6 Things Your Pediatrician Wants You to Remember in 2017

The new year is a great time to kick start healthy habits with your children that can be practiced all year long. We spoke to Dr. Reshmi Basu, a CHOC Children’s pediatrician, who offered the following tips:

pediatrician
Dr. Reshmi Basu discusses 6 things your pediatrician wants you to know this year.
1. Get your flu shot

If you haven’t received your flu shot this season, it’s not too late. Remember, the nasal flu vaccine is not recommended this season. The flu can make you much more sick than a regular cold and can have more complications, like pneumonia, so it’s important that everyone in the household over 6 months old receives it. If there is a new baby in the family, you can protect the baby by making sure anyone in contact with the baby has received the flu vaccine.

2. Wash hands often to keep germs away

Proper handwashing is especially important during cold and flu season. And remember to wash for at least 15-20 seconds and make sure to scrub between fingers and under nails.

3. Protect your child’s skin

During the winter it’s important to moisturize frequently throughout the day, especially after baths or showers, to treat and prevent dry skin. And, if you’ll be out in the sun, don’t forget the sunscreen. It’s best to apply it 15-30 minutes before sun exposure and reapply often.

4. Make well-child appointments and stay up-to-date on vaccinations.

 When children are young, there are frequent well checks with the pediatrician and these appointments usually include vaccines. As children get older (after 5 years old) and vaccines are not a part of every visit, it is easy to forget the well checks. They are still important, however, to see how your child is growing, how she is doing in school, and discuss any concerns. It’s also a good opportunity to get the flu shot (depending on the time of year) and make sure all other vaccines are up to date. Download CHOC’s  guide to making shots less stressful for kids.

5. Stay active.

The American Academy of Pediatrics recently lifted their rule on no screen time for kids under 2, with some limitations. Find time to be active. Make it a family activity– go on a hike, ride bikes together, or play in the park.

6. Read aloud to young children, starting at birth.

Try to read together for at least 15 minutes every day. Reading to your kids from a young age can help them with their speech development, communication skills, and even academic performance. And it’s a fun way to spend time together!

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When to See the Pediatrician This Season

As soon as the school year begins, pediatricians start seeing more infectious diseases because these illnesses are more communicable in a classroom setting. Poor weather enhances that communicability, so these ailments become even more prevalent during winter months. It can often be difficult for parents to decide which infections can be treated at home and which require a trip to the pediatrician.

We spoke with Dr. Michael Cater, a CHOC Children’s pediatrician, about what ailments parents should keep a close watch for this season, and how to tell when it’s time to make an appointment with their child’s doctor.

when to see pediatrician
Dr. Michael Cater, a CHOC Children’s pediatrician, offers advice on when to see the pediatrician this season.

Influenza season tends to pick up in late December or early January, Dr. Cater says, but its prevalence in the community depends on how many people get immunized. The Centers for Disease Control recommends that everyone over the age of 6 months receive an influenza vaccine. However, for this season, the nasal flu vaccine is not available.

Sometimes it is difficult for parents to decide which illnesses can be treated at home and which ones require a trip to the pediatrician. Dr. Cater offers tips on when it’s time to make an appointment:

  • Many infectious diseases in children are associated with a fever. If a fever of 100.4 degrees or higher lasts longer than three days, then a visit to the pediatrician is needed for future evaluation.
  • Labored breathing that doesn’t respond to home remedies. This could be an indication of a more serious respiratory infection.
  • If a child is vomiting and does not respond to dietary restriction.
  • Cases of diarrhea when the child doesn’t respond to dietary restrictions.
  • Sore throat associated with a fever and tenderness in the neck. This could indicate Strep throat, requiring antibiotics for the most effective treatment.
  • Ear pain in conjunction with an upper respiratory infection such as a cold, especially if the ear pain begins four or five days after the onset of the cold. This is highly suggestive of an ear infection, requiring antibiotics for the most effective treatment.

To avoid common infections this season, remember to get your family vaccinated against influenza, and practice proper hand washing technique. Children should wash their hands:

  • Before eating
  • After going to the bathroom
  • After blowing their nose
  • After playtime

Use hand sanitizer when you’re on the go and think your child may have touched something contaminated with germs, but use actual soap and water when you see dirt. Spend at least fifteen seconds vigorously washing hands front and back, and between the fingers.

Download this guide to personal hygiene to help prevent the spread of germs this season.

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How to Make Shots Less Stressful

Vaccines represent significant breakthroughs in medical research and disease prevention. When the Centers for Disease Control’s recommended immunization schedule is followed according to plan, it is shown to be the most effective and safest way to protect your child from potentially fatal diseases, according to Dr. Jasjit Singh, medical director of infection prevention and control at CHOC Children’s. However, the process of going to the pediatrician and receiving shots can be stressful, or even anxiety-producing, for young children.

A patient’s relationship with their pediatrician is important, and once you have found the right primary care doctor for your family, it can set the stage for their feelings toward medical professionals or clinical settings later in life. Studies show that preparing your children for vaccinations should ideally include three components: explaining what will happen, how it will feel, and strategies for coping with any related stress or discomfort. Follow these simple steps on how to make shots less stressful.

