tag:blogger.com,1999:blog-59232310859262881682024-03-13T08:47:17.796-07:00A Pediatrician's BlogThe thoughts and ponderings of a pediatrician and father of threePeter Junghttp://www.blogger.com/profile/12235011146063672219noreply@blogger.comBlogger53125tag:blogger.com,1999:blog-5923231085926288168.post-66149613392553104012021-08-28T18:29:00.008-07:002021-08-28T18:40:39.756-07:00Post #57 All Encompassing COVID Scenario Chart <div class="separator" style="clear: both; text-align: left;"><div class="kvgmc6g5 cxmmr5t8 oygrvhab hcukyx3x c1et5uql ii04i59q" style="background-color: white; color: #050505; font-family: system-ui, -apple-system, system-ui, ".SFNSText-Regular", sans-serif; font-size: 15px; font-variant-ligatures: normal; margin: 0px; orphans: 2; overflow-wrap: break-word; text-decoration-thickness: initial; white-space: pre-wrap; widows: 2;"><div dir="auto" style="font-family: inherit;">This updated chart should help families know what to do for almost any COVID scenario. <span style="font-family: inherit;"> </span></div></div><div class="o9v6fnle cxmmr5t8 oygrvhab hcukyx3x c1et5uql ii04i59q" style="background-color: white; color: #050505; font-family: system-ui, -apple-system, system-ui, ".SFNSText-Regular", sans-serif; font-size: 15px; font-variant-ligatures: normal; margin: 0.5em 0px 0px; orphans: 2; overflow-wrap: break-word; text-decoration-thickness: initial; white-space: pre-wrap; widows: 2;"><div dir="auto" style="font-family: inherit;">The Low-Risk vs High-Risk chart is a BLUE FISH concept and it is NOT from the CDC. Because of the abundance of other viruses out there, we have found it far more helpful to use this criteria to help delineate those we consider "presumed" cases. The conservative thing to do is to consider even one Low-Risk symptom COVID until otherwise proven. Of course testing can always help as well.</div></div></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: left;"><a href="https://1.bp.blogspot.com/-nyhdsZCvnS4/YSrlZKFYRmI/AAAAAAAAAN4/e1CENZ2HgeckooVBq1EvvgQwgRpdhyvGQCLcBGAsYHQ/s1024/Jung%2BCOVID%2Breturn%2Bto%2Bschool%2Bchart%2B81024_1.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1024" data-original-width="792" height="781" src="https://1.bp.blogspot.com/-nyhdsZCvnS4/YSrlZKFYRmI/AAAAAAAAAN4/e1CENZ2HgeckooVBq1EvvgQwgRpdhyvGQCLcBGAsYHQ/w606-h781/Jung%2BCOVID%2Breturn%2Bto%2Bschool%2Bchart%2B81024_1.jpg" width="606" /></a></div><br /><a href="https://1.bp.blogspot.com/-evpHV5bJGBw/YSriK5woL5I/AAAAAAAAANw/sg_9GN5OwgE2nvrtLsl5OfVGWZFaYLu6ACLcBGAsYHQ/s1024/Jung%2BCOVID%2Breturn%2Bto%2Bschool%2Bchart%2B81024_1.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><br /></a></div><br /><p><br /></p>Peter Junghttp://www.blogger.com/profile/12235011146063672219noreply@blogger.com0tag:blogger.com,1999:blog-5923231085926288168.post-46131419705223181532021-08-20T05:53:00.009-07:002021-08-27T16:22:56.805-07:00Post #56 Back-to-School Advice for the COVID-19 Delta Surge<style class="WebKit-mso-list-quirks-style">
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</style><p class="MsoNormal" style="font-size: medium;">It is with a mix of frustration and hope that I am writing a second back-to-school blog about COVID-19. At this same time last year, there were so many unknowns about the pandemic and how to handle returning to school. The uncertainty led to fear, which in turn fueled a respect for the virus, which unfortunately is lacking in the current decision-making to ban mask mandates. The irony is we have so much more science and data than we did at this time last year that we could and should be smarter about our policies. Nonetheless, with some children vaccinated, and more to become eligible soon, this next school year should be better than the last.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;">Make no mistake, COVID-19 is alive and kicking and stronger than ever, buttressed by the Delta variant - especially among those who are unvaccinated, which sadly includes all children less than 12 years of age.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;">If the vaccine were already available to all school-age children, it would make our decisions much easier to navigate – especially for those who want to immunize their children and mitigate COVID-19 risk.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;">For those who do not plan to vaccinate their kids, the status quo isn’t any different from a “choice” standpoint, but even these students would benefit from their peers being vaccinated as each shot administered brings the entire student body one step closer to herd immunity. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;">Unfortunately, we begin this school year with a large portion of our students ineligible for the vaccine, which is why masking is so very important, especially to protect those children with underlying health issues.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;">If the pandemic has done nothing else, it has exposed how differently each family approaches risk. As a pediatrician, we see this everyday in our office, as we navigate choosing car seats, SIDS concerns, medications, tests, and different therapies. Each choice has a tradeoff and every family has their own approach, which is why medicine is truly as much an art as it is a science.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;">Accommodating the varying risk appetites of several hundred families as schools reopen, especially in this polarized political climate, is a herculean task with no easy answer. No matter the policy, there will be naysayers much like the parable of the old man, son, and the donkey. But at the end of the day, decisions have to be made and unlike figuring out who sits on the donkey, science and data can and should help guide our thought process. Importantly, let’s appreciate our teachers, caregivers, and administrators no matter how things play out. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;">In writing my advice for returning to daycare and school, I have come up with some parameters to assist in decision-making. I recognize there are many caveats to each family’s situation as they come up with the best solution for their own children. One important thing to bear in mind is that our decisions not only affect our children, they affect your neighbor's and friend's children too (and vice versa).</p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;">Daycare<o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoListParagraphCxSpFirst" style="mso-list: l2 level1 lfo1; text-indent: -0.25in;"><!--[if !supportLists]-->1.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Until the current delta variant surge lessens, when possible I think it is preferable to forego daycare. This may only be for a short time until things improve. I don’t have a clear mathematical answer as to when to return, but a reasonably safe criteria would be when the ICU/hospital capacity is no longer critically full at the children’s hospitals in Houston as it is now. <o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="mso-list: l2 level1 lfo1; text-indent: -0.25in;"><!--[if !supportLists]-->2.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->For those who are unable to pull their children from daycare, if the facility is following best practices for COVID-19 and the majority of employees are vaccinated and all the adults are masking, I think it is reasonably safe to continue attending daycare. Don’t be afraid to ask the staff about masking policies and overall staff vaccine status – it is important to advocate for your child! Importantly, it would behoove the parents to both get vaccinated as there is a real risk in their infant bringing COVID-19 home to them.<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="mso-list: l2 level1 lfo1; text-indent: -0.25in;"><!--[if !supportLists]-->3.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->For all children 2 years and older, who don’t have a medical reason not to wear a mask, I would highly encourage mask wearing, even if it is not mandated and others are not complying. Be sure to use a high quality mask.<o:p></o:p></p><p class="MsoListParagraphCxSpLast" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;">Elementary School/Middle School<o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo2; text-indent: -0.25in;"><!--[if !supportLists]-->1.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->How safe school is without mandatory masking remains to be seen. Ideally, masks would be mandated other than for those medically unable to wear them. But even without mandatory masking, I think it is reasonable to send children to school, but would highly recommend they wear a high quality mask, regardless of whether other children do or not.<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo2; text-indent: -0.25in;"><!--[if !supportLists]-->2.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->The COVID-19 vaccine should drop down to 5 years of age hopefully by this fall/winter, and when it does I would encourage everyone to get their children protected as soon as possible. Same as daycare, it would behoove the parents to become vaccinated ASAP.<o:p></o:p></p><p class="MsoListParagraphCxSpLast" style="mso-list: l0 level1 lfo2; text-indent: -0.25in;"><!--[if !supportLists]-->3.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Until the delta variant surge lessens, it may be wise to limit indoor group activities with other children outside of school hours. The more indoor time your child spends with other unvaccinated children, the greater the risk of catching COVID-19, and while the test positivity rate remains high during the surge, aside from school which I deem essential, it is best to reduce exposure otherwise. As things improve, such as the ICU capacity no longer being critically full, it would be reasonable to consider returning back to certain indoor activities. Group outdoor activities (ideally masked) for the most part should be safe, even now.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;">High School<o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 38.85pt; mso-add-space: auto; mso-list: l1 level1 lfo3; text-indent: -0.25in;"><!--[if !supportLists]-->1.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->The key is to get vaccinated. Every pediatrician I know has vaccinated their teenager(s). Even with the real risk of transient myocarditis (inflammation of the heart), we all recognize the risk/benefit ratio heavily favors immunizing our teenagers. If your teen is vaccinated, I think they can participate in all school activities safely.<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 38.85pt; mso-add-space: auto; mso-list: l1 level1 lfo3; text-indent: -0.25in;"><!--[if !supportLists]-->2.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Even if your child is vaccinated, I would still encourage them to wear a mask, more for the sake of others, as they themselves will be fine, but they could potentially spread the virus to others who are vulnerable and/or immunocompromised. For those who are unvaccinated, they absolutely should wear a mask.<o:p></o:p></p><p class="MsoListParagraphCxSpLast" style="margin-left: 38.85pt; mso-add-space: auto; mso-list: l1 level1 lfo3; text-indent: -0.25in;"><!--[if !supportLists]-->3.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Despite the delta variant surge, those who are vaccinated should be quite safe, but they can become vectors for spreading the virus. Help them to be aware of this and should they become exposed and/or symptomatic, test for COVID appropriately and should they test positive, have them properly isolate to help mitigate spread of the virus. The better we are all proactive about the pandemic, the sooner things will improve.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;">The bottom line is that school for the most part is reasonably safe for all children, but best practices such as masking and getting vaccinated when eligible are paramount to reducing real risk. Daycare is reasonable, even now, but when possible, waiting out the current surge would be preferable.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;">Risk appetite is different for every family, but keeping our children safe is a common goal that everyone can rally behind. As much as the pandemic has already stolen from the precious childhoods of our families, it is crucial that we band together as a community to protect this upcoming school year.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p>Peter Junghttp://www.blogger.com/profile/12235011146063672219noreply@blogger.com0tag:blogger.com,1999:blog-5923231085926288168.post-25364407472309879762021-05-08T09:45:00.012-07:002021-05-09T12:49:32.486-07:00Post #55 COVID-19 Vaccine for 12 to 15 Year Old Adolescents<p><span style="font-family: arial;">The Pfizer vaccine will soon be offered to 12-15 year olds, raising a mild conundrum for parents.</span></p><p class="MsoNormal" style="margin: 0in 0in 0.0001pt;"><span style="font-family: arial;"><span>Should they skip the vaccine, given that most children have fared well when infected with COVID-19 (many already having been infected)?</span><span> </span></span></p><p class="MsoNormal" style="margin: 0in 0in 0.0001pt;"><span style="font-family: arial;"> </span></p><p class="MsoNormal" style="margin: 0in 0in 0.0001pt;"><span style="font-family: arial;">Or should they immunize their child(ren), even though the vaccine is relatively new and doesn’t have a long track record?<o:p></o:p></span></p><p class="MsoNormal" style="margin: 0in 0in 0.0001pt;"><span style="font-family: arial;"><br /></span></p><p class="MsoNormal" style="margin: 0in 0in 0.0001pt;"><span style="font-family: arial;">Vaccines have had their missteps, most notably the recalled RotaShield immunization in 1999. However, the recall of RotaShield and the recent temporary pause of the Johnson&Johnson COVID-19 vaccine should instill confidence in the robustness and capability of the Vaccine Adverse Event Reporting System.<o:p></o:p></span></p><p class="MsoNormal" style="margin: 0in 0in 0.0001pt;"><span style="font-family: arial;"><br /></span></p><p class="MsoNormal" style="margin: 0in 0in 0.0001pt;"><span style="font-family: arial;">255 million doses of the COVID-19 vaccine have been given in the United States to date, with over one-third of the population being fully immunized. 1 out of 3 people you see today will have completed their vaccines, and if the immunizations were causing serious side effects, the data should have captured it by now.<o:p></o:p></span></p><p class="MsoNormal" style="margin: 0in 0in 0.0001pt;"><span style="font-family: arial;"><br /></span></p><p class="MsoNormal" style="margin: 0in 0in 0.0001pt;"><span style="background-color: white; background-position: initial initial; background-repeat: initial initial; color: #16183a; font-family: arial; letter-spacing: -0.05pt;">In March, Pfizer reported results from a study with 2,260 children ages 12 to 15. None who received the vaccine contracted COVID-19. There were 18 cases of COVID-19 among children who received the placebo.<o:p></o:p></span></p><p class="MsoNormal" style="margin: 0in 0in 0.0001pt;"><span style="font-family: arial;"><br /></span></p><p class="MsoNormal" style="margin: 0in 0in 0.0001pt;"><span style="background-color: white; background-position: initial initial; background-repeat: initial initial; color: #16183a; font-family: arial; letter-spacing: -0.05pt;">The <a href="https://www.inquirer.com/health/coronavirus/covid-vaccine-kids-teens-12-15-pfizer-20210504.html">vaccine works in adolescents.</a><o:p></o:p></span></p><p class="MsoNormal" style="margin: 0in 0in 0.0001pt;"><span style="font-family: arial;"><br /></span></p><p class="MsoNormal" style="margin: 0in 0in 0.0001pt;"><span style="background-color: white; background-position: initial initial; background-repeat: initial initial; color: #16183a; font-family: arial; letter-spacing: -0.05pt;">I recently attended to a 15 year old male varsity soccer player with no past medical history, who ended up in the ICU for 10 days due to COVID-19 pneumonia. Thankfully, he survived. The vaccine would have prevented this.<o:p></o:p></span></p><p class="MsoNormal" style="margin: 0in 0in 0.0001pt;"><span style="font-family: arial;"><br /></span></p><p class="MsoNormal" style="margin: 0in 0in 0.0001pt;"><span style="background-color: white; background-position: initial initial; background-repeat: initial initial; color: #16183a; font-family: arial; letter-spacing: -0.05pt;">There have been over 275 deaths in children 18 years and younger in the United States thus far from the pandemic. <o:p></o:p></span></p><p class="MsoNormal" style="margin: 0in 0in 0.0001pt;"><span style="font-family: arial;"><br /></span></p><p class="MsoNormal" style="margin: 0in 0in 0.0001pt;"><span style="font-family: arial;"><span style="background-color: white; background-position: initial initial; background-repeat: initial initial; color: #16183a; letter-spacing: -0.05pt;">And as new variants of COVID-19 infiltrate society, the onus to get protected increases. </span><span><o:p></o:p></span><span style="background-color: white; color: #16183a; letter-spacing: -0.05pt;">Even if your child has already been infected with COVID-19, the benefits of broader and longer protection make it worthwhile to receive the vaccine.</span></span></p><p class="MsoNormal" style="margin: 0in 0in 0.0001pt;"><span style="font-family: arial;"><br /></span></p><p class="MsoNormal" style="margin: 0in 0in 0.0001pt;"><span style="background-color: white; background-position: initial initial; background-repeat: initial initial; color: #16183a; font-family: arial; letter-spacing: -0.05pt;">As a pediatrician and father of three, it is quite clear that the benefits of the vaccine outweigh the potential unknown risks. <o:p></o:p></span></p><p class="MsoNormal" style="margin: 0in 0in 0.0001pt;"><span style="font-family: arial;"><br /></span></p><p class="MsoNormal" style="margin: 0in 0in 0.0001pt;"><span style="background-color: white; background-position: initial initial; background-repeat: initial initial; color: #16183a; font-family: arial; letter-spacing: -0.05pt;">My 17 year old has received both doses of the Pfizer vaccine, my 15 year old (who contracted a mild case of COVID-19 last summer) will receive it as soon as it is available next week, and my 13 year old received the Moderna vaccine via a clinical trial earlier this year (we are fairly certain based on his reaction to the injections it was not the placebo). <o:p></o:p></span></p><p class="MsoNormal" style="margin: 0in 0in 0.0001pt;"><span style="font-family: arial;"><br /></span></p><p class="MsoNormal" style="margin: 0in 0in 0.0001pt;"><span style="background-color: white; background-position: initial initial; background-repeat: initial initial; color: #16183a; font-family: arial; letter-spacing: -0.05pt;">Risk calculus with a new vaccine is never easy. But parents can take a large amount of comfort in the data we have collected thus far.<o:p></o:p></span></p><p class="MsoNormal" style="margin: 0in 0in 0.0001pt;"><span style="font-family: arial;"><br /></span></p><p class="MsoNormal" style="margin: 0in 0in 0.0001pt;"><span style="background-color: white; background-position: initial initial; background-repeat: initial initial; color: #16183a; font-family: arial; letter-spacing: -0.05pt;">Presently, the safety data of 255 million given doses combined with the risk of death and unknown long-term effects from a COVID-19 infection clearly outweigh the unknown specter of side effects from receiving the vaccine (and with each passing day there is more and more data supporting the safety of the vaccines).<o:p></o:p></span></p><p class="MsoNormal" style="margin: 0in 0in 0.0001pt;"><span style="font-family: arial;"><br /></span></p><p class="MsoNormal" style="margin: 0in 0in 0.0001pt;"><span style="background-color: white; background-position: initial initial; background-repeat: initial initial; color: #16183a; letter-spacing: -0.05pt;"><span style="font-family: arial;">I strongly encourage all parents to protect their adolescents as soon as the vaccine is available. The sooner we all become protected, the sooner we can put this pandemic behind us.</span><span style="font-family: Cambria;"><o:p></o:p></span></span></p>Peter Junghttp://www.blogger.com/profile/12235011146063672219noreply@blogger.com0tag:blogger.com,1999:blog-5923231085926288168.post-63224705264928132172021-03-28T13:45:00.011-07:002021-03-29T09:14:16.883-07:00Post #54 Summer Camp Guidance During the COVID-19 Pandemic (2021)<p><span style="font-family: Cambria;">With the widespread deployment of COVID-19 immunizations and the knowledge that children are at far lower risk for serious COVID-19 disease and complications, it may be tempting to sign your children up for summer camp.</span> </p><p>However, please bear in mind that because the COVID-19 vaccine will likely not be available for children (under 16yo) until late 2021/early 2022 and with the spread of new COVID-19 variants, there is still real risk to children from the pandemic.</p><p class="MsoNormal" style="font-size: medium;"><o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;">Some questions to ask yourself in choosing whether or not to send your child to summer camp this year:<o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo1; text-indent: -0.25in;"><!--[if !supportLists]-->1.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->How healthy is your child? Do they have any chronic health conditions that would put them at an increased risk for significant illness from COVID-19, such as (but not limited to) diabetes, asthma, or an immune deficiency?<o:p></o:p></p><p class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo1; text-indent: -0.25in;"><br /></p><p class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -0.25in;"><!--[if !supportLists]-->2.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->How important is this camp to your child? If they are ambivalent about going, it may not be worth the increased exposure. If they have been looking forward to it for a long time, a serious family discussion may be warranted.<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -0.25in;"><br /></p><p class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -0.25in;"><!--[if !supportLists]-->3.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Can you defer this camp until next year and substitute a safer option this year?<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -0.25in;"><br /></p><p class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -0.25in;"><!--[if !supportLists]-->4.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->An overnight camp would post the highest risk due to indoor close quarters. Is there a day camp alternative as a safer option this year?<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -0.25in;"><br /></p><p class="MsoListParagraphCxSpLast" style="mso-list: l0 level1 lfo1; text-indent: -0.25in;"><!--[if !supportLists]-->5.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->What safety measures is the camp taking against COVID-19? Is there a screening process? What happens if someone get sick at camp? Will they be following CDC guidelines? <o:p></o:p></p><p class="MsoListParagraphCxSpLast" style="mso-list: l0 level1 lfo1; text-indent: -0.25in;"><br /></p><p class="MsoListParagraphCxSpLast" style="mso-list: l0 level1 lfo1; text-indent: -0.25in;">6. If there remain unvaccinated individuals at home, are they at risk for serious disease if the child brings COVID-19 home from camp?</p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;">While summer camps create some of the best memories of childhood and friendships that last a lifetime, the pandemic still demands our attention. Although we are almost out of the woods with the COVID-19 pandemic, until children are vaccinated, risks must still be weighed against the benefits of camp. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;">In the midst of a pandemic, there is no easy one-size-fits-all answer in deciding whether to send your child to camp or not. </p><p class="MsoNormal" style="font-size: medium;"><br /></p><p class="MsoNormal" style="font-size: medium;">Hopefully, the questions above will provide each family a framework in determining their best plans for the summer.</p><p class="MsoNormal" style="font-size: medium;"><o:p></o:p></p><style class="WebKit-mso-list-quirks-style">
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</style>Peter Junghttp://www.blogger.com/profile/12235011146063672219noreply@blogger.com0tag:blogger.com,1999:blog-5923231085926288168.post-73918001476609462712021-01-03T13:32:00.010-08:002021-01-04T04:22:55.900-08:00Post #53 Parenting by Paul David Tripp: Ownership Parenting vs. Ambassador Parenting<p><span style="font-family: Times; font-size: 14pt;">A big picture worldview excerpt from Paul Tripp’s book</span><span style="font-family: Times; font-size: 14pt;"> </span><i style="font-family: Times; font-size: 14pt;">Parenting </i><span style="font-family: Times; font-size: 14pt;">really blew my mind this morning. It really helps to put into perspective how we should approach parenting and what our responsibilities truly are and what we can and should turn over to God.</span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;">Too many parents saddle themselves with unnecessary and unrealistic burdens about their role in raising their children, which can lead to fractious relationships and sinking self-worth (for both parties).<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;">The passage below is in the introduction of Paul Tripp’s book and it was so overwhelmingly insightful, I wanted to share this with everyone who has children, especially if you are struggling. The contrast of <b>ownership parenting </b>vs. <b>ambassador parenting </b>is succinct yet powerful.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;">I believe this information is helpful for all families, but in particular if you are a Christ follower, these parenting principles can help redefine your relationship with your children and allow you to properly understand your identity, work, success, and reputation as a mother or father.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><i><span style="font-family: Times; font-size: 14pt;">Parenting </span></i><span style="font-family: Times; font-size: 14pt;">by Paul David Tripp<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><b><span style="font-family: Times; font-size: 14pt;">Ownership parenting </span></b><span style="font-family: Times; font-size: 14pt;">is motivated and shaped by what parents want for their children and from their children. It is driven by a vision of what we want our children to be and what we want our children to give us in return. It seems right, it feels right, and it does many good things, but it is foundationally misguided and misdirected and will not produce what God intends in the lives that he has entrusted to our care. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;">There, I’ve said it! Good parenting, which does what God intends it to do, begins with this radical and humbling recognition that our children don’t actually belong to us. Rather, every child in every home, everywhere on the globe, belongs to the One who created him or her. Children are God’s possession (see Ps. 127:3) for his purpose. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;">That means that his plan for parents is that we would be his agents in the lives of these ones that have been formed into his image and entrusted to our care. The word that the Bible uses for this intermediary position is <b>ambassador</b>. It really is the perfect word for what God has called parents to be and to do. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;">The only thing an ambassador does, if he’s interested in keeping his job, is to faithfully represent the message, methods, and character of the leader who has sent him. He is not free to think, speak, or act independently. Everything he does, every decision he makes, and every interaction he has must be shaped by this one question: “What is the will and plan of the one who sent me?” <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;">The ambassador does not represent his own interest, his own perspective, or his own power. He does everything as an ambassador, or he has forgotten who he is and he will not be in his position for long. Parenting is ambassadorial work from beginning to end. It is not to be shaped and directed by personal interest, personal need, or cultural perspectives. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;">Every parent everywhere is called to recognize that they have been put on earth at a particular time and in a particular location to do one thing in the lives of their children. What is that one thing? It is God’s will. Here’s what this means at street level: parenting is not first about what we want for our children or from our children, but about what God in grace has planned to do through us in our children. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;">To lose sight of this is to end up with a relationship with our children that at the foundational level is neither Christian nor true parenting because it has become more about our will and our way than about the will and way of our Sovereign Savior King.