On Call with Editor Donna Thomas

Do you have a teenager who just got their license, or do they have friends who have just gotten their and your child is now a frequent passenger? It all starts to happen in their junior year in High School in NJ.

In March the AAA report was all over the media reporting the significant rise in numbers of teens texting while driving, resulting in accidents.

It’s never too early or too late to engage in conversation with your children about the dangers of texting and driving. As a matter of fact, it needs to be an ongoing conversation, gentling reminding them of the danger and consequences.

It can often be awkward for your teen to speak to a friend about texting while driving, so you need to be able to give them ways they can open up the conversation with their friend who is the culprit.

There was an excellent article on aboutkidshealth.com that I would suggest you all read. As well as the many other well written related articles linked to this article, which I am happy to share with our readers:

5 Ways to Get Drivers to Stop Texting

More and more passengers are speaking up about texting and driving. If a texting driver is making you nervous but you're not sure how to bring the topic up, here are some ideas:

1.    The direct approach. Say, "I'm sorry, but I get really nervous when people text and drive." Wait to see how the person responds. Most people will admit it's probably not a good idea or they'll at least put down the phone.

2.    The subtle approach. If you don't feel comfortable telling a driver to quit texting outright, try hinting:"Would you like me to type for you since you're driving?" Or, since more states are handing out tickets for texting and driving, you could say, "I've seen a lot of cops out today, you might not want to text right now." Or point out things the driver has missed seeing (or narrowly missed hitting). As in, "Did you see that dog/kid/overturned bank truck?"

If you know the person your driver is texting, ask the driver to hand over the phone so you can say something. Then send a message that says, "Driving, talk to you later."

If your driver teases you about being nervous, it's the perfect opener to say, "Yeah, texting and driving freaks me out. You never know if the person in front or behind is doing it too."

3.    The "Wow, look at that bad driver!" approach. Point out drivers who wander into the next lane, drive 45 on the highway, run a stop sign, or stop at a green light. Then make guesses about who they're texting. Or make up a variation on the punch buggy game, awarding points each time you see a driver who seems to be texting (this has the added benefit of forcing your own driver to focus on the surroundings, not the screen).

4.    The group approach. If your whole group thinks a driver is a hazard, make a plan together. Take away the driver's car keys: It's what you're supposed to do with drunk drivers, and studies show that texting drivers are even more dangerous. Or agree not to ride with that person. If several people boycott a driver, he or she will get the message.

5.    The life-saving approach. If someone continues to text and drive or mocks you for worrying about it, avoid riding with that person. Let texting drivers know you're cutting them off (if you feel comfortable doing so) — a little shame makes people think twice about bad habits. Or say something like, "My dad told me I can't ride with you because he says you text and drive."

Speaking of parents: As we all know, it's not just young drivers who text. If you're stuck in a car with an adult who is texting (or tweeting or emailing) behind the wheel, be direct and tell them to stop. Most adults know that parents are constantly telling kids not to text and drive, so they should feel embarrassed enough to put down the phone.

If a driver absolutely won't stop texting or laughs at you for being nervous, don't argue. The last thing anyone needs is a road-raging, texting driver. Get out the car as soon as you can. Next time that driver offers to give you a ride, say, "no, thanks."

On Call with Editor Donna Thomas

In recent months the media has reported a spike in Measles outbreaks in the U.S. Although there has only been only one suspected case in NJ, released by the New Jersey Department on Health last week, it is currently being investigated. The one year old child, who resides in Jersey City had not been vaccinated. The doctors at Pedimedica do not feel parents should become alarmed, however they stress the importance on having your child properly vaccinated for all recommended immunizations at the appropriate ages.

To learn more about the Measles and recommended vaccinations, we share with our readers an informative article from kidshealth.org, the #1 most-trusted source for physician-reviewed information on children's health and parenting issues.

About Measles
Measles, also called rubeola, is a highly contagious respiratory infection that's caused by a virus. It causes a total-body skin rash and flu-like symptoms, including a fever, cough, and runny nose. Though rare in the United States, 20 million cases happen worldwide every year.
Since measles is caused by a virus, there is no specific medical treatment for it and the virus has to run its course. But a child who is sick should drink plenty of fluids, get lots of rest, and be kept from spreading the infection to others.

