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Daily Dose

How To Treat A Cough

1.30 to read

It is FINALLY March which often is the last month that our pediatric office is inundated with illness. I can now honestly tell exhausted parents (and our nurses) that this could possibly be their child’s last cold of the 2013-2014 winter season. I would still keep my fingers crossed as well.

But, with that being said I still hear coughs throughout the exam rooms and the beeping of the pulse oximeter measuring a child’s oxygenation. These are sounds I rarely hear once we hit April-May.  Parents continue to be concerned about their child’s cough and parent’s and children alike are tired.... often due to sleep disruption due to coughing.  

While numerous remedies to suppress nightime cough have been tried, most of the studies done in children ( over 1 year of age) showed no benefit with either dextromethorphan (found in many OTC cough and cold preparations) or diphenhydramine (Benadryl).  On the other hand, there have been 3 randomized controlled trials showing the effectiveness of honey on reducing nighttime coughing brought on by an upper respiratory infection (also known as a cold.)

Honey has been used for a variety of medicinal uses for thousands of years, but like many other things (Power Rangers, Hello Kitty, Rocky and Bullwinkle), the use of honey is making a comeback!!  While different types of honey have been tried (the first study used Buckwheat honey, others have tried eucalyptus and citrus honey,) the type of honey used has not been found to be significant. There has yet to be a study done using the traditional clove honey we all have in our pantries.  

The mechanism for how the honey works to suppress the cough is still unclear. Some feel it is the antioxidant effect of honey, as well as its antimicrobial effects.  Others postulate that the sweet taste may  even reduce the central sensory nerves urge to cough.  Whatever the mechanism, most parents and children don’t care if they just can stop coughing at night!

Honey may safely be used in children OVER the age of 1 year.  The typical dose is 1/2 tsp for children between 1-5 years, 1 tsp for 6-11 years and 2 tsp for older children.

Give it a try on those last hacking coughs this month....spring is just around the corner.

Daily Dose

Are Parents Too Connected?

1.30 to read

Has your spouse, babysitter or other child care provider ever called you to come home “because the baby is crying”?  It seems that technology, which is readily at our finger tips 24/7, has created yet another dilemma - what to do if a baby is crying? 

Pre-cell phone days, there really was not much to do if you the parent left home and your baby/child started crying.  Outside of calling the restaurant, store, movie theater (directly), and asking them to page a parent, most of us just muddled through a crying child.  I also think that in most cases, said child eventually stopped crying (unless there was an obvious reason that could be “fixed”) and by the time you the parent returned home, all was typically well.  

But now, with a cell phone in every hand, it only takes one call to summon the parent of a crying child.  I think this is a good news/bad news dilemma.  The good news is: parents may feel more comfortable leaving their child with a babysitter, knowing that they may be reached in the event of an emergency.  The bad news is:  is a baby or child who is only crying, typically an emergency?  Depends on your definition. 

The reason I bring this up is that I often hear young parents, and especially mothers, tell me that during the first several months of their infant’s life, they cannot leave the house for more than minutes, before being called home....because the baby is crying.  Some of these mothers are really “stressed out and exhausted” and need a bit of a get-away to “re-boot”. I am not talking about a trip to the day spa. I am simply talking about an hour or 2 to go to the store or meet a friend for lunch or just sit alone in the park and read a book.  Just a bit of quiet after being home with a baby day in and day out for the first 4 weeks of their newborn’s life.  If you have been there you understand. 

But, now that they have a cell phone, there is CONSTANT communication.  The minute the baby cries, the cell phone rings....”the baby is CRYING, come home.”  My husband would tell you that his best parenting started the first time I left him alone with our first son and I actually went away for the weekend.  (I believe the baby was 6 or 7 weeks old and off I went breast pump in hand to a reunion.)  No cell phones then, and guess what, he did a great job!!!!  He told me how after the first 24 hours he figured out that he really didn’t have to have the baby in the bathroom with him in order to take a shower. He later told me that the first shower he took, not only was our son in the room in his “bouncy” chair, but he left the shower door open as the door got steamy and he couldn’t see the baby!! How cute is that. 

Technology, as wonderful as it is, may also enable us to “cop out” when things get a bit difficult.  That goes for parenting as well. 

Turnoff your phone off sometime and let the “other parent” or babysitter handle it for awhile. Being disconnected is NOT always a bad thing!

Daily Dose

When Bug Bites Get Infected

1.00 to read

It is the season for bug bites and and I am seeing a lot of parents who are bringing their children in for me to look at all sorts of insect bites. I am not always sure if the bite is due to a mosquito, flea or biting flies, but some of them can cause fairly large reactions. 

The immediate reaction to an insect bite usually occurs in 10-15 minutes after bitten, with local swelling and itching and may disappear in an hour or less. A delayed reaction may appear in 12-24 hours with the development of an itchy red bump which may persist for days to weeks.  This is the reason that some people do not always remember being bitten while they were outside, but the following day may show up with bites all over their arms, legs or chest, depending on what part of the body had been exposed. 

Large local reactions to mosquito bites are very common in children. For some reason, it seems to me that “baby fat” reacts with larger reactions than those bites on older kids and adults. (no science, just anecdote). Toddlers often have itchy, red, warm swellings which occur within minutes of the bites. 

Some of these will go on to develop bruising and even spontaneous blistering 2-6 hours after being bitten. These bites may persist for days to weeks, so in theory, those little chubby legs may be affected for most of the summer. 

Severe local reactions are called “skeeter syndrome” and occur within hours of being bitten and may involve swelling of an entire body part such as the hand, face or an extremity. These are often misdiagnosed as cellulitis, but with a good history of the symptoms  (the rapidity with which the area developed redness, swelling, warmth to touch and tenderness) you can distinguish large local reactions from infection.

Systemic reactions to mosquito bites including generalized hives, swelling of the lips and mouth, nausea, vomiting and wheezing have been reported due to a true allergy to the mosquito salivary proteins, but are extremely rare. 

The treatment of local reactions to bites involves the use of topical anti-itching preparations like Calamine lotion, Sarna lotion and Dommeboro soaks.  This may be supplemented by topical steroid creams (either over the counter of prescription) to help with itching and discomfort. 

An oral antihistamine (Benadryl) may also reduce some of the swelling and itching. Do not use topical antihistamines. Try to prevent secondary infection (from scratching and picking) by using antibacterial soaps, trimming fingernails and applying an antibiotic cream (polysporin) to open bites. 

Due to an exceptionally warm winter throughout the country the mosquito population seems to be especially prolific. The best treatment is prevention!! Before going outside use a DEET preparation in children over the age of six months, and use the lowest concentration that is effective.  Mosquito netting may be used for infants in strollers.  Remember, do not reapply bug spray like you would sunscreen. 

Daily Dose

What is Stomach Flu?

1.30 to read

I have seen a lot of patients in recent weeks with complaints of “stomach flu”.  Just to be clear the “stomach flu” really is not FLU at all and has nothing to do with “flu/influenza”.  The stomach stuff is actually called gastroenteritis, and is typically caused by a virus.  If you have been watching the news, you have heard about yet another cruise ship where many passengers and crew have been sickened and the boat had to return to port. 

Most gastroenteritis causes vomiting, diarrhea, and stomach cramps.  It is pretty miserable.  The most common cause of the stomach “bug” is a virus called norovirus. Norovirus is now the most common cause of gastroenteritis in the United States. Rotavirus was previously the most common cause of viral gastroenteritis, but since the rotavirus vaccine has been introduced for infants, rotavirus has now been surpassed by norovirus.  Viruses are really smart, sneaky and strong (which is called virulent in medical terms). 

Norovirus makes you feel awful (who likes to vomit?)  and is very easy to pick up. Where it takes exposure to many viral particles to get sick from some viral illnesses, a recent study in The New England Journal of Medicine found that as few as 10-100 norovirus particles may cause disease. It is a very efficient virus and may even be acquired by breathing in the viral particles. (gross example, someone vomits and you are in the room and breathe the virus -  think about your child spewing vomit). 

Norovirus peaks in the 6-18 month old child. By 5 years of age 1 in 6 children will have seen their doctor for vomiting/diarrhea caused by norovirus. 

The key to combating norovirus is hydration.  The virus typically lasts several days with vomiting usually shorter than the diarrhea.  Treat vomiting with frequent sips of clear liquids and increase the volume of liquid over time. Once your child is tolerating liquids and vomiting has stopped you can let them eat. If your child is over the age of 1 year and diarrhea is a big problem, I would restrict dairy for a couple of days as well. Probiotics may help as well. 

Knowing that norovirus can be transmitted by hand to mouth as well, good hygiene is important....especially after the bathroom...so make sure those little hands are washed.

Daily Dose

Give Your Family a Sleep Check-up

Now that school is back in session, I wonder if everyone has gotten back into healthy sleep habits.Now that your kids are back in school this new year, I wonder if everyone has gotten back into healthy sleep habits?

It seems that the high school and college crowd takes advantage of long weekends or breaks to “catch up” on sleep. That means sleeping from about 1 or 2 am until at least noon. That also means that I rarely saw my children awake. The same thing was reported by many of my adolescent patients. The ones that came in for morning appointments looked like they had literally rolled out of bed, and were not even fully awake. They looked at it as a “punishment” to have to go to an appointment before noon. I, on the other hand know that morning appointments tend to get seen in a more timely manner than those late in the afternoon when I have had a chance to get behind (despite my best efforts, I promise!). Now the statistics released from the Youth Behavior and Risk Survey of 12,000 high school students just reinforced that our teens are truly sleep deprived. Only about eight percent of teens reported getting the recommended nine hours of sleep on school nights. There were 10 percent of teens that reported sleeping only five hours a night, while another 25 percent reported getting six hours of sleep on average on school nights. Thus, it appears that adolescent sleep deprivation is rampant and cumulative. As any parent knows, kids of all ages get irritable when they don’t get enough sleep. Lack of sleep also leads to difficulty learning and concentrating, but may also affect other activities outside of academics. Teen drivers may be more prone to have automobile accidents when sleep deprived. They are also found to have a higher incidence of depression. There are also studies that lack of sleep may contribute to obesity. With a new semester starting what better time to review bedtimes and sleep habits. I firmly believe that all children need to have bedtimes and that means adolescents too. For that to happen a family needs to not only be organized to get everyone ready for bed, but a parent needs to check on their teen to make sure that they are going to bed. I know it is hard to stay up after a long day at work, but if unsupervised many teens will stay up. They are not only studying, but they are on line on Facebook, or texting on their phones or playing video games or watching TV. Teens are the kings and queens of multitasking, or so they think and somehow the time just slips away. That is until morning when they are exhausted. So make a commitment to “tuck in your teen”, even if that means setting your alarm to get up and do it. That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

The Difference Between Cradle Cap And Dandruff

1.15 to read

I recently received a question from a Twitter follower related to cradle cap and dandruff. She wanted to know if there was a difference in the two.

You know there really isn’t as they are both due to seborrheic dermatitis, an inflammatory condition of the skin in which the skin overproduces skin cells and sebum (the skins natural oil). Cradle cap is the term used for the scaly dermatitis seen on the scalp in infants. It is also seen on the eyelids, eyebrows, and behind the ears. It is typically seen after about three months of age and will often resolve on its own by the time a baby is eight to 12 months old. It is usually simply a “cosmetic” problem for a baby as it looks like a yellowish plaque on a baby’s scalp and is often not even noticed by anyone other than the parents. Unlike seborrheic dermatitis in adults, cradle cap typically doesn’t itch. It is thought that cradle cap may occur in infancy due to hormonal influences from the mother that were passed across the placenta to the baby. These hormones cause the sebaceous glands to become over active. In some severe cases an infant’s scalp becomes really scaly and inflamed and causes even more parental concern, as it appears that the infant is uncomfortable and may be trying to scratch their head by rubbing it on surfaces. The treatment for cradle cap is to wash the baby’s scalp daily with a mild shampoo and then to use a soft comb or brush to help remove the scales once they have been loosened with washing. When washing the head make sure to get the shampoo behind the ears and in the brows (keeping the soap out of baby’s eyes). This is usually sufficient treatment for most cradle cap. In situations where the greasy scales seem to be worsening it may help to put a small amount of mineral oil or olive oil on the baby’s head and let it sit (I left a small amount on my children’s heads overnight) and then to shampoo the following day. The oil will help the scales to loosen up and come off more easily. For babies that have very inflamed irritated cradle cap a visit to your pediatrician may be warranted to confirm the diagnosis. In persistent cases I often recommend shampooing several times a week with a dandruff shampoo that has either selenium (Selsun) or zinc pyrithione (Head and Shoulders) making sure not to get any in the infant’s eyes. I may then also use a hydrocortisone cream or foam on the scalp that will lessen the inflammation and itching. In these cases it may take several weeks to totally clear up the problem. As children get older, especially during puberty, you may see a return of seborrhea as dandruff. Again you can use dandruff shampoos. It also seems that with the overproduction of sebum there is an overgrowth of a fungus called “malessizia” so using a shampoo for dandruff as well as a antifungal shampoo (Nizoral) often works. I have teens alternate different shampoos, as sometimes it seems to work better than always using the same shampoo for months on end. Teens don’t like white flakes falling from their scalp and unlike a baby, a teen is worried about the cosmetic issues of seborrhea! That’s your daily dose, we’ll chat again tomorrow. Send your question to Dr. Sue!

Daily Dose

How to Treat Croup

1.15 to read

Now that the weather seems to change daily, croup season is here. Have you heard the sounds of raspy, throaty voices in your house lately? This "noise" is ushering in croup season! Croup is an infection that causes swelling of the larynx (vocal box) and trachea (windpipe) that in turn makes the airway just beneath the vocal cords become swollen and narrow. When you have swelling and narrowing of the airway breathing becomes more difficult and noisy and the sound that is made, almost like that of a seal barking, is called being “croupy”. Croup is quite common in young children, but the sound the emanates from that child when they cough, can be scary and concerning for both parent and child. Children are most likely to get croup between the ages of six months and three years. As a child gets older croup is not as common as the trachea gets larger with age and therefore the swelling does not cause as much compromise. When you awaken in the middle of the night to hear your child “barking” in the next room you need to know what to do. Most croup is caused by a common virus, so croup is not treated with antibiotics. The mainstay for the treatment of croup is try and calm you child, as they may be scared both from the tight feeling in their chest, as well as the sound that is made when they are breathing and coughing. The best treatment for croup seems to be taking your child into the bathroom and turning the shower on hot. Let the steam from the hot water fill the room and sit in there and read a book or two to your child. Typically within five to 10 minutes (before the hot water runs out) the moist hot air should help your child’s breathing. They may still have the barking, croupy cough, but they should be more comfortable and will not look like they are having trouble breathing. If the moist steam does not work, and it is a cool fall night, go outside. That is right, taking your “croupy” child from the moist heat in the bathroom, outside to cool night air may also help open their airways. If your child is showing signs of respiratory distress, with color change with coughing (turning blue while coughing, red is always good), is retracting (using their chest muscles between the ribs to help them breath), is grunting with each breath, or seems quite anxious and having trouble breathing you should call for emergency help. If a child is having real difficulty breathing they may be admitted to the hospital to have supplemental oxygen or breathing treatments. Steroids have also been helpful when used for the correct patient population. Steroids may be used in both an outpatient and inpatient setting. Steroids help to reduce inflammation in the trachea and the symptoms lessen over several days. Steroids used in a short burst are not harmful to your child, and are indicated in a child who may have mild respiratory distress due their croup symptoms. Your child may have symptoms of croup for several days, and for some reason they always seem to be worse at night. Put your child to bed with a cool mist humidifier in their room for the next several nights, this will also help to provide moisture to their airway. It is not uncommon for some children to seem more “prone to croup” and may get it recurrently all fall and winter. Have the humidifier handy and in working order! That’s your daily dose, we’ll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

Staph Infections Often Appear Quickly

The latest thing in my office has been a bout of staph skin infections.

 In fact, I am typing this and I am going to attach a picture of one of my patients who I just saw with a fairly “classic” staph infection on their leg. What did we do before parents had iPhones that took pictures of their children’s maladies that could be forwarded to you day and night? It really does come in handy for a visual of skin related rashes and infections. So, staph is the common term used when doctors are discussing Staphylococcus aureus, a bacteria that is known to cause infections and is  commonly seen with skin infections. These skin infections present as a boil, or cellulitis (infection of the skin and soft tissues), or  impetigo, or other infections related to the skin. But in this case we are going to look at a boil (an abscess within the skin) and  surrounding cellulitis. Staph infections often appear quickly, “almost overnight”, when a parent or child may notice a bump that may resemble a bite. But in this case this “bite” rapidly reddens and becomes tender and warm to the touch. It really looks “angry” and as my grandmother used to say “festers”. Parents will often call and say, “I think my child has a spider bite”, when in reality it is a brewing staph infection. When I hear spider biter, out of the blue, I think staph. I jokingly tell parents, “I don’t think there are enough spiders in the world to cause all of these “bites” that are really staph infections.” Since staph is a bacteria it is susceptible to antibiotics. But over the last several years we have seen children of all ages presenting with resistant staph infections, typically with MRSA or methicillin resistant staph. This is an important distinguishing factor, as this will determine which antibiotic is used to treat the infection. In order to figure out which antibiotic to use, the doctor needs to culture the “pus” that is in the boil. That means growing the bacteria from the “bite, boil, infection” and identifying the bacteria, and from that culture the lab will also determine which antibiotic the bacteria is susceptible to. All of this information will ensure that your child is put on the appropriate antibiotic to treat the infection. At times it is necessary to drain the infection and in more serious cases, a child may be admitted for IV antibiotics. I often have parents ask, “Where did we get this?” Staph is everywhere, on our hands, in our noses and on other commonly shared objects like towels, changing tables and in locker rooms. Encourage your child to wash their hands, try to avoid touching their noses, and to avoid picking at cuts and bites. Despite all of this, we all have micro-abrasions on our skin that are not even visible and that tiny staph bacteria can just hop on in and develop a random infection. Staph skin infections really do have a “typical” appearance. That is why I am showing you this picture. If you see your child suddenly develop a “bite” that looks like this, you need to call the doctor. The sooner the infection is treated the better. That’s your daily dose, we’ll chat again tomorrow! Send your question to Dr. Sue.

Daily Dose

Prebiotics and Probiotics

1:30 to read

There has been plenty of discussions about using prebiotics and probiotics in your child's diet. What is the difference between the two? There has been a lot of discussion lately (in both medical and lay literature) surrounding the use of prebiotics and probiotics.  The first question patients/parents often ask is what is the difference between the two “biotics”? Prebiotics are non-digestible nutrients that are found in foods such as legumes, fruits, and whole grains. They are also found in breast milk.  Prebiotics have also been called fermentable fiber. Once ingested, prebiotics may be used as an energy source for the good bacteria that live in the intestines. Probiotics are beneficial live bacteria that you actually ingest. These bacteria then pass from the stomach into the intestine to promote “gut health”. The gut is full of bacteria and these are the “good bacteria”.  

There are currently hundreds of different probiotics being marketed. The research on the value of using prebiotics and probiotics has been ongoing, but there are actually very few randomized, double blind, controlled studies to document that pre and pro-biotics provide any true benefit to treat many of the diseases that they are marketed to treat. There are several areas where probiotics have been shown to be beneficial. By beginning probiotics early in the course of a viral “tummy infection” in children the length of diarrhea may be reduced by one day. Probiotics have also been shown to be moderately effective in helping to prevent antibiotic associated diarrhea, but not for treatment of that diarrhea.

There are also studies that are looking at giving very low birth weight premies probitoics to help prevent a serious intestinal infection called necrotizing enterocolitis. To date there seems to be evidence to support this and there are currently more ongoing studies. Studies are also being done to look at the use of probiotics as an adjunct to the treatment of irritable bowel syndrome, infantile colic, and chronic ulcerative colitis as well as to possibly prevent eczema.  While preliminary results are “encouraging” there is not enough evidence to date to support their widespread use. In the meantime, there are so many different products available.  Prebiotics and probiotics are now often found in dietary supplements as well as in yogurts, drink mixes and meal replacement bars. It is important to read the label to see if these products are making claims that are not proven such as, “protects from common colds”,  or “good bacteria helps heal body”.  Many of the statements seem too good to be true!

Until further studies are done there is no evidence that these products will harm otherwise healthy children, but at the same time there is not a lot of data to recommend them. They should never be used in children who are immunocompromised,  or who have indwelling catheters as they may cause infection. This is a good topic to discuss with your doctor as well.

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