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Posts for tag: Cough

By contactus@priority-pediatrics.com
November 06, 2018
Category: Treatments
Tags: Cough   colds   medicine   honey   cough medicine   Vicks Vapo Rub  

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By Perri Klass, M.D. of the New York Times

 

Parents are often disappointed or even a little bit upset when I tell them there’s no medicine to help their coughing, sneezing, drippy-nosed children feel better. There’s nothing that works, I say, and medicines can have bad side effects. We don’t recommend any of the cough and cold medications for children under 6.

But after all, parents are intimately aware of just how miserable a cough and a runny nose and congestion can make a small child feel, from cranky days to disruptive nights.

And often there is something both comforting and familiar about those over-the-counter medicines, which figure in many parents’ memories of their own sick days way back when. “They all took these medications themselves, there’s a comfort in knowing that,” said Dr. Ian Paul, a professor of pediatrics at Penn State College of Medicine.

In a new review in The BMJ, researchers considered evidence on whether a variety of over-the-counter cough and cold medicines are effective for treating runny nose, congestion and sneezing, as well as the question of whether they can do harm.

“Parents are always worried that something bad is happening and they have to do something,” said Dr. Mieke van Driel, who is a professor of general practice and head of the primary care clinical unit at the University of Queensland in Australia, and was the first author on the study. As a primary care physician herself, she said, she is well aware of the urgency that parents feel to find something that will relieve their children’s distress.

“Unfortunately, our research shows there’s very little evidence,” she said, and especially in children, “we were actually quite amazed by how little there was — hardly anything to be enthusiastic about.”

In addition to understanding that there is no evidence that these medications help, Dr. van Driel said, parents need to understand that there are clear risks in using them in young children. The Food and Drug Administration originally recommended against any over-the-counter cough and cold preparations in children under 2; the American Academy of Pediatrics has extended the recommendation to apply to all children up to 6. And after manufacturers voluntarily withdrew products marketed for infants, and changed labels to recommend against use in young children, researchers found a drop in children coming to emergency rooms for problems with these medicines, which in past studies ranged from hallucinations to cardiac arrhythmias to depressed level of consciousness.

When it comes to the sniffles or the cough associated with the common cold, “these symptoms are self-limited,” said Dr. Shonna Yin, an associate professor of pediatrics and population health at N.Y.U. School of Medicine. Parents can help comfort their children without giving medications, she said, offering plenty of fluids to keep children well hydrated, and honey for a cough in children over a year old (no honey for babies under a year because of the risk of botulism). Other measures may include ibuprofen or acetaminophen for fever and saline nose drops for congestion.

Our 2007 study was the first to show that honey was more effective than dextromethorphan” — a common cough suppressant — “or no treatment,” said Dr. Paul. Since then, other studies have shown that honey does relieve cough, and the accompanying sleep disturbance. Organic agave nectar, on the other hand, had only a placebo effect, said Dr. Paul, who noted that over the past 10 years, he has consulted for many of the manufacturers of these medications, and carried out studies funded by them.

“The bottom line,” he said, “is that for all of the over-the-counter cough and cold medications, there is limited to no evidence of efficacy for any cold symptoms, particularly in those under 6 years.”

Studies have not shown that cough suppressants help children cough less, or that antihistamines and decongestants help them sleep better. Medicines which can help a child with a runny nose from seasonal allergies won’t help that same child when it’s a cold virus making the nose drip; the underlying mechanisms are different.

Even for older children and adolescents, Dr. Paul said, the evidence of efficacy is not strong for most of the ingredients in cough and cold medications, and there is always the danger of side effects, particularly when the medicines are taken in too-large doses, which can happen because there are so many different preparations, with so many different combinations of drugs.

Dr. Yin is working on a project funded by the F.D.A. to improve the labeling and dosing instructions on children’s cough and cold medications; so far, she said, the research has shown that parents in the study population are confused about the intended age ranges of the medicines, about the active ingredients, and about dosing. Many of these preparations contain several different drugs, including a cough suppressant, a decongestant, an antihistamine and a medicine for pain and fever.

“In my own practice, I reassure them, I check the child, I make sure I’ve covered the ears, the lungs, the throat,” Dr. van Driel said. “I reassure the parent, this is a cold, a cold is a self-limiting disease, we have capable immune systems that will take care of it, it will take about a week.” People need to feel confident in their bodies, she said, instead of relying on medicines. “I would tell them, there’s not a lot we know that helps. Don’t give him anything you might give your older child or take yourself,” said Dr. van Driel.

