HPV Vaccine in Boys: New AAP Guidelines:

The vaccine already has been recommended for girls and young women since 2006 largely to prevent cervical cancer. But health authorities never expressly encouraged the vaccine for young boys, saying only that they “could” receive it to protect against genital warts and certain cancers and to help prevent the spread of HPV.

The American Academy of Paediatrics now recommends giving the HPV (human papilloma virus) vaccine to boys as well as girls. As you know I have always recommended this. The new Guidelines include:

§               Boys aged 11 to 12 years should be routinely immunized with HPV4, using the same schedule as for girls.

§               Boys and men aged from 13 to 21 years who have not already been immunized or who have not completed their vaccines should finish the series.

§               Men aged from 22 to 26 years who have not already been immunized or who have not finished the full series may be administered the recommended vaccine. (The AAP guidelines note that "cost-efficacy models do not justify a stronger recommendation in this age group.")

(View article via this link http://www.medscape.org/viewarticle/759495 )

If you would like me to administer the vaccine to your children or indeed yourself please contact Kelly on 02072244668

In common with American practice I administer Gardesil which protects against more papilloma viruses than Ceverix which is the vaccine currently administered to girls in schools.

Gardesil also has the advantage that it can also be given earlier.

Shingles:

Shingles:

Shingles is an illness in the elderly (ages 60 and above) which is caused by the same virus as chicken pox, meaning that anyone who has had the common childhood illness is at risk of developing shingles in the future. The virus lies dormant following recovery from chickenpox and may become active to cause shingles later in life.

Symptoms include over-sensitivity and a burning sensation, followed by a rash of small raised spots that turn into fluid-filled blisters and then scabs. The rash can be debilitating and the pain may last for a long time after the rash is gone.

In 2010 a Department of Health edict said that all people in the United Kingdom over 70 should receive the new shingles (chickenpox reactivation) vaccine. This move could help to prevent many cases of Shingles which affects one in four adults at some point.

Shingles can be life threatening at any age but tends to be more severe in older people. The NHS has not been able to create a vaccination schedule for these yet as there is difficulty in manufacturing and the manufacturers are already at full capacity. Due to these supply problems very few eligible people have received it. Production is currently being increased to accommodate the potential demand of the vaccine. However it is unknown how long this will take. 

The vaccine may prevent shingles in half of those who receive it and ease the symptoms for the rest.

If you have a family member who has not received the vaccine and wishes to then please contact us on 02072244668 to make an appointment. The cost of the vaccine and administration is £200. 

February 2012 Newsletter

Meningococcal C vaccine in adolescents

The meningococcal C strain can cause life threatening meningitis at any age. It is particularly prevalent in the teenage years.

Your child will have received immunisation against this bacterium as a baby if he/she is less than seven years of age otherwise not. In any event this immunity wanes over 10 years so in America a follow up dose is recommended at 11 years of age. This is not given in the UK but I recommend it.

It was originally thought that this would provide immunity for at least another 10 years but recent research has shown  that this is not the case and in many protection wanes after about 5 years .

The recommendation in America is now that a second dose is given at least 2 months after the first.

I also recommend this for my patients.

This is important as the peak incidence of meningococcal disease is in the teenage years.

If your child is coming up to the teenage years then I recommend that he/ she should be given 2 doses of the conjugate meningococcal vaccinesepareted by 2 months.

 Two doses of the Human Papilloma Vaccine can be given at the same time.

I use the Gardesil preparation as this protects against 4 strains of the papilloma virus causing cervical carcinoma rather than Ceverix the vaccine used routinely in UK which protects only against two

At present it is only given to girls but I recommend giving it to boys as well as  they are generally the vectors.

Contact Kelly on 020 7224 668 to book an appointment or if you have any questions.

Human Papillomavirus

CIN (cervical intra-epithelial neoplasia) is usually the result of a virus infection: the human papilloma virus (HPV). HPV is a very common virus that can affect the cells of the cervix. It is mainly passed on during sexual intercourse. Most women who have had sexual intercourse will have the virus at some time in their life, but for many their immune system will get rid of the virus and they won't even know they had it.

Cancer of the cervix can take many years to develop. Before it does, early changes occur in the cells of the cervix. These abnormal cells are not cancerous, and are called (CIN). Some doctors call these changes pre-cancerous. This means that the cells might develop into cancer if they are not treated. It is important to know that most women with CIN do not develop cancer. CIN may also be referred to as dysplasia or dsykaryosis.

