New Report on Autism Rates

A new report on autism prevalence rates isn’t generating many headlines.

Why?

“There was not a statistically significant change in the prevalence of children ever diagnosed with autism spectrum disorder from 2014 to 2016.”

Zablotsky et al on Estimated Prevalence of Children With Diagnosed Developmental Disabilities in the United States, 2014–2016

While the rate seemed to increase on paper, from 2.24 to 2.76%, it was not a statistically significant change. If it had been a statistically significant change, then you could think autism rates really were increasing and the report would have made headlines beyond anti-vaccine websites.

“By trying to say that there is no significant increase, is the government hoping to reassure people that autism isn’t a significant problem? That the rising number of children with autism isn’t something that anyone has to worry about? Are they trying to avoid a panic?”

Dr. Bob Sears

As most people likely understand, the term significant is used in the report as a statistical term.

When something is found to be statistically significant, then you can be fairly confident that it wasn’t caused by chance alone.

“Significance is a statistical term that tells how sure you are that a difference or relationship exists.”

What does “statistical significance” really mean?

So by stating that “there was not a statistically significant change in the prevalence of children ever diagnosed with autism spectrum disorder,” they were not “trying to avoid a panic.” There is no conspiracy.

Unlike Dr. Bob and some others, they were simply trying to not mislead people into thinking that the change from 2.24 to 2.76% meant something that it did not.

Reports About Autism Rates

Another thing to keep in mind as you think about this report – there are multiple reports about autism prevalence rates that come out every few years.

The latest report uses National Health Interview Survey data that was collected by the National Center for Health Statistics.

Unlike the autism prevalence reports from the Autism and Developmental Disabilities Monitoring (ADDM) Network that we are used to, which reported a rate of 1 in 68 children in 2016, the NCHS reports:

  • National Health Interview Survey question about autism.
    The National Health Interview Survey question about autism.

    rely on parent reports during a telephone survey – one of the questions that they are asked is if a health professional has ever told them that their child has autism, but that diagnosis is not confirmed by looking at medical or school records

  • are prone to recall bias – parents might not accurately recall what doctors have told them in the past about their child
  • have questions that have changed over the years, for example, when PDD was added in 2014, it was thought that it might have confused some parents who didn’t know that a pervasive developmental disorder is different than a developmental disorder
  • look at lifetime prevalence

And not surprisingly, over the years, the NHIS has typically reported higher autism rates than the Autism and Developmental Disabilities Monitoring Network.

autism-rates
The NCHS autism prevalence rate reports have traditionally been higher than others.

So what does this new report on autism prevalence mean?

It means the same thing that all of the other recent reports have been saying, that autism prevalence rates seem to be unchanged.

What to Know About Autism Rates

After increasing for several years, autism rates seem to be unchanged, but that hasn’t kept anti-vaccine folks from trying to get parents to panic about changes in prevalence rates that are not statistically significant.

More on Autism Rates

30 Uncommon Diseases Parents Should Learn to Recognize

Did you know that just because your younger child is pulling at their ears, it doesn’t automatically mean that they have an ear infection?

It could be teething, an over-tired infant or toddler, or a kid with a cold and their ears are popping because of congestion.

Understanding common, and some not so common symptoms of pediatric diseases can help make sure that your kids get diagnosed and treated quickly.

Symptoms of Classic Pediatric Diseases

Most parents are familiar with the more classic pediatric diseases and the signs and symptoms that accompany them, such as:

  • Appendicitis – classically, it starts with pain near the belly button, which quickly worsens and moves to the lower right side of your child’s abdomen. Appendicitis is not always classic though
  • Croup – often starts in the middle of the night with a seal bark cough, heavy breathing that sounds like wheezing, and a hoarse voice
  • Diabetes – type 1 diabetes is classically associated with polydipsia (drinking a lot), polyuria (frequently urinating large amounts), and weight loss
  • Ear infection – in addition to ear pain, fussiness, or tugging at their ears, kids with an ear infection will usually have cold symptoms, or at least might have had a recent cold, with a cough and runny nose
  • Fifth disease – red cheeks that appear to be slapped followed by a pink lacy rash on a child’s arms and legs that can linger for weeks
  • Hand, foot, and mouth disease – caused by the coxsackievirus A16 virus, kids with HFMD classically have ulcers in their mouth and little red blisters on their hands and feet. They might also have a fever and a rash on their buttocks and legs.
  • Hives – hives or whelps are raised, red or pink areas on your child’s skin that come and go, moving around over a period of three to four hours and are a sign of an allergic reaction. Unfortunately, unless your child is taking medicine or just eat something, it can be hard to find the allergic trigger. You often don’t need to though, as hives can also just be triggered by viral infections and might not come back.
  • Impetigo – honey colored crusted areas on your child’s skin that are a sign of a bacterial infection
  • Ringworm – a fungal infection that can appear on a child’s skin (tinea corporis), feet (tinea pedis), groin (tinea cruris), nails (tinea unguium), or scalp (tinea capitis)
  • Roseola – another viral infection, this one is caused by human herpesvirus 6 (HHV-6) and 7 and causes a high fever for three or four days, and then, as the fever breaks, your child breaks out in a pinkish rash. The rash starts on their trunk, spreads to their arms and legs, and is gone in a few days.
  • Swimmer’s ear – the tricky part about recognizing swimmer’s ear is that you can get it anytime you get water in your ear, not just after swimming, leading to pain of the outer ear, especially when you push or tug on it.

