever after their childhood immunizations – their immune system is getting to work.

Sometimes you may feel feverish or achy after getting a shot, but it is a small price to pay for how sick you could get the flu. The most common complaint we hear after giving a flu shot is some soreness around the area where the shot was given.

I heard the flu nasal spray is back again this year. Can we do that instead of the flu shot?

Yes – as long as your child does not have a history of asthma/wheezing/respiratory problems and is two years or older. Last year, we still recommended the injections over the nasal vaccine since it was the first year back on the market after being removed in the 2017-2018 season. Based on data from the 2018-2019 season, the American Academy of Pediatrics now recommends either the injection or the mist.

If you have more questions, please talk to your child’s pediatrician. Remember, it takes about two weeks for your body to build up an antibody response, so the earlier you get the  vaccine, the better.

To schedule an appointment call 888-227-3762.  

Cold and Flu Season is Here

With cold and flu season amost here one of the frequently asked questions from patients is, “when should I get vaccinated?” The answer is, you should get a flu vaccine before flu begins spreading in your community.

It takes about two weeks after vaccination for antibodies that protect against flu to develop in the body, so make plans to get vaccinated early in fall, before flu season begins.

CDC recommends that people get a flu vaccine by the end of October. Getting vaccinated later, however, can still be beneficial and vaccination should continue to be offered throughout flu season, even into January or later.

Children who need two doses of vaccine to be protected should start the vaccination process sooner, because the two doses must be given at least four weeks apart.

To schedule your flu shot contact your primary care clinician. (Schedule below).

Should you get sick know that you can be treated at one of our ExpressCare locations. (Andover or Riverwalk/ Lawrence) visit https://pmaonline.com/express-care/ to schedule an appointment online and for site hours.

 

Dangers of Vaping

What is vaping?

Vaping uses electronic cigarettes (or e-cigarettes) to simulate traditional cigarette smoking. E-cigarettes are battery-powered or chargeable smoking devices. Some look like traditional cigarettes or pipes. Others are designed to look like pens or USB memory sticks. They use a cartridge (or pod) filled with liquid. The liquid typically contains nicotine, flavorings, and other chemicals. When you puff on the mouthpiece of the device, it activates a heating element. This heats up the liquid in the pod and turns it into vapor. You then inhale the vapor. This is why it’s called “vaping.”

E-cigarettes are often marketed as a safer alternative to smoking. But they’re not safe. They still put an addictive drug and chemicals into your body and into the air around you.

teen girl vaping

How is vaping different from JUULing?

Vaping and JUULing are the same thing. JUUL (a brand of e-cigarettes that look like USB memory sticks) is a very popular vaping device among teenagers. So popular, in fact, that its brand name has become a verb to describe vaping. Teens may also use the term “ripping” to describe smoking an e-cigarette or JUUL. For more on JUULing and how it relates to teens, see “Teens and JUULing,” below.

Disputing common myths about e-cigarettes

The makers of e-cigarettes market them for a variety of uses. Researchers are still in the early stages of studying e-cigarettes. But studies have shown that e-cigarettes still contain harmful chemicals, including nicotine. Myths about e-cigarettes claim that the devices are:

  • E-Cigs are NOT a safer alternative to smoking cigarettes. Makers claim that e-cigarettes don’t contain the harmful chemicals that cigarettes do. Of course, this is not true. Most devices contain nicotine. A JUUL pod contains either 3% or 5% nicotine. A JUUL pod that contains 5% nicotine is equivalent to the amount of nicotine in one pack of cigarettes.
  • E-cigs are addictive. While there are some cartridges that don’t contain nicotine, most do. Any time a smoker inhales nicotine, he or she is inhaling an addicting and harmful chemical.
  • You cannot use e-cigs indoors. At first, makers of e-cigarettes said that e-cigarettes were appealing because they could be smoked in places that didn’t allow traditional cigarette smoking. This is no longer true. Many states have created laws that prohibit vaping in the same areas where traditional smoking is not allowed.
  • E-cigs are not really a way to quit smoking. Marketers claim it is easier to quit smoking if you switch to vaping first. In fact, e-cigarettes contain nicotine and may even lead to a user becoming a traditional cigarette smoker.

