Death from chicken pox declined 88%, from 4.1 in ten million people to just 0.5 per ten million.  The study by the CDC was published in the August 2011 issue of the AAP journal Pediatrics, comparing death rates in the early ’90′s (before introduction of the vaccine) to the mid-2000′s.

This improvement occurred with a single injection.  Subsequently, a 2-dose regimen has been introduced, because other research has shown that 5% of children don’t achieve proper immunity to chickenpox from a single injection.

So we can expect even better numbers, the next time the numbers are run!

–  David Epstein, MD

For decades, cough and cold medications were sold freely, over the counter.  Drug stores and pharmaceutical companies sold brands like Dimetapp, Pediacare, Delsym, Robitussin, and many others; there was a huge market for these medications, and companies competed fiercely.  They contained antihistamines, decongestants, and sometimes acetaminophen or other fever reducers.

Parents relied on these medications to suppress the cough and congestion from colds and viruses.   However, it’s been hard to prove that they actually work.  And there were so many kinds, and so many dosing regimens, that occasionally parents would be confused into administering an incorrect dose; on occasion, a child would suffer.

A few years ago, the FDA took these medications off the market for kids under 4 years old, citing the health risks and lack of proof of efficacy.  The FDA also discourages using the prescription version of these medications, although some are still available.

But if your child is suffering from cold and cough symptoms, some simple remedies can still help.

Run a vaporiser in the child’s room at night. (In winter, a steam vaporiser will make the room less clammy than a cold-water humidifier.)

Hot tea, especially with honey (buckwheat if you can find it), is helpful for cough.

And lots of fluids will help suppress a cough, and make a sick child feel better.

You can find more suggestions in this handout; click here to read more.

–  Dr. Epstein

The move is aimed at prescription medications that contain Chlorpheniramine, Brompheniramine, Phenylephrine, Dextromethorphan, Guaiafenesin, Pseudoephedrine, and a couple of similar ingredients.

I have prescribed these medications for my patients for many years, and never heard of any serious problems.  Unfortunately, they will no longer be available.  There may be other medications that I can substitute, but I suspect that they may be in short supply until their manufacturers can catch up with the demand caused by their competitors being knocked off the market.

This move does not affect the over-the-counter cold and cough medications still available that contain the same ingredients.  You can still buy Pediacare, Delsym, and several other medications that are sold to treat the symptoms of upper respiratory infections.  But the FDA also changed the labeling on these medications several years ago, to remove recommendations to use these medications for kids under 4.

To see the FDA’s list of newly banned prescription cough medications, click here.

To read my usual recommendations for treating the symptoms of the common cold, click here to be transferred to our practice website.

–  David M. Epstein, MD

Over a thousand mothers and their infants on an Indian reservation were studied.  Infants whose mothers received flu vaccines were 40% less likely to catch influenza themselves, and 40% less likely to be hospitalized for it.

The effect of fathers’ flu shots on the health of their infants was not studied, but one can assume that it would benefit the kids as well.

Since 1997, experts have recommended that pregnant women should be given flu vaccine.  But acceptance of this advice has been very slow.  Many of the families in my practice are happy to have the infants vaccinated, but the parents are reluctant to be vaccinated themselves.

But, as an accompanying editorial says: “Maternal influenza vaccination targets 2 high-risk groups with 1 vaccine dose – we can’t afford not to act.”  Perhaps this study will reassure these parents, and encourage them to get their own flu shots every year!

–  David Epstein, MD

Archives of Pediatric and Adolescent Medicine.  Vol 165, No. 2, Feb 2011, p. 104-111.

Here’s how the survey is performed.  Researchers associated with the CDC made random calls to thousands of households (73,000 for this survey), and asked the parents a series of questions about the health of members of the house.

Childhood ADHD was one of the conditions they asked about.  The researchers asked if the child had “ever” been diagnosed, if he was “currently” diagnosed, and if the child was currently on medication.  The survey data was based solely on these randomized calls; no medical records were examined, and no independent assessment of the patients were made.

This week’s newspapers are stressing the “9.5%” number.  Headlines say “One in ten American children has ADHD.”  But what does this mean?  The excitement stems partly from the perception of an increase; in the past, most studies have found that 5% of American children have ADHD.  Delaware’s numbers are the 4th-highest in the country.  But does this make sense? How could the rate of ADHD double in just 4 years?

