Spring 2008 Newsletter
WELCOME to this revival of Pediatric Specialists’ Newsletter.  We hope to provide you with interesting and helpful information, and welcome your feedback on our new publication. 
Spring Health
Lyme Disease
Submitted by Nancy Delgiudice, PNP
 Lyme disease is caused by bacteria which are transmitted to humans by a bite from an infected deer tick.  Deer ticks are most often found near wooded areas, tall grass, and brush.  Not all deer ticks carry Lyme disease and some areas of the state have a higher incidence of Lyme disease (e.g. Cape Cod, Martha’s Vineyard, and Nantucket).  Most Lyme disease is caused by the nymphal tick which is as tiny as a poppy seed or the dot made by a pencil on a piece of paper.  Since these ticks are so small, they often go undetected on the human body.  Lyme disease can also be caused by adult ticks, but since these are larger (about the size of an apple seed) they are more commonly discovered. The tick needs to remain on the human body for at least 24 hours for Lyme disease to be transmitted. Large wood ticks do not carry Lyme disease. Since the nymph stage of the tick occurs from May to July, this is the time of highest incidence of Lyme disease.
The symptoms of Lyme disease are variable.  About 60% of those infected with the Lyme bacteria develop a “bull’s-eye” rash at the site of the bite a few days after being infected.  The rash does not itch or hurt. The bull’s eye rash may be accompanied by flu-like symptoms with fever, headache, and muscle aches which occur within the first few weeks after the tick bite.  Occasionally other rashes are seen with Lyme disease. There is a later form of Lyme disease which occurs 3-5 weeks after the initial tick bite. This may include a rash on parts of the body distant from the bite, and can be accompanied by arthritis, meningitis, or Bell’s Palsy (partial facial paralysis).
Lyme disease is treated with antibiotics, and children generally recover fully.  Prophylactic antibiotics are not recommended at the time of tick bite, since even in endemic areas, the risk of Lyme disease after a tick bite is low.  If symptoms of Lyme disease are present, children are treated with antibiotics.
Prevention is the key to avoiding Lyme disease.  If possible children should be dressed in long-sleeved shirts and long pants tucked into socks if they are playing in wooded, tick-prone areas.  Light colored clothing is best so that ticks can be seen.  Insect repellent containing DEET (see below for more info insect repellent) can be used in older children and sprayed on the clothing of younger children.  At the end of the day a “tick check” should be done while bathing.  If an attached tick is found it should be removed with tweezers, pulling straight out with a twisting motion.  Do not be alarmed if some of the tick parts remain embedded, this does not create higher risk of infection.

Safety:
Booster Seat Law
This month Governor Patrick signed a new law requiring children under 8 years old and 4’9” to ride in a booster seat at all times.  The booster seat positions the seat belt across the child’s shoulder and waist, rather than across her abdomen or neck.  The new law will go into effect in mid July and carries a $25 fine.  38 states have booster seat laws, although Massachusetts is the first Northeast state to have such a law. 
Following is a summary of the current car seat safety recommendations:
Rear Facing Infant Carrier Seats:

1. Newborn to about 6 months
2. Weight under 20 pounds.
3. Height under 26 inches.

Rear Facing Convertible Seats

1. 6 months to 1+ years old
2. Weight under 30 pounds
3. Top of head at least 1 inch below top of seat

Forward Facing Seat

1. Over 1 year of age
2. Weight between 20 and 40 pounds
3. Top of shoulders below harness straps on seat

Booster Seat with Adult Lap and Shoulder Belt

1. Under 8 years old
2. Weight over 40 pounds
3. Height under 4’9”

       Front Seat:

1. No child under 13 years old should ride in the front seat

 
Nutrition:
Healthy Treats
Submitted by Leah Spitzer, MD
Here are some recipes for healthy treats for kids that have been well received by my teenagers.

Double Chocolate Brownies

¾ C whole wheat pastry flour
1C “natural” sugar*
1/2C semi-sweet chocolate chips
6Tbsp unsweetened cocoa
1 tsp baking power
¼ tsp salt
6T canola oil
½ C unsweetened applesauce
2 large eggs
1 tsp vanilla extract
Preheat oven to 350 degrees,  grease 8”x 8” pan.  Mix dry ingredients together.  Add wet ingredients, stir.  Bake at 350 for 30-35 minutes.
*Any type of sugar will work – I use a mixture of organic cane sugar and erythritol sweetener.