Symptoms of Uncommon Pediatric Diseases

Although not necessarily rare, it is often uncommon for the average parent, and some pediatricians, to be familiar with all of the following conditions unless they have already been affected by them.

Having dark, brown or Coca Cola-colored urine is a classic sign of acute post streptococcal glomerulonephritis.
Having dark, brown or Coca Cola-colored urine is a classic sign of acute post streptococcal glomerulonephritis. Photo by Vincent Iannelli, MD

Why should you know about them?

Some are medical emergencies. Missing them could lead to a delay in seeking treatment.

Others, while they might not be emergencies, often lead parents to seek treatment, but it might not necessarily be the right treatment if someone doesn’t recognize what is truly going on with your child.

  1. Acanthosis nigricans – dark thickened (velvety textured) skin often found on the back of an overweight teen’s neck, and sometimes in their armpits and other skin folds, and which can be a sign of type 2 diabetes
  2. Anaphylaxis – while a severe allergic reaction like anaphylaxis is not easy to miss, getting proper treatment is sometimes difficult. This life-threatening reaction requires an epinephrine injection as soon as possible, something that some parents and even some emergency rooms seem hesitant to do.
  3. Bell’s Palsy – children with Bell’s palsy develop a sudden weakness or paralysis of the muscles of one side of their face. Fortunately, the symptoms usually begin to resolve in a few weeks.
  4. Breath holding spells – a young child having a breath holding spell will actually pass out! While it sounds scary, since they follow a typical pattern, either the child is crying forcibly (cyanotic breath holding spell) or something painful happened suddenly (pallid breath holding spell), and they quickly wake up and are fine, you hopefully won’t panic if you ever see one.
  5. Cat scratch disease – after a bite or scratch from an infected cat or kitten, a child will develop a few lesions at the scratch site, but will also develop enlarged lymph nodes nearby – typically their armpit or neck if they were scratched on the arm.
  6. Cyclic vomiting syndrome – possibly related to migraines, children with cyclic vomiting syndrome have repeated episodes of intense nausea and vomiting, sometimes leading to dehydration, every few weeks or months
  7. Diabetes insipidus – like type 1 diabetes, kids with diabetes insipidus urinate a lot and drink a lot, but it has nothing to do with their blood sugar. It can follow a head injury or problem with their kidneys.
  8. Encopresis – kids with encopresis have soiling accidents, sometimes leading parents to think that they have diarrhea. Instead, they are severely constipated and have small amounts of liquidy stool  involuntarily leaking into their underwear after getting passed large amounts of impacted stool.
  9. Erythema multiforme minor – triggered by infections and sometimes medications, kids with EM have a rash that looks like hives, but instead of going away, they just keep getting more spots, some of which look like target lesions. The severe form of EM, erythema multiforme major is fortunately rare.
  10. Geographic tongue – a curiosity more than a condition, children with geographic tongue have bald areas on their tongue where the papilla have been lost (temporarily). The name comes from the fact that the shapes of the bald areas vary in size and shape and they move around. They are not painful, although parents typically don’t notice them until they look in their child’s mouth when they complain of a sore throat or other problem.
  11. Henoch-Schonlein Purpura (HSP) – episodes of HSP typically follow an upper respiratory tract infection, when kids develop a rash (palpable pururpa), stomach aches, arthritis (joint swelling and pain), and more rarely, kidney problems. The rash is distinctive – red dots (petechiae) and a hive-like rash that looks like bruises.
  12. Hemolytic Uremic Syndrome (HUS) – follows a diarrheal illness with E. coli, in which toxin from the bacteria causes bleeding (from low platelets) and anemia (destruction of red blood cells) and can lead to kidney damage.
  13. Intussusception – colicky abdominal pain (severe pain that comes and goes) and loose stools that are filled with blood and mucous (red currant jelly stools) in young kids, typically between the ages of three months and three years
  14. Kawasaki disease – it is important to recognize when a child might have Kawasaki disease, because early treatment might help prevent serious heart complications from developing. The initial signs and symptoms of Kawasaki disease can include a prolonged fever (more than five days), swollen lymph glands, pink eye (without discharge), rash, strawberry tongue, irritability, swelling of hands and feet, red and cracked lips, and as the fever goes away, skin peeling.
  15. Nephrotic syndrome – kids with nephrotic syndrome have swelling (edema), around their eyes, on their legs, and even their belly. All of the swelling causes them to quickly gain weight. Because, at first, the swelling is worse in the morning and gets better as your child is up and about, it might be mistaken for other things that cause swelling, like eye allergies. Nephrotic syndrome won’t get better with eye drops though.
