University Health System Weblog

Dr. Kami Larsen answers the question: “Should I be concerned if my 2-year-old child can’t talk yet? She just grunts a lot.”

Absolutely! By the time a child has reached two years old, they should have a vocabulary of 50 to 100 words, and should be putting two words together to form small sentences or phrases. Anytime we see a child that has a speak delay by this age, an evaluation for the delay needs to be done.

This may involve hearing testing, evaluation by a speech pathologist, and possible evaluation for autistic spectrum disorder. Which path we, as health care providers, choose to take first depends on a number things, including the child’s ability to follow instructions, how they interact with other kids, how they ask for things, whether or not they pretend play, and various other things. The bottom line is making sure your pediatrician knows about these things and getting an evaluation started sooner rather than later.

Kami Larsen, M.D. is a pediatrician at University Health System in Las Vegas, Nevada. Dr. Larsen is assistant professor of pediatrics at the University of Nevada School of Medicine and medical director of Kids Healthcare Clinic.

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Dr. Kami Larsen answers the question: “As a parent, what should I know about child immunizations?”

In my practice as a pediatrician, I encounter concerned parents every day. Many times their concerns are about common illnesses, diet and sleep patterns. Lately however the same question keeps recurring—How safe are my child’s vaccinations?

It’s a question I hear over and over and typically I can spend 30 minutes or more informing families about this. The truth is that in recent years the Web has made it easier for families to find information about vaccinations. The problem however is that not all of this information online is complete, accurate or up-to-date and some information can even be harmful to your child’s safety.

Most parents want to do what’s right for their child, and so do most pediatricians. In recent decades, vaccines have played an unbelievable role in decreasing the number of serious illnesses, hospitalizations and deaths in children. Without childhood vaccinations, thousands of kids each year would die from illnesses like measles, chicken pox and whooping cough. Due to this dramatic decline, many people believe that these illnesses that pediatricians vaccinate against have been wiped off the face of the earth. Unfortunately this simply isn’t true. We still have outbreaks of measles, pertussis (or whooping cough) and other vaccine preventable diseases. Just this winter (2007), Clark County (or metropolitan Las Vegas) faced an outbreak of mumps.

As parents we tend to have a false sense of security and assume that the miracles of modern medicine will keep our children out of harm’s way. For our parents and grandparents the reality of infectious disease is only a memory away. Before immunizations 20,000 cases of paralytic polio were reported each year. These epidemics left thousands of children in braces, wheelchairs and iron lungs.

Before measles immunization was available, now part of the MMR vaccine, nearly everyone in the U.S. got measles. What we tend to forget is that about 450 children each year died from the infection. Up to 20 percent of those infected with the virus are hospitalized and encephalitis with concurrent brain damage may result. Many of the cases we see today are a result of travelers visiting the U.S. and carrying the infection with them. In a city like Las Vegas, the number of visitors is large and outbreaks among residents who aren’t immunized are common.

Pediatricians also commonly see outbreaks of whooping cough, another serious illness. Unfortunately the most serious complications of this infection are in children. According to the Centers for Disease Control and Prevention, between 1990-96, 57 people died from pertussis—49 were babies (less than six months old). The coughing fits associated with the illness are so severe that many children can’t eat, drink or sleep. They may end up with pneumonia, seizures and even brain damage.

This is just the beginning of the story. Today our children are fortunate enough to have vaccines that prevent against several forms of meningitis, hepatitis, tetanus, chicken pox and other life-threatening infectious diseases. Many of these illnesses are viral and can’t be treated with antibiotics. I can’t count the number of times I’ve heard a parent say to me, “We all had chicken pox and survived.” The truth is not everyone who’s had chicken pox has survived. Disease that once were common aren’t today. That is the benefit of immunizations.

Despite this many parents recently have decided against vaccinating their children for multiple reasons. However more often bad information is behind these decisions.

There’s a misconception that vaccinations cause autism. It’s important to note that there has never been a scientific link between autism and childhood vaccinations. Many proponents of this theory blame thimerosal, a preservative commonly used in the past. In 2001 a recommendation to remove thimerosal from immunizations was passed. The only immunization currently in use containing thimerosal is the inactivated influenza vaccine.

Any medication has the risk of side effects and this holds true for vaccines. However, in general, the risks are minimal and the risk of a serious side effect are rare. Concurrently the risks associated with acquiring the illnesses I mentioned above outweigh those of immunizations.

It’s important that parents get accurate information and facts. Helpful information is easily accessed online at the American Academy of Pediatrics or from your child’s pediatrician.

As a mother of two, I’m faced with the same decisions as any other parent. Each day I fight to protect my children and help nurture them into happy and healthy adults. Don’t gamble with your child’s health. Talk about immunization with your child’s pediatrician today.

Kami Larsen, M.D. is a pediatrician at University Health System in Las Vegas, Nevada. Dr. Larsen is assistant professor of pediatrics at the University of Nevada School of Medicine and medical director of Kids Healthcare Clinic.

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Dr. Kami Larsen answers the question: “In general do young children need a multivitamin supplement?”

