Wednesday, March 4, 2020

Coronavirus and COVID-19


Introduction
     Coronaviruses are a group of viruses that cause illnesses in humans, mammals, and birds. In humans, the viruses typically cause respiratory illnesses. In 2019, a new (“novel”) coronavirus infection was first found in China. It has been named COVID-19. Since that time, the infection is spreading to other countries. As of 2/4/2020, the countries with the most widespread numbers of coronavirus infections are China, Japan, South Korea, Iran, and Italy. However, many other countries have had some cases and this list is likely to expand as the infection spreads. Because this is a new viral strain, people are not immune to it from a prior infection.

How The Illness Presents
     COVID-19 presents with symptoms similar with influenza: fever, cough, and fatigue. Sore throats and shortness of breath have been less common at the start of the illness. As with influenza, most of the cases of breathing difficulty (respiratory distress) are occurring later in the course of the illness – the average is 8 days after the onset of the illness. It is the respiratory distress that has caused the deaths associated with the COVID-19. A patient with COVID-19 infection with respiratory distress will be breathing hard and fast, as well as coughing very frequently.
     Most of the severe infections have been in adults, especially older adults. The more severe infections are also in those with underlying medical conditions, such as asthma, heart conditions, and diabetes. As with other respiratory illnesses, there will be some persons with COVID-19 infection where the illness is very mild.

Testing For COVID-19
     There are tests for this virus. The testing is NOT available at this point in doctor’s offices and urgent cares. The testing is more available through large hospitals, emergency departments, and health departments. At this time, we do not have this testing available to us.
     Who should be tested? If someone with worrisome symptoms with a known exposure to someone with the virus OR recent travel to a country where the illness is more wide-spread (China, Iran, Japan, South Korea, Italy). Realize, if a child had a possible exposure or concerning travel history AND had a cough, fever, and respiratory distress, they likely have another virus – often influenza with pneumonia.

What To Do
     If your child has traveled to a country where the virus is more common OR they have had an exposure to someone known to have the infection AND has a fever and cough, especially if they have breathing problems, they should be seen at the pediatric emergency room. You should CALL AHEAD to alert the emergency room before you arrive to discuss how to avoid exposing others to the infection.
     As with avoiding all common respiratory viruses, frequent hand washing, avoiding places where ill people may be (large gatherings), and covering your nose with sneezing and covering your cough. Wearing a mask Is appropriate IF you have symptoms, but it is not currently recommended if you are trying to avoid getting the virus.
     This information will very likely change quickly. The www.cdc.gov website is an excellent source of up to date information.


Tuesday, April 17, 2018

Dr. Jeff's retirement on April 30, 2018

     We are fast approaching Dr. Jeff's retirement on April 30th, 2018!
     Dr. Jeff founded Hilliard Pediatrics in 1990 after finishing his pediatric residency at Columbus Children's Hospital. Starting a practice on your own meant seeing all the patients, taking all the nighttime and weekend call, and seeing both healthy newborns and children hospitalized at Children's Hospital.           The practice grew and grew with Dr. Jeff's hard work and excellent care. 
     Over the years, the office has moved locations - from Leap Court to Berry Leaf Lane (in 1996) to Trueman Court (2011) - and grown as other doctors joined the practice.
     Dr. Jeff has been passionate about Hilliard Pediatrics, his family, sailing and painting, and the environment. Dr. Jeff has run marathons, raised bees, painted exam rooms and portraits, and had some great life adventures.
     What has never changed is Dr. Jeff providing excellent pediatric care for his patients. The patients will miss him and we at the office will sure miss him. He will be remembered for his dedication to his patients, his infectious laugh, and how many lives he positively impacted.
     Thank you Dr. Jeff for all that you have done!



Monday, January 22, 2018

Dr. Mike Patrick's Pediacast pediatric podcasts

     Dr. Mike Patrick, M.D. from Nationwide Children's Hospital has a podcast called Pediacast that has an amazing amount of information for patients and families. I highly recommend it! He and guests cover many topics. If you are unfamiliar with it, http://www.pediacast.org/ is the web address. It can also be found wherever you find other podcasts (iTunes, etc.).

Saturday, January 6, 2018

Is it too late to get the flu shot?

