Pedipatter Our Blog


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

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, 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.

By David Cotlar
April 11, 2018
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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.

By David Cotlar
April 11, 2018
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Although the news coverage has  receded a bit,  many  articles still describe the recent enterovirus 68 outbreak as a “mystery virus.”   While there have been hundreds of children affected with the illness and spread to additional states being reported, it is not really a new virus or a particularly mysterious one.  While enterovirus is not a household health term, it is a fairly large group of viruses and part of a larger family of common ones.  There are a few things about this particular agent that are notable.  One  is that serotype 68 is not a common type for this time of year. Two,  that the outbreak has developed unusually rapidly  (though it does coincide with the start of school, so not so remarkable) and  this agent  has currently been reported in twelve states.  Most significantly is that while it usually presents with  the common symptoms of many other respiratory viruses–runny nose, sneezing, cough–it does often take on a complicated course in many children with asthma.  It is the severe cough and wheezing with the resulting breathing difficulty that is responsible for the large number of children who have had to be hospitalized and in some cases be given  respiratory assistance.

As with most respiratory viral illnesses, there is no specific treatment.   The approach parents should take if children come down with these symptoms is essentially what is the usual for respiratory viral infection:  rest, adequate fluids, appropriate fever control and, generally, avoidance of OTC cold/cough medications.    A doctor’s office visit is not necessary for every cold-like illness. The most important component of care is really good observation for  indicators  that a more severe infection is developing: watching for high fever, severe cough, wheezing or other breathing difficulty, and poor fluid intake or keeping down liquids.  And we always add, anything else that suggests a worsening, really sick-appearing child.  There should be prompt notification of a physician to determine if a timely office visit (or after hours, an appropriate urgent-care facility evaluation) is warranted.

It is also important to recognize that like most viruses, this one is transmitted from person-to-person. This means that  frequent, really careful hand washing with soap,  covering the face when coughing or sneezing, and avoidance of shared cups or eating utensils of sick children, is very important.   Such measures can help prevent infection or limit its spread to fewer individuals.  And, in case you are wondering, there is no vaccine for this or similar respiratory viruses.

As of this posting,  there have not been any cases in the Houston area or elsewhere in Texas.  Should this change, it will certainly be prominent in the City’s media outlets.  Until then, parents should treat respiratory viruses as they generally have, keeping in mind that other viruses can sometimes cause more complicated illnesses, and the same observation as is above is always appropriate.


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