PediaCast 184 * Influenza and Flu Vaccine
- Flu Vaccine
Dr Dennis Cunningham
Nationwide Children's Hospital
Announcer 1: This is PediaCast.
Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike!
Dr. Mike Patrick: Hello everyone and welcome to PediaCast, a pediatric podcast for moms and dads. This is Dr. Mike coming to you from the campus of Nationwide Children’s Hospital in Columbus, Ohio, and I’m joined today by Dr. Dennis Cunningham. He is a physician with the section of Infectious Diseases here at Nationwide Children’s Hospital. We’re going to talk about the flu, so it is that time of year and we’ve had several parents right in and asked us to talk about influenza. So we’re just going to do just that.
Before we get to Dr. Cunningham, I want to remind you that it’s easy to get a hold of us. If you have a question or a comment, or a topic idea for us, just go to pediacast.org and click on the contact link. You can also email firstname.lastname@example.org. If you go that route, make sure you let us know who you are and where you are from, and the same thing goes for the phone line, the Skype line as we call it, 347-404-KIDS, that’s 347-404-5437. You can leave us a message that way. Back to our last show, or a couple of shows ago, I guess it was, we had a question from the Skype line, so you could be the next one, just call that number and ask your question there.
All right, so let’s turn our attention to our studio guest today, Dr. Dennis Cunningham is a physician with the section of Infectious Diseases here at Nationwide Children’s Hospital, and an associate professor of Pediatrics at the Ohio State University College of Medicine. He is Physician Director of the Department of Epidemiology and Infection Control at Nationwide Children’s. So welcome to PediaCast, Dr. Dennis Cunningham.
Dr. Dennis Cunningham: Thanks for the invitation.
Dr. Mike Patrick: I really appreciate you stopping by. Before we get to, specifically influenza, I just wanted to ask you a little bit about immunizations in general. I know a lot of parents, the whole immunization process, sort of how they get developed and the recommendations come out, to again, physicians saying to parents, “Hey, this is what your kid needs.” A lot of that, that whole process is really fuzzy and there is also a lot of bad press out there that immunizations get from groups that spread myths around about autism and other effects that shots can have, and so there is a lot fear out there that parents have. And one of the things that, when you tell them, no they are safe, they have been tested, and they are monitored. A lot of times, parents will roll their eyes like there is this conspiracy within the government to hide, if there would be a problem. In your experience, is that sort of thing actually true or happened?
Dr. Dennis Cunningham: I haven’t seen anybody who has had any harm from a vaccine. Now, I can’t say anything as a 100% safe, that just would be a gross exaggeration, but everything in medicine is risk and benefit. I have seen kids die from vaccine preventable diseases. I have seen kids die from chickenpox. I have seen infants die from pertussis, and it’s just awful to see these preventable diseases.
And as far as health vaccines are made, once a company or an academic institution identifies a possible vaccine target, it’s about another 15 to 20 years and almost $800-900 million later before that even would ever come to the market. So, some of the more recent vaccines, let’s talk about Rotavirus vaccines, the first Rotavirus vaccine, RotaTeq, that was approved a few years ago. That was tested in over 75,000 children before it made to the market, which is really a huge number.
Dr. Mike Patrick: Right. And when there was, there was an issue with the first Rotavirus vaccine that came out, and I guess I always use that as an example, that there is really not a conspiracy to keep unsafe things in the market. Because that when they thought that there could be an association between the vaccine and a type of bowel obstruction, called intussusception, and as soon as they recognize that there could, that association, they pulled it from the market.
Dr. Dennis Cunningham: It was interesting when that happened. Where I did my fellowship, PeggyReynolds was actually the person who did all the clinical trials for this, and it was interesting to see this from the ground floor, but the system work. They are monitoring work and this was taken off the market. So as far as conspiracy, I hear that doctors are making all this money and that’s why we’re pushing this. But I certainly wish I had that kind of money, because for sure you don’t earn that in Pediatrics.
