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Saturday, August 17, 2013

Post #40 Flu Vaccine Update 2013-2014 (Quadrivalent vs Trivalent)

How is the flu vaccine formulated?

Flu viruses are always changing. Each year, experts study thousands of flu virus samples from around the world to figure out which viruses are making people sick and how these viruses are changing. With this information, they forecast which viruses are most likely to make the most people sick during the next flu season. These strains are then used to make the flu vaccine for the next flu season.
The 2013-14 U.S. trivalent influenza vaccines will contain:

*an A/California/7/2009 (H1N1)pdm09-like virus
*an A/Victoria/361/2011 (H3N2)-like virus
*a B/Massachusetts/2/2012-like virus

The newer quadrivalent vaccines will include an additional vaccine virus:

*a B/Brisbane/60/2008-like virus

While the H1N1 virus and the H3N2 virus used to make the 2013-2014 flu vaccine are the same viruses that were included in the 2012-2013 vaccine, the recommended influenza B vaccine virus(es) are different from those in the 2012-2013 influenza vaccine for the Northern Hemisphere.

When to get vaccinated?

Yearly flu vaccination should begin in September or as soon as the vaccine is available and continue throughout the influenza season, as late as March or beyond. The timing and duration of influenza seasons vary.

In our area, a local pediatrician friend has already reported 2 cases of flu "A" seen in siblings this past week at their office.  A rapid flu test was used, however at this time no further confirmation is available.  If confirmed, this may point towards an early and long flu season.

While influenza outbreaks can happen as early as October, most of the time influenza activity peaks in February or later. About 2 weeks after vaccination, antibodies that provide protection against influenza virus infection develop in the body.

How many shots will my child need?
This year's seasonal flu vaccine will again include the Novel 2009 H1N1 vaccine which was used during the recent global pandemic and which was also included in the past three seasonal flu vaccines. This means your child will only need to get vaccinated with ONE TYPE of flu immunization this year.

If your child is 9 years or older, regardless of what flu immunizations have been given in the past, they will only need ONE immunization this flu season.

However, if your child is under 9 years of age, they may need TWO immunizations this year. See the chart below to assist you in knowing how many shots your child will need this flu season.

If your child needs 2 flu vaccines this year, they should be spaced apart by a minimum of 4 weeks (28 days). There is no deadline by which the 2nd flu vaccine needs to be completed, but once the minimum 4 weeks has passed, the sooner the better as your child will have optimal protection only after the 2nd immunization.

0 flu shots since July 2010
1 flu shot since July 2010
2 flu shots since July 2010
Under 9 years of age
2 flu shots needed
2 flu shots needed
1 flu shot needed
9 years of age of older
1 flu shot needed
1 flu shot needed
1 flu shot needed

If your child is under 6 months of age, they are too young to receive the flu vaccine.  It is imperative for all surrounding family members (and caretakers) to receive the flu vaccine as soon as possible to create herd immunity.  Essentially, if everyone surrounding the infant is protected, it decreases the risk that the baby will be exposed to the live flu virus.

Quadrivalent vs. Trivalent flu vaccine

Traditionally, the flu vaccine covers 3 different strands of the flu virus (2 "A" strands and 1 "B" strand) and is labeled a trivalent vaccine.  Starting  this year, some of the the flu vaccine products will be expanded to include 4 different strands of the flu virus (2 "A" strands and 2 "B" strands) thus adding 33% more protection.

This means that both the trivalent flu vaccine and the quadrivalent flu vaccine will be available this year.  Within approved indications and recommendations, no preferential recommendation is made for any type or brand of licensed influenza vaccine over another by the CDC (Center for Disease Control).

The manufacturing process for the quadrivalent vaccine is the same as the trivalent vaccine and as such there should be no increased adverse effects in using the newer quadrivalent vaccines.

At our office, the trivalent injection vaccines are shipping out sooner than the quadrivalent injection vaccines (with no shipping date for the quadrivalent injection vaccines given as of 8/17/13).  The quadrivalent nasal vaccines are shipping now.  Unfortunately, children under 2 years of age and those with asthma (and a few other scenarios - please see CDC website) cannot receive the nasal vaccine and must receive the injection vaccine.

