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Anatoly Belilovsky, MD

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Mumps are Back: How to Protect Your Kids
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by Dr. Anatoly Belilovsky January 8, 2010

U.S. health officials have officially declared the current mumps outbreak in the New York and New Jersey area the largest in years. With close to 180 diagnosed cases thus far, it is especially important to take precautions and prevent contraction of the viral disease. Here's what you need to know about mumps.

What is mumps?

It is a highly contagious viral infection. The mumps virus attacks selected tissues in the body. Its "favorite" is the salivary gland, especially the parotid glands located in front of and below the ear canals, but also all the salivary glands located under the lower jaw. It is the swelling of these glands that produces pain and the characteristic facial changes. The virus also occasionally attacks testicles (especially in postadolescent males), pancreas, and can cause inflammation of the brain (meningoencephalitis) and of the auditory nerve, leading to loss of hearing.

Why is mumps making a comeback?

Mumps is a bit of a mystery right now. In the past, "comebacks" of vaccine-preventable diseases were due to the "fading" of antibody levels with age (smallpox, diphtheria, and tetanus are known to require boosters every 10 years to maintain protection), high concentrations or crowding of unvaccinated individuals (hemophilus, whooping cough), immunosuppression (TB, polio) and "antigen drift," or mutations of pathogens (flu, pneumococcus). Any of these could be happening here.

Another explanation is a "mimic" disease: Back in the 70's, Lyme disease was discovered when a doctor noticed far more cases than expected of what appeared to be juvenile rheumatoid arthritis in a small town; investigation of this cluster led to the discovery of Lyme disease. What brings up this possibility is this: The one patient I saw had an absolutely perfect clinical picture of mumps, including contact with other mumps cases-but the blood test did not confirm it. Is this really mumps, or an emerging infection that mimics it perfectly? At this point, I would hesitate to guess.

Why is the vaccine not working? Are people not getting it?

It IS working; let's not forget that mumps is more contagious than swine flu, and if the vaccines were worthless, we would have more mumps than flu around-not 180 cases, but more than 180,000. As to why it did not work as well as expected, that is a subject of an ongoing investigation. The Health Department is trying to find the common denominator in the affected individuals-down to cross-checking lot numbers of the vaccines administered many years ago to these patients, to see if there may have been a defective batch back then. What we seem to have is vaccine failure in less than one percent of recipients even in the fairly small communities where the cases occurred. Once you realize that people with mumps shopped, worked, and took public transportation while highly contagious (the week before appearance of symptoms), without the epidemic extending beyond this small group, you see how effective the vaccine really was.

How can we protect ourselves from it?

It wouldn't hurt to get another measles, mumps, rubella (MMR) vaccine. Even if vaccine failure is to blame for this epidemic, isolation is probably impractical, as viral shedding can continue for nearly a month, starting days before any symptoms are present. Treatment is supportive: Drink lots of fluids to let saliva flow freely, and avoid sour foods that cause overstimulation of salivary glands. "Real" treatment, such as IV fluids, is only needed in the fairly small fraction of patients who develop pancreatitis (severe abdominal pain with nausea), meningoencephalitis (severe headache with mental status changes), or other rare complications. Infertility is a possible consequence of testicular inflammation in postadolescent males, but at this time no specific treatment is available to prevent this.


April Showers Bring Allergies
Filed in archive Allergies , Consumer Alert by Gloria Gamat on March 22, 2010
April Showers Bring Allergies
© It'sGreg
The rainiest season of the year is upon us, and unfortunately, so are wet-weather allergens. Dr. Anatoly Belilovsky, a New York pediatrician and renowned children's allergy expert with more than 20 years' experience, offers ways for parents
to protect their children from the most common rain-induced allergens:

Take extra care to rid your house of mold. The biggest source of wet-weather allergies are mold spores. Moisture promotes rapid growth of mold and mildew, and children sensitive to airborne spores ("seeds" by which they propagate) will suffer during these times.

Crack a window. Rain encourages many people to keep their windows closed-ideal conditions for leaving airborne allergens suspended in maximum concentration. Make sure your home and especially your child's room are properly ventilated to avoid trapping allergens in the air.

Be mindful of time spent outdoors. Wet weather promotes growth of flowering plants. Trees bloom, grasses grow, weeds sprout up - and allergens abound. Parents of children with allergies should monitor the time their children spend outdoors, and take precautionary measures.

Give the house a good dusting. Pollen and mold spores settle quickly and easily on furniture, countertops and clothing. Be sure to wash clothes and wipe down surfaces frequently.

Think ahead. If you think your children will need allergy medicines (antihistamines and nasal/inhaled steroids), start them BEFORE symptoms occur; they are more effective at preventing attacks than at stopping them, and they are safe enough that an extra week or two of use won't pose a hazard to your child.

For more information in managing your spring allergy symptoms
, check out the AAAAI page.


Tackling Weight Issues as a Family
Monday, March 08, 2010 (0 Comments)
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Losing Weight: A Simple Guide to Tackling Weight Issues as a Family

By Anatoly Belilovsky, M.D.

Weight control fits very poorly into the pattern of health care. Part of the problem is in the effort America has put in to making medicine accessible, affordable, and painless. "Improving the delivery of health care” is a catchphrase I have been hearing for a quarter of a century.

When it comes to explaining excess weight, it is commonly said that obesity and other weight issues run in families. What is a problem for the parent is frequently a problem for the child. This is true, but simply referring to "genetics” is not an accurate explanation. Getting to the bottom of familial weight problems requires the expertise of someone who is able to provide adequate counsel to both children and adults. And the most effective expert is your family pediatrician.

When it comes to tackling family obesity, the first question most people have for their family pediatrician is, "does my family have a physical disease that is making us fat?” The answer is, yes and no. "Real” diseases that produce obesity do exist: hypothyroidism and Prader-Willi syndromes are two examples. In pediatrics, however, all these "real” diseases combined account for fewer than 5% of children suffering from obesity. The rest have exogenous obesity – simply eating too much.

