Bee Stings, Emergency Care, Influenza – PediaCast 388

Show Notes

Description

  • This week we explore why bees are more aggressive in the fall and how to prevent and treat their stings. We also cover emergency care for kids. When should you call 911? And does your child need an emergency department or urgent care? Finally, we introduce a new segment of the program: Pediatrics in Plain Language. We’ll talk about influenza (and flu shots) in terms everyone can understand… without dumbing down the science! We hope you can join us!

Topics

  • Bee Stings
  • Emergency Care for Kids
  • Pediatrics in Plain Language
  • Influenza
  • Flu Shots

Guests

Links

Transcription

Announcer 1: This is PediaCast.

[Music]

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 once again to PediaCast. It's a pediatric podcast for moms and dads. This is Dr. Mike, coming to you from the campus of Nationwide Children's Hospital on Columbus, Ohio. 

It's Episode 388 for October 18th, 2017. We're calling this one "Bee Stings, Emergency Care, and Influenza". I want to welcome everyone to the program. 

Before we get started, last week, we covered Food as Medicine with Dr. Maria Mascarenhas from the Children's Hospital of Philadelphia and Dr. Ala Shaikhkhalil, from here at Nationwide Children's Hospital. And we talked about the importance for all of us, kids and grown-ups, of increasing our consumption of vegetables and fruits. 

And we learned that we really shouldn't say fruits and vegetables — we should say vegetables and fruit because the vegetables are more important, but they don't taste as good in some people's opinion, including my own —  and the health benefits of eating those vegetables in terms of illness prevention and in some cases, even treating disease. And it really was a fantastic interview. If you haven't heard it, I'd recommend you take a listen. Again, that was PediaCast 387.

And as a follow-up to that topic, food as medicine, you've heard me mention the Parents On Demand Network, which you can find at ParentsOnDemand.com. It's just a group of podcasts that really cater to the health and wellbeing of families. And PediaCast is proud to be included in that group of podcasts. 

0:02:05

And I realized another podcast in that group called the Lean Green Dad is chockfull of terrific information for moms and dads who are trying to increase the amount and variety of plant-based foods that they're getting in their kids' diets in a healthy way. 

So we covered the importance of vegetables and fruits in our last episode here on PediaCast. If you want some practical tips from the frontlines of actually making those changes, then be sure to check out Lean Green Dad. 

The host of that program, by the way, Cory Warren, first, he's very practical and upbeat and positive and realistic, which is important because change — and dietary change is no different — change is difficult. Especially when that change involves some things that may not to you taste as good as some other things. Although I hear that as you make that change, the taste becomes more palatable. And it becomes a taste that you want, that's the hope. And he understands that and walking parents and families through the process. 

Actually, we need to get Cory on this program to explore some of those tips and tricks of increasing our consumptions of vegetables for parents and kids alike. So stay tuned for that possibility. In the meantime, check out his podcast, Lean Green Dad. 

And you'll find it in all the usual places you'll find podcasts, iTunes, Google Play, mobile podcasts apps. Also, LeanGreenDad.com and again, ParentsOnDemand.com. And I'll put a link to it for you in the Show Notes for this episode, 388, over at PediaCast.org, so you can find it easily.

All right, let's move on. So, here we are smacked dab in the middle of Fall and you can tell it's that time of year by the topics we're covering today. On the one hand, we're still dealing with bee stings and kids are outside playing and climbing and running, jumping, hurting themselves, breaking bones, getting cuts and scrapes. In the pediatric world, we're still seeing all of these things every day.

0:04:11

In addition, fall allergies are in full swing which can lead to serious flare-ups of asthma-related breathing difficulties. All of which means that parents are seeking emergency medical care for injuries and illnesses. So, we'll talk about that today. When should you go to the emergency department versus an urgent care center versus your doctor's office? How should you get there? When should you call 911? 

We'll answer those questions and a few more including what can we do about overutilization of emergency medical services? When emergency departments and 911 are overwhelmed with non-urgent matters., there are consequences to the healthcare system as a whole. So we'll consider that concern as well with the couple of great guests — Dr. Julie Leonard, she's a pediatric emergency medicine doc here at Nationwide Children's and with the chief, Jim Davis who serves as Deputy Chief of Emergency Medical Services for the City of Columbus, Division of Fire.

So, they'll be stopping by soon. And then, even though it's still bee sting and injury season, it's also time to start thinking about the flu and flu shots. And now is the time to get one if you haven't already and we'll talk about why that is.

We're going to talk about the flu with our first installment of a new PediaCast series, sort of a mini-series within a podcast, called Pediatrics In Plain Language. We'll talk about what that means. It's going to be with Dr. Mary Ann Abrams and Dr. Alex Rakowsky. They're fellow pediatricians at Nationwide Children's. And they're going to introduce the series, explain exactly what we mean by pediatrics in plain language.

It's something we're going to do about once a quarter in 2018. So, they're going to be regularly appearing guests as we just cover some what I consider bread and butter topics of pediatrics, just stuff we see all the time that parents always have lots of questions about. We're going to talk about that in terms of the flu and flu shots. That's coming your way at the end of today's program.

0:06:07

First though, let's consider bee stings. You'll probably notice that bees — yellow jackets and hornets in particular — are more aggressive in the Fall. And you know what I'm talking about like you're having a picnic outside, if it's June or July, I mean you see some bees maybe over on the flowers. But as you get closer into fall, they start really paying attention to your food and your drinks. And even if you walk away with your drink, they start following you. 

And it really does seem to be something that occurs in the fall more than it does in the spring and summer. And so, I got to wondering, why is that? And it's not something you learn in medical school. So, I did a little Google search like everyone does and I came across some pretty interesting information about why it is that bees are more problematic this time of year. 

And the first reason is there's more of them. So the larvae emerge as adults for these hornets and yellow jackets in the late summer. And so, as you get into fall, there's really more of them competing for food. Also, in the fall, the food becomes more scarce. In addition to that, their diet actually changes. So in the spring and summer, especially as we're talking about yellow jackets and hornets, they're more carnivorous after a protein diet in the spring and summer and they're really feeding on other insects. 

And then, as we turn into fall, their attention goes from protein foods to sugar-based foods. As they're preparing for winter, now they're really after more sugar. And a lot of the fruits have fallen to the ground, they're starting to rot, there's not as many of them. So again, food is scarce, there's more of them. And they're after more of a sugar kind of thing. And so, that's why they really go after sweetness and their food and beverages. 

And they want that sugar for themselves but also they take it back to the hive and feed it to the queen, so that she can really plump up and prepare for winter. And then, they also are very aggressive in protecting the hive as we get closer to colder weather. And what all that means is more interaction with humans, more aggressive behavior, and more chance for bee stings. 

0:08:21

So how do you prevent a sting? Well, first if you're in an area that you know there are bees, just move to a different area. Just get away from them, walk away calmly, don't swat at them. That can be difficult for me to do. But you just want to walk away. 