It is this author's opinion that when possible, a quadrivalent vaccine is preferable as it protects against an additional "B" strand that the trivalent flu vaccine does not.  However, from a timing standpoint, if the quadrivalent is unavailable, it is probably more important to get the trivalent vaccine as soon as possible, rather than to wait on an unknown availability date.

In the event that a child will need two flu vaccines this year, it is ideal to get as many quadrivalent doses as possible.  The most ideal would be to receive both flu immunizations with the quadrivalent vaccine. 

However, if this is not possible or ideal because of vaccine availability, the next best scenario is to receive at least one quadrivalent and one trivalent, although this is only marginally better than receiving two trivalent shots.  Because of timing and availability, if both shots given are the trivalent vaccine, this is still preferable to waiting on the quadrivalent vaccine, if availability is uncertain.

Children receiving the nasal flu vaccine and requiring two doses do not have to worry about this issue, as all nasal flu vaccines are expected to be quadrivalent this year.

Parents should know that in a child who requires two flu immunizations this year (see chart above), the reason it is recommended to get the second immunization is that in a naive immune system, a single injection of a flu strand does not afford very good protection.  (This is pertinent mostly with the injection as the nasal flu vaccine affords good protection with one dose - however two may still be recommended per the CDC algorithm.)  For ideal protection, a booster of the same strand should be given as soon as possible.

This is why a single injection of the trivalent vaccine (which has 3 flu strands) followed by a booster injection of the quadrivalent vaccine (which has 4 flu strands) or vice versa is only marginally better than receiving two trivalent flu shots. 

In the preceding scenario, the 2nd "B" Brisbane strand (which is only included in the quadrivalent vaccine) would only be received once.  Thus, there would be good protection against 3 strands of flu and only marginal protection against the quadrivalent-only strand of Brisbane "B"  flu.

In the end, practically speaking, timing is probably more important than worrying about quadrivalent vs. trivalent flu vaccine.  When possible the quadrivalent should be received, but when the quadrivalent is unavailable it is probably best to move forward with the trivalent vaccine.   The faster the flu season infects children, the more important timing becomes.

If the quadrivalent vaccine is unavailable, some parents may initially opt to get the readily available trivalent flu shots (once or twice) and then desire to follow-up with two additional boosters of the quadrivalent flu shots as they become available. 

This could possibly lead to a scenario where a child receives 3 or 4 flu shots during this season (1-2 initial trivalent shots followed by two quadrivalent shots).  This would ensure early protection against the 3 strands of flu in the trivalent vaccine followed by addtional protection against the Brisbane "B" strand which is only covered by the quadrivalent vaccine.

As the author of this blog, I am unsure about the safety of receiving 3 or 4 flu shots in a single season.  The flu shot has been historically shown to be very safe with few side effects, but I am unsure of the data regarding this many shots.  

The pediatrician and parents will have to weigh the risk and prevalence of the Brisbane "B" strand vs. the unknown potential side effects of receiving 3 or 4 flu shots.  This author's educated guess is that there is little risk to a 3rd or 4th flu vaccine in a single season, but at this time I have no specific data to support this claim.

At our office, the quadrivalent vaccine will be preferentially given, when in stock, unless otherwise requested by the parent.

Flu Vaccine Egg Allergy Protocol (per CDC)

1. Can the child eat lightly cooked egg (e.g., scrambled egg) without reaction?
If so, the vaccine should be administered per usual protocol

2. After eating eggs or egg-containing foods, does the child experience ONLY hives?
If so, the vaccine should be administered and the child will be observed for reaction for at least 30 minutes following vaccination

3. After eating eggs or egg-containing foods, does the child experience other symptoms such as: cardiovascular changes (e.g., hypotension), respiratory distress (e.g., wheezing), gastrointestinal symptoms (e.g., nausea/vomiting), reaction requiring epi-nephrine, or reaction requiring emergency medical attention?
If so, the child shoud be referred to an allergist with expertise in the management of allergic conditions for further evaluation.

When will the vaccines be available at Blue Fish Pediatrics Memorial?