Most women have regular cervical screening (the smear test). The test is designed to find early changes in the cells of the cervix, so that treatment can be given to prevent a cancer from developing. Although the aim of cervical screening is to prevent cancer, it can also sometimes detect a cancer that has already developed.

There are more than 100 types of HPV and each type is identified by a number (e.g. HPV 16). Some types of the virus can cause genital warts, and other types can cause CIN in the cells of the cervix. The CIN usually clears up once the immune system has got rid of the virus. In some women the virus remains for a number of years and in a few of these women the CIN will develop into cancer if it is not treated.

The type of HPV can affect whether CIN develops or not - only certain types, such as 16, 18, 31 and 33 (known as 'high risk' types) seem to be associated with the development of abnormalities of the cervix.

Many women have heard that having sexual intercourse at an early age and having multiple sexual partners can increase the risk of developing cervical cancer. They may be distressed that friends and family could think they fall into these categories.

It is important to remember that although these factors can increase the chances of catching the virus, many women who have only had one sexual partner have HPV, and may go on to develop CIN or cervical cancer. So there is no reason for yourself or others to feel that you are to blame for having cervical cancer.

You have heard about the new quadrivalent vaccine against human papilloma virus (HPV) GARDASIL which will both prevent cervical carcinoma (approximately 200 women a year die from this condition in the UK) (HPV16/8) and reduce this incidence of genital warts by 90%.(HPV 6/11) in the vaccinated population.

It now has a product license in the UK for children between the ages of 9-26 years (girls ) and 9-16(boys).

My wholehearted recommendation is that boys and girls should receive it when they attain the age of  9. (The boys should receive it both to reduce the risk of genital warts and to reduce the population carriage of HPV 16 and 18 which can cause cervical carcinoma in women.) Protection against the papilloma viruses is likely to be long lasting.

The immunisation programme is for 3 doses of the vaccine:

First dose             Time  0

Second dose        2 months

Third dose             6 months

Abdominal Pain

Abdominal Pain
There are many different causes of abdominal pain in children, sometimes the child’s other symptoms - fever,
nausea, vomiting or diarrhoea are a bigger clue to the problem than just the pain in the abdomen.
Some common causes of abdominal pain in children include:-

Gastroenteritis is an inflammation of the stomach and intestines caused by intestinal infection that causes
cramps and diarrhoea.  The diarrhoea may be very watery, and may contain blood or mucus.  Viruses cause up
to 40% of the infectious diarrhoea cases in the UK.  It is the second most common illness following upper
respiratory infections.  Treatment is directed at replacing fluids, salts and minerals (electrolytes) loss as a result
of diarrhoea - the objective is to prevent dehydration.  Viral gastroenteritis does not respond to antibiotic
therapy.  Prevention is directed at hand washing and proper food handling.

There are 20 to 35 million cases of gastroenteritis each year.  This can be caused by viruses, bacteria or
parasites.  Many types of virus are responsible for gastroenteritis.  The most common are Rotavirus and
Norwalk virus.  Rotavirus is often responsible for  severe gastroenteritis in infants and young children.
Norwalk virus is more often associated with institutional group related viral outbreaks - most common in
Winter in school aged children through contaminated food or water.  Gastroenteritis can also spread from
person-to-person contact, if it is caused by Shigella bacteria or by one of the intestinal viruses.

Appendicitis is an infection  of the appendix, a tube like glandular structure attached to the beginning of the
large intestine (colon).  Appendicitis can cause pain in the lower right portion of the abdomen along with
nausea, vomiting and fever.  It is uncommon below one year of age and most common in the late teens and
early twenties.  It is commoner in males than in females.  Appendicitis usually begins with crampy, colicky-like
mid abdominal pain and loss of appetite then progresses rapidly to the “classic” signs of appendicitis.

Irritable Bowel Syndrome is a condition characterised by increased motility of the small  and large
intestine. It is a mysterious illness which causes occasional attacks of abdominal pain, cramps and diarrhoea,
with or without episodes of constipation.  There is no fever.  The disease may be blamed on many different
factors, including diet and a stressful lifestyle.  Increasing dietary fibre and eliminating stimulants to the
gastrointestinal tract such as caffeine may be beneficial.  Anxiety reduction measures may also be helpful.

