Tag Archives: AZAAP

Lack of sleep may be associated with obesity

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Top eight myths about childhood vaccines

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Arizona hospitals ramp up quality pediatric emergency care

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Autism research: right here in Arizona

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Urinary tract infections: Can you tell by the smell?

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Reacting to an autism diagnosis: what’s next?

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Understanding pediatric sudden cardiac arrest (SCA)

Would you recognize the warning signs of pediatric sudden cardiac arrest (SCA)? If not treated in minutes, SCA can result in death.

In a new policy statement to be published online on Monday, March 26, the American Academy of Pediatrics (AAP) provides guidance for pediatricians on underlying cardiac conditions that may predispose children to SCA.

Although the risk for SCA increases when children with underlying cardiac disorders participate in athletics, SCA can occur at very young ages and also when a child is at rest.

Research supports the need for a SCA registry, says the AAP. A registry would help experts gain a better understanding of the nuances of the condition.

Plus, many cardiac disorders are known to be genetic, so the evaluation of family members, even if asymptomatic, could be a critical step in the overall diagnosis of disorders predisposing to pediatric and young adult SCA.

We asked Arizona Pediatric Cardiology Consultants (APCC), members of the Arizona Chapter of the American Academy of Pediatrics, to weigh in on what parents need to know about SCA.

How common is SCA?  

According to the Centers for Disease Control, each year 2,000 individuals less than 25 years of age will die suddenly with the majority of these having a cardiac etiology.

What causes SCA?

Pediatric sudden cardiac arrest and sudden cardiac death can occur with various types of cardiac causes, including conditions in the heart muscle (such as hypertrophic cardiomyopathy), unusual positioning of a coronary artery, or an electrical disturbance within the heart. (Long QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia).

More on genetic cardiac conditions from the Sudden Arrhythmia Death Syndrome Foundation (SADS)

How are family members evaluated, and what symptoms may be indicators that a child is pre-disposed to this? 

Signs that may suggest an increased risk for SCD include fainting or seizure with exercise, excitement, or startle, significant dizziness with exertion, unusual and consistent shortness of breath or chest pain with exercise.

If a family member has died suddenly or unexpectedly at a young age, has unexplained seizure disorder, died at a young age from a heart problem, or has a history of fainting, then screening is appropriate.

How do doctors determine if a child is at risk? What tests are performed?

Evaluation by a pediatric cardiologist will include a thorough individual and family history, ECG, physical exam and perhaps an echocardiogram, an exercise stress test, and genetic testing if necessary.

Would automatic external defibrillators (AED) on playing fields and in schools help?

A great majority of these deaths relate to a life-threatening arrhythmia, ventricular fibrillation. CPR and use of an AED may be life saving.  AEDs are often found in airports, casinos, and government buildings.

However, there is no law in Arizona currently requiring AED within schools, recreational sports fields, or other private facilities.

Are efforts being made to increase the availability of AEDs?

The decision about whether to have an AED on location is left up to the individual organization.  APCC’s electrophysiologists are making an effort to educate schools, sports organizations, and families regarding the importance preparation to prevent SCD.

The role of an ECG in all sports physicals remains a debated topic within the United States.  It is, however, very important to ask specific questions (use the attached screening tool) for risk factors and then refer to a pediatric cardiologist for further assessment.

What should parents or caregivers do if they believe a child might be at risk?

Once an individual is identified as having any of the conditions listed above, it is very important for first degree relatives to also be evaluated by a pediatric cardiologist even if they are not experiencing symptoms.

Sudden Cardiac Death is devastating to not only the families of those affected but to the communities in which they live.  Educating  families, schools, sports leagues, and primary care providers about quick and effective screening for children at risk for SCD is a first step in prevention.

Increased community awareness and the availability of AEDs in schools and sporting venues will help avert a tragedy.

Karen S. Eynon, RN, MSN, CPNP, MATS,  compiled these answers with support from Mitchell Cohen, MD, Andrew Papez, MD, and Jennifer Shaffer, RN, MS, CPNP, all of Arizona Pediatric Cardiology Consultants along with information from SADS.org.  

