Newsletter - Fall 2009
Posted on Nov 25, 2009
Greetings from Lake Forest Pediatrics
It is our privilege to bring you another edition of the Lake Forest Pediatric Associates newsletter. Our hope is that you will learn something new with each publication. We try to provide timely and seasonally informative topics. Should there be a topic you would like reviewed, please let us know.
We are featuring two new physicians to our practice. They are Dr. Katie Hidaka and Dr. Katie Hanley. Both began at the end of the Summer. Both came highly recommended and we are very glad they have joined our practice.
The PNP Pointers topic for this issue is Winter Safety Tips.
Our Hot Topic is H1N1 Influenza A and Seasonal flu. You may recall, we discussed H1N1 in the last newsletter, but this topic bears repeating and updating.
We will also discuss otitis media, commonly known as the ear infection.
As always, should you have any comments, please feel free to notify us. Thank you for trusting us with the healthcare of your children.
Please visit our website. It offers many helpful tips and answers frequently asked questions.
LFP Profile
Dr. Katie Hidaka joined our group in August. She completed her undergraduate degree at the University of Illinois in 2002 and received her medical degree from Northwestern University in 2006. Dr. Hidaka then went on to complete an internship and residency at Children’s Memorial Hospital this year. She grew up in Western Springs, IL. Dr. Hidaka was married this summer prior to starting practice and just recently moved to Lake Forest. Her hobbies include reading and traveling, and she hopes to start a garden in her new backyard. Her husband is also a physician practicing Internal Medicine at Northwestern.
Dr. Katie Hanley also started with us this summer. She is a graduate of Lewis College in Romeoville, IL and began a career in accounting with Arthur Anderson prior to going to medical school. She attended medical school at the University of Illinois Chicago and then completed her pediatric residency at Children’s Memorial Hospital. She lives in Chicago but plans on relocating to Vernon Hills. Dr. Hanley has 8 brothers and sisters
and 32 nieces and nephews. Dr. Hanley enjoys tennis and bike riding and she played softball in college.
We are excited to have both Drs. Hidaka and Hanley join our group.
Otitis Media
Otitis media is known more commonly as the ear infection. Just about every child has had at some time an ear infection, with some children having multiple episodes. Otitis media is seen year round, but its incidence increases in the colder months. It is a common cause of sleepless nights for both children and their parents. Many times an ear infection follows the onset of an upper respiratory infection. Otitis media is caused by infected fluid in the middle ear space. This is the space behind the ear drum. The eustachian tubes are areas that help to aerate the middle ear space and regulate pressure in this area. During the course of an upper respiratory infection, the eustachian tubes are dysfunctional and pressure builds up leading fluid to leak into the middle ear space. If the fluid persists long enough, it can get infected causing the ear drum to thicken and eventually bulge out. At this time the diagnosis of an ear infection is made. When fluid is present, but not infected, this is known as otitis media with effusion. For the most part, acute otitis media is treated with antibiotics. Just about all cases of otitis media are caused by viruses or bacteria. Generally, amoxicillin is chosen as a first line agent in non-penicillin allergic children. Low and higher dose regimens are determined by number of ear infections, age, and other factors. Other antibiotics that are generally effective against otitis media are amoxicillin-clavulanic acid, and a class of drugs called cephalosporins. Your pediatrician decides which antibiotic is best. It is very important to make the right diagnosis of otitis media, so as not to over prescribe antibiotics. Your pediatrician or pediatric nurse practitioner is well trained to make the right decisions about the diagnosis and treatment of this ubiquitous illness.
No doubt, your child or a child you know has had “tubes” put in his or her ears. Pressure equalizing tubes are inserted by an otolaryngologist through the ear drums during a simple outpatient procedure. The tubes act to keep pressure equalized on both sides of the ear drum, generally preventing fluid from building up. It takes many episodes of otitis media or chronic ear fluid before your child may need tubes, but in the right setting, they provide long term relief for children with frequent ear infections. Hearing loss/decrease due to persistent fluid often is a reason for tubes as well. These tubes generally fall out on their own. Otitis media is generally an illness of younger children. The younger the child, the more horizontal the eustachian tubes. As children grow, the angle of the eustachian tube changes promoting better aeration and drainage. It is rare for an older adolescent and adult to get an ear infection.
PNP POINTERS - From the desk of a pediatric nurse practitioners
Cold weather is upon us, so we felt that some winter safety tips would be a good idea to remind us all of the dangers of the cold. The American Academy of Pediatrics offers some tips and good ideas to keep in mind.
Dress infants and children warmly in several thin layers for outdoor activities. Long johns, one to two shirts, pants, and a sweater with a coat are quite effective in keeping the cold out. Of course, a hat covering the ears, and mittens or gloves are a must.
