But pressure against these videos has continued to mount.  Disney, who bought Baby Einstein in 2001, calls the bad publicity a “smear campaign.”  But on September 4th, as reported this week on the New York Times front page, the Campaign for a Commercial-Free Childhood convinced Walt Disney Studios to offer a full refund.  The refund applies to any Baby Einstein DVD purchased after mid-2005.  Return your DVD, and get a check for $15.99 – no questions asked!  You don’t even need the original receipt, or even the box.  Just mail in your Baby Einstein DVD before March 4, 2010.

To download the refund form, click here. Or go to the Baby Einstein website, and search for “einstein moneyback;” the link for the refund form will be on the right-hand side of the page.

Remember that the American Academy of Pediatrics still recommends that there’s no reason to turn on the TV at all, for children under 2 years old; and for kids over 2, limit screen time to 10 hours a week.

–  David Epstein, MD

People ask if I recommend the Swine Flu vaccine.  Yes, I certainly do!  When we receive it, I’ll administer it to my staff and myself (at the direction of the Division of Public Health).  Then we’ll offer the vaccine to our most frail patients (with cerebral palsy, chronic lung diseases, etc).  Then we’ll invite you to schedule an appointment to receive it.

Just as for the regular “seasonal” flu vaccine, there will be a nasal mist Swine Flu vaccine, as well as shots.  We’ll offer these to our patients as we receive them.  I doubt that we’ll receive our entire allotment at once, so some patients may have to wait to receive it.

Are you worried about the vaccine?  Please be reassured.  The H1N1 vaccine has been tested on thousands of patients already.  The manufacturing processes are the same as for the “regular” seasonal flu vaccines.  So the new vaccines can be expected to give the same immunity, and the same low chance of side effects, as the vaccines against “regular” flu.  And we are certainly seeing cases of H1N1 flu in the office (perhaps two cases a week now), so it’s a good idea to get immunized.

–  David Epstein, MD

We are able now to vaccinate all our patients against seasonal flu, regardless of insurance.  (The only exception is for Medicaid patients between 3 years and 7 years old who have asthma; that vaccine is still back-ordered.)

I invite you to call our office (392 – 2077) and speak to our staff to schedule a convenient appointment.

–  Dr. Epstein

For patients with “Commercial” insurance (Blue Cross, Aetna, Coventry, etc.): we have all “regular flu” vaccines:
-  shots for all children under 3
-  nasal spray for all children over 2 (EXCEPT those with asthma)
-  shots for all children over 3 (INCLUDING those with asthma) (This is *new!* as of 9/25/09; so if we delayed giving flu vaccine last month because your child has asthma, NOW you can call us to schedule a flu shot.)

For patients with “Medicaid” insurance (Delaware Physician’s Care, Unison, etc.):
-  We have flu vaccine ONLY for patients over 8 years old (healthy or asthmatic).  I will post a note here when they are delivered; we hope to have them by Halloween.

“Swine Flu” (Novel H1N1) vaccines:  As of 10/7/09:
-  NO vaccines yet.  They will be delivered in shipments spread across many weeks.  The CDC is just starting to distribute Swine Flu vaccine to hospitals.
-  Eventually we will have both nasal vaccines and injections
-  “High Risk” patients will be vaccinated first
-  I will post a note here when they are available, we hope by Halloween.

We are able to immunize most of our patients against “seasonal” (regular) flu.  We have been immunizing kids under 3 with flu shots since mid-August.  We are also able to immunize most kids over 2 with the nasal “FluMist,” except kids with asthma; we can give them flu vaccine injections.

Separate vaccinations against both regular flu and Swine Flu are needed for the best protection.  I strongly recommend that all patients receive flu vaccine, both “seasonal” and H1N; parents should also be vaccinated if possible.

Currently, physicians are being asked to “prioritize” testing for the H1N1 flu virus.  In general, we are advised not to run tests unless the patient is sick enough to consider hospitalization.  If we test everyone with fever, the labs will be overwhelmed, which will delay really sick patients from getting test results.  Also, not every case of Swine Flu must be treated with Tamiflu.  There is concern that overuse of antiviral medications like Tamiful may induce the Swine Flu virus to mutate and develop resistance.

