Posts tagged ‘texarkana pediatrics’

The What, Why, Who & When for HPV Vaccinations

by Dr. Annie Baker

What is HPV?

Human papillomavirus (HPV) is a virus that is spread by skin-to-skin contact, usually including sexual intercourse, or any other contact involving the genital area. Over one hundred different types of HPV have been identified; more than fifty of these are known to infect the cervix and approximately fifteen are known to cause cervical cancer.

Researchers have labeled the HPV types as being high or low risk for causing cervical cancer. HPV Types 6 and 11 can cause about 90 percent of genital warts. These types are low-risk because they do not cause cervical cancer. HPV Types 16 and 18 are the high-risk types that cause most cases of cervical cancer. HPV types 45 and 31 are also high-risk types, causing about 5 to 10 percent of cervical cancers.

Why The HPV Vaccine?

It has been estimated that 75 to 80 percent of sexually active adults will acquire HPV infection before the age of 50. That’s over 250 million in the U.S. alone, with the majority of those occurring between the ages of 15- 26. Most people who are infected with HPV have no signs or symptoms, therefore they don’t realize they have it.

Cervical cancer is the third most common female cancer worldwide and HPV types 16 and 18 cause approximately 70 percent of cervical cancers and 50 percent of precancerous cervical lesions. HPV types 16 and 18 are also found in 72 percent of anal cancers and 69 percent of precancerous anal lesions. Although it remains an uncommon cancer, the incidence of anal cancer is increasing in the United States and other countries.

HPV types 6 and 11 also cause 90 percent of genital warts. Genital warts are associated with physical and psychological morbidity and have a high rate of treatment failure. Remember that males also acquire HPVrelated disease including genital warts, and less commonly, penile and anal cancer, which are similar to cervical cancer in their strong association with HPV infection. Note: Although condoms may help prevent other sexually transmitted diseases, condoms do not provide complete protection from HPV infection because condoms do not cover all exposed genital skin. Most HPV infections have no signs or symptoms and are usually unrecognized.

HPV Vaccine WHO & WHEN:

HPV VACCINES Gardasil, a quadrivalent HPV vaccine, targets HPV types 6, 11, 16, and 18 [11] while Cervarix, a bivalent vaccine, targets HPV types 16 and 18. HPV vaccine is indicated for girls and boys BEFORE the onset of sexual activity.

Either vaccine can be administered to girls aged 11-12 years and can be administered to those as young as 9 years of age (15-16); girls and women ages 13-26 years who have not started or completed the vaccine.

The quadrivalent (Gardasil) HPV vaccine can also be used in males aged 9-26 years to prevent genital warts. Administering the vaccine to boys before the onset of sexual activity is optimal.

Remember HPV vaccine efficacy and safety in boys and young men helps prevention of genital ulcers and anal cancer, but also possibly prevents decreased transmission of HPV infection to female sex partners and potential for prevention of oral cancers.

Both HPV vaccines are administered as a three-dose series of IM injections over a six-month period, with the second and third doses given 1-2 months and then six months after the first dose.

Again, the clinical trial data of vaccine efficacy in men and women suggest that immunization with HPV vaccine is most effective among individuals who have not been infected with HPV. Thus, the optimal timing of HPV immunization is before sexual activity occurs. Therefore, vaccinate earlier rather than later!

July 3, 2012 at 2:32 pm Leave a comment

Childhood Obesity: Know The Facts

By Christina Payne, MD

Healthy eating habits should be established early with children to prevent obesity.

It’s time for your son’s 9 year-old check-up. He appears healthy,

but needs a physical form signed for camp. He isn’t due for shots and

hasn’t contracted anything more than a cold in the last year, so the

entire appointment seems unnecessary. As your doctor visits with you,

he expresses concern that your son is obese and discusses a nutrition

and exercise regimen to help the condition. He also suggests blood

work to evaluate cholesterol and blood sugar levels, which seems

premature to you given he is only 9. Although always appearing a

little “pudgy”, he has never given cause for alarm. He goes to P.E. three

days a week and plays outside on a regular basis. Lunch is eaten from

the school cafeteria and dinner often involves fast foods due to a busy

family schedule.

 

Childhood obesity is defined as a body mass index (BMI) greater

than the 95 percentile for age and gender. BMI is calculated as weight

(in kilograms) divided by height in meters squared. An overweight or

at-risk child has a BMI greater than the 85 percentile. Most physicians

calculate the BMI with their electronic charting systems at check-ups

for children over 3. Almost one in five children in the United States

is overweight or obese, this amount tripling over the past 30 years.

Therefore, obesity prevention and diagnosis is fast becoming a regular

part of health maintenance. Obviously, appropriate nutrition leads the

list of interventions to maintain healthy weight children. Guidelines

can be found online at http://www.mypyramid.gov. AHA nutrition guidelines.

Good nutrition along with regular exercise must be enforced to help

prevent obesity and its associated diseases.

 

Obese children have increased medical care usage when

compared to healthy weight children. They begin developing adult type

illnesses at a young age, often requiring medications still unapproved

for children. Type 2 diabetes, hyperlipidemia (elevated cholesterol),

hypertension, asthma, and fatty liver disease are the main medical

issues increased in obese children. Obstructive sleep apnea is 5 times

more likely in obese children compared to those at a healthy weight.

Orthopedic conditions and sports related injuries are significantly

higher in these children as well. Once present, most of these issues tend

to worsen into adulthood. Fortunately, weight reduction and a modified

lifestyle help reverse these problems. Obesity is definitely a major

problem to be treated by the medical community, but also a serious

public health issue as well.

