Acetaminophen is one of the most common drugs given to kids and one of the hardest to give correctly, because it’s sold in many forms. This chart can help you choose the right dose for your child, from birth to 96-plus pounds.

View and print this acetaminophen dosage chart.

Take note! As of July 2011, infant concentrated drops are being phased out in the United States and replaced with less-concentrated form of the medicine. The concentrated drops are still safe to use as long as the dose is correct. They are three times as concentrated as the new infant medicine, so use caution: Know your child’s weight and follow the dosage chart.

David B. Roos, M.D.

David B. Roos, MD

Wal-Mart announced Wednesday it has pulled Enfamil Premium Newborn formula from its

store shelves nationwide after the death in Missouri of a newborn boy who was given the

formula. The move was a precautionary measure, Wal-Mart said. No government or

manufacturer recall had been issued as of Thursday, December 22.

Mead Johnson Nutrition said the lot of 12.5-ounce cans had tested negative for the

suspected rare bacterium, Cronobacter sakazakii, before being shipped. The lot number

ZP1K7G is stamped on the bottom of the formula can.

Public health experts are investigating the source of the possible contamination and also

whether any patient or environmental factors such as the water used in preparing the

powdered formula played a part. Mead Johnson is preparing a public statement to be

posted to its Enfamil.com website.

Parents are encouraged to follow World Health Organization guidelines for safely preparing

powdered infant formula. These include: washing your hands with soap and water, cleaning all

feeding equipment in hot, soapy water and preparing enough

formula for just one feeding at a time.

As we go into a long holiday weekend (the AAP is closed until Tuesday, December 27),

updated information may appear on the FDA.gov, CDC.gov, Missouri Department of Health ( http://health.mo.gov ) and Enfamil.com websites.

David Roos, M.D.

Asthma can be a frightening and overwhelming diagnosis. Parents often come in to the office requesting that their child be tested for asthma. How do you know if your child has asthma?

 Asthma, also referred to as Reactive Airway Disease or RAD, can occur on a mild- intermittent basis or can occur on a persistent basis. Symptoms of RAD may include a chronic cough that has persisted over a month, a chronic cough that only occurs at night, a cough or wheeze that occurs during or after exercise or activity. Sometimes a respiratory illness, such as RSV (Respiratory Syncytial Virus) may predispose or trigger RAD symptoms in a young child.

 RAD can be hereditary. Children and adolescents with allergies and eczema may be more likely to develop RAD. RAD can have several “triggers”. Common RAD triggers include animal dander, dust mites, molds, pollen, tobacco smoke and second hand smoke, exercise, cold weather, upper respiratory illness.

 Physical symptoms of RAD include wheezing, feelings of chest tightness and shortness of breath, and a tight, persistent cough.

 RAD is treated with two types of medications known as Rescue and Controller Medications.

 Rescue medications are used to bring about fast or immediate relief of the RAD symptoms. These medications open the airway and help to ease the work of breathing. The rescue medication should be available at all times in case of emergent or worsening symptoms. The rescue medications should only be used when RAD symptoms are present.

Controller medications need to be taken on a daily basis to control RAD, whether symptoms are present or not. The controller medications help to prevent RAD symptoms before they start, so the rescue medication might not be needed as often. These medications also help to control the amount of excess mucus and inflammation that occurs as a result of the RAD. If RAD is not adequately treated, scarring and permanent lung restriction can occur.

 Rescue and controller medications come in inhaler forms, that include metered dose inhalers, flexhalers, and diskus. We recommend that inhalers be administered via a spacer or aerochamber for more accurate administration of the medication. Rescue and controller medications also come in liquid form to be administered through a nebulizer. The nebulizer is the more preferred method for infants and young children and for those children with more acute RAD symptoms.

 Children and adolescents with RAD should have regular appointments to evaluate the effectiveness of their treatment regimen every 3 to 6 months. An Asthma Action Plan should be established for all children with asthma, and then the plan should be reviewed and updated at subsequent follow up appointments. All children with asthma should have a flu vaccine every season, as well as, all family members.

 Vona Lantz, CPNP

Does My Child Have the Flu?

 As we head into peak flu season, it might be helpful to review just what exactly is “the flu.” The flu is caused by the influenza virus and circulates in the winter season. It is characterized by sudden onset of high fever, body aches, cough, headache and fatigue. These severe symptoms can last up to 4-5 days and generally make a person miserable.

 Influenza is sometimes confused with colds or stomach “bugs” but it is not the same thing.

 Vomiting and diarrhea illnesses are often erroneously referred to as ‘the flu’ but are not caused by the influenza virus. The influenza virus does not typically causes intestinal symptoms. (Although it may occasionally cause vomiting in some young children.)

