An Emerging Travel Disease- MERS (Article)

Disease prevention and control has become an important part of life in the age of globalization and frequent international travel. Since children frequently have opportunities for international travel, parents need to stay vigilant and informed about new, emerging infectious diseases. Right now, the Korean peninsula is struggling with an emerging respiratory disease that researchers think jumped from camels in the middle east to humans. Continue reading

Mandatory Flu Shot for Preschoolers? (Article)

Should the influenza vaccine be made mandatory for young children? Though childcare facilities have long required many vaccines to prevent children from contracting diseases, the influenza vaccine has often been overlooked. As the flu is generally perceived to be less threatening than diseases such as Hepatitis B, polio, or diphtheria, many parents forgo the recommended influenza vaccine and focus on more serious disease vaccines. However, the flu spreads rapidly and relentlessly, especially throughout childcare facilities, and it can cause a child to become very sick. Typically, the flu causes a high fever, sore throat, coughing, nausea, vomiting, and severe body aches, but in more severe cases, it can lead to hospitalization and even death. Pre-school aged children are especially prone to severe flu-related illnesses and complications. Thus, the flu cannot be overlooked, and if a small annual vaccine can prevent it, perhaps it’s time to tweak the list of recommended vaccines.

The state of Connecticut was the second U.S. state to implement the required influenza vaccines for children between the ages of 6 and 59 months who were entering childcare facilities. Since September of 2010, when Connecticut added the vaccine to the required vaccine list, the vaccine rate increased from 67.8 % to 84.1%, while the number of hospitalizations showed a marked decrease. Connecticut is a prime example of the effectiveness of the vaccine in preventing the spread of the illness.

As we can see, the influenza vaccine is incredibly effective. If this one little step in prevention can prevent our children from suffering the miserable symptoms of the flu and spreading it to others, perhaps our states should reconsider their vaccine policies. For those who would be against the vaccine for medical or religious reasons, waivers would be available, so overall, such policies would do far more good than harm. Even if states are slow to enact such changes, consider getting your child vaccinated anyway. Your precious child will be kept safe from the flu virus inevitably found hiding all over childcare facilities. In addition to the vaccine, washing hands, avoiding contact with the sick, and avoiding touching the eyes, nose, and mouth will help reduce the risk of getting the flu. Most importantly, for your child’s sake, don’t hesitate, vaccinate!

I welcome your comments at my blog, Until next time.

Smo Notes:

Written collaboratively by Keri Register and Paul Smolen M.D.

Which Bronchiolitis Treatment is Best? (Article)

Bronchiolitis, a common viral infection of the lungs in infants, is a very difficult condition for pediatricians to treat. Fortunately, a new study has given doctors a way to improve an old treatment that seems to really help the infants who are afflicted: on-demand nebulized breathing treatments.

In a recent study, researchers who were focusing on the most effective treatments of acute bronchiolitis in infants found that “on-demand” breathing treatment schedules reduced hospital stays more than traditional fixed-treatment intervals. Acute bronchiolitis is a common respiratory virus that limits the passage of air through tiny pathways, known as bronchioles, in infants’ lungs. The bronchioles become inflamed and mucus fills the pathways, making breathing difficult. Acute bronchiolitis is most often caused by a virus called RSV but can also be brought on by the same virus that causes the common cold or even the flu. Symptoms include a stuffy or runny nose, coughing, or a mild fever, followed by worsening coughing and wheezing. The illness sometimes results in hospitalization, mostly in infants less than 4 months of age. There are a wide variety of treatment options available, including inhaled racemic adrenaline, inhaled bronchodilators like albuterol, and inhaled saline, all designed to open these tiny airways.

Both adrenaline and saline mist treatments were found to reduce airway blockage and clear mucosal obstructions in infants with bronchiolitis, but the researchers found that the timing of the treatments made quite a difference; infants who received treatment on-demand, whenever a treatment was deemed necessary, had, on average, a 14 hour shorter hospital stay. Interestingly enough, they also received fewer treatments and had less need of supplemental treatments such as ventilators or oxygen.

A simple change in the timing of breathing treatments is making healthcare better for infants with bronchiolitis.  The shortening of hospitalization time can reduce the costs associated with treatment and  reduce the risk of inadvertently contracting another illnesses by exposure to other sick children. The on-demand schedule also allows infants to have minimal sleep disruption, more comfort, and an even faster recovery.  Good news for everyone!

Your comments are welcome at, the home of portable, practical pediatrics. Until next time.

Smo notes:

1.  Håvard Ove Skjerven, M.D., et al, Racemic Adrenaline and Inhalation Strategies in Acute Bronchiolitis,

N Engl J Med 2013; 368:2286-2293June 13, 2013DOI: 10.1056/NEJMoa1301839


HPV news… prevention works (Article)

The HPV vaccine has gained much attention in recent news, but there are many questions as to what it actually does and if it actually works. Experts at the CDC are now recommending that all children get vaccinated with the HPV vaccine long before they are sexually active.  I hear many parents question the wisdom of this vaccine until they understand how deadly HPV viruses can be. HPV, or human papilloma virus, is the most common STD in America. The infections affect people of all ages: teenage girls, boys, men, women, and even babies.  Fourteen million people become infected with HPV each year and are therefore put at greater risk for cervical cancer and head and neck cancers. Though every year, 19,000 women develop cervical cancer, and 8,000 men develop penile or head and neck cancers that are directly linked to the HPVs, many parents do not fully recognize the real danger of HPV infections.

The first HPV vaccine was approved for use in girls and young women in 2007 and recent data indicate its value.  Statistics gathered by the CDC shows that the HPV vaccine is incredibly effective, and therefore invaluable to protect our teenagers’ current and future health. Among girls ages 14 through 19 who were studied, the HPV infection rate has dropped by 56% in the past four years, even while vaccine rates are low. In the CDC sample population studied, just 5.1% of teenage girls became infected, compared to a pre vaccine rate of 11.5%. Imagine how low infection rates will be when far more children are vaccinated! If your teen hasn’t been vaccinated already, please don’t wait. The HPV vaccine has proven to be safe and effective defense against HPV. The inconvenience of simply getting a few injections is nothing in comparison to the devastating consequences of cancer.

Parents need to keep in mind that the HPV vaccine is a powerful tool to prevent cancers but only works if it is given before a person is infected, hence the young recommended age.  Remember this Doc Smo pearl: “Prevention trumps treatment, every time.”  Lets pass on a HPV free world to the next generation in the same way we were given a world without smallpox.  I hope you agree that a few shots is a small price to pay to avoid all that future pain and suffering.

Smo Notes:


Written collaboratively by Keri Register and Paul Smolen MD