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Pediatric Patient Education

Mother with baby.Premier Pediatrics is passionate about education. We believe the foundation of a solid future for our children begins with our education as parents. Keeping informed of the latest information, technologies, procedures and practices empowers parents to make decisions with confidence.

Premier Pediatrics offers our Pediatric Patient Education page as a free service. You’re invited to access this web page at anytime.

You’ll find links to reputable, verified educational sites featuring articles, commentaries, videos and more. As research is a never-ending endeavor, new information is constantly being released. Premier Pediatrics will continually update this page to reflect the latest information.

One of our key goals is to help parents became an active and literate partner in their children’s healthcare. Here in this section we provide helpful information that you may need to know in order to take care of your child perfectly!


An allergy is an immune response or reaction to substances that are usually not harmful.


Allergies are pretty common. Both genes and environment play a role.

The immune system normally protects the body against harmful substances, such as bacteria and viruses. It also reacts to foreign substances called allergens, which are generally harmless and in most people do not cause a problem.

But in a person with allergies, the immune response is oversensitive. When it recognizes an allergen, the immune system launches a response. Chemicals such as histamines are released. These chemicals cause allergy symptoms.

Common allergens include:

  • Drugs
  • Dust
  • Food
  • Insect venom
  • Mold
  • Pet and other animal dander
  • Pollen

Some people have allergy-like reactions to hot or cold temperatures, sunlight, or other environmental triggers. Sometimes, friction (rubbing or roughly stroking the skin) will cause symptoms.

An allergy is not usually passed down through families (inherited). However, if both your parents have allergies, you are also likely to have allergies. The chance is greater if your mother has allergies.

Allergies may make certain medical conditions, such as sinus problems, eczema, and asthma, worse.


The part of the body the allergen touches affects what symptoms you develop. For example:

  • Allergens that you breathe in often cause a stuffy nose, itchy nose and throat, mucus production, cough, and wheezing.
  • Allergens that touch the eyes may cause itchy, watery, red, swollen eyes.
  • Eating something you are allergic to can cause nausea, vomiting, abdominal pain, cramping, diarrhea, or a severe, life-threatening reaction.
  • Allergens that touch the skin can cause a skin rash, hives, itching, blisters, or skin peeling.
  • Drug allergies usually involve the whole body and can lead to a variety of symptoms.

Exams and Tests

The health care provider will perform a physical exam and ask questions, such as when the allergy occurs.

Allergy testing may be needed to find out whether the symptoms are an actual allergy or are caused by other problems. For example, eating contaminated food (food poisoning) may cause symptoms similar to food allergies. Some medications (such as aspirin and ampicillin) can produce non-allergic reactions, including rashes. A runny nose or cough may actually be due to an infection.

Skin testing is the most common method of allergy testing. One type of skin testing is the prick test. It involves placing a small amount of the suspected allergy-causing substances on the skin, and then slightly pricking the area so the substance moves under the skin. The skin is closely watched for signs of a reaction, which include swelling and redness. Skin testing may be an option for some young children and infants.

Other types of skin tests include patch testing and intradermal testing. For more information, see: Allergy testing

  • Blood tests can measure the levels of allergy-related substances, especially one called immunoglobulin E (IgE).
  • A complete blood count (CBC) called the eosinophil white blood cell count may also help diagnose allergies.

In some cases, the doctor may tell you to avoid certain items to see if you get better, or to use suspected items to see if you feel worse. This is called “use or elimination testing.” This is often used to check for food or medication allergies.

The doctor may also check your reaction to physical triggers by applying heat, cold, or other stimulation to your body and watching for an allergic response.

Sometimes, a suspected allergen is dissolved and dropped into the lower eyelid to check for an allergic reaction. This should only be done by a health care provider.


Severe allergic reactions (anaphylaxis) need to be treated with a medicine called epinephrine, which can be life saving when given right away. If you use epinephrine, call 911 and go straight to the hospital.

The best way to reduce symptoms is to avoid what causes your allergies. This is especially important for food and drug allergies.

There are several types of medications to prevent and treat allergies. Which medicine your doctor recommends depends on the type and severity of your symptoms, your age, and overall health.

Illnesses that are caused by allergies (such as asthma, hay fever, and eczema) may need other treatments.

Medications that can be used to treat allergies include:


Antihistamines are available over-the-counter and by prescription. They are available in many forms, including:

  • Capsules and pills
  • Eye drops
  • Injection
  • Liquid
  • Nasal spray


Anti-inflammatory medications (corticosteroids) are available in many forms, including:

  • Creams and ointment for the skin
  • Eye drops
  • Nasal spray
  • Lung inhaler

Patients with severe allergic symptoms may be prescribed corticosteroid pills or injections for short periods of time.


Decongestants can help relieve a stuffy nose. Do not use decongestant nasal spray for more than several days, because they can cause a “rebound” effect and make the congestion worse. Decongestants in pill form do not cause this problem. People with high blood pressure, heart problems, or prostate enlargement should use decongestants with caution.


Leukotriene inhibitors are medicines that block the substances that trigger allergies. Zafirlukast (Accolate) and montelukast (Singulair) are approved for people with asthma and indoor and outdoor allergies.


Allergy shots (immunotherapy) are sometimes recommended if you cannot avoid the allergen and your symptoms are hard to control. Allergy shots keep your body from over-reacting to the allergen. You will get regular injections of the allergen. Each dose is slightly larger than the last dose until a maximum dose is reached. These shots do not work for everybody and you will have to visit the doctor often.

Support Groups

See: Asthma and allergy support group

Outlook (Prognosis)

Most allergies can be easily treated with medication.

Some children may outgrow an allergy, especially food allergies. However, once a substance has triggered an allergic reaction, it usually continues to affect the person.

Allergy shots are most effective when used to treat people with hay fever symptoms and severe insect sting allergies. They are not used to treat food allergies because of the danger of a severe reaction.

Allergy shots may need years of treatment, but they work in most cases. However, they may cause uncomfortable side effects (such as hives and rash) and dangerous outcomes (such as anaphylaxis).

Possible Complications

  • Anaphylaxis (life-threatening allergic reaction)
  • Breathing problems and discomfort during the allergic reaction
  • Drowsiness and other side effects of medicines

When to Contact a Medical Professional

Call for an appointment with your health care provider if:

  • Severe symptoms of allergy occur
  • Treatment for allergies no longer works


Breastfeeding can help prevent or decrease allergies when you feed babies this way only for 4 to 6 months. However, changing a mother’s diet during pregnancy or while breastfeeding does not seem to help prevent allergies.

For most children, changing the diet or using special formulas does not seem to prevent allergies. If a parent, brother, sister, or other family member has a history of eczema and allergies, discuss feeding with your child’s doctor.

There is also evidence that being exposed to certain allergens (such as dust mites and cat dander) in the first year of life may prevent some allergies. This is called the “hygiene hypothesis.” It came from the observation that infants on farms tend to have fewer allergies than those who grow up in more sterile environments. However, older children do not seem to benefit.

Once allergies have developed, treating the allergies and carefully avoiding allergy triggers can prevent reactions in the future.