Dr. Mike Patrick: It’s right absolutely. All right, so let’s talk about the flu a little bit. I guess a good place to start is what exactly is the flu?
Dr. Dennis Cunningham: The flu is a virus and it’s a respiratory virus, meaning it can infect your nose, your throat, and your lungs. There is no such thing as stomach flu. It doesn’t make vomiting or diarrhea. Flu is usually a weak illness and high fevers. You can get above 103 in kids; adults, we even feel pretty rotten, even with a 101 fever. But you’re basically in bed for a week, because you feel so awful. Fevers, aches, and pains.
Dr. Mike Patrick: Right, and it’s a virus that causes this.
Dr. Dennis Cunningham: It is a virus, and that’s important. Antibiotics don’t work to stop it.
Dr. Mike Patrick: A lot of parents, when they come in and their kid has vomiting and diarrhea. They say he has got a flu bug or he has got, stomach flu. But this is a respiratory illness.
Dr. Dennis Cunningham: It’s a respiratory illness.
Dr. Mike Patrick: How many people are affected by the flu?
Dr. Dennis Cunningham: It’s been estimated that there’s probably over 300 million infections a year in the United States alone, and I always find it a little bit funny, if you see some who dies of meningococcal, meningitis, a bacteria that infects the brain. It’s in all the press. A 170 people die a year on average from that in this country.
Dr. Mike Patrick: Compared to 30 million.
Dr. Dennis Cunningham: But if you look at deaths from flu. It’s 35,000 to 60,000 a year in the U.S. alone, and many of them were children. So I think people hear about the flu and they become comfortable with it. It’s not that bad, but we get some sick kids hospitalized.
Dr. Mike Patrick: How is it that the flu ends up making you sick?
Dr. Dennis Cunningham: What happens when the flu virus starts making more of itself and producing its proteins, our body makes an immune response to destroy it. And some of the chemicals that are made, we call it interferon, and basically makes your white blood cells attack this virus better and interferon, that would give you these aches and pains, the fever. So, it’s actually our body’s immune response that is actually causing the symptoms.
Dr. Mike Patrick: So the virus, when it attacks the respiratory cells, the throat, the nose, and possibly down into the lungs, it basically causes those cells to become influenza factories, to make more of the virus.
Dr. Dennis Cunningham: Exactly. The virus basically puts its genetic code into our cells and it’s become factories, where you just make tons and tons of viruses.
Dr. Mike Patrick: And then that destroys those cells so that they can't do the normal function and…
Dr. Dennis Cunningham: Absolutely, and the other thing besides the interferon making you not feel good, when you start damaging that protective layer, in our respiratory tract, that lets bacteria come in and then sets us up for a bacterial pneumonia to come in afterwards, and it can make you have trouble breathing, it makes you start of coughing out a lot of mucous and a lot of viruses, you little hairs that move things out stop working.
Dr. Mike Patrick: And we talked a little about this specific symptoms associated with the flu. So, just to kind of sum those up again, fever, the muscle aches, the headache, nasal congestion, cough, sore throat, those kind of…
Dr. Dennis Cunningham: And another pretty classic symptom is when you move your eyes side to side, you keep your head still and just move the eyes, you even feel like you have pain around the eyes, and that’s pretty classic for viruses such as flu.
Dr. Mike Patrick: the flu obviously is not the only virus that will cause those symptoms. So during the winter time, you may have a few different episodes where you’d get a runny nose and congestion and possibly a fever with it, even as an adult. What are some other illnesses that can cause similar symptoms?
Dr. Dennis Cunningham: Oh, there are tons of viruses. There is something called RSV, parainfluenza, and adenovirus. There is a whole bunch of them. The real difference is flu is the only one that really makes you feel sick for a week. With the others, you may have a few days of fever, but you’re still able to go to work. You feel pretty rotten, but true flu, you are really stuck in bed, and it’s an effort to even get up and get a drink or water or go to the bathroom.
