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Dr. Jason Perlman on Flu Testing and Treatment

Every parent, old or new, knows that the winter season is flu season. While the virus is common, the symptoms can be quite uncomfortable for kids, so we get a lot of parents in with questions, especially regarding flu testing and treatment. This month, Dr. Jason Perlman, our resident ID specialist, weighs in what to know for healing from the flu in 2018.



Jason, you are an ID doctor, what does that mean?

It means that in addition to my pediatric training, I spent 3 years studying infectious diseases (i.e.; bacteria, viruses, funghi, and parasites) and how they interact with children when they cause illness.

Does Tribeca Pediatrics test for flu?

We do not test for flu because by the time symptoms of the virus show up, treatment or management of the illness wouldn’t change. Basically, when you’re sick with the flu, and showing symptoms your doctor will be able to start a treatment plan without waiting for any type of test results.

What is Tamiflu? Does Tribeca Pediatrics administer this treatment for illnesses?

Tamiflu is the standard anti-flu medication. However, we do not treat the flu with this medication. Tamiflu is only effective within 48 hours of a flu diagnosis (when symptoms show up), and is said to shorten the time spent sick by 2 days, if you’re lucky. And the treatment is not without side effects. These include abdominal pain, vomiting and diarrhea, and delirium. Especially since Tamiflu is only a therapy, not a cure, our doctors haven’t found that the benefits outweigh the side effects.

Does Tribeca Pediatrics test for RSV?

We do not test for RSV. RSV, Respiratory Syncytial Virus, is a seasonal infection, and is the most common cause of Bronchiolitis. Bronchiolitis presents itself as a bad cold, wet cough, fever, and wheezing, especially in children younger than 2 years old. Many viruses can cause Bronchiolitis. Ultimately, treating the condition is what benefits the child, not identifying those symptoms specifically caused by RSV.

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Dr. Jason Perlman on Flu Testing and Treatment

Every parent, old or new, knows that the winter season is flu season. While the virus is common, the symptoms can be quite uncomfortable for kids, so we get a lot of parents in with questions, especially regarding flu testing and treatment. This month, Dr. Jason Perlman, our resident ID specialist, weighs in what to know for healing from the flu in 2018.



Jason, you are an ID doctor, what does that mean?

It means that in addition to my pediatric training, I spent 3 years studying infectious diseases (i.e.; bacteria, viruses, funghi, and parasites) and how they interact with children when they cause illness.

Does Tribeca Pediatrics test for flu?

We do not test for flu because by the time symptoms of the virus show up, treatment or management of the illness wouldn’t change. Basically, when you’re sick with the flu, and showing symptoms your doctor will be able to start a treatment plan without waiting for any type of test results.

What is Tamiflu? Does Tribeca Pediatrics administer this treatment for illnesses?

Tamiflu is the standard anti-flu medication. However, we do not treat the flu with this medication. Tamiflu is only effective within 48 hours of a flu diagnosis (when symptoms show up), and is said to shorten the time spent sick by 2 days, if you’re lucky. And the treatment is not without side effects. These include abdominal pain, vomiting and diarrhea, and delirium. Especially since Tamiflu is only a therapy, not a cure, our doctors haven’t found that the benefits outweigh the side effects.

Does Tribeca Pediatrics test for RSV?

We do not test for RSV. RSV, Respiratory Syncytial Virus, is a seasonal infection, and is the most common cause of Bronchiolitis. Bronchiolitis presents itself as a bad cold, wet cough, fever, and wheezing, especially in children younger than 2 years old. Many viruses can cause Bronchiolitis. Ultimately, treating the condition is what benefits the child, not identifying those symptoms specifically caused by RSV.

Dr. Percy Huggins Discusses Cold Treatments

Watch Dr. Percy Huggins, from our Greenpoint office, discusses cold treatments.

