Flu shots! Get your flu shots here!!

Yay, flu shots have arrived! Call today to schedule your child’s nurse visit, or check our Facebook page for walk-in hours.

Why get a flu shot? 

Simply put, flu shots save lives. A study by the American Academy of Pediatrics found that receiving a flu shot reduced the risk of dying from influenza by 65% in healthy children. Getting a flu shot reduces the risk of a PICU admission for flu-related illnesses by 75%.  In the 2017-2018 flu season alone, nearly 200 children died from influenza in the United States. 80% had NOT been vaccinated. 

In a good year, it will reduce your child’s risk of catching the flu by 40-80%. And even in a bad year, children & adults who received a flu shot and still catch the flu have a much shorter duration of illness. Two or three days of illness sounds a lot better than 7-10 days!

And let’s not forget, getting flu shots protects the people around us. Infants cannot receive a flu shot until they are 6 months old. Some children and adults have a medical reason to not get the flu shot, or are immunocompromised and at high risk for complications from the flu.

Who should get one? 

Everybody over the age of 6 months.

The only contraindication is in someone who has a history of allergic reaction to a previous flu vaccine.

When should you get one? 

Today! There is no evidence that it’s better to wait until later in the flu season to get your flu shot. Cases are already being reported sporadically, and in a typical season the numbers will start climbing by Thanksgiving. The vaccine takes 2-3 weeks to be fully effective.  Typical “flu shot season” begins October 1st and runs through March.

For any child younger than 8 years who has never had a flu shot before or has only had 1 dose ever before, two doses of the flu vaccine are required (1 month apart). Full immunity effect will not be present until 2-3 weeks after the 2nd dose.

Which flu shot should you get? 

This year we are only stocking the injectable version of the flu vaccine, based on different recommendations between the CDC and the AAP regarding the use of the FluMist. If there is evidence that the FluMist is just as effective as the shot this year, we will stock it for next season. But in previous years, it was far less effective, and that is not a risk we are willing to take.

However, feel free to ask for the shot blocker! And a sticker for afterwards.

But Doc, won’t the flu shot give me the flu? 

Nope. Cannot happen. That’s like making an omelette from egg shells. You may be achy or have low-grade fever after a shot — but that is just a sign of your robust immune system responding to the introduction of foreign material. You may coincidentally come down with a cold, which is more likely to happen if you wait until winter for your flu shot when most people have 1-3 colds per month. But you will NOT catch influenza from the vaccine.

Any other questions about the flu shot? We hope to see you in the office soon to get yours!

‘Tis the Season…..for Coughs and Colds

It’s the middle of December. Your child has seemingly had a runny nose for weeks already. How do you know when to call the doctor? What can you do at home?

Winter is known as “cold & flu season” for a reason. Many illnesses DO have a seasonal aspect — influenza being the most common seasonal illness. Also as it gets colder outside, we spend more time indoors. And it is much easier to spread germs indoors, so we tend to catch more bugs this time of year.

The average child has 10-12 viruses per year. Group them heavier in the winter months, and yes, it will seem like your child has a runny nose non-stop for months. Typically, however, these are back-to-back viruses and not one long illness.

You know that viruses do not improve with antibiotics. But maybe it’s something worse. Or maybe a mild virus has progressed to a major illness. So when should you call the doctor?

  • An infant younger than 60 days old with temperature of 100.4F or higher (measured rectally) should be seen, regardless of other symptoms.
  • Any child with difficulty breathing — such as rapid breathing, wheezing, barking cough or a harsh noise when breathing in (stridor), using extra muscles to breathe, or if he cannot finish a sentence without taking a breath — should be seen right away.
  • A child younger than 2 years of age who has ear pain bad enough to wake them at nighttime, or fever that persists beyond 48hrs in the setting of congestion/runny nose, should be checked for an ear infection.
  • A child older than 2 years with ear pain and/or fever (over 101F) for more than 48hrs should be checked out as well.
  • A child older than 2 years with a sore throat and NO other cold symptoms (runny nose/cough) should be checked for strep throat.
  • If your child’s symptoms seemed to improve and then suddenly get worse again, they should be seen to rule out a secondary bacterial infection.
  • A child who cannot drink enough fluids to have some urine output every 6 hours, minimum, needs to be seen.

