February 2003

I hope you will enjoy reading our inaugural monthly newsletter. Our goal is to provide both parents and children in our practice information that is medically informative, community oriented, and easy to read. I have many ideas but would be happy to incorporate any suggestions you, our patients, have to offer. Features I will incorporate include: Dr. B’s thoughts, parents’ question of the month, kids’ question of the month, patients in the news (your children’s awards, achievements, etc.) and even entertainment reviews. So, happy reading and happy New Year.

Dr. Barenfeld

Influenza------------------------------------------------

Entertainment News

Wasn’t Harry Potter and the Chamber of Secrets great! I give it 3 stethoscopes (out of 4). News flash!! J.K. Rowling has completed Book 5: “Harry Potter and the Order of the Phoenix”, due out June 21. It is 768 pages long. It begins: “The hottest day of the summer so far was drawing to a close, and a drowsy silence lay over the large, square houses of Privet Drive . . . The only person left outside was a teenage boy who was lying flat on his back in a flowerbed outside Number 4.” It is sure to keep both your kids and me busy reading all summer long!

Yes, it’s flu season! Influenza affects 10-20% of the U.S. population each year, resulting in more than 110,000 hospitalizations. Certain children and adolescents are at high risk of complications from influenza including: 1. Asthma or other chronic lung disease, 2. Heart and kidney disease, 3. Those receiving long term aspirin therapy, 4. Infants from birth to 23 months old, and 5. Pregnancy for those women who will be in their 2nd or 3rd trimester during the epidemic season. Treatment of the flu is mostly supportive (Tylenol, fluids, bed rest). Antibiotics will not help unless a secondary infection occurs such as ear infection or bronchitis. This secondary infection occurs in 20-25% of flu patients. There are new treatments available for the flu. These are only minimally effective, have side effects and are not widely used, especially in Pediatrics. Prevention of flu involves good hand washing and covering one’s mouth when coughing. However, influenza is highly contagious and is difficult to avoid during epidemics. Over time, people become immune to circulating influenza strains. However, disease persists and prevention remains a challenge because influenza viruses constantly mutate. Influenza vaccine: Each Spring the FDA selects the strains to be included in the yearly vaccine based upon those predicted to contribute to the epidemic in the upcoming flu season. The vaccine is safe and is recommended for children > 6 months age at high risk as mentioned above. Vaccination begins in October and continues though December. Protection peaks two weeks after vaccination and usually lasts 4 – 6 months. Efficacy ranges from 30-80% depending on the recipient’s age and immunocompetence and the match of the vaccine against circulating strains. Influenza vaccine given as a nasal spray has been developed and is waiting approval by the FDA. It appears to be safe and effective and avoids the pain of an injection. Over the next few years recommendations for vaccinating all children 6 to 23 months will be adopted and even broader coverage in the future. For now keep the Tylenol handy.

Parent Question of the Month---

Q. We recently read that ear infections don’t need to be treated with antibiotics. Is this true?

A. Overuse of antibiotics in the U.S. has led to high rates of antibiotic resistance. Many infections previously treated with penicillin and amoxicillin are no longer effective. In the Netherlands and other European countries, antibiotics are frequently withheld in cases of ear infection. It is also true that up to 70% of ear infections will resolve without treatment. I’ve certainly made a convincing argument against the use of antibiotics, haven’t I? Not so fast, Dr. B! First: we cannot tell by looking in the ear which infections will resolve on their own. Secondly: Those infections that don’t resolve and are left untreated can cause serious complications including hearing loss and need for surgical treatment. So, although in the Netherlands, bacterial resistance to antibiotics is low, lots of children have hearing loss and other complications. Thirdly: Antibiotic use has been shown to decrease the length of time for ear pain and quicken the resolution of infection. How many of you want to stay up another night with your child screaming with ear pain? So with all that being said, most physicians are still in favor of treating all cases of ear infection.