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CONJUNCTIVITIS

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CONJUNCTIVITIS Powered By Docstoc
					  Keeping Kids
    Healthy
Dr. Emily Maiella
Naturopathic Physician


432 Greenfield Rd
Montague MA 01351
413.230.4462
      With pediatric patients
Herbal Safety
Types of Herbal Preparations
Compliance Issues
Dosing Specific for Children
Childhood Illnesses
Parental satisfaction
      Immune Support
   (Prevention and Acute)

            Vitamin D
            Probiotics
      Elderberry (Sambucus)
          Andrographis

Be prepared. Have medicines on hand.
    Cold and Flu Prevention
Basic Prevention, try to have the whole
 family on the following….

Research backs it up!
        Randomized trial of vitamin
       D supplementation to prevent
       seasonal influenza A (H1N1) in
             schoolchildren.

DESIGN:From December 2008 through March
 2009 a randomized, double-blind, placebo-
 controlled trial comparing vitamin D(3)
 supplements (1200 IU/d) with placebo in
 schoolchildren. The primary outcome was the
 incidence of influenza A, diagnosed
 with influenza antigen testing with a
 nasopharyngeal swab specimen.
      Proves really effective!
• RESULTS: Influenza A occurred in 18 of 167 (10.8%)
  children in the vitamin D(3) group compared with 31
  of 167 (18.6%) children in the placebo group. The
  reduction in influenza A was more prominent in
  children who had not been taking other vitamin D
  supplements and who started nursery school after
  age 3 y. In children with a previous diagnosis of
  asthma, asthma attacks as a secondary outcome
  occurred in 2 children receiving vitamin D(3)
  compared with 12 children receiving placebo
• CONCLUSION:This study suggests that vitamin D(3)
  supplementation during the winter may reduce the
  incidence of influenza A, especially in specific
  subgroups of schoolchildren.
     How Vitamin D works….
In a study published in the journal Nature Immunology,
   researchers from the University of Copenhagen
   found that when a variety of white blood cells known
   as a T-cell comes across a pathogen (virus, bacteria,
   tumor, fungus) in the bloodstream, it extends a
   receptor in search of vitamin D. If the WBC
   encounters the vitamin, the T cell becomes
   "activated." If there is not enough vitamin D in the
   blood, the cell remains passive and no immune
   response occurs.
            How Vitamin D works..
The body produces vitamin D upon exposure to
  sunlight. It can also be found in eggs, fatty fish,
  fortified milk and in supplement form. Once activated,
  (by vitamin D) a T-cell transforms into one of two
  kinds of cells. One type seeks out and destroys all
  traces of the infectious agent, while the other records
  information about the pathogen and transmits it to
  other parts of the immune system. These latter
  ("helper") cells help the immune system respond
  quickly should infection with a similar pathogen occur
  at a later date.

http://ods.od.nih.gov/factsheets/vitamind
     Can’t help but to share
Side note: all of the other conditions
  which Vitamin D is extremely helpful for:
Colon and breast cancer prevention
Auto-immune conditions of all types
Multiple sclerosis
Osteoporosis/osteopenia
Probiotics
     =
  for life
  Effect of Lactobacillus gasseri, Bifidobacterium
  longum, B. bifidum on common cold episodes: a
      double blind, randomized, controlled trial
The aim of this study was to investigate whether the consumption
  of Lactobacillus gasseri, Bifidobacterium longum, B. bifidum,
  during at least 3 months influences the severity of symptoms
  and the incidence and duration of the common cold.

