Ask the Expert

An interview 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 100.0 degrees, but many of the kids can have fevers in the 102-104 degree range.   The majority of patients also have a sore throat and cough.   Mild to moderate symptoms of an upper respiratory infection (runny nose, nasal congestion) are also quite common.   Abdominal discomfort and vomiting can occasionally accompany the infection. 

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 have stopped routinely testing patients for influenza.  There are two major reasons for this: first, over the past few months, nationwide data has demonstrated the rapid influenza test does a poor job of detecting the H1N1 influenza virus.   It misses anywhere between 40% and 90% of cases.   Given that the test’s sensitivity is so unreliable, it does not make sense to use it to routinely test for the virus.   Second, in the great majority of cases the test result is not going to influence treatment decisions.   Patients need to receive appropriate treatments based on their clinical picture rather than being based on 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.   However, there are certain patients who would merit an exception to this: children under age 2, children with severe disease and children with underlying medical conditions should still receive anti-viral treatments (eg. Tamiflu) to prevent complications from the influenza infection.

Q.  Have these young patients needed to be hospitalized?
A. To date, very few pediatric patients have been hospitalized in our Pediatric Center.   These few admitted patients had severe disease and/or complications of influenza such as pneumonia.

Q.  What should a parent consider when deciding whether to bring a child to the emergency department with flu symptoms?
A. The first thing that a parent should do is to call their pediatrician so that they can jointly assess whether the child needs an emergent evaluation or can be managed at home.   With children who are under the age of two, or children that have any underlying medical conditions (such as asthma or arthritis), I would probably have a lower threshold to get them evaluated by the pediatrician or in the emergency room.  In addition, if a pediatrician is not available, then I would generally recommend that children with any of the following symptoms come to the emergency room:
   ·          Fever over 102.5 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. Pretty much, yes.   However, one difference between the H1N1 strain and the seasonal flu is that the H1N1 flu 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. There are a few different theories that attempt to explain this.   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. While adult physicians are extremely capable in the diagnosis and treatment of influenza, pediatricians and specialty pediatric nurses are trained to recognize subtle clues that might indicate more severe infections or complications of the disease.  In addition, pediatric doctors and nurses are probably more comfortable evaluating nuanced clinical findings in infants, toddlers and adolescents, which can lead to a more appropriate evaluation and diagnosis in these patients.


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.

For updates on seasonal and H1N1 flu this winter, consult the following web sites:
   www.cdc.gov
   www.flu.gov
   www.hopkinsmedicine.org/flu
   www.montgomerycountymd.gov/h1n1flu