Pediatrician - New Port Richey
2044 Trinity Oaks Boulevard Suite 235
New Port Richey, FL 34655
(727) 375-5437

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By Thuy Pham MD
January 26, 2017
Category: Uncategorized
Tags: antibiotics  

THE FACTS.

Did you know that antibiotics are the most common cause of adverse drug reactions in children?  

As much as 30% of all antibiotics prescribed in outpatient settings are unnecessary. Most of this inappropriate use is for respiratory infections such as sinus infections, ear infections, pneumonia, the common cold, asthma, respiratory allergies.  And over one hundred thousand emergency room visits per year are due to antibiotic adverse reactions. Typical reactions can range from allergic drug rash, diarrhea, vomiting to anaphylactic shock, bone marrow suppression, renal failure, even death. Severe diarrhea secondary to C.dificile can lead to dehydration and sometimes fatality.  Studies have shown that only half of patients with respiratory infections or urinary infections are receiving the recommended first-line drug treatments.

What about antibiotic resistance?

While adverse reactions to medications are individual and short term problems, antibiotic resistance is a community and global long term issue. The incidence of superbugs resistant to conventional antibiotics is rising. Factors contributing to resistance are use of antibiotics when it is unnecessary, prescription of antibiotics that are not first line therapy, and inappropriate dosage or duration of medications. 

What can you as a patient do to help?

Let your doctor know that you are comfortable with “watchful waiting" and prefer not be treated with antibiotics unless it is absolutely necessary. Some Pediatricians may overprescribe because of pressure from anxious parents who are worried that if their child does not improve quickly they may miss work, school or a planned birthday party or vacation. Parents not uncommonly tell their pediatricians that their doctors have put adult family members on antibiotics for a respiratory infection and request antibiotics for their child. In reality, a viral respiratory infection or an environmental respiratory allergy will not improve with antibiotics.

Take your child to a doctor who has their records and knows their history. The after hour clinic, the minute clinic, the  emergency room doctor will be more likely to overprescribe antibiotics because of lack of access to your child's medical records and lack of opportunity  to follow up your child’s symptoms, increasing  their liability.  An emergency room physician or an after hour clinic provider is also more likely to prescribe a broad spectrum antibiotic or a “z-pack” rather than a first line therapy for the same reasons.

Please refrain from treating yourself from your child with a “left-over” or half-used bottle of antibiotics that you found in your medicine cabinet without consulting with your physician.

When you come home without antibiotics after an office visit with a doctor that you trust please do not think that you have wasted your valuable time or copay. You may have been to a physician who really cares about you, your child and your community. Please help raise awareness for antimicrobial stewardship.

 

Dr.Thuy Pham is an associate at Pediatric Specialists Medical Group and a Board Certified Pediatrician.

 

 

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By Sheridan Hernandez MD
October 27, 2016
Category: infants
Tags: babies   SIDS  

New AAP SIDS (sudden infant death syndrome) prevention guidelines.                                  

 

The American Academy of Pediatrics (AAP) has recently released a report indicating that studies have shown, that sleeping in the same room as your infant for up to 1 year can significantly reduce the risk of SIDS.

 

Currently, according to the CDC, about 3500 infant deaths a year are attributed to SIDS and other sleep related disorders. Babies are at greatest risk for SIDS from birth to 4 months of age, but are still considered at some risk for the first year of life. Recent research has shown that sleeping in the same room as your infant for at least the first 6 months of life, and ideally the first year of life, can decrease the risk of SIDS by 50%. However, this does not mean having the baby co sleep with parents in their bed. Adult mattresses tend to be too soft, there is too much loose sheeting and blankets that can cause strangulation, and baby can over heat, all of which can increase the risk of SIDS. Your infant should be in a crib or bassinet with a firm mattress, without bumpers, stuffed animals and a lot of loose blankets. Baby should also, always be placed on his or her back.

 

Other things that a parent can do to prevent SIDS is keeping the room temperature between 68 and 72 degrees Fahrenheit, and running a ceiling fan that keeps air flowing. Also, according to the AAP report, breastfeeding significantly reduces risk of SIDS, as does keeping a tobacco smoke free environment. The report also found that pacifier use reduces the SIDS risk and is now recommended for sleep and nap times. Babies should not be left to sleep for long periods in car seats, strollers and swings.

