Houston Area Pediatric Specialists

Independent pediatric specialists aim to serve our community. We want to share news and analysis regarding our specialties and our practices.

Wednesday, February 29, 2012

Too Many Soft Drinks May Be Associated with Respiratory Diseases

Too Many Soft Drinks May Be Associated With Respiratory Diseases
Chronic respiratory conditions like asthma seems to occur more frequently in people drinking large quantities of sugary soft drinks, inflammation may be the key.

Soda Linked to Lung Disease

More bad news for soda lovers: in addition to obesity and heart disease, the sugary drinks may be tied to asthma and chronic obstructive pulmonary disease (COPD), Australian researchers found.
People who consumed at least a half a liter of soft drinks a day were more than twice as likely to develop either lung condition compared with those who didn't partake at all (OR 2.33, 95% CI 1.51 to 3.60), Zumin Shi, MD, of the University of Adelaide in Australia, and colleagues reported in Respirology.
The cross-sectional study, however, couldn't prove causality, and researchers not involved in the study suspect an overall unhealthy diet effect might be at play.
"High soda intake is a good marker for poor overall diet, and poor overall attention to health," David Katz, MD, director of the Prevention Research Center at Yale University in New Haven, Conn., said in an email to MedPage Today. "It likely suggests greater exposure to everything from tobacco smoke to air pollution."
Sugar-sweetened beverages have long been linked to a host of poor health outcomes, includingstroke and heart disease, but no study has yet assessed potential ties to asthma or COPD, the researchers said.
There are many potential explanations for the increased burden of asthma in Western countries -- less exposure to indoor allergens, improved hygiene, and use of antibiotics (the "hygiene hypothesis"), as well as poor diet and increased obesity -- but fewer noted risk factors for COPD.
Smoking, of course, is a major one, but up to 50% of airway obstruction can't be explained away by cigarette use, they wrote, thus the need to identify novel risk factors.
The group looked at data from the South Australian Monitoring and Surveillance System on 16,907 adults, mean age 46.7, who responded to phone interviews from March 2008 to June 2010.
The prevalence of asthma and COPD, based on self-reported doctor diagnosis, was 12.5% and 4.4%, respectively.
Though the vast majority (72%) said they didn't drink any soda at all, 11.4% reported taking down more than a half a liter of soft drinks every day. In addition to carbonated brand-name soft drinks, lemonade, flavored mineral water, and sports drinks were consumed.
Shi and colleagues found that folks who drank this level of soda had a higher prevalence of asthma and COPD than those who didn't drink any (14.7% versus 11.9% and 6% versus 4.2%, respectively).
In multivariate analyses adjusting for sociodemographic factors, intake of fruit and vegetables, and other life style factors, drinking half a liter of soda a day was associated with an odds ratio of 1.26 for asthma (95% CI 1.01 to 1.58) and an OR of 1.79 for COPD (95% CI 1.32 to 2.43) compared with never drinking soda.
The researchers also saw combined effects for drinking soda and smoking. Consuming more than half a liter a day and being a current smoker carried a 6.6-fold greater risk of COPD and a 1.5-fold higher risk of asthma than not smoking and drinking soda, they reported.
"The combined effect of soft drink consumption and smoking on asthma/COPD emphasizes the importance of lifestyle factor clustering in the etiology of asthma/COPD," they wrote. "Promoting a healthy lifestyle should be encouraged as one means of preventing asthma/COPD."
The mechanisms behind the relationships, however, are unclear. Both asthma and COPD are associated with inflammation, and it could be that foods promoting oxidative stress and inflammation could affect the pathogenesis of these diseases, they wrote.
Drinking soda has also been tied to a higher risk of obesity, which in turn leads to a greater likelihood of developing both lung diseases, they said.
And studies have shown that chemicals such as phthalates from plastic bottles, as well as allergies to preservatives such as nitrites and sulphites, may be linked to asthma.
In addition to not being able to prove causality, the study was limited by its reliance on self-reported data.
Still, Shi and colleagues concluded that "regardless of whether there is a cause-and-effect relationship, the public health implications of consumption of large volumes of soft drink are substantial."

