How to use antibiotics safely and wisely

Since the first discovery of penicillin, antibiotics have been a useful and beneficial tool in fighting a wide variety of bacterial infections. But antibiotics must be used wisely and safely and only used when medically necessary in order to get the most benefit from them. For the last decade or more, health care professionals have been concerned because antibiotics have been over-prescribed, overused and misused for so long that many of them are losing their ability to fight illnesses. Many types of bacteria have already become resistant to some of the older “first-generation” antibiotics making them almost useless against some illnesses. New antibiotics are being developed but bacteria can adapt and become resistant to them to them too, if they are not used carefully. Doctors are trying to their part to stop antibiotics from being overused by not prescribing them unnecessarily. We can help, too, by learning more about these “miracle drugs” and how to use them properly and safely.

What Do Antibiotics Do?

Antibiotics fight bacteria. (Think of them as “bacteria-busters”!) There are many different kinds of bacteria that cause many different illnesses. Because of the wide variety of bacteria, there is also a wide variety of antibiotics that have been developed to treat them. When your doctor diagnoses a bacterial infection she will determine which antibiotic is appropriate for that particular infection.

If your doctor diagnoses a bacterial infection, ask her if it is absolutely necessary to use an antibiotic. Some bacterial infections can be cleared up without antibiotics when under a doctor’s supervision. For example, antibiotics used to be routinely and automatically prescribed for ear infections in young children. However, research has shown that many of these infections can heal on their own without antibiotics as long as a doctor is monitoring the infection. Talk with your doctor about the necessity of using an antibiotic, the pro’s and con’s of using one versus not using it, then follow her advice and directions.

Not all infections are bacterial. Most common, minor illnesses are caused by viruses. Viral and bacterial infections may share some of the same symptoms but they are very different infections and must be treated differently. If your doctor diagnoses a viral infection, it is unwise to pressure her into giving you a prescription for an antibiotic because antibiotics are useless against viruses. It would be a waste of money and would contribute to the problem of resistant bacteria due to antibiotic misuse.

When You or Your child is Prescribed an Antibiotic

The questions that you need to ask your doctor include:

• The name of the medicine (both brand name and generic name)
• The amount to be given (dosage)
• The times to be given (schedule)
• Possible side effects
• Potential drug interactions with any other medicine you are taking
• When to call or come back in if symptoms have not improved

Be sure that the doctor is aware of any other medications (including over-the-counter medications and herbal supplements) that are being used. If the antibiotic is for your child, ask about the taste and if it can be mixed with juice or food to disguise a bad taste. (We have been blessed with a pediatrician who tastes tests medicines so he can be honest with his patients about whether they are yucky or not. And if he has a choice of what to prescribe, he gives them the best tasting one.)

When You Go to the Pharmacy

Ask the pharmacist to give you written instructions on:

• When to take the medicine (schedule)
• How long you need to take it for (most of the time you will continue until all of the antibiotic is gone)
• How much to take (dosage)
• Side effects

Also ask whether or not the medicine:

• Can be taken with or without food
• Needs to be refrigerated
• Needs to be shaken well (if a liquid)
• Can be mixed with food or liquid to disguise a bad taste

Make sure the name of the medicine and the amount and times to be given on the label match what your doctor told you. Liquid medications need to be measured precisely, ask for a measuring device if you don’t have one. If other medications/supplements are being used, tell the pharmacist and ask about drug interactions. Some medications can be dangerous when mixed.

Taking or Giving the Antibiotic at Home

When giving or taking the antibiotic at home, make sure to stick as closely as possible to the scheduled times. If a dose is missed, do not double dose. If it is almost time for the next dose, then do not take the skipped dose, just take the next one on time. If it is still a few hours until the next dose, take the skipped one and then adjust the time to take the next one accordingly. If two or more doses have been skipped, call your doctor for instructions. Always call the doctor or pharmacist if you have questions.

Be sure to use a medication measuring cup, dropper, or oral syringe for liquid medications. Kitchen teaspoons and tablespoons can vary widely so don’t use them to measure medicine. (I wonder how many times we got the wrong dose when our moms gave us medicine using kitchen spoons?) Do not cut pills in half or crush them unless you have been told to or have checked with the pharmacist first because it could alter the effectiveness. Do not mix the antibiotic with juice, milk, or anything else to make it taste better unless the pharmacist says that it is okay to do so because certain antibiotics have to be taken on an empty stomach. Also, calcium and vitamin C can lessen the effectiveness of some antibiotics.

Always finish all of the prescribed antibiotic unless the doctor has instructed otherwise. Just because the symptoms may be alleviated after a few doses and you feel better, it does not mean that the infection is completely gone. Not finishing an antibiotic allows the remaining bacteria to learn how to adapt to the antibiotic and become resistant against it.

Side Effects

Common side effects of most antibiotics include: mild diarrhea, nausea, abdominal discomfort, and headaches. All antibiotics have the potential for side effects but that does not mean that every person will have the same ones. Most of the time, side effects are mild. If you have side effects that are moderate to severe, contact your doctor or pharmacist. Don’t stop using the medication without checking first. If your doctor instructs you to stop taking the medicine before it is finished, throw out the remaining amount. Do not save it for another illness.

Storing Antibiotics

Keep antibiotics (and, of course, all other medications) out of the reach of children. Put them in a cool, dry, dark, safe place or if it needs refrigeration, put it on the highest refrigerator shelf. Bathroom medicine cabinets are exposed to too much humidity which can lessen the effectiveness of some antibiotics.