  16. Night terrors – most common in preschoolers and younger school age children, kids with night terrors ‘wake up’ in the early part of the night screaming and are confused and impossible to console, because they are really still asleep. The episodes are not remembered the next morning and are often triggered when kids are off their schedule or under extra stress.
  17. Nursemaid’s elbow – you are walking with your toddler and all of a sudden he gets mad, drops to the ground while you are holding his hand, and then he refuses to move his arm or bend his elbow. Did you break his arm? It’s probably a radial head subluxation, which your pediatrician can usually easily reduce.
  18. Obstructive sleep apnea – although many kids might snore normally, with obstructive sleep apnea, the snoring will be loud, with pauses, gasps, and snorts that might wake your child up or at least disturb their sleep.
  19. PANDAS – Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections is characterized by OCD and/or tics that appear or suddenly worsen after a strep infection.
  20. Peritonsillar abscess – a complication of tonsillitis, it can cause fever, severe throat pain, drooling, a muffled voice (hot potato voice), and swelling on the side of one tonsil, pushing the uvula towards the other side
  21. Pica – while many younger kids put things in their mouth, kids with pica crave and eat all of those non-food things. Since it can be a sign of iron-deficiency, talk to your pediatrician if you think that your child might have pica.
  22. Pityriasis rosea – kids with pityriasis rosea have a rash that starts with a herald patch (looks like a ringworm) and is then followed by a lot of small, oval shaped red or pink patches with scale on their trunk. The rash, which may be a little itchy, can last for up to 6-12 weeks.
  23. POTS – teens with Postural Orthostatic Tachycardia Syndrome have dizziness, fatigue, headaches, nausea, difficulty concentrating and other symptoms related to alterations or dysfunction in the autonomic nervous system (dysautonomia).
  24. Pyloric stenosis – since so many infants spit up, it is not uncommon for the parents and pediatricians to sometimes delay thinking about pyloric stenosis when a baby has it. Unlike reflux or a stomach virus, with pyloric stenosis, because their pylorus muscle becomes enlarged, no food or liquid is able to leave their stomach and they eventually have projectile vomiting of everything they try to eat or drink. It is most common in babies who are about three to five weeks old.
  25. Scalded skin syndrome – unlike typical bacterial skin infections, with scalded skin syndrome, exotoxins that certain Staphylococcus aureus bacteria cause the skin to blister and appear burned, with eventual skin peeling
  26. Stevens-Johnson Syndrome – a rare skin reaction that can be triggered by medications, beginning with flu like symptoms, but then progressing to a blistering rash that includes their mouth and eyes.
  27. Testicular torsion – if one of the testicles twists around the spermatic cord, it can cut off blood flow and quickly lead to permanent damage. Sudden, severe pain and swelling often make it easy to recognize this medical emergency, but sometimes the pain comes on more slowly or the pain is dismissed as happening from trauma, epididymitis, or torsion of the appendix testis.
  28. Toxic synovitis – typically following a viral infection, kids with toxic synovitis have hip pain and limping for a few days, but otherwise seem well, without high fever or other symptoms
  29. Vocal cord dysfunction – often misdiagnosed as asthma, especially exercise induced asthma, and other things, kids with vocal cord dysfunction often have episodes of repeated shortness of breath, chest tightness, wheezing, and coughing – just like asthma. They don’t improve though, even as more asthma medicines are added, which should be a red flag that they don’t have asthma and could have vocal cord dysfunction instead.
  30. Volvulus – a volvulus occurs when the intestines twists on itself, cutting off blood blow. In addition to severe abdominal pain, these kids often having vomiting – typically of a green, bile looking material (bilious vomiting). Green vomitus can also be a sign of other intestinal obstructions, but all would be a medical emergency.

Is knowing about these conditions always helpful?

No, especially if you don’t know what a ‘seal bark’ or ‘hot potato voice’ sounds like or what ‘red currant jelly’ looks like, but it likely shouldn’t hurt to get a little more educated about the diseases that could be causing your child’s symptoms.

What to Know About Recognizing Symptoms of Pediatric Disease

Having the internet and access to Google doesn’t make you a doctor. Get real medical advice if you think that your child is sick and has symptoms that have you concerned. It does help to know which symptoms to be concerned about though.

More on Recognizing Symptoms of Pediatric Disease

 

Choosing the Best ADHD Medication for Your Child

There are a lot of options when it comes to treating kids with ADHD.

In addition to behavioral therapy, there are a number of different stimulant and non-stimulant medications.

How do you choose the best ADHD medication for your child?

Is there a best ADHD medication for your child?

What Types of ADHD Medication Are Available?

When DSM-II was published, in 1968, Ritalin had already been studied and was being used to treat hyperkinetic children with minimal brain dysfunction syndrome.
When DSM-II was published, in 1968, Ritalin and Adderall had already been studied and were being used to treat hyperkinetic children with minimal brain dysfunction syndrome.