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><b><span style="font-family: Times; font-size: 14pt;">Owner or Ambassador? <o:p></o:p></span></b></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;">I therefore distinguish between these two models of parenting in four areas that every parent somehow, in some way, deals with: identity, work, success, and reputation. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;">The way you think about and interact with these four things will expose and define who you think you are as a parent and what you think your job is in raising your children. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><b><span style="font-family: Times; font-size: 14pt;">1. Identity: Where you look to find your sense of who you are. <o:p></o:p></span></b></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><b><span style="font-family: Times; font-size: 14pt;">Owner: </span></b><span style="font-family: Times; font-size: 14pt;">Owner parents tend to look to get their identity, meaning, purpose, and inner sense of well-being from their children. Their children tend to be saddled with the unbearable burden of their parents’ sense of self-worth. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;">I have to say this: parenting is a miserable place to look for your identity, if for no other reason than the fact that every parent parents sinners. Children come into the world with significant brokenness inside of them that causes them to push against the authority, wisdom, and guidance of their parents. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;">Parents who are looking to their children for identity tend to take their children’s failures personally, as if they were done against them intentionally, and respond to their children with personal hurt and anger. But the reality is that God simply does not give you children in order for you to feel that your life is worthwhile. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><b><span style="font-family: Times; font-size: 14pt;">Ambassador: </span></b><span style="font-family: Times; font-size: 14pt;">Parents who approach parenting as representatives come to it with a deep sense of identity and are motivated by meaning and purpose. They don’t need to get that from their children because they have gotten it from the One whom they represent: the Lord Jesus Christ. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;">Because of this they are freed from coming to their children hoping that they will get from them what no child is able to give. They are freed from asking family life to give them life because they have found life and their hearts are at rest. Because of this, they are now freed to forget themselves and parent with the selflessness and sacrifice that ambassadorial parenting requires. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><b><span style="font-family: Times; font-size: 14pt;">2. Work: What you define as the work you have been called to do. <o:p></o:p></span></b></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><b><span style="font-family: Times; font-size: 14pt;">Owner: </span></b><span style="font-family: Times; font-size: 14pt;">Owner parents think that their job is to turn their children into something. They have a vision of what they want their children to be, and they think that their work as parents is to use their authority, time, money, and energy to form their children into what they have conceived that they should be. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;">I have counseled many children who were breaking under the burden of the constant pressure of parents who had a concrete vision and were determined that these children would be what these parents had decided they would be. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;">Owner parents tend to think that they have the power and personal resources to mold their children into the children they envision. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><b><span style="font-family: Times; font-size: 14pt;">Ambassador: </span></b><span style="font-family: Times; font-size: 14pt;">Parents who really do understand that they are never anything more than representatives of someone greater, wiser, more powerful, and more gracious than they are know that their daily work is not to turn their children into anything. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;">They have come to understand that they have no power whatsoever to change their children and that without God’s wisdom they wouldn’t even know what is best for their children. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;">They know that what they have been called to be are instruments in the hands of One who is gloriously wise and is the giver of the grace that has the power to rescue and transform the children who have been entrusted to their care. They are not motivated by a vision of what they want their children to be, but by the potential of what grace could cause their children to be. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><b><span style="font-family: Times; font-size: 14pt;">3. Success: What you define success to be. <o:p></o:p></span></b></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><b><span style="font-family: Times; font-size: 14pt;">Owner: </span></b><span style="font-family: Times; font-size: 14pt;">These parents tend to be working toward a specific catalog of indicators in the lives of their children that would tell them that they have been successful parents. Things like academic performance, athletic achievement, musical ability, and social likability become the horizontal markers of how well they have done their jobs. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;">Now these things are not unimportant, but they simply are unable to measure successful parenting. Good parents don’t always produce good kids, and parents should constantly be asking themselves where they get the set of values that tell them whether they have “good” kids or not. I am afraid that many good parents live with long-term feelings of failure because their children have not turned out the way they hoped. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><b><span style="font-family: Times; font-size: 14pt;">Ambassador: </span></b><span style="font-family: Times; font-size: 14pt;">These parents have faced the scary truth that they have no power at all to produce anything in their children. Because of this they haven’t attached their definition of successful parenting to a catalog of horizontal outcomes. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;">Successful parenting is not first about what you’ve produced; rather, it’s first about what you have done. Let me say it this way: successful parenting is not about achieving goals (that you have no power to produce) but about being a usable and faithful tool in the hands of the One who alone is able to produce good things in your children. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><b><span style="font-family: Times; font-size: 14pt;">4. Reputation: What tells people who you are and what you’re about. <o:p></o:p></span></b></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><b><span style="font-family: Times; font-size: 14pt;">Owner: </span></b><span style="font-family: Times; font-size: 14pt;">Owner parents unwittingly turn their children into their trophies. They tend to want to be able to parade their children in public to the applause of the people around them. This is why so many parents struggle with the crazy, zany phases that their children go through as they are growing up. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;">They’re not so much concerned about what that craziness says about their children, but what it say about them. Children in these homes feel both the burden of carrying their parents’ reputation and the sting of their disappointment and embarrassment. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;">Owner parents tend to be angry and disappointed with their children, not first because they’ve broken God’s law, but because whatever they have done has brought hassle and embarrassment to them. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><b><span style="font-family: Times; font-size: 14pt;">Ambassador: </span></b><span style="font-family: Times; font-size: 14pt;">These parents have come to understand that parenting sinners will expose them to public misunderstanding and embarrassment somehow, someway. They have come to accept the humbling messiness of the job God has called them to do. And they understand that if their children grow and mature in life and godliness, they become not so much their trophies, but trophies of the Savior that they have sought to serve. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-family: Times; font-size: 14pt;">For them, it’s God who does the work and God who gets the glory; they are just gratified that they were able to be the tools that God used. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-size: 14pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;"><span style="font-size: 14pt;">If you found this information as powerful as I did, I encourage you to read the rest of the book. Paul Tripp is one of my favorite Christian authors and his insight into parenting is both biblical and practical.<o:p></o:p></span></p>Peter Junghttp://www.blogger.com/profile/12235011146063672219noreply@blogger.com0tag:blogger.com,1999:blog-5923231085926288168.post-29596907963848724152020-09-23T16:20:00.010-07:002022-05-04T08:00:01.115-07:00Post #52 Overkill: When Modern Medicine Goes Too Far by Paul Offit M.D.<p><span style="font-family: arial;"><b style="background-color: white; color: #222222; orphans: 2; widows: 2;">Overkill: When Modern Medicine Goes Too Far by Paul </b><span style="color: #222222;"><span style="caret-color: rgb(34, 34, 34);"><b>Offit M.D.</b></span></span></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; min-height: 14px; orphans: 2; widows: 2;"><span style="font-family: arial;">I am admittedly a huge fanboy of Paul Offit, an infectious disease guru at Children's Hospital of Philadelphia, one of the preeminent pediatric hospitals in the world. </span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; min-height: 14px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; min-height: 14px; orphans: 2; widows: 2;"><span style="font-family: arial;">His latest book <i>Overall: When Modern Medicine Goes Too Far,</i> is a collection of medical facts that are already known to the well-read individual, but fly in the face of wrongly-held, out-dated, commonly-believed medical concepts. </span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; min-height: 14px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; min-height: 14px; orphans: 2; widows: 2;"><span style="font-family: arial;">The majority of the incorrect information was previously considered the standard of care, but newer and better science and studies have clearly demonstrated updated - often conflicting - medical truths.</span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; min-height: 14px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; min-height: 14px; orphans: 2; widows: 2;"><span style="font-family: arial;">I have summarized some of the more salient facts here as a quick read for the over-worked and under-rested parent, so that they can take better care of their precious little ones without having to read the whole book (although I highly recommend it). </span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; min-height: 14px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; min-height: 14px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><b><span style="font-family: arial;">Chapter 1: Treating Fever Can Prolong or Worsen Illness</span></b></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; min-height: 14px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;">Fever-reducing medicines are found to prolong and worsen infections in experimental animals and people. Societies that use fever-reducing meds suffer a 5% increase in flu cases and deaths. Researchers have estimated that avoiding fever-reducers during a flu season would save about 700 lives in the USA and about 40,000 lives worldwide every year.</span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; min-height: 14px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;">In my pediatric practice I only recommend fever-reducers for two reasons:</span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; min-height: 14px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><ol style="background-color: white; color: #222222; font-variant-ligatures: normal; orphans: 2; widows: 2;"><li style="font-stretch: normal; line-height: normal; margin: 0px;"><span style="font-family: arial;">If a fever is affecting a child’s activity level to the point they refuse to drink, fever-reducers may help perk a child up to encourage fluid intake to stay hydrated</span></li><li style="font-stretch: normal; line-height: normal; margin: 0px;"><span style="font-family: arial;">As a litmus test. The activity level of a child is a great way to assess how serious an infection truly is. If a child’s activity level is down, a fever-reducer can help perk them up (even if for just 30 minutes), which should reassure a parent that their fever source is very likely non-serious. If a child's activity level continues to be depressed despite taking a fever-reducer, it is a good idea to touch base with your pediatrician.</span></li></ol><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; min-height: 14px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><b><span style="font-family: arial;">Chapter 2: Finishing the Antibiotic Course is Often Unnecessary</span></b></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; min-height: 14px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="color: #222222; font-family: arial;">The thinking used to be that antibiotic courses needed to be fully completed per doctor’s order to prevent antibiotic resistance from occurring. Many health organization including the World Health Organization in 2016 used to ingrain this idea into doctor's and patient's heads alike. </span></p><p style="background-color: white; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="color: #222222; font-family: arial;"><br /></span></p><p style="background-color: white; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="color: #222222; font-family: arial;">However, multiple studies for many different types of infections in both adults and children have shown that finishing the antibiotic course is <span style="caret-color: rgb(34, 34, 34);">unnecessary</span></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; min-height: 14px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;">Pediatric Urinary Tract Infections</span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; min-height: 14px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;">In 2002, Australian investigators reviewed the results of ten studies of 650 children, and they found that for a bladder infection there was no difference between 2 to 4 or 7 to 14 days of antibiotics when measured by the elimination of bacteria from the urine and for resolution of clinical symptoms.</span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; min-height: 14px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;">Other Pediatric Infections</span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; min-height: 14px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;">Studies now show that for adults and as well for children old enough to describe their symptoms, the best advice for diseases such as bladder infections, kidney infections, pneumonia, sinus infections, skin infections, appendicitis, and ear infections is to stop the course of antibiotics when symptoms begin to improve. </span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; min-height: 14px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;"><span style="color: #222222;">When the immune system, working <span style="caret-color: rgb(34, 34, 34);">synergistically</span> with the antibiotics, has defeated the bacteria, the signs and symptoms of inflammation, such as fever and accompanying symptoms will abate and at this point the bacteria are no longer actively reproducing.</span></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; min-height: 14px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; min-height: 14px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><b><span style="font-family: arial;">Chapter 3: Antibiotic Drops Don’t Treat Pinkeye</span></b></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; min-height: 14px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;">About 70% of people who develop conjunctivitis (pinkeye) will visit their doctor. Most will receive an antibiotic that costs the healthcare system between $377 and $857 million each year!</span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; min-height: 14px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;">The most common cause of conjunctivitis is allergies - every year up to 40% of Americans suffer from allergic pinkeye. The second most common cause is viruses - about 80% of infectious pinkeyes are caused by viruses. The least common cause of pinkeye is bacterial.</span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; min-height: 14px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;">A simple rule for differentiating the 3: allergic is itchy, viral is accompanied by other cold symptoms, and bacterial causes thick, purulent discharge. Unfortunately there is a lot of overlap. But even so, the studies show that antibiotics don’t treat bacterial conjunctivitis.</span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; min-height: 14px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;">In 2012, researchers from the University of Edinburgh reviewed all of the existing studies on conjunctivitis and they found two high-quality studies, one of which was performed in children.</span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; min-height: 14px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;">In July 2005, researchers from Oxfordshire in the U.K. divided 320 children into 2 groups. One group was given antibiotic drops every 2 hours for the first day and then 4 times a day until the infection resolved. The other group was given a placebo eye drop. Seven days later, 86% in the antibiotic group and 83% in the placebo group were cured - an insignificant difference.</span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; min-height: 14px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;">The adult study from Switzerland and the Netherlands found the same result.</span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; min-height: 14px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;">As a consequence of these studies, the American Academy of Ophthalmology now recommends watchful waiting for those suffering from acute pinkeye, whether it’s caused by bacteria or not.</span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; min-height: 14px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;">Complications of using antibiotic eye drops include irritation, emergence of antibiotic resistant strains, and expense of the medication. In general, patients are probably better off using cheaper over-the-counter lubricating eye drops or cold compresses for comfort.</span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; min-height: 14px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;">Unfortunately (and incorrectly), many work places and schools will not allow return until drops have been utilized for 24 hours.</span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; min-height: 14px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; min-height: 14px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><b><span style="font-family: arial;">Chapter 8: Embrace Allergenic Foods for Infants</span></b></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; min-height: 14px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;">In 2000, medical advisory boards in the United States put out recommendations to avoid peanut-containing foods early in life. By 2008, overwhelming evidence proved that this recommendation was useless and not decreasing the incidence of peanut allergies.</span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; min-height: 14px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;">In 2015, researchers from the U.K. published a groundbreaking study called the LEAP trial, for “Learning Early About Peanut Allergies.”</span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; min-height: 14px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;">Between 2006 to 2009, 640 infants between 4 and 11 months old who had eczema or egg allergies or both were divided into 2 groups. One group consumed 6 grams of peanut protein per week until age 5; the other group was instructed to completely avoid all peanut-containing foods. </span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; min-height: 14px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;">At the end of the study there was an 86% reduced risk of developing peanut allergies in the group that was fed peanuts early on. In other words, eating peanuts early in life decreased the risk of peanut allergies later in life. </span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; min-height: 14px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; min-height: 14px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><b><span style="font-family: arial;">Chapter 10: Avoid Reflux Medicines for Fussy Babies</span></b></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; min-height: 14px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;">All babies cry and all babies spit up, but very few require treatment for gastroesophageal reflux disease (GERD). If they are gaining weight appropriately, there is low cause for concern.</span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; min-height: 14px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;">Evidence clearly shows that reflux medicines do not work to treat fussy babies. In fact reflux medicines are known to cause several concerning side effects:</span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; min-height: 14px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><ol style="background-color: white; font-variant-ligatures: normal; orphans: 2; widows: 2;"><li style="color: #222222; font-stretch: normal; line-height: normal; margin: 0px;"><span style="font-family: arial;">Decreased stomach acid which increases the risk of bacterial infections such as pneumonia and necrotizing enterocolitis. Acid kills bacteria, so reducing it increases the risk of infection.</span></li><li style="font-stretch: normal; line-height: normal; margin: 0px;"><span style="font-family: arial;"><span style="color: #222222;">Reflux medicines change the healthy bacteria living in our intestines (the <span style="caret-color: rgb(34, 34, 34);">microbiota)</span> which can have downstream effects on obesity, allergies, diabetes, and other medical problems.</span></span></li><li style="color: #222222; font-stretch: normal; line-height: normal; margin: 0px;"><span style="font-family: arial;">More recently, a study of 850,000 babies found that those who received reflux meds were at higher risk of bone fractures.</span></li></ol><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; min-height: 14px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;">It is much safer to burp frequently, position upright after feeds, thicken feeds, and if breastfeeding avoid milk, eggs, coffee, and spicy foods - all of these things can be discussed in more detail with your pediatrician.</span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; min-height: 14px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; min-height: 14px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><b><span style="font-family: arial;">Chapter 18: Don’t Ice Sprains</span></b></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; min-height: 14px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;"><span style="color: #222222;">The acronym RICE (rest, ice, compression, elevation) was originally developed by a Baylor College of Medicine doctor named Gabe Mirkin. Because of the easy-to-remember acronym, it was widely used as the standard of care for sprains. However, clear evidence <span style="caret-color: rgb(34, 34, 34);">since has demonstrably </span>refuted the RICE method, leading to Dr. Mirkin himself no longer recommending to follow his original advice.</span></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; min-height: 14px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;">Multiple well-done studies from New Zealand, Ireland, Amsterdam, and Taiwan have shown that icing sprains delays healing.</span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; min-height: 14px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;">The key to healing is inflammation, which recruits helpful immune cells to the damaged area by increasing blood flow. Increased blood flow also promotes the manufacturing of collagen, which is necessary to create new, healthy ligaments and muscles.</span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; min-height: 14px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;"><span style="color: #222222;">Therefore, anything reducing blood flow, such as rest, ice, compression, and elevation, actually stymies the healing process. Of course all of these things lessens the initial pain, so people are still tempted to employ these techniques. However, for <span style="caret-color: rgb(34, 34, 34);">faster</span> healing, you are better off using warm compresses, stretching, and movement to promote blood flow to the injured area.</span></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;"><span style="color: #222222;">The remaining chapters are not quite as relevant to pediatrics (or the truth is better known - such as the teething chapter) but they are equally compelling. I have listed them below as the chapter titles themselves express the salient information which can be expounded upon by reading the actual book. The book itself is a quick read and well catalogued with studies that drive each point home. It is time well spent and the dividends will lead to better health for the whole family.</span></span></p><p style="background-color: white; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;"><span style="color: #222222;"><br /></span></span></p><p style="background-color: white; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;"><span style="color: #222222;">Modern medicine continues to progress at an exponential rate, but as Paul Offit clearly demonstrates, sometimes it is important to take a breath and make certain that in proactively treating things we are not causing more harm than good.</span></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><br /></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><br /></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;">Chapter 4: Vitamin D Supplements Aren't a Cure-all</span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;">Chapter 5: Supplemental Antioxidants Increase the Risk of Cancer and Heart Disease</span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;">Chapter 6: Testosterone for "Low T" is Dangerous and Unnecessary</span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;">Chapter 7: Baby Aspirin Doesn't Prevent First Strokes or First Heart Attacks</span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;">Chapter 9: The False Security of Sunblock</span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;">Chapter 11: Prostate Screening Programs Do More Harm Than Good</span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;">Chapter 12: Thyroid Cancer Screening Programs Do More Harm Than Good</span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;">Chapter 13: Breast Cancer Screening Programs Aren't Exactly as Advertised</span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;">Chapter 14: Heart Stents Don't Prolong Lives</span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;">Chapter 15: Surgery For Knee Arthritis is Unnecessary</span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;">Chapter 16: Don't Remove Mercury Dental Fillings</span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;">Chapter 17: Vitamin C Doesn't Treat or Prevent Colds</span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;"><br /></span></p><p style="background-color: white; color: #222222; font-stretch: normal; font-variant-ligatures: normal; line-height: normal; margin: 0px; orphans: 2; widows: 2;"><span style="font-family: arial;">Chapter 19: Teething Doesn't Cause Fever</span></p>Peter Junghttp://www.blogger.com/profile/12235011146063672219noreply@blogger.com0tag:blogger.com,1999:blog-5923231085926288168.post-11882628458246632622020-08-01T11:48:00.007-07:002020-08-01T13:38:17.843-07:00Post #51 Our Family’s School Decision Making Process<p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;">My boys do not want to wear pants.