All About Ticks

We field calls about them year round but have been hearing a lot about them lately!   Dr Lily Joseph is here to help with all your tick-related questions!

While ticks are prevalent year-round in the Northeast and Mid-Atlantic, bites tend to be more common in the summer months when our families are spending more time outside. These pesky bugs love to live in brushy and wooded areas, but they may even be hiding in our backyards in the DMV.

Ticks carry a host of infections and the best way to prevent infection is to avoid tick bites. Clothes are our first layer of protection! Choose light, breathable clothes that cover the arms and legs fully. For hiking or playing in tall grasses, try dressing kids in long-pants tucked into closed-toed shoes. Pro tip: light colored clothes make it easier to spot ticks.

Insect repellants are also key! The American Academy of Pediatrics supports the use of DEET-containing products up to 30% strength in children over 2 months old. 10% DEET will offer protection up to 2 hours and 30% DEET protects for about 5 hours. Picaridin is another recommended option–5% Picaridin protects for 3 hours and 20% protects for up to 8-12 hours with similar efficacy to DEET. DEET or Picaridin repellants should be applied to areas of exposed skin and not to the skin that is covered by clothes. Other products containing citronella, catnip oil, and other essential plant oils are not recommended due to lack of data on safety and efficacy.

Treatment of clothing with Permethrin products is another great option, especially before kids go away for camp! Treat clothes with 0.5% Permethrin products using the product instructions. This will offer protection through multiple launderings. Never apply these directly onto the skin.

Despite our best efforts, tick bites still may happen! Most tick-borne infections require the tick to be attached to the body for more than 36 hours. I recommend incorporating tick checks into your family’s bedtime routine every night. Be sure to check in the armpits, between the legs, and even in the hair where bugs can hide.

If you find a tick on your child, don’t panic! Use clean tweezers to carefully remove the tick as soon as you notice it. Make sure you remove the whole thing, as sometimes they can break into pieces during the removal process. Clean the area well with soap and water and cover it with a bandaid and some topical antibiotic ointment like Polysporin. If the tick has been on the skin for an extended period, your child may need antibiotics to prevent Lyme disease! Call for an appointment or to speak to your child’s doctor to discuss the next steps.

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Watch: Building Resilience: How Families Can Prepare for the Uncertain School Year Ahead!

In August, Dr. Sexter spoke on a panel in conjunction with the ADAA (Anxiety and Depression Association of America) about the challenges of starting a new school year.   Click the link to watch this educational webinar designed to equip parents with the tools to help kids thrive emotionally, socially and academically.

 

Building Resilience: How Families Can Prepare for the Uncertain School Year Ahead!

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Sun Safety

Summer fun tends to mean more sun exposure. Here are some tips from Dr. Joseph to keep your family safe in the sun!

First off, if you can, limit sun exposure! This may mean staying inside between 10AM-4PM when the UV rays are at their strongest or looking for shadier areas when enjoying the outdoors.

Sun protective clothing is a great option, especially when you may be outside for a long time. I also recommend hats with at least a 3-inch brim—not only do they protect the more sensitive skin on the face, ears, and neck, they are also totally adorable!

What about sunscreen? We’ve all stood in the sun protection aisle staring blankly at huge selection of options! I recommend products containing zinc oxide or titanium dioxide as the active ingredient as they have proven to be safe for kids and offer great protection from the sun. Choose products with SPF (sun protection factor) of at least 30. I always recommend avoiding products with added fragrance as these can be irritating to sensitive skin. I find the mineral stick sunscreens super convenient, especially for younger kids–they don’t have to be rubbed in as much and have less risk of dripping into the eyes. Apply sunscreen to all exposed skin at least 15 minutes before going outside and be sure to reapply about every 2 hours, or after kids have been in the water.

Don’t forget about the eyes! Sun exposure puts our eyes at risk of cataracts, macular degeneration and even sun burn on the eyes (aka photokeratitis). Encourage your kids to wear sunglasses with UV protection. Lots of brands make sunglasses even down to newborn size!

Now that you’ve got all the info you need to protect your family from the sun, go out and enjoy this especially hot DC summer!

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Measles

With measles cases rising in the United States this year, we are fielding lots of questions from concerned parents.  Dr. Tara Mamdouhi is here to answer some of those.

