Child Health News June 2017 (Pedcast)

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Introduction:

From gestation to graduation, if it involves kids, you’ve tuned into the right place. I’m your host, Doc Smo, a board certified pediatrician with 35 years of experience and a whole lot to say. It’s been a while since I have done a child health news update and there has been some very interesting stuff coming down the pipe recently. My journals have actually had some new studies that I thought you might be interested to hear about. Today, I thought I would bring my listeners some of this interesting new research and throw some ideas at you that might improve both your knowledge and just maybe, your children’s health.   What are the experts thinking about and which child health issues are getting attention in the world of pediatrics?  Stay tuned to find out. You don’t want to miss today’s post, so warm up your mp3 player, turn up the volume of those buds, and get ready for the next edition of Portable Practical Pediatrics.

Musical introduction

Study #1- The Continuing Saga of Fruit Juice

Fruit juice has gotten a bad reputation in the U.S. despite its heavy marketing by the fruit juice industry. It is considered a sugary drink that many researchers believe is at ground zero of the obesity epidemic in the U.S.  I’ve been preaching about the evils of fruit juice for years. I have been telling my patients and their families that eating fruit is healthy and great, but concentrating the sugar from fruit into juice and separating the sugar contained in the fruits from the fiber of the fruit is quite harmful. Fruit juice, I would tell them, contains way more sugar than eating the whole fruit since multiple pieces of fruit needed to be used to make one cup of fruit juice. The juice contains the sugar of many pieces of fruit! That was my story until April 2017, when, to my surprise, I opened my journal from the Academy of Pediatrics and see a meta analysis (that’s a retrospective look at many studies combined) that concluded that fruit juice, in moderation, after a child’s first birthday, that is not consumed in excess of six ounces/day, that is pasteurized, and not used as a frequent hydration source that could lead to dental decay, may not be harmful to a child’s health.  Now, my eyes are falling out of my head when I read that 100% fruit juice may actually be considered a health enhancement in a child’s diet, serving as a source of real fruit. This is heresy I say! This is way afield of the pediatric playbook!  I remember all the studies in the 1980’s that showed malnutrition in toddlers consuming apple juice, albeit excessive quantities of apple juice. Have these authors forgotten about the pesticide Alar in apples that sent public health officials into cataclysmic spasms?  Could apple juice actually be a healthy food??? First, there was a study that showed that diluted apple juice is actually better at preventing dehydration in children with diarrhea than scientifically formulated rehydration drinks ***.   Now fruit juice is considered a healthy nutrient!  What planet am I on? Could the manufacturers of fruit juice actually have been right all these years? The debate continues so stay tuned- time will tell us.

Study #2- Does Today’s Whooping Cough Vaccine (Tdap) Effectively Prevent Whooping Cough?

Followers of Portable Practical Pediatrics will be familiar with this important topic. I have done many posts on the subject in the past. *** It has becoming obvious to researchers who do vaccine research that the conjugated whooping cough vaccine that we currently use called Tdap is not protecting today’s children the way the older whole cell vaccine did. This fact has been graphically demonstrated in a new study from Kaiser Permanente published in March of 2017. From their data, they found that the effectiveness of the Tdap vaccine in 10 year olds who received it was between 60-76% in the first year and rapidly fell to 9% effective by the fourth year. Recall, that older children only get one of these vaccines every 10 years after their 10th birthday. That means that for 6 of the 10 years after their Tdap vaccine, they are at high risk of carrying and spreading the whooping cough bacteria. If they spread this to an infant who is not vaccinated, the result is devastating, something that is too horrible to contemplate. If you want to see what whooping cough can do to an infant, click the link on my post but I warn you, it is upsetting. ***  So you are probably asking, why not go back to the older whole cell vaccine that seemed to work. Well, we don’t because it has too many high fever and severe local reactions to use. It’s time for the CDC and the other infectious disease experts to come up with a new strategy to contain this horrible disease. Now don’t construe that Doc Smo is telling you not to get the Tdap vaccine for your kids–I am not. I’m simply letting you know that some changes will be coming. Stay tuned.

Study #3- How are we doing at Eliminating Human papilloma Infections in Girls and Women?

I hope all my listeners have heard about the HPV vaccine that was approved in the US in 2005. It was the first cancer prevention vaccine ever licensed. It was first approved for use in adolescent girls and young women up to the age of 26 years and in 2012, approved for use in boys as well.  So how is it working at eliminating human papilloma infections you ask?  Well, a study published in March 2016 gives us an answer and the answer is… it works very well. Overall, the prevalence of HPV infections of the oncogenic strains has fallen by 64% among the girls 14-19 years of age. Today, unvaccinated teenage girls have a 17% chance of being infected with a cancer causing HPV strain. If she had been vaccinated with at least one dose of vaccine, her risk drops to 2%. So, does the vaccine work-definitely. Are today’s children at risk of getting infected–unfortunately yes. Should you seriously consider getting your children vaccinated–definitely. I get a lot of parents who ask me why does a child need to get the HPV vaccine so young, they are not sexually active and not at risk?  Well, that is true, but that will change at some point and the vaccine only works pre exposure.  If a 11-13 year old gets the vaccine, we know they will get the full benefit of the vaccine since we know, they have not had exposure to human papilloma viruses. That’s the reason in a nutshell. If you are going to all the effort and expense of getting the vaccine, you might as well get the full benefits. Additionally, the CDC has determined that two instead of three doses are needed if a child completes the series by age 15. Fewer shots are nice, don’t you think?

Study #4- Do Children with Acute Appendicitis Always Need Surgery?

The final study that caught my eye was a study that looked at an alternative to surgery for children with an acute appendicitis. You heard me right, a child who has a condition that is synonymous with emergency surgery, who is successfully treated instead with IV antibiotics to calm their infected appendix down. The authors concluded that the “medical-non surgical” approach to a child who is sick with an appendicitis, in some cases, is both effective and safe. I’ll never forget one of our fine local pediatric surgeons telling families who had a child with an acute appendicitis that if their child didn’t have an appendectomy soon and the appendix ruptured, that their child could develop scarring in their abdomen and potentially have a life long illness. Certainly taking the child’s appendix out have solved their problem but little did this wise surgeon know that maybe some IV antibiotics and tincture of time would have also done the trick.

Conclusion

Well, that’s it for this installment of Portable Practical Pediatrics. If you enjoy learning about child health with pedcasts, please take a moment to leave a review on iTunes and subscribe to my blog at www.docsmo.com. Your email address will only be used to let you know of new content…nothing else. I promise. This is Dr. Paul Smolen, recording this post in studio 1E, trying hard to make news about child health, anything but stealth. Until next time.

 

Smo Notes:

Fruit Juice and Health Studies

http://pediatrics.aappublications.org/content/early/2017/03/21/peds.2016-2454

http://pediatrics.aappublications.org/content/early/2017/03/21/peds.2017-0041..info

Whooping Cough Vaccine Not very effective

http://pediatrics.aappublications.org/content/pediatrics/early/2016/02/03/peds.2015-3326.full.pdf

Is HP Vaccine Effective?

http://pediatrics.aappublications.org/content/early/2016/02/19/peds.2015-1968

Non-operative treatment of Acute Appendicitis

http://pediatrics.aappublications.org/content/early/2017/02/15/peds.2016-3003

 

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