<o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;"><br /></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;">A small factor, but part of the reason they campaigned for remote learning. My daughter, who generally prefers clothing, remained on the fence.<o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;"><br /></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;">The remote vs. in-person learning decision has so many different factors it is very difficult as a pediatrician to give families a single clear answer.<o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;"><br /></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;">As new data emerges, it further confounds a family’s decision that seemed crystal clear just 2 internet articles ago.<o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;"><br /></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;">Several people have asked point blank, “What are you doing for your own kids?”<o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;">If I have left your text unanswered or have not replied to your email or Facebook comment, I apologize! A binary, “remote” or “in-person” response seemed too hasty and irresponsible.<o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;"><br /></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;">While every family will have their own personal best answer, I hope sharing how my wife and I arrived at our decision will benefit the process for other parents.<o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;"><br /></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;">To start off, some demographics are in order:<o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;"><br /></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;">Our children are 12, 14, and 16 years of age – boy (7th grade), boy (9th grade), girl (11th grade) respectively. I am a pediatrician and my wife is a former elementary school teacher and now stay-at-home mom.<o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;"><br /></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;">We are zoned to Cy-Fair Independent School District and the schools our children attend are Title 1 schools, with an eclectic mix of socio-economic backgrounds.<o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;"><br /></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><b><span style="color: #1d2129; font-size: 13pt;">Children’s Health</span></b><span style="color: #1d2129; font-family: georgia; font-size: 13pt;"><o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><b><span style="color: #1d2129; font-size: 13pt;"><br /></span></b></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;">The first and most important factor in making our decision was the health of our children. As of the writing of this blog, the overall risk to healthy children from COVID-19 is very small.<o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;"><br /></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;">The CDC keeps a provisional <a href="https://l.facebook.com/l.php?u=https%3A%2F%2Fdata.cdc.gov%2FNCHS%2FProvisional-COVID-19-Death-Counts-by-Sex-Age-and-S%2F9bhg-hcku%2Fdata%3Ffbclid%3DIwAR0QFa9uzk73VdEDQPmCghgwQn-vQVNbD3b25CKWU7TQyq5Jc1UO8jIjr-o&h=AT1MZs7YPnyAepG8uce_lBdNTzQoP0-4n6YN65okSOwOQHhi9CmrWqfC2z-wXyFVbScKLRdAErdVclHwX-fciS5jGvKG_X1T0rq8F_vgZuj2kgfCGPkoxqWj8kFDaV_NHwV761hw"><span style="color: #385898; text-decoration-line: none;">death count</span></a> by age, and as of August 1, 2020, there have been a total of 42 deaths in children younger that 15 years for the entire country. To put things in perspective there have been <a href="https://l.facebook.com/l.php?u=https%3A%2F%2Fgis.cdc.gov%2FGRASP%2FFluview%2FPedFluDeath.html%3Ffbclid%3DIwAR1crv-lZVqb6P8AiDxxkM7jr2q3xtr84-Idg20HqgmophOgTOdmHTO9qL8&h=AT3ZkZ9G71altzz1UxLri7BaR29qBzFELptwA2zdxyhxKb7ZqLsxtqRo2ckeSYH5hPIaBpo_w90vYv1TPx4SYABkK4FT-4n_jFQIcikC29bvGL-ZPBlp_DZhNSflQ3CfBmzQ8jnK4H3BtGJkEyO4ow"><span style="color: #385898; text-decoration-line: none;">185 deaths</span></a> due to influenza in children younger than 18 for the 2019-20 season. Overall, children have <a href="https://l.facebook.com/l.php?u=https%3A%2F%2Fwww.nytimes.com%2F2020%2F07%2F20%2Fparenting%2Fcoronavirus-children-spread-covid-19.html%3Fsmid%3Dfb-share%26fbclid%3DIwAR2hooTAIkqWie10_QLs3xrC46t8_XJFvs1Dkx7JH86SenwoPwu4tC2pK68&h=AT1bp7Lwkrdm8Zd0auPxy8_X_9kCFtqsmG_x1I6c_FdCXsGrjxho5F-40Jlhv3QddF9s0phWIlGPHmA-jQ24ueGqOhU6TBupOQNn2cyUkJZF5FCQuQtaMoMZ3ByvPy1Yv3SCpmpi"><span style="color: #385898; text-decoration-line: none;">fared extremely well</span></a> with the pandemic in terms of deaths and medical complications.<o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;"><br /></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;">If I were only factoring in the health risk to our children, I would feel safe sending them to school, given a few caveats that I will get to later in this blog.<o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;"><br /></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><b><span style="color: #1d2129; font-size: 13pt;">Family’s Health</span></b><span style="color: #1d2129; font-family: georgia; font-size: 13pt;"><o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><b><span style="color: #1d2129; font-size: 13pt;"><br /></span></b></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;">Our home is solely occupied by our nuclear family (no grandparents) and everyone is in relatively good health with no underlying health conditions.<o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;"><br /></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;">If we had people over 60 living at home (the older the more concerning) or if someone at home had a serious underlying medical problem, I would be much more concerned about in-person learning.<o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;"><br /></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;">The <a href="https://l.facebook.com/l.php?u=https%3A%2F%2Fjamanetwork.com%2Fjournals%2Fjamapediatrics%2Ffullarticle%2F2768952%3Ffbclid%3DIwAR2VaQbm74woD2mckBLsfjz6EBD3hKjl7OLv2pQF43OJ7f39lSkmivvjF8o&h=AT24xqz12_673QLmKQy5f3nvfFGjZudn_EFoYbPw0ODNgvwpqzguKNfCfKBKHgCZk58q1ODOtPkzsNehKuX_ncjZJ_VFyEfMbTQwo3qBtuPynJGAq0a7klTAMNkHruWFwp1xFH18"><span style="color: #385898; text-decoration-line: none;">newest data from Chicago</span></a> shows that, contrary to earlier studies, young children do get infected and do have high levels of virus.<o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;"><br /></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;">Further, in a <a href="https://l.facebook.com/l.php?u=https%3A%2F%2Fwww.nytimes.com%2F2020%2F07%2F31%2Fhealth%2Fcoronavirus-children-camp.html%3FreferringSource%3DarticleShare%26fbclid%3DIwAR3GvlPrf-3MFUj2s3M9KeC2cnUpP4_SUopaRz38AIqIFTglYsJTFzdbYwo&h=AT1_rk901DsTKuH23tTyvSH8zzeHGnIun9JBN4ma05MYOT3UeN_HuHVJgWDjpWceajEDZ-jGwoGBA11__ZMDJtt4whIEg0wApQJ-J7RjWqXG3qYiLecVC2w-M7xadT_8uQuDwEl8"><span style="color: #385898; text-decoration-line: none;">study</span></a> from a Georgia sleep-away camp of all ages, of 344 campers and staff for whom tests were available, 260 tested positive after just a few days at camp.<o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;"><br /></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;">The vast majority of kids may not get seriously ill, but it appears they can bring it home, and as such, an important part of the decision making process has to include the risk to family members.<o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;"><br /></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><b><span style="color: #1d2129; font-size: 13pt;">Community Spread</span></b><span style="color: #1d2129; font-family: georgia; font-size: 13pt;"><o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><b><span style="color: #1d2129; font-size: 13pt;"><br /></span></b></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;">The initial data from <a href="https://l.facebook.com/l.php?u=https%3A%2F%2Fwww.nytimes.com%2F2020%2F07%2F11%2Fhealth%2Fcoronavirus-schools-reopen.html%3Faction%3Dclick%26module%3DRelatedLinks%26pgtype%3DArticle%26fbclid%3DIwAR1gR5-9PmNub3h_fssMN6th_U4_575N9BC974hh0HrzqJhd7FXZ4rBIzag&h=AT1JaBg51NpbnN8rqOCb03xgQCb-rDIP9L6J5VrAmM5xcODWQpKKbi4s1MX_M7z6Uq2Wi8wYBMyn7QGIvUQHSBG13L2GhgUABcNDlBF2bG0PKcqLQepRjlEbURu6I5Am1wNn8jRW"><span style="color: #385898; text-decoration-line: none;">Europe</span></a>, <a href="https://l.facebook.com/l.php?u=https%3A%2F%2Fpediatrics.aappublications.org%2Fcontent%2F146%2F2%2Fe2020004879%3Ffbclid%3DIwAR35EbHlufyMC-TX47uM-yRqPN0g2UmKHBRPkbXvTjTFobMwwHLk3ZvIWP4&h=AT3BQRkeahqJjPG3NS7unPjdvldWRzgvbGat9B0IYjnIfubVaxpNTHrjk6TWb-ut38hbh9iJ6XusSVUFKUhG3BlY0YUc6uU1sDY-zzbgwgLQQ2uDxVDU4rN15f0dZAxWkPAaphOZ"><span style="color: #385898; text-decoration-line: none;">Asia</span></a>, and <a href="https://l.facebook.com/l.php?u=http%3A%2F%2Fncirs.org.au%2Fsites%2Fdefault%2Ffiles%2F2020-04%2FNCIRS%20NSW%20Schools%20COVID_Summary_FINAL%20public_26%20April%202020.pdf%3Ffbclid%3DIwAR0Y4cPw3AaANjedkTf3XSY_7elhfKqO85tOWbZqqMB1c_xmNlr28oDtumc&h=AT0VartJZTIUPLERoE2Cww7IT_3GRnQaeUrYElCTZCxHdJYoXnHPxSszlxvOpqljc8oYmwywUhZQyhvycZLD1DhPE8iyM0QwH4HmyJLSWCbF8fUqYz-dHzYQ3mwZ2r02xSK93XjJ"><span style="color: #385898; text-decoration-line: none;">Australia</span></a> was quite comforting in terms of community spread risk from reopening schools. It is important to note that local COVID-19 caseload numbers were low and under control in the countries that reopened schools.<o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;"><br /></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;">The recent data from <a href="https://l.facebook.com/l.php?u=https%3A%2F%2Fwww.npr.org%2Fsections%2Fcoronavirus-live-updates%2F2020%2F06%2F03%2F868507524%2Fisrael-orders-schools-to-close-when-covid-19-cases-are-discovered%3Ffbclid%3DIwAR3tQQJ4O4WwEeB88iCElNMlkor3--Sx6RbVL73N9oaJkr3p3SPlmNRdT-8&h=AT1q8i8q6AWRujOvUFc7_b1ILX3GQ0XbJmXZ7v_leYNaiCnUqeX4HMr1bivszui7zOGeeOTOOU9uOnix2Lu58u_Xph-Mb006HX1ZMZ1azTeG04gMhNqEJG4SO747ZLdXmCFZgA1w"><span style="color: #385898; text-decoration-line: none;">Israel</span></a>, <a href="https://l.facebook.com/l.php?u=https%3A%2F%2Fwww.nytimes.com%2F2020%2F07%2F18%2Fhealth%2Fcoronavirus-children-schools.html%3Ffbclid%3DIwAR0EBtoJg3MTuFKL3V2INisU9J7pNXDudgq2HO21d7hwapWfULJcIx8rLpk&h=AT03LZ3aBK6rJEJxid2r61Ct6EvmGPkp629gm6u9s8t40_ufrTqgl0urXV9dH2QHsZgApBkwxcvFZxTKSbQjkEhQ0GI0NPr-3grhrqYPyDwG39eqmKVtcORX4M_Oyl33vlCJGLpB"><span style="color: #385898; text-decoration-line: none;">South Korea</span></a>, Georgia, and Chicago has rained on the parade.<o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;">Epidemiologists all agree that schools will contribute to spread in some fashion, but to what extent is still up for debate. The pendulum appears to be swinging towards children being as infectious as adults.<o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;"><br /></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;">Ultimately, regardless of children’s infectiousness, the more important factor affecting community spread will be a school’s ability to follow certain protocols: masking, social distancing, and sanitizing. If these measures are rigorously followed, community spread should be minimal.<o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;"><br /></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;">Additionally, it will be prudent to pay attention to local COVID-19 statistics. If caseloads are rising and hospital are overwhelmed, school closures may be necessitated.<o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;"><br /></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;">Another important factor in community spread will be the population density at each school. As more families opt out of in-person learning, it will commensurately improve the risk for those who do attend, including the risk to our educators, many of whom will not have a choice but to be physically present.<o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;"><br /></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;">For those who have the ability to do so, I encourage you to strongly consider remote learning to lessen the risk for those who cannot.<o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;"><br /></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><b><span style="color: #1d2129; font-size: 13pt;">Educational Value</span></b><span style="color: #1d2129; font-family: georgia; font-size: 13pt;"><o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><b><span style="color: #1d2129; font-size: 13pt;"><br /></span></b></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;">A child’s aptitude for learning remotely has to be a major factor. For some children, the value of in-person school is enormous.<o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;"><br /></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;">Can they learn independently?<o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;"><br /></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;">Can they focus for extended periods of time?<o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;"><br /></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;">Will the lack of peer stimulation hamper their education?<o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;"><br /></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><b><span style="color: #1d2129; font-size: 13pt;">Continuity</span></b><span style="color: #1d2129; font-family: georgia; font-size: 13pt;"><o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><b><span style="color: #1d2129; font-size: 13pt;"><br /></span></b></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;">Attending in-person school may get interrupted from time-to-time should quarantine and isolation protocols be triggered by someone in the classroom testing positive for COVID-19.<o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;"><br /></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;">This may force remote learning for periods of time, disrupting the continuity and flow of school.<o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;"><br /></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;">For those kids who do not do well with change, remote learning may be the better option.<o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;"><br /></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><b><span style="color: #1d2129; font-size: 13pt;">Family Decision</span></b><span style="color: #1d2129; font-family: georgia; font-size: 13pt;"><o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><b><span style="color: #1d2129; font-size: 13pt;"><br /></span></b></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;">These were some of the variables that my wife and I contemplated as we arrived at our decision. We let our children voice their opinions as well, which we factored in.<o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;"><br /></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;">So what did we decide?<o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;"><br /></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;">I thought my wife said it perfectly, so with her permission, I have copied her words from her recent Facebook post.<o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;"><br /></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;">“We are going online for the first grading period for the following reasons:<o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;"><br /></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;">· Online instruction will be live and interactive (as opposed to the video lessons we did last spring).<o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;"><br /></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;">· My kids are able to focus fairly well with the online learning.<o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;"><br /></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;">· They actually are not going insane with the lack of peer interaction (they see some friends occasionally, with safety measures in place). I know this is a big deal for a lot of kids, and I totally get it.<o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;"><br /></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;">· Our school community is around 70% low income. A lot of those families would benefit from in-person instruction, so we will be 3 less kids on campus to try to help with the numbers.<o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;"><br /></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;">· If school has to shut down, we won’t have to transition from in-person to online instruction (I still can’t wrap my head around what this will look like).<o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;"><br /></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;">· Masking for long periods of time is hard. So is wearing pants.<o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;"><br /></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;">So this is our decision. We will do this for the first grading period and see how it goes. Stuff is constantly changing, so it’s hard to plan ahead this far in advance. We still have a lot of questions about how things will work, but we just have to wait and see.”<o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;"><br /></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;">As my wife mentioned, this is a decision in flux that may change as new data or family issues emerge.<o:p></o:p></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;"><br /></span></p><p class="MsoNormal" style="background: white; font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="color: #1d2129; font-family: georgia; font-size: 13pt;">But at least for the first six weeks, my boys will be pants-less.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: cambria; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: justify;"><o:p> </o:p></p>Peter Junghttp://www.blogger.com/profile/12235011146063672219noreply@blogger.com0tag:blogger.com,1999:blog-5923231085926288168.post-44906255313932459692020-07-23T05:48:00.008-07:002020-08-01T11:37:03.595-07:00Post #50 School Reopening during the COVID-19 PandemicThere is probably not a more emotionally charged topic of discussion currently than that of school reopening this fall. And for good reason - nearly everyone has a stake in it.<br />
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Society is concerned because of the real risk of increased community spread.</div>
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Teachers are concerned because of the COVID-19 risk to themselves and how the logistics of school will directly affect their livelihood and stress level as they have to constantly adjust to the barrage of changes and duties. </div>
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Families are concerned because of the COVID-19 risk to their children and to those living at home. Not to mention, many depend on school to allow for both parents to work. And what about the <a href="https://www.nytimes.com/2020/07/15/health/coronavirus-schools-reopening.html?action=click&module=RelatedLinks&pgtype=Article">educational risks</a> if everything is remote learning? And if kids stay home, will mom and dad working from home stay sane?</div>
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The number of different factors weighing in on the discussion is overwhelming. The implications affect the economy, family lives, the future of our country, and society as a whole. Superintendents, teachers, and those directly affecting school policy have their work cut out for them - thank you in advance for everything you are doing.</div>
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A good place to start the discussion is assessing the real risk to the different groups as listed above.</div>
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<u>Students</u></div>
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A recent <a href="https://www.nytimes.com/2020/07/18/health/coronavirus-children-schools.html">study</a> of nearly 65,000 people in South Korea made an important distinction in children younger than 10 and those between the ages of 10 and 19, in that the younger group transmits the virus much less often than adults do. </div>
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Ten years is not some magical demarcation as almost everything in medicine is a continuum with COVID-19 risk increasing commensurately as a child ages. For those seeking a <a href="https://jamanetwork.com/journals/jama/fullarticle/2766524?fbclid=IwAR2Cw0plv5haX7fJneBgv1QDwuKmmGhnIcXUD-Vr1kx_Rup1Y7rl8tCQojc">technical explanation</a> of this, it is likely related to the lower number of ACE2 receptors in the respiratory tract of children. </div>
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Other possible factors that may contribute to children posing lower risk could stem from their smaller volume of breaths and the fact that they are short and thus their inhalation and exhalation is closer to the ground and not in the same plane as adults. Obviously, if they are in school and with their peers, the latter advantage becomes less relevant.</div>
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The take home message here is that younger children pose a substantially lower risk for COVID-19 spread than older children and adults. Elementary school is likely safe. Middle school and high school remain suspect. </div>
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As for deaths in children, the CDC keeps a provisional <a href="https://data.cdc.gov/NCHS/Provisional-COVID-19-Death-Counts-by-Sex-Age-and-S/9bhg-hcku/data">death count</a> by age, and as of July 22, 2020, there have been a total of 36 deaths in children younger that 15 years for the entire country. To put things in perspective there have been <a href="https://gis.cdc.gov/GRASP/Fluview/PedFluDeath.html">185 deaths</a> due to influenza in children younger than 18 for the 2019-20 season. Overall, children have <a href="https://www.nytimes.com/2020/07/20/parenting/coronavirus-children-spread-covid-19.html?smid=fb-share&fbclid=IwAR0cMJs7d6HmsstdGPaudtU1Xk2-LvLadtP2GrLdByPNDXS73WpjOGqUhHg">fared extremely well</a> with the pandemic in terms of deaths and medical complications.</div>
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<u>Families</u></div>
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There is a real risk that students attending school will bring the virus home to their families. For those living with their grandparents or an immunocompromised individual or family members with underlying health issues, this poses a difficult conundrum. </div>
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A recent <a href="https://pubmed.ncbi.nlm.nih.gov/32430964/">systematic review</a> of 700 scientific papers found that children are rarely the index case in outbreaks and were unlikely to impact the COVID-19 mortality in older people. While this data gives a great deal of reassurance, children still contribute to some level of spread, and as the South Korean data demonstrated, older kids are likely on par with adults in terms of risk.</div>
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<u>Teachers</u></div>
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The <a href="https://www.nytimes.com/2020/07/11/health/coronavirus-schools-reopen.html?action=click&module=RelatedLinks&pgtype=Article">best data</a> on school spread comes from other continents where school reopenings have already taken place.</div>
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An excellent <a href="http://ncirs.org.au/sites/default/files/2020-04/NCIRS%20NSW%20Schools%20COVID_Summary_FINAL%20public_26%20April%202020.pdf">case study</a> in Australia looked at 18 infected individuals (9 students and 9 staff) from 15 schools from March to mid-April of this year. 735 students and 128 staff were close contacts of these initial 18 cases. <b>No teacher or staff member contracted COVID-19 from any of the initial school cases. </b>However, one child from a primary school and one child from a high school may have contracted COVID-19 from the initial cases of their schools.</div>
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Another <a href="https://pediatrics.aappublications.org/content/early/2020/07/08/peds.2020-004879?fbclid=IwAR0ZAht5Aow0SSfnOgEyHgDi2C16Ya7MH7VXRgIXhOq0B172qm9U-n9emZE">paper</a> from the Journal of Pediatrics reviewed outbreaks in Switzerland, China, France, and Australia (cited above) and found that children are rarely drivers of COVID-19 transmission.</div>
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This is not to say that there is zero risk to teachers from students, but the data suggests it is minimal. And while children are unlikely to infect teachers, other staff and teachers pose a real risk to each other; adult to adult transmission is real and South Korea suggests students 10 and older are on par with adults.</div>
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<u>Guidelines are Needed</u></div>
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If school reopening is to happen, detailed guidelines must be in place. The American Academy of Pediatrics (AAP) recently published excellent <a href="https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/covid-19-planning-considerations-return-to-in-person-education-in-schools/">guidance</a> for reopening schools.</div>
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A key phrase they used was that <b>"policy makers should acknowledge that COVID-19 policies are intended to mitigate, not eliminate, risk."</b> This is important to bear in mind. If we are attempting a zero risk solution, it will not happen.</div>
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AAP outlines key principles in consideration of reopening schools:</div>
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<li>School policies must be flexible and nimble.</li>
<li>Strategies may need to be revised and adapted depending on the level of virus transmission in the school and community.</li>
<li>Policies should be practical, feasible, and appropriate for the child's developmental stage.</li>
<li>Special considerations should be made for the medically fragile, impoverished, and those with developmental challenges or special health care needs.</li>
<li>Minimize exclusion.</li>
<li>Policies should be guided by supporting the overall health and well-being of all involved.</li>
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Strategies recommended by the AAP include to cohort classrooms to minimize crossover, utilizing outdoor spaces when possible, limiting visitors, mandating face coverings, spacing desks 3 to 6 feet apart, eliminating lockers, having teachers rotate instead of students, and creating one-way hallways.</div>
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As states consider the different options before them, some are appropriately using local COVID-19 caseload numbers and hospitalization rates as a <a href="https://www.nytimes.com/2020/07/17/us/california-schools-reopening-newsom.html">qualification</a> to reopen schools. Especially for middle school and high school this seems prudent. The data from Australia, Europe, and Asia school reopenings came from countries where the pandemic was under far better control than it currently is within the United States. </div>
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Moving forward, should COVID-19 numbers improve within the community at large and thresholds are met, school reopenings should merit serious consideration. But in states where the intensive care units are at capacity and caseloads are rising, prudence makes sense.</div>
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Of course, this poses a dilemma for working parents. This is where a novel idea such as <a href="https://www.nytimes.com/2020/07/20/opinion/coronavirus-reopen-schools-economy.html">Safe Centers for Online Learning</a> (SCOLs) could come into play. Essentially, for those who cannot watch their children at home, students could do online learning and be cared for in large venues, such as convention centers, stadiums, performing art centers, and parks that are currently going unused. </div>
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Whether it be SCOLs or some other concept, relief must be provided in some form to allow for parents to return back to work. This will be an essential component of moving our economy forward. </div>
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Without question, for the upcoming school year, there will be a new normal. Each school district and family will be faced with a plethora of decisions as they weigh risks and benefits. Luckily, many countries have wrestled with these same questions ahead of us and provided helpful data. Ultimately, each family understands their needs and risk appetite best. </div>
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Ideally, schools will have the ability and resources to offer multiple options to accommodate each family. Hopefully, the information provided here will empower parents as they navigate school reopenings during the pandemic.<br />
