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?

The Great Vaccine Debate

A GREAT discussion about vaccines is on our friend Ari Brown's website at http://www.windsorpeak.com/baby411/Vaccine.pdf

It is so hard to sort out fact from fiction in this age of vaccine fears. Dr. Brown has kindly allowed us to access this excerpt from her book Baby 411. We hope you read it and pass it along. We couldn't have said it better ourselves!
No matter which side of the vaccine debate you are on, make sure you have open and frank dialogue with your pediatrician. Open communication is key, and you can work together to devise a plan of action that both of you are comfortable with.

By the way, if you don't already have a copy of Dr. Brown's book Baby 411...run, don't walk...buy it. It's a must-have for any parent, and could save you a trip or two to our office!

Diary of a Doc: Dr JJ -- 1186 Days and Counting

First of all, I want to thank you all for your good wishes for DOD. He’s hanging in at home and gathering a little strength, day by day. As for the boy, he trekked to Chicago last weekend, riding shotgun with a librarian from Flint, for a national backgammon tournament. Backgammon shares a space in his heart with poker, but somehow the former seems more legitimate in mom’s mind (no seedy, smoky, sunglass-clad, shifty-eyed visuals in my brain). Having never set foot on the streets of “ChiTown” (except for his layovers in the airport), Max now understands why everyone LOVES Chicago (except in the deep of Winter). Here he was, kid from the BIG City, calling mom in absolute wonder at the gorgeous architecture, river through the City, admiring the vibrancy and beauty of this incredible jewel in the middle of the US! The tournament was held out in the ‘burbs, and Max quickly was humbled (and his scratched together entry fees and buy ins quickly gone) by the finesse and skill held by those many years senior to him. He didn’t mind being excluded early – as that gave him time to meet his heroes of this “sport,” garner some knowledge, and most importantly, stand back and realize that winning at this level requires years and years of practice, dedication, and, as he realized, many losses on the way to victory. His mind set zoomed from the fantasy of winning (as a young neophyte) to the reality of realizing that true dedication, humbling losses and resilient persistence are the qualities of someone who succeeds. I hope that he will apply this experience, and these lessons to his life on campus, and his life on this planet. I already started to see a hint of it when he was not hired as a campus tour guide (a plum paid position), and set about to try again in the fall (with no anger, angst, or assigning blame)……now let’s hope he finds a job this summer as he returns home April 29 for 3 months!

Baby Silk Honored with 2 Major Awards!

What a week we've had! We learned, in the span of 2 days, that our Baby Silk line was honored with not one, but TWO very exciting awards!
Our Babysafe Sunscreen Towelettes were honored last week with the prestigious NAPPA Gold Award (the National Parenting Publications Awards' highest honor) and our Soothing Bottom Relief Diaper Rash Cream and Gentle All-Over Clean Cleansing Towelettes each won a PTPA (Parent Tested Parent Approved) Award!
Having one product recognized like this is an honor...but three? Wow. Just wow!
The NAPPA seal is one that is recognized by parents everywhere and is a great mark of credibility for consumers and retailers alike.
The PTPA award is exciting because it was bestowed upon us by parents themselves. What more could we ask for?
So THANK YOU NAPPA...THANK YOU PTPA...and most especially, THANK YOU parents. It is for you and your kids that we do what we do, both as pediatricians and as the makers of Baby Silk. We are honored to have become a part of your lives!

Diary of a Doc: Dr. JJ -- 1212 Days and Counting

Well, where have the last several weeks gone?? Real life has stepped in the way of late -- as plans for a week away took a hairpin turn back to Los Angeles! My father-in-law was admitted to the ICU at Cedars, and by last Sunday, we seriously thought we were going to lose him. That said, for Max it was an automatic decision to return home instead of trying to feign enjoyment in NYC while grandpa (or DOD, Dear Old Dad, as we call him) was fighting for every breath. So Max (and his friend Lorin) returned home Tuesday, immediately sailing into DOD's room, and actually finding him a bit improved (as he had made no progress for 9 days prior). As the other grandkids gathered 'round as well, I think DOD decided he couldn't throw in the towel, and started to fight all week -- inspired by the young who sat at his side daily. I think Max (and Bruce and I) heard more funny (and secret) stories from Grandpa this week than we had heard in the last 20 years. It was as if he had unlocked more of his legacy and made sure it was verbally given to the kids. What a great gift! Although an emotionally draining few weeks, Max and Lorin left yesterday knowing that DOD was being transferred to a regular room, and against all odds would make it home.
As the kids' adventure got derailed, we made sure (with the kindness and generosity of friends) that they returned to Michigan with a few memories -- innumerable rides on The Simpson's at Universal Studios (thanks Janice!), a Laker's game (thanks Rex & Val!), and a day on the firing range in Tujunga (where Lorin looked like Annie Oakley, and shot more like a pro than a novice). The kids helped Bruce and I refocus and settle down, as initially every phone ring made us both jump, thinking we were going to hear the worst.
The kids returned to a HUGE storm just in time, and today we return to a regular life -- with its completely unexpected twists and turns...
We are grateful to all those who have returned DOD to us, and thank our friends and family for all their support and love.

