From The Desk Of dr.Dan

2020-2021 Flu Information


It is the time of the year when we all should get our flu shots, especially during this Covid-19 Pandemic.  I recommend it for everyone 6 months and older and especially for those under 2 years of age and patients who have chronic medical problems.  In patients under 9 years of age who have never had an influenza vaccination, they need 2 shots separated by at least 28 days.  Getting a flu vaccine is the first and best way to protect yourself from the flu.  Even if the strains of flu in the vaccine are mismatched to circulating strains, the flu vaccine can decrease severity of symptoms and the risk of hospitalization or death.  Other ways to protect yourself are washing your hands, getting adequate sleep, and eating a healthful diet.


The flu is a respiratory infection that can cause symptoms such as sudden onset fever, chills, aches and pains, deep cough, and sore throat.  10-20% of children may have GI symptoms.  If you become ill, cover your cough (cough into elbow or tissue), wash your hands frequently, stay home, and keep your children home until they are without fever for 24 hours and are well enough to actively participate in school.  Treatment is supportive:  push fluids, encourage rest, and offer small volumes of food frequently.  Acetaminophen and/or ibuprofen may be used for fever and aches or pains.  Refrain from giving aspirin or aspirin-containing products (such as Pepto-Bismol).


Tamiflu and Xofluza (children 12 years and older) are antiviral medicines that may be used to treat the flu.   They can decrease the flu and may decrease the severity of symptoms.  Tamiflu may be expensive and may cause nausea, vomiting, and headache; for these reasons I use it mainly for children less than 5 years and those with chronic conditions (asthma, heart problems, kidney problems, neurological conditions, diabetes, etc.) or if parents request it.  Tamiflu is only effective if started during the first 48 hours of symptoms.  Xofluza is fairly well tolerated, but can cause nausea and headache, and has a shorter time to symptom improvement.


The main complications of the flu are:


  • Secondary bacterial pneumonia:  usually evidenced by new, significantly high fever 5-7 days into the illness with shaking chills, increased cough, fast breathing rate, and labored breathing.


  • Rhabdomyolysis:  muscle breakdown of the legs by the virus causing extreme leg pain and tea or cola-colored urine.


  • Primary viral pneumonia:  difficulty breathing and fast breathing rate (50-70 breaths/minute)


  • Bronchiolitis:  wheezing, difficulty breathing, and fast breathing rate


  • Croup syndrome:  extreme stridor when breathing in and difficulty breathing


  • Dehydration:  if oral intake of fluids is inadequate to meet demand, dehydration may occur.  Symptoms are a dry, tacky inside of mouth, not urinating for 8-10 hours or longer, dark circles under eyes, and lethargy (no interest in drinking)


The bottom line is that if you suspect your child has the flu and they are acting quite ill, then seek consultation at my office, at an urgent care (Close to Home Centers) staffed by pediatricians, or at Nationwide Children’s Hospital Main Campus ED downtown (630 Children’s Dr. Columbus, OH  43205) or Nationwide Children’s Hospital Lewis Center ED (7853 Pace Dr. Delaware, OH  43015).


And if you haven’t gotten your children immunized against the flu, do it now!!!



New Car Seat Requirements for 2014


  • There are new changes from the National Highway Traffic Safety Administration regarding car seat restraint that take effect in 2014.


  • There is a common child seat system call LATCH, which stands for Lower Anchors and Tethers for Children. Instead of threading the seat belt through a bulky car seat, the seat is secured by latches that hook into tethers on the top and bottom of the car’s back seat (Either the LATCH system is used or the seat belt, never both).



  • The NHTSA revision call for parents of children ages three and up not to use the lower anchors if children and their car seat have a combined weight of 65 pounds or more. Effective February, 2014, the new rule will be instituted because the strength of the lower anchors cannot be guaranteed in an automobile accident. The rule only applies to the lower anchor; the top anchor (tether) may still be used or you can secure the seat using the seat belt.


  • Whenever you are in doubt about the proper instillation of your car seat contact an expert in this area. Appointments can be made by calling station 131 (Mifflin Township) at 614-471-0542.

Car Seats & Safety


  • Each year thousands of young children are injured or killed in car crashes. It is extremely important to always have your infant or child ride in a properly installed car safety seat. The type of seat you use depends on your child’s age, size, and the type of vehicle you have.


  • All infants and toddlers should ride in a rear-facing car seat until they are 2 years of age or until they reach the highest weight or height allowed by their car seat’s manufacturer. These children can then ride in a forward-facing car seat with a harness as long as possible. All children whose weight or height is above the forward-facing unit for their car seat (usually at 4-5 years old) should use a booster seat. When children are equal to or greater than 4 feet 9 inches in height (usually at 8-12 years of age) they can use a lap and shoulder seat belt.


