Understanding H1N1!

August is when kids and parents are preparing for the beginning of the new school year. Families are busy buying new gear for school, shuttling kids to sports try- outs and annual school exams.
For pediatricians, back to school is also a time when we talk about the upcoming flu season and flu shots with families.
Parent have many questions about the flu, here are the top 5 most important things to understand about swine flu.
1.) Who is at risk for H1N1 (swine flu)?
High risk individuals for H1N1 include pregnant women, and those with other chronic medical conditions including diabetes, heart disease, asthma and kidney disease.
Vaccines are assumed to become available in October. The CDC currently is advising vaccination for those who are at greatest risk for H1N1 including the following:
1.)pregnant women, 2.)people who live with or care for children younger than 6 months of age, 3.)health care and emergency medical services personnel, 4.) persons between the ages of 6 months through 24 years of age, and people from ages 25 through 64 years who are at higher risk for novel H1N1 because of chronic health disorders including diabetes, asthma, heart and kidney disease.
2.) Do I need the H1N1 vaccine if I get the seasonal flu vaccine.Yes. The H1N1 vaccine is to be given in conjunction with the seasonal flu vaccine. They can be administered on the same day.
3.) What are the symtpoms of H1N1?They symtopms are similiar to seasonal flu and include, fever, cough, sore throat, chills, faitgue. Some people have reported vomiting and diarrhea also.swine flu symptoms are simliar to regualr
4.) How is H1N1 (swine flu) different from seasonal flu?it affects more people less than age 25 than the older population and most individuals with serious complications were between 25-64 years old. Seasonal flu generally causes more seroious complications in the population greater than 65 years.
5.) Who needs tamiflu, the anti-retroviral medication?The CDC recommends it only for those kids who are at high risk for severe complications or those with severe disease. Not for those with mild H1N1.

Obama's Speech Speech

Over the last few days there has been much said about President Obama's school speech delivered today.
Many concerned parents and citizens argue that having children in school listen to his speech is tantamount to propaganda. Advocates argue that the President is just trying to inspire the children.
As a health care advocate, I see kids in the office who can't name the vice president of the U.S. They are not involved in politics and cannot tell you what is going on in the world politically.
If parents choose to ban their children from listening to a speech, how can we expect these children to grow into adults engaged in their communities welfare?
Like him or not, our president is reaching out to our children. If parents do not like his message to their kids, then it is imperative upon them to have a dialoge with their kids about what they consider an better alternative to his message.
What does listening to the President of the U.S. do for the kids?
Firstly and most importantly it provides an opportunity to the children to be curious and to take an interest in something greater than their own personal needs. Listening to their President may inspire them to seek ways to change the system they don't like or get more involved with a system they do like. It may spark discussions with teachers and peers, allowing them to open themselves to greater possibilities. Without the option to hear the President, how can children be involved in their future, their country and ultimately their health.

Firework safety guide

For many families fireworks are as much a part of fourth of July as the parades, picnicking and food.

However, many states have banned the personal use of fireworks. Individual states have different laws, California law prohibits the use of most personal fireworks making exception for a few types of personal fireworks.

However, the only advice for firework safety is don't do it.

This phrase deserves repeating "don't do it". Fireworks are dangerous.

Why? Fireworks pose the obvious fire hazard which has tremendous cost related to fire damages and the unaccounted environmental cost. Injuries related to firework usage top the list of problems. The national council on firework safety reports that the Consumer Product and Safety Commission estimates that 9,600 people were treated for fireworks-related injuries in 2004. The National Council also estimates that approximately 30% of these injuries occur with illegal or homemade fireworks.

And who suffers the most injuries from these fireworks? The American Academy of Pediatrics reports that in past years over 45 % of injuries occur in children under 15 years. These kids suffer with burns to the eyes, hands and face.

Many adults remember growing up using sparklers with fond memories. The American Academy of Pediatrics reports that over 2/3 of sparkler injuries were to kids under 5 years. Most parents don't realize that the sparklers can reach temperatures of 1000 degrees Fahrenheit at the tip and can cause deep burns. Many parents think it is okay to use fireworks labeled "safe". It is important to remember that every type of consumer firework has been associated with serious injury or death.

So what is safe?

