John C Kim and International Adoption Video

Monday, March 31, 2008

Drug Resistance, Explained - Well - Tara Parker-Pope - Health - New York Times Blog

Drug Resistance, Explained - Well - Tara Parker-Pope - Health - New York Times Blog

A good explanation, but we still need to keep the big picture alive, no one wants to go back to the days of waiting out a fever, and the dreaded mortality, particularly in children that often occurs with serious infections, because we have no antibiotics to use. This is a powerful and perverse form of human natural selection, and still occurs in many parts of the world, and we generally consider this one of the travesties of our economic and moral system. Antibiotics are good. They just need to be given more carefully. And we need to recognize their limitations.

The Claim: A Fever in a Baby Is a Sign of Teething - New York Times

The Claim: A Fever in a Baby Is a Sign of Teething - New York Times

This is a common misconception, and very occasionally results in late diagnosis on the part of parents.

Friday, March 28, 2008

Treasury Dept. Seeks New U.S. Power to Keep Markets Stable - New York Times

Treasury Dept. Seeks New U.S. Power to Keep Markets Stable - New York Times

This gives significantly more power to the fed, and what is it's countervailing power?

kiddoc - med_funny.jpg

kiddoc - med_funny.jpg

this is in some ways uncannily accurate, some insights into how medical students make their decisions

Wednesday, March 26, 2008

On bad coughs during colds

Bad coughing after three days of the cold is a common and yucky complaint. I understand they can really affect the family's quality of life, i.e. sleep.
Bottom line: if they have fever, particularly high fevers, it is more likely to be a pneumonia or influenza depending on the season.
What is most important is how fast they're breathing, and how overall sick they are. If they are breeding fast and seem sick, I would be more concerned about a pneumonia, that should be treated right away.
  • Coughing like this can be simply a URI or upper respiratory tract infection, most likely a good news bad news scenario. Usually this kind is cold is caused by a virus. Most commonly rhinovirus. Also parainfluenza, Boca virus, metapneumovirus, RSV, influenza, adenovirus, etc. you get the picture. Most of these viral illnesses are not very treatable. The good news is, they are generally self-limited. The expected course is a cold like that would be between five and seven days. The exception is influenza, which can occasionally cause significantly more severe disease. That is treatable within 48 hours with an anti-influenza medication called Tamiflu .
  • After seven days, and there is worsening of symptoms, this is most likely a sinus infection. This is usually caused by a bacteria. This is usually heralded by worsening of cough, rhinorrhea, fever, poor sleep, and headache. Green snot, is no longer considered predictive for a bacterial sinus infection. This should be treated with an antibiotic.
  • -the other causes of a cough in this case are postnasal trip. This can sometimes be helped with antihistamines like Benadryl. I can be helpful particularly because for most kids at help some sleep. Sometimes Astelin which is a nasal antihistamine can help. We use it in children over six years of age.
  • Re: cough suppressants, generally I avoid them as they interrupt the normal and even healthy expectoration of yucky stuff in the lungs. However, it really messes up kids sleep. So the products that seem to help our products that contain Guaneficin. The benefit of this is not very substantial over placebo. But they are not many significant side effects. This is the stuff that is in the Robitussin type products.
  • -With respect to codeine and other narcotic products, they generally have not been shown to be of any help more than Robitussin or honey, and they have quite a few more side effects like constipation, nausea and occasionally more severe ones like confusion and lethargy.

  • Other causes of cough are ear infections; there is a reflex on your ear drum that if you touch it makes you cough. Sometimes, cough like this is a sign of asthma, and many times you can't tell that they are wheezing by listening to them. Sometimes they don't wheeze at all, they just cough. Occasionally in small children, a bad cough like this can be caused by swallowed foreign body, like toy part or coin in the lungs, although their cough is usually quite severe and they usually have fevers.
  • -sometimes bad coughs like this, can be a result of a pneumonia. They can be relatively mild, what we call walking pneumonia. These kinds of pneumonias can be treated and should be treated in order to decrease your child's infectivity.

Nasal steroids like Veramyst do not work until you have given it to them regularly for at least a week. It doesn't totally kick in until about two to three weeks.

The bottom line is that if the cough is weird or is pretty severe, we should take a look at your child in the office, and coughs can occasionally be a little complicated.

