lice infestation

The Facts of Lice, and How To Treat Them

It’s back-to-school time, and one thing you may not be prepared for is your child coming home from school with a lice infestation. If the very thought is making your skin crawl, our concierge family doctors at MD 2.0 in Jupiter want to assure you that, while head lice are annoying and distasteful, they are not dangerous.

The facts

According to the Centers for Disease Control and Prevention (CDC), an estimated six million to 12 million infestations occur each year in the U.S. among children ages three to 11. And, although creepy, head lice are not known to spread disease.

• Head lice are found worldwide. In this country, infestation with head lice is most common among pre-school children attending child care, elementary schoolchildren, and the household members of infested children.

• Head lice are found in three forms: the egg (also called a “nit”), the nymph, and the adult.

• Personal hygiene or cleanliness in the home or school has nothing to do with getting head lice, the CDC says. Head lice move by crawling; they cannot hop or fly. They are spread by direct contact with the hair of an infested person. Anyone who comes into head-to-head contact with someone who already has head lice is at greatest risk.

• Despite the old myths, it is very uncommon to pick them up by sharing hats, scarves, coats, combs, brushes, towels, headphones, or any other personal items, although it can happen. Dogs, cats, and other pets do not play a role in the spread of head lice.

• Head lice and their nits soon die if they have no human host to feed on; nits need temperatures close to that found on the human scalp in order to hatch.

• The CDC, the American Academy of Pediatrics, and the National Association of School Nurses all take issue with the “no nits” policy of many school systems nationwide, which prevent children with head lice from attending school; these organizations contend that head lice are not a public health risk.

How to spot head lice

Often parents have little warning about an infestation of head lice until they’re combing or styling their child’s hair.

Head lice and their nits are found almost exclusively on the scalp, particularly around and behind the ears and near the neckline at the back of the head. Less commonly, head lice can also be found on the eyelashes or eyebrows.

The nits can range in color from white to brown and may look like dandruff, scabs, or droplets of hairspray. A fully grown, developed adult louse is about the size of a sesame seed, has six legs, and is tan to grayish-white in color.

Other signs and symptoms include:

• a tickling feeling of something moving in the hair;
• itching caused by an allergic reaction to the bites of the creature;
• irritability and difficulty sleeping (head lice are most active in the dark); or,
• sores on the head caused by scratching, which can sometimes become infected with bacteria found on the person’s skin.

How to treat them

The adult female head louse lays her eggs at the base of the hair shaft nearest the scalp, and are firmly attached there. They hold tightly to the hair with hook-like claws at the end of each of their six legs. Nits are so firmly cemented to the hair shaft that they can be difficult to remove even after they hatch and the empty casings remain.

Most home remedies have been found not to work. The most dangerous of these is gasoline, which the CDC emphatically warns against using.

The CDC recommends treatment with either an over-the-counter (OTC) preparation or a prescription medication known as a pediculicide, following the instructions on the label carefully. It also warns against using a combination shampoo/conditioner or conditioner alone prior to treatment, and advises not to re-wash hair for one to two days after treatment.

If a few live lice are still found eight to 12 hours after treatment, but are moving more slowly than before, do not re-treat. If live lice are still evident after this period, talk to us for the best way to proceed. Some head lice have developed a resistance to OTC treatments and may require a prescription product.

Also, if you’re still not sure whether your child has an infestation, we can make a definitive diagnosis; we can also tell you whether the infestation is still active and recommend ways to treat it.

swimming bug

Watch Out for This Unpleasant Swimming Pool ‘Bug’

What would summer be without the silky feel of warm water caressing hot skin as you glide across a swimming pool?

But as a timely reminder that nothing is perfect, this month the U.S. Centers for Disease Control and Prevention (CDC) in Atlanta published a report warning swimmers to take precautions against a microscopic parasite that can take up residence in pools and water playgrounds. So our concierge family practice doctors at MD 2.0 in Jupiter want to alert you to this possible hazard.

Symptoms and Causes

The infection, Cryptosporidium, or “Crypto,” is the most common cause of diarrhea and occurs when swimmers swallow pool water which is infected with it. The resulting illness can last for up to three weeks, leaving sufferers with watery diarrhea, stomach cramps, nausea or vomiting, and, possibly, dehydration as a result.