METHODS:A study was performed over at least 3 months during
  winter/spring periods. 479 healthy adults (aged 18-67) were
  supplemented daily with vitamins and minerals with or without
  the probiotic bacteria. Cellular immune parameters were
  evaluated in a randomly drawn subgroup of 122 volunteers
  before and after 14 days of supplementation. During common
  cold episodes, the participants recorded symptoms daily. Stool
  samples were collected before and after 14 days of probiotic
  supplementation to quantify fecal Lactobacilli and Bifidobacteria
  using qRT-PCR.
     Probiotics shorten duration
• The total symptom score, the duration of common
  cold episodes, and days with fever during an episode
  were lower in the probiotic-treated group than in the
  control group:
• A significantly higher enhancement of cytotoxic plus
  T suppressor cells (CD8+) and a higher
  enhancement of T helper cells (CD4+) was observed
  in the probiotic-treated group
• The intake of probiotic bacteria during at least 3
  months significantly shortened common cold
  episodes by almost 2 days and reduced the severity
  of symptoms
•   Clin Nutr. 2005 Aug;24(4):479-80.
       How probiotics help….
From the very first breath you take, you're exposed to
  probiotics.
On the way through the birth canal during a vaginal
  deliver, a newborn gets dosed with bacteria from their
  mother’s birth canal. This event starts colonization in
  the infant's gastrointestinal (GI) tract of 'good'
  bacteria. N
New research now shows many caesarean-section
  infants have less-than-optimal health after birth. This
  is most likely because they are not exposed to the
  mother's healthy bacteria in the birth canal which
  would then serve to populate its own GI tract.
        Probiotics ( = for life)
As you mature, you're faced with many threats
  to the beneficial bacteria in your gut... from
  chlorinated drinking water... to overly-
  processed foods.The 'good' bacteria in your
  gastrointestinal system can only provide you
  with optimum health if the proper balance of
  different types of bacteria is maintained in
  your gut.
This is where probiotics can have a profound
  effect... not just on your GI health, but on your
  overall health as well.
The intestine is the largest immunological organ
  in the body and contains 70% to 80% of all
  IgA-producing cells. When exposed to a virus
  (etc) by the oral route, a secretory immune
  response is obtained, which is mediated by
  secretory IgA.
probiotics increase the number of IgA-secreting
  cells, which migrate from the Peyers patches
  to distant mucosal sites such as the
  respiratory glands. This is where the gut
  and respiratory tracts interface.
  The Gut and EENT inteface
the mucosal barrier also makes up our mouth,
  throat, eyes, the upper part of our lungs,
  nasal cavity, the urethra in men and women,
  and the vagina in women. So those external
  surfaces are also covered in secretory IgA.
• Probiotics also increase T-cell production of
  TNF-α in response to adenovirus exposure
  and influenza A (variant of H1N1) exposure
   For your own research….

probiotics and eczema, allergies and
  asthma
              RSV
Most common serious acute respiratory
 illness in infants and young children

Can manifest with mild cold-like
 symptoms

Can also be severely acute and can
 include coughing, quick/short breaths
 (fast breathing greater than 50 breaths
 per minute), labored breathing and lack
 of oxygen. Infants- want to sit up (more
 fussy laying down b/c they can’t catch
 breath).
                  COUGH/RSV
• INCIDENCE
      • RSV affects nearly ALL infants by the age of 2, most are
        not acutely affected.
      • 125,000 children hospitalized each year, 1-2 % of these
        will die from it.
      • Infants less than 1 year of age are most severely
        affected.
      • Generally seasonal between Fall and Spring of every
        year.
      • Can affect adults as well.
• WHO’S AT RISK?
      • Spread easily by physical contact. Can live for half an
        hour on hands or five hours on countertops and used
        tissues.
      • Infants born prematurely, with chronic lung disease,
        immunocompromised or with some forms of heart
        disease are at a greater risk.
                                RSV
•   SIGNS/SX
        • Nasal congestion
        • Nasal flaring
        • Cough (often croupy or barking)
        • Tachypnea/labored breathing or SOB
        • Hypoxia (cyanosis)
        • Wheezing
        • Fever
        • Symptoms usually appear 4-6 days after exposure

•   Sequela
              – Can be mild cold or lead to pneumonia and bronchitis can
                set up for damage towards asthma-
              – Can lead to otitis- drainage more thick mucous than other
                colds and viruses can lead to separate infection to ear.
              – Respiratory failure is a concern.
              – Asthma-may get asthma 6 months later not uncommon
              RSV TREATMENT
    Thyme and Eucalyptus essential oil rubbed on chest and under nose.
    Gaia herbs makes a really nice chest rub, formulated by Dr. Mary Bove

•   Quercetin powder (1/4 tsp twice a day) opens up airways mildly,
    mucolytic, and for inflammation, for acute cough. 500mg 2x/day, mix it
    in applesauce.

