Hot Topics

The Media overwhelms us on a daily basis when it comes to health information making it difficult for parents and families to decide what to believe. We at East Bay Pediatrics would like to offer reliable information on some of the topics which you may hear about in the paper or on the news.

From the American Academy of Pediatrics (AAP): Healthy Children.org | Protect Tomorrow

In the News: H1N1 (Swine) Flu | Tylenol Recall |   Vaccinations  | Medicine and the Economy  | Autism  | MRSA  | Testicular Cancer

Environmental Health Issues: Melamine  | Plastics (BPA and phthalates)  | Lead

prop 1D

HealthyChildren.org (added December 2009)

The American Academy of Pediatricds (AAP) recently launched HealthyChildren.org, an interactive website for parents.  It has compiled information on over 300 health care topics from AAP guidelines, policies, parenting books and patient education materials. Knowing that the information comes from AAP experts allows you to trust that you are receiving information from an accurate and up-to-date resource.

  • Find information related to any age from prenatal through young adulthood. There are topics on anticipatory guidance, safety and prevention, family life, healthy living, immunizations, common childhood conditions and more. 
  • The Hot Topics section contains frequent updates on current pediatric headlines whether it is a disease outbreak, a product recall or other AAP news. 
  • Customizable and interactive! Create an account (if desired) and enter the ages of your children. The site then customizes the main Web page with age-specific information and sends you a monthly newsletter, also with age-specific information. 
  • Tag information to your Facebook and social networking pages!

prop 1D

H1N1 (Swine) Flu (updated Dcember 2009)

H1N1 (swine flu or Novel Influenza) is a new influenza virus causing illness in people. This new virus was first detected in people in April 2009 in the United States. There is a lot of information from the media on this topic. The information below reviews some information about the disease, its spread, treatment and vaccination. We suggest these two sites in addition to the information below.

What is H1N1?

  • The H1N1 virus causes an influenza illness, often characterized by fever, body aches, cough or sore throat, abdominal pain, and headache.

How it H1N1 spread?
It spreads the same way that seasonal (human) flu spreads

  • germs can spread by infected people coughing and sneezing
  • by people touching their mouths, nose or eyes after touching an infected surface
  • infected people can spread the disease (are contagious) one day prior to symptoms and for up to seven days after symptoms start. Children may be contagious for even longer.
  • You cannot get H1N1 from eating pork.

How can we prevent the spread of H1N1?

  • The best way to prevent the spread of flu is to wash your hands! Warm soapy water prior to eating and after being in public areas can decrease your exposure to all viral illnesses.
  • Avoid touching your eyes, nose and mouth.
  • Teach your child to cover his or her cough.
  • Keep your sick child out of school until fever-free for 24 hours.

What should you do if your child gets sick?
The majority of those who are infected will have an illness with fever and the above symptoms and recover on their own. As with any febrile illness, if your child has a fever, he or she should stay home from school or day care until fever-free for 24 hours.
Our advice for when to see a doctor matches our advice for any other illness. Please call us (925)254-9203, option 6 for any of the following reasons :

  • Your baby less than 12 weeks old has a fever greater than 100.4 F (call any time of night)
  • Your child over 12 weeks old has a fever for three days or more
  • Your child’s fever returns after a 12-24 hour period.
  • Your child is not passing urine or making tears for more than 6 hours
  • Your child does not smile or show interest in playing for several consecutive hours

Generally there is no reason to rush to the emergency room. However, you should take your child to the emergency room or Call 911 for any of the following reasons:

  • Your child cannot speak while trying to breathe
  • Your child has blue or dark purple color to the nail beds, lips, or gums
  • Your child is not responding to you because he is tired or weak

How are patients with H1N1 treated?