Wednesday, February 22, 2012

Study Links Colic in Infants to Migraines in Moms

Colic is a repetitive phenomenon that is interpreted as painful yet has no pathologic findings..like migraine. JR

Study Links Colic in Infants to Migraines in Moms

Mothers with chronic headache condition more than twice as likely to have babies who cry excessively Link here
Monday, February 20, 2012HealthDay Logo
HealthDay news image
MONDAY, Feb. 20 (HealthDay News) -- Experts are beginning to believe some that some non-headache health problems in childhood -- such as vomiting and vertigo -- might be linked to migraines later in life. Now, a new study suggests a connection between mothers with migraines and colic in infancy.
Colic is a condition marked by excessive crying in an otherwise healthy child.
"Mothers with a history of migraine were more than two-and-a-half times more likely to have a baby with colic than mothers who didn't have migraine," said study author Dr. Amy Gelfand, a pediatric neurologist with the Headache Center at the University of California, San Francisco.
The findings were released online Feb. 20 and Gelfand and colleagues will present them in April at the American Academy of Neurology's annual meeting in New Orleans.
The researchers developed a questionnaire to help pinpoint whether a baby had colic and to identify mothers who had been diagnosed with a migraine, a condition believed to have a strong genetic link.
"We surveyed the mothers when they brought their babies into the pediatrician's office for their two-month well-baby check-up," Gelfand said.
Data from 154 mothers and their babies showed that nearly 29 percent of the babies whose mothers had a history of migraine had colic, compared with about 11 percent of babies whose moms did not report migraines.
"There was a trend when fathers answered the survey, too," Gelfand added. She said 93 survey-takers answered paternal migraine history questions. The results: about 22 percent of colicky babies had a father with migraine compared to only nearly 10 percent of the babies who did not have the condition.
Chronic and often disabling, migraine headaches affect more than 29 million Americans, according to the U.S. Department of Health and Human Services' Office on Women's Health.
Three-quarters of migraine sufferers are women and previous research suggests about half of migraine sufferers remain undiagnosed.
"The bottom line is that migraine is an inherited disorder that involves the whole body," said neurologist and pain medicine specialist Dr. Joel Saper, director of the Michigan Headache & Neurological Institute, in Ann Arbor.
Saper, who was not involved in the study, said people who are prone to migraine react to overstimulation throughout the course of their lives. He said the new research suggests "it's very possible colic is an early manifestation of migraine."
Saper explained that babies and children have immature nervous systems that don't work the same way as an adult's. He said migraine -- a neurological condition -- might manifest differently in babies and children.
"The underlying pathophysiology might be the same, but the reflexes are different," Saper said.
The researchers said colic did not appear to be linked to the sex of a child. Also, while they did not ask whether babies were breast- or bottle-fed, other studies suggest colic rates do not differ for the two groups of infants, Gelfand noted. She said it's still being debated whether cow's milk protein might play a role in some children, though.
Currently, most parents are advised to wait out the weeks or months it takes for colic to resolve, to sooth and hold their baby, and to ask for help -- a parent time-out -- if the chronic crying frays nerves.
Commenting on the study, pediatrician Dr. Tai Lockspeiser, an assistant professor of pediatrics at the University of Colorado School of Medicine and Children's Hospital Colorado, said, "All babies cry and colic is just one end of the spectrum." She recommends "the 5 S's System" made popular by Dr. Harvey Karp: swaddling, sucking, side-lying, shushing and swaying. "There are some great YouTube videos of this online that demonstrate exactly what these are," Lockspeiser said.
For her part, Gelfand said that "it's too early to change any kind of protocol for colic. But this gives pediatricians and neurologists another hypothesis to consider. Parents could try non-medication strategies that help some adult migraine sufferers, she said.
"Turning down loud music, going to a quiet room and decreasing stimulation might help," Gelfand said. She also suggested moms and dads keep a "crying diary" to track when colic flare-ups tend to occur and anything that seems to calm the baby.
Saper said the new research offers another clue into the evolution of migraine in an individual. "We are now able to say this child may be on a pathway."
The next research step will be to follow the babies over the years, said Gelfand.
"Right now we're using the mothers' migraines, but what we really want to know is do these babies themselves go on to have migraine," she said.
The data and conclusions of this research should be viewed as preliminary until published in a peer-reviewed journal.
SOURCES: Amy Gelfand, M.D., pediatric neurologist, Headache Center, University of California, San Francisco; Tai Lockspeiser, M.D., assistant professor of pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado; Joel Saper, M.D., director, Michigan Headache and Neurological Institute, Ann Arbor, Mich.; Feb. 20, 2012, abstract, American Academy of Neurology annual meeting (April 2012), New Orleans
Related MedlinePlus Pages
Page last updated on 21 February 2012

