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GlaxoSmithKline (GSK) is discontinuing production of Flovent HFA (fluticasone propionate) and Flovent Diskus. Flovent HFA and Flovent Diskus are inhaled corticosteroid medicines used as a controller medicine to treat asthma (and sometimes off-label for a gastrointestinal illness called Eosinophilic Esophagitis or EoE.)

GSK notified the FDA of this decision on June 2, 2023. The last date the product will be available for ordering is Dec. 31, 2023. GSK believes a supply of these products will be gone by early 2024.

If you use Flovent HFA or Flovent Diskus, here are some steps you can take:

• Refill your current Flovent prescription as soon as possible.
• Your child will need to switch to another medication in 2024. Some brand name options may include ArmonAir Digihaler and Arnuity Ellipta. These are dry powder inhalers approved for ages 5 and older, but cannot be used with a mask/spacer. Qvar is a breath-activated device with similar issues, but can be adapted to use with a spacer/mask with some manipulation of the device (not ideal.)
• A generic fluticasone metered dose inhaler is available. However, some insurers are not covering the generic and others don’t consider it a preferred treatment, which can lead to higher copays and the need for prior authorizations that delay access.
• Asthmanex HFA is a similar, but not identical, inhaled corticosteroid (mometasone) that may also be substituted, but needs to be covered by insurance.

Bottom line, CONTACT YOUR INSURANCE NOW to find out what they will cover in place of Flovent in 2024.

Read more here.

Our office will be closed Thursday, November 23rd in honor of the Thanksgiving Holiday. One of our physicians will be on call for emergency sick issues. To reach our on call MD, call our office and follow the prompts.

We will reopen Friday morning for sick acute visits only until noon, We will also be in the office Saturday and Sunday morning for sick acute visits only.

To request an appointment, please log into your patient portal accountand fill out a SICK VISIT APPOINTMENT REQUEST, or call our office prior to 10 am to book a visit.

Cold and cough season has clearly arrived! Unfortunately kids get a lot of colds, on average 8 a year. Colds can cause sore throats, congestion, sneezing, coughs and fever (usually 5 days or less.)  Since each cold can last 7-10 days, and most colds are during October thru April, it may seem as if your child is sick the entire winter.  This isn’t forever, as their immune systems develop memory of these germs and can fight them off more easily as they age. But the early years can be a beast!

A cough is an important defense mechanism that meant to clear the airways. Acute coughs are most often caused by an upper respiratory tract virus.

Dry coughs are usually viral, caused by inflammation of the lower airway, sometimes causing hoarseness or, in younger children, stridor (a high pitched sound on breathing in.) This is called croup, and can be caused by many different cold viruses.

The best treatment for croup is breathing in either cold outdoor air, warm, steamy mist (or a mix!)  A dose of ibuprofen also helps inflamed airways, and fever that may also be present. Croup is almost always worse at night and better in the am, and may last a day or two before it comes a typical snotty cold. If your child is struggling to breathe or has persistent stridor please call us.

Dry coughs are often followed by wet/loose coughs as the respiratory tract secretes mucous to fight invaders (cold germs, pollens, other airway irritants.)

Mucous, whether from the lower respiratory tract or the nose/sinuses is usually clear in the beginning of an illness then changes color (white/yellow/green) as white cells rush in to help fight illness.

We do not worry about colored mucous unless your child has:

• Been sick for 10-14 days with worsening symptoms
• Ear or chest pain
• Difficulty breathing/wheezing
• Conjunctivitis (reddening of the eyes along with a persistent, thick colored discharge).  Red eyes with a watery discharge early in illness are typically caused by a virus, and not treated with antibiotic drops.

Treatment of cough and congestion:
Remember that coughing isn’t all bad.  It helps clear mucus from your airway.  

Teach children to cough into their elbows.  Coughing with the mouth closed also helps avoid the walls of the lower throat from rubbing together and causing more irritation.

• Water/fluids– water, juice, warm chicken soup or tea helps loosen congestion and prevent dehydration.  Avoid caffeine, excess sugary beverages.

• Saline nasal drops/sprays– OTC saline nasal sprays help relieve thick congestion and stuffiness.    For infants, lay baby on its back and give a good squirt of saline up each nostril- it is safe for them to swallow or inhale the liquid.  You can gently suction out excess mucous with a snot-sucker (avoid frequent suctioning as it can irritate the nose.) Saline sprays can also be used in older children as often as necessary.  

• OTC Astepro is a topical decongestant spray that can be safely used twice a day in older kids with heavy congestion or stuffiness- if too drying, add nasal saline and some Vaseline to the lower third of the nostrils to avoid irritation/bleeding.

