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Posts for category: Uncategorized

By contactus@napeds.com
July 07, 2019
Category: Uncategorized
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If you, your children, or your dogs have been outside in the past few months, you’re surely aware that tick season is back. And if you have spent much time here in New England, you are likely well aware of Lyme disease. Caused by a bacteria known as Borrelia burgdorferi, Lyme is one of several diseases that can be transmitted after a tick bite. Here are a few things to know about ticks and Lyme, and some trusted resources to review:

Signs and symptoms– The most well-known symptom of Lyme is likely the bullseye rash known as erythema migrans. This rash shows up within several weeks after a tick bite, but is not itchy or raised so it can be easily missed. Other symptoms can be flu-like symptoms (fever, headache, fatigue) that occur 2-4 weeks after a tick bite. Later symptoms of Lyme can include Lyme arthritis (typically swelling and pain in one larger joint, commonly a knee), Lyme meningitis (severe headache, fever, and neck stiffness), or Bell’s palsy (a facial paralysis that causes drooping of one side of the face and an asymmetric smile). These symptoms can occur months after a tick bite

Prevention – There are a number of things you can do to prevent ticks – check yourself, your children, and your pets after coming in from being outdoors. Use insect repellant when going outdoors, and wear long sleeved light clothing when you can. 

In order for Lyme to be transmitted, all of the following things need to happen:

  1. A patient needs to be bitten by a deer tick (other ticks such as the larger dog ticks do not carry Lyme)
  2. The deer tick needs to be carrying Lyme disease (according to researchers at UMass, about 30% of the deer ticks in the area carry Borrelia burgdorferi– which means 70% do not)
  3. The tick needs to be attached for 36-48 hours (while it may be theoretically possible for a tick to transmit disease sooner, this is thought to be quite unlikely). 

Treatment– If you find a tick on you or your child, take the following steps.

  1. Don’t panic.
  2. Using fine nosed tweezers or a device such as a ‘Tick Key’, grasp the tick as close to the skin as possible and slowly pull back until the tick is removed. Wash the area with soap and water and remove what you can, but do not worry about getting every last bit of the tick out.
  3. If the tick has been attached for longer than 36 hours, or is engorged, and you are reasonably certain that it is a deer tick, it may be worthwhile to provide a single dose of prophylactic antibiotics. Call our office for details. We do not recommend a weeks-long course of antibiotics for a tick bite alone without other symptoms.
  4. If the tick has not been attached that long, or is not engorged, simply keep an eye on the area over the next few weeks looking for the typical bullseye rash. Also be alert to any unusual flu-like symptoms (fever, headache, fatigue) in the next two to four weeks
  5. If you notice a typical bullseye rash, even without a history of a tick bite, contact our office as many times we will proceed with treatment of Lyme simply based on symptoms.

Testing– The lab at UMass can provide testing of ticks to determine if they carry Borrelia burgdorferior a number of other disease-causing agents. While this data can be helpful for research, and while a negative test can be reassuring that the tick you found did not carry a disease, we do not generally recommend starting treatment based on a tick test alone. For this reason, it is not essential to send ticks in for testing.

My child was diagnosed with Lyme – will they be OK?– We see many cases of Lyme disease each year, and children tend to respond quite well to antibiotics, particularly when identified early on (ie when the bullseye rash is seen). Depending on symptoms, a course of antibiotics usually runs 2 to 4 weeks. The New York Times recently published an article describing one family’s experience with Lyme treatment.  

Where can I find more information?  The Centers for Disease Control page on Lyme has a ton of information on Lyme disease and current research

In Summary:

  1. If you’re going outside this summer, use insect repellant and make sure to check yourself and your children for ticks regularly.
  2. If you find a tick, remove it immediately with tweezers or a tick key. If it is an engorged deer tick that was attached for more than 36 hours, give us a call. If it’s not, keep an eye out for the typical bullseye rash or other flu like symptoms over the next 2 weeks
  3. Visit cdc.gov/lyme for more information
By contactus@napeds.com
January 29, 2019
Category: Uncategorized
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Flu season is upon us –

We have seen a significant increase in the number of cases of influenza in our community. Here are a few things to remember:

What to Look For
Influenza usually comes on quickly, most commonly with fever (sometimes as high as 104 or 105), but also with cough, sore throat, headache, nausea/vomiting, and/or body aches. Some children can get extremely sick so it’s important to keep a close eye on your child and call us if you are concerned. In particular, if you think your child had the flu and appears to be getting better, but then suddenly gets sick with another high fever right away, it’s a good idea to call.

The New York Times published a good article on the flu last year which is still relevant -- https://www.nytimes.com/2018/02/07/well/family/children-flu-infants-deaths-influenza-complications-fever-breathing-symptoms.html

How to treat it
Influenza is a virus, and in most cases, in otherwise healthy individuals, you can treat the symptoms and allow the body’s immune system to fight off the illness. This includes lots of fluids and rest, as well as ibuprofen or acetaminophen for aches, pains, and fever. There is a medication called Tamiflu (oseltamivir) that is often used to help treat people with the flu, most commonly people who are at high risk of complications (children under age 2 or with chronic diseases such as asthma, diabetes, heart disease, immunocompromise, or neurologic diseases such as seizure disorder or autism). Tamiflu is not like an antibiotic – it does not kill the virus – but it can stop the virus from replicating and if started in the first 48 hours of the illness, it can shorten the duration of symptoms. If 48 hours has passed since the first symptoms started, it is not likely to help, and Tamiflu can have side effects of its own including nausea, vomiting, and (rarely) neurologic side effects such as confusion. Tamiflu can sometimes be used as prophylaxis to prevent the flu should someone in the household have it, but we typically reserve this only for patients who are at very high risk.

