H1N1 (Swine Flu): To Vaccinate or Not To Vaccinate

A week or so ago, our friends at StrollerTraffic.com came to us with their readers' most pressing questions about the new H1N1 vaccine. Seems their inbox (like ours) has been overflowing with questions, confusion, and dare we say, a little bit of panic.
Being on their panel of experts, we of course were happy to field the most frequently asked questions, break down the facts, explain some of the issues and controversies surrounding the vaccine, and hopefully talk a couple of readers down off the ledge so they could make a sound, educated decision about whether to vaccinate or not to vaccinate.
Here, the full unedited version of "Worth a Shot? H1N1 (Swine Flu) Vaccine Update", originally written for and published by StrollerTraffic.com.
(Disclaimer, it's a bit long...but we think, worth the read...So fill up your coffee cup, put up your feet, break it down into 2 parts if you have to, and enjoy!):

WHEN WILL THE VACCINE BE AVAILABLE?
The first 7 million doses of H1N1 vaccine began shipping the week of October 5. Another estimated 60-195 million doses are anticipated to ship over the next few months in weekly batches. Currently we have no information as to the where the rollout of the doses will occur. The best strategy is to watch your local news and keep abreast of notices posted or sent by your health care provider.

ARE THEY ANTICIPATING ENOUGH TO MEET DEMAND? WHO ARE THE PRIORITY RECIPIENTS?
Hopefully, yes -- especially as it pertains to high risk individuals. The first groups who will be targeted for immunization are the following:

• Household members/caregivers of babies under 6 months of age
• Children 6 months - 4 years of age
  
• Children 5 years - 18 years of age with high risk health conditions (asthma, lung disease, sickle cell anemia, heart disease, chronic kidney disease, immune compromise, chronic asprin therapy, blood diseases, neuromuscular diseases, diabetes, and HIV)
• Pregnant women
• Adults with high risk health conditions
• Health care workers
• Very obese individuals (BMI >35)
• Elderly living in nursing homes & assisted living facilities

IS THERE ANYONE WHO THE VACCINE IS NOT RECOMMENDED FOR?
For individuals with severe egg allergy, or history of anaphylaxis to egg or any components of the vaccines, immunization is not recommended. In addition, individuals with a history of Guillain-Barre Syndrome shouls not receive the influenza vaccine.

WHAT ARE THE DIFFERENCES AMONG THE 4 VERSIONS OF THE VACCINE?
Currently 4 manufacturers have been producing H1N1 vaccine. Three are producing shots, and one is producing a nasal spray.

• CSL Brand: FDA-approved for individuals 18 years of age or older
• Novartis Brand: FDA-approved for people 4 years of age or older. There are 2 forms of this shot:
  1: Multi-dose vials -- using thimerosal as a preservative
  2: Pre-filled single-dose syringes -- thimerosal used in the manufacturing process but extracted before final production
  

• Sanofi Brand: FDA-approved for children 6 months of age or older. There are 2 forms of this shot.
  1: Multi-dose vials -- thimerosal-free
  2: Pre-filled single-dose syringes -- thimerosal-free
  
  
• Medimmune: FDA-approved nasal spray for individuals 2 years of age to 49 years.

The SAME stringent manufacturing standards and processes used for the production of regular seasonal influenza vaccine apply to the H1N1 vaccine as well.

WHAT SHOULD I KNOW ABOUT THE VACCINE IN NASAL SPRAY FORM AND HOW DO I CHOOSE BETWEEN THE SHOT AND THE NASAL SPRAY FORM?
The mist form of H1N1 vaccine is very similar to Flumist - the vaccine used for seasonal flu protection. It is a live-attenuated vaccine, and is thimerosal-free. It is FDA approved for healthy people 2-49 years of age. Two doses are needed for kids under 10 (given a month apart), and one dose for kids 10 years of age or older.
If your child does not have a history of asthma, recent wheezing, or a high-risk health condition, the mist form of the H1N1 vaccine is a non-painful option for your child. The downside might be a day or two of sore throat, sniffles and/or a low-grade fever. Live virus preparations typically activate a different arm of the immune system and may result in more prolonged immunity. The H1N1 pandemic vaccine in mist form is free, however your health care provider will likely charge an administrative fee to cover the cost of staff time, disposal of syringes, and administrative time necessary to obtain the vaccine.
Certain individuals SHOULD NOT receive the mist form of H1N1 vaccine. They include:

• Individuals with severe/anaphylactic reaction to egg or components of the vaccine (gentamicin, gelatin or arginine)
• Pregnant women
• People with asthma or active wheezing; children under 5 years of age with recurrent wheezing
• People with immune deficiencies
• People with underlying medical conditions that may be aggravated by live vaccine (always check with your health care provider)
• Children under 2 years of age
• People with extremely stuffy, congested noses (as absorption of the vaccine may not occur)
• Children or adolescents on chronic aspirin therapy
  

SHOULD I WORRY IF MY CHILD CAN ONLY GET A FLU SHOT THAT USES THIMEROSAL PRESERVATIVE?
No. Priority for thimerosal-free vaccine will be given to pregnant women and children. However, if the only flu vaccine available for administration is one in which thimerosal was either used in manufacturing or a tiny amount in the final product, it is still a good idea to get the vaccine.
Thimerosal is a preservative that has been used since the 1930's to prevent contamination isn some multi-dose vials of vaccines (preservatives are not required for vaccines in single-dose vials). Thimerosal contains approximately 49% ethylmercury, not to be confused with Methlymercury (found in sushi and large pelagic fish such as halibut, swordfish and tuna). The kidneys excrete thimerosal very effectively, while methylmerciry is fat-soluble and more likely to be absorbed by its host.

