Spring is here! Allergy therapy update

Posted March 4, 2019 by Dr. Roy
Categories: Medical problems

Tags: , ,

The Pediatric Insider

© 2019 Roy Benaroch, MD

Ah, the sounds of spring. Birds tweeting, bees buzzing, and noses sniffling and sneezing. Fortunately, there are some great medicines out there to help reduce the symptoms of spring allergies, and most of them are inexpensive and over-the-counter. Here’s an updated guide to help you pick the medicines that are best to relieve your family’s suffering.

But first: before medications, remember non-medical approaches. People with allergies should shower and wash hair after being outside (though it’s not practical or good to just stay inside all spring!) You can also use nasal saline washes to help reduce pollen exposures.

For my medicine guide this year, I’ve included some photos to make these easier to find. A new trend seems to be color coding, with generics matching the brands in color and “look and feel”. That’s good if it makes the cheaper generics easy to find — they work just as well, and really should be your first choice for any of the options below.

Antihistamines are very effective for sneezing, drippy noses, and itchy noses and eyes. The old standard is Benadryl (diphenhydramine), which works well—but it’s sedating and only lasts six hours. There are better choices. Benadryl products are usually packaged in a pink, hidden sad and lonely in the bottom row.

Pink Benadryl makes people sleepy. There are better options.

It’s better to use a more-modern, less-sedating antihistamine like Zyrtec (cetirizine), Claritin (loratidine), or Allergra (fexofenidine.) All of these are OTC and have cheap generics. They work taken as-needed, or can be taken every day. Antihistamines don’t relieve congested or stuffy noses—for those symptoms, a nasal steroid spray is far superior.

Zyrtec and cetirizine come boxed in springtime green.

 

If Claritin’s for you, it comes in friendly blue.

 

Very few words rhyme with purple. This is Allegra.

There are a just a few differences between the modern OTC antihistamines. All are FDA approved down to age 2, though we sometimes use them in younger children. They all come in syrups, pills, or melty-tabs. Zyrtec is the most sedating of the three (though far less than Benadryl). Zyrtec and Claritin are once a day, while Allegra, for children, has to be taken twice a day. A 2017 study showed that Zyrtec is marginally more effective than Claritin, so I’ve been recommending that one first.

This year, there is one new player among the OTC antihistamines, called “Xyzal.” OK, I admit the name is cool — but it is therapuetically identical to Zyrtec. I don’t think it’s worth its typically-higher price.

Arresting orange says “XYZAL!”

Decongestants work, too, but only for a few days—they will lose their punch quickly if taken regularly. Still, for use here and there on the worst days, they can help. The best of the bunch is old-fashioned pseudoephedrine (often sold as generics or brand-name Sudafed), available OTC but hidden behind the counter. Don’t buy the OTC stuff on the shelf (phenylephrine), which isn’t absorbed well. Ask the pharmacist to give you the good stuff hidden in back.

Nasal Steroid Sprays include many choices, all of which are essentially equivalent in effectiveness: OTC Nasacort, Flonase, Rhinocort, Sensimist, and many generics are available. All of these products are essentially the same. They all work really well, especially for congestion or stuffiness (which antihistamines do not treat.) They can be used as needed, but work even better if used regularly every single day for allergy season.

Lots of steroid nasal sprays. They’re all essentially the same.

Some minor distinctions: Nasacort is approved down to age 2, Flonase to 4, and Rhinocort to 6, though there’s no reason to think any are more or less safe for children. Flonase is scented (kind of an odd, flowery scent, which seems weird in an allergy medicine), and seems to be a little more burny to some people than the others. My personal favorite is Nasacort or its generic version. Here’s a quirk: Nasacort comes in 2 differently-packaged versions, for adults and for children. But the product itself is the same. The pediatric version sells for less, but it’s a smaller bottle. I guess because children are smaller. Weird.

Children’s and regular Nasacort (and generic triamcinolone) are the same product in a different-sized bottle.

Nasal oxymetazolone (brands like Afrin) are best avoided. Sure, they work, but after just a few days your nose will become addicted, and you’ll need more frequent squirts to get through the day. Just say no. Steroid nasal sprays are much safer than OTC Afrin.

Eye allergy medications include the oral antihistamines, above; and the topical nasal spray steroids can help with eye symptoms, too. But if you really want to help allergic eyes, go with an eye drop. The best of the OTCs is Zaditor. There’s a generic version, though some people have told me the generic stings a bit.

Zaditor? Who names these things?

