Dr. Joanna Dolgoff-Pediatrician & Nutrition Expert,

creator of Red Light, Green Light, Eat Right

November 30 - 7:15-9 PM

No fee Registration recommended

One out of every three children is obese and another one out of every three children is overweight. Joanna Dolgoff, M.D. will highlight the various causes and medical consequences of this worsening epidemic. She will also give specific strategies that parents can use to both prevent their child from gaining weight and to help their overweight child lose weight safely and effectively. Learn about her Red Light, Green Light, Eat Right program which is offered at PHA, and often covered by insurance.

Tuesday October 25th 7-9 PM

Wednesday December 7th 7-9 PM

with Dr. Goldstein

Fee - $10 per person. Class size limited to allow for hands on experience.
This two-hour class offered approximately every other month will review Basic CPR and choking for the infant and child. Through video and hands on experience with a mannequin, parents and childcare givers become familiar with important life-saving techniques. Plenty of time for questions.
This course does not meet the requirements for CPR certification.
Registration required. Click here to register.

Pediatric Sleep Workshop

“It’s Time To Get Your Family The Sleep You Need and Deserve”

Wednesday October 12, 2011

No fee, preregistration recommended

Noon

Whitney Roban, Ph.D.
of SLEEP-EEZ KiDZ

Are you and your child sleep deprived? 

Are you desperate for a full night’s sleep? 

Do you feel frustrated and exhausted? 

If you answered “yes” to the above questions, then it’s time to get your family the
sleep you need and deserve.  Please join Dr. Whitney Roban to learn everything you need to know about raising a great sleeper. 

Topics to be discussed include:

* How much sleep children need as they grow

* Age appropriate schedules and routines

* Key aspects to raising a great sleeper

* Summary of sleep training techniques

* Why sleep is so important

in children and adults

Tuberculosis was once the leading cause of death in the United States. Effective antibiotic regimens have dramatically decreased the number of cases nationwide, though resistant strains have emerged. While the risk for TB is greater in communities with lower socioeconomics, it is important that all communities remain vigilant.

Recommendations regarding risk factors and testing in both children and adults have changed. Understanding TB, the types of infection, how it is spread and how it is prevented can help equip parents with the knowledge to protect themselves and their children against a realistic and potentially dangerous infection.

You can only get infected with TB by directly breathing in TB germs that a person coughs into the air. You cannot get TB from someone’s clothes, drinking glass, eating utensils, handshake, toilet, or other surfaces.
If your child has been exposed, the risk of transmission of TB from casual contact is low. In addition, TB has no symptoms in the early stages, so there is plenty of time for diagnosis and treatment.

If your child has been exposed, or if you are very concerned because of risk factors (see screening below), arrange to come in for a PPD skin test known as a Mantoux test. This routine screening test is a very effective way of determining if your child has been exposed.

Screening
Screening of individuals who may be at increased risk is a crucial aspect of TB prevention. The Mantoux test, which has been in use since the 1930s, is the best screening test. It is often referred to as a PPD because a Purified Protein Derivative of TB is injected under the skin. People who have active or latent infection will have a reaction. In the 1960s and 1970s, when TB rates were very high, universal testing of all children at regular intervals was required. This is no longer the recommendation.
The American Academy of Pediatrics (and the Centers for Disease Control, the American Thoracic Society and the Infectious Diseases Society of America) is now recommending “targeted tuberculin skin testing” or TST which means only testing the children who are at high risk.
Pediatricians (including your doctors at PHA) are using screening questionnaires (see below) and only testing children when risk factors are present. Studies have carefully evaluated and validated this method of screening.

Screening questionairres should include the following questions:

1) Was your child born outside the United States?
2) Has your child traveled outside the United States?
3) Has your child been exposed to anyone with TB?
4) Does your child have close contact with a person who has had a positive TB skin test result?
5) Does your child spend time with anyone who has been in jail or a shelter, uses illegal drugs or has HIV?
6) Has your child had raw milk or eaten unpasteurized cheese?
7) Does your child have a household member who was born outside the United States?
Does your child have a household member who has traveled outside the United States?
A child or adolescent should be tested by his or her physicianonly if more than one risk factor is present.The skin test (PPD) needs to be checked in 48 hours. If the skin in the testing area becomes raised and hard, further evaluation and treatment may be needed.
The physician should evaluate any reaction to the skin test. Treatment is very complex. Therapy is determined by the size of the reaction, evidence of active TB, and a patient’s general medical health. Even in the least complicated case — a positive skin test, no symptoms, and a negative chest x-ray, — 9 months of medicine is required. More specific information is available at the CDC website, www.cdc.gov/mmwr .

