Halloween 2009 – Happy, Healthy and Safe

I start writing this and I almost feel like I want to apologize…because instead of writing about all the “scary things” our kids are going to be this Halloween, I write instead about all the scary things we need to protect them from. So I’d like to propose a deal: I’ll share with you some of the best tips I’ve found to keep our kids safe this year (…thank you Child Safety Examiner, the National Center for Missing and Exploited Children and Dr Kristie McNealy)…and then I’ll share with you my favorite not so scary safety tip that should be good for at least a few smiles…and maybe between the two, we’ll find our way to a happy, healthy and safe Halloween together. 

Trick-or-Treat…Safely

1. (CSE) Make sure your child’s costume is comfortable and manageable. Avoid top heavy costumes that could topple him, or flowing, trailing costumes that could get wound around her feet and cause her to fall. Avoid using anything around the neck that may pose a strangulation hazard.
2. (NCMEC) Make sure children are able to see and breathe properly and easily when using facial masks. All costumes and masks should be clearly marked as flame resistant. (CSE) For the littlest trick-or-treaters, you may want to avoid masks all together. Choose a fun hat or headpiece, or a dab of allergen-free makeup instead. (Pediatric Safety note: Please keep in mind that recent studies have found that many face paints have lead and other toxic ingredients, so research any face paints carefully before applying http://ow.ly/xldL )
3. (CSE) Avoid using real candles in pumpkins on doorsteps, and keep an eye out for them at homes you visit. Trailing costumes or props could get too close and catch fire, or the pumpkin could tip over. Opt for battery operated instead.
4. (CSE) If your kids will be trick-or-treating in the dark, make sure they have flashlights or glow-sticks and remind them to stay on the alert for traffic.
5. (CSE) Remind kids not to eat or drink anything that is given to them until a parent looks it over first. This includes not only Halloween treats, but any potions or weird substances that might be part of a haunted house or Halloween decorations. Make sure kids know that even though things may look like food, they might not be. Feed your kids a meal or small snack before they head out so they’ll be less tempted to sample candy along the way before you’ve had the chance to check it out.
6. (CSE) When checking kids’ loot, be on the lookout for food your child may be allergic to, as well as any recalled foods or items that may pose a choking hazard for kids under 5.

Don’t Let Food Allergies Spoil the Fun

1. (Dr McNealy) Review the Rules – If they are old enough to understand, remind your child which foods are safe, and which are not. If there are candies or treats that they should be sure to avoid, discuss that. Tell them to bring their loot to you, so you can be sure to remove anything that might be harmful. Also let them know what to do if they do eat something that they might be allergic too.
2. (Dr McNealy) Read Labels: When you check over your kid’s Halloween candy, remember to read labels. Formulations change pretty frequently, so you should even check foods that have been safe in the past. Remove anything that doesn’t have an ingredient list.
3. (Dr McNealy) Keep Your Epi-Pen or Allergy Medication Handy: Remember that accidents happen, and be prepared as usual with your child’s epi-pen, or whatever medication your doctor recommends for an allergic reaction.
4. (Dr McNealy) Keep Safe Treats on Hand: Keep some safe candy, treats or small toys on hand to replace anything you have to confiscate. If you have the chance, you can even make up a few treat bags to drop with friends or neighbors, so you’ll know that at least a few people on your trick-or-treat route will have surprises that your child can keep and enjoy.

And Unfortunately Because There are Predators Out There…

1. (NCMEC) Be sure older children TAKE FRIENDS and younger children are accompanied by a TRUSTED ADULT when “Trick or Treating.”
2. (NCMEC) Accompany younger children to the door of every home they approach and make sure parents and guardians are familiar with every home and all people from which the children receive treats.
3. (NCMEC) Teach children to NEVER approach a home that is not well lit both inside and outside and NEVER enter a home without prior permission from their parents or guardians.
4. (NCMEC) Remind them to NEVER approach a vehicle, occupied or not, unless they are accompanied by a parent or guardian.
5. (NCMEC) Children should be cautioned to run away immediately from people who try to lure them with special treats. Tell them that if anyone tries to grab them to make a scene; loudly yell this person is not my father/mother/guardian; and make every effort to get away by kicking, screaming, and resisting.

If all else fails, take man’s best friend along…

 

…that should surely chase away anything that goes bump in the night…or at least keep the kids entertained while you steal – I mean sort through all their candy. HAVE A SAFE & HAPPY HALLOWEEN!

