Is it really candy or is it medicine?

As I'm sitting and eating my daughter's trick-or-treat candy, I can remember how upset I was when I heard someone tell my daughter that the chewable acetaminophen tablets were candy so that she would take it.  Many candies look like the medicine that you may have in your home. For example, green m&m's look like green iron pills that many adults take every day. When left unattended, children may sneak the colorful pills into their mouths, mistaking them for candy. Here are some helpful hints on how to get your kids to take their medicine. Some safety tips for poison prevention can be found in an article in Parents magazine. Other tips can be found on the web site for the American Association of Poison Prevention. Also, keep the phone number for the Poison Control Center near your phone, and call if you think there might have been an exposure. Teach the number to your children: 1-800-222-1222 and that medicine is not candy.

Does your child usually suffer from asthma in the fall?

If  your child was off, or on lower dosages, of asthma controller medicines over the summer, have they been resumed, yet? A review of kids' health insurance data presented earlier this week at an American College of Chest Physicians meeting (Chest 2008) found that the peak months for emergency room visits and hospitalizations are October and November, while medication use peaked in December.  Summer is the low season for seeking health care for asthma and use of asthma meds.  I agree with the strategy to restart controller medicines before predicted attacks occur, instead of waiting until one hits.

When I was working as a pediatric clinical pharmacist, September marked the beginning of my busy season for asthma education, and it would continue into the winter months. So, this trend is in line with what was reported in the study. Many of my patients' asthma attacks were triggered by weather changes, seasonal allergies, or a cold. Not taking medicine properly was another reason.  Here are some of my favorite teaching points: 

• Be consistent about the timing of the doses and don't stop medicines without consulting your child's doctor; 
• If the doctor says it's ok to stop or give lower doses during the summer, don't forget to ask when to restart them. Some children have attacks triggered by high humidity in the summertime, so it is possible that your child may need it all year round, especially if there are chronic exposures to other common triggers;
• Don't forget to refill prescriptions.  Many kids end up in the hospital because they run out of their inhalers;
• Make sure the correct technique is being used to give the medicines, especially inhalers. Ask your pharmacist, nurse, or doctor to show you;
  
• Understand how and why the medicines work and teach your child. For example, using the controller medicines during an acute asthma attack does not help; 
• Ask questions about your child's asthma, even if you, or someone you know, has asthma; and
• Oh, don't forget that flu annual flu shot!

No cough/cold meds for kids under 4 - Don't worry, be happy

With the frequent weather changes, I'm preparing myself for colds in one, if not both, of my children.  Kids get 6-10 colds a year, according to the NIH.  This was definitely true when my daughter was an infant.  Yes, I had many nights of interrupted sleep because of her colds, but I never gave her any OTC cough or cold medicines.   No antihistamines to help her fall asleep, either.  Instead, I tried putting saline drops in her nose, suctioning it out with a bulb, propping her up on a pillow, using a cool-mist humidifier when the heat was on in the room, giving her plenty to drink, and just being patient.  Sometimes it took more than one of these methods, but in the end we both got more sleep.  

I avoided the medicines because I didn't want her to feel more miserable with palpitations from decongestants or excessive drowsiness from the cough medicines.  Besides, she wouldn't have been able to tell me any of that.  Of note, most of the products that had "infant" on their labels referred consumers to their physicians for dosing in children under 2.  As a pediatric pharmacist, I have been asked by pediatricians for my recommendations.   I did not always have an answer, though, because some products have not been studied in children.  So, when the drug companies pulled their infant cough/cold products off of the shelves a year ago and the Food and Drug Administration (FDA) made the recommendation this past January to forgo these products in children under the age of 2, I voiced my support.  Until we have more data to support their use in young children, they should be avoided.  Earlier this month, the members of the Consumer Healthcare Products Association (CHPA) volunteered to update the product labels to state "do not use" in children under 4 and to provide new measuring devices with the products.   The FDA will continue to seek more information about these medicines.

In the meantime, don't worry about these medicines being removed from your ammunition against colds in younger kids.  Instead, be happy that the FDA is taking action to make sure that the medicines indeed work and are safe for our children.  For tips on using OTC medicines safely in older children, check out this Daily News article.  The American Academy of Pediatrics has some great additional non-medicine tips for relieving the symptoms of a cold.  Remember that a cold is caused by a virus, and even these methods will not shorten the course of the illness (1-2 weeks), but it can help your child feel better without your worrying about side effects.  Do NOT give adult medicines to your child.  As a pediatrician I worked with always used to say, "a tincture of time" will do wonders.   Oh, and don't forget to give your child the flu shot this year.

