Car Seats

Recently, the news reported on the importance of car seats for toddlers. Here are the some of the child passenger safety recommendations.

Rear Facing in the back seat:

• Birth to one year of age and
• 20 lbs or under

Forward Facing in the back seat:

• Toddlers from one year to four years of age and
• 20 lbs to 40 lbs
• It is best to keep the toddler rear facing as long as possible

Booster seat in the back seat:

• Children from four years of age to about eight years
• 4' 8" tall or under
• Children should stay in a booster seat until the adult seatbelt fits correctly over the lap and shoulder

Seatbelts in the back seat:

• Children at least eight years old
• 4' 9" and taller

Seatbelts in either the back or front seat:

• Teenagers 13 years old and older

Here are some enlightening statistics:

1. Children riding in the front seat are 40% more likely to be injured in a crash than those riding in the back seat.
2. Children in the back seat are about 38 percent less likely to be injured in a crash.
3. Car seats reduce the risk of death by 71% for infants and by 54% for children ages 1-4.
4. Booster seats reduce injury to 4-8 year olds by about 59%.
5. 42% of all unintentional childhood deaths are due to crashes.
6. Motor vehicle crashes claims nearly 1,800 children's lives and results in more than 274,000 injuries each year.
7. Approximately 80 percent of car seats are not installed and/or used correctly.
8. Seat belt use among young children often depends upon the driver’s seat belt use. Almost 40% of children riding with unbelted drivers were also unbelted.

Motor vehicle injuries are the leading cause of death among children in the United States!!!

Please follow the car seat recommendation, confirm proper installation, and always wear seatbelts. Talk to your health care professional for more information.
Excellent resources include the Healthy Children website and the NHTSA site.

Thank you.

Happy Holidays!

Wishing everyone a safe and joyous Holiday Season!!!

Water and Infants

During my infant well child exams, I advise mothers not to give water to infants. I usually get a perplexed face from the mother and sometimes a few words from the grandmother. During residency, I rotated through AI DuPont Children's Hospital emergency room. One evening, a young infant boy came to the ER with a seizure. He had no medical problems and no history of seizures. His family history was unremarkable. The family denied any high fevers or any accidental ingestions. Upon further investigation, the baby was recovering from a viral cold and the parents were giving water to prevent dehydration. Labs revealed a critically low sodium (hyponatremia). The baby was treated and released and the parents were counselled on not to give water to infants.

Providing water to infants to prevent dehydration increases the risk of seizure by diluting and then decreasing the sodium count in the blood. The low sodium then causes altered brain activity. The reasons why this occurs are 1) kidneys are not mature to flush out the excess water and 2) the infant diet does not contain enough salt to balance the excess water. Water intoxication can lead to several signs and symptoms including drowsiness, irritability, facial swelling, low body temperature, poor coordination, nausea and vomiting, irregular breathing, and then seizures.

Treatment is giving infants anti-seizure medications and salt containing fluids. Prognosis is excellent. Babies typically recover without any problems.

The best way to prevent water intoxication seizure is to not give water to babies. This includes tap water and commercially bottled water. Also, there have been reported cases of water intoxication from repeated dunking during swimming lessons. If the baby shows signs of dehydration, continue to give formula and/or breast milk. An oral rehydration solution such as Pedialyte can also be utilized.

Contact your primary care physician for more information. Thank you and have a nice day.

Cocaine and the Heart

A 40 year old male presented to the ER with complaints of severe chest pressure and trouble breathing. The symptoms began earlier in the day and progressively worsened. His medical history was remarkable for tobacco use but no cardiac problems. Diagnostic tests were performed which confirmed his heart attack. He was also found to have a positive drug test. Typically, young males do not have a heart attack unless there is a precipitating factor such as cocaine use.

Cocaine is the most abused illegal stimulant in the United States. About 15% of adults have tried cocaine. About 34 million people age 12 or older have experimented with this highly addictive drug and about 1.5 million are regular users. Recently, the percentage of college students using this substance has increased.

