Daily Dose

Is It A Viral Sore Throat Or Strep Throat?

1.30 to read

It only takes the winter season to usher in an array of illnesses in the pediatrician's office. As you know, we are smack in the middle of flu season, with cases and deaths being reported daily. To review (again), flu like symptoms for all influenza strains are typically similar with fever, sore throat, cough, congestion, headaches and body aches. Occasionally there may be some nausea or vomiting but that is not seen as often. Flu like symptoms seem to begin with general malaise and then develop over the next 12–24 hours and you just feel miserable. Some of the confusion now is about sore throats and the difference between a sore throat with the flu, which is due to a viral infection, and strep throat, which is a bacterial infection. As for most things in life, nothing is 100 percent and the same goes for viral and bacterial sore throats. But, with that being said, there are certain things that might make a parent think more about a viral sore throat than strep throat and vice versa. Viral sore throats, which we are seeing a ton of with the flu right now, are typically associated with other viral symptoms which include cough, and upper respiratory symptoms like congestion or runny nose. A viral sore throat may or may not be accompanied by a fever. In the case of flu, there is usually a fever over 100 degrees. With a viral sore throat you often do not see swollen lymph nodes in the neck (feel along the jaw line) and it doesn’t hurt to palpate the neck. If you can get your child to open their mouth and say “AHHH” you can see the back of their throat and their tonsils, and despite your child having pain, the tonsils do not really look red, inflamed or “pussy”. Even though it hurts every time you swallow, to look at the throat really is not very impressive. Strep throat on the other hand, typically occurs in winter and spring (that is when we see widespread strep), but there are always some strep throats lurking in the community, so it is not unusual to hear that “so and so” has strep, but you don’t hear a lot of that right now. Over the next 2 months, there will be a lot more strep throat. Strep throat most often affects the school-aged child from five to 15 years. Children get a sudden sore throat, usually have fever, and do not typically have other upper respiratory symptoms (cough, congestion). This is another opportunity to feel your child’s neck and see if their lymph nodes are swollen, as strep usually gives you large tender nodes along the jaw line. When you look at the throats of kids with strep they usually have big, red, beefy tonsils (looks like raw meat) and may have red dots (called petechia) on the roof of the mouth. The throat just looks “angry”. Sometimes a child will complain of headache and abdominal pain with strep throat. Some children vomit with strep throat. The only way to confirm strep throat, again, a bacterial infection, is to do a swab of the back of the throat to detect the presence of the bacteria. There are both rapid strep tests and overnight cultures for strep. Most doctors use the rapid strep test in their offices. If your child is found to have strep throat they will be treated with an antibiotic that they will take for 10 days. Again, antibiotics are not useful for a viral sore throat and that is why strep tests are performed. I’m sure we’ll talk more about sore throats, but in the meantime, get those flashlights out and start asking your kids to say "ahhh". That's your daily dose for today. We'll chat again tomorrow.

Daily Dose

Hot Hand-Foot Syndrome

I was recently reading a dermatology article that I found quite interesting. The article was discussing “Hot Hand-Foot Syndrome” and showed a picture of a child with bright red palms and soles. It made me stop and read the article, as I am sure I had recently seen a child that looked like that picture. This puzzling syndrome presents with the sudden (acute) onset of warm, tender, red nodules and plaques on the palms and or soles.

Most children will also complain of low-grade fever, malaise and tenderness of the palms and soles that may even restrict walking or use of the hands and fingers. The presentation of this often looks like some sort of viral infection (fever, malaise) with a “weird” rash, but in actuality this is an illness caused by the bacteria Pseudomonas aeruginosa. This bacterium is found in water and soil and can enter the skin through hair follicles, sweat gland ducts, or micro-breaks in the skin. The most common place to be exposed to this bacterium is in hot tubs, saunas or swimming pools. You do not realize that you have even been exposed, but with a good history you may find that the child had been in a hot tub in the last 24

Daily Dose

Over The Top Birthday parties

1.15 to read

Birthday parties are getting to be quite a big deal...even for a one year old. I have had several parents in with their children for their 1 year old check up and they often bring along birthday party pictures. WOW!

Some of these bashes look like they could be a swee” sixteen or a wedding.  No kidding. I thought I had hit the jackpot when I started printing birthday invitations on my color printer....but these days some of the invitations are printed and delivered to other “1 year olds” who I assume cannot read yet. Thankfully their parents are also included as +2. 