Whether your child’s ADHD symptoms include problems with inattention, hyperactivity and impulsivity, or both, the treatments are the same:

  • Stimulants – Adderall/Amphetamine vs Ritalin based
  • Non-Stimulants – Intuniv (extended release guanfacine), Kapvay (extended release clonidine), Strattera

Remember, that although often underused, it is recommended that behavior therapy be the first treatment for younger, preschool children with ADHD. Both medication and behavior therapy are typically recommended for older children with ADHD.

Other off-label medications for ADHD that are also sometimes used include bupropion (Wellbutrin), tricyclic antidepressants such as desipramine (Norpramin), and imipramine (Tofranil), and modafinil (Provigil or Nuvigil).

Yes, we have come a long way from Dr. Charles Bradley’s first studies of benzedrine (racemic amphetamine) in 1937.

How to Choose ADHD Medication for Your Child

Once you start looking at medication options, the first thing to keep in mind is that there is no one single ADHD medication that is better than others for all kids.

The best ADHD medication is going to be the one that your child will take and which controls your child’s symptoms without side effects (or with minimal side effects) for as long as you need it to, without costing an arm and a leg.

So, do you want an ADHD medication that comes as a chewable pill, a pill or capsule that your child can swallow, a capsule that can be opened and sprinkled on food, a dissolvable tablet (ODT), a liquid, or a patch?

How long do you want it to last? 4, 6, 8, 10, 12 hours?

Is your child going to take it every day or just on school days?

What ADHD medicines has your child already tried?

Answering those questions will help to narrow down which ADHD medicine might be best for your child.

ADHD Medications

Again, there is really no one best ADHD medicine.

“…stimulant medications are highly effective for most children in reducing core symptoms of ADHD.”

American Academy of Pediatrics ADHD Clinical Practice Guideline

And you don’t even have as many options as you think you do.

While it may seem like there are dozens of medications available to treat ADHD now, most are really just different variations of the same few active ingredients.

And if you don’t have insurance or if you have have a high deductible, you will want to know that those that aren’t yet generic (in bold) are going to be much more expensive than the others:

  • Short Acting Stimulants (4 to 6 hours) – Adderall, Evekeo, Focalin, Methylin (chewable), ProCentra (liquid), Ritalin, and Zenzedi (often taken twice a day)
  • Intermediate Acting Stimulants (6 to 8 hours) – Dexedrine, Ritalin SR, Methylin ER
  • Intermediate to Long Acting Stimulants (8 to 10 hours) – Focalin XR, Metadate CD, Metadate ER, and Ritalin LA
  • Long Acting Stimulants (10 to 12 hours) – Adderall XR, Adzenys XR-ODT, Aptensio XR, Concerta (Methylphenidate ER), Cotempla XR-ODT, Daytrana (patch), Mydayis, Quillichew ER (chewable), Quillivant XR (liquid), and Vyvanse (capsule and chewable)
  • Non-Stimulants – Intuniv, Kapvay, Strattera

In general, stimulants are thought to work better than non-stimulants, but again, there isn’t one stimulant that is consistently better than another.

And there isn’t one medication that targets specific symptoms better than another, so you don’t need to look for a specific medication just because your child has the inattentive type of ADHD vs another who is also hyperactive and impulsive.

Deciding Which Medication Is Best for Your Child

Which ever medicine you choose, you typically want to start at a low dose and slowly adjust the dose up or down as necessary based on how well it is working and whether or not your child is having any side effects.

“…more than 70% of children and youth with ADHD respond to one of the stimulant medications at an optimal dose when a systematic trial is used.”

American Academy of Pediatrics ADHD Clinical Practice Guideline

Keep in mind that:

  • generic, short acting Ritalin (methylphenidate) is often going to be your least expensive option
  • coupons are often available for newer medications to lower or eliminate your copay, but that doesn’t help you if you don’t have insurance, have a high deductible, or if a medication isn’t covered by your insurance
  • it often takes a few days for kids to adjust to being on an ADHD medication, so don’t judge them too quickly
  • it doesn’t take weeks or months for an ADHD medication to work, so don’t wait too long to make adjustments
  • if your child is having major side effects, don’t just switch medications, be sure to switch the active ingredient too. For example, if a low dose of Metadate CD made your child very irritable and caused trouble sleeping, then switching to Ritalin LA doesn’t make much sense, as they are both time release versions of methylphenidate. Other ADHD that contain methylphenidate as an active ingredient include , Aptensio, Concerta, Cotempla XR-ODT, Daytrana, Methylin, QuilliChew ER, and Quillivant XR.
  • many of the newest medications, including Evekeo, Zenzedi, and Mydayis, are really just different forms of Dexedrine, one of the first ADHD medicines.
  • you can open and sprinkle the contents of Adderall XR, Aptensio XR, Focalin XR, Metadate CD, Ritalin LA, and Vyvanse on applesauce if your child can’t swallow these capsules. The contents of Vyvanse is a powder and will easily dissolve in a small amount of water! These are often less expensive options than a newer chewable, liquid, or dissolvable tablets.
  • you can not open Concerta and Metadate CD or you will ruin the time release delivery system. They must be swallowed whole.
  • while there is an authorized generic for Concerta, there are some generic versions that do not have the same therapeutic effect because they do not have the same extended delivery system. Make sure you are getting an authorized Concerta generic.
  • some extended release ADHD medications simply mimic taking the medication twice a day, giving 50% of the dose in the morning and another 50% later in the day, like Adderall XR, Focalin XR, Metadate ER, Ritalin LA, and Vyvanse
  • other extended release ADHD medications have different time release schedules. For example, Concerta gives 22% of the dose immediately and then slowly time releases the rest throughout the day. Similarly, Metadate CD releases 30% of the dose immediately and the rest later. Aptensio XR uses a 40/60 delivery system. And Daytrana, the patch, slowly time releases the dose throughout the day.
  • although some people start the day with an intermediate or long acting medication to get their child through school and then a short acting medication after school, before doing this, consider increasing the dose of the intermediate or long acting medication to see if it will last longer
  • non-stimulants are pills that must be swallowed and they typically must be given to your child every day for them to work properly
  • genetic tests to try and see which medications will work best for your child have not been tested on kids
  • even if you are only going to be giving your child medication on school days, be sure to give it every single day at first, even weekends, so that you can more easily see what side effects it might be causing. Otherwise, since it could wear off by the time you see your child after school, you might miss uncommon side effects, like if it made him too calm or more irritable.
  • being able to concentrate and do your work and not getting distracted and talking with your friends all of the time is not a side effect – it is the desirable effect.

Most importantly, know that you can take out a lot of what might seem like guess work if you have a good understanding of how these medications work.

What To Know About Choosing an ADHD Medication

For the great majority of kids with ADHD, one of the many available medications will help to control their symptoms of inattention, hyperactivity, and impulsiveness. Learn how to choose the best one for your child.

What To Know About Choosing an ADHD Medication

Mindfulness for Kids and Parents

Have you ever heard of mindfulness?

These kids don't look like they need any help focusing on the present moment - having fun playing with each other!
These kids don’t look like they need any help focusing on the present moment – having fun playing with each other! Photo by Todd Fahrner

Once upon a time, you probably would not have if you weren’t Buddhist.

Mindfulness is a form of meditation.

“Most of the time, we are lost in the past or carried away by the future. When we are mindful, deeply in touch with the present moment, our understanding of what is going on deepens, and we begin to be filled with acceptance, joy, peace, and love.”

Thich Nhat Hanh on The Long Road Turns To Joy

But much like yoga, an ancient Hindu practice, mindfulness has become popular without understanding its spiritual ties.

Benefits of Mindfulness

Why practice mindfulness?

What are the benefits of mindfulness?

You can actually find some studies that have found all kinds of benefits of mindfulness, from increased immune functioning to boosting your memory and attention span.

Now, I would view any of those benefits with a lot of skepticism, but the benefits that do seem plausible include decreasing stress and anxiety and improving your sleep, etc.

“Mindfulness meditation on breath, perhaps the most well-known type, involves sitting quietly, resting or closing your eyes and bringing your attention to your breath. When your attention drifts away, which it is likely to do, simply usher your attention back to your breath without judgment.”

AAP on Just Breathe: The Importance of Meditation Breaks for Kids

The American Academy of Pediatrics even suggests that mindfulness meditation can be helpful for children, although it is a clinical report from the Section on Integrative Medicine that is examining “best-available evidence.”

Does Mindfulness Work?

Many of us would like mindfulness to work.

Stress and anxiety are big problems today, both among kids and their parents. Their pediatricians too. So should we all start reading books on mindfulness?

Or go to a mindfulness group parenting class or start mindfulness-based cognitive therapy?

“Despite existing methodological limitations within each body of literature, there is a clear convergence of findings from correlational studies, clinical intervention studies, and laboratory-based, experimental studies of mindfulness—all of which suggest that mindfulness is positively associated with psychological health, and that training in mindfulness may bring about positive psychological effects.”

Keng et al on Effects of mindfulness on psychological health: A review of empirical studies

Considering that many reviews have been critical and the one with the most praise could only find a suggestion of positive associations, although I have always liked the idea of mindfulness, I am skeptical of its use as a medical treatment.

“I think the best current summary is to consider mindfulness like yoga, or a specific form of exercise. There is evidence that doing yoga has specific health benefits. However, those benefits are likely not specific to yoga and are universal to exercise. It is therefore more accurate to say that exercise has many health benefits, and yoga is a form of exercise.”

Steven Novella on Is Mindfulness Meditation Science-Based?

Can we just say that being mindful is a way to help you relax?

And being able to relax has some health benefits?

Give mindfulness a try if you want. Just don’t expect miracles and realize that with all of the distractions that you likely have in your life, being truly mindful is going to be much more difficult than you could ever imagine.

