Ask the Pediatrician: Dr. Molly

Category: Cold and flu

Tamiflu: Is it really good, necessary for everyone?

Tamiflu shortages are everywhere. Pharmacies are having to take the capsules meant for adults and compound them into a liquid version safe for younger children. I've had parents who have had to call multiple pharmacies to find which has the medication and can prepare the liquid version.

It is frustrating on many levels, not the least of which is that the patients for whom I prescribe Tamiflu are high-risk kids.

I suspect some pediatricians are giving even otherwise healthy kids with milder illnesses the medication and this is resulting in the relative shortage. The problems with doing this are many.

First, using Tamiflu for everyone with flu-like symptoms is very likely to result in a huge growth in Tamiflu resistance. This is the same phenomenon that occurs when lots of kids in daycare or preschool are on amoxicillin for infections. Eventually, the bugs that cause the illnesses get resistant to the amoxicillin and it doesn't work anymore. Last summer, a camp in North Carolina had a widespread outbreak of H1N1 and decided to put every camper on Tamiflu to prevent the flu from spreading. One case of person-to-person transmission of Tamiflu resistant flu appeared as a result. What that means is that this virus can change and then Tamiflu will stop working. Not a good thing!

Second, using Tamiflu for everyone with flu-like symptoms is resulting in a shortage of the medication so that when kids who are high risk, such as those with asthma, really need it, little is available.

These reasons sound like a big deal, but when I tell parents of otherwise healthy children who have swine flu these are the reasons I'm not writing a prescription for their child, it doesn't really seem to matter to them. They have a sick kid in front of them and just want to help their child get better and decrease the child's risk of complications.

Third, and more convincing, is that Tamiflu has a lot of side effects. About half of all kids who take it will throw up, have stomach aches or diarrhea. A small percentage of them will have nightmares or even hallucinations. It isn't a benign medication to use and is very expensive (about $100 per course) for families without good prescription coverage.

Lastly, and also somewhat convincing, is that the rate of transmission in households is only 15 percent-25 percent at best, which means if you have a child infected there is only a small chance other members of the household will come down with symptoms. Treating the child isn't going have much benefit for the rest of the family and because Tamiflu has significant side effects, unless the child is high risk or very, very sick, it just isn't worth it.

Category: Babies

Jaundice in healthy-term newborns: What's the big deal?

More than half of all full-term babies will have some degree of jaundice. Jaundice is a yellowing of the skin due to excess amounts of bilirubin in the blood and is usually seen first on the second or third day of life and is at its worst on the fifth day before slowly improving.

For most infants, jaundice is nothing to worry about but for some it can lead to serious problems if not recognized and treated.

Jaundice occurs because the amount of bilirubin in the blood exceeds the body's ability to get rid of it. Bilirubin is a breakdown product of red blood cells. Living in the uterus is a relatively low oxygen state (sort of like living at a high altitude) and as a result the body makes more red blood cells to compensate. When the baby is born, she enters an oxygen-rich world and no longer needs the extra red blood cells, so they quickly break down. One of the byproducts of this process is bilirubin. At the same time, the liver, which is the first place that bilirubin gets processed by the body, is still waking up. It didn't need to do much in utero and as such isn't ready to handle the load. To top that off, the main way bilirubin is excreted by the body is in poop and newborns, especially those just learning to nurse, aren't exactly poop machines the first week of life. These factors conspire to create a jaundiced baby.

When these are the only factors, most of the time the jaundice peaks around the fifth day of life, then fades after that. This is no coincidence. It is around the fourth day or so that most mothers' milk comes in and babies' pooping frequency picks up a day or so later.

As you might guess, there are several ways this balance can get out of whack. If mom's milk is delayed coming in, if the baby is a poor feeder, if the bilirubin level gets high enough it will cause the baby to be much sleepier and make the whole process worse or if the baby's umbilical cord wasn't clamped off quickly leading to even more red blood cells to degrade and dispose of are just some of the factors that can influence how high the bilirubin level gets. Other factors that could cause severe jaundice include illness in the infant (further stressing the liver), an incompatibility with mother's blood (Rh or ABO type differences) or some genetic problems like G6PD deficiency or galactosemia.