Signs and Symptoms
While measles is probably best known for its full-body rash, the first symptoms of the infection are usually a hacking cough, runny nose, high fever, and red eyes. Children who get the disease also may have Koplik's spots, small red spots with blue-white centers that appear inside the mouth.

The measles rash breaks out 3-5 days after symptoms start, and can coincide with high fevers up to 104°F (40°C). The red or reddish-brown rash usually first shows up as flat red spots on the forehead. It spreads to the rest of the face, then down the neck and torso to the arms, legs, and feet. The fever and rash gradually go away after a few days.
Measles is highly contagious — 90% of people who haven't been vaccinated for measles will get it if they are near an infected person. Measles spreads when people breathe in or have direct contact with virus-infected fluid, such as the droplets sprayed into the air when someone with measles sneezes or coughs. A person who is exposed to the virus might not show symptoms until 8-10 days later.

People with measles are contagious (can spread the disease) from 5 days before the rash appears until about 4 days after that, and are most contagious while they have a fever, runny nose, and cough.

Recent Outbreaks
Measles is very rare in the United States. Before measles vaccination became available in the 1960s, more than 500,000 cases were reported every year. Back then, about 500 people died of the disease each year, and around 4,000 people a year had encephalitis (swelling of the brain) from the disease.

Due to widespread immunizations, the number of U.S. measles cases declined steadily to a low of 37 people in 2004. From 2000 to 2007, only about 63 cases per year were reported.
But recent years have seen spikes in measles outbreaks, including 131 cases in the first half of 2008 and 644 cases in 2014. Most U.S. outbreaks begin with people who were infected outside of the country, with the disease spreading quickly in areas where too few people have received the vaccine. About 85% of people infected with measles were not immunized or their immunization status was unknown, although they were eligible to receive the vaccine.

The people at highest risk of getting measles during these outbreaks are infants (who aren't old enough to get the vaccine), pregnant women, and people with poor nutrition or weakened immune systems.The most important thing you can do to protect your kids from measles is to have them vaccinated according to the immunization schedule prescribed by your doctor.

On Call with Editor Donna Thomas

In last months issue of On Call, Pedimedica addressed the need for children and adults to get the flu shot if they hadn't yet been vaccinated. Although the vaccine doesn't  guarantee that you won't  get the flu, it does reduce your risk, and in some cases can lessen the severity of your symptoms if you do become infected.

Editor Donna Thomas turned to KidsHealth.org, the most-visited site devoted to children's
health and development, to answer some frequently asked questions that parents have regarding the Flu. If you have any further questions or concerns don't hesitate to call your Pedimedica doctor.

Is It a Cold or the Flu?
Your child is sent home from school with a sore throat, cough, and high fever — could it be the flu that's been going around? Or just a common cold?
Although the flu (or influenza) usually causes symptoms that make someone feel worse than symptoms associated with a common cold, it's not always easy to tell the difference between the two.

Symptoms Guide
The answers to these questions can help determine whether a child is fighting the flu or combating a cold:

Flu vs. Colds: A Guide to Symptoms

Questions                                      Flu                 Cold
Was the onset of illness ...            sudden?         slow?
Does your child have a ...             high fever?     no (or mild) fever?
Is your child's exhaustion level ...severe?           mild?
Is your child's head ...                  achy?              headache-free?
Is your child's appetite ...             decreased?      normal?
Are your child's muscles ...          achy?              fine?
Does your child have ...               chills?             no chills?

If most of your answers fell into the first category, chances are that your child has the flu. If your answers were usually in the second category, it's most likely a cold.

But don't be too quick to brush off your child's illness as just another cold. The important thing to remember is that flu symptoms can vary from child to child (and they can change as the illness progresses), so if you suspect the flu, call the doctor. Even doctors often need a test to tell them for sure if a person has the flu or not since the symptoms can be so similar!

Some bacterial diseases, like strep throat or pneumonia, also can look like the flu or a cold. It's important to get medical attention immediately if your child seems to be getting worse, is having any trouble breathing, has a high fever, has a bad headache, has a sore throat, or seems confused.
While even healthy kids can have complications of the flu, kids with certain medical conditions are at more of a risk. If you think your kid might have the flu, contact your doctor.