These parents are very clever and most of the parties had themes....with the invitation, cake and party favors all coordinating. Looked like a ton of work for the parents to put this all together. If anything, this is not a “last minute” event...lots of planning and executing. I wonder if second or third children have such elaborate “bashes”.

I know I seemed to be able to throw together a birthday party at the last minute when necessary, but I am sure that was for child number 2 or 3. My husband did remind me of our first child’s 1st birthday when we had many friends and their toddlers over. He also reminded me that it was about 110 degrees in June, and that we had a plastic baby pool that we put a bunch of hot sweaty kids in, with parents who wished that they could have fit as well.  Not sure where those pictures are.

But it seems that petting zoos, bounce houses (maybe for the adults), magicians, and even super heroes arrive to celebrate this latest group of 1 year olds.  There are themed cakes with a miniature one for the birthday child too so that they may fully indulge in their “first sweet” A few of my moms had gluten free cakes made, just because. There are often tons of gifts as well, but many parents are opting to then donate them to one of our local children’s hospitals....a wonderful idea.

Lastly, with all of the fancy new apps and iPhone photos, many of the parties look like they have been professionally photographed (some of course had been).  Some of the precious 1 year old birthday children even had several wardrobe changes to celebrate the big day (yes, those were mostly little girls), I guess to get an early start on future occasions like the wedding.

What do you think about first birthday parties... I just think it might be worth waiting till your child can appreciate it as well?

Daily Dose

Baby Bling Can Be Dangerous!

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I recently saw a TV segment on “blinging” your baby and toddler. It seems that the latest craze is decking out not only little girls, but also little boys. Being the mother of three sons I can understand wanting to “dress up” boys as well (little boy clothes can be a bit boring) but a few of the models on TV were wearing necklaces. 

Now, a boy wearing a necklace doesn’t bother me at all, but a baby or toddler with a necklace worries me!  This isn’t about gender, rather about safety.  

A necklace is a real choking and strangling danger for babies and young children. I know that many parents receive necklaces for their babies on the occasion of a baptism and in some cultures an infant is given a necklace made of string or beads to wear soon after birth. 

But, whenever a baby comes into my office with a necklace on I discuss the possibility, even if remote, of the child suffocating if the necklace gets caught or twisted around the child’s neck. There is no reason to even risk it! 

Baby bling is great if you want to put your child in cute shirts, hats, or even trendy jeans. Go for it!  But I would never put a necklace on a child. It is akin to the adage about peanuts...when should a child be allowed to eat peanuts?  When they can spell the word!  

We pediatricians are no longer worried about peanut allergies in the young child, it is the choking hazard that is the real concern. It’s the same for a necklace. Let your child wear it when they can spell the word, or put it on when your 3 year old plays dress up, but take it off once finished. There is no need to ever have a young child sleep in anything like a necklace, or anything that has a cord until they are much older. 

Children ages 4 and under, and especially those under the age of 1 year, are at the greatest risk for airway obstruction and suffocation.  So, put the necklace back in the jewelry box for awhile. You can re-wrap for re-gifting and re-wearing at a later date. Safety before bling! 

Daily Dose

Treating Dry Skin

The best way to counter the effects of the winter weather is by using moisturizers on the skin, and lubricants in the nasal passages.I am reminded once again of the cold weather and the problems that ensue with dry skin, dry mucous membranes and frequent upper respiratory infections. The best way to counter the effects of the winter weather is by using moisturizers on the skin, and lubricants in the nasal passages, and by good hand washing, which also leads to dry skin. It seems to be a vicious cycle. The only solace is that we are well into winter weather and its effects.

The air is cold, the heat is running and your skin gets dehydrated. Bathing and showering with your usual soaps may not work at this time of year. You might try using a more gentle soap such as Vanicream, Cetaphil, Purpose, or Basis. Try bathing a little less frequently, with shorter periods in the bath. Every other day would be fine during the winter. The hotter the water the more drying it may be, so turn it down a notch to where it is warm and comfortable. If the kids are bathing, let them play awhile before lathering them up, and once soapy, rinse and get them out of the bath water. Pat dry lightly and while they are still a bit, damp rub in a moisturizer, and creams are better than lotion. Vanicream, Cetaphil cream or Eucerin creams. A little Vaseline up the nostrils before bedtime will keep the nasal passages moisturized too. Keep it up until spring. That's yours daily dose, we'll chat again tomorrow.