Those guidelines are fine & dandy, but what about influenza itself? The one and only treatment option for the flu only works if started within 48hrs of onset of symptoms — the sooner the better. The medication is not without side effects though, so is often reserved for the sickest patients — those with underlying conditions such as asthma or heart disease, for example. If you suspect your child has influenza — especially after a known exposure and/or if they have underlying conditions — the sooner you bring them in to be tested the better. Not sure how to tell if it’s flu or just another virus? If the symptoms came out of nowhere it’s a pretty good indication of influenza. Was your child happily playing and eating in the morning, then suddenly has a fever and body aches after lunch? Potentially flu. Is your child too sick to play his favorite game or read her favorite book? Potentially flu. I sometimes say I can diagnose influenza by a “positive horizontal sign,” meaning this is the child who is laying down on the table with their coat over them when I walk into the room, NOT the kid sitting up and playing with toys. If you suspect flu, come in as soon as you can so we can check for it and potentially treat it.

If your child does NOT meet any of the guidelines above and you want to try to manage the symptoms at home, focus first on hydration. The better hydrated someone is, the better they will feel. For children over 1 year, you can use honey as a cough suppressant. A cool-mist humidifier often helps keep the airways open and moist. Some aromatherapy may or may not help, such as Vick’s VapoRub or Pads, but be sure to use only “Baby Rub”on the younger kids and never apply anything directly to the skin. What about cold & cough medicines? There are entire pharmacy aisles devoted to them. But they simply do not work. And may have side effects. Never use them on children younger than 6 years old, and use discretion with older kids — again, they are unlikely to help and more likely to hurt.

Of course, if your home remedies are not working or you have any concerns about your child’s health, do not hesitate to call our office. We will be happy to schedule an appointment any time — remember same day appointments are guaranteed if you call by 12pm. 

Looking for ways to AVOID getting sick altogether?

#1: Get a flu shot (it’s not too late!). Even on years when the efficacy is not great at preventing you from catching influenza, it will still shorten the duration of the illness better than any medication.

#2: Wash hands! Wash before eating anything, after coming into contact with bodily fluids (including after sneezing, coughing, or using the bathroom), or any other time you think you should.

#3: Maintain a healthy diet. Your immune system can not function to its full potential if you are not feeding it a diet rich in vitamins & minerals.

Top 10 Rules of Car Seat Safety

The most dangerous thing you do with your child on a regular basis is get into the car. The most common cause of death in children under the age of 15 is unintentional injury, and the most common cause of unintentional injury is car accidents. Between 2010 and 2014, 2,885 children died in motor vehicle accidents nationwide — an average of 11 children a week. The Atlanta area, in particular, is known for its terrible traffic and thus high rate of car accidents: An average of five people a day or 31 people a week die in Georgia accidents. In Georgia, there were 1.53 deaths per 100 million vehicle miles traveled. The U.S rate was 1.42 deaths per 100 million vehicle miles.

As patients of Briarvista Pediatrics already know, I am car-seat safety advocate. That means that I am committed to keeping your children safe by reviewing the standards of car safety at each and every well-child visit. I will be posting a series of articles regarding safety at each stage of infancy/childhood, going more into depth on a few of these topics, but here are the top ten things I want you to know:

#1) The BEST car seat is the one that fits your child, your car, your budget, and is both installed and used properly each and every time. Car seat safety guidelines are pass/fail only; scores are not released. Thus the $50 car seat is JUST AS SAFE, as far as anyone knows, as the $400 car seat. Higher price tags typically correlate to higher height/weight limits, easier installation, more luxurious fabrics, and extras such as cupholders. But do not feel like you need to spend a lot of money to keep your child safe; if the $400 seat is installed or used improperly, it is more dangerous than the $50 seat installed and used correctly.

#2) ALWAYS read the manual! No one buys a new piece of technology without reading the instruction manual. A car seat is no different. You need to read it through, front to back, before attempting to install or use it. And don’t forget to register the car seat — that’s how the manufacturer will reach you if there are any recalls.

#3) Aim for MAXIMUMS, not minimums. Every time you “graduate” your child from one stage of car seat safety to the next — e.g. from a rear-facing seat to a forward-facing one, or from a harnessed seat to a booster seat — you lose points. Each step “up” is really a step “down.” So aim to reach the maximums of your seat, not the minimums. Rear-face as long as possible. Keep your child in a harnessed seat as long as possible. Do not move out of the booster simply because your child is the minimum height.