Tuesday, February 21, 2012

Can Tylenol Explain the Rise in Asthma?

Some asthma researchers are worried that the rise in asthma and Tylenol use is too coincidental.  Does this mean you should restrict acetaminophen use in your child?

Does Tylenol Worsen Asthma For Kids?

Parents and doctors around the world have been alarmed by the dramatic increase in childhood asthma.
One factor in the upswing is better detection by doctors, but at least one doctor thinks a common over-the-counter drug also has something to do with it.
Dr. John McBride sees lots of kids with asthma. He's a pediatric pulmonologist at Akron Children's Hospital in Ohio. He knew of studies that raised concern about the safety of acetaminophen — brand name Tylenol — to treat colds and fever in kids with asthma. So he decided to look more closely at the research.
"I was stunned," he says. All the studies he looked at showed a link between asthma and acetaminophen.
"The more acetaminophen somebody takes, the more likely it is that they have asthma," he says. "Also, there's an incredible consistency. Everybody around the world who's looked for this association has been able to find it."
In asthma, the airways of the lungs get blocked by mucous and narrow. That leads to wheezing and shortness of breath. The rise in asthma has closely paralleled the increased use of acetaminophen.
There are no scientific studies proving the medication causes asthma, but McBride says it may make asthma worse in kids who already have it.
Nine-month-old Martez coughs and wheezes as McBride examines him and talks with his mom, Ceasha Moorer, about his asthma. "He coughs. He wheezes. There are multiple symptoms," she says. "He works very hard to breathe. When he's excited from crawling or even laughing, then he breathes really hard."
In the past when Martez got a cold, Moorer gave him Tylenol. But that seemed to make his symptoms worse. At McBride's suggestion, she stopped using it. Then one day, her aunt was looking after Martez when he had a cold.
"I told her don't give him Tylenol," Moorer says. "I didn't specify that it was acetaminophen. She actually gave him a cold medicine, but it seemed to make him kind of worse. I looked at the active ingredients and acetaminophen was in the active ingredients."
In fact, acetaminophen is an ingredient in many cough and cold products — includingNyQuil, Robitussin and Theraflu. It might exacerbate the asthma because it decreases levels of a molecule called glutathione, which protects the lungs.
"So removing the beneficial effect of glutathione exactly at a time children's lungs are being irritated might end up being just one factor that contributes to the onset of an asthma attack," McBride says.
McBride's recommendation? Don't give acetaminophen to a child who has asthma. Other doctors say it's too soon for that advice.
Many other factors could play a role in the rise of asthma, according to Dr. Stanley Szefler, head of pediatric pharmacology at National Jewish Health in Denver. "Vitamin D insufficiency, dietary changes, air pollution or better control of infections are perhaps all related to the increasing prevalence of asthma," he says.
Johnson & Johnson, maker of Tylenol, said in a statement that the medicine has been used safely and effectively for more than 50 years. "There are no prospective, randomized controlled studies that show a causal link between acetaminophen, the active ingredient in Tylenol, and asthma," the company said.
It's important to control a child's fever, Szefler says. McBride agrees but says ibuprofen is a safer bet — at least until ongoing studies provide answers about the safety of acetaminophen for kids with asthma.

Sunday, February 19, 2012

High Air Pollution Days Can Increase the Risk of Asthma-related Hospitalization

In a recent study published in the Journal of Allergy and Clinical Immunology, researchers in Canada studied the effect on aeroallergens and the likelihood of hospitalization due to asthma.  As expected, aeroallergen exposure increased the risk of hospitalization.  However, that risk was amplified significantly on high air pollution days.

