By Jannette H. Rivera, M.D.

1. How does a parent know if their infant or child is developing a food allergy or a reaction to something in the environment?

Environmental allergies can manifest themselves as watery eyes, runny nose, nasal congestion, sneezing and cough. Food allergies can evidence themselves through vomiting, diarrhea, abdominal pain, rash or hives, and in severe cases, shortness of breath and difficulty breathing (anaphylaxis). If parents suspect their child has allergies, charting the child’s food intake and activities along with symptoms experienced may shed some light as to possible allergens. If you suspect environmental allergies, a positive response to a trial dose of antihistamines may be all that is needed to confirm the diagnosis. Also, discuss your concerns with your child’s doctor, since many common allergies can be diagnosed with simple blood tests, in addition to skin testing.

2. What are the best ways to treat allergies?

The best treatment for allergies is to avoid the offending agent. If this is not possible, medications are always an option. Treatments include topical steroid nasal sprays, both sedating and non-sedating antihistamines and leukotriene inhibitors. Nasal sprays work by decreasing inflammation in the nose. Antihistamines work by decreasing the effects of histamine on the respiratory tissues and leukotriene inhibitors work by decreasing inflammation in the respiratory tract. Each treatment can play a significant role in decreasing allergy symptoms. Determining which treatment is best for each person depends on the allergens and the individual’s response to the medications.

3. What breakfast foods do you recommend for kids?

Foods rich in whole grains and protein such as oatmeal, yogurt and eggs, for example, are excellent choices for breakfast. A good breakfast will give your child a head start to their day, providing the necessary substrates to fuel their minds and bodies. Avoid foods high in simple sugars such as some breakfast cereals, as these will only raise your child’s blood sugar and make them feel tired and less energetic later in the day.

4. What type of diet is recommended for children?

Children should be taught early on to make healthy food choices and to eat well-balanced meals. Moderation is the key. In general, parents should avoid giving their children foods that are high in salt, fat –especially saturated and hydrogenated fats — and simple sugars. Foods that are freshly prepared, as opposed to processed foods, will help limit the intake of these ingredients. Limit fast food as well, since these are heavy in salt and fat.

5. What type of vitamins do you recommend for children?

Most healthy children eating well-balanced diets do not need to take vitamins. There is no proof that consuming more than the recommended daily allowance of nutrients is beneficial. On the contrary, consuming excessive amounts of vitamins A, D, E and K can actually be harmful. If you are not sure whether your child may need vitamins, discuss this with your pediatrician. Depending on your child’s nutritional needs, you may select a multivitamin with or without minerals. Children’s vitamins can now be obtained in liquid, hard and soft chewable, and gum form with a variety of tastes to choose from.

6. Besides basic immunizations for school, what other vaccines should parents be aware of?

Parents should be aware that there are vaccines available to prevent other severe diseases such as meningitis, genital warts, cervical cancer and profuse diarrhea. Meningitis is an infection of the tissues surrounding the brain. It is usually fatal and serious neurological deficits can occur. Pneumoccocal bacteria are known to infect the ears, sinuses, lungs, blood and brain. Parents should know that they can have their child vaccinated against pneumoccocal disease. The pneumoccocal conjugate vaccine does not prevent all types of pneumoccocal disease, but may prevent their child from getting meningitis due to the more common types of pneumoccocal bacteria. In addition, there is a meningococcal conjugate vaccine available that can prevent meningitis caused by meningococcal bacteria. Like the pneumacoccal vaccine, the meningococcal vaccine does not protect against all meningococcal bacteria, but will protect against the most common types of infections. The pneumoccocal conjugate vaccine is administered to children in one to four doses depending on the age it is first given. The meningococcal conjugate vaccine is administered to adolescents in one dose. There is another vaccine available for young ladies that will protect against certain types of human papilloma virus, or HPV. When administered, this vaccine could protect against 90 percent of genital warts and 70 percent of cervical cancers caused by the HPV types found in the vaccine. The HPV vaccine is administered in three doses over a six-month period. The rotavirus causes significant vomiting and diarrhea in hundreds of infants yearly, causing severe dehydration and requiring hospitalization. The rotavirus vaccine is an oral vaccine administered in three doses in the first six months of life.