Bottom line: for mild eye or nose symptoms, a simple oral antihistamine is probably the best first line. For more severe symptoms OR symptoms dominated by clogging and stuffiness, use a steroid nasal spray. You can also use both, in combination, an antihistamine PLUS a steroid spray, for really problematic symptoms. Anything not improving on that combo needs to see a doctor.

This is an updated version of previous posts.

 

 

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A user’s guide to the confusing world of milk – updated!

Posted February 28, 2019 by Dr. Roy
Categories: Medical problems

The Pediatric Insider

© 2019 Roy Benaroch, MD

Milk sure has gotten complicated. You’ve got, of course, milk—the white stuff that comes out of cows—in different varieties of fat content, and lactose-free versions, too. And soy milk, and rice milk, and almond milk, and hemp milk. And organic milk. Fortified with omega-3 acids, like DHA and ARA! And don’t forget goat milk, which has natural goaty goodness. How can you decide?

Let me suggest a definition to start with: milk is a beverage that’s high in protein, and has other nutritional stuff in there too. It’s a great food for mammal babies like our own. For about the last 8,000 years humans have domesticated animals to continue to drink milk and eat dairy products well past infancy.

Is milk necessary? For babies, yes—they can’t really eat other things. Rarely does one see a one-month-old thriving on Doritos Locos Tacos. By about 9 months of age, human babies are starting to get a significant chunk of their calories from solids, and by 12-15 months could probably do just fine without any milk at all. Some will just refuse it. Still, milk is an easy and tasty source of protein and calcium, so it’s traditionally a part of a child’s diet for many years.

A clarification: we sometimes refer to infant formula as “milk” — but it is very different stuff, designed to feed babies less than one year of age. Do not feed any ordinary “milk”, including all of the examples below, to babies before their first birthday.

What’s with all of the milk variants, then? Are they better than ordinary cow milk?

 

Mammal milks

Lowfat milk – Ordinary, full-fat milk has about 4% milkfat in the USA. It used to be thought that infants needed that high milkfat, but a 2008 AAP statement corrected that misimpression, and their most recent statement on cardiovascular health reiterated that for families with heart health or obesity concerns (that should be all of us), low fat milk is appropriate starting at age 1. Lowfat milk is usually available in a range from 1-2% milkfat.

Skim milk – Even lower in fat is skim (or “skimmed”) milk, which has 0% milkfat. It has correspondingly more protein and carbohydrate and even a little more calcium per serving than ordinary milk. But if you put it in coffee, it is an abomination.

Organic milk – I don’t think it’s worth the extra cost. The main concern seems to be the use of supplemental cow growth hormone by many conventional dairies to increase milk supply. There’s zero convincing evidence that this is harmful to humans, and zero biologic plausibility that it could cause trouble for our kids. To me, the most legitimate objection to conventional milk is that production may be unhealthy or cruel for the cows.

Raw milk – Ew. Stay away from unpasteurized things loaded with nasty microorganisms, OK?

Lactose-free milk – great for those with lactose intolerance. That means babies and young children almost never need it. Lactose intolerance is essentially non-existent in newborn humans and other mammals, because human milk is loaded with lactose. It develops later in life, typically in teens or young adults.

Goat milk –Expensive! It’s deficient in micronutrients like folate, and has no advantage over cheap and readily available cow’s milk. Still, it’s got that goat cache.

Omega-3 fortified milk – Omega-3s are so-called essential fatty acids that are part of brain and retina tissue. Children probably need some, and we really don’t know how much is ideal or sufficient. Conditions of omega-3 deficiency are difficult to identify, and may not even exist. Still, it’s probably a good idea to eat fish once in a while, or try an omega-3 supplement of some kind. I don’t know why it ought to be added to milk in particular. I wonder if they’ll make a Nestle Quik Fish Flavor?

A2 milk – Has a slightly different casein protein than ordinary cow’s milk (chemically, A2 differs by one amino acid.) The short version of the complex story is that there is no good, independent evidence that this version of milk is more healthful than conventional cow’s milk. The company that sells it claims otherwise.

 

Plant milks

All of these may be suitable for those allergic to cow’s milk protein. All are lactose-free, since plants don’t make lactose.

Rice milk – this isn’t milk. It’s high-carb, and low-protein. Drink it instead of apple juice, if you want. But it isn’t a milk substitute at all.

Coconut milk – I grew up with a coconut palm in my backyard. Coconut milk to me is when you get after you bash the husk off a ripe coconut and then pound a screwdriver through one of the spots on the inner, softball-sized thing. It takes 20 minutes to get about an ounce. The coconut milk you easily can buy as a beverage is high in sugar and low in protein, and really isn’t a milk at all.