 

 

 

 

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References:

1. Basic Safety Halloween Precautions and Tips for Adults and Kids: Oregon State Police Missing Children Clearinghouse and the National Center for Missing and Exploited Children
2.  Top 10 Halloween Safety Tips for Families: Child Safety Examiner October 28, 2009
3.  Trick-or-Treat Food Allergy Safety: Dr Kristie McNealy October 26, 200
4. Thanks also go out to PediatricSafety’s EMS Safety Expert Jim Love for our “man’s best friend” photos.

First Year Developmental Milestones: Learn the Signs…Act Early

Have you ever wondered how your child is growing and developing compared to other children of the same age? It wouldn’t be unusual if you have.  Skills such as taking a first step, smiling for the first time, and waving “bye bye” are called developmental milestones, and they have often held a special place in the bragging hearts of grandparents everywhere.  There is however another side to developmental milestones.  One that is even more valuable to parents. 

Although no two children grow at the same rate, experts agree there are “normal” signs of development.   Children reach milestones in how they play, learn, speak, behave, and move (crawling, walking, etc.).  Given the reports that have been published recently about the increased findings of autism in the US, it is not surprising that more and more parents are searching for information to help them identify signs of delayed development.   Knowing that early recognition and action have the potential to make a difference, the CDC has incorporated some wonderful information on developmental milestones from the AAP into the Learn the Signs…Act Early pages of their site and provided access to some terrific resources to help if assistance is needed.

Here are the milestones you can monitor for your child’s first year…   

By 3 months of age:

Social and Emotional

• Begins to develop a social smile
• Enjoys playing with other people and may cry when playing stops
• Becomes more expressive and communicates more with face and body
• Imitates some movements and facial expressions

 Movement

• Raises head and chest when lying on stomach
• Supports upper body with arms when lying on stomach
• Stretches legs out and kicks when lying on stomach or back
• Opens and shuts hands
• Pushes down on legs when feet are placed on a firm surface
• Brings hand to mouth
• Takes swipes at dangling objects with hands
• Grasps and shakes hand toys

Vision

• Watches faces intently
• Follows moving objects
• Recognizes familiar objects and people at a distance
• Starts using hands and eyes in coordination

Hearing and Speech

• Smiles at the sound of your voice
• Begins to babble
• Begins to imitate some sounds
• Turns head toward direction of sound

By 7 months of age:

Social and Emotional

• Enjoys social play
• Interested in mirror images
• Responds to other people’s expressions of emotion and appears joyful often

 Cognitive

• Finds partially hidden object
• Explores with hands and mouth
• Struggles to get objects that are out of reach

 Language

• Responds to own name
• Begins to respond to “no”
• Can tell emotions by tone of voice
• Responds to sound by making sounds
• Uses voice to express joy and displeasure
• Babbles chains of sounds

 Movement

• Rolls both ways (front to back, back to front)
• Sits with, and then without, support on hands
• Supports whole weight on legs
• Reaches with one hand
• Transfers object from hand to hand
• Uses hand to rake objects

 Vision

• Develops full color vision
• Distance vision matures
• Ability to track moving objects improves

By 12 months of age:

Social and Emotional

• Shy or anxious with strangers
• Cries when mother or father leaves
• Enjoys imitating people in his play
• Shows specific preferences for certain people and toys
• Tests parental responses to his actions during feedings
• Tests parental responses to his behavior
• May be fearful in some situations
• Prefers mother and/or regular caregiver over all others
• Repeats sounds or gestures for attention
• Finger-feeds himself
• Extends arm or leg to help when being dressed

Cognitive

• Explores objects in many different ways (shaking, banging, throwing, dropping)
• Finds hidden objects easily
• Looks at correct picture when the image is named
• Imitates gestures
• Begins to use objects correctly (drinking from cup, brushing hair, dialing phone, listening to receiver)

 Language

• Pays increasing attention to speech
• Responds to simple verbal requests
• Responds to “no”
• Uses simple gestures, such as shaking head for “no”
• Babbles with inflection (changes in tone)
• Says “dada” and “mama”
• Uses exclamations, such as “Oh-oh!”
• Tries to imitate words

 Movement

• Reaches sitting position without assistance
• Crawls forward on belly
• Assumes hands-and-knees position
• Creeps on hands and knees
• Gets from sitting to crawling or prone (lying on stomach) position
• Pulls self up to stand
• Walks holding on to furniture
• Stands momentarily without support
• May walk two or three steps without support

 Hand and Finger Skills

• Uses pincer grasp
• Bangs two objects together
• Puts objects into container
• Takes objects out of container
• Lets objects go voluntarily
• Pokes with index finger
• Tries to imitate scribbling

