Manuel Medical Clinic's Blog

Immunization during pregnancy

May 28, 2016

​Most important vaccines during pregnancy! There has been a reluctance to vaccinate pregnant women because of prevalent misinformation. Here are the two vaccines all pregnant women should receive: Influenza Vaccine: Why is it important? It is significant because babies get antibodies transferred from mother when mothers receive flu vaccines, and flu vaccine offers protection to newborns who are vulnerable to get flu during the first six months of age; as flu vaccine is approved for infants only after six months of age. Flu vaccines also protect mothers from contracting severe degree flu infections. Severe degree flu infections are reported to be associated with a high degree of still births, premature deliveries, and increased chance of autism. In short, it is important for all pregnant women to receive flu vaccine. Tdap Vaccine Vaccination to prevent whooping cough, Tdap, is another very important vaccine during every pregnancy. This is usually given between 27 to 36 weeks...

Autism in children

May 24, 2016

Autism, an issue of grave concern: Powlin Manuel MD, MS (Psychology). Message of hope for parents with autism! Most parents are extremely discouraged when the diagnosis of autism is presented. This is especially true for parents of a young child. For more information Click here.Reason for optimism for parents of chidlren with autism The optimistic side of the story is that fact that:children with autism get better in their performance over period of time as they get older! Eye contact develops later! Language issues – such as echolalia seen as repeating other’s statements vanish! Proper language usage is achieved as they grow! Reading skills will develop as they grow older! Repetitive compulsive behavior reduces in frequency! Abnormal food aversions slowly disappear! Sensory hyper-sensitivity (intolerance to loud noises) diminish! Behavior issues such as abnormal level of tantrums get better!  Autism is a disorder of mind,  more common in males, characterized by impaired...

Poison Ivy Contact Dermatitis

May 21, 2016

​  Contact dermatitis is caused by an allergic reaction to a chemical present in leaves, flowers, plants, or chemicals in a product. Contact allergic reactions are different than acute reactions in their mechanism. Contact allergy causes skin rashes in about 48 to 72 hours after exposure. Migration of immune cells to the area of contact and release of products of inflammation lead to redness, itching, swelling, and at times pustules appear around the area of contact. Poison ivy is one of the most common causes of allergic skin reaction in USA. The skin reaction due to poison ivy allergy is known as poison ivy dermatitis. People with allergic to poison ivy can also experience a reaction also to poison oak, mango, cashew, and Ginko. Poison ivy plant is identified by leaves being in groups of three or more leaves. It is important to be able to recognize the plant so that you can avoid exposure to them. The plant starts appearing in spring and continue to be there until late fall as...

Allergens in May

May 19, 2016

What triggers allergy this month? There are many flowering plants in May. Many of them do not induce allergic reaction. May being Asthma Awareness Month, we examine the allergens that induce asthma attack during this month for example Logustrum. Ligustrum is a common hedge plant often used in landscape developments. The shrub grows to a height of about 20 feet and is identified by its oval leaves. Ligustrum is in bloom during the month of May in Southern United States, carrying white flowers with pleasant smell. It may bloom in early summer in the northern region. There are different species of ligustrum, Ligustrum lucidum, Ligustrum japonicum, Ligustrum obtusifolium, Ligustrum ovalifolium, Ligustrum quihoui, Ligustrum sinense, and Ligustrum vulgare. Many individuals are allergic to ligustrum pollen. When inhaled it can trigger symptoms of a runny nose, blocked nose, itchy eyes,  cough and wheezing.  

Asthma and Vitamin D

May 12, 2016

Vitamin D and Asthma: Powlin Manuel MD, MBA, MS May being declared as Asthma Awareness Month, we will continue to examine various aspects of asthma especially understand factors that could be useful in prevention of asthma attack. Can Vitamin D be helpful in reducing the severity of asthma? Vitamin D is involved in influencing functions of many cells in our body. Adequate levels, more than 20/ml is helpful to maintain and lower levels of Vitamin D (<12/ml) is found to be not good for asthma control. Vitamin D influences cell function by affecting gene expression, program that controls functions every cell in our body. Maternal intake of Vitamin D can result help in children having less incidence of wheezing during the first three years of life. Vitamin D is related to asthma activity according to some studies. Vitamin D intake has also helped to improve the beneficial effect of steroid treatment in asthma. http://www.cdc.gov/asthma/world_asthma_day.htm  

Do women suffer from asthma more than men?

May 11, 2016

Asthma in Women: Powlin V. Manuel MD, MS, MBA. More women than men develop asthma symptoms as adults. One reason behind this increase in incidence of adult-onset asthma in women is the development of symptoms around the menstrual periods. The severity of symptoms of asthma is also higher in women around the premenstrual periods (52%). This is high compared to men experienced severe asthma in only in 30% of self-reported incidence of adult-onset asthma (Rao, C.K. et al, 2013). Asthma is a disease of the airway in which contraction of the tubes of the respiratory system occurs in response to many factors. Apparently hormonal changes can affect the sensitivity of airway to external factors. Allergic reaction to inhalant allergens is one of the triggers. Other triggers to include are: changes in temperature, humidity, barometric pressure, immune response to infections and irritants, and as the current report suggests, the response to hormonal changes. More aggressive treatment of...

Tree pollen and asthma

May 10, 2016

​Why is asthma getting worse now in May? Tree pollen allergy is one of the main triggers in spring. Pecan trees for example, start producing the flowers in April and continue with pollination in May. The trees are identified by its long sickle shaped leaves, with pointed tips. Pollen is associated with sinus symptoms - sneezing, blocked nose and post-nasal drip in patients with allergy, and increases chance of asthma attacks. Patients with asthma and allergies carry a certain type of cells of immune system known as Mast Cells in higher numbers in their bronchial tubes compared to those who do not suffer from allergies. Mast cells have a mechanism of releasing neurochemicals such as histamine in the airway on exposure to allergens, which leads to bronchospasm and an asthma attack. Research studies using recent technology to identify genes related to mast cells have shown that in certain patients with allergies, this gene is more prevalent, the patients suffered from more...

Latex Allergy and Skin Rash

May 10, 2016

Recurrent skin rashes? Latex allergy could be one reason!Latex Allergy: Powlin Manuel MD, Board-certified allergistThough not common, latex allergy can be a bothersome problem causing dermatitis on contact. Rubber gloves, brassieres, shoes, girdles, contraceptives are the usual sources. Many components of gloves and shoes reactions are really bothersome for those who need to get exposure at work causing very unpleasant skin allergies. Rubber sensitivity can be a direct cause of persistent dermatitis. If you already suffer form eczema latex can cause a flare up.Patch testing for to diagnose allergy to rubber-related products causing dermatitis.Visit us at www.Facebook.com/pediatricallergist for information on allergies.

Dust Mite Allergy and Asthma

May 18, 2015 Dust Mite Allergy and Asthma

Dust allergy is one of the most common triggers of asthma. If you are allergic to dust the following symptoms are noticed on exposure to dust:Blocked noseStuffy noseSneezingRunny noseItchingCoughWheezingFor many individuals, suffering from asthma dust often triggers an attack of asthma. This could be due to dusts acting as a trigger from irritation of the nerve endings lining the airway tubes, as well as nostrils or an allergic reaction to different components of dust. Most of the dust particles are filtered and kept in the nose and sinuses and are thus prevented from entering the lower airway. Once trapped in the nose, sneezing is triggered resulting in forceful expulsion of dust particles. Sudden production of mucus is one way to wash away the dust particles trapped in the nasal passage. Further entry of dust particles is reduced by blockage of the nose due to swelling of the mucosal lining. Entry of dust particles in the upper airway and sinuses may induce a contraction of the...

Spring, wild flowers, and allergy

May 18, 2015 Spring, wild flowers, and allergy

​Spring, wild flowers and allergySpring is very exciting because of the wide variety of flowers that add to the beauty of the natural landscape. Even wild flowers contribute to pleasurable experience of spring. Camomile is one wild flower widely present and flowering in spring.You can see them all over the open fields. Allergic dermatitis has been reported on exposure to camomile plants and camomile flowers. People who are hypersensitive to ragweed need to be careful of the exposure to camomile as it may may trigger symptoms of allergy due to cross-reactivity

Abdominal Pain and Kidney Stones in Children

May 18, 2015

One of the most common reasons why teenage children are brought to the office is abdominal pain. It is often difficult for parents as well as a pediatrician to decide whether the complaint is real (organic) or perceived (with no specific cause could be found)! Stress from school, whether due to academic challenges or social issues such as bullying, the complaint of visceral pain and absenteeism from school due to abdominal pain is common. At times, the reason for the pain could be the kidney stones. The following facts will help parents understand whether the pain is due to kidney stones: pains due to kidney stones are more likely if it runs in the family, and if there was a previous incidence of kidney stones. Kidney stones are more probable in girls. The most common type of kidney stone being due to calcium oxalate, drinking lemon juice daily can reduce the incidence of future formation of kidney stones according to some authorities.

Cypress and Cedar Allergy

May 18, 2015 Cypress and Cedar Allergy

Cedar AllergyCypress and Cedar Pollen Allergy: Cypress Tree Pollen Many of my patients have asked what is causing their symptoms at this time of the year. They suffer from exacerbation of allergy symptoms, includingsneezing, cough and wheezing in Febrary due to allergy to cypress and cedarpollen. While many parts of the country are facing extreme cold weather, inthe Southern United States cypress and cedar pollen is causing an earlypresentation of spring for those with an allergy to cypress and cedar.  

