June 29, 2009

Clarification on HIB booster post

We need to post a clarification regarding the HIB booster for toddlers. Kids who are 12-15 months will be getting their HIB booster at their upcoming well child visits, which is the regular vaccination schedule prior to the shortage.

Any child between 15-60 months old who has not received his final booster shot, can get it now. We commented that kids under age 3 need to be caught up on this HIB booster dose because that is the primary group of kids who had to wait to get that vaccine until the shortage was over. But, any child under age 5 who is not up to date for HIB vaccine should get it.

Sorry for any confusion!

June 25, 2009

Attention toddlers: HIB booster shot is back!

The Centers for Disease Control announced today that medical providers can now resume giving the much needed HIB booster shot to toddlers.

HIB stands for Haemophilus Influenzae B. It's a bacterial infection that can cause meningitis and serious throat swelling (epiglottitis) among other things. There has been a nationwide shortage of this vaccine for quite a while now, and as a result, the limited supply was being given only to infants who had no protection against the disease. Toddlers who had already gotten their primary vaccination series have had to wait on their booster dose.

Here are the official recommendations:

  • Infants should receive their primary Hib series at ages 2, 4 and 6 months, and a Hib booster dose on time at 12 through 15 months of age.
  • Older children for whom a Hib booster dose was deferred should receive the Hib booster at the next routinely scheduled visit or medical encounter.
  • Mass recall of children for their catch-up Hib booster dose is not recommended at this time because physicians may encounter supply problems during such a massive recall.

"Updated Recommendations for Use of Haemophilus influenzae Type b (Hib) Vaccine: Reinstatement of the Booster Dose at Ages 12-15 Months," MMWR, June 26.

I highlighted the bullet point above so that every toddler in my practice doesn's show up at my office tomorrow morning asking for a HIB shot!  I know with my own practice, it will take a little time to get additional HIB vaccine in our office from our supplier. That will probably be the case for your doctor's office as well.

So, what does that mean for you?
If you have a child who is 12-15 months old, he will get his HIB booster just like he would have normally.

If you have a child who is between the ages of 18-36 months, ask your doctor if your child is due to get his HIB booster next time you are in for an office visit. Medical providers will be trying to catch all these kids when they come in for sick or well child visits, but you can help us remember!

May 29, 2009

New Vitamin D drops

If you have been following our blog on this topic, you know that the AAP changed its recommendations for Vitamin D supplements this past fall. All breastfed babies, and babies receiving less than 32 oz a day of formula should get a Vitamin D supplement.

Previously, I recommended Tri-Vi-Sol (a trio of Vitamin A,D, and C) for those supplements. Now, there is a new option—D-Vi-Sol. Yep, you guessed it, it is just Vitamin D. Look for it in stores now.

Pic o' the week: Hand-foot-and-mouth

-3
This is the bug of the week in Austin, TX....and probably many other places across the country. Typically, we see this virus (official name: Coxsackie virus) every spring and summer. It's not serious, but it is contagious. It spreads through infected saliva—so little kids who put toys in their mouths are notorious for spreading it through daycare. Young kids will have a fever and may be no other obvious symptoms to mom and dad. Except, they are less interested in drinking because they have sores in the back of their mouths. If you are lucky, there is a rash on the hands and feet (like the one in the picture) to confirm the diagnosis.

I personally think it should be called hand,foot, mouth, and anus--because sometimes the rash ends up there too.

Photo courtesy of Jason Reichenberg, MD, dermatologist.

May 21, 2009

Chemical castration as autism therapy?

Yes, you read it correctly. A medical doctor (who is not an endocrinologist) and his son (who has no medical degree at all) are touting their "revolutionary" therapy to treat autism. It's called the Lupron Protocol. Lupron is a hormone used to treat some forms of prostate cancer as well as to chemically castrate sex offenders. Using it in young boys can have a significant impact on their growth, bones, and sexuality. The doctor/son team claim their research shows a benefit for children who have autism spectrum disorders.

Fortunately, I am not the only one who is disturbed by this! Today's Chicago Tribune article http://www.chicagotribune.com/health/chi-autism-lupron-may21,0,3647307,full.story
does a great job of exposing this dubious and dangerous therapy.