Watch a free firework show.

Here are some options in and around San Francisco:

1.) Fisherman's Wharf

2.) Berkeley Marina

3.) Concord Downtown

4.) All other Bay Area

Get Outside

Summer is upon us. School is out and the kids are home. With 30% of our children obese it is important to remember to get your children off the couch out into the fresh air. Even if your child is not obese, your child is in school all year, now is the time to take advantage of the weather and get them breathing the fresh air. In these economic times it may be difficult to find things to do which are educational, fun, outdoors and budget friendly. Here are some great places to take kids of all ages in the Bay Area. If you don't live in the Bay Area check your local mother's group, the local paper or ask another mom for some good ideas.

1.) Pick your own fruits! http://www.harvest4you.com/ Pick fruits with your kids! Let them learn about where their food comes from. They will enjoy it more. Then go home and cook with them.

2.) Ardenwood Farms http://www.ebparks.org/parks/ardenwood

3.) Hiking with the Kids http://www.trails.com/activity.aspx?area=15004

4.) Picnic in the park can't find time to go anywhere or have no budget for travel expenses: a picnic in the park always brings families together: bring a frisbee, bring some balls, learn how to juggle, blow bubbles, or bring a water squirt gun. But go outside!

Parental Refusal of Vaccines, are your kids safe?

You and your newborn daughter arrive to pick up your son from school. You walk into your child's school and learn that there has been an outbreak of whooping cough. You decide not to worry because your son received his vaccinations. But wait, what about your newborn girl?

Many parents feel safe from vaccine-preventable diseases like whopping cough and measles. That feeling of safety is partly because the public health initiatives to vaccinate children had been successful. In the past, most children remained unvaccinated only for medical or religious reasons. Currently, anti-vaccine advocates are dominating the news with flashy celebrities  and their misinformation on vaccine safety. That has left many parents confused about vaccines. Due to this, many parents have chosen not to vaccinate leaving many communities and schools exposed to preventable disease.

An article by the New England Journal of Medicine cites that parents in over 48 states can choose not to vaccinate their kids for any non medical reason. Did I emphasize, any non-medical reason?  The same New England Journal of Medicine article states "Major reasons for vaccine refusal in the United States are parental perceptions and concerns about vaccine safety and a low level of concern about the risk of many vaccine-preventable disease(s)." 

Parents of unvaccinated children assume that their children are safe from disease. As a pediatrician, and a mother, it seems incredible that their assumption is that whooping cough is safer than the vaccine.  These parents rely on herd immunity , the likelihood that your vaccinated children will not be ill and therefore will not pass disease along to their unvaccinated children. 

But are these unvaccinated children really safe from disease? A recent study in the June 2009 Pediatrics journal  demonstrated that children who were not vaccinated for whooping cough are 23 times more likely than the vaccinated children to get the disease.  The herd immunity works only if the entire herd is vaccinated. If you have more people in the community choosing not vaccinate the concept no longer applies. So, contrary to those parents beliefs, unvaccinated children are more likely to get whooping cough.

Parents of vaccinated children may think that their children are safe from these diseases. However, in the case of an illness such as whopping cough, the vaccines immunity can wane with time or the vaccine can fail to cause immunity. Enter an unvaccinated child with whooping cough in a large school and vaccinated children can be affected also. Now bring home a new baby brother or sister,  a grandparent or an immunosurpressed individual and the  entire community is affected with severe disease . The same New England Journal of Medicine article  states "Vaccine refusal not only increases the individual risk of disease but also increases the risk for the whole community." Recently in the US , we are experiencing the largest measles outbreaks in years partially due to the increased number of unvaccinated children. 

As a parent, it seems unfair that another parents decision not to vaccinate can have harmful consequences for my community and my family. The question many physicians and parents are asking is, does a parent have a right to refuse a vaccine for a non-medical reason?   As a parent, I do believe parents should have the right to choose for their children. However,  that right to opt out of vaccination process should come with disease and vaccine education. I will repeat myself here: the consequences of a single parents decision not to vaccinate can affect entire communities and cost innocent people their lives.  The same NEJM  study describes a proposed law in Arkansas which would  "suggest that parents seeking non medical exemptions be provided with counseling on the hazards of refusing vaccination."