Treatment
Some kids with chronic medical conditions may become sicker with the flu and need to be hospitalized, and flu in an infant also can be dangerous. For severely ill kids or those with other special circumstances, doctors may prescribe an antiviral medicine that can ease flu symptoms, but only if it's given within 48 hours of the onset of the flu.
Most of the time, you can care for your child by offering plenty of fluids, rest, and extra comfort.
And if the doctor says it's not the flu? Ask whether your child should get a flu shot.

Tips for Treating the Flu
The flu can make someone feel pretty miserable for up to a week, but it usually won't need medical treatment unless a person develops complications.

Some people are at high risk for serious complications if they get the flu, including children younger than 5 years old, pregnant women, people with asthma, and those with weakened immune systems. If they get the flu and their symptoms are reported within the first 2 days of the illness, a doctor might prescribe an antiviral medicine. But these medicines usually only shorten the course of the infection by 1 or 2 days.

If your child gets the flu:

• Offer plenty of fluids (fever, which is common with the flu, can lead to dehydration). If your child is tired of drinking plain water, try ice pops, icy drinks mixed in a blender, and soft fruits (like melons or grapes).
• Encourage your child to rest in bed or on the couch with a supply of magazines, books, quiet music, and perhaps a favorite movie.
• Give acetaminophen or ibuprofen for aches and pains (but do not give aspirin unless your doctor directs you to do so).
• Dress your child in layers so you can add and remove layers during bouts of chills or fever.
• Ask a close relative or faraway friend to call and help lift your child's spirits.
• Take care of yourself and the other people in your family! If you haven't done so, ask your doctor whether you (and other family members) should get a flu vaccine. Also, wash your hands well and often, especially after picking up used tissues.

If your doctor prescribes medicine to ease symptoms, be sure to call the pharmacist before you go to pick it up. The flu can strongly affect many areas of the United States, so some pharmacies might have trouble keeping the medicines in stock.

On call with Dr. Kolsky

Although it's important to get vaccinated early in the fall, it's not to late to get your children vaccinated for the Flu. Dr. Kolsky recommends parents read this article from Kids Health, the most-visited site on the Web for information about health, behavior, and development from before birth through the teen years.

Dr. Kolsky believes it's important for parents to become educated on the vaccine and how it can help keep your family healthy through the holidays and into the new year.

Is it too late to get the Flu vaccine? 

 

Flu season runs from October to May, with most cases happening from late December to early March. But the flu vaccine is usually offered from September until mid-November. Getting vaccinated before the flu season is in full force gives the body a chance to build up immunity to (protection from) the virus. 

Even though it's best to get vaccinated as soon as the flu vaccine is available, getting the vaccine later can still be helpful. Even as late as January, there are still a few months left in the flu season, so it's still a good idea to get protected.

Who Should Get the Flu Vaccine?

The flu vaccine is recommended for everyone age 6 months and older. It's especially important for people who are at greater risk of developing health problems from the flu to get vaccinated. They include: 

• all kids 6 months through 4 years old (babies younger than 6 months are also considered high risk, but they cannot receive the flu vaccine)

• anyone 65 years and older

• all women who are pregnant, are considering pregnancy, have recently given birth, or are breastfeeding during flu season

• anyone whose immune system is weakened from medications or illnesses (like HIV infection)

• residents of long-term care facilities, such as nursing homes

• anyone (adults, teens, and kids) with a chronic medical condition, such as asthma

• kids or teens who take aspirin regularly and are at risk for developing Reye syndrome if they get the flu

• caregivers or household contacts of anyone in a high-risk group (like children younger than 5 years old, especially those younger than 6 months, and those with high-risk conditions)
• Native Americans and Alaskan Natives

Kids under 9 years old who are getting the flu vaccine for the first time will receive two separate doses at least a month apart. Those under 9 who have received the flu vaccine before still might need two doses if they did not receive at least two vaccines since July 2010, or if the number of doses they've received since July 2010 is unknown. This is to ensure that all kids are vaccinated against the H1N1 flu strain that surfaced in 2009. Kids older than 9 years old only need one dose of the vaccine.

It can take 1 to 2 weeks for the flu vaccine to become effective, so it's best to get vaccinated as soon as possible.

 

Listen

Types of Flu Vaccine

Different types of vaccines are available. One type (called trivalent) protects against three strains of the flu virus (usually, two types of influenza A viruses and one influenza B virus). Another (called quadrivalent) protects against four strains. 