There is no convincing evidence of harm caused by the low doses of thimerosal in vaccines, except for minor reactions like redness and swelling at the injection site. However, in July 1999 the Public Health Service (pHS0 agencies, the American Academy of Pediatrics (AAP) and vaccine manufacturers agreed that thimerosal should be reduced or eliminated in vaccines as a precautionary measure.
Thimerosal-free influenza vaccines are available, but in limited quantities (availability will improve as manufacturing capabilities are expanded). Priority for thimerosal-free vaccine will be given to pregnant women and children. However, if the only flu vaccine available for administraion is one in which thimerosal was either used in manufacturing or a tiny amount in the final product, it is still a good idea to get the vaccine. To date, there is still not any substantial proof that thimerosal is harmful in any way.

ARE THERE ANY CONTROVERSIES AROUND THE VACCINE, ITS INGREDIENTS, ETC?
The H1N1 vaccine does NOT contain any aluminum or other adjuvants (products that increase a body's response to a vaccine). Other countries have used adjuvants since 1997 but the US manufacturers have never done this. As a result all H1N1 vaccine (in all forms) is adjuvant-free. This has been a source of debate because using an adjuvant makes it easier to create more vaccine to meet demand.
Many parents have come to use with concerns that the H1N1 vaccine may cause Guillain-Barre Syndrome (GBS). Certainly on the internet this concern is a hot topic. It's worth a little extra reading on the CDC website to set the record straight.

IS IT A ONE DOSE SHOT OR IS A BOOSTER REQUIRED?
H1N1 vaccine has slightly different ground rules* than regular seasonal flu vaccine. Think of the first dose as "priming" the immune system, and the second one as "activating" the child's immunity. One dose will NOT protect a child 6 months of age through 9 years.
*Normally, regular seasonal flu vaccine requires 2 doses the FIRST YEAR it is given for children under 9 years or age, and then once yearly after that.)

ARE THERE ANY POSSIBLE SIDE EFFECTS CAUSED BY THE VACCINE?
Typical reactions to the H1N1 vaccine are anticipated to be the same as those experienced with regular seasonal flu vaccine. For the shots, these include possible pain/soreness at the injection site, muscle ache, headache, low grade fever (usually for a day or two), fainting (usually in adolescents) and rarely allergy to one of the components of the vaccine. For the nasal mist preparations (since they have low levels of the live virus) nasal congestion and stuffiness are fairly common for a few days after administration, in addition to possible low grade fever, muscle aches and fatigue.

HOW HAS THE VACCINE DONE IN CLINICAL TRIALS?
Two different 2009 H1N1 influenza vaccines have been enrolled in clinical trials as of July 2009 -- one made by Sanofi Pasteur in Swiftwater, PA and the other by CSL Limited in Melbourne, Australia. Initial review of the data involving more than 500 healthy adult volunteers showed both vaccines to be safe and effective. Because of these positive results, clinical trials began on children on August 18, 2009 using the Sanofi H1N1 vaccine.
The pediatric trials have involved eleven medical centers nationwide, and more than 1200 children between the ages of 6 months to 17 years have been given the vaccine. Preliminary results published 9/21/09 showed that an effective immune response was seen in the majority of 10-17 year old eight to ten days after receiving the vaccine. Younger children generally had a weaker early response to the vaccine.
Current ongoing studies are addressing whether there is a dose:response relationship with the vaccine - i.e. is giving more of the vaccine going to yield better or longer immunity? In addition, the effectiveness of combining seasonal influenza vaccine with the 2009 H1N1 vaccine is also being examined. Data will be updated as it comes in from the National Institutes of Alelrgy and Infectious Diseases (NIAID) and from the National Institute of Health (NIH).

SHOULD MY CHILD GET BOTH THE SEASONAL FLU VACCINE AND THE H1N1 VACCINE?
Yes, it's a good idea to protect your child from all threatening strains of flu this year. Most health care providers already started administering regular seasonal flu vaccine early in September. Unfortunately, full production and shipments of vaccine to all health care entities were held in order to produce H1N1 vaccine. As a result, your health care provider may be awaiting shipment of more regular seasonal flu vaccine (especially preservative-free formulations) -- and all any of us can do is wait patiently for the remainder.
Both seasonal flu shots and H1N1 shots can be given on the same date and if a repeat dose is needed, those doses can be given together as well. The only tricky part here is that a child cannot receive protection from two MIST preparations on the same day. So a parent has the prerogative to opt for one shot/one mist. If you only want your child to receive flu protection in mist form exclusively, you must separate all those doses by 4 weeks -- thus stretching out immunization over 4 months and possibly delaying the timely administration of second doses, if required.
Also, keep in mind that if your child has had any other live virus vaccine (ie MMR, Chicken Pox or Rotavirus vaccine) within the last month, you should wait FOUR weeks after that vaccine before administering any flu vaccine.

