News on the Latest Food Recalls and Foodborne Disease Outbreaks

Breaking news – In addition to some new outbreaks, some popular foods have recently been recalled because of concern for Salmonella contamination, including four varieties of Goldfish crackers from Pepperidge Farms and many types of Ritz Cracker Sandwiches and Ritz Bits.

It is not unusual for a food to get recalled.

Many have to do with undeclared eggs, gluten, peanut, or milk, things that can trigger food allergies, but some are because of potential bacterial contamination.

“When two or more people get the same illness from the same contaminated food or drink, the event is called a foodborne disease outbreak.”

CDC on Reports of Selected Salmonella Outbreak Investigations

And some lead to outbreaks that get people sick.

In fact, since 2006, there have been between four and fourteen multistate foodborne outbreaks each year, involving everything from ground beef and cantaloupes to sprouts and peanut butter.

The Latest Foodborne Disease Outbreaks

Do you remember hearing about any of these outbreaks?

Unfortunately, many people don’t know about these recalls and outbreaks until it is too late – when they are or someone they know gets sick.

That’s why it’s important to stay up-to-date on the latest food recalls and outbreaks, including:

  • an ongoing Salmonella outbreak that has been linked to raw turkey products that has gotten 90 people sick in 26 states
  • an ongoing Vibrio parahaemolyticus outbreak that has been linked to fresh crab meat from Venezuala that has gotten 12 people sick in 4 states
  • an ongoing Salmonella outbreak that has been linked to recalled Spring Pasta Salad from Hy-Vee grocery stores that has gotten 21 people sick in 5 states
  • an ongoing Cyclosporiasis outbreak that has been linked to salads sold at McDonalds that has gotten at least 286 people sick in 14 states
    Honey Smacks cereal has been linked to a Salmonella outbreak.
    Honey Smacks cereal has been linked to a Salmonella outbreak.

     

  • an ongoing Salmonella outbreak that has been linked to recalled Kellogg’s Honey Smacks cereal that has gotten at least 100 people sick in 33 states.
  • a resolved Salmonella outbreak that has been linked to pre-cut melons from Caito Foods in Indiana that has gotten at least 77 people sick in 9 states.
  • a resolved Salmonella outbreak that has been linked to recalled shell eggs from Rose Acre Farms’ Hyde County farm of Seymour, Indiana and has gotten at least 45 people sick in 10 states. Over 200 million eggs are being recalled that were sold in restaurants and stores (Target, Food Lion, and Walmart) in Colorado, Florida, New Jersey, New York, North Carolina, Pennsylvania, South Carolina, Virginia, and West Virginia.
  • a resolved E.coi 0157:H7 outbreak that has been linked to romaine lettuce from the Yuma, Arizona growing region and has gotten at least 210 people sick in 36 states, including 5 deaths. Although there has been no official recall, we have been warned to not buy or eat romaine lettuce from the Yuma growing region (it is no longer being sold, but some product may still be in homes) or if you don’t know where it is from.
  • a resolved Salmonella outbreak that has been linked to recalled bulk packages of International Harvest, Inc. brand Go Smiles Dried Coconut Raw that has gotten 134 people sick in 8 states

If your child is sick and has eaten any of the foods listed in an ongoing outbreak, be sure to call your pediatrician or seek medical attention.

How can you avoid these outbreaks?

“Since 1996, there have been at least 30 reported outbreaks of foodborne illness associated with different types of raw and lightly cooked sprouts. Most of these outbreaks were caused by Salmonella and E. coli.”

Sprouts: What You Should Know

Although proper cooking and food handling can help keep your family from getting sick in some cases with these recalled foods, it likely won’t with others, such as when fruits and vegetables, that you eat raw, are contaminated with bacteria.

Got Salmonella? You might, if you eat these recalled eggs.
Got Salmonella? You might, if you eat these recalled eggs.

That’s why you have to be aware of food recalls and be sure that you don’t eat foods that have been recalled, especially if anyone in your family is considered to be at high risk to get sick (younger children, anyone with a chronic illness, anyone who is pregnant, etc.). Many experts suggest avoiding those foods that are at high risk of contamination for high risk people, including raw sprouts, uncooked and undercooked beef, pork, and poultry, eggs that aren’t pasteurized, and of course, raw milk.

Also be sure to seek quick medical attention if you have eaten them and get sick (diarrhea, vomiting, abdominal pain, and fever, etc.).

What to Know About Food Recalls and Foodborne Outbreaks

It is important to be aware of food recalls and foodborne disease outbreaks, whether they are caused by Salmonella, E. coli, or Listeria, so that you can take steps to avoid those foods and keep your family from getting sick.