And while you can sell mindfulness, it is now a billion dollar industry, you can’t really buy it.

You can start with turning off the TV unless you are watching a specific program. And putting your phone down when the kids are around. Basically, get away from always trying to multitask and focus on who you are with or what you are doing at any one moment.

And learn about breathing

What to Know About Mindfulness for Kids and Parents

There might not be much proof that it works, but mindfulness might be worth a try if you are just looking for a way to help you and your kids relax.

More About Mindfulness for Kids and Parents

Is There a Cure for Peanut Allergies?

Many parents likely got excited recently when they read about a possible cure for peanut allergies.

Peanut allergy could be cured with probiotics
Medical News Today

While these types of treatments are called cures by some people, what they do is desensitize you to peanuts, so that if you have a reaction, it is less severe. Some don’t have reactions anymore though. Probiotics were just part of the ‘cure’ though. They were paired with oral immunotherapy.

Is There a Cure for Peanut Allergies?

So is there really is a cure for peanut allergies?

I’m guessing it doesn’t matter if you call it a cure or a treatment if you have a child with a severe peanut allergy, you really just want to know if it is available for your child, right?

And again, there isn’t a simple answer.

Although it does seem like they are being used more and more, many of these treatments are still being tested, so they likely aren’t available everywhere, or in some cases, anywhere outside of a trial.

Among the treatments for peanut allergies, besides avoidance and treating anaphylactic reactions with epinephrine, you some day soon might be able to get your child with peanut allergies:

  • a wearable skin patch to provide epicutaneous immunotherapy (EPIT)  – in phase III studies
  • a pill to provide orally administered biologic immunotherapy  – in phase III studies
  • oral immunotherapy with Xolair (FASTX) – in phase II studies
  • a combination of probiotics with peanut oral immunotherapy (PPOIT)
  • sublingual immunotherapy (SLIT) – in phase III studies
  • a vaccine – in early phase I studies

How do these treatments work?

The patch is the easiest to explain. Kids simply apply a new patch that contains peanut protein on their skin each day.

Oral immunotherapy is similar, kids are exposed to peanut protein, but unlike the patch, the dose is steadily increased each day, until you read a maintenance dose, that you continue eating each day. Most of these treatments use some variation of the characterized oral desensitization immunotherapy (CODIT) method to control and maintain desensitization.

And these treatments are not just for peanuts. Similar studies are being done for eggs and milk. And theoretically, they can be done for anything that can trigger an IgE-mediated allergic reaction, from foods and medicines to environmental allergens.

The downside? In addition to side effects, in most cases, you have to continue eating the thing you are allergic to every day, otherwise your allergy might return.

So, Is There a Cure for Peanut Allergies?

While many of these treatments are promising, they are not ready for regular use in every doctor’s office.

“The aim of OIT is to administer a food allergen slowly, in small but steadily increasing doses, until the patient stops reacting to the food (termed becoming desensitized to the food). OIT studies have shown promising results, though adverse reactions are frequent and may cause significant side effects like abdominal pain, wheezing and/or diarrhea. Published data from placebo-controlled trials have shown that only 50 to 70 percent of patients attempting OIT complete desensitization, with the failures primarily due to side effects. Also, there currently are no standardized protocols or foods used in OIT and no FDA approved approach that could allow insurance to reimburse for this therapy. Thus, there are challenges with the current practice of OIT.”

FARE Statement on Oral Immunotherapy for Food Allergies

That doesn’t mean that you can’t get some of these treatments right now or overcome those challenges.

Avoiding peanuts is not always as easy as you think... Peanuts under my seat on a plane.
Avoiding peanuts is not always as easy as you think… Peanuts under my seat on a plane. Photo by Vincent Iannelli, MD

Just keep in mind that “An allergist doing OIT for patients in a private practice develops his/her own individualized protocols and uses his/her unique food preparation.”

If your child’s food allergy has led to severe stress and anxiety for your family, that might not matter though. You probably don’t want to wait anymore if there is a chance at reducing your child’s chance of having a severe, life-threatening allergic reaction.

Still, find a pediatric allergist who has a lot of experience doing private practice OIT.

On the other hand, if you are fine refilling your child’s epi-pens every year and working hard to avoid peanuts, then maybe wait until the jury comes in and we get an official recommendation and more standardized treatments become more widely available.

What Else Should You Be Doing About Food Allergies?

If you don’t do private practice OIT, then in addition to strictly avoiding the things to which your child is allergic and making sure that an epi-pen is always readily available, the latest guidelines recommend that your child have:

  • annual testing if they have a milk, egg, soy, or wheat allergy
  • testing every two to three years if they have a peanut, tree nut, fish, or shellfish allergy

Why retest?

Kids do sometimes outgrow their allergies, especially if the allergy isn’t to peanuts or tree nuts. And even for peanuts, about 20% of kids have a chance of outgrowing their allergy.

Also remember that it is now recommended that infants at high risk for peanut allergies, especially those with eczema, have an early introduction of peanut proteins, sometimes as early as four months of age.