Immunization and Achieving Immunity

January 21, 2015

Immunization and Achieving ImmunityThere are always questions about immunization, especially amidst a flood of pieces of misinformation, widely present in the Internet. Many parents have a tendency to delay vaccination for one reason or another; many parents want the immunization to be not given at the same visit, as the schedule suggests. We come across this issue frequently. We advise that all required vaccinations be given at the same time. The reason is simple; that is if not given together, an interval of more than 30 days will be required between the administration of live virus infections for the best effect. The purpose of administering vaccines is to achieve immunity to the diseases that can be prevented. If not given at the suggested intervals, the effectiveness of vaccines may be diminished. It is best to give all immunizations at the recommended times in life.

Allergy in Winter

January 21, 2015

Asthma Cedar AllergyWinter is not the season usually associated with pollen allergy. However, pollen grains from certain trees appear in Winter, which can induce allergic reaction on inhalation leading to sneezing, wheezing, and triggering of asthma attack. Pollen grain from mountain cedar trees, which grows in abundance in the Southern United States is a predominant source of allergy in December.”The pollen appears copiously from late fall to late winter” inducing misery to patients with sinus allergy and asthma. Other Juniper species include red eastern cedar.Cedar AllergyTreatment for allergy to cedar pollen is basically allergy shots; pollen extract immunotherapy produces significant decreases in symptoms during the cedar pollen season. Patients experiencing worsening of allergy symptoms during winter may consult allergists for possible immunotherapy (allergy shots).Juniper allergy

When will children grow out of milk allergy?

January 21, 2015

Eczema of infantsMilk allergy  When will children grow out of their milk allergy?Milk allergy is a common problem; 2% to 3% of children are affected by it. While most children present with a mild degree of problems such as eczema and stomach complaints, rarely the milk allergy can cause serious reactions. Many parents want to know when their children will stop suffering from milk allergy.Research shows about 50% of children will get rid of their allergy to milk by five years of age. Another 20% will be able to tolerate milk products by five years even though they may show allergy to whole milk.The onset of milk allergy can occur very early as early as the first month of life. The symptoms are caused by immune changes in the gut in response to milk allergy. These changes can be due to the production of an antibody called IgE antibody or due to infiltration by immune cells causing damage to the intestines.The acute reactions which most parents are worried about, are IgE-mediated...

Practical problem with combining breast and bottle feeding

January 21, 2015

Combining breast and bottle feedingBabies refusing to continue with breast feeding when bottle feeding is also offered a very common problem many young mothers face. Many infants doprefer a bottle to breast. It is much easier to get milk from a bottle than having to work (suck) to get milk. Many mothers have asked this questionabout what to do. We recommend feeding from breast first for about 15minutes from each side, and then offer a bottle. If the baby is still hungry, heor she will take more milk from the bottle. If infants show a preference tobottle feeding, it is a good idea to feed from breast only for a few days andthen introduce a...

Fall Season and Allergy

January 21, 2015

The onset of fall season is associated with many colorful flowers. It is also associated with many flowering allergenic plants. Many individuals develop symptoms of allergy with the beginning of fall season. Ragweed pollen still predominates the pollen through the air, along with with grass and Elm Tree pollen.Along with many flowering ragweeds, you many colorful weeds carrying yellow flowers; these are golden rods; they are not associated with inducing allergy symptoms in fall season.Goldenrod:Golden rods are producing attractive flowers now in many deserted areas across the land. They add a nice color to panoramic view. Goldenrod can grow to height between about three to five feet. They carry bright yellow flowers and slender stems. The leaves are linear with serrated edges.Allergy tests are done for goldenrod as they are associated with symptoms of allergy. However, the pollen from goldenrod is not often air-borne as the pollen is heavy and sticky and is rarely carried through...

Allergy Alert: Ragweed Season

January 21, 2015

ragweedRagweedRagweed Season Alert!Ragweed AllergyWe are in the ragweed season now; At this time, ragweed pollen is the predominant allergen in the air; it a bad news for people with ragweed allergy. Ragweeds are very prevalent in USA, but the allergy symptoms occur only in the seasons at which the pollen are distributed in the air. There are different types of ragweeds: giant ragweed, short ragweed, perennial ragweed, southern ragweed, and canyon ragweed. Ragweeds are mostly distributed on pastures, open fields, and waste places. The pollen gets airborne and reaches areas near the fields in high concentration. Ragweed pollen entering the nose, most of them, are held back in the nose by filtering mechanisms of the nasal passage, If you are allergic to ragweed pollen, antibodies present in the cells of the nose put up a fight,resulting in release of a chemical called histamine in the nose. Histamine increases the blood flow to the area of contact. The glands of the nasal passage...

Treatment for Food Allergy?

January 21, 2015

Peanut s could cause an acute allergic reaction.Many patients seek advice from physicians concerning their food allergy.This could be due to an immediate unpleasant, often serious reactionfollowing consumption of some food, or due to a reaction occurring, hours todays after eating the suspected food. The most accurate diagnosis is anexperience of a reaction to a certain food, such as having hives and itchingimmediately after eating peanut or crabs. This scenario is good after theoccurrence of a reaction.Hives – peanut...

What causes allergy in May?

January 21, 2015

Allergic rhinitisMulberry PollenMulberry Tree May is the month inwhich mulberry treesstart pollination.Pollen of red andwhite mulberry, andpaper mulberry arereleased in  largequantities. Pollen ofred, white, and papermulberry are highlyreactive to those withan allergy to mulberrypollen. Red mulberryis native to the whole of Eastern  United States, while white and papermulberry are seen in the warmer regions of the country. Symptoms ofsneezing, blocked nose, and itchy eyes are very frequent when the allergenicpollen is inhaled or in contact with the eyes.Mulberry TreeGrass Pollen AllergyGrass pollen...

What causes allergy symptoms in April?

January 21, 2015

Iris Flowers?Iris is one of the very common ornamental plants in April producing beautiful flowers for a short duration. Iris flowers have been reported to be sensitizers related to skin reactions, contact dermatitis. Positive patch test reactions to iris flowers have been reported.Iris allergyGrass Pollen AllergyEarly spring is marked by green, and that means grass pollen in the air.Allergy to grass pollen is commonly associated with allergic rhinitis (sinusallergy) with sneezing and blocked nose, allergic conjunctivitis with eyewatering, swelling of eye lids, and triggering of an asthma attack. Grasspollen allergy is diagnosed by skin tests or blood tests. If allergy tests showpositive results and if the symptoms are worse during grass pollenseason,  allergy shots are prescribed to help develop a tolerance to grasspollen. Recently oral allergy treatment by sublingual route has been introduced.Grass pollen allergyPecan Tree Pollen AllergyPecan trees are producing the flowers  in...

ADHD, Aggressive Behavior, Defiance Disorder and Parents

January 21, 2015

Parent’s actions may contribute to children’s behaviorSeeing the ever-increasing incidence of behavior problems in children, such as ADD, defiance, and poor anger control, I have come to wonder whether some aspects of parenting is part of the problem. I will start with and example: a child while in the office, is climbing up and is about to fall from the examination table, running around and spilling water from the faucet; mother shows no concern and is busy with her cell-phone. This has become a frequent observation in our setting. Parents being very occupied with things other than parenting is a factor, the child never receiving a consistent model to follow, lacking a proper direction. After seeing children with ADHD for more than 35 years, the problem is getting worse. Single parents are always multitasking; this leaves very little time for parents to give enough attention they seek for. When the child feels a lack of concern, he or she may act out to get what the child...

​What is causing, sneezing and wheezing in March?

January 21, 2015

The number of patients coming to the office with cough, sneezing, and headache has increased substantially during this week in March. In addition to oak tree pollen and pine pollen, willow tree blooms add to symptoms of allergy. Willow trees are seen more in the wet areas; they have long pointed leaves. . These trees produce small yellowish greenish flowers, now appearing in the southern states.Allergy to willow tree pollen is common in the states where willow trees are present. The symptoms are produced by histamine and serotonin produced on the nose and sinuses of patients who are allergic to willow pollen. Asthma symptoms can also be triggered by allergic reaction to willow pollen. Allergy shots are available, which may help to develop resistance to willow pollen.Willow tree allergy Allergy causing pollen in March: Oak treeAllergy season is open in Louisiana in March. Based on the patients already presenting with an acute attack of sinus allergy and watching the trees blooming,...

Sinus headache in winter, not due to allergies!

January 21, 2015

Sinus headacheSinus problems with congestion of the nasal passage and headache are very common complaints in winter. Many patients will show up in an allergy clinic with headache to rule out allergies. Even though allergy is a common cause of sinus congestion and headache, in winter it is usually not the case. In winter in most of the country pollen and mold are not present in the air. During this time of the year sinus headaches are associated with dryness in the environment, especially with the heater being used. Use of humidifiers may be of help in this situation. Saline nose spray also helps to keep the sinus passage from the effect of dryness.

Tips to reduce fall as you age

January 21, 2015

How to prevent dizziness and fallTips to reduce fall in when you get up from bed:Average Americans live for about 80 years. That is pleasant news thanks to our better nutrition and the excellent doctors. However, as we live longer, many of us develop the problem of dizziness when we stand up from lying position. The chance of fall increases in the aging population; fall can make our life miserable due to increased chance of fractures as age. This is due to a sudden decrease in blood pressure when we assume supine position, and thus reduced blood flow to our brain. How do we reduce the chance of dizziness and fall as we get older? Galicia, G and other researchers (2013) found that if we do some exercise while lying down before we get up by performing “10 full extensions of lower limbs starting from 60⁰ flexion of hip and 90⁰ flexion of ankle joints against resistance,”  the fall in blood pressure while standing up could be reduced....

