Pedipatter Our Blog
Occasionally diseases that are actually pretty rare attract enough attention though media (and social media), that they are perceived to be far more prevalent and threatening than they actually are. Current prime example: AFM, an acronym for acute flaccid myelitis, a serious condition similar to polio in its clinical picture. It affects the nervous system, specifically the spinal cord, causing weakness and paralysis in arms and legs, and, like polio, affects mostly young children. The CDC began keeping track of this illness only since there was a prominent jump in cases in 2014, and the reason for its recent media attention was a recent spike in the number of cases from August to October of this year. There were similar sudden increase in cases in 2014 and 2016, also in the summer and early fall, almost all in children, bring the total to about 120 for 2018, and a few more than 400 since 2014.
The illness generally starts with fever and mild respiratory or GI symptoms, followed by the development of the neuromuscular signs of arm/leg weakness and sometimes pain. The clinical picture may also include weakness of eye/eyelid activity, speech, swallowing, and even respiratory failure. Diagnosis is based on history and exam, as well as blood and spinal fluid studies and MRI findings in the brain and spinal cord. There is no specific treatment available, though a number of therapeutic measures have been tried though not in controlled studies. The recovery pattern is highly variable, with some patients recovering rather quickly, but others having to deal with lengthy periods of paralysis.
The most prominent question about AFM remains without a solid answer: what is the cause of this affliction? Since polio was caused by infection with a particular virus, it might have seemed that this was too. However, this has not been nearly so straightforward . Several viruses, including other members of the enterovirus family that includes poliovirus, have been detected in AFM patients, so have several other viruses including coxackie, West Nile and other viral agents, but causal relationship has not been established. Sometimes no virus is found. It is not even clear if the cause is direct viral infection, or if a virus causes an immune or inflammatory response in the nervous system. Clearly, a substantial degree of mystery remains here, but also a lot of ongoing research.
And how should parents view all this? Most importantly, realize how uncommon AFM is despite the extensive media attention, fewer than 100 cases a year in the whole country. Next, follow common precautions the CDC recommends including good handwashing, reasonable avoidance of individuals with viral infection, and seasonal mosquito repellent use. Finally a word about immunization. With so much anxiety and attention from a rare disease for which there is no vaccine available, how ironic and unfortunate it is that so many parents fear and even avoid immunization for more likely illnesses with clearly recognized and essentially preventable infections, and potentially severe, even lethal outcome. Just doesn’t make sense.
A footnote. With memories of polio reawakening with the appearance of AFM, it is worth recalling the history of polio in the country, and of an environment when a particular vaccine was desperately sought and awaited, and accepted by parents with the enthusiasm it deserved. You can appreciate this in a fine video production from the American Experience series, at https://www.amazon.com/My-Lai/dp/B004AUMAAY/ref=sr_1_1?s=instant-video&ie=UTF8&qid=1543207048&sr=1-1&keywords=american+experience+documentaries. Not sure this is free without Amazon Prime, but it’s worth watching.
Vaccine for the 2018-2019 flu season is now arriving in physicians’ offices and other facilities that offer vaccine administration, and on September 3rd the AAP announced its policy statement on this year’s flu vaccine recommendations. We wanted to share the basic information to better educate parents about this important annual recommended immunization.
- Flu vaccine should be considered as essential for even healthy children, starting at six months, as serious complications can occur in even healthy children. It should be given when avaiable (now), but especially by late October.
- For the 2018-2019 flu season, the injectable form of flu vaccine is recommended as the primary choice. Although the nasal spray will be available, it is has been less effective in recent seasons and is expected to again be so this year.
- This year's quadravalent vaccine will contain components against different strains of A and B, as well as one B strain which was in last year's product.
- The number of doses depends on the child's age and vaccine history. Children up to eight years should receive two doses (separated by a month) if this is the first time being vaccinated. Only a single dose is necessary for kids nine and up, or for children up to eight years who have received at least two doses of vaccine before, even if not in the same season.
- All children with egg allergy can receive influenza vaccine without any addition precautions beyond those recommended for any vaccine. Egg allergy is not a contraindication for flue vaccine, nor does it require special consideration.
- Aniviral medications are often beneficial in the treatment and control in influenza, but are not a substitute for flu vaccination.
- Annual vaccination is the best way to prevent the flu. The vaccine works well, but its effectiveness varies from year to year, depending on how closely the particular flu virus in a community match the strains included in the vaccine. The CDC tracks vaccine effectiveness year to year, to better protect communities the following year.
- The most common side effects from the flu shot are pain and tenderness at the sit of injection. fever is also seen within 24 hours after administration in about 10 to 35% of kids younger than 2, much less often in older children and adults.
- Children can not get the flu from the shot. However, because the vaccines are made from killed or weakened viruses, mild systemic symptoms such as nausea, malaise, headace, muscle ahces, and chills can occur.