And of course, we always tell parents what to watch out for, symptoms that might suggest that something more than a cold is going on. Any respiratory difficulty in a child has to be taken seriously, so a baby who is breathing too fast or a child who is working harder than normal to breathe should be checked out. High fevers are concerning, as are any of the signs of influenza, such as shaking, chills and body aches; influenza in children can be treated with antiviral drugs — and prevented with flu shots.

 

Children with the “common cold,” on the other hand, should generally be able to eat and drink, should be alert and able to play — or at least, susceptible to distraction. “It’s unfortunate because the illnesses are so common, young children and babies suffer, parents miss work — but we’re no further along than we were 60 years ago,” Dr. Paul said. “We still don’t have good therapeutics for the common cold.” So read stories, bend the screen time rules, boil up the chicken soup.

“If you give people information and tell them what to expect,” Dr. van Driel said, “they generally accept that they don’t need medication.”

By contactus@priority-pediatrics.com
August 23, 2018
Tags: Cough   Influenza   immunizations   Vaccines   DTaP   Tdap   Pertussis   Whooping Cough   DTP  

Whooping Cough, Claimed the Life of a San Bernardino County Infant

 

The California Department of Public Health (CDPH) announced [Tue 17 Jul 2018] pertussis, better known as whooping cough, claimed the life of a San Bernardino county infant. This is the 1st confirmed infant death from the disease since 2016, when 2 deaths occurred.

 

"This baby's death is a tragedy for the family and for California as a community, as this is a preventable disease," said Dr Karen Smith, CDPH director and state public health officer. "This serves as a grim reminder that whooping cough is always present in our communities, and immunizations are the 1st line of defense."


What whooping Cough looks and sounds like: https://www.youtube.com/watch?v=TIV460AQUWk

 

Akron's Children's Hospital Video about Pertussis: https://www.youtube.com/watch?v=8QWdEwjBEBw

 

Each year, 50-200 California infants are hospitalized with pertussis. CDPH and the Centers for Disease Control and Prevention (CDC) recommend that expectant mothers receive the whooping cough booster shot (also called Tdap, or tetanus, diphtheria and acellular pertussis vaccine) at the earliest opportunity between 27 and 36 weeks of every pregnancy, even if previously immunized. Getting immunized during pregnancy boosts a mother's immunity and passes on protective antibodies directly to their babies before birth. This helps protect newborns until they are old enough to begin receiving their own whooping cough immunizations at 6 to 8 weeks of age.

 

"No baby should have to be hospitalized due to a vaccine-preventable disease, and certainly no baby should die," said Dr Smith. "To give babies the best protection, I urge all pregnant women to get vaccinated against whooping cough as early as possible during the 3rd trimester of every pregnancy."

 

To avoid the spread of whooping cough, CDPH also recommends that:

- parents immunize their babies against whooping cough as soon as possible. The 1st dose is recommended at 2 months of age, but can be given as early as 6 weeks of age;

- California 7th grade students [should] receive the whooping cough booster, Tdap;

- adults should receive a whooping cough booster once in their lives.

 

 

Dominican Republic

Source: Hoy Digital [in Spanish, machine trans, edited

Two children under 2 [years of age] died in the last week at the Robert Reid Cabral Children's Hospital because of whooping cough, a contagious and vaccine-preventable disease. The dead are a girl aged 15 months from the community of Cambita, San Cristóbal and another one of 3 months, who lived in La Romana.

 

Also, another 28 children have been admitted with this disease, which calls the attention of the pediatricians of the hospital, since the vaccine that immunizes is included in the Expanded Program of Immunizations (PAI).

 

The official website of the Ministry of Health, in the epidemiology component, defines pertussis as an endemic respiratory disease that commonly affects children under the age of 5, with infants under 6 months of age at the highest risk of complications, but also it can affect teenagers and adults. The use of the vaccination scheme with DPT [diphtheria, pertussis, tetanus] or pentavalent [diphtheria, tetanus, pertussis, hepatitis B, and _Haemophilus influenzae_ type b (Hib)] is the main prevention measure, while pertussis outbreaks tend to occur every 3 to 4 years, according to official information.

 

So far this year [2018], 29 probable cases of whooping cough have been reported, 7 in the last 4 epidemiological weeks. As many as 9 out of 10 cases correspond to children under 1 year of age. Santo Domingo Norte and Santiago are the demarcations that register the highest number of cases.

 

Faced with this situation, the Ministry of Health instructed the provincial directorates and corresponding health areas to ensure adequate research and response to preventable diseases.