On new babies

On new babies,
Lesson number one the most important thing to teach your children is how to forgive you. Listen up, you may be perfect or near-perfect in your workplace but in child-rearing you'll be a screwup like the rest of us.
Some of us will screw up royally. In fact, it happens right around birth. For some of us even before birth. Sorry this is such a negative intro, but the truth can be difficult to swallow, just ask the 4 year old what they think of that Augmentin. Actually, if you think about it acknowledging this will give you tremendous freedom. The reason we are so anxious about all sorts of things is that we are afraid. We are afraid of not doing it right. In fact, many of us are very anxious because we are afraid of not doing it just right. And I want to tell parents, relax a little bit. Stop struggling against the machine, that is against your unrealistic expectations. You will not do it just right. Having said that, it's a wonder and it really is a wonder that children, namely our children will thrive and grow and become beautiful. Actually, the little old newborn Yoda like creature is quite beautiful already to you. Don't apologize for it. This is the legacy of your genetic, Parental love delusion. Embrace it!
You'll make many mistakes. And your baby, marvelous as they come is resilient, flexible, and amazing. They are very very good at being alive and staying alive. Even to thrive. Babies are remarkably resilient. You don't have to do everything right, you just have to do one thing right. Love your child. Or put another way, love your child by delighting in your child.
Now as very newborn babies, this is easy enough. Mainly they lay their sucking on mother's breast or formula bottle and look beautiful. Even their crying is slightly pathetic and beautiful. Heck even their pooping and peeing is sort of cute and beautiful. It is cute and beautiful until the crying goes on and on and on, and then something else kicks in entirely. It smells of hopelessness, impotence (especially for the man), inadequacy, and sheer pain superimposed on fatigue, stress, hunger and hormones. This is the pain and beauty of parenting.
So relax, you can stop feeling so guilty. The guilt will come. You will not get everything right and your baby will thrive despite you and because of you. But mainly, babies know what to do. They know how to cry when they're hungry, suck when they're hungry, cry when they're tired, sleep when they're tired, poop and pee and so on. So this is the foundation of parenting, that you have a lot to learn, and your child will be teaching you nearly every day something that you did not know. There will be Mistry's that neither you, nor your partner, nor your partner's parents, or your pediatrician will be able to figure out. You will use your gut and intuition, and sleep deprived semi-hallucinatory cognitions to keep your baby warm and well fed. Dry and fairly rested. And most of all loved and delighted in.

Babies do weird things:
in the first 24 to 48 hours, they sleep a lot. You would think they would be a little more excited and stimulated to be in the world. It may be, nobody really knows what babies think,that they're struggling with denial about being born. Or, that coming out into the world is really quite traumatic and as many children and infants do when they're stressed, they sleep. My first child, Annie slept 22 out of the first 24 hours of the first two days of her life. I looked up in pediatrics textbook whether this was normal. It was hard to find. I think it was normal. Babies sleep a lot. The strange thing is, some babies sleep a lot, and some babies sleep almost all the time. As many things are in pediatrics, there is a wide range of what we consider normal.
She breast-fed, for 10 to 15 minutes and then fell promptly asleep. Then, after three hours after cajoling her, whispering to her, singing to her, and finally pinching her (not that hard), she fed again and promptly fell back asleep. You get the idea.

Other weird baby things.
They breathe funny. This is called periodic breathing. This is, they breathe rapidly, as if they are hyperventilating before diving for deep-sea pearls. It is shallow and hyper for 10 to 20 seconds, and then abruptly they seem as if they've caught up, and they practically stop breathing. Take a deep breath. This is normal. This is called periodic breathing. If you want, try meditating with the same breathing pattern and some people get a little buzz out of it.

They poop funny. In the beginning, they poop this tarry sticky goop called meconium stool. It is wonderful and gross. Wonderful because it means that your babies digestive system is working and the teeny little bit of breast milk or formula is making its way through your baby's body. Rejoice in your baby's first poop and fart. It means that a most important part of their physiology is working. In fact, we would not discharge you until your baby pooped. It is gross, because it is unusually and unreasonably sticky. On some, primordial level we are amazed and truth be known somewhat disgusted at this kind of excrement. However, keep in mind this is one of your baby's celebratory moments. Clap, rejoice, sing and dance, even if you have been assigned to clean it. It is wonderful. Remember that first one, even savor it. Embrace this stool. There will be many many many to come. And they will never be as delightful again.

an interesting juxtaposition of autism and MMR charts

his is an interesting chart of media hype the California graph and a more rigorous scientific study the Yokohama study that describes one of the relationships between MMR and autism.
dn7076-1_572.jpg (JPEG Image, 572x719 pixels)

One of the most asked about questions I get regarding immunizations is Many the link between measles mumps rubella vaccination on autism. Basically as respectfully as I can say this, this putative causal link is old news. And the news is this is essentially or refuted. We don't know what causes autism but we know that measles mumps rubella (MMR) vaccination does not.
-the original study from 1998 published by a gastroenterologist from England Andrew Wakefield which suggested that MMR may cause autism was in fact based on 12 children and was retracted by most of its co-authors.

The Japanese studied in Yokohama what happened to autism rates after the MMR vaccine had been removed. The Japanese removed it in April 1993 because of concerns regarding meningitis not autism. While the study cannot logically completely rule out that causes autism in some small subset of children, there is no biological plausibility for it and thus far despite significant attention being paid to it as well as research money, no evidence for it as well.

Healthy Sleep why sleep matters and the science of sleep

Healthy Sleep
An excellent Web primer site on physiology and the health benefits of sleep, from Harvard and WGBH Boston.

Personal Web site for John C Kim: KIDDOC.ORG

I am a pediatrician specializing in General Pediatrics, International Adoption Medicine, and in the diagnosis and coaching of families pursuing joy.