So what's the big deal? If so many infants get jaundiced it is normal for an infant to do so and therefore why worry about it? Although it is normal for infants to get jaundiced, if it turns out that for whatever reason the bilirubin level gets excessively high (the exact level that is worrisome varies by the age of the infant and is different at 24 hours than 30 hours than 72 hours for example) permanent brain damage can occur. This damamge is called kernicterus. Early symptoms of kernicterus include a high-pitched cry, difficulty waking the baby to feed and low muscle tone. If the high bilirubin level isn't treated the damage can progress causing long-term changes in muscle tone, IQ, vision and hearing. Because of this grave potential, any baby who looks very yellow and is losing weight, feeding poorly, stooling infrequently or is listless needs immediate medical attention. Babies will be treated with phototherapy (UV light therapy) that causes the chemical shape of the bilirubin to change enough so it can be excreted in the urine as well as the stool, expediting its removal from the bloodstream.

The main way a parent can be proactive is to make sure your baby is seen by a doctor on the third or fourth day of life, before bilirubin peaks, for assessment. So if your baby goes home from the hosptial on day 2, you should be seeing your doctor one-two days later. The old two-week followup isn't appropriate anymore.

Most experienced pediatricians are pretty good at eyeballing jaundiced babies and accurately predicting which will have worrisome bilirubin levels just by looking. Still, sometimes even the most experienced doctor is wrong and so if you notice your baby is getting much more jaundiced, is listless and feeding poorly, you should encourage the doctor to do a bilirubin test to be on the safe side.

By the same token, if you see your doc on day 4 of life and your baby wasn't too jaundiced but on day 6 he looks like a pumpkin, you should trust your instincts and go back in.

Jaundice will progress from top to bottom and then receded bottom to top so the first and last places jaundice is seen is on your baby's face. Be sure to look at her abdomen and legs, too, because this is where most of the action is around the time we worry most about jaundice.

If your baby has a high bilirubin and needs phototherapy, most often this happens in a hospital setting although if caught very early, a therapeutic blanket with the phototherapy lights built in called a biliblanket can be prescribed. Either way, if your baby is jaundiced enough to need this sort of intervention, it is important the doctor screen for things like blood group incompatibility, excess red blood cells, albumin level (the protein that carries bilirubin around in the blood) and tests for the genetic causes of high bilirubin in the full-term newborn.

If your baby is premature or sick, jaundice happens on a different schedule and can be much more severe and dangerous. Be sure to let your doctor know if your baby was born early or has any signs of illness.

Although jaundice is common and most often resolves naturally, a few babies will have seriously high levels of bilirubin in their blood and as a result jaundice needs to be taken quite seriously.

Category: Fever

Know when, when not to worry about fever

Fever freaks out parents. In reality, fever is a good thing; it's just the body's attempt to fight off infection. Hopefully, the information below will allay some of your concerns. I encourage you to print this article and the dosing charts and put them on your fridge or bulletin board for future reference.

As you all know, flu season is upon us much earlier than usual and as such fevers are high and so are anxiety levels. When should worry about a fever? The short answer: almost never! Fever is not dangerous. Even fevers as high as 105 are not harmful in and of themselves. Fever is a sign that the body is fighting something and even illnesses as mundane as the common cold can cause big fevers. Here's the bottom line:

• Your doctor needs to know immediately about any baby under 3 months of age with a temperature over 100.4 degrees (without adding a degree).
• A temperature is considered a fever when it reaches near 101 degrees taken by any method without adding any degrees. Even if your child usually has a temperature that is below normal when he's well, a fever isn't a fever until the temperature reaches above 100.4 degrees. Ear temperatures are the least reliable and tend to give higher temps than other methods. I prefer under arm or rectal temps for young kids and oral temps for older children. The temperature strips for the forehead and the pacifier temp measures are much less unreliable than other methods.
• Fever gets dangerous to the brain above 106 degrees.
• Seizures due to fevers can happen at any degree and although incredibly frightening to see, they are not harmful. Of note, influenza viruses rarely cause febrile seizures. Lowering a fever or preventing it from getting "too high" is not how a febrile seizure works, so worrying about a high fever because it will cause a seizure is wrong.
• Acetaminophen (Tylenol) or ibuprofen (Motrin) will not lower the temperature by more than a degree or so at best. Don't expect medications to do anything more than make your child more comfortable and if you are lucky, lower the temperature a little, too.
• Even if the temperature is still rising despite using Tylenol or Motrin, as long as the temp remains below 105 degrees or so, the fever alone isn't worrisome.
• Fever will make your child listless, breathe a bit faster and her heart rate will be much faster than normal. In addition, some children with fever will vomit, though this doesn't make the fever any more worrisome.
• Fever is worrisome when your child is so listless that even with Tylenol or Motrin on board, she won't interact with you, watch TV or read.
• There is no role for alcohol rubdowns or even tepid baths. Alcohol baths are dangerous because the alcohol can get absorbed into the body, causing toxic sedation. Tepid baths will just make your child mad without any long-term lowering of the temperature.
• Some doctors recommend alternating Tylenol and Motrin, but I do not. Pick one and stick with it. Because fever isn't dangerous, there's no reason to be measuring it over and over. You will know if your child has a fever and because the degree doesn't matter to us, don't take temps in the middle of the night or waken your child to give fever reducers when he is sleeping.

Dosing charts

Acetaminophen: For dosing, remember to always use weight for dosing if you know it. Tylenol dosing chart
Ibuprofen: I don't recommend Motrin or other ibuprofen medicine until kids are over 6 months old. Weigh trumps age in determining dose. Ibuprofen dosing chart.

More about H1N1 and flu

Category: Cold and flu

H1N1 testing helps determine treatment, use of scarce vaccine

H1N1 has hit Michigan hard. The CDC identified Michigan as one of the states with widespread disease. Luckily, most of the cases have been mild, but even so, many children have been hospitalized and a few in Michigan have died. What's maddening is that despite the media's focus on the illness and importance of getting the vaccine, the supply of vaccine remains limited. Thousands of people are waiting hours, sometimes in the cold and/or rain, to get their children vaccinated. Thousands more search in vain to find a place to get it.

My office has been swamped with calls and office visits for feverish kids whose parents worry their kids are infected with the swine flu virus. Many of these kids turn out to not have H1N1 and the ones who did haven't been terribly sick. Still, when I say the words "probable swine flu" there is always a look of panic on the parent's face.

In most doctors' offices, we can only do the rapid influenza test that doesn't differentiate between the swine flu and other seasonal flu strains. In fact, because well more than 99 percent of all influenza in hospitalized patients is the H1N1, it is a very safe bet that child with a positive test at this point has H1N1 influenza. The other rub has been that the office- based test is not foolproof. About 30 percent-40 percent of the time the test will be negative even when the child has the H1N1 strain.

All of this worry and inaccuracy of the test makes the decision about whether or not to start Tamiflu that much more difficult. The CDC recommends only high-risk children (those under 2 years or with chronic medical conditions like asthma, cerebral palsy, diabetes, etc.) need Tamiflu treatment because the vast majority of otherwise healthy kids are weathering the illness easily.

So what am I doing in my office? I am primarily testing those kids with whom I am considering using Tamiflu and the others in my office who are tested are done so if they look particularly sick. If a high-risk child looks really sick, even if the test is negative, I am prescribig Tamiflu. For otherwise healthy kids, unless they look incredibly sick, I am not initiating treatment.