Wallace DV, Dykewicz MS, Bernstein DI, Blessing-Moore J, Cox L, Khan DA, et al. The diagnosis and management of rhinitis: an updated practice parameter. J Allergy Clin Immunol. 2008 Aug:122(2).

Kurowski K, Boxer RW. Food allergies: detection and management. American Family Physician. 2008 June:77(12).

Bielory L, Friedlaender MH. Allergic conjunctivitis. Immunol Allergy Clin North Am. 2008 Feb;28(1):43-58, vi.

Sicherer S, Sampson HA. Journal of Allergy and Clinical Immunology 2010 Feb 125 (2 suppl2) S116-25.

Borish L. Allergic rhinitis and sinusitis. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 259.


Asthma is a disease that causes the airways of the lungs to swell and narrow, leading to wheezing, shortness of breath, chest tightness, and coughing.


Asthma is caused by inflammation (swelling) in the airways. When an asthma attack occurs, the lining of the air passages swells and the muscles surrounding the airways become tight. This reduces the amount of air that can pass through the airway.

In persons who have sensitive airways, asthma symptoms can be triggered by breathing in substances called allergens or triggers.

Common asthma triggers include:

  • Animals (pet hair or dander)
  • Dust mites
  • Certain medicines (aspirin and other NSAIDS)
  • Changes in weather (most often cold weather)
  • Chemicals in the air or in food
  • Exercise
  • Mold
  • Pollen
  • Respiratory infections, such as the common cold
  • Strong emotions (stress)
  • Tobacco smoke

Many people with asthma have a personal or family history of allergies, such as hay fever (allergic rhinitis) or eczema. Others have no history of allergies.


Most people with asthma have attacks separated by symptom-free periods. Some people have long-term shortness of breath with episodes of increased shortness of breath. Either wheezing or a cough may be the main symptom.

Asthma attacks can last for minutes to days, and can become dangerous if the airflow is severely blocked.

Symptoms include:

  • Cough with or without sputum (phlegm) production
  • Pulling in of the skin between the ribs when breathing (intercostal retractions)
  • Shortness of breath that gets worse with exercise or activity
  • Wheezing

Emergency symptoms that need prompt medical help:

  • Bluish color to the lips and face
  • Decreased level of alertness, such as severe drowsiness or confusion, during an asthma attack
  • Extreme difficulty breathing
  • Rapid pulse
  • Severe anxiety due to shortness of breath
  • Sweating

Other symptoms that may occur:

  • Abnormal breathing pattern — breathing out takes more than twice as long as breathing in
  • Breathing temporarily stops
  • Chest pain
  • Tightness in the chest

Exams and Tests

The doctor or nurse will use a stethoscope to listen to your lungs. Wheezing or other asthma-related sounds may be heard.

Tests that may be ordered include:

  • Allergy testing – skin or a blood test to see if a person with asthma is allergic to certain substances
  • Arterial blood gas (usually only done with patients who are having a severe asthma attack)
  • Chest x-ray
  • Lung function tests, including peak flow measurements


The goals of treatment are:

  • Control airway swelling
  • Stay away from substances that trigger your symptoms
  • Help you to be able to do normal activities without asthma symptoms

You and your doctor should work as a team to manage your asthma. Follow your doctor’s instructions on taking medicines, eliminating asthma triggers, and monitoring symptoms.


There are two kinds of medicines for treating asthma:

  • Control medicines to help prevent attacks
  • Quick-relief (rescue) medicines for use during attacks

Long-term Medicines

These are also called maintenance or control medicines. They are used to prevent symptoms in people with moderate to severe asthma. You must take them every day for them to work. Take them even when you feel OK.

Some long-term medicines are breathed in (inhaled), such as steroids and long-acting beta-agonists. Others are taken by mouth (orally). Your doctor will prescribe the right medicine for you.

Quick-relief Medicines

These are also called rescue medicines. They are taken:

  • For coughing, wheezing, trouble breathing, or an asthma attack
  • Just before exercising to help prevent asthma symptoms caused by exercise

Tell your doctor if you are using quick-relief medicines twice a week or more. Your asthma may not be under control and your doctor may need to change your dose of daily control drugs.

Quick-relief medicines include:

  • Short-acting inhaled bronchodilators
  • Oral corticosteroids for when you have an asthma attack that is not going away

A severe asthma attack requires a checkup by a doctor. You may also need a hospital stay. There, you will likely be given oxygen, breathing assistance, and medications given through a vein (IV).


  • Know the asthma symptoms to watch for.
  • Know how to take your peak flow reading and what it means.
  • Know which triggers make your asthma worse and what to do when this happens.

Asthma action plans are written documents for managing asthma. An asthma action plan should include:

  • Instructions for taking asthma medicines when your condition is stable
  • A list of asthma triggers and how to avoid them
  • How to recognize when your asthma is getting worse, and when to call your doctor or nurse

A peak flow meter is a simple device to measure how quickly you can move air out of your lungs.

  • It can help you see if an attack is coming, sometimes even before symptoms appear. Peak flow measurements help let you know when you need to take medicine or other action.
  • Peak flow values of 50% – 80% of your best results are a sign of a moderate asthma attack. Numbers below 50% are a sign of a severe attack.

Outlook (Prognosis)

There is no cure for asthma, although symptoms sometimes improve over time. With proper self-management and medical treatment, most people with asthma can lead normal lives.

Possible Complications

The complications of asthma can be severe, and may include:

  • Death
  • Decreased ability to exercise and take part in other activities
  • Lack of sleep due to nighttime symptoms
  • Permanent changes in the function of the lungs
  • Persistent cough
  • Trouble breathing that requires breathing assistance (ventilator)

When to Contact a Medical Professional

Call for an appointment with your health care provider if asthma symptoms develop.

Call your health care provider or go to the emergency room if:

  • An asthma attack requires more medicine than recommended
  • Symptoms get worse or do not improve with treatment
  • You have shortness of breath while talking
  • Your peak flow measurement is 50% – 80% of your personal best

Go to the emergency room if these symptoms occur:

  • Drowsiness or confusion
  • Severe shortness of breath at rest
  • A peak flow measurement of less than 50% of your personal best
  • Severe chest pain
  • Bluish color to the lips and face
  • Extreme difficulty breathing
  • Rapid pulse
  • Severe anxiety due to shortness of breath


You can reduce asthma symptoms by avoiding triggers and substances that irritate the airways.

  • Cover bedding with allergy-proof casings to reduce exposure to dust mites.
  • Remove carpets from bedrooms and vacuum regularly.
  • Use only unscented detergents and cleaning materials in the home.
  • Keep humidity levels low and fix leaks to reduce the growth of organisms such as mold.
  • Keep the house clean and keep food in containers and out of bedrooms. This helps reduce the possibility of cockroaches. Body parts and droppings from cockroaches can trigger asthma attacks in some people.
  • If a person is allergic to an animal that cannot be removed from the home, the animal should be kept out of the bedroom. Place filtering material over the heating outlets to trap animal dander. Change the filter in furnaces and air conditioners often.
  • Eliminate tobacco smoke from the home. This is the single most important thing a family can do to help someone with asthma. Smoking outside the house is not enough. Family members and visitors who smoke outside carry smoke residue inside on their clothes and hair. This can trigger asthma symptoms. If you smoke, now is a good time to quit.
  • Avoid air pollution, industrial dust, and irritating fumes as much as possible.