Hopefully that will help decrease the number of kids who need these kinds of treatments in the future.

What to Know About Treating Peanut Allergies

Oral immunotherapy and some other treatments are providing new options to help kids with severe food allergies avoid life-threatening reactions.

More About Treating Peanut Allergies

Molluscum Contagiosum

Molluscum contagiosum is a very common childhood skin rash, that surprisingly, few parents seem to have ever heard of.

While most parents have likely have heard of eczema, ringworm, and impetigo, a diagnosis of molluscum might leave them with their head scratching. Hopefully their kids won’t be scratching too.

Molluscum is contagious!

Symptoms of Molluscum Contagiosum

Molluscum contagiosum lesions are typically small and dome shaped, with a small dimple in their center. Although often flesh colored, they can also be pink.

They are usually found alone or grouped on a child’s chest or back, arm pit, or around the skin folds of their elbow and knees.

For many children, molluscum don’t cause any symptoms and the rash is simply a cosmetic problem. Others can get redness and scaling on the skin around the molluscum rash, and it may be itchy.

Another characteristic is that molluscum will sometimes have a plug of cheesy material coming out of the central part of the lesion.

Spotting Molluscum Contagiosum

The diagnosis of molluscum is usually made based on their classic appearance.

Three molluscum lesions on a child's arm.
Three molluscum lesions on a child’s arm. Photo by Vincent Iannelli, MD

The diagnosis can be confusing at first though, when the molluscum are still very small. It may take a few weeks for the lesions to grow before they look like more typical molluscum lesions.

Molluscum might also be confused with other rashes if they are red and inflamed when you go see your pediatrician, or if there is a lot of redness around the rash. That might make your pediatrician think that your child has a small abscess or simple eczema.

Getting Rid of Molluscum Contagiosum

Since molluscum usually goes away in about six to nine months on its own, some pediatricians advocate not treating it. Keep in mind that it can sometimes last for two to four years and may spread aggressively, which is why others do recommend treating molluscum with:

  • Direct removal with a curette
  • Cryosurgery – freezing
  • Cantharidin – a blistering agent
  • Aldara cream (Imiquimod) – also used for genital warts, although they are not related to molluscum
  • Retin A cream (Tretinoin) – also used for acne

All of these treatments have their shortcomings though.

Direct removal and cryosurgery are painful. Cantharidin can cause large blisters. Aldara is expensive. And Retin A doesn’t always work well when used by itself. Also, both Aldara and Retin A can be very irritating to the normal skin that surrounds the molluscum rash.

More About Molluscum Contagiosum

So what should you do about your child’s molluscum?

Talk with your pediatrician or a pediatric dermatologist about your options, which might include:

  • Leaving the molluscum alone, especially if your child has already had them for several months and they are not spreading. Just avoid sharing towels and skin-to-skin contact with others, because they are contagious. It is not a reason to stay out of school or daycare though.
  • Trying direct removal with a curette or cryosurgery if your child only has a few lesions. Although it can be painful, your pediatrician can consider using a topical anesthetic.
  • Using cantharidin if your child doesn’t have a lot of lesions. It is not FDA approved in the United States though, so not all doctors have it, and it can sometimes produce large blisters.
  • Using Aldara cream or Retin A cream – either alone or together on alternate days.

Most importantly, if you do treat your child’s molluscum, watch for new lesions during treatment. They are contagious and start spreading the infection again, even if the initial treatment was successful. And molluscum has a very long incubation period – up to about two months!

Other things to know include that:

  • Molluscum contagiosum is caused by a double-stranded DNA poxvirus.
  • Molluscum can be spread by direct contact with an infected person, touching contaminated objects (such as towels, toys, or clothing), and on a child when they scratch a lesion and then scratch other areas of their skin (autoinoculation). So encourage your child to not pick at them.
  • Molluscum can grow aggressively in children who have a weakened immune system.
  • Molluscum can be a sexually transmitted infection in older teens and adults. It is so common in young children though, that unless there are other signs or suspicions, it is usually not considered a sign of abuse, even if you find an isolated lesion in the anogenital area.

Also keep in mind that a pediatric dermatologist can be helpful if your child has molluscum that isn’t responding to standard treatments.

What to Know About Molluscum Contagiosum

Molluscum contagiosum is a very common viral infection that can cause a skin rash in children. Although difficult to treat, it does typically go away on its own – eventually.

More Information on Molluscum Contagiosum

The Breastfeeding Elimination Diet for Fussy Babies with Allergic Colitis

What should you do when your breastfeeding baby gets fussy?

Your Fussy Baby

Babies cry. Talk to your pediatrician if the crying seems to be excessive, especially if you have a hard time consoling your baby.
Babies cry. Talk to your pediatrician if the crying seems to be excessive, especially if you have a hard time consoling your baby. (CC BY 2.0)

Like a formula fed baby, you should make sure your fussy breastfeeding baby isn’t hungry and doesn’t have a fever, colic, reflux, teething, an upper respiratory tract infection, and all of the other things that can make them fussy.

After eliminating those, and seeing your pediatrician to make sure that your baby has been gaining weight well, it might be time to eliminate things from your diet, as your baby might have allergic colitis (protein-induced colitis).

This is especially true if your breastfeeding baby is fussy, extra gassy, and has foul smelling, green, mucousy stools. You might also notice streaks of blood in your baby’s stool or that your baby has bad eczema already.

While babies can’t be allergic to your breast milk, they can certainly be allergic or intolerant to any number of things that you eat or drink and which enter your milk.

Foods To Eliminate First

Even before you start to think about foods to eliminate from your diet, please keep in mind that this isn’t a reason to stop breastfeeding and switch to formula. Since most formula is based on cow’s milk, your baby will likely continue to have problems on most routine formulas. Some babies even continue to have problems drinking an expensive hydrolyzed protein formula (Alimentum or Nutramigen) and have to move to an even more expensive elemental formula (Elecare, Neocate, or PurAmino).

Once you do begin to think about eliminating foods from your diet, you should probably start with milk and diary foods. Those are the most likely to cause issues with your baby, either an allergy or intolerance. And they are probably the easiest to avoid. If supplementing with some formula, be sure that it is milk and soy free. A hydrolyzed protein formula (Alimentum or Nutramigen) would usually be a good first choice.

The Breastfeeding Elimination Diet

If that doesn’t work, you can continue to eliminate other foods or foods groups from your diet, one at a time until you find what is triggering your babies symptoms, including:

  • soy
  • citrus fruits
  • eggs
  • nuts
  • peanuts
  • wheat
  • corn
  • strawberries
  • chocolate
  • fish and shellfish

The Academy of Breastfeeding Medicine recommends that after eliminating a food or food group, breastfeeding moms “wait a minimum of 2 weeks and up to 4 weeks,” although they should see improvement much sooner, within 2 to 3 days.

A Faster Breastfeeding Elimination Diet

Eliminating one food group at a time and waiting to see if it works can take time. A faster, but much more extreme approach is to eliminate most high-allergen foods all at once.

So what do you eat on this restrictive diet?

On this type of low-allergen diet, a breastfeeding mom might end up only eating foods like lamb, pears, squash, and rice. Other foods in this type of total elimination diet might also include chicken and turkey, potatoes, apples, and bananas.

Once your baby’s symptoms resolve, you can then slowly start introducing foods back into your diet, one food or food group at a time each week. Of course, stop a food if your child’s symptoms come back after it is reintroduced into your diet.

After avoiding a problem food for about six months and once your infant is 9 to 12 months old, you can likely reintroduce it into your diet and watch for symptoms

Another option, before trying the total elimination diet, might be to avoid milk, soy, fish, shellfish, and wheat. Then go total if that doesn’t work.

More About Breastfeeding Elimination Diets

Remember that once your baby is better and you are back on a fairly regular diet, simply avoiding the one or two foods that your baby can’t tolerate, it is still possible that your baby will be fussy sometimes. While it could mean that you ate something you weren’t supposed to, it also mean that you baby is teething, has a cold, is off her schedule, has developed reflux, or any number of other things. It’s not always going to be about food issues.

Also keep in mind that:

  • you should take vitamins (in addition to your daily prenatal vitamin, you will likely need extra calcium) to make up for anything you are missing in your elimination diet, especially calcium, vitamin D, iron, and folate, etc. and make sure you are getting enough protein and calories
  • missing the hidden ingredients in foods are likely a big reason why babies continue to have symptoms while you are following an elimination diet (for example, milk can sometimes be found as an ingredient in luncheon meats, many baked goods, and many other nondairy products) – check food labels and understand how to identify hidden ingredients in foods
  • lactose free cow’s milk, low fat cow’s milk, and other animal milks, including goat milk, are not good substitutes if you are trying to avoid cow’s milk in an elimination diet. Even soy milk and other soy products can often cause similar reactions. You also should try and make your own, homemade baby formula.
  • some vitamins and supplements can be a source of hidden milk, soy, and wheat
  • after avoiding a food for about six months and once your infant is 9 to 12 months old, you can likely reintroduce it into your diet and watch for symptoms
  • a registered dietician can help manage make sure you are getting all of the nutrients you need on this restrictive diet
  • in addition to your pediatrician, a pediatric gastroenterologist can also help manage your baby with allergic colitis, especially  when you need to follow a total elimination diet

Fortunately, allergic colitis is not common, so few breastfeeding mothers should have to try, or stick with, any of these types of restrictive diets.

And since some studies are showing that babies who just have some rectal bleeding don’t even have allergic colitis and that their symptoms go away without any interventions, make sure your baby’s symptoms actually warrant these types of treatments.

What To Know About Breastfeeding Elimination Diets

A breastfeeding elimination diet can be helpful if your baby is overly fussy and might have a milk protein allergy or intolerance to other foods that you are eating.

More Information on Breastfeeding Elimination Diets