The kids are back to school and despite the generally mild weather we all can feel the subtle change of the season’s temperature pattern. We have already started to see some early respiratory illness and have begun to administer flu vaccine with over 300 children vaccinated to date. Remember that preschool and daycare enrolled children must have flu vaccine by NJ law before December 31. Many places have their own forms to be filled out documenting that the flu vaccine was given. If you don’t have one, we can accommodate by providing a certificate of vaccination. Many are inquiring about Flu Mist (nasal spray vaccine). As of today 10/2/18, we have obtained limited intranasal vaccine for our patients. Of course we have the traditional Flu injection that is quadrivalent (four strains of Flu virus). This means that we have the best available vaccine that is, of course, preservative free. Be careful of advertisements for Flu vaccines from urgicenters and chain pharmacies, as all Flu vaccine is not the same. There are many brands of Flu vaccine that have only three strains (trivalent) and have preservatives. Notchview will always attempt to have preservative-free vaccine. Notchview will continue our policy of 365 day office hours and of course our most popular early walk-in hours at the Clifton office only Monday to Friday. Because of the increasing demand for appointments for Flu vaccine, we will do our best to accommodate requests. We have found that one good strategy is to pull the children out of school slightly early so that one can avoid the after school ‘sickness’ rush with longer wait times as we get into the heart of the flu season.
CHANGE OF SEASON-WHEEZING TIME
It is now almost common place for infants and children to have home nebulizers for administering medication by inhalation for wheezing, cough, shortness of breath and chest tightness. We refer to this as REACTIVE AIRWAY DISORDER (RAD), when the bronchial tubes become overly sensitive causing spasms and constriction especially during episodes of intercurrent respiratory illness e.g. common cold. These children are generally called ‘wheezers’ and they have persistent cough, at times with gagging and vomiting. They also have middle of the night cough patterns that cause sleep disruption for the patient and their family. Exertional or exercise induced wheezing may also be a sign of RAD. Many people believe that this disorder is bronchial asthma and although asthma-like, it is reassuring that many patients will outgrow this disorder by early elementary school. Make sure you have adequate medication, called bronchodilators, which are available by prescription only. Remember to change the tubing for the nebulizers frequently.
THE DREADED COXSACKIE, HAND FOOT AND MOUTH
If you are parents of a daycare or preschool enrolled child, you are all too familiar with the Coxsackie virus. This virus, for which there is no treatment, runs rampant in these settings since it is a respiratory/airborne contagion. The characteristic mouth sores and rash that can appear anywhere but have a predilection for palms and soles, may be accompanied by high fever, marked irritability, poor fluid intake and generally ‘pretty unhappy campers’. This year we have seen many parents contracting this virus from their kids, giving the parent a true feeling of how miserable their children feel during these illnesses. Many parents have missed up to one week of work because of this infection. Remember that the rash itself is not contagious but rather is passed from child to child by airborne particles. There is also a lot of controversy as to when the children can return to the childcare center or school. The Doctors at Notchview can help you sort that out as well as assessing the hydration and the level of sickness in your child. The very unfortunate issue with Coxsackie is that there is no immunity built up by having the illness and it is not uncommon for child to have this virus multiple times during a season.
PEANUT ALLERGIES-HOT TOPIC
Allergy to peanut (actually not a nut at all) is a frequently discussed topic for young children. We have updated you in the past about a new approach to early exposure to peanut in an attempt to reduce allergic tendency in your child. Past approaches have attempted to limit exposure until the older toddler period. Now new recommendations are to expose the infants early to peanut butter, as young as 6 months of age. If cautious exposure reveals no apparent reaction, then it is presumed that the infant is not allergic. The doctors at Notchview can help guide you as to how and when to accomplish this. Another newer advancement in peanut allergy strategies are the new tests that are available by blood testing to help diagnose the type of allergy and severity of sensitivity. Some of the newer testing available e.g. immunocap testing, will provide the specific components of individual foods, in this case peanut, and gives a snapshot of potential severity of reaction that could possibly occur, giving the parents and patient heightened future surveillance and treatment regimens. In the case of peanut, the components are referred to as ‘ara’ classes. These components are also available for selected tree nuts as well as milk and egg. Patients with prior diagnosis before the advent of component testing may request to be retested with the new version of the blood test.