  • Most patients with fever or cough do not need to be treated.
  • If your child has a fever, you may treat him or her with acetaminophen (Tylenol) or ibuprofen (Advil or Motrin).
  • DO NOT use aspirin if you suspect flu in your child. Aspirin can cause a liver complication called Reye's syndrome in children with influenza.
  • Treatment with medications such as Tamiflu (oseltamivir, available for children age 12 months and over) or Relenza (zanamivir, available for people over 7 years of age) is being restricted to hospitalized patients and those under the age of 5 who are at high risk of complications from the flu or those in close contact with someone at high risk. High risk patients include the very young, immunocompromised patients, and those with chronic medical problems such as asthma, heart disease, diabetes, and other medical problems. Anti-viral medications such as Tamiflu and Relenza may have severe side effects, particularly in children. In general, the CDC and pediatricians are not recommending the use of Tamiflu in otherwise healthy children.

Is there a vaccine for H1N1?

Because this virus is a new or “novel” strain of the flu virus, most people have little or no immunity to the virus. H1N1 Vaccine is recommended for anyone 6 months to 24 years of age. In particular, those who live with or care for infants younger than 6 months of age and those with chronic medical problems or a weakened immune system should be vaccinated.

H1N1 vaccine is being made in two forms: H1N1 flu shot and H1N1 flumist (nasal spray) form. H1N1 flu shots contain inactivated (killed) virus and can be given to children over the age of 6 months. H1N1 flumist contains live, attenuated virus and can be given to healthy children over the age of 2 years. Those with chronic medical problems (including asthma) should not receive the vaccine in the flumist form. Children under the age of 10 years need two doses of H1N1 vaccine in either form, at least one month apart. Older children only need one dose of the vaccine.

H1N1 vaccine in either form does not protect against seasonal flu. Children should be vaccinated against both seasonal flu and H1N1 flu. Children can receive both vaccines at the same visit but they cannot receive both of the flumist vaccines at the same time. After a dose of the mist form of either vaccine, children must wait at least 4 weeks prior to having any other live virus vaccines.

Vaccine against H1N1 is being distributed by the county public health departments. East Bay Pediatrics will update the flu vaccine page on this website any time vaccine is available.Contact your public health department for more information.

Is there a recall of the H1N1 vaccine?

Yes, there has been a recall of several lots of the H1N1 injectable thimerisol-free vaccine, the shot form of the vaccine for children under the age of 3 years AND several lots of the H1N1 flumist. See the CDC website for more information about the preservative-free shot recall or about the flumist recall.

  • Both recalls are not due to safety concerns, but to a potential lack of potency of the vaccines.
  • It is not necessary to determine which children may have received this vaccine since no action needs to be taken.
  • The only recommendation from the CDC is that children under the age of 10 years get a second dose of vaccine (same as the recommendation prior to the recall). If your young child has already received two doses of H1N1 vaccine, then nothing further needs to be done. If your child is under 10 years old and has received one dose of the vaccine, he or she should receive a second dose at least 4 weeks after the first dose. If your child is over the age of 10 years, no further doses are necessary.

sources: CDC guidelines, Dr. Gupta’s advice for parents on H1N1, and Children's Hospital Oakland Infectious Disease Control Unit

tylenol

Tylenol (updated May 2009)

McNeil Consumer Healthcare announced yesterday it is voluntarily recalling a number of OTC children's and infants' liquid formulations including certain Tylenol, Motrin, Zyrtec and Benadryl products. Generic forms and competitor brands (e.g. Advil) of these medications are not being recalled and are safe to use. Chewable and tablet forms are not being recalled and are safe to use. Chewable forms may be crushed and if necessary dissolved in a small amount of fluid.

The company said the reason for the recall is that some of the products may not meet quality standards.  Some of the products included in the recall may contain a higher concentration of active ingredients than specified; others may contain inactive ingredients that may not meet internal testing requirements; and others may contain tiny particles. There is very low likelihood of any adverse reactions in patients who have taken these medications, however he company urges consumers to discontinue use of the recalled products.

View the company website to determine if the medcations in your home are part of the recall: http://www.mcneilproductrecall.com and http://www.fda.gov/medwatch

Vaccines (updated April 2010)

Vaccinations have been a hot topic in the media for the last few years. East Bay Pediatrics supports vaccinating all children as recommended by the American Academy of Pediatrics (AAP) and the American Committee on Immunization Practices (ACIP). Our office policy on vaccines reflects our commitment to protecting children from vaccine-preventable diseases. The California Department of Public Health has recently issued two Health Advisories: one for measles and one for pertussis.

