Flu Shots OK for People With Egg Allergy

Currently, we recommend Flu shot (influenza vaccine) to all children above 6 months old. This article should be able to reassure the parents whose children has egg allergy:

For years, people with egg allergy were told to avoid the flu vaccine because it contains egg protein and could trigger a reaction, but this advice no longer stands. People with egg allergies can -- and should -- get the flu shot this year, according to a new report by the American Academy of Allergy, Asthma & Immunology.

Why the change?
"We now know with confidence that most people with egg allergy can receive the flu shot without reaction," says the report’s author, James T. Li, MD, PhD, an allergist at the Mayo Clinic in Rochester, Minn.
There is a "detectable, but very low" amount of egg protein in the H1N1 and seasonal flu vaccines, and studies have shown that the majority of people with egg allergy do not have an allergic reaction to the flu shot, he says.
"The number of reactions wasn't zero, but it was low, and most reactions were not serious," Li tells WebMD.
Caution is still advised in certain scenarios. For example, there is still some question on whether people with severe egg allergy can receive the flu shot, he says.

We hope those children with allergy also get to enjoy the benefits of flu shots. 

Constipation

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What is constipation? It is difficult to define the normal frequency of bowel opening. However,
the American Academy of Pediatrics (AAP) had outlined normal frequency of bowel movements for children.
In general, the bowel frequency is less than 3 times per week, the stools are usually hard, dry and difficult to eliminate. It can be hard large stool or hard pellet like stools.
How to solve this problem, the AAP has recommended the following "10 commandments" (adapted):

1. Drinking plenty of water can help regulate constipation.
2. Encourage high-fiber fo such as whole-grains, fruits, vegetables and Pedia-Lax Fiber Gummies.
3. Avoid giving your child large amounts of foods which could lead to constipation. Every child is different. Discuss dietary changes with your pediatrician.
4. Help your child set up a regular toilet routine.
5. For the younger child, reward them for attempting to have a bowel movement and for successfully having a bowel movement. (Sticker charts, etc.)
6. Be attuned to your child's body and behavior. For instance, if a younger child exhibits symptoms like clenching buttocks or crossing legs, help them to the bathroom. If your child is soiling his underpants and hiding them in embarrassment, address the issue with your child in a sensitive manner.
7. Discuss your child's feelings with them in an empathetic manner. Children, at every age level, are embarrassed, scared, and maybe even angry about their situation. Make them feel like they are being heard, understood, and helped. Help them feel like they are in control by allowing them to be part of the development of a constipation management plan.
8. Parents should never show anger and frustration about the child's constipation to the child. Nor should the parent be overly obsessed with the child's bowel habits. These could be detrimental to the management of constipation and the well-being of the child.
9. If you notice any of the symptoms listed in "How do I know if my child is constipated?" contact your pediatrician as soon as possible. Do not wait for days to see if it will resolve on its own. The key to good management is recognizing the symptoms and addressing them before the situation worsens.
10. Encourage your child to be physically active. Exercise along with a balanced diet provides the foundation for a healthy, active life.

You may explain the body digestive system to your children with this chart, as a picture is better than a thousand words:
You may keep a fibre diary for your children as well.

Ambulatory Paediatrics

I attended the 32nd Malaysian Paediatric Association congress in Kuala Lumpur from 15 to 17 October 2010. This year theme is Ambulatory Paediatrics. I totally agree with what the President, Professor Zabidi Hussin (please click to view his blog), said:

"... provide expertise within a larger community-based setting... Children are certainly best looked after in their own homes at all times and more so when they are sick."

Some interesting topics include:

• Identifying and Managing Sleep Problems in Infants
• Snoring in Chidren
• Assessment of Nutrition in Children
• Practice and Malpractice in complementary feeding in early childhood
• Nocturnal enuresis
• Food allergy in children

As a children doctor, I strive to give the best possible medical care and as far as possible, to allow children to stay at their home en route to recovery.

A 28 day-old baby with jaundice

A mother exclusively breastfeeds her baby. Her baby has persistent jaundice but otherwise well. The parents are very concerned.The doctor writes the following letter to the baby. The baby name is BB, and the parents are Mr & Mrs AA, for the sake of their privacy.

Dear Ms BB,

Hi, good day!

First and foremost, I would like to tell you that Mr & Mrs AA are very loving and caring parents. You must be the luckiest girl on earth to be their little girl. I believe your 2 year-old elder sister must be totally agree with me.

Just to recapitulate, your highest serum bilirubin level was only 238 umol/L when you are 10 days old. This was normal physiological jaundice. When I saw you this morning, you have grown into a 28 day-old cute little girl. You looked slightly jaundice but otherwise active, well and healthy. For your information, your father had just arrived home from his US business trip that morning. He must be tired after the long travel but for your sake, he brought you to my clinic immediately.

Please be reassured that you are a very healthy baby girl. Your problem of prolonged jaundice is just part of a normal body process. I can confidently say this because you are well, pass normal colour stool and the blood investigation is normal. Your liver function test shows you have unconjugated hyperbilirubinemia. Total bilirubin 197 umol/L, direct 7, indirect 190.

Your mother, Ms A gives you the b(r)e(a)st feed, the most nutritious food on earth. Although this may contribute to your prolonged jaundice but her decision to continue breastfeeding is the best decision.

I can see your parents are very concerned with your prolonged jaundice. Mr A had googled online for information on neonatal jaundice. Nevertheless, not all the online information is reliable. I have attached an articles for your parents to read so as to alleviate their anxiety. I hope this helps.

BREASTFEEDING A NEWBORN WITH JAUNDICE

I am privileged to be your paediatrician.

Thank you.

Yours truly,

Allergy - Where does it start & Where does it end?

I chaired an allergy workshop in G Hotel, Penang on 26 September 2010.

Assoc Prof Dr Amir Hamzah Abdul Latiff from Monash University Malaysia gave a very interesting lecture on "Allergy - Where Does It Start & Where Does It End?".

I found this is a very interesting topic, a question I have never give a deep thought.

Does allergy start before pregnancy, during pregnancy or after delivery?
Does allergy end as a result of prevention, treatment or sadly, death?
Is it true the answer is "from womb to tomb", as shown below?

I will spend more time on this topic -- Allergy.