At the Calm Mom.com, our goal is to help readers calm their anxiety about the day-to-day realities of being a new mom. This fall, however, we face a new twist on the day-to-day worries – the H1N1 flu (often referred to as “swine flu”). It’s hard to ignore – it’s all over the media and people are talking about it everywhere we go. The problem is that information is wildly inconsistent and it is these inconsistencies that can so easily stir up anxiety.

This month, at the Calm Mom.com, we have two voices to help calm your fears about this timely issue. First, I will share some thoughts from a psychologist’s perspective on how to calm all those worries swirling around your head. Then, we are so lucky to have a pediatrician and fellow new mom respond to your concerns from a medical perspective. Read on, and please forward this article to friends who would find it helpful.

A Psychologist’s Perspective:

When we first started to hear about H1N1 back in the Spring, I’ll admit, I was anxious. No one likes to think about their little ones getting terribly ill. Yet, I quickly started to work my way out of my anxiety in much the same way I would with any patient who has health-related anxiety. My two-step Calm Thinking Strategy has worked for me, and for many of the moms with whom I work:

Step One: Acceptance – Many of us, and many of our children are going to get the H1N1 flu.

Step Two: De-catastrophize – But, for the overwhelming majority of us, it is going to be okay!

Sounds simple, huh? But, it works. Anxiety gets the better of us when we try too hard to prevent bad things from happening. Yes, there are reasonable steps we can take to reduce our risk (see below), but there is no way to prevent illness altogether. When we spend our days going to vast effort to prevent illness (i.e., constantly washing our hands, obsessively checking in with people about their health before getting together with them, avoiding most activities previously enjoyed by ourselves or our kids), our anxiety paradoxically gets worse. Similarly, if we try to push thoughts of flu out of our heads (“Don’t think about it! It’s too stressful”), we end up thinking about it with greater frequency and intensity. Instead, when we accept a fear (“Hmmm….we might get the flu”), and more or less go about our lives normally, our fear actually tends to lessen. It really does. Try it, and you’ll see.

You then need to go one step further. Once you accept that you and your family might get the flu, you need to focus on the facts and ignore the fiction. Although the flu sounds awful, and although you will hear (primarily in the media) about truly dreadful things happening to people who have it, the truth is that for the vast majority of people, it isn’t that bad. People feel ill for a few days and then they are back on their feet.

So, once you accept that you might get the flu, remind yourself that you will be able to manage and that you will be okay.

At the Calm Mom.com, our goal is to help readers calm their anxiety about the day-to-day realities of being a new mom. This fall, however, we face a new twist on the day-to-day worries – the H1N1 flu (often referred to as “swine flu”). It’s hard to ignore – it’s all over the media and people are talking about it everywhere we go. The problem is that information is wildly inconsistent and it is these inconsistencies that can so easily stir up anxiety.

We are so lucky this month to be able to address these inconsistencies with the help of Robyn Cohen, MD, MPH (and mother of two little ones!). Dr. Cohen is an Assistant Professor of Pediatrics at Drexel University College of Medicine and an Attending Physician, Section of Pulmonology at St. Christopher’s Hospital for Children in Philadelphia, PA.

Dr. Cohen so kindly answered some common medical questions about H1N1:

1. What can moms of toddlers and preschoolers reasonably do to help their kids stay well this fall and winter?

   One of the most important things moms can do is to get both the seasonal and H1N1 flu vaccines for their children. In fact, the CDC has determined that children between 6 months and 4 years of age are a top priority for the H1N1 vaccine. There are lots of rumors floating around about the H1N1 vaccine being “new” and “untested.” The facts are that the H1N1 vaccine is made and produced the same way as the seasonal flu vaccine; the only difference between the two is that the H1N1 vaccine targets the current H1N1 strain.

   A second important thing to remember is the importance of frequent hand washing. If your child is in daycare, preschool, music class, or any other setting in which they are in close, indoor contact with lots of other young children, try to remember to wash your child’s hands (with either soap and water or hand sanitizer) before and after they participate in these activities.

2. How about moms of new babies (under 6 months)? Should new moms and babies be staying home this fall/winter? We have been hearing about doctors advising new moms to stay away from baby music classes, mommy and me groups, etc. Yet, it would seem that if you steer clear of these activities, you should also avoid the grocery store, the mall, and visits with relatives. How do moms balance safety (i.e., flu prevention) with their own mental health (i.e., getting out of the house to be with other people)?