•   Vitamin C 50mg x age in years, twice a day.

•   Echinacea 1 drop for every 2 lbs. body weight given every 2 hours

•   Composition Essence Gaia makes it- children - eclectic formula. 5
    drops in warm water. Tastes sweet and warming. Put it in drinking
    water. Use it when things are more severe than in a mild cold.
RSV/COUGH TREATMENT
 Wet or dry cough formulations with antivirals
    – Glycyrrhiza (wet or dry)
    – Melissa officinalis
    – Lobelia (wet)
    – Prunus serotina
    – Viburnum spp.
    – Verbascum
    – Hyssop
    – Thymus vulgaris
    – Inula
    – Anise
    COUGH/RSV TREATMENT
•   Homeopathic Treatment (Spongia, Pulsatilla, Drosera, Ant-t for barking
    cough) Antimonium and carbo veg (likes to be fanned)-hypoxia and
    blue
•   Humidifiers-humidifying room, and essential oils on stove in water, can
    get oils in air with humidifier but may get germs into air. Use hot-air
    humidifiers.

•   Hydrotherapy
             – Steamy bathroom
             – Constitutional hydrotherapy
              -Wet/warming sock treatment (for warming sock treatment,
               go to my website for print out)
          Syrup of Thyme and Ivy
                  Leaves
1234 children and adolescents (623 boys and 611 girls)
  ages 2-17 with acute bronchitis and productive cough
Non-interventional post-marketing surveillance study
Treatment days: 0, 4 and 10
Acute bronchitis with productive cough in children and
  adolescents can be treated safely and effectively with
  the thyme and ivy syrup. A ten-day treatment using
  age-appropriate dosages led to a clear improvement
  in the symptoms or cure with very good tolerability.
Marzian O. “Treatment of acute bronchitis in children and adolescents. Non- interventional
   postmarketing surveillance study confirms the benefit and safety of a syrup made of extracts
   from thyme and ivy leaves” MMW Fortschr Med (2007 Jun 28) 149(27-28 Suppl):69-74
                             Andrographis
Treatment of acute infectious viral or bacterial diseases of the
   respiratory, urinary and GI systems.
• Randomized, double-blind, placebo controlled
  clinical trial
• •152 Patients with acute pharyngotonsillitis
• •6 grams daily for a week
• •Relief of fever and sore throat
• equal to paracetamol (over the counter pain
  reliever)
• Lower doses found not to be as effective
•   Thamlikitkul V., Dechatiwongse T., Therapong S, et al, J Med Assoc.Thai 1991;74(10);
         Andrographis: Acute and
            PREVENTATIVE
• 107 healthy children
• 200mg /day of andrographis ( 11.2mg
  andrographolides) or Placebo for 3 months (equals 1
  gram herb)
• By the 3rd month –significant decrease in the
  incidence of colds in the andrographis group
  compared to the placebo group.
• The relative risk of catching cold was 2:1 times lower
  for the andrographis group.

•   (Caceres DD, Hancke JL, Burgos RZ, et al. Phytomed 1997;4 (2) 101-104)
                    Andrographis
• This is a great herbs to initiate for prevention if your
  child has a history of ear infections, chronic bronchitis
• Increase the dose, triple it if on a preventive dose if
  child gets sick.