  • Be honest. Tell children their vaccines may be uncomfortable or bothersome for a second or two, and have them practice slowly counting to two seconds so they get a sense of how long that really is. Tell them what to expect at their appointment, and explain why the procedure is necessary and how it will help them.
  • Use Neutral Language: Request that the health care providers let your child know what will happen and when, using neutral language such as “we’re ready to start,” advises Marni Nagel, a pediatric psychologist.
  • Encourage them to ask questions. Remind them that they can ask any questions they want to of their doctor or nurse.
  • Time the appointment well. For babies and toddlers, scheduling the appointment around their bottle/feeding time may help. Receiving a bottle or feeding right after the shot may help soothe your baby.
  • For infants, engaging in at least 4 of the 5 S’s has been shown to reduce distress after immunizations, says Nagel. These include swaddling, placing on the side/stomach while holding, making shushing sounds, rocking, and sucking. Sucking can be done through breastfeeding, a bottle, or pacifier. For infants, dipping their pacifier in sugar water has been shown to decrease stress associated with immunizations. You can also talk to your doctor about breastfeeding during and/or after the immunization.
  • Topical anesthetics. Ask your pediatrician if topical numbing agents may be appropriate for your child.
  • Control your reaction. Children are increasingly observant as they get older, and they will take careful note of your reaction. Remain calm and be mindful of your demeanor, and it may help send a message to your child that they need not be stressed either.
  • Distraction techniques. These will vary depending on your child’s age and interests, but could include telling stories and jokes, looking at a picture book or finding a hidden picture like “Where’s Waldo,” or blowing bubbles.
  • Positive Rewards/Treats. Consider going out for ice cream, going on a special outing such as to the park or playground, or another small treat after your appointment to encourage good behavior, or to soothe your child.

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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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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New Vaccination Law: What it Means for Your Family

Echoing longstanding recommendations from the American Academy of Pediatrics supporting childhood immunizations, a new vaccination law in California eliminates the ability to cite a ‘personal belief exemption’ from mandatory childhood vaccinations. This means that in order to be enrolled in public or private child care centers,  preschools, primary or secondary schools, children must be vaccinated against the following  10 diseases: diphtheria, Haemophilus influenzae type b (bacterial meningitis), measles, mumps, pertussis (whooping cough), polio, rubella, tetanus, hepatitis B and chicken pox. We spoke to Dr. Katherine Williamson, a CHOC Children’s pediatrician, on what this new vaccination law means for children and families.

Dr. Katherine Roberts
Dr. Katherine Williamson

Q: What does California’s new vaccination law mean for children and families?

A: Some parents think that this means vaccines are now mandatory- but for decades, every state in the U.S. has required that children be vaccinated against certain diseases. This change means that personal belief exemptions to these long-standing mandatory vaccines can no longer be applied. It will make schools a safer place for children- those who are already healthy, and those who are immunocompromised. California is not an anomaly in creating a law such as this. Many other states have already adopted similar laws, and results in those places show that they’ve been successful in preventing outbreaks of vaccine preventable diseases.

Q: Why is it important for parents to follow the immunization schedule outlined by the AAP?

A: The current immunization schedule outlined by the AAP and Centers for Disease Control & Prevention has been researched and proven to be the most effective and safest way for children to be vaccinated against potentially fatal diseases. It’s important to know that there’s no existing alternative schedule that has been studied to show it’s as safe and effective.

I get frequent questions from expectant and new parents who are concerned about the number of vaccines given to kids at one time under this schedule. The amount of antigen in the vaccine that is put into their child’s body is 10,000 to 100,000 times less than if they just got a common cold, so there’s no chance of overwhelming their immune system.

Q: How do medical exemptions affect children through this new law?

A: Medical exemptions to vaccines are not common, but children that qualify would still be exempt, as they are immunocompromised, or in even less frequent instances, they have allergic reactions to vaccines. Children with medical exemptions will be in a much safer position because they won’t be surrounded by other kids who could pass on a fatal dose of measles, for example.

Q: How do vaccines fit into a patient’s overall lifelong medical care?

A: Vaccines and proper hand washing, more so than all other interventions, have proven to be among the most safe and effective ways to prevent disease.

Q: Is there anything else you’d like to share with parents about vaccines?

A: All diseases for which kids are vaccinated in U.S. have the potential to be fatal, and we still see instances of these diseases. While some are in higher rates than others, all have increased in frequency in areas where children are not vaccinated, and international travel makes even diseases such as polio a potential risk.

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The HPV Vaccine: A Pediatrician’s Perspective

By Dr. Shruti Vora, pediatric resident at CHOC Children’s

What is HPV?

Human papilloma virus affects nearly all sexually active men and women at some point in their lives according to the Centers for Disease Control and Prevention (CDC). Many people “clear” or fight off their infections within one to two years, never knowing that they ever had an infection at all. A percentage of people with the virus do not clear their infections and may develop genital warts, cervical cancer, head and neck cancers, and penile cancers.