What happens to a person who overeats – in very simple terms:

As the food is digested, carbohydrates are converted into glucose. Glucose enters the bloodstream, and the pancreas makes insulin, which signals cells to take in the glucose and use or store it. Most cells have only a limited capacity; the exception is fat cells which can put away a virtually unlimited amount of glucose after converting it to fat. The greater the carbohydrate load, the more insulin is produced to make this happen. And when all the glucose is put away and insulin is still there, the blood glucose drops. You get hungry again. Very hungry.

Two things will produce and contribute to this cycle: overeating and starvation. Low blood sugar will induce severe hunger; severe hunger will lead to overeating; overeating will lead to high insulin secretion; which will lead to low blood sugar. Fat, for all practical purposes, simply goes to fat cells and, mostly, stays there.

Here, therefore, are the key principles of manageable weight loss that both parents and children can abide by:

1. Do not starve.

a. Do not skip breakfast. A small carbohydrate snack such as a fruit or a sandwich is perfect.

2. Do not drink your calories. The only acceptable drinks are:

a. water

b. skim milk (NOT lowfat, that still has plenty of fat in it)

c. IF YOU MUST, diet drinks are acceptable (though not recommended).

d. NOT juice. Juice is a fruit from which everything good has been removed. If you made the juice yourself, then you yourself threw out the good stuff. It’s the fruit that you want, so save yourself calories by eating fruit as opposed to consuming juice.

3. DO NOT eat while doing something else: reading, watching TV, playing games. Parents should make a conscious effort to serve meals at a table with little distractions. Ultimately, eating should be boring enough that you'd be happy to be done with it.

4. As much as possible, eat with family or friends. Their own intake will guide you subconsciously.

5. Know your foods!

a. The simplest factor to control is fat intake. Parents should know the fat content of every food that they and their children eat.

b. Write down everything you eat. Really. That will immediately destroy any illusion you might have that you are eating "not that much” but gaining weight anyway. For the first few days, add up your calories. When you realize how far over 2000 a day you are actually going, you will see room for improvement. After that, just count (and limit) fat. Try to stay under 20 grams a day of fat. In every meal, "simple” sugars and "complex” carbohydrates will be present. More complex carbs are released into the bloodstream slowly, and produce a smaller insulin spike. In any given meal, complex carbs should exceed sugars by at least five times, 10 times would be better.

6. a. For the purposes of weight control, there is very little difference between "good” and "bad” fat – but "good” fat is better for other health aspects such as cardiovascular health. Mammal fats (milk, cheese, butter, cream, bacon, beef) are the worst; fish (not seafood) fats are best; and plant fats vary (olive and canola are probably best). Try to make as much of your fat allowance as possible from the good fats – but sticking to good fats is no reason to go over that allowance.

b. Good (lowfat) meats are bison, ostrich, skinless turkey, skinless chicken breast.

c. Nuts and seeds tend to be high in fat, as are of course olives; avocado is the only "soft” vegetable that is high-fat. All other fruits and vegetables are acceptable.

d. Breads vary: some have more added fat than others; also, the higher the fiber content, the better. Fiber supports digestive health; it also produces the "filled” sensation that fights hunger longer.

These weight loss guidelines might be simple, but many efforts are often wasted when parents fail to consistently monitor progress over the long term. Visit your family pediatrician frequently, so that progress can be accurately measured. Your pediatrician can prescribe the best plan for you and your children, and put your family on the right track to healthy eating habits and successful weight control.

Dr. Anatoly Belilovsky is a leading New York pediatrician and director of the 365-day-a-year Belilovsky Pediatrics:


Board-certified in pediatric medicine, the Princeton graduate is listed as one of America’s Top Pediatricians and is a recipient of the Americhoice Quality of Care Award for his groundbreaking work with pediatric asthma patients. Dr. Belilovsky received a B.A. in chemistry from Princeton University and his M.D. from the University of Connecticut.


Pediatrician Anatoly Belilovsky on touch and massage for baby’s and children
June 26, 2009 – 5:34 pm

About Dr. Belilovsky: Dr. Anatoly Belilovsky is a New York pediatrician whose 365-day practice, Belilovsky Pediatrics, is an Americhoice Center of Excellence in pediatric care. He is a graduate of Princeton University and served as a clinical instructor in pediatrics at Cornell’s Weill College of Medicine. For more information, visit his Web site and blog: www.babydr.us

1. How important is nurturing touch for a child’s development and health?

It’s essential, of course. Touch plays two major roles: it is the route by which the child first learns of the caring parent, and it is the route by which caring restraint is first administered (first to keep from falling, then to keep from crawling off the changing table, then to keep from running into traffic).

2. What kind of behavior or health problems might a child show because of a lack of positive touch?

Attachment disorders are the primary consequence of remote parenting; depression is also common. Many times, children also display behavioral problems when they have no nurturing restraint or strong parental connection.

3. When would you advise parents to massage their child?
It’s always a great idea to connect with your own children, and, most importantly, protect them, during vulnerable or stressful situations. Children have a great sense of empathy and can pick up parents’ intentions and connection very easily – whether a parent is comforting them or protecting them with their touch.

4. What was the effect on the child?

Protective, nurturing touch will always give children a deeper sense of security and confidence.

5. How can nurturing touch influence relationships within a family?

Well, if the touch was absent, the relationships weren’t normal to begin with. Contact is the foundation of projecting a parent’s love directly to the child – plain and simple. Children and parents will connect emotionally and their relationship will evolve normally – where the parent is the natural protector and comforter for the child.

6. What are the benefits for parents of using nurturing touch with their child?

Contact helps parents feel needed by their child and, many times, soothes their own nerves in a stressful situation, like a child’s doctor visit or when the child is highly emotional.

7. For which type of child or health problem would touch be particularly beneficial?

A: Many times, children we refer to as “hyperactive” are actually just children looking for guidance. The first, and the most effective, guidance is contact guidance, which shows assertive authority in a gentler way, and in many cases, the child will not learn otherwise.

8. In Russia, where you’re from, it is much more common to massage babies and children compared to in the USA. What makes this difference between both cultures?

In general, Russians are a more contact-focused population and culture – on the one hand, business partners and friends are met with affectionate kisses, but on the flip side is an innate tendency toward more aggressive contact. While that part can be misinterpreted as violent, child massage is an excellent example of Russians’ nurturing parenting style.