• Andrographis treatment can significantly shorten the
    course and duration of the common cold


•   Hancke J., Burgos R., Caceres D., Phytother 1995: 9:559-562
               Andrographis
                Pediatric Dosing
• Prevention use .5-1 gram powder, .5-2 mls liquid
  extract daily
• Acute infection use 2 grams powder or 4 mls 1:2
  liquid extract
• Combine with warming herbs such as ginger,
  cinnamon, and astragalus

• Safety, toxicity and contraindications;
• No significant adverse effects have been noted.
• High doses may cause gastric discomfort, anorexia,
  and vomiting.
• Contraindicated in pregnancy (animal studies)
           Andrographis

• Acute bacterial infections of GU, GI and
  respiratory systems.
• Good for an alternative long term
  antibiotic.
Long used in both Chinese and Ayurvedic
  medicine, this intensely bitter herb has
  powerful antiviral activity.
Bitter tonic, immune stimulant,
  anthelmintic, antihepatotoxin,
  cholagogue and anti-inflammatory.
It can be used for colds, influenza, sore
  throats, Lyme disease, hepatitis and
  other viral infections. In India it is
  considered superior to quinine for
  malaria.
It is also used for infestations of intestinal
  parasites such as Giardia, Blastosistus
  hominis and Dientaoeba fragilis.
              SAMBUCUS NIGRA
                 (Elderberry)
• Elderberry Extract Inhibits Several Strains of Influenza
• Controlled, double blind study

• 6 day outbreak of influenza B

• Significant improvement of symptoms in 93% of group in 2 days

• In vitro studies have shown inhibition of influenza types A and B

•   J. Altern. Comp. Med 1995
      Sambucus/Elderberry
• The fruit has always been an anti-flu
  remedy, but don’t forget about the
  flower parts too! Great fever herb.
• Keeping it in mind for all chronic viral
  infections, herpes etc.
• Start in September, end in January for
  prevention.
          Anti-viral Action of Berry
• Constituents neutralize the activity of the
  hemagglutinin spikes found on the viral
  surface. When these hemagglutinin spikes
  are deactivated the viruses can no longer
  pierce cell walls, enter the cell and replicate.
• Influenza viruses A and B, Herpes simplex
  virus type 1 (HSV-1)

•   Zakay-Rones Z, Varsano N, et al. Inhibition of several strains of influenza virus in vitro and reduction of
    symptoms by an elderberry extract (Sambucus nigra L.) during an outbreak of influenza B Panama. J Altern
    Complement Med 1995;1:361-369.
•   Zakay-Rones Z, Thorn E, et al.Randomized study of the efficacy and safety of oral elderberry extract in the
    treatment of influenza A and B virus infections. J Int Med Res 2004;32:132-140.
              Elderberry
• The berry helps to colonize good gut
  flora b/c of the phytophenols. High Anti-
  oxidant and anti-inflammatory qualities.
• Indicated for those respiratory infections
  that have a lot of mucus, b/c kids
  swallow the mucus, and that alters the
  flora. And remember what happens
  when the flora gets altered…trouble!!
         Not just anti-viral!
       2011 Elderberry Study
• Inhibitory potential of the extract on the
  propagation of human pathogenic H5N1-type
  influenza A, influenza B virus, and clinically-
  relevant human respiratory bacterial
  pathogens

• RESULTS: a standardized elderberry liquid
  extract possesses antimicrobial activity
  against both Gram-positive bacteria of
  Streptococcus pyogenes, group C and G
  Streptococci, and the Gram-negative
  bacterium Branhamella catarrhalis in liquid
                   Not just anti-viral!
                 2011 Elderberry Study
• The liquid extract also displays an inhibitory
  effect on the propagation of human
  pathogenic influenza viruses.

• CONCLUSION: elderberry liquid extract is
  active against human pathogenic bacteria as
  well as influenza viruses.
Krawitz C, Mraheil MA, Stein M, et al, Inhibitory activity of a standardized elderberry liquid extract against
    clinically-relevant human respiratory bacterial pathogens and influenza A and B viruses. In: BMC

     Complement Altern Med (2011) 11:16
         Elderberry Dosage
• Minimizes those post-viral bacterial
  infections!