May 14, 2009

Chicago babies go BPA-free

Yesterday, the Chicago City Council voted unaminously to ban the sale of baby bottles and sippy cups that contain the chemical, bisphenol-A (BPA). This ban comes before the FDA has completed its ongoing investigation of the chemical. Law or no law--FDA or no FDA, consumers have already started driving BPA out of the marketplace, anyway.

Read the New York TImes article for more details:
http://www.nytimes.com/2009/05/14/us/14plastic.html?ref=health

May 08, 2009

Binkies and breastfeeding can mix

This week actually brought health news other than H1N1 virus.

A study in this month's Archives of Pediatric and Adolescent Medicine sought to debunk a myth that's been circulating for quite some time: Pacifiers don't make a baby or mom choose to stop breastfeeding. Once again, correlation does not necessarily mean causation. Although babies who use a pacifier may breastfeed for a shorter time in their lives than those who do not use a pacifier, the pacifier itself is not the reason. Parents who choose to use a pacifier may also choose to nurse for a shorter period of time—for a variety of reasons that should be explored and addressed to improve breastfeeding rates.

After reading this study, I personally feel better and less conflicted in the advice I give to parents. I am a strong breastfeeding advocate. But, I also know that newborns have very few strategies to console themselves other than sucking. That's why the pacifier works. However, I do think breastfeeding should be well established before offering up that binkie. Babies can suckle a little differently with a pacifier vs the breast (especially if you use a brand other than Soothie), and it can cause some real discomfort to mom if that happens.

For the first couple of weeks, try letting your newborn suck on your finger to settle down. Then, you can offer a pacifier later on. If you do go the paci route, just know when to stop using it!! Your toddler has no good reason to have a pacifier—really, folks.

Pacifiers and Breastfeeding: A Systematic Review. Nina R. O’Connor, MD; Kawai O. Tanabe, MPH; Mir S. Siadaty, MD, MS; Fern R. Hauck, MD, MS Arch Pediatr Adolesc Med. 2009;163(4):378-382.

May 02, 2009

H1N1 update, from the trenches

This week, I have blogged quite a bit about official recommendations coming from the CDC and state health departments. They have gone above and beyond in keeping everyone informed.

I thought you all might find it helpful to hear what is going on near "ground zero" here in Texas. I have purposely tried to keep my own opinions out of this because I do not think speculating on an evolving situation is helpful. But, being in the trenches all week dealing with concerns of this flu virus, I can give you a unique perspective. I work in a large pediatric practice in Austin, TX--specifically Travis County, where there have been no confirmed cases of H1N1 (formerly called swine) flu. There have been "probable" and "suspected" cases, but none confirmed. The week started with a flurry of phonecalls which progressed to a flurry of appointments by the end of the week. Appropriately concerned parents brought their children in (as they were told to) if their child had a fever, runny nose, cough, or sore throat.

Here's what I saw this week: a lot of children, none of whom were very sick!

Here are 6 things I have been telling every parent who asks (which is everyone, by the way.. you are not alone!)

1. Who needs to get tested?
Dutifully, I have sent out flu swabs on virtually every child's snot who didn't have a really good excuse to be sick otherwise...partially to ease parents' fears, partially to help identify the magnitude of this infection, and obviously, to treat anyone who truly has influenza infection (and give preventative medication to those exposed to that person). By and large, the kids I have seen and tested just look like they have the common cold and do not look like they have the flu. In ordinary circumstances, I suspect most parents would not have even bothered to bring their child the doctor for evaluation.

2. What does H1N1 disease look like?
Typically, kids with the typical flu we see every year look sick, run high fevers and have body aches and chills before the cough and runny nose starts. It will take some time to figure out if many cases of this new viral illness are mild (like having a cold)--or do all these snot-nosed kiddos just have a run of the mill common cold virus? Our Texas state health department is trying to keep up with all the specimens they are receiving (1500 this week, just from my county alone). Those test results will help us figure it out.