Brozek JL, Bousquet J, Baena-Cagnani CE, Bonini S, Canonica GW, Casale TB, et al. Allergic rhinitis and its impact on asthma (ARIA) guidelines: 2010 revision. J Allergy Clin Immunol. 2010;126:466-76.

Lugogo N, Que LG, Fertel D, Kraft M. Asthma. In: Mason RJ, Broaddus VC, Martin TR, et al., eds. Murray & Nadel’s Textbook of Respiratory Medicine. 5th ed. Philadelphia, PA: Elsevier Saunders; 2010:chap 38.

National Asthma Education and Prevention Program Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. Rockville, MD. National Heart, Lung, and Blood Institute, US Dept of Health and Human Services; 2007. NIH publication 08-4051. Available at Accessed May 14, 2014.

Nowak RM, Tokarski GF. Asthma. In: Marx JA, Hockberger RS, Walls RM, et al., eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, PA: Elsevier Mosby; 2009:chap 71.

Common Cold

The common cold usually causes a runny nose, nasal congestion, and sneezing. You may also have a sore throat, cough, headache, or other symptoms.

Alternative Names

Upper respiratory infection – viral; Cold


It is called the “common cold” for good reason. There are over one billion colds in the United States each year. You and your children will probably have more colds than any other type of illness.

Colds are the most common reason that children miss school and parents miss work. Parents often get colds from their children.

Children can get many colds every year. They usually get them from other children. A cold can spread quickly through schools or daycares.

Colds can occur at any time of the year, but they are most common in the winter or rainy seasons.

A cold virus spreads through tiny, air droplets that are released when the sick person sneezes, coughs, or blows their nose.

You can catch a cold if:

  • A person with a cold sneezes, coughs, or blows their nose near you
  • You touch your nose, eyes, or mouth after you have touched something contaminated by the virus, such as a toy or doorknob.

People are most contagious for the first 2 to 3 days of a cold. A cold is usually not contagious after the first week.


Cold symptoms usually start about 2 or 3 days after you came in contact with the virus, although it could take up to a week. Symptoms mostly affect the nose.

The most common cold symptoms are:

  • Nasal congestion
  • Runny nose
  • Scratchy throat
  • Sneezing

Adults and older children with colds generally have a low fever or no fever. Young children often run a fever around 100-102°F.

Depending on which virus caused your cold, you may also have:

  • Cough
  • Decreased appetite
  • Headache
  • Muscle aches
  • Postnasal drip
  • Sore throat


Most colds go away in a few days. Some things you can do to take care of yourself with a cold include:

  • Get plenty of rest and drink fluids.
  • Over-the-counter cold and cough medicines may help ease symptoms in adults and older children. They do not make your cold go away faster, but can help you feel better. Over-the-counter (OTC) cough and cold medicines are not recommended for children under age 4.
  • Antibiotics should not be used to treat a common cold.
  • Many alternative treatments have been tried for colds, such as vitamin C, zinc supplements, and echinacea. Talk to your doctor before trying any herbs or supplements.

Outlook (Prognosis)

The fluid from your runny nose will become thicker and may turn yellow or green within a few days. This is normal, and not a reason for antibiotics.

Most cold symptoms usually go away within a week. If you still feel sick after 7 days, see your health care provider to rule out a sinus infection, allergies, or other medical problem.

Possible Complications

Colds are the most common trigger of wheezing in children with asthma.

A cold may also lead to:

  • Bronchitis
  • Ear infection
  • Pneumonia
  • Sinusitis

When to Contact a Medical Professional

Try treating your cold at home first. Call your health care provider if:

  • You have problems breathing.
  • Your symptoms get worse or do not improve after 7 to 10 days.


To lower your chances of getting sick:

  • Always wash your hands. Children and adults should wash hands after nose-wiping, diapering, and using the bathroom, and before eating and preparing food.
  • Disinfect your environment. Clean commonly touched surfaces (such as sink handles, door knobs, and sleeping mats) with an EPA-approved disinfectant.
  • Choose smaller daycare classes for your children.
  • Use instant hand sanitizers to stop the spread of germs.
  • Use paper towels instead of sharing cloth towels.

The immune system helps your body fight off infection. Here are ways to support the immune system:

  • Avoid secondhand smoke. It is responsible for many health problems, including colds.
  • Do not use antibiotics if they are not needed.
  • Breastfeed infants if possible. Breast milk is known to protect against respiratory tract infections in children, even years after you stop breastfeeding.
  • Drink plenty of fluids to help your immune system work properly.
  • Eat yogurt that contains “active cultures.” These may help prevent colds. Probiotics may help prevent colds in children.
  • Get enough sleep.


Turner RB. The common cold. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 369.

Fashner J, Ericson K, Werner S. Treatment of the common cold in children and adults. Am Fam Physician. 2012;86(2):153-159.

Singh M, Das RR. Zinc for the common cold. Cochrane Database of Systematic Reviews 2011, Issue 2. Art. No.: CD001364.

Diaper Rash

A diaper rash is a skin problem that develops in the area beneath an infant’s diaper.

Alternative Names

Dermatitis – diaper and Candida; Candida-associated diaper dermatitis; Diaper dermatitis


Diaper rashes are common in babies between 4 and 15 months old. They may be noticed more when babies begin to eat solid foods.

Diaper rashes caused by infection with a yeast (fungus) called Candida are very common in children. Candida grows best in warm, moist places, such as under a diaper. Candida diaper rash is more likely to occur in babies who:

  • Are not kept clean and dry
  • Are taking antibiotics or whose mothers are taking antibiotics while breast feeding
  • Have more frequent stools

Other causes of diaper rash include:

  • Acids in the stool (seen more often when the child has diarrhea)
  • Ammonia (a chemical produced when bacteria break down urine)
  • Diapers that are too tight or rub the skin
  • Reactions to soaps and other products used to clean cloth diapers


You may notice the following in your child’s diaper area:

  • Bright red rash that gets bigger
  • Very red and scaly areas on the scrotum and penis in boys
  • Red or scaly areas on the labia and vagina in girls
  • Pimples, blisters, ulcers, large bumps, or sores filled with pus
  • Smaller red patches (called satellite lesions) that grow and blend in with the other patches

Older infants may scratch when the diaper is removed.

Diaper rashes usually do not spread beyond the edge of the diaper.

Exams and Tests

Your doctor or nurse can often diagnose a yeast diaper rash by looking at your baby’s skin. A KOH test can confirm if it is Candida.


The best treatment for a diaper rash is to keep the diaper area clean and dry. This also helps prevent new diaper rashes. Lay your baby on a towel without a diaper whenever possible. The more time the baby can be kept out of a diaper, the better.