 Since the flu and colds both cause respiratory symptoms, it can be confusing to figure out which one you or your child has. A comparison of symptoms:

SYMPTOM                  COLD                          FLU

——————————————————————————–

Fever      Rare or Low-grade (up to 104F)             High

——————————————————————————————–

Body aches        Minimal                                   Prominent

——————————————————————————————–

Cough        Mild to Moderate                   Common and Severe

 ———————————————————————————————

Stuffy Nose     Prominent &  Common               Sometimes

——————————————————————————————–

Headache             Rare                                   Prominent

———————————————————————————————

Fatigue                 Mild                          Can last up to 2 weeks

——————————————————————————————–

Complications      Ear/sinus infection    Can be serious: Pneumonia

If you are not sure if your child may have the flu, call our office for an appointment. We have rapid flu tests that can detect the virus. A nasal swab is used to obtain a specimen and the test takes 10 minutes to run. If the test is positive, we may opt to treat your child with anti-viral medication but only if started within 24-48 hours after onset of symptoms. These medications help lessen the severity and length of illness.

 And don’t forget, it is not too late to still get a flu shot. We have vaccine available in our office for our patients and their parents!

 Jaime Fell, PA-C

Diet:

1. Offer More Fresh Fruit and Vegetables- Use some creativity and put fruits and veggies into your kid’s daily diet. Vitamins and minerals in these foods help support their immune system. Some of the best sources of vitamins include apricots, bananas, blueberries, broccoli, tomatoes, cantaloupe, carrots, mango, papaya, spinach, strawberries, and sweet potatoes.

2. Reduce Sugars and Artificial Sweeteners- Kids generally have too much refined sugar in the processed foods and sweets they eat. This is a problem because sugar suppresses the immune system. Artificial sweeteners offer fewer calories than sugar but are no help for immunity. Aspartame may cause headaches and Splenda may cause gas or diarrhea.

3. Use Good Fats- Kids need a certain amount of good fats like Omega 3 fatty acids to stay healthy and build up their immune system. Flax seed oil and many types of fish, like salmon, are good sources of Omega 3. Flax seed oil can be added to oatmeal or other hot cereals and your kids will continue to enjoy their cereal like they always have.

4. Offer Yogurt- Give active culture yogurt to your kids to help them restore the healthy bacteria (Lactobacillus) in their digestive system. Yogurt is also high in calcium to support strong bones, teeth and muscle. Avoid the yogurts that are high in sugar and colored like candy. Probiotics can also be helpful.

5. Encourage Healthy Fluid Intake- Children and adults generally need more fluids than they are currently drinking. Offer your kids more water and more 1% or 2% milk each day and a limited amount of vitamin rich fruit juices. Avoid sodas and other beverages high in sugar or artificial sweeteners.

6. Offer Vitamins and Minerals- Vitamins help the immune system. Vitamins A, C, and E are collectively known as the anticancer vitamins. The immune system needs these plus minerals like zinc and selenium to do its job. Zinc boosts the immune system and reduces the severity and duration of colds and other viral infections. Dark green leafy vegetables like cabbage, broccoli and kale and orange vegetables like carrots are high in Vitamins A, C, and E. These vitamins and minerals support helper T-cells and this strengthens immunity. Vitamins and minerals also help in fighting colds and flu. Vitamin C is available in many fresh fruits. Vitamin and mineral supplements are helpful for all children to ensure a healthy foundation for their immune system. Centrum Junior Chewable vitamins and Emergen-C Junior (powder which is added to water to make a fizzy, fruit flavored drink) are two of the many vitamin and mineral choices for school-aged kids.

Lifestyle Influences:

1. Insist On Adequate Sleep- Make sure your children are getting enough sleep. The amount of sleep needed by children every night varies by their age. Sleep gives your kids time to store up new energy and make necessary repairs for the day ahead.

2. Encourage Exercise- Kids need exercise every day. Exercise strengthens muscle, balances emotions and builds up the immune system while it makes the rest of the body healthier. Be creative with options for exercise: walk, run, ride bikes, swim, participate in sports, dance or exercise with the Wi or at a health club. Exercise with your kids.

3. Be A Good Example- Kids model most of their behavior after watching their parents walk through life. Think seriously about not smoking cigarettes or abusing alcohol or drugs. These addictions all suppress immunity and lead to many other problems for you and your children. Give them a good example to follow with your own healthy choices concerning nutrition and exercise.

David B. Roos, M.D. 11/23/2011

All Dressed Up:

• Plan costumes that are bright and reflective. Make sure that shoes fit well and that costumes are short enough to prevent tripping, entanglement or contact with flame. • Consider adding reflective tape or striping to costumes and Trick-or-Treat bags for greater visibility.

