With the holidays fast approaching and a brand new year just around the corner, now is as good a time as any to get your household on a healthy track.

Eat healthy this during the holidays without missing out.

We understand that holiday traditions are important, and that there are certain not-so-healthy dishes you and your family simply can’t live without. Good news, you don’t have to. There are many ways you can have your festive cake and eat it too. For instance, here are some helpful tips from the Mayo Clinic on how to modify traditional recipes with healthy ingredients. You can also pack in additional vitamins and nutrients by sneaking in pureed vegetables. Click here to learn how.

Another great way to ensure that you and your family stay holiday healthy is to choose organic fruits and vegetables for every dish you make. Also, if you can, make sure the meat you buy comes from an organic farm. As we covered previously, organic farming methods can make all the difference to you and your child’s health.

If you’re in the mood to start new healthy holiday traditions, check out this collection of delicious organic food recipes from Organic Authority.

Make your 2012 resolution a healthy one.

Don’t let leave these tips behind–bring them with you into the New Year! Resolve to make more informed choices about what your child eats, and create a healthy household by making organic meals at home. After all, establishing a nutritious diet early on will set your child up for a lifetime of healthy eating for many New Years to come.

From all of us at Getzwell Pediatrics, we wish you a happy and healthy holiday season!

Please call us at 415.826.1701 to discuss how to improve your family’s health through eating healthy and other preventive strategies we specialize in.

Barker, D.J.P. “Fetal Origins of Coronary Heart Disease.” http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2550226/pdf/bmj00601-0037.pdf

Giscombe, C. L. & Lobel, M. (2005). Explaining disproportionately high rates of adverse birth outcomes among African-Americans: The impact of stress, racism, and related factors in pregnancy. Psychological Bulletin, 131(5), 662-683. Retrieved from PubMed database.

Glynn, L. M., Hobel, C. J., Sandman, C. A., Schetter, C. D. (2008). Pattern of perceived stress and anxiety in pregnancy predicts preterm birth. Health Psychology, 27(1), 43-51. Retrieved from PubMed database.

PVC shower curtains:  http://www.chej.org/showercurtainreport/documents/VV%20national%20final.pdf

Paul, Anne Murphy.  Origins: How the Nine Months Before Birth Shape the Rest of Our Lives. www.anniemurphypaul.com/

Steingraber, Sandra.  Having Faith, An Ecologist’s Journey To Motherhood. www.steingraber.com

Center for Environmental Health: www.ceh.org

Making Our Milk Safe: www.safemilk.org

Campaign for Safe Cosmetics: www.safecosmetics.org

Physicians for Social Responsibility[SF chapter]: www.sfbaypsr.org

Breast Cancer Fund: www.breastcancerfund.org

Pesticide Action Network: www.panna.org

Childbirth Connection: www.childbirthconnection.org

Children’s Environmental Health Network: www.cehn.org

Coalition for Improving Maternity Services: www.motherfriendly.org

Collaborative on Health and the Environment: www.healthandenvironment.org

TEDx The Endocrine Disruption Exchange: www.endocrinedisruption.com

Environmental Working Group: www.ewg.org

Healthy Child Healthy World: www.healthychild.org

Natural Resources Defense Council: www.nrdc.org/breastmilk

Science and Environmental Health Network: www.sehn.org

Sandra Steingraber: www.steingraber.com

UCSF Report: Shaping Our Legacy: www.prhe.ucsf.edu/prhe/pubs/shapingourlegacy.pdf

Women to Women Discussion on Endocrine Disruptors: www.womentowomen.com/detoxification/endocrinedisruptors.aspx

Washington Toxics Coalition’s Early Exposure Study: www.watoxics.org/publications/earliest-exposures

Dr. Mark Hyman: www.drhyman.com

Institute for Functional Medicine: www.functionalmedicine.org

** A special thanks to EcoBirth for helping to compile resource links! **

For those who have been following GetzWell’s Facebook posts, you know we have been delving more deeply into how human health is inextricably linked to the health of our food supply and the sustainability of our planet.  As Dr. Hyman tells us, “The ecology of eating — the importance of what you put on your fork — has never been more critical to our survival as a nation or as a species.”  I couldn’t agree more.

