During flu outbreaks, the highest infection rates occur among school-age children.  Children are important disseminators of disease in the community.  For every 100 children in U.S. elementary schools, influenza accounted for an estimated 20 days of work missed by their parents and 22 secondary illness episodes among other family members.  While the fatality rates are very low, infection rates in healthy children have averaged between 10% and 40% each year, with approximately 1% of infections resulting in hospitalization.  Hospitalization risk is substantially higher for children younger than 2 years of age compared to those older than 2 years.

The following is a list of vaccines available at GetzWell:

- 6-36 months of age: half size single dose preservative-free vaccine (Fluzone)

- 2 yrs and older: nasal spray flu mist vaccine (preservative-free)

- 3 yrs and older: full size single dose flu vaccine (preservative-free)

Some reasons you may want to vaccinate:

• Infants in the first 2 years of life are at a higher risk than older kids and adults of becoming infected with the influenza virus and suffer more severe disease and more frequent hospitalization.
• Healthy people living with either infants or the elderly may get vaccinated to decrease the likelihood of transmitting the virus to these high risk groups.
• Research has shown that preventing the flu decreases the chance of ear infections.
• The preservative-free Fluzone is available immediately on a first-come first-served basis.
• If you are traveling with the entire family over Christmas, ski week, or spring break you may want to be vaccinated to protect you and the kids from infection during these high risk weeks and having to cancel the trip.
• If you don’t know whether to reserve mist or shot, consider that mist is more effective in kids 2-6 years old as compared to the flu shot.  The shot is more effective at causing immunity in kids 6 and older and adults.

Flumist is safe for breast feeding mothers.

Some reasons not to vaccinate:

• Allergy to eggs.
• Low-risk (e.g. breastfed baby with stay-at-home mom without older siblings in group child care settings or school).
• Parents are able to stay home with sick infant/child who becomes ill with the flu, which allows for close monitoring and perhaps preventing the severe effects of the disease.

In an effort to protect the little ones, we will offer flu vaccine to parents and other family household contacts such as grandparents and nannies/babysitters. Remember to wash hands frequently with soap and water, use alcohol based hand sanitizers if you don’t have access to a sink, to cough or sneeze into an elbow or tissue, and stay home from work, school or daycare if you are sick.

Fevers are part the body’s effort to activate the immune system, so they are one of our innate protective mechanisms. Most fevers are good for children because fevers help them to fight infection.

The body’s temperature normally fluctuates throughout the day and peaks in the late afternoon and evening. For instance, an oral or axillary (under the arm) temperature can be 97.6° F  (36.5° C) in the morning and go to a high of 99.5° F (37.5° C) in the evening. Similarly, a rectal temperature can be as low as 98.4° F (36.9° C) in the morning and become as high as 100.3° F (38° C) in the late afternoon.

If your child has a fever, remember to stay calm and use the following definitions to put your child’s fever into perspective (If your child is less than 6 months old, then you should immediately call your doctor.):

• 100-102 F (37.8-38.9 C)  Low grade fevers are beneficial (Try to keep temps here*)
• 102-104 F (38.9-40.0 C)  Moderate grade fevers are beneficial*
• > 104 F (>40.0 C)       High fevers cause discomfort but are harmless
• > 105 F (>40.6 C)       Higher risk of bacterial infection
• > 108 F (>42.2 C)       The fever itself can be harmful

Many people mistakenly believe that fevers cause brain damage and that temperatures above 104° F (>40° C) are dangerous. However, fevers caused by infection do not produce brain damage. Only body temperatures over 108° F (42.2° C) can cause brain damage, and body temperature only climbs to this level with very high environmental temperatures. (Example:  being inside a closed car on a hot day.)

Fevers only need to be treated if they cause discomfort, and these are usually fevers over 102 or 103° F (38.9 or 39.5° C). The exact number of your child’s temperature or fever is not as important as how your child looks and feels. Is he/she alert, interactive, curious despite the fever? Is he/she drinking and urinating?  Is he/she complaining of pain or very uncomfortable?  These are the questions that should be asked to determine if you should seek out a doctor’s care (* unless your child is less than 6 months of age, then you should call your doctor immediately).