Keep your food and drinks covered. Be sure to pour your drinks into a clear container. So if they crawl inside, you can see there's a bee in there. You might not want to drink that one. No fun when a bee crawls into your soda can and you don't know it. So pour your drinks into clear containers. 

And then, with your clothing, you want to avoid bright flower-like colors. That seems to make sense. And also avoid perfume and cologne. You don't want to smell sweet to attract those hornets and yellow jackets. 

Honeybees aren't quite the same, they're still going after pollen where they can. They'll go after some sweet things, but it's really those hornets and yellow jackets that seem to be more of a problem in the fall. 

Now, if you do get stung, there's a couple of possibilities of what can happen. The most common thing is what we would call a local tissue reaction. So it's just a localized allergic reaction at the site of the sting, and you get some surrounding redness and swelling, some pain and itching. And it's just localized right to that area. 

If you see a stinger, you want to go ahead and remove it. Now, you don't want to use tweezers particularly if it was a honeybee. Again, less of a problem in the fall compared to those yellow jackets and hornets. But if it was a honeybee, they typically leave the venom sac with a stinger and if you use tweezers, you're going to squeeze that venom sac and inject more of the venom into the skin, which will cause more intense reaction. 

So you do have to be careful about that. So better, just use a flat surface like a credit card and just scrape the stinger and that will knock it out of the skin for you. 

0:10:10  

And then, ice is a great idea. If you put ice, you don't want to put directly on the skin because you worry about frostbite, but you can put ice in a zip lock bag, wrap it around in a washcloth. And that cold will help reduce the redness and the swelling. And they can also help a little bit with the itch and the pain. 

And then, an age-appropriate dose of an oral antihistamine, something like Benadryl, that can help in terms of reducing the redness and swelling. Also, 1% hydrocortisone cream that you can buy over the counter, topical, that can help. 

Ibuprofen, Tylenol, acetaminophen is the drug name for Tylenol. Those things can also help reduce swelling and pain. Ibuprofen more so on the swelling, both of them will help with pain. 

And then, you hear about the home remedies, meat tenderizers, baking soda pastes. I've even heard of people saying you should put toothpaste on a bee sting. Those things, they certainly aren't going to hurt, probably aren't going to help as much as the other things that we've talked about. 

So those are those local reactions which are quite common. Less common, thankfully, is something we would call anaphylaxis, which is a whole body allergic reaction to a bee sting. And so, not only are you going to have redness and swelling at the site of the bee sting. But if you have hives elsewhere on the body, start to have any breathing problems, coughing, difficulty breathing, wheezing, difficulty swallowing, facial swelling, drooling, abdominal pain, vomiting, really any symptom that's distant from the site of the actual sting, we worry about anaphylaxis. 

And these can get severe very quickly. And so, if it's the first time that it's happened and it's a severe reaction, you want to call 911. And the emergency medicine for that is going to be epinephrine. 

0:12:03

And if it's happened to you before and your doctors prescribed and epi auto-injector or an EpiPen, if you're going to be around bees and you know you're allergic to them in this way, then you want to carry that with you and use it right away if you do get stung and start to have any kind of reaction at all. 

Other medicines can help again, things like Benadryl, steroid medicines, but epinephrine is really the first line, epi, epi, epi. And do carry that auto-injector with you if you do have a history of allergy. 
And still, even if you use the injector, you still want to seek help on urgent care center or emergency department. Call 911 if the symptoms aren't going away or coming back, so that you can get help because those can become life threatening. 

So hope that helps, get out there and enjoy the last bit of warm weather, but watch out for those bees and act quickly if you do get stung. 

All right, let's move on. We're going to consider emergency care and influenza today. Before we get to our guests, I do want to remind you if there's a topic that you would like us to talk about on PediaCast, it's easy to get in touch, just head over to PediaCast.org and click on the Contact link. 

Also, I want to remind you, the information presented in every episode of PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. So if you have a concern about your child's health, make sure you call your doctor and arrange a face-to-face interview and hands-on physical examination. 

Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement, which you can find at PediaCast.org. 

All right, let's take a quick break and I will be back to talk more about emergency care and the flu. It's all coming up right after this.   

[Music]

0:14:12

Dr. Mike Patrick: Welcome back to the program. Dr. Julie Leonard is a pediatric emergency medicine physician at Nationwide Children's Hospital and an associate professor of Pediatrics at the Ohio State University College of Medicine. Dr. Leonard is a returning guest on the program. She stopped by the studio back in Episode 353 to talk about neck injuries in children. 

She joins us today to talk more about pediatric emergency care, so let's give a warm welcome back to Dr. Julie Leonard. Thanks for joining us again.  

Dr. Julie Leonard: Thanks for having me. 

Dr. Mike Patrick: Really appreciate it. We're also joined by Dr. Jim Davis. He is assistant fire chief of Emergency Medical Services for the City of Columbus, Division of Fire. Chief Davis holds a doctorate in Education. He's a registered nurse and a certified emergency medical technician paramedics. In other words, he's really smart especially when it comes to emergency response and teaching others how to do it well. 

So Doctor and Chief Jim Davis, thanks to you, too, for stopping by today. 

Dr. Jim Davis: Thanks for having me. 

Dr. Mike Patrick: Really do appreciate it. Dr. Leonard, let's start with you, when do should parents consider taking their child to an emergency department? 

Dr. Julie Leonard: Well, it really centers around recognizing when a child has a life threatening illness or injury. Some things are obvious but others are subtle. So it really is taking a look at how that illness or injury is affecting the child. 

So as an example for an injury, if the injury is one that they can't control, bleeding as a cut with direct pressure and they need immediate assistance, they would call an ambulance for that and go to the emergency department. Versus, if they have a cut and they know it's likely they need stitches and they can't control the bleeding, then they could take themselves to the emergency department.  

0:16:05

Other examples would be a child with asthma for instance. And the asthma can be controlled with the inhaler they're using at home at the child's not showing signs of serious respiratory distress. That's a scenario where it's likely that the patient can either see their pediatrician or call the pediatrician's office and get some advice or be seen in the emergency department if they're referred to do so after talking with the pediatrician. 

Dr. Mike Patrick: Yeah, I think that's a great piece of advice that your pediatrician is there for you 24 hours a day basically when someone's on call. And so, if there ever is a question where you're not quite sure, it's not immediately life threatening but you're not quite sure — "Is this something that should go to the emergency room or to an urgent care? Can it wait till tomorrow?" — you need someone to give you that advice, your regular doctor, whoever is covering for them on call, would be a great resource to get that information. 

Dr. Julie Leonard: Absolutely, that actually helps not only the family decide when to bring their child to the emergency department but it also helps us. Sometimes, there's a need to have some advanced warning when a patient's coming in after they've had that conversation with the family. And so, in turn, the office would call and let us know their patient's coming in and give us some additional information, which is helpful to us in caring for their child.