Urinary Tract Infections can affect the bladder, kidneys or both and are usually caused by one of the
species of intestinal bacteria, especially E. coli.  Urinary tract infections can cause pain in the lower abdomen,
in the flank or in the middle of the back.  They can also cause discomfort during urination, frequent urination,
bedwetting, fever and other symptoms.  Antibiotics are used to control bacterial infections.  Recurrent urinary
tract infection requires careful evaluation to see if a urinary tract abnormality is present, especially in children
under 3 when vesico-ureteric reflux can cause permanent kidney damage (see urinary tract infection).
Prevention of acute urinary infections centres around careful hygiene, liberal fluid intake, elimination of bubble
baths and prophylactic antibiotics.


Lactose Intolerance is marked by a difficulty digesting lactose (contained in milk and dairy products).
Lactose intolerant people have indigestion, bloating, and diarrhoea after eating or drinking anything that
contains lactose.  Primary lactose intolerance is genetically determined and increases with age.  Approximately
two thirds of the word population have lactose intolerance.  It is common in Asians, Africa Europeans, Native
Americans and South American Indians.  Severe lactose malabsorption may follow gastroenteritis or other
intestinal inflammation and can occur in anyone.  It is transient and treated by elimination of lactose containing
products.

Peptic Ulcers are an erosion in the lining of the beginning port small intestine.  While previously thought to
be due to diet and stress, current research indicates most peptic ulcers are caused by a bacterial infection due to Helicobacter Pylori.  They cause a burning pain under the ribs and this pain is often relieved by eating and by taking antacids.


A gastric ulcer is a result of an inbalance between acid and pepsin secretions, leading to
inflammation of the stomach.  Antacids and ulcer healing medications are usually an effective treatment,
combined with antibiotics to eradicate the H.Pylori if this is present (confirmed with blood test for anti-bodies)
Abdominal pain can be a symptom of many different kinds of illness in children, including illnesses that seem
to have no relation to abdominal organs.

What to look for:
Whenever your child has abdominal pain, it is important to find out as much as possible about the location of
the pain, the type of pain (burning, crampy, dull), and the time that the pain started (after/before eating).  For
example, pain in the lower right side of the abdomen may be a sign of appendicitis; crampy pain around the
naval is intestinal pain; and crampy pain that begins after a child drinks milk or eats ice cream may mean
lactose intolerance.

Look for other symptoms like nausea and vomiting or diarrhoea and cramps could be a sign of gastroenteritis.
Fever and a burning feeling when a child urinates can be signs of a urinary tract infection.  Fever with
occasional bouts of diarrhoea and/or constipation, can be irritable bowel syndrome.

Other signs to look for : a distended abdomen; a painful and rigid abdomen; bleeding in any form - bruises
(bleeding under the skin) on the surface of the abdomen); vomiting blood or bloody bowel movements.  These signs require immediate attention.

What to do
We may have a good idea of what is happening to your child after hearing the symptoms and performing a
physical examination.  Because the symptom of abdominal pain is a part of may illnesses, the next step can be
anything from reassurance that the problem is minor to an emergency hospital admission.  Lactose intolerance
can be treated by a simple switch to non-lactose products but appendicitis needs immediate surgery to remove the infected appendix.

Autism

Autism

Autism is a neuro-chemical dysfunction of the brain of unknown cause.  It alters the child’s ability to
communicate and socialise.  It comes on before the child is 2 ½ years old and may be associated with
learning disability.  It may however be difficult to ascertain the child’s intellect because of communication
difficulty.  Autistic children are often withdrawn, they need “sameness” and often get very upset when even
small environmental changes are made.  They may have problems with language development and in
playing with others.

  Boys are affected more than girls and genetics play an important part.  In twin
studies, if there is an affected identical twin, then the other twin will have an 80% chance of being affected
and with non-identical twins, this falls to 20%.  Brain injury, perhaps occurring during pregnancy has also
been mooted as a possible cause.  Relatives of autistic children will often have difficulty processing
language.

There is some evidence that serotonin is found in a higher concentration in children with autism.
It used to be thought that autism was due to poor parenting and although this is not the case, some parents
may show some mildly autistic features.


What to look for:

Symptoms of autism come on before 2 ½ years of age.  They tend to be withdrawn, like playing on their
own and experience difficulty when playing with other children.  There may have delayed language
development and some may never develop language at all.  Eye contact may be poor and they are likely to
have difficulty with games that involve taking turns.  They have trouble with pretend and imaginative play.
They may indulge in repetitive movements such as rocking. Over half the children with autism will have some degree of learning disability.