The vaccine can be given to kids in two different ways: by injection with a needle (the flu shot), or sprayed into the nostrils (nasal spray or nasal mist).

Both ways of delivering the vaccine are effective, but recent studies show that the nasal spray may work better in younger children. So experts recommend that healthy kids 2 to 8 years old get the nasal spray vaccine when available. If it's not available, the flu shot should be given (kids should not wait for the nasal spray to get vaccinated). The nasal spray isn't recommended for kids with certain medical conditions or pregnant women. 

Some vaccines are approved only for adults at this time, such as egg-free vaccines and intradermal shots, which are injected into the skin (instead of muscle) with a smaller needle.

Those Who Should Not Get the Vaccine

Certain things might prevent a person from getting the vaccine. Talk to your doctor to see if the vaccine is still recommended if your child:

• has ever had a severe reaction to a flu vaccination

• has Guillain-Barré syndrome (a rare condition that affects the immune system and nerves)

In the past, it was recommended that anyone with an egg allergy talk to a doctor about whether receiving the flu vaccine was safe because it is grown inside eggs. But health experts now say that the amount of egg allergen in the vaccine is so tiny that it (but not the nasal mist) is safe even for kids with a severe egg allergy. This is especially important during a severe flu season.

 

Still, a child with an egg allergy should get the flu shot in a doctor's office, not at a supermarket, drugstore, or other venue. And if the allergy is severe, it might need to be given in an allergist's office.

If your child is sick and has a fever, talk to your doctor about rescheduling the flu vaccine.

Are There Side Effects?

Most people do not have any side effects from the flu shot. Some have soreness or swelling at the site of the shot or mild side effects, such as headache or low-grade fever.

Some people who get the nasal spray vaccine may develop mild flu-like symptoms, including runny nose, headache, vomiting, muscle aches, and fever.

Where Can My Family Get the Vaccine?

The flu vaccine is available at:

• many health care settings, including doctors' offices and public, employee, and university health clinics
• some pharmacies
• some supermarkets
• some community groups or centers
• some schools

If you have an HMO insurance plan, be sure to check with your primary care doctor before having your kids vaccinated outside the office, since most HMOs will pay for shots only if they're given through.

On Call with Dr. Basil Bruno

Raising teens is both rewarding and challenging from a social and academic perspective. It is also a very important time for teens to learn how to take charge of their health care. Dr. Bruno shares this very informative article from kidshealth.com on how to guide your teens through this process.

Please feel free to reach out at any time to ask any of the doctors or staff for assistance in educating your family on important health matters. We are there to support you.

Helping Teens Take Charge of Their Health Care

Preparing kids for independence and adulthood brings many challenges for parents — teaching teens to drive, negotiating later curfews, researching colleges, discussing tough topics, to name just a few.

 
Among these hurdles is helping teens start managing their own health care. It can be hard to let go — after all, mom and dad have been handling the doctors' appointments, prescriptions, immunizations, and countless other medical concerns since their kids were born.

But it's important to guide teens toward taking on this responsibility. After all, parents won't always be around to manage their children's health care — and in most cases, once their kids become adults, legally they won't be allowed to.

 
And keep in mind that the decisions made in the teen years about things like alcohol, drugs, healthy eating, exercise, sex, and smoking can have long-term consequences — even if teens feel invincible. Becoming more invested in their own health care lets teens learn more about and understand the potential outcomes of choices they make now.
 
At what age are teens able to start taking some control? It can vary: factors like a teen's maturity level, health issues, and ability to keep track of the details all play a role, as does a parent's willingness to relinquish control.

 

So, how can parents start handing over the reins? It can begin by talking about medical topics in age-appropriate ways with their kids; for instance, discussing medications they take and why, or teaching kids with chronic conditions ways to help care for their medical equipment. Maybe your teenage son or daughter is ready to handle filling and refilling his or her own prescriptions.

It's important for moms and dads to let their adolescents have some private time to talk with the health care provider. During puberty and the teen years, kids are likely to have questions or issues that they're not comfortable discussing with a parent in the room. (But be assured that a doctor who feels that a patient who might be at risk for self-harm or harming another will alert a parent.) 

If you think your child might need additional help with teen issues, consider having your son or daughter meet with an adolescent medicine specialist. These doctors not only are well-versed in the care of teens' physical health problems but also have additional training in helping their patients deal with risky behaviors and mental health concerns. 