The CDC’s June report noted that, between 2009-2017, reported outbreaks have increased an average of 13 percent per year. Thirty-five percent of the outbreaks were linked to swimming in pools and water playgrounds; 15 percent were linked to contact with cattle, particularly nursing calves; 13 percent were linked to contact with infected people in childcare settings; and three percent were linked to drinking raw (i.e., unpasteurized) milk or apple cider.

Tough to Kill

Unlike other swimming pool infections, Crypto is resistant to the typical concentration of chlorine. Crypto is protected by an outer shell that makes it tough to kill, the CDC reports. For example, it can survive for days in chlorinated water in pools and water playgrounds or on surfaces disinfected with chlorine bleach.

Crypto can easily cause outbreaks because it only takes a few germs to make someone sick, and there can be millions of Crypto germs in feces.

Even in pools which are treated to recommended levels, the Crypto parasite can survive for up to 10 days. The only way to respond to an outbreak of Crypto, the CDC says, is closing the pool and treating the water with high levels of chlorine, called hyperchlorination.

“Young children can get seriously sick and easily spread Crypto,” said Michele Hlavsa, R.N., M.P.H., chief of the CDC’s Healthy Swimming Program. “They don’t know how to use the toilet and wash their hands, or are just learning how. But we as parents can take steps to help keep our kids healthy in the water, around animals, and in childcare.”

Precautions

According to the CDC, outbreaks caused by Crypto occur most commonly in the summer. It recommends the following steps to protect yourself and others:

 

• Do not swim or let kids swim if they have diarrhea.

• If diagnosed with Cryptosporidiosis, do not swim until two weeks after diarrhea completely stops.

• Do not swallow the water you swim in.

• Keep kids with diarrhea at home and away from childcare.

• Wash your hands with soap and water after coming in contact with animals or anything in their environment, especially animal feces. Alcohol-based hand sanitizers do not work effectively with Crypto.

• Take kids on frequent bathroom breaks, and don’t change diapers in the pool area—do so in a diaper-changing area away from the pool.

• Rinse off in the shower before getting into the water to help remove any germs on your body that could contaminate the pool water.

• Remove shoes worn in animal environments (barns, pens, etc.) before going inside your home.

• If you drink milk or apple cider, buy only pasteurized types.

 

Those with healthy immune systems don’t require special treatment if they contract this unpleasant bug. However, the CDC warns that those who are especially young or old or who have compromised immune systems are at increased risk for life-threatening dehydration or malnutrition. If your immune system is compromised in any way, you develop blood in your stools, are having trouble staying hydrated, or if the illness lasts longer than 10 days, be sure to let us know.

screen time for kids

Screen Your Kids’ Screen Time

Our concierge family doctors in Jupiter understand that, in a world dominated by screens, trying to limit your children’s screen time can be a daunting task. But the World Health Organization (WHO) recently released new guidelines that largely track those issued two years ago by the American Academy of Pediatrics (AAP).

 

What is ‘screen time’?

First, let’s define what constitutes “screen time.” The AAP defines it as time spent using digital media for entertainment purposes. The organization does not include time spent doing homework in its recommendations. The WHO has a similar definition of passively watching entertainment on a screen. But the overall thrust of its guidelines were aimed, not just at the sedentary activities of viewing computers, smartphones, and televisions, but at improving physical health through sufficient exercise and sleep.

In addition, the AAP guidelines addressed screen time for children of all ages, while the WHO recommendations focused on children under age five.

 

Problems with infants

Both groups recommend no screen time at all for infants 18 months and younger.

“The noise and activity of a screen are distracting for a child,” Dr. Yolanda Reid Chassiakos told CNN. Chassiakos is the lead author of the AAP’s report. She said banning screen time for babies is crucial, not only for brain development but for healthy parent-child connections.

 

“Even if the baby isn’t directly looking at the screen—for example, if a mother is nursing her child on the couch while watching TV—the baby can be overstimulated by the lights and sounds, which may cause distress and sleep problems.”

 

Chassiakos also noted that screens tend to interfere with creating intimate bonds between parents, children, and siblings and that tech-free bedrooms can help promote better sleep. Other experts have warned that screen time may inhibit a child’s ability to develop language and social skills.