• DO NOT USE over the counter nasal decongestants such as afrin or neo-synephrine more than 2-3 days, as they can cause rebound congestion when stopped. 
• Honey- safe to use for coughs and sore throats in children older than one.  2 teaspoons (10 milliliters) of honey has been found to be as effective as OTC cough medicine in a study of children with URIs. Best given straight up, honey coats and soothes an irritated oropharynx. Thinner agave syrups like Zarbees are not effective and should not be given to infants.

• Pectin cough pops– safe to use in children at least 3 years of age who don’t choke easily.  Pectin coats the throat, and helps soreness and cough.

• Humidification– cold viruses thrive in dry conditions, and dry air also dries mucous membranes causing a stuffy nose and sore throat. Cool mist humidifiers help add moisture to the air- place it close to your child’s bed so they are effectively breathing in the mist. Be sure to clean it weekly (or more often) following the manufacturer’s instructions.

• Sitting in a steamy bathroom for a several times a day is a great way to loosen secretions and soothe irritated throats (run hot water until the mirrors are foggy then play in the room, not the hot shower, for 10-15 mins.) Avoid warm mist humidifiers as they can cause steam burns if  touched.

• The Boogie Micro-Mist Saline Inhaler (https://www.boogiewipes.com/product/boogie-micro-mist-saline-inhaler/) can be used in all ages to humidify both the upper and lower respiratory tract. If you have a nebulizer, saline nebs can also help humidify airways (do not use if a child is wheezing, unless directed by the pediatrician.)

• Ibuprofen/Acetaminophen- fine to use for aches, pain, fever as needed (for children 2+ month unless otherwise directed). Dosages by weight are on our website.

• Benadryl– a first-generation (sedating) antihistamine that may provide minor relief of congestion, sneezing and watery eyes, can be used in children 2+ months unless otherwise directed. Newer antihistamines like zyrtec and allegra are good for allergy, but not for colds.  Can use with acetaminophen or ibuprofen. Dosing by weight  for all three are available on our website.

• Delsym/Robitussin DM–  a long acting cough medication (dextromethorphan) that can be used for irritative coughs not relieved by non medicated measures in children over age 4.  This only suppresses the cough reflex, and does not decongest.  Can use with Benadryl, acetaminophen and/or ibuprofen.Delsym dosing:
  · Children 12 and older- 10 ml (2 teaspoons) every 12 hours
  · Children 6- 11 years- 5 ml (1 teaspoon) every 12 hours
  · Children 4-6 years- 2.5 ml (1/2 teaspoon) every 12 hours

• Expectorants (guanfacine)- meant to thin mucous, but not particularly effective.What NOT to use for coughs and colds:

• Avoid raising the head of a crib unless directed- babies move, and may end up in a dangerous position.

• Antibiotics– these attack bacteria, but do not work against viruses.  We will not prescribe antibiotics without evaluating your child, and only use them for treatment of likely bacterial ear infections, bacterial sinusitis and bacterial pneumonia.  Overuse of antibiotics can lead to antibiotic-resistant bacteria.

• Over the counter mixed ingredient cold and cough medications in children younger than 4- the FDA has recommended against the use of such medications due to serious and significant side effects and lack of efficacy in young children. 

• Homeopathic remedies– have no evidence or safety data for any cold symptoms.

• Zinc– most high quality studies show no benefit to the use of zinc, and the mineral can cause significant side effects such as bad taste, nausea, and even permanent loss of the sense of smell in zinc-containing nasal cold remedies

Winter is a tricky time for car seats. As a general rule, bulky clothing, including winter coats and snowsuits, should not be worn underneath the harness of a car seat.

In a car crash, fluffy padding in a coat immediately flattens out from the force, leaving extra space under the harness. A child can then slip through the straps and be thrown from the seat.

Here are some tips to help strike that perfect balance between keeping little ones warm as well as safely buckled in their car seats.

How to keep your child warm & safe in the car seat

Note: The tips below are appropriate for all ages. In fact, wearing a puffy coat yourself with the seat belt is not a best practice because it adds space between your body and the seat belt.

1. Store the carrier portion of infant seats inside the house when not in use. Keeping the seat at room temperature will reduce the loss of the child’s body heat in the car.

2. Get an early start. If you’re planning to head out the door with your baby in tow on winter mornings, you need an early start. You have a lot to assemble, and your baby may not be the most cooperative. Plus, driving in wintry conditions will require you to slow down and be extra cautious.

3. Dress your child in thin layers. Start with close-fitting layers on the bottom, like tights, leggings or long-sleeved bodysuits. Then add pants and a warmer top, like a sweater or thermal-knit shirt. Your child can wear a thin fleece jacket over the top. In very cold weather, long underwear is also a warm and safe layering option.

