Doctor Mih - Pediatric Office

08/30/2025

07/30/2025

04/02/2025

Doctors in West Texas are reporting vitamin A toxicity in measles patients, raising concerns about misinformation. Several unvaccinated children hospitalized with measles have shown abnormal liver function, likely from excess vitamin A supplementation. There's important nuance here: vitamin A has a legitimate role as a supportive treatment for measles when properly administered by healthcare professionals, yet it can be dangerous when misused.

When given under medical supervision (typically as two large doses 24 hours apart), vitamin A can help address the depletion caused by the measles virus and potentially reduce severity—but it does not cure the infection. The National Foundation for Infectious Diseases specifically recommends vitamin A treatment for all children with measles in the US, regardless of nutritional status.

However, vitamin A has absolutely no preventative effect against measles infection. The MMR vaccine remains the only way to prevent measles, with 97% effectiveness after two doses. Vitamin A supplementation primarily benefits those with deficiencies, which are rare in developed countries like the US. Whether from "natural" sources like cod liver oil or supplements, excess vitamin A can cause serious, sometimes irreversible health problems—making medical supervision essential for all vitamin A treatment.

https://www.cnn.com/2025/03/26/health/texas-measles-vitamin-a-toxicity/index.html
https://www.healthychildren.org/English/tips-tools/ask-the-pediatrician/Pages/can-vitamin-a-prevent-or-cure-measles.aspx
https://www.nfid.org/what-you-should-know-about-measles-and-vitamin-a/
https://www.mayoclinic.org/diseases-conditions/measles/diagnosis-treatment/drc-20374862 #:~:text=Giving%20a%20child%20vitamin%20A,be%20given%20to%20younger%20children.

03/20/2025

In this Healthier Hawaii, we’re talking about the dangers of va**ng for adults but particularly for children.

02/16/2025

You may have heard me recommend against cough medications for children less than 6 years of age. Why is that? What can you use instead?

One of the main ingredients in over-the-counter cough medications is dextromethorphan (eg, Robitussin and Delsym). Several studies have found no benefit in using dextromethorphan when it comes to cough severity or sleep quality. Side effects (although rare when used at reasonable doses) include confusion, speaking difficulties, stupor, nystagmus, ataxia, urinary retention, dystonia, coma, hallucinations, tachycardia, seizures, and respiratory depression.

Guaifenesin (eg, Mucinex) is another common over-the-counter ingredient for treating cough. While the side effect profile is much less concerning than dextromethorphan, this drug has failed to show measurable effects on sputum volume or viscosity in clinical trials, suggesting that it is unlikely to be effective when used to treat acute respiratory tract infections (aka the common cold).

What about v***r rubs? A randomized trial of Vicks VapoRub found that a single application was associated with a decrease in cough and congestion when compared to placebo. Children also reportedly had improved sleep as well. Because of the presence of camphor as an ingredient, seizures can result from v***r rub ingestions, so do NOT allow your children to eat it. Avoid use in children under 2 years old (they are highly likely to rub it in their mouth and/or eyes). Make sure to apply to the chest or neck, not inside the nose.

At any age, a cool-mist humidifier or v***rizer can be used to moisten the air to lessen cough and congestion. ☁ Do not worry about the color or consistency of your child’s mucus – the idea that green is bad is a myth.

One of my favorite things to teach parents: A sore throat paired with the cough and runny nose is likely viral and does NOT warrant testing for strep throat! Older kids can try gargling salt water. Otherwise, offer plenty of fluids, rest, and Tylenol/Motrin as needed for discomfort.

Coughing is the body's natural way of protecting the lungs from mucus build-up and subsequent pneumonia. If the cough is really bothersome (interfering with sleeping, eating, etc.), try giving half a teaspoon of honey for children ages 1-5 years or 1 teaspoon for kids ages 6 and above. Cough drops or lozenges are okay at the age of 4 years and up, but they serve as a choking hazard for younger children. Do not given honey to infants less than 1 year of age.

Lastly, cough and congestion can last for weeks. HANG IN THERE, but see your doctor if a true fever (100.4F and above) lasts for more than 4 days in a row. Prevent the spread of germs by washing your hands (or using alcohol-based hand sanitizer) a LOT. Cover your nose and mouth with a tissue or sleeve whenever you cough or sneeze. Avoid touching eyes, nose, and mouth whenever possible. 👍

Primary Sources:

1. Lam SHF, Homme J, et al. Use of antitussive medications in acute cough in young children. J Am Coll Emerg Physicians Open. 2021 Jun 18;2(3):e12467

2. Lowry JA, Leeder JS. Over-the-Counter Medications: Update on Cough and Cold Preparations. Pediatrics in review 2015;36:286-98.

02/08/2025

https://www.pbs.org/parents/thrive/how-to-raise-a-self-confident-girl

Find out how you can empower your daughter and bolster her self-confidence.

01/18/2025

Currently Hawaii is experiencing high rates of viral respiratory illnesses. Of note, we have been seeing especially high rates of influenza. Symptoms include fever, body aches, nasal symptoms, headache, chills, and generally feeling crummy!

https://www.cdc.gov/respiratory-viruses/data/index.html

01/06/2025

https://www.facebook.com/100068442188430/posts/901360665488665/

09/19/2024

Federal officials have announced the recall of products that may be harmful to children.

09/09/2024

Our office now has influenza vaccines available! We have already been seeing influenza cases through the summer. Typically the flu season starts in September and runs through May, so we expect the rates to increase this fall and winter. Current patients may contact us for an appointment.

After careful study, we have transitioned from the traditional egg-based vaccine (Fluzone and others) to the cell-based vaccine (FLUCELVAX).

The main advantage is that cell-based vaccines have shown greater protection compared to egg-based vaccines. More detailed information from the CDC here: https://www.cdc.gov/flu/prevent/cell-based.htm