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One thing is and has always been true: children are the future - let's keep them safe and make sure we provide them the best education possible.</div>
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Peter Junghttp://www.blogger.com/profile/12235011146063672219noreply@blogger.com9tag:blogger.com,1999:blog-5923231085926288168.post-89954586896452444172020-06-13T08:40:00.005-07:002020-09-14T16:41:08.721-07:00Post #49 Church Small Group Meeting Guidance during COVID-19 Pandemic<div class="MsoNormal" style="font-family: cambria; margin: 0in 0in 0.0001pt;">
<b><span style="color: #1c1e21; font-family: inherit , serif; font-size: 13pt;">Updated June 13, 2020<o:p></o:p></span></b></div>
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<span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;">Disclaimer: COVID-19 is a pandemic in flux. As the number of active cases and hospital ICU occupancy changes and new research comes out, </span><b><span style="color: #1c1e21; font-family: inherit , serif; font-size: 13pt;">recommendations will change</span></b><span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;">. Please check with your church, doctor, local health departments, and <span style="color: #385898; font-family: inherit , serif; text-decoration: none;"><a href="https://l.facebook.com/l.php?u=https%3A%2F%2Fwww.CDC.gov%2F%3Ffbclid%3DIwAR3XZ_jfuNlK1q91S3q0biUvsfG8XLKqXxXjT9gj0whSRWCdV_tDe782QYA&h=AT3OeDP6ELen49glTTYKfFghjO07yUcoLNKDZ_EP2BUWb8XdFtJKlqj3-h2SXGA2ZEf1gLqfZbdFxsCVvuizKbJQLeX4niQO27G3hMp7EF4zafCjYNM_daoEm3-VoiqU30iL3VgK">www.CDC.gov</a> f</span>or the most up-to-date information and guidance on meeting in person.<o:p></o:p></span></div>
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<span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;">As most people know by now, COVID-19 is mainly targeting the old, immunocompromised, and individuals with underlying health issues. But it bears reminding that <a href="https://l.facebook.com/l.php?u=https%3A%2F%2Fwww.hopkinsmedicine.org%2Fhealth%2Fconditions-and-diseases%2Fcoronavirus%2Fcoronavirus-and-covid-19-younger-adults-are-at-risk-too%3Ffbclid%3DIwAR3rtmLPJLBK0XtyutHg9mjMS4m5nJU6uyOUvxVku_DshDb7LruCraPG2rI&h=AT3AZuNrDfRQq2FFqGxJ_jaykrCulBOXp-27vhLSL7_HsjdMjU0HWD1OHnk5mGo8G-MNRtCPFnAdZoyOLwQ-BDclDkcVdebL2mBW0DFJTgKGMCb6aERtrVJT5-sxl85HXMPgMq93"><span style="color: #385898; font-family: inherit , serif; text-decoration: none;">normal, healthy young adults are also getting severely ill</span></a>. </span></div>
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<span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;">Importantly, children of all ages have been afflicted by a condition now termed <a href="https://l.facebook.com/l.php?u=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fdaily-life-coping%2Fchildren%2Fmis-c.html%3Ffbclid%3DIwAR0G6xNLAXeaVwzt-UzLM7JwlyD-37ZdY9opqUYsJzF82qrUK8kCHwzRunI&h=AT0gE0zm2QftuuxtxeD5LAasoHBzofrKKsUxAV8Jhb1CAqV6lGw2Wt9g1DWbiPP0rh98sBRUonfahS1TWfMgCdyLgDZh3BOwgqAXK7DF8WLq-4lZiaupby0brLFUDa3U-Y-zWZKt"><span style="color: #385898; font-family: inherit , serif; text-decoration: none;">Multisystem Inflammatory Syndrome in Children (MIS-C)</span></a>, which has led to some deaths in normal, healthy kids with no underlying health issues. MIS-C and healthy young adults getting severely ill is a small risk, but it is a real risk. Please bear this in mind.<o:p></o:p></span></div>
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<span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;">However, at some point we all take risk. Driving down the freeway could lead to a fatal accident but we do it everyday. Children attending school even when there is no pandemic could lead to meningitis, but we do it everyday.<o:p></o:p></span></div>
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<span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;">The key is calculating risk and minimizing it without going overboard - which is a very tricky thing to do with a new virus such as COVID-19.<o:p></o:p></span></div>
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<span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;">If you are older than 60 years, have serious health issues, or are immunocompromised - you should not join an in-person meeting of a small group until further notice from public health officials.<o:p></o:p></span></div>
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<span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;">If you are living with anyone meeting any of these criteria, you should strongly consider not joining an in-person meeting of a small group as you are putting that individual at real risk.<o:p></o:p></span></div>
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<b><span style="color: #1c1e21; font-family: inherit , serif; font-size: 13pt;">If you do not meet either of the above two criteria, meeting in a small group may be reasonable with the following parameters:</span></b><span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;"><o:p></o:p></span></div>
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<b><span style="color: #1c1e21; font-family: inherit , serif; font-size: 13pt;">1. </span></b><span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;"><b><span style="color: #385898; font-family: inherit , serif; text-decoration: none;"><a href="https://l.facebook.com/l.php?u=https%3A%2F%2Fwww.cnn.com%2F2020%2F06%2F12%2Fhealth%2Fcoronavirus-mask-wellness-trnd%2Findex.html%3Ffbclid%3DIwAR3BlQz3PqsB8o7K-L20aOND4TKGkum_TlBlwU5n3KJFY5hPL4qQVHBzrOY&h=AT1ggQRJlvLCqzom2BJB4813V4AGIYZsbnX19ot3brHYa1_OahxcMa4oFPyK3lUqAKlWJFiv9qFioAERXdPQC6EDsyUFnsEOI_rvm4okm6EMbhrFOuADioFr-pMgDiJmLh8vw57_">Masks</a> </span></b></span><b><span style="color: #1c1e21; font-family: inherit , serif; font-size: 13pt;">should be worn as much as possible and for the entirety of the meeting.</span></b><span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;"><o:p></o:p></span></div>
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<span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;">2. If cases of COVID-19 in your city are rising, it is probably better not to meet in person. A great resource for this in Houston is <a href="https://l.facebook.com/l.php?u=http%3A%2F%2Fwww.tmc.edu%2F%3Ffbclid%3DIwAR3AXApk28TpdHzLdUyPj-ARZYJZ9Owsr66W2_mkj0APaO48O47qIU5bniQ&h=AT3CmzNCzzxHikU7iDdU4Sm_ng2c5HZibaNXMFb4_GmVVVqVMbFl2a3ldUc3n9lnNtExbiTQmfkZsu6tIFrZ7gg1PYxgXJXb5SThQ7Ekv-dRUQBr5EjqH_0J9Ie_NAsbDet0uBug"><span style="color: #385898; font-family: inherit , serif; text-decoration: none;">www.TMC.edu</span></a>.<o:p></o:p></span></div>
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<span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;">3. If you do meet, <span style="color: #385898; font-family: inherit , serif; text-decoration: none;"><a href="https://l.facebook.com/l.php?u=https%3A%2F%2Fwww.nytimes.com%2F2020%2F06%2F09%2Farts%2Fmusic%2Fchoirs-singing-coronavirus-safe.html%3Ffbclid%3DIwAR3tWZTveSfpgg_xmJqanslYJfhiNH6hK4l37Ojl1VKnWoRpVngrFRRXFq4&h=AT0tvAoWPQQY26F3VVLLBuc3KqD4Ojr8o_W3-HdGs6lWukxfgQBpLfpMDj7qND8EI_G_HVQWzCS6xWJmdg4nv8Cv8oDaMzvjtjnnKLYSXH0cr4luTkeMQNmabgTrwtgf_9qvxozJwJNKNUV-s39SNQ">SINGING</a> </span>is one of the biggest risks. It is highly advisable not to sing indoors at all. Either do praise time outside (with masks ideally) or skip praise time altogether. Even with masks on, singing in a confined space is a serious risk for spread – many people do not wear snug fitting masks and mask quality is highly variable.<o:p></o:p></span></div>
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<span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;">4. It is advisable for mealtime to be done outdoors as it necessitates removing your masks. If you do eat indoors, you should be 6 feet apart ideally. <span style="color: #385898; font-family: inherit , serif; text-decoration: none;"><a href="https://l.facebook.com/l.php?u=https%3A%2F%2Fwww.nytimes.com%2F2020%2F05%2F14%2Fhealth%2Fcoronavirus-infections.html%3Ffbclid%3DIwAR0-YsNUyIht-Ao-S7gr5eRS17k1YMhj2DHnoGCWE74ZCr7vFyAHr7hURT8&h=AT1Ldva8nkBQO1Gnabd-BWaY21cIEG9FVJeBb7IK7oYYcd5p858FgJkOoRq0sOze5lrrd-pR0JKADDCr6Rtc_1wY5j1tWRPKaLupEA2dqQCmYQEHD8yyL9hZmUBkxZLQzcxsLhCz">Talking to one another</a> </span>for 10-15 minutes in close proximity without masks is an easy way for COVID-19 to spread.<o:p></o:p></span></div>
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<span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;">5. Whoever is handling food prep must be masked when serving food. Everyone should thoroughly wash hands prior to eating.<o:p></o:p></span></div>
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<span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;">6. Word time, sharing time, and prayer time can be done indoors, but outdoors is still preferable when reasonable. Either way, try to remain 6 feet apart. If sitting indoors, <a href="https://l.facebook.com/l.php?u=https%3A%2F%2Fwww.hhcorp.org%2Fhhc%2Findex.php%2Fcovid-19-resources%2Fpreventing-covid-19-spread-with-good-air-circulation%3Ffbclid%3DIwAR0swo9OcptJW0LgzSijeXpaNA6m3AJxI8udSrljRCKe7EVeUcPuA0Me6xM&h=AT3EEwyckfKdonQgvrt0PILiF1bhajxajrgUak0YeqeDpro7k8vrboqX9ajFrNCLDWvp3RY7qMiP92E-uJnGCuAasLecGWipWBwlUKQDpkMHptNZxvc8JFfKmQQEoBB7Chki6FpD"><span style="color: #385898; font-family: inherit , serif; text-decoration: none;">good air circulation is very important</span></a>: turn on the AC and ceiling fan and open windows when possible.<o:p></o:p></span></div>
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<span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;">7. Do not hug or shake hands. Elbow bumps are ok.<o:p></o:p></span></div>
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<span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;">8. <span style="color: #385898; font-family: inherit , serif; text-decoration: none;"><a href="https://l.facebook.com/l.php?u=https%3A%2F%2Fwww.businessinsider.com%2Fcoronavirus-risk-higher-tight-indoor-spaces-with-little-air-flow-2020-5%3Ffbclid%3DIwAR0QAwK93sKsW6YVqIE94k08nSG_mCGU-MaBRfAgR7qMkGrppWfMiEZrxbs&h=AT1049zKNPQBLr-NrmimTtrZXb-zkyFUsut-xHfnx5OacQ13ZTxiQXWBrrKXOyQ87ZTq8y1uB7J05SBSe-dQyUHHpTsjxBBncN4kUIdVkTaDueOH5_Sx7ynPH2hx-mDtwUGWNhfr">Try to keep any indoor portion of the small group as short as possible.</a> </span>Consider moving rooms when feasible for each segment of the small group meeting to keep the surrounding air fresh and new. Open, airy rooms with good air circulation are the safest.<o:p></o:p></span></div>
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<span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;">9. Should you meet in-person, especially if the meeting is indoors, <span style="color: #385898; font-family: inherit , serif; text-decoration: none;"><a href="https://l.facebook.com/l.php?u=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fcommunity%2Flarge-events%2Fconsiderations-for-events-gatherings.html%3Ffbclid%3DIwAR1_Pc4SvgWCOS-FQzHnjhEV70bEODDWxsktcg4G2gu1hy7YNOGHBYUKlfA&h=AT11nUAOhygWuLtPoEItky48A0IwiyJGjeQgmvosmjRYO2HUtwYdbNXNAL5J75WjwzcTahFV9pV5ki40Qc5FkGsbAyyTr1ebI64fn4Y1sRzvgxsf2iJLNFDQ31N3bui_0vBAFkiO">the smaller the group the safer.</a> </span>At this time, 10 people (including children) would be a reasonable cap to your group size.<o:p></o:p></span></div>
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<b><span style="color: #1c1e21; font-family: inherit , serif; font-size: 13pt;">10. Anyone who is possibly sick should ABSOLUTELY NOT come.</span></b><span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;"><o:p></o:p></span></div>
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<span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;">11.</span><b><span style="color: #1c1e21; font-family: inherit , serif; font-size: 13pt;"></span></b><span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;">Anyone who cannot afford a two week quarantine period should they later find out someone in the group tested positive, should NOT come.<o:p></o:p></span></div>
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<span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;">12. Anyone who is or is living with someone who is awaiting a COVID-19 test* or has recently been diagnosed with COVID-19 or is displaying COVID-19 symptoms should NOT come. <span style="color: #385898; font-family: inherit , serif; text-decoration: none;"><a href="https://l.facebook.com/l.php?u=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fif-you-are-sick%2Fquarantine-isolation.html%3Ffbclid%3DIwAR0w3GEz0u0p-a9hChxDyJQJIIqyjTGjTQezKjvOS4k6pqNLExLT1qewDHQ&h=AT3ywPYu7cQEwaGygXMUwIhUAnLH1jdb2zgyTeE4zUxAqjaiLtv7dksHihy8zyOdPd8mk5Og_vll8b6kXRq9oy91uurxvqv_qQ6J1If0t5Tn1g42qxThhRJS7UTr7cNNHYF0z9aI">See scenarios below to help with timeframe on returning.</a></span><o:p></o:p></span></div>
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<i><span style="color: #1c1e21; font-family: inherit , serif; font-size: 13pt;">*For the purposes of this guidance and the information below, a COVID-19 test refers to the nasopharyngeal nucleic acid swab test and not the antibody test – there is a major difference between the two tests that is beyond the scope of this guidance.</span></i><span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;"><o:p></o:p></span></div>
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<span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;">· </span><b><span style="color: #1c1e21; font-family: inherit , serif; font-size: 13pt;">Close contact with COVID but No Test Pending</span></b><span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;"><o:p></o:p></span></div>
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<span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;">o Safe to return after 14 day quarantine at home AND no symptoms develop during that time.<o:p></o:p></span></div>
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<span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;">· </span><b><span style="color: #1c1e21; font-family: inherit , serif; font-size: 13pt;">Asymptomatic and COVID Test Pending</span></b><span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;"><o:p></o:p></span></div>
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<span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;">o It is definitely safest to wait until the COVID test is back. However if the individual is completely symptom free AND wearing a mask the ENTIRE time, it is reasonable to partake but would not advise.<o:p></o:p></span></div>
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<span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;">· </span><b><span style="color: #1c1e21; font-family: inherit , serif; font-size: 13pt;">Symptomatic and COVID Test Pending</span></b><span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;"><o:p></o:p></span></div>
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<span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;">o Do not join until the test result returns AND the individual meets the criteria in one of the following scenarios.<o:p></o:p></span></div>
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<span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;">· </span><b><span style="color: #1c1e21; font-family: inherit , serif; font-size: 13pt;">Asymptomatic and Positive COVID Test</span></b><span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;"><o:p></o:p></span></div>
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<span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;">o Safe to return when either of below criteria met:<o:p></o:p></span></div>
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<span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;">§ 10 days after the first test was performed and remains asymptomatic.<o:p></o:p></span></div>
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<span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;">OR<o:p></o:p></span></div>
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<span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;">§ 2 negative nasopharyngeal swab specimens collected at least 24 hours apart. Tests for clearance should be done a minimum of 5 days after the initial POSITIVE test was performed.<o:p></o:p></span></div>
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<span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;">· </span><b><span style="color: #1c1e21; font-family: inherit , serif; font-size: 13pt;">Symptomatic and Positive COVID Test</span></b><span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;"><o:p></o:p></span></div>
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<span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;">o Safe to return when either of below criteria met:<o:p></o:p></span></div>
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<span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;">§ It has been 10 days since the onset of symptoms AND no fever for 3 days AND significant improvement of symptoms (cough, runny nose, etc.).<o:p></o:p></span></div>
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<span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;">OR<o:p></o:p></span></div>
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<span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;">§ 2 negative nasopharyngeal swab specimens collected at least 24 hours apart. Tests for clearance should be done a minimum of 5 days after the initial POSITIVE test was performed.<o:p></o:p></span></div>
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<span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;">· </span><b><span style="color: #1c1e21; font-family: inherit , serif; font-size: 13pt;">Symptomatic but Negative COVID Test</span></b><span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;"><o:p></o:p></span></div>
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<span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;">§ Safe to return when 24 hours without fever without the use of fever-reducing medication AND significant improvement of symptoms.<o:p></o:p></span></div>
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<span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;">Some of these recommendations may seem over-the-top, but COVID-19 warrants a high level of vigilance. It is a very serious illness and there is a long way to go before the pandemic is over. <o:p></o:p></span></div>
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<span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;">The safest thing of course is to meet through video-conferencing. At the present moment, it is this author’s preference until the risk further decreases.<o:p></o:p></span></div>
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<span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;">Remember when you get together, you are not only potentially sharing germs with the people in your small group, but you are also sharing germs with everyone they live with and everyone they live with may be sharing germs with you. The larger the group, the greater the risk to everyone at the meeting.<o:p></o:p></span></div>
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<span style="color: #1c1e21; font-family: "georgia"; font-size: 13pt;">Hope this guidance helps as you do the Lord's work!<o:p></o:p></span></div>
Peter Junghttp://www.blogger.com/profile/12235011146063672219noreply@blogger.com0tag:blogger.com,1999:blog-5923231085926288168.post-12249009561448698492020-03-07T21:04:00.000-08:002020-04-05T11:13:54.277-07:00Post #48 Coronavirus COVID-19 Pandemic Update<div class="MsoNormal" style="font-family: Cambria; font-size: 12pt; margin: 0in 0in 0.0001pt;">
<span style="font-size: 12pt;">Well before news of COVID-19 wreaked havoc on our borders, travels, news cycle, and hand sanitizer supplies, influenza was quietly going about its yearly routine business with minimal hubbub from the media.</span><br />
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<span style="font-size: 12pt;">To put things in perspective, consider that for the 2019-20 flu season, there have been an estimated 20,000 - 52,000 deaths thus far per the Center for Disease Control in the United States alone. That is just one country.</span><br />
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In contrast, there have been approximately 3,600 deaths from COVID-19 <b><i>worldwide</i></b>. More deaths are sure to follow, and quite possibly, the final tally may far outstrip that of the seasonal flu.<o:p></o:p></div>
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An unknown enemy is always more frightening than one that is known. With the flu, we know what to expect, we have medications to combat it, and most importantly there is an effective vaccine readily available each winter.<o:p></o:p></div>
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Unfortunately, with COVID-19 there are still a LOT of unknowns. </div>
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But we know substantially more now than we did when this all started and we are learning more each day.<br />
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<b>The Case Fatality Rate (CFR) is likely overestimated and will hopefully trend down.</b><br />
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One of the best handles as to the seriousness of a pandemic is to look at the Case Fatality Rate and compare it to other previous pandemics. </div>
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The <a href="https://en.wikipedia.org/wiki/Case_fatality_rate" target="_blank">Case Fatality Rate</a> is simply the ratio of deaths from a certain disease to the total number of people diagnosed with this disease for a certain time period.</div>
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As a frame of reference, the 1918 Spanish Flu, one of the worst pandemics of all time, had a CFR of approximately 2.5% to 10% - meaning that about 2.5 to 10 percent of all people who caught the Spanish Flu died. Anything greater than 2.5% would certainly be devastating worldwide.</div>
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Conversely, the seasonal flu typically has a CFR of approximately 0.1%, which is still concerning, but as mentioned in the introduction of the blog, the world has learned to take this in stride.</div>
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The more data is collected, the more accurate the CFR estimates become. The initial CFR estimates for COVID-19 were in the 2-3% range and recently the World Health Organization released a <a href="https://www.worldometers.info/coronavirus/coronavirus-death-rate/#who-03-03-20" target="_blank">3.4% estimate</a>.</div>
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Certainly, these estimates are enough to give even the staunchest epidemiologist pause.</div>
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But in order to make the best guesstimates of CFR early in the course of a pandemic there must be widespread testing. Lesser testing detects fewer cases, which skews the CFR higher. This was seen with the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3809029/" target="_blank">2009 H1N1 Influenza Pandemic</a>. </div>
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Currently, there are two microcosms of the pandemic that can give us the best estimates of the CFR for COVID-19. In both instances, widespread testing of the particular cohort has provided better data and thus a truer estimate of the real CFR.</div>
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<b>1. The Diamond Princess cruise ship</b><br />
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The <a href="https://slate.com/technology/2020/03/coronavirus-mortality-rate-lower-than-we-think.html?fbclid=IwAR0J6gBZQB2_Y87oNPmiT1gM4phbQq2xSkeXvWQyLQR0suLtoxmVWMsGiwo" target="_blank">Diamond Princess cruise ship</a> which had approximately 700 lab confirmed cases of COVID-19, has reported 7 deaths to date. This translates to a CFR of 1%. Importantly, it should be noted that all of the deaths occurred in passengers 70 years and older.</div>
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<b>2. South Korea</b></div>
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South Korea is currently testing thousands of people a day and thus far 6,088 cases have been detected of which 37 have died. This translates to a <a href="https://www.vox.com/2020/3/5/21165973/coronavirus-death-rate-explained" target="_blank">CFR of 0.6% for South Korea</a>. This is probably more accurate than the cruise ship figure, as the Korea numbers are more age-demographically balanced, whereas the cruise was populated by predominantly older people.</div>
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While a 0.6% CFR is much better than a 3.4% CFR, it is still significantly higher than the seasonal flu's 0.1% CFR. That figure would translate to 6x the number of people dying, if the same number of people who catch the flu annually were to catch COVID-19. </div>
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The hope is that even in South Korea, there are many who have been infected that have NOT been tested, and are thus unaccounted for in the statistics. Accurately capturing their data would certainly bring the CFR percentage even lower. </div>
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The bottom line is that while it is unlikely that the final CFR tally will come in at 3.4%, there is a strong chance that this pandemic is more deadly than the seasonal flu. More testing, better data, and clarity are sure to come.</div>
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<b>Thus far, children are not being seriously affected.<o:p></o:p></b><br />
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A huge encouraging statistic as a pediatrician is that no children under 10 years of age have died from the COVID-19 to date and, for unclear reasons <a href="https://www.nytimes.com/2020/02/05/health/coronavirus-children.html" target="_blank">few children are developing severe symptoms</a>. <span style="font-size: 12pt;">This pattern is similar to what was seen during the outbreaks of SARS and MERS. </span><br />
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Children are at <a href="https://www.medrxiv.org/content/10.1101/2020.03.03.20028423v1" target="_blank">similar risk as the rest of the population</a> in terms of becoming infected; so it is imperative to consider them as vectors of the virus, especially since they are less symptomatic and thus more ambulatory, and less prone to prudent hygiene habits.</div>
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<b>Healthy people 60 years and younger are at much lower risk.</b></div>
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Although there are some fatalities in nearly every age demographic, <a href="https://www.worldometers.info/coronavirus/coronavirus-age-sex-demographics/" target="_blank">the vast majority of deaths are occurring in individuals 60 years and older</a>. Further, people who have <a href="https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/high-risk-complications.html" target="_blank">a severe chronic medical condition affecting their heart, lungs or kidneys</a> are also at greater risk. This follows a similar pattern to influenza and most severe respiratory viruses.</div>
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<b>So, if there is a silver lining in any of this, those who are under 60 years of age without significant health problems have an excellent prognosis should they become infected with COVID-19.</b></div>
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Further encouraging is that about <a href="https://www.who.int/news-room/q-a-detail/q-a-coronaviruses" target="_blank">80% of people who contract COVID-19 recover without needing special treatment</a>.</div>
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But the fact remains that as of the writing of this blog, the CFR is likely higher than the seasonal flu and possibly significantly higher. Intensive Care Units and hospitals in <a href="https://www.washingtonpost.com/health/2020/03/07/how-doctors-treat-sickest-coronavirus-patients/" target="_blank">China</a> and in <a href="https://www.reuters.com/article/us-health-coronavirus-southkorea/thousands-wait-for-hospital-beds-in-south-korea-as-coronavirus-cases-surge-idUSKBN20R05M" target="_blank">South Korea</a>, particularly near the epicenters of the outbreaks are overwhelmed.</div>
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If these two countries are a peek into the future for the rest of the world, this is going to be a long and difficult battle and it will have to start with grassroots efforts. We as a society will need to be vigilant in following the directives of our public health officials and practicing a high level of personal hygiene habits. </div>
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The CDC has an <a href="https://www.cdc.gov/coronavirus/2019-ncov/about/prevention-treatment.html" target="_blank">excellent list</a>:</div>
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<li><span style="font-family: "cambria";">Avoid close contact with people who are sick.</span></li>