AFTER WHAT DATE IS IT TOO LATE TO GET THE VACCINE?
Peak flu season varies across the US -- on the East Coast and Northern regions flu season peaks around the holidays, whereas on the West Coast and Southern regions, often it peaks as late as February. Unfortunately, since H1N1 novel strain seems to know no "season" (having surged in the Spring, quieted a bit in summer, now ramping up again) anytime is appropriate, but the earlier the better. What we have yet to know is whether we will need to have to repeat inoculations more than once yearly, given the propensity of H1N1 to occur year round (as typical influenza vaccines last generate only 4-6 months of immunity).

For regular updates on H1N1 and its vaccine, we suggest you visit the CDC Website regularly, and/or follow @CDCflu on twitter.

To read the edited version of this article, "Worth a Shot? H1N1 (Swine Flu) Vaccine Update" visit StrollerTraffic.com and their health and safety section.

Sun-Proofing Your Child's Skin: Dr. JJ's guest blog as seen on Huffington Post

This month marks the beginning of beach vacations, pool parties and outdoor BBQs, which means it's a crucial time to keep your child's skin protected from the sun's harmful UV rays. May's National Skin Cancer Awareness Month reminds us all to practice sun safety -- not just during the year's hottest months, but year round. A parent has good reason to engage in sun protection early on: One blistering sunburn from unprotected sun exposure as a child can possibly double the risk of melanoma (the most serious form of skin cancer) later in life. And one in 55 people will be diagnosed with melanoma during their lifetime, according to The Skin Cancer Foundation.

In spite of these sobering statistics, most of us -- more than 66 percent -- don't use sun protection regularly. But if we help the youngest members of the family start off on the right track, and as parents we begin to practice what we preach, our children will be more likely to make a habit out of protecting themselves.

To find out how, click here to read more from Dr. JJ's guest blog on Huffington Post.

Swine Flu (H1N1): Part 2 - Q&A and FAQs

With the second swine flu-related death in the U.S. (first of a U.S. citizen) occurring yesterday, we decided it was a perfect opportunity to post Part 2 of our swine flu update. We chatted with Tara Mandy, publisher of StollerTraffic.com, an online resource and weekly e-newsletter for city moms with kids under 3. Tara came to us for some tips and perspective (OK...and to help talk her and her readers off the ledge) and we were, of course, happy to oblige!
Here, we answer some of her and her readers' most pressing questions:

Are babies and toddlers more or less susceptible to Swine Flu (H1N1)?
Babies and toddlers who are below school aged, are less likely to be exposed to social situations, which would then expose them to swine flu. However, if infants and toddlers do become infected with Influenza, they are more likely to have a more severe or prolonged illness which can be associated with more complications.

Are there special considerations for pregnant women?
Pregnant women are deemed to be in the high-risk group, if again, we take our experiences from past influenza pandemics. They should take precautions to reduce their risks of contracting swine flu. These actions include frequent hand washing, covering coughs, avoiding contact with ill people and reducing unnecessary social activities in crowded settings. If a pregnant woman has swine flu, she can be treated with antiviral therapy, though these drugs have not been formally tested for use in pregnancy. Past experiences with Tamiflu and Relenza have shown them to be safe and effective in pregnancy with no observed ill effects seen in their newborns.

When should you call your pediatrician?
If your child has a sudden onset of fever along with a sore throat, cough, headache or body aches, call your pediatrician. Reports seem to indicate that the swine flu presents with an acute onset of high fever, and a rapid progression of the other symptoms. If you bring your child within a day or two of fever onset, anti-viral therapy is more likely to be effective. Most health care providers are equipped to diagnose flu in their offices. If your doctor suspects your child has influenza, he/she may perform a wash of your child's nasal secretions and submit it to your local public health department for analysis by the CDC.

When should you NOT call your pediatrician?
If you basically feel like you have the common cold or stomach flu virus -- both are common at this time of year. Do not call your doctor to obtain anti-viral therapy "just in case". This important therapy is reserved for those truly in need. Do not call your doctor if your child has NO symptoms and you have NOT travelled to a high risk area or had contact with a person suspected of having H1N1 (swine) flu.

What are Tamiflu and Relenza?
Tamiflu (oseltamivir) and Relenza (Zanmivir) are both FDA approved anti-flu antivirals that have been used to treat Influenza in the past and are deemed to be effective against the current swine influenza A virus (H1N1). They work best if started within 48 hours from the onset of flu symptoms.

What's the difference between the two?
Tamiflu is approved for treatment in patients 1 year of age or older. It is available in liquid or pill form and should be taken twice a day for 5 days for active flu. During pandemic conditions, there are dosage recommendations extending down to 3 months of age.
Relenza is for treatment of patients who are 7 years or older. It is also for preventative treatment for patients 5 years or older. It is taken twice a day for 5 days and inhaled directly into the lungs.

Are Tamiful and Relenza "okay" for babies/toddlers? Nursing moms? Pregnant women?
FDA approval of these antivirals are as per the ages described above. However during epidemics, Tamiflu can be used for children down to 3 months of age under the Emergency Use Authorization clause (EUA). Nursing moms and pregnant women can be treated with both Tamiflu and Relenza.

Is there a shortage of either one?
The U.S. Government has a stockpile of these antivirals, but judicious use of these medications is recommended, and we don't want to risk developing viral resistance to the drugs. That means that these medications should not be used daily "just in case" for prevention. They are to be used only in the vent of H1N1 illness and for household contacts of flu victims.