Some patients have asked about taking the children out in public.  But I don’t think it’s necessary to “huddle” at home.  Only a general curfew would be effective at curbing transmission; most people who contract flu (H1N1 or regular) will recover anyway; and in the meantime we have to live our lives.  Kids need social stimulation too!  Frequent hand washing (or hand sanitizer) is your best protection.

–  Dr. Epstein

So far, Swine Flu hasn’t seemed very serious.  Most cases have recovered fully; fewer than 500 people have died from it in the US so far this year.  This is a remarkably low number, considering the high rate of transmission.

But the concern is that if the Swine Flu virus mutates into a more virulant strain, but retains its high contagiousness, things could get much worse.  This is what happened during the 1918 pandemic of H1N1 flu, which killed 100 million people (5% of the world’s population).

Our medical care is certainly better than it was in 1918, and we hope that another pandemic like 1918’s would not be as lethal.  We now have antiviral medications, better hospitals, antibiotics, and better worldwide communications.  But we are not completely protected:  strains of Swine Flu resistant to antiviral medications have been reported.  And many people in the world have never seen a doctor and can’t get to a hospital at all!

I recommend that everyone get a flu vaccine.  Adults should get them, for their own protection and so that it doesn’t spread to the kids.  Kids should get them, for their own protection and so it doesn’t spread to their friends and classmates.

Flu shots are routinely given to kids 6 months and older.  (Nasal spray vaccination is a nice alternative for kids over 5 years old who don’t have asthma.)  Two vaccinations, one month apart, are required if you’ve never had flu vaccine; one vaccine per year is required after that.  This year, vaccine against Swine Flu will be administered separately; we probably won’t get ours in stock until Thanksgiving according to the Delaware Division of Public Health.

Never had a flu shot?  This year is a good time to start!  Afraid of the flu vaccine?  There’s no reason to be; people who claim that the “flu vaccine made me sicker” are usually confused by a coincidental illness unrelated to the flu vaccine.

Keep checking my website (click here); I’ll keep posting updates about flu vaccine and Swine Flu.

–  David Epstein MD

Everyone is concerned.  However, worldwide, fears of a global “pandemic” are starting to recede.

For the latest information about the status of Swine Flu in Delaware, click here to go to the Medical Society of Delaware’s website.

For information about the symptoms and medical care of Swine Flu, click here to go to the CDC’s website.

Without fever, there’s not much concern about Swine Flu.  Don’t forget that most kids with fever have something else!! Our office is still seeing several kids a week who have been sickened by Strep Throat, for example, which is treatable with standard antibiotics.  Viral tonsillitis is also giving our patients high fevers as well; these kids get better in a few days with supportive treatment.

Some patients have asked to stockpile Tamiflu at home.  I urge my patients to resist this temptation.  I am very concerned about the flu bugs developing resistance to our medications (which they do very easily).  The Tamiflu should not be administered without a good indication, such as a close eposure to a sick child with culture-proven flu.  Exposure to a sick child who has not been tested, no matter what country they’re from, is not a good indication for starting Tamiflu.

But our office does have the ability to obtain nasal swabs for Swine Flu testing, for transport to local laboratories.  Please call if you are concerned about your child.

–  Dr. Epstein

Now, a review article in the AMA’s pediatrics journal (April 2009) reassures us that pacifiers may be okay for breastfed babies, after all. 4 randomized trials were reviewed; babies were assigned to the “pacifier” or “no pacifier” groups. All four studies showed no effect of pacifier use on breastfeeding outcomes. In fact, more than half of babies in the “no pacifier” groups actually were given pacifiers by their parents, but these babies breast-fed just as well.

In several observational studies, babies not using pacifiers did breastfeed somewhat more, but the authors speculate that this might be due to family attitudes towards breastfeeding, rather than an effect on breastfeeding by pacifiers. That effect would be difficult to distinguish with this type of study, which is why the randomized trials carry more weight.