What to do:
A child with symptoms of autism needs to be seen by a Paediatrician who may make a referral to a
Neurologist or Psychiatrist with experience in treating such children. Other conditions mimic autism so
your doctor may well want to do some tests which will include a thorough physical examination, along with
an IQ and hearing test, a brain scan and EEG (an electroencephalogram, a painless recording of the
electrical brain waves).  Your doctor may also want to do some blood tests to look for metabolic problems
(problems with the way your child’s body handles nutrients and other body chemicals), a screen for poisons
and also chromosome tests.

If it is confirmed that your child does suffer from autism, there are several types of treatment.

A) Behaviour therapy, where your child is helped to learn new patterns of behaviour when interacting
with others and unlearn unhelpful  behaviour patterns.

B) Educational therapy,  where a very structured school setting may help your child to communicate
better and to learn social skills.

C) Medical therapy, with various types of medicines, including anti-depressants and haloperidol
which may cause a significant improvement.

Ask to see a paediatrician if:

Your child is withdrawn and is having difficulties communicating with others.  If your child has never
learnt to speak or his speech is delayed.  If your child has poor eye contact, has difficulty playing
participation games with other children, has problems with sharing and give and take or has problems with
symbolic play.

Croup

Croup is a virus infection of the voice box (larynx) and windpipe (trachea) and usually affects children up to the age of 5 years.  Croup often begins like a normal cold then the child develops a harsh, barking, “croupy” cough - often at night-time.  The voice is hoarse and the child may develop a noise when breathing in (stridor).  The stridor is due to narrowing of the trachea caused by the virus infection.  At first, the stridor may only be noticed when the child is active.  Croup may last for 3-4 days.

WHAT TO DO

Paracetamol may be given if the child has a fever.  Antibiotics do not help as croup is caused by a virus infection.

A mild attack of croup will often settle by nursing the child in a warm humid room, such as the bathroom, with the hot water taps are on.  The child should never be left alone in the bathroom with the hot water taps on.

Humidifiers in the bedroom may help.

Croup will often become worse at night and the child may be more settled if someone stays with them.  They may also breathe more easily if they are sitting up or lying against 2-3 pillows for support.

TAKE YOUR CHILD TO A DOCTOR OR HOSPITAL URGENTLY:-  IF

   

     Sucking in of the breast bone occurs on breathing in and the child is: 

(           having to work harder to breathe.

(           If stridor develops when the child is at rest.

(           If your child looks sick or becomes restless.

    

Emergency room treatment for croup is nebulised Pulmicort (Budesonide) 2mg.

September 2011 News Letter

Dr Richard Primavesi

117A Harley Street

0207 224 4668

Seasonal flu immunisation

This year’s flu vaccine is identical to last year’s which has been given to millions of children and adults without significant side effects.

I wholeheartedly recommend it for all children over 6 months of age.

If your child had two flu immunisations last year then he only needs one dose this year.

If not then he should have 2 doses separated buy at least four weeks.

-          Seasonal flu immunisation  appointments available from the first week of October  2011

-          I recommend to all children from the age of 6 m and upwards

-          Will need 2 doses separated by 2 m if first time

-          Can do parents and other members of family at same time

Childhood obesity

Continues to be a much discussed issue

Worries that two much concern by teachers may have led to the increase in the cases of anorexia in preschool children

By direct and indirect (bullying) mechanisms

Many parents are concerned that their child’s picky eating may be an early sign of anorexia nervosa – if they still indulge in junk food then it is not.

Please contact me on 02072244668 or richard@healthychild.co.uk  if you have any concerns. 

We now have a blog which gives information on recent health updates for children. Please visit the website at: http://www.healthychild.co.uk/

Travel Immunisations

Hepatitis B

The disease hepatitis B can be contracted from being bitten or scratched at school ( this is why hepatitis B immunisation is given to all children in America at birth and has been for more than 10 years ).It can also be acquired at birth from and infected mother or from breast feeding. There is a 10-20% mortality from acute liver damage and then it can cause liver cancer and progressive liver damage for life .For this reason it is an important cause of death in developing countries.

The immunisation which is very safe and effective is given at time zero, 1 month and at 6 months (it is recommended to children from 1 years old only). A fourth dose is generally given in 5 years.

