Flu & You: Protecting Your Family During the Flu Season

Originally posted on my US News & World Report parenting blog (Feb 16)

THIS YEAR’S flu season is officially reaching its peak, and this year’s strain of influenza virus is cause for considerable concern, striking with a vengeance not seen in decades. It’s causing more severe illness, more hospitalizations and even more children’s deaths, as parents do what they can to try to protect their kids.

In reality, the strategies being recommended to combat this year’s flu are essentially the same as those employed in years past. While you’re likely to have heard about many of these strategies before, it’s nevertheless useful to remind ourselves of the importance of washing our hands and covering our coughs; getting everyone in the family who is 6 months or older vaccinated; and being on alert for and recognizing early the signs of the flu – such as fatigue, body aches, cough, sore throat and fever – and it’s potential complications, from sinus infections and pneumonia to heart problems, particularly in more vulnerable individuals, like the very young and very old or those with compromised immune systems.

Now that’s easy to say, and it sounds like easy enough advice to follow. Yet each year I’m left wondering why it is that, as parents, we don’t always feel confident in our approach to fighting the flu. In large part, it’s the fault of the virus responsible for causing the flu. The influenza virus is cunning in its ability to change from year to year, which makes it all the more difficult to protect against.

But I would also suggest that there are some parenting practices and commonly held parenting beliefs that, despite our best intentions, stand to get in the way when it comes to protecting our children, and ourselves, from flu’s wrath.

It’s useful to start with a clear understanding of what “the flu” actually is, and what it isn’t….

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Parenting a sick child: When a child’s cough is cause for concern

I was recently asked by a concerned parent, “When is a kid’s cough something you should worry about?” As a pediatrician, I feel obligated to point out from the outset that, in most instances, this is a question that really needs to be discussed directly with one’s own pediatrician. There are, however, several general cough concepts I can share with you that will hopefully help you gain a better big picture perspective.

It’s first worth pointing out that a cough, at the most basic level, is simply a reflex that exists to help keep things out of the airway. Even though it may not seem like it when your child is up and coughing in the middle of the night, a cough (like a fever) can actually serve a useful purpose.

As for considering the various causes of a cough, some of the most common in children include infections, asthma, choking or having something stuck in the airway, croup, habit coughing, and certain medical conditions (usually ones children are born with). Some are easy to identify, while other causes can take a bit more sleuthing. Even when you have identified the underlying cause, it may not always give you a definitive answer as to whether to be concerned. In the case of cough-inducing infections, plenty of common colds can cause an inconvenient, annoying cough. Pertussis, on the other hand (also caused by an infection and referred to as “whooping cough”) is known for it’s nagging cough…and the fact that it can prove deadly to infants.

When it comes right down to it, figuring out when to worry about a cough needs to be treated as a problem-solving venture. The following are some of questions most worth considering and the symptoms you’ll want to be on the lookout for.

Age matters.  Any cough in a baby three months or younger warrants a visit to the doctor’s office.

At a loss. It’s one thing to cough. It’s altogether another when the cough takes one’s breath away and is accompanied by more concerning signs such as troubled, noisy, and/or fast breathing.

Time of day. Taking note of how much, how often, and even when during the course of the day and/or night your child coughs can provide some telltale clues. Mucus drainage, for example, typically tends to trigger an increase in nighttime coughing. Habit coughs, on the other hand, tend to go away during sleep.

Persistence counts. More than 2 weeks of a cough definitely warrants a check-up. Coughs associated with run-of-the-mill colds don’t usually last this long, while pneumonia, sinusitis, and other causes of persistent cough often do.

Describe the circumstances. Any history of a sudden cough – especially following a gagging or choking episode – is particularly concerning for a foreign object in an airway.

Over-exposure. Consider if your child’s cough matches that of his siblings, his preschool classmates, or others he’s recently come in contact with. While I’m on the subject, let me also take this opportunity to add that while it’s a very wise idea to take advantage of practical and effective measures to stop the spread of germs – think hand washing, vaccines, and basic disinfection of contaminated surfaces – it’s unnecessary and, more importantly, unrealistic to think that you can (or should) keep your child away from all germs.

