Infant Anemia, Breast Milk Antibodies, Herpes – PediaCast 057

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Topics

• Infant Anemia
• Antibodies in Breast Milk
• Herpes Outbreak

Transcription

Announcer 1: This is PediaCast.

[Music]

Announcer 2: Welcome to PediaCast, a pediatric podcast for parents, the listener edition. And now, direct from BirdHouse Studios, here is your host, Dr. Mike!

Dr. Mike Patrick: Hello, everyone and welcome to PediaCast. It is episode 57 for Tuesday, October 9th, 2007. It's our listener edition and we are going to answer some of your questions about anemia, breast milk and herpes. How's that for selection of topics?

Being on vacation for a week and a half did lead to a little bit of backlog of your questions and comments. So this week we're going to have two listener shows in an effort to catch up a little bit, because we did have some good questions and I want to try to get to as many of them as we can.

And of course, if you have a question that you'd like us to address or have lines on a great interview or any other ideas for us here at PediaCast, just drop us a line. If you go to pediacast.org, you can click on the Contact link or you can email pediacast@gmail.com or call the voice line at 347-404-K-I-D-S. That's 347-404-K-I-D-S.

Let me also remind you as always that the information presented in PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for a specific individual. If you have a concern about your child's health, be sure to call your doctor and arrange a face-to-face interview and hands-on physical examination. So we are not practicing medicine here, folks. We're just trying to get some answers to your questions, but in terms of making healthcare decisions for your kids, you still need to talk to your personal doctor.

Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement, which you can find at pediacast.org. So with that in mind, we'll be back to answer your questions, right after this short break.

[Music]

02:52

OK. First up is Heather from Southern California and Heather says, "Thank you so much for your fantastic program! Your PediaCast #54 was so timely. Our daughter has a sacral dimple and a bit of a tail for lack of a better description and underwent an MRI last January at the age of 14 months. It was determined that she has spina bifida occulta with no complications. I was so impressed with the way you described sacral dimples, tethered cords and the such. You really put it in every mom and dad's terms. I just love your show! Our daughter is now 24 months old and was diagnosed with labial adhesions at her two-year checkup last week. Her adhesion is pretty severe and closed completely over the vagina. She was prescribed the Pemarin… Premarin cream (Yes, I'm a doctor, folks). She was prescribed the Premarin cream but our doctor failed to go into depth about the different side effects. Thank you for taking the time to go into such depth. I would have been very concerned if she had experienced the development or many period that you mentioned if I had had no warning." She goes on to say, "I do hope you had a great time here in Southern California. We were at Disneyland October 3rd and 4th, so I kept my ears open for your voice."

Thanks, Heather. But I wasn't going to stand in line and say, hello, everyone and welcome to PediaCast. But it's too bad. It would have been fun to meet up. She says, "Thanks again for doing what you do and doing it so well." So thanks again for your comments, Heather. We really, again, did just have a wonderful time in Southern California. Golly! I just can't believe the weather there. It was absolutely beautiful and everyone who lives there kept saying, oh, it's like this all year long. Aahhh, boy, that's the life!

And of course, great people, too. And then our last day at Disneyland was actually October 2nd, so we just missed seeing you, Heather, and it would have been fun. Our next vacation, I'll have to let you guys know where we're going to be and if anyone's around we'd be more than happy to meet up.

05:02

OK. Listener number two, this comes from Amy in Massachusetts and Amy says, "Thank you for putting out such a great podcast. I've been enjoying listening and learning from you since my son was born. I have a topic suggestion and hopefully, I haven't missed a previous discussion. My son was recently diagnosed with anemia at his one-year visit with his pediatrician. Could you please discuss what this actually means, any effects this may have on him and offer any suggestions to help solve this problem. I've been trying to address it with diet change, but could this mean an underlying problem? Thanks again. Sincerely, Amy."