As a parent, you know your child best. If your child is not meeting the milestones for his or her age, or if you think there could be a problem you do have resources:

• call your child’s pediatrician and share your concerns – don’t wait.  If you or your child’s doctor think there may be a delay, ask for a referral to a specialist who can do a more in-depth evaluation of your child.
• call your state’s public early childhood system to request a free evaluation to find out if your child qualifies for intervention services. This is sometimes called a Child Find evaluation. You do not need to wait for a doctor’s referral or a medical diagnosis to make this call.  To find the contact for your state, call National Dissemination Center for Children with Disabilities (NICHCY) at 1-800-695-0285 or visit the NICHCY website.
• there is some great information on the CDC website If You’re Concerned page about “What to Say” when you call and “What to Do” while you’re waiting for help.
• A page of Links to Useful Sites:  Parenting and Family Support;  Healthcare Providers that offer testing and intervention resources;  Childcare and Early Education resources

Watch for these milestones in your child over time and don’t make any judgements based on a single day. Remember, each child is different and may learn and grow at a different rate. However, if your child cannot do many of the skills listed for his or her age group, you should consult your pediatrician.  According to developmental specialists Joyce Powell and Dr Charles Smith, remember to take into account if your child was born sooner than his or her due date and be sure to deduct the number of months early from his or her age. A 5-month-old born 2 months early would be expected to show the same skills as a 3-month-old who was born on his or her due date. 

Please remember, you are the most important observer of your child’s development.  You will know before anyone if there is a delay in reaching any of their key milestones.   The good news is, the earlier it’s recognized the more you can do to help your child reach his or her full potential.

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Milestone Work Referenced:

• From CARING FOR YOUR BABY AND YOUNG CHILD: BIRTH TO AGE 5 by Steven Shelov, Robert E. Hannermann, © 1991, 1993, 1998, 2004 by the American Academy of Pediatrics.
• Powell, J. and Smith, C.A. (1994). The 1st year. In *Developmental milestones: A guide for parents*. Manhattan, KS: Kansas State University Cooperative Extension Service. 

Swine Flu for Parents: Real World Answers Part II

In our last post we walked you through what we hope was everything you needed to know about the virus in general:  how to recognize symptoms, avoid the virus and take care of your kids if they happened to catch it. Our goal today is to provide you with the same kind of detailed information…but on the vaccines. We’re not going to make choices or judge anyone’s decisions or tell anyone what they should believe or what actions they should take. But there is a lot of information out there, a lot of rumor and a lot of conjecture. There are polls saying that a large percent of parents are choosing not to vaccinate for the swine flu because of concerns about what is or isn’t in the vaccines…And there are numerous mixed message coming from the media. What we can do is help you sort through all the media coverage and pull together some of the best, most reliable information currently available to hopefully provide you with some much needed “real world” answers to some very important questions. AND THEN…we will let you make your own decision about what’s right for you and your child. So as we did yesterday…let’s start off with a little background, but this time… about the H1N1 vaccine…

The H1N1 vaccine for kids…

Dr Ari Brown: The vaccine will be available as both a nasal spray and a shot. Currently the FDA has approved three flu shots from three manufacturers and one nasal spray from another manufacturer. Keep in mind that all of these protect against just H1N1. They will NOT protect against the other flu strains we typically see in the fall and winter season

All three vaccine shots are inactivated vaccines and like the seasonal flu vaccines are created with egg product, so people with egg allergies need to steer clear. Here are the key differences between the 2 brands that have been approved for young children:

• Novartis Brand: FDA approved for children four years of age and older. There are two forms of this shot: The single dose uses thimerosal in the manufacturing process but then it is extracted before the final production. The multidose vials use thimerosal as a preservative
• Sanofi Brand: FDA approved for children six months of age and older. There are two forms of this shot—a single dose in a prefilled syringes and a multidose vial. Both products are thimerosal preservative free.

The nose spray is similar to the Flumist vaccine used for seasonal flu vaccine. It is also made with egg product and it does not have any preservative.

• Medimmune makes the H1N1 nasal spray. It is FDA approved for healthy people two years old up to 49 years of age. Because it is a live vaccine, pregnant women, people with asthma, people with immune deficiencies, and those with underlying medical conditions should NOT get this vaccine.

If I choose to vaccinate, how many shots or doses does my child really need?

