Toxoplasmosis: A Risk For Pregnant Moms

     Most pregnant women are warned about not changing the cat’s litter box. The reason is a microscopic parasite called Toxoplasma gondii. This parasite can infect almost any mammal but needs to spend part of its lifecycle in cats. The cat gets infected by eating small, infected mammals and then the parasite multiplies in the cat’s gut and is excreted in the stool. The mammals become infected by eating the cat’s stool and the cycle continues. The parasite doesn’t usually cause problems in adult humans who become infected, but if a pregnant woman becomes infected, the parasite can travel through the blood stream, cross the placenta and infect the baby in the uterus. This can cause serious neurologic problems and blindness in the unborn baby.

     If the cat is an indoor cat, there isn’t much risk as long as you don’t have a mouse problem.  If the cat is an outdoor cat, infection is easy. Our cats used to leave squirrel feet or bunny kidneys on our front step every morning. Outdoor cats are hunters.

     Humans become infected by exposure to cat stool. Mothers are advised to not change the litter box or, if they do, to wear gloves and wash well afterwards. But they should be careful to wash their hands after any cat contact and also both before and after preparing any food (the parasite can be present in raw meat). Another less obvious source of infection is the sandbox. I built an open sandbox for my daughter and realized that she couldn’t use it because every cat in the neighborhood used it as a litter box.  A pregnant woman who doesn’t own cats might not be concerned about allowing her older child to play in a sandbox or playground, but that child could come away with the parasite on his clothes and hands and easily infect the mother. Mom could also be exposed when she is gardening. “Wash up” after any outdoor activity is good advice for both kids and their pregnant moms.

Kids and TV

     A study done by the Center for Child Health, Behavior And Development in Seattle was published in the March issue of Pediatrics and it gives an interesting slant on the ongoing debate about children and television.

     Most studies in the past have shown that the more television children watch, the more those children have obesity, school problems, aggression, antisocial behavior and early sexual behavior. In fact, another study in the same issue of Pediatrics reported that the more television children watched, the more likely those children were to have a criminal conviction before reaching age 26.

     The Seattle study, however, did not look at how much television children watched. The researchers studied how the content of the programs affected the children’s behavior. They allowed the children to watch as much television as they usually did, but they replaced violent and inappropriate content with educational and non-violent programs. They also decreased antisocial and violent content of the DVDs, videos, and computer games that the children were exposed to. The study was based on the well-established fact that children copy behavior that they see. The children were 3 to 5 years old and the study lasted 12 months. The children’s parents, relatives and day care workers were all involved in changing the viewing content.

     After 12 months, the children in the study showed significant improvement in their social and emotional responses to testing.  Low-income boys showed the greatest benefit. It is clear that not viewing violent and antisocial media improves children’s attitude and behavior. The authors of the study said it best: “Although television is frequently implicated as a cause of many problems in children, our research indicates that it may also be part of the solution”.

When A Child Pees, And Pees And Pees Again

     After age three, many young children develop the complaint of needing to urinate frequently. I have heard parents say that they have to stop at a number of gas stations on any short trip and that they have learned where the bathrooms are in most of their favorite stores. The child urinates a small amount and then needs to go again within an hour. This only occurs during the day (there is no new bedwetting or frequent urination at night) and the child does not have pain on urination.

     Sudden onset of frequent urination in a child can be a sign of urinary infection or diabetes, so it always has to be evaluated by the child’s caregiver. But simple examination of a urine sample will rule out both of these problems. Constipation can also cause frequent urination, but the history usually includes abdominal cramping, gas and large stools. Parents also need to be sure that the child is not drinking excessive fluids, especially juice. But if the child has no other symptoms and has a normal urine sample, he probably has simple frequent urination.

     For most of these children, the problem is a behavior problem. Although medications are sometimes used for this, reassurance and support are the best cures. If the examination by the child’s caregiver doesn’t show any disease, that can be the first step in reassuring the child that he is healthy and that this problem will go away. The parents can then explain to the child that “we need to practice holding our pee for a little longer.” After the child urinates, set a time that is longer than the time the that child wants to urinate again and explain that it will be all right if the child waits to go longer and that he won’t have an accident - “I know you feel like you need to pee, but it will be fine if we wait just a little longer. Don’t be afraid.“ When the child successfully waits, praise him. Some physicians recommend a small “reward”, but I’ve found that rewards need to be continually increased. A parent’s praise is the most important reward a child can receive. As the time between urinations increases, start setting other rules: “Please pee just before we leave because we are not going to stop the car on the way. Don’t worry, you can go again when we get to the store”. These children will frequently get very upset if told that they won’t be allowed to urinate, so I always reassure them that they will be able to urinate, but “we are just going to wait a little longer”.

     Keep extending the time between urinations. Tell the child’s teacher that the same program can be followed at school or daycare. Because the problem usually resolves with behavior modification, I do not recommend medications unless the child has some other problem that has been proven to respond to medication.

    

Vitamin C For Colds

-->

     While looking around the local pharmacy, I noticed eight different kinds of vitamin C preparations for children. Most of them claimed to boost the immune system and many claimed to prevent or cure common colds. For over 70 years, people have believed that vitamin C can prevent or treat disease, but there has been very little evidence to back up those beliefs.

     People have tried different natural products to treat common colds. Echinacea is touted to be helpful for colds, but studies show it is no more effective than sugar-pill placebo. Zinc was tried, but oral zinc causes nausea and vomiting and zinc nasal sprays can cause permanent loss of sense of smell. Vitamin C has a very low risk of side effects, even in children, and it is believed to have an effect on the immune system, although it is not clear what that effect is.

     In January of 2013, the Cochrane Database published a review of 72 different studies done since 1966 on vitamin C’s effects on colds. The results were mixed but interesting. They found that if people who are involved in extreme physical activities (such as marathon runners) took daily vitamin C supplementation, they got fewer colds. However, they found that the same daily supplemental vitamin C did not protect normal children and adults from getting colds. The interesting part of this review was that children and adults who took daily vitamin C supplementation (1 -2 grams a day for children) had a significant reduction in the duration of cold symptoms. In other words, vitamin C didn’t protect people from getting colds - they got colds as frequently as people who didn’t take vitamin C – but, when people took low-dose vitamin C on a daily basis, the colds lasted a shorter time and seemed to be less severe.

    The review then looked at the effects of starting a high dose of vitamin C (up to 8 grams) as a treatment after people had caught a cold. This did not make any difference on the cold symptoms.

     I believe that this study shows that daily, low-dose vitamin C decreases the severity and duration of cold symptoms in children even though it does not keep children from catching colds. It also shows that giving high-dose vitamin C after you catch a cold is worthless. Perhaps parents could give children 1-2 grams of vitamin C daily during cold and flu season and give a break for the children (and for the parent’s budgets) during summer.