• Elderberry fruit syrups- standardized to 30-38
  percent elderberry
• Powdered extracts- 500 mg (capsule) 2-3
  times daily for 3-4 days
• Liquid form, dosed at one tablespoonful (15
  ml) three times daily
• Acute viral infections- treat at least three days
                   EARACHE
Pain and or discomfort in or around the ear. An
  earache develops when the tissue lining the middle
  ear or eustacian tube swells.

Immature Eustachian tube (the tube that connects the
  middle ear to the throat). In infants and young
  children this tube is much shorter and is angled. It is
  therefore much easier for bacteria to migrate from the
  nose and throat up into the middle ear space. As the
  child grows this tube becomes more vertical, so
  germs have to travel "up hill" to reach the middle ear.
  This is one-reason children "outgrow" ear infections.
             Otitis Media
Inflammation of the middle ear with the
  development of a bacterial infection.
  Immune response to this infection
  causes a collection of fluid in the middle
  ear space or a rupture of the tympanic
  membrane due to the fluid build-up.
                 EARACHE
Earache may be due to acute ear infection (otitis
media), water or fluid in the ear (swimmers ear/ otitis
externa) or inflammation/ blockage of the eustacian
tube due to allergies, associated respiratory
infections (eg. colds), travel (air or to higher altitudes)
and sometimes accompanies teething and
physiological obstructions.
EARACHE/OTITIS MEDIA
 Ear pain or discomfort, with or without respiratory
   symptoms
 Fever
 Drainage from ear if tympanic membrane bursts
 Sleeplessness (ear pressure increases while
   lying down)
 Irritability
 Change in eating habits
 Change in hearing
 Refusal to nurse on side that hurts, pain worse
   when lying down.
 vomiting
            EARACHE/OTITIS
More frequent in the winter
Teething- assoc. with fluid production
consumption of cows milk in early childhood
feeding position (bottles while lying down)
smoking in household
fetal alcohol exposure
genetic predisposition (eg. Children with Downs Syndrome)
Family predisposition decrease in IgG2 or IgA
prior episodes of otitis media
poor nutritional status
daycare setting
early introduction of solid foods
Underlying viral infections (RSV or Influenza),
Underlying food or environmental allergies
Association with pacifier use
                  EARACHE
Have your child seen immediately if……

• Ear pain accompanied with fever >105.0 F (R/O
  severe infection, mastoiditis)
• Any fever in infants < 12 weeks old.
• There is pus, blood tinged or other abnormal colored
  fluid draining from ear.
• Pointed object was inserted into ear canal (eg.
  Pencil, stick, etc>) (R/O perforated eardrum)
• Child is in severe pain and cannot nurse, sleep, etc.
• Stiff neck or headache ( R/O meningitis)
• Vomiting or Chills
         EARACHE AT HOME
Keep child in upright position (when sleeping prop up on
  pillows.
Use heat to help bring circulation and soothe the area.
Warm onion treatment: cut onion in half or in very slick
  slice. Bake for 15 minutes or microwave for about 2
  (until steaming) Wrap onion in gauze or clean cloth
  (should feel warm but not too hot!) Apply to ear area
  until relief is felt. Repeat as necessary.
Warm olive oil infused lavender essential oil or
  commercially prepared eardrops infused with garlic
  and mullein.
(Never place anything in ear if a ruptured or perforated
  eardrum is suspected)
              EARACHE
Keep child well-hydrated and decrease
   sugar intake
Give immune support teas made with
   herbs such as lemon balm, echinacea,
   chamomile, garlic, and astragalus.
Zinc, Vitamin C, Essential fatty acids
   (omega 3 and 6)
If antibiotics are used or have been used
   in the past supplement with probiotics to
   help restore normal gut flora.
 Homeopathics for EARACHES
• Homeopathy: Some of the more commonly used to
  treat ear infection include:
• Pulsatilla- weepy, clingy, wants to beheld, extremely
  changeable mood, better in open air, fever 100 to l02,
  little or no thirst, refusal to drink
• Belladonna- earache comes on suddenly with intense
  pain, may have fever up to 104, hot and flushed face,
  dilated pupils
• Chamomilla- extremely irritable and changeable,
  does not know what he wants, worse in the evening,
  needs to be carried back and forth
                EARACHE
• Antibiotic treatment is most likely indicated if
  there are signs of systemic bacterial infection,
  mastoiditis, or other complications.
• Antibiotics: risk of resistant strains,
  increased risk when child has been
  treated with antibiotics in the last 3
  months. The absence of overt
  symptoms does not mean bacterial
  infection is cured.
                  EARACHE
• Pain reliever and anti-inflammatories (ibuprofen or
  acetominophen. are often given to reduce pain and
  fever. But I usually recommend riding the fever out.