Cocaine is a powerful stimulant of the central nervous system. It comes from the leaves of the Erythroxylum coca bush located in South America. Cocaine can be injected, snorted, swallowed, smoked, or rubbed onto gums. Its effect is immediate and wears off in about thirty to sixty minutes.

The signs and symptoms of cocaine use include:
1. Euphoria
2. Increasing sense of alertness
3. Elevated mood
4. Paranoia
5. Restlessness
6. Anxiety
7. Dilated pupils
8. Excited speech
9. Decreased appetite
10. Sense of power
11. Hallucinations

There are many more symptoms....here are some of the detrimental health effects
1. Increase risk for heart attacks
2. Abnormal and life threatening heart rhythms
3. Stroke
4. Emphysema
5. Stomach ulcers
6. Kidney failure
7. Impair sexual function
8. Psychosis

The risk of heart attack in the first hour after using cocaine is 24 times normal!!!
Nearly one-fourth of heart attacks in people ages 18 to 45 are cocaine related.

The patient underwent cardiac stenting and had a full recovery. I can only hope this was a wake-up call.

There have been thousands of cocaine related deaths but the one I always remember is Maryland basketball star Len Bias.

Talk to your children about drugs. A helpful guide is on the Family Doctor website. Click here.

Contact your primary physician for more information.
Also, useful websites include:
National Institute on Drug Abuse
Substance Abuse Treatment Facility Locator

If you have never tried cocaine, please don't...it only takes one time to potentially ruin your life.

Postpartum Depression

I recently saw a 22 year old patient with complaints of fatigue, muscle aches, and feeling down for several weeks. She recently had her second child with no obstetrical complications. She feels depressed and is also worried about not bonding with her baby. Her medical history is unremarkable with no history of psychiatric disorders. She has a very supportive family. The patient was diagnosed with postpartum depression and was started on treatment with success.

Postpartum depression is a common type of depression affecting about 15% of women after the birth of their child. PPD usually begins several weeks after delivery but can occur anytime in the first year. PPD can last for several weeks to months.

There is a milder form of depression called the baby blues that begins a couple days after delivery and lasts for about 2 weeks. About 50% of women experience this condition. The signs and symptoms include trouble sleeping, irritability, heightened emotions, but it does not interfere with the mother's ability to care for her child. PPD does affect the woman's ability to function.

Risk factors include history of depression, psychosocial stress, lack of family support, young age, substance abuse, and problems with a previous pregnancy.

It is not clear what causes PPD but hormonal or chemical changes may play a factor.

Signs and symptoms of PPD (lasting more than two weeks) include:
1. Agitation
2. Feeling sad, hopeless, and overwhelmed
3. Crying a lot
4. Fatigue
5. Loss of appetite
6. Insomnia
7. Trouble focusing, remembering, or making decisions
8. Feeling worthless
9. Loss of interest or pleasure in activities
10. Headaches
11. Chest pain
12. Body aches
13. Lack of motivation
14. Withdrawal from friends and family
15. Decreased sex drive
16. Negative thoughts about the baby

Treatment includes
1. Family support
2. Asking for help
3. Rest and taking naps
4. Exercise, take walks
5. Talk to other mothers
6. Breast feeding
7. Eating healthy and continuing a prenatal vitamin (add fish oil to your diet)
8. Counselling with a professional
9. Medications such as antidepressants

Postpartum psychosis is a rare, severe form of postpartum depression that requires immediate medical attention. Mothers may experience hallucinations, display bizarre behavior, thoughts of hurting or killing herself or the infant. Postpartum psychosis requires psychiatric hospitalization and treatment.

Bringing a newborn into the world is a beautiful but life changing experience. If you have any concerns of the "baby blues" or postpartum depression, contact your physician immediately. Early intervention will improve the quality of the baby's life and your life.

Here is a postpartum checklist adapted from the New England Journal of Medicine
Click here

Talk to your healthcare professional for more information. Thank you.