Pavlov’s legacy went far beyond the salivating dogs. His theory of “nervism” stated that all organs are “told” what to do by the nervous system, and diseases arise from “improper” control. Massage, heat, cold, and other “nerve” techniques became very popular in that era, and sometimes effective, but all in all, when the issue became politically charged and other views were suppressed, it was the children who suffered.




What are the 3 most common mistakes parents make when visiting the pediatrician?

Expert: Dr. Anatoly Belilovsky, director of 365-day medical center, Belilovsky Pediatrics, in New York. His blog is www.belilovskypediatrics.com.

1. Choosing a doctor that's the wrong fit.

"Every pediatrician is not going to fit with every parent personality. So often I hear, 'Oh my friends said you're great!' and it turns out that that while that doctor may have worked for your friend, they're the wrong fit for you. For instance, if you're a parent that's deathly afraid when your child gets a fever, which is a common complaint, you'll want a pediatrician that displays a bit more empathy toward fevers, as opposed to a doctor that quickly assures you it's nothing serious. Also, some parents require longer dialogues and explanations than others; find a doctor that complements that. References are a great way to find a trusted pediatrician but ask your friends in-depth questions before you visit: What's so great about this doctor? Can you describe specific episodes? Why would you choose them for your son or daughter? And of course, don't feel obligated to stick with a doctor just because a friend referred you. They might be great at what they do, but not a perfect match."

2. Always wanting a prescription.

"Too often, parents bring their children to their doctor, expecting to leave with a prescription. And when they don't, they consider it a waste of time. We have a model we follow: treat, counsel, educate. This means some cases require treatment, some only require education. Example: baby acne and bug bites. First-time parents often over-react to these problems, and expect a prescription, when pediatricians can really only offer advice. Of course, if you feel like a doctor is dismissing your child's case, seek a second opinion. But realize not all problems require the same solution. Another tip: If you don't understand your doctor's verbal explanation, ask him to use an analogy or diagram. I once treated a child whose father didn't understand hip dysplasia. I found out he was a marine engineer, so I made him a diagram, and all of a sudden, he understood!"

3. Delegating visits.

"This is a minor mistake compared to the first two, but still important. And this is sending your child to their pediatrician with someone who doesn't know the whole story, for instance grandparents or nannies. Often, these people don't know your child's entire medical history or the details of the problem at hand, which makes our job more difficult. Later, we'll get calls from parents who couldn't be there in person, and it turns out there's a whole different story we weren't aware of. Or, we'll try to reach parents, only to get a call the next day wanting to know what's going on. It's much easier for both parties to address issues in person and for parents to get the straight story from the horse's mouth. Obviously, sometimes parents have to work or travel but, for instance, my practice is open seven days a week/365 days a year. If you're really invested, you'll find a time to bring your child that works with your schedule."

— As told to Andrea Zimmerman




A Sacramento mom dishes on parenting, family and everything in between

July 27, 2009

Baby-proofing a home? Cartoon can serve as starting point, expert says

Child-proofing a home is a necessity for anyone with an infant or toddler in the house, but just how many safety precautions does a parent need to take?

As many as possible.

"There's only one area in which children have a mental deficiency and that's their sense of self-preservation," said Dr. Anatoly Belilovsky, a New York pediatrician and child-safety expert who I interviewed recently for a story about summer safety issues.

Belilovsky's recommendation for parents looking to remove household hazards is simple, yet clever: watch the first four minutes of the 1988 movie "Who Framed Roger Rabbit."

"They did a good job of hitting household hazards," he said of the opening scene, in which Roger is attempting to babysit Baby Herman. "Watch very carefully with an eye to all the hazards the baby sees - it's a really good primer for household safety."

Baby Herman starts off in a playpen but quickly escapes, using drawers to climb atop the kitchen counter, inadvertently turning on stove burners with his foot and falling face down in a sink full of water and dishes in his quest to reach the cookie jar.

To watch for yourself, go to this You Tube clip:


There are also loads of kid safety products on the market.

One of the handiest kid-proofing items came to The Bee from Australian-based Dream Baby, a child safety product company.

It's a simple cable combination lock intended to help keep children out of cabinets and sells for $9.99.

We discovered another great use for the device: It also locks side-by-side refrigerator doors, thus helping keep kids safe from ingesting spicy condiments or pulling glass jars off shelves.

For more information, go to Dream Baby's Web site.

The best piece of child-proofing equipment, however, is an attentive parent and common sense, Belilovsky said.

"There is no substitute for thinking," he said.





Every Breath You TakeQ: What is asthma, really?
A: Asthma is the reversible narrowing of bronchi,
the pipes through which air reaches your lungs.
Look at it this way: Imagine breathing through
your eyes. Have you heard of bronchospasm?
That’d be like your eye was closed. Bronchial
inflammation? That’d be like your eye was swollen
shut and filled with gunk. Reversible obstruction? That’d be like your eye was shut one minute (a trigger response) and wide open the next.

Q: Why is there so much asthma lately?
A: The theory that makes the most sense, and is best backed up by evidence, is the hygiene hypothesis. In several studies, it was found that in developing countries, people who were infested by intestinal parasites had less allergy and asthma than those who were not, and in a German study, less asthma was found in children who survived a life-threatening infection. The immune system is constantly on the lookout for infections and parasites and, lacking real targets for the immune cells to attack, sometimes attacks healthy tissues or overreacts to minor infections. There are a number of infectious agents such as respiratory syncytial virus or mycoplasma that have been identified as commonly associated with asthma, and, of course, pollutants can trigger attacks. Blaming all asthma on outdoor pollution is probably incorrect, as the air is cleaner now than it has been for hundreds of years because of stricter environmental controls.

Q: How is asthma treated?
A: There are medications like albuterol, which relaxes the muscles holding the airway closed; steroids, which decrease the swelling; and antibiotics, which treat the infections that may either trigger or complicate asthma episodes. A common mistake is to assume that, if shortness of breath is absent, all is well. This error is best avoided with the use of a little toy called a peak flow meter. It measures how fast you can breathe out, compared with both your personal best and the ideal calculated for your age and height. Peak flow numbers will drop long before actual shortness of breath appears, allowing you to adjust your treatment or seek help early. Another dangerous mistake is to treat with beta-agonists (like albuterol) alone. They work quickly, but in the worst attacks, they fail without warning; dependence on beta-agonists has caused many deaths in asthmatics. Think of them as fire extinguishers; if you use one daily, there is something wrong in your kitchen, and they are useless against a big fire. There are a number of preventive medications that keep attacks from happening, and a number of rescue medications that stop breakthrough attacks, but the old “can’t breathe, take a puff” routine is not only useless, but potentially deadly.

