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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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.