Daily Dose

Update: Back-to-School Vaccines

Which vaccines do your kids need as they head back to school? Dr. Sue fills you in. With only a few days or weeks to go (for some) before school resumes, it's important to know August happens to be National Immunization Month.  For every age child that is getting ready for school there are, immunizations that are necessary and for any child who has missed or lapsed immunizations it is a good time to update and “catch-up”.

Children entering kindergarten (ages 4-6) will need to have had a  DTaP (diphtheria, tetanus and acellular pertussis), an IPV (inactivated polio), MMR (mumps, measles, rubella) and Varivax (chickenpox) vaccines.  (These are all booster doses). It has also been recommended that children over the age of 1 year (who have completed their 4 dose Prevnar series with Prenvar 7) and who are under the age of 6, receive a booster dose of the newer Prevnar 13 . (see previous blog from Spring 2010). For those children between the ages of 11-12 years there are also booster doses (for older children and adults too) of the tetanus, diphtheria and pertussis vaccine (TdaP) as well as the meningococcal vaccine.  These shots are typically given before entering 7th grade. If your child is over the age of 11 years and has not yet received the meningococcal vaccine I would go ahead and get it, even if they are still in later elementary school and it may not be “required”.  (The names of the vaccine are Menactra or Menveo). This vaccine prevents a devastating form of meningitis and bacterial blood infection that often leads to a rather rapid death in the adolescent and young adult age group. There is also the recommendation that all adolescents who “missed” receiving a meningococcal meningitis vaccine during their high school years receive a dose prior to entering college. In fact, in the state of Texas, this is the first year that ALL college freshmen must show proof of immunization prior to moving into their dormitory.  This is due to the fact that meningococcal meningitis has a higher attack rate for adolescents and young adults, especially those living in close living quarters, such as a dormitory. Once you get the vaccine it takes awhile for your body to develop antibodies and therefore immunity, so college students who get vaccinated once arriving at school, will also have to wait 10 days before they are allowed to move into their dorm.  If you son or daughter is heading to college in the next several weeks, go get the vaccine now, so that you will have a 10 day window to show proof of vaccination. With outbreaks of pertussis on the west coast, and actually clusters throughout the United States, this is a good time to reiterate that all adults should have a tetanus, pertussis and diphtheria vaccine too!! That means every 8–10 years and you want to make sure you have gotten the vaccine containing acellular pertussis, which prevents the adult population from spreading whooping cough to infants who have not yet been immunized or who are just getting their own 3 dose series. Even adults need to continue getting vaccinated and the TdaP vaccine is recommended for adults until 65 years of age. What can you expect from me over the next few weeks? Updates about flu vaccine once again. How time flies! That's your daily dose for today.  We'll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

Hand, Foot & Mouth Disease

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They say a picture is worth a thousand words and I believe it, especially as it pertains to rashes and pediatric illnesses. My iPhone has become a wonderful educational tool for my patients in the office, online and via social media.

It seems rather late in the season for Coxsackie virus to be occurring (typically more late summer early fall) but I am seeing so many little patients with the classic skin findings of “hand-foot and mouth” disease (HFM).  Some of the cases have been so classic that I took pictures of the rash, as once you see HFM you tend to know it!  Unfortunately, you may see this rash and think you won’t see it again, but you can get HFM more than once, so you will definitely know what you are dealing with once you have seen it.

HFM disease is a viral illness which typically occurs in younger children, although I occasionally see a miserable teenager who has classic Coxsackie virus findings.  In most cases the rash is preceded by a few days of fever and malaise and then the viral papules appear on the hands and soles of the feet. At the same time those papules and vesicles are often in the child’s throat, so you may see a toddler who is drooling more as it hurts to even swallow their spit!

Most kids with HFM don’t feel well and are irritable and fussy.  Occasionally you will see a child who appears totally happy, never had a fever and only has the classic Coxsackie rash on the hands, feet. The rash often occurs on the buttocks as well and may be equally as uncomfortable for those in diapers.

Because HFM is a viral illness there is no treatment per se.  This is where the TLC becomes important. You can use acetaminophen or ibuprofen for the fever or even for the throat discomfort. I am also a fan of things like popsicles, pudding, ice cream and Slurpees to help with the throat pain. Just make sure your child stays hydrated during the illness, they will eat their meals once they are feeling better.

