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New Office, Teen Topics, Infant Colic and Epi Pen Recalls

New construction at 6900 S. Rice Ave, Bellaire.May 2017 Newsletter Nurture Pediatrics

We will move to our new office this June 2017!

Pokemon Go Players are Happy People!

Excessive video game time can leave children isolated and overstimulated, but a recent study found that people who play Pokemon Go are more likely to spend time outside, be more active, connect socially and feel happier!

Just be sure you pay attention to your surroundings. Adults should accompany children on their Pokemon Go adventures.

https://www.sciencedaily.com/releases/2017/04/170412145214.htm

 

Preteen and Teen Depression

How can you know if your teen is depressed?

 

At Nurture Pediatrics, we screen for depression at well checks with a simple questionnaire that alerts us to teens who may be struggling with depression, anxiety, or other emotional disturbances. It is an avenue for discussion.

 

If you have noticed these classic signs of depression in your child, make time to schedule a visit with your pediatrician for your child’s mental health:

Signs of Teen Depression

 

  • Lack of interest in hanging out with usual friends/family
  • Loss of interest in hobbies that usually appeal to your teen
  • Poor sleeping (awakening at night or unable to fall asleep)
  • Large shifts in weight (excessive gain or loss of weight)
  • Unusual irritability of your preteen or teen
  • Acting odd – as if under the influence of alcohol, drug or medication
  • Talk of self-injury or cut marks on the forearms, abdomen, thighs
  • Text messages about self-injury
  • Change in usual level of self-care and hygiene
  • Talk of feeling depressed, low self-esteem
  • Drops in academic performance
  • Skipping classes/school

 

 

Every teen goes through ups and downs in mood, but if you are in doubt, it is best to seek care. Suicide rates among teens are increasing. Cyber bullying is still on the rise. ANY talk of suicide in your child should cause you to seek immediate care. Seemingly random comments like, “It’s too much,” “No one would miss me,” or “Everyone would be better off without me” should be taken seriously.

 

We are here to help with all aspects of your teens health. Consult your pediatrician who can refer you to resources for mental health care and start early treatment.

Infantile Colic – Why does my baby cry so much?

If you have ever held an inconsolable baby, then you have experienced the helpless feeling that many parents with colicky babies experience Babies with Colicnearly every day for potentially 2-3 months. It is frustrating and can feel overwhelming.

 

Colic is a term used for an infant less than 3 months of age who cries excessively. Most babies cry for 45 min to 2 hours per day on average during the second month of life (4-8 weeks of age). Babies who cry for 3 hours or more per day, more than 3 days per week and more than 3 weeks are generally considered “colicky.”

 

Characteristics of a Colicky Infant:

  • Crying comes on suddenly and is more high-pitched and strong than usual crying.
  • Crying clusters during evening time hours.
  • Colicky babies can feel stiff (hypertonic) when crying.
  • Colicky babies are difficult to console even when offered a nursing/feeding.

Warning signs that crying is probably NOT due to colic:

  • Fever (100.4 by rectum)
  • Lethargy (difficult to arouse) and seeming weak
  • Excessive vomiting
  • Excessive sweating
  • Poor weight gain/growth
  • Poor feeding – weak suckling
  • Abnormal stools – blood, excessive mucus or lack of stools at least every few days.
  • Decrease in wet diapers

Diagnosis of Colic

Any baby with excessive crying or who is difficult to console should have a thorough exam by a pediatrician. There are many medical conditions that can cause excessive crying:

  • Inadequate breast-milk supply and Feeding Disorders
  • Congenital Heart Disease
  • Acid Reflux (GERD)
  • Milk Protein Sensitivity
  • Inborn Errors of Metabolism (screened by Texas Newborn Screen)
  • Infections (Group B Strep, UTIs, etc.) and a myriad of other problems.

Colicky babies have a normal physical exam, growth and development.

 

Treatment of Colic

  • Time: Colic resolves on its own by 3 months of lifeColic Treatment for Babies
  • Probiotics: lactobacillus can safely be given to infants 1 month of age and older
  • Avoid Cow Milk Protein: Nursing mother avoids cow milk protein; bottle-fed infant switches to a hydrolyzed formula
  • Soothing Techniques: Swaddle, white noise, swing, pacifier, walk outside
  • Baby Wearing: Baby Bjorn, Boba Wrap, Baby K’Tan, Moby Wraps

Why does colic occur?

Overstimulation Theory

Since most babies have increased crying time starting at about 4 weeks of life, with a peak at 6 weeks of life and improving after 2 months of life, some experts feels that colic is not a separate problem, but an extreme of this neurodevelopmental phase. All babies have dramatic improvement in their hearing and vision during the second month and it is possible for a baby to have overstimulation during the day that results in crying in the evening. Have you noticed that your baby may sleep beautifully in an infant carrier in a loud restaurant at dinner time but then have a terribly fussy night? This phenomenon supports the overstimulation theory. As the brain continues to develop, the infant is able to manage the stimuli better and the crying improves by the third month naturally. Avoidance of passive TV viewing or excessively loud environments can help the infant with colic. Spending time outside each day as weather permits can improve colic.