At Blue Fish Pediatrics Memorial, during regular office hours (starting August 19, 2013), the flu vaccine will only be available at well visits for all patients of Blue Fish Pediatrics Memorial and family members living in the same household with patients under 6 months of age.  Flu vaccine will also be administered during sick visits at their doctor's recommendation.

The flu vaccine will be administered at all well child visits until supplies are exhausted (no additional appointment or phone call is required).

To help accommodate our busy families, we have designated four Saturdays for flu shots (the clinic will still be open on these Saturdays for sick patients).

Because of the high volume, these flu clinics are for BLUE FISH MEMORIAL PATIENTS ONLY. Weekday vaccine appointments will be made for Cypress patients who arrive at these flu clinics. For more information, please see the CYPRESS flu newsletter.

The dates of the Saturday Blue Fish Pediatrics Memorial flu clinics:

Saturday    Sept 14, 2013          8:00 AM—1:00 PM
Saturday    Sept 28, 2013          8:00 AM—1:00 PM
Saturday    Oct 12, 2013           8:00 AM—1:00 PM
Saturday    Oct 26, 2013           8:00 AM—1:00 PM

Any Blue Fish Memorial patient or parent is eligible to receive the flu vaccine on these four specially designated Saturdays.  Also eligible are any family member(s) living in the same household with patients under 6 months of age.  On these specially designated Saturdays you will not need an appointment and can walk-in at your convenience for the flu vaccine.

·        The availability of certain flu products may be limited towards the end of the flu season.
·        The intradermal flu vaccine will NOT be available at Blue Fish.
·        The recombinant flu vaccine will NOT be available at Blue Fish.

Saturday, July 13, 2013

Post #39 Vomiting and Diarrhea (Gastroenteritis) in Children: A Practical Guide

It certainly looks, sounds and smells awful, but vomiting and diarrhea are rarely dangerous.

Vomiting, not to be confused with spitting up, is the expulsion of food from the stomach.  Spitting up is more of a laundry problem than a medical problem, and kids who spit up do not become dehydrated.  

Diarrhea is a little harder to define, because watery stools are fairly common and most healthy individuals will experience it from time to time for reasons which do not qualify as diarrhea.

Frequent stools can be normal too, especially in breast-fed babies, who might dirty the diaper every time they feed, up to 12 times a day. It often looks watery and yellow with little remnants that look like seeds. Despite appearances, this is not diarrhea.

In general, diarrhea is a sudden increase in stool frequency, three to four times more often than usual. It has a general watery consistency, but frequency is the most important defining attribute.

No matter how copious the diarrhea, in developed countries it rarely leads to dehydration because it's easy to replenish lost fluids.

By far, the most common cause of vomiting is viral "gastroenteritis," a fancy medical term for an infection of the intestines that disrupts the normal digestive process.

While viral gastroenteritis can present with many symptoms, including headache, fever, decreased appetite, abdominal cramps and muscle aches, diarrhea and vomiting dominate. 

What to expect
In general, a child will vomit for one or two days, with three to six separate episodes of vomiting per day.  Diarrhea typically lasts much longer, from one to two weeks, with approximately six to 15 episodes per day.

Illness usually begins 12 hours to four days after exposure and lasts for three to seven days.

Viral gastroenteritis peaks in the winter; that's when 70 to 90 percent of cases are seen in the hospital.

Rotavirus Vaccine
There are many different viruses that cause various forms of gastroenteritis. Rotavirus is the most common virus and the most common cause of gastroenteritis overall.

A vaccine to combat rotavirus was introduced in 1998, but was pulled from the market in 1999 because the risk of developing a bowel obstruction was linked to the vaccine.

In 2006, two newer versions of the vaccine were introduced, RotaTeq and Rotarix. They have been proven to be safe and very effective in reducing hospitalizations, dehydration, emergency room visits, and most importantly, death.

Since the vaccine, the number of severe cases of gastroenteritis has significantly dropped and the majority of cases can now be handled at the pediatrician's office instead of the hospital.

Non-viral causes of gastroenteritis
A small percentage of gastroenteritis infections are caused by bacteria, the biggest sign of which is bloody diarrhea. 