More on Food Recalls and Foodborne Outbreaks

Updated July 25, 2018

Can You Really Predict or Calculate Your Child’s Future Height?

What’s the most common question most pediatricians get?

No, it is not about eye color, although that’s a common one too.

It’s about how tall a child is going to get when they finish growing.

Can You Really Predict or Calculate Your Child’s Future Height?

Your pediatrician can’t see into the future, so how can they predict how tall your kids will be when they get older?

While it is true that we don’t have a crystal ball to help us see into the future, we do have a lot of science on our side that can help us get a glimpse.

So it’s not a trick, just basic genetics, which tells us that tall parents typically have tall children, and vice versa.

How To Predict Your Child’s Height

How tall will your kids be when they grow up?
How tall will they be?

So how tall will your kids be?

How tall are you and your spouse or partner? In general, you can predict your child’s future height based on their genetic potential, which is based on their biological parents’ average height.

To see how tall your kids will be, you can:

  1. Record mom’s height (in inches).
  2. Record dad’s height (in inches).
  3. Average the two heights together.
  4. Do you have a girl? Subtract 2 1/2 inches from your average heights and that is your daughter’s predicted height as an adult.
  5. Do you have a boy? Add 2 1/2 inches from your average heights and that is your son’s predicted height as an adult.

While not perfect, your kids have a 68 percent chance of being within 2 inches and a 95 percent chance of being within 4 inches of this predicted height.

Want to test it out? See if you reached your own genetic potential by calculating what your own height should have been using your mom and dad’s height. Are you close?

But can’t you just double your child’s height when they are two year’s old? Doesn’t that predict their adult height too? While that is another method, it isn’t clear how accurate the prediction might be.

Another method might be to simply follow your child’s growth curve on a growth chart and see where they end up. Like the two years times two method, following the curve might not be accurate, as the growth curve incorporates an average age for starting puberty. Kids who start puberty on the later side of normal can benefit from a late growth spurt and continue growth in their late teen years that can push them up a few percentiles on the growth chart.

Being a late bloomer can be genetic though, so even if other methods underestimate your child’s height in this case, the genetic potential method might still be accurate.

Does any of this matter? It actually does and monitoring your child’s growth isn’t just something that parents do for fun.

If a child doesn’t seem to be reaching their genetic potential for growth, that could be a sign that something is getting in the way of their growing properly. Do they have uncontrolled asthma? Are they taking a medication that could affect their height, causing short stature? Do they have a thyroid, metabolic, or genetic condition?

Is your child already much taller than everyone in the family? While that is also sometimes a concern, as some conditions lead to excessive growth or a tall thin body type, the most common reason for a child to be taller than their parents is that their are other tall relatives in the family.

Talk to your pediatrician if you are concerned about your child’s growth or have questions about how tall or shot they might become.

What to Know About Predicting Your Child’s Height

While trying to predict your child’s future height is fun to do, it is also an important tool that your pediatrician might use to make sure they are growing properly and meeting their genetic potential for growth.

More on Predicting Your Child’s Height

What to Do If Your Teen Is Talking About Suicide

Suicide is a public health issue that concerns all of us. It is one of the reasons that many pediatricians get involved in pushing for stronger gun safety laws and teach parents to store any guns that they have locked, unloaded, with the ammunition locked elsewhere.

As you will learn, “reducing access to lethal means” is one of the first things you should do if your child is talking about suicide.

Is Your Child Talking About Suicide?

Although there are many warning signs of suicide, one is that a child or teen might simply starts talking about wanting to die.

According to the National Institute of Mental Health (NIMH), they might also:

  • Talk about feeling empty, hopeless, or having no reason to live
  • Talk about great guilt or shame
  • Talk about feeling trapped or feeling that there are no solutions
  • Talk about feeling unbearable pain, both physical or emotional
  • Talk about being a burden to others
  • Talk or think about death often

And it is important to keep in mind that instead of actually ‘talking’ about any of this with you, a parent, your child might instead talk about it with their friends, text someone, or post messages on Facebook, Instagram, Snapchat, or inside a chat room of one of the games they play.

What to Do If Your Child Is Talking About Suicide

So what do you do if your child is talking about suicide?

Get help as soon as possible.

“Asking someone about suicide is not harmful. There is a common myth that asking someone about suicide can put the idea into their head. This is not true. Several studies examining this concern have demonstrated that asking people about suicidal thoughts and behavior does not induce or increase such thoughts and experiences. In fact, asking someone directly, “Are you thinking of killing yourself,” can be the best way to identify someone at risk for suicide.”

Suicide in America: Frequently Asked Questions

While getting help might start with a call to your pediatrician, the National Suicide Prevention Lifeline is always available at 1–800–273–TALK (8255). Call immediately to figure out the best way to help your child, before they have a chance to hurt themselves.