What are the downsides of taking Tamiflu or Relenza as a preventative?
Taking either drug in a preventative regimen is indicated only under certain specific circumstances. Essentially, these medications are recommended for the very young, or very old or those with chronic underlying illnesses who have been exposed to suspected or confirmed swine flu. These include household contacts, school contact or travel contacts to high-risk areas.
Tamiflu has side effects that may include nausea, vomiting, abdominal pain, seizures or behavior changes.
Relenza may cause breathing problems, especially in patients with underlying lung disease or asthma. It may also cause seizures, confusion or abnormal behavior.

Are there any other preventative measures worth considering?
Definitely. Here are some practical tips (mentioned in our previous swine flu post, but worth reiterating):

• Avoid who are ill and thrive with those who are well
• STAY HOME IF SICK and don't return to work, school or daycare until well and fever free for at least 24 hours
• WASH HANDS WASH HANDS WASH HANDS when coming in from school, outside or work and before putting anything in your mouth
• If you are coughing, cough into your sleeve or tissue. Wash hands frequently throughout the day.
  
• Don't share food or drinks with others. Secretion exchange is a common route of infection.
  
• Don't ask for trouble by traveling to high risk areas
• Call your pediatrician if your child has true flu symptoms so that they can diagnose and treat early (within 24-36 hours of onset of fever). True flu symptoms include fever (usually over 101-103), chills, headache, sore throat, runny eyes and nose, cough and aches. Influenza A symptoms tend to hit a bit harder, so symptoms recognition is usually obvious
• When new strains of flu emerge, such as H1N1, it takes 4-6 months to develop an appropriate vaccine to cover that strain. Already efforts are in place to develop a vaccine against H1N1, in addition to other new strains of influenza that have attacked worldwide.

Again, we can't emphasize enough the power of STAYING HOME IF YOU ARE ILL, so that the freedom to move about and attend schools, events, travel and activities of daily living is maintained for those who are healthy.

Should I keep my baby/toddler under any sort of quarantine if I live in a city where swine flu has been confirmed?
It's always easier to prevent illness than to diagnose and treat it, however, it is reasonable to move about your community and do the things you need to do if you have reasonable control over whom you come in contact with. For example, a day long jaunt to a large indoor play place may not be advised if you have H1N1 in your community. But a birthday party in your home attended by healthy, asymptomatic children is reasonable. This is the time when communities need to work together to preserve public health, so keep attuned to the advisories delivered by your local health departments.

While we would advise against unnecessary crowded or social contacts, obviously if you live in a densely populated urban area like New York City, staying locked in your home and not using public transportation is not always practical.

The most critical advice we can offer as pediatricians is that we all do our part to stay healthy and prevent unnecessary spread of germs. This means STAY HOME if you feel sick and wash your hands (and your children's' hands)...A LOT...especially after you come in from the outdoors or a social situation.

We must remember that the total number of cases of confirmed swine flu in the US really amounts to a relative handful (as of 5/6, 642 cases nationwide), and that with the support of our medical and public health communities, we are equipped to handle this situation. We must also keep in perspective that the case described in the US have been mild to moderate in severity (aside from the tragic exceptions in the case of 2 recent deaths in Texas), and that local communities affected are reacting appropriately and outcomes have been good so far.

Any thoughts or insight you can provide to help explain the 2 recent deaths (and help calm any panic)?
Very young children and the elderly are more at risk for dying to getting really sick from the flu. Approximately 36,000 Americans die every year form the influenza virus. Of this number, in 2007-2008, 83 were children. So deaths in this age group represent a minority, albeit a tragic one. While we would never ever want to minimize the grief that the families of these families are experiencing, 2 deaths from swine flu, relative to the total average number of deaths from flu every year, is not a cause for public panic.

Our recommendation is that we use this tragedy as an opportunity to reemphasize to parents the critical importance of vaccinating your kids from influenza every year* (hence this year's recommendation from the AAP that ALL children between the ages of 6mo and 18yrs be vaccinated with the flu vaccine!).
*Important note: this vaccine does not protect against this particular strain, however the medical community is working quickly on developing a specific swine flu vaccine.

Like we said, remember that flu from Influenza claims the lives of 36,000 Americans yearly (most often in the elderly and very young) and infects millions of Americans every winter -- and the great majority survive and thrive.
We said it in our last post (so forgive the redundancy) but we'll say it again: It is still too early to tell how severe this now prolonged flu season will be, but remember that summer is coming, and the flu virus tends to want with warm weather. Keeping this in mind, we anticipate a short outbreak, with the help of Mother Nature. Some of the hysteria thankfully seems to have waned a bit, but we still want to emphasize that we all use common sense, be sensible, stay calm, and WASH your hands!

Swine Flu (aka H1N1): Part 1 - Our Perspective

With the media and government putting us all on the edge of our seats worrying about a possible pandemic of swine flu, it's important to have basic factual information and a realistic perspective about what is happening as questions and fears grow with every news report. While we know this blog entry is going to be a bit lengthy, we decided this was not the time to edit. We are choosing to fully explain the situation in a very straightforward manner, with as much information we have at this point, and answer some of the most common concerns we've addressed in our pediatric practices.

Simply speaking, Swine Flu (H1N1) is just a new, unexpected strain of influenza A. We are all familiar with the concept of new strains of flu -- it's why we need to revaccinate every year to keep up with changes in the makeup of of flu viruses. But since Swine Flu only comes around once or twice a century, most humans have no acquired or natural immunity. Swine Flu strains are typically not included in flu vaccines, and thus more people may be susceptible to illness in a pandemic situation (though this is not at this point classified as a 'pandemic').

