Pediatrician - New Port Richey
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New Port Richey, FL 34655
(727) 375-5437

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By Sheridan Hernandez MD
February 12, 2018
Tags: Atopic Dermatitis  

Hello, Dr. Hernandez here.

 

Many children have atopic dermatitis (AD) also known as eczema. I thought today I would I share some of our latest understanding and knowledge of AD.

 

AD affects 10-20% of all children and 1-3 % of adults. It can range from a mild condition which is generally quite easily managed with creams, ointments, oils and lubricants, to a very severe condition which causes severe breakdown of the skin barrier with associated unbearable itching. The severe form of eczema can be quite debilitating, causes a lot suffering and, unfortunately, can be very difficult to control.

 

AD has increased two to threefold in the last three decades in industrialized countries, but this increase has not been found in areas that are primarily rural and agricultural. Both genetic and environmental factors are felt to play a critical role in the expression of AD. For example, from a genetic point of view, a child of parents, both of whom had an atopic condition such as asthma, allergic rhinitis (hay fever etc.) or eczema, is 5 times more likely to have early onset, childhood eczema, than a child of parents neither of which had an atopic condition. From the environmental point of view, children whose mothers were exposed during pregnancy to farm animals in particular, but also dogs and cats, were less likely to develop early childhood AD, than the children of moms who had no such exposure. Also children who are fed yogurt with live active cultures in the first year of life have a decreased likelihood of developing AD (PASTURE study- Protection against allergy study in rural environments).

 

Childhood AD has been broken down into 3 types, early transient means the condition starts before age 2 but resolves by age 4, early persistent which means it starts before age 2 and lasts at least to age 6 (these children are much more likely to have AD that lasts to adulthood) and late onset AD that starts after age 2. Children with the early onset types are at increased risk of developing asthma by age 6 and are also at increased risk of developing or having food allergies. Children with early persistent AD are at the highest risk for both respiratory and food alleges.

 

Unfortunately, early persistent AD can be very difficult to manage. Topical corticosteroids are the most widely used treatment, but because of side effects of long term regular use they are not really recommended for maintenance therapy. Ceramide lipid creams such as EpiCeram can be very effective, as can calcineurin inhibitors such as tacromlimus and pimecromlimus. UV light therapy can also be effective.

 

Although there is no magic bullet answer out there to cure eczema, I think it is important for the parents of children with more severe AD or eczema to be aware of the increased risk their children have for developing asthma and allergies. They can then be proactive and observe their kids for signs of allergy and asthma and seek appropriate care. Furthermore, I wanted parents to be aware that there are some new treatments emerging that have been found to be helpful in treating this very troublesome condition.

 

As always, it is my honor and privilege to take care of your beautiful kids. Peace

 

Dr. Hernandez

By Thuy Pham, MD IBCLC
June 29, 2017
Category: infants
Tags: Starting Solids  

Thinking of starting your baby on solids? Try Baby Led Weaning.

 

Baby led weaning is a method of introducing baby food which relies of your baby’s natural cues and interests. It simply means bypassing pureed foods and letting your baby feed himself real food from the start. Instead of spoon feeding commercially prepared processed rice cereal or jar foods you can let your baby finger feed herself soft pieces of cooked vegetables or fruits. Your baby learns to chew first with his gums, then swallow.

 

This sensical approach  is a natural transition from breastfeeding on demand to introducing solid foods. Bottle-fed babies also adapt well to this method of feeding. Many eager parents tend to start solids too early. Instead you should wait for your infant to show for signs of readiness, such as interest in family meal time,  ability to sit without support, to pick up toys with fingers, loss of tongue thrust reflex(pushing solids out of the mouth with tongue). There is no need to ponder about which jar foods to buy, simply give your baby soft cooked wholesome vegetables that you prepare for your family at meal times, put it on his high chair tray and let him enjoy! Get your camera and be prepared to capture the moment when he explores, picks up, mashes and tastes his first foods.

 

Some examples of easy, wholesome BLW first finger foods are:

. banana chunks

. soft steamed carrot sticks

. slices of ripe avocados

. peeled slices of cucumbers (great for teething babies)

. boiled egg yolks

. peeled slices of peaches

 

Safety 

It is best to wait until your child is at least 6 months old and exhibits signs of readiness as stated above. Avoid foods that are choking hazards, such as whole grapes, apples with skin attached, nuts. In the first few weeks of BLW, you may see your baby gag. Remember gagging is a protective reflex to prevent foods from traveling too far to the back of the mouth where it can obstruct the airway.. Your child may have a mild cough and makes little noises. It is different than choking, when your child looks terrified, appears unable to breathe and makes no noise.

 

If you are wondering whether BLW is right for you, check with your paediatrician to that your child is developmentally ready to proceed.

 

Reference

Baby Led Weaning by Gill Rapley

 

Thuy Pham, MD, IBCLC

 

 

May 02, 2017
Category: parenting
Tags: Untagged

Hello Parents!

 

My blog today discusses a recent study that assessed the effects spanking. Now I know this blog will be considered controversial by some, and the study I am going to discuss briefly, will be disregarded by others. But for those who are not already emotionally invested in their opinion one way or the other, and are simply interested in the findings of this recent and well regarded scientific study, here goes.

 

The study was published in 2016 in the Journal of Family Psychology. The authors were Elizabeth Gershoff of the University of Texas at Austin, and Andrew Grogan-Kaylor of the University of Michigan. The researchers looked at 5 decades of research that involved 160,000 children. It is felt to be the most complete analysis studying the long and short-term outcomes from spanking to date.

