Patient Education...

The following is information pertaining to the care of your child.  It includes some suggestions on when you need to call the doctor and what immunizations are given at well child visits.

When to call the doctor

Fever itself will not harm your child and does not necessarily require treatment.  But you should call the pediatrician if:

• Your child is under 3 months of age and has a rectal temperature of 38º C (100.4º F) or higher.
• Your child is lethargic or irritable.
• Fever has been present for longer than three days.
• Your child also has symptoms such as sore throat, ear pain, abdominal pain, or pain when urinating.
• Your child is drinking less fluid than usual and has had fewer than four wet diapers in the past 24 hours or two urinations during waking hours.
• You are worried that your child is less active than normal or is having trouble breathing, whether or not he/she has a fever.

Routine Well Child Visits with Immunization(s)

The Flu And Your Child
by: Yuri E. Cook, MD, FAAP

The school year has begun and healthy, summer–rested kids are now heading off to class each day. Unfortunately, the start of the school year is soon followed by the start of the cold and flu season.

While most people use the word “flu” to describe any type of cold or stomach illness, doctors use this word specifically for a group of illnesses caused by strains of the influenza virus. True “flu” is a miserable and often dangerous illness. Symptoms of the flu can include fever, headache, body aches, and fatigue, along with coughing, sore throat, and runny nose. Tummy symptoms, such as nausea and vomiting, are commonly seen in children. In some cases, the flu can lead to complicating secondary illnesses like bacterial pneumonias or can be associated with severe complications of the central nervous system, heart, or immune system.

Influenza infection is a viral infection that spreads primarily from person to person via respiratory droplets, similar to those sprayed during coughing and sneezing. The “incubation period” (the time between when one is exposed and when symptoms develop) is usually between 1 and 4 days. Moreover, people can be contagious and spread the illness as much as a full day before they develop symptoms. Both of these characteristics make the flu likely to spread rapidly through places like schools and daycares, and can make outbreaks difficult or impossible to control.

Because it is a viral illness, the flu itself cannot be treated or controlled with antibiotics. There are a few antiviral medications that have been used to treat influenza, but in the past two years, the flu virus has acquired resistance to some of them. Even though some medicines are still active against the flu virus, they may not always be helpful in preventing or treating the illness.

The best method of protecting children against influenza remains annual vaccination (the “flu shot”). Therefore, most physicians recommend the flu vaccine for all eligible children over the age of 6 months, unless there are medical reasons not to give the vaccine. More importantly, there are specific groups of children that should be vaccinated against the flu because they are at especially high risk of severe illness or complications from flu infection. These include:

1. All children between the ages of 6 months and 5 years of age

2. Children between 6 months and 18 years of age who are receiving chronic aspirin therapy

3. Children with chronic lung or heart disease

4. Children with chronic metabolic disorders such as kidney problems, diabetes, blood disorders, or immune deficiencies

5. Children with neurological disorders that predispose them to respiratory illness

6. Residents of chronic care facilities

7. All family members of children who fall into the above groups, including parents and siblings of infants LESS than 6 months age, who are at risk of serious infection but are too young to receive the vaccine.

Two different types of flu vaccine are available. One is an inactivated, or “killed virus” vaccine, known as the “flu shot.” This type can be given to most children over the age of 6 months. Children less than 9 years of age need to receive two doses the first year they are vaccinated, and one dose per year in subsequent years. The inactivated flu virus is give by injection (shot) only and is very safe, with few reported side effects. Contrary to popular myth, children do NOT get the flu from the flu shot.

The second type of flu vaccine is a “live virus” vaccine and is administered as a nasal spray. Like the flu shot, the nasal spray is given twice the first year to children under 9 years of age who have never received vaccination before. While the nasal spray vaccine contains a live virus, it also does NOT cause the flu. This vaccine is very well tolerated and safe for healthy children aged 5 years and above. However, it should not be given to children with chronic illnesses such as asthma, heart disease, diabetes, blood disorders, and immune disorders. It should also not be given to children on aspirin therapy, pregnant women, or children with a history of certain neurological problems.

Flu shots and the nasal spray may be available at physicians’ offices as early as September. Some doctors will wait until October to give the flu vaccine to elderly patients. However, most pediatricians recommend giving the flu vaccine as soon as possible, especially to young children who never received the flu vaccine before. These children will need two doses of vaccine the first year, with both doses ideally administered before December.

Parents should also be aware that flu vaccine shortages have occurred on occasion during the past several seasons. When this occurs, pediatricians will follow the recommendations of the CDC to alter their usual vaccination practices and may postpone or restrict vaccinations, so that all high-risk children are vaccinated first.

In addition to vaccinating their own patients, some pediatricians may offer vaccination to other family members, expectant mothers, and caretakers of young infants. If you have any questions regarding recommendations for or availability of the flu vaccine, call your doctor’s office.