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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

How to Treat A Vomiting Child

We are definitely in the throes of "sick season" in our office and with that comes a lot of kids with vomiting. I remember the first time that one of my own children vomited.

We were in Target, he was about two and he had said he "was sick". Now, seeing that he was not very specific and did not elaborate, I just went on shopping. Several minutes later, as he sat in the cart (with seat belt fastened), he just looked at me wide eyed and suddenly vomited. This is the moment as a parent that you understand the difference between babies that "spit up", and true, projectile vomiting! Now what do you do once your child has vomited (besides rush out of Target as fast as you can)? Once a child has vomited it is important not to give them anything else to eat or drink, for at least 30 to 45 minutes. That means even if they are "begging" for a drink, as you will probably see it come right back at you if you do. After waiting, you want to begin re-hydrating with clear liquids. Not a good idea to pull out the milk or food yet. In an infant you can use Pedialyte, which is an oral electrolyte solution, and instead of breast milk or formula you can try feeding your infant about an ounce of Pedialyte every 10 to 15 minutes and see if they can keep Pedialyte down. In toddlers and older children I use Gatorade, as it is not quite as "salty" and kids seem to take it better. Again, frequent small sips of Gatorade while you wait to see if the vomiting is persistent. Don't go too quickly on giving them larger volumes. The key is small amounts, frequently, which are easier to handle. As your child keeps down the Pedialyte or Gatorade you can increase the volume that they are taking and decrease the frequency. The main thing you are trying to do with a child of any age is to keep them from getting dehydrated and their vomiting is typically due to a viral illness affecting their GI tract. Because it is typically a virus that is the culprit for nasty vomiting, it just takes time to get through the illness. There is no "miracle" cure, and watching your child vomit, or cleaning up the vomit that invariably is usually not in the toilet, is one of the worst parenting jobs. That being said, there are very few children who will not experience vomiting at least once or twice during their childhood, so you need to keep "clear liquids" on hand in the pantry. Having powdered Gatorade around is a lifesaver at 2 a.m when your four-year-old wakes up and throws up. If you are giving the clear liquids, and your child tolerates larger volumes, but then vomits again later on, you just back up and start all over with smaller amounts more frequently. It is somewhat like a "balancing act" to give enough that they are hydrated, but at the same time to not give too much at one time that they vomit again. Slow and steady is the mantra. You should always be looking for your child to have tears, a wet and moist mouth (put your finger in there, it should come out with some saliva on it), and urine. It is often hard to tell if a child in diapers has had a wet diaper as they will not be "soaking" the diaper and smaller amounts of urine are "wicked" with the new super absorbent diapers. Children will also be pitiful after vomiting and may seem "lethargic" to you, but if they are an infant and can smile and make good eye contact or they are an older child who can tell you they feel terribly and don't want to drink Gatorade or play with their blocks they are probably not dehydrated. If in doubt, give your doctor a call to discuss what is going on. After using Pedialyte and Gatorade, and your child has not vomited for six to eight hours you can try adding some formula or breast milk, or other liquids such as chicken soup or a Popsicle. I still would not start solid food until the child has kept down other liquids. We parents all worry if our children don't "eat" but the fluids are the important part, and as we all know, a day without out chicken nuggets or peanut butter will be okay. Keep up the fluids!! If your child continues to vomit despite your best efforts with "slow and steady" fluids you need to call the doctor. We have plenty of patients that we see everyday to make sure they are hydrated, and to even watch them while they take fluids in our office. Occasionally, when all else fails we will have to hospitalize a child for IV hydration. Oh yes, remember to wash your hands frequently as these nasty viruses are contagious and parents will often find themselves getting sick after their children. That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

First Cold

1:30 to read

My office is hopping with a lot of little ones and their first colds. The worst cold that a parent experiences is not their own cold, but their child’s first  one.  Unfortunately, babies that are born in the fall and winter months often get their first cold earlier than a baby born during the spring and summer. 

It is such a helpless feeling for a new parent to see their baby with a runny nose, red rimmed eyes and a cough.  While newborns routinely experience nasal congestion, a cold is different. With a cold the baby’s nose will run and have clear to colored mucous,  and they will typically cough, just like all of us with a cold. They just look so pathetic...but you need to know what to watch for....as there will be more colds throughout the winter.