• New research is suggesting that 80% of
  uncomplicated ear infections will resolve within 4 to 7
  days without antibiotics.

• Aspirin and salicylate containing compounds
  should never be given to children.
                 Myringotomies

• Surgical techniques are often done to treat children
  who have chronic recurring incidence of ear
  infections.

• before undergoing such extreme measures
  underlying causes such as food allergies or
  nutritional deficiencies should be ruled out.
• Myringotomies can cause permanent scarring and
  thickening of the eardrum.
  Playing more, Breast-feeding less

• Common in early childhood, greatest risk age 2-5. b/c
  stop breast feeding, put everything in mouth, and
  increased socialization.

• Increased incidence in the pre-school setting due to
  exposure to increased number of bacterial serotypes
  at a time when structurally the eustachian tube is
  most at risk for congestion.
Side note….swimmers ears

  • Otitis externa: inflammation of the ear canal
    secondary to loss of protective cerumen,
    contact dermatitis, underlying otitis media,
    staph or pseudomonas infection.
  • Swimmers ear prevented with drops of vinegar
    and 70% ethyl alcohol
     TX/MANAGEMENT
Encourage breast feeding
Avoid cow milk dairy in the
 preschool population
Treat/avoid known food
 sensitivities
Treat/avoid environmental
 allergens
Avoid second hand smoke
Careful dental hygiene especially when a tooth
  is lost
Ear lavage to remove impacted cerumen (wax)
Cod liver oil (tsp.)-to decrease ear wax and
  prevent formation
Bioflavonoids and a multi vitamin with zinc
Vaccination: HIB- has brought number of fx’s
  down, including conjunctival infections.
General Immune Support

Vit C-50mg X age in years given every 2 hours
  during illness.
• Esberitox: echinacea tablets full dose when
  sick,
• NAC-mucolytic: dose > 2 years old 500-600 mg
  2-3 times a day
• Thymactive (homeopathic thymus gland
  and homeopathic echinacea)
General Immune Supports
 Herbs: glycerite or tincture tolerated:
  echinacea, astragalus, sambucus,
  thyme (if baby under a year of age and
  still nursing, treat through mom). You
  can use Glycerites in the ear directly, as
  they pull water from the middle ear,
  thereby decreasing pressure.
Local treatment for pain relief
   Warm Garlic-mullein oil based drops daily before
    bed. 3-5 drops per ear for 3 days. Tx with both
    ears put in cotton ball and lie down soon. 4
    cloves of garlic mashed into olive oil make it at
    home. Some oil will come out. Rinse with
    H2O2 in the morning to visualize ear drum. Do
    not put in drops when rupture is diagnosed or
    suspected.
   Baby Tylenol PRN-best if don’t have to. Add a
    drop of aconite tincture to the ear oil and that
    cuts pain right away.
   Ear drops for pain relief: allium, calendula,
    hypericum, verbascum, lavender, vitamin E in
    an oil base.
   Thyme and eucalyptus oil rubbed behind the
Earache/Otitis at Home

 Tilt up head of med or mattress

 Onion ear muffs prn (as needed) for pain and
  antimicrobial treatment when TM ruptured-
  draws out pain and inflammation.

