Saturday, October 30, 2010

Those Dangerous Foods

I am often asked when it is safe to introduce foods such as eggs, peanuts, and fish to an infant.  These foods can cause allergic reactions in some children, so parents are understandably anxious about introducing them to their infant or toddler.  My answer:  it is safe when she is old enough to eat it without choking on it. 

Choking?  What about the allergy risk?  Well, we just do not know when is the right time to introduce foods that may cause allergic reactions.  Despite the strong opinions you might encounter on the topic, there is very little scientific evidence that delaying the introduction of a certain food will decrease the chance of having an allergic reaction.  In fact, there is some evidence, although not conclusive, that early introduction of a food may actually decrease the risk of developing an allergy to that food. 

In 2000, the American Academy of Pediatrics recommended withholding foods such as peanuts and shellfish until a child was 2-3 years old.  The AAP also recommended that pregnant women and breast feeding mothers avoid these foods.  In 2008, the AAP revised this recommendation, stating that there is little evidence that the previous recommendations made any difference. 

Everyone has an opinion, and this is mine.  After 12 months old, I give parents free reign to introduce any foods that the parent eats.  I also warn parents to use common sense in terms of choking hazards.  Is it possible the child may have an allergic reaction to peanut butter?  Yes, but it is also possible the family could be in an auto accident driving home from the grocery store where they purchased the peanut butter.  There is risk to everything we do.  It is important to realize that delaying the food does not affect this risk.

If there is a family history of severe allergic reactions to foods, I may tailor my recommendations a little.  There are rare cases where I will recommend allergy testing before giving a child a certain food because of previous reactions or family history.  For most families, I recommend what I have done with my own children.  After a year old, if I am eating it, he or she can eat it.

Saturday, October 9, 2010

Flu Shot Season is Here

It is that time of year again.  Time for flu shots and time to battle the myths that surround the flu shot.  Here are a few:
  • "The flu shot makes you sick."  This is by far the most common reason parents refuse the flu shot for their children.  The injectable flu vaccine is a dead virus and it cannot make you sick.  It is injected to create an immune response so that the recipient develops antibodies to protect against the flu, but the dead virus is incapable of replicating and creating a true flu illness.  So why do so many people think the flu shot makes people sick?  If 100 people receive a flu vaccine and on their way home from the doctor's office two of them get a speeding ticket, does anyone think the flu shot caused the speeding ticket?  (I hope not, but when it comes to immunizations, I have heard weirder claims.)  Now let's say two of the 100 people who received their flu shot caught a stomach virus the same day.  They are going to be convinced the flu shot made them sick.  I believe this is the phenomenon that leads to the myth that the flu shot makes one sick.  There are many illnesses circulating within our communities this time of year.  When someone catches an illness shortly after receiving a flu vaccine, he or she assumes that the shot caused the illness.  Not true.  (For the purpose of full disclosure, the live-attenuated nasal vaccine (FluMist®) can cause some cold symptoms after it administration.  This is a well known side effect.)
  • "The flu only makes older people sick."  Wrong.  The flu is an equal opportunity illness.  It does not care about age.  In fact, the very young are at high risk for complications from the flu.  Last season, when the H1N1 virus was the predominant circulating strain, death rates were highest in children less than two years old and pregnant women.  Children with underlying health problems, such as asthma or diabetes, are also at higher risk of complications.  Each year, an average of 36,000 people die from the flu or complications from the flu in the United States.  This is about 12 times the number of people who tragically died in the 9-11 terrorist attacks, and this happens each year without much media coverage or concern from the public. 
  • "Antibiotics cure the flu."  Nope, sorry.  The flu is a virus and an antibiotic will not improve flu symptoms.  There are antiviral medications that can help to shorten the illness if they are started early enough, but even these are far from miracle workers.  If you catch the flu, expect to be sick at least a week no matter what medications you take.  It is well known that the flu can lead to secondary bacterial infections, such as ear infections or pneumonia, that do require antibiotics.  These infections typically occur five to seven days after the flu illness starts. 
  • "The flu shot is part of a government conspiracy to make us sick."  Uhh, I have nothing for this one.
The flu vaccine is recommended for all children from six months to 18 years old.  Infants under six months old can be protected by everyone else in the household receiving a flu vaccine.  Call your doctor today and get your shot.