Category: Pediatric News

The Abbott Recall of Similac, Alimentum, and Elecare Formula of 2022

Check the lot numbers of your powdered Similac, Alimentum and EleCare infant formula and do not feed your baby recalled formula.

Understandably, many parents and their pediatricians are concerned about last week’s infant formula recall.

Abbott voluntarily recalled specific lots of Similac, Alimentum, and EleCare powdered infant formulas over concern that they could be contaminated with Cronobacter sakazakii and Salmonella Newport.

As you are hopefully aware by now, Abbott voluntarily recalled specific lots of Similac, Alimentum, and EleCare powdered infant formulas over concern that they could be contaminated with Cronobacter sakazakii and Salmonella Newport.

The Abbott Recall of Similac, Alimentum, and Elecare Formula of 2022

Do you have any of the recalled infant formula?

Affected formula include specific lots of powdered:

  • Alimentum
  • Alimentum for Toddlers
  • Elecare
  • Elecare Jr
  • Similac Human Milk Fortifier
  • Similac Total Comfort
  • Similac Total Comfort Advance
  • Similac Total Comfort Sensitive
  • Similac Advance
  • Similac Organic
  • Similac Pro Advance
  • Similac Pro Sensitive
  • Similac Pro Total Comfort
  • Similac Sensitive
  • Similac Sensitive Spit Up
  • Similac Spit Up
  • Similac Spit Up Non-GMO

So you may have recalled formula if the multidigit lot number on the bottom of the container (check your lot numbers) of your powdered Similac, Alimentum, or EleCare (all types shown above) that you bought or got as samples includes:

  • 22 through 37 as the first two digits of the code; and 
  • the code on the container contains K8, SH or Z2; and 
  • the expiration date is 4-1-2022 (APR 2022) or later.

If your formula does not contain that information, then it is not included in the recall and you can continue to feed it to your baby.

“If your product is included in the recall, do not use the product and do not dispose of it.  Follow the instructions for return.  If you have questions about feeding your child, contact your healthcare professional.  ”

Abbott Recall General FAQs

The recalled formula was manufactured at one of Abbott’s manufacturing facilities in Sturgis, Michigan, where an onsite FDA inspection found several positive Cronobacter sakazakii results.

An inspection that was triggered by complaints of four infant illnesses (three for Cronobacter and one for Salmonella) from three states – Minnesota (1), Ohio (1), and Texas (2).

“All four cases related to these complaints were hospitalized and Cronobacter may have contributed to a death in one case.”

FDA Investigation of Cronobacter and Salmonella Complaints: Powdered Infant Formula (February 2022)

Did you recently feed your baby any of the recalled formula?

“Cronobacter bacteria can cause severe, life-threatening infections (sepsis) or meningitis (an inflammation of the membranes that protect the brain and spine). Symptoms of sepsis and meningitis may include poor feeding, irritability, temperature changes, jaundice (yellow skin and whites of the eyes), grunting breaths, and abnormal movements. Cronobacter infection may also cause bowel damage and may spread through the blood to other parts of the body.”

FDA Investigation of Cronobacter and Salmonella Complaints: Powdered Infant Formula (February 2022)

While serious, fortunately, Cronobacter infections are rare, especially in older infants. Still, you should seek immediate medical attention if your child has any of the above symptoms.

Many parents, in addition to the fear that their baby might get sick, are facing another big problem – what do they feed their baby if their usual formula is no longer available?

Talk to your pediatric provider, but typically you might consider the following as replacement formulas:

  • A liquid or ready-to-feed version as a substitute for the recalled powdered Similac or Alimentum. Unfortunately, EleCare and Elecare Jr only comes as a powdered formula.
  • Neocate, PurAmino, Alfamino, EquaCare or Essential Care as substitutes for EleCare – might not be perfect match though…
  • Neocate Jr, PurAmino Jr, Alfamino Jr, EquaCare Jr. or Essential Care Jr. as substitutes for EleCare Jr. – might not be perfect match though…
  • Nutramigen, Gerber HA, Pregestamil, or a hypoallergenic store brand as a substitute for Alimentum – might not be perfect match though…
  • Nutramigen for Toddlers as a substitute for Alimentum for Toddlers – might not be perfect match though…
  • Enfamil, Gerber, or a store brand formula as a substitute for standard Similac Advance.
  • A store brand ‘complete comfort’ formula as a substitute for Similac Total Comfort.
  • Enfamil AR or a store brand with added rice starch as a substitute for Similac for Spit-Up.
  • Enfamil Sensitive or a store brand ‘sensitivity’ formula as a substitute for Similac Sensitive, etc.
  • Enfamil Human Milk Fortifier as a substitute for Similac Human Milk Fortifier.

And no, you should not feed your baby recalled formula – not even if you make it with boiled water!

You should also not switch to cow’s milk or goat milk before your infant is 12 months old. Find an alternative formula instead!

Abbott Infant Formula Recall Hype or Hazard

Fortunately, illness from these types of recalls are rare.

Why?

Even with recalls involving possible bacterial contamination, it is mostly premature babies, newborns, and younger infants who are at high risk to get sick. And many of them are either breastfed or get liquid formula until they are older, so aren’t actually exposed.

“Consider using liquid formula when possible. If your baby gets formula, consider using formula sold as a liquid rather than a powder. This is especially important when your baby is less than 3 months old or if your baby was born prematurely or has a weakened immune system. Liquid infant formula is made to be sterile (without germs) and should not transmit Cronobacter infection when handled carefully. Powdered formula is not sterile.”

Cronobacter Infection and Infants

Preparing formula with hot water (at least 158°F/70°C), another thing parents of newborns and younger infants often do, can also lower the risk of getting sick with Cronobacter.

What to Know About the Abbott Infant Formula Recall

Check the lot numbers of your powdered Similac, Alimentum and EleCare infant formula and do not feed your baby recalled formula. Alternatives to these formulas should be available.

More on the Abbott Infant Formula Recall

Are Baby Foods Tainted With Dangerous Levels of Heavy Metals?

Review easy ways to reduce your child’s risk from heavy metals in baby food.

Why do some parents think that baby foods are tainted with dangerous levels of toxic metals?