Keep blankets, quilts, pillows and other loose bedding out of an infant’s sleeping environment. These may contribute to SIDS. One piece sleepers do a nice job keeping children warm.
Frostbite happens when the skin becomes frozen. Generally frostbite affects fingers, toes, ears and one’s nose. Any area that has frostbite may become pale, and can blister. Should this situation occur, bring the child inside, and use warm, but not hot water over the areas affected. Warm washcloths may be used too. Cover areas with clothing or blankets. Kids may describe pain, numbness, or the sensation of burning. If these sensations continue for several minutes after warming, then call your doctor.
Winter sports/activities
Sledding- consider having your child wear a helmet. Sledding should always be feet first or sitting upright.
Ice Skating – Skate in the same direction of the crowd. Consider having your child wear a helmet. Skate only on approved surfaces.
Skiing or snowboarding – Never ski or snowboard alone. The AAP recommends that no child under age 7 be allowed to snowboard. Consider wearing a helmet. Make sure equipment is properly fitted.
(From AAP Winter Safety Tips. www.aap.org)
LFP HOT TOPIC- INFLUENZA
With the last newsletter, pandemic H1N1 influenza was discussed. With this newsletter, we will discuss seasonal influenza and then update the information for novel H1N1. Seasonal influenza that affects humans is of two types. They are Influenza A and B. A can be subtyped further into H1N1 and H3N2. H stands for hemaglutinin and N for neuraminidase. These are proteins on the influenza virus that give influenza its identity. The current “swine” flu is also an H1N1 but an entirely new strain. Each year seasonal influenza virus can mutate slightly requiring the production of a different influenza vaccine for that season. Generally seasonal influenza infections occur between October and April of each year.
Influenza viruses are spread mostly through transmission of droplets between individuals. One can also acquire the virus through contaminated surfaces. The incubation period is from 1 to 5 days. Symptoms of infection include fever, chills, muscle aches, cough, nasal congestion and drainage. Most illness lasts from 3-6 days. Complications of influenza can occur. These include pneumonia, ear infections, and wheezing exacerbations in those children with asthma. Most children recover uneventfully, but some go on to be quite ill and require hospitalization. Every year about 200,000 people are hospitalized and 36,000 people die from the seasonal influenza illness. In children about 1% are hospitalized. Most of these children are under age 2. It is possible to test for influenza. Most standard testing kits, including the one we use in our office can differentiate from Influenza A and B, but does not subtype any further. If one is diagnosed with seasonal influenza type B, Tamiflu can be helpful for treatment. It is important to note however, that this medicine does not cure a patient, but it may decrease the length of time that one is ill. This difference may only be one day less. It is recommended to treat only certain groups of children, especially the very young and older children with underlying illness or diseases.
The best way to protect ourselves from influenza is through vaccination. Two vaccines exist currently for seasonal influenza- an inactivated vaccine given as an injection, and a live, weakened vaccine that can be absorbed through the nose (FLUMIST).
As mentioned above, pandemic H1N1 influenza is a new subtype of influenza. In other words, it has not been seen in humans in any previous season. It infected its first victims last Spring 2009 and we currently have a pandemic, meaning novel influenza has spread globally. Remember, the term pandemic only refers to the amount of illness, not the severity of illness. Influenza pandemics have occurred in the past, and are generally the result of genetic material mixing between humans and animals creating a new virus.
Generally, more children and younger adults are sicker and require hospitalization with novel H1N1 than are older adults and the elderly. This is the opposite trend from seasonal influenza.
A vaccine is currently being distributed for novel H1N1 influenza, but production and distribution have been slow. Lake county residents began to get the vaccine in October 2009. About 180 million doses are expected to be produced. Please check our website for information about influenza, and the availability of the H1N1 vaccine. We recommend that children get this vaccine when it is available for the same reasons we recommend getting the seasonal influenza vaccine. The higher risk groups include patients with chronic underlying disease including asthma, diabetes, heart disease, or immune dysfunction. Other high risk groups are children less than 5, and pregnant women.
These higher risk groups as well as hospitalized patients with probable or confirmed cases of H1N1 influenza may receive treatment. Tamiflu and Relenza are two medicines shown to be effective against this new influenza.
If you have influenza, seasonal or novel H1N1, the current recommendation is to stay home until fever free for 24 hours without the use of fever reducing medications. Avoid coughing and sneezing within three to six feet from other people. As with many viruses, hand washing with soap and water is a very effective prevention technique we can do. (most information from Centers for Disease Control website, CDC.org, the Lake County Health Dept, and VIS from Children’s hospital of Philadelphia)