 Cranio-sacral therapy with mobilization of the
  temporal bone
    Manual Therapies
Warming socks-use it in all kids, wet socks.
Contrast hydrotherapy over ear.
Warm applications to ear including hair dryer
Lymphatic drainage
    Earache follow up
Continue treatment for 24 hours after child stops
 complaining of pain

   If not better in 48-78 hours, adjust treatment

   Return to doctors office after resolution to
    visualize membrane-make sure they are
    better

   Children with frequent recurrent AOM or
    chronic effusion should have their hearing
    assessed to prevent language delay-3
    months of continuous effusion have hearing
    tested.
       Propolis and Acute Otitis Media
                Clinical Study

• Efficacy of a propolis and zinc suspension in
  preventing AOM
• 122 children aged 1-5 years with a documented
  history of recurrent AOM
• 3month trial
• Prospectively, blindly, randomized 1:1 to receive the
  suspension plus elimination of environmental risk
  factors or elimination of environmental risk factors
  only
  Marchisio P, Esposito S, Bianchini S, et al. Effectiveness of a propolis and zinc solution in
  preventing acute otitis media in children with a history of recurrent acute otitis media. Int J
 Propolis and AOM Clinical
           Study
• The administration of a propolis and zinc
  suspension to children with a history of rAOM
  can significantly reduce the risk of new AOM
  episodes and AOM-related antibiotic courses,
  with no problem of safety or tolerability, and
  with a very good degree of parental
  satisfaction.
  Marchisio P, et al. Int J Immunopathol Pharmacol (2010)
  23(2):567-75
            Echinacea Herbal Blend
    Effectiveness of an herbal preparation


• Echinacea 50mg, propolis 50 mg, and vitamin
  C 10mg in preventing respiratory tract
  infections in children:

• A randomized, double-blind, placebo-
  controlled, multicenter study.
• during a 12-week winter period
• 430 children,
• aged 1 to 5 years, two-times per day dosing
              Echinacea Herbal Blend
      Effectiveness of an herbal preparation

A preventive effect of the product containing
  echinacea, propolis, and vitamin C on the
  incidence of respiratory tract infections was
  observed.

(Cohen HA Varsano I Kahan E Sarrell EM Uziel Y.,: Arch Pediatr
  Adolesc Med (2004 Mar) 158(3):217-21
    Probiotics and Gut Flora
Probitocs, REALLY one of the most
  important tonic medicines for children.
Astragalus, helps to build SIgA
High phyto-phenols, helps to build the
  microbiota.
Astragalus, slippery elm, marshmallow
Chronic cycle with child, if can get to take
  andrographis, that’s really great.
CONJUNCTIVITIS

Viral, bacterial or allergic

discharge: viral or allergic

swelling and redness of the lids:
bacterial

if chronic, consider food allergy or
allergy to dust, chemicals or pollen
 Viral or bacterial?

– Bacterial 50% of cases with Hib and
  Chlamydia (neo-natal) as the most common
  cause in developed countries. Bacterial
  infections are the most common in
  preschoolers, and are often accompanied
  by earaches)
– Viral 20% of cases (adenovirus pink eye
  seen in older school aged kids and are
  usually accompanied by sore throats)
– Culture negative, allergic 30%
       Conjunctivitis

Bright red conjunctiva
Edema (swelling)
Hemorrhages
Discharge, watery, stringy or purulent with
  matting of the lashes
Itching and stinging
Photophobia
Allergic shiners
        Conjunctivitis
Tearing
Foreign body sensation
Preauricular (in front of ears) lymph nodes may
 be painful or swollen
Sore throat and fever associated with adenovirus
Herpetic vesicles (did mom or dad touch a
 Herpes lesion and touch the baby)
Conjunctival papillomas (warts) associated with
 HPV
     TX/ MANAGEMENT FOR
        CONJUNCTIVITIS

Prophylatic erythromycin
Systemic treatment with erythromycin for infections caused
  by Chlamydia.