Dr. Michel Cohen Debunks Cold Treatments

Here is a roundup of some common cold remedies and Dr. Cohen’s assessment of their effectiveness from his book, The New Basics:

  • Nose drops push the mucus down the throat but only temporarily; there’s much more where that came from. These drops are also unpleasant for a baby’s nose. An aspirator is even worse.
  • Propping up your child may harness the awesome power of gravity to drain mucus from her head. This effect is limited, however, by the fact that a propped-up baby will wiggle and slide down to the bottom of the crib sooner or later.
  • Humidifiers and vaporizers make you feel proactive. Hissing and misting, they purport to loosen up the mucus, but as you know, the thickness of the mucus isn’t really the problem . . . it’s the quantity. And no amount of humidity can affect that.
  • Decongestants, which are all similar in nature, are generally useless. In the best scenario, they dry out the secretions for an hour or two, but as soon as the effects wear off, the mucus returns with a vengeance. These medicines also have potentially dangerous side effects (and in fact were taken off the market for children younger than 4 due to cases of death). You may not mind a little drowsiness at night, but reverse effects are very common, and they could keep your child awake and restless all night.My advice? Stay away, no matter how enticing the copy on the packaging makes these drugs sound.
  • Acetaminophen and ibuprofen can help lower the fever, but since the fever is already low grade, there isn’t much to bring down. You could, however, use these to decrease your child’s overall discomfort.
  • Alternative treatments: I haven’t seen anything in the health food store that makes a difference in regard to the prevention or treatment of cold symptoms. That includes echinacea, one of the all-time homeopathic favorites, as well as vitamin C.


  • Watch Dr. Percy Huggins, from our Greenpoint office, discusses cold treatments.

    Dr. TJ Gold Discusses Introducing Solids

     

    Flu Season

    With school back-in-session, changes in weather and schedule can majorly affect your routine, and your child’s health. While anyone is liable to catch the flu year-round, cooling temperatures, along with more time spent indoors, can trigger this virus to spread more easily. The flu vaccine is an option for keeping little ones healthy, so we’ve rounded up some information to help you figure out if the vaccine is right choice for your family.  

    What It Is

    The flu vaccine was created to respond to the changes in the flu virus as it constantly evolves. On a given year, it might not be much of an issue, while others, a wide spread of the virus can cause public concern. Flu symptoms generally include a fever, body aches, nasal discharge, and coughing. Young children especially can have reactions that include respiratory distress, stomach pain, and vomiting. The symptoms will usually last for a few days, and although there’s no cure, there are a number of over-the-counter fever and pain reducers that can help ease the discomfort and pain of the virus. It may lead to rare symptoms including pneumonia, dehydration, ear infections and sinus infections.

    The Shot (No Mist)

    Following recommendations from the CDC of its ineffectiveness this season, we will not be offering the flu vaccine in mist form this year.

    At Tribeca Pediatrics, we offer the traditional flu vaccine in injection form and your little one will be good to go. The flu vaccine can be administered starting at 6 months old. If your child is under nine years old and has never received the flu vaccine or only one dose prior, they will need to come back in one month for a booster shot.

    Some have reported having flu-like symptoms for a short time after receiving the vaccine, and this is a normal reaction that should last a short period of time. If your child has flu-like symptoms and a persistent fever for a few days, schedule an appointment to be seen.

    State Requirements

    Flu shots are not required for school attendance in either New York or California. In New Jersey, children ages 6 months to 59 months, are required to receive the annual flu shot if they are in daycare or preschool.

    Bottom Line

    If your child has a chronic condition such as asthma that would make having the flu tougher on them, you may want to consider the vaccine more seriously. Otherwise, it’s just a matter of parental preference.

    Whatever your decision is, we’ll be here to support your family all flu season. Please don’t hesitate to contact us if you have further questions.

    Shoestring

    No matter how prepared we are, childbirth doesn’t always go 100% according to plan. Not even for a pediatrician like myself.  

    Just last week my partner’s water broke with no time to make it to the hospital. She was screaming and my child’s head was crowning, so we were left to our own devices with no midwife in sight (long story). 

    When it became evident that there was no other option but to receive the baby myself, I rolled up my sleeves, pulled my newest baby daughter’s head down, unknotted the cord around her neck and delivered her. She took a deep breath and cried, I took a deep one too. 

    During the childbirth, I remembered my first days as a pediatric resident watching births in the delivery room. I realized it was the right moment to clamp the umbilical cord. First, I tried an Office Depot clamp, which was ineffective. Dental floss and iPhone chargers came to mind too. But in the end, it was a shoestring that saved the day.

    Like I said, childbirth doesn’t always go 100% according to plan. I am, however, happy to report that the baby, Michelle, and her mother, Mika, are doing well. My eldest daughters have even nicknamed her, Shoestring.