The WHO took these recommendations a step further, noting that improving physical activity and sleep among young children, while limiting sedentary behaviors such as screen viewing, can help prevent problems later in life stemming from becoming overweight and out of shape.

 

The recommendations

Here are the WHO’s new guidelines:

Infants younger than one

  • no screen time at all
  • physical activity several times a day, including floor-based play and 30 minutes of tummy time
  • limiting restraint (in a stroller, high chair, or caregiver’s back) to less than an hour at a time
  • 14-17 hours of quality sleep, including naps, for infants three months and younger
  • 12-16 hours of quality sleep, including naps, for those between four and 11 months

 

Children between one and two

  1. no screen time for one-year-olds
  2. one hour of screen time for two-year-olds
  3. 180 minutes a day in physical activity (not necessarily structured exercise)
  4. limiting restraint to less than one hour at a time
  5. between 11 and 14 hours of quality sleep, including naps

 

Children between three and four

  • one hour of screen time
  • 180 minutes a day of physical activity, including 60 minutes of vigorous running and jumping games
  • 10-13 hours of quality sleep, which may include naps

 

“Too often, I see tired, overscheduled kids who eat on the run during the week and become sedentary on weekends because they are exhausted,” Dr. Jennifer Shu, an AAP spokeswoman, told CNN.

 

As always, we are here for you and your family, so feel free to consult us regarding any questions you may have about shielding your children from excessive screen time.

protect child from drowning

How To Protect Your Child From Drowning

Drowning is one of the leading causes of death in children. Our concierge primary care doctors in Jupiter, want to emphasize the importance of teaching children not only the rules associated with being in and around water, but how to swim at an early age.

The American Academy of Pediatrics (AAP) recently released updated guidelines recommending swimming lessons for toddlers, revising long-standing guidance against swimming lessons for children under age four.

Start early

The earlier guidelines were based on the belief that children under four could not master the skills required to hold their breath and coordinate their limbs properly to develop adequate swimming skills. There was also a lack of evidence that swimming lessons would help prevent drownings in the under-four age group, as well as the suspicion that swimming lessons for such young children might confer a false sense of security in their parents.

But one study reported that lessons between the ages of one and four produced an 88 percent reduction in drownings. These findings, coupled with the fact that children between the ages of one and four are at the highest risk for drowning, eventually changed the thinking and led to the revisions. Of course, they’re not all going to be mini-Michael Phelps, but the AAP stresses that they can be taught basic water skills and water safety skills.

“Floating, grasping the wall, climbing in and out of the water, turning back to the wall . . . a lot of times children end up falling into the water and they look to the furthest point, and if they just turned around they would be better off,” Katie Lee of the Goldfish Swim School in Long Island, New York, told CBS News.

It’s a matter of allowing very young to feel comfortable in the water, and not panic if they find themselves in it unexpectedly. You can start by holding your baby in your arms, moving them slowly back and forth, allowing them to feel the silky sensation of water on their skin. You can sing to them, and even bob them up and down, reinforcing the feeling that being in water is fun.

Slightly older children can be taught to blow bubbles in the water, thus learning how to avoid swallowing water. You can also teach them how to float on their backs and kick their legs as you hold them up. Formal swimming lessons with a certified swimming instructor can start as early as age one, depending on the child’s physical abilities and emotional development.

Reduce risk

In addition to teaching your child basic water skills, it is critical to be vigilant at all times to prevent a tragedy. Young children can drown in as little as two inches of water, and within 90 seconds without breathing, oxygen in the brain begins to drop. Other experts cautioned that the perception of children flailing around in the water when they fall in is largely myth. Very young children tend to fall in and immediately sink.

“Don’t even run into the house for a second to go to the bathroom or grab the phone,” Dr. Mark Waltzman, a pediatric emergency medicine expert, told CBS News.

Other suggestions from AAP to prevent drowning include the following:

  • Parents should never leave children alone or in the care of another child while in or near bathtubs, pools, spas, or other open water.
  • Empty water from buckets and other containers immediately after use.
  • Never leave young children alone in the bathroom. Toilet locks can prevent drowning of toddlers.
  • Even with older children and better swimmers, the supervising adult should focus on the child and not get distracted with other activities.