Soy milk – Milk made from legumes (pea and soy, usually), often have the highest protein content of the plant-based milks. There may be some cross reactivity between cow’s milk and soy especially, so beware if you’re allergic. Fears about estrogen-like effects of soy are overblown and not worth the worry.

Pea milk – An unfortunate name, but a nutritious product, high in protein. If you want dairy-free and you don’t mind paying a premium price, brands like “Ripple” might be what you’re looking for.

Almond (and other nut) milk – Typically has about half the protein of cow’s milk. And some varieties add a lot of sugar, which makes them more of a delicious dessert than a milk.

Oat milk – Similar to nut milk in protein content (about half of cow’s milk), but the brands I’ve found also have quite a bit of added sugar too.

Hemp milkThis groovy milk has a moderate protein content, similar to nut or oat milk, and is also low in sugar.

Confusing? You bet. I pretty much just drink conventional skim. Though sometimes, a nice Café au Lait hits the spot.

Updated from a previous post

 

Chocolate best for cough? How to spot misleading headlines

Posted February 25, 2019 by Dr. Roy
Categories: In the news, Pediatric Insider information, The Media Blows It Again

The Pediatric Insider

© 2019 Roy Benaroch, MD

I’ve got a new course out – The Skeptic’s Guide to Health, Medicine, and the Media available in video from The Great Courses or audio from Audible. Both have trial offers, free returns, yada yada, check it out! I didn’t cover the chocolate-for-cough story below in the course, but if you find it interesting, or want to learn more about the best way to review health articles with a skeptic’s eye, this course is for you! Why not buy a copy for a friend, too? (Hey, never hurts to ask!)

Everyone loves chocolate, and nobody likes to cough. So when headlines like these appeared, it made a big media splash:

Apparently Chocolate Might Be Better for Treating Coughs than Honey and Lemon – from UK’s Metro

Chocolate Fights Coughs Better Than Codeine, Says Science – from allrecipes.com

Chocolate Is a Better Cough Suppressant than Medicine, Study Says – from The Atlanta Journal Constitution

Never Mind Honey and Lemon, the Best Cure for a Cough is CHOCOLATE: Leading Professor Busts Common Cough Myths… — from The Daily Mail

Looks good, huh? Chocolate for a cough – and the headlines say it’s better than medicine, based on Science! These are legit, big news organizations (well, maybe not allrecipes.com, but I threw that in there to illustrate just how pervasive these stories can get). You’d think they would have dug a little bit to see if their own headlines were true.

But they didn’t. If you want to know what The Science really says, you have to read past the headlines and past the media spin. The best way to do that is to look at the actual study – where the information, originally came from. If you review the articles above, many just point to each other, or quote experts. But with a little digging, I found the actual study that lead to these headlines here.

So what did the study actually show? They didn’t compare chocolate to codeine, or honey, or lemon – so any headline that made that comparison is false. And the study medicine itself wasn’t just chocolate, it was a mixture of three active medicines in a chocolate base. So any conclusion that it was the chocolate itself that made the difference is, well, silly and unjustified.

The study compared the chocolate-mixed medicines (a brand called “Unicough”) to another kind of cough medicine, called “simple linctus,” which contains a single ingredient not found in Unicough. If the authors wanted to look at the potential effect of the chocolate, they should have compared two identical products, one with and one without chocolate. But that’s not what was done.

And: the study itself was negative. That is, for the primary endpoint of the study, there was no difference in cough among people taking the chocolate-containing Unicough versus the “simple linctus.” There were some differences in what are called “secondary outcomes,” but that doesn’t mean the study showed that Unicough was superior. And: the study itself was funded by the manufacturer of Unicough, and one of the authors was a Unicough employee. Somehow that wasn’t mentioned in the fawning media stories.

The chocolate-for-cough study was misrepresented, and its conclusions reported incorrectly. Unfortunately, this is common in media portrayals of health news. There were some skeptical outlets that tried to present the other side of this story, but as so often happens the voice of reason was too little, too late. The story had already developed a life of its own. If you think chocolate might help your cough, go ahead and try it – but don’t be fooled by headlines like these.

Eager to learn more about interpreting media stories? Check out my new course! I cover many more examples of both good and bad reporting, and will teach you how to tell the difference. They’ve got it at Amazon too! What are you waiting for?! Go buy buy buy now!