Q: What are alternative treatments for asthma?
A: First of all, emotional distress is a well-known asthma trigger. The lungs and the brain are connected by the vagus nerve, and vagus activity is known to produce asthma attacks, so whatever makes you feel less anxiety will probably have an effect against asthma. Secondly, a number of plants produce toxins that, in small quantities, have an asthma-blocking activity. Unfortunately, as these toxins are needed by the plants to keep them from being eaten by animals, they tend to have serious side effects. Ephedrine in ma huang, theophylline in tea, and scopolamine in deadly nightshade are examples of such poisons. Many currently used medications are “declawed,” less toxic derivatives of natural plant poisons. Thirdly, human and animal adrenal glands produce steroid hormones, some of which fight the inflammation that is part of an asthmatic event. Both natural versions of these hormones and synthetic derivatives are used sparingly, as they produce their effect by suppression of immunity. “Declawed” versions of these hormones are easily destroyed in the bloodstream; they are given as inhalations directly into the airways and do not produce measurable effects anywhere else in the body.

Physical activity appears to help more often than not; exercise-induced asthma appears to be less common than asthma that gets better with consistent exercise. In any case, asthma should never serve as an excuse for reduced activity. Finally, anything that controls heartburn will probably reduce asthma severity as well—and since caffeine, fat, overeating, spicy foods, alcohol, smoking and tight clothing can all induce heartburn, avoiding them might be worth a try.

Dr. Anatoly Belilovsky is a New York pediatrician whose 365-day practice, Belilovsky Pediatrics, won an AmeriChoice award for Center of Excellence in asthma care. He is a graduate of Princeton University and served as a clinical instructor in pediatrics at Cornell’s Weill Medical College. For more information, visit his website and blog www.babydr.us.




by Rose Garrett
August 18, 2009
Topics: Back to School, H1N1 Flu (Swine Flu), more...
Education Issues Today

Back to school season is full of preparation for teachers, from organizing lesson plans to prepping classrooms for the year ahead. But this fall, teachers are preparing for a new element in the classroom: the unpredictable threat of a swine flu epidemic.

Researchers are rushing to develop a swine flu vaccine, but the advent of flu season will likely outpace the release of an effective vaccine. “With a flu pandemic starting possibly in early to mid-September, and the protection through injection not available until December at the earliest, we have several months of coverage that we have to figure out how to get around,” said Jerald Newberry, Executive Director of the NEA Health Information Network.

That means that teachers, as well as parents and school administrators, need to be on high alert during the notoriously hectic back to school season. Wondering how teachers can prepare? Here are 10 ways that teachers can ready classrooms and students for swine flu this fall:

1. Wash Hands. “The tools in our toolkit are fairly limited,” said Newberry, but hand washing is still the best way to keep the flu virus from spreading. Teachers should encourage children to wash their hands frequently and thoroughly throughout the day, and should follow suit themselves. “Hand sanitizer would certainly not be a bad idea,” added Anatoly Belilovsky, M.D., director of a pediatric practice in Brooklyn, NY.
2. Keep Coughs and Sneezes Covered. The flu virus is spread through droplets from sneezes and coughs, so students should be taught how to cover their mouths correctly, and teachers should model proper technique. Sneezing or coughing into your hands or a tissue is good, but it’s even better to use the crook of your arm. Remember to always wash hands afterwards!
3. Send Sick Students Home Immediately. “There is some evidence that swine flu may be more virulent than the ordinary flu,” said Joseph Bellanti, M.D., Professor of Pediatrics and Microbiology/Immunology at Georgetown Medical Center. However, he urges that people be sensible and follow the same protocol as with ordinary flu. “Body aches, fever, sore throat, cough, runny nose and headache” are all symptoms of the flu, said Bellanti, and indicate that students should be sent home as soon as possible.
4. Give Allowances for Absenteeism. Parents and students alike may feel pressure to avoid sick days, but sending kids to school with even a hint of flu symptoms is a dangerous idea. Teachers should stress that taking sick days when a child is actually sick is not only okay, it’s imperative to prevent the spread of the illness. “Respect the parent’s decision of when to send kids to school and when not to,” urged Belilovsky. Make it clear that homework allowances will be given and student will have the opportunity to make up classwork when they return to school.
5. Keep Classrooms Clean. Surfaces such as desks and doorknobs get a lot of traffic in classrooms, and can be a magnet for germs. “Work with the school custodian to keep the room extra clean,” advises Newberry, saying that teachers will likely need to take on more cleaning duties in the classroom.
6. Experiment with Social Spacing. The CDC recommends that teachers devise ways to keep students further apart from one another, whether it means moving desks, holding classes outside, or otherwise experimenting with social distancing. However, Amy Garcia, President of the National Association of School Nurses, says social spacing may be a challenge this year due to increased over-crowding in classrooms. That means that teachers may need to get creative when it comes to keeping students a safe distance from one another.
7. Be Aware of Your Own Health. Teachers come into contact with scores of students every day. “There’s a very good chance that some of our members will be exposed and many will get sick,” said Newberry, of the NEA. Keep your immune system healthy by getting lots of sleep and taking vitamins, including vitamin D, and don’t try to soldier on if you feel the beginnings of flu-like symptoms: go home and stay home until 24 hours after symptoms have disappeared.
8. Develop Strategies for Homework. “As much as possible, continue the lesson plan that’s going on at school with homework assignments that students can do at home, and have makeup activities to help catch kids up,” advised Newberry. Whether it’s making class assignments and materials available online, or developing an action plan with parents for getting homework home, establish a system for getting materials to sick students before school starts.
9. Stay Organized. Teachers know how to stay organized, but keep in mind that substitute teachers may need to pick up mid-lesson if principle teachers get sick. Make sure that your lesson plans will be legible to a sub, and keep class materials centralized or filed in an organized fashion so that they will be easy to find and follow.
10. Prepare an Info Packet for Parents. Swine flu sounds scary, and it’s easy for parents to panic without knowing all the facts. Prepare your students’ families by putting together a packet full of information and recommendations, to be sent home on the first day of school or on back to school night. Be sure to include a list of flu symptoms, and tips for what to do if children get sick.