 

So what did they find? The analysis focused on what most of us would think of as normal spanking. This is hitting the child with an open hand on the behind or extremities. And in short, what the scientific evidence found, was that spanking is ineffective and has a number of long term harmful consequences to children. To quote Elizabeth Gershoff, "We found that spanking was associated with unintended detrimental outcomes and was not associated with more immediate or long-term compliance, which are parents’ intended outcomes when they discipline their children.”

 

So to restate, spanking did not result in immediate or long-term compliance but also had unintended bad outcomes. Some of the negative outcomes of spanking were that children were more likely to defy their parents, have anti-social behavior and develop mental health problems even into adulthood. Also children who were disciplined physically were more likely to use corporal punishment on their own children.

 

Parents must decide whether or not to spank their children, but I for one, having read about the findings in this study, would not recommend it.

 

Below I have included a couple of links that reference the study in case you would like to read more.

 

Peace and love to all those wonderful kids and parents out there.

 

Doctor Hernandez

 

 

http://www.livescience.com/54591-spanking-makes-kids-defiant.html

 

https://news.utexas.edu/2016/04/25/risks-of-harm-from-spanking-confirmed-by-researchers

 

 

 

 

By Douglass Hasell MD
March 02, 2017
Category: Influenza
Tags: Influenza   the flu  

Flu season has hit our area in full force. 

How do you know if someone in your family has gotten the Flu?  IF they suddenly develop fever, especially with chills, headache, muscle achiness, cough and generally feel terrible and just want to lie in bed under a lot of covers, they probably have the Flu.  Worsening cough, sore throat and a runny or congested nose will usually follow..  Some people will have partial immunity and their symptoms may not be as severe but a typical Flu infection makes people feel very ill for 3-5 days and then they will start to feel like they are starting to get better.  

What should you do if you think your child has the Flu?  If they are considered high risk because of their age (less than 2 yrs. old),  or underlying medical condition, they should definitely be evaluated.  If they are school aged and don’t have any underlying medical condition they can be managed at home with increased fluids, fever control with Tylenol or Ibuprofen (but never Aspirin) and some of grandma’s restorative chicken soup.  If their fever is lasting longer than 4-5 days or they are not showing signs of improvement by this time they should be seen and evaluated. 

Another reason to have your child evaluated when you think they have the Flu is if you want to put them on Tamiflu.  This is a medication covered by most, but not all, insurances.  It is given twice daily for 5 days to treat the Flu and once a day for 10 days to prevent household contacts from getting the Flu.  It shortens the course of the Flu by an average of about a day if given in the first 48 hours of infection and helps prevent transmission when taken by contacts. This can be significant when you consider how ill the Flu can make you and the lost school and work days caused by Flu infections in children and their family members.   So if your child has important upcoming events, such as performances or athletic events, or spread to other family members would be especially problematic, then it is best to get your child in to our office as soon as they develop classic Flu symptoms, preferably within  the first 48 hours.  A rapid Flu test can be done and a decision to treat the patient or contacts can be made based on the result.  One must keep in mind however that the rapid flu test is not that sensitive and may have a false negative result (a negative result in a patient who has the Flu) in 20-30 % of infected patients.  Because of this if a patient is evaluated during Flu season and has classic Flu symptoms a decision may be made to treat them with Tamiflu without doing a rapid Flu test or even if the result is negative in certain situations.  These cases are usually discussed with parent and the child and an informed decision is made.

  Douglass Hasell MD

By contactus@psmgfl.com
March 01, 2017
Category: Uncategorized
Tags: Untagged

Flu season has hit our area in full force. 

How do you know if someone in your family has gotten the Flu? 

IF they suddenly develop fever, especially with chills, headache, muscle achiness, cough and generally feel terrible and just want to lie in bed under a lot of covers, they probably have the Flu.  Worsening cough, sore throat and a runny or congested nose will usually follow..  Some people will have partial immunity and their symptoms may not be as severe, but a typical Flu infection makes people feel very ill for 3-5 days and then they will start to feel like they are starting to get better.  

What should you do if you think your child has the Flu? 

If they are considered high risk because of their age (less than 2 yrs. old),  or underlying medical condition, they should definitely be evaluated.  If they are school aged and don’t have any underlying medical condition they can be managed at home with increased fluids, fever control with Tylenol or Ibuprofen (but never Aspirin) and some of grandma’s restorative chicken soup.  If their fever is lasting longer than 4-5 days or they are not showing signs of improvement by this time they should be seen and evaluated.  Another reason to have your child evaluated when you think they have the Flu is if you want to put them on Tamiflu.  This is a medication covered by most, but not all, insurances.  It is given twice daily for 5 days to treat the Flu and once a day for 10 days to prevent household contacts from getting the Flu.  It shortens the course of the Flu by an average of about a day if given in the first 48 hours of infection and helps prevent transmission when taken by contacts. This can be significant when you consider how ill the Flu can make you and the lost school and work days caused by Flu infections in children and their family members.   So if your child has important upcoming events, such as performances or athletic events, or spread to other family members would be especially problematic, then it is best to get your child in to our office as soon as they develop classic Flu symptoms, preferably within  the first 48 hours.  A rapid Flu test can be done and a decision to treat the patient or contacts can be made based on the result.  One must keep in mind however that the rapid flu test is not that sensitive and may have a false negative result (a negative result in a patient who has the Flu) in 20-30 % of infected patients.  Because of this if a patient is evaluated during Flu season and has classic Flu symptoms a decision may be made to treat them with Tamiflu without doing a rapid Flu test or even if the result is negative in certain situations.  These cases are usually discussed with parent and the child and an informed decision is made.

Douglass Hasell, MD





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