Sleep and Health

January 21, 2015

All of us know that we need sleep; and we feel lousy without enough sleep. When we get a good night sleep, we feel great, and we are ready to meet the challenges of the day. I always wondered how lack of sleep makes feel the way I feel, lousy. Scientists Lulu Xie and other researchers (2013) found explained that sleep natural sleep facilitates the elimination of chemicals that accumulate in the brain during the wakeful hours of the day and clear the brain of the toxins through exchange with the cerebrospinal fluid of the brain. This could be thought of a mechanism similar to our kidneys removing the chemicals from our body to keep us healthy. Remember to get as much sleep as possible…do not lose sleep just to watch movies…bad for brain!http://www.sciencemag.org/content/342/6156/373

Divorce and Children

January 21, 2015

During my practice of pediatrics for  38 years, one event that emotionally haunt many children perhaps is the divorce their parents. Being unable to cope with the differing mind-set of their parents, many unpleasant emotional states, mainly anxiety, become manifest. I try to reassure the children that it is not their fault; their parents are moving in different directions, and that, more than fifty percent of other children also face the same problems in their lives. Parents failing to fulfill their dreams and goals with the first partner in life, go on to settle their lives with a new partner, without knowing the that the second marriage results in divorce sixty percent of times. We, as a society, have not figured out what causes such a common incidence of divorces in families. Studies have shown that “abundance of and strengths in relationship” between couples is related to “both partners being independently secure and have feeling of worth even when not...

Penicillin Allergy

January 21, 2015

Penicillin allergy, not as common as people believe!Many patients come to our office with a history of penicillin allergy; they have been avoiding penicillin for a long time. The incidence of penicillin allergy is very low; carrying the label of penicillin allergy results in the use of many other stronger and more side-effects. Research shows that even though about 8% of population claim to have penicillin-allergy, merely a fraction of them is truly hypersensitive to penicillin – actually just one in fifty reported cases was really allergic to penicillin.

Teenagers and Fainting Attacks

January 21, 2015

As a pediatrician in practice for about 40 years, I have seen many teenagers brought in to the office for because of a fainting episode. This causes a panic in school, in office, and in churches while watching the services. We know from our experience this is not usually a condition to worry about.  It is often due to reduced flow of blood to brain because of loss of nerve control that regulates blood flow to brain and the children do fine once they lie down for a little while and restore the blood flow to brain. However, there are situations in which case there could be a heart defect which goes undetected resulting in occasional serious harm. Tretter, J.J. & Kavey, R.W. (2013) in their research found the following which help us differentiate a serious condition from the usual sycope that occurs in children: is safer if the fainting is not related to exercise, if there is no family history of heart disease, if the physical examination by a doctor is normal, and if the EKG is...

Fruits and Diabetes

January 21, 2015

​Are fruits good or bad?Physicians as well as patients are often confused about the role of fruits and fruit juices on their diet. Patients sometimes ask whether they should avoid some fruits that could be associated with diabetes. Is it good or bad in with respect to development and management of diabetes? Muraki, I et al, (BMJ 2013;347:f5001) shed light on the role of fruits and its association of the risk of developing type II diabetes. In their follow-up of thousands of men and women Muraki et al, found that the association of type two diabetes “differed significantly among individual fruits.” The authors state that increased consumption of blueberries, grapes, and apples are associated with a lower risk for type two diabetes. The authors caution that higher intake of fruit juices is associated with higher risk for diabetes.http://www.bmj.com/content/347/bmj.f5001

Probiotics and antibiotics

January 21, 2015

Probiotics do not seem to afford protection when using antibiotics: ​Probiotics have become very popular recently because of the media attention about its benefits. Many patients request probiotics because of the increased awareness of its perception of benefits in maintaining better health while taking antibiotics. In a recent study, Allen, S. J. et al, 2013, found no benefit in use of probiotics when studied for its effectiveness in controlling “diarrhea severity, frequency of abdominal symptoms, length of hospital stay, and quality of life.” We may be wasting money by taking probiotics along with antibiotics. Visit for further information:http://www.sciencedirect.com/science/article/pii/S0140673613612180

Anxiety Disorders in Children

January 21, 2015

​Anxiety disorders are very common in children. In my practice of over 40 years, I have seen anxiety disorder  in children manifesting in many different ways. It can include issues such as going backward on toilet training to having severe stomach pain in the morning . Often it is hard for a pediatrician to tell the parents that the symptoms are due to an emotional issue, as they refuse to accept the suggestion. The anxiety disorders encountered in our daily practice include:Acute stress reaction causes anxiety in many children, usually last for less than 30 days. Common situations we encounter in children  include death of family members or friends, and divorce of parents. Any stress can can induce an acute stress reaction; children usually handle these situations and come out after finding a resolution in their own mind. One of the common situations we find are acute stress reaction after the school opens, the symptoms showing up as headaches, abdominal pain, and chest pain....

Why you should tests for ADHD early?

January 21, 2015

​After being in practice for almost 40 years, I still see children being brought into the office for evaluation of ADHd for the first time in their teenage years. There are many reasons why parents postpone the tests for ADHD – many deny the fact that ADHD exists; they refuse to think that their child is suffering from ADHD. You should do the tests early if the teachers point out that the child may be suffering from ADHD. If ADHD is the reason for the teacher’s concern, denying the diagnosis and treatment puts the child in a difficult position for the following reasons:If not treated, the children are not able to concentrate and miss out on the instructions provided in school leading to academic failures – leading to perception of being not as good as other students and negative self-esteem. If not treated, the children with ADHD cannot take control over the requirements of situations, unable to inhibit impulses and sit quiet in a class room, and being labeled as disruptive...

Omega- fatty acids, prostate cancer, and heart disease

January 21, 2015

Think twice before spending our hard-earned money on omega-3 fatty acids!​We spend our money eagerly on buying omega-3 fatty acids with the hope that these will help to protect our heart and other reported health-benefits. There was a recent report from research studies that additional consumption of omega-3 fatty acids did not prevent heart disease. A new report by Brasky, T.M. et al (2012) casts additional doubt on the wisdom of consuming omega-3 fatty acids – the researchers found that higher levels of omega-3 fatty acids are associated with prostate cancer.http://jnci.oxfordjournals.org/content/105/15/113

Eggs, heart disease and stroke

January 21, 2015

All these years we were told not to eat eggs as it can increase the cholesterol and thus chance of dying from heart disease and stroke.  The logic behind this recommendation is based on the fact that egg contains about 200 mg of cholesterol each, and the American Heart Association suggests that we do not eat more than 300 mg of cholesterol per day. Being a patient with coronary heart disease it came as a pleasant surprise when Rong, Y et al (2013) reported that we could eat one egg per day without risking a chance of heart disease or stroke <http://www.bmj.com/content/346/bmj.e8539>. The authors showed that egg consumption was not associated with heart disease or stroke except in patients with diabetes.

Calcium supplements waste of your money?

January 21, 2015

There has been a recent trend towards buying calcium supplements with the idea that it will help to promote bone mineral density, especially in the elderly, the growing population. This idea is promoted by the increasing reports of fractures in this population as well as the advertisements on products such as Tums. A recent research by Anderson, J.J.B. (2012) showed that there is very little connection between calcium intake and bone mineral density regardless of age and sex. We may be wasting money on calcium supplements.

Low-fat diet is the way to lower weight

January 21, 2015

Many of us are confused with the conflicting reports on different diets and weight loss. While lower total calorie intake is important to prevent obesity, research by Hooper, L. et al (2012) has shown that greater reduction in fat intake is associated with greater weight loss. The authors found that lower weight, body-mass index, and lower waist circumference were associated with lower fat intake. <http://www.bmj.com/content/345/bmj.e7666>

Teenage muscle strength and early death

January 21, 2015

Lower muscle strength in teenage years related to increased risk for early death as an adult – Powlin Manuel MD, MBA, MSAs pediatricians, we find that the one-goal most teenagers have in common is to build muscles; they do all kinds of things to increase muscle strength and muscle mass. Psychologists have explained this as an expression of biologically driven need to compete with other teenage males for attracting females. There could be more reasons as shown by recent research. Ortega, F.B.et al (2012) reported that low level of muscular strength in adolescence is associated with all cause premature mortality due to heart disease and suicide. Maybe, it is the drive for survival that motivates the teenagers to build muscle strength.

General health checks, waste of money?

January 21, 2015

Physicians have traditionally recommended general health checks with the goal of early detection of diseases and attaining a better life outcome. A recent study by Krogsboll, L.T. et al (2012) suggested that general health checks had no effect on mortality, work absence, or disability. The authors recommend that moneys be spent not on healthy physicals as they do not contribute to lower mortality or morbidity. What are your thoughts on this subject?

Dangers of energy drinks

January 21, 2015

As a pediatrician, in practice for 40 years, it bothers me to read the reports about the deaths related to consumption of energy drinks by our teenagers and young adults.  A recent report from researchers in Sweden of 20 deaths (Howland, J. & Rohsenow, D.J., 2013) related to caffeine intoxication (a blood levels greater than 80 micrograms/mL) rings the alarm bell, as this level can be reached by consuming about 12 highly caffeinated drinks within a few hours. This is especially alarming as majority of college students have reported consuming energy drinks. The authors caution that mixing energy drinks with alcohol could be a deadly combination as it can impair judgment of your ability to take control of your own actions. The sad story is that many of these consumers are not aware of the hidden dangers of consuming large quantities of these toxic drinks at a very productive age in their lives.