Let your kids know that there are hotlines to call if they ever need to talk to someone when they are feeling anxious or depressed.

And know that help is available.

Most importantly, don’t ignore or dismiss your child’s talk because you don’t believe them.

Talking to Your Kids About Suicide

What would your kids do if a friend texted them and said they were thinking of killing themselves? Would they come tell you?

What if their friend told them to keep it a secret?

What if they were thinking about suicide?

Since we know that talking about suicide is not harmful, is there any good reason to not talk to your kids about what to do in these situations?

Have you?

Your kids should know that they can always come talk to you and:

  • how to call the National Suicide Prevention Lifeline, 1–800–273–TALK (8255), which is available 24 hours a day for anyone who needs help
  • how to contact the crisis text line – text HOME to 741741, and text with a trained Crisis Counselor 24 hours a day
  • what to do when a friend is talking about suicide
  • about the Lean On Me anonymous peer support via text network
  • about the Trevor Project, the leading national organization providing crisis intervention and suicide prevention services to lesbian, gay, bisexual, transgender, and questioning youth, including a hotline, chat and text help service
  • about the Disaster Distress Helpline for “24/7, 365-day-a-year crisis counseling and support to people experiencing emotional distress related to natural or human-caused disasters.” Anyone can call 1-800-985-5990 or text TalkWithUs to 66746 to connect with a trained crisis counselor.
  • how to report suicidal content on Facebook
  • how to report suicidal content on Twitter
  • how to report suicidal content on Instagram (tap “…” below the post and then tap “Report Inappropriate,” select “This Photo Puts People At Risk > Self-Harm”)
  • how to report suicidal content on YouTube (click “More” and then highlight and click “Report” in the drop-down menu. Click “Harmful dangerous acts,” then “Suicide or self-injury” to trigger a review)

Again, talk to your kids so that they know not to ignore any warning signs, as one day, they might be in a position to save one of their friends.

What to Know About Talking to Your Kids About Suicide

Talking and asking about suicide is a good first step in getting someone who might hurt themselves help.

More on Talking to Your Kids About Suicide

5 Rare Syndromes That Parents Should Learn About

I’ve talked about classic and uncommon diseases that parents should learn about before. From acanthosis nigricans to volvulus, they are conditions that are fairly common. Or at least not rare.

There are another group of syndromes that it can be good to be aware of, not necessarily because you will ever know someone that is affected by them, but rather because they are so hard to diagnosis, increased awareness is important.

5 Rare Syndromes That Parents Should Learn About

What are these rare syndromes? They include:

  • Ehlers-Danlos syndromes – now includes thirteen subtypes of connective tissue disorders, at least one of which can cause infants to have repeated, unexplained fractures that can be confused with child abuse
  • Mitochondrial genetic disorders or mito – genetic diseases that can affect multiple organ systems in the body and can cause a variety of signs and symptoms, from developmental delays and muscle weakness to seizures. The type of mutation and whether it is in mitochondrial DNA or nuclear DNA determines the type of mito disorder, of which there are many, including Alpers syndrome, Barth syndrome, Co-enzyme Q10 deficiency, Kearns–Sayre syndrome, Leigh syndrome, MELAS, and Pearson’s syndrome, etc.
  • 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. With the OCD, these young kids might also have anxiety, including separation anxiety, depression, irritability, regression in their behavior, sleep problems, or school problems, etc. Although it has since been renamed PANS, Pediatric Acute-onset Neuropsychiatric Syndrome, you should still have the “temporal association between Group A streptococcal infection and symptom onset/exacerbations” to have PANS.
  • POTS – teens with Postural Orthostatic Tachycardia Syndrome have dizziness, fatigue, headaches, nausea, difficulty concentrating and other disabling symptoms related to alterations or dysfunction in the autonomic nervous system (dysautonomia). POTS is actually fairly common. What’s rare is for parents and pediatricians to know about POTS, and to therefore get kids diagnosed.
  • 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 these kids don’t have asthma and could have vocal cord dysfunction instead.

Have you ever heard of these disorders? No one would be surprised if you hadn’t.

Although a few are indeed rare, even when children do have them, it often takes years and years and visits to many different doctors before many of these kids finally get a diagnosis. That can mean years and years of unnecessary treatments and more importantly, the missed opportunity to get the proper treatment and hopefully relief for your child’s symptoms.

Why don’t all doctors learn more about these conditions so that they can be sure to recognize them as early as possible?

It’s not that simple. For every teen you every see with POTS, there will likely be dozens with vasovagal syncope or orthostatic hypotension. Same goes with the Ehlers-Danlos syndromes, which can sometimes be confused with the more common hypermobility spectrum disorders, which might just cause kids to have some extra aches and pains.