 

Abdominal Pain Theory

Many infants with colic have excess gas, straining and crying with stool passage and tend to pull their legs in and out during crying. This has led to the common idea that colic is directly due to abdominal discomfort. A study from Pediatrics showed a decrease in crying in 50% of babies who were supplemented with lactobacillus reuteri (Pediatrics, Sept 2010, Vol 126, issue 3). Prior studies showed that infant bacterial flora change from predominantly lactobacillus species to the more common E coli around 1-2 months of life. Often infants with colic vomit and spit up frequently and seem to pass more gas. Could it be that they swallow more air during crying? There is even some correlation with childhood migraine and history of excessive crying as an infant. http://www.medscape.com/viewarticle/827825#vp_2

Use of probiotics after 1 month of age, avoidance of gripe water containing fructose, avoidance of excessive cow milk protein in the breastfeeding mother’s diet (or use of hydrolyzed formula for the bottle-fed infant), massage and stretching exercises can help to soothe crying for the colicky infant.

 

If you have an infant with colic, look for outlets to meet other mothers and support groups. Accept help from family members who will spend time with your infant. If you feel overwhelmed, lay your infant in a crib on her back and leave the room to call a trusted friend for help. Sometimes allowing a 15-20 minute break for your infant to lay in his crib while you calm yourself is important for your sanity and your baby’s safety!

 

New Mother Resources:

Bellaire Young Mothers: http://www.bellaireyoungmothers.org/

Meyerland Young Mothers (and Fathers): https://www.bigtent.com/groups/mmoyc

Bellaire Mothers of Multiples: http://www.bellairemoms.org/

Mothers of Preschoolers (birth to kinder): http://www.mops.org/

La Leche League: http://www.llli.org/

On Line Connection Center (great for a working parent with limited daytime hours): http://community.babycenter.com/

Houston New Moms: http://www.houstonnewmoms.com/

Southwest Houston Resource Directory: http://swhouston.macaronikid.com/

Epi-Pen Recall

The U.S. Food and Drug Administration is alerting consumers to Meridian Medical Technologies’ voluntary recall of 13 lots of Mylan’s EpiPen EpiPen 2 Pak Recall 2017and EpiPen Jr (epinephrine injection) Auto-Injector products used for emergency treatment of severe allergic reactions. This recall is due to the potential that these devices may contain a defective part that may result in the devices’ failure to activate. The recalled product was manufactured by Meridian Medical Technologies and distributed by Mylan Specialty.

While the number of reported failures is small, EpiPen products that potentially contain a defective part are being recalled because of the potential for life-threatening risk if a severe allergic reaction goes untreated. Consumers should keep and use their current EpiPens if needed until they get a replacement. Consumers should contact Stericycle at 877-650-3494.

As stated on the product label, consumers should always seek emergency medical help right away after using their EpiPens, particularly if the device did not activate.

At this time, the 13 lots identified – distributed between Dec. 17, 2015, and July 1, 2016 – are the only EpiPen lots impacted by the U.S. recall. Consumers who have EpiPens from lots that are not included in this recall, do not need to replace their EpiPen prior to its expiration date.

Product/Dosage NDC Number Lot Number Expiration Date
EpiPen Jr Auto-Injector, 0.15 mg 49502-501-02 5GN767 April 2017
EpiPen Jr Auto-Injector, 0.15 mg 49502-501-02 5GN773 April 2017
EpiPen Auto-Injector, 0.3 mg 49502-500-02 5GM631 April 2017
EpiPen Auto-Injector, 0.3 mg 49502-500-02 5GM640 May 2017
EpiPen Jr Auto-Injector, 0.15 mg 49502-501-02 6GN215 September 2017
EpiPen Auto-Injector, 0.3 mg 49502-500-02 6GM082 September 2017
EpiPen Auto-Injector, 0.3 mg 49502-500-02 6GM072 September 2017
EpiPen Auto-Injector, 0.3 mg 49502-500-02 6GM081 September 2017
EpiPen Auto-Injector, 0.3 mg 49502-500-02 6GM088 October 2017
EpiPen Auto-Injector, 0.3 mg 49502-500-02 6GM199 October 2017
EpiPen Auto-Injector, 0.3 mg 49502-500-02 6GM091 October 2017
EpiPen Auto-Injector, 0.3 mg 49502-500-02 6GM198 October 2017
EpiPen Auto-Injector, 0.3 mg 49502-500-02 6GM087 October 2017

 

 

Thank you for reading our May issue of Nurture Pediatrics Newsletter!

– J. Pate, MD

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