Would You Drug Your Child to Enhance Academic Performance?

by Amy Hatch (Subscribe to Amy Hatch's posts) May 11th 2009 2:00PM

Categories: Playground Bureau, Extreme Childhood

Giving kids stimulants like Ritalin can give them a competitive edge, but should healthy kids be drugged into success? Photo courtesy of sxc.hu.
College students are buying or borrowing drugs like Ritalin from their ADHD-diagnosed peers in order to party hard on the weekends while still making the grade during the week. The most prevalent users are young men at highly competitive universities -- but the trend doesn't stop there.

Parents of non-ADHD children would be willing to give their kids ADHD drugs to enhance their academic performance, according to a recent article about neurologically enhancing drugs in The New Yorker. This troubling trend is on the rise, health experts say, thanks to our cutthroat culture.

A study in the journal Nature found that parents of children who do not suffer from ADHD or ADD would be willing to give their younger kids neurological stimulants in order to help them power through their academic experience. While that surely raised my eyebrows, it doesn't surprise New York City pediatrician and Cornell University instructor Dr. Anatoly Belilovsky.

"These stimulants have been in use, particularly by various military forces, since at least World War II," says Belilovsky. "We know cocaine as a rapid-acting, highly addictive drug today, but its 'sustained-release' formulation, chewed coca leaves, allowed many generations of Andean warriors to maintain peak fighting efficiency. It was clearly destructive in the long run, but as it improved their chances of survival in battle, it allowed them to have a long run in the first place."

OK, so the military uses it. But giving it to kids? Just to make sure they ace that math test? Doesn't that seem a little extreme? Sure, says Belilovsky -- extreme, but not all that unusual. He cites stage moms, pageant parents and the academically competitive as "archetypes" who would be willing to enhance their kids' performance by any means.

"This is a more common situation and tendency than many might realize," he says. "Asking for stimulants to beat other competitive school applicants is not a far step from yelling 'Kill him!' at a hockey game. It is perhaps worth noting that ours is not a society that eats the runts of its litters, but enough families act as if it were."

Giving children these drugs (when they are not medically necessary) can give them an edge over their "un-enhanced peers," says Belilovsky. "Imagine your thoughts jumping around inside your brain like middle-schoolers at recess," he explains. "Stimulants make them behave more like Marines on maneuvers."

Getting into Harvard certainly would be a coup for any child, but there are side-effects from these drugs, and using them for this purpose is "off label" (not approved by the Food and Drug Administration). "While many physicians are prescribing these drugs for non-ADHD patients, I do not recommend this at all," says Belilovsky. "The side effects, like dehydration, crash and burn, appetite loss, and nausea outweigh the benefits when someone is able to function normally and be productive through their own focus, without the aid of drugs."

There is also the risk that kids could suffer from a hyper-focused state, become obsessed with non-essential tasks, or even experience clinical paranoia. They could also have sleep issues, says Belilovsky.

Sounds like the risks outweigh the benefits to me. Then again, my kids are 4 years and 9 months old. What lengths would I go to in order to see them succeed? While I'd like to think I would allow them to develop naturally, I've already experienced bursts of hyper-competitiveness: She can't do the right pencil grip! He isn't waving bye-bye!

My husband is a Harvard graduate and a doctoral candidate. I was a lackluster student whose unrealized potential haunts her. I'd say we have lots of reasons to push our kids to do well, and society is so focused on outward success. I hope we never succumb to these pressures, but I sure can see why you would.




Jar No More

In an effort to save money and better control what their kids are eating, more parents are turning toward making their own baby food

By Dana Carman
CTW Features

Today's modern conveniences sure do make life easy. How did we once live without the microwave, the meal in a box or fast food? Life is busy, everyone knows that, and with nutty schedules, some days there's just no time for the prep, cook, serve days of old, which is why for some, the idea of making their own baby food - an item readily available in multiple flavors in cute little jars - may seem a big time suck when that time could be spent elsewhere.

But speaking of spending, they're not convenient for nothing. Karen Cicero, the food and nutrition editor for "Parents" magazine, tells the story of a co-worker who makes his 8-month-old child's food and estimates that for every jar of canned fruit he buys, he can make the equivalent of 12 jars using fruit bought at the supermarket on sale. "It could save you $20 to $25 a week," Cicero says. "Right now, the big thing is the cost savings."

A quick cost shopping comparison showed pre-packaged banana baby food bought at Walgreen's was $1.79 and a half-dozen bananas at Whole Foods cost $.99. Jennifer Taggart, author of The Smart Mama blog and book, "The Smart Mama's Green Guide," (Center Street,2009) made all her own baby food for her two children, now ages 4 and 6. She wanted to limit their pesticide intake as well as utilize locally grown vegetables to reduce resource consumption. "At that time, the selection of organic baby food was relatively limited," she says. Along that same line, "those little jars are waste intensive," Taggart says. "Baby food is expensive. It's way cheaper to buy a sweet potato and you get eight servings out of it." Taggart utilized the popular ice-cube tray method, which she notes are easy to pop out and serve.

Cicero says that another advantage to homemade is that you can introduce your child to more flavors because, while there is a plentiful variety of flavors available on the market today, there's still more outside the jar.

That said, there are some foods that children under certain ages shouldn't eat if you're making them at home. Because jarred food can be tested for things like high levels of nitrates, a parent interested in home-making baby food should consult the American Academy of Pediatrics' Web site for information on the recommendations.

It's no secret that when it comes to babies, everyone's got an opinion. Whether or not to make your own food is a personal decision and in no way renders one a good or bad parent. It's simply a matter of choice. In Taggart's case, it was important to her to know exactly what her kids were eating. But as New York-based pediatrician, Dr. Anatoly Belilovsky notes, "presumably you get the same nutrition as you would from store bought with a little more vitamin losses from the cooking process." Belilovsky says that the only really big advantage he sees is that it's a bonding experience. "You put your love and effort into your own baby food," he says.



"It's the Behavior, Stupid."