Check with your child’s physician if you are concerned about risks for SCA.

More from Parent Heart Watch, a network of parents and partners dedicated to reducing the effects of SCA.

 

Breastfeeding and the milk supply over time

As a work-outside-the-home mom, Laurie Jones, MD, IBCLC, a pediatrician and lactation consultant at St. Joseph’s Hospital and Medical Center, says she’s faced plenty of her own breastfeeding challenges. “I know all the pitfalls and traps that you can fall into that prevent mothers from reaching their goals.”

But Jones, an AzAAPmember, says she’s learned to put her own milk supply, Continue reading

An increase in synthetic marijuana use among teens

Synthetic versions of marijuana are sending some teens to the hospital, says a case report to be released in the April issue of Pediatrics.

The drugs, created in uncontrolled settings and sold in gas stations and convenience stores, consist of herbs sprayed with chemicals that mimic the

Courtesy DrugFreeAZ.org

psychoactive properties of THC, Continue reading

Breastfeeding: debunking that “not enough milk” myth

Human babies have survived on their mother’s milk for millions of years, just like all other mammals, says Laurie Jones, MD, IBCLC. And a woman’s ability to make milk and nourish her baby is not based on a fragile system.

The majority of mothers are quite capable of feeding their young.  In fact, Jones says that 95 to 99 percent of mothers make enough milk for their baby.

Well check: Dr. Laurie Jones and one-month-old Sophia Gulbis and her mom, Stephanie Gulbis

When it comes to feeding a new baby, there were no other options but breastfeeding  until the relatively recent past. “We all forget that, says Jones, an AzAAP chapter member who practices at St. Joseph’s Hospital and Medical Center.

But today, says Jones, many mothers believe that when they have a baby, they won’t be able to make enough milk. “So many of their friends or family have planted the seeds of doubt.”

Modern hospital practices tend to inhibit built-in mechanisms for bountiful milk production, says Jones. “New mothers are bombarded with advertising for formula ‘supplements,’ and their doctor or hospital may give them free formula samples ‘just in case.’”

More on how Arizona hospitals are helping new moms to meet breastfeeding goals

And that perpetuates the myth that they won’t make enough.  “Our modern culture, beliefs, medical practices, and artificial substitutes have given rise to a false epidemic of not enough milk.”

Baby Sophia has been exclusively breast-fed since birth and now weighs 10 lbs.

It’s a combination of factors that lead a mother to begin feeding both breast and formula in the first days and weeks after her baby is born, says Jones, and that’s what leads to a reduced milk supply.

“That’s the number one reason mothers stop breastfeeding and do not reach the recommended 12 months,” says Jones. “It’s because of perceived — or real –low milk supply.”

What works

In the first few weeks when the mother’s body is figuring out how much milk to make, it is critical that she is given unrestricted access to her baby with no rules or limits on feeding.

“Many parents mistake a newborn’s constant need to suck as a sign of being underfed,” she says. “But babies are programmed to suckle frequently to bring in a mother’s full milk production.”

Dr. Jones examines Sophia's mouth and palate.

Babies have long been wired that way — because it ensures a safe, close proximity to their mothers. The amount of suckling in the first 5 days is a predictor of the supply for the following six months.  Anything that stands in the way of this natural regulation will prevent a mother from exclusively breastfeeding.

Jones, a pediatrician who is also an International Board Certified Lactation Consultant, helps educate medical professionals on how critical the first few days after birth can be for a new mother to get off on to a good start in establishing her milk supply.

From the moment the baby is born, says Jones, the only thing a new mom needs to do is be close to the baby to allow the mother-baby dance to unfold. Milk production will increase dramatically around the third day post partum.

More on skin-to-skin contact

It sounds simple, and natural, keeping a new mother and her baby close, those first few days right after birth.

But that’s not always what happens for women who deliver in the hospital. Jones points to research showing that on the very first day after birth — post-partum day one –there are an average of 54 interruptions to a mother’s hospital room, with each interruption averaging 17 minutes in length.