Wet or Dry. A mucusy cough is often referred to as a “wet” cough, whereas a cough without mucus is more likely to be called a “dry” cough. While determining whether a cough is wet or dry doesn’t automatically determine the underlying cause or inherently tell you how concerned to be, it can prove to be useful information.

For better or for worse. It’s fairly straightforward but worth saying that taking note of what triggers your child’s cough and what makes it better can be key in figuring things out. Croupy coughs tend to be worse at night and better with moist air. Asthma coughs can be caused by known allergens, may worsen with exercise and respond well to albuterol or other asthma medications.

Additional warning signs. Any time a child has other accompanying symptoms of concern such as a high fever, coughing so hard they are vomiting, coughing enough that they refuse (or are unable) to drink, or cough up blood, it’s time to head to the doctor. to the doctor.

Originally posted on Omaha World Herald’s Live Well Nebraska

Fighting fever phobia: The facts about fever for parents

This seems like an appropriate time to spend a few minutes focusing  on the subject of fever, in part because it’s one that effects (and therefore interests) just about every parent I know, and also because we happen to be right in the middle of cold and flu season – a time of year during which children inevitably experience far more than their fair share of fevers.  It’s also because fever phobia amongst parents is usually far more pervasive than it is warranted. That’s not to say that fever is inconsequential, but rather that we should all take the time to brush up on exactly what fever is, what it represents, when it does (or doesn’t) need to be treated, and how to do so appropriately. Fortunately,  the American Academy of Pediatrics just pulled together all of the latest expert thinking on the management of fever in children and released it in a clinical report entitled Fever and Antipyretic Use in Children.

Given the importance of the subject,  I figured it would be particularly helpful to review just what these latest fever recommendations tell us about fever.

A healthy respect for fever.  It’s important to understand that fever is not an illness, but rather a common and normal response to infection. While fevers can in some instances signify a more serious underlying infection, they are unlikely to endanger generally healthy children.

It’s a matter of degree – or is it?  According to the AAP’s report, the use of fever-reducing medications should be focused on making children more comfortable, rather than getting rid of fevers altogether. It’s certainly useful to own a thermometer and to know how to accurately measure your child’s temperature. But all too often, parents unnecessarily focus on using fever-reducing medications to fight their child’s temperature back down to normal and keep it there.

The benefits of fever. While I know it may be hard to recognize any benefits when you’re home caring for a sick child, the report reinforces that fever is actually thought to have a  beneficial effect when it comes to the body’s efforts to fight infection.

Fighting fever phobia. The most common fear that parents, caregivers and even health care providers often share is that high fevers, if left untreated, will result in seizures, brain damage, or worse. In fact there is no evidence to support this fever phobia, as there is no evidence that fever itself worsens the course of an illness or that it causes long-term neurologic complications.

Treat with care. Acetaminophen products (like Tylenol) and ibuprofen products (such as Motrin or Advil) are considered equally safe and effective for use in the treatment of fever for children 6 months of age and older. That said, it is especially important for these fever-reducing medications to be dosed accurately and given no more often than necessary or recommended (every 4-6 hours for acetaminophen and 6-8 hours for ibuprofen). As for giving them in combination or alternating them, as is often discussed, it may be effective but shouldn’t be done unless absolutely necessary since it increases the risk of making dosing errors.

Originally posted on Omaha World Herald’s Live Well Nebraska

What’s the Big Deal About Chickenpox?

I presume that many of you just received the same notification that I got in my children’s school newsletter regarding Nebraska’s new 2011-2012 School Year Immunization Law. For any parents who may have missed it: in short, the state of Nebraska will soon require all students (K-12) to have two immunizations (instead one) for Varicella (Chickenpox) unless they provide written documentation verifying prior varicella infection. In keeping with Nebraska’s current immunization laws, children won’t be allowed to attend classes in public or private school until the school has written proof of either prior chickenpox infection or the required two varicella shots.

