October 2021 Newsletter
Bambini News
Since mid-summer, pediatric practices across the country have smashed records for office visits -- brought on primarily by bizarre outbreaks of both RSV and influenza -- bugs we usually see in winter (but were strangely absent early this year). Here at Bambini, this was compounded by the loss of two of our clinicians. As most of you are aware, we have been closed to new patients since late July.
We are happy to report, however, that not only is Lauren Van Buren PA returning to telemedicine but also Charisse Pecorella FNP will be joining our practice next week! Charisse is a graduate of Mount Saint Mary College and has a strong interest in newborn care, pulmonary and sleep disorders, and complementary medicine. The Pecorellas have a one year-old little girl at home. For more info, please click here. We're still not sure, however, when we will be reopening to new patients.

Besides the badly-timed outbreaks of RSV, flu, strep, and even Coxsackie we have been seeing, another factor that is driving record volume in our office is the demand for testing. Two years ago, a child that sneezed in the classroom got a temp check at the school nurse and was sent back to class. Now, parents are getting called to pick their child up ASAP and not send them back without a COVID test! Further complicating matters has been intermittent shortages of testing supplies. For the latest information on testing at Bambini (we are still testing adults and have even added T-Cell assay), please see the homepage of our website or click here.

We finally have influenza vaccine in stock for both our HMO (Aetna, MVP, etc) and VFC (Medicaid plans) patients, and have our first "flu shot clinic" Columbus Day. The AAP is okay with kids getting both a COVID vaccine and flu shot on same day, but we have seen no large studies on this practice.

As you likely are aware, earlier this month, Pfizer submitted a request for Emergency Use Authorization (EUA) to the FDA for administration of a new lower-dose version of their mRNA product to children age 5-11 years. What do we think about this? Well, last month the American Academy of Pediatrics advised its members that they can lose their license for "providing misinformation or disinformation" to parents about COVID vaccines. They left it to our imagination, it seems, to figure our exactly what that includes.🙄

Clearly, this will be a difficult and potentially contentious decision for parents -- going even beyond the angst brought on by mandates imposed by a number of colleges and universities earlier this fall. We hope to see both parents in clear agreement before their 5-11 year-old son or daughter is brought in.
Obesity & COVID-19
Unfortunately, the Delta strain seems to have a penchant for children. We have seen almost as many kids testing positive as we did during the big COVID-19 wave back in January.

We even had our first acute COVID-19 admission, a five-day-old newborn who spiked a temp at the same time its parents started feeling sick. Thankfully, the baby did fine and was discharged after 48 hours. 
 
But in parts of the country where Pediatric Intensive Care Units are full, children with COVID-19 often have one thing in common: obesity. Paradoxically, pediatric obesity rates have actually increased since the pandemic began -- ouch! According to a study published in August, about 46% of elementary school age kids in the US are overweight or obese.

How can concerned parents help keep their kids at a healthy weight? Scientists have learned that if they want to make a mouse fat, they feed it linoleic acid -- the primary fat in vegetable and seed oils -- including soybean, canola, corn, and safflower oil. These oils can be found in many salad dressings, mayonnaise, margarines, and fried foods.

Parents do well to start reading food labels and moving away from these foods and condiments. Both carbs and seed oils can be a real issue with school lunches and fast food. For additional suggestions, please review our recently updated advice sheet on this timely subject.
Early Treatment Frustrations
Two weeks ago, Elizabeth Mumper MD, an integrative pediatrician with 41 years of practice experience from the Rimland Center in Lynchburg VA, wrote about a prescription for ivermectin she sent in for an adolescent patient from her practice with diabetes.

To her chagrin, the pharmacist refused to fill it. She went so far as to bring 93 references and an review article to the local Walgreens, but to no avail.

The American Academy of Pediatrics (Dr. Mumper is a Fellow of the AAP) recommends against use of ivermectin, hydroxychloroquine, and just about everything except Tylenol for early outpatient care of children with COVID-19.

Fortunately, most Bambini patients that take some combination of supplemental vitamins C & D, quercetin, NAC, elderberry, or probiotics have done quite well through the pandemic.
Can Breastfed Babies "Go Keto"?
In a word, "Yes!" We have known for quite some time that children with epilepsy often respond favorably to a ketogenic diet -- even when multiple prescription drugs fail to bring seizures under control.

But what to do about a breastfeeding baby with epilepsy? Mother's milk has enough lactose to keep ketones at bay.

Earlier this month, a case report from New Zealand explained a creative approach to this dilemma. Doctors at Christchurch Hospital placed the lactating mother of an infant with epilepsy on a ketogenic diet. 61% of her intake was dietary fat (e.g. butter, eggs, cream, bacon, MCT oil, etc).

How did the baby make out? Over a three month period of observation, the infant was put into nutritional ketosis and visible seizures eliminated. Wow!