Why does it matter? The American Academy of Pediatrics recommends that babies should be offered a pacifier for naps and sleep after 1 month of age (after nursing is established), for the first year or so of life. (Some studies suggest that pacifiers during sleep might reduce the chances of SIDS, although this is not definite.)

So now I feel comfortable reassuring parents that it’s ok to use pacifiers when their infant sleeps. I still recommend that an alert but fussy infant should be offered a feeding before giving a pacifier, to encourage on-demand feeding. And in any event, the use of pacifiers (and bottles) should be ended by 15 months.

(Archives of Pediatric and Adolescent Medicine 2009; 163(4): 378-382)

– David M. Epstein, MD

A new program to improve the nutritional quality of food, and to further promote breastfeeding, has been put in place this year.  Delaware’s Department of Health and Human Services is one of the first states to implement the new program.

Are you interested in the program? or do you think your family might qualify?  Click HERE to see Delaware’s WIC program website.  For information about the federal funding, click here.

–  David M. Epstein, MD

There is no doubt that physicians should prescribe steroid medications carefully.  However, I am not convinced that these studies should alter our standard treatment for wheezing and allergy in children.

One study enrolled 687 children younger than 6 years old, admitted to hospitals in England for wheezing.  Those who received prednisolone (Orapred and other brands) stayed in the hospital 11 hours on average; those who received placebo stayed 14 hours on average.  There was no difference in side effects.  The authors concluded, despite the 20% reduction in hospital stay, that the prednisolone was unnecessary.

These results are puzzling.  Typically, young children might wheeze from asthma, or from a viral infection.  Many previous studies have found a big benefit from using prednisolone to treat wheezing children with known asthma, often quickly relieving their breathing difficulty.   However, the benefit is less clear for children wheezing due to a viral infection.  In my practice, I have found that prednisolone in short courses is effective in reducing wheezing in some, but not all children.  Side effects have been minimal.  I will prescribe it sometimes, if there is a family history of asthma, to try to keep a child out of the hospital.

I am concerned that this study lumped these two groups of wheezing children together, diluting the apparent benefit of the short course of prednisolone.  Steroids have been used for decades as a safe and effective treatment for asthma-related wheezing, when carefully used along with albuterol and other treatments.  Further research might show a diminished role for steroids in the future, or find better rescue treatments for children with asthma attacks, but the weight of evidence still leads me to feel comfortable treating asthmatic children with prednisolone for wheezing and difficulty breathing when necessary.

The second study, performed in Canada, enrolled 129 healthy toddlers and preschool children to receive 10 months of either high-dose inhaled fluticasone, or placebo, hoping that the fluticasone would prevent wheezing.  It did; wheezing severe enough to require oral steroids was reduced from 18% to 8% of children.  However, children receiving fluticasone gained less weight (1 pound) and less height (1/4 cm).  The authors concluded that the benefits of preventative high-dose fluticasone might not outweigh the risks.

I agree with their conclusions, as far as they go.  High dose fluticasone appears to carry potential risks of slowed growth.  However, the study used doses of fluticasone that are 4 to 8 times higher than the standard doses of Flovent, Flonase and Veramyst that we use in children.  Previous studies, with larger numbers of children over longer periods of time, have shown minimal or no measurable effect on height growth from daily use of the usual doses of steroids.  This study does not persuade me to avoid using standard doses of fluticasone and other steroids for children who need them.

No medication should be prescribed without weighing the potential benefits against possible side effects, and discussing them with the family.  And further research may change expert opinion.  But as things stand now, I remain reassured that our usual, standard treatment of asthma and hay fever remains safe and effective, when used properly.

–  Copyright 2009,  David M. Epstein MD

Some people wonder if vaccination for chicken pox is necessary at all, since many cases are mild and self limited.  Unfortunately, there are some children who suffer severe or permanent damage from the complications of chicken pox.  And public health experts point out that the cost to society of the parents’ lost days from work and school, to care for a week-long contagious illness, adds up over an entire population!

– David Epstein, MD