Friday, November 22, 2013

Food safety tips

Food Safety Tips

It is certainly not a sterile world, and as soon as they are able, your baby will start putting anything that they can reach into their mouths. (You can't even begin to imagine the phone calls we get about the more disgusting items that some of our little patients have managed to get their hands..and mouths on.)

So yes, the world is full of germs, and while I don't generally get too concerned about a little dirt here and a big sloppy dog kiss there, food-borne bacteria are especially nasty and we need to minimize any exposure.

Infants and young children are particularly vulnerable to food-borne illness because their immune systems are not developed enough to fight off infections.
That is why extra care should be taken when handling and preparing their food and formula.
This is especially important for infants under 6 months of age.

Here are some basic food safety guidelines:

*Wash hands for at least 20 seconds before food preparation. Soap is best. Hand sanitizer will do. Re wash as needed after handling food that might carry germs (poultry, meat, raw eggs)

*Make sure kitchen towels and sponged are changed and cleaned frequently (sponges can go through the dishwasher)

*Keep your refrigerator temperature at 40 degrees or colder and your freezer below 0 degrees.
(One way to make sure that the Freezer has continued to have safe temps is to freeze a baggie filled with ice cubes....If they remain cubes, you are in good shape, if they melt and refreeze as a block of ice that means that at some point your freezer was not cold enough)
Label things in your freezer and rotate so that you are using up older stuff first. 

*check the dates of baby food jars and make sure the lid pops when you open them

*Don't "double dip" with baby food: Never put baby food back in the refrigerator if your child doesn't finish it.
Your best bet: Don't feed your baby directly from the jar. Instead, put a small serving of food on a clean dish. Add more as needed with a clean spoon. Remember that once saliva has come into contact with the food it is no longer sterile and some bacteria can grow quickly.

*Don't leave open containers of liquid or pureed baby food out at room temperature for more than two hours.
Bacteria thrive in temperatures between 40-140 degrees

*Don't store opened baby food in refrigerator for more than three days.
If you are not sure that the food is still safe, remember this saying: "If in doubt, throw it out"
(see links below for guidelines on how long food stays safe) 

*Make sure that foods are properly cooked. A food thermometer is the best tool for this.
Chicken ( white meat/ dark meat)...170/180
Eggs....not runny

For all of you "older kids" who will be baking this holiday season.
Watch out for  batter. (I am a notorious offender), but 
even one lick from raw food containing a contaminated egg can get you ill.

Myth: Freezing food kills harmful bacteria that can cause food poisoning
Fact: bacteria can survive freezing temperatures. When food is thawed, bacteria can still be present and can begin to multiply.
Cooking food to the proper internal temperature is the best way to make sure any bacteria is killed.

Myth: vegetarians don't need to worry about food poisoning
Fact: Fruits and vegetables are an important part of a healthy diet, but like other foods they may carry a  risk of food-borne illness.
Always rinse produce well under running tap water.
Never eat the pre-washed 'ready to eat' greens if they are past their freshness date or if they appear slimy 

Myth:  Plastic or glass cutting boards don't hold harmful bacteria on their surfaces like wooden cutting boards do.
Fact:  Any type of cutting board can hold harmful bacteria on its surface.  Regardless of the type of cutting board you use, it should be washed and sanitized after each use.  Solid plastic, tempered glass, sealed granite, and hardwood cutting boards are dishwasher safe. However, wood laminates don't hold up well in the dishwasher.  Once cutting boards of any type become excessively worn or develop hard-to-clean grooves, they should be discarded.

Myth:  Locally-grown, organic foods will never give you  food poisoning.
Fact: Any food, whether organic or conventional, could become unsafe with illness-causing foodborne bacteria at any point during the chain from the farm to the table.  Consumers in their homes can take action to keep their families safe.  That is why it is important to reduce your risk of foodborne illness by practicing the four steps: Clean, Separate, Cook, and Chill.

Some excellent resources for food safety tips are  (this site keeps track of any food recalls)   (great site for seeing how long food will last)   (this site has loads of kid friendly activities)

breast milk storage/ pumping guidelines

Friday, November 15, 2013

Dealing with Fevers


There are so many methods out there for measuring a body temperature. I personally don't feel the need to invest in any expensive thermometers. I am generally quite satisfied with a digital underarm reading. The important thing is that however you take it, your thermometer seems accurate. Test it on yourself or other family members and take your child's temp when they are healthy to make sure you trust it.
One of my favorite brands is Becton Dickinson. These are reasonably inexpensive on Amazon and have been reliable in my experience.
If you have one of the new ear or temporal scanning ones
units feel free to keep using that. Sometimes their "high" readings seem a little higher than I believe to be accurate, Don't ever let a number freak you out.