Can a genetic test tell you if a medication will work?

Posted January 14, 2019 by Dr. Roy
Categories: Medical problems

Tags:

The Pediatric Insider

© 2019 Roy Benaroch, MD

“Personalized” medicine sounds appealing. Rather than just guessing at what medication to try, a genetic test can figure out, in advance, which medications will be effective and which medications are more likely to make you sicker.

Except it doesn’t work. It’s mostly marketing and hype.

The FDA has officially warned consumers and physicians that genetic tests sold to predict patient responses to medications shouldn’t be used. They’re not FDA approved, and in most cases there’s no reason to think that these tests can accurately predict how a medication is metabolized or what it’s likely to do when you take it. These tests are being aggressively marketed to the general public and to physicians, and they don’t deliver what they promise.

Medicines for conditions like depression, acid reflux, and heart disease have been highlighted by the FDA – though many other medicines have become targets for these tests, too. And these tests do reveal certain genetic “polymorphisms” (variations) that all of us carry, variations that affect the way medicines are metabolized and processed in our bodies.

The problem is that our knowledge about these polymorphisms is rapidly evolving, and it’s far from complete. It turns out that dozens or maybe hundreds of genes can have overlapping functions, and (with few exceptions) we don’t yet know all of the genes involved. And for each gene, there may be hundreds or thousands of variations in the general public. Or, maybe, some of us have a unique variant that hasn’t been seen before. These companies have no way to test the gene variants to know their function. They rely on proprietary databases, riddled with incomplete data and assumptions.

Just one example: when the MTHFR gene and its variants was first described, it seemed like MTHFR polymorphisms could have wide-ranging and significant health effects. It turned out that’s completely wrong. MTHFR “variations” are so common in the general public that it’s fair to say we all have polymorphisms, and almost none of these has any clinical importance. Even the 23andMe company, which makes money selling genetic tests, discourages MTHFR testing, saying “Despite lots of research – and lots of buzz – the existing scientific data doesn’t support the vast majority of claims that common MTHFR variants impact human health.” Still, many families are still relying on misguided MTHFR testing pushed by naturopaths and chiropractors to make health decisions. And this is just one of the hundreds of genes these kinds of tests rely on.

Genetics shows great promise, and I think the future includes a big role for genetic testing. But we don’t have the knowledge, yet, to use the results of these tests to better-guide therapy. But that doesn’t mean that therapeutic decisions, now, are entirely guesswork. Reviewing a family history and the exact nature of a problem often gives physicians some good clues to help guide decisions. I know, that sounds old-fashioned. But talking and listening remain the best ways for docs and patients to work together to make the best decisions.

 

Breastfeeding increases the risk of newborn readmission. Now what do we do?

Posted January 9, 2019 by Dr. Roy
Categories: Nutrition, Pediatric Insider information

Tags: , ,

The Pediatric Insider

© 2019 Roy Benaroch, MD

An August 2018 paper in Academic Pediatrics found an unsettling conclusion: breast-fed newborns have about double the risk of needing to be hospitalized in their first month of life, compared to babies who were formula-fed. The numbers are solid, and they jibe with the real-life experience of many pediatricians, including me. So what should we do about it?

The study itself looked at about 150,000 healthy, normal newborns born in Northern California hospitals from 2009 to 2013. The study authors were able to collect data on how these babies were fed in the few days following birth from hospital records (dividing them into groups of all-breast, all-formula, and a mixed group that did some of both.) They were then able to track these babies over the first month of their lives to see which ones ended up hospitalized for any reason. Most of the hospitalizations were related to dehydration and jaundice, which are closely linked to inadequate feeding.

The good news is that relatively few of these babies ended up back in the hospital – whether bottle-fed, breast-fed, or both, most babies did great. But babies who were breast-fed were much more likely than formula-feeders to end up underfed and hospitalized. Among vaginal deliveries, the risk of rehospitalization was 2.1% for bottle-fed babies versus 4.3% for breast-fed babies (the risk for mixed feeders was in between.) That’s about double the risk. Mathematically, the “number needed to harm” was 45. That is, for every 45 babies exclusively breast fed, one extra baby would end up in the hospital. Not good.

Among Caesarian births, the differential was less, with an increased risk of hospitalization of 2.1% (breast) versus 1.5% (formula). Both of these numbers are lower than the risk of rehospitalization for vaginal deliveries, probably because c-section babies already spend an extra day or two in the hospital. This provides more time for good feeding to be established (whether breast, bottle, or both.)

