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?

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!