Dr. Mike Patrick: Yeah, it just really wipes you out. Now, how can the flu, other than the symptoms, so let’s say a patient goes to the doctor, they have these symptoms, they seem pretty severe, how can the flu be differentiated from the other viruses that causes similar symptoms.
Dr. Dennis Cunningham: Just by examining a person, I can't tell. There are actually many tests, and some doctors can do this right in their office, where you put a swab in the nose and in 20 minutes, you can tell which virus it is. It rules out some of the more common things such as influenza, and the nice thing to know if you do have influenza, we do have some medicines that work against this virus, but the key is, you have to treat it early for the medicines to work.
Dr. Mike Patrick: Now the flu test that the doctors can do in their office, and I guess there is really two different kinds of flu test, the rapid one that can just be done in any office, and then more of a specific one that really looks for genetic material of the flu virus, and that’s a more accurate test.
Dr. Dennis Cunningham: It is. It’s more accurate, but it’s a lot harder to do, and that’s why those tests are only really done in laboratories.
Dr. Mike Patrick: More expensive, right?
Dr. Dennis Cunningham: They are very expensive, but the rapid test that you can get done similar to a rapid strep test in a doctor’s office, they are pretty decent and they can help to know if we need to treat or not.
Dr. Mike Patrick: Do you have any numbers on accuracy rates with those, whether they are false negative, false positives.
Dr. Dennis Cunningham: Every test can have false positives, which means it’s a positive result when you don’t have the virus, or false negative, where it comes up as a negative result and you do have the virus. It really varies which strain of flu, but let’s say on average, you can detect a little bit over 80% of all influenza viruses with that rapid test. If you use the more elaborate genetic test, but usually, we only use in hospitalized patients. You can get well above 95%.
Dr. Mike Patrick: If you were a kid, if you were a physician I should say, and you have a child who has classic flu symptoms and we’re going to talk a little bit about increased risk for flu. So let’s say you’re in a high risk group, would you bank o the negative flu test or would you say, well, you have high risk factor group, you have negative flu test, but I really think you have the flu because there is a lot of flu out there right now, and you have the classic symptoms. I mean, 80% correct rate on there, would you still…
Dr. Dennis Cunningham: It’s the treat, not treat. I tend to treat.
Dr. Mike Patrick: Case by case.
Dr. Dennis Cunningham: It depends on the case, absolutely. Let’s say you’ve had an organ transplant, you had a heart transplant. So, your immune system is much more weak than the average person. If I have any clinical concern, or if I think on exam there is any chance you have flu, I’d rather start the medicine and then order a more specific test. I don’t get that test back the same day, but for these medicines to work, you have to start them within 48 hours, and if you’re in these high risk groups, it’s always better to start early.
Dr. Mike Patrick: Got you, and that’s why you really need a physician, not a vending machine for these kind of decision, because there is so many variables that go into making a clinical decision.
Dr. Dennis Cunningham: Absolutely, and the most important variable is experience. I have been doing Infectious Diseases in children for over 10 years. Am I perfect, absolutely not, I think I’m pretty good, but you just can’t read in a text book and get 10 years experience or more under your belt.
Dr. Mike Patrick: Or a computer program to make the decision.
Dr. Dennis Cunningham: Computers are great, I call it my peripheral brain, between my iPad and my Blackberry, but there is no substitute for the exam.
Dr. Mike Patrick: Now, what sort of complications can arise from the flu? So we got the set of symptoms that we’ve talked about, the fever, arthralgias muscle aches, and joint pains, and cough, a little bit of sore throat, but then in terms of complications beyond those things, what do you see?