How to prevent it
Your best bet for prevention is still the age-old recommendation of good handwashing! Try not to share food or beverages, and teach your children to cover their mouth when coughing (and don’t forget to do it yourself!)

Also, it’s not too late to get your flu vaccine! The flu vaccine does seem to be a pretty good match this year and more importantly, while the flu vaccine may not be able to completely prevent the flu, it does seem to be effective at preventing complications of the flu such as pneumonia, hospitalization, or death. Please call to set up an appointment if you would like to come in for a flu vaccine.

By contactus@napeds.com
September 17, 2018
Category: Uncategorized
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The flu season is soon to be back, and the American Academy of Pediatrics has published their updated recommendations for flu vaccination for the year. Here are some of the major takeaways:

  • Everyone over the age of 6 months of age should receive an influenza vaccine, as soon as it is available (for NAP patients, that will be in the next 1-2 weeks)
  • The injectable flu shot continues to be the most effective form of vaccination. While there is limited availability of the live attenuated nasal spray (Flumist) this year, both the AAP and NAP recommend getting the injectable shot as it has proven effectiveness whereas Flumist has been ineffective in past years. In situations where the child refuses the shot, we can consider giving the nasal vaccine. Children under 2 and with certain medical conditions such as persistent asthma cannot receive the nasal flu vaccine.
  • Children under the age of 9 who have not received the flu vaccine in the past, or only have received one vaccine, will need to get two vaccines, spaced one month apart, to be protected
  • The flu vaccine has proven effectiveness against serious complications of influenza. 80-85% of the 180 pediatric deaths from influenza last year were in children who had not been vaccinated. 50% of the pediatric deaths occurred in children without underlying risk factors such as asthma or diabetes.

Please stay tuned to our Facebook page or watch your e-mail for information on when our flu vaccine clinics will be scheduled. We will have many convenient times during the day, after school, and on weekends, so that you can come in to get your children vaccinated.

By contactus@napeds.com
September 17, 2018
Category: Uncategorized
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This summer, the American Academy of Pediatrics updated their recommendations on car seat safety. In particular, they have recommended that all infants and children should sit in a rear-facing car seat as long as possible, until they have reached the height/weight limits of the seat. (Previously, the AAP had recommended switching to forward facing at 2 years of age)|

The AAP also confirmed the following recommendations:

  • Once they are facing forward, children should use a forward-facing car safety seat with a harness for as long as possible, until they reach the height and weight limits for their seats. Many seats can accommodate children up to 65 pounds or more. 
  • When children exceed these limits, they should use a belt-positioning booster seat until the vehicle’s lap and shoulder seat belt fits properly. This is often when they have reached at least 4 feet 9 inches in height and are 8 to 12 years old. 
  • When children are old enough and large enough to use the vehicle seat belt alone, they should always use lap and shoulder seat belts for optimal protection.
  • All children younger than 13 years should be restrained in the rear seats of vehicles for optimal protection.

More information can be found in the AAP's press release on their statement and more details about car seat safety in general can be found at the healthychildren.org website.

By contactus@napeds.com
February 19, 2018
Category: Uncategorized
Tags: Untagged

As most of you know, it has been a particularly bad influenza season, one full of coughs, fevers, and full waiting rooms at the pediatrician’s office.

A few things to remember:

  1. Is it the flu? Or just a cold? There is a significant difference between influenza and the common cold. Here is a great blog post about telling the difference as well as some good information about the flu. http://twopedsinapod.org/2018/02/flu-treatment-for-kids/
  2. When should I bring my child in to be seen? Here is another good article about how to tell when your child’s illness might be the flu, and when you should bring him into our office to be seen. Many times you may be able to manage your child’s illness at home. Call us if you’re not sure.  https://www.nytimes.com/2018/02/07/well/family/children-flu-infants-deaths-influenza-complications-fever-breathing-symptoms.html
  3. Do I need a flu test? Tamiflu? Given the seriousness of the flu season this year, there has been a shortage of both influenza testing kits as well as the antiviral medication Tamiflu. Not every child needs to be tested for the flu, and in many cases we can make decisions on whether or not to treat without testing. Tamiflu can sometimes be helpful in shortening the course of the illness if it is started early enough in the illness, but is not always recommended or required. Here is a good article with some information about this anti-viral medication https://www.usatoday.com/story/news/2018/02/12/tamiflu-answer-your-flu-heres-what-you-need-know/330646002/
  4. Should I still get my child a flu shot? It’s not too late to get vaccinated! While the flu vaccine may not always prevent the flu, a recent study has shown that it can significantly decrease the risk of death from influenza. Call our office to see about getting your child’s flu vaccine, if you haven’t yet. https://www.cdc.gov/media/releases/2017/p0403-flu-vaccine.html

Thank you for bearing with us during this incredibly busy flu season. We know the waits have been longer and the waiting rooms busier but we are working hard and doing our best to help you and your children stay healthy!



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