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.

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!

The Common Cold

Dr Shawn Binns, MD, helps us navigate this runny nose time of year.

It’s back to school season once again, and we all know what that means – a return of those all-too-familiar coughs, sniffles, and sneezes. That’s right, cold and flu season is upon us once again.

The common cold is a viral illness that is associated with varying amounts of cough, congestion, sore throat, fevers, headaches, decreased appetite, and fatigue. It is not caused by just one type of virus – rather by many different viruses including rhinoviruses, adenoviruses, enteroviruses, and parainfluenza viruses. RSV is also a common cold virus, though may cause more significant symptoms in infants and young toddlers. Influenza viruses tend to cause a more abrupt onset of symptoms, higher fevers (102-104F), body aches, and more of an upset stomach than the common cold does. I’ll mainly focus on the common cold today, but check back later this season for more information on the flu.

How do you get it?

Cold viruses are usually transmitted via droplets that spread from a cough or sneeze of an infected person or from touching a virus-contaminated surface and then touching our nose or eyes – no wonder they’re so easy to catch!

It is entirely normal for your child to have around 6-8 colds every year, possibly even more if your child has recently started daycare or preschool. While this can mean a seemingly endless stream of sniffles and coughs those first few months, know that children who previously attended daycare or preschool tend to have fewer colds during school-age due to having built up prior immunity from all the bugs they had as toddlers.

How can we treat the common cold?

So I have both bad news and good news for you – the bad news is that there is no treatment that will immediately treat your child’s underlying virus. This means we don’t have silver bullet meds like antibiotics that we use to treat bacterial infections. The good news is that our bodies already have all the tools it needs to fight off these nasty bugs, and there are even some things you can do to help:

Hydration, hydration, hydration
– Keeping your child well-nourished will help their body stay in the fight against these viruses. Your body will need even more nutrition, especially from fluids, to help keep the virus at bay and eventually overcome it. Make sure your child is drinking plenty of fluids and urinating regularly. Continue to offer food regularly, but don’t be shocked if your child’s appetite is less than usual while they are sick – their appetite should come back in full force once they recover.

Tylenol and Ibuprofen
– Fevers are a normal and healthy response by your body – they help to keep the viruses from continuing to replicate and spread throughout your body and give your immune system a chance to catch up and eventually win the battle. Despite these benefits, fevers can make your child feel pretty crummy, and make them breathe harder and faster while decreasing their appetite and energy levels. You can help them feel better by giving Tylenol or Ibuprofen (AKA Motrin, Advil) for comfort. Ibuprofen should not be given to infants under 6 months of age. Please see our table at https://springvalleypediatrics.net/medication/ for weight-based dosing recommendations.

Is there anything I can do about that stubborn cough, stuffy nose, or sore throat?
– In fact, there is! Warm fluids, such as tea or soup, can help 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). For infants, you can use nasal saline drops – apply several drops to each nostril and suck out those pesky boogers with a NoseFrida.

– There are also numerous over-the-counter cough and cold medicines – too many to fully discuss here. Many of these medications may not be very helpful or may even have unwanted side effects. Please call your pediatrician if you have questions regarding these medications.

When should we be concerned that this is more than just a cold?

Most common colds resolve after about 5-7 days, though it is common for a cough to linger for a bit longer than that. If the other symptoms are resolving and the cough is steadily improving, this is not necessarily a concern and can be monitored at home. If the cough lasts for more than 2 weeks or does not seem to be improving, please follow up with your child’s pediatrician.

Fevers due to a common cold generally only last up to 3-4 days. You should call your pediatrician if your child has a fever for more than 3 days in a row without any sign of improving, especially if accompanied by a persistent sore throat or cough. If your child is under 3 months old and has a rectal temperature of 100.4F or higher, you should call your pediatrician immediately as this can be a sign of a more serious illness and may require evaluation in the emergency room.

Other reasons to contact your child’s pediatrician include if your child is working hard to breathe, if their symptoms initially improve but worsen again within a few days, if they develop a brand-new fever or ear pain several days into their illness, or if symptoms persist without improvement for more than 1 week.

How can we prevent spreading these germs to others?