Dr. Dennis Cunningham: The main reasons why kids would come into a hospital is, as I mentioned before, the flu virus attacks that protective lining. Think of it like a surround wrap almost where air can go through it, but the viruses and bacteria can't. If the virus gets in there and damages that protective layer, bacteria get in and you can get the bacterial infection on top of it. So you might have flu for three or four or five5 days, you start feeling better, and all of a sudden, you’re worst. It might be a bad bacterial pneumonia.
Occasionally, you see kids who have such problems breathing. They actually winds up needing to be on a ventilator or a machine to help them breath. The last complication which we do see several times a years, is you can actually get your muscles breaking down in your legs or your arms, it’s called rhabdomyolysis, and that can be pretty painful. It’s easily treated, but it’s not fun, and the nice thing is, we can prevent all these complications with some really safe vaccines.
Dr. Mike Patrick: When we talked about the death rate from the flu, that so many kids and adults die each year from the flu, is it usually the pneumonia that ends up doing that or are there…?
Dr. Dennis Cunningham: The pneumonia is the largest part. Occasionally, and we saw this with the H1N1 or the “Swine Flu” back in 2009-2010. There was so much inflammation as a reaction to the virus. People actually had their lungs starting to shut down. It goes into what we call acute respiratory distress syndrome. Basically, your lungs are so inflamed, they don’t work well anymore and you need help to breathe.
Dr. Mike Patrick: So we talked about treating the flu, especially in the high risk groups, when you have someone with a positive test, are you highly or suspicious that they are infected with the flu. What are some of our treatment options?
Dr. Dennis Cunningham: There are two main drugs we have available in the market. I’m going to use the brand names only because the generics are so hard to pronounce and people won’t remember. Tamiflu comes as a pill and as a liquid. You can take it morning and night for five days, and that’s pretty effective. That’s licensed for kids as young as one year of age. The other drug we have, it’s called Relenza, and it’s pretty much the same class of drug, but it’s an inhaler. So it means, you have to put something into your nose or into your mouth then you have to breathe in as you push it. It’s a little bit harder to use. It’s licensed for kids as young as six years of age. They are not the most expensive drugs. I don’t mean to say that they are very cheap, but on average, it’s about $50 to 60 for a treatment course if you get this wholesale at a pharmacy.
Dr. Mike Patrick: And it’s important to get those started right away.
Dr. Dennis Cunningham: They work the best in outpatients, if you can start it within 48 hours of your first symptom. After 48 hours, there is really not a benefit in the outpatient world.
Dr. Mike Patrick: Is that because the virus has already done so much damage and there is…?
Dr. Dennis Cunningham: But at that point, the virus has made so many copies of itself, the system is already there. If you can start early and prevent all those viruses from being made, you don’t get as much of the interferon and you don’t get all the systemic or all the other symptoms such as the fever, body aches, and fatigue.
Dr. Mike Patrick: We tried to look at all sides of an issue here on PediaCast, and so, are there complications or side effects with flu treatment. I mean, are there issues with the treatment itself?
Dr. Dennis Cunningham: Every medicine can have risks. Some of the older medicines that we don’t really use anymore, the Amantadine and Rimantadine, they could actually cause kids to act funny. It would make the brains have a little bit of encephalitis or inflammation. So, we really don’t use those anymore. The Tamiflu and Relenza, you certainly can get a side effect from it such as an allergy, but for the most part in healthy kids only getting five days, it’s pretty safe. It’s when you’re in the hospital and you have a lot of immune problems, a weakened immune system, where you see side effects.
Dr. Mike Patrick: I think a couple of years ago, there was something out from Japan, where they thought Tamiflu could be causing seizures or delirium, and in teenagers, self-harm behaviors, but then, some argued no, it was actually the effects of the flu that were causing those things. Any comment on either way for that?