Yet blood does not necessarily mean bacterial gastroenteritis.

With viral gastroenteritis, the skin of the anus or the lining of the intestine can become irritated and cause small amounts of bleeding.

However, if it appears the amount of blood is greater than 10 percent of the entire stool or bleeding recurs with several consecutive stools, your child needs to see the pediatrician promptly. A stool test can confirm diagnosis.

Bacterial gastroenteritis infections can become quite severe and require close monitoring, possibly in the hospital, and sometimes will benefit from antibiotic therapy.

Another cause of gastroenteritis, although infrequent, is parasites.

The most commonly seen parasitic cause of diarrhea and vomiting in the United States is Giardia Lamblia, which is most often picked up in a daycare setting. It is rarely dangerous and can be treated with antibiotics.

If your child has diarrhea that lasts longer than two weeks, a stool test will help get to the bottom of things.  Prior to the two week mark, a stool test is generally not needed.

Dangers of dehydration
Although vomiting and diarrhea can be exhausting for a parent, vomiting and diarrhea in and of themselves are not dangerous to a child.

The potential of dehydration is the greatest danger.  A simple way to understand dehydration is to think of your child's body as a box.  As long as fluids coming out of the box are replaced by fluids going into the box, your child will not become dehydrated. 

In a healthy child, fluids come out of the box through sweat, urine and stool.  During a bout of gastroenteritis, fluids will also escape via vomit and diarrhea. 

Usually, fluids can be replenished by having the child drink water and other drinks, but during a bout of gastroenteritis, it can be hard to stop those fluids from pouring back out.

When that happens, fluids can be given intravenously in the hospital. Fortunately, studies show this is rarely necessary and that oral rehydration usually works as good as an IV.

Parents might want to opt for colorless rehydration products. Anything red or purple masks more serious symptoms, such as blood in vomit or stool.

Test the waters before allowing your child to drink freely by following this simple plan:

  1. To allow stomach muscles to recuperate, do not give fluids for 30 minutes after vomiting.
  2. Give one teaspoon of Pedialyte (for children less than 1-year-old) or Gatorade (for children older than 1-year) every five minutes for 30 minutes.
  3. After 30 minutes of sipping every five minutes, wait 20-30 minutes without drinking fluids.  If they do not vomit you can allow them to begin drinking Pedialyte or Gatorade freely.
  4. If at any time they vomit again, repeat the above cycle, starting from the beginning.
  5. Advance quantity slowly as your child demonstrates tolerance to fluids.

If your child fails this cycle more than two times, call the pediatrician.

Road to recovery
If you allow a child who has vomited to drink or eat again too soon, it will likely come right back out because the stomach needs time to recover.

Just like muscles are sore and flaccid after a hard run, stomach and intestinal muscles are also weak after several bouts of vomiting.  This makes it difficult for the stomach and intestines to push food down as it normally would, a muscular process called peristalsis. 

As a result of the muscles being tired, food cannot progress naturally through the digestive system, so the body sends it back up again.

So, just like you would ease your leg muscles into walking after a hard run, the same must be done for a child who has been throwing up.

Refeeding advice
Most parents have heard of the BRAT diet – bananas, rice, applesauce, and toast. But the Centers for Disease Control, among other medical organizations, believe the diet is unnecessarily restrictive.

Once your child can tolerate approximately 12 ounces of fluid without vomiting, you can offer breads, pastas, crackers, soups, and bland foods such as baked chicken or baked potatoes without much seasoning or fat.  Some medical websites have a refeeding chart that is helpful, such as this one on our practice's website.

Lactose Intolerance
After a bout of gastroenteritis, some kids will experience temporary lactose intolerance.

Lactase, the enzyme that helps digest lactose (a sugar in milk), is secreted from the lining of the gut, which is stripped away when infection occurs. The lining will heal, but lactose intolerance can last a few days or even weeks or months.  It is generally short-lived.

If you notice your child is bloated or uncomfortable after eating or drinking dairy products, limit those foods, switch to lactose-free milk or try lactaid pills. The symptoms should eventually subside and your child can get back to drinking milk.

