Doc Clarke's Blog: June 2013

What’s the big deal about pertussis? (www.cdc.gov/pertussis)

Pertussis (aka whooping cough) is a highly contagious bacterial respiratory illness that causes severe cough and/or trouble breathing in young children and infants.

Pertussis vaccines are effective, but not perfect.

- Protective immunity from the current (post-1990s) childhood vaccine wanes after 5 to 10 years and rarely lasts more than 12 years. This is why booster vaccination has been recommended for adolescents and adults since 2005.

- Before pertussis vaccines became widely available in the US in the 1940s, about 200,000 children were infected each year and about 9,000 died as a result of the infection.

2012 had the most reported cases since 1955 with over 41,000 cases and 18 deaths (15 deaths under 1 year old). In more typical years there are ~10,000-25,000 cases reported and ~10-20 deaths.

Infants are at greatest risk for getting pertussis and then having severe complications from it, including death (even when appropriately treated).

- About 50% of infants < 1 year old who get pertussis are hospitalized

- 1-2% of hospitalized infants die. Most deaths < 6 months old.

When the source can be identified, ~80% of infants with pertussis catch it from someone at home:

a. 55% parents (mom 30-40%; dad 15%)

b. 15-20% siblings

c. 10-25% friends, cousins, others

d. 10% aunts or uncles

e. 5% grandparents

f. 2% other caretakers

What’s the big deal about the flu? (www.cdc.gov/flu)

Influenza (aka the flu) is a highly contagious viral respiratory illness with annual Fall/Winter seasonal peaks.

The annual flu vaccine varies in its effectiveness; therefore flu infection will occur among some individuals who received the flu vaccine that season.

6 months old is the minimum age to get the flu vaccine.

15-40% of preschool and school-aged children catch the flu each year.

Infants younger than 6 months are at the highest risk for flu-related hospitalization and death.

In the 2012-2013 flu season, there were over 100 pediatric deaths:

- 90% had not received the flu vaccine for the current season.

- 60% had identifiable risk factors for flu-related complications.

I knew the baby needed shots, but we probably need them too? (www.vaccine.chop.edu)

Confirm that all future household contacts (such as older siblings) and all potential caregivers (grandparents, close friends, nannies, etc.) are up-to-date on all of the recommended adult vaccines (www.goo.gl/W6GJM).

Pertussis booster: One booster dose of tetanus, diphtheria, and pertussis (Tdap) vaccine if you have not previously had this vaccine. Starting in 2013, pregnant women should get a Tdap during each pregnancy. Tdap may be given regardless of when the last tetanus and diphtheria (Td) dose was given.

It takes about 2 weeks for the pertussis vaccine to produce immunity. (www.goo.gl/JF8Pg)

Influenza: once per flu season (each school year, i.e. Fall/Winter). The flu vaccine is especially recommended for household contacts of infants under 6 months old.

International Travelers: specific travel vaccines and/or malaria prevention medications may be required.

Do your own research: www.cdc.gov/travel.

Get vaccinated and/or get prophylactic meds for malaria via an international travel medicine clinic or your doctor.

What info should I make sure to bring/know about my baby's birth when we go to the first pediatrician appointment?

In a perfect world, all of your baby's essential medical records would seamlessly and legibly arrive at your pediatrician's office well before your first appointment. This does not always happen.

Do your best to gather the following minimum information for that first appointment:

- Birth weight

- Gestational age

- If the baby was born by C-section, why?

- Was the baby in the breech position at birth? In the third trimester?

- Were there any problems with jaundice?

- Was the hepatitis B vaccine given, and if so when?

How and what should I feed her?

All pediatricians strongly encourage and support giving human breast milk as the exclusive source of nutrition for newborns. I have listed the numerous health benefits in a prior blog post.

If it turns out that exclusive breast feeding is not possible and/or is not your choice, the following link from the AAP gives useful guidance on choosing the right formula, bottles and nipples for your infant: www.goo.gl/QDdTP

She’s been fed and changed, but she’s still upset. Now what? (www.goo.gl/rEW5n)

Taking care of a newborn is challenging.

Newborns eat, sleep, pee, poop, hiccup, sneeze, burp, pass gas, spit up, cry and fuss.

Happiest Baby on The Block (see the resource section at end of this post) is an excellent summary of well-established calming techniques to help with excessive crying and fussing.

What do I need in my medicine cabinet?

Diaper cream, fragrance-free moisturizing cream/ointment, thick diaper cream, vaseline, water soluble lubricant (KY jelly), small gauze pads, infant rectal thermometer, alcohol wipes, infant acetaminophen (newborn dosing is not always on the package), 1% hydrocortisone cream, 1% clotrimazole cream, NoseFrida (preferred over the regular bulb suction aspirator), infant fingernail clippers, small tweezers, and a small emery board.

How do I minimize the risk of SIDS? (www.cdc.gov/sids)

Sudden infant death syndrome (SIDS) is defined as the "sudden death of an infant younger than one year of age, which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history."

SIDS is the leading cause of death 1- 12 months of age and is most common 1- 4 months old, with 90% of cases occurring before 6 months old.

More than 95% of SIDS cases are associated with one or more risk factor.

Major Pre-natal SIDS Risk Factors:

a. Young maternal age (less than 20 years old)

b. Maternal smoking during pregnancy

c. Late or no prenatal care

d. Preterm birth and/or low birth weight

Major Post-natal SIDS Risk Factors:

a. Sleeping on stomach

b. Sleeping on a soft surface and/or with bedding accessories such as loose blankets and pillows (www.goo.gl/nbes3)

c. Bed-sharing (aka co-sleeping)

d. Overheating