Does this mean we should discourage breast feeding? Of course not. Most breast-fed babies do great, and there are some health advantages of breastfeeding. But we need to be honest with ourselves, and honest with moms who are trying to do the best thing for their babies. Nursing isn’t perfect. It’s not a perfect food*, and it’s not a perfect method. There are pros and cons to both nursing and formula feeding, and parents (and babies) deserve an honest appraisal.

Nursing moms also need support. That includes “technical support” (ie “How to do it”) but also emotional and medical support – which should include time for rest, and an honest evaluation of how both moms and babies are doing. There is a role for formula, both for moms who choose to use it and for situations where babies aren’t getting enough to eat. Families, pediatricians, nurses, and lactation specialists all need to work together, without guilt or finger-pointing, to help keep babies and moms healthy.

*Human breast milk is an inadequate source of vitamin D from birth, and an inadequate source of iron by 4-6 months of life.

The safest peanut allergy policy for schools is …

Posted January 3, 2019 by Dr. Roy
Categories: Medical problems

The Pediatric Insider

© 2019 Roy Benaroch, MD

Peanut allergies can be a serious problem, and many exposures happen when our kids are at school. On average, there are probably about 5 peanut-allergic children in each of our nation’s 100,000 school buildings. What’s the best policy for schools to use to help protect these kids from potentially fatal reactions?

Different schools have taken different approaches, and as far as I can tell there is no authoritative national guideline to tell them what to do. So they’re “winging it.” Choices include:

  1. Having a 100% peanut-free school – no peanuts served, no peanuts allowed to be brought in.
  2. Not allowing peanuts to be served, but allowing kids to bring their own peanut-containing foods if they wish.
  3. Setting aside peanut-free classrooms.
  4. Setting aside peanut-free lunch tables.
  5. Having no specific policy, and hoping for the best.

Some schools have combined or blended these policies, and (hopefully) most also include an educational component for both teachers and students not to share foods. But the question remains: which of these really works to help prevent serious allergic reactions?

An August, 2017 study in the Journal of Allergy and Clinical Immunology provides some clues. The study was done in Massachusetts, where school nurses are required to report any administration of epinephrine. Since epinephrine should always be used for serious allergic reactions, those reports are a good way to track what’s going on. The circumstances of every epinephrine administration were reviewed, and only those given for nut or peanut reactions were included in the analysis. The authors also surveyed all of the Massachusetts’ school nurses to compile feedback on each school’s peanut policies, to see which policies were most successful in reducing the need for epinephrine.

The results might surprise you. Self-designated “peanut-free” schools had higher rates of administration of epinephrine than schools without a peanut-free policy. Now, the numbers of reactions were small, here, and different schools defined or enforced their policy of “peanut-free” in different ways. Still, a “peanut-free” designation was no panacea. It did not make epinephrine unnecessary, and was associated with an increased rate of peanut reactions. The authors speculate that this may be because the “peanut-free” school label may lead to a false sense of security.

The only policy that was associated with a decreased rate of epinephrine use was setting aside peanut-free tables in eating areas. Perhaps that’s because this kind of policy is easier to enforce.

Peanut-restrictive policies are an important part of protecting allergic kids, but they may have some downsides. Peanut-allergic children may be socially excluded or suffer bullying. And non-allergic kids may rely on peanut products as a healthy and inexpensive part of their diet. Whatever policies are pursued, they should be guided by the best evidence – what really works, and what best promotes the overall health of all of a school’s students?

Blanket policies may be less effective than a combination of several elements. Schools at every grade need to teach their students and faculty about food allergies and how to avoid exposures. And every food-allergic child needs an individualized plan that considers their risk of a life-threatening reaction along with their own ability to monitor their food intake. Epinephrine should be readily available in classrooms and eating areas (without requiring each individual child to have their own personal devices – that’s wasteful and expensive and awkward.) I know, that’s complicated and takes work. Schools prefer an easy-to-spell, one-sized-fits-all approach. Kids deserve better.

Acute Flaccid Myelitis – what parents need to know now

Posted November 16, 2018 by Dr. Roy
Categories: Medical problems

The Pediatric Insider

© 2018 Roy Benaroch, MD

You’ve probably seen it on the news – a rare, polio-like illness is causing cases of paralysis in children. Here’s the latest info, based on our best current knowledge from the CDC.