Certainly, the sense of acceptance of a diagnosis of ADHD in parents and health professionals is increasing.  And treatment with medication is better accepted, due to shifting social acceptance, adn decreasing side effects and cost.

But frankly, I doubt that there has been an increase in the actual, biological prevalence of the symptoms of ADHD.  A close look at the CDC’s data supports such skepticism.  Although parents said that 9.5% of their children “had ever” been diagnosed with ADHD, only 4.8% were actually being treated with medication, a small increase from the 4.3% rate reported in 2003.

The 4.8% figure much more closely matches other studies, which have reported a stable 5% incidence of ADHD for many years.

Clearly, ADHD is a debilitating problem for a significant number of children.  Treatment with medication can give dramatic relief, in my experience and in many studies.  But I doubt that the CDC’s most recent report reflects an actual increase in the problem.

Click here to see the CDC’s data.

Click here for more information about how I diagnose and treat ADHD.

–     David Epstein, MD

The last thing you need is to be worried that jaundice in your newborn will make everything worse.  If jaundice is a concern, please have a look at this handout that I just posted.  Click here to read it!

–  David Epstein, MD

But medications can be expensive!  Your insurance plan’s drug benefit should help cover the cost, but sometimes there’s a problem.

If you arrive at your pharmacy and discover that your prescription is much more expensive that you expected, please have the pharmacy call us right away.  Perhaps we’ve prescribed a brand that your insurance company doesn’t cover.  Or perhaps there’s an equivalent medicine that works the same but costs less.   Or maybe the drug manufacturer has a “trial program” that would get you started at minimal cost.

We are quite happy to make a switch if we think it will work as well.  But we don’t know about the cost problem unless you tell us.   Don’t be shy!  Unfortunately, we can’t keep track of all the insurance formularies, because they’re all different.   And we don’t keep drug samples in our office.  But with the help of your pharmacist, we can find out which effective treatment will result in the lowest out-of-pocket expense for your family.

I’m always sad to hear that a family has decided not to purchase medication that I’ve prescribed because they can’t afford the cost, or that the family spent more than necessary.

Whether the medication is for eczema, asthma, ADHD or an infection, there’s almost always a way to make sure that you can afford your medication.   PLEASE call us before deciding that you can’t afford a medication that we’ve prescribed!

–  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

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

In order to stop the bleeding, a clot must form.  The quickest way is to have the child sit calmly, with the head tilted slightly forward (as if looking at the floor at the far end of the room).  Pinch both nostrils closed, and hold them closed for 10 minutes or longer, while the child breathes through his mouth.

Pinching the nostrils creates a closed cavity; the blood flows forward into the cavity and sits, forming a clot.

Do not tilt the head backward!  If you do, the blood will flow back, down the throat.  No clot will form, and the child will swallow the blood, which may cause a stomache upset.

Do not open the nostrils before waiting the full 10 minutes.  If you release the nostrils too early, the partly-formed clot dislodges, and the process must start again.

If the nosebleed does not stop within an hour or so, you may need to go to an Emergency Room to have the bleeding cauterized.  (Keep the head down and the nose pinched on the trip there – maybe the bleeding will stop!).

–  Once the bleeding has stopped, you can think about how this happened.

Was the nosebleed caused by a blow to the face?  If so, and if nasal stuffiness persists, the child should see an ENT surgeon within a few days.  (This might indicate a possible hematoma).   If the tip of the nose is pushed to one side (when viewed from the chin with the face turned up), there may be a dislocation (“broken nose”) that requires a visit to an ENT surgeon.  “Raccoon eyes” (bruising around the eyes a couple of days later) may also indicate a nasal fracture.

Are the nosebleeds recurrent?  You can can reduce the frequency and severity of nosebleeds by treating the child’s chronic hay fever, avoiding cigarette smoke, using a humidifier, and using saline drops in both nostrils twice a day.

Does the child always bleed from the same nostril?  If so, there may be a “bleeder” inside the nose that an ENT can cauterize.

If the nosebleeds seem severe, last excessively long, or are increasing in severity and frequency, please give us a call!

–  David M. Epstein, MD