The best methods for preventing the spread of these cold viruses are the tried and true – frequent handwashing/use of hand sanitizer and avoiding frequent touching of your face. Sneezing or coughing into a tissue or into the crook of your elbow will help to limit the number of respiratory droplets spread into the air and thus, decrease the risk of transmission.

If your child is experiencing viral symptoms and must go out, please encourage them to wear a mask to help prevent spread. Once your child has been fever-free for 24 hours with improving symptoms, they may return to school unless otherwise specified by your pediatrician.

And as always, get your yearly flu vaccines.

RSV and the new vaccine

Dr. Sexter in The New England Journal of Medicine

Dr. Sexter’s work on the COVID-19 vaccine in children under the age of 5 years old has been published in The New England Journal of Medicine.  Check out this link to read the article.

Spring Valley Pediatrics in the News

We are always honored to speak out on behalf of our patients and medicine.

Dr. Sexter got to talk to WUSA9 about the COVID-19 vaccine trial for kids.  Click here to hear her interview and read more!

Dr. Long spoke with ABC Australia about the COVID-19 vaccine for children 5-11 years old.  Click here to watch her interview or read the article.

Dr. Sexter on WUSA9

Dr. Sexter got to talk to WUSA9 about the COVID-19 vaccine trial for kids.  Click here to hear her interview and read more!

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.

 

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!

 

Babies and Spit Up – When to See the Pediatrician

For many first-time parents, baby spit up can be a bit terrifying. There is a very fine line between what is “normal” and when you should seek help from your pediatrician.  Dr. Jessica Long helps to clear up some common spit up misconceptions…

When I found out I was pregnant with my first daughter, I daydreamed about lazy mornings cuddling with her, taking long walks together through our neighborhood, introducing her to all of my favorite childhood spots in DC, and of course all of the adorable clothes. What did not play a starring role in my motherhood fantasy was the amount of spit up that would end up on her, me, my husband, the dog, and really anything within a four foot diameter after she ate. Her spitting caused her no distress and certainly did not slow down her impressive weight gain but wow did it lead to a lot of laundry.

Spit up is an incredibly common baby phenomenon. In fact, more than half of babies younger than 3 months old spit up daily. For most babies, gastroesopahgeal reflux (GER) is a natural occurrence that, while annoying, causes no health problems and improves with time.   However, in some babies it may cause complications – in which case we call it GERD (gastroesophageal reflux disease) – and requires evaluation by your pediatrician.

For all of those parents out there with “happy spitters” who smile while you grab your tenth burp cloth of the morning, there are thankfully some simple things you can do to help reduce the amount of curdled milk you are scrubbing off the sofa.

First off, there’s only so much room in that tiny baby belly and if it gets overfilled with milk there is nowhere for it to go but out. Do your best to not overfeed your baby. Also, try to minimize gas in your baby’s belly so that, as a gas bubble escapes, it doesn’t bring up half the meal as well. Some babies need to take burp breaks in the middle of their feeding as well as at the end in order to not have a wet burp down your back shortly after eating.

While tummy time is important for motor development and can help to relieve gas, it is best to avoid it right after feeding. That extra pressure on the stomach is more likely to send its contents all over the living room rug. Holding your baby upright for 20-30 minutes after eating also helps to keep everything in her stomach right where it belongs.

Still spending more time with the laundry machine than enjoying that sweet social smile of your baby? It is important to have regular follow up with your pediatrician to ensure that gastroesophageal disease is ruled out. Talk with your pediatrician to see if diet changes would be helpful. Some breastfed babies may be sensitive to dairy or egg and having mom avoid these foods could cut down on spit ups. Similarly, a formula fed baby might prefer a hydrolyzed formula. Adding a small amount of oatmeal to bottle feedings has also been shown to help reduce the amount of spit up. However, chat with your baby’s doctor before altering anyone’s diet.

With spit up, time is the best remedy. As your child grows, spitting up will be less of an issue and your little one will be on to new and exciting problems such as desperately wanting to play with electrical outlets and finding every choking hazard accidentally left around your house. Parenthood is a journey and spit ups will soon be a distant memory. The overabundance of laundry in your home will unfortunately be an ongoing problem.