It can be safely combined with hepatitis A (both are killed, mercury free vaccines) and given using the same time schedule.

Hepatitis A is usually a less serious disease than B rarely causing death but is much more easily caught usually from contaminated water or food.

I have been giving hepatitis B immunisation at my clinic to children now for  over 7 years and I now give both as combined hepatitis A and B immunisation particularly if foreign travel is considered.

Hepatitis A

Hepatitis A is spread though contaminated food and water and can cause inflammation of the liver and jaundice. It occurs throughout the world and vaccination is advised when good standards of hygiene cannot be guaranteed. One dose may give protection for one year. To increase the length of protection to at least 10 years, a second dose will be required. It is recommended to children from 1 years old only.

Typhoid Fever

Typhoid fever is also spread through contaminated food and water and can result in severe illness in some individuals. It can occur worldwide and vaccination is recommended for travellers to areas where sanitation and hygiene is very poor. The vaccine can be given from 18 months of age and lasts for 3 years.

(There is now a combined Hepatitis A and Typhoid vaccine from GSK called Hyper-tyrix) 

Yellow Fever

Yellow fever is spread by mosquitoes. It is a serious, sometimes fatal, illness. It occurs in parts of tropical South America and sub-Saharan Africa. The vaccine can be given from 9 month of age, lasts for 10 years and should be given at least 10 days before travel. Yellow fever vaccination is mandatory for travel to some countries.

You will not be allowed to enter these countries without a valid international certificate of  vaccination.(The yellow fever vaccine can only be administered at a registered yellow fever clinic)

Meningococcal meningitis

Meningococcal meningitis is a bacterial infection that is spread by droplets form an infected person’s nose and throat. It occurs most frequently in sub-Saharan Africa and vaccination is particularly recommended for those who are going to live and work for more than 4 weeks. Vaccination against the meningococcal strains A,C,W and Y is mandatory for entry to Saudi Arabia in order to attend the hajj or for the Umrah.  One dose of vaccine should provide protection for 3-5 years.

Rabies

Rabies is fatal disease spread by the saliva of infected animals. It is present in many countries but is as higher risk in some developing countries. If you are travelling in rural areas of high-risk countries away from medical care, then you should consider vaccination before you go and avoid touching any local animals, even if they appear healthy. If you are bitten abroad you should seek medical attention immediately -even if you have been vaccinated. The course consists of 3 injections over 3-4 weeks.

Japanese Encephalitis

Japanese Encephalitis is a life- threatening viral disease which affects the brain. The virus is spread by mosquitoes in South East Asia and the Far East. The risk of infection is greatest during , or just after, the wet season. The vaccine is recommended for travellers who will be staying for a month or longer, especially if travel will include rural areas. Vaccination can be given from one year of age and 2 or 3 doses are given over 2-4 weeks.

Diphtheria/tetanus/Polio

Everyone should have completed a course of the these vaccinations . Ensure that boosters are up-to-date before travelling to certain destinations.

• Polio: for travel to areas where polio still occurs such as Africa and India.
• Diphtheria: for travel to developing countries or Eastern European destinations.
• Tetanus: for travellers to remote locations or locations without access to good medical care

 

 

 

Tick –Borne Encephalitis

Tick –Borne encephalitis is a viral infection spread by ticks and occurs in the summer months in forested areas of central of eastern Europe and Scandinavia. Vaccination is recommended for those who will spend prolonged periods in infected areas or those who will be camping or working in forest during the summer months.

Malaria Prevention

Malaria is a serious disease that is transmitted by mosquito bites. It can occur in many tropical destinations. There is no vaccination available, so prevention consists of a combination of preventive medication and avoidance of mosquito bites.

Avoid being bitten by insects wherever possible; use insect repellents, wear light, loose clothing and sleep under a mosquito net if your accommodation is not air-conditioned. Seek advice on the most appropriate anti-malarial medication to suit your needs from your doctor.

Remember that anyone who has visited a Malarious country should mention this to their doctor if they develop a high fever up to two years after travelling.

How to take Malarone paediatric tablets:

In order to prevent malaria, it is important that the child starts taking Malarone paediatric tablets 1 or 2 days before travelling to a country or countries where there is a risk of catching malaria through being bitten by infected mosquitoes. Malarone Paediatric tablets should be taken each day while in these countries and for 7 days after returning home. If the trip will include visits to some areas or countries where malaria is a problem and also to some where it is not a problem, it is important to continue to take malarone paediatric until 7 days after leaving the last area or country where malaria can be caught.