A baby (over the age of 2 months) may run a bit of a fever with their cold. A fever is defined as a temperature over 100.4 degrees. I am old school and still do rectal temperatures....just don’t think the temporal and ear thermometers are accurate.  The fever, if they even have one, should not last more than a day or two and should respond to the appropriate dose of acetaminophen for your child’s weight.

The biggest concern for a baby with a cold is how they are breathing. While they may look pitiful with that gunky nose, and have a loose junky cough, how your child is breathing is most important. You need to actually look at your child’s chest while they are breathing and coughing to make sure that they are not having any respiratory distress. Undo their onesie or take off the nightgown and look at their chest.  You do not want to see your child’s chest moving in and out (which is called retracting) or see that they are using their tummy (which is going up and down) to help them breathe.  The cough may sound horrible, but always look at their chest (visual more important than audible). They should also be nice and pink...even when they are coughing.  A cool mist humidifier in their room at night will also help.

Best thing for gunky nose is a nasal aspirator or nose Freda with some saline drops. Clearing the nostrils is often one of the best ways to help your child breathe, which will also help them to take the bottle or breast. A baby may not eat as well when they are sick (same as you and me) but they will take enough to stay hydrated and have wet diapers.  Being sick at any age typically effects your appetite and as your child is feeling better their appetite will improve as well.

Getting past that first cold is a milestone for baby and parents....but if you have any concerns about your child’s breathing, hydration or persistent fever, always call your doctor.

Daily Dose

Does the Color of Mucus Really Matter?

1.30 to read

It is that time of year and everyone seems to have a cold, including me!! I am actually “on” my second cold of the month, so I am feeling like a toddler who gets sick every two to three weeks.  

This is really a good time to talk about mucus. I wonder how many people will keep reading now? But I do get lots of questions and comments from parents who are worried about the color of their child’s mucus. Runny noses and mucus color are discussed as often as color of poop. And just like poop, the color of your nasal mucus is usually not terribly significant. 

If you happen to have a cold yourself, you probably notice that your nasal discharge changes throughout the day, that is unless you are a teenager, and they swear they never look at mucus or stool color!! I think we notice “green snotty noses” among children between the ages of six months and four years, when they typically don’t blow their noses and many times the mucus is either wiped off of their face or they wipe it themselves on their shirt sleeve, (which then leaves a telltale sign of the color of the mucus). Once a child can blow their nose and dispose of the Kleenex, the color of the mucus does not seem to be a hot topic of discussion.

So, what does color of mucus mean? When you have a cold, the nasal discharge associated with that viral infection typically begins as a clear discharge, that changes over several days into a thicker and more purulent (green) discharge. The color may be due to the white cells that are in the mucus that are producing antibodies to fight the cold. 

As a cold progresses the green mucus then changes back into a more clear discharge and eventually goes away, but that is usually after a seven to 10 day course. It is also common to see thicker “booggers” in the nose in the morning or after your child’s nap as the dry air they are breathing makes the mucus thicker and they are not wiping or blowing their noses so the mucus is thicker. Same for us, we also usually have thicker greener nasal discharge in the morning, while the “snot’ has been sitting overnight. The best way to clear out any color mucus is by using saline nasal irrigation. It works great for all ages. By clearing the nasal passages, it will prevent a secondary bacterial infection which and cause a sinus infection.   

Most doctors use length of time of nasal discharge as more indicative of an infection than color of mucus. Typically in a pediatric patient an antibiotic for a “presumed” sinus infection is not even considered until a child has had over 14 days of a “gunky” green nasal discharge. Remember too, that the nose can clear up and the cold can go away, only to be followed in another week or two by another cold. It is the season. With that being said I am off to blow my nose again and wash my hands! 

That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

Dealing with Warts

1.30 to read

Warts are one of the most common skin lesions seen in pediatric practices. Warts also drive parents and some kids crazy!  According to one study up to about 1/3 of school children have warts.  

Warts are viral infections of the skin which are caused by human papilloma viruses (HPV).  There are more than 100 types of HPV and different types of HPV cause different types of warts. The most common warts on hands and knees are caused by HPV types 1,4, 27, 57.  These are not the HPV types that cause sexually transmitted infections 

Some people seem to be more prone to getting warts than others, and it is not uncommon to see several children in one family dealing with warts. The HPV virus is spread through skin to skin contact or through contaminated objects or surfaces. In other words, they are hard to prevent.  HPV can also have a long incubation period, so when parents ask, “Where and when did my child get this wart virus?”, my answer is typically, “not even the CIA will be able to tell you that”.  

I many cases if the warts are left alone they may resolve on their own in months to years (one study showed two thirds remission in 2 years) ......but with that being said, most teens (especially girls) want those warts to “be gone!” 

There are several different ways to treat warts and one of the most effective is with over the counter (OTC) products that contain salicylic acid.  Salicylic acid acts as an irritant that activates an immune response against HPV.  There are tons of different OTC products and in many studies there was not one product that proved superiority over another, so I would buy an “on sale” salicylic acid for starters. I know from using these on my own children that you have to be consistent and persistent in their use....but it did work. 

If OTC products don’t seem to be working the next step for those who are determined to try and get rid of the wart,  is to head to the doctor who may try freezing the wart with liquid nitrogen or using cantharidin.  Unfortunately, there is typically a little pain involved with these products. 

Like so many other things, sometimes it may pay to just to wait it out and see if the virus just gives up and goes away!

Daily Dose

Homemade Cure for Coxsackie?

1:30 to read

Desperate times call for desperate measures…or so it seems according to several of my patient’s mothers who have resorted to all sorts of “cra-cra” stuff to “treat” their child’s “HFM” - hand foot and mouth infection.  Remember, HFM is a viral infection that most children get in the first several years of life. It may cause all sorts of symptoms but in a classic case the child develops a macular-papular (flat and/or raised) vesicular rash on the palms, soles and buttocks. In some children the rash is fairly mild and in others it can look pretty disgusting and uncomfortable…but it has to fade away on its own…with time.

 

There has been a lot of HFM in our area and much anxiety among parents about this infection….fueled a lot by social media identifying who has HFM and where they go to school and how many cases there are. (too much information!!). Parents are even posting…places to “stay away from”. So, some of my patient’s parents are scouring their child looking to see if there might be a bump..and could this be HFM and if so, what do I do to “stop” it!  That would be “nothing” besides good hand washing..as this is a viral infection and you may be exposed to it almost anywhere.

 

Since coxsackie virus has been around for years, this means that most adults had the virus when they were young.  But, several moms and dads whose children have HFM have also shown me a rash on their palms and soles, that I presume may be HFM? They are kind of freaked out and may be uncomfortable too…but this is not life threatening.  Even so,  several parents are resorting to THE GOOGLE to get their medical information… and one young mother kindly brought me all of the stuff that she had gotten to treat her son’s HFM as well as hers.  She was earnest in hoping that this was the “cure”…and did I know about all of these remedies?

 

Here we go, her potions!  Epsom salts for baths as this is an “antiviral”, turmeric and ginger in veggie juice, crushed garlic which she was mixing with small amounts of orange juice and squirting into her toddlers mouth with a syringe, lavender essential oil and lastly “virgin” coconut oil massages.   

 

I was most impressed that her sweet toddler was eating, drinking and bathing in all of this!!! Unfortunately, despite her best efforts it took about 2 weeks for his rash to totally disappear and she kept him under house arrest for most of that time!!  He really could have gone out long before that as he was over his acute illness, but she wanted every “mark” to have faded. She was most chagrined to hear that he might get HFM again. I am not sure the her “voo-doo” did any good, except in her mind. 

 

Lastly, if you do resort to “internet medicine” remember the oath, “first do no harm” and check with your pediatrician about some of the advice you might find online, not everything may be safe.

 

Daily Dose

World Health Organization Virus Alert!

1.15 to read

An article in the news caught my eye today when I noticed that The World Health Organization (WHO) called an emergency meeting to discuss the infectious disease known as MERS (Middle East Respiratory virus, formerly known as nCoV).   This is only the second time that the WHO has called an emergency meeting, the first being in 2009 with the H1N1 bird flu virus.

While the name is complicated the biggest issue is that this VIRUS has only been identified in the past year. It was identified in 2012 as a “novel coronavirus” and is similar to the SARS virus from a decade ago.  This virus which also causes a respiratory illness has been confirmed in 55 patients mainly from the Middle East.  There have been a few cases reported in travelers from other countries ( France, UK, Italy and Tunisia) who had been to the Middle East.  Saudi Arabia has had 40 reported cases.  The alarming fact is that 31 of the 55 cases have died.