Let’s harness the power of our forks and “vote” by purchasing local, sustainable and organic food whenever possible.  The “extraordinary thing is that we have the ability to move large corporations and create social change by our collective choices,” says Dr. Hyman.

In Health,

Julia Getzelman, MD

Over the last fifty years, increasing numbers of children in the US and other developed countries have been diagnosed with asthma, diabetes, obesity, autism and many other health conditions that were once rare in children.  The typical medical explanation for this trend has been that our genetic make up, lifestyle choices and environmental exposures after we are born are the principal contributors.  However, recent research provides significant evidence that the intrauterine milieu and our 9 months of fetal life play a vital role in determining an individual’s lifelong health.

Recognizing the impact of this research and the importance of the fetal environment, many parents-to-be want to know what steps they can take during pregnancy to optimize both the physical and emotional well being of their baby.

Studies have demonstrated the “power of your plate” in pregnancy, emphasizing the importance of prenatal nutrition.  For example, women who gain excessive weight during pregnancy tend to have heavier toddlers, and lower birth weight babies have an increased risk of diabetes in adulthood.(2)  In addition, exposure to pesticides, antibiotics and hormones (used to grow animal and plant foods), and bisphenol-A (from canned foods) may disrupt the developing endocrine and immune systems of babies.

A recent study involving public health data derived from more than 650,000 children born in California from 1992 – 2002 suggests that the closer two siblings are born together, the higher the risk for autism in the second child.  The data showed that siblings born fewer than 12 months after the first child are much more likely to develop autism compared to those born 25 or more months after the first baby.(3)  A likely explanation is maternal nutrition and fatty acid deficiencies as a result of the first pregnancy.

Scientists are also exploring the possibility that conditions in utero not only impact the physical health of the fetus but also emotional and mental well being.  Catherine Monk, professor of psychiatry at Columbia University, reports that even before birth a mother’s moods may affect her child’s development.  There are measurable signs of stress in the fetuses of women who are depressed or anxious during pregnancy.  In addition, there have been increased rates of premature delivery and low birth weight among babies born to depressed women, suggesting there are links between a mother’s mood and an infant’s sensitivity to stress, and perhaps even temperament, after birth.(4)

Unfortunately, environmental toxins play a significant role in fetal development in today’s world.  As an example, on a daily basis most of us are exposed to polycyclic aromatic hydrocarbons (PAHs), pollutants that come from burning fossil fuels, among other things.  Pregnant women pass this chemical to their developing babies, and significant DNA damage due to PAHs has been found in the cord blood of newborns.  PAH pollution during pregnancy is also linked to adverse birth outcomes including low birth weight, premature delivery, and heart malformations.

Although there are many things as we cannot control about our environment, we can and must take proactive steps to reduce toxic exposures, eat wisely and minimize stress during pregnancy.  See Greening the Womb Intro for practical steps you can take to make a difference in your baby’s health.  Additionally, Dr. Getzelman offers prenatal nutrition and greening the womb consultations for pregnant women and couples who want to become pregnant.  Please contact us at GetzWell for additional information and to make an appointment: 415.826.1701 or reception@getzwell.com.

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1. Paul, Annie Murphy. “Time” 4 October 2010: 50-55.

2. Paul, Annie Murphy. “Time” 4 October 2010: 50-55.

3. Cheslack-Postava K. Pediatrics. 2011; doi:10.1542/peds.2010-2371.

4. Paul, Annie Murphy. “Time” 4 October 2010: 50-55.

• Colds are caused by viral infections of the nose and throat.
• The average healthy child will experience between 6-10 colds a year.
• While colds are not serious, about 5-10 % of children will develop a bacterial complication (e.g. ear infection).

