Showing posts with label Pediatrics. Show all posts
Showing posts with label Pediatrics. Show all posts

Sunday, April 27, 2008

Flu Vaccine For Children

One last thing on the flu. In a follow up to the previous post, our pediatric consultant, Dr. Janesta Noland, would like you to know that there is a new recommendation for flu vaccine for children.

The Advisory Committee on Immunization Practices (ACIP) unanimously voted at its winter meeting to expand recommendations for flu vaccinations to include children age 5-18 years. Previously, the vaccine was recommended for all children ages 6 months to 5 years as well as children of any age with high risk conditions such as asthma, cardiac disease or diabetes. Although the vote was unanimous, the decision about when it should go into effect was not. If practitioners were to implement the recommendation in the 2008-2009 influenza season, supplies of vaccine would likely be inadequate.

In the very youngest - children aged 6 to 23 months - vaccination prevents hospitalization in 74% of those who are fully immunized. (Of note, in children who do not receive the second dose of the vaccine, hospitalization is prevented in only 39%.) Although death or hospitalization is much less likely in healthy school-age children compared to younger children or children with high-risk conditions, 10-30% of children are afflicted with influenza illnesses annually which results in a large number of missed school days. And 5-7% of those aged 5-18 years visit the doctor for influenza each year and many receive antibiotics unnecessarily.

For parents to decide whether to vaccinate their children for influenza, they must weigh the likelihood of being infected with influenza, the predicted efficacy of the vaccine, risk of side effects of the vaccine, and the risk of going to the doctor, receiving antibiotics or missing school, or having more serious complications of flu resulting in hospitalization or death.

What About Thimerosal in Vaccines?

Thimerosal (a mercury-containing preservative) has been removed from nearly all pediatric vaccines because of concerns about a possible relationship between mercury and autism. These concerns could be the subject for a 12-volume dissertation so we will leave that for another discussion. It should be noted, however, that the current ACIP recommendations are that all children less than 36 months should receive thimerosal-free vaccine when supplies are adequate. Many pediatricians provide preservative-free vaccine exclusively, even for children older than 3 years. Ask your child’s doctor.

Tuesday, April 01, 2008

Fever Is Your Friend

Dr. Janesta Noland, one of the premiere pediatricians in the bay area, has agreed to share her expertise with us and to answer some of your questions on children's health issues.

Many parents fear that fever represents something dangerous happening in their child’s body. Could the child have a dangerous infection? Could the fever itself cause damage?

First, let’s talk about fever – what it is and what causes it. A fever is defined as temperature of 100.4F (38C) or greater taken rectally, 99.5F (37.5C) taken orally, or 99F (37.2C) taken under the arm. Fever happens when the body’s thermostat increases its set point. (Of note, children may sometimes develop increased body temperature when playing, but this is not fever because the set point is not elevated and the body will respond appropriately to return the temperature to normal.) Body temperature is controlled in the brain in a structure called the hypothalamus. Certain cytokines (cell activators) stimulate the hypothalamus to increase body temperature by increasing heat production via shivering or increased muscle tone and by preventing heat loss via constriction of blood vessels. External factors such as some parts of bacteria also act on the body to trigger fever.

Why does fever happen? Is it a disease? Fever was first identified as a symptom rather than a disease by a German physician in the 1800s. Fever is thought to make the body a more inhospitable place for invading organisms, some of which have strict temperature preferences. Fever also increases the effectiveness of white blood cells at fighting infection: they move more effectively, remove offending organisms more effectively and are less sensitive to toxic effects of invading organisms. Thus, fever may actually be desirable in helping rid the body of infection! Fever can be dangerous at extremely high temperatures, over 107F, but the primary downsides of fever are increased need for fluid and general discomfort. In young children (under 5 years), febrile seizures occasionally occur. Although frightening, these are not dangerous.

How can a parent know when to treat a child’s fever, or when to call a pediatrician? Here are general guidelines:
1) Any fever in an infant less than 8 weeks old should be brought to the attention of your pediatrician immediately.
2) Call your pediatrician if your child acts very ill, is not arousable, has a stiff neck or will not drink.
3) Signs of fever associated with a bacterial infection include stiff neck, pain on urination, or cough together with decreased energy. See your pediatrician if any of these signs occur.
4) Since both bacteria and viruses can cause fever, and since viruses are much more common, it is OK to observe your child if she is well-appearing when her temperature is down and is able to take in liquids. However, if the fever lasts more than 4 or 5 days (at which point most fevers caused by viruses go away), or if fever recurs after going away for a day or two, see your pediatrician to evaluate for a possible secondary bacterial infection.
5) If your child has a febrile seizure, call your pediatrician.

References: please see above links.