Lack of vaccination and Whooping Cough

January 21, 2015

As immunologists, we like to see most of our children vaccinated; this unfortunately does not happen because of different reasons. We still see cases of whooping cough, which makes the life of patients and parents very uncomfortable. Misegades, L.K. (2013) found that the unvaccinated children were nine times more likely to suffer from whooping cough than vaccinated children: their study showed that lack of vaccination continues to be a major risk factor for whooping cough. Let us get all our children vaccinated and thus reduce the burden on our healthcare cost.

Wheat allergy, celiac disease or wheat intolerance?

January 21, 2015

In our office many patients come with complaints of diarrhea and abdominal discomfort relieved often by avoiding wheat. The question is if it is due to wheat allergy or chronic disorders such as celiac disease. Tests for celiac disease (such as such as serum antitransglutaminase and anti-endomysium IgA abtibody) are often negative in these patients. Tests for wheat allergy by skin tests as well as RAST test in serum for wheat allergy are also often negative. This would be considered wheat intolerance, a vague term used in the absence of wheat allergy and celiac disease.  Carroccio et al (2012) found that there are some patients who get better when they avoid wheat even though both allergy tests and tests for celiac disease are negative and the author suggests that some type of wheat sensitivity is present in these patients and they get better by eliminating wheat from their diet.

Breast and early solid feeding to prevent allergies?

January 21, 2015

There has been real confusion among parents about the advantage of breast-feeding and when to start solid foods. We (physicians) are responsible for the confusion as we keep changing the recommendation for introduction of solid foods. We used to advise parents to avoid early introduction in order to avoid allergies – the recommendation has changed recently.The following the latest observation based on the studies of Nwaru, B.I. et al (2013):1. Early introduction of wheat, rye, oats, barley, fish and eggs decrease the risk for asthma, allergic rhinitis, and atopic ensitization in childhood.2. Longer duration of breast feeding, but not exclusive breast feeding was protective against development of non-allergic asthma.The following is the recommendation of the American Academy of Pediatrics: Exclusive breast feeding for four to six months; follow it with introduction of complementary foods.We suggest based on the current findings published by the researchers, to stay with exclusive...

Can supplemental calcium be bad for you?

January 21, 2015

Many women are taking regular doses of additional calcium, some with added Vitamin D because reports of high incidence of osteoporosis after menopause. Michaelsson, K. et al (2013) reported that “high intakes of calcium in women are associated with higher death rates from all causes and cardiovascular disease but not from stroke.” The authors found the risk was higher with higher doses of more than 1400 mg/day. Women need to go less aggressive in their intake of total calcium from dietary and from calcium supplements.

Sugar intake and diabetes

January 21, 2015

The recent increase in prevalence of diabetes along with the increase in obesity would leave an impression that increased food intake could be the reason for higher prevalence of diabetes. The research by Basu et al (2013) suggests that it is the increase in sugar intake that leads to higher chances of diabetes rather than the total calories consumed. The authors say, “difference in sugar availability statistically explains variations in diabetes prevalence at a population level that are not explained by physical activity, overweight or obesity.” Let us cut down our intake of sugar and reduce the chance of embracing diabetes in the future.

Can olive oil and nuts reduce heart disease?

January 21, 2015

There are many conflicting reports on the value of different types of food in maintaining good health. The question of whether inclusion of olive oil and nuts in your diet (Meditereranean Diet) reduce heart disease was addressed by Estruch, R. et al (2013). The authors reported that among persons at high for heart disease “a Mediterranean diet supplemented with extra-virgin olive oil or nuts reduced the incidence of major cardiovascular events,” meaning that it is good for your health. Add some olive oil, add some nuts, thus add some pleasurable days to your healthy life.

Asthma and Daycare Connection

January 21, 2015

As specialists taking care of patients with asthma, we try to educate our patients about the factors that trigger asthma attacks.One of the most frequent triggers is exposure to allergies. In many children, less than one year of age cold virus triggers wheezing. The common viruses causing cold symptoms are rhinovirus and coronaviruses. Of this, rhinovirus seemed to induce wheezing in certain children with special genetic setup. Calskan M et al (2013) found that patients carrying a certain genetic setup (17q21 locus) when exposed to cold viruses have 26 fold increase in chance of developing wheezing. In the children at this age, allergy is not the most common cause of inducing wheezing, rather it is the rhinoviruses. That could be the reason for increased incidence of wheezing in children attending daycare centers.

When will my child grow out of milk allergy?

January 21, 2015

During my 36 years of practice as an allergist, many parents have asked me “the question of when my child will grow out of milk allergy? This is a condition that affects 3% of children, and the parents like to know the natural course of milk allergy. Wood et al (2013) found that by the age of five years, half of the children grew out of their milk allergy, and another 20% could have milk contained in baked products. This is important finding as we do not really need to drink milk after five years of age, but we need to eat baked products containing milk.

Asthma in women

January 21, 2015

More women than men develop asthma symptoms as adults. One reason behind this increase in incidence of adult-onset asthma in women is the development of symptoms around the menstrual periods. The severity of symptoms of asthma is also higher in women around the premenstrual periods (52%). This is high compared to men experienced severe asthma in only in 30% of self-reported incidence of adult-onset asthma (Rao, C.K. et al, 2013). Asthma is a disease of the airway in which contraction of the tubes of the respiratory system occurs in response to many factors. As we discussed earlier, allergy is one of the triggers. Other triggers to include are: changes in temperature, humidity, barometric pressure, immune response to infections and irritants, and as the current report suggests, the response to hormonal changes.

Asthma and Obesity

January 21, 2015

As specialists taking care of patients with asthma, we have noticed that obese patients with asthma feel more dyspnea than non-obese. The reason we assume, is the mechanical effort the muscles of respiration require to exert, to expand the lungs, especially in a fast breathing state associated with an asthma attack – muscle fatigue sets in early. Recent studies evaluated the severity of asthma symptoms in patients with obesity following surgery to relieve obesity (bariatric surgery). Following surgery when the patients lost weight, significant improvements in symptoms and lung function followed (Dixon et al, 2011). This was especially true for patients with asthma and absence of allergies.

Allergy and Asthma

January 21, 2015

​Identifying and managing allergies is an important step in taking care of patients with asthma; this, however, is not always incorporated into practice. Patients with asthma and allergies carry a certain type of cells of immune system known as Mast Cells in higher numbers in their bronchial tubes compared to those who do not suffer from allergies. Mast cells have a mechanism of releasing neurochemicals such as histamine in the airway on exposure to allergens, which leads to bronchospasm and an asthma attack. Research studies using recent technology to identify genes related to mast cells have shown that in certain patients with allergies, this gene is more prevalent, the patients suffered from more allergies, possed more cells related to allergy in their airway, demonstrated increased sensitivity of airway, and increased relief from using inhaled steroids (Corren et al, 2011 as cited in Wenzel SE, 2013).What does this mean to patients with asthma and their physicians? There are...

Why is asthma often difficult to control?

January 21, 2015

About twenty percent of patients with asthma are classified by physicians as difficult to control. While there are many reasons, one point that needs attention is the fact that allergy is not considered a triggering factor, and often nothing is done to assess the effects of allergens in the continuation of the misery; the patients continue to be exposed to the allergens. A large percentage of asthmatics with early-onset asthma (asthma starting earlier than 12 years of age) are skin tests positive on allergy tests. Seventy-five percent of patients with early-onset asthma in one study had allergies (Moore et al, 2010 as cited in Wenzel SE, 2013). Testing for allergies is easy, if you find anything, you are allergic to, you need to do something about it: avoid them, reduce exposure, or to immunize against them.

To Continue or Stop ADHD Medications During Summer Holidays? Powlin V. Manuel MD, MS, MBA.

January 21, 2015

The question of the use of ADHD medications during summer holidays has been a matter of debate. In our office, we advise parents to discontinue the medications during the holidays in order to reduce the chance of developing tolerance. The principal reason is that one of our goals -the main goal of treatment of ADHD – is to improve academic performance, and most often for these children not much teaching activity happens during the holidays. However, treatment with medication is not only for academic improvement. The other goals are: improving attention, improving control of impulsive actions, increase the ability to inhibit spontaneous behavior (thinking before acting), improved emotional regulation, and to decrease aggression. We continue treatment in summer holidays based on the need to fulfill these needs, based on the individual situation.

How do I get relief from my allergies?

January 21, 2015

As allergists, we get many questions concerning what one can to get relief from allergy, especially in spring allergy season. Basically, the question is what we can take without going to the doctor. It is all about the over the counter antihistamines.There are two categories of antihistamines, one old inexpensive but effective sedating and the new expensive non sedating ones. The sedating antihistamines available are Benadryl and chlorpheniramine and others. Claritin and Allegra are non sedating. Both groups of antihistamines are effective in providing relief from allergies; the second generation antihistamines, however, are much safer. For nasal blockage, you will need decongestants such as pseudo ephedrine in addition.

What is the earliest age the allergy tests are accurate? Powlin V. Manuel MD, MBA, MS.

January 21, 2015

Many parents are confused about what is the earliest age the allergy tests can be done. The confusion is made worse by the conflicting message provided by the pediatricians and family physicians. Allergy tests can be accurate at any age. When you should test for a particular allergy depends on the individual situation. In children with eczema, diagnosis of food allergy by tests earlier could reduce the progression of atopic disease, if the tests help us to avoid the allergenic food. Food allergy is very common in children presenting with eczema early in life. In my experience in my family, we tested one of our children with early-onset eczema at five months of age and found that she was allergic to milk. Avoiding milk since then made dramatic changes in her skin rash. I would advise the samefor any child.

​To continue or discontinue ADHD medications during the summer holidays? Powlin Manuel MD, MS, MBA.