The update in Nebraska’s Immunization Law, with its increased requirement from one to two doses of chickenpox vaccine, came as no surprise to me since I make it a point to keep current on the latest immunization recommendations. That said, I have found that parents have had many questions about the chickenpox vaccine ever since it first became available in the US over 15 years ago. I figured it might therefore be useful to address some of the questions I’m most frequently asked about chickenpox and the vaccine.

What’s the big deal about just getting chicken pox? Let me first say that I fully understand the temptation for parents to consider chickenpox a not-such-a-big-deal childhood infection. After all, it is usually mild and self-limited – known primarily for being highly contagious and causing an itchy rash, fever and maybe some accompanying fatigue. What I have found, however, is that parents are often unaware of the fact that prior to the vaccine, chickenpox was also responsible for about 11,000 hospitalizations and 100 deaths in the US every year. Young children and adults were (and still are) more likely to develop serious symptoms as chickenpox infection can lead to severe skin infection, scarring, pneumonia, and even brain damage or death. In other words, chickenpox can be a very big deal.

Does the chickenpox vaccine work? Yes. The chickenpox vaccine does work to prevent chickenpox, as most people who get the vaccine will not get chickenpox. In fact, a single shot is estimated to be 80 to 90 percent effective. That said, it is possible to get chickenpox after having been vaccinated. Less than an estimated 1 to 3 percent of vaccinated children each year develop a mild varicella-like syndrome involving fewer blisters, less likelihood of fever, and shorter duration of symptoms.

Can you get chickenpox from the shot? While most people who get the chickenpox vaccine don’t have any problems with it, according to the CDC’s Chickenpox Vaccine Information Statement approximately 1 in 25 may develop a mild rash up to a month after getting the vaccine. While it’s possible for people with this rash to infect others, it’s extremely rare.

Why are two chickenpox shots needed instead of just one? Like a majority of other vaccines, it has been determined that chickenpox requires a second shot in order to provide adequate immunity. It is true that when chickenpox vaccine was first introduced in the US in 1995, it was initially recommended as a single shot (between the ages of 12 and 15 months). In 2006, however, the Advisory Committee on Immunization Practices recommended adding a second dose (between the ages of 4 and 6) after outbreaks were seen in previously vaccinated school-age children.

While I understand the temptation to cringe at the thought of yet one more shot added to our children’s already immunization schedule, I would like to suggest that we remember to be grateful for the fact that we have available to us a chickenpox vaccine that is much safer than getting the disease itself.

Originally posted on Omaha World Herald’s Live Well Nebraska

Preventing Carbon Monoxide Poisoning: What Every Parent Needs to Know

In an attempt to maintain my glass-half-full view of the world, I’m always relieved when I sit down to read the morning paper and come across a good tragedy-averted story interspersed amongst the doom and gloom. So believe me when I say I was particularly happy to read John Schreier’s article, Carbon monoxide sickens students. While it’s unfortunate that more than 40 UNL students recently wound up at the hospital after waking to symptoms consistent with carbon monoxide poisoning, the operative word in this description would have to be “waking.” Because the fact of the matter is that carbon monoxide is one of the leading causes of poisoning deaths in the United States. Often dubbed “the silent killer,” this toxic gas is colorless, tasteless and odorless, but has the deadly ability to disrupt the body’s use of oxygen. In other words, things could have been worse at the UNL fraternity house. Much worse.

Recognizing this, my thoughts immediately turned to the fact that this near-tragedy (with its thankfully happy ending) might momentarily grab people’s attention long enough for me to convey some very important safety information.

I certainly don’t mean to imply that no one would pay attention to information about carbon monoxide precautions except in times of tragedy. But human nature has me convinced that it’s all too easy for the out-of-sight, out-of-mind principle to take over – especially when it comes to the many hidden and/or silent dangers around the house and a not-so-subtle reminder of these dangers can go a long way towards helping focus everyone’s attention on the following simple yet potentially life-saving home safety measures.

