Nasal Flu Vaccine Not Recommended This Season

An advisory committee of the Centers for Disease Control and Prevention recently recommended that the nasal spray influenza vaccine not be used this upcoming flu season. In this Q&A, Dr. Jasjit Singh, medical director of infection prevention and control at CHOC Children’s, offers an explanation.

Dr. Jasjit Singh
Dr. Jasjit Singh

Q: What does this mean for influenza vaccine recommendations for the upcoming flu season?

A: All individuals over the age of 6 months are recommended to get the influenza vaccine, and that will continue to be the case.  However, for this season at least, the nasal flu vaccine is not an option. Therefore, parents will need to plan for their children to get the flu shot this upcoming season.

Q: How does the standard flu shot differ from the nasal spray version in terms of composition and effectiveness?

A: Both the flu shot and the nasal spray contain the anticipated predominant circulating strains of influenza every year, but the nasal spray strains are made of weakened live virus while the flu shot is made of inactivated viral components. The CDC reviewed data from this past season that suggested that the nasal spray did not perform as well as it had in the past.

Q: Besides ensuring their children get a flu shot, what else can parents do to help prevent the flu?

A: In addition to ensuring their child is vaccinated against the flu every year, there are many things parents and other caregivers can do to help prevent the flu. Use proper hand-washing techniques, use respiratory etiquette, and stay home from work or school if you are sick with the flu, to prevent spreading it to others.

Q: What do you anticipate will be parents’ reactions to this recommendation? Is there anything else you’d like them to know? Is there anything else you’d like to share with parents about the importance of vaccinations?

A:  Vaccinations are one of the most effective public health measures that have been developed and they save thousands of lives each year. Influenza vaccinations are important because young children can get quite sick from the flu, and some even require hospitalization. Every year there are pediatric deaths in the U.S. due to influenza, about half of which occur in normal healthy children. Children can pass influenza on to the elderly or other fragile members of our community. It’s important for adults to get the flu shot too, particularly those who are caring for young children. Even though the nasal spray is not an option for vaccinating this particular season, it is still important to have your child vaccinated for this year.

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Meet Dr. Kenneth Kwon

CHOC Children’s wants its patients and families to get to know its specialists. Today, meet Dr. Kenneth Kwon, a pediatric emergency medicine specialist. Dr. Kwon attended medical school at Columbia University. He completed an internship at UCLA, a pediatric residency at Lucile Packard Children’s Hospital at Stanford University, and an emergency medicine residency at UC Irvine. He has been on staff at CHOC for eleven years and currently serves as director of pediatric emergency services and Chief of Staff elect at CHOC Children’s at Mission Hospital.

Dr. Kenneth Kwon

Q: What are your special clinical interests?
A: Pediatric trauma and injury prevention.

Q: What are your most common diagnoses?
A: Fractures, head injuries, lacerations, febrile illnesses, and abdominal pain.

Q: What would you most like community/referring providers to know about you/your division at CHOC?
A: We are a comprehensive general emergency department and trauma center with an emphasis on pediatric and family-centered care. We have pediatric-friendly facilities including a pediatric waiting area and Child Life services, and we have the resources of a children’s hospital in our building and at our fingertips.

Q:  What inspires you most about the care being delivered here at CHOC?
A: CHOC is on the forefront regionally and nationally when it comes to patient safety and quality care, and that is not more evident than in the emergency department. I have worked in over ten emergency departments in my career, and I can safely say that the ED at CHOC at Mission is top-notch when it comes to timeliness and scope of care, facilities and staff.

Q: Why did you decide to become an emergency medicine physician?

A: During pediatric residency, I was particularly interested in high acuity care. I was deciding between neonatal/pediatric intensive care and pediatric emergency medicine. But I missed treating adults and the elderly, so I decided to pursue a second residency in emergency medicine. Now I get the best of both worlds, which is treating high acuity patients of all ages, with a particular emphasis on children.

Q: If you weren’t a physician, what would you be and why?
A: I would have become a music producer. I’ve always loved music and even dabbled as a disc jockey in college. I was never good at singing or dancing.

Q: What are your hobbies/interests outside of work?
A: Golf, family time, listening to obscure 80’s one-hit wonders, and sampling local microbrews.