At a time of economic uncertainty that hearkens back to Bill Clinton's celebrated 1992 election theme, "It's the economy, stupid," a new study was released this week that reminds us that, for weight control, "it's the behavior, stupid."

In this study, researchers from the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality (AHRQ) evaluated methods for weight loss and the prevention of further weight gain in children and teens.

The researchers found that the obese children who completed weight loss programs with a focus on behavioral management weighed between 3 pounds and 23 pounds less, on average, than obese children who were not involved in such programs. This weight difference was the greatest among those who were enrolled in more intensive programs.

"We have to find effective and healthy ways of helping our children and teens who already are obese get to a healthier weight," AHRQ Director Carolyn M. Clancy said in an agency news release.

The medium- to high-intensity behavioral management programs investigated in this study met for more than 25 hours, usually once or twice a week, for six months to a year. The most effective programs included techniques to improve diet and exercise habits, and some programs focused on goal setting, problem solving, and relapse prevention.

In one of the studies included in the report, 8- to 16-year-old obese children who participated in a high-intensity behavioral management weight loss program gained less than one pound on average, compared with their obese counterparts who were not participating in the program and gained almost 17 pounds.

Wellspring Academies and Camps are the most intensive of all weight loss programs that focus on behavioral change. Wellspring's outcomes demonstrate average weight loss of 3-5 lbs. per week, with alumni maintaining or continuing weight loss following completion of the program.

Dr. Anatoly Belilovsky is a New York-based pediatrician and the proud parent of a Wellspring alumnus. He understands that it's all about behavior and recently posted the following on his practice's blog:

Education vs. Training

For those of us who have a driver's license, education is what we got to pass the written exam; training is the actual lessons in a dual-control car. And the difference is that we can drive after being trained, but not after being educated.

This lesson was recently driven home to me in a most impressive fashion. I drove my son to a weight-reduction camp, and returned a month later to pick up a much different person. 16 pounds lighter, yes, but that's the least of it. I picked up someone who learned responsibility, self-respect, self-reliance, confidence, and strength. I picked up someone who was trained in all the values I had tried to teach, by precept and by example. And I picked up a lesson in what pediatricians can and cannot do.

To read Dr. Belilovsky's full blog posting, please visit http://belilovskypediatrics.com/news/2008/09/20/education-vs-training.

In these challenging times, it's important to focus on the things we can control, and not fret about the things we cannot control.

One thing we can control is our behavior. With the right training, your child can return to a healthy weight and become a successful long-term weight controller.



Late Bloomers

Around my daughter's first birthday, I started to get anxious about her motor skills. Lena had just gotten the hang of crawling and cruising, and I was thrilled about it -- until I noticed that my friend's 1-year-old was walking and even climbing stairs like a pro. Rationally, I knew it was a bad idea to compare them, but the fact that Lena hadn't figured out how to do something her peer had already mastered made me worry. "There's a wide age range for hitting many milestones, and it's completely normal for children to have differences in abilities, motivation, and pace," says Anatoly Belilovsky, M.D., a pediatrician in Brooklyn, New York. "Parents should remind themselves that raising kids isn't a competitive sport."

Still, even the most laid-back moms and dads will find it hard not to stress when it comes to milestones as major as walking and talking. We asked the experts to highlight the developmental skills that send parents into panic mode -- and what you can do to help if you think your toddler is lagging behind.




Third-hand Smoke and Babies
The Dangers Smoke Residue Poses to Small Children
By Teri Brown

Her youngest is 4 years old and Melton has changed things completely. "We had no qualms at all about not letting him around smokers, even relatives," Melton says. "Smoking had been outlawed at our house, and we don't even allow smokers to hold him or to baby sit or spend any great deal of time around him. I just say no. Smoking and nicotine residue are a danger to everyone, and being socially correct is less important to me than protecting my family."

Dr. Anatoly Belilovsky, a New York pediatrician whose practice, Belilovsky Pediatrics, won an Americhoice award for Center of Excellence in asthma care, says cigarette smoke is dangerous whether it's second- or third-hand smoke. "As far as the child's health is concerned, there is not much difference between third-hand and secondhand smoke," says Dr. Belilovsky. "That's the whole point: Giving your child a hug while wearing smoke-sodden clothes may be as hazardous as if you actually smoked in the same room as this child. In more technical language, third-hand smoke contains the less volatile components of secondhand smoke, some adsorbed on the surface of fabric, some deposited as dust and some simply wafting through the air. Since adsorption is how cigarette filters remove some of the smoke components, third-hand smoke contains more of these chemicals, released directly from the burning tip into the ambient air."

The Dangers of Third-hand Smoke
Babies and toddlers are uniquely susceptible to the exposure of third-hand smoke. Because children are on the floor and have a tendency to mouth things, they actually get exposed to more of the toxic residue than adults do. Factor in their small size, and the risk of getting sick from third-hand smoke is increased.

"Children are still developing," Dr. Belilovsky says. "Their immature immune systems may mistake components of smoke for dangerous germs and attack them, beginning the inflammatory process that ends in bronchitis or asthma. Other components may interfere with development of the nervous system. And, of course, carcinogens have so much more time to do their work if the first exposure is in early childhood."

According to Dr. Belilovsky, the two clearly hazardous types of cigarette smoke components are irritants and carcinogens, and it is these types that are more concentrated in third-hand smoke. Irritants both mimic effects of respiratory infections and make the actual infections more frequent and more severe.




Boost your child’s self-esteem
10 ways to encourage & empower your child
Michele Thompson, MS

Self-esteem is one of the most important factors in your child becoming a thriving, confident adolescent who grows up to be a stable, driven and independent adult. We asked well known New York pediatrician Dr Anatoly Belilovsky for the best ways to boost a child’s self-esteem.
Mother and Daughter
The importance of self-esteem

Dr Belilovsky's practice, Belilovsky Pediatrics, is considered an Americhoice Center of Excellence in pediatric care. He says that fostering your child’s self-esteem instills a sense of motivation to achieve: “Self-esteem is tied to motivation in a feedback cycle -- motivation pushes a child to achieve, achievements fuel self-esteem. Self-esteem also helps children develop into leaders, not followers; they feel more freedom to follow their own interests, set independent goals and be confident in their decision making.”