The good news is that, unlike many strains of influenza that are not responsive to therapy, this Swine Flu strain, H1N1, is TREATABLE with Tamiflu or Relenza. In the last year our practice alone has treated 390 cases of documented influenza. Some, but not all, patients received Tamiflu, but many were treated conservatively with rest, fluids, supportive care and staying out of work, school or daycare until symptoms resolved. We had no children hospitalized due to the flu, and had good outcomes, even with just supportive care as treatment.

Because the US Government has stockpiled Tamiflu, should H1N1 become a problem in our communities, we anticipate ample supplies to treat this strain of the flu.

We continue to remind families that the best way to stay healthy and avoid flu risk is to:

• Avoid those who are ill and thrive with those who are well
• STAY HOME IF SICK and don't return to work, school or daycare until well and fever free for at least 24 hours
• WASH HANDS, WASH HANDS, WASH HANDS when coming in from school, outside or work and before putting anything in your mouth
• If you are coughing, cough into your sleeve or tissue. Wash hands frequently throughout the day
• Don't share food or drinks with others. Secretion exchange is a common route of infection.
• Don't ask for trouble by traveling to high risk areas
• Call your pediatrician if your child has true flu symptoms so that they can diagnose and treat early (with 24-36 hours of onset of fever). True flu symptoms include fever (usually over 101-103), chills, headache, sore throat, runny eyes, cough and bodyaches. Influenza A symptoms tend to hit a bit harder, so symptom recognition is usually obvious.

When new strains of flu emerge, such as H1N1, it takes 4-6 months to develop an appropriate vaccine to cover that strain. Already efforts are in place to develop a vaccine agains H1N1, in addition to other new strains of influenza that have attacked worldwide.

We must remember that the total number of confirmed cases of Swine Flu in the US (109 as of the morning of 4/30/09) really amounts to a handful, and that, with the support of our medical and public health communities, we are equipped to handle this situation. We must also keep in mind that flu claims the lives of 36,000 Americans yearly (most often in the elderly and very young) and infects millions of Americans every winter -- and the great majority survive and thrive. It is still too early to tell how severe this now prolonges flu season will be, but remember that summer is coming and the flu virus tends to wane with warm weather. We anticipate a short outbreak with the help of Mother Nature. So hang in there -- and continue to be calm and sensible!

Stay tuned for Part 2: a Q&A with Tara Mandy, publisher of StrollerTraffic.com. Tara has been fielding a ton of questions from concerned parents, so she came to us for answers. We'll share them with you in our next blog posting...

AAP Considering Update: Rear-Facing Carseats Until Age 2

In case you haven't heard, the American Academy of Pediatrics is considering changing their carseat policy in 2010 to recommend REAR-FACING carseats for ALL children up to the age of TWO YEARS. Not official at this point (though that implication is making the rounds...even to our offices!).
Even if little feet touch the seat, injury rates and severity have been shown to decrease dramatically with kids in the rear-facing position. In fact, according to research, toddlers between the ages of 12 and 23 months who ride rear-facing in a car seat are more than FIVE times safer than toddlers in that same age group who ride forward-facing in a car seat.
We're thinking it's a great idea to turn your tots back to rear-facing -- for their health and safety. Your sanity may suffer a little bit, but safety comes first!

We want to know what you think. How do you feel about this potential recommendation? Will you turn your kids back to the rear-facing position?

Health & Safety Tip: Are you keeping your New Year's Stay-Healthy Resolutions?

Well, we're 22 days in to the New Year and it's awe-inspiring to think how much change we've all been surrounded by of late! With all this excitement, it's sometimes easy to forget the promises we made to ourselves at the top of the year, so we thought we'd check in and see how your progress is going on your New Year's resolutions. We know how difficult it is to keep them, however well-intended they may be. So we're sharing our favorite stay-healthy resolutions that are actually easy to keep (and easy to pick up again any time of year)!

1. "I resolve to use sunsreen on my family every day."
   We know, we know..."But it's January! And we're not at the beach!" Believe it or not, harmful UV rays don't just make their appearance Memorial Day through Labor Day. Exposure to UV rays adds up all year round. The most effective way to prevent skin cancer (aside from staying out of the sun) is to use sunscreen 365 days a year. Our favorite (though we know we're biased) is the Babysafe Sunscreen Towelettes SPF 30+. These indispensable sunscreen wipes are so easy to pop in the pocket of your winter coat and have a perfect amount of sunscreen to cover any exposed areas like face, ears & back of the hands -- any time of year.
   
   
2. "I resolve to wash my hands...a lot!"
   In our pediatric practices we are constantly bombarded with nasty germs, yet we rarely get sick. Our most tried & trued stay-healthy secret is surprisingly simple: We wash our hands constantly! Hand washing is the most effective (and easiest) way to prevent the spread of germs that cause colds, the flu, and several gastrointestinal disorders. Help your kids get in the habit early by teaching by example. Make it fun and lather up to a rousing rendition of the ABCs! If you don't have soap and water handy, go ahead and use a great multipurpose alcohol-free wipe or all-natural hand sanitizer.
   
