Advice Archives - Woodinville Pediatrics

For the 2018-2019 influenza immunization season, AAP recommends flu shot

The American Academy of Pediatrics recommends pediatricians give children inactivated influenza vaccine (flu shot) in the upcoming season and use live attenuated vaccine (intranasal flu vaccine, aka Flumist) only as a last resort.

Annual influenza vaccination is recommended for everyone 6 months and older.

For the 2018-’19 season, the AAP recommends inactivated influenza vaccine (IIV3/4) as the primary choice for all children because the effectiveness of LAIV4:

was inferior against A/H1N1 during past seasons; and
is unknown against A/H1N1 for this upcoming season.

LAIV4 may be offered for children who would not otherwise receive an influenza vaccine (and for whom it is appropriate by age and health status).

As always, families should receive counseling on these revised recommendations for the 2018-’19 season.

A Safer Family. A Safer World

A Safer Family. A Safer World: from UW Medicine/Harborview Hospital, information designed for parents, caregivers, and other caring adults to help them prevent the sexual abuse of children. Available in multiple languages. Here are the links for English and Spanish.

Why coughs are so difficult to suppress, and what you can do about it.

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Instead of cough medicine, try drinking lots of fluid. Humidity. Honey if over 1 year of age.

If you can’t stop it, try to cover your mouth and nose with a tissue when you cough or sneeze. Put your used tissue in the waste basket.

If you don’t have a tissue, cough or sneeze into your upper sleeve or elbow, not your hands.

Why get flu vaccine: from Huffington Post

From Huffington Post: With summer decidedly behind us, it’s time to start thinking about where to get this year’s flu shot.

Yes, it’s flu season again. And yes, the best way to protect yourself from coming down with the virus is still a vaccine.

Dr. Tom Frieden, director of the U.S. Centers for Disease Control and Prevention, made that message loud and clear Thursday at the annual National Foundation for Infectious Diseases press conference on flu vaccines.

“If we could increase vaccination coverage in this country by just five percent more, that would prevent about 800,000 illnesses and nearly 10,000 hospitalizations,” said Frieden. “Flu vaccine is one of the best buys in public health.”

How 2016’s vaccine is different than last year

This year, there are two basic types of flu vaccines: one that protects against three strains of flu, and one that protects against four.

Both flu vaccines protect against the strains seen early in the season in the U.S., including the commonly known H1N1 (swine flu), H3N3 and a Type B strain. The only difference between the two is that the “quadrivalent” vaccine also protects against a second Type B strain.

While it seems logical that more coverage is better, the CDC doesn’t have a recommendation for which one to get ― just that you scoop up whichever shot is available.

“The problem is that a vaccination deferred is often a vaccination forgotten,” Frieden explained. In other words, it’s most important that you get a shot soon rather than holding out for one you might prefer.

There is one big change to the CDC’s flu shot recommendations: People who were counting on the nasal spray form of the vaccine will have to settle for a shot. The CDC recommends only the injection for preventing the flu for the 2016-17 season after concerns arose last year about the effectiveness of the spray.

Of the 144 million Americans who got vaccinated against the flu last year, about 20 million opted for the nasal spray.

Don’t wait until the last minute to get your shot

Last year’s flu season was moderate; there were fewer doctor’s visits, hospitalizations and deaths linked to flu and pneumonia compared to the preceding three seasons. The 2015-16 season started picking up in late December and continued to swell through early March, but don’t wait until the beginning of this December to get inoculated.

For one reason, it takes time to build the antibodies to fight the flu. In adults, the shot takes effect after about two weeks. For kids under eight who may need two shots to be fully vaccinated, injections have to be spaced more than four weeks apart, so the earlier they get the first shot, the better.

Secondly, there’s no way to predict when you’re going to come into contact with someone who has the flu and could spread it to you. It’s best to be vaccinated before the virus starts sweeping through your community.

Ideally, the CDC says, everyone should get their flu vaccine by the end of October, although shots received later in the year will still be beneficial.

Flu shots save lives

Unlike the common cold, the flu can progress from congestion and fatigue to more serious symptoms, like fever, chills and muscle aches that can knock you out for several days.

Medical complications caused by the flu include pneumonia, blood infections, diarrhea and seizures. In worst case scenarios, the flu can lead to death, especially for the very young or the very old.

While the CDC does not directly count deaths related to influenza, their analyses estimate that they can range from 3,000 to about 49,000 people per year. Vaccines can prevent this: During the 2012-13 season, over 100 children died of the flu or flu-related complications, but 90 percent of those children did not receive the flu vaccine.

The vaccine is also extremely important for pregnant women, who are at an increased risk of hospitalization and death from flu. In addition to protecting them from the flu, the vaccine is also linked to the prevention of preterm delivery and gives young infants immunity during the first six months of their life, when they are too young to get the vaccine themselves.

There’s also evidence to show that vaccines can prevent flu-related complications, like heart attack and stroke in older populations, said Dr. Wilbur Chen, chief of adult clinical studies within the Center for Vaccine Development.