Well, Amy, thanks for your question. Let's first talk about anemia in terms of what is the definition of anemia. By definition, anemia is a deficiency in hemoglobin. Now hemoglobin is the substance in red blood cells that carries oxygen from the lungs to the tissues and then it carries carbon dioxide from the tissues back to the lungs. So a deficiency of hemoglobin results in a decreased ability of the body to distribute oxygen and eliminate carbon dioxide.

Now the body compensates to some degree by increasing heart rate and breathing. The reason that that helps is because if you increase the circulation and the exchange of oxygen and carbon dioxide, so you basically are getting more use out of the individual red blood cells. So since you have less hemoglobin, less red blood cells in the blood to do the job of moving oxygen and carbon dioxide around, if you move what's there faster, you get more use or you recycle them more and can exchange gas a little quicker.

So one of the things that happens when kids are anemic is that often times their heart rate will start to increase and their breathing will start to increase so that they can compensate by having more gas exchange faster. Eventually though, this sort of compensation fails and you end up with a decreased amount of oxygen going to the tissues and an increased amount of carbon dioxide staying in the tissues. And this combination leads to a reduced ability of cells to grow and function.

And in babies, this is a particular trouble for the growing brain and the nervous system. And indeed, many studies have shown that infant anemia when it is prolonged and untreated can lead to a reduction in IQ points later in life. So having a good supply of oxygen is important for brain development and that's why we aggressively look for anemia in babies and treat it when we find it.

07:51

So how do we look for anemia? Generally, we check babies for anemia some time between nine and twelve months of age. And this is done with a simple blood test that either measures hemoglobin or measures something called the hematocrit, which gives you an idea, it's not quite as precise, but it gives you an idea whether anemia is there or not.

And if these blood tests are low, then we have to figure out what is causing the anemia and then we have to address that underlying problem in order to raise the hemoglobin back to its expected levels. We could do an entire in-depth episode or two or three on anemia and maybe we will some time.

It's actually a good idea because at all ages anemia is something that can be an issue and most parents know the word anemia but they don't really know what it means and what causes it at different age groups and of course there are lots of different things that can cause it. So like I say, it would be an in-depth topic all on its own.

But in this case, let's talk about just the most common cause of anemia in the nine to twelve-month old age range because that's what this question is about so we're going to just stick with that.

09:04

OK. I feel like we should have a drum roll here. What is the most common cause of anemia in nine to twelve-month old babies? This is one of those like are you smarter than a fifth-grader, are you smarter than your pediatrician? What do you think it is? Any guesses?

The answer is iron deficiency. The reason for that is the body needs iron to make hemoglobin. So if you have low iron then you have a reduced ability to make hemoglobin and so you have anemia.

So what do you do? Well, if a child has iron deficiency, we generally try to increase the amount of iron that they're getting in their diet. And this is most easily done with an iron supplement. And then once we put them on an iron supplement, we recheck the hemoglobin, usually monthly until it's back up to where we want it to be. And then once the hemoglobin is in the range where we want it, we usually continue the iron supplements for another two or three months to increase the body's iron stores, so it's less likely that they'll get anemic again. So basically, store up that iron for later use.

If the hemoglobin doesn't respond to an iron supplement as prescribed by your doctor or if the anemia is unexpectedly severe or if there are other blood work abnormalities, then we have to rethink iron deficiency as the cause and look for another cause. And there are lots of them, again, that's a much lengthier discussion which we'll have to save for another day.

So basically, anemia is something if you find it you want to listen to what your doctor is telling you. And if you do an iron supplement at the request of your doctor, make sure you do follow up and to be sure that the hemoglobin is back up where it ought to be.