Does air pollution increase the effect of aeroallergens on hospitalization for asthma?


Clinical experiments demonstrate that the asthmatic response to an aeroallergen can be enhanced by prior exposure to an air pollutant.


We sought to compare the effects of ambient aeroallergens on hospitalization for asthma between high and low air pollution days in 11 large Canadian cities.


Daily time-series analysis was used, and results were adjusted for day of the week, temperature, barometric pressure, and relative humidity.


The relative risk of admission for an interquartile increase in tree pollen levels was 1.124 (95% CI, 1.101-1.147) on days of lower values of fine particulate matter with a median aerodynamic diameter less than or equal to 2.5 μm (PM2.5) compared with 1.179 (95% CI, 1.149-1.21) on days of higher PM2.5 values. Significant (P ≤ .05) differences in the relative risks of admission between lower versus higher values of particulate matter with a median aerodynamic diameter less than or equal to 10 μm in diameter were 1.149 (95% CI, 1.118-1.181) versus 1.210 (95% CI, 1.161-1.261) for ascomycetes, 1.112 (95% CI, 1.085-1.14) versus 1.302 (95% CI, 1.242-1.364) for basidiomycetes, 1.159 (95% CI, 1.125-1.195) versus 1.149 (95% CI, 1.129-1.169) for deuteromycetes, and 1.061 (95% CI, 1.016-1.107) versus 1.117 (95% CI, 1.092-1.143) for weeds.


We identified an association between aeroallergens and hospitalizations for asthma, which was enhanced on days of higher air pollution. Minimizing exposure to air pollution might reduce allergic exacerbations of asthma.

Saturday, February 18, 2012

Barking, whooping, wheezing and bleeding coughs: What is a cough?

A great reference on cough...What is a cough? JR

Your Child's Cough

Coughs are one of the most common symptoms of childhood illness. Although a cough can sound awful, it's not usually a sign of a serious condition. In fact, coughing is a healthy and important reflex that helps protect the airways in the throat and chest.
But sometimes, your child's cough will warrant a trip to the doctor. Understanding what different types of cough could mean will help you know how to take care of them and when to go to the doctor.

"Barky" Cough

Barky coughs are usually caused by a swelling in the upper part of the airway. Most of the time, a barky cough comes from croup, a swelling of the larynx (voice box) and trachea (windpipe).
Croup usually is the result of a virus, but can also come from allergies or a change in temperature at night. Younger children have smaller airways that, if swollen, can make it hard to breathe. Kids younger than 3 years old are at the most risk for croup because their airways are so narrow.
A cough from croup can start suddenly and in the middle of the night. Often a kid with croup will also have stridor, which is a noisy, harsh breathing (often described as a coarse, musical sound) that occurs when a child inhales.

Whooping Cough

Whooping cough is another name for pertussis, an infection of the airways caused by the bacteriaBordetella pertussis. Kids with pertussis will have spells of back-to-back coughs without breathing in between. At the end of the coughing, they'll take a deep breath in that makes a "whooping" sound. Other symptoms of pertussis are a runny nose, sneezing, mild cough, and a low-grade fever.
Although pertussis can happen at any age, it's most severe in infants under 1 year old who did not get the pertussis vaccine. Pertussis is very contagious, so your child should get the pertussis shot at 2 months, 4 months, 6 months, 15 months, and 4-6 years of age. This shot is given as part of the DTaP vaccine (diphtheria, tetanus, acellular pertussis).
The Tdap vaccine (which is similar to DTaP but with lower concentrations of diphtheria and tetanus toxoid for adults) is given to children at 11-12 years and once again in adulthood as a part of one of the tetanus boosters. Adults are recommended to receive this pertussis vaccine since immunity to pertussis lessens over time. By protecting yourself against pertussis, you are also protecting your kids from getting it.
Since pertussis is very contagious, it can spread from person to person through tiny drops of fluid in the air coming from the nose or mouth when people sneeze, cough, or laugh. Others can become infected by inhaling the drops or getting the drops on their hands and then touching their mouths or noses.