That begs the question about why even do the test. I do it because at this point in the season if a child tests positive, whether I treat them or not, chances are this is the H1N1 virus and they will be immune and not need the vaccine when it finally does become widely available. The CDC still recommends all children who have not had their flu strain typed to know for sure it is H1N1 should receive the vaccine. However, in this climate of limited availability and the lack of other influenza strains, I feel comfortable that my patients with positive rapid influenza tests do indeed have H1N1 and need not get the swine flu vaccine. If a child has had a flu-like illness but tested negative for influenza or wasn't tested at all, that child should still get the vaccine when it is available.

This epidemic of sorts has tested the public and private health sectors and their ability to not only implement a disaster plan of sorts, but also has helped me fine tune how I communicate with my patients to minimize unnecessary office visits and phone calls. Offices that have recorded information when you call, Web sites that are frequently updated or e-mail lists for patients have been able to run their offices more smoothly despite the worry and frenzy surrounding the swine flu epidemic.

Category: Teens

Beaumont offers free heart screening for teens this weekend

Have you ever worried your child may be one of those tragic few who die unexpectedly while playing sports? Have a family history of unexplained death in young family members? Because most insurances don't cover evaluations for athletes who aren't having any symptoms and the major cause of sudden cardiac death among athletes is often symptom-free until too late, screening for hypertrophic cardiomyopathy is difficult to do.

Lucky for you, this Saturday the Beaumont Hospitals is offering a free screening program for high school students. The screening will include a health history review, blood pressure measurement and an EKG, which can often show evidence of the hypertrophic heart. This screening will take place at the Oakland University Recreation and Athletic Center in Rochester, Mich.

You must preregister for this event and can do so by calling (800) 633.7377 (Monday through Friday, 8 a.m. to 6 p.m., or Saturday, 9 a.m. to 1 p.m.) or visit Beaumont's Web site. Click here for more information and the downloadable forms needed.

Category: Skin

Stitches, glue or nothing? Managing cuts

All kids will get bumps and bruises and some will even get cuts and gashes. I get a lot of calls from parents unsure if they need to take their child to the ER for these wounds.

In general, you must get a wound closed within eight hours of the injury if stitches or glue are to be used. In other words, you often can't wait until the next morning when your doctor's office is open to make this decision.

Sometimes the need for stitches is obvious, but other times it's a tossup. When wounds are on joints or the face in areas near the lips or eyes, even if they are small, they often heal better if closed professionally. Any cut that doesn't stop bleeding quickly or whose edges can't easily be opposed and held that way by a bandage needs assessment. Even jagged wounds that look like they would be hard to stitch together often can be and will heal with less scarring if you do.

Usually, the option when you get to the ER is to stitch or use a a superglue designed for the skin. The location of the laceration and its severity often dictate which is best. Stitching the wound will ensure the ends will be opposed and stay that way as the wound heals, but it requires local anesthetic and may leave additional marks from the stitches as the wound heals. The glue is attractive because it requires no needles, but it isn't as much a sure thing when it comes to keeping the edges tightly together as the cut heals. If the cut reopens, there is no recourse because the wound will be too old at that point for a second glue attempt or stitches. Most of the time, the folks in the ER have so much experience with lacerations that they can tell on first glance which method is best and will recommend that one.

Parents often call from the ER and ask if I can facilitate having a plastic surgeon come in to close the wound if stitches are to be used. Unless the wound is severe enough that extensive repair is needed (usually under anesthesia) no plastic surgeon will come in anyway. To be honest, the doctors and physician assistants in the ERs close so many wounds, they are often as good, if not better, than the surgeon at closing these, especially because the wound is rarely made by something as precise and clean as a scalpel.

Abrasions or scrapes cannot be stitched up. Even if they are oozing for a long time, just keeping them covered is the best you can do.

Over-the-counter and prescription products that purport to minimize scarring have not been shown to make a difference in the severity of the scar in the long run and therefore are not beneficial. Just keep the wound clean and dry and nature will do its job.

Category: Private parts

Circumcision pros and cons

Considering circumcision? There are two sides to every argument and let me tell you, both sides of this issue are passionate.

