May 07, 2010

 

 

CONVENIENCE CLINICS
We are aware that convenience clinics are marketing themselves as a safe, easy way to obtain quick medical care; they imply that obtaining treatment for you or your child is as simple as a trip to the drugstore, but that not accurate.
These clinics do not have the endorsement of any established medical body. They are staffed by minimally supervised nurse practitioners with variable pediatric and adult medical training. They are not available after hours or for follow-up. They have no hospital privileges. They may be “quick”, but the discontinuous, sporadic care they offer is contrary to recommendations of virtually every medical board and academy; we do not support the concept or participate in their activities.
The Board Certified Pediatricians and Internists at Plaza Family Care constantly update our skills to keep pace with medical advances. We have regular evening, weekend, and holiday hours. We are available 24/7/365. Our Pediatricians are on staff at the finest children’s hospital in the area.
We believe you and your children are individual patients not commodities in the aisle behind cosmetics and magazines, and we look forward to providing you with the best medical care possible.

Allen Menkin, MD, MS, FAAP, Patrick A. Caruso, MD, FAAP, Adam M. Dick, MD, FAAP, Kristen Walsh, MD, FAAP, Jimmy Chang, MD, Lillian Theune, DO, Dana Brahms, MD, Melissa Libert, DO, FAAP

 

 

June 28, 2010

 

Vaccine/Immunization Policy
The Pediatricians at Plaza Family Care are troubled by widespread, unfounded, media driven fears about vaccine safety. Childhood vaccination is one of the greatest success stories of modern medicine. Safe and effective immunization has resulted in the virtual elimination of many serious childhood diseases in this country. We have long ago forgotten what it was like to see a child with polio relegated to life in an iron lung, or to know a youngster made blind, deaf, and vegetative by bacterial meningitis. Hundreds of millions of children have grown to healthy and productive adulthood because of vaccines. And we now have two vaccines that prevent cancer.

 

This has not been the universal experience. In the developing world a quarter of a million children die of measles every year, and many more are left with permanent brain damage. Bacterial meningitis and soft-tissue or blood infection have equally bad outcomes. Thousands of babies die from vaccine preventable diarrhea. Over 500 cases of polio have been reported in Central Asia in 2010.

 

Modern jet travel makes it likely that infected people will unwittingly enter the United States from abroad. Newark Liberty Airport puts us 45 minutes from anywhere in the world. Measles outbreaks in San Diego and Long Island were caused by travelers from Europe and Israel; the victims were largely unvaccinated or under-vaccinated children.

 

We have had preventable childhood deaths in Philadelphia and Minneapolis because a meningitis vaccine was temporarily unavailable. There is a whooping cough epidemic in California. Ordinary Influenza kills over 36,000 Americans every year.

 

A number of years ago a vocal minority insisted that a vaccine preservative, thimerosal, caused autism. No linkage was ever established, but thimerosal was removed from infant vaccines. This increased the cost of vaccines substantially and had absolutely no effect on the rising incidence of autism.

 

Claims that Measles-Mumps-Rubella vaccine causes autism have been totally debunked. There is no link between the vaccine and that disorder. An oft cited article in Lancet purporting a connection has been withdrawn; the Editors comment was, “We (all) really messed up.” The British have revoked the license of Andrew Wakefield, the article’s lead author. They concluded that he acted dishonestly, unethically, and in “callous disregard” for the suffering of children. The best available data continually inform us that no vaccine or vaccines, (in any combination, with or without preservative,) cause autism.

 

Individuals and groups that oppose vaccines for whatever reason try to make a case that the “antigenic challenge” to an infant’s immune system is somehow dangerous. That is qualitative and quantitative foolishness. The antigenic challenge of a single ear infection is greater than that of all vaccines given over a lifetime…combined.

 

Infants are highly vulnerable to Pertussis, meningitis, measles, mumps, German measles, chicken pox, and influenza. They also face greater group exposure/risk than most adults. From a public health standpoint, it is almost impossible to contain an epidemic without immunizing infants and children. That is why there are recommendations they be immunized as early as possible and requirements to be met before daycare or school attendance.