   
3. "I resolve to adhere to the 30-second rule."
   Did you know the most effective way to maintain your and your baby's precious moisture barrier is to smooth on a moisture balm within about 30 seconds of patting dry? We like to call it the "30-second rule", and it's one of our favorite techniques to recommend to parents of children with eczema and dryness. Especially as the temperature continues to drop and winter dryness threatens even normally supple skin, we suggest at least a once-daily dose of moisture balm. A note to parents of children with very dry skin or eczema: One key to successfully treating these conditions is REPEATED application throughout the day.
   
   
4. "I resolve to up the antioxidant ante."
   Antioxidants protect us (and our babies) on the inside and out, aiding in skin repair and strengthening blood vessels. Blueberries are our top "superfood" choice for little ones (they're packed with antioxidants, phytoflavinoids, Vitamin C and potassium!) and a recent British study even showed that an antioxidant-rich Mediterranean diet may even prevent allergic rhinitis and asthma symptoms in youngsters. When it comes to the outside, be sure to look for antioxidants like Vitamin E, Avocado Oil, Grapeseed Extract and Olive Squalane to protect baby's uniquely delicate skin from environment damage.

These resolutions we know we can keep... Now if only somebody would make it easier for us to stop eating chocolate and start jogging!

It’s that time of year, the holidays are upon us, and travel reaches a fever pitch at the end of November. Here are a few tried and true tips for safe and sane travel with your young ones:

Stay healthy on the go! Before you travel, make sure your children’s vaccinations are up to date, including flu vaccine (have your pediatrician guide you) – especially since nothing stops people from traveling to loved ones during the holidays – not even colds or flu!

Arrive early at the airport. If it is naptime, find a quiet corner for your child to nap while awaiting your flight. A rested child is a better traveler.

Always pack comfort items for your baby or tot . A lovey, pacifier or blanket are essential. For older children - a couple of favorite books, a favorite packable toy or a stuffed fuzzy friend are always a welcome companion.

Remember to also pack some light snacks for your tots or older children. Babies will do well with nursing or sucking on a bottle during take offs and landings as this will reduce discomfort associated with middle ear pressure changes.

Sample-size your routine! Current regulations permit a maximum size of 3oz bottles of creams, lotions, or gels as carry-on items. Baby Silk...To Go! is a perfect carry-on choice: 1oz tubes containing diaper rash cream and liquid powder, together with 2oz bottles containing hair &body wash and moisture balm are TSA-approved for carry-ons and make for an easy pass through at the security gate. (Don’t forget to also bring your Babysafe Sunscreen Towelettes!) We suggest you check www.tsa.gov the day prior to departure for the most updated security information, to avoid unnecessary delays at the security checkpoint.

Children like to be comfortable traveling, too! Their softest PJs are better choices than their most fussy outfit! Save that for your destination. If you’re also traveling with a toddler, be sure to keep their shoes on when walking around a plane – unexpected injuries can be prevented.

If you are changing time zones, keep your child on his “home” time schedule until you arrive at your destination. Once at your destination, expect that for every hour time change you experience, your child will need a day to adjust …on the return leg, the same occurs. Try your best to remember regular naps and a consistent place for your child to sleep. Ironically, keeping a baby up and missing naps usually results in very sleepless nights.

Whether you are traveling near or far, or not at all, we wish you a happy, healthy and loving time with family and friends this holiday season!

Health Tip: How to Perform a Breast Self-Exam

Get the facts.
Breast self-exam, as part of a 3-part program (including self-exam, mammograms and clinical breast exams every 3 years starting at age 20) can be an important element in the early detection of breast cancer. But how many of us really know how?

Here, a step-by-step guide on 3 different ways to perform a breast self-exam:
IN THE SHOWER

• Put one hand behind your head, elbow facing upward
  

• With the pads of your three middle fingers, move your hand over the entire breast area
  

• Use right hand for left breast, left hand for right breast
  

• Use one of the three following patterns to examine your breasts: 1)Circle: in a series of circles around your nipple, middle of breast, and outside perimeter of breast; 2) Up & Down: up and down in a zig zag pattern from top to bottom over the entire breast; or 3) Wedge: in a series of "wedges", working from the nipple outward in 8 or so sections
  

For consistency, be sure to examine the same way each time, using the pattern and technique recommended by your healthcare professional at your clinical breast exam. (The American Cancer society recommends the up & down pattern.) Check for lumps, knots or thickenings.

LYING DOWN

• Place a pillow or towel under your right shoulder, with your right hand behind your head.
  

• Using your left hand, follow the same technique (using one of the above patterns) as in the shower. Then lower your right arm slightly and with your left hand, check your right underarm.
  

• Check for lumps, knots or thickenings.
  

• Repeat on the other side, using your right hand to check the left breast and underarm.
  

IN FRONT OF A MIRROR

• With your hands firmly pressing down on your hips, check for changes in shape, size or skin texture of your breasts. Then raise your arms overhead and check again. Be sure to note any swelling, redness or skin dimpling. Also be sure to check for any changes in your nipple or unusual discharge.
  

Be sure to perform a self-exam monthly (perhaps after your periods when your breasts are not full or tender) and report any changes or irregularities to your healthcare professional immediately.

An important note: This guide is not intended as a replacement for medical care. For a complete diagnosis and course of treatment, please see your doctor.