Temperatures can be measured in either Fahrenheit or Celsius
Here is a quick conversion chart that might come in handy.

98.6 F=37 C

For this post, I will be referring to the temperatures on the Fahrenheit scale.

For any child older than 2 months, as long as your child is active and happy, I generally don't feel the need to "treat" a fever unless it is over 101.5 or so.

Parent's often ask me, "When do we need to worry about a fever?"
I am always more interested in your child's overall mood and behavior than I am in any specific number on a thermometer.
I am much more concerned about the lethargic, whimpering child who has a 99 temperature than I am the singing child with 104.
But, here is the Nurse Judy's rule about fevers:

If the fever is over 102 (It doesn't matter how you measure, just be consistent):

*Treat with proper dose of Acetaminophen or Ibuprofen

*Do a tepid bath or place cool compresses on the forehead, insides of elbows and neck

*Get them drinking. Little sips at a time are fine. Popsicle s and ice-chips are good for older kids

*re check the temp in 45-60 minutes

If it is STILL over 102 and hasn't budged at all, that is a fever that I am concerned about.
It is time to get your child seen.

When children are in the process of spiking a fever, it is not uncommon for them to tremble and look shaky.
When fevers are breaking it is common to have lots of sweating.

One of the more frightening aspects of a fever can be a febrile seizure. About 4% of children will have these.
Febrile seizures are scary to watch, but they usually stop within 5 minutes. They cause no permanent harm.
Trust me, if you have never heard of this..watching your child have a seizure has been reported as the scariest experience EVER.
Knowing that that they do happen once in a while and are generally harmless should help ease the terror.
If your child is having a seizure they may have large jerky motions and their eyes may roll back.
Your job is to stay calm. Make sure their airway is open. It is perfectly reasonable to call 911

Once your child has had even one febrile seizure we tend to be more aggressive with fever control and will treat even a low grade fever. It is important to talk with your doctor about this so that you have a plan in place that you are comfortable with.
Most kids grow out of the seizures by the time they are 5 years old.


As I mentioned before, a fever by itself doesn't alarm me.
If the fever is accompanied by a very fussy child, I want them seen so that we can figure out what is going on.

Most of the time, if a fever lasts for more than 3 days, I consider it time to have a look so that we can make sure there isn't an infection source
(like ear infection, urinary tract infection, strep throat or pneumonia)

 During flu season, we sometimes do see a fever that lasts for five days or longer.
If there is something going around, I will occasionally relax my "3 day rule". If the kids seems like they are 'managing' (drinking, peeing, easy breathing, consolable, fever responds to medications) I am okay watching them for another couple of days.

If your infant is under 8 weeks of age we want to be notified of any fevers!However, there are a few common causes..
*over bundling....
Seriously, some times the babies come in with 10 blankets wrapped around them.
Please don't do that. The best rule of thumb is giving them one layer more than you are wearing.
If your baby was indeed over bundled, get some of those layers off and re check the temp in about 10 minutes to see if they have cooled down.
Sometimes if moms milk isn't in yet, babies can be simply dehydrated and need to get some fluids. This is the time that you need to squirt some milk or formula directly into your baby's mouth. You can use a syringe or a dropper.
More often than not the elevated temperature will normalize fairly quickly from some fluids.

If there is no obvious cause for an elevated temperature, and it doesn't resolve within 30 minutes your baby needs to be evaluated. Giving a fever reducing medication to a newborn should only be done under strict guidance from your pediatrician.

Some fever facts:

*Fevers turn on the body immune system. They are one of our body's protective mechanisms
*Many fevers can actually help the body fight infection.
*Fevers that are associated with most viral syndromes and infections don't cause brain damage. Our normal brain's thermostat will not allow a fever to go over 105 or 106.
*Only body temperatures higher than 108°F (42.2°C) can cause brain damage. Fevers only go this high with high environmental temperatures (e.g., confined to a closed car.)
To keep track of the current illnesses that are circulating, check out the Monday updates on the Noe Valley Pediatrics blog.

Friday, November 8, 2013

Influenza update

This week, one of the moms in the practice was asking me about my thoughts on whether or not she should get the flu vaccine for her child.
Every flu season is completely different. Some times it rolls around in February and we hardly notice it. Sure, a few folks
Certainly we have plenty of patients who get it and have a miserable week or so, but nothing too memorable.
Unfortunately we can't really predict what any Flu season will look like.
It wasn't all that long ago that the H1N1 swept through and many otherwise young and healthy adults and children died!
There was a run on the limited vaccine and it was a nightmare.
One never knows when the Flu season will be especially severe. More years than not, deaths from influenza are reported. Invariably the media beats the drums and causes a bit of a frenzy and then folks can't get their children vaccinated fast enough. Historically, when that is the case, the supply does run out.