 

Unimmunized or incompletely immunized pre-adolescents/ adolescents are at risk for whooping cough, meningitis, chicken pox, hepatitis and Human Papilloma Virus (HPV). The hepatitis B vaccine your baby gets at birth was the first anti-cancer vaccine in history. It prevents chronic hepatitis and liver cancer for life. Gardasil, a vaccine given to girls and boys at 10-11 years of age, protects against the most common STI and prevents cervical cancer in adulthood. Adults need to be immunized for whooping cough, (Adacel). Their childhood immunizations have worn off long ago. It is recommended that women receive this vaccine immediately after childbirth. Unimmunized adults risk bringing this dangerous disease home to susceptible babies and elderly relatives.

 

Modern vaccines are tested exhaustively before licensing, and undergo continuous surveillance after release. They are taken out of production if there is even a suggestion or a suspicion that they might be contaminated or dangerous. Infrequently, individuals may have serious side effects, but the safety record is extremely good.

 

We administer vaccines according to the most recent policies and recommendations of the American Committee on Immunization Practices and the American Academy of Pediatrics. It has been conclusively demonstrated that deferring, delaying, or dividing recommended vaccines does nothing to prevent any measurable complications or side effects. It doesn’t accomplish anything other than leaving infants and children at prolonged risk from dangerous diseases.

 

As parents you have a primary requirement and right to assure the health of your children. As doctors we have a primary obligation to help you make the best choices. We ask that you consider sound data, not anecdotes, sensational headlines, celebrity pronouncements, and scare tactics when you make those decisions.

 

Thank you for trusting us with your children,

 

Allen Menkin, MD, MS, FAAP
Patrick A. Caruso, MD, FAAP
Adam M. Dick, MD, FAAP
Kristen Walsh, MD, FAAP
Melissa Libert, DO, FAAP

For further information please contact:
www.vaccinateyourbaby.com
www.autismsciencefoundation.com

 

July 12, 2011

 

The Green Baby
As part of "greening" Plaza Family Care, we ran a series of guest articles on the "green baby" in our Newsletter. Following is a short anthology of those articles.

Green living has recently, infiltrated nearly every aspect of American popular culture. Ideas and philosophies once considered unusual or extreme, are now regarded as reflecting new trend focused on addressing global climate change and preservation of earth's natural resources. We are constantly focused on how our parenting choices impact our child's health and development; those same choices can affect the kind of planet they will inherit. Green parenting does not need to be complicated or expensive. In many ways, it can be viewed as getting back to basics. By parenting in ways that would be more familiar to generations past, we can help the environment heal and our children thrive.

Breastfeeding is probably the greenest parenting choice we can make and it requires no technology change, we are physiologically designed for it. It creates no waste, requires no farming of animals or land for production, uses no packaging, and does not need to be processed or transported. Breastfeeding is also free, while non-organic infant formula feeding costs can range from $1000-1500 per year.

The World Health Organization recommends exclusive breastfeeding for the first 6 months of life and continued nursing through age 2 or beyond. Worldwide, many children nurse throughout their first 5 years. The benefits of breastfeeding for infants and children have been widely published, but are worth repeating: breastfed children have lower incidents of ear and respiratory infections, constipation and diarrhea. Children who are breastfed may also receive protection against SIDS, obesity, diabetes, asthma and allergies.

While breastfeeding may be natural and ideal for our children, it isn't always easy. There is a steep learning curve for all infants and new nursing mothers, but most women are able to breastfeed successfully if given the proper support and instruction.

If you choose to formula-feed your child, there are also ways to "green" the process. Organic formula ensures that your baby's food is free of pesticides, growth hormones, antibiotics and steroids. Avoid heating plastic products in the microwave, as this can cause chemicals from the containers to leach into its contents. Products made out of glass, corn or bamboo are alternatives to plastic, if you are seeking other options.

A few Resources:

http://www.kellymom.com/index.html
Provides comprehensive evidence-based information on breastfeeding, sleep and parenting.

http://www.ilca.org/i4a/pages/index.cfm?pageid=3432
Find a board-certified lactation consultant in your area.

http://www.organic-baby-resource.com/baby-health.html
Information on green parenting, feeding and diapering.

http://www.motherlove.com/product/5100-More-Milk-Plus-Capsules.html
Herbal supplements for pregnancy through lactation

http://www.llli.org/
La Leche League International. Breastfeeding support groups and resources. Erin Schmitt, Guest Columnist

 