 

Measles has been surging in the U.S. and abroad, and we want to make sure our patients are protected! Measles is a highly contagious viral illness that spreads through respiratory droplets. It typically begins with high fever, runny nose, and red, watery eyes, followed by a characteristic red rash that starts on the face and travels downwards. The rash typically appears about 3-5 days after initial symptoms. About 20% of people with measles will require hospitalization for things like pneumonia or encephalitis (swelling of the brain). Measles is particularly dangerous for babies and young children.

The good news is that we have a safe and effective vaccine to help protect against measles! The measles vaccine (which covers measles, mumps and rubella—also known as the MMR vaccine), is typically given at 12 months and 4 years old. For patients who are at increased risk of measles exposure, a dose of MMR may be given between 6 and 12 months of age for early protection. This dose does not count as one of the two doses needed for full protection. For children between 12 months and 4 years old who are at increased risk of measles exposure, the second dose may be given early in order to give full protection earlier. The second dose can be given as early as one month after the first dose.

As of now, there have been no known local outbreaks of measles in the D.C. area. Therefore, no early vaccination is needed for families staying locally. For families traveling internationally or to an area in the U.S. with increased measles cases, the CDC recommends that babies ages 6-11 months get one dose of MMR and that everyone age 12 months and older receive two doses of MMR (at least one month apart). If you have a child under 4 years old and have any international travel plans or plan to travel within the U.S. to areas with measles transmission, please reach out to our office about potential early vaccination!

Source: www.cdc.gov/measles

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Welcome Dr. Lily Joseph

We are very excited to announce that Dr. Lily Joseph will be joining Spring Valley Pediatrics this summer.

A native Washingtonian and former patient of Spring Valley Pediatrics, Dr. Joseph is a graduate of the University of Pennsylvania where she earned a B.A. with honors in Psychology and Chemistry. She went on to attend Georgetown University School of Medicine where she was honored for excellence in Pediatrics. She completed her pediatric residency at Children’s National Medical Center.

Dr. Joseph emphasizes health education and prevention in her practice. She is especially interested in childhood development, mental health, and creating long-lasting relationships with patients and families. She is thrilled to return to Spring Valley Pediatrics to provide her patients with the same excellent care she received as a child.

She lives in Washington, D.C. with her husband and their corgi, Abraham. In her free time, she enjoys experimenting with new recipes at home and eating at D.C.’s many delicious restaurants.

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Ear Pain – Everything You Need to Know

Ear Pain

Hello, everyone! Dr. Binns here, back again to review one of the most common reasons parents schedule sick visits with us – the dreaded earache.

What causes an earache?

The most common reason parents bring their children in for an earache is to see if they have an ear infection (AKA otitis media/middle ear infection), but there are other reasons why their ears may be hurting. Some examples include:

  • Swimmer’s ear (AKA otitis externa)
  • Fluid buildup behind the eardrum
  • Earwax buildup
  • Rash/skin infection around the ears
  • Pain originating elsewhere that can be felt in the ears, such as pain in the mouth or throat (this is very common in teething infants and toddlers)

Ear infections often occur after viral illnesses or colds. Sinus pressure and mucus build-up from your child’s illness can cause inflammation and blockages in their nose and sinuses. Specifically, there is a small tube that connects the middle ear space to the nose called the eustachian tube (this is what enables us to pop our ears when we fly in an airplane). Anything that blocks this tube can set a child up for an earache, as obstruction can lead to accumulation of mucus behind the eardrum. The bacteria and viruses that normally live in your sinuses can then grow in that fluid without anywhere to drain out naturally. This causes the eardrum to bulge and swell, leading to the characteristic ear pain we associate with ear infections.

Ear infections are more common in kids for a few reasons. A child’s immune system is not as fully developed as an adult’s, making them more vulnerable to getting sick in general. Younger children, especially those who attend daycare, are also frequently exposed to all sorts of germs, leading to lots of colds. In addition, children have shorter, narrower eustachian tubes than adults, making it easier for these tubes to get blocked and for fluid to accumulate behind the eardrum.

How can my doctor help?

Your doctor will ask questions about how your child has been doing and what other symptoms they have such as fever, cough, or if they have had any drainage from their ears. If your child is found to have an ear infection, your doctor may prescribe an antibiotic to help treat the infection, though bear in mind that many ear infections are caused by viruses and not bacteria. Ear infections caused by viruses tend to be associated with milder symptoms than those caused by bacteria and will generally resolve without antibiotics. In some cases, your pediatrician may opt to observe your child’s symptoms for 24-48 hours with a plan to treat with antibiotics if their symptoms do not improve by then, or if their symptoms worsen.

