by Dr. Kathleen Maurer
Not too many years ago, children got most of their shots before they started kindergarten, and older children only needed an occasional tetanus booster . Things have changed over the past decade, and several important vaccines are now recommended for 11-18 year olds. Your pre-teen or teen-ager may be less than enthusiastic about getting vaccines when they come if for a sports physical or yearly exam, but it may help if they are prepared and understand the benefits of being protected from some very serious diseases.
1. Hepatitis A - This vaccine protects against a virus that affects the liver and can easily be transmitted person to person. There have also been a number of outbreaks through contaminated food or food handlers. International travel is also a risk factor, but with a more global society, community outbreaks have become more common. About 10-11 years ago, we began routinely giving Hepatitis A vaccine at 15 months and 2 years of age, so most of our younger patients have already had this vaccine, but many over 12 have not had this. Beginning in 2018, Kentucky Schools are requiring this vaccine for all students, so those who have not had it will need to get it. Students will need to have 2 doses of Hepatitis A vaccine at least 6 months apart. If your child has not had both doses of Hepatitis A vaccine, please call our office to schedule an appointment.
2. Pertussis (whooping cough) - Although this vaccine is included in the routine baby shots and preschool boosters, immunity tends to wane over time, and community outbreaks have become common. Older children and adults with pertussis may only have a very persistent and annoying cough, but this disease can be very dangerous and even fatal for vulnerable newborns and babies who are too young to be fully vaccinated. Beginning about 6 years ago, the Center for
Disease Control (CDC) and American Academy of Pediatrics (AAP) recommend all 11 year olds receive a dose of pertussis vaccine which is combined with tetanus vaccine (Tdap). This is now required for all Kentucky School children. (also recommended for all women during pregnancy, close contacts of all newborns and infants, childcare workers, and healthcare providers)
3. Meningitis A vaccine (meningitis A, C, W, Y) -This vaccine protects against several strains of bacteria that can infect the blood, brain and spinal cord and cause serious and life threatening illness. It is most common in teens and young adults, and can spread quickly. The scary thing about this devastating and potentially deadly infection is that it can infect otherwise healthy young people, and its onset tends to be very rapid. A dose of Meningitis A vaccine is required at age 11, with a booster dose at age 16. (Certain high-risk patients may need to get this vaccine before age 11)
4. Meningitis B vaccine - This vaccine protects against a serogroup of the meningitis bacteria that is not included in the required Meningitis A vaccine. Within the past 5 years, multiple college campuses have experienced outbreaks of Meningitis B. The symptoms are identical to the other strains of meningitis, causing serious illness or deaths. Two doses of this vaccine are recommended for 16-18 year olds, and especially encouraged for those who will be heading to college.
5. HPV - Human Papilloma Virus is very prevalent in the population in general and is the cause of almost all cases of cervical cancer in women and some genital and head and neck cancers in men, as well as genital warts. Although its primary means of transmission is through sexual contact, it is not only careless people who contract this infection. Most people have no symptoms at all from this virus and it eventually clears on its own, but some cases will persist and lead to cancers. The first HPV vaccine, which covered for the most common cancer-causing strains, was approved in 2006. The current Gardasil 9, which has expanded protection against more strains of the virus, was approved in 2014. HPV vaccine is recommended for both boys and girls, ages 11 and up (approved down to age 9) Those who receive the first dose of vaccine prior to their 15th birthday only need 2 doses, 6 months apart, while those 15 and older will need 3 doses.
Earlier this year my blog discussed various diets, their common characteristics and best current recommendations. This month, I wanted to begin discussing the individual components and how much we need in our diets.
The first question onmivorous (eat everything) people ask vegetarians is "where do you get your protein?" Most Hindus would beg to differ. They are healthy and enjoy a vegetarian diet or a Lacto (milk products) vegetarian diet. So maybe we don't have to eat meat protein; vegetables, dairy, legumes, eggs, grains and nuts can be rich sources of protein. Humans need less than half a gram of protein per pound of their healthy weight daily or making it real, a 22 pound toddler needs about 8 grams of protein. A single egg contains around 6, a piece of bread 2-4 or more, a 4 ounce glass of milk is 4 grams. So that meal for breakfast would give the child all the protein or a minimum of 12 in that meal alone for the day. Recent studies have shown that children who eat an egg per day in the second year of life are taller generally (similar findings are out there about whole cow's milk vs. plant milks). How should this information form our habits? A typical 110 pound woman needs around 40 grams of protein per day. If we take in about a third of that for breakfast, it will keep us satisfed until lunch compared to a similar breakfast in calories but without enough protein.
Some foods and their protein amounts: Cooked meats and fish are about 7 grams per ounce, 1 egg is 6 grams, 8 ounce glass of milk is 8 grams, 1/2 ounce nuts is 6 grams, 1 tablespoon of peanut or other nut butter is 7 grams, 1/4 cup of cooked beans, peas or tofu is 7 grams, 1/3 cup of cottage or ricotta cheese is 10 grams, 1 cup of cooked oatmeal is 7 grams, 1 ounce of cheese (the harder tend to be higher) is 4-12 grams, breads or a bagel is 2.5 - 10 grams (variable), cerieals, cold per serving are very variable, pasta is 12.5 grams, Quinoa, teff, amaranth are variable but rich sources of protein.