Jones sees women start giving formula in the hospital after their baby is born because they think they don’t have enough milk right after delivery. That’s not true, says Jones.

Facts on milk supply from Dr. Jones:  

  •  A woman only needs ONE breast to feed ONE baby. Expectant women begin making milk around 16 weeks in to a pregnancy.
  •  The baby’s stomach can hold about 7 to 15 milliliters comfortably in the first day of life.
  • The average volume of a feeding is 7 to 10 milliliters – about a teaspoon and a half.

    A spoonful of milk is about 7 milliliters

    “It’s amazing how nature delivers the perfect amount to the baby,”  says Jones.

When mother and baby are kept in direct contact with minimal interruptions, the baby will nurse frequently.  A minimum number of feedings is about 8 to 12 per 24 hours.  

  •  How do you know the baby is getting enough? Count wet (W) and stool (S) diapers:  Day 1 (1W, 1S), day 2 (2W, 2S), day 3 (3W, 3S), day 4 (4W, 4S), and day 5 to one month — about 6 to 8 of each.
  •  Pacifiers can steal time at the breast and lower milk supply when used in the first two weeks, too.
  •  Topping off with formula after breastfeeding will decrease a mother’s milk supply, and no formula should be given to a breastfeeding infant without a true medical indication and for a short therapeutic intervention.
  • If the baby won’t latch onto the breast for some reason in the first days after birth, the simplest fastest option is to hand express the milk in the mother’s breast and feed it to the baby on a spoon.
  • Pumps cannot get the colostrum milk out as easily as a mother can by hand, and there is a lot of set up and cleaning and time distraction involved in pumping.
  • Bottles of pumped milk should be avoided in the first 3 to 4 weeks when the fast flow of the bottle can create breast refusal.

More breastfeeding facts from Dr. Jones: Size doesn’t matter

  1. Women with small and large breasts make the same volume of milk per day.
  2. The rare 1 to 5% of mothers with true insufficient glandular tissue (IGT) who cannot make an exclusive milk supply should have a full medical evaluation before they are given that diagnosis.
  3.  The condition would not become apparent until a few weeks after the baby is born, and the infant is exclusively breastfed with inadequate growth.
  4.  Low milk supply is a medical condition that should be evaluated by a team,

Baby Sophia was treated for tongue-tie in the first few days after birth, which helped Stephanie to meet her breastfeeding goals.

including the mother’s obstetrician, baby’s physician, and an IBCLC.   There are maternal hormonal causes of a reduced supply, and some infant conditions, like tongue-tie, that can reduce supply.

Many of these issues can be reversed with the right information and support, and even those rare women with IGT can provide 100% at breast feeds with a combination of their own milk and supplementer tubing-fed donor milk or formula.

You can’t see it…but it’s there!

There’s a misperception that a mother should produce more milk over time, says Jones. But studies show that the milk supply is pretty much the same from month one to month twelve. Jones says that is “shocking to most people who are used to seeing bottle-fed babies take higher and higher volumes over time.”

But the same volume of milk grows a human baby beautifully from month one to month twelve for two reasons: (1) the fat and calorie content of human milk changes from day to day and month to month and (2) breastmilk-fed infants burn fewer calories per day than formula-fed infants.

What to ask a prospective pediatrician about breastfeeding

Drinking cow’s milk formula is an inefficient process that makes an infant require more volume over time, and the caloric content of formula is the same every day of the infant’s life.

Breastfeeding is an elegant, mother-baby biological connection, says Jones, yet several barriers today stand to put a wrench in a system that has nurtured humans throughout history.

“Mothers doubt their own bodies, doctors unnecessarily supplement, hospitals separate mother from baby for convenience, pacifiers are given to quiet the baby, culture dictates a baby be on a schedule, insurance won’t pay for lactation support after hospital discharge.”

There are many forces that attempt to undermine an essential biological process, says Jones, “but a mother with the commitment to breastfeed can overcome all these barriers with the right information and support.”