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Daily Dose

Viral Skin Rashes

We often see in kids are viral rashes (exanthems) that seem to appear as the other viral symptoms are resolving.While on the topic of skin, let's talk about viral rashes in kids. As every parent knows, your child will get several 100 or is it 1,000 viruses during their 18 years at home with you. Most of these viral infections present with typical fever, runny nose, cough and are more common during the winter months, and more frequent in the younger child. We are in the thick of these now.

What we also often see in kids are viral rashes (exanthems) that seem to appear as the other viral symptoms are resolving. It is not unusual to see a child who has had several days of fever develop a blotchy, red, flat rash on their body (not purple or bruise like) which doesn't seem to bother the child at all. The rash is not itchy, and may even come and go. This is often concerning to a parent as people say, "maybe it is the measles or chickenpox." The biggest distinguishing factor with a post viral rash is just that, it is later in the course of the illness and is actually appearing as you child is improving, all the more confusing for a parent. Measles and chickenpox are still present in the U.S. and worldwide. Unfortunately, due to decreasing immunization rates in some areas, outbreaks of chickenpox and measles have recently been reported. But in the case of these illnesses the rash occurs early in the course of the illness, along with the other symptoms. Children with both measles and chickenpox appear ill and the rash starts early and continues throughout. If your child has a fever and a rash at the beginning of an illness give your doctor a call to discuss the symptoms and appearance of the rash and whether they should be seen. But a rash that occurs late in the illness is often just the tale end of the virus and by then your child should be feeling better, not worse. In most cases of a post viral rash, the rash will disappear over the next several days and the child is good to go (until the next virus finds their prey!) That's your daily dose, we'll chat again tomorrow.

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Daily Dose

Coronavirus

1:30 to read

Coronavirus is here…does that cause you concern?  It is causing a lot of concern among mothers in my practice and community as they are posting “my son has coronavirus”. Of course that leads to a Google search and the next thing you know I have parents calling concerned about SARS! (a rare complication).

 

Coronavirus (which is named for the crown like shape of the viral particles under a microscope) is just another fall and winter virus that typically causes cold like symptoms with a scratchy throat, congestion, runny nose and cough. It may also cause several days of fever.  Coronavirus “acts” like many of the other viruses that we are seeing now, including rhinovirus and parainfluenza.

 

While most everyone gets a  coronavirus infection in their lifetime, knowing the name of the virus really doesn’t change anything about the treatment. Having your child’s nose or throat swabbed and sent for a fairly expensive test so that “you may have peace of mind” does not dictate any different treatment than that of any other respiratory virus.  Symptomatic relief has been the advice for treating all of these upper respiratory infections….long before we could test for them in an office setting. 

 

How do you treat it?  Treat the fever if there is one and do not send your child to daycare or school until they have been fever free for 24 hours (you also need to stay home if you have a fever). Use over the counter saline nose drops to help suction your child’s nose or to help thin the mucous so that they can “blow” more effectively. Take a steamy shower to relieve the congestion and loosen the cough. Use a cool mist humidifier in your child’s room (especially if you have the heat running). Make sure to teach your children how to “cough into their elbow” rather than their hands. 

 

I am continuing to hold a lot of hands as parents worry about all of these different respiratory viruses….but naming them is not going to change treatment in the otherwise healthy child. Making sure your child washes their hands and try to teach your older children to keep their hands away from their eyes, nose and mouth will serve you better than worrying about which virus they may have been exposed to. 

 

In the case of any illness, if you become concerned about how your child is breathing and respiratory distress, you need to place an immediate call to your pediatrician or a visit to the ER.  Do not be soconcerned about naming the illness. 

 

 

 

 

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Daily Dose

Do's & Don'ts About Antibiotics

1.30 to read

I have had many parents call me asking for me to prescribe an antibiotic for their child's cold and I tell them time and again...they do not work when your child has a cold!

Antibiotic prescribing is highest for young children. But, antibiotics need to be used appropriately in order to ensure that drugs are effective, as well as to prevent antibiotic resistance.  The whole country is well into the “cough and cold season” and most of these illnesses are caused by viruses.  ANTIBIOTICS can only cure bacterial illnesses - not viral illnesses. 

Taking an antibiotic for a viral illness will NOT cure your child’s cough and cold, nor will it help your child feel better any faster, and it will NOT keep others from catching your child’s viral illness.  These viral illnesses include colds, influenza (flu), RSV, most sore throats (unless strep) and even most sinus infections.  Not even all ear infections may need an antibiotic to resolve, especially in children over the age of 2-3 years. 

Although many people “believe” that green mucous means a bacterial infection, as your body’s immune system works to fight off a viral upper respiratory infection mucous can change color. It is quite common for the color to change from clear, to yellow to green before the viral infection resolves. This does not mean that a child (or adult) needs an antibiotic. 