What is TB?
Specifically, tuberculosis is bacterial infection caused by Mycobacterium tuberculosis. The bacteria are almost always transmitted through an airborne route. An infected individual can spread the infection by coughing, sneezing, even just talking. When inhaled by another person, the bacteria enter the lungs and cause infection.

Difficulty in identifying and controlling TB results from not every infected person feeling sick. Many are infected for years, even decades, before they know. In most, the body is able to fight the bacteria and keep them from growing. The bacteria remain alive but inactive inside the body. This is a latent TB infection (LTBI). People with a latent infection have no symptoms. They do not feel sick and are not contagious. However, without identification and treatment these people may develop symptoms and become contagious.
When the body cannot control the infection, the bacteria begin to multiply; this is an active TB infection (ATBI). Active TB causes weakness, fatigue, fever, chills, sweating at night and weight loss. Because tuberculosis grows in the lungs, infected people experience bad coughing, chest pain and even coughing up blood. Those with active TB are contagious.

Three basic principles are used in the control of TB in the U.S. First is the critical task of diagnosing people with active infection. There are approximately 20,000 new cases of active TB in the U.S. each year. New York has the highest number of new cases in the country followed by California, Texas, Florida and Hawaii.
Identifying people exposed to an individual with active TB is the second step in control and prevention. Interestingly, by the time a person with active TB is diagnosed, 30% to 40% of people identified as close contacts have evidence of exposure and latent TB infection.

Once a person develops LTBI there is a 5% to 10% chance that active disease will develop. The risk for progression to active TB disease varies. Half the people who progress to active TB do so in the first two years. Acquisition of latent TB infection in infancy and early childhood (<5 years old) is a strong risk factor for progression. Medical conditions — including diabetes, kidney disease and immune system disorders (especially HIV) — also increase the risk for active TB. Thus, identifying people exposed to an individual with active TB is an important tool to detect additional cases of active TB and also identifies people in the early stages of latent TB, when the risk for progression is greatest.

Unfortunately, TB is a global problem. Poor conditions and lack of medical resources contribute to 8 million new diagnoses of active TB and 3 million deaths annually. It is estimated that 20% to 30% of the world’s population is infected with TB. But with careful screening, TB in the United States should be controlled and serious consequences prevented. Careful attention to risk factors and possible exposures will help to protect our children

What is ADHD… it covers more than you might realize

About 5 - 9% of children have Attention-Deficit/Hyperactivity Disorder (ADHD). Note that this includes those children who are diagnosed without the Hyperactivity (formally referred to as ADD). ADHD is a neurologic disorder that is a result of an imbalance of neurotransmitters in the brain. It has been recognized as a legitimate diagnosis by The American Medical Association, American Academy of Pediatrics, National Institute of Mental Health, Centers for Disease Control and Prevention, American Psychiatric Association, American Academy of Child & Adolescent Psychiatry, and the U.S. Department of Education.
While most people are aware that the primary symptoms of ADHD are inattention, impulsivity, and in some cases hyperactivity, many people do not realize that equally present in most cases is a degree of emotional dysregulation: a greater than appropriate difficulty managing one’s emotions (inhibiting or moderating one’s behavior, self-soothing or calming down from strong emotions, or refocusing attention after an emotional event). In addition, there are several conditions that often accompany ADHD and can sometimes mask or distract from the diagnosis such as learning disabilities, sleep disorders, anxiety and depression.

How is ADHD diagnosed?

There is no single way to diagnose ADHD. A licensed health professional with specific knowledge about ADHD needs to gather information about the child’s behavior in various settings and conditions. A medical professional must also rule out other factors such as hearing or vision problems, family stressors, or other medical or psychiatric problems that may have similar symptoms. The American Psychiatric Association’s Diagnostic and Statistical Manual-IV has standard diagnostic criteria used to properly diagnose ADHD. It can be found at: http://www.cdc.gov/ncbddd/adhd/diagnosis.html