Q: What was the funniest thing a patient told you?
A: An adage in pediatric emergency care is when a child comes in with a nosebleed, you don’t ask if he picks his nose, you ask him which finger he uses. When I asked this question to one of my pint-sized patients, he answered that he used all of them, and then proceeded to demonstrate by sticking each of his 10 fingers in his nose individually. It was priceless.

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Olympic Medalist Turned Physical Therapist

When athletes of any caliber come to physical therapy appointments, they often struggle with emotional hurdles as big as their physical challenges. Working with an expert who understands their struggles can make it easier to cope, especially when that expert is a former Olympian.

Robin Beauregard, a physical therapist at CHOC Children’s and two-time Olympic medalist in women’s water polo, understands the physical challenges that can sometimes stand in the way of achieving athletic goals.

olympics

“Having a career in athletics helps me establish a rapport with my patients, particularly my history with sustaining and overcoming injuries,” she says. “Sincere empathy creates a stronger bond than sympathy.”

Shortly before the team was named for the Sydney Olympics in 2000, the first time women’s water polo was to be recognized as an Olympic sport, Beauregard dislocated her knee and didn’t know if a recovery was possible. Distraught but determined, she committed fully to her physical therapy plan, as well as a rigorous conditioning program, and made the team. They’d win a silver medal that year, and a bronze four years later. She was later inducted into the USA Water Polo Hall of Fame.

Beauregard’s experience with physical therapy in the midst of her Olympic career ultimately played a big role in her professional career.

“I was not the perfect patient, but it prepared me for being a physical therapist because it gave me an idea of asking only what is reasonable of my teen and young adult patients,” she says. “I really do understand their worry of not being able to get back to the top level in their sport, but also weighing the risks of not wanting to cause further or permanent injury.”

Growing up in Southern California, Beauregard loved to be outdoors and was always active. Having an older brother who was also athletic made her competitive, too. She started swimming competitively for a local club team on her fourth birthday simply because her brother swam, and she wanted to be as a good as he was. Water polo came into play just four years later, and by age 8 she joined a competitive club team.

But when she got to high school, there was no girls’ varsity team. Instead of giving up on her passion, she simply joined the boys’ team instead. Playing with the boys didn’t faze her, or them, since they’d been competing together for almost a decade by that point. When opponents made comments about playing with a girl, she channeled it into her game and used it as fuel to play even harder.

olympics

After high school, she attended UCLA to play water polo, and originally planned on becoming an orthopedic surgeon. She later changed her path to physical therapy, which would ultimately give her a different kind of interaction with patients and athletes.

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Breastfeeding Resources for Moms in the NICU

By Crystal Deming, RN, lactation consultant at CHOC Children’s

Surgery, ventilators, central lines with IV nutrition, and medications are just some of the tools that can save and improve lives of babies in the CHOC Children’s neonatal intensive care unit (NICU). Yet some parents may overlook a mother’s own breast milk as lifesaving or as a medication as well. In the NICU, our mantra to new moms is “Your Milk is Medicine.” From the moment our families are admitted to our care, we begin the process of helping moms understand the value of their breast milk for their infant, giving them helpful information, necessary equipment and continual support from our multidisciplinary team, to help them produce and express breast milk for their own infant and to support breastfeeding when it becomes appropriate.

breastfeeding

Kangaroo Care

Our goal is to lessen the strain of separation by including families in the care team, by collaborating with parents and promoting their participation in the care of their infant. We initiate skin to skin contact, or Kangaroo Care, as soon as possible and have protocols to do this safely with even the smallest infants. Families later comment that this first experience holding their infant was a time of healing and bonding. This intimate interaction provides a break from the stress that can come with not being able to take your baby home from the hospital right away. Moms, babies and family members secrete oxytocin with this skin to skin touch and that gives them a sense of relaxation, wellbeing and promotes bonding. Skin to skin care often increases a mom’s milk supply, and we consider this holding the first step toward breastfeeding.

Assistance in Obtaining Breastfeeding Supplies

We can assist moms in obtaining a breast pump for home or connect them with a free pump to borrow, or help her submit a prescription to her insurance until she can obtain one of her own to keep. From hour one, we help teach hand expression and techniques to improve milk removal. Later we help moms maintain their milk supply, while supporting hydration and nutrition with our meal program, where some meals are provided free of charge when moms are in the hospital with their baby. We can also help with breast and nipple issues that can develop with prolonged pumping, as well as assist with storage when moms have a full milk supply but are waiting for their little one to grow into full size feedings.