 

Finally, the AAP reports that, so called safety items that are offered and sold to parents, have not been proven to reduce the incidence of SIDS. These include anti SIDS mattresses and home cardiopulmonary monitors. Parents likely should not waste their money on these items. The AAP reports they are unable to offer a recommendation at this time, on bedside sleepers that attach to parents' beds, as there is insufficient research.

 

Fortunately SIDS is relatively rare but it is always tragic when it does occur. Following the AAP guidelines should help parents to feel less anxious, and in spite of having a newborn, may actually help parents to sleep a little better.

 

 

 

Dr. Hernandez

 

 

By Thuy Pham MD
October 17, 2016
Category: Zika

Best Insect Repellents to Protect Against Zika Virus 

 

Zika infection is transmitted by the Aedes mosquito. Prevention plays a crucial role in deterring its spread as there is currently no available treatment. The Center of Disease Control recommends limiting travel to high risk areas, using protective clothing, mosquito control outside and inside the home and applying topical insect repellent. However  choosing the right bug spray can be a challenging and confusing process due to the vast number of products available over the counter.

 

Insect repellents sold in the US are required to be registered with the Environmental Protection Agency. This process requires data documenting the efficacy and safety of the repellent both to humans and to the environment.  Although numerous active ingredients are available on the market, The CDC and the American Academy of Pediatrics recommend DEET(N<N-diethyl-meta-toluamide), picaridin IR3535, oil of lemon eucalyptus, or para-methane-diol. Published literature revealed that DEET at 20% concentration or greater was the most effective insect repellent.

 

According to the EPA, DEET has low toxicity; it can be safely used in children, pregnant women and adults without any age restriction.  The concentration of DEET in an insect repellent is important, since a higher concentration correlates with longer duration of protection.

 

Recently Consumer Reports evaluated and compared several insect repellents against Aedes mosquitoes.  Below is a summary of the most recommended effective products.

 

Products                         Active Ingredients                            Features

 

Off Deep Woods VIII             DEET 25%                              8-hour duration

 

Bens 30% DEET Tick             DEET 30%                              7.5-hour duration

and Insect Wilderness

Formula                                                  

 

Sawyer Family Insect              DEET 20%                              11-hour duration

Repellent                                                                                 Timed-release product

 

Natrapel                                   Picaridin 20%                          8-hour duration

 

Repel Lemon                           Oil of Lemon                           7-hour duration

Eucalyptus                               Eucalyptus 30%

 

 

I hope you find this information helpful. 


Thuy Pham, MD, FAAP

By Sheridan Hernandez MD
July 22, 2016
Category: Dr Hernandez
Tags: Viral Infection  

As a pediatrician, I hate viruses. I hate them even though they are one of the most relevant reasons my job, as a pediatrician, exists. Here's the main reason I hate viruses. If your child contracts a viral infection, in almost every circumstance, I can't cure them. Often I can I can make a specific diagnoses. Many viruses may, for example, have a specific rash or a specific test by which to confirm the infection. For example, chicken pox has a specific rash as does roseola. I can test for influenza right in the office, and Mono and RSV through the lab. So at least, in these instances, I can be specific when I tell you, as a worried parent, what is going on. But still these viruses have no cures, and so I can only treat the symptoms. I understand how frustrating it can be, to you, as a parent, when I, as the doctor, say that these symptoms are caused by a virus and it will have to run its course. I assure you guys, I am not trying to avoid treating your baby, there simply is no treatment.

What is more frustrating for both you as a parent and me as a pediatrician, are viruses that cannot typically be easily diagnosed specifically, either in the office or otherwise. For example, one thing I hate especially, is a severe vomiting and diarrhea infection. While vomiting and diarrhea can represent other more serious pathology at times, by far the most common reason is a "stomach bug", in other words a virus. And there are so many viruses that cause these symptoms. A child who has vomited multiple times worries his or her parents terribly. The child will appear miserable and the parent feels helpless. Believe me I understand, I have watched my own children suffer through such infections. Parents desperately want me, as the doctor, to do something. I really wish I could. But there really isn't any treatment for a viral "stomach bug". Anti nausea/vomiting medications are really not recommended for young children in these circumstances and antibiotics would be likely to make things worse. Antibiotics kill bacteria not viruses. If I give a child with an intestinal virus an antibiotic, and kill the good bacteria that are supposed to live in the gut, then the virus can thrive even more. What I can do, is advise you on how to keep your child hydrated and what you might feed him/her that may help. The only good thing about these viruses is that they are usually very short lived.