  • Recognize the potential signs of carbon monoxide (CO) poisoning. Symptoms can admittedly be non-specific, variable and wide-ranging, but most commonly include headache, nausea, dizziness, and a general feeling of malaise that can be confused for a viral infection. See a doctor right away if everyone in the household begins to experience flu-like symptoms at the same time, especially if the symptoms seem to get better upon leaving the house.
  • Have the number to Poison Control (1-800-222-1222) posted by the phone and don’t hesitate to call it should you suspect CO poisoning.
  • Make sure to put a CO detector on each level of your home.
  • Never leave a car running in the garage, even if the garage door is open. Dangerous fumes can not only fill the garage in minutes, but also easily seep their way into the house.
  • Get household appliances that have the potential to leak carbon monoxide such as furnaces, wood stoves, fireplaces, gas water heaters, ovens, stoves and clothes dryers serviced yearly to make sure they are in good working order.
  • Refrain from using charcoal grills indoors (or in closed-in spaces) and never use a gas oven to provide heat for your home, as both can be dangerous sources of carbon monoxide gas.

Originally posted on Omaha World Herald’s Live Well Nebraska

Giving Thanks: Things the Whole Family Can be Thankful For

I bought my turkey this past weekend. Not only did I buy it, but I even took a moment to think about how thankful I am for it. Sure I’m thankful because I love turkey, but also simply because I am fortunate enough to be able to afford a turkey. As a parent, I know full well that taking a simple weekend task like grocery shopping and turning it into a shared reflection on what our family has to be thankful for is likely to lead to some eye-rolling from my tween- and teenage children.

But the fact of the matter is that there’s no better time than the present (i.e. Thanksgiving week) to take a few moments – whether waiting in line at the grocery store or gathered with family and friends around the Thanksgiving table – and reflect on those things in your life for which you’re truly thankful. While trips to Disneyland, ipods, and the latest greatest toddler toys will understandably spring to mind first, I suggest you challenge your children, and yourself, to dig deeper. As a pediatrician and parent, I figured I’d get you started by sharing some of my own, all-too often taken for granted things to be thankful for.

Breathing through your nose. Spoken like a true pediatrician, right? But years of tending to snotty nose colds (my own, my children’s, and others’) has taught me that it’s hard to take time to stop and smell the roses if you can’t breath through your nose. You may think I’m kidding, but I’m not. Just think how many times your child’s (or your own) stuffy nose cold has kept you up at night and caused you misery. Instead of being frustrated by the annual average 6-10 colds that kids catch each year and the fact that we still don’t have a cure for the common cold, I suggest that we all remember to be grateful for each day that we wake up healthy.

Shots. I figure while we’re on the subject of waking up healthy, I’d take this opportunity to give my thanks to modern medicine and all of the medical pioneers that have given us vaccines. No, I’m not a huge fan of needles, and neither are my children. But I have such a healthy respect for the dreadful diseases we are now able to prevent by simply making sure that our children’s (and our own) immunizations are up-to-date that I count each and every shot a blessing, needles and all.

Car Seats. As someone who had 3 kids in just over 3 years – the youngest of whom only just outgrew the need for a car seat at age 10 – I am certainly aware of the parental challenges inherent in the purchasing, installing, and juggling of car seats, especially during holiday travel season. Yet despite having spent every day of the past 10 years overseeing the use of numerous seats of my own, I’m exceedingly grateful for the fact that car seats even exist, much less that they are so incredibly effective in protecting kids from harm. With nothing more important than my children’s health and safety, car seats (and all those who contribute to making sure that children are secured safely) deserve my thanks.

Cell Phones. Yes, I do have tween- and teenage children of my own. And yes, I do face the daily parental challenge posed by a world now dominated by texting tots and teens and threatened by everything from cyberbullying to sexting. But having just returned from a mobile health summit in Washington DC, I am now very, very grateful for cell phones. World thought leaders the likes of Bill Gates, Director of the National Institutes of Health Francis Collins, and the president of the Rockefeller Foundation joined over 2500 attendees from around the world who all share the belief that cell phone technology is the tool by which we will be able to reach the world’s poorest and provide them with access to better health.

Here in the United States, innovative programs like text4baby are making use of the ubiquitous nature of cell phones to put valuable health information and access to local resources right at the fingertips of pregnant women and new moms.

While I will absolutely not be thankful for any cell phones that make their way to my family’s Thanksgiving table, I will nevertheless be grateful that they exist, not just to make my life easier, but improve the health and well-being of those less fortunate than me.

