Winter 2010 Newsletter

What to Expect From After-Hours Phone Calls

If your child is an established patient at Trestlewood Pediatrics, we want you to feel confident that, even when the office is closed, there is a physician available to help you with urgent questions about your ill child. We wrote these notes thinking it would be helpful for families to understand how our after-hours phone system works. The after-hours phone number for established patients of Trestlewood Pediatrics is 998-0554. As of 2010 there is no charge for an urgent, brief, after-hours phone call. Most calls of this type take less than 3 to 4 minutes.

Office Cell Phone
When you call you will be pleased to notice that we do not use an answering service. Instead you will speak to the doctor on call directly on our office cell phone. If the doctor cannot take the call immediately (perhaps while driving, or taking another call), then the call will be returned using information you have left on our voice mail. We strive to return calls within 30 minutes. Sometimes we are at the hospital or answering other calls, however, and a return call is delayed. You should call back if you have not heard from us within 30 to 60 minutes.

The most important information to leave on the voice mail is your name, your child’s name and age, and your phone number. A few words about the problem can be helpful (“she is wheezing,” “I think he broke his arm.”). If the message is too long it will delay us in returning the call.

Our Goals in Answering Calls
When the doctor talks to you about your child he/she is trying to determine how serious of a problem this is and what needs to be done for it right now. This is called “triage.” For example, is it best to treat this problem at home with over the counter medications or home comfort measures and see the child in the office tomorrow, or should the child go to the emergency room now?

After hours the doctor does not have your child’s medical record, information about medication and allergies, and other important data needed to provide a thorough assessment and treatment plan. While a worried parent might understandably hope for a complete evaluation, diagnosis, plan, and prescription, this is actually very difficult for the doctor to do over the phone. In most cases the doctor’s goal after hours is to get your child through the night in the safest, simplest way we can until we can provide more thorough and personal care in the office.

It would be unusual for the doctor to call in a prescription, such as an antibiotic, without seeing your child in the office.

Calling About Specific Problems
Our web site might be helpful in addressing some simple questions, thus making some phone calls unnecessary. Also, the patient folder has information about common illnesses (fever, vomiting, diarrhea, sore throat, ear pain, pink eye, constipation, coughs, colds). The fever information includes a dosing chart for children under 35 lbs. for acetaminophen (Tylenol) drops and suspension, and for ibuprofen (Motrin, Advil) drops and suspension.

Because we cannot see the child, rashes are very difficult to diagnose over the phone. With a rash we will attempt to determine if it represents a serious illness (the child would appear extremely ill in that situation) or if it is an allergic rash (such as hives). To receive a diagnosis beyond this, the child would need an appointment in the office.

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By order of the Kalamazoo County Health Department, we can only offer general testing for influenza and will be unable to distinguish between the strains (including H1N1). The type of influenza does not affect treatment or contagiousness.

Symptoms of Flu
Symptoms of flu include fever (usually high), headache, extreme tiredness, dry cough, sore throat, runny or stuffy nose, and muscle aches. Although nausea, vomiting, and diarrhea can sometimes accompany the flu, the term “stomach flu” is a misnomer and is sometimes used to describe gastrointestinal illnesses caused by organisms other than the flu virus.

Most people recover fully after one to two weeks, but some develop serious complications, such as pneumonia. The very old and very young are most at risk for complications as are people with chronic health problems such as asthma, diabetes, respiratory conditions, and immunologic disorders.

Contagiousness and incubation period
Virus-infected droplets coughed or sneezed into the air spread influenza. Symptoms usually appear one to four days after a person is exposed to the flu virus. People are contagious for about 24 hours before they exhibit symptoms until about seven days after that. Compared with adults, children have high infection rates and prolonged viral shedding with large amounts of infectious virus. They also come into close contact with many other children thereby increasing their risk of exposure to the influenza virus.

Prevention
The single best way to prevent the flu is to get vaccinated each fall. This fall there will be two different flu vaccines; one for the seasonal flu viruses and one for the novel H1N1 (swine flu) virus. The seasonal flu vaccine can be given either in a shot or nasal mist. Children with history of asthma and all children under the age of 2 must get the shot. The seasonal flu vaccine is given once per year unless the child is under 9 years old and getting the flu shot for the first time. In the first year a young child receives the flu vaccine, it needs to be given in 2 doses, about a month apart, to ensure immunity.

The vaccine that will be available for the novel H1N1 influenza virus will not be available until later this fall, most likely late October. Limited doses of the nasal mist are expected to be available, just like the seasonal flu vaccine. The difference is that everyone will need to get two doses of this vaccine about a month apart to ensure immunity. At this time, how the Michigan Department of Community Health plans to distribute the vaccine has not been made public.

Because the vaccine is not foolproof, however, there are other ways to protect against the flu.

• Avoid close contact with people who are sick;
• Stay home from work, school, and errands when you are sick to avoid spreading your illness, and keep kids home from daycare when they are ill;
• Cover your mouth and nose with a tissue when coughing or sneezing;
• Wash your hands often to help protect you against germs;
• Avoid touching your eyes, nose or mouth.

The American Academy of Pediatrics recommends flu vaccine for all children over 6 months of age, their household contacts, and out of home caregivers.

Certain persons should not receive the vaccine including those who are allergic to eggs or chickens because the vaccine is produced in egg embryos. Speak with our office about the appropriateness of the flu vaccine for your child, and to receive complete vaccination information.

Treatment
Children with the flu should rest in bed to help their bodies fight the infection. Fluids are helpful to prevent dehydration and mobilize secretions in the airway. A non-aspirin medication such as acetaminophen can be taken to relieve aches and pains and to reduce fever. Do not give your child aspirin because of the risk of Reye syndrome (a neurological disorder) associated with aspirin use and influenza.

A few drugs have been approved in children for the treatment of influenza. They have side effects, however, and must be used within two days of onset of illness to be effective. In addition, they are only effective in reducing flu symptoms by about one day. Talk with your doctor about whether these drugs are indicated in your child.

Call us if your child is less than six months old and shows signs of the flu, if your child seems particularly ill, or any time you have a question about your child’s condition.

For further information on the flu, check out the following web sites.

• www.michigan.gov/flu
• www.cdc.gov/ncidod/diseases/flu/fluinfo.htm
• www.kidshealth.org

Taken in part from Department of Health and Human ServicesCenters for Disease Control and Prevention Fact Sheet

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