If your child is getting frequent ear infections, your doctor may refer you to see an Ear, Nose, and Throat doctor (ENT/Otolaryngologist) for evaluation and to discuss whether your child may benefit from ear tube placement.

It’s 7pm and I can’t get in to see my pediatrician until tomorrow morning. Is there anything I can do at home to make my child feel better?

Absolutely! You can give your child ibuprofen (if they are more than 6 months old) or Tylenol as needed to help soothe their pain. You can also apply heat or ice to the ear. As long as your child’s symptoms are manageable with these supportive measures, it is ok to wait until the morning to see your doctor. Your child should be seen in the ER if they have severe pain that is not responsive to ibuprofen or Tylenol, if they have a fever higher than 105F, or if they develop other severe symptoms.

Is there any way to reduce my child’s risk of getting ear infections?

Make sure your child has received their recommended routine immunizations, including their pneumococcal vaccines (PCV) and yearly influenza vaccines. These will also help to decrease the risk of ear infections.

While ear infections are not contagious, the often-preceding viral illnesses are. Encourage your child to wash their hands frequently, especially after playing with other children. Minimize exposure to people with colds and secondhand smoke, as both are associated with an increased risk of ear infections. In addition, a child’s early nutrition has been associated with reduced risk of ear infection. Specifically, studies have shown that breastfeeding during infancy has been associated with a reduced risk of developing ear infections.

Remember that we are open 7 days a week and 365 (or 366 this year!) days a year, including holidays and weekends.

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Breakthrough in the Fight Against Type 1 Diabetes

We are excited to inform our patients and their families that the FDA recently approved a new treatment that helps delay the onset of type 1 diabetes in at-risk individuals. The new treatment, called teplizumab, is a monoclonal antibody treatment that modulates the immune system to reduce the body’s attack on the insulin-producing cells in the pancreas. By lessening this attack, teplizumab can help delay the onset of type 1 diabetes by several years. This delay can provide a precious window of time free from the daily management of type 1 diabetes, which can be invaluable for children and their families.

You may be wondering how we determine who may benefit from and be eligible for this treatment. Fortunately, we can evaluate you or your child with a simple blood test collected in our in-house lab! For patients with a family history of type 1 diabetes, or a personal/family history of other autoimmune disorders, a blood test can be done to screen for certain autoantibodies, which indicate whether someone is likely to develop type 1 diabetes in the near future. If you believe you or your child may be at increased risk, reach out to your doctor about getting the blood test done with your next blood draw! We are so excited to offer this important screening to our patients and families and hopefully help decrease the burden of type 1 diabetes.

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Flu 101

Hey, everyone! Dr. Binns here, back with more info on these nasty winter bugs. Following up on last month’s common cold post, I’m back to talk about the dreaded flu.

What is influenza?

Influenza, otherwise known as “the flu”, is a common viral illness that is most prevalent during the colder months of the year. Children with the flu usually develop an abrupt-onset fever, body aches and fatigue, often accompanied by other respiratory and gastrointestinal symptoms such as cough, congestion, sore throat, nausea, and vomiting.

The flu tends to last longer than a typical cold – your child may be feeling pretty crummy for about a week – and may still have some lingering symptoms for about 1 more week afterwards. Flu symptoms can become severe enough to require hospitalization in a small percentage of children – this is more common in children who fall into high-risk categories. This includes (but is not limited to):

  • Children younger than 5 years old, especially those younger than 2 years old
  • Children with asthma or other chronic lung disorders
  • Children with heart disease
  • Children that are immunocompromised
  • Children with sickle cell disease
  • Children with metabolic disorders
  • Children with neurologic disorders, such as seizures or neuromuscular diseases such as cerebral palsy

How is this virus spread?

The flu is mainly transmitted from person to person via respiratory droplets spread through coughing, sneezing, or talking. You can also pick the virus up from touching a contaminated surface and touching your mouth, nose, or eyes.

How can you differentiate between a common cold and the flu?

This can be difficult because there are some overlapping symptoms that can be attributed to both common colds and the flu. I have created a handy table for you that summarizes some of the key differences between the common cold and the flu.

