Tag Archives: germs

Clean Hands, Dirty Elbows…Healthy Kids (Article)

Flu season isn’t quite over yet, which is why it is more important than ever to prevent the spread of germs.  Teaching children the importance of washing their hands and covering their coughs correctly can protect against a myriad of illnesses ranging from the common cold to whooping cough to the flu.

Experts at the Center for Disease Control and Prevention (CDC) recommend these 4 steps to help stop the spread of germs:

  • Have your children cover their noses and mouths with a tissue when they cough or sneeze, and then put used tissues in the trash can.
  • If your child doesn’t have a tissue, have her cover her cough with the inside of her elbow (not her hands, as so many of us were taught by our parents!)
  • Have your children wash their hands often with soap and warm water for 20 seconds at each washing.
  • Teach your children to use an alcohol-based hand rub if soap and water are not available.

Not only is the common cold responsible for 22 million missed school days per year, but once your child is sick, it’s only a matter of time before the rest of the family follows suit.  Washing your hands and covering your coughs are two important ways to stop the spread of germs. Remember, germs need us to move them around: they can’t walk or crawl on their own.

Habits are hard to break, so why not set good habits for both you and your children from the very beginning?  Teach your children the correct way to cough and sneeze, and make sure you do it the correct way as well.  Although they might not always listen the first time you tell them, repetition is a great teacher.  Washing your hands together is a great way to teach them how important the habit is.

Though it may not seem like much, these two tactics (that take only seconds to teach and practice) can help keep your children, your household, and your community healthy.  Your comments are welcome at www.docsmo.com. We would love to hear from you.  Until next time.

Abbie Doelger- research intern, Davidson College

Paul Smolen- Doc Smo

Sources:

http://www.cdc.gov/flu/protect/covercough.htm

http://kidshealth.org/PageManager.jsp?dn=KidsHealth&lic=1&ps=107&cat_id=128&article_set=25608

http://coldflu.about.com/od/prevention/qt/Cover-Your-Cough.htm?p=1

What’s Up with all the Children with Allergies? (Pedcast)

The news is full of articles about allergy in children.  What is happening?  Is allergy more common today and why? In today’s pedcast, Dr. Smolen gives you some of his and other physician’s thoughts on the increasing frequency of allergy in today’s world.

 

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To my new listeners, thank you.

To my seasoned listeners, welcome back.

 

I was reading the Wall Street Journal of all place and having coffee with the Mrs..

I came across a report about an article in New England Medical Journal, which points out that farm life exposes children to far more microbes and this early exposure significantly reduces a child’s chance of asthma or eczema.

This observation is a big help to researchers since they are struggling to explain the obvious increase incidence of all allergic disorders, especially in children.

The subject of allergy is a hot, hot issue in medicine and one of the important questions when it comes to children’s health: why so much allergic disease???

I am not an allergist but I am someone who deals with matters of children’s health on a daily basis and I have the perspective of time to observe changes.

I therefore feel that I may have something to contribute to the discussion.

I thought it is important to make parents aware of some research that might have practical implications to their day-to-day lives.

So, lets get started with a our discussion of allergy. Let’s review some research I found interesting, and give you The DocSmo view of the allergy epidemic of the 20th and 21st centuries in the western world.

 

Somehow our bodies know what is us, and what is foreign.

Somehow our bodies figure out how to sort out what foreign things to react to and which to ignore.

Reacting to germs is an essential part of that process.  Particularly important for children.

A strong immune system is paramount to a child’s existence.  Their very survival depends on a functioning immune response.

From the beginning of mankind, the children who survived were those who could mount a targeted, brisk immune response to invasion.  A strong and targeted immune function was essential to survival.

Fast forward to modern times, when immunizations, clean water and food etc. have eliminated most of these threats to survival.

Today most children grow up in a very clean world, very different from his or her parents just a few generations ago.

Just because the germs are mostly gone doesn’t mean their bodies have forgotten what to do!  Could the kid’s immune system simply be bored?

Maybe since children don’t have to defend against as many microbes, they are having responses to more minor irritants.

 

What we call allergy is an inappropriate immune responses to things that children should be tolerant!

These immune responses are so critical to a child’s survival 200 years ago, but are now targeting nonsense threats like peanuts and grass pollen.