Circumcision has some concrete pros. Firstly, the rate of HIV and penile cancer in circumcised men is lower than those who are not. Secondly, the rate of HPV infection (the virus that causes cervical cancer in women) is much lower as well. Because women get colonized with this virus through sex with men who have it (and are usually without any symptoms themselves) this is a benefit for men and women. Third, hygiene is straightforward in the cirumcised penis. Lastly, boys who are circumcised are much less likely to have urinary tract infections than uncircumcised boys.

Circumcision has some concrete cons, too. It is a surgical procedure and has some small but real risks, including bleeding, damage to the head of the penis and pain. Second, men who have been circumcised as adults report a change in sexual sensation afterward, although reports of sexual enjoyment overall do not differ between circumcised and uncircumcised men.

If boys are taught good hygiene, men use condoms regularly unless they are in a long-term monogamous relationship, the medical advantages to circumcision diminish and what is left are primarily issues of culture. In many cultures, male circumcision is not the norm. Indeed, most of the world doesn't circumcise except for religious reasons. In the United States, however, circumcision has become very common - especially among white middle and upper classes.

I often get asked if an uncircumcised boy is more likely to be the object of teasing in school and my answer is no. I often suggest parents consider the circumcision status of the other male family members in the decision as well as their comfort teaching the hygiene and sexual practices that would minimize risk if they choose not to have their son circumcised.

Circumcision does have medical benefits, but given the fact that the risks can be minimized through good teaching about hygiene and sexual practices, the decision is still on the shoulders of parents.

Category: Viruses

Cold sores: causes, symptoms, strategies to prevent recurrence

Cold sores are a pain in more ways than one. They are ugly, of course, but for many they are numerous enough inside the mouth to cause difficulty eating and sleeping.

Cold sores are actually a viral eruption caused by herpes simplex - yep, that herpes, the one that can cause problems on any mucus membrane including the genitals and mouth. There are two strains of the herpes simplex virus. For a long time we thought type 1 infected the mouth and type 2 the genitals, but in truth both are found in both places.

The first time a person experiences cold sores, they are often accompanied by fever, headache and body aches. Once the virus infects the nerves cells of the mucus membrane once, it lives there forever, dormant and waiting to resurface. Cold sores pop up in the same places because the virus lives in specific nerves and erupts in that nerve's location again and again.

The first symptoms of cold sores are tingling and a sense of swelling that can't be seen. Within a day or two, the characteristic blisters appear on the lips or ulcers appear in the mouth. The blisters and ulcers last about 10-14 days before the body beats back the virus into submission and it returns to its dormant state.

Things that stress the immune system or local trauma can cause the virus to reappear. Incidents such as illness, sunburn on the lips, fever and emotional stress can focus the immune system in other places or weaken it to the point that the virus can come out of its dormancy and cause cold sores.

It makes sense that the best ways to prevent cold sore from recurring is to do things that boost the body's immune system, limit emotional stress and diminish trauma to the lips and mouth.

L-lysine is an amino acid that can boost immune system function and improve the strength and resiliency of the mucus membranes, thereby reducing recurrences. Anyone, including children, can safely take L-lysine and kids who take 500 mg daily and adults who take 1,000 mg each day have significantly fewer outbreaks than those who don't. In addition, if at the first sign of tingling you increase the dose to 2,000 mg daily for kids and 3,000 mg daily for adults, the duration and severity of the outbreak is much less. Zinc and vitamin C also play important roles in mucus membrane health and Vitamin D3 is important in maintaining immune function. So in addition to L-lysine, a multivitamin with these micronutrients should keep your immune system as strong as possible.

Exercising, eating well, getting adequate sleep and encouraging a healthy balance between work and family life along with nurturing yourself can also help decrease the likelihood stress will play a role in cold sore outbreaks.

Lastly, using sunscreen on your lips summer and winter when outdoors for prolonged periods can help minimize sunburn trauma to the lips - a known trigger for cold sore outbreaks.