What is the vaccine made of?

Scientists use a “virus-like particle” to make the HPV vaccine. It cannot cause HPV because it is not a portion of the actual virus. The serotypes (specific strains) responsible for the majority of cancers are HPV 16 and 18.  Ninety percent of genital warts are caused by HPV 6 and 11. All four serotypes are contained in the quadrivalent (four type) Gardasil vaccine. Gardasil 9, which covers nine additional strains, will soon be replacing the quadrivalent Gardasil, offering even better protection.

If HPV is transmitted sexually, and my child is not having sex, why do they need to get the vaccine?

The HPV vaccine is a preventative vaccine. Studies have shown that in patients who never had HPV, the effectiveness of preventing pre-cancerous changes to the cervix was 97-100 percent . This is why the vaccine is recommended in all girls before they begin to be sexually active. The vaccine is also known to be more effective when given at a younger age. It is recommended in girls 9-26 years of age.

My son is not at risk for cervical cancer, why should he get the vaccine?

The vaccine is recommended in all boys ages 9-21 years due to the fact that many head and neck, penile and anal cancers are directly linked to HPV serotypes 16 and 18. Vaccinating males can also help prevent cervical cancer in their female partners by reducing the rate of transmission.

I am concerned that my child will become sexually active at an earlier age because they received the HPV vaccine.

This is a common concern and actually has been studied multiple times. In the journal Pediatrics in 2012, doctors looked at the medical records of 493 girls who received the HPV vaccine and 905 who did not. There was no difference between the number of pregnancies, rates of sexually transmitted disease testing, or discussions regarding birth control between the two groups.

How do we know that giving the vaccine will not have any side effects?

The most common side effect has been pain and redness at the site of the shot. Fainting has also been reported as the second most common side effect, but the CDC has recommended some years ago for all patients to stay seated or lying flat for 15 minutes after the injection is given. This has greatly reduced the number of fainting spells and subsequent falls.

The HPV vaccine is a rare opportunity for you to make an investment in your child’s future and potentially prevent cancer in our young ones.  Ask your pediatrician about it.

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Childhood Vaccinations

To ensure maximum protection against diseases, children should receive vaccinations at the correct, recommended age, a CHOC Children’s infectious disease specialist tells Research 360,° a podcast highlighting research at the hospital.

In this segment, Dr. Antonio Arrieta discusses proper timing of vaccinations, dispels myths surrounding vaccinations, and details his current research at CHOC. Listen in to hear more about childhood vaccinations.

Hosted by Executive Director of Research Brent Dethlefs, Research 360° features interviews with scientists, physicians, educators, scientific news-and policy-makers to provide the listening audience with context, and scientific and social commentary intended to engage and inform.

Learn more about CHOC’s Research Institute.

Protect Your Child With Vaccinations

National Infant Immunization Week (April 21-28) is coming up, and highlights the importance of protecting infants from vaccine-preventable diseases. This important campaign is a call to action for parents, caregivers, and healthcare providers to ensure that infants are fully immunized against 14 vaccine-preventable diseases, such as influenza, hepatitis, pertussis, and more.

In the United States, vaccines have reduced or eliminated many infectious diseases that once routinely killed or harmed thousands of infants and children each year. However, the viruses and bacteria that cause vaccine-preventable disease and death still exist and can be passed on to people who are not immunized. These diseases result in doctor visits, hospitalizations, and even death.

To help protect your child, be sure to talk to your child’s pediatrician to ensure that your little one is up-to-date on his immunizations.

For a schedule of recommended immunizations for children from birth to six years old, from the Centers for Disease Control and Prevention, please click here: http://www.cdc.gov/vaccines/parents/downloads/parent-ver-sch-0-6yrs.pdf

For an adolescent immunization schedule, or to learn more, please click here: http://www.cdc.gov/vaccines/recs/schedules/default.htm

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Vaccines Are Necessary and Effective

An article published by the New York Times this week, reported that a new study found that although most parents believe that vaccines protect their children against disease, one in four think some vaccines cause autism in healthy children. Additionally, nearly one in eight have refused at least one recommended vaccine.

Vaccines are necessary — and effective, says Maria Tupas, M.D., medical director of the CHOC Primary Care Clinics. “For more than 50 years, vaccines have saved the lives of millions of children,” she says. “Most childhood vaccines are 90 percent to 99 percent effective in preventing disease. And if a vaccinated child does get the disease, the symptoms are usually far less serious.”

Dr. Tupas explains that the alleged link between the MMR vaccine and autism has been vigorously studied and disproved by extensive and well controlled studies, including those by the Institute of Medicine and Centers for Disease Control.  Current research on autism points to multiple factors, including the possibility of a genetic component or exposure to toxins or viruses during pregnancy. The increase in autism diagnoses may be at least partially attributed to pediatricians simply becoming better at recognizing symptoms at earlier ages.

As children with autism spectrum disorders benefit from early intervention and behavior modification, Dr. Tupas advises parents concerned about possible symptoms to contact their pediatrician.

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