I wrote about the toddler's breakfast; how about for grown ups? If we try to get a quarter or a third of our protein for breakfast, how about a peanut butter sandwich on whole grain bread, an egg cheese and veggie omelet, greek yogurt with fruit, nuts or a quality granola topping, a breakfast burrito? Cereals can be a good breakfast but many are short on protein. Where are these gram amounts shown? On all food labels it's listed. On another blog, I will discuss fats, carbohydrates, fiber and some of the micro nuturients we should get in a varied, balanced diet. Remembering the 5-2-1-0 plan recommended for children (and adults) 5 servings of fruits and bvegetables per day, 2 hours max of screen time (except for school work), 1 hour of exercise and 0 sugared drinks, but getting a good breakfast with enough protein is an excellent start and enough protein the rest of the day is essential.
Did you know Food and Allergy Awareness Week was May 14-20, 2017? Well, it’s never too late to be aware of Peanut Allergies.
One of the most common food allergies in children is peanuts, and the prevalence in the United States is increasing. Food allergies most often begin in the first 2 years of life. In countries, including the United States, where peanut introduction is delayed, peanut allergies have more than doubled in young children. The Learning Early about Peanut Allergy (LEAP) trial was the first randomized trial to show the benefit of early introduction of peanut into a child’s diet resulting in a decreased risk of developing peanut allergy.
Children who are at increased risk for developing a peanut allergy include:
The American Academy of Pediatrics (AAP) recently introduced new guidelines for the introduction of peanuts.
There are two methods for allergy testing: blood testing for peanut-specific IgE or skin prick testing.
When introducing peanuts to an infant, remember whole nuts and peanut butter can be a chocking hazard. We suggest adding water to smooth peanut butter and make a puree. Put the puree on the tip of the spoon and feed your child. Wait and watch for any reactions. Allergic reactions to peanuts can include hives (raised, red areas of skin that are itchy), swelling of the tongue, trouble breathing/wheezing, vomiting or diarrhea.
For further information on food allergies visit
- FARE (Food Allergy Research and Education) foodallergy.org
I have been a Family Nurse Practitioner for almost seventeen years. I worked at Kosair Hospital (now known as Norton Children's Hospital) for six years, prior to that as an Onocology/Renal/Transplant nurse. I also worked at Norton Hospital while attending nursing school at the University of Louisville. I have spent all of my professional years working with children and families. I cannot imagine doing anything else. But the face of healthcare and insurance and its cost has changed dramatically in my years of practice.
The ever changing dilemma of health insurance coverage for ourselves and our family affects us all. As a mother and wife keeping up with what is covered in my plan, annual deductibles, pharmacy benefits, co-pays and in and out of network providers is a huge undertaking. Once you think you have it down a new enrollment period is upon you and it changes again. One thing that I am certain of is you need to understand your plan and be an advocate for yourself. Take advantage of the programs your insurance company has in place to keep costs down, ask questions, be friendly with your health insurance representatives and ASK QUESTIONS. With the passage of "Obamacare" a few years back one of the most beneficial components is wellness benefits for all at no or minimal cost. This is especially important for our children as they grow. They need to be seen at each recommended and scheduled time for Well Baby-Child/Adolescent/College Age student visits. The importance of seeing a trusted and well informed Pediatrician/Osteopath/Nurse Practitioner/Physician Assistant is imperative for health guidance and illness prevention in our next generation of adults. The rise in healthcare costs and a US population that seems to get less fit each year should be a concern for us all. Our children truly are our future and how we raise them and teach them will impact who they are as adults. I believe healthcare is a basic right but the idea that it should come without financial responsibility and accountability is a reality we likely will not see again in our lifetime. So plan and prepare, realize that health insurance is part of a famly budget. Here are some websites to help you begin to get informed. A healthy mind and body is essential for us all.
By Dr. Kathleen Maurer
It's time to schedule physicals!!!
Did you now that the Academy of Pediatrics recommends a yearly physical for all school aged children? Those who sign up to play sports or register for summer camps are required to have a physical before they can participate. When time is short and schedules are busy, it might seem convenient to stop in at the local retail clinic at your grocery store or pharmacy. When children seem healthy, parents may wonder if it is really necessary that they schedule a yearly visit at their pediatrician's office, but there are some very good reasons why this is important:
-Your child's pediatrician or nurse practitioner is familiar with your child and has access to their medical records, including their complete medical history, immunizations, growth charts, allergies, medication, and other important information
-A yearly exam may pick up on health issues that are not always obvious, such as high blood pressure, scoliosis, a new heart murmur, a concerning skin lesion, abnormalities of growth or abnormal pubertal development
-If an abnormality is found at the yearly exam, your pediatrician is able to order labs or imaging, make referrals and arrange appropriate follow up
-Guidelines for yearly exams include important screenings for health problems, and age-specific discussions about topics such as nutrition, safety, body changes, risky behaviors, etc
-Yearly exams provide an opportunity for your child to become comfortable with their physician, and less likely to be overly anxious about doctor visits in the future
-If your child is due for immunizations these can be provided at the yearly exam
-You may have heard the term "Medical Home" which has become an important concept within this past few years. It is widely recognized that patients are likely to receive better care if they have one primary physician or group where all of their records are in one place and all of their health care is co-ordinated.
So call early to get your children in for their physicals and get the jump on sports season! Some families schedule their yearly physicals around the time of their child's birthday, and others come in during the spring and summer so they will be ready for camp or conditioning for team sports. We have forms available at our office for school physicals and sports physicals. If your child needs a camp physical or if their school has their own form, please bring them in when you come.
We look forward to seeing you!
This website includes materials that are protected by copyright, or other proprietary rights. Transmission or reproduction of protected items beyond that allowed by fair use, as defined in the copyright laws, requires the written permission of the copyright owners.