Tackling Cold and Flu Season

Influenza (the flu) is a viral infection of the nose, throat, and lungs caused by influenza viruses. This is different from the stomach flu, which causes vomiting and diarrhea. The flu has similar symptoms to the common cold, however symptoms are usually more severe with the flu than the common cold. Typically the treatment of the two is the same.

You can find more information on flu virus and flu activity on


Flu viruses spread mainly by droplets made when people with the flu cough, sneeze or talk. These droplets can land in the mouths or noses of people who are nearby, even people up to 6 feet away! Less often, a person might get the flu by touching something that has flu virus on it and then touching their own mouth, eyes or nose.


Symptoms of the flu can include fever, cough, sore throat, runny or stuffy nose, body aches, headache, and chills. Some people with the flu will not have a fever, up to 2/3 of people with the flu can be asymptomatic and still be able to spread the flu virus. People with the flu may be able to infect others by shedding virus one day before even showing symptoms, and up to 5 to 7 days after symptoms have begun. Typically flu symptoms can last from 5-7 days, and sometimes up to 2 weeks.


The best way to prevent your child from getting the flu is to get the seasonal flu vaccine.

It is also recommended that all family members and care takers of small children receive the vaccine.

In addition to getting vaccinated, take and encourage your child to take everyday steps that can help prevent the spread of germs. This includes:

  • Stay away from people who are sick.
  • If your child is sick with flu-like illness, try to keep him or her in a separate room from others in the household, if possible.
  • CDC recommends that your sick child stay home for at least 24 hours after his or her fever is gone except to get medical care or for other necessities. The fever should be gone without the use of a fever-reducing medicine.
  • Cover coughs and sneezes with a tissue.
  • Wash hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub.
  • Avoid touching your eyes, nose and mouth. Germs spread this way.
  • Keep surfaces like bedside tables, surfaces in the bathroom, kitchen counters and toys for children clean by wiping them down with a household disinfectant according to directions on the product label.


If your child were to get flu-like symptoms there are a few steps you should take.

  1. Keep your child comfortable by reducing pain or fever. The best medications for this are acetaminophen and/or ibuprofen. Conduct your child’s healthcare provider if you have any questions about the dosage or administration of either of these medications. You can also find a convenient dosing chart on our website Avoid giving products containing aspirin in children as this can potentially cause severe reactions in children, called Reye’s syndrome.
  2. Keep your child hydrated with water or other clear fluids such as Pedialyte or Gatorade, which replace electrolytes.
  3. If you child has any underlying health conditions, such as asthma, diabetes, other chronic issues, or is very young, see your health provider as soon as flu-like symptoms develop. These children should be tested for the flu and may be candidates for anti-viral treatment (discussed below).
  4. Manage your child’s upper respiratory symptoms (cough and nasal discharge) using home remedies that are known to be effective in minimizing symptoms without causing harmful side effects. Most complications from the flu (pneumonia, and ear infections) occur from mucus in the body that isn’t cleared.


Some of these remedies include:


  1. Have your child blow their nose often, or if they are younger you may need to suction their nose with a bulb or Nose Frida (sometimes with some saline drops or spray in the nose prior to suctioning) to clear their airways for them.
  2. Use steam from warm showers to help loosen mucus and make it easier for the body to clear the congestion.
  3. For children over 12 months of age, honey can be used as an effective cough medication that won’t have the side effects that the over-the-counter medications have. Over-the-counter cough medications are not recommended by the American Academy of Pediatrics for the treatment of cough due to potentially harmful side effects.
  4. Elevate the head of the child’s bed by placing some pillows or rolled towels under the mattress to prop up the child when they are sleeping. This can help alleviate symptoms at night.
  1. Protect yourself and others by keeping the sick child away from others, and taking standard precautions to protect others from infection like keeping surfaces clean, and washing hands often.


When you should see your doctor:


  1. If your child has an underlying condition or is under 2 years old and presents with flu-like symptoms.
  2. If your child seems very ill- exhibiting true lethargy or irritability.
  3. If your child is not tolerating fluids and is showing signs of dehydration (lethargic, no urine production in more than 6 hours, or is lacking tears or has a dry mouth).
  4. If your child is showing signs that they are having trouble breathing (rapid breathing, making noises when they breathe, or are using accessory muscles in their chest or stomach to breathe).
  5. If your child has had symptoms for a few days but then seems to worsen. This can sometimes be a sign of a new illness, or potentially a complication from the initial illness.