 

With that as background, let’s look at the numbers when it comes to allergic diseases…food allergy,. Asthma, eczema, and allergic rhinitis (hay fever)  ESTIMATES vary widely.

Food allergy… up 400%

 

Asthma… up 1000%

Eczema ….up 300%

Hay fever …up 200 %

 

I was taught that these disorders are genetic, Either you get them or you don’t.

Certainly our genes haven’t changed radically in the past 100 years.

What is up?  Why is this happening?

Here are a few recent research studies that might shed some light on this question.

 

 

Lets go back in time a few decades when the Berlin wall in Germany was built.

One side Germans living the Western lifestyle, modern, wealthy, clean, artificial ventilation for both heat and cold, and all the other stuff that we enjoy today.

On the communist side were Germans living the lifestyle that existed in the late 19th century: dirty industry, primitive heating systems such as burning coal or wood, dirty air and water, and fairly ubiquitous poverty.

Fast-forward until the year 1989.  The wall comes down Mr. Gorbachov, tear this wall down.  Well, the people on both sides did just that.

Perfect natural experiment to look at the affect of environment on people.   Same genetic populations, living side-by-side…totally different environments.

What did researches find?  Rates of allergic disease (asthma, hay fever, eczema) were much higher on the clean side of the wall rather than the dirty.  The OPPOSITE of what you would have expected!  Maybe the West Germans were TOO clean.

 

Lets get back to that NEJM article this week. Children who are exposed to barns at an earlier age and more frequently have a significantly LOWER incidence of Asthma and eczema.

What’s going on in a barn: dirt, animal wastes and a lot of pollen, especially grass pollen.

Being exposed to dirt and germs , especially at a young age, seems to be protective when it comes to allergies.

The opposite of what was expected.

Again, maybe the city kids are too clean?

 

These observations and many others have led to what is called the Hygiene Hypothesis. A child’s immune responses and tolerance to the world are altered negatively by lack of exposure to dirt and germs early in life.

Could it be that western children are growing up in a world that is TOO clean and this is causing the rather precipitous rise in allergic disease seen especially in the past 50 years.

Maybe we are creating the problem of allergy by staying inside with artificial heat and cold so much, eating super clean water and food, sleeping on clean artificial bedding , constantly scrubbing dirt off as fast as it touches our children, our obsession with clean hands, not living with animals, and changing the natural grasses, trees and other vegetation in our constant quest to change the natural order around us.

Makes sense to me that if allergy shots can alter immune response and make us tolerant. So could natural exposure.

The answers are not in yet but we are beginning to get an understanding of the complexity of our immune system .

Stay tuned!

Question coming in;

 

Question:  Doc Smo, This is your friend Her Dieter from Germany. I have a question.  If I am hearing you right, you are saying that my little venarschnitzels are too clean, and that they need more time getting exposed to microbes, especially the kind found outside.  Is that right?

 

You got it.  Lot less allergic disease in those children who slop them pigs, shuck some corn, and spend time on the old farm.  The same is probably true for any child who spends a lot of time outside.

 

Question:  How do the experts feel about dogs and cats in the house.  Do they help or hurt allergic children?

 

Good question.  From my reading the answer is both.  Exposure to furry creatures like dogs and cats in the house in the first year of life seems to diminish the chance that a child will develop asthma.  On the other hand, exposure to animals such as dogs and cats in older, already allergic children often makes their allergic symptoms much worse.   I know that answer is as clear as mud but that’s the best I have.

 

Question:  Is the same thing true for food allergy?  I thought early exposure was bad! Is there a way to keep my little snitzels from being allergic to certain food?

 

That is a subject for an entirely different Pedcast but let’s just say that avoiding early exposure to very allergenic foods have not reduce the incidence of food allergy.

The truth is, We just don’t know the best age to introduce allergenic foods

We do know that breastfeeding reduces allergic disease especially eczema

(In fact, in another natural experiment with peanut exposure…conclusion was early exposure is preferable!)

 

Summary- “When it comes to Allergy”

Early experiences change the way our immune system develops.

New research indicates that early exposure to a variety and high quantity of germs lessens the chance of allergic disease, if the exposure is done early!

-Growing up in a too clean environment may harm a child’s health.