Dr. Dennis Cunningham: Further studies haven’t supported those findings in Japan. And one of the things we’ve always known about flu, and this is a rare complication, but you can get encephalitis or brain inflammation from the flu, and that certainly can make, especially young kids act funny. They might start making bizarre statements like, “I want to walk the toothbrush.” Or they might keep saying, several things, such as, “I want eggs. I want eggs. I really want eggs.” And you give them eggs, they want them. And it’s frightening for parents, absolutely, but we know flu can do that, but it does not seem to be a real problem in terms of side effects of the medicine. As far as teenagers harming themselves, I haven’t seen anything else to even suggest that.
Dr. Mike Patrick: I will say that in the past several years, since we have been using Tamiflu, pretty consistently, I have not seen any of these things personally.
Dr. Dennis Cunningham: And I use a lot of it for my inpatients.
Dr. Mike Patrick: Now, what about viral resistance to these medications?
Dr. Dennis Cunningham: There have been some strains of influenza which are resistant to Tamiflu, but they might still be susceptible to the Relenza. So we monitor that in this country. At this time, it has not been a big problem, and for the average person who is pretty healthy, even if there is some resistance, you’re probably okay. There resistance seems to be the biggest problem, and let’s say a bone marrow transplant patient who got infected with the flu, he has been on the drug for five or six months. We do know resistant comes then, but it doesn’t seem to be a big problem at this time.
Dr. Mike Patrick: Do you recommend these medications for anyone who is diagnosed with the flu, or just those in high risk groups?
Dr. Dennis Cunningham: When you look at the studies that have been done, it’s really recommended for the people who are at the highest group. It does say that you can use it on anybody. It has a Food and Drug Administration approval for that, but it’s really the high risk people who get the most benefit out of it.
Dr. Mike Patrick: And then what is the Swine Flu and Bird Flu?
Dr. Dennis Cunningham: Flu can grow in just about any mammal. It can infect horses, whales, birds, people, pigs, and what can happen is the flu virus has eight little genes in it, and when two different flu viruses infect the same animal or person, they can kind of recombine and make new viruses. So Swine Flu, originally, it was thought that 2009-2010 flu originated in pigs. So that’s why it was called Swine Flu. Bird Flue is a little bit different, and that type of virus has never been seen in humans, just very rare cases in the Far East and very upward areas, and we don’t have any protection from similar infections in the past. So that’s why people worry about the Bird Flu, but at this point, we haven’t really had any outbreaks in this country except on a couple of poultry farms and the number of people who have gotten Bird Flu and died, it’s under 500 worldwide, so that’s really a small number.
Dr. Mike Patrick: So, is the reason that those tend to be more severe and we worry more about big epidemic infections if they got loose because we don’t have natural immunity?
Dr. Dennis Cunningham: Absolutely, and that’s absolutely what happened with the Swine Flu in 2009, the last time there had been a case of Swine Flu in the country was in the 1970s, I think 1976. So you actually found the people who were over 30, didn’t get very sick from the “Swine Flu” because they had been exposed previously. It was really the people on their 30’s and younger who had the most risks.
Dr. Mike Patrick: When we talked about the immune system and fighting the flu, you know, parents often say, “Hey, so my kid got chickenpox. Can they get it again, or you know, can you get a specific infection more than once?” Obviously, people get the flu more than once, why is that?
Dr. Dennis Cunningham: Once you’re infected with one type of flu, you're protected against that flu for the rest of your life. The problem is there are hundreds of types of flu and they can, as I said before, they can kind of share their genetic material and make new strains. So that’s why every year we recommend the vaccine, because every year there’s usually different strain floating around and that’s why we need to change the vaccine to match that.
Dr. Mike Patrick: How do they determine which flu vaccine or which strains of the flu to put in the vaccine each year?
Dr. Dennis Cunningham: In this part of the world, we have flu in the winter. Same thing in the Southern Hemisphere, so we look at what’s circulating down in Australia, New Zealand, South America, Africa, the Polynesian Islands, and we look what’s circulating and then the World Health Organization and Centers for Disease Control take their best guess of what’s probably going to come here. And that’s how they pick their vaccine strains. And they have to pick in February to get your September vaccines. So it takes a while to make it. The good news is, currently flu vaccines have three different viruses in it for protection and people are looking at four and even five different flu types in there so we can increase the odds of having a good effective vaccine.