<li><span style="font-family: "cambria";">Avoid touching your eyes, nose, and mouth.</span></li>
<li><span style="font-family: "cambria";"><b>Stay home when you are sick.</b></span></li>
<li><span style="font-family: "cambria";">Cover your cough or sneeze with a tissue, then throw the tissue in the trash.</span></li>
<li><span style="font-family: "cambria";">Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe.</span></li>
<li><span style="font-family: "cambria";"><b>Facemasks: CDC does NOT recommend that people who are well wear a facemask.</b> Those who are showing symptoms should wear them to prevent the spread of disease. Health care workers and caregivers should also wear them when taking care of those who are infected.</span></li>
<li><span style="font-family: "cambria";">Wash your hands often with soap and water for at least 20 seconds. If soap and water are not available use an alcohol-based hand sanitizer with at least 60% alcohol.</span></li>
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For the sake of those who are most vulnerable, we must band together to slow the spread of this disease. By slowing transmission, hopefully hospitals will not be overwhelmed with a tsunami of cases leading to a likely depletion of important resources such as ICU beds, ventilators, and healthcare workers. </div>
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Additionally, there is hope that by this time next year a vaccine will be available. As more research is published and experience gained, the medical community will develop a better understanding of which combination of antiviral medications and treatments work best.</div>
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And if COVID-19 mimics other respiratory viruses, the upcoming warmer weather may provide a temporary reprieve, giving the world a chance to catch its collective breath before the battle begins anew in the upcoming fall and winter. </div>
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Based on current epidemiological data, it is likely that the COVID-19 virus is not going away anytime soon. But the human race is strong and resourceful and we have more weapons at our fingertips than ever before. </div>
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Now, more than ever, for the sake of the elderly and those with fragile health, it is imperative that we do the small things like washing our hands and staying at home when sick. </div>
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When we stand together, there is nothing too strong or too deadly that the human spirit cannot overcome.</div>
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Peter Junghttp://www.blogger.com/profile/12235011146063672219noreply@blogger.com8tag:blogger.com,1999:blog-5923231085926288168.post-61654343234705163522020-02-22T11:07:00.000-08:002020-02-26T20:11:01.623-08:00Post #47 How to Optimally Utilize Tamiflu<div class="MsoNormal" style="background: white; color: #333333; font-family: Cambria; font-size: 12pt; margin: 0in 0in 0.0001pt;">
<span style="color: black; font-family: "calibri";"><b>The take home message is that because of side effects and costs, using Tamiflu during the flu season should not be a knee-jerk reaction.</b></span><br />
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<span style="color: black; font-family: "calibri";">Every year in the United States, the <span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial;">CDC estimates that influenza results in between 9 million – 45 million illnesses, between 140,000 – 810,000 hospitalizations, and between 12,000 – 61,000 deaths (approximately 100 – 200 being pediatric fatalities; typically 80% not vaccinated). </span></span><o:p></o:p></div>
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<span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; color: black; font-family: "calibri";">In the United States, the immense burden of the flu is unparalleled by any other pathogen, but fortunately there is a vaccine and antiviral medications which help to mitigate the yearly morbidity and mortality wrought by influenza.</span><o:p></o:p></div>
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<span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; color: black; font-family: "calibri";">Because the flu changes its shape every year by a process called antigenic shift and drift, it is necessary for individuals to receive annual flu vaccines to maintain optimal protection against the virus. Protection from illness proffered by the immunization typically wavers between 40 – 60% in any given year; it is by far the best, no-brainer weapon that modern medicine has to offer against influenza. This author races to have it completed for his entire family every flu season as soon as the vaccine is available.</span><o:p></o:p></div>
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<span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; color: black; font-family: "calibri";">Beyond the vaccine, there are several antiviral medications that are also helpful in combatting the flu. To be clear, the antiviral medications are second line treatment as they are less effective, more expensive, and carry more side effects. </span><o:p></o:p></div>
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<span style="color: black; font-family: "calibri";">The most common antiviral medication we use in pediatrics is Tamiflu (Oseltamivir), which is the only medication approved in children under 7 years of age. It works by inhibiting one of the key enzymes of the flu virus called neuraminidase. Tamiflu does not kill the flu virus, rather it slows down its ability to replicate, allowing the body's immune system to eventually (hopefully) overcome the virus. </span><o:p></o:p></div>
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<span style="color: black; font-family: "calibri";">When given within the first 48 hours of the illness, it has been shown to reduce the overall duration of symptoms by approximately one day. In patients who are sick enough to warrant hospitalization, there are benefits to utilizing Tamiflu even outside of the initial 48 hour window as it can decrease the risk of complications from the flu. </span></div>
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<span style="color: black; font-family: "calibri"; font-size: 12pt;">Overall, Tamiflu is well tolerated; but there are side effects, the most common being:</span></div>
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<li style="color: #333333; font-family: Cambria;"><span style="color: black; font-family: "calibri"; font-size: 12pt;">Gastrointestinal complaints (such as vomiting) in 14% of Tamiflu recipients</span></li>
<li><span style="font-family: "calibri";">Neurological complaints (such as hallucinations) in 5% of Tamiflu recipients</span></li>
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<span style="font-family: "calibri"; font-size: 12pt;">Although Tamiflu can be an effective anti-flu medication - because of its side effects, timing constraints, and cost, like every other tool in medicine it must be utilized with judicious discretion. It is important to note that unlike the flu vaccine, where the protection lasts throughout the flu season, the benefits of Tamiflu are short-lived and are limited to when it is being ingested.</span></div>
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<span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; color: black; font-family: "calibri";">During the flu season parents often request Tamiflu as either treatment for an ill child or for prophylaxis to protect their healthy children. </span><o:p></o:p></div>
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<span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; color: black; font-family: "calibri";"><br />Some quick (but not all encompassing) criteria for when to consider Tamiflu, given that a flu test is positive, is as follows:</span><o:p></o:p></div>
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<span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; color: black; font-family: "calibri";"><br /><b>Child has had symptoms less than 48 hours AND is less than 2 years of age OR has an underlying health condition such as asthma, diabetes, or some other type of chronic illness.</b></span><o:p></o:p></div>
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<span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; color: black; font-family: "calibri";"><br />In most children, who meet this criteria, Tamiflu should be strongly considered; however, if the child appears well and has good follow-up available, Tamiflu can be deferred.</span><o:p></o:p></div>
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<span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; color: black; font-family: "calibri";"><br />Conversely, some quick (but not all encompassing) criteria for when to consider NOT utilizing Tamiflu, even when a flu test is positive, is as follows:</span><o:p></o:p></div>
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<span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; color: black; font-family: "calibri";"><br /><b>Child has had symptoms for longer than 48 hours OR appears well and is responding appropriately to fever reducers. Especially, if they are vaccinated, the necessity of Tamiflu decreases.</b></span><o:p></o:p></div>
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<span style="color: black; font-family: "calibri";"><br /><span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial;">The three most common scenarios we are confronted with in our pediatric practice are as follows:</span></span><o:p></o:p></div>
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<span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; color: black; font-family: "calibri";"><br /><b>1. Child is sick and has a documented positive test confirming the flu.</b></span><o:p></o:p></div>
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<span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; color: black; font-family: "calibri";"><br />Generally, if the child has been sick for less than 48 hours AND is less than 2 years of age or has any underlying heath conditions such as asthma, it is prudent to start a five day course of Tamiflu ASAP. If the child is acting well and responds favorably to fever reducers </span><span style="color: black; font-family: "calibri";">there is less onus to giving Tamiflu, especially if they are appropriately vaccinated against the flu.</span><o:p></o:p></div>
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<span style="color: black; font-family: "calibri";"><br /><b>2. Child is sick but does not have a documented positive test confirming the flu.</b></span><o:p></o:p></div>
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<span style="color: black; font-family: "calibri";"><br />Because of the side effects and cost of Tamiflu, whenever possible, it is prudent to have a confirmatory test of flu completed before committing to treatment. One caveat to this is if a recent family member has tested positive for flu AND it has been less than 48 hours since exposure AND the child clearly has flu-like symptoms, there may be value in starting Tamiflu ASAP. However, similar to scenario one above, unless they are under 2 years of age or there is a chronic medical condition, Tamiflu may not be needed - especially if they have been properly vaccinated.</span><o:p></o:p></div>
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<span style="color: black; font-family: "calibri";"><br /><b>3. Child is well but has been exposed to the flu.</b></span><o:p></o:p></div>
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<span style="color: black; font-family: "calibri";"><br />Per Uptodate.com:</span><o:p></o:p></div>
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<span style="color: black; font-family: "calibri";">"Postexposure prophylaxis is not routinely recommended for otherwise healthy children but may be warranted within 48 hours of exposure for children who have had close contact with a confirmed or suspected case of influenza during the infectious period (ie, one day before the onset of symptoms until 24 hours after the fever ends) AND who are at high risk for complications of influenza. Postexposure prophylaxis should be used only when antivirals can be started within 48 hours of the most recent exposure."</span><o:p></o:p><br />
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<span style="color: black; font-family: "calibri";">It should be noted that postexposure prophylaxis has modest benefits which end as soon as Tamiflu is no longer being taken.</span><br />
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<span style="color: black; font-family: "calibri";"><b>The bottom line is, whenever possible, a confirmatory flu test can help best guide treatment. And of course, consulting your pediatrician can help you make the best decision as to if and when to initiate treatment. </b></span><o:p></o:p></div>
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<span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; color: black; font-family: "calibri";">It is always a bit confounding, each flu season, to observe several families who openly embrace Tamiflu, while shunning the flu vaccine because they are concerned about putting "synthetic" material into their child's body. </span><o:p></o:p></div>
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<span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; color: black; font-family: "calibri";"><br />Our pediatric offices deal with far more side effects from Tamiflu yearly - including vomiting and hallucinations - compared to the relatively nominal side effects of the flu vaccine, which are redness, swelling, and pain at the site of injection.</span><o:p></o:p></div>
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<span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; color: black; font-family: "calibri";"><br />When used properly, Tamiflu is an effective weapon against the flu, but the best protection for your child is to immunize them against influenza each and every winter. The flu can be a dangerous disease, but with proper preparation and care, you can significantly mitigate the risk to your family.</span></div>
Peter Junghttp://www.blogger.com/profile/12235011146063672219noreply@blogger.com0tag:blogger.com,1999:blog-5923231085926288168.post-82282036533633799572019-04-30T06:29:00.002-07:002020-02-23T06:58:16.186-08:00Post #45 How to be Optimally Measles Immunized<!--[if gte mso 9]><xml>
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<br />
<span style="background-color: white; color: #444444; font-family: arial;">Measles is a highly contagious disease
caused by a virus. It spreads through the air when an infected person coughs or
sneezes – the kicker is this can happen 2 hours AFTER said person has left the
room. Measles starts with a fever; soon after, it causes a cough, runny nose,
and red eyes. Then a rash of tiny, red spots breaks out which starts at the
head and spreads to the rest of the body.</span><br />
<span style="background-color: white; color: #444444; font-family: "arial";"><br /></span>
<span style="background-color: white; color: #444444; font-family: "arial";">It is important to recognize that fever
and rash are extremely common in children and </span><b style="background-color: white; color: #444444; font-family: arial;">the vast majority of
fever/rash cases will not be Measles. </b><span style="background-color: white; color: #444444; font-family: "arial";">Unless you are reading about local cases of Measles in the news – it is
highly improbable that your child has Measles, especially if they are
vaccinated.</span><br />
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<span style="color: #444444; font-family: "arial";">
<br />
Per the CDC, two doses of the MMR (Measles/Mumps/Rubella) vaccine are about 97%
effective at preventing measles; one dose is about 93% effective.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; margin-bottom: 15.0pt;">
<span style="color: #444444; font-family: "arial";">The typical pediatric office will offer
the first MMR at the 1yo check-up and the second MMR at the 4yo check-up. Note
that the 4yo MMR is typically administered as part of a combination vaccine which
includes both the MMR vaccine and the Varicella (Chicken Pox) vaccine, while
the 1yo MMR is not part of a combination vaccine – so they may show up in
different parts of your vaccine record.<br />
<br />
If you are concerned about the current measles outbreak and you would like to
proactively make sure your child’s MMR vaccine coverage is optimal, below are
some options:</span><span style="color: #444444; font-family: "arial"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
<ol start="1" type="1">
<li class="MsoNormal" style="background: white; color: #444444; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "arial"; mso-fareast-font-family: "Times New Roman";">If
your child is under 6 months of age, MMR is not recommended. At this
age the antibodies of the mother against Measles (which are the protective
proteins your immune system makes in response to vaccines) are still quite
prevalent in the baby, thus rendering the immunization mostly ineffective.</span></li>
<li class="MsoNormal" style="background: white; color: #444444; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "arial"; mso-fareast-font-family: "Times New Roman";">If your
child is 6-12 months of age, an early MMR dose can be given for
protective purposes. By 6-12 months of age, the maternal antibodies
are less prevalent (but not completely gone) and thus an early MMR can be
beneficial – one prospective randomized trial showed an 87% level of protection at 9 months of
age. <i style="mso-bidi-font-style: normal;">The early MMR is recommended
for any 6-12 months of age baby traveling internationally.</i> Please note
that any MMR given before 12 months will not count towards the completion
of the routine MMR series and the normal 1yo and 4yo MMR vaccine should
still be given in the future. <b>Unless you have concern for exposure to
non-vaccinating populations, at this time, this vaccine is not routinely warranted
by current CDC recommendations.</b><o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #444444; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "arial"; mso-fareast-font-family: "Times New Roman";">If
your child is 1-4 years of age, two doses of the MMR vaccine,
separated by 28 days can be given. Typically the two doses are given at
the 1yo and 4yo check-up; however, the 2nd MMR dose can be given
early. If the 2nd dose is given early it does satisfy the CDC criteria for
future school enrollment and does not need to be repeated. <i style="mso-bidi-font-style: normal;">The early 2nd MMR is recommended for
any 1-4 year old child traveling internationally.</i> A small percentage
of children will not respond adequately to the first MMR; however, nearly
all children who do not respond to the first MMR will respond adequately
to the second MMR. <b>Unless you have concern for exposure to
non-vaccinating populations, at this time, this vaccine is not routinely
warranted by current CDC recommendations.</b><o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #444444; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "arial"; mso-fareast-font-family: "Times New Roman";">If
your child is over 4 years of age and two doses have been given, no
further MMR vaccines are recommended. A third dose may sometimes be recommended
during a MUMPS outbreak, but it does not help increase the protection
against measles. <o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #444444; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "arial"; mso-fareast-font-family: "Times New Roman";">If you
are an adult born after 1957 but before 1989, you may need an additional
MMR vaccine. Most people born before 1957 are assumed to have naturally
been infected with the virus through Measles outbreaks. Anyone born 1989
or later should have received two MMR vaccines, as that is when the CDC
changed routine recommendations from one MMR to two MMRs. However, if you were born
between 1957-1989, there is a good chance you only received one MMR
vaccine and to give yourself the best protection it would be prudent to
get a second MMR. If you are unsure or cannot find your record, you can
either get a blood test to measure the level of your protection, or it
would probably be simpler to get an MMR booster as there is no harm in
getting extra MMR immunizations.</span></li>
</ol>
<div>
<span style="color: #444444; font-family: "arial";"><br /></span></div>
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<span style="color: #444444; font-family: "arial"; mso-fareast-font-family: "Times New Roman";">Bottom line is if you have some concern for exposure to
non-vaccinating populations or you are traveling internationally, a proactive
early first or second MMR is reasonable. But in most cases, unless there is a
known outbreak in the community, following the routine CDC schedule for MMR is
sufficient.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="color: #444444; font-family: "arial"; mso-fareast-font-family: "Times New Roman";"><br /></span></div>
<div class="MsoNormal" style="background: white; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="color: #444444; font-family: "arial"; mso-fareast-font-family: "Times New Roman";">Per Uptodate.com: </span><span style="background: white; color: #232323; font-family: "arial";">Concern
has been raised about a possible link between measles, mumps, and rubella
vaccination and autism and other chronic diseases. Multiple studies have failed
to demonstrate any such association. However, there is an association between
congenital rubella syndrome and autism, highlighting a potential role for
rubella immunization in the prevention of autism spectrum disorders.</span><span style="color: #444444; font-family: "arial"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="background: white; color: #232323; font-family: "arial";"><br /></span></div>
<div class="MsoNormal" style="background: white; margin-bottom: 15.0pt;">
<span style="color: #444444; font-family: "arial";">To find out more about measles, please
visit the CDC Measles FAQ page at </span><a href="https://www.cdc.gov/measles/about/faqs.html"><span style="color: #141da4; font-family: "arial"; text-decoration: none;">www.cdc.gov/measles/about/faqs.html</span></a><span style="color: #444444; font-family: "arial";"><o:p></o:p></span></div>
<!--EndFragment-->Peter Junghttp://www.blogger.com/profile/12235011146063672219noreply@blogger.com1tag:blogger.com,1999:blog-5923231085926288168.post-42837855711142937122016-06-03T14:33:00.001-07:002017-04-03T01:36:53.428-07:00Post #44 Transitioning Babies to Solid Foods<div>
This is an unedited excerpt from my 2nd book, "What to Know Before Having Your Baby" - coming out in February of 2017.<br />
<br />
<div class="MsoNormal" style="line-height: normal; mso-outline-level: 2;">
<span style="font-size: 12.0pt;">Because infants begin their life on breast milk,
parents often think that milk is essential for their child’s diet even beyond
the first year of life.<span style="mso-spacerun: yes;"> </span>While milk is
absolutely important for the first few months of life, once babies can start
eating solids, the value of milk (breast, formula, or cow’s) quickly diminishes.<span style="mso-spacerun: yes;"> </span>Milk’s main purpose is for humans (and
animals) to provide an easy source of nutrition to their babies until they are
ready for solid foods – which offer a far greater diversity of nutrition.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; mso-outline-level: 2;">
<span style="font-size: 12.0pt;"><br /></span></div>
<div class="MsoNormal" style="line-height: normal; mso-outline-level: 2;">
<span style="font-size: 12.0pt;">By one year of age, the bulk of a child’s nutrition should
be from solid foods – ideally they should be eating a well-balanced diet pulling
from all of the food groups.<span style="mso-spacerun: yes;"> </span>At a maximum,
a one year old should be taking no more than 24 oz of milk or formula, and as
long as they are eating a balanced diet, there really is no minimum amount of milk
that a one year old needs.<span style="mso-spacerun: yes;"> </span>And though
milk does offer vitamin D and calcium – you can get plenty of vitamin D from
the sun and all the calcium you need from meat, certain vegetables, soy, nuts,
beans and other solid foods. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; mso-outline-level: 2;">
<span style="font-size: 12.0pt;"><br /></span></div>
<div class="MsoNormal" style="line-height: normal; mso-outline-level: 2;">
<span style="font-size: 12.0pt;">Solid food introduction can begin anywhere between 4
to 6 months of age.<span style="mso-spacerun: yes;"> </span>Traditionally,
parents in the U.S. start with cereal, move to fruits & vegetables, and
add meats as the last food group.<span style="mso-spacerun: yes;">
</span>However, many experts now recommend reversing that order as meats are
the most nutritious in vitamins and minerals and cereals are mostly filler
foods with the least amount of nutrition.<span style="mso-spacerun: yes;">
</span>Regardless of the order, by 8 to 9 months of life at the latest, babies
should be eating from every food group, and ideally the sooner the better.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; mso-outline-level: 2;">
<span style="font-size: 12.0pt;"><span style="mso-spacerun: yes;"><br /></span></span></div>
<div class="MsoNormal" style="line-height: normal; mso-outline-level: 2;">
<span style="font-size: 12.0pt;">Past concerns about causing food allergies led to a
very conservative approach to introducing solid foods. Recommendations were to
give only one new food every 3 days and certain foods such as peanuts and eggs
were to be avoided until several years of age.<span style="mso-spacerun: yes;">
</span>New data has clearly shown that this thinking was incorrect and it is now
known that early introduction of foods (particularly highly allergenic foods)
is helpful and reduces the risk of food allergies in the future.<span style="mso-spacerun: yes;"> </span>Outside of honey, which can cause botulism,
all other foods are safe to eat for babies as long as parents are careful of
choking hazards.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; mso-outline-level: 2;">
<span style="font-size: 12.0pt;"><span style="mso-spacerun: yes;"><br /></span></span></div>
<div class="MsoNormal" style="line-height: normal; mso-outline-level: 2;">
<span style="font-size: 12.0pt;">As for the “one new food every 3 day rule” – although
this rule might help figure out what food caused an allergy by making the
process of elimination easier, most kids with true allergies will have to
undergo a series of tests if a true food allergy is suspected, thus making this
rule unnecessary and a bit overly restrictive.<span style="mso-spacerun: yes;">
</span>It is perfectly reasonable and definitely easier to be aggressive and
introduce several new foods at a time.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; mso-outline-level: 2;">
<span style="font-size: 12.0pt;"><br /></span></div>
<div class="MsoNormal" style="line-height: normal; mso-outline-level: 2;">
<span style="font-size: 12.0pt;">While there is a whole line of baby foods available at
the supermarket, feel free to offer bite size portions of soft foods that
parents eat for their own meals.<span style="mso-spacerun: yes;"> </span>Foods
such as pastas, baked potatoes, soft meats, and steamed vegetables are all
safe, nutritious, and tasty for babies to consume as soon as they can chew well.<span style="mso-spacerun: yes;"> </span>The more flavors children encounter early on,
the less picky they will be later!<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; mso-outline-level: 2;">
<span style="font-size: 12.0pt;"><br /></span></div>
<div class="MsoNormal" style="line-height: normal; mso-outline-level: 2;">
<span style="font-size: 12.0pt;">So go ahead and give them a bite of your dinner –
they’re probably eyeing you as you eat it and wondering where their portion
is!<span style="mso-spacerun: yes;"> </span>As long as you can mash a food
between your pointer finger and thumb, even with no teeth, baby’s gums are
powerful and can handle it.<span style="mso-spacerun: yes;"> </span>The sooner
they are eating real foods, the sooner you can cook one meal and make your life
easier.<span style="mso-spacerun: yes;"> </span>And ultimately if it is
nutritious for you, it is nutritious for them. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; mso-outline-level: 2;">
<span style="font-size: 12.0pt;"><br /></span></div>
<div class="MsoNormal" style="line-height: normal; mso-outline-level: 2;">
<span style="color: black; font-size: 12.0pt;">So how should you incorporate the solid
foods into your current feeding schedule? The truth is there is no singular best way, but here is one method of doing it. Pick one meal to
begin with such as the feeding closest to breakfast time. Before giving
formula or breast milk, start by allowing your baby to eat as much solid food
as they will take. When they will no longer take any more solids, top
them off with their normal bottle or breastfeeding until they are full.