Diaper Rash
For little ones still in diapers, a bad bout of diarrhea is often accompanied by diaper rash. Even the best diaper-changing parent can't keep up with diarrhea and its potential irritation of the skin.

The rash is caused by bile acids in the stool, and although the irritation can be controlled, it probably won't improve until the diarrhea subsides.

To prevent diaper rash:

  1. Clean the bottom with a soft cloth and use gentle strokes to prevent further abrasion.
  2. Allow for adequate air-drying of the skin.  If pressed for time use a blow dryer on cool setting to dry the skin.
  3. After air-drying, apply a thick coating of a barrier cream such as Desitin, Vaseline, Vitamin A&D, etc.
  4. If the skin looks particularly irritated, a 10-minute soak in plain water without soap can help. Air-dry and apply a thick coating of diaper cream.

Occasionally, the skin becomes so broken down it becomes susceptible to bacterial and yeast infections.  If the diaper rash is progressively getting worse despite following the above advice, visit the pediatrician.

Most stomach viruses will run their course without any medications, but if your child is miserable, you can use Liquid Maalox Regular Strength Antacid Suspension to ease tummy pain.

Children 1-2yrs: 1/2 teaspoon, four times a day. Do not take more than 2 teaspoons in a 24 hour period.

Children 2-6yrs: 1 teaspoon, four times a day. Do not take more than 4 teaspoons in a 24 hour period.
Children >6yrs: 2 teaspoons, four times a day. Do not take more than 8 teaspoons in a 24 hour period.
Anti-vomiting medications, such as Zofran (generic name: Ondansetron) can be used if the oral rehydration cycle is failed twice.  Because of a small potential for side effects, it is best to use this medication as a back-up and not as the primary treatment modality.

A lot of parents ask about probiotics. Some reviews have demonstrated a benefit in reducing stool output and the duration of diarrhea.  However, the jury is still out as to how helpful they are, which ones work best, and how much exactly is needed.  

Further, there have been a few reported cases of harmful side effects.  It may be safer to use a yogurt with a high concentration of healthy bacteria until additional studies help steer recommendations on how to best utilize probiotics.

Antidiarrheal medications are almost never recommended.  If something bad is inside your intestines, it is best to let it come out.

Antibiotics are never needed for viral infections.  Even for the rarer bacterial causes of gastroenteritis, antibiotics are controversial.

Overall, try not to overreact when your child is vomiting or has diarrhea. As with most aspects of parenting and childhood, this too shall pass.


How do I know if it's a virus or something different such as food poisoning?
Food poisoning is typically short lived, lasting less than 24 hours. It's caused by a reaction to toxins generated by bacteria growing in food. The stomach will vomit up its contents until all of the toxins are expelled, after which there is a rapid recovery. Usually, a lack of diarrhea and the short burst of vomiting is what will differentiate food poisoning from a stomach virus. In most cases, treatment is not necessary.

Should I worry if I see blood in my child's vomit or stool?
More often than not, blood represents injury to the lining of the stomach, esophagus or gut. Like a knee abrasion, it will heal with time. In general, it's a good idea to touch base with the doctor if you see blood, but most cases are not dangerous.

Should vomiting or diarrhea hurt so much? My child often cries out in pain.
Vomiting and diarrhea can cause cramping and sore digestive muscles. Most pain will subside as the illness improves. Severe pain that seems to worsen in intensity and increase in frequency should be reported to a doctor.

Can I treat symptoms with OTC medications?
In general, medications are not needed as the virus will soon run its course. But use your judgment. A timely dose of anti-vomiting medication can keep the child from having to receive an IV or visit an ER, but most of the times adherence to an oral rehydration plan is all that is needed.

What if my child is desperately thirsty and asking for a drink soon after vomiting?
A small ice chip from time to time would be reasonable, but if that too is vomited, the stomach may need at least 30 minutes to rest.

Wednesday, May 15, 2013

Post #38 The Common Cold

It's been around for centuries, and there is no cure. Millions of people every year are miserable because of it, but there is no vaccine. It is the common cold.

Back in the 16th century, folks dubbed it a "cold" because symptoms seemed to pop up in conjunction with exposure to cold weather.

