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Dear Patients and Friends,

We have finally broken the social media barrier. Please like and share our Facebook page (Jeffrey A Hirschfield, MD PA) and follow us on Twitter (@toppediatrician) for news concerning current research opportunities, and office news.

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Dr. Hirschfield and the team.

Acne and its effects

Acne can occur at any age with the majority of cases involving infants and teenagers when hormonal stimulation is more pronounced.  Of course, parents of adolescents need to be cognizant of the potential psychosocial implications of moderate to severe acne, particularly those individuals with more severe presentations.  The overwhelmingly majority of acne cases in these age groups are simply transient and commence in the preadolescent & adolescent years and are not generally associated with an underlying disease.  If your “child” develops acne it would be worthwhile to seek consultation by a medical professional to rule out a possible hormone imbalance.

For acne to even develop an individual must have active glands stimulated by hormones that result in follicle plugging, sebum production, inflammation, and the generation of the acne bacteria, Propionibacterium acnes. Acne treatments start usually with a topical treatment of Benzoyl Peroxide acting as an antibacterial agent for mild cases.  When used in combination with oral antibiotics for more moderate cases the Benzoyl Peroxide may help to lessen the resistance of the bacteria to the oral antibiotics.


  • Childhood acne should be evaluated for other causes
  • Always use hypoallergenic washes or soaps for facial cleansing daily
  • Do not use antibacterial soaps
  • Always use a sunscreen that is  a rating of 30 SPF+ and reapply since the sunscreens are not waterproof
  • It is acceptable to use Benzoyl Peroxide in adolescents with mild acne cases
  • Avoid scarring and the psychological impact by seeking medical attention in cases of moderate to severe cases of acne





A cold is a cold and when a cough is not a cold

It is common for physicians to inquire from patients about shortness of breath or nighttime coughing spells.  Concerns should be raised about the possibilities of lower respiratory involvement versus upper respiratory involvement when there is intense cough, cough associated with exercise, or when the cough makes the individual awake at night.  In children, we usually consider cough to be acute, usually mild, not constant, and not involving shortness of breath.  If the cough is lingering or involves shortness of breath or is not improving, seek a healthcare professional.

Typical symptoms on an upper respiratory infection or “cold” are common in all age groups, these include runny nose, runny eyes, sneezing, fevers, and sore throats; however, you need to consider other causes, in addition to infections, particularly when the symptoms are lingering or involve shortness of breath. In all age groups, your doctor should include a comprehensive history to look for evidence of allergies, smoking history, cardiac history, or reflux history which could contribute to cough.  If the cough is moderate, constant, includes shortness of breath, or has a nighttime presentation, see a doctor.  Other non-infectious causes of cough may include congenital anomalies, foreign bodies, asthma, copd, reflux, or allergies. Historical information and specific cough details may help your doctor to determine what therapies are warranted.

It is important to remember that all coughing episodes do not support the need for an antibiotic at the doctors visit.  For example, asthma sufferers may need acute treatment with oral steroids to control the inflammation associated with asthma, for reflux sufferers the acute therapy may be antacid therapy and for common cold sufferers, the treatment may include frequent nasal saline and fever control to help promote healing  and resolution of the nagging symptoms of a cold.  But the simple message here is, not all colds are colds and to know when to seek medical attention.

Pediatric Vaccinations and the Naysayers

I urge parents who are concerned about vaccinations to review all the facts about vaccinations, rather than rely on a conversation or poor journalistic coverage that is not fair and balanced.  As a pediatrician, I ask all the parents in the practice to agree to routine vaccinations for their child(ren).  Failure to do so leads to an ever increasing incidence of Measles and other highly preventable infectious diseases that will continue to flourish in our communities, ultimately incapacitating or killing even innocent individuals.

Parents, if you have specific concerns, please discuss them with your pediatrician about why you have concerns, either of a specific vaccination, (ie MMR) or about a general aversion to the pediatric vaccination programs.  Nevertheless, failure to vaccinate your newborn or child may put innocent infants, child(ren), or adults in harms way from exposure to your underimmunized or not immunized child(ren).  Don’t be the “little blue person who turns red” as illustrated below.

I took an oath on graduation from medical school.  I owe it to every patient to “do no harm”.  I urge each and every parent to please follow standard vaccination practices and provide these life-saving vaccines to your child(ren).  Failure to do so ultimately places responsibility for unnecessary disease or death of innocent persons squarely on the shoulders of those who use the flawed “herd immunity” approach that naysayers know all about.


Illustration of Community Immunity (also known as “herd” immunity)

Community Immunity (“Herd” Immunity) Vaccines can prevent outbreaks of disease and save lives. When a critical portion of a community is immunized against a contagious disease, most members of the community are protected against that disease because there is little opportunity for an outbreak. Even those who are not eligible for certain vaccines—such as infants, pregnant women, or immunocompromised individuals—get some protection because the spread of contagious disease is contained. This is known as “community immunity.” In the illustration below, the top box depicts a community in which no one is immunized and an outbreak occurs. In the middle box, some of the population is immunized but not enough to confer community immunity. In the bottom box, a critical portion of the population is immunized, protecting most community members. The principle of community immunity applies to control of a variety of contagious diseases, including influenza, measles, mumps, rotavirus, and pneumococcal disease.


Consider alternatives to dairy consumption

Over and over, we read articles, watch news reports, and are taught from a very young age about how cow’s milk and dairy consumption are good for “bones” and “good for us”.  Many nutrition experts and research institutions are now more vigorously questioning these long-standing views that cow’s milk and dairy consumption is good.  Consider this, why are brittle bones and high hip fracture rates in American women at the highest level when compared to the rest of the world? It is a fact that American women consume more cow’s milk than in most countries around the world.  So, naturally you are likely to ask the question why do we have such a problem in our country with hip fractures?  Isn’t calcium derived from cow’s milk supposed to be a good thing? Maybe not.

Yet the science behind this belief may just tell a different story. Cows milk contains both high levels of calcium and animal derived protein (ie casein) both that are consumed at substantial levels in the USA and are known to cause increased calcium urinary excretion, that may lead to brittle bones and subsequent fractures.  So we may just have the scientific response to why brittle bones and American women suffer from this disease at record rates while other countries with predominant plant-based sources of nutrition do not.  Of course, there will always be skeptics out there!  I urge your families to become educated about your health and to consider alternative sources of calcium and proteins in your diets, like the consumption of plant-based alternatives like beans and green vegetables.


The China Study Startling Implications for Diet, Weight Loss, and Long-Term Health, T. Colin Camplell, PhD and Thomas M. Campbell II, 2006