Dr. Mike Patrick: How are their odds at predicting? Are they usually pretty good?
Dr. Dennis Cunningham: First, it’s about 50-50 if you look at the past 13 years. Now even some years, if there is a little bit of a difference, there are some cross protection. So the flu vaccine, every year, it is worked. Does it work better some years than others? Absolutely, but there is no year it has been a waste of time or money.
Dr. Mike Patrick: Yeah. So we keep our fingers cross that it’s a great match this year?
Dr. Dennis Cunningham: So far what’s been found a few cases in the United States and in Europe so far, it looks like a great match.
Dr. Mike Patrick: So how, obviously, we wanted people to experience the flu and have to be treated for the flu, a sort of a last resort. I mean, what we really want to do is prevent it from happening in the first place.
Dr. Dennis Cunningham: Absolutely.
Dr. Mike Patrick: So what’s the best way to prevent, so for parents out there and their kids from getting the flu?
Dr. Dennis Cunningham: There are two things to protect yourself. Number one, get the vaccine, number two good hand washing so that you don’t spread it when you sneeze or cough into your hands. And if you're really sick and have a high fever, don’t go to work or school. All you’re going to do is feel miserable and infect other people.
Dr. Mike Patrick: And we talked a little bit about the flu vaccine being given each year whereas other vaccine, you just get them a few times and that immunity lasts for a much longer period of time. Is the reason that you have to get a flu shot every year only because different strains come around or is that also that the immunity is short lived?
Dr. Dennis Cunningham: We do know for the flu shot that the immunity is short lived less than a year. Some of the live virus such as the FluMist does give longer term protection but no one has looked at 10 years down the road. So really, we don’t have lifelong protection and the fact that there are different strains every year that’s why we change the vaccine.
Dr. Mike Patrick: It’s been in the news recently that there was work toward more of a permanent flu vaccine that would cover lots of different strains and be more of a lifelong immunity. Is that on the horizon or is that still several years away?
Dr. Dennis Cunningham: People are still looking at that. What I suspect that’s going to happen is we’re going to make master flu vaccine. So let’s say we got a “Bird Flu,” that came into the human population, so that, let’s say within six months we could have a general vaccine to give some protection, and then work on a more specific one. It doesn’t look like we’re close right now to getting one universal flu vaccine, but 10-15 years down the line it’s very possible someone will find that.
Dr. Mike Patrick: Sure. You talked a little bit about the FluMist, the nasal one. Is one better than the other, their pros and cons, who should get which one?
Dr. Dennis Cunningham: Anyone who is six months or older can get the traditional flu shot, which is the needle into the muscle. The FluMist, it’s approved for people between the ages of two and 49 years of age. The advantages in kids two to five years of age, it’s twice as effective as the shot. And that was shown in New England Journal Article, it was quite powerful. People can’t get the Mist if they had uncontrolled asthma or if they have chronic medical condition. So really, about 80 percent of all kids are eligible for the FluMist between the ages of two and 18.
Dr. Mike Patrick: So if they’re eligible for it, it would seem that that offers better protection?
Dr. Dennis Cunningham: I suspect that’s true. We know it’s definitely true for the younger children. I think there are enough theoretical reasons that the live virus or Mist is better. And that’s what I get and what I give to my children.
Dr. Mike Patrick: Did you get your flu vaccine yet?
Dr. Dennis Cunningham: I already had mine. Actually I think the first day Employee Health offered it.
Dr. Mike Patrick: Is that are you first in line?
Dr. Dennis Cunningham: Well, I helped give the vaccine so I’m vaccinated the first day.
Dr. Mike Patrick: Gotcha. I just had mine a couple of day ago and I didn’t get the injection and I have to say, it doesn’t hurt that much.