Diary of a Doc: Dr. JJ -- 1240 Days & Counting

Our intrepid Max, fully outfitted in khaki green Northface expedition parka and LL Bean subzero boots continues to love the freezing cold, ice storms, snow and subzero temperatures that define the heart of winter in Michigan. Spring break for the Wolverines comes the third week of February -- as the kids are likely to be in the depths of seasonal affective disorder, dreading short days and long nights, and tired of the daily slog through snow drifts to get to class, the prospect of a little fun for a week keeps them warm with hope.
Max's first inclination was to return home for some R&R. However, knowing that we would force him out on the trail of identifying employment for summer dashed his dreams of sleeping in, eating trays of food lovingly prepared by mom, and the prospect of doing nothing. Skip to Plan B -- a trip to Mount Rushmore, by bus, enduring 36 hours in a smelly seat with perfect strangers. Good enough? NO! Skip to Plan C -- a quick trip to New York to visit the United Nations, see a Broadway show, take in the Museums before they are impassable in the Spring, a return to Ellis Island to caress the inscribed names of his great grandparents -- you bet! With the kind offer of a friend to stay in her apartment while there, Max will trek to the bigger city to take inn a little culture, a lot of history, and while not really having a chance to defrost, enjoy the vibrancy that is Manhattan.
It will be a little late to see Conan, but no less thrilling.
So what does Mom do? Put away the trays (ready to be laden with home cooked food), forget about fluffing up the pillows, put herself back in the office to work, and mope a bit...all part of the necessary process of emancipation and detachment that both parent and young people experience at this stage of life! So much of the college experience comes from not what is conveyed in the classroom, but rather the coping, resourcefulness and creativity that comes from striking out on one's own, problem solving, living within a budget and surging forward steadily into real adulthood.
Yeah, I'm moping a bit, but inside, I am totally proud!

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!

Diary of a Doc: Dr. JJ

A year and a half ago, I started to blog about my son in my practice newsletter - counting down the 400 days he had at home until his graduation from High School. Was he ready to go forth into the big world of college? Had we given him the right tools?
He successfully completed his journey and started as a freshman at the University of Michigan in September. Yet another countdown started, as I blog about his progress in college, our progress as empty nesters, and reflections of the life he faces currently. Enjoy as we pick up on this week's entry, and check back every Friday as we update our countdown...

1257 Days and Counting...

Brrrrr.....it's cold in Ann Arbor - freezing temps are hitting the entire Midwest and Northeast. From the comfort of our tropical climate, we shudder at the thought of even a 40 degree morning in LA - and yet thousands of our kids trudge bravely through several feet of snow, ice and slush to go to class, grab a hot chocolate, nourish in the dining hall, or just go to work! Max related that the other night, in the midst of an almost-blizzard, the fire alarms went off in his dorm, the kids trudged downward and outside, dreading the cold, and beleagured at the hour. What did they face at the front door - an army of energetic colleagues from the dorm across the way - and a pile of thousands of pre-made snowballs at the ready! The battle was on, the freezing temps didn't matter, as the proud warriors engaged in a contest that none of us could or would survive at our age. This is just one example of how our perspective changes with youth. Seriously, aside from a brief weather report from Max, I have not heard ONE complaint from him about the cold. His daily description is "It's so beautiful mom", and "thanks for the great coat and boots - 'cause I'm not cold."....and here I am this week, dreading a trip to NY, Boston and Providence next Friday - imagining that upon leaving the safe confines of a warm airport terminal, that I will IMMEDIATELY turn into a human popsicle and never recover! Of course the very mention of my anxiety arouses huge guffaws from my son, and a reminder from him that I have a little natural insulation to help me through such ordeals - oy!

The kids are gearing up for a celebration of hope on Tuesday as the inauguration and its' personal significance to Max and his friends is truly huge. I hope that we all stop and pause on Tuesday and realize the signficance of this very day. Think about the millions who will happily stand in the cold, ice, and snow to witness history, to revere freedom, and to support our country and its new president. Take the opportunity to share this event with your children, as it will generate such a variety of discussion points - both from the past and present. Whatever your politics, it is incumbent upon all of us to link together in mutual support in order to survive these tough economic and political times...

Have a great week - and enjoy this historic moment!

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!