Today, science has identified more than 200 different types of cold viruses that are specific to humans.

Most children will catch six to 12 colds per year, typically in rapid succession and usually in the wintertime – and this is actually quite normal.

Kids with colds can be quite miserable, leaving parents desperate for relief and pediatricians quite frustrated at their inability to treat it. Since doctors can't treat the virus, parents are often eager to treat the symptoms.

Unfortunately cough and cold medications do not work.

You're probably surprised to hear that, especially since countless options line the aisles of pharmacies. But decades of research on cough and cold medications have shown a lack of effectiveness in children.

More concerning is the fact that cough and cold medications can actually cause dangerous side effects in children, even to the point of death.

In January 2008, the Food and Drug Administration (FDA) issued a public health advisory for parents and caregivers stating that over-the-counter (OTC) cough and cold products should not be used to treat infants and children less than 2-years of age because of serious and potentially life-threatening side effects.

The American Academy of Pediatrics (AAP) goes even further, recommending that children less than 6-years of age should not use cough and cold medications. According to the AAP, "a variety of rare, serious health problems have been associated with use of these medications in children, including death, convulsions, rapid heart rates and decreased levels of consciousness."

Why don't they work? The answer is Mother Nature.

Infection begins when a cold virus lands in the nose or mouth, either from contaminated fingers or from the droplets in the coughs and sneezes of an infected individual.

The in-flight virus then attaches itself to the surface of the skin inside the nose (the mucus membranes.)  From there, the virus invades a nearby cell, where it hijacks part of the cell's regular function.  The virus replicates, the cell ruptures, and the newly-replicated viruses quickly overwhelm unsuspecting cells.

One of the key parts of this cycle is the destruction of nasal skin cells.  The presence of germs and the death of cells results in an inflammatory reaction – and miserable cold symptoms begin.

Inflammation and damage to the inner nasal skin cells is exactly why there is very little that can be done to help heal a common cold. In this case, Mother Nature, not a pediatrician, is the healer. It simply takes time and has to run its course.

Think back to the last time you fell and skinned your knee.  You probably cleaned it with alcohol and dabbed antibiotic ointment on the skin to prevent it from getting infected.  It eventually scabs over, and when the scab peels off, fresh new skin is revealed.

With a cold, the damaged skin surface in the nose and at the back of the throat is similar to the damage sustained on a skinned knee.  Just as the knee takes time to heal, so does the inner skin that lines the nose and throat.

No amount of cough or cold medications will accelerate the healing process. Until healing occurs, there will be mucus and there will be coughing. Depending on the amount of damage, this process takes at least two to four weeks.

Coughing is a protective mechanism designed to move mucus through the respiratory track. In a child with or without asthma, coughing can be worse at night because during the day gravity and activity helps mucus drain and clear from the airways; however at night, laying horizontal and the lack of movement allows mucus to pool in the airways thus increasing the coughing bouts.

Nasal congestion and nasal discharge usually signals the beginning of a viral infection.  The mucus is clear for the first few days, cloudy for several more, and then clear again near the end.  Any mucus that has been in the nose or throat for longer than one day is often a cloudy yellow or green color.

Contrary to popular belief, this is not a sign of bacterial infection nor is it a reason for antibiotics. The color is caused by enzymes in the body's immune system. It's a normal stage in the life cycle of a viral upper respiratory infection.

Congestion is usually the worst from day two to six of the illness.

Coughing usually begins soon after congestion starts.  Most coughs represent the body's efforts to protect the airway.  When mucus slides down the windpipe from the nose, it stimulates a cough reflex to prevent mucus from invading the lungs.

Babies are not very efficient coughers, so they tend to have more difficulty clearing their airway. Concerned parents will often visit the pediatrician on day three to five of the illness because that's when the coughing keeps everyone up at night.

Fever sometimes announces the beginning of a viral infection. The fever typically resolves after two to three days, but can last longer than one week.

While the symptoms of a cold can be annoying and lengthy, the good news is that it will eventually resolve and improve without intervention.  Rest, tender loving care and little bit of Tylenol and Motrin to help keep the child comfortable is all that is typically needed.