    Now that I’ve shared a piece of my life with you today, I also wish to share a thought. I’ll be personally revisiting my theories documented in my book, The New Basics, but with much more experience under my belt. So I’ll be sharing the updates, tweaks, and confirmations in advice I find, for a whole new series to post in our monthly blogs. Looking forward to it.

    Dr. Michel Cohen

    Sunscreen and Bug Spray Q & A

    Summer is in full swing and the heat is on! It’s the perfect time to enjoy the outdoors, which can come with it’s own set of discomforts, namely, sunburn and bug bites. Dr. Maja Castillo, of our Chelsea office, came to the rescue to give you help tips you need to get through those dog days of summer!

    The UVA’s and UVB’s of Sunscreen

    We all know how important sunscreen is to reduce exposure to the sun’s harmful and painful UV rays. There’s a lot of information regarding proper use and types of sunscreen, it’s easy for parents to feel overwhelmed. Here is some helpful advice from Dr. Castillo:

    When should I start using sunscreen on my baby?
    For sunscreens most manufacturers state sunscreen should be used only over 6 months of age. There are two types of sunscreens: chemical sunscreens and barrier sunscreens. Chemical sunscreens neutralize UV rays. Barrier sunscreens use zinc oxide to block sun rays. While I do think it’s best to try to minimize sun exposure for babies under 6 months, especially during peak hours (10am to 3pm) of the summer, I also know it’s impossible to avoid the sun 100%. For infants over 2 months, I think using barrier sunscreens with zinc as the active ingredient is a good idea when you are on the beach or going to take a dip in the pool. Sun rays bounce off water and can even get to an infant under a sun umbrella!

    How often should sunscreen be applied?
    No matter what age the child is, sunscreens need to be reapplied every 1-2 hours. You really don’t need more than 30 SPF but reapplication is key and is what is most often forgotten. Remember to apply even when it’s hazy or cloudy outside. UV rays will penetrate and I most often see kids with severe sunburns when they’ve been out all day on a cloudy cooler day!

    What are some of your favorite brands to use?
    For barrier sunscreens, Blue Lizard and Neutrogena Baby Face Stick. For a combination of barrier and mild chemical sunscreen, I recommend Vanicream.

    What other precautions should I take?
    Avoid any spray sunscreen! Although spray sunscreens are easy and convenient to apply, it wears off very quickly and also contains high levels of skin irritants. I’ve seen kids covered in blisters from spray and pediatric dermatologists say they are horribly harsh on sensitive skin.

    Beating the Bugs

    With all the worry about bug-borne illnesses, getting the right info on insect repellents definitely has its challenges as well. Dr. Castillo provides us with handy information on this topic too!

    Is it safe to use insect repellent?  
    Insect repellents are generally safe over 2 months of age. Per the CDC, even DEET (up to 30%) is safe on kids skin, however, there are newer repellents that may be better. Picaridin is a repellent formulated to mimic a component in black pepper! It may actually be more effective against ticks and other insects.

    What precautions should I take when applying insect repellent to my child?
    Generally for children under three, who often put their hands in their mouths, I prefer to have parents apply DEET or Picaridin to clothing, shoes, hats and strollers and use natural oils, such as Badger Balm, to the skin. It’s also a good idea to use netting and light weight long sleeved clothing for infants instead of relying on repellents. Remember they can’t tell you when they are being bitten. I’ve seen small children (including my own) get totally attacked in the park and covered in bites in 5-10 minutes!

    Favorite brands and why? What about reapplication?
    – Sawyer Picaridin Lotion (for skin) and Spray (for clothing) – lasts 8 hours
    – Avon Picaridin Pipes – Individual packs for backpacks and diaper bags
    – Badger Balm – Natural but needs to be reapplied every 1-2 hours.
    – Oil of Eucalyptus – More natural and safer than deet but can irritate skin so it’s recommended 3 years and up. It needs to be reapplied every 4-6 hours.

    Summer can be a rough season to weather when it comes to protecting the delicate skin of your little ones, but thanks to Dr. Castillo’s sage and to-the-point advice, we’re sure you and your family will be armed and ready for whatever comes your way! As always, be sure to give us a call if you have any lingering questions!

