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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
   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
                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
             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
THANKS TO MARY BOVE FOR THE SLIDE INFO
                             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)
THANKS TO MARY BOVE FOR THE SLIDE INFO
                   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)


THANKS TO MARY BOVE FOR THE SLIDE INFO
          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.
THANKS TO MARY BOVE FOR THE SLIDE INFO
           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
     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
            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
THANKS TO MARY BOVE FOR THE SLIDE INFO
       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.
           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
 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
         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
•   THANKS TO MARY BOVE FOR THE SLIDE INFO
     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
  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.
  THANKS TO MARY BOVE FOR THE SLIDE INFO
 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
•   THANKS TO MARY BOVE FOR THE SLIDE INFO

				
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