If you have leftover antibiotics in your medicine cabinet, do not use them. Using or giving an antibiotic to one person that has been prescribed for another person can be very dangerous, even life-threatening. You would not have a full course of treatment and the antibiotic may not even be effective against the specific bacteria causing your illness. Instead, ask your pharmacist how to properly dispose of any leftover antibiotic. Do not throw any medicine in the trash because small children and pets could have access to them there.

When All the Medicine is Gone

Hopefully you will be feeling much better by the time you have finished all of your antibiotic. If, however, your symptoms haven’t cleared up and you are still feeling sick, call your doctor. She may want you to come back in for a re-check visit or she may call in a different, stronger antibiotic for you.

These guidelines are of a general nature and not intended to replace the advice and supervision of your physician or pharmacist.

Top 10 Things A New Mother Must Know

Here are the top things every new mother should know:

1. Don’t let the baby eat dirt
   (If the baby poops green…don’t worry)
2. Don’t let the baby eat grass
3. If the baby screams when you take away the bottle, chances are you didn’t put enough rum in it
4. Should a rash develop, have yourself checked out immediately
5. Mother in laws who think you are incompetent give helpful advice can become clumsy around this oughta take care of the old bat accidental kitchen spills
6. Teething is normal. Stay away from baby if urge continues
7. Don’t try to pawn the gas smell on the baby. We all know it was you
8. Mothers and fathers do things differently and that’s o.k. The baby will grow up to know the truth love you both and realize that you are always there for them I do way more
9. Sucking snot out of baby’s noise is to be expected. Using a straw is not.
10. If screaming and crying persist, go into another room or you will wake the baby

Keeping Kids Safe: Common (and Not So Common) Choking Hazards

Keeping kids safe is top on the minds of most parents, but sometimes hazards are just not that obvious. Introducing foods to infants and toddlers can be great fun, but it also brings opportunities for danger. A little knowledge about how to avoid choking can go a long way in avoiding serious emergencies.

I wrote in a previous post about using pixie stix to get kids to take their medicine. I am going to co-opt this old favorite treat for our lesson about choking hazards. What does a powdered candy have to do with choking hazards, you might ask?

The text and photo from this blog demonstrates that kids can make nearly anything into a choking hazard:

“Looks like fun, right? Probably. But a tube of powdered candy of that size might as well be a loaded gun. It’s frickin dangerous. I know.

When I was thirteen and tried putting the whole mega-Pixie Stick worth of flavored sugar in my mouth, I laughed and inhaled and the moisture in my throat hardened the sugar into a moist sugar ball lodged squarely in my trachea.

One my friends knew the Heimlich maneuver and managed to dislodge the bright blue coagulation into a psychedelic pool of vibrantly scarlet regurgitated Big Red Cola. It was the [last] time I touched either Pixie Stix or Big Red.

It wasn’t my time but I think, when I’m ready, that is exactly how I want to go.”

I love this post for several reasons…

1. This photo is a pediatrician’s nightmare.
2. That someone could avoid impaling himself with the sharp plastic tube but instead manage to obstruct his trachea with powdered candy is a mark of real talent. It’s amazing that we have any children left unharmed.
3. I love the word “frickin” and will try to use it as often as possible in this blog and in my real life. Not to worry, I will avoid using it around kids.
4. Speaking of near-death-by-food, I almost poked my eye out with a loaf of bread once. That story will probably never make it into this blog, so contact me directly if you’re interested. It is as embarrassing as it sounds….
5. Though the Olympics was more than a year ago, swimming boys still make me think of Michael Phelps. I love Michael Phelps. I’m not the only one.

Seriously though, while pixie stix are not usually cited as top choking hazards, choking is a real hazard for children, and food is the number one culprit.

It’s amazing what a mostly-toothless little one can manage to eat. Starting at about 9 months of age, babies can begin to manage foods of a variety of textures and shapes. But remember, kids less than 4 years old may not chew, grind, or gum food well and are at great risk for choking. The most common choking hazards are round firm foods (hot dogs, grapes, nuts, popcorn), and sticky/gooey foods like peanut butter or sticky snacks and candies. Chunks of uncooked vegetables and fruits can also make their way down the wrong tube. Candy and gum top the list of foods that send choking children to the emergency room.

Tips for Parents:

How can you prevent choking? Here are a few tips…

• Take an infant and child CPR class: if you did not take one before your child was born, try to do so by 6 months of age, before your little one starts solids. If you have taken the class, review the course materials as a little refresher.
• To avert the need to perform these life-saving maneuvers on your child, avoid potentially hazardous food until your child is four to five years old. Cook foods well or cut firm foods into pieces less than 1/2 inch in size.
• Give your child small portions, adding to his plate as he finishes.
• Make (and enforce) a household rule that all food is eaten at the table. In a chair. And no eating while running (with scissors). Or playing. Or lying down. Or in a car (or a bus or a taxicab or hot air balloon).
• Limit distractions (tv, pets, games, clowns) at mealtime.
• Watch out for “chipmunking”: hoarding food in the cheeks of an eager eater. Kids really do this.
• Keep helpful older sibs from feeding the little one. They will not provide the same level of supervision that you will.
• And most importantly, NEVER leave a young child alone while eating.

Useful Links:

• For more ideas on avoiding choking on foods and other objects, check out this tip sheet from the AAP
• And since food is not the only thing that your kids can choke on, the Consumer Products Safety Commission gives good information about recalls on toys and tips for avoiding choking on toys.

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/

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