Thursday, October 22, 2009

Local Pediatricians Talk about Kids and H1N1

Last Friday was a very hectic day at Piedmont Pediatrics. Dr. Dennis Rustom blamed the H1N1 flu. “We are seeing some cases here, but mostly I have been spending my days talking about it, reassuring parents and discussing what to do if they see symptoms in their children.

“More people are getting the message now: If your child has a fever, even a low-grade one, have them stay home from school – and keep them home until they are symptom-free for at least 24 hours. Manage the coughing and aches and pains with Tylenol and Motrin, and keep them hydrated.”

Dr. Joshua Jakum, also of Piedmont Pediatrics, said that most children with flu will get better in a week or so, and don’t need to see the doctor unless there is labored breathing, a danger of dehydration because of severe vomiting or diarrhea, or if the child’s skin is very pale or blue-looking.

The teenage population is being hit hard, according to Dr. Rustom. “Teenagers tend to let things go. Parents don’t know they are sick at first. By the time we see them, they feel like they’ve been hit by a truck. With kids, just like adults, sometimes it’s ‘the bigger they are, the harder they fall.’ They can feel pretty bad, but they are coming out of it just fine.”

Both pediatricians strongly recommend that children get vaccinated when the vaccine becomes available in the next couple of weeks. (See for details on flu availability.)

Dr. Jakum acknowledges that there is a fear of developing Guillain-Barré Syndrome (a severe neurological disorder) or other side effects from the flu vaccine. He responded, “You are more likely to experience Guillain-Barré Syndrome as a result of getting the flu than from getting the vaccine. We’ve been making safe vaccines for many years and have a lot of data, a lot of experience with it. The H1N1 vaccine appears to be as safe and effective as any seasonal flu shot.”

Dr. Rustom added, “Some people are afraid that they rushed the vaccine out too quickly, without enough testing, but thousands of people have taken the vaccine with very good results. If parents are comfortable with the regular seasonal flu vaccine, they should not have reservations about the H1N1 flu vaccine. Get your kids vaccinated. The benefits far outweigh any possible negatives. I’m going to get it; my kids are going to get it.”

Other questions Dr. Rustom is answering in his office are about testing and about Tamiflu (an anti-viral medication that can shorten the duration of the H1N1 flu). “We have to be very, very careful about using Tamiflu. We are concerned that if it is used too much, the flu strain may become resistant to it and we won’t have it as a tool to use in the most severe cases. Some practices are giving it out like candy, but we are administering it only when there are underlying conditions, like neurological disorders, diabetes, cystic fibrosis or very severe asthma.”

Dr. Jakum agreed, “The danger is in using Tamiflu so much that we end up having a drug-resistant super bug on our hands. We need to reserve it for the highest-risk patients. Not all pediatric patients will get Tamiflu.”

The age of the child is also a factor in how the flu needs to be treated. Very young infants are in the high-risk category. Dr. Rustom said, “We had a 4-month-old baby we hospitalized and put on Tamiflu. The baby was completely fine within 24 hours and was sent home.”

Dr. Jakum confirmed that, “We are especially cautious with the little ones, up to 24 months old.”
As for testing, Dr. Jakum explained that the tests for H1N1 "can be inaccurate and we don't always test. Instead we rely on our clinical judgement."

Dr. Rustom said, “If you or your kids have the flu, assume it’s the H1N1 flu. Ninety-nine percent of the flu out there is H1N1.”

Drs. Rustom and Jakum agree that it’s hard for parents to see their children sick, and that worrying is natural. Dr. Jakum said, “A lot of parents want treatment for their children, but the best opportunity we have is prevention: Hand-washing, coughing and sneezing into a tissue or into the fold of your elbow, and getting vaccinated.”

Dr. Rustom concluded, “The healthier you are, the easier time you are going to have if you get the flu. As I tell my parents every day, “make sure your kids get enough rest, healthy food and exercise. A healthy immune system can fight this off in four or five days.”

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