Immunization Update - Influenza Vaccine

The CDC Advisory Committee on Immunization Practices has approved an interim recommendation stating that the NASAL SPRAY form of the influenza vaccine should not be used in any setting in the upcoming 2016-2017 season. Review of data by The Advisory Committee on Immunization Practices indicated that the NASAL SPRAY form of the vaccine had been ineffective against influenza A (H1N1) in children 2-17 years old for the past three seasons. It is still important to protect our children from the influenza virus by yearly immunization. For this season the injectable form of the influenza vaccine will be offered.

AAP backs new ACIP recommendation on influenza vaccine

AAP News staff

Health care providers should not use live attenuated influenza vaccine (LAIV) in the upcoming 2016-’17 season due to poor effectiveness, a Centers for Disease Control and Prevention (CDC) committee said Wednesday.

Academy leaders say they support the interim recommendation by the CDC’s Advisory Committee on Immunization Practices (ACIP).

“We agree with ACIP’s decision today to recommend health care providers and parents use only the inactivated vaccine for this influenza season,” said AAP President Benard Dreyer, M.D., FAAP.

The AAP recommends children ages 6 months and older be immunized against influenza every year. Previously, the CDC and AAP had recommended either form of flu vaccine – the inactivated influenza vaccine (IIV) that is given by injection and is approved for all patients older than 6 months, or LAIV which is given by intranasal spray and is approved for healthy patients ages 2 through 49 years.

However, new data presented to the ACIP showed that currently only IIV provides protection against flu. The ACIP assessed data from the past three influenza seasons and cited evidence of poor effectiveness of LAIV during this time period.

“We do understand this change will be difficult for pediatric practices who were planning to give the intranasal spray to their patients, and to patients who prefer that route of administration,” said AAP CEO/Executive Director Karen Remley, M.D., M.B.A., M.P.H., FAAP. “However the science is compelling that the inactivated vaccine is the best way to protect children from what can be an unpredictable and dangerous virus. The AAP will be working with CDC and vaccine manufacturers to make sure pediatricians and families have access to appropriate vaccines, and to help pediatricians who have already ordered intranasal vaccines.”

Dr. Dreyer stressed the need for continued immunization against influenza every year.

“Flu vaccine is the best way we have to protect children and being immunized every year significantly reduces the risk of a child being hospitalized due to flu,” he said.

Source: http://www.aappublications.org/news/2016/06/22/InfluenzaVaccine062216

The Prevalence of Picky Eaters

I frequently speak to parents struggling with picky eaters. I categorize some children as "healthy but narrow eaters" others I induct into the "Beige Food Group Society". Many families have one child who is an adventurous eater and another child who is a picky eater demonstrating that this quality is somewhat innate. One of my tips for families is to compromise with a child in the following manner. A particular food of protest must stay on the plate during every meal in which this food is served. The child does not have to eat it. Often after many exposures to the look and the smell of the food, the child will initiate a sampling. As a mother of twins, I experienced this myself. I would continue to serve a food because one of my twins liked it. The other twin would scoff at it but eventually try it. If I had only one child, I may have stopped presenting this particular food forgoing the opportunity for the scoffer to try it. Below is a great article with many helpful tips about the challenges of picky eaters. Enjoy!

The Do’s and Don’ts of Feeding a Picky Eater

A CHOP psychologist offers her “do’s” and “don’ts” for helping picky eaters expand their palates — and how to know when it’s time to seek professional help.

Is your 5-year-old still eating the same three foods she’s liked since age 2 — and little else? Do you worry she’ll be off to college some day and still never know the joys of fruits or vegetables?

You’re not alone. A recent Pediatrics studyfound that about 20 percent of preschoolers are either moderate or extreme picky eaters. These kids only eat a narrow range of foods and their picky eating causes enormous stress for families.

