Saturday, July 20, 2013

Common Sleep Myths - by guest blogger Kerrin Edmonds

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Social Media really is shrinking the world. How else would I be able to keep up with my friends without leaving my living room? I've realized that people I know from different aspects of life somehow know each other because they are friends of friends. I can easily share great information with hundreds of people with one easy click.

Business networking through social media is a wonderful tool. I have recently been contacted by a number of sleep consultants who found me through Facebook. Since there are always so many questions about sleep, I'm excited that many of these certified sleep consultants have offered to share articles when they write them. Some have been published on other sites, and I have (or will) post those articles on my Social Media sites. For those who have great information to share but don't have a website to link, I will have them guest blog here.

I'm excited to introduce my first ever guest blogger, Kerrin Edmonds.

Kerrin grew up on California’s Central Coast and has lived there her whole life.

Growing up with a Mom who owned and ran her own preschool, as well as being the oldest of three kids, Kerrin has always been around children from the start. But her passion for babies and more particularly, for baby sleep issues, was born with her first baby. After weeks of crying and sleepless nights, she felt there had to be a better way……So she started her journey to a better sleep for her whole family. After graduating from the Family Sleep Institute, and becoming certified with the International Sleep Consultants Association, Kerrin founded “Meet You in Dreamland,’ where she helps families find and keep their restful nights sleep.

Kerrin also works with a local group called Pickles and Tickles, a organization that offers early intervention services to families with children under the age of three.

Kerrin lives in California's San Luis Obispo North County with her husband, daughter, son, funny looking little dog and sweet kitties.

Common Sleep Myths
By Kerrin Edmonds
As we parent our children in regards to sleep, there is a myriad of information, recommendations, myths, rules and even legends! It can be tough to sort through and make sense of it all. In this article I will respond to 5 of the most common Sleep Myths.
  1. Putting Rice Cereal in a Babies Bottle will help them Sleep Longer-
This one has been around for decades! Many studies have  proven that babies who were given rice cereal in their bottle did not sleep any longer than those who did. Some parents have even found the opposite to be true….that babies who were given too much rice cereal or were given rice cereal at a young age suffered from indigestion and tummy upset.

  1. Keeping a baby/child up later at night will make them sleep in.
This one couldn’t be further from the truth. While on the surface this makes sense, we must think biologically not logically when it comes to our child’s sleep. If we allow our children to become overtired they release a hormone called Cortisol, which is similar to adrenaline. This hormone makes it very hard for them to fall and stay asleep. Babies sleep better, longer, and cry less if they are put to bed early in the evening. Babies who go to sleep late in the evening are often "over tired", even though they seem to have energy. A typical and healthy bedtime, depending on how they napped during the day is between 6-8 pm.

  1. A Baby should sleep through the night at 12 weeks-
While this would be nice, and does happen in some cases with some babies, it can be an unrealistic expectation and just cause stress if it doesn’t happen for you. It isn’t unreasonable for a baby to “need” a feeding during the night till around 9 months of age.

  1. My child doesn’t need as much sleep as other children-
I hear this one a lot in my profession and while this might make a parent feel better about how little their child sleeps, it really isn’t true. It is true that some kids need/love sleep more than others but usually this varies by only an hour or two, not huge amounts that I tend to see. It is not uncommon for children to fight sleep but that doesn’t mean they don’t need it.  I am confident that all children can be taught to be good sleepers…..and isn’t that what we want?!

  1. You can sleep train a newborn-
In all reality you can’t sleep train or schedule a newborn. Sometimes an infant might appear to be on a schedule until it suddenly changes. This is because our babies Circadian Rythmn or body clock is not biologically mature yet. This maturing starts around 4-5 months of age and this is when we can start scheduling naps, etc.

Most basic baby sleep myths can be busted by remembering to think biologically instead of logically in regards to our children’s sleep.  Respecting and encouraging our children’s need for sleep is something every baby deserves!

Saturday, July 13, 2013

Flu Shot Information 2013-14 Season

Dr. Mellick getting FluMist
Dr. Stuppy getting a flu shot

Many parents are already asking about this year's flu vaccine, which means we've done a great job in the past making them aware that they need to think about getting the vaccine before they start seeing people get sick!

We feel so strongly that the vaccine is effective at protecting not only the person vaccinated but also the community around them that our office requires all staff to get a vaccine. We made the Honor Roll for Patient Safety from the Immunization Action Coalition for this requirement!

What's new this year?

Every year scientists predict which strains of Influenza A and Influenza B will likely be prevalent. The World Health Organization makes the recommendations for the vaccine based on these predictions. The strains chosen are the same for every company that makes the vaccine. The difference this year is that some will have three strains (trivalent) with two A and one B, others will have four strains (quadrivalent) with two A and two B.

Flu shot season causes headaches for doctor's offices. 

We must anticipate our need many months in advance and get our orders in. Each year the vaccine demand varies (a lot based on press reports on how badly people are getting sick, which we don't know when ordering). As more places offer vaccines (such as offices and pharmacies) the numbers of people getting vaccines at their doctor's office might go down. (I am biased, but of course believe getting them at your doctor's office is superior since we keep all your medical records in one place.)