 

 

Dr. T comments:

For every case of reported Whooping Cough, 100 cases go unreported and unrecognized. Teens and adults are usually not as sick as children under age one year, but they are highly contagious. Whooping Cough is called the 100 day cough. Sometimes the cough is so bad, that one can break a rib or two. Women who are pregnant are antibody factories. That is why pregnant women are encouraged to have the Tdap vaccine shot every pregnancy in their last trimester even if they have had it before. The antibodies against Pertussis that they produce because of the Tdap vaccine passes through the placenta to their babies offering them some protection until their babies are old enough to receive immunizations to stimulate their own immune systems to produce their own protective antibodies. 

 

The same reasoning applies to pregnant women getting the influenza shot in their last trimester as well. Babies can not get a flu shot until they are six months old. So in addition to the gift of life, mothers who get the flu shot (in season) and a Tdap also give the gifts of antibody protection to their newborn infants. Not a bad way to start a healthy life!

 

The Wrong way to Cover Your Mouth when coughing!

 

If a person has had the disease, Whooping Cough, this disease does not convey life-long immunity as many other illnesses do. Appropriate immunizations against Whooping Cough also do not convey life-long immunity to the disease. All teens and adults should have at least one Tdap vaccine. Right now there is no recommendation for adults to have Tdap booster, however we know that Whooping Cough antibody protection from a Tdap only lasts 3-5 years. Even though we depend on a mother's Tdap antibodies passing through the placenta to protect her baby, even though it is not Public health Policy, it still seems wise to me that all adults who are going to be around a newborn in the baby's first year of life should have a current Tdap "booster" if it has been more than 3 or 4 years since the adult's last Tdap. Perhaps National Policy will eventually change to this recommendation. Don't know! But I do know that Pertussis antibodies from a Tdap only last 3-5 years and then are gone.

 

All forms of Whooping Cough immunizations are effective and safe and can be given with any other vaccine that is needed, e.g. influenza vaccine, etc. As a community we depend on each other for many things. This includes protection from serious disease. We expect restaurant employees to wash hands before they leave the restroom. We expect each other to not drink and drive, to not text and drive, to cover our face appropriately when we cough. Similarly, we should expect each other to get safe and effective immunizations to protect each other, our children and our families from preventable contafious disease. 

 

Ask your doctors about your current immunizations status and that of your children. If you've not had a Tdap, get one. If you've not had a flu shot, plan to get one. The flu shot is now so purified, that even people with egg allergy can get one. September and October are perfect months for a flu shot. The flu shot is preferred this year, 2018, over the nasal spray influenza vaccine. 

 
By contactus@priority-pediatrics.com
December 10, 2017
Tags: Cough   Influenza   Flu   Vaccines   colds   prevention   Hand Washing   Hand Hygiene   Hygiene  

Some Things Old and Some Things New & Some Things Never Change

 

Let’s repeat the basics.  Most Winter illness is viral and spreads through body fluid contact.  What fluid is this, you might ask? I speak of air-borne (and hand-borne) small droplets of saliva and mucus that sprays from our mouths and noses when we sneeze or cough. This means when one has a cold and/or sore throat, no matter how young or how old we are or how sick we feel, we will ALWAYS be contagious to others.

 

So one of life’s lessons we want to teach our children is how NOT TO SHARE these body fluids, when they are ill. Now here’s a fact most people don’t know:

 

Viruses commonly live in our noses and mouths intermittently and episodically even when one is completely well__without symptoms of illness at all. This is called viral shedding and it happens frequently, and we have no clue that we are contagious! Yes, you can be infectious to others even when you are completely well.  Who knew!?

 

So another life lesson that we should teach our kids is not to share saliva or mucus with others even when one is well. If you think we don’t do this all the time, think again. Kids and adults share gum, pizza, cookies, cupcakes, drinks, utensils, toys, etc without a second thought when they are well, and often when they are ill.  This is a behavior that can be altered more easily when one is sick, but occurs unconsciously when we are well. I am not saying we should make our kids phobic, over-anxious or compulsive about germs, or ourselves, for that matter, but that good hygiene habits of behavior are in the best interest of everyone.

 

Since it is fairly obvious that saliva sharing is a fact of life__like frequently touching our faces with our hands unconsciously every day__teaching our kids and ourselves how to contend with this reality is another life lesson to learn. It’s called handwashing and the use of hand sanitizers safely.  Sounds like a simple thing to teach our kids, but it is not. As parents we want handwashing to become an automatic behavior, not just something the kids do when we are watching and ask them to do it. We want them to do it at school, when they are out with their friends, and at home before sitting down to a meal, for example.