January 21, 2015

Most parents like their children to be on ADHD medications during the summer holidays as they think that without medication, the life in their home will be in chaotic.  As a rule, I advise the parents to discontinue the medications during summer. The reason for this is simple; there is no dire need for increased attention when the school is closed, and no academic activity is going on. If you keep the child on medications without giving them a break, the child will develop tolerance to the effect of medications, and the physicians will be forced to keep increasing the dose, and the side effects are set in motion. The teachers cannot afford to be patient with the students as the hyperactivity will interfere with their work: the parents should practice some patients and try to tolerate the behavior of their children for their own good!

​ADHD or Oppositional Defient Disorder (ODD)?

January 21, 2015

Many parents report that the children with ADHD show anger, irritability, and at times plain defiance. These behaviors are more frequent in children with ADHD compared to other children. Oppositional Defiant Disorder occurs in 2% to 6% of children without ADHD.  Often these symptoms show up at the peak at the level of stimulant medication or when the medication wears off. However, there is another disorder, Oppositional defiant disorder (ODD) which needs to be considered as the management can be different. Child with ODD exhibit “a negativistic, hostile, and defiant behavior lasting more than six months; often lose temper, argues, defies, and deliberately annoys people, spiteful, and vindictive,” Miller, K.J., 2013). To label it Oppositional defiant disorder, four of the above symptoms must be present for more than six months.

Disparities in Health Care

January 21, 2015

As physicians we are aware that disparity in delivery of healthcare exists among different population groups such as ethnic minorities and individuals belonging to the low socio-economic group. I was surprised to read about the fact patients older than 65 years of age also receive inferior healthcare delivery. After paying all life for Medicare, it isdistressing to learn that we join minority and people of the lower socioeconomic group as far as receiving quality health care. Forty percent of a primary-care physician in a survey acknowledged the existence of healthcare disparities in their own practices, while 88% acknowledged its existence in general (Wenger, N.S., 2013)

Immune Functions and Faith

January 21, 2015

I listened to a lecture on “the aftereffects of spiritually transformative experiences” on behavior and outlook presented by Holden, J.M. (2013). Then it dawned on me that as immunologists often we ignore or fail to convey to our patients the effect of spirituality and religious beliefs on healing and efficiency of immune system. Researchers have shown that immune system activity is positively influenced by positive religious and spiritual expression. Improved activity of immune system has been documented in those with strong religious beliefs (Koenig, H.G., McCollough, M.E., Larson, D.B., 2001). It may be that having a strong spirituality and faith can make our immune system more efficient, and we can survive better.Powlin V. Manuel, MD, MBA, MS.

Vaccine Complications

January 21, 2015

While many claims of vaccine complications have no evidence, there are some complications based on the report of the Institute of Medicine. Following complications are based on evidence. Chicken pox infections have occurred followingimmunization with varicella vaccine. Allergic reactions (anaphylaxis) to varicella vaccine, influenza vaccine, hepatitis B vaccine, tetanus and meningitis vaccines, HPV vaccines are evidence based. Joint pains in children with MMR vaccines have been recorded.

Preventing Whooping Cough in Adults

January 21, 2015

Whooping Cough Prevention is Adults: Powlin Manuel MD, MBA, MS.One of the common causes of persistent cough in adults is an infection called Pertussis (whooping cough). This is interesting because it has been a preventable disease on the rise recently. In Colorado between 1997 and 2000, research showed that refusal for pertussis vaccine was associated with 23-fold increased risk for pertussis risk (Tempte, J. L., 2012). Many patients do not know that there is a new vaccine, Tdap, which is very safe for adults, and this can prevent contracting whooping cough in adults. Ask your doctor about Tdap vaccine for adults.

​Immunization and Parent’s Doubts: Powlin V. Manuel, MD, MBA, MS.

January 21, 2015

At Manuel Medical Clinic and Allergy Center, achieving maximum ideal immunization has been a goal for a long time. However, we have not been able to achieve our goals at full immunization of our patients. Parent’s reluctance has been the main factor. For example, measles is almost completely preventable by immunizing our children by giving MMR shot. Eighty-seven percent of incidence of measles has been on children who were not vaccinated (Temte, J.L., 2012). We advise parents to make sure that your children are vaccinated before they visit a foreign country where measles is prevalent.

Misconceptions about Immunization

January 21, 2015

Immunization and Parent’s Doubts: Powlin V. Manuel, MD, MBA, MS.At Manuel Medical Clinic and Allergy Center, achieving maximum ideal immunization has been a goal for a long time. However, we have not been able to achieve our goals at full immunization of our patients. Parent’s reluctance has been themain factor. There are many obstacles contributing to parent’s reluctance to comply with recommendations for immunization of their children. The concern for long term complication resulting from immunization is one main reason. There are many other myths about immunization, which are found to be base-less and are just assumptions. Contributing to the lack of compliance are the myths such as measles, mumps, and rubella vaccine contributing to autism, thimerosal being related to autism, and diphtheria and tetanus toxoids and acellular pertussis vaccine being related to sudden infant death syndrome. The real fact is that none of the above assumptions are true (Temte, J.L., 2012).Let...

Sinus Blockage

January 21, 2015

Allergy and Sinus Blockage: Powlin V. Manuel, MD, MBA, MSThis is time many patients come to the office with complaints of sinus congestion and blockage.You can get clogged up nose from congestion of the nasal passage which results in blockage of sinus openings. This can result from allergy as well as an inappropriate response to pressure and humidity changes. Blocked sinuses can result in infection leading to sinusitis of viral or bacterial origin. Bacterial sinusitis needs to be treated with antibiotics. Please see your doctor if needed.

Tinnitus and Allergy

January 21, 2015

Tinnitus and Middle Ear Fluid: Powlin Manuel MD, MBA, MS.Many patients come to our office with perception of sounds such as a continuous or recurrent buzz. They come to allergists as it is occasionally associated with fluid in the middle ear. Tinnitus is reported in as much as 15% of population (Chau, J, 2013). Though not caused by allergy, tinnitus can be associated with middle ear fluid, which is often associated with dysfunction of eustachian tube and allergic disorders. There are many causes for tinnitus, one of the most common being side effects of medications such as aspirin and ibuprofen. Stress and fatigue can also can cause tinnitus. Treatment of ear disease, and massage therapy are helpful. Talk to your doctor if the problem continues.

Preventing cold and flu through gargling frequently

January 21, 2015

Preventing Cold and Flu through frequent Gargling: Powlin Manuel MD, MBA,MS.Preventing cold and flu by Gargling!Most Americans do not practice gargling the mouth, while many Asians frequently have the habit of gargling mouth different times during a day. This practice of gargling has been shown to be effective in reducing the multiplication of viruses entering our mouth thus reducing the incidence of cold and flu. Kitamura et al (2005) showed gargling with plain tap water can achieve this result while other studies showed that gargling with half tea spoon of salt in 8 ounces of water reduced upper respiratory infections by 40% (Sonnenberg, W.R., 2013). Let us practice gargling frequently and give a break to our mucosal immune system!

Flu Vaccines and Ear Infections

January 21, 2015

Many parents still refuse flu vaccine for their children. Many pediatricians are also not aggressive in promoting flu vaccines as flu itself is not dangerous for infants and children. However, flu vaccines definitely help to make life easier for parents from one bothersome and frequent problem: ear infection in children. Influenza vaccine showed 32% reduction in incidence of otitis media (middle ear infection) in children 6-30 months of age in day-care centers (Sonnenberg, W.R., 2013). I would say that is an additional reason why parents should be encouraged to give flu vaccine for their children.New Information on Flu VaccinesNew information on flu vaccines as a result of different studies show that there is about 50% chance of suffering from Flu even after receiving flu vaccines. However, the most important and promising fact is that the chance of dying from complications of flu infection is almost eliminated if you receive flu vaccine. The disease you in those who are immunized...

Food Refusal Behavior: Powlin Manuel MD, MBA, MS (Psychology)

January 21, 2015

During my 36 years of practice, I find one phenomenon on the rise – the food worries about the food refusal by infants and children. The irony is that this happens at a time when the leaders of our cities, states and the country are at the same time working hard at reducing obesity – which has grown in an epidemic proportion.About 25-40% of normal children have some type of feeding disorder that requires medical intervention (Sondheimer, J.M., 2013). It is important to understand that the abnormal feeding practices and excessive interest or emotions on feeding expressed by the caretakers, parents, grandparents, etc. contribute to the continuation of the problem.How to deal with food refusal behavior? The following parenting tips have been helpful:Avoid unnecessary and even harmful feeding practicesAvoid weighing the child frequently,avoid excessive interest and emotional attachment to your child’s feeding such as clapping when the child swallows the food,  pretend crying and...

How early can an allergy tests be done?

January 21, 2015

Allergy does runs in the family. Many parents want to know how early an allergy test be done. Some parents are anxious to find out if an allergic reaction be prevented by doing some tests. We do not recommend doing any test for allergy in anticipation of an allergy in the future. Tests are recommended if the baby develops symptoms of allergy. If the baby develops eczematous rashes early, and if the parents have milk allergy, allergy tests for milk can be done at any age, based on the clinical correlation, to avoid milk. In that case avoidance of milk can reduce the chance of flare-up of eczema and other allergic symptoms.

