Glenbrook Pediatrics

Health Bulletin Fall 2009/Winter 2010

Here is some information about new vaccines that have been released, and news from Glenbrook Pediatrics.

The seasonal influenza vaccine and the H1N1 vaccine are currently available at our office. Please continue to check our web site for updates.

Click here for more information about the seasonal influenza
Click here for more information about the H1N1 influenza
There are many new vaccines available for children of all ages:

Hepatitis A: This has now been added to the American Academy of Pediatrics (AAP) routine immunization schedule for toddlers between the ages of 1 and 2. It is available to anyone who would like to prevent this vomiting and diarrhea illness, especially those visiting high risk travel areas such as Mexico and South America. It is a two shot series that is given six months apart.
Varicella (chicken pox #2): The AAP has recommended a second varicella vaccine routinely for all those between 4 and 6 years of age, and as a catch-up for all other age groups because of background cases of disease over the past 5 years.
Gardasil (HPV): A three shot series given over a six month time frame to prevent cervical cancer in adolescent females.
Menactra: A vaccine protective against the most common form of meningococcal meningitis, as rare but devastating form of meningitis. It is licensed for children beginning at age 11 and lasts 10 years.
Tdap: This is the tetanus shot (dT) with pertussis (Tdap) added in for the older age group given the recent rise in whooping cough in local high schools. We also recommend that if it has been at least two years since a last tetanus vaccine that the Tdap be given. This includes parents and caregivers, especially those of young infants.

We recommend yearly physicals for all children 3 and older. Pediatricians can provide help with the prevention of physical, emotional, school and family issues, as well as provide guidance on safety concerns at each age, new vaccines and health concerns. We are your ally in taking care of your child, adolescent and young adult.
Our triage nurse is available during the time our office is open to answer medical questions, questions about scheduling a medical test, or to retrieve the results of testing done.
We have the following monthly seminars at our office (All classes are free and held in our office. Call 847.729.6445 x18 to reserve your spot!):

Prenatal Class: 2nd Tuesday of every month @ 7pm
Breastfeeding Class: 3rd Tuesday of every month @ 7pm

Seasonal Influenza

Seasonal influenza usually affects our area beginning in January, extending through March or April. Vaccination has begun this year, starting in September. The current influenza vaccine recommendations for the 2009-2010 influenza season for infants, children and adolescents include:

6 months and older with chronic heart or lung conditions (i.e.: asthma)
6 months and older with chronic metabolic diseases, such as diabetes, chronic kidney disease, weak immune system (chemo, HIV, immune deficiency) or difficultly handling respiratory secretions (i.e.: trach, spinal cord injury)
6 months to 18 years on long term aspirin therapy
Women who are pregnant during the influenza season (call your OB)
All children ages 6 months to 18 years. **This is a new recommendation as of 2008, expanded from previous age range of 6 months to 5 yrs. Influenza vaccination creates less disease for children, their families, and the high risk individuals around them.
6 months to 18 years on long term aspirin therapy
Healthy household contacts of children less than 5 yrs old, and adults over 50 years of age

Influenza (Flu) – Seasonal Type
Barton D. Schmitt, M.D., Denver, CO. Copyright 2000. Revised 8-9-2009

Seasonal Flu Definition: Influenza is a viral infection of the nose, throat, windpipe, and bronchi. The main symptoms are a cough, sore throat and runny nose. Usually there’s more muscle pain, headache, fever, and chills than seen with colds.
Cause: Flu is caused by influenza viruses. Flu viruses change yearly, which is why people can get the flu every year. It spreads rapidly because the incubation period is only 2 days.
Diagnosis – How to know that your child has Influenza: If influenza is widespread in your community and your child has flu symptoms, then he or she probably has flu. You don’t need to get any special tests. You don’t need to call or see your child’s doctor, unless your child develops a possible complication of the flu.
How to treat seasonal flu: The treatment of flu depends on your child’s main symptoms and is no different from the treatment of other viral respiratory infections. Bed rest is not necessary. Antibiotics are not helpful.