A staff report from the US House of Representatives showed that "commercial baby foods are tainted with significant levels of toxic heavy metals, including arsenic, lead, cadmium, and mercury."

It’s likely because they recently read articles and posts about a staff report from the US House of Representatives which showed that “commercial baby foods are tainted with significant levels of toxic heavy metals, including arsenic, lead, cadmium, and mercury.”

A report that was prompted by a study last year, What’s in my baby’s food?, that found 95% of baby food tested contained lead, arsenic, mercury or cadmium.

Are Baby Foods Tainted With Dangerous Levels of Heavy Metals?

Wait, what?

Commercial baby foods really are “tainted with significant levels of toxic heavy metals, including arsenic, lead, cadmium, and mercury?”

Yes, it seems that they are.

As compared to the maximum allowable levels in bottled water that are set by the FDA, the latest report found that baby foods and their ingredients tested at up to 91 times the arsenic level, up to 177 times the lead level, up to 69 times the cadmium level, and up to 5 times the mercury level.

How has this happened?

“FDA HAS FAILED TO CONFRONT THE RISKS OF TOXIC HEAVY METALS IN BABY FOOD. THE TRUMP ADMINISTRATION IGNORED A SECRET INDUSTRY PRESENTATION ABOUT HIGHER AMOUNTS OF TOXIC HEAVY METALS IN FINISHED BABY FOODS.”

Baby Foods Are Tainted with Dangerous Levels of Arsenic, Lead, Cadmium, and Mercury

We have been hearing about arsenic in rice and baby food for nearly 10 15 years, so it is hard to make this a Trump problem…

“In the context of arsenic in baby food, there are only two FDA regulations for specific products—an unenforceable draft guidance issued in July 2013, but never finalized, recommending an action level of 10 ppb for inorganic arsenic in single-strength (ready to drink) apple juice, and an August 2020 final guidance, setting an action level for inorganic arsenic in infant rice cereals at 100 ppb.”

Baby Foods Are Tainted with Dangerous Levels of Arsenic, Lead, Cadmium, and Mercury

How about we just look at it as a problem that needs to be fixed?

Do you want the FDA to add more regulations for baby foods, ensuring that they are all safe and free of heavy metals?

To understand why that wouldn’t be a quick fix, you have to understand how these baby foods likely became tainted with heavy metals. After all, it’s not like the baby food manufacturers are adding them as an ingredient…

The problem is that the rice, vegetables, and fruits that they use to make baby food are actually tainted with arsenic and other heavy metals!

“Step one to restoring that trust is for manufacturers to voluntarily and immediately reduce the levels of toxic heavy metals in their baby foods to as close to zero as possible. If that is impossible for foods containing certain ingredients, then those ingredients should not be included in baby foods.”

Baby Foods Are Tainted with Dangerous Levels of Arsenic, Lead, Cadmium, and Mercury

Yes, let’s hope that the companies stop making baby food that is contaminated with heavy metals and if they don’t, let’s set high FDA standards for baby food to make sure that they do.

Either way, we are going to need a food supply that isn’t tainted with heavy metals…

“On August 1, 2019, FDA received a secret slide presentation from Hain, the maker of Earth’s Best Organic baby food, which revealed that finished baby food products contain even higher levels of toxic heavy metals than estimates based on individual ingredient test results. One heavy metal in particular, inorganic arsenic, was repeatedly found to be present at 28-93% higher levels than estimated.”

Baby Foods Are Tainted with Dangerous Levels of Arsenic, Lead, Cadmium, and Mercury

And no, simply switching to organic foods isn’t the answer.

What Parents Should Know About Heavy Metals in Baby Foods

So what should parents do?

One obvious thing is to keep pressure on politicians and the companies that make baby food to fix this problem.

But that’s a long term fix…

Right now, you should understand that while baby foods do likely contain these heavy metals, it is not at toxic levels that will cause immediate harm.

And understand that many of the studies on exposure to heavy metals and risks for children were not necessarily specific to baby foods, but were often on general environmental exposure.

Children are exposed to heavy metals from many sources, including parents who smoke, lead in paint and water, and mercury in seafood, etc.
Children are exposed to heavy metals from many sources, including parents who smoke, lead in paint and water, and mercury in seafood, etc.

Still, you should work to decrease your child’s risk of exposure to heavy metals from food by:

  • avoiding apple juice, as like rice, apples can take up arsenic in the soil they are grown in, although keep in mind that infants shouldn’t be given any juice anyway
  • feeding your kids a variety of rices and grains, including oatmeal, barley, multi-grain rice, basmati rice, millet, and quinoa, etc. – remembering that iron-fortified cereals are a good source of iron, so typically shouldn’t be avoided all together
  • looking for rice-free baby snacks and limiting how many rice crackers and rice cakes your older kids eat
  • avoiding teething biscuits, as they are typically made with rice flour
  • offering your baby a variety of vegetables, understanding that carrots and sweet potatoes are often the ones that are most heavily contaminated with heavy metals, so continue to give since they are also high in nutrients, but mix in with a lot of other veggies
  • offering a variety of plant based milks if your older child has a milk allergy (giving breastmilk or an iron fortified infant formula until 12 months), so that they aren’t just drinking rice milk

What else can we do?

“Chemicals are part of our daily life. All living and inanimate matter is made up of chemicals and virtually every manufactured product involves the use of chemicals. Many chemicals can, when properly used, significantly contribute to the improvement of our quality of life, health and well-being. But other chemicals are highly hazardous and can negatively affect our health and environment when improperly managed.”

Action is Needed On Chemicals of Major Public Health Concern

We can focus on real risks, instead of the never ending parade of things that we might be told to worry about, from pesticide residues and sunscreen ingredients to vaccines and GMOs.

Instead of allowing yourself to be overwhelmed and scared of made up risks, focus on things that really might affect your kids, like this news about heavy metals in baby foods.

But even then, understand that the risk isn’t so high that you have to throw out of the jars of baby food you just bought and start making your own. Just give your child a good variety of foods, so that they don’t get too many of the same foods that might contain heavy metals.