     The simple answer is no. It is not too late to receive the flu vaccine if you or your child has not yet received it this season.
     The influenza season started early this year. By late November, a number of cases were appearing in Central Ohio. The season usually runs from December through March.
     Although a report out of Australia reported that the vaccines effectiveness versus the H3N2 strain (one of 4 in the vaccine) was only 10% last year, the Centers for Disease Control and Prevention report the U.S. effectiveness was between 30-40% (significantly better) and it is likely going to be closer to that percentage in the U.S. this influenza season. Here is a link to more information from the CDC.
     We have been out of the vaccine since early November. But there are other ways to get the vaccine:
1. The Franklin County Health Department is able to give the vaccine to those 6 months and above. You can schedule an appointment to receive the vaccine by calling 614-525-3719 or going to www.myfcph.org/shots to make an appointment.
2. The urgent cares staffed by nurse practitioners (such as Minute Clinics) are able to give the vaccine to children 18 months or 24 months and above (it varies). Check here for more information.
3. Many pharmacists are able to give the flu vaccine to those 7 years of age and above. Check with your favorite pharmacy for more details.

Saturday, December 23, 2017

Storing Breast Milk and Formula

     We are frequently asked in the office about how long breast milk and formula can be safely stored. The major risks for going past this limits is accidentally introducing an unhealthy bacteria to the infant ("spoiled milk") or the breast milk or formula having its ingredients break down.
     Although you can find a wide variety of guidelines on the Internet, I find it easier to keep it simple to remember: follow the Rules of Six for breast milk storage. Breast milk can be safely consumed if stored for 6 hours at room temperature, 6 days in the refrigerator, and 6 months in the freezer. If the breast milk is kept in an insulated cooler bag, it should be used within 24 hours.
     The guidelines for formula are different. A bottle of formula should be kept at room temperature for no more than 1 hour. Formula prepared from powder then stored in the refrigerator should be used within 24 hours. Formula prepared from concentrate or ready-to-feed formula may be stored in the refrigerator for 48 hours. A can of powdered formula should be used within 30 days of opening.
     Here is a link to some more detailed information about safely storing breast milk from the Centers for Disease Control. Here is a link to an article about storing infant formula from Healthy Children.

Wednesday, December 20, 2017

Updated Information on the Prevention of Tooth Decay

     In the 23 years I have been in practice, the recommendations about fluoride and children has changed. Although there is great deal of information supporting the safe use of fluoride to prevent tooth decay, recommendations about how much and how often have frequently changed. Here is an updated description of the current recommendations.
     One note: you can find a lot of misinformation on the Internet. And a great example is the misleading, non-scientific, and sometimes outright false and outrageous anti-fluoride information on the Internet. Do not believe this misinformation. It safe to use fluoride to prevent teeth decay.
     The current recommendations:
1. It is helpful to have your child drink fluoridated water and to cook using fluoridated water. In Central Ohio, our public water supply has fluoride added. Drinking bottled water does not reliably give enough fluoride. Most household water filters do not remove fluoride, but it is worthwhile making sure (by reading the filter's information).
2. Once babies have their first teeth, brush their teeth daily with a grain of rice sized amount of fluoride containing toothpaste. Once they reach 3 years of age, it should be a pea sized amount of fluoride containing toothpaste.
3. Routinely see the dentist by 3 years of age, sooner if recommended by the pediatrician.
4. Fluoride varnishes are recommended once a number of teeth have extruded. We now do the fluoride varnish at 18 month, 24 month, and 30 month check ups. The kids seem to be tolerating it just fine. The varnish stays on your teeth for 4-6 hours. During those 4-6 hours, it is best to maintain a soft diet and avoid hot liquids. Do not brush or floss during that 4-6 hours after the varnish (you can resume normal dental care the next day). If you take supplemental fluoride, stop for 3-4 days after the varnish is applied.
     If you interested in reading more, here is a link to more information from the website Healthy Children.

Friday, December 8, 2017

What to do when children and teenagers vomit with exercise.

     Some athletes vomit during exercise. This can happen at younger ages, but typically occur when teenage athletes push themselves hard during workouts. There are some things to do to help prevent this issue.
     One of my teenage sons has struggled with vomiting when pushing himself during workouts. He does vomit more easily with bad coughs or stomach upset versus some other folks, but he did not have vomiting with exercise until high school.
     If someone struggles with this issue, we would ask some other questions to make sure it was not from something more complicated. We ask questions about acid reflux and and whether the vomiting happens after coughing. We ask about timing of eating and drinking when it comes to exercise.
     If nothing else is complicated about the history, there are some helpful recommendations to help reduce the chances of vomiting during exercise.
-- Eat a small snack 30 minutes before exercise.
-- Avoid exercising in extreme heat.
-- Watch your exercise intensity. The athlete may need to dial-back their intensity.
-- Stay hydrated. Drink 8 ounces of water every 20 minutes of exercise. If the exercise is going to be high-intensity for more than 45-60 minutes, drink sports drinks instead of water.
-- Cool down gradually.

     If your child struggles with this issue and is not improving while following these recommendations, call during routine office hours to discuss.