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

We’ve only received 100 doses of the shot for infants and toddlers so far.  We hope to have further shipments soon, so that we can vaccinate everybody, but it’s possible we’ll run out temporarily.  Remember that you need 2 doses (at least 3 weeks apart) for the best immunity (estimated at 85%), but the first shot gives some useful protection (estimated at 75%).  So we’ll try to give everybody the first dose before we start giving boosters.  Once we have received enough vaccine, we’ll start administering the boosters.

We have also received a second shipment of the H1N1 shot for older kids (with preservative).  So now we have enough H1N1 vaccine to vaccinate all our high-risk patients for their first vaccine.  If your child has asthma (or other high risk illness), you should be on our schedule now to receive the first dose.  I’ll post a note here when we have enough for boosters.  We now have enough seasonal flu vaccine for all our patients as well; all kids should be given both.

To give you some perspective, Delaware Modern Pediatrics has received only 300 of the 2300 doses of H1N1 we ordered for our patients.  Obviously, supplies are still tight.  This is not the fault of the Division of Public Health; the manufacturing process for flu vaccine is antiquated and slow.  We have similar supply problems with the seasonal flu vaccine in most years (though not this year); but the shortages haven’t been as noticeable because demand for flu shots has never been this high.

Should you have your kids vaccinated through school?  Yes, absolutely, if you can!  The only exception is for kids with asthma (or other serious underlying disease) who are being offered only the nasal flu vaccine at school; those patients should be given the injection (available through our office for our current patients).

Should you sign your child up?  Yes!   If the school is ready to give your child a flu vaccine, I recommend that you participate.   We expect to have the vaccine in stock also, but I don’t know when it will be delivered.  If you’d prefer that we administer it instead of your school’s nurse, we’ll be happy to help.  (I’ll post a note on the blog when we get it in!)

The Swine Flu nasal vaccine probably will be delivered before the injections.  The live nasal flu vaccines are perfectly appropriate for any child over 2 years old, if they don’t have asthma (severe enough to have 4 attacks a year or more, or needing daily asthma medication.)

–  David Epstein, MD

If we were not able to give your child (under 2) seasonal flu vaccine because we were out of stock for the past couple of weeks, you may now call to make an appointment and get caught up!  I encourage everybody to get vaccinated!

–  David Epstein, MD

You might have heard stories:  “I got a flu shot once and I was never so sick!”  This is absolutely an old wives tale.  You cannot contract the flu from a flu shot;  and getting a flu shot certainly protects you from getting influenza.

Unfortunately some people get confused by terminology.  People sometimes call any illness “the flu.”  A stomache bug, allergies, a head cold, any fever … any of these might be called “the flu” or “flu-like symptoms” by a non-medical person.  Obviously flu shots won’t help protect against these illnesses.

But true influenza, type A, B, or H1N1, which goes around the world every year, is different.  The flu shots (and the nasal mist vaccine) certainly protect you (and your child) from getting Influenza.  They have very few side effects, other than some low grade fever or muscle aches for a day or so.  So there’s no reason to stay away from them.

Some people have expressed fear about the H1N1 (Swine Flu) vaccine, because they think it’s “new.”  In fact, the vaccine manufacturing process is the same as for the regular (“seasonal”) flu vaccines, for both the shots and the nasal mist.  So the side effects may be expected to be the same.

So, get your flu shots!

–  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

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