AFM is a sudden illness that causes weakness in one or more extremities – one arm or (less likely) a leg, or any combination of arms and legs. The words in the name express the key features: it’s acute, beginning over hours or sometimes a few days; it’s flaccid, meaning the affected body parts are floppy and weak; and it’s a myelitis, meaning the disease occurs in the spinal cord. The muscles are fine, the brain is fine, but the area of the spinal cord that carries signals to the muscles becomes inflamed and stops working. You can see distinctive changes on an MRI scan of the spine to help confirm the diagnosis.

The first cases of what was later named AFM were reported in California in 2012. The CDC started closely tracking cases of AFM in 2014, when a surge of reports about the illness began to appear in the United States and overseas. Since then, we’ve seen a striking pattern, with most cases occurring in the late summer and early fall, August through October. In the US, we’ve also seen an unexplained pattern where most cases occur in spurts every other year – in 2014, 2016, and now again in 2018. 2015 and 2017 had far fewer cases.

Over 400 cases of AFM have been reported in the US over the last four years, including about 80 in 2018 so far. Most states have reported at least one case, including Georgia. There doesn’t seem to be geographic focus in any area. Overall, the rate is less than one in a million people – AFM is a very rare disease. Almost all cases of AFM have occurred in children, at an average age of 4-6 years.

Several different viral infections have been found in children with AFM, though it’s unclear that these viruses were the cause of the symptoms. The most-commonly associated viruses are from a family called “enteroviruses”, including one that has been implicated in groups of acute severe respiratory disease called enterovirus D68. Other viruses have been investigated including West Nile or Japanese Encephalitis viruses, herpes viruses, and adenoviruses. Most commonly, no specific viral infection is found. The cause of most cases of AFM is unknown.

Still, it seems most likely that a viral infection is the trigger, because of the seasonality of the disease and its propensity to strike children rather than adults. Similar symptoms were once seen with the polio virus, and multiple tests for polio have been performed in  children reported with AFM. But it’s never been found — polio itself is not the cause AFM in the United States or abroad. The CDC is continuing to investigate the possibility of one or more viral triggers, an inflammatory condition triggered after a viral infection, or a possible environmental trigger as causes of AFM.

Children with AFM typically have a preceding illness with fever, runny nose, cough, vomiting, or diarrhea 1-2 weeks prior to the beginning of AFM symptoms. Often these common viral symptoms have resolved by the time AFM begins, with its rapid onset of limb weakness. There may be near-complete paralysis (inability to move the limb), or varying degrees of weakness. Sometimes, symptoms including stuff neck, headache, or pain in the limbs accompanies the weakness. It’s also sometimes possible for AFM to affect the nerves in the upper neck and head, causing a face or eyelid droop, difficulty swallowing or speaking, or a hoarse or weak voice.

Children with AFM need to be hospitalized. Many tests need to be done to narrow down the diagnosis and rule out other causes of weakness (including blood tests, a lumbar puncture, and MRI scans.) Children with AFM can develop weakness of the muscles that help them breathe, and may need to be treated in an ICU. Neurologists, infectious disease specialists, and public health officials will all help guide care.

There isn’t solid evidence that any specific treatment is effective, since good clinical trials of therapy haven’t been performed yet. It’s been difficult to study AFM because it’s so rare, and the disease progresses quickly. In addition to supportive care, many people with AFM have been treated with intravenous immunoglobulin, steroids, and plasmapheresis. Though some children with AFM have recovered quickly, many continue to have lasting paralysis requiring long term care.

So what should parents do about this? First, there’s no need to panic. The press and Facebook like to stir up trouble with blaring headlines and clickbait titles – but remember that AFM is really rare, with about 100 or so cases a year occurring across the entire country. Polio caused about 15,000 cases of paralysis a year in the 1950’s before a vaccine was introduced. We’ve come a long way, and your children are, overall, far safer than children have ever been from infections, environmental illnesses, and trauma.

Some common-sense steps can probably help. Most cases of AFM seem to have a viral trigger, so avoiding infections is a good idea. Teach your children to practice good handwashing, and keep them out of group care when they’re ill. Though we don’t have a vaccine to prevent AFM, vaccines can prevent the neurologic complications of other infections like influenza, measles, and mumps – so be sure to keep your child fully vaccinated. And seek care immediately if your child becomes weak in one or more limbs.

And, please, support your public health community and the scientists who work to keep your children safe. There’s always another new health challenge out there (Ebola, Zika,  SARS, and MERS, to name a few.) We need to keep our public health infrastructure strong to help tackle AFM and whatever the next challenge turns out to be. Go science!

More info from the CDC’s AFM home page, the October 2018 CDC press briefing, and the November 2018 webinar for clinicians