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Ask the Expert: Pediatrician Dr. Antonio Caceres

In this edition of  “Ask the Expert,” Dr. Antonio T. Caceres answers questions from several Go West readers. Dr. Caceres has been a member of the practice at New Beginnings Pediatrics in Geneva since 2006. He is a board certified pediatrician and a fellow of the American Academy of Pediatrics. He obtained his Doctor ofDr. Antonio CaceresMedicine degree from the University of Santo Tomas in the Philippines and graduated cum laude.  After completing his internship and pediatric residency training at Christ-Hope Children’s Hospital in Oak Lawn, Ill., he attended theUniversity of Illinois at Chicago Hospital from 1999 to 2001 for a clinical fellowship in Neonatology.  “Dr. Tony,” as he would like his patients to call him, is a big Chicago Bears fan and enjoys his free time with his three sons. His areas of interests are asthma, allergy and neonatology.

Q. My 6-year-old daughter loves the liquid yogurt Danimals. Is that a suitable substitute for milk?

A. Those liquid Dannon Danimals are simply irresistible. They taste good, they look good. They are, however, not a substitute for milk. The reason is that they only contain 1/3 the amount of calcium found in an average cup of milk. Calcium is important for healthy bones. One advantage that liquid Danimals do have is that they are low in saturated fats and cholesterol, and therefore recommended for kids who are slightly to moderately overweight, but who (also) love to drink milk.

Q.  How often should you bring in your kid for a “well  child” visit after the toddler years?  I feel like since they’ve become school age, I don’t really think about taking them in for a checkup like you do when they are babies/toddlers.

A. The answer is yearly. The reason for a yearly check-up is to make certain that their growth and development is at par with their ages. Namely weight, height and nowadays more important is their BMI (body mass index). Moreover there might be new recommendations for vaccinations (such as new vaccines) that a child may need to get for school or to prevent them from getting sick. Lastly, a yearly hemoglobin check (a finger poke to check for anemia) and a urinalysis (to check for early signs of kidney problems and diabetes) are equally important.           

Q. For parents who want to have their children immunized against the flu this year, can you shed any light on how the shots will be handled for this season? Will the H1N1 shot be separate from the regular flu shot? Will kids need to get two H1N1 shots if they had two last year? Are shortages expected?

A. Flu shot, we’ve got no problem this year. No shortage. In fact our clinic got our shipment last week. Therefore, it is now available. The H1N1 strain is now combined in this year’s flu vaccine. If your child received two doses of the H1N1 last year, they only need to get one dose this flu season. Not so many (parents) are aware of the FluMist (flu vaccine in a nasal spray). It is painless. Many of my patients prefer this versus the shot.

Q. Do you have any tips or suggested resources for parents who have children who are particularly picky eaters? I am lucky that my toddler is usually quite a good eater -- and will try most foods if she sees us eating them -- but she certainly has her moments. And I have many friends whose children just refuse to eat anything but really basic food, like chicken fingers, applesauce, cheese, etc. The parents don’t want their kid to starve, and they don’t want every meal to become a battleground, either.

A. One website that I always use is www.healthychildren.org. It is peer reviewed, updated annually and prepared by the AAP (American Academy of Pediatrics).

You are definitely right. The dinner table should never be a battleground. A toddler will eat whenever he or she feels hungry. I recommend PediaSure for true picky eaters. It contains vitamins, minerals, fiber, iron, protein, and the extra calories picky eaters may de deficient with. Lastly, make sure to avoid choke food hazards in the toddler years.

Q. Both of my twins (almost 9 months old) are allergic to the milk protein. The girl bled at 3 months of age and that's how the pediatrician found out, the boy just had many issues with regular formula and at the beginning it was thought it was just colic, until later, at around 4 months he was diagnosed.

Our pediatrician says there are high chances both (most likely the girl) will be allergic to bunch of other stuff  -- milk, soy, beef, nuts, etc. -- and they need to run blood tests at 1 year of age on both. What are their chances of having all these allergies for their rest of their lives? … None of my other kids have allergies at all, so this is a whole new scary world for me.

A. On a positive note, most milk protein allergies get outgrown at 4 or 5 years of age. Only a few goes up to adolescence. For your twins, soy milk and elemental formulas (Alimentum, Nutramigen) are alternatives. When they turn 1, soy-based milk or rice milk can be started. ImmunoCAP testing (blood test for allergy as an alternative for traditional skin prick testing) has a reasonable sensitivity as early as 6 months of age. I use this a lot in my practice. The absence of food allergy in your other kids carries a favorable prognosis for your twins. No one would be able to predict, though, if your twins will also have allergies to other food groups. A referral to an allergist will be helpful.

Q. My 5-year-old daughter was recently diagnosed with "seasonal" allergies this week.  She was started on OTC meds along with Flonase nasal spray. At what point would one decide to pursue allergy testing to better pinpoint the allergens rather than chalking it up to the generic category of "seasonal allergies"? For some family history, her dad suffers seasonal and pet allergies.

A. Allergy testing is undertaken when environmental modification and medications are not helping with the allergy symptoms. Another indication of allergy testing is when symptoms become life threatening (anaphylaxis). Anaphylaxis is characterized by difficulty of breathing, lips and eyelids swelling and difficulty swallowing. This is a medical emergency and you should seek medical attention right away. (Call 911.) During spring and summer, the majority of allergens are in our backyards. During fall and winter, when we start staying indoors, the usual culprits are dust mites, molds, animal danders and stuffed toys.

Note: This column is for general informational and educational purposes only, and should not be construed as personal medical advice or instruction Always consult with your healthcare provider, or your children's physician, regarding your own personal health and wellness and that of your family, or any questions you may have regarding a medical condition.

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