• Because masks can limit or block eyesight, consider non-toxic makeup and decorative hats as safer alternatives. Hats should fit properly to prevent them from sliding over eyes. • When shopping for costumes, wigs and accessories look for and purchase those with a label clearly indicating they are flame resistant.

• If a sword, cane, or stick is a part of your child’s costume, make sure it is not sharp or too long. A child may be easily hurt by these accessories if he stumbles or trips.

• Obtain flashlights with fresh batteries for all children and their escorts.

• Do not use decorative contact lenses without an eye examination and a prescription from an eye care professional. While the packaging on decorative lenses will often make claims such as “one size fits all,” or “no need to see an eye specialist,” obtaining decorative contact lenses without a prescription is both dangerous and illegal. This can cause pain, inflammation, and serious eye disorders and infections, which may lead to permanent vision loss.

• Teach children how to call 9-1-1 (or their local emergency number) if they have an emergency or become lost.

Bronchiolitis is a common illness of the respiratory tract caused by a viral infection that affects the tiny airways, called the bronchioles, that lead to the lungs. As these airways become inflamed, they swell and fill with mucus, making breathing difficult.

Bronchiolitis:

-most often affects infants and young children because their small airways can become blocked more easily than those of older kids and adults

-typically occurs during the first two years of life, with peak occurrence at about 3 to 6 months of age

-is more common in males, children who have not been breastfed, and those who live in crowded conditions Day-care attendance and exposure to cigarette smoke also can increase the likelihood that an infant will develop bronchiolitis.

Although it is often a mild illness, some infants are at risk for a more severe disease that requires hospitalization. Conditions that increase the risk of severe bronchiolitis include prematurity, prior chronic heart or lung disease, and a weakened immune system due to illness or medications. Kids who have had bronchiolitis may be more likely to develop asthma later in life, but it is unclear whether the illness causes or triggers asthma, or whether children who eventually develope asthma were simply more prone to developing bronchiolitis as infants. Studies are being done to clarify the relationship between bronchiolitis and the later development of asthma. Bronchiolitis is usually casused by a viral infection, most commonly respiratory syncytial virus (RSV). RSV infections are responsible for more than half of all cases of bronchiolitis and are most widespread in the winter and early spring. Other viruses associated with bronchiolitis include rhinovirus, influenza (flu), and human metapnuemovirus.

Signs and Symptoms

The first symptoms of bronchiolitis are usually the same as those of a common cold:

-congestion

-runny nose

-mild cough

-mild fever

These symptoms last a day or two and are followed by worsening of the cough and wheezing.

Sometimes more severe respiratory difficulties gradually develop, marked by:

-rapid, shallow breathing

-a rapid heartbeat

-drawing in of the breathing assessory muscles of the neck and chest with each breath, known as retractions

-flaring of the nostrils -irritability, with difficulty sleeping and signs of fatigue or lethargy The child may also have a poor appetite and not feed well or become dehydrated. Vomiting after coughing may occur as well.

Less commonly, babies especially those born premature, may have episodes where they briefly stop breathing (apnea) before developing other symptoms. In severe cases, symptoms may worsen quickly. A child with severe bronchiolitis may get fatigued from the work of breathing and have poor air movement in and out of the lungs due to the clogging of the small airways. The skin can turn blue (cyanosis), which is especially noticeable in the lips and fingernails. The child also can becomed dehydrated from working harder to breathe, vomiting, and taking in less during feedings.

Contagiousness

The infections that cause bronchiolitis are contagious. The germs can spread in tiny drops of fluid from an infected person’s nose and mouth, which may become airborne via sneezes, coughs, or laughs, and also can end up on things the person has touched, such as used tissues or toys. Infants in child-care centers have a higher risk of contracting an infection that may lead to bronchiolitis because they are in close contact with many young children.

Prevention

The best way to prevent the spread of viruses that cause bronchiolitis is frequent handwashing. It may help to keep infants away from others who have colds or coughs. Babies who are exposed to cigarette smoke are more likely to develop more severe bronchiolitis compared with those from smoke-free homes. Therefore, it is important to avoid exposing children to cigarette smoke. Although a vaccine for bronchiolitis has not yet been developed, a medication can be given to lessen the severity of the disease. It contains antibodies to RSV and is injected monthly during peak RSV season. The medication is recommended only for infants at high risk of severe disease, such as those born very prematurely or those with chronic lung or heart disease.

Incubation

The incubation period ranges from several days to a week, depending on the infection causing bronchiolitis. Duration Cases of bronchiolitis typically last about 12 days, but kids with severe cases can cough for weeks. The illness generally peaks on about the second or third day after the child starts coughing and having difficulty breathing and then gradually resolves.