Once they seem to have the hang of one meal, add a second around
lunchtime, and soon thereafter a third around dinnertime. It is that
simple!</span><span style="font-size: 12.0pt;"> <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; mso-outline-level: 2;">
<span style="color: black; font-size: 12.0pt;"><br /></span></div>
<div class="MsoNormal" style="line-height: normal; mso-outline-level: 2;">
<span style="font-size: 12.0pt;">Some simple rules of thumb with feeding:<o:p></o:p></span></div>
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<span style="font-size: 12.0pt;"><br /></span></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level2 lfo1; mso-outline-level: 2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-size: 12.0pt; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span style="font-size: 12.0pt;">You are in charge of the quality of food, the child is
in charge of the quantity of the food.</span></b><span style="font-size: 12.0pt;"><span style="mso-spacerun: yes;"> </span>They will never shortchange themselves!<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level2 lfo1; mso-outline-level: 2; text-indent: -.25in;">
<span style="font-size: 12.0pt;"><br /></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level2 lfo1; mso-outline-level: 2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-size: 12.0pt; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span style="font-size: 12.0pt;">Aim for a balanced diet over a week at a time.</span></b><span style="font-size: 12.0pt;"><span style="mso-spacerun: yes;"> </span>Not every day
and certainly not every meal needs to be perfectly balanced.<span style="mso-spacerun: yes;"> </span>It all goes to same place!<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level2 lfo1; mso-outline-level: 2; text-indent: -.25in;">
<span style="font-size: 12.0pt;"><br /></span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: normal; margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level2 lfo1; mso-outline-level: 2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-size: 12.0pt; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span style="font-size: 12.0pt;">A child’s growth controls their appetite, not the
other way around.</span></b><span style="font-size: 12.0pt;"><span style="mso-spacerun: yes;"> </span>Your kids will grow in spurts controlled by
their hormones and appetite will follow accordingly.<span style="mso-spacerun: yes;"> </span>Again, they will never shortchange
themselves!<o:p></o:p></span></div>
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<span style="font-size: 12.0pt;">Ideally, your child should be eating 3 solid food
meals a day covering all of the different food groups by 8 to 9 months of
life.<span style="mso-spacerun: yes;"> </span>And by one year of age, children
should essentially be eating what their parents are eating.<span style="mso-spacerun: yes;"> </span>The bottom line is there is a lot of freedom
in how to start solids.<span style="mso-spacerun: yes;"> </span>Try lots of
different foods and have some fun with it!<o:p></o:p></span></div>
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Peter Junghttp://www.blogger.com/profile/12235011146063672219noreply@blogger.com1tag:blogger.com,1999:blog-5923231085926288168.post-39782755017271085732015-12-10T04:48:00.001-08:002022-05-04T08:35:14.606-07:00Post #43 My Father the Pediatrician<!--[if gte mso 9]><xml>
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<br />
<div class="MsoNormal">
I recently wrote a <a href="http://www.amazon.com/What-Know-Before-Seeing-Pediatrician/dp/1578266068/ref=sr_1_1?ie=UTF8&qid=1449751374&sr=8-1&keywords=what+to+know+before+seeing+your+pediatrician" target="_blank">new book</a> geared to help parents have more meaningful conversations with their pediatrician and which will hopefully save them a copay or two as well! As I reflect back on the five year journey in writing this book, I wanted to highlight the contributions of my biggest influence – my dad.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
In the summer of 1973, my father, thirty years at the time,
boarded a plane with his best friend to fly overseas for the very first time in
his life. Having recently finished
medical school and his mandatory army training in South Korea, he was headed to
the United States to begin his residency in Passaic, New Jersey. He would leave his recently espoused and
pregnant wife behind to pave the way for a better life in the land of
opportunity.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
On a layover in Tokyo, a fancy new camera caught my dad’s
eye. Japan at the time was light years ahead
of Korea in terms of technology and my father reckoned that electronics were
cheaper in Tokyo than they would be in New Jersey. He and his friend saw an easy opportunity to
arbitrage a quick profit and spent what little money they had in hopes of selling
the camera as soon as they immigrated into the States. As fate would have it, the camera was cheaper
in America – is a good deal ever to be found at the airport other than possibly
duty-free goods?<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
With even less money now but a fancy state-of-the-art camera
to chronicle his adventures, my father began working long hours and preparing
for the arrival of my mother who was ready to give birth to moi soon. The camera was an inauspicious start that
would belie the incredible blessing that the United States would be to our family.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
My parents both took huge risks (most have paid off better
than the camera) and made many sacrifices to give my brother and I a better
life. As a father of three now, although
I am much more cognizant and thankful for what they must have encountered to
establish life here in America – learning the trade of medicine in a foreign
tongue, racism, no nearby family support, and the lack of any good Korean
restaurants in Passaic (the travesty!) – I will likely never fully comprehend their
early difficulties.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
My father actually completed two separate residencies in
America. When he first arrived in the
United States, he trained as a family practice doctor and for a while after
moving to Virginia, my family enjoyed a comfortable life. But as a foreign medical school graduate, my
father was not allowed to sit for the board certification exam for family
practice and so he decided to pursue a second residency in pediatrics (who did
allow foreign graduates to sit for board certification). I will forever be grateful for his career
change!<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
We returned to New Jersey, replete with a new little brother
having been born in Virginia, and for three years the four of us lived on the
meager salary of a pediatric resident.
We lived in the bottom floor of a tiny two-bedroom duplex that had a scrumptious
bakery at the foot of the hill we lived on.
Although we were poor, my brother and I were always happy, catching
fireflies in the summertime and throwing snowballs and eating warm pumpkin
pies from the bakery during the cold winters.
After finishing his training, my parents were eager to start their
future elsewhere, so we headed south to Houston, Texas.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
My father’s first practice was on Bingle road next to a
diner that served the best chocolate ice cream shakes. I still remember the antiseptic smell that
would overpower you as Donna the nurse would walk you to the back, tempting you
to lose the said consumed shake.
There are many memories of me wailing as I received various vaccinations
and penicillin shots – a tradition that my daughter has taken to new depths of
sobbing. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
My father opened his first solo pediatric practice in 1985 at Memorial City hospital on Frostwood road in Professional Building One. My mother served as the office manager and
ran the business operations and the never-aging Masako, who still works for me
today, was one of their first new hires.
Many of my friends from church worked for my father at one time or
another, a tradition that I still carry on today.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I finished my own residency training in 2002, and after a
short mission trip to Vladivostok, Russia joined my father’s practice – a true
mom and pop organization with their newly minted pediatrician son in tow! In late 2004 my father retired to go to the
mission field in Yanbian, China, after which Dr. William Pielop and I started
Blue Fish Pediatrics which just opened its third office in Katy and hired its
thirteenth doctor this year. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Looking back at my career and life, it is easy to appreciate
the outsize influence my dad has had on me.
I love the Lord. I married a
beautiful Korean woman. I am mildly
OCD. And I love my work as a pediatrician. Lucky for me and because of the sweat equity
that both my mom and dad put into his practice, I never had to flip a camera to
get my start in medicine. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Dad, thank you for your hard work, sacrifice, and your love
for the Lord. For everything you have
done for me, I would like to dedicate my new pediatric book to you. Without you, I would never be where I am
today. <o:p></o:p></div>
<!--EndFragment-->Peter Junghttp://www.blogger.com/profile/12235011146063672219noreply@blogger.com4tag:blogger.com,1999:blog-5923231085926288168.post-78031906196622833192015-08-09T21:14:00.005-07:002022-05-04T08:42:01.602-07:00Post #42 A book review - Being Mortal: Medicine and What Matters in the End by Atul Gawande<div class="MsoNormal">
In his breathtaking book, <i>Being Mortal: Medicine and What Matters in the End</i>, Atul Gawande
(one of my favorite authors) elegantly describes three different modalities of
patient counseling that doctors employ. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The first is the oldest and most traditional approach, a paternalistic
relationship. The doctor not only has
the knowledge to guide the patient, but also possesses the experience and
wisdom to make decisions on their behalf.
</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The second type of relationship is termed "informative." Here the doctor informs you about the facts
and figures related to your medical problem, along the lines of a talking <i>Wikipedia</i> page donning a white coat, but
allows you to make your own decisions in regards to your health. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
And finally, the third type of relationship is called
"interpretive." Here the
doctor asks a series of probing questions to discover your priorities and assists you in navigating the medical maze to achieve your goal. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Methodically, Gawande utilizes a small gamut of actual patients
he has encountered in real life, including his own father, and through their life
stories he takes the reader step by step in his maturation process as he
evolves from a mixture of initially employing the first two approaches -
leaning heavily towards the informative style - to an actualization of becoming
an "interpretive" doctor.</div>
<div class="MsoNormal">
</div>
<div class="MsoNormal">
At times, along the way, Gawande has to remind himself of
what he has learned from palliative experts and even Daniel Kahneman's research
on kidney stones and colonoscopies (another favorite of mine! - the author not
the procedure), to stay true to his new "interpretive" approach,
which over time he recognizes as being a clear cut above the other two
modalities. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
His most moving example is his own father, who is diagnosed with
a spinal tumor and begins losing first
his grip in tennis and later his grip over day to day activities. His father, also a physician (as is his
mother - slacker family the Gawandes), seeks the counsel of two neurosurgeons,
both of whom have excellent pedigrees and reputations. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The first doctor goes into information overdrive overwhelming
both Atul and his father, and despite being doctors themselves, they struggle
with the tsunami of facts and statistics which leaves them feeling rudderless
with no sense of direction; the neurosurgeon himself advocates operating right away.</div>
<div class="MsoNormal">
</div>
<div class="MsoNormal">
The second doctor, takes the time to listen to the father's
desires and goals in life, especially his optimal endgame, and helps the family
to formulate a plan which will maximize his ability to achieve what is most
important to him at that given moment in time.
The interpretive doctor exemplified.
</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Rather than jumping at surgery which could lead to further
complications - together, the neurosurgeon and the Gawandes arrive at the
decision to wait on surgery, which although promises some relief of pain and
restoration of function, also carries with it the risk of leaving the elder
Gawande a quadriplegic. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Although one of his hands is slowly becoming numb, in his limited time
following the initial consultation during which he decides to forgo surgery, Gawande's
father throws himself into his role as newly elected Rotary district governor and
precedes to follow through on a goal to speak at the meeting of each of his
district's fifty-nine clubs, not just once but twice to each group. (If the Gawandes make you feel insufficient,
join the club.)</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Over time, the tumor takes its toll and several years after
the initial diagnosis, and several important life goals later, Gawande's father
finally decides to submit to surgery.
The surgery goes well, but in 20/20 reflective hindsight, it becomes
clear that had they followed the advice of the first surgeon, the scalpel would
have been utilized several years prematurely and the hand of unnecessary risk
would have been forced sooner than required.
</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Even in pediatrics, although on a much less dire scale, I
personally see how the interpretive doctor modality is superior to simply being
informative or paternalistic. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Although, I understand the natural history of an ear
infection, and how 80% of ear infections in children over two years of age will
improve without antibiotics, albeit with a slightly longer course of pain; I
don't know the family's schedule (unless I ask). </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Perhaps there is an important wedding they need to fly to
over the weekend or maybe the family has a vacation coming up that has been in
the works for several months. While
these are not life or death situations, I can fully appreciate the importance
of preserving the quality time of a much needed break for the family,
especially if it is a once-in-a-lifetime trip to Disney World that has
received an immense amount of planning and a considerable portion of the family
budget.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
This would certainly push me to recommend antibiotics over
watchful waiting. Certainly, we should
be judicious about antibiotic use when at all possible, but how can one weigh
the risk of a 10 day course of amoxicillin and its small contribution to the
scourge of antibiotic resistant bacteria vs. the preservation of a once-in-a-lifetime
trip to Disney World. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
It is impossible to weigh in terms of any sort of risk
assessment or even epidemiological probabilities. Even my nerdy Pi-loving math professor
brother would struggle with this.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
And that is precisely the point. I can't quantify the decision by myself,
but by understanding the family's immediate goal and knowing the studies and
treatment options for an ear infection, I can <b><i>help</i></b> a mom and dad to
decide what is best for their family in the given situation.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
These are ideas that have been floating around in my head
for a while and as he so often does, Gawande's timely prose has helped sharpen thoughts that needed some coaching and fine-tuning. </div>
<div class="MsoNormal">
<i><br /></i></div>
<div class="MsoNormal">
<i>Being Mortal</i> is well worth reading for anyone who has grappled not
just with medical decision making but is interested in a strategy for
approaching the end of one's life and maximizing their personal goals with the
assistance of the modern medical community who has hopefully read this
insightful book.</div>
Peter Junghttp://www.blogger.com/profile/12235011146063672219noreply@blogger.com0tag:blogger.com,1999:blog-5923231085926288168.post-658317594688925922014-12-05T07:52:00.002-08:002014-12-05T07:52:58.607-08:00Post #41 Update on the 2014-15 Flu Vaccine<span style="-webkit-text-stroke-width: 0px; background-color: white; color: #141823; display: inline !important; float: none; font-family: Helvetica, Arial, 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 14px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19.3199996948242px; orphans: auto; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">The main circulating flu this year is a recently mutated H3N2 strain (91% in one sample). Because of this new mutation, the vaccine currently used is not a great match for this particular strain. </span><br />
<br />
<span style="-webkit-text-stroke-width: 0px; background-color: white; color: #141823; display: inline !important; float: none; font-family: Helvetica, Arial, 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 14px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19.3199996948242px; orphans: auto; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">In my medical opinion, this paradoxically makes it even MORE IMPORTANT to get the flu vaccine. Mainly, because the worse protection the flu vaccine offers, the more widespread the flu will be this year, and this increases the likelihood that a large percentage of people, both immunized and unimmunized, will contract the flu. However, those who are unimmunized will be at an even greater risk of catching the flu. </span><br />
<br />
<span style="-webkit-text-stroke-width: 0px; background-color: white; color: #141823; display: inline !important; float: none; font-family: Helvetica, Arial, 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 14px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19.3199996948242px; orphans: auto; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">Essentially, there is less herd protection this year and everyone is going to get exposed. And while the flu vaccine is not a great match it still offers some protection against the new H3N2 strain, and since it is highly likely that almost everyone is going to get exposed to the flu, some protection is better than no protection. Also, the flu vaccine protects against the 9% of other strains circulating. </span><br />
<br />
<span style="-webkit-text-stroke-width: 0px; background-color: white; color: #141823; display: inline !important; float: none; font-family: Helvetica, Arial, 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 14px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19.3199996948242px; orphans: auto; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">Sadly, 5 kids have already died this year from flu-related illnesses and the flu season is just beginning.</span><br />
<br />
<span style="-webkit-text-stroke-width: 0px; background-color: white; color: #141823; display: inline !important; float: none; font-family: Helvetica, Arial, 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 14px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19.3199996948242px; orphans: auto; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><a href="http://www.nytimes.com/2014/12/05/health/cdc-warns-that-flu-season-may-be-more-deadly-than-usual.html?_r=0" target="_blank">Deadlier Flu Season Is Possible, C.D.C. Says</a></span>Peter Junghttp://www.blogger.com/profile/12235011146063672219noreply@blogger.com0tag:blogger.com,1999:blog-5923231085926288168.post-33204570551219994232013-08-17T12:26:00.001-07:002013-08-28T09:32:46.866-07:00Post #40 Flu Vaccine Update 2013-2014 (Quadrivalent vs Trivalent)<b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; mso-fareast-font-family: "Times New Roman";">How is the flu vaccine formulated?</span></b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span><br />
<br />
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 12pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 14pt; mso-fareast-font-family: "Times New Roman";">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. <o:p></o:p></span></div>
<span style="font-family: "Times New Roman","serif"; font-size: 14pt; mso-fareast-font-family: "Times New Roman";">The 2013-14 U.S. trivalent influenza
vaccines will contain: <o:p></o:p></span><br />
<span style="font-family: "Times New Roman","serif"; font-size: 14pt; mso-fareast-font-family: "Times New Roman";"><br />
*an A/California/7/2009 (H1N1)pdm09-like virus <br />
*an A/Victoria/361/2011 (H3N2)-like virus <br />
*a B/Massachusetts/2/2012-like virus<o:p></o:p></span><br />
<br />
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 14pt; mso-fareast-font-family: "Times New Roman";"><o:p>T</o:p></span><span style="font-family: "Times New Roman","serif"; font-size: 14pt; mso-fareast-font-family: "Times New Roman";">he newer quadrivalent vaccines will
include an additional vaccine virus:<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 14pt; mso-fareast-font-family: "Times New Roman";">*a B/Brisbane/60/2008-like virus<br /><br />
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. <o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 14pt; mso-fareast-font-family: "Times New Roman";"><o:p> </o:p></span><span style="font-family: "Times New Roman","serif"; font-size: 14pt; mso-fareast-font-family: "Times New Roman";"><br />
<b>When to get vaccinated?</b><o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 7.7pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 14pt; mso-fareast-font-family: "Times New Roman";">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. <o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 7.7pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 14pt; mso-fareast-font-family: "Times New Roman";">In our area, a local pediatrician friend has already
reported 2 cases of flu "A" seen in siblings this past week at their
office.<span style="mso-spacerun: yes;"> </span>A rapid flu test was used,
however at this time no further confirmation is available.<span style="mso-spacerun: yes;"> </span>If confirmed, this may point towards an early
and long flu season.<br />
<br />
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. <br />
<br />
<br />
<b>How many shots will my child need?</b></span></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 7.7pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 14pt; mso-fareast-font-family: "Times New Roman";">This year's seasonal flu vaccine will again include the Novel 2009 H1N1 vaccine<b>
</b>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 <b>ONE TYPE </b>of flu immunization this year. <br />
<br />
If your child is <b>9 years or older</b>, regardless of what flu immunizations
have been given in the past, they will only need <b>ONE </b>immunization this
flu season. <br />
<br />
However, if your child is <b>under 9 years of age</b>, they may need <b>TWO </b>immunizations
this year. See the chart below to assist you in knowing how many shots your
child will need this flu season. <br />
<br />
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.</span></div>
<br />
<table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: currentColor; mso-border-alt: solid windowtext .5pt; mso-padding-alt: 0in 5.4pt 0in 5.4pt; mso-yfti-tbllook: 1184;">
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<tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;">
<td style="background-color: transparent; border: 1pt solid windowtext; mso-border-alt: solid windowtext .5pt; padding: 0in 5.4pt; width: 119.7pt;" valign="top" width="160"><div class="Default" style="margin: 0in 0in 0pt;">
</div>
</td>
<td style="background-color: transparent; border-color: windowtext windowtext windowtext rgb(0, 0, 0); border-style: solid solid solid none; border-width: 1pt 1pt 1pt 0px; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0in 5.4pt; width: 119.7pt;" valign="top" width="160"><div class="Default" style="margin: 0in 0in 0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 14pt; mso-fareast-font-family: "Times New Roman";">0 flu shots since July 2010<o:p></o:p></span></b></div>
</td>
<td style="background-color: transparent; border-color: windowtext windowtext windowtext rgb(0, 0, 0); border-style: solid solid solid none; border-width: 1pt 1pt 1pt 0px; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0in 5.4pt; width: 119.7pt;" valign="top" width="160"><div class="Default" style="margin: 0in 0in 0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 14pt; mso-fareast-font-family: "Times New Roman";">1 flu shot since July 2010<o:p></o:p></span></b></div>
</td>
<td style="background-color: transparent; border-color: windowtext windowtext windowtext rgb(0, 0, 0); border-style: solid solid solid none; border-width: 1pt 1pt 1pt 0px; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0in 5.4pt; width: 119.7pt;" valign="top" width="160"><div class="Default" style="margin: 0in 0in 0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 14pt; mso-fareast-font-family: "Times New Roman";">2 flu shots since July 2010<o:p></o:p></span></b></div>
</td>
</tr>
<tr style="mso-yfti-irow: 1;">
<td style="background-color: transparent; border-color: rgb(0, 0, 0) windowtext windowtext; border-style: none solid solid; border-width: 0px 1pt 1pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt; width: 119.7pt;" valign="top" width="160"><div class="Default" style="margin: 0in 0in 0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 14pt; mso-fareast-font-family: "Times New Roman";">Under 9 years of age<o:p></o:p></span></b></div>
</td>
<td style="background-color: transparent; border-color: rgb(0, 0, 0) windowtext windowtext rgb(0, 0, 0); border-style: none solid solid none; border-width: 0px 1pt 1pt 0px; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt; width: 119.7pt;" valign="top" width="160"><div class="Default" style="margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 14pt; mso-fareast-font-family: "Times New Roman";">2 flu shots needed<o:p></o:p></span></div>
</td>
<td style="background-color: transparent; border-color: rgb(0, 0, 0) windowtext windowtext rgb(0, 0, 0); border-style: none solid solid none; border-width: 0px 1pt 1pt 0px; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt; width: 119.7pt;" valign="top" width="160"><div class="Default" style="margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 14pt; mso-fareast-font-family: "Times New Roman";">2 flu shots needed<o:p></o:p></span></div>
</td>
<td style="background-color: transparent; border-color: rgb(0, 0, 0) windowtext windowtext rgb(0, 0, 0); border-style: none solid solid none; border-width: 0px 1pt 1pt 0px; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt; width: 119.7pt;" valign="top" width="160"><div class="Default" style="margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 14pt; mso-fareast-font-family: "Times New Roman";">1 flu shot needed<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 2; mso-yfti-lastrow: yes;">
<td style="background-color: transparent; border-color: rgb(0, 0, 0) windowtext windowtext; border-style: none solid solid; border-width: 0px 1pt 1pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt; width: 119.7pt;" valign="top" width="160"><div class="Default" style="margin: 0in 0in 0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 14pt; mso-fareast-font-family: "Times New Roman";">9 years of age of older<o:p></o:p></span></b></div>
</td>
<td style="background-color: transparent; border-color: rgb(0, 0, 0) windowtext windowtext rgb(0, 0, 0); border-style: none solid solid none; border-width: 0px 1pt 1pt 0px; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt; width: 119.7pt;" valign="top" width="160"><div class="Default" style="margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 14pt; mso-fareast-font-family: "Times New Roman";">1 flu shot needed<o:p></o:p></span></div>
</td>
<td style="background-color: transparent; border-color: rgb(0, 0, 0) windowtext windowtext rgb(0, 0, 0); border-style: none solid solid none; border-width: 0px 1pt 1pt 0px; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt; width: 119.7pt;" valign="top" width="160"><div class="Default" style="margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 14pt; mso-fareast-font-family: "Times New Roman";">1 flu shot needed <o:p></o:p></span></div>
</td>
<td style="background-color: transparent; border-color: rgb(0, 0, 0) windowtext windowtext rgb(0, 0, 0); border-style: none solid solid none; border-width: 0px 1pt 1pt 0px; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt; width: 119.7pt;" valign="top" width="160"><div class="Default" style="margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 14pt; mso-fareast-font-family: "Times New Roman";">1 flu shot needed<o:p></o:p></span></div>
</td>
</tr>
</tbody></table>
<br />
<div class="Default" style="margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 14pt; mso-fareast-font-family: "Times New Roman";">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.<br />
</span><span style="font-family: "Times New Roman","serif"; font-size: 14pt; mso-fareast-font-family: "Times New Roman";"><br />
</span></div>
<div class="Default" style="margin: 0in 0in 0pt;">
<br />
<span style="font-family: "Times New Roman","serif"; font-size: 14pt; mso-fareast-font-family: "Times New Roman";"><b>Quadrivalent vs. Trivalent flu vaccine </b></span></div>
<span style="font-family: "Times New Roman","serif"; font-size: 14pt; mso-fareast-font-family: "Times New Roman";">
</span><span style="font-family: "Times New Roman","serif"; font-size: 14pt; mso-fareast-font-family: "Times New Roman";"><br />
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 <span style="mso-spacerun: yes;"> </span>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.<br />
<br />
</span><span style="font-family: "Times New Roman","serif"; font-size: 14pt;">This
means that both the trivalent flu vaccine and the quadrivalent flu vaccine will
be available this year.<span style="mso-spacerun: yes;"> </span>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).<o:p></o:p></span><br />
<br />