Usually, malarone paediatric tablets should not be taken for more than 28 days.

Weight (kg)	Number of Malarone Paediatric tablets
11-20 21-30 31-40	1 Malarone Paediatric tablet daily 2 Malarone paediatric tablets as a single dose dialy 3 Malarone paediatric tablets as a single dose daily

Bed-wetting

Bedwetting (Nocturnal Enuereis)

Bedwetting, also called nocturnal enuresis, occurs when a child accidentally passes urine at night during sleep, after the age that he would be expected to be dry. It is not something that the child does on purpose.  Doctors often separate bedwetting into two types, primary enuresis and secondary enuresis.  In primary enuresis, the child has never been dry at night.  In secondary enuresis, the child was dry at night for one year but has suddenly and unexpectedly started to wet the bed again.  In general, boys are about three times more likely to have problems with bedwetting than girls and the problem tends to run in families.

Primary enuresis (never being dry) is probably caused by some delay in a child’s development, since the percentage of children with this type of bedwetting decreases with age.  At age 5, the % for males is 7% and for females 3%; at age 10 the % for males is 3% and 2% for females.  One % of males at 18 is still enuretic.  Persistent bedwetting may be the result of inadequate and inappropriate toilet training.  Psychological factors may play a part, especially if the child spent his toddler years living through times of unusual stress.  Children of immigrants, children who live in overcrowded conditions and those who come from families with psychiatric illness are all at risk from primary enuresis.  Some experts believe that primary enuresis is related to a slower development of nerves and brain centre that allow a child to control urination.  Others believe that the child’s bladder may be smaller than normal for size.  Still others blame a reversed pattern of urine production, so the child’s body makes more urine at night than during the day.

In secondary enuresis (bedwetting after being dry), stress is often to blame, although it is important to exclude a urinary tract infection.  Usually the child begins bedwetting when a sudden change occurs in their world. Almost any change in the environment, good or bad, can be a trigger.  This includes a new baby, a death in the family, parental or marriage problems, a new home or school.  It may be related to sexual abuse.

What to look for

In most children with bedwetting, soaked sheets and wet pyjamas are things that parents will see.  Still, it is wise to look for signs of a urinary tract infection.  He may urinate more often than normal during the day or complain of an uncomfortable or “burning” feeling when urinating, and the urine may look cloudy or have a very strong smell.  Other symptoms include fever, chills and pain in the back or lower abdomen.

 

 

 

 

What to do

If your child is younger than 6 years old, just give him time.  Let him know that about 1 in 5 of his classmates have the same problem and that almost all children outgrow bedwetting before the age of 10.  To help your child achieve his first dry night, try these suggestions :-

·      Encourage and praise him for dry nights.  Never punish, scold or blame.

·      Remind your child to urinate before going to bed.  If he doesn’t feel the need to urinate, tell him to “try” anyway.

·      Limit liquids in the last two hours before bedtime.

·      Use real cloth underwear rather than nappies or plastic pants.  “Grown-up” or “trainer” pants help remind your child to stay dry.

·      To make clean up easier, use plastic sheets or place a large plastic bag under cloth sheets.

If your 6 year old is still bedwetting, you may want to ask your doctor for suggestions.  By this age, most children can use an incentive with gold stars or small rewards for each dry night.  During the day your child can practice holding his urine for a few extra minutes rather than running to the bathroom right away.  He can also try starting and stopping his stream as he urinates, to help strengthen and control muscles around the urethra.  By this age, your child can help with a morning clean up after a wet night.  This is important as it empowers him.

After age 7, your doctor may recommend a personal enuresis alarm.  An alarm uses sounds or vibrations to wake your child if he wets his underwear.  It is important that he wakes up completely and quickly as soon as the alarm rings so that a conditioned response develops between having a sensation of urine in the urethra and waking.  This will require you to wake him as soon as you hear the alarm.  Some doctors prescribe a nasal spray or oral Desmopressin at night, a drug that is similar to the body hormone that switches off urine production.

Call your doctor if

Your child is wetting the bed at night and is age 6 or older, and never had a dry night, or started bedwetting after having many dry nights.  Also call your doctor if your child has pain, discomfort or a “burning” feeling when urinating, has urine that is cloudy or smelly, has a fever, chills, pain in the back or abdomen or often runs to the bathroom during the daytime and always seems to be thirsty.