Treatment

Most cases of bronchiolitis are mild and require no specific treatment. Antibiotics are not useful because bronchiolitis is caused by a viral infection, and antibiotics are only effective against bacterial infections. Albuterol nebulizer treatments (often used for asthma) are not very effective in opening the airways in bronchiolitis. Infants who have trouble breathing, are dehydrated, or appear fatigued should always be evaluated by a doctor. Those who are moderately or severely ill may need to be hospitalized, watched closely, and given fluids and humidified oxygen. Rarely, in very severe cases, some babies are placed on ventilators to help them breathe until they start to get better. The best treatment at home for most kids is time to recover and plenty of fluids. Making sure a child drinks enough fluids can be difficult, however, because infants with bronchiolitis may not feel like drinking. They should be offered fluids in small amounts at more frequent intervals. Indoor air, especially during winter, can dry out airways and make the mucus stickier. Some parents use a cool-mist vaporizer or humidifier in the child’s room to help loosen mucus in the airway and relieve cough and congestion. To clear nasal congestion, use a bulb syringe and saline nose drops. This can be helpful before feeding and sleeping. Sometimes, keeping the child in a slight upright position may help improve labored breathing. When to Call the Doctor Call your doctor if your child: -is breathing rapidly, especially if accompanied by retractions or wheezing -might be dehydrated due to poor appetite or vomiting -is sleepier than usual -has a high fever -has a worsening cough -appears fatigued or lethargic Seek immediate help if you notice your child having difficulty breathing and the cough, retractions, or wheezing are getting worse, or if his lips or fingernails appear blue.

For most children, stimulant medications are a safe and effective way to treat ADHD symptoms. As glasses help people focus their eyes to see, these medications help children with ADHD focus their thoughts better and ignore distractions. This makes them more able to pay attention and control their behavior. Stimulants may be used alone or combined with behavior therapy. Studies show that about 80% of children with ADHD who are treated with stimulants respond well once the right medication and dose are determined. Two forms of stimulants are available: immediate-release (short-acting) and extended-release (long-acting). Immediate-release medications usually are taken every 4 hours, when needed. They are the cheapest of the medications. However, they can be abused/bought/or sold and have to be taken frequently at school. Extended-release medications are now the more preferred way to treat ADHD because of their smooth, gentle, sustained effects throughout the entire day. They are taken once in the morning, and children do not have to take a dose at school. Most extended-release capsules cannot be crushed or chewed; a few, however, can be opened and sprinkled on food or dissolved in water for children who have difficulties swallowing tablets or capsules. There are two newer medications that are non-stimulants which can be tried when the stimulant medications are ineffective or have significant side effects. It may take some time to find the best medication, dosage, and schedule for your child; he may need to try different types of stimulants or other medication. Some children respond to one type of stimulant but not another. The medication dosage may also need to be adjusted. The dosage is not based solely on his weight. The dosage will vary over time to achieve the best results and minimize side effects. The medication schedule may be adjusted depending on the target outcome. For example, if the goal is to alleviate symptoms at school, your child may take the medication only on school days. It is important for your child to have regular medical checkups to monitor how well the medication is working and check for possible side effects.

Side effects occur sometimes. These tend to happen early in treatment and are usually mild and short-lived, but in rare cases can be prolonged or more severe. The most common side effects include -Decreased appetite/weight loss -Sleep problems -Social withdrawal Some less common side effects include -Rebound effect (increased activity or a bad mood as the medication wears off) -Transient muscle movements or sounds (tics) -Minor growth delay Very rare side effects include -Significant increase in blood pressure or heart rate -Bizarre behaviors (agitation, very emotional, obsessive-compulsive, hallucinations) Sleep problems do not exist for Strattera, but initially it may upset your child’s stomach. Tenex/Intuniv/Clonidine can cause drowsiness, fatigue, or a decrease in blood pressure. More than half of children who have tic disorders also have ADHD. Tourette syndrome is an inherited condition associated with frequent tics and unusual vocal sounds. The effect of stimulants on tics is not predictable, although most studies indicate that stimulants are safe for children with ADHD and tic disorders in most cases. Most side effects can be relieved by changing the medication dosage, adjusting the medication schedule, or using a different stimulant or trying a non-stimulant.

Close contact with your pediatrician is required until you find the best medication and dose for your child. After that, periodic monitoring by your doctor is important to maintain the best effects. To monitor the effects of the medication, your pediatrician will have you and your child’s teacher(s) fill out behavior rating scales; observe changes in your child’s target goals; notice any side effects; and monitor your child’s height, weight, pulse, and blood pressure.