4. As a general rule of thumb, infants should wear one more layer than adults. If you have a coat on, your infant will probably need a coat, and blanket. Just remember to remove the coat and blanket inside the car before putting your child in the car seat.

5. Don’t forget hats, mittens and socks or booties. These help keep kids warm without interfering with car seat straps. If your child is a thumb sucker, consider half-gloves with open fingers or keep an extra pair or two of mittens handy—once they get wet they’ll make your child colder rather than warmer.

6. Tighten the straps of the car seat harness. Even if your child looks snuggly bundled up in the car seat, multiple layers may make it difficult to tighten the harness enough. If you can pinch the straps of the car seat harness, then it needs to be tightened to fit snugly against your child’s chest.

7. Use a coat or blanket over the straps. You can add a blanket over the top of the harness straps or put your child’s winter coat on backwards (over the buckled harness straps) after he or she is buckled up. Some parents prefer products such as poncho-style coats or jackets that zip down the sides so the back can flip forward over the harness. Keep in mind that the top layer should be removable so your baby doesn’t get too hot after the car warms up.

8. Use a car seat cover ONLY if it does not have a layer under the baby. Nothing bulky should ever go underneath your child’s body or between her body and the harness straps. Be sure to leave your baby’s face uncovered to avoid trapped air and suffocation. Many retailers carry car seat bundling products that are not safe to use in a car seat. Just because it’s on the shelf at the store or sold online does not mean it is safe!

9. Remember, if the item did not come with the car seat, it has not been crash tested and may interfere with the protection provided in a crash. Never use sleeping bag inserts or other stroller accessories in the car seat.

10. Pack an emergency bag for your car. Keep extra blankets, dry clothing, hats and gloves, and non-perishable snacks in your car in case of an on-road emergency or your child gets wet on a winter outing.

There are two new immunizations available for children this season, in addition to the traditional flu vaccine.  Saugatuck Pediatrics will be ready to administer all three on opening (Flu, COVID19 and RSV-Beyfortus.)  Here is more information to help you make an informed decision for your child(ren) about these recommended immunizations.

1.   COVID 19 vaccine
This year the COVID19 vaccine is a monovalent (single strain) vaccine targeting the current circulating variant XBB (an omicron variant.)

• All children aged 6 months and older are eligible for the vaccine.
• We will offer the Moderna version for children ages 6 mo to 18 years.
• If you started the COVID19 initial series at Village (or elsewhere), we can complete the series at Saugatuck IF THE VACCINE WAS MODERNA for ages 5 and under.
• For BOOSTER doses (after the primary series ages 5 and under, or anyone ages 6+) we can administer the Moderna brand (the CDC now allows mixing of vaccine type after the primary series is complete.)
• The incidence of myocarditis (heart inflammation), rarely seen in teens and young adults after the initial COVID19 vaccines, was significantly less (2 cases out of 650,000 vaccines) after the bivalent booster, likely due to the increased spacing between vaccines.  This number is actually the same as the background risk of myocarditis (i.e. the risk of the condition without getting the vaccine.) The risk of myocarditis is much more common with natural COVID infections.
• If your child has recently had COVID you can wait up to 3 months to get the booster, but there is still a risk of waning immunity, and it is safe to get vaccinated as soon as COVID symptoms are gone and your child is no longer contagious (10 days from initial symptoms, with the first day of symptoms considered “day 0”.)

2.   RSV (Nirsevimab or Beyfortus)
This is not a vaccine, but is still considered an “immunization.” It is an injection of long lasting antibodies against RSV that should provide protection throughout the RSV season (October thru end of March in Connecticut.) RSV, or Respiratory Syncytial Virus, is a cold virus that most of us get yearly, but infants are much more likely to suffer from severe symptoms, including wheezing, ear infections, and hospitalization (studies showed a 75% decrease in need to see an MD/hospitaization for RSV with this immunization, with antibodies lasting at least 150 days or more!) This immunization is approved for two groups:

• All infants aged newborn to 7 months born during or entering their first RSV season.
• Infants or children aged 8-19 months who are at increased risk for severe RSV disease and entering their second RSV season. This includes children with chronic lung disease, are severely immunocompromised or have cystic fibrosis with lung disease.
• This shot can be administered at the same time as other childhood vaccines, including COVID19.
• Maternal RSV vaccine was approved by the FDA on August 21, 2023. The CDC does not recommend nirsevimab for most infants born to a mother who received maternal RSV vaccine, except for infants where less than 14 days have elapsed between vaccination and birth.

AAP FAQs are available here.

Here is a great chart from “Your Local Epidemiologist” summarizing this season’s immunization offerings: