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Daily Dose

Mumps Outbreak!

1:30 to read

The latest infectious disease outbreak is in the Boston area where several colleges have reported cases of mumps. Mumps is a viral illness that causes swelling of the salivary glands as well as other symptoms of fever, fatigue, muscle aches and headache.    Harvard University has been hit the hardest and has now documented over 40 cases this spring.  Boston is a city with numerous colleges all in close proximity, and there are documented mumps cases at Boston University, University of Massachusetts  and Tufts as well.  These Boston area colleges are all in close proximity and are merely a walk, bike or train ride away from one another, so these students, while attending different universities may all co-mingle at parties and athletic events.

Mumps is spread via saliva (think kissing), or from sharing food, as well as via respiratory droplets being spread after coughing or sneezing. It may also be spread via contaminated surfaces that will harbor the virus. People may already be spreading the virus for  2 days before symptoms appear and may be contagious for up to 5 days after their salivary glands appear swollen….so in other words there is a long period of contagion where the virus may inadvertently be spread. It may also take up to 2-3 weeks after exposure before you come down with mumps.

All of the students who have come down with mumps had been vaccinated with the MMR vaccine (mumps, measles, rubella).  Unfortunately, the mumps vaccine is only about 88% effective in preventing the disease. Despite the fact that children get two doses of vaccine at the age of 1 and again at 4 or 5 years….there may be some waning of protection over time. This  may also contribute to the virus’s predilection for young adults in close quarters on college campuses. Something like the perfect infectious disease storm!

In the meantime there are some studies being undertaken to see if adolescents should receive a 3rd dose of the vaccine, but the results of the study are over a year away.

In the meantime, be alert for symptoms compatible with mumps and make sure to isolate yourself from others if you are sick.  Harvard is isolating all of the patients with mumps for 5 days….which could mean that some students might even miss commencement.  Doctors at Harvard and other schools with cases of mumps are still on the watch for more cases …stay tuned.

 

 

 

 

Daily Dose

Diagnosing Diabetes

1.15 to read

I often see parents who come in worried that their child might have diabetes. I thought this would be a great opportunity to discuss the symptoms of type 1 diabetes, which was previously known as juvenile onset diabetes. 

While there is much in the news about type 2 diabetes, which is typically related to childhood obesity, the mystery of type 1 diabetes has not yet been totally elucidated. Type 1 diabetes affects about 1 in 400 children and adolescents. There does seem to be a genetic predisposition (certain genes are being identified) to the disease and then “something” seems to trigger the development of diabetes. Researchers continue to look at viral triggers, or environmental triggers (such as cold weather as diabetes is more common in colder climates). Early diet may play a role as well, as there is a lower incidence of diabetes in children who were breast fed and who started solid foods after 6 months of age.   

In type 1 diabetes the pancreas does not produce enough ( or any) insulin. Insulin is needed to help sugars (glucose) in the diet to enter cells to produce energy.  Without insulin the body cannot make enough energy and the glucose levels in the blood stream become elevated which leads to numerous problems. Children with type 1 diabetes are often fairly sick by the time they are diagnosed.  

The most common symptoms of type 1 diabetes are extreme thirst (while all kids drink a lot this is over the top thirst) frequent urination ( sometimes seen as new onset bedwetting with excessive daytime urination as well), excessive hunger,  and despite eating all of the time, weight loss and fatigue.  

Any time a child complains of being thirsty or seems to have to go the bathroom a lot, a parent (including me) worries about diabetes. But, this is not just being thirsty or having a few extra bathroom breaks or wetting the bed one night. The symptoms worsen and persist and you soon realize that your child is also losing weight and not feeling well. 

Although diabetes is currently not curable, great strides have been made in caring for diabetics and improving their daily life. I now have children who are using insulin pumps and one mother has had an islet cell transplant. The research being done is incredible, and hopefully there will one day be a cure. 

In the meantime, try not to  worry every time your child tells you they are thirsty or tired, as all kids will complain about these symptoms from time to time.  But do watch for ongoing symptoms.  

Lastly, eating sugar DOES NOT cause type 1 diabetes. Now it may lead to weight gain which can lead to type 2 diabetes....but that is another story. 

Daily Dose

Zika Virus

1:30 to read

If you are pregnant or planning on becoming pregnant in the near future you need to be aware of the Zika virus.  This virus is spread via the Aedes mosquito (as is West Nile Virus, Dengue fever and Chikunguyna), and has been found in Africa, Southeast Asia, the Pacific Islands , South America and Mexico.  The Zika virus was also just confirmed in Puerto Rico and the Caribbean in December.  There are new countries confirming cases of Zika virus almost every day, as the Aedes mosquito is found throughout the world.  

When bitten by a mosquito that has the Zika virus, only about 1 in 5 people actually become ill.  The most common symptoms are similar to many other viral infections including fever, rash, joint pain and conjunctivitis.  For most people the illness is usually mild and lasts for several days to a week and their life returns to normal.  Many people may not even realize that they are infected. 

Unfortunately, if a pregnant mother is infected with the Zika virus, the virus may be transmitted to the baby.  It seems that babies who have been born to mothers who have been infected with the Zika virus may have serious birth defects including microcephaly (small head) and abnormal brain development. There have been more than 3,500 babies born with microcephaly in Brazil alone…and just recently a baby was born in Hawaii with microcephaly and confirmed Zika virus. In this case the mother had previously lived in Brazil and had relocated to Hawaii during her pregnancy.  The virus to date has not been confirmed in mosquitos in the United States.

Because of the association of the Zika virus and the possibility of serious birth defects, the CDC has announced a travel advisory stating, “until more is known and out of an abundance of caution, pregnant women in any trimester, or women trying to become pregnant, should consider postponing travel to the areas where Zika virus transmission is ongoing”.  

Should pregnant women have to travel to these area they should follow steps to prevent getting mosquito bites during their trip. This includes wearing long sleeves, staying indoors as much as possible, and using insect repellents that contain DEET.

Researchers are continuing to study the link between Zika virus and birth defects in hopes of understanding the full spectrum of outcomes that might be associated with infection during pregnancy. There will be more data forthcoming.

At this point the safest way to avoid being bitten is to stay away from the countries who have had confirmed cases of the Zika virus.  But as the weather warms up in the United States and mosquitos become more abundant there is concern for Zika virus to be found here.  It only takes one infected mosquito to bite one person who then contracts the virus….should that person be bitten by another mosquito, that mosquito may acquire the infection and so it spreads.  There is not known to be human to human transmission of the virus.

Daily Dose

Migraines in Children

1.15 to read

I received an email via our iPhone App inquiring about migraines in children. Headaches are a common complaint throughout childhood, but pediatricians have recognized that children have many different types of headaches which include migraine headaches. 

Migraine headaches are best diagnosed by obtaining a detailed history and then a thorough neurological exam. There are several characteristics of childhood migraines that are quite different than adult migraines. While adult females have a higher incidence of migraine headaches, males predominate in the childhood population. 

Childhood migraines often are shorter in duration than an adult migraine and are less often unilateral (one sided) than in adults. Only 25-60% of children will describe a unilateral headache while 75-90% of adults have unilateral pain.  Children do not typically have visual auras like adults, but may have a behavioral change with irritability, pallor, malaise or loss of appetite proceeding the headache.  About 18% of children describe migraine with an aura and another 13% may have migraines with and without auras at different times. When taking a history it is also important to ask about family history of migraines as migraine headaches seem to “run in families”. 

Children who develop migraines were also often noted to be “fussy” infants, and they also have an increased incidence of sleep disorders including night terrors and nightmares. Many parents and children also report a history of motion sickness. When children discuss their headaches they will often complain of feeling dizzy (but actually sounds more like being light headed than vertigo on further questioning). 

They may also complain of associated blurred vision, abdominal pain, nausea and vomiting, chills, sweating or even feeling feverish. A child with a migraine appears ill, uncomfortable and pale and will often have dark circles around their eyes. It seems that migraine headaches in childhood may be precipitated by hunger, lack of sleep as wells as stress. But stress for a child may be positive like being excited as well as typical negative stressors. 

Children will also tell you that their headaches are aggravated by physical activity (including going up and down stairs, carrying their backpack, or even just bending over). They also complain of photophobia (light sensitivity) and phonophobia (sensitive to noises) and typically a parent will report that their child goes to bed in a dark room or goes to sleep when experiencing these symptoms. 

Children with migraines do not watch TV or play video games during their headaches. They are quiet, and may not want to eat, and may just want to rest.  Nothing active typically “sounds” like fun. To meet the diagnostic criteria for childhood migraine, a child needs to have at least 5 of these “attacks” and a headache log is helpful as these headaches may occur randomly and it is difficult to remember what the headache was like or how long it lasted, without keeping a log. 

There are many new drugs that are available for treating child hood migraines and we will discuss that in another daily dose.  Stay tuned! 

Daily Dose

National Poison Prevention Week

1:30 to read

It is National Poison Prevention Week and it seem appropriate since I just received a call last week from an anxious mother whose toddler had gotten into some medication at their house. The child was fine but I reminded her that more than 2 million people each year, about half under the age of 6, ingest or come into contact with a poisonous substance.  The majority of these incidents occur when parents or babysitters are present but are not paying attention at the time. As I remind parents, it is IMPOSSIBLE to watch your child, even with just one child, all of the time. So…it is necessary to take steps to try to prevent accidental poisonings.

 

The most dangerous potential poisons are medicines, cleaning products, liquid nicotine, pesticides, gasoline and kerosene. I am always surprised to hear that a child will drink gasoline (YUCK right?) but toddlers do crazy things and put EVERYTHING in their mouths.

 

When “child-proofing” the house against so many dangers, try to keep as many poisonous products outs of a child’s reach and view as possible.  Install safety latches on all cabinets that may contain any hazardous products …including laundry products and cleaning products. I would advise against using any detergent “pods” with children under the age of 6 and use powder or liquid instead.  A safer product is worth a little bit of hassle!

 

Make sure that ALL medications, even vitamins are in containers with child safety caps (adults can’t open them but kids seem to?), but you must also keep them out of reach of children and I would recommend a cabinet that you can lock.  There have been several occasions when a parent has left a pill out on a counter for another child to take and then suddenly the toddler has chewed it up…this has been most common with stimulant medications.  Grandparents who are visiting also forget and leave their medications out and kids seem to find these as well.

 

Another common potential poison comes in the form of a button cell battery. These are common in remote controls, key fobs, greeting cards and even musical children’s books and not only pose a choking hazard but may cause tissue damage. If your child ingests a battery it is imperative that you seek immediate treatment at an emergency room.

 

If you are ever in doubt about the potential for poisoning call Poison Help at 1-800-222-1222. They are experts in walking you through potential side effects, treatments and need for an ER visit!  One of my patients just asked me if there is a limit to how many times you can call Poison Control…she seems to be a frequent flyer.

 

 

 

 

 

 

 

 

Your Child

Probiotics Reduce Diarrhea and Respiratory Infections

2.00 to read

A daily dose of probiotics can reduce the occurrences of diarrhea or respiratory tract infections in children who attend day care according to a new study.

Probiotics are live microorganisms that are similar to the natural and beneficial microorganisms found in the gut. They are often referred to as “good bacteria.”

In a study in Mexico, researchers tested 336 healthy children ages 6 months to 3 years who were attending day care centers. Half received a daily dose of Lactobacillus reuteri, a beneficial gut bacterium naturally present in many foods and in most people; the other half got an identical placebo.

The children were given probiotics or the placebo for 3 months and then followed for another 3 months without the supplements. During the study, 69 episodes of diarrhea were reported in the placebo group and 42 in the group receiving the probiotics. The placebo group had 204 respiratory tract infections, compared with 93 in those taking L. reuteri. And the placebo takers spent an average of 4.1 days on antibiotics, while the supplement users averaged 2.7 days. The differences persisted during the 12-week follow-up.

“What’s notable here is that they used a specific probiotic in a good design and they also did follow-up,” said Stephen S. Morse, an infectious disease specialist at Columbia University who was not involved in the study. “This strengthens the evidence for the value of probiotics, but we still have a lot to learn.”

The research group concluded that a daily administration of probiotics in healthy children in day care centers “had a significant effect in reducing episodes and duration of diarrhea and respiratory tract infection, with consequent cost savings for the communities”.

Probiotics have been added to many food and beverage products making it easier for parents to add them to their child’s diet.

The most common food is yogurt but some manufacturers have added probiotics to ice creams, granola bars, cereals, juices and yes…even pizza.

Some parents swear by probiotics saying that they have eased their children’s symptoms of colic, eczema and intestinal problems.

Antibiotics kill bad bacteria, but they can also kill the good bacteria and throw a child’s gut flora out of balance - leading to gastrointestinal distress. Previous studies have shown that adding supplements or foods containing probiotics to a child’s diet can have a positive affect on his or her bacterial balance.

The study was published in the journal Pediatrics and was supported by a grant from a manufacturer of probiotic supplements.

Sources: Nicholas Bakalar, http://well.blogs.nytimes.com/2014/03/17/probiotic-eases-ills-in-children/?_php=true&_type=blogs&_r=0

Nancy Gottesman, http://www.parents.com/toddlers-preschoolers/feeding/healthy-eating/probiotics-the-friendly-bacteria/

Daily Dose

Home From School

1:30 to watch

I continue to talk about it being  the “sick season” and thankfully it is now February!  Parents are all tired of having sick children and I can now at least assure them that we are halfway to the end of upper respiratory and flu season.

 

But, with that being said that means I am still seeing children with RSV, Flu and every other virus I can think of. Remember, the majority of the illness I see every day in my office is VIRAL.  It really doesn’t matter if you can put a name to the virus, as the treatment is the same. Rest, fluids, fever control and watch for any respiratory distress or symptoms of dehydration. As I told one young mother who said that her other child had been tested for RSV (by another doctor), testing the child I was now seeing will not make any difference in how we treat the illness. So, why make the child uncomfortable when doing the swab and also drive up health care costs, for no change in treatment recommendations.  I think people are confused about what the test actually does….it does not change how a child is treated, and it also causes a lot of “alarm” as the mother of one patient goes home to tell her friends that her child has RSV and then the school starts sending out emails and parents become more anxious and alarmed that they may have been exposed….as they are every day all over our city.

 

So…when do you know it is time to keep your child home from day care or school as we all know these viruses are spread at home, school and work as well.  

 

If your child has a fever over 100.5 degrees (by any method of taking their temperature) they should not go to day care or school for at least 24 hours after becoming fever free (without fever lowering medication).

 

If your child is vomiting, 2 or more times in the last 24 hours, they should stay home. Some young children may vomit after coughing as well, but if infrequent they may attend school. 

 

Diarrhea as defined by two or more loose, watery stools that are “out of the ordinary stool pattern” for your child. Any child having diarrhea that does not stay contained within a diaper should stay home. A child who has blood in their stool should not attend day care or school (and should see the doctor).

 

Children with strep throat may return to school after 24 hours if they are fever free and have received the appropriate antibiotic therapy.  (Newer article suggests 12 hours if they are feeling well).

 

Your child does not need to stay home due to a cold, cough, runny nose (of any color) or scratchy throat if they do not appear ill and do not have a fever. Look at how your child is behaving…some times a day of rest may be needed (even when you get sick, right?) 

 

Most importantly, it is not necessary to name the virus that your child might have, but to follow the guidelines for keeping them home (as well as out of stores, church, and after school activities) until they are feeling better. Wash hands, cover coughs and yes….still get the flu vaccine. It is not too late…the ground hog even said we still have a lot of winter left.

 

 

 

Daily Dose

Strep Throat

1:30 to read

It is still what I call “sick season” and strep throat is here and for some reason even seems to “flourish” during early spring.   Strep throat is a bacterial infection that is typically seen in school aged children between the ages of 4-16 years (but may be seen in younger children and adults on occasion).  Strep symptoms begin with a sore throat, often a fever, swollen lymph nodes in the neck, and some children may have a headache as well as abdominal symptoms with vomiting. 

Because strep throat is due to a bacterial infection it is treated with an antibiotic.  But in order to diagnose strep throat your child will need to have a rapid strep test which entails having a swabbed specimen taken from your child’s throat (tonsils and posterior pharynx).  The test is pretty easy and most children don’t mind a throat “swab” or specimen (we call it tickling your tonsils), although some children may gag and even vomit.  But rest assured, there is not a needle involved in a strep test!!  The rapid strep test takes about 5 - 10 minutes and will determine if your child needs an antibiotic. This test if really accurate, but in our office we also do a back up overnight culture (old school) on all negative rapid strep screens so as not to miss any false negative tests.

While strep is treated with an oral antibiotic (on occasion a shot for a vomiting child ), the rule of thumb was 24 hours at home after beginning antibiotics before returning to school or outside activities. An interesting study published in the Pediatric Infectious Disease Journal concluded that “children treated with amoxicillin (who are not allergic ) by 5 pm, and if fever free, could attend school the following day” and not put other children at risk.

Although this was a small study (only 111 children ), the authors found that 91% of the children who had received an appropriate initial dose of amoxicillin, had undetectable group A Strep on the rapid test and on a  throat culture on the second day. 

While this study is interesting, I also think that there are several important points to be made. A child with strep throat may no longer be contagious after 12 hours, but how are they actually feeling?   Did they sleep well that night? Do they still have a sore throat or maybe a headache? (despite being fever free) Is it better for that child to stay at home for a day rather than rushing back to school when “not at the top of their game”?

I do realize that it may be helpful for working parents as it would get them back to work more quickly as well, we still need to consider how their child is feeling.  Sometimes, while an antibiotic will “treat” the infection, a day of rest, fluids and no school may be just what the doctor ordered.  I still think we need to look at the individual child…and make a decision based on multiple factors. 

 

 

 

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