Typical Cold Symptoms

• Runny or congested nose—it’s okay for mucus to be clear, cloudy, yellow or even green!
• Fever of 100° F or greater that lasts for up to three days (72 hours)
• Sore throat or hoarseness
• Red, watery eyes
• Coughs that last up to three weeks

From Cold to Worse (When symptoms require a trip to GetzWell)

• Earache or discharge from the ear
• Fever that lasts more than three days
• Fever that went away for 24 hours and then returns
• Sore throat that lasts more than five days
• Coughs that last more than three weeks or a worsening cough
• Respiratory distress or wheezing

Treatment and Immune Support

• Comfort measures
  • Humidity—Try a cool-mist humidifier in the room and nasal saline drops to help moisten mucus membranes.  Suctioning mucus with a “nose frida” is often helpful.
  • Elevate the head while sleeping to reduce post-nasal drip stimulated coughs.  Fold blankets or towels under the crib mattress to elevate.
  • Increase fluids to help reduce congestion and prevent dehydration (milk counts too as it’s NOT linked to increased phlegm production).
• Immune Boosting Products and Treatments
  • Oscillococcinum: A homeopathic remedy that can safely be used at any age at both onset of cold symptoms and as weekly prevention during cold season.
  • Cold Calm: Another homeopathic medication that can be used at onset of cold symptoms at any age.
  • Echinacea/Eyebright: An herbal tincture that can be given daily during cold and flu season as a daily immune system booster.
  • Echinacea/Astragalus: An herbal tincture that can be given at the onset of a cold for deep immune support.
  • Probiotics: A daily supplement that helps to boost both the innate and acquired immune responses.
  • Chestal: A homeopathic cough medication that can be used to reduce cough (contains honey and shouldn’t be given to children less than one year due to risk of botulism).
  • Honey: A simple natural product found to be effective at suppressing cough (not for infants under one due to botulism).
• Over-the-Counter Products
  • There are NO cold and cough formulations approved by the FDA for use in children under four years old and in general they are ineffective at curing the common cold.
  • Ibuprofen can be given to reduce fever.  Please contact us for correct dosing as dosage should be based on a child’s weight, not age.

The Mayo Clinic defines chronic constipation as a two week period marked by several days between bowel movements that are accompanied by hard, dry and difficult-to-pass bowel movements and abdominal pain, irritability, nausea, poor appetite, or bright red blood on the surface of hard stools. Parents should also seek medical advice if they notice symptoms like abdominal bloating, forceful straining with bowel movements, and/or lumpy, hard or small pellet-like stools along with a feeling lingering fullness. Children with serious constipation often refuse to go to the toilet, hide in order to maintain privacy, soil their underwear and/or wet their beds.

While the quality and frequency of bowel movements varies from one child to another, it is important not to ignore symptoms of constipation. Chronic sufferers may experience encopresis (the involuntary leakage of feces that occurs in 60% of children with chronic constipation) which invariably results in shame, guilt, isolation and social stigma, and they may also distend their bowels causing nerve damage to their GI tracts and even experience rectal prolapse.

What to consider if your child begins to show signs of constipation:

• increasing fluids and exercise
• decreasing all dairy consumption
• teaching relaxation techniques (particularly deep, slow breaths while relaxing the pelvic muscles)
• regular abdominal massage
• supplementing with magnesium
• introducing a multi-species probiotic that contains Lactobacilli and Bifidobacteria
• adding age-appropriate fermented foods like sauerkraut, tempeh, or miso
• increasing dietary fiber (A good measure is 5-6 grams of fiber plus your child’s age. For instance, a 5 year old should have 10-11 grams of fiber per day.)

Raw fruits and vegetables have the most fiber, but cooked ones are also beneficial. Remember that the harder a vegetable is, the more fiber it has. Keep in mind that in order to reap the benefits of fiber, it is very important to drink adequate amounts of water (a minimum of 3 glasses) to help with the passage of stool in the intestines. If your child requires more than these general lifestyle and dietary changes to manage his/her constipation, please contact us for a consultation:  415.826.1701.