It's also wise to talk about health insurance and medical records to older teens. Although young adults can stay on their parents' plan until age 26 under the health care reform bill, many will be on their own well before that — and eventually all will have to know how to navigate the insurance system and keep track of their records.

On Call with Dr. Molly Thomas

Vaccines and Your Teen

Most teens, at this time of year are thinking more about the end of school, graduation, and going to the beach.  As parents, however, what we think about most is keeping them safe.  As you plan the summer and think about your teen's visit for a school physical and forms, keep in mind that teen vaccines are one of the most important ways to keep our children safe.  The following is a summary of some of the most common questions and answers that come up during visits with my teen patients. 

What are the vaccines necessary for teens and pre-teens?

There are 4 vaccines that are recommended by the American Academy of Pediatrics (AAP) as well as by the Center for Disease Control (CDC).

HPV Vaccine:  Human papillomavirus (HPV) vaccines help protect both boys and girls from both cancers caused by HPV as well as the virus itself.  Girls and boys should begin and finish the vaccine when they are 11 or 12 years old. 

Meningococcal Conjugate Vaccine: MCV protects against the bacteria that causes meningitis as well as bacterial sepsis.  Meningitis is a very serious and sometimes fatal condition that includes swelling of the brain and spinal cord.  Pre-teens need this vaccine at age 11 or 12 as well as a booster when they are 16. 

Tdap Vaccine:  This vaccine protects against 3 serious infectious diseases; Diptheria, Tetanus and Pertussis.  Pre-teens should get a booster at age 11 or 12. If your teen did not get one as a pre-teen they should have one now. 

Flu Vaccine: The annual flu vaccine not only protects against the flu virus; it also protects against the health issues that flu causes such as dehydration, worsening of asthma or diabetes for those who suffer those diseases, and even pneumonia. 

Are vaccines safe?

These vaccines are very safe.  Many parents and patients are accustomed to researching information on the internet and can be put off by the unreliable literature that is published there.  It is important to always research medical information at a reputable site that relies on research and scientific data to report findings.  Great sites include www.cdc.gov and www.healthychildren.org.  Side effects caused by vaccines are minimal.  Some children may have mild effects such as redness or soreness in the arm.  Some teens may feel light headed or even faint after vaccines or other medical procedures.  Lying down for a few minutes after shots can help preven this.  Side effects are quite mild compared to the serious disease that they prevent.  

Why do I need to give my teen vaccines and do they really need boosters?

Your child is still not protected from an illness until he or she gets a full course of vaccines.  As our kids go off to camp and to college it is important to realize that they will be living in close quarters with large numbers of people and are very at risk for catching communicable diseases and so we do not want to leave them unprotected. 

Missing a shot or a booster may not seem like a big deal but that little two second "ouch" protects you from illness that have major side effects.  For example, older teens and adults who get mumps can become infertile.  Those who get chickenpox as older teens are more at risk for pneumonia, as well as serious skin infections such as MRSA.  Shots do save lives.  Hepatitis attacks the liver and can ultimately kill.  HPV infection can cause cancer.  1 in 10 people with meningococcal disease will die from it.  The good news is that if you have missed a booster or even a whole series of shots you can simply pick up right where you left off.  Its never too late.   

What if I need help paying for vaccines?

Most insurance plans cover the cost of vaccines.  If you do not have insurance coverage, the Vaccines For Children (VFC) program may be able to help.  Our offices participate in VFC and the program provides vaccines for children up to 18 years who are not insured, underinsured on Medicaid or are American Indian. 

As a final thought, it is important to remember that it is normal to be nervous about getting shots.  If your teen has this problem try to suggest techniques such as deep breathing or coughing as the shot goes in.  The pinch lasts for only a second but the protection lasts a long, long time. 

 

 

References:

1. Vaccines for Pre-teens and Teens:  What Parents Should Know.  US Department of Health and Human Services

2. Your Preteens and Teens Need Vaccines Too! CDC Website

3. www.healthychildren.org

4. www.teenshealth.org

 

It's time to schedule check-ups now!

It's time to schedule check-ups now!
Its almost summer! Time to make appointments for camp and school physicals for June and July. It's important to schedule now as appointments fill up quickly by August!

Attention:  Important health news for all travelers!
Under the travel advisory all children 6-11 months of age need MMR vaccine for international travel.