What are the dangers of vaping?

Experts have a number of concerns about the safety of e-cigarettes and vaping.

  • E-cigarettes contain nicotine. In large doses, nicotine can be toxic.
  • Nicotine stimulates your central nervous system. This increases your blood pressure, breathing, and heart rate. Higher doses of nicotine can cause blood pressure and heart rate to go up higher. This can lead to an abnormal heart rate (arrhythmia). In rare cases, this can cause heart failure or death. Over time, nicotine can lead to medical problems. These include heart disease, blood clots, and stomach ulcers.
  • Nicotine increases the level of dopamine in your brain. This chemical messenger affects the part of the brain that controls feelings of pleasure. It can motivate you to use nicotine again and again to get that feeling of pleasure. You do this even though you know it is a risk to your health and well-being. That is what makes nicotine addictive.
  • The ingredients in the liquid are not labeled. This means that we don’t know for sure what’s in the liquid.
  • There are often chemicals in the liquid. Some of these are known to cause cancer. One study found a toxic chemical that is found in antifreeze.
  • Tiny particles are released by the heating element and may be harmful. These particles can cause inflammation in the lungs, which can cause bacterial infections or pneumonia.
  • The liquid in the cartridge can be poisonous if someone touches, sniffs, or drinks it. There has been an increase in poisoning cases of children under 5 who have had access to the liquid.
  • “Secondhand smoke” is still a problem for e-cigarettes. Secondhand e-cigarette vapor contains chemicals that harm the lungs and hearts of people who aren’t vaping.
  • They serve as an introductory product for preteens and teens. Many kids start with vaping and then move on to other tobacco products.
  • Right now, there is little regulation when it comes to e-cigarettes. Even if it isn’t a JUUL product, there are many other kinds of e-cigarettes available. Doctors do not know what may be in them.

Teens and JUULing

E-cigarettes are popular among teens and are now the most commonly used form of tobacco among youth in the United States, according to the National Institute on Drug Abuse. As of August, 2018, JUUL accounts for an estimated 71 percent of the teen e-cigarette market. Reasons for this include:

Teenagers face increased risks from JUULs/e-cigarettes. The teen years are a critical time in brain development. This puts young people uniquely at risk for long-lasting effects. Nicotine affects the development of brain circuits that control attention and learning. It puts kids at higher risk of having mood disorders and permanent problems with impulse control. It also affects the development of the brain’s reward system. This can make other, more dangerous, drugs more pleasurable to a teen’s developing brain.

Kids who use e-cigs like JUULs are also more likely to become smokers than kids who do not, according to a three-year study. The study followed high school students as they transitioned from e-cigarettes to traditional ones.

There is much still to be learned about e-cigarettes and vaping. Since it’s relatively new, there aren’t long-term studies on the effects it may have. Until these long-term effects are known, doctors are encouraging patients to avoid e-cigarettes.

How do I talk to my child about JUULing?

If you suspect your child is JUULing (and even if you don’t), ask him or her about it. Start a conversation. Ask if they’ve seen friends doing it or seen JUULing at school. Use this opportunity to tell them the dangers of JUULing. JUULing is addictive. JUULing has been shown to lead to smoking. Smoking causes cancer, heart disease, and emphysema. Smoking is responsible for 1 in 5 deaths in the United States.

What if my child is already JUULing?

Talk to your child about quitting. Make an appointment for you and your child to talk to your family doctor about the best ways to quit JUULing. Your doctor may suggest a plan that includes some of the FDA-approved elements for smoking cessation listed below.

Things to consider

The FDA has approved 7 medications for smoking cessation in adults. These include nicotine gum, nicotine patches, and medicines. (Vaping is not one of the 7 approved methods.) There is little evidence that these same tactics will work for vaping.  If you are trying to stop vaping, here are some tips to consider:

  • Talk to your doctor. He or she may be able to suggest nicotine replacement therapy. They also may be able to prescribe medicines to help you quit.
  • Make a plan. Set a date to begin the quitting process. Set goals as part of your process. These can be as small as having one less e-cigarette a day for a week. Then you can continue to cut back on a schedule until you no longer smoke or vape.
  • Stay busy. Keep your mind off smoking by keeping busy. Do activities with your hands to keep them ovvupied. Plan ahead for times when you know you’ll want to smoke, such as after a meal or when you go out.
  • Put off cravings. Cravings can be hard to resist, but they usually pass. Tell yourself to wait until a certain time, and the urge to smoke will often be gone by then.
  • Get support. Surround yourself with people who support you. Tell your friends and family that you are quitting so they can be supportive. If you don’t want anyone to know you smoke or vape, join an online or in-person support group.