Tips for Getting a Diagnosis for These Rare Syndromes

How can you get a quick, or relatively quick diagnosis if your child has one of these syndromes? A little luck and a lot of increased awareness. This can also help avoid getting diagnosed when your child probably shouldn’t.

“Vocal cord dysfunction is an asthma mimic. Diagnosis of this condition requires a high index of suspicion if unnecessary treatments are to be avoided.”

Varney et al on The successful treatment of vocal cord dysfunction with low-dose amitriptyline

It can especially help to understand that:

  • Children with EDS often score 6 out of 9 on the Breighton scale.
    Children with EDS have hypermobility and often score 6 out of 9 on the Beighton scale. (Photo by Cattalini et al CC by 4.0)

    you might suspect that your child has one of the Ehlers-Danlos syndromes if they seem to be “double jointed,” often complain of growing pains, have a lot of sport’s injuries, poor wound healing, and/or skin that is hyper-extensible.

  • mitochondrial disorders are rare and children often don’t have classic signs or known genetic defects that make getting a diagnosis easier. There are checklists of signs, symptoms, and physical exam findings to look for, testing that can be done, and family history to look for, that may help if you suspect that your child has a mito disorder. Why would you suspect that your child has a mito disorder? They might have unexplained low muscle tone (hypotonia), muscle weakness, poor growth (failure to thrive), seizures, and lactic acidosis.
  • there aren’t always easy blood tests that help to make these diagnoses. Even when there are, like in the case of PANS/PANDAS, an elevated strep titer, some health care providers will make a diagnosis with a titer that isn’t really elevated or isn’t rising. Or in a child that has had no evidence of a strep infection. You should suspect PANDAS when a younger child (before puberty) suddenly develops (abrupt onset) obsessions, compulsions, and/or tics.
  • since many teens have issues with dizziness and fatigue, to make a diagnosis of POTS, they should have a real tilt test which demonstrates that their heart rate goes up at least 30 to 40 beats per minute within 10 minutes of going from a supine (lying down) to a standing position. The problem is that many health care providers do the tilt testing improperly, getting heart rate and blood pressure measurements at the wrong time. The easiest way to do a tilt test (active stand test) is to have the child lie down for a good 10 minutes, and check their heart rate and blood pressure. Then have them stand up (being careful they don’t faint) and check them again immediately, noting the differences.
  • although vocal cord dysfunction can be triggered by the same things and have the same symptoms as asthma, the treatments are greatly different. Instead of asthma inhalers, kids with vocal cord dysfunction learn breathing techniques and might get voice therapy. Other clues that a child might have vocal cord dysfunction include normal pulmonary function tests, that they have stridor, instead of wheezing, and that episodes come and go more quickly than a typical asthma attack.

With a prevalence of about 1 in 5,000 people, the average pediatrician might never see a child with EDS or a mito disorder.

Pediatricians are much more likely to see kids with PANDAS, POTS, and vocal cord dysfunction. More awareness  of all of these syndromes can help make sure that kids get a quick diagnosis and proper treatments.

A referral to a pediatric specialist or team of specialists can also be helpful if you suspect that your child has any kind of rare or unexplained syndrome.

What to Know About Getting a Diagnosis for These Rare Syndromes

Your pediatrician can help if you suspect that your child has any of these difficult to diagnose conditions.

More on Getting a Diagnosis for These Rare Syndromes

Can You Skip Your Newborn Baby’s Eye Ointment?

A lot of what happens in the delivery room and newborn nursery once your baby is born is routine.

Tragically, skipping some of this routine care, from a RhoGAM shot to the vitamin K shot and hepatitis B vaccine, is becoming standard for some anxious parents.

Some even want to skip getting the antibiotic ointment that is placed on their baby’s eyes that can help prevent ophthalmia neonatorum, which can lead to blindness.

Ophthalmia Neonatorum

Since we don’t usually think of pink eye (conjunctivitis) as a serious disease, it is likely hard to imagine that neonatal conjunctivitis (ophthalmia neonatorum) could lead to blindness. It does though – or did.

Ophthalmia neonatorum due to Gonococcus infection.
Ophthalmia neonatorum due to Gonococcus infection. (Photo by Murray McGavin CC BY 2.0)

The main cause was Neisseria gonorrhoeae, a sexually transmitted infection that could be passed to a baby when they were born. Similarly, Chlamydia trachomatis can cause ophthalmia neonatorum.

That ophthalmia neonatorum could be prevented was first discovered by a German gynecologist in 1881. Dr. Carl Siegmund Franz Credé instilled a drop of silver nitrate into a newborn’s eyes immediately after they were born and this greatly decreased the rates of infections in babies born in his hospital.