Her are some steps parents can take that might help reduce allergic disease in their children.

Breastfeeding as long as possible.

Get your children outside as often as you can.

Turn of the A/C and heat whenever possible and open those windows.

Hand hygiene is really important when your children are spending lots of indoor time with other kids but not when they are at the park. Outdoor dirt won’t hurt.  Calm down about outside dirt.

When it comes to allergy, furry pets in the house seem to be harmful to older already allergic children but may, and I emphasis may actually be of benefit to very young non-allergic children.

Allergies are probably similar to other biologic phenomena—a complex interaction of genetics and environment.  Back to that nature /nuture question-again

 

Hope you enjoyed that discussion

Please feel free to make comments on iTunes or Face book are welcome

Invite your friends to subscribe.

If you are a medical professional and would like to send comments-highlight on blog

More reading can be found in SmoNotes

 

Dr Paul Smolen, broadcasting from studio 1 E, Queen City, Charlotte, NC

Hoping your children get just the right amount of dirt on their toes and pollen in their nose

 

 

Until next time.

SmoNotes:

1.

NICOLAI, T.. “Epidemiology of Pollution-induced Airway Disease: Urban/rural Differences in East and West Germany.”
Allergy : European Journal of Allergy and Clinical Immunology 52.38 (1997): 26-29. Web. 10 Mar. 2011.
<http://onlinelibrary.wiley.com/doi/10.1111/j.1398-9995.1997.tb04866.x/abstract>.

2.

Ring, J. et al “Environmental Risk Factors for Respiratory and Skin Atopy: Results from Epidemiological Studies in Former East and West Germany.” International Archives of Allergy and Immunology 118.2-4 (1999): 403-407. Web. 10 Mar. 2011. <

3.

Bacharier, Leonard B., and Robert C. Strunk “Pets and Childhood Asthma—How Should the Pediatrician Respond to New Information That Pets May Prevent Asthma?” Official Journal of the American Academy of Pediatrics 112.4 (2003): 974-976. Web. 10 Mar. 2011. <http://pediatrics.aappublications.org/cgi/content/full/112/4/974>.

4.

Wang, Shirley S. “Greater Germ Exposure Cuts Asthma Risk.” Wall Street Journal 23 Feb. 2011: 1A. Web. 10 Mar. 2011 <

5.

Greer, Frank R., Scott H. Sicherer, and Wesley Burks “Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Timing of Introduction of Complementary Foods, and Hydrolyzed Formulas.” American Academy of Pediatrics 121.1 (2008): 183-191. Web. 10 Mar. 2011. <

6.

Toit, G. et al “Different Prevalence of Peanut Allergy in Children in Israel and UK Is Not due to Differences in Atopy.” Allergy and Clinical Immunology 117.2 (2006): S33. Web. 10 Mar. 2011. <http://www.jacionline.org/article/S0091-6749(05)02857-5/fulltext>.

7.

Ege, Markus J. et al “Exposure to Environmental Microorganisms and Childhood Asthma.” New England Journal of Medicine364.1 (2011): 701-709. Web. 10 Mar. 2011. <http://www.nejm.org/doi/full/10.1056/NEJMoa1007302>.

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Understanding Your Child’s Ear Infections Step by Step (Pedcast)

Ear infections, or otitis media, are a painful part of childhood. Understanding the biology behind the development of ear infections can help parents see the warning signs and take preventative measures. Thus, in this pedcast, Doc Smo walks you through the stages of ear infections and provides listeners with ways to help prevent them.

Transcript:

 

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By some estimates, 40% of visits to pediatricians are for ear infections.

Most children have otitis before the age of 2 years.

I Thought today, we would talk about why children get them, should they be treated, and can they be prevented?

Parents have these questions all the time.

So lets get started with our discussion with a trip down, you know where, science lane.

 

There are loads of germs in our nose that can cause ear and sinus infections…all the time!  That’s right, sinus and ear infections are usually an overgrowth of germs we already carry.

So why don’t we have ear infections all the time?

To understand the answer to that question, need to know how our noses work.  That’s right, our noses.

Remember the structures that are attached to our noses, our sinuses in every direction around our nose, our ears through the Eustachian tubes, our eyes up through the lacrimal ducts, and our throat pulling up the rear.  