And no, you don’t have get your kids tested for heavy metals if your main concern is exposure to heavy metals in baby food…

More on Heavy Metals in Baby Foods

The Experts Defending Anthony Fauci

Anthony Fauci is receiving a lot of support from doctors, scientists, and public health experts.

Not surprisingly, more and more experts are speaking out to defend Dr. Anthony Fauci.

Anthony Fauci is receiving a lot of support from doctors, scientists, and public health experts.
Anthony Fauci is receiving a lot of support from doctors, scientists, and public health experts.

These experts understand that Dr. Fauci “deserves our deepest gratitude and support” and is “our best hope in these challenging times.”

The Experts Defending Anthony Fauci

Harold Bauchner certainly wasn’t alone in stating his public support for Dr. Fauci.

“As 12,000 medical doctors, research scientists and public health experts on the front lines of COVID-19, the infectious diseases community will not be silenced nor sidelined amidst a global pandemic. Reports of a campaign to discredit and diminish the role of Dr. Fauci at this perilous moment are disturbing.”

IDSA Statement in Support of Anthony Fauci, M.D.

The Infectious Disease Society of America issued their own statement.

“If we have any hope of ending this crisis, all of America must support public health experts, including Dr. Fauci, and stand with science.”

IDSA Statement in Support of Anthony Fauci, M.D.

And so did the Association of American Medical Colleges, whose members comprise all 155 accredited U.S. and 17 accredited Canadian medical schools; nearly 400 major teaching hospitals and health systems, including 51 Department of Veterans Affairs medical centers; and more than 80 academic societies, with 173,000 faculty members, 89,000 medical students, 129,000 resident physicians, and more than 60,000 graduate students and postdoctoral researchers in the biomedical sciences.

“The AAMC is extremely concerned and alarmed by efforts to discredit Anthony Fauci, MD, our nation’s top infectious disease expert. Dr. Fauci has been an independent and outspoken voice for truth as the nation has struggled to fight the coronavirus pandemic….

Taking quotes from Dr. Fauci out of context to discredit his scientific knowledge and judgment will do tremendous harm to our nation’s efforts to get the virus under control, restore our economy, and return us to a more normal way of life.

America should be applauding Dr. Fauci for his service and following his advice, not undermining his credibility at this critical time.”

AAMC Statement in Support of Anthony Fauci, MD

Hopefully Dr. Fauci knows how much the majority of people value his work and trust his opinions.

“We have been very fortunate to have Dr. Anthony Fauci at the helm directing infectious diseases research at NIH for so many years. His leadership and support of a rigorous scientific process has been critical to transforming HIV from a death sentence to a chronic condition​, saving millions of lives worldwide. His voice and expertise need to be amplified not silenced if we are going to get control of the COVID-19 pandemic​, which has now taken the lives of more than 135,000 Americans and more than 570,000 people worldwide.”

HIV Medicine Association Stands with Science and Anthony Fauci, MD

And we know that the only way out of the COVID-19 pandemic is with our public health experts, like Anthony Fauci, leading the way.

“In his role as Director of the National Institute of Allergy and Infectious Diseases (NIAID), Dr. Fauci has fostered a longstanding and productive collaboration with the ATS. He has faithfully served the American people through six presidential administrations, always providing sound, science‐based guidance to threats large and small. As we move forward to combat COVID‐19, his scientific knowledge, expertise, and counsel will continue to be of critical importance.”

Statement by the ATS Executive Committee supporting Anthony S. Fauci, M.D., Director, National Institute of Allergy and Infectious Diseases

As cases of COVID-19 once again surge, one thing is becoming clear:

“Science, not politics, must guide COVID-19 response“

AIBS Supports Dr. Fauci

We can’t wish the SARS-CoV-2 virus away…

I am a pediatrician and #IStandWithFauci.

We need health experts like Anthony Fauci to help guide us through this. And we need people to listen to his advice.

More on Anthony Fauci

What Did the AAP Say About Sending Kids Back to School?

The AAP has offered guidance for a safe way to get our kids back in school during the COVID-19 pandemic. Will schools follow any of it when they open up?

The American Academy of Pediatrics recently issued some guidance about what to do about kids going to school this fall.

The AAP said a lot more than that parents should send their kids back to school. They offered guidance on how to safely send kids back to school...
The AAP said a lot more than that parents should send their kids back to school. They offered guidance on how to safely send kids back to school…

Not surprisingly, folks are a little confused about what they actually said…

What Did the AAP Say About Sending Kids Back to School?

It is true, the AAP guidance does favor opening up schools this fall.

“With the above principles in mind, the AAP strongly advocates that all policy considerations for the coming school year should start with a goal of having students physically present in school. The importance of in-person learning is well-documented, and there is already evidence of the negative impacts on children because of school closures in the spring of 2020. Lengthy time away from school and associated interruption of supportive services often results in social isolation, making it difficult for schools to identify and address important learning deficits as well as child and adolescent physical or sexual abuse, substance use, depression, and suicidal ideation. This, in turn, places children and adolescents at considerable risk of morbidity and, in some cases, mortality. Beyond the educational impact and social impact of school closures, there has been substantial impact on food security and physical activity for children and families.”

COVID-19 Planning Considerations: Guidance for School Re-entry

But, that isn’t all they said…

The goal is for kids to be in school this fall...

To get to that goal of opening schools, the AAP offered a list of key principles that schools should follow, including that:

  • school policies are going to have to be “flexible and nimble” so that they can quickly change as we get new information, especially “when specific policies are not working”
  • schools develop strategies that depend on the levels of COVID-19 cases in the school and community
  • schools make special considerations and accommodations for those who need them, “including those who are medically fragile, live in poverty, have developmental challenges, or have special health care needs or disabilities, with the goal of safe return to school”

So clearly, this is not a one-size-fits-all, lets open up schools no matter what kind of thing.

“Highest Risk: Full sized, in-person classes, activities, and events. Students are not spaced apart, share classroom materials or supplies, and mix between classes and activities.”

CDC on Considerations for Schools

The AAP didn’t say to simply open up schools without doing anything else…

“No single action or set of actions will completely eliminate the risk of SARS-CoV-2 transmission, but implementation of several coordinated interventions can greatly reduce that risk. For example, where physical distance cannot be maintained, students (over the age of 2 years) and staff can wear face coverings (when feasible). In the following sections, we review some general principles that policy makers should consider as they plan for the coming school year. For all of these, education for the entire school community regarding these measures should begin early, ideally at least several weeks before the start of the school year.”