AAP: The seasonal flu vaccine is given separate from the H1N1 vaccine and is available now for all children ages 6 months through 18 years. If your child is less than 9 years old and this is his or her first time getting a flu vaccine, s/he will need two doses.

Parents and caretakers of infants under 6 months of age should also get the seasonal flu vaccine now to protect these children who are too young to be vaccinated.

Dr Brown: For H1N1 flu, kids under ten will need a series of two shots or doses, given approx. one month apart. Ten years of age and older will only need one shot or dose for protection. Infants under 6 months are too young to be vaccinated.

It is definitely a good idea to get both vaccinations, but keep in mind all live-attenuated flu vaccines (the nose sprays) must be given at least four weeks apart so you have an adequate immune response to the vaccinations. So, if your child gets Flumist over the next few weeks for seasonal flu, he has to wait a full four weeks to get the H1N1 nose spray. Consider that before getting Flumist right now.

There is not a special time interval to receive seasonal flu shot and H1N1 shot.

My kids are not great with shots – any suggestions?

Mattel Children’s Hospital UCLA: The good news is that there are several techniques that parents can use to positively impact their child’s experience when getting a needlestick – the key is to be creative and use the right combination of tactics depending on your child’s age, the particular procedure being done and the child’s fear level.

Parents of young children can bring soap bubbles and ask them to blow bubbles during the injections, suggesting they are “blowing away the hurt.”With a crying infant, if the parent places the plastic bubble maker in front of their mouth, as they cry out, they will make bubbles. “I have seen babies stop crying mid-cry because they were distracted by the bubbles,” said Dr. Lonnie Zeltzer, director of the Pediatric Pain Program.

For older children and adolescents getting the shots, but parents can help the child to breathe out slowly to relieve the pain.

Parents can ask their kids to use their imagination and experience being somewhere else really fun during the injections, such as at the park or at the beach. Other distraction ideas include jokes, video games, stories and music.

Experts have also advised parents to ask doctor for a prescription for a numbing cream or patch and put on the areas to be injected. Or if the doctor approves, parents can give the child a dose of pain reliever, such as Tylenol, about one hour before the injection.

After returning home, put an ice bag on the injection site to reduce local swelling and pain.

Finally, do not lie to your child about getting an injection…No one likes to get poked with a needle, but if you reassure your child that there are ways to make the hurt go away, then you can help them achieve a successful, less painful experience

Am I better off with the H1N1 nose spray? What about antivirals and the nose spray?

Dr Brown: If someone is taking an antiviral (such as Tamiflu), he should not take the nasal vaccine until it has been at least 48 hours after completing the medication. And, if a person receives the nasal vaccine, he should not take an antiviral (such as Tamiflu) for two weeks after being vaccinated unless it’s medically necessary. That’s because the medication will reduce the ability for the vaccine to work.

What about vaccine safety concerns?

Folks, here I will depart from providing information – only because this topic could be a post unto itself. I will say that Dr Brown, The American Academy of Pediatrics, Public Health of Canada and Pediatric Safety’s own Dr Kim among others feel confident in their recommendations to immunize (please read Dr Kim’s comments at the end of this article). I will also say that other professionals – including some in the medical profession – feel differently.  What I can do is provide you with several links that should hopefully give you some useful reference points to consider… For my family, I feel safer with the H1N1 vaccination than taking a chance without one.

• Dr Ari Brown on vaccine safety, thimerosol concerns, adjuvants and Guillain-Barre Syndrome
• Safety questions on vaccines – Children’s Hospital of Boston
• Health Canada Flu Watch on vaccine safety, thimerosol concerns, and adjuvants for Canadian citizens
• Weighing Possible H1N1 Vaccine Risks – Dr Jennifer Ashton on Both Sides of the Flu Vaccine Coin

When will the vaccine be available?

Dr Brown: The seasonal flu vaccine (both shot and Flumist nose spray) is available now.

Wall St Journal: For the United States: The first available H1N1 vaccine will be the nasal spray for 2 years and older and started distribution as of Tuesday; the first H1N1 vaccine shots for 6months and older, could start becoming available for high priority groups (pregnant women and anyone with an “at risk” medical condition) as early as later this week. 45 million doses are expected to be distributed across the US by mid-October. Approx. 250 million doses have been ordered which should cover any American who wants to be vaccinated

Public Health Agency of Canada: For Canada: The Canadian government intends to purchase 50.4 million doses of H1N1 vaccine on behalf of the provinces, territories and federal populations, which should meet the need of every citizen desiring vaccination. The government remains on target to have a safe and effective vaccine available in November 2009. However we expect the vaccine could be available as early as mid October should this be necessary.