Removing Concerns about Baby Shots

January 21, 2015

Having been in practice for about 40 years I find one issue that has not changed – the fear the parents have about immunization. The most common concern included: receiving multiple shots at one time, fear of autism, fear of thimerosal effect.Multiple shots: we try to give as many shots as possible to keep the schedule current; many parents worry about it. There is no increased risk due to simultaneous administration of many shots. Worry about autism: this is one worry that keeps alive – worry that autism is related to vaccination: several studies have shown that there is no connection between autism and immunization. Thimerosal (mercury) is another concern: there is no relation between thimerosal and any ill-effects; moreover, the fact is that most vaccines with thimerosal have been removed except for some multidose vaccines.Not taking vaccines carries many risks.

Obesity and Asthma

January 21, 2015

One of the main problems in obese patients who come to the office with asthma is the difficulty in deciding the role of obesity in the severity of symptoms. Clearly, obsese patients suffer from more dyspnea or feeling of shortness of breath compared to non-obese asthma patients. Dixon et al, 2011 found that obese patients with asthma significantly improved in their symptoms, lung functions, and brochial reactivity after they underwent surgery for weight reduction and managed to reduce weight. This was espcially true in those patients with low incidence of allergies. Weight reduction needs to be part of treatment in patients with asthma and obesity.

Hives following a viral infection

January 21, 2015

Many of our patients have concern about the odd-looking skin rashes that continue to bug them even days after the initial infection. Viral rashes could vary in nature from macules and papules due to chicken pox and mononucleosis to hives, which can last for a long time. Red itchy bumps suggest hives. Viruses come to our body, enter the cells of different types and take over the management of the affected cells just like a new manager. Our immune system reacts by antibodies to reject them, and will eliminate them. The problem is that it can take many weeks to years before they are succefully eliminated and we are free of hives. During this time antihistamines prescribed by your doctor can keep you comfortable.

Identifying Food Allergy

January 21, 2015

Food allergy is very common in children; without any doubt many pediatricians have come across of their young patients with ezcema getting worse with eating certain foods. Even worse situations are rare cases of acute allergic reactions to food and almost lethal reactions to milk. The questions becomes suspect when adults experience symptoms due to perceived reactions to food. During the 35 years of allergy practice many patients again and again presented the question of which is the best test for food allergy.The best way to check for food allergy is first to keep a diary and correlate the symptoms of discomfort perceived by you at your age. If food allergy is suspected, and if you do not know which food is causing the problem, skin tests for all food items will be practical. Blood tests for all items of food can be very expensive. When I say blood tests , I mean tests for IgE antibodies such as RAST tests. Many tests based on detection of IgG antibodies are not always clinically...

​Difficult Asthma: why some patients with asthma do not get better?

January 21, 2015

In my experience of treating asthma for the last 35 years, some asthmatics have difficulty in getting better, despite what we assume to be an ideal treatment. With new information now available about gene expression we are getting a better understanding of the type of patients who are difficult to treat.However, most often the following are the reasons why some patients do not achieve satisfactory control: not taking medications as prescribed, continued exposure to allergens, presence of sinus infection, presence of gastro-esophageal reflux disease, presence of nasal polyp, and presence of certain genetic setup including obesity, and smoking. Patients and physicians need to be aware of the reasons why patients do not get better despite a “good treatment.&quot; The more we know, the better we can take care of ourselves.

Tics or Tourette’s syndrome?

January 21, 2015

During my practice as a pediatrician for the last 38 years, I found that this is a nagging question in the minds of many patients. With my background in psychology, I try to have an overall look at this question.Tics or repetitive movement disorders are reported to be present in 5% to 20% of children (Koch, T.F., 2013).I see patient’s tics showing up vocal (repetitive sounds) and motor (repetitive movements). These can include: blinking of eyes, twitching of hands, shrugging of shoulders, sniffing, snorting, repeating words and others. Most of these children will grow out of this condition. as they become adults (75%). It could be temporary in many children often aggravated by anxiety and may get better within one year. If it lasts more than one year, it is considered permanent. It is called Tourette’s syndrome when it starts before 18 years of age, and present regularly, and causes significant impairment. The condition becomes of increased concern for parents when it is...

Whooping Cough (Pertussis) Vaccination

January 21, 2015

​Whooping cough or pertussis has been of recent interest for adults as well as children recently as infectivity of this organism in very high with almost everyone exposed can be susceptible to get the infection after exposure to infected individuals. It is important to know the new recommendation on the vaccination to prevent pertussis infection which follows:Pertussis Prevention:Immunization recommendations (Maldonaod, Y.A., 2013):There are two vaccines approved: Boostrix for childern 10 years and older, and Adacel for children 11 years and older. American Academy of Pediatrics reommends Tdap for 11 to 18 years of age and adults 65 years or older who anticipates contact with infants or those who has not received persutssis vaccines in the past.

Skin rashes in chilren

January 21, 2015

Skin rashes in children, often starting at very early, at the age of three months is truly annoying to parents and the infants. The most common cause is atopic dermatitis, or eczema. The skin is dry; the children start scratching, skin abrasion from scratch leads to infections; bacteria such as Staphylococcus grow on the skin; the body develops an allergic reaction to the products of bacteria, then you get worsening of the condition; you scratch more – the vicious cycle goes on repeating. Food allergy often contributes to worsening of symptoms.The most important issue to be addressed is adding moisture to skin by repeated application of moisturizing creams (not lotion). Creams such as CeraVe, or petroleum jelly, can be of real help if applied repeatedly and generously. Of course, allergens should be avoided, and infection needs to be aggressively treated.

Dogs and Allergy

January 21, 2015

Allergy to dogs is common, though less common than cat-allergy. Many patients love to have a dog even though the allergy tests show mild degree of allergy to dogs. In that case, it may be more desirable to have an out-door dog, if you have any chance of allergy to dog dander. When you have an indoor dog, it is likely that your sight reaction may become a larger problem. If you must have an indoor dog, go for the smallest dog such as Chihuahua, which has the least tendency to shed hair and dander. However, it is probably better not to invest in a dog even if the allergy test showed only mild reaction.

Eczema and Allergy

January 21, 2015

Many of patients and even many physicians are not aware that many patients with eczema suffer from allergy especially to food. In those situations often allergens cause a flare-up of the skin rash. Eczema is a very common condition; many pediatricians are familial with its management. Ask your pediatrician if you need to see a specialist; he or she will know whether the condition in your child is related to allergies, as is the case often. If so a visit with an allergist (who are very familiar eczema) will address the cause of exacerbation. Knowing what makes it worse helps.

Is it anxiety or asthma?

January 21, 2015

Many of my patients have problem deciding if they are having an episode of anxiety or a bronchospasm due to an allergy or environemtal factors. Patients ask me what they can do to exhale efficiently. Being an allergist with MS in psychology probably prompts me to suggest you to take some Yoga classes. The reason: anxiety causes a feeling of not being able to exhale, even though your lung’s tests tell me that you normally exhale fully. In allergy inducing a bronchospasm, the test will show less power to exhale. Yoga will train you to enjoy a normal breath and reduce anxiety. Even if you are a person suffering from asthma, the practice of yoga may help to strengthen your nerves and give relief.

Hives on contact

January 21, 2015

Hives on contact, known as contact urticaria is a frequent condition which makes a patient visit an allergist. Contact urticaria means hives in which agents such as plant products, raw fruits, vegetables, seafood, when in contact such as in occupation, cause hives. In children, contact with pet saliva, and in housewives, contact with detergents, soaps and lotions are the usual culprits. The most useful measure will be to identify the contact allergen, and stay away from contact if possible.

Tests for Herpes

January 21, 2015

​Herpes infection is very common, the most common being Herpes Labialis, which is also called cold sores. There are more serious herpes infections also. Patients are often confused about the test results they receive – IgM, IgG, viral culture etc. Negative IgM and negative culture suggest that there is no acute infection. Positive IgG shows that you have had past infection. There is another test polymerase chain reaction (PCR) which has been widely used recently. Tzanck smear shows the presence of herpes virus also. Rarely, more than one test is ordered by your physician – it could get expensive, though.

Mucus in Asthma

January 21, 2015

​Thick mucus has been a real problem for my patients with asthma.One common cause of difficulty in breathing in patients with asthma is thickening of mucus secretion which can plug the airway and result in worsening of asthma.Mucus thinning medications such as guaifenesin present in Mucinex and Robutussin has been very beneficial. One other item which I prescribe to patients is a mixture of Dyphylline and guaifenesin (Difil-G) which I find very useful to bring the secretion up because of additional dilating effect on airway.

Oral allergy Syndrome

January 21, 2015

Recently many patients have experienced an itching inside mouth after eating for no apparent reason. Itching inside mouth can result from different reasons from an allergy to yeast infection. A condition called oral allergy syndrome has been talked about recently. Oral allergy syndrome is a condition with itching in throat and mouth due to pollen associated food allergy in about 5% of population. If you are allergic to birch pollens, you may develop itching inside the mouth upon ingestion of fruits and vegetables. Eating cooked food can avoid symptoms.

How do you know if it is due to food allergy?

January 21, 2015

The best way to know if your symptoms are due to food allergy is to have a diary and write down the foods with worsening of the rash. Rash limited to legs and neck area alone are not usually caused by food allergy. Rash on area of contact and if it is recent you may suspect contact allergens such as poison ivy. It is not likely related to thyroid problems. Seeing an allergist is an option to rule out if your rash is due to allergies.

Celiac disease

January 21, 2015

Celiac disease has been getting a lot of attention recently. One reason is the development of accurate tests to make a diagnosis. One such test is IgA antitransglutaminase antibodies.IgA antitransglutaminase antibodies are 98% sensitive for diagnosis of Celiac disease. IgA antibodies as a whole are situated on the surface lining of intestines. IgA antibodies are like the guns mounted on the old fortresses to expel enemies – the first line of defense. In Celiac disease by mistake this antibody is directed against tissue transglutaminase and results in symptoms of Celiac disease.