    Summer Time, Ticks and Lyme

    June is here and summer is right around the corner! It’s that wonderful time of year when the weather gets warmer, the days get longer and the lists of outdoor activities are numerous – and so are the bugs. More specifically, Lyme carrying ticks. In fact, there has been a population explosion of these little suckers this season due to our mild winter along with some other contributing factors. This month, we’re here to give you some guidance on how to prevent and respond to tick bites and Lyme rash so you can get ready to enjoy your summer worry free.  

    Tick Tock, It’s that Lyme

    As you may know, Lyme disease-carrying deer ticks are of special concern in our region. Lyme starts with a rash, and may progress to a wide range of other symptoms, such as fever and joint pain, if left unnoticed and untreated. With such a bloom in the deer tick population for 2017, it’s natural to be cautious, however, increased attention of the disease has in some cases spilled over into hysteria, resulting in countless unnecessary prescriptions and blood tests, not to mention vacation-destroying panic and anxiety. There are some notable points you should know about Lyme disease:

    Only deer ticks transmit Lyme Disease – Lyme disease is caused by being bitten by a deer tick or one of its “cousins” found around the world. Deer ticks are also known as blacklegged ticks in the U.S. Dog ticks, Lone star ticks and other types of ticks are unable to transmit Lyme disease.

    Probability of getting Lyme after a bite is low – If a tick is removed within 24-72 hours of biting, risk of infection drops dramatically.  In fact, even if the tick is attached for 72 hours, the risk of developing Lyme Disease is only about 1%.

    The disease is treatable with a simple antibiotic – When treated with antibiotics, especially when diagnosed early, Lyme resolves in almost all people. 

    If you find a tick on your little one, don’t panic. Simply remove the tick, either with tweezers or even by scraping it off with a blade or credit card – it’s not necessary to have a doctor do this. These little guys hang on tightly, but it’s okay if some small piece of the tick is left in the skin. In order to be transmitted, the tick must be alive and actively sucking blood. Any remaining pieces of of the tick will eventually disintegrate, so don’t bother digging them out as rooting around could cause an infection. Once removed, throw the tick away. There is no need to save it and bring it in for analysis since treatment for any tick bite remains the same. As with most bug bites, you may see slight inflammation and redness in the area. Over the counter antibiotic ointment may be used if the area should become red, painful and infected. Characteristic Lyme rash would appear one to three weeks later. It is circular and red, and the center gradually clears, forming what looks like a bull’s-eye with a red and scaly edge. Lyme rashes vary in intensity and appearance, so any redness that appears after a few days requires medical attention.

    The Best Offense is a Good Defense

    Do not feel like you need to test yourself or your children yearly for Lyme disease, especially if there has been no symptoms present. These blood tests are known to be inaccurate and give a false sense of alarm. Tests that are used to detect Lyme in ticks are also unhelpful. Final test results could take anywhere from 6-8 weeks, during which time we may have already seen the characteristic Lyme disease rash and treated it. We treat sick children, not sick ticks.

    Lyme is easily cured with treatment – you can expect the rash to clear up within a week or so. Lyme disease cases that progress to a more severe or chronic condition are mostly caused by a rash that went unobserved or dismissed. It’s important to act quickly and keep a close eye on things should you find that your youngster brought some uninvited guests home with them after the day’s activities, but there’s no need to panic. Dr Karen Moalem, from our Bay Ridge office adds, “It is all about prevention…In areas where there are ticks, it is helpful to tie up hair or wear a hat, wear long sleeves and pants, and to tuck shirts into pants as well as pants into socks. Insect repellent can be applied to most fabrics and shoes, and do a great job deterring the ticks. Bathing within 1-2 hours of coming indoors can prevent ticks that are on the skin from becoming attached. And since tick bites are painless, it is most important to get in the routine of performing daily tick checks. Don’t forget the hidden places, such as genitalia, belly button, hairline, and armpits!” If you suspect your child has been bitten by a tick and the resulting symptoms are a concern, please give us a call to schedule an appointment to be seen in the office.

    Springing into Allergy Season

    April showers bring May flowers – and with it comes the itchy eyes, sneezes and sniffles we all know so well to signal the start of allergy season. Our mild winter coupled with an early taste of spring have certainly made for increased pollen counts and a longer battle against the allergens in the air. This month, we want to focus on giving you some tips on how to get through the season without too much distress or discomfort so you and your family can enjoy the sunshine.  