Most, well, all pediatrician's offices have some form of after-hours line. And that's usually in the form of first being screened by a nurse and when needed, they talk to the physician directly. 

Dr. Mike Patrick: So you know a child when they need help fairly immediately. Parents know this, "Okay, this is something that can't necessarily wait till tomorrow," when a child fell off a trampoline, their arms looks a little deformed. They're in a lot of pain. But at the same time, their life is not necessarily immediately at risk, so not necessarily going to call 911. But I'm trying to make this decision, do I go to an emergency department, or do I go to an urgent care center? What sort of injuries are best suited in illnesses for each of those types of facilities? 

0:18:23

Dr. Julie Leonard: Yeah, exactly. So children that have an obvious deformity of a limb needs to go to an emergency department. That is likely going to require the expertise of a physician that's beyond the physicians and the nurse practitioners that are working in urgent care centers. They're also likely going to need sedation, which urgent care centers usually aren't in a position to provide, to render care for that. 

On the other hand, a child that has some similar mechanism of injury where they might have some tenderness in the arm but it's not obviously deformed, that kind of injury potentially could be screened in an urgent care center or even through the pediatrician's office. And if they find an injury, that's unlikely you're going to need an immediate surgical response to it. They can usually arrange for their appropriate care. 

Dr. Mike Patrick: So if something looks like it's going to need specialists to take care of, then you're probably better off going to the emergency room. And if it's something that you just need a pediatrician now, but your doctors not open, and maybe they have lab facilities and X-ray on site, sort of more comprehensive care, then the urgent care maybe more where you want to go. 

Dr. Julie Leonard: Correct. Correct. 

Dr. Mike Patrick: And you would advise a pediatric urgent care if that's available in your community. 

Dr. Julie Leonard: Absolutely, the skill set for caring for children is definitely different than caring for adults. In general, kids are actually pretty healthy. And so, our approach to caring for a child tends to be fairly focused and direct. And there are obvious differences in the type of testing that you would order or even medications you would prescribe. 

0:20:16

Dr. Mike Patrick: And if, let's say your community does not have a pediatric urgent care, this might be a conversation you want to have with your regular doctor before you need an urgent care to say, "Okay, so what facility in town would I go to after hours that would maybe do best for my kid?" Your doctor would have some experience in knowing which facilities maybe are a little more inclined to taking care of children than others.

Dr. Julie Leonard: Absolutely, Mike. I mean, I think that's a very good point. Your physician is going to be well versed in the medical resources in your community. And so that's another great reason to call first. 

Obviously, if it's a 911 situation where you know you needed immediate lifesaving interventions, you're going to call 911 first. But these kinds of questions about I know my child needs some medical care, I just don't know which level or how to access it. It's a great question for your pediatrician's office. 

Dr. Mike Patrick: One other point of view with this is we've kind of been coming at this from what's best for the child in terms of a pediatric facility. Do they need emergency services or urgent care? Or your doctor's office going to be okay? But then we can also look at this from the perspective of the system. 

So there's going to be some types of illnesses and injuries that are best suited for urgent care, your doctor's office versus the emergency room because of the resources that are placed upon the system. Speak a little bit about that issue. 

Dr. Julie Leonard: Yeah, so to give you an example, from just injury, let's say that somebody severely cuts a finger where it's likely near amputation. That would be a good example. 

0:22:08

The resources required actually to care for that injury are highly specialized. And even in the community such as Columbus where you have many emergency departments, there's really only one in the community that's actually capable of mounting all the resources when you have been near amputation. 

So there's subspecialty services involved. And it's set up that way because those resources are expensive and they're highly technical. And so again, the understanding within the community of what level of resource you need is really scaled that all hospitals are not equivalent. 

It's a tiered system where you have your most basic level of care that's provided through your general physician's offices. Then layered over that, slightly more available through urgent care centers where they might be able to do some diagnostic tests like basic X-rays or maybe some basic blood tests. 

And then, layered on that, you have your kind of first tier of emergency departments that are really meant to just stabilize patients and in fact get them moved on to a higher level of care or to take care of just some general basic emergency medical problems. 

And then, that tier just keeps going up until you get to what we called the quaternary centers where centers that specialized for instance and burn care or care for critically ill children, pediatric intensive care units. 

Dr. Mike Patrick: Yeah, absolutely. And one issue that I think that the system as whole sees is that when folks who maybe have non-urgent injuries and illnesses kind of show up in those higher level care centers, you can sort of clog the system up and make it more difficult to care for people who truly need that level of service. 

0:24:17 

Dr. Julie Leonard: Exactly. The system is set up such that ideally, what you want to have happened is people hit the right point in the healthcare system where they're at the right level of resources. Because if we have lot of children that are coming to Nationwide Children's Hospital's emergency department that have problems that can actually be taken care of at the urgent care centers or pediatricians office's and urgent visits, the wait time gets long. We might be overlooking or missing a patient that's in waiting that actually does need our care while we're busy caring for patients that could be cared for in other settings. 

Dr. Mike Patrick: Of course, if a parent is truly concerned that their child has an emergency situation, even if the emergency department personnel don't necessarily perceive it the same way, parents should still go where they feel like they need their child to be seen. We don't want to keep people from going to the emergency because they say, "Well, maybe this isn't severe enough." If you think it is, you probably ought to go. 

Dr. Julie Leonard: Absolutely. I mean, we want to get the right message which is to appropriately utilize resources. But when in doubt, when you're unsure, then you need to seek emergency medical services. 

Dr. Mike Patrick: Yeah, yeah. I want to bring Chief Davis into the conversation. As we think about parents and trying to make a decision, one of the decision points may be, "Is this something that I call 911 for, or can I safely get my kid to an emergency department?" How do you sort of make that decision whether to initiate a call to 911?

0:26:03

Dr. Jim Davis: Well, I think the first thing that we want to make sure everybody understands is when in doubt, make the call. Pick up the phone and dial 911 if you're in a situation that you're unsure of. Because we would rather come and have it not turn out to be a big problem than have people be afraid to call because of fear that it's not, and it turns out to be a big problem that we may have made a difference in the outcome of the situation. 

I think primarily people need to understand that the purpose of the 911 system is to be available for families and patients who have either life-threatening or potentially life-threatening illnesses and injuries. Because the goal of our system is to bring the care to the community and start the care and provide a good level of service during transport to the most appropriate facilities that Dr. Leonard references. 

So I think that's the big thing. We don't want people not calling for fear that they made the wrong call, but we want them to understand that the purpose of the system is there and designed around trying to be available for the right patient at the right time. 

Dr. Mike Patrick: Yeah, so if they truly are concerned, please call. But calling may not even guarantee that they're going to end getting transported to an emergency department, correct? 

Dr. Jim Davis: No. I think that's a great point that people need to understand, is that there's sometimes is a mindset that when you call and a 911 system arrives, you're developing a relationship . And that relationship is established when that team of people arrive and start asking you questions to understand what you're or what the person that you called for is experiencing and how these symptoms developed or how the situation developed. 