During flu outbreaks, the highest infection rates occur among school-age children.  Children are important disseminators of disease in the community.  For every 100 children in U.S. elementary schools, influenza accounted for an estimated 20 days of work missed by their parents and 22 secondary illness episodes among other family members.  While the fatality rates are very low, infection rates in healthy children have averaged between 10% and 40% each year, with approximately 1% of infections resulting in hospitalization.  Hospitalization risk is substantially higher for children younger than 2 years of age compared to those older than 2 years.

The following is a list of vaccines available at GetzWell:

- 6-36 months of age: half size single dose preservative-free vaccine (Fluzone)

- 2 yrs and older: nasal spray flu mist vaccine (preservative-free)

- 3 yrs and older: full size single dose flu vaccine (preservative-free)

Some reasons you may want to vaccinate:

• Infants in the first 2 years of life are at a higher risk than older kids and adults of becoming infected with the influenza virus and suffer more severe disease and more frequent hospitalization.
• Healthy people living with either infants or the elderly may get vaccinated to decrease the likelihood of transmitting the virus to these high risk groups.
• Research has shown that preventing the flu decreases the chance of ear infections.
• The preservative-free Fluzone is available immediately on a first-come first-served basis.
• If you are traveling with the entire family over Christmas, ski week, or spring break you may want to be vaccinated to protect you and the kids from infection during these high risk weeks and having to cancel the trip.
• If you don’t know whether to reserve mist or shot, consider that mist is more effective in kids 2-6 years old as compared to the flu shot.  The shot is more effective at causing immunity in kids 6 and older and adults.

Flumist is safe for breast feeding mothers.

Some reasons not to vaccinate:

• Allergy to eggs.
• Low-risk (e.g. breastfed baby with stay-at-home mom without older siblings in group child care settings or school).
• Parents are able to stay home with sick infant/child who becomes ill with the flu, which allows for close monitoring and perhaps preventing the severe effects of the disease.

In an effort to protect the little ones, we will offer flu vaccine to parents and other family household contacts such as grandparents and nannies/babysitters. Remember to wash hands frequently with soap and water, use alcohol based hand sanitizers if you don’t have access to a sink, to cough or sneeze into an elbow or tissue, and stay home from work, school or daycare if you are sick.

Fevers are part the body’s effort to activate the immune system, so they are one of our innate protective mechanisms. Most fevers are good for children because fevers help them to fight infection.

The body’s temperature normally fluctuates throughout the day and peaks in the late afternoon and evening. For instance, an oral or axillary (under the arm) temperature can be 97.6° F  (36.5° C) in the morning and go to a high of 99.5° F (37.5° C) in the evening. Similarly, a rectal temperature can be as low as 98.4° F (36.9° C) in the morning and become as high as 100.3° F (38° C) in the late afternoon.

If your child has a fever, remember to stay calm and use the following definitions to put your child’s fever into perspective (If your child is less than 6 months old, then you should immediately call your doctor.):

• 100-102 F (37.8-38.9 C)  Low grade fevers are beneficial (Try to keep temps here*)
• 102-104 F (38.9-40.0 C)  Moderate grade fevers are beneficial*
• > 104 F (>40.0 C)       High fevers cause discomfort but are harmless
• > 105 F (>40.6 C)       Higher risk of bacterial infection
• > 108 F (>42.2 C)       The fever itself can be harmful

Many people mistakenly believe that fevers cause brain damage and that temperatures above 104° F (>40° C) are dangerous. However, fevers caused by infection do not produce brain damage. Only body temperatures over 108° F (42.2° C) can cause brain damage, and body temperature only climbs to this level with very high environmental temperatures. (Example:  being inside a closed car on a hot day.)

Fevers only need to be treated if they cause discomfort, and these are usually fevers over 102 or 103° F (38.9 or 39.5° C). The exact number of your child’s temperature or fever is not as important as how your child looks and feels. Is he/she alert, interactive, curious despite the fever? Is he/she drinking and urinating?  Is he/she complaining of pain or very uncomfortable?  These are the questions that should be asked to determine if you should seek out a doctor’s care (* unless your child is less than 6 months of age, then you should call your doctor immediately).