Is it possible to avoid getting a cold? If so, how?
It is virtually impossible to avoid catching colds from time to time.  However, careful hygiene – the most important being washing of hands – can reduce the frequency. Vitamin C, Echinacea and nearly all alternative forms of treatment have not been shown to be effective in preventing colds.

When do I need to see the doctor?
Any cold can become complicated by a secondary infection such as a middle ear infection, sinus infection, or pneumonia.  Typically, a child will appear as if they are getting better from the cold, when all of a sudden, there will be a sudden increase in symptoms including (but not limited to):  a spike in fever, increase in fussiness, labored breathing, and loss of activity.  While a cold cannot be treated and will get better with time, secondary infections need to evaluated and appropriately treated.

What else can I do to treat the cold?
Unfortunately, other than time nothing works great.  A few things that are safe and might help.

1.  Sleeping with the head propped higher than the body can allow gravity to help drain unwanted mucus away.

2.  Frequent suctioning can help.  Nasal saline solution can help break up the mucus.  Bulb suctions are good, but the NoseFrida suctioning device is even better.  Any irritation and nose bleeds from suctioning trauma can be treated with small dabs of petroleum jelly.

3.  Cool mist humidifiers can help mask the tickly feeling in the back of the throat and also help to keep the mucus from becoming too thick.  They are hit or miss, but not harmful.  Medicated humidifiers are not recommended as there is no evidence to support their use.

4.  In children over 1 year of age, 1-2 teaspoons of honey can be given frequently to help soothe the throat and mask the tickly feeling in the back of the throat.  This can help control the cough.

Saturday, February 16, 2013

Post #37 Asthma: A Pedi Perspective - Part 5 of 5

Frequently Asked Questions:

 I have asthma. Does this mean my child will have it too?

There is definitely a genetic component to asthma, but how big a role genes play is unclear. While there isn't a specific asthma gene, it is more likely that your child will inherit the tendency to develop asthma.

Why does asthma seem to come and go?
Asthma is inflammatory in nature, and there are certain things (triggers) that can cause a flare up.

I don't like the thought of my child being on daily medication. I also worry about the medication losing its effectiveness, and then not working when we really need it to.  Can't he just have meds when he's having symptoms?
Regular use of preventative medications is the best way to calm and prevent flare-ups. If everybody with asthma used the proper medications, the number of hospitalizations and deaths would decrease. Remember, preventative asthma medications are only helpful when used before symptoms begin.  Remember, sunblock only works if you put it on before the sunburn actually occurs.

Will my child outgrow asthma?
Many children will eventually outgrow the propensity to have asthma flare-ups as their lungs mature and their bodies get bigger.  Even then, children who get better with age have a recurrence in adulthood. There is no cure for asthma, although it can be managed and controlled with medication.  The bottom line is that the factors which make a lung asthma-prone can still be present as an adult but the likelihood of flare-ups go down as the lung matures and grows physically larger.

Can food allergies cause asthma?
While asthma is more common in children with food allergies, the presence of food allergies do not guarantee a child will have asthma.

Can the use of asthma medications prevent remodeling changes in the lungs?
Unfortunately the answer is probably not.  More research is needed, but it appears that remodeling changes in the lungs cannot be stopped by diligent use of preventative medications such as corticosteroids - much of this is genetically predetermined.  However, responsible use of asthma medications can decrease the number of bad wheezing episodes and significantly improve the overall quality of life.  How much remodeling matters to overall asthma issues is unclear but we do know that in most children symptoms will improve as they get older.

What is the difference between Albuterol and Xopenex?
Scientifically speaking, Xopenex is just the R-enantiomer of Albuterol, while Albuterol is both a R-enantiomer and S-enantiomer 50:50 mixture.  Practically speaking either medication works as a rescue medication and both are very safe.  Xopenex produces less tachycardia (fast heart rate), however the difference is likely modest.  In children with severe heart conditions it may be necessary to use Xopenex, but for most children either is fine and cost-effectiveness should guide which version of the medication to use.