Comparison of Common Cold and Influenza Symptoms

  Common Cold Influenza
Onset of symptoms Gradual, over 1-3 days Sudden
Fever Sometimes, may be low-grade up to ~102F Common, often high fevers up to 102-105F
Body aches Sometimes, usually very mild if present Very common
Fatigue Mild Usually severe
Upset stomach/nausea/vomiting Rare Common
Headache Sometimes Common
Cough Common Common
Sore throat Sometimes Sometimes

 Similar to COVID, the only way to know for sure if it is the flu is to be tested. If you are concerned your child may have the flu, please call our office to schedule an appointment with your pediatrician for evaluation and flu testing.

How do you treat the flu?

Make sure you are keeping your child well-nourished, especially with fluids, to help them fight off this virus. Warm fluids such as tea or soup help to soothe sore throats and relieve congestion. You can also use a cool mist humidifier to help your child breathe a little easier at night. For children older than 12 months, you can give 1 teaspoon of honey either straight or mixed into a beverage to help with cough and sore throat (honey should be avoided in children under 12 months old due to the risk of botulism).

Unfortunately, the flu is known for causing high fevers. When children have fevers, they can feel pretty wiped out and may even breathe harder and faster than usual. You can help them feel better by giving Motrin (after 6 months of age) or Tylenol for comfort. Please see our table at https://springvalleypediatrics.net/medication/ for weight-based dosing recommendations.

There are also antiviral medications, such as Tamiflu, that may slightly reduce the severity and length of symptoms if started within the first 48 hours of illness, though may have side effects such as upset stomach, nausea, and vomiting. Your pediatrician may also decide to start Tamiflu later in the course of illness for children in certain high-risk categories.

When to seek emergency care

  • If your child has a fever higher than 105F
  • If your child is unable to tolerate fluids
  • If your child is having a lot of trouble breathing or catching their breath

How to prevent getting and spreading the flu

As always, frequent handwashing helps. In addition, covering your mouth with the crook of your elbow if you need to cough or sneeze will help prevent the spread of respiratory droplets that could infect others. This is a great skill for parents to teach and reinforce with their children at home. Please keep your child home from school if they are sick to help limit the spread of their illness to their classmates. If your child is feeling sick and must go out, please encourage them to wear a mask if possible. They may return to school once they are fever-free for 24 hours with improved symptoms.

The very best way to prevent getting the flu is to get your annual flu vaccination. These vaccines are available as a shot and as a nasal spray – the spray is available for children over the age of 2 without certain chronic health conditions. While children who have received their yearly influenza vaccine can still get the infection, they will often have milder symptoms than those who are not vaccinated and are less likely to require hospitalization. If you or your child have not yet received their influenza vaccine this year, please call us at (202) 966-5000 to schedule an appointment to receive their vaccine.

Remember that we are open 7 days a week and 365 days a year, including holidays and weekends. Wishing you all a safe and happy holiday season!

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FASTING LABS

You’re probably used to getting blood drawn at your yearly check up with your doctor.  We use these tests to glean all kinds of information about our patients.  Depending on the age of the patient we may check for anemia (not enough red blood cells), lead level, Vitamin D, and cholesterol.  For routine blood tests, our patients can have them done anytime regardless of if they have recently eaten.  However, sometimes we ask that our patients have fasting labs done.  How do you do them and why are they done?

Fasting labs mean that you don’t eat or drink anything besides water for 8-12 hours before coming in for your blood draw.  You can have dinner the night before but nothing to eat in the morning before coming to the office.  You can, and should, take any medications you would normally take in the morning.

Be sure to drink water – lots and lots of water!  When you are dehydrated (don’t have enough water in your body) your veins are smaller which makes it harder to draw your blood.  You also may feel light-headed if you have not had enough water to drink.  Feel free to bring a snack with you to enjoy once your blood is drawn.

Fasting labs give us a more accurate look at your cholesterol, triglycerides and glucose (blood sugar).  When you eat or drink, nutrients and ingredients enter your blood stream and can falsely elevate these tests.  A fasting test gives your doctor more accurate information about your body.

If  you are not sure if you should fast before your labs, call our office to ask.

 

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WHAT TO CONSIDER WHEN CHOOSING A PEDIATRICIAN

Calling all moms-to-be! One of the most important decisions you can make leading up to your baby’s debut is selecting a pediatrician that is a good fit for your family. Read on for tips from Dr. Jessica Long  on what to look and questions to ask when interviewing potential pediatricians.

