Bambini April 2016 Newsletter 
Pityriasis:  Bambini's Experience
Rarely a week goes by in spring that we do not see a teen or two presenting to our office with pityriasis, a rash that affects mainly the torso. Spots are about inch, oval-shaped, and are slightly raised.

About half the patients we see also have a herald patch. This spot, also on the torso, is typically 2 or 3 inches across and can be mistaken for ringworm. Most textbooks say the cause is unknown, it lasts 6 to 8 weeks, and there's nothing that can be done to shorten the duration. We beg to differ.
According to DermNet New Zealand, however, "pityriasis rosea is associated with reactivation of herpes viruses 6 and 7, which cause the primary rash roseola in infants. Influenza viruses and vaccines have triggered pityriasis rosea in some cases."

In other words, just as shingles is a reactivation of varicella (also called human herpes virus 3) in a limited area of the body, pityriasis is a flare of the human herpes viruses that cause roseola in babies.
Other sources such as eMedicine dispute this link but it makes sense to us. Pityriasis is not contagious. It's often preceded by a viral illness. Kids only get it once. Acyclovir, an antibiotic used to treat herpes virus, has been shown to help in bad cases.

In our practice, we once saw a teen with a wicked case of pityriasis whose mother fed her a ton of carrots and had her lay in the sun. The rash resolved in a couple days (she did look a bit orange)!  While dermatologists typically advocate steroid creams, we favor aloe or calendula topically.   
Other skin conditions that might be mistaken for pityriasis include nummular eczema, tinea versicolor, and PLEVA. If you're not 100% sure about your teen's rash, a visit would be prudent.
Vaping:  How Safe and Healthy?
Speaking of teens, the latest fad that has been generating concerns from parents in our practice is vaping. A quick search shows there are now about a dozen Vape shops within 25 miles or so of our office. When we opened in 2010, there may have been one or two.
Proponents of vaping argue that e-cigarettes expose both primary and second-hand users to a lot few chemicals than tobacco. Vaping fluid consists primarily of glycerin, propylene glycol, nicotine, and flavorings. There is also growing evidence that vaping can help tobacco smokers quit.
Back in January, however, we received a phone call from Westchester Medical Center. A 17 year-old from our practice, had been admitted with chest pain. Imaging studies disclosed a pneumo-mediastinum (an air collection around the heart). The young man admitted to vaping shortly before the chest pains developed.
Besides being uncharted, potentially-risky waters, we also see vaping as a likely stepping stone toward tobacco use and other bad habits. A study of some 2,000 high schoolers from Honolulu published in January supports this contention.
Vitamin B3, closely related in structure to nicotine, is a potent vasodilator. Perhaps some of you have experienced a "niacin flush." Think about it - anything taken along with nicotine gets delivered much, much deeper into our tissues.
If your teen asks about vaping, perhaps respond: "Just how deep into your lung tissue did you want to deliver that propylene glycol and blueberry flavoring?" Certainly there are healthier ways to satisfy the craving for B3 (e.g. inositol, probiotics, B-complex, etc).
Bambini actually take sides with the AAP on this one. And for an informative Powerpoint on the topic, click here.  Do you have opinions or observations on this matter?  Share them with others on our Facebook page (below link to this newsletter).
Is Breastfeeding Natural?  The AAP Weighs In
In the current issue of Pediatrics, the flagship publication of the AAP, psychologists Jessica Martucci and Anne Barnhill, PhD wrote:

Medical and public health organizations recommend that mothers exclusively breastfeed for at least 6 months. This recommendation is based on evidence of health benefits for mothers and babies, as well as developmental benefits for babies. A spate of recent work challenges the extent of these benefits...
Building on this critical work, we are concerned about breastfeeding promotion that praises breastfeeding as the "natural" way to feed infants. This messaging plays into a powerful perspective that "natural" approaches to health are better... Promoting breastfeeding as "natural" may be ethically problematic, and, even more troublingly, it may bolster this belief that "natural" approaches are presumptively healthier.
In a rather scathing commentary, Dr. Maya Shetreat Klein responded:
Today, I'm officially ashamed to be board-certified in pediatrics. This article describes what is literally the STUPIDEST so-called scientific paper I've ever seen. The authors of the paper, published in the widely read AAP journal Pediatrics, recommend that we stop calling breastfeeding natural, because the word natural is linked to "problematic" practices as home birth, homeschooling and the rejection of GMO foods.
In an op-ed published in Examiner, Alicia Bayer wrote:
The authors are especially concerned that promoting natural practices such as breastfeeding will harm vaccination rates, since many parents who follow natural parenting practices also delay or decline vaccines for their children. Thy also cite other examples of the "fallacy" that natural choices are intrinsically better, including the rejection of GMO foods, the preference for organic over conventionally grown foods and concerns over water fluoridation.
Suggesting that the media distort the truth about breastfeeding by deleting the word "natural" is a ludicrous attempt at manipulating public opinion. It's duplicitous. If the authors don't personally believe that breastfeeding is the most natural way to feed babies, well, that's too bad. They should do their homework - and maybe direct their efforts elsewhere. Meanwhile, they should leave the media, and moms, out of it.
Will Eating Two Breakfasts Make Kids Fat?
We've known for some time now that skipping breakfast promotes excessive weight gain in children -- this is somewhat counter-intuitive. But what happens when kids eat two breakfasts? Can that backfire and also lead to excessive weight gain?
Last month, in an article published in Pediatric Obesity (Imagine, a whole medical journal devoted to an epidemic that didn't exist 25 years ago!), researchers from the nearby University of Connecticut described results of their study aimed at this question.
Surveys and physical measurements were completed among students from 12 randomly selected schools. Some 500 fifth graders were followed for three-years. Not surprisingly, frequent breakfast skippers were found to have an increased chance of obesity. Weight changes from year to year, however, were similar between double breakfast eaters and other students.  Food for thought! 
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