Whole Grain Peanut Butter Chocolate Chip Cookies
1C Whole wheat flour
1 ¼ C quick cooking oats
1tsp baking soda
½ tsp salt
½ C peanut butter
½ C olive oil
¼ C sweetener*
½ C brown sugar*
1 tsp vanilla extract
2 large eggs
2/3 C mini semi-sweet choc chips
1 C chopped nuts (optional)
Preheat oven to 350 degrees.  Beat oil, peanut butter, sugars, and vanilla in mixer until creamy.  Add eggs one at a time, beating after each addition.  Mix in remaining dry ingredients, then choc chips and nuts.  Drop by rounded teaspoon onto ungreased baking sheets.
Bake 8-10 minutes at 350
Makes about 5 dozen cookies. 
*I use ½ C organic cane sugar and ¼ C erythritol or Splenda.

Staff Update
We regretfully lost 3 long time nurses to retirement this year, and deeply miss Ann Gookin, Barbara Beck, and Judy Rowe.  All are happily enjoying retirement.
We welcome several new nurses to our staff: Denise Embree, RN and Kathleen White, RN.
We also wish good luck to Nancy Callan, PNP in her new job running a school-based health clinic in her home town of Worcester.  She will return on a part time basis during the summer
We continue to benefit from our association with Heather Stone, RD, LDN.  Heather is available to meet with patients in our office for nutritional counseling.  Appointments may be arranged by contacting her directly at 508- 577-3765.

Ask the Doctor

Question: My child is experiencing a runny nose and itchy eyes which I think might be allergy related.  What is the best medicine to give him?
Answer: There are several over   the counter options for allergy treatment.   General allergy symptoms of runny nose and mild cough can be treated with antihistamines such as Claritin (also sold as Alavert or generic loratadine).  This is available in liquid, melt-away, or tablet form.  Claritin is given once daily and is not sedating. Another antihistamine newly available over-the-counter is Zyrtec which comes in liquid, chewable, or tablet form.  For itchy eyes we recommend Zaditor eye drops which are very effective for allergic conjunctivitis.  If allergy symptoms don’t respond to over the counter treatments, a prescription nasal spray is often recommended.
Question:  Should I worry about bisphenol–a (BPA) in plastic bottles or sippy cups?

Answer:  Bisphenol-a is a chemical often found in polycarbonate hard plastic bottles, food storage containers, refillable water bottles, and the lining of soft drink and food cans.  Recently there has been public debate about whether BPA is a health hazard. 
The evidence that BPA is harmful comes from animal studies. Studies in rats showed that injection or ingestion of BPA caused changes in mammary and prostate tissue which suggested a potential cancer risk.  There is no direct evidence that BPA is hazardous to humans, but concern has been raised about the possible risk to pregnant women and infants. 
For those who want to limit exposure to BPA, glass baby bottles, or BPA-free baby bottles and sippy cups are becoming more widely available.  Nalgene-type refillable water bottles are soon to be made of BPA-free plastic as well. 
Question: What insect repellent should I use on my child?
Answer:  Studies have shown that insect repellents containing DEET are the most effective on the market.  According to the American Academy of Pediatrics Committee on Environmental Health, DEET has no increase in absorption through the skin beyond 2 months of age and is safe to use in children. 
Concentrations of DEET vary from 10% to 30% or more.  It is not recommended to use concentrations greater than 30% in children.  It is generally recommended that DEET not be reapplied within the same day. 
Some tips for use:
Studies support use after age 2 months, but limiting use on the skin before age 1 year may be prudent.
Spray clothes, hats, strollers to limit the amount applied to the skin.
Do not use combination sunscreen and insect repellent products as sunscreen needs to be frequently reapplied.
Do not spray DEET-containing repellents near food and do not apply on the hands.
Wash skin thoroughly at the end of day.
Alternative:  Picaradin-containing products are also considered safe and effective.  Picaradin needs to be reapplied after 2-3 hours and should not be applied more than 2x/day.   It is recommended for anyone with a skin sensitivity to DEET products. 

Suggestions:

We always appreciate your help in improving our practice, and welcome any feedback you provide.  Please let us know if there is any way we can improve your experience at Pediatric Specialists. Feedback can be sent by the email link on our website www.pediatricspec.com . Feed back for the Foxboro office should be sent to customerservicefoxboro@pediatricspec.com and for the Wrentham office to customerservicewrentham@pediatricspec.com.  We also will soon be providing suggestion boxes in both offices to receive your comments.
Feedback or submissions for our newsletter can be sent to drspitzer@pediatricspec.com.

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