The Breast Cancer Research Foundation has a great resource in its Breast Cancer Basics Library. Be sure to check it out for video and articles about everything from more details on how to perform a self exam to understanding the stages of breast cancer.

The Magic Mommy Kiss, and the Baby Silk Babysafe Sunscreen Towelettes, Seen Round the World

We’re not going to lie and say that it’s not unbelievably exciting (a dream, really) to wake up to photos of an A-list celebrity toting our products along with her most precious cargo (who, P.S., is definitely one of the most adorable tots in town). When we saw the pics of Jennifer Garner planting a big ‘ol magic mommy kiss on her darling Violet, while holding our Babysafe Sunscreen Towelettes, our “awwwwwws” turned to “WOOHOO!”s.

As founders of a company, in a celebrity-obsessed society, we couldn’t dream of a better caught-on-film moment. But as pediatricians, what REALLY excited us was seeing a mom diligent about sun safety…in almost-October!

“What a FABULOUS opportunity” we exclaimed, “to remind everyone that the sun’s harmful UV rays don’t take a vacation just because you came back from yours!”

So, here are a few tips and reminders to help us keep our kids protected, 365 days a year.

• Just because it’s cool outside doesn’t mean UV rays aren’t present and harmful. The temperature may have dropped by a few degrees, but UV rays are still present! Sunscreen is just as much of a post-labor day must-have as it is in the Spring and Summer
• Pack a lunch, pack a sunscreen single. Typically, daycares and schools don’t provide sunscreen for their students, yet kids spend considerable time outdoors (even in the winter). Recess, playtime, lunchtime, or school sports are all opportunities for UV exposure and an important time for sunscreen application.
• Don’t forget about afterschool sports. Whether it’s big brother or sister on the field, or baby cheering them on from the stands, even that hour or two a couple times a week adds up to a significant amount of time exposed to UV rays. If you’ve applied sunscreen to your child before school, don’t forget to reapply prior to heading out to practice.
• Baby it's cold outside! UV rays can be reflected off snow and other surfaces, so don’t forget to protect exposed areas with a broad spectrum sunscreen during winter sports or while perfecting your snow angel skills.

Health & Safety Tip: Have Fun in the Sun...Safely!

☼Summer time is for relaxing and having fun in the great outdoors. It’s also time to think about sun safety. The most common type of skin cancer in the US is caused by unprotected sun exposure (specifically UVA and UVB ultraviolet rays) in childhood and adolescence.

☼ Between 60% to 80% of sun exposure happens before we turn 18 years of age. That’s because children spend more time outdoors than most adults, especially in the summer.

☼ The majority of lifetime sun damage occurs before the age of 18, and did you know that just two or three blistering sunburns during childhood can DOUBLE the risk of skin cancer later in life? More than 90% of all skin cancers are caused by the sun, and yet less than 33% of adults, adolescents, and children routinely use sun protection.

☼UVA (the “AGING rays”) cause wrinkling, spotting and skin cancer by penetrating deep into skin. UVB (the “BURNING rays”) sizzle the top layer of skin and contribute to skin cancer risk.

Here are some practical tips to help reduce these risks:

• Avoid direct sun exposure during the peak hours of the day, usually between 10AM to 4PM. Harmful UV radiation is maximal during this interval. Stay in the shade if possible. Reapply sunscreen at 2-4 hour intervals if your child is dry, at 1-2 hour intervals if swimming or wet.

• Dress your child in UV infused clothing (Cabana Life and Wallaroo Hat Company are examples) or use an SPF rinse on tightly woven cotton clothing to raise the SPF value from 5 (regular cotton t-shirt) to spf 30 (we like SunGuard Laundry Aid).

• Your child should wear sunglasses that offer 99-100% blockage from ultraviolet rays (check for ANSI rated UVA & UVB protection). Also, remember a hat with a wide brim that will shade the face and cover the ears.

• Be more diligent about consistent sunscreen use around the water, sand and snow as they all reflect the sun’s rays, increasing the risk of sunburn. (Our Baby Silk Babysafe Sunscreen Towelette Singles are a convenient way to take sun protection on the go...no matter the locale or temperature!)

• The American Academy of Pediatrics and the American Academy of Dermatology recommend that, if avoidance of sun exposure is not possible, babies - no matter how young - should be protected with a sunscreen that has at least a SPF15 and offers both UVA and UVB protection (broad spectrum.) In addition, due to the sensitivity of young children’s skin, the ideal sunscreen should be one containing Zinc Oxide and Titanium Dioxide (pure physical block ingredients). These two ingredients offer the safest protection with the least potential for skin irritation. Unlike a chemical block, which needs minimum 20 minutes absorption time to be fully effective, a physical block will work immediately upon application, as the sun’s rays are reflected from the barrier on top of the skin.

• Use enough sunscreen for effective protection. One ounce (the size of a shot glass) is recommended per application. If a chemical sunscreen is used, apply it to your child’s face and body, wait 20 minutes and re-apply (so that any missed spots are covered, and areas that wear against clothing or sweat get double coverage). Reapply at 1-2 hour intervals if swimming or wet, and at 2-4 hour intervals all through the day. (Our Baby Silk Babysafe Sunscreen Towelettes have a premeasured dose of sunscreen to adequately cover the average 2-year old from head-to-toe.)

• Always patch test any new topical product on a small area of skin on the extremities or trunk. Wash off or discontinue use if redness, itching or irritation occurs. Discard sunscreen that has passed its expiration date. A good rule of thumb is that, if it is more than 2 seasons old, it has lost its potency.