Research shows that children with high self-esteem feel worthwhile and that this feeling of self-worth positively influences their nteractions with family, friends and classmates. They tend to make friends easily, can control their behavior, are cooperative and able to follow age-appropriate rules and show enthusiasm for new activities. They are creative, full of energy and, in general, happy. Additionally, studies have shown a correlation between high self-esteem and health.
10 Ways to boost your child’s self-esteem
1. Listen to your child

You know how dismissed you feel when someone doesn’t listen to you, but as an adult you can reason that the person was distracted or simply rude. A child may not yet recognize this and end up feeling insignificant and devalued. Take time to sit with your child and really listen to what she wants to tell you.
2. Be encouraging

Dr Belilovsky recommends that you give your child words of encouragement on a regular basis. He says, “They will store this positive reinforcement away and remember it when feeling down about their performance.”
3. Don’t over-praise

Recognizing your child’s accomplishments is essential in fostering self-esteem, but beware of "praise inflation." Dr Belilovsky advises that you save superlative praise for achievements that push your child's personal boundaries. Overusing "big" praise for trivial achievements means that you have no greater praise in reserve for the really praiseworthy actions.
4. Accept your child

Despite your best intentions to get your child to play violin, perhaps he's more interested in sports or art. It’s important to accept and support your child’s interests – even if those interests aren’t your own. Believing in children helps them believe in themselves and feel confident about seeking out things that are important to them.
5. Make sure criticism is constructive

Boosting your child’s self-esteem doesn’t mean letting him do whatever he wants. Children need limits and rules, and when they misbehave or do something that can put them in danger, it is your job to let them know. Dr Belilvosky recommends constructive critisism that is not shameful or scornful. He says, “Be direct about the [fact that it was the] action, not her personality, that disappointed you. Find something to praise in the middle of critique -- show that you understand the motivation behind the unsuccessful action. You never want to attack your own child’s character.”
6. Encourage independent decision-making

There are many opportunities for your child to make decisions. Dr Belilovsky says that allowing your child to make her own decisions -- like how to handle a sibling dispute -- will foster independent decision making and give her a feeling of responsibility for the outcome.
7. Openly show love and affection

Children who know they are loved feel more secure in day-to-day dealings as well as deep inside. Showing your child warmth, affection and love will make him feel accepted, signficant and a valuable part of your life and life in general. Be open with your hugs, pats on the back and genuine words of caring. Not only will you show your child that he is worthy of love -- you will help him see that love and affection are natural, normal parts of life.
8. Encourage creativity

Giving children the opportunity to learn about different activities (music, cooking, sports etc.), allows them to find healthy modes of self-expression and fosters their creative spirits. In addition, they gain a sense of mastery and confidence in trying new things. Dr Belilovsky says, “Encourage your children to develop hobbies and interests that they truly enjoy and can develop their skills. This gives them a sense of accomplishment and individuality.”
9. Be a good role model

Children learn from their parents. Check in with yourself and make sure your words and actions reflect positive self-esteem. Putting yourself, your spouse or other people down teaches your child that you don’t value yourself or others. Show your child that you respect, love and care about yourself and that you find worth in family members, friends and people in general.
10. Coach your child to reach higher goals

Dr Belilovsky says it is essential to show children all the possibilities open to them in life. Coach her -- don’t demand from her -- to reach toward higher goals. This puts her in the driver’s seat and, over time, this will develop as a cornerstone to her actions.




Consultant. Vol. 47 No. 2

Systemic Allergic Reaction to Embedded Sewing Needle
February 1, 2007

A thriving boy was brought to the office 3 weeks after his first birthday. His mother reported that there was "something wrong with his knee." On visual examination, the knee appeared perfectly normal. On palpation, however, a 4-cm linear induration was evident over the knee fat pad, just medial and distal to the patella. It appeared soft, crepitant, and associated with the skin. No tenderness was noted on palpation; the infant did not object to palpation of this density any more than to auscultation, otoscopy, or anthropometric measurements. No erythema, ecchymosis, or signs of trauma were evident near the lesion. The only possibly relevant history was that the child had spent his birthday at his grandmother's home in the Ukraine a month earlier. He was constantly with his mother during that time, and no trauma was ever reported.

Radiographs were initially considered, but it was felt that the soft lesion was unlikely to be radiopaque. The infant was referred to a pediatric surgeon who agreed with the findings but was unable to determine the cause of the lesion.

Four days after the initial visit, the child returned to the office with urticaria. This was thought to be a reaction to the grape juice that was newly introduced to the child's diet. The grape juice was discontinued and the child was treated with an oral antihistamine. By day 7, however, the urticaria was severe enough to require epinephrine and oral corticosteroids.

Radiographs were ordered by Anatoly Belilovsky, MD, of Brooklyn Hospital and Michael LaCorte, MD, of Schneider Children's Hospital in Brooklyn, NY. To everyone's surprise, the films revealed a sewing needle in the subcutaneous tissue. The child's mother did not sew at home; however, sewing needles had been present at the grandmother's home where the infant had crawled about on his hands and knees.

A repeated examination of the child's knee revealed no sign of an entry wound; there was no ecchymosis, no tenderness, and no local reaction, and the lesion still appeared soft and yielding on palpation, with some crepitus.

Stainless steel always contains chromium and usually nickel as well. Either metal may produce systemic allergic phenomena with only localized exposure.

Based on this information, the needle was removed "urgently" 13 days after the initial presentation, while the infant was still being treated for urticaria. The tiny incision healed uneventfully and there was no evidence of rash during a 3-month follow-up.

Two aspects of this case are noteworthy:

* This child had generalized urticaria that developed roughly a month after a needle became embedded. There was no localized reaction.
* Every clinician who examined this child found the lesion to be soft and flexible. For this reason, radiographs were delayed by a week.

Although the most common presentation of metal allergy is chronic, lichenified, contact dermatitis from nickel-containing jewelry and accessories, systemic atopic and urticarial reactions to localized contact with alloys and salts have been described. Metallothionein induction and subsequent sensitization are thought to be a possible disease mechanism.

The take-home message: an intractable idiopathic allergic process in a child may be the result of ingested, inhaled, implanted, or imbedded metal.