And then, an assessment's completed just like an assessment on an emergency department. And then, there's the discussion about options, whether or not transport is immediately warranted or not, what hospital or what location is appropriate for that person to be transported to. In both the adult and pediatric setting, it occurs the same way. 

0:28:11

Then, there's the establishment of an agreement in that situation, that the patient has a right, and the family has a right when working with our system in the pediatric environment. They have a right to refuse to go to the emergency department with us. And we primarily make sure that we're leaving people with good recommendations for follow-up care if they're not going to go with us. We'll make sure you call your pediatrician, make sure you call your family doctor, make sure that you seek medical attention if your signs and symptoms continue. And call us back if your symptoms get worse or you're just generally not feeling better, and we'd be happy to take you to the emergency department if that's the appropriate location. 

Dr. Mike Patrick: In most places, does that triaging occur unseen or does that sometimes happen with the 911 operator? 

Dr. Jim Davis: So the highest critical calls that we experienced such as somebody not breathing or their heart not beating, we do everything that we can do to stay on the phone with those folks from the time of that call. And we refer to that as a zero-minute response time. 

It's physically going to take us somewhere between four and six minutes on average to get to you. But what we try to do is we try to stay on the phone with the caller and give pre-arrival instructions and teach the person over the phone how to intervene in the care of that patient until we physically arrive. 

Sometimes, it frustrates people because they're upset. Situations developing in front of them and they just want us to get off the phone and get here. But the fact is that we need them to get involved in a lot of the situations that are the highest critical in order to help us make a difference in the outcome of that patient. So instruction start right then and there as the call is being dispatched. And then, that goes on until our folks arrive. 

0:30:14

Dr. Mike Patrick: So the folks who answer the phone calls for 911 have some medical training as well. 

Dr. Jim Davis: Yeah, they have medical training. They have basic medical training at a minimum. And as well, they have a list of pre-arrival instructions that have been vetted over time to be the best, safest, most efficient instructions to try to teach a lay person to do and get them to follow through and to listen to the instructions of the dispatcher to make a difference. 

Dr. Mike Patrick: And I would imagine, sometimes, you do get some calls through 911 that truly are not emergencies. And maybe even folks just looking for transportation. Is that a significant problem? 

Dr. Jim Davis: Well, in some cases, it's a significant problem. As an example, folks need to understand that the 911 system first and foremost is primarily for, "Hey, there's an auto accident here." "My baby is sick," whatever it is, "And I need help." 

It's not for "What time are the fireworks?", "Can you tell me what's going on down the street from my house?" There's a 311 system in the city of Columbus and in most major communities that can help you answer those non-emergent situations. So that'd be the first point that I'd make. 

Secondly, would be that when people do call, a lot of times the reason that they're seeking the 911 system is because they either A, don't know what to do, or B, they're frustrated with the system as it currently exist. 

They've called their family doctor, they haven't got a return call. They've gone to the emergency department and they were placed in triage and then sat in the waiting room and they felt that it was an extended period of time. 

So they feel that the easiest thing that they can do to get their questions answered immediately,  and a lot of cases it is, is to pick up the phone and dial 911 because in a couple of minutes, somebody's going to be there to help you. And that's not always the most appropriate thing to do. It places the community at risk and it places our folks at risk. 

0:32:25

Dr. Julie Leonard: Jim brings up a really good point. When you call an ambulance, and even if they bring you to the emergency department, that doesn't guarantee that they're going to actually be placed immediately in a room. Patients still go through the same triage process of determining who is the sickest patient whether they came by a private motor vehicle or they came by EMS. So it's not uncommon that the EMS will be called and the family actually ends up in the waiting room, waiting for a room.

And I also think there's a degree of that expectation. I'll get seen sooner if I call and if the ambulance brings me but it's actually not how the system works. 

Dr. Mike Patrick: There's really pulling on both sides for parents who find themselves in the situation. Because on the one hand, like you truly are concerned and maybe frustrated and your pediatricians not calling you back and you're just not sure, is this an emergency or not? And at the same time, you don't necessarily want to have the ambulance come and then sort of be out of commission for someone who has a heart attack down the street and who really did need it when your child didn't necessarily.

And so, I totally understand. I guess this would be a plug for pediatricians to have a really good on-call system with quick response and someone dedicated to answering these phone calls for folks. 

Dr. Julie Leonard: Absolutely. There's a lot of literature actually that supports the robustness of that interaction with the pediatrician's office is actually one of the major ways that you can reduce ED visits and use of EMS. 

0:34:06

Because oftentimes, actually, many of the things that as healthcare providers we would not consider emergencies, but families are seeking for. As an example, a child has a fever the middle of the night, what they want is reassurance. They're up, they're worried, they want to know that their child's going to be okay. And the robustness of that call that they have with the pediatrician's office is kind of a key driver of whether or not ultimately they're going to show up in the emergency department or not. 

Dr. Jim Davis: If I can add to that, doctor, I think it's also an opportunity to plug the idea of people having their own home family emergency plan and understanding a little bit about what to do — how to make the right call, who to call, and how to develop the communication skills working with each other on describing what you're seeing and what's unfolding in front of you. 

Because I think we all train our folks to take an emergency situation that's really bad and make some type of sense and calm out of it. So we work with our people to walk into these situations that other people are freaking out over and really upset because their baby's sick and take that situation and make some sense of calmness out of it. 

That doesn't mean that our folks have any lack of empathy or any lack of interest in providing that good quality care. It's just we have worked with our people to take that stressful situation and bring it back down to a level of, "Hey, we've got this, we'll take good care of you here and we got it going."

And sometimes folks get frustrated because they don't sense us as urgent as they feel the situation is. Would you agree? 

Dr. Julie Leonard: I agree. I mean, that's also something we see in emergency department. A large part of my job is allaying of family's fears of what could potentially happen to their child and spending a lot of time calming and decompressing the situation. 

0:36:18

Dr. Mike Patrick: So really a push for folks, call your regular doctor unless it's truly life-threatening in front of you. And regular doctors, health care providers of all sorts, really if you have a robust system in place to be able to get back in touch with folks who have concerns, that's really going to help the system. 

Dr. Julie Leonard: Yeah, and I think that to further flush out Jim's idea of this home safety plan. I mean, really times have changed. We're no longer picking up our wall phone and have it list the numbers taped on the wall next to it. Oftentimes, families are working off their cell phones or only have a cell phone. 

So it would be important to have those numbers programmed into your phone of who you're going to call. So it's right there at hand. So here's the after-hours number programmed into my phone and asking your physician what they want you to do at an appointment. 

Dr. Mike Patrick: Yeah, absolutely. 

Dr. Julie Leonard: Like can you give me some guidance on what I should do should I need help after-hours? 