Team Support

With developmental specialists, lactation consultants and specialty trained nurses, our team helps moms to adapt positioning and use tools to assist latching. We help moms learn the special behaviors of a premature or healing infant and to pace their feeding accordingly. Each mother/infant relationship is unique and our goal is to help families to have a fruitful and satisfying experience together. For some this can become exclusive breastfeeding and for others, partial breastfeeding that is neither stressful nor overwhelming. And for some we support their difficulty in producing milk while continuing to support skin to skin care and parental involvement in decision making and for the care of their infant in other ways.

World Breastfeeding Week

World Breastfeeding Week is an annual health observance recognized by more than 170 countries around the world, being celebrated this year from August 1-7. One of its goals is to show the importance of, “Good Health & Wellbeing,” and how incorporating breastfeeding has been shown to improve the lives of infants and children. Breastfeeding supports a baby’s health, development and even survival, but we also recognize there are health benefits for their mothers as well.

Learn more about the benefits of breast milk.

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Recognizing the Importance of Vaccines

By Jennifer Yen, clinical pharmacist at CHOC Children’s

August is National Immunization Awareness Month, an annual observance highlighting the importance of vaccinations in people of all ages. August is a great time to make sure everyone is up-to-date on their vaccines, as the summer starts to wind down and children prepare to head back to school. It is also a great time to start planning ahead to receive the flu vaccine.

The immunization schedule outlined by Centers for Disease Control & Prevention and supported by the American Academy of Pediatrics has been shown to be the most effective and safest way to protect your child from potentially fatal diseases. Other proposed alternative schedules have not been researched to show their safety or effectiveness. However, if any of the vaccines are delayed, your child is still able to receive them and “catch-up” before adolescence. Infants who have been vaccinated according to the schedule are protected from 14 diseases by the time they turn 2.

By getting your vaccination, you are not only protecting yourself, you are protecting those who are unable to receive vaccines, such as infants who are too young to start vaccinations and those with weakened immune systems who cannot receive vaccinations. Many vaccine-preventable diseases are still common in other parts of the world.

Don’t Forget Your Flu Shot

Flu season usually peaks between December and February, but can start as early as October and last as late as May. The CDC recommends a yearly flu vaccine for everyone 6 months of age and older, and encourages the public to receive one as soon as the flu vaccine becomes available to ensure that as many people as possible are protected before flu season begins. Check with your primary care provider if you should receive a total of one or two doses per season, dependent upon vaccination history.

Talk to your doctor or other health care professional to make sure you and your loved ones are up-to-date on vaccinations. Families who need help paying for childhood vaccines should ask their healthcare professional about the Vaccines for Children Program, which provides vaccines at no cost to eligible children who do not otherwise have access to recommended childhood vaccines.

Learn more about vaccinations and how they can protect your children and community.

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Beach Safety 101

Trips to the beach can be a great source of family fun, but be mindful of these safety tips before you head for the sand, courtesy of CHOC Children’s community education team.

Know Before You Go

Always check weather reports for the beach and surrounding area before heading out for a day of fun in the sun. Never visit the beach or swim in the ocean during extreme weather, such as thunder or lightning. Be aware of posted signs and warning flags, or ask the nearest lifeguard if you’re not sure what they mean. Try to set up your home base for the day in a spot that’s close to a lifeguard station. Brightly covered umbrellas can be an easy way for swimmers to spot your group’s location from the water, as well as offering added sun protection.

What to Bring

Everyone over six months of age should wear sunscreen whenever they’re outdoors, so be sure to pack enough sunscreen with SPF 30 or higher. Apply every two hours, and more often if you’re in and out of the water. Wide-brimmed hats and sunglasses can provide extra protection.

Drink plenty of water to avoid heatstroke. CHOC recommends that children drink the number of 8 oz. cups of water equal to their age. For example, a six-year-old should drink six 8 oz. glasses of water every day. Pack healthy snacks for added fuel.

Injury Prevention

Running and playing in the sand can be fun for both children and kids at heart, but always make sure to wear shoes at the beach. Hidden dangers in the sand like broken glass can ruin a fun beach day in no time, and on especially hot days, the temperature of the sand itself is enough to burn your feet. Some beachgoers using fire pits may inadvertently leave hot coals in the sand, which can retain heat and burn feet long after they were in use.