Questions to ask your doctor

  • Can I quit JUULing cold turkey?
  • Is there any sort of nicotine replacement I could try while quitting JUUL? Do you recommend this?
  • How long should it take me to quit JUULing?

Continue reading “Dangers of Vaping”

Viral Gastroenteritis aka ‘Stomach Bug’

It seems the stomach bug is around, so what are the signs? 

What are the symptoms of viral gastroenteritis?

Gastroenteritis is typically cause by a virus and symptoms usually begin about 1 to 2 days after the virus gets into the body.

Common symptoms include:

  • Nausea
  • VomitingWoman holding stomach in pain
  • Watery diarrhea

Other possible symptoms are:

  • Mild Headache
  • Fever
  • Chills
  • Stomachache

Signs of dehydration:

  • Decreased urine output
  • Dark-colored urine
  • Dry skin
  • Thirst
  • Dizziness

Signs of dehydration in young children:

  • Dry diapers (from a lack of urination)
  • Lack of tears
  • Dry mouth
  • Drowsiness
  • Sunken fontanel (the soft spot on the top of an infant’s head)

How is viral gastroenteritis diagnosed?

Your healthcare provider will most likely diagnose your condition based on your history and symptoms. You will rarely need testing. If your symptoms persist, your healthcare provider may ask for a stool sample to look for viruses, bacteria, and parasites.

Can viral gastroenteritis be prevented?

You and your children can help prevent viral gastroenteritis by taking these steps:

  • Wash hands for 20 seconds with soap and water after going to the bathroom, after changing a diaper, and before touching any food.
  • Use alcohol-based sanitizers.
  • If someone in the house has gastroenteritis, wash all surfaces that might be contaminated with a bleach-based cleaner.

How is viral gastroenteritis treated?

In most cases, you simply need to drink plenty of fluids and rest at home until the virus leaves your system. In rare cases, you may need treatment for severe dehydration, with IV (intravenous) fluids.

Helpful home care tips include:

  • Drink plenty of light fluids like water, ice chips, fruit juice, and broth. Keep in mind that sports drinks are high in sugar and are not appropriate if you are extremely dehydrated. In this case, you will need an oral rehydration solution.
  • Avoid drinks that contain milk, caffeine, and alcohol.
  • Once you feel hungry again, start with mild, easy to digest foods. (BRAT Diet – Bananas Rice Apples Toast)
  • Rehydrate children with oral rehydration solutions.

When should I call my healthcare provider?

Viral gastroenteritis is common in children and adults. In most cases, the disease is not serious and will run its course in a few days. Call your healthcare provider if you or a family member has vomiting or diarrhea that’s not getting better, worsening abdominal pain, if you see blood or tar-like stool, or if you have any signs of dehydration.

If your doctor is unable to see you, you can be seen at one of ExpressCare locations in Andover or Riverwalk/ Lawrence.  Visit www.pmaonline.com/expresscare to learn more or to schedule an appointment online.

We Screen, We Clean and We Protect.

To everyone who needs us now, come get the care you deserve. Our Safe Care Commitment is in effect at all of our locations providing  you with the safest possible environment for our patients and staff.

We screen to protect you, your families, and our staff

Patients visiting our offices for healthcare appointments are screened for symptoms upon arrival. If symptomatic, patients are cared for via virtual visits.

We also provide urgent care services at our Expresscare Riverwalk location which has a separate area where we use preventative measures.

We adhere to best practice safety protocols in those settings.

We follow special infection prevention guidelines for care provided to protect our patients and our staff.

We also provide telehealth services via video so you can access care and get the treatment you need from the comfort of your home or office.

Our goal is to keep everyone safe.