Parents need to stand together to protect our children and communities. 

 

When Mommy and Baby Are Ill

Help!

As recently as yesterday, I felt horrible. Vomiting, diarrhea, and all the rest of it. Gross I know, but you get the picture.

I was weak and tired, wanting to sleep, sleep all day. Pre-baby, no problem, I would call in sick to work and then rest became my drug of choice.

Since the birth of my daughter all of that has changed.  I am ill this week and  so is my little girl. Trying to juggle a regular day with baby,home and work is hard enough. But when my daughter is ill, the neediness is exponentially increased. Add to that my run down immune system. I felt like I was drowning, with no energy to fight back to the top.

How, how does anyone do it? Work, get sick, take care of yourself, and your child while baby daddy ploughs away at work. I am not sure there are any good answers to that one, except, get help fast from anyone and everyone.

Here are some of my suggestions to surviving your families illnesses:

1.) make your doctor's visit early on.

2.) take your medicine, (especially if it is sleep)

3.) have a back up plan ; someone to help you, a friend, neighbor, relative or a babysitter.  If you cant get a sitter, find another mommy, have a barter "illness" system worked out. She looks after your kid while you are ill and you look after hers the next time.

4.) take shortcuts. I am not one to take a shortcut to most things, must be the medical training. But if there is anytime to take shortcuts now is it!

5.)have frozen food ready for your kid, go online to get groceries, ask a friend to run an emergent errand. 

6.)and occasionally, if it is really bad, call in sick to work or ask your spouse to.

A-typical day

A-typical day

A close friend of mine is 8 months pregnant. In her pre-pregnant life, she was and is an ambitious, witty professional.  She is not in the world of health care. And she is scared ****less about what comes after the pregnancy. Just like I am nervous about my 15 month old daughter's impending adolescence.

My friend wanted to know what motherhood was like. I could not give her just one answer. I could only tell her about my greatest challenge. The work and home life balancing act.

When I was pregnant, I pressed my supervisors to grant me the extended extended 6 month maternity leave. You know the kind that is only available in Australia. I felt so lucky when they said yes! The first 5 months of my daughter's life I knew she benefited greatly from my being at home. After all the griping I did about the difficulty of breastfeeding, I stuck with it, she and I were bonded and she was thankfully happy and healthy. But really, it took me awhile to realize that it was me who needed to be home with her. 

I needed to be the one person who knew her the best. She may have needed me for sustenance, but I needed her for so much more. Early in the morning my husband would bring her into our room, and despite my chronic exhaustion, when she looked at me with a smile of recognition and sounds gushing from her mouth, I became silly putty. Even now. No matter how tired I was, I was as in love.

Time just flew by. She was one month old and then five months old. With all the sleepless nights, I am at a loss for which month she developed which skill. And I'm supposed to be a pediatrician. 

But, the 5th month something changed in me. I don't know when it hit me exactly. I think it was gradual, but it hit me hard. I needed, I had to go back to work. The incessant routine, which I loved: nursing, burping, changing, napping, playing and then starting over was great, but I needed more. 

Before my daughter was born I decided that I would be back at work at 6 months. So I was only a month away. I was excited to get back to work, be a part of an adult world and return to my professional persona. However, I knew that I had learned so much while staying home and I now loved now so much more.  Thinking all of this made feel guilty.

How could I be excited about going back to work. What about my daughter's well being? But what about my needs? This was my ongoing mental ping pong. 

The first day came. With all of the physical preparation of training the babysitter I did not feel any less stressed out. Add to that, my daughter did not sleep at all the night before my first day back at work. It didn't matter though, I was up until midnight also, wondering if after 6 months of maternity leave I would remember how to practice medicine.  Morning came, and leaving was not easy. I can usually separate emotions enough to keep going, a trait most doctors learn in medical school. But today, this time, I could not. I called and checked on her every hour. Asked about every feeding, nap, pee and poo. I was even thinking of her between diagnosing a child with appendicitis and telling a mother her child had asthma. 

My daughter is now 15 months old. She still misses and wants to be with mostly just me. But life for me is the art of balance, and I am hoping the balance of mommy at work a few days and mommy at home a few days is healthy for both of us.