 

Believe it or not, it’s never too late to learn this behavior         [https://www.youtube.com/watch?v=zxlQn7KaCNU].

 

Handsanitizers [https://www.livestrong.com/article/88193-hand-sanitizer-kill-bacteria/] with greater than or equal to 60% alcohol are effective hand-hygiene products but they should not be licked off the hands. So allowing young children under 5 years old to use them independently without supervision is not safe, since hands often end up in mouths. As soon as the hands are dry (after waving them in the air for a few seconds) there is no danger. Of course the sanitizing benefit of these products are short term since hands rapidly touch the world and end up in mouth not long after.  But you have to start somewhere. Choosing time and place to use an alcohol-based hand sanitizer is a good idea. You can’t do it every 5 minutes through the day but certain situations, like the petting zoo, necessitate applying sanitizer frequently. After visiting a public restroom, even if you’ve washed your hands, is another good time to use sanitizer.  Remember to use it when visiting the mall or taking your seat at a movie theater (or leaving the theater), and after using an escalator in the mall or airport.  What these places have in common is that they are all public, meaning the world has touched all the areas you and your children are touching as you go through the day.

 

Sanitizer hand wipes are OK, but my guess is they are used less effectively than the gels which can be rubbed into tiny spaces on cuticles and between fingers by you and your children very easily. And there is no tissue to dispose of afterwards.

 

I don’t have anything against against hand washing. It’s great if you have the time to do it, but when you don’t hand sanitizers come to your rescue.

 

So that’s hand care. What about cough and sneeze hygiene? Not complicated. Most grown ups were taught to cover their mouths with their hands when they were kids. No question this is polite, but think about it..... totally ineffective in preventing the spread of body fluid (saliva and runny nose juice) between people since our hands then go on to touch other people and objects.

 

Today, kids in preschool and nursery school are being taught correctly, the 21st century way, the Elbow Cough-Cover. It’s quick and readily accessible and in itself NOT impolite to whip your elbow to your face and cover your mouth and nose with your elbow. Sure, no question, you will have germs on your elbow, but NOT YOUR HANDS! You can teach this to your children of all ages. You can role model it as well.

 

A cute story I like to tell kids this time of year (with parent permission if Santa comes to their house) goes like this:  Santa doesn’t visit a home by himself. It’s a lot of work to deliver presents to good children all over the world, so he brings some of his helpers along in the sled. All the helpers want to go with him. (Remember the movie “Elf”. Good thing all the elves aren’t the size of Will Ferrell.) Some of the elves have colds, coughs and runny noses. So they have to know how to cover their face properly when they cough and sneeze. Santa doesn’t want elf germs to get on everyone’s gifts. So Santa’s helpers who can cover their faces with their elbows get to go, but the helpers who don’t know how, stay at the North Pole with Mrs. Clause practicing the Elbow-Cough-Cover so they can go with Santa next year. The punchline: Santa likes it when kids cover their faces with their elbows too when they cough and sneeze. I guess you can always add that the elves have to take and use their hand sanitizer every time before they go down the chimney with Santa to help deliver the presents.

 

If you like this parable, feel free to use it. No copyright on it as far as I know, since I made it up.

 

One more thing about our hands, we use them almost always to greet others__hand to hand shake.  It’s social and appropriate and certain to transmit illness back and forth with every greeting.  So why not greet one another with an elbow-bump or a fist-bump through the Winter virus season? Seems like such an easy solution, if we could only make it the social norm [https://www.youtube.com/watch?v=eYtLQc0YaMo].  If we could just get our media-TV physician personalities, like Dr. Oz and Dr. Gupta and Dr. Snyderman, to endorse the social greeting elbow-bump, this greeting could sweep the nation.  Well, we do what we can, us parents and physicians. Maybe our preschool and school teachers could teach this greeting, just as they teach the elbow-cough-cover technique. Bring it up at your next PTA meeting.

 

One More Time About Influenza Vaccine

 

If you have not yet obtained your adult Influenza vaccine or one time Tdap (Whooping Cough) booster and would like a housecall to update these important vaccines, please contact me or Shelly.

I can administer the appropriate influenza vaccine to your children, yourselves and close family, sitters, nannies, etc. who share time with your family. These vaccines can be offered through Winter and early Spring to enhance protection against the Flu and Pertussis among all persons over the age of 6 months.  Unfortunately, there is no Flu vaccine as of yet for infants under the age of 6 months.