10:55

OK, let's move on. The next question comes from Beth in Arizona and Beth says, "Dr. Mike, I have a two-year old and about 18 months ago she had an outbreak on her face that started out looking like a spider bite. Then our pediatrician thought it was a staph infection. Six months later, she had another outbreak at the exact same spot. It didn't get as big because I headed to the doctor right away. They told me they think she has herpes, like that, and a cold sore. But the outbreak will be on her cheek instead of her lip. The same day, my mom got diagnosed with the exact same thing but her outbreak happened under her nose. Both my mom and my daughter were prescribed Acyclovir, which helped my daughter's outbreak not spread like it did the first time. I'm glad we have that, but is there anything I can do to prevent it from happening in the first place? Both times my daughter had a cold for a month. It was winter and she was just slightly sick for a while. They said that when her immunity is low or if she's just stressed out she can have outbreaks. Is there anything we can do to prevent it? Thank you so much for your podcast. I really feel so much more aware of the things I should be for my kids. Thank you. Beth."

So thanks for your question, Beth. Like the chickenpox virus, I know we've talked about this before, but like the chickenpox virus, herpes lives in a dormant state in a nerve cell body. So you have nerves and part of the nerve goes to the nerve ending in the skin and that travels to a nerve body. If you think back and you're going to have to really probably stretch your brain here a little bit, but I'm sure that at some point like high school biology or if you took college biology class, you probably talked about nerves and the facts that they have a cell body, dendrites and axons. See, I know I'm tickling your brain a little bit, but I'm sure you learned that at one point or another.

12:54

So the nerve has a cell body and in that nerve cell body is where the herpes virus lives in kind of a dormant state. They can live there your whole life, but the immune system usually keeps it in check. But if the immune system gets busy or you're stressed out and that taxes the immune system as well, then the herpes virus can reactivate and if that happens it travels down the nerve and causes an outbreak in the area of skin that is served by that nerve in question.

There's really no way to kill the dormant herpes virus, but Acyclovir does kill the active form that went down the nerve to the skin and caused the outbreak. So the best approach really, if you want to prevent it, is either not get exposed to herpes virus to begin with, which is pretty much impossible, because it's everywhere and kids transmit it in their saliva and then their upper respiratory passages.

And we talked before about cold sores and herpangina in a previous episode. And if you search the archives, there's a whole discussion on that. But it is easy to spread and kids can get it pretty easily, so that's not really a good approach to preventing it. So the next best approach is to keep the immune system healthy and untaxed.

So hand washing is going to be important, avoid sick contacts as much as possible, but of course that's difficult to do. And at the first sign of another outbreak, which often is pain or itch or funny sensation of the skin prior to the rash breaking out, contact your doctor because starting Acyclovir at that point may prevent a significant outbreak. But once you have the outbreak, there's really not going to be a lot you can do it about it. It's best to start that Acyclovir as soon as you can.

14:49

Now, this is generally more of a nuisance issue than a health crisis, but there are some exceptions. Herpes outbreaks near the eye or on the sides or tip of the nose may signal herpes infection in the eye and this can lead to corneal scarring and loss of eyesight. So this is really important that any herpes outbreaks around the eye and that includes the sides and tip of the nose as well, you want to make sure that those are dealt with promptly.

Also, if outbreaks of herpes are frequent or in more than one location, you want to make sure the immune system itself is not the problem and there are tests that can be run to make sure the immune system is functioning correctly. And immune system function and testing is another great topic for an in-depth show at some point in the future.

Boy, I had someone asked me one time, aren't you going to run out of topics doing a pediatric podcast? I don't think so. And by the time we cover them all, which is pretty much impossible to do, your kids will all be grown up and I'll be talking to the next generation. So I think we'll be OK and you should see how thick some pediatric textbooks are. So I think we have plenty of material that we can cover.