Today, erythromycin ophthalmic ointment and povidone-iodine have largely replaced the use of silver nitrate for preventing ophthalmia neonatorum, but it works on the same principle – killing any bacteria that might cause neonatal conjunctivitis, especially those that cause blindness.

Can You Skip Your Newborn Baby’s Eye Ointment?

Why skip a treatment that can prevent your baby from getting an infection that can lead to blindness?

Gonococcal ophthalmia neonatorum caused by a maternally transmitted gonococcal infection.
Gonococcal ophthalmia neonatorum caused by a maternally transmitted gonococcal infection. (Photo by CDC/ J. Pledger)

Since ophthalmia neonatorum is generally caused by gonorrhoea and chlamydia, most parents who think about skipping their baby’s eye ointment are likely fairly confident that they don’t have one of these sexually transmitted infections. And most of them will likely be right.

In fact, some countries, including Australia, the UK, Norway, Denmark, and Sweden, have stopped routine ophthalmia neonatorum prophylaxis. Some just treat those babies who are at high risk for infections, especially if they didn’t receive prenatal care or have a maternal history of STIs, etc.

In the United States, routine use of erythromycin 0.5% ophthalmic ointment within 24 hours of a baby’s birth for the prevention of ophthalmia neonatorum is still the standard of care. In fact, it is required by law in many states.

What are some of the issues to consider when thinking about skipping your baby’s eye ointment?

  • the incidence of gonorrhoea and chlamydia have been increasing in recent years and it is very possible to have these STDs without obvious symptoms
  • up to 30 to 50% of babies born to a mother with gonorrhoea or chlamydia will get neonatal conjunctivitis, even if they had a cesarean section
  • not all pregnant women are routinely tested for gonorrhoea and chlamydia
  • ophthalmia neonatorum caused by gonorrhoea or chlamydia can very quickly lead to permanent scarring and blindness
  • ophthalmia neonatorum caused by gonorrhoea or chlamydia is not as easy to treat as routine pink eye, often requiring hospitalization and systemic antibiotics
  • gonorrhoea and chlamydia aren’t the only bacteria that can cause severe neonatal conjunctivitis

Most importantly, if you are thinking about skipping your baby’s eye ointment, know that places that routinely stopped using eye ointment to prevent ophthalmia neonatorum often  saw an increased incidence of gonococcal ophthalmia, while rates remain very low in the United States.

“The annual figures for ON reported during the study period, under statutory health protection regulations, underestimated the actual occurrence of this disease by a very substantial amount.”

Dharmasena on Time trends in ophthalmia neonatorum and dacryocystitis of the newborn in England, 2000–2011: database study

And you are likely to get worried every time your baby has a little eye discharge or redness, just like parents who skip vaccines worry when their child has a fever or cough.

Since the eye ointment that is used is safe (erythromycin doesn’t cause the irritation that silver nitrate used to in the old days), why take the risk of an infection that can lead to blindness?

What to Know About Skipping Your Baby’s Eye Ointment

The use of erythromycin eye ointment after your baby is born can help to prevent a serious infection that can lead to blindness. Don’t skip it.

More on Skipping Your Baby’s Eye Ointment

Common Foot Problems That Your Kids May Have

Do your kids ever complain about problems with their feet?

From athlete's foot to toe walking, your pediatrician can help evaluate your child's foot problems.
From athlete’s foot to toe walking, your pediatrician can help evaluate your child’s foot problems. Photo by Vincent Iannelli, MD

If not, they probably will at some point…

Common Pediatric Foot Problems

Fortunately, not all of those complaints will be caused by real problems.

Some will be though, so it is important to learn about common pediatric foot conditions (comprehensive information is provided in the links below), including:

  • ankle sprains – it is typically good news to hear that your child only has an ankle sprain and that nothing is broken, but that doesn’t always mean a quick recovery. A moderate or severe ankle sprain can mean a recovery plan that takes up to 6 to 12 weeks! Remember the RICE protocal (Rest, Ice, Compression, and Elevation) and an age appropriate dose of a nonsteroidal anti-inflammatory drug, like ibuprofen or naproxen, if your child has a mild sprain, and see your pediatrician if your child sprains their ankle and has severe pain, can’t bear weight on their foot, or isn’t getting better.
  • in-toeing – unless a baby’s foot is rigid (a sign of club foot), in-toeing is usually normal and doesn’t require treatment. That’s despite what you may hear from grandparents who swear up and down that they remember wearing special shoes when they had in-toeing. While they probably did, that isn’t routinely done anymore, as most kids grow out of their in-toeing without treatment.
  • out-toeing – also usually normal and doesn’t require treatment with special shoes or casting, like they did “in the old days.”
  • athlete’s foot – common in older teens, who can have dry, scaling skin on their feet that itches or burns, especially between their toes, athlete’s foot (tinea pedis) is less common in younger children who are more likely to have JPD. Athlete’s foot can usually be treated with an over-the-counter antifungal medication. If it doesn’t go away after a few weeks, it is time to think of another diagnosis, consider if your child might have a secondary bacterial infection, or if a prescription oral medication might be necessary.
  • fungal nail infections – in addition to athlete’s foot, kids can also get a fungal infection in their toe nails (onychomycosis). If mild, a topical antifungal medication may be all that is needed to treat your child’s fungal nail infection, but oral antifungal drugs are usually needed.
  • plantar warts – sometimes confused with corns, plantar warts are common in kids and can be treated with over-the-counter remedies when they become bothersome.
  • blisters – if your kids are active, or if they are relatively inactive, but you end up on a long walk on a vacation, they will likely end up with a friction blister on their feet at some point. What do you do? Apply a hydrocolloid gel bandage (readily available over-the-counter) to the blister, draining large blisters if necessary.
  • ingrown toenails – common in teens who pick at or trim their toenails too short, ingrown toenails (onychocryptosis) can become really bothersome when they become infected. If soaks and antibiotics don’t help, the ingrown toenail may need to be surgically removed. Make sure your kids wear shoes that fit properly and trim their toenails straight across to prevent them from getting ingrown toenails.
  • heel pain – many active pre-teens and teenagers have pain in their heels. It is often caused by Sever disease (think of it like growing pains instead of a “disease”) and can be treated with heel pads or cups, icing after sports, stretching exercises, and symptomatic care.
  • flat feet – while parents often complain that their kids have flat feet, most have flexible flat feet and don’t need treatment. On the other hand, some rigid flat feet, which is more rare, and might require treatment. Does your child have an arch when they stand on their tip toes?
  • overpronation – does it seem like your child’s ankles bend inward when he stands or walks, even to the point that he wears out the inside parts of his shoes quicker than the outside? While it can be normal, if it is leading to foot, ankle, knee, or back pain, then your child likely needs arch supports for his shoes (pronation insoles) or custom made orthotics.
  • toe walking – while normal before age two to three years, children who continue to toe walk after age three to five years, especially if they always toe walk or refuse to walk in a normal heel-to-toe pattern should have an evaluation and will likely need therapy to help them walk properly.
  • bunions – can kids really get bunions? They can, presenting with a big bump at the base of their big toe (juvenile hallux valgus), which will turn toward the second toe.
  • bunionette – when they occur at the base of your child’s little toe, the painful bump is called a bunionette.
  • corns and calluses – often confused with a plantar wart, you can often tell the difference between a corn or callus and a wart because warts disrupt normal skin lines and might have little black ‘seeds’ inside them (broken blood vessels). If you still aren’t sure, just remember that warts are more common than corns and calluses in kids.
  • curly toe – kids with curly toes have underlapping toes and while it often doesn’t cause symptoms, when it does, surgery can fix it.
  • juvenile plantar dermatosis – JPD is often confused with athlete’s foot, as they have similar symptoms – red, scaling skin on the feet and toes. JPD, which is also called sweaty socks syndrome, occurs in younger kids and spares the toe webs though, and it is not caused by a fungus. Wearing cotton socks, and changing them frequently, shoes that fit well, and applying a moisturizer and steroid cream can treat JPD.
  • foot odor – does your child have smelly feet? While you likely want to blame a fungus, stinky feet are usually caused by a bacterial infection, an infection that might cause a very mild rash on the bottom of your child’s feet that can go unnoticed – and smelly feet. It can be treated with a topical antibiotic ointment, not letting shoes get wet, and changing sweaty socks often.
  • sweaty feet – a lot of kids have sweaty feet and unfortunately, that can lead to some of the problems listed above. Some have really sweaty feet (plantar hyperhidrosis) though, to the point that they have to change their socks several times a day. It might also help to buy super absorbent insoles for all of their shoes, moisture wicking socks (Drymax and Copper sole socks, etc.), absorbent foot powder, and mesh type shoes.

Need extra help with your child’s feet?

See your pediatrician. Depending on the issue, a pediatric dermatologist, pediatric orthopedic surgeon, or a podiatrist with expertise in pediatric conditions might also be helpful.

What to Know About Common Pediatric Foot Problems

From athlete’s foot and blisters to plantar warts and sweaty feet, there are many foot problems that parents should learn about and hopefully learn to prevent.