Dr. Dennis Cunningham: No, and I think the other message I should just make sure parents know. If you're uncomfortable with the live vaccine component and you want to give the shot instead, that’s perfectly fine. My bottom line is both are effective, both will help protect your kids and yourself, so either one sounds like a good idea.
Dr. Mike Patrick: And even though you’re saying it’s OK, you don’t have concerns about the intranasal one or the live vaccine, obviously because that’s what you’ve had this year.
Dr. Dennis Cunningham: I have no concerns about that, there’s a lot of benefits. Live virus vaccines will weaken the virus, but they give the best protection for the longest amount of time. You look at measles, and you look at varicela and mumps and rubella, those were all live virus vaccines that actually give you pretty good protection with one or two doses.
Dr. Mike Patrick: And both of my kids this year did have the FluMist already and so again, I don’t have, you know, I had the injection, they had the FluMist, and you know, I have no concerns either.
Dr. Dennis Cunningham: I’d be happy if a child receives either.
Dr. Mike Patrick: So most of the primary care and offices out there now do have their flu vaccine whether be the injection or the FluMist, so I will just encourage all parents out there, this is the time right now get in, they probably are offering flu shot clinics where you just basically walk-in, get it done to protect your child for this winter.
Dr. Dennis Cunningham: And the other option is I’d like people to go to their medical home and see their doctor, but if you really pinch for time pharmacies do offer the vaccine. It depends on which pharmacy you go to but some will vaccinate 16 and up, some 14 and up. For your teenagers, where it’s hard to get them to the doctor, that might be an option.
Dr. Mike Patrick: Yep, that’s great. Are there any schools that do it?
Dr. Dennis Cunningham: We actually have worked with Columbus Public Health and we do work on vaccinating kids. Last year I believe around 8,000 public school students received the flu vaccine in that school system.
Dr. Mike Patrick: That’s great.
Dr. Dennis Cunningham: It is great. The biggest problem is getting the parental consent. Saying, “I agree, let my kid get the vaccine”, getting it back to school but Columbus Public Health is doing that again and I think it’s a wonderful idea.
Dr. Mike Patrick: That’s great. Well, we appreciate you stopping by the studio today. Before you run, one thing we’re asking all of our guests about board games, because we like to encourage families to sit down and do stuff together, not just watch TV. So, just from your own family, what’s one of your favorite board games?
Dr. Dennis Cunningham: Kids on Stage, it’s kind of a charades where there that you pick a card and it might have an action or a picture and the kids have to act it out or describe it, and I think it’s great for imagination. My 6-year-old daughter and 4-year-old son love playing that game with mom and I.
Dr. Mike Patrick: So Kids on Stage?
Dr. Dennis Cunningham: Yes.
Dr. Mike Patrick: I have to write it, I have not heard of that one before.
Dr. Dennis Cunningham: It’s a good one. I still like Shoots and Ladders and Candyland as well, but I think my kids like some of the newer games.
Dr. Mike Patrick: Yeah, sure. All right, well, thanks to Dr. Dennis Cunningham for stopping by. We appreciate it. Also thanks for taking time out of your day to make PediaCast a part of it. We really appreciate it. Your reviews in iTunes are helpful, as your mentions on your blogs, Facebook, and your Tweets, and make sure you tell your doctor about PediaCast and all your family and friends as well. We do have a new thing to help you out with that. If you head over to pediacast.org and click on the resource tab, we have a PediaCast flier to PDF that you can download and print out and hang up on bulletin boards just to help spread the message about the show. We appreciate that. And again, if you have a topic that you’d like us to cover, just go to PediaCast.org and click on the contact link. You can also email email@example.com or again the Skype line number is 347-404-KIDS, that’s 347-404-K-I-D-S, and until next time, this is Dr. Mike saying, “Stay safe, stay healthy, and stay involved with your kids.” So long everyone.
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