Tips for homes with pools include these useful guidelines:

  • Never turn your back on a child in the water, even for a moment.
  • Be sure to install child-proof fencing all the way around the pool. Fences should be at least four feet high, with self-closing and self-latching doors that open outward. Consider door alarms for those that open directly into the pool area.
  • Also remove any structures that would allow them to circumvent the fence, such as ladders and toys.
  • If a child is missing, always check the pool first—seconds count.
  • Empty portable pools when not in use.
  • Always make sure a responsible adult is watching the children playing in or near the pool area (with no distractions, e.g., smartphones off).

If you have questions about age-appropriate swimming lessons and activities for your child, don’t hesitate to contact us.

concierge doctor

The Best Kids’ Toys May Not Be What You Think

As we get closer to the holidays, you may be scrambling to fill out your child’s wish list for Santa. So your concierge doctors at MD 2.0 in Jupiter, Florida, would like to offer you some food for thought, courtesy of the American Academy of Pediatrics (AAP). Last week, the AAP released a report suggesting that parents skip the pricey electronics in favor of the old-fashioned toys: blocks, puzzles, even empty boxes.

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rare disease afm

Mysterious Illness Spreading, But Still Very Rare

Your concierge family practice doctors in Jupiter, Florida, at MD 2.0., have been hearing concerns from our patients about the recent publicized increases of a rare polio-like disease occurring mainly in children. The Centers for Disease Control and Prevention (CDC) is investigating as many as 127 cases of acute flaccid myelitis (AFM) in at least 22 states this year. Some news outlets place the number of states affected closer to 30, because reporting cases to the CDC is voluntary, and this information may not have reached the CDC yet.

The symptoms of AFM are very similar to polio, a disease that was eradicated in the U.S. through the use of universal immunization. AFM affects a person’s nervous system, specifically the spinal cord, causing weakness in one or more limbs. It tends to begin about a week after a slight fever or respiratory illness, but can suddenly appear as weakness in the arms and legs. Other symptoms can include slurred speech or difficulty swallowing, or a “drooping” appearance in the face. Many patients recover quickly, while others continue to have paralysis requiring ongoing care.

More than 90 percent of the cases the CDC has confirmed have occurred in children under age 18; the average age is four. Although one death from AFM was reported last year, no deaths have been associated with the illness so far this year.

Cause still unknown

AFM was even rarer prior to its first major U.S. outbreak in 2014 when 120 cases were confirmed. The illness seemed to slack off in 2015 with only 22 confirmed cases, then spiked again in 2016 (149 cases), dropped in 2017 (33 cases), and now in 2018, we have 62 confirmed cases so far with an additional 65 suspected cases being investigated by the CDC. So not only do the cases seem to be rising then declining from year to year for reasons that are still unclear, but they also seem to cluster in the fall months. There are no state clusters, however, suggesting the illness is not spread from person to person but arises spontaneously.

The most frightening thing about AFM is that scientists have been unable to pinpoint a cause. All the confirmed AFM patients have been tested for poliovirus, and have definitively tested negative. The CDC has also tested every case for evidence of a wide range of known pathogens (germs) or viruses and has been unable to detect a consistent pattern among those affected.

What is known

Scientists continue to look for a common thread. Given the persistent controversy over vaccinations, it should be noted that those affected have differing histories on vaccinations: Some of the patients were vaccinated, some were not. (Incidentally, in October an unvaccinated child in Florida became the first person to die from this year’s flu.)

Unless it can be found that all those who contracted the illness share a common trait, such as being or not being vaccinated or contracting the same type of cold or flu, or having traveled to a certain place or having come in contact with some pollutant, the cause of the syndrome will remain a mystery.

What is also known is that the chances of developing AFM is less than one in a million, according to the CDC.

Should you worry?

The likelihood of you or your child developing this distressing illness is miniscule, but there is a chance, especially since this is a year in which the cases are spiking. But we believe there is little cause for concern. As a parent, you should take the typical precautions you always do to ensure your child stays healthy: obtaining the recommended vaccinations, ensuring they wash their hands regularly and practice accepted hygiene methods, eating well, exercising, and getting enough sleep.

Just be aware that AMF strikes with little warning, and watch your child for any signs of the symptoms described above. If you have any concerns or questions, please don’t hesitate to contact us immediately.