Dr. Mike Patrick: One phone number everyone should have in their contacts is the National Poison Center number because that's another resource that you could call if your child ingested something and they don't appear life threatening. They look normal but they did ingest something you're not quite sure what to do.  That number is 1-800-222-1222 no matter where you are in the United States. 

And I'm going to put that number in the Show Notes because that's one a little easier to forget than 911. But still, that National Poison Center line gets you to your local poison center regardless of where you are when you call it, and a great resource. 

Dr. Julie Leonard: That's a good example of a service that has actually substantially cut down on emergency department visits because they are able to do a really robust job of screening these calls in terms of what needs medical attention and what does not and do it very safely. 

0:38:16

Dr. Jim Davis: And for an EMS perspective, if we are in that situation, somebody that a child's ingested something, provided that the child got an appearance of stability and is not really a sick kid at that time, then we encourage them to the reach out to the Poison Center as well, establish that relationship, establish a plan. And that maybe another situation where a child is not transported. And so I think that's a great example. 

Dr. Mike Patrick: Well, I really appreciate both of you coming and talking to us today about pediatric emergency care.

I'm going to have a lot of links and resources for you if you are interested in learning more about this topic. Again, the Poison Center line, 1-800-222-1222, I'll put that phone number in the links. 

Another one, I wrote a blog post at 700 Children's, Urgent Care or Emergency Department: Which One is Right for Your Child's Needs? So I encourage you to check out that blog post. 

Also, A Parent's Guide to Emergency Department and Urgent Care Services, that's a digital article from Nationwide Children's. 

Healthy Children from the American Academy of Pediatrics, so HealthyChildren.org. They have articles on Is it a Medical Emergency or Not?, When to Call Emergency Medical Services, First Aid Guide for Parents & Caregivers, all terrific resources for emergency type situations. 

And then, there's a couple of American Academy of Pediatrics Policy Statements that pediatric providers should be aware of — Nonemergency Acute Care: When It's Not the Medical Home, and another one, Guidelines for Care of Children in the Emergency Departments. 

So just some things that both parents and providers can use and we'll have links to all those things in the Show Notes for this episode, 388, over at PediaCast.org. 

So once again, Dr. Julie Leonard and Dr. Jim Davis, thank you both so much for being with us today. 

Dr. Jim Davis: Thank you. 

Dr. Julie Leonard: Thank you. 

0:40:00

[Music]  

Dr. Mike Patrick: Welcome back to the program. We  are ready to embark on our very first installment of what I hope will be a regularly recurring series on PediaCast. We're calling it Pediatrics in Plain Language. And we'll explain exactly what that means in a moment. 

The goal here is to present one of these segments for you, Pediatrics In Plain Language, about once a quarter or once a season on a common and pertinent pediatric topic. 

And for a series kickoff, our Fall 2017 edition, we're going to talk about influenza, better known simply as the flu. And it seemed like a good one to cover first because it's the time of the year that we recommend flu shots for nearly everyone. So we'll cover the basics of the flu itself and the vaccine, which is really not only pertinent information for the health of your children, but also for you, the adult listener because adults also get the flu. And flu shots are recommended whether you are young or old. 

Now, another reason I'm excited about this series is that I'll be inviting the same guests back to the studio each time we cover one of these topics. And these are handpicked guests who have been on PediaCast in the past. They're true champions of the program and our goal of promoting health literacy for moms and dads and improving the health of children everywhere. They're fabulous primary care pediatricians at Nationwide Children's Hospital, faculty members at the Department of Pediatrics at the Ohio State University College of Medicine. 

So without further delay, let's give a warm PediaCast welcome to our Pediatrics in Plain Language panel, Dr. Mary Ann Abrams and Dr. Alex Rakowsky. Thanks so much to both of you for being here today. 

Dr. Alex Rakowsky: Thanks, Mike. 

Dr. Mary Ann Abrams: Great to be here. 

0:42:08

Dr. Mike Patrick: Let's start with you, Dr. Abrams, what do we mean by the phrase Pediatrics in Plain Language? What exactly is that? 

Dr. Mary Ann Abrams: Let's just start with plain language, what it is. What is it? Plain language means it's clear language. It's not baby talk. It just lets people focus on the message and not get lost in complex words or complex phrasing that uses the words and the number of words that we need. 
An example in medicine is we often accidentally start using complex medical terms or jargon terms as we call them. And then, it leaves people wondering what did we just say, and then they often miss the rest of that message. 

And even simple words that have a common meaning in everyday use can mean different things in medicine. A good example of that is the word trigger. We talk about that a lot with asthma and allergies and people don't usually think of that word in terms of medical issues. So if we talk about triggers and then keep talking, sometimes they can be left in the dust wondering what is that being talked about. 

Dr. Mike Patrick: Yeah, because once you're thinking about what does that word mean, then you're not really hearing the rest of the word and can really miss the message. And this really goes back to this idea of health literacy. 

And for folks who are interested in learning more about what exactly is health literacy, how do you learn about your child's health, how can you be the best advocate or supporter of your child's care, we did a couple of PediaCast on this specifically in the past episode, 354, and then one for physicians, pediatric providers, PediaCast CME Episode 20. And I'll put links to both of those shows in the Show Notes for this episode, 388, so folks can find that easily if you're interested in learning more. 

So let's move on to the flu and we're going to try to discuss this in plain language and maybe catch each other if we are using jargon. So Dr. Abrams, what is the flu and what signs and symptoms does it cause? 

0:44:09

Dr. Mary Ann Abrams: Well, that's a great question. Flu to people has a lot of meanings. And a lot of times when people hear the word flu, they think of what we often call the stomach flu with vomiting and diarrhea. But the kind of flu that we're talking about today is technically called influenza, although we'll be calling it the flu most of our time together.

And what makes it different? It comes on really quickly and it comes on really bad. You get a sudden fever, you got chills, you get body aches, you get a terrible cough, you can feel wiped out and weak. Sometimes you also have stuffy nose and sore throat, and kids can have some vomiting and diarrhea.

But the main thing about influenza or the flu that we're talking about today is your whole body is basically miserable. And it spreads by coughing, sneezing, close contact. And you probably know that in the United States at least, the main flu season is in the winter. It can start this month in October and it can last into the spring. 

Dr. Mike Patrick: And there are other viruses that can cause similar symptoms. So how would we know that this is the flu versus just the regular cold virus?

Dr. Mary Ann Abrams: Well, a lot of times people do think that the flu is just a bad cold, but it's a lot more than that. In addition to making you miserable, like those symptoms that I described, it's important to know that flu can cause serious illnesses, other illnesses and complications. 

It can put you in the hospital and it can cause death especially among some people who are more vulnerable to getting really bad influenza. That can be young children under age two especially, but even under age five, and even healthy kids. People who have underlying health conditions, and that includes asthma, diabetes, sickle cell disease, pregnant women, and also older people. 

0:46:01

And then, when you get the flu, it can last up to a week. And you miss a lot of school and a lot of work. And it can linger even after that. 