Other tips include:

  • Change your baby’s diaper often and as soon as possible after the baby urinates or passes stool
  • Use water and a soft cloth or cotton ball to gently clean the diaper area with every diaper change. Do not rub or scrub the area. A squirt bottle of water may be used for sensitive areas.
  • Pat the area dry or allow to air-dry.
  • Put diapers on loosely. Diapers that are too tight do not allow enough air flow and may rub and irritate the baby’s waist or thighs.
  • Using absorbent diapers helps keep the skin dry and reduces the chance of getting an infection.
  • Always wash your hands before and after changing a diaper.
  • Ask your doctor or nurse which creams, ointments, or powders are best to use in the diaper area.
  • Ask if a diaper rash cream would be helpful. Zinc oxide or petroleum jelly-based products help keep moisture away from baby’s skin when applied to completely clean, dry skin.
  • Do not use wipes that have alcohol or perfume. They may dry out or irritate the skin more.
  • Do not use corn starch on your baby’s bottom. It can make a candida diaper rash worse.
  • Do not use talc (talcum powder). It can get into your baby’s lungs.

Certain skin creams and ointments will clear up infections caused by yeast. Nystatin, miconazole, clotrimazole, and ketaconazole are commonly used medicines for yeast diaper rashes. You can buy these without a prescription.

Sometimes a mild corticosteroid cream may be used. Talk to your doctor before trying this on your baby.

If you use cloth diapers:

  • Do not put plastic or rubber pants over the diaper. They do not allow enough air to pass through.
  • Do not use fabric softeners or dryer sheets. They may make the rash worse.
  • When washing cloth diapers, rinse 2 or 3 times to remove all soap if your child already has a rash or has had one before.

Outlook (Prognosis)

The rash usually responds well to treatment.

When to Contact a Medical Professional

Call your health care provider if:

  • The rash gets worse or does not go away in 2 to 3 days
  • The rash spreads to the abdomen, back, arms, or face
  • You notice pimples, blisters, ulcers, large bumps, or sores filled with pus
  • Your baby also has a fever
  • Your baby develops a rash during the first 6 weeks after birth


Krol A, Krafchik B. Diaper area eruptions. In: Eichenfield LF, Frieden IJ, Esterly NB. Neonatal Dermatology. 2nd ed. Philadelphia, PA: Elsevier Saunders; 2008:chap 16.

Morelli JG. Cutaneous fungal infections. In: Kliegman RM, Stanton BF, St. Geme JW III, et al., eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 658.


Normal or healthy baby stools are soft and loose. Babies have frequent stools during the first 1 – 2 months. Because of this, it may be difficult to tell when your baby has diarrhea.

Most babies have a stool pattern that is typical for them. This pattern may change slowly over time. Look for the following to help decide whether your baby has diarrhea:

  • A sudden increase in how often your baby has stools
  • More than one stool per feeding
  • Stools that appear to be more watery

If your baby is feeding poorly, or has nasal congestion or a fever, the changes you notice are more likely to be diarrhea.

Most diarrhea in children is short-lived. It is usually caused by a virus, and goes away on its own. Other causes of diarrhea include:

  • A change in the baby’s diet or the breast-feeding mother’s diet
  • Use of antibiotics by the baby or breast-feeding mother
  • Rare diseases such as cystic fibrosis

Infants and young children (under age 3) can dehydrate quickly, so they should be watched very carefully. Dehydration means that the body does not have enough water or liquids.

Signs of mild dehydration:

  • Dry eyes and crying with few tears or no tears
  • Fewer wet diapers than usual
  • Less active than usual or irritable
  • Slightly dry mouth

Signs of moderate dehydration:

  • Dry skin that is not springy
  • Sluggish or lethargic
  • Sunken appearing eyes

Signs of severe dehydration:

  • No urine output in 8 hours
  • Skin that is pinched between fingers fails to spring back to its original shape
  • Sunken fontanelle (the soft spot on top of the head) in infants
  • Very lethargic or possibly unconscious


Make sure the child gets plenty of liquids.

  • If you are nursing, the doctor will probably recommend that you continue nursing. Breast-feeding helps prevent diarrhea, and it also speeds recovery.
  • If your baby still seems thirsty after or between nursing or feeding sessions, you can add an oral rehydration solution, such as Pedialyte. Often, your pediatrician will recommend extra fluids that contain electrolytes. Follow the doctor’s instructions. Do not use sports drinks for young infants.

Talk to your pediatrician right away if there are signs of dehydration. If the infant develops signs of moderate or severe dehydration, he or she should be seen right away.

The following can help prevent diaper rash:

  • Air drying
  • Frequent diaper changes
  • Protective ointments and creams, such as Desitin
  • Rinsing the bottom with water

Cut down on baby wipes during diarrhea.

Call your pediatrician if:

  • A newborn (under 3 months old) has diarrhea
  • Diarrhea contains blood, mucus, or puss
  • Fever and diarrhea last for more than 3 days
  • The child appears dehydrated
  • The child has more than 8 stools in 8 hours
  • The diarrhea does not go away in older infants or lasts in children for 2 days or longer
  • Vomiting continues for more than 24 hours


Canavan A, Arant BS Jr. Diagnosis and management of dehydration in children. Am Fam Physician. 2009;80:692-696.


The first fever a baby or an infant has is often scary for parents. Most fevers are harmless and are caused by a mild infection. Overdressing a child may even cause a rise in temperature.

Regardless, you should report any fever in a newborn that is higher than 100.4 °F, taken rectally, to the child’s doctor.

Fever is an important part of the body’s defense against infection. Many older infants develop high fevers with even minor illnesses.

Febrile seizures do occur in some children and can be scary to parents. However, most febrile seizures are over quickly. These seizures do not mean your child has epilepsy, and do not cause any lasting harm.

Your child should drink plenty of fluids.

  • Do not give your child too much fruit or apple juice. Dilute these drinks by making them one half water, one half juice.
  • Popsicles or gelatin (Jell-O) are good choices, especially if the child is vomiting.

Children can eat foods when they have a fever. But do not force them to eat.

Children who are ill often tolerate bland foods better. A bland diet is made up of foods that are soft, not very spicy, and low in fiber. You may try:

  • Breads, crackers, and pastas made with refined white flour
  • Refined hot cereals, such as oatmeal or cream of wheat

Do not bundle up a child with blankets or extra clothes, even if the child has the chills. This may keep the fever from coming down, or make it go higher.

  • Try one layer of lightweight clothing, and one lightweight blanket for sleep.
  • The room should be comfortable, not too hot or too cool. If the room is hot or stuffy, a fan may help.

Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) help lower fever in children. You child’s doctor may tell you to use both types of medicine.

  • In children under 3 months of age, call your doctor first before giving them medicines.
  • Know how much your child weighs. Then always check the instructions on the package.
  • Take acetaminophen every 4 to 6 hours.
  • Take ibuprofen every 6 to 8 hours. Do not use ibuprofen in children younger than 6 months old.
  • Do not give aspirin to children unless your child’s doctor tells you it’s OK.

A fever does not need to come all the way down to normal. Most children will feel better when their temperature drops by even one degree.

A lukewarm bath or sponge bath may help cool a fever.