We hope our vaccine overview has been a help. We know you have some tough decisions in the weeks ahead…and we hope we gave you some useful information that makes it a little easier for you to make some of them.  We also know it can be a bit scary…and that no matter how good the information we provide, sometimes it just helps to hear a few words of advice from someone who speaks from the heart…and while she may not be your own pediatrician, she’s really great with kids and she cares an awful lot… So here is Dr Kim, our own in-house pediatrician, to give you her thoughts on the H1N1 vaccines.  In the end…we leave it up to you and your pediatrician to decide on the best path forward for your kids…

Here’s my take on the upcoming flu season and influenza vaccines for children this year.

First, every single year the regular seasonal influenza kills approximately 35,000 people in America. And it is responsible for severe illnesses and hospitalizations, as well as the missing of school and work days, for many more kids and families.

As much as we may wish, we cannot prevent your children from getting sick each winter. There are more than 200 cold viruses and we have no vaccines to prevent these illnesses. But influenza is among the most severe and the most miserable of the viruses, and we can prevent severe illness with vaccinations.

But is it safe doctor?

I have fielded questions from worried parents and watched the media stir up fears for the past months about the safety of the H1N1 vaccine.

Many patients and writers in the press have expressed concerns about the “new-ness” of the H1N1 vaccine. That concern is based on a lack of understanding of the way that flu vaccine is made. Every year a “new” influenza vaccine is made based on the circulating strains of virus and given to millions of people with excellent safety and efficacy. The H1N1 vaccine has been made in the same way, at the same companies and factories. We know how to do this well and safely.

Some people worry that there is not enough safety data. In my opinion, there is never “enough” safety data. But again, given the track record of similarly-made flu vaccine in the past, there is not reason to be concerned that this vaccine will be unsafe at all.

Others worry that the vaccine will not be effective, citing concerns that the virus may mutate and change. Virologists know that this is rare in a single flu year, and we have watched the virus through the spring in Mexico, the summer here and the winter in the southern hemisphere, and the virus has not changed; there is no reason to expect that it will do so this winter.

Other concerns relate to preservatives used in childhood vaccines, such as thimerisol. Please keep in mind that many studies have been done to evaluate the safety of these compounds, and no good scientific study has ever shown that the very small amounts of thimerisol used in vaccines are harmful to children. 

Finally given the recent media attention, questions have been raised about the 1976 flu vaccine and Guillain-Barre Syndrome.  What isn’t being given as much attention is that the 1976 flu vaccine was made in a completely different way than the current swine flu vaccine, with less sophisticated and safe vaccine technology.  So there’s no reason to suspect that GBS (which is typically present at a mild level in the general population), would increase at all with this year’s H1N1 vaccine.

In summary, as I mentioned in my previous post on this topic, I am strongly recommending both the regular seasonal flu vaccine and the H1N1 vaccine to my most vulnerable patients this winter: young children, those with chronic illnesses like asthma, pregnant women, and the parents and caregivers of babies younger than 6 months old who cannot yet be vaccinated. I think that these vaccines are safe, and I think that they are important. They will save lives and decrease pain and suffering this winter.  And as always I recommend to families getting enough rest (sleep-deprived bodies are much more vulnerable to illness), staying well hydrated, practicing extra-vigilant hand hygiene, and reducing stress and increasing joy (both of which have measurable impacts on the immune system)!

I hope that you all have a fun and safe fall and winter! -Dr Kim

Dr Kim Newell is a pediatrician in a busy outpatient practice in San Francisco. At Princeton University she studied the history of religious thought and practice around the world. Only in modern times have healing and religion been separate fields of study. She attended medical school at the University of Pennsylvania to learn the practice of medicine in a busy urban teaching hospital. Along the way she lived in India for a year and worked at hospitals in Guatemala, Uganda, and on the Navajo reservation in New Mexico, where she learned to be grateful for the luxury that allows her patients to fret over the small things. She completed her pediatric residency at the University of California at San Francisco (UCSF). Dr. Kim would like to help parents build healthy families by arming them with knowledge and tools, as well as a bit of lightness and laughter. She believes that the joys of parenting should outweigh the worries. Dr Kim blogs at drkimmd.com