Treatment of the flu


The flu is a viral illness and in most cases does not require any treatment beyond the symptomatic care listed above, which you can do at home. In some cases, children may be candidates for anti-viral treatment of the flu. Anti-viral treatment is aimed at limiting the course and duration of the virus and therefore minimizing potential complications. Children who typically qualify for treatment are:

  • The very young (<2yrs)
  • Any child with a serious chronic illness
  • Any child who is immune-compromised or lives with someone who is immune-compromised.

Anti-viral treatment is most effective when started within 48 hours of the onset of flu symptoms.


The most common medication used in Pediatrics to treat the flu is Tamiflu (Oseltamivir).

You can find more information on

There are both pill and liquid formulations of the medication and typical treatment lasts for 5 days. Most common side effects include nausea, vomiting, skin reactions, and in severe cases neuropsychiatric events such as hallucinations. Talk with your pediatrician if anti-viral treatment is necessary for the management of flu for your child.


Happy and healthy season from Heights Pediatrics!

Immunizations help prevent serious illnesses and diseases that can present a serious health risk to your child and to others. It is important for your children to be up to date on their immunizations, which is why regular immunization schedules are implemented by our practice. Regular immunizations are an important part of your child’s health and development.

At Heights Pediatrics, we provide up-to-date immunizations that follow the schedule recommended by the AAP, or American Academy of Pediatrics. We are sometimes able to make minor modifications to the immunization schedule based on parent’s requests, although this is not always possible; if you would like to make modifications to your child’s immunization schedule, please be sure to discuss your request with your child’s doctor.

The following is a quick and handy guide to the immunizations we currently provide. We schedule the following immunizations, as recommended by the AAP:





Last year there were 2 developments in our vaccine schedule. First, the new version of  Guardasil vaccine came out . It is called Guardasil 9 and the main difference is that this vaccine is expanded to cover 9 serotypes of HPV virus rather then previous 4. That means that the vaccine is more protective then the previous one. It is approved for girls ages 9-26 y and boys 11-15.

You can learnmore at :


Another development was a recommendation to immunize all kids at risk for Meningococcal meningitis type B. It is a standing recommendation to immunize all 11 and 16year old with Menactra, that covers meningococcus meningitis type A,C,W and Y. In recent years, we have seen increased incidence of type B in this country.  See more here

It is our opinion that all kids travelling to countries with high incidence of Meningococcal disease type B  as well as all kids that are going to college.


We also recommend that all patients 6 months and older receive a yearly influenza shot before the start of influenza season. For children 2 years and older without history of wheezing can get the nasal Immunization called flumist. Sometimes it is difficult to administer to our younger patients as it is preferable that children not cry during administration.

If you have any questions about particular immunizations or your child’s immunization schedule, please don’t hesitate to call our office during business hours.

If your child is not immunized or you have previously followed a different immunization schedule at a different practice and you would like your child to become our patient, you must discuss your child’s medical history and immunization schedule with one of our doctors before you can join our practice.

Vomiting and diarrhea are mostly caused by viral infections of the GI tract. Sometimes, they could be caused by bacteria or parasites (especially after travel) or spoiled food. Other illnesses that may cause these symptoms include respiratory infections, otitis media, strep throat, and urinary tract infections. In rare instances a more serious condition, such as bowel obstruction, appendicitis, meningitis, poisoning, or head injury, may cause vomiting with or without diarrhea. Bilious (green) vomiting, bloody vomiting, or bloody diarrhea need urgent evaluation.


Treatment of Vomiting and Diarrhea:


Mostly, vomiting will stop within 24 to 48 hours. Diarrhea will often continue for over a week, and it may be over 2-3 weeks before the stools return to normal. Unfortunately, Kaopectate and other over the counter mediacations are not helpful. Actually, all they do is stop the intestines from moving, allowing the virus to continue to do its damage. It is better to get the virus out of the body, even if it takes a few extra days. Antibiotics or other prescription medications are only used in the few cases that are caused by bacterial or parasitic infections. Majority of bacterial infection are not treated with antibiotics as they tend to get better on their own.

The main goal of management of vomiting and diarrhea is to prevent dehydration.

When hydrating the body, it usually is best to give Pedialyte or another  oral rehydrating electrolyte solution. During the vomiting phase, it is best to give small amounts like a sip or a dropper every 5-10 minutes. Increase the amounts slowly and if your child begins to vomit again, you probably went too quickly. We recommend then giving a stomach a rest  for 30 minutes before starting again with small sips.