Our practice, and I am sure all others, welcome questions from parents in an efforts to maximize the number of families we can immunize. It is worth adding that vaccinating your children does not only protect them. By reducing the likelihood of coming down with influenza themselves, this also might prevent spread to babies too young to get the vaccine themselves (and who are at higher risk for more serious illness), and elderly people in whom the vaccine might not work as well.
Hard to believe it’s been 25 years, though I remember the excitement of taking my own kids to the first one: in a few weeks, on Sunday, the 26th of August, our city's outstanding arts organizations will offer the annual Houston Theater District Open House. This is a free, fun-filled, family day of learning more about Houston’s many major performing arts organizations. Hours are from noon until 5:00 (well, the symphony concert starts at 4:00) This is probably the only such event in the country, and is offers youngsters the opportunity to explore performing arts venues with which most kids and even some adults are completely unfamiliar. This is really a unique opportunity for kids to explore different seating levels, stages, the whole terrain of concert halls like Jones Hall, the Wortham Theater, and the Hobby Center, and the Alley Theatre, all of which required extensive renovation after the Harvey flooding.
But there is much more than just seeing big music spaces. Adults and children alike can enjoy activities and live performances by several of the Theater District’s groups including: musical theater shows, behind-the-scenes backstage tours, interactive "musical instrument petting zoo," meet-and-greets with costumed performers, complimentary trolley rides between venues, food trucks, and a free Houston Symphony concert at Jones Hall at 4 PM. Parking is no problem, as there is the huge underground parking facility as well as nearby garages and surface lots.
The annual event presents a preview of Houston’s vibrant arts season, and there is special pricing for many of our arts organizations' seasons. Yes, it’s quite hot outside, but very cool inside all the venues. Children of all ages will really get a lot from this rare opportunity. Details of the schedule of the day’s performances, as they are finalized can be found at http://www.theaterdistrictopenhouse.com/
One of the most important goals of pediatric checkups, especially in the first two or three years, is monitoring child development. Recognition of the attainment of developmental milestones at the proper age is vital both for recognizing delays that might prompt a search for a specific diagnostic reason, and for initiating early intervention that can make a huge difference in long-term optimal accomplishment and success. Over the years, pediatricians and their staff have gone from making broad observational developmental assessment, to carefully carrying out increasingly detailed screening and surveillance, with various tools providing earlier, more sensitive recognition of delay.
Not surprisingly, the internet is offering increasing assistance, and now a new phone app from the CDC (Centers for Disease Control) is bringing a valuable new—and free—tool for parents and pediatric professionals, “Learn theSigns, Act Early.” Available for download from GooglePlay and the AppStore from cdc.gov/ActEarly, this multi-faceted site offers milestone checklists featuring interactive milestone guidelines for children aged 2 months to 5 years. There are photos and videos to help parents understand and evaluate their children’s attainment of these. Parents can score "yes," "not yet," or "not sure" to each milestone. There are also tabs for “When to Act Early,” recommended “Tips and Activities,” and a Milestone Summary page, as well as free materials such as books and charts.
This excellent resource can be really valuable to parents, and will enable them to assemble developmental data to bring to their children’s checkups, making their pediatricians’ own assessment more detailed and accurate.
An important part of the safety awareness portion of a well baby/child visit has always been a review of safety measures appropriate for the child at the age of the particular visit. Most of the subjects discussed–car seats, secure storage of medication and household products, electrical subjects–have been standard for decades. But every so often a subject of a newly recognized hazard presents itself, such as electronic “button” batteries or small magnets over the last five or so years. And just within the last year or two, another new source of serious injury has developed: concentrated laundry detergent pods which have resulted in more than 10,000-12,000 calls yearly to poison control centers, currently about 30 a day.
Although conventional laundry detergent has been sampled by children in presumably enormous numbers for many years, even decades , it seldom caused significant injury. But these newer single-use highly concentrated packets with multi-colored packaging containing Tide, Gain, Purex and other well-known detergent names are really different in this respect. For reasons that are not fully understood by experts in toxicology–but probably related to the rapid ejection of the super-concentrated product– the injuries from them are far more threatening . They include profuse vomiting, respiratory distress, and depression of the central nervous system, and ventilator support has at times been required due to aspiration into the lungs. There has also been at least one serious eye burn reported. The number of fatalities in the last couple years is about seven, and they have not all been in children. These severe ingestions have also occurred in some elderly people with dementia.
Detergent manufacturers have already tried to make some packaging changes to reduce the eye appeal and risk of children’s getting into them, although other steps have been suggested but not yet implemented. But as with all those other potential opportunities for toddlers and children to sustain serious injury–or worse–through the countless common and less common accidents for which they are at risk, this is one more thing for parents to know about and take the basic measures to prevent.
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