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Relevant Links

• U.S.A.H1N1 Vaccines, 195 Million Doses: Availability, Safety Issues by Dr Ari Brown (Dr Brown is a pediatrician, book author, child health advocate, and a mom. Dr. Brown is Board Certified and is a Fellow of the American Academy of Pediatrics. She has appeared on the Today Show, CNN, Dr.Phil, RachaelRay and ABC News)
• Frequently Asked Questions About H1N1 Flu (Swine Flu) – AAP
• How to make flu shots easier for kids – Mattel’s Children’s Hospital, UCLA
• Public Faces Long Wait to Get New Flu Vaccine – Wall Street Journal 10/5/09
• Health Canada flu watch
• Each week the CDC publishes an update on flu statistics including location of flu activitiy, type of flu, hospitalization and mortality stats.  For those interested, the data can be found here:  2009 H1N1 Flu: Situation Update by CDC October 2, 2009  http://www.cdc.gov/h1n1flu/update.htm
• At Pediatric Safety, we have an active link to the latest flu news from flu.gov.  Visit us here for updates or sign up for email updates http://www.pediatricsafety.net/awareness/

Swine Flu for Parents: Real World Answers Part I

On Tuesday October 6th, the very first doses of swine flu vaccine started to arrive in doctor’s offices around the United States. These doses however will arrive in extremely limited quantities and initially are targeted for those considered to be “in high risk”. Soon however, as supply becomes more readily available, there will be some very important decisions to be made by every individual – and more important to us here at Pediatric Safety – by every parent. Not surprising, there are some difficult questions that need to be answered for each parent to feel comfortable making these decisions. That’s what our goal is…over the course of this post and the one following. There’s an incredible amount of information out there about the swine flu…along with a lot of mixed messages. What we hope to do is pull together the best, most reliable information currently available from some of our best sources and provide you with some “real world” answers to some very important questions. AND THEN…we will let you make your own decision about what’s right for you and your child. So to start us off…a little background…

What exactly is the “swine flu” and how is it different from the regular or “seasonal” flu?

CDC: Swine flu is a new influenza virus causing illness in people. This new flu was first detected in people in the United States in April 2009. It was originally referred to as “swine flu” because laboratory testing showed that many of the genes were very similar to flu viruses that normally occur in pigs in North America (note: that theory didn’t actually pan out – but the name stuck).

Swine flu spreads the same way that seasonal flu spreads -mainly from person to person through coughing or sneezing by people with influenza. Sometimes people may become infected by touching something – such as a surface or object – with flu viruses on it and then touching their mouth or nose.

American Academy of Pediatrics (AAP): At this point the 2009 H1N1 virus does not appear to be any more severe than seasonal flu. However there are some small differences. Unlike seasonal flu, which tends to cause more significant illness in elderly people and very young children, H1N1 flu (swine flu) is most common in people 5 to 24 years old. Also, while seasonal flu usually peaks in January or February, the 2009 H1N1 virus has caused illness during the summer months and remains active as we head into the fall and early winter.

How do I know if I or my child has swine flu?

AAP: Children with influenza have a sudden onset of fever, chills, sore throat, cough, and runny nose. It may also cause headache, muscle aches, tiredness, nausea, vomiting and belly ache. The flu is different from the common cold, but it can be hard to tell which one your child has because typically a child with a cold can have a stuffy nose, sneezing, scratchy throat, hoarse voice, dry cough (usually from mucous dripping down the throat), and slight fever. One additional comment from the CDC: most people with 2009 H1N1 have had mild illness and have not needed medical care or antiviral drugs, and the same is true of seasonal flu. Most people with flu symptoms do not need a test for 2009 H1N1 because the test results usually do not change how you are treated.

Are there actual tests for the flu and are they accurate?

CDC: A number of flu tests are available to detect influenza viruses. The most common are called “rapid influenza diagnostic tests” that can be used in outpatient settings and they provide results in 30 minutes or less. Unfortunately a rapid test’s ability to detect the 2009 H1N1 flu varies, therefore you could still have the flu, even though your test result is negative. Rapid tests do however appear to be better at detecting the flu in children than adults. There are other more sensitive flu tests that require specialized laboratories, but these tests are typically only recommended for cases with serious health risks. In most cases, if a healthcare provider suspects you have the flu – whether seasonal or swine flu – having test results that confirm it will not change how they will treat you.

What is the best way I can protect my child (and myself) from getting sick?