And finally, it's very contagious, so you can give it to other people that you live with or work with or play with. 

Dr. Mike Patrick: Why do we make such a big deal about the flu? So there's this complications, but really these can be some serious complications, right? 

Dr. Alex Rakowsky: Yes, Mary Ann mentioned that the flu can be severe and sudden. So even for a person who has no long-term health issues or what we call chronic illnesses, they can have seven to ten days of symptoms and that can lead to dehydration, severe fatigue, severe muscle legs which can just lead to some problems down the road. 

More importantly, we have what we call second infections, where because of fuel build-up in your body, you can get a pneumonia or an ear infection for example. And then, pneumonia is when you're not feeling well can be very severe, even in a child or an adult who is relatively healthy. 

For somebody who has long-term problems like asthma or diabetes or arthritis, getting the flu can actually be deadly. And we see a fair number of kids and adults get admitted every year for complications from the flu early on just because your lungs sort of had a bad response or the joints had a bad response. So it can be a severe infection with complications. 

And just to quickly mention, thereby over a 100,000 admissions every year at the hospitals if not more, and that's a good season. A good season meaning not too much flu in the country for people who have flu symptoms. These are admissions. 

And then, several thousand people in a year that's light will die of the flu. And we've had years we've had over 20,000 to 30,000 die from the flu or complications. 

Dr. Mike Patrick: So this kind of brings up a point where if someone has a high fever, runny nose, congestion, cough and they go to their doctor, whether there's a flu test done or not, and their doctor says I think this is the flu, so we can expect this to last awhile. So now we know that these complications are possible, what symptoms should parents be looking for that maybe something more than just the flu like pneumonia is happening? 

0:48:09

Dr. Alex Rakowsky: You really want to focus on signs that the child is not doing very well. So fever by itself that can be brought down by let's say, ibuprofen or acetaminophen, Tylenol. And the child feels better, eats a little bit better when you give them those medicines usually is a good sign.

But if you have a child who's breathing very quickly, is not really responding the way they should, is lying around, hasn't eaten all day, looks like they're struggling to catch their breath, a quick heart rate, sweating an awful lot. And parents have this amazing unique perspective on their child that they can just say you just don't look right. We have parents come in to clinic and say my child just doesn't look or act right today. And most times, they're so dead on. It's one of those situations where if you're really worried about the child, bring him in. 

Dr. Mike Patrick: And even if you've been in before but you are worried that things are getting worse or that they're not getting better like you expected them to get better, come on back. 

Dr. Alex Rakowsky: And that's the problem with the flu compared to say a common head cold where it's going to last three to five days. The flu can be around for 7, 10, 14 days with some people. And you can get complications or secondary infections up to ten days out. 

For example, pneumonia come out seven to ten days after you started getting flu symptoms. So it's one of those situations where the parents really have to monitor their kids. And when in doubt, just call somebody. 

Dr. Mike Patrick: Yeah, another complications we don't always think of, we think of complications in terms of in the body, so like pneumonia for instance which can be life threatening. But the other complication can really be on lots of income for parents who may not be able to go to work because their kid is sick. The lost of education time because kids can't get go to school. Maybe they get behind in their homework or they don't understand an important concept that's going to be tested in the future. 

And so, there are complications from the flu that can occur that even aren't necessary medical.

0:50:03

Dr. Alex Rakowsky: And that's a great point. So I think a lot of people fail to realize that there are plenty of businesses in this country that don't have paid time off. And a lot of the people that we serve in our clinics or a lot of people that we know either get paid on a daily basis or get paid for amount of hours that they work per week. 

So actually being home if a child for seven to ten days, that's a huge pay cut for them, for that time period. We're fortunate to work in institution where we have some paid time off, but a lot of places don't. I was actually sort of surprised in getting ready for this show, that up to 50$ of people in this country do not have any guaranteed time off or a sick leave. And that's a pay cut. For people who were distraught, that can be a significant pay cut. 

Dr. Mike Patrick: So given that, the complications both medical at your home and where you live, I think it's really important to prevent the flu when we can, right? 

Dr. Alex Rakowsky: Yeah, so I kind of look at prevention in three ways. The first is just personally, what can I or you do to prevent flu for you or for me? The first is the flu vaccine. And the flu vaccine, while not a 100% guarantee to avoid the flu will at least make the flu less aggressive or sort of less severe for you. 

The second issue is — it sounds kind of silly — but avoid people who you know are sick at work. So if you're working for a colleague who's sneezing, saying I don't feel good, is looking like they have a fever, and you have kids at home, it may be good to either ask them to wear a mask or wear a mask around them. 

Wash your hands commonly and this is a thing for the kids, where especially for the sports teams where they're out there playing basketball, they come back during half time. Wash your hands. It may be one of those things where, because we just put our hands to our face all the time, just because we're human. 

And then, don't share any water bottles or drinking goodies with your buddies who may be sick. A more sort of colleague, family, work perspective, ask people who are sick not to visit or not to come to work if they are really not feeling just to kind of help stop spread of the flu. 

0:52:16

And then, I think a topic we don't talk enough about is just like more of a societal look at this. There should be more push for the flu vaccines. The more people vaccinated, the less chance of getting severe cases, the less chance of the flu being spread around. 

And maybe even advocate for businesses to have guaranteed days off. A lot of businesses can afford it but if there are some kind of different perspective on how we actually treat days off, then it will be easier for parents who don't feel well or have a child who doesn't feel well to stay home and not feel like they have to go back to work. 

 Dr. Mike Patrick: Yeah, absolutely. Dr. Abrams, with regard to the flu shot, sometimes we hear, "Well, the flu shot didn't work this year." Why does that sometimes happen? And is that reason to be "Should I really get a flu shot if it's not going to work?" How can we sort of advocate for flu shots when we don't know 100% that we've got the right match in terms of the flu virus that's going to be around in a given year? 

Dr. Mary Ann Abrams: That's a great question. So let me kind of explain, talk a little bit about vaccine efficacy. 

Dr. Mike Patrick: Oh, yeah, so efficacy, that's another one of those big words. 

Dr. Mary Ann Abrams: Good catch, sorry. Let me talk a little bit about how the flu shot works and why it may not work as well as we want it to and hope it will and expect it to during a given year. And it can be really confusing. 

So couple of things are important to know. First, as we've talked a lot about a little bit earlier, there are other viruses than can make people sick with symptoms that are similar to the flu. Therefore, people might think, "Oh, I got the flu vaccine. I still got sick." But without those tests and without those tests being a 100% on the point or correct, we don't really know that was the flu. So that may be one reason people think the vaccine didn't work. 

0:54:07

Another is the main reason, and it's really about how the flu vaccine actually works and how the flu virus behaves. So it's a very changeable virus. And every year, we have to make a new kind of flu vaccine. We do the best research we can to figure out what type of flu virus is going to be out there during the coming year. During the summer, we gear up and make those flu vaccines and start rolling them out and giving them to people in the fall. 