Swim Safely

The most common beach injuries occur in the water due to strong waves. Remember that swimming skills are different for the pool and the ocean, so even though you may be an experienced pool swimmer, in the ocean you could face strong currents, rip tides, and unpredictable conditions. If you are caught in a rip current, swim parallel to the shore until you get out of it, and then you can safely change course and swim towards shore.

If your child is not a strong swimmer, be sure they are wearing a U.S. Coast Guard Approved, properly fitting life vest and are under close supervision. Always use the buddy system when swimming and never go alone. Not all beaches are suitable for swimming, so be sure to check posted signage.

You might be sharing the water with ocean life, so be aware of animal life in the area you are visiting.

Hold off on swimming in the ocean with a cut or open wound, as it could lead to infection. Any abrasions must be closed and healing before you go in the water. Although rinsing small cuts or wounds with salt water is generally encouraged, the ocean’s water is not clean enough to get the job done. Instead, wait for any wounds to close before taking a dip in the ocean.

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Living with Arthritis: Carson’s Story

Seventeen-year-old Carson comes from a close-knit family of athletes and had been playing baseball for a decade when consistent, unexplained pain left his family stumped and looking for answers. Countless physical therapy and orthopedic appointments, plus endless X-rays, filled the next 18 months. When an MRI of his spine lead the radiologist reading his images to assume they were from a middle-aged person who’d played a lifetime of contact sports, rather than a 15-year-old boy, finally the family had a clue that Carson’s pain was not just an overuse injury.

At the time, pre-diagnosis, he was traveling a couple hours roundtrip every few days for orthopedic appointments related to wrist, elbow and shoulder pain.

He was ultimately referred to Dr. Andrew Shulman, a CHOC Children’s pediatric rheumatologist, and finally Carson’s family had the answers they’d been seeking for years. Carson was diagnosed with Juvenile Ankylosing Spondylitis, a form of arthritis that affects the spine and sites where muscles, tendons and ligaments attach to bones in the body. He was also diagnosed with Pain Amplification Syndrome, a condition in which patients develop abnormal pain sensitivity. The nervous system processes normal sensations from movement and environmental experience as pain signals. Carson’s family had never heard of Pain Amplification Syndrome before he was diagnosed.

“Dr. Shulman is such a powerful presence in my life,” says Carson. “The way that he explains things, he makes everything so much easier to understand. He relates directly to me.”

juvenile arthritis

Looking back as far as eighth grade, a lot of Carson’s issues were tied to this condition. He had tried everything from water therapy to hypnosis, but nothing was working. Then Dr. Shulman recommended acupuncture and Carson’s mom Andrea says Ruth McCarty, director of Chinese medicine and acupuncture at CHOC, was ‘unbelievable in getting Carson to a good place.’

Carson’s care team also includes physical therapist Robin Beauregard and pediatric gastroenterologist Dr. Mitchell Katz.

Carson’s family is also a key component of his care team.

“Dealing with these diagnoses is a team effort,” says Carson. “My dad carries me up the stairs when my Pain Amplification Syndrome flares up and I can’t walk, and I squeeze his hand during Humira injections. My mom helps me mentally, and she’s made this so much easier to manage. Dr. Shulman has given us a path forward.”

Despite still making his school’s baseball team while fighting a dual diagnosis, Carson could no longer cope with the week or two of pain that came with playing a single inning. Now he works out daily in a gym whether he’s experiencing a flare up or not, which helps with both diagnoses. To fill the void that competitive baseball left, he often plays catch with his friends and former teammates.

“Carson’s journey with arthritis is a powerful one. It speaks to the importance of diagnosing arthritis, and the outcomes we can achieve with therapy,” says Dr. Shulman. “His experience shows that multi-disciplinary care has been transformative.”

Learn more about rheumatology services at CHOC Children’s.

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The Importance of a Pediatric Surgeon

Children are not just “little adults” and when possible, should be treated by a physician who is specially trained in pediatrics. Their physiology is different, and since they’re still developing, their organs are not always in exactly the same location. In this episode of CHOC Radio, Dr. David Gibbs, a pediatric surgeon and the director of trauma services at CHOC, discusses:

Hear more from Dr. Gibbs in this podcast:

CHOC Radio theme music by Pat Jacobs.