Finding out you’re pregnant is such an exciting time!   After the initial thrill and announcing the news to friends and families, you suddenly realize there is so much you need to accomplish before this little one makes his or her debut. If you’re like me, you suddenly have a to-do list a mile long that includes practical things like buying a car seat as well as slightly neurotic endeavors like deep cleaning the floor boards of the entire house (it’s called “nesting” for a reason). One thing you definitely want to cover before your due date is choosing a pediatrician.

As both a mom and a pediatrician, I naturally have some insight into what you should look for in choosing a practice and a doctor for your baby. This is someone you will be spending a lot of time with, especially in the first year of your baby’s life, and who will get to know you and your family for decades to come. She will support you through challenging times and illnesses as well as celebrate your child’s growth and milestones. She will provide sound medical and practical advice when the internet tells you to panic, or to cure your baby’s runny nose by burning toadstools under her crib, or to put your sniffly infant on a three-week juice cleanse. The relationship between a pediatrician and her families is filled with trust, respect and caring – how do you pick someone who can provide this for you?

First off, ask around. Friends, family, and coworkers can be a great place to start before you do your own research. Make sure the physician is certified by the American Board of Pediatrics, which is in charge of training and board-certifying pediatricians across the country. You likely want a practice that is relatively close – like I said, you’ll be spending plenty of time with your pediatrician. Next, schedule a meet and greet to check out the practice and get to know the physicians there.

When you visit the office, make sure there are separate waiting areas for well children and sick children (an additional space designated for infants only is even better!). Especially for your baby’s routine first-year visits, it’s a big comfort to know that there’s an extra layer of protection between you and the teenager who got mono at soccer camp.

Besides just seeing if you “vibe” with the physician you meet, there are some important questions you’ll want to get the answers to as well. Be sure to ask what happens if your child gets sick or hurt outside of normal office hours and you need to ask a question. Is there a physician you can reach by phone or a nurse triage line? What are weekend and holiday hours? How easy is it to talk directly to your pediatrician? As a mom I can promise you your child will become ill at the least convenient time (vomiting as you get on an airplane, ear infection on Christmas morning) but knowing what aid your pediatrician can offer during those moments can be a big relief. Be sure to ask how quickly you can be scheduled for a sick visit and what wait times typically are once you’ve checked in. You already likely know what a pain it can be to wait to see a doctor – now imagine doing that with a sick child.

You probably have already thought about things such as breastfeeding and immunizations, and you want to make sure you have a supportive physician. Is lactation support available? Does she advocate for the immunization schedule recommended by the American Academy of Pediatrics and Centers for Disease Control? You don’t want any unvaccinated children in the waiting room who could expose your little one to an illness he is too young to be vaccinated against.

While you are pregnant it may seem silly to think ahead to “big kid” needs but now is the time to ask. What is the turn around time for school and camp forms and is there an additional charge? What happens if your child has to be admitted to a hospital or see a specialist – what role will your pediatrician play in those situations? How long can your child continue to see the pediatrician before graduating to an adult physician?

Perhaps most importantly, is this a physician you feel you can talk to and trust? You will, after all, be calling him in the middle of the night the first time your baby has a fever or seeking his guidance when your little one goes through a frustrating sleep strike. As a pediatrician, I greatly value the relationship I get to make with my patients and their families (it’s the best part of my job) and want to make sure they feel the same way. Doing your research before your due date allows you to find the right fit for you.

Choosing a pediatrician is ultimately a personal decision. It doesn’t matter if you have the world’s most brilliant doctor on speed dial if you don’t feel comfortable asking for and following her advice. But I hope it comes as no surprise that I think Spring Valley Pediatrics does all the big and little things right.

Whether you are newly pregnant, new to the area, or just looking for a change, we love meeting new families at Spring Valley. We are open 365 days a year so if your little one wakes up with a fever on a weekend morning or Thanksgiving Day, he can be seen. We try to be incredibly accessible to our families, offering a call in time each weekday morning where you can talk to your physician directly. After hours one of our physicians is on call 24/7 and happy to answer your urgent questions. We find that our patients and families are most comfortable when they can see the same pediatrician for all visits and strive to ensure you always see your doctor for well and sick visits. If you want to learn more and check out our office and physicians, call our office for a complimentary new patient consultation at 202-966-5000. We look forward to meeting you and your family!

 

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