This really depends on the age of the child and on their dietary habits. For infants of breast feeding mothers, it is extremely important to start a multivitamin with vitamin D at two months of age. This is particularly important if the baby is exclusively breast fed as breast milk is lacking in vitamin D and a deficiency of this can lead to vitamin D deficiency rickets. For formula fed infants, this risk is much lower and those children do not typically need a supplement at as early an age.

For older toddlers and children, a vitamin supplement is helpful if they don’t have a well-balanced diet. Most toddlers tend to have limited exposure to dark green vegetables and meat, so for these kids a supplement is helpful.

The last factor to consider is whether or not kids are getting any fluoride in their diet. The tap water in southern Nevada has fluoride in it, but for those families who choose to use bottled water, either purchasing water that has already been fluorinated or using a vitamin supplement with fluoride is a good idea.

It is always important to remember, however, that vitamins are medication, and they should only be given under a parent’s supervision. With the recent introduction of popular gummy candy-like vitamins, the risk of intoxication from vitamin A and others has risen. Make sure they are stored in a locked cabinet, out of the reach of younger children.

Kami Larsen, M.D. is a pediatrician at University Health System in Las Vegas, Nevada. Dr. Larsen is assistant professor of pediatrics at the University of Nevada School of Medicine and medical director of Kids Healthcare Clinic.

Have a question? University Health System doctors answer select questions from readers like you.

Dr. John Gosche answers the question: “My child has continuous abdominal pain. How do I know if she needs surgery?”

Thankfully most children won’t need to meet me in my role as a pediatric surgeon. But unfortunately a small number of kids have a medical condition requiring surgical care. In today’s post, I’m going to cover the typical presentation and symptoms related to three abdominal conditions that may need surgery: appendicitis, volvulus and intussusception.

Appendicitis

The appendix is a non-essential structure attached to the part of the colon known as the cecum, usually located in the right lower portion of the abdomen. Inflammation of the appendix, or appendicitis, is the most common reason for emergency surgery in children. The lifetime risk of appendicitis is about nine percent for boys and seven percent for girls.

Appendicitis most commonly develops in children 12 to 18 years old but can develop at any age. Appendicitis happens when the lumen of the appendix becomes blocked, causing a build-up of secretions and pressure inside the appendix, which leads to bacterial growth, tissue swelling, inflammation and ultimately impairment of the blood supply to the appendix’s wall. Appendicitis commonly causes abdominal pain, nausea, vomiting, a loss of appetite and low-grade fever. The abdominal pain associated with appendicitis classically begins as a poorly localized mid-abdominal pain followed minutes or hours later by sharp pain that localizes to the right lower portion of the abdominal wall.

Unfortunately many experience less typical symptoms of appendicitis and as a result, appendicitis can be a difficult diagnosis to confirm. Early diagnosis and treatment is key to decreasing the risk of serious complications. In many cases findings during a physical exam and simple blood tests will help confirm a diagnosis, although some children may require x-rays as well.

Volvulus

Volvulus is twisting of the intestine that frequently impairs blood supply to the affected area of the intestine. Volvulus is commonly associated with malrotation, when the intestine doesn’t position normally in a child’s abdomen during development, causing the base of the intestine to be narrowed and making the intestine prone to twisting. Malrotation may not cause symptoms before twisting. Usually volvulus happens in the first weeks of life. Midgut volvulus however can happen at any age including before birth or later in life. Common symptoms include vomiting yellow or green discharge, abdominal pain in older children or irritability in infants.

Later symptoms include extreme sleepiness and blood in the stool. Early diagnosis and treatment are critical to prevent permanent injury or loss of the intestine. Unfortunately, the symptoms may be nonspecific and may be due to other less life threatening conditions. Prompt medical evaluation however should be sought when a child develops bilious emesis and severe abdominal pain. A special radiographic study called an upper gastrointestinal contrast series can help diagnose malrotation.

Intussusception

An intussusception is movement of one segment of the intestine into an adjacent segment. In intussusception the trapped bowel becomes swollen and its blood supply is compromised. This condition most commonly occurs in five to nine month old infants. Often an intussusception will follow gastroenteritis or an upper respiratory tract infection. The classic symptom of intussusception is episodic, severe abdominal pain. Affected infants frequently scream in pain and draw up their legs during an episode lasting a few minutes then seem normal between episodes.

Other symptoms include vomiting that may become bilious, passage of blood through the rectum and lethargy. The symptoms can be nonspecific but a history of severe, episodic abdominal pain should be a concern. Parents should seek medical advice. A special radiographic test called a contrast enema can confirm the diagnosis and in many cases can be used to push back or reduce the intussuscepted intestine, avoiding the need for surgery. The success rate with contrast enema reduction depends on early recognition and treatment.

Summary

Abdominal conditions requiring emergency surgical care are uncommon in children. Unfortunately many of these conditions may present with symptoms difficult to distinguish from less life-threatening illnesses. Severe or persistent abdominal pain, especially pain that has a unique pattern or associated with bilious vomiting, should raise concern about a potentially serious problem and should prompt immediate medical attention.

John Gosche, M.D., Ph.D. has practiced medicine for more than 20 years. He is professor and chief of the pediatric surgery division at the University of Nevada School of Medicine. Dr. Gosche is board certified in general surgery and pediatric surgery. He practices in Las Vegas.

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