Post #36 Asthma: A Pedi Perspective - Part 4 of 5

Conundrum of cause

According to a 2010 National Health Interview Survey by the Centers for Disease Control, more than 10 million U.S. children aged 17 years and under have ever been diagnosed with asthma, and 7 million still have it.

The study shows that boys were more likely than girls to become diagnosed with asthma.

Furthermore, asthma cases in children under 4-years-old increased by 160 percent between 1980 and 1994. And there's been a steady increase in the nearly two decades since then.

An analysis by the U.S. Agency for Healthcare Research and Quality states that the percentage of children who use prescription medications for asthma has nearly doubled from 29 percent in 1997 to 58 percent in 2007.

While that could simply mean we're better at diagnosing asthma and have access to better medications, it's still easy to see why asthma is considered the leading chronic illness in kids.

But we don't really know why.

There is definitely a genetic component to asthma.  How big a role genes play isn't clear, nor is it obvious whether or not the environment is a factor – and if so, to what extent.

The "hygiene hypothesis," says that early exposure to the dirtiness of life helps prevent asthma.  If your child isn't exposed to dirt, other kids, and cold viruses early on, it leads to an imbalance in the immune system that in turn increases the risk of developing asthma. 

One real-life example of this is the fact that country boys have less asthma and allergy issues than city boys.  They grow up around animals and are exposed early on to lots of thing, thus the immune system is more balanced and less prone to asthma and allergies later on.  However, keep in mind that even country boys get asthma, just less so than city boys.  It seems that early exposure to “life” reduces the risk of asthma - but doesn't entirely prevent it. 

That's because the overall likelihood of developing asthma is multi-variable:  Environment, genetics, number of early colds, allergies, and other factors all play a part.  Sometimes the genetics are too strong to overcome.  But just because asthma runs in the family does not guarantee your child will develop it, although they do have a higher risk. 

Should asthma actually manifest itself, it's important to avoid the triggers that exacerbate it. Therein is the "Catch 22."  Early on, when there is no asthma, let your kids be exposed to stuff and hopefully they will never develop asthma.  Yet should your child eventually get diagnosed with asthma, from that point on you may need to avoid the things that trigger it. 

Triggers are things that make asthma worse or can cause an asthma attack – defined as any acute change in symptoms that interrupts your child's normal routine or requires medical intervention.

  • Exercise:  The majority of children with asthma will present symptoms when they exercise such as coughing and wheezing.
  • Pollen:  This is a common allergen.  Most children with asthma have allergies, and allergies are a major trigger of asthma symptoms.
  • Animals with fur or hair:  Keep pets out of your child's bedroom, remove carpeting, and install a HEPA filter.
  • Mold:  Control indoor humidity.  Repair water leaks no matter how small.
  • Dust mites:  These critters live in mattresses, pillows, upholstered furniture, and carpets.  Get allergy-proof bedding and pillowcases.  Frequently wash bedding in hot water.  Avoid stuffed toys.  Vacuum and dust often.
  • Weather changes:  When air quality is poor, keep your children indoors and make sure they are compliant with asthma medications.
  • Airborne chemicals or dusts:  Try to avoid things like scented candles and air fresheners.
  • Menstrual cycles:  Monthly hormone fluctuations can trigger symptoms.  Make sure your daughter is compliant with asthma medications.
  • Viral infection:  Symptoms may flare with a cold.
  • Smoke:  Avoid tobacco and wood burning.

While parents do their best to make sure the home environment is asthma friendly, don't forget to check daycares, school and relatives' homes. Some triggers can't be avoided, which is why it's important to make sure your child is compliant with his or her medication regime.

That being said, there is no guarantee that an asthma outbreak or attack can be foiled by regular preventative medicine.

There are many different strengths of preventative medicine, and these are tailored-based on the severity of the asthma.  The hope is that as kids get older, they outgrow their propensity to have asthma flare-ups and can eventually be weaned off medications.

Nearly half of children will have a decrease in asthma symptoms by the time they hit adolescence, but about half of those will develop symptoms again when they're adults.

So even though asthma cannot be cured, both you and your child can breathe easier knowing that it can be controlled – and that even after a diagnosis of asthma, he can get back to the business of being a kid.