 

Treatment of the obese child involves interventions in almost all

areas of life. Busy families may have good intentions but have difficulty

putting a physician’s recommendations into practice. The goal of

weight reduction therapy is to allow younger children to maintain their

weight as they grow taller, and older children to undergo slow weight

loss (around one or two pounds per month). Successful dietary plans

enforce portion control and food selection. One such plan called We

Can!, is sponsored by the NIH (http://wecan.nhlbi.nih.gov). More rapid

weight loss or complicated cases should involve a nutritionist. The

American Academy of Pediatrics Sports Medicine and Fitness

recommends 60 minutes of physical activity a day. To get this amount

of exercise definitely requires more time than school programs allow.

The entire family must be involved in the change, from the type of foods

kept at home to family time afterschool and on weekends. Studies have

shown that if just one parent is present for a sit down meal with the

family in the evening, those children are more likely to maintain a

healthy weight.

 

In conclusion, the topic of weight management and obesity in

children is a very sensitive topic, but its treatment is essential for a

healthy childhood. Patients like the boy mentioned at the beginning of

this article are rapidly increasing. As pediatricians, our goal is to

encourage healthy changes without making a child feel insecure or

develop other unhealthy eating disorders. Steady lifestyle modification

with progressive small changes in diet and exercise over time remains

the mainstay of treatment.

 

Nutrition Guideline for a healthy weight

  • Exclusive breastfeeding for 6 months and continued breastfeeding until at least 12 months
  • Limit dining out for meals
  • Limit sugared beverages
  • Eat breakfast daily
  • Eat a diet rich in calcium
  • Try to eat whole grains when possible
  • Consume recommended daily intake of fruits and vegetables
  • Allow a child to self regulate the quantity of food he eats within
  • the appropriate portion size
  • Have at least five family meals at home per week

 

May 9, 2012 at 8:01 pm Leave a comment

Should Your Child Eat A Gluten-Free Diet

By Christine Payne, MD

Should your child eat a gluten-free diet, check the facts before making the decision

When we shop for groceries, most of us check the nutritional facts for calories, protein, preservatives, etc. trying to provide the healthiest choices for our families. Should we also be looking for a gluten-free label as well?  In the last several years, gluten has come under attack as a culprit in many diseases. Currently, it has been scientifically proven to cause celiac disease and as one component in wheat allergy.  Many people are also convinced it can be a factor in other medical disorders as well.  Searching gluten sensitivity or intolerance on the Internet brings up numerous websites and blogs, their authors passionate about linking gluten to many illnesses. Testimonials abound proclaiming resolution of conditions such as irritable bowel disease and migraines to improvement in developmental disorders like autism and ADHD. Much of this informationin the media is currently unproven, and should be examined with caution.  The jury is still out whether the gluten-free diet is an extraordinary cure, or just snake oil.

Gluten is a protein found in wheat, barley and rye.  Celiac disease occurs when this protein causes an immune-mediated reaction ingenetically predisposed people.  This reaction destroys the lining of the intestine, resulting in the malabsorption of nutrients.  Affecting 1% of the population of the United States, it is one of the most common chronic disorders in children.  Issues range from the gastrointestinal symptoms of diarrhea, poor weight gain and abdominal pain, to other findings such as short stature, delayed puberty and arthritis.  Reliable screening tests are available for celiac disease involving blood tests for endomysial antibody and tissue transglutaminase.  Intestinal biopsy often accompanies the evaluation.  Children with chronic gastrointestinal symptoms, poor growth, or evidence of malnutrition should be tested.  Likewise, children with certain associated diseases should also be checked.  Treatment for positive individuals includes mandatory, complete removal of all gluten from the diet. This results in symptom improvement often in a matter of weeks. Referrals to a nutritionist and gastroenterologist are also important.

Intolerance or sensitivity to gluten is something else altogether.  It is a basket term linking gluten ingestion to a multitude of medical problemsin people with negative celiac disease tests. Many of these individuals still report improvement of many symptoms when going to a gluten free diet. In an effort to treat frustrating conditions like autism and hyperactivity, many parents place their children on diets free of gluten as well.  This is not advisable unless instructed by a medical doctor.  Altering a child’s diet in this way can lead to both inadequate calories and vitamin D and B12 deficiencies among other problems.  Although research is underway, currently the gluten-free diet as a treatment in children who do not have celiac disease is unproven and possibly harmful.

On a practical note, gluten-free diets are extremely difficult. Gluten is found not only in bread, baked goods and pasta, but is used in many foods as a thickener or filler.   Occasionally, a few products catering to this diet can be found in major grocery stores; but most of these items need to be purchased at specialty shops.  Determining what contains gluten on a restaurant menu is also next to impossible, making dining out troublesome. Understandably the foods taste strange to kids new to the diet.  My daughter described gluten free brownies as bitter and chewy, not to mention the mix was three times the cost of the regular Betty Crocker variety.

In conclusion, unless advised by your pediatrician or gastrointestinal specialist, a gluten-free diet should not be placed upon your child. If done inappropriately, it can be unhealthy not to mention extremely difficult for your child’s palate.  We have learned much about celiac disease in the last few decades.  Hopefully further research will shed light onto other gluten-associated disorders. Until then, following the good ole food pyramid with lots of fruits and vegetables is usually the best option.

May 9, 2012 at 7:54 pm 1 comment