MMR Vaccination

Measles, Mumps and Rubella Immunisation

I believe that MMR (triple dose: PRIORIX GSK) immunisation has a reasonable safety profile from the available evidence at the moment.  Two of my three children have been given the MMR immunisation.  The Department of Health recommends MMR immunisation.  Information can be obtained on their web site at http://www.doh.gov.uk/cmo/cmoh.htm

Some of the concerns about MMR immunisation stem from the research of a group at The Royal Free Hospital led by Dr Andrew Wakefield, who have suggested that both the measles infection and measles vaccination can be associated with an increased risk of Crohn’s disease (an inflammatory disease of the bowel), and that MMR vaccine may be associated with the development of autism (a disorder frequently diagnosed in the 2^nd year of life). 

MMR was introduced into the UK immunisation programme in 1988, since when around 10 million immunisations have been given to children at the age of 13-15 months as well as at 4 years of age and no obvious statistical relationship between MMR and autism or Crohn’s has been established.  This said, I understand as a parent your concerns given the present media attention to MMR and the fact that it may be considered unnatural to get infected with three live, albeit attenuated viruses, all at once.

I believe that giving the measles, mumps and rubella immunisation separately provides an acceptable way of immunising against these three conditions.  There is, however, little evidence in the literature that they are safer when given singly.  It has been suggested that they are marginally less effective when given singly because the immune response obtained is not so great.  However, it is just the sheer volume of the immune response when all are given at the same time which has given cause for concern.  The single measles, rubella and mumps immunisations do not have a UK product licence but do in France, France and USA respectively.   They are the same attenuated viruses as in the MMR. That is for measles the Schwartz strain, for rubella the Wistar RA27/3M and the mumps the Jeryl Lynn Strain. As with any vaccines there may be problems with availability. 

(Currently the Mumps Vaccine is unavailable. It has been off the market for about 2 years now.)

The other disadvantage of giving the immunisations separately is the time it takes for the full immunisation programme to be completed.  I recommend a period of six months between immunisations as by this time the acute antibodies to an infection have fallen back to normal levels.  (Dr Andrew Wakefield at The Royal Free Hospital recommends one year.  There is some evidence that having the wild measles and mumps within a year of each other in childhood predisposes to Crohn’s disease).  These are both empirical times.

My experience with giving the immunisations singly over the past 4 years is that they are at least as effective at inducing protective antibodies as the MMR. Also if I had given as many MMRs as I have given completed single immunisations I would have expected between 6 and 10 children to be admitted to hospital with fever induced fits .So far none have needed admission or had fits, neither have any children had measles, mumps or rubella after or whilst waiting immunisation.

                                                                                                                                                           

                                                                                                                                   

POSSIBLE REACTIONS TO MEASLES, MUMPS AND RUBELLA IMMUNISATIONS

Allergic reactions to the individual components of the measles, mumps and rubella immunisations

After any immunisation one can have an acute allergic reaction to it and so following immunisation I ask you to wait for about 10 minutes (or one hour if there is a suspicion that your child is egg allergic).  It is also possible to have an allergic type reaction 24 – 48 hours after the immunisation with swelling at the site, fever and irritability.  This should be treated with regular a Calpol

The infective elements of the reaction tend to occur later than this:

Measles 

With the measles vaccine there is a 1:10 chance of a modified measles like illness at 5–12 days after immunisation with fever, rash, irritability and diarrhoea.  You should treat this with regular Calpol and Nurofen as it is said that 1 in 1000 children will develop a febrile convulsion or fit following the measles (or MMR) immunisation.

With both the measles and rubella components the child may very rarely develop a rash of small bruise-like spots in the six weeks after immunisation.

Mumps

A modified mumps infection following the mumps immunisation is less common than with measles and occurs later, 2–3 weeks after the immunisation, with pain and swelling in the parotid glands (the glands just beneath the ear), fever and irritability.  There is generally no rash.  Again Calpol or Nurofen should be given regularly.

Rubella

Following the rubella immunisation there is not usually very much in the way of an infective reaction but more often there is a post viral “reactive arthritis” with pain and swelling in the joints which occurs 2–3 weeks after the immunisation.