Since January 2010, nine cases of measles have been reported in California, as many cases as in ALL of 2009. Measles can affect any age group. It is characterized by fever and rash at the same time. Fevers may be as high as 105 degrees; the rash tends to spread downward from the forehead. Measles can be prevented by the MMR vaccine (measles, mumps, and rubella) which is usually given at one year and at 4 years of age. Those travelling outside of the country should check their vaccine status.

Almost twice as many pertussis (whooping cough) cases have been reported in California in the first quarter of 2010 compared with the same time period last year. There have been two infant deaths from pertussis in California in 2010: one each from Los Angeles and Fresno Counties. As has been the case with all pertussis deaths in California over the past decade, both were infants less than 3 months of age. The spread of pertussis can be limited by vaccination. Young children are vaccinated through the DTaP vaccine. Adolescents age 11 years and up and adults can be vaccinated with the Tdap vaccine. In particular, those in close contact with young infants should receive the vaccine.

Reliable resources on vaccines, their effects, and side effects are sometimes difficult to find in the media. Listed here are a few links to websites which may answer some of your questions about vaccines.

American Academy of Pediatrics In addition to policy on vaccines, the AAP's new Immunization Page contains up-to-date information on vaccines for parents. Or check out the Sound Advice audio information on the HealthyChildren.org website.

Centers for Disease Control and Prevention (CDC) The CDC provides Vaccine Information sheets (links available on our vaccine schedule page). The parent information page provides several articles on topics including understanding vaccines, questioning vaccines, myths about vaccines, and risks of not vaccinating.

Paul Offit Dr. Offit has written several books about vaccines and the myths which surround vaccines. Check them out at your local library or bookstore:

  • Vaccines: What Every Parent Should Know
  • Autism's False Prophets: Bad Science, Risky Medicine, and the Search for a Cure

Immunization Action Coalition The most thorough website in regards to the latest information on vaccines and safety. Check out Dr. Ari Brown's article Clear Answers & Smart Advice about your Baby's Shots. The Vaccines in the News section lists recent articles in the media regarding vaccines.

Parents of Kids with Infectious Diseases (PKIDs) can tell you more about preventing the spread of diseases, from handwashing to vaccines. This organization also provides support for parents whose children have fallen ill to certain diseases.

Vaccine Preventable Diseases Sanofi Pasteur has developed a comprehensive review of vaccine preventable diseases with information from the World Health Organization (WHO). Their brochure is available in our offices.

Medicine and the Economy

Medicine and the Economy (added April 2009)

The downturn in the economy is affecting all of us. Medicine is much more entwined with the economy than in the past because of the rising cost of health care, health coverage and employer-based health insurance. Many employers are choosing less expensive health care plans which may not cover health costs, including preventive care and vaccines for children. Those who lose their jobs may not be able to afford COBRA coverage or may need to change to individual coverage plans.

East Bay Pediatrics strives to continue to provide comprehensive health care to all of our patients. We offer several options for families with financial limitations and would like to remind you of those services here. Please contact our business office if you have any questions at (925)438-1100 option 8.

  • claim submission As always, our business office submits claims to your insurance so that you don't have to. If you are owed a refund, you will be notified at your next visit.
  • assistance with claim disputes Our business office automatically disputes some unpaid cliams. If you have a dispute regarding a claim to the insurance company, our business office can offer you advice, including conference calling with you and the insurance company to help you get your questions answered and your claim processed correctly.
  • payment plans If you cannot afford to pay for your child's health care at this time, we are willing to set up a payment plan that meets your needs. Please notify the business office as soon as possible if you are having financial difficulties. We will do our best to make payments easier.
  • negotiations with insurance companies The physicians of East Bay Pediatrics are continually communicating with insurance companies to establish reasonable payment for services. We are currently in negotiation with Blue Cross PPO, the only major provider with whom we are not contracted.

