The 2013-2014 Flu Vaccines

     Yet again we are in the time of the year where we are headed into the influenza "flu" season. Our recommendations from past years remain the same: 1. Everyone 6 months and above should get the flu vaccine each year (with very few exceptions -- the most common one is a history of anaphylaxis to egg). 2. The flu shot can be given to anyone 6 months and above. It is the only flu vaccine recommended for those with a history of diabetes, asthma, and a serious heart condition. 3. The flu nasal spray ("Flu Mist) is available for 2 years of age and above who are in otherwise good health. It is still not approved for usage below 2 years of age or with children with asthma, diabetes, or a serious heart condition.
     This year, you will hear more about the "quadrivalent" vaccine. This means that there are four strains in the vaccine (not the usually three). About half of the time in the last 11 years, there has been a two strains of the B influenza virus in the community. Nationwide, on average, this will help prevent an extra 300,000 cases of influenza each year by adding the fourth strain into the vaccine.
     Our Flu Mist vaccine is quadrivalent this year. It has two A strains and two B strains. The flu shot we purchased this year is not quadrivalent -- it is the 3 strain trivalent vaccine. We decided to order this because there was a significant increased cost to the quadrivalent shot, the quadrivalent shot was approved for "just" 3 years of age and above, and there was a chance our supply of the quadrivalent vaccine might not be ideal. We believe the 3 strain trivalent vaccine will very likely give good protection. It is likely we will have the quadrivalent flu shot in future years.
     Our website has the dates for our flu vaccine walk-in clinics for the Fall of 2013. We actively encourage all of our patients to receive the flu vaccine at our office this Fall.

September is a peak asthma month

     We will see many children with a history of asthma in the office with worsening symptoms in September. The Fall allergies are bad at this time of year (ragweed, other weeds, and molds), the weather changes frequently, and children are back in school getting more illness exposures. It is easy for many children to get off of their normal preventative medication during the warm weather months. All of these factors make it more likely for us to notice a dramatic increase in wheezing during the back to school time of year.
     We cannot do much about the weather and you cannot stay inside in air conditioning all the time to avoid the allergies. And despite our best efforts to avoid the illnesses with back to school time, this is also difficult. So what to do?
     The most important thing to do is to make sure that your child is taking their daily preventative medication (inhaled steroids, Singulair(r), etc.). Starting this now or before this season starts is very important. It takes a couple weeks to get the most benefit from these medications. It is also time to get a flu shot. This helps prevent a case of flu which can cause a worsening of the asthma.
     Please call the office if you have questions.

Food Allergy Action Plan

      The Food Allergy and Anaphylaxis Network (FAAN) has a terrific Food Allergy Action Plan form. In the case of a child having an exposure to the food or foods they are allergic to, it provides clear-cut instructions on what to do and when to do it. A link here connects you to the website and their form, the Action Plan.
      When the child has a food allergy and needs to have school or preschool prepared, they will have a form to be completed and signed by the physician. Many times, they will appreciate and we will strongly recommend that in addition the FAAN Food Allergy Action Plan also be completed. This provides more precise information. The school forms will essentially allow us to say "if there is a food allergy reaction, give Benadryl and epinephrine". However, the Action Plan allows us to say more accurate information such as "if they are wheezing, pale, and dizzy, give epinephrine and then do these other steps". We have the Action Plan available in the office to complete at your child's appointment or you can print out at home and bring in at your child's appointment.
      One other point: it is strongly recommended to have two epinephrine injectors (EpiPen or Auvi-Q) available with the child at all times. There are two injectors in the "twin pack" so that a second injection is available if needed if a reaction occurs. Over the years, it has been found at least 1 out of 5 times (20%), a second dose is needed soon after the first. And there are many occasions when someone did not have a second dose and died because of a severe reaction that could have been avoided with a second dose of epinephrine.

Swaddling Infants

     Swaddling infants is something of a controversial topic recently. It is done from the start at the hospital for newborns. There is a new article from the American Academy of Pediatrics here that has an excellent discussion of the topic.
     What do I recommend? It is fine to swaddle from birth until 8 weeks of age, make sure there is room at the chest for the infant to comfortably breath (you should be able to get your hand between the blanket and the infant), and make sure the swaddling is looser around the hips.

Dog Bite Prevention Week

     The week of May 19th through 25th is dog bite prevention week. The American Academy of Pediatrics has a good two page information sheet about preventing dog bites. With more outdoor time, the warm weather months are always when we see and hear more about children suffering from dog bites. Here is a link to the AAP page on preventing dog bites. Help your children be safe out there!

Natural disasters.

     The horrible tragedy in Oklahoma this week makes me wonder how children recover from these events. My children were recently in a car accident that resulted in significant car damage but only dings and scratches to my children. And it was very stressful for my family.
     The American Academy of Pediatrics has a webpage with many good resources for dealing with these tragedies. You may find it helpful, whether you are thinking about how to discuss these with your children or you yourself are responding to catastrophic event. Here is a link to the American Academy of Pediatrics webpage.

Medications for colds, allergies, and sinus infections that are safe during breastfeeding.

     We are often asked for our advice regarding medications that breastfeeding mother's may take while they have symptoms of colds, allergies, and sinus infections. We generally advise to avoid medications as much as possible while breastfeeding. However, we recognize breastfeeding mom's may want to take a medication to help with their symptoms.
     Based on our experience, what we have read, and scientific research, this is what we want you to know:
1. Know that decongestants (such as Sudafed) and antihistamines (such as Zyrtec, Claritin, Benadryl, and Allegra) sometimes decrease a mother's milk supply. This is hard to know if this is going to happen to you, but be especially cautious if you struggle with your milk supply.
2. Side effects for infants can include drowsiness, wakefulness, and irritability. If they happen with one dose, they are likely going to happen each time you take the medication. If worrisome, stop taking the medication. Your infant may not show any sign of side effects, however.
3. Sudafed (decongestant) or Benadryl (antihistamine) are generally considered safe to take and are options for you to take.
4. The less-sedating antihistamines for allergies (Claritin, Zyrtec, and Allegra) are also fine.
   
      As always, I like what the website Kelly Mom has to say about this issue. Please call if you have questions!