COVID-19 Planning Considerations: Guidance for School Re-entry

They offered guidance on how to safely open schools.

Or at least how to open schools as safely as possible, as the alternative of keeping kids at home has risks too. And many people are skeptical that a strategy of closing schools is all that helpful in controlling the spread of SARS-CoV-2.

So the AAP guidance says that we open schools and also plan for:

  • Physical distancing – cohort classes, block schedules, rotating teachers instead of students, etc.
  • Cleaning and disinfecting
  • Testing and screening – schools will need a rapid response plan for when a child or staff member develops a fever at school.
  • Face Coverings and PPE – although it won’t be possible in all situations and for all children, “school staff and older students (middle or high school) may be able to wear cloth face coverings safely and consistently and should be encouraged to do so.”
  • Organized Activities – although this isn’t something most folks want to hear, they should understand that opening schools doesn’t mean that everything will be back to normal… “It is likely that sporting events, practices, and conditioning sessions will be limited in many locations.”

If we do all of that, will it really be safe to go to school with these guidelines?

Unfortunately, the most important part of the guidelines, the section on Testing and Screening, was a bit light on details…

“Parents should be instructed to keep their child at home if they are ill.”

COVID-19 Planning Considerations: Guidance for School Re-entry

The guidelines acknowledge that it will be too hard to do temperature checks and symptom screening each day and that schools should have a rapid response plan if anyone has a fever had school, but then what?

“Here in Colorado, I’ve been following our state health department website very closely. They update data every day and include the outbreaks in the state they are investigating. As you can imagine, there are lots and lots in long-term care facilities and skilled nursing homes, some in restaurants and grocery stores. There have been a total of four in child care centers, and we do have a lot of child care centers open. In almost every one of those cases, transmission was between two adults. The kids in the centers are not spreading Covid-19. I’m hearing the same thing from other states, as well.”

Why a Pediatric Group Is Pushing to Reopen Schools This Fall

So what’s going to happen if kids in school start to get sick and test positive for COVID-19?

Among the 950 COVID-19 in Texas daycare centers are 307 children.
Among the 950 COVID-19 in Texas daycare centers are 307 children. (Dallas Morning News)

The 60,000 members of the AAP who didn’t participate in writing the guideline know what’s going to happen…

A ton of parents from the school are going to call their pediatricians looking to get their kids tested!

What likely should happen?

That classroom or cohort and their close contacts should move to self-quarantine and home/online education until they pass the incubation period from their last contact.

“Put in place the infrastructure and resources to test, trace and isolate new cases.”

Safely Reopening America’s Schools and Communities

(I’m guessing we will get more details about this from the AAP soon and well before school starts. )

Most importantly though, our communities should do everything they can to keep their case counts down – wash hands, practice social distancing, wear a face cover.

And if we are going to send our kids back to school, we should make sure that we are protecting all of the folks making that possible.

Can we do all of that?

Sure!

Will we???

Sending Your Kids Back to School

Are you still unsure about whether or not you should send your own kids back to school?

I don’t blame you…

Some things to consider when making the decision:

  • is your child or any of their contacts at risk for a more severe case of COVID-19, including having an underlying, chronic medical condition, keeping in mind that the risk increases with age, especially once you reach age 65 years? If possible, online schooling might be a better option for students in high risk categories.
  • was staying home from school hard for your child? If your child had problems learning at home or the social isolation was an issue, than that would make going back to school even more important.
  • will your school or school district be “flexible and nimble” and respond to new information, rising case counts, and evolve their policies if necessary?

Most importantly, if you send your kids back to school, are you going to be constantly worried that they are going to get COVID-19 or bring home the SARS-CoV-2 virus? If so, then keep them home this fall.

On the other hand, if they are healthy, have no high risk contacts at home, and are eager to go back to school, then you should probably feel comfortable sending them if the school follows the guidance offered by the AAP.

More on COVID-19

Why Are Social Distancing Kids Still Getting Sick?

Why are some kids still getting sick if they are have been our of school and stuck in the house for weeks because of COVID-19?

COVID-19 has kept most kids out of school for some time now. Many are also out of daycare. And few are out playing with friends.

So why are some still getting sick? What else is going on with kids stuck at home while we are all social distancing to flatten the curve.

Why Are Social Distancing Kids Still Getting Sick?

The first thought of some parents and pediatric providers upon reading this might be, wait, what, kids are still getting sick?

Flu activity is low in most of the United States.
Flu activity is low in most of the United States.

And that’s because it does seem that in addition to flattening the COVID-19 curve, staying home from school and daycare, washing hands, and general social distancing techniques has worked to keeps from getting sick with the flu and most other contagious diseases!

So while pediatric providers are available to do telemedicine appointments, it certainly isn’t business as usual, even as their days have gotten quite unusual.

Some kids are still getting sick though, and while we know what you are thinking, most probably don’t have COVID-19.

Why?

It might be because:

  1. they aren’t social distancing as well as they think they are, keeping in mind that with many diseases, people can be contagious for a few days before they show symptoms and you can sometimes catch germs from touching fomites, or objects that a sick person has recently touched. That still doesn’t mean that they have COVID-19 though. If they have contact with others, they could catch almost anything.
  2. they caught something from someone who had a disease a few weeks or months ago and is still shedding. For example, some infants can shed RSV for as long as 4 weeks after they get better. And they can shed the virus that causes hand, foot and mouth disease (HFMD) for almost two months! Human parainfluenza viruses (HPIV), a common cause of colds and croup (seal bark cough), can also shed for many months.
  3. they caught something from someone who had a viral disease that causes a lifelong latent infection with periodic reactivation and shedding. Wait, what? While herpes (cold sores) is the main disease you might think of as causing a lifelong latent infection, there are others. You may not realize this, but after getting roseola (causes a high fever for a few days, followed by a rash after the fever breaks), HHV-6 (human herpes virus-6) kind of does the same thing. The big difference is that while you shed HHV-6 in your saliva from time to time, you don’t have any symptoms. You can get other folks sick though, especially older infants, once they lose the passive immunity they got from maternal antibodies.
  4. they have a sore throat caused by a virus, allergies, or reflux, but have tonsil stones and a positive strep test because they are a strep carrier. Nearly 20% of kids are thought to be carriers of strep, which means that every time they get tested, they will be positive, whether or not they actually have strep throat. That means that you don’t have to worry about testing the dog to see if they are carrying strep…
  5. they were exposed to a disease with a long incubation period. While the incubation period (the time between getting exposed to something to when you get sick) is just a few days for many diseases, it can be several weeks or months for others. In fact, your child might not get sick until 30 to 50 days after being exposed to someone with mono!
  6. they had a virus a few weeks ago and now have Gianotti Crosti syndrome (GCS), a post-viral rash on a child’s legs, arms, and buttocks. Although GCS might linger for weeks or months, it eventually goes away on its own. Another rash, this one likely caused by reactivation of the virus that causes roseola, might have you thinking your child is covered in ringworm (how would they get that if they haven’t left the house??). Instead, they likely have pityriasis rosea.
  7. their symptoms are caused by a non-contagious infectious disease that is spread from an animal or insect and not from another person – think Lyme disease (ticks), Cat scratch disease (cats), and West Nile virus (mosquitoes), etc.
  8. they got sick (bacteria, virus, or parasite) from contaminated lake or well water, which can cause diarrhea – giardiasis, Crypto, shigellosis, norovirus,
  9. they got sick (bacteria, virus, or parasite) from eating raw or contaminated food – giardiasis, shigellosis, norovirus, E. coli, salmonellosis
  10. their symptoms are caused by a non-infectious disease, which could be anything from allergies and asthma to poison ivy or herpes zoster (shingles).

It is also possible that their symptoms are being caused by anxiety, fear, and stress, which is not unexpected as they see schools closed, people getting sick and wearing masks, and are likely unsure about what’s coming next.

Has your child been sick recently?

Do you have a pet turtle or chickens in your backyard? They could be a source for Salmonella…

Do you understand why now?

Now call your pediatric provider if you have questions and need help getting them well, especially if they seem anxious or have extra stress from being home all of the time and away from school and their friends.

You especially want to call if you think that they might actually have COVID-19. While most kids have mild symptoms or are asymptomatic, if your child has a fever, cough, and difficulty breathing, you should call your pediatric provider or seek medical attention.

More on Covid-19 Kids Getting Sick

Telemedicine for Parents and Pediatric Providers

Ideally, we would continue to see kids in our office when they are sick, but until the COVID-19 pandemic is over, telemedicine is a great alternative to help us keep all of our kids healthy and recognize when they are truly sick, perhaps even needing immediate medical attention.

Many parents and pediatric providers are getting a crash course in telemedicine because of the COVID-19 pandemic.

Although using virtual visits when kids are sick certainly isn’t a new idea, many things have gotten in the way of making online visits to pediatric offices more popular. Chief among them is the simple fact that most people prefer an in-person, in-office visit.

Telemedicine for Parents and Pediatric Providers

Unfortunately, with the risk of spreading the SARS-CoV-2 virus, even when kids don’t have symptoms, in-office visits aren’t always possible and certainly aren’t always safe anymore.

That doesn’t mean that your pediatric provider is going to close, as other non-essential businesses are doing.

Newborns, infants, children, and teens still need to be seen for essential preventative care and when they are sick.

“Be flexible. Consider modifying your clinical schedule and physical space to minimize risk. Increase capacity to deliver telehealth when possible.”

Sally Goza, MD, FAAP President, American Academy of Pediatrics

Still, we are going to have to change how we provide that care until the COVID-19 pandemic is over.

Remember, while it is true that kids aren’t thought to be at risk for severe COVID-19 symptoms, they likely can still get and spread the spreading SARS-CoV-2 virus.

That’s why most pediatric providers are encouraging patients with fever and respiratory symptoms (URI, cough, runny nose, difficulty breathing) to stay home and are instead moving to phone/virtual consultations.

And with community spread in more and more areas, many are switching to telemedicine visits for any non-essential visit. Is your child due for an ADHD recheck? Do you need to discuss test results or need your pediatrician to look at a rash? Is your child constipated? With the risk of COVID-19, these are all ideal reasons to ask for a telemedicine appointment instead of visiting the office.

“Aetna announced it will offer zero co-pay telemedicine visits nationally for any reason for the next 90 days for all commercial plans. Humana, Blue Cross Blue Shield of Massachusetts, Horizon Blue Cross Blue Shield of New Jersey, and others have announced similar expansions of telehealth coverage.”

Opportunities To Expand Telehealth Use Amid The Coronavirus Pandemic

Before COVID-19, the simple fact that most insurance companies didn’t pay for telemedicine visits got in the way of there becoming more popular. That’s changed now, as have some laws and regulations (especially HIPAA restrictions) that had previously made it harder to do telemedicine.

Making the Most of Your Telemedicine Visit With Your Pediatric Provider

While some parents likely are excited about doing telemedicine visits, since they can be more convenient than visiting the office, many others probably still have doubts.

However you feel about it, since it is likely that your child might need a telemedicine visit before this is all over, let’s look at how we can all make the most of it.

To start, if possible, make the telemedicine visit with your usual pediatric provider or someone else in their office. Sign their telehealth consent form and review other polices and procedures before your online appointment.

It can also help if, just before the visit, you:

  • weigh your child
  • check your child’s temperature
  • check your child’s heart rate or pulse
  • check your child’s respiratory rate (count the breaths per minute)
  • write down all of the medicines your child has been taking
  • write down all of your child’s symptoms, including how long they have had them and if they are getting better or worse
  • write down how your child’s symptoms are affecting their eating, sleeping, and other activities, for example, are they drinking fluids, playful, consolable, or are they just crying all of the time?
  • write down any questions you have, as you might forget them during the telemedicine visit!
  • make sure you have a flashlight handy in case your provider wants to take a look at your child’s throat. Maybe even practice having them open wide before the visit.

And most importantly, understand how you are going to connect to your pediatric provider for the online visit! Are you using Facetime, Skype, or a website like doxy.me, etc?