H1N1 Flu

H1N1 flu has not to date been more dangerous that the seasonal flu, but since it made its way around the world since last Spring, it is being monitored for signs of altering its pattern during the flu season. The highest risk groups for this illness are slightly different than the seasonal flu, and they include:

Children under 5 years of age
Pregnant women
People with chronic diseases (such as asthma, diabetes, heart disease)

H1N1 Flu - Information
Barton D. Schmitt, M.D., Denver, CO. Copyright 2000. Revised 8-9-2009

H1N1 Definition: H1N1 (also known as Swine flu) is a viral infection of the nose, throat, windpipe and bronchi. The main symptoms are a cough, sore throat, runny nose and fever. If you don’t have a fever, you don’t have the H1N1 flu. Usually there’s more muscle pain, headache, fever and chills than seen with colds.
Cause: Flu is caused by the H1N1 virus. It started in March 2009 and by June had spread to most of the world (a pandemic). After exposure (close contact), 20% of people come down with symptoms in 4 to 6 days.
Diagnosis – How to know that your child has H1N1 flu: If H1N1 flu is widespread in your community and your child has flu symptoms with a fever, then he or she probably has H1N1 flu. You don’t need to get any special tests. You don’t need to call or see your child’s doctor, unless your child develops a possible complication of the flu (see the “call you child’s doctor” section).
How to Treat H1N1 Flu: The treatment of H1N1 Flu depends on your child’s main symptoms and is no different from the treatment of other viral respiratory infections. So far that rate of complications is no different than with regular Seasonal Flu. Bed rest is not necessary. Antibiotics are not helpful.

Treating Seasonal and H1N1 Flu

H1N1 flu has not to date been more dangerous that the seasonal flu, but since it made its way around the world since last Spring, it is being monitored for signs of altering its pattern during the flu season. The highest risk groups for this illness are slightly different that the seasonal flu, and they include:

Fever or Aches: Give acetaminophen (Tylenol®) or ibuprofen (Advil®) for fever over 102°F (39°C) or for any pain. Children and adolescents who have influenza should never take aspirin (this statement is based on recommendations from Dr. Barton Schmitt, not from Glenbrook Pediatrics).
Cough: For children over age 6, give cough drops. If your child is over 1 year of age, give honey (1/2 to 1 teaspoon as needed). Never give honey to babies. If honey is not available, you can use corn syrup. Drugstore cough medicines are not as helpful as honey. Also, they are not approved for children under 4 years old.
Sore Throat: Tylenol or ibuprofen is very helpful for throat pain. Children over 6 years old can suck on hard candy. Children over 1 year old can sip warm chicken broth.
Stuffy or Blocked Nose: Saline (or warm water) nose drops followed by suction (or nose blowing) will open most blocked noses. Use nasal washes whenever your child can’t breathe through the nose. You can buy saline spray without a prescription. Saline nose drops can also be made by adding ½ teaspoon (2 ml) of table salt to 1 cup (8 oz or 240 ml) of warm water.
Antiviral medicine (such as Tamiflu): The American Academy of Pediatrics and CDC recommend prescription antiviral medicines be used for all HIGH-RISK children (see #6) who come down the flu. Mostly HEALTHY children with seasonal or H1N1 influenza do not need antiviral medicine unless they develop serious symptoms (such as pneumonia). Antiviral medicines must be started within 48 hours of the start of influenza symptoms to have an effect. They usually reduce the time your child is sick by 1 or 2 days. They improve the symptoms, but do not cure the disease. If you have other questions about antiviral medicine, talk with your healthcare provider.
HIGH-RISK children: Children are considered high-risk for complications if they have any of the following conditions: lung disease (such as asthma), heart disease (such as a congenital heart disease), diabetes, sickle cell disease, kidney disease, cancer or weak immune system conditions, diseases requiring long-term aspirin therapy, pregnant teens or healthy children less that 2 years old.
Expected Course: The fever lasts 2 to 3 days, the runny or stuffy nose 1 to 2 weeks, and the cough 2 to 3 weeks.