Breast milk lavage. It is powerful medicine.

Compress with black tea bags or Stellaria (chickweed)

Lavage with Chamomile, Hydrastis or Calendula. Wiping
  from inside to outside, with a clean cotton ball every time.
  Use a few drops in the eye or lavage.
                   CAVITIES
Dental caries (tooth decay) is caused by a specific
  group of cariogenic bacteria, like Streptococcus
  mutans, which convert dietary sugars into acids that
  dissolve the mineral in tooth structure.
Another significant contributing factor is the imbalanced
  flora in the mouth (and to some extent the gut)
This occurs when carbohydrates (or sugars) break up
  into sugars and bacteria act on it. Watch out for
  those teething biscuits and other carby snacks!
Look into gut flora and try probiotic mouth rinses.
3 factors interrelated to cause caries
1. susceptible tooth surface
2. the presence of caries-inducing bacteria
3. a substrate capable of maintaining bacterial growth

the main bacteria responsible for caries is Streptococcus
    mutans and the favorable environmental bacterial
    growth is acidic
dental plaque (made of polysaccharides, bacteria and
    salivary glycoproteins) accelerate the development of
    caries by acid production as well as by resisting the
    buffering and remineralization attempts of the saliva
sugary foods are implicated in causing caries (they lead
    to an acidic oral milieu) esp. if they are sticky (ie fruit
    leathers, dried mangos, prunes, raisons…)
    Licorice root and cavities
Taste nice and traditionally used in
  pediatric medicine.
Great compliance
Not only an incredible anti-viral (one of
  our best…)
Study with dental caries and tooth decay
  caused by strep mutans
          Licorice Root for Dental
                   Caries
(Glycyrrhizol A), an active compound of licorice roots, has strong antimicrobial
    activity against cariogenic bacteria
Two pilot human studies indicate that a brief application of these lollipops (twice a
   day for 10 days/21 days) led to a marked reduction of cariogenic bacteria in the
   oral cavity among most human subjects tested.
Licorice herbal lollipop could be a novel tool to promote oral health through
    functional foods and these sugar-free lollipops are safe and their antimicrobial
    activity is stable
SM numbers were reduced for 22 days after the last lollipop

•   Hu CH, He J, Eckert R, et al. “Development and evaluation of a safe and
    effective sugar-free herbal lollipop that kills cavity-causing bacteria.” Int J Oral
    Sci (2011 Jan) 3(1):13-20
   Insomnia, Restlessness,
           ADHD
A combination of valerian and lemon balm is
  effective in the treatment of restlessness and
  nervous-sleep time problems
918 children, 12 years
Children were evaluated for therapeutic efficacy
 and tolerability.
Distinct and convincing reduction in severity
  was found for all symptoms in the
  investigators' and parents' ratings.
        Lemon balm and Valerian
In conclusion, the preparation was effective in the treatment of
    younger children with restlessness and dyssomnia and it was
    very well tolerated.
Lemon balm helps to activate the parasympathetic, and relaxes the
    muscles, BUT it really helps to center the mind. Combine with
    gotu kola for mind-centering. Lemon balm can be used to calm
    and stimulate, good for acute and chronic situations. School
    aged-anxiety.


(Muller SF, Klement S, Phytomedicine (2006 Jun) 13(6):383-7)
      Lemon Balm and infants

Lemon balm tea can also be given to infants with irritable digestive
  tracts, and consequently the sleep disturbances that come along
  with that discomfort. Can be expressed thru breast milk and/or
  given to the infant. Brew 1/2 of tea, with 1 tsp if herb. Brew for
  3 minutes and not more. Nice punch for kids.

				
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