 

We should also be aware that when we immunize, we are not just protecting ourselves and our families.  We are also helping those in our community who cannot get immunized because of weakened immunity from advancing age, illness disease, cancer or chemotherapy.  They depend upon the rest of us to do what we can to protect them from these diseases by keeping our vaccines current. If you believe that we are our brothers’ keepers and have an obligation not to make others seriously ill through immunization apathy, please give this issue serious thought and consider staying current with your vaccines even if you have never had the flu and don’t think that Whooping Cough will make you very sick.

 

Please call Shelly (404-654-0426) or me or shoot us a text message and I will get back to you to schedule a house visit for the vaccine(s) you request:

 

Fluzone® Influenza Virus Vaccine, Contains No Preservative: Pediatric Dose  Children 6-35 months of age (Single-dose, prefilled syringe, without needle, 0.25 mL) also available for over 35 months of age through adult years.    

 

You can learn more about this and all vaccines at www.immunize.org.

 

If my Influenza vaccine supplies run out, you should still be able to find the vaccine at your local neighborhood pharmacies for a while longer yet.

 
By contactus@priority-pediatrics.com
October 07, 2017
Category: Infectious Disease
Tags: Cough   Facts   Bronchiolitis   RSV   Rhinovirus   Metapneumovirus  

According to a Decision Support in Medicine article published in Pediatric News, reinfections with RSV occur throughout life but generally are limited to the upper airway in healthy individuals.

The younger the child in whom RSV infection occurs, the more likely the disease will be severe, requiring hospitalization or intensive care. In a 2009 study, Hall et al., noted that 1.7% of infants less than 6 months of age in the United States were hospitalized for RSV infection, with considerable variation among communities throughout the country. Despite this high hospitalization rate, only approximately 40 children in the United States die each year from complications of bronchiolitis. Bronchiolitis tends to be more severe when associated with RSV than with other viral causes, such as influenza, parainfluenza, human metapneumovirus, and rhinovirus. Although many older children and young adults are infected with RSV, those infections tend to occur primarily in the upper respiratory tract. RSV becomes a problem again in old age: it is estimated that some 14,000 elderly Americans die of RSV-associated infections each year.

Lance Chilton, MD, FAAP

Professor of Pediatrics

University of New Mexico

 

In children with bronchiolitis, the duration of symptoms has been estimated at 2-3 weeks.

Explanation

According to a Decision Support in Medicine article published in Pediatric News, “[r]ecovery from bronchiolitis can require weeks; the median duration of symptoms has been estimated at 12 days, but up to 20% of children continued to have intermittent cough at 3 weeks after onset of illness. A long-term association with increased risk for asthma in later childhood has been demonstrated for infants with severe bronchiolitis requiring hospitalization, although it is unclear if this is a complication of bronchiolitis or an underlying characteristic of the child.”

Knowing the prolonged course of RSV infection is helpful to those caring for young children who have suffered the disease in helping everyone understand the persistence of symptoms and the likelihood of eventual recovery from them. Counseling on the expected course and the lack of available therapy to avoid or treat prolonged cough, increased nasal secretions, and respiratory distress will avoid impossibly optimistic predictions of quick relief.  Those caring for children—parents and health care providers alike—should be aware that cough medications have severely limited effectiveness; codeine-containing preparations should be avoided in children.

Lance Chilton, MD, FAAP

Professor of Pediatrics

University of New Mexico

RSV spreads by large droplet transmission directly from patient to patient or by contact with viral particles on surfaces, which remain infectious for several hours

 

The clinical course of human metapneumovirus (HMPV) and RSV appear to be similar. HMPV is “another paramyxovirus that has infectious characteristics similar to those of RSV in regard to seasonal characteristics and mode of infection. HMPV was relatively recently described, but studies of banked specimens show it consistently has accounted for 3% to 19% of bronchiolitis cases,” according to a Decision Support in Medicine article published in Pediatric News.

 
Rhinovirus is a common coinfecting agent with RSV or human metapneumovirus.
Rhinovirus, a cause of the common cold, is a common coinfecting agent with RSV or human metapneumovirus. “Rhinovirus has an emerging role as a cause of bronchiolitis and is more common in children older than 6 months of age. Rhinovirus is known as a common trigger of wheezing in older children with chronic lung disease and asthma,” according to a Decision Support in Medicine article published in Pediatric News.
 
 
By contactus@priority-pediatrics.com
January 05, 2016
Category: Colds

I've come across another nasal aspirator which parents may find useful this winter, the NoseFrida®.  This inexpensive "snot-sucker" will be handy little item when our little ones have a congested obstructed runny nose. Check it out.