If you treat a fever, temperatures don’t always normalize. With treatment (removal of clothing, cool bath, ibuprofen), temperatures often drop 2 or 3 degrees Fahrenheit (1-1.5° C), usually enough to allow your child to feel a little better. And if the fever “doesn’t break,” this isn’t cause for alarm. There is no greater risk that a fever that doesn’t come down is caused by a serious infection. Fevers that don’t respond to fever medicine (usually ibuprofen or acetaminophen) can be caused by viruses or bacteria.  And there are no medicines that kill viruses.

Fevers will not continue to climb higher and higher if not treated. Fevers from infection usually stop rising at about 105-106° F (40.6 or 41.1° C) or lower, because the brain’s thermostat keeps body temperatures lower than this.

Not every child with a fever is at risk for a febrile seizure. Only about 4% of all children will ever have a febrile seizure. If your child has a febrile seizure, though it is scary to watch, they cause no permanent harm and usually last less than 5 minutes. Children who experience febrile seizures have no increased risk of developmental delay, learning disability, or epilepsy.

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The first period of pertussis illness is deceptive because it usually just causes mild upper respiratory symptoms.  Then in the final 8 weeks, the bacterium produces terrible coughing spells which deprive the person of oxygen.  Worse, if a young baby is infected, (s)he may stop breathing altogether.  And it is often the parents or caregivers of infants who unwittingly infect their babies with pertussis.

We encourage everyone be vaccinated against whooping cough (see below for particularly high risk categories) and particularly caregivers of those too young to have had several doses of vaccine (babies under 9 months of life specifically).  We know that immunity to whooping cough begins to wain 5 or so years after being boosted and that even having the disease does not protect against future infection.  So all preteens, teens and adults need to get the booster vaccine.  We offer the booster, Tdap, for all parents and caregivers in addition to vaccinating our littlest patients with DTaP.   We particularly recommend vaccination for those in the following categories:

• Pregnant women (2nd or 3rd trimester) and their family members
• Parents and caregivers of newborns or infants under 9 months
• Unvaccinated or undervaccinated children
• Preteens, teens, adults (who haven’t had a booster shot in the last 5 years)
• Anyone with protracted cold symptoms or cough, especially those who have not been vaccinated, should be evaluated

Call us at 415.826.1701 (or email reception@getzwell.com) to schedule your Tdap booster or to have your child start or complete the primary vaccine series: 415.826.1701.  We also welcome non-members interested in vaccination or evaluation.

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In the traditional model, insurance companies set prices for physician services that encourage a rapid turnover, high volume practice. An insurer might set a price for a 5-7 minute visit at $35, for instance, but only pay $50 for 15 minutes or $70 for 30 minutes of care. In order to cover the exorbitant overhead that accompanies an insurance-based practice (including an entire staff of billing specialists and collection agents), physicians must see as many patients per hour as possible to make their practices viable. This turnstile approach has led to a ‘quick fix’ culture in medicine and discourages the development of meaningful relationships between families and their care providers. GetzWell Pediatrics categorically rejects this system as it isn’t the best way to care for kids (or anyone, for that matter).

Moreover, just because GetzWell is fee-for-service does not mean patients cannot use their insurance. In fact, most patients with PPO insurance receive some, often significant, reimbursement (subject to the specific terms of each policy). It is a very easy process to seek reimbursement or credit from insurers following office visits. Each time a patient receives care, GetzWell generates a ’superbill’ reflecting payment along with a description of services. By simply mailing or faxing the superbill directly to the insurer, most families report they are reimbursed or otherwise credited within 4 weeks (based on the specific terms of their policy).

By remaining ‘out of network,’ GetzWell’s doctors and patients collaborate to make important health care decisions without interference from insurance companies. Insurers are relegated to a still important but secondary role whereby they cover some primary care costs plus emergencies, severe illness and catastrophic matters. As a result, the quality of care at GetzWell is unsurpassed and many unique services are available including:

• Individually tailored care plans to fit the needs and lifestyles of patients by focusing on the underlying causes of illness and health and not merely suppressing symptoms;
• Guidance about safe vaccination and individualized vaccine schedules based on each child’s risk factors and the family’s beliefs and lifestyle;
• 24/7 direct access to GetzWell pediatricians by phone and email;
• More time spent per visit in order to answer questions, get to know parents and children, foster trusting relationships, provide education and discuss options as part of a holistic plan of care (e.g., a typical well child visit lasts 40 – 45 minutes in contrast to about 12 minutes in a traditional pediatric practice);
• Options outside of typical prescription medications including food and lifestyle interventions, homeopathy, supplements, and developmental/emotional advice;
• A combination of Western medicine and complementary and alternative approaches to illnesses or chronic problems that cannot be “fixed” by typical 20^th Century approaches;
• A collaborative team comprised of board certified pediatricians plus an experienced certified lactation consultant, a pediatric nurse practitioner with a specialty in children’s development, and a psychotherapist with a focus on families and mothers (because transitioning to parenthood is one of life’s toughest yet most rewarding challenges!).
• At GetzWell, we love what we do and this is reflected in the warmth with which families are greeted upon entering the office, the undivided attention patients receive at every visit, the unparalleled access  and, most importantly, the result—having a child who is unusually healthy, seldom or never requiring antibiotics or other prescription medications. We value each patient, family and interaction and cherish the opportunity to practice medicine in a way that’s consistent with our deepest principles and beliefs.

GetzWell’s mission is based on the conviction that parents and trained health care professionals, not the insurance companies, should decide how kids are cared for. This is why we are ‘out-of-network.’

Please call us at 415.826.1701 to schedule an appointment. We look forward to meeting you!

GetzWell Pediatrics         1701 Church Street          San Francisco,  CA      94131                www.getzwell.com.

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A:  After the first few days of life when your baby has meconium bowel movements that are very dark and sticky, it’s normal for your newborn’s poop to begin to be very watery and seem like diarrhea.  Breast fed infants, in particular, have BMs that are loose and seedy and range in color from brown to mustard yellow to green.  A typical newborn’s poop looks a lot like grainy mustard–think Grey Poupon country style!

Q:  My newborn must have a cold because he keeps sneezing.

A:  It’s very unlikely that your baby is sick.  Newborns often sneeze quite a bit and we think of it as nature’s way of allowing your baby to blow his nose.  New babies have very small nasal passages and usually make a little bit of mucus which can produce some degree of nasal congestion.  This usually isn’t a problem, but because newborns don’t know they can breathe through their mouths, you may hear your newborn’s breathing and think it means he is having difficulty.  As long as your baby is feeding well, is content, doesn’t seem to be struggling to breathe or crying a lot (which forces babies to mouth breathe) he is likely just fine.

Q: We want to take our baby girl to a party but she is only 2 weeks old.  Is this OK?

A:  The immune system of a newborn is immature and the more people she is exposed to the greater the likelihood she may catch something which could cause her to become quite sick.  We generally stress being very careful regarding hand hygiene and potential exposure to germs for the first 60-90 days of life, when pediatricians consider a fever a sign that an infection may be serious.  Hand washing is the best way to prevent introducing illness-causing germs to your newborn; proper cleaning of your hands involves rubbing them together for 15 seconds (or 3 rounds of “Row Row Row Your Boat”) with good old soap and warm water or the use of an alcohol based hand sanitizer.

Q:  Which hand sanitizers are best?

A:  Generally we recommend an alcohol based product which is rated 0-2 on the Environmental Working Group (EWG) cosmetics database toxicity scale (http://www.cosmeticsdatabase.com) so that you’re sure to purchase something effective while avoiding highly toxic ingredients.  This is an important factor when considering what to buy for you and your baby.  EWG is a tremendous resource available to guide purchasing decisions.  Babies and small children have very thin skin and immature detoxification systems, and thus are vulnerable not only to what we feed them but also to what we use on their skin, what we clothe them in, and what they breathe.

Q:   Do I need to give my 2 month old baby Vitamin D drops?  There is not much sun in our San Francisco neighborhood and we spend most of our time indoors.

A:  Vitamin D is important to our health and many of us have insufficient levels due to lack of adequate sunlight exposure or supplementation.  The American Academy of Pediatrics (AAP) recommends all children receive a vitamin D supplement starting in the first few days of life because evidence has shown this could have life-long benefits.  Furthermore, because of the growing body of evidence that a pregnant woman’s vitamin D status is important to her developing fetus, the AAP has recommended that physicians caring for pregnant women consider vitamin D testing during pregnancy.

At GetzWell we test all new mothers’ vitamin D levels and often find they are lacking.  This is critical both for mothers’ health and directly impacts the breast feeding baby.  Once we have these results, we can tailor our recommendations to each mother and baby as part of our effort to optimize the health of our patients and families.

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*House Calls are only available in San Francisco and Pacifica.