  • Lukewarm baths work better if the child also gets medicine. Otherwise, the temperature might bounce right back up.
  • Do not use cold baths, ice, or alcohol rubs. These often make the situation worse by causing shivering.

When to Contact a Medical Professional

Talk to your child’s doctor or go to the emergency room when:

  • Your child does not act alert or more comfortable when their fever goes down.
  • Fever symptoms come back after they had gone away.
  • The child does not make tears when crying.
  • Your child does not have wet diapers or has not urinated in the past 8 hours

Also, to your child’s doctor or go to the emergency room if your child:

  • Is younger than age 3 months and has a rectal temperature of 100.4 °F (38 °C) or higher
  • Is age 3 to 12 months old and has a fever of 102.2 °F (39 °C) or higher
  • Is under age 2 and has a fever that lasts longer than 48 hours
  • Has a fever over 105 °F (40.5 °C), unless the fever comes down readily with treatment and the child is comfortable.
  • Has had fevers come and go for up to a week or more, even if they are not very high.
  • Has other symptoms that suggest an illness may need to be treated, such as a sore throat, earache, diarrhea, nausea or vomiting, or a cough.
  • Has a serious medical illness, such as a heart problem, sickle cell anemia, diabetes, or cystic fibrosis.
  • Recently had an immunization.

Call 911 if your child has a fever and:

  • Is crying and cannot be calmed down
  • Cannot be awakened easily or at all
  • Seems confused
  • Cannot walk
  • Has difficulty breathing, even after their nose is cleared
  • Has blue lips, tongue, or nails
  • Has a very bad headache
  • Has a stiff neck
  • Refuses to move an arm or leg
  • Has a seizure
  • Has a new rash or bruises appear


Mick NW. Pediatric fever. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Mosby Elsevier; 2013:chap 167.

Stomach Pain

Almost all children have abdominal pain at one time or another. Abdominal pain is pain in the stomach or belly area. It can be anywhere between the chest and groin.

Most of the time, it is not caused by a serious medical problem. But sometimes abdominal pain can be a sign of something serious. Learn when you should seek medical care right away for your child with abdominal pain.


When your child complains of abdominal pain, see if s/he can describe it to you. Here are different kinds of pain:

  • Generalized pain or pain over more than half of the belly. Your child can have this kind of pain when they have a stomach virus, indigestion, or gas, or when they become constipated.
  • Cramp-like pain is likely to be due to gas and bloating. It is often followed by diarrhea. It is usually not serious.
  • Colicky pain is pain that comes in waves, usually starts and ends suddenly, and is often severe.
  • Localized pain is pain in only one area of the belly. Your child may be having problems with his/her appendix, gallbladder, or stomach (ulcers).

If you have an infant or toddler, s/he depends on your seeing that s/he is in pain. Suspect abdominal pain if s/he is:

  • More fussy than usual
  • Drawing his/her legs up toward the belly
  • Eating poorly


Your child could have abdominal pain for many reasons. It can be hard to know what is going on when your child has abdominal pain. Most of the time, there is nothing seriously wrong. But sometimes it can be a sign that there is something serious and your child needs medical care.

Your child mostly likely is having abdominal pain from something that is not life threatening. For example, your child may have:

  • Constipation
  • Gas
  • Food allergy or intolerance
  • Heartburn or acid reflux
  • Stomach flu or food poisoning
  • Strep throat or mononucleosis (“mono”)
  • Colic
  • Air swallowing
  • Abdominal migraine
  • Pain caused by anxiety or depression

Your child may have something more serious if the pain does not get better in 24 hours, gets worse or gets more frequent. Abdominal pain can be a sign of:

  • Appendicitis
  • Gallstones
  • Stomach ulcers
  • Hernia or other bowel twisting, blockage or obstruction
  • Inflammatory bowel disease (Crohn’s disease or ulcerative colitis)
  • Intussusception, caused by part of the intestine being pulled inward into itself
  • Tumors or cancers
  • Urinary tract infections
  • Sickle cell disease crisis

Home Care

Most of the time, you can wait for your child to get betteranduse home care remedies. If you are worried or your child’s pain is getting worse or lasts longer than 24 hours, call your health care provider.

Have your child lie quietly to see if the abdominal pain goes away.

Offer sips of water or other clear fluids.

Suggest that your child try to pass stool.

Avoid solid foods for a few hours. Then try small amounts of mild foods such as rice, applesauce, or crackers.

Do not give your child foods or drinks that are irritating to the stomach. Avoid:

  • Caffeine
  • Carbonated beverages
  • Citrus
  • Dairy products
  • Fried or greasy foods
  • High-fat foods
  • Tomato products

Do not give aspirin, ibuprofen, acetaminophen (Tylenol), or similar medicines without first asking your child’s health care provider.

To prevent many types of abdominal pain:

  • Avoid fatty or greasy foods.
  • Drink plenty of water each day.
  • Eat small meals more often.
  • Exercise regularly.
  • Limit foods that produce gas.
  • Make sure that meals are well-balanced and high in fiber. Eat plenty of fruits and vegetables.

When to Contact a Medical Professional

Call your doctor if the abdominal pain does not go away in 24 hours.

Seek immediate medical help or call your local emergency number (such as 911) if your child:

  • Is a baby younger than 3 months and has diarrhea or vomiting
  • Is currently being treated for cancer
  • Is unable to pass stool, especially if the child is also vomiting
  • Is vomiting blood or has blood in the stool (especially if the blood is maroon or dark, tarry black)
  • Has sudden, sharp abdominal pain
  • Has a rigid, hard belly
  • Has had a recent injury to the abdomen
  • Is having trouble breathing

Call your doctor if your child has:

  • Abdominal pain that lasts 1 week or longer, even if it comes and goes
  • Abdominal pain that does not improve in 24 hours. Call if it is getting more severe and frequent, or if your child is nauseous and vomiting with it.
  • A burning sensation during urination
  • Diarrhea for more than 2 days
  • Vomiting for more than 12 hours
  • Fever over 100.4 degrees F
  • Poor appetite for more than 2 days
  • Unexplained weight loss

What to Expect at Your Office Visit

Talk to the provider about the location of the pain and its time pattern. Let the provider know if there are other symptoms like fever, fatigue, general ill feeling, change in behavior, nausea, vomiting, or changes in stool.

Your provider may ask the questions about the abdominal pain:

  • What part of the stomach hurts? All over? Lower or upper? Right, left, or middle? Around the navel?
  • Is the pain sharp or cramping, constant or comes and goes, or changes in intensity over minutes?
  • Does the pain wake your child up at night?
  • Has your child had similar pain in the past? How long has each episode lasted? How often has it occurred?
  • Is the pain getting more severe?
  • Does the pain get worse after eating or drinking? After eating greasy foods, milk products, or carbonated drinks? Has your child started eating something new?
  • Does the pain get better after eating or having a bowel movement?
  • Does the pain get worse after stress?
  • Has there been a recent injury?
  • What other symptoms are occurring at the same time?

During the physical examination, the doctor will test to see if the pain is in a single area (point tenderness) or whether it is spread out.