16:05

OK. And finally, we have Sarah from Maryland and Sarah says, "Dear, Dr. Mike. I have a 17-month old daughter and I have a 17-month old question. I have asked everyone I know — my daughter's pediatrician, my gynecologist, my anatomy and physiology professor — and now I'm starting on people I don't know. Perhaps the answer to this question is too technical or perhaps this is just another opportunity to let people know how important breastfeeding is. Anyway, my question is how do the antibodies in breast milk get from the acidic or destructive environment of the digestive system into the baby's tissue or circulatory system where they can do some good? Which antibodies, IgA, IgG, IgD, etc. are able to escape the digestive system? How long are these antibodies beneficial? I've heard something about a baby's gut closing implying, perhaps, that after a certain point the digestive system may let fewer things escape so that the antibody benefit of breastfeeding may end before moms finish breastfeeding, though of course, other benefits may still apply. Thanks, Dr. Mike. I enjoy learning from your podcast very much. Sincerely, Sarah."

Well those are great, great, great, great questions, Sarah. And I'll be honest with you, I had to do a little bit of research on this, myself. Of course, once you find the answer as a doctor, one of these things you can't know everything about everything. You just can't. So what a good doctor does is when they don't understand something or they don't remember something, you'll look it up. And then sometimes when you find the answer you say, oh, I knew that. And this was one of those cases.

17:49

So let's tackle the stomach acid issue first. Most of the immunoglobulin in breast milk turns out to be a special form of antibody called secretory IgA. And this is the form of antibody that is present in our intestines. So older kids and adults alike have plenty of secretory IgA in their intestine already. It's a special type of antibody that's basically coated with a substance that protects the antibody from the damaging effects of stomach acid and digestive enzymes.

So remember antibodies are basically proteins and our intestine is built to digest proteins. So it's a very good question. In fact, I'm going to go off on a little bit of a tangent just very quickly. One of the things that's sort of out there on the Internet right now is that is it possible that hormones in cow's milk could be causing obesity in our children; maybe you've heard this before. But it's not a really good argument because the hormones that would be in breast milk would be destroyed in your stomach. There really not going to have much effect in children by drinking cow's milk, so that's an important point.

And the antibodies in breast milk are the kind of antibody that is specially made to be protected in the stomach and small intestine. So the body's pretty smart that way. The breast milk antibodies are protected against the harmful effects in the intestine.

19:34

Now, this also means that breast milk antibodies are best at fighting off intestinal diseases like the ones that cause vomiting and diarrhea. In terms of how long breast milk is beneficial, well that's a point of debate really in the medical community. Breast milk will always have antibodies in it regardless of how long mom breastfeeds and these antibodies will continue to provide some protection as long as the baby nurses, especially with regard to intestinal-type illnesses.

But you can't breastfeed forever and those secretory IgA antibodies that are in the breast milk aren't going to last forever. So sooner or later, a baby is going to have to enter the real world and make their own antibodies. And the longer that a baby relies on mom's antibodies, the longer it's going to take to start making them on their own.

I mean, there are only two ways that your body makes antibodies, either you get vaccinated for a disease or you get exposed to the real organism in question. You don't just start making a whole host of antibodies against all the different diseases on your own. You have to have that disease enter your body or that microorganism, whether it be a bacteria or a virus that causes that disease, has to enter your body. You usually get sick from it. Your body makes antibodies against it and then those antibodies are ready to fight that bacteria or virus the next time it comes along. And of course that's how vaccines work — you're fooling the body into thinking it's been exposed to that bacteria or that virus so that it makes antibodies, so when the real bacteria or virus comes along, you have some protection against it.

So as long as a baby is getting mom's breast milk, there's this passive immunity or the baby is just using mom's antibodies to fight things off. But that doesn't offer any long-term protection at all and you're basically just delaying the inevitable that your child is going to have to get sick a number of times in order to be protected into the future.

21:41

It's like when people become pediatricians, when we're training, we're sick all the time because every time we come in contact with a new virus, we have to get it to make immunity so the next time we see it we don't get sick anymore. And new teachers will tell you the same thing, new nurses will tell you the same thing that they're sick all the time. But after a couple of years, you catch most of the viruses that are out there and hopefully the rest of your career you're going to be pretty healthy.