MRSA

Autism (updated April 2009)

The diagnosis of Autism Spectrum Disorders (ASD) now ranges from severe autism (non-communicative, fully dependent, sometimes combative) to mild autism (able to function in mainstream school and work with some behavioral intervention) and includes disorders such as Asperger's syndrome and Pervasive Developmental Disorder (PDD). These are lifelong diseases with no cure. Briefly, autism is a disorder of social, emotional and communication skills. Patients with autism may not show affection, may not look at something when you point to it, or know when to speak during a conversation.

We don't know what causes autism: research continues to try to reveal why the rates of autism specturm disorders are increasing. (See the above section on vaccines to learn more about why we don't think vaccines are the cause of autism.) We do, however, know that some interventions can help a child with autism spectrum disorders be more successful in society. Early detection is key to assisting children and families with coping with the disorder. Our practice offers the screening tool M-CHAT at the 18 and 24 month well visits. If you are worried that your child is losing developmental milestones or has difficulty with non-verbal cues such as pointing, making eye contact or showing affection, speak to your doctor. You do not need to wait for your next scheduled well visit.

Resources for Autism Spectrum Disorders:

  • American Academy of Pediatrics (AAP) Refer to the AAP website page on autism for parent-friendly information about the disorder. The page includes a fact sheet on Autism published by the CDC
  • Regional Center The Regional Center of the East Bay (RCEB) serves both Alameda and Contra Costa Counties. It offers evaluations and services for children with developmental disabilities including Autism and Autism Spectrum Disorders. You can contact them yourself or have your physician refer you to the Regional Center for an evaluation.
  • Children's Hospital Autism Intervention (CHAI) Children's Hospital Oakland provides an autism intervention center which provides individual and group services for children with autism spectrum disorders under the age of three years. They can be referred through the regional center, the school district, or the caregiver.
  • Quest Camps The Quest Camp offers a safe setting for children with behavioral, emotional or social difficulties.
  • Music Therapy Behavioral intervention comes in all forms. We have a local music therapist who specializes in children with autism.

MRSA

Testicular Cancer (added April 2009)

Testicular Cancer made a big hit in the media when biking expert Lance Armstrong was diagnosed and treated for the disease then continued on to win the Tour de France (again). This disease affects young men mostly age 18-40 with a tendency toward the younger age group. The disease is asymptomatic so testicular self exam is essential to early detection and treatment. Testicular exam by a physician is part of the routine physical. We also teach teens how to perform a testicular self exam. WebMD offers a useful guide to testicular exams for young men.

Testicular Cancer

Melamine

Some infant formulas in China were found to be contaminated with melamine, a component of certain types of plastics. This chemical may have caused renal failure and even death in some children in China. Formulas in the United States have not been found to contain this chemical and should be safe to feed your child.

The Pediatric Environmental Health Specialty Units (PEHSU) are regionally based environmental health experts who are the most reliable source of information regarding environmental health issues in children. The unit for our region (includes California, Arizona, Nevada, Hawaii and the Pacific Islands) is based here in San Francisco. Their fact sheet on melamine may help to clarify who is at risk and what foods may be contaminated.

Plastics (BPA and phthalates)

Plastics contain Bisphenol A (may have estrogen effects) and phthalates (may have anti-androgen effects). Both of these chemicals are found in many other products (phthalates are in products such as lotions) and levels are rising in the human population. There are no regulations about either of these chemicals but many companies are producing consumer goods which are Bisphenol A-free (BornFree baby bottles) and phthalate-free (California baby). Hard, clear plastics have more Bisphenol A and items which are more scratched up (your old Nalgene bottle) or are microwaved are more likely to release the chemical.

The Pediatric Environmental Health Specialty Units (PEHSU) are regionally based environmental health experts who are the most reliable source of information regarding environmental health issues in children. The unit for our region (includes California, Arizona, Nevada, Hawaii and the Pacific Islands) is based here in San Francisco. Their fact sheet on plastics may help to clarify the risks and how to protect yourself and your child.