AAP: There are some everyday actions that you and your child can do to help prevent the spread of germs that cause respiratory illnesses like influenza. Most of these are common sense recommendations, but it doesn’t hurt to have a reminder…plus we threw in a little fun with kids in mind:

• Cough or sneeze into your elbow or upper sleeve. If you use a tissue instead, cover your nose and mouth with it when you cough or sneeze. Throw the tissue in the trash right after you use it. (See who has the best aim – extra points for making sure it gets in the trash)
• Wash hands often with soap and water, especially after you cough or sneeze. Wash hands for 20 seconds, which is about as long as it takes to sing the “Happy Birthday” song twice. You can use alcohol-based hand cleaners but keep in mind that alcohol-based products are toxic if ingested by children. (Don’t worry about the small amount left on hands after use.)
• Avoid touching your eyes, nose or mouth. Germs spread this way. (Kind of like that old game of “operation” – see who avoid touching for the longest period of time)
• Make sure your kids know to go to the school nurse if they start to feel sick during school. Children who are sick should stay home until 24 hours after their temperature has fallen below at least 100.4°F without the use of fever-reducing medications. Note: Normal body temperature is different for each child. In general, 100.4°F (38°C) or higher is a sign of fever.
• On a serious note – make sure to seek medical care if you or your child is severely ill, such as having trouble breathing. Antiviral medicines may help.
• The H1N1 vaccine is currently in production, but supply will be limited for the next couple of weeks. The U.S. plans to have 195 million doses of vaccine, but it will be distributed in several batches on a weekly basis. Once it is available, this is a decision you as a parent will need to make for yourself and your child.  (More on vaccines in our Part II of Swine Flu for Parents)

Finally, make a plan in case you or your child get sick and need to stay home for a week or so; a supply of over-the-counter medicines, alcohol-based hand rubs (for when soap and water are not available), tissues and other related items could help you to avoid the need to make trips out in public. Also, keep your child’s pediatrician’s number handy, just in case.

What should I do if my child gets sick?

AAP: Any child younger than 3 months who has a fever (rectal temperature of 100.4°F or higher) should see a pediatrician.

In a child older than 3 months has mild illness, he should stay home from school or child care until he has been fever-free for 24 hours without the use of fever-reducing medications. Encourage them to drink liquids, especially if they are not eating well. Chicken soup can provide liquids and has been found to alleviate symptoms. If your child is otherwise healthy, call your pediatrician to see if an appointment is needed.

If your child has underlying health problems (for example, heart or lung problems, weakened immune system, chronic kidney disease, sickle cell disease, asthma, or a severe neurological disorder not including ADHD or autism), see a pediatrician as soon as mild flu symptoms start.

If your child has severe symptoms, has been to an area where there have been cases of swine flu, or been directly exposed to a swine flu patient, call your doctor for advice. Your doctor can help you decide whether your child needs to be seen or if they may need to be treated with an antiviral medicine.

If on the other hand, your child experiences any of the following warning signs, seek urgent medical care.

• Fast breathing or trouble breathing
• Bluish or gray skin color
• Not drinking enough fluids
• Severe or persistent vomiting
• Not waking up or not interacting
• Being so irritable that the child does not want to be held
• Flu-like symptoms improve but then return with fever and worse cough

Are any medicines recommended to help children with swine flu?

AAP: Children with influenza should never receive any product that contains aspirin. Acetaminophen (Tylenol) and ibuprofen (Advil and Motrin) are fine to treat fever and body aches in children. Cough and cold medications do not help, and should not be used, especially in young children under 4 years of age.

Most adolescents, adults and children do not need antiviral medicines. Overuse of these medications could be counter-productive and lead to resistance. Parents with children who are at high risk of complications from flu (such as those with chronic disease or cancer, or very young children) should talk with their doctor in advance about what to do if they notice flu-like symptoms.

It is expected that oseltamivir (Tamiflu) will be more effective if taken soon after the onset of symptoms, rather than later in the course of the illness. Based on a recent study, Tamiflu may have more side effects in children than in adults; your pediatrician can help you decide if this medication is right for your child. Zanamivir (Relenza) is not for young children under 7 years of age.

Your pediatrician will decide when treatment is indicated and which drug is best to treat your child.

We hope our swine flu overview has been a help. And we promise to provide just as detailed a review of vaccines in Part II. We also know that no matter how good the information, sometimes you just need a few words of advice from someone that makes you feel confident…that’s your doctor, not a government doctor…and while we can’t ask each of your pediatricians to comment, we can leave you with some words from our own in-house pediatrician…so for today, here are Dr Kim’s thoughts on the upcoming flu season for children this year:

In the upcoming winter, we expect that there will be both seasonal influenza and the new strain of H1N1 influenza commonly known as swine flu. There is already quite a lot of H1N1 virus circulating, and I see children daily who have swine flu.