What is the value in finding out if it’s ADHD now rather than waiting and seeing how a child develops?
Very often parents and professionals prefer to take a “wait and see” approach when it comes to monitoring childhood development. Often children do mature and develop at different paces and will outgrow difficulties that are present early on. Generally, ADHD is not diagnosed until grade school, but in certain children the symptoms are severe enough to warrent exploration earlier. We know now that early intervention for ADHD, just as with speech, occupational therapy and physical therapy, can have positive life altering results. Knowing specific practices for parenting and teaching a child with ADHD can go a long way in safeguarding them from some of the negative habits and behaviors that may otherwise develop. Children with ADHD often experience social difficulties, and learning difficulties that, when addressed, can protect them from some of the bruises on their self esteem and self image down the road. When parents are educated about how ADHD may affect their child, they can closely monitor and partner with their child to create that all important special protective bond.

Where can you learn more?

Fortunately today, there are so many resources available to learn about the symptoms and treatment of ADHD. It is always important to be sure that the information you are collecting, however, is factual and not anecdotal or laden with opinion. For reliable web sources, check websites such as www.CHADD.org, www.add.org, and http://www.nimh.nih.gov. And for excellent books, read Driven to Distraction by Dr. Ned Hallowell and Taking Charge of ADHD by Dr. Russell Barkley. Also, seek out lectures at your school, library, or local community center.

How is ADHD treated?

We have learned so much in the past decade that helps us improve the lives of children and adults who are diagnosed with ADHD. One of the greatest treatments available is gaining a firm knowledge of how ADHD is specifically affecting the person individually, as it impacts each person differently. Medication for ADHD has been around since 1937 and is still recognized as an important part of treatment for many individuals with ADHD because of it’s safety and benefits. Finally, Therapy and ADHD Coaching are also recognized as beneficial, as much for the parents as for the child with ADHD. The ultimate success of the child will be greatly determined by how much the parents help the child recognize not just how to work with their difficulties, but how to capitalize on their tremendous strengths and potential as a result of their unique wiring.

Cindy Goldrich, Ed.M., ACAC, is a Certified ADHD Parent Coach, specializing in parenting children who struggle with ADHD, Executive Function issues, and the challenges of the teen years. She holds a master’s in Counseling Psychology from Columbia University and ADHD Coach Certification from the Institute for the Advancement of AD/HD Coaching. Additionally she is a Certified Mentor for Think:Kids, formally The Collaborative Problem Solving (CPS) Institute, dedicated to understanding and helping challenging children and adolescents, and has trained with Dr. Edward Hallowell. Cindy has served on the Board of the Long Island Branch of the International Dyslexia Association and is an active member of CHADD (Children & Adults with Attention Deficit Disorder). She is also a member of ADDA (Attention Deficit Disorder Association), ACO (ADHD Coaches Association), and IAAC (Institute for the Advancement of ADHD Coaching).

boy with inhaler

Exercise-Induced Asthma

Many children seem short of breath with exercise, especially with the intense exercise that is part of team sports. Some of these children just need a little more conditioning, and some need medical intervention for a condition called exercise-induced asthma.

Your child may have exercise-induced asthma if…
-exercise causes a cough
-shortness of breath lasts more than a few minutes after
exercise stops
-exercise tolerance doesn’t improve as the season progresses
- your child seems to limit exertion
- all the other kids seem to be having an easier time

Exercise-induced asthma affects 90% of children with known asthma, and many children with no other symptoms of asthma. Symptoms of exercise-induced asthma include wheezing, tightness in the chest, shortness of breath and coughing. The symptoms usually start 10 minutes into exercise and will continue up to several hours after the exercise stops. Symptoms may not occur with every activity or at all times during the year. Some children experience exercise-induced asthma only when running the mile outdoors in April, while others have a harder time with cold weather sports.

The lungs of children with exercise-induced asthma are sensitive to the cold, dry air that is inhaled during exercise. Symptoms can be decreased if your child remembers to warm up and cool down with light exercise for 5-10 minutes. Breathing in thru the nose (which humidifies the air before it reaches the lungs) will also decrease symptoms.

If your child continues to have symptoms, it is time to visit your doctor. A combination of history, physical exam and pulmonary function tests will help us decide how to deal with your child’s symptoms. There are many medications which can be taken prior to and/or during exercise that will eliminate the symptoms of exercise-induced asthma. If your child is currently using an inhaler prior to sports and still having trouble, there are other medications to try.

With a little planning your child with exercise-induced asthma will reap the benefits, both physical and social, that come with participation in sports.