If you have an active cold sore, avoid kissing, sharing towels, drinking glasses, toothbrushe, and eating utensils to minimize spread to others. You can use topical ointments that are available over the counter to decrease symptoms, but if the outbreak is severe or the recurrences are frequent despite the natural strategies outlined above, you should talk to your doctor about the possibility of going on a low dose of acyclovir, an antiviral medication, that can diminish the frequency and severity of attacks. Kids with braces and cold sores often need to do this because the metal in their mouths is causing constant minor trauma.

I learned a lot at pediatrics conference

I recently got back from a five-day meeting of the American Academy of Pediatrics, which hosted its annual National Conference and Exhibition in Washington, D.C. Boy, did I learn a lot! I will have fodder for blogs galore!

I love this meeting. More than 7,000 pediatricians from all over the world attend and there are hundreds of lectures, workshops, plenary talks and meet the expert sessions on topics ranging from genetics to orthopedics to feeding issues to advocacy to obesity to you name it! I was on the planning group for six years and helped put this meeting together so I know the staff, speakers and leadership of the AAP well. This year, however, I didn't help plan it and just got to go, learn and enjoy!

Here are a few of the pearls I learned, some of which will be fleshed out into longer pieces over time:

• High fructose corn syrup (or just fructose) is in everything we eat that we don't make ourselves and is metabolized in ways that are shocking. Consuming fructose leads to fatty liver, high lipid levels in the blood (which can lead to atherosclerosis), excessive insulin production (which can lead to diabetes), and unlike glucose actually sends a message to the brain to eat more even when you have consumed a lot of calories! I am already limiting fructose in my family's diet since coming home!
• Tics in kids really can't be diagnosed until they are around age 5. Before then many kids will have repetitive movements that are tic-like called stereotypies but only a small portion will go on to have frequent tics as older children. Most kids with ADHD on stimulant medication who have tics do not have to stop their medication. Data show that even if the medication increases the tic frequency a bit, the ADHD is worse than that symptom.
• The ability to know how your body will respond to medications based on your genetics as well as whether or not you will go on to have any one of hundreds of diseases is just on the horizon. Primary care docs will have the opportunity to do an even better job guiding wellness.
• Aromatherapy isn't a crock! There is actual data that show it can work for certain things like nausea.
• One in five children in the United States lives in poverty.
• H1N1 live virus vaccine needs to be separated from the seasonal live virus vaccine by only two weeks. The shots can be given simultaneously as can one shot and one live virus.
• The Nuvaring contraceptive is really easy for teens to use and they don't have to remember to do something every day.
• None of the additives to infant formulas (DHA, probiotics, etc.) have been shown to have significant benefit over the old formulations in otherwise healthy term infants.
• When starting infants on solid foods, veggies, fruits, and meats should be first, not rice cereal.
• Babies who see allergenic foods early and often (even before six months) are significantly less likely to be allergic than those whose parents wait to introduce them.
• Developmentally disabled adults who cannot read or do math can be trained to do complex repetitive tasks, so don't sell your cognitively or developmentally challenged child short!
• There is almost no role for soy formula. If a child can't tolerate milk formula, he should go to the extensively hydrolyzed formulas.
• Assistive technology and gadgets for kids with disabilities are amazing, varied, creative and can help almost any child communicate more easily.
• The brains of kids with ADHD and dyslexia are actually wired differently as seen by functional MRIs than typical kids, lending more credence to the concept that these are not deficiencies in parenting or teaching but true physiologic differences.

Whew! I really did learn a lot! And I didn't even mention the sessions on hiring Gen Y, fainting, parasitic infections and sports medicine I attended.

Let me know which of these "pearls" you are interested in learning more about!

Category: Cold and flu

H1N1 update: Michigan is being hit hard now

Iinfluenza has really started to hit our area hard. The following Q&A will help you understand who needs to be seen, when testing should be done and who needs Tamiflu treatment:

Q: When do I suspect my child has influenza? What are the symptoms?
A: Fever higher than 101.5 degrees along with sore throat and body aches is the first sign followed by headache, congestion and cough. The kids look very sick, down and out and are not interested in playing, eating or even really watching TV.

