Pediatrician Practice

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06/07/2019

Infant nutrition in the first year of life – what types of foods to avoid in this age?

First year of life is called infancy, in the first half or the first 6 month the main foods are milk preferably breast milk and vitamin D. In the second half of the first year milk is still the main nutritional need but complementary foods are also started because only the milk is not enough for all the babies nutritional need, vitamin D is still needed and iron is also added to the daily need of the infant , because infant is growing fast needing more iron and may develop iron deficiency anemia which effects his growth and development.
It is very important to remember not to start any foods before completion of 4 month because infants gastrointestinal tract cannot digest any foods except milk and chance of getting to allergic problem increases. The following are the foods that have to be avoided in the first year of life:

• Spinach: which is leafy vegetables and contains large amount of nitrate which by nitrate converting bacteria in gastrointestinal tract will be changed to nitrite. Nitrite interferes with transportation of oxygen by red blood cells resulting in cyanosis or a serious condition called “blue baby syndrome”.
After the first year as the child grows, there is more hydrochloric acid produced in the stomach which destroys the nitrate converting bacteria, so spinach can be given after the first year of age.

• Honey: It may contains spores of bacterium called clostridium botulinium which can germinate in the baby’s immature digestive system and cause infant botulism which can be potentenially fatal . The symptoms of botulism start 8 to 30 hours after eating the honey are constipation ,muscle weakness and loss of head conterl, difficulty in swallowing and drolling .Botulism if not treated quickly it can be fetal and it may take 10 days to several month for some one to recover fully.Treatmen is through interavenous fluid,nasogasteric feeding and an antitoxine called botulism immunoglobulie intervenous(BIDIV) whch should be given as soon as possible
Normal cooking at 70 degree for 2 minutes can kill botulinium bacteria but not its spores and in order to kill the spores sterilization process equivalent to 121 degree for 3 minutes is required.The botulinum toxine itself can be inactivated rapidly at temperature greater than 80 degree.

• Egg White: Inspite of egg yolk, egg white contains four proteins which are highly antigenic and may cause allergic reaction. Other food stuff that may cause food allergy in infants are peanut, tomato, wheat. Citrus fruits and strawberries.

• Cow’s milk should not be used in the first year because of its high content of protein and salt which makes its digestion very difficult. It also does not have enough amount of minerals and vitamins needed for the infant’s good growth.

Dr. Hossein Sardarizadeh
Specialist Pediatrician

15/10/2018

Radiation Risk of Taking X-ray and Scan in Children

Questions: Is there any risk in exposing children to x-ray? My child is coughing for last 2 weeks and my pediatrician ordered a chest x-ray for him. Is it completely safe?
Answer: When your child is ill or injured you want to do whatever the tests is needed as soon as possible. Sometimes this test like x-ray or CT scan exposes child to radiation which can link to cancer later in life in some individual, especially the growing child is more sensitive to radiation. There is no doubt that x ray and scan are helpful and even sometime life saving but no one should be expose to radiation that is not wisely ordered and benefit of the test should outweigh the risk of radiation exposure.
So before any imaging study is done for your child you should ask several questions from your doctor:
1. Does this imaging test uses radiation; does he really needs this imaging test? And if yes what type?
2. Are there any options or alternatives like ultrasound rather than using ionizing radiation?
3. If the test ordered is a CT scan which exposes the child to much more radiation compared to a simple x-ray, parents should consider going to a children hospital rather than a general hospital which are more likely to adjust the scanner to deliver a child size dose of radiation for that particular image. It is very important to use the lowest dose possible when scanning a child.
The amount of radiation exposure depends on the type of imaging test used, for example a single chest x-ray exposes a child to about 0.1 mSv (millisieeverts which is a measure of radiation exposure). This is about the same amount of radiation people are exposed to over the course of about 10 days naturally or a mammogram exposes a woman to 0.4 mSv which is the amount of a person should expose in nature over 7 weeks and a CT scan of abdomen or pelvis can expose a person to 10 mSv. Radiation exposure to all these sources can add up over the life time and increases the chance of cancer in future. So in any child that may need to be exposed to radiation or x-ray, is better to reconsider its necessity or at least to see if other imaging test which uses no radiation like sonography or MRI can be substituted. Dental x-ray is one of the lowest radiation dose and a routine exam which include 4 bitewings is about 0.005mSv, which is less than one day of natural background radiation or about the same amount of radiation exposure from a short airplane flight (1-2 hours). American Dental Association also recommends the kids and teens get bitewing x-ray not more frequent than every 6-12 months if they have cavities, of course the frequency depends on medical and dental history and current condition.
One way to lessen repeated exposure of children to unnecessary radiation is to concentrate on clinical skill of the physician like taking a good history of patient, a good physical examination, and sometime keeping the child in the hospital for few hours of observation before submitting him to radiation if clinical situation permits. Follow up of the case during period of observation may also help to choose a better option and save the kid from receiving unnecessary radiation. This type of thinking along with parent not wanting an answer right away and putting too much pressure on the doctor can be very helpful.

DR. HOSSEIN SARDARI-ZADEH
PEDIATRICIAN

06/09/2018

IS INFLUENZA VACCINE A MUST FOR CHILDREN ?
Many parents ask if influenza vaccine is absolutely needed for children or is infleunza one of the basic vaccines that the child should receive.
The answer is yes, influenza is a serious disease and children need to receive it once a year during cold season from October to March. Influenza virus is more pathogenic in two extreme of life, in small children and old ages .Every year many children die in different countries because of not having enough immunity against influenza viruses , they develop lung infection ( broncho pneumonia) and other complications like ear infection and sinusitis specially kids less than 3 years old.. It is part of routine vaccination program in some countries like United Kingdom and Finland.
There are many types of influenza vaccines but the one usually used in children and adolescents is an inactivated vaccine that covers for 3 strains of influenza viruses giving protection 2-3 weeks after vaccine given. It is recommended for all individual aged 6 months and above unless child is febrile or suffering from an acute infection. There is no age limit for receiving the vaccine and the one used used in older age above 60 has added adjuvants which makes it stronger to more enhance the immune response.
Side effect is rare and mostly is the cold symptoms which disappear in 1-2 days. It can be given to all pregnant ladies at any time and during breast feeding too which apart from protecting the mother it will help for transmission of transplacental antibody and protects the baby. If mother is not protected, influenza viruses may cause premature delivary,still birth and even neonatal death. Influenza vaccine is absolutely needed in high risk children with special conditions like brachial asthma, chronic pulmonary or cardiac diseases and those with Immune suppressive disorder.
Dr.Hossein Sardarizadeh
Pediatrician