Lastly, while antibiotics may be life saving, there are potential complications that can occur when taking an antibiotic, including tummy aches and diarrhea as well as serious allergic reactions.  You want to only take antibiotics when really needed. 

I have spent the last 2 weekends on call and already feel like I have seen a million green runny noses, including my own!!  But a little saline nose rinse, lots of kleenex, some steamy showers and time will work for the majority of us.  Almost every parent asks me “don’t you have something else that will WORK for this cold”? Honestly, if I did I would be taking it myself and selling it on the internet for $9.99 a bottle!!  I do know, but it is not an antibiotic! 

But you can go to www.cdc.gov/getsmart/index.html . This site may give you some more tips on how to help your child’s viral illness. 

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

Cold & Flu Season

1:30 to read

Despite the fact that the weather is beautiful in most parts of the country, it is Fall which means more viral upper respiratory infections. This is especially true of the 12-15 month old children who are now getting their “first of many” colds.  Many of their parents are concerned as to why they are suddenly getting sick…as they have not been sick before?

 

Well, here is the deal. Last fall and winter these children were babies in arms, and were not crawling and walking which also means they were not exploring their environment and all of the germs that go with touching EVERYTHING!  During that first winter season (if a child is not not  in day care or school) and does not have siblings (to get them sick) they may luck out for the first 2 - 12 months without a runny nose or cough. 

 

But….those days come to an end once they become toddlers. This is not alarming at all, but just a fact of life.  Toddlers will catch a little bit of everything once they hit one. That means they may have a cold, cough or even a fever every month…for the next fall/winter/early spring months, (which is about the next 5-6 months).  As a parent of a new toddler this is really difficult to fathom!

 

Every parent wants to know how they can “avoid” these illnesses….short answer is it is impossible and you should actually look at each viral illness as a victory which primes the immune system, and helps develop antibodies to some of the viruses we are all exposed to every day.  With each viral illness your child’s immune system is actually getting stronger…and you will notice that around the age of three your child will not catch as many colds and coughs as they did when they were younger. I know that seems like such a long time!! Unfortunately, parents of toddlers also catch a few more illnesses as they too are “over exposed” by their child. 

 

Remember to always watch your child for any difficulty breathing by looking at their chest with their shirts off - you do not want to see them look like they are “working with their ribs to breathe”. You also need to make sure they are well oxygenated and should turn red with cough and never a dusky blue color…especially important in young infants. Any concerns call your doctor.

 

So…gear up for winter as peak upper respiratory season is not even here yet!!  Get those flu vaccines too. 

Daily Dose

What's making Your Child Sick?

1:30 to read

As our office is getting ready for the onslaught of “sick season” I am already getting numerous phone calls from concerned parents about illnesses in their schools.  One thing that is the same each year….once kids go back to school, whether it is daycare, preschool or elementary school, young children start to get sick.  Parents wonder why this is the case and is it REALLY normal?

 

It is very normal for otherwise perfectly healthy little children to catch just about everything that is “going around”. Once a child is a toddler they play in close contact with their friends and put “germy” hands and toys into their mouths, so a younger child catches more viral illnesses than a 5 or 6 year old.  In fact, it is not uncommon for a toddler to catch 10 -12 viral illnesses in one year. That means they are sick at least once a month if not more. But, the good news is most of the illnesses are self limited and resolve with minimal treatment with over the counter fever control medications, fluids, rest and a lot of tender loving care!

 

But, with the advent of many rapid in office tests that allow a doctor and parent to know within hours which virus is causing their child’s  cough and cold, I am actually seeing more and more worried parents. I got a call yesterday from a mother who had gotten a “note/email” from her child’s school that there was a child who had rhinovirus.  Rhinovirus is just one of many viruses that cause the common cold!!  There is really no need for a school to let parents know that there is a child who has a cold.  But if you hear the words rhinovirus, metapneumovirus, adenovirus, or parainfluenza virus (which has nothing to do with the flu), it sounds pretty scary.

 

Although being able to swab a child’s nose to determine which virus is causing their fever, cough and runny nose is fairly easy, and it may be helpful in certain situations (such as a child who has a compromised immune system, or a premature baby with lung problems), for the “normal healthy child” identifying the name of the virus is not necessary, and most importantly it typically does not change how the doctor or parent will care for the child.  

 

So… I would encourage doctors to be judicious in ordering these tests and parents to understand why they are NOT routinely done.  The social media chain of identifying which child has which virus is not helpful and may make an already anxious parent, even more anxious. 

 

Bottom line, wash your hands, get a flu shot and get ready for a lot of coughs and colds in the next few months!