3. Are there other illnesses out there right now?
YES! Right now, both Strep throat and Hand-Foot-and-Mouth (caused by coxsackievirus) have made their annual trek into my community. Both can cause fever without an obvious source (unless you look in your child's mouth or your child has a rash). Hand-Foot-and-Mouth can cause a rash--pimply or ant-bite or flat red dots on the hands and feet (and sometimes around the anus). Strep can cause a sandpapery red raised dot rash on the trunk. (Check out baby411.com bonus material "rash-o-rama" for pictures). So, if your child has a fever and is eating less or complaining of a sore throat, it's quite possible he has a throat infection and not H1N1 virus. Get it checked out. To complicate matters even further, Influenza B--one of the common typical influenza strains-- is also floating around for the annual "end-of-flu-season" sale. A viral nose swab can differentiate whether your child has Influenza A (possibly H1N1) and Influenza B--which is NOT swine flu. Influenza B, like H1N1, is treatable with antiviral medication.

4. Should we be worried?
Concerned and aware—yes. Worried to the point of cancelling a birthday party or locking your doors and windows—no. I am not downplaying the attention to this new virus. The CDC and World Health Organization are right to have concerns about a novel strain of flu virus that almost no human will be immune to. But no one knows at this point whether this flu strain is any more serious than others and if it spreads any more easily than the other germs we are familiar with. I do have great respect for infectious diseases. The typical influenza viruses we see every year kills 36,000 Americans annually. Hence, the reason why I am such a supporter of vaccines—if there is a way to prevent the spread of these illnesses, it would be silly to opt out and risk getting the disease! This current experience is a good reminder of that.

5. What should I tell my child?
Most kids that I have seen in my office this week, as well as my own children, are keenly aware of swine flu. And, if their parents are freaked out, they are too. That is counterproductive. You can explain that there is a flu virus going around and if someone gets the illness, they can take medicine for it. That's the truth.

6. Where should I go to seek medical attention?
If you have a medical home, use it. That's the phrase used to describe your primary care doctor or clinic. Emergency rooms are not the place to go, unless it is truly an emergency. Primary care practices and clinics are all capable of doing appropriate flu testing and sending those specimens where they need to go. We have all been kept well informed by our local and state health departments.

April 30, 2009

Swine flu, greetings from Texas update

Many of you that read this blog are patients in my Austin, TX practice. For those of you following this story closely, please see the latest confirmed swine flu count from our state health department here:
http://www.dshs.state.tx.us/swineflu/default.shtm

There are 26 confirmed cases, including the child from Mexico City who died in Houston. There are no confirmed cases in Travis County.

I'll keep you posted!

April 29, 2009

4 things you might want to know about swine flu (H1N1)

With new cases being reported and the first death of a child reported in the U.S. today, it's not surprising that parents have lots of questions about how to deal with the potential infection with this new strain of influenza virus. Here are 4 things you might want to know about:

1. Fever is the first clue. If you or your child has the sniffles or a cough but doesn't have a fever, it's unlikely to be influenza. Fever is usually the first sign of illness, accompanied by bodyaches and chills. Little ones who are too young to tell you that will be fussy/irritable and less interested in playing or eating. And, they initially have no other obvious symptoms of infection. And fever, by definition, is 100.4 F or greater. For a child under age two, I recommend taking the temperature rectally. Again, if there's no fever, it's not flu. If your child has a fever and you cannot figure out why, or if your baby is under four weeks of age with a fever, call your doctor!

2. Antiviral meds work. Both Tamiflu and Relenza appear to be effective in both treating H1N1 virus (if medications are started within 48 hours of symptoms) and in preventing the spread to those who have been exposed to someone with a confirmed case of H1N1 influenza virus. You don't need the medicine if you don't fit into either of those categories. While Tamiflu is only FDA approved for children over one year of age, the Centers for Disease Control has listed emergency dosing for kids ages 0-1 who have the disease and kids ages 3 months-1 year who have been exposed on their website. Pregnant and nursing women can also take these medications.

3. Say no to Pepto, and aspirin. If your child is 18 years or younger, do not give aspirin or products with aspirin-like ingredients (i.e. Pepto Bismol) when he has influenza or a flu-like illlness. These medications can trigger a serious liver disease called Reye Syndrome.

4. If you have questions, go to the source: The Centers for Disease Control has done an excellent job of keeping the public informed moment to moment. Their website has frequent updates at www.cdc.gov/swineflu/

Your email address:


Powered by FeedBlitz