But the flu virus doesn't stop. It keeps kind of hanging out and it continues to change, and if it changes enough during the flu season, then that match or that fit between the vaccine and the flu virus that's making people sick isn't a good match. And that's when you hear some of the results of studies that say the flu vaccine didn't work as well. 

Plus, there's several different kinds of flu viruses that are the target of the vaccine, and one of them may be more common than the others during a certain year. And if that fit isn't quite right, that will affect how well the vaccine works. 

But all is not lost. Even when there's not a good fit, the vaccine can still be effective in helping decrease how sick you feel, how sick you get. It can help decrease hospitalization. If you're in the hospital, it might not make you have to be there quite as long. And it can prevent some of those complications that Alex talked about a few minutes ago. 

And finally, it can help keep you from spreading the flu to other people that you live with or that maybe are not able to get the vaccine themselves. 

Dr. Mike Patrick: I want to be a little bit of a myth buster for a moment. And there's a lot of reasons that folks give for not wanting to get a flu shot. One, you may have experienced either in yourself or your child, when you've had a flu shot in the past that you felt like you got sick after you had the shot. Maybe you had a fever, you feel achy.

0:56:14

And actually, the shot didn't give you the flu because if you get the injectable kind, it's an inactive virus. It's not a live a virus, so you can't really get the flu. But your immune system at work can cause those symptoms. 

So you can feel like you have a fever. Usually, it's a low grade fever, but then sometimes it can be higher fevers. And you feel achy. That just means your immune system's making those antibody so when the real flu comes along, it's going to protect you. 

But you're only going to feel like that for a day or two, whereas with the flu, as you said, Dr. Rakowsky, it could be ten days, right? 

Dr. Alex Rakowsky: I'm actually one of those people who gets the body aches and the low grade fever every single year. So I've had…

Dr. Mike Patrick: Still worth it. 

Dr. Alex Rakowsky: Yeah. But it's very predictable, 24 hours after the flu shot, I feel like I haven't slept all night. And I get body aches and low grade fever, but usually for the day, I feel a lot better. And it is worth it and sort of like predictable. 

I think for families who are getting the flu shot for the first time, it's good to let them know that this can occur. In fact, it's pretty common to get a little achy feel afterwards. Take some Tylenol, take some rest, but this will pass pretty quickly. 

Dr. Mike Patrick: Some folks mentioned mercury in the vaccine. And we do have most pediatric doses of flu vaccine are single doses. So it's just one bottle per one shot, and there's no mercury in that, correct? 

Dr. Alex Rakowsky: That's correct, yeah. 

Dr. Mike Patrick: It's just the multi-dose vials which is more commonly seen in adult medicine where you draw some of the vaccine and give it. But you can always request, "Hey, I don't mercury in it." And that's not going to be problem. Not that I'm advocating mercury in vaccines was a problem to begin, but that's not a concern with the flu shot in kids. 

0:58:02

Dr. Alex Rakowsky: Yeah. 

Dr. Mike Patrick: And then, in terms of allergies, sometimes we hear egg allergy, shall I get a flu shot? That's something you want to talk to your doctor about. There is some evidence that it is safe even if you have an egg allergy to get a flu vaccine. After the vaccine, someone may want to watch you for a little bit, make sure you're not going to have a reaction. Definitely talk to your child's doctor, talk to your child's allergist. But it used to be with say, if you have an egg allergy, no flu shots, but that's not true anymore. 

Dr. Alex Rakowsky: Yeah, for severe egg allergies, we'll still at least call the allergist to see if they want to see him. Well, for the kids who have either mild egg allergy or the more common situation where you really don't know what the egg allergy is, in other words, he may have had a rash after eggs one time, we'll give the vaccine. We'll watch them, usually watch them 15 minutes afterwards. And usually, they don't have any problems at all. 

Dr. Mike Patrick: And if your physician does not feel comfortable with that, usually the allergist would be happy to do the flu shot in their office. And they're quite used to dealing with allergic reactions that happen after injections, like allergy shots. 

[Laughter]

Dr. Alex Rakowsky: Yeah, I agree. 

Dr. Mike Patrick: So they're ready for you.

And then, I want to bring this up. So this is going to be a big word. It's a very rare complication of flu vaccines called Guillain-Barre syndrome . And I only mentioned it because we have mentioned it and talked about it in-depth on this podcast. In fact, Episode 341, we talked about it in great detail. We'll have a link to that in the Show Notes for you. And this is a real possible complication to the flu, but it's extremely rare, it happens about one to two cases for every million vaccines that are given. 

And the thing that folks should remember is actually getting the flu. So getting sick with the actual flu virus can also cause this to happen. In fact, probably more commonly than from the vaccine. 

And so, I just want to mention it because people will come across this as a fearful thing that oh, this can happen. But it's much more dangerous to drive your car to get the flu vaccine than the risk that this would actually happen to you. 

Dr. Alex Rakowsky: I agree, yeah. 

Dr. Mary Ann Abrams: That's a very good point. 

1:00:00

Dr. Mike Patrick: Okay, so prevention of flu, we've talked about some great ways to do that. Let's talk about….

Dr. Mary Ann Abrams: One other thing. 

Dr. Mike Patrick: Absolutely, yes. 

Dr. Mary Ann Abrams: You've kind of talked about this but not quite, a lot of times, people will say, "I got the flu vaccine and I got really sick after that. And I got the flu." And you've kind of touched on that, but just to reinforce, a lot of times, it's the stomach flu that they got, which is a totally different kind of flu. 

Second, it could just be another one of those viruses that's out there that causes a really bad cold or a respiratory breathing problem, that causes a bad cough and some fever. 

But the bottomline is the flu vaccine is very safe and it has no alive X virus in it. So it's impossible for it to cause you to get the flu. 

Dr. Mike Patrick: Yes. 

Dr. Alex Rakowsky: And second, also one other thing, I work in a clinic for a lot of immigrants and foreign language speaking patients. And in a lot of languages, flu and virus have the same word. Or our interpreters end up using the same word. The gripe in Spanish will be used a lot for head cold. And also, they'll say "fucuna contra gripe" or a vaccine against the flu. So the parents are commonly thinking, "Oh, this is a vaccine against a cold," because it's an interchangeable word. 

So I think you have to be very clear with interpreters if you have a clinic where you have to use interpreters or using interpreters to kind of make sure that they're specifically saying this is against a type of severe viral illness. Because otherwise, parents can get disappointed. They'll say, "Well, you gave me a cold vaccine and she had three colds this winter. What's up?" 

And I've noticed that a lot for Spanish patients where our interpreters will commonly use the word for cold interchangeable with the flu vaccine. 

Dr. Mike Patrick: That's a really good point. And we should reinforce with families that the flu is much worse than those three colds that your kid had in terms of high fever for such a long period of time. 