The Devil Is in the Diapers

One of the easiest ways to lessen your baby's impact on the environment is to use cloth diapers instead of disposables. This may sound daunting at first, as visions of pins and plastic pants run through your mind, but today's cloth diapers are not the same as the ones your grandmother used. The variety of cloth diapers currently available on the market is broad enough to meet any parent's needs. Everything from traditional prefolds with covers to easy to use "all in one" (AIO) systems are available, making it easy to find a cloth diapering system that works for your family. For a great explanation of all of the different types of cloth diapers, go to http://diaperpages.com/cd_article.php. Among the reasons to use cloth diapers are:

Cost
The amount of money saved by using cloth diapers as opposed to disposables can be as much as $2196 from birth to potty training, depending on which type of cloth diapers you choose.i That does not take into consideration the fact that cloth diapers can be used for more than one child. For subsequent children, diapering is virtually free. Additionally, and somewhat surprisingly, there is a huge market for used cloth diapers! Websites like www.hyenacart.com and www.diaperswappers.com provide forums for parents to sell and trade used cloth diapers. Sounds gross? Consider this: the cloth diaper laundry services that have been around for ages are re-circulating cloth diapers among different families. As long as the diapers are washed properly, there is no sanitation or health issue!

The only ongoing cost associated with cloth diapers is the cost to wash them. Many families use diaper services which pick up dirty diapers and drop off clean ones. Prices for such services vary greatly by region, and using this type of service adds to the environmental impact of diapering by using fuel to transport the diapers back and forth. Washing cloth diapers at home is easier than you might think, less expensive than using a diaper service, and better for the environment. A simple, inexpensive "green" laundry detergent can be made by mixing 2 parts Borax, to 2 parts Washing Soda, to 1 part Oxiclean. Two tablespoons per washer load is sufficient. (Charles, Rockin' Clean, Country Save, Allen's, and Original Tide are also fine.) While your baby is exclusively breast or formula fed, the entire diaper (poop and all!) goes right into the wash. Waste during this phase is water soluble. Once a baby starts eating solids, the feces should be removed from the diaper prior to washing. In generations past this meant scraping the diaper clean, (not very appealing). There is no longer any need to scrape poop from diapers before washing! A number of companies sell flushable liners that go inside the diaper. When your little one has a bowel movement, the liner is removed and flushed down the toilet, along with the poop. If your angel only urinates, some of the liners can actually be washed and used again! Another product that eases the burden of using cloth diapers is the diaper sprayer. This little gadget, which looks like a small shower head, attaches to the hose on the back of your toilet, hangs on the wall, and allows you to rinse feces off of the diaper and straight into the toilet. After that, the diaper simply goes into the diaper pail with the others until wash day. Using a diaper pail with a lid, lined with a special liner, and washing them every two to three days should keep odors at bay.

Health and Safety Concerns
Dioxins Dioxins are a toxic by-product of bleaching with Chlorine. There are eco-friendly, Dioxin free disposable diapers (http://www.chorinefreediaper.com) but most disposable diapers, (and white cloth or paper goods, tampons, surgical dressings, or any product that is "bright" white), contain this and other undesirable chemicals. There is no established link between your baby's health and these chemicals but we know they can be absorbed through the skin and they have been associated with serious medical problems including cancer, immunodeficiency, and hormonal disorders.ii Properly washed cloth diapers do not contain Dioxin or other potentially dangerous compounds.

Just about all of the problems reported to the Consumer Protection Agency regarding disposable diapers ( chemical burns, noxious chemical odors, babies pulling disposables apart and putting pieces of plastic into their noses and mouth, choking on tab papers and linings, plastic melting onto the skin, and ink staining the skiniii ) are avoidable by using cloth. Anecdotal evidence suggests that babies who are cloth diapered typically experience fewer diaper rashes than those using disposables.

The Environment
Consider that approximately five million tons of untreated waste and a total of two billion tons of urine, feces, plastic, and paper are added to landfills annually.iv Conservative estimates indicate that each child will use at least 5600 disposable diapers from birth to potty training!v That's an awful lot of diapers in our landfills. It is estimated that a disposable diaper takes between 250 and 500 years to decompose.vi The burden of disposable diapers will be left for future generations to bear. One of the kindest things you can do for your children and their planet is to use cloth diapers and keep disposable diapers out of our landfills.