"Safe sun" doesn't have to be a contradiction in terms. Know your sun facts, be prepared ( a little Girl Scout motto that has stuck with us!), and HAVE FUN! Happy Summer!

As seen on Better.tv: Head Lice

Head lice - yuck! Amazing how 2 little words can make you so...itchy! (Ever wonder where the term "lousy" came from? Now you know!)
There are many misconceptions about head lice that are simply not true. Head lice know no bounds (neither cultural nor socioeconomic) and are not a reflection of poor hygiene. Common to very popular belief, they do not jump from one head to another (don't look for any lice going for the pole vaulting gold in Beijing this Summer), and though they are incredibly disruptive and annoying, they are not dangerous. Here are a few tips on how to prevent, spot and treat head lice, and even some recommendations for a support team!

Remember...this advice does not constitute care...and the final call is with your pediatrician.

PREVENTION: lice can infest through DIRECT contact – so sharing hats, hair ornaments, caps, scarves and other adornments with others should be prevented. Lice can live on inanimate objects for a few hours, so even surfaces like movie theater seats/airline seats/car seats can be vehicles for spread – wearing a CAP to the movies (hair tucked under) might be a good strategy.

HOW TO RECOGNIZE: active lice are obvious – they are tiny, crawl, and hang out at the hairline under the nape of the neck, behind the ears, and hide in the depths of hair. Their eggs (called NITS) adhere pretty firmly to the hair shaft about 1/4" to 1/2" from the scalp. Nits are often mistaken for dandruff and vice versa. If you have a child with an ITCHY scalp AND see nits or live lice, your kid’s condition is obvious. Lice can also infest eyebrows and beards – anywhere there is a hairy hiding place.

TREATMENT: OTC: Many of the over the counter treatments are ineffective – partially due to some resistance that has developed with the lice themselves, but also because the MOST IMPORTANT STEP OF TREATMENT, which is to PICK OFF ALL THE NITS is hard to do. Lice combs may help, but the most tedious, yet effective way to cure an outbreak is to go through EVERY strand of hair and physically pick out the nits with your fingers. With boys, piece of cake – haircut, buzz ‘em, most don’t mind. With a child with luxurious locks, pin up 1 inch sections of all the hair, round up some magnifying dimestore glasses, a bright light, and a big bucket of patience and go through section by section.

Prescription treatments: there are 2 that we use pretty routinely – Elimite (permethrin – oil of chrysanthemum) and Ovide.

With Elimite, we saturate the dry hair/scalp and leave on for 8-12 hours, shampoo out, NIT PICK – and repeat in a week. Ovide (malathion, an insecticide) always works, but we restrict it’s use to older children.

ALTERNATIVE REMEDIES: From our good friends at DrGreene.com...

Most alternative treatments are untested, but early reports are promising. One method with widespread stories of success is the Vaseline (or mayonnaise) treatment. Cover the infested head liberally in Vaseline. Place a shower cap over the entire head for the night (or an eight-hour period). Then shampoo the Vaseline out of the hair. This treatment is reported to "smother" the lice. The downside of this method is that the Vaseline does not shampoo out of the hair easily -- in fact, it usually takes a week or so to get it all out. The upside is that it is not toxic, and from all reports, it seems to work. Washing the hair with dishwashing liquid, which has a degreasing agent in it, may help. I've smothered my own hair in mayonnaise (loved the smell), and it came out easily with Dove Ultra dishwashing liquid.
The Packard Children's Health Services Pediatric Hotline at Stanford is hailing another popular treatment. It uses regular shampoo and three ingredients that can be found at most health-food stores:
Shampoo (use an inexpensive brand such as Prell -- these seem to mix more easily with the oils).
3 tbsp olive oil.
1 tsp tea tree oil.
1 tsp rosemary or eucalyptus oil.
Add the oils to a small amount of shampoo and mix well. Work into hair and leave on for half an hour with a tight-fitting shower cap. This mixture has a strong smell. The fumes may burn the eyes, so don't lean forward. Wash hair two or three times to get the oil out. Repeat the procedure if necessary.
I'm hearing positive reports about this nontoxic treatment, though to my knowledge, no medical studies have been conducted to establish the efficacy or possible side effects of this treatment.
One of our readers suggested using a hot blow-dryer for 15 minutes, morning and evening, in conjunction with thorough nit combing. The heat helps to kill the nits and adult lice, but the combing is essential to the process. This type of treatment should not be combined with the over-the-counter treatment.

ENVIRONMENT: so anything that has touched infested scalps needs to be dealt with – sheets, hats need to be washed in hot water/dried on hot. If seat cushions/pillows/toys have been in contact with the lice, they can just be bagged up in large trash bags for 2 days (lice can’t live that long without a human host) and then tossed in the dryer for a few minutes to remove the nits (or vacuumed). All hair brushes/combs need to be soaked in boiling water.

WHO CAN HELP: There are several services out there that will NIT PICK for you – some come to your home, some are housed in salons. Check for a service in your area, but a few we like are:

Hair Fairies : http://hairfairies.com/

Lousy Nit Pickers : http://www.louseynitpickers.com/

The Hair Whisperers : http://www.liceremovalla.com/

Some will accept a prescription from your doctor, and some insurers will actually pay for delousing!

Good luck!