From a business perspective, no one wants to be stuck with thousands of dollars of unused vaccine-- we can't stay in business if we lose money. We also don't want to have kids at risk of disease because they're unprotected and unable to find an appropriate vaccine when we run out. We certainly don't want parents yelling at our staff because we run out. Sometimes we've ordered enough overall, but our shipping allotments don't come fast enough for the demand. Shortages have happened over the years, something beyond anyone's control.

Scheduling mass flu vaccine clinics is often the best way to vaccinate large numbers of patients, but they are fraught with complications: how many people will show up, what flu vaccine (injectable vs nose spray) will they need? How many doses do we need on hand to hold a clinic? In times of shortages or low stock, how do you prioritize who gets the vaccine -- or do you want to just keep giving to anyone until it is gone so the office isn't stuck with unused vaccine at the end of the season? Do you give one dose to a 6 month old who you know won't be able to get the 2nd dose due to your supply running out?

This year there's a new spin to the variety of headaches: different vaccines will be available. Not just injectable vs nose spray. There will be some with 3 strains of virus, others with 4 strains. (For a review of how strains get into vaccine and how this year is different, see Quadrivalent Flu Vaccines: Four Means More Protection.)

So this year we have new questions: How are we supposed to order the different types, who gets which type, and are they interchangeable? How will the public perceive the difference and will they demand one or the other? Will insurance companies reimburse the cost appropriately, given that one is more expensive than the other? While in health care our goal is to keep everyone as healthy as can be, no office can afford to lose money on vaccines and stay in business.

What kinds of vaccine will be available this season?

There are many companies that make influenza vaccine, each with their own indications. For a complete list, see the chart on the CDC website. Our office has pre-ordered the FluMist and the Fluzone products (both forms) in part because we didn't know which would be available at the start of the season. We do not purchase the brands that are only available for older children or adults. Ask your doctor what they order.

All FluMist will be quadrivalent (4 strains) and is for children over 2 years without high risk conditions, such as asthma (presumed based on previous recommendations, this year's statement has not been released yet). It is expected to start shipping in July or August, though any individual office may not receive their order with the first shipping dates.

Fluzone Quadrivalent (4 strains) is an injectable vaccine for everyone over 6 months of age. It has already sold out  based on pre-season orders and will be available in limited quantities. Shipping dates will begin in August or September.

Fluzone Trivalent (3 strains) is an injectable vaccine for everyone over 6 months of age. It is expected to begin shipping in July and August. I have not heard of shortages.

Is adding a new strain dangerous?

Based on the chaos in the year of H1N1, I know that many parents fear "new" strains added to a flu shot. In actuality, every year the vaccine changes with very rare exception. That is because the flu strains predicted to cause disease change year to year. Adding a new strain does not make the vaccine less safe, just more effective.

Who needs the flu vaccines and how will they be given?

As of today, the finalized recommendations have not been approved. The preliminary recommendations  continue to recommend flu vaccine for all people over 6 months of age. (The link should update to the final recommendations as they become available.)

Last year it was recommended to start giving the vaccine as soon as it was received (previously it was suggested to wait until October so it remained effective throughout the season, but the vaccine is effective longer than previously thought so earlier vaccine is effective.) I presume this will remain the same.

If a child under 9 years of age has not had flu vaccine before, they need 2 doses in the same season to "prime" and "boost" immunity. If only one vaccine was given, the next season the child needs 2 doses unless they have gotten 2 of the same strain before. (This was easier last year because it was a rare year that the vaccine didn't change, so they could have gotten one the season prior, and the booster last year.) For children over 9 years, only one dose is needed, even if never received previously. After that first year of 2 doses, each year everyone just needs one dose unless it dramatically changes (as in the H1N1 year). I suspect since 3 of the 4 strains are the same this year, if a child needs 2 doses because they have not had 2 doses of the same strains, the vaccines are interchangeable. We will all find out when the final recommendation is given.

At this point I have not heard if high risk people should get preference for the quadrivalent vaccine. I don't think this will be possible in many cases, since many of the high risk are under 2 years old, and not eligible for FluMist. The injectable quadrivalent vaccine is in short supply, and many offices are likely to not get it at all. I personally feel it would be bad to wait for the quadrivalent vaccine if we have the trivalent vaccine in stock and an eligible patient is in the office. I'd rather vaccinate than potentially miss the opportunity all together. I'm sure others will differ in opinion since the quadrivalent vaccine is better protection. Talk to your pediatrician about their preference.

Although we cannot require all patients to get vaccinated, we certainly encourage it and try to make it as painless as possible (though the kids who get shots don't always agree). We will once again allow any patient in the office to get a flu vaccine (even if just there with a sibling for an appointment) and we will offer on line sign up for our clinics. On line sign up has proved very popular, both among our nurses and the families who come. It has really made the process run much more smoothly. There will not be a co pay collected at those clinics. (After we submit the claim to your insurance company if they tell us differently we will send a bill, but do not expect that in most cases.) Be sure you have registered for our e-Newsletter so you will be among the first to know when sign ups are ready for our patients. (No dates are set yet because we have not gotten verification on shipping dates. Please don't call the office to ask-- staff have no idea.) We will put information on our website as it becomes available in addition to posting on our Facebook page and sending the e-Newsletter.

We will all have to wait to see how this plays out! Every year something is new with the flu vaccine. What will be next?