Hello! Glad to be here.

Yes! The flu shot is essential for all infants and children, age 6 months and up. Influenza can be a fatal disease, especially in the young and the immunosuppressed. Our best hope at controlling the spread of the flu is the vaccine.

The flu virus is common and unpredictable, and it can cause serious complications and death, even in healthy children. Immunization each year is the best way to protect children.

Each year, on average, 5 percent to 20 percent of the U.S. population gets the flu, and more than 200,000 people are hospitalized from complications. At least 145 children died from the flu last year, although the actual number is probably much higher since many flu deaths aren’t reported. If you choose not to vaccinate your child, you not only endanger your own child but also others.

Although influenza can be treated with antiviral medications, these drugs are less effective than we would like, expensive, and have a lot of side effects.

The American Academy of Pediatrics and the Center for Disease Control strongly recommends annual influenza immunization for all people ages 6 months and older, including children and adolescents. In addition, household contacts and out-of-home caregivers of children with high risk conditions and all children under the age of 5 especially should be vaccinated.

Young children, people with asthma, heart disease, diabetes, weakened immune systems, and pregnant women are at high risk for complications of influenza, such as pneumonia.

About half of all Americans get vaccinated against the flu each year, including 50 percent of pregnant women. This number needs to get better. Ask your child’s school, daycare center, or sports coach, “How are we promoting the flu vaccine for these children?”

If you are healthy, it doesn’t matter which form of the vaccine you get:

The quadrivalent influenza vaccines for the 2015-2016 season contain the same 3 strains as the trivalent vaccine, plus an additional B strain. Although this may offer improved protection, the AAP does not give preference for one type of flu vaccine over another.

Last flu season, the nasal spray vaccine (the live attenuated quadrivalent influenza vaccine, or LAIV) did not offer greater protection than IIV against the predominant strain of influenza virus. Some people with illnesses that affect the immune system can only get certain forms of the vaccine, which is why the different vaccines are available. If you are healthy, either vaccine is appropriate.

Please don’t delay vaccination in order to wait for a specific vaccine. Influenza virus is unpredictable. What’s most important is that people receive the vaccine as soon as possible. Remember, influenza is already here!

Yes! The flu has already hit St. Louis this year!

This year’s flu vaccine is expected to work better than last year’s vaccine. Here’s why:

Last year’s flu season was particularly severe because the predominant strain was an influenza A called H3N2, which was not included in the vaccine. The vaccine for the 2015-16 season contains the H3N2 strain.

There should be plenty of vaccine for everyone this year:

For the 2015-16 season, manufacturers have projected that they will produce between 171 and 179 million doses of flu vaccine. At least 40 million doses have already shipped.

That's great to know. Thank you, Dr. B.

I've worked in the pediatric ER many Halloween nights, and mostly I see kids who were really too sick to go out for Halloween but tried to make it anyway. I see a LOT of asthmatics, kids with fevers, and vomiting kids.

We have had this problem in past years...A child has a cough but no fever and really wants to go trick or treating. It's really hard to say no. But I think it's better to limit the time outside in the cold if you child is starting to show symptoms of a cold.

By 7pm on Halloween the little ones appear, gasping for breath. When we get our first asthmatic, we know the night has just begun. The cool night air full of fall allergens will set off even a mild asthmatic. Every Halloween I hand out pediatric dragon-decorated masks that attach to nebulizers and blow smoking albuterol into little asthmatic lungs. We give grape flavored orapred, a steroid to reduce lung inflammation. It seems more like a trick than a treat.Kids with asthma will often push it too far while trick-or-treating, trying to make it to a few more houses before they go home for their inhaler. If you have a child with asthma, be sure to give all their maintenance medications before you go out and bring your inhaler with you. Coughing won’t stop? Asthma shouldn’t keep kids from activities like trick-or-treating. Sounds like your little creature needs an asthma action plan.

It's very common for parents to worry about whether their child is making good friends and about the quality of those friendships. To be honest, these concerns don't stop even when they are in their teens. I hear from plenty of parents who worry about their child's social development. We all recognize how essential friendship is to a good quality of life.

And asking her about her friend's interests and families is another low-pressure way to encourage sociability.

Immodest Halloween costumes are just an extension of the adult clothing styles that are now commonplace for our pre-pubertal daughters. After almost ten years of practice as a pediatrician, I’ve witnessed a decade of kids’ underwear trends and styles. Sexy underwear are appearing on younger and younger girls, from Victoria’s secret satin, to thong, to fluorescent string bikinis. Their child-like, curve-less hips aren’t made for sexy underwear. So why do moms let their daughters wear adult-styled underwear?

I’ve heard all the arguments:

“Thong underwear are for preventing panty lines—they are functional, not meant to be sexy.”

“Pretty underwear help girls feel good about themselves. They’re important for self-esteem.”