#4) Make sure you know what the maximums actually are: Most car seats have a “whichever comes first” rule for maximums, not a “whichever comes last.” In other words, it’s EITHER/OR, not BOTH. An infant seat, for example, may have a 30lb weight limit and a 30″ height limit. That means that when your child is 30″ tall — no matter the weight, which is typically still less than 30lbs — the carseat is outgrown. Most harnessed forward-facing seats are outgrown when the child’s shoulders are above the highest harness position — no matter if the child has reached the height OR weight limit! This information will be found in your manual.

#5) Do not use ANY after-market products. That means that if it did not come in the box, it is not safe to use with the car seat (with very few exceptions for when the manufacturer sells their own products separately). These products inlude, but are note limited to: strap covers, infant body support cushions, seat protectors, cold-weather snuggle systems, and more. Check out the Car Seat for the Littles post for some more examples of after market products

#6) No bulky clothes in the car. Adding bulk — such as from heavy, puffy coats — leaves space between the strap and the body. That slack can mean the harness or seat belt cannot function as it’s supposed to in the event of a car accident. No one — including adults — should be wearing bulky clothes in the car. If it’s particularly cold out and you cannot pre-warm your car, I suggest using jackets as blankets and putting them on top of the harness or belt; you can put the coat back on properly once you arrive at your destination. Here’s a crash-test video that demonstrates this point. One layered fleece jackets are okay to use in the car. There are also some car seat specific winter coats on the market, but that seems to be overkill for Atlanta, where it’s only really cold for a few weeks out of the year.

#7) Rear facing is always safer. No child should be turned forward facing before the age of 2 years, but it’s absolutely a safer choice beyond the 2nd birthday. Again, aim for the maximums of the seat. Remember that when rear facing, harness straps should come from at or below the child’s shoulders.

#8) Harnessed is always safer. That’s why race car drivers and astronauts have harnesses! Moving from a harnessed seat to a booster + seatbelt requires that the child take responsibility for his or her own safety. Harnessing means you have taken responsibility. Aim for the maximums. Remember that when forward facing, harness straps should come from at or above the child’s shoulders.

#9) Your child needs to stay in a booster seat until 4’9″ tall — at MINIMUM. Once reaching that height, you can stop using the booster IF the child passes the 5 step test.

#10) No child younger than 13 years old should be in the front seat of a car. It does not matter how tall or heavy he is. It does not matter how mature she is. Front seats — airbags, in particular — were designed for adults. Period.

So there you have it. Watch the blog for more details about some of these points in upcoming posts, and feel free to ask me about anything mentioned here. My job is to review the basics — your job is to keep your child as safe as possible. Buckle up and drive safely!

 

Back to School

School days, school days, merry golden rule days…..How is it already back-to-school time? This summer flew right past me. Wow.

Back to school means a lot of different things to different people. To kids, it means the end of the freedom of summertime. Back to structure and homework. For parents, it means back to busy evenings and hectic mornings. And for pediatricians, it means back to seeing sick kids.

Below, I’ll address the hectic mornings. But first, let’s discuss why your kid is going to get sick as soon as he goes back to school and ways to avoid it. During the summer, kids tend to be outside more – wide open spaces where the germs can float away. Once they are back inside a classroom, they are exposed to more germs that like to just sit on surfaces. One child sneezes at the pool and no one notices. The same child sneezes inside a packed classroom and the germs land on the surrounding desks or tables. Then the next child sits at that desk, is exposed to the droplets, and then touches his own nose.

In addition, when constantly exposed to similar germs the immune system builds up and offers protection. But when not exposed to those germs, the immune system forgets how to fight them off. So after an extended break – such as summer vacation – the immune system doesn’t remember what to do to prevent illness. Don’t worry, this isn’t unique to students. I tend to never catch the bugs that I see in the office, unless I’ve spent more than a week away from seeing patients. Then I catch everything until my immune system builds back up.

What can you do to prevent your kid from getting sick? Make sure she’s getting enough sleep, for one thing. The immune system needs rest to stay strong, so aim for 9-10 hours/night for elementary students and 8-9 hours/night for junior high and high school students. Then teach your child from an early age to not share drinks/bottles/food and to avoid putting their mouth on a water fountain. Finally, make sure he washes his hands well after using the bathroom and before eating. That means soap & water, rubbing the entire time he sings “Happy Birthday” twice. Regardless, remember that the average person (kid or adult) catches 8-10 illnesses each year. Since these tend to be clustered in the winter months, it could very easily be a new virus every few weeks.