Once the vomiting has passed for at least 6-8 hours, your child can begin solid foods. Simple foods will be the best – Cheerios, crackers, rice, bananas, apple sauce or chicken noodle soup. You also want to add simple proteins like lean meats. Please avoid fatty foods and fruit juices.

Sometimes after a bout of diarrhea children can have a temporary lactose deficiency and then all products with lactose should be stopped.

Use of a probiotic is helpful in decreasing the amount and frequency of diarrhea when caused by a viral illness. This good bacteria now available in powder or capsules and helps to restore the balance in the digestive system. Currently our favorite probiotic is Bio-Gaia or Florastor, available at well stocked pharmacies and online.


Signs of dehydration


  • Few or no tears when crying
  • Dry or sticky mouth
  • Eyes that look sunken into the head
  • Soft spot (fontanelle) on top of baby’s head that looks sunken
  • Lack of urine or wet diapers for 6 to 8 hours in an infant (or only a very small amount of dark yellow urine)
  • Lack of urine for 12 hours in an older child (or only a very small amount of dark yellow urine)
  • Dry, cool skin
  • Lethargy or irritability


Reasons to call us


  • Vomiting not improved after 24 hours.
  • Greater than 10 episodes of vomiting and/or diarrhea in a 12 hour period.
  • Fever greater than 103 degrees.
  • Bloody or green vomiting or bloody stool
  • Infant or child who is listless, difficult to awaken, disoriented, or irritable.
  • Abdominal pain that becomes worse and is not relieved by the vomiting or diarrhea.
  • Swollen or distended abdomen.
  • Vomiting associated with a severe headache, stiff neck, or painful urination.
  • Infant or child who cannot cry tears or has not urinated in greater than 8 to 10 hours.

Flu Shot

To all our dear patients:

As you all know, we strive to provide the best care possible for all our children. In order to do that, we pay close attention to research, science and breaking news.

We think that our practice reflects our beliefs- our breastfeeding statistics are far above the nation average, our immunization rates are close to 100%, We have not seen a case of infant pertussis which we believe if a reflection of our recommendation to “cocoon” all our newborns.

With increasing amount of information and misinformation on the WWW we find it imperative to provide parents with the most accurate and updated information. As help and a resource for our parents we have decided to start this blog, where we will try to post new, seasonal, interesting or even controversial information.

We hope you will enjoy it- and hopefully learn something in the process.

So our first contribution will be seasonally appropriate:

What is new with flu shots this year and why is there limited amount of nasal flu vaccine?

Screen Shot 2015-11-16 at 5.46.44 PM

Every year in the fall we try to accommodate all our patient’s demands for immunizations against influenza. As per CDC all children over the age of 6 months should be vaccinated. For the second year flu immunization is obligatory for children attending day care and pre-K. We share the opinion that all children and adults should get immunized if possible.

Many parents have easier time persuading their children to come into the office to get the nasal flu vaccine. The nasal spray flu vaccine – also called FluMist or LAIV (Live Attenuated Influenza Vaccine) – contains weakened live viruses. It’s approved for use only in healthy people 2 to 49 years old who are not pregnant. The regular flu vaccine is an injection that delivers an inactivated (killed) form of the virus.

Unfortunately, a production delay of the FluMist flu vaccine has U.K. pharmaceutical giant AstraZeneca scrambling to alleviate shortages at doctors offices this flu season.

Only 5 million doses of the vaccine made by Gaithersburg-based MedImmune, the biologics research and development arm of AstraZeneca PLC (NYSE: AZN), has been delivered so far this season. AstraZeneca originally said it planned to distribute 15 million doses.

We have encountered some unforeseen challenges with production of two of the four strains contained in our vaccine, which has impacted delivery timing,” an AstraZeneca official said in a statement.

“As a result, a substantial portion of FluMist Quadrivalent doses will be available later in the influenza season relative to prior seasons.” As we are told, we should not expect our next shipment before December, which may be too late if we get our flu epidemic in early. So we encourage everybody to make the trip to our office and we promise to make it as great of an experience as possible (we have few tricks up our sleeves!).

And while we are at it – all adults can get their flu shot as well and be a good role model for their kids!

See you soon!

Dr. Silverblatt and staff at Heights Pediatrics

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