How can I be around the flu so much, day in and day out, and all these other viruses and not be sick all the time? It's because I did my share or I had my turn with those viruses and bacteria so my immune system can fight it off pretty easily. But I wasn't born that way. I had to make those antibodies on my own.

So this is one of the reasons, too, especially in little ones in daycare centers and kindergarteners, first graders, the reason they seem to be sick all the time is of course that they have to catch every organism that comes along in order to be protected from it next time.

So really by prolonging breastfeeding you're giving your child antibody protection but you're also delaying their ability to make their own protection. So yes, breastfed babies have less illness than formula-fed babies, but they're still going to be prone to those same illnesses when mom does stop breastfeeding. You're just delaying the inevitable. And while that child is susceptible, the babies who were fed formula who were sick more often as a younger child will be less susceptible at least to the infectious diseases they already had.

23:28

And so what I'm saying by that is if you have a kid who stays home with mom and mom breastfeeds and is never in daycare and never really gets exposed to anything, those kids typically when they go off to kindergarten are just sick all the time because it's their time to catch everything. Whereas the kids whose parents, let's say bottle-fed and they went to a daycare center and they were sick all the time as an infant and a toddler, they do pretty well in kindergarten, first, second grade because they've been exposed to so much in the past they have better immunity.

So does this mean you shouldn't breastfeed, that you should take your young children to daycare, get them exposed to everything, get it over with and just give them formula? Noooo!!! That's not at all what I'm saying. So please, don't write in to the La Leche League and tell them I said you shouldn't breastfeed.

I'm just explaining why, OK? I'm not passing judgment here. Younger infants have a harder time fighting infection. They can become septic and dehydrated much more easily. So keeping them healthier during the first year of life is important.

I think it is important to avoid daycare centers. It is important to breastfeed. And then as kids get a little older let them fight off the viruses and bacteria. I'm just explaining why we observe what we observe. But some time between 12 and 18 months, mom's protection becomes less important. The baby's immune system matures, it fights microorganisms more effectively and at that point it's time to let the baby's immune system take over so he or she can begin to make the antibodies that will protect him or her for many, many years to come.

OK. I know I went off on a little bit of tangent there and I apologize. So the main question, Sarah, your question, the secretory IgA is a special antibody that is in the intestine and it's protected and that's the one you see in breast milk and that's why it does not get destroyed by stomach acid and digestive enzymes.

OK. Well that wraps things up for today's show. We'll be back and say one last goodbye, right after this.
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26:18

All right. Well thank you for tuning in. I really appreciate it. And as the audience grows I'm able to spend more and more time doing this because when you have a bigger audience you can kind of justify it to your wife and your kids and to all the people who have to understand that this project just takes up so much time.

But anyway, thank you for tuning in everyday. Also thanks to Vlad over at Vlad Studio and you can visit him at vladstudio.com, for providing the artwork for our website and the feed. Don't forget if you haven't done so already, reviews in iTunes are just extremely helpful. We're hanging out at about 125 reviews and I'd really like to have 200 reviews if that's possible within the next month or two. That would really help out a lot. I know we have over a thousand listeners easily, so 200 reviews in iTunes should not be too hard. So if you have not done that yet, I'd really appreciate it. It only takes a couple of minutes to write down a review in iTunes.

Don't forget another listener episode will be coming up later this week so if you recently wrote a question and we haven't gotten to it, don't hold your breath because, no, yeah, don't hold your breath because it'll be a couple of days. I'm not sure what that means really, don't hold your breath, because it didn't really fit there, did it? I'm sorry. I'm still on vacation, folks. We're going to do a research round-up episode tomorrow and then on Thursday we'll have that other listener episode and we'll wind things up on Friday with a special guest. So that's all coming up later this week.

I'll catch you tomorrow and until then, this is Dr. Mike Patrick saying stay safe, stay healthy and stay involved with your kids. So long everybody!

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