Q: What's the difference between H1N1 and seasonal influenza?
A: The symptoms are the same and both can give illness that ranges from mild to severe. Deaths in healthy and high-risk children occur with both, but early information indicates because none of us has immunity to the new H1N1 virus, lots more kids are getting sick with it.

Q: What if there's a case at my child's school - should I keep him home or what should I do?
A: I would not keep your healthy child at home. This situation will be the case every day for the next few months and unless you plan to homeschool your child this year, he should go. We will not be putting high-risk kids on Tamiflu when the only exposure is a classmate. Only 20 percent to 30 percent of household contacts will get the flu when exposed within the family, so the risk is even smaller for contact with classmates.

Q: When do I need to take my child to the doctor's office?
A: If your child is at high risk for complications from influenza you should take your child in within 48 hours of the start of symptoms. If your child is low risk, you should bring him in if the fever lasts more than three days to make sure there is not a secondary bacterial infection, or if the fever goes away for a full day and then returns at 101 degrees or higher.

Q: How do I know if my child is high risk?
A: High risk kids are those younger than 5 or any child with asthma, diabetes, heart conditions requiring daily medication, cystic fibrosis or any condition that affects ability to breathe easily (cystic fibrosis, very low muscle tone, etc.).

Q: What if I have a child who is high risk but it is the sibling of that child who is sick?
A: In that case, take the sick child to the doctor for assessment. High-risk siblings of likely influenza cases will need medication to try to minimize their chance of getting the illness or lessening the symptoms.

Q: Are you going to test for influenza in the office?
A: Most offices have a rapid test for influenza available. All high-risk kids (or siblings of high-risk kids) should be tested, but the test is not foolproof. About 30 percent of the time the test will be negative even with influenza present. So even if the test is negative, your high-risk child should be treated with Tamiflu to be on the safe side if the clinical presentation is consistent with influenza.

Q: Should all kids who have a positive test be treated with Tamiflu?
A: No. Only those children at high risk for complications should be treated. For the vast majority of children, the illness will be uncomfortable but not dangerous. To discourage the H1N1 virus from morphing and becoming resistant to Tamiflu, it is not recommended that otherwise healthy children receive it.

Q: How do you know that the influenza cases you are seeing now are H1N1? Can you do the test to know for sure?
A: Only hospitalized cases are being tested specifically for the H1N1 strain. Across the nation, more than 98 percent of all of the influenza seen and typed is H1N1 so it is safe to assume every case seen now is the swine flu. This will get tricky in late December or January when the seasonal flu will start to get mixed in, especially because the seasonal flu is not made better with Tamiflu because it is resistant to it.

Q: What if my child was exposed to another child with influenza during a sleepover or other intense and prolonged contact? Should he receive the medication to help minimize the chance he will get sick?
A: Only if he is high risk.

Q: We stood in line to get the H1N1 vaccine at the health department clinics last weekend. When can we get the seasonal vaccine?
A: When your child can get the seasonal vaccine depends on the type of H1N1 vaccine he received. If he received the live virus intranasal vaccine and you want to get the intranasal seasonal vaccine, you will need to wait two weeks. If you got the intranasal vaccine but are willing to get the seasonal flu shot, you can get that at any time. If you got the H1N1 vaccine as a shot, you can get either the intranasal or the shot for the seasonal flu vaccine at any time. Remember, the intranasal vaccine can only be given to children older than 2 without a history of wheezing or asthma and cannot be given when an infant younger than 6 months or anyone with an immune-compromising illness is in the household.

Q: Should we be taking our kids to CVS or Wal-Mart to get the seasonal vaccine?
A: Retail-based pharmacies will not administer the vaccine to anyone younger than 4 years of age and because the seasonal flu is still a ways off, I think it is more than safe to wait and get the vaccine at your doctor's office when it comes in.

More information is available on the CDC flu site as well as the Michigan Department of Community Health site. You can also read my other blog posts on seasonal and H1N1 flu, too.