    Climate Change is Real and the Earth is Round

    If you’re noticing a more powerful punch this year when it comes to your allergies, you’re not imagining it. Factors such as climate change and air pollution have had a steady impact on the amount of pollen released each year. Take last year for example; we saw the start of 2016’s allergy season in May, a month earlier than usual. Pollen has also been lasting longer through September. With the pollen count having risen already, 2017 promises to be the longest and most unwelcome pollen season yet for New Yorkers.

    When it comes to your kids, the effects of allergy season can vary. Allergy symptoms include itchy nose/throat, clear runny nose, sneezing and teary eyes. Contrary to what you may have heard, respiratory allergies are relatively rare in children. Babies and infants are less likely to display symptoms as their bodies are still developing and reacting to the allergens of the world. It takes several years of exposure to allergens for a child to start to develop a reaction.

    The symptoms you’re noticing could be blamed on a lingering cold. While a cold or allergy reaction may show similar signs, signs like yellow/green mucous and fever may be indicative of a cold. Cold symptoms also tend to be shorter as opposed to allergy symptoms which can linger for weeks or months. In rare cases, an airborne allergen can trigger an intense breathing reaction or a swelling of the airway.

    Coping with Budding Symptoms

    If your little one is indeed feeling symptoms of seasonal allergies, treatment options can be limited. Over the counter antihistamines might prove to reduce symptoms for a little while, but these medications also come with the added effect of drowsiness. Longer acting allergy medications, such as Zyrtec, cause less drowsiness, but may be less effective. Nasal sprays, as you have probably experienced, can also become less powerful with repeated use.

    In general, the best treatment for allergies is simply avoiding the allergen whenever possible, however taking advantage of the gorgeous weather and the various outdoor activities that come with it may prove to be a balancing act. Dr. Zaentz, from our Greenpoint neighborhood office, gives some additional great advice: “When outside, wear sunglasses and a hat to avoid pollen getting into your eyes. After getting home, it is a good idea to shower and change clothes to get rid of pollen from your hair and skin.” If you can, encourage your child to get used to the occasional sniffles without too much medicinal interference. Of course, if your child’s allergy symptoms start to get worse or become unbearable, please call us to schedule an appointment.

    Standardized Stress

    A recent study found that the average child takes over 100 standardized tests from pre-k through the rest of their educational years. For many, that means 100 nail-biting opportunities for children as young as four to get stressed the heck out. Under pressure, from organizations like Let Kids Be Kids, the UK has recently started measures to do away with standardized tests like the SAT, because of how they adversely affect both students and teachers. But alas, for us in the states, standardized tests are here to stay, at least for the time being. This month, we will be discussing some stress management strategies for both you and your child to make test-taking healthier, and maybe even a bit happier too. 

    Perspective is Everything

    Not everyone experiences stress before test taking. You remember that kid in your class who was always preternaturally chill, got good grades on everything, and seemingly glided through life on a metaphorical Disney float? While they do exist, if your child is NOT one of these unicorns of the human world, in addition to making yourself available for study help, talk to them. Encourage your child to discuss their hopes and fears. What is the worst that could happen if they do badly on the test? The best that could happen if they ace it? Having an open and honest discussion about the real immediate and life-long consequences of the result of that particular test will help put things in perspective, and reduce anxiety for both of you.

    Recognize the Signs

    It is helpful for both parents and kids to recognize the signs of test anxiety. They can include, dry mouth, nausea, headache, rapid heartbeat, mental blackouts and trouble concentrating. We know you can’t be with your child in the testing room, but discuss these symptoms with them beforehand, and remind them that there are some simple practices they can employ to calm down and get through it. Chewing gum is a simple stress reducer, as is slowing down and taking their time with each question. Telling your child to check in with their breath will help refocus the mind, as will simply taking a break to stare at the ceiling and remember the discussion the two of you had about how this one test will actually affect their life.

    Stress Stinks

    There are no two ways about it, stress stinks. It gets in the way of how our minds and bodies function, and over time can cause both physical and psychological damage. Despite the unnecessary amount of testing and pressure that is put on our young people these days, an ulcer just isn’t worth a perfect score. So, while we wait for our country to catch up to our friends in the UK, let’s all just take a breath and remind both ourselves and our kids that though it’s important to study and be prepared, test scores aren’t everything. You’ll get into the college you’re meant to get into, life is a winding road no matter what, and after high school, no one cares what anyone got on their SATs.

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