<div class="Default" style="margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 14pt;">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.<o:p></o:p></span></div>
<br />
<div class="Default" style="margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 14pt;">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).<span style="mso-spacerun: yes;">
</span>The quadrivalent nasal vaccines are shipping now.<span style="mso-spacerun: yes;"> </span>Unfortunately, children under 2 years of age and
those with asthma (and a few other scenarios - please see <a href="http://www.cdc.gov/flu/professionals/acip/2013-summary-recommendations.htm#table2" target="_blank">CDC website</a>) cannot receive
the nasal vaccine and must receive the injection vaccine.<o:p></o:p></span></div>
<br />
<div class="Default" style="margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 14pt;">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.<span style="mso-spacerun: yes;"> </span>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.<o:p></o:p></span></div>
<br />
<div class="Default" style="margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 14pt;">In
the event that a child will need two flu vaccines this year, it is ideal to get
as many quadrivalent doses as possible.<span style="mso-spacerun: yes;">
</span>The most ideal would be to receive both flu immunizations with the quadrivalent
vaccine.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<br />
<div class="Default" style="margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 14pt;">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.<o:p></o:p></span></div>
<br />
<div class="Default" style="margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 14pt;">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.<o:p></o:p></span></div>
<br />
<div class="Default" style="margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 14pt;"><o:p>P</o:p></span><span style="font-family: "Times New Roman","serif"; font-size: 14pt;">arents
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.)<span style="mso-spacerun: yes;"> </span>For ideal protection, a
booster of the same strand should be given as soon as possible.<o:p></o:p></span></div>
<br />
<div class="Default" style="margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 14pt;">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.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<br />
<div class="Default" style="margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 14pt;">In the preceding scenario, the
2nd "B" Brisbane strand (which is only included in the quadrivalent
vaccine) would only be received once.<span style="mso-spacerun: yes;"> </span>Thus, there would be good protection against 3
strands<span style="mso-spacerun: yes;"> </span>of flu and only marginal protection
against the quadrivalent-only strand of Brisbane "B" <span style="mso-spacerun: yes;"> </span>flu.<o:p></o:p></span></div>
<br />
<div class="Default" style="margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 14pt;">In
the end, practically speaking, timing is probably more important than worrying
about quadrivalent vs. trivalent flu vaccine.<span style="mso-spacerun: yes;">
</span>When possible the quadrivalent should be received, but when the
quadrivalent is unavailable it is probably best to move forward with the
trivalent vaccine. <span style="mso-spacerun: yes;"> </span>The faster the flu
season infects children, the more important timing becomes.<o:p></o:p></span></div>
<br />
<div class="Default" style="margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 14pt;"><o:p></o:p></span><span style="font-family: "Times New Roman","serif"; font-size: 14pt;">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.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<br />
<div class="Default" style="margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 14pt;">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).<span style="mso-spacerun: yes;"> </span>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.<o:p></o:p></span></div>
<br />
<div class="Default" style="margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 14pt;">As
the author of this blog, I am unsure about the safety of receiving 3 or 4 flu
shots in a single season.<span style="mso-spacerun: yes;"> </span>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.<span style="mso-spacerun: yes;">
</span><o:p></o:p></span></div>
<br />
<div class="Default" style="margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 14pt;">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.<span style="mso-spacerun: yes;"> </span>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.<o:p></o:p></span></div>
<br />
<div class="Default" style="margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 14pt;">At
our office, the quadrivalent vaccine will be preferentially given, when in
stock, unless otherwise requested by the parent.<o:p></o:p></span></div>
<br />
<div class="Default" style="margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 14pt;"><o:p></o:p></span><br /></div>
<div class="Default" style="margin: 0in 0in 0pt;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 14pt;">Flu
Vaccine Egg Allergy Protocol (per CDC) </span></b></div>
<span style="color: windowtext; font-family: "Times New Roman","serif"; font-size: 14pt;"></span><br />
<span style="color: windowtext; font-family: "Times New Roman","serif"; font-size: 14pt;">1. Can the child eat lightly cooked egg (e.g., scrambled egg)
without reaction? </span><br />
<div class="Default" style="margin: 0in 0in 0pt;">
<b><span style="color: windowtext; font-family: "Times New Roman","serif"; font-size: 14pt;">If so, the vaccine should be administered per usual protocol <o:p></o:p></span></b></div>
<br />
<div class="Default" style="margin: 0in 0in 0pt;">
<span style="color: windowtext; font-family: "Times New Roman","serif"; font-size: 14pt;">2. After eating eggs or egg-containing foods, does the child
experience ONLY hives? </span></div>
<div class="Default" style="margin: 0in 0in 0pt;">
<b><span style="color: windowtext; font-family: "Times New Roman","serif"; font-size: 14pt;">If so, the vaccine should be administered and the child will be
observed for reaction for at least 30 minutes following vaccination <o:p></o:p></span></b></div>
<br />
<div class="Default" style="margin: 0in 0in 0pt;">
<span style="color: windowtext; font-family: "Times New Roman","serif"; font-size: 14pt;">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? </span></div>
<div class="Default" style="margin: 0in 0in 0pt;">
<b><span style="color: windowtext; font-family: "Times New Roman","serif"; font-size: 14pt;">If so, the child shoud be referred to an allergist with
expertise in the management of allergic conditions for further evaluation.<o:p></o:p></span></b></div>
<br />
<br />
<div class="Default" style="margin: 0in 0in 0pt;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 14pt;">When
will the vaccines be available at Blue Fish Pediatrics Memorial? </span></b><span style="font-family: "Times New Roman","serif"; font-size: 14pt;"><o:p></o:p></span></div>
<br />
<div class="Default" style="margin: 0in 0in 0pt;">
<span style="color: windowtext; font-family: "Times New Roman","serif"; font-size: 14pt;"><o:p>At Blue Fish Pediatrics Memorial, during regular office hours (starting August 19, 2013), the flu vaccine will only be available at well visits for <b>all patients of Blue Fish Pediatrics Memorial and family members living in the same household with patients under 6 months of age. </b> Flu vaccine will also be administered during sick visits at their doctor's recommendation.</o:p></span></div>
<br />
<div class="Default" style="margin: 0in 0in 0pt;">
<span style="color: windowtext; font-family: "Times New Roman","serif"; font-size: 14pt;">The flu vaccine will be administered at all well child visits
until supplies are exhausted (no additional appointment or phone call is
required). </span></div>
<br />
<div class="Default" style="margin: 0in 0in 0pt;">
<span style="color: windowtext; font-family: "Times New Roman","serif"; font-size: 14pt;">To help accommodate our busy families, we have designated <b>four
Saturdays </b>for flu shots (the clinic will still be open on these Saturdays
for sick patients). </span></div>
<br />
<div class="Default" style="margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 14pt;">Because
of the high volume, these flu clinics are for <b>BLUE FISH MEMORIAL PATIENTS
ONLY</b>. Weekday vaccine appointments will be made for Cypress patients who arrive
at these flu clinics. For more information, please see the CYPRESS flu
newsletter.<o:p></o:p></span></div>
<br />
<div class="Default" style="margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 14pt;">The
dates of the Saturday Blue Fish Pediatrics Memorial flu clinics: </span></div>
<br />
<div class="Default" style="margin: 0in 0in 0pt;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 14pt;">Saturday
<span style="mso-tab-count: 1;"> </span>Sept 14, 2013<span style="mso-tab-count: 1;"> </span> 8:00 AM—1:00 PM </span></b></div>
<div class="Default" style="margin: 0in 0in 0pt;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 14pt;">Saturday
<span style="mso-tab-count: 1;"> </span>Sept 28, 2013<span style="mso-tab-count: 1;"> </span> 8:00 AM—1:00 PM </span></b></div>
<div class="Default" style="margin: 0in 0in 0pt;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 14pt;">Saturday
<span style="mso-tab-count: 1;"> </span>Oct 12, 2013 <span style="mso-tab-count: 1;"> </span><span style="mso-spacerun: yes;"> </span>8:00
AM—1:00 PM </span></b></div>
<div class="Default" style="margin: 0in 0in 0pt;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 14pt;">Saturday
<span style="mso-tab-count: 1;"> </span>Oct 26, 2013 <span style="mso-tab-count: 1;"> </span><span style="mso-spacerun: yes;"> </span>8:00
AM—1:00 PM </span></b><span style="font-family: "Times New Roman","serif"; font-size: 14pt;"><o:p></o:p></span></div>
<br />
<div class="Default" style="margin: 0in 0in 0pt;">
<span style="color: windowtext; font-family: "Times New Roman","serif"; font-size: 14pt;">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.</span></div>
<br />
<div class="Default" style="margin: 0in 0in 2.2pt 0.5in; mso-list: l0 level1 lfo1; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="color: windowtext; font-family: Symbol; font-size: 14pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="color: windowtext; font-family: "Times New Roman","serif"; font-size: 14pt;">The availability of certain flu products may be limited
towards the end of the flu season. </span></div>
<div class="Default" style="margin: 0in 0in 2.2pt 0.5in; mso-list: l0 level1 lfo1; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="color: windowtext; font-family: Symbol; font-size: 14pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="color: windowtext; font-family: "Times New Roman","serif"; font-size: 14pt;">The intradermal flu vaccine will NOT be available at Blue
Fish. </span></div>
<div class="Default" style="margin: 0in 0in 2.2pt 0.5in; mso-list: l0 level1 lfo1; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="color: windowtext; font-family: Symbol; font-size: 14pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="color: windowtext; font-family: "Times New Roman","serif"; font-size: 14pt;">The recombinant flu vaccine will NOT be available at Blue
Fish. <o:p></o:p></span></div>
Peter Junghttp://www.blogger.com/profile/12235011146063672219noreply@blogger.com7tag:blogger.com,1999:blog-5923231085926288168.post-30456501616337070762013-07-13T11:07:00.003-07:002013-07-13T21:20:52.117-07:00Post #39 Vomiting and Diarrhea (Gastroenteritis) in Children: A Practical Guide<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">It
certainly looks, sounds and smells awful, but vomiting and diarrhea are rarely dangerous.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">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. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">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.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">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.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">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.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">No matter
how copious the diarrhea, in developed countries it rarely leads to dehydration
because it's easy to replenish lost fluids.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">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.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">While
viral gastroenteritis can present with many symptoms, including headache,
fever, decreased appetite, abdominal cramps and muscle aches, diarrhea and
vomiting dominate. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<u><span style="font-family: "Cambria","serif"; font-size: 12.0pt;">What to
expect<o:p></o:p></span></u></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">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.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">Illness
usually begins 12 hours to four days after exposure and lasts for three to
seven days.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">Viral
gastroenteritis peaks in the winter; that's when 70 to 90 percent of cases are
seen in the hospital.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<u><span style="font-family: "Cambria","serif"; font-size: 12.0pt;">Rotavirus
Vaccine<o:p></o:p></span></u></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">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.<span style="color: red;"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">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.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">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.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">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.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<u><span style="font-family: "Cambria","serif"; font-size: 12.0pt;">Non-viral
causes of gastroenteritis<o:p></o:p></span></u></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">A small
percentage of gastroenteritis infections are caused by bacteria, the biggest
sign of which is bloody diarrhea. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">Yet blood
does not necessarily mean bacterial gastroenteritis. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">With viral
gastroenteritis, the skin of the anus or the lining of the intestine can become
irritated and cause small amounts of bleeding.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">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.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">Bacterial
gastroenteritis infections can become quite severe and require close
monitoring, possibly in the hospital, and sometimes will benefit from
antibiotic therapy. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">Another
cause of gastroenteritis, although infrequent, is parasites.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">The most
commonly seen parasitic cause of diarrhea and vomiting<span style="color: red;"> </span>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.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">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.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<u><span style="font-family: "Cambria","serif"; font-size: 12.0pt;">Dangers
of dehydration<o:p></o:p></span></u></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">Although
vomiting and diarrhea can be exhausting for a parent, vomiting and diarrhea in
and of themselves are not dangerous to a child.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">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. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">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. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">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.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">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.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">Parents
might want to opt for colorless rehydration products. Anything red or purple
masks more serious symptoms, such as blood in vomit or stool.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">Test the
waters before allowing your child to drink freely by following this simple
plan:<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<ol start="1" style="margin-top: 0in;" type="1">
<li class="MsoNormal" style="margin-bottom: 0.0001pt;"><span style="font-family: "Cambria","serif"; font-size: 12.0pt;">To allow stomach
muscles to recuperate, do not give fluids for 30 minutes after vomiting.<o:p></o:p></span></li>
<li class="MsoNormal" style="margin-bottom: 0.0001pt;"><span style="font-family: "Cambria","serif"; font-size: 12.0pt;">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.<o:p></o:p></span></li>
<li class="MsoNormal" style="margin-bottom: 0.0001pt;"><span style="font-family: "Cambria","serif"; font-size: 12.0pt;">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.<o:p></o:p></span></li>
<li class="MsoNormal" style="margin-bottom: 0.0001pt;"><span style="font-family: "Cambria","serif"; font-size: 12.0pt;">If at any time they
vomit again, repeat the above cycle, starting from the beginning.<o:p></o:p></span></li>
<li class="MsoNormal" style="margin-bottom: 0.0001pt;"><span style="font-family: "Cambria","serif"; font-size: 12.0pt;">Advance quantity
slowly as your child demonstrates tolerance to fluids.<o:p></o:p></span></li>
</ol>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">If your
child fails this cycle more than two times, call the pediatrician.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<u><span style="font-family: "Cambria","serif"; font-size: 12.0pt;">Road to
recovery<o:p></o:p></span></u></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">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. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">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. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">As a
result of the muscles being tired, food cannot progress naturally through the
digestive system, so the body sends it back up again.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">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.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<u><span style="font-family: "Cambria","serif"; font-size: 12.0pt;">Refeeding
advice<o:p></o:p></span></u></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">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.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">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 <a href="http://www.bluefishmd.com/vomiting-and-diarrhea-gastroenteritis/">website.</a><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<u><span style="font-family: "Cambria","serif"; font-size: 12.0pt;">Lactose
Intolerance<o:p></o:p></span></u></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">After a
bout of gastroenteritis, some kids will experience temporary lactose
intolerance.<u><o:p></o:p></u></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">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.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">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.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<u><span style="font-family: "Cambria","serif"; font-size: 12.0pt;">Diaper
Rash<o:p></o:p></span></u></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">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. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">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.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">To prevent
diaper rash:<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<ol start="1" style="margin-top: 0in;" type="1">
<li class="MsoNormal" style="margin-bottom: 0.0001pt;"><span style="font-family: "Cambria","serif"; font-size: 12.0pt;">Clean the bottom with a soft cloth and use gentle strokes
to prevent further abrasion. <o:p></o:p></span></li>
<li class="MsoNormal" style="margin-bottom: 0.0001pt;"><span style="font-family: "Cambria","serif"; font-size: 12.0pt;">Allow for adequate air-drying of the skin. If pressed for time use a blow dryer on
cool setting to dry the skin.<o:p></o:p></span></li>
<li class="MsoNormal" style="margin-bottom: 0.0001pt;"><span style="font-family: "Cambria","serif"; font-size: 12.0pt;">After air-drying, apply a thick coating of a barrier
cream such as Desitin, Vaseline, Vitamin A&D, etc.<o:p></o:p></span></li>
<li class="MsoNormal" style="margin-bottom: 0.0001pt;"><span style="font-family: "Cambria","serif"; font-size: 12.0pt;">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.<o:p></o:p></span></li>
</ol>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">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.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<u><span style="font-family: "Cambria","serif"; font-size: 12.0pt;">Medications<o:p></o:p></span></u></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">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.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 12.0pt; mso-margin-bottom-alt: auto;">
<b><span style="font-family: "Cambria","serif"; font-size: 12.0pt; mso-ascii-theme-font: major-latin; mso-bidi-font-family: Helvetica; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-latin;">Children 1-2yrs:</span></b><span style="font-family: "Cambria","serif"; font-size: 12.0pt; mso-ascii-theme-font: major-latin; mso-bidi-font-family: Helvetica; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-latin;"> 1/2 teaspoon, four times a day. Do
not take more than 2 teaspoons in a 24 hour period.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 12.0pt; mso-margin-bottom-alt: auto;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt; mso-ascii-theme-font: major-latin; mso-bidi-font-family: Helvetica; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-latin;"><br /></span></div>
<div class="MsoNormal" style="line-height: 12.0pt; mso-margin-bottom-alt: auto;">
<b><span style="font-family: "Cambria","serif"; font-size: 12.0pt; mso-ascii-theme-font: major-latin; mso-bidi-font-family: Helvetica; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-latin;">Children 2-6yrs:</span></b><span style="font-family: "Cambria","serif"; font-size: 12.0pt; mso-ascii-theme-font: major-latin; mso-bidi-font-family: Helvetica; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-latin;"> 1 teaspoon, four times a day. Do
not take more than 4 teaspoons in a 24 hour period.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 12.0pt; margin-top: 12.0pt; mso-margin-bottom-alt: auto;">
<b><span style="font-family: "Cambria","serif"; font-size: 12.0pt; mso-ascii-theme-font: major-latin; mso-bidi-font-family: Helvetica; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-latin;">Children
>6yrs:</span></b><span style="font-family: "Cambria","serif"; font-size: 12.0pt; mso-ascii-theme-font: major-latin; mso-bidi-font-family: Helvetica; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-latin;"> 2 teaspoons,
four times a day. Do not take more than 8 teaspoons in a 24 hour period.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 12.0pt; margin-top: 12.0pt; mso-margin-bottom-alt: auto;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">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.</span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; mso-ascii-theme-font: major-latin; mso-bidi-font-family: Helvetica; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-latin;"><o:p></o:p></span><br />
<span style="font-family: "Cambria","serif"; font-size: 12.0pt; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"><br /></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">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. </span><br />
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;"><br /></span>
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">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.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">Antidiarrheal
medications are almost never recommended.
If something bad is inside your intestines, it is best to let it come
out. <o:p></o:p></span><br />
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;"><br /></span>
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">Antibiotics are never needed for viral infections. Even for the rarer bacterial causes of gastroenteritis, antibiotics are controversial.</span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">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.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<b><span style="font-family: "Cambria","serif"; font-size: 14.0pt;">FAQs:<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<b><span style="font-family: "Cambria","serif"; font-size: 12.0pt;">How do I know if it's a virus or something
different such as food poisoning?<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">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.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<b><span style="font-family: "Cambria","serif"; font-size: 12.0pt;">Should I worry if I see blood in my child's
vomit or stool?<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">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.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<b><span style="font-family: "Cambria","serif"; font-size: 12.0pt;">Should vomiting or diarrhea hurt so much? My
child often cries out in pain.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">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.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<b><span style="font-family: "Cambria","serif"; font-size: 12.0pt;">Can I treat symptoms with OTC medications?<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">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.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<b><span style="font-family: "Cambria","serif"; font-size: 12.0pt;">What if my child is desperately thirsty and
asking for a drink soon after vomiting?<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt;">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.</span></div>
Peter Junghttp://www.blogger.com/profile/12235011146063672219noreply@blogger.com6tag:blogger.com,1999:blog-5923231085926288168.post-16822918533213669752013-05-15T08:13:00.001-07:002013-05-15T08:39:44.828-07:00Post #38 The Common Cold<div class="MsoNormal">
<br />
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: Calibri;">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.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: Calibri;">Back in the 16th century, folks dubbed it a
"cold" because symptoms seemed to pop up in conjunction with exposure
to cold weather.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: Calibri;">Today, science has identified more than 200
different types of cold viruses that are specific to humans.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: Calibri;">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.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: Calibri;">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.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: Calibri;">Unfortunately cough and cold medications do
not work.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: Calibri;">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.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: Calibri;">More concerning is the fact that cough and
cold medications can actually cause dangerous side effects in children, even to
the point of death. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: Calibri;">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.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: Calibri;">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."<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: Calibri;">Why don't they work? The answer is Mother
Nature.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: Calibri;">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.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: Calibri;">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.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: Calibri;">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.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: Calibri;">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.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: Calibri;">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.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: Calibri;">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.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: Calibri;">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.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: Calibri;">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.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: Calibri;">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.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: Calibri;">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.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: Calibri;">Congestion is usually the worst from day two
to six of the illness.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: Calibri;">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. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: Calibri;">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.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: Calibri;">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.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: Calibri;">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.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: Calibri;"><b>FAQs</b><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: Calibri;"><b>Is it possible to avoid getting a cold? If so,
how?</b><o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: Calibri;">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.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: Calibri;"><b>When do I need to see the doctor?</b><o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: Calibri;">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.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: Calibri;"><b>What else can I do to treat the cold?</b><o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: Calibri;">Unfortunately, other than time nothing works
great. A few things that are safe and
might help.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: Calibri;">1.