Another symptom that frustrates parents is the sore throat. Although, of course, sore throats can be caused by strep, that only accounts for a small percentage of sore throats. There are many, many viruses that cause a sore, red throat, swollen tonsils and even white spots and pus on tonsils. Very often it is not strep and an antibiotic will do nothing and potentially could cause harm. Actually, I would love if every sore throat was caused by strep. As a pediatrician, I love strep in a way. There is a very good, fast test to diagnose it, and most antibiotics can treat it. Usually, the patient will be feeling better in 24 hours. I wish every infection was like strep. But unfortunately as I said, most sore throats are not strep, they are viral. And so once again I may say to you, the concerned parent, it will have to run it's course. Believe me, there is nothing I would like more than to be able to give you a fast and easy treatment and If it existed I would prescribe it. And so the same goes for snotty stuffy noses caused by viruses, coughs caused by viruses and rashes caused by viruses.  None of this is to say you should not bring your child to the clinic when you are concerned. Sometimes, symptoms that might usually be caused by a viral infection are actually due to a dangerous condition that needs rapid treatment. It is my job to be aware of this, and to be astute and observant enough to recognize when there is something more serious going on, your even, just simply something that is treatable like strep. Please remember parents, when I say it is a virus and there is no treatment other than time, I am most certainly not saying it is nothing. A virus is an infection and it can make a child feel and look miserable. I know that from experience both as a doctor, and a parent. The good thing is that most viruses are not serious and your child should make a full recovery quickly.

It is my honor and privilege to care for all those beautiful children and I will continue to do the best I can to serve them as effectively as possible.

See you next time, 
Dr. Sheridan Hernandez

By Christopher Pope ARNP
July 06, 2016
Category: Zika
Tags: Zika Virus  

                                     

As of this writing there have been 263 confirmed cases of Zika virus in Florida since January. As the number of Zika cases raises so too do fears that the virus will start causing the severe birth defects that are occurring in infants throughout the Caribbean and South America.  What are the real risks for our children here in Florida?

First, the good news.  The Zika virus poses little threat to children and infants.  Only one in five infected individuals will exhibit symptoms and those that have symptoms will usually only have mild viral symptoms such fevers, aches, pains and a rash.  Secondly, all of the cases in the United States thus far have been contracted in other countries or through sexual activity with infected individuals who had recently travelled to at-risk countries.    The primary mode of transmission in countries most affected by Zika is through mosquito bites.  Thankfully no mosquitoes have been identified in the U.S. as carrying the virus.

So why is there so much fear about this virus? When pregnant women contract the virus, their unborn baby is at risk for severe birth defects that cause a small head (microcephally) which results in serious brain disorders and developmental delays.  The larger the population of infected people in our area, the more likely the virus will take hold in the mosquito population. If the virus becomes mosquito-born, then we will see a significant increase in Zika cases and likely an increase in children born with severe birth defects will follow.

What can we do to reduce our risk from the Zika virus?  The biggest risk for contracting the virus currently is by traveling to countries whose mosquitoes carry the virus.  If you are a woman who is pregnant or at risk of becoming pregnant or a man who potentially could cause his partner to become pregnant, then it would be wise to avoid traveling to countries in the Caribbean or Central and South America where the virus is wide-spread.  To find out which countries are high risk consult the CDC website at http://www.cdc.gov/zika/index.html. In addition to being selective about your travel destinations it would be wise to take measures to protect yourself from mosquitoes at home.  Mosquitoes love to breed in pools of stagnant water, so make sure you don’t leave empty buckets, flower pots etc. outside to fill up with rain water.  We might also want to do a little investigating about who is running for mosquito control in our county in the next election and elect the most qualified individual.  Finally we should all protect ourselves and children from mosquito bites through simple measures such as wearing light-weight long-sleeved clothing, mosquito netting over strollers, etc. when in mosquito infested areas, using insect repellent, and avoiding being out at dusk and dawn when mosquitoes are their most active.

CLICK HERE FOR INFORMATION ABOUT CHOOSING AN INSECT REPELLENT FOR YOUR CHILD

The Zika virus has only been recognized for a very short time, which means there is much we do not know about it.  We will watch closely for any news about Zika that may be relevant to our patient families’ health and pass it along to you.

Christopher Pope, MSN, CPNP





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