Originally posted on Omaha World Herald’s Live Well Nebraska

Coughs, Kids & Vaccines: Why parents are the key to silencing the sounds of pertussis!

You really don’t have to listen very hard to hear the sounds of the season – the rustling of fall leaves, the weekend cheers of husker fans, and lawnmowers out for one last run before being swapped out for snow blowers. But if you ask me, the most noticeable sounds this time of year are all of the coughs, sniffles and sneezes that predictably make their annual show of force during cold and flu season. For parents and pediatricians alike, these are familiar sounds that we learn to live with and treat as needed. This year, however, we are hearing a lot more than usual about another sound – a sound for which we should all be listening carefully: the sound of pertussis.

Perhaps you’ve heard of pertussis – also commonly referred to as whooping cough – from your pediatrician. Some of you may remember reading about it each time you received the standard set of vaccine information sheets describing each of your child’s scheduled immunizations, since the DTaP (the “P” part referring to pertussis) vaccine is routinely given.

Chances are that if you’ve been following the national news lately, however, you may have also heard that there’s a pertussis outbreak in California. In the world of infectious diseases, let me assure you that California isn’t very far away from Nebraska, and this outbreak is not just another news story about an isolated incident hundreds of miles away. The spread of pertussis in California is, in fact, proving to be the worst outbreak in 60 years, having already claimed the lives of 10 infants under the age of 3 months. If that’s not a reason to stop and take notice, I don’t know what is.

The fact of the matter is that pertussis is caused by one of the most contagious bacteria we know. The infection can start out seeming like a common cold, but over the course of a couple of weeks manifests itself as an escalating cough which then turns into coughing episodes sometimes severe enough to result in vomiting or the characteristic “whoop” sound that represents the dramatic effort to draw air back into the lungs.

While adults typically experience weeks (if not months) of a cough that just won’t go away, they don’t often “whoop” like kids do. Neither do babies under 6 months of age – a fact that increases their risk of life-threatening illness or death at a time when they can’t yet be vaccinated (under 2 months) or haven’t developed full immunity (under 6 months of age). Unable to draw air back into their lungs, babies may gasp, gag, or simply stop breathing altogether – making them the most vulnerable at a time when they are also the most at risk.

As someone committed to helping insure the health and well-being of all children, I’ve therefore pulled together some very important facts about whooping cough, who is at risk, and what each of us can do to prevent the spread of pertussis in hopes that we protect all of Nebraska’s children and adults against a sound you never want to hear at any time of the year….the sound of a young child with pertussis.

Make sure your child is up to date on his/her shots. DTap is recommended at 2, 4, 6 and 15-18 months, and again at 4-6 years. The best time to get your child protected against pertussis is the first day your child becomes eligible for each recommended immunization.

Get your adult tetanus booster. Immunity to whooping cough doesn’t last forever. Any adult (or teen) who doesn’t remember getting a pertussis booster shot, or hasn’t had one since they were immunized as a child needs to get vaccinated. The fact of the matter is that babies too young to be protected by the vaccine rely solely on all of us to not expose them. Sadly, an estimated 3 out of every 4 babies with life-threatening pertussis infection got it from a loved one. Prevent this from happening by rolling up your own sleeves, getting an adult booster shot, and doing your part to limit the spread of pertussis.

Be on the lookout for pertussis and contact your doctor or your child’s pediatrician with any concerns. It’s all too easy to mistake pertussis for the common cold at the outset of the infection, and while people are contagious for up to a month, antibiotics are of little benefit after the first week or so. Half of babies with whooping cough end up needing to be hospitalized.

Listen to the sound of pertussis. If my blog hasn’t already convinced you, or you simply want more information, watch my recent pertussis-focused CNN interview with Kiran Chetry on American Morning, go to www.soundsofpertussis.com and let Jeff Gordon of NASCAR fame convince you, or simply listen to what a baby with pertussis sounds like .

Now let’s all commit to doing everything we possibly can to silence the sounds of pertussis.

Originally posted on Omaha World Herald’s Live Well Nebraska