When does your child need to see a doctor? Some reasons include symptoms that improve and then worsen again, fever less than 101F for more than 2 days, sore throat in the absence of cold symptoms, cough waking her at nighttime, or anything else you find concerning. Don’t forget, we are available for same-day sick visits if you call early in the day.

Here are my best tips for handling those hectic mornings:

  • Prepare everything you can the night before. Pack up the backpacks, lay out clothes (and shoes!!), get lunches ready. Sign permission slips or reading logs. Get your child to help do this before bed.
  • Don’t skip breakfast – even for adults! Try to incorporate a protein into breakfast to help get through the morning hours. Add peanut butter to the English muffin, hard boil a dozen eggs on Sunday night and have them peeled and ready to grab in the morning, stock Greek yogurt pouches for a ready-to-eat protein, or eat a piece of string cheese as you walk out the door. If all else fails, throw some things into your blender for a healthy-start smoothie: fruit for sweetness, Greek yogurt or peanut butter powder for protein, some spinach or kale for extra vitamins, and milk or a splash of 100% juice to blend.
  • Have a checklist in a visible spot so your child can be responsible for getting himself ready to leave. Picture charts are helpful for the younger kids. Items on the checklist may include getting dressed, brushing teeth, eating breakfast, putting on shoes, etc. Include any chores your child may have as well, such as feeding the dog or cleaning off the table.
  • Leave extra time! If your morning routine takes 45 minutes, wake the kids up an hour before you need to leave the house. This will allow for the inevitable emergency, such as an extra bathroom stop or not being able to find a favorite jacket. Not sure how much time you need? Have a dry run the week before school starts. Plan an outing somewhere early one morning and time how long it takes to get everyone out the door.

Don’t forget to take a picture of your kids on their first day of school! It’s always fun to compare the first & last day, or the first day of each grade. We’d love to see these pictures on our Facebook page, too! Check it out and be sure to follow us for important announcements.

Welcome to Briarvista Pediatrics!

So glad you’ve found our website, and hopefully that means you’ve also found our office. Please be sure to contact the office if you need more information about our location, hours, services, insurance contracts, or anything else.

I chose to open my own practice so that I can provide the kind of medical care to my patients that I want to receive as a parent. That means access to the doctor – and you’ll see here that we’ve adopted a variety of easy ways to reach our office. I’m also guaranteeing same day appointments and same day responses – check out the office policies. And don’t worry, although the office is closed on weekends I haven’t forgotten how hard it is to be a working parent – schedule your child’s next check-up during one of our “Well Check Wednesday” evening sessions!

I often get asked about my training/background and how that changes the way I practice medicine. As you’ll see in my bio,  not only did I complete a primary care pediatrics residency, I then spent two additional years in a fellowship focused on academic medicine. What does that mean? During those extra years, I took advance coursework in medical statistics and spent a lot of time teaching medical students and residents. Although I don’t do much with Kaplan-Meir curves these days, what this means to you is that I understand how to interpret the data. When a new study comes out identifying a risk factor for autism or a better treatment model for ear infections, I can take apart the numbers and fully understand the clinical implications. In other words, I can practice evidence-based medicine without worrying if I might be misinterpreting the information.

The years I spent teaching help me better relay these findings to my patients and/or their parents. I like to break down the evidence into easy to understand tidbits and use real-world metaphors and analogies whenever possible. And when the evidence is beyond redoubt, I’ll make sure to relay that as well.

For example, I have zero concerns about the safety of vaccines but have personally seen the diseases that are vaccine-preventable and devastating. Most parents have not had first-hand experience with whooping cough, measles, or H. Flu meningitis. So you may need to simply trust me when I say that the diseases are scarier than the vaccines. That’s why our vaccine policy is so simple – if you cannot trust that as your child’s doctor, I only have his or her best interest in mind, then this practice is unlikely to be a good fit for you. (Don’t worry, I’ll be blogging more about specific vaccines and vaccine-preventable diseases at a later date.)

So be sure to watch this space for exciting features in the coming months (and years). And if you have any specific questions or topics you’d like to see covered here, please let me know. Can’t wait to see you in the office soon!