When we first discovered the new H1N1 flu virus, the world watched and worried to see how severe it would be, and there was a great deal of anxiety and even panic. We now know a great deal about this virus, and luckily, there is no reason to panic. We have seen many many cases in my own office, and throughout the US. And public health officials watched it evolve in the winter of the southern hemisphere.

The good news is that the new H1N1 illness is generally no more severe than the usual seasonal flu strains. There are several differences, however. Since none of us has any innate immunity to this strain, H1N1 has been incredibly contagious: in my practice when one family member gets sick, it usually wipes out the whole family for a few days.

Another difference is that we have seen more severe illness and even deaths in pregnant women, which is why the current recommendations for vaccination have pregnant women on the list of high-risk groups who should receive priority for the vaccine.

What does it feel like to get the swine flu? The symptoms are similar to the usual seasonal flu, except many patients with swine flu get not only rapid onset fever, cough, body aches and headaches, but also have the pleasure of some vomiting and diarrhea. Fun.

The illness can be mild but is usually miserable and can be severe, especially in younger children without a fully developed immune system or in those children with chronic illnesses like asthma or compromised immune systems. And it does cause deaths in children. We would like to prevent childhood deaths if at all possible.

I am strongly recommending both the regular seasonal flu vaccine and the H1N1 vaccine to my most vulnerable patients this winter: young children, those with chronic illnesses like asthma, pregnant women, and the parents and caregivers of babies younger than 6 months old who cannot yet be vaccinated. They will save lives and decrease pain and suffering this winter.

I am also recommending, as I always do, that families focus on their overall health, especially in the winter cold and flu season. That means getting enough rest (sleep-deprived bodies are much more vulnerable to illness), staying well hydrated, practicing extra-vigilant hand hygiene, and reducing stress and increasing joy (both of which have measurable impacts on the immune system)!

I hope that you all have a fun and safe fall and winter!  -Dr Kim 

Dr. Kim Newell is a pediatrician in a busy outpatient practice in San Francisco. She would like to help parents build healthy families by arming them with knowledge and tools, as well as a bit of lightness and laughter. She believes that the joys of parenting should outweigh the worries. Dr Kim blogs at drkimmd.com

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Relevant Links

• 2009 H1N1 Flu (Swine Flu) and You – CDC Sept 24, 2009
• Influenza Diagnostic Testing During the 2009-2010 Flu Season - CDC Sept 29, 2009 
• Frequently Asked Questions About H1N1 Flu (Swine Flu) – AAP
• Each week the CDC publishes an update on flu statistics including location of flu activitiy, type of flu, hospitalization and mortality stats. For those interested, the data can be found here: 2009 H1N1 Flu: Situation Update – CDC October 2, 2009
• At Pediatric Safety, we have an active link to the latest flu news from flu.gov. Visit us here for updates or sign up for email updates http://www.pediatricsafety.net/awareness/

Saving Lives – Helping Kids Escape a Locked Car Trunk

We all know little kids love to climb. And hide-and-seek is often a favorite game. Unfortunately no matter how often you stress the danger, a car trunk can still look like a great place to play. That said, I think all of us would agree that with little kids around it’s a good idea to have an internal trunk release – especially since they are known to be the easiest and fastest way to escape from inside of a car trunk. What may not be commonly known however is that most vehicles older than model year 2002 do NOT have a trunk release accessible from inside the trunk compartment. An organization called Kids and Cars has made it a priority to not only pass on this information but to try and address the problem.

Kids and Cars‘ goals are to ensure that not only are children never left unattended in or around vehicles but also to support the design of safer vehicles that eliminate unnecessary deaths and injury to children. Kids and Cars maintains a national database tracking deaths and injuries to children left unattended in or around motor vehicles. Currently there is no federal or state agency that collects this information

Tonight, Janette Fennell, founder of Kids and Cars.org will appear on SpikeTV’s “Surviving Disaster: Home Invasion” during the segment on how to escape from a locked car trunk. And for the 2 weeks following the airing (September 22 – October 6), Kids and Cars.org will offer an after-market Emergency Trunk Release kit at a special “donation price” that includes free shipping.

If you do not currently have an emergency glow-in-the-dark trunk release, it is imperative you purchase one whether from Kids and Cars or elsewhere; if you have one I highly recommend making sure every child knows what it is and how to use it. Three children lost their lives this summer after gaining access to a car trunk that did not have this simple safety device. Not a single trunk related fatality has been reported where one of these devices was installed.    The message is clear…we just need to hear it.