Telemedicine Do’s and Don’ts

Are you and your child (yes, you want your child to be with you during the telemedicine visit!) ready for your first telemedicine visit with your pediatric provider?

Do have everything ready at home and be prepared for when your pediatric provider “shows up” to the visit.

It is also a good idea that you:

  • don’t use medical terminology, like lethargic (is your child really hard to wake up?), dehydrated (just mention the last time your child urinated, etc.), or say that your child is having trouble breathing (is your child breathing fast and hard or having trouble catching their breath?) – instead, just describe what your child is doing and how they are acting, which, since it is a telemedicine visit, your provider will actually get to see for themselves!
  • don’t say that you can’t control your child’s fever, if what you really mean is that it goes back up after their fever reducer wears off, and remember that fever is typically just a symptom, like a cough or runny nose, and not a sign of how sick your child is
  • don’t ask for or expect a prescription, especially for an antibiotic, just because you had an online visit with your provider. Studies have found high rates of antibiotic prescribing during telemedicine visits, especially for kids with respiratory infections, and that hopefully won’t continue as telehealth becomes more popular.
  • avoid sitting in a dark or noisy room, as that will make it harder for your provider to see and hear you

And at the end of the visit, make sure you understand your child’s diagnosis, recommendations for treatment, and most importantly, don’t forget to ask when you should expect that your child should begin to get better and the signs to look for that might indicate that they are getting worse.

“We recognize we are all practicing pediatrics in circumstances we have never encountered before in our careers.”

Sally Goza, MD, FAAP President, American Academy of Pediatrics

Are there limits to telemedicine?

Sure.

We can’t sew up a cut that needs stitches, for example, but you know what? If your child falls and cuts themselves, we can do a telemedicine visit to let you know if they do need stitches, maybe saving you a visit to the office or the ER.

Ideally, we would continue to see kids in our office when they are sick, but until the COVID-19 pandemic is over, telemedicine is a great alternative to help us keep all of our kids healthy and recognize when they are truly sick, perhaps even needing immediate medical attention.

More on Telemedicine for Parents and Pediatricians

COVID-19 Hype or Hazard

Hopefully you are concerned, but aren’t panicking about the new coronavirus that is all over the news right now.

Breaking News: we have seen community spread in the US, at least nine 41 deaths, and more cases in more states. (see below)

What do you think of the news of the 2019 novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)?

Experts say don't panic about the 2019 novel coronavirus.

Are you ready to put on a mask, never leave your home, or just wait and see what happens?

COVID-19 Hype or Hazard

Hopefully you are concerned, but aren’t panicking and want to wait and see what happens over the next few days, weeks, and months.

So what’s going on?

A new coronavirus, 2019-nCoV SARS-CoV-2 has been detected in Wuhan, China and it is spreading, killing some people.

Why is this a concern?

While there are coronaviruses that are very common, even causing many cases of the common cold, there are others that are much more serious.

Seasonal coronavirus are very common during cold and flu season.
Seasonal coronavirus are very common during cold and flu season.

These include the coronaviruses that cause SARS and MERS.

A worldwide outbreak of severe acute respiratory syndrome caused by SARS-CoV caused 8,098 cases and 774 deaths in 2002-03. It also started in China.

MERS-CoV, which causes Middle East Respiratory Syndrome, has been causing cases and deaths since 2012.

What’s Next With COVID-19?

Why are experts concerned about SARS-CoV-2?

Check for Travel Alerts and Warnings before your next trip.
Check for Travel Alerts and Warnings before your next trip.

Mostly because of past experiences with SARS and MERS.

There is also the fact that there is no treatment or vaccine for 2019-nCoV.

Coronavirus that shows up on those large respiratory panels that some health providers do is seasonal coronavirus = the common cold.
Coronavirus that shows up on those large respiratory panels that some health providers do is seasonal coronavirus = the common cold.

And no, your doctor won’t be able to routinely test you for SARS-CoV-2. Testing can be done for those who are high risk, but it still involves sending the specimens to a lab at your local or state health department or the CDC.

That shouldn’t put you into panic mode though…

“Two cases of 2019-nCoV have been reported in the United States. Both patients had recently returned from Wuhan, China. More cases are likely to be identified in the coming days, including more cases in the United States.”

COVID-19 Frequently Asked Questions

Unless you have recently traveled to Wuhan, China an area where there is a COVID-19 outbreak or have had close contract with someone who traveled to an area with a lot of cases while they were sick, then you likely aren’t at much risk to get sick with this virus.

“For the general American public, who are unlikely to be exposed to this virus at this time, the immediate health risk from COVID-19 is considered low.”

Coronavirus Disease 2019 (COVID-19) Situation Summary

It is certainly not something to ignore though.

Since first being detected in Wuhan, China on December 29, 2019, cases have spread to 28 41 46 64 72 134 other countries.

“More cases are likely to be identified in the coming days, including more cases in the United States. It’s also likely that person-to-person spread will continue to occur, including in the United States.”

Coronavirus Disease 2019 (COVID-19) Situation Summary

Most experts expect SARS-CoV-2 to become a pandemic, but that still shouldn’t put you into panic mode…

Experts are also working to learn more so that we know:

  • the original source of the virus – is it the animal markets in Wuhan, China?
  • the incubation period – it seems to be 1 to 14 days
  • how contagious the virus can be and how it spreads – close contact
  • how serious are the complications of infection or how deadly is this virus – so far, “reported illnesses have ranged from mild to severe, including illness resulting in death,” but the latest worldwide mortality rate of 1.4 to 3.4% is much higher than seasonal flu
  • can the virus be contained – this seems unlikely…

We got one answer recently, as it seems that people with the virus are contagious before they have symptoms.

What’s next?

Don’t panic. Plan ahead.

Stay up to date on SARS-CoV-2 information and call your health care provider if you have flu-like symptoms and recently traveled to Wuhan, China or had contact with someone who is under investigation for COVID-19.

“Limited reports of children with COVID-19 in China have described cold-like symptoms, such as fever, runny nose, and cough. Gastrointestinal symptoms (vomiting and diarrhea) have been reported in at least one child with COVID-19. These limited reports suggest that children with confirmed COVID-19 have generally presented with mild symptoms, and though severe complications (e.g., acute respiratory distress syndrome, septic shock) have been reported, they appear to be uncommon.”