If you treat a fever, temperatures don’t always normalize. With treatment (removal of clothing, cool bath, ibuprofen), temperatures often drop 2 or 3 degrees Fahrenheit (1-1.5° C), usually enough to allow your child to feel a little better. And if the fever “doesn’t break,” this isn’t cause for alarm. There is no greater risk that a fever that doesn’t come down is caused by a serious infection. Fevers that don’t respond to fever medicine (usually ibuprofen or acetaminophen) can be caused by viruses or bacteria.  And there are no medicines that kill viruses.

Fevers will not continue to climb higher and higher if not treated. Fevers from infection usually stop rising at about 105-106° F (40.6 or 41.1° C) or lower, because the brain’s thermostat keeps body temperatures lower than this.

Not every child with a fever is at risk for a febrile seizure. Only about 4% of all children will ever have a febrile seizure. If your child has a febrile seizure, though it is scary to watch, they cause no permanent harm and usually last less than 5 minutes. Children who experience febrile seizures have no increased risk of developmental delay, learning disability, or epilepsy.

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A:  After the first few days of life when your baby has meconium bowel movements that are very dark and sticky, it’s normal for your newborn’s poop to begin to be very watery and seem like diarrhea.  Breast fed infants, in particular, have BMs that are loose and seedy and range in color from brown to mustard yellow to green.  A typical newborn’s poop looks a lot like grainy mustard–think Grey Poupon country style!

Q:  My newborn must have a cold because he keeps sneezing.

A:  It’s very unlikely that your baby is sick.  Newborns often sneeze quite a bit and we think of it as nature’s way of allowing your baby to blow his nose.  New babies have very small nasal passages and usually make a little bit of mucus which can produce some degree of nasal congestion.  This usually isn’t a problem, but because newborns don’t know they can breathe through their mouths, you may hear your newborn’s breathing and think it means he is having difficulty.  As long as your baby is feeding well, is content, doesn’t seem to be struggling to breathe or crying a lot (which forces babies to mouth breathe) he is likely just fine.

Q: We want to take our baby girl to a party but she is only 2 weeks old.  Is this OK?

A:  The immune system of a newborn is immature and the more people she is exposed to the greater the likelihood she may catch something which could cause her to become quite sick.  We generally stress being very careful regarding hand hygiene and potential exposure to germs for the first 60-90 days of life, when pediatricians consider a fever a sign that an infection may be serious.  Hand washing is the best way to prevent introducing illness-causing germs to your newborn; proper cleaning of your hands involves rubbing them together for 15 seconds (or 3 rounds of “Row Row Row Your Boat”) with good old soap and warm water or the use of an alcohol based hand sanitizer.

Q:  Which hand sanitizers are best?

A:  Generally we recommend an alcohol based product which is rated 0-2 on the Environmental Working Group (EWG) cosmetics database toxicity scale (http://www.cosmeticsdatabase.com) so that you’re sure to purchase something effective while avoiding highly toxic ingredients.  This is an important factor when considering what to buy for you and your baby.  EWG is a tremendous resource available to guide purchasing decisions.  Babies and small children have very thin skin and immature detoxification systems, and thus are vulnerable not only to what we feed them but also to what we use on their skin, what we clothe them in, and what they breathe.

Q:   Do I need to give my 2 month old baby Vitamin D drops?  There is not much sun in our San Francisco neighborhood and we spend most of our time indoors.

A:  Vitamin D is important to our health and many of us have insufficient levels due to lack of adequate sunlight exposure or supplementation.  The American Academy of Pediatrics (AAP) recommends all children receive a vitamin D supplement starting in the first few days of life because evidence has shown this could have life-long benefits.  Furthermore, because of the growing body of evidence that a pregnant woman’s vitamin D status is important to her developing fetus, the AAP has recommended that physicians caring for pregnant women consider vitamin D testing during pregnancy.

At GetzWell we test all new mothers’ vitamin D levels and often find they are lacking.  This is critical both for mothers’ health and directly impacts the breast feeding baby.  Once we have these results, we can tailor our recommendations to each mother and baby as part of our effort to optimize the health of our patients and families.