 

 

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Daily Dose

Flu is Here!

1:30 to read

Well, I knew that it would happen sooner or later…that is when would I see my first case of Influenza 2017-2018?  Unfortunately, it is it happening sooner than later as I am seeing more than a handful of children with classic flu like symptoms that come on quickly including high fever, body aches, chills, sore throat and cough. The few children that I have seen have looked like “flu victims” as they are laying down on exam table with a coat or blanket over them despite having a fever and say “they feel terrible”. Their flu tests have been positive for influenza!

 

To remind you there are two types of influenza: A and B. The patients that I have been seeing have had Influenza A which is typically the more “severe”  illness than Influenza B.  The flu vaccine (all of which is injectable this year) is a quadrivalent vaccine, which means it contains 2 influenza A viruses and influenza B virus.  The vaccine components are selected each season based on the worldwide surveillance of flu activity and specifically what have been the prevalent viruses in the southern hemisphere in the months prior to our flu season.

 

The CDC tracts flu activity around the country every year, and they are currently reporting very little flu based on tests from surveillance sites throughout the U.S (only about 2.9% of tests are positive for flu this week)  The Dallas County Health Department also tracts influenza activity and are reporting that 4.7% of their tests were positive for influenza, most of which is influenza A. 

 

The CDC is predicating that is may be a “tough” flu season based on the most recent data from Australia.  They are just wrapping up their flu season as it is early spring there now. Australia has had one of their worst flu seasons in recent years with the predominant strain being an influenza A - H3N2 virus, which typically causes more severe illness. Fortunately, this years flu vaccine contains the H3N2 virus.

 

Many people (including my patients and their parents) ask “why get the vaccine if it is not 100% effective?” The vaccine typically is between 40 - 60 % effective in preventing flu and if you are unlucky enough to get the flu after being vaccinated you typically have a less serious illness, are less likely to have complications and to require hospitalization. Seems like an easy choice to me. 

 

So….it is really important to get that vaccine now…if indeed we are gong to have an early and severe fu season you don’t want to wait. It takes about 2 weeks post vaccine to develop antibodies and protection too…it is not immediate.

 

Parents with babies under 6 month of age also need to make sure they are immunized as well as anyone that cares for the baby.  Babies under 6 month of age cannot get flu vaccine, so they need to be protected by having everyone around them vaccinated. 

 

Our son and his wife just had their first baby last week…a BOY!! So I assure you everyone in our family has already been vaccinated to protect that precious new grandson of ours. Welcome Stewart Wilson! 

 

  

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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

Vomiting Kids

1:30 to read

Pick a virus ….and it is probably circulating in your area!  Seems we are at the peak of upper respiratory season, influenza like illness season and also vomiting and diarrhea season. In other words, lots of sick kids right now.

 

I just started seeing a lot of vomiting again!!  It is the worst for both the child and the doctor’s office where it seems many a child has vomited either in the car, coming up the elevator or in the exam room.  YUCK for all.

 

Remember, norovirus is the most common virus that causes vomiting and diarrhea and it is VERY contagious. Not only via “dirty hands” but it is also airborne…so in other words, those standing near by a child who is vomiting (parents, other sibs) are probably being exposed as well. That is the main reason you probably see an entire family who gets sick almost simultaneously.  

 

If your child vomits….DO NOT give them anything to eat or drink for at least 30 min. I know that is hard as they are asking for a drink,  but you need to give their tummy a minute to “recover” before challenging them with a few sips of Pedialyte or Gatorade.  A SIP is the key word too….tiny amount to start in hopes that they do not vomit again.  

 

I just saw a 6 year old little boy who had been vomiting several times during the night.  His Dad said that he had given him Zofran to help stop the vomiting (this is a prescription).  I use a lot of Zofran in children who are vomiting as it can go under the tongue.  But after the Zofran his son felt better….so he gave him strawberries and a waffle!! Surprise? He vomited again!!

 

Don’t be fooled and start trying to feed your child too quickly after they are vomiting. I know parents worry that “their child is not eating”, but fluids are the important part of staying hydrated. As one little boy told me, “ it feels like there are grasshoppers in my tummy”!! So well put. I grumbling tummy needs time to heal and frequent sips of clear liquids (no dairy) are the best way to prevent dehydration. As your child tolerates a small volume you can go up a bit and gradually increase the amount that they take.  I usually wait a good 4-6 hours after a child has successfully tolerated fluids before I even consider giving them food. Then I start with crackers, noodles or something bland (that I also don’t mind cleaning up) in case they vomit again.  

 

You are just wanting to make sure your child stays hydrated…tears, saliva and urine!  Keep washing those hands. 

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DR SUE'S DAILY DOSE

Stay healthy this flu season.

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