This season we still do have plenty of vaccine available.
Most of the adults and big kids who have gotten the shots have had a very uneventful time aside from a day with a mildly sore arm.
Some of the babies getting the shot for the first time have had low grade fevers and increased fussiness for a night.

(some years the shots seem to cause more side effects than others)

It also remains to be seen if this years vaccine is a good match for the circulating virus.

I have a feeling that this season the Flu is going to hit early and hit hard.
We have had our first positive Flu test this week.
The baby was quite ill with mostly respiratory symptoms and ended up being sent over to the emergency room for evaluation.
(I am happy to report that he is fully recovered)

Infants can't get the flu shots until they are 6 months of age. If this is the first year of getting the protection, your child will need two shots. There needs to be 4 weeks in between the first and the second shot. It is okay to have the interval be a little longer, but it can't be sooner.
It takes a week or so to get the immunity from the vaccination.
(Alas, our little flu patient had just gotten the second shot a day or so before becoming ill.)
If your child is over the age of two you will have the choice between the shot and the nasal flu mist.
All of our vaccine is preservative free.
We are also lucky enough to have only the newer quadrivalent vaccine (80% of the vaccine out there is the older trivalent formulation that protects against 3 strains rather than 4)

I hope I am wrong and that we have a mellow season ahead, but I suggest getting that flu shot if you haven't done it yet.

Friday, November 1, 2013


What is severe RSV disease?

Respiratory syncytial virus (sin-SISH-shul VI-rus), or RSV, is a common, seasonal, and easily spread virus. In fact, nearly all children will get their first RSV infection by age 2.  
Like most viruses it ranges in it's severity from case to case.
Severe RSV disease is the number one reason babies under 12 months old have to be admitted to hospitals in the US.
You know the wretched colds that knock you flat and stand out in  your memory? These are the colds that come with runny noses, sniffling and sneezing, harsh cough and fever. That illness might well be RSV.
I actually can almost diagnose it over the phone when I hear the patients coughing. The cough sounds like it hurts.

There is a test that we can do in the office (a swab to the nose) to see if it is RSV or not, but unless your child is looking really sick we might not bother. It doesn't necessarily change the approach.
We often do nebulizer treatments for our wheezers, but with RSV they don't always help all that much.

Time usually fixes this and all that we can offer is often the same symptomatic treatment  and supportive care that we would do for any bad cold and cough
Treat the fever as needed
Clear the mucous with saline/ breast milk and a Nose Frida/ aspirator
Keep the heads elevated
Do doses of steamy bathrooms and use a humidifier at night.
Increase fluids during the day.

RSV can cause ear infections and pneumonia

Severe RSV disease symptoms include:

  • Coughing or wheezing that does not stop
  • Fast or troubled breathing
  • A bluish color around the mouth or fingernails
  • Spread-out nostrils and/or a caved-in chest when trying to breathe
  • Gasping for breath

If your child is having trouble breathing, or significant trouble feeding, they may need to be hospitalized for a night or two for fluids, oxygen and observation.
I would say that we have several kids routinely hospitalized for this every year. (not just young babies)
There is no other real treatment for RSV other that close observation, but for certain high risk patients, there is a medication that is given monthly that significantly protects them.
This medication is called Synagis.
If your child was premature (earlier than 35 weeks gestation), has cardiac or pulmonary issues they may qualify. Talk to your doctors office ASAP to find out if your child fits into the guidelines. Alas the guidelines are quite restrictive. This season I will be giving the synagis to only 4 of our patients.
The medication is given monthly during the RSV season for a total of 5 doses.
In California the official RSV season starts on November 1st
(I don't think that RSV knows that it has a season...but that is when the almighty insurance companies will start shipping the medication)

Since most of our children can not get protected with synagis, please take precautions to prevent the spread of this nasty virus, especially for the youngest most vulnerable babies.

  • Wash your hands before touching your child. Make sure others wash up, too
  • Clean toys, crib rails, and any other surfaces your baby might touch
  • Try to keep your baby away from crowds. Avoid anyone with a cold or fever
  • Don't let anyone smoke near your baby. Tobacco smoke can increase the risk of severe RSV disease

Sadly it takes multiple exposures before you develop immunity. Most folks get it about 8 times until they finally seem to be safe!
It spikes again in older folks when the immunity tends to wane and it can sweep through retirement communities, so be cautious for the older adults in your life as well.