Hepatitis B Tests

January 21, 2015

As immunologists we are asked questions about the blood tests result for hepatitis B especially concerning the antigen and antibody. Here is the explanation about the surface antigen and surface antibody: Hepatitis B surface antibody is an immune response to Hepatitis B antigen in serum, which appears 1 to 10 weeks after exposure to hepatitis B virus. Antigen means something that makes our immune system produce an antibody to fight. In acute hepatitis B infection, the virus is the surface antigen (detected in serum) leading to production of surface antibody, to expel the virus, lasting for life. There are many other components in the blood test results for hepatitis B; we discuss them one at a time.

Food allergy and food intolerance

January 21, 2015

Many patients are often confused about allergy to food and food intoloerance. Especially this is common with milk allergy and milk intolerance due to deficiency of an enzyme needed to digest milk. When call it allergy it means that we can demonstrate an IgE that our immune system produce to fight a food. When we call it intolerance, it means food does not agree but there is no evidence of an allergy. This is true for symptoms to wheat also. The common symptoms of lactose intolerance and wheat intolerance would be diarrhea and abdominal cramps, and blotting. Lactose intolerance induces the symptoms starting a few hours after ingestion. Wheat intolerance is a vague term, in the absence of wheat allergy (lack of IgE to wheat), can present similarly, while wheat allergy can induce symptoms of anaphylaxis with a rapid onset of symptoms.

Toys for kids with autism

January 21, 2015

​Kids with autism spectrun disorders have a tendency to be obsessed with certain activities.Interaction with these children at personal level is beneficial to stimulate their learning and adjustment to daily living. Many electronic toys with predictive outcomes by tapping on different buttons can promote their repetitive behavior and is to be discouraged. For an interesting article on this issue please go to http://autismwhisperer.net/2012/12/08/presents-and-autism-some-thoughts-for-the-holidays/

Jellyfish rash

January 21, 2015

Many patients come with a rash on their body after a visit to the beach, the rash being due to an encounter with jellyfish. Jellyfish sting while in sea is another common experience, many of us have gone through. The appearance of rashes due to jellyfish sting could vary from small to large hives like lesion depending on the size of contact and the extent of reactivity you have. There are 100 different species of jellyfish, and the appearance of rash can vary depending on your body and the body of the jellyfish. It is a reaction to the venom that enters the body.

Your antibodies: IgG and IgM

January 21, 2015

As immunologists we get questions about what does it mean to have IgG and IgM antibodies. IgG antibody levels indicate an immunity resulting from past exposure to an infectious agent such as virus or bacteria.IgM antibodies are produced during the acute stage of infection as these antibodies have multiple facets to fight infections. IgM antibodies being negative indicates that you do not have an active infection.These tests are done in serum samples.

Shell fish allergy

January 21, 2015

Many of my patients suffer from shell fish allergy. Often they are perplexed because they never had a reaction before. Red splotches all over the body after eating shell fish could be related to an allergic reaction to shell fish. It could be a late reaction. Even if you did not have a reaction in the past, you could have developed an antibody to shell-fish recently, thus reacting now. Avoid shell fish in the future. If you want to confirm the diagnosis, you could make an appointment with an allergist.

Loss of taste after viral infections

January 21, 2015

Patients often are worried whether they will get the taste back after they loose them after a viral infection of mouth.We appreciate a taste by chemical senses situated in the taste buds; our tongue has nerve endings with receptors for taste. These receptors react to sweet, sour, salts, bitter, and umami. Viral infections such as those causing canker sores may affect the nerve endings that send signals to the brain that interprets these different tastes. Our body has a capacity to replace these signal transmitting nerve cells, and you will regain your taste.

Beneficail Effect of Green Coffee Extract

January 21, 2015

There has been increasing interest on behalf of patients about the effects of consuming green coffee extract. Green coffee been extract possesses higher concentration of chlorogenic acid in coffee. Chlorogenic acid in research studies has been found to have blood pressure lowering effect, and also effect on inhibiting fat accumulation, and antioxidant activities. Farah, A., Monteiro, M., Donangelo, C.M., & Lafay, S. (2008) showed that when consumed chlorogenic acid is highly absorbed and metabolized in humans. I have not come across any publication citing drug interactions with green coffee extract. There are reported association between coffee intake and adverse pregnancy outcomes, including miscarriage, preterm birth, impaired fetal growth and development, and of fetal anemia. As far as diabetes is concerned high coffee intake have been associated with reduced risk for type 2 diabetes and impaired glucose tolerance indicating a beneficial effect. I would suggest to limit the...

Difference between Flonase and NasalCrom

January 21, 2015

Because of the repeated advertisements about different medications on television, people have questions about how different medications are used for the same conditions. We often get such questions concerning Floase and NasalCrom, both used for treating sinus allergies. Both Flonase and NasalCrom help to reduce inflammation.There are some differences in the way they reduce inflammation:Flonase being a steroid possesses a much broader effect by acting on many agents that are involved in causing the inflammation.Because they have a broader set of actions, they are considerably stronger than NasalCrom, which carries a narrower limited action in blocking just the set of chemicals belonging to the category of leukotrienes. Both effects and side effects are often smaller when you use NasalCrom.

Undersatnding what is wrong in autism

January 21, 2015

​I have had more questions about what is the connection between disorder of brain and autism than most other conditions. I have taken care of many patients with autism during my 35 years of pediatric practice. Having a Master’s Degree in Psychology and following the progress of these patients for many years from early childhood to being adults, have given me an opportunity to explain some of what is going on in these children.It has been a really difficult task to understand autism and its relationship to neurological structures; of-course, it is connected to brain function. Professor Wang at Princeton University (Wang, 2010) explains it in the most simplistic way that I could understand. Here is the content of what he explains: He attributes three regions in brain known as the insular cortex, the insula, and the amygdala, the regions of brain involved in feeling of fear and anxiety as well as feeling of emotional states in other people. These regions of brain are also involved...

Differentiating Chickenpox from other rashes

January 21, 2015

Chicken pox is a very common condition especially now, so also many other rashes.Parents are often at a loss to differentiate between the two. Children with Chicken may also suffer from fever, very often. You will see some rashes developing some fluid in them. This, along with a red base (skin) usually will suggest the diagnosis of Chickenpox. Chicken pox usually get better without any treatment children; it could be a dangerous condition in adults.

High Functioning Autism and Progress

January 21, 2015

High Functioning Autism is being recognized and diagnosed more often recently than ever before. I see many parents with many questions, and it is very disheartening not to know how the child is going to progress. The answer is still not clear as even among those diagnosed and categorized as high functioning; there is a wide variation in the cognitive functions. Most children with communication disorders are directed to programs such as Early Steps, which incorporate some therapies such as occupational and speech therapies, which do have a positive impact. If all the resources are utilized, and if the child gets early intervention, the child will catch at varying degrees based on the cognitive status (baseline ability for overall functioning).Powlin Manuel MD, MS (Psychology)For answers to more medical questions visit www.avvo.com.

Exciting research on food allergy and genetic link

January 21, 2015

Recently researchers could identify a specific gene related to immune system reacting against the components of egg. Because of nanotechnology a lot more detailed information about all aspects of genetic changes leading to diseases will be known to scientists. With introduction of DNA nanoparticle complexes, researchers have been able to read out mutations in DNA sequences leading to many diseases (Kelly, S., 2012). We are living in an exciting era of exploding knowledge.

Misunderstanding concerning circumcision in babies

January 21, 2015

Many parents are worried about the skin getting reattached to the margin of the glands-penis. There is no reason to worry about this because of the following is the reason: majority of people in the world do not do circumcision. There is a lot of misinformation about the skin around the glands. Many pediatricians ask the parents to pull the skin back even in babies who are not circumcised causing significant discomfort for babies, as well as emotional discomfort for parents. Normally only by six years of age the skin becomes loose enough to be pulled retracted, coinciding with the release of a small quantity of sex hormones. The reason for this is that there in no need for the skin to be pulled back. Many insurance companies do not pay for circumcision because it is considered an unnecessary procedure, the idea being that you cannot make anything more perfect on a routine basis than was designed by nature. The only justification in scientific community for advocating circumcision...

Estrogen cream and labial adhesion

January 21, 2015

As a pediatrician I often get questions about the use of estrogen cream for labial adhesion in little babies. Many parents are concerned about the side effects of the cream.Pediatricians vary in their practice styles; that means that there are different ways to practice. In my practice of the last 35 years, I have not come across any side effects by using the estrogen cream. However, I prescribe it only if the labial adhesion covers a significant area. Visit www.avvo.com for more answers to your medical questions.

Sinus or Allergies

January 21, 2015

​Patients often ask about feeling bad with sinus congestion and wonder whether it is due to allergies. Feeling sluggish and slightly feverish, and being tired are not the classical symptoms of allergy; those symptoms are more often due to viral infections, probably of the sinuses. Weather changes such as low humidity and and low barometric pressure can also cause sinus symptoms.Taking pseudo-ephedrine and other decongestants can relieve the symptoms of pressure due to congestion of the sinuses. How long can you take? It is taken on the as-needed basis. You have to be careful as it may increase blood pressure and is not advised for individuals with high blood pressure.

Belly Pain in Children

January 21, 2015

We often here about mothers talking about visiting specialists because the children talk the belly hurting. Children talk about belly hurting often. If the pain does not look significant, there is usually no serious problem – constipation could be a common issue. Please make a visit to your regular pediatrician, and do not worry about going to any specialist. If the pediatrician finds any reason to suspect a problem, he or she will refer you to a specialist, which is rare.For more answers to your medical questions, vist www.avvo.com.