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CHOC Patient Named Calif.’s Children Miracle Network Hospitals Ambassador

Eight-year-old Jordin has sickle cell disease, a disorder that means her red blood cells are misshapen, which can lead to reduced blood flow to many parts of her body, and frequent hospital stays at CHOC Children’s for pain management. But for her, it’s also been an opportunity to fundraise and raise awareness of sickle cell disease.

CHOC is proud to be part of the Children’s Miracle Network Hospitals family, a national network of corporate partners and programs whose fundraising allows CHOC to help kids like Jordin, and offer exceptional care and state-of-the-art treatments and technology for patients and families with the most complex needs in pediatric medicine.

Recently named a Children’s Miracle Network Hospitals Champion, Jordin will spend the next year traveling the country and raising awareness of the needs of children’s hospitals throughout the nation, including those of CHOC.  Each year, one child from every state is honored with this ambassador position.

Jordin’s ambassador tour kicked off with a trip to Washington, D.C. where Champions shared their inspiring stories to encourage charitable support for children’s hospitals, including attending Senate meetings on Capitol Hill. The end of her year as ambassador will conclude with a trip to Orlando, Fla. as the ambassadors reunite to thank and further inspire those who support the children’s hospitals the Champions depend on.

Jordin CMNH
Jordin’s family joined her on her ambassador tour to Washington, D.C.

Jordin’s history with CHOC runs deep. When she was 3 years old, Jordin was admitted to CHOC for complications of sickle cell disease. Her care team suspected acute chest syndrome, one of the most common causes of death in sickle cell patients. Due to technology constraints at the time, tests were sent offsite for evaluation and getting results could take up to a week.

As they awaited the results, Jordin’s family made a commitment to help other kids fighting sickle cell disease.

“During that week, we realized that we needed to step up and do something for CHOC, so no other families had to wait this long,” said Jordin’s mom, Karen.

Karen recruited family and friends with event planning, social media and fundraising experience to form Jordin’s Journey, a group of people dedicated to fighting sickle cell disease, and helping Jordin. They raised $32,000 to secure a Sebia Electrophoresis machine, which helps monitor and treat blood disorders efficiently at CHOC.

When she grows up Jordin wants to be a doctor so she can help other children the way she’s been helped.

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Tick Bites: Fact vs. Fiction

Tick bites can be a common summer nuisance depending on where your activities or travels take you. Parents should be aware of common misconceptions related to ticks, says CHOC Children’s pediatrician Dr. Katherine Roberts.

Parents can help prevent tick bites: Fact

There are several things parents can do to help their children avoid tick bites.

  • Stay on a path when hiking
  • Wear long pants, and tuck pants into long socks
  • On clothes, use permethrin spray. On the skin, use insect repellent with 30 percent DEET. Be aware that this generally only lasts on the skin for one to two hours, so reapply often if you’re spending extended time outdoors.

Remove ticks by lighting a match near the arachnid: Fiction

This age-old myth can lead to accidental injuries, says Roberts, and should always be avoided. Instead, dip a cotton ball in liquid soap, and soak the tick for one to two minutes. Then locate the head of the tick and use a tweezers to pull it straight out. If the tick  is still latched on to the skin,  hold the head of the tick straight out for 30-60 seconds and it will release from the skin. Then drop the tick into a jar of rubbing alcohol to eliminate it. If the tick is too small to grab with a tweezers, use a credit card or popsicle stick to slide it off the skin. Most tick bites don’t result in any symptoms or side effects, and removal at home is sufficient care.

Tick bites lead to Lyme disease: Rarely

The likelihood of contracting Lyme disease via a tick bite in southern California is extremely small, says Roberts.  There are many variations of ticks and only one- deer ticks, not commonly found in this region- transmits Lyme disease. Since deer ticks are tiny, they are easily missed.  Always do a full body check for ticks after going outdoors, and pay close attention to the head, neck and scalp, since ticks gravitate to those areas.

Consult your pediatrician if you cannot remove the tick in its entirety, or if your child becomes symptomatic. Lyme disease symptoms include fever, muscle aches, joint aches and headaches. If you were recently in an area known for deer ticks, most notably the northeastern United States or the upper Midwest, watch out for small red rings one to two inches from a possible bite site, which may be a sign of Lyme disease. Treatment includes one to two weeks of antibiotics, and most children make a complete recovery with no complications.

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