  • All children should ride in the back seat until 13 years of age. Two tests can detect possible problems with car seat installation: the inch test and pinch test. A properly installed car seat should not be able to be moved an inch side-to-side or front-to-back at base; and you should not be able to pinch together any excess webbing at child’s shoulder.


In our Gahanna community we have excellent resources to check that car seats are properly installed. Mifflin Township Division of Fire employs a certified child passenger safety technician who can help ensure proper instillation. To schedule an appointment, call 614-471-0542. also is an excellent website for car seat and other safety and health information.


Your Child's Sleep Problems


Sleep problems can be some of the most difficult pediatric problems. Following are some helpful hints in dealing with your child’s sleep problems.


  • Babies should sleep on their backs; as they learn to roll over they will sleep as they desire.


  • Day-night confusion is common in newborns, but dissipates by six weeks of age.


  • Try to have your infant sleep in his/her crib and in their own bedroom by two to three months of age. Allow them to learn how to fall asleep on their own by this time and not rely on a pacifier or rocking to sleep.


  • Toddlers usually convert from two naps per day to one nap per day by fifteen to eighteen months. Most children give up their one nap per day by two to three years.


  • Below is a list of how many hours of sleep per night children need.
  • Newborns sleep 15-18 hours per day
  • 1-4 week old sleep 15-16 hours per day
  • 1-4 month old sleep 14-15 hours per day
  • 4-12 month old sleep 14 hours per day
  • 1-3 year old sleeps 12-14 hours per day
  • 3-6 year old sleeps 10-12 hours per day
  • 7-12 year old sleeps 10-11 hours per day
  • 12-18 year old sleeps 8-9 hours per day


A very good reference book for sleep issues is:


Solve Your Child’s Sleep Problems

by Richard Ferber, M.D.

Cold Weather Injuries


Exposure to cold can produce various injuries as a result of our inability to adapt to cold. People can develop localized injury to a body part (frostnip or frostbite) and generalized cooling of the whole body (hypothermia). Children are at increased risk of cold weather-related injuries.


  • Frostnip is a mild cold weather-related injury that typically affects the face, ears, toes, and fingers. The affected area may be pale and the child may complain of itching, burning, or pain. Numbness or tingling are frequently present. Simple rewarming restores normal color and sensation and there is no permanent tissue damage.


  • Frostbite occurs when there is freezing of body tissue, usually the hands, feet, nose, ears, cheeks, and chin. Frostbite injuries can be superficial (involving the skin and subcutaneous tissues) or deep (involving tendons, muscles, nerves, and even bone). Superficial frostbite injuries have a better prognosis.


  • The signs and symptoms of frostbite vary, depending on the severity of the injury. The first signs often include pain, burning, tingling, numbness, and pale-colored skin. Clear-colored skin blisters may develop. As the injury progresses to deeper tissues the following signs and symptoms may develop: complete loss of sensation and then function; pale, yellowish, bluish, gray or mottled skin color; blood-filled skin blisters; and firm or hard feeling skin and tissue.





  • Move indoors and remove all wet clothing and constrictive clothing and footwear.


  • Avoid massaging or rubbing the area.


  • Frostnip will improve by breathing into hands, placing hands in your armpits, or submerging your hands in warm water.


  • Frostbite injuries require immediate medical attention at a health care facility. Loosely wrap the affected area in a sterile dressing or clean blanket. Cotton or gauze may be placed between fingers and toes. At the hospital rapid rewarming in a tub of warm water that is between 104-108 degrees Fahrenheit is the treatment of choice. If frostbite is present, hypothermia may also be a problem and requires special treatment. Never rewarm and thaw the area if there is a risk that it may refreeze.


  • Remember that the best treatment is prevention. The frequency of frostbite injuries increase at temperatures below 14 degrees F. Risk of frostbite becomes even greater at wind chill temperatures of -13 degrees F; and a wind chill of -49 degrees F will cause skin to freeze very rapidly. So do not allow your children to play outside in very cold weather. Have them wear warm clothing and dress in layers. Undergarments should wick moisture away from the skin. Thick cotton garments should be chosen for the second layer with a tightly woven moisture-resistant outer layer. Bring children in at regular intervals and check fingers and noses for signs of frostnip or frostbite. And make sure your children stay dry; wet clothes increase chance of heat loss.


Winter is a great time for fun, invigorating outdoor activities. Just be aware that the cold can harm your children if you are not careful.



Engaged Fathers


A recent study published in the journal Social Service Review found that teens who received more attention from their fathers had fewer emotional and behavioral problems.  Other studies have demonstrated improved grades and better food choices when fathers are more involved and model healthful eating.  So let us fathers and grandfathers continue to do our best for our progeny!




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