People ages 65 and older should also make sure they’re up to date with their pneumococcal vaccine too, which can prevent pneumococcal pneumonia, a serious flu-related complication.

Of course, there’s no guarantee that the vaccine will 100 percent protect you from the virus. However, people who get the vaccine are less likely to get ill and are less likely to spread the disease to others. If you get vaccinated and still end up with the flu, it’ll probably be less serious than it would have been had you not gotten the shot.

Nearly everyone should get a flu shot

Anyone over the ages of six months old who doesn’t have medical conditions that would cause them to react badly to the shot should get one.

The CDC lists special populations for whom a severe bout of flu could cause serious medical complications, saying these groups should be prioritized in the event that there’s a shortage of vaccines. In no particular order, they are children ages six months to five years old; people 50 years old and over; immunosuppressed people (including those who are immunosuppressed because of medicine or HIV); pregnant women; children and teens on long-term aspirin therapy; nursing home residents; people with asthma, diabetes or other chronic diseases; the extremely obese; and Native Americans/Alaska Natives.

People who have severe, life-threatening allergies to the vaccine, or anyone who has ever had Guillain-Barre syndrome, will have to skip their shot and rely on theherd immunity of those around them to be protected.

During the 2015-16 flu season, about 46 percent of Americans over the age of six months got vaccinated, a slight decrease from the year before.

“It’s not perfect; we wish it were better,” said Frieden about the vaccine. “But it will cut your risk of flu, if the match is good, by at least a half. And that’s far better than anything else you can do to protect yourself against the flu.”

When Teenagers Bristle at ‘How Was School?’ From NY Times

Asking teenagers more specific questions about their day is just one strategy to help them open up. Credit Getty Images

“How was school today?”

If your house is like mine, the conversation will go something like this:

“Fine.”

“What did you do?”

“Nothing.”

In reality, few days are entirely fine, and none are entirely empty. So how do we improve on this perennial flop of an exchange?

As adults we can often forget how stressful middle and high school can be. While some students are energized by school, most find their days taxing, even under the best conditions.

Adolescents may have fun at school with their friends, but they are also in close quarters with scores of peers they didn’t choose. The rough adult equivalent would be to spend nine months of the year in all-day meetings with 20 or more random age-mates — and be expected to bounce home and share enthusiastic updates.

Elementary has historically been more fun and less pressured than the later grades, but this is no longer true in many communities. We should bear that in mind on the days that our younger children seem worn down by school and when our teenagers seem altogether fed up with it.

Many kids, having brooked a demanding day, are ready to leave it in the rearview mirror. They may receive the greeting “How was school?” as we would a cheerful: “Describe all the tedious things you did today!”

In truth, “How was school?” is often short for, “I love you and miss you and would like to touch base.” Throwing the door wide open by inviting teenagers to talk about any part of the day may seem like we are meeting them more than halfway in our conversational efforts. But seeing it from the teenager’s perspective, our broad question may cover more ground than a weary teen can consider.

Posing more specific questions usually helps. Asking, “How is that group project going?” or “Did you guys do sprints again in practice?” can move things in the right direction, especially when our tone conveys that we have no agenda or angle to pursue.

Even better, drop your line of inquiry if your teenager puts a topic on the table. Should an adolescent say, “English was stupid today,” a warm “How come?” can keep the conversation going. At my practice, I am often charged with engaging fragile adolescents on delicate subjects. Asking, “How come?” with genuine curiosity and without judgment has long been my most reliable ally in the effort to help teenagers open up.

Sometimes “How was school?” gets a detailed answer, but not one the parent had in mind. Though teenagers will often share good or interesting news, they’re just as likely to respond with a complaint, or an entire rant. Having held it together throughout the day, they may be primed to blow off steam when we unwittingly invite them to do so.

When the griping begins, parents often step in with well-meaning suggestions. “Did you tell the office about your jammed locker?” or “Have you let your teacher know that you didn’t understand the assignment?” From here, the conversation almost invariably takes the same unhappy path: Parents try to convince the teenager of the wisdom of their guidance, and the teenager tries to convince the parents that they just don’t get it.

And the adolescent is often right. Teenagers, like adults, typically grouse to seek relief, not advice. If we can keep that in mind, asking “Do you want my help, or do you just need to vent?” lets us offer the kind of support our children are hoping for. Allowing teenagers to complain is not the same as endorsing their complaints. Healthy venting sessions usually let adolescents return to school (and adults return to work) less burdened the following day.

At the literal end of the day, most parents simply want to connect with their teenagers. More than it may seem on the surface, our adolescents often want to connect with us, too. To help make this happen, we might set aside our terms and consider meeting them on theirs.

Several months ago at a school I was visiting, I met with a group of ninth-grade students. As I often do, I asked them, “When I meet with your parents tonight, is there anything that you want me to pass along?” A hand shot up, followed by its owner, an earnest girl who stood to say, “Please tell them that when I complain about my school day, the only thing I want them to say back is, ‘Oh my God, that stinks.’ ” Her classmates nodded, and some even quietly applauded.

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