Sleeping with the head propped higher than the body can allow gravity to
help drain unwanted mucus away.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: Calibri;">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.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: Calibri;">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.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: Calibri;">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.</span></div>
</div>
<div class="MsoNormal">
<br /></div>
Peter Junghttp://www.blogger.com/profile/12235011146063672219noreply@blogger.com1tag:blogger.com,1999:blog-5923231085926288168.post-51904357733030057582013-02-16T04:23:00.001-08:002013-02-16T05:00:27.332-08:00Post #37 Asthma: A Pedi Perspective - Part 5 of 5<!--[if gte mso 9]><xml>
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</xml><![endif]--><span style="font-family: inherit;"><span style="font-size: small;"><u><b>Frequently Asked Questions:</b></u></span></span><br />
<span style="font-family: inherit;"><span style="font-size: small;"><br />
<b> I have asthma. Does this mean my child
will have it too?</b></span></span><br />
<div class="MsoNormal">
<span style="font-family: inherit;"><span style="font-size: small;">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. </span></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;"><span style="font-size: small;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;"><span style="font-size: small;"><b>Why does asthma seem to come and go?</b></span></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;"><span style="font-size: small;">Asthma is
inflammatory in nature, and there are certain things (triggers) that can cause
a flare up. </span></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;"><span style="font-size: small;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;"><span style="font-size: small;"><b>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? </b></span></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;"><span style="font-size: small;">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.</span></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;"><span style="font-size: small;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;"><span style="font-size: small;"><b>Will my child outgrow asthma?</b></span></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;"><span style="font-size: small;">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. </span></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;"><span style="font-size: small;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;"><span style="font-size: small;"><b>Can food allergies cause asthma?</b></span></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;"><span style="font-size: small;">While asthma is
more common in children with food allergies, the presence of food allergies do
not guarantee a child will have asthma. </span></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;"><span style="font-size: small;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;"><span style="font-size: small;"><b>Can the use of asthma medications prevent
remodeling changes in the lungs?</b></span></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;"><span style="font-size: small;">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.</span></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;"><span style="font-size: small;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;"><span style="font-size: small;"><b>What is the difference between Albuterol
and Xopenex?</b></span></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;"><span style="font-size: small;">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.</span></span></div>
Peter Junghttp://www.blogger.com/profile/12235011146063672219noreply@blogger.com0tag:blogger.com,1999:blog-5923231085926288168.post-7012072161316948452013-02-16T04:23:00.000-08:002013-02-16T04:56:39.554-08:00Post #36 Asthma: A Pedi Perspective - Part 4 of 5<span style="font-size: small;"><span style="font-family: inherit;"><b><u>Conundrum of cause</u></b></span></span><br />
<br />
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;">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. </span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;">The study shows
that boys were more likely than girls to become diagnosed with asthma.</span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;">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.</span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;">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.</span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;">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.</span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;">But we don't
really know why.</span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;">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.</span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;">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. </span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;">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. </span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;">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. </span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;">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. </span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;">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.</span></span><br />
<br />
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<![endif]--><span style="font-family: inherit;"><span style="font-size: small;"><b>Triggers</b></span></span><br />
<ul>
<li><span style="font-family: inherit;"><span style="font-size: small;"><span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"></span><b>Exercise:</b> The majority of children with asthma will
present symptoms when they exercise such as coughing and wheezing.</span></span></li>
<li><span style="font-family: inherit;"><span style="font-size: small;"><span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"></span><b>Pollen:</b> This is a common allergen. Most children with asthma have allergies, and
allergies are a major trigger of asthma symptoms.</span></span></li>
<li><span style="font-family: inherit;"><span style="font-size: small;"><span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"></span><b>Animals
with fur or hair:</b> Keep pets out of
your child's bedroom, remove carpeting, and install a HEPA filter.</span></span></li>
<li><span style="font-family: inherit;"><span style="font-size: small;"><span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"></span><b>Mold:</b> Control indoor humidity. Repair water leaks no matter how small.</span></span></li>
<li><span style="font-family: inherit;"><span style="font-size: small;"><span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"></span><b>Dust mites:</b> 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.</span></span></li>
<li><span style="font-family: inherit;"><span style="font-size: small;"><span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"></span><b>Weather changes:</b> When air quality is poor, keep your children
indoors and make sure they are compliant with asthma medications.</span></span></li>
<li><span style="font-family: inherit;"><span style="font-size: small;"><span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"></span><b>Airborne
chemicals or dusts:</b> Try to avoid
things like scented candles and air fresheners.</span></span></li>
<li><span style="font-family: inherit;"><span style="font-size: small;"><span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"></span><b>Menstrual
cycles:</b> Monthly hormone fluctuations
can trigger symptoms. Make sure your
daughter is compliant with asthma medicat<span style="font-size: small;">ions.</span></span></span></li>
<li><span style="font-family: inherit;"><span style="font-size: small;"><span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"></span><b>Viral infection:</b> Symptoms may flare with a cold.</span></span></li>
<li><span style="font-family: inherit;"><span style="font-size: small;"><span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"></span><b>Smoke:</b> Avoid tobacco and wood burning.</span></span></li>
</ul>
<br />
<span style="font-size: small;"><span style="font-family: inherit;">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.</span></span>
</div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;">That being said,
there is no guarantee that an asthma outbreak or attack can be foiled by regular
preventative medicine.</span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;">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.</span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;">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.</span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;">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.</span></span></div>
Peter Junghttp://www.blogger.com/profile/12235011146063672219noreply@blogger.com2tag:blogger.com,1999:blog-5923231085926288168.post-23561489782966548482013-02-16T04:21:00.002-08:002013-02-16T06:24:01.626-08:00Post #35 Asthma: A Pedi Perspective - Part 3 of 5<!--[if gte mso 9]><xml>
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<span style="font-family: inherit;"><span style="font-size: small;">Inhaled
medications are the mainstay of therapy, and are delivered two different ways. The
first is a nebulizer, which is a machine that emits humidified air combined
with medication. The child inhales the air through a mask.</span></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;"><span style="font-size: small;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;"><span style="font-size: small;">The other way to
receive inhaled medication is through "Metered Dose Inhalers." MDIs
are the puffers that most people are familiar with. Medication is sprayed
directly into the mouth, but a contraption called a "spacer" helps
make sure the medication goes directly into the lungs. Using an MDI without a
spacer leads to half of the medication missing its mark – a waste of money that
also comes with the risk of under medicating.
In general, MDIs (as opposed to nebulizers) are cheaper, more portable, and
quicker and are therefore becoming the modality of choice in pediatrics.</span></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;"><span style="font-size: small;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;"><span style="font-size: small;">So what's in the
medication? The two most common groups of meds are preventative medications of
which corticosteroids are the mainstay and rescue medications of which
albuterol is the mainstay. </span></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;"><span style="font-size: small;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;"><span style="font-size: small;">Inhaled
corticosteroids are used on a daily basis, whether the child has symptoms or not,
to prevent future episodes of wheezing. Think of it as sunblock for the lungs.
The child puts it on every day to prevent future troubles.</span></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;"><span style="font-size: small;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;"><span style="font-size: small;">Beta-agonists are
the Aloe vera that soothes the sunburn once it happens. Albuterol is the most
commonly used beta-agonist. It works by relaxing the muscles of the airways in
the lungs, helping them open to let more air through. The effects of Albuterol are
short lived. It needs to be given again and again, usually every four hours,
until symptoms subside. The Albuterol, or aloe Vera, makes one feel better
after the burn, but does not prevent future episodes. Only sunblock, or inhaled
corticosteroids, can do that.</span></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;"><span style="font-size: small;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;"><span style="font-size: small;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;"><span style="font-size: small;">Some parents get
freaked out by the word "steroids," picturing pumped-up athletes
risking illegal consumption just to make their muscles bigger. Rest assured
that corticosteroids are not the same thing. Corticosteroids are similar to
steroids that already occur naturally in the body.</span></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;"><span style="font-size: small;"><br /></span></span></div>
<span style="font-family: inherit;"><span style="font-size: small;">That being said,
corticosteroids can affect your child's height by causing temporary growth delay.
But if that’s the case, it's very minimal, and should resolve through catch-up
growth once the medication is stopped. It will not prevent your child from
reaching his or her genetic potential in height. And, keep in mind that the
side effects of corticosteroids are considerably less serious than the side
effects of poorly-controlled asthma – which includes stunted growth overall,
even death. </span></span>Peter Junghttp://www.blogger.com/profile/12235011146063672219noreply@blogger.com0tag:blogger.com,1999:blog-5923231085926288168.post-25778232059391056362013-02-16T04:21:00.000-08:002013-02-16T04:56:19.291-08:00Post #34 Asthma: A Pedi Perspective - Part 2 of 5<!--[if gte mso 9]><xml>
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</xml><![endif]--><span style="font-family: inherit;"><span style="font-size: small;"><u><b>Diagnosis is in the details</b></u></span></span><br />
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<div class="MsoNormal">
<span style="font-family: inherit;"><span style="font-size: small;">Asthma is a
disease that is diagnosed by history. In
other words, one cannot make a diagnosis of asthma the very first time a child
wheezes. It's like your friend who show
up late to your home for dinner; it would be premature to label them
"tardy" after one episode, but if they come late multiple dinners in
a row, they are likely "tardy" friends. With every subsequent wheezing episode, the
more likely these are not one time events but a sign that there is underlying
asthma.</span></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;"><span style="font-size: small;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;"><span style="font-size: small;">If asthma is
suspected, your child may be referred to a lung specialist for a series of
pulmonary function tests - this is typically needed in the more severe cases
while the milder cases can be handled by an experienced pediatrician. Not only will this confirm the diagnosis, it
will help define the severity of the disease.</span></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;"><span style="font-size: small;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;"><span style="font-size: small;">These tests are
designed to measure lung volume and respiratory muscle function, but must be
performed correctly in order to be accurate. It's not very easy to measure lung
function in small children, which is why pediatricians rely heavily on history.
The more episodes of wheezing and shortness of breath a child experiences, the
more likely the child is asthmatic.</span></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;"><span style="font-size: small;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;"><span style="font-size: small;">Another way to
diagnose asthma is to start children on asthma medications and see if they
respond. If they respond positively, meaning they experience an easing of
symptoms, they probably have asthma. If the medication does not help, the
wheezing and coughing is probably secondary to a cold virus.</span></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;"><span style="font-size: small;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;"><span style="font-size: small;">The diagnosis of
asthma can be tricky, and while there are tools to help, it requires the
combination of history, tests, and serial exams to be as precise as possible.</span></span></div>
Peter Junghttp://www.blogger.com/profile/12235011146063672219noreply@blogger.com0tag:blogger.com,1999:blog-5923231085926288168.post-17921483398230387672013-02-16T04:20:00.000-08:002013-02-16T04:58:08.703-08:00Post #33 Asthma: A Pedi Perspective - Part 1 of 5<span style="font-size: small;"><span style="font-family: inherit;">It's difficult to
diagnose, can attack without warning, and unfortunately we don't know exactly what
causes it.</span></span><br />
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;">It's said to be the
most common chronic medical problem in children, fortunately it's manageable
with medication.</span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;">Asthma is a lung
disease that causes inflammation and narrowing of the airways, making it hard
to breathe.</span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;">While it affects
people of all ages, it most often starts in childhood. According to the
American Academy of Pediatrics, between 80 to 90 percent of people with asthma
develop symptoms by the age of 4 or 5.</span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;">Parents tend to
worry at the first sign of a cough or wheeze, but in reality, a one-time
episode is not indicative of asthma. That would be like labeling a friend of yours
"tardy" just because she showed up late one time.</span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;">Further coloring
the diagnosis of asthma in shades of grey is that children with asthma can
present with different symptoms at different times.</span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;"><br /></span></span></div>
<div class="MsoNormal">
<u><b><span style="font-size: small;"><span style="font-family: inherit;">When to
wonder</span></span></b></u><br />
<br /></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;">The most common
symptoms of asthma are coughing, wheezing, chest tightness, shortness of breath
and difficulty breathing.</span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;">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.</span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;">Coughs caused by
a virus can last anywhere from two to six weeks or sometimes even longer, but
chronic coughing - coughing for more than eight weeks - should be brought to
the attention of a doctor. Although
asthma can present with just coughing, an experienced doctor can help
distinguish between a cough caused by a cold virus (or other germs) versus a
cough secondary to asthma. It should be
noted however that in a child with asthma, cough is often initiated by a cold
virus and exacerbated by the underlying asthma producing a mixed picture, hence
it may take a few visits to delineate whether asthma is a true player or not.</span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;">Often the
easiest way to differentiate the two is a trial run of asthma medications to
see if there is a response to the medications or not. If there is a response,
the good news is there is something you can do for the cough. The bad news is
your child may have asthma. If there is no response to the medicine, the good
news is your child is unlikely to have asthma. The bad news is there's not much
you can do about the cough. Keep in mind
that in children with asthma, there is usually a mixed picture of a cold virus
triggering asthma symptoms; in other words the asthma medications will help
control the asthma but not the symptoms brought on by the cold virus itself, so
a positive response may not be a complete response.</span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;">Although asthma
can present with just coughing, a child with true asthma will typically have a chronic
cough combined with wheezing. However,
note that what most moms call wheezing and what most doctors call wheezing often
differ. There are many sound-a-likes to
wheezing that can be best distinguished by an experienced clinician.</span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;">Wheezing occurs
when the muscles in the airway tense up or clamp down due to inflammation. The
result is decreased diameter in the airways, making it more difficult to move
air. Just like you make a whistling sound when you purse your lips and breathe,
the airways also make a wheezing sound when the diameter is narrowed. </span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;">Just as a
chronic cough on its own does not mean your child has asthma, a wheezing
episode alone is not necessarily indicative of it either, since both of these
things can happen in response to a bad cold. A cold virus may cause just enough
inflammation in the lungs to cause a one-time wheezing episode. </span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;">That being said,
kids with asthma will not only wheeze chronically but their lungs will actually
show changes that can be seen under a microscope. This is called
"remodeling."</span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;">Airway
remodeling is a response to long-term airway inflammation that can lead to
permanent structural changes.</span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: inherit;">Asthma is more
likely to manifest itself in long-term changes if it shows up before age 3,
with the child displaying obvious symptoms of these changes by age 6. Asthma that starts after age 6 is less likely
to become a long-term problem. </span></span></div>
Peter Junghttp://www.blogger.com/profile/12235011146063672219noreply@blogger.com0tag:blogger.com,1999:blog-5923231085926288168.post-76258490362618348322012-08-29T20:05:00.004-07:002012-09-05T06:42:29.776-07:00Post #32 Flu Vaccine Update 2012<span style="font-family: inherit;"><b>How is the flu vaccine formulated?</b></span><br />
<span style="font-family: inherit;">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 three 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. <br /><br />On February 23, 2012 the WHO recommended that the Northern Hemisphere’s 2012-2013 seasonal influenza vaccine be made from the following three vaccine viruses: <br /><br />*an A/California/7/2009 (H1N1)pdm09-like virus <br />*an A/Victoria/361/2011 (H3N2)-like virus <br />*a B/Wisconsin/1/2010-like virus (from the B/Yamagata lineage of viruses) <br /><br />While the H1N1 virus used to make the 2012-2013 flu vaccine is the same virus that was included in the 2011-2012 vaccine, the recommended influenza H3N2 and B vaccine viruses are different from those in the 2011-2012 influenza vaccine for the Northern Hemisphere. </span><span style="font-family: inherit;"><br /></span><br />
<span style="font-family: inherit;"><br /><b>When to get vaccinated?</b></span><br />
<span style="font-family: inherit;">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. <br /><br />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. <br />
<br />
<br />
<b>How many shots will my child need?</b><br />
This year's seasonal flu vaccine will again include the Novel 2009 H1N1 vaccine<b> </b>which was used during the global pandemic and which was also included in the 2010-2011 and 2011-2012 seasonal flu vaccines. This means your child will only need to get vaccinated with <b>ONE TYPE </b>of flu immunization this year. <br /><br />If your child is <b>9 years or older</b>, regardless of what flu immunizations have been given in the past, they will only need <b>ONE </b>immunization this flu season. <br /><br />However, if your child is <b>under 9 years of age</b>, they may need <b>TWO </b>immunizations this year. See the chart below to assist you in knowing how many shots your child will need this flu season. <br /><br />Please note that the decision tree sponsored by the CDC (Centers for Disease Control) and ACIP (Advisory Committee on Immunization Practices) are slightly different this year. Our office has decided to use the ACIP decision tree as it is more conservative. <br /><br />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. </span><br />
<span style="font-family: inherit;"></span><br />
<span style="font-family: inherit;"><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: currentColor; mso-border-alt: solid windowtext .5pt; mso-padding-alt: 0in 5.4pt 0in 5.4pt; mso-yfti-tbllook: 1184;">
<tbody>
<tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;">
<td style="background-color: transparent; border: 1pt solid windowtext; mso-border-alt: solid windowtext .5pt; padding: 0in 5.4pt; width: 119.7pt;" valign="top" width="160"><div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
</div>
</td>
<td style="background-color: transparent; border-color: windowtext windowtext windowtext rgb(0, 0, 0); border-style: solid solid solid none; border-width: 1pt 1pt 1pt 0px; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0in 5.4pt; width: 119.7pt;" valign="top" width="160"><div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Calibri;">0 flu shots since July 2010<o:p></o:p></span></b></div>
</td>
<td style="background-color: transparent; border-color: windowtext windowtext windowtext rgb(0, 0, 0); border-style: solid solid solid none; border-width: 1pt 1pt 1pt 0px; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0in 5.4pt; width: 119.7pt;" valign="top" width="160"><div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Calibri;">1 flu shot since July 2010<o:p></o:p></span></b></div>
</td>
<td style="background-color: transparent; border-color: windowtext windowtext windowtext rgb(0, 0, 0); border-style: solid solid solid none; border-width: 1pt 1pt 1pt 0px; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0in 5.4pt; width: 119.7pt;" valign="top" width="160"><div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Calibri;">2 flu shots since July 2010<o:p></o:p></span></b></div>
</td>
</tr>
<tr style="mso-yfti-irow: 1;">
<td style="background-color: transparent; border-color: rgb(0, 0, 0) windowtext windowtext; border-style: none solid solid; border-width: 0px 1pt 1pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt; width: 119.7pt;" valign="top" width="160"><div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Calibri;">Under 9 years of age<o:p></o:p></span></b></div>
</td>
<td style="background-color: transparent; border-color: rgb(0, 0, 0) windowtext windowtext rgb(0, 0, 0); border-style: none solid solid none; border-width: 0px 1pt 1pt 0px; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt; width: 119.7pt;" valign="top" width="160"><div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<span style="font-family: Calibri;">2 flu shots needed<o:p></o:p></span></div>
</td>
<td style="background-color: transparent; border-color: rgb(0, 0, 0) windowtext windowtext rgb(0, 0, 0); border-style: none solid solid none; border-width: 0px 1pt 1pt 0px; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt; width: 119.7pt;" valign="top" width="160"><div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<span style="font-family: Calibri;">2 flu shots needed<o:p></o:p></span></div>
</td>
<td style="background-color: transparent; border-color: rgb(0, 0, 0) windowtext windowtext rgb(0, 0, 0); border-style: none solid solid none; border-width: 0px 1pt 1pt 0px; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt; width: 119.7pt;" valign="top" width="160"><div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<span style="font-family: Calibri;">1 flu shot needed<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 2; mso-yfti-lastrow: yes;">
<td style="background-color: transparent; border-color: rgb(0, 0, 0) windowtext windowtext; border-style: none solid solid; border-width: 0px 1pt 1pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt; width: 119.7pt;" valign="top" width="160"><div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Calibri;">9 years of age or older<o:p></o:p></span></b></div>
</td>
<td style="background-color: transparent; border-color: rgb(0, 0, 0) windowtext windowtext rgb(0, 0, 0); border-style: none solid solid none; border-width: 0px 1pt 1pt 0px; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt; width: 119.7pt;" valign="top" width="160"><div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<span style="font-family: Calibri;">1 flu shot needed<o:p></o:p></span></div>
</td>
<td style="background-color: transparent; border-color: rgb(0, 0, 0) windowtext windowtext rgb(0, 0, 0); border-style: none solid solid none; border-width: 0px 1pt 1pt 0px; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt; width: 119.7pt;" valign="top" width="160"><div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<span style="font-family: Calibri;">1 flu shot needed<o:p></o:p></span></div>
</td>
<td style="background-color: transparent; border-color: rgb(0, 0, 0) windowtext windowtext rgb(0, 0, 0); border-style: none solid solid none; border-width: 0px 1pt 1pt 0px; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt; width: 119.7pt;" valign="top" width="160"><div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<span style="font-family: Calibri;">1 flu shot needed<o:p></o:p></span></div>
</td>
</tr>
</tbody></table>
<br />
If your child is under 6 months of age, they are too young to receive the flu vaccine. It is imperative then 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.<br />
<br />
<br />
<b><span style="font-family: inherit;">Will a quadrivalent vaccine be available for the 2012-2013 season? </span></b><br />
Traditionally, the flu vaccine covers 3 different strands of the flu virus and is labeled a trivalent vaccine. Starting next year some pharmaceutical companies will produce a flu vaccine that will be expanded to include 4 different strands of the flu virus thus adding 33% more protection.<br />
<span style="font-family: inherit;"></span><br />
<span style="font-family: inherit;">Flu vaccine for the US market is produced and distributed by the private sector. While some manufacturers are planning to produce a quadrivalent (four component) vaccine in the future, quadrivalent vaccine is not expected to be available for the 2012-2013 season. </span><br />
<span style="font-family: inherit;"></span><br />
<span style="font-family: inherit;">Of note, on February 29, 2012, quadrivalent flu vaccine manufactured by MedImmune, LLC was licensed by FDA for use in the United States. </span></span><br />
<br />Peter Junghttp://www.blogger.com/profile/12235011146063672219noreply@blogger.com0