Winter and Asthma

January 21, 2015

​For many patients changing weather in fall, when the temperature drops, is the time for asthma exacerbation. There has not been enough time for the body to get used to cooler weather and it induces a spasm of airway tubes leading to cough spell and asthma attacks. It is good to be protected from cold when the weather turns cold. In many patients with asthma cold can bring an attack of asthma. At times, it is the cool air they inhale that brings on an attack. Sometimes having a protection in front of nose and mouth to reduce the inhalation of chilly air would help.

Skin itching with no rash

January 21, 2015

Many times patients experience skin itching, often intense with no skin rash. When patients experience itchy feeling and no rash, it is unlikely that it is due to allergic reaction. Most allergic reactions on skin are accompanied by some type of rash. What causes itchy feeling? Occassionally, the most likely cause is the change in temperature, more likely the change in humidity (which usually drops with a drop in temperature). Hydrating the whole body with creams such as CeraVe usually gives good relief. Even using a humidifier in room could be of help.For more answers to your medical questions visit www.avvo.com

Wheat allergy or gluten sensitivity.

January 21, 2015

​Recently gluten allergy or gluten sensitivity have become a hot topic. Recent information is confirms the fact that this has been a condition which was not previously recognized, now diagnosed mroe often because of more reliable diagnoistic tests. Gulten allergy is as we define by allergy tests in not only allergy, as allegy tests may be negative. It is the result of more complex immune reaction. The following video segment may be useful for our patients:http://tvnz.co.nz/sunday-news/john-hudson-killer-wheat-5127083/video

When should you see an allergist?

January 21, 2015

People get one type of allergic reaction or another and often wonder when they should see an allergist. We tell our patients that it depends on how serious the reaction is. The severity of allergic reactions will tell us whether we need to investigate the cause of it now or later. If you have an acute reaction (anaphylaxis), it will be important to find out what caused it; that means that you may have to see an allergist. If the reaction was more like hives, then there is no need for rush work-up as the condition may resolve over a period of time. That is how you decide whether you want to see an allergist. Personal finance and whether your insurance will cover the expense also plays a role in that decision.Visit www.AVVO.com for medical advice.

ADHD in Girls

January 21, 2015

I have come across the question of why ADHD is higher in boys than girls. That is an excellent question! However, the answer is, ADHD is not more common in boys than girls; both suffer from ADHD without significant difference in incidence. The difference is in the hyperactive manifestation of ADHD; the boys move around more than girls; do more disruption to class than girls; during their teenage years when the testosterone kicks in, they become more aggressive than girls. The girls with ADHD have the same incidence as far as the attention deficit is concerned. However, attention deficit alone does not catch the attention teachers and caretaker and hence not reported and tests done by professionals. For more answers for your medical questions visit: www.AVVO.com.

Cat Allergy and Children

January 21, 2015

Children love cats, adults love cats, but what to do if your child develops allergy to cat? It is a very common problem. Symptoms of sneezing and skin itches get worse. Ever a bigger problem is when an attack of asthma is triggered by the presence of a cat.What can you do? The best option is not to have a cat. If that impossible, do the following:Give frequent baths to cat will help.Keep the cats away from bed room strictly.See an allergist for allergy shots to make the child develop tolerance.

Recurrent cough and Allergy

January 21, 2015

Cough lasting for two months needs to be investigated; that means you need to see your doctor. If you have family history of asthma and allergy, chronic cough with itching could be due to allergies. There are many other causes of recurrent cough depending on your age. If you are free of cough in between those days of cough, it is less likely to be a serious condition, and more probable to be related to allergies.Visit www.avvo.com for answers to your medical questions.

Headaches: Migraine or Tension-headache?

January 21, 2015

This is a very common and relevant question. We differentiate migraine from other types of headaches looking for the presence of other symptoms classified as autonomic symptoms. They include: nausea, vomiting, photophobia (light sensitivity), and phonophobia (sound sensitivity). A positive family history is present in 85% of patients having a positive family with migraine in first-degree relatives). Patients with migraine also exhibit a desire for isolation and to lie down, recurrent pattern of attacks, being normal between attacks (Gladstein, 2012). If autonomic symptoms as described earlier are absent it is more likely to be tension headache.For more answers to your health-related questions visit AVVO.com

Allergy and Passive Smoking

January 21, 2015

Allergy and Passive SmokingAllergy or intolerance to smoke is a very common problem. It is the most frequent agent who brings on airway re-activity and ending in an asthma attack. Many regulations are in place to protect patients from exposure to passive smoking.This has been a problem for me personally, as I am very intolerant of tobacco smoke making me experience a shortness of breath; I understand your situation. Where there are laws in place concerning workplace safety from passive smoke inhalation, you may report to the supervisors and convince them to take measures to enforce the laws.Visit www.avvo.com for medical advise.

Constipation and Allergy

January 21, 2015

Can constipation be due to allergies?Patients at times ask the question of why they have constipation, whether it is related to allergy, and why medication do not work. It is not due to allergy.Constipation is a common medical condition. Stool softeners usually help; the most frequent reason for not finding the result you desire is not taking dose sufficient and frequent enough to stimulate the emptying of the contents.Diet can also play a role. High-fiber diets and fruit juices taken in sufficient quantity regularly can be of help.Use of suppositories such as over the counter glycerin suppository have been beneficial to evacuate the last part that you feel is still hanging-in there. Many individuals have this negative impression about using the suppositories thinking that the behavior will be habit forming; I do not think that is a real issue.If you have serious worries about it you may want to see a gastroenterologist who can have a look inside to decide if you have any abnormality.

Seizures and Memory Loss

January 21, 2015

Memory loss immediately after a seizure is common. It is only temporary. In seizure, there is an excessive discharge of electrical stimulus arising from a certain area of brain for different reason, heredity being one of them. Some patients even experience a temporary paralysis. It is often a matter of great concern for parents and caretakers. These do not last. It is important to follow up with diagnositic tests and treatment prescribed.Vist www.avvo.com for answers to medical questions

Swimmer’s Ear

January 21, 2015

Swimmer’s ear is a very common problem in summer. Cerumen of ear is a leading cause. Ear wax could result in increased incidence of a swimmer’s ear. Ear wax can retain water when you submerge in water through regular swimming. This is especially a problem during summer. Guest, J.F., Greener, M.J., Robinson, A.C., &amp; Smith, A.F, (2004) found that impacted cerumen is a major cause of primary care consultation, and a common problem in ENT patients. The first step is prevention of ear infection.The following will help to reduce the chance of the swimmer’s ear:1. Removal of ear wax that causes impaction before summer swimming starts by visiting your doctor may reduce the chance of external otitis.2. Blow-dry your ears with low heat setting after returning from swimming. Hold the hair dryer about 2 inches away and blow-dry for about 2 minutes.The following will help to get rid of the swimmer’s ear:Apply drops of a mixture of vinegar and rubbing alcohol in equal quantity in the...

How to Prevent Recurrent Ear Infections

January 21, 2015

Incidence of ear infections is in early childhood. This is especially true in the first ear of life and in toddlers. The following measures will help to reduce recurrent ear infections:– Breast feeding.– Avoid smoking.– Avoid feeding while lying down.– Routinely give Flu Vaccine– Routinely give Pneumococcal Vaccine.– Avoid day care if possible.– Choose day care with small group of children.– Treat upper respiratory infections promptly.– Avoid allergens and treat allergies promptly.References:Clements, D.A. et al. (1995). Influenza A Vaccine Decreases the Incidence of Otitis Media in 6- to 30-Month-Old Children in Day Care. Arch Pediatr Adolesc Med.149(10):1113-1117.Duncan, D. et al., (1993). Exclusive Breast-Feeding for at Least 4 Months Protects Against Otitis Media. Pediatrics,91(5), 867-872.Niemela, M., Uhari, M.,& Mottonen, M. (1995). A Pacifier Increases the Risk of Recurrent Acute Otitis Media in Children in Day Care Centers. Pediatrics, 96 (5), 884...

How does mind affect the Immune System?

January 21, 2015

As an immunologist and student of psychology I summarize the mind-body connection as follows:We are born with a genetic tendency to perceive life-events differently.Perception is influenced by our past experience (child abuse etc.). Stressors affect the limbic system – the emotional part of the brain. That leads to activation of autonomic system (increased heart, diarrhea, sweating, head ache etc.).Increased stressors lead to increased production of cortisol, and adrenalin etc.Increased chronic cortisol levels lead to decreased immune function (recurrent colds etc.,)Increased stressors diminish DNA duplication of nerve cells of a certain part of the brain – hippocampus and atrophy of that part of the brain.We need duplication of DNA to produce dopamine etc. to prevent depression.Reduced levels of dopamine and other neurochemicals lead to diminished cognitive abilities and reduced memory and depression.We need normal mind for normal function of the body!

Temper Tantrums in Children

January 21, 2015

It is a common problem! Related issues include:Personality of the childI believe temperaments are built in the personality of the child and child is born with them.CommunicationImmature development of language and not understanding what the parents want and not understanding what the child wants could be factor.How to deal with Temper TantrumsExplain the rules that apply to the child.Use rewards to complying; give rewards closer to the good behavior; provide immediate reinforcement for any worthy behavior.Ignore and do not yield to aggression; ignore behaviors in spite repeated attempts to get attention.Provide alternative activities to give time to settle down.Time-outTime-out for ages: 2 to 6 years of ageDuration: one minute per yearProvide a warning onceProvide an explanationReturn to time-in immediately afterConsistency in reward and punishment techniques and a lot of patients will be your friend!