More on Common Pediatric Foot Problems

Prescribe These Inexpensive Medications for Kids, Not Tho$e

The Auvi-Q epinephrine injector retails for over $2,500 each.
The Auvi-Q epinephrine injector retails for over $2,500 each, but it is recommended that folks have at least two!

Folks are no longer surprised when outrageous drug prices make the news.

Remember the $600 EpiPens?

We got less expensive alternatives after folks complained and there was a lot of media attention, but many other drugs are still expensive.

Did you know that there is a diaper rash cream on the market that costs over $600? What’s startling, is that the cream, Vusion, is simply made up of three ingredients that are available over the counter – miconazole (an antifungal drug), zinc oxide, and petroleum jelly.

There is also a pill for pinworms, Emverm, that costs $600!

Saving Money on Pediatric Prescriptions

There is one very easy way to save money on your next pediatric prescription.

That’s right, make sure your child really needs it.

No, that doesn’t mean not filling your pediatrician’s prescription, but it can mean simply asking if a prescription medication is really necessary the next time your kids get sick. Unfortunately, many conditions are over-treated, from ear and sinus infections to pink eye and reflux.

Also, when your child does need a prescription, instead of asking for a coupon, ask if a lower cost, generic alternative might be appropriate.

You can also:

  • make sure the medication is covered by your drug plan, if you have one
  • get a 90 day supply if it is a medication that your child uses long-term, like to control asthma
  • ask about optimizing your child’s dose so that they don’t need multiple pills, for example, taking one 30mg capsule is likely less expensive than taking two 15mg capsules each day
  • see if an alternative form of the same medication might be less expensive. For example, a tube of mupirocin (Bactroban) cream is a lot more expensive than a tube of mupirocin ointment, although both forms of the topical antibiotic can be used in the same situations. Similarly, ondansetron (Zofran) syrup is more expensive than ondansetron orally disintegrating tablets, which is often used when kids have nausea and vomiting.

To save money on prescriptions, you might also use a service like GoodRx, to search for the lowest prices at nearby pharmacies. Especially if you have a high deductible or if a medicine isn’t covered by your insurance, it can sometimes be cheaper to use GoodRx, or a similar service with discount cards, than to go through your insurance plan. And remember that some pharmacies, like at Walmart, offer many $4 generic drugs.

Lastly, ask your pediatrician for samples and go through the manufacturer’s patient assistance plan for help paying for your medicines.

Prescribe These Inexpensive Medications, Not Tho$e

Still can’t afford your child’s prescription?

Fortunately, there is almost always an alternative medication that is less expensive, but will work just as well, that you can ask your pediatrician about. It doesn’t do your child any good if your pediatrician prescribes a medication, but you don’t get it because you can’t afford it. Ask about an alternative instead.

In general, if you need a coupon to get the drug, you can expect that it is an expensive medication. And even if the coupon makes it affordable for you, remember that someone is still paying for it, and in the end, that’s likely going to be you in the form of higher insurance rates.

Will any of these alternatives work for your child?

 

Expensive Drug Less Expensive Alternative*
Vusion (diaper rashes) use Lotrimin + Triple Paste
Advair, Dulera, Symbicort (asthma) generic AirDuo1
Moxeza or Vigamox (pink eye) ofloxacin oph drops2
Auvi-Q (epineprine inj) generic Adrenaclick or EpiPen3
Emverm (pinworms) Reese’s Pinworm Medicine (OTC)
Omnaris, QNasl, Veramyst (allergies) generic Flonase (fluticasone propionate) or Nasacort (triamcinolone) (OTC)
Patanase (allergies) azelastine
 Suprax (UTI) trimethoprim/sulfamethoxazole or Cefdinir4
Suprax (ear infection) high dose amoxicillin or Augmentin or Cefdinir
Ciprodex, Cipro HC (ear drops) ofloxacin oph drops5
Vyvanse, Mydayis (ADHD) generic Adderall XR or Adderal6
Aptensio, Cotempla XR-ODT, Daytrana, QuilliChew ER & Quillivant XR (ADHD) generic Concerta or Ritalin6
EpiDuo, Ziana (acne) benzoyl peroxide/clindamycin
or Differin (OTC)
Solodyn, Doryx (acne) minocycline, doxycycline
Sklice, Ulesfia (lice) spinosad (Natroba) or an OTC treatment
Nexium (GERD) lansoprazole (Prevacid)7 OTC
Cutivate, Elocon, Topicort (eczema) triamcinolone 0.1% cream
 Clarinex (allergies) loratadine (Claritin)8 OTC
Xyzal (allergies) cetirizine (Zyrtec)8 OTC
levalbuterol (Xopenex) (asthma) albuterol8
Patanol, Pataday, Pazeo  (allergies) Zaditor9 (OTC)

*To be clear though, these aren’t direct brand name to generic equivalents. Most are less expensive alternative medications that many pediatricians use every day though. Many were once the primary treatment and were found to work well. They were eventually replaced by newer medications, which were thought to work better, even though there are rarely head-to-head studies that actually prove that they work better than older, now less expensive medicines.

  1. AirDuo – this is a generic preventative asthma inhaler, which like Advair, combines fluticasone propionate and salmeterol. The main downside? It can’t be used with a spacer.
  2. Before looking for lower cost antibiotic eye drops to treat pink eye, you should maybe reconsider the need to treat pink eye in the first place. Most experts now think that pink eye is usually a viral infection, and even when it is caused by a bacteria, unless it is severe, it will likely go away without treatment. Most importantly, keep in mind that according to the AAP, “exclusion is no longer required” for kids with pink eye if they are in daycare or school, which is often why many parents seek treatment in the first place.
  3. Epinephrine injectors are lifesaving medicines for kids with food allergies. They were one of the first medicines to expose how drug coupons helped drug prices soar (the $600 EpiPens), while parents got free medicines for their kids – at least if they had insurance and a co-pay to worry about. Those paying cash or who had a high deductible plan were stuck with high priced drugs. Less expensive epinephrine injectors are now available, but one of the most expensive medicines on our list is back – Auvi-Q. Although the manufacturer advertises that it is available for just $0 for commercially insured patients, each injector pack (comes with 2 injectors and a trainer) actually costs up to $2,500! And since it is recommended that kids have multiple injector packs to store in multiple places, the real price is at least $5,000.
  4. Suprax (cefixime) was once a popular antibiotic for UTIs, especially once it became generic. Then, because it was maybe not popular enough, they stopped making it. It came back though, but not with a generic price tag. Some push it as a better choice for kids with persistent ear infections, but keep in mind that when mentioned on the list of antibiotics in the AAP ear infection treatment guide, it is suggested that when multiple antibiotics have failed, “a course of clindamycin may be used, with or without an antibiotic that covers nontypeable H influenzae and M catarrhalis, such as cefdinir, cefixime, or cefuroxime.” There is likely no benefit to using Suprax by itself or over a less expensive antibiotic.
  5. Can you really use ofloxacin ophthalmic drops in a child’s ear? Yes, although it is an off-label treatment. You just can’t use otic (ear) drops in a child’s eyes. While eye drops are sterile, ear drops aren’t. And for some reason, eye drops are less expensive than ear drops.
  6. Most newer, once a day ADHD medicines are expensive. Some aren’t even covered on insurance plans. Generic medicines are going to be less expensive than newer brand name medicines and short acting stimulants, like Adderall and Ritalin, are the cheapest. Your child just has to take a repeat dose around lunch time.
  7. In many ways, we have come a long way in treating infants with reflux. Gone are the days of using medicines with dangerous side effects, like Propulsid (cisapride) and Reglan (Metoclopramide). Now, if they have gastroesophageal reflux disease (GERD), they are usually treated with an antisecretory agent to reduce acid and pain, but not necessary reduce the amount of spitting up. This can include histamine H2 receptor antagonists, like Zantac (ranitidine), and proton pump inhibitors (PPIs). Before Nexium packets for delayed release oral suspension became available, we had Prevacid Solutabs, which are now available OTC. This would be an off-label treatment.
  8. Clarinex and Xyzal are new classes of medications that turn a drug made up of a racemic mixture (Claritin and Zyrtec) into a single enatiomer. Basically, these drugs are made up of two mirror images of themselves. The theory is that if you make a new drug with just one of those mirror images, then it will work better and cause less side effects. For the great majority of people, these new drugs just cost more. Xopenex was one of the first drugs to use this method, as it is just the R-enantiomer or isomer of albuterol = levalbuterol. Does it work better than albuterol? No. Some people do think that it has fewer side effects, so it might be worth a try if your child gets very jittery or gets an elevated heart rate when he takes albuterol.
  9. Why try an over-the-counter medicine when prescription medications are available? Many medicines that are now over-the-counter, from Allegra and Claritin to Flonase and Nasacort, used to only be available with a prescription. Like these and many more medications, Zaditor allergy eye drops was once a prescription drug. It is available for kids who are at least three years old and might be worth a try before you spend money on a more expensive allergy eye drop.

In general, just remember that the “latest and greatest” medication isn’t always the greatest. Sometimes it is just newer and more expensive. Don’t be afraid to ask about an alternative if it is too expensive.

What to Know About Saving Money on Pediatric Prescriptions

Medications can be expensive, but there are things you can do to try and save money the next time your kids get a prescription from their pediatrician.

More on Saving Money on Pediatric Prescriptions