Now you may wonder why this really interests me???  I am always interested in emerging infectious diseases and how this infection might make its way to the U.S. as all doctors need to stay abreast about new infections.   But, coincidentally, I have just returned from overseas and 2 days later, I have an upper respiratory infection and cough. Now, I really do FEEL OKAY but as I have reminded people before infectious diseases are just a plane ride away.  You can never really know how you may contract a viral illness and the MER-S virus has been found to have human-to-human transmission. 

The WHO still does not know the original source or route of the virus that caused human illness.   This again reiterates the importance of vaccines and disease prevention!!!! While there is not a vaccine (to date) for MERS, there are plenty of vaccines that when given are working well to prevent communicable diseases.  (another reason to vaccinate your child!)

So.....I am going to be watching for further updates from the WHO and CDC about this virus......and in the meantime I will keep drinking fluids, and covering my mouth when I cough. I will say my trip was really fun!!    

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Daily Dose

More Zika News

1:30 to read

There continues to be more and more information being published about Zika and the continued concerns over side effects of the viral infection. So there are several new key facts that every parent needs to know.

Based on more research the CDC and WHO have now confirmed the link between Zika virus infection and birth defects. Two interesting studies were just published further substantiating the link. The first was in the journal Stem Cell in which researchers found that the Zika virus selectively infects cells in the brain’s outer layer which makes “ those cells more likely to die and less likely to divide normally and make new brain cells.” In other words, Zika preferentially affects tissues in the brain and brain stem of the fetus.  While this does not prove that Zika causes microcephaly it certainly points to the fact that brain cells are very susceptible to the virus and if the cells don’t divide to make new cells….one would think the brain would be smaller as would the head (microcephaly).

Another article in the New England Journal of Medicine reported on research that had been done on 88 pregnant women in Rio. The article stated, “infection during pregnancy has grave outcomes including fetal death, placental insufficiency, fetal growth restriction and central nervous system involvement.”  They also stated that “major fetal abnormalities were found in nearly a third of the women who had been infected and had undergone ultrasounds.” This virus seems to act like some other viruses (rubella) that have caused congenital infections and brith defects as well. The study also showed that the Zika virus may affect the placenta as well, which could cause miscarriages and/or still births.

While much of the Zika virus news has focused on pregnant women and associated birth defects, countries with high rates of Zika infections have also seen an increase in the number of cases of Guillian Barre Syndrome (GBS), a neurological disorder which causes muscle weakness and varying degrees of paralysis.  A study published in The Lancet reviewed results of blood tests from patients who had Zika and GBS in French Polynesia, which was the site of an earlier Zika outbreak. Of the 42 patients that had been diagnosed with GBS, 41 had antibodies to Zika, which is more evidence that Zika may be the cause of the serious neurological condition. While GBS has been seen in children and adolescents post Zika, it tends to be seen more frequently in older adults and is actually a bit more common in men.

Although it seems that the virus affects pregnant women and older adults in different ways, the severe side effects of Zika are in both cases related to the nervous system. There is still much research to be done to elucidate the how and the why, before any type of cure or vaccine is available, but all of these studies are getting scientists one step closer.

Another issue that scientists continue to work on is how to best test for Zika virus.  It is still not clear how long the incubation period is after being exposed to Zika virus, and remember about 80% of people will not even realize they were infected. With that being said, one of the tests ( called a PCR test)  requires that the patient’s blood be drawn within 4 - 7 days after being bitten by the infected mosquito. Another test ( Zika MAC-ELISA) , may be the better test as it may be used for a longer period of time after being bitten. Both of these tests are being used for diagnosis and are now being sent to qualified labs to help speed up the diagnosis of Zika. 

In the meantime as warmer, humid weather is approaching the United States, we all need to be pro-active about using insect repellant, reduce standing water (it has been raining in TX for days), and wear long sleeved clothes and pants when possible. Stay tuned for further updates as the CDC expects to see cases of Zika in the U.S. over the coming months. To date all of the Zika cases that have been diagnosed in the U.S. have been imported and not acquired here.  

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