See diaperdecisions.com.
http://www.realdiaperassociation.org/diaperfacts.php, citing Allsopp, Michelle.  Achieving Zero Dioxin: An emergency strategy for dioxin elimination.  September 1994.  Greenpeace.  http://archive.greenpeace.org/toxics/reports/azd/azd.html and Greenpeace.  New Tests Confirm TBT Poison in Procter & Gamble's Pampers: Greenpeace Demands World-Wide Ban of Organotins in All Products. 15 May 2000.

http://archive.greenpeace.org/pressreleases/toxics/2000may152.html.
See http://www.thenewparentsguide.com/diapers.htm.
See http://www.thenewparentsguide.com/diapers.htm.
See http://www.theecofriendlyfamily.com/2010/07/ive-never-looked-back.html.
See http://www.realdiaperassociation.org/diaperfacts.php, citing Lehrburger, Carl. 1988. Diapers in the Waste Stream: A review of waste management and public policy issues. 1988. Sheffield, MA: self-published. Cori Herbig, (nee Menkin), Guest Columnist

Playing Green

There are many occasions when we buy children toys. We can always examine the safety of toys and items we purchase for our children and find possibilities for "greening" their play experiences.

Most toys sold in the US are made from unlabeled plastic (there is no number coding required like there is on food containers and consumers can't easily determine what kind of plastic is used). Pragmatically, this means that toys are not easily recyclable and parents don't have access to information about what their children may or may not be exposed to.

PVC is a common plastic used in the production of many toys, and growing number of parents are trying to avoid it. Chemicals involved in the production and released in the use and destruction of PVC have been linked to endocrine and developmental disorders. Soft plastic toys, such as dolls and teethers, are particularly likely to have been made with PVC.

To minimize exposure, you can purchase toys made from materials other than plastic (wood, metal, cloth, etc.). If you do purchase plastic toys, look for toys that are labeled with a 2, 4 or 5 (meaning they are made of non-chlorinated plastic). Because Europe has stricter requirements for toy safety, many European toy manufacturers (Haba, Selecta, etc) use green materials. Some companies are now marketing plastic toys made from recycled materials. Green Toys Inc is one such company, selling toys such as trucks, tea sets and blocks made from recycled milk jugs. Their products are free of toxic phthalates and BPA (Bisphenol-A). Melissa and Doug products are widely available in popular US stores, and they repeatedly test their products for traces of lead and heavy metals. Independent toy stores tend to have more variety than major retailers and they also support smaller toy manufacturers who may have greener production and transportation practices. The added benefit of purchasing green toys from independent retailers is that we are able to support local business owners and our local economy.

Purchasing green toys for your children does not have to break the bank. For our family, playing green has meant spending our money on fewer high-quality and non-toxic toys. We stick to the basics. Child development experts agree that quality of play is not enhanced by quantity. Teaching our children moderation and providing them with simpler toys that require more self-guided action and imagination is actually healthy for them. Discount stores such as Home Goods and TJ Maxx often have wooden and imported toys for sale at reduced prices. Our family also loves consignment stores and rummage sales, where high-quality toys can be found for a fraction of what they cost new and gently-used toys can be given new life.

Lastly, toy cleaning can also be greened. www.safemama.com , a website dedicated to eco-conscious and non-toxic parenting, recommends creating a natural cleaning formula that can be combined in a spray bottle for easy clean-up. Spray directly onto toys or onto a cloth for wiping.

Cleaning Spray Recipe:
- 1 Cup Water
- 1 Cup Distilled White Vinegar
- 6 drops of Tea Tree Oil (natural antiseptic qualities)

To read more detailed information about the components of PVC and plastic toys:
http://mothering.com/green-living/toxic-toy-story?page=0,0
For up to date information on product recalls and an opportunity to sign up for email alerts:
http://www.cpsc.gov/
Comprehensive eco-conscious and non-toxic parenting resource:
http://safemama.com/
Green toys made from recycled milk jugs (Phthalate and BPA free):
http://shop.greentoys.com/home/index/3130.0
Melissa & Doug's Safety Policy:
http://melissaanddoug.com/feature02n.phtml
Erin Schmitt, Guest Columnist

 

Babywearing

"Babywearing" is a relatively new term for a practice that parents around the world have traditionally utilized… that is, wearing our babies. Babywearing is a practical and gentle tool for bonding with and comforting your baby or toddler, while also managing to have use of your two hands for other tasks. It is safe for healthy newborns and many carriers are designed even to carry hefty toddlers. The advantages to babywearing are many. For newborns, being so close to a familiar heartbeat and voice is comforting and can help ease their transition to life outside of the womb. Babies who are carried tend to cry less than babies who are not, because they spend more time in a quiet-alert state. This also lends itself to learning, which is further enhanced by their being able to experience the world from the same vantage point that we do. Because they are able to engage with the world from a safe position, worn babies are supported in developing a secure attachment to their caregivers.