One flu over the baby's nest

If you are pregnant or have children less than 6 months of age at home, consider getting your flu shot soon! You can get it at your doctor's office or go to a flu clinic (a pharmacy near you may offer it). I received mine this week from my local Rite Aid Pharmacy and paid $30. Another place to try is your employee health office; it may be offered for free or charge a nominal fee of $10 for administrative costs.

It’s Worth a Shot! Why is it important to get the flu shot even if you do not work in a health care facility or school? Well, you can acquire the infection and be so sick that you would have to miss work or school for a week. It’s even worse if you have small children at home and no help. Or you may have to miss work if your child has the flu. You can also spread it to the rest of your family. Children, especially infants, are very vulnerable to infections and their complications. In fact, many have died from the flu. For the 2007-2008 flu season, the Centers for Disease Prevention and Control (CDC) reported that pediatric deaths included seven children aged less than 6 months, 16 aged 6-23 months, 18 aged 2-4 years, and 42 aged 5-17 years.  Unfortunately, 92% (58/63 cases) whose vaccination status was known did not receive the flu vaccine  This is likely to be underreported. Deaths in adults do not have to be reported.

Who Should Get the Vaccine? Anyone who wants to lower his/her chances of getting and/or spreading the flu can get the flu vaccine. However, the CDC and ACIP recommend that certain people should get the vaccine every year because they are at higher risk of having serious complications from the flu infection or they live with or take care of people who are at high risk for complications. These are also the people who receive priority to get the vaccine if there should be a shortage of the vaccine. The 2008-2009 recommendations are:

• Children aged 6 months up to their 19th birthday (vaccination for 5-18 years of age is a new recommendation this season)
• Pregnant women
• People 50 years of age and older
• People of any age with certain chronic medical conditions: pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, hematological or metabolic disorders (including diabetes mellitus)
• People who have any condition (e.g., cognitive dysfunction, spinal cord injuries, seizure disorders, or other neuromuscular disorders) that can compromise respiratory function or the handling of respiratory secretions or that can increase the risk for aspiration;
• People who are receiving long-term aspirin therapy who therefore might be at risk for experiencing Reye syndrome after influenza virus infection
• People who live in nursing homes and other long-term care facilities
• People who live with or care for those at high risk for complications from flu, including:

Health care workers

Household contacts of persons at high risk for complications from the flu

Household contacts and out of home caregivers of children less than 6 months of age (these children are too young to be vaccinated)

The bottom line is, get you and your child(ren) vaccinated. The time is now. Make the appointments today. Flu season is usually between December and March; the peak of the past season was in February. So if your baby turns 6 months-old between now and April, let the doctor give the shot. If your older children are under 19 years-old, bring them in for their annual flu shot. Don’t forget about yourself!

Don't like shots? You can ask for the intranasal flu vaccine (FluMist), but not every clinic carries it. The intranasal option is approved by the Food and Drug Administration (FDA) for people 2 through 49 years-old. Beware, it could be more uncomfortable than a needle stick. Also, if your child has asthma and is 5 years-old and younger, the shot should be given to avoid the risk of an asthma attack. There are other conditions when this option may not be appropriate as compared to the shot.

But I got the flu from the flu shot! You may experience some flu-like symptoms after the shot, if not a sore arm, but you did not get the flu from the shot. It may be just pure coincidence, or you may have a cold. Don't use that as an excuse. Protect yourself and your kids. And if you are a health-care worker, protect your patients, too!

VERY IMPORTANT: If your child is under 9 years-old and is receiving the flu vaccine for the first time, he/she will get TWO shots this year. The two shots should be at the same dose, at least one month apart to boost the immune response. Thereafter, your child will only receive 1 dose per year to prevent the flu illness. It is not unheard of that some less experienced practitioners have divided the dose in half and gave one half the dose the first month and the other half the next month. Don’t panic if your child only gets one dose this year because they can get the two doses next year.

For more information about the flu and the flu vaccines, visit www.cdc.gov.