CDC on Frequently Asked Questions and Answers: Coronavirus Disease-2019 (COVID-19) and Children

And even if you are starting to get nervous, at least you don’t have to worry too much about your kids. So far, there is no evidence that children are more susceptible to COVID-19 and there are reports that they actually get milder symptoms!

Lastly, if you haven’t yet, be sure to get a flu vaccine.

Affected geographic areas include China, Italy, South Korea, Iran, and Japan.
As we see community spread in more areas, the criteria to guide evaluation of PUI for COVID-19 continues to loosen up.

If you are going to develop a fever and symptoms of lower respiratory illness during cold and flu season in the United States, especially if you haven’t traveled to a high risk area, then it is probably the flu, not the new coronavirus…

More on COVID-19 Hype or Hazard

Does Zantac Cause Cancer?

While you might be worried over the hype about NDMA in Zantac, just remember that this is the same stuff that adds tiny extra risk of cancer from eating bacon.

Breaking News – Zantac syrup, made by Lannett, has been recalled too.

Have you heard the news that taking ranitidine (Zantac) could cause cancer?

I’d be surprised if you haven’t…

Does Zantac Cause Cancer?

So does Zantac really cause cancer or is this just media hype?

“The U.S. Food and Drug Administration has learned that some ranitidine medicines, including some products commonly known as the brand-name drug Zantac, contain a nitrosamine impurity called N-nitrosodimethylamine (NDMA) at low levels. NDMA is classified as a probable human carcinogen (a substance that could cause cancer) based on results from laboratory tests. NDMA is a known environmental contaminant and found in water and foods, including meats, dairy products, and vegetables.”

FDA Statement alerting patients and health care professionals of NDMA found in samples of ranitidine

Ok, so Zantac might contain NDMA and NDMA could cause cancer.

But NDMA is found in many things, so how concerned should we be about it being in Zantac?

“Although NDMA may cause harm in large amounts, the levels the FDA is finding in ranitidine from preliminary tests barely exceed amounts you might expect to find in common foods.”

FDA Statement alerting patients and health care professionals of NDMA found in samples of ranitidine

Although the FDA is still “evaluating whether the low levels of NDMA in ranitidine pose a risk to patients,” so far, it doesn’t sound like a very big concern.

While Novartis AG’s Sandoz division, which makes ranitidine, has stopped distributing their generic version of Zantac, Sanofi will continue to distribute brand name Zantac. And many other companies make ranitidine, so it will likely continue to be available.

Most companies are voluntarily recalling their prescription and over-the-counter versions of ranitidine tablets, capsules, and syrup.

How do medications become contaminated with NDMA?

In the case of blood pressure medications (sartans), regulators began looking for NDMA last year.

“It is now known that these impurities can form during the production of sartans that contain a specific ring structure known as a tetrazole ring under certain conditions and when certain solvents, reagents, and other raw materials are used. In addition, it is possible that impurities were present in some sartans because manufacturers had inadvertently used contaminated equipment or reagents in the manufacturing process.”

Sartan medicines: companies to review manufacturing processes to avoid presence of nitrosamine impurities

Ranitidine doesn’t contain a tetrazole ring, but as with the sartans, it is possible that the NDMA formed during production or that contaminated equipment or reagents were used in the manufacturing process.

“Valisure’s research, along with that of Stanford University and others, found that NDMA was the result of the “inherent instability” of the ranitidine molecule.”

Valisure Detects NDMA in Ranitidine

And food?

“The typical diet in most countries contains nitrates, nitrites, and nitrosamines. Nitrates and nitrites occur naturally in fruit and vegetables, which are regarded as an important part of a healthy diet due to the powerful evidence of beneficial health effects against cancer. In the same time, nitrates and nitrites are often used as food additives in processed meats such as ham, bacon, sausages, and hot dogs, to retard microbial spoilage, and preserve meat products recognizable appearance and flavor as well. A high consumption of processed meats is linked to an increased gastric cancer risk, and many people consider nitrates/nitrites as the main reason for that. Nitrosamines are produced by chemical reactions of nitrates, nitrites and other proteins.”

Song et al on Dietary Nitrates, Nitrites, and Nitrosamines Intake and the Risk of Gastric Cancer: A Meta-Analysis

NDMA is not in food because of contamination.

“…excess lifetime cancer risk was calculated separately for each of the five nitrosamines and then summed to arrive at a total excess lifetime cancer risk of 1.46 × 10-6 (or about 1 in 683,000) due to average population exposure to nitrosamines through pork bacon.”

Cancer Risk from Nitrosamines in Pork Bacon

And the cancer risk from NDMA in food is considered to be small.

“Nitrosamines are ubiquitous in the human environment and have been detected in food items, including cured meat, bacon, fish, and beer, in cosmetics, drugs, and in the front passenger areas of new cars.”

Exposure to high concentrations of nitrosamines and cancer mortality among a cohort of rubber workers

The bigger risk is likely from nitrosamines in cigarette smoke and occupational exposures.

What should you do if your child takes ranitidine?

Still, do you want to give your kids a medicine that might contain a substance that could cause cancer?

“The FDA is not calling for individuals to stop taking ranitidine at this time; however, patients taking prescription ranitidine who wish to discontinue use should talk to their health care professional about other treatment options. People taking OTC ranitidine could consider using other OTC medicines approved for their condition. There are multiple drugs on the market that are approved for the same or similar uses as ranitidine.”

FDA Statement alerting patients and health care professionals of NDMA found in samples of ranitidine

Since the risk seems so small, whether or not you continue giving your child Zantac or you switch to something else might depend on how easy it would be to switch.

Over the counter Zantac is approved for adults and children 12 years and over. There are many options to treat reflux for these folks, including Pepcid, Prevacid, Nexium, and Prilosec, etc.

On the other hand, prescription ranitidine syrup is approved for infants as young as one-month-old. Not many medicines are approved at this age.

There is one though.

Although not an H2-receptor antagonists like ranitidine, Nexium is another reflux medicine that is approved for infants. It is a proton pump inhibitor (also decreases the production of acid in the stomach) that is available in delayed release oral suspension packets.

Should you stop taking Zantac?

So what should you do?

Although doing nothing or switching seem like your two options, if your child’s reflux has been well controlled on Zantac for awhile, this might be a good idea to ask your pediatrician if a trial off medications might be appropriate.

Most infants and children eventually outgrow having reflux and are able to wean off their reflux medicine. Is your child ready?

Of course, you shouldn’t stop your child’s medicine without talking to your doctor first. And instead of stopping their Zantac, it might be better to switch to another reflux medicine.

“Carcinogens do not cause cancer at all times, under all circumstances.”

American Cancer Society on Known and Probable Human Carcinogens

Could you keep taking Zantac? That’s also an option for now, especially if you only expect that your child will be on it for a short time, but as more manufactures declare that they will recall and stop shipping ranitidine, you might have to switch anyway.

Whatever you do, don’t panic over this news. Your kids are almost certainly not at any real increased risk to develop cancer just because they have been taking Zantac.

More on NDMA in Zantac

Updated: October 30, 2019

The New Vaccine Surveillance Network Report on Enterovirus D68 Infections

Anyone who has been following the outbreaks of Acute Flaccid Myelitis the last few years will likely think the following report is long overdue.

The report, Enterovirus D68–Associated Acute Respiratory Illness — New Vaccine Surveillance Network, United States, July–October,2017 and 2018, is especially welcome by those folks who are already convinced that AFM is associated with EV D68.

The New Vaccine Surveillance Network Report on Enterovirus D68 Infections

But wait, why was surveillance done through the New Vaccine Surveillance Network?

And for that matter, what is the New Vaccine Surveillance Network?

“The New Vaccine Surveillance Network (NVSN) includes study sites that focus on population-based surveillance and data collection on the use and impact of vaccines and the impact of vaccine policies. Since 2006, NVSN sites have conducted active, population-based surveillance for hospitalizations and outpatient visits associated with acute gastroenteritis (AGE) in children (2006-present). NVSN sites have conducted surveillance for acute respiratory illness (ARI) from 2000 to 2009, and again beginning in 2015.”

New Vaccine Surveillance Network (NVSN)

Before you start thinking that this means a new Enterovirus D68 vaccine is coming out soon, many NVSN studies have nothing to do with vaccines…

“NVSN supports broad-based surveillance and research projects for acute gastroenteritis and acute respiratory infections in areas with a population base of at least 500,000.”

New Vaccine Surveillance Network (NVSN) Overview

In addition to studies on the flu and pneumococcal disease, they have done studies on norovirus, coronavirus, human metapneumovirus, HPIV, RSV, and rhinovirus infections.

So what did they find out about Enterovirus D68 infections?

“Based on preliminary data, test results were positive for EV-D68 for two (0.08%) of 2,433 patients with ARI who were tested during 2017 and 358 (13.9%) of 2,579 tested during 2018. “

Enterovirus D68–Associated Acute Respiratory Illness — New Vaccine Surveillance Network, United States, July–October, 2017 and 2018

There were a lot more EV D68 infecions in 2018 than there were in 2017

And what does that mean?

Considering that we had “only” 33 confirmed cases of AFM in 16 states in 2017 and at least 223 confirmed cases of AFM in 41 states in 2018, the rise in EV-D68 cases seems to correlate with the rise in AFM.

“Although AFM is rare in the United States, these AFM surveillance data, along with the EV-D68 activity documented through NVSN, provide additional supporting evidence for a temporal association between EV-D68 respiratory illness and AFM. “

Enterovirus D68–Associated Acute Respiratory Illness — New Vaccine Surveillance Network, United States, July–October, 2017 and 2018

Again, few people are going to be surprised by this news…

So, what’s next?

You mean besides the 2019 AFM season?

More on Acute Flaccid Myelitis News


Infants’ Ibuprofen Concentrated Oral Suspension Recall

Three lots of Infants’ Ibuprofen Concentrated Oral Suspension that were made by Tris Pharma, Inc. and sold under the Equate, CVS Health, and Family Wellness brands and sold at Wal-Mart, CVS, and Family Dollar stores have been recalled.

Three lots of Infants' Ibuprofen Concentrated Oral Suspension that were made by Tris Pharma, Inc. and sold under the Equate, CVS Health, and Family Wellness brands and sold at Wal-Mart, CVS, and Family Dollar stores have been recalled.

If you have little kids who sometimes take pain or fever medications, you will want to check your medicine cabinet for this recall.

Three lots of Infants’ Ibuprofen Concentrated Oral Suspension have been recalled because the concentration in the bottle might be higher than they it is supposed to be.

What does that mean?

Although they are supposed to be at a 50mg per 1.25ml concentration, if it is indeed higher, then if you gave your child 1.25ml, they might get more than just 50mg.

“To date, Tris Pharma, Inc. has not received any reports of adverse events related to the lots of product that are the subject of this recall.”

How much more? We don’t know, since we don’t know what the “potentially” higher concentration might be.

Infants’ Ibuprofen Concentrated Oral Suspension Recall

Fortunately, the recall is limited to just 3 lots of  Infants’ Ibuprofen Concentrated Oral Suspension that were made by Tris Pharma, Inc. and sold under the Equate, CVS Health, and Family Wellness brands and sold at Wal-Mart, CVS, and Family Dollar stores.

Do you have any recalled Ibuprofen?
Do you have any recalled Ibuprofen? Check your lot numbers!

If you have the recalled Ibuprofen, don’t use it. Contact Tris Pharma for a refund.

And seek medical attention if you think your child got too much Ibuprofen and is having any symptoms, especially nausea, vomiting, epigastric pain, or more rarely, diarrhea.

Fortunately, getting extra Ibuprofen is not usually as dangerous as getting extra Acetaminophen.

Although, of course, neither is good! Be careful when dosing your kids and be sure they need it first.

Oh, and yes, at least in this case, store brand Ibuprofen at Family Dollar and Wal-Mart is the same as store brand Ibuprofen at CVS…

More on Infants’ Ibuprofen Concentrated Oral Suspension Recall