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New Directions

Issue: Winter 2009 - 2010

Update on Flu: H1N1 With Dr. David Reitman, chairman of pediatrics at Suburban Hospital

Q. Has Suburban Hospital been seeing an increase of patients coming to The Pediatric Center with symptoms of flu?

A. Definitely. Over the past few months, the Pediatric Center has seen about a 30% increase in volume, largely due to concerns about the H1N1 Influenza.    


Q. What kind of symptoms do these patients have?

A. Almost all of the patients present with a temperature over 100º, but many of the kids can have fevers in the 102-104º range. Other symptoms of H1N1 include:

  • sore throat and cough
  • runny nose or nasal congestion
  • abdominal discomfort and vomiting

Q. Are you testing them for swine flu?

A. In accordance with the most recent recommendations from the Centers for Disease Control and Prevention (CDC) and the Dept. of Health and Mental Hygiene (DHMH), we are not routinely testing patients for influenza. There are two major reasons for this: first, nationwide data has demonstrated the rapid influenza test is not reliable. It misses anywhere between 40% and 90% of cases.  Second, in the great majority of cases the test result is not going to influence treatment decisions.  Patients are treated based on their symptoms and medical history rather than on the result of a single lab test. 


Q. How are you treating them?

A. From what we are seeing both in the Pediatric Center as well as nationwide, the current strain of influenza does not require any specific treatment other than fluids, rest and fever control with over-the-counter medications. An exception would be children under age 2 with severe disease and children with underlying medical conditions who would likely receive anti-viral medications, such as Tamiflu, to prevent further complications.


Q. What should a parent consider when deciding whether to bring a child to the emergency department with flu symptoms?

A. First, call your pediatrician and together determine, based on the child's symptoms, if the child needs emergency care. If a pediatrician is not available, then I generally recommend that children with any of the following symptoms come to the emergency room:

  • Fever over 102.5º for more than 2-3 days
  • Shortness of breath, rapid breathing, or the appearance of difficulty breathing
  • Persistent vomiting or diarrhea (where no liquids can be held in the stomach)
  • Severe head, facial, ear or neck pain
  • Symptoms that appear to worsen over time rather than improve

Q. Is this advice the same for children who may have the seasonal flu?

A. Yes. However, one difference between the H1N1 strain and the seasonal flu is that H1N1 tends to cause more severe disease in children, adolescents and young adults (in comparison to seasonal flu, which causes severe disease in older adults).


Q. Why are certain age groups more susceptible to the swine flu?

A. The predominant theory is that older adults had prior exposure to the swine flu outbreak in 1976 and that many of them either had the infection or received the vaccine at that time, thus giving them some degree of immunity. Because children and young adults have not had this exposure, they would be more susceptible to contracting the disease.


Q. What are the advantages of bringing a child to an Emergency Department focused on children?

A. The ambience of Suburban Hospital's Pediatric Emergency Department is designed to be more comforting for children. It avoids having kids in the often-raucous and unpredictable environment of an adult emergency room. Pediatricians and specialty pediatric nurses are trained to recognize subtle clues in infants, toddlers, and adolescents that might indicate more severe infections or complications of a disease, and that can lead to a more appropriate evaluation and diagnosis. 


The Suburban Hospital Pediatric Center provides emergency and inpatient care for children up to age 17 in a kid-friendly, family-centered environment. For more information, go to www.suburbanhospital.org/pediatrics.


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