* Jin GB, Nakayama H, Shmyhlo M, et al. High positive frequency of antibodies to metallothionein and heat shock protein 70 in sera of patients with metal allergy. Clin Exp Immunol. 2003;131:275-279.
* Takazawa K, Ishikawa N, Miyagawa H, et al. Metal allergy to stainless steel wire after coronary artery bypass grafting. J Artif Organs. 2003;6:71-72.
* Tamai K, Mitsumori M, Fujishiro S, et al. A case of allergic reaction to surgical metal clips inserted for postoperative boost irradiation in a patient undergoing breast-conserving therapy. Breast Cancer. 2001;8:90-92.




Baby Bloopers

Tips on Handling Embarrassing Baby Situations
By Renee Roberson

Depending on what types of baby books you read before you bring your little bundle of joy home, you may or not be prepared for one of the most important ways your life will change as a parent. Babies, cute and loveable as they are, have an uncanny and often uncontrollable ability to embarrass the daylights out of their parents (usually in the most inopportune situations and places) so it's best to go ahead and plan now for the best ways to handle these mortifying – although probably humorous much later – predicaments.

Diaper Disasters
It's amazing how much poop a tiny baby can expel, and it often happens in the most public places throughout that first year of life. Dr. Anatoly Belilovsky, a pediatrician in New York who runs the 365-day practice Belilovsky Pediatrics, agrees that diaper messes are often unavoidable with small infants. "With infants, diarrhea if often preceded by crankiness, a bad appetite and rumbling stomach," he says. "If this happens before a planned outing, this may be your baby's way of telling you he or she is feeling bad and perhaps the trip should be avoided."

But sometimes, as in the case of New Albany, Ind., mom Mindy Harrington, leaving the house is unavoidable. While on an airplane flight to visit her husband, Harrington noticed a stench making its way through the airplane and realized it was coming from her daughter, who was under a year old at the time. The mess oozed out of her daughter's diaper and straight into Harrington's lap.

"I had no change of clothes and I didn't have anything but a onesie for her," Harrington says. "I hobbled to the bathroom with no help from the flight attendants and managed to squeeze ourselves into the small compartment. I got her changed and had to just wipe my skirt off the best I could. I had to finish out the flight with the same clothes on."

Even if your baby doesn't have diarrhea, breastfed infants are known to have looser stools than those who drink formula, so carrying a change of clothes for both you and the baby is probably a wise idea anytime you venture far away from home. Think of it as your own little insurance policy against accidents.

Spit Happens
Speaking of messes caused by baby's bodily functions, spit up can cause more of a spectacle than many parents can imagine when packing the diaper bag the first few times. Babies eat around the clock during the first few months, and spitting up can be a frequent occurrence. Throw in anxious parents and a different setting and you can have a recipe for disaster.

"A full feeding distends the abdomen quite a lot, and throwing up, though common in any case, is also a common response to stress, in this case, being in public with lots of unfamiliar smells and sounds, and with Mom probably transmitting some of her own discomfort and stress in the public setting to the baby," Dr. Belilovsky says.

As the mother of a 14-month-old, Amanda Snook from Lansing, Mich., has experienced a wide range of embarrassing moments with her son. While in a posh department store dressing room with her son, she tried unsuccessfully to get him to burp after a nursing session.

baby bloopersSnook picked him up, put his head on her shoulder and carried him out into the store to tell her husband she couldn't get him to burp. As if on cue, her son opened his mouth and spit up what seemed like the entire contents of his stomach onto the polished floor of the cosmetics department.

Mortified because the mess hit the legs of several customers standing by, Snook ran around trying to clean up the mess with the tissues and cotton balls on the counter nearby. Her husband tried to cordon off the area to keep anyone from falling in the mess and getting hurt.

Snook says she has learned a valuable life lesson since becoming a parent – life is unpredictable. "I can only do so much," she says. "The biggest thing to keeping my sanity is that I have to remember to be calm. If I start to lose it, everyone starts to lose it."

Dr. Belilovsky notes that preparation and advance planning is the key when facing outings with your baby. Packing plenty of wipes and changes of clothes for everyone can make it much easier to bounce back from a less-than-desirable situation.

Crying Chaos
All babies go through an adjustment period after leaving the cozy comfort of the womb. Some babies transition to the noises and sounds of their new environment more quickly than others, and it may take months before your baby is comfortable on outings outside your home.

Dr. Patricia Anderson, an educational psychologist and author of Parenting: A Field Guide (Aviva Press, 2009), knows that small children can embarrass their parents quite easily. She says that planning ahead is the best approach, but knows that there are times when plans can be derailed, such as the case of Illinois mom Jessica Fuqua.

After a last-minute cancellation from their babysitter, Fuqua and her husband took their infant twins to meet friends for dinner at a very fancy restaurant. One of the babies happened to be teething on that evening, and nothing, even Orajel, Tylenol and teething rings, seemed to help ease the crying.

baby bloopers"It was so embarrassing," says Fuqua, who says even their waiter tried to offer helpful suggestions. "In situations like these, you just have to stay calm and just realize that it's not your child's fault; she's just in pain and doesn't know how to handle it."

Fuqua, her husband and her dinner companions all took turns holding the baby and taking her back and forth to the restroom. Fuqua learned the important lesson that babies are unpredictable and don't have the ability to control what's going on in their lives or their reactions.

Dr. Anderson recommends being mindful of other people around you when your baby causes a disturbance in a public place and relieve their stress if you can. Taking your crying child out of a quiet dining area is a good solution. "There will be situations where you can't do that," Dr. Anderson says. "In that case, your sincere apologies can help."

What Others Are Really Thinking
Any parent who has attempted an outing with a young child has probably stood in your shoes more often than she cares to remember, so don't ever feel like you're alone while enduring an unsettling experience with your baby in public.

"Embarrassment rests on the assumption that other people are looking at you with reproach," Dr. Belilovsky says. "I can say, as a parent, when I see a baby making a mess in a public place, my first thought is, 'been there, done that, got the stains to prove it!'"

"Remember that everyone was a child once and made a mess at some time," Dr. Anderson says. "Call for clean up on aisle five, offer to pay for the damages or cleaning and carry on. Your child will continue to embarrass you for years to come; get used to it!"