Four Seasons Pediatrics

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First Flu Cases At Four Seasons Pediatrics

We have seen our first two cases of test documented flu this week.   It is possible that Flu activity will increase over the coming weeks.  When this happens it will also result in taxing the healthcare setting in all areas (Medical Offices, Emergency Rooms, Urgent Cares).   We highly recommend that children under 3 be vaccinated immediately if you have not done so (the highest risk age group).  We will continue to vaccinate children in our office.  We highly recommend that you vaccinate as soon as possible, if you have not already done so.  As the flu increases, please consider the following suggestions:

TIP 1: Prevent Infection: The predominant way that respiratory illnesses like the Flu are spread is from person to person in respiratory droplets of coughs and sneezes. Germs can also spread when a person touches something contaminated and then touches their eyes, nose or mouth. Some viruses and bacteria can live up to 48 hours or longer on surfaces like cafeteria tables, doorknobs and desks. To help stop the spread of germs:

  • Avoid touching eyes, nose, or mouth.
  • Consider greeting with a nod rather than a handshake
  • Avoid close contact with people who are sick. When you are sick, keep your distance (e.g. 1 meter/3 feet or more) from others to protect them from getting sick.
  • Stay away from crowds when you have a choice

TIP 2: Hand washing: Hand washing is a simple habit, something most people do without thinking. Yet hand washing, when done properly, is one of the best ways to avoid getting sick. This simple habit requires only soap and warm water or an alcohol-based hand sanitizer — a cleanser that doesn’t require water.

Antibacterial soaps were banned by the FDA in 2017. Note, these soaps are no more effective at killing germs than is regular soap. Using antibacterial soaps may lead to the development of bacteria that are resistant to the products’ antimicrobial agents — making it even harder to kill these germs in the future. In general, regular soap is fine.  Wash before eating or preparing food, after coughing, sneezing or blowing your nose, after using the restroom, or after touching another person.

Follow these instructions for washing with soap and water:

  • Wet your hands with warm, running water and apply liquid soap or use clean bar soap. Lather well.
  • Rub your hands vigorously together for at least 15 to 20 seconds. (Sing the ABC song)
  • Use a towel to turn off the faucet.

TIP 3: Cough Etiquette: Cover your mouth and nose when coughing or sneezing, using tissues and disposing of them in a trash receptacle immediately. If tissues are not available, cough or sneeze into your sleeve. Then wash your hands.

TIP 4: Boosting Your Immune System: Your immune system responds to how you treat your body.  Reducing stress, getting consistent rest, and eating plenty of fruits and vegetables are important in this regard.  Maintain your hydration

TIP 5: Get the Flu Vaccine: The Flu Vaccine is your safest and best treatment to prevent the Flu.  It is safe and effective.

Some say “the Flu is a bad cold”.  Please remember 25,000 people die in the United States each year from the flu.  This is the seventh most common cause of death in the US.  It exceeds the number of deaths from homicides and suicides combined. There are between 100-200 pediatric deaths from the flu each year.  This is five to ten times the deaths from the next 5 vaccine preventable diseases combined!

Some say “the wrong virus is sometimes picked for the vaccine”.  The selection of the virus is amazingly accurate.  On average, selection is correct two out of three years.  Even when a different strain circulates, most people get partial protection from the vaccine.

Some say “the vaccine doesn’t work”. In Japan there was a mandatory school vaccination for children for influenza for 23 years. Parents did have the option to opt out, but if they did not then children were vaccinated.  Vaccination rates for children were extremely high.  The vaccination of Japanese children prevented about 37,000 to 49,000 deaths per year, or about 1 death for every 420 children vaccinated. As vaccination in school was discontinued, the excess mortality rates in Japan increased back to the high rate they experienced before (almost 4 times higher than the 23 years vaccines were given).1,2

Some say “only do natural things, the vaccine is a toxin”.  There is nothing natural about the body being ravaged with influenza.  It releases toxins within the body called cytokines.  To get the natural infection, means more people would die without the vaccination.

Some say “I never get the shot, and I haven’t gotten the flu”.  Of all those who get influenza, not all have symptoms, but are just as capable of spreading the virus to others who may get very sick.  As the studies above show, the more we vaccinate, the more we protect each other.  Studies show that some people may transmit the infection to others without evening knowing you have the flu.

Some say “I got the flu shot once and got the flu”.  The timing of the flu vaccine is often given when virus after virus is going around.  You may be incubating a virus at the time of the vaccine  and this virus is often blamed as a vaccine reaction. Most vaccine reactions are over in less then 24 hours.  Today’s vaccinations are the results of years and years of scientific study and data gathering on millions of children by thousands of our brightest scientists and physicians.  The benefit of the Flu Vaccine leads us to strongly recommend it.

When to Call the Office for the Flu3:

It may help to start with a view of current flu activity.  You can click here for a map which shows the current flu activity in the United States.  Click here for current week activity.  In the mean time, we wish to alert you to signs of the Flu.   Please remember, those who are most at risk of a serious complication are:

  • Children under age 2
  • Those between the ages of 2-24 who look extremely ill
  • Those with a chronic disease, especially an underlying respiratory (lung) disease such as asthma, heart disease, kidney disease, liver disease, blood conditions (such as cancer) or metabolic problems including diabetes
  • Those with conditions that can compromise respiratory (lung) function (cerebral palsy, spinal cord injuries, seizures, neuromuscular disorders)
  • Those who are immunsuppressed (HIV) or on medications that can cause immunosuppression
  • Children who are on long term aspirin

With all that said, please make the following considerations to be seen in the office:

Symptoms of the Flu:

The flu will cause a fever (which tends to be higher than other viruses) along with a cough and or sore throat.  Other features to look for include:

  • a prominence of body or muscle aches, headache and chills than most other viruses
  • an appearance of illness with a glassy look to the eyes
  • a runny nose that will tend to be profuse

Most healthy people who develop the flu recover completely and do not need treatment.

Treatment with Anti-Viral Medications (Tamiflu)

Tamiflu is a medication that specifically stops the flu virus from multiplying.  It shortens the duration of illness by about 1 day if started in the FIRST 48 hours of the illness.  This is most beneficial in high risk groups.  Just like other medications, indiscriminate use, will cause resistance to this medication.  See Influenza Antiviral Therapy for information about Tamiflu if it has been prescribed.  Our practice will CONSIDER the use of Tamiflu for children (especially during peak influenza activity) who are in the first 48 hours of a Flu Like Illness AND are:

  • Under 2 years of age OR
  • Has a medical condition outlined above OR
  • Appears moderately to extremely ill to us when examined

Please remember that a course of Tamiflu will only protect you while you are on it.  After it leaves your body, you or your child can contract the flu.  The flu vaccine is still the most effective strategy to prevent the flu or at least cause a less serious infection.  We want to provide you with a strategy to manage the weeks when Flu Activity peaks in our area.  We encourage you to come in for evaluation when you need to.  This does not mean you should come right into the office for every cold or virus.   This is an important consideration.  Coming into the office may expose you to the Flu at a time when it is most contagious in the community.  The sickest most contagious children come into a doctors office.

Call EMS 911 NOW
· Severe difficulty breathing (struggling for each breath, making grunting noises with each breath, unable to speak or cry because of difficulty breathing, severe retractions)
· Bluish lips or face now (R/O cyanosis and need for oxygen)
· Not waking up or interacting
· Sounds like a life-threatening emergency to the triager
· Being so irritable that a young child will not be held
Go to ED NOW (or to Office With PCP Approval)
· Child sounds very sick or weak to the triager (R/O sepsis)
Go To Office NOW
· Difficulty breathing, not relieved by cleaning out the nose (R/O bacterial pneumonia)
· Fever >105°F, rectal or oral (R/O serious bacterial infection).
See Today in Office
· Parent wants child seen
· Yellow scabs around the nasal openings (R/O impetigo)
· Fever present >3 days (R/O secondary infection usually otitis)
· Fever returns after going away for 24-48 hours (R/O secondary infection)
· Symptoms have been present for 48 hours or less AND (REASON – Provider to determine if anti-virals are indicated)
- Child is younger than 2 years OR
- Has certain chronic medical conditions (pulmonary, cardiac, renal, hepatic, hematologic or metabolic including diabetes) OR
- Has conditions that can compromise respirtory function (cognitive dysfunction, spinal cord injuries, seizures, neuromuscular) OR
- Immunosuppressed by medications or HIV OR
- On long term aspirin therapy
See Within 3 days in Office
· Nasal discharge present for greater than 10 days
· Cough present for greater than 3 weeks
· Influenza lasts greater than 10 days
Home Care
· Probable influenza with no complications
HOME CARE ADVICE FOR INFLUENZA
1. Reassure the Caller:  For most people, influenza is just a bad cold.  The treatment of influenza is based on the symptoms.  Bedrest is not necessary, but helpful for some.
2. For a runny nose with profuse discharge, blow or suction the nose:
· Reassure the parent that the nasal discharge is natures way of washing out the virus.
· Blowing the nose is all that is needed.
· Apply petroleum jelly to the nasal openings to protect them from irritation.  Clean the skin first
3. For a Blocked Nose, Use Nasal Washes
· Importance: A young infant cannot nurse or drink from a bottle, unless the nose is open
· Use warm water or saline nose drops to loosen up the mucous followed by suctioning or blowing.  Repeat until clear.  Most stuffy noses are blocked by dried mucous.  Suctioning alone or blowing will not remove it.  Neither can medicines.  Do nasal washes especially to help with eating or sleeping
· Saline Nose Drops: 1/2 teaspoon to 8 ounces (1 cup) of warm water.
· Humidifier: Use if the air is dry to sooth the air passages.
4. Fever Medicine:  For fever over 102 degrees F, use acetaminophen or ibuprofen (buffer with some food).  The goal is comfort, fever does not need to be eliminated.  Do not use aspirin for fever due to the risk of Reyes Syndrome.
5. Cough Medicine: For mild cough or hoarseness use 2-5 ml of corn syrup or buckwheat honey for younger children > 1 year old, or cough drops for children > 4 years.  We want to encourage a productive cough, not suppress it.
6. Sore Throat Relief:  For mild sore throat, give warm chicken broth for children > 1 year old, or cough drops for children > 4 years.
7. Contagiousness:  Spread can be rapid because the incubation period is only 24-36 hours, and the virus is very contagious.
8. Expected Course:  The fever lasts 2-3 days, the runny nose 5-10 days, and the cough 2-3 weeks.
9. Call back if
· Fever lasts > 3 days
· Fever returns after going away for 24-48 hours
· Nasal Discharge last > 10 days
· Your child becomes worse.

When should I call 911?

  • If you see severe difficulty breathing (struggling for each breath, making grunting noises with each breath, unable to speak or cry because of difficulty breathing, severe retractions/sucking in between the ribs)
  • Bluish lips or face
  • Not waking up or interacting
  • Your young child is so irritable that they will not be held

When should I take my child to the Emergency Room?

  • Under our advice if your child appears very sick or weak

You should call us to be seen now (if the office is open) if:

  • There is difficulty breathing, not relieved by cleaning out the nose
  • Fever >105°F, rectal or oral

We should see you today in the office if:

  • You feel your child is sick enough that you want them seen
  • Yellow scabs are around the nasal openings (possible impetigo)
  • Fever is present >3 days – to make sure there is not a secondary infection like an ear infection
  • Fever returns after going away for 24-48 hours – to make sure there is no secondary infection
  • Symptoms have been present for 48 hours or less AND you fit one of the groups for consideration of Tamiflu (see at risk groups above)

Other considerations for an office appointment – we expect a higher volume of office visits over the few weeks when the flu really increases in our area.  The following are symptoms which do require an office visit.  There are symptoms listed below which could potentially wait for up to 3 days.  We will attempt to see most patients on a same day basis, but we may sometimes need to limit the following patients with these symptoms from same day appointments in order to accommodate patients who may need more immediate care.  Call to be seen within 3 days if:

  • there is a daily nasal discharge present for greater than 10-14 days and it is not improving (possible sinusitis)
  • there is a cough present for greater than 3 weeks
  • Influenza lasts greater than 10 days

What can I do to help treat symptoms at home?

HOME ADVICE FOR INFLUENZA

For most people, the treatment of influenza is based on the symptoms.

  1. Bedrest is not necessary, but helpful for some.
  2. For a runny nose with profuse discharge, blow or suction the nose.  The nasal discharge is natures way of washing out the virus.  Blowing the nose is all that is needed.
  3. Apply petroleum jelly to the nasal openings to protect them from irritation.  Clean the skin first
  4. For a Blocked Nose, Use Nasal Washes.  A young infant cannot nurse or drink from a bottle, unless the nose is open.  Use warm water or saline nose drops to loosen up the mucous followed by suctioning or blowing.  Repeat until clear.  Most stuffy noses are blocked by dried mucous.  Suctioning alone or blowing will not remove it.  Neither can medicines.  Do nasal washes especially to help with eating or sleeping.  We usually don’t advise suctioning for more than 3-5 days.    For Saline Nose Drops: 1/2 teaspoon to 8 ounces (1 cup) of warm water.
  5. Humidifier: Use if the air is dry to sooth the air passages.
  6. Fever Medicine:  For fever over 102 degrees F, use acetaminophen or ibuprofen (buffer with some food).  See the medication dosing area of our website or click here.  The goal is comfort, fever does not need to be eliminated.  Do not use aspirin for fever due to the risk of Reyes Syndrome.
  7. Cough Medicine: For mild cough or hoarseness use 2-5 ml of corn syrup or buckwheat honey for younger children > 1 year old, or cough drops for children > 4 years.  We want to encourage a productive cough, not suppress it.
  8. Sore Throat Relief:  For mild sore throat, give warm chicken broth for children > 1 year old, or cough drops for children > 4 years.
  9. Contagiousness:  Spread can be rapid because the incubation period is only 24-72 hours, and the virus is very contagious.
  10. Expected Course:  The fever lasts 2-3 days, the runny nose 5-10 days, and the cough 2-3 weeks.
  11. Call back if:  the fever lasts > 3 days, the fever returns after going away for 24-48 hours, the nasal discharge last > 10 days, or you feel your child becomes worse.

REFERENCES:

1. The Japanese experience with vaccinating schoolchildren against influenza. N Engl J Med. 2001 Mar 22; 344(12):889-96.

2. Mass vaccination of schoolchildren against influenza and its impact on the influenza-associated mortality rate among children in Japan.Clin Infect Dis. 2005 Oct 1; 41(7):939-47. Epub 2005 Sep 1.

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