MEASLES IN EUROPE
Measles continues to thrive in Europe mainly because of suboptimal immunizations rates. Eastern Europe alone has recorded over 5,000 cases of Measles since January and 2,600 noted in France. Many Europeans view Measles as an annoyance illness but the truth is this year there have been 13 recorded deaths from Measles. In France one in four cases must be hospitalized, which represents a nightmare for hospitals. Measles is so contagious that hospitals do not know where to put these patients for fear of infecting others. Children less than two are at great risk and less than one is the greatest risk. Aside from death, other very serious reactions frequently occur such as pneumonia and brain infection (encephalitis) which usually is accompanied by seizures. There is no treatment known. By recommendation, we vaccinate our patients starting at one year of age. At times, because of European travel by small children with their parents, we will vaccinate them prior to departure although the risk for illness if exposed is still great and they still must continue with the series as recommended.
FDA APPPROVES FIRST GENERIC EPIPEN
The FDA has approved generic Epipen and Epipen Jr. for life threatening allergic emergencies. These are called Epinephrine Auto Injectors. Unfortunately, the approval is only for children over 33 pounds. The lack of availability and high cost, despite insurance Rx coverage, makes this a well received relief for parents who believe it has been a long time coming since the out of pocket cost is many times prohibitive. The school nurses do a wonderful job of monitoring the allergic status of their children with allergy action plans and requirement that these life saving injectors to be stored in the Nursing office. Of course, this medication must be provided by the parents.
Bug Bite PreventionInsect/Tick Repellents by Ruba Hanna, MD
Although ticks are associated with warmer weather, the truth is many exposures occur in the fall and early winter when people indulge in hiking, apple picking, yard work and brush cleanup, playground activity and picnicking. The best protection against insect and tick bites is avoidance: keep children away from thickly wooded areas, stagnant pools of water, uncovered foods and gardens. Don’t use scented soaps, perfumes, or hair sprays. Keep children indoors when possible at dusk, when many biting insects emerge. If your child is bitten or stung, remove the stinger as quickly as possible. The best method is to use a fingernail or credit card to scrape the visible stinger off horizontally (avoid squeezing the stinger, which may inject more venom to the skin). Of course, we want you and your children to enjoy nature and the great outdoors, so if you want to venture out here are the recommendations for repellants: DEET, PICARDIN and PERMETHRIN are chemicals in repellants and are by far the most effective against ticks, which can transmit diseases like Lyme/Rocky Mountain Spotted Fever. These are also effective against mosquitoes, which can transmit West Nile virus/Zika. Note that repellents DO NOT work against stinging insects (bees, wasps or hornets). Insect repellants should not be used on children under 2 months of age, or on the hands of young children who might suck on their fingers. DEET is safe to use on skin. The current AAP and CDC recommendations are to use 20-30% DEET on children for adequate coverage with many OTC products ranging from less than 10% to 30% DEET. 10% DEET will only protect for about thirty minutes. PICARIDIN repels insects and makes them less likely to bite; it can be sprayed on anything and is safe on skin. PERMETHRIN is a great option to treat clothing (it is safe on the skin but does not work well). Permethrin is safe and compatible with almost all fabrics. Repellants made from essential oils found in plants such as Cedar, Eucalyptus, Tea Tree are generally much less effective than DEET, and only provide short-term protection. Do NOT use combination sunscreen/insect repellants that are commercially available. Sunscreens need to be applied every 2 hours, and repellants should NOT be reapplied that often. DEET may also make the SPF factor lower, decreasing the sunscreen’s effectiveness.
Important Disclaimer: The information on notchviewpediatrics.com is provided as a supportive service to Notchview Pediatrics, LLC and is not meant to replace the advice of the physicians and nurses who care for your child. All medical advice, information, and recommendations should be considered to be incomplete without a comprehensive evaluation by the physicians at Notchview Pediatrics, LLC.