Cough With Wheezing

If your child makes a wheezing (whistling) sound when breathing out, this could mean that the lower airways in the lungs are swollen. This can happen with asthma or with a viral infection (bronchiolitis). Also, wheezing can happen if the lower airway is blocked by a foreign object.

Nighttime Cough

Lots of coughs get worse at night. When your child has a cold, the mucus from the nose and sinuses can drain down the throat and trigger a cough during sleep. This is only a problem if the cough won't let your child sleep.
Asthma also can trigger nighttime coughs because the airways tend to be more sensitive and irritable at night.

Daytime Cough

Cold air or activity can make coughs worse during the daytime. Try to make sure that nothing in your house — like air freshener, pets, or smoke (especially tobacco smoke) — is making your child cough.

Cough With a Fever

A child who has a cough, mild fever, and runny nose probably has a common cold. But coughs with a fever of 102° F (39° C) or higher can sometimes be due to pneumonia, especially if a child is weak and breathing fast. In this case, call your doctor immediately.

Cough With Vomiting

Kids often cough so much that it triggers their gag reflex, making them vomit. Also, a child who has a cough with a cold or an asthma flare-up might throw up if lots of mucus drains into the stomach and causes nausea. Usually, this is not cause for alarm unless the vomiting doesn't stop.

Persistent Cough

Coughs caused by colds due to viruses can last weeks, especially if your child has one cold right after another. Asthma, allergies, or a chronic infection in the sinuses or airways also might cause persistent coughs. If the cough lasts for 3 weeks, call your doctor.

When to Call the Doctor

Most childhood coughs are nothing to be worried about. However, call your doctor if your child:
  • has trouble breathing or is working hard to breathe
  • is breathing more quickly than usual
  • has a blue or dusky color to the lips, face, or tongue
  • has a high fever (especially if your child is coughing but does NOT have a runny or stuffy nose)
  • has any fever and is less than 3 months old
  • is an infant (3 months old or younger) who has been coughing for more than a few hours
  • makes a "whooping" sound when breathing in after coughing
  • is coughing up blood
  • has stridor (a noisy or musical sound) when breathing in
  • has wheezing when breathing out (unless you already have a home asthma care plan from your doctor)
  • is weak, cranky, or irritable
  • is dehydrated

What Your Doctor Will Do

One of the best ways to diagnose a cough is by listening. Knowing what the cough sounds like will help your doctor decide how to treat your child. The treatment for different types of coughs can vary, based on the cause.
Because most coughs are caused by viruses, doctors usually do not give antibiotics for a cough. A cough caused by a virus just needs to run its course. A viral infection can last for as long as 2 weeks.
Unless a cough won't let your child sleep, cough medicines are not needed. They might help a child stop coughing, but do not treat the cause of the cough. If you do choose to use an over-the-counter (OTC) cough medicine, call the doctor to be sure of the correct dose and to make sure it's safe for your child.
Do not use OTC combination medicines like "Tylenol Cold" — they have more than one medicine in them, and kids can have more side effects and are more likely to get an overdose of the medicine.
Cough medicines are not recommended for children under age 6.

Home Treatment

Here are some ways to help your child feel better:
  • If your child has asthma, make sure you have an asthma care plan from your doctor. The plan should help you choose the right asthma medicines to give.
  • For a "barky" or "croupy" cough, turn on the hot water in the shower in your bathroom and close the door so the room will steam up. Then, sit in the bathroom with your child for about 20 minutes. The steam should help your child breathe more easily. Try reading a book together to pass the time.
  • A cool-mist humidifier in your child's bedroom might help with sleep.
  • Sometimes a brief exposure to the cool air of the outdoors can relieve the cough. Make sure to dress your child appropriately for the outdoor weather and try this for 10-15 minutes.
  • Cool beverages like juice can be soothing and it is important to keep your child hydrated. But do not give soda or orange juice, as these can hurt a throat that is sore from coughing.
  • You should not give your child (especially a baby or toddler) OTC cough medicine without first checking with your doctor.
  • Cough drops are OK for older kids, but kids younger than 3 years old can choke on them. It's better to avoid cough drops unless your doctor says that they're safe for your child.
link to site

Reviewed by: Yamini Durani, MD
Date reviewed: May 2011
Originally reviewed by: Iman Sharif, MD