   This is a tough question because the immune systems of very young infants (less than 8 weeks of age) are less protective than those of older infants and toddlers. I would probably avoid the scenarios you describe for infants in this young (<8 weeks) age group, and then to use your judgment as your infants get older. If you are contemplating an activity in which close contact is highly likely (i.e. a sick infant or child will have the opportunity to cough on your infant – not just cough across the room), that might not be the best idea. But getting out of the house and visiting with friends and family are important! Going to the mall, restaurants, and the grocery store are generally safe activities because unfamiliar people aren’t likely to get close enough to cough on your child. And before visiting with friends and family, a quick call to make sure everyone is healthy may be just what you need to put your mind at ease.

3. Another anecdote we heard recently concerned breastfeeding: A mom of a 6-month old baby was planning on discontinuing breastfeeding. Her pediatrician admonished her, stating that by stopping, she would be decreasing her child’s immunity and increasing his risk of contracting the flu. Myth or fact?

   There is strong evidence that breastfeeding is associated with a reduced risk of respiratory infections as well as many other health benefits, however the most important thing to remember is that a happy mom is going to have a happier baby. If you feel that it’s time to stop breastfeeding for whatever reason, make sure that you are really ready to stop and congratulate yourself for having made it as long as you did.

   The CDC website addresses the question about breastfeeding and protection against H1N1 specifically:

   “Since this is a new virus, we don’t know yet about specific protection against it. Mothers pass on protective antibodies to their baby during breastfeeding… Antibodies help fight off infection.” (http://www.cdc.gov/h1n1flu/infantfeeding.htm) However, a decision to stop or continue breastfeeding is a very personal one, and moms should be proud of any length of time they were able to breastfeed their babies.

4. We have been hearing a lot about flu patients flooding ERs and pediatrician’s offices. If we suspect our babies or kids have the flu, what are the signs that we should take them to be seen by a doctor rather than just nursing them along at home? And, if they are well enough to be nursed along at home, what can we do to make them feel better?

   The advice for when to seek medical treatment are the same for this year’s flu virus as they are for any other illnesses. You should see the doctor if your child has: 1) respiratory distress – difficulty breathing, breathing too fast, “retracting” (belly muscles or the muscles in between their ribs are tugging when they are breathing), flaring nostrils; 2) signs of dehydration – vomiting and can’t keep any liquids down, excessive diarrhea, less than 2-3 wet diapers per day, dry lips, racing heart rate that’s not explained by fever 3) lethargic or inconsolable. For children less than 3 months of age, call the doctor if they have a fever greater than 100.4 F. Once children are older than that, fever itself is no longer a medical emergency and in fact is one of the body’s ways of fighting infection.

   As moms, we all want to make our kids feel better when they are sick. You can use acetaminophen (Tylenol) and ibuprofen (Motrin, Advil) for relief of fever and body aches. Many children will lose their appetites when they are sick and that’s perfectly OK – as long as they are drinking enough fluids to have 2-3 wet diapers (or urinate 2-3 times) in a 24 hour period. Sometimes that takes a little creativity, but things like soup and ice pops count as fluids. A warm bath – or even sitting in a steamy bathroom while a hot shower is running – can help with nasal congestion. Otherwise, you should avoid over-the-counter cold/cough/flu medications because of the risks of dangerous side effects in young children.

   Calling your pediatrician’s office if you have concerns is always a good way to start – you can’t catch the flu over the phone. The nurses and doctors can then tell you whether they think the safer thing for your child is to bring them in to the office– or stay out of their waiting room. Nurses and doctors can elicit a lot of useful information from you over the phone to make that decision. Of course, if you are worried that your child is severely ill, seek medical attention right away.

5. What are some things that moms can say to themselves to calm their fears about the H1N1 flu?
   
   The H1N1 flu virus is no more dangerous than the usual seasonal flu virus – the difference is that so many more people are being infected when compared to the usual seasonal flu. Using common sense precautions – regular hand washing, getting your child vaccinated, avoiding certain situations that enable other people to get close enough to cough on your child – are the best ways to prevent getting the flu. For otherwise healthy children who do get the flu, the overwhelming majority will be able to be “nursed though it” without special treatment. And for very young infants as well as children and adults with medical conditions such as asthma, there is an effective antiviral medication (Tamiflu) that can reduce the severity of the illness.

   One thing to keep you calm when you’re about to drop your preschooler off in a classroom full of coughing children is that cough alone is not H1N1 flu virus. A child must have a fever as one of their symptoms, and having a fever does not necessarily mean it’s an H1N1 infection. Young children frequently get fevers for other reasons (other cold viruses, ear infections, etc).