“She has to change for PE, and everyone sees her underwear. She doesn’t want to wear regular cotton underwear anymore.”

“Shopping at Victoria’s secret with my kids is a great time to talk about why sex is a normal, healthy thing.”

Here’s what I think: childhood is getting shorter—our daughters are growing up too soon. Our daughters are trying to look like grown-ups before they have grown-up bodies. Tweens wearing sexy underwear is just another example of all the other adult trends that have worked their way into childhood. According to the American Society of Plastic Surgeons, More than 326,000 18-and-unders had plastic surgery procedures in 2004 to correct something that made them self-conscious. Kids as young as 10 and 12 go to tanning salons, in many states without parental permission. One woman in New Jersey was arrested for bringing her six year old into a tanning device with her. And clothing styles for girls over seven look more like ladies clothes than kid’s clothes. Most moms I know struggle to find summer clothes for their daughters that cover their thighs.

Up until a certain age parents have control of the pocketbook. Even if it makes you unpopular or uncool for that night, just say no.

But I would also try to explain why dressing like that, even in a costume, is not a good idea, rather than just saying it's trashy.

Getting started on the costume earlier also gives you the time to pull together something creative and modest, so you don't have to buy a pre-made costume.

Here are 6 tips to reduce the sugar:

1. Limit the route and do something else with the rest of Halloween night: We will focus trick-or-treating to one or two blocks in our neighborhood. By keeping the number of houses that we visit down, the amount of candy that we acquire will be less. My son will join me for the remainder of the night sitting on our front porch handing out candy to other trick-or-treaters. There are a number of fun family activities for Halloween night that can keep the time spent trick-or-treating limited while still having fun such as watching a Halloween-themed movie, reading scary stories by flashlight, or turning one room of the home into a haunted house.

2. Limit the size of the pumpkin: My children have multiple pumpkins and other receptaclesHalloween to use to collect their candy. I will have them take the smallest of these candy carriers with us when we go door-to-door. A small container will fill up faster and helps the child feel as though he or she has taken in a huge haul. I am always amazed by the number of trick-or-treaters who put their candy into a plastic shopping bag or pillow case. It would take a lot of candy to feel that one of those was full and it was time to go home.

3. Write down your five favorite candies before you leave: Before leaving for trick-or-treating, children can write down their five favorite types of candy. When they get home, they can then keep anything that is on the list and get rid of anything that is not on the list. Making the list of favorites ahead of time may make the sorting process easier at the end of the night.

4. Find a candy buy-back program: Many dentist offices and other organizations participate in candy buy-back programs that allow children to sell their candy for a per pound price or to trade the candy for other non-food prizes. Visit www.halloweencandybuyback.com to find local dentists and organizations that buy candy and then donate it to Operation Gratitude, which includes the candy in care packages sent to US military personnel as well as veterans, Wounded Warriors, and first responders. If your local area does not have a candy buy-back program, you can offer to buy some of your child’s candy. Let them use the money for a non-food treat and find somewhere in your community that might accept the candy as a donation such as a local food pantry, soup kitchen, or domestic violence shelter.

5. Develop a pieces-per-day rule: Portion control is neither original nor exciting, but it works. We use a two-pieces-per-day rule in our house to limit how much candy our children eat. We keep the candy stash on a high shelf in the cupboard to keep it out of sight of our young ones (and to make it harder for us to “steal”). It may be helpful to pick an “expiration date” for the candy stash and agree to throw out any pieces that have not been eaten while following the piece-per-day-rule (which may prevent you from having to combine Halloween candy with marshmallow Peeps come spring).

6. Get creative: I found several ideas for using Halloween candy creatively online. Ideas include baking with the candy such as using pieces of chocolate bar instead of chocolate chips for making cookies, creating candy art by using Skittles® and other small candies as mosaic “tiles,” and getting a head start on the holiday gingerbread house.

Here are some things I've done in the past: 1. Put most of the candy in the freezer. It's hard to binge on frozen candy. 2. Bring most of it to your work the next day. 3. Donate to troops overseas or hospitals. 4. Offer to buy your child a small toy in exchange for most of the candy.

In short, though, I would ask the teacher how your child compares to other kids in the class by specific subjects. For example, how does your child do compared to peers with math? Ask what you should focus on at home to enrich your child's curriculum. Then get in the classroom and volunteer.

Clearly, Dr. B and I have been in the same situation as you, Kirkwood Mom.

Lastly, if you attend conferences with a spouse, ask him in advance to limit small talk as not to take up any part of that valuable 10 minute conference time. Speaking from experience here.

That said, there are coaches and leagues that prioritize safety more than others. Talk to other parents whose children play to find out which ones have the best reputations and safeguards in place.

My editor, who has two very active sons who play hockey, says she would not let them play football. She doesn't believe there are enough safeguards in place yet. And study after study points to too many injuries.

Thank you everyone for the questions this week. Have a wonderful Halloween and see you here next month!