“I’ve worked with children and parents for 12 years, and parents of picky eaters are among the most miserable, second only to the parents of kids who refuse to go to school,” says Katherine Dahlsgaard, PhD, ABPP, lead psychologist of the Anxiety Behaviors Clinic in CHOP’s Department of Child and Adolescent Psychiatry and Behavioral Sciences.

“It is heartbreaking for parents when their kids don’t enjoy family meals, eat like all the other kids at birthday parties, or participate in big celebrations like Thanksgiving,” she says.

With the right treatment, however, even extremely picky eaters can be taught to broaden their palate. We asked Dr. Dahlsgaard for her “do’s” and “don’ts” when it comes to feeding picky eaters — and how to tell when it’s time to seek professional help.

  • Do remember that picky eating is often “developmentally normal.” Children across the globe go through a picky eating phase from about age 2 to about age 4. “We think it starts out partly as a built-in protective impulse in a child. When a toddler can wander off out of a caregiver’s sight and potentially pick things off the ground to put into his mouth, Nature has instilled in him a wary sense that says, ‘This is a new ‘food,’ and I won’t like it,’” she says.
  • Don’t blame yourself.  “Most picky eating cannot be explained by poor parenting. The proof for that is that many picky eaters have siblings who eat just fine,” says Dr. Dahlsgaard. “So I let parents know their child probably came into the world with a brain that is just more rigid about trying new foods. I ask parents of picky eaters to allow some compassion for themselves about how frustrating that is,” she adds.
  • Don’t give up on a new food! Try over and over again. The reason: Research says it takes eight to 15 times to introduce a new food before your child will accept it. Yet parents typically offer a food three to five times before deciding their child is never going to like it.
  • Do make sure your child comes to the table hungry. “Often, parents aren’t even aware of how frequently their child eats and drinks,” says Dr. Dahlsgaard. “Have your child wait two hours between a snack and mealtime, and one hour between a drink and mealtime,” she says.
  • Don’t fear your child’s hunger. “Lots of parents worry about their child feeling hunger pangs. They offer a quick snack, or give in to a demand, to relieve any such discomfort. But it’s OK for your child to feel hungry; he’s not starving. Being hungry means he’s looking forward to the next meal,” says Dr. Dahlsgaard.
  • Do set limits around food and talk in a matter-of-fact tone. “Many parents are very shy about setting limits around food in a way they’re not shy about setting bedtime limits, for instance,” says Dr. Dahlsgaard. “In a neutral tone, you might say something like: ‘You need to eat a bit of this in order to have dessert.’ You don’t need to yell or show emotion other than a little optimism. And if your child doesn’t eat it, don’t react, but be sure to follow through on withholding dessert. It’s just the consequence of not tasting a food. You should also avoid talking about it later and instead move on with your evening,” she says.
  • Do establish mealtime routines. Try to eat your dinner around the same time every night; keep distractions like phones and TV out of mealtime; talk about pleasant topics so kids associate positive feelings with mealtime. “Remember that kids get the vast majority of their calories in the first 20 minutes, so set a happy tone to start the meal and keep time at the table short to avoid boredom,” says Dr. Dahlsgaard.
  • Don’t be afraid to ask for help. Severe picky eaters may need extra help from a professional to move beyond their limited eating choices. Prior to age 15, children often aren’t motivated to change. “They’re not unhappy about their picky eating, only their parents are,” says Dr. Dahlsgaard. How can you tell if your child’s habits are severe? Look for signs such as:
    • Being extremely unwilling to taste any new food, even after having it on her plate multiple times.
    • Extreme distress about food your child doesn’t prefer; for instance, she may avoid all bagels because she once found a seed on her bagel that she wasn’t expecting.
    • Developing aversions to foods she used to eat.

If you think your child is a severe picky eater, be sure to seek out a professional who has extensive experience treating the problem. At CHOP, psychologists like Dr. Dahlsgaard can help parents faced with this issue learn to use a method that rewards children for trying different foods and adding new options to their diet.

“Children should learn how to overcome extreme picky eating not just for the sake of their physical health, but for a greater sense of well-being. Eating a range of foods and enjoying a meal are critical to a well-lived life,” adds Dr. Dahlsgaard.

Contributed by: Katherine Dahlsgaard, PhD, ABPP
Published on Feb 22, 2016 in Health Tip of the Week

Link to article: http://www.chop.edu/news/dos-and-donts-feeding-picky-eaters#.V17FQbsgtph

The Clock is Ticking Towards Tick Time

Enjoy Hiking and stay in the center of the trail

Enjoy Hiking and stay in the center of the trail

Stages of tHE deer tick

Stages of tHE deer tick

The Clock is Ticking Towards Tick Time

A tick is a tiny creature with an amazing power to wreak havoc upon an otherwise pleasant family outing on a day filled with sunshine.

Ticks can attach to any part of the human body, but are often found in hard-to-see areas such as the groin, armpits, and scalp.

Most of the time, ticks can be removed swiftly at home using the following tips:

1)  Stay calm. You are must larger than the tick.

2)  Locate tweezers

3)  With your thumb and forefinger, press down lightly on the skin on either side of the tick and pull outward.  This will make the skin taut and easier to isolate the little critter.

4)  Forget it is a little critter. Pretend it is a little piece of gravel.

5) With the tweezers, grab the head of the tick, or the entire tick if it is tiny, and pull straight up with steady, even pressure. Do not jerk or twist the tick. You may feel a little resistance and your child may feel a little pinch at this point.

6)   1-2-3 PULL!!

Grab the tick by the head and pull straight upwards

Grab the tick by the head and pull straight upwards

7)  Once the head is removed, soak the area in soapy water.  Treat it like you would if a splinter had been removed. Consider applying antibacterial cream and a band aid.

8)   Expect a mild irritation of the skin. It may scab. It may look like a mosquito bite afterwards simply due to the bite and the removal process. This should go away in 1-2 days. Watch for signs of infection.

9)   Do not use petroleum jelly, nail polish, a lit match or any other remedy to smother the tick.  Your goal is to just get the tick out.

10)  Watch for a rash that appears at the site and spread out reaching a diameter of 12 inches or more between 3 -30 days after the tick bite. This rash is an early sign of Lyme Disease

Lyme Disease

In most cases, the tick must be attached for 36 to 48 hours or more before the Lyme disease bacterium can be transmitted.

Early Signs and Symptoms of Lyme Disease (3-30 days after tick bite)

·       Fever, chills, headache, fatigue, muscle and joint aches, and swollen lymph nodes

·       Erythema migrans (EM) rash:

o   Occurs in approximately 70 to 80 percent of people infected with Lyme Disease

o   Begins at the site of a tick bite after a delay of 3 to 30 days (average is about 7 days)

o   Expands gradually over a period of days reaching up to 12 inches or more (30 cm) across

o   May feel warm to the touch but is rarely itchy or painful

o   Sometimes clears as it enlarges, resulting in a target or “bull's-eye” appearance

o   May appear on any area of the body

Lyme Disease Symptoms

 

Please consult your doctor for further assistance with tick removal or concerns about symptoms.

Content source: 

·       Centers for Disease Control and Prevention

When Is It Teen Moodiness and When Is It Depression?

This is a great article on the mood changes that accompany adolescence - easy to read and well written. Remember the adolescent brain is still developing. We need to support our adolescents the same way we supported them when they were learning to walk. Stand beside your teen, just like you did when he or she was learning to walk. Allow some stumbling. Catch the big falls and keep your eyes wide open.  

To read the full article, visit Empowering Parents.

Multilingual Kids Develop Multiskills

How interesting! Being exposed to more than one language as a child has some benefits that I would not have thought of. There are obvious advantages like being able to participate in more conversations and feeling comfortable ordering from a menu on the other side of the world but more importantly .....

Recent studies suggest that children who speak two languages or simply spend time in an environment where two or more languages are spoken have improved social abilities including the ability to take someone else's perspective in order to understand his or her meaning.

Makes sense! - when we don't understand what someone is saying, we look at them more intently and try to use context clues and cues to grasp what the person is saying. Children do this too and children in multilingual environment are better at it!

Muy bien!

The Superior Social Skills of Bilinguals

Gray Matter
By KATHERINE KINZLER MARCH 11, 2016

  • BEING bilingual has some obvious advantages. Learning more than one language enables new conversations and new experiences. But in recent years, psychology researchers have demonstrated some less obvious advantages of bilingualism, too. For instance, bilingual children may enjoy certain cognitive benefits, such as improved executive function — which is critical for problem solving and other mentally demanding activities.

Now, two new studies demonstrate that multilingual exposure improves not only children’s cognitive skills but also their social abilities.

One study from my developmental psychology lab — conducted in collaboration with the psychologists Boaz Keysar, Zoe Liberman and Samantha Fan at the University of Chicago, and published last year in the journal Psychological Science — shows that multilingual children can be better at communication than monolingual children.

We took a group of children in the United States, ages 4 to 6, from different linguistic backgrounds, and presented them with a situation in which they had to consider someone else’s perspective to understand her meaning. For example, an adult said to the child: “Ooh, a small car! Can you move the small car for me?” Children could see three cars — small, medium and large — but were in position to observe that the adult could not see the smallest car. Since the adult could see only the medium and large cars, when she said “small” car, she must be referring to the child’s “medium.”

We found that bilingual children were better than monolingual children at this task. If you think about it, this makes intuitive sense. Interpreting someone’s utterance often requires attending not just to its content, but also to the surrounding context. What does a speaker know or not know? What did she intend to convey? Children in multilingual environments have social experiences that provide routine practice in considering the perspectives of others: They have to think about who speaks which language to whom, who understands which content, and the times and places in which different languages are spoken.

Interestingly, we also found that children who were effectively monolingual yet regularly exposed to another language — for example, those who had grandparents who spoke another language — were just as talented as the bilingual children at this task. It seems that being raised in an environment in which multiple languages are spoken, rather than being bilingual per se, is the driving factor.

You might wonder whether our findings could be explained as just another instance of the greater cognitive skills that bilingual children have been observed to have. We wondered that, too. So we gave all the children a standard cognitive test of executive function. We found that bilingual children performed better than monolingual children, but that the kids who were effectively monolingual yet regularly exposed to another language did not. These “exposure” children performed like monolinguals on the cognitive task, but like bilinguals on the communication task. Something other than cognitive skills — something more “social” — must explain their facility in adopting another’s perspective.

In a follow-up study, forthcoming in the journal Developmental Science, my colleagues and I examined the effects of multilingual exposure on even younger children: 14- to 16-month-old babies, who are hardly speaking at all. In this study, led by Zoe Liberman and in collaboration with Professor Keysar and the psychologist Amanda Woodward, babies were shown two versions of the same object, such as a banana, one of which was visible to both the infant and an adult, the other visible to the baby yet hidden from the adult’s view. When the adult asked the baby for “the banana,” the baby might hand her either object — both were bananas, after all — yet if the baby understood the social context, he would reach more often for the banana that the adult could see.

We found that babies in monolingual environments reached equally often for the two bananas. Babies in multilingual environments, including those who were exposed to a second language only minimally, already understood the importance of adopting another’s perspective for communication: They reached more often for the banana that the adult could see.

Multilingual exposure, it seems, facilitates the basic skills of interpersonal understanding. Of course, becoming fully bilingual or multilingual is not always easy or possible for everyone. But the social advantage we have identified appears to emerge from merely being raised in an environment in which multiple languages are experienced, not from being bilingual per se. This is potentially good news for parents who are not bilingual themselves, yet who want their children to enjoy some of the benefits of multilingualism.

Katherine Kinzler is an associate professor of psychology and human development at Cornell University.