The strains of the viruses given singly are exactly the same ones as in the MMR so your doctor will have come across the various components to the reactions if your child develops these.  However please let me know if you think your child has had any reaction to any of the given vaccines on 02072244668 in hours or on 07765162004 out of hours.

After the MMR there is a 1 in 1000 chance that your child will be admitted to hospital with a febrile convulsion .To date with 4 years experience we have had no serious reactions to the single vaccines we have given.                                 

Flu Vaccination

     Flu Vaccination                                                    

Influenza is an illness capable of affecting the entire respiratory tract from the nose and throat down to the bronchial tubes and lungs.  It is caused by a group of 3 viruses (influenza A, B or C).  Unfortunately these viruses keep changing from year to year, forming new outer coats which our immune system can’t recognize. This means that even if you or your child had influenza in the past, this year’s virus may be different enough to infect either of you again.

Influenza spreads very rapidly by direct contact with nasal mucus from an infected person or by inhaling droplets coughed or sneezed into the air.  The virus is fragile and does not survive for long in the air or on surfaces of furniture, kitchen or bathroom facilities.  Illness usually begins 1 to 3 days after exposure.

I recommend flu immunization for all children between the ages of six months and sixteen.

I have been offering annual flu immunization to all children that I see in my clinic now for over 5 years.

The reason for this is that the individuals that are particularly at risk from the complications of influenza are the very young and old. In the UK it is offered to the old but not young .In most other developed countries it is offered to both old and young for instance the USA.

Children over the age of six months may receive flu vaccine (though from ages 6 to 35 months it is given at a reduced dose).

For children under the age of 13 years, who have not been vaccinated previously, or who have never before been ill with flu, a second dose four weeks later is advised for full protection.

An annual immunization needs to be administered because the types of influenza most likely to cause an out break each year changes and so the vaccine has to be specially prepared every year to combat the most likely influenza types to cause an outbreak. The manufacturers have got better at doing this year on year.

 

If you would like to make an appointment for your family to be immunized this year then please contact us 0207 224 4668.

Healthy Child Clinic

Services We Provide General Paediatric advice - specialist interest in paediatric asthma, eczema and obesity Paediatric homoeopathy. Referrals accepted from General Practitioners, other Consultants and parents for diagnosis and management of medical paediatric problems. Referral if necessary to specialist paediatric opinion (usually available within 48 hours) and allied paediatric services on site: dietetics, physiotherapy, occupational therapy, eye and hearing tests. In-patient hospital assessment if necessary. Developmental assessment. Immunisations (including travel immunisations): Flu, BCG, Hep A&B, Chicken Pox, Prevenar 13, Single Measles and Rubella, MMR, Rotavirus, Meningitis, Pediacel, Gardasil, Preschool Jab  Advice and written reports prepared on behaviour problems and problems related to schooling, ADHD etc. Support and advice offered to parents regarding a large range of medically related conditions Medico-legal advice including preparation of reports and attendance in Court.      Code of Practice Copy of medical report/GP letter given to parents Waiting time less than 1/4 of an hour Out-patient appointment (new) within 48 hours Out-patient appointment (urgent) within 24 hours. We have an out of hours line if you need to contact us urgently. Complaints. Please contact Kelly Anyogu on 020 7224 4668 Location: The Clinic is located at 117a Harley Street London                                    W1G 6AT                                    02072244668                                    info@healthychild.co.uk  Nearest tube stations: Regents Park                                  Baker Street  Buses: 30,27,18,453 to Harley Street

Hepatitis B Immunisation

Hepatitis B immunisation

 The disease hepatitis B can be contracted from being bitten or scratched at school ( this is why hepatitis B immunisation is given to all children in America at birth and has been for more than 10 years ).It can also be acquired at birth from and infected mother or from breast feeding. As an adult it can be acquired from sharing needles and from sexual intercourse.

There is a 10-20% mortality from acute liver damage and then it can cause liver cancer and progressive liver damage for life .For this reason it is an important cause of death in developing countries.

The immunisation which is very safe and effective is given at time zero, 1 month and at 6 months. A fourth dose is generally given in 5 years.

It can be safely combined with hepatitis A (both are killed, mercury free vaccines) and given using the same time schedule.

Hepatitis A is usually a less serious disease than B rarely causing death but is much more easily caught usually from contaminated water or food.

I have been giving hepatitis B immunisation at my clinic to children now for  over 7 years and I now give both as combined hepatitis A and B immunisation particularly if foreign travel is considered.