The virus is contracted from person to person as well as from contaminated surfaces. This means that it is not uncommon to see “outbreaks” in daycare and preschools as the toddler set shares their germs better than their toys. The incubation period after exposure is about 3–7 days.

Once your child is fever free for 24 hours they may return to school as the rash may last anywhere from 5 – 7 days. Best prevention is still good hand washing.

Thanks to all of my little patients who were so helpful in letting me take pictures of their rash! I am getting better with the iPhone camera all of the time.

That’s your daily dose for today.  We’ll chat again tomorrow. 


Daily Dose

Nightmares & Night Terrors

Nightmares and night terrors are common occurrences during the toddler, pre-school and early elementary years.I have been receiving a few emails about the difference between nightmares and night terrors. First off, nightmares and night terrors are common occurrences during the toddler, pre-school and early elementary years.

Nightmares are scary dreams that occur during REM sleep (which occurs towards the end of sleep when REM sleep is most intense) and dreams are vivid. A child awakens after a nightmare being scared, anxious and afraid to go back to bed. Night terrors on the other hand occur during the first few hours after a child falls asleep, when non-REM sleep is the deepest. During a night terror your child may cry out, have dilated pupils, an increased heart rate, sweating and heavy breathing. They appear to be awake but in reality are only partially aroused and will have no memory of the event. During a night terror a child will not recognize you or allow you to comfort them and may become even more agitated if you try to hold them. Parents are often equally frightened by the event, as it is disconcerting trying to decide why your child has awakened in such distress. Just like other familial traits, sleep disturbances (parasomnias) seem to run in families. A lot of work is being done to isolate genetic loci related to sleep habits. Both nightmares and night terrors seem to be more frequent in children who have not had a good night's sleep. Try to have a regular bedtime routine, and limit television exposure prior to bedtime. Read books to your children about dreams and nightmares that incorporates their favorite characters in the same situation (one of our favorites was Franklin in the Dark, there was not a cuter turtle with a nightlight!). Be creative and make a dream catcher to catch the bad dreams and keep them away, or discuss soothing images prior to bed. WE had "monster dust and wands " that our boys used to spray the room before bed and they all had a favorite night light (how they slept with three nightlights blazing was beyond me). Our middle son was the most creative; he blew up an alligator pool toy that he placed outside his bedroom door each night. When asked what he was doing he replied, "my alligator will eat the monsters before they come into my room! How can a parent argue with that? That's your daily dose, we'll chat again tomorrow. Send your question to Dr. Sue!

Daily Dose

Head Flattening on the Rise!

1:30 to read

A recent study published in the online edition of Pediatrics confirms what I see in my practice. According to this study the  incidence of positional plagiocephaly (head flattening) has increased and is now estimated to occur in about 47% of babies between the ages of 7 and 12 weeks.  

The recommendation to have babies change from the tummy sleeping position to back sleeping was made in 1992. Since that time there has been a greater than a 50% decline in the incidence of SIDS. (see old posts).  But both doctors and parents have noticed that infants have sometimes developed flattened or misshapen heads from spending so much time being on their backs during those first few months of life.

This study was conducted in Canada among 440 healthy infants.  In 1999, Canada, like the U.S., began recommending  back sleeping for babies. Canadian doctors had also reported that they were seeing more plagiocephaly among infants.  

The authors found that 205 infants in the study had some form of plagiocephaly, with 78% being classsified as mild, 19% moderate and 3% severe.  Interestingly, there was a greater incidence (63%) of a baby having flattening on the right side of their heads.  

Flattening of the head, either on the back or sides is most often due to the fact that a baby is not getting enough “tummy time”.  Although ALL babies should sleep on their back, there are many opportunities throughout a day for a baby to be prone on a blanket while awake, or to spend time being snuggled upright over a parent’s shoulder or in their arms.  Limiting time spent in a car seat or a bouncy chair will also help prevent flattening.

Most importantly, I tell parents before discharging their baby from the hospital that tummy time needs to begin right away. It does seem that some babies have “in utero” positional preference for head turning and this needs to be addressed early on. Think of a baby being just like us, don’t you like to sleep on one side or another?  By rotating the direction the baby lies in the crib you can help promote head turning and prevent flattening.  

Lastly, most cases of plagiocephaly are reversible. Just put tummy time on your daily new parent  “to do list”.   


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