7. What should one look for when selecting a pediatrician?

When selecting a pediatrician, parents should take into account not only the pediatrician, but the office and its staff. Ask questions pertaining to the following: office hours, scheduling of sick visits, scheduling of well visits, how calls are handled during office hours, how after-hours calls are handled and if there are any charges for after-hours services provided. Ask if you can schedule a time to meet with the pediatrician prior to your first appointment. During this visit, take the time to observe the surroundings and friendliness of the office staff. Ask the physician if they have hospital privileges, where these privileges are held and how they handle hospital admissions. What is acceptable to a parent depends on their expectations and needs.

8. What are the five most common issues you are treating your patients for? Do you see any trends developing with any of these issues?

Acute otitis media, commonly known as ear infection, continues to be one of the most common diagnoses made in the office on a day-to-day basis. Although it is treated with common antibiotics, I am finding that more children are in need of multiple courses of antibiotics due to antibiotic resistance. Another common problem that I treat relates to skin infections and boils. Although common bacteria cause a lot of these infections, I am noticing an emergence of methicillin resistant staph aureas, or MRSA, which can be more difficult to treat. Streptococcus pharingitis, better known as strep throat, is another common occurrence. Although amoxicillin continues to be the drug of choice, I also have noticed an increase in amoxicillin-resistant strains. Reactive airway disease, or asthma, is a cause of significant morbidity in my pediatric population. Unfortunately, I continue to see children living in environments where they are constantly exposed to second-hand smoke, which is well known to aggravate their condition. Finally, diarrhea is also a common reason for office visits. Contrary to what most parents expect, most cases of diarrhea are not of an infectious nature, but rather are caused by excessive consumption of fruit juices. This is also known as toddler’s diarrhea.

Health Alert: Childhood Obesity

As a physician, I am very concerned about the increasing numbers of obese children, their lack of exercise and poor eating habits. The body mass index, or BMI, is a number calculated from an individual’s weight and height. It is used to screen for obesity. In children, the BMI is calculated and then referenced on a percentile curve. This is done because a child’s BMI may vary based on age and gender. A child with a BMI between the 85th and 95th percentile for their age and gender is considered at risk to become overweight. A child with a BMI above the 95th percentile is considered overweight and at risk for potential health problems. Less than the 5th percentile is considered underweight. If you would like to calculate your child’s BMI, you can log on to the following Web sites : www.cdc.gov/nccdphp/dnpa/bmi/ or www.kidsnutrition.org/bodycomp/bmiz2.html.

I sometimes find that other members of a child’s family model unhealthy behaviors. Therefore, this makes it somewhat difficult to address the problem of childhood obesity. Many parents will try to provoke change in their child, not realizing that this is a family affair. Kids are most successful in achieving dietary and behavior modifications when all family members are involved in the process.

Another factor that has been slowly contributing to the problem of childhood obesity is the amount of time children spend in front of a screen, whether it is the television, computer or electronic games. Without guidance, children will spend countless hours in front of a screen, robbing them of the opportunity to exercise their bodies and minds in other ways. I get looks of disbelief from children when I encourage parents to limit screen time to less than two hours per day. Exercise does not have to be a “painful” experience. A brisk, 30-minute walk every other day can have a positive effect on the body. If this seems overwhelming, I encourage my patients to start at a level that is comfortable for them. The important thing is getting started on a routine that includes exercise and smart food choices.

It is often hard for parents to understand how present obesity in children can correlate to future health problems. Childhood obesity puts children at risk for adult heart disease, stroke, diabetes, osteoarthritis, obstructive sleep apnea and gall bladder disease, as well as certain types of cancer, such as colon and postmenopausal breast cancer. Childhood obesity is preventable if doctors, parents and patients work together.

Jannette H. Rivera, M.D. is a board certified pediatrician in a very busy private practice in Clermont, FL. Dr. Rivera’s passion for the overall well being of children is illustrated by her annual mission trips to Central America.