Prevention of Seasonal and H1N1 Influenza

Flu Shots:

Seasonal: Yearly flu shots are the best way to prevent influenza and are recommended for all children over 6 months.
H1N1: We recommend getting all family members protected. Consult with your healthcare provider. As of this writing, no information has been available about the vaccine. It is currently being tested. We will let you know if our office obtains the vaccine via a postcard mailing.

Preventing spread to others: The virus is spread by sneezing, coughing, and hand contact. Cover the nose and mouth with a tissue when coughing or sneezing. Wash the hands frequently. Your child may return to child care or school after the fever is gone for at least 24 hours.

Call Your Child’s Doctor Now (night or day) If…

Your child looks or acts very sick
Breathing becomes difficult or fast
Dehydration occurs (no urine in 12 hours, dry mouth, no tears)

Call Your Child’s Doctor During the Day If…

You think your child needs to be seen
Your child is in the HIGH-RISK group
Earache or sinus pain occurs
Fever lasts more than 3 days
Cough lasts more that 3 weeks
Your child becomes worse

Common Questions:

What should I do if my child had fever and other flu symptoms?

Most people should recover from the seasonal or H1N1 flu without needing medical care. Here’s what you need to do:

Keep your sick child at home until at least 24 hours after there is no longer a fever or signs of a fever (without the use of a fever-reducing medicine).
If your health department says the flu has become more severe, extend the time sick children stay home to at least seven days, even if they feel better sooner.
People who are still sick after seven days should continue to stay home until at least 24 hours after symptoms have gone away.
Call the school or daycare to notify that your child has flu symptoms.
Do not take your child any place where he/she might expose others to the flu.
Do not give aspirin or aspirin-containing products (like Pepto Bismol®) or ibuprofen (Advil®, Motrin®, Nuprin®) for relief of fever (this statement is based on recommendations from Dr. Barton Schmitt, not from Glenbrook Pediatrics).
Do not give over-the-counter cold medicines to children younger than 4 years of age.

What should I do if my child has a chronic illness and flu symptoms?

A chronic illness (like asthma, diabetes, cystic fibrosis and others) can make your child’s flu more severe.
Immediately contact your doctor or specialist for advice about your child’s unique case. This is important because the antiviral medicines used to treat flu work best when started within the first 2 days of getting sick.

Does my child need to see a pediatrician for flu care?

Call your pediatrician if your child’s flu symptoms get more severe or if you are worried about your child’s illness.
Call your doctor if your child is younger that 2 years and not drinking enough fluids.
Your child does not have to be tested for the seasonal /H1N1 flu unless he/she needs to stay in the hospital.
Your doctor may prescribe a drug called Tamiflu.

When should I take my child with flu symptoms to the emergency room? If you have a true medical emergency, that take your child to the nearest emergency room. If your child shows any of these warning signs, seek emergency medical care:

Fast breathing or trouble breathing
Bluish or gray skin color
Not waking up or not interacting
Being so irritable that he or she does not want to be held
Not urinating or no tears when crying

If a family member is sick with flu-like symptoms, do I need to keep my child out of school? Does my whole family need treatment?

If your child is not sick, then he/she can go to school.
If your health department says the flu has become more severe, keep any school-ages kids home for 5 days from the time the household member became sick.
Family members who are not sick usually don’t need treatment.
The best thing you can do is to limit contact with the sick person as much as possible.
Make sure everyone in your family washes his/her hands often.

Where can I find the latest information on H1N1 flu?

Center for Disease Control (CDC): 1-800-232-4636, 24 hours/day
www.cdc.gov/h1n1flu
www.flu.gov
For resources in other languages (Chinese, Arabic, Russian and other), visit the Office of Minority Health website: www.omhrc.gov