Babywearing has been a true sanity-saver for me, allowing me to engage closely with my daughter while we go about our day together. In her sling, she is involved with the world around her but within safe and comfortable parameters. With our carriers, I have been able to take her places I never would have been able to manage with a stroller: steep inclines in the woods, our tiny narrow-aisled grocery store, even volunteering at a local shelter. My daughter is nearly 3 years old and walks a lot, but she will still take naps in her sling or find comfort snuggling while we shop.

In the US, we are fortunate to have many options when it comes to babywearing and many parents find it useful to have different carriers for different occasions. Soft-structured carriers, made by companies such as Ergo and Beco, provide great low back support and have straps similar to a backpack. Generally, the carriers are made to allow you to wear babies or toddlers on your front or back (obviously babies should not be worn on backs until they have full control of their heads and necks). I use our Ergo for carrying my daughter while I walk the dog, because I love how secure she is in it (even now, at 32lbs!)… I don't need to frequently readjust or reposition her.

Wrap carriers involve a long piece of fabric that is wrapped around the baby and the adult. They can be cumbersome to learn, but there are an incredible number of different positions and ways to wrap the fabric, allowing parents tremendous flexibility. Most wearers find these wraps very comfortable and feel that their babies are very well supported in them. Wraps come in either stretchy fabric (such as those made by Moby) or woven fabric. Stretchy wraps are best suited for infants and young babies, while woven wraps can be used through toddlerhood. Slings come two designs: ring slings and pouch slings. Ring slings have more fabric to manage, but can be adjusted to suit the size of the baby or wearer. Pouch slings are lightweight and compact, but may or may not be adjustable depending on the brand. Depending on design, babies can be worn in several positions (including upright tummy to tummy, cradled, on your hip, or even on your back). Slings are wonderful for breastfeeding parents, since babies are able to nurse while they are in the sling (some sling-wearing mamas even manage to nurse while walking or running errands!). If nursing parents seek coverage, the sling can seamlessly provide that. There are many slings on the market. My personal recommendation, for the sake of the wearer's comfort, is to choose one with a padded shoulder. I love my Maya Wrap, which has a padded shoulder, strong woven fabric, and a convenient pocket sewn into the tail of the sling.

Last Spring, the Consumer Product Safety Commission issued a warning for parents using infant slings, amidst reports of infants suffocating while being worn. The CPSC did not make a distinction as to the type of carrier being used, but they should have. The babies who died from suffocation were being worn in a sling referred to as a "bag sling." These slings, sold by popular brands such as Infantino, basically resemble an open duffle bag with a strap to go across a parent's shoulders. They have since been recalled and pulled off the market, but can still be found in children's consignment stores. Bag slings are not safe, as they position an infant in an unsupported, curled position that can compress their airway. There are many design flaws of these slings that present significant safety concerns and parents are urged to stop using them. For more information, comparing the safety of these slings to other carriers, see:
http://baby-carrier.blogspot.com/2008/01/draft-babywearing-safety-bag-slings.html

Babywearing is safe, if done correctly and with well-designed carriers. Many parents in the US are discovering how nicely babywearing works in their lives. If you have questions about using your carrier, you can call the manufacturer or check out this website, which has detailed instructions for many carriers: http://www.thebabywearer.com/index.php?page=usinglinks

For a great guide to baby carriers and help figuring out which one may be best suited to you: http://www.thebabywearer.com/index.php?page=whattype

For a comparison of ring slings and pouch slings: http://www.thebabywearer.com/index.php?page=pouchslingcomparison

Carriers mentioned:
http://www.becobabycarrier.com/about.asp
http://www.ergobabycarrier.com/
http://www.mobywrap.com/
https://www.mayawrap.com/
Erin Schmitt, Guest Columnist