They may do some tests to check on the pain. The tests could be:

  • Blood, urine, and stool tests
  • CT scan
  • Ultrasound of the abdomen
  • X-rays of the abdomen


Ebell MH. Diagnosis of appendicitis: part 1. History and physical examination. Am Fam Physician. 2008;77:828-830.

Bundy DG, Byerley JS, Liles EA, Perrin EM, Katznelson J, Rice HE. Does this child have appendicitis? JAMA. 2007;25:438-451.

Rimon, N, Bengiamin RN, Budhram GR, King KE, Wightman JM. Abdominal pain. In: Marx JA, ed. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 21.

Sreedharan R, Liacouras CA. Major symptoms and signs of digestive tract disorders. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 298.

Weydert JA. Recurring abdominal pain in pediatrics. In Rakel D, ed. Integrative Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2012:chap 44.


A sunburn is reddening of the skin that occurs after you are exposed to the sun or other ultraviolet light.

The first signs of a sunburn may not appear for a few hours. The full effect to your skin may not appear for 24 hours or longer. Possible symptoms include:

  • Red, tender skin that is warm to the touch
  • Blisters that develop hours to days later
  • Severe reactions (sometimes called sun poisoning), including fever, chills, nausea, or rash
  • Skin peeling on sunburned areas several days after the sunburn

Symptoms of sunburn are usually temporary. But the skin damage is often permanent and can have serious long-term effects, including skin cancer. By the time the skin starts to become painful and red, the damage has been done. Pain is worst between 6 and 48 hours after sun exposure.


Sunburn results when the amount of exposure to the sun or other ultraviolet light source exceeds the ability of the melanin to protect the skin. Melanin is the skin’s protective coloring (pigment). Sunburn in a very light-skinned person may occur in less than 15 minutes of midday sun exposure, while a dark-skinned person may tolerate the same exposure for hours.

Keep in mind:

  • There is no such thing as a “healthy tan.” Unprotected sun exposure causes early aging of the skin.
  • Sun exposure can cause first and second degree burns.
  • Skin cancer usually appears in adulthood. But it is caused by sun exposure and sunburns that began as early as childhood. You can help prevent skin cancer by protecting your skin and your children’s skin from the harmful rays of the sun.

Factors that make sunburn more likely:

  • Infants and children are very sensitive to the burning effects of the sun.
  • People with fair skin are more likely to get sunburn. But even dark and black skin can burn and should be protected.
  • The sun’s rays are strongest during the hours of 10 a.m. to 4 p.m. The sun’s rays are also stronger at higher altitudes and lower latitudes (closer to the tropics). Reflection off water, sand, or snow can make the sun’s burning rays stronger.
  • Sun lamps can cause severe sunburn.
  • Some medications (such as the antibiotic doxycycline) can make your skin easier to sunburn.
  • Some medical conditions (such as lupus) can make you more sensitive to the sun.

Home Care

If you do get a sunburn:

  • Take a cool shower or bath or place clean wet, cool wash rags on the burn.
  • Do not use products that contain benzocaine or lidocaine. These can cause allergy in some persons and make the burn worse.
  • If there are blisters, dry bandages may help prevent infection.
  • If your skin is not blistering, moisturizing cream may be applied to relieve discomfort. Do not use butter, petroleum jelly (Vaseline), or other oil-based products. These can block pores and so that heat and sweat cannot escape, which can lead to infection.
  • Over-the-counter medicines, such as ibuprofen or acetaminophen, help to relieve pain from sunburn. Do not give aspirin to children.
  • Cortisone creams may help reduce the inflammation.
  • Loose cotton clothing should be worn.

When to Contact a Medical Professional

Call a health care provider right away if you have a fever with sunburn. Also call if there are signs of shock, heat exhaustion, dehydration, or other serious reactions. These signs include:

  • Feeling faint or dizzy
  • Rapid pulse or rapid breathing
  • Extreme thirst, no urine output, or sunken eyes
  • Pale, clammy, or cool skin
  • Nausea, fever, chills, or rash
  • Your eyes hurt and are sensitive to light
  • Severe, painful blisters

What to Expect at Your Office Visit

The doctor will perform a physical exam and look at your skin. You may be asked questions about your medical history and current symptoms, including:

  • When did the sunburn occur?
  • How often do you get sunburn?
  • Do you have blisters?
  • How much of the body was sunburned?
  • What medicines do you take?
  • Do you use a sunblock or sunscreen? What type? How strong?
  • What other symptoms do you have?


Sunburn is better prevented than treated. Ways to prevent sunburn include:

  • Use a broad spectrum sunscreen of SPF 30 or higher. A broad spectrum sunscreen protects from both UVB and UVA rays.
  • Apply a generous amount of sunscreen to fully cover exposed skin. Reapply sunscreen every 2 hours or as often as the label says.
  • Apply sunscreen after swimming or sweating and even when it is cloudy.
  • Use a lip balm with sunscreen.
  • Wear a hat and other protective clothing. Light-colored clothing reflects the sun most effectively.
  • Stay out of the sun during hours when the sun’s rays are strongest between 10 a.m. and 4 p.m.
  • Wear sunglasses with UV protection.


Krakowski AC, Kaplan LA. Exposure to radiation from the sun. In: Auerbach PS, ed. Wilderness Medicine. 6th ed. Philadelphia, Pa: 2011:chap. 14.

Lim HW, Hawk JLM. Photodermatologic disorders. In: Bolognia JL, Jorizzo JL, Schaffer JV, eds. Dermatology. 3rd ed. Philadelphia, Pa: Elsevier Saunders; 2012:chap 87.

Vaccine Controversies

2015-Premier Pediatrics’ Position on Immunization:

As a parent, you can choose whether or not to vaccinate your child. We encourage you on behalf of your child and the other children in your child’s school or child care facility to immunize your child.
Here at Premier Pediatrics we believe in vaccinating every child in accordance with the CDC recommended schedule. We no longer vaccinate according to Dr. Sears & AAP Schedule, nor do we accept patients who choose not to vaccinate. We do not make exceptions for this policy to protect the heath and welfare of our other patients and staff.

Shahab Eunus, MD, FAAP

Dear Parents,

As a pediatrician who not only cares for your children’s health and wellbeing but also looks into the burning issues that concern our parents. Immunization risks and benefits are one of them. I have done an extensive literature review and found following facts to share with you:

MMR & Autism: Andrew Wakefield , a UK former surgeon and medical researcher and twelve other authors published a paper in Lancet (1998) claiming a causative connection between the MMR vaccine, Autism and autistic enterocolitis. His study focused on tests carried out on 12 children who had been referred to the Royal Free Hospital in Hampstead for gastrointestinal problems. Ten of Wakefield’s twelve co-authors of the Lancet paper later published a retraction. Later it has been found:

  • “Wakefield ordered investigations “without the requisite pediatric qualifications” including colonoscopies, colon biopsies and “spinal taps” on his research subjects without the approval of his department’s ethic’s board and contrary to the children’s clinical interests, when these diagnostic tests were not indicated by the children’s symptoms or medical history.”
  • “3 of 9 children reported with regressive autism did not have autism diagnosed at all. Only one child clearly had regressive autism;
  • “Despite the paper claiming that all 12 children were “previously normal,” five had documented pre-existing developmental concerns”;
  • “Some children were reported to have experienced first behavioral symptoms within days of MMR, but the records documented these as starting some months after vaccination”;
  • “In nine cases, unremarkable colonic histopathology results—noting no or minimal fluctuations in inflammatory cell populations—were changed after a medical school research review to “non-specific colitis”;
  • “The parents of eight children were reported as blaming MMR, but 11 families made this allegation at the hospital. The exclusion of three allegations — all giving times to onset of problems in months — helped to create the appearance of a 14 day temporal link”;
  • “Patients were recruited through anti-MMR campaigners, and the study was commissioned and funded for planned litigation. He also purchased blood samples – for £5 each – from children present at his son’s birthday party”.
  • According to BMJ, Wakefield received more than 435,000 pounds ($674,000) from the lawyers.
  • Wakefield has applied for a patent for single antigen measles vaccine before starting campaign against MMR
  • He also had planned to launch a “diagnostic kits” for the new condition, “autistic enterocolitis” and predicted to make more than $43 million a year but failed after Wakefield’s superiors at University College London’s medical school disapprove.

On 28 January 2010, a five-member statutory tribunal of the General Medical Council (UK) found some three dozen charges proved, including four counts of dishonesty and 12 counts involving the abuse of developmentally challenged children.

The panel ruled that Wakefield had “failed in his duties as a responsible consultant”, acted both against the interests of his patients, and “dishonestly and irresponsibly” in his published research.

The Lancet immediately and fully retracted his 1998 publication on the basis of the GMC’s findings, noting that elements of the manuscript had been falsified. Wakefield was struck off the UK Medical Register in May 2010, and may no longer practice medicine.

Vaccines and Mercury:AfterWakefield’s paper thimerosal containing vaccines (TCVs) and autism controversies started in the USA. Though no data could prove any link,as a precautionary measure since Summer 2001 thimerosal (a mercury containing preservative) was removed from most vaccines, except for some multi dose influenza and tetanus vaccines (what still contains trace amount of thimerosal). These vaccines are not used in our practice. Please note that thimerosal contains ethylmercury a non toxic form of mercury as opposed to it’s toxic form- methylmercury . Ethylmercury clears much faster from the body and also decomposes quicker in the brain (suggesting a lower risk of brain damage) than methylmercury (a potent neurotoxin).Symptoms of mercury poising and symptoms of autism are not the same though one will expect to see the same symptoms if autism was caused by Thimerosal.

Here are some data from population studies found in Wikipedia:

  • The only epidemiologic research that has found a purported link between thimerosal containing Vaccines (TCVs) and autism has been conducted by Mark Geier, whose flawed research has not been given any weight by independent reviews.
  • In 2003, the AAP criticized Geier’s study, as containing “numerous conceptual and scientific flaws, omissions of fact, inaccuracies, and misstatements”.
  • When the Institute of Medicine reviewed vaccine safety in 2004, it dismissed Geier’s work as seriously flawed, “uninterpretable”, and marred by incorrect use of scientific terms.
  • New Scientist reported that the Institutional Review Board which approved some of Geier’s experiments with autistic children was located at Geier’s business address and included Geier, his son and wife, a business partner of Geier’s, and a plaintiff’s lawyer involved in vaccine litigation.
  • In January 2007, a paper by the Geiers was retracted by the journal Autoimmunity Reviews.
  • In 2011, Geier’s medical license was suspended by the state of Maryland, over concerns about his autism treatments.

Multiple studies have been performed on data from large populations of children to study the relationship between the use of vaccines containing Thimerosal, and autism and other neuro-developmental disorders. Almost all of these studies have found no association between TCVs and autism, and studies done after the removal of Thimerosal from vaccines have nevertheless shown autism rates continuing to increase.

  • In Europe, a cohort study of 467,450 Danish children found no association between TCVs and autism or autism spectrum disorders (ASDs), nor any dose-response relationship between Thimerosal and ASDs that would be suggestive of toxic exposure. An ecological analysis that studied 956 Danish children diagnosed with autism likewise did not show an association between autism and Thimerosal.
  • A retrospective cohort study on 109,863 children in the United Kingdom found no association between TCVs and autism, but a possible increased risk for tics. Analysis in this study also showed a possible protective effect with respect to general developmental disorders, attention-deficit disorder, and otherwise unspecified developmental delay.
  • Another UK study based on a prospective cohort of 13,617 children likewise found more associated benefits than risks from Thimerosal exposure with respect to developmental disorders.
  • A Canadian study of 27,749 children in Quebec showed that Thimerosal was unrelated to the increasing trend in pervasive developmental disorders (PDDs). In fact, the study noted that rates of PDDs were higher in the birth cohorts with no Thimerosal when compared to those with medium or high levels of exposure.
  • A study performed in the US which analyzed data from 78,829 children taken from the Vaccine Safety Datalink (VSD) did not show any consistent association between TCVs and neurodevelopmental outcomes.
  • Another study which studied children enrolled in HMOs that participated in the VSD found no evidence of a causal relationship between early exposure to mercury such as from Thimerosal and deficits in neuropsychological functioning, although the authors did not address autism specifically.
  • A later study performed in the same HMO groups found no increased risk of autism or autism spectrum disorders with increased exposure to Thimerosal in early life from vaccines or immunoglobulins, and actually found decreased risk for ASDs with increased ethylmercury exposure when adjusting for covariates in certain exposure periods.
  • A study performed in California found that removal of Thimerosal from vaccines did not decrease the rates of autism, suggesting that Thimerosal could not be the primary cause of autism.
  • A study on children from Demark, Sweden and California likewise argued against Thimerosal Containing Vaccines being causally associated with autism.

Alternative Schedules : “ too many shots overwhelms the child’s immune system or many of the infections are no more existent” from this hypothesis alternative schedules came into existence and some of them like Dr. Sear’s Schedule became popular .The section below will try to answer to this hypothesis. Dr. Sear’s schedule advocates delaying and splitting vaccines ,instead of giving them as per CDC, AAP, AAFP recommendation (2 mo,4 mo,6 mo,12 mo,15 mo,18 mo etc) to give them monthly.CDC recommendations are based on world wide experience and studies, Dr. Sears Schedule is based on his guess only. Not getting into details of immunology or biology, there are some practical problems with this schedule:

  • The first year of life is the most vulnerable period when children’s immune system is not well developed, taking into consideration of this specificity the CDC recommendation puts extra stress to deliver the bulk of immunization at this time period. Dr. Sear’s schedule is not considering this fact
  • With CDC “too many shots” child gets them once and may remember only one episode (not 1 shot or 5 shots).With monthly shots the child is placed under tremendous stress of getting shots creating and confirming the already existing phobia “doctors office means shots”, you can expect and be ready to have big tantrums when your child is sick and needs to see a doctor
  • Each time the child goes through the shots his/her cortisol levels goes up and we do not know what is the long term effect of this stress hormone. Predisposing to future anxiety disorders ? who knows?
  • It’s a hassle for parents to take off from job to come every month , hence we see missed or even more delayed shots .