1:02:00

Dr. Mary Ann Abrams: And one other point, when you get the flu vaccine, it does take about two weeks for it to kick in and reach full effectiveness. So it is possible if you happen to have been exposed to flu, the real flu, and a couple of days before you got the vaccine. And the vaccine hasn't had time to kick in, that that also could unfortunately lead to getting the flu. 

So that's why we start our flu vaccination campaigns earlier in the fall to make sure we reach everybody as much as possible before it really hits hard. 

Dr. Mike Patrick: Right, yeah. So please everyone, get flu shots for yourself and your kids and this is definitely the time of the year to do that. Now, once you have the flu, tell us a little bit about what's involved in treating it. 

Dr. Alex Rakowsky: Kind of break it down into sort of different patients. So if you have a child who's less than six months who cannot get the flu shot, infants can get a horrible symptoms with the flu. And that's a child that should really be closely watched with the pediatrician.

So if you have an infant that, God forbid, got the flu, it's one of those you need to closely monitor that baby. It's usually what we call symptom care where you kind of give Tylenol or acetaminophen for fever, try to push the flu, try to push as much food as possible, but that's a child that's you're watching closely. 

For older kids who have gotten the flu vaccine and then get sick, usually it's going to be a milder case. A lot of this is symptom care. 

For kids who didn't get the flu vaccine and are really ill, for a child who has no long-term issues and no chronic diseases, there is a medicine called Tamiflu, which is an antiviral or a medicine against the virus or the cause of the flu, that is pretty effective in decreasing symptoms. It doesn't get rid of the flu. It just kind of shortens it. It makes it a little bit less severe or actually a fair amount less severe. So for kids who have had the flu symptoms for less than two days, 48 hours, we'll commonly start the Tamiflu. 

Dr. Mike Patrick: If they've been sick longer, it's less likely to be effective. 

Dr. Alex Rakowsky: Yeah. And then for kids who actually have like a long-term issue — asthma, or they live at home with somebody who couldn't get the flu shot because they're talking chemotherapy or they're in a long-terms steroids, et cetera — in that kind of situation, we'll treat them regardless of how long they are just to kind of, one, make that child feel better. But two, to also make sure that they're not spreading the flu to other family members or loved ones. 

1:04:23

Dr. Mike Patrick: Yeah, great. Well, I appreciate both of you stopping by, as we talk about the flu. Hopefully, in plain language, there may be a couple of times we weren't so great at that and we'll have to catch ourselves next time. Yeah, one more thing?

Dr. Mary Ann Abrams: I just wanted to take up one more point based on what we were just speaking about. If there's a child under six months who's too young to get the vaccine, one of the other important recommendations is that the people around that child, or anyone else who can't or doesn't get the vaccine, that they be vaccinated to protect them. 

So anyone who lives with that child, people who take care of them and daycare or healthcare workers, so you want to protect that child or cocoon them so they don't get sick. 

Dr. Alex Rakowsky: That's a great point. 

Dr. Mary Ann Abrams: Or someone who has a problem with their immune system that maybe can't get a good flu vaccine response. 

Dr. Mike Patrick: Yeah, absolutely. And pregnant women should get the flu vaccine because they will make antibody against the flu, which will go through the placenta into the baby's body and maybe give the baby a little protection against the flu that way, too. 

Dr. Alex Rakowsky: And there's always going to be children in your class, in your school, in your neighborhood that are getting treated for cancer, have rheumatoid arthritis, have long-terms complications where they eat the meal and medicine that sort of keeps them from getting a flu shot because they have concerns about it. Or they may just be too sick just to kind of get adequate immunization. 

So those are the kids where you really want to cocoon them as well, not just the infants. But if you have somebody at home, you should make sure that you sort of do the best you can to avoid that. 

Dr. Mary Ann Abrams: And unfortunately, steering clear of anybody who's sick is not a failsafe or full proof either because you can start to be contagious with the flu a day or two before you actually start having symptoms. So you look great, but tomorrow, you could have the flu and I've been around you today, so I can get sick. 

1:06:12

Dr. Mike Patrick: And we here that a lot where folks will say, well, they weren't around anyone who's sick. They don't go to school. They're not in a church or nursery. We did go to the grocery store though but there wasn't anyone coughing but still, you're going to come across this stuff and the vaccine's the best way to protect against it. 

Well, thanks again for stopping by. We're going to have you back. We need to plot out a chart for next year and what topics we're going to cover. I'm really excited that you guys will be joining us. 
I'm also going to put some more links in the Show Notes for this episode, 388, over PediaCast.org. Those two health literacy podcast that I mentioned earlier. 

Also, we did one with Dr. Dennis Cunningham who is a pediatric infectious disease specialist and we did a show on influenza and flu vaccine. It was Episode 184. So it was awhile ago but much more detail in terms of the science of the disease if you're interested in that. 

Dr. Mike Brady is also an infectious disease specialist and we talked about flu vaccine in Episode 352. So I'll put links to these things so you can learn more if you're interested. 

Also, some resources from the Centers for Disease Control and Prevention that are really targeted for families and also the American Academy of Pediatrics. So lots of flu resources for you in the Show Notes for this episode. 

So Dr. Mary Ann Abrams and Dr. Alex Rakowsky, thanks again to both of you for stopping by today.   
   
Dr. Alex Rakowsky: Thank you. 

Dr. Mary Ann Abrams: Thank you. 

[Music]

1:08:05

Dr. Mike Patrick: We are back with just enough time to say thanks to all of you for taking time out of your day and making PediaCast a part of it. Really do appreciate that.       
     
Also, thanks to our many guests this week, Dr. Julie Leonard, Dr. Mary Ann Abrams, Dr. Alex Rakowsky, all from Nationwide Children's. Also, Jim Davis, deputy chief of Emergency Medical Services for the City of Columbus Division of Fire. I appreciate all of them taking time and sharing their expertise with us. 

Don't forget, you can find PediaCast in all sorts of places. We are in iTunes, Google Play, iHeart Radio, Stitcher, TuneIn, most mobile podcast apps. Just search for PediaCast. 

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And also those face-to-face referrals really matter. So be sure to tell your family, your friends, neighbors, co-workers, babysitters, those who work in daycares, grandparents. Anybody who takes care of kids or has kids could really benefit from our evidence-based content..

Please do let them know about the program, including by the way your child's doctor or other health care provider. Please let them know about PediaCast so they can share the show with their own families and the other patients and folks that they see. 

And let them know, we also have a program for them, PediaCast CME. It is similar to this program, we turn up the science a couple of notches and offer free Category 1 Continuing Medical Education Credit. Shows and details are available at the landing site for that program, which is PediaCastCME.org. 

1:10:16

Thanks again for stopping by and until next time, this is Dr. Mike saying stay safe, stay healthy, and stay involved with your kids. So long, everybody. 

[Music] 

Announcer 2: This program is a production of Nationwide Children's. Thanks for listening. We'll see you next time on PediaCast.  

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