November 2003

There has been a major change in the recommendation for influenza vaccination. The flu shot is now recommended for all children 6 months to 2 years of age. We are also giving the vaccine to all children as per parent’s request. Don’t hesitate to ask us for further details. Hope you all have a happy Thanksgiving!

Dr. Barenfeld

Flattening of the Skull --------------------------------

Flattening of the back of the skull or occiput is quite common. At birth many infants have a misshapen head due to the infant’s position in the uterus or through the birthing process. This condition resolves itself without treatment during the first few months of life. However with the onset of the American Academy of Pediatrics “Back to Sleep” campaign in 1992 to prevent SIDS we have seen a large increase in flattening of the occiput. This is because all babies spend much more of their time flat on their backs. Since the infant’s skull is relatively soft, this position slowly causes flattening by gravitational forces alone. Several things can be done to help prevent this problem. Supervised “tummy time” while the infant is awake is recommended and also facilitates development of upper shoulder strength. Nightly alternating of the head position to the left and right during sleep or alternating the end of the crib in which you place your baby to sleep (your infant will usually look toward the door) will help. Once flattening has occurred several recommendations will quickly alleviate the problem. The techniques mentioned above should be utilized. In addition, placing your baby on the other end of the changing table will force your baby to turn the opposite way to face you. Similarly, placing toys on the side of the stroller, swing, crib, or infant seat to which you want your baby to turn is helpful, and alternating the hip or arm with which you carry your baby will also accomplish the same goal – look away from the flattened side. Neck motion exercises are important as these equally strengthen your baby’s neck muscles. Neck exercises should be done with each diaper change or at least five times per day until the problem is corrected. Three repetitions of each exercise should be done.

Exercise 1. The first exercise is designed to improve rotation of your child’s head to the right and left. Place one hand on your child’s chest. Place the other hand on the side of your child’s face. Gently but firmly turn the head so that the chin moves toward the shoulder. Turn the head only to the point of resistance, hold for 10 seconds, and release. Switch hands and repeat the same steps, turning the head to the shoulder in opposite direction.

Exercise 2. The second exercise is designed to improve bending of your child’s head to the side. Place one hand on your child’s upper chest and shoulder area so that his or her body does not move. Hold the top of your child’s head with the other hand. Gently but firmly tilt the head to the side, pressing the ear toward the shoulder. Press only to the point of resistance, hold 10 seconds, and release. Switch hands and repeat the same steps, tilting the opposite ear to the shoulder.

During the exercises that move the tight area of your child’s neck your child will fuss and squirm. However, consistent use of these exercises gradually will improve your child’s neck mobility.

Parent Questions of the Month------------------------------------

Q. What can you tell me about the new nasal flu vaccine I have seen advertised on T.V.?

A. This new vaccine is called FluMist. It is the first nasal flu vaccine in the U.S. As many of you know, there is an effective injectable influenza vaccine which has been available for many years. It is recommended for all individuals 6 months of age through adulthood, especially those persons with chronic medical problems (see Gazette Feb. 03). The biggest advantage FluMist has is that it is not an injection. This avoids the “needle phobia” that many children have and since all influenza vaccines are administered yearly, this fear of injections is a major issue. FluMist is as safe and effective as the injectable vaccine. There are several disadvantages to FluMist. FluMist is only recommended at this time for individuals 5 – 49 years of age and cannot be given to those people with chronic medical problems such as asthma, diabetes, and heart disease, or to pregnant women. So those people most at risk of complications from influenza and, therefore, those that need to be vaccinated most should not get FluMist. Also, since FluMist is a live vaccine it should not be given to those who are immunosuppressed or those who come into close contact with immunosuppressed people. FluMist is also not currently covered by the insurance companies and must be paid for out of pocket. We do have FluMist available for those who are interested. Please don’t hesitate to ask one of us if you have further questions.