Solution for Infantile Spasms

One of the biggest challenges when dealing with drug therapy and children is finding the right dose of the medicine, especially if there aren't any dosage recommendations from the manufacturer that are FDA-approved. Another challenge is delivering the medicine to the child, especially a young child who cannot swallow solid dosage forms. Oftentimes, tablets are crushed or capsules are opened to make a solution or a suspension (depending on how well the particles dissolve in water), but this cannot be done with all medicine. Nor should this be done at home, unless advised by the pharmacist or your child's doctor for single doses to be given shortly after preparation.

It is always exciting to see that a drug that has been available for adults become approved for use by children. Additionally, it is going to be available as an oral solution and in a strength that can be easily measured by a parent. It certainly broadens the treatment options and may even increase the adherence of the regimen. One such addition is Sabril (vigabatrin) oral solution for infantile spasms in children aged 1 month to 2 years. This is the first drug to be approved by the FDA for this condition. Vigabatrin has been available as tablets for adult use in the treatment of complex seizures in combination with other medicines. More about infantile spasms and Sabril is found in the press release. May many more pediatric oral dosage forms become available soon.

"Pokey" in the thigh or arm?

My daughter knows vaccinations as "pokeys" and so we introduced that term to my toddler son, who was due for his measles-mumps-rubella (MMR) and varicella (chicken pox) vaccines on last Friday. He accepted the two shots in each thigh with some discontent, but was easily distracted from his pain. He has really thick thighs at close to 32 pounds. One might wonder, shouldn't he have gotten them in his arm because of the size of his thighs? Well, the MMR and varicella vaccines are given in the fat tissue (subcutaneous injection) just below the skin, so it was fine for my son. This also explains the lack of injection site reactions (redness, hardness, or warmth) that I noticed with the other vaccines that he has received. Of note, most of the routine childhood vaccines are given into the muscle area on the side of the thigh (anterolateral) or arm (deltoid muscle). Whether it is given in the arm or leg depends on the age of the child and the muscle mass available in the arm vs. leg. The routine childhood vaccines that are given subcutaneously are MMR, varicella, and inactivated polio. When he is due for his diptheria-tetanus-pertussis vaccination at his next visit, it will be an intramuscular injection that will go into his deltoid muscle. In the meantime, I'll be watching out for the rash and fever in the next couple of weeks.

Don't wait on managing preschooler's weight

I have a 40-pound preschooler, but she's been steady at this weight for almost a year. She is also very tall for her age. Still, I need to make sure she eats right and stays active so that she does not become a statistic quoted by the CDC: 1 in 7 children ages 2 to 4 years is obese. Obese preschoolers are at risk for developing diabetes, high cholesterol, and asthma later in life. Don't wait on managing the little one's weight. Reduce the risk of obesity by avoiding sugary drinks and high-calorie snacks and encouraging fruits, vegetables, and maintaining an active lifestyle (no more than 2 hours of television per day). Breastfeeding is also recommended, but I also have a 30-pound toddler, so I have some work ahead of me. Here are some tips on how to help your child maintain a healthy weight.

Is your state breastfeeding-friendly?

I never thought twice about the laws surrounding breastfeeding in public. It was never an issue in New York, but I probably should have checked in Connecticut before I nursed my son in front of the dentist while my daughter was getting her teeth cleaned or while she was playing soccer on the field. Is it still considered indecency even if I use a hooter hider (yes, this is the real name for a designer cloth for breastfeeding)? Find out how your state compares to others regarding breastfeeding laws.

August is National Immunization Awareness Month

We've come a long way with vaccinations. Although most of the diseases (for example, polio) prevented by vaccines are no longer common in the United States, we still need to vaccinate our children to avoid outbreaks. Kids that are not fully vaccinated can become very sick and spread the disease to a community very quickly. As a parent, it is ok to have questions and concerns about vaccines. The Centers for Disease Control and Prevention (CDC) has valuable information about vaccines, including the most up-to-date vaccine schedules for both children and adults. With school starting next month, make sure your children are fully vaccinated to protect them and their classmates with this guide.

Medication Allergies - Know the answers to these questions

Just started giving your child a new medication and (s)he has developed hives, difficulty breathing, fever, swelling of the lips or eyes, an itchy rash, or anaphylaxis? Chances are your child has been exposed to this medication (or an ingredient of this medication) in the past. Note that sometimes it is the inactive ingredient (for example, the dye, preservative, filler of the tablet) that is the culprit. Medication allergies are rarely fatal, but they can be scary and do warrant immediate attention, especially if your child appears to be struggling to breathe. If your child has a history of severe allergies and has an Epi-Pen, use it as directed and call 911. If it is a mild reaction, a dose of diphenhydramine (Benadryl) is all that is necessary to relieve the symptoms. Be sure to contact your child's pediatrician or allergist beforehand.

To help confirm that the reaction was a true drug allergy, a detailed history is crucial. Be prepared to answer these questions: When did the reaction occur? What drugs were you giving your child? How soon after taking the drugs did your child have the reaction? What kind of reaction did your child have? How severe was the reaction, and how long did it last? If your child had a rash, did it blister, peel, or cause ulcers in the mouth, vagina, or rectum? Has your child since taken that drug or one like it without a reaction?

Sometimes a side effect (or intolerance to the medication) is mistakenly labeled as an "allergic reaction." For example, having an upset stomach, diarrhea, or rash to a penicillin are common side effects and they resolve on their own, even when the medicine is continued. Attributing these to an allergic reaction could pose problems in the future, especially if the best course of therapy involves a penicillin. Optimal therapy may end up being delayed as your child is being desensitized to the medication. So, talk to your child's doctor and pharmacist to clarify whether what your child is experiencing is a side effect or an allergic reaction. Also, if your child is allergic to shellfish, soy, eggs, cross-sensitivity to certain medications and vaccines is possible. Be sure to alert your doctor and pharmacist about these food allergies so that they can be updated on your child's medication profile.