Dr. Robert Sears’ website has following report (dated Sep 9, 2008) : New study Shows no link between MMR vaccine and Autism-should parents still delay and split up the MMR shot?

A multicenter study (Harvard, Columbia, Mass General, CDC, and the AAP) involving 38 children (25 with Autism and 13 without) was released today, Sept 3, 2008. Its purpose was to duplicate the original research done by Dr. Wakefield in 1998 that raised questions about a link between MMR vaccine and autism. Doctors from some of the most reputable medical institutions did intestinal biopsies on 25 children with autism and 13 children without, and found only one child in each group with measles virus in their intestinal lining. Wakefield, on the other hand, had found measles in most of his 12 autistic patients and only a small percentage of his non-autistic control patients. The authors of this new study conclude that their results provide “strong evidence against an association of autism with persistent Measles Virus RNA in the GI tract or MMR vaccine exposure. “It has been my practice to delay the measles part of the MMR vaccine until age 3 years . This is one of the most controversial parts of my Alternative Vaccine Schedule. This recommendation was made based on Wakefield’s findings. Now, in light of this new and seemingly credible study, the need to delay the Measles vaccine and split up the MMR has come into question.

Too many shots : does multiple vaccines overwhelm immune system? (adapted from Paul A Offit et al). Studies indicate that immune system has the capacity to respond to extremely large numbers of antigens. Theoretical capacity determined by diversity of antibody variable gene regions would allow for as many as 10,000 vaccines at any one time without overwhelming the immune system. Thanks to advances in protein chemistry children are exposed to fewer antigens in vaccines today than in the past. Please review the following chart:













Small pox ~200 Small pox
Hepatitis B
Total ~200 ~ 3217 ~3041 123-126

Herd immunity: Children who are not immunized still are protected against life threatening infections owing to the fact most children around them are immunized. This is called herd immunity. But when too many parents choose not to immunize their children they not only put their children at risk but the whole society by losing it’s herd immunity .

Premier Pediatrics, LLC’s position on immunization:

  • We immunize ourselves, our children, friends and relatives.
  • Every year during Flu season we care for hundreds of children with flu but we rarely get flu and we think it’s due to yearly flu shots what we take every year before the flu season.
  • Immunizations are not 100% risk free and there are some side effects but we strongly believe that benefits of immunization far outweigh the risks of side effects
  • In light of all present data we believe that immunizations or thimerosal do not cause autism. In the era of universal exposure to electromagnetic fields, genetically modified foods, hormones and pesticides, antibiotics, lack of physical activities, instead of looking for the real cause of autism just pointing a finger at immunization is nothing but shortsightedness.
  • We strongly recommend our parents to immunize their children and when needed themselves

On a personal note : I was born and raised in a 3rd world country where universal immunization is not available and where thousands of children die each year from vaccine preventable diseases .There is no doubt or dispute about whether the immunization is beneficial or not. I still remember the day when we fought all night to keep my cousin alive from a disease called “diphtheria” but lost the battle. Thanks to universal immunization most new generation US pediatricians , physicians and parents have not seen even one case of Diptheria. So the disease seems non- existent or just a myth. If we let our society loose our “ herd immunity” that we have achieved through our long and hard battle against life threatening infections, we may end up being in a situation like hundreds of 3rd world countries which are only few hours plane ride away.

Thank you for your attention .Truly yours,

Shahab Eunus, MD, FAAP, President, Premier Pediatrics, LLC


References :

  • Paul Offit, MD “ Thimerosal and Autism”
  • Paul Offit , et al Addressing parents concern: Do multiple vaccines overwhelm or weaken the infants immune system?
  • www.chop.eduCachedSimilarYou +1’d this publicly. Undo
  • The Children’s Hospital of Philadelphia’s Vaccine Education Center.
  • Hviid, et al., “Association between thimerosal-containing vaccine and autism,” Journal of the American Medical Association 2003;290:1763-1766.
  • T. Verstraeten, et al., “Safety of thimerosal-containing vaccines: a two-phased study of computerized health maintenance organization databases,” Pediatrics 2003;112:1039-1048.
  • J. Heron, J. Golding, and ALSPAC Study Team. “Thimerosal exposure in infants and developmental disorders: a prospective cohort study in the United Kingdom does not show a causal association,” Pediatrics. 2004;114:577-583.
  • N. Andrews, et al., “Thimerosal exposure in infants and developmental disorders: a retrospective cohort study in the United Kingdom does not show a causal association,” Pediatrics, 2004;114:584-591.
  • Fombonne, E., et. al., “Pervasive Developmental Disorders in Montreal, Quebec, Canada: Prevalence and Links with Immunizations” Pediatrics. 2006;118:139-150.
  • Frank Destefano,MD,MPH (CDC’s immunization safety office in Atlanat)
  • Wikipedia
  • Some other internet sources, unable to recall

Useful Links

Here are a few reputable sites which provide great information for any parent!

American Academy of Pediatrics (AAP) recommends every parent to visit this website. The American Academy of Pediatrics is an organization of 60,000 pediatricians committed to the attainment of optimal physical, mental, and social health and well-being for all infants, children, adolescents, and young adults. This website contains general information related to your child health issues with more specific guidelines.

Children and Adults with Attention-Deficit/Hyperactivity Disorder

CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder) is the nation’s leading non-profit organization serving individuals with AD/HD and their families. CHADD has over 16,000 members in 200 local chapters throughout the U.S. Chapters offer support for individuals, parents, teachers, professionals, and others.

Parents Med Guide

These guides are designed to help patients, families, and physicians make informed decisions about obtaining and administering the most appropriate care for a child with ADHD or depression.

Childhood Bipolar Disorder

The Juvenile Bipolar Research Foundation is the first charitable organization solely dedicated to the support of research for the study of early-onset bipolar disorder. Our board is a remarkable one, made up of dedicated parents, treating professionals and world class clinical investigators and basic science researchers.

Detect Autism Early

When a developmental delay is not recognized early, children must wait to get the help they need. This website contains very helpful information that help you to undergo all the ways you should measure your child’s growth.

The PDD Assessment Scale/ Screening Questionnaire

The questionnaire available below is an experimental screening tool based on the DSM-IV criteria for autism which states that to be diagnosed as autistic.

Centers for Disease Control and Prevention

In this website you can find most general information about the Immunizations for your child such as immunization Schedules, Recommendations, Vaccines in United States, Vaccines side effects and lots more valuable information. We recommend parents to read this information and then talk to us for the further procedures. Our professionals will provide you our best advice, we work with your concerns, and eventually we follow your directions.

American Academy of Pediatrics Immunization

This website is the American Academy of Pediatrics (AAP) complete Immunization resource center, for parents as well as healthcare professionals.
We are here to help guide you and your child every step of the way!

Cerebral Palsy Guide

This national organization provides free educational information, financial options and emotional support for parents and children affected by cerebral palsy.

Cerebral Palsy Group

Cerebral Palsy Group is an online resource for anyone who has been affected by cerebral palsy, brain injuries, or birth injuries.  They offer information and support to help provide resources and education to those affected by CP.