Normally every time we take a breath through our nose, we put fresh air into our sinuses and ears. If our noses are working properly, each breath opens the windows and lets in fresh air into our sinuses and ears and at the same time equalizing the pressure with the ambient pressure around us.

In addition, the cells that line our nose, sinuses and ears secrete a steady trickle of mucous that is kept moving by our cilia, little brooms that constantly sweep the mucous into our throats.  A gentle river of mucous flows through our noses, sinuses, ears and bronchioles all the time cleaning and moving away dirt and germs away from our healthy respiratory system.

The combination of moving mucous and fresh air keeps germs from ganging up on us.

 

Now think of a child, especially a baby.  A cold means a swollen nasal passage without air moving and loads of extra mucous. Babies don’t blow their noses, remember! This is the recipe for a sinus and ear infection.

Stagnant mucous in airless places.

Here is the sequence of events:

Virus attaches itself to the nasal membrane causing swelling lining cells.  The medical jargon for this is apoptosis or swelling of cells.  We can feel that at the beginning of a cold.

The children’s tiny sinus and ear Ostia become obstructed from airflow causing a VACUUM to form in the ears and sinuses.

Your body doesn’t like a vacuum and fills up these spaces with mucous (when your child’s doctor says, fluid in ear…this stage).

Remember that bacteria in the nose, now it has warm, sugary pockets of stagnant fluid to grow in and BAM, a hot ear infection.

Since bacteria grow so fast, it can be only a matter of hours between fluid in the ear and a raging infection.

The body’s natural defenses, moving mucous and fresh air are not there to keep the germs from taking over.

Children who carry the allergy gene have all the same events occur but the swelling inside their noses is from both dust and pollen allergy and viral infections.  These children are especially prone to ear infections.

So what’s the perfect storm for ear infections?

Under 2 years of age….Promotes…Small nose and no blowing.

Remember this Doc Smo pearl, “Rivers that don’t flow are nasty!”

Being in an environment where infection with respiratory viruses is frequent…..  Being around a lot of other young children.

Remember this Doc Smo pearl…. “Infectious diseases are contagious!”

 

Being a child with eczema, food allergy, or recurrent wheezing…  having the allergy gene which means lots of swelling in the nose and loaded with mucous.

 

If your child is prone to ear and sinus infections…practical tips that might help.

 

1. Avoid crowds of children to play with especially when they are very young and put things in their mouths.  Touch is the method of spread.

2. Be especially careful with group care if your child exhibits signs of allergy.

3. Play with other children outside whenever possible, even when it is cold.  Unlikely to transfer germs outside.

4.Unless your child has clear allergy, Avoid cold medicines with antihistamines, which can make nasal mucous thicker… poor flow means more infections.

5. If your young child has loads of otitis media, try a milk free diet for 2-4 weeks to see if it helps.

6. Hose those little noses with saline a lot… water is a natural cleaner.  Use it!

7. Try and avoid treating ear infections in children older than 2, after your child can talk.  More on this subject listen to “Bugs and Drugs”

 

 

That wraps up todays “Pedcast” Thank you for listening.  I hope your understanding of ear infections is better now.

If you enjoyed this talk, try some other DocSmo episodes which you can find at my website, DocSmo.com, at my face book page or on ITunes.

Comments are welcome.

 

This is Dr. Paul Smolen.

Recording in full digital sound from studio 1E in Charlotte, NC.

Wishing your children noses full of warm breezes and years without sneezes

 

Until next time
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Going Public with Your Newborn, How and When! (Pedcast)

Doc Smo here. Thanks for joining me today. One of the most frequently asked questions that I get in the newborn nursery is, “When can I take my newborn to church, when can I take my baby to the mall, and when can I have my friends over?” Well you will find varying opinions on this subject and the truth is that there is no science behind any of this. I don’t believe that there is a right answer to this question. Different cultures have developed different norms. For instance in traditional Greek society, I am told that babies are isolated from public exposure for the first 60 days of life and in traditional